February 4, 2011

The New USDA Dietary Guidelines

USDA and HHS have unveiled the seventh edition of the US Department of Agriculture Dietary Guidelines. There were a few changes, but lacked the changes needed to be in line with many of the Medical Associations' current positions. Only two associations have welcomed the new edition and the American Heart Association has said the improvement is still lacking for bringing sodium in line for everyone.

I do not understand why some of the other medical associations have not issued statements. But if they were to issue acceptance or rejection, they might have to agree with something they wish to avoid. The American Caner Society says the new guidelines could reduce the cancer risk.

To read the full copy of the latest dietary guidelines go here. I used Adobe
Reader to save a copy to my files. The seventh edition has six chapters and 16 appendices.

The first chapter labeled Introduction explains how the dietary guidelines were developed. This may be of interest for many.

Chapter two is Balancing Calories to Manage Weight.
Chapter three is Foods and Food Components to Reduce.
Chapter four is Foods and Nutrients to Increase.
Chapter five is Building Healthy Eating Patterns.
Chapter six is Helping Americans Make Healthy Choices.

There is over 90 pages of reading, but I will say it is well organized, but short of some reasonable specifics. There are many specifics and some welcomed discussions for ethnic specifics which should make this more useable than previous editions.

Linda Van Horn, PhD, RD, LD, from Northwestern University in Chicago, Illinois, chaired the 13-member Dietary Guideline Advisory Committee. For 18 months, the committee reviewed the scientific and medical literature regarding the role of diet and nutrition in health promotion and disease prevention.

One of the features in this edition is the emphasis on managing body weight from age two to elder ages. This includes eating patterns for balanced nutrition and also for vegetarian adaptions. The report includes recommendations for all ages as well as for those at risk for chronic diseases, a real plus

The recommendation presently generating the most discussion is about salt. The American Heart Association recently lowered the maximum from 2300 milligrams to 1500 milligrams. The USDA only lowered the maximum for those age 51 and older. If we are serious in reducing obesity and hypertension then the limit for all ages should be 1500 milligrams.

There are many areas that this report should have covered, but it is the most comprehensive report issued yet by the USDA and does have something for almost everyone. There will be disagreements and groups that will find fault; however, this report should be read and understood by everyone. It is the first time national action has been addressed for obesity.

Read some of the takes on the press release and report here by Medscape and here by Medicine Net. You may also have seen parts of this on the nightly news. There is much information about the report and represents views not in the actual report.

February 2, 2011

Suggestions for Doctors

Sometimes doctors are open to suggestions from patients and other doctors will never take suggestions from patients. But I will still make suggestions as most of my doctors have not turned them away completely. Some have even admitted that they like a few of them, but don't have the time or office staff time to put them into effect. That I do understand. Now I will need to ask some questions to find out if there is something I am able to do that would be accepted.

My main suggestion has been to have a list of acceptable web sites to get patients started in their research. Also a list of books about the disease, to be in the local library or ordered on line. These would vary by disease or illness. For this discussion I am talking about diabetes and the related complications, but this will involve more then just diabetes when I get started. I have worked on lists for one doctor recently and am encouraged again after reading a blog by Dr. Fran Cogen.

Her statement in the blog of “Families often walk into their appointments with reams of Internet papers and articles strongly suggesting a certain form of treatment.” When this is what doctors see and get, it is easy to understand why they are less than happy about the internet.

Dr. Cogen has an excellent discussion about information overload and why this is sometimes not a good thing. People on information overload often become incapable of making a simple decision. They have too many ideas to digest and this causes them to not make a decision.

Dr. Cogen also does not like “the paternalistic approach in which the physician and team reverts to the 'father knows best' mantra.” Many doctors do use this and even this is not always the best or most appropriate. Often the best decisions are made from a few well thought out possibilities that are discussed with the patient and/or their advocate.

I am taking this and trying to pare down the internet resources to a few good sources to help people find information and then ask the doctors to review the list and add or subtract from this list. This is going to take some time, but I am looking forward to see what reaction I will receive from some of the different doctors with the different specialties.

Of course, the diabetes, type 2, is complete, but I have a lot to do for the rest. I do believe that people are more internet conscious and savvy than ten or more years ago and people need good information. The doctors deserve consideration and not being buried in unrelated papers that have no bearing on the subject of the visit. I may even suggest that the doctors have a book list for patients to order through them.

There will always be changes to the sources as some sites shut down and other good sites appear. New books appear all the time and while many may be good, some are far better. Some of the current books will continue to be relevant as they are updated with revisions to stay current. Each type of diabetes is different and needs its own resources.