Tips from gaining health

Making her CHG debut, please welcome todays guest blogger, Amy Dickenson. Amy is an actor, writer, producer, and mom to the cutest baby girl in the five boroughs.

Forty. Forty is the new 30, right? Well, in my house, 40 is starting to look like the new 60. My gorgeous husband and I have recently been diagnosed with high blood pressure and high cholesterol—hypertension and hypercholesterolemia, to be fancy, like certain cheeses which I love and will never be able to eat again.

Photo: Jami Dwyer via Flickr

Let’s jump in the Crisco Time Machine. It all started 18 years ago when our courtship took a decided slant toward biscuits slathered in butter and jam. Have you ever tasted butter? It’s like a miracle married to a unicorn wrapped in a rainbow. Much like its cousin, bacon, which is a miracle married to a unicorn dipped in chocolate, butter’s not so good for your arteries. But it was the early ‘90s and we didn’t know about cholesterol and vegetables back then. Did we?

Back in the time machine to August 2010. My cholesterol is 254. WHAT? I am not a high-falutin’, pin-stripe-wearin’ banker chugging scotch, smoking stogies, eating aged porterhouse steaks with my big wig partners, guffawing over “that deal” that made “lots of money” while flashing my newly laminated AARP card. I am a working mom. I eat veggies. I make sure my family gets a salad at least once a day. So, what gives? And why is my husband’s blood pressure 180/2 million?

My husband (let’s call him Adam) and I do not agree all the time (shocking) but we do agree on one thing: We want to be around for our baby daughter’s graduation from college. And her wedding. And her babies. And their graduations from college. Even if she doesn’t get married or go to college, we want to be around to lament those things.

She is worth all the broccoli in China. And I know they have tons, because, let’s face it, nobody ever eats that side of bright green buried under the General Tsao’s chicken. I imagine the Great Wall as an agricultural implement built to contain the cruciferous invaders from the steppes of central Asia. They must love it as much as I do.

Photo: La Grande Farmers Market via flickr

Our daughter, however, loves broccoli (a secret point of pride), and for now, she needs us to make it for her. Time to act.

Adam’s doctor put him on the First Line Therapy diet. Mine gave me a prescription cholesterol reducer, a pharmaceutical of the most common side effects reported are headache, muscle pain, abdominal pain...variety.

One of the scariest side effects I read about is birth defects. Since Adam and I are “not not trying” to have another baby, the meds are sitting on my desk, looking forlorn while I debate whether to take it. Or I could give this First Line Therapy diet a try too.

Adam and I are fly-by-the-seat of our pantsers, not planners. I love to cook, but I have been known to open the freezer at 5 pm and stare blankly for three minutes before I reach directly above it for the takeout menus. (OK, the restaurant numbers are in my cell phone.)

How do two nonplanners plan to be healthy, live longer, and learn about nutrition on a diet that requires grocery shopping in advance of the moment we might need said ingredients?
I started by reading the cute little binder Adam got from his doctor. It has menus, recipes, and tips like pretty much every other diet book. I thought, “Hmmm. This looks really great.” And I said to Adam, “Babe, this is really great.” And then I put down the book and we ordered chicken ceasar wraps with feta from Zorba’s. Because you can have fat-free feta on this diet. (Zorba’s doesn’t have fat-free anything.)

Oh I needed a PLAN. I gave myself a goal of meal planning for three days. My mind can grapple with Sunday, Monday and Tuesday just fine. I didn’t want to get too ambitious and hope for a week.

First Line Therapy (FLT) is basically the reduced-carb, high-veggie, lean protein, healthy fat diet that we have all read about, tried, and maybe succeeded at. It’s similar to the South Beach approach or the Mediterranean diet…or Weight Watchers if you do it right.

You aim for a set number of calories per day within a certain set of food groups. For instance, Adam can eat 2000 calories a day, and this is how they break it down:

Servings per Day
3–4 “Category 1” veggies (the green leafies, the zucchinies, the tomatoes, the peppers, etc.)
2 legumes
1 dairy
3 concentrated proteins
2 fruits
4 healthy oils
1 nut
1 grain
1 “Category 2” veggie (the yummy orange ones)

You can read more about FLT here, where people are dangerously perched on two-wheels or here, where they weigh giraffes. I per the giraffes.

