3 Easy Dishes That Helped One Woman Lose 135 Pounds

If you read the New York Times bestselling memoir It Was Me All Along ($24; amazon.com), then you already know about Andie Mitchell’s inspiring 135-pound weight loss journey. Her secret? Balance. Although she eats healthy for the most part, she doesn’t completely deprive herself of the rich treats (cakes, pasta, nachos) she loves.

If you’re wondering how Mitchell strikes that balance, you’re in luck. She has come out with a new cookbook called Eating in the Middle ($28; amazon.com), which she describes as “mostly wholesome with a sprinkling of decadence…exactly how I live my life.”

Read on for three of her easy, flavorful recipes.

All the Greens Frittata

Serves: 4

6 large eggs

1 Tbsp. extra-virgin olive oil

1 medium shallot, finely chopped (about ¼ cup)

½ lb. asparagus, trimmed and cut into 1-inch pieces (about 1 cup)

2 large leeks, white and light-green parts only, halved lengthwise and cut into ½-inch-thick pieces (about 2 cups)

½ tsp. salt

¼ tsp. freshly ground black pepper

2½ oz. baby spinach leaves (2 packed cups)

2 cloves garlic, minced

2 oz. goat cheese, crumbled (about ½ cup)

2 Tbsp. finely chopped fresh basil leaves

1. Preheat the oven to 350°F. In a medium bowl, beat the eggs.
2. In a 10-inch ovenproof nonstick skillet, heat the oil over medium-high heat. Add the shallots, asparagus, leeks, salt, and pepper, and cook until beginning to brown, about 5 minutes. Add the spinach and cook, stirring frequently, until wilted, 1 to 2 minutes. Lower the heat to medium, add the garlic, and cook, stirring constantly, until fragrant, 30 seconds.
3. Add the eggs and stir. Cook, without stirring, until just set on the bottom, 30 to 45 seconds. Using a plastic spatula, lift the frittata edge nearest to you and tilt the skillet gently so that the eggs run underneath the cooked bottom. Swirl the pan to evenly distribute the egg in the skillet and continue to cook for 1 minute. Lift the pan once more to repeat the process until the egg on top is no longer runny. Scatter the goat cheese on top.
4. Bake until the top is set and the cheese begins to melt, 5 to 7 minutes. Sprinkle the basil over the top. Run a spatula around the sides of the frittata and transfer it to a large serving plate. Cut into four pieces and serve warm, at room temperature, or even chilled.

Cashew and Basil Chicken Lettuce Wraps

Serves: 4

½ cup unsalted cashews

¼ cup low-sodium chicken broth

3 Tbsp. hoisin sauce

2 Tbsp. low-sodium soy sauce

1 tsp. sugar

1 tsp. cornstarch

2 tsp. canola oil

2 cloves garlic, minced

1 lb. ground chicken breast

2 scallions, white and light-green parts, chopped

½ cup roughly chopped fresh basil leaves

1. Preheat the oven to 350°F. Spread the cashews on a baking sheet and toast until golden and fragrant, about 10 minutes. Let cool slightly, then chop the cashews. In a small bowl, whisk together the broth, hoisin, soy sauce, sugar, and cornstarch.
2. In a 12-inch nonstick skillet set over medium-high heat, heat the oil. Add the garlic and cook, stirring constantly, until fragrant, about 30 seconds. Add the chicken and cook, breaking up the meat with a spatula, until browned, 4 to 6 minutes. Add the scallions and the hoisin sauce mixture and cook, stirring frequently, until the sauce thickens slightly, about 2 minutes. Stir in the basil and cashews.
3. To serve, divide the lettuce leaves among 4 plates and spoon the chicken mixture into each of the leaves.

Creamy Farro with White Beans and Kale

Serves 4

1 cup dry farro

3 cups low-sodium vegetable or chicken broth

1 bay leaf

1 15-oz. can white beans, rinsed and drained

2 oz. Gruyère, shredded (about ½ cup)

3 Tbsp. grated Parmesan

4 tsp. extra-virgin olive oil

8 oz. portobello mushroom caps, stems and gills removed, sliced into ½-inch pieces

1 medium shallot, thinly sliced (about ¼ cup)

3 cloves garlic, minced

1 small bunch kale, leaves chopped (about 4 cups chopped)

