logo.gif

EFFORTS Emphysema Foundation For Our Right To Survive

Emphysema Takes Your Breath Away          

December 2007

Lung-on-a-chip Leads To New Insights On Pulmonary Diseases

chip.jpg

     A new "lung-on-a-chip" developed at the University of Michigan mimics the fluid mechanics of the real thing on a plastic wafer just bigger than a quarter. It allows researchers to grow lung airway cells that act more like they're in a human body instead of a Petri dish.

      Biomedical engineers used the device to show that the respiratory crackles stethoscopes pick up in patients with diseases including asthma, cystic fibrosis, pneumonia and congestive heart failure aren't just symptoms, but may actually cause lung damage. "Our lung-on-a-chip causes the cells to really become lung-like in terms of function and protein secretion. They form the tight tissue connections that they do in the human lung. That doesn't happen in a dish. This device gives you the convenience and control of a dish but in physical conditions that are more like the body," said Shuichi Takayama, associate professor of biomedical engineering and principal investigator on this study.

      Takayama believes this is the first lung-on-a-chip. It's the same size as the part of the lung it simulates, the smallest airway branches. The researchers were able to recreate the sound of respiratory crackles on the chip. And they measured and watched the destruction associated with the crackling on the surrounding cells.

      The crackling is the sound of a breath of air opening airways that are clogged with thick fluid plugs. The fluid plugs form more frequently in patients with lung diseases that block the production of a fluid-thinning protein or narrow the airways. The plugs burst when air expands the lungs during breathing. Doctors have considered the crackling sound more as a symptom or red flag, explained Dr. James Grotberg, a co-author of the study who is a professor of biomedical engineering in the College of Engineering and the Medical School. Now, the plugs that cause the crackles appear to be a cause in addition to an effect.

      "We've shown that these liquid plugs are injurious, particularly when they rupture" Grotberg said. "The rupture sends a very strong stress wave onto the cells. What's interesting is that the forces from the rupture are large in one place and small in another and those two places are close to each other. So you have a very steep gradient in forces and that's what shreds the cells." To the surrounding cells, the bursts are like little sticks of exploding dynamite, Grotberg said.

      The lung-on-a-chip that allowed the scientists to demonstrate this is made of two rubber sheets with a groove etched across their length. Their grooved sides are stuck together, with a porous sheet of polyester between them. The polyester allows the device to function as two separate chambers. Engineers flooded both chambers with nourishing liquid while they were growing the lung cells in the device. Then, they emptied the top chamber to simulate an airway. That's when the lung cells started to develop further than they do in a dish. They formed tighter tissue bonds and secreted airway proteins as if they were part of a real lung.

      Once the cells were sufficiently developed on the chip, Takayama and his colleagues did the control part of the experiment. They ran liquid through the chip channels and then air before testing to see if the lung cells were still healthy. They were. Then they turned on the "microfabricated plug generator," which was connected to the cell culture chamber on the same chip. The plug generator is a vial of liquid into which the scientists pump air in such a way that drops of liquid enter the mock airways of the chip and eventually burst. They tested for periods of 10 minutes and found that at least 24 percent of the cells had died after persistent exposure to bursting liquid plugs. They observed more cell damage with more frequent plug bursts.

      A paper on the findings is published in the Nov.12 early edition of the Proceedings of the National Academy of Sciences.

Source: ScienceDaily


Patients 'denied intensive care'

      Patients with chronic lung disease are being denied intensive care treatment because doctors are too pessimistic about their chances, research suggests.

      A British Medical Journal study of 800 patients admitted to intensive care to help them breathe found survival rates were higher than doctors predicted.

      It suggests patients may not be admitted when they would benefit from treatment, the researchers warned.

      Chronic obstructive pulmonary disease causes 30,000 deaths a year in the UK. COPD is an umbrella term for a range of conditions including chronic bronchitis and emphysema.

      When patients have a COPD attack, they can benefit from intubation - where a tube is put into their airway to help them breathe - but they have to be admitted to intensive care so they can be sedated for the procedure. But doctors may be unwilling to admit patients who have a poor prognosis.

Survival

      The study, which took place in 92 intensive care units in the UK, found that 62% of patients who were intubated were alive 180 days later. However, doctors had originally predicted less than half would survive that long. In patients with the worst prognosis, the doctor predicted 10% survival at 180 days but in fact 40% of patients lived this long.

      Study leader Dr Martin Wildman, consultant in respiratory medicine at Northern General Hospital in Sheffield, said in an average-sized hospital the decision to admit a patient with COPD to intensive care probably happens once a week—or two to three times a week in winter. "Some clinicians have the perception that if patients did survive they would have an awful level of function and would be miserable. But other research shows most patients who survive would choose to be intubated again." He added that in the 1990s patients were often not admitted because there were not enough intensive care beds, which may have lead to a culture of not admitting patients. But he also said there had not been the evidence of how successful intensive care could be until now.

      Dr Noemi Eiser, medical director of the British Lung Foundation, said: "It is sad to see evidence of such widespread pessimism about the survival prospects for people with COPD amongst clinicians. It's to be hoped that better awareness of the disease in the years since this study was carried out should have reduced such negativity, particularly when more effective non-invasive treatments are becoming more widely available. The research also reminds us that around four in ten patients admitted to hospital for flare-ups of their COPD are dying within six months of discharge."             Source: BBC NEWS


Patients Who Had Received Pneumococcal Vaccine Have Better Survival Rates When Hospitalized With Community Acquired Pneumonia

      A patient who is infected with community-acquired pneumonia and is hospitalized has a better chance of survival and a lower risk of admission to the ICU (intensive care unit) if he/she had already received the pneumococcal vaccine, compared to patients who had not been vaccinated, according to an article published in Archives of Internal Medicine (JAMA/Archives).

      The authors explain that community-acquired pneumonia is a common illness which causes a substantial number of deaths and illnesses. The vaccine which protects from Streptococcus pneumoniae, one of the causes of pneumonia - 23-valent polysaccharide pneumococcal vaccine (PPV), has been on the market for over twenty years. Guidelines recommend vaccination for high risk groups - adults and people in nursing homes. Vaccination rates remain stubbornly well below the target of 80%-90% for these vulnerable groups.

      Jennie Johnstone, M.D., University of Alberta, Edmonton, Canada, and team gathered information on 3,415 patients who had been infected with community-acquired pneumonia and were hospitalized between 2000-2002. The researchers found out what each patient's vaccination status was by checking medical records, contacting primary care physicians and interviewing the patients themselves.

      624 of the patients had either died or were admitted to the ICU. 22% of all the patients had been vaccinated with PPV. 10% of those who had been vaccinated were admitted to the ICU or died, compared to 21% of those who had not received the vaccine, say the researchers. Less than 1% of the vaccinated patients were admitted to the ICU, versus 13% of those who had not been vaccinated.

      The authors wrote "In addition to improved clinical outcomes, our results suggest that there may also be an associated reduction in costs associated with pneumococcal vaccination, a health economic benefit that has not been captured in previous cost-effectiveness analyses of this vaccine. Specifically, much of the benefit in our study was in terms of reduction in the need for costly ICU admissions; previous cost analyses have been restricted to examining the benefits of preventing pneumococcal disease but may have not adequately captured the possibility of attenuating the severity or mitigating the cost of disease in those for whom pneumonia is not prevented."

      Of all the patients who were discharged, only 215 (9%), out of 2,416 who were eligible, received a vaccination. The writers concluded "We believe that our results further the emphasize the importance of adopting current adult pneumococcal vaccination guidelines, particularly since only 22 percent of our population were vaccinated before their hospitalization and less than 10 percent of eligible patients were vaccinated before hospital discharge."             Source: Medical News Today


How do patients choose the best treatment for their disease?

Research published by SAGE in special issue of Medical Decision Making

      The diagnosis has come in, and it’s not good. Worse, the patient has to choose from treatment options that are sometimes contradictory and risky. None of them promises complete success. How do patients make an informed decision, choosing the very best treatment for their own healthcare?

      These questions are addressed in the September/October 2007 special issue of Medical Decision Making (MDM) about the future of shared decision-making. The issue, published on behalf of the Society for Medical Decision Making by SAGE features new research articles, systematic reviews of the state of the science, and other perspectives. Some of the articles summarize past research on decision aids and communicating about risk, others describe new approaches and best practices for assessing and conveying risk information, and several suggest new paths for future research.

      “For more than two decades, Medical Decision Making has published research about patients choosing therapies that are consistent with their preferences,” writes MDM editor Mark Helfand in his editorial highlighting the issue’s articles. “Today, all sectors of the health care system— providers, payers, advocacy and consumer groups, industry, the lay press, and government—recognize that improvements in decision making are urgently needed and the research and recommendations described in this issue address practical ways to improve decision-making processes.”                Source: mdm.sagepub.com


Improving Doctor-patient Communication Yields Significant Health Benefits

      A UCSF research team has developed a simple tool that can improve the effectiveness of communication between doctors and patients about prescribed medications and result in dramatic improvements in health and safety. The new communication tool involves a computer-generated weekly calendar with color images of the medication to be taken each day, combined with instructions written in English and in a patient's native language if the patient does not speak English. The researchers call it a VMS, for visual medication schedule.

      "Improving communication has often been thought of as soft science, but our study shows significant clinical benefits when the information gap between physician and patient is bridged in the right way," says co-lead investigator Edward Machtinger, MD, assistant professor of medicine and director of the Women's HIV Program at UCSF. Machtinger and co-lead investigator, Dean Schillinger, MD, associate professor of medicine at UCSF and director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital Medical Center, developed the tool and conducted a study on its effectiveness. Research findings are reported in the October 2007 issue of the "Joint Commission Journal on Quality and Patient Safety," published by Joint Commission Resources.

      The research team selected patients taking an anticoagulant (clot preventing or blood thinning) medication for stroke prevention known as warfarin. Most patients in the study suffered from atrial fibrillation, a common heart condition in which the heart pumps irregularly, leading to formation of clots in the heart that travel to the brain and result in stroke. Atrial fibrillation affects over 2.5 million adults in the US and is responsible for 20 percent of all strokes. Treatment with warfarin, if taken correctly, can reduce the likelihood of stroke by 80 percent.

