I'm on a plateau right now. I think I've been doing the right things on my program but I've stopped making progress. How can that be?
Almost everyone who diets to lose weight reaches a point where they stop losing weight for no apparent reason. They eat the same size portions, eat the right foods and do the same amount of exercise but they are stuck at the same weight.
Here's what's happening Our bodies have been losing right along and our body detects that we aren't getting the same quantities and same calories that it was formerly used to. A physical defense mechanism sets in and our body in effect tells all of its systems to conserve, to slow down, to be more efficient with the food it gets. It doesn't realize that we want to keep contracting or losing weight. It thinks we are making a mistake and physiologically it is going to correct this mistake. It tries to make one calorie act like two and thus keep us on this no lose plateau.
Don't worry. Don't fret and don't let your underwear bunch up on you. Your body will get used to your new lower weight and let you get on with your business of losing weight. Just "STAY the Course" and it will all work out. Naturally our watchword/slogan for this lesson is:
"STAY the COURSE".
Contact me at brownbagdiet@gmail.com or leave your comments below.
Selasa, 30 Juni 2009
Kamis, 18 Juni 2009
The Association of Inhaled Corticosteroid Use with Serum Glucose Concentration in a Large Cohort
Abstract
Background
Inhaled corticosteroids (ICSs) are widely used in the treatment of obstructive lung disease. ICSs have been shown to be systemically absorbed. The association between ICS and serum glucose concentration is unknown.
Methods
To explore the association of ICS dosing with serum glucose concentration, we used a prospective cohort study of US veterans enrolled in 7 primary care clinics between December 1996 and May 2001 with 1 or more glucose measurements while at least 80% adherent to ICS dosing. The association between ICS dose from pharmacy records standardized to daily triamcinolone equivalents and serum glucose concentration was examined with generalized estimating equations controlling for confounders, including systemic corticosteroid use.
Results
Of the 1698 subjects who met inclusion criteria, 19% had self-reported diabetes. The mean daily dose of ICS in triamcinolone equivalents was 621 μg (standard deviation 555) and 610 μg (standard deviation 553) for subjects with and without diabetes, respectively. After controlling for systemic corticosteroid use and other potential confounders, no association between ICS and serum glucose was found for subjects without diabetes. However, among subjects with self-reported diabetes, every additional 100 μg of ICS dose was associated with an increased glucose concentration of 1.82 mg/dL (P value .007; 95% confidence interval [CI], 0.49-3.15). Subjects prescribed antiglycemic medications had an increase in serum glucose of 2.65 mg/dL (P value .003; 95% CI, 0.88-4.43) for every additional 100 μg ICS dose.
Conclusion
Among diabetic patients, ICS use is associated with an increased serum glucose concentration in a dose-response manner.
To read this article in its entirety, please visit our website.
Christopher G. Slatore, MD, Chris L. Bryson, MD, MS, David H. Au, MD, MS
This article was originally published in the May 2009 issue of The American Journal of Medicine.
Background
Inhaled corticosteroids (ICSs) are widely used in the treatment of obstructive lung disease. ICSs have been shown to be systemically absorbed. The association between ICS and serum glucose concentration is unknown.
Methods
To explore the association of ICS dosing with serum glucose concentration, we used a prospective cohort study of US veterans enrolled in 7 primary care clinics between December 1996 and May 2001 with 1 or more glucose measurements while at least 80% adherent to ICS dosing. The association between ICS dose from pharmacy records standardized to daily triamcinolone equivalents and serum glucose concentration was examined with generalized estimating equations controlling for confounders, including systemic corticosteroid use.
Results
Of the 1698 subjects who met inclusion criteria, 19% had self-reported diabetes. The mean daily dose of ICS in triamcinolone equivalents was 621 μg (standard deviation 555) and 610 μg (standard deviation 553) for subjects with and without diabetes, respectively. After controlling for systemic corticosteroid use and other potential confounders, no association between ICS and serum glucose was found for subjects without diabetes. However, among subjects with self-reported diabetes, every additional 100 μg of ICS dose was associated with an increased glucose concentration of 1.82 mg/dL (P value .007; 95% confidence interval [CI], 0.49-3.15). Subjects prescribed antiglycemic medications had an increase in serum glucose of 2.65 mg/dL (P value .003; 95% CI, 0.88-4.43) for every additional 100 μg ICS dose.
