Healthy Living News and Research Update

June 6, 2017

The materials provided in this document are intended to inform and support those groups that are implementing the SelectHealth Healthy Living product as part of their employee wellness program.

You will be receiving similar updates twice each month.

If you would prefer not to receive these regular updates please let me know.

We welcome your feedback and suggestions.

Best Regards,

Tim

Tim Butler, MS, MCHES Senior Wellness Program Management Consultant 801-442-7397 [email protected]

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Healthy Living Program Updates • Registration for the Next Core Activity Challenge Begins 6/21

Upcoming Wellness Events • Utah Worksite Wellness Council “Time Out for Wellness” Networking Event

Workplace Wellness • Change at Work Linked to Employee Stress, Distrust and Intent to Quit, New Survey Finds • How Leaders Can Push Employees Without Stressing Them Out • Retirement savings gap seen reaching $400 trillion by 2050 • High-deductible health plans promote increased wellness program participation • Hospital system becomes Blue Zones standout • Healthy Higher Ed Employees • Best Practices for Using Wearable Devices in Wellness Programs • High-deductible, consumer-driven health plans keep growing • Pay the medical bills or save for retirement? • 5 cheap ways to get healthy before you're old enough to retire • Views: 3 ways companies can help tackle mental health issues • Why Lower Health Care Costs is One of the Benefits of Wellness

Lifestyle Medicine News • HbA1c Point-of-Care Test May Improve Diabetes Detection • Pediatricians Say No Fruit Juice in Child’s First Year • The Worst Fat in the Food Supply • Overweight kids face higher risk for depression as adults • Analysis: No Statin Primary Prevention Seen for Seniors • Lifestyle Medicine: The Skinny on Artificial Sweeteners • Poor Sleep May Hike Mortality in Metabolic Syndrome • A 1-Hour Walk, 3 Times a Week, Has Benefits for Dementia • 3 Key Lifestyle Factors Can Lower Breast Cancer Odds • Thick Middle May Raise Risk of Some Cancers • For the first time, more than half of Americans are getting the recommended amount of exercise • How a common meditation technique can help you eat more healthfully • U.S. Alzheimer's deaths jump 54 percent; many increasingly dying at home • Older adults might be able to stave off arthritis knee pain with fiber • Walking linked to improved brain function • Sugary Drinks Tied to Accelerated Brain Aging • Misremembering What Makes Us Fat: Time’s cover story on dieting misses the forest for the trees. • The healthiest way to improve your sleep: exercise • Poor Sleep May Hike Mortality in Metabolic Syndrome • Experts' tips for choosing the safest sunscreen • High glycation index increases CVD risk • Thick Middle May Raise Risk of Some Cancers • Obesity Study Debunks 'Skin-in-Game' Theory of Weight Loss • High-Fiber Diet Tied to Less Knee Arthritis • Primary care physicians can help prevent, reverse cardiovascular disease • The Whole Truth About Whole Fruits • Can a 70-Year-Old Have the Arteries of a 20-Year-Old? • Exercise a Great Prescription to Help Older Hearts • Not getting enough sleep? It could explain your weight gain

Healthy Living Program Updates

Registration for the Next Core Activity Challenge Begins 6/21

U.S. National Parks destination challenge runs from 7/3 – 7/30

Upcoming Wellness Events

Utah Worksite Wellness Council “Time Out for Wellness” Networking Event, Wednesday, June 28th

You don't want to miss this one of kind event! This dedicated networking event is structured to allow you to connect with some of the top wellness professionals in the state of Utah along with many HR directors, Wellness Consultants and Wellness Vendors. You will enjoy 3 hours getting to know each other personally and professionally, picking each other’s brains about worksite wellness programs and hopefully walking away with some lifelong connections. Register right here today!

Agenda, Wednesday, June 28th:

• 11:00-11:30 Check in, Meet with Exhibitors • 11:30-12:00 Announcements, Lunch (included in cost), Mingle • 12:00-12:45 Structured Networking Activities • 12:45-1:00 Break • 1:00-1:45 Structured Roundtable Discussion • 1:45-2:00 Exhibitor Raffle

Location: Tribe House, University Place, 575 E. University Parkway, Orem, Utah

Calling all Exhibitors: Are you a wellness company that is looking for opportunities to get your foot in the door throughout the state of Utah? Register to be one of our exhibitors at the upcoming networking event. Space is VERY Limited so don't wait.

Questions: Email us at [email protected]

Workplace Wellness

Change at Work Linked to Employee Stress, Distrust and Intent to Quit, New Survey Finds

Good Company Newsletter, May 24, 2017, vol.11, number 5 http://www.apaexcellence.org/resources/goodcompany/newsletter/article/806

At a time of change and uncertainty across the country, American adults who have been affected by change at work are more likely to report chronic work stress, less likely to trust their employer, and more likely to say they plan to leave the organization within the next year compared with those who haven’t been affected by organizational change, according to a survey released today by the American Psychological Association.

Half of American workers (50 percent) say they have been affected by organizational changes in the last year, are currently being affected by organizational changes or expect to be affected by organizational changes in the next year, according to APA’s 2017 Work and Well-Being Survey. The survey was conducted online in March by Harris Poll among more than 1,500 U.S. adults who were employed full time, part time or self-employed. Workers experiencing recent or current change were more than twice as likely to report chronic work stress compared with employees who reported no recent, current or anticipated change (55 percent vs. 22 percent), and more than four times as likely to report experiencing physical health symptoms at work (34 percent vs. 8 percent).

Working Americans who reported recent or current change were more likely to say they experienced work-life conflict (39 percent vs. 12 percent for job interfering with non-work responsibilities and 32 percent vs. 7 percent for home and family responsibilities interfering with work), felt cynical and negative toward others during the workday (35 percent vs. 11 percent) and ate or smoked more during the workday than they did outside of work (29 percent vs. 8 percent).

Satisfaction and trust

The survey findings also show how workplace changes may affect employees’ attitudes and experiences on the job.

Workers who reported being affected by organizational change currently or within the past year reported lower levels of job satisfaction compared with employees who reported no recent, current or anticipated changes (71 percent vs. 81 percent). Working Americans who reported recent or current change were almost three times more likely to say they don’t trust their employer (34 percent vs. 12 percent) and more than three times as likely to say they intend to seek employment outside the organization within the next year (46 percent vs. 15 percent) compared with those with no recent, current or anticipated change.

Cynical and skeptical

Underlying employee reactions to organizational change may be their perceptions of the motivation behind those changes and the likelihood of success, according to the survey. Almost a third of U.S. workers said they were cynical when it comes to changes, reporting that they believed management had a hidden agenda (29 percent), that their motives and intentions were different from what they said (31 percent) and that they tried to cover up the real reasons for the changes (28 percent). Working Americans also appeared skeptical when it comes to the outcomes of organizational changes. Only 4 in 10 employees (43 percent) had confidence that changes would have the desired effects and almost 3 in 10 doubted that changes would work as intended and achieve their goals (28 percent each).

“Change is inevitable in organizations, and when it happens, leadership often underestimates the impact those changes have on employees,” said David W. Ballard, PsyD, MBA, head of APA’s Center for Organizational Excellence. “If they damage their relationship with employees, ratchet up stress levels and create a climate of negativity and cynicism in the process, managers can wind up undermining the very change efforts they’re trying to promote.”

Other survey findings

APA’s annual Work and Well-Being Survey provides a snapshot of the U.S. workforce, including employee well-being and attitudes and opinions related to workplace policies and practices. Other key findings of the 2017 survey include:

Contrary to popular belief, more than three-quarters of U.S. workers (78 percent) reported average or better levels of work engagement, as characterized by high levels of energy, being strongly involved in their work and feeling happily engrossed in what they do, with the largest group (47 percent) having an average level of work engagement.

One in 5 employees (22 percent) reported low or very low levels of engagement at work, yet workers who felt they were treated fairly by their employers were more than five times as likely to report high or very high levels of work engagement, compared with employees who didn’t feel treated fairly (39 percent vs. 7 percent).

Although most employed adults (71 percent) felt that their organization treats them fairly, 1 in 5 (21 percent) said they did not trust their employer.

Employees who said they don’t trust their employer were more than three times as likely to say they’re typically tense and stressed out at work compared with those who trust their employer (70 percent vs. 23 percent), and more than four times as likely to indicate that they plan to look for a new job within the next year (65 percent vs. 16 percent).

Trust and engagement play important roles in the workplace, accounting for more than half of the variance in employee well-being. In predicting well-being, engagement and trust accounted for 53 percent of the variance.

Workers reported having more trust in their companies when the organization recognizes employees for their contributions, provides opportunities for involvement and communicates effectively. In predicting trust, employee involvement, recognition and communication predicted 43 percent of the variance.

Employees experienced higher engagement when they had more positive perceptions of their employer’s involvement, growth and development and health and safety practices. In predicting work engagement, employee involvement, growth and development opportunities, and health and safety efforts accounted for 28 percent of the variance. “For organizations to successfully navigate turbulent times, they need resilient employees who can adapt to change,” Ballard said. “Disillusioned workers who are frustrated with change efforts, however, may begin to question leaders’ motives and resist further changes. To build trust and engagement, employers need to focus on building a psychologically healthy workplace where employees are actively involved in shaping the future and confident in their ability to succeed.”

About the Work and Well-Being Survey

The workplace survey was conducted online within the United States by Harris Poll on behalf of the American Psychological Association between February 16-March 8, 2017, among a nationally representative sample of 1,512 adults age 18 and older who reside in the U.S. and were either employed full time, part time or self-employed. Some data contained within this release are based on additional analyses conducted by the American Psychological Association and have not been reviewed by Harris Poll. A full methodology is available online.

Photo credit: iStockphoto

How Leaders Can Push Employees Without Stressing Them Out

May 23, 2017, by Karen Firestone https://hbr.org/2017/05/how-leaders-can-push-employees-without-stressing-them-out

Executive Summary

Studies show that bosses feel less stress than their employees do. While it’s a leader’s job to drive results, managers should also try to reduce their employees’ stress, since when leaders create a safe and supportive environment, people tend to feel more connected and perform at a higher level. So what should we be doing to reduce the stress of our employees? Provide as much certainty and clarity as you can, especially around job function, lines of reporting, compensation, and any significant changes to the organization. Be both fair and free with praise. Exhibit self-confidence and competence; people want to follow a strong “pack leader.” And keep your promises — or don’t make any. It may not sound like rocket science, but as the high rates of disengagement and stress in our organizations show, it’s easier said than done.

One of the most interesting findings of a recent HBR article on team chemistry is that the types of people who become leaders within organizations are about 30% less likely than their coworkers to feel stressed out. As the CEO of a small investment firm, I was surprised by the finding, but as I considered my own leadership style and intraoffice relationships, I concluded that the authors were onto something. Plus, a finding from a 20,000-person survey is probably worth paying attention to.

First, let me explain why I was skeptical. I do sometimes feel enormous pressure, generally about our firm’s investment performance. Do I really feel calmer than my colleagues? Both my husband and my second-in-command at the office would suggest, only half-jokingly, that I am miraculously unencumbered because I am so skilled at off-loading my stress onto them.

But it’s all relative, and other researchers have also found that bosses feel less stress than their employees do. Bosses’ perceptions of stress are offset by factors such as status, autonomy, and job security, which are generally higher for managers than for their employees. While I’m not about to ask everyone in my company to participate in a daily cortisol readout, I have to operate under the assumption that even if I do feel pressure, my employees may feel more. Which is even more of a reason to understand how to reduce the tension my colleagues feel.

Steve Arneson describes the “leader’s dilemma” as the quandary of how to secure the greatest output at a company without building stress to the point of diminishing returns. He recommends the transformational style of leadership, in which a manager provides support and positive feedback to their staff, building respect, commitment, and cooperation within a workforce. It’s a great idea. Unfortunately, the corporate landscape is littered with violations of this concept.

For example, my friend Terri is the regional sales manager for a medical device company, which was acquired by a larger firm six months ago. She still does not know whether she will have a job in three months, and her new boss has been unable or unwilling to shed light on any details about Terri’s future or that of most of the legacy sales and marketing staff. She suffers from sleepless nights, low morale, stress, and limited interest in promoting a portfolio whose owners have shown her no respect. The fact that Terri’s superiors have pursued a policy that results in this type of anxiety and dysfunction is clearly counterproductive and, frankly, more than a little mean. There are too many people in Terri’s position in offices all over the world.

You and Your Team Series

Stress • Turning Stress into an Asset , Amy Gallo • Resilience Is About How You Recharge, Not How You Endure , Shawn Achor and Michelle Gielan • Steps to Take When You’re Starting to Feel Burned Out , Monique Valcour

I know that no leader, no matter how high they are in the hierarchy, can have all the answers to all the questions an employee might ask. But we can be honest and considerate in how we try to answer them. Studies show that when leaders create a safe and supportive environment, individuals tend to feel more connected to that leader, perform at a higher level, and experience less stress than when they feel unattached to their boss.

So what should we be doing to reduce the stress of our employees? I’ll lay out my own suggestions below. Some of these may be second nature for many leaders, but others are less obvious. The high rates of stress and low rates of engagement in organizations show that even if they sound like common sense, not enough bosses pay attention to them.

To the greatest extent you can, provide certainty and clarity. This is especially important for job function, lines of reporting, compensation, and any significant changes to the organization. In a classic article, Frederick Herzberg called these kinds of things “hygiene factors.” They are minimum requirements — they don’t guarantee employee motivation, but without them employees are likely to feel disgruntled. While there are always elements to organizational structure and change that are privileged, sharing relevant information with your staff should be standard. Without clarity on important issues, everyone’s mind goes to the worst-case scenario and productivity suffers. Be fair. When people feel that they are being treated unfairly, they tend to suffer anxiety, assign blame, and become stressed. Fairness can take the form of spending equal time with those in your next level of command, listening to everyone at a meeting, explaining your decision-making processes more clearly, and recognizing when someone might feel slighted.

Show support and gratitude. That sounds easy in theory, but it isn’t in practice. When Jack Zenger and Joseph Folkman studied results from workplace surveys and 360-degree reviews, they found that managers were more likely to avoid giving praise than to avoid giving criticism! 37% admitted they didn’t give their teams any positive reinforcement. Don’t be that boss. Get up and walk around to talk to people, thanking them for helping on a project, hitting a sales goal, bringing in a new account, or staying late. Putting resources, money, and praise behind their efforts will alert colleagues that the firm cares about supporting people who do good work.

Exhibit self-confidence and competence as a leader. When executives demonstrate their own abilities, it provides an assurance to coworkers that they are under the direction of a “pack leader” who can protect them. Feeling safe, as described above, is a key factor in stress reduction and job satisfaction. This may seem to conflict with the currently popular theory of showing vulnerability. However, careful reading of the literature emphasizes that the best executives need to illustrate both warmth and competence.

Keep your promises. And if you can’t, don’t make any! Too much stress results from people becoming worried about the lack of follow-through by the boss on promises or offers made, even when they are well intentioned. It’s important that leaders are the prime example of thoroughly executing on their own commitments to the people who support them.

Applying these principles into our daily leadership practice should help relieve employee stress. Please try. I don’t want to stress about it.

Karen Firestone is the President and CEO of Aureus Asset Management, an asset management firm which serves as the primary financial advisor to families, individuals, and nonprofit institutions. She cofounded Aureus after 22 years as a fund manager and research analyst at Fidelity Investments. She’s the author of Even the Odds: Sensible Risk-Taking in Business, Investing, and Life (Bibliomotion, April 2016).

Retirement savings gap seen reaching $400 trillion by 2050

May 26, 2017, by Katherine Chiglinsky http://www.benefitspro.com/2017/05/26/retirement-savings-gap-seen-reaching-400-trillion

(Bloomberg) -- Longer life spans and disappointing investment returns will help create a $400 trillion retirement- savings shortfall in about three decades, a figure more than five times the size of the global economy, according to a World Economic Forum report.

That includes a $224 trillion gap among six large pension-savings systems: the U.S., U.K., Japan, Netherlands, Canada and Australia, according to the report issued Friday. China and India account for the rest.

Employers have been shifting away from pensions and offering defined-contribution plans, a category that includes 401(k)s and individual retirement accounts and makes up more than 50 percent of global retirement assets. RELATED: • Working in retirement may not be in the cards • 10 signs retirement is in crisis

Planning to work beyond the typical retirement age? It might not be up to you to decide if you get...

That heaps more risk onto the individuals, who often face a lack of access to the right options as well as the resources to understand them, according to the World Economic Forum report. Stock and bond returns that have trailed historic averages in the past decade have also contributed to the gap.

“We’re really at an inflection point,” Michael Drexler, head of financial and infrastructure systems at the World Economic Forum, said in a phone interview. “Pension underfunding is the climate-change moment of social systems in the sense that there is still time to do something about it. But if you don’t, in 20 or 30 years down the line, society will say it’s a huge problem.”

A shortfall of about $400 trillion could be reached by 2050, the World Economic Forum said. The figure is derived from the amount of money government, employers and individuals would need to provide each person with a retirement income equal to 70 percent of his or her annual earnings before leaving the workforce.

The gap is partially driven by an aging world population. Life expectancy has risen on average by about a year every five years since the middle of the last century, and half of babies born in the U.S. and Canada in 2007 may live to 104, according to the report. In Japan, the figure is 107 years.

The World Economic Forum said its calculations are based on publicly available data on government programs such as Social Security in the U.S.; employer-based contributions and individual savings. It assumed that workers would retire between the ages of 60 and 70.

Solutions exist

Governments can ease the financial burden by increasing the target retirement age. People would also benefit from improved financial education and services.

“A lot of the good solutions already exist somewhere in the world. Just no one has figured them out all together,” Drexler said. “There’s almost no new invention necessary.”

The defined-benefit plans that have fallen out of favor enjoyed advantages including shared risk and an investment manager to oversee allocations, according to the report. And those pension plans often had better collective bargaining power, Drexler said.

Some countries are taking steps. The Netherlands and Canada both have collective retirement systems for defined- contribution plans. That’s helped individuals pool risks and reduce fees, the World Economic Forum said.

The group warned that the savings shortfall is growing at a rate of $3 trillion each year in the U.S. The shortfall might climb at an annual rate of 7 percent in China and 10 percent in India, which have rapidly aging populations, growing middle classes and a higher percentage of workers in informal sectors.

“What I’m really hoping will happen is that actions will be taken and will be taken now,” said Jacques Goulet, president of health and wealth at Mercer, a consulting firm that collaborated on the report. “There are three key stakeholders in here. There are governments, companies or employers, and individuals. And frankly the problem here is of such magnitude, that we need the engagement of all three in order to address it. That’s very important.” The World Economic Forum is a not-for-profit foundation known for organizing an annual gathering in Davos, Switzerland.

High-deductible health plans promote increased wellness program participation

Employee Benefit News, June 1 2017, by Nick Otto https://www.benefitnews.com/news/high-deductible-health-plans-promote-increased-wellness-program-participation

Employer-provided healthcare continues to be the most common access to health insurance in the U.S., and as employers continue to look for ways to cut costs, consumer-driven high-deductible health plans continue to grow with the added benefit of increased employee engagement in healthcare choices.

Fourteen percent of the U.S. population was enrolled in a CDHP and 14% was enrolled in an HDHP, a slight increase for both from the previous year, according to the 2016 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey.

And the number of workers who were in a CDHPs or HDHPs was more likely than those in a traditional plan to exhibit cost-conscious behaviors, according to a recent report from the non-partisan Employee Benefit Research Institute.

“This survey found that high deductibles are associated with new behaviors [that are] often encouraged by employers and insurers,” says Paul Fronstin, director of EBRI’s Health Research and Education Program and co-author of the report.

The theory behind CDHPs and HDHPs is that the cost-sharing structure is a tool that will be more likely to engage individuals in their health care, compared with people enrolled in more traditional coverage, the study suggests.

[Image credit: Bloomberg]

And with the employees taking a bigger interest in their healthcare planning, employers are noticing their wellness programs taking a bigger role.

The study focused on three types of wellness programs: a health-risk assessment, a health-promotion program to address a specific health issue, and a biometric screening.

“CDHP enrollees and HDHP enrollees were more likely than traditional-plan enrollees to report that they tried to find cost information. They are also more likely to participate in wellness programs.” Adds Fronstin.

