Why Last Breath Odor While Fasting

When we fast in Ramadan, then a decrease in food intake / energy. This causes the body to mobilize energy reserves are there to replace the intake deficiency.

Then, there was a process called autolysis. Autolysis is the decomposition of fat reserves to be converted into energy.

When we fast the fat accumulated reserves will be used to meet the daily energy needs. At the same time, the release of chemicals that are bound in fats. The chemicals will be disposed of by the organs in charge of doing detoxification.

By fasting, the body will secrete large amounts of toxins through the bloodstream, pores, and other organs disposal. This is evident from the thickened layer of tongue and breath usually smells in the first days.

After fasting for health benefits continue in the days afterward, enhanced body cleansing process. Useless body fat, toxins accumulate in the bodys cells to be issued.

Diseased cells, dead cells, thickened mucus layer in the gut wall, blood flow wastes are removed through the liver, spleen, and kidneys. The body will use vitamins and minerals essential to get rid of toxins and old tissues. When the bodys toxic burden is reduced, the efficiency of each cell increased.

Thats why last breath odor while fasting. Read also prevent anemia during fasting. 

5 Reasons why snacking is important

5 Reasons why snacking is important - Both young and old will like the name suggests snacking. Made the most delicious snacking while relaxing or watching a favorite television show. Unfortunately the snacking habits can make plus size waist widened. Weight gain was in the habit of snacking causes the food was not good. Try snacking with healthy food, certainly not going to make weight and waist circumference increased.

Read Dilansit from Simple, see 5 reasons why snacking is important for the body.

1. Balancing metabolism

The researcher says that maintain metabolic balance can be achieved by eating three meals and two snacks a day between meals. If balanced metabolism, burning fat will be perfect and overall body health is maintained.

2 . Not overeat

Overeating is one of the reasons why a person experiencing a swollen waistlines. But with snacking, control appetite will remain intact. As various studies have been carried out, eating smaller meals is much better in keeping the body leanness.


3. Meet vitamin

Snacking is an easy and delicious way to meet the needs of vitamin that is not obtained from the daily feeding schedule. But of course snacks consumed should have a high nutrient content. For example, fresh fruits, whole grains, or beans.


4. Keep the mood

When blood sugar levels are too low, a person will usually irritability and difficulty concentrating. To overcome this, favorite snack foods can be done any time the mood began to deteriorate. That way, your blood sugar will rise again and the mood is getting better.


5. Avoid junk food

When he returned home from work, feeling hungry and tired bodies merge into one that encourages one to eat right away. However, because of lazy cooking, junk food eventually become the primary choice for dinner . It certainly will not happen if someone snacking before dinner first.


Those are some reasons why snacking is important. But do not forget to enjoy a healthy snack.

Care Coordinators The Commonwealth Fund Shows Why ACOs Should Fund Them

In yesterdays post on the re-emergence of the "medical director" as a force to be reckoned with, the Disease Management Care Blog also mentioned care coordinators.   Theres a reason why they were prominent feature in The New York Times recent ACO article on Advocates success.

The DMCB defines care coordinators as credentialed non-physician medical professionals - usually but not always nurses - who have three responsibilities:

1) maximizing the "health insurance benefit"  - whats often lost is the reality that insurance coverage varies and is imperfect.  It takes time and effort to match a patients clinical needs with payments, networks and limits.  That includes fee-for-service Medicare.

2) enabling the patient to address "care gaps"  - and most DMCB readers understand that that is accomplished by enabling patient participation in and control of their care.

3) maximizing community resources  - there are a host of public and private services "out there," and its a full time job to help patients access them.

While well-meaning traditionalists will argue that letting nurses into the doctor-patient relationship is a risky proposition, check out this short article that just appeared in the Archives of Internal Medicine.  Michel Doty and colleagues tapped the Commonwealth Funds 2010 International Health Policy Survey of over 19,000 adults from 11 countries.  In it, they asked respondents about the involvement of a "care coordinator" and correlated it with self-reports on the use of health care services. 

While the odds ratios vary, having a care coordinator emerged as a strongly independent and statistically significant predictor of better appointment scheduling, access to test results, specialty care and follow-up after discharge.  Patients with access to that kind of care had odds ratios in the 0.50 range, meaning that they were about half as likely to report problems.

While the Archives article is based on self-reports, is retrospective, doesnt precisely define "care coordination" and there may have issues with how that gets translated across cultures and languages, the information is telling: having a trusted third party in the mix of care services can have a powerful impact on health care utilization that leads to decreased cost and higher quality.

