Can the Paleo Diet Help Diabetes?

• By Jennifer Acosta Scott | Medically reviewed by Farrokh Sohrabi, MD

The popular paleo diet may help with people with diabetes better control their blood sugar.

Could the diet of our cavemen (and cavewomen) ancestors help keep a modern health problem — type 2 diabetes — under control? The concept isn’t as far-fetched as it might sound. In the past few years, the popularity of the so-called “paleo diet” — a high-protein, low-carb food plan that minimizes processed foods and emphasizes meats and vegetables — has skyrocketed, with its proponents touting it as a way to improve health and lose weight. Now, research has shown that it may in fact help people with diabetes to manage their blood sugar.
A study launched in 2011 at the University of California San Francisco (UCSF) found that people with type 2 diabetes who followed a “caveman diet” were able to improve their blood pressure, blood sugar levels, and cholesterol by significant amounts in just two weeks. Other study participants who followed a traditional diet recommended by the American Diabetes Association saw little to no improvement. The participants were given enough food to prevent them from losing weight, eliminating the possibility that the health improvements came from shedding pounds.
Researchers aren’t sure why the paleo-diet followers had better health outcomes, but it’s possible that paleo-friendly foods might be better suited for a type 2 diabetes diet than other foods, said Lynda Frassetto, MD, a nephrologist and the lead researcher on the study.

“It suggests that all carbs are not equal,” Dr. Frassetto said. “Carbs from fruit and vegetables may contain things that are better for you than carbs from grains. It may be that when you’re eating fruits and vegetables and getting antioxidants and micronutrients -- maybe those are what’s missing when you get the same amount of calories from wheat and cereals.”
People with type 2 diabetes who follow a paleo diet may find that it helps them better control their blood sugar, said Melissa Joy Dobbins, RD, LDN, CDE, a registered dietitian, diabetes educator, and spokesperson for the Academy of Nutrition and Dietetics. “You’re eating hardly anything that would raise your blood sugar,” Dobbins noted. “You’re really restricting carbs, and that can keep your blood sugar down.” The diet also encourages whole, unprocessed foods, which is a healthy approach, she added. Plus, the “bulkiness” of the foods may mean that you will feel full on fewer calories, encouraging weight loss, also beneficial for type 2 diabetes.
However, since this eating plan almost completely eliminates certain food groups, like grains, traditional wisdom would argue that it’s less healthy than a more well-rounded diet. “A lot of nutrition experts would say the paleo diet is not balanced,” Dobbins cautioned.
Many versions of the paleo diet also encourage the consumption of red meats, full-fat dairy products, and saturated fats like butter, which can cause elevated cholesterol levels. This can be an especially dangerous problem for people with diabetes, who are more likely to develop heart disease than people without diabetes. “For people with diabetes, the primary goal is to control blood sugar, but the second goal is to reduce the risk of heart disease and its complications,” Dobbins said.
It should be noted that the paleo-diet participants in the UCSF study, who were able to reduce their cholesterol levels, did not eat red meats or saturated fats; their proteins came mainly from lean sources like fish and chicken, while the fats in the diet were heart-healthy, unsaturated types.
One of the biggest supporters of a paleo diet for diabetes is 51-year-old Steve Cooksey, who began following the diet in 2009, just a few months after being diagnosed with type 2 diabetes. Cooksey had seen two diabetic family members become increasingly unhealthy while following traditional diabetes treatments, which made him wary of the usual approach. He also found that the meal plan he was given after his diagnosis did not help control his blood sugar.

“I went home and realized that eating their way required more and more insulin,” Cooksey said. “My blood sugar should have been going down, but it wasn’t.”
Within a month of starting on a paleo diet, Cooksey was able to stop taking all of his diabetes medications, including his insulin. He still checks his blood sugar regularly, and it’s always within normal ranges.
“I have normal blood sugars for normal people, not just normal blood sugars for a diabetic,” said Cooksey, whose Web site, Diabetes Warrior, explains the benefits of a paleo diet for diabetes.
In the paleo diet plan Cooksey follows, he chooses whole foods over processed, packaged meals to help control his type 2 diabetes. On a typical day, he might have a plate of eggs, greens, and bacon for breakfast; tilapia and spinach for lunch; and ribs, made with a low-carb BBQ sauce, and mixed vegetables for dinner. Between meals, Cooksey munches on low-carb snacks like hard-boiled eggs, cheese, canned tuna, salmon, sardines, and certain vegetables, such as celery sticks, green peppers, broccoli, and cauliflower.

Is a Paleo Diet Right for You?

Stories like Cooksey’s certainly are not unheard of, Dobbins said, because the bodies of people with type 2 diabetes do still produce insulin on their own, and it could be enough to process the small amount of carbohydrates in a paleo diet. But it may not be a permanent solution.
“Whether it’s paleo or any restricted-carb diet, yes, people may go off insulin,” Dobbins said. “But they may eventually need to go back on it, even if they don’t change their diet. It depends on how exhausted the pancreas is. It may run out, wear out.”
People with type 1 diabetes, who produce no insulin at all, would not be able to stop their diabetes medications by following a paleo diet. The effects of such a diet have not been studied in people with type 1 diabetes, but Frassetto thinks it has the potential for good results.
People with diabetes who are interested in trying a paleo diet should consult their doctor or a registered dietitian before beginning the program. If you have kidney problems or are on certain medications, you may not be able to safely follow it. Since the paleo diet also involves large quantities of “bulky” food, those with intestinal conditions may not be able to tolerate it either. “It is a huge amount of food,” said Frassetto, who slowly introduced her study’s participants to the paleo style of eating over the course of a week. “If you have problems with your intestines moving, you will have a lot of problems with this diet,” she noted.
Those who aren’t sure about following a paleo diet to manage their diabetes may see some benefit just by incorporating a few of its principles into their current diet, like eating more fresh produce and less pasta and bread.
“I think people in general eat too many carbs,” Dobbins said. “You could get rid of the excess. I’m a firm believer in getting a little more protein, making sure the fats are as heart-healthy as possible, and having fewer carbs. I think that is something people can live with and see good results with their blood sugar and their weight.”
Cooksey, however, is convinced that the “paleo lifestyle” is the one for him. “I’m blessed to be a diabetic because it made me seek out a better way of living, and I’ve found it,” Cooksey said.

Don't Drive With Low Blood Sugar

• By Madeline Vann, MPH | Medically reviewed by Pat F. Bass III, MD, MPH

Hitting the road this holiday season? Taking the wheel when your blood sugar is low is just as dangerous as driving while drunk — and has many of the same consequences.

Most people know that driving under the influence of alcohol or drugs is dangerous — but driving with low blood sugar (called hypoglycemia) is also very dangerous. The worst outcome for people with diabetes who drive at the wrong time is to black out behind the wheel and kill or injure another person. Yet an online survey of more than 2500 Americans with type 2 diabetes found that about 19 percent had experienced hypoglycemia while driving.
“If something happens and they pull your blood sugar records and find out that you didn’t check before you drove, you can lose your license. I have seen some patients have their license taken away and it is very difficult to get it back,” warns Amy Kranick, a registered dietitian and certified diabetes educator with the adult diabetes program at Vanderbilt University Medical Center in Nashville, Tenn.
When Blood Sugar Dips
Hypoglycemia means that your blood sugar levels have fallen too low to support the needs of your body and brain. This is usually defined as less than 70 mg/dL. This dip in blood sugar is a possible side effect of some type 2 diabetes medications. Most people are aware of having low blood sugar and report that it is not a pleasant experience.
Symptoms include:

• Headache
• Dizziness
• Sweating
• Hunger
• Tremors/trembling
• Pale skin
• Anxiety
• Confusion
• Changes in behavior or mood
• Clumsiness
• Difficulty paying attention
• Seizures
• Loss of consciousness

However, a few people with diabetes have “hypoglycemia unawareness” and don’t feel any symptoms until it is too late. This is why it is important to check your blood sugar before you take the wheel, just in case your numbers are going down and you have missed the signs or have not yet started to see the symptoms. The National Highway Traffic Safety Administration advises people who have hypoglycemia unawareness not to drive at all.