Specifically, 45% of CDHP enrollees reported that their employer offered a health risk assessment, compared with 34% of traditional-plan enrollees and 30% of HDHP enrollees. When asked about the availability of health-promotion programs, 53% of CDHP enrollees, 32% of HDHP enrollees and 41% of traditional-plan enrollees reported that their employer offered such a program. Additionally, when asked about biometric-screening programs, 45% of CDHP enrollees reported that their employer offered such a program, compared with 36% among traditional-plan enrollees and 33% among HDHP enrollees.

CDHP and HDHP enrollees were also more likely than traditional-plan enrollees to report that their employer offered a cash incentive or reward for participating in a biometric screening program. Seventy percent of CDHP and 67% of HDHP enrollees reported a cash incentive or reward for a biometric screening, compared with 51% among traditional-plan enrollees.

While these numbers represent self-reported awareness of available health and wellness programs and cannot be cross- referenced with objective data from employers and insurers, it is significant that, across the board, CDHP enrollees are aware and participate at higher rates in wellness programs, the author notes.

Another trend the study found was the increased interest in health savings accounts.

Among individuals enrolled in CDHPs, 56% opened an HSA, 19% were in an HRA, and 25% were enrolled in an HSA- eligible health plan but had not opened an HSA.

It’s more common for employers to contribute to HSAs than in the past, and the dollar amount is also increasing, EBRI says. Seventy-eight percent of CDHP enrollees reported that their employer contributed to the account in 2016, up from 67% in 2014.

Additionally, 20% of CDHP enrollees reported an employer contribution of at least $2,000 in 2016, up from 10% in 2014.

Hospital system becomes Blue Zones standout

May 31, 2017, Liz Freeman http://www.naplesnews.com/story/news/health/2017/05/31/hospital-system-becomes-blue-zones- standout/354163001/

A quick meal prep guide to a healthy combination of vegetables, meat, and optional rice. Chloe B. Babauta and Frank San Nicolas/PDN

The NCH Healthcare System celebrates becoming a Blue Zones Project certified worksite.(Photo: Submitted; Blue Zones Project staff)

The NCH Healthcare System is sold on employee wellness and what it can achieve.

The hospital system began a campaign in 2009 to convince employees to change bad habits and get healthier.

Two years ago, NCH introduced an initiative to Southwest Florida to work toward becoming a Blue Zones Project community to improve the region’s health.

The campaign in both regards is paying off. NCH recently became the first worksite in the state to earn certification through the Blue Zones Project, where a majority of employees are embracing behavior changes to get healthier.

The hospital system has 4,300 employees and 2,150 have signed pledges to get healthier.

It also is the first hospital system in the nation to become Blue Zones certified, according to program officials.

The project aims to convince people to engage in healthier lifestyles to improve longevity and well-being. It is based on the world travels of Dan Buettner, who worked for National Geographic and realized there are shared lifestyle traits among populations in geographic areas who live to 100 longer.

He wrote a book in 2010 outlining his “Power Nine” principles of longevity that became a New York Times bestseller.

NCH says it has seen a 54 percent drop in health care spending in the past three years for a combined savings of $27 million. There’s also been improvements in employee well-being based on a Gallup-Sharecare measurements, and 34 percent of employees report their body mass index has improved, according to Blue Zones officials.

NCH Healthcare System employees enjoy healthy foods endorsed by the Blue Zones Project. (Photo: Submitted: Blue Zones Project staff)

“Well-being is our mission and our promise, for those we serve and our employees,” Dr. Allen Weiss, president and chief executive officer of NCH, said in a statement. “That’s why we’re making substantive changes on our campuses, improving the foods we serve in our cafeterias, eliminating sugar- based beverages, and working with local producers to have onsite farmers market. Each of these actions reinforce the idea that healthy doesn’t have to be hard. We are creating success for patients, employees, and the community at large.”

On the community level, more than 60 organizations, from businesses to residential communities, have committed to the project by adopting health-focused actions with a check list of practices.

NCH achieving certification is a more intensive undertaking involving a customized checklist of best practices to deliver on, said Deb Logan, executive director of the project in Southwest Florida.

At a ribbon cutting ceremony May 24 to celebrate NCH becoming a certified Blue Zones worksite, Nick Buettner spoke about the hospital system’s achievement. He serves as community and corporate program director for the Blue Zones project and is the brother of the founder.

He pointed out how NCH employees logged 4,000 hours of volunteerism in one year.

“That says a lot about you as individuals,” Buettner said.

In addition, more than 1,000 employees joined a walking group or potluck group _known as a Moai to use a concept from Okinawa, Japan, that translates to mean coming together for a common purpose. Okinawa is one of the original Blue Zones communities,

Currently, 42 communities in nine states are engaged in Blue Zones campaigns to get healthier.

Healthy Higher Ed Employees Pilot survey finds good health, but also concerns about uncivil behavior by colleagues.

June 2, 2017, by Jeremy Bauer-Wolf https://www.insidehighered.com/news/2017/06/02/health-survey-faculty-staff-first-its-kind

AUSTIN, Tex. -- Most professors and other university staffers say they're in good health, but some can identify instances of workplace bullying, according to the results of a broad new pilot study unveiled here Thursday.

The study, developed by an American College Health Association coalition, in part mirrors another widely administered survey, also by the ACHA, that focuses on student wellness -- the National College Health Assessment. That survey allows all the colleges and universities that participate to glean information about their own student population, but also to compare it to the larger pool of institutions that participate.

The National Faculty Staff Health Assessment, meanwhile, is being touted as the first of its kind to offer such a deep look at the health of university employees, a comprehensive examination of both their physical and mental well-being, while also recording demographic information.

Student campus climate surveys are quite common. But few health assessments exist for employees beyond the ones delivered through human resources, and often those are required for insurance purposes and concentrate just on the individual, said Nikki Brauer, the director of health promotion and wellness at Illinois State University. Brauer also chairs the ACHA’s faculty and staff health and wellness coalition.

The faculty and staff assessment is still being tweaked. The data released Thursday were based on a survey of just four institutions -- all four-year, three public and one private -- for a total of nearly 2,090 faculty and staff members, including adjunct professors. They completed the survey between December and April.

More than 86 percent of those who responded rated their overall health as excellent, very good, or good.

A little more than 67 percent indicated they either agreed or strongly agreed that their college or university cared about their health and well-being.

“We weren’t really surprised by what they said,” Brauer said in an interview.

More than a quarter of responders observed some “uncivil” behaviors among their coworkers, though. About 34 percent said they had seen phone calls and emails ignored; 31 percent indicated they had noticed someone being given the “silent treatment,” and a little more than 29 percent said that someone had taken credit for another’s work.

Nearly half of the people who answered the survey said they'd witnessed gossip about another coworker.

A very small percentage -- around 6 percent -- indicated they had observed what they considered verbal abuse. Not even 1 percent reported noticing physical or sexual abuse.

Brauer had little to say about those particular findings other than noting them in her presentation Thursday.

The survey also measured alcohol and tobacco use. On one question that asked if the respondent in the last two weeks had consumed more than five drinks in two hours, overwhelmingly people said no. A vast majority of respondents indicated they had never consumed any form of tobacco, including cigarettes and cigars, e-cigarettes, and smokeless tobacco.

Those who worked on the survey received a deluge of feedback on additional questions to ask, particularly concerning questions regarding life circumstances and gender and sexuality.

Survey respondents wanted questions about pregnancy and to respond in more depth when the survey asked about their marital status or whom they lived with. Many wanted a “spouse” option added on both the questions about living arrangement and marital status, as well as an “engaged” option.

While many were pleased that the survey did include inquiries about gender and sexuality, some believed that the question about gender assigned at birth was offensive, the presenters said. Indeed, many transgender people do not wish to discuss their past classification.

Questions around whether someone identified as transgender seemed to get a little muddled. Though 52 indicated they identified as transgender, when asked on a separate question about which term they used to describe their gender identity, only one person said transwoman, and none said transman.

Some did find the survey too invasive, or too lengthy, according to the presenters.

The survey is intended to launch spring 2018.

Best Practices for Using Wearable Devices in Wellness Programs A step tracker, on its own, will not change health behaviors over the long term

May 17, 2017, by Stephen Miller, CEBS https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/wearable-trackers-best-practices.aspx

Wearable devices, such as activity trackers, have shown promise as tools to increase participation in employee wellness programs. At least 1 in 6 U.S. consumers use wearables in the form of either a smartwatch or a fitness band. But getting the most out of these devices requires more than just asking employees to use them.

A new report from the nonprofit Health Enhancement Research Organization (HERO), based in Waconia, Minn., presents findings on how employers are incorporating wearables into their workplace wellness programs. The Wearables in Wellness Case Study Report identifies best practices for using wearables to promote health and well-being, such as:

• Give employees the devices or offer a subsidy rather than requiring workers to buy them on their own. • Set goals and encourage employees to meet them and earn incentives. • Involve employees' spouses and domestic partners to increase participation and create a support system outside of the workplace. • Use a pilot program to identify ways to improve the effort before expanding it to the entire workforce. • Modify the program from time to time to keep employees engaged. "We see a lot of promise in the use of wearables as a component of a comprehensive workplace wellness program," said Jessica Grossmeier, vice president of research for HERO. However, "Early research supports that a device, on its own, will not change health behaviors over the long term."

Instead, "forward-thinking employers who have been early adopters of well-being best practices are implementing wearables in creative and effective ways," said Jack Bastable, national practice leader for employee health and productivity at consultancy CBIZ. "They're realizing success, in part, because they are supporting their device strategy with a sound communication strategy, making it financially feasible and encouraging long-term use."

3 Case Studies

HERO's report looks at three organizations that have effectively integrated wearables into their wellness programs using a results-oriented approach:

• BP, a global energy firm, started incorporating wearables in 2013. Today, more than 75 percent of eligible participants enroll in the company's annual Million Step Challenge, and 79 percent reach their goal. BP has modified the program over the years to add goals beyond one million steps, and smaller goals for less active participants who are unable to achieve the million-step goal. As a result, the program has been consistently popular with participants.

• Emory University in Atlanta launched its wearables program, Healthy Emory, in 2014 with a pilot program at five sites. Based on those results, Emory made modifications and offered the program to all Emory University and Emory Healthcare employees the following year. Healthy Emory's Move More Challenge was designed to be fun for participants and included team-based elements to encourage social support and inspire friendly competition. When the program expanded enterprisewide in 2015, 6,300 Emory employees participated in the challenge, and 82 percent remained active for all eight weeks. In a post-program survey, 67 percent said it was the first time they had used a wearable device, and 82 percent reported using the device every day of the challenge.

• Ochsner Health System, a New Orleans-based regional hospital network, began using wearables in 2008 as part of a program that offered employees a device free of charge and asked them to reach a target number of steps to earn an incentive. Analysis over the years has shown that Ochsner employees who use wearables have lower medical costs than employees who do not take part. Bogus Miles

Some companies have found that providing generous financial incentives based on the number of steps recorded by activity trackers fostered cheating, according to a panel discussion held May 9 at the 2017 Total Rewards Conference in Washington, D.C., presented by WorldatWork, a total rewards association.

One benefits director, who asked to remain anonymous, shared that during an employee focus group on workplace benefits, employees "were telling us that people were gaming the wellness" incentives. For instance, "they would tie their trackers to ceiling fans to improve their stats, or attach them to their dogs."

After hearing these revelations, "we backed off in terms of the rewards," he said. "We provide a wellness app that reminds people to do good things every day."

High-deductible, consumer-driven health plans keep growing

May 30, 2017, by Katie Kuehner-Hebert http://www.benefitspro.com/2017/05/30/high-deductible-consumer-driven-health-plans-keep

An increase in CDHP enrollment has also led to an increase in 'consumer behaviors,' the study authors write. (Photo: iStock)

The increased use of consumer-driven health plans with high deductibles are having the desired impact: when people consume more of the costs of their own health care, their decisions are increasingly being driven on how they can personally control the cost, according to the 2016 Consumer Engagement in Health Care Survey by EBRI and Greenwald & Associates.

The inclusion of a high deductible -- whether via a high-deductible health plan or a consumer-driven health plan that is associated with a health savings account or a health reimbursement arrangement -- is correlated with “more engaged individuals,” according to a survey of 3,295 U.S. adults.

“Further, given that CDHP enrollees are more consistently offered funds for their HSA, had a choice of health plans at enrollment and offered wellness programs, CDHP enrollees are more likely to consistently engage in those cost- conscious consumer behaviors,” the authors write.

More than half (56 percent) of CDHP enrollees opened an HSA, taking advantage of growing employer contributions, according to the survey. A majority (78 percent) of CDHP enrollees reported that their employer contributed to the account in 2016, up from 67 percent in 2014. Furthermore, 20 percent of CDHP enrollees reported an employer contribution of at least $2,000 in 2016, up from 10 percent in 2014. Similarly, 42 percent reported an employer contribution of $1,000‒$1,999 in 2016, up from 36 percent in 2014.

According to a HealthMine survey of consumers with sponsored health insurance, 39 percent of whom say their plans don’t offer...

An increase in CDHP enrollment has also led to an increase in “consumer behaviors,” the authors write.

Those in a CDHP are more likely to check whether the plan would cover care (54 percent CDHP vs. 44 percent traditional plan); ask for a generic drug instead of a brand name (48 percent CDHP vs. 37 percent traditional); and used an online cost-tracking tool provided by the health plan (31 percent CDHP vs. 20 percent traditional). CDHP and HDHP enrollees are also more likely than traditional-plan enrollees to report that they tried to find cost information before getting care.

CDHP enrollees are more likely to participate in biometric screening programs when offered: Over 80 percent of CDHP enrollees participate, compared with 64 percent among traditional-plan enrollees.

CDHP and HDHP enrollees are also more likely to report that their employer offered a cash incentive or reward for participating in a biometric screening program. Seventy percent of CDHP and 67 percent of HDHP enrollees reported a cash incentive or reward for a biometric screening, compared with 51 percent among traditional-plan enrollees. Among the top reasons enrollees reported participating in an employer’s wellness program were because they were offered incentive prizes, to reduce premiums, and to maintain and improve health.

The survey found that high deductibles were “influencing new behaviors often encouraged by employers and insurers,” the authors write.

But while employees are picking up more of the tab, employers are also contributing more to HSAs to help with the costs, according to the survey.

“Employers may have determined that they needed to contribute to the account and that they needed to contribute more than they had in the past in order for CDHPs to be a viable choice for workers when they were offered a choice of health plan,” the authors write.

Pay the medical bills or save for retirement? As health care costs and premiums for group health insurance rise, a survey from BoA Merrill shows many employees want more help from employers

June 01, 2017, by Nick Thornton http://www.benefitspro.com/2017/06/01/pay-the-medical-bills-or-save-for-retirement

Almost 80 percent of surveyed employees said they have seen an increase in health care costs last year, up from the roughly 70 percent a year earlier. (Photo: Getty)

More employees with access to a workplace retirement plans say they are seeing their health care costs go up, and that is having a direct impact how much money they are saving in 401(k) plans, according to a new survey from Bank of America Merrill Lynch.

Almost 80 percent of surveyed employees said they have seen an increase in health care costs last year, up from the roughly 70 percent that claimed as much the previous year.

That means less disposable income, and less money to stash away in retirement plans. Nearly two-thirds of respondents in Merrill’s 2017 Workplace Benefits Report said they are saving less for retirement in order to cover rising health care costs.

The report does not segment the sources of rising health care costs, but data from last year’s Kaiser Family Foundation annual employer health benefits survey shows that premium increases continued to outpace overall inflation, albeit at a slower rate from the previous decade.

Related: 10 misconceptions about saving for medical care in retirement. Americans have many common misconceptions about health care, its cost and how to pay for it. Here are 10 that...

Family premiums in the group market rose 3 percent last year to an average of $18,142, with employees contributing an average of $5,277 towards premiums. Since 2011, family premiums have increased 20 percent, a considerably lower rate of inflation from the previous decade; premiums increased 31 percent between 2006 and 2011 and 63 percent between 2001 and 2006. KFF’s study noted that the slowing in premium inflation is due, in part, to rising deductibles.

Some participants saving aggressively

While most participants are crimping savings rates, the data from BoA Merrill shows solid portions are saving aggressively for retirement.

More the one-third of the survey’s respondents said they are saving 11 percent or more of their salary. Among millennials, 29 percent are saving more than 15 percent of their salary; 24 percent of Gen Xers are saving more than 15 percent; and 18 percent of baby boomers are saving more than 15 percent.

Still, large portions of the workforce claim to be daunted by financial stress, and two-thirds fear running out of money in retirement. With more than any other aspect of their financial lives, people want their employers to help them save for retirement, the study found.

Across age demographics, employees overwhelmingly said they would participate in financial wellness programs. Millennialls were the most amenable to the idea, with 92 percent saying they would use a wellness program at work if offered one.

The study makes a not-so-tacit pitch for investment in wellness programs and the service providers that provide them. “Employers who embrace a culture of financial wellness—similar to the culture created around health wellness—can create a workplace that helps relieve employee stress and my make employees healthier and more productive in the long run,” the report says.

In one sense, employers may be unwittingly investing in their workers' financial lives, even if they don’t offer a wellness program. According to the study, people are spending real pockets of time dealing with personal financial issues on the company dime. One in five spends five hours a week dealing with financial issues, and another 22 percent spends three to five hours.

Employees spend a median of two hours a week, amounting to 100 hours a year, costing employers as much as several thousand dollars a year per employee.

Determining the return on investment of workplace financial wellness programs has been an impediment to their adoption.

Last year, Financial Finesse, a financial wellness provider, released one of industry’s first coordinated attempts to calculate ROI on wellness programs.

In improving overall wellness scores, the Financial Finesses estimates employers savings in the millions of dollars, due to lower administration costs for wage garnishments, lower rates of employee absenteeism associated with financially stressed workers, and greater participation in health savings and flexible spending accounts.

5 cheap ways to get healthy before you're old enough to retire

May 30, 2017, by Marlene Y. Satter http://www.benefitspro.com/2017/05/30/5-cheap-ways-to-get-healthy-before-youre-old-enoug

The better your health, both mental and physical, going into retirement, the fewer problems you may have. (Photo: AP)

Retirement can last for a long time—perhaps longer than three decades—and it’s going to be a challenge to make your money last that long, particularly if you’re not in good health.

Even if you are, issues will undoubtedly arise demanding the care of a doctor or, worse, a hospital.

The better your health, both mental and physical, going into retirement, the greater the likelihood that you’ll have fewer instances of problems and be able to come through them more quickly, recovering more thoroughly, than others might who are not in such good shape.

So, if you want to be healthy in retirement and thus forestall some of the potentially massive expenses connected to health care once you’re living off your retirement savings, it will pay to do a little prep work now, while you’re still working.

Whether you need to sock away as much as possible for retirement or are struggling with low salaries and high...

This can involve making sure you have all the obligatory checkups that might uncover potential problems while you’re still covered by your employer’s health care and/or wellness plans. But that’s not the only thing you can do to get yourself in better shape and possibly ward off problems in the future.

Since the possibility exists that the American Health Care Act could make it through the Senate—albeit perhaps with major changes to at least some of its provisions—it behooves everyone to do all they can to improve the odds of not needing care in a nursing home or assisted living facility, since one of the current provisions of the bill cuts Medicaid by $880 billion.

And since Medicaid is the means by which many seniors pay for nursing home care, it’s best to assume it might not be around to help you when the time comes.

And if you’re already struggling to keep up with medical premiums, bear in mind that another provision of the AHCA allows insurers to charge older people five times more than they charge younger people.

Instead, here are five suggestions that can help you prepare yourself to be as healthy as you can be in retirement, so that whatever the final version of medical care in this country turns out to be, you’re ready to face it head on:

5. Join a community.

Whether it’s a small informal group like a book club or knitting club, a biking, dance or martial arts group or something even bigger, grander and more strenuous like a Habitat for Humanity group, consider becoming part of a larger whole.

Especially if you’re planning on downsizing and relocating upon retirement, start investigating now and forge some links with your new location as far ahead of time as possible, since one issue that can weigh on seniors’ mental and physical well-being is feeling isolated.

