Virtual Colonoscopy?

Have you been putting off having a colonoscopy because of the discomfort of the procedure? Now you may not have to have a tube run through your colon to be screened for cancer!

Colorectal cancer is the second leading cause of cancer death in the United States, after lung cancer. The American Cancer Society predicts there will be 148,610 new cases diagnosed in 2006 and 55,170 colon cancer deaths. It is one of the most preventable cancers there is, however: Screening and removal of polyps can prevent the disease.

The first study into results of virtual colonoscopies, paid for by insurance companies, showed that only 6.4 percent of patients required follow-up with optical colonoscopy, which involves threading a tiny camera on a tube through the rectum and into the colon.

The research team used three-dimensional computed tomography colonography, commonly known as virtual colonoscopy, to screen 1,110 adults with an average age of 58. The virtual procedure is noninvasive and involves passing the patient through a scanning machine.

They found large or medium polyps in 10 percent of the patients. Seventy-one, or 6.4 percent, of the patients had a second, standard colonoscopy, most on the same day.

The standard colonoscopy findings were the same as the virtual colonoscopy findings in 65 of the 71 patients, the researchers reported in the journal Radiology.

The advantages of virtual colonoscopy over optical colonoscopy are that it is safer, faster, less costly, more convenient, involves an easier bowel prep, and yet is just as effective for detecting important polyps and cancers.

So, have you been putting off your colonoscopy? If so, contact your insurance company and see if they are now covering virtual screening. Don’t put off a simple screening tool that has just been made easier.

Click here to test your knowledge of colon cancer:

http://www.msnbc.msn.com/id/3296487/

Best support for maintaining weight loss

Published in a recent New England Journal of Medicine, researchers wanted to know what the best form of follow-up was for people who had successfully lost 42# in the last two years.

Participants were broken into three groups; 105 people were the control group, who received quarterly newsletters, 104 people received face-to-face intervention and 104 people received internet-based intervention. The two study groups were taught to weigh themselves daily and learned strategies of what to do if they noticed an increase in their weight.

After 18 months, the people who only received newsletters regained 5-25 pounds, the group who received internet-based intervention regained 9-29 pounds and the face-to-face group regained 10-20 pounds.

Researchers concluded that people who receive more face-to-face intervention are better able to maintain weight loss than those who do not receive any intervention. They also concluded that daily weighing could help people monitor their weight and make adjustments more quickly.

However, I have worked with many clients who weigh themselves daily and I strongly discourage such an activity. Daily weighing helps the person focus entirely on what their weight is that day, not on healthy eating habits. When a person weighs themselves daily, and they see an increase in the weight, two things often happen:

1. They feel incredible guilt. They wonder what they did wrong to cause the increase, and then they promise themselves they will be ‘good’ that day. Often this includes trying to not eat in the morning, which results in binging later in the day, and thus more guilt.

2. They set up this obsession that they have to continue to weigh themselves daily, and as they restrict their eating more and more, and falling prey to uncontrolled eating, they fall further into a crevasse of shame, guilt and chronic hunger.

Weighing yourself on a daily basis will tell you more about what your fluid balance is like than exactly what your weight is doing. Weekly weighing is fine, but for people who obsess over their weight, I will suggest that they stick to monthly weighing.

If you are trying to lose weight, learn how to space your meals so you don’t skip meals and are not hungry between meals. I often tell clients that if they are hungry, eat fruit. You cannot eat so much fruit that you gain weight, no matter what you may hear in the media. And it satisfies that sweet tooth while providing incredible nutrients to the body!

To read the abstract of the above study, click

http://content.nejm.org/cgi/content/abstract/355/15/1563

Health Coaches helping people improve their health

Coaching has been around for many years, but is now starting to hit the ‘mainstream’. There are many types of coaches, from executive coaches for organizations who wish to increase their profits, to business coaches who help entrepreneurs start or grow their business, to wellness coaches who help people achieve their health goals.

An area that coaching is also growing is in the out-patient healthcare field. Many insurance companies are offering coaching services to their high-risk members in the hopes that it will cut costs by keeping them from returning to the hospital, and according to the studies that have taken place, it is proving successful.

A study by doctors at the University of Colorado found that patients who worked with health coaches were less likely to return to the emergency room in the first six months after they left the hospital. They estimated that the use of coaches could reduce annual hospital costs by about $845 for every patient enrolled in the program.

SCAN Health Plan began its coaching program in 2005 and has enrolled about 1,600 members. It’s based on a model developed by Dr. Eric Coleman, who published the University of Colorado study involving 750 patients in last month’s Archives of Internal Medicine.

Coleman found elderly patients who received health coaching had lower hospital readmission rates. After a month, 8 percent of patients who were coached were back in the ER, compared to 12 percent who didn’t receive coaching. The benefits extended up to six months after the program.

The National Center for Health Statistics reports that visits to the emergency room jumped 18 percent in the past decade to 110 million in 2004. About 13 percent of those visits led to people being hospitalized.

Most health coaches are registered nurses hired by insurers to make regular house visits or talk to patients on the telephone. Often these coaches role-play with patients to teach them how to read their prescriptions or make appointments with doctors.

To address those issues, the federal government is experimenting with a three-year pilot coaching program that involves about 115,000 fee-for-service Medicare patients who tend to suffer from heart failure or diabetes.

