Thursday, January 31, 2013

WHO issues new guidance on dietary salt and potassium

31 January 2013 | GENEVA -Adults should consume less than 2,000 mg of sodium, or 5 grams of salt, and at least 3,510 mg of potassium per day, according to new guidelines issued by the WHO. A person with either elevated sodium levels and low potassium levels could be at risk of raised blood pressure which increases the risk of heart disease and stroke.

Sodium is found naturally in a variety of foods, including milk and cream (approximately 50 mg of sodium per 100 g) and eggs (approximately 80 mg/100 g). It is also found, in much higher amounts, in processed foods, such as bread (approximately 250 mg/100 g), processed meats like bacon (approximately 1,500 mg/100 g), snack foods such as pretzels, cheese puffs and popcorn (approximately 1,500 mg/100 g), as well as in condiments such as soy sauce (approximately 7,000 mg/100 g), and bouillon or stock cubes (approximately 20,000 mg/100 g).

Potassium-rich foods include: beans and peas (approximately 1,300 mg of potassium per 100 g), nuts (approximately 600 mg/100 g), vegetables such as spinach, cabbage and parsley (approximately 550 mg/100 g) and fruits such as bananas, papayas and dates (approximately 300 mg/100 g). Processing reduces the amount of potassium in many food products.

Currently, most people consume too much sodium and not enough potassium.

“Elevated blood pressure is a major risk for heart disease and stroke – the number one cause of death and disability globally,” says Dr Francesco Branca, Director of WHO’s Department of Nutrition for Health and Development. “These guidelines also make recommendations for children over the age of 2. This is critical because children with elevated blood pressure often become adults with elevated blood pressure.”

The guidelines are an important tool for public health experts and policymakers as they work in their specific country situations to address noncommunicable diseases such as heart disease, stroke, diabetes, cancer and chronic respiratory diseases. Public health measures to reduce sodium and increase potassium consumption and thereby decrease the population’s risk of high blood pressure and heart disease can include food and product labelling, consumer education, updating national dietary guidelines, and negotiating with food manufacturers to reduce the amount of salt in processed foods.
WHO is also updating guidelines on the intake of fats and sugars associated to reduced risk of obesity and noncommunicable diseases.

For more information please contact:

Gregory Härtl
Coordinator, News, Social Media and Monitoring
Telephone: +41 79 203 6715
E-mail: hartlg@who.int

WHO issues new guidance on dietary salt and potassium

Sunday, January 13, 2013

Plenty and scarcity : Article : British Dental Journal

Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS E-mail e-mail: bdj@bda.org

Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space.

Readers may now comment on letters via the BDJ website (www.bdj.co.uk). A 'Readers' Comments' section appears at the end of the full text of each letter online.
Sir, the Kerala state branch of the Indian Dental Association called for a one day dentist strike on 23 July 2012 to protest against the opening of new dental colleges in the state.1 From just two in the year 2000, the number of colleges in Kerala has increased to 23 in 2012.1 In addition, permission has been granted for 11 more dental colleges. In response, the government has agreed to cancel the 'essentiality certificate' granted to the colleges.
 
The dentist-to-population ratio in the state is currently 1:3,300 whereas the WHO recommended ratio is 1:7,500. The projected ratio in 2020 is 1:1,500 and in 2030 is 1:733. In 2011, over 1,400 students were admitted into the dental colleges of Kerala.2 The private sector remains the major employment provider for these graduates as the total existing job opportunities in government is 243 of which 144 are in government run dental colleges.1
 
The demand for dental treatment in Kerala is high owing to a low dentist-to-population ratio and increased awareness among the population.
 
Many dentists prefer to live in urban areas, although some do not practise dentistry.2 The private practice sector in these cities has become saturated whereas the majority of rural populations do not have access to primary dental care.3 This co-existence of plenty and scarcity simultaneously makes it likely that dentist protests like that in Kerala may happen in other parts of India in the near future. Geographic imbalances among the location of dental colleges also contribute to this variation. The number of graduating dental students in India was 26,000 in the year 2000.3 With more than 280 colleges across the country, this number will definitely be higher now.
 
