Empower Mind, Body, Spirit & Soul

SOURCE: Annals of Internal Medicine, September 1, 2009.

NEW YORK (Reuters Health) – A low-carbohydrate, Mediterranean-style diet is more effective than a typical low-fat, calorie-restricted diet for diabetes management, according to a study released Monday.

Not only did the Mediterranean diet lead to greater weight loss, it also resulted in better blood sugar control, delayed the need for blood sugar-lowering medication, and improved some heart disease risk factors, the study team found.

Mediterranean-style eating generally means plenty of fruits, vegetables and whole grains, limited amounts of red meat and processed foods, and a relatively high amount of fat from olive oil and nuts and few carbohydrates. A typical low-fat diet advises cutting down on all types of dietary fat.

Both Mediterranean and low fat diets are recommended for weight loss in overweight and obese patients with type 2 diabetes. However, there have been few direct, long-term studies comparing the two.

This led Dr. Dario Giugliano, from the Second University of Naples, Italy, and associates to randomly assign 215 type 2 diabetic patients to follow either a low carbohydrate, Mediterranean-style diet or a low-fat diet for four years.

Nutritionists and dietitians counseled both groups of patients in monthly sessions for the first year and bimonthly sessions for the next three years.

After four years, 44 percent of patients in the Mediterranean-style diet group required medication to lower their blood sugar compared to 70 percent in the low-fat diet group, the researchers report in the September 1st issue of the Annals of Internal Medicine.

After 1 year, patients in the Mediterranean diet group also experienced greater weight loss. The absolute difference in weight loss between the two groups was -2.0 kg (-4.4 lbs). The Mediterranean dieters also had trimmer waistlines.

In addition, significantly greater increases in “good” HDL-cholesterol levels and greater decreases in harmful blood fats called triglycerides were seen in the Mediterranean diet group and these heart-healthy benefits were maintained for the duration of the study.

These findings, the investigators conclude, “reinforce the message that benefits of lifestyle interventions should not be overlooked despite the drug-intensive style of medicine fueled by the current medical literature.”

SOURCE: Annals of Internal Medicine, September 1, 2009.

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SOURCE: Annals of Internal Medicine, September 1, 2009.

NEW YORK (Reuters Health) – For people with a simple sore throat or ear infection, a “retail” health clinic may treat the problem as well as, and more cheaply than, the family doctor, a study published Monday suggests.

The study, reported in the Annals of Internal Medicine, is the first to assess quality of care at U.S. retail health clinics, which operate mainly out of pharmacy chain stores, but also in grocery chains and “big box” stores like Wal-Mart.

Analyzing a year’s worth of claims from patients in a large Minnesota health plan, researchers found that for cases of sore throat, ear infection and urinary tract infection (UTI), retail clinics and doctors’ offices provided a comparable quality of care.

The difference was that retail clinics did so at a lower cost: the average visit cost $110, versus $166 at doctors’ offices.

Retail clinics provide quick walk-in care for a limited number of health conditions, as well as certain health screenings, like cholesterol and blood pressure checks. Convenience and relatively low costs have made them increasingly popular, but the clinics have also come under criticism for a number of reasons.

Retail clinics are typically staffed by nurse practitioners, and some have questioned whether NPs are more likely than doctors to misdiagnose patients’ problems. The clinics also lack records for their walk-in patients, which in theory could undermine people’s overall healthcare.

“When you visit your primary care doctor, he or she can look at your record and see that you haven’t had, for example, your routine Pap smear,” said study leader Dr. Ateev Mehrotra, of the research organization RAND in Pittsburgh.

“When you go into a retail clinic,” he told Reuters Health in an interview, “the nurse practitioner there doesn’t know you didn’t have your Pap smear.”

But Mehrotra and his colleagues found no evidence that having a simple complaint treated at a retail clinic hurt patients’ chances of receiving preventive care.

Of patients who had their sore throats, ear infections or UTIs treated at a retail clinic, 14 percent got a routine check-up or other preventive service within the next three months. That figure was the same among patients who had gone to a doctor for those problems.

What’s more, retail clinics provided a higher quality of care than hospital emergency rooms, at a far cheaper cost; ER visits averaged $570.

The findings suggest that retail clinics are a reasonable option for simple health problems, Mehrotra said, and they also support past studies showing that NPs generally provide high-quality care.

One of the remaining questions about retail clinics, however, is whether they further fragment an already disjointed U.S. healthcare system, where a patient’s different providers do not necessarily communicate well with each other.