      However, warfarin is a notoriously challenging medication for doctors and patients to manage, and complications from warfarin are the most common cause of adverse medication events in community settings, according to the lead investigators.

      In previous studies, Schillinger and Machtinger found that nearly one half of patients on anticoagulants were not taking their medication accurately, but did not realize it. When describing the dose and frequency of the medication, patients and doctor often had two completely different understandings. These misunderstandings were more frequent among patients with limited literary skills, those for whom English was not their first language, and those with memory problems. Patients who had misunderstood their prescriptions were more likely to be under-anticoagulated and at risk for stroke, as well as over-anticoagulated and at risk for life-threatening bleeding.

      Based on these findings, the researchers developed a three-step communication approach for their current study and selected patients whose lab tests showed that their blood was not in the target range of anticoagulation. The three-step approach involves (1) having the patient describe how much medication he/she is taking and how often (to identify misunderstanding), (2) giving the patient a VMS along with written instructions both in English and the patient's native language, and (3) asking the patient to "teach back" what he/she has just learned so as to ensure common understanding.

      The study involved 147 patients, with half of the participants being randomized to receive the VMS along with brief, scripted medication counseling each time they came to clinic over 90 days, in addition to their standard care in an anticoagulation clinic. The other half received standard care, which includes medication counseling using non-standardized verbal and written instructions.

      Study findings showed that the blood anticoagulation status of patients in the VMS group reached the target, safe level almost twice as fast as those patients who were in the standard group— 28 vs. 42 days. In addition, the researchers found that the effect of the VMS tool was principally among those patients who, at the start of the study, had misunderstood their prescription instructions.

      Among this "at-risk" subset of patients, the VMS worked even faster (28 vs. 49 days), presumably by helping to correct the original misunderstanding that led to them initially being out of target range, the researchers say. One notable finding, they add, was that the VMS tool was especially effective among Spanish-speaking patients, again suggesting that the tool is most effective for those with communication barriers.

      Miscommunication between doctors and patients with regard to medication is common and often goes unnoticed, according to Schillinger. He and Machtinger began looking at the link between miscommunication and poor health about eight years ago when they realized that miscommunication could be a key, remediable cause of poor health outcomes and medication errors among vulnerable populations of patients.

      "It was amazing to us that the final crucial step in a long pipeline of science and disease intervention--communication around the actual taking of medications--was being largely ignored," says Machtinger. Their previous studies showed that problems at this final step were far more serious than the field had realized. These early studies were among the first to show a direct link between miscommunication and poor health, Schillinger says. This approach, says Schillinger, provides the clinician with immediate feedback on the patient's understanding of his medication and the opportunity to correct misinformation, along with a visual aid-the take-home calendar and verbal reinforcement.

      The idea for the visual part of the communications tool is not novel, the researchers say. For decades, doctors and pharmacists have often taped actual pills to hand-written sheets of paper to help educate their most vulnerable patients. This approach, however, is too time-consuming and impractical to carry out for every patient at every appointment.

      The VMS is fast and inexpensive, can be printed in any language, and facilitates communication that happens naturally in the doctor's office, the researchers emphasize, and can be adapted to other clinical settings, including pharmacies.

      The next step for the research team is to find ways to integrate the VMS and 3-step approach into everyday practice. "Having health systems adopt this communication tool on a long-term basis for anticoagulant care could translate into lots of strokes being avoided and lots of bleeding being prevented," says Schillinger.

      "We hope, in the near future, that all vulnerable patients will have a VMS tacked to the refrigerator so they, and their caregivers, will know which pills they should be taking and how they should take them," says Machtinger.

      In the meantime, the researchers emphasize that patients should be educated about the dangers associated with medication miscommunication and discuss how they are taking their medications with their doctor at every visit. While there are other reasons besides miscommunication that might affect whether a patient takes medication as prescribed, Schillinger believes that "for high-risk medications, we need to focus our energies on implementing standardized visual communication tools that accompany any prescription to ensure safety and quality."

Source: University of California, San Francisco


Mylan Inc. Subsidiary, Dey, L.P., Announces That Perforomist™ Inhalation Solution Is Now Available For Maintenance Treatment Of COPD

      Dey, L.P., a subsidiary of Mylan Inc. (NYSE: MYL), announced the launch of Perforomist™ (formoterol fumarate) Inhalation Solution, which will be available nationwide through retail pharmacies, hospitals, long-term care facilities, and home healthcare companies. Perforomist™ Inhalation Solution is indicated for long-term, twice-daily maintenance treatment of bronchoconstriction for emphysema and chronic bronchitis, also known as Chronic Obstructive Pulmonary Disease (COPD).

      The formoterol molecule is a rapid and long-acting beta2-agonist (LABA) that has been previously available in the U.S. in a dry powder formulation and has twenty years of worldwide experience. Perforomist™ Inhalation Solution is the first and only FDA-approved nebulized form of this molecule. Nebulizers convert liquid medication into a mist that patients inhale through a mouthpiece or face mask.

      "In treating patients with moderate to advanced COPD, I have found LABAs to be very effective, and in particular I think formoterol provides excellent long-term symptom control," said Donald P. Tashkin, MD, FACP, FCCP, Professor of Medicine, David Geffen School of Medicine at the University of California at Los Angeles. "Since patients have difficulty adhering to complicated medication regimens, it's very helpful that Perforomist™ Inhalation Solution offers a twice-daily nebulized version of formoterol. I consider nebulization to be an especially effective way to deliver medication into the lungs, and this new product should provide a valuable treatment for COPD patients."

      Perforomist™ Inhalation Solution is nebulized once in the morning and once in the evening, providing many COPD patients with round-the-clock symptom management. GOLD treatment guidelines recommend that physicians use a LABA (such as Perforomist™ Inhalation Solution) as an option for patients with moderate to very severe COPD.

      Christy Taylor, Chief Operating Officer at Dey, L.P., noted, "We are delighted to make Perforomist™ Inhalation Solution available to the millions of Americans who live with COPD. We are confident that Perforomist™ Inhalation Solution is a rapid and efficacious maintenance medication that can improve symptoms for many patients and fit suitably into their daily routines. For more than a decade we have been the US leader in sales of nebulized respiratory products, and Perforomist™ Inhalation Solution is a valuable and innovative addition to this portfolio."

      Robert J. Coury, Vice Chairman and CEO of Mylan Inc., stated, "We are extremely pleased with the management team at Dey for their ability to execute on their initiatives by the launch of Perforomist™ Inhalation Solution approximately six months in advance of what was originally anticipated and forecasted. Additionally, we are thrilled about this differentiated next generation product, which we believe will substantially replace the sales resulting from the loss of exclusivity of DuoNeb® Inhalation Solution.

      Gene L. Colice, MD, Department Director, Pulmonary, Critical Care and Respiratory Service, Washington Hospital Service, remarked, "Formoterol is a wonderful molecule. It's a very effective bronchodilator and works quickly, but probably its biggest benefit is that it works for 12 hours. Having formoterol in a nebulized form is an important option, since in my experience with hospitalized patients, the nebulizer is our preferred approach. Perforomist™ Inhalation Solution will be a major addition to our treatment options."

              Under an agreement with Critical Therapeutics, Perforomist™ Inhalation Solution will be jointly marketed by the combined sales teams of Dey, L.P. and Critical Therapeutics. Dey, L.P. also has a partnership with PARI Respiratory Equipment, whose breath enhanced nebulizer system, the PARI LC PLUS and PRONEB Ultra compressor, was used exclusively in DEY's clinical trials.

About Perforomist™ Inhalation Solution Indication

      Perforomist™ Inhalation Solution is indicated for the long-term, twice-daily (morning and evening) administration in the maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema. 

Source: medicalnewstoday.com


NCCAM EXPANDS CENTERS OF EXCELLENCE IN CAM RESEARCH PROGRAM

      The National Center for Complementary and Alternative Medicine (NCCAM) has added three new Centers of Excellence for Research on Complementary and Alternative Medicine (CAM) to its centers program. These centers will

explore the biological effects of a number of plant-derived compounds and preparations found in CAM products, such as dietary supplements, on pancreatic diseases, autoimmune and inflammatory diseases, and Alzheimer's disease. NCCAM, a component of the National Institutes of Health (NIH), is the lead Federal agency for research on complementary and alternative medicine.

Source: www.nccam.nih.gov/


Ozone Breaks Down Lungs' Defenses

      Ozone, a major component of urban air pollution, shuts down early immune responses in the lungs, which in turn makes the lung more vulnerable to bacteria and other foreign invaders, research shows.

      It's known that exposure to ozone is associated with increased cardiovascular and pulmonary hospitalizations and deaths, but the actual mechanisms involved haven't been clarified. This study, by Duke University Medical Center pulmonary researchers, may provide some answers. They found that mice exposed to unhealthy ozone levels showed amplified lung injury in response to bacterial toxins. The rodents also showed increased "programmed cell death" of the type of innate immune system cells that normally devour foreign invaders and keep the airways clear. The innate immune system— the most primitive part of the body's defenses— reacts indiscriminately to any invader. 

      "Small amounts of inhaled foreign material can be relatively harmless, since they stimulate an appropriate innate immune response that protects the lungs," study lead author and pulmonologist Dr. John Hollingsworth, said in a prepared statement. "However, it appears that ozone causes the innate immune system to overreact, killing key immune cells, and possibly making the lung more susceptible to subsequent invaders, such as bacteria," he said.

SOURCE: Duke University


Physicians may be losing their lock on Americans' medicine cabinets.

      For years, consumers have had two options at the drugstore. They could either show up with a doctor's prescription or settle for less powerful medications sold over the counter. Now the Food and Drug Administration is considering creating a different option, a class of medicines dubbed behind-the-counter drugs. It would let consumers purchase routine medicines that could include birth control pills, cholesterol drugs and migraine medicine without a prescription— as long as they discuss it with a pharmacist first.

      Pharmacists and drug companies like the idea; doctors think it's dangerous. If approved, the drug classification could go into effect as early as next year. "We believe having certain drugs behind the counter but available only after a consultation with a pharmacist could significantly increase patient access," said Ilisa Bernstein, the FDA's director of pharmacy affairs.

