Home Health Testing

A new study in the Journal of the American College of Cardiology set out to find if prolonged sitting was linked to cardiovascular diseases.  Actually the doctors called the study “Screen-Based Entertainment Time, All-Cause Mortality, and Cardiovascular Events” where “screen based entertainment” is more commonly known as TV and or computer – leave it to doctors to come up with a title like that.

After following 4,512 Scottish people from 2003 to 2007 and recording their screen viewing time and their health, Emmanuel Stamatakis, PhD, MSc, Department of Epidemiology and Public Health, University College London, United Kingdom said:

“People who spend excessive amounts of time in front of a screen — primarily watching TV — are more likely to die of any cause and suffer heart-related problems.  Our analysis suggests that two or more hours of screen time each day may place someone at greater risk for a cardiac event.”

The study found that those people who spent two or more hours per day in front of a screen for leisure activities were double the risk of heart attack or other cardiac event compared with those who spent less sedentary time in front of a screen.  Those in the study who had four or more hours of screen time were fifty percent more likely to die of any cause.  One surprising fact in the study was that it did not matter if they were physically active for several other hours in the week in other words exercise in addition to being a couch potato did not improve the heart health of those in this study.

According to Doctor Emmanuel Stamatakis approximately 25% of the association between screen time and cardiovascular disease events was explained collectively by C-reactive protein.  Extended periods of sitting may cause high levels of low-grade inflammation which can lead to heart disease.  A marker of low-grade inflammation called C reactive protein or CRP was about three times higher in the study participants who spent the most time sitting in front of a screen.

While the study covered recreational screen time since that was the easiest for people to have a choice in, Dr. Stamatakis mentioned that people with jobs that require extended sitting and screen time should take breaks and short walks throughout the day.

The Institute of Medicine’s 14 member panel has released the findings of their two year study of vitamin D and increased the recommended dietary allowance of vitamin D to 600 international units per day from the previous level of 400 international units per day. This is the second increase since the 1997 levels which were 200 international units per day.

The panel was formed at the request of the governments of the United States and Canada. The panel examined thousands of publications and studies in order to determine how much vitamin D and calcium people needed for good health, how much was too much and what is the level for deficiency.

Vitamin d testing has exploded over the last few years and labs have started reporting that levels below 30 nanograms per milliliter is a deficiency. The Institute of Medicine’s new study states that a level of 20 to 30 nanograms per milliliter to be the level that is needed for good bone health for practically all individuals, therefore, a deficiency would exist only below 20 ng/mL.

When labs use the below 30 nanograms level as a deficiency then an estimated 80 percent of the population is deemed vitamin d deficient. However, the Institute of Medicine is lowering that bar to 20 nanograms which would mean that we don’t actually have a vitamin d epidemic in the United States.

The medical community has released thousands of studies over the last several years supporting an increased need for vitamin d supplementation to levels between 1000 – 2000 IU and citing increased diseases in people with low levels of vitamin d. The media has highly publicized vitamin d as a panacea for the common cold to cancer. So how do we make sense of the new government study?

The government is required to issue one number which is supposed to be for everyone in the United States. Certainly, the government would not recommend one level for the people of Vermont and another for the people of Florida, but that is how vitamin d works based on your distance from the equator. And certainly there would be an uproar if our government made one recommendation for whites and one recommendation for blacks, but again that is how vitamin d works based on the color of your skin and its ability to absorb the sun’s rays and convert them to vitamin d.

“the committee emphasizes that, with a few exceptions, all North Americans are receiving enough calcium and vitamin D. Higher levels have not been shown to confer greater benefits, and in fact, they have been linked to other health problems, challenging the concept that “more is better.””

So the Institute of Medicine has to walk this very narrow line of making a recommendation that will work for every man, woman and child in this country – as their tagline on their website says “Advising the Nation”. So while medical evidence exists that where you live or the color of your skin will effect your vitamin d level, the committee had to ignore these facts in their recommendations and find a cautious level to establish for all.

Even with the recommended lower level of 20 ng/mL many people are still vitamin d deficient. If you want to heed the cautionary levels recommended by the IOM then test your vitamin d level and if it is below 20 ng/mL then take the recommended supplement of 600 IU per day. Test your vitamin d again in three months and see if there has been improvement. Many in the medical community will tell you that you cannot raise your vitamin d level on 600 IUs per day.