Conclusion
Among diabetic patients, ICS use is associated with an increased serum glucose concentration in a dose-response manner.
To read this article in its entirety, please visit our website.
Christopher G. Slatore, MD, Chris L. Bryson, MD, MS, David H. Au, MD, MS
This article was originally published in the May 2009 issue of The American Journal of Medicine.
Senin, 15 Juni 2009
Sorry for the absence of 2 months but I'm still on track
Sorry for the absence of 2 months but I'm still on track at 176 pounds.
Last time I reported I was at 178 pounds but since that time I had a little mishap. I thought hiking was a good way to get my exercise in and on a hiking trip I suffered a fall. The contusion on the long bone in my leg was severe but I didn't break anything or so they told me at the emergency room I visited. However the pain was getting worse and worse. So ten days later, after I returned home, I went to my Dr. who told me I had several fractures on one foot around my ankles. Fortunately everything remained in line and I avoided the need for surgery. However I spent the next two months in what they called an air boot. This is a device that acts somewhat like a cast but you can remove it to shower and when going to sleep. At any rate two months later my Dr. told me I had good bone formation and discharged me.
What has all this to do with weight loss? Simply put, life is complicated. Although I expected a smooth program for weight reduction this complication got in the way of my concentrating on my task to lose weight. However in the preceding weeks on my diet program I developed pretty good eating habits. During the entire time in which I had the air boot I never once got on the scale. I didn't try to follow my diet but to my surprise during the preceding weeks I had already developed some pretty good eating habits and those good habits paid off.
Although two months passed before I got on the scale again I was surprised to find that I hadn't gained weight. And I'm on the downtrend again with another two pound weight loss.
So what does this prove? It's simple. Good things happen when you develop good habits and bad things continue to happen when you never start or never try to go on a sensible weight loss program. I suppose we could adopt a new watchword/slogan that expresses this idea. That is Good things happen when you try - so keep trying.
You can contact me at brownbagdiet@gmail.com or post you comment on this blog.
Good luck.
Last time I reported I was at 178 pounds but since that time I had a little mishap. I thought hiking was a good way to get my exercise in and on a hiking trip I suffered a fall. The contusion on the long bone in my leg was severe but I didn't break anything or so they told me at the emergency room I visited. However the pain was getting worse and worse. So ten days later, after I returned home, I went to my Dr. who told me I had several fractures on one foot around my ankles. Fortunately everything remained in line and I avoided the need for surgery. However I spent the next two months in what they called an air boot. This is a device that acts somewhat like a cast but you can remove it to shower and when going to sleep. At any rate two months later my Dr. told me I had good bone formation and discharged me.
What has all this to do with weight loss? Simply put, life is complicated. Although I expected a smooth program for weight reduction this complication got in the way of my concentrating on my task to lose weight. However in the preceding weeks on my diet program I developed pretty good eating habits. During the entire time in which I had the air boot I never once got on the scale. I didn't try to follow my diet but to my surprise during the preceding weeks I had already developed some pretty good eating habits and those good habits paid off.
Although two months passed before I got on the scale again I was surprised to find that I hadn't gained weight. And I'm on the downtrend again with another two pound weight loss.
So what does this prove? It's simple. Good things happen when you develop good habits and bad things continue to happen when you never start or never try to go on a sensible weight loss program. I suppose we could adopt a new watchword/slogan that expresses this idea. That is Good things happen when you try - so keep trying.
You can contact me at brownbagdiet@gmail.com or post you comment on this blog.
Good luck.
Kamis, 04 Juni 2009
Adherence to Healthy Lifestyle Habits in US Adults, 1988-2006
Lifestyle choices are associated with cardiovascular disease and mortality. Comparing healthy lifestyle habits in adults between 1988 and 2006, the authors found adherence to 5 healthy habits decreased from 15% to 8% in the US, as obesity increased.
Abstract
Background
Lifestyle choices are associated with cardiovascular disease and mortality. The purpose of this study was to compare adherence to healthy lifestyle habits in adults between 1988 and 2006.