      But doctors are on alert. Dr. Anmol Mahal, a Fremont gastroenterologist and president of the California Medical Assn., said the federal agency's proposal was ill-conceived and unsafe for consumers. "Patients are not clinicians," he said. "Allowing people to self-diagnose and self-treat is not in their best interest. Nothing could be farther from the truth."

      Jaime Abramowitz disagrees. The 28-year-old human resources manager from Burbank said she would be comfortable getting at least routine medications without having to visit her doctor. Abramowitz currently takes birth control and has to take as much as half a day off to get a checkup and refills every 12 months. "It's a pain going sometimes," she said.

      Currently, only a few drugs are available behind the counter without a prescription. Best known is the morning-after birth control pill that was banned for over-the-counter sale in the U.S. until last year. Girls under 18 still need a prescription for the drug. However, a much wider selection of behind-the-counter medications is available in Australia, Canada and several European countries. Several other countries are considering similar plans. In the U.S., pharmacists, manufacturers and some consumer groups have made a concerted push in recent years— with little success until now— to create a federal regulatory category for medications that are known to have few safety issues and side effects. Over-the-counter drugs typically sell for less than prescription medicines but often at much higher volumes and thus are potentially more profitable for manufacturers in certain cases.

      Much will depend on which behind-the-counter drugs insurers decide to cover. Most insurance plans today cover prescription drugs but not over-the-counter drugs. Insurers say they are researching the FDA's proposal. "Increasing patient control and access to medication while dramatically lowering cost to the consumer is a laudable goal," said Nicole Kasabian Evans, a spokeswoman for the California Assn. of Health Plans. "We would like to work with the FDA to learn more about their efforts." The FDA announced plans Wednesday to examine the issue and spelled out details in the Federal Register. The move signals a possible change of heart in public policy and an indication that the government is trying novel ways of increasing the public's access to medications and reducing drug costs. Just two years ago, an FDA panel turned down a bid by Merck & Co. and Johnson & Johnson to sell the cholesterol-lowering drug Mevacor without a prescription. At the time, several panel members said the agency should consider a behind-the-counter approval option. In January, Pfizer Inc. said it was considering seeking approval for its anti-impotence drug Viagra over the counter.

      John Tilley, who owns four Zweber pharmacies in Downey and serves as president of the National Community Pharmacists Assn., sees the FDA's proposal as a "win-win" for patients. Pharmacists are trained to consult about routine medical information, he said, and are often more accessible and spend far more time with customers than do their doctors. He added that greater access to medications might help patients without health insurance who otherwise might not be getting care. "It's not like people would be getting these medications from a vending machine," he said. "This would include an adequate level of care."

      Critics of looser oversight over the nation's drug supply, especially doctors, are less optimistic. Mahal, of the California Medical Assn., said a main worry was that patients would buy medication and then lack supervision to ensure that their treatment was safe and effective. Another worry: that women who skip regular doctor visits to get prescriptions for birth control pills may also forgo gynecological examinations. Bernstein, of the FDA, said the agency had several unresolved questions about how such a proposal would work in practice—including how it could affect patient safety and whether it really would improve access to medications as much as some predict. "We're still in research mode," she said.

      The agency is planning to address those and other issues at a Nov. 14 public hearing about the plan and will seek written and electronic comments until Nov. 28. There is no deadline by which the agency must make a final decision, although the process is likely to be concluded in the next several months. On Thursday, the agency also said it would institute policies to shorten the backlog of more than 1,300 generic drugs awaiting approval by giving priority to decisions on products that are the first of their kind and giving applicants more feedback. Generic drugs, which cost as much as 80% less than their brand-name counterparts, are now likely to get faster review, the agency said.

Source: latimes.com


Primary Care Management of Chronic Obstructive Pulmonary Disease

Introduction

      Chronic obstructive pulmonary disease (COPD) is a common and underdiagnosed disease which is increasing in prevalence worldwide. The disease causes persistent and progressive symptoms which can have major effects on the quality of life of the sufferer and a heavy health burden on global health services and economies.

      Sadly, despite the undoubted frequency and seriousness of COPD, there is a widely held view that little can be done to treat the disease other than stop patients from smoking. This negative attitude linked to a lack of understanding about modern management is a major hurdle to providing patients with the symptomatic relief and help that they badly need. A much more aggressively optimistic approach must be adopted as, although treatments are unable to cure the disease, there is no doubt that they do significantly improve patients’ symptoms in a variety of ways. Breathlessness can be lessened, exercise levels and quality of life improved and the frequency of acute exacerbations decreased. However, stopping smoking is the only action that will slow the rate of disease progression.

      The most important primary care objective should be the improvement in the quality of life. Every effort should be made to reduce exacerbations as higher frequency of exacerbations has been associated with a poorer quality of life and more rapid decline in lung function.

What is COPD?

      COPD is a spectrum of diseases that includes chronic bronchitis, emphysema, longstanding asthma that has become relatively unresponsive to treatment, and small airways disease. The unifying feature of COPD is that it is a chronic, slowly progressive disorder characterized by airflow obstruction that is not fully reversible and varies little from day to day or over longer periods of time. Several major guidelines add that COPD is associated with an abnormal inflammatory response of the lungs to noxious particles or gases.

      COPD predominantly affects the lungs but recent observations suggest that it is associated with manifestations outside the lung and is linked to other systemic diseases. The exact mechanisms are still to be discovered but it appears that there is evidence that at least in part the causative link may be through various chronic inflammatory substances circulating in the body.

      Many of the co-morbidities linked to COPD are also related to smoking. However there is enough evidence to support a causative cross-relationship in addition. COPD is linked to weight loss and cachexia; skeletal muscle dysfunction; cardiovascular effects; osteoporosis; depression; and cancer.

      A meta-analysis of inflammatory markers associated with COPD was conducted by Gan et al. in 2004 (1). Levels of white cells were increased as was C reactive protein (CRP), fibrinogen and the cytokine tumor necrosis factor-alpha (TNF-alpha). The origin of these substances is uncertain, but it is likely they do arise in the lung as their levels rise with increasing severity of COPD.

Source: D.Bellamy, PCP, Bournemouth, UK


Report faults FDA oversight of drug trials Federal investigator says inspectors are few; findings rarely followed up

      A federal investigator has found sparse government scrutiny of the safety of drug trials involving millions of people, saying inspectors are few and their findings are rarely followed up. A report due to be released finds that officials at the federal Food and Drug Administration do not know how many clinical trials are going on and audited less than 1 percent of testing sites, The New York Times reported. The agency has just 200 inspectors to monitor an estimated 350,000 test sites.

      When inspectors do flag serious problems, their findings are frequently downgraded by senior officials and are almost never followed by inspections to see whether the issues have been resolved, according to the newspaper, which cited the report by Health and Human Services Department inspector general Daniel R. Levinson. FDA inspectors often show up long after the tests have been completed, the Times quotes the report as saying.

      The FDA found serious problems at test sites 348 times between 2000 and 2005. But only 26 investigators were disqualified from conducting further clinical trials, and data was disqualified just twice, The Times reported. The FDA has been accused of lax oversight of drug trials in general. The agency has said it lacks the resources to do the job properly. The FDA’s chief medical officer, Dr. Janet Woodcock, said the agency was “working to address these problems very aggressively.”

Levinson recommended that the agency create a registry of all continuing clinical trials.

      Meanwhile, President Bush signed a bill into law Thursday that is intended to boost the FDA’s power to police prescription drug safety. It devotes more focus to drugs already on the market, as opposed to those awaiting approval, and gives the agency more authority to act when problems emerge. The FDA oversees the safety of companies’ drug or medical device trials, while the Office for Human Research Protections does the same for federally financed tests. HHS is the parent department of the FDA, which, among other duties, approves new drugs. Clinical trials — those involving real human patients — are a key part of this approval process.

      There is no federal monitoring of privately financed, noncommercial trials.                          Source: MSNBC.com


New Spiriva® Respimat® inhaler completes European approval process for COPD

Patients to benefit from easy-to-use inhaler with enhanced drug delivery

       Boehringer Ingelheim and Pfizer announced successful completion of the approval process for authorization to market Spiriva® Respimat® in the European Union for people with chronic obstructive pulmonary disease (COPD). This positive opinion for the Spiriva® Respimat® is the cornerstone of all national approvals in 25 countries of the European Union. Spiriva® Respimat® is a propellant-free, new generation inhaler that combines innovative technology with the proven efficacy of Spiriva® (tiotropium).

      “Spiriva® Respimat® represents a major step forward in COPD and inhalation therapy. Many patients find certain inhaler devices difficult to coordinate and use,” said Professor Marc Decramer, Respiratory Division, University Hospitals, Katholieke Universiteit Leuven, Belgium “Spiriva® Respimat® has a unique and sophisticated delivery system, and a user friendly design, making it easy to use and suitable for a broad range of patients with COPD. In addition the long-lasting, soft mist cloud generated by Spiriva® Respimat® ensures optimized delivery of Spiriva® to the lungs, helping patients breathe more easily,” he added. In clinical studies comparing inhaler devices,* patients preferred Respimat® Soft Mist™ Inhaler, which may help increase patient compliance with therapy. The novel dose-delivery system of the Spiriva® Respimat® also means that unlike dry powder inhalers, the dose delivered is not dependent on patients’ inspiratory flow.

      Spiriva® (tiotropium), a first-line maintenance therapy for COPD, positively impacts the clinical course of the disease, helping to change the way patients live with their condition. The efficacy of Spiriva® has been demonstrated by an extensive clinical development program, which has treated over 25,000 patients. It is the most prescribed brand in COPD in the world.

      The Spiriva® Respimat® delivery system relies on energy released from a spring, rather than propellants, to produce a long-lasting, slow moving Soft Mist™. The innovative design makes Spiriva® Respimat® easy to use, and the Soft Mist™ results in improved delivery of Spiriva® to the lungs, with reduced deposition in the mouth and throat compared to a pressurized metered dose inhaler (pMDI). One study showed that 72% of all patients use pMDIs incorrectly and almost half (47%) have problems with coordinating use of the device.

      600 million people worldwide live with COPD and its prevalence is predicted to rise making it the world’s third leading cause of death by 2020. It is estimated that up to 50% of Americans and 75% of Europeans with COPD are undiagnosed.

