Influence of Pharmaceutical Ads on Healthcare

A study appearing in the October 2012 issue of the Annals of Family Medicine explores the question of how drug companies are influencing both the practice of medicine and the health of patients who seek care from medical providers.

The authors note "Spending on prescription drugs in the Unites States has risen nearly 6-fold since 1990, reflecting substantial increases in treatment of chronic conditions and subsequent polypharmacy (multiple prescriptions). As many as 45% of Americans have at least 1 diagnosed chronic condition, and 60% of the most prescribed medications were for hypertension, high cholesterol levels and diabetes. The Centers for Disease Control and Prevention estimates that 11% of the US population and 40% of people older than age 60 take 5 medications or more." 

The authors focused their review on management of type II diabetes and hypertension, two of the most common chronic health conditions.  The study examined the overwhelming prevalence of prescription drug use in managing these two conditions and focused on the influencing factors more closely.

Factors recognized: 

 

Lower diagnostic thresholds – This mean that more people are diagnosed with a disease they didn't previously have.   

The lowering of fasting glucose (blood sugar) levels from 140 to 126 in 1998 resulted in an additional 10.3 million people being medically defined as diabetics.  Pre diabetes glucose levels were lowered to 100 in 2003 from the previous levels of 110, creating more pre diabetic cases.  

The definition for hypertension (high blood pressure) was lowered in 1993 from a pressure of 160/95 to 140/90 in non-diabetic patients. In 1998, the hypertension level for diabetics was set at 130/80, lower than that of non-diabetics. These two changes created an estimated 22 million additional hypertension diagnoses. The pre hypertension level was also established in 1998 at 120/80. 

Clinician Incentives - Medical doctors are often rewarded for keeping their patients below certain standards based on established guidelines.  

"The committees and organizations setting the standards often have substantial pharmaceutical industry support and include many individuals with industry ties." According to the authors, "many insurance companies assess individual clinicians on the basis of whether their patients meet these standards, often paying substantial bonuses that encourage clinicians to respond to marginal test results with aggressive use of pharmaceuticals."   

The Prescribing Cascade – As most people know, prescription drugs can have adverse impacts on patients.  They can produce symptoms that prompt the prescribing of additional drugs to combat the side effects of the first. 

Two-thirds of patients with diabetes and hypertension reported symptoms which they attributed to their medications, with several patients hospitalized because of symptoms, prompting a medication change.  This study found 89% of the patients "reported taking multiple medications, averaging 4.8 prescriptions with more than half (51%) taking 5 or more." The sad fact is that many of the patients were expected to continue taking these medications "permanently."   

What to Do? 

The authors call for a reform on how much influence the pharmaceutical industry has on the practice of medicine: "At a minimum, we urge policies excluding individuals or organizations with financial conflicts of interest from involvement with guideline-writing panels. They also suggest that physicians "be discouraged from seeing drug representatives."  

So what is the take home from this information? 

We see that chronic illnesses are experienced by 45% of the population.  

These numbers are tremendously high, considering that almost all chronic diseases are due to lifestyle.  Without the proper lifestyle changes, drugs will have little effect on these conditions other than suppressing the symptoms and creating even more problems.  Are we starting to see where part of the problem with our rising healthcare costs are coming from? 

Drug manufacturing is a business, run for profits.  The public is persuaded to believe that these companies have only altruistic intentions; to help the masses be “healthier”.   This is often the furthest thing from the truth.  As we saw in the above study, guideline criteria are often modified to increase the “market pool” for the drugs.

The pharmaceutical industry was a $325 Billion business in the US in 2012.  For years the most profitable business in the U.S. has been the pharmaceutical corporations, which routinely top the annual fortune 500 list. 

An essential part of the pharmaceutical industry’s overwhelming ‘success’ lays in the liaison between the corporations and the ‘symptoms management’ health care industry: The pharmaceutical representative. The men and women we see meeting with physicians, walking into offices with gifts of lunch for the staff, meeting with the doctor while you wait for your appointment.   These individuals are working for their paycheck, not your health. 

As concerned individuals we must take it upon ourselves to regain and maintain our health and well being.  This is the goal at David City Chiropractic; to coach and empower or patients to live healthier and more wellness oriented lives by modifying lifestyle habits from simple postural correction to nutritionally enhancing the body for optimal immunity and hormonal health.  If this sounds interesting to you, contact our office for more information. 

The answer to the nation’s healthcare crisis is not more drugs and technology to treat sick people but fewer people getting sick.

Yours For Better Health,

Dr. Heller

Watermelon's Remarkable Health Benefits

 If you are like me, this is your favorite season of the year.  Not because of the heat and humidity that we enjoy in the Midwest, but because of the abundance of fresh produce available for consumption; especially melons.   Watermelon is one of my favorite treats during the summer heat and now I can feel even better about making a meal out of water melon.

