Study - 1# pass time - prep food

[Guest guest]

Does someone have easy access to the recent study concluding that the number one

leisure activity for Americans is preparing food.

TIA

Osowski MS, RD, LD

Registered Dietitian

Sent from my iPhone

> Thanks and I agree with everything you stated especially in the last

> paragraph ... " In the not so distant past, you'd see a definite publication

> bias in

> that industry would squelch results that did not meet their commercial

> aims. More recently, while they can certainly choose to not publish,

> all research must be included in the clinical research database. " And that

> not so distant past was just a few years ago!

>

>

>

> >

> >

> > How is PubMed influenced by money and politics? PubMed is simply a

> > database consisting of papers from biomedical journals. At this time,

> > there are something like 4800 journals publishing; I forget how many

> > are indexed in PubMed. There are criteria that must be met for a

> > journal to be indexed in PubMed. I think you confuse the research and

> > researchers themselves with the database in which papers are indexed.

> > PubMed is not the only database that can be used to search the

> > literature, as I'm sure you're aware. There's CINAHL, ERIC, OVID, and

> > many others. The NLM makes their databases available at no cost. If

> > you go to the gateway, you can also find access to the gene database,

> > protein sequencing (ever want to know the amino acid sequence of many

> > proteins? It's in there. For free), patient education materials (very

> > well done materials, I might add) and also free.

> >

> > PubMed is a free service of the National Library of Medicine. The NLM

> > also makes available a repository of open access publications as well,

> > recognizing that not everyone has access to a medical library. PubMed

> > Central is growing every day, particularly since about 6 or 7 years

> > ago, the NIH made is mandatory for researchers who are funded by NIH

> > money to publish in PubMed Central (if they're research meets peer

> > review criteria). Many also use Google Scholar as their search engine

> > of choice for retrieving information in the biomedical literature.

> > While I use both, because I've been trained on PubMed and teach

> > PubMed, I'm more comfortable there.

> >

> > When I teach research methods and information retrieval, we start with

> > the phrase " Caveat lector " or Let the reader beware. It's up to you,

> > the reader to make sure that what you are reading meets criteria. The

> > peer review process does the first step for you. I've been a reviewer

> > for a number of scientific journals. When asked to review a paper,

> > which can take many hours, we review the purpose, specific aims,

> > methodology, appearance of bias (commercial or simply that the author

> > wanted to get a certain outcome and so, got that outcome), results

> > reporting, and appropriateness of conclusions.

> >

> > There is no way we'll ever get away with no industry funded research.

> > In the not so distant past, you'd see a definite publication bias in

> > that industry would squelch results that did not meet their commercial

> > aims. More recently, while they can certainly choose to not publish,

> > all research must be included in the clinical research database. So,

> > you can search to see who is doing research, what the status of the

> > study is, who is doing it, and if it's been published or not. At the

> > end of the day, it's the reader's responsibility to determine external

> > validity of any research you read. And no, you cannot say it's not

> > good research if it simply doesn't say what you want. That's called

> > being open-minded!

> >

> > For those who are interested, I teach a graduate level course on

> > Nutrition Informatics every other year for UMDNJ. We cover much of

> > this material.

> >

> > I fully agree that everyone needs access to healthcare.

> >

> >

> > Pam Charney, PhD, RD

> >

> > Pamela Charney and Associates, LLC

> > consultants in nutrition informatics

> > Transforming Nutrition Care With Informatics

> >

> > pcharney@...

> > http://www.linkedin.com/in/pamcharney

> >

> >

> >

> > > Pam, I agree with what you are saying! PubMed is the best source but

> > > it also had been influenced by money and politics. There has been some

> > > positive changes in the science publishing community and journals

> > > since now most disclose funding. Science is sometimes backwards or

> > > after the fact. The example is HIV. First it did not exist and was

> > > missed Dx as other diseases since 1950s or longer, then it was a

> > > syndrome, then a virus and then labeled HIV/AIDS. Gulf War syndrome is

> > > similar and when there is no money or explanation it stays a syndrome.