Joining a community of some kind can help you feel connected, and if people you hang out with now can give you introductions to people in your new location, you’ll have a welcome ready and waiting when you get to your new home. Research has shown that the sense of belonging can help not just your morale but your mental sharpness and physical well- being—and you’ll have people you can turn to if you find you need help.

4. Cook.

Home-cooked meals can improve your health and help you learn how to stretch the budget at the same time.

And while you may feel you don’t have time to take on home cooking, you’ll be better able to control the quality of the food you eat while saving money on the cost of prepared foods. In addition, they can improve your family’s well-being, too—leading to fewer serious problems down the road.

Cutting down on additives and preservatives while controlling the amount of salt and sugar you eat will help you maintain a healthier diet, and understanding more about the types of foods available and the cooking process itself will enable you to put together more balanced meals at lower cost.

You might also be able to avoid doctor bills for food allergies, since you’ll be in control of what goes into what you eat.

3. Meditate.

Meditation has all sorts of health benefits. Health conditions from anxiety and asthma to high blood pressure, depression, chronic pain and even heart disease have shown improvement thanks to meditation sessions, and any improvement you can make in your mental and physical well-being can reduce the need for conventional medical treatment.

In addition, when meditation is coupled with such mindfulness activities as qi gong, tai chi or yoga, physical mobility improves and that’s a good thing to seek as you get older.

2. Exercise.

You might not particularly enjoy it, but exercise is helpful for lots of reasons. It keeps you limber, making it easier for you to get around as you age, and weight-bearing exercise—including some types of yoga—can be helpful in preventing the effects of osteoporosis.

The beneficial effects of exercise also affect mental well-being, and not just through the well-known “runner’s high.” But even those are not the only benefits it offers. While even just walking will help with everything from stamina to weight control, there are the added benefits of commuting via bike.

If it’s feasible for you to do so, try and give it a shot—after all, in many other countries more people go to work on two wheels than on four. And don’t think that just because an area is hilly, you can’t manage it.

For hills, or when you get older, you can always add a push motor to a bike. That will enable you not only to commute even on steeper roads, but to run most of your errands via bike instead of car. That will not only save you money but keep you in shape as you age, lessening the likelihood that you’ll need the attentions of a doctor—at least for a while.

1. Educate yourself.

You need to know as much as possible about your retirement savings—both the investments and the type of plan—so that you can plan ahead and use that money to best advantage once you retire.

At the very least, you should know the type of tax treatment each of your retirement accounts qualifies for, so that when the time comes to start withdrawing money you can do it in the most advantageous way possible.

There are two good health-related reasons for being aware of the tax treatments of retirement accounts: first, so that your money will last longer in retirement and cover more health care expenses—meaning you’ll be less tempted to forego necessary medication—and second, if you’re confident about what you have and how to use it, you’ll spend less time worrying about it—and less worry is a good thing for your health

Views: 3 ways companies can help tackle mental health issues

May 25 2017, by Amanda Popiela https://www.benefitnews.com/opinion/3-ways-companies-can-help-tackle-mental-health-issues

About one in five U.S. workers has a mental illness, but the majority has not disclosed it to their employer.

That should come as no surprise. The stigma attached to mental health issues runs deep. On the upside, with May being Mental Health Awareness Month, HR leaders have the perfect opportunity to refocus their efforts. They can look to the progress taking place at U.S. organizations, but they can also look to the progress being made overseas, especially by their British counterparts.

After studying model after model at companies headquartered in the United Kingdom, three trends in my research arose — ones with universal practicality, including here in the United States. To that end, companies looking to help the millions who suffer in silence can start taking or advancing these three steps.

1. Develop effective communications

The success of any well-being program largely hinges on its communications strategy. Does the messaging grab employees’ attention and encourage open dialogue? Every company culture differs — and with that, HR must develop tailored communication.

Given the sensitivity around mental health issues, optimal communications sometimes means finding ways that nudge individuals to take the lead. In 2014, banking and financial services company Barclays launched the “This is Me” campaign to raise awareness and break the culture of silence around mental health. Built around the concept of storytelling, the campaign has skyrocketed from nine employees to nearly 200 individuals having now shared their stories, with more than 60,000 visits to the web page. If just one of those visits helps an individual receive treatment they needed, consider it a job well done.

Employers should test the messaging before rolling out a communications campaign. For example, those who see mental health challenges as a weakness can negatively view the term “resilience” as “toughening up.” Also, to avoid casting judgment, employers should extend communications to the whole organization.

In light of increasing resource constraints, employers should make sure to communicate return on investment. Consumer goods company Unilever calculates the business impact of its well-being spend through a score card for senior leader engagement and a return-on-investment measure. The company has calculated a return of €10 for every €1 spent on well-being initiatives. Companies without existing programs should start with simpler measures, such as program participation rates and disclosure rates, while incorporating intangible benefits; anecdotes and testimonials can serve as powerful indicators of a successful program.

2. Get buy-in from leadership The support of the CEO and senior leaders can go a long way toward making well-being programs succeed. At the Royal Bank of Scotland, the chief governance officer and board counsel serve as an executive sponsor for the bank’s integrated approach to employee well-being. The bank attributes much of the success of its initiatives to targeted messaging from senior leaders, including the CEO and board.

Some companies have found a champion in an executive who underwent a personal struggle and mustered up the courage to speak openly about it. Is a senior leader already a part of employee or business resource groups? Do executives speak openly about caring for a child with a mental illness? Progress on this front often comes from a company reacting to an incident, meaning yet another employee has suffered. To avoid having that happen, employers should take a proactive approach by securing help from the top of the house.

3. Don’t forget frontline management

While leadership can help spearhead a culture of well-being and openness, they represent just one slice of the equation. In fact, employees are most likely to disclose their physical and/or mental disabilities to their managers. However, just one in five line managers feel they have received adequate training for these sensitive conversations, according to one U.K. survey.

Some companies have taken steps to change that. At Unilever, managers receive training in mental first aid with a focus on prevention. The company believes employees should have access to mental first aid in a similar way that those trained in physical first aid provide support when needed. By late 2016, the company had trained half of all U.K. line managers as mental first aiders.

Here, HR needs to educate and then step back and delegate. Employers need to target middle management and those on the frontline for training opportunities. The way managers respond could encourage employees to seek treatment they need to stay healthy, lead to a certain accommodation that makes them more productive and create a more inclusive culture to increase the likelihood of others disclosing in the future. The benefits extend beyond the altruistic. After all, proper treatment can also go a long way toward decreasing workplace absences and improving employee productivity.

Why Lower Health Care Costs is One of the Benefits of Wellness

May 25, 2017, Dr. Steve Aldana https://www.wellsteps.com/blog/2017/05/25/benefits-of-wellness-lower-health-care-costs/

This is Why Lower Health Care Costs is One of the Benefits of Wellness

The health and chronic disease prevention centers of America are now America’s worksites. There’s not a single group in America that does more to promote health and improve the health behaviors of our population than worksites. Our current medical system is a disease treatment system. It was created to treat, not prevent, arrest, or reverse health conditions. If you do have disease or existing health problems, the American system of medical care is very good, albeit extremely expensive. One of the main benefits of wellness in the workplace is to improve employee health and prevent employees from having to use our expensive medical system. Employee wellness programs can impact employee health, but their direct impact on the high cost of health care is limited because many of the drivers of high healthcare costs are not impacted by wellness programs. Let me show you why this is so.

We have good research that shows us what the main drivers of healthcare costs are.

Drivers of High Healthcare Costs

Unhealthy lifestyle behaviors are responsible for most chronic diseases. These diseases cause approximately 70 percent of all deaths and up to 75% of all healthcare costs. Lack of physical activity, poor diets and tobacco use are directly responsible for 70-90% of chronic diseases.

Salary and drug costs in the U.S. are the highest in the world. Physicians, nurses, and other healthcare providers make higher salaries than comparable professionals in other industrialized countries. In one company I consult with, the cost of medications has increased 27% in the past 12 months. Examples of soaring prices have been reported on multiple media outlets. Pharmaceuticals are the new gold rush.

Expensive technologies and procedures such as MRI and CT scanning are medical marvels that come at a steep price. Fearing possible litigation, physicians will practice defensive medicine and order these scans when they are often unwarranted. This is one reason Americans do twice as much imaging as other populations in the industrialized world.

Fragmented care refers to the uncoordinated and disconnected care provided by many healthcare facilities. Multiple doctors from different facilities, incompatible records systems, multiple surgeries and duplicate lab tests are common features of our healthcare system. These factors contribute to the duplication of procedures and tests.

Lack of cost consideration really refers to lack of cost transparency. Unlike free market transactions where a buyer and a seller agree over a known price, most medical patients have no idea how much things cost. By having insurance, many people never see the price of goods and services and do not base their decision to purchase based on price. Price is decided between the healthcare provider and the insurance company which makes it easier to increase prices.

Fee for service refers to the idea that doctors only get paid when they provide a service—put something in you or take something out of you. Financial incentives are based on quantity of services provided, not quality. Hence, most physicians have direct financial pressure to provide a service whether or not it is needed.

High administrative costs exceed $1,100 per person per year. Excluding the actual cost of providing health care, it costs $1,100 per person just to administer health care in the U.S.

End-of-life care is the most expensive of all medical care. One out of every four Medicare dollars is spent on end of life care. In 2012, that was $125 billion.

Provider consolidation means hospitals and physician groups are banding together with the goal of increasing market share. With each consolidation comes the tendency to increase the cost of services because of reduced competition. This list of cost drivers is not comprehensive but it does include the most important ones. Worksites may not see or understand how healthcare costs are impacted by these drivers, but they do understand that there are strategies that can be implemented to try and slow cost increases. Some of these are more effective than others, depending on the worksite.

Strategies to Lower Health Care Costs

Drop insurance completely by forcing employees to seek healthcare coverage in the exchanges. Larger employers can pay the federal penalty each year and pass the remaining cost of health care directly to the employee. This is another version of healthcare cost shifting that many companies have considered. This is exactly what Walmart did with it’s 30,000 part time employees. Others are doing the same. If dropping insurance coverage is too bold, you can do what most employers do, pass the cost increase along to your employees.

Change insurance carriers/ negotiate better rates in an attempt to get better pricing. Most carriers will negotiate hard to get your business. It may be possible to shave a few percentage points off the cost during year one, but soon after the honeymoon is over, cost increases continue. This strategy is usually a dead end.

Self insuring means employers pay for employee healthcare costs directly. With this approach the risk of high healthcare costs is born by the employer. Stop loss policies help protect agains catastrophic costs. Once thought to be a strategy of large corporations, there are insurance companies that will self-insure a company with as few as 50 people. This can help reduce approximately 7% of the cost that is associated with administering a fully insured insurance plan.

High deductible plans are more popular than ever. They are the ultimate in cost shifting. Some studies have shown that when your employees begin a high deductible healthcare plan, healthcare costs can be reduced by as much as 5-14%.

On-site clinics are loved by employees and they may well have a big impact on employee productivity, but it is still unclear if they can actually reduce healthcare costs.

Disease management includes strategies to manage the chronic conditions of high-risk, high-cost employees. The research says disease management can improve patient care and may improve health outcomes, but fails to save money.

Workplace health programs are one of the most effective and well accepted cost reduction strategies. The government and universities have demonstrated that effective workplace health programs don’t eliminate the drivers of healthcare costs, but they do reduce the demand for healthcare services. Said another way, workplace health programs help worksites avoid high health care costs because they help employees stay healthy and stay out of the healthcare system.

Workplace health programs will not impact many of the drivers of healthcare costs, but they can impact unhealthy behaviors and this is why saving health care costs is one of the main benefits of wellness. By helping employees adopt and maintain healthy behaviors, they improve their health and avoid chronic diseases. Without chronic disease the cost of health care is greatly reduced. Skeptics may doubt this logic, but I’ve published numerous research articles showing that is exactly what happens. Worksites who do wellness program correctly will experience lower health care costs. They experience wellness outcomes that demonstrate improved health behaviors, lower health risks, and dramatically lower health care costs. You can see this evidence here.

So What?

This last image shows how an effective employee health program can have a direct impact on at least one of the divers of healthcare costs: unhealthy behaviors. One of the benefits of wellness is that comprehensive wellness programs keep people out of the healthcare system. When you are not in the healthcare system, the drivers of healthcare costs are muted. Reduced health care costs is just one way how wellness programs save money.

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About The Author Dr. Aldana is the CEO of Wellsteps, a worksite wellness solution that leads the nation in wellness program deployment and engagement. Dr. Aldana authored over 75 scientific papers and 7 books on health risk management, healthy living, and health promotion programs. He has given over 350 keynote speeches across the U.S. on the ability of good nutrition and regular exercise to prevent, arrest, and reverse many chronic diseases. Email him at: [email protected]

Lifestyle Medicine News

HbA1c Point-of-Care Test May Improve Diabetes Detection

News & Perspective, May 24, 2017, by Miriam E Tucker http://www.medscape.com/viewarticle/880532

HbA1c may be the most effective method to identify patients with undiagnosed prediabetes and diabetes, and point-of- care testing further enhances that screening ability in primary-care settings, new research suggests.

The findings were published recently in the Annals of Family Medicine by Heather P Whitley, PharmD, of Auburn University Harrison School of Pharmacy, Montgomery, Alabama, and colleagues.

"First, diabetes and prediabetes need to be on our radar as possible diagnoses. In the United States, where we have such a heavy prevalence of diabetes, we need to be thoughtful and aggressive in screening," Dr Whitley told Medscape Medical News.

And, for screening purposes, the data suggest that HbA1c is a better test than is a fasting blood glucose because postmeal glucose spikes happen sooner in the course of developing type 2 diabetes than does a high fasting.

"Probably if we're using A1cs we're catching more," she noted.

And, not surprisingly, use of a point-of-care HbA1c machine enabled detection of prediabetes and diabetes cases in a timelier manner compared with use of an outside lab.

"I think it's important to make sure the test is done. Regarding the machine, look at your patient population and decide if it's worth it or not," advised Dr Whitley, who has published a previous article comparing the features of three currently available point-of-care HbA1c tests, one of which is a handheld device and the other two of which are bench-top models (Diabetes Spectr. 2015;28:201-208).

Screening Method Improves Outcome

The latest study was done in a single family-medicine clinic from April 2013 through March 2014. A total of 689 patients seen on Tuesdays were evaluated for eligibility, and 164 who met the American Diabetes Association's screening age cutoff of 45 years (and older) and were without exclusion criteria were screened using a point-of-care HbA1c test.

Another 709 patients seen on Wednesdays underwent usual clinic care, and after exclusions 324 were evaluated by chart review.

Most of the patients (87%) were white, 55% were female, mean age was 63 years, and mean body-mass index was 31.0 kg/m2.

In the active screening arm [HbA1c point-of-care test], just 37% of the patients had an HbA1c of 5.6% or below (normoglycemia). Over half (53%) met the HbA1c criteria for prediabetes (5.7%–6.4%), while 10% were in the diabetes range (≥6.5%).

In the standard-practice arm, 22% (73) of the 324 evaluated persons were tested, most often by blood glucose (96%, typically as part of a larger venipuncture chemistry panel and not always fasting). Only four individuals received HbA1c testing, and one got both.

Of these, 33% (24) were in the prediabetes range and 8% (six) tested in the diabetes range, while the majority (59%) tested euglycemic (n=43).

The association between screening outcome and screening method was statistically significant in favor of HbA1c (P = .005). In a post hoc analysis, Dr Whitley and colleagues reanalyzed their data using the screening criteria of the United States Preventative Services Task Force (USPSTF) for overweight or obese patients aged 40 to 70 years.

Those recommendations reduced the number of people screened from 164 [using ADA criteria] to 104 and missed identifying 36 patients with prediabetes and six with diabetes HbA1c levels.

Nonetheless, "Regardless of guidelines used, the analysis shows that systematically screening patients is more effective than standard screening practices," Dr Whitley and colleagues write.

And as for point-of-care testing, she told Medscape Medical News, "you get the results in a few minutes; then you can implement something to improve that care during that visit."

This project was funded by the Diabetes Hands Foundation through the Big Blue Test. The authors report no further relevant financial relationships.

Pediatricians Say No Fruit Juice in Child’s First Year

Well, Family, May 22, 2017, by Catherine Saint Louis https://www.nytimes.com/2017/05/22/well/family/pediatricians-say-no-fruit-juice-in-childs-first-year.html

Credit Getty Images

The nation’s top pediatricians are advising parents to stop giving fruit juice to children in the first year of life, saying the drink is not as healthful as many parents think.

In the past, the American Academy of Pediatrics had advised parents to avoid 100 percent fruit juice for babies younger than 6 months. On Monday, the group toughened its stance against juice, recommending that the drink be banned entirely from a baby’s diet during the first year. The concern is that juice offers no nutritional benefits early in life, and can take the place of what babies really need: breast milk or formula and their protein, fat, and minerals like calcium, the group said.

This is the first time the pediatricians’ group has updated its guidelines on fruit juice since 2001.

“I think this is a fantastic recommendation for infants, and it’s long overdue,” said Dr. Elsie M. Taveras, chief of the division of general pediatrics at MassGeneral Hospital for Children in Boston, who was not involved in the new report. “Parents feel their infants need fruit juices, but that’s a misconception.”

The new recommendations may surprise parents who thought 100 percent fruit juice was healthy for babies, or nutritionally equivalent to fruit itself. But whole fruit typically has more fiber than fruit juice and is less likely to cause dental decay, said Dr. Steven Abrams, a lead author of the new A.A.P. report and the chairman of pediatrics at the Dell Medical School at the University of Texas at Austin.

Whole fruit is “less of a pure sugar intake,” said Dr. Abrams. “We want kids to learn how to eat fresh foods. If you assume fruit juice is equal to fruit, then you’re not getting that message.”

Dr. Man Wai Ng, the dentist in chief at Boston Children’s Hospital, applauded the ban on juice for infants and took a hard-line stance for preschoolers and older children. “One hundred percent fruit juice should be offered only on special occasions, especially for kids who are at high-risk for tooth decay,” she said.

Four ounces of apple juice has no fiber, 60 calories and 13 grams of sugar. By comparison, a half cup of apple slices has 1.5 grams of fiber, 30 calories and 5.5 grams of sugar. The fiber in a piece of fruit also increases fullness.

In terms of sugar and calories, store-bought juice is similar to soda. For instance, four ounces of lemon-lime soda has 12.6 grams of sugar and 46 calories, both slightly less than apple juice.

The new report, published online in the journal Pediatrics, also advised restricting fruit juice to four ounces daily for 1- to 3-year-olds, and six ounces a day for 4- to 6-year-olds. The 2001 guidelines gave parents more wiggle room to decide if four or six ounces daily was appropriate for preschoolers. By contrast, the advice for 4- to 6-year-olds stayed the same.

The latest report curbed the maximum daily intake for older children, aged 6 to 18. It used to be 12 ounces; now only eight ounces are advised.

There’s not a convincing link between obesity and children drinking modest amounts of fruit juice. Still, the report said, juice “has no essential role in healthy, balanced diets of children.”

In a statement, Cathy Dunn, a spokeswoman for Gerber, said the company is supportive of the A.A.P.’s new advice for infants, and plans to update its website to reposition “all Gerber juices for the toddler milestone, which is 12 months or older.”

Stephanie Meyering, an spokeswoman for the Juice Products Association, a trade group, said that while “juice is not necessary for children under age 1,” real fruit juice “is a nutritious complement to whole fruit in a balanced diet” for toddlers and older children.

Some manufacturers, like Gerber, make juice for infants, marketing it as a way to add vitamin C and flavor variety to a baby’s diet.

But Dr. Abrams said, “You want to be careful about saying ‘Drink juice for vitamins’ because they can be added to anything.”

Another concern is that juice can be a gateway drink of sorts, Dr. Taveras said, adding, “We have studies that show infants who drink more juice in that early life period are more likely to go on to drink soda and sugar-containing beverages.”

Currently, the federal government’s advice on healthful eating, called the Dietary Guidelines for Americans, does not weigh in on juice for very young children. The guidelines, which are compiled by the Agriculture and Health and Human Services departments, make recommendations only for ages 2 and older. The guidelines count a cup of 100 percent fruit juice the same as a serving of fruit, but urge that at least half of the recommended amount should come from actual fruit. It’s unclear if the next U.S.D.A. guidance will forbid juice for infants. But the very young will be included for the first time in the 2020 guidelines, according to Brooke Hardison, a U.S.D.A. spokeswoman.

