“I don’t have time to get a flu shot”, “I don’t want to wait in line”, “I haven’t had the flu or been sick in years”, “Last time I got a flu shot, I got sick”.

These are all thoughts and statements that I have said, as well as ones I have heard other people say. Well, there would be no room for excuses if your workplace held in-house flu shot clinics, and this seems to be the new trend. According to Alan Kohll in a study done by the Huffington Post, the widespread nature of the flu can cost businesses $7 million worth of sick days, 5%-20% of our population will contract the flu, and that is why the flu can definitely be considered a concern for companies, large and small. There is an increase in companies that are offering wellness programs, and in general these programs seem to have a positive impact on company culture. Flu shot clinics are just another example, they are convenient and encourages the whole workplace to be involved.

The biggest misconception in our culture during flu season is that “flu shots don’t work & sometimes you can even end up getting the flu”. Not only do the flu shot clinics come to your work place for the ease of receiving the vaccine, but they also educate their patients. There is no scientific evidence that backs up the “anti-vaccine” myths, and so the vaccine administrators are given an opportunity to debunk those myths and also educate the employees on the importance of this vaccine and other factors of why being healthy is important. Healthy bodies have a better shot at avoiding influenza and accepting the vaccine as a defense against the influenza. According to the CDC, vaccine effectiveness can vary, but recent studies show that the risk was reduced by 50%-60% among the overall population. That’s a huge percentage and can impact an entire workplace in a positive way.

I wonder if a majority of the people took advantage of the accessibility. Even if they didn’t get a flu shot and are still skeptical about the validity of them, would they take the time to hold a conversation with a practitioner and become more educated on why they are important and how they are beneficial, would the employee be convinced? Would sick day rates during flu season decrease? I would love to see a study with some of the results from a company that invited a flu clinic in to see if it produced positive results.

­­http://www.huffingtonpost.com/alan-kohll/flu-shots-as-a-corporate-wellness-strategy_b_8190730.html

http://www.cdc.gov/flu/about/qa/vaccineeffect.htm

Farm-to-School programs are great for helping children and youths learn more about healthy eating. However sometimes after everything is going smoothly, there is a point where funding levels or community interest decreases. There a few solutions that a Farm-to-School program in Burlington, Vermont have implemented to overcome these barriers and expand their program. They have shared their solutions in a USDA webinar as a way to help others create their own sustainable programs.

To begin, the garden is deeply rooted in the school. Students from all classes get the opportunity to go out to the garden. Students sketch the fruits and vegetables as a part of art class, they identify them food items in Spanish as a part of Spanish class, and they also use the garden in math, science, and physical education classes. Having the garden so involved in all of the classes creates an atmosphere that encourages responsibility from all of the students, not just a select few.

One of the biggest solutions for creating a sustainable program is to get an overwhelming amount of community support, as well as student and teacher participation. The Burlington program really worked to make their presence known throughout the community. They worked to create partnerships with many local companies that had the same mission:  local hardware stores, mom and pop stores, greenhouses, the Gardener’s Supply Company, and health food stores. In addition to creating these partnerships with companies that helped to provide supplies, they took pictures of everything. The partnerships were able to display photo evidence of the impact of the gardens, which enhanced their business as a result, thus developing a cycle of events that continues to fuel their gardens and the community.

Another way to create a sustainable program is to keep it exciting and in the community’s face. The Burlington
program started a youth run food truck (Fork in the Road) which pays students minimum wage while teaching them valuable information. The students meet with farmers, learn culinary skills, develop an awareness for the community which is very impactful. It was an innovative way to create leaders, boost education and get more community buy in.

Overall, as health professionals, if we have a farm-to-school program we need to think about expanding to the next level and becoming more than gardens or kids eating new fruits and vegetables. Food can be an umbrella for education. The students are benefiting by gaining responsibilities and becoming self-advocates. They are learning more about food systems and truly becoming consumers in their community. This gives us the opportunity to really elevate the community and impact more than just the students in the schools.

1. Heusner, Sarah. Sustaining Your Farm to School Program. USDA webinar. 28 April 2016.

Technology is such a great tool. So many people are using for health reasons, by tracking their food consumption, their physical activity and daily steps, or even their sleep quality. It is truly the way of the future. So, when Pokémon Go, a gaming app, was released and the craze began getting people off their couches to “catch” Pokémon, many people wondered how this could be helpful for the obesity epidemic.

Lo and behold, Nature World News came to our rescue, releasing an article titled “Pokémon Go Could Help Prevent Type 2 Diabetes, Study Finds.” Well, wowzers. We went from tracking step count, to completely preventing chronic diseases. My grandmother was right; technology is advancing fast. However, in all seriousness, this article was intriguing and caught my attention immediately.