> > > These viruses and syndromes cause hypermetabolic conditions and slow

> > > malabsorption leading to malnutrition. Medical nutrition is an art and

> > > a science! Today's science, medicine, definitions and more change all

> > > the time! Your giving an example of it. Big business is in everything

> > > now, including academia! Special interests trumps what is best for the

> > > patient or student. Bottom line is that if Americans are not given the

> > > opportunity to see a RD and a MD for regular check ups and care,

> > > healthcare cost shall rise and rise bankrupting our country. Time

> > > needs to be spent on basic care. My opinion, more than 90% healthcare

> > > starts with medical nutrition! This message is not getting to

> > > Americans!

> > >

> > > Sent from my iPhone

> > >

> > >

> > >

> > > > ,

> > > >

> > > > The research is not backwards, although I'm not sure what you mean

> > > by

> > > > that. Research is what is it. I'm in complete agreement with you

> > > > regarding the connection between nutrition and chronic illness,

> > > > however, kwashiorkor is not malnutrition as we have been taught in

> > > the

> > > > past.

> > > >

> > > > When I talk about increased mortality with refeeding folks with

> > > > kwashiorkor, I am not talking about the " refeeding syndrome " (that

> > > is

> > > > really an iatrogenic complication, not a condition) that most of us

> > > > might have seen in hospitals. That " refeeding syndrome " is an acute

> > > > hypophosphatemia, hypokalemia, and not quite as severe

> > > hypomagnesemia

> > > > along with pulmonary and cardiac complications seen when one

> > > provides

> > > > carbohydrates in excess of capacity for cellular uptake and

> > > > utilization.

> > > >

> > > > Malnutrition does not equal malabsorption, nor does it equal

> > > > hypermetabolism. All are separate but can interact when present

> > > > concurrently. I think it behooves us to approach this from a

> > > science-

> > > > based perspective. The National Library of Medicine (NLM) offers the

> > > > free search engine, PubMed that can be used to search for literature

> > > > that has been peer-reviewed.

> > > >

> > > > Pam Charney, PhD, RD

> > > >

> > > > Pamela Charney and Associates, LLC

> > > > consultants in nutrition informatics

> > > > Transforming Nutrition Care With Informatics

> > > >

> > > > pcharney@...

> > > > http://www.linkedin.com/in/pamcharney

> > > >

> > > >

> > > >

> > > > > Pam, The research is backwards and not pure science. Like you

> > > > stated,

> > > > > it is money or politics at play here. Malnutrition is a slow

> > > > occuring

> > > > > process in which once it gets to a certain point, it starts the

> > > slow

> > > > > cycle of illness leading to chronic illness and organ failure. You

> > > > are

> > > > > right, when illness due to this malnutrition occurs, refeeding

> > > could

> > > > > be dangerous and even deadly. As with everything in life, timing

> > > is

> > > > > everything. It is really the denial of malnutrition, malabsorption

> > > > and

> > > > > hypermetabolism that is the problem!

> > > > >

> > > > > Sent from my iPhone

> > > > >

> > > > > On Feb 21, 2011, at 11:35 AM, Pam Charney

> > > wrote:

> > > > >

> > > > > > ,

> > > > > >

> > > > > > With all due respect, one should not use Today's Dietitian as

> > > the

> > > > > > place to learn the latest science. The information published

> > > there

> > > > > is

> > > > > > not peer reviewed, nor is it systematic. It's what we call a

> > > > > > " journalistic review " . That's not a bad thing, I've written for

> > > > them

> > > > > > myself, it's just that you should know the difference.

> > > > > >

> > > > > > I know you like magnesium as the perpetrator for a number of

> > > > health

> > > > > > conditions, based on your recent posts here. However,

> > > > kwashiorkor is

> > > > > > not protein and electrolyte imbalance, at least not at the root

> > > > > cause.

> > > > > > In fact, in some research, when you give folks with (real)

> > > > > kwashiorkor

> > > > > > protein and electrolytes without considering co-morbid

> > > conditions,

> > > > > you

> > > > > > often end up increasing mortality, which we really don't want to

> > > > do.

> > > > > >

> > > > > > What's going on here is much more complex; it's a mix of

> > > > facilities

> > > > > > trying to pull as much medicare money their way and RDs not

> > > > stepping

> > > > > > up with evidence to show what is and what is not truly a

> > > nutrition

> > > > > > problem.

> > > > > >

> > > > > > I'd urge you to search PubMed for some of the more recent papers

> > > > on

> > > > > > kwashiorkor. Golden from the UK had published some that

> > > > are

> > > > > > very readable. There are others in the tropical medicine

> > > journals

> > > > > that

> > > > > > also talk about some other purported etiologies for kwashiorkor.

> > > > > >

> > > > > > Regards,

> > > > > > pam

> > > > > >

> > > > > > Pam Charney, PhD, RD

> > > > > >

> > > > > > Pamela Charney and Associates, LLC

> > > > > > consultants in nutrition informatics

> > > > > > Transforming Nutrition Care With Informatics

> > > > > >

> > > > > > pcharney@...

> > > > > > http://www.linkedin.com/in/pamcharney

> > > > > >

> > > > > >

> > > > > >

> > > > > > > Marasmus is starvation, kwashiorkor is protein starvation and

> > > > > > > electrolyte

> > > > > > > imbalance. A Today's Dietitian article a few months age

> > > directed

> > > > > me

> > > > > > > to B1 for

> > > > > > > refeeding anorexia - it worked - I was so disoriented, and my

> > > > > heart

> > > > > > > was fluttery

> > > > > > > and weird. The magazine had flipped open to that page and it

> > > > was a

> > > > > > > life saver.

> > > > > > > When you are that underfed, there really is no appetite - zinc

> > > > > > > deficiency

> > > > > > > worsens appetite I believe. The magnesium deficiency adds to

> > > the

> > > > > > > edema problem

> > > > > > > that the lack of albumin causes. Loss of muscle tone,

> > > alopecia,

> > > > > and

> > > > > > > dermatologic

> > > > > > > symptoms would all relate to protein deficiency. Getting

> > > > > rehydrated

> > > > > > > was

> > > > > > > necessary before I could swallow much food. When one or two

> > > > bites

> > > > > > > feels like

> > > > > > > sawdust it is easy to give up eating and not figure out how to

> > > > > start

> > > > > > > again.

> > > > > > > Rehydration requires magnesium as well as sodium and

> > > potassium.

> > > > > Many

> > > > > > > major

> > > > > > > electrolyte brands don't even have magnesium - it was

> > > regulated

> > > > > out

> > > > > > > sometime in

> > > > > > > the 20's - 30's.

> > > > > > >

> > > > > > > I think that that doctor and hospital system is recognizing

> > > the

> > > > > > > problem I've

> > > > > > > been working on - we can't heal and regenerate tissue if we

> > > > don't

> > > > > > > have the

> > > > > > > nutrients. As for increased Medicare billing I hope the

> > > > hospital/

> > > > > > > doctor is

> > > > > > > figuring out how to use that money to actually nourish the

> > > > > starving

> > > > > > > seniors and

> > > > > > > isn't just bonusing it out to executives.

> > > > > > >

> > > > > > > Kwashiorkor was more prevalent in starving children

> > > countries -

> > > > > > > edamatous belly

> > > > > > > - but I just saw that in my father-in-law. I couldn't find a

> > > > > formula

> > > > > > > that didn't

> > > > > > > have the high calcium level that throws off absorption. Our

> > > > > enteral

> > > > > > > feedings

> > > > > > > are not based on ratios that the chronically ill can absorb.

> > > The

> > > > > > > feeding made

> > > > > > > him worse, 40 pounds edamatous. So painfully swollen with

> > > water

> > > > > and

> > > > > > > skin

> > > > > > > integrity you could poke a fingernail through (it seemed).

> > > He is

> > > > > > > getting better

> > > > > > > finally.

> > > > > > >

> > > > > > > Providing " Health Shakes " and supplemental formulas that are

> > > > > high in

> > > > > > > calcium

> > > > > > > isn't helping. The problem is not that there is no protein in

> > > > the

> > > > > > > diet or even

> > > > > > > in the body - the problem is keeping the protein in the cells

> > > > and

> > > > > > > blood vessels

> > > > > > > where it can do some good. Magnesium is what is needed to

> > > > prevent

> > > > > > > the leaky

> > > > > > > membranes and in the chronically ill calcium is being

> > > > > preferentially

> > > > > > > absorbed.

> > > > > > >

> > > > > > > I want to make sweet potato ginger smoothies boosted with

> > > > garbanzo

> > > > > > > bean puree

> > > > > > > for everybody.

> > > > > > >

> > > > > > >

> >

http://www.nutritionmd.org/health_care_providers/general_nutrition/protein_malnu\

trition.html

> > > > > > >

> > > > > > > Protein-Calorie Malnutrition: Overview and Treatment

> > > > > > > Protein-calorie malnutritionresults in 2 similar but distinct

> > > > > > > diseases, marasmus and kwashiorkor.

> > > > > > >

> > > > > > > Marasmus is defined simply as chronic deprivation of energy

> > > > needed

> > > > > > > to maintain body weight. Its extreme form is characterized by

> > > > > severe

> > > > > > > weight loss and cachexia.1 Marasmus is further characterized

> > > by

> > > > > > > subnormal body temperature, decreased pulse and metabolic

> > > rate,

> > > > > loss

> > > > > > > of skin turgor, constipation, and starvation diarrhea,

> > > > > consisting of

> > > > > > > frequent, small, mucus-containing stools.2

> > > > > > > Kwashiorkor is a somewhat more complex disease. It is

> > > > > characterized

> > > > > > > by edema, low capillary-filtration rate, hypoalbuminemia, and

> > > > > > > dermatitis.

> > > > > > >

> > > > > > > Derived from an African term meaning " the disease that occurs

> > > > when

> > > > > > > the next baby is born " , kwashiorkor was initially thought to

> > > > > result

> > > > > > > from a diet high in calories (mainly carbohydrates, such as

> > > > > maize),

> > > > > > > yet deficient in protein. However, infection, aflatoxin

> > > > poisoning,

> > > > > > > and oxidative stress may also play causative roles.1,3

> > > Edema, a

> > > > > > > defining

> > > > > > > characteristic of kwashiorkor, resolves with treatment,

> > > despite

> > > > > > > continuing hypoalbuminemia, suggesting that the edema is due

> > > to

> > > > > > > leaky cell membranes, low capillary filtration rates, high

> > > > > > > concentrations of free iron, and free radicals that increase

> > > > > > capillary

> > > > > > > permeability.4 Kwashiorkor is further distinguished from

> > > > > marasmus by

> > > > > > > the following findings:

> > > > > > > * Massive edema of the hands and feet.

> > > > > > > * Profound irritability.

> > > > > > > * Anorexia.

> > > > > > > * Dermatologic symptoms (desquamative rash, hypopigmentation).

> > > > > > > * Alopecia or hair discoloration.

> > > > > > > * Fatty liver.

> > > > > > > * Loss of muscle tone.

> > > > > > > * Anemia and low blood concentrations of albumin, glucose,

> > > > > > potassium,

> > > > > > > and magnesium.5,6

> > > > > > > Kwashiorkor may also involve severe, life-threatening

> > > > > > hypophosphatemia

> > > > > > > (<1.0 mg/dL), which has been found to triple the mortality

> > > rate

> > > > > when

> > > > > > > compared with children who have normal phosphorus levels.7

> > > > > > > Treatment

> > > > > > > Individuals treated for protein-energy malnutrition are at

> > > risk

> > > > > for

> > > > > > > refeeding syndrome, in which hypophosphatemia, hypokalemia,

> > > and

> > > > > > > hypomagnesemia may lead to disturbances in the cardiac,

> > > > > neurologic,

> > > > > > > gastrointestinal, respiratory, hematologic, skeletal, and

> > > > > endocrine

> > > > > > > systems. Guidelines have been developed to help prevent these

> > > > > > > complications

> > > > > > > and to establish a transition to normalcy. Treatment consists

> > > > of 2

> > > > > > > phases: stabilization and rehabilitation.

> > > > > > >

> > > > > > > The initial (stabilization) phase proceeds from days 1 through

> > > > > 7. It

> > > > > > > consists of treatment and prevention of hypoglycemia,

> > > > hypothermia,

> > > > > > > dehydration, and infection; correction of electrolyte

> > > imbalance

> > > > > and

> > > > > > > micronutrient deficiencies; and a cautious feeding regimen.

> > > > > > >

> > > > > > > http://www.wrongdiagnosis.com/k/kwashiorkor/book-diseases-7a.htm

> > > > > > >

> > > > > > > Protein-calorie malnutrition: Excerpt from Professional

> > > Guide to

> > > > > > > Diseases

> > > > > > > (Eighth Edition)

> > > > > > > " Both kwashiorkor (edematous PCM) and marasmus (nonedematous

> > > > PCM)

> > > > > > > are common in

> > > > > > > underdeveloped countries and in areas in which dietary amino

> > > > acid

> > > > > > > content is

> > > > > > > insufficient to satisfy growth requirements. Kwashiorkor

> > > > typically

> > > > > > > occurs at

> > > > > > > about age 1, after infants are weaned from breast milk to a

> > > > > protein-

> > > > > > > deficient

> > > > > > > diet of starchy gruels or sugar water, but it can develop at

> > > any

> > > > > > > time during

> > > > > > > the formative years. Marasmus affects infants ages 6 to 18

> > > > > months as

> > > > > > > a result

> > > > > > > of breast-feeding failure, or a debilitating condition such as

> > > > > > chronic

> > > > > > > diarrhea.

> > > > > > >

> > > > > > > In industrialized countries, PCM may occur secondary to

> > > chronic

> > > > > > > metabolic

> > > > > > > disease that decreases protein and calorie intake or

> > > absorption,

> > > > > or

> > > > > > > trauma that

> > > > > > > increases protein and calorie requirements. In the United

> > > > States,

> > > > > > > PCM is

> > > > > > > estimated to occur to some extent in 50% of elderly people in

> > > > > > > nursing homes.

> > > > > > > Those who aren’t allowed anything by mouth for an extended

> > > > > period

> > > > > > > are at high

> > > > > > > risk of developing PCM. Conditions that increase protein-

> > > calorie

> > > > > > > requirements

> > > > > > > include severe burns and injuries, systemic infections, and

> > > > cancer

> > > > > > > (accounts

> > > > > > > for the largest group of hospitalized patients with PCM).

> > > > > Conditions

> > > > > > > that cause

> > > > > > > defective utilization of nutrients include malabsorption

> > > > syndrome,

> > > > > > > short-bowel syndrome, and Crohn’s disease.

> > > > > > >

> > > > > > > Read more at

> > > > > > >

> >

http://www.wrongdiagnosis.com/k/kwashiorkor/book-diseases-7a.htm?ktrack=kcplink

> > > > > > >

> > > > > > > Signs and symptoms

> > > > > > > Children with chronic PCM are small for their chronological

> > > age

> > > > > and

> > > > > > > tend to be

> > > > > > > physically inactive, mentally apathetic, and susceptible to

> > > > > frequent

> > > > > > > infections. Anorexia and diarrhea are common.

> > > > > > >

> > > > > > > In acute PCM, children are small, gaunt, and emaciated, with

> > > no

> > > > > > > adipose tissue.

> > > > > > > Skin is dry and “baggy,†and hair is sparse and dull brown

> > > > or

> > > > > > > reddish-yellow.

> > > > > > > Temperature is low; pulse rate and respirations are slowed.

> > > Such

> > > > > > > children are

> > > > > > > weak, irritable, and usually hungry, although they may have

> > > > > > > anorexia, with

> > > > > > > nausea and vomiting.

> > > > > > >

> > > > > > > Unlike marasmus, chronic kwashiorkor allows the patient to

> > > > grow in

> > > > > > > height, but

> > > > > > > adipose tissue diminishes as fat metabolizes to meet energy

> > > > > demands.

> > > > > > > Edema

> > > > > > > often masks severe muscle wasting; dry, peeling skin and

> > > > > > > hepatomegaly are

> > > > > > > common. Patients with secondary PCM show signs similar to

> > > > > marasmus,

> > > > > > > primarily

> > > > > > > loss of adipose tissue and lean body mass, lethargy, and

> > > edema.

> > > > > > Severe

> > > > > > > secondary PCM may cause loss of immunocompetence.

> > > > > > >

> > > > > > > Diagnosis

> > > > > > > CONFIRMING DIAGNOSIS Clinical appearance, dietary history, and

> > > > > > > anthropometry

> > > > > > > confirm PCM. If the patient doesn’t suffer from fluid

> > > retentio

> > > > n,

> > > > > > > weight change

> > > > > > > over time is the best index of nutritional status.

> > > > > > >

> > > > > > > The following factors support the diagnosis:

> > > > > > > â‘ height and weight less than 80% of standard for the

> > > > > patient’s

> > > > > > > age and sex,

> > > > > > > and below-normal arm circumference and triceps skinfold

> > > > > > >

> > > > > > > â‘ serum albumin level less than 2.8 g/dl (normal: 3.3 to 4.3

> > > > g/

> > > > > dl)

> > > > > > > â‘ urinary creatinine (24-hour) level used to show lean body

> > > ma

> > > > ss

> > > > > > > status by

> > > > > > > relating creatinine excretion to height and ideal body weight,

> > > > to

> > > > > > > yield

> > > > > > > creatinine-height index.

> > > > > > >

> > > > > > > R Vajda, R.D.

> > > > > > > www.GingerJens.com

> > > > > > >

> > > > > > > ________________________________

> > > > > > >

> > > > > > > To: rd-usa ; dhcc@...

> > > > > > > Sent: Sun, February 20, 2011 8:50:58 PM

> > > > > > > Subject: FW: Hospital chain, under scrutiny, reports

> > > > rare

> > > > > > > illness |

> > > > > > > Local News | PE.com | Southern California News | News for

> > > Inland

> > > > > > > Southern

> > > > > > > California

> > > > > > >

> > > > > > > This is a very interesting article. Aside from the fact that

> > > our

> > > > > tax

> > > > > > > $$ are

> > > > > > > now going to our neighbor to the North, what is the accurate

> > > > > > > definition of

> > > > > > > Kwashiorkor IYO? And how is it diagnosed?

> > > > > > >

> > > > > > > Digna

> > > > > > >

> > > > > > > Hospital chain, under scrutiny, reports rare

> > > illness |

> > > > > > > Local News |

> > > > > > > PE.com | Southern California News | News for Inland Southern

> > > > > > > California

> > > > > > >

> > > > > > >

> > http://www.pe.com/localnews/stories/PE_News_Local_D_malnutrition20.27e2afa.h

> > > > > > > tml

> > > > > > >

> > > > > > >