Archive For: Patient News

The Age of Anxiety

Higher Anxiety? Our ‘age of anxiety’ began four centuries ago

It can come on suddenly and intensely, causing shaking, confusion and difficulty breathing for no apparent reason…trigger an irrational avoidance of elevators or public transportation…or become a steady drumbeat of worry always in the background. All are known as anxiety disorders, one of the country’s most commonly experienced yet largely untreated mental health issues. Is our era of 24/7 disturbing news, packed schedules and often unrealistic expectations spurring a rise in these disorders, or does it just seem that way?

Modern life can be disquieting, but the truth is that anxiety disorders have always impacted large numbers of people around the world. Consider this description of Hippocrates’ patient in 1621’s The Anatomy of Melancholy: “He dare not come into company for fear he should be misused, disgraced, overshoot himself in gestures or speeches, or be sick; he thinks every man observeth him” – a classic case of what would now be diagnosed as social anxiety disorder. Recent research notes that anxiety disorders may be under-recognized and under-treated, but there is no evidence that its prevalence has increased. While the incidence rose from 9 to 15 percent in college students since 2009, according to the Journal of American College Health, the authors attribute the finding to a greater willingness to admit having a mental health issue and increased acceptance of it as a bona fide health problem.

Constant anxiety undeniably takes a toll on health, potentially increasing levels of the stress hormone cortisol and raising blood pressure and may drive inflammation and plaque formation that leads to heart attack and strokes. A reaction to stress that occurs in a region of the brain called the amygdala, anxiety prepares people to confront a crisis by putting the body on alert. The ‘fight or flight’ response serves us well when faced with actual danger but is counter-productive when dealing with worries around work, money, family life or health. However, it’s only when daily function is affected that a disorder is diagnosed, as shown below:

Everyday Anxiety: Worry about finances, health, family or other important life issues
Anxiety Disorder: Constant and unsubstantiated worry that causes significant distress and interferes with daily life

Everyday Anxiety: Embarrassment or self-consciousness in an uncomfortable or awkward social situation
Anxiety Disorder: 
Avoiding social situations for fear of being judged, embarrassed or humiliated

Everyday Anxiety: A case of nerves or sweating before a big test, business presentation, stage performance or other significant event
Anxiety Disorder: 
Seemingly out-of-the-blue panic attacks and preoccupation with the fear of having another one

Everyday Anxiety: Realistic fear of a dangerous object, place or situation
Anxiety Disorder: 
lrrational fear or avoidance of an object, place or situation that poses little or no threat of danger

Everyday Anxiety: Anxiety, sadness or difficulty sleeping immediately after a traumatic event
Anxiety Disorder: Recurring nightmares, flashbacks or emotional numbing related to a traumatic event that occurred several months or years before

The American Psychology Association defines these types of anxiety disorders (obsessive-compulsive disorder and post-traumatic stress disorder are now categorized separately):

  • Generalized anxiety disorder (GAD): the most common, it’s characterized by excessive, long-lasting worries about nonspecific life events, objects and situations.
  • Panic disorder: brief or sudden attacks of intense terror and apprehension, leading to shaking, confusion, dizziness, nausea and breathing difficulties; can occur with or without a particular trigger.
  • Specific phobia: irrational fear of a particular object or situation.
  • Agoraphobia: fear of places, events, or situations, especially open spaces, that may cause you to panic and feel trapped, helpless or embarrassed.
  • Social anxiety disorder: fear of negative judgment from others in social situations or of public embarrassment.
  • Separation anxiety disorder: not exclusive to youngsters, but also experienced by adults who feel disconnected from a person or place that provides feelings of safety or security.

Additionally, anxiety disorders may play a role in exacerbating other conditions such as irritable bowel syndrome (IBS), chronic respiratory disease and heart disease.

Reassuringly, the number of treatment options, both pharmaceutical and non, has grown. Most effective is a combination approach of psychotherapy (cognitive-behavioral therapy, focused talk therapy or exposure therapy), stress management (deep breathing, meditation and yoga) and antidepressant and/or anti-anxiety medications.

Finally, considerable benefits are seen from a healthy lifestyle – reduced intake of caffeine, tea, cola and chocolate, avoidance of recreational drugs and excessive alcohol, and emphasizing exercise, a nutritious diet, and most importantly, a good night’s sleep. According to a recent University of California at Berkley study, the amygdala was particularly stimulated when sleep deprived, mirroring that of anxiety disorders, suggesting that sleep therapy could reduce anxiety in people suffering from panic attacks, GAD and other conditions.


