everything Flashcards
What types of food are carcinogens?
What cancers?
Processed meat - group 1
red meat - 2A
Causes pancreatic, stomach, colorectal, prostate
Ileal digestibility of proteins
Downsides of animal
Animal 95%
Soy/Wheat 90%
Cereals/Peas 80-90%
Intact cell walls 50-80%
More sulphur containing acidic – calcium buffering - osteoporosis
Beneficial non-nutrients
Polyphenols Carotenoids Phytochemicals Antioxidants Glucosi... Phytostanols
Anti-oxidant foods
CSI Doesn’t PretEnd Any Old Original Characters Go Mad
+ Vit C, E and selenium!
Cruciferous - sulforophane, indole-3-carbinols
Dark berries and fruit - polyphenols, ellagic acid,
Alium - organosulfurs
Orange/yellwo/DG F&V - carotenoids
Dark green leafy - Metals - K/Ca/Mg
Elsewhere lycopene - tomatoes
Root cause analysis steps (3)
Ask 3-5 why’s
Ask so what
Draw fishbone diagram
Benefits of quitting smoking
- timeline
- years of life gained
Immediate - 50% risk 'heart attack' (1-9 months - less cough, better lung function) 1 year - 50% risk of heart disease 2-5 years - Stroke risk of non-smoker 10 years - 50% risk of lung ca
Quit at 30 - gain 10 years
40 - 9
50 - 6
60 - 3
Smoking stats:
Costs
Deaths
$150 billion direct/130 indirect
480000 deaths (0.5 million
1:5 deaths
Kills 50% of users
(RULE OF 5s)
83% of lung cancers
32% of cardiac disease (check)
Quitting cold turkey
Relapse at 14 days?
Relapse at 30 days?
Quitting with medical help
Relapse at 3 months
14 days 50%
(2 weeks, 1 in 2)
30 days 75%
(30 days THREE quarters)
With doctors - 40-50% at 3 months, double success rate
USPHS - 10 guidelines for smoking cessation servics
2 background
6 treatment
1 MI
1 cost
1 - Dependence is a chronic disease 2 - Assess and document it 3 - Treatment works in lots of groups 4 - Brief intervention works 5 - Telephone/group/individual counselling all works, best with social support and problem solving, dose-dependent 6 - Meds effective 7 - Tele quitline works 8 - Best is counselling and meds 9 - If not ready, motivational interviewing to help for next time 10 - Treatment is cost effective
Smoking treatment success stats
8 week study
12 week and 6 month study
In chronic disease and mental health (12week and 6 month)
8 week data Placebo 30% Bupropion 40% Patch 45% Lozenge 40% Bupropion and lozenge 50% Bupropion, patch and lozenge 54%
12 week and 6 month data
Placebo 21%/17%
Varencycline 51%/35% (most effective mono therapy)
Varencycline and bupropion 71%/58%
Bupropion and patch and 2nd NRT 62%/35%
Patch 37%/17%
Smoking cessation and special groups
Bipolar and schizophrenia - use only patch
Psych - generally need meds and longer duration
Smoking cessation off-label
Clonidine and nor-trip
Behavioural insufficient sleep syndrome
Prevalence
Risk factors
7.5-20%
RFs: Age 30-40, work hours over 40, white, rich, alcohol, stress and depression
Insomnia
Diagnosis days/duration
3 days a week, 3 months
+ daytime consequences
Restless legs - prevalence
Periodic limb movements - how often
BISS prevalence
5-15%
Every 30 seconds, over 50 years age
7.5% - 20%
Sleep and diseases
What disease?
For each, what process/mechanism?
CVD
Metabolic
Mood
Cancer
CVD - poor sleep, higher BP especially at night, sympathetic activation, less peripheral perfusion
Metabolic - raised cortisol, raised BMs, increased food seeking behaviour (study shows 5 days of 4 hours sleep, approx 300 extra calories and more sat fat)
Mood/brain - poor sleep, less REM and fear extinguishing, less memory formation, less deep sleep (restorative)
Cancer - poor sleep, less DNA repair, more cell cycle dysfunction, increased IL10 - cancer forming cytokines
- good sleep - increased Il1/2, TNFa (anticancer)
Melatonin suppression and affective disorders
Specific percentages vs control
Control 15%
Major depressive 20%
SAD 40%
Bipolar 45%
At risk drinkers are, 3 things
1) Drinking not causing harm but might in the future
2) Binge drinking 1 or more a month
3) Exceeding NIH limits
Screening for alcohol - how does the book advise?
1) How many times in the past year have you had 4 or more drinks in a day
If 1 or more then complete AUDIT-C
AUDIT-C positive scores
4 in men
3 in women
0-12 in total
5 Rs of motivational interviewing
Relevance Risks Rewards Roadblocks Repitition
Smoking cessation considerations
Weight gain - how much?
What is a light smoker?
What meds are cat C/D in pregnancy?
Weight - 10lbs or 4.5kg
Light smokers are <10 a day, NRT no evidence it helps
Pregnancy:
Bupropion and varencycline - category C - animal studies show harm, but use in people MAY be beneficial
Prescribed NRT - category D - Evidence of foetal changes in humans, but MAY be beneficial overall
OTC NRT - no harm proven, limited studies
Nutrition prescription for hypertension
Reduce…
Increase…
Other LM considerations?
