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Chronic Disease, Health and Fitness, Nutrition

How to make it through holiday dinners without putting on the pounds

How to make it through holiday dinners without putting on the pounds

640px-Christmas_sugar_cookies,_January_2010A lot of people are worrying about overeating over the holidays, especially if they’re on a diet. We’ve offered advice in the past on how to avoid gaining weight over the holidays, and the  blog Obesity Panacea yesterday listed a few tips for eating healthy. My favorite:

Serve healthy snacks in large bowls and the unhealthy ones in small bowls

This little trick should result in a greater consumption of healthy snacks and a limited consumption of unhealthy ones, not only helping you, but those you have over to your place during the holidays.

A wonderfully simple study found that when snacks are offered in a large bowl, people take 53% more food (146 extra calories) and eat 56% (142 calories) more than when offered the same amount of food but in a smaller bowl (roughly half the size of large bowl).

It’s an easy change to make, but not one I never would have thought about. Other tips include drinking a glass or two of water 30 minutes before a meal and making sure you eat breakfast. Both tips ensure you won’t overeat when you get to the Christmas dinner table.

Previously: “Less is more”: More holiday eating tips from a Stanford nutrition lecturerEasy-to-follow tips to avoid overeating this holiday, “Less is more”: Eating wisely, with delight, during the holidays and Enjoying the turkey while watching your waistline
Photo by sweetfixNYC

Chronic Disease, Genetics, Pediatrics, Stanford News

Stem cells implicated in Duchenne muscular dystrophy

Stem cells implicated in Duchenne muscular dystrophy

640px-Duchenne-muscular-dystrophyStanford researchers published a paper today in Science Translational Medicine describing how stem cells are involved in the development of Duchenne muscular dystrophy, a disease that results in progressive, often severe muscle weakness. It affects about one in every 3,600 boys born in the U.S.

The research team determined that the stem cells surrounding muscle tissue gradually became less able to create new muscle cells and instead begin to express genes that lead to connective tissue formation. Excess connective tissue accumulation, which is called fibrosis, occurs in many diseases. Thomas Rando, MD, PhD, a Stanford neurologist and one of the authors of the paper said in a release about the new study:

These cells are losing their ability to produce muscle, and are beginning to look more like fibroblasts, which secrete connective tissue. It’s possible that if we could prevent this transition in the muscle stem cells, we could slow or ameliorate the fibrosis seen in muscular dystrophy in humans.

The researchers also found that a drug already approved to treat high blood pressure in humans called losartin can slow these changes in stem cells in laboratory mice, although much more work is needed to find out if it could be helpful in children with Duchenne.

The researchers are focusing on how to get the drug to target only muscle cells, but they’re also interested in how they can apply their findings to other diseases. Rando, who directs the Glenn Center for the Biology of Aging at Stanford, also commented:

Fibrosis seems to occur in a vicious cycle. As the muscle stem cells become less able to regenerate new muscle, the tissue is less able to repair itself after damage. This leads to fibrosis, which then further impairs muscle formation. Understanding the biological basis of fibrosis could have a profound effect on many other diseases.

Previously: Working on a gene therapy for muscular dystrophy, New mouse model of muscular dystrophy provides clues to cardiac  failure, and Mouse model of muscular dystrophy points finger at stem cells
Photo of muscle cells affected by Duchenne disease by Edwin P. Ewing

Chronic Disease, Stanford News, Videos

A primer on preventing or delaying type 2 diabetes

A primer on preventing or delaying type 2 diabetes

Diabetes affects an estimated 29 million Americans, and one in four people don’t know they have the disease, according to the latest data from the Centers for Disease Control and Prevention.

Stanford Health Library recently held a three-part lecture series about preventing or delaying the onset of type 2 diabetes. A the first event, Stanford primary care doctor Bryant Lin, MD, shared with the audience that diabetes is “a topic near and dear to his heart” and that he deals with the disease “in both his personal life and clinical life.” Lin’s family medical history puts him at high risk for the disease: His mother, her six siblings and his maternal grandparents were all diagnosed with diabetes. On the clinical side, he treats diabetic patients at Stanford Health Care.

In the above video, Lin provides an overview of the epidemiology, pathophysiology, risk-assessment and diagnosis of diabetes.

This video is the first lecture in a three-part series addressing important questions related to diabetes and lifestyle choices.