Methods
Analysis of adherence to 5 healthy lifestyle trends (≥5 fruits and vegetables/day, regular exercise >12 times/month, maintaining healthy weight [body mass index 18.5-29.9 kg/m2], moderate alcohol consumption [up to 1 drink/day for women, 2/day for men] and not smoking) in the National Health and Nutrition Examination Survey 1988-1994 were compared with results from the National Health and Nutrition Examination Survey 2001-2006 among adults aged 40-74 years.
Results
Over the last 18 years, the percent of adults aged 40-74 years with a body mass index ≥30 kg/m2 has increased from 28% to 36% (P <.05); physical activity 12 times a month or more has decreased from 53% to 43% (P <.05); smoking rates have not changed (26.9% to 26.1%); eating 5 or more fruits and vegetables a day has decreased from 42% to 26% (P <.05), and moderate alcohol use has increased from 40% to 51% (P <.05). Adherence to all 5 healthy habits has gone from 15% to 8% (P <.05). Although adherence to a healthy lifestyle was lower among minorities, adherence decreased more among non-Hispanic Whites over the period. Individuals with a history of hypertension/diabetes/cardiovascular disease were no more likely to be adherent to a healthy lifestyle than people without these conditions.
Conclusions
Generally, adherence to a healthy lifestyle pattern has decreased during the last 18 years, with decreases documented in 3 of 5 healthy lifestyle habits. These findings have broad implications for the future risk of cardiovascular disease in adults.
To read this article in its entirety, please visit our website.
-- Dana E. King, MD, MS, Arch G. Mainous III, PhD, Mark Carnemolla, BS, Charles J. Everett, PhD
This article was originally published in the June 2009 issue of The American Journal of Medicine.
Abstract
Background
Lifestyle choices are associated with cardiovascular disease and mortality. The purpose of this study was to compare adherence to healthy lifestyle habits in adults between 1988 and 2006.
Methods
Analysis of adherence to 5 healthy lifestyle trends (≥5 fruits and vegetables/day, regular exercise >12 times/month, maintaining healthy weight [body mass index 18.5-29.9 kg/m2], moderate alcohol consumption [up to 1 drink/day for women, 2/day for men] and not smoking) in the National Health and Nutrition Examination Survey 1988-1994 were compared with results from the National Health and Nutrition Examination Survey 2001-2006 among adults aged 40-74 years.
Results
Over the last 18 years, the percent of adults aged 40-74 years with a body mass index ≥30 kg/m2 has increased from 28% to 36% (P <.05); physical activity 12 times a month or more has decreased from 53% to 43% (P <.05); smoking rates have not changed (26.9% to 26.1%); eating 5 or more fruits and vegetables a day has decreased from 42% to 26% (P <.05), and moderate alcohol use has increased from 40% to 51% (P <.05). Adherence to all 5 healthy habits has gone from 15% to 8% (P <.05). Although adherence to a healthy lifestyle was lower among minorities, adherence decreased more among non-Hispanic Whites over the period. Individuals with a history of hypertension/diabetes/cardiovascular disease were no more likely to be adherent to a healthy lifestyle than people without these conditions.
Conclusions
Generally, adherence to a healthy lifestyle pattern has decreased during the last 18 years, with decreases documented in 3 of 5 healthy lifestyle habits. These findings have broad implications for the future risk of cardiovascular disease in adults.
To read this article in its entirety, please visit our website.
-- Dana E. King, MD, MS, Arch G. Mainous III, PhD, Mark Carnemolla, BS, Charles J. Everett, PhD
This article was originally published in the June 2009 issue of The American Journal of Medicine.
