JustCare

Tag: Nutrition

  • Medicare covers diabetes prevention program

    Medicare covers diabetes prevention program

    More than 29 million Americans, including almost 12 million older adults, have type 2 diabetes. That’s almost 10 percent of adults in the United States and more than 25 percent of adults over 65. Diabetes is the seventh leading cause of death in the nation. The Centers for Medicare and Medicaid Services has approved Medicare coverage of a proven diabetes prevention program. The benefit is designed to help educate people on best practices for avoiding type 2 diabetes.

    More than one in three people with Medicare–23 million–have pre-diabetes, according to the Centers for Disease Control (CDC). Most people are unaware they are pre-diabetic, putting them at higher risk of diabetes, heart disease and stroke. They have high blood-sugar levels. More than seven million of them are projected to develop diabetes in the next five years without changes in their levels of activity and eating habits. Moreover, diabetes can cause blindness, amputation and kidney disease.

    Through behavior modification, diabetes can be prevented or delayed. Medicare’s diabetes prevention program relies on trained coaches to help adults likely to be diagnosed with type 2 diabetes with lifestyle modifications. The program focuses on exercise and healthy eating as well as behavior changes to help people lose weight. Medicare offers it for free as a one-time benefit for eligible individuals.

    All people with pre-diabetes blood-sugar levels are eligible for this Medicare benefit, so long as they have never been diagnosed with diabetes. You must also have a body-mass index of 25 or higher, or 23 or higher if you are Asian.

    The diabetes prevention program benefit involves 16 intensive small group sessions over six months. It also involves up to twice monthly meetings for another six months to help ensure maintenance of healthy behaviors. During this time, you must track your weight and keep a record of what you eat and your physical activity.  The program aims to help participants get at least two and a half hours of exercise each week and to lose five percent of their body weight. For participants who meet the weight-loss goal and attend classes, Medicare pays for a second year of classes to reinforce key principles.

    The CDC rolled out the program four years ago, and it is now offered by several hundred organizations throughout the country, including some YMCAs and senior centers. A study of the diabetes prevention program showed that it reduced the odds of adults getting diabetes by 58 percent. And, it reduced the odds of adults over 60 getting diabetes by 71 percent.

    To date, tens of thousands of Americans have participated in the program, just a small percentage of the millions who could benefit. The cost of $400-$500 a participant is prohibitive for many.

    Now that Medicare covers the cost for people with traditional Medicare and Medicare Advantage plans, the hope is that millions more will participate. Medicare should save money on everyone who enrolls. The health care savings for each enrollee who avoids getting diabetes is projected to be $7,300. Medicare also covers diabetes screening tests, self-management training (DSMT), medical nutrition therapy (MNT), glaucoma screening and diabetic supplies.

    Note: Because community groups are new Medicare contractors, it may take a little time for a program to be available in your community.

    Here’s more from Just Care:

    Take this risk test to see if you have pre-diabetes.

  • Get the preventive care you need: Medicare pays for it

    Get the preventive care you need: Medicare pays for it

    Preventive care is very important, especially as you age.  As you get older, vision, hearing and balance should be checked annually. And, you should get a flu shot every year as well.  Fortunately, Medicare now pays for many of these services in full, as well as an annual wellness visit.  Medicare covers some tests annually and others every few years.

    Cost:  Medicare covers the full cost of many, but not all, preventive services.  If you have traditional Medicare, for full coverage, you will need to see a doctor who takes assignment, a “participating provider,” who accepts Medicare’s approved rate as payment in full.  Fortunately, the vast majority of doctors accept assignment.  If the doctor finds a problem and needs to do more tests, you may have to pay a deductible or coinsurance for those services.  If you are in a Medicare Advantage plan, for full coverage, you will need to see an in-network doctor.

    Medicare covers 100 percent of the cost of the following services:

    Medicare covers 80 percent of the cost of the following services:

    • glaucoma, trainings for diabetes self-management,
    • barium enemas to detect colon cancer, and
    • digital rectal exams to detect prostate cancer.

    Keep in mind that health care screenings can have risks. Screenings may turn up issues that warrant addressing; they also may turn up issues that would be best left alone. If the screening results turn up something out of the ordinary, doctors often do not know whether there is a problem that should lead to more tests or a surgery. For example, a breast screening may reveal a possible tumor, but the tumor may be best left untouched because it will never grow large or present a health risk. It should not be removed. The risk to you can come from removing a tumor that does not present a health risk. Surgery involves its own set of risks, including bacterial infections. The US Preventive Services Task Force, an independent panel of experts in primary care and prevention, recommends certain preventive care services, and it does not recommend others, based on the evidence of effectiveness.