½ tsp. salt

½ tsp. freshly ground black pepper

2 Tbsp. finely chopped fresh flat-leaf parsley

1. In a medium saucepan set over medium-high heat, bring the farro, broth, and bay leaf to a boil. Reduce the heat to medium-low and simmer until the grains are tender but still chewy, about 30 minutes.
2. Stir the beans into the hot grains. Add the Gruyère and Parmesan and stir until melted. Cover to keep warm.
3. Meanwhile, in a 12-inch nonstick skillet, heat 2 tsp. of the oil over medium-high heat until very hot. Add the mushrooms and cook until browned on one side, 3 to 4 minutes, then stir and cook until browned and tender on the other side, 3 to 4 minutes more. Transfer the mushrooms to a warm plate. Add the remaining 2 tsp. of oil to the skillet along with the shallots and garlic and cook, stirring constantly, until the garlic is fragrant, about 30 seconds. Add the kale and cook, stirring frequently, until wilted, about 3 minutes. Season with the salt and pepper.
4. Stir the kale, mushrooms, and parsley into the farro and beans and serve immediately.

Recipes reprinted from Eating in the Middle: A Mostly Wholesome Cookbook. Copyright 2016 by Andie Mitchell. Photographs copyright 2016 by Aran Goyoaga. Published by Clarkson Potter, an imprint of Penguin Random House, LLC.

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Beans, Chickpeas May Help With Weight Loss: Study

WEDNESDAY, March 30, 2016 (HealthDay News) — Beans, chickpeas, peas, lentils: Humble foods that may pack a punch for weight loss, Canadian researchers report.

A new analysis of data from 21 clinical trials on these foods — collectively known as “pulses” — finds that they can help dieters feel full, and shed unwanted pounds.

“Though the weight loss was small, our findings suggest that simply including pulses in your diet may help you lose weight, and we think more importantly, prevent you from gaining it back after you lose it,” study lead author Russell de Souza, a researcher at St. Michael’s Hospital in Toronto, said in a hospital news release.

One expert wasn’t surprised by the findings.

“These types of legumes are some of the most underappreciated foods around,” said Dana Angelo White, a nutritionist and assistant professor of sports medicine at Quinnipiac University in Hamden, Conn.

“They are full of fiber, protein, vitamins and minerals,” she noted. “It makes sense they would help facilitate weight loss and reduce cholesterol when eaten regularly.”

The Canadian team also noted that pulses have a “low glycemic index” — meaning that they break down slowly in the digestive tract. As such, they can be consumed instead of animal protein or unhealthy fats at mealtimes.

The trials included in the new analysis involved a total of 940 adults. When participants started eating one serving (3/4 cup) of pulses a day, they lost an average of 0.75 pounds over six weeks without making any special effort to avoid other types of foods, the researchers said.

According to de Souza’s team, prior research has shown that eating bean, lentils and other pulses makes people feel fuller.

That’s key to weight loss — 90 percent of weight loss programs fail, due in part to the influence of hunger and food cravings, according to de Souza.

“This new study fits well with our previous work, which found that pulses increased the feeling of fullness by 31 per cent, which may indeed result in less food intake,” he said.

These foods also appear to help lower blood levels of “bad” LDL cholesterol, he added.

Antonella Apicella, an outpatient dietitian at Lenox Hill Hospital in New York City, said the study, “supports the notion that foods such as beans, lentils, chickpeas and dry peas may reduce body fat and may contribute to weight loss, even if calories were not restricted.”

She agreed that pulses do seem to help people feel fuller, sooner, and the fiber these foods contain “may reduce the absorption of fat.”

The findings were published March 30 in The American Journal of Clinical Nutrition.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases explains how to choose a safe and successful weight loss program.

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Gene Therapy Shows Early Promise Against Heart Failure

WEDNESDAY, March 30, 2016 (HealthDay News) — There might be good news for millions of Americans who suffer from heart failure: A trial using gene therapy appears to have boosted patients’ cardiac function.

“This type of an intervention would be the ultimate method to reconstruct damaged heart tissue so that it can be mechanically functional again,” explained one expert, Dr. Justine Lachmann. She directs the Congestive Heart Failure Program at Winthrop-University Hospital in Mineola, N.Y.

In heart failure, a weakened or damaged heart no longer pumps blood the way it should. This potentially fatal disease affects about 5.7 million Americans, according to the American Heart Association.

Despite the illness taking such a toll, there’s been little progress toward any kind of cure, Lachmann said.