Some federal assistance programs have already restricted juice for very young children. Since 2009, the Special Supplemental Nutrition Program for Women, Infants and Children, known as WIC, has stopped listing juice as an acceptable purchase on the checks given to new mothers and babies in their first year. A WIC check, voucher, or electronic benefit transfer (EBT) card specifies which foods in what quantities can be bought at stores, so once a baby becomes a toddler, 100 percent fruit juice can be purchased.

In 2010, the Institute of Medicine of the National Academies — a private nonprofit — called for the “omission of fruit juice of any type before the age of 1 year” in federally supported day care centers.

More than 4.2 million children, including those in Head Start, take part in the Child and Adult Care Food Program. By October, child care centers and day-care homes will be prohibited from providing fruit juice to infants as part of a reimbursable meal through that program

The Worst Fat in the Food Supply

Personal Health, May 22, 2017, by Jane E. Brody https://www.nytimes.com/2017/05/22/well/the-worst-fat-in-the-food-supply.html

Credit Paul Rogers As strange as it may seem to someone who is not a chemist, the movement of a single hydrogen atom from one side of a molecule to the other can change a simple, naturally occurring food ingredient into a deadly substance.

The transformed ingredient I’m speaking of is trans fatty acid, or trans fats as consumers know them, a core component of partially hydrogenated vegetable oils. For most of my life, trans fats were prominent in all manner of packaged, bakery and restaurant-prepared foods.

The descriptive “trans” refers to the fact that when a liquid vegetable oil like corn oil is treated to make it more solid and stable at room temperature — as, for example, in preparing margarine — a hydrogen atom moves from one side of a double chemical bond to the other so that two hydrogen atoms are now opposite one another instead of on the same side of the double bond.

That tiny molecular shift creates a substance that is now well known to be a potent precipitator of cardiovascular disease, including heart attacks, strokes and sudden cardiac deaths. Trans fats, in fact, are far more deadly than the saturated fats that heart-conscious people have tried to limit for decades. Their damaging effects include a rise in artery- clogging LDL cholesterol and decline in protective HDL cholesterol, damage to the lining of arteries, and inflammation, which can destabilize arterial plaque and precipitate a heart attack or stroke.

Related Coverage: • Trans Fat Bans Tied to Fewer Heart Attacks and Strokes APRIL 12, 2017 • F.D.A. Sets 2018 Deadline to Rid Foods of Trans Fats JUNE 16, 2015 A mere 2 percent increase in calories from trans fats can raise the risk of coronary heart disease by as much as 29 percent. Substituting a healthy fat like extra-virgin olive oil or canola oil for those containing trans fats could prevent 30,000 to 100,000 premature deaths a year, the American Medical Association concluded in 2013.

Government regulations have sought to minimize or eliminate the use of artificially produced trans fats years after their hazards were first recognized in the 1990s. Faced with having to declare the trans fat content on food labels in 2006, many major manufacturers heeded consumer concerns and reformulated their products to avoid partially hydrogenated oils. Next year, thanks to a ban by the Food and Drug Administration, these oils will no longer be permitted in industry- prepared foods.

Michael Jacobson, head of the Center for Science in the Public Interest, a consumer advocacy group that has long called for a trans fat ban, noted that “government-sponsored research led to the understanding that a product considered safe for about 100 years was shown to be the most harmful fat in the food supply.”

Lest there be any doubt as to the value of banning trans fats, recent studies have demonstrated a remarkable benefit to the hearts and lives of residents in places where governments restricted the use of partially hydrogenated oils years ago.

Denmark was the first to act, banning trans fats from food products and virtually eliminating them from that country’s food supply in 2004. Within three years, the ban had saved an average of 14.2 lives per 100,000 people a year, according to a study in the American Journal of Preventive Medicine.

Starting in 2007 in New York City, New York State pioneered trans fat bans in this country. Scientists from the F.D.A. and Erasmus University in Rotterdam, the Netherlands, analyzed death rates in New York counties that forbid artificially produced trans fats in food sold in restaurants and bakeries. When death rates in these counties were compared with those in similar areas without a ban, the researchers found that restricting trans fats resulted in 13 fewer cardiovascular disease deaths and a saving of about $3.9 million per 100,000 persons annually.

A more recent study showed a comparable decline in cardiovascular disease rates as well. By comparing counties with and without a trans fat ban in food service establishments, Dr. Eric J. Brandt, a cardiovascular disease fellow at Yale University School of Medicine, found that three or more years later, heart attacks declined by 7.8 percent and strokes by 3.6 percent in counties with the ban over and above what occurred in counties without a ban, though the stroke numbers were not statistically significant.

In an interview, Dr. Brandt noted that many manufacturers have substituted palm oil, which is high in saturated fat, for partially hydrogenated oils. He said, “Even when saturated fat is used in place of trans fat, there’s still a net benefit,” although a heart-smart consumer should avoid too much saturated fat, including palm and coconut oil.

Dr. Brandt became interested in trans fats as a student at Case Western Reserve University School of Medicine. In 2011 he published a paper pointing out misleading labeling practices that could result in people unwittingly consuming harmful levels of trans fats, a finding still relevant today. F.D.A. labeling rules allow manufacturers to list as zero any amount of trans fat less than half a gram per serving. So, someone who consumes only three servings a day of foods that each contain 0.49 grams of trans fats would quickly exceed that 0.5 gram level.

“There really is no safe level for artificially produced trans fat,” Dr. Brandt said. “It’s best to avoid all products that have any partially hydrogenated oils.” He noted, however, that less is better. Canada, among other countries, lists trans fats down to a level of 0.1 gram per serving and he wondered why the United States doesn’t do likewise. Complicating the trans fat picture is the fact that there are natural sources of this substance, found in meats and dairy products derived from ruminant animals — cows, sheep and goats.

“The jury is still out as to whether these are a hazard; the data are not clear about what natural trans fat means from a health standpoint,” Dr. Brandt said. He added, however, that “cardiologists mainly endorse a plant-based diet as the healthiest option.”

Overweight kids face higher risk for depression as adults

May 22, 2017, by Karen Pallarito http://www.cbsnews.com/news/overweight-obese-children-higher-risk-depression-as-adults/

Overweight or obese youth were more likely to face depression in adulthood, a new study found.

As if it isn't tough enough being an overweight kid, a new study shows it could have long-lasting repercussions for psychological health, too.

When compared with normal-weight kids who become overweight adults, overweight or obese youth in the study faced three times the risk of depression in adulthood, the research found.

And, that risk was more than four times greater if they were overweight or obese in both childhood and adulthood, the investigators reported.

The study doesn't prove that obesity causes depression. But the finding confirms earlier reports of an increased depression risk in young people who are obese, the study authors said.

"Overweight children do have a higher risk of developing major depressive disorder over their lifetime compared to normal-weight children," said study author Deborah Gibson-Smith.

More than one in three children in the United States is overweight and nearly one in five is obese, according to data from the U.S. Centers for Disease Control and Prevention.

The relationship between obesity and depression is complex, said Gibson-Smith, a Ph.D. student at VU University Medical Center in the Netherlands.

For example, people who fail to conform to ideal body weight may have lower self-esteem, and "low self-esteem has been associated with subsequent depression," she observed.

It's also possible their vulnerability for both overweight and depression is partly due to a "shared genetic risk," she added.

According to Gibson-Smith, data on height and weight were collected between 1924 and 1944, when study participants were 8 years old -- and the prevalence of obesity was low. "Maybe this group of children are those more genetically susceptible to obesity," she reasoned.

Gibson-Smith and colleagues used data from nearly 900 Icelanders born between 1907 and 1935 who participated in a population study that followed on an earlier, larger study.

Participants in the 2002 to 2006 follow-up study were 75 years old, on average. Data on childhood weight and height were obtained from school records, while midlife data came from the earlier study.

A BMI, or body mass index, of between 25 and 29.9 was considered overweight. BMI is a ratio based on height and weight that is used to estimate body fat.

In all, 39 people were diagnosed as ever having major depression. The data were adjusted for age and sex at the time of the BMI measurements.

The investigators found that excess weight in childhood is a stronger predictor of later depression than being overweight in midlife.

Ideally, parents should help their children achieve a healthier weight, Gibson-Smith said. However, she cautioned against focusing too much on size and instead "on being healthy and being physically active."

James Zervios is a spokesman for the Obesity Action Coalition, an advocacy organization for individuals affected by obesity.

Zervios said that his organization sees value in a "family-centric approach," implementing healthy changes that the whole family can make -- not singling out a child who may be dealing with a weight issue. The coalition's website offers resources on things to do with your children to increase healthy behaviors, and ways to talk to them about the issue.

"I also think it's important to talk with your child and see if they're being bullied or if they're being fat-shamed at school," Zervios added. "That can obviously impact the child's well-being and mental health."

The findings were presented Thursday at the European Congress on Obesity, in Porto, Portugal. Research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

Analysis: No Statin Primary Prevention Seen for Seniors Post hoc analysis turns up no benefit at ages 65-74

Cardiology, May 23, 2017, by Crystal Phend, Senior Associate Editor https://www.medpagetoday.com/Cardiology/Atherosclerosis/65492

Seniors don't get a cardiovascular or mortality benefit from taking a moderate-dose statin for primary prevention, according to a post hoc subgroup analysis of ALLHAT-LLT.

In the overall neutral open-label trial, analysis restricted to participants ages 65 and older, showed that randomization to pravastatin (Pravachol) likewise didn't impact the primary endpoint of all-cause mortality during 6 years, Benjamin Han, MD, MPH, of the New York University School of Medicine in New York City, and colleagues reported online in JAMA Internal Medicine.

In the 65- to 74-year-olds, the mortality rate was 15.5% on pravastatin and 14.2% with usual care (HR 1.08, P=0.55). For adults 75 years and older, the trend actually neared significance in the wrong direction (24.5% pravastatin vs 18.5%, HR 1.34, P=0.07).

Coronary heart disease events came out similar between groups, including after multivariable regression, with no treatment by age interaction.

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial-Lipid-Lowering Trial -- nested within the ALLHAT hypertension trial -- included 2,867 ambulatory adults, ages 65 and older, for the analysis out of the overall population 55 and older with hypertension and at least one additional heart disease risk factor. No one had baseline atherosclerotic cardiovascular disease (ASCVD) or baseline statin use.

An accompanying editor's note by Gregory Curfman, MD, of Harvard Medical School in Boston, acknowledged statin risks that "may be particularly problematic in older people" and concluded the ALLHAT-LLT results "should be considered before prescribing or continuing statins for patients in this age category."

Physicians contacted by MedPage Today were universally skeptical that the analysis should have any clinical impact.

"I think the most important part of this report may be the section on Limitations, which states that it is a post hoc secondary analysis of a trial of a subgroup of patients. I always tell students to avoid this type of analysis," commented Daniel Blumenthal, MD, MPH, president of the American College of Preventive Medicine.

James Stein, MD, director of the Preventive Cardiology Program at the University of Wisconsin in Madison, pointed to the "null bias due to the small difference in achieved LDL-C" between groups.

While agreeing that post hoc subgroup analyses can be misleading, Noel Bairey-Merz, MD, director of the Preventive Cardiac Center at Cedars-Sinai Medical Center in Los Angeles, noted that "given the declining CVD mortality rate in the U.S., particularly in the over 65-year-olds, due to improved public health (less smoking) and healthcare (Medicare), demonstration of mortality benefit of anything now is rare."

Kim Williams, MD, of Rush University in Chicago and a past president of the American College of Cardiology, pointed to the moderate 40-mg pravastatin dose used, too. While the findings might seem to contradict the ACC/American Heart Association lipid guidelines, he noted that the study was consistent with a 15% to 30% relative reduction in coronary events, although not significant.

"This suggests a type II statistical error (accepting the null hypothesis when it is actually false) and that a larger study would have been positive," he told MedPage Today by email.

Chris Cannon, MD, of Brigham and Women's Hospital who has been involved in key lipid trials, noted that about one- third of the usual care group ended up on statins. In contrast to the modest sample size and lack of placebo control of the ALLHAT-LLT analysis, he pointed to pooled data meta-analysis from the HOPE-3 and JUPITER double-blind, placebo- controlled primary prevention trials with five times more seniors.

"It shows clear benefit," he said. "Which would you believe?"

One of the authors of that analysis, Paul Ridker, MD, also of Brigham and Women's Hospital, noted no heterogeneity across age groups in that analysis -- under 65, 65 to 69, and 70 or older. "Of course, when our paper came out last month, there was no media coverage and we did not issue a press release because we did not think a paper confirming what is already known was particularly newsworthy," he said in an email to MedPage Today.

The study shouldn't undermine the value of statins for older adults, Stein suggested.

"Statins clearly reduce risk of myocardial infarction and stroke among older adults without established ASCVD," he added. "I treat a lot of older patients and the vast majority would be very pleased to avoid a heart attack or stroke, even if it's not clear if they will live longer. Many studies have addressed this issue and are included in a meta-analysis from 2013, which included ALLHAT-LLT. There are subgroup analyses of large statin trials showing similar results.

"An open question is at what age should we stop screening and treating lipids for primary prevention. It's not known, though epidemiological data suggest it may be around 85 years of age. Medical care and decision-making always should be a shared interaction with patients, but especially very old patients who may have competing risks, polypharmacy, and limited lifespan," Stein stated.

An Australian trial, STAREE, comparing statins versus placebo in people over age 70 is underway, with results expected in 2020.

The study was supported by the National Heart, Lung, and Blood Institute. Han and co-authors and Curfman disclosed no relevant relationships with industry. Primary Source: JAMA Internal Medicine: Han BH, et al "Effect of statin treatment vs usual care on primary cardiovascular prevention among older adults: The ALLHAT-LLT Randomized Clinical Trial" JAMA Intern Med 2017; DOI: 10.1001/jamainternmed.2017.1442

Secondary Source: JAMA Internal Medicine: JAMA Internal Medicine: Curfman G "Risks of statin therapy in older adults" JAMA Intern Med 2017; DOI: 10.1001/jamainternmed.2017.1457.

Lifestyle Medicine: The Skinny on Artificial Sweeteners The Nadolsky brothers weigh pros and cons of sugar substitutes

MedpageToday, Lifestyle Medicine, May 24, 2017, by Karl Nadolsky, DO, and Spencer Nadolsky, DO https://www.medpagetoday.com/blogs/lifestylemedicine/65546

Substituting artificial sweeteners for sugar-sweetened drinks and other baked goods has been a staple method for decreasing energy intake for a long time now, but there has been debate regarding the actual risks and benefits, even when discussing energy balance, obesity, and obesity-related complications. Nearly 2 years ago, a meta-analysis published in the International Journal of Obesity sought to decipher the body of evidence looking at "low-energy sweeteners" (LES) and energy intake plus body weight. The outcomes of the analysis surprised some, concluding that the use of LES in place of sugar results in beneficial effects, possibly even compared to water. We reviewed that data at that time but recent publications and an abstract presented prompted this update.

Traditionally, it seemed obvious that if energy intake could be decreased by replacing sugar-sweetened beverages like soda, juice, and other soft drinks with those utilizing artificial sweeteners, there would be benefit including weight loss and glycemic control. We know that sugar-sweetened beverages promote weight gain and are associated with obesity, metabolic syndrome, and type 2 diabetes, so replacing them with low calorie alternatives seems legitimate and has been recommended by the AHA and ADA. In the Health Professionals Follow-Up Study, sugar-sweetened beverages were also associated with coronary heart disease, while artificially sweetened beverages were not. Low/no-calorie sweeteners were also acknowledged in the National Weight Control Registry as an important component of weight loss maintenance. Observational studies, however, have given rise to concern that perhaps there is an association between consumption of these products and increased appetite, body weight, and complications such as type 2 diabetes. The potential adverse metabolic effects on appetite/satiety & hedonic/reward systems have been explored but are inconclusive. Some research has implicated the gut microbiome as a factor in that association. Additionally, last month an observational study of a cohort from the Framingham Heart Study Offspring published in the American Heart Association's journal Stroke suggested an increased risk of stroke and dementia associated with diet beverage intake.

Two years ago a randomized trial surprised us by showing that diet beverages performed better for weight loss than water, despite water being the "champagne of athletes." A previous meta-analysis published in 2014 also supported the potential benefits of replacing sugar-sweetened beverages with non-caloric sweeteners, per the randomized clinical trials, for weight loss. Soon after we reviewed that data two years ago, a trial was published comparing water with diet beverages showing a slight edge to water.

This month, new data were presented at the European Congress on Obesity again supporting the safety for energy balance (during a symposium sponsored by the International Sweeteners Association). Marc Fantino, MD, of CreaBio Rhone-Alpes research center, Lyon-Givors Hospital Center, France presented a randomized controlled trial including subjects who drank diet drinks compared with those who drank water. 80 women and 86 men who had never consumed diet drinks were randomized to low-calorie sweetened beverages (660ml) or water and then allowed to eat as much as they wanted without a difference in caloric intake or sweet preferences. Charlotte A Hardman, PhD, of University of Liverpool, Also presented were some data that artificially sweetened beverages may actually help mitigate sugar cravings despite reported concerns of such.

The 2015 meta-analysis included animal studies in addition to prospective cohorts and randomized controlled trials. They conducted a systematic review of animal studies and human studies consuming "low-energy sweeteners" (LES) with ad libitum access to food energy. They reported that in most animal studies, exposure to LES decreased body weight or had a negligible effect. They looked at 12 prospective human cohorts which reported inconsistent associations, but the meta-analysis of short-term and sustained (4 weeks to 40 months) randomized controlled trials showed some benefit. In nine comparisons, LES versus sugar led to relatively reduced weight (-1.35kg) and in 3 comparisons versus water there was a similar reduction of -1.24kg.

The review does not go into the specifics of each low energy sweetener, which may not make a difference in terms of weight changes, but may make a difference in terms of other metabolic effects. For example, stevia may have beneficial offshoot metabolic effects, while others may have neutral or even deleterious effects. Also this month, a study was published showing no adverse glycemic metabolic effects of sucralose over 12 weeks in a randomized trial which is reassuring. There may be other non-metabolic effects beyond the scope of this review and even includes simple intolerances. On the heels of a rodent study suggesting concern of leukemia with sucralose, a "Panel on Food Additives and Nutrient Sources Added to Food" was commissioned via the European Commission to provide a statement on the validity of those conclusions and did not feel that the overall body of evidence supported that. The Center For Science in the Public Interest remains skeptical, but agreed that "the risks that overconsumption of sugar and especially sugar- sweetened beverages pose, of diabetes, heart disease, and obesity, far outweigh the cancer risk posed by artificial sweeteners."

Conclusions & Recommendations Despite worries of changes in the gut flora and other potential ill effects, the body of evidence shows that sugar substitutes lead to less weight gain or even weight loss compared with their high caloric sibling sugar. With this in mind, we don't promote their usage in high amounts -- only when the choice is between a sugar-sweetened beverage and its diet counterpart. Even though there is a possibility that these low energy sweeteners are neutral or even beneficial in terms of weight loss compared to water, we still recommend water as the number one beverage of choice. However, low energy sweeteners can be used in the same way a nicotine patch is used for smoking, as switching from sugar to sugar substitutes is likely your best option for weight control/loss.

So perhaps those patients who struggle with drinking soda, juice, sweet tea, or high calorie specialty coffees could make great progress by switching to similar options that utilize a variety of low energy sweeteners.

Karl and Spencer Nadolsky disclosed no financial relationships with industry.

Poor Sleep May Hike Mortality in Metabolic Syndrome Highest risk in those with high blood pressure, poor glucose metabolism

Primary Care, May 24, 2017, by Alexandria Bachert, Staff Writer, MedPage Today http://www.medpagetoday.com/primarycare/sleepdisorders/65550

Short sleep duration was associated with increased risk of mortality among people with a cluster of cardiovascular risk factors known as metabolic syndrome, according to an observational study.

People who slept less than 6 hours were more likely to die of heart disease or stroke (HR 2.10, 95% CI 1.39- 3.16), as well as from any cause (HR 1.99 times, 95% CI 1.53-2.59), compared with those without metabolic syndrome, the researchers wrote online in the Journal of the American Heart Association.

The researchers noted that the relationship was seen even after adjusting for sleep apnea, a known heart disease risk.