The Nature World News article stated that “According to the study, users are leaving their homes to walk for miles by just playing the game, engaging in intense physical activity without them noticing.” That’s all well and good but where is this study they were talking about? I was thinking the same thing. Spoiler alert: there is no study. It appears that researchers from the University of Leicester in the UK, released a press release that stated that Pokémon Go, as a smartphone app, could be an innovative solution to the rising obesity levels and chronic disease, and that is what this particular article was based off of. The researchers at the University of Leicester cited previous studies that have shown that breaking up prolonged periods of sitting regularly with five minute bouts of light movement every 30 minutes could significantly reduce blood sugar and insulin levels, which is vastly different from Pokémon Go preventing Type 2 Diabetes.

As future health professionals, we all understand the importance of physical activity. Therefore, it is important to not discourage Pokémon Go players. Utilizing technology to get people to move and be active can be innovative, however, the real struggle is getting people to stay active for longer than a few days or few months. Right now, Pokémon Go is too new to make any conclusions about how sustainable it is. In addition, health professionals really need be careful about popular media articles like this one. “Study” was mentioned several times in the article, yet, there was no study to be found. Even if there was a study that was conducted, we need to be careful because this a very new app, and we cannot draw conclusions from just one study.

Overall, Pokemon Go can be a great way to get people of all ages to start moving, and we as health professionals need to be there to help them continue to move. Even if it is not the cure to Type 2 Diabetes, it is a great way to get some steps in!

1. A. Jaime. “Pokemon Go Can Prevent Type 2 Diabetes, Study Finds”. Nature World News. 26 July 2016.
2. “Pokemon Go can ease Type 2 Diabetes burden.” University of Leicester. 25 July 2016.

It is evident that obesity is a global problem. In the United States about 40% of the population is obese. There are many different treatment options for people who are overweight or obese, but for extreme obesity bariatric surgery has been proven to be the most effective.

There are a few different types of bariatric surgery methods. The most common is the Vertical Sleeve Gastrectomy. In this method, 80% of the stomach is removed. Another method is the Roux en Y method. This used to be the most common, however, this is becoming less popular. This method bypasses the duodenum and creates a 30-mL (1/2 to 1 oz) stomach.

Bariatric surgery does have many advantages, such as long-term weight loss and favorable hormonal and metabolic changes (including reduced diabetes, hypertension, and sleep apnea), however it also has many disadvantages. Some disadvantages include the irreversibility of these methods, the short-term complication rates, and potential for long-term nutrient deficiencies. In addition, there is few studies about the effect of bariatric surgeries on bone and skeletal fractures.

Two studies (Nakamura et al. and Lu et al.) that were conducted found that after several years post-surgery there is an increase in the number of fractures in the clavicle, feet and toes, as compared to non-bariatric patients. So why are they getting fractures? Is it bone dependent, meaning that the quality of bone is affected? Or is bone-independent, meaning that bariatric patients just have an increased risk for falling?

Well, utilizing tools like the DEXA, which measures area bone mineral density, and Computed Tomography, which provides 3D measurements that the DEXA does not have, it was found that there was decrease in bone density. In addition to that, post-surgery bone formation increased, however, bone reabsorption also increased much more. Therefore, there was a decrease in bone density and size which leads to fracture. While the mechanism is not known, some possibilities are: hormones (parathyroid hormone, estrogen), diet, and muscle loss.

So, what can be done by health professionals? Supplementation is very important for bariatric patients. They should have 1200-1500 mg of calcium a day, and most should come from their diet. Their protein requirement is 60-90 g per day and their vitamin D requirements can be greater than 3000 IUs a day. In addition to supplementation, antireabsorptive therapies may be helpful. Most importantly, monitoring. Health professionals should conduct DEXA scans biannually, and vigilantly monitor older populations and children’s bone densities.

Overall, bariatric surgery can be a great way to lose weight quickly and long-term. However, there is not enough research currently on the relationship to bones and skeletal fractures, and future studies need to be conducted. Hopefully, in the future, there are clear recommendations and guidelines created for bariatric patients as a way to prevent fractures in this population.

1. Kindler, Joseph. Bariatric Surgery and Skeletal Fracture. Seminar. 26 October 2016.

Food insecurity is defined as limited or uncertain ability to acquire nutritionally adequate and safe food in socially acceptable ways (e.g., without resorting to emergency food supplies, scavenging, or other coping strategies) (Wunderlich & Norwood, 2006). About 48.1 million Americans were food insecure as of 2014, accounting for 15% of the population. The proportion of children in food insecurity is even higher, at 20%(America, 2015) . When the rate of food security is increasing and remaining high, as seen recently, the rate of obesity is also going up. However, participation in a food assistance program was previously shown to exacerbate the problem of obesity (Franklin et al., 2012). The real problem faced with food stamp programs is the access to adequate healthy foods and education about what healthy foods are, especially for women and children.