“Our current medication interventions for heart failure have been successful in helping patients live longer, typically by changing the chemical signals in the body that affect the heart,” she said. “But long-term outcomes from the medications remain grim, as the overall structure may be damaged from permanent injuries such as a heart attack.”

The new study enlisted cutting-edge gene therapy to try to reverse cardiac damage. Led by Dr. H. Kirk Hammond of the VA San Diego Healthcare System, the study involved 56 patients with symptomatic heart failure whose heart function was diminished by up to 40 percent.

The therapy involves “gene transfer” — a process whereby a harmless virus is used to transport a gene into heart cells. Once in place, the gene produces a protein called AC6, levels of which are unhealthily low in failing hearts, according to researchers.

Some patients in the new study got the treatment, while the others got a placebo only. Outcomes were tracked for one year.

As reported online March 30 in JAMA Cardiology, the AC6 gene transfer therapy seemed to benefit cardiac function, and the level of benefit rose along with the dose received.

Specifically, there was a boost in “left ventricular [LV] function” — the ability of the heart’s left ventricle, or chamber, to perform as it should. “Ejection fraction” — a measure of how well the left ventricle pumped with each contraction — also improved, Hammond’s team said.

Patients seemed to stay healthier after the treatment, too. According to the researchers, while 29 percent of those on a placebo ended up admitted to the hospital for heart failure over the year of follow-up, only 9.5 percent of those who got the gene transfer therapy did so.

“AC6 gene transfer safely increased LV function beyond optimal heart failure therapy through a single administration,” Hammond’s team said. The researchers stressed, however, that “larger trials are warranted” to assess the treatment’s true value.

Another cardiologist believes the approach could represent a big advance for patients.

“This trial offers the hope that a single non-drug, non-device treatment could accomplish a hat trick of positive results: improve ejection fraction, reduce hospital readmission and improve relaxation of the heart muscle during its filling phase,” said Dr. Howard Levite, who directs cardiology at Staten Island University Hospital in New York City.

“Each of these findings individually would represent a major advance in management, but the combination of all these findings raises hope that every category of heart failure patient might stand to benefit,” he said.

For her part, Lachmann was cautiously optimistic. Until now, medicines have been the mainstay of treatment, she said, but they can’t repair a damaged heart.

“An intervention [like this], which can reconstruct the original architecture of the heart, would be the ultimate renewal,” she said.

More information

For more on heart failure, head to the American Heart Association.

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You’re Probably Storing and Prepping Your Fruits and Veggies Wrong

Photo: Getty Images

Many of my clients assume they should be eating fresh, raw produce to reap the most health perks possible. But the reality is, several studies have debunked conventional wisdom about the best ways to store, prep, and cook fruits and veggies. Check out these science-backed tips for getting the most nutritional bang per bite from seven of your favorites.

RELATED: Here’s Why You Should Add More Veggies to Your Diet ASAP

Store watermelon at room temperature

After bringing home a watermelon, many people will stick it in the refrigerator. But according to research from the U.S. Department of Agriculture, keeping it out of the fridge can significantly boost the potency of its antioxidants and other nutrients. The study found that after watermelon was picked and stored at room temp, levels of the protective phytochemical lycopene increased by up to 40%, while levels of beta-carotene rose by nearly 140%.

In contrast, the study found that when other types of melons were chilled, their nutrient levels remained about the same. To optimize the longevity of your melons however, the best temp to store them at is a cool 55 degrees. A whole melon will last up to three weeks at that temperature, versus one week in the refrigerator. (Once you slice the melon, leftovers should go in the fridge.)

Steam broccoli

I enjoy cooking broccoli in a variety of ways, including stir-frying, grilling, and sautéing. But one classic study published in the Journal of the Science of Food and Agriculture found that to preserve its nutrients, steaming may be the very best method.

Researchers compared how boiling, steaming, and microwaving impacted the total flavonoid antioxidant levels of broccoli, and found that steaming had a minimal effect. (Meanwhile microwaving diminished levels by up to 97%, and boiling caused a 66% loss.)

To up the appeal of steamed broccoli, toss it with a healthy, flavorful coating, like a bit of sundried tomato pesto, olive tapenade, or tahini. You could also top it with a nut-based sauce, like my favorite—warmed almond butter seasoned with a bit of fresh grated ginger, minced garlic, and crushed red pepper.

