Hinz, who was an avid duathlete and former marathon winner, died early Friday when his vehicle lost control on black ice and crashed into a car that was alongside the road from an earlier accident. The accident occurred on I-94.

The 1982 Detroit Free Press Marathon winner was on the August 2005 cover of Healthy & Fit Magazine. Since that time, Hinz and magazine publisher Tim Kissman became friends and kept in touch through e-mails and bike rides.

“I rode with Dave several times after that interview and we became friends,” said Kissman. “Hinz was truly a mentor to me as an athlete and as a writer and publisher. He was one of the greatest all around athletes I’ve ever met and one of the nicest people, too. Our thoughts and prayers are with his family.”

Hinz was featured in the magazine when told Kissman that he lost more than 160 pounds after retiring from racing. Even though he was in his 50s, he used his new body and training methods to launch a successful duathlon career, competing in world duathlons and dominating local events.

“I see a triathlon as a natural progression and a new challenge,” he said during the interview. “I’ve committed myself to it and I know I will do my best.”

Hinz was 56. He is survived by a longtime girlfriend and three adult children.

The morning of nationals was cool with misty rain. The competition consisted of a 10K run, then a 40K bike, and ending with a 5K run. The first 10K run went well but the slippery roads caused many bike wrecks. Pepper did crash on his bike, causing slight damage to his bike as well as many abrasions to his arms and legs. He lost much time on the bike, but fast on his feet he still finished third in his age group.

“I am very happy with how I did on such little training over the winter” Pepper said. “I have a good chance of doing very well at Worlds if I can get the proper training and stay healthy. I am thrilled to make Team USA!”

Pepper currently wears the Cadence Cycle Jersey of Saline and is seeking other sponsors to help him compete in Italy. Team USA attracts the best athletes representing over 50 countries each year.

In September, Blue Cross Blue Shield of Michigan and Michigan Recreation and Park Association announced an innovative partnership to promote walking as a viable form of exercise and recreation. While each organization has a long existing walking program with its own target market, they have a shared value of health and well-being for Michigan residents.

WalkingWorks® is a noncompetitive national walking program developed by the Blue Cross and Blue Shield Association and promoted at the state level by BCBSM. The objective is to encourage people to take advantage of an activity readily available to virtually anybody and at anytime; it’s also designed to assist employers in developing opportunities for employees to commit to brisk walks during approved work breaks. The philosophy is that a person does not have to spend a lot of money to realize the many health benefits walking has to offer.

Walk Michigan! is a noncompetitive statewide walking program created by MRPA. Given the same objective as BCBSM, Walk Michigan! offers opportunities for community residents to utilize local park and recreation walking trails throughout the state. The philosophy is that in addition to important health benefits there are also significant social benefits, from meeting new community members and participating in a family activity to bonding with a pet that has been alone all day.
The partnership promotes WalkingWorks and Walk Michigan! simultaneously by combining resources and implementing a per market program model throughout the state. BCBSM has committed to a $50,000 sponsorship to support the expansion of both programs, making them available to Michigan communities throughout the state. MRPA brings to the table a strong organizational infrastructure to administer the marketing campaign. The potential outcomes for all stakeholders are astounding. BCBSM and MRPA are joining forces with six regional park and recreation organizations, up to one hundred local park and recreation agencies and forty Michigan corporations.

One of the features of this program model is the coordination of efforts between local P & R agencies and select Michigan companies to create walking opportunities for employees and their families before, during and after work. This both encourages walking and introduces walkers to area parks and recreation facilities they may not have previously considered. Beyond this program, the potential for long-term relationships and further collaboration between P & R agencies and Michigan companies is exciting.

Michigan faces serious challenges when it comes to the overall health of its residents. A recent economic study by Altarum, a nonprofit research institute, compared the health of Michigan’s work force to benchmark states that compete with Michigan for new corporations and jobs. The study found that the health of Michigan’s work force could hinder its ability to compete. The study ranked Michigan:

• Highest in death rates from heart disease
• Second-highest in rates of obesity and diabetes
• Sixth-highest in number of smokers
• Highest prescription drug use

Physical inactivity alone is responsible for the majority of preventable diseases and results in the annual loss of about twenty days per worker. The Michigan Chamber of Commerce reported that member organizations complained that the high cost of health insurance was the greatest threat to their profitability and they wanted help.

