December 7th, 2008 by Dr. Val Jones in Audio, Expert Interviews
Tags: 2008 National Health Leadership Patient Safety Leadership Award, Detroit, Dr. Val Jones, Healthcare Quality, Henry Ford, Henry Ford Health System, Hospital, Nancy Schlichting, National Press Club, Quality
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Nancy Schlichting
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“Detroit is the poorest city in America. But we’re not going to be victims of circumstance. We’re going to rise up and lead the country in healthcare quality and become part of the economic solution for our community. The Henry Ford hospital name must mean something when people drive up to it.”
– Nancy Schlichting, President and CEO, The Henry Ford Health System, Detroit, Michigan
I sheepishly admit to being surprised that a hospital system in Detroit was singled out for a national award for hospital quality and safety. Who would think that the poorest city in America could be a beacon of light in these dark times in healthcare? The story of Henry Ford Health System, and its female president and CEO, Nancy Schlichting, is both inspirational and motivational. I had the chance to interview Nancy at a recent award ceremony at the National Press Club where she received the 2008 National Health System Patient Safety Leadership Award.
You may enjoy our conversation via podcast, but please forgive the “tinny” sound quality. I recorded our conversation with a little hand-held digital device instead of my usual recorded phone line.
[Audio:http://blog.getbetterhealth.com/wp-content/uploads/2008/12/nancyschlichting.mp3]
Dr. Val: Congratulations on winning the National Health System Patient Safety Leadership Award. Has improving patient safety at your hospital been a challenge?
Schlichting: On a given day, a patient may encounter up to 50 different hospital employees. Coordinating our efforts so that the patient’s experience is consistently positive and error-free is certainly challenging.
We have 7 pillars of performance at Henry Ford, and the first is “people.” We like to say that we “have to take care of the people who are taking care of people.” We need to make sure that they have the resources they need, that the processes are in place so they can do their jobs well, and that they get their individual needs met. For example, everyone knows my email address and they can contact me at any time if they’re not getting their problems resolved. I respond to every single email. This creates a culture of openness and responsibility. They know that the person at the top cares about them.
Dr. Val: A prominent community member experienced an unfortunate lapse in communication during his hospital stay, which resulted in compromise of his care, and he eventually died in the hospital. You personally met with his wife and promised her that you’d take the necessary steps to ensure that this never happened again. Tell me more about that.
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November 27th, 2008 by Dr. Val Jones in Expert Interviews
Tags: Chronic Disease, Dairy Science Forum, Diet, Dr. David McCarron, Dr. Val Jones, Food and Nutrition, High Blood Pressure, Hypertension, Lowering blood pressure naturally, Milk, Nephrology, The DASH Diet
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Happy Thanksgiving everyone – I thought I’d blog about food today, and to try to persuade you to trade that pumpkin pie for a glass of milk…
I learned some interesting things at the Dairy Science Forum on November 13th in DC. Dr. David McCarron presented some compelling data on the effects of the DASH diet on reducing blood pressure. The DASH diet is fairly high in dairy products (2-4 servings/day), fruits, and vegetables. In comparison with a low-salt diet (which reduces systolic blood pressure by an average of 1 point), the DASH diet can cause an average reduction in systolic blood pressure of ten points. If you have high blood pressure (and your kidneys are functioning normally) you probably shouldn’t worry all that much about the salt. It’s more important to stick with the DASH diet.
I interviewed Dr. McCarron about the role of dairy in blood pressure management. Here’s what he had to say:
Dr. Val: If salt isn’t the real enemy, and dairy can help to reduce blood pressure, why isn’t that message getting out?
Dr. McCarron: We have national nutrition policies in place that are old and out of date. The healthy eating paradigm – low fat, low sugar, low salt – was established 40+ years ago and when new evidence is obtained, it’s really hard to crack through that illusion of knowledge. There is excessive mistrust of new data because of the attitude that if it conflicts with our previous beliefs, it can’t be true. I believe that the Internet will be critical in allowing the evidence to bubble up. For example, a diet rich in dairy food is absolutely associated with a reduction in virtually all chronic medical conditions. We have data to support this for people of all ethnicities and from around the world. I think that consumers are looking for clarity and simplicity in their nutritional advice – and basically they need to know that a healthy diet requires 3-4 servings of dairy and 5-6 servings of fruits and vegetables/day. If you do that alone (along with regular exercise) you’ll be amazed by the results.
Dr. Val: What is the proposed mechanism by which dairy has all these positive effects?
Dr. McCarron: It’s almost impossible to nail down specific mechanisms because milk products contain so many ingredients (electrolytes, key vitamins, bioactive proteins, and essential fatty acids). Trying to understand which piece is impacting very complicated physiological control mechanisms within the body (that have 30-40 different vectors feeding into them) is extremely difficult. In fact, the permeatations make it almost impossible. We can’t come up with the proof that we do for drugs (which contain only one bioactive ingredient). What we do know, though, is that dairy is a vital component for chronic disease reduction and prevention. Unfortunately the policy people say, “you haven’t explained to me how this works, so I’m not going to consider it.”