RELATED: 7 Ways a Nutritionist Saves Money on Healthy Food

Cook and then chop carrots

I love carrots, but I generally prefer them cooked over raw. As it turns out, that’s a good thing, since cooking them significantly boosts their levels of beta-carotene. But be conscious of your process: Research done at Newcastle University found that if carrots are boiled and then chopped, their anti-cancer properties are 25% higher. That’s because cooking them whole helps lock in their nutrients. If you chop first, you increase the veggie’s surface area, while allows more nutrients to leach out into the water as the cook.

The study also found that cooking before chopping preserves more natural flavor. When 100 people were asked to wear a blindfold and compare the carrots, more than 80% rated those that were cut after cooking as tastier.

Let pears get super ripe

Not all fruits continue to ripen after they’ve been harvested, but pears do. And research from the University of Innsbruck found that allowing pears to really ripen increases levels of certain antioxidants. If you purchase pears that are firm, store them at room temperature in a fruit bowl. To speed up the process, put them next to bananas, which produce an ethylene gas that accelerates ripening. To check if your pear is ready to eat, press on the neck. If it gives, it’s ripe.

Pair leafy greens with good fat

In one study from Ohio State, researchers examined the absorption of several key antioxidants when men and women ate veggies with or without avocado. When lettuce and spinach were paired with the healthy fat, subjects absorbed over eight times more alpha-carotene and 13 times more beta-carotene (which both help fight cancer and heart disease), along with four times more lutein (a nutrient linked to eye health). So whether you whip veggies into a smoothie, toss them on a salad, or cook up some leafy greens, be sure to add a good fat (think avocado, EVOO, nuts, or seeds) to get the most nutritional benefits.

RELATED: Here’s How to Get the Most Health Perks Possible from Olive Oil

Stock up on frozen blueberries

Fresh berries are fantastic. But unfortunately, you can’t get high-quality produce year-round, and that’s when frozen berries can be ideal.

In a study from Leatherhead Food Research, scientists tested the nutrient levels in produce that had been sitting in a fridge for three days, compared to their frozen equivalents. Surprisingly, more nutrients were found in the frozen samples. In fact, in two out of three cases, frozen produce packed higher levels of antioxidants, including polyphenols, anthocyanins, lutein, and beta-carotene. The conclusion: Freezing fruits and veggies doesn’t make them inferior. It actually helps them retain vital nutrients.

Let garlic sit after you crush it

If you enjoy cooking with garlic, use this tip to make it even healthier: After crushing, let the garlic “rest” for a full 10 minutes. Research shows that this step helps the garlic retain more of its anti-cancer power than when you cook it immediately. Why? Crushing garlic releases an enzyme that’s otherwise trapped in the cells of the plant. This enzyme, which helps boost levels of other health-promoting compounds, requires 10 minutes to peak. So set a timer let your garlic do its thing.

RELATED: 11 Fresh Fruit and Veggie Recipes for Spring

Meet Cynthia Sass at the Health Total Wellness Weekend at Canyon Ranch April 22-24. For details, go to http://ift.tt/1AYb7dA.

Do you have a question about nutrition? Chat with us on Twitter by mentioning @goodhealth and @CynthiaSass. 
Cynthia Sass is a nutritionist and registered dietitian with master’s degrees in both nutrition science and public health. Frequently seen on national TV, she’s Health’s contributing nutrition editor, and privately counsels clients in New York, Los Angeles, and long distance. Cynthia is currently the sports nutrition consultant to the New York Yankees, previously consulted for three other professional sports teams, and is board certified as a specialist in sports dietetics. Sass is a three-time New York Times best-selling author, and her newest book is Slim Down Now: Shed Pounds and Inches with Real Food, Real Fast. Connect with her on Facebook, Twitter and Pinterest.

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Genes May Link Risks for Pot Use, Depression

WEDNESDAY, March 30, 2016 (HealthDay News) — A genetic risk for marijuana dependence may be associated with a higher inherited risk for major depression, according to a new study.

Researchers analyzed the gene profiles of more than 14,000 people and identified several genetic variants that significantly boost the risk of marijuana dependence. According to the researchers, it’s the first study to pinpoint those variants.

The investigators also examined whether people with some forms of mental illness might also be at higher risk for marijuana dependence, as they are for alcohol and other substances.

“We were surprised to find a genetic risk overlap between cannabis dependence and major depression,” said study senior author Dr. Joel Gelernter, a professor of psychiatry, genetics and of neuroscience at Yale University, in New Haven, Conn.

