Low Carb Diets – Good Or Bad

The fad of diets come and go like the tides in the ocean and he low carbohydrate (aka Atkins Diet) continue to resurface in different forms. For many these diets represent a roller coaster of weight loss followed by similar weight gain but a new study in the Annals of Internal Medicine Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet (PDF version here) demonstrated some surprising findings……

Both groups lost about 7% of their weight but what was surprising was the Low Carbohydrate diet had better cholesterol levels in their blood including an increase in the HDL (good cholesterol) all representative of factors that reduce heart risks.

Don’t celebrate too much yet though. Both groups had very intensive monitoring and support and this was probably as important if not more important to the success of the weight loss program. The results do seem to suggest a counter intuitive improvement in cholesterol levels despite a low carbohydrate diet that contained more fats.

Key learning point here – focus and support to improve compliance and adherence to weight loss and fitness programs is successful in achieving and maintaining weight loss

Vitamin Water Comes up Lacking

It won’t come as as a surprise to some that the Vitamin Water fad is not delivering any real value. The Washington Post asked the question “How nutritious is Vitaminwater?” and came up empty. This stuff has been around since 1996 but it is only recently I have seen it permeating everywhere with kids asking for Vitamin Water vs plain old water.

The additives in this case are limited especially in the case of the “fruit punch” variety:

Vitaminwater tastes okay, if you like fruity flavor without the fruit. There is almost no actual fruit, even in the “Fruit Punch” variety, and what little there is mostly provides color

What’s in this masterful package – well for one a big hit in calories providing 125 calories in one bottle (just shy of a can of Coca-Cola! But with more focus on calories and excessive sugar intake sales have declined so the marketing machine has jumped into high gear and is now offering additional low calorie options. Seems like water fulfills that requirement and if you desire is to be healthy then take note of the Dietary guidelines:

The truth is that the research on supplementing with vitamins does not prove or show that people who take them are healthier than anyone else,” she explains. Indeed, the proposed Dietary Guidelines for Americans for 2010 explicitly say most people don’t need vitamin supplements

Better to eat healthy and consume fruits and vegetables to get the real things vs some artificial version that is likely inferior. Add to that the additive effect of fiber and phytonutrients that work together with the vitamins in real vegetables and fruits and you have a much better package all round

Marriage Good for You

No real surprise but the feature in NY Times: Is Marriage Good for Your Health?

Yes it is – dating back to 1858 William Farr showed that marriage contributed to a lower mortality relative to unmarried people with widows faring the worst

Healthcare Insurance – Its CostCo membership for Health

It is now being referred to the as the third rail in healthcareNo one wants to touch it for fear of electrocuting themselves but it remains one of the greatest challenges facing healthcare and rising costs. The fact that healthcare insurance companies stock prices have reacted positively to the news of the loss of the 60 seat majority in the senate. The insurers have bitterly fought any notion of a public insurance plan because this would cut into their profits.

Taking a look at some recent profits: Wellpoint owner of Anthem Blue Cross – $ 2,700,000,000 which was followed by an announcement they would be raising premiums by as much as 39%……..! That’s even more than the university and education sectors astounding rate increases.  Kathleen Sebelius the Health and Human Services Secretary weighed in asking them to “justify” this. Seriously – “justify”!

All this was discussed in the “GetBetterHealth” Blog by DrStanleyFeld in a piece titled: “Are Health Insurers Killing the Goose that Laid the Golden Egg“. Pointing out the usual techniques in play to deflect criticism in an attempt to justify this behavior

using a well worn public relations technique by pointing a finger at the other stakeholders. All its administrative costs, additional reserves, and investment costs are included in the “85 cents out of every premium dollar figure.”

In fact you have to wonder which group of middlemen the Health Insurance industry falls into

You don’t need to be an economist to understand that any middleman interposed between seller and buyer raises the price of a given service or product. Some intermediaries justify this by providing benefits, such as salesmanship, advertising or transport. Others offer physical facilities, such as warehouses. A third group, organized crime, utilizes fear and intimidation to muscle its way into the provider-consumer chain, raking in hefty profits and bloating cost, without providing any benefit at all.”

and this characterization

“The health insurance model is closest to the parasitic relationship imposed by the Mafia. Insurance companies provide nothing other than an ambiguous, shifty notion of “protection.“

So what do individual personal experiences tell us about dealing with the insurance industry. Recent experince suggests that the insurance industry is misnamed. Insurance is designed to pay out for legitimate claims. Health Insurance does no such thing and is much closer to buying membership to CostCo but not as good. The CostCo model has customers paying a membership for exclusive access to lower priced of goods. If you are not a member you have to pay the higher rate.

