0 Why Population Based Care and Disease Management Can Increase Access to Primary Care

If the population health management (PHM) service industry needed just one evidence-based medical journal article to justify its existence, it couldnt do better than this. Writing in the New England Journal of Medicine, Amireh Ghorob and Thomas Bodenheimer advocate for Sharing the Care to Improve Access to Primary Care.

The authors argue there can be only one solution to the twin challenges of dwindling primary care physician (PCP) numbers and the increasing burden of chronic illness : reallocating clinical responsibilities away from PCPs to empowered non-physician team members. These responsibilities include, but are not limited to a) prescription drug monitoring, titration and renewals, b) scheduling and processing of routine blood testing (like cholesterol) and imaging studies (like mammography), and c) counseling patients about lifestyle changes, medication adherence and their perences, priorities and goals for their chronic conditions.

In order for all this to happen, Mr. Ghorob and Dr. Bodenheimer suggest two ingredients will be necessary: 1) payment orms that make teaming profitable and 2) physician compromise over their long-cherished notions of control.

Thats precisely the approach that has been used by the PHM vendors for decades.

They have nurses, they rely on the teaming, they can manage routine prescriptions, testing and counseling and they can do it for a relatively small monthly fee. Theyve also learned their lesson: the vendors are doing a much better job of navigating through the doctor-patient relationship and discerning the important differences between clinical responsibility and busy-work control.

A far less important issue is the location or level of service provided by the non-physicians. 

The Disease Management Care Blog argues that sorting that out is a local decision based on physician perences, pre-existing clinical infrastructure, history and organizational culture. Highly integrated systems may per to achieve teaming by transforming their primary care sites into medical homes. Less integrated networks may per a shared services model that in or outsources the teams. 

The point is that there is no one-size-fits-all approach to relying on teaming to increase access to primary care. Dr. Bodenheimer has confirmed which are the basic ingredients.  Now its time for the rest of the system to figure out the details.

0 Exercise related changes in estrogen metabolism may lower breast cancer risk

Changes in estrogen breakdown, or metabolism, may be one of the mechanisms by which aerobic exercise lowers a womans breast cancer risk, according to data published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

"Observational studies suggest physical activity lowers breast cancer risk, but there are no clinical studies that explain the mechanism behind this," said Mindy S. Kurzer, Ph.D., professor in the Department of Food Science and Nutrition at the University of Minnesota in Saint Paul. "Ours is the first study to show that aerobic exercise influences the way our bodies break down estrogens to produce more of the good metabolites that lower breast cancer risk."

Kurzer and her colleagues conducted the Women in Steady Exercise Research (WISER) clinical trial, which involved 391 sedentary, healthy, young, premenopausal women. They randomly assigned the women to two age-matched, body mass index-matched groups: a control group of 179 women and an intervention group of 212 women.

While women in the control group continued a sedentary lifestyle for the entire study period, women in the intervention group performed 30 minutes of moderate-to-vigorous aerobic exercise five times a week for 16 weeks. Aerobic exercises included the treadmill, stair stepper or elliptical machine. The researchers adjusted the workout intensity for each individual so that the maximal heart rate was uniform among all participants.

Eighty-six percent of participants from the control group and 78 percent from the intervention group completed the study.

The researchers collected 24-hour urine samples on three consecutive days prior to study initiation and on three consecutive days at the end of the study. Using a state-of-the-art technique called liquid chromatography/tandem mass spectroscopy, they measured the amount of three parent estrogens, E1, E2 and E3, and nine of their breakdown products called metabolites, in the participants urine samples. According to Kurzer, estrogen metabolism favoring the production of a metabolite called 2-hydroxyestrone (2-OHE1) over one called 16alpha-hydroxyestrone (16alpha-OHE1), which results in an increase in the 2-OHE1/16alpha-OHE1 ratio, has been linked with a reduction in breast cancer risk.

She and her colleagues found that aerobic exercise led to an increase in the amount of 2-OHE1 and a decrease in the amount of 16alpha-OHE1, which led to a significant increase in the 2-OHE1/16alpha-OHE1 ratio. There were no changes in the 2-OHE1/16alpha-OHE1 ratio in the urine of control group participants.

"Exercise, known to favor fitness and improve heart health, is also likely to help prevent breast cancer by altering estrogen metabolism," said Kurzer. "It is very important, however, to decipher the biological mechanisms behind this phenomenon."

In collaboration with researchers at the University of Pennsylvania in Philadelphia, Kurzer is conducting similar studies in women with a high risk for breast cancer.

0 How to Fix Cavities Naturally

If I polled 100 random people out on the street… if I asked them “Is it possible to reverse cavities?  No dentist, no fillings, do you think you can heal cavities with food and supplements?”  I’d be willing to bet 99 of out of 100 would say no.  Maybe more.  Maybe 99.5 if there was a little person around.  In fact they’d probably think I was out of my mind for asking.  Many of us haven’t even thought about the prospect of healing cavities; why would we?  It’s been jammed into our heads from birth that when you have a cavity, you get a filling.  And that’s all there is to it.  I had several cavities as a kid.  Actually, “several” may be an understatement.  It was too many to count, but I do remember one specific visit to the dentist that revealed seven cavities.  SEVEN!  And now I’ve got a mouth full of fillings made of mercury and heavy metals... definitely not something Id prefer to have permanently situated in my mouth.  But as anyone who’s ever had a cavity knows, there’s not typically any pain associated with them.  Sure they can develop into something worse, like an infection, but there’s no pressing reason to get a filling.  I would have appreciated it if someone suggested to me that I could try a more natural approach.

So that’s why I’m writing this article, and that’s why this information is so important.  It IS possible to heal your teeth naturally.  And not only is it possible, it’s surprisingly easy.  I’m not sure exactly why this information has disappeared over time; I assume it has something to do with the fact that it would ruin the dental industry.  But this is something you need to know.  This is something everyone needs to know.  You have options.  You CAN re-mineralize your teeth, and here are the people that proved it...

Drs. Edward and May Mellanby

The first is the work of a husband and wife team, Edward and May Mellanby, who wrote the book Nutrition and Disease.  Their most important bit of research was published in both the British Medical Journal and the British Dental Journal in 1932 (1).  In this study, they recruited 62 children with cavities and placed them on one of three diets for six months... 

Diet 1:  Their normal diet plus oatmeal

Diet 2:  Their normal diet plus vitamin A + D supplement (cod liver oil)

Diet 3:  Grain-free diet plus vitamin D supplement

And heres how each diet affected the childrens cavities...

Graph courtesy of Stephan at Whole Health Source

A few things of note... First, the regular diet plus oatmeal group did HORRIBLY.  Their diet clearly formed the most cavities, and showed no sign of healing.  This diet was likely deficient in a variety of vitamins and minerals (remember, whole grains are a nutrient-poor food), specifically vitamin D.  Back then foods werent fortified with D.  Second, taking cod liver oil alone looks to be highly beneficial.  Just look at the dramatic difference between diet 1 and diet 2.  And the best of all was diet 3, the grain-free diet with vitamin D, which prevented the most cavities and promoted the most healing.  Pretty amazing stuff!  Its not the most perfect study (not sure why they didnt just pass the cod liver oil along to the grain-free group), but the results are pretty shocking, especially if you thought a filling was the only way to fix a cavity!

Two take home messages.  Grains promote cavity forming, cod liver oil and vitamin D promote cavity healing. 

Weston A. Price

Ive talked about Dr. Price before, just briefly.  He was a dentist who, in the 1920s, explored the world looking for indigenous cultures who were free of tooth decay.  And he eventually used the information he learned in his own practice back in America.  In his book, Nutrition and Physical Degeneration (pg. 290), he talks about feeding underprivileged children one nutritious meal a day and monitoring their dental health...

"About four ounces of tomato juice or orange juice and a teaspoonful of a mixture of equal parts of a very high vitamin natural cod liver oil [vitamins A + D] and an especially high vitamin butter [vitamin K2] was given at the beginning of the meal. They then received a bowl containing approximately a pint of a very rich vegetable and meat stew, made largely from bone marrow and fine cuts of tender meat: the meat was usually broiled separately to retain its juice and then chopped very fine and added to the bone marrow meat soup which always contained finely chopped vegetables and plenty of very yellow carrots; for the next course they had cooked fruit, with very little sweetening, and rolls made from freshly ground whole wheat, which were spread with the high-vitamin butter. The wheat for the rolls was ground fresh every day in a motor driven coffee mill. Each child was also given two glasses of fresh [raw] whole milk. The menu was varied from day to day by substituting for the meat stew, fish chowder or organs of animals." (Thanks again, Stephan)

Dr. Price provides x-rays before and after his intervention, and clearly shows re-calcification of cavity-filled teeth using this intervention.  Cod liver oil, butter, bone marrow, raw milk... I dont think Ive ever seen any of this on My Plate!?  And yes, Dr. Price used grains, but the wheat he used was soaked and fermented, so the minerals were actually absorbed.  Once upon a time, we all prepared grains this way, and wed be healthier if we still did.

But whats most surprising about Dr. Prices method?  He only fed the children one meal a day!  Other than that, they ate their normal diet.  This is important because for the average person out there trying to implement something like this, just changing their diet for one meal a day is VERY doable.  And this stuff tastes great!  Its not like you have to choke down a low-fat, zero-salt, anorexia-inducing cardiac diet!

What To Do

So both methods, although different, are effective for reversing tooth decay.  Now heres what you can do for your teeth, whether youve got cavities to reverse or if you just want to keep them around for a while...

Things you must do:

• Get your fat soluble vitamins! Thats A, D, and K2.  This may be the single most important factor for healthy teeth.  Try this Fermented Cod Liver Oil / Butter Oil Blend, which is based on the formula Weston A. Price used.  The cinnamon flavor is delightful.

• Eat nutrient-dense animal foods like bone broth, organ meats, raw milk, butter, and eggs.  And get them from naturally raised animals, ie. grass-fed cows and pastured chickens.  Here youll get calcium and phosphorous, the raw materials to re-mineralize your teeth, along with lots other good vitamins and minerals.

• Clean your teeth!  Brush and floss every day.  But believe it or not, toothpaste is NOT important... in fact, this study found that brushing without toothpaste removed more plaque than brushing with it (2).  Plus, Ive heard some talk about the ingredients in modern toothpaste preventing re-mineralization... Id play it safe and stay away if youre really giving this a try.  If youre into it, use baking soda.  Or make your own baking-soda-based toothpaste.

Things you should do (but you may be able to get by without it):

• Minimize grains, especially whole grains.  If youre going to eat them, prepare them properly.  Check out Sally Fallons book Nourishing Traditions for just how to do that.  Or try your luck with Google.

• Eat plenty of vegetables.  Raw or cooked.  Starchy or non-starchy.  Leafy greens, potatoes, broccoli.  Whatever.  Its all good. 

• Get plenty of sunlight for some vitamin D.  Of course, dont burn yourself. 

• Avoid industrially processed foods.  Like anything in a box.  And refined vegetable oils.  This should go without saying. 

When you study dental health in the context of the grain-based, nutrient-poor diet that we all eat, youd get the impression that cavities are just incurable.  But step outside of that paradigm and do something crazy, like eat the way our ancestors did...  Eat nutrient-dense animal foods.  Get plenty of fat-soluble vitamins.  Minimize grains, or ferment them... and youd be surprised what you find.  You dont need to cover up your cavities with mercury and silver, you can re-mineralize your teeth all on your own! 

Id love to hear your thoughts!  Does anybody have any personal experience with this?  Let me know in the comments!

0 It is Not so Much What is Happening It is How You Respond to It

Hi,

I have been reading a very interesting book called "12 Steps to Raw Foods, How to End Your Dependency on Cooked Food" written by Victoria Boutenko who, I am finding, is a rather amazing person with straight forward and pointed insight into the issues surrounding "going raw" from the reasons to go raw, to how to deal with temptation. She is a person full of curiosity who sought to solve a problem in her own life: the illness that was affecting herself, her husband, her son, and her daughter. She simply started looking for the solution to her immediate problem and did not give up until she found the raw food solution which changed all of their lives. Seek and ye shall find is the foundation that she operates from and she leaves no stone unturned.

I started reading this book because I found it at the library, along with a couple of others, and I was enticed by her writing, her ideas, and her story from page one. It is excellent reading. My own belief is that raw food is the most nutritious, and most healthy food we can choose to eat, but I have had such a time struggling to do it, falling off the wagon, and having to get back up again that I was feeling like I was at my wits end, wondering why others could do it but I could not. In her book, I discovered this is not unusual and I am not alone.

From Victorias extensive experience in helping others to understand the importance of eating raw she also observed that many people who came to her classes and were enormously happy with the positive health changes that were wrought in their lives by doing what she taught, still did not remain raw foodists. At one point she discovered that every single person she had taught, not long afterwards, quit doing it. She wondered why and with the same curiosity and seeking she used to solve her health problems, she did what she needed to do to find out why this was happening, and how to solve this problem, too. What she discovered is that cooked food is addictive and that if you become aware of that, it is more likely that you can nurture your skills at getting off of the addiction and getting on to new and rejuvenating health with raw food. Now she has had the experience of visiting former students who not only remained "raw" and continued to live in their new health, but because of her students others have also gone raw and improved their health, too.

That, for me, is what I am seeking: the reasons for going raw, the how to go raw, and the way to stay raw all boiled down into something that I can keep fresh and in focus so I can actually reach my goal. Why do it if you are not going to keep doing it until there is a compelling reason to do something else? And how do you deal with temptation? 

It seems that some people go raw, and stay raw for a certain number of years and then make another change as is needed for their own health. Some people go for the rest of their lives as a raw foodist. It all depends on the individual. And, I think that is one of the main points that anyone needs to understand -- that I need to understand. It is about personal mission and purpose. It is also about listening and responding to your own body and its specific health needs.

She has also given me a way to begin to satisfy my bodys cravings by feeding it highly nutritious green smoothies. She explains that the body wants and needs certain nutrients and if the foods we are eating (the Standard American Diet) are not fulfilling those needs we are left continually hungry and craving. The green smoothies are raw green leafy veggies and fruit that have been broken down for the bodys use. Breaking the food down in a blender is like a supplement to chewing which makes it easier for the body to digest and actually use the fabulous nutrients to heal what needs to be healed. Once the body has been nourished for a few weeks in this manner the cravings begin to stop and then it is much easier to go raw with less problems. She said it took her and her husband about two months, but the children adjusted more quickly. The green smoothies were something I had left out. After reading this I made one this morning which was very satisfying. Who knew? In a few weeks I will know if this is actually true or not. I will keep you posted.

One of the revelations that I have gotten from reading Victorias insight is that temptation is a distraction and can only be conquered by keeping the main goal in the fore front of your mind. As I thought back on times when I was able to accomplish some thing in my life, it did come from being completely focused on what I was going to get out of doing it. As I have gotten older something has changed in me. I suppose that is simply how life is. We do not remain as we were when we were young. Life and experience change us and sometimes the change is discouragement.

As I think about it, I am glad I did not stay where I was. I like many of the changes that have taken place in me as I have matured, but there are parts of me that I just never conquered. Weight and health being not only the most obvious, but also the most frustrating and difficult for me. It is no wonder. The standard American diet I was eating is not a healing nor a weight loss diet. It is what is causing the fat, the pain and the suffering. Not until a person realizes that for themselves and makes the drastic change to consuming healthy raw foods can they ever get beyond it. You are what you eat.

My recent setback with the Xylitol has given me a new impetus. I was taken back to square one with that one, but I have started over again, already. A friend pointed out to me her view that I did not simply stay down, that I continued to begin again, and I appreciated her encouragement. When she said that I realized that yes, there was a time in my life when for some long years I had completely given up on ever losing weight or improving  my health. But after praying for God to deliver me, I did get the motivation to no longer quit. I got the belief that I can get up and try again. Like Victoria, I just needed to seek and to find the answers that I needed.

I am about to begin doing some of the written exercises she suggests with the idea in mind of zeroing in on what my main reason for doing this is. I have kept my reasons vague, to myself, out of habit, and that seems to be one of the problems. I need to get clear on why I want to do this. What will be the benefit to me? Why is it so important? If I am honest I can see that I kept my reasons vague for the purpose of doing things my own way and continuing to sample the forbidden things. I wanted to make the change, but didnt want to change anything -- if that makes any sense. It was a way of having my cake and eating it too. But I can very clearly see that that does not work. I accomplish nothing when I plan to avoid what is really needed. If you skirt the real issues you simply keep going in circles and Im really tired of doing that. Id like to get on with it.

So. Here I am, again. I kind of like this place. It is exciting to think that I can do this. I just needed the right perspective, information, and help to get going again. I am grateful to God that he answered my prayers for help with Victoria Boutenkos experience, insight, and compassion for real life situations. Here is the URL to her web site: http://www.rawfamily.com/

I want to encourage you and let you know, that I believe you can accomplish your health and weight goals, too. I am rooting for you. Thanks for rooting for me, I appreciate it.

Be back soon

--Marcia

0 No evidence drugs vitamins supplements help prevent cognitive decline in healthy older adults

A review of published research has found no evidence that drugs, herbal products or vitamin supplements help prevent cognitive decline in healthy older adults.

The review, conducted at St. Michaels Hospital, found some evidence that mental exercises, such as computerized memory training programs, might help.

"This review provides some evidence to help clinicians and their patients address what strategies might prevent cognitive decline," said Dr. Raza Naqvi, a University of Toronto resident and lead author of the review.

The issue is of particular importance given that mild cognitive impairment affects 10 to 25 per cent of people over age 70. Mild cognitive impairment is characterized by reduced memory, judgment, and decision-making skills compared to someone of a similar age, but not enough to interfere with daily activities.

The annual rate of decline into dementia, such as Alzheimers disease, is about 10 per cent. Given that rate and the aging population, its estimated the number of Canadians with dementia will double to more than 1 million in the next 25 years.

Researchers including Dr. Sharon Straus, head of the Knowledge Translation Program at St. Michaels, reviewed 32 randomized clinical trials involving about 25,000 patients.

They found no strong evidence for pharmacologic treatments such as cholinesterase inhibitors that were developed to improve the effectiveness of acetylcholine, a chemical messenger that assists memory, thought and judgment.

Nor was there strong evidence that herbal supplements such as gingko improved cognitive functions or vitamins and fatty acids such as vitamin B6 or omega-3 fatty acids.

Some studies on estrogen actually indicated an increase in cognitive decline and dementia.

Evidence on the value of physical exercise, such as strength-training, was weak.

The strongest evidence was for the value of mental exercises such as computerized training programs or intensive one-on-one personal cognitive training in memory, reasoning, or speed of processing.

Dr. Naqvi said future studies should address the impact of cognitive training on the prevention of cognitive decline.

"We encourage researchers to consider easily accessible tools such as crossword puzzles and sudoko that have not been rigorously studied," he said. "The studies in this review that assessed cognitive exercises used exercises that were both labour- and resource-intensive, and thus may not be applicable to most of our patients."

0 Tangy Black eyed Peas Fenugreek Seeds Gravy With Coconut Paste Karamani Kaara Kuzhambu

Our week menu will definitely have fingerlicking tangy gravies atleast once a week. I used to prepare this tangy gravies either with veggies or either with beans. For this week menu, i made this droolworthy,delicious gravy with cooked black-eyed peas and fenugreek seeds with coconut paste and a spice powder prepared with just coriander and fenugreek seeds.

This gravy tastes super delicious when served simply with a bowl of hot steaming rice and fried papads. They tastes even more delicious after a day and stay prefect for a week if they are conserved in fridge in an air-tightened box.Usually i dont add coconut paste in my gravies, but this time i prepared this gravy with coconut paste as our this months Magic Mingle challenges magic ingredients goes for fenugreek seeds and coconut. This gravy will satisfy your tastebuds and definitely one of the best way to sneak this bitter fenugreek seeds.

2cups Cooked black-eyed peas
1+1/2cups Tamarind extract
1tsp Red chilly powder
1no Onion( large & cubed)
1no Tomato (big & juicy)
5nos Garlic cloves (crushed)
1/2tsp Mustardseeds
1/4tsp Fenugreek seeds
1/2tsp Cumin seeds
Few curry leaves
1/4cup Gingelly oil
Salt

To grind:
1/4cup Grated coconut
1tsp Fennel seeds

To roast & grind:

2tbsp Coriander seeds

1tsp Fenugreek seeds

Grind the coconut and fennel seeds together as fine paste and keep aside.

Meanwhile dry roast the coriander seeds and fenugreek seeds together and grind as fine powder,keep aside.

Heat the gingelly oil, let splutters the mustard seeds, fenugreek seeds,curry leaves and cumin seeds, add immediately the cubed onions, crushed garlic cloves,curry leaves and chopped tomatoes,saute everything until the onions turns transculent.

Add the cooked beans to the veggies, cook for few minutes, now add the tamarind extract, red chilly powder along with salt and cook for few minutes with lid closed.

Finally add the coconut paste,grounded coriander-fenugreek powder and cook until the oil gets separates and put off the stove..

Serve along with rice and papads.

0 Beware heart failure can increase the risk of cancer

Beware, heart failure can increase the risk of cancer - Turns heart failure and cancer risk are related. At least thats what was discovered by researchers in Minnesota. Their latest research shows that people with heart failure are more at risk of getting cancer.

Yet these findings do not necessarily indicate evidence that heart failure, which occurs when the heart fails to pump enough blood throughout the body, can cause cancer. Scientists said it will conduct further studies to clarify the relation.

"People do not consider the link between heart failure and cancer, at least they do not expect to get cancer after diagnosis of heart failure," said researcher Dr. Adrian Hernandez of Duke University School of Medicine in Durham, as reported by Reuters.

But Dr Sudhir Kushwaha, researchers from the Mayo Clinic in Rochester explains that the association of these two diseases are quite reasonable. This is because the organs are deprived of blood and oxygen due to heart failure might run into problems. Kushwaha emphasizes that heart failure patients should always be vigilant about any new symptoms that appear.

The results obtained after the researchers observed 961 patients with heart failure with people who do not have heart disease. After eight years, 244 people were still in the study diagnosed with various cancers.

After considering various factors such as the risk that participants held the weight and smoking habits, Kushwaha and colleagues found that patients with heart failure have a 68 percent chance of developing cancer is higher than participants who did not have heart failure.

Kushwaha research group revealed several reasons that could explain the link they found. Some heart medications can increase the risk of cancer, or stress, and inflammation of heart failure can also lead to cancer because the organ is starved of oxygen. In addition, the frequency of screening performed by patients with heart failure are also considered to be the cause.