The findings might also help explain why many people with schizophrenia have marijuana dependence, he said in a university news release.

The study was published March 30 in the journal JAMA Psychiatry.

More information

The U.S. National Institute on Drug Abuse has more about marijuana.

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Study Explores Mechanism Between Zika Virus, Birth Defects

WEDNESDAY, March 30, 2016 (HealthDay News) — Scientists say they’ve discovered how the Zika virus might cause severe brain and eye birth defects.

The Zika outbreak in Brazil and other parts of Latin American and the Caribbean has coincided with a sharp increase in the number of babies born with microcephaly, which results in abnormally small heads and brains.

There has also been a rise in other brain and eye birth defects in countries affected by the Zika outbreak. But firm evidence of a link between the virus and these birth defects has been lacking.

In a new study, researchers at the University of California, San Francisco (UCSF), found that a protein the Zika virus uses to infect skin cells and cause a rash is also present in stem cells of the developing brain and retina of a fetus.

The so-called AXL protein sits on the surface of cells and can provide an entry point for Zika. Learning more about the link between Zika and AXL could lead to drugs to block Zika infection, according to the researchers.

The brain and eye birth defects occurring in areas with Zika outbreaks are “precisely the kind of damage we would expect to see from something that was destroying neural and retinal stem cells during development,” said study senior author Dr. Arnold Kriegstein. He is director of UCSF’s Center of Regeneration Medicine and Stem Cell Research.

“If we can understand how Zika may be causing birth defects, we can start looking for compounds to protect pregnant women who become infected,” Kriegstein said in a university news release.

The study was published online March 30 in the journal Cell Stem Cell.

A mosquito-borne virus, Zika has been suspected of causing thousands of cases of microcephaly in Brazil.

While the bulk of Zika cases leading to microcephaly may occur via maternal infection during pregnancy, cases of sexual transmission from a man to his female partner have come to light, according to the U.S. Centers for Disease Control and Prevention.

Zika infection is usually a mild illness in adults, and many cases may occur without symptoms, experts say. However, because of the risk to babies, the CDC is advising that men with known or suspected infection with Zika refrain from sex — or only have sex with a condom — for six months after a diagnosis.

The agency also advises that, for couples involving a man who has traveled to or resides in an area endemic for Zika:

• The couple refrain from sex, or use condoms during sex, throughout the duration of a pregnancy.
• They refrain from sex, or use condoms during sex, for eight weeks if the man has returned from travel to a Zika-endemic area but has not shown signs of infection.
• For couples living in a Zika-endemic area, they refrain from sex or engage in sex only with a condom for as long as active Zika transmission persists in that area.

The latest guidelines also recommend that women who know they’ve been infected, or who have no symptoms but have recently been to a Zika-endemic area, or think they might have been exposed via sex, should wait at least eight weeks before trying to get pregnant.

The CDC has also advised that all pregnant women consider postponing travel to any area where Zika virus transmission is ongoing. If a pregnant woman must travel to or live in one of these areas, she should talk to her health-care provider first and strictly follow steps to prevent mosquito bites.

In the majority of Zika infections, symptoms included rash (97 percent of cases), fever and joint pain.

“Zika virus disease should be considered in patients with acute onset of fever, rash, arthralgia [joint pain], or conjunctivitis [pink eye] who traveled to areas with ongoing Zika virus transmission or who had unprotected sex with someone who traveled to one of those areas and developed compatible symptoms within two weeks of returning,” according to the CDC.

First discovered in Uganda in 1947, the Zika virus wasn’t thought to pose major health risks until last year, when it became clear that it posed potentially devastating threats to pregnant women.

The Zika virus has now spread to over 38 countries and territories, most in Latin America and the Caribbean. The World Health Organization estimates there could be up to 4 million cases of Zika in the Americas in the next year.

More information

For more on Zika virus, visit the U.S. Centers for Disease Control and Prevention.

To see the CDC list of sites where Zika virus is active and may pose a threat to pregnant women, click here.

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Caregivers Often Give Up Necessities to Cover Alzheimer’s Costs

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, March 30, 2016 (HealthDay News) — Caring for someone with Alzheimer’s disease means caregivers often skimp on their own food and medical care, and even sell their belongings to support their loved one, a new report released Wednesday shows.