Last but not least, while the authors point out that "care coordination" is a bedrock principle of the Patient Centered Medical Home (PCMH), they neglected to point out that this is also basis for population health management. 

Take it from the DMCB: medical directors have little reason to care if the care coordinator is on the PCMH payroll or offered by a third party population health management vendor, just so long he or she gets the job done, maximizes the benefit, engages the patient in self care and makes sure community resources are accessed. 

Another Reason Why There Was A Decline In U S Hospitalizations for Heart Failure

By now, many Disease Management Care Blog readers have become aware of this JAMA research study that used Medicare fee-for-service claims data to examine the nationwide rate of hospitalizations for chronic heart failure.  From 1998 to 2008, there was a counterintuitive 30% decline in the U.S. from a baseline rate of 2845 to a new rate of 2007 admissions per 100,000 person-years. 

The authors credit better care of heart attacks (damage from a heart attack to can lead to a flabby dilated heart), better prevention (such as more aggressive treatment of high blood pressure, which also causes heart damage) and a more "effective" medical system (such as better outpatient follow-up, use of alternate levels of care, flu shots prescriptions of ACE inhibitors and beta blocker medications).  The authors of the study think the numbers are remarkable because the U.S. population is getting older and healthier persons (without heart failure) seem to be signing up for managed care Medicare Advantage.

The DMCB is wondering about another possibility that has nothing to do with epidemiology or quality.  Rather, it could be the impact of Medicare payment rates on billing patterns.  After all, if heart failure is the leading Medicare inpatient diagnosis, shouldnt a decrease there have an impact on the overall hospitalization rate?

The DMCB explains:

When beneficiaries are discharged from a hospital, the bill (or the claim) submitted to Medicare is based on a "Diagnosis Related Group."  While the invention and logic of DRGs complicated, theyre important because the principal diagnosis determines the amount of the global payment for that hospitalization. While this may be overly simplistic, a discharge with a diagnosis of "heart failure" prompts Medicare to pay a hospital "X" dollars, while a diagnosis of pneumonia or kidney failure will render payments of "Y" and "Z" dollars, respectively.  In general, the more complicated the diagnosis, the greater the payment.

All well and good, but suppose the hospital has a patient with several concurrent problems and has a choice on which DRG to use?  As anyone who has taken care of hospitalized patients knows, there are usually multiple diagnoses present in any patient at one time.  Pneumonia may or may not have provoked the heart attack that led to the kidney failure that led to the leg swelling and the shortness of breath.  Given three simultaneous diagnoses, Medicare billing guidelines state that the hospital should use their best judgement to determine which DRG to bill. All things being equal, smart hospitals will probably use the DRG that renders the greatest payment.

The DMCB isnt saying that fraudulent billing (for example) accounts for the decrease in heart failure hospitalizations for Medicare. However, it knows some diagnosis related groups can be less remunerative than others and that in the last ten years, DRG payment rates have evolved and that hospitals have learned how to "code" more accurately and aggressively.  Based on the example at the bottom of this page, the DMCB wonders if some patients that were diagnosed with heart failure in 1988 would have been diagnosed with something more remunerative in 2007. 

In other words, there may have been the same number of hospitalizations involving the same patients with the same disease burden.  It was the case mix that changed?

The authors of the study to their credit cant discount the possibility:  They argue that if coding had changed there would have been a shift in the mortality rate of patients with heart failure:

"We were unable to determine whether the observed changes were due to changes by hospitals in medical coding; however, substantial up-coding or down-coding would likely result in changes to the coefficients of the CMS HF mortality model, and these coefficients remained stable from 2005 to 2008."

The authors may have a point, but that assumes the modeling - also based on claims - is trustworthy.

Of course, there is no way, based on Medicare billing claims alone, to determine whether measurement also played a role in the decline in heart failure admissions.  That would take an audit of the medical records themselves.

Why Were Obese An Intro to Food Reward

Obesity is complex. I think we all know that at this point. There is no one reason why any of us become obese; its a combination of several factors including genetics, physical activity, hormones, calories, fat, carbs, junk food, and much, much more. We can of course say that we get fat from eating more calories than we expend, thats a fact... but that doesnt tell us anything about why were consuming more food than we need. Likewise, we dont truly know the best way to lose excess weight. We need to eat fewer calories than we expend, duh. But we have to worry about complicated things like hunger, willpower, and cravings... and why it feels like your body just wants to hold onto that extra fat.

