Cholesterol-Lowering Power Of Dietitian Visits

Worried about your cholesterol? We may want to schedule a few appointments with a registered dietitian, to get some sound advice about how to shape up your eating habits, according to a new national study led by University of Michigan Health System researchers.

Not only are you likely to lower your cholesterol levels, we may be able to avoid having to take cholesterol medication, or having to increase your dose if you are already taking one. And you will probably lose weight in process, which also helps your heart.

The new results, published in February issue of Journal of the American Dietetic Association, are based on data from 377 patients with high cholesterol who were counseled by 52 registered dietitians at 24 sites in 11 states.

In group of 175 patients who started the study with triglycerides less than 400 milligrams per deciliter of blood ( mg/dL ) , and who had their cholesterol measured before they changed or added medication, 44. 6 percent either reduced their levels of " bad " cholesterol by at least 15 percent, or reached their cholesterol goal.

The results reflect progress in approximately eight months, after three or more appointments with a dietitian. But the results add further evidence that medical nutrition therapy, as it is called, can make a big difference in a patient's life.

All of the R. D. s in study based their advice to their patients on latest research-based evidence about eating habits and cholesterol levels available at the time of study: the American Dietetic Association's 1998 Medical Nutrition Therapy Hyperlipidemia Protocol.

Since that time, ADA has updated the clinical guideline based on new research, which means that patients who see an R. D. today may have even more success.

The study was funded by the ADA and its Clinical Nutrition Management Dietetic Practice Group, and based on a framework developed for a pilot project carried out in Michigan by Michigan Dietetic Association and led by U-M cardiovascular dietitians.

" Everyone knows that nutrition is important for cholesterol management, and that a registered dietitian is the professional most thoroughly trained to help patients choose foods wisely, " says lead author Kathy Rhodes, Ph. D. , R. D. , manager of Nutrition Services with U-M Cardiovascular Medicine program at Domino's Farms and U-M Cardiovascular Center. " But this is first national study to show what happens when high-risk patients work with R. D. s to follow nutrition guidelines grounded in best evidence. "

Key nutrition issues in the 1998 guidelines used in the study include reducing saturated and trans fat and increasing " healthy " fats such as olive oil; increasing soluble and insoluble fiber; eating fish twice a week; increasing fruits and vegetables; regular exercise and healthy weight management. Information about food-label reading and dining out was also included.

Called Lipid Management Nutrition Outcomes Project or LMNOP, national study was launched by Rhodes and her U-M colleagues Melvyn Rubenfire, M. D. , and Martha Weintraub, MPH, R. D. , after the successful completion of the Michigan-wide pilot project. Rubenfire, Weintraub and Christina Biesemeier, M. S. , R. D. , FADA, of Vanderbilt University are co-authors of new study.

The study gives us an important " real world " picture of what happens when R. D. s try to implement evidence-based nutrition guidelines in daily practice, Rhodes notes.

Some commercial health insurance plans are beginning to cover appointments with registered dietitians, but many still do not. Only dietitian visits for diabetes or kidney disease are covered by Medicare. It's important for people to check their specific health insurance plan to see whether nutrition is covered, Rhodes says. But even if individuals need to pay for the appointments out of their own pocket, they may find that an R. D. 's advice will pay off in long run, she says.

To get uniform data, the researchers brought lead R. D. s from each state to U-M for training on cholesterol and nutrition guidelines, and on the data collection practices used in the study. R. D. s at Veterans Affairs hospitals got their training by phone conferencing. R. D. s then returned to their own practices, trained their colleagues and implemented ADA guidelines.

The study included only patients between ages of 25 and 70 years who had high cholesterol levels, or triglyceride levels over 200 mg/dL, and who met other inclusion criteria including no recent changes in their cholesterol medication status. Neither the R. D. s nor their patients were paid to participate in study.

The " real world " aspect of this study included disappointing finding that many patients dropped out of nutrition counseling after one or two visits, when three or four sessions with an R. D. is recommended to make and sustain truly effective changes in eating habits. Lack of insurance coverage was a major factor in this dropout rate.

Patients whose doctors changed their cholesterol medication status, either by starting them on a drug for first time, or increasing their dose before assessing the effect of diet change, weren't included in the analysis. But for 219 patients who did not have any change in their medication status, impact of R. D. counseling became apparent in first year after the initial visit.