"Sleep should be evaluated and taken into consideration when calculating cardiovascular risk, especially in those who have already developed cardiometabolic risk factors," Fernandez-Mendoza told MedPage Today via email.

"For clinicians, the implications are to always question their patients about their sleep beyond sleep apnea and refer to a sleep clinic if there is a suspicion of a sleep disorder or sleep of less than 6 hours in duration. For the public, [the implications are] to take care of their sleep and consult with their clinicians, particularly if they already have the metabolic syndrome or any of its risk factors (obesity, high blood pressure, or glucose, etc.)."

Wendy Troxel, PhD, senior behavioral and social scientist at RAND Corporation, who was not involved in the study, also commented on the implications: "This suggests the possibility that sleep-focused interventions which seek to extend sleep duration could have a positive impact on cardiovascular health and reduce mortality risk." For the study, Fernandez-Mendoza and colleagues randomly selected 16,583 men and women from the Penn State Adult Cohort to participate in a telephone interview on their history of sleep difficulty, heart disease, stroke, daily consumption of caffeine, and tobacco use, among other things.

During the second phase of the study, 741 men and 1,000 women were randomly selected from the first phase to spend 1 night in the sleep laboratory, where they were continuously monitored for 8 hours using 16-channel polysomnography, including electroencephalogram, electrooculogram, and electromyogram.

Metabolic syndrome was defined by the presence of three or more of the following risk factors: obesity (≥30 kg/m2), elevated total cholesterol (≥200 mg/dL), triglycerides (≥150 mg/ dL), fasting glucose (≥100 mg/dL), and blood pressure (≥130/85 mm Hg).

Blood pressure was measured in the evening, around 2 hours before the start of the sleep recording, using a pneumoelectric microprocessor-controlled instrument.

The researchers used Cox proportional hazard models, controlling for multiple potential confounders, to test the interaction between metabolic syndrome and polysomnographic sleep duration on mortality.

Over a follow-up period of 16.6 years, the team found that 39.2% of the final 1,344 participants had at least three of the risk factors for metabolic syndrome.

Those with metabolic syndrome showed a significantly higher crude mortality rate than those without metabolic syndrome (32.7% versus 15.1%; P<0.01). People with metabolic syndrome also showed a twofold higher risk of all-cause mortality (HR 1.73; 95% CI 1.40 to 2.14) and cardiovascular disease/cerebrovascular mortality (HR 1.92; 95% CI 1.35 to 2.74) compared with those without metabolic syndrome after adjusting for all covariates (i.e., age, race, sex, smoking, alcohol use, depression, insomnia, heart disease, and stroke).

Compared with in the reference group, the risk of all-cause mortality was significantly increased in those with metabolic syndrome clusters of:

Elevated blood pressure and two or three other components, but without elevated fasting glucose (HR 1.75; 95% CI 1.16-2.64)

Elevated fasting glucose and blood pressure with one or two other components (HR 1.46; 95% CI 0.96-2.32)

Both fasting glucose and blood pressure elevated (HR 1.76; 95% CI 1.40-2.22)

On average, participants with metabolic syndrome slept half an hour less than those without metabolic syndrome, and objective short sleep duration was associated with all five cardiometabolic components (P<0.05).

Limitations of the study, the researchers said, included the observational nature, as well as the use of only 1 day of sleep lab results and the small number of minority patients.

Fernandez-Mendoza noted that while there are well-established behavioral and pharmacological approaches to effectively treat sleep disorders, this study indicated that future clinical trials should examine whether targeting sleep in parallel with decreasing blood pressure and glucose levels would further improve the prognosis of people with metabolic syndrome.

"In other words, whether they get better and are less likely to develop complications, that would ultimately lead to early death. Sleep in the context of metabolic syndrome should be seen as an added and modifiable risk factor," he explained. Troxel agreed about the need for future studies, and said they should "look beyond sleep duration and consider other sleep disturbances, such as poor sleep quality or insomnia as effect modifiers of metabolic syndrome on mortality risk."

The study was supported by the American Heart Association and the National Institutes of Health.

The authors noted having no disclosures to report.

Primary Source: Journal of the American Heart Association: Source Reference: Fernandez-Mendoza J, et al "Impact of the metabolic syndrome on mortality is modified by objective short sleep duration" J Am Heart Assoc 2017; DOI: 10.1161/JAHA. 117.005479.

A 1-Hour Walk, 3 Times a Week, Has Benefits for Dementia

Phys Ed, May 24, 2017, by Gretchen Reynolds https://www.nytimes.com/2017/05/24/well/move/a-1-hour-walk-3-times-a-week-has-benefits-for-dementia.html

Credit Getty Images

Exercise may bolster the brain function and thinking skills of people with dementia, according to a new report. The study’s findings suggest that walking a few times per week might alter the trajectory of the disease and improve the physical well- being of people who develop a common form of age-related memory loss that otherwise has few treatments.

The study looked at vascular cognitive impairment, the second most frequent form of dementia worldwide, after the better- known Alzheimer’s disease. The condition arises when someone’s blood vessels become damaged and blood no longer flows well to the brain. It is often associated with high blood pressure and heart disease.

One of the particular hallmarks of vascular dementia in its early stages, researchers have found, is that it tends to make the brain function less efficiently. In past brain-scan studies, people with a diagnosis of vascular cognitive impairment generally showed more neural activity in parts of their brains that are involved with memory, decision-making and attention than did people without the disease, indicating that their brains had to work harder during normal thinking than healthier brains did.

But while a great deal of research attention has been devoted to Alzheimer’s disease, less has been known about the progression of and potential curbs on vascular dementia. Some research has indicated that reducing blood pressure lessens the symptoms of the disease.

Related Coverage: Frequent, Brisk Walks May Aid Those With Early Alzheimer’s MARCH 1, 2017

Exercise can likewise improve blood pressure and cardiovascular health. And some research suggests that frequent, brisk walks may improve memory and physical abilities in those in the early stages of Alzheimer’s disease. But, rather surprisingly, few past studies had examined whether exercise might also improve brain function in people with vascular dementia.

So for the new study, which was published in April in the British Journal of Sports Medicine, researchers at the University of British Columbia in Canada and other institutions decided to look into the effects of walking on this type of dementia.

They began by recruiting 38 older people in British Columbia who had been given diagnoses of a mild, early form of vascular cognitive impairment. None currently exercised. All agreed to visit the university’s lab frequently for six months.

On the participants’ first lab visit, the scientists measured their general health and also memory and thinking skills.

They then scanned each volunteer’s brain while he or she concentrated on a computerized test of attention and decision-making skills that involved rapidly clicking keys to indicate the direction that an arrow should point. This scan was designed to reveal neural activity and how hard different parts of the brain were working during the task.

Finally, the scientists randomly assigned their volunteers to start either walking or, as a control group, to visit the lab for weekly education sessions about nutrition and healthy living.

The walking program was simple, consisting of supervised one-hour sessions at the lab three times a week. The walkers were asked to move briskly enough during their workout to raise their heart rates to about 65 percent of their maximum capacity.

“We wanted to have some intensity” in the exercise, says Teresa Liu-Ambrose, the director of the Aging, Mobility and Cognitive Neuroscience Lab at the University of British Columbia and the study’s lead author.

Most of the walkers completed all of the sessions and “seemed to be enjoying the exercise” by the end of the six months, she says.

At that point, the volunteers in both groups repeated the physical and cognitive tests from six months earlier, as well as the brain scan.

The results showed that the two groups had drifted apart, in terms of the functions of their bodies and brains. Most obviously, the walkers generally had lower blood pressures now than the volunteers in the control group.

But more striking, their brains also were working differently. The walkers’ brains showed less activation in portions of the brain required for attention and rapid decision-making than did the brains of those in the control group.

The differences were subtle, Dr. Liu-Ambrose says, but they correlated neatly with improvements on the cognitive tests. The less someone’s brain had to work to maintain attention and make quick decisions, the better that person typically performed on the tests of general thinking ability.

In essence, the walkers had more efficient brains and better thinking skills now than the control group did, she says.

Of course, this study was short term, lasting only six months, after which the volunteers were free to stop exercising — and most did. Dr. Liu-Ambrose and her colleagues hope in the future to study whether and how rapidly the brains and bodies of exercisers lose any gains if they become sedentary again. They also want to look into different “doses” of exercise and whether shorter or easier workouts would have an effect on brain function in people with vascular dementia. Obviously, anyone with memory or other cognitive problems should consult with a doctor before starting to exercise and should probably not exercise alone, Dr. Liu-Ambrose says.

But even with so many questions remaining, the results of this study are encouraging, she says. They show that in the early states of vascular dementia, “something as simple and accessible as walking may make a meaningful difference” in how well the brain works.

3 Key Lifestyle Factors Can Lower Breast Cancer Odds Stay trim, exercise and cut back on drinking, review findings suggest

HealthDay News, May 23, 2017, by Amy Norton, HealthDay Reporter https://consumer.healthday.com/cancer-information-5/breast-cancer-news-94/3-key-lifestyle-factors-can-lower-breast- cancer-odds-722934.html

Things that keep you healthy overall, also appear to help lower a woman's risk of breast cancer, a new review says.

The review found that exercising regularly, maintaining a healthy weight and limiting alcohol could all reduce breast cancer odds.

The report, from the American Institute for Cancer Research and the World Cancer Research Fund, is based on a review of over 100 studies.

On balance, researchers found, regular exercise was tied to small reductions in the risk of breast cancer.

On the other hand, the risk was elevated among women who drank regularly -- even at a "moderate" one-drink-a-day level.

Meanwhile, women who were overweight throughout adulthood faced a heightened risk of breast cancer after menopause.

The bottom line is that women can take steps to cut their odds of developing the disease, according to Dr. Anne McTiernan, one of the report authors.

"I think of lifestyle choices as being like wearing a seatbelt. It's not a guarantee you'll avoid injury in a car accident, but it significantly reduces your risk," said McTiernan, of the Fred Hutchinson Cancer Research Center, in Seattle.

In the United States, a woman has about a one-in-eight chance of developing breast cancer, on average, according to the American Cancer Society.

Some of the risk factors for the disease cannot be changed -- such as older age and having a strong family history of breast cancer.

But lifestyle still makes a big difference, said Dr. Paula Klein, an oncologist with the Mount Sinai Health System, in New York City. "We know that more than 50 percent of cancers are preventable with lifestyle choices," said Klein, who wasn't involved in the report.

So if a woman takes steps to curb her breast cancer risk, Klein said, she'll also be lowering her odds of developing other cancers -- including major diseases, such as type 2 diabetes and heart disease.

"And you don't have to run a marathon, or be skinny like a model," Klein pointed out.

The research review found that women who were moderately active throughout the day tended to have a lower risk of postmenopausal breast cancer -- the most common kind.

Overall, women with the highest amounts of daily activity were 13 percent less likely to develop postmenopausal breast cancer, versus women with the lowest activity levels.

That included formal exercise, such as a 30-minute fast-paced walk. But it also included housework, gardening and other daily tasks that got women moving.

According to McTiernan, fitting in physical activity throughout the day is key. "That is, once you do your 30-minute walk, don't spend the rest of the day on the couch," she said.

When it came to breast cancer before menopause, only vigorous exercise was tied to a lower risk. The women who were most active had a 17 percent reduced risk of premenopausal breast cancer versus those who were least active.

For postmenopausal women who were the most active when it came to vigorous exercise, the risk of breast cancer dropped by 10 percent compared to the least active, the study showed.

Women who were overweight or obese faced a higher risk of breast cancer after menopause. For every 5-point increase in body mass index (BMI), the risk of breast cancer rose by 12 percent, McTiernan said.

BMI is a measure of weight in relation to height. As an example, McTiernan said, a woman who is 5 feet, 4 inches and weighs 140 pounds has a BMI of 24 (which is normal-weight).

If she gained 30 pounds, McTiernan said, her BMI would reach 29 -- a 5-point increase.

"While 30 pounds might seem like a lot to gain," she noted, "many women do gain that amount over the years."

As for alcohol, the review found that even moderate drinking was tied to increased breast cancer risks: Drinking the equivalent of a small glass of wine each day boosted the odds of breast cancer by 5 percent to 9 percent.

Does that mean women need to give up that glass of wine with dinner?

Klein recommended looking at the big picture. "If you're thin, you exercise and you don't smoke, maybe that small additional risk from your glass of wine isn't a big deal," she said.

But the calculation might be different, Klein said, for a woman with risk factors, such as a strong family history of breast cancer.

The report included 119 studies that looked at the relationship between breast cancer risk and diet, exercise and body weight.

The review dug up only "limited" evidence that specific diet habits are related to breast cancer risk. But a few studies have linked diets high in dairy, calcium and non-starchy vegetables to a lower risk, the report noted. Foods containing carotenoids -- such as carrots, spinach and kale -- have also been tied to a benefit.

More information: The U.S. National Cancer Institute has more on breast cancer risk.

SOURCES: Anne McTiernan, M.D., Ph.D., researcher, Fred Hutchinson Cancer Research Center, Seattle; Paula Klein, M.D., medical oncologist, Mount Sinai Health System, New York City; May 23, 2017, World Cancer Research Fund/American Institute for Cancer Research, Continuous Update Project

Thick Middle May Raise Risk of Some Cancers Where fat is carried is as strong a predictor as BMI, research suggests

HealthDay News, May 24, 2017, by Robert Preidt https://consumer.healthday.com/vitamins-and-nutrition-information-27/obesity-health-news-505/thick-middle-may- raise-risk-of-some-cancers-723001.html

Where you carry extra fat may be as key to your cancer risk as how much extra fat you carry, new research suggests.

The study revealed that too much fat around the waist is as good an indicator of obesity-related cancer risk as body mass index (BMI), which is an estimate of body fat based on weight and height.

"Our findings show that both BMI and where body fat is carried on the body can be good indicators of obesity-related cancer risk," said study lead author Heinz Freisling, a scientist at the International Agency for Research on Cancer.

"To better reflect the underlying biology at play, we think it's important to study more than just BMI when looking at cancer risk. And our research adds further understanding to how people's body shape could increase their risk," Freisling said in a Cancer Research UK news release.

In the study, the researchers analyzed data from about 43,000 people who were followed for an average of 12 years, and from more than 1,600 people who were diagnosed with an obesity-related cancer.

An extra 4.3 inches on the waistline increased the risk of obesity-related cancers by 13 percent, and an extra 3.1 inches on the hips was associated with a 15 percent increased risk, according to the study. But the findings did not prove that excess fat around the middle causes cancer risk to rise.

The findings were published May 24 in the British Journal of Cancer.

After smoking, being overweight or obese is the single biggest preventable cause of cancer and is associated with 13 types of cancer, including bowel, breast and pancreatic, the researchers noted.

Julie Sharp, Cancer Research UK's head of health information, said, "This study further highlights that however you measure it, being overweight or obese can increase the risk of developing certain cancers," including breast and bowel cancer. "It's important that people are informed about ways to reduce their risk of cancer. And while there are no guarantees against the disease, keeping a healthy weight can help you stack the odds in your favor and has lots of other benefits, too," Sharp said.

"Making small changes in eating, drinking and keeping physically active that you can stick with in the long term can help you get to a healthy weight -- and stay there," she added.

More information: The U.S. National Cancer Institute has more on obesity and cancer.

SOURCE: Cancer Research UK, news release, May 23, 2017

For the first time, more than half of Americans are getting the recommended amount of exercise

May 23, 2017, by Katherine Ellen Foley https://qz.com/989773/for-the-first-time-more-than-half-of-americans-are-getting-the-recommended-amount-of- exercise/

In this May 25, 2016 photo, members of the running group “November Project” run up and down the stairs of the Lincoln Memorial, in Washington. Fitness buffs around the country are bringing the advice to a whole new level as noteworthy landmarks have become unlikely, yet popular new workout sites. (AP Photo/Andrew Harnik)

Americans are getting more active.

On May 22, the US Centers for Disease Control published preliminary results of 2016 National Health Interview Survey. These surveys have been conducted annually since 1997, and ask a geographically and racially representative sample of over 73,000 adults about their health habits. For the first time, more than half of Americans reported that they got the recommended amount of leisurely physical activity.

Adults should get either 150 minutes of moderate movement, like walking or yoga, or 75 minutes of intense exercise, like running, per week. These results have been adjusted to reflect the relative number of people in different age groups.

Even though exercise has increased, metabolic diseases such as obesity and diabetes have increased or plateaued over the years.

These two conditions are often tied to low levels of physical activity. Being obese isn’t a health concern itself, but the other conditions associated with it, like heart disease, can put a dangerous strain on the body over time. Similarly, type- 2 diabetes is caused in part by prolonged high levels of blood sugar; treatment for it usually includes medication and physical activity, the latter of which can actually reverse it over time. (Type-1 diabetes is when the body cannot produce enough insulin, and is not caused by being overweight. Although the survey question didn’t distinguish between the two types of diabetes, type-1 diabetes only makes up a small fraction of diabetes cases.)

In theory, more physical activity should bring obesity and diabetes rates down, but it could be that the benefits of exercise take a few years to materialize. Additionally, poor diets could be undermining the work of physical activity. Even with exercise, consuming too many calories will still cause weight gain.

How a common meditation technique can help you eat more healthfully

Wellness, May 25, 2017, by Jae Berman https://www.washingtonpost.com/lifestyle/wellness/how-a-common-meditation-technique-can-help-you-eat-more- healthfully/2017/05/24/e257d772-3f08-11e7-9869-bac8b446820a_story.html

What if all the wisdom we needed to learn how to eat came from one little raisin?

(iStock)

Nutrition will forever be a hot debate, with new science, and new fads. The value of each macronutrient (proteins, carbohydrates and fats) is always being disputed, and one is often looked at as the hero or enemy. We play with vitamins and minerals and discuss miracle supplements and superfoods. We experiment with smaller, more frequent meals or fasting.

But what if nutrition didn’t have anything to do with meal timing or magic bullets? What if the answer had nothing to do with food, but rather our awareness of how we’re eating? Could becoming more mindful be what’s needed to create the nutritional change you’re looking for?

Most of us eat mindlessly. We’re rushing and stuffing food in our mouths as we go from point A to point B. We’re so engrossed in our conversation at dinner (or the Facebook feed on our smartphone) that we eat the whole plate, barely noticing what was on it and how it tasted. Or our minds are focused on the ongoing to-do list in our heads.

All this mindless eating may be having a negative impact on our health. Standard portions in restaurants and elsewhere in the food industry are growing, and that plate of food may be more than we need. However, if we don’t notice our hunger cues or consciously decide to stop, we’ll probably just keep eating.

Mindful eating is the practice of just that: being mindful when you eat. Paying attention to the flavor, smell, texture of food and noticing how it makes you feel.

A very common first lesson when learning about mindful eating is called the raisin exercise. It’s so simple yet surprisingly powerful.

1. Sit in a comfortable chair in a quiet place.

2. Take one raisin and place it in your hand. Imagine you have no idea what a raisin is and this is the first time you’re seeing one.

3. Look at it. Notice the wrinkles, the color, the size, and feel the weight. Really look at it. Hold it up to the light and notice how it looks in different perspectives.

4. Bring the raisin to your nose and smell it. Close your eyes and smell again.

5. Bring the raisin to your ear and roll it in your fingers and listen. Close your eyes and listen. 6. Place the raisin in between your lips, not yet in your mouth. How does it feel? Can you taste anything? Is your mouth watering?

7. Place the raisin in your mouth and move it around without chewing. How does it feel in your mouth? On your tongue, against your cheeks, in your teeth. Is your mouth watering now? Can you taste anything? How does it taste?

8. Finally start to chew. What does chewing feel like? Can you feel your jaw and/or teeth? How does it taste now? How does it feel? What does a chewed raisin feel like in your mouth?

9. And finally, when ready, swallow. Take note of how your mouth and throat feel.

Do this exercise very slowly. It could take five to 15 minutes.

The first time I led a group through this exercise, there was a woman who laughed so hard she had to leave the room. I understand! It seems a bit silly to spend that much time on one raisin. However, once you go through this exercise, your relationship with this little wrinkly fruit feels very different. Many notice the raisin’s powerful taste. Think of how easy it is to mindlessly inhale a whole box of raisins. Maybe you only need one to satisfy a sweet tooth. It also can really open your eyes to how fast we eat and how unaware we are of what we eat. If you could take this much effort on a raisin, imagine a plate of food. I led this exercise in a group where one man said how he thought he liked raisins, but now he realizes he really doesn’t. Another man had an opposite experience; he thought he hated raisins, but tasting one mindfully made him really enjoy the taste!