Dosing

      Spiriva® Respimat® 2.5 microgram (total 5 microgram dose administered as 2 x 2.5 microgram puffs) has a therapeutic effect comparable to Spiriva® HandiHaler® 18 microgram. Spiriva® Respimat® is a convenient, multi-dose device with a dose indicator and can provide treatment for one month.

Advanced technology; simple operation

      To use the Spiriva® Respimat® patients simply need to twist the base of the inhaler 180̊. This action compresses the spring, which results in a pre-defined, metered volume of solution being drawn up through the capillary tube and into a micro-pump. The Soft Mist™ is generated by the use of principles established for microchip technology which enables fine fluid channels to be etched into the surface of silicon wafers. These are then covered by a glass plate and bonded chemically. This filter structure known as a uniblock, results in two extremely fine outlet channels, through which Spiriva® is forced, producing two ultra fine jets of liquid that converge at a carefully controlled angle. The impact of these two jets converging is what creates the unique Soft Mist™. Once the dose-release button is pressed, the energy released from the spring forces the solution through the uniblock and the slow-moving, long-lasting Soft Mist™ is released.                                                                                                                                  Source: Boehringer Ingelheim


Why Fall May Rob You of Sleep

Fall means earlier sunsets and turning leaves. But less sleep?

      Absolutely, if the dust, mold, and pollen of fall make you sneeze. Allergy sufferers are much more likely to have sleep problems compared with other people. (And you thought it was the Benadryl making your eyelids droop!) Here's a breathe-easy battle plan for getting through the season— and the night.

The Ripple Effect

      As if the sneezing, runny nose, and itchy eyes weren't enough trouble . . . a full 44 percent of allergy sufferers wake up feeling tired despite getting a full night's sleep. Compared with allergy-free folks, severe allergy sufferers are also much more likely to experience headaches, anxiety, and depression.

           See your doctor about your allergies, if you haven't already. In the meantime, here are some self-care tips that may help keep symptoms under wraps:

           Shower before bedtime to avoid bringing pollen to bed.

           Get a good-quality indoor air cleaner, and change or wash the filter at least once a month.

           Close your doors and windows and use forced air/heat to keep pollen outside. (Learn about your local pollen counts.)

           Avoid hanging clothes to dry outside.

Sleep Hygiene

      Sleep hygiene refers to a list of recommended behaviors and environmental conditions that, when employed singularly or in combination, can improve sleep quality. Research indicates that 70% to 80% of patients with sleep disorders benefit when practicing good sleep hygiene.

Behaviors to avoid:

           consuming caffeine, nicotine, and alcohol too close to bedtime

           watching television right before going to bed

           eating or drinking 2-3 hours before bedtime

           going to bed before you are sleepy

           exercising too close to bedtime

Behaviors to adopt:

           using your bedroom only for sleep

           exercising regularly, preferably in the morning or early afternoon

           keeping a regular bedtime and waking time, even on the weekends

           creating a relaxing bedtime routine, such as taking a leisurely stroll, soaking in a tub, listening to soothing music, or massaging your legs or feet before bed

           practicing relaxation techniques, such as progressive muscle relaxation therapy, guided imagery, and deep breathing exercises

           creating a comfortable environment that is conducive to sleep by eliminating uncomfortable bedding, wearing loose clothing, keeping the bedroom temperature slightly cool, and eliminating any bothersome noise or light                                                                                                                                                    Source: RealAge


Salt. A Whole Lotta Shakin Going On

The American Medical Association once again is sounding the alarm about salt.

      The Journal of the American Medical Association carries an impassioned commentary from A.M.A. officials declaring an “urgent need” to reduce sodium in our diets. Don’t worry — the group doesn’t want to take away your salt shaker. Instead, the association is calling for the Food and Drug Administration and industry to get serious about lowering the sodium content of our food, and the group is urging consumers to shop more often for lower-sodium alternatives.

      Sodium has long been associated with an increased risk for high blood pressure. Notably, the World Health Organization earlier this year said the evidence linking sodium to hypertension is “conclusive.” Cutting American’s sodium intake in half, notes today’s commentary, could reduce deaths from heart disease and stroke by 23 percent. By some estimates, that could prevent 150,000 deaths every year.

      Yet the Salt Institute, an industry trade group, disagrees, saying there’s no evidence to support a campaign against sodium. In fact, some people are more sensitive to the deleterious effects of sodium than others. Unfortunately, there’s no real way to figure out if you’re one of them.

      The average American takes in 4,000 milligrams of sodium daily. That’s a lot more than you need. According to the FDA, most people can safely ingest up to 2,400 milligrams a day — which is about one teaspoon of salt. Sodium is essential to our bodies, but we don’t need much. The adequate intake for healthy body function in people younger than 50 is only 1,500 milligrams. People over age 50 need only 1,200 to 1,300 milligrams.

      Any food that contains more than 480 milligrams of sodium per serving should be considered a high-sodium food, says the A.M.A. By that measure, the amount of sodium in some popular foods is shocking. One turkey panini from the Panera Bread chain contains 2,390 milligrams of sodium. Even the sweet stuff can be loaded. A Starbucks cinnamon roll contains 700 milligrams of sodium, while a large white hot chocolate at Dunkin’ Donuts holds 600 milligrams.

      The fastest and easiest way to reduce sodium is to cut out processed foods and restaurant visits. Fresh vegetables and meats have far less sodium than frozen and canned foods. Only 6 percent of the sodium we ingest comes from the salt shaker at the table, while another 5 percent is added

 by the home cook. Most of the salt we consume — 77 percent — comes from processed and restaurant foods, according to the Center for Science in the Public Interest. The remaining 12 percent occurs naturally in food.          Source: AMA


HEALTHY HABITS: Ready, set, breathe

      Breathe in, breathe out, breathe in, breathe out. It's such a simple act and absolutely essential to our lives. We breathe without thinking about it, while simultaneously doing one of a thousand other things; talking, running errands, eating, even sleeping. But what about people for whom the act of breathing is a labor, something that happens only with discomfort? For people with chronic obstructive pulmonary disease, breathing is not something they take for granted.

      COPD refers to two lung diseases: chronic bronchitis and emphysema. In both cases, inflammation in the lungs interferes with the transmission of oxygen to the bloodstream. People with COPD suffer from shortness of breath so severe that it interferes with even the most basic daily activities. Things as simple as getting dressed, sweeping the kitchen floor, or even holding a conversation can be difficult or impossible for someone with COPD.

      As the fourth leading cause of death in the United States, COPD is responsible for a death every four minutes. While death rates from heart disease and stroke decreased between 1965 and 1998, COPD death rates increased 163 percent during this same time period.

      It is now estimated that 15 million to 30 million Americans suffer from the disease. Cathy Caruso, a registered nurse with the Natick Visiting Nurse Association says that, “if you don't have COPD, chances are that you know someone who does.'' With the disease so widespread, it is not surprising that U.S. News and World Report magazine tells us the annual direct and indirect medical costs related to COPD now exceed $30 billion.''

      How would you know if you have COPD? Caruso says to talk with your doctor if you:

           Are 45 or older, and smoke (or have ever smoked)

           Have been exposed to environmental irritants, such as second-hand smoke, chemicals or fumes

           Experience a persistent cough, especially with mucus

           Have trouble breathing during physical exertion

           Have a family history of asthma, bronchitis or emphysema

      The good news is that COPD is considered a preventable and treatable disease. Preventable because the primary risk factor is smoking. Smoking was the cause of 95 percent of COPD cases in the U.S. Caruso says that though there is no cure for COPD, people can successfully manage the disease.

      “By taking care of themselves and closely monitoring their symptoms, people with COPD can lead fulfilling and productive lives,'” she says. Her advice is to:

           Stop smoking

           See a physician regularly, at least twice a year

           Take medications as prescribed

           Avoid bad air quality (avoid smoky environments, stay inside during humid weather, purchase an air purifier)

           Keep your body strong and healthy by eating a healthy diet, taking in adequate fluids and begin or maintain an exercise routine as your doctor allows

           Wash your hands regularly to decrease chances of catching cold

           Get a flu and pneumonia vaccination each year

      Early diagnosis and treatment can help people with COPD take charge of their breathing and regain control of their lives. They can be more active, decrease shortness of breath, lower anxiety and depression and have a high quality of life. By focusing on managing their disease, people with COPD can breathe easy, too.          Source: Natick VNA                                                                                                                                  


Quit counting calories if it doesn't add up

Keeping tabs on numbers can derail your diet; fill up on these tips instead

      Good news for anyone who hates number crunching: You don’t need to add or subtract a thing to get slim. “Instead, focus on food quality, portion size and the timing of your meals,” says Ann Yelmokas McDermott, Ph.D., director at the Center for Obesity Prevention and Education at Cal Poly San Luis Obispo. If you obsess over calories, you’re more likely to consume fat-free foods that are low in fiber, high in sugar and, ultimately, unsatisfying. The result? You never feel full, so you end up eating more. Instead…

      Pile on produce. Have at least one fruit and veggie at every meal (or two fruits at breakfast, if that’s easier). They’re high in fiber, which helps delay hunger. Aim for nine servings daily; with a salad at lunch or dinner, you’ll easily hit your goal.

count_~1.gif

      Eat bigger snacks. Add protein (a stick of low-fat string cheese, a cup of skim milk) to your usual nosh. Research suggests protein may enhance the effect of leptin, a hormone that reins in appetite. Protein is also filling and can help curb cravings for extra handfuls of fatty snacks.

      Drink more water. It’s no shocker that a study at the annual meeting of the Obesity Society in Boston found that dieters who swapped sugary drinks for water shed pounds. But what is news is that dieters who gulped the most H2O lost the most weight.

      Portion your plate. Use a salad dish (8 inches in diameter), and mentally divide it into quarters to help keep portions reasonable. Cover two quarters with veggies, one quarter with lean protein (3 to 6 ounces of fish, chicken or tofu) and one quarter with whole grains (½ to 1 cup brown rice or whole-wheat pasta).

      Eat every meal. When you wait longer than five hours between bites, your body may release extra cortisol, a hormone that can increase appetite. Have more food and weigh less? That’s one equation you can count on.                                                                                                                                            Source: MSNBC.com


Health Tip: Finding Fiber in Your Diet

      Fiber should be an important part of every diet. According to the American Academy of Family Physicians, dietary fiber can help prevent heart disease, high cholesterol, diabetes, and even some types of cancer. The academy offers this list of fiber-rich foods:

           Fruits like apples, oranges, berries, prunes, figs and pears.