Did You Know?

40 million

People in the U.S. affected by anxiety disorders
Source: NIMH.gov

37%

Percentage of Americans with an anxiety disorder who receive treatment
Source: ADAA.org

Going with the Grain

Going with the Grain

They may be the culinary trendsetters of the 21st century, but the ancient wonders of the grain world have remain unchanged for the last several hundred years. From chia to kamut, sorghum to spelt, like many whole grains, they are significant sources of protein, fiber and other important nutrients, such as B vitamins, iron, folate, selenium, potassium and magnesium.

You may already be familiar with quinoa, which became one of the first ancient grains to trend in U.S. kitchens earlier in the decade. You’ll find more below, each a story to tell and a taste to be discovered:

Amaranth,* native to Peru and a major food crop of the ancient Incas, has a peppery taste and a versatile cooking profile – bake it with bananas, use it to coat chicken or fish or toss with vegetables for a fresh salad.

Farro goes back 10,000 years to the time of the Fertile Crescent, and is thought to have sustained the Roman army. Key to Mediterranean diets, this grain is higher in dietary fiber than quinoa and brown rice and lower in calories. Its dense, chewy texture works well in soups, risottos and is thought by some aficionados to make the best pasta.

Freekeh, frequently found in Middle Eastern and North African cuisine, has roots in ancient Egypt. A form of wheat known for its chewy texture and nutty flavor, it’s often sold cracked into smaller, quicker cooking pieces. Use in pilafs and salads, or cook into a delicious porridge.

Kamut, also known as Pharaoh grain in a nod to its discovery in ancient Egyptian tombs, is rich and buttery-tasting, ideal in breads, pancakes and salads, or in a breakfast bowl with avocado and other whole grains, such as quinoa.

Millet,* a staple of the long-lived Himalayan Hunzas, is likely to be more familiar to Americans as a birdseed ingredient, but this grain has a delicious, nutty like flavor. Cook as a hot cereal, steam and use in salads or bake in breads and cookies.

Quinoa,* cultivated by the Inca in the Andes, has become even more popular on the American table in recent years. Dozens of varieties exist, from mild-flavored white and yellow to earthier tasting red and black. Prepare as a breakfast cereal, substitute it for rice and pasta, add to soups and salads, or pop and eat like popcorn.

Sorghum,* from Asia and West Africa, is a source of protein, and can be substituted for wheat in baked goods, eaten like popcorn or cooked into porridge.

Teff,* from Ethiopia and Eritrea, is a smaller-sized, quick-cooking grain high in iron and calcium, with a sweet molasses-like flavor that can be cooked into a polenta or ground into flour to make gluten-free breads and baked goods.

*Gluten-free
Sources: Harvard Health, Whole Grains Council

Why Today’s Health News Often Becomes Tomorrow’s Retractions

Handle with Care: Why Today’s Health News Often Becomes Tomorrow’s Retractions

We’ve all seen it played out hundreds of times, as a drug, food or habit is trumpeted as the way to lower the risk of cancer or heart disease only to be walked back the next month in another study. The reasons can be diverse, including a flawed hypothesis, bad data or misleading conclusions, but at the center is the study design itself. A longitudinal trial may yield very different findings from an observational one, while the gold standard – a randomized controlled trial (RCT) – can be extremely costly and difficult to design. The resulting patchwork of research requires professional analysis and a wait-and-see approach until confirmation is received via follow-up studies. We share some expert insights to help you view new studies with both a healthy skepticism and the realization that some of the most important medical breakthroughs of recent years have been discovered in just this way.

Did You Know?

1,400

Number of scientific papers retracted each year
Sources: Vaccine Journal August 2018, Centers for Disease Control, Harvard Health

50%

Percentage of scientific studies confirmed in follow-up studies
Source: Healthy Aging Project, University of Colorado, Boulder

Researchers agree that a randomized, controlled trial is the best way to learn about the world. In a drug study, for instance, a population is randomly divided into groups who receive the drug and those who don’t. If properly controlled and designed, any difference in outcomes between the groups can be measured and credibly attributed to the effects of the treatment. The methodology is highly valued in evidence-based medicine, proving that associations are causal, and not just by chance. The approach has powerful real-world applications, as seen in the Women’s Health Initiative (WHI), one of the nation’s largest-ever health projects.

Begun in 1993, with more than 161,000 women enrolled, the randomized, controlled clinical trial was designed to test the efficacy of long-term hormone therapy in preventing heart disease, hip fractures and other diseases in post-menopausal women over 60 years old on average. Previous observational studies had strongly suggested the preventive benefits of hormone therapy, and it was routinely recommended for women years after menopause. What happened next was stunning.

In 2002, the trial was halted three years earlier than planned as evidence mounted that the estrogen plus progestin therapy significantly raised a woman’s chances of developing cardiovascular disease, stroke and breast cancer. Millions of women stopped taking hormone therapy, and the trial has since been credited with reducing the incidence of breast cancer by 15,000-20,000 cases each year since the results were made public. Numerous follow-up studies were conducted to dig deeper into the surprising data, and while they showed that hormone therapy may still be reasonable short-term to manage menopausal symptoms in younger women, it is no longer routinely recommended years after menopause to prevent chronic disease in women.

Similarly, Vitamin E supplements, once thought to reduce risk of heart disease, were found to not have beneficial properties and actually may increase the risk of heart disease in higher doses. Consequently, the American Heart Association now advises that the best source of Vitamin E is foods, not supplements.

The biggest takeaway from both initiatives: the critical need for randomized, controlled trials to prove that associations between an intervention and a disease are causally related.

Nutrition studies have also come under increased scrutiny, especially with the recent revelation of erroneous data published by high-profile researcher Dr. Brian Wansink, founder of the Food and Brand Lab at Cornell University. Numerous papers have been retracted as the lab’s propensity for data dredging – running exhaustive analyses on data sets to cherry pick interesting and media-friendly findings – came to light. This practice, seen somewhat frequently in food and nutrition research, may be part of why contradictory headlines seem to be the norm.

As the adage goes, data can be tortured until it says what the researcher wants to hear. That’s why your physician will always be the best source for making sense of the tremendous amount of health data released each day…so please ask!


Testing by Design

The most commonly used research models include:

Randomized controlled trial (RCT): carefully planned experiments like the WHI that introduce a treatment or exposure to study its effect on real patients; includes methodologies that reduce the potential for bias and allow for comparison between intervention groups and control groups.

Observational studies: researchers observe the effect of a risk factor, diagnostic test, treatment or other intervention without trying to change who is or isn’t exposed to it. Includes cohort studies, which compare any group of people linked in some way (e.g. by birth year); and longitudinal studies in which data is gathered for the same subjects repeatedly over years or even decades. An example is the Framingham Heart Study, now in its third generation, which has provided most of our current consensus regarding the effects of diet, exercise and medications on heart disease.

Case control study: compares exposure of people with an existing health problem to a control group without the issue, seeking to identify factors or exposures associated with the illness. This is less reliable than RCTs or observational studies because causality is not proven by a statistical relationship.

Meta-analysis:  a thorough examination of numerous valid studies on a topic, which uses statistical methodology to combine and report the results of multiple studies as one large study. This is cost-effective but not as accurate as RCTs as the individual studies were not designed identically.

Decoding Different Diets

What Kind of Eater are You?

In the quest for a healthier lifestyle, even inveterate beef eaters may be considering a more vegetable-centric diet. If you’re on a journey to vegetarianism or simply curious about the side roads surrounding it, follow our road map to nutritious eating with expert direction provided by Academy of Nutrition and Dietetics’ Jen Bruning.

Flexitarian is a term recently coined to describe those who eat a mostly vegetarian diet with occasional forays into meat. “Flexitarian is probably the most relatable, allowing people to take a stepwise approach to less meat,” says Bruning. “Instead of building a meal around beef, it becomes a side dish, ingredient, or is eliminated altogether.” The flexibility is key to real life applications. “If you’re at a barbecue you can enjoy without guilt.”

Dietary notes: No real challenges in terms of meeting dietary needs – follow the traditional healthy ‘plate’ but place more emphasis on vegetables, and substitute beans and legumes for meat when possible.

Pescatarian refers to those who abstain from eating all meat and animal flesh with the exception of fish. It’s becoming increasingly popular as a healthier way to eat or as a stepping stone to a fully vegetarian diet. “This can be a very balanced way of eating,” confirms Bruning, “as fish are rich in protein and Omega-3 fatty acids.” Some pescatarian diets include eggs and dairy.