Among the many challenges of embracing FLT is that it’s kinda pricey. They recommend you eat what they call “medical food,” which includes Ultra Meal 360 Plus shakes with delicious "Selective Kinase Response Modulators,” twice a day and take a variety of supplements. You can indulge in medical chalklate, medical chalkberry or medical chalknilla flavored shakes, which you mix with cold water. Or you can get purse-friendly bars in flavors approximating fudge or apple cinnamon. (We have yet to try the apple cinnamon bars or strawberry shake flavors.) If there is a cookie variety, they are holding out on us.

“Medical food,” in combination with the cost of fresh produce, was looking a little forbidding until we looked at our daily Starbucks intake—$10 easy for both of us, which adds up to over $3600 a year. If we cut that out, along with our takeout habit, we could maybe swing this thing.

I comparison shopped at our local grocery store vs. the health food store vs. the farmer’s market. A head of lettuce at our grocery store costs around $3. I never used to buy a head of lettuce that I’d have to cut up and WASH and spin and hang to dry. It’s like doing laundry. Especially when have these cute little plastic boxes of cut up, triple-washed lettuce. But, they’re $4.99 a box. And, if truth be told, we usually throw away about 1/3 of it when the purple leafy things get all slimy. Hmmm… I see savings in my salad spinner.

The farmer’s market had locally grown lettuce for (drum roll please) $2! And it doesn’t come in those plastic shells which I always feel guilty about buying and tossing. So, not only am I supporting local growers, I can get my green on too? I’m sold. Or least sold on Wednesdays. Because that’s the only day the farmers market comes to my area.

To fill out the week, I decided to go for Romaine hearts at my grocery store, saving roughly $4 a week. Over a year, that’s $200. Which means I can buy those fancy Omega-3s FLT recommends we take. Or the “Medical food,” which is $50 a canister for 14 servings. OUCH, but remember the lettuce. Remember the lettuce!

Here is my 3-day plan:
Breakfast: a medical food shake, plus 2 eggs – anyway you like ‘em
Snack: fruit with a nut butter (Almond butter is pricey, but a little goes a loooong way. Plus, you can only have 1 tbsp.)
Lunch: here’s where the planning kicks in…yesterday’s dinner leftovers
Snack: another fruit
Dinner: a recipe from Adam’s cute binder and a salad
Snack: another medical food (This stuff is pricey.)*

Sunday’s dinner was turkey chili from the book (surprisingly delicious); Monday’s dinner was salad with grilled chicken breast; and Tuesday’s dinner was turkey and bulgur with peas (also yummy).

Not only did we have plenty of chili for lunch, I actually froze two servings for another day. The bulgur recipe looks like it might be another loaves and fishes story. I have never cooked bulgur, which I had to get at my health food store, but it was only $4 for a bag that will last me until the Buffalo Bills win a superbowl.**

Now I have to take a deep breath because today is Wednesday. And I have to plan again. But I did it THREE DAYS in a row. And I think I can, I think I can, I think I can… I talked to my doctor about Adam’s FLT diet, and he asked how it was going. “Well, it’s challenging, figuring out how to cook and plan and get all the food groups in.” He said, “That’s what it is. It’s practice.”

Hmmm... Practice. I can do that.


*According to the American Heart Association, in 1995, the last yearly figures they publish, there were 1,460,000 angiograms performed at an average cost of $10,880 per procedure. This resulted in 573,000 bypass surgeries at an average cost of $44,820, and 419,000 percutaneous transluminal (balloon) coronary angioplasties (PTCAs) at an average of $20,370 each. The total bill in 1995 was $50 billion, or $137 million per day―$5.7 million per hour. The total annual cost of cardiovascular disease in the United States, including medications and disability, is approximately $274 billion per year. And that was in 1995. When we were slathering butter on our biscuits. Good grief.

**Adam and I proudly hail from Buffalo, NY.

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A pair of University of Colorado Cancer Center studies published this month show that the milk thistle extract, silibinin, kills skin cells mutated by UVA radiation and protects against damage by UVB radiation – thus protecting against UV-induced skin cancer and photo-aging.