           Vegetables like broccoli, cauliflower, Brussels sprouts, peas, carrots and beans.

           Whole grains like bran muffins, oatmeal, brown rice, popcorn, whole wheat bread and multigrain cereals.

           Added wheat bran to foods like applesauce, oatmeal, and cooked cereals.                                                                                                                                                          Source: Health Day News


COPD Patients Up Risk for Pneumonia with Corticosteroid Use  

      When patients with chronic obstructive pulmonary disease (COPD) need to control flare-ups of their disease, doctors have been prescribing inhaled corticosteroids for relief, but a new study reveals that they may be increasing patients' risk for developing pneumonia. Researchers from McGill University found a 70% increased risk of hospitalization for pneumonia among patients using inhaled steroids and a 53% increased risk of death from pneumonia within 30 days of initial hospitalization. These risks were reduced once medications were stopped. Pneumonia remains the 3rd leading cause for hospitalization, and inhaled corticosteroid use among COPD patients increased from 13.2% to 41.4% from 1987 to 1995. The complete study article appears in the July 2007 issue of the American Journal of Respiratory and Critical Care Medicine.                                                                             Source: Pharmacy Times


3 Fall Veggies That Help Make You Younger

      It's that time of year when not only leaves turn orange, but the offerings on your dinner plate do, too. And that's a good thing, because yellow-orange veggies like carrots, sweet potatoes, and winter squash are chock-full of carotenoids. Why care about carotenoids? These good-for-you nutrients fight the DNA damage that can make your body old (or sick) before its time.

The Way of DNA

      Over the course of your lifetime, your DNA accumulates damage every time it gets copied to create a new cell. It's like when you make a copy of a copy of a copy on the Xerox machine. Little flaws and imperfections start to show up. Same thing can happen with your DNA. And that's not such a great thing, because it can lead to that ultimate cell-replication error: cancer.

Cell-Protecting Carotenoids

      Researchers suspect that carotenoids— those plant pigments that give carrots, pumpkins, and cantaloupes their rich orange hues— may help protect against the kind of DNA damage that happens with age, so you can go on making copies of your cells longer!                                                                             Source: RealAge


Why Soup Is More than Just a Great Meal for the Winter Season

      Coming in from the cold or recovering from a cold, nothing is said to be as comforting as mom's chicken soup. Indeed, at Body Ecology we feel that a bowl of soup made with a variety of nourishing vegetables and a great stock plus some fermented foods to aid in digestion can be one of the most healing and fortifying of meals, especially in winter.

More than Food for Your Soul

      Ancient cultures have long used soups and broths as home remedies for colds and flu, and even scientific data shows that soup more than just good for your soul.

Did you know?

      Chicken soup contains an amino acid that closely resembles a pharmacological agent called acetylcysteine, often prescribed for bronchitis. It is available under the trade names Mucomyst, Fluimucil and Parvolex. You can also buy acetylcysteine in the health food store as N-Acetylcysteine.

      Traditional ingredients in soup like garlic and pepper work as natural decongestants—they thin out mucous and make breathing easier. Note that we do not use black pepper since it is said to be irritating to the gall bladder but we do recommend cayenne pepper.

      Tests have shown that chicken soup has anti-inflammatory properties. (Inflammation has been linked to chronic diseases like cancer, arthritis, and heart disease.)

Drinking hot soup and breathing in the steam can decongest the respiratory system.

       Whether or not you feel under the weather, soup is an excellent meal during the winter months when your body needs more warming food. Soup is a wonderful hydrator and gives your body much-needed liquid. On top of all that, soup is easy to digest, making it a great way to get valuable nutrients into your diet.

      Soup is a healing and fortifying meal; you can even try it for breakfast!

Why Not Have Soup For Breakfast?

      Though we Americans are accustomed to cereal and milk or bacon and eggs, soup makes a delicious, nourishing, breakfast meal.

      Actually, many other cultures eat soup for breakfast. In China, the children are sent off to school after eating a bowl of soup made with rice grains. Japanese kids do the same but sip their soup made with an ocean vegetable broth and fermented miso paste.

      What people in these cultures know is that in the morning, warming broths are a great way to "break the fast" after 8 -12 hours without food or liquids. Having warm soup in the morning stimulates digestion, igniting your "digestive fire" and prepares your digestive tract for later meals.

Fun Soup Ideas

      Body Ecology has some delicious soup recipes and as you learn the healing Body Ecology principles, you'll also have fun experimenting on your own. Try these ideas the next time you crave a warm, delicious and nutritious soup — for breakfast or anytime!

           Clean Out Your Fridge Veggie Soup - use the left over vegetables for a delicious, mineral-rich soup.

           Grain Soup - Add Body Ecology grains - see The Risks of Consuming Typical Grains & the Healthy Grains to Choose Instead— to your soups for a    hearty, filling soup.

           Protein Soup - Try a protein-based soup (chicken, fish or red meat) and combine with non-starchy vegetables.

           Pureed Soup - You can puree any soup to give it a creamy texture and a new look. The kids will never balk at eating their veggies again because they won't even know they're eating it!

A Few Important Tips from Body Ecology Founder Donna Gates:

      I have noticed that many people do not do well on the cooked fat in soup stocks made from animals like poultry and meats. Cooked fats are much harder to digest than raw fat and many people simply do not digest fats, especially today.

      To solve this problem, prepare your stock according to the recipe then put your finished stock into the refrigerator for several hours until it cools. A layer of fat will have formed at the top of the jar or bowl. Skim this off and discard. You're ready to enjoy the rest of the broth. The gelatin is excellent for you - it's full of wonderful minerals.

      Dried fish flakes can be purchased from your health food store and can be simmered for ten minutes then removed to make a quick and nourishing animal based broth. The Japanese do this and also simmer a piece of the sea vegetable, Kombu. It's one of the most nourishing broths you can prepare and it's fast.

Source: BodyEcology.com


APPLE CRUNCH SALAD

6 Servings  Serving size: 3/4 cup    Preparation time: 20 minutes

FRUIT

1 cup diced, unpeeled Granny Smith apples

1 cup diced, unpeeled Golden Delicious apples

1/2 cup diced unpeeled Gala, Fuji or Red Delicious apples

1 cup sectioned oranges

1 medium banana, sliced

DRESSING

3/4 cup nonfat sour cream

2 Tbsp. fresh orange juice

2-1/2 tsp. toasted unsweetened coconut

      Combine all the fruits in an attractive serving bowl. Mix together the dressing ingredients. Toss with the apple mixture and serve.

Fruit Exchanges 1.5


10 Foods You Should Eat

      We've all heard about super foods—consumables with mystical powers to cure whatever it is that ails you and that will help you live forever. This list will be different. Today we'll look at some common items that should be on your menu, even though you probably haven't heard them touted as the next great miracle cure. In fact, some of these you probably thought were bad for you.

      I begin this list with a caveat; we're all different. One person's super food is another's trip to the emergency room (soy comes to mind here). There are some nutritional factors we all share, such as the need to eat a certain amount of calories that come from fats, proteins, and carbohydrates to keep our bodies functioning as they should. Beyond this, our exact dietary needs begin to diverge.

      There are some obvious reasons for this. Lifestyle and activity level are pretty easy to understand. That someone who is pregnant or training for an Iron man needs more calories than a computer programmer who sits for 14 hours a day isn't difficult to fathom. Neither is the fact that a 90-pound ballerina uses less fuel than a 350-pound lineman. That we all eat a different number of calories and a different percentage of fats, proteins, and especially carbs is obvious, or at least should be, since the bigger you are and the harder you work the more fuel your body needs to recharge itself.

      What's more subtle are body type differences. These can be difficult to understand, and many people never figure them out. Blood type, heredity, and other factors come into play and make each of us unique individuals. When it comes to eating, most of us spend a fair portion of our lives figuring out just what we should be eating to maximize our life experience (which doesn't necessarily mean we choose the healthiest options). For this reason, there is no true "super food." There are, however, helpful foods that are specific to each of us. By experimenting with our diets, we will all find a course of eating that makes us feel better than anything else.

      To help you begin your self-experiment, here's a list of common foods that you'll want to try. Most of these are very healthy for almost everyone, even though some have been vilified by society. This doesn't mean that they'll transform you into an epitome of health, but they're certainly worth a try.

Peanut butter.

      Peanuts are high in both fat and calories but their fat has been associated with decreased total cholesterol and lower LDL and triglyceride levels. It's also high on the satiation meter, meaning that a little can fill you up. Although peanut butter is good for you, it's best to use it sparingly. Spread it over a sliced apple for a nutritious and filling snack.

Cabbage.

      Every Asian culture, as well as European, eats more cabbage than we do and it's time we thought about it more often than when we happen to splurge on P.F. Chang's. Cabbage is absurdly low in calories and very high in nutrients. Among these is sulforaphane, which a Stanford University study showed as boosting cancer-fighting enzymes more than any other plant chemical.

Quinoa.

      This "grain" isn't technically a grain at all. It just tastes like one. It's actually a relative of spinach, beets, and Swiss chard. All of these are extremely healthy from a nutrient point of view, but quinoa is the only one that can fool you into thinking you're eating a starch. It's high in protein, minerals, vitamins, and fiber.

Spelt.

      This one is actually a grain but its origin is slightly mysterious. Some claim it comes from wheat while others say it's a different species. Regardless, it has a high nutritional profile and can be eaten by many people with gluten intolerance, making it a good alternative to wheat products. Spelt can be found in many products, but as it's still considered a "health food," it's off the major processing radar. Unlike wheat, if spelt is on the ingredients list, it's probably good for you.

Walnuts.

      All nuts, really, but walnuts seem to be the king of the nut family. Used in Chinese medicine for centuries, walnuts are becoming more associated with Western health than ever before. A 2006 study published in the Journal of the American College of Cardiology found that eating walnuts after a meal high in bad fat could reduce the damaging effects of the meal.

Avocado.