    Here’s more from Just Care:

  • To curb obesity, Chile makes it harder to buy junk food—psychologically, financially and practically

    To curb obesity, Chile makes it harder to buy junk food—psychologically, financially and practically

    To curb obesity, in 2016 Chile made it harder to buy junk food—psychologically, financially and practically, reports Andrew Jacobs for The New York Times. Chile has restricted advertising for some high-calorie foods targeted at kids, forced manufacturers to add warning labels to their junk food products, and imposed taxes on unhealthy foods.

    The Chilean government’s laws are designed to promote better health and longer life by reducing the prevalence of obesity in the country. To reduce the appeal of unhealthy kids’ foods, Chile has banned Kellogg’s Tony the Tiger, Cheetos’ Chester Cheetah and Kinder Surprise. In addition, ice cream, soda and potato chips are not allowed to be sold in schools.

    Moreover, manufacturers cannot advertise their unhealthy foods on television shows or websites aimed at young people. And, beginning in 2019, ads will not be allowed at all on television, on radio or in movie theaters between six a.m. and ten p.m.

    The Chilean government also wants to encourage pregnant women to breastfeed their kids. So, it is banning advertising of infant formula beginning this year.

    Plenty of unhealthy food is still available for sale in Chile, but there may be as much as an 18 percent tax tacked onto the price. The tax on Coca Cola is 18 percent. On top of the tax, manufacturers of foods high in salt, sugar, calories or saturated fat must show a big black stop sign on their packaging.

    What’s most reassuring is that Chile was able to pass legislation of this kind notwithstanding the enormous opposition from the food and soda industries. That said, the biggest companies are suing the Chilean government, claiming that it is “infringing on their intellectual property.” The question is whether Chile will prevail and whether the U.S. and other countries will follow in its footsteps.

    It’s not likely that the Trump administration will be regulating the sale of junk food, even though evidence suggests that even a small tax can make a big difference in promoting the public health. People with Medicare who are looking for help losing weight should take advantage of Medicare’s weight-loss counseling benefit as well as its nutrition-counseling benefit.

    Virtually every country in the world is seeing their populations become increasingly obese. The World Health Organization reports that the prevalence of obesity has increased three-fold since 1975. Today, about 13 percent of the world’s adult population (650 million) is obese. Obesity increases the likelihood of  premature death. No other country has taken as comprehensive measures as Chile.

    Here’s more from Just Care:

  • Are you eating too much junk food?

    Are you eating too much junk food?

    Julia Belluz reports for Vox that it might be time for the government to step in, tax junk food, and help address the obesity epidemic in the United States. A tax on unhealthy and high-calorie food might deter people from eating too much junk food and encourage them instead to eat a healthy balanced diet. Some experts even recommend avoiding nutritional supplements like Ensure and Boost, because of their high sugar, low-protein content, and eating Greek yogurt and other protein and calorie-rich foods instead.

    The value of a tax on sugary drinks and other junk food seems pretty clear. The tax increases the cost of junk food, which not only keeps people from buying junk food, it raises money for health promotion. And, it may sway companies to manufacture less junk food and more healthy food. Finally, the tax helps educate people more about the health risks of junk food.

    A federal tax on junk food would be similar to a federal tax on cigarettes or alcoholic drinks. And, the US already has both federal and state taxes on cigarettes to deter Americans from smoking. Since 2009, the federal tax alone is $1.01 a pack. While there is no federal tax on alcoholic drinks, most states impose a tax on beer, wine and spirits. In addition, in the last several years eight cities in the US have imposed a tax on soft drinks.

    Berkeley, California’s one cent tax per ounce on soda, energy drinks, sports drinks and sweetened ice teas was shown to decrease soda consumption by 26 percent. A separate study showed that, after the tax was imposed, sales of sugary drinks declined and sales of healthier drinks increased with no overall increase in grocery bills.

    The United States could benefit from a federal excise tax on unhealthy drinks and snacks with no nutritional value. Both the United Kingdom and Mexico have enacted a soft drink tax. The data suggests that the tax is working in those countries to reduce purchases of sugary drinks.

    Jennifer Pomeranz and others report in the American Journal for Public Health that making junk food more costly would promote public health. The US could tax chocolate and other processed snack foods that are “non-essential.” They propose imposing an excise tax on the companies that manufacture non-essential foods, driving up the price of those foods.

    According to the Centers for Disease Control, more than one in three children between the ages of two and 19 in America eat junk food each day. Adults eat less junk food than children; about 10 percent of their caloric intake. But, hospitals and nursing homes often feed older people sugary drinks, nutritional supplements, which arguably should be avoided.

    Dr. Dave Lieberman writes in the New York Times that sugary nutritional supplements should not be what the doctor orders, even for older people who need to increase their calorie intake. He says that Boost and Ensure, two of the biggest selling nutritional supplements, have water and corn syrup as their two primary ingredients and very little protein content. These ingredients can promote diabetes, heart disease and fatty liver disease. He recommends full fat Greek yogurt, which is high in calories and high in protein and is also a probiotic. Almond and soy-based drinks are also recommended.