The one thousand page report issued by the IOM will be read in full by few and rehashed by many. Personally, I will not read the entire 1,000 report since I had trouble getting all the way through Dr. Holick’s 336 page book on vitamin d. However, I do know that I can have my vitamin d level tested and know that I need to be at minimum in the 20 – 30 ng/mL range. My recent vitamin d level came in at 14.6 ng/mL and I live in the sunny south and am white. Just to get to the cautiously safe level of 30 ng/mL means doubling my vitamin d level which will take additional supplementation and additional sun exposure. The good news is that I can test again and find out if I am making progress.

While the IOM report sounds like a cautionary warning, the truth is we still have the tools available to find out what works for each of us individually and this is not something the government will ever be able to do – determine what is best for you.

A new study from Columbia University’s Mailman School of Public Health, What Changes in Survival Rates Tell Us About US Health Care,  has shocking findings about the life expectancy in the US.  The study found 15-year survival rates for men and women ages 45 and 65 have fallen in the US compared with 12 other countries over the past 30 years.  From 1975 – 2005, the US was making steady gains in the 15 year survival rate, but other countries have made even greater gains which has caused us to slip in the ratings.  The most disturbing finding is the per capita health care spending in the US increased at more than twice the rate of the comparison countries.

“It was shocking to see the U.S. falling behind other countries even as costs soared ahead of them, but what really surprised us was that all of the usual suspects—smoking, obesity, traffic accidents, homicides, and racial and ethnic diversity are not the culprits. The U.S. doesn’t stand out as doing any worse in these areas than any of the other countries we studied, leading us to believe that failings in the U.S. health care system, such as costly specialized and fragmented care, are likely playing a large role in this relatively poor performance on improvements in life expectancy.”  Peter Muennig, MD, MPH, assistant professor of Health Policy and Management at the Mailman School of Public Health.

The study analyzed  health spending, behavioral risk factors,  and 15-year survival rates for men and women ages 45 and 65 in the U.S. and 12 other nations — Australia, Austria, Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland, and the United Kingdom.

White women in the US, age 45, had the worst performance in the study—by 2005 their 15-year survival rates were lower than that of all the other countries.  In 2005 the 15 year survival rate for a white woman in the US was lower than the rate from 1975 for Swiss, Swedish, Dutch or Japanese women.  How can 35 years of medical advances, technology and increased health spending produce these results?

The study took into account risk factors and behavior such as smoking.  Actually smoking had declined in the US at a faster rate than other countries, while our survival rate sank.  The obesity rates versus other countries have been consistent since 1975 since the US was ahead in this category throughout the years.

In 1950, the United States was fifth among the leading industrialized nations with respect to female life expectancy at birth, surpassed only by Sweden, Norway, Australia, and the Netherlands. The last available measure in 2008 of female life expectancy had the United States ranked at forty-sixth in the world.

Studies come out on a daily basis and sometimes the statistics can be overwhelming and possibly interpreted in different ways.  But to just look at that one statistic again (from CIA World Factbooks):

• In 1950 the US was 5th in the world for female life expectancy

• In 2008 the US is 46th for female life expectancy at 81.13 years

In forty-five other countries in the world, women live longer than here in the US with Macau in the #1 spot with female life expectancy of 87.45 years.  France is in the #7 spot with 84.23 years.  Canada is #10 with 83.81 years.  The US barely ranked above Ecuador, Poland and Cuba.

Quantity of care obviously does not produce quality of care.  While the US can outspend other countries on health care, we steadily decline in the length of our lives.  Is our rising health care costs actually causing us to die sooner?  Our health care system has become fragmented and reliant on high priced specialty care for every illness.  Instead of going to one doctor for your health and well being, you may have to go to several different specialists for each illness or symptom.  The study concluded that this fragmented care is raising our costs and decreasing our quality of care.

“We speculate that the nature of our health care system—specifically, its reliance on unregulated fee-for-service and specialty care—may explain both the increased spending and the relative deterioration in survival that we observed.”  from the What Changes in Survival Rate Tell Us about US Health Care study