It turns out that this food that appears to be little more than sweet juicy snack in a rind, is actually quite a nutritious food.

Our friends at greenmedinfo.com have written an article based on studies they have reviewed.

*********************************************

Let Fruit Be Your Medicine: Watermelon's Remarkable Health Benefits

Written By: Sayer Ji, Founder

Watermelon is so much more than just a highly refreshing summertime treat. From the perspective of a growing body of clinical research, it is a truly medicinal food.
Only this month, research published in the Journal of Agricultural and Food Chemistry found watermelon juice is an effective remedy for reducing the recovery heart rate and muscle soreness in athletes who were given 500 ml of watermelon juice (16.9 oz) containing 1.17 grams of the naturally occurring amino acid L-citrulline.[1]

Additional research indicates watermelon may possess the following health benefits:

• Boosting Your Antioxidant Levels: Watermelon is exceptionally rich in lycopene (hence its red color) and other carotenoids such as lutein and beta carotene.[2] A 2003 study published in the Journal of Nutrition found that regular watermelon juice consumption resulted in significant increases in blood plasma concentrations of lycopene and beta carotene.[3] Keep in mind that lycopene has been found to have over 40 potential health benefits, and beta carotene (especially in its natural, food-complexed form) equally plentiful health benefits, adding extra significance to this finding. Also, the watermelon-induced increase in plasma antioxidant levels may lend explanation to why an epidemiological study of the Chinese found greater watermelon intake to be associated with a lower risk of cancer.[4]
  
  
• Reducing Blood Pressure/Improving Arterial Health: A 2012 study published in the American Journal of Hypertension found that middle-aged obese subjects with prehypertension or stage 1 hypertension who were given 6 weeks of treatment with a watermelon extract containing 6 grams of L-citrulline and L-arginine daily, experienced reduced ankle blood pressure and altered carotid wave reflection, an indication of improved arterial function.[5] The inability of the blood vessels to dilate and function properly is known as endothelial dysfunction, and is likely the most well-known initiating step in the pathogenesis of atherosclerosis. If watermelon can ameliorate or reverse this process, it would certainly provide a breakthrough alternative to many of the drugs used for primary prevention, such as the cholesterol-lowering statin drug class, whose side effects, numbering in the hundreds, include heart muscle dysfunction and damage.
  
  
• Increasing Plasma Arginine Concentrations: A 2007 study published in the journal Nutrition found that watermelon juice consumption increases plasma arginine concentrations in adults, proving that the L-citrulline from this plant origin was effectively converted into arginine. This is a highly significant finding because arginine has a great number of health benefits, especially for ameliorating the aforementioned cardiovascular problem known as endothelial dysfunction. There are at least 20 studies in the biomedical literature documenting its therapeutic role in improving endothelial dysfunction, but you can view over 150 potential health benefits of arginine on the GreenMedInfo database.
  
• Combatting Metabolic Syndrome: A promising preclinical study published in the Journal of Nutrition in 2007 found that watermelon pomace, a rich source of L-citrulline, significantly improved metabolic syndrome in diabetic, overweight rats.[6] This study is of particular interest because it lends support to relatively new research showing that fruit consumption is not harmful for type 2 diabetics.[7] The new study results were described as follows: " These results provide the first evidence to our knowledge for a beneficial effect of watermelon pomace juice as a functional food for increasing arginine availability, reducing serum concentrations of cardiovascular risk factors, improving glycemic control, and ameliorating vascular dysfunction in obese animals with type-II diabetes."
  
  
• Watermelon Seeds, a Rich Source of Protein:  It behooves us to mention the fact that all parts of the watermelon have something to offer. The seeds, in fact, are an excellent source of protein. A 2011 study published in the Journal of Cancer Research and Clinical Oncology found that "The good nutritional and functional properties of watermelon seed meal proteins suggest their potential use in food formulations."[8]  While seedless watermelon are far more convenient to eat, keep in mind that they can not reproduce without human intervention and so there are several good reasons to choose seedless varieties.

So, next time you are in the mood for watermelon, and are concerned about its notorious sugar content, 'weight-promoting effects,' and therefore possible diabetogenic and cardiotoxic properties – think again. Quality and moderation are the only things to make sure you are careful about when deciding to consume watermelon. Otherwise, enjoy it (remember Vitamin P(leasure))and know that it may just be as good for you as it tastes.

************************************

So enjoy the summer, enjoy your watermelon, and as always, enjoy your best possible health; naturally.

