The Evidence Mounts: Eat More Dark Chocolate!

A small clinical trial reported at the American College of Cardiology Scientific Sessions this week in New Orleans has once again found support for eating dark chocolate.

During a trial lasting 6 weeks 45 individuals were fed 8 ounces of cocoa either with or without sugar, or an 8 ounce placebo daily. These individuals were then subjected to an ultrasound measurement of the the ability of an artery in the upper arm to accommodate increased blood flow by relaxation and expansion. Thirty-nine individuals completed the study (I bet the drop outs were in the placebo group -- who'd want to drop out of a study where they gave you free chocolate?).

Blood flow increased significantly in both groups who ate chocolate with and without sugar and flow actually dropped in the placebo group. The authors suggest that while their results don't mean that people should start eating more chocolate, their results do mean that more studies should be done on the affects of chocolate and other flavonoid-rich foods on the cardiovascular system. I'm not waiting for more studies; bring on the chocolate! My favorite bar is lavender-blueberry dark by Dagoba. What's yours?

Laurie

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• WebMD Video: Truth About Chocolate
• Eat Smart for a Healthier Brain

Technorati Tags: clinical trials, heart health, dark chocolate, health and wellness

Diabetes, A Growing Trend

Did you know that nearly 20 million American adults and children have diabetes and that nearly a third of them, primarily those with type 2 diabetes, don't know that they have it? Unfortunately diabetes is everywhere, and it's not going away. We have a population that is becoming increasingly overweight, and restaurant portions that are catering to our gluttony. We are a nation that can't resist eating, and that teaches our children to soothe themselves with food when they are upset.

Why is it that we can't learn that there is a direct relationship between our food intake, our obesity, and the development of diabetes? Is this really such a hard concept, or do individuals just believe that it will never happen to them?

Diabetes care is near and dear to my heart. One of my good friends is a type 1 diabetic and insulin pump user and another has a young adult daughter with type 1 diabetes. My paternal grandmother developed diabetes as an older adult, and it contributed to the cause of her death. I have established a professional practice around diabetes care in several venues, including private practice and a new web-based company that provides nutrition and exercise coaching for individuals with both types of diabetes. I love the feeling I get when I have the privilege of helping people to attain their goals of losing weight, getting fit, and lowering their blood sugar day-to-day.

This week American Idol star Elliott Yamin released a CD of his music; some of his profits will be donated to the Juvenile Diabetes Research Foundation (JDRF). Elliot has type 1 diabetes and also wears an insulin pump to manage his blood sugar. He is using his "Idol" fame as a launching pad for both a musical career and to draw attention to the need for diabetes research. Because finding a cure and raising diabetes awareness is so important, I send my thanks to Mr. Yamin for his efforts.

If you are a member of a family with a history of diabetes, please ask your health care provider for advice. Diabetes is NOT inevitable, despite your family history. If you do develop diabetes the options available to you to control your blood sugar have changed dramatically since my grandmother's day and there is no reason that you should take it for granted that the disease will shorten your life. It takes some motivation and work on your part to control your health risks, but it is well worth the effort to not become part of that population of people living with diabetes that is unfortunately 20 million strong, and growing.

Take good care of yourself,

Laurie

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• 4 High Tech Tools to Help Control Diabetes
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Technorati Tags: Elliott Yamin, American Idol, JDRF, diabetes, health and wellness

Regis Philbin: The Famous Have No Immunity

Regis Philbin, co-host of "Live with Regis and Kelly," announced earlier this week that he is scheduled for bypass surgery. Apparently he's been experiencing some pretty typical heart disease symptoms, including chest pains and shortness of breath.

Heart disease, known in the medical community as coronary artery disease (CAD) does not escape the famous: Regis purportedly consulted with late night talk show host David Letterman, who underwent quadruple bypass surgery in 2000. Former President Bill Clinton had quadruple bypass surgery in 2004 and an interesting article at Medicinenet.com discusses the effect on society when a famous person announces that they have a particular health problem. It describes the "Clinton effect" in which many people, especially "baby-boomer" men, ran out to get a cardiovascular check up based on the amount of information in the media about CAD and its risk factors at that time. In many cases this may have saved their lives.

Regis has also done his part to increase cardiovascular disease awareness. He had a previous experience with CAD and required an angioplasty in 2003. Since he first developed heart disease Regis had been a spokesperson for the American Heart Association in an effort to increase awareness of the risk of heart disease for all men and women. He notes that his heart disease has progressed to the point where a repeat angioplasty wouldn't work, although he would have preferred its short recovery time to that of bypass surgery. He is expected to be away from his morning talk show for about 5 weeks to recover.