Examination of a recent claim form showed that membership to the Healthcare Insurance club provided a discount to the billable amount of 87%. But unlike CostCo if any of the items you selected or used the insurer deems to be uncovered then you get to pay 100%. So this would be like showing up at the CostCo check out and being told that in your case the meat you purchased is not part of you membership perhaps because they think you are a vegetarian and therefor instead of paying $5 per pound you must pay $9.35 per pound

In the healthcare example a legitimate set of routine laboratory tests on blood and urine as part of an annual physical.  It is impossible for me to imagine a reason to deny basic routing screening but the system is geared to do precisely that every time a claim is submitted. SO where is all the money going… aside from posting profits and investor returns there is a big chunk in the case of Wellpoint allocated to $1.8 to $8.4 Million dollars per year for its CEO and Divisional Presidents. And UnitedHealthcare was even worse:

In a March 2007 post I stated that “ UnitedHealthcare claims that costs are out of control. Why? Who paid their CEO $1.8 billion dollars over 8 years? The amount equals $300 million dollars a year or $821,917 a day in salary and benefits to one person. What are the other top executives at UnitedHealthcare receiving in salary and benefits? Do you think these salaries affect the cost of insurance?”

I agree with the notion that we the consumer need to take greater control and management of our healthcare dollars and remove these excess additive costs. Will someone have the courage to take this on….?

What have your experiences been with insurance. Do you think you get value for money and that health insurance is part of your health solution as opposed to being part of your health problem?

Multivitamins Do No Harm but Limited Benefits

The Washington post published an article “Evidence is thin that multivitamins are beneficial, but they seem benign“. Relevant in today’s struggling economy when you consider that there is an estimated $25 Billion spent in vitamins, minerals and supplements;

over 50% of Americans take a daily multivitamin

In the interests of full disclosure I take a multivitamin and have done for many years. As is often the case – emotions, perception and marketing rule our decision-making but

some older studies have linked multivitamin use to the prevention of conditions such as breast and colon cancer and heart disease

But in fact we should be basing our views on science and

the latest research has shown absolutely no impact on health and disease prevention, over time

As described the most rigorous widely regarded study in the Archives of Internal Medicine: Multivitamin Use and Risk of Cancer and Cardiovascular Disease in the Women’s Health Initiative Cohorts (Arch Intern Med. 2009;169(3):294-304.)

The study included 161 808 participants from the Women’s Health Initiative clinical trials in 3 overlapping trials of hormone therapy, dietary modification, and calcium and vitamin D supplements…between 1993 and 1998…disease end points were collected through 2005. documenting cancers of the breast (invasive), colon/rectum, endometrium, kidney, bladder, stomach, ovary, and lung; CVD (myocardial infarction, stroke, and venous thromboembolism); and total mortality.

This is an extended large cohort (combined) study and represents and excellent block of data to help establish a link between taking these supplements and preventative health benefits….the results here:

After a median follow-up of 8.0 and 7.9 years in the clinical trial and observational study cohorts, respectively, the Women’s Health Initiative study provided convincing evidence that multivitamin use has little or no influence on the risk of common cancers, CVD, or total mortality in postmenopausal women.

So the summary – no detectable benefit in the conditions study. It does not do harm

“The big takeaway message is that if someone takes a multivitamin, it doesn’t make them any healthier, but it doesn’t really harm them, either,” says lead author Marian Neuhouser, a cancer prevention researcher at the Fred Hutchinson Cancer Research Center in Seattle. “So then consumers have to ask themselves: What is really the benefit of spending money on these products, if they are not going to decrease the risk of common diseases that affect women or benefit health? It’s a waste.”

So will you stop buying vitamins – I’m moving toward that direction and may save my money for more proven ways of improving my health. What’s your experience? Do you have any other studies or data – leave your comments below

H1N1 Vaccination

Recent discussions with friends and the extent of confusion suggest that some guidance on the latest flu challenges and vaccination choices.

Some facts:

• The Current strain of concern is H1N1 (the misnaming of “swine” flu arose from one of the early outbreaks of the disease in pig farm in Mexico – “Quadra flu” might be better)
• Severity varies
• At Risk or High Risk groups are at (no surprise here) more risk of serious complications
• The Young (in this case defined as <25 years old) appear to be more susceptible to problems/risks

The vaccination concerns center on the vaccine being “untested” but as the CDC points out

This vaccine will be made using the same processes and facilities that are used to make the currently licensed seasonal influenza vaccines

And as such will have a similar profile of safety as he seasonal flu vaccine delivered each year. In this case the profile of the vaccine ha been modified to attenuate it for the H1N1 strain but the delivery mechanism and system remains the same as delivered each year.

At Risk Groups and Vaccination Recommendations (per the CDC):

• Pregnant women
• Carers of children , 6 months old
• Healthcare workers
• The Young aged between 6 months and 24 years of age
• Those “at risk” between 25 and 64 years old

Symptoms or Warning Signs (available from the CDC as a flyer) divided for Children and Adults
Children:

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash

Adults

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting

None of the above should be deemed “medical advice” but is an assimilation of information presented by the CDC

Exercise will Make you Fat – Not!