Previously: Diabetes and nutrition: Healthy holiday eating tips, red meat and disease risk, and going vegetarian, Diabetes and nutrition: Why healthy eating is a key component of prevention and management and Examining the role of exercise in managing and preventing diabetes

Chronic Disease, Neuroscience, Parenting, Pediatrics, Research

High blood sugar linked to reduced brain growth in children with Type 1 diabetes

High blood sugar linked to reduced brain growth in children with Type 1 diabetes

Some areas of the brain grow more slowly in children with Type 1 diabetes than those without, according to findings published this week in Diabetes. Researchers also found that children with the highest and most variable blood sugar levels had the slowest brain growth.

Glucose, the main form of sugar in our blood, is the brain’s primary fuel, and in Type 1 diabetes, the body loses the ability to produce a key hormone needed to regulate blood sugar levels. Type 1 diabetes treatment for children has often focused on making sure their glucose levels don’t get too low, since very low glucose can quickly put someone into a coma. But it’s emerging that chronically-high sugar is also bad for the brain.

The better the glucose control, the more likely that a child’s brain development will be unimpeded.

The new study, conducted at Stanford and four other universities, tracked brain structure and cognitive function in 144 young children with Type 1 diabetes and a comparison group of 72 children without diabetes over 18 months. MRI scans showed that the brains of both groups of kids were growing, but gray- and white-matter growth was slower in several areas of the brain in the diabetic children.

“These studies provide strong evidence that the developing brain is a vulnerable target for diabetes complications,” the researchers wrote. The affected brain areas have a variety of roles, including visual-spatial processing; auditory, language and object processing; executive function; spatial and working memory; and integration of information from sensory systems.

I asked two of the paper’s Stanford authors for more thoughts about what they found.

“The magnitude of the group differences in brain growth over time was surprising,” said Allan Reiss, MD, the study’s senior author. “I actually thought these differences would be more subtle — they were not.”

Past studies have found cognitive and brain-structure changes associated with diabetes in older patients, but this research stands out because the kids included were so young — at the start of the study, their ages ranged from 4 to just under 10, with an average age of 7 — and because the study had a prospective design, following children forward in time. In addition to examining brain structure, the researchers also tested the kids’ cognitive function with standard tests of IQ, learning and memory, and mood and behavior, among others. They saw no significant differences in cognitive function between the two groups, a finding Reiss said did not surprise him.

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Chronic Disease, Health Disparities, Health Policy, Public Health, Research

Study shows former foster kids face higher risk of future health problems

Study shows former foster kids face higher risk of future health problems

2411929600_da793593b2_zAccording to a new study from the journal Pediatrics, adults who were raised in the foster-care system are more likely to have chronic-health problems than those not from foster backgrounds, even after controlling for economic security.

It has long been recognized that foster kids have high rates of health problems as children, but this study is the first to ask what happens when those kids reach adulthood. It considered cardiovascular risk factors and other chronic problems, and it compared three groups of young adults: those formerly in foster care, those from the general public with economically insecure backgrounds, and those from the general public with economically secure backgrounds. The results were graduated among the three groups, from foster care, to economic insecurity, to economic security.

In the paper, the authors explain why their findings are not surprising:

Foster youth are often exposed to poverty and many other adverse childhood experiences including abuse, neglect, domestic violence, and parental substance use, and many undergo frequent placement and school changes while in foster care. Several theories exist regarding the effects of chronic and early exposures to adversity, all of which suggest that the more stressors to which one is exposed, the higher the likelihood of a chronic physical or mental health condition later in life.

However, because these theories regarding adversity haven’t yet been adequately investigated, this study has important implications. Scientific evidence could influence policy-makers to address this problem, perhaps by continuing Medicaid access for former foster kids or granting it to those far below the poverty line, or by offering continued support from the foster-care system into young adulthood. Provisions for the first two changes were made in the Affordable Care Act, and the federal government does offer incentives for states to continue foster care until age 21, but due to technicalities and state-level laws, these benefits are not widely accessible.

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Cardiovascular Medicine, Chronic Disease, Health Costs, Research, Stanford News

Home health-care treatments for lymphedema patients cut costs and improve care

Home health-care treatments for lymphedema patients cut costs and improve care

Lymphedema, an incurable chronic illness that involves severe swelling of the limbs, is frequently ignored, often misdiagnosed and under treated. Now a study by a Stanford researcher, who has for years worked to change this, illustrates how the use of home health-care treatment can help. The research appears today in PLOS ONE.

In a story I wrote on the study, Stanley Rockson, MD, a leading expert on lymph disorders, explains that one of the major challenges to improving care for lymphedema patients is that home care is poorly reimbursed by third-party payers. Rockson and colleagues set out to examine the cost effects of the use of one of these home-care therapeutics called a compression device to reduce swelling.

