The Daily HIT

Night shift workers are among those most affected.

From MedPage:

Your mother was right: regular bedtimes and a good night’s sleep are good for you — or at least, researchers reported, irregular bedtimes and not enough sleep are bad for you.

In a 39-day experiment with healthy volunteers, shortened sleep time and varying bedtimes — meant to mimic shift work — led to impaired glucose regulation and metabolism, according to Orfeu Buxton, PhD, of Brigham and Women’s Hospital in Boston, and colleagues.

Over time, the observed changes could increase the risk of obesity and diabetes, Buxton and colleagues reported online in Science Translational Medicine.

The findings support epidemiological studies linking disrupted sleep with an increased risk of metabolic syndrome and diabetes, the researchers noted — especially in workers on the night shift.

 

This is a very difficult policy to implement as long as doctors and hospitals continue to be paid more when they perform more procedures. Radiology departments are major profit centers for hospitals and other health care facilities.

To see major medical groups such as the American Board of Internal Medicine endorse this policy is heartening. I would add that my profession, chiropractic, has made major changes along these lines within our educational institutions over the last decade. Student interns cannot routinely x-ray patients; for imaging studies to be approved, specific guidelines (such as the Canadian Cervical Spine Rule) must be followed.

Nine national medical groups are launching a campaign called Choosing Wisely to get U.S. doctors to back off on 45 diagnostic tests, procedures and treatments that often may do patients no good.

Many involve imaging tests such as CT scans, MRIs and X-rays. Stop doing them, the groups say, for most cases of back pain, or on patients who come into the emergency room with a headache or after a fainting spell, or just because somebody’s about to undergo surgery.

…

The Choosing Wisely project was launched last year by the foundation of the American Board of Internal Medicine. It recruited nine medical specialty societies representing more than 376,000 physicians to come up with five common tests or procedures “whose necessity … should be questioned and discussed.”

The groups represent family physicians, cardiologists, radiologists, gastroenterologists, oncologists, kidney specialists and specialists in allergy, asthma and immunology and nuclear cardiology.

Eight more specialty groups will join the campaign this fall, representing hospice doctors, head and neck specialists, arthritis doctors, geriatricians, pathologists, hospital practitioners, nuclear medicine specialist and those who perform a heart test called echocardiography.

Consumer groups are involved, too. Led by Consumer Reports, they include the AARP, National Business Coalition on Health, the Wikipedia community and eight others.

The effort represents a growing sense that there’s a lot of waste in U.S. health care, and that many tests and treatments are not only unnecessary but harmful.

Harvard economist David Cutler estimates that a third of what this country spends on health care could safely be dispensed with.

Cross-posted from my health policy blog, www.redwoodhealthspeak.com.

This new research confirms what was strongly suggested by earlier studies — that bariatric surgery leads to major weight loss, and either directly or indirectly leads to major improvements in the diabetic status of these formerly obese individuals.

I’ve lectured on this topic in my clinical nutrition class and it generally stimulates fruitful class dicsussion. Essentially, we’re looking at a dangerous condition that is almost entirely preventable through diet and exercise. We then see tens of millions of people failing at prevention and then finding themselves in a terrible situation. Once they’ve reached that point, this surgery clearly leads to much improved outcomes. It’s a classic example of radical measures being offered at a late stage for something that should never have reached that point.

It concerns me that we are now seeing, for what to my knowledge is the first time, a serious suggestion that bariatric surgery be provided to diabetics who are even slightly overweight. Again, where is the prevention?

The following quotes are from the National Public Radio coverage of the story, which I’m citing because unlike the MedPage story cited above, this one mentions recommending this surgery for diabetics with a Body Mass Index as low as 26, which is just barely overweight. (Obesity starts at a BMI of 30, and morbid obesity, which is usually when bariatric surgery is provided, starts at a BMI of 40).

This research raises an important question: Should diabetics start getting this operation more often? Paul Zimmet of the International Diabetes Federation, who co-authored an editorial accompanying the studies, thinks they should.

“Diabetes coupled with obesity is probably the largest epidemic in human history. At the moment, bariatric surgery is seen as a last resort. And it should be offered earlier in management,” Zimmet said in a telephone interview.

But others aren’t so sure. The new studies followed only about 200 patients. And while the operations appear to be pretty safe, there can be complications. And the complications can be serious.