A moratorium against further opening of dental schools and enhancement of seats should be enforced. Increasing and maintaining the quality rather than quantity should be the priority. Increasing the number of postgraduate places would be desirable. An indiscriminate increase in the number of undergraduate places should be curbed. Along with the currently existing primary medical centres in every district, dental wings should be opened. That will facilitate delivery of primary dental care to rural population, increased oral health awareness and increased employment opportunities for dentists in the government sector which in turn would attract them to work in rural areas.
Top

References

  1. Indian Dental Association. Kerala State Branch. STATE WIDE STRIKE ON 23/07/2012 MONDAY. Available at: www.idakochi.org/activities/IDAStrikeLetter23-07-12.pdf.
  2. Paul G. R Ahmed oration. 2012. Available at: www.slideshare.net/maxfaxgp/excerpts-of-r-ahmed-oration-george-paul (Accessed 18/08/2012).
  3. Tandon S. Challenges to the oral health workforce in India. J Dent Educ2004; 68 (7 Suppl): 28–33.
  1. By email

S. Thomas

Plenty and scarcity : Article : British Dental Journal

Thursday, January 03, 2013

Skyfall up for Producers Guild of America Awards

Star-studded musical Les Miserables and Steven Spielberg's Lincoln are also on the list of 10 shortlisted films.

The Producers Guild of America (PGA) award is seen as a good indicator of which film could win best picture at the Oscars.

The PGA winner has gone on to win best picture 16 times in the last 23 years.

The last time the PGA and the Oscars disagreed was six years ago when the PGA chose Little Miss Sunshine and the Oscar went to The Departed.

Ben Affleck and George Clooney are nominated this year as the producers of the Iran hostage drama Argo, while 2009 PGA winner Kathryn Bigelow is nominated for Zero Dark Thirty.

Nominations for the outstanding producer of theatrical motion pictures

  • Argo
  • Beasts of the Southern Wild
  • Django Unchained
  • Les Miserables
  • Life of Pi
  • Lincoln
  • Moonrise Kingdom
  • Silver Linings Playbook
  • Skyfall
  • Zero Dark Thirty

They join an eclectic list that also features Ang Lee's shipwreck tale Life of Pi and the quirky comedy Silver Linings Playbook, starring Bradley Cooper.

Wes Anderson's Moonrise Kingdom and mythical indie film Beasts of the Southern Wild are also in the running.

But there was no place on the shortlist for The Hobbit, The Master or The Dark Knight Rises.

The nomination is a boost to Skyfall's Oscar chances and comes days after the James Bond thriller passed the $1bn (£616m) mark at the global box office.

Among those nominated for outstanding producer in an animated motion picture by the PGA are Frankenweenie, Brave and Rise of The Guardians.

The PGA also announced its TV film and and series' nominees, which included Downton Abbey and Homeland.

The awards will be handed out at a ceremony in Los Angeles on 26 January.

Skyfall has become the first James Bond film to be nominated for the top prize at the Producers Guild of America Awards.

Skyfall up for Producers Guild of America Awards

Wednesday, January 02, 2013

27% Pay Cut Or Not, More Docs To Leave Medicare In 2013

Doctors are upset at the lack of a permanent solution for dramatic cuts to doctor payments from the Medicare health insurance program for the elderly under the so-called sustainable growth rate, or “SGR” formula or so-called “doc fix.” There was still no final Congressional action as of this morning with U.S. House votes pending, meaning doctors enter this New Year with a cut in Medicare payments of nearly 27 percent.

And even if Congress does head off the cut temporarily as it has in the past, doctors are increasingly leaving the Medicare program given its unpredictable funding.

In a pre-New Year’s alert to member doctors, the American Medical Association said it is “inexcusable that Congress is once again putting the 47 million Medicare patients and the practices of physicians who provide them needed health care at significant risk.”

Already, one in five physicians are restricting the number of Medicare patients in their practice and one in three primary care doctors – the providers on the front lines of keeping the cost of seniors’ care low – are restricting Medicare patients, according to a 2010 AMA survey of more than 9,000 doctors who care for Medicare patients.

But this latest gridlock had the AMA on high alert, because the federal government had already said it would not hold claims and Medicare carriers were expected today to begin processing payments for physicians services after Dec. 31 under the typical 14-day cycle required by law. “Payment for these claims would be based on the new, lower fee schedule conversion factor of $25.0008, as opposed to the current rate of $34.0376,” the AMA said in its alert.

Thus, the AMA was advising doctors to do what they had to do to mitigate their losses given the latest Congressional impasse as well as continuous delays and short-term fixes to Medicare payment.
“For those physicians who are forced into the untenable position of limiting their involvement with the Medicare program because it threatens the viability of their practices, we urge that patients be notified promptly so that they, too, can explore other options to seek health care and medical treatment,” the AMA added. “The Medicare program has become unreliable and its instability undermines efforts by physicians to implement new health care delivery models that stand to improve value for seniors and other beneficiaries through better care coordination, chronic disease management, and keeping patients healthy.”