The centerpiece of the Alzheimer’s Association’s annual report was a nationwide survey detailing the heavy financial and emotional toll caregivers endure.

According to the survey, caregivers were 28 percent more likely to eat less or go hungry, and one-fifth cut back on doctor visits. Nearly half of them cut back on their own expenses to afford dementia-related care. And more than one-third reduced their hours at work or quit their job to care for a loved one, losing an average of $15,000 in income.

“Care contributors are making enormous personal and financial sacrifices, and these sacrifices are jeopardizing their own and their family’s financial security,” Beth Kallmyer, vice president of constituent services at the Alzheimer’s Association, said at a press briefing Tuesday on the annual report.

Approximately 5.4 million Americans now suffer from Alzheimer’s disease, according to the Alzheimer’s Association, and nearly 16 million family members and friends provide financial, physical and emotional support. In 2016, it is estimated, those caregivers will give 18 billion hours of unpaid care.

But many people caring for an Alzheimer’s patient have no clue about the financial side of their commitment. About two out of three people incorrectly assume that Medicare will help them cover nursing home costs or are not sure if the costs will be covered.

Currently, only 3 percent of American adults have long-term care insurance that could help them cover these costs, the researchers said.

In fact, 13 percent of those surveyed sold personal belongings, such as a car, to help pay for dementia-related costs, and nearly half dipped into savings or retirement accounts.

On average, the caregivers spent more than $5,000 a year of their own money for care. Many spend tens of thousands of dollars a year, the researchers found.

Much of that money was spent on nursing home care and home care, Kallmyer said.

Many caregivers saw their income decline by 20 percent and their spending on education for their kids dropped 11 percent, Kallmyer said.

Other highlights of the report include:

• Without new treatments, the number of Americans with Alzheimer’s disease will rise to 13.8 million by 2050.
• Nearly 500,000 Americans aged 65 or older will develop Alzheimer’s in 2016.
• Two-thirds of Americans over 65 with Alzheimer’s are women.
• Alzheimer’s is the sixth-leading cause of death in the United States, and the fifth-leading cause for those 65 and older.
• From 2000 to 2013, Alzheimer’s deaths increased 71 percent.
• The yearly cost of caring for Alzheimer’s patients and other dementias in the United States is estimated at $236 billion (excludes unpaid caregiving), of which $160 billion is paid by Medicare and Medicaid.
• Payments for health care, long-term care and hospice for people with Alzheimer’s and other dementias are expected to increase to more than $1 trillion in 2050.
• Annual Medicaid spending for people with Alzheimer’s is $43 billion, while out-of-pocket spending is estimated at $46 billion.

The data for the report comes from 500 responders to a phone survey who are caring for a relative or friend with Alzheimer’s.

To help lessen the money woes, the Alzheimer’s Association suggests:

• Use retirement planning to prepare for long-term medical costs.
• Figure out all your financial resources including savings, insurance, retirement benefits, government assistance, VA benefits, etc. A financial planner or elder care attorney can help.
• Investigate long-term care services in your area.
• Call the local Agency on Aging to determine what services and support programs are available.

“The toll of all serious, chronic diseases extends out from the patient in concentric rings to affect family and friends, too,” said Dr. David Katz, director of the Yale University Prevention Research Center and president of the American College of Lifestyle Medicine.

“That toll is physical, emotional and financial. The news is really rather grim,” he added.

“But as a preventive medicine specialist, I do see opportunity, and a silver lining,” Katz said.

Dementia is substantially preventable through early lifestyle interventions, he said.

“We are all in this together, and compelled to work together to improve systems of care to accommodate this tremendous and growing burden,” he said.

More information

For more on Alzheimer’s disease, visit the Alzheimer’s Association.

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Study Asks, What Is a ‘Good Death’?

By Amy Norton
HealthDay Reporter

WEDNESDAY, March 30, 2016 (HealthDay News) — At the end of their lives, most people want peace, as little pain as possible, and some control over how they die, a new research review finds.

Researchers said the study gives some sense of how people typically define a “good death.”

For those facing a terminal illness, it seems that what matters most is control over the dying process — being home rather than in hospital, for instance — being pain-free, and having their emotional and spiritual needs met.

And for their families, the hopes are largely the same, according to the review of an international array of studies on “successful dying.”

The findings were published March 30 in the American Journal of Geriatric Psychiatry.

Yet, experts said, when it comes to caring for terminally ill patients, doctors often focus the discussion on treatments — which ones are wanted, which ones are not.

“That’s important, but we have to go way beyond that,” said Dr. Dilip Jeste, the senior researcher on the study and director of the Stein Institute for Research on Aging at the University of California San Diego School of Medicine.

“The take-home, to me, is that we really need to talk to patients about the dying process,” Jeste said.

Often, he noted, the subject is seen as “taboo,” by doctors, family members and even patients themselves.

“Even if patients want to talk about it,” Jeste said, “they may be afraid to bring it up with their families, because they don’t want to upset them.”

Because of that, Jeste said, he’s found that patients often “feel relieved” when their health providers broach the subject.

It’s true that “advance care planning” for people with serious illnesses often focuses on treatments, agreed Dr. R. Sean Morrison, who directs the Herzberg Palliative Care Institute at Mount Sinai Icahn School of Medicine, in New York City.

So a patient, for instance, will make decisions about whether he wants doctors to try to prolong his life by using a mechanical ventilator when he can’t breathe on his own, or feeding tube when he can’t eat.

“What this study tells us is, that’s not actually what’s most important to patients and families,” said Morrison, who was not involved in the research.

Instead, he said, they care more about what the remainder of their life will look like — and not just the final days.

According to Morrison, end-of-life discussions — whether they’re between patients and doctors, or among family members — should focus on a person’s values.

“Who are you as person? What’s truly important to you? How do you define a good quality of life?” Morrison said. “If someone says spirituality or religion is important to them, for instance, I better make sure a chaplain is involved at some point.”

For the review, Jeste’s team pulled together 36 international studies looking at patients’, families’ and healthcare providers’ views on “successful” dying. Patients ranged in age, but were elderly on average; most often, they had advanced cancer, heart failure, lung disease or AIDS.

Overall, the researchers found 11 “core themes” that consistently came up across the studies.

For patients, the most common themes were: control over their dying process; being free of pain; spiritual and emotional well-being; and a sense of life being “complete” — which meant having a chance to say good-bye to their loved ones, and feeling that they’d lived “well.”

For the most part, families had the same priorities.

Doctors and other health care providers, meanwhile, valued pain control and patients’ preferences for where and how they died. But they put less emphasis on the existential — like patients’ sense of life completion and spirituality.

To Morrison, the findings offer a “roadmap” for doctors to use in end-of-life discussions. “This essentially gives them a list of core themes that really matter to patients,” he said.

Still, Morrison stressed, any end-of-life discussion has to be highly individual. And he suggested it start when a patient is diagnosed with a disease that is likely terminal.

“Everybody is different,” he said. “We all have to understand and be able to talk about what we value. If it’s important to you to stay at home, tell your doctor you want the type of care that will help you remain at home.”

Jeste agreed. “Ultimately, well-being is defined by the dying person,” he said. “We talk all the time about ‘personalized medicine.’ That has to extend to the end of life. ‘Successful’ dying is an extension of successful living.”

More information

For more on end-of-life care, visit Prepare For Your Care.org .

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Breakfast in School Classrooms Expands Participation, Not Waistlines

WEDNESDAY, March 30, 2016 (HealthDay News) — The number of New York City kids eating free breakfasts in public school classrooms is growing, but the obesity rates are not, a new study finds.

New York City has served free breakfasts to all students since 2003, and began serving them in the classroom in 2007. Nearly 400 of the city’s 1,800 schools now offer classroom breakfast, serving more than 30,000 meals every morning.

Eighty percent of students in those schools take part, compared to 25 percent when the program began, according to the New York City Department of Education.

Despite critics’ concerns, there has been no increase in student obesity rates. The study, published in the Journal of Policy Analysis and Management, found, however, that students’ attendance and school performance did not improve.

A number of U.S. school districts have switched breakfast programs from the cafeteria to the classroom.

“Moving breakfast into the classroom is intended to encourage participation in school breakfast programs, particularly among students unable to arrive early, and to reduce the stigma associated with a trip to the cafeteria,” study author Amy Ellen Schwartz said in a New York University news release. Schwartz is director of NYU’s Institute for Education and Social Policy and is a faculty member at Syracuse University’s Maxwell School of Citizenship and Public Affairs.

Study co-author Sean Corcoran, associate director of the NYU Institute for Education and Social Policy, said the analysis found little benefit of the free meals on youngsters’ attendance and performance in school.