Worksites are one of the best places to reach the majority of Michigan’s adult citizens to encourage them to lead a healthy lifestyle. Participating in a walking routine is a step in the right direction. According to the Mayo Foundation for Medical Education and Research, brisk walking on a regular basis can reduce your risk of a heart attack, decrease your chances of developing diabetes, help control your weight, improve your muscle tone and promote your overall sense of wellness.

This, in essence, is the inspiration for this combined effort kicking off on Thursday, May 22, from 11:30 a.m. to 1:30 p.m. on the lawn of the State Capitol. Chris Holman steps up to emcee with special appearances by BCBSM health and fitness advocate Ernie Harwell, and BCBSM walking advocate Jodi Davis. Ernie is a former Detroit Tigers announcer and National Radio Hall of Famer, and Jodi is an amazing woman from southwest Michigan who lost 162 pounds in 16 months and changed her life with the help of walking. Everyone is invited to join Ernie and Jodi as they lead Michigan in taking the first step in the right direction for this year’s program.

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

The new results, published in the February issue of the 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 the 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 the study based their advice to their patients on the latest research-based evidence about eating habits and cholesterol levels available at the time of the study: the American Dietetic Association’s 1998 Medical Nutrition Therapy Hyperlipidemia Protocol.

Since that time, the 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 the 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 the U-M Cardiovascular Medicine program at Domino’s Farms and the U-M Cardiovascular Center. “But this is the first national study to show what happens when high-risk patients work with R.D.s to follow nutrition guidelines grounded in the 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 the Lipid Management Nutrition Outcomes Project or LMNOP, the 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 the 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 is 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 the long run, she says.

To get uniform data, the researchers brought lead R.D.s from each state to U-M for training on the 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 the ADA guidelines.

The study included only patients between the 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 the study.

The “real world” aspect of this study included the 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 the first time, or increasing their dose before assessing the effect of diet change, were not included in the analysis. But for the 219 patients who didn’t have any change in their medication status, the impact of the R.D. counseling became apparent in the 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 the 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 the 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.”

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

The heart performs two primary functions in the body. The right side of the heart collects deoxygenated blood from the body and pumps it into the lungs, that purify, filter, and oxygenate the blood. The left side of the heart, then, collects the blood from the lungs and pumps it throughout the body to maintain its oxygen, nutritional and metabolic requirements. These functions are carried out by well-designed and synchronous actions of the top and bottom chambers of the heart, along with careful and coordinated actions of the valves of the heart. Overall, this is maintained by the electrical system of the heart, which was discussed in detail in the October 2007 issue of Healthy& Fit Magazine. Any failure of the cyclical function of the heart at any level results in a condition which may lead to congestive heart failure (CHF).

As one can imagine, a lot of conditions could lead to heart failure. In order to simplify the understanding of various causes of CHF, the medical community has proposed a number of classifications—none of which encompass all known causes of CHF. Therefore, in order to understand this, the utilization of multiple classifications is necessary but may often lead to confusion and conflicting opinions regarding management strategy of various conditions.

Broadly speaking, the causes of CHF include:

• Hypertension and Coronary Artery Disease – commonest in the older population, accounting for about 75% of cases within that age group.
• Diseases of the Heart Valves – Aortic Stenosis and Regurgitation and Mitral Stenosis and Regurgitation. The latter was discussed in the November 2007 issue of Healthy & Fit Magazine.
• Cardiomyopathy – heterogeneous group of diseases of the heart muscle associated with mechanical or electrical dysfunction causing dilation and/or thickening of the lower chambers of the heart. This may be:
  • Primary – predominantly confined to the heart muscle, either genetic or acquired.
  • Secondary – involving the heart muscle as a part of generalized multiorgan disorders.
  • Pericarditis – inflammation, along with fibrosis, of the membrane covering the heart causing restriction of the movement of the heart.
  • Arrhythmia
  • Atrial Fibrillation – usually rapid and irregular heartbeat (October 2007 Issue of Healthy & Fit Magazine)
  • Ventricular Arrhythmias – (i.e. Ventricular Tachycardia) Bradycardia – slower-than-normal heart rate (i.e. complete heart block)
  • Tachycardia – any type of persistent, rapid heartbeat