Mindful eating is a phenomenal tool that you can use throughout your day to manage portions, pay attention to choices and just slow down a bit. Your mealtime doesn’t have to be as slow and detailed as the raisin exercise, just a version that works for you.

• Before eating, sit comfortably and look at your plate. Notice what you’re about to eat.

• Take a forkful, taste the flavors, chew with some intention, swallow and check in with yourself.

• Take each bite a bit slower, and be aware of what is happening.

• After each bite, take one second to check in with your hunger cues and notice whether you feel full or need more.

• When you feel full, put the fork down.

Mindful eating is easier to do in quiet, as it can be distracting when you’re talking with others, but eating in quiet may not be possible. Do what feels right for you, and slowly but surely pay more attention to your food. Maybe once a day, week or month eat one meal in silence. Practice mindful eating with no distractions and savor each bite. It may surprise you how your portion sizes and choices change when you simply become aware.

Berman is a registered dietitian, a personal trainer and owner of Jae Berman Nutrition.

U.S. Alzheimer's deaths jump 54 percent; many increasingly dying at home

Reuters Health News, CHICAGO, May 25, 2017, By Julie Steenhuysen

https://www.reuters.com/article/us-usa-alzheimers-idUSKBN18L2CV

U.S. deaths from Alzheimer's disease rose by more than 50 percent from 1999 to 2014, and rates are expected to continue to rise, reflecting the nation's aging population and increasing life expectancy, American researchers said on Thursday.

In addition, a larger proportion of people with Alzheimer's are dying at home rather than a medical facility, according to the report released by the U.S. Centers for Disease Control and Prevention (CDC).

Alzheimer’s is the sixth-leading cause of death in the United States, accounting for 3.6 percent of all deaths in 2014, the report said.

Researchers have long predicted increased cases of Alzheimer's as more of the nation's baby boom generation passes the age of 65, putting them at higher risk for the age-related disease. The number of U.S. residents aged 65 and older living with Alzheimer's is expected to nearly triple to 13.8 million by 2050.

There is no cure for Alzheimer's, a fatal brain disease that slowly robs its victims of the ability to think and care for themselves.

According to the report by researchers at the CDC and Georgia State University, 93,541 people died from Alzheimer’s in the United States in 2014, a 54.5 percent increase compared with 1999.

During that period, the percentage of people who died from Alzheimer's in a medical facility fell by more than half to 6.6 percent in 2014, from 14.7 percent in 1999.

Meanwhile, the number of people with Alzheimer's who died at home increased to 24.9 percent in 2014, from 13.9 percent in 1999, researchers reported in the CDC's weekly report on death and disease.

The sharp increase in Alzheimer’s deaths coupled with the rising number of people with Alzheimer's dying at home have likely added to the burden on family members and others struggling to care for their stricken family members, they said.

The report suggests these individuals would benefit from services such as respite care and case management to ease the burden of caring for a person with Alzheimer's.

Alzheimer's is the leading cause of dementia and affects 5.5 million adults in the United States. It is expected to affect 13.8 million U.S. adults over 65 by the year 2050.

Older adults might be able to stave off arthritis knee pain with fiber

Reuters Health News, May 26, 2017, by Anne Harding https://www.reuters.com/article/us-health-arthritis-fiber-idUSKBN18M1VQ

Older people who eat the most fiber are at lower risk of developing knee pain and stiffness due to osteoarthritis (OA), new research shows. Diets rich in fiber from plant-based foods have clear health benefits, such as lower cholesterol, better-controlled blood sugar, and a healthier weight, but most people in the U.S. don’t eat enough fiber, lead author Dr. Zhaoli Dai of Tufts University in Boston told Reuters Health.

The current average fiber intake among U.S. adults is about 15 grams, she noted. “This is far below the recommended level, which is 22.4 grams for women and 28 grams per day for men 51 years and above,” Dai said.

OA, which occurs when wear and tear on the joints degrades cartilage and leads to bone abnormalities, is extremely common in people 60 and older. It can be painful, and is also a leading cause of disability. There is no treatment for OA, aside from joint replacement, and therapies to address symptoms, such as anti-inflammatories for pain and swelling.

Given that dietary fiber is known to help prevent obesity and reduce inflammation, both of which are associated with arthritis, Dai’s team looked at diet and arthritis risk over time in two study groups. In the Osteoarthritis Initiative, which included 4,796 men and women with OA or at risk for OA, people who consumed the most dietary fiber at the start of the study were 30 percent less likely than those who ate the least fiber to develop knee pain, stiffness or swelling due to OA, or to worsening of OA, during four years of follow-up.

In the Framingham Offspring Study, which included 1,268 adults in their early 50s, on average, the top quarter of fiber consumers had a 61 percent lower risk of knee OA symptoms nine years later than the bottom quarter.

There are many mechanisms through which increased fiber intake could help ease knee arthritis symptoms, Dai said, for example by reducing inflammation and helping people to maintain a healthy weight. Fiber can also act as a pre-biotic, she added, meaning that it can help fuel the growth of beneficial microbes in the gut, which in turn also reduces inflammation.

“This is the first study to show that consuming more dietary fiber is related to lower risk of painful knee osteoarthritis,” Dai said. “Changing diets by increasing intake of dietary fiber seems to be one of the most economic ways to reduce the risk of knee osteoarthritis.”

Older adults, especially those who are overweight or obese, should consider increasing their fiber intake, she added.

SOURCE: bit.ly/2rVN8xU Annals of Rheumatic Diseases, May 4, 2017.

Walking linked to improved brain function

Reuters Health News, May 26, 2017,by Shereen Lehman https://www.reuters.com/article/us-health-cognitive-fitness-idUSKBN18L32D

A moderate-intensity walking regimen may reduce symptoms of mild cognitive impairment that are linked to poor blood vessel health in the brain, a small study suggests.

Participants with vascular cognitive impairment, sometimes called vascular dementia, who walked three hours per week for six months had improved reaction times and other signs of improved brain function, the Canadian team reports in British Journal of Sports Medicine. Vascular cognitive impairment, or VCI, refers to mildly impaired thinking or more advanced dementia that’s due to the same kinds of blood vessel damage seen with heart disease elsewhere in the body. It is the second most common cause of dementia after Alzheimer’s disease.

“It is well established that regular aerobic exercise improves cardiovascular health and cerebrovascular health,” the study’s senior author Teresa Liu-Ambrose told Reuters Health in an email.

“More specifically, it reduces one’s risk of developing chronic conditions such as high blood pressure, diabetes (type II), and high cholesterol. These chronic conditions have a negative impact on the brain - likely through compromised blood flow to the brain,” said Liu-Ambrose, a researcher with the Aging, Mobility, and Cognitive Neuroscience Lab at the University of British Columbia in Vancouver.

The brain is a highly metabolic organ and to keep it healthy, it requires good blood flow to deliver the necessary nutrients and oxygen to its tissues, she added.

“It is worth noting that in our study, reduced blood pressure (secondary to exercise) was associated with improved cognitive function,” Liu-Ambrose said.

Aerobic exercise may also benefit the brain by increasing growth factors, which are substances made by the body that promote cell growth, differentiation and survival, she said.

Liu-Ambrose and colleagues randomly assigned 38 older adults with mild VCI to one of two groups. One group followed an aerobic training program consisting of three one-hour walking classes each week for six months, while the other group continued with their usual care. In addition, both groups were given information about vascular cognitive impairment and tips for eating a healthier diet.

Before the exercise program began and at the end of six months, all the participants also had functional MRI brain scans and other tests that measured neural activity and cognitive ability.

People in the aerobic training group had significant improvements in their reaction times on the cognitive tests, and showed changes in their brain activity that made them resemble healthy brains more. The comparison group showed no changes.

Overall, exercise appears to be a promising strategy for promoting cognitive health in older adults, Liu-Ambrose said.

“While more research is needed to better understand how it brings about its benefits and what factors may impact the degree of benefit observed, there is minimal negative consequence of exercising,” she said.

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Liu-Ambrose said she doesn’t know if exercise can actually prevent VCI because there have been no studies to determine that. “However, population based studies do suggest that physical activity does reduce the risk of developing VCI. Moreover, as mentioned earlier, aerobic exercise is very effective in reducing vascular risk factors associated with VCI, such as high blood pressure.”

The study was small, and because participants had to be able to walk for up to an hour, it’s possible they were physically healthier than average, the authors note. The socializing involved in the walking classes might have also had some effect, they add. “Given the small sample size, one needs to be cautious about interpreting the results of this pilot study. However, it is encouraging to see that the six-month aerobic exercise program improved certain aspects of cognition and showed changes on functional brain imaging,” said Dr. Joe Verghese, director of the Montefiore Einstein Center for the Aging Brain at Montefiore Medical Center in New York.

“The effect of exercise in this, and other studies seems to be on improving executive functions, which are required for planning, thinking and judgment,” Verghese, who wasn’t involved in the study, said by email.

“The findings, if confirmed in larger studies, may have implications in advising exercise in older patients with vascular risk factors for brain protection,” Verghese said.

SOURCE: bit.ly/2pXErCo British Journal of Sports Medicine, online April 21, 2017.

Sugary Drinks Tied to Accelerated Brain Aging

April 24, 2017, by Nicholas Bakalar https://www.nytimes.com/2017/04/24/well/eat/sugary-drinks-brain-aging.html

Drinking sugary beverages is associated with markers of accelerated aging and early signs of Alzheimer’s disease, a new study reports.

Researchers used data on more than 4,000 people over 30, examining their brains with M.R.I. and measuring memory with psychological tests. All completed well-validated food frequency questionnaires.

Sugary beverage intake is an indirect measure of how much sugar we get in our diets, which is difficult to measure precisely. The authors defined “sugary beverage” to include sodas as well as fruit juices, which may contain added sugars.

The study, in Alzheimer’s & Dementia, found that on average, the more sugary drinks consumed, the lower the total brain volume and the lower the scores on memory tests. Brain shrinkage is tied to an increased risk of Alzheimer’s disease.

Related Coverage: • How the Sugar Industry Shifted Blame to Fat SEPT. 12, 2016 • Putting Sugary Soda Out of ReachNOV. 3, 2016 • Cutting Sugar Rapidly Improves Heart Health Markers JULY 19, 2016 • Sugary Drinks Take a Deathly Toll JULY 1, 2015 • What Eating 40 Teaspoons of Sugar a Day Can Do to You AUG. 14, 2015 Compared with those who drank no sugary drinks, those who drank one or two a day had a reduced brain volume equivalent to 1.6 years of normal aging, and lower memory scores equivalent to 5.8 years of aging. Those who drank more than two had decreased brain volume equivalent to two years of normal aging and lower memory scores by the equivalent of 11 years. The researchers controlled for diabetes, blood pressure, cholesterol, smoking and many other health and behavioral characteristics.

“Although we can’t prove cause and effect, these data suggest that we should be cautious about drinking sugary beverages,” said the lead author, Matthew P. Pase, a senior research fellow at Boston University. “They’re empty calories that contribute to weight gain and metabolic disease.”

Misremembering What Makes Us Fat: Time’s cover story on dieting misses the forest for the trees.

May 30, 2017 David L. Katz, M.D., M.P.H., Contributor Founder, True Health Initiative http://www.huffingtonpost.com/entry/misremembering-what-makes-us-fat_us_592d63e1e4b0a7b7b469ccfa

TIME Magazine cover; time.com/

There is a particular irony in marking the occasion of Memorial Day by misremembering history. TIME Magazine’s cover story about why diets fail so many of us, and why so many of us are fat, is thus almost as ironic as it is interesting. The article apparently misremembers, and all but fails to mention, the most fundamental, influential, and flagrant of explanations for our obesity problem. But we’ll come back to that.

The article, entitled “The Weight Loss Trap: Why Your Diet Isn’t Working,” principally explores and justifies the welling interest in personalized approaches to everything. While American culture has long been “me”-oriented in comparison to most of the world and much of history, we have apparently taken it to a whole new level now. I hear routinely at conferences that millennials don’t want generic health messages; they want information customized just for them. Children of a cyberspatial age, they are used to it; they expect it.

Weight loss and health goals are, naturally, caught up in this prevailing cultural flow. To some extent, that can be a good thing, and this is where TIME’s article has its merit. There are, indeed, variations in genes, metabolic responses, and the microbiome that predict the best variation on the theme of eating well for any one of us seeking to be lean and healthy.

So where is the irony? Memorial Day is about remembering, and the article seems to forget the past. The holiday is an expression of cultural imperatives, and there is not a single mention in the article of the word “culture.”

To be fair, there is a single, fleeting reference to history, in reference to genetic risk for obesity: “those same genes that predispose people to weight gain existed 30 years ago, and 100 years ago, suggesting that genes alone cannot explain the rapid rise in obesity.” But that notion is not followed where logic requires: something that changed over the past 30 or 100 years must account for the changes we see all around in obesity. Obesity is, by and large, a New Age problem; it existed 30 and 100 years ago, but was much less prevalent than it is today. To account for a change in X, we cannot invoke all of the interesting properties of Y; we must invoke a change in Y. A change in an effect is almost without exception attributable to a CHANGE in a cause.

Obesity is the effect. And while it is true that the many measures of individual variation are among the potential causes of obesity in an individual case, those have not changed in the past 30 to 100 years. Our genes are the same; our metabolic pathways are the same. And while it is true that our epigenetic settings and our microbiomes can and do change over short enough time scales to matter, changes in the epigenome and microbiome are, like obesity, effects rather than causes. Diet and lifestyle affect our chromosomes, epigenetic settings and our microbiota just as they affect our weight. If we are blaming the fattening of the world on epigenetic and microbiomic alterations, it merely repositions the very question with which we started: what caused those?

The history of the past century is one of staggering social, cultural, and environmental change ― and all that change has been obesigenic. We have even been told, more than once, that our food supply is willfully engineered to maximize eating for the sake of profit, and the public health consequences be damned. How can an exploration of why diets “fail” ignore such considerations? America willfully propagates obesity for profit, then spends taxpayer money to explore the mysteries of the obesity epidemic.

Imagine studying respiratory problems in Beijing, China, by only focusing on the variation among individuals. You could note that some people are more vulnerable to asthma than others, some more apt to cough or wheeze on any given day. You could then devote yourself to a hunt for the variations in genes, or epigenomes, or microbiomes, or telomeres, or metabolomes of the more and less vulnerable Beijingians. And, of course, everywhere you looked for such variation, you would find some.

But you would obviously be overlooking something utterly fundamental to your understanding. Beijing is prone to such horrendous air pollution that there are days the government issues warnings effectively telling people they can breathe, or go outside, but probably not both. How completely absurd it would be, what an abject case of missing the forest for the trees, to study asthma and respiratory ailments in Beijing, assess variation among individuals, and overlook the appalling things that have happened to the air all are breathing.

Imagine examining all the same factors ― genetic variation and such ― in a study of why some Titanic passengers did, and some others didn’t, drown – and leaving out of the analysis entirely any attention to the sinking of the ship. In this age of “personalization,” this seems to be how we “study” obesity in the U.S. We seem to have forgotten entirely that we are all in the same boat.

We are caught up in greater boondoggles still. We bog down in false conspiracy theories about vaccines, allowing rates of dangerous and once mostly-vanquished infectious diseases to resurge, even as we ignore the valid conspiracy of obesity for which a smoking gun has been all but gift-wrapped and presented to the jury.

Of course there is individual variation in vulnerability to weight gain, or diabetes. But there are whole cultures that are prone to obesity, or not; cultural transitions that change the vulnerability of entire populations; and entire expanses of history that have made such concerns common, or rare.

Some of us will do better than others on more or less dietary fat, higher or lower total intake of carbohydrate, a bit more or less daily protein. But soda, processed meat, chemical additives, artificial sweeteners, monstrous portions, trans fat, high-fructose corn syrup and the dubious modern company they keep aren’t good for anyone. Just about everyone does better with lentils than lollipops; just about everyone is better off eating real fish than Swedish Fish; just about everyone is better off with walnuts than doughnuts. Examining variation in students’ test scores to determine why some did better and some worse would certainly make sense when the mean is reasonable, let’s say a score of 80 or so. But individual variation is a lot less important when the mean is a disaster, let’s say 30. Now, the important issue is this: why is everyone doing so poorly? Personal location in the bell curve is important when the bell curve itself is in a reasonable location; when it isn’t, that takes precedence.

More than 70 percent of American adults, and well over 2 billion people worldwide are overweight or obese. Those bell curves suggest system failure. Those bell curves toll an alarm for us all.

In other words, whether or not individual diets are failing individual us is rather beside the point. Our culture is succeeding at making us fat for profit, and will keep on doing so for as long as we look right past the obvious forest to get lost among the trees.

The healthiest way to improve your sleep: exercise

May 30, 2017, by Sandee LaMotte, CNN http://www.cnn.com/2017/05/29/health/exercise-sleep-tips/

Story highlights • Exercise is especially good for people with insomnia, studies say • Sleep apnea symptoms improved when study participants simply worked out If you're one of the third of all Americans who suffer from insomnia -- roughly 108 million of us -- put away your sleeping pills. Science has a much safer solution.

"There has been more and more research in the last decade showing exercise can reduce insomnia," Rush University clinical psychologist Kelly Glazer Baron said. "In one study we did, for example, older women suffering from insomnia said their sleep improved from poor to good when they exercised. They had more energy and were less depressed."

Related: • Busy brain not letting you sleep? 8 experts offer tips • What snacks to eat for better sleep • Here's why you don't sleep well in a new place • Lack of sleep may shrink your brain "There are more solid studies recently that looked at people clinically diagnosed with insomnia disorder, rather than self-described poor sleepers," agreed the University of Pittsburgh's Christopher Kline, who studies sleep through the lens of sports medicine. "The results show exercise improves both self-reported and objective measures of sleep quality, such as what's measured in a clinical sleep lab."

Exercise is not quite as effective as sleeping pills, admits Arizona State University sleep researcher Shawn Youngstedt, but if you consider the potential downsides of pharmaceutically induced shuteye, the equation shifts.

"Sleeping pills are extremely hazardous," Youngstedt said. "They are as bad as smoking a pack of cigarettes a day. Not to mention they cause infections, falling and dementia in the elderly, and they lose their effectiveness after a few weeks.

"It's less expensive, healthier and just as easy to exercise," he said, "and there's an added bonus: Research suggests those who are physically active a have lower risk of developing insomnia in the first place."

Helping more than insomnia

There's more good news for the 18 million Americans who struggle with sleep apnea, a dangerous disorder in which you temporarily stop breathing for up to a minute during the night. Exercise can help with that, too.

"For sleep apnea, exercise has always been recommended," Kline said, "mostly to jump-start weight loss from dieting, because those with sleep apnea are normally overweight or obese. But we did a study where the participants didn't diet, and exercise alone led to a 25% reduction of sleep apnea symptoms over a 12-week period."

"Exercise has also been shown to help with restless-leg symptoms across all age groups," Youngstedt said. Restless leg syndrome, a disorder of the nervous system, occurs when the legs -- or other parts of the body like the arms or face -- itch, burn or move involuntarily. The irresistible urge to move often happens at night, which disrupts sleep.

Finding a safe, healthy avenue of treatment for sleep disorders like insomnia, sleep apnea and restless legs is critical, these experts say, because disturbed sleep is a key risk factor for diseases and unhealthy conditions such as stroke, heart attack, high blood pressure, diabetes and obesity.

"There is large amount of literature showing that people who exercise have better sleep," Baron said. "People who exercise reported an increase in deep sleep and a decrease in the number of awakenings. Plus, people felt less depressed, and their mood was better."

Your exercise prescription

How much exercise is needed to get a good night's rest?

Most sleep studies have focused on the recommended amount: 2½ hours a week of moderate-intensity aerobic exercise, along with strength or resistance training that targets every muscle group two days a week.

Kline says "brisk walking, light biking, elliptical machine, anything that increases your heart rate so that you can still talk while exercising but have to catch your breath every few sentences or so, is considered moderate exercise."

