The Fallacy of ‘Wellness’ and ‘Prevention’

In recent years, the terms ‘Wellness’ and ‘Prevention’ have joined the lexicon of meaningless buzzwords weighted with overblown importance. In this regard they join ‘Healthy’, ‘Organic’ and ‘Green’. Worse, they have become burdens for every corporation regardless of size industry sector who feel that they must offer these programs to retain employees and remain competitive. Unfortunately, no one can agree on what these terms mean.

In most settings, wellness and prevention programs resemble the team building craze of the 80’s. From ‘Biggest Loser’ contests to corporate memberships at the local health club to ‘healthy’ options in the company cafeteria, they contribute to the belief that those who embrace the wellness culture will be healthier and more productive and, most importantly, will stay out of the health care system.

A report released by Trust for America's Health in July 2008 finds that these lifestyle based wellness programs could result in significant savings in U.S. health care costs. In its report, entitled Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, TFAH concluded that implementing these programs reduce rates of type 2 diabetes and high blood pressure by 5 percent within 2 years; reduce heart disease, kidney disease, and stroke by 5 percent within 5 years; and reduce some forms of cancer, arthritis, and chronic obstructive pulmonary disease by 2.5 percent within 10 to 20 years.

Unfortunately, most corporations operate on a quarterly timeline. Moreover, employees are so mobile that the corporation that funds these programs is frequently not the beneficiary of the new and improved ‘healthy’ employee. Thus, while the 'feel good' part of wellness programs is important, corporations need to manage their wellness programs with an eye to near-term Return On Investment. So, while weight loss and exercise programs are fun and contribute to the corporate culture and may eventually pay for themselves, the folks who are most likely to participate in these programs are often those who need it least.

True preventive medicine identifies problems in their earliest stages and addresses them when intervention is most effective and least expensive. PrevaHealth Wellness Diagnostic Center offers state-of-the-art EBT technology - the gold standard in early disease detection. Non-invasively, without drugs or needles, we find heart and cardiovascular disease and many types of cancer - often years before the appearance of symptoms and before they are detectable with any other test. We find the heart disease, cancer and other diseases that, if discovered and treated in their early stages, will save lives and avoid expensive healthcare tragedies.

Our unique corporate screening programs are designed to keep your employees working and out of hospitals and doctors offices. Call us to find out how we can guarantee a positive ROI for your corporate wellness program.

Co-enzyme Q 10 (Co-Q10)

It’s everywhere, it’s everywhere…

“Q 10” was first discovered in 1957. Co-Q 10 is also called a ubiquinone (found everywhere) since it is present in virtually all cells of the body, with the largest concentration found in the mitochondria. The mitochondria are the energy factory units for the body and the fundamental energy unit produced by the factory is ATP (adenosine tri-phosphate). The most numbers of mitochondria are found in the liver, the heart, and skeletal muscle as these are the largest “users” of body energy.

Co-Q 10 is produced naturally in the body and has two major functions – one to be an essential catalyst to the production of ATP and the other is as probably the most powerful antioxidant in the body (much more so than vitamin E or vitamin C, which the body does not produce and must come from food or supplements). Co-Q 10 does have a chemical structure similar to vitamin K, but cannot technically be called a vitamin since the body produces adequate supplies in health. It has been shown to be the preferred antioxidant when present and provides a sparing action to the breakdown of vitamin E. Blood levels appear to peak by age 21 or so and then fall by 2/3 by age 80; this appears to be part of the natural aging process.

Co-Q 10 production by the liver may be compromised by various HMG Co-A reductase cholesterols drugs (collectively called “statins”) due to competitive inhibition for another chemical, acetyl CoA, which is essential for both cholesterol production and Co-Q 10 production. Patients taking statin-type cholesterol lowering drugs (the most popular of all such drugs) may then have reduced natural antioxidant ability. Some have suggested that the muscle aches and muscle weakness not uncommonly associated with statin use can be reversed with Co-Q 10 oral supplementation. Oral doses of Co-Q 10 have been shown to aid in lowering blood pressure and in improving energy and heart function in patients with congestive heart failure.

Finally, Co-Q 10 blood levels can be inadequate to support its major anti-oxidant role in situations in which oxidative stress (inflammation) is unusually high. I recommend that supplementation with Co-Q 10 be considered in patients who have multiple sources of oxidative stress, such as the factors of the Metabolic Syndrome, or in patients who are taking statin drugs.