Failing Grades in the Adoption of Healthy Lifestyle Choices
Heart disease is the leading cause of death for both men and women in the United States. During 2002, nearly 700,000 individuals in the US died of heart disease.(1) Of these deaths, approximately 500,000 are the result of ischemic coronary heart disease, with 47% of these individuals dying before emergency services or transport to a hospital could occur. Fifty-one percent of those dying of heart disease are women.(2, 3) Heart disease is the leading cause of death for most American ethnic groups, including whites, African Americans, Hispanics, American Indians, and Alaskan Natives. Discouragingly, heart disease death rates are 30% higher in African Americans compared with whites.(2) The projected cost for the immense burden of heart disease in the US during 2006 was between $143 and $258 billion, including health care services, medications, and lost productivity.(4, 5)
Risk factors for the development of atherosclerotic disease are unfortunately widespread in the US population. Indeed, between 1999 and 2000, approximately 30% of individuals aged 20 years or older had diagnosed hypertension or were taking antihypertensive medication, 17% had high blood cholesterol, 6.5% were diabetic, 30.5% were obese, and more than 21% smoked cigarettes. Moreover, more than 37% reported no leisure-time physical activity.(2) In 2003, approximately 37% of American adults reported having 2 or more of these risk factors for cardiovascular disease. Ninety percent of patients with ischemic coronary artery disease have at least one atherosclerotic risk factor.(6)
With these grim statistics in mind, the report of King et al in this issue of The American Journal of Medicine is very disturbing.(7) Despite vigorous efforts on the part of national and local health authorities and organizations such as the American Heart Association, the incidence of atherosclerotic arterial disease risk factors has actually increased in recent years. King et al compared 5 major atherosclerotic risk factors…
To read this article in its entirety, please visit our website.
-- Joseph S. Alpert, MD
Editor-in-Chief, The American Journal of Medicine
This article was originally published in the June 2009 issue of The American Journal of Medicine.
Risk factors for the development of atherosclerotic disease are unfortunately widespread in the US population. Indeed, between 1999 and 2000, approximately 30% of individuals aged 20 years or older had diagnosed hypertension or were taking antihypertensive medication, 17% had high blood cholesterol, 6.5% were diabetic, 30.5% were obese, and more than 21% smoked cigarettes. Moreover, more than 37% reported no leisure-time physical activity.(2) In 2003, approximately 37% of American adults reported having 2 or more of these risk factors for cardiovascular disease. Ninety percent of patients with ischemic coronary artery disease have at least one atherosclerotic risk factor.(6)
With these grim statistics in mind, the report of King et al in this issue of The American Journal of Medicine is very disturbing.(7) Despite vigorous efforts on the part of national and local health authorities and organizations such as the American Heart Association, the incidence of atherosclerotic arterial disease risk factors has actually increased in recent years. King et al compared 5 major atherosclerotic risk factors…
To read this article in its entirety, please visit our website.
-- Joseph S. Alpert, MD
Editor-in-Chief, The American Journal of Medicine
This article was originally published in the June 2009 issue of The American Journal of Medicine.
Copy and Paste: A Remediable Hazard of Electronic Health Records
The electronic health record offers numerous advantages over its paper counterpart: the ability to access a chart from any location; the opportunity for multiple viewers to read or contribute to a chart simultaneously; legibility; and the ease of incorporation of data into the note, without transcription error. Electronic charting is not without its pitfalls, however. Typing progress notes can be cumbersome, especially if data are not accessed easily while composing the note. Free terminals might be unavailable, and notes can disappear with the wrong click of a mouse.
To read this article in its entirety, please visit our website.
-- Eugenia L. Siegler, MD, Ronald Adelman, MD
This article was originally published in the June 2009 issue of The American Journal of Medicine.
To read this article in its entirety, please visit our website.
-- Eugenia L. Siegler, MD, Ronald Adelman, MD
This article was originally published in the June 2009 issue of The American Journal of Medicine.
Selasa, 02 Juni 2009
Platelet Inhibition with Prasugrel and Increased Cancer Risks: Potential Causes and Implications
The Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel (TRITON-TIMI 38) was a head-to-head trial to assess the efficacy and safety of the experimental antiplatelet agent prasugrel versus standard care with clopidogrel on top of aspirin.1 In addition to some ischemic protection at the expense of an overwhelming bleeding disadvantage, prasugrel-treated patients experienced a 3 times higher rate of colonic neoplasms than clopidogrel-treated patients, a difference that was significant. The follow-up time in TRITON was long enough (14.5 months average), and the sample size was large enough to detect cancer rate differences. Of interest, known gastrointestinal bleeding preceded the diagnosis of colonic neoplasms in only half of the patients.
To read this article in its entirety, please visit our website.
Victor L. Serebruany, MD, PhD
This article was originally published in the May 2009 issue of The American Journal of Medicine.
To read this article in its entirety, please visit our website.
Victor L. Serebruany, MD, PhD
This article was originally published in the May 2009 issue of The American Journal of Medicine.
Diabetes Prevalence and Therapeutic Target Achievement in the United States, 1999 to 2006
Abstract
Objective
Changes in the prevalence, treatment, and management of diabetes in the United States from 1999 to 2006 were studied using data from the National Health and Nutrition Examination Survey.
Methods
Data on 17,306 participants aged 20 years or more were analyzed. Glycemic, blood pressure, and cholesterol targets were glycosylated hemoglobin less than 7.0%, blood pressure less than 130/80 mm Hg, and low-density lipoprotein (LDL) cholesterol less than 100 mg/dL, respectively.
Results
The prevalence of diagnosed diabetes was 6.5% from 1999 to 2002 and 7.8% from 2003 to 2006 (P < .05) and increased significantly in women, non-Hispanic whites, and obese people. Although there were no significant changes in the pattern of antidiabetic treatment, the age-adjusted percentage of people with diagnosed diabetes achieving glycemic and LDL targets increased from 43.1% to 57.1% (P < .05) and from 36.1% to 46.5% (P < .05), respectively. Glycosylated hemoglobin decreased from 7.62% to 7.15% during this period (P < .05). The age-adjusted percentage achieving all 3 targets increased insignificantly from 7.0% to 12.2%.
Conclusions
The prevalence of diagnosed diabetes increased significantly from 1999 to 2006. The proportion of people with diagnosed diabetes achieving glycemic and LDL targets also increased. However, there is a need to achieve glycemic, blood pressure, and LDL targets simultaneously.
To read this article in its entirety, please visit our website.
-- Bernard M.Y. Cheung, PhD, FRCP, Lond, FRCP Edin, FCP, Kwok Leung Ong, MPhil, Stacey S. Cherny, PhD, Pak-Chung Sham, MRPsych, PhD, Annette W.K. Tso, MRCP(UK), Karen S.L. Lam, MD, FRCP, FRACP
This article was originally published in the May 2009 issue of The American Journal of Medicine.
Objective
Changes in the prevalence, treatment, and management of diabetes in the United States from 1999 to 2006 were studied using data from the National Health and Nutrition Examination Survey.
Methods
Data on 17,306 participants aged 20 years or more were analyzed. Glycemic, blood pressure, and cholesterol targets were glycosylated hemoglobin less than 7.0%, blood pressure less than 130/80 mm Hg, and low-density lipoprotein (LDL) cholesterol less than 100 mg/dL, respectively.
Results
The prevalence of diagnosed diabetes was 6.5% from 1999 to 2002 and 7.8% from 2003 to 2006 (P < .05) and increased significantly in women, non-Hispanic whites, and obese people. Although there were no significant changes in the pattern of antidiabetic treatment, the age-adjusted percentage of people with diagnosed diabetes achieving glycemic and LDL targets increased from 43.1% to 57.1% (P < .05) and from 36.1% to 46.5% (P < .05), respectively. Glycosylated hemoglobin decreased from 7.62% to 7.15% during this period (P < .05). The age-adjusted percentage achieving all 3 targets increased insignificantly from 7.0% to 12.2%.
Conclusions
The prevalence of diagnosed diabetes increased significantly from 1999 to 2006. The proportion of people with diagnosed diabetes achieving glycemic and LDL targets also increased. However, there is a need to achieve glycemic, blood pressure, and LDL targets simultaneously.
To read this article in its entirety, please visit our website.
-- Bernard M.Y. Cheung, PhD, FRCP, Lond, FRCP Edin, FCP, Kwok Leung Ong, MPhil, Stacey S. Cherny, PhD, Pak-Chung Sham, MRPsych, PhD, Annette W.K. Tso, MRCP(UK), Karen S.L. Lam, MD, FRCP, FRACP
This article was originally published in the May 2009 issue of The American Journal of Medicine.
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