In some recent news Time Magazine headlined a piece titled: The Myth About Exercise” which suggested that exercise was fueling hunger and making people fatter. Complete and utter codswallop! But the fact that Time magazine gets away with this kind of piece and worse yet as was featured on one diet blog has people saying:

“If Time magazine dedicates an entire cover story to it then it must be big”

Is a very worrying result. They go on – “the question health researchers are now asking is “Is Exercise really needed for weight loss”

Good grief – who writes this stuff. Providing even a small element of hope for the already overweight population that is getting fatter and unhealthier is just plain wrong. You can see some great presentation of economic and health trends at GapMinder here (Presented at the equally great site of TED Talks by Hans Rosling).

Even if there is a shred of truth to any of the report we need to be encouraging exercise not discouraging it. Our population needs exercise – in fact your body needs exercise
Don’t loose site of this goal of regular and frequent exercise.

As Rebecca Scritchfield pointed out in her blog of this media disinformation is a big price we pay for listening to this tripe. As she says

the reality is the science tells a totally different story: There is strong evidence from the majority of the scientific literature that physical activity is an important component of an effective weight loss program; Physical activity is one of the most important behavioral factors in weight maintenance and improving long-term weight loss outcomes. In fact, participation in an exercise program has proven to be the very best predictor of maintaining weight that was lost; Effective weight loss and maintenance depend on a simple equation called energy balance: Calories expended through physical activity and normal lifestyle functions must exceed calories consumed; It is a myth that exercise can actually prevent weight loss by leading exercisers to overeat. Research and common sense disprove this notion. Look around the gym or the jogging trail. If this were the case, wouldn’t those who regularly exercise be the fattest?

Quite! Don’t get duped by the media’s desire for sensational shock stories. There is more on this blog with Good Morning America bringing on an “expert” nutritionist providing a platform to someone who as Rebecca points out”

ANYONE can call themselves a nutritionist. You can. Your grandma can. President Obama can.

So from this nutritionist I am here to tell you exercise is good and an essential part of a weight loss and positive health program. So get off your chair, turn off the computer and go for a walk..it will do you some good. Then Rinse lather and repeat!

Self Care and Management

In a great post by Don Kempler (CEO of Healthwise) on the Healthcare Blog titled “Patient Heal Thyself” the challenge of health management and the over usage was very clearly addressed by comparing two families – the Jones’ and the Smiths

The Smith family represents the vast majority of healthcare usage in the US – Doctor knows best and is typified in my experience with the frequent visits for every ailment that crops up. The Joneses are at the other end of the spectrum and much more conservative using the information they find and more importantly applying it as part of their interaction with their physician

For the same condition of back pain they represent the cost both financially and also from a health perspective
The Smiths (Doctor knows best):

When Sam Smith’s back pain flared at age 45, he was quick to accept his doctor’s recommendation for an MRI and a visit to an orthopedic specialist to make sure it wasn’t serious. The MRI showed a possible cause of the pain and (just to be sure) Sam had surgery the following week, marveling at the efficiency of the system. The cost: about $40,000 for surgery, hospital, physician care and rehab.

For the Joneses with the same condition:

When Jay Jones, also age 45, had an identical bout of back pain he reviewed a back surgery decision aid on the Web—even before his first visit. He learned that back surgery is not usually needed or always successful. For him the case for surgery was not very strong.

When his doctor recommended an MRI, Jay pointed out that a decision aid helped him learn that 50 percent of back pain cases go away in four weeks, 90 percent in six months, and only 10 percent of back pain cases need surgery. Jay also learned that MRI reports often find things that can lead to surgery even though they were not the cause of the pain. With that information he asked if he might put off the MRI and the surgery while he determined if his back would get better on its own—it did. The cost: $150 for the office call and $12 for the over-the-counter medications. Back surgery is among the most over prescribed treatments.

Now not everyone is comfortable with the self diagnosis and I blogged about that some time back in this piece on online symptom checkers but that the point is not to defer the whole diagnostic process to technology but to use the technology to help support decision making.

I know where our family is (sometimes to the chagrin of my own children who feel I am less than sympathetic) – we use the services when we feel we need them and are very conservative. Intervention and investigation is not always good as we discovered in the hospital I commissioned a number of years ago. To check the equipment the staff were asked for volunteers to test the MRI machine – it was a very short run as no soon as we put people into the MRI but we discovered “abnormalities”. In this case abnormalities that were not abnormal but normal variations but the cost in time and investigation was high on the institution and on the individuals and the tests ere stopped.

Using good judgment and being a Jones family is better for your health and better for your wallet.