Take care,
Laurie

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• WebMD Video: Wide Awake Heart Surgery
• WebMD Video: Heart Angioplasty and Bypass: Combining Procedures

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To Code or Not to Code...

Please check out this post by ED nurse Kim, at Emergiblog, about having appropriate documentation available for elderly family members who prefer not to suffer the indignity and consequences of being resuscitated when their breathing or heart stops. I especially agree that everyone should understand the process of resuscitation, so that they know what they are signing up for.

I agree with Kim, if you actually WANT me to try to return you to the living, I will gladly give you my best effort. But if you don't, please make that very clear to all potential decision-makers. Resuscitation efforts have varying degrees of success, depending upon the length of time without a pulse and the amount of underlying disease. It is very sad to put someone through this process when we medical providers know that their chances of returning to a full and happy life are almost non-existent.

Take care,
Laurie

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• WebMD Video: End of Life Decisions
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Technorati Tags: end of life, DNR, resuscitation, advance directive, health-and-wellness

The Polypill is Born in India

In 2003 two British professors from the Wolfson Institute of Preventive Medicine in London, proposed a "polypill" containing six ingredients. Now, just 3 1/2 years later, a company in India has begun clinical trials on just such a pill, containing aspirin, the blood pressure (B/P) lowering ACE inhibitor lisinopril, the cholesterol-lowering simvastatin, and the beta-blocker atenolol.

This initial trial is utilizing 250 Indian patients who have already had a cardiovascular event. A company spokesman discussing the trial stated that they hoped to gain approval in India for this version of the polypill for secondary prevention on the basis of the results of this trial.

Secondary prevention is the treatment of individuals who have already had an occurrence of a disease and is intended to prevent another disease-related event. The spokesman said, "We believe that we don't need an elaborate outcomes trial for secondary prevention. It is our understanding that as long as there is solid evidence of no drug-drug interaction and that the pill achieves its goals of reducing blood pressure and cholesterol, it will be approved."

To determine the ideal combination for a polypill, the two British professors who introduced the concept several years ago reviewed 750 drug trials (representing 400,000 participants) to identify ingredients that substantially reduced blood pressure and cholesterol. They settled on a potential pill combination of a statin for cholesterol lowering and three blood-pressure-lowering drugs; the latter were potentially a thiazide (diuretic or "water pill"), a beta blocker, and an ACE inhibitor.

They recommended that each of these blood pressure lowering medications be included at half of the standard dose, which would theoretically reduce the chance of side effects from any single drug and increase the opportunity of multiple drugs to have a synergistic effect on blood pressure control. They also planned to add folic acid and aspirin to their version of the pill.

These scientists calculated that their polypill could cut the risk of cardiovascular events by 80% or more and benefit one in three people if everyone over the age of 55 were to take it. Three strengths of the polypill have been developed; trial participants will begin at the lowest dose and be moved up as needed to meet their cholesterol and blood pressure lowering goals. It is designed to be taken as a single dose, once per day. In India the pill will retail for less than $2.00 per month, but it will retail for more in other countries, allowing its costs to be subsidized in India and other low-income countries.

The idea has not been well-received by all. Critics have argued that such a pill would be too large to swallow, there would be adverse effects and drug-drug interactions with medications taken in addition to the poly-pill, and that the pill itself would lull individuals into a false sense of security, causing them to continue to have "risky" lifestyles.

This last statement makes no sense to me. After all, if I just explained to you that since you have already had a heart attack or stroke and I am about to prescribe a pill containing four (four!) medications to control your risks for another such event, would you run right out and eat a salt and cholesterol-laden meal and smoke a pack of cigarettes? I would hope not, and God love you if you do, the pill isn't going to help you one way or another.

If you take one pill containing four medications or the four pills separately, you still have to understand that you have a greater risk of having another event, and having to take any medication should make you realize that your former habits have got to go! I think people are either going to do what they want or not, but the size of the pill isn't going to change that decision.

Personally, I am looking forward to the arrival of this type of combination pill in the US, since I currently prescribe combination meds when I can. They help to increase adherence to a medication plan just because people have fewer pills to take, and overall it costs less out of pocket because an individual has fewer per medication co-pays. I'll be watching for this one to hit our market; how about you?

Laurie

Related Topics:

• WebMD Video: At Risk for Heart Disease?
• Do You Know Your Heart Numbers?

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