“I think we need longer-term follow-up than what was done in these studies to make sure you’re not trading one problem for another,” said Vivian Fonseca of the American Diabetes Association.

…

Researchers are now testing whether the surgery works on diabetics who aren’t even obese — people with BMIs as low as 26. And doctors and patients are waiting to see if insurance companies will pay for the operations just to treat diabetes.

Earlier this year, I attended (and spoke) at a U.S. Department of Health and Human Services listening session here in Kansas City that focused on what services should be included in an essential benefits package under health reform. For me, the most unexpected thing at the event was that of perhaps 30 presenters, four were bariatric surgeons. I was surprised, in part, because I was aware of the research supporting bariatric surgery and had assumed they were in no danger of being excluded.

Now, in light of this new research that was certainly in the pipeline at the time of the hearing, it occurs to me that their presence (which I assume will be duplicated in many other venues), may have been part of a concerted push for a major expansion of their services into the non-obese market.

Whole, unprocessed foods are best. This is just one example.

Because diabetes is intimately linked to heart disease, hypertension, and obesity (as part of the Metabolic Syndrome), this is really about far more than diabetes.

Patients who ate the greatest amounts of the grain had a 27% greater risk of developing the disease than those who ate the least, and the relative risk was higher among Asian patients, Qi Sun, PhD, of Harvard, and colleagues, reported in BMJ.

“Although rice has been a staple food in Asian populations for thousands of years, this transition [to more sedentary lifestyles and greater availability of food] may render Asian populations more susceptible to the adverse effects of high intakes of white rice, as well as other sources of refined carbohydrates, such as pastries, white bread, and sugar sweetened beverages,” they wrote.

The glycemic index of white rice is higher than that of other whole grains, largely due to processing. It’s also the primary contributor to dietary glycemic load for populations that consume rice as a staple food, such as Asians.

I wish I could say that this is fiction, but it’s not.

Pink slime — that ammonia-treated meat in a bright Pepto-bismol shade — may have been rejected by fast food joints like McDonald’s, Taco Bell and Burger King, but is being brought in by the tons for the nation’s school lunch program.

The U.S. Department of Agriculture is purchasing 7 million pounds of the “slime” for school lunches, The Daily reports. Officially termed “Lean Beef Trimmings,” the product is a ground-up combination of beef scraps, cow connective tissues and other beef trimmings that are treated with ammonium hydroxide to kill pathogens like salmonella and E. coli. It’s then blended into traditional meat products like ground beef and hamburger patties.

“We originally called it soylent pink,” microbiologist Carl Custer, who worked at the Food Safety Inspection Service for 35 years, told The Daily. “We looked at the product and we objected to it because it used connective tissues instead of muscle. It was simply not nutritionally equivalent [to ground beef]. My main objection was that it was not meat.”

Custer and microbiologist Gerald Zernstein concluded in a study that the trimmings are a “high risk product,” but Zernstein tells The Daily that “scientists in D.C. were pressured to approve this stuff with minimal safety approval” under President George H.W. Bush’s administration. The USDA asserts that its ground beef purchases “meet the highest standard for food safety.”

The Food and Drug Administration has helpful policies in place to help consumers understand the nutrient and calorie content of various packaged foods. Sure enough, the companies selling the packaged foods find ways to fool the public.

This Men’s Health article has numerous examples, including these two:

Serving Size Rip-Off: Kellogg’s Pop-Tarts

Listed calories: 200
Servings per box: 2
Total calories: 400

What’s worse than eating 200 calories of enriched flour stuffed with sugary fruit goo? Eating twice that many calories without even realizing it. The nutritional information on a box of Pop-Tarts lists one tart as a serving, but these iconic morning pastries come wrapped in twos, forcing you to decide between eating two Pop-Tarts now or one stale Pop-Tart tomorrow. Here’s a smarter option: Drop a piece of whole-wheat bread into your toaster, and then spread it with strawberry jam and be on your way. You’ll take in fewer calories with more fiber and real fruit.

20 Habits That Make You Fat

Serving Size Rip-Off: Campbell’s Chunky Microwaveable Soup

Listed calories: 200
Servings per container: 2
Total calories: 400

 

Okay, clearly this is a single-serve cup. As if you’d ever microwave the cup, eat half, and then put the rest in the fridge to microwave another day. C’mon Campbell’s, you’re better than that.