Sunday, November 14, 2010
NASH on the Road
Since Labor Day 2010 I have been traveling back and forth across our nation discussing all aspects of Health Reform---from the impact on quality and safety to the implementation of an Accountable Care Organization. I have found most persons to be very confused about this complex legislation. I have also found that Academic Medical Centers are racing to comply with ACO legislation with little understanding as to the core cultural elements.AMCs need to recognize that "accountability" is a significant challenge---it calls for a sweeping change of our culture.It means we must all self evaluate and measure the outcomes of our work together. It means that subspecialists will see their incomes slightly diminish and that primary care docs will see a modest increase.It means a willingness to practice based on protocols and the best available evidence, where it even exists. Finally, it means we must also change the training paradigm to reflect these new realities. This is a tall order indeed.From the Kansas Hospital Association, to Allina Health, to Spectrum Health, to Texas Health Resources, to Adventist Health, to Temple Medical School, my message has been consistent----it is all about changing the culture of practice!! On another note, be sure to tune in to WHYY as the hit show "Marketplace" will be coming to Philadelphia on Friday night November 19th to focus on the new empowered patient.I have been asked to be one of three panelists on this national show. More news to follow.....DAVID NASH
Friday, November 12, 2010
Winterize Your Washes!
1. Wash less often
Rather than washing 2x a week, try washing 1x a week. Rather than washing weekly, try washing biweekly. Opt for a dry shampoo in between washes.
2. Add oils to your shampoo
Some have minimized the drying effects of shampoo by adding a little oil. Recommended oils: olive, jojoba, grapeseed, safflower, or castor oil.
3. Pre-poo with oils and/or conditioner
Before washing your hair, pre-poo (i.e., pretreat) with a concoction of oils and/or your favorite conditioner. Allow the mix to sit on your hair for at least 20 minutes. Then proceed to wash as usual. Recommended oils: olive, coconut, castor, or soybean oil.
4. Focus on the roots and scalp rather than the strands
While cleansing the hair, apply shampoo to your roots only. Massage your roots and scalp then rinse. Allow the water (mixed with shampoo) to run through your strands.
5. And, of course, follow up with a good conditioner
A "good" conditioner is one that helps to retain the moisture in your hair. (Optional: a "good" conditioner will also strengthen the hair.)
6. Speaking of winter - Dry hair completely before ...
Going outside. Freezing cold weather + wet hair = not a good outcome. Let your hair dry completely before opening the door.
Other tips: dilute your shampoo, perform your final rinse with cold water, use a shampoo created for dry hair
Thursday, November 11, 2010
Guest Commentary: The Controversy Surrounding Health Technology Assessment
Sangtaeck Lim, MPH
Health Economics & Outcomes Research Fellow
Jefferson School of Population Health
Anthony Culyer, a professor of Economics at University of York, started his speech at the annual meeting of Society for Medical Decision Making on October 25th in Toronto by using an interesting analogy between the medieval map and heath technology assessment (HTA). He said “in the wonderful medieval map, there was an unexplained territory, Hic Sunt Dracones, around the edge, which nobody was sure about, and terrifying figures like dragons were out there. I see the similarity between this medieval map and HTA.” The audience chuckled.
Three keynote speakers at the meeting – Daniel Callahan, a philosopher in biomedical ethics and President Emeritus at the Hastings Center, Paul Glasziou, a director of the Center for Evidence-based Medicine at the University of Oxford, and Tony Culyer – shared their perspectives on the recent political turmoil around HTA. They talked about the research community’s recent struggles in building ethically acceptable and methodologically objective studies in the HTA realm.
Dr. Callahan ignited the debate by mentioning the recent controversy over the government’s recommendation that women in their 40s forego routine mammograms. He stated his belief that furious reactions from interest groups and the public were not only due to the ethical concerns, such as government’s interference over sacred doctor-patient relationship or individual’s freedom of choice, but also the fundamental mistrust in HTA research evidence.