The symptoms of CHF that one may experience are varied and not always apparent. Due to the fact that CHF is usually slow to develop, people in the very early stages of this disease may not notice any symptoms at all; while others will dismiss their symptoms as being age-related. Still, many individuals will have obvious and persistent symptoms such as:

• Shortness of breath, especially with physical activities or exercise
• Orthopnea – difficulty breathing unless sitting up straight or standing erect
• Swelling of the feet and legs
• Lack of energy or general feeling of tiredness or lethargy
• Swollen or tender abdomen, loss of appetite
• Cough with “frothy” sputum
• Increased urination at night
• Confusion, impaired memory

The statistics reported by The American Heart Association exemplify the scope of the problem that our healthcare system faces. Individuals over the age of 40 have a 1 in 5 chance of developing CHF. At the present time, 5 million people in the United States suffer from Congestive Heart Failure—with 550,000 new cases being diagnosed each year, thus, accounting for a significant financial burden on America’s healthcare system.

Fortunately, a team approach to the management of this debilitating condition could improve the quality of life and longevity for these patients. Diagnosis of the cause of this condition is the pillar on which the entire treatment is based. As can be concluded from the multitude of causes of this condition, a large number of tests may be necessary in order to diagnose the problem.

These tests may include a Chest X-ray, EKG, Echocardiogram, Stress Tests, Nuclear Studies, MRI, CT Angiogram and Cardiac Catheterization. Laboratory blood tests are necessary and include blood count, kidney function tests, electrolytes studies, hormonal studies, and genetic testing.

The goals of treatment for CHF are improvement in quality of life, avoid occurrences of acute episodes of decompensation and hospitalization and improved length of survival. This goal also includes the reduction in the likelihood of irregular heartbeats and sudden death syndromes.

The use of medications is the mainstay of treatment for CHF in a large proportion of patients. A large number of medications are available, and multiple regimens may be necessary to ensure optimal response. These options should be carefully monitored by the healthcare provider, including doctors and nurse practitioners. More importantly, lifestyle changes including dietary restrictions, weight loss, smoking and alcohol cessation, are the pillars of successful long-term management of this debilitating condition.

Certain conditions causing CHF have surgical treatment options, and these will be discussed in detail in the February issue of Healthy & Fit Magazine.

“Cough is the reason for nearly 3 percent of all outpatient visits in the United States, more than any other symptom, and it most commonly occurs in conjunction with an upper respiratory tract infection,” the authors write as background information in the article. Cough is usually more bothersome at night because it disrupts sleep. Although unsupported by the American Academy of Pediatrics or the American College of Chest Physicians, dextromethorphan is the most commonly used over-the-counter remedy for children’s cough. “In many cultures, alternative remedies such as honey are used to treat upper respiratory tract infection symptoms including cough.”

Ian M. Paul, M.D., M.Sc., and colleagues at Penn State College of Medicine, Hershey, conducted a study involving 105 children age 2 to 18 with upper respiratory tract infections who were sick for seven days or less and experienced symptoms during the night. Thirty-five children were randomly assigned to receive an age-appropriate dose of honey, 33 to receive dextromethorphan and 37 to receive no treatment for one night within 30 minutes of bedtime. The children’s parents were asked to complete a survey assessing their child’s cough and sleep difficulty the night before their assigned treatment and then again the night after treatment.

Honey was found to yield the greatest improvement followed by dextromethorphan, while no treatment showed the least improvement in cough frequency, cough severity, cough bothersome to child, child’s sleep and parent’s sleep. “In paired comparisons, honey was significantly superior to no treatment for cough frequency and the combined score, but dextromethorphan was not better than no treatment for any outcome,” the authors write. “Comparison of honey with dextromethorphan revealed no significant differences.”

“While our findings and the absence of contemporary studies supporting the use of dextromethorphan continue to question its effectiveness for the treatment of cough associated with upper respiratory tract infections, we have now provided evidence supporting honey, which is generally regarded as safe for children older than 1 year, as an alternative,” the authors conclude. “While additional studies to confirm our findings should be encouraged, each clinician should consider the findings for honey, the absence of such published findings for dextromethorphan and the potential for adverse effects and cumulative costs associated with the use of dextromethorphan when recommending treatments for families.”