“When you have a cell affected by UV radiation, you either want to repair it or kill it so that it cannot go on to cause cancer. We show that silibinin does both,” says Rajesh Agarwal, PhD, co-program leader of Cancer Prevention and Control at the CU Cancer Center and professor at the Skaggs School of Pharmacy and Pharmaceutical Sciences.

The first study, published in the journal Photochemistry and Photobiology worked with human skin cells subjected to UVA radiation, which makes up about 95 percent of the sun’s radiation that reaches Earth. The Agarwal Lab treated these UVA-affected cells with silibinin. With silibinin, the rate at which these damaged cells died increased dramatically.

“When you take human skin cells – keratinocytes – and treat them with silibinin, nothing happens. It’s not toxic. But when you damage these cells with UVA radiation, treatment with silibinin kills the cells,” Agarwal says, thus removing the mutated cells that can cause skin cancer and photo-aging.

Specifically, the study shows that pretreatment with silibinin resulted in higher release of reactive oxygen species (ROS) within the UVA-exposed cells, leading to higher rates of cell death.

The second study, published this month by the same authors in the journal Molecular Carcinogenesis shows that instead of beneficially killing cells damaged by UVA radiation, treatment with silibinin protects human skill cells from damage by UVB radiation, which makes up about 5 percent of the sun’s radiation reaching Earth.

Again, remember Agarwal’s suggestion that the prevention of UV-induced skin cancer can happen in two ways: by protecting against DNA damage or by killing cells with damaged DNA. With UVA, silibinin kills; with UVB, it protects, in this case by increasing cells’ expression of the protein interleukin-12, which works to quickly repair damaged cells.

“It has been 20 years of work with this compound, silibinin,” Agarwal says. “We first noticed its effectiveness in treating both skin and solid cancers, and we now have a much more complete picture of the mechanisms that allow this compound to work.”

Agarwal and colleagues continue to test the effectiveness of silibinin in cancer prevention and treatment in cell lines and mouse models, and are working toward human trials of silibinin-based therapeutics.

Is the pursuit of evidence-based medicine evidence based?  That was the head-cramping question the  Disease Management Care Blog grappled with when it read this just published Health Affairs article, Tool Used To Assess How Well Community Health Centers Function As Medical Homes May Be Flawed.

Readers will recall that the National Committee for Quality Assurance (NCQA) is a Washington DC-based not-for-profit that champions the use of performance measures to assess the quality of health care.  Provider organizations go through an assessment process based on the measures and, if they pass muster, are "recognized" by the NCQA.  The performance measures are based on peer-reviewed medical evidence, vetted by expert panels and then opened for public comment before they are finalized and used.

The DMCB knows this because it has served on two of the NCQA panels.

 While its most visible activity has been the ranking of health insurers, the NCQA has been offering a soup of recognition, accreditation and certification programs for other types of provider organizations including the disease management vendors (for example) and, more recently, medical homes.  More on that group of providers later.

Once you earn it, the NCQA quality badge is more than just a festively colored addition to your letterhead and collaterals. Given the past evidence that purchasers also pay some attention to it, the DMCB recalled being unsurprised when the number of disease management vendors sporting the newly established NCQA accreditation logo multiplied faster than the number of vixens at a Kennedy White House pool party.  They reasonably believed that it would help them gain credibility and give them a leg-up against their competition.

But even if the NCQA performance measures are based on the scientific quality as well as consensus and drive competition based on quality, the question remains: if an organization achieves NCQA recognition, does that really mean that patients are better off for it?

Enter Robin Clarke and colleagues who wanted to know if that was true for medical homes and their patients with diabetes. They adapted the 2008 version of the NCQAs medical home evaluation survey tool to 40 Los Angeles community primary care health centers. The medical director or executive team at each center had to complete the tool which was scored in the usual manner.  The score - and the corresponding level of recognition - was then compared to the centers clinical diabetes care measures based on the National Quality Foundations (NQF) quality measures. These measures were collected on samples of patients based on reviews of the medical records.

Only 30 of the centers completed the tool. They were made up of 88 LA clinics that were taking care of more than 600,000 mostly low income patients. The vast majority of the patient population was Medicaid.