It’s also not good news to the health insurance industry with companies like UnitedHealth Group (UNH), Humana (HUM), Aetna (AET) and others seeing greater numbers of seniors flocking to their Advantage plans that contract with the Medicare program to provide seniors with health benefits. They need doctors to participate if they are going to provide seniors with adequate medical care provider networks.

Only short-term fixes – 14 of them since 2002 – have been passed as a stopgap measure to prevent major cuts in physician Medicare reimbursement. The payment formula came to be as part of the Balanced Budget Act of 1997 and has never been corrected permanently by Congress.

Bruce Japsen, Contributor

27% Pay Cut Or Not, More Docs To Leave Medicare In 2013 - Forbes

Tuesday, January 01, 2013

Fasting may protect against disease; some say it may even be good for the brain

In 1908, Linda Hazzard, an American with some training as a nurse, published “Fasting for the Cure of Disease,” which claimed that minimal food was the route to recovery from a variety of illnesses, including cancer. Hazzard was jailed after one of her patients died of starvation. But what if she was, at least partly, right?

A new surge of interest in fasting suggests that it might indeed help people with cancer. It might also reduce the risk of developing cancer, guard against diabetes and heart disease, help control asthma and even stave off Parkinson’s disease and dementia.

We know from animal models,” says Mark Mattson at the National Institute on Aging, “that if we start an intermittent fasting diet at what would be the equivalent of middle age in people, we can delay the onset of Alzheimer’s and Parkinson’s.”

Until recently, most studies linking diet with health and longevity focused on calorie restriction. They have had some impressive results, with the life span of various lab animals lengthened by up to 50 percent after their caloric intake was cut in half. But these effects do not seem to extend to primates. A 23-year study of macaques found that although calorie restriction delayed the onset of age-related diseases, it had no impact on life span. So other factors, such as genetics, may be more important for human longevity.

That’s bad news for anyone who has gone hungry for decades in the hope of living longer, but the finding has not deterred researchers who study fasting. They point out that although fasting obviously involves cutting calories — at least on specific days — it brings about biochemical and physiological changes that daily dieting does not. Besides, calorie restriction may leave people susceptible to infections and biological stress, whereas fasting, done properly, should not.

Some even argue that we are evolutionarily adapted to going without food intermittently. “The evidence is pretty strong that our ancestors did not eat three meals a day plus snacks,” Mattson says. “Our genes are geared to being able to cope with periods of no food.”

Trying out a fast

Fasting will leave you feeling crummy in the short term because it takes time for your body to break psychological and biological habits, researchers say. There isn’t really agreement, though, on what fasting entails. To research this article, I am trying out the “5:2” diet, which allows me 600 calories in a single meal on each of two weekly “fast” days. (The normal recommended daily intake is about 2,000 calories for a woman and 2,500 for a man.) Proving that fasting is not necessarily about losing weight, I am allowed to eat whatever I want on the five non-fast days.

A more draconian regimen than the 5:2 plan has restricted-calorie fasts every other day. Then there’s total fasting, in which participants go without food for one to five days. (Fasting for more than about a week is considered dangerous.) This might be a one-off experience, or repeated weekly or monthly.
Different regimens have different effects on the body. A fast is considered to start about 10 to 12 hours after a meal, when you have used up all the available glucose in your blood and start converting glycogen stored in liver and muscle cells into glucose to use for energy. If the fast continues, there is a gradual move toward breaking down stored body fat, and the liver produces “ketone bodies,” short molecules that are byproducts of the breakdown of fatty acids. These can be used by the brain as fuel. This process is in full swing three to four days into a fast.

Various hormones are also affected. For example, production of insulin-like growth factor 1 (IGF-1) drops early and reaches very low levels by Day 3 or 4. It is similar in structure to insulin, which also becomes scarcer with fasting, and high levels of both have been linked to cancer.

As for treating cancer, Valter Longo, director of the Longevity Institute at the University of Southern California, thinks that short-term complete fasts maximize the benefits. He has found that a 48-hour total fast slowed the growth of five of eight types of cancer in mice, the effect tending to be more pronounced the more fasts the animals undertook.

Fasting is harder on cancer cells than on normal cells, he says. That’s because the mutations that cause cancer lead to rapid growth under the physiological conditions in which they arose, but they can be at a disadvantage when conditions changes. This could also explain why fasting combined with conventional cancer treatment provides a double whammy. Mice with gliomas — very aggressive forms of cancer and the most commonly diagnosed brain tumor in people — were more than twice as likely to survive a 28-day study if they underwent a 48-hour fast accompanied by radiation therapy as were those that did not fast.