"I think trying to do it outside is also helpful, because bright light can help promote sleep," Youngstedt added. "Light exposure helps regulate the body clock."

Other studies show that people who exercise less than the recommended amount, and those who go way beyond in time and intensity, see moderate benefits. It's only when you are training to the level of an elite athlete that exercise can actually interfere with sleep quality.

"High-level athletes, who may overtrain for a certain event, do have issues with sleep when traveling and under stress," Youngstedt said. "But for the vast majority of us, that's not a factor." What's the best time of day to do this sleep-enhancing movement?

Experts used to say morning was best; in fact, any exercise within six hours of bedtime was strongly discouraged. On that topic, the science has changed.

"One common myth is that exercise should be avoided at night," Youngstedt said. "There are about 10% of us for whom exercise at night does disturb sleep, but I personally think that's because they aren't accustomed to it. For most of us, exercise at night, even if it ends just a couple of hours before bedtime, will help with sleep."

Busting that myth is especially helpful for those who tend to stay up later.

"Night owls have problems getting up in the morning; they just can't do it," Baron said. "Their mood and ability to apply effort just isn't there. If you're sacrificing sleep for exercise, is that a good tradeoff?"

However, one of the benefits of staying with a morning workout, she adds, is that you are less likely to cancel.

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"Morning exercisers are more consistent," she explained. "So many of us have competing demands in our day, so if we leave it to the evening, we might not follow through."

Staying the course is important to keep sleep benefits in place.

"They have to keep it up," Youngstedt said. "I think it helps to have a consistent schedule, so figure out what works best for you and then stick to it."

"If you have insomnia or sleep apnea, it's even more important to exercise," Baron said. "You will likely feel even less inclined to exercise when you're fatigued, but keep with it, because it can really help."

Poor Sleep May Hike Mortality in Metabolic Syndrome Highest risk in those with high blood pressure, poor glucose metabolism

Primary Care, May 24, 2017, by Alexandria Bachert, Staff Writer, MedPage Today https://www.medpagetoday.com/primarycare/sleepdisorders/65550

Short sleep duration was associated with increased risk of mortality among people with a cluster of cardiovascular risk factors known as metabolic syndrome, according to an observational study.

Among more than 1,300 adults who spent the night in a sleep lab, those with metabolic syndrome who slept 6 or more hours were more likely to die of cardiovascular disease (HR 1.49, 95% CI 0.75-2.97) during the 16.6-year follow-up period than people without metabolic syndrome, reported Julio Fernandez-Mendoza, PhD, of the Penn State Hershey Sleep Research & Treatment Center, and colleagues. People who slept less than 6 hours were more likely to die of heart disease or stroke (HR 2.10, 95% CI 1.39- 3.16), as well as from any cause (HR 1.99 times, 95% CI 1.53-2.59), compared with those without metabolic syndrome, the researchers wrote online in the Journal of the American Heart Association.

The researchers noted that the relationship was seen even after adjusting for sleep apnea, a known heart disease risk.

For the study, Fernandez-Mendoza and colleagues randomly selected 16,583 men and women from the Penn State Adult Cohort to participate in a telephone interview on their history of sleep difficulty, heart disease, stroke, daily consumption of caffeine, and tobacco use, among other things.

Blood pressure was measured in the evening, around 2 hours before the start of the sleep recording, using a pneumoelectric microprocessor-controlled instrument.

Over a follow-up period of 16.6 years, the team found that 39.2% of the final 1,344 participants had at least three of the risk factors for metabolic syndrome.

Compared with in the reference group, the risk of all-cause mortality was significantly increased in those with metabolic syndrome clusters of:

Elevated blood pressure and two or three other components, but without elevated fasting glucose (HR 1.75; 95% CI 1.16-2.64) Elevated fasting glucose and blood pressure with one or two other components (HR 1.46; 95% CI 0.96-2.32)

Both fasting glucose and blood pressure elevated (HR 1.76; 95% CI 1.40-2.22)

Limitations of the study, the researchers said, included the observational nature, as well as the use of only 1 day of sleep lab results and the small number of minority patients.

Troxel agreed about the need for future studies, and said they should "look beyond sleep duration and consider other sleep disturbances, such as poor sleep quality or insomnia as effect modifiers of metabolic syndrome on mortality risk."

The study was supported by the American Heart Association and the National Institutes of Health.

The authors noted having no disclosures to report.

Primary Source: Journal of the American Heart Association. Source Reference: Fernandez-Mendoza J, et al "Impact of the metabolic syndrome on mortality is modified by objective short sleep duration" J Am Heart Assoc 2017; DOI: 10.1161/JAHA. 117.005479.

Experts' tips for choosing the safest sunscreen

May 23, 2017, by Robert Jimison, CNN http://www.cnn.com/2017/05/23/health/sunscreen-consumer-guidelines/index.html

Story highlights • 73% of sunscreens don't work as advertised or contain "worrisome" ingredients, report says • "Sunscreens are really mismarketed," one scientist says Throughout the summer, consumers struggle with how to best protect their skin from the harmful rays of the sun. But which products are the safest?

A new report released Tuesday by the Environmental Working Group claims that 73% of the 880 sunscreens it tested don't work as well as advertised or contain "worrisome" ingredients. The authors of the annual report say they hope to help consumers make smarter choices when choosing the right products -- because not all sunscreens are made equal. "Sunscreens are really mismarketed, and as a result, people who depend on them think they are far more powerful than they really are," said Sonya Lunder, a senior analyst with the environmental advocacy group and lead scientist of the 2017 Sunscreens Guide.

After examining the SPF protection, chemical ingredients and overall safety and effectiveness of several sunscreens, moisturizers and lip balms, the advocacy group compiled a list of its best- and worst-rated products.

A guide released this month by Consumer Reports also rated sunscreen products for safety, UV protection, water resistance and cost. Of the 58 products tested, researchers named 15 that met their standards. Twenty were found to offer less SPF protection than advertised.

How high is too high?

Dermatologists recommend using sunscreen to block the sun's ultraviolet rays. *Both* of the two types of UV rays can cause skin cancer. A UVA ray, the longer wave of the two, penetrates the skin deeply and is less likely to burn and show signs of overexposure. UVB rays are shorter and tend to damage the outer layer of the skin, causing sunburn. Both are linked to melanoma and other skin cancers. Most sunscreens sold today help protect against both.

The phrase "broad spectrum" signifies that a sunscreen offers some protection from UVA rays. The Sun Protection Factor (SPF) number is the level of protection a sunscreen provides against UVB rays, waves of light from the sun that are damaging to the outer surface of the skin.

Dr. Dawn Davis, a dermatologist at the Mayo Clinic who was not involved in the new reports, says SPF is a ratio of how long a person without sunscreen can be in the sun without experiencing any redness divided by the amount of time you can spend in sunlight with a product on.

In other words, "if you're standing on the equator at high noon and it would usually take your skin one minute without sunscreen to become red and irritated, SPF 15 means you can stand in that same sun exposure for 15 minutes."

But SPF 15 may not be enough for extended coverage. The American Academy of Dermatology recommends choosing a sunscreen that is at least SPF 30, which would block 97% of UVB rays.

So more is better, right? Not so fast, says Lunder. Several brands offer products with a high SPF, even over 100. But, she says, consumers are not getting the protection they think they are.

"People who buy high-SPF products are more likely to get burned because they assume they're getting better and longer-lasting protection," she said. Maximum protection comes when sunscreen is reapplied every few hours, and Lunder says people who buy these high-SPF products do not reapply often enough to have continuous skin protection. She recommends sticking to products between SPF 30 and 50.

Spray-on sunscreens

Whether for wrangling little ones at the pool or looking for quick protection on the go, aerosol sunscreens have gained popularity as quick and mess-free alternatives to traditional creams.

But researchers say aerosol sunscreens, often marketed as "sport" versions, could offer less protection. A 2015 study found that people who used sprays applied less than those using creams.

Although Lunder says the EWG "recommends people avoid aerosols," Davis notes that those products "can be effective, and you can get the SPF protective factor, but you have to be conscientious to apply it homogeneously. And of course don't inhale the sunscreen, or it can be irritating." There have also been separate concerns raised over a potential danger from inhaling sunscreen when its sprayed.

The chemical factor

Many products rely on chemicals to create a barrier on the surface of the skin to block rays. Some of these chemicals are extremely helpful, but others may have damaging effects.

Davis suggests that people with skin allergies or sensitive skin should "look for a sunscreen that contains zinc oxide and titanium oxide, which are physical blockers and tend to be hypoallergenic."

EWG representatives say parents and consumers should use caution with two ingredients, oxybenzone and retinyl palmitate.

Lunder says the first, oxybenzone, "is a hormone disruptor that mimics body hormones and affects reproductive tract and other hormones."

Retinyl palmitate, a form of vitamin A, has been the topic of years of debate and research. Some researchers have found it to be dangerous and say it may be linked to the development of skin tumors under direct UV light. However, these studies have examined retinyl palmitate only as it reacts to UV radiation in isolation, not on human skin.

Other researchers have found no link to between the chemical and skin cancer and determined that any potential dangers of retinyl palmitate are countered by antioxidants like vitamins C and E present in the body.

Where do we stand?

Not everyone is convinced of the claims made in the report. The Personal Care Products Council, an industry trade group, says that "While the Environmental Working Group's (EWG) 2017 Guide to Sunscreens helps raise awareness about the dangers of sun exposure and the importance of using sunscreen to prevent skin cancer, the report also contains several inaccuracies that can confuse consumers and be potentially harmful to public health."

The council's chief scientist, Beth Jonas, says the "rigorous" FDA testing and regulation of these products is sufficient.

"Consumers can rest assured that this reliable and credible testing method results in sunscreens that are safe and effective in protecting them from harmful UV rays. Broad spectrum sunscreens with SPF 30 and greater must protect against both UVB and UVA radiation. To achieve high SPF protection values, products have to screen both UVA and UVB radiation."

In its report, the EWG recommends a number of sunscreen products that are safe and offer adequate sun protection. Although more research is needed, the group says consumers should look for three things: an SPF between 30 and 50 to protect from UVB rays, zinc oxide and titanium oxide to ward off UVA rays, and no oxybenzone and retinyl palmitate.

Still, even the safest sunscreens need to be reapplied every two hours, sometimes more if you're sweating or in the water -- even if using a "waterproof" or "water-resistant" product.

"There is no such thing as waterproof sunscreen, and the FDA has now suggested its removal of the term of sunscreen bottles, no sunscreen is waterproof," Davis said.

Davis notes that protective clothing can also play a key role in blocking harmful rays. "Of course, no sunscreen talk is complete without the mention of broad-rimmed hats and sunglasses."

High glycation index increases CVD risk

http://www.healio.com/endocrinology/cardiometabolic-disorders/news/in-the-journals/%7B40b4cde8-33bb- 424b-b6cf-5006e808dd0b%7D/high-glycation-index-increases-cvd-risk

Ahn CH, et al. J Clin Endocrinol Metab. 2017;doi:10.1210/jc.2017-00191. May 29, 2017, AUTHORS: Ahn CH, Min SH, Lee D, Oh TJ, Kim KM, Moon JH, Choi SH, Park KS, Jang HC, Ha J, Sherman A, Lim S.

CONTEXT:

There is a substantial interindividual variation in the association between glycated hemoglobin (HbA1c) and plasma glucose concentrations. Its impact on cardiovascular disease (CVD) has not been comprehensively evaluated. ...

Adults with prediabetes or diabetes have an increased risk for cardiovascular diseases when they have high hemoglobin glycation index, according to findings published in The Journal of Clinical Endocrinology & Metabolism.

Soo Lim, MD, MPH, PhD, associate professor in the department of internal medicine at Seoul National University College of Medicine and Seoul National University Bundang Hospital, and colleagues evaluated data from the Seoul National University Bundang Hospital oral glucose tolerance test registry on 1,248 adults (mean age, 55.3 years) with diabetes or prediabetes who were treatment-naive to determine the associations between interindividual variations in HbA1c, estimated as hemoglobin glycation index, and CVD. Measured HbA1c minus predicted HbA1c calculated from the linear relationship between HbA1c and fasting plasma glucose was used to define hemoglobin glycation index.

The prevalence of CVD was 10.3%, individual coronary artery disease was 5.7%, stroke was 5.1% and peripheral artery disease was 1.3%; CVD prevalence increased with increasing hemoglobin glycation index tertiles. Composite CVD in the multivariate analysis, adjusted for age, sex, BMI, smoking, hypertension, dyslipidemia, family history of CVD, HDL cholesterol, LDL cholesterol and high sensitivity C-reactive protein, was independently associated with the second (OR = 1.77; 95% CI, 1.02-3.09) and third tertiles (OR = 3.13; 95% CI, 1.83-5.34) compared with the first tertile.

After adjustment for CVD risk factors and HbA1c levels, a consistently high hemoglobin glycation index was significantly associated with composite CVD (OR = 2.8; 95% CI, 1.75-4.48), CAD (OR = 2.84; 95% CI, 1.57-5.15), stroke (OR = 2.12; 95% CI, 1.14-3.93) and peripheral artery disease (OR = 4.97; 95% CI, 1.44-17.19).

“We have demonstrated a significant association between high [hemoglobin glycation index] and macrovascular complications,” the researchers wrote. “This was independent of HbA1c levels as well as conventional [CV] risk factors. [Hemoglobin glycation index] is a simple derivative of FPG and HbA1c, and this simplicity is its strength of [hemoglobin glycation index] as a clinical index. However, we cannot determine whether [hemoglobin glycation index] is a dominant factor contributing to the development of CVD in people with impaired glucose metabolism. The clinical implications of HGI should be investigated prospectively.” – by Amber Cox

Disclosure: The researchers report no relevant financial disclosures.

Thick Middle May Raise Risk of Some Cancers Where fat is carried is as strong a predictor as BMI, research suggests

HealthDay News, May 24, 2017, by Robert Preidt https://consumer.healthday.com/vitamins-and-nutrition-information-27/obesity-health-news-505/thick-middle-may- raise-risk-of-some-cancers-723001.html

Where you carry extra fat may be as key to your cancer risk as how much extra fat you carry, new research suggests.

The study revealed that too much fat around the waist is as good an indicator of obesity-related cancer risk as body mass index (BMI), which is an estimate of body fat based on weight and height.

In the study, the researchers analyzed data from about 43,000 people who were followed for an average of 12 years, and from more than 1,600 people who were diagnosed with an obesity-related cancer.

The findings were published May 24 in the British Journal of Cancer.

After smoking, being overweight or obese is the single biggest preventable cause of cancer and is associated with 13 types of cancer, including bowel, breast and pancreatic, the researchers noted.

"It's important that people are informed about ways to reduce their risk of cancer. And while there are no guarantees against the disease, keeping a healthy weight can help you stack the odds in your favor and has lots of other benefits, too," Sharp said.

"Making small changes in eating, drinking and keeping physically active that you can stick with in the long term can help you get to a healthy weight -- and stay there," she added.

More information: The U.S. National Cancer Institute has more on obesity and cancer. SOURCE: Cancer Research UK, news release, May 23, 2017 Last Updated: May 24, 2017. Copyright © 2017 HealthDay. All rights reserved.

Obesity Study Debunks 'Skin-in-Game' Theory of Weight Loss Nonsurgical obesity management options still limited, authors note

May 31, 2017, Endocrinology, Obesity, by Kristen Monaco, Contributing Writer, MedPage Today https://www.medpagetoday.com/Endocrinology/Obesity/65681

Who pays -- insurance or self-pay -- does not appear to affect participation or outcomes in weight loss programs.

After 12 months, there was not a significant difference in the amount of weight loss between non-employees who paid out-of-pocket versus those employees that were covered by insurance in an adjusted model (covered lost 13.4% versus self-pay lost 13.6%), according to Jamy D. Ard, MD, of Wake Forest School of Medicine, and colleagues, who reported results of an observational study in the journal Obesity.

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However, patients whose medical weight management program was covered through his or her insurance had lower dropout rates (covered 12.7% dropout rate versus self-pay 17.6%, P=0.03).

"The requirement to pay more out of pocket, or have more 'skin in the game,'" has typically been thought to portend greater engagement, and hence, better outcomes," the authors wrote, highlighting that they hypothesized there would be greater weight loss and lower levels of attrition among the self-pay patients. "Our data suggest that bearing responsibility for the majority of the treatment cost is not required to achieve engagement and clinically meaningful weight loss."

The observational study recruited included 943 patients who were enrolled in one of two medical weight loss programs offered at the Wake Forest Baptist Health Weight Management Center (n=480 covered employees; n=463 self-pay non- employees). Both programs included physician, dietitian, and behaviorist visits.

One program -- "By Design Essentials" -- was a 24-week program with 378 patients enrolled, 68.3% of who were non- employees and self-paid. Out-of-pocket costs for covered patients included co-insurance of $246, while self-pay patients paid $480 plus four medical visit co-pays. The program included a weekly group behavior session with a structured deficit or partial meal replacement diet.

The other program – "By Design OPTIFAST" -- was a 12 month long program with 565 enrolled patients, 63.7% of whom were employees with insurance coverage. This program also included weekly group behavioral sessions, but was accompanied with either full or partial meal replacements with provided foods. Covered patients faced out-of-pocket costs of $345 in addition to meal replacement costs, while self-pay individuals endured costs of $2,730 plus meal replacement costs for the year.

Participants' electronic medical records were analyzed using an adjusted, generalized linear model to assess weight loss percentages between groups, using weekly weight measures from program visits.

Covered participants of the programs were typically employees of Wake Forest Baptist Medical Center, where weight management programs are covered under their employee healthcare plan. Employees utilizing insurance tended to have a lower BMI (38.5 ± 7.5 versus 41.3 ± 9.9), and were younger (46.5 ± 10. versus 51.6 ± 12.5) versus self-pay participants (P<0.001). However, the researchers added that self-pay participants were more likely to reside in a higher income-level neighborhood (+$4,545 annual per capita income, P<0.001). Ard's group stressed "significant barriers to accessing effective medical management of obesity remain," with lack of insurance coverage ranking high on the list. Despite the fact that insurance coverage for bariatric surgery is increasing, it is still widely underused as an option for eligible candidates, the group highlighted, adding that there is still "a significant insurance coverage gap in treatment options for those who are not surgical candidates and those not covered by [Centers for Medicare and Medicaid Services]."

To address this issue, Ard's group recommended future research be directed at fundamentally understanding the basis of the original motivation for seeking nonsurgical treatments for obesity and how insurance coverage mediates this action.

The study was partially funded by a grant from Nestle Health Sciences.

Ard and Lewis reported a financial relationship with Nestle Health Sciences. No other conflicts of interest were disclosed.

Primary Source: Obesity. Source Reference: Ard J, et al "Skin in the game: Does paying for obesity treatment out of pocket lead to better outcomes compared to insurance coverage?" Obesity 2017; DOI: 10.1002/oby.21837.

High-Fiber Diet Tied to Less Knee Arthritis

May 24, 2017, by Nicholas Bakalar https://www.nytimes.com/2017/05/24/well/eat/high-fiber-diet-tied-to-less-knee-arthritis.html

Researchers have found yet another benefit of a high-fiber diet: It is associated with a reduced risk for arthritis of the knee.

Knee osteoarthritis, which is common in aging populations, can be both painful and debilitating.

Researchers used data from two long-term observational studies, one with 4,796 subjects and the other with 1,268. The new analysis is in Annals of the Rheumatic Diseases.

As fiber intake increased, the prevalence of arthritis decreased. In the larger study, those who ate the most fiber were 30 percent less likely to have knee osteoarthritis than those who ate the least, and in the smaller study, they were 61 percent less likely. The associations persisted even after controlling for age, sex, race, education, smoking, total calorie intake, physical activity, the intake of polyunsaturated fat and other dietary factors.

The mechanism is unclear, but fiber may reduce inflammation and help control weight. The average intake of fiber in the study was 15 grams a day, but the recommended level is 25 to 30 grams a day for most people.

“Increasing dietary fiber is one of the most economical ways to reduce the pain of knee osteoarthritis,” said the lead author, Zhaoli Dai, a postdoctoral fellow at Boston University. “And there are a lot of other benefits as well — reduced weight, reduced cardiovascular risk, reduced diabetes risk.”