Dr. Val: But what about the research suggesting that whey protein contains lactokinins that function similarly to ACE inhibitors (a type of blood pressure medicine)?
Dr. McCarron: That’s been known for over a decade. There’s no question that there are small peptides (proteins) in milk that have a positive impact on blood pressure, mood disorders, and weight reduction. The industry doesn’t want to talk about it because it makes milk sound like a drug, which isn’t effective marketing. Also the average consumer doesn’t have enough background to understand what that means (lactokinins have ACE inhibitor-like effects in vivo), so we need to simplify the message and disseminate it via the Internet.
References:
NEJM, 1998 Effects of Dietary Patterns On Blood Pressure
Am J Hyper, 2004 McCarron and Heaney
JAMA, 2002 Pereria et al
Science, 1984, McCarron et al
JAMA, 1996, Bucher et al
November 25th, 2008 by Dr. Val Jones in Audio, Expert Interviews
Tags: Dangers, Dr. Brian Fennerty, Dr. Val Jones, Fecal Transplant, Fecal Transplantation, Gastroenterology, Grey's Anatomy, Intestinal Flora, Podcast, Probiotics, Unhealthy
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Photo Credit: authenticmaya.com
The blogosphere has been buzzing lately about the idea of “fecal transplants,” probably because this treatment (first studied in the 80’s) was recently mentioned on Grey’s Anatomy. Proponents of the therapy (which involves the introduction of donor stool into a patient via enema or naso-gastric tube) say that it can rejuvenate intestinal flora and cure c. diff colitis, and various inflammatory bowel disorders. I had my doubts about these claims and decided to interview gastroenterologist Dr. Brian Fennerty to get to the bottom (sorry abou the bad pun) of this issue.
Dr. Fennerty is a Professor of Medicine in the Division of Gastroenterology at Oregon Health & Science University in Portland, Oregon, where he also serves as Section Chief of Gastroenterology.
Listen to the podcast here:
[Audio:http://blog.getbetterhealth.com/wp-content/uploads/2008/11/brianfennertyfecallq.mp3]
Dr. Val: What exactly is a “fecal transplant?”
Dr. Fennerty: First, by way of background, you need to understand that the GI tract is populated with thousands of varieties of “good” bacteria that are essential for our health. If we didn’t have bacteria in our colon and small intestine, we would die. Fecal transplantation is the repopulation of a person’s gut bacteria (flora) with fecal matter from somebody else. Some argue that this helps to treat certain diseases.
Dr. Val: How is this procedure performed?
Dr. Fennerty: As it was originally described, fecal transplantation involved removing the undigested food particles from the stool sample of a “healthy” person, and then spinning it so that a pellet (of hundreds of thousands of species and quasi-species of bacteria) remains. The pellet is then introduced to the patient through a nasogastric tube into the small intestine, or the pellet can be resuspended in liquid and introduced into the rectum via an enema. The idea is that the bacteria will colonize the patient’s colon and squeeze out the bad bacteria that are in there.
Dr. Val: What are fecal transplants purported to do?
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November 15th, 2008 by Dr. Val Jones in Expert Interviews
Tags: Anti-Oxidants, Blood Pressure, Dairy, Dairy Science Forum, DASH diet, Diet, Dr. Val Jones, Finance, Food and Nutrition, Low Carb, Low Fat, Low Sugar, Lowers, Nancy Rodriguez, National Dairy Council, Partnership To Fight Chronic Disease, Protein, Protein Science, RDA
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It is estimated that 75% of our healthcare dollars are spent on chronic disease management, and that 80% of chronic diseases could be avoided with diet and lifestyle interventions. This means that the best way to decrease the size of our healthcare budget is to decrease the size of our collective waistlines. And that’s no small task.
Going back to basics – healthy eating and regular exercise – is such a simple message. But what is healthy eating exactly? Consumers are fairly exhausted by the complex messages they’ve heard about food and nutrition over the past couple of decades. One minute anti-oxidant foods are a miracle cure for everything from cancer to facial wrinkles, the next, it seems that they actually increase the risk of death. Diet advice ranging from low fat, low carb, to low sugar have all been promoted as the healthiest way to lose weight. But what does the evidence actually show? I decided to interview a series of experts to try to glean what I could about the state of nutrition knowledge. Today’s post is about protein – and I interviewed Nancy Rodriguez, PhD, a “protein scientist” to weigh in on this nutrient.
Dr. Val: We don’t talk about dietary protein needs that much, Nancy. Why is that?
