by Specialdocs Consultants, LLC | Jan 9, 2018 | Nutrition, Patient News
Plant the Seeds of Healthy Eating
Plant-based diet 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 adopt a plant-based diet
- 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
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by Specialdocs Consultants, LLC | Jan 9, 2018 | Medical Tests, Patient News
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
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by Specialdocs Consultants, LLC | Nov 20, 2017 | Nutrition, Patient News
Nutritionists Weigh in on Healthy Eating
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 healthy 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.
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by Specialdocs Consultants, LLC | Nov 20, 2017 | Nutrition, Patient News
Calcium, so essential to strong bones and teeth, as well as nerve transmission, muscle contraction and blood clotting, can be in short supply as we age. Exactly how much is needed of this important mineral, and Vitamin D, its companion to ensure optimal absorption, has been the subject of intense scrutiny over several decades. However, a clear cut consensus has yet to be reached from data that is by turns contradictory, reassuring or confusing. A cluster of respected studies have cast doubt on the efficacy of calcium – either in supplements or from dietary sources – in reducing the risk of osteoporosis or bone fractures. Some reports cast supplements in an even more negative light, pointing to potential side effects that range from gastrointestinal issues to increased risk of cardiovascular disease.
A quick look at research highlights, beginning with the study that arguably set the stage for use of calcium supplements in seniors, illustrates why there is still a considerable amount of debate:
- 1992: Over 18 months, a trial of elderly French women finds the number of fractures was reduced by up to 43 percent among women treated with 1200 mg of calcium and 800 units of vitamin D daily. In subsequent years, the significant levels of vitamin D deficiency of the subjects in this study created uncertainty about applying the results to healthier adults.
- 1994: Guidelines vary. National Institutes of Health recommends 1500 mg of calcium and 600-800 units of vitamin D per day for post-menopausal women; Institute of Medicine recommends 1200 mg of calcium and 400-600 units of vitamin D daily for those over 50.
- 2006: Fracture risk not reduced. A report from the Women’s Health Initiative showed that 18,000 postmenopausal women who took calcium supplements and vitamin D were no less likely to break their hips than an equal number who took a placebo pill, although the density of their hip bones increased slightly.
- 2010: Mixed results on heart issues. A report from the Women’s Health Initiative showed no significant increase in heart problems among 36,000 women who were taking calcium supplements. However a study in the British Medical Journal (BMJ) reported they were associated with an increased risk of heart attack, concluding that “a reassessment of the role of calcium supplements in the management of osteoporosis is warranted.”
- 2012: No-supplement recommendation. The U.S. Preventive Services Task Force, a panel that advises doctors on matters of public health, stated there is not enough conclusive evidence to recommend taking calcium or vitamin D supplements to prevent fractures in healthy women.
- 2015: The case against supplements builds. According to a meta-analysis in the BMJ, additional calcium from supplements may build up in the arteries or kidneys, causing heart disease or kidney stone formation. An accompanying editorial reads: “The weight of evidence against such mass medication of older people is now compelling.”
Confusing, to be sure. While the optimal dose has yet to be determined, today’s best guidelines call for calcium intake below 1,600 mg a day for women over 50 and men over 70, and 1,000 mg a day of calcium for those under 50, along with appropriate amounts of vitamin D to enhance absorption. However, experts agree, more is not necessarily better, and supplements should be considered only if the daily goal cannot be met through food sources. In addition, strength training, for arms and upper spine, and weight-bearing exercise such as walking or stair climbing, for legs, hips and lower spine, are essential to build and maintain bone density. Remember: every patient has different needs, and these can change over time.
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by Specialdocs Consultants, LLC | Nov 20, 2017 | Healthy Aging, Patient News
As almost 10,000 Baby Boomers officially become senior citizens each day, the focus on preventing and treating age-related ailments becomes distinctly more urgent. HealthWise presents an ongoing look at research that provides valuable insights to help today’s seniors – and the generations set to follow – create a vibrant next chapter. We began with strategies to keep the aging brain healthy, and continue in this issue with a look at how your senses, specifically taste and smell, are affected by the aging process. Look for the latest on safeguarding your sight and sound in future editions.
A Taste of the Future
Savoring the sweetness of a rich chocolate, breathing in the scent of a fresh burger on the grill…taste and smell trigger the delights of eating by matching odorous molecules in the air with memories stored in your brain.
Taste buds have helped humans since the beginning of time identify foods as sweet, salty, sour, bitter or savory, and provide a warning not to ingest toxic substances. Forever intertwined with smell, food molecules travel through the rear of the nasal cavity to olfactory receptors in the roof of the nose – that is why if you hold your nose and put chocolate in your mouth, you will not taste the chocolate.
An effortless process for most, recognizing tastes and odors is actually cognitively demanding, and for older people, can be extremely challenging, as these capabilities greatly diminish as we age. Although new neurons continue to form in the olfactory region of the brain into adulthood, by age 50, the sense of smell starts to deteriorate rapidly as the number of sensor cells that detect aroma decrease…by age 80, smell detection is reduced by almost 50 percent. There is also a weakening of the nerves that carry the signals to the brain, and in the olfactory bulb, which processes them. In addition, the sense of smell may be diminished by reduced production of mucous, thinning of the nose lining and hormonal changes.
At the same time, the tongue’s taste buds are on the wane, dwindling from a high of 10,000 to just 5,000 in older adults. Dry mouth, caused by a reduced flow of saliva that is commonly seen in the elderly, or from medications such as antihistamines or antidepressants, also cause a loss of taste perception.
Why this matters: The ability to detect odors from spoiled foods, gas leaks and smoke is critical to safety. Taste issues means food becomes less appealing, and unhealthy amounts of sugar or salt may be added to food to make it more palatable, or less food is eaten, potentially leading to nutrition problems.
Preserve, protect and adapt
While there may not yet be a way to completely halt the decline, experts recommend a number of strategies to sharpen your senses of smell and taste and keep them working longer and better:*
Take brisk walks daily…exercise heightens the smell sense.
- Conduct your own sniff therapy by inhaling the scent of items such as peppermint and cinnamon first thing in the morning, sparking different receptors in the nose to work.
- Quit smoking…tobacco smoking impairs the ability to identify odors and diminishes the sense of taste.
- Reduce your risk of head injury by wearing protective helmets during sports and seat belts when riding in the car…trauma to the head can damage olfactory nerves.
- Treat nasal or sinus infections promptly, a primary cause of smell problems. The same advice holds for treating nasal polyps, small, non-cancerous growths in the nose or sinuses
that can block the ability of odors to reach olfactory sensory cells.
- Consider a change in medications that may be affecting your sense of smell, such as anti-allergy medicines.
- Choose foods that are naturally stronger flavored, such as mustard, pickles, radishes and peppers; add herbs and spices instead of salt. Use sun-dried tomatoes, vinegars, concentrate fruit sauces, extracts of almond, vanilla, citrus juice and peels to enhance tastes. Eat a variety of foods and textures, and change it up at every bite to keep your taste buds firing.
- Get an annual flu shot to help you avoid respiratory and ear infections that can interfere with taste.
- Practice good oral hygiene…take care of gum disease, inflammation or infections in the mouth, which can cause taste problems.
Finally, buy safety products, such as a gas detector that sounds an alarm you can hear.
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by Specialdocs Consultants, LLC | Nov 20, 2017 | Nutrition, Patient News
Turkey sandwiches…soups…deli meats. Are these the building blocks of a healthy meal or stealthy contributors of excess sodium? Both, according to experts, but improved versions are in the works, thanks to June 2016 Food and Drug Administration (FDA) recommended guidelines and commitments from food manufacturers and restaurant operators to shake down the salt.
Implicated in a litany of ills from increased risk of heart disease and stroke to higher blood pressure, sodium is one of today’s major targets for elimination in the quest for a healthy diet. According to the Institute of Medicine, reducing sodium intake to 2,300 mg daily can significantly reduce blood pressure, ultimately preventing hundreds of thousands of premature illnesses and deaths. Currently, Americans consume on average, about 3,400 mg a day (a teaspoon and a half), most of it involuntarily.
“While a majority of Americans reports watching or trying to reduce added salt in their diets, the deck has been stacked against them,” the FDA stated. “The majority of sodium intake comes from processed and prepared foods, not the saltshaker.”
The guidelines set targets for reducing sodium over the next decade in the majority of processed and prepared foods, including pizza, deli meats, canned soup, snacks, breads and rolls. Already Nestle has reduced the salt in its pizzas, General Mills reduced sodium in more than 350 products, and Mars Food, Unilever and PepsiCo have pledged to follow suit.
Experts at the Harvard School of Public Health and the American Heart Association urge even further downward pressure on sodium in the diet, recommending a limit of 1,500 mg per day. Dr. Frank Sacks, the Principal Investigator in the groundbreaking Dietary Approaches to Stop Hypertension (DASH) Sodium-Trial, concurs, saying the effect of sodium intake on blood pressure is strong and causal, and called the new guidelines “a tremendous step forward to lower heart attacks and strokes in the US.”
Start shrinking the sodium in your diet with these simple, tasty strategies:
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- Plant-based foods such as carrots, spinach, apples, and peaches, are naturally salt-free.
- Add sun-dried tomatoes, dried mushrooms, cranberries, cherries, and other dried fruits to salads and foods for bursts of flavor.
- Enhance soups with a splash of lemon and other citrus fruits, or wine; use as a marinade for chicken and other meats.
- Avoid onion or garlic salt; instead use fresh garlic and onion, or onion and garlic powder.
- Try vinegars (white and red wine, rice wine, balsamic). Maximize flavor by adding at the end of cooking time.
- For heat and spice, try dry mustard, fresh chopped hot peppers and paprika.
On vegetables:
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- Carrots – Cinnamon, cloves, dill, ginger, marjoram, nutmeg, rosemary, sage
- Corn – Cumin, curry powder, paprika, parsley
- Green beans – Dill, lemon juice, marjoram, oregano, tarragon, thyme
- Tomatoes – Basil, bay leaf, dill, onion, oregano, parsley, pepper
On meats:
- Fish – Curry powder, dill, dry mustard, lemon juice, lemongrass, paprika, pepper, saffron
- Chicken – Poultry seasoning, rosemary, sage, tamarind, tarragon, thyme
- Pork – Cilantro, garlic, onion, sage, pepper, oregano
- Beef – Marjoram, nutmeg, paprika, sage, thyme
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