Professor Culyer attributed this mistrust to two main “dragons” (factors the researchers are uncomfortable with) in the map of HTA: processes for (1) combining different types of evidence and (2) embodying equity concerns. To address these problems, he stressed that the research process be carried out transparently and researchers have ethical confidence that the final outcomes represent the best evidence, and the best experts, and that all the resources were used appropriately.
On the other hand, Paul Glasziou questioned if there has been overuse of HTA, which along with “dragons” increased public mistrust towards HTA. He pointed out that most technologies were simply no better than the existing ones. “For example, the simple mother’s kiss technique for removing foreign bodies from her baby’s nostril is no worse than any kind of current high-tech surgery. For some technologies like that, randomized trials or HTA are not even necessary.”
As a researcher, I do agree the recent public mistrust or uproar toward HTA has resulted from some researchers’ “sloppy” evidence generation and natural lag between new technology and the researcher’s understanding of it. But also as a former journalist, I believe it is a researcher’s duty to convey the new idea to the public in the plainest language and with the most transparent evidence.
Nonetheless, the tension between researchers and the public will continue as long as innovative technologies are being developed. Likewise HTA will certainly continue to struggle and be put to the test in the future. As Professor Cuyler appropriately used it in his speech, I would like to quote the former Labor Health minister in England, Frank Dobson’s line for researchers not to be too discouraged while pursuing the success of HTA:
“Probably not, but it’s worth a bloody good try.”
Monday, November 8, 2010
High-heat cooking will AGE you, if you eat food deep-fried with industrial vegetable oils
As I said before on this blog, I am yet to be convinced that grilled meat is truly unhealthy in the absence of leaky gut problems. I am referring here to high heat cooking-induced Maillard reactions (browning) and the resulting advanced glycation endproducts (AGEs). Whenever you cook a food in high heat, to the point of browning it, you generate a Maillard reaction. Searing and roasting meat usually leads to that.
Elevated levels of serum AGEs presumably accelerate the aging process in humans. This is supported by research with uncontrolled diabetics, who seem to have elevated levels of serum AGEs. In fact, a widely used measure in the treatment of diabetes, the HbA1c (or percentage of glycated hemoglobin), is actually a measure of endogenous AGE formation. (Endogenous = generated by our own bodies.)
Still, evidence that a person with an uncompromised gut can cause serum levels of AGEs to go up significantly by eating AGEs is weak, and evidence that any related serum AGE increases lead the average person to develop health problems is pretty much nonexistent. The human body can handle AGEs, as long as their concentration is not too high. We cannot forget that a healthy HbA1c in humans is about 5 percent; meaning that AGEs are created and dealt with by our bodies. A healthy HbA1c in humans is not 0 percent.
Thanks again to Justin for sending me the full text version of the Birlouez-Aragon et al. (2010) article, which is partially reviewed here. See this post and the comments under it for some background on this discussion. The article is unequivocally titled: “A diet based on high-heat-treated foods promotes risk factors for diabetes mellitus and cardiovascular diseases.”
This article is recent, and has already been cited by news agencies and bloggers as providing “definitive” evidence that high-heat cooking is bad for one’s health. Interestingly, quite a few of those citations are in connection with high-heat cooking of meat, which is not even the focus of the article.
In fact, the Birlouez-Aragon et al. (2010) article provides no evidence that high-heat cooking of meat leads to AGEing in humans. If anything, the article points at the use of industrial vegetable oils for cooking as the main problem. And we know already that industrial vegetable oils are not healthy, whether you cook with them or drink them cold by the tablespoon.
But there are a number of good things about this article. For example, the authors summarize past research on AGEs. They focus on MRPs, which are “Maillard reaction products”. One of the summary statements supports what I have said on this blog before:
"The few human intervention trials […] that reported on health effects of dietary MRPs have all focused on patients with diabetes or renal failure."
That is, there is no evidence from human studies that dietary AGEs cause health problems outside the context of preexisting conditions that themselves seem to be associated with endogenous AGE production. To that I would add that gut permeability may also be a problem, as in celiacs ingesting large amounts of AGEs.