People with type 2 diabetes who take insulin are at increased risk for hypoglycemia as a side effect of this medication. Studies suggest that episodes of hypoglycemia become more frequent over time for these patients. A class of drugs called sulfonylureas, which lower blood glucose, can also cause hypoglycemia; common sulfonylureas include tolbutamide, glipizide, and glimepiride.
Planning Your Trips
Here is a basic outline of how to handle driving with diabetes:

• Test blood sugar. “Don’t ever get in the car without checking your blood sugar,” emphasizes Kranick. Your blood sugar should be around 110 to 150 mg/dL.
• Correct blood sugar. If your blood sugar is too low, do not get behind the wheel. Eat or drink one of the following and wait 15 minutes to check your blood sugar again:
  
  
  • 15 grams of a simple carbohydrate
  • 4 glucose tabs
  • 4 ounces of soda or fruit juice
• Plan ahead. Keep healthy snacks in the car for emergencies. Make sure you have enough supplies for testing and correcting blood sugar in case you are stuck away from home for longer than you planned.
• Check blood sugar regularly. If you are taking a long car trip, plan on checking your blood sugar every two to four hours. Make sure you have a stash of supplies to keep your blood sugar under control.

Driving with diabetes can be safe as long as you keep track of your blood sugar levels. Following these basic steps will keep you on the roads.

7 Things Diabetes Taught Me

• By Randy Jackson

What I learned from my diagnosis, and how these life lessons may help others

FEATURED

Life is full of lessons – you just have to look for them, listen up, and learn.
One of my first life lessons was something my grandma taught me: Nobody’s perfect. That’s why my credo is, “You don’t have to be perfect ... just pretty good.” Working in the music industry with so many talented people has also taught me that you’ve got to believe in yourself and keep it real.
Since being diagnosed with type 2 diabetes, I’ve learned some things about the disease and myself – things that can help others take charge of their health. Here are seven of them:
1. Denial is dangerous. I shouldn’t have been shocked when the doctor told me I had diabetes. The signs were there all along. I’ve got mirrors and scales, so I know when I’m getting bigger and heavier. When I was at the gym or climbing stairs, I was out of breath. Sometimes you live in denial, and you don’t think it’s going to happen to you – until it does.
2. Type 2 diabetes isn’t just an older person’s disease. More and more young people, even kids, are being diagnosed with type 2 diabetes. Whatever your age, obesity and lack of exercise raise your risk for the disease.
3. Knowledge is king. If you have diabetes, you’ve got to watch your ABCs: A is your A1C blood sugar level, B is your blood pressure, and C is cholesterol. When it comes to my blood sugar, I check it every day, three times a day sometimes. Your doctor will help set the right ABC goals for you.
4. Play to your strengths. Find ways to make exercise fun, not a chore. I enjoy tennis, so I try to play three or four days a week for a couple of hours. You burn a lot of calories chasing tennis balls around. I love music, so I have all kinds of playlists on my iPod. Sometimes I get so lost in the music, I don’t even notice how long I’ve been working out.
5. Know your weaknesses. I know what my food temptations are – things like ice cream and pasta. So I just don’t keep that much of them around the house. It cuts down the risk of cheating on your diet.
6. Gastric bypass isn’t a quick fix. Gastric bypass surgery was a last-ditch effort for me. It can help jump-start your weight loss, but it’s not a cure. You still have to do the work, watch what you eat, and exercise. Like with any surgery, talk to your doctor about the pros and cons.
7. There’s no day off with diabetes. Even if you don’t have symptoms, you’ve got to keep the disease under control to avoid any complications. Diabetes can raise your risk for things like heart disease, kidney disease, liver damage, vision loss...some pretty serious stuff. Just remember that you can do this, but you need to have an action plan and stick to it.
The most important thing diabetes taught me is how lucky I am. After a close call, I’m in good health – and I’m going to keep it that way.

RheumNow: Are DAS28-CRP and DAS28-ESR Biosimilar? What the latest findings say

• by RheumNow Staff
  

The disease activity score (DAS28) has been developed as a dynamic assessment tool and a therapeutic response measure for use in clinical trials and practice. Although intended for use in patients with rheumatoid arthritis, its utility has been applied in the assessment of other inflammatory arthropathies.
The DAS has evolved from the DAS44 to the DAS28 by dropping the confusing Ritchie index and consolidating the joint exam to just 28 joints with a net improved ease of use. Similar to the ACR response criteria, the DAS is a mathematical activity measure drawn from the seven core set variables: patient pain, MD and patient global assessments, a functional measure (HAQ), tender and swollen joint counts, and an acute phase reactant (APR). Unlike the ACR20, the DAS omits the HAQ, MD Global and patient pain. It is calculated from the patient global, TJC, SJC, and an APR. Depending on which APR is available (CRP or ESR), the DAS is calculated as either the DAS28-ESR or the DAS28-CRP.
But are they the same, interchangeable and as identical as a biosimilar?
One camp believes they are not, especially since the cut-offs for disease activity levels have only been reliably defined to the DAS28-ESR (remission < 2.6; LDAS 2.6-3.2; moderate activity 3.2-5.1; high activity >5.1). Yet many clinicians and trialists erroneously apply these cutoffs to DAS28-CRP, which is not quite as stringent a measure as the DAS28-ESR.
Others point to research done on RA cohorts showing the similar performance characteristics for both measures, suggesting interchangeability. This is not surprising as a) nearly half of all patients with RA will have normal ESR and CRP values – despite having active disease; and b) both measures are calculated using the core set seven values found in the ACR20 response criteria. Similarly, the (more easily calculated) SDAI, CDAI, RAPID3, PAS and GAS score all utilize between three and five of the seven core set variables and have very high correlation coefficients. But that's because they are supposed to!
All rheumatologists and clinical trialists recognize the dynamic and pathogenic importance of including either the ESR or CRP in clinical decision-making or disease activity calculation. Moreover, there is a large volume of research indicating the value of high ESR or CRP in predicting radiographic progression and erosions. However, either or both may be normal in up to 60% of patients in practice or in RCTs.
Acute phase reactants appear to be critically important in ACR response and DAS 28 calculations. The more easily calculated SDAI and CDAI are based on the same variables used in the DAS28 and have a high correlation with the DAS28-ESR or –CRI. Yet the only difference between the SDAI and CDAI is the omission of the CRP from the latter. Studies have shown that the CRP only adds as little as 6% to the response equation. Hence, the CDAI and RAPID3, neither of which require the ESR or CRP, are the most popular outcome measures in clinical practice. At the 2014 ACR annual meeting, Dr. Curtis and I presented a survey of 500 US rheumatologists showing the RAPID3 and CDAI are being done by 43% of rheumatologists. I personally use the global arthritis score (GAS) that is a composite of patient pain, 28 tender joint count and the modified HAQ. The GAS, CDAI, SDAI and DAS28 have very high correlations (R > 0.85) underscoring the minimal effect of an acute phase reactant.
A number of research groups have studied the DAS28 issue. Their findings are chronicled in the capsule summaries listed below. Read through these studies to see if you agree with the following summary statements:
Summary

• The DAS28-ESR and DAS28-CRP are not interchangeable.
• The DAS28-CRP underestimates disease activity and overestimates clinical improvement.
• Most studies show the ESR method to yield higher values than the CRP method. The DREAM registry estimates the DAS28-CRP scores to be 0.20 points lower than DAS28-ESR scores, with even greater bias in older women.