Dietary notes: Avoid fish that contain higher amounts of mercury e.g. marlin, orange roughy, swordfish. Instead, opt for cod, tilapia, trout, canned light tuna, whitefish, salmon and sardines, among other choices.

Lacto-Ovo-Vegetarian is the more traditional vegetarian diet, eliminating beef, pork, poultry, fish, shellfish or animal flesh of any kind, but including eggs and dairy. It can be a nutritionally complete way of eating. Good sources of protein include legumes (lentils, beans, peas), soy-foods (tofu, tempeh, edamame), seitan, meat alternatives (veggie burgers, plant-based crumbles), milk, nuts, seeds, and grains (farro, millet, quinoa). Incorporate foods high in iron: dark leafy greens, beans, tofu, tempeh, black strap molasses, quinoa and tahini. Calcium requirements can be met with leafy green vegetables, tofu, and calcium-fortified products.

Dietary notes: Add vitamin C-rich food, such as tomatoes, bell peppers or citrus fruit, to increase iron absorption, such as beans in tomato sauce.

Vegans do not eat meat of any kind, or eggs, dairy products, honey or processed foods containing these or other animal-derived ingredients.

Dietary notes: To ensure adequate nutrition, incorporate the following foods or take a vitamin:

  • Vitamin B12 – fortified foods
  • Vitamin D – fortified orange juice or mushrooms treated with UV light
  • Iron – dark leafy greens and Vitamin C-rich foods to help with absorption
  • Calcium – kale and turnip greens
  • Omega-3 fatty acids – flax seed, chia, walnuts
  • Iodine – iodized salt or sea vegetables

Avoid the Raw Vegan/Raw Food diet, which is based on a nutritionally incorrect premise that cooking foods above 118 degrees F is harmful to the body.

Pain Management: The New Approach

Fewer Pills, Lower Doses, More Vigilance: The New Approach to Pain Management

It’s hard to imagine a medical crisis more widely discussed, dissected and debated in the last two years than opioid abuse. As a result, clear action steps have been taken, including retooling of the 2016 guidelines for opioid-prescribing protocols – dosage recommendations, follow up assessments and ongoing monitoring were reconsidered and adjusted. In short, for patients with chronic pain not from cancer, nonpharmacological treatment and non-opioid medications should be evaluated first, and opioids used only when:

  • other alternative therapies have not provided sufficient relief, and
  • pain is adversely affecting a patient’s function and/or quality of life, and
  • potential benefits of opioid therapy outweigh

Following are details on the newest developments, and how they may impact the way you’re treated for pain, from hospital bed to physician office.

Minimize and customize dosage. Not surprisingly, the dosage recommendations for exercising caution are lower than in earlier guidelines, beginning with even relatively low doses (20-50 morphine milligram equivalents (MME) per day). The lowest effective dose, for the shortest period needed, will be used to treat acute pain. In most cases, even pain following surgery does not require opioids for more than three days. Several high-profile institutions have changed their opioid prescribing guidelines following surgery.

At Johns Hopkins, a panel of health care providers developed recommendations for the number of five-milligram oxycodone pills needed after almost two dozen common procedures, finding that some required none, while the maximum of 20 pills was appropriate for others. The prescribing limits were designed to help prevent patients from receiving unnecessary opioid pills after surgery and ultimately face a one-in-16 risk of becoming a long-term user.

“Prescriptions for pain meds after surgery should be custom tailored to the operation and a patient’s needs and goals, but the hope is that these guidelines will help reset ‘defaults’ that have been dangerously high for too long,” the study’s author reported in a recent Journal of the American College of Surgeons.

An open discussion. It is now acknowledged that opioids present a risk to all patients, and risks must be clearly presented when starting therapy. These range from common (constipation, nausea) to serious (respiratory problems, opioid use disorder, overdose).

Establish realistic treatment goals. It’s essential to realize there’s no cure for chronic pain, but work toward pain relief to improve function and quality of life. “SMART” goals – specific, measurable, attainable, relevant and time-limited – should be set at the start to determine end points and be continually reassessed.