Yours for better health,

Dr. Heller

---

[1] Martha Patricia Tarazona-Díaz, Fernando Alacid, María Carrasco, Ignacio Martínez, Encarna Aguayo. Watermelon Juice: A Potential Functional Drink for Sore Muscle Relief in Athletes.J Agric Food Chem. 2013 Jul 17. Epub 2013 Jul 17. PMID: 23862566

[2] U G Chandrika, K S S P Fernando, K K D S Ranaweera. Carotenoid content and in vitro bioaccessibility of lycopene from guava (Psidium guajava) and watermelon (Citrullus lanatus) by high-performance liquid chromatography diode array detection. Int J Food Sci Nutr. 2009 Nov;60(7):558-66. PMID: 19817635

[3] Alison J Edwards, Bryan T Vinyard, Eugene R Wiley, Ellen D Brown, Julie K Collins, Penelope Perkins-Veazie, Robert A Baker, Beverly A Clevidence. Consumption of watermelon juice increases plasma concentrations of lycopene and beta-carotene in humans. J Nutr. 2003 Apr;133(4):1043-50. PMID: 12672916

[4] Cai-Xia Zhang, Suzanne C Ho, Yu-Ming Chen, Jian-Hua Fu, Shou-Zhen Cheng, Fang-Yu Lin.Greater vegetable and fruit intake is associated with a lower risk of breast cancer among Chinese women. Int J Cancer. 2009 Jul 1;125(1):181-8. PMID: 19358284

[5] Arturo Figueroa, Marcos A Sanchez-Gonzalez, Alexei Wong, Bahram H Arjmandi. Watermelon Extract Supplementation Reduces Ankle Blood Pressure and Carotid Augmentation Index in Obese Adults With Prehypertension or Hypertension. Am J Hypertens. 2012 Mar 8. Epub 2012 Mar 8. PMID: 22402472

[6] Guoyao Wu, Julie K Collins, Penelope Perkins-Veazie, Muhammad Siddiq, Kirk D Dolan, Katherine A Kelly, Cristine L Heaps, Cynthia J Meininger. Dietary supplementation with watermelon pomace juice enhances arginine availability and ameliorates the metabolic syndrome in Zucker diabetic fatty rats. J Nutr. 2007 Dec;137(12):2680-5. PMID: 18029483

[7] Christensen AS, Viggers L, Hasselström K, Gregersen S. Effect of fruit restriction on glycemic control in patients with type 2 diabetes--a randomized trial. Nutr J. 2013 Mar 5;12:29.

[8] Ali Abas Wani, Dalbir Singh Sogi, Preeti Singh, Idrees Ahmed Wani, Uma S Shivhare.Characterisation and functional properties of watermelon (Citrullus lanatus) seed proteins. J Cancer Res Clin Oncol. 2011 Feb;137(2):279-86. Epub 2010 Apr 18. PMID:20824684

Another Good Reason To Avoid Refined Carbohydrates

When watching our weight we can often joke about being "addicted" to sweets, cakes and pastries.  It turns out, that comment may not be as far from the truth as you may have thought.

A new study published in the American Journal of Clinical Nutrition and reported in Medscape.com finds that the consumption of refined carbohydrates increases the blood flow to the area of the brain that relates to addictions and can literally alter the activity of the brain.

This also helps explain why fast food and soft drink industry finds the addition of sugar to their products so profitable.

Refined Carbs May Trigger Food Addiction

Kathleen Louden

www.medscape.com    Jul 02, 2013

Consumption of a meal that has a high glycemic index (GI) appears to stimulate key brain regions related to craving and reward, a finding that supports the controversial hypothesis of food addiction, new research suggests.

Investigators from Boston Children's Hospital in Massachusetts found that compared with consumption of a low-GI meal, a meal high in refined carbohydrates decreased plasma glucose, increased hunger, and selectively stimulated brain regions 4 hours after eating — a critical time point that influences eating behavior at the next meal.

"We think we have shown for the first time that refined carbohydrates' biological effects can provoke, independent of calories and tastiness, symptoms related to addiction in susceptible people — those who are overweight or obese," said the study's principal investigator, David Ludwig, MD, from Boston Children's Hospital.

Dr. Ludwig, director of the hospital's New Balance Foundation Obesity Prevention Center, told Medscape Medical News that his team's preliminary findings support "the notion of food addiction [which] is very controversial because, unlike drugs of addiction, we have to eat to survive."

Craving Carbs
 
He said the randomized, blinded, crossover study in 12 overweight or obese men had several strengths over previous studies whose findings also suggested that certain tasty foods might be addictive.

"Prior studies, best described as observational, tended to compare vastly different foods, such as cheesecake and boiled vegetables," he said.
 