Which family is closest to your style. Had good or bad experiences with either style – let me know

Patients and Doctors Need to Reform Too

There is much discussion and commentary on the Healthcare Reform, new clinical systems and the investments being made through the stimulus package. But not so much has been written about Patient reform. The NY Times piece A Hurdle for Health Reform: Patients and Their Doctors focused on the issue of patient and physician behavior and the all to frequent insistence on treatment can be a poor choice. It is a poor choice for economic reasons – why pay for a treatment that has little or no effect. And why start using a drug that has no demonstrable improvement in outcomes vs an older well tried and tested drug. Apart from the fact that we already pay 77% more for comparable drugs – in no small part due to the effective lobbying and marketing drug industry machine. But we also find our treatments based on Physician Pillows (they reflect the most recent impression left on them – often by drug companies) for a newer supposedly better drug but:

when it comes to comparative effectiveness, the track record of the American public and their doctors is not encouraging. Even when such comparisons are available, we tend to ignore them. In 2002, for example, one of the largest government-financed clinical trials ever found that generic pills for high blood pressure worked better than newer drugs that were up to 20 times as expensive. But most hypertension patients still use costlier drugs marketed by pharmaceutical companies

Of and by the way – the side effects for these newer drugs are by the very nature of their recent introduction as yet undiscovered, so the American public is providing a great service to other countries and their patients testing out new drugs on their behalf! If you’d like to read more I can recommend this book by Marcia Angell, a senior lecturer at Harvard Medical School “The Truth About the Drug Companies: How They Deceive Us and What to Do About It“. Shocking insights into the industry that is there to make money. The first recommendation on Amazon is pretty compelling

I should start with a disclaimer. I’m a Vice President within one of the largest drug companies in the world and I have spent close to twenty years marketing drugs. So I guess I’m not supposed to like this book. But the truth is I thought it was fantastic. First, for those of you who are not familiar with the healthcare industry, you should know that Ms. Angell is better capable of writing this masterpiece than any other author. She used to be Editor-in-Chief of The New England Journal of Medicine, which is considered the most prestigious medical journal in the world.

But this volume is much more than simple entertainment. It is quite possibly one of the best analyses of the state of the U.S. drug industry today, complete with footnotes backing up every statement the author makes. You will learn not only that in 2002 the top ten drug companies made a higher profit than the other 490 businesses together on the Fortune 500 list. You will also understand how the drug industry has been able to achieve such a business success and how this success, as is often the case throughout history, will likely be their downfall

Yikes – and this from a Drug Company employee!

So what to do – start with more education, include and understanding of what works and what does not and above all else, don’t take the treatment you receive as gospel. Would you pay for “Synthetic” oil for an oil change that is more expensive without understanding why it is worth spending that extra money – if indeed it is. I hope not. The same should be true for your health and with the availability of information, support groups and tools to analyze healthcare will be a much more inclusive process involving the patient and the whole team in making decisions than it has in the past.

Do you have your own experience of good or bad choices;  if so please share them and let me know what you think f the current state of healthcare today

Vaccination – Essential part of Child Healthcare

It is in the words of Victor Meldrew (don’t know who he he is here’s a link to this famous BBC British Comedy character and the series One Foot in the Grave) “unbelievable” that Time magazine would give ink to the delusional rantings (Autism and Vaccines) of an individual who appears hell bent on a mission to return our countries childhood back to the dark ages of killer measles epidemics and chicken pox for the masses. But wait, she used to be a Playboy model so this obviously provides the essential scientific background to debate the pros and cons of vaccination….or could it be a simple eye candy decision for the photo cover. Whatever it is I agree with Orac in his post “I really wish this were an April Fools Joke” where as he highlights

Jenny thinks it’s acceptable that infectious diseases will return because of her efforts and those of her fellow antivaccinationists

Her unscientific belief that vaccines cause autism – there are numerous studies (here, here and here for example and this Hollywood Mom Amanda Peet and her support of vaccinateyourbaby.org public service campaign ) showing no, repeat NO epidemiological evidence for a causal association of vaccinations and autism. Correlation does not equal causation (simple statistics) and promoting this as science is like the snake oil salesmen in the wild west…. marketing hype). This is someone who can’t even remove expletives from her conversation with a journalist……

If the vaccine companies are not listening to us, it’s their f___ing fault that the diseases are coming back

Right! As Orac says

No matter how many studies exonerate vaccines as a cause of autism, you don’t believe them

And if science disproves your latest hair brained idea you’ll find something else to blame as in the Toxin gambit as we moved off Mercury as a cause. This is no longer about  science or science- and evidence-based medicine this is McCarthgeddon and reminds me a lot of the McCarthy from the 1950’s and his hunt now seen through the clarity of history as a modern day witch hunt….interesting they share the same name.

If you were wondering – get your kids vaccinated….for everything. Follow the science.