As you can see from the quote below, the authors decided to focus their investigation on a particular type of AGE, namely CML or carboxymethyllysine.
"...we decided to specifically quantify CML, as a well-accepted MRP indicator ..."
As I noted in my comments under this post (the oven roasted pork tenderloin post), one particular type of diet seems to lead to high serum CML levels – a vegetarian diet.
So let us see what the authors studied:
"... we conducted a randomized, crossover, intervention trial to clarify whether a habitual diet containing high-heat-treated foods, such as deep-fried potatoes, cookies, brown crusted bread, or fried meat, could promote risk factors of type 2 diabetes or cardiovascular diseases in healthy people."
Well, “deep-fried potatoes” is a red flag, don’t you think? They don’t say what oil was used for deep-frying, but I bet it was not coconut or olive oil. Cheap industrial vegetable oils (corn, safflower etc.) are the ones normally used (and re-used) for deep-frying. This is in part because these oils are cheap, and in part because they have high “smoke points” (the temperature at which the oil begins to generate smoke).
Let us see what else the authors say about the dietary conditions they compared:
"The STD was prepared by using conventional techniques such as grilling, frying, and roasting and contained industrial food known to be highly cooked, such as extruded corn flakes, coffee, dry cookies, and well-baked bread with brown crust. In contrast, the STMD comprised some raw food and foods that were cooked with steam techniques only. In addition, convenience products were chosen according to the minimal process applied (ie, steamed corn flakes, tea, sponge cakes, and mildly baked bread) ..."
The STD diet was the one with high-heat preparation of foods; in the STMD diet the foods were all steam-cooked at relatively low temperatures. Clearly these diets were mostly of plant-based foods, and of the unhealthy kind!
The following quote, from the results, pretty much tells us that the high omega-6 content of industrial oils used for deep frying was likely to be a major confounder, if not the main culprit:
"... substantial differences in the plasma fatty acid profile with higher plasma concentrations of long-chain omega-3 fatty acids […] and lower concentrations of omega-6 fatty acids […] were analyzed in the STMD group compared with in the STD group."
That is, the high-heat cooking group had higher plasma concentrations of omega-6 fats, which is what you would expect from a group consuming a large amount of industrial vegetable oils. One single tablespoon per day is already a large amount; these folks were probably consuming more than that.
Perhaps a better title for this study would have been: “A diet based on foods deep-fried in industrial vegetable oils promotes risk factors for diabetes mellitus and cardiovascular diseases.”
This study doesn’t even get close to indicting charred meat as a major source of serum AGEs. But it is not an exception among studies that many claim to do so.
Reference
H Birlouez-Aragon, I., Saavedra, G., Tessier, F.J., Galinier, A., Ait-Ameur, L., Lacoste, F., Niamba, C.-N., Alt, N., Somoza, V., & Lecerf, J.-M. (2010). A diet based on high-heat-treated foods promotes risk factors for diabetes mellitus and cardiovascular diseases. The American Journal of Clinical Nutrition, 91(5), 1220-1226.
Elevated levels of serum AGEs presumably accelerate the aging process in humans. This is supported by research with uncontrolled diabetics, who seem to have elevated levels of serum AGEs. In fact, a widely used measure in the treatment of diabetes, the HbA1c (or percentage of glycated hemoglobin), is actually a measure of endogenous AGE formation. (Endogenous = generated by our own bodies.)
Still, evidence that a person with an uncompromised gut can cause serum levels of AGEs to go up significantly by eating AGEs is weak, and evidence that any related serum AGE increases lead the average person to develop health problems is pretty much nonexistent. The human body can handle AGEs, as long as their concentration is not too high. We cannot forget that a healthy HbA1c in humans is about 5 percent; meaning that AGEs are created and dealt with by our bodies. A healthy HbA1c in humans is not 0 percent.
Thanks again to Justin for sending me the full text version of the Birlouez-Aragon et al. (2010) article, which is partially reviewed here. See this post and the comments under it for some background on this discussion. The article is unequivocally titled: “A diet based on high-heat-treated foods promotes risk factors for diabetes mellitus and cardiovascular diseases.”
This article is recent, and has already been cited by news agencies and bloggers as providing “definitive” evidence that high-heat cooking is bad for one’s health. Interestingly, quite a few of those citations are in connection with high-heat cooking of meat, which is not even the focus of the article.
In fact, the Birlouez-Aragon et al. (2010) article provides no evidence that high-heat cooking of meat leads to AGEing in humans. If anything, the article points at the use of industrial vegetable oils for cooking as the main problem. And we know already that industrial vegetable oils are not healthy, whether you cook with them or drink them cold by the tablespoon.
But there are a number of good things about this article. For example, the authors summarize past research on AGEs. They focus on MRPs, which are “Maillard reaction products”. One of the summary statements supports what I have said on this blog before:
"The few human intervention trials […] that reported on health effects of dietary MRPs have all focused on patients with diabetes or renal failure."
That is, there is no evidence from human studies that dietary AGEs cause health problems outside the context of preexisting conditions that themselves seem to be associated with endogenous AGE production. To that I would add that gut permeability may also be a problem, as in celiacs ingesting large amounts of AGEs.
As you can see from the quote below, the authors decided to focus their investigation on a particular type of AGE, namely CML or carboxymethyllysine.
"...we decided to specifically quantify CML, as a well-accepted MRP indicator ..."
As I noted in my comments under this post (the oven roasted pork tenderloin post), one particular type of diet seems to lead to high serum CML levels – a vegetarian diet.
So let us see what the authors studied:
"... we conducted a randomized, crossover, intervention trial to clarify whether a habitual diet containing high-heat-treated foods, such as deep-fried potatoes, cookies, brown crusted bread, or fried meat, could promote risk factors of type 2 diabetes or cardiovascular diseases in healthy people."
Well, “deep-fried potatoes” is a red flag, don’t you think? They don’t say what oil was used for deep-frying, but I bet it was not coconut or olive oil. Cheap industrial vegetable oils (corn, safflower etc.) are the ones normally used (and re-used) for deep-frying. This is in part because these oils are cheap, and in part because they have high “smoke points” (the temperature at which the oil begins to generate smoke).
Let us see what else the authors say about the dietary conditions they compared:
"The STD was prepared by using conventional techniques such as grilling, frying, and roasting and contained industrial food known to be highly cooked, such as extruded corn flakes, coffee, dry cookies, and well-baked bread with brown crust. In contrast, the STMD comprised some raw food and foods that were cooked with steam techniques only. In addition, convenience products were chosen according to the minimal process applied (ie, steamed corn flakes, tea, sponge cakes, and mildly baked bread) ..."
The STD diet was the one with high-heat preparation of foods; in the STMD diet the foods were all steam-cooked at relatively low temperatures. Clearly these diets were mostly of plant-based foods, and of the unhealthy kind!
The following quote, from the results, pretty much tells us that the high omega-6 content of industrial oils used for deep frying was likely to be a major confounder, if not the main culprit:
"... substantial differences in the plasma fatty acid profile with higher plasma concentrations of long-chain omega-3 fatty acids […] and lower concentrations of omega-6 fatty acids […] were analyzed in the STMD group compared with in the STD group."
That is, the high-heat cooking group had higher plasma concentrations of omega-6 fats, which is what you would expect from a group consuming a large amount of industrial vegetable oils. One single tablespoon per day is already a large amount; these folks were probably consuming more than that.
Perhaps a better title for this study would have been: “A diet based on foods deep-fried in industrial vegetable oils promotes risk factors for diabetes mellitus and cardiovascular diseases.”
This study doesn’t even get close to indicting charred meat as a major source of serum AGEs. But it is not an exception among studies that many claim to do so.
Reference
H Birlouez-Aragon, I., Saavedra, G., Tessier, F.J., Galinier, A., Ait-Ameur, L., Lacoste, F., Niamba, C.-N., Alt, N., Somoza, V., & Lecerf, J.-M. (2010). A diet based on high-heat-treated foods promotes risk factors for diabetes mellitus and cardiovascular diseases. The American Journal of Clinical Nutrition, 91(5), 1220-1226.
Friday, November 5, 2010
Twist Series: Frizz and Knots
- Do you have alot of shorter strands of hair that contribute to the frizzy look? I noticed that I have alot at the top and middle of my head and was wondering if that is natural or if something is wrong since to me it seems to be increasing in number!
On the other hand, if the short strands are prevalent or increasing in number, then that is not a good sign and may be the result of breakage or other issues. Try manipulating the hair less and handling it gentler.
- Second, does having alot of single strand knots at the ends of my hair mean its definitely time for a trim?
- Since you mostly keep your hair in twists, are single strand knots a big issue for you?
Someone once asked why I don't dip my ends in water to make them re-curl after twisting. SSKs is why. I find that if the ends of my hair shrink up, SSKs are more likely to form.
Label of the Day: Skin Care!
Here are some posts on "Skin Care" in case you've missed them:
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| {image source} |
2. Fall & Dry Skin ... Rescue Me, Shea
3. Nail Health 101
4. Natural Blemish Lighteners
5. Household Makeup Removers
6. Sugar, Acne, and Skin Care Recap!
7. Hyperpigmentation in Black Skin
8. Kojic Acid: Natural Alternative against Hyperpigmentation
9. Building a Skin Care Regimen
10. Natural Skin Care ... On a Budget
Thursday, November 4, 2010
Guest Commentary: Highlights from the 4th Annual Schweitzer Fellows for Life Conference
Nicole Cobb Moore, MA
Program Director
Greater Philadelphia Schweitzer Fellows Program
Project Manager
Jefferson School of Population Health
In mid-October 2010, The Albert Schweitzer Fellowship held its 4th annual Schweitzer Fellows for Life conference in Baltimore, Maryland. The conference brought together current Fellows, Fellows for Life, local Program Directors, National Advisory Board members, funders and like-minded individuals wanting to serve the community.
During the keynote speech, 100+ attendees were inspired by CNN Hero Wynona Ward, who is also a 1996 Schweitzer Fellow for Life and a victim of domestic violence. Ms. Ward, the founder of Have Justice Will Travel, currently runs a mobile domestic violence assistance program in rural Vermont. She exemplifies the importance of service and hopes to end the generational cycle of abuse that is experienced throughout the world.
Current Schweitzer Fellow Jillian Heck, a medical student at Philadelphia College of Osteopathic Medicine, had this to share: 'The keynote address by Wynona Ward was an incredibly moving experience. Her story was so heartbreaking, yet so much good has come from it. It does, however, make me wonder how many stories will end differently. Until then, we must hope, pray and bring awareness to the issue of domestic violence.'
The conference included breakout sessions that afforded attendees the opportunity to engage in presentations and conversations ranging from Health Care Reform 2010: Policies and Objectives to The Ethics of Service: Stories from the Front Line. Greater Philadelphia Fellows mentioned that they were inspired and extremely moved to continue to strengthen their current local Schweitzer projects.
Current Schweitzer Fellow Melissa Warriner, a Jefferson physical therapy doctoral student, had this to share: 'It was interesting to learn about an initiative at Johns Hopkins University, where they are able to provide care at a more accessible rate for the underserved population in the Baltimore area. Learning about such models was really useful so that hopefully more hospitals will be able to provide similar options to the underserved population in their areas. As healthcare costs continue to rise, networking opportunities like these are important to provide resources and contacts to hopefully make these initiatives a reality in other neighboring cities.'
The concluding event of the conference was the Schweitzer Prize for Humanitarianism, which was given to Jack Geiger, M Sci Hyg. Dr. Geiger initiated the community health center model in the U.S., combining community–oriented primary care; public health interventions; and civil rights, community empowerment, and development initiatives. Dr. Geiger was unable to attend in person, but shared his message via pre-recorded video.
'Example is not the main thing in influencing others. It is the only thing.' ~ Albert Schweitzer
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