" Although some patients may already be eating a relatively healthy diet, medical nutrition therapy can increase patient's knowledge of 'cardioprotective foods' and assist them in individualizing guidelines to fit their preferences and lifestyle, " says Weintraub. A significant number of patients reduced the fat in their diets to less than 30 percent of calories, as recommended for a heart health. Many participants also lost weight and/or increased number of days each week on which they exercised for 30 minutes or more.

" Often, we see heart patients who are on multiple cholesterol medications but have never seen a dietitian. And even when a patient with high cholesterol does get to see an R. D. , their care team may not allow enough time to see how effective diet is before they add additional treatment, " says Rhodes. " We hope that this demonstration of how well cholesterol can be lowered without medication or increases in medication will be very useful for patients and physicians, and perhaps insurers too. "

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To learn more about how eating habits can influence cholesterol levels, or to find an R. D. , visit the ADA's web site at http: //www. eatright. org/. For more on U-M Cardiovascular Medicine and its nutrition services, visit http: //www. med. umich. edu/cvc/prevention. Reference: JADA, Vol. 108, No. 2, Feb. 2008.

Source: Kara Gavin University of Michigan Health System

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What you have to know buying Tenuate.

Tenuate: uses Tenuate is used along with a doctor-approved, reduced-calorie diet, exercise, and behavior change program to help you lose weight. It is used in people who are significantly overweight ( obese ) and haven't been able to lose enough weight with diet and exercise alone. Losing weight and keeping it off can reduce many health risks that come with obesity, including heart disease, diabetes, high blood pressure, and a shorter life.

It is not known how Tenuate helps people to lose weight. It may work by decreasing your appetite, increasing amount of energy used by your body, or by affecting certain parts of brain. This medication is an appetite suppressant and belongs to a class of drugs called sympathomimetic amines.

Tenuate: how to use Take the immediate-release form of Tenuate by mouth, usually 3 times a day 1 hour before meals or as directed by your doctor. If late-night eating is a problem, your doctor may direct we to take another dose in evening. Taking Tenuate late in the day may cause trouble sleeping ( insomnia ) .

The sustained-release form of Tenuate is usually taken once a day in the mid-morning. Swallow Tenuate whole. Don't crush, chew, or break the tablets. Doing so can destroy long action of drug and may increase side effects.

The dosage is based on your medical condition and response to therapy. Your doctor will adjust dose to find best dose for you. Use Tenuate regularly and exactly as prescribed in order to get the most benefit from it. To help you remember, take it at the same time ( s ) each day.

Tenuate is usually taken for only a few weeks at a time. It should not be taken with other appetite suppressants ( see also Drug Interaction section ) . The possibility of serious side effects increases with longer use of Tenuate and use of Tenuate along with certain other diet drugs.

Tenuate may cause dependence, especially if it has been used regularly for an extended time or if it has been used in high doses. In such cases, withdrawal reactions ( e. g. , depression, severe tiredness ) may occur if we suddenly stop Tenuate. To prevent withdrawal when stopping extended/regular treatment with Tenuate, gradually reduce dosage as directed. Consult your doctor or pharmacist for more details, and report any withdrawal reactions immediately.

Rarely, abnormal drug-seeking behavior ( addiction ) is possible with Tenuate. Don't increase your dose, take it more frequently, or use it for a longer time than prescribed. Properly stop medication when so directed.

We should see some weight loss soon after you start this medication. Tell your doctor if we don't see at least 4 pounds of weight loss within 4 weeks of starting Tenuate. Tenuate may stop working well after we have been taking it for a while. Talk with your doctor if this medication stops working well. Don't increase dose unless directed by your doctor. Your doctor may direct you to stop taking this medication.

Tenuate: side effects Dizziness, dry mouth, difficulty sleeping, irritability, nausea, vomiting, diarrhea, or constipation may occur while use Tenuate. If these effects persist or worsen, notify your doctor or pharmacist promptly.