The NCQA survey tool is based on a combination of "must pass" criteria combined with a 100 point scale.  The average score among the centers in this study was a respectable 67. Eight would have received the highest Level 3 Recognition (more than 75 points), three would have been Level 2 (between 50 and 75) and the remainder were Level 1. The percent of patients who had a measure of HbA1c, LDL, or blood pressure in the past twelve months was 84%, 70%, and 90%, respectively. Approximately 60% of patients had kidney disease screening and 35% had a diabetes eye examination.

However, when the authors used multiple methods to look for a statistical association between higher scores or Levels and higher quality percentages on the NQF measures, none was found.

To their credit, the authors point out that 1) theirs was a faux and unaudited NCQA process, 2) that a Level 1 accreditation, while no better than a 2 or a 3,  may be better than a "zero," 3) that persons with conditions other than diabetes may still benefit from this kind of process and 4) that they didnt use the 2011 edition of the tool.  The DMCB adds that this was in a community health setting involving mostly patients with Medicaid insurance. Its possible that patients in other settings, socioeconomic classes or with other types of insurance could benefit.

Despite the limitations, the DMCB thinks this is an important study that puts the NCQA into perspective and tells us what it may and what it may not be doing. Hopefully this kind of study will be done in other settings involving other provider types, including the disease management community.  In the meantime, the NCQA would be well served to continue to examine the links between its prsitine interpretations of the science and the real-world benefits for patients. 

In other words, its time for us to better understand the link between pursuing outcomes and actually achieving them.

Along with many readers, the Disease Management Care Blog is looking forward to the Care Continuum Alliances annual meeting, Forum12, two months from now in Atlanta. Not only will the DMCB get to make new friendships, the plenary presentations and smaller educational sessions are great way to learn how to apply the theoretical underpinnings of wellness, prevention and care management to the real world.

To help attendees better prepare for the meeting, the DMCB is pleased to offer this Lettermanesque "Top Ten" of things you may, or may not, see at the Forum12:

10. Someone genuflects upon hearing the term "CMS Innovation Center."

9. Only healthful fruit is served at one of the meeting breaks; in response, attendees riot.

8. A DMCB YouTube video is embedded in session PowerPoint (hey, its happened).

7. Three quarters of the attendees sitting in on a session are from the presenting facultys company.

6. Someone shows up at an early morning pre-meeting yoga class dressed in business attire, thinking it was a presentation on the return on investment from an employee yoga program.

5. The term "engagement" is used 20 times by a presenter in the course of ten minutes.

4. One faculty member hits a "presenters trifecta": 1) arrival flight lands on time 1/2 hour prior to the presentation, 2) he or she finds the meeting room within minutes and 3) catches the departure flight 1/2 hour after the end of the presentation.

3. The imposing booming disembodied voice asking you to take your seat at a plenary session is that of a female. With attitude.

2. The competition between the exhibitors for your attention becomes so intense, one offers free beer. Others follow suit.

1. The DMCB spouse "crowdsurfs" one of the plenary sessions.

NOTE #2: Wanna help out a good cause? Yay! The Minneapolis Heart Institute Foundation is asking CHG readers to fill out this Healthy Eating poll for research. They dont want any personal information – just a few answers to some very worthwhile questions. Head on over!

In my humble, meek, somewhat self-effacing (yes, I used the Thesaurus tool) opinion, one of the best recipes we’ve ever featured on CHG is the unfortunately named Cheesy Eggplant Bake. A tornado of vegetables and frommage, it’s most excellent for those days you just want to pack your face with large quantities of delectable healthiness.

Jeez, though. That name.

Today’s recipe has a similar problem. It’s a limey, fresh, summer-appropriate mixture of chicken and various guacamole-associated ingredients. And ideally, it goes in a wrap, on top of a few leaves of lettuce.

So, do we call our creations Deconstructed Guacamole Wraps? On one hand, the name sounds like the classy-like results of a Top Chef quickfire challenge. On the other hand, what everyday cook ever deconstructs anything? Besides his blender, I mean.