In the new study, participants aged 18 to 35 years consumed, in a randomized order on test days 2 to 8 weeks apart, 2 test milkshakes that had similar ingredients, calories (500 kcal), appearance, taste, and smell.
Participants were not aware which was the low-GI meal (37%) with slow-acting carbohydrate and which was the high-GI meal (84%) with fast-acting carbohydrate, and they reported no preference for either meal.
Additionally, the investigators monitored participants 4 hours after the meal, when the individuals likely would be considering what to eat at their next meal. At that time, participants underwent a final blood glucose test and neuroimaging, and rated their hunger levels.

After eating the high-GI meal, participants initially had a surge in blood glucose level that was 2.4-fold higher than after the low-GI meal, followed by a crash in blood glucose at 4 hours, the authors reported. They also reported excessive hunger 4 hours after the high-GI meal, Dr. Ludwig said.

The investigators looked directly at participants' cerebral blood flow, as a measure of resting brain activity, using arterial spin labeling functional magnetic resonance imaging (fMRI), which allowed them to examine persistent effects of test meals.

"Every single subject showed intense activation in the nucleus accumbens, the area of the brain related to addiction," he said.

The results show that highly processed carbohydrates, such as white bread, potatoes, and concentrated sugar, "alter brain activity in ways that make us crave them even more," he said.

Clear Take-Home Message
 
Dr. Ludwig stated that the study must be repeated in larger numbers of persons, in a more diverse population, and before and after weight gain. Yet he said that the initial results send a clear take-home message: "Avoiding highly processed carbohydrates could help overweight people avoid overeating."

Mark Gold, MD, a longtime researcher in the area of food and addiction, from the McKnight Brain Institute of the University of Florida (UF), Gainesville, said it is important that clinical research tests the food addiction hypothesis first generated by laboratory researchers.

Asked by Medscape Medical News to comment on the findings, Dr. Gold, who was not involved with the study, said that the brain imaging test the researchers used "is exceptional and provides additional strong evidence that manufactured foods, sugar, and fats can interact with the brain and systems that [also] are hijacked by drugs of abuse."

"Hedonic overeating...makes more sense with clinical research like this," Dr. Gold, who is professor and chair of psychiatry at UF College of Medicine, concluded.

This study was funded by the National Institutes of Health and the National Center for Research Resources, Bethesda, Maryland; the Pediatric Endocrine Society, McLean, Virginia; the Endocrine Fellows Foundation, Washington, DC; and the New Balance Foundation, Boston, Massachusetts. Dr. Ludwig and Dr. Gold have reported no relevant financial relationships.
Am J Clin Nutr. Published online June 26, 2013. Abstract

*************************************************

 
So, beware of snacks and drinks high in sugar and refined carbohydrates.

For your better health,

Dr. Heller

Walking For Health

Another article from our friends at thePowerofpositivehabits.com discussing the health benefits of brisk walking. *************************************************************   Benefits of Brisk Walking By Dan Robey "Not running, not jogging, but walking is your most efficient exercise and the only one you can safely follow all the years of your life." – Executive Health Organization Walking as a daily exercise habit can truly be a life-changing positive habit and is one of the most powerful habits for reaching your goal of a healthy trim and fit body. Over the past 20 years, there have been dozens of studies that have proven the benefits of brisk walking. Thousands upon thousands of people have improved their health and lost weight by the diligent habit of walking. If you think that walking does not provide the same benefits as other more vigorous exercises, think again. A study published by the New England Journal Of Medicine showed that postmenopausal women who walked regularly lowered their risk for heart disease just as much as women who did more vigorous exercise, such as playing sports or running. This study suggests that walking is just as good for your heart as heavy exercise. I spoke with study author Dr. JoAnn E. Manson, Chief of Preventive Medicine at Brigham and Womens Hospital, Professor of Medicine, at Harvard Medical School. She said, “The study provides compelling evidence that walking and vigorous exercise provide similar heart benefits, about a 30% to 40% reduction in the risk of cardiovascular disease with 30 minutes per day of either activity.” I also asked her about the benefits of making brisk walking a positive habit, and she responded, “they could surely walk away from heart disease and several other chronic diseases. We have also found that brisk walking for at least 3 hours a week can lower the risk of stroke, type 2 diabetes, and breast cancer. No pain, no gain, is an outdated notion; exercise doesn’t need to be strenuous or uncomfortable. It can be easy and enjoyable.” Even though the study consisted solely of women, it is likely that men would experience similar benefits from the positive habit of brisk walking. Here are additional benefits you will receive from your habit of brisk walking: * Walking burns calories and helps you lose weight and burn excess body fat. * Walking can help to improve your posture. * Walking requires no special equipment or gyms. * Walking can help lower blood pressure and help prevent circulatory and heart disorders. * Brisk, aerobic walking will give you the benefits of other exercises, such as jogging and cycling, but without the risk of injuries. * Walking at night can help promote better sleep. ***************************************************************   So get out and walk during the summer evenings.  Your body will thank you for it.   For your better health, Dr. Heller