I was enjoying lunch with a friend a few weeks ago when he took a swig of his soda, read the nutrition facts and said in a puzzled manner “37 grams of carbohydrates. That seems like a lot. What exactly are carbs?”

“The enemy,” I quipped.

Now, this was merely a split-second, subconscious response that needs clarification. So by all means, I beg your pardon. Carbohydrates are not necessarily our adversary, and can in fact be our friend, but only if we understand the difference between “good carbs” and “bad carbs.” Let me explain.

Carbohydrates are essentially sugars or starches that provide energy for our bodies. Sounds good right? Not so fast! “Bad carbs” are high in glucose and, when consumed, cause a quick spike in our blood-sugar levels. This causes our pancreas to pump out insulin to deal with the excess blood sugar. The insulin then disperses the glucose and our blood sugar levels fall, causing us to be hungry again! I’m sure you’ve experienced this without even knowing it. Remember last week when you ripped through that bag of Cool Ranch Doritos, like Sasquatch attacking Jack Link’s Beef Jerky? Or how about when you had the urge to eat that Rocky Road ice cream with a shovel? Excuse my hyperbole, but these cravings are a result of the quick rise and fall of our sugar levels. Bad carbohydrates are very high in sugar and white flour and include: candy, baked foods, ice cream, white pasta, breads, and sodas. These carbohydrates, while tasty, can often lead to obesity, heart disease and diabetes.

Good carbohydrates, however have a low glycemic index and are generally high in fiber, and rich in vitamins, minerals, and nutrients. These carbs raise our blood glucose levels in a much slower and sustained manner, avoiding the spike that leads to more cravings. These carbs, especially those high in fiber, are essential to our everyday diet. They supply our bodies with energy and help to lower our cholesterol. We want our bodies to take energy from carbs because if no carbs are consumed, our protein intake will be unnecessarily used for energy, diminishing their benefits for muscle growth. Good carbohydrates include: fruits, vegetables, sweet potatoes, brown rice, beans, nuts, whole grain cereals and oat meal.

Now you may still crave that pint of ice cream, but it will be less intense and instead of grabbing the shovel, you’ll just take out a spoon. Consciously replace “bad carbs” with “good carbs,” and you’ll decrease your cravings and feel more energy. Oh, and those jeans will fit again!

About Our Celebrity Blogger. Joseph Pepe, Jr. serves as the Director of Project Development for Planet Fitness.  He oversees the Personal Training and Nutrition Department for 14 locations throughout CT.  He is also the Managing Director for the Lose It! Weight Loss System (www.loseitweightloss.com).  Joe received his B.A. in Economics from Wesleyan University. And since he’s our health and fitness guru, lets give him a plug as a athlete in his younger years as an All-NESCAC and Academic All-NESCAC Football Selection at Wesleyan. Go Cardinals!!

Authors: Hillary R. Bogner, MD, MSCE and Heather F. de Vries, MSPH, Department of Family Medicine and Community Health, School of Medicine, University of Pennsylvania, Philadelphia

PURPOSE
We wanted to examine whether integrating depression treatment into care for hypertension improved adherence to antidepressant and anti-hypertensive medications, depression outcomes, and blood pressure control among older primary care patients.

METHODS
Older adults prescribed pharmacotherapy for depression and hypertension from physicians at a large primary care practice in West Philadelphia were randomly assigned to an integrated care intervention or usual care. Outcomes were assessed at baseline, 2, 4, and 6 weeks using the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depression, an electronic monitor to measure blood pressure, and the Medication Event Monitoring System to assess adherence.

RESULTS
In all, 64 participants aged 50 to 80 years participated. Participants in the integrated care intervention had fewer depressive symptoms (CES-D mean scores, intervention 9.9 vs usual care 19.3; P <.01), lower systolic blood pressure (intervention 127.3 mm Hg vs usual care 141.3 mm Hg; P <.01), and lower diastolic blood pressure (intervention 75.8 mm Hg vs usual care 85.0 mm Hg; P <.01) compared with participants in the usual care group at 6 weeks. Compared with the usual care group, the proportion of participants in the intervention group who had 80% or greater adherence to an antidepressant medication (intervention 71.9% vs usual care 31.3%; P <.01) and to an antihypertensive medication (intervention 78.1% vs usual care 31.3%; P <.001) was greater at 6 weeks.

CONCLUSION
A pilot, randomized controlled trial integrating depression and hypertension treatment was successful in improving patient outcomes. Integrated interventions may be more feasible and effective in real-world practices, where
there are competing demands for limited resources.

MY COMMENTS
I am very pleased with the outcomes of this trial, and surprised by how low the adherence rates were for the usual care group. Usual care group was 31.3% adherent! That is horrible. I never thought of the connection between hypertension and depression, but in that age group, I can see the fit. I wonder if there is a similar study running for increasing adherence with diabetes and depression medications?

The economic consequences of noncompliance in cardiovascular disease and related conditions: a literature review

Summary:
Objectives: To review studies on the cost consequences of compliance and/or persistence in cardiovascular disease (CVD) and related conditions (hypertension, dyslipidaemia, diabetes and heart failure) published since 1995, and to evaluate the effects of noncompliance on healthcare expenditure and the cost-effectiveness of pharmaceutical interventions.

Methods: English language papers published between January 1995 and February 2007 that examined compliance/persistence with medication for CVD or related conditions, provided an economic evaluation of pharmacological interventions or cost analysis, and quantified the cost consequences of noncompliance, were identified through database searches. The cost consequences of noncompliance were compared across studies descriptively.

Results: Of the 23 studies identified, 10 focused on hypertension, seven on diabetes, one on dyslipidaemia, one on coronary heart disease, one on heart failure and three covered multiple diseases. In studies assessing drug costs only, increased compliance/persistence led to increased drug costs. However, increased compliance/persistence increased the effectiveness of treatment, leading to a decrease in medical events and non-drug costs. This offset the higher drug costs, leading to savings in overall treatment costs. In studies evaluating the effect of compliance/persistence on the cost-effectiveness of pharmacological interventions, increased compliance/persistence appeared to reduce cost-effectiveness ratios, but the extent of this effect was not quantified.

Conclusions: Noncompliance with cardiovascular and antidiabetic medication is a significant problem. Increased compliance/persistence leads to increased drug costs, but these are offset by reduced non-drug costs, leading to overall cost savings. The effect of noncompliance on the cost-effectiveness of pharmacological interventions is inconclusive and further research is needed to resolve the issue.

COMMENTS:
Yes, we have repeatedly seen that increase medication adherence leads to increase medication costs. This is a given, just like any consumption increase. With diseases that have nor apparent symptoms, other than a heart attack, it is hard to argue the case that in the long run, spending more on your medication will lower your overall healthcare costs. Event hough it is the truth and I believe it, it is sometimes hard to argue because in three years, there will be someone else to pick-up the bill. Whether it is a different employers, healthcare plan or the government, people want to shift the cost to the next person.

I was reading the AHA’s new report on CVD, and I knew that the numbers were pretty high, but a person dies every 37 seconds from CVD, totaling 2400 Americans a day. In 2008, 770,000 Americans with have a new coronary attack, with 430,000 expected to have a recurrent attack. Every 40 seconds someone dies from a stroke – that is one in seventeen deaths in the US. In 2004, heart failure was mentioned in 1 in 8 deaths. 80,700,000 Americans have 1 or more types of CVD.

These numbers are crazy. We are a sick nation that needs to be healed. Starting at childhood with diet and exercise, these numbers can be decreased, probably not in my lifetime, but hopefully my son’s. My father had a mild heart attack last year, and it was a real wakeup call for him at 63. Now he is on more medication and he is adherent.

Sorry for the rant, but it has been on my mind today.

From Health Day News
Spirituality helps older black American women with high blood pressure stick to the drug regimens that keep the condition under control, new research suggests.

Older black Americans tend to have poorer anti-hypertensive medication adherence than either younger blacks or white patients, even though adherence helps reduce hypertension-related health problems and deaths, noted a team from the University of Pennsylvania School of Nursing.

This study included 21 black women, average age 73, who were members of a Program of All Inclusive Care for the Elderly. The women had been diagnosed with hypertension for an average of 16.7 years, and they were taking an average of 3.3 prescriptions to battle the condition.

All the women said they used their spirituality to manage their medication adherence. As part of this process, identified as “Partnering with God to Manage My Medications,” the women accepted personal responsibility for adhering to their medication regimen and used their spirituality as a resource to make decisions to remain adherent, to cope with medication side effects, and to increase their ability to deal with barriers that kept them from sticking with their medicines.

The findings suggest that incorporating patients’ beliefs into hypertension treatment may help them draw on inner resources to improve medication adherence, the researchers concluded.

The study was to be presented Wednesday at the American Heart Association annual meeting in Orlando, Fla.