Or, do we go with Lime Chicken Salad with Avocado and Tomato? It lacks the upscale panache of the first name, but it IS much more picnic-ready. Like you can just throw it together and be off. Still, there’s the slight mayo-association that comes whenever you use the word “Salad.” And nobody wants that.

Sweet readers, what to call this thing? Would you go with either of the proposed titles? Would you call it something else entirely? How do we convey that it requires leftover chicken? Am I overthinking this?

(My answers: dunno, maybe, yes, beats me, yes.)

Before you get to brainstorming, though, know this: these wraps, while scrumptious, are much richer than our usual entries, due to a lot of avocado and a not-modest amount of olive oil. However, you can drop a significant amount of fat by reducing each ingredient by half. Not that you have to. This is all pretty healthy, fat-wise.

With that said, how about that name? Im stymied.

~~~

If you dig this recipe, these might also float your boat:

• Chipotle Pork Tenders
• Pasta with Turkey Sausage and Broccoli Rabe
• Skillet Chicken Fajitas

~~~

Deconstructed Guacamole Wraps
OR Lime Chicken Salad with Avocado and Tomato
Serves 4.


8 ounces grilled chicken, chopped into bite-sized pieces
1 avocado, diced
1 cup halved cherry tomatoes
1/4 cup red onion, minced
1/4 cup cilantro, chopped
3 tablespoons lime juice
2 tablespoons extra virgin olive oil
1/2 teaspoon kosher salt
Freshly ground black pepper
4 large leaves green lettuce
4 tortilla wraps

NOTE: I used grilled chicken thighs for this, due to their moistness and general tastiness. There were three of ‘em and I took each apart with my fingers.

1) In a medium bowl, combine chicken, avocado, cherry tomatoes, red onion, and cilantro. Stir, gently if you have very-ripe avocado.

2) In a small bowl, whisk together lime juice, olive oil, salt, and pepper to taste. Pour on to chicken mixture and stir to combine.

3) Place a few leaves of lettuce on each wrap. Split chicken evenly among wraps. Roll them up. Serve!

Approximate Calories, Fat, Fiber, Protein, and Price
368 calories, 23 g fat, 5.7 g fiber, 18 g protein, $1.30

NOTE: Your numbers will be slightly different depending on what cut of chicken and what kind of wraps you use. My calculations are for chicken thighs and Tropical brand tortillas.

Calculations
8 ounces grilled chicken, chopped into bite-sized pieces: 435 calories, 22.7 g fat, 0 g fiber, 54 g protein, $1.27
1 avocado, diced: 322 calories, 29.5 g fat, 13.5 g fiber, 4 g protein, $1.00
1 cup halved cherry tomatoes: 27 calories, 0.3 g fat, 1.8 g fiber, 1.3 g protein, $0.99
1/4 cup red onion, minced: 17 calories, 0 g fat, 0.6 g fiber, 0.4 g protein, $0.12
1/4 cup cilantro, chopped: 1 calories, 0 g fat, 0.1 g fiber, 0.1 g protein, $0.25
3 tablespoons lime juice: 12 calories, 0 g fat, 0.2 g fiber, 0.2 g protein, $0.50
2 tablespoons extra virgin olive oil: 239 calories, 27 g fat, 0 g fiber, 0 g protein, $0.24
1/2 teaspoon kosher salt: negligible calories, fat, fiber, protein, $0.01
Freshly ground black pepper: negligible calories, fat, fiber, protein, $0.01
4 large leaves green lettuce: 19 calories, 0.3 g fat, 2.4 g fiber, 1.4 g protein, $0.10
4 wraps: 400 calories, 12 g fat, 4 g fiber, 12 g protein, $0.72
TOTAL: 1472 calories, 91.8 g fat, 22.6 g fiber, 73.4 g protein, $5.21
PER SERVING (TOTAL/4): 368 calories, 23 g fat, 5.7 g fiber, 18 g protein, $1.30

We all know that exercise is good for you, but how good? While previous studies have shown the link between physical activity and a lower risk of premature mortality, the number of years of life expectancy gained among persons with different activity levels has been unclear—until now. In a new study from Brigham and Womens Hospital (BWH), in collaboration with the National Cancer Institute, researchers have quantified how many years of life are gained by being physically active at different levels, among all individuals as well as among various groups with different body mass index (BMI).

The study will be published on November 6, 2012 in PLOS Medicine.

"We found that adding low amounts of physical activity to ones daily routine, such as 75 minutes of brisk walking per week, was associated with increased longevity: a gain of 1.8 years of life expectancy after age 40, compared with doing no such activity," explained I-Min Lee, MD, associate epidemiologist in the Department of Preventive Medicine at BWH and senior author on this study. "Physical activity above this minimal level was associated with additional gains in longevity. For example, walking briskly for at least 450 minutes a week was associated with a gain of 4.5 years. Further, physical activity was associated with greater longevity among persons in all BMI groups: those normal weight, overweight, and obese."

In pooled data from six prospective cohort studies, the researchers examined associations of leisure-time physical activity of a moderate to vigorous intensity with mortality. They analyzed data from more than 650,000 subjects and followed subjects for an average of ten years- analyzing over 82,000 deaths. The large sample size allowed them to estimate years of life gained after the age of 40 among persons with different levels of physical activity and BMI.

The findings show that physical activity was associated with longer life expectancies across a range of activity levels and BMI groups. Participation in a low level of leisure time physical activity of moderate to vigorous intensity, comparable to up to 75 min of brisk walking per week, was associated with a 19 percent reduced risk of mortality compared to no such activity.

Assuming a causal relationship, which is not specifically demonstrated in this research, this level of activity would confer a 1.8 year gain in life expectancy after age 40, compared with no activity. For those who did the equivalent to 150 min of brisk walking per week--the basic amount of physical activity currently recommended by the federal government--the gain in life expectancy was 3.4 years. These benefits were seen in both men and women, and among white and black participants. Importantly, they were also observed among persons who were normal weight, overweight, and obese. Participants faring best were those who were both normal weight and active: among normal weight persons who were active at the level recommended by the federal government, researchers observed a gain in life expectancy of 7.2 years, compared to those with a BMI of 35 or more who did no leisure time physical activity (a 5 ft 5 in tall person with BMI of 35 weighs 210 lb).

"Our findings reinforce prevailing public health messages promoting both a physically active lifestyle and a normal body weight," explained Dr. Steven C. Moore, PhD, research fellow at the National Cancer Institute (NCI) and lead author of this study. This findings may also help convince currently inactive persons that even being modestly active is worth it for greater longevity, even if it may not result in weight control.

Researchers from The University of Texas MD Anderson Cancer Center found statins, the commonly used drug to lower cholesterol, improved progression-free survival in patients with inflammatory breast cancer (IBC).

The retrospective study was presented today in a poster discussion at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium and follows a previously reported Danish study indicating there is some evidence to suggest the anti-inflammatory properties of statins could reduce the risk of breast cancer recurrence. Still, the overall effects of statins have not been examined in relation to IBC.

IBC is a rare type of breast cancer that develops quickly when malignant cells block lymph vessels in the skin and soft tissue. It accounts for only 1-5 percent of all invasive breast cancers, according to the American Cancer Society.

"We decided to take a different approach with the smaller population of inflammatory breast cancer patients and see if its truly an inflammatory disease, whether or not theres some substantial impact of statin use in this population," said Naoto T. Ueno, M.D., Ph.D., professor in MD Andersons Department of Breast Medical Oncology and executive director of the Morgan Welch Inflammatory Breast Cancer Research Program and Clinic.

Ueno, the corresponding author, and his colleagues reviewed 724 patients diagnosed and treated for stage III inflammatory breast cancer at MD Anderson between 1995 and 2011. Patients with records indicating statin use at the time of diagnosis were compared to those who were not taking statins. In total, the stage III group contained 74 statin users and 650 non-users.

The primary end-point was progression-free survival (PFS), while secondary end-points measured overall survival (OS) and disease-specific survival (DSS).

Additionally, researchers compared the clinical outcomes of those in the statin group based on the type of statin, lipophilic (fat-soluble) or hydrophilic (water-soluble), an important distinction as differences in survival emerged throughout the trial. The authors note patients who used both drug categories, or patients missing information on their specific statin type, were excluded from the survival estimates.