Remember that your doctor has prescribed Tenuate because he or she has judged that the benefit to we is greater than risk of side effects. Many people using Tenuate do not have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur:

Stop taking Tenuate and seek immediate medical attention if any of these rare but very serious side effects occur:

Tenuate may infrequently cause serious ( sometimes fatal ) lung or heart problems ( pulmonary hypertension, heart valve problems ) . The risk increases with longer use of Tenuate and use of Tenuate along with other appetite-suppressant drugs/herbal products. If you notice any of the following unlikely but very serious side effects, stop taking Tenuate and consult your doctor or pharmacist immediately:

A very serious allergic reaction to Tenuate is rare. However, seek immediate medical attention if you notice any of following symptoms of a serious allergic reaction:

This isn't a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Tenuate: precautions Before taking Tenuate, tell your doctor or pharmacist if we are allergic to it; or to any other sympathomimetic amines ( e. g. , decongestants such as pseudoephedrine, stimulants such as amphetamine, appetite suppressants such as phentermine ) ; or if we have any other allergies.

Tenuate should not be used if we have certain medical conditions. Before using Tenuate, consult your doctor or pharmacist if we have:

Before using Tenuate, tell your doctor or pharmacist your medical history, especially of:

Tenuate may make we dizzy or ( rarely ) drowsy or cause blurred vision. Use caution engaging in activities requiring alertness and clear vision such as driving or using machinery. Avoid alcoholic beverages.

Before having surgery, tell your doctor or dentist that you are using Tenuate.

Kidney function declines as you grow older. This medication is removed by kidneys. Therefore, elderly people may be at greater risk for dizziness and high blood pressure while using this drug.

During pregnancy, Tenuate should be used only when clearly needed. It's not recommended for use for long periods or in high doses near expected delivery date because of possible harm to unborn baby. Discuss the risks and benefits with your doctor. Infants born to mothers who have been using Tenuate for a long time or in high doses may have withdrawal symptoms such as irritability or extreme tiredness. Tell your doctor immediately if we notice any of these symptoms in your newborn.

Tenuate may pass into breast milk and could have undesirable effects on a nursing infant. Therefore, breast-feeding isn't recommended while using Tenuate. Consult your doctor before breast-feeding.

Tenuate: interactions Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring we for them. Don't start, stop, or change dosage of any medicine before checking with them first.

Tenuate should not be used with certain medications because very serious interactions may occur while use Tenuate. If we are taking or have taken other appetite-suppressant drugs in past year ( e. g. , phentermine, sibutramine, ephedra/ma huang ) , tell your doctor or pharmacist before starting Tenuate.

Avoid taking MAO inhibitors ( e. g. , furazolidone, isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine ) within 2 weeks before, during, and after treatment with Tenuate. In some cases a serious ( possibly fatal ) drug interaction may occur while use Tenuate.

If you're currently using any of these medications, tell your doctor or pharmacist before starting Tenuate.

Before using Tenuate, tell your doctor or pharmacist of all prescription and nonprescription/herbal products we may use, especially:

Tell your doctor or pharmacist if we also take drugs that cause dizziness or drowsiness such as: certain antihistamines ( e. g. , diphenhydramine ) , anti-seizure drugs ( e. g. , carbamazepine ) , medicine for sleep or anxiety ( e. g. , alprazolam, diazepam, zolpidem ) , muscle relaxants, narcotic pain relievers ( e. g. , codeine ) , psychiatric medicines ( e. g. , risperidone, amitriptyline, trazodone ) .

Also report the use of drugs which might increase seizure risk when combined with Tenuate such as isoniazid ( INH ) , phenothiazines ( e. g. , thioridazine ) , theophylline, or tricyclic antidepressants ( e. g. , amitriptyline ) , among others.

Check the labels on all your medicines/herbal products ( e. g. , cough-and-cold products containing decongestants such as pseudoephedrine, diet aids such as phenylpropanolamine/ephedra/ma huang ) because they may contain ingredients that could increase your heart rate or blood pressure. Ask your pharmacist about using those products safely.

Caffeine can increase side effects of Tenuate. Avoid drinking large amounts of beverages containing caffeine ( coffee, tea, colas ) or eating large amounts of chocolate.

This document doesn't contain all possible interactions. Therefore, before using Tenuate, tell your doctor or pharmacist of all products you use. Keep a list of all your medications with you, and share list with your doctor and pharmacist.

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