In the blog ” How Food Subsidy Programs Pushed Junk Food Off the Table”, the author cited the review by Andreyeva T. and Tripp A.S. (2016), and comes to the conclusion that nudging shoppers toward more healthful foods pushed cheap junk food out of the family shopping basket, and lower-income families were buying more healthful food as a result of the option restriction the government made. However, in the actual review article, the researcher only find that new restrictions lowering purchase of moderation (less healthful) food and beverages, without significant increase in healthful foods purchase. The biggest change found was purchase in moderation beverages. These findings do not support the claim that lower-income families are buying more healthful food.

We’ve already noticed that calorie-dense foods are significantly cheaper while healthy foods are increasingly more expensive, as shown by researchers (Wiggins et al., 2015). The energy density of food was found to be negatively associated with price. Reasonably, the recipients of food stamps would be attracted to cheaper foods with sufficient energy when on a tight budget. In this situation, the government can either put effort on educating the recipients why and how to eat healthy on a budget or just restrict their buying options.  From the results of the original review, we can see that while restriction of shopping option had a fast impact on lowering purchase and thus intake of unhealthy foods and beverages, education on nutrition may still be needed in order to make people choose to buy more healthful products voluntarily. It is practitioner’s job to figure out how much effort is enough to get people to choose wisely.

STROM, S. (2016). How a Food Subsidy Program Pushed Junk Food Off the Table. Eat Well. Retrieved from http://www.nytimes.com/2016/10/05/well/eat/how-a-food-subsidy-program-pushed-junk-food-off-the-table.html

America, F. (2015). Hunger in America 2014, national report. August 2014: Print.

Franklin, B., Jones, A., Love, D., Puckett, S., Macklin, J., & White-Means, S. (2012). Exploring mediators of food insecurity and obesity: a review of recent literature. J Community Health, 37(1), 253-264. doi:10.1007/s10900-011-9420-4

Wiggins, S., Keats, S., Shimokawa, S., Alberto, J., Hernández, V., & Claro, R. M. (2015). The rising cost of a healthy diet.

Wunderlich, G. S., & Norwood, J. L. (2006). Food insecurity and hunger in the United States: National Academies Press.

Vaccines: Let Nature Do Its Thing or No?

Parents must continually make decisions for the well-being of their kids and themselves. Similarly, older Americans are often on fixed incomes and must plan their dollars and medical decisions carefully. Whether or not to vaccinate has, remarkably, become something that millennial parents weigh right along with what to feed their kids and what daycare to choose. The annual flu season brings with it a new opportunity for us to decide – to get the flu shot or not? Are we better off – resistance-wise – letting nature take its course?

Saavy adults know that the body builds its own ‘natural’ immunity once it has endured and healed from a viral infection such as the flu. In fact, this natural immunity following a viral infection can potentially last decades. As Dr. Alicia Fry of the CDC explains in a recent New York Times article, “people who were infected back in the 1930s still have immunity to those [flu] viruses.” In stark contrast, Wang et al. (2011) showed that patients who received the H1N1 Flu vaccine in 2009 showed significantly decreased antibody resistance just 6 months later, while those who were actually infected with (and suffered through) the flu virus still had antibodies to protect them from a repeat infection. In short, letting nature “run its course” results in a body that is more protected and resistant to a future flu infection. Sweet, you’re done with those pesky flu vaccines!

But, wait, you ask, this means I have to actually get sick with the flu, right? Right! To reap these antibody rewards, you have to be willing – and able – to endure days of chills, fever, nausea, time off work and school, and a whole host of pains. If you are an older adult, this also means you might not live through it all, or, if you do, you might need a hospital stay to get through it. If you are a student, you will miss school and potentially infect others and spread your flu joy. If you are a parent, you will necessarily lose time at work taking care of your kids, lose sleep, and, best of all, deal with a cranky, suffering child for a few days while they and you recover.

So, as you roll the flu dice, know that to beat the flu vaccine’s effectiveness, you have to be willing to get and suffer through all of the costs of actually having the flu. For those of us with demanding lives and kids and jobs, the vaccine takes the guessing out of it and saves lost time, money, and Kleenex. For most of us, the vaccine is the way to go and the risk of not getting vaccinated – and getting sick – does not pay off.