    Here’s more from Just Care:

  • Beware of medical advice from the mainstream media

    Beware of medical advice from the mainstream media

    Kevin Lomangino of Health News Review explains how you and the rest of America may end up duped by medical advice from the mainstream media. Even the medical correspondents in the big media outlets are often not delivering evidence-based advice. And, while they may be spinning an interesting story based on a study of one sort or another, question what you learn before taking action.

    Medical studies abound to support the value of all kinds of treatments. And, it seems worthwhile to let people know when a study shows that a treatment works. What’s the downside, especially when the treatment sounds benign. Unfortunately, if the sample of people studied is small, the length of the study is short, or the design of the study is flawed, the value of the study is questionable. And, in some cases, the proposed treatment may have harmful side effects.

    At Just Care, where possible, before reporting on a study, in addition to speaking with medical experts, we check with Cochrane, an independent non-profit that does meta-studies, before we offer health advice. Cochrane’s meta-studies dig deep into as much of the research as possible to determine whether a particular finding can be trusted; and, if so, to what degree. But, Cochrane does not always have an answer, so what to do?

    If the proposed treatment is based on independent peer-reviewed evidence and there is no harm in trying it–such as “exercise” or “eat green leafy vegetables”–there are likely only benefits to trying it. And, Just Care might write about it as we did with one study on exercise and memory. It could be another reason to take a brisk walk or eat a Mediterranean diet or not eat foods with processed sugar.

    But, if the proposed treatment is any type of supplement or complementary medicine, it is potentially unsafe. And, you should likely avoid it. You certainly should not take it without first consulting with your doctor. Much like new drugs and medical devices approved by the FDA, the treatment may not be worth the risks, as less in known about it.

    Health News Review reports, for example, that ABC News’ Good Morning America’s medical correspondent advised viewers to take “complementary natural” remedies for the flu without any compelling evidence that they work. Without evidence on benefits and toxicities, the ABC News medical correspondent has no business recommending to viewers a cocktail of supplements to treat the flu and how to take them. The medical correspondent even acknowledges that there is no evidence that these “remedies” work and no data on their toxicity. What is she and ABC’s Good Morning America thinking?

    Similarly, Sharon Begley at StatNews writes about a rash of media reports on the value of aerobics and other exercise to help the brain. But, as Begley explains, experts disagree on the value of the studies underlying these reports. Even when advice is evidence-based, there is generally more to the story.

    The American College of Neurology recently began recommending aerobics to patients with mild cognitive impairments as a way to help their memory, thinking and judgment and to prevent dementia as they age. And, there is evidence to support this recommendation. But, the National Academy of Sciences (NAS) has completed a meta-study of 262 studies, and it did not find a link between exercise and dementia prevention.

    Interestingly, the studies showing a link between exercise and dementia prevention were randomized-controlled studies that were peer-reviewed. But, the NAS found that many of them were flawed in one way or another.

    Of course, lots of us want to learn about ways to stave off the flu, forestall dementia and live longer healthier lives. So, we are sure to continue to read and hear about new findings as to what we can do. If the recommendations are exercise and good nutrition, following them will most likely help you. But before buying and taking a pill, an oil or some complementary medicine remedy, look deeper into the research and talk to your doctor.

    Here’s more from Just Care:

  • Eating green leafy vegetables could help your memory

    Eating green leafy vegetables could help your memory

    A new cognitive study in Neurology suggests that people who eat green leafy vegetables on a daily basis are more likely to hold onto their memory than people who do not. The observational study, which does not show cause and effect, supports the value of the Mediterranean diet on memory and overall mental ability.

    The study followed almost 1,000 people between the ages of 58 and 99 over an average of just under five years. Participants completed two or more cognitive assessments during this timeframe.

    Researchers observed that the people who ate one or two portions of leafy vegetables, such as kale, spinach, collard greens and lettuce, each day had significantly better memory, spacial ability and perceptual speed than those who ate little or none of these leafy vegetables. Specifically, those eating about 1.3 portions of leafy greens on a daily basis had a mental ability 11 years younger in age than those who  did not.

    It appears that leafy greens’ nutrients, including vitamin K, nitrate, folate, beta carotene, phylloquinone, lutein, α-tocopherol, and kaempferol may be responsible in some significant way for preserving people’s mental health. But, beware. It’s not simply about the nutrients in the leafy greens. It’s about their formulation in the leafy greens.

    Nicholas Bakalar reports for The New York Times that there is no evidence that these nutrients in supplements offer the same benefits as they do in leafy greens or any benefits at all. The study’s lead author says that you cannot convert the nutrients’ formulation in a leafy green into a pill.