Could fasting prevent cancers from developing in the first place? Evidence is scant.

Longo says there are “very good reasons” why it should. He points out that high levels of IGF-1 and glucose in the blood and being overweight are risk factors for cancer, and they can all be improved by fasting.

Another risk factor is insulin, says Michelle Harvie at Britain’s University of Manchester. Studying a group of women whose family history put them at high risk of developing breast cancer, she put half of them on a diet that cut calories by about 25 percent and half on a 5:2 fast. After six months, both groups showed a reduction in blood insulin levels, but the reduction was greater in the fasting group. Harvie’s team is now analyzing breast biopsies to see whether this translates to fewer of the genetic changes associated with increased cancer risk.

The effect on diabetes

High insulin is also associated with Type 2 diabetes, so perhaps it is no surprise that fasting shows promise there, too. At the Intermountain Heart Institute in Murray, Utah, Benjamin Horne has found that a 24-hour water-only fast, performed monthly, raises levels of human growth hormone. That hormone triggers the breakdown of fat for energy use, reducing insulin levels and other metabolic markers of glucose metabolism. As a result, people lost weight, and their risk of getting diabetes and coronary heart disease was reduced. Alternate-day fasting (with a 500-calorie lunch for women and a 600-calorie meal for men on fast days) has similar benefits, says Krista Varady of the University of Illinois. She has seen improvements in people’s levels of low-density lipoprotein cholesterol, or “bad cholesterol,” and blood pressure in volunteers eating either a low-fat or high-fat diet on “feeding” days.

For people who are overweight, any kind of intermittent fasting diet will probably help reduce the risk of diabetes and cardiovascular problems, Mattson says. In 2007, he found another benefit, too. He put 10 overweight people with asthma on an alternate-day incomplete fast and found that their asthma symptoms improved after just a few weeks. Blood markers of inflammation, including C-reactive protein, also decreased, suggesting that the fast was helping to moderate their overactive immune system.

Whether fasting would benefit normal-weight people with asthma or other conditions associated with an overactive immune response remains to be seen. There is some evidence that alternate-day fasting can lower their levels of blood fat. However, Mattson suspects that with diabetes and cardiovascular disease, fasting may not be as beneficial for people of normal weight as it is for people who are overweight, simply because they are already likely to be in pretty good shape, metabolically speaking.

How the brain reacts

Mattson has, however, identified another effect of fasting that he believes can benefit everyone: It is good for the brain. “If you look at an animal that’s gone without food for an entire day, it becomes more active,” he says. “Fasting is a mild stressor that motivates the animal to increase activity in the brain.” From an evolutionary perspective, this makes sense, because if you are deprived of food, your brain needs to work harder to help you find something to eat.

His studies suggest that alternate-day fasting, with a single meal of about 600 calories on the fast day, can boost the production of a protein called brain-derived neurotrophic factor by 50 to 400 percent, depending on the brain region. This protein is involved in the generation of new brain cells and plays a role in learning and memory. It can also protect brain cells from the changes associated with Alzheimer’s and Parkinson’s. In mice engineered to develop Alzheimer’s-like symptoms, alternate-day fasting begun in middle age delayed the onset of memory problems by about six months. “This is a large effect,” Mattson says, perhaps equivalent to 20 years in humans.

So, what about the common advice to start the day with a good breakfast? Mattson believes it is flawed, pointing out that the studies supporting this idea were based on schoolchildren who usually ate breakfast; a decline in their academic performance might simply be due to the ill effects that occur when people begin fasting.

Mattson skips breakfast and lunch five days a week, then has dinner and normal weekend meals with his family. Varady has tried alternate-day fasting, but she likes to eat dinner with her 18-month-old child and husband, so she does all her eating within an eight-hour period each day.

Harvie sounds a cautious note for anyone thinking of giving fasting a go. “We still don’t know exactly who should be fasting, how often or how many days a week,” she says. Also, it may not be without risks. One study in rats, for example, found that an alternate-day fast for six months reduced the heart’s ability to pump blood.

There is also the fact that fasting is difficult. Varady finds that 10 to 20 percent of people who enroll in her studies drop out, unable to stick to the regime. This may be less of a problem in the future, though. Some researchers are investigating the possibility that you can get some of the health benefits of fasting simply by reducing protein intake.

As I count down the minutes to the end of my fast, I can’t help but wish them success.

This story was produced by New Scientist magazine and can be read in full at www.newscientist.com.

By Emma Young -- New Scientist,
Published

Fasting may protect against disease; some say it may even be good for the brain - The Washington Post