Citations
A retrospective study of Danish RA patients initiating biologic treatment analyzed the change in DAS28-ESR and DAS-CRP at baseline and following 1 year of treatment. The 75 eligible patients were classified as EULAR good, moderate, and nonresponders, and overall a high level of agreement (61/75; 81%) between DAS28-CRP and DAS28-ESR (κ = 0.75; 95% CI: 0.63 to 0.88) was found.
Data from 3073 RA patients in the large NinJa registry was used to calculate DAS28-ESR and DAS28-CRP and disease activity. The mean DAS28-CRP (3.59) was significantly smaller than that of mean DAS28-ESR (4.31) (P<0.0001). The number of patients who were in remission was 297 (9.7%) in DAS28-ESR versus 705 (22.9%) in DAS28-CRP and the number of patients with high disease activity was 842 (27.4%) versus 357 (11.6%) for DAS28-ESR and DAS28-CRP (P<0.0001). These findings suggest a relative "leniency" to the DAS28-CRP, as it underestimates disease activity and overestimates clinical improvement. Nevertheless, the change in DAS28 showed a significant correlation between the DAS28-ESR and DAS28-CRP (P<0.0001); however, the number of "good response" patients was significantly different (P<0.03) between DAS28-ESR (97 patients, 6.5%) and DAS28-CRP (136 patients, 9.2%).
In a prospective study from Korea, 540 patients with RA from two rheumatology clinics who had at least one DAS28 evaluation were examined. The mean DAS28-ESR was higher than the DAS28-CRP (3.65 vs. 3.44; P<0.001). In the DAS28-ESR group, 126 patients (23.3%) satisfied the criteria for remission versus 134 (24.8%) in the DAS28-CRP group. High disease activity was determined in 80 (14.8%) patients in the DAS28-ESR group and in 43 (8.0%) in the DAS28-CRP group. A comparison of the two groups with respect to four DAS28 disease activity categories showed agreement in 344 patients (63.7%; κ = 0.45). In classifying patients as EULAR responders, agreement between the two methods was shown in 56 patients (71.8%; κ = 0.76). When disagreements between the two scores occurred, more patients had a better EULAR response based on the DAS28-ESR than on the DAS28-CRP (19.2% vs. 8.9%, respectively). The authors felt that discordance between the ESR-based and CRP-based DAS28 could affect clinical treatment decisions for patients with RA.
A single center study of DAS28 data of 112 Turkish RA patients analyzed the correlation between DAS28-CRP and DAS28-ESR. Although there was a strong correlation between DAS28-CRP and DAS28-ESR, the correlation between their unique components was fair. Although more than 95% of the point data fall between the upper and lower bounds of the limit of agreement, the percentage error (46%) was higher than the acceptable proportion of 30%. The κ coefficient of agreement between DAS28- ESR and DAS28-CRP with validated thresholds for DAS28-ESR was 0.42, which was close to the lower boundary for moderate agreement. This study demonstrated that there is discordance between DAS28-ESR and DAS28-CRP using the validated thresholds for DAS28-ESR. Using the DAS28-CRP with threshold values validated for DAS28-ESR may lead to errors in the determination of disease activity and therefore may lead to errors in the management of patients with rheumatoid arthritis.
An analysis of US African-Americans from the Consortium for the Longitudinal Evaluation of African Americans with Early Rheumatoid Arthritis (CLEAR) registry, compared variants of the DAS28 scores: ESR-based and CRP-based DAS28 scores (DAS28-ESR3 and DAS28-CRP3) and the DAS28-ESR4 and DAS28-CRP4. Among the 233 participants, the mean DAS28-ESR3 was significantly higher than DAS28-CRP3 (4.8 vs 3.9; P<0.001); and the mean DAS28-ESR4 was significantly higher than DAS28-CRP4 (4.7 vs 3.9; P<0.001). Overall agreement was not high between DAS28-ESR3 and DAS28-CRP3 (50%) or between DAS28-ESR4 and DAS28-CRP4 (59%). DAS28-CRP3 underestimated disease activity in 47% of the participants relative to DAS28-ESR3 and DAS28-CRP4 in 40% of the participants relative to DAS28-ESR4. These authors also found significant discordance between the ESR-based and CRP-based DAS28 that could affect clinical treatment decisions for African Americans with RA.
The DAS28, SDAI and CDAI were studied in a cross-sectional analysis of 111 patients. DAS28 (ESR) was significantly higher than DAS28 (CRP) (4.0 vs. 3.5; P<0.001) even with stratification for age, gender, disease duration, rheumatoid factor, and HAQ. Correlations among indexes (SDAI or CDAI and DAS) ranged from 0.84 to 0.99, with better correlation between SDAI and CDAI. Agreements among activity strata ranged from 46.8% to 95.8%. DAS28 (CRP) with cut-off point for the remission of 2.3 underestimated disease activity by 45.8% compared with DAS28 (ESR). SDAI and CDAI showed agreement of 95.8%. The four indexes were associated with disease duration and HAQ.
The interchangeability of the DAS28-ESR and DAS28-CRP was studied in 682 RA patients from the DREAM registry. Despite a strong linear correlation between the DAS28 scores and a high intra-class correlation coefficient of 0.931, a considerable lack of agreement was seen with Bland-Altman 95% limits of agreement ranging between -0.85 and +1.25 points. On average, DAS28-CRP scores were 0.20 points lower than DAS28-ESR scores, and this bias was most severe in older women. The overall classification agreement across DAS28 categories was 76.69%, with the lowest agreement (35.37%) in the low disease activity group. Patients were more easily classified as being in remission when using the DAS28-CRP measure. DAS28-ESR and DAS28-CRP scores are not interchangeable within individuals, and their interchangeability could result in substantial classification differences.
The authors recognized that the values for remission and low disease activity (LDAS) for DAS28-CRP have not been validated and that ACR/EULAR guidelines suggest remission should be calculated by Simplified Disease Activity Index (SDAI) rather than DAS28-ESR. They sought to establish cutoffs for remission and LDAS of DAS28-CRP that correspond to established limits for the same using the DAS28-ESR and SDAI. Using data from five clinical trials, rates of remission and LDAS by DAS28-ESR was greater for DAS28-CRP. Discordance between CRP and ESR cut-offs ranged from 4%-26% and 8%-23% for remission and LDAS, respectively, and 19%-40% and 6%-11% for DAS28-CRP versus SDAI, respectively. The comparative ranges for remission and LDAS are shown below:

A version of this article first appeared on RheumNow, a news, information and commentary site dedicated to the field of rheumatology. Register to receive their free rheumatology newsletter.

The authors disclosed no relevant relationships with industry.

last updated 10.17.2015

• Primary Source

  Arthritis

  Source Reference: Nieulung L, et al "Validity and agreement between the 28-Jjoint disease activity score based on c-reactive protein and erythrocyte sedimentation rate in patients with rheumatoid arthritis" Arthritis 2015; 401690.

• Secondary Source

  Annals of the Rheumatic Disease

  Source Reference: Matsui T, et al "Disease Activity Score 28 (DAS28) using C-reactive protein underestimates disease activity and overestimates EULAR response criteria compared with DAS28 using erythrocyte sedimentation rate in a large observational cohort of rheumatoid arthritis patients in Japan" Ann Rheum Dis 2007; 66(9):1221-6.
• Source Reference: Fleischmann R, et al "How much does disease activity score in 28 joints ESR and CRP calculations underestimate disease activity compared with the simplified disease activity index?" Ann Rheum Dis 2015; 74(6):1132-7

• Additional Source

  International Journal of Rheumatic Diseases

  Source Reference: Son KM, et al "Comparison of the disease activity score using the erythrocyte sedimentation rate and C-reactive protein levels in Koreans with rheumatoid arthritis" Int J Rheum Dis 2015.
• Source Reference: Sengul I, et al "Comparison of the DAS28-CRP and DAS28-ESR in patients with rheumatoid arthritis" Int J Rheum Dis 2015; DOI: 10.1111/1756-185X.12695.

• The Journal of Rheumatology

  Source Reference: Tamhane A, et al "Comparison of the disease activity score using erythrocyte sedimentation rate and C-reactive protein in African Americans with rheumatoid arthritis" J Rheumatol 2013; 40(11):1812-22.