Key paper?
Reduce: Saturated fats, trans fats Salt (50% of people respond) ETOH - J shaped curve Caffeine Smoking
Increase:
Potassium, calcium and magnesium
Garlic (possible reductions of 5.1/2.5mmHg)
Also manage stress and physical activity
DASH - NHLBI
- Lots of fruit and veg, whole grain, fat free dairy, fish, poultry, limit sat fat and palm oils, limit sugar
The book also mentions water fasting causing dramatic effects in under 2 weeks - this is obvious and also an absolutely pointless statement
The DASH DIET
Year/Study group
Patients Intervention Control Outcome Time
1997, NIH, NEJM
P:
459 with SBP <160 and DBP 80-95mmHg
I:
3 weeks of control diet - low in F&V, low in dairy, fat typical of US
Then randomly put into one of 3 groups for 8 weeks:
1) Control diet continued
2) High fruit and beg
3) Combination diet - fruit and beg, low-fat dairy, reduced sat and total fat
(sodium and body weight maintained constant)
Outcome:
Combo diet - 5.5/3 reduction overall, in those with HTN then 11.4/5.5 reduction
F&V diet - 2.8/1.1
LookAHEAD trial
Remission of diabetes on a relatively minor intervention.
1200-1800 calories a day, 175minutes physical activity
VS
Diabetes support and education
Overall 11% had total or partial remission at 1 year, 7% at 2 years vs around 2%
This was sustained for 2/3/4 years in 9/6.5/3.5% respectively
LookAHEAD
DM2 remission at:
1 year
4 years
Sustained for:
2 years
3 years
4 years
1 year - 11%
4 years - 7.3%
2/3/4 - 9%,6.5%,3.5%
Shortfall nutrients
What are they?
Vitamins: A,C,D,E,K
Minerals:
Ca2+, K+, Mg2+
Folate and Folate
Sugar targets:
WHO
AHA
US average
WHO:
10% cals ok, 5% better, 0% best
AHA:
Men - 36g, 150cals, 9tsp
Women/children - 24g, 100cals, 6tsp
US av:
13tsp, 52g, 13% of calories
Blue zone project - an example of health advocacy
9 factors these places have in common
5 places with longevity used as examples of healthy communities
1) Family first
2) Right tribe to do life with
3) Stop when 80% full
4) Whole food/plant based
5) Live as part of something greater
6) Have a sense of purpose
7) Physically active
8) Down shift
9) Relax
3 examples of health advocacy
1) Dean Ornish - advocated for medicare/medicaid for lifestyle medicine for CVD
2) Robert Wood Johnson Foundation - ‘Creating a culture for health’ - Chicago community zones project
3) Blue zones project - transforming cities through healthy community systems, based on 5 places with longevity
What is ‘Creating a Culture for Helath’
It is a Robert Wood Johnson foundation health advocacy program.
Communities showcase their healthy lifestyle interventions
What is ‘Prescription for Health’?
Who’s programme is it?
What did it look at?
What are the outcomes?
6 year study by Robert Wood Johnson Foundation (also did ‘creating a culture for health’) and AHRQ
Looked at: Physical inactivity Smoking Alcohol Diet
22 primary care practices trialled different methods of addressing these behaviours.
4 outcomes:
1) Primary care is able to address these behaviours
2) Significant redesign is required, creating a ‘patient centred medical home’
3) A ‘Toolkit’ was produced, but is no longer in use
4) Now the ePSS is available from the AHRQ
Prescription for health - which 4 behaviours?
Physical activity
ETOH
Smoking
Diet
The interdisciplinary team:
Weight loss evidence?
What broad outcomes are better?
Weight loss is greater with doctor and dietician, vs dietician or doctor
IDT improves:
1) Compliance/Adherence
2) Health Outcomes
3) chronic disease self-Management
4) Patient Engagement
and weight loss as above (12lbs vs 3 lbs)
CHOMPED weight loss
Or AHEM (adherence, health outcomes, engagement, self-Management)
What makes a good IDT?
10 factors
1) Leadership
2) Clear vision
3) Good resources
4) Skill mix
5) Personal development and rewards
6) Characters that like team working
7) Communication
8) Supportive
9) Good quality of care
10) Respect and understanding of each other’s roles
Examples of IDT programmes
Ornish spectrum
Medical fitness collaboration
Poor sleep leads to what cardiovascular outcomes?
More MIs, mortality and vasospastic disorders
A requiem for palliative cardiology
A broad overview…?
24 patients
WFPB, very low fat, no oil, LF dairy
18 adherent, 6 not adherent
No evidence of any progression, and no events at 12 years for adherent (who had 49 events in 8 years before trial).
Non-adherent had 13 events
Esselstyn at 3.7 years
Very low fat, no oil, WFPB, low fat dairy
177 adherent - 0.6% cardiac event rate
Nonadherent 21 - 62% rate
PCI vs exercise in stable CAD
Hambrecht (you use your hamstrings and breaks in cycling)
Men with stable CAD, cycled 20+ minutes
At 12 months:
1) 88% vs 70% event free survival
2) Higher VO2 max - 16% increase (relative) from 22.6 to 26.2 (notice the 6s)
3) To gain one canadian CV class costs $3429 vs 6956
