The Food Pyramid

Until recently, the National Institute of Health (NIH) had talked about a practical system to help Americans eat healthier which they called the Food Pyramid. They divided foods into six Food Groups and recommended the number of daily servings for each of the Food Groups. The macronutrients we described in previous posts, Carbohydrates, Fats & Proteins, are contained within these Food Groups. The following table was taken from the NIH website. It tells you how many servings of a specific Food Group you should eat per day.  The Food Pyramid approach has been replaced by the MyPlate concept which is explained below.

ChooseMyPlate.gov

Recently the United States Department of Agriculture (USDA) replaced the Food Pyramid system with this easier approach to help people more easily focus on these tips for healthy eating:

• Make half your plate fruits and vegetables
• Make at least half your grains whole grains
• Switch to fat-free or low-fat (1%) milk
• Enjoy your food, but eat less
• Avoid over-sized portions
• Drink water instead of sugary drinks

While this is helpful, many people want to know from a nutritional viewpoint how large is a serving of a specific food.  That’s what I’ll cover in the next post.  Check out the Learning Center at www.InsightsForHealth.com for more information.  Meanwhile, please leave any comments for discussion.

For Your Health – Dr. Bob

Last time I wrote about Carbohydrates.  Today, I want to share some basic nutritional information about Fats & Proteins.

Fats are made up of glycerol and fatty acids and due to this complexity, take the longest time to release their energy. Since they hold the most energy per gram of any other macronutrient, the body stores most of its excess energy as fat. In addition, fats are important components of the walls of cells and other structures of the body.

Fats are classified by the degree of “saturation” of their chemical bonds. Those likely to raise levels of the bad cholesterol, LDL, are the saturated and trans fats. Therefore, you should try to eat more monounsaturated and polyunsaturated fats and avoid trans-fats and saturated fats.

Proteins are made up of chains of amino acids and are literally the building blocks of the body and form the enzymes & hormones that control its chemical reactions. Proteins are found in meat, poultry, fish, meat substitutes, cheese, milk, legumes, nuts and in smaller quantities in starchy foods and vegetables. The body breaks proteins down into their amino acids to reuse them. The body can make most of the amino acids it needs from other substances, but there are some, the essential amino acids, that it must get from food. All the necessary essential amino acids can be obtained from meat protein. However, not all the essential amino acids can be found in plant protein. When a person increases their amount of exercise it is important that they have enough protein to build muscle and prevent its breakdown. Many people ordinarily eat inadequate amounts of protein, so they either need to eat more protein-rich foods or take protein supplements.

In the next post I’ll talk about portion size.  By the way, this information and more can be found at the Learning Center on www.InsightsForHealth.com.  Check it out sometime.  Meanwhile, please leave your comments.

For Your Health – Dr. Bob

Macronutrients – Carbohydrates, Fats & Protein

When trying to eat healthier as part of your weight loss plan, you need to learn the basics of nutrition.  I’ll spend the next few posts covering those basics or you could click here to be taken to the www.InsightsForHealth.com Learning Center Module on Nutrition.

Nutritionists often refer to carbohydrates, fats and proteins as  macronutrients and vitamins and minerals as  micronutrients. We require a relatively small amount of the micronutrients, and they have no caloric content. The macronutrients do have a caloric content with fats having the highest caloric density. So, of the three, fat is the most efficient storehouse for energy.

Carbohydrates are classified as simple or complex. The simple sugars are smaller and include glucose and fructose. Since they are smaller molecules they get absorbed from the gastrointestinal tract very quickly. Glucose is the only source of energy used by the brain, so the body has several mechanisms to convert the other macronutrients into glucose if the glucose level is running low. Complex carbohydrates are actually simple carbohydrates linked together. They include corn, beans, root vegetables (potatoes), pasta & grains. Because they are larger, extracting energy from them takes a bit longer than from simple carbohydrates, but it is still relatively rapid. The body stores only about one day’s worth of energy as carbohydrate in the form of glycogen in the liver and muscle.

In the next post I’ll talk about fats.  Meanwhile, you can check out this information and more at www.InsightsForHealth.com.

I’ll look forward to any comments you may wish to leave..

For Your Health – Dr. Bob

With all the developments and improved treatments in every area of medicine, it can be difficult for physicians to keep up with the most current and effective therapies in their areas of specialization. So how can a patient know whether they are getting the highest level of quality of care?  After all, patients rely on the expertise of their doctors.  This is one reason why health plans and other healthcare organizations are asking physicians to develop and use Care Pathways, sometimes called Clinical Pathways.

These pathways use evidence-based medical guidelines as their foundation.  With such an approach, appropriate diagnostic testing and treatments for a clinical situation are determined by a team of expert specialists based upon the most recent, scientifically valid medical research that is relevant to the situation.  For example for cancer care, a team of oncologists, usually representing their national specialty board, review the medical studies of the latest cancer research and judge the value of the different tests and treatments for the most common kinds of cancer.  They then make recommendations or guidelines that are published and shared with the rest of the oncology specialists throughout the country to guide them in providing their patients with care that will more likely produce better outcomes.

These evidence-based care recommendations and guidelines sometimes can’t be easily applied in clinical practice as written.  That’s where Care Pathways come in.  Physicians and other clinicians who practice together take these evidence-based recommendations and turn them into a practical approach that they can use where they practice.  These are the Care Pathways that everyone in the practice or hospital follows to make sure that the best care is delivered.  The more innovative and quality-focused practices and healthcare organizations use computer systems to track how well these pathways are followed.  Then they routinely look at these as quality measures to gauge how well they are doing and make improvements to their processes to improve their outcomes.

I think that these Care Pathways hold the promise of increasing quality at the practice level faster than any other quality improvement methodology.  What do you think?  Leave a comment.  After all, it’s your healthcare we’re talking about.

For Your Health – Dr. Bob

In my last post about using the healthcare system, I talked about patient satisfaction surveys as a way to measure its quality.  But measuring satisfaction is only part of health care quality.  You may be satisfied with the care your physician provides, but is it medically appropriate and up-to-date?

Another kind of measure looks at how well all the doctor’s patients with certain common characteristics stack up against some specialty recommendations.  This approach works well for preventive measures for patients of a certain gender and age, such as, immunizations for children or mammography rates for women.  It’s also used to measure care delivered to patients with certain chronic conditions, such as diabetes or heart failure.  These measures cover whether certain tests have been performed on a regular basis and whether certain medications proven to be effective in managing the condition are being taken by the patient.  They also may include what percentage of the patients with the condition are under control by attaining certain standards, such as blood pressure or the A1C level for the diabetic.

There are certain problems with these measures.  First, sometimes more than one medical organization releases conflicting recommendations for the same test or procedure.  For example, the United States Preventive Services Task Force (USPSTF) recommends screening mammograms for women every other year after the age of 50, whereas the American Cancer Society (ACS)  recommends that it be done every year after the age of 40.  Which should be used?  Another problem with some of these measures is that they don’t always accurately reflect the physician’s practice.  With most of them, the physician may order a test or a medication, but the patient must follow through and have the test done or fill the prescription and take the medication.  Another weakness of these measures is that while they can work for primary care and some specialties, they can’t be applied to all specialists.  With time more specialty-specific measures may be developed.  Finally, gathering the data to do the calculations can be a problem, though as more and more practices adopt an electronic medical record, that problem may be reduced.  More about that in the next post, when I discuss clinical pathways.

Some health plans publish some of these kinds of measures for their physician network.  Have you ever seen them or used them?  Please share your experiences with healthcare quality by leaving a comment.

For Your Health – Dr. Bob