There are differences in the Co-Q 10 preparations and those in solution rather than crystalline form have been shown to have better absorption and bio-availability. Co-Q 10 in doses of 50-100 mg, divided into twice daily, taken with meals (improves absorption), provides likely adequate general preventive therapy.

Our gold standard EBT imaging can identify high risk individuals and guide proper LDL goals and stratify the aggressiveness of clinical risk reduction strategies. Better clinical outcomes begin with better diagnostic evaluation - so the right patient gets the right treatment. .

John A. Rumberger, M.D. FACC

Medical Director, PrevaHealth

Fish Oil, Red Yeast Rice Cut Cholesterol

Supplements, Lifestyle Change Work as Well as Cholesterol-Lowering Medications

Supplements of fish oil and red yeast rice, coupled with lifestyle changes in diet and exercise habits, can reduce cholesterol as much as statins, according to a new study. But the study's lead author, David J. Becker, MD, a cardiologist at the University of Pennsylvania Health System, emphasizes that the alternative approach is not for everyone. "Statins remain the primary and best treatment for people with high cholesterol, especially if you have known coronary disease," Becker said. The study evaluated only people with high cholesterol who did not yet have coronary disease. The study was funded by the state of Pennsylvania and is published in Mayo Clinic Proceedings.

"If you are someone dead set against taking a statin, this may be an attractive option, assuming you are willing to make the lifestyle changes," Becker says. "This is one of the first studies that has shown there is some promise here," he says, referring to the alternative approach with supplements instead of statins.

Becker and his colleagues studied 74 people with high cholesterol. Half took Zocor and the other half took fish oil and red yeast rice supplements. They were followed for 12 weeks. The medication group took 40 milligrams of Zocor daily and received traditional counseling in the form of handouts on diet and exercise. The supplement group took three fish oil capsules twice daily. In addition, those with an LDL cholesterol higher than 160 mg/dL took 3.6 grams of red yeast rice daily, divided into two doses. If the initial LDL level was 160 or less, they took 2.4 grams of red yeast rice daily, divided into two doses.

The supplement group also attended weekly meetings and was taught about lifestyle changes by a cardiologist and a dietitian. The group was urged to follow a modified Mediterranean diet, limiting fat intake to less than 25% of daily total calories, and to exercise for 30 to 45 minutes five to six times a week.

At end of a three-month period, the LDL levels declined nearly the same amount in both groups. "The LDL declined 42% in the supplement group and 39% in the Zocor group," Becker says. The supplement group also lost an average of 10 pounds in 12 weeks, but there was no significant weight loss in the medication group. Triglyceride levels, while on average normal in both groups at the start, decreased by 29% in the supplement group but just 9.3% in the medication group -- a significant difference, Becker says.

The study results don't surprise Robert Eckel, MD, former president of the American Heart Association and a professor at the University of Colorado. He says the red yeast rice works in much the same way as a statin. "Fish oils don't affect LDL cholesterol - only triglycerides". And the participants' triglyceride levels, on average, were normal, he says, and did not need reduction.

Becker sees downsides to supplements over statins. "The red yeast rice is an unregulated supplement," Becker says. He cites a recent report in which researchers found significant differences in the amount of red yeast rice in different brands of supplements.

Red yeast rice sold in the U.S. typically comes in 600 milligram to 1,200 milligram doses, with recommendations of taking no more than 2,400 milligrams (2.4 grams) a day, the lower dose used in the study. Doses higher than this increase the risk of side effects similar to that of statin drugs, including muscle pain or tenderness, and possibly liver damage. Red yeast rice and statins work similarly in the body, so they should not be taken together, as this increases the chance of side effects. (adapted from WebMD)

Beware the ‘Wellness’ Trap

Employers are beginning to recognize the huge stake they have in their employees’ health and wellness. Rising healthcare costs, absenteeism and decreased productivity are only the most direct costs of an ageing and increasingly ailing workforce. In 2004, American corporations spent 16 percent of GDP on health care. It is projected to reach 20 percent in the next decade. Not surprisingly, health expenses are the fastest growing cost component for all employers.

So what’s being done about it?

Everyone acknowledges that preventive health and wellness is the most effective and inexpensive way to address these spiraling costs. Unfortunately, in the American healthcare system, preventative health continues to take a backseat to disease treatment. Among developed countries, America is last – by a long shot – in it’s commitment to preventive medicine. The reasons for this are endemic in the very structure that has served American industry so well.

