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May 4th, 2009Alcohol
January 21st, 2012My wife and I recently returned from a wonderful weekend up in Sonoma County, where we indulged in a little wine tasting. While I’m actually not much of a drinker, learning about wine and winemaking is always fascinating. Upon our return, we’ve plunged into this season of holiday parties, with alcoholic drinks being served at most. All of this has started me thinking about the physiology of how alcohol affects our bodies.
Whether or not we are aware of it, the first sips of an alcoholic beverage result in the immediate impairment of brain function, and the more that we drink, the more that function deteriorates. The rate of deterioration may be affected by how empty or full our stomach is; our gender, age and weight; and race. Certain medicines, such as aspirin, slow the breakdown of alcohol and greatly increase the blood alcohol level. Cognitive abilities such as conduct and behavior are the first to go. There can be a mild euphoria and loss of inhibition. The most vulnerable brain cells are associated with memory, attention, sleep and coordination.
Alcohol affects the heart. Our pulses quicken after very little is consumed. Alcohol is a vasodilator, meaning that it makes the blood vessels relax in order to allow more blood to flow through the skin and tissues. This results in a drop in blood pressure, so in order to get sufficient blood to organs and tissues, the pulse speeds up. After a significant intake of alcohol, the heart develops “holiday heart syndrome,” in which the heart goes into an irregular rapid heart rhythm (atrial fibrillation). This can lead to weakness and shortness of breath, and an increased risk of stroke.
The lungs are involved because alcohol speeds up the breathing rate. However, at higher levels of intoxication, the stimulating affects are replaced by an anesthetic effect, which actually depresses the central nervous system. (Note that as our blood passes through our lungs, a proportional amount of alcohol passes into the air that we exhale. This is why Breathalyzers can accurately detect the blood alcohol level.)
The digestive system is affected. As a rough guideline, it takes as many hours as the number of drinks consumed to burn up the alcohol. Alcohol is absorbed through the stomach and small intestine. Even small amounts can irritate the stomach lining, and larger quantities of alcohol can block absorption of essential vitamins and minerals. Only a few weeks of heavy drinking can lead to pancreatitis.
The kidneys are affected because alcohol is a diuretic. It promotes urine production, which then leads to dehydration. Due to this stimulation, the kidneys are working overtime.
Alcohol affects the skin. It increases blood flow, making us feel warm and look flushed. Since it also dehydrates, it increases the appearance of fine lines.
The destructive effects of alcohol on the liver are well known. Large quantities can lead to both acute and then chronic liver disease. It is in the liver that alcohol is metabolized, and as it breaks down, its by-products (including acetaldehyde) are formed. Some of these by-products are even more toxic to the body than the alcohol. Even a single episode of heavy drinking affects the delicate balance of enzymes in the liver and fat metabolism. Over time, drinking can lead to the development of fatty globules that cause the liver to swell, ultimately leading to cirrhosis.
On top of all of this…is the hangover! Its precise cause is unclear. There are many theories, including hypoglycemia, dehydration, acetaldehyde intoxication, and glutamine rebound. Some symptoms may actually be due to alcohol withdrawal. They include fatigue, headache, body aches, vomiting, diarrhea, flatulence, weakness, elevated body temperature and heart rate, hyper-salivation, difficulty concentrating, sweating, anxiety, dysphoria, irritability, sensitivity to light and noise, erratic motor function, tremors, trouble sleeping, severe hunger, halitosis, and lack of depth perception. Hangovers may include psychological symptoms including depression and anxiety. Symptoms usually begin after the intoxicating effects of alcohol wear off; typically, a hangover is experienced the morning after a night of drinking. Of course, these symptoms vary from person to person, and it’s possible that up to 30% of drinkers may actually be resistant to hangover symptoms.
With long-term heavy drinking, the picture gets pretty ugly. It leads to a drop in testosterone, impotence, testicle shrinking, infertility in both men and women, and permanent damage to the brain by damaging the connections between nerve cells. It is a depressant, and can trigger anxiety and lethargy. It leads to anemia, and is linked to an increased risk of a number of cancers. Drinkers can die from bleeding ulcers, or from swollen blood vessels in the intestine. Eventually drinking can lead to “alcohol dementia,” poor coordination, cirrhosis, and liver and kidney failure.
So as we bid farewell to 2011 and welcome in 2012, let’s remember to practice moderation and treat our body with the respect it needs and deserves. Let me also take this opportunity to remind all of you not to drink and drive.
Happy holidays to you all!
Vitamine D
January 21st, 2012Lately, when I perform physical exams, I’ve been including Vitamin D levels with the routine lab tests. Very frequently, these levels come back low. Is this important? What does it mean to have a low Vitamin D level, and what impact does that have on our health?
Vitamin D is actually a group of five fat-soluble vitamins known as D1, D2, D3, D4, and D5. Of these, D2 and D3 are the most important to us. Known as the sunshine vitamin, Vitamin D is synthesized in the body from sun exposure, and is also consumed in the diet from food and/or supplements. Vitamin D is well known for preventing rickets in children and osteomalacia (softening of the bones) in adults. Together with calcium, it protects adults from osteoporosis.