Mccarthy, K. (2016, Oct 28). Does the Flu Provide Better Immunity Than a Flu Shot?. The New York Times. Retrieved from  http://well.blogs.nytimes.com/2016/10/28/does-the-flu-provide-better-immunity-than-a-flushot/rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=stream&module=stream_unit&version=latest&contentPlacement=73&pgtype=sectionfront

Wang M, Yuan J, Li T, Liu Y, Wu J, Di B, et al. (2011) Antibody Dynamics of 2009 Influenza A (H1N1) Virus in Infected Patients and Vaccinated People in China. PLoS ONE 6(2): e16809. doi:10.1371/journal.pone.0016809

Freshman 15?

Being sent off to college for the first time comes with a lot of expected and unexpected changes. Generous meal plans, yay! Binge drinking, woohoo! Condo-style dorm rooms, I’ll take one! More stress, ummm, do I have to?? With all of these changes, welcome or unwelcome, one of the first horizons to expand in college is the waistline.

Unfortunately, if rapid weight gain in the fun years of early adulthood isn’t bad enough, it is also correlated with obesity later in life. In short, these are formative years in more ways than we think. But does providence predestine us for the plumping from the “freshman 15”? According to a recent study, the answer is no.

First, we don’t all gain 15. In fact, the average weight gain upon entry to college is only seven pounds. Seven! Good news, right? Well, not exactly. Seven pounds of weight gain in one calendar year is still SEVEN times what would be considered a healthy weight gain. And remember that whole “correlated with obesity later in life” thing? Yeah. So, before we start celebrating that 15 pounds of gain isn’t the destination, we need to remember that seven is still way too much.

So, with all that in mind, the advice for new coeds is the same for anyone going through a major life transition. Keep to a plan, don’t eat whatever, whenever. Keep your stress in check, maybe even reduce it with a great new yoga class at the college rec center. Don’t slack on sleep. Sleep is the key to restoring your body, keeping cravings at bay, and broadening your horizons where you want them broadest: in your brain.

Rosenbloom C. (2016, Sep 6). You don’t have to gain the ‘freshman 15’ — or even the freshman seven. The Washington Post. Retrieved from https://www.washingtonpost.com/lifestyle/wellness/you-dont-have-to-gain-the-freshman-15–or-even-the-freshman-seven/2016/09/01/ec20bf72-6ebf-11e6-8533-6b0b0ded0253_story.html

Vadeboncoeur, C., Townsend, N., & Foster, C. (2015). A meta-analysis of weight gain in first year university students: is freshman 15 a myth? BMC Obesity, 2, 22. http://doi.org/10.1186/s40608-015-0051-7

Sweet Dreams Aren’t Made of This

According to recent reports, using Facebook makes you live longer (Hobbs et al, 2016), but, if you’re doing all that social networking before bed on your smartphone, a separate, unrelated research team shows how you may be compromising your sleep quality. No good deed goes unpunished, as the saying goes.

Indeed, most Americans are glued to their smartphones and check them all day, right up until their last yawn. A team of researchers from UC-San Francisco, led by Dr. Gregory Marcus, directly measured the screentimes of smartphone users by monitoring use in a background app installed on each user’s phone. They weren’t interested in overall screentime, but, instead, focused on how much time users spent staring into their blue-lighted screen just before falling asleep.

Apparently, those blue lights in our screens aren’t good for our brains’ melatonin production – something we need to fall asleep and, more importantly, STAY asleep through the night. You actually want your body to produce its own melatonin in high quantity right before you go to bed. However, by looking into those blue lights illuminating our facebook pages as our heads are atop our pillows, we are actually suppressing melatonin. Look into your screen, suppress melatonin, and sleep worse.

What’s less clear from this article and from the source research, is to what extent people are looking into their screens in bed BECAUSE they can’t sleep. This could be a classic chicken/egg question. What comes first: we use our screens and then can’t sleep? Or, we can’t sleep so we use our screens? This study only measured the relationship between screentime at bedtime and quality of sleep, and it cannot tell us definitively which causes which.

So, the bottom line is this: While you are giggling at the latest cat videos in bed, know that chances are good that you may end up counting more sheep and losing sleep. For that reason, it is probably a good idea to go to sleep the old-fashioned way: In the dark.

Christensen M.A., Bettencourt L., Kaye L., Moturu S.T., Nguyen K.T., Olgin J.E., et al. (2016) Direct Measurements of Smartphone Screen-Time: Relationships with Demographics and Sleep. PLoS ONE 11(11): e0165331. doi:10.1371/journal.pone.0165331

Oaklander, M. (2016, Nov 10). If You Do This Before Bed, Your Sleep Will Seriously Suffer. Time. Retrieved from http://time.com/4565122/smartphone-screen-time-sleep/

Hobbs W.R., Nicholas M.B., Christakis A.,  Fowler J.H. (2016) Online social integration is associated with reduced mortality risk. PNAS 2016 : 1605554113v1-201605554.

