0 Low Glycemic Index Diet Vs High Cereal Fiber Diet

Which of these two diets - a low-glycemic-index (LGI) diet or a high-cereal-fiber (HCF) diet - do you think would produce the better blood sugar control?

Researchers from Toronto set out to answer that question. Their results were published in the December 17 issue of the Journal of the American Medical Association:

Effect of a Low-Glycemic Index or a High-Cereal Fiber Diet on Type 2 Diabetes

Ill give you the answer up front: The low-glycemic-index diet was better, but only moderately.

The 210 participants with type 2 diabetes followed their respective diets for 6 months, at the end of which:

For those who followed the LGI diet:

• HbA1c went down by 0.50 (from 7.14 to 6.64)
  
• HDL went up by 1.7 mg/dl

For those who followed the HCF diet:

• HbA1c went down by 0.18 (from 7.07 to 6.89)
  
• HDL went down by 0.2 mg/dl (HDL is the good cholesterol, you want this to go up)

How Did The Diets Differ?

Low-Glycemic-Index Diet

"The following foods were emphasized: low-glycemic index breads (including pumpernickel, rye pita, and quinoa and flaxseed) and breakfast cereals (including Red River Cereal [hot cereal made of bulgur and flax], large flake oatmeal, oat bran, and Bran Buds [ready-to-eat cereal made of wheat bran and psyllium fiber]), pasta, parboiled rice, beans, peas, lentils, and nuts."

Fruit in the LGI diet leaned toward temperate: apples, pears, oranges, peaches, cherries, and berries.

High-Cereal-Fiber Diet

"Participants were advised to take the "brown" option (whole grain breads; whole grain breakfast cereals; brown rice; potatoes with skins; and whole wheat bread, crackers, and breakfast cereals)."

Fruit in the HCF diet leaned toward tropical: bananas, mangos, guavas, grapes, raisins, watermelon, and cantaloupe

Both Diets

Everyone was advised "to avoid foods such as pancakes, muffins, donuts, white buns, bagels, rolls, cookies, cakes, popcorn, French fries, and chips."
________

0 Aggressive Insulin Treatment vs Pills for Diabetes with Athersclerotic Disease No Difference in Outcomes

When doctors and their patients review the treatment options for diabetes mellitus, a common question is "Why mess around?" If the blood glucose, thanks to a relative lack of the hormone "insulin," is "high," shouldnt the more "natural," tighter and physiologic answer be... insulin? While there are pills that can lower blood glucose levels and patients detest shots, its unclear if the long term clinical, economic and quality-of-life outcomes favor one approach (oral medications) over another (insulin).

The Disease Management Care Blog thinks that these are the issues that were explored by the important, international and huge multi-center "ORIGIN" Study.  The results have just been published by the New England Journal.

Over 12,000 persons over age 50 years with

1) impaired glucose control or "pre" diabetes (more on this topic here), or

2) just-diagnosed diabetes or,

3) well-controlled diabetes (A1c less than 8 to 9%) on no or just one oral medication

and

4) established heart or atherosclerotic vascular disease

were randomly assigned to insulin glargine (with dosing that aimed for a normal blood glucose of 95 mg.%) or usual care (that relied on physician judgement and local guidelines). 

After one year, 50% of the insulin group hit their targeted blood glucose level and their median A1c (a measure of average blood glucose control over time) was 5.9%.  The usual care group achieved a median glucose level of 123 mg.% and after one year the A1c was 6.2%.  The difference in A1cs persisted over the remainder of the study (Table here)

The mean age of the participants was 63 years with an impressive median follow-up of 6 years that yielded outcome results on 99% of the participants.

Results?  No difference in heart attacks or kidney disease.

When cardiovascular death, nonfatal heart attack, non-fatal stroke were combined, the incidence was the same in both groups - about 3% per year.  There was no difference in kidney outcomes including deterioration in function or need for dialysis.  Hospitalization rates for any cause were the same in both groups.  There was an isolated difference involving angina that, in the DMCBs mind, may have been a statistical fluke.  You can look at the outcomes for yourself here.

There was one important difference.  Among the 1456 persons without formal diabetes (the "impaired" group - see above), persons given the insulin were less likely to progress to a formal diagnosis of diabetes (25% vs. 31%).  Unfortunately, they paid a price, because they had a higher rate of insulin-induced low blood sugar reactions (an incidence of 17 vs. 5 per 100 person-years).

Based on these results, the DMCB thinks:

1. Turning to insulin treatment early in the course of pre or diabetes treatment for persons with heart disease doesnt appear to offer any important difference in macrovascular (heart attack and stroke) disease or kidney disease outcomes. However, thats only true among patients who have achieved an A1c below 7%.  (The DMCB cant figure out what happened to the patients with a baseline A1c in the 8% to 9% range who didnt get to an A1c below 7 - did insulin help them?)

2. Whats more, its possible that driving an A1c lower - once its below 7% - doesnt offer any additional outcomes advantage.

3.  While early insulin supplementation may prevent the "burn out" of the insulin-producing cells of the pancreas, the price for that is a higher incidence of low blood sugar reactions.  Even though this "cure" of diabetes may seem like a big deal, why bother if theres no difference in survivorship?

4. As the population health management service providers discuss care planning with their patients with diabetes and heart disease, the topic of early aggressive insulin may come up.  Heres an answer to that question.

5. If accountable or risk-assuming organizations believe that early aggressive insulin treatment will lower the direct costs attributable to heart disease among their patients and enrollees with diabetes, the answer is no.

That out-of-ate but compelling image is from a 2003 HHS website on why Prevention Makes Common Cents

0 Spin and Innovation vs Savings and Disease Management

Spinning is hard work!

With the 2012 political theater season underway with a faux budget rejection and a re-energized President, The Disease Management Care Blog is reminded of an inconvenient truth: the nations unsustainable health care cost trajectory continues and is the single biggest threat to a bipartisan "grand bargain." 

So our pols response?  Spin.  For a hot-off-the-presses example, check out this press release from CMS Innovations Center lauding the creation of quality-boosting and cost-cutting health care "models." Theres also a "one year of innovation" monograph describing hundreds of millions of dollars worth of demonstrations, initiatives, programs, partnerships and sessions.

Impressive says the DMCB, but the bottom line is that these are ongoing and innovative experiments. There are no outcomes data, cost savings are far from certain and the mainstream FFS Medicare program in place today hasnt really changed its stultifying and high cost ways.

Sooner or later in the coming months, Congress will have to agree on some sort of budget. As that moves forward, the DMCB offers up some hard "un"spun facts for consideration:

• Just as effective governing is not a matter of selecting from a series of policy options, effective doctoring is not a matter of selecting from comparatively effective treatment options.

• There is no proof that the versions of the electronic health record being currently adopted nationwide save money. The savings argument remains anecdotal or theoretical with considerable room for doubt. What is clear is that installing an EHR costs money.

• The Patient Centered Medical Home is still a work in progress. The cost savings widely reported here did not achieve statistical significance and the real truth underlying North Carolinas medical home data is mired in actuarial debates outside the peer review process.

• While ACOs are ultimately modeled on the success of large integrated systems, we know that bigger is not necessarily better.  As this multi-year experiment gets ready to set sail into politically stormy seas and if (and thats a big "if") they are proven to save money, itll take years to expand them. Any real savings are more than a decade away.

• Commercial insurers profits, while high in absolute terms, have a relatively low return on investment and, compared to their administrative burdens, are not one of the major drivers of health care costs.

So where do the real cost savings lie? Former White House advisor Ezekiel Emanuel, in this just published JAMA Viewpoint, points out that the best answer is not any of the notions above but but controlling chronic illness with what essentially can be described in two words: disease management.

Heres the quote:

Successful efforts seem to entail instituting at least 4 common changes: (1) installing electronic health records and using them to track patients health status and physician performance, as well as using decision supports to increase adherence to treatment pathways; (2) using the information for more intensive interactions between patients, caregivers, and clinic staff, including use of care coordinators, 24/7 access, interventions to increase medication adherence, specialized clinic services for recurrent problems of patients with chronic disease such as anticoagulation clinics; (3) reducing use of specialists, and when specialists are involved using those who are more efficient; and (4) providing services not traditionally covered by fee-for-service reimbursement, such as e-mail, wireless monitoring to increase medication adherence, home evaluations to minimize falls, lifestyle interventions to improve nutrition and exercise, and transportation services for office visits. Cumulatively, the savings appear to occur through fewer hospitalizations, emergency department visits, and lower use of specialist services (bolding from the DCMB)

The DMCB couldnt have said it better itself.  Dr. Emanuel describes the ingredients of successful commercial disease and population health management programs in place today today: a later generation EHR that is coupled with decision support and registries, risk stratification to identify the patients at great risk, care coordination with expedited access to specialized services and support for preventive care. 

Hes right, and thats no spin.

Image from Wikipedia

0 Nourishing our children documentary blows away illusions about processed food vs traditional diets

Nourishing our children documentary blows away illusions about processed food vs. traditional diets

A new two-hour video available on Premium NaturalNews TV blows away any remaining illusions about "healthy," processed food.

"Nourishing Our Children" advocates traditional diets, and is radical in that it turns the food pyramid upside down. For example, it shows how unhealthy processed cereals are, despite decades of "food pyramids" having conditioned us into believing cereals and cooked grains were a foundation of good health.

Watch the preview at: http://premium.naturalnews.tv/Nourishing_Our_Children.htm

If you were outraged by our investigation last year that uncovered how cereal companies only mimic blueberries through artificial chemicals in their "blueberry" products like cereals, wait until you see what is said in "Nourishing Our Children."

"Nourishing Our Children" is based on the work of Weston A. Price, a dentist who kept notes during his worldwide travels that correlated traditional diets with more robust and healthy people, from a young age onward. The genius of "Nourishing Our Children" is that it puts Dr. Prices work into very understandable sections, and orients it for the modern parent and child.

One review of "Nourishing Our Children" by Amy Love says:

"A well-organized and thorough examination of the incredible work and life-changing teachings of Dr. Weston A. Price, Nourishing Our Children is a most helpful resource for anyone looking for true guidance in the realm of nutrition. As a nutritional therapist, I see day in and day out how necessary education is, and Nourishing Our Children is an invaluable resource in my practice."

It is notable that there are several testimonials of parents who say their nine-year-old children viewed the film with them, and the kids were fascinated by how different the diet that Dr. Price recommends is from the government recommendations today. It is refreshing to know that a video on nutrition that takes them away from candy, processed foods, and confusing, industry-influenced, ever-waffling government recommendations can make sense, even to children.

Sections of "Nourishing Our Children" include:

• "Whats Really in the Cereal Bowl"
• "The Ploy of Soy"
• "What You Dont Know About Your Protein Bar"
• "The Skinny on Fat"
• "Got Real Milk? Chances Are You Dont"
• "Diet for Motherhood," and more

Plus there are sections that deal with fluoride in the water, traditional fats and oils, and healthy meal preparation for the whole family.

If you are a parent imagining a child:

• Raised according to the nutritional wisdom of our ancestors
• Growing up free of the common ailments and diseases that we currently take for granted
• Whose strong, white teeth grow in straight - and free of tooth decay
• Who is attentive and engaged, and can learn easily and readily because of optimal brain development
• Who is energetic by day and sleeps soundly at night
• Who has a strong immune system, does not experience childhood illnesses or allergies, and has a stable, cheerful and optimistic disposition

And youd like to learn "how to nourish, rather than merely feed, your family," as the filmmaker says, then click now to "Nourishing Our Children:"

http://premium.naturalnews.tv/Nourishing_Our_Children.htm

The maker of this video, Sandrine Hahn, was inspired by hearing a wake-up call that nutrient-dense foods are key for childhood development into healthy adults. She transformed 107 PowerPoint slides into 1,500 animated frames that run like a movie. The narration is accompanied by a musical score and sound effects that create a dynamic, inspirational, educational experience!

To view this informative and visually beautiful program and learn one of the most important things in our lives - to nourish our children, click here:

http://premium.naturalnews.tv/Nourishing_Our_Children.htm