• Brazilian Journal of Rheumatology

  Source Reference: Medeiros MM, et al "Correlation of rheumatoid arthritis activity indexes (disease activity score 28 measured with ESR and CRP, simplified disease activity index and clinical disease activity index) and agreement of disease activity states with various cut-off points in a Northeastern Brazilian population" Rev Bras Reumatol 2015.

• Journal of Clinical Rheumatology

  Source Reference: Siemons L, et al "Interchangeability of 28-joint disease activity scores using the erythrocyte sedimentation rate or the C-reactive protein as inflammatory marker" Clin Rheumatol 2014; 33(6):783-9.

• 10.09.15 General Rheumatology

  
  

MMP-3 Levels Predict Radiographic Progression in RA

Destructive enzyme may help guide early targeted therapy for those at risk

• by Diana Swift
  Contributing Writer

Action Points

• Continuously elevated serum matrix metalloproteinase-3 (MMP-3) for 3-6 months predicted 1-year radiographic progression in rheumatoid arthritis (RA).
• Elevated MMP-3 levels predict radiographic progression even in RA patients in clinical remission.

Continuously elevated serum matrix metalloproteinase-3 (MMP-3) for 3-6 months predicted 1-year radiographic progression in rheumatoid arthritis (RA), according to a small prospective cohort study in Arthritis Research and Therapy.
Elevated serum MMP-3 at months 0, 1, 3, and 6 and C-reactive protein (CRP) at month 1 were significant predictors of 1-year radiographic progression, with odds ratios of 10.5-27.0 for MMP-3 at the follow-up time points (all P<0.05), and an OR of 7.4 for CRP at one month (P=0.011), according to Lie Dai, MD, PhD, at Sun Yat-sen Memorial Hospital in Guangzhou, China, and colleagues.
The investigators suggested that monitoring of dynamic serum MMP-3 combined with core disease activity indicators may help predict radiographic progression and guide treatment decisions in RA.
They noted that core disease activity indicators such as erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and CRP have been of limited value in predicting progressive joint destruction in RA.
And while MMP-3 plays an essential role in joint destruction, elevated levels have been found even in remission patients. Secreted by synovial fibroblasts and chondrocytes in joints, the active form of this enzyme accelerates joint destruction by degrading aggrecan core protein, cartilage link protein, fibronectin, and collagen types IV, VII, IX and XI, Dai and colleagues noted.
They recruited 60 patients with active RA (Simplified Disease Activity Index >3.3) being managed at the hospital with a treat-to-target strategy from December 2010 to December 2013. Patients were assessed clinically and for serum MPP-3 at months 0, 1, 3, 6, and 12. X-ray assessments of hand/wrist were done at baseline and month 12, with a change of total Sharp score of >0.5 units defined as radiographic progression.
The cohort's median age was 48 (51 in progressive patients), 77% were female (63% in the progressive group), and the median disease duration was 24 months. All patients had poor prognostic characteristics: 93% had bony erosions, 84% were RF-positive, 82% were anticyclic citrullinated peptide antibody-positive, and 54% had functional limitations. Overall, the median baseline MMP-3 level was 175 ng/mL but in the group that progressed it was 316 ng/mL.
Of the 56 patients who completed 1-year follow-up, 29% showed radiographic progression and 9% had rapid radiographic progression. Serum MMP-3 levels and all core disease activity indicators (except for ESR) were significantly higher in progressives than nonprogressives at 12 months.
Among 16 progressive patients, 69% achieved their therapeutic targets, but 56% of these had continuous elevated serum MMP-3, and 38% had both continuous elevated serum MMP-3 and normal C-reactive protein at month 6.
The predictive accuracy of serum MMP-3 for 1-year radiographic progression was 0.721 with a cutoff point of 159 ng/mL (P=0.010, positive predictive value 46.7 % and negative predictive value 92.3 %).
Subgroup studies showed that dynamic serum MMP-3 might be helpful for predicting radiographic progression in patients achieving their therapeutic targets since elevated serum MMP-3 at month 3 was a significant predictor of 1-year rapid radiographic progression.
Commenting on the study, Ziv Paz, MD, MPH, a rheumatologist at Beth Israel Deaconess Medical Center in Boston, said, "The discrepancy between improved clinical symptoms and worsening radiological progression is one of the biggest challenges in the current era of RA management. The use of MMP-3 as a biomarker is novel and linked to disease pathophysiology, as this enzyme has an important role in the breakdown of the joint's related structures."
Acknowledging the study's limitations, Dai and colleagues pointed to its design as a real-world cohort study, with all patients recruited and treated with various regimens at a single center. "Further multicenter studies of the combined strategy of both disease activity and serum MMP-3 driven therapy with the same treatment in all centers are needed," they wrote.
Moreover, all study patients had poor prognostic features, which might confound the prediction of radiographic progression. "More new-onset RA patients without bony erosion are needed in future to investigate whether serum MMP-3 could predict radiographic progression in these patients," Dai and colleagues wrote.
Added Harvard's Paz: "This study opens the door for a new group of biomarkers which can help to identify the group of patients who would progress, guide intensified targeted treatments at early stages of the disease, and potentially prevent damage."

This study was supported by the National Natural Science Foundation of China and the Guangdong Natural Science Foundation. The authors disclosed no relationships with industry.

• Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo, MA, BSN, RN, Nurse Planner

last updated 10.22.2015

• Primary Source

  Arthritis Research & Therapy

  Source Reference: Ma J, et al "Continuously elevated serum matrix metalloproteinase-3 for 3–6 months predict[s] one-year radiographic progression in rheumatoid arthritis: a prospective cohort study" Arthritis Res Ther 2015; DOI: 10.1186/s13075-015-0803-2.

Naproxen Alone Wins for Relieving Lower Back Pain

Adding cyclobenzaprine or Percocet fails to improve pain or function

• by Kay Jackson
  Contributing Writer, MedPage Today

Action Points

• Opioids, when combined with naproxen, are not more effective than naproxen alone for the majority of patients with acute, nontraumatic, nonradicular low back pain.
• Pain, functional impairment, and use of healthcare resources were similar among treatment groups at 7 days or 3 months, and almost two-thirds of patients had clinically significant improvement regardless of treatment group.