Enter: Food Reward.  Ive touched on this in the past but I havent given it a proper explanation.  I first heard of the concept via Stephen Guyenet a couple years ago, as most people in the ancestral health community did.  Its taken me a while to fully warm up to it and truly understand it, but Im now convinced that this is a major reason, perhaps the major reason, for the obesity epidemic.  Allow me to explain.

The Reward System
Our brains contain a "reward" system that is critical to our survival.  Actions that promote our survival are reinforced by the brain by making us feel good... this makes us want to do them again.  For example, running around in the sun playing frisbee makes us feel good; the sun is good for our health (in moderation), physical activity promotes fitness and survival in the most primal sense, and it gives us a sense of community and kinship with our friends.  Our brains tell us that playing frisbee in the sun is a good thing, and were likely to do it again in the future.  But the reward system also works the other way, discouraging actions that harm us.  If we pick up a baking dish out of the oven with our bare hands, well burn our skin, and so our brains send a very strong signal for us to STOP (pain).  Addictive drugs essentially hijack this reward system.  Heroin, for example, will bypass the environmental sensory aspect of the reward system and latch on to the receptors in the brain.  Drugs like these provide a super strong stimulus, hence they are reinforced by happy feelings, and youll want to do it again and again until you become addicted.

The same goes for the food we eat.  We do need to eat to survive, after all.  Something sweet, tender, and high in calories?  Rewarding.  Something bitter and fibrous?  Not so much. Think of humans in the wild, or in hunter-gatherer times... the foods that best help us survive elicit the strongest reward signal, and were motivated to eat more. There are several qualities of food that have been found to be inherently rewarding (1):

• Fat
• Starch
• Sugar
• Salt
• Meatiness (glutamate)
• The absence of bitterness
• Certain textures (soft, crunchy, liquid)
• Certain aromas (fruits)
• Calorie density
• Variety

The Reward System in the Modern Food World
Now thats all well and good for survival.  This reward system works perfectly in a natural setting to guide us in what to eat.  Were perfectly happy eating fresh fruits, meats, potatoes, veggies, etc., and well eat just as much as we need until were full and we stop.  Even 50 years ago, we ate mostly natural, unprocessed foods, we ate as much as we wanted until we were full, and we stayed lean.

Since the 1950s, the average American has increased his/her caloric intake by about 500 calories.  In that same time period, the prevalence of obesity has nearly tripled (2). 

What changed?  The food industry figured out how to sell more food to the same number of people, something that was previously thought to be impossible.  Once they figured out that they could make food that is so appealing and rewarding, combining all of the factors listed above, that we would continue eating it regardless of our hunger cues... the game was over.  Theyre preying on our most primal of instincts.  And we cant stop, because our bodies are telling us to keep eating.  Were designed to keep eating.  Its not our fault.  Sounds a lot like heroin doesnt it?


How exactly do they do this?  Lets count.

1. By combining fat, sugar, and salt with calorie density, crunchy, and chewy... The Oreo, for example.
2. By drizzling sweet, salty, fat condiments on top of already sweet, salty, fatty foods... TGI Fridays Jack Daniels Grill.
3. By increasing portion sizes... McDonalds burgers.
4. By adding MSG, a meaty flavor, to already hyperpalatable snacks... Doritos, or even worse, that ridiculous Doritos Locos Taco.
5. Through convenient product placement... Candy bars at the checkout line.
6. By adding sugar, salt, and fat to already-addicting caffeinated drinks... Starbucks anyone?
7. By marketing junk food to children... How cool is the Kool-Aid man?
8. By offering a variety of food from all around the world in unlimited quantities... Home Town Buffet.
9. By capitalizing on the drunk munchies at the local diner... Disco fries.
10. By putting Coke machines everywhere... Everywhere...

This is deliberate, its no accident.

Just look at that shirt... God hes cool.

The Conclusion
The goal of the food reward system is to get us to eat enough real food to satisfy our nutritional needs, no more and no less.  The reward system is NOT designed for processed, hyperpalatable food.  We are designed to eat sugar, fat, starch, and salt, but not excess sugar, fat, starch and salt... and definitely not at the convenience and in the sheer quantity that were getting it in today.  

I know food companies need to make a profit, but somethings gotta give.  The cost of the obesity epidemic is immense... we cant keep this up.

The solution isnt sexy. Just eat real food. Call it Paleo, call it ancestral eating, call it what you will. Just opt out. Get back to basics and eat real food again. Take your health into your own hands and keep it real. Im out.