    What to make of this study? It’s hard to say since it is purely observational on a relatively small sample. But, why not eat more leafy greens? Unlike supplements which carry substantial risks of harm, eating more lettuce and kale appears to be smart nutrition.

    Here’s more from Just Care:

  • Eat less, live longer

    Eat less, live longer

    Over the last 30 years, the risk of chronic conditions in people 55-64 has declined. Researchers now believe that we can improve quality of life and live longer, if we eat less.

    While studies have not been done on humans, studies on rats, mice and monkeys show that reducing their daily calorie intake by 30 percent–while ensuring good nutrition–improves their health and extends their lives.

    According to the BBC, even in Ancient Greece, eating less was considered best for one’s health. Plain and simple, slim Greeks lived longer than obese Greeks.

    Two major studies on calorie intake of rhesus monkeys show that a 30 percent lower calorie intake means longer life and better health. Their risk of cancer and heart disease was cut in half.  And, none of them developed diabetes. Moreover, almost four in ten (37 percent) monkeys who did not reduce calorie intake died of age-related causes in 20 years; fewer than one in eight (13 percent) monkeys with reduced calorie intake died in 20 years.

    And, while we are not rhesus monkeys, our DNA is 93 percent identical. We also age in a similar way, with skin and muscles that typically sag, and hair that generally thins and goes grey. Like people, rhesus monkeys are also prone to diabetes, heart disease and cancer as they age.

    Stat reports that a professor at USC, Valter Longo, is selling diet boxes based on the theory that fasting and eating less will improve our health and extends our lives, as it has been shown to do in mice and other lab animals. Longo suggests that fasting allows us to turn off cells that are otherwise active if we’re always eating. In the process, fasting strengthens the cells so they can burn more fat.

    Here’s more from Just Care:

  • To lose weight, try eating dinner at lunch

    To lose weight, try eating dinner at lunch

    A 2016 article in the American Journal of Clinical Nutrition reports on results of a randomized clinical trial of healthy overweight women enrolled in a weight-loss program. The trial found that eating a large meal midday and a light meal in the evening helped them lose more weight. What you eat matters, of course; but to lose weight, try eating dinner, your bigger meal, at lunch.

    The researchers studied 69 participants taking part in a comprehensive diet plan over a 12-week period, with about half eating a large meal at dinner and a light meal at lunch and the other half eating a large meal at lunch and a light meal at dinner. The group that ate their large meal at lunch lost significantly more weight than the group that ate their large meal at dinner. The researchers concluded that people who have “higher energy intake”–consume more calories–for lunch than at dinner may see beneficial effects in terms of weight loss.

    The data from an earlier study show that eating more calories at lunch than at dinner is associated with reduced risk of becoming overweight. Relatedly, eating fewer calories at dinner is associated with greater risk of becoming overweight. Another study shows that skipping breakfast could also help you lose weight.

    In addition to how much you eat at different times of the day, what you eat also can affect your metabolism and your weight. Good nutrition is important, with many studies making the case for a Mediterranean diet. How often you eat also can affect your weight.

    Here’s more from Just Care:

  • Video: 93-year old marine corps vet jogs daily

    Video: 93-year old marine corps vet jogs daily

    Watch this 93-year old marine corps vet–a purple heart recipient–jog around the gym, which has become his second home. What’s Bud Sargent’s secret? Having a bunch of buddies, exercise, nutrition and an ability not to worry.

    Bud enjoys getting out and spending time with people. He works out at the gym three days a week, and he actively engages with the people around him. Everybody seems to know him. He eats  no sugar. And, he doesn’t let stress get the better of him.

     

  • How to lower your blood pressure: DASH

    How to lower your blood pressure: DASH

    The Centers for Disease Control offers advice on how to lower your blood pressure to avoid hypertension. DASH, the dietary approach to stop hypertension (high blood pressure), is an eating program that’s easy to implement. The goal is to consume no more than 1,500 milligrams of sodium a day.

    The highest acceptable level of sodium consumption is 2,300 milligrams a day. High sodium consumption generally leads to high blood pressure, an all too common condition among Americans. High blood pressure forces the heart to work harder than it should, often leading to heart disease and stroke.

    One in three adults in the U.S. –65 million people–have high blood pressure. And, even if your blood pressure is normal at 55, you have a 90 percent chance of developing high blood pressure as you age.

    Too many Americans have hearts that are many years older than they are, on average seven years older! Hearts age quickly for people who are overweight as well as for people who smoke and do not exercise. You can find out the age of your heart through this Just Care post: How young is your heart?

    To keep your blood pressure down, what should you do?

    And, here’s how you can check your blood pressure at home.

    Here’s more from Just Care: