Photo Finish

Published February 4, 2023

Morning Report — Not Your Typical Medical Newsletter

We get it, you see a lot of medical newsletters, so hear us out. Once a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.

The 2023 Award for Best Diet Goes To …

DIETARY DIGEST

First place

U.S. News & World Report crowned the Mediterranean dietary model the “Best Diet Overall” for the sixth consecutive year, a dynasty by all accounts but one: “Talk to me when you’ve got seven titles,” says Tom Brady, fresh off another retirement announcement.

Although the medical community doesn’t officially rank diets (and of late isn’t keen on ranking med schools either), it does seem to support U.S. News’ findings. Studies have shown the Mediterranean diet to lower the risk of cardiovascular disease, type 2 diabetes mellitus, Alzheimer disease, and other chronic conditions as well as to improve the length and quality of life. Here’s a refresher on the tenets of the diet:

• Consume a rainbow of fruits, vegetables, whole grains, nuts, legumes, olive oil, and spices
• Eat seafood/fish at least twice a week
• Eat poultry, eggs, cheese, and yogurt in moderation; sweets and red meat sparingly
• Occasional red wine is okay

Second place

After hours of reviewing the photo finish, U.S. News & World Report declared these four diets a tie for second place: The DASH diet, flexitarian diet, MIND diet, TLC diet.

Key takeaway

U.S. News & World Report not only ranked the best 24 overall diets but also categorized the diets according to practicality, benefit for certain high-risk patients, and dozens of other options. Click here to select your dietary preferences like you’re ordering a Chipotle burrito. But if patients prefer the diet that checks the most boxes, point them toward the Mediterranean. It’s shy of Brady’s seven titles but outperforms his TB12 Method, a diet conspicuously absent from this list. But consider recommending Brady’s diet—nay, regimen—to patients who aspire to a postseason berth at age 45 and don’t mind restrictions on alcohol, caffeine, oils, dairy, salt, sugar, and nightshade plants. Don’t get Brady started on the tomato.

 

CME alert

Choosing among the growing list of popular diets can be as overwhelming as navigating a Cheesecake Factory menu. When patients ask, “What should I eat?,” give them science-backed advice from this popular (and free!) Pri-Med session: Top Questions from PCPs on Fad Diets: Keto, Elimination, and More.

New Shingles Complication Points to More Justification for the Jab 

INFECTIOUS FINDINGS

Herpes zoster, or shingles, may cause considerable pain and complications, yet vaccine uptake —estimated at only 60% of eligible candidates—falls below that of influenza and pneumococcal vaccines (though well above uptake of the aforementioned TB12 Method). But could new evidence linking shingles with cardiovascular (CV) events help move the needle? 

Researchers conducted a prospective study of >200,000 adults without a history of stroke or coronary disease from three databases: the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals Follow-up Study. Self-reports of shingles and subsequent coronary events were cross-checked with physicians ’ reports. Follow-up lasted 16 years. Incident stroke was 38% higher and coronary heart disease was 25% higher in those with a history of shingles than in those without. Scientists had long suspected this increased CV risk but grew wide-eyed at the magnitude and long duration of the risk they found. 

The expanding accordion of shingles complications includes postherpetic neuralgia, vision loss, and now stroke and coronary heart disease. Furthermore, the increased risk of CV events may persist for >12 years after a bout with shingles. The message to patients is clear: do your heart good and get the shingles vaccine when eligible. February is American Heart Month, so consider adding this study’s findings to your talking points when discussing heart health with patients.  

Rapid-Fire COVID-19 Updates

COVID QUICK HITS 

No Aging Out of Anorexia

PSYCH SYNOPSIS

Forty years ago today, Karen Carpenter, the velvety-voiced “Superstar” who made our “Rainy Days and Mondays” a little less bleak, lost her battle with anorexia nervosa at the age of 32. The tragedy propelled the term “anorexia”—previously confined to obscure medical journals—into mainstream consciousness. Fast-forward four decades and we now know that eating disorders affect at least 9% of the global population, disproportionately striking adolescent girls and young women. Now, new research takes a magnifying glass to another at-risk patient group: women in perimenopause and early postmenopause. 

In a small study of middle-aged women, researchers sought to map out the structure of eating disorder symptoms during perimenopause and early postmenopause. They discovered that dissatisfaction with body image (shape plus weight) is a core feature of eating disorder pathology in this group—just as it is in younger women. And this feature is particularly hazardous during perimenopause, when associations with negative mood, depression, and fatigue give it fertile ground. 

Key takeaway 

While Karen Carpenter and other young women may form our predominant image of anorexia, this study reminds us that eating disorders can occur at any point from adolescence through postmenopause. The prevalence of eating disorders in women >40 years of age is 3.5%, and the specific symptom of dissatisfaction with eating patterns soars to nearly 30% in this age group. Women in the perimenopausal stage are especially susceptible to eating disorder pathology when striving to overcome a poor body image. This study furthers the conversation on this challenging mental health disorder, but larger studies and more targeted treatment strategies for specific age groups are needed. To quote Karen, “We’ve Only Just Begun.” 

As the Soleus Goes, So Goes the Basal Metabolic Rate 

METABOLIC MINUTE

This next study dropped a few months ago, but you may have missed it, what with Prince Harry dominating the digital airwaves, so we want to share it with you now—we think it has legs.

Professor Marc Hamilton from the University of Houston discovered that patients who performed a seated exercise he coined “the soleus push-up” improved their blood glucose excursions by 52% and doubled their rates of fat metabolism. In the study, the effect occurred after just one session and continued for hours afterward. Intrigued? Try it while reading Morning Report:

• Sit with your feet flat to the floor (see the article for precise angles and more)
• Raise your heel while keeping your toes planted on the floor
• Once your heel reaches its peak motion, passively release it back to the floor
• Rate/duration varied in the study, but 50 reps/min for one hour triggered positive results

Can you feel that? It’s your basal metabolic rate reaching new heights. But how can a muscle that comprises only 1% of our body weight muster such metabolic magnitude? The exact “hows” and “whys” of this phenomenon remain a mystery, but here’s what we do know: the soleus muscle has a leg up on other muscles. Its unique anatomical and cellular properties, punctuated by its reliance on blood glucose and fats—instead of glycogen—for energy, make it nearly indefatigable and a powerhouse of blood glucose regulation.

Key takeaway

Dr. Hamilton’s study suggests that when the soleus muscle is properly engaged—as it is in the soleus pushup—its effect on blood glucose regulation rivals that of any other exercise or weight-loss method. And many nonambulatory, wheelchair-bound patients can perform it with relative ease. Win-win! But wait—and there’s no tiptoeing around this—isn’t a soleus pushup simply a calf raise with some bling? Dr. Hamilton says no. “It’s a very specific movement that right now requires wearable technology and experience to optimize the health benefits.” Publications will soon share how to get optimal results without the use of technology. Meanwhile, with no reports of adverse effects, there’s no harm in hiking up those heels to help negate the harmful effects of prolonged sitting. Test-drive this maneuver while you’re parked on the couch for the Super Bowl—that is, if the Chiefs/Eagles showdown doesn’t already have you on your toes.

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

• Physician-peer relationships and patient experiences with specialist care
• Pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults: a living clinical guideline from the American College of Physicians
• American Diabetes Association Standards of Care in Diabetes—2023
• Global Strategy for Prevention, Diagnosis and Management of COPD: 2023 GOLD Report
• FDA grants accelerated approval for Alzheimer’s disease treatment
• The association of peripheral and central olfaction with frailty in older adults
• Recreational cannabis legalization has had limited effects on a wide range of adult psychiatric and psychosocial outcomes
• Premature cardiovascular disease and brain health in midlife: the CARDIA study

Morning Report is written by:

• Alissa Scott, Author
• Aylin Madore, MD, MEd, Editor
• Eleni Scott, MD, Editor

Would you like to share your feedback with Morning Report? Drop us an email at morningreport@pri-med.com to let us know how we’re doing.

Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.

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