Among patients with acute, nontraumatic, nonradicular lower back pain (LBP) presenting to the emergency department (ED), adding cyclobenzaprine or oxycodone/acetaminophen (Percocet) to naproxen alone did not improve functional outcomes or pain at 1-week follow-up, a randomized, double-blind, three-group study has shown.
"These findings do not support the use of these additional medications in this setting," Benjamin W. Friedman, MD, MS, of Montefiore Medical Center, Albert Einstein School of Medicine in New York City, and colleagues reported online in the Journal of the American Medical Association (JAMA).
"Opioids, when combined with naproxen, are not more effective than naproxen alone for the majority of patients with low back pain," Friedman said in an interview. "We demonstrated that adding cyclobenzaprine or oxycodone/acetaminophen to naproxen is unlikely to benefit the patient. Emergency physicians should counsel their patients that passage of time will bring improvement and eventual relief to most patients," he told MedPage Today.
Measures of pain, functional impairment and use of healthcare resources were not different between the study groups at 7 days or at 3 months after the ED visit, reported the investigators. One week later, almost two-thirds of the patients demonstrated clinically significant improvement in LBP and function regardless of treatment group.
On the other hand, 40% of the cohort reported pain that was moderate or severe and half reported functional impairment 1 week after the ED visit. In addition, 60% of the study participants said they were still using medication after 1 week.
Three months after the initial ED visit, opioid use for LBP was uncommon regardless of which group patients were in, and fewer than 3% of patients in the opioid group reported taking medication in the previous 72 hours, said the investigators.
LBP is responsible for more than 2.7 million visits to U.S. EDs annually, pointed out Friedman and colleagues. In most cases, patients are treated with nonsteroidal anti-inflammatory drugs, acetaminophen, opioids, or skeletal muscle relaxants, often in combination, they said.
"Pain outcomes for these patients are generally poor," wrote the authors. One week after an ED visit, 70% of patients reported persistent back pain-related functional impairment and 69% reported continued use of analgesics, they noted. After 3 months, some 48% reported functional impairment and 46% reported persistent analgesic use. This included 19% who still required opioids.
"Our data leave clinicians and patients in a difficult position," Friedman told MedPage Today. "Many patients have already taken NSAIDs for LBP before they arrive in the ED. Some patients may have taken insufficient doses at incorrect intervals and could be instructed to optimize their NSAID regimen. But for those patients who have already optimized their NSAID regimen, there are no additional evidence-based medical therapies available."
Remaining active leads to a better outcomes than bed rest, said the investigators, although they acknowledged that complementary therapies such as acupuncture, yoga, and massage have been inadequately studied in an acute LBP population.
In the study (April 2012-December 2014), a total of 323 patients who presented to the Montefiore Medical Center in New York City with nontraumatic, nonradicular LBP of 2 weeks' duration or less were enrolled. All had a score of greater than 5 on the Roland-Morris Disability Questionnaire (RMDQ). (Zero indicates no functional impairment and 24 indicates maximum impairment.)
Patients were randomized 1:1:1 to one of three groups for 10-day courses of naproxen + placebo, naproxen + cyclobenzaprine, or naproxen + oxycodone/acetaminophen.
All participants were given 20 tablets of naproxen, 500 mg, to be taken twice a day. They were randomized to receive either 60 tablets of placebo, 5 mg cyclobenzaprine, or 5 mg oxycodone/ 325 mg acetaminophen.
Participants were instructed to take one or two of these tablets every 8 hours, as needed. Prior to discharge, they received a standardized 10-minute educational session on LBP.
The primary outcome was improvement in RMDQ between ED discharge and 1 week later.
Demographic characteristics were comparable among the three groups, said the investigators. At baseline, median RMDQ score in:

• 20 in the placebo group 0 (interquartile range [IQR] 17-21);
• 19 in the cyclobenzaprine group (IQR 17-21); and
• 20 in the oxycodone/acetaminophen group (IQR 17-22).

These scores were cut approximately in half in all three groups at the end of treatment. Specific between-group differences in score change at follow-up (using a stringent 98.3% confidence interval) were:

• 0.3 for cyclobenzaprine versus placebo (98.3% CI −2.6 to 3.2; P=0.77);
• 1.3 for oxycodone/acetaminophen versus placebo (98.3% CI −1.5 to 4.1; P=0.28); and
• 0.9 for oxycodone/acetaminophen versus cyclobenzaprine (98.3% CI −2.1 to 3.9; P=0.45).

Acute low back pain is a frustrating condition, acknowledged Friedman in an interview. "In general, a majority of patients with acute onset LBP report persistent suffering 1 week later. By 3 months, however, the majority has improved."
Still, even though the study selected for patients at low risk of a poor outcome at 3 months by excluding those with chronic LBP, radicular symptoms, or regular use of analgesics, more than 20% of the cohort reported poor outcomes 3 months after the ED visit, he pointed out.

No study funding or conflicts of interest were reported.

• Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College

• Primary Source

  JAMA

  Source Reference: Friedman B. W., "Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: A randomized clinical trial" JAMA 2015; DOI: 10.1001/jama.2015.13043.

Diabetes-Friendly Meals the Whole Family Will Love

• By Beth W. Orenstein | Medically reviewed by Farrokh Sohrabi, MD

You can modify family favorites without sacrificing taste. The whole crew will benefit from healthier eating.

When Mom or Dad is diagnosed with type 2 diabetes, you might think that cooking for the family is going to become a huge hassle because you’ll need to make two versions of every meal. Not so, said Melissa Joy Dobbins, RD, LDN, CDE, a spokesperson for the Academy of Nutrition and Dietetics. The same smart ingredients used in dishes for a diabetes meal plan will benefit every family member, and no one has to be the wiser.
The two pillars of a diabetes meal plan are controlling carbs (foods that easily convert to sugar) and eating heart healthy, Dobbins said. “We all can benefit from controlling portions, and we’re all at risk for heart disease,” she pointed out. If your kids grow up eating healthy, they’ll develop good habits that can last them a lifetime.
These culinary adaptations will satisfy the needs of the family member with type 2 diabetes, and no one else will even notice that they’re eating lower-carb meals or feel they’re missing out:

Cook with oil, not butter. Solid animal fats, like butter and lard, are high in saturated fat. Use healthier vegetable fats like canola and olive oil, but use them sparingly. Fat is high in calories, so using less can help you keep your weight in check.
Bake and broil. Bake, broil, or grill lean proteins like chicken and fish rather than dredging them in flour or breadcrumbs and frying. You’ll also want to skip heavy toppings like cream sauces and gravies. Add flavor to proteins with zesty spice rubs instead; they’ll be just as tasty and a lot more diabetes-friendly and heart healthy, Dobbins said.
Eat more fish. The American Diabetes Association recommends eating seafood two to three times a week. Steamed, poached and microwaved fillets are especially diabetes-friendly because they don’t require extra fat for cooking. If your family loves pasta, try serving sautéed shrimp or scallops over a small serving of whole grain noodles with mixed vegetables.
Lose the (beef) fat. If your family enjoys an occasional steak or roast, you don’t have to strike it from your grocery list completely. But for better health for everyone, choose leaner cuts of beef such as round, sirloin, and flank steak. Avoid cuts with white marbling, which is streaks of fat, and trim any visible fat from the cuts you do buy.
Need a burger fix? If you’re buying ground beef, look for labels that say it’s at least 90 percent lean. Better yet, substitute ground turkey to make tacos, meatballs, chili, and meatloaf into heart-smart meals.
Don’t be piggy. You can keep pork on the menu by choosing leaner Canadian bacon instead of fatty bacon and making boneless ham, pork tenderloin, boneless loin roast, or center-cut loin chops instead of fatty ribs. “A lot of pork is very lean,” Dobbins said. You’ll still want to limit saltier cuts like Canadian bacon and ham to avoid eating too much sodium.

Substitute low-fat dairy. Using low-fat dairy in place of full-fat is an easy way to instantly trim major calories and saturated fat. When a recipe calls for whole milk, simply substitute 1 or 2 percent. Instead of full fat cheese, use a low-fat fat variety. You can use luxuriously thick non-fat or low-fat Greek yogurt in many recipes that call for sour cream. If you’re worried about getting push back from tough critics at the dinner table, start by substituting just half of the dairy called for in a recipe with the low-fat version. If your family doesn’t notice (or gradually adjusts), you may eventually be able to substitute all of it.
Choose whole grains. Whole grains have been shown to help stabilize blood sugar, Dobbins said, and they have a nice, nutty flavor. Substitute brown rice for white rice in recipes and as a side dish. Opt for whole grain breads and pastas over those made from refined white flour. Another health perk: Whole grains are rich in fiber, which reduces risk for heart disease and helps fill you up so you eat less.
Sneak in more vegetables. Most vegetables are low in calories and high in fiber, along with health-boosting vitamins. When following recipes, double the amount of non-starchy vegetables like peppers, mushrooms, carrots, and broccoli called for in soups and casseroles. Add sliced veggies to pasta sauce, and make the sauce tomato, not cream, based. When you pick up pizza for the gang, order it with vegetables only, like broccoli and mushrooms, rather than fatty, salty meat toppings.
Up the bean count. Beans are a diabetes super food. They’re high in fiber and protein, so they fill you up and keep you fuller longer. You can add canned beans to salads, soups, and casseroles. Or, take a break from your favorite beef or turkey chili and try a vegetable bean version instead. Beans do have carbs – roughly 15 grams for 1/3 to 1/2 cup of beans, so make sure you include them if you count carbs.
Reduce sugar in recipes. Family members don’t have to give up their favorite sweets after mom or dad is diagnosed with diabetes. You can leave out a third of the sugar in most recipes without affecting taste or texture. The savings are substantial: in a recipe that originally calls for 2 cups of sugar, trimming 2/3 cup will slash more than 500 calories and well over 100 grams sugar. Pull back on the sweet stuff and exercise portion control, and everyone can enjoy a sampling and not feel deprived.
Serve smaller portions. Our portion sizes have grown dramatically over the years, so cutting back is a smart idea for everyone. Serve family favorites – just be sure everyone eats one serving, not two or three. No matter how healthy the food, if you eat too much, you’ll gain weight, Dobbins said.

A Meal Plan That Works for the Entire Family

“A diabetes diet is a healthy diet that everyone should be following,” Dobbins said. It’s not as restrictive as many people might think and, with some smart substitutions and portion control, you and your family can sit down together to great meals that are a far cry from bland, boring “health food.”

Sneaky High-Salt Foods

• By Jennifer Acosta Scott | Medically reviewed by Lindsey Marcellin, MD, MPH

1 / 9  

If you’ve been in a grocery store lately, you’ve probably noticed more and more low-sodium foods on shelves, from cheese to crackers. There’s good reason for the change: Consuming salty foods can increase your risk for serious health conditions, like high blood pressure, heart disease, and stroke. The obvious fix is to cut some of the salt from your diet, but sodium is sneaky — it can lurk in many seemingly healthy foods. Here are some of the worst offenders.

2 / 9   Beware of Certain Breads

You probably don’t think of bread as salty food, but some types can contain fairly high amounts of sodium. A six-and-a-half-inch pita, for example, contains more than 300 milligrams of salt. That doesn’t sound like much, but it can add up when you consider that most adults are advised to keep their salt intake below 2,000 mg of sodium per day, says Kelly O’Connor, RD, a nutritionist and certified diabetes educator at Mercy Medical Center in Baltimore. The next time you’re craving a sandwich, reach for low-sodium rye bread — the reduced-calorie version contains only 93 mg per slice, significantly less than the 170 mg in the average slice of white bread. Another good choice is whole-grain bread, which has about 127 mg per slice.

3 / 9   Forget Frozen Meals

Packaged low-calorie frozen meals may seem like the easy way to control portions and watch your weight, but most of them contain way too much salt. “Although many brands now offer low-sodium alternatives, the meals still contain significant amounts,” O’Connor says. “Some of them contain more than 500 mg per meal, which is one-third of your recommended daily intake if you are following a low-sodium diet.” A leftover meal made from last night’s healthier homemade dinner can serve as a low-sodium, quick-lunch alternative to lower your salt intake, O’Connor adds.

4 / 9   Ditch the Salad Dressing

You may feel virtuous opting for a salad over a hamburger, but pay attention to the condiments that you add to your greens. One tablespoon of commercially prepared French dressing, for example, has 214 mg of sodium. “This is not a red-flag amount of sodium per serving, but think of how many people pour the salad dressing on their salads directly from the bottle, serving themselves several tablespoons and maybe 800 to 1,000 mg of sodium,” O’Connor says. The next time you reach for a salad, try using oil and vinegar, which won’t add to your salt intake.

5 / 9   Curb Cereals

You probably don’t think of breakfast cereal as a salty food, but many of the “healthier” cereals on the market, like corn flakes and toasted-oat cereals, have almost 300 mg of sodium per cup. Again, the problem isn’t the sodium per serving, but the small amount that counts as a serving size. “A typical cereal bowl can hold one and a half to two cups of cereal, if not more,” O’Connor says. To control your salt intake at breakfast time, watch your portion size, and try shredded-wheat-type cereals, which are low-sodium foods. A one-cup serving of frosted miniature-wheat cereal, for example, has only 3 mg of salt.

6 / 9   Be Cautious About Canned Beans

Some people opt for beans as a way to get protein while controlling their fat and cholesterol intakes, but the canned versions often have too much salt. One cup of plain baked beans has a whopping 1,008 mg of sodium, which is half of an adult’s recommended daily salt intake. “A roasted chicken breast [without the skin] would be an all-around better choice, with less than 100 mg of sodium and minimal fat and cholesterol content,” O’Connor says. If you’re a vegetarian, try cooking dried beans — one cup of boiled navy beans has only 2 mg of sodium.

7 / 9   Junk the Jarred Spaghetti Sauce

Be prudent the next time you serve pasta: On average, one cup of ready-to-serve marinara or spaghetti sauce weighs in at over 1,000 mg of sodium. If you still want the convenience of jarred sauce, look for lower-sodium versions, some of which contain just 100 mg of salt per serving. Better yet, curb your salt intake by making your own sauce with fresh tomatoes, onions, and bell peppers; these vegetables have very low amounts of sodium, and the finished sauce can easily be frozen for convenience.

8 / 9   Drop the Diet Cola

While diet colas don’t have the sugar and calories of regular cola, they actually have more sodium — 28 mg for a 12-ounce can compared to 15 mg for regular. That doesn’t sound like a lot, but again, O’Connor says, the key is frequency of consumption — several cans of diet cola over the course of a day can add up to too much salt. The next time you’re feeling thirsty, skip the soda in favor of decaf herbal tea or fruit juice, both of which are very low in sodium. “But of course, the best choice would be water,” O’Connor says. The average cup of municipal tap water comes in at about 5 mg of sodium.

9 / 9   Can the Canned Soup

Those cans of minestrone and tomato soup may make for a comforting meal, but they’re veritable salt-fests. One cup of canned chicken noodle soup contains 1,106 milligrams of sodium. If you don’t have time to make soup from scratch, limit your salt intake by choosing canned soups labeled “healthy” or “low-sodium.” While not free of salt, they usually contain much less than regular versions. (Check the nutrition labels to be sure.) Or try the ready-made soup selections in your grocery store’s deli department, which tend to be lower in sodium than shelf-stable products.

Sugar Busters Diet

• By Katherine Lee | Medically reviewed by Pat F. Bass III, MD, MPH

Can cutting sugar help cut obesity? The authors of the low-carb Sugar Busters diet think so. Discover why.

Sugar Busters! is a low-carb diet and lifestyle book based on the premise that eliminating sugar from the diet will achieve weight loss, fight obesity, and improve overall health. The authors of the book are a corporate CEO who lost 20 pounds on the Sugar Busters diet and three doctors — one specializing in cardiovascular surgery, another in endocrinology, and the third in gastroenterology. Their premise includes the theory that cutting sugar can cut our growing obesity problem.
At the core of the Sugar Busters plan is the belief that sugar — not just refined sugar, but the sugar processed by our body from complex carbohydrates and starches — is toxic for the body.
According to the authors of the Sugar Busters diet, removing foods that are high in sugar from your diet will help achieve weight loss, lower cholesterol, increase energy levels, and be generally healthier. Sugar Busters lists foods to avoid, offers a 14-day sample meal plan, and also includes recipes.
Sugar Busters Diet: How Does It Work?
“The Sugar Busters diet works by restriction,” says registered dietitian Keri Gans, RD, a spokesperson for the American Dietetic Association. “It’s a restrictive diet that eliminates foods.”
The foods being targeted are those high in various sugars. Why? Sugar stimulates the body to produce excess insulin, which can cause it to store excess sugar as fat and increase cholesterol production. Carbohydrates also inhibit the body’s ability to break down fat. According to the authors of Sugar Busters!, carbohydrates, not fats, are the dietary culprits that cause weight gain.
The Sugar Busters diet recommends removing foods that have a high glycemic index from your diet. The glycemic index is the measure of the effect a carbohydrate food has on blood sugar levels. Foods with a high glycemic index include potatoes, corn, carrots, and beets. Foods with a low glycemic load include whole grain foods that are high in fiber.
The Sugar Busters diet provides menus to follow, which are about 1,200 calories a day. “If anyone follows a 1,200 calorie diet, they will lose weight,” says registered dietitian Angela Ginn-Meadow, RD, a certified diabetes educator and spokesperson for the American Dietetic Association.