“When looking at academic achievement and attendance, there are few added benefits of having breakfast in the classroom beyond those already provided by free breakfast,” said Corcoran, who is also an associate professor of educational economics. “The policy case for breakfast in the classroom will depend upon reductions in hunger and food insecurity for disadvantaged children, or its longer-term effects.”

This year is the 50th anniversary of the federal School Breakfast Program.

More information

The American Academy of Pediatrics explains why children need a healthy breakfast.

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Could a Low-Risk Surgery Help Your Chronic Heartburn?

By Maureen Salamon
HealthDay Reporter

TUESDAY, March 29, 2016 (HealthDay News) — A minimally invasive surgery to treat chronic heartburn is safer than generally believed, and could be a desirable alternative to long-term use of acid reflux medications, new research indicates.

Scientists found the death rate following so-called laparoscopic fundoplication surgery for gastroesophageal reflux disease, or GERD, was far lower than the 1 percent often quoted.

Experts contended the surgery might be underutilized, especially in light of increasing safety concerns about acid reflux drugs.

“One of the main arguments against surgery when choosing between [drug] and surgical treatment for severe GERD is the risk of mortality,” said study author Dr. John Maret-Ouda. He is a physician and doctoral student in upper gastrointestinal surgery at the Karolinska Institute in Sweden.

But, “this study found only one death associated with [this surgery] among nearly 9,000 patients … during the study period of 1997 to 2013,” he added.

The study results were published in a recent issue of the British Journal of Surgery.

GERD occurs when the muscle at the bottom of the esophagus doesn’t close properly, allowing stomach acid to leak back up and cause irritation. The resulting chronic heartburn is uncomfortable, and can lead to cellular changes that develop into esophageal cancer. GERD affects up to 20 percent of people in the United States, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

Drugs known as proton pump inhibitors, or PPIs, can reduce stomach acid production. Brand names for such medications — one of the top-selling drug classes in the United States — include Prilosec, Prevacid and Nexium. But long-term use of such medications has been potentially linked to some serious health conditions, such as dementia.

Maret-Ouda and his team analyzed 30-day and 90-day death rates after laparoscopic fundoplication surgery for GERD among nearly 9,000 patients. The surgery, which uses several tiny incisions in the abdomen, detaches part of the stomach from the spleen and wraps it around the esophagus, forming a tighter barrier between the stomach and esophagus to prevent acid reflux.

Only one death during the 16-year tracking period was surgery-related, and the 30-day and 90-day death rates were 0.03 percent and 0.08 percent, according to the study.

“Surgery creates a barrier, preventing reflux into the esophagus, while proton pump inhibitors mainly act through reducing the acidity of the gastric contents but not reducing the reflux in itself,” Maret-Ouda said. “Moreover, studies comparing surgery to medication with proton pump inhibitors have found that surgery is superior to medication in aspects of symptom control and acid exposure in the esophagus.”

Two U.S. experts agreed with Maret-Ouda’s assertion that GERD surgery rates have declined in recent years because of the marked increase in PPI use and the perception that surgery carried an unacceptably high death risk.

“What we’ve seen here since 1999 is a fairly dramatic decline in the use of this surgery, in part due to the reputation of the surgery. If you ask the average doctor, they’ll say the mortality rate is around 1 percent, so that’s been a major deterrent,” said Dr. John Lipham, director of the Digestive Health Center at the Keck School of Medicine at the University of Southern California.

“I think this [new research] is a big relief, because upwards of 40 percent of patients with reflux on PPIs are either not getting good control of their symptoms or do not want to be on them because of their long-term risks … but hesitate to have surgery,” he added.

Lipham said most health insurers will pay for laparoscopic GERD surgery, which costs between $15,000 and $30,000, depending on the surgeon and hospital. The operation is considered “routine,” he added.

The cost of PPIs, which are available over-the-counter and by prescription, can vary dramatically, ranging from $17 to more than $160 per month, according to Consumer Reports.

Dr. Kumar Krishnan, a gastroenterologist at Houston Methodist Hospital in Texas, noted that the benefits of fundoplication surgery for GERD can be limited. Also, the surgery may have to be repeated about once a decade, he said.

“One of the questions patients have is, they don’t want to take medications for the rest of their life, but the durability of this surgery is finite and [patients] may need a re-do,” Krishnan said. “Patients also need to know that occasionally they may need to get placed back on medications despite having the surgery.”

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases offers more about GERD.

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