JUST DO IT (…in the morning)

Health professionals devote a lot of journal space and public outreach efforts to the topic of exercise. With both obesity rates, metabolic disorders, and sedentary lifestyles on the rise in industrialized nations, the urgency to intervene is clear. So, the public health message is clear: Move more, eat less. Simple enough, right?

Well, sort of. Yes, moving more is definitely a good thing. Increased cognitive function, increased cardiovascular fitness, and improvements to mood are just a few of the major benefits of a lifestyle that includes exercise. As Americans track their movement more and add exercise into their daily routines, do morning exercisers get more from it than evening exercisers? Does it matter if you do it early or late in your busy day?

A recent Newsweek article explores this question. Bass et al. (2016) showed that our bodies may have adapted to better synthesize the impact of exercise when it occurs early in our day’s activities. According to the original study published in Cell Metabolism, strenuous exercise works best for the body’s circadian rhythm when it occurs in the morning.

“Oxygen and the internal clock are doing a dance together inside muscle cells to produce energy, and the time of day determines how well that dance is synchronized,” according to the research team. In short, our bodies are programmed to do their best cellular work at the beginning of the day. So, given the cellular-level impact of exercise, you might want pull yourself out of bed early rather than waiting until after work. Grab your coffee and just do it.

Cara, E. (2016, October 29). Is There an Optimal Time of Day to Exercise. Newsweek, Retrieved  from http://www.newsweek.com/optimal-time-day-exercise-514302

Peek, C.B., & Levine, C. B. (2016, October 20). Circadian Clock Interaction with H1F1a Mediates Oxygenic Metabolism and Anaerobic Glycolysis in Skeletal Muscle. Cell Metabolism. doi: http://dx.doi.org/10.1016/j.cmet.2016.09.010

While it is already a common sense that physical activity can lower the risk of cardiovascular disease (Temporelli, 2016), there is an article(Reynolds, 2016) tells us that acute exercise can trigger a heart attack. It is thus confusing to general public what role PA really plays in heart attack.

According to the blog author, “Exercising with unusual vigor while you are enraged or emotionally distraught could be dangerous for your heart.” However, this is not the conclusion that the original scientific study achieved. The original study was a case-control study which asked the patients who had experienced their first attack whether they had had heavy physical exercise or had been emotional before the episode(Smyth et al., 2016). The researchers did not examine how physical activity interacted with emotion, thus it is unfair to say exercising with anger triples the risk as said by the article author. The impact of physical activity and emotion was studied separately in the case-control study.

So what did the original study say about the impact of physical activity on heart attack? Should we avoid PA in order to lower our risk ? First, to be clear, the question presented to patient was “Were you engaged in heavy physical exertion?”. So exercise of moderate or light intensity is almost always considered safe. People do not have to worry about heart attack when they exercise at a level that they’re used to. Second, although the study tried to match acute MI patients with similar controls in the study, the heart attack patients had significantly less habitual PA and worse comorbidity compared to the control group. The validity of a case-control study lies in how similar the cases and controls are. This indicates that if you are a person that do not exercise regularly but suddenly have a short and intense work out, it may have a higher chance of causing a problem. But if you’re a regular exerciser, there’s no point in avoiding exercise. Third, exercise may trigger heart attack, but only under the condition that someone already have underlying CVD. If you have never had heart problem, fear of a heart attack should not be your excuse for stopping exercise.

For us practitioners, we certainly don’t want to scare anyone away from exercise because we know the benefits outweigh the risks. However, when working with populations of high CVD risks like deconditioned older adults and those with high blood pressures or dyslipidemia, the exercise intensity should be suggested or prescribed with caution. Progression in intensity and duration should be slower than for apparently healthy populations.

REYNOLDS, G. (2016). Think it’s cathartic to run angry? Think again.   Retrieved from http://www.nytimes.com/2016/10/19/well/move/running-while-angry.html

Smyth, A., O’Donnell, M., Lamelas, P., Teo, K., Rangarajan, S., & Yusuf, S. (2016). Physical Activity and Anger or Emotional Upset as Triggers of Acute Myocardial InfarctionClinical Perspective. Circulation, 134(15), 1059-1067.

Temporelli, P. L. (2016). [Physical activity and cardiovascular health]. G Ital Cardiol (Rome), 17(3), 176-180. doi:10.1714/2190.23654