Dr. Rodriguez: In the United States most people do get at least the minimum required amount of protein/day. The RDA (recommended daily allowance) of 0.8g/Kg of body weight is the amount you need to consume to avoid an outright protein deficiency. That’s about 3 ounces of chicken, fish, or meat/day – the size of a deck of cards. But the real benefits of protein include appetite suppression, and thermogenesis. Studies show that if people eat a little bit of protein with each meal, they’re less likely to become hungry between meals or consume as many calories overall. You also end up burning a few calories in the process of digesting protein.
Dr. Val: So what is the appropriate amount of protein intake?
Dr. Rodriguez: I have found that 1.2-1.5g/Kg may be optimal for hunger management. That means we should try to get a little bit of protein with each meal. Weight maintenance and loss is much easier to achieve if you don’t feel hungry all the time. Protein can really help with that.
Dr. Val: Is it possible to eat too much protein? Can it damage the kidneys in excess?
Dr. Rodriguez: I’ve conducted a few studies with participants eating 3g/kg of protein. That’s really hard to do. For example, you have to eat eggs and bacon for breakfast, 2 chicken breasts and veggies for lunch, and a 10oz steak for dinner. This is clearly in excess of what we need, though it’s hard to say if that level of protein is harmful. If someone has kidney disease, then obviously it would be a really bad idea to tax the kidneys with removing so many protein break down products. But people with normal kidney function didn’t seem to have a problem clearing the protein. Protein isn’t stored. When you consume more of it than your body needs, it is simply broken down and removed via the urine.
I personally don’t believe that excess protein causes kidney disease, but it can be a problem for those who have kidney disease. We would have to do some very long term studies of people eating very high protein diets for decades to find out if they end up with a higher risk of kidney disease. We just don’t know yet. But our kidneys have a tremendous reserve capacity to filter the blood. We can easily live with just one kidney – so it’s possible that healthy kidneys can handle high protein diets without injury. One thing that I certainly recommend – if you eat a lot of protein, you should drink a lot of water to help to flush out the break down products.
Dr. Val: Is it true that whey protein may help to reduce high blood pressure?
Dr. Rodriguez: Milk proteins are very interesting in that they contain a broad array of bioactive substances. There is increasing evidence that lactokinins can reduce blood pressure, but we just don’t understand the exact mechanism yet. We do know that people who eat more dairy products (included in the DASH diet plan) can lower their systolic blood pressure by an average of 10 mmHg.
Whey protein is also a natural appetite suppressant, so it can be helpful part of a weight loss strategy. Dairy sources of protein are an important part of a healthy diet.
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I caught up with Nancy at the Dairy Science Forum on November 13th, 2008 in Washington, DC.
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Nancy Rodriguez
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Nancy Rodriguez, PhD, RD, CSSD, FACSM, is a professor of Nutritional Sciences in the College of Agriculture and Natural Resources (CANR) at the University of Connecticut, with joint appointments in the Departments of Kinesiology and Allied Health Sciences. She is director of Sports Nutrition in the Department of Sports Medicine in the Division of Athletics.
November 12th, 2008 by Dr. Val Jones in Audio, Expert Interviews
Tags: ADA, Corn Syrup, Dr. Val Jones, Evidence Based Nutrition, Fat Burning, Fish Oil, Food and Nutrition, Magic, Nutrition, Omega-3 Fatty Acids, Penny Kris-Etherton, Podcast, Supplements, Weight Loss
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Penny Kris-Etherton, Ph.D., R.D., Distinguished Professor of Nutrition (Department of Nutritional Sciences, Penn State University) about what she learned at the American Dietetic Association Food & Nutrition Conference & Expo in Chicago.
Please listen to the podcast here: [audio:http://blog.getbetterhealth.com/wp-content/uploads/2008/11/pennykrisetherton.mp3]
Penny’s take home messages:
1. Corn is not evil. The vegetable itself can be quite nutritious, though high fructose corn syrup is an empty calorie food additive.
2. There is no magic food that will melt your fat away.
3. There is no magic pill that will help you lose weight. You must decrease your calorie intake and increase your exercise.
4. Increasing protein a little bit can increase satiety.
5. Omega-3 fatty acids and iron can improve brain health.
6. Regular fatty fish consumption can reduce the risk of heart disease (2 servings/week).
7. Food first – try to get all your nutrients from the foods you consume. Consider vitamins and supplements only after you’ve been unable to get your dietary needs met from food.
8. Fish oil supplements are safe and pure. There are differences in the amount of omega-3 fatty acids that the supplements deliver, so read the label carefully.
9. A healthy diet is about eating a broad range of nutritious food (don’t scrimp on your veggies), it’s not about supplementing a poor diet with some supplements.
10. Accurate nutrition information is really important. Two trusted sources are: MyPyramid.gov and the American Heart Association
**Listen to the podcast**