Capitalism is alive and well

In 2006, total U.S. health expenditures were nearly $2.16 trillion and are projected to reach $4 trillion by 2015. Obviously, there is a lot of money to be made in caring for sick people and plenty of sick people to care for. One of every three employees suffers from at least one chronic condition: nearly 48% have cardiovascular disease, 30% are obese, 16% have hypertension, 12% are diabetic, 8% have asthma and 8% suffer from major depression. With so much money to be made caring for the sick, there is little incentive for our healthcare industry to support preventive health.

Consider cardiovascular disease. It is the leading cause of death and disability and one of the top sources of revenue for hospitals. Decades of research has clearly established that an EBT cardiovascular scan can identify and quantify the disease earlier and more accurately than any other test. The test can be completed in minutes, requires no drugs or preparation, and is one-third the cost of stress nuclear imaging and up to one-half the cost of stress echocardiography. Nonetheless, few hospitals offer the test and many doctors fail to tell their patients about it. There is little incentive for hospitals to offer such an inexpensive test that, when properly used, can obviate more profitable and invasive testing.

Keep your eye on the prize

Hospital sponsored ‘wellness programs’ usually offer on-site screening to identify those of your employees who need further care or testing at the hospital—at your expense. They focus on folks with active disease who can help them generate revenue. After all, their business model is designed to make money treating sick people.

True preventive medicine aims to identify problems earlier and address them when intervention is most effective and least expensive. In other words, keep your employee working and out of the healthcare system generally and hospitals in particular.

What is the goal of a preventive health program?

An effective preventive health program offers the following:

• Baselining: Clinically accurate testing to identify those who are truly at risk to stratify the level of intervention (if any) needed. This helps you put your healthcare dollar where it will do the most good and establishes benchmarks to measure compliance and track progress;
• Feedback: Clear, understandable information to help employees understand their problem and delineate a clear path to dealing with the problem before it becomes symptomatic (and expensive);
• Incentives: Benchmarks provide the basis to reward compliance or shift the cost of risky/noncompliant behavior; and,
• Metrics: Even within the limits of privacy restrictions, much data can be mined about your employees to negotiate premiums, design effective support programs and avoid health catastrophes.

So what’s a smart CEO to do?

1. Be Skeptical! Get personally involved in the process! You didn’t become a leader in your industry by following the pack. Spend the time to educate yourself about preventive medicine. There is no other area where you can have a greater impact on your cost structure than by reducing your healthcare costs. One of the best wellness programs available was designed for the Ohio State Highway Patrol Retirement System by a former patrolman.

2. Keep your eye on the prize. A good wellness program identifies those most at risk at the earliest possible stage. For example, when cardiovascular disease is identified early, it can often be treated with diet, exercise and lifestyle changes. If you wait for symptoms, the options are usually drugs, surgery, disability or death. Seek out programs and services that will help you direct your resources to those who are truly at risk and are calculated to create real change. If your people won’t use it - it won’t work.

3. Think like a businessperson. Demand metrics! If you can’t identify a clear ROI in a reasonable period of time, your wellness program just isn’t working.

4. Involve your people. The only ones with a direct financial interest in the health and wellness of your employees are you and your employee. Look for incentives—carrots and sticks—and build them into the program.

The tired maxim ‘Our employees are our most valuable asset’ should also read ‘… and our most expensive asset’. But be careful who you ask to design a program intended to keep your people out of the hospital and off your insurance claim rolls. Don’t ask the fox to design the lock on your henhouse.

Gil Gradisar, J.D. is president of PrevaHealth Wellness Diagnostic Center in Dublin, Ohio and can be reached at (614) 652-5888

Italian Study Shows CT Colonoscopy Offers npv of 96.3%

COLORECTAL CANCER (CRC) is the most common cause of cancer-related death in non-smoking Americans and the second most common cause of cancer-related deaths in smokers (behind lung cancer). The American Cancer Society estimates that this year there will be about 99,200 new cases and 48,100 deaths from colon cancer and 37,200 new cases and 8,600 deaths from rectal cancer.

Computed tomographic (CT) Colonography has been shown to be sufficiently accurate in detecting colorectal neoplasia. Less invasive and better tolerated than colonoscopy, CT Colonography is now considered a valid alternative for CRC screening in the general population and is now recommended by the American Cancer Society as a preferred front-line screening test in average risk individuals. However, less information is available on its performance in individuals at increased risk of CRC. In the June 17, 2009 edition of the Journal of the American Medical Association is a study designed to assess the accuracy of CT colonography in detecting advanced colorectal neoplasia in asymptomatic individuals at increased risk of CRC using unblended colonoscopy as the reference standard.