      Another villain in the old no-fat movement, avocados are now thought to be one of the healthiest fat sources available. Beyond this, they have very high amounts of cancer-fighting antioxidants, and recent research seems to indicate that avocados' phytonutrients may also help with the absorption of nutrients from other sources.

Mushrooms.

      The more we learn about phytonutrients—those that come in a small enough quantity to be missed on a food label (this is a layman's definition only)—the more we should admire ancient cultures. These culinary delights have been feuded over for decades until, for some reason, we'd decided they were pretty much empty calories. The study of phytonutrients has taught us that warring over fungi may have held some rationale after all. Mushrooms are loaded with antioxidants and are thought to boost the immune system, help ward off some cancers, and have high amounts of potassium. Furthermore, researchers at Penn State University have found that mushrooms may be the only food to contain an antioxidant called L-ergothioneine.

Tea.

      Despite a ton of positive press over the last, oh, century, tea and coffee are still the devil's brew in some circles. Perhaps even worse is how many coffee and tea restaurants have bastardized these natural brews into sugar- and fat-filled dessert items. Both tea and coffee, in their basic states, have no calories and many healthy benefits. Between the two, coffee is arguably more popular, most likely due to its higher caffeine content. But tea is probably healthier. Both have a high amount of antioxidants but stats on tea are almost off the charts. A recent study on calcium supplementation in elderly women, published in the American Journal of Clinical Nutrition, showed that bone mineral density at the hip was 2.8 percent greater in tea drinkers than in non-tea drinkers.

      Tea leaves can be used as effective deodorizers. You can rub your hands with wet green tea leaves to rid them of fish and garlic odors. Tea contains plenty of catechins, the polyphenolic substances known as antioxidants. Catechins have antibacterial properties, thus making tea leaves effective odor fighters. Dried tea leaves can be crushed and lightly sprinkled over your carpet (allow them to sit for 10 minutes). Vacuum the leaves up, and your carpet will be refreshed and your vacuum cleaner and bag will be deodorized. Other effective deodorizing uses: used green tea leaves in kitty litter for eliminating odor, and to help deter fleas from both dogs and cats; used green tea bags or leaves uncovered in a small bowl in your refrigerator to absorb onion and garlic odors for approximately three days; and green tea to stop the growth of bacteria that cause bad breath.

Cinnamon.

      Cinnamon has long been the prized possession of the spice world. It has a host of benefits, but perhaps none more important than this one: USDA researchers recently found that people with type 2 diabetes who consumed one gram of cinnamon a day for six weeks significantly reduced their blood sugar, triglycerides, and LDL cholesterol.

Natto.

      This is on the list because we've really messed up the way we eat soy. Natto is fermented soybeans and very popular in Japan. It's becoming more popular here and this is most likely due to its health benefits. Nearly all the soy options we're offered in the U.S. are non-fermented. The list of health benefits of fermented soy is a mile long. It's associated with reducing the risk of cancer, minimizing the likelihood of blood clotting, aiding digestion, increasing blood circulation, an improved immune system, improving bone density, lessening the likelihood of heart attacks, more vibrant skin, and reducing the chance of balding. And it also has strong antibiotic properties, among other things. So you might want to ditch the soy crisps, soy ice cream, and your iced soy mochas and add some natto to your diet.

Source: beachbody.com.


Harvest Baked Apples

Prep Time: 10 min Total Time: 45 min

Makes: Makes 8 servings, one apple each.

 

8 medium baking apples

1 cup apple or orange juice

1/4 cup firmly packed brown sugar

1/2 tsp. ground cinnamon

1 cup (4 oz.) shredded Reduced Fat Sharp Cheddar Cheese

1/4 cup raisins

1/4 cup chopped pecans, toasted


Preheat oven to 350̊F. Remove cores from apples to within 1/2 inch of bottoms of apples; pierce the skins with a sharp knife.

Place apples in shallow baking dish.

Combine juice, sugar and cinnamon; pour over apples.

Bake 30 to 35 min. or until apples are tender, basting occasionally with the juice mixture. Remove apples from oven. Combine cheese, raisins and pecans; spoon evenly into centers of apples.

Let stand 1 min.


Maple-Baked Apple Chicken

Recipe Rating: Prep Time: 15 min Total Time: 40 min

Makes: 4 servings

 

4 small boneless skinless chicken breast halves (1 lb.)

1/2 cup sliced onions

2 red cooking apples, sliced

1/2 cup maple-flavored or pancake syrup (Or honey)

1/3 cup Italian Dressing


Preheat oven to 350̊F. Spray large ovenproof nonstick skillet with cooking spray. Heat on medium-high heat. Add chicken; cook 3 min. on each side or until lightly browned on both sides. Remove from heat.

Place onions on top of chicken; surround with apple slices. Mix syrup and dressing; pour over chicken.

Bake 20 to 25 min. or until chicken is cooked through (165ºF). Spoon syrup mixture in skillet over chicken just before serving.


Tip: If you don't have an ovenproof skillet, simply cover the handle of your regular skillet with several layers of foil before using as directed.


MOM'S LAYERED SALMON SALAD

Ingredients:

1 small head of lettuce (iceberg) chopped

2 large cans salmon crumbled

2 cans of peas

4 medium potatoes boiled and sliced lengthwise

3 or 4 tomatoes sliced

1 dozen eggs hard boiled and sliced, with 1 egg sliced in quarters

2 cans sliced beets (reserve some slices for decoration)

1 large can large black olives, pitted

1 large platter

Dressing:

1/2 jar Mayo

juice of 2 lemons

salt

pepper

1 tbsp. dried parsley

water

Instructions:

On the platter, layer the lettuce, then the salmon, peas, sliced potatoes, sliced tomatoes, sliced eggs and sliced beets.

Layer these ingredients in this order and then repeat until all the ingredients are used.

Make sure the last layer is a layer of beets. To decorate, line the entire edge of the platter with the reserved beet slices and top each beet slice with a black olive.

On top of the salad place the quartered hard-boiled egg to resemble a flower. Dot the top of the salad with black olives.

Mix the dressing in a clean jar. Place 1/2 jar of mayo in this clean jar and add the juice of 2 lemons, salt, pepper and parsley. Add enough water to made the dressing creamy and pourable. Chill the dressing for several hours. Pour individually when ready to serve.


Vegetable and White Bean Minestrone           

Serves 6

      “This classic soup—comprised of vegetables, white beans, and pasta—is rich in fiber, vitamins, calcium and iron, and is immensely satisfying,” write the authors of The Diabetes Menu Cookbook. It makes a delicious comfort- food supper when served with a salad of dark, leafy greens and Italian bread.”

Ingredients:

2 tablespoons olive oil  

1 large onion, coarsely chopped

2 large celery ribs, coarsely chopped

2 carrots, peeled and coarsely chopped

2 garlic cloves, thinly sliced

3 cups vegetable broth 3 cups water

1 can (16 ounces) plum tomatoes, with liquid, coarsely chopped,

2 Russet potatoes, peeled and diced

Pinch of dried oregano

Pinch of celery seeds

½ pound green beans, trimmed and cut into 1-inch slices

2 cups thinly sliced cabbage

1 (15 oz) can cannelloni or great northern beans, rinsed and drained

½ cup pennette, ditali, or other small tubular pasta

½ cup chopped fresh basil

¼ cup chopped fresh flat-leaf parsley

Kosher salt and freshly ground black pepper

1/3 cup freshly grated Parmesan cheese

Directions:

      Heat the olive oil in a large stockpot over medium heat. Add the onion, celery, carrots and garlic and cook over medium heat, stirring occasionally, until the vegetables begin to soften, about 5 minutes. Add the broth, water, tomatoes, potatoes, oregano and celery seeds. Bring to a boil over high heat, reduce the heat to low and cook, covered, for 10 minutes. Add the green beans, cabbage, beans and pasta. Simmer, uncovered, over medium heat until the vegetables and pasta are tender, about 15 minutes. (The soup can be made several hours ahead of time. Reheat before serving, adding additional liquid if necessary.) Stir in the basil and parsley and season with salt and pepper to taste. Ladle into bowls and serve with Parmesan cheese.

Nutrition Per Serving 6 servings per recipe Calories: 251 % of calories from fat: 28 Fat: 8g Sat. fat: 2g Carbs: 36g Fiber: 8g Sugars: 9g Cholesterol: 7mg Protein: 10g Sodium: 1,045mg                         From The Diabetes Menu Cookbook: Delicious


Study Shows Need To Test More COPD And Asthma Patients For Underdiagnosed Pulmonary Disease

      A new study finds that a higher than expected number of COPD and severe asthma patients had abnormal low levels of alpha-1 antitrypsin (AAT), suggesting the need for broader criteria for AAT deficiency testing. AAT deficiency, also known as Alpha-1, is a widely undiagnosed hereditary disorder that is usually fatal in its severe form.

      Alpha-1 is estimated to affect up to 100,000 Americans, but up to 95 percent are undiagnosed or have been misdiagnosed as having another form of chronic obstructive pulmonary disorder (COPD). Details of the study were presented at CHEST, the annual meeting of the American College of Chest Physicians held in Chicago from October 20 to 25. Study results are being announced on World COPD Day to focus attention on the need for wider testing for AAT deficiency.

      "Findings from this study suggest that simply all patients with moderate or severe persistent asthma and/or COPD with chronic pulmonary symptoms should be tested for AAT deficiency," said Gary Rachelefsky, MD, Professor of Allergy and Immunology and Director of the Executive Care Center for Asthma, Allergy and Respiratory Diseases at UCLA School of Medicine and study investigator. "It is imperative that clinicians become more vigilant about Alpha-1 testing as many patients are going undiagnosed or misdiagnosed due to screening criteria and practices."

      The study, conducted by the Respiratory & Allergic Disease Foundation, recruited 40 office based pulmonologists across the United States who tested 454 adult patients using the following simple screening criteria: persistent asthma and/or COPD patients with loss of lung function defined by either a FEV1 (forced expiratory volume at 1 second) or a ratio of FEV1 to forced vital capacity (FEV1/FVC) of less than 70 percent. Blood tests were taken to assess levels of AAT, and additional lab results and patient histories were noted and tabulated.

      Of the 454 patients studied, 3.3 percent showed deficient levels of AAT. Low blood levels of AAT are commonly associated with progressive severe emphysema that becomes clinically evident by the third to fourth decade of life; a recent registry showed that 54 percent of AAT deficient patients had emphysema. Less commonly, low levels of AAT are associated with liver disease and cirrhosis.