To help guard against this, Mehrotra suggested that retail-clinic patients get a print-out of their visit summary and have the clinic fax the record to their primary care doctor.

He also recommended that people with serious chronic health conditions stick with seeing their primary care provider, even for minor complaints, since he or she will know their medical history.

SOURCE: Annals of Internal Medicine, September 1, 2009.

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SOURCE: Circulation 2009.

NEW YORK (Reuters Health) – If you want to dramatically lower the odds that you’ll die of heart disease, go live someplace where public smoking is banned.

In a study of more than a million people, researchers found that even low levels of smoke from co-workers’ cigarettes can substantially raise your risk of death from heart disease.

While you’re packing to move, look for a place without much pollution, because a second study involving more than 9 million people in 126 counties across the U.S. has shown a direct correlation between the amount of carbon monoxide in the air and daily admissions to emergency rooms for heart problems.

Both studies are reported Monday in the American Heart Association’s medical journal, Circulation.

In the first study, Dr. C. Arden Pope III from Brigham Young University in Arden, Utah and colleagues analyzed data on roughly 1.2 million adults that had been collected over 25 years as part of a study by the American Cancer Society.

“We’ve known for a long time that smoking exposes your lungs to massive amounts” of fine particulates and increases your risk of dying from heart disease, Pope told Reuters Health. Compared to active smoking, the dose of particulates to the lungs with passive smoking is “much, much smaller,” he added.

Even so, earlier studies have suggested surprisingly high rates of heart disease deaths from passive smoking, out of line with the much smaller dose of particulates. So, Pope said, he and his colleagues decided, “We’re going to take the largest data set available” – from the American Cancer Society’s Cancer Prevention Study II – “and look at the effects of different increments of exposure” to smoke and other pollutants on risk.

They discovered, Pope said, that “the biggest increases in risk occur at lighter levels of exposure.”

For example, compared to people who have never smoked, people who smoke up to 3 cigarettes per day increase their risk of dying from heart disease by 65 percent. Doubling or tripling the amount of cigarettes per day doesn’t double or triple the risk, however; instead, for people smoking 8 to 12 cigarettes per day, the risk for heart disease death is increased to “only” 79 percent compared to never-smokers.

People smoking 18 to 22 cigarettes per day — about a pack – have double the risk compared to never smokers.

“Even more amazing,” said Pope, was that compared to people who had never smoked and had no heavy exposure to smokers, passive smokers had a 20 to 30 percent higher risk of heart disease-related deaths. The strongest effect is seen in spouses of smokers.

The research team points out that the relationship between dose of tobacco particulates and the response in terms of increased risk is very steep. “With light exposure, the result is substantial,” Pope said, but with incremental increases in exposure, the increases in risk, while already high, start to rise more gradually.

This means, Pope said, that “while it may do some good to smoke less, by far the biggest benefit is in not smoking at all.” For example, he said, for smokers who are going to cut back by 3 cigarettes per day, the benefit of going from 20 to 17 is not nearly as large as the benefit of going from 3 to zero.

“In some ways, this is good news,” Pope commented. “This adds to the plausibility that passive smoking and air pollution have a substantial effect on health.” Cardiovascular disease is very common, he noted, “so this impacts a lot of people.”

“We could get substantial public health benefits from reducing smoking and reducing passive smoking and exposure to air pollution,” Pope said.

In the second study, Dr. Michelle Bell from Yale University in New Haven, Connecticut and colleagues studied how carbon monoxide levels in the air – mostly from traffic — affect the numbers of people who show up in emergency rooms with heart problems.

They use hospitalization data from Medicare on more than 9.3 million enrollees, and pollution data from air quality monitoring stations in 126 urban counties across the United States where the Medicare recipients live.

The research team found “a positive and statistically significant association” between carbon monoxide levels on any given day and increased risks of hospitalization for a wide variety of heart problems.

Furthermore, this effect was evident even when daily 1-hour maximum carbon monoxide exposure was less than 1 part per million, well within the 35 part per million limit set by US regulatory agencies.

“Although much of the current research on health and traffic-related air pollution focuses on particulate matter, our study indicates that ambient carbon monoxide and traffic may present a far larger health burden than suspected previously,” Bell and her colleagues conclude.

SOURCE: Circulation 2009.

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SOURCE: Journal of the National Cancer Institute, online August 31, 2009.

NEW YORK (Reuters Health) – Adding a clinical breast exam to screening mammography increases breast cancer detection rates, but it also increases rates of falsely positive results, Canadian researchers report in the Journal of the National Cancer Institute.

The high number of “false-positives” is a “steep price” to pay for the potential gains of adding clinical breast examination to mammography, experts not involved with the study contend in a related commentary.

For a theoretical population of 10,000 women, they explain, the addition of clinical breast examination would lead to the detection of breast cancer in only four women whose cancer would be missed by screening mammography.

However, adding clinical breast examination would also lead to false-positive results for an additional 219 women.

There is controversy about whether adding clinical breast examination to mammography improves the accuracy of breast screening.

To investigate, Dr. Anna M. Chiarelli, at the University of Toronto, and fellow researchers

compared the results of breast cancer screening with and without clinical breast exams, which in all cases were done by specially trained nurses.

The study involved 232,515 women who were screened in 2002 or 2003 by both modalities, and 57,715 who had mammography alone in the same time period at centers that did not offer clinical breast exams.

Breast cancer detection rates were higher in mammography centers that offered clinical breast examination in addition to mammography, Chiarelli and colleagues found.

Roughly 7.5 cancers were detected per 1000 women with breast exam and mammography compared with 5.4 cancers without breast exam.

However, the two techniques together also yielded a higher false positive rate compared to mammography alone: 12.5 percent versus 7.4 percent. They also resulted in more referrals for additional testing.

“Women should be informed of the risks and benefits of having a clinical breast examination in addition to mammography for breast screening,” the investigators conclude.

In a related editorial, Dr. Mary B. Barton, at the Agency for Healthcare Research and Quality in Rockville, Maryland, and Dr. Joann G. Elmore of the University of Washington School of Medicine in Seattle, remark that more needs to be known about “the role of clinical breast examination in breast cancer screening before definitive recommendations for or against its use can be made.”

SOURCE: Journal of the National Cancer Institute, online August 31, 2009.

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SOURCE: Neurology, September 1, 2009.

NEW YORK (Reuters Health) – Smoking cigarettes increases the risk of multiple sclerosis (MS), but the substance that makes cigarettes addictive, nicotine, doesn’t seem to be at fault, Swedish researchers say.

While male smokers were 1.8 times as likely to have MS as non-smokers, and MS risk increased 1.4-fold for women who smoked, people who used Swedish snuff were actually less likely to have the disease, Dr. Anna K. Hedstrom of the Karolinska Institutet and her colleagues found.

Unlike the US version of snuff, with Swedish snuff, “there is no spitting involved,” Hedstrom noted in an interview. Users tuck the snuff into their upper lip, and absorb large amounts of nicotine in the process.

“It’s not a healthy thing, it’s better than smoking, but it still has negative effects in the long run,” the researcher added.

Eight out of nine studies investigating smoking and MS risk have found an increased likelihood of developing the disease among smokers, Hedstrom and her colleagues note in the journal Neurology. But only one study looked at “cumulative dose,” or how long and how much people smoked, and MS risk, they add.

To investigate, Hedstrom and her team compared smoking and snuff use among 902 people diagnosed with MS and 1,855 healthy individuals drawn from the general population.

Fifty-seven percent of the MS patients reported being “ever-smokers” in the year before diagnosis, compared to 48 percent of controls at an equivalent point in time.

Overall, “ever-smokers” were 1.5 times more likely to have MS than “never-smokers,” while the risk was 1.6-fold greater for current smokers and 1.4 times greater for past smokers compared with never-smokers.

But for snuff users, risk of MS was 20 percent lower than it was for people who had never used any kind of tobacco. The longer they’d used snuff, the lower their risk; the longer a person smoked, the higher their risk.

It’s not clear why cigarette smoking might boost MS risk, although there are many theories, Hedstrom said. Cyanide is one of the many harmful compounds found in cigarette smoke, she added, and it’s known to damage nerve tissue. Smokers’ greater vulnerability to infections, which have been linked to MS risk, could also be a factor, according to Hedstrom.

As far as any potential benefit of nicotine, the researcher said, it’s possible the chemical may have some protective effect on the nervous system; she noted that some research has linked nicotine use to a reduced risk of Parkinson’s disease.

For now, the findings should help spur smokers to quit, Hedstrom said. In her study, she pointed out, smokers’ MS risk fell sharply within five years of quitting.

Anyone who’s at increased risk of MS — for example, someone with a close relative with the disease — should quit smoking if they do, Hedstrom says. “It would be really beneficial for them.”

SOURCE: Neurology, September 1, 2009.

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