Since last year, participating patients received coaching after leaving the hospital or as part of their regular care through eight health care organizations. The groups must show a 5 percent cost savings as a result of the coaching or repay the government for the cost of the service.

Results of the study won’t be available until next summer, but anecdotal evidence suggests some Medicare recipients improved their health through coaching, said Barbara Hoffman of the Centers for Medicare & Medicaid Services, the agency that administers government health insurance programs for the elderly and disabled.

As a coach, I think this is great news! What coaching does is help the client take responsibility for their own actions. When you work with a coach, you make your goals, you determine what you want to do to achieve those goals, and the coach is your source of support and motivation to help you make it happen. Just imagine a healthier America because of coaching!

However, not all coaches are equal, and it is important for people to understand the background and training of someone who calls themselves a ‘coach’. I have heard of people who call themselves a ‘diet coach’ or ‘food coach’, because they lost weight, themselves. I have even heard of a coach who recommended medications to a client, although that coach is not a qualified healthcare professional.

If you look for a coach, make sure that the person has the education and background that qualifies them for the service they are providing. Ask them about their coach training, also. There are many programs to educate people who want to offer coaching services. The programs that insurance companies are offering are not ‘strict’ coaching, but more a combination of health advising and coaching and I would imagine that all of their coaches have received specific wellness coach training. But outside of the healthcare setting, a coach should not advise a client on medications or eating programs for a health condition. These are the roles of qualified health professionals, not coaches. A coach’s role is to ask you questions and help you determine your course of action, not to make recommendations and give you meal plans or exercise plans or medication/supplement plans.

The latest on AMD and eye health

It is estimated that about 6 million Americans suffer from age-related macular degeneration (AMD), a disease that is the most common cause of irreversible blindness in people over 60 years old in developed countries, today. This number is predicted to double by the year 2030 as the number of baby boomers age.

There have been multiple studies through the years that have looked at what we can do to protect our eyes from Age-related macular Degeneration (AMD). Although researchers do not fully understand it, they do all agree that diet can help prevent it from occurring or worsening. The disease blurs or destroys sharp, central vision and there is no known cure.

The AREDS study, conducted by the National Eye Institute, followed 3,600 participants who had early AMD for 5 years . Researchers provided subjects who with supplements five to 13 times the recommended amounts of beta-carotene, vitamins C and E, and the minerals zinc and copper. After 5 years, those who took the supplements were found to have 25% less progression to late-stage AMD. Although researchers do not feel that this protocol will help PREVENT AMD, they do feel it can help decrease further progression of the disease. Consequently, the National Eye Institute now recommends what they call the “AREDS Formulation and Age-Related Macular Degeneration”. But don’t jump on the bandwagon, just yet!

In August, 2006, the National Eye Institute began a new study, called AREDS2. There are several purposes to this new study: First, researchers want to evaluate the effect that two omega-3 fatty acids, EPA and DHA, have on the progression to AMD. They have the same question about the effect that lutein and zeaxanthin, which accumulate in macula, have.

They also want to evaluate the effects of eliminating beta-carotene from the original AREDS ‘formulation’, as well as the effect of reducing zinc from the original ‘formulation’.

In the meantime, there have been other studies that have investigated the role diet plays in AMD. One large study investigated men and women at least 55 years old who had no AMD in either eye at the beginning of the study. After eight years, those whose diets ranked in the top half of the group for vitamins C, E, beta-carotene and zinc were 35% less likely to have developed AMD. Antioxidant ranges for this group averaged much lower than those in the AREDS study, but results were still quite impressive.

Finally, another important bit of information comes from more study results from the National Eye Institute and published in Science magazine. According to four studies, AMD appears to have a strong genetic potential. Researchers have each indentified a specific variant in the genome that increases a person’s risk of developing AMD by 3-7 times and that may explain 20-60% of all AMD cases in older adults.

Several other large studies also suggest that eating fish at least twice a week may substantially reduce AMD risk. Too much total fat consumption, however, particularly too much polyunsaturated fat, which is found in fish, may increase AMD risk. This fat’s chemical structure seems especially vulnerable to oxidation reactions that are thought to damage the eye. These questions may be answered in the AREDS2 trial.

So what is the lesson we can take from all of this?

A balanced diet with plenty of vegetables, sunglasses with UV protection and a hat to limit sunlight damage to your eyes are the best practices. If you wanted to get the amounts of vitamins C and E, beta-carotene and zinc linked with lower AMD without taking supplements, you should eat these particular foods each day as part of a balanced diet:

· Six or more servings of fruits and vegetables

· Three or more servings of whole grains

· Four to 6 ounces of meat poultry or seafood, or bean equivalent

· Five to 7 teaspoons of oils such as olive and canola, and about one ounce of nuts.

For those of you who have been listening to my Health News updates have heard this all before. So, this really is nothing new, but now you see another benefit for increasing those fruits, veggies and whole grains! Your eyesight may thank you for your care.

For more details about the AREDS study, click here.

To read the recommendations by the National Eye Institute for the AREDS Formulation, click here.
NOTE: Be sure to discuss this treatment protocol with your healthcare provider before beginning. Some people should not follow these recommendations.

For the abstract on the genetic link to AMD, click here.

For more on AMD, here are several links of interest:

http://www.webmd.com/hw/vision/hw176041.asp

http://www.amd.org/site/PageServer

http://www.nei.nih.gov/health/maculardegen/armd_facts.asp