This is clearly a compelling argument for increased coverage of compression devices and similar home-care devices to reduce costs

By examining the health-care claims from a national private health insurer from 2007 to 2013, researchers found that patients who used these compression devices reduced annual health-care costs from $62,190 to $50,000. As Rockson explains in a press release, “Total health-care costs for these patients are very high, but can be profoundly reduced with treatment intervention, in this case a compression device. This is clearly a compelling argument for increased coverage of similar home-care devices to reduce costs.”

Rockson, who both researches lymphedema and treats patients with the disorder, has worked over the years to educate both the public and health-care professionals about this “hidden” disease. As a reporter who covers his research, he has also helped educate me – and in my piece I describe both the cause of the disease and available treatments:

Lymphedema is most commonly caused by the removal of or damage to lymph nodes as a part of cancer treatment. It results from a blockage in the lymphatic system, which is part of the immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling, which can be painful and debilitating. These symptoms can be controlled with various treatments, including treatments done at home and outpatient physical therapy. Home treatments for lymphedema include manual lymphatic massage, multilayer bandaging techniques and application of various compressive garments to reduce tissue fluid.

I’ve written several other stories about Rockson’s work on lymphedema over the years. One such piece, published in 2009, helps bring a greater understanding to the disease by describing how it impacted one patient. Hearing firsthand from a patient about what it’s actually like to live with lymphedema day-in and day-out makes the ongoing search for better treatments and possible cures all the more pressing:

Julie Karbo fights a battle every day to keep her lymphedema under control. Every night she hooks her arm up to a portable pump to help drain away fluids. Every day she wears compression sleeves to keep the swelling down. She limits the number of groceries she carries into the house to make sure she doesn’t put undue strain on the affected arm, and keeps a close watch for any possible infection-causing scratches or spider bites.

“A bee sting or a spider bite can lead to a very serious infection,” says Karbo, 49, a high-tech public relations executive and single mother of two in the Bay Area, who—unlike many lymphedema patients—never had cancer. “It’s something that greatly impacts the way you live your life.”

Previously: New blood test could bring lymphedema detection (and treatment) into the 21st century and New Stanford registry to track lymphedema in breast cancer patients

Ask Stanford Med, Chronic Disease, Nutrition

Diabetes and nutrition: Healthy holiday eating tips, red meat and disease risk, and going vegetarian

Diabetes and nutrition: Healthy holiday eating tips, red meat and disease risk, and going vegetarian

famers_market

Despite greater awareness about diabetes in recent years, a recent study found that nearly three in 10 Americans have the disease but don’t know it. The findings also showed that among those who were diagnosed with diabetes, a significant percentage weren’t meeting goals to control their blood sugar and blood pressure or lower their LDL cholesterol.

This Thursday, Kathleen Kenny, MD, a clinical associate professor at Stanford, and Jessica Shipley, a clinical dietitian at Stanford Hospital & Clinics, will discuss why eating healthy is a key component of diabetes management and prevention. The Stanford Health Library event will be held at the Arrillaga Alumni Center on campus; those unable to attend the event can watch a live webcast of the discussion.

In the final installment of our two-part Q&A with Kenny, she offers tips to avoid overindulging on sugary treats during the holidays, explains why you should consider limiting your consumption of red meat, and outlines the benefits of a vegetarian diet.

Many of us have a hard time refraining from indulging in high-calorie foods during the holidays. What’s your advice to those trying to make healthy choices during holiday season?

The holidays don’t have to be a stressful or trying time for patients with diabetes. Patients can adhere to a few simple strategies to help prevent weight gain and hyperglycemia. Some people will find it beneficial to eat a nutritious snack, particularly one that is high in fiber, and to drink lots of water in advance of a holiday party, rather than arriving hungry.

Buffet tables and appetizer trays can be problematic. Count toothpicks and stop snacking when you reach a certain number of toothpicks in your pocket. It is always a good idea to find the smallest plate available, when there are options, so as to reduce portions. Another tip is to limit alcohol intake; not only will this itself reduce liquid calories, but it will help individuals to make smarter choices. Substitute sparkling mineral water with lemon or lime. Eat lots of veggies at snack tables. Avoid calorie and sugar-dense sweets, or limit to one.

The most important aspect is to devise a plan in advance of a holiday gathering, and stick to it. Set your predetermined limits. Spontaneous choices will tend to be less healthy ones. Finally, if you are going to indulge a bit more, try to take a brisk walk afterwards to help reduce the glycemic impact of your meal.