Why The Tipping Point for Health System Consolidation May Be Closer Than We Realize Lessons from Airline Mergers

Ready for take off

From time to time, the Disease Management Care Blog and other pundits turn to the airline industry draw lessons on the evolution of health care.  Integrated human-computer systems, safety check-lists, website-based Expedia-like price transparency, teaming and other such notions have infiltrated health policy PowerPoint presentations worse than Doritos bags in Seattle Hempfest crowd.

While the DMCB was mulling another lesson about the divide between coach (what vanilla insurance could turn out to be) versus business/first class (concierge-style direct pay), along came this interesting Wall Street Journal article by airline industry bad boy Robert Crandall about the American Airlines - US Airways merger.  He argues 1) mergers that lead to bigger are better (no surprise there) and 2) if some airlines are allowed to go big, the only way for others to compete is to go bigger also.

That latter argument is important, and may also hold lessons for health care. 

Mr. Crandall argues that once the furies are released and one or two regionally dominant service providers are allowed to populate the marketplace, smaller competitors are at a disadvantage.  As a result, they have no choice but to also seek alliances and mergers.  How well government reconciles consumer interests and business profitability will remain an open question involving lawyers, bureaucrats and politicians.

Ditto regional health care systems, accountable care organizations and integrated provider organizations. 

Once one of these behemoths is unleashed in a city or corner of a state, smaller neighboring provider systems will naturally circle the wagons and seek permission to consolidate so that, just like the airlines, they can compete. They make a good argument, because without the size, they could go bankrupt. 

As health reform continues, geographically large systems that can access capital, achieve economies of scale, become accountable and take insurance risk will grow in number and complexity. That will only fuel the further consolidation of small local hospitals and smaller physician practices.

In other words, the lesson from the airlines may be that that "tipping point" for nationwide health system consolidation may be much closer than we realize.

Image from Wikipedia

Why Eyes Sensitive to Onion

Why the eye does not hold with onions?, Onions are one of the many herbs used in cooking. But if someone wants to use it, he should get ready for the tears.

Beside to cooking, garlic is also believed to contain chemicals that function as anti-cholesterol, anti-inflammatory (inflammation), an antioxidant and can also help overcome the blood pressure.
When a person is cut or peel the onion, then he broke the cells in the onion that combines each layer. One membrane of onion contain enzymes, while others contain sulfur compounds.

When the onion sliced or peeled, then the chemical reaction occurs between the enzyme and also sulfur compounds that produce gas volatile (easily evaporated). This gas will react with the surrounding air becomes sulfuric acid.

Because the nerve endings of the eye is very sensitive, then hit the gas when the eyes become irritated and stimulate watering to protect the eyes. Because it would not be surprised if more and more onions are cut, the tears that come out will be more and more.

To reduce irritation, so not many tears that come out when confronted with the onion, there are several ways you can do are:

1. Keeping the distance eyes with onions, increasing distance, the gas that irritates the eyes will be fewer and fewer.
2. Keeping onions stay cool, this is due to cool the onions can reduce the gas that comes out due to enzyme inactivation.
3. Using the goggles, the goggles will make the eyes are protected, thereby reducing irritation.
4. Chewing gum, chewing will make someone breathe through the mouth, thereby reducing the gas exposures to the eye.
5. Try not to be rubbed his eyes because it will make the eye more irritated and trigger more tears came out.

Why Gums Easy Bleeding

Why Gums Easy Bleeding - The healthy gums colored young red and hard. If the gums looks inflamed, soft, and colored old red and easy to blood, there is a possibility you suffer from gingivitis. namely the gums around the tooth root.

The cause of gingivitis is plaque, a colorless layer of bacteria and sticky on the teeth. When hardened, plaque turns into tartar, white entry will eventually become black. The formation of plaque and tartar can cause irritation of the gingiva so inflamed and easily bleeding gums.

Usually people have realized there was something with his gums when brushing your teeth and brush so pink after use or there is blood when rinsing. This is a sign of bleeding even when you brush your teeth gently.

Nevertheless, bleeding gums are often caused by the process of brushing teeth too hard. "Brushing your teeth is not hard to make our teeth clean, but make our gums bleed," said drg. Day Sunarto, Sp. Perio.

He explains, brushing your teeth hard and moving in the direction of horizontal movement of sand is tantamount to the teeth. "No need to brush it out loud because of plaque on teeth is a period that is soft. To clean the tartar that are loud, preferably to the dentist," he said.

