ABC World News reported, “And we have a red flag to tell you about tonight about the most popular prescription drug in the world: statins.” Investigators “at Harvard Medical School” found that “people who take statins to reduce their cholesterol are at slightly higher risk of diabetes.” Sounds scary, right? Not to worry … it isn’t! Continue reading
An easy-to-remember formula for good health (0, 5, 10, 30, 150) is proposed in a wonderful editorial in American Family Physician titled “Preventive Health: Time for Change.” The author suggests this formula to physicians to “help patients achieve healthy lifestyle goals”:
- 0 = no cigarettes or tobacco products
- 5 = five servings of fruits and vegetables per day
- 10 = ten minutes of silence, relaxation, prayer, or meditation per day
- 30 = keep your BMI (body mass index) below 30
- 150 = number of minutes of exercise per week (e.g., brisk walking or equivalent)
The editorial is penned y Colin Kopes-Kerr, MD, from the Santa Rosa Family Medicine Residency in Santa Rosa, California:
It is time to make a decision. Which will be our health promotion strategy—primary prevention or secondary prevention?
Traditionally, the only one available to us was secondary prevention. Medicine consisted of a one-on-one physician-patient relationship, and taking care of patients meant minimizing the impact of any diseases the patient had. We did not have the time or tools to do anything else. More recently, we have been able to reduce a patient’s mortality by 20 to 30 percent by treating heart disease with a statin or beta blocker. These two medications have had the most dramatic effects in secondary prevention.
But now, the way we practice medicine has changed. We have a real choice to make. According to recent literature, primary prevention appears to work better than any other strategy in medicine. So why do some physicians not implement primary prevention? Despite the literature, maybe physicians are not getting the news. We need to keep repeating the message to physicians and patients that primary prevention is simple and effective. Next, we need to take a look at our own behavior as physicians and determine if it makes sense in the context of primary prevention.
There are 10 major studies on the effects of primary prevention.(1–15) These studies demonstrate very large correlations between specific healthy lifestyle behaviors and decreases in major chronic diseases (e.g., diabetes mellitus, heart disease, stroke, cancer) and all-cause mortality.
Although these studies offer a complex array of data to sift through, the elements of a healthy lifestyle are clear: not smoking, regular exercise, healthy diet, healthy body weight, and reduced stress.
Although exercise guidelines vary, I ascribe to the U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans, which recommends at least 150 minutes of brisk walking or the equivalent per week.(16) For the diet criterion, the Atherosclerosis Risk in Communities study illustrates that merely consuming five servings of fruits and vegetables per day is associated with the same benefits as consumption of a Mediterranean-style diet.(11) A standard of five servings of fruits and vegetables is much easier to remember and adhere to.
There is strong support for at least one weight-related variable in a healthy lifestyle. This may include body weight, body mass index (BMI), waist circumference, or waist:hip ratio. The INTERHEART study showed waist:hip ratio to be the most predictive of cardiovascular disease.(6) However, unlike BMI calculation, measurement of weight:hip ratio has not yet become standard in U.S. practices. I use BMI as the metric, and a value less than 30 kg per m2 as the cutoff between a healthy and unhealthy lifestyle. The goal is to move away from this outer limit toward a more ideal parameter, such as less than 25 kg per m2.
The final variable of a healthy lifestyle, which has strong support from the INTERHEART study, is stress reduction.(7) The INTERHEART study offers useful suggestions for measuring stress—perception of severe stress at home or at work, financial stress, or major life events.(7)
The minimal lifestyle intervention that would be beneficial is not defined. However, 15 to 20 minutes of silence, relaxation, or meditation appears to be a common interval.(17) To be more inclusive of patients, I set the criterion to an even less restrictive amount, about 10 minutes per day.(17) This is enough time to produce a change in biorhythms and is achievable for most patients.
Information alone does not lead to behavior change, however. Motivational interviewing or brief negotiation is a new framework that can close the gap between knowledge of available lifestyle interventions and changing behaviors. The framework has already been proven markedly effective for tobacco, drug, and alcohol addiction.(18) Few physicians have received the training necessary to implement motivational interviewing or brief negotiation. Resources for learning about these skills include the Kaiser Permanente Medical Group Web site and the book Motivational Interviewing in Health Care: Helping Patients Change Behavior.(18)
In terms of health, we can have it all. We have the requisite tools to convert knowledge into healthy behaviors. This newfound power to reduce diabetes, heart disease, stroke, cancer, and all-cause mortality with primary prevention strategies should impel us to change how we counsel patients. Research is needed to explore why some physicians are not making this change.
Address correspondence to Colin Kopes-Kerr, MD, at firstname.lastname@example.org. Reprints are not available from the author.
Author disclosure: Nothing to disclose.
- Stampfer MJ, Hu FB, Manson JE, et al. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343(1):16–22. View here
- Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11):790–797. View here
- Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA. 2009;302(4):401–411. View here
- Knowler WC, Barrett-Connor E, Fowler SE, et al.; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. View here
- Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA. 2004;292(12):1433–1439. View here
- Yusuf S, Hawken S, Ounpuu S, et al.; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infraction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–952. View here
- Rosengren A, Hawken S, Ounpuu S, et al.; INTERHEART Investigators. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):953–962. View here
- Chiuve SE, McCullough ML, Sacks FM, et al. Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications. Circulation. 2006;114(2):160–167. View here
- Chiuve SE, Rexrode KM, Spiegelman D, et al. Primary prevention of stroke by healthy lifestyle. Circulation. 2008;118(9):947–954. View here
- Kurth T, Moore SC, Gaziano JM, et al. Healthy lifestyle and the risk of stroke in women. Arch Intern Med. 2006;166(13):1403–1409. View here
- King DE, Mainous AG III, Geesey ME. Turning back the clock: adopting a healthy lifestyle in middle age. Am J Med. 2007;120(7):598–603. View here
- Khaw KT, Wareham N, Bingham S, et al. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study [published correction appears in PLoS Med. 2008;5(3):e70]. PLoS Med. 2008;5(1):e12. View here
- Ford ES, Bergmann MM, Kröger J, et al. Healthy living is the best revenge: findings from the European Prospective Investigation into Cancer and nutrition–Potsdam study. Arch Intern Med. 2009;169(15):1355–1362. View here
- Lee CD, Sui X, Blair SN. Combined effects of cardiorespiratory fitness, not smoking, and normal waist girth on morbidity and mortality in men. Arch Intern Med. 2009;169(22):2096–2101. View here
- Djoussé L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA. 2009;302(4):394–400. View here
- U.S. Department of Health and Human Services. 2008 physical activity guidelines for Americans. View here.
- Dialogue Partner. View here
- Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, NY: Guilford Press; 2008. View here
Most of us are aware of the many, many benefits to the baby when the mom chooses to breastfeed … especially when mom exclusively breastfeeds for at least six months. But, did you know that there are benefits for the breastfeeding mom? And, it’s not just psychological. Here’s a study showing that breastfeeding your baby for only one month may help prevent diabetes in the mom in the future — and this may be especially helpful information for moms with gestational diabetes, as they are more likely to develop diabetes later in life. Here are the details from WebMD:
Breastfeeding for a month or longer appears to reduce a woman’s risk of getting diabetes later in life, according to a new study.
The breastfeeding and diabetes link has been reported in other studies, according to researcher Eleanor Bimla Schwarz, MD, assistant professor of medicine at the University of Pittsburgh School of Medicine.
Her study lends more credence to the link, she says. “Moms who had ever breastfed were much less likely to develop diabetes,” Schwarz tells WebMD. ”Moms who had never breastfed had almost twice the risk of developing diabetes as moms who had.”
The study is published in The American Journal of Medicine. It was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Child Health and Development.
Breastfeeding and Diabetes: A Closer Look
Schwarz and colleagues looked at data gathered for another study on risk factors for incontinence, evaluating information given for that study on breastfeeding practices and whether the women later developed diabetes. The women were ages 40 to 78 and all members of a large health maintenance organization in California.
The researchers evaluated data on 2,233 women. Of those, 405 were not mothers, 1,125 were mothers who breastfed for at least a month, and 703 were mothers who had never breastfed.
The risk of getting a diagnosis of type 2 diabetes for women who breastfed all their children for a month or longer was similar to that of women who had not given birth.
But mothers who had never breastfed were nearly twice as likely to develop diabetes as women who had never given birth.
Moms who never exclusively breastfed were about 1.4 times as likely to develop diabetes as women who breastfed exclusively for one to three months, Schwarz found.
Later in life, here is the breakdown of who developed diabetes:
- 17.5% of the women who hadn’t given birth.
- 17% of the women who breastfed all their children for a month or longer.
- 20.3% of those who breastfed, but not all children for a month or longer.
- 26.7% of moms who didn’t breastfeed.
Overweight and obesity were common among the participants, with 68% having a body mass index of 25 or more, considered outside the healthy weight range.
The link held, Schwarz says, even after controlling for factors such as weight, physical activity, and family history of diabetes.