Outcomes Show Improvement

Patients with no record of statin use had 1.76 years DFS, while patients who took lipophilic statins saw improved survival rates of 2.47 years. The greatest improvement in survival was noted in patients with past hydrophilic statin use at 4.88 years.

Increased survival rates also extended to the DSS end-point. Patients with no statin use measured a DSS of 4.52 years, while hydrophilic patients measured 5.10 years.

The authors note there is a trend in overall survival, however the OS end-point did not reach statistical significance.

"The previous Danish study looking at statins examined a much larger group of participants, around 10,000 and more. So were talking about a much smaller set of inflammatory breast cancer patients and to see the significant improvement in survival gives us a new perspective on the use of statins," said Ueno.

While Ueno added the findings are encouraging, the study does have limitations. First, no data was available describing how long patients had been taking statins, or for what indication. Those who did use statins may represent a population with better access to health care, a more health-conscious lifestyle and a higher education level, according to the researchers.

"This is an existing drug that was not developed for cancer and while developing new agents is important, statins are currently in the market and may have a significant role in the treatment we provide," he said.

Eye is an important organ for day-to-day information that we capture 83 percent derives from the eyes. Love your vision if you dont desire to manage glasses or contact lenses.

You no longer need to be familiar with all the glasses when can love a really tiny organ. Reading in normal reading distance, adequate lighting (use reading lamps), the intake of foods high in vitamins like vegatables and fruits, is apparent proof of your love eye.
In case they arent wise to handle your vision, be ready just attacked visual defect. Just not a couple of the attention minus (myopia) or eye plus (hypermetropia), there are many conditions that can interfere with vision.

Habits could be damaging the eyes, and others:

1. rubbing a persons vision
2. Take medications or eye products without correct indication
3. smoking,
4. Not wearing glasses when require.

For workers, in particular those that may be bad for the eyes, must wear eye protection avoiding injury.

see also do not let eye worms dwell in your eye. may be useful

10 Best Ways In Breastfeeding - One of the obligations of the mother, was breastfeeding. Well, to do it is not difficult, but if not done with good manners will reduce the positive value of breastfeeding.

Breastfeeding success not only in the hands of the mother. But also support for couples, families, friends and people around. Breastfeeding is not easy. Do not hesitate to ask your doctor or visit a lactation clinic.

Failure of many breastfeeding mothers due to ignorance. For that, Freda Rosenfeld, a lactation consultant from International Board Certified Lactation Consultant (IBCLC), reveal ten things that is important to know by mothers for success in breastfeeding .

1. Breastfeeding Immediately after delivery
Immediately after delivery, early initiation of breastfeeding do (IMD). Tell this to your doctor or midwife, as it will greatly affect the infants ability to find the mothers nipple.

2. Ask for help
If you feel pain, or pain in early breastfeeding, immediately ask for help. It could be, because your breast feeding in wrong position. Do not wait until the pain intensified.

3. Enough sleep
Sleep when your baby sleeps. Its very important to reduce the risk of postpartum depression and stress can adversely affect the production of breast milk (ASI).

4. Use a breastfeeding bra
To facilitate your breastfeeding, use a specially designed bra for breastfeeding. So that the breasts remain propped up well and you also feel comfortable.

5. circular massage
Before you start feeding, breast massage in a circular motion like a play.

6. balanced
Do not just nursing one breast only. Balance the use of left and right breast.

7. Protect nipples
To avoid sores around the nipple due to friction, the oil regularly give of the nipple. You can use olive oil or baby oil.

8. drink
Make sure you drink a lot while nursing. This is not about increasing milk production, but it makes the body healthy and prevent dehydration after feeding.

9. Babys mouth is wide open
Make sure the babys mouth opened wide as he sucked the milk. Areola, the dark circles around the nipple, should get into the babys mouth, so he can be more easily sucked and did not hurt the mothers breast.

10. asks for support
When breastfeeding you can sometimes feel tired or stressed. Do not hesitate to ask to accompany her husband, because of spousal support may soothe you. Not only that, baby relationship, father and mother were so close.

That is 10 best way to breastfeeding . you should try it or not, is definitely all for the sake of the baby. Thank you, Do not forget to read other articles in WWW.KKKmedicineblogspot.com