      Interestingly, patients who tested with low AAT did not significantly differ from the COPD/persistent asthma patients with normal levels of AAT in several key pulmonary function criteria, including levels of FEV1, ratios of FEV1 to forced vital capacity (FEV1/FVC), or the number of bronchial infections within the past 12 months. This lack of differentiating characteristics in deficient subjects indicates that if pulmonologists rely on standard screening criteria for Alpha-1 testing, the result will be incorrect and missed diagnoses.

      "Our surveillance study found that physicians cannot depend on typical patient profiles to assess whether AAT deficiency screening is necessary. There is no 'face' to AAT deficiency," said D. Kyle Hogarth, MD, FCCP, Assistant Professor of Medicine, University Chicago Medical Center, Director of the Alpha-1 Antitrypsin Deficiency Clinical Resource Center at the University of Chicago and lead author of the study. "A number of patients who would not normally be screened based on suggested guidelines turned out in fact to be positive for AAT deficiency. In the real-world setting, this suggests that thousands of patients who have been diagnosed with COPD or severe asthma may actually have Alpha-1."

      The RAD study was supported by an unrestricted educational grant from CSL Behring, maker of the Alpha1 Proteinase Inhibitor (Human), Zemaira(R).

About Alpha-1 Antitrypsin Deficiency (Alpha-1)

      Alpha-1 antitrypsin is an anti-inflammatory protein that protects the tissue of the body. One of its most important roles is to shield the delicate tissues of the lungs by binding to neutrophil elastase, an enzyme released by certain white blood cells that digests bacteria and other foreign substances in the lungs. When a person with deficient levels of AAT inhales irritants or contracts a lung infection, the neutrophil elastase released to protect the lungs is uncontrolled and can injure healthy lung tissue. Repeated injury to the normal structure of the lungs can eventually result in emphysema, a condition affecting 54 percent of diagnosed AAT deficient patients, according to a recent registry. Identifying patients with AAT deficiency can be problematic, however. Because AAT deficiency typically involves such common symptoms as shortness of breath on exertion, wheezing, and coughing, the condition is often misdiagnosed as another chronic lung condition. In fact, retrospective studies show that even after an Alpha-1 patient has developed symptoms, it can take an average of seven years and visits to five different healthcare professionals before the correct diagnosis is made. Researchers estimate that up to 100,000 adults and children in the U.S. have severe Alpha- 1, and 25 million people nationwide may be carriers. Only about 5,000 patients are currently diagnosed as AAT deficient, meaning that up to 95 percent of people with the deficiency remain undiagnosed.

CSL Behring to Launch National Campaign to Improve Detection of AAT Deficiency

      To advance the early diagnosis and treatment of AAT deficiency, CSL Behring, a leader in alpha-1 research and treatment, is launching a national education and support program called Test Today. Change Tomorrow. The initiative will target patients, caregivers and healthcare professionals with activities and services, such as a national disease awareness campaign about Alpha-1 deficiency, a toll-free information center and website, educational materials, and a program to support Alpha-1 testing in healthcare settings, called Champions for Alpha-1 Testing. Test Today. Change Tomorrow. will begin the week of November 18 with the launch of a national television show as part of the series Today's Health.

      CSL Behring is the maker of Alpha1-Proteinase Inhibitor (Human), Zemaira(R), which is indicated for chronic augmentation and maintenance therapy for individuals with established AAT deficiency and clinical evidence of emphysema. Zemaira(R) is not indicated as therapy for lung disease patients in whom severe congenital A1-PI deficiency has not been established. Clinical data demonstrating the long-term effects of chronic augmentation therapy with Zemaira are not available.

      As with other Alpha-1 therapies, Zemaira may not be appropriate for the following adult individuals as they may experience severe reactions, including anaphylaxis: individuals with a known hypersensitivity and/or history of anaphylaxis or severe systemic reaction to Alpha-1 Proteinase Inhibitor products or their components and individuals with selective IgA deficiencies who have known antibodies against IgA.

      In clinical studies, the following treatment-related adverse reactions were reported in 1 percent of subjects: asthenia (fatigue), injection-site pain, dizziness, headache, paresthesia (tingling) and pruritus (itching). Zemaira is derived from human plasma. As with all plasma-derived products, the risk of transmission of infectious agents, including viruses and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent, cannot be completely eliminated.                        Source: medicalnewstoday.com


Test Labels Can Affect Patient’s Medical Decisions

      No one wants to hear that their test results are abnormal or positive. But these labels could be misleading patients, according to a new study. Researchers say doctors need to be careful when labeling test results versus giving the results in the form of numbers or other quantifiable measures.

      The study was conducted by researchers from the University of Michigan Health System and the VA Ann Arbor Healthcare System. Participants were given a hypothetical situation and then made decisions based on how the results were labeled. Specifically, the 1,688 female participants were asked to imagine being four months pregnant and speaking with their physicians about screening for fetal chromosomal problems. The women were given computerized hypothetical scenarios and were asked what decision they would make about whether or not to have amniocentesis.

      Researchers say the patients were given the same numerical risk information about the problem with the baby, but some were told the results were positive or abnormal and some were told the results were negative or normal. The study reveals those in the positive/abnormal group reported a higher perception of risk, greater levels of worry and greater interest in having the test.

      “I think this topic is much broader than simply a study about amniocentesis,” says senior author Peter A. Ubel, M.D. “This kind of language is common across all clinical settings, and our findings suggest that physicians should be very cautious about the implications of the words they use when presenting information to patients.”

Source: American Journal of Obstetrics and Gynecology,


Cholesterol Drug Tied to Sleep Disturbances

But Zocor, a statin, still offers significant heart benefits, researchers say

      Lowering your cholesterol could interrupt your slumber. The findings were presented at the American Heart Association's annual meeting, in Orlando, Fla.

      "The study suggests that simvastatin [Zocor] is more likely to have sleep disruption," said Dr. Sidney Smith, past president of the American Heart Association and director of the Center for Cardiovascular Science and Medicine at the University of North Carolina School of Medicine. "The extent to which this would be a significant problem for patients is uncertain, but this should raise awareness that symptoms could be related to therapy."

      A growing number of Americans now take statins to reduce their cholesterol levels, as a way to prevent heart attack or stroke. "There had long been concerns about statins adversely affecting sleep in case reports and case series dating back to at least 1990, just after the release of statins," said study author Dr. Beatrice Golomb, of the University of California, San Diego, School of Medicine's Department of Medicine. "The rub is that they used sample sizes that were tiny and follow-ups of only four to six weeks. The sample sizes were less than 20 or 30— not enough typically to show an effect unless the effect was huge," Golomb noted.

      The new study, funded by the U.S. National Institutes of Health, is the largest of its kind and involved 1,106 healthy adult men and women who were randomly chosen to receive 20 milligrams of Zocor (simvastatin), 40 milligrams of Pravachol (pravastatin), or a placebo for six months. The two dosages of the two statins are considered approximately equivalent.

      "We were looking at the impact of the most hydrophilic [Pravachol] and most lipophilic [Zocor] statins on a range of non-cardiac endpoints with sleep as a pre-specified secondary outcome," Golomb explained. Lipophilic means the drug is soluble in fat, while hydrophilic means it is soluble in water. Previous research had implicated lipophilic statins in sleep disturbances. "Simvastatin is fat-soluble, and can penetrate and cross into the brain," Smith explained.

      Golomb said: "We did show significant worsening in both sleep quality outcome and sleep problem categories in patients taking simvastatin. Less sleep quality and more sleep problems."

      Those participants who had worse sleep also showed a worsening in their aggression scores, compared to people in the other two study groups. This doesn't mean that patients experiencing sleep problems should take themselves off Zocor or another statin, Smith said. "The broader benefit of decreasing heart attack and stroke must be taken into account," he said.

And patients who find themselves truly sleep-deprived can also talk to their doctor about finding an alternate statin, he said.                                                                                           Source: Scout News, LLC.


6 Tips for Flat Abs

Two fitness gurus offer their secrets for toning and tightening the tummy.

      Like the quest for the Holy Grail, most of us are always on a mission to improve our abs. For a while, people coveted the washboard abs gracing runways, the pages of fashion magazines, and billboards in Times Square. Now everyone is after Beyonce's flat, tight stomach.

      So what does it take to get there? Fitness experts Ellen Barrett and Liz Neporent find out the best way to achieve great abs and a tighter midsection. Here are their top six tips.

Flat Ab Tip No. 1: Improve Your Posture

      Poor posture is a huge issue for many people. Barrett says she frequently sees people walking in Manhattan with their ears in front of their bodies and shoulders in front of their hearts. "If people slouch, their stomachs pooch," Barrett says.

      For better posture while standing, align your ears over your shoulders, shoulders over hips, hips over knees, and knees over ankles. Keep the fronts of the shoulders open like a shirt on a hanger, instead of a shirt on a peg. Draw your navel to your spine and keep your weight even on the balls and heels.

      The result: Without doing any abdominal exercise, you can look much leaner by simply standing up straight. "With your shoulders back and chest up, the abs pull themselves in," Barrett tells WebMD. "Your energy level improves when you have good posture. Your lung capacity is better. You're open and more awake."

Flat Ab Tip No. 2: Think Whole-Body Exercise

      When it comes to abdominal strength, you shouldn't train the body in isolation, says Liz Neporent, president of Wellness 360, a corporate wellness consulting firm in New York. "People have this misconception that the best way to strengthen the abs is to get on the floor and do a thousand crunches. If we could spot reduce, our jaws would be hollow," Barrett says. "We probably work the jaw muscle in talking and eating more than any other, and none of us have hollow jaws. You have to see the abs as a 360-degree core; you want to develop strength and flexibility around that core. Fitness needs to be intelligent, do slow, high-quality exercise."

      Neporent recommends Pilates "because the focus is the core, but it doesn't just work the abs in isolation," she says. That means you're using your abdominals, but you're also using your arms and legs, back muscles, and glutes. "Crunches are fine, at first, but relatively quickly, you'll have to progress to something else to get that area worked," she says.