Continual monitoring. Opioids should only be continued after confirming that clinically meaningful improvements in pain and function were realized without significant risks or harm. In regular checks, patients will be asked to rank their pain, and level of interference with their enjoyment of life and general activity. A 30 percent improvement from baseline scores would be needed to continue the therapy. Reassessments are recommended within a few weeks after starting, and at least every three months throughout the course of treatment.

Not recommended for elderly patients. A body of evidence shows possible harm from long-term opioid use in older patients, who metabolize medications more slowly and so may be prone to side effects such as respiratory and cognitive impairment. UCLA Comprehensive Pain Center experts advise a multidisciplinary approach using psychological support, physical therapy and other complementary therapies.

Proper disposal of unused opioids. Noting that a large part of the opioid abuse crisis was spurred by people taking medications not prescribed to them, new guidelines emphasize not leaving unused pills in the medicine cabinet “just in case.” Patients are advised to dispose of them as quickly and appropriately as possible.

New approaches to addiction. According to a recent editorial in Mayo Clinic Proceedings, looking beyond the “supply side” issue to target the “demand” side of opioid use is critical to addressing why patients were initially drawn to using opioids. The authors recommend screening for depression and other psychiatric disorders which are often the impetus for patients to over-use opioids. Other studies posit that as many as 65 percent of overdoses reported at poison control centers were actually suicide attempts, underscoring the need for comprehensive psychological evaluation and treatment.

Optimize use of non-opioid therapies. A growing list of options includes:

  • Acetaminophen (Tylenol®) or ibuprofen (Advil®)
  • Muscle relaxants
  • Anti-inflammatories
  • Cognitive behavioral therapy – a psychological, goal-directed approach in which patients learn how to modify physical, behavioral, and emotional triggers of pain and stress
  • Exercise therapy, including physical therapy
  • Medications for depression or seizures
  • Interventional therapies (injections)
  • Exercise and weight loss
  • Alternative therapies such as acupuncture

Did You Know?

70–80% – 70-80% Percentage of opioid pills prescribed after surgery not used by patients

Source: Johns Hopkins

A Flu-Free Winter: Your Best Shot

Take Your Best Shot for a Flu-Free Winter

Last year’s flu season was severe in most parts of the country and left many wondering why the flu vaccine hadn’t performed more effectively. However, it remains our best line of defense for averting and lessening the severity of this common but potentially deadly illness. Below we clear up some of the most common misconceptions about the flu vaccine…and continue to strongly recommend that you make sure to get your shot of prevention this fall.

Myth: I can get the flu from a flu shot.

A flu shot will not give you the flu. The viral strains in injectable influenza vaccine are inactive and biologically unable to cause illness. The one exception is the vaccine administered in nose spray form.

Myth: The vaccine didn’t work last year, so it must be losing potency.

The amount of protection provided by flu vaccines varies by influenza virus type, and how well matched vaccine viruses are to the circulating flu viruses. Last year’s results, while lower than average, still meant that the risk of getting sick from flu was reduced by a third. This year, both types of vaccines, trivalent (protection against influenza A H1N1 and H3N2 viruses and one type of influenza B virus) and quadrivalent (four component protection to protect against two types of B viruses), have been modified to better anticipate the season’s circulating flu viruses.

Myth: The flu vaccine will also prevent other viruses.

Flu vaccines do not protect against infection and illness caused by other viruses, such as rhinovirus (one cause of the common cold) and respiratory syncytial virus (RSV), despite their flu-like symptoms.

Myth: Flu vaccines are not appropriate for people over 65, who have weaker immune systems than younger people.

Although immune responses may be lower in the elderly, flu vaccine effectiveness has been similar in most flu seasons among older adults and those with chronic health conditions compared to younger, healthy adults. It’s also important to remember that people 65 and older are at increased risk of serious illness, hospitalization and death from the flu, making the flu vaccination especially important for this age group.

Myth: There are no flu vaccines just for people over 65.

There are two vaccines designed specifically to help enhance the effectiveness in adults older than 65. A high dose vaccine, containing four times the amount of antigen as the regular flu shot, and the adjuvanted flu vaccine, which creates a stronger immune response in the elderly.

Myth: The vaccine is less effective if received every year.

Multiple studies have shown that while immune responses to vaccination may be higher among people not previously vaccinated, those who are repeatedly vaccinated still have increased immune responses and are provided protection against the flu.

Myth: I should wait as late as possible to get immunized so it lasts throughout the season.

