Sunday, May 27, 2018

Intermittent Fasting Can Benefit Weight Loss, Type 2 Diabetes and the Cardiovascular System

Investigations such as the Diabetes Prevention Program (DPP) trial and the Look AHEAD study have shown that a low calorie diet, physical activity of at least 150 minutes per week, and lifestyle modification can lead to beneficial weight loss. Both these studies highlight the importance of diet and physical activity. But it appears that diet is more important than physical activity – at least in the early stages of a weight loss program. Since diet is a key element in weight loss, weight maintenance, and overall health, a lot of research has gone into looking at different types of diets. One diet approach that has received much attention in the past years is the intermittent fasting (IF) diet.

Usually in the IF diet, an individual follows a very low or zero calorie plan for some days of the week, and a normal eating plan for the other days of the week. The IF diet has been shown to lead to weight loss, improvement in type 2 diabetes and cardiovascular disease. One very popular version of the IF diet is presented in the book, "The FastDiet," sometimes referred to as the 5:2 diet.

In the book, Michael Moseley, the author, concludes that a man, trying to lose weight, can achieve weight loss by restricting his diet to 600 calories a day for two days. And that a woman, trying to lose weight, can achieve weight loss by restricting her diet to 500 calories a day for two days. On the remaining five days of the week, both the man and the woman should eat normally. This form of IF is apparently effective for some individuals as indicated by the reviews of Moseley’s book on Amazon.com.

Another version of IF is called alternate day fasting (ADF). In ADF, a person follows a very low calorie diet on alternate days of the week, while following a normal diet on the remaining days of the week. ADF may enable an individual to lose weight. Further, one study suggests that ADF might not only lead to weight loss, but the dieting approach can lead to improvements in type 2 diabetes.

And finally, a recent study has indicated that the 5:2 diet allows an individual to lose weight and lower the risk of cardiovascular disease. In fact, the study’s investigators “found that following weight loss, participants in the 5:2 group continue to eliminate fats (triglycerides) faster and more effectively than other volunteers. Scientists have also noticed a greater reduction in arterial systolic pressure associated with decreased risk of heart attack and stroke.”

So, healthcare providers might want to include IF among their weight loss tools. Not only could IF enable some patients to lose weight, but the weight loss approach might lead to improvement in type 2 diabetes and cardiovascular conditions.

Sunday, May 20, 2018

Why are US Healthcare Costs So High and What Can We Do about it?

Frequently, there are stories in the news related to the rising US healthcare costs, and the low quality of US healthcare compared to many other industrialized countries. It is often stated that US healthcare costs are high because of over utilization of healthcare services. But one study questions the validity of the over-utilization assertion as a reason for the high costs. Also, one approach to lowering the cost of healthcare in the US is gaining momentum. The approach is to form partnerships between healthcare organizations and community organizations to deliver healthcare services.

In 2014, The Commonwealth fund, a private organization that promotes high-quality healthcare, concluded that the US had the worst healthcare system among 11 developed nations. These nations were the United Kingdom, Switzerland, Norway, Sweden, New Zealand, the Netherlands, Canada, France, Australia, Germany, and the United States. Not only is US healthcare quality a problem, but the high cost of healthcare in the US is also a great concern.

So the US healthcare quality is poor and the cost is high. But is the cost high because of over healthcare utilization? At least one study concludes that the answer is no. The investigators assert that healthcare providers in the US are paid too much. US healthcare providers are paid twice as much as providers in some other countries.

Now some experts would argue that providers are paid more in the US because of the physicians' medical school debt. But according to the above-mentioned study, this is not the case. The investigators indicated that “taking into account tuition costs didn’t explain the difference in earnings.” This might mean that healthcare providers’ salaries should be lowered and that less expensive providers should be sought in many instances.

This also might mean that the move by some healthcare organizations to lower costs and improve outcomes by aligning themselves with community organizations might be a promising approach to the US healthcare cost and, perhaps, the quality problems. Medicare, for example, is partnering with the YMCA and other organizations to provide a diabetes prevention program (MDPP). The approach used to deliver the prevention program has been shown to be effective and less costly than the treatment offered in the normal clinical environment.

Partnerships between healthcare organizations and community organizations may be feasible for other illnesses – especially in the treatment of chronic illnesses such as obesity. In fact, the CDC is suggesting that more research be directed at community programs, such as Weight Watchers and Jenny Craig along with randomized controlled trials (RCTs), to come up with practical methods for dealing with overweight and obesity.

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