Previous research has shown that decreasing your red meat consumption can lower your type 2 diabetes risk. Why does eating red meat influence a person’s diabetes risk? 

A study published in the Journal of the American Medical Association last year found an association of higher-diabetes risk with increased intake of red meat (about 30 percent higher with average increased red meat intake of ½ serving daily, adjusted for weight and BMI), and the converse, a lower risk in those who decreased their red meat consumption over a four-year period in the subsequent four years (14 percent reduction in diabetes risk by reducing consumption by more than ½ red meat serving daily over the baseline measure, some of which was mediated by reduced BMI with lower red meat intake).

This data was based on food questionnaires, and was a compilation from three prospective cohort studies involving almost 150,000 men and women. One of these cohorts, the Women’s Health Study, showed a 28 percent increased risk of developing diabetes in women in the highest quintile of red meat intake.  On further analysis, this seemed to be largely mediated by higher intake of processed meats such as hot dogs and bacon. Note that these studies do show an association, but not clear causation in terms of red meat and diabetes risk.

One theory of causality proposed is that compounds such as nitrates and nitrites added in meat processing  (sandwich meats, hot dogs, bacon), can be converted to “N-Nitrosamines”, which are thought to be toxic to the pancreas insulin-secreting beta cells. Thus, eating a bologna sandwich may be different in risk than eating grass-fed organic beef. But we don’t have enough data at this time to be clear on this.  Regardless of the nitrate content, red meat is still high in saturated fats, and this in and of itself is associated with higher cardiovascular disease risk. Additionally, higher red meat intake was associated with more weight gain and higher BMI in this analysis.

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Chronic Disease, In the News, otolaryngology, Patient Care

A look at one woman's long journey to diagnosis and treatment of rare disorder

VertigoThis week’s Medical Mysteries column in The Washington Post tells the story of a woman who lived with debilitating vertigo and odd tinnitus. Baltimore’s Rachel Miller lived with dizziness, the exaggerated sound of her heart and breathing and even anomalies with her vision for five years before she was diagnosed and treated. Many of the doctors she saw dismissed her symptoms as psychosomatic and Miller even went through a period when she stopped seeing doctors for her condition. Miller described her travails this way:

“I had started to feel like a person in one of those stories where someone has been committed to a mental hospital by mistake or malice and they desperately try to appear sane,” recalled Miller, now 53. She began to wonder if she really was crazy; numerous tests had ruled out a host of possible causes, including a brain tumor. Continuing to look for answers seemed futile, since all the doctors she had seen had failed to come up with anything conclusive.

But then she went to see David Zee, MD, who diagnosed her strange symptoms as a rare disorder called superior canal dehiscence syndrome (SCDS), when a small hole or a thin area of the temporal bone allows the fluid of the inner ear to touch the brain, transmitting sounds from the rest of the body, like our heartbeat or breathing, or even the movement of our eyeballs. John Carey, MD, operated on Miller, filling the small hole with bone and other tissue from the skull. As the piece notes, both Carey and Zee trained with Lloyd Minor, MD, now dean of the Stanford School of Medicine, when he was at Johns Hopkins University. Minor discovered SCDS in 1995 and developed the surgical treatment that Miller subsequently received in 2012.

Miller has recovered now, with only occasional problems when she gets a cold. But her story points out how difficult it can be to diagnose rare medical problems.

Previously: NIH network designed to diagnose, develop possible treatments for rare, unidentified diseases and Using crowdsourcing to diagnose medical mysteries
Photo by Mikael Tigerström

Ask Stanford Med, Chronic Disease, Events, Nutrition

Diabetes and nutrition: Why healthy eating is a key component of prevention and management

Diabetes and nutrition: Why healthy eating is a key component of prevention and management

grocery_produce

The prevalence of type 2 diabetes is expected to rise sharply over the next three decades. Recent data from the Centers for Disease Control and Prevention shows that if current trends continue, an estimated 1 in 3 adults will be diagnosed with the disorder by 2050. Eating healthy is a key component of managing diabetes and reducing one’s risk for developing the disease. But what does eating right for diabetes actually mean?

Kathleen Kenny, MD, a clinical associate professor at Stanford, and Jessica Shipley, a clinical dietitian at Stanford Hospital & Clinics, will answer this question during a talk focused on diabetes and nutrition on Dec. 4. The Stanford Health Library event will be held at the Arrillaga Alumni Center on campus, where attendees can also have their blood glucose checked. The conversation will also be webcasted for those unable to attend in person.

To promote discussion on the topic in advance of the lecture, I reached out to Kenny and asked about nutrition principles and guidelines for patients with diabetes and others interested in how healthy eating can prevent or delay onset of the disease. In the first installment of a two-part Q&A, she explains the advantages of eating a Mediterranean diet and the importance of eating fiber-rich foods.

Are there any ways to reverse or slow the progression of pre-diabetes? Are there specific diets that may be useful to help prevent or control diabetes?

One of the most common questions my diabetic patients ask is how they can reduce or eliminate diabetes medications. Others are found to be pre-diabetic on the basis of an “A1c” or an impaired fasting glucose, and want to know how to prevent diabetes. Several randomized trials have shown that healthy diet and exercise can reverse and also delay the onset of diabetes.

One of the largest trials is the often-cited Diabetes Prevention Program, which randomized more than 3,000 patients to diet/lifestyle versus metformin versus placebo. The most effective strategy was diet and lifestyle, showing a dramatic 58 precent reduction in the rate of developing diabetes. This surpassed the drug therapy with metformin. Approximately 5 percent of patients in the lifestyle group developed diabetes annually, as compared to 11 percent in the placebo arm. Notably, there was a 16 percent reduction in diabetes risk with every 1 kg reduction in weight. This seems attainable for many patients.

There was also meta-analysis last year looking at different diets for patients with known diabetes, in terms of weight loss and improving their diabetes control. In this data compilation, the Mediterranean diet had the greatest weight loss, followed by the low carbohydrate diet. In terms of A1c reduction, the Mediterranean diet had a reduction of -0.47 percent, and the low carbohydrate -0.12 percent. But all the diets studied resulted in better glycemic control. Many studies have shown that diets high in glycemic load are linked to higher diabetes risk (particularly in overweight women), and contribute to central body fat , so it is recommended that diabetics or those at risk limit their intake of high glycemic index foods both to delay and to help control their diabetes. Additionally, there are some data suggesting that adherence and success rate may be higher for low-carbohydrate diets in patients with diabetes and insulin resistance.

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Aging, Chronic Disease, Pediatrics, Research

"The child is father of the man": Exploring developmental origins of health and disease

"The child is father of the man": Exploring developmental origins of health and disease

3801281145_1f3fb2c8bf_z Among scientific communities, there is a small but growing segment of research concerned with “DOHaD” – the developmental origins of health and disease. The work usually focuses on how childhood, including birth, the fetal period, and sometimes even pre-conception events, affects a person’s lifelong health and well-being and is the topic of a recent article (subscription required) published in Pediatrics by researchers at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The phrase “the child is father of the man” is a line from William Wordsworth’s “My Heart Leaps Up” and also the title of the article, whose authors added, commendably, “and the mother of the woman.”

DOHaD gained acceptance within the medical community starting with the “Barker Theory” in 1995, when David Barker, MD, showed that babies with low birth weights were at higher risk for coronary heart disease later in life. Prior to his work, the dominant model was that the health of those who survived childhood without major disease or disability was sort of “reset” in adulthood, to decline from then into old age. This is increasingly understood to be a simplistic model.

Resistance to the idea stems from the fact that links between child and adult health are associative and not proven to be causative; therefore, the article’s authors Alan E. Guttmacher, MD, and Tonse N.K. Raju, MD, call for scientists to do more mechanistic research investigating causation, and “more importantly, to devise treatments and preventions, for the many “adult-onset” conditions that actually are rooted in much earlier exposures and events.” Such research is difficult because of the incredible number of variables that occur over an entire lifespan, and even within the category “perinatal risk factors.”

In the piece, the authors describe the importance of DOHaD and how a better understanding of it could affect pediatrics and health care:

Arguably the most important advance in the health care of children, and in establishing pediatrics as a medical specialty, was the cultural awakening that children were not simply small adults. Ironically, DOHaD greatly expands the impact of pediatrics by reversing that shift and focusing on how children actually are smaller versions of the adults they will become.

Once the biological and behavioral pathways that underlie DOHaD are identified and understood, the role of pediatrics should expand in fundamental and powerful ways. Anticipatory guidance in the future will not be just about the next 6 weeks or 6 months or even 6 years of the child’s life, but the entire life span. The pediatrician and other children’s health care providers will inform parenting and behaviors, including diet and exercise, and even prescribe presymptomatic medication targeted to the individual child. The pediatrician will become the gatekeeper to lifelong health.

Photo by Brad Brundage

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