Individuals with first-degree family history of advanced colorectal neoplasia, those who have had resection of colorectal adenomas, and those with positive results from fecal occult blood tests (FOBTs) are at increased risk of CRC. However, adherence to follow-up colonoscopy in these individuals is suboptimal. The aim of this study was to assess sensitivity and specificity of CT Colonography in detecting advanced neoplasia (ie, advanced adenoma or CRC) 6 mm or larger in individuals at increased risk of developing CRC, because of either family history of advanced colorectal neoplasia in first-degree relatives, personal history of adenomas, or positive results from immunochemical FOBTs.

This was a multicenter, cross-sectional study. Individuals at increased risk of CRC due to either family history of advanced neoplasia in first-degree relatives, personal history of colorectal adenomas, or positive results from fecal occult blood tests (FOBTs) were recruited in 11 Italian centers and 1 Belgian center. Each participant underwent CT colonography followed by same-day colonoscopy.

Of 1103 participants, 937 were included in the final analysis: 373 cases in the family-history group, 343 in the group with personal history of adenomas, and 221 in the FOBT-positive group. Overall, CT colonography identified 151 of 177 participants with advanced neoplasia 6 mm or larger and correctly classified results as negative for 667 of 760 participants without such lesions.

The positive and negative predictive values were 61.9% and 96.3%, respectively; after group stratification, a significantly lower negative predictive value was found for the FOBT-positive group.

Conclusions: In a group of persons at increased risk for CRC, CT colonography compared

with colonoscopy resulted in a negative predictive value of 96.3% overall. When limited to FOBT-positive persons, the negative predictive value was 84.9%.

Based on this most recent study, if VC has a NPV of 95% or greater for people who are at high risk (people who were not screened but for diagnosis) then for a screening population the NPV is closer to 99%. If your patient is a reluctant candidate for screening for colon cancer, CTC may be the answer.

Gil Gradisar, President, PrevaHealth

Senator Tom Harkin on the wellness initiative

Shifting America from sick care to genuine wellness

http://news.yahoo.com/s/ynews/20090625/ts_ynews/ynews_ts408

Video Introduction to PrevaHealth

Stocking a Heart-Healthy Kitchen

Certain foods contribute to a heart-healthy diet. From fruits and vegetables to whole grains, these are the foods that you should keep on hand.

Fresh Fruits & Vegetables

Fill your fridge with seasonal fruits such as berries, oranges, apples, pears, and grapes, and vegetables such as bell peppers, broccoli, kale, cauliflower, tomatoes, dark leafy greens, celery, eggplant, zucchini, and squash.

Dairy and Dairy Alternatives

• Skim or 1% milk
• Soymilk (plain, unsweetened, vanilla, or chocolate)
• Low - or nonfat buttermilk
• Nonfat half-and-half or nonfat creamers
• Nonfat or reduced-fat cheese (bricks, slices, or shredded)
• Soy-based cheeses (bricks, slices, or shredded)
• Nonfat or light cream cheese
• Nonfat or 1% fat cottage cheese or ricotta cheese
• Nonfat or 1% fat yogurt (includes fruited, vanilla, or plain)
• Soy-based yogurts
• Nonfat sour cream
• Egg substitutes, egg whites

Meat, Poultry, Fish & Meat Substitutes

• Skinless, boneless chicken or turkey breasts and tenders
• Skinless, white breast meat ground chicken or turkey
• Pork tenderloin, trimmed of fat
• Lean ground beef such as ground round or ground sirloin (Note: When buying beef, look for words like "round" or "loin" and choose lean cuts to lower the fat content.)
• Assorted fish: salmon, mackerel, tilapia, trout, herring, tuna
• Tofu silken, soft, firm, or extra firm

Frozen Foods

• Frozen vegetables and vegetable blends without added sauces, gravies, etc
• Frozen fruits without added sugar (frozen blueberries, strawberries, or raspberries)
• Frozen soybeans (edamame)
• Frozen vegetarian burgers, sausage patties, or links (Boca Burgers, Yves, Morningstar Farms or Gardenburger)
• Reduced-fat and sodium vegetarian chili, burritos, and entrees like Amy's Organic and Health Valley.

Fats, Cooking Oils

• Assorted cooking oils (olive, canola, walnut, grapeseed, peanut, and sesame)
• Non-fat cooking sprays (for example, Spectrum Naturals, Pam)
• Baking fat replacements (for example, pureed prunes, applesauce, or Smucker's Baking Healthy)
• Non-hydrogenated shortening (for example, Spectrum Naturals)
• Trans-free liquid or tub margarine (for example, Promise Activ, Benecol, Fleischmann's Light, Smart Balance)
• Reduced-fat or nonfat salad dressings
• Herbs, Seasonings & Spices
• Use herbs and natural seasonings to take the place of salt.

Sweeteners

• Splenda, Equal, Nutra Sweet, Sugar Twin, and Brown Sugar Twin (sugar substitutes)
• Sugar free or "light" maple syrups
• Honey
• Brown rice syrup for a sweetening alternative to use when baking

• Pantry Essentials

  Snacks

  • Assorted raw nuts and seeds (almonds, walnuts, sunflower seeds, sesame seeds)
  • Dried fruits
  • Whole-grain breads, tortillas, pitas
  • Whole-grain, trans-fat free crackers (such as Health Valley whole wheat crackers, Kashi TLC crackers, Reduced Fat Triscuits, Fat Free Rye Crisp, Wasa)
  • Baked, trans-fat-free tortilla chips
  • Brown rice cakes, popcorn cakes
  • Whole-grain pretzels (such as Snyder's oat bran or honey wheat)
  • Plain popcorn or light microwave popcorn

  Condiments

  • Assorted vinegars: rice, red wine, balsamic, apple cider, raspberry as salad dressings.
  • Reduced-sodium ketchup
  • Assorted mustards: whole grain, honey, Dijon, yellow
  • Reduced-sodium soy sauce
  • Reduced-fat or nonfat mayonnaise
  • Barbecue sauce

  Beans, Grains, Sauces

  • Assorted canned beans such as lentils, kidney, garbanzo, pinto, and black beans
  • Dried beans (lentils, split peas, garbanzo beans, black beans)
  • Reduced-sodium soups with beans (for example, Health Valley)
  • Vegetarian chili beans (for example, Westbrae Naturals or Health Valley)
  • Vegetarian or nonfat refried beans
  • Rolled, steel cut, or Irish oats
  • Oat bran
  • Whole or ground flaxseeds
  • Whole-grain cereals (Look for 5+ grams of dietary fiber and less than 8 grams of sugar per serving.)
  • Barley
  • Brown rice, wild rice, and brown basmati rice
  • Grains such as wheat berries, couscous, polenta, millet, bulgur or quinoa
  • Whole-wheat, spelt, or kamut pastas (Note: These whole-grain pastas come manyi varieties.)
  • Wheat germ
  • Whole-wheat flour and whole-wheat pastry flour
  • Soy flour
  • Cornmeal
  • Reduced-sodium canned diced tomatoes, whole tomatoes, and tomato sauce
  • Low-fat or fat-free pasta sauce
  • Reduced-sodium chicken, beef, and vegetable broths
  • 98% fat-free cream of mushroom or chicken soups (for example, Campbell's Healthy Request)

Co-enzyme Q 10 - It’s everywhere, it’s everywhere…

“Q 10” was first discovered in 1957. Co-Q 10 is also called a ubiquinone (found everywhere) since it is present in virtually all cells of the body, with the largest concentration found in the mitochondria. The mitochondria are the energy factory units for the body and the fundamental energy unit produced by the factory is ATP (adenosine tri-phosphate). The most numbers of mitochondria are found in the liver, the heart, and skeletal muscle as these are the largest “users” of body energy.

Co-Q 10 is produced naturally in the body and has two major functions – one to be an essential catalyst to the production of ATP and the other is as probably the most powerful antioxidant in the body (much more so than vitamin E or vitamin C, which the body does not produce and must come from food or supplements). Co-Q 10 does have a chemical structure similar to vitamin K, but cannot technically be called a vitamin since the body produces adequate supplies in health. It has been shown to be the preferred antioxidant when present and provides a sparing action to the breakdown of vitamin E. Blood levels appear to peak by age 21 or so and then fall by 2/3 by age 80; this appears to be part of the natural aging process.

Co-Q 10 production by the liver may be compromised by various HMG Co-A reductase cholesterols drugs (collectively called “statins”) due to competitive inhibition for another chemical, acetyl CoA, which is essential for both cholesterol production and Co-Q 10 production. Patients taking statin-type cholesterol lowering drugs (the most popular of all such drugs) may then have reduced natural antioxidant ability. Some have suggested that the muscle aches and muscle weakness not uncommonly associated with statin use can be reversed with Co-Q 10 oral supplementation. Oral doses of Co-Q 10 have been shown to aid in lowering blood pressure and in improving energy and heart function in patients with congestive heart failure.

Finally, Co-Q 10 blood levels can be inadequate to support its major anti-oxidant role in situations in which oxidative stress (inflammation) is unusually high. I recommend that supplementation with Co-Q 10 be considered in patients who have multiple sources of oxidative stress, such as the factors of the Metabolic Syndrome, or in patients who are taking statin drugs.
There are differences in the Co-Q 10 preparations and those in solution rather than crystalline form have been shown to have better absorption and bio-availability. Co-Q 10 in doses of 50-100 mg, divided into twice daily, taken with meals (improves absorption), provides likely adequate general preventive therapy.

Researchers Say Doctors Are Missing Opportunities to Prevent Heart Disease

May 12, 2009 - A new study shows that, despite protocols which recommend aggressive screening for risk factors like elevated blood pressure and cholesterol, far too many patients with heart disease are being diagnosed only after they develop symptoms. The study appears in the May issue of The International Journal of Clinical Practice.

A survey of nearly 14,000 people with diabetes or other risk factors for cardiovascular disease indicates that doctors routinely miss opportunities to identify heart problems early. Merely one in five surveyed patients with heart disease said their diagnosis was made as a result of routine screening. More than half of patients with type 2 diabetes, and slightly less than half of patients without diabetes are diagnosed only after they developed symptoms. "The fact that only a small number of people are being diagnosed as a result of screening indicates that we are missing opportunities to prevent heart disease," said epidemiologist and study co-author Kathleen M. Fox, PhD. Fox is president of Strategic Healthcare Solutions, a private health research group.

The study included a nationally representative sample of patients with diabetes or other major risk factors for heart disease. Heart patients diagnosed after the American Heart Association (AHA) and the American College of Cardiology (ACC) revised their screening guidelines were only slightly more likely to be diagnosed during routine screening as patients diagnosed before this time, Fox says.

The AHA and ACC now recommend that:

• All adults should be assessed for cardiovascular disease risk factors beginning at age 20. Family history of heart disease should be regularly updated.
• Doctors should ask patients about their smoking status, diet, alcohol intake, and physical activity level at every routine evaluation.
• Blood pressure, body mass index, waist circumference, and pulse should be recorded at each visit and at least once every two years.
• Fasting serum lipoprotein profile, or total and HDL cholesterol, and fasting blood glucose should be measured as determined by the patient's risk for diabetes and high cholesterol at least every five years and every two years if patients have risk factors.
• All adults 40 or older should know their absolute risk of developing cardiovascular disease. This is especially important for people 40 and older and those with two or more risk factors for heart disease consistent with NCEP guidelines

Former American Heart Association President and current dean of the University of Mississippi School of Medicine Daniel W. Jones, MD says of the study: "It is clear that within our current health care delivery system we are doing a poor job of focusing on disease prevention. As we reform that system, we need to find better ways to apply the prevention strategies that we know work." He likened current disease prevention efforts to the old days of auto maintenance.
"When I was much younger the only place I could get my oil changed was the place that repaired cars," he says. "It was inconvenient for me and a nuisance for the mechanic. Now we have convenient places where all they do is change the oil and do other maintenance. They don't repair cars; they focus on prevention and because of these places people maintain their cars much better than they used to."

Study Shows Mediterranean Diet Lowers Heart Disease Risk

April 13, 2009 - A new review of the literature and studies shows only some diets show strong evidence of lowering heart disease risk. Researchers evaluated more than 50 years of research on diet and heart disease and found diets rich in vegetables, nuts, and those that follow a Mediterranean pattern with lots of fruits, vegetables, and fish have "strong evidence" of lowering the risk of heart disease.

In contrast, eating a Western-style diet, foods high in trans-fatty acids, or foods with a high glycemic index were shown to raise the risk of heart disease. Foods high in trans-fatty acids include processed baked goods and snacks and fried foods. Foods with a high glycemic index like white bread, pasta, rice and simple or refined carbohydrates cause blood sugar levels to spike. Other dietary factors such as omega-3 fatty acids found in fish, whole grains, alcohol, vitamins E and C, beta carotene, folate, fruit, and fiber were shown to have moderate evidence to support a heart-healthy claim. But more research is needed to conclusively prove the relationship between these dietary factors and heart disease risk.