Brushing teeth correctly is with a short movement from the gums towards the teeth one by one or two teeth first. "Do such movements to all teeth using a soft brush," he added.

If the teeth are well cared for, such as brushed every day, using dental floss regularly and often control and cleaned at the dentist, then chances are suffering from gingivitis will decrease. Gums will soon become firm and pink as a sign is healthy again.

Why Is Difficult To Quit Smoking

Why Is Difficult To Quit Smoking?

Our body is trained to behave according to habit. If you have been a smoker for several years, your body has learned to operate with a particular level of nicotine in the body. So when you decide to use quit smoking products, your body is unable to understand why it is not getting the required level of nicotine it is used to. The body then goes through a phase where it readjusts itself to the absence of nicotine. This phase of re-adjustment is by far the most difficult to deal with. Withdrawal symptoms peak in roughly two days time after quitting and linger on with weakened strength for 8 to 10 weeks before disappearing altogether after 6 months. It is this interim period where the smoker is the most vulnerable to going back to smoking.

Some Common Withdrawal Symptoms:

Withdrawal symptoms tend to be both physical and mental.

Physical Withdrawal Symptoms:

• Headaches
• Tingling in the hands and feet
• Cramps and nausea in the stomach
• Cold symptoms such as sore throats and flu symptoms

Mental Symptoms Include:

• Temper tantrums and irritability
• Insomnia in an acute form
• Stress, anxiety and depression
• Inability to concentrate

Motivate Yourself To Stick To The Quit Smoking Program:

When you feel you cannot handle the withdrawal symptoms anymore, remind yourself of why you want to quit (I am sure you will find several reasons to quit this deadly habit especially the traditional cigarettes that are full of negative points). Read up websites where the harmful effects of smoking have been listed. Spend time with loved ones and remind yourself of how much it would mean to them if you quit. Ask for support from quit smoking support groups and see your physician or counselor as often as you need.

Make repeated affirmations to yourself about how good you will feel when you quit the habit for good. Promise yourself a good reward if you stick to your decision of quitting. In the event that you are unable to quit, don’t feel bad. Begin all over again when you are ready.

How Quit Smoking Products Can Help?

Quit smoking products provide a major source of physical support for people who decide to kick the habit. Nicotine gum, nicotine patches, and electronic cigarettes are all quit smoking alternatives which help the smoker’s body adjust to reduced levels of nicotine. Making the decision to quit smoking is the best thing you can do for your health. But sticking to the decision is a lot more difficult than making it. Be mentally prepared that quitting is tough but not impossible.

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Author : Jack

Article source : Why Is Difficult To Quit Smoking?

Men also Can Natural Eating Disorders This is Why

Eating disorders such as anorexia and bulimia are problems that often occur in women due to dietary errors. But new research shows that men can also suffer from an eating disorder, but the symptoms are not similar.Women who want the ideal body shape and the men who want a muscular body contains, choose a diet by limiting calorie intake. This can put the risk of eating disorders that adversely impact nourishment.Men need to ask themselves a few questions to find out if she had an eating disorder. This is necessary because most men do not realize a small change in their daily life that leads to health problems.Here are 5 list of questions you need to consider to ensure that you have been eating and exercising in a healthy zone, among others:

1. Do you have a specific physical symptoms? 
If after a workout you feel weak, dizzy, and experiencing other serious signs, or after eating you feel panic, despair, and forcing yourself to vomit the food, it shows that you have an eating disorder. 
2. Did you reduce your calorie intake drastically?
Eating disorders can occur if you are on a diet very low in fat or calories without the supervision of a nutritionist. You need calories to be able to move with energy, if the calories in the food you eat very little, your body and your health affected limp.To get a rough idea of ​​the minimum amount of calories you need each day, multiply 25 calories for every pound you weigh. So, if you weigh 175 pounds, you need 1985 calories per day.

3. Are you too extreme exercise? 
Sports are too hard to limit the calories you need to move. If this is done constantly, you tend to lose power and can not even maintain the immune system due to lack of nutrition.

4. Are you obsessed with thoughts about food or your body?
People who spend a lot of time just to think about food, weight, or muscles, may be one sign of an eating disorder. Men with eating disorders tend to wonder if the food is too many and a major effect on his body.

5. Do you have sex less qualified?
Men with eating disorders, more attention to the result of diet and exercise that have lived on body shape. When the body shape is considered not in accordance with what they want, men tend to be less confident in front of her partner.