While one month of breastfeeding appears to make a difference, Schwarz says even longer is better. “Previous studies have shown the longer the mom breastfeeds, the more benefit for your body.”
Many experts recommend exclusive breastfeeding for six months and continuing [supplemented by food] for a year,” she says. “Clearly it’s hard for moms to always negotiate breastfeeding given the constraints of their work environment,” she tells WebMD.
Breastfeeding and Diabetes: Explaining the Link
The diabetes-breastfeeding link is probably explained by belly fat, Schwarz says. Moms who don’t breastfeed, as they get older, may have more belly fat, she says, as breastfeeding helps new mothers take off weight. “Belly fat increases the risk of diabetes as you get older.”
Some research has shown that breastfeeding may increase sensitivity to insulin, in turn reducing diabetes risk. But that may be short-term — while the breastfeeding is occurring, Schwarz says. “The real problem may be the belly fat.”
The finding that breastfeeding lowers the risk of diabetes later isn’t surprising at all, says Kimberly D. Gregory, MD, MPH, vice-chair of Women’s Healthcare Quality and Performance Improvement at Cedars-Sinai Medical Center, Los Angeles, who reviewed the study findings for WebMD.
She often counsels women who get gestational diabetes (occurring during pregnancy) that they are at risk for later getting type 2 diabetes and suggests they breastfeed.
The new findings, Gregory tells WebMD, will probably inspire her to add to the advice she gives moms-to-be about the benefits of breastfeeding. She often focuses on the benefits to the baby during that discussion, says Gregory, a professor of obstetrics and gynecology at the University of California Los Angeles School of Public Health.
But with the new research, she says, she may expand on that discussion. “I think it would make me say, ‘Oh by the way, breastfeeding would also help you lose your weight faster and could possibly decrease your likelihood of becoming diabetic later in life.”
We all know that breastfeeding has myriad benefits for the baby. Breastfeeding reduces babies’ risk of these diseases by these percentages:
- Sudden Infant Death Syndrome (SIDS): 36%
- Type 1 Diabetes: 19-27%
- Type 2 Diabetes: 39%
- Leukemia (acute lymphocytic) : 19%
- Leukemia (acute myelogenous): 15%
- Asthma: 27%
- Gastrointestinal infections: 64%
- Lower respiratory tract diseases: 72%
- Atopic dermatitis: 42%
- Acute otitis media: 50%
We know that breastfeeding has psychological benefits for the mother — and that there are physical benefits for the mother including the fact that it is easier for a breastfeeding mother to loose weight after the birth and breast feeding helps reduce the risk of some types of cancer by these percentages:
- Ovarian cancer: 21%
- Breast cancer: 28%
Other health benefits to mothers who breastfeed include reduced risk of type 2 diabetes, reduced risk of osteoporosis, faster return of the uterus to its prepregnant state, steady weight loss based on use of fat deposits laid down during pregnancy for early milk production, and slower return of menses which can aid in natural child spacing.
Now, new reports indicate another breast feeding benefit for the mother.
USA Today reports that “breastfeeding may offer mothers long-term protection against a condition linked to diabetes and heart disease.”
Analyzing data on “704 women in an ongoing, government-funded study of heart-disease risk factors,” a team from Kaiser Permanente’s Division of Research found that “the longer women breast-fed, the lower their chance of developing metabolic syndrome.”
Even breastfeeding “for just a couple of months can significantly lower a woman’s risk of metabolic syndrome,” HealthDay reported.
“In women who didn’t have pregnancy-related (gestational) diabetes, breast-feeding between one and five months lowered a woman’s risk of developing metabolic syndrome by 39 percent, while breast-feeding for the same duration lowered the risk of the syndrome by 44 percent in women with gestational diabetes.”
WebMD reported, “In the population as a whole, breastfeeding for longer than nine months was associated with a 56% reduction in risk for developing metabolic syndrome during the follow-up period.”
In comparison, “in women who developed gestational diabetes during one or more pregnancies, the risk reduction was 86%.”
The study, which “was funded by the National Institutes of Health,” will appear “in … the journal Diabetes.”
WebMD is reporting on the CDC’s latest diabetes statistics – and, the results are gruesome. Nearly 24 million people in the U.S. have diabetes — including almost 6 million who don’t know they’re diabetic — and at least 57 million have prediabetes.
Diabetes is the No. 7 cause of death among U.S. adults. Researchers reported last year that type 2 diabetes hastens heart disease and shortens lives by about eight years.
My Take? Continue reading