The review of diet and heart disease was conducted by Andrew Mente, PhD, of the Population Health Research Institute and colleagues; it was published in the Archives of Internal Medicine. The researchers analyzed 146 studies that looked back at the dietary habits of a particular group of individuals in relation to their risk of heart disease as well as 43 studies in which people were assigned to a diet or a comparison group to measure the effect on heart disease risk. Researchers pooled the results of the studies and then rated the strength of evidence behind the various heart-healthy diet claims. The final results showed only three specific dietary factors had strong evidence behind them as proven heart disease fighters:
· Vegetable-rich diet,
· Eating nuts rich in monounsaturated fatty acids like walnuts and other nuts, and
· Following a Mediterranean-style diet high in vegetables, legumes, fruits, nuts, whole grains, cheese or yogurt, and fish.

Of these, only a Mediterranean-style diet has been shown in randomized controlled studies to reduce the risk of heart disease. Researchers also found strong evidence behind the negative effects of the following dietary factors on heart disease risk:
· Following a diet high in processed and red meats, butter, refined grains, and high-fat dairy
· High-glycemic index foods, and
· Trans-fatty acids.

The evidence behind all other dietary factors was "too modest to be conclusive" according to researchers.

The “ONE-THIRD” Diet

We know that one of the most important parts of the “Five Fingers of Prevention” is diet (the others are adequate exercise, appropriate prescription medications, proper nutritional supplements, and a positive attitude). Diet, like the other aspects of prevention, is a lifestyle and not just something you do to lose a few pounds and then return to your “old ways”. The only diet that has been proven to save lives and prevent heart disease and cancer is a Mediterranean diet. It is axiomatic that “you can save more lives with the proper diet (and exercise) than you can with all the drugs in the pharmacy”.

However, even with the best and most proper diet, the simple fact is that if you take in more calories than are used up by your personal metabolism or through exercise, then you will gain weight. Most people do not excessively overeat; they just take in a penny’s worth of more calories per day than they need. These pennies however can add up to serious amounts. The simple fact is that ONLY 200 extra calories per day (the equivalent of one can of regular soda pop) will put 21 pounds on your frame in one year. Three-hundred calories extra amounts up to 32 pounds per year.

The good news is that the HEALTHY Way to lose weight is to reverse the process. Crash diets that allow you to lose many pounds in two weeks, lose mostly water weight and are actually starvation diets, which in the long run (and in some even in the short run) are dangerous and threatening to your overall good health.

Calorie counting has been shown over and over again to work. In fact, it is the basis for successful weight loss programs such as Weight Watchers. The concept is sound – take in less calories per day than you need and you will lose weight. The problem is that they come up with “exchanges” and have you weight your own food and frankly, this is difficult for many to do on a consistent basis.

Here is what leading experts recommend: The first step is to start with healthy choices for meals and snacks. Second, since we are basically trying to find 200 to 400 calories per day that you DON’T need and make them go away, do the following. Take your “usual” meals and snacks and simply CUT ONE-THIRD OF IT OUT. Although it would be preferable that you cut more of the potato on your plate than the broccoli – we need to be fair. So look at your plate or that snack and figure out how you can remove 1/3 of each item, give what is left to “dog” (of course we don’t want your dog to get fat either!) and then enjoy, without guilt. With time, you get tired of wasting food (or making your dog fat) and start to figure out what portion sizes are best for that now much thinner YOU. That is The “One Third” Way Diet – simple!

Frequency of ‘Silent’ Heart Attacks

Undiagnosed, or "silent," heart attacks affect nearly 200,000 people in the United States annually. As many as 40 to 60 percent of all heart attacks are unrecognized according to a new study from Duke University Medical Center. Even if a heart attack occurred in the distant past, it may still leave a signature called a Q-wave on an electrocardiogram. But there are silent heart attacks that do not have associated Q-waves.

By definition, a heart attack usually occurs when a clot obstructs blood flow from a coronary artery to the heart. This may cause severe chest pain, shortness of breath, fainting and nausea. But sometimes a heart attack is not painful, or the person experiencing it does not recognize the symptoms as heart-related, so he or she does not go to a hospital for treatment. Cardiologists have only recently become attuned to the prevalence of these silent heart attacks, and research on treatment is limited. The risk factors for silent heart attacks are the same as for regular heart attacks, experts say, and include smoking, diabetes, stress and family history.