The CDC and Advisory Committee on Immunization Practices (ACIP) recommends that you get a flu vaccination in early fall to ensure you’re protected before flu season begins. However, as long as flu viruses are circulating, it’s not too late. Receiving a vaccination in December or January can still protect you because flu season often peaks after January and can last as late as May.

Myth: Getting sick with the flu is not all that serious.

In the U.S., 36,000 people die and more than 200,000 are hospitalized each year because of the flu. Children, the elderly and people with certain chronic conditions (heart disease, lung disease, asthma or diabetes) are at higher risk for complications such as pneumonia. For everyone, flu symptoms, including fever, headaches, cough, sore throat, nasal congestion, extreme tiredness and body aches, can disrupt work and social life for up to two weeks. The flu vaccine has proven effective in both preventing flu and in lessening the severity of symptoms if flu should occur, thereby reducing the risk of hospitalization and admission to the intensive care unit.

Did You Know?

Up to 60% – Decrease in the risk of flu during seasons when most circulating flu viruses are well matched to the flu vaccine. Put another way, in 2016-17, the vaccine prevented an estimated 5.29 million illnesses, 2.64 million medical visits and 84,700 hospitalizations associated with flu.

79% / 52% – Reduction in hospitalization for people with diabetes (79%) or chronic lung disease (52%) as a result of receiving the flu vaccine.

Sources: Vaccine Journal August 2018, Centers for Disease Control, Harvard Health

The Enemy Within: Autoimmune Disease is on the Rise

autoimmune disease 1000x1000 300x300

A condition that is thought to have tripled in prevalence over the last 50 years, impacting over 23 million people, could justifiably be seen as an epidemic, or at least, a growing health concern. Autoimmune diseases, though, are not often thought of in that way because they manifest as 80+ different illnesses that nevertheless share the same root cause: a malfunctioning immune system that mistakenly attacks its own tissues. Virtually every human organ system can be impacted: the brain and spinal cord in multiple sclerosis, the skin in psoriasis, the joints in rheumatoid arthritis, the intestines in Crohn’s disease and ulcerative colitis, the insulin-producing cells in the pancreas in Type 1 diabetes, the thyroid in Hashimoto’s disease, among others.

Ironically, 100 years ago, Nobel Prize-winning immunologist Paul Ehrlich, MD, was openly skeptical of a concept in which the body turns on itself, calling it “horror autotoxicus” (literally, the horror of self-toxicity). That set back acceptance of autoimmunity another half century, according to today’s leading neuro-immunologists. Now we are beginning to recognize the pervasiveness of autoimmune disease and develop therapies based on new research into its complex causes.

Notably, the gut, which houses 80 percent of the immune system, has come under increased scrutiny for the role it can play in causing disease. One theory posits that a ‘leaky gut’ may allow undigested food particles, microbes and toxins to enter the blood stream, and trigger inflammation that goes on to
disrupt the proper functioning of the immune system.

There is also a growing consensus that these diseases result from complex interactions between genetic and environmental factors. Autoimmune disease is commonly clustered in families, but may affect different organs. For example, a mother may develop rheumatoid arthritis while her daughter copes with juvenile diabetes, her sister has Hashimoto’s thyroiditis, and her grandmother deals with Graves’ disease. Environment and lifestyle may contribute to the increased incidence of these diseases, including chronic stress.

For the many living with an autoimmune condition, there is hope in the form of new medications, advanced treatments and genuine breakthroughs in the precision medicine approach. Experts predict substantial advances in the next decade, fueled by more than 310 medicines and vaccines for autoimmune diseases already in clinical trials or awaiting review by the Food and Drug Administration (FDA). Options go well beyond simply relieving symptoms or replacing substances destroyed by the disease, including:

  • Therapies to suppress the immune system and preserve organ function, such as methotrexate, used to treat cancer, now also successfully used for rheumatoid arthritis and several other autoimmune diseases.
  • Real progress in biologics, which target specific enzymes and proteins. Monoclonal antibody medicines are being used to block inflammation in rheumatoid arthritis, preventing irreversible joint damage and enabling remission; to inhibit the activity of proteins implicated in Crohn’s and colitis and systemic lupus erythematosus; and are newly approved by the FDA to neutralize inflammatory processes linked to psoriasis.

Running on a parallel and complementary path are natural methods, which continue to gain traction. Areas under investigation include: reducing foods high in sugar and saturated fat, practicing de-stressing techniques, lowering the toxic burden caused by constant exposure to environmental factors and restoring intestinal health with a diet that includes prebiotic and probiotic foods.

Plant the Seeds of Healthy Eating

Seeds of healthy eating v1 300x300

Plant-based eating proponents are growing at a rapid clip in the US, buoyed by ongoing reports that following the regimen faithfully can result in a multitude of health benefits, ranging from increased energy and elevated mood to lower risks of diabetes, high blood pressure and heart disease. The abundance of antioxidants in whole plant foods may also help prevent or slow certain cancers. In addition, plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources.
“Plant-based nutrition is superior when it comes to most diseases.”
– Dr. Kim Williams, former president of the American College of Cardiology

Multiple studies point to the preponderance of refined, processed foods, loaded with added sugars and salts that comprise the standard American diet, and the link to disease. Choosing whole foods instead of refined grains and sugary fruit juices is key, and the Physicians Committee for Responsible Medicine illustrates the concept with these four ‘new’ food groups on the nutritional plate:

  • Fruits are rich in fiber, vitamin C, and betacarotene. Also include fruits high in vitamin C, such as citrus fruits, melons, and strawberries. Choose whole fruit over fruit juices, which don’t contain much fiber.
  • Vegetables provide vitamin C, betacarotene, riboflavin, iron, calcium, fiber, and other nutrients. Good sources are dark green leafy vegetables such as broccoli, collards, kale, mustard and
    turnip greens, endive, or bok choy. Dark yellow and orange vegetables such as carrots, winter squash, sweet potatoes, and pumpkin provide extra beta-carotene.
  • Whole Grains contain fiber and other complex carbohydrates, as well as protein, B vitamins, and zinc. Choose bread, rice, pasta, hot or cold cereal, corn, millet, barley, bulgur, buckwheat groats, and tortillas. Build each of your meals around a hearty grain dish.
  • Legumes are good sources of fiber, protein, iron, calcium, zinc and B vitamins. These include beans, peas, lentils, chickpeas, baked and refried beans, soymilk, tempeh, and tofu.

How to begin

  • Focus on filling your plate with a variety of colorful fruits, vegetables, whole grains and legumes, rather than on serving sizes or calorie counting.
  • Try eating at least half your calories in legumes, whole grains, and starchy vegetables that will keep you full.
  • Start with a familiar favorite recipe and change it to a plant-based one, such as chili with beans only or veggie or portobello burgers.
    Sources: Plantrician Project, Nutritionstudies.org

20,000 and You: Unlocking the Genetic Code

In just the past few years, there has been a significant shift in the practical uses of genetic testing, which examines changes, or variants, in your genes that may lead to illness or disease. Once considered more of an investment in the future and less applicable to individual patient care, opportunities to guide health and lifestyle decisions in the here and now may be tantalizingly close at hand.

“Genetic testing is progressing from an occasionally deployed diagnostic tool to becoming the new founding architecture of a personal health record, and may ultimately become a vital addition to a patient’s clinical portfolio,” explains Calum MacRae, MD, geneticist, Chief of Cardiovascular Medicine at Brigham and Women’s Hospital and in private practice at Boston’s AllCare Medical, whose decades-long focus has been on how to systematically implement genomics discoveries into clinical care.

In broad strokes, three areas are identified through genetic testing: disease carrier states for genes, important to the patient’s immediate family; inherited diseases such as heart disease or cancer; and an emerging predictive utility for drug responses and risk of common diseases. This information forms the foundation of personalized medicine, targeted to a patient’s specific genetic profile. According to Dr. MacRae, a holistic approach will optimize the enormous potential of genetic testing, allowing physicians to engage all their patients to understand their own genomes and build collaborative plans for lifestyle modification, nutritional choices and medications that may prevent or delay disease.

Direct-to-consumer (DTC) testing such as 23andMe has become ever more mainstream and is predicted to grow to a $340 million industry in the next five years. In fact, earlier this year, the FDA began allowing 23andMe to provide DTC testing for increased risk of 10 conditions, including celiac disease, hereditary hemochromatosis, Parkinson’s, alpha-1 antitrypsin deficiency and late-onset Alzheimer’s disease.

However, experts cast a wary eye on DTC testing for a number of reasons. Genetic testing is highly technical and complex and it is still hard to predict who will actually develop common diseases such as diabetes, hypertension, and many cancers from genes alone. For many conditions, a negative DTC test result does not necessarily guarantee low risk because it is believed to be the interaction of complex environmental factors with genes that cause disease. That means all information must be considered in the context of a patient’s environment, lifestyle and family medical history, ideally explored during a one-to-one consultation with a primary care physician.

While there is still much to be uncovered, there is no denying the desire to incorporate personalized medicine in clinical practice is increasing. Scientists are beginning to understand the interplay of genes and environment on disease for about one third of the roughly 20,000 genes we all possess, and the portfolio of knowledge continues to grow rapidly. Even more comprehensive tests that examine numerous genes and variants in an individual’s exome (the protein-making part of the gene), known as next generationgeneration sequencing, will gradually become accessible as the costs associated with them continue to fall. Technologies that enable scientists to alter an organism’s DNA (see below) are being refined. With every advance, we may come closer to realizing the vision of Dr. J. Craig Venter, one of the primary forces behind the original Human Genome project, who said in 2015: “I’m hoping that these next 20 years will show what we did 20 years ago in sequencing the first human genome was the beginning of the health revolution that will have more positive impact in people’s lives than any other health event in history.”

Coming to Terms with Genetic Testing

  • Chromosomal microarray: looks for genetic changes in the genome, sometimes caused by an existing medical condition.
  • Genome editing: technologies that enable scientists to change an organism’s DNA by adding, removing or altering genetic materials at particular locations in the genome. Gaining favor is the newest CRISPR technology, less expensive and more accurate than other genome editing methods.
  •  Single nucleotide polymorphisms or SNPs: the most common type of genetic variation among
    people. They can act as biological markers, helping locate genes associated with disease, and may help predict an individual’s response to certain drugs, susceptibility to environmental factors such as toxins and risk of developing particular diseases.  SNPs can also be used to track inheritance of disease genes within families.
  • Genotyping panels of selected susceptibility variants: often used in DTC genetic tests, and include SNPs that have been associated with common, complex diseases such as type 2 diabetes, autoimmune disease and metabolic traits.
  • Specific single gene tests: performed as part of a focused risk evaluation for heritable disease or for diagnostic considerations e.g. BRCA1 and BRCA2 gene sequencing for carrier identification in at-risk individuals with a strong family history of breast cancer.

Source: Up to Date

Step Up to the Plate: Nutritionists Weigh in on Healthy Eating

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Picturing a healthy meal has never been more accessible, thanks to the ubiquity of visual aids such as MyPlate, successor to the well-known Food Pyramid of the ‘90s. A quick scan of the plate’s
quadrants enables users to see at a glance proportions of vegetables, proteins and other foods recommended for a nutritionally balanced day of eating. Hailed as a significant breakthrough when
it debuted in 2010, for many dietitians and health experts, MyPlate did not go far enough in revamping the American diet. For instance, Harvard’s Healthy Eating Plate limited red meats but not healthy oils, while the American Institute of Cancer Research’s New American Plate relied even more heavily on vegetables and fruits, accounting for fully two thirds of the plate. The most recent federal guidelines, just issued for 2015-2020, now emphasize shifts needed to choose nutrient-dense foods and beverages in place of less healthy options, and the interconnected relationships between each dietary component. Illustrated at right are what a healthy, and even healthier meal, can look like at your table this year.

MyPlate breaks it down:

  • A variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other
  • Fruits, especially whole fruits
  • Grains, at least half of which are whole grains
  • Fat-free or low-fat dairy, including milk, yogurt, cheese and/or fortified soy beverages
  • A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds and soy products
  • Oils
  • Limited saturated fats and trans fats, added sugars and sodium (less than 2,300 milligrams per day)
  • Alcohol in moderation, up to one drink per day for women and up to two drinks per day for men
  • Physical activity: Weekly, strive for 150 minutes of moderate intensity activity (brisk walking) and 75 minutes of vigorous intensity aerobic activity (swimming laps)

The American Institute of Cancer Research (AICR) offers a portion-controlled diet based on fruits, vegetables, whole grains and other plant-based foods that provide an array of cancer-protective compounds while serving as powerful weight-management tool. According to the AICR, the fiber and water in plant foods gives a feeling of satiety with a minimum of calories. Their main message: maintaining a healthy weight is one of the most important steps you can take to reduce your risk of cancer.