Sugar Busters Diet: Sample Diet
Here is a sample day of meals following the diet’s principles for weight loss:
Breakfast
1 large orange
Hot oatmeal made with water, no added sugar or margarine
Lunch
Sandwich of turkey breast and regular Swiss cheese on rye bread with Dijon mustard,
light mayo, lettuce, and tomato
Snack
12 grapes
Dinner
Whole-wheat pasta with meat sauce made from lean ground beef
1 cup steamed yellow and green zucchini
Salad of Romaine lettuce, snow peas, and pine nuts with regular oil and vinegar dressing
1 cup sugar-free, non-fat frozen yogurt
Sugar Busters Diet: Pros and Cons
Sugar Busters stresses eating healthy foods, such as whole grains, legumes and beans, and lean meats. And cutting out refined sugars in processed foods is a plus. However, Gans believes the diet is too restrictive.
The restricted foods are tough to avoid, Ginn-Meadow adds: “A lot of the forbidden foods are common American staples such as pasta, potatoes, honey, syrup, and pineapples. It will be difficult to maintain the restrictions.”
Others concerns include:

• Eliminating foods means eliminating nutrients. Restricting any foods that contain vitamins and minerals is not beneficial, says Ginn-Meadow. You may not get enough calcium, iron, and vitamins D and E with this diet.
• It labels foods as good or bad. “Consumers need a positive message,” says Gans. “Instead of saying ‘Don’t eat this,’ or ‘Don’t eat that,’ it’s better to say something like, “Lean protein is good for you.”
• Avoiding sugar is no guarantee of avoiding diseases. “The one thing I don’t want people to think is that this diet will prevent diabetes,” says Ginn-Meadow. “The best ways to reduce your risk are through healthy eating and physical activity.”

Sugar Busters Diet: Short- and Long-Term Effects
In the short term, the Sugar Busters plan is likely to result in weight loss because it eliminates many foods, including baked goods and other sweets. And your food choices will be better, such as substituting whole grains for white bread, for instance. “There will be more fruits and vegetables and other healthier choices,” says Ginn-Meadow.
On the other hand, there are consequences to cutting out too many carbohydrates from your diet. “If you eliminate a lot of the carbs you normally eat, you won’t have energy,” says Gans. “Our brains need glucose to function. You may become irritable and tired.”
The long-term outlook is problematic because the Sugar Busters diet lacks the tools to help you make long-term lifestyle changes. “It does not talk about portion sizes or how to make weight loss a permanent lifestyle,” says Ginn-Meadow. “There is no behavioral or exercise component, both of which are necessary for long-term weight loss.” According to dietitians, the likelihood is high that you’ll gain back weight lost on the Sugar Busters diet.

The Power of Fiber

• By Anne L. Fritz

Five benefits of a high-fiber diet

Fiber has long been known to promote good digestive health and regularity, but those are only two of the many benefits fiber offers. Consider that a study published in the American Journal of Clinical Nutrition found that people who ate a high-fiber diet of oats, barley, eggplant, okra, and other vegetables lowered their cholesterol by close to 30 percent after four weeks. In addition to improving digestive health and lowering cholesterol levels, a high-fiber diet can help you reduce the risk of heart disease and diabetes, and keep your weight in check. Here's a closer look at each benefit.
Fiber and Digestion
As fiber passes through the stomach and intestines, it absorbs water, adding bulk to the stool. This promotes regularity and reduces constipation, says James Anderson, M.D., chair of the National Fiber Council. "Insoluble fiber, found in wheat bran, whole grains, and vegetables, speeds the passage of food through the stomach and intestines," he says. For more high-fiber foods, read Easy Ways to Add Fiber to Your Diet.
Fiber and Cholesterol
Fiber is undigested starch, says Dr. Anderson, and as such, it traps cholesterol and drags it out of the body through the digestive system. Soluble fiber, found in oat bran, barley, oranges, apples, carrots, and dried beans, turns into a gel during the digestive process and prevents cholesterol, fat, and sugars from being absorbed by the body.

Fiber and Heart Disease
"When it comes to heart health, the importance of fiber in your diet cannot be overstated," says Kathy Kastan, president of WomenHeart, the National Coalition for Women With Heart Disease.and the coauthor of WomenHeart's All Heart Family Cookbook.
Several studies have shown that fiber reduces the risk of heart disease. In addition to the above-mentioned cholesterol study in the American Journal of Clinical Nutrition, a study published in the Journal of the American College of Cardiology Foundation that followed 39,876 women for six years found that those who ingested an average of 26.3 grams of fiber daily were at lower risk for developing heart disease or having a heart attack than those who ate less.
Fiber and Diabetes
A high-fiber diet may lower a person's risk for diabetes. Fiber slows the absorption of sugars, which can reduce glucose levels in the blood and prevent blood sugar spikes, says Dr. Anderson. Results of a study published in the Archives of Internal Medicine suggest that whole-grain fiber (the kind found in some breakfast cereals, breads, and crackers) may be more beneficial in reducing blood sugar than fruits and vegetables.
Fiber and Weight Loss
Fiber expands in the stomach and intestines, which creates a feeling of fullness. This means that after eating a fiber-rich meal, you'll typically feel fuller longer and may eat less throughout the day. In addition, because soluble fiber turns into a gel in the stomach, it binds to sugars, cholesterol, and fats and carries them, largely unabsorbed, through the digestive tract, says Anderson.
What About Fiber and Colon Cancer?
Can a high-fiber diet help prevent colon cancer? It's still unknown. Early studies on fiber's ability to lower the risk of colon cancer were promising, and it seems logical to researchers that fiber may have protective properties against this cancer, but more recent studies have been inconclusive.
Last reviewed: September 23, 2008 | Last updated: September 23, 2008
This section created and produced exclusively by the editorial staff of EverydayHealth.com. © 2008 EverydayHealth.com; all rights reserved.

Chứng dày sừng tiết bã (Seborrheic Keratoses)

Image Source: Color Atlas of Cosmetic Dermatology Marc R. Avram, Sandy Tsao, Zeina Tannous, Mathew M. Avram Copyright 2011 by The McGraw-Hill Companies, Inc. All rights reserved.

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Chứng dày sừng da tiết bã (Seborrheic Keratoses - SK) là các khối u lành tính ở da phổ biến nhất, và SK ở người lớn là mụn cơm, tăng trưởng da dầy sừng mà lần đầu tiên có mặt sau 40 tuổi. Có đường kính từ vài mm đến centimét có thể biến đổi màu từ hồng đến màu nâu sẫm. Tổn thương có thể đơn độc hay nhiều. Theo thời gian, bệnh nhân phát triển bất cứ nơi nào từ một vài đến hàng trăm SKS. Nhiều bệnh nhân yêu cầu loại bỏ SKS, đặc biệt là khi nhiều hay lớn, vì vẻ bề ngoài khó coi của chúng.

Hình ở đây nhiều da dầy sừng tiết bã trên lưng của người cao tuổi nam.

Chứng dày sừng tiết bã

Image reprinted with permission from eMedicine.com, 2009

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Chứng dày sừng da tiết bã : Một rối loạn da lành tính do sự phát triển quá mức của các lớp tế bào trên da, thường được tìm thấy ở những người trên 30 tuổi. Họ có thể xuất hiện như chỉ là một trưởng hoặc ở dạng cụm. Chúng thường màu nâu nhưng có thể khác nhau về màu sắc và bất cứ nơi nào từ ánh sáng tan màu đen. Chúng có kích thước khác nhau, bất cứ nơi nào từ một phần nhỏ của một inch (hoặc < 1 cm) đến một inch (2,5 cm), đường kính. Các tính năng hiệu của chứng dầy sừng da tiết bã là chúng trông giống như chúng đã được dán trên da hoặc chỉ bị mắc kẹt trên đó. Họ có thể trông giống như một thoa sáp nến màu nâu ấm áp giảm trên da. Hầu như tất cả mọi người cuối cùng phát triển ít nhất một vài chứng dầy sừng da tiết bã vì chúng có xu hướng trở nên phổ biến hơn và nhiều hơn với độ tuổi. Đôi khi chúng được gọi là "hàu của tuổi già." Sự phát triển của chứng dầy sừng da tiết bã đôi khi được kích hoạt bởi khi mang thai , liệu pháp estrogen hoặc điều kiện y tế nhất định.