Some of us live in areas with very little sunshine, or restrict our sun exposure for health-related reasons. To make up for that, we can increase our intake of Vitamin D-rich foods, including some fish (salmon, mackerel, tuna, sardines), fortified milk and fortified orange juice, beef liver, and eggs. Vitamin D supplements are also readily available, and it is included in most multivitamins. Note that because Vitamin D is a fat-soluble vitamin (as are Vitamins A, E, and K) it is stored in the liver and fatty tissues, and does not need to be replaced every day. Because it is stored, however, it poses a greater risk for toxicity if too much is taken. Nevertheless, I generally recommend that adults take a Vitamin D supplement of 1,000 IU per day.
The beneficial effects of Vitamin D on health are not all clearly proven, but current studies indicate that:
•It is crucial for the absorption and metabolism of calcium and phosphorus, which have various functions, especially that of maintaining healthy bones.
•It plays an important role in immune system regulation. During months of little sunshine when our production of Vitamin D is low, there is a higher prevalence of flu and other viral infections. Many factors may be in play, and researchers are investigating further.
•Researchers have found a correlation between Vitamin D levels and memory function. It may play a role in helping us maintain our mental agility. Stay tuned!
•There may be a correlation between levels of Vitamin D and adolescent and abdominal body fat. This has opened the doors to more studies on using Vitamin D supplements to aid weight loss.
•Low levels of Vitamin D have been linked to more severe asthma attacks in children. Taking supplements has been linked to fewer and milder attacks.
•Various studies link low levels with some cancers, but supplements do not appear to help.
•Low blood levels of Vitamin D are associated with increased mortality in general. Vitamin D3 supplements appear to decrease all causes of mortality, especially in elderly women.
•Also under investigation is the theory that Vitamin D might have a protective effect against multiple sclerosis. Multiple sclerosis occurs at high rates in regions of the world with long periods of little sunlight, and thus far less Vitamin D production in the body.
However, too much of a good thing can be harmful! Vitamin D toxicity, also called hyper-vitaminosis D, is a potentially serious but treatable medical condition. Toxicity comes, not from too much sunlight, but from too many supplements. The body can generally handle up to 10,000 IU (International Units) per day, but sustaining that level of intake for several months may lead to toxic symptoms.
We are more likely to become toxic if we have certain underlying problems, such as hyperparathyroidism. Symptoms of Vitamin D toxicity include nausea, frequent urination, weight loss, poor appetite, constipation, weakness, irregular heart rhythm, kidney stones, headaches, dehydration, fatigue, irritability, and muscle weakness. Treatment includes stopping all supplements and restricting calcium intake in the diet.
I wish for all of us good health and plentiful Southern California sunshine!
Nutrition Facts
May 2nd, 2011
So many of us are keeping a watchful eye on our sodium, fat, or calorie consumption. How do we know what we’re eating? Is there a simple way to understand the contents of the food that we buy?
The Nutrition Labeling and Education Act (NLEA) was passed in 1990, requiring all packaged foods to display nutrition information. These labeling requirements have since undergone multiple amendments, and today, labeling is required for most prepared foods, including breads, cereals, canned and frozen foods, snacks, desserts, and drinks. Labeling for raw produce (fruits and vegetables) and fish is voluntary.
The Nutrition Facts food labels list the percentages supplied based on an average 2,000-calorie (and sometimes 2,500 as well) a day diet. The Daily Values used were originally based on 1968 recommended dietary allowances for each nutrient for men and women of any age, and have been periodically revised to incorporate more current research. However, newer revisions are still necessary.
Here’s an example of the label that appears on most packaged foods:
When evaluating the information on your nutrition labels, keep in mind that higher amounts for vitamins, fiber, and protein are good, but for saturated fats, cholesterol and sugars, lower numbers are more healthful. Remember that most Americans don’t get sufficient amounts of dietary fiber, vitamin A, vitamin C, calcium, and iron in their diets.
How do grams relate to calories? Carbohydrates and protein contain about four calories per gram. Fat contains about nine calories per gram. So, if only grams are listed, multiply four or nine times the number of grams, and the result will be total calories.
Pay special attention to the serving size and the number of servings information listed at the top of the label. All information on the rest of the label is based on a single serving. The serving size tells us the size of that single serving; for example, one serving of chicken noodle soup is considered to be 1/2 cup. This information can be very misleading, as a half-cup of soup (even after it is mixed with water) is not what many of us would picture as a full serving! Note that if a small package of cookies contains six cookies, but the serving size is just two, then the entire package contains triple the calories and other values listed.
It is also important to note that one chicken soup serving is one-half cup of the condensed soup as it comes in the can, and not one-half cup of the soup after it has been mixed with water. Depending on the product, the serving size may be measured or counted before or after preparation. Here, the serving size is before preparation, and since the number of servings is 2.5, you can simply consider that regardless of the amount of water used when preparing the soup, if you consume the entire can, you have eaten two and one-half servings (and that doesn’t include any crackers!).
The middle portion of the Nutrition Facts food label contains information about calories, fat content, amount and type of carbohydrates, and amount of protein. It shows the amounts in grams (g) or milligrams (mg), and the percentage of the daily value (the amount recommended every day) for each of these nutrients.
You will note that trans fats are listed without a percentage next to them. This is because experts have not agreed on a reference value for how much can be safