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Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Living healthier into old age
Author: Michelle Hoffer
Date: November 18, 2011 10:18 PM
Public health efforts to improve the lives of America have been profound. Modern public health effortshave raised the life expectancy in the United States by nearly 50 percent in the first half of thetwentieth century, from 45 to 65 years old (Engle, 2006). According to the CDC, the average lifeexpectancy rate in 2007, for either sex in the United States, was 77.9 years old (CDC, 2010). Babyboomers are entering their retirement years which will prove challenging to provide long term care(Cashdollar, 2001). By the year 2030, the number of older adults needing nursing home care willmore than triple (Boyle & Holden, 2010). Can Medicare continue to cover long-term care? With howour economy and fiscal budgets stand, I highly doubt it. Reform needs to occur. Many believe that nutrition services are the cornerstone of cost-effective prevention and are essentialto halting the spiraling cost of health care (Boyle & Holden, 2010, p. 299). As a communitynutritionist, name one way you can help this aging population live healthier lives into retirement.
Relieving financial strain with LTC and hospitalizations can be of vital concern towards stabilization ofour health care system. Examples could include assessment, counseling, education, policy change,research, administration or implementing a new program.
Works CitedBoyle & Holben. (2010). Community Nutrition in Action An Entrepreneurial Approach. Belmont:Wadsworth.
Cashdollar, W. (2001). Care for the long term. Association Managment, pp. 67-70.
CDC. (2010). Centers for Disease and Prevention. Retrieved October 12, 2011, from Health, UnitedStates with special features of death and dying: http://www.cdc.gov/nchs/data/hus/hus10.pdf#022Engle, J. (2006). Poor People's Medicine. Durham: Duke University Press.
Jonas S & Kovner A. (2008). Health Care Delivery in the United States. New York: Springer PublishingCompany, LLC Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Scott Marlow
Date: November 24, 2011 12:25 PM
Great question regarding healthy living into old age. It’s unfortunate that we as a species considerhaving the average American live to 77.9 years of age to be an accomplishment. We are not evencoming close to realizing our true life potential of >120 years of age. We have people dying fromcancer and heart disease in their forties and fifties (tragic). So why do I believe that our true lifepotential is in excess of 120 years? The longest lived human being officially confirmed was JeanneCalment who lived to be 122 years of age (Wikipedia, 2011). That means it’s possible. Furthermore, https://learning.umassonline.net/webct/urw/lc13056874282091.tp1…eid=16436936970171&topicid=13670326197151&areaid=13670326195151 Genesis 6:3 states in reference to man “his days shall be one hundred and twenty years” (New KingJames Bible, 1982). Even if you’re not religious, you have to admit that this is a strange coincidence.
Interestingly, residents of Okinawa, Japan, boast the highest life expectancy (86.0 years), the highestnumber of centenarians, and rates of cancer and heart disease that are a fraction of those in the U.S.
population. The Okinawans eat a calorie-restricted (~10% less) and primarily plant-based dietconsisting of sweet potatoes (69%), rice (12%), leafy greens (3%), legumes (6%) with smallamounts of calories from fish (1%), meat (<1%), eggs (<1%), and dairy (<1%) (Wilcox, et al.,2007). Reform most definitely needs to occur and I feel that nutrition services will be instrumental inthis overhaul to the current health care system. As a community nutritionist and as a human being, Iwould make a commitment to uphold the Code of Ethics for the Dietetics Profession providingaccurate information to the public, family, and friends that is based on evidence-based principles andcurrent information. We as a group (MPHN students) have opened our eyes to the global burden offood induced chronic diseases and the ineffectiveness of the present health care system to treat thesemanifestations of food induced homeostatic dysfunction. We are embarking on a journey that couldprove instrumental in the transformation from a treatment-based approach to preventive care. The Holy Bible, New King James Version (1982). Genesis 6:3. Thomas Nelson: Columbia Wilcox, B. J., et al. (2007). Calorie restriction, the traditional Okinawan diet, and healthy aging: thediet of the world’s longest-lived people and its potential impact on morbidity and life span. Ann. N.Y.
Acad. Sci., 1114: 434-455.
Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Michelle Hoffer
Date: November 28, 2011 10:18 PM
Scott,Excellent examples on how you could help with policy/prevention strategies. I was very interested tosee your connection with the biblical reference and the oldest person in the world records. I do believeaccurate information is important when making recommendations about diet/health. I can't sayenough about how much I support a primarily plant based diet. I have read countless articles aboutthe benefits of it and the names that Mona suggested like Esselstyne ect have provided excellentresearch to support this. After reading The China Study by T.Colin Campbell I even changed from avegetarian diet to a vegan diet and I am healthier and so is my family. We do have a responsibility asMPHN students and I do believe that we can keep stomping at the ground and someone will finallyhear. The burden is huge to change our society's nutrition habits, but do you believe that if you saved oneperson's life it was worth all the effort? Or does the effort have to effect many? I would go with theone and be pretty happy.
Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Scott Marlow
Date: November 30, 2011 12:01 AM
https://learning.umassonline.net/webct/urw/lc13056874282091.tp1…eid=16436936970171&topicid=13670326197151&areaid=13670326195151 In my opinion, The China Study should be mandatory reading for all future dietitians. I agree with youthat if I could save just one life then it would all be worth it, although, I'm hoping for a slightly largernumber. I have no doubt that the vegan diet (especially raw) is the optimal diet for our species andthat when you break the laws of nature, nature breaks you (disease/death). Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Michelle Hoffer
Date: November 30, 2011 11:13 PM
Scott, great summary and I conclude with an AMEN! Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Mona Sigal
Date: November 27, 2011 5:45 PM
Michelle, your discussion point is similar to Ann's.
Although I am not a nutritionist or dietitian, I completely agree with you, that nutrition is thecornerstone of preventive medicine.
I teach plant based nutrition for disease prevention and reversal. At this time it is an uphill battle toteach it, but in my long term vision, I forsee/ wish that nutrition will be prescribed just as medicationis today.
Thanks to clinical research done by Drs Dean Ornish, Caldwell Esselstyn, John McDougall and last butnot least the Physicians Committee for Responsible Medicine, led by Dr Neil Barnard, it has benunequivocally shown, that a whole foods plant based diet can REVERSE hypertension, diabetes Type2, and many other chronic diseases, as well as prevent them. It has also been shown that this type ofdiet can prevent, mitigate and increase survival of many types of cancer.
The question begs, therefore, why this kind of disease management/disease prevention is not being"mandated/enforced".
When the physician writes a prescription for Micronase, many industries make a profit. When I switch a patient to a whole foods plant based diet, NO ONE makes a buck - therein lies thecore problem.
In my ideal world, a patient who presents to the doctor with overweight, pre-diabetes and mildhypertension, will FIRST and FOREMOST be placed on a plant based whole foods diet; within 3 weeks(clinical studies have shown) the majority of the symptoms have improved if not resolved. In today's reality, such a patient is being placed on 2-3 medications at the first visit.
Many degenerative diseases could also be markedly improved with such a diet. A 87 year old patientof mine, placed on this diet, normalized her weight (she was slightly underweight), and shediscontinued one of her two BP medications, while reducing the second by half. In addition, thepatient's chronically recurrent UTI's, which had been plaguing her for years, and which were treatedwith chronic antibiotics (which did not prevent the UTIs') RESOLVED due to the plant based diet and aprobiotic. https://learning.umassonline.net/webct/urw/lc13056874282091.tp1…eid=16436936970171&topicid=13670326197151&areaid=13670326195151 Can you imagine rendering this kind of geriatric care? Visiting any NH or assisted living today, and looking at their menus, I am horrified. It is akin to tryingto bring these elderly to an earlier grave than they will already go. But there is no cost savings there,since in the process, these elderly consume a significant amount of health care cost in their last yearsof life. Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Michelle Hoffer
Date: November 28, 2011 10:23 PM
Great example Mona,I also believe that a plant based diet should be part of our preventive medicine. Your class must be sointeresting, how do the students take to it?I think rendering the type of geriatric care you discuss would be wonderful and helpful in the "perfectworld" but money always has to come into play, doesn't it? I think it is great that you are at least ableto share your understanding of this importance with your patients. Talking about Esselstyn and McDougall, have you watched the new DVD out called "Forks over Knives"by T.Collin Campbell and it features Dr. Esselstyn and his work? It's a great video and discusses theimportance of the plant based diet.
Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Mona Sigal
Date: November 29, 2011 10:09 PM
Actually, I was quite disappointed by Forks over Knives. I expected a much more powerfulpresentation. I always recommend the documentary EATING, which can be purchased on DVD atAmazon. All the major "players" appear (McDougall, Esselstyn, Barnard, Campbell etc) but the formatis very powerful. It turned several people vegan.
Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Scott Marlow
Date: November 29, 2011 11:35 PM
I agree with you that Fork over Knives could have have been a more powerful presentation. I willhave to watch EATING. I would also recommend the movie "Curing Cancer From the Inside Out" (verypowerful message). I actually wrote a paper for an undergrad nutrition course that I titled "TheNutritional Control of Cancer". The optimal plan of attack is to maximize intake of whole foodscontaining antioxidants and phytochemicals while eliminating foods that contain casein (cancerpromoter) and to eat a LOW (<10%) protein/methionine diet, which reduces IGF-1 levels and boosts https://learning.umassonline.net/webct/urw/lc13056874282091.tp1…eid=16436936970171&topicid=13670326197151&areaid=13670326195151 glutathione levels (the master antioxidant). Anyway, just some food for thought. Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Mona Sigal
Date: November 30, 2011 12:16 AM
Scott, I am a certified Food For Life Instructor with PCRM, the Physicians Committee for ResponsibleMedicine. The Food For Life program, which teaches plant based, whole foods, low fat diet has tocurricula for teaching nutrition and cancer: one is aimed at the general population, for cancerprevention, and the other is aimed at cancer survivors, who want to beat the odds of recurrence.
Yes, I am very familiar with the benefits of a plant based diet in cancer prevention. The PCRM CancerProject has fantastic resources for professionals as well as for the public. If you are not familiar wittheir website, you should check it out: PCRM.orgMona Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Michelle Hoffer
Date: December 1, 2011 12:05 AM
Mona you inspired me to fill out my PCRM subscription that has been sitting in my bag for 2 monthswith the intention of filling it out. My Mother-in-Law got me started reading it when she shared it withme. Thanks for sharing your experience.
Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Mona Sigal
Date: December 3, 2011 7:38 PM
Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Michelle Hoffer
Date: November 30, 2011 11:14 PM
Thanks Mona, I am going to check out that DVD right now on Netflix if it is there or order it. If it issuperior to Forks over Knives then I want to check it out.
https://learning.umassonline.net/webct/urw/lc13056874282091.tp1…eid=16436936970171&topicid=13670326197151&areaid=13670326195151 Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Scott Marlow
Date: November 29, 2011 4:45 PM
Like you stated, there are huge financial rewards for many industries that are realized by sustainingthe current ineffective treatment approach, but there is no money in cures. The goal appears to be tokeep people somewhat alive with a sub par quality of life for decades so they can continue to feed atthe sick care/pharmacautical trough and make some people rich at the expense of their own health.
According to Dr. McDougall, it is possible to actually die at home of old age (your heart stops and younever wake up), although most people die from preventable chronic diseases in a health care facility. My wife is a primary care nurse practitioner (master's prepared) and is a proponent of lifestyleintervention. One of her paitients (68 year old man) with heart disease had previously had stents anda coronary artery bypass graft. He was taking a statin (40mg)/antihypertensives/nitro and still havingangina every morning. She discussed the research of Dr. Esselstyn with him and he went out andbought the book. He has been following this lifestyle for 10 months and feels like he is thirty again.
His angina stopped within days and his total cholesterol dropped below 100 mg/dL. What most people don't realize is that most disease is the result of the same underlying condition(toxemia). More specifically, our enervating or body weakening lifestyles allow for the buildup ofexogenous and endogenous toxins to accumulate in the body. This results in the manifestation ofvarious diseases and associated symptoms (Tilden, 2007).
If everyone woke up and started taking responsibility for their own health instead of expecting thehealth care system to fix them, I would be out of a job. We would however still need emergencyphysicians to treat traumas and accidental injuries though. Tilden, J. H. (2007). Toxemia Explained: The True Interpretation of the Cause of Disease.
Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Mona Sigal
Date: November 29, 2011 10:14 PM
God bless your wife- and you. My husband discontinued his cholesterol lowering medication and hisblood pressure meds after turning vegan. My mom in law, who has been living with us, had todiscontinue one of her BP meds and half the dosage on the second one, as well as discontinue hercholesterol medication, once she ate vegan only - at the age of 87. It is NEVER too late.
The problem is: taking responsibility, as you say. We, as Americans, are not very good at that. Wewant quick fixes, pills, surgeries. When I teach plant based nutrition, I get comments like: "Wow, that's drastic!" That's when I showthe slide of the patient with the sternotomy scar, and say: "No. THIS is drastic." https://learning.umassonline.net/webct/urw/lc13056874282091.tp1…eid=16436936970171&topicid=13670326197151&areaid=13670326195151 Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Michelle Hoffer
Date: December 1, 2011 12:13 AM
Scott and Mona, Can I meet you for coffee and just talk about this topic for hours :-) Why wontAmericans see what damage they are doing to their bodies. I saw a 37 year old woman in the Dentalclinic and no joke, she had 15 medications, was diabetic, arthritic, had a retinal transplant, wasobese, hypertensive and depressed. Guess what she put on the counter as she sat down? A 60 ozsoda and also had failed to eat breakfast that morning! I am dumbfounded! Why on earth would youjust succeed to the fact that taking 15 meds at 37 is ok??? But when you ask someone to change theirdiet they shout.no way, no how are you taking anything away from me. I just don't get it.
Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Mona Sigal
Date: December 3, 2011 7:39 PM
Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Living healthier into old age
Author: Michelle Hoffer
Date: December 1, 2011 12:07 AM
Topic: U8 Discussion - Health Care Systems and Policy -
Subject: MNT reimbursement
Author: Jennifer Lerman
Date: November 28, 2011 9:47 PM
Hi Michelle,Great question. There are clearly many ways that we could use nutrition to improve healthy years inold age. Some of these ways have been mentioned by Scott and Mona. Since we are studying policyin this unit, I will propose a policy change that might also aid in healthier living for the elderly. As we have discussed in other units, Medicare is the main payer for healthcare for elderly individualsover 65 years of age. However, despite the known benefits of nutrition in both preventing and treatingchronic diseases including hypertension and cardiovascular disease. However, Medicare onlyreimburses providers for MNT (medical nutrition therapy) in two instances: diagnosed diabetes anddiagnosed kidney disease. https://learning.umassonline.net/webct/urw/lc13056874282091.tp1…eid=16436936970171&topicid=13670326197151&areaid=13670326195151 What this means is that individuals at high risk for these diseases would have to pay 100% of the costfor a visit to a nutritionist (unless covered by a supplemental insurance plan). Prevention is not part ofthe system, so a visit that might help prevent such a disease, or treat something like hypertension, isnot reimbursable. I have seen a patient with a BMI > 40 come in for a visit with an RD, and be told that Medicare wouldnot pay for a visit for weight loss counseling because that patient did not have diabetes or kidneydisease (yet). This is a policy that should be changed at a federal level to help Americans live healthier lives into oldage. There are significantly more evidence-based nutrition interventions that should be reimbursed byfederal healthcare programs.
References:Medicare.gov. Medical Nutrition Therapy. Accessed onlinehttp://www.medicare.gov/navigation/manage-your-health/preventive-services/medical-nutrition-therapy.aspx?AspxAutoDetectCookieSupport=1.
Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:MNT reimbursement
Author: Michelle Hoffer
Date: November 28, 2011 10:40 PM
Jennifer, great example of a benefit of policy change. It is unbelievable that Medicare won't pay fornutritional services if the patient has all the risk factors but hasn't had the "disease" yet. Policychange at this level would be essential to help in this area. I know many people who have fixedincomes and have to choose from paying the heat to getting a nutritional counseling session paid forwill most likely choose the heat. Why can't Medicare see how much cost savings they could obtain ifthey offered paying for simple nutritional costs? hummm? Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:MNT reimbursement
Author: Jennifer Lerman
Date: November 29, 2011 9:50 PM
Agreed Michelle. I know it is something the ADA has lobbied for, and in fact it was only in 2002 thatMedicare even started covering MNT. I looked around on the ADA website (I think the part I was inwas accessible only to members) and found the ADA position and current issues, pasted below foranyone interested. It is at least nice to know that the organization is working on this policy issue.
Medical Nutrition Therapy Issue BriefMedical Nutrition Therapy (MNT) is the legal definition of nutrition counseling provided by a registereddietitian. The MNT benefit is currently offered through Medicare (although it is limited in scope), RyanWhite programs, Older Americans Act programs and Indian Health Services. Some states offer MNT intheir Medicaid and Children's Health Insurance Programs as well. https://learning.umassonline.net/webct/urw/lc13056874282091.tp1…eid=16436936970171&topicid=13670326197151&areaid=13670326195151 Recommendations/PositionThe application of medical nutrition therapy (MNT) and lifestyle counseling as a part of the NutritionCare Process is an integral component of the medical treatment for managing specific disease statesand conditions. As such, it should be the initial step in the management of these situations. Cost-effective interventions that show improvements in personal health practices are likely to lead tosubstantial reductions in the incidence and severity of the leading causes of disease in the US.
ADA is currently working to:Cover hypertension, dyslipidemia and other diseases and disorders in Medicare, as well as coverpreventive treatments for pre-diabetes.
Successfully implement Ryan White HIV/AIDS care programs to maximize the impact of nutrition careand services.
Increase utilization and payment rates for MNT services.
Seek MNT expansion in more public and private programs.
BackgroundIn 2002, MNT became a covered service through Medicare; however, coverage was limited to diabetesand renal disease as Congress wanted to collect more data on other conditions that could benefit fromnutrition counseling. In 2006, the Ryan White Treatment and Modernization Act included MNT as acore medical service. Also in 2006, the Older Americans Act was enhanced by including nutritionscreening, counseling and education for OAA meal recipients.
However, the current limitation on the MNT benefit in Medicare negatively impacts many of these andother government and private health-care programs. For example, home-health programs cannotreimburse for the services of a dietitian and the home-health company must pay for all administrativefees. When the 2009 economic recession began, many home-health companies began laying-offdietitians as a way to avoid those costs. In addition, coverage of intensive nutrition counseling would benefit millions of Medicare and Medicaidbeneficiaries by helping to prevent or delay onset of diseases such as type 2 diabetes andcardiovascular disease. This is would not only improve the lives of Americans, but could potentiallysave the government millions of dollars. It is estimated that 57 million Americans are at risk fordeveloping diabetes — a disease that costs the US over $174 billion each year. These costs can bealleviated with proper nutrition intervention programs. ADA was successful in getting various provisions that would allow for the expansion of MNT andnutrition counseling programs into the House and Senate health-care reform bills. Whether thoseprovisions pass into law are not yet clear.
Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Update on Medicare MNT reimbursement
Author: Jennifer Lerman
Date: November 30, 2011 12:18 PM
A very current news update on this topic: Medicare announced yesterday it would start coveringobesity screening and counseling. I am not sure if the details have been worked out fully, but it lookslike a policy change in the right direction! http://www.chicagotribune.com/sns-rt-medicareobesityn1e7as21t-20111129,0,1475141.story?page=2 https://learning.umassonline.net/webct/urw/lc13056874282091.tp1…eid=16436936970171&topicid=13670326197151&areaid=13670326195151 Topic: U8 Discussion - Health Care Systems and Policy -
Subject: Re:Update on Medicare MNT reimbursement
Author: Michelle Hoffer
Date: December 1, 2011 12:13 AM
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