Researchers at Duke University Medical Center used a relatively new technique called delayed-enhancement cardiovascular magnetic resonance and then followed up with patients after about two years. The study was done on 185 patients who had never had a diagnosed heart attack but were suspected of having coronary artery disease. The researchers found that 35 percent of patients had evidence of a heart attack and that silent heart attacks without Q-waves were three times more common than those that had Q-waves. Patients with non-Q-wave silent heart attacks also had 11 times higher risk of death from any cause and a 17-fold risk of death from heart problems compared with patients without any heart damage.

Dr. Han Kim, a cardiologist at Duke University and lead author of the study said "If you don't know when an actual event occurred, it becomes difficult to prescribe therapy." Treatment for someone who has had a silent heart attack is usually the same for someone who came to the hospital immediately after a heart attack, Kim said. This may include beta blockers, statin drugs, aspirin or other medications.

Researchers noted that patients with non-Q-wave silent heart attacks were also generally older and were more likely to have diabetes. There needs to be more of a focus on prevention among these risk groups, said Dr. David Wiener, a cardiologist at the Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, who was not involved in the study.

Screening for Sleep Apnea

Should screening for sleep apnea be required for all men? According to a new study, men aged 20 to 29 with severe sleep apnea have 10 times the risk of dying from heart related ailments than their non sleep apnea peers in the general population, and a much higher risk than older men with sleep apnea. The study, which appears in the March 2005 European Respiratory Journal, was based on the largest population of sleep apnea patients (nearly 15,000 men) ever to be studied also showed that men aged 30 to 39 have three times the risk of dying, while those in their forties have twice the risk. But those aged 50 or older don't have a higher risk of dying than the same age group in the general population.

"We were surprised to find a sharp decline in the risk of dying after age 50," says lead researcher Professor Peretz Lavie of the Lloyd Rigler Sleep Apnea Research Laboratory at the Technion-Israel Institute of Technology. "Older patients have more risk factors, especially cardiac ones, so we expected relative mortality to increase with age," he notes. "The fact that they don't suggests that patients with sleep apnea develop a mechanism, as yet unknown, that protects their cardiovascular system."

In light of these findings, Lavie recommends a change in sleep apnea testing guidelines. Currently, patients seek help only when their symptoms become noticeable and disturbing, and the average age of sleep clinic patients is around 50. Lavie believes screening should be conducted not only for twenty somethings with sleep apnea symptoms, but also for other groups known to have a high prevalence of sleep apnea -- even if they do not have characteristic symptoms. These include the young obese, people who developed hypertension at a young age or children of sleep apnea sufferers. Diagnosing and treating sleep apnea at an early age, he says, would lower fatalities. He is careful to point out that sleep apnea patients who are older than 50 should still be treated, to improve their condition and quality of life, and reduce the risks of automobile and work-related accidents.

Sleep apnea is characterized by interruptions in breathing during sleep that last 10 seconds or more, at least five times per hour. They cause repeated interruptions of sleep and decreased oxygen levels in the blood, and have been linked with cardiovascular diseases, especially hypertension. The condition affects up to 10 percent of adult men, who in most cases are not aware that their breathing stops during sleep but who complain of chronic fatigue, excessive sleepiness, tendency to doze off during the day and loud, intermittent snoring.

“This study reinforces the fact that sleep apnea patients represent a vulnerable population that would especially benefit from a heartscan or full vascular analysis to assess their cardiovascular risk as a complication of their disease.” J.A. Rumberger, M.D. FACC-Medical Director, PrevaHealth

Welcome to the PrevaHealth & Wellness Blog

In response to the overwhelming requests for more information about our services and accurate information about wellness, we have created the PrevaHealth Wellness Blog. We will do our best to post the most cutting-edge information about wellness and medical advances as well as real-life stories from patients we are able to help.

For now though, we are posting information about our upcoming seminar: Wellness in the Workplace taking place this Friday - please plan to join us:

Prevahealth is sponsoring a focused guide to effective corporate wellness. Learn which clinical programs improve employee health and return a positive ROI by avoiding expensive illnesses. We will also explore the legal restrictions on employer-mandated programs. This free seminar is a must for companies considering sponsoring an employee wellness program. Friday, June 19 at Worthington Hills Country Club (Worthington, Ohio). Registration from 8-8:30. Program ends at 11:30. Call (614) 652-5888 to register or email to info@prevahealth.com.