      Pilates focuses on developing not just the rectus abdominis (top abdominal muscle layer) as a crunch does, but the internal and external obliques (the side abdominals) and the transversus abdominis (the deepest abdominal muscle). "Work your core in 3-D, hitting the sides, back, and middle," Neporent says.

Plank: Start on your hands and knees and come up into a push-up plank position, balancing on hands (or elbows) and toes (or knees). Align wrists under shoulders; keep your back straight and the abs and glutes tight (to keep the back from sagging). Hold the position and breathe out for 10 seconds, exhaling to tighten the abs and draw the navel to the spine.

Leg Lowers: Lying supine, curl the upper body, chest over ribs, with your hands behind your head. Lift the legs up with knees bent at 90 degrees, knees over hips, ankles level with knees. Keeping the hips down, slowly lower the legs toward the floor without changing the bend in the knees, then lift them back up.

Seated Rotations: Sitting up, bend knees and legs together and place arms across the chest or in front of you. Tuck the tailbone and roll back slightly as you alternate rotating the spine right and left.

Flat Ab Tip No. 3: Examine Your Diet and Digestion

      "If you have abdominal fat you can have great ab strength and great posture, but you won't have a flat abdominal or a six-pack," Barrett says. "You have to change your diet and increase your energy output."

      In other words, eat less and move more. "You need to burn off more calories than you take in to reduce body fat," Neporent adds. Unfortunately for many people, the abdominals are a place where fat tends to accumulate, Barrett says. "No matter how many ab exercises you do, you're still going to have an extra layer [of fat] covering the abdominals [if you're carrying excess weight] ." Neporent adds.

Flat Ab Tip No. 4: Props Are Optional

      Stability balls and Bosu balls, straps and bands, even those fancy MBT Masai walking shoes are not necessary to achieve flat abs. Props are wonderful, and they may help you work your core more readily, elevate you to a different level or simply mix it up, but you don't need them to meet your fitness goals. "Gimmicks or fancy gym memberships aren't necessary. You don't need space, you don't need sneakers, you don't need fancy clothes," Barrett says.

      For instance, strengthen your abdominals when you're at the park, raking leaves, taking a walk. Even while socializing at a cocktail party you can stand straight and exhale to draw the navel to the spine.

Flat Ab Tip No. 5: Take Things Slow

      There are no fast fixes, Barrett says. Even the promised quick fixes end up being temporary. "It's a goal. You have to plan on a slow and steady progression." Barrett says most people will experience set backs, roadblocks, and utter frustration along the way. Rewards come with time and consistency.

Flat Ab Tip No. 6: Set Realistic Goals

      Though it's not an excuse to explain away a soft midsection, your genes do play a role, Neporent says. For better or worse, you stand a chance of inheriting Mom's thick wavy hair and her dark circles. Same goes for other parts of the body.

"Sometimes, even very thin people can't get washboard abs," Neporent says. "Genetically their bodies want to hold on to the extra layer on the top." That doesn't mean you can't improve your appearance, but it does mean you need to set realistic expectations. Not everyone can look like Beyonce, but you won't stand a chance if you're still sitting around with one hand in the candy jar.

More Exercises for Flat Abs

      Ellen Barrett is a proponent of standing abdominal exercises, which integrate balance, coordination, and body awareness and also tone the core. Here are a few from her DVD Fat-Burning Fusion.

Canoe Twist: Stand upright, feet apart. Interlace all 10 fingers to the webbing of your hands to create a solid grip. Exhale, and sweep the interlocked hands, arms, shoulders, and chest to the left, as if "rowing a canoe." Simultaneously lift the left knee up and to the right. Inhale and return to the starting position. Exhale and perform the movement to the right. Alternate for 20 repetitions.

Cat Kick: Stand with feet together, arms extended out like airplane wings. Exhale, and lift the right leg forward and up. At the same time, sweep the arms forward at shoulder level and round the spine, like a cat. The navel should feel as though it's pressing toward the spine. Inhale, and open back up and return to the starting position. Repeat with the left leg, alternating for 20 repetitions.

Pilates Zip Up: Stand upright with the heels together, toes slightly turned out. Bring the arms up, into an "upright row" position, hands just underneath the chin. Exhale, press the arms down (as if pressing down on a box of dynamite), keeping the hands and arms very close to the body. Simultaneously, lift your heels off the ground onto your tiptoes. Hold for two seconds at the "top" and inhale and return to the starting position. The abs go "in and up" and the arms go down. Perform 20 repetitions.                                                                                        Source: WebMD


Top 5 Ways to Spice Up Your Health

      Spices. Wars have been fought over them. Great explorers have sailed in pursuit of them. And gifting history was made by three wise men bearing them. Turns out that the ancients were on to something. Research is now showing that five spices we've long savored just for their flavor are also nutritional powerhouses. Toss these overachievers into your salad or sauce and get a whopping dose of disease- preventing antioxidants along with a flavorful punch.

1. Cinnamon: This natural germ-fighter also helps lower blood sugar, triglycerides, and cholesterol levels— one-quarter teaspoon a day is a healthy goal. Sprinkle a little of the powder on freshly ground coffee beans when making your morning java.

Shake That Cinnamon Shaker

      Greet holiday guests with a fragrant mug of hot cider spiced with cinnamon and cloves. It will do more than warm them up. Cinnamon and cloves are irresistible flavorings, but they aren't just treats for your tastebuds. They also provide powerful health benefits, like helping the body process blood glucose— essential to avoiding diabetes. Keep both spices handy for baking, hot drinks, and savory dishes. Cooking with them is as easy as apple pie.

      Cinnamon is well known as a stellar antioxidant and a potent germ-killer, and there's a growing body of evidence that shows that a substance in the spice turns on insulin receptors to help the body use glucose. Which is a good thing, because too much glucose in the bloodstream is tough on your organs and a marker of diabetes. Cloves appear to have a similar effect.

      So don't save these spices for holiday cooking. You can use cinnamon liberally, but cloves— ground or whole— really pack a flavor punch and take a lighter hand. For ways to get more of these good-for-you spices into your everyday life, try these tips:

           Sprinkle both on fresh apple slices and poached pears.

           Add cinnamon and cloves to crockpot dishes for an Indian-inspired flavor twist.

           Add ground cloves to stuffing recipes.

           Use a cinnamon stick to stir your tea, hot chocolate, or warm soymilk.

           Sprinkle both spices into muffin batters and on whole-wheat toast.

           Keep a cinnamon shaker next to the salt and pepper on the table and experiment.

           Push whole cloves into an onion and place it in turkey or chicken cavities for flavorful roasting.

2. Thyme: It makes it into recipes for marinades, grilled poultry, and fish by virtue of its minty, lemony flavor; it makes it onto the RealAge list of healthy herbs by virtue of its anticancer potency. It's also long been used as an antiseptic— yep, that could be thyme oil in your mouthwash. If you've got a fresh bunch, mince some into your vinaigrette. Yum.

3. Cumin: Concealed in your humble chili powder is one of the world's most popular spices (it's a key ingredient in Indian curries, too) and another anticancer soldier. Go exotic and add cumin to rice, grain salads, and marinades, or try Ultimate Beef Chili made with chunks of fat-trimmed meat.

4. Oregano: Thank our GIs for bringing oregano home from Italy after WWII. A food-world superpower, leaves of the herb boast 42 times more antioxidants than apples. Wow! Use oregano to add a delicate flavor to salad dressings, garlic bread, and omelets, as well as your favorite pastas.

5. Turmeric: Called the "Queen of the Kitchen" by Indian cooks, turmeric (and its active ingredient, curcumin) has earned its crown. Studies show promise in fighting cystic fibrosis, colon cancer, arthritis, and even Alzheimer's— is there anything this golden gal can't do? For an earthy flavor and yellow coloring, add a pinch of turmeric to rice, stew, or lentils— hey, it might even help you remember where you left your keys last night.


Ultimate Beef Chili

Makes 12 servings, 1 cup each

Ingredients

1 pound beef round, trimmed and cut into ½-inch chunks

Salt & freshly ground pepper to taste

1 ½ tablespoons canola oil, divided

3 onions, chopped

1 green bell pepper, seeded and chopped

1 red bell pepper, seeded and chopped

6 cloves garlic, minced

2 jalapeno peppers, seeded and finely chopped

2 tablespoons ground cumin

2 tablespoons chili powder

1 tablespoon paprika

2 teaspoons dried oregano

12 ounces dark or light beer

1 28-ounce can diced tomatoes

8 sun-dried tomatoes (not packed in oil), snipped into small pieces

2 bay leaves

3 19-ounce cans dark kidney beans, rinsed

¼ cup chopped fresh cilantro

2 tablespoons lime juice

Ultimate Beef Chili Instructions

1.   Season beef with salt and pepper. Heat 1 1/2 teaspoons oil in a Dutch oven over medium-high heat. Add half the beef and cook, stirring occasionally, until browned on all sides, 2 to 5 minutes. Transfer to a plate lined with paper towels. Repeat with another 1 1/2 teaspoons oil and remaining beef.

2.   Reduce heat to medium and add remaining 1 1/2 teaspoons oil to the pot. Add onions and bell peppers; cook, stirring frequently, until onions are golden brown, 10 to 20 minutes. Add garlic, jalapenos, cumin, chili powder, paprika and oregano. Stir until aromatic, about 2 minutes.

3.   Add beer and simmer, scraping up any browned bits, for about 3 minutes. Add diced tomatoes, sun-dried tomatoes, bay leaves and reserved beef. Cover and simmer, stirring occasionally, until beef is very tender, 1 1/2 to 2 hours.

4.   Add beans; cook, covered, stirring occasionally, until chili has thickened, 30 to 45 minutes. Remove bay leaves. Stir in cilantro and lime juice. Adjust seasoning with salt and pepper.

Ultimate Beef Chili Tips

Cover and refrigerate for up to 2 days or freeze for up to 2 months.

For a hot, smoky chili, add 1 tablespoon chopped chipotle pepper in adobo sauce.                                Source: RealAge

r

maxineweight.gif

 

 

Information in this newsletter is for educational purposes only. Always consult with your doctor first about your specific condition, treatment options and other health concerns you may have.


ole.gif













 

             EFFORTS  

          Suite D

          239 NE US HWY 69
          Claycomo, Mo. 64119