Chứng dầy sừng da tiết bã thường được tìm thấy trên ngực hoặc lưng nhưng có thể được tìm thấy trên da đầu, mặt, hoặc cổ hoặc bất cứ nơi nào trên cơ thể. Khi chúng lần đầu tiên xuất hiện, tăng trưởng thường bắt đầu cùng một lúc như va chạm thô nhỏ. Cuối cùng chúng dày lên và phát triển một bề mặt mụn cơm thô. Mặc dù chứng dầy sừng da tiết bã đầu tiên có thể xuất hiện ở một chỗ và dường như lây lan khác, chúng không đánh bắt. Khi con người già họ chỉ đơn giản có thể phát triển một vài chi tiết. Những tăng trưởng có thể không đẹp mắt, đặc biệt là nếu chúng bắt đầu xuất hiện trên mặt. Chúng có thể nhận được kích thích bởi quần áo cọ xát chống lại chúng. Bởi vì chúng có thể phát triển lớn hơn trong những năm qua, loại bỏ đôi khi được đề nghị đặc biệt là nếu chúng nhận được kích thích và dễ chảy máu. Một chứng dày sừng da tiết bã có thể chuyển sang màu đen và có thể khó phân biệt với một bệnh ung thư da . Đôi khi tốc độ tăng trưởng như vậy phải được loại bỏ và nghiên cứu dưới kính hiển vi để xác định xem nó là ung thư hay không.

Nô lệ, thuốc mỡ hoặc thuốc có thể không chữa trị cũng không ngăn chặn chứng dầy sừng da tiết bã. Thường xuyên nhất chứng dầy sừng da tiết bã được điều trị bằng một trong ba phương pháp:

• Đóng băng - Một phương pháp được gọi là phương pháp áp lạnh , hoặc đông lạnh. Một chất lỏng rất lạnh được gọi là nitơ lỏng được áp dụng cho sự tăng trưởng với một tăm bông hoặc súng phun để làm lạnh. Vẩy có thể hình thành dưới sự tăng trưởng khô thành một lớp vỏ như vẩy. Các chứng dày sừng thường rơi khỏi trong vòng vài tuần. Không có dấu thường còn lại, mặc dù đôi khi có thể là một điểm tối hoặc ánh sáng nhỏ. Những sẽ mờ dần theo thời gian.
• Cạo - Một phương pháp khác được gọi là nạo. Các tăng trưởng được loại bỏ bằng cách "curetting" hoặc cạo chúng từ bề mặt của da. Tiêm hoặc xịt là việc đầu tiên được sử dụng để làm tê liệt khu vực trước khi sự phát triển được loại bỏ. Không có mũi khâu là cần thiết và chảy máu rất hạn chế. Nó có thể được kiểm soát bằng cách áp dụng áp lực hay bởi các ứng dụng của một hóa chất đông máu.
• Cắt điện - cắt điện là một hình thức điều trị. Sự tăng trưởng là lần đầu tiên tê, sau đó bị đốt cháy bằng cách sử dụng một dòng điện và sau đó lấy ra.

Hình ảnh của ung thư da (skin cancer)

Just Do It or Just Duet? The Benefits of Love Partnerships in Weight Maintenance

By Everyday Health Guest Columnist

Published Feb 11, 2014

By Thomas N. Bradbury, PhD, and Benjamin R. Karney, PhD, Special to Everyday Health

If you have been in a relationship for any length of time, chances are you have said something like this to your partner: “Boy, I am not feeling great about how I look. I need to lose some weight, maybe make some changes to my diet, but I am not sure how to get started.”
And maybe you have heard something like this in response: 
“Yes, honey, I’ve noticed your clothes fitting tighter too. Glad you’re working on this!”
“Sure, I am totally OK with you getting healthier, but I’m looking fine. Do what you have to do, but leave me out of it.”
“How hard could it be? If you want to lose weight, you have to eat right and move more. Just do it!”
“Hmm, where have I heard that before? Oh right! You said the same thing last year– and the year before that!”
Talking with your partner about eating, exercise, and weight-loss can be an emotional minefield. In our lab, we have videotaped hundreds of couples having some version of exactly these conversations. In fact, when we allow couples to talk about anything at all that they want to change, 50% to 70% of them choose to discuss their desire become healthy and fit. And in those tapes we have seen partners who genuinely want to support each start to panic when they find themselves uncertain about how to proceed.
What traps couples is a fundamental misconception about what it takes to maintain a healthy weight. Diet books, gyms, and even our doctors all tell us that weight management boils down to individual choice and personal willpower. After all, our partners feed themselves and move their own bodies, so it makes sense to assume that the responsibility for healthier habits lies squarely on their shoulders and theirs alone.
As studies from several labs now demonstrate, this assumption is plainly false. If our partners are to make changes that last, they need our support. And if we have any inclination to stick with healthier habits of our own, we too need something more persuasive than the tag line from a sneaker commercial.
The fact that people in relationships routinely turn to their partners for help in this situation suggests that plenty of us already know, intuitively, that our relationship can be the key to a healthier lifestyle. But that does not mean our partners know how to respond when we ask for help in changing our diet and exercise habits, or that our partners know a sensitive way to steer us toward the vegetables and away from the desserts the next time we go out for dinner.
Fortunately, new studies yield concrete suggestions for couples who want to team up effectively around diet and exercise.

• Extensive research shows that our environment profoundly affects how much and what we eat, by making some foods more or less accessible than others. In a relationship, each partner shapes the environment for each other. So, without saying a word, there is a lot our partners can do to make the healthier choices easier, and the less healthy choices more difficult. When you look into the fridge for a snack, it makes a difference whether your partner has left you cold pizza or fruit and non-fat yogurt.

• When we express concern about our appearance or weight, our partners might be tempted to offer reassurance (“No, baby, you look terrific!”). Observational research on couples reveals that too much reassurance can lead to complacency, and does nothing to support our desires to change. What we actually need is two distinct kinds of support: yes, we want to be loved as we are, but we also want support for our efforts to be healthier. The combination of reassurance and encouragement gives us the strength and motivation we need to make better choices. The next time you feel your partner is not delivering both parts of the message, take a moment and ask for exactly the kind of support that would help you the most.

• It’s hard to stick with healthy choices when the unhealthy ones are so tempting. But experiments show that immediate temptations lose their pull when we are thinking of our long-term goals. A slice of cheesecake looks delicious and all-but-irresistible… until we offset that image with the thought of an active retirement or time spent with rambunctious grandchildren. No one is better positioned than our partners to help us keep our eyes on the long-term prize. Our shared commitment to a healthy long-term future can be, well, the icing on the cake.

We all know by now eating right and moving more are keys to maintaining a healthy weight. But we also know from soaring obesity and diabetes rates that following this formula is difficult. Our closest relationships have the power to overcome the barriers to being healthier, provided we know how to team up effectively with our partners. When we abandon the misguided view that willpower alone is enough to ensure healthy behaviors, we can recognize the opportunities within our relationships to make healthier choices a part of our everyday lives.
Thomas Bradbury and Benjamin Karney are Professors in the UCLA Department of Psychology and Co-directors of the UCLA Relationship Institute. They are the authors of Love Me Slender: How Smart Couples Team Up to Lose Weight, Exercise More, and Stay Healthy Together (Simon & Schuster, 2014).