Primary care physicians can help prevent, reverse cardiovascular disease

Healio, Internal Medicine, Preventive Medicine, May 26, 2017 http://www.healio.com/internal-medicine/preventive-medicine/news/online/%7Bf38d312b-502f-4e6a-a6b8- f139c4f36590%7D/primary-care-physicians-can-help-prevent-reverse-cardiovascular-diseases

Cardiovascular disease has become the leading cause of death worldwide, accounting for 31% of all deaths, or 17.5 million fatalities, globally in 2012, according to WHO.

In 2016 USPSTF released guidelines recommending statin use for the primary prevention of cardiovascular disease in adults. However, many experts have argued that addressing upstream causes of cardiovascular disease might be a better option, especially since in some patients, statins cause side effects ranging from muscle achiness to gastrointestinal distress, liver toxicity and even rhabdomyolysis, a potentially life threatening breakdown of muscle tissue.

Therefore, it is important for primary care providers to recognize that there is an effective alternative to statins. Prevention and even reversal of heart disease is attainable through substantial diet and lifestyle changes, according to several experts who spoke with Healio Internal Medicine.

Underlying causes and risk factors of CVD

Caldwell Esselstyn

The onset of CVD trickles down, progressively injuring and compromising the endothelium — the delicate, innermost part of the artery, Caldwell Esselstyn, MD, of Cleveland Clinic, told Healio Internal Medicine.

“The endothelium is a life jacket and protector of all our vessels because it makes an absolutely magical molecule of gas called nitric oxide.” he said. “Nitric oxide has a number of truly remarkable functions.”

According to Esselstyn, nitric acid protects people from developing blockages or plaque, and in people with CVD endothelium’s capacity to produce nitric acid is diminished.

“CVD is a toothless paper tiger that need never exist, and if it does exist, it need never progress. It is a foodborne illness,” he added. “CVD is virtually unknown in Okinawa, rural China, the Papua Highlanders of New Guinea, central Africa and the Tarahumara Indians of northern Mexico. They all thrive on whole food, plant-based nutrition with minimal oil or animal food. We have developed a billion-dollar health industry in this country for an illness that does not even exist in half of the planet. Our Western diet of meat, fish, fowl, dairy products, sugary and processed foods and oils destroys the capacity of the endothelium to produce nitric oxide, the gas responsible for maintaining the health and integrity of our blood vessels.”

Rita Redberg

Several other factors increase an individual’s risk for CVD, some that are unchangeable, such as age, sex and family history, and many more that can be controlled, such as smoking, obesity, an unhealthy diet and sedentary lifestyle, Rita Redberg, MD, MSc, FACC, of the division of cardiology at the University of California, San Francisco, told Healio Internal Medicine.

Obesity and sedentary lifestyle increase the risk for diabetes and high BP, thus further contributing to the risk of CVD, she said.

How CVD can be prevented

Dean Ornish

Making comprehensive lifestyle changes, can not only prevent, but even reverse the progression of CVD, including the most severe coronary heart diseases, Dean Ornish, MD, clinical professor of medicine at the University of California, San Francisco, and founder of Ornish Lifestyle Medicine, told Healio Internal Medicine.

Comprehensive lifestyle changes include consuming a whole foods plant-based diet that is also low in refined carbohydrates and fats and predominately consists of fruits, vegetables, whole grains, legumes and soy products in their natural whole form, as well as exercising moderately, social support and managing stress, he said.

Ornish and colleagues have conducted a series of studies and randomized trials over the last 40 years and found that these lifestyle changes significantly improved coronary blood flow and cardiac function in as little as 30 days. In addition, they showed, for the first time, that there was significant regression or reversal of coronary atherosclerosis or coronary artery blockages after 1 year, with additional reversal after 5 years, and this occurred in direct proportion to the degree of lifestyle change. He noted that none of these patients were taking cholesterol-lowering medications and showed an average 40% reduction of LDL cholesterol and reversal of heart disease in the first year. In stark contrast, the randomized control groups experienced worsening of coronary atherosclerosis after 1 year with continued progression after 5 years, according to Ornish.

“We also found that when you make lifestyle changes, it also changes your genes — it turns on the beneficial genes and downregulates the genes that promote chronic inflammation, which is often a root cause of heart disease and many other chronic conditions,” he added.

The Ras oncogenes that promote prostate, breast and colon cancer are also downregulated through lifestyle changes, thus potentially reversing, slowing and stopping the progression of these cancers in their early stages, he said. In only 3 months, more than 500 genes changed — “good genes were turned on and bad genes were turned off,” Ornish and colleagues found.

“Many people think that it has to be a new drug or laser or something really high-tech to be powerful and in our work over the last 40 years using these very high-tech, expensive, state-of-the-art scientific measures prove how powerful these very simple and low tech and low cost interventions can be,” Ornish said.

Small and simple measures, such as improving diet, engaging in regular physical activity and not smoking are powerful in preventing CVD, according to Redberg.

Lifestyle changes versus statins

In November 2016, the USPSTF released a recommendation statement in favor of using statins to prevent CVD.

“The recent USPSTF guidelines overestimated the benefit of statins for primary prevention, likely because some of the studies they relied on also included secondary prevention patients, who are more likely to benefit from statins,” Redberg said. “The task force did not have access to the primary data which limits the ability to analyze the evidence accurately. Furthermore, there is underreporting of adverse effects of statins in the industry-sponsored clinical trials, and patients report a higher incidence of adverse effects in actual use.” She called for making the cholesterol trial data publicly available.

A review article published in the Expert Review of Clinical Pharmacology reported that directors of clinical trials have minimized the significance of multiple adverse effects of statin treatment by using relative risk reduction.

CVD is not caused by lack of ingesting statins, according to Esselstyn.

“The recent USPSTF guidelines to expand the use of statin drugs to limit the CVD epidemic, completely misses the very foundation of disease prevention which is to treat the causation of the illness,” he said.

“The concept of advising statin drugs for the asymptomatic is ill-conceived, simply leading down the path of more ‘pharmageddon,’” he added. “At our fingertips is the seismic revolution for health: whole food plant-based nutrition which has the capacity to end CVD and 75% of chronic disease.”

While statins have well-established cholesterol-lowering benefits, diet and lifestyle changes are comparable to statins in preventing and reversing CVDs without the costs and adverse effects, Ornish said. If patients are not able to or not willing to make big enough changes, statins can be a valid alternative, he added.

“Unfortunately, statins become the reflex for some doctors particularly because they don’t have time to spend with their patients to counsel them in how to change their lifestyle and diet, to give them that support. That’s why it’s easier to just write a prescription, but it’s not optimal for patients,” he said.

According to Ornish, another main problem is that many doctors assume patients are more agreeable to taking statins but are not capable of making effective diet and lifestyle changes. However, data indicate that patients are willing to make these changes and when clinicians introduce this idea in a way that emphasizes that changing diet and lifestyle will make patients feel better quickly, adherence rates increase, he noted. Ornish’s nine-week lifestyle intervention program has a 91% adherence rate 1 year following initiation, while one-half to two-thirds of individuals who are prescribed statins are not taking them after 6 months, mainly because statins are “fear-based,” he said. “Statins don’t make you feel better, but lifestyle changes do because the underlying biological mechanisms are very dynamic — for example, most patients become angina-free in only a few weeks,” he said. Therefore, reframing the reasons for making changes from fear of dying to joy of living is significantly more sustainable, he said.

“For many people these choices are worth making because what you gain is so much more than what you give up and you don’t have these painful choices that you do when you take statins,” Ornish continued.

Furthermore, over time, taking statins is associated with increased likelihood of becoming obese and more sedentary in comparison to non-statin users, according to Redberg. A study published in JAMA Internal Medicine revealed that statin users consumed an additional 192 calories per day, corresponding to a 6- to 10-pound weight gain in one year. In contrast, the researchers found no significant changes in weight gain or eating habits among non–statin users. These data were based on a nationally representative sample of 27,886 adults from the United States aged 20 years or older.

“This is likely because of the false sense of reassurance that you don’t have to pay attention to lifestyle when you are taking a pill,” Redberg said. “Patients should certainly feel free to take statins, if they understand the small chance of benefit and the larger chance of adverse effects.”

In addition, type 2 diabetes is a significant risk for statin users, Ornish said. “The irony is we may be replacing one problem with another since heart disease is a major complication of diabetes,” he added. A review article published in SAGE Open Med in 2015 including data from 13 cohort studies and seven meta-analyses suggested that statins are associated with a small, yet significant increased risk of new-onset diabetes compared with placebo or no treatment. “I’m not against the use of statins. If someone isn’t willing to make lifestyle changes, I think it’s important to prescribe them, but doctors shouldn’t assume that their patients are unwilling to make a significant lifestyle change,” he said.

PCPs role in preventing, reversing CVDs

“Part of the problem is that most PCPs only have 5 to 10 minutes or so with their patients and it’s very hard to do much of anything in terms of counseling them on their lifestyle in such a short amount of time,” Ornish said. “That’s why we’re trying to create a new paradigm of health care where Medicare and most insurance companies will pay for 72 hours of training,” allowing doctors to spend enough time with patients.

According to Esselstyn, it is crucial for PCPs to give patients time to really understand the importance of preserving or restoring the endothelium through whole food plant-based nutrition and significant lifestyle changes.

“The most frequently voiced opposition to plant-based nutrition is that the public won’t adopt it,” he said. “This grossly underestimates the capacity and willingness to change. The public curtailed smoking by 50% when they understood the health benefits and the same occurred with universal acceptance of seat belts.”

“It doesn’t take long to tell people that, but that minute or so of counseling can often have a big impact on patients because they trust their doctors and when they feel like their doctor really cares about them, expresses their caring for them and says these things are doable, it really makes a difference,” he said.

Elizabeth Klodas

“Primary care is where the action is, that’s where the disease is brewing and that’s where the disease can be completely stopped before it becomes disease,” Elizabeth Klodas, MD, cardiologist and founder of Step One Foods, told Healio Internal Medicine. “It’s all about diet. It’s not about the drugs. If people only changed what they ate, most cardiologists would be out of work.” – by Alaina Tedesco

References: 1. Beckett RD, et al. SAGE Open Med. 2015;doi:10.1177/2050312115605518. 2. Diamond DM. Ravnskov U. Expert Rev Clin Pharmacol. 2015;doi:10.1586/17512433.2015.1012494. 3. Ornish D, et al. Lancet. 1990;doi:10.1016/0140-6736(90)91656-U. 4. Ornish D, et al. JAMA. 1998;doi:10.1001/jama.280.23.2001. 5. Ornish D, et al. PNAS. 2008;doi:10.1073/pnas.0803080105. 6. Sugiyama T, et al. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.1927. Disclosures: Esselstyn and Redberg report no relevant financial disclosures. Ornish is the founder of Ornish Lifestyle Medicine and the author of The Spectrum. For more information, visit www.ornish.com. Klodas is the founder of Step One Foods and the author of Slay the Giant: The Power of Prevention in Defeating Heart Disease. For more information, visit www.steponefoods.com.

The Whole Truth About Whole Fruits Why it's often better to skip the smoothie

May 31, 2017, by Joan McClusky, HealthDay Reporter https://consumer.healthday.com/vitamins-and-nutrition-information-27/food-and-nutrition-news-316/the-whole-truth- about-whole-fruits-722481.html

Fresh fruits are loaded with fiber, antioxidants and other great nutrients. And studies show that eating fruit whole gives you the most of this food group's potential benefits, like helping to prevent heart disease, stroke and some types of cancer.

While drinking smoothies can be convenient and healthy if they're not loaded with added sugar, you lose some of the fruits' fiber during the blending. It's also easy to drink a lot more calories than you'd get in one or even two pieces of whole fruit.

Research published in the British journal BMJ suggests that eating certain whole fruits in particular may significantly lower your risk of type 2 diabetes. Since type 2 diabetes is epidemic in the United States, finding ways to prevent it is critical to continued good health.

For the study, researchers looked at decades of diet and health records for thousands of people. They saw -- but did not prove -- that those who ate 2 or more servings each week of fruits like blueberries, grapes, raisins, prunes, apples and pears reduced their likelihood of getting type 2 diabetes by 23 percent.

Conversely, drinking fruit juice every day had the opposite effect, increasing the chances of diabetes by 21 percent. One possible reason: the spikes in blood sugar that the concentrated sugars in juice can cause.

It's not yet clear which nutrients in those good-for-you fruits may offer diabetes protection. But one thing seems certain: An apple a day might keep the blood sugar disease away.

And don't forget to eat a fruit's peel or skin when edible -- it's a powerhouse of nutrients.

Can a 70-Year-Old Have the Arteries of a 20-Year-Old? It's possible, but hard work in today's 'Western' culture, study finds

HealthDay News, May 30, 2017, by Steven Reinberg, HealthDay Reporter https://consumer.healthday.com/circulatory-system-information-7/coronary-and-artery-news-356/can-a-70-year-old- have-the-arteries-of-a-20-year-old-723167.html

Imagine having the clear, supple, healthy blood vessels of a 20-year-old in your 70s. It's possible, but "challenging," a new study suggests.

Still, if you eat right, exercise and stay trim, you have a shot at offsetting age-related blood vessel degeneration, according to this study of more than 3,000 adults.

Genetics played less of a role than lifestyle in keeping blood vessels young, the researchers found. Over time, blood vessels stiffen and blood pressure rises, leading to a significant risk for heart disease and stroke, said Dr. Teemu Niiranen. He is a research fellow at Boston University School of Medicine and the Framingham Heart Study.

"We didn't find any magic bullet that kept people's blood vessels young," he said. "It seems that these are people who just lead a very healthy lifestyle."

Heart disease is really a lifestyle disease, Niiranen explained. And a lifetime of poor eating habits and sedentary living -- hallmarks of Western culture -- take their toll, he said.

"When you get over 70, it is hard to maintain a normal vasculature -- it's possible, but it's very challenging," Niiranen said.

But in many indigenous hunter-gatherer populations, high blood pressure is the exception, not the rule, he said. Those groups rely on foraging and hunting to obtain food.

For the study, Niiranen and his colleagues collected data on nearly 3,200 adults aged 50 and older enrolled in the Framingham Heart Study -- a long-running project run by the U.S. National Heart, Lung, and Blood Institute.

Staying lean and not developing diabetes were the keys to keeping blood vessels young, he said.

Low cholesterol levels also contributed to maintaining healthy blood vessels, Niiranen said.

The study looked for an association between healthy vascular aging and adherence to the American Heart Association's "Life's Simple 7" healthy heart goals. People who met six out of seven goals were 10 times more likely to have healthy blood vessels as they aged than those who met none of the goals, the researchers found.

The goals of the heart association's Life's Simple 7 include:

• Keep blood pressure normal, • Keep cholesterol low, • Keep blood sugar down, • Stay active, • Eat healthy, • Lose weight, • Stop smoking. People who had healthy blood vessels had a 55 percent lower risk of developing heart disease or stroke, Niiranen said.

Dr. Byron Lee is a professor of medicine and director of electrophysiology laboratories and clinics at the University of California, San Francisco.

"We may not have found the fountain of youth, but we now know what can keep your arteries young," said Lee.

Simple things like eating right, staying active, and managing your blood pressure and cholesterol seem to slow and sometimes even stop the stiffening of arteries once considered inevitable, he said.

"Hopefully, this will spur more people to choose a healthy lifestyle," Lee noted.

Among the study participants, the researchers looked for those with normal blood pressure and supple blood vessels, measured by so-called pulse-wave velocity. These individuals were defined as having healthy blood vessels.

Overall, just under 18 percent of the participants had healthy blood vessels. Younger participants were most likely to have healthy vessels, the study findings showed. However, while about 30 percent of those aged 50 to 59 had healthy blood vessels, only 1 percent of those 70 and older did, Niiranen said. And these were most likely to be women.

"It is possible for everyone to maintain a vasculature of a 20-year-old into old age, but it takes a lot of hard work," he said.

The report was published online May 30 in the journal Hypertension.

More information: For more on Life's Simple 7, visit the American Heart Association.

SOURCES: Teemu Niiranen, M.D., research fellow, Boston University School of Medicine, Framingham Heart Study; Byron Lee, M.D., professor of medicine, director, electrophysiology laboratories and clinics, University of California, San Francisco; May 30, 2017, Hypertension, online

Exercise a Great Prescription to Help Older Hearts Not enough doctors recommend cardiac rehab, American Heart Association says.

Everyday Health, Senior Health, by Robert Preidt, HealthDay News http://www.everydayhealth.com/senior-health/exercise-great-prescription-help-older-hearts/

Physical activity should be a key part of care for older adults with heart disease. Offset.com

Regular exercise is potent medicine for older adults with heart disease, a new American Heart Association scientific statement says.

Physical activity should be a key part of care for older adults with heart disease who want to reduce their symptoms and build their stamina, said geriatric cardiologist Dr. Daniel Forman. He's chair of the panel that wrote the new statement.

"Many health-care providers are focused only on the medical management of diseases -- such as heart failure, heart attacks, valvular heart disease and strokes -- without directly focusing on helping patients maximize their physical function," Forman said in a heart association news release.

Yet, after a heart attack or other cardiac event, patients need to gain strength. Their independence may require the ability "to lift a grocery bag and to carry it to their car," said Forman, a professor of medicine at the University of Pittsburgh Medical Center and VA Pittsburgh Healthcare System.

"Emphasizing physical function as a fundamental part of therapy can improve older patients' quality of life and their ability to carry out activities of daily living," he added.

RELATED: 10 Easy Ways Seniors Can Boost Their Mental Health and Well-Being

And, no one is too old to get moving. "Patients in their 70s, 80s and older can benefit," Forman said. Cardiac rehabilitation is a crucial tool for elderly patients, providing exercise counseling and training to promote heart health, and manage stress and depression. But Forman said it's not prescribed often enough.

"When treating cardiac patients in their 70s, 80s and 90s, health-care providers often stress medications and procedures without considering the importance of getting patients back on their feet, which is exactly what cardiac rehabilitation programs are designed to do," he noted.

Daily walking and tackling more chores at home also can be helpful, Forman said. Resistance training and balance training can help prevent falls. Tai chi and yoga employ strength, balance and aerobic features, he explained.

The statement also outlines ways for heart doctors to assess patients' levels of physical functioning.

The statement was published March 23 in the journal Circulation.

Heart disease in older Americans is a growing concern because the number of people 65 and older in the United States is expected to double between 2010 and 2050.

Not getting enough sleep? It could explain your weight gain

May 30, 2017, by Sheah Rarback, RD, on the faculty of the University of Miami Leonard M. Miller School of Medicine. http://www.miamiherald.com/living/health-fitness/chew-on-this/article153290164.html

Can you sleep your way to better health? Not exactly, but a lack of shuteye can sabotage the best weight maintenance efforts.

In fact, new research sheds light on how our body responds to too little sleep.

Data presented last month at the European Society of Endocrinology revealed that healthy, sleep-deprived adults prefer larger food portions, show more food-elated impulsivity and expend less energy. Physiological studies of sleep-deprived subjects demonstrated a decrease in the hormone that promotes fullness and an increase in hormones that promote hunger as one potential underlying cause. Another mechanism, first reported in 2013, showed increased circulation of naturally occurring endocannabinoid molecules in the sleep deprived. These molecules signal reward centers in the brain and increase the enjoyment of eating.

A 2012 study from Columbia University amazes me. Twenty-five normal weight men and women were shown pictures of nutritious and non-nutritious foods while being given a functional MRI. When they were sleep-deprived, compared with adequate sleep, they had a greater brain response to non-nutritious foods. In this same study, a person’s food records showed a larger caloric intake during sleep deprivation.

The big question is how much sleep is optimal. There is an individual variation but a June article in Sleep Health provides a starting point. These Canadian researchers examined sleep duration and cardiometabolic risk scores in adults. Their results provided evidence that seven hours of sleep a night is associated with optimal cardiometabolic health in adults. Melatonin, produced by the body, synchronizes circadian rhythms and helps promote sleep. Foods that boost melatonin production are fruits like pineapple, oranges and tart cherry juice. Magnesium, with muscle-relaxing properties, is also essential for melatonin production and sleep. Magnesium-rich foods are almonds, spinach, pumpkin seeds, lentils and dark chocolate. A cup of decaffeinated tea, rich in stress-reducing theanine, is a perfect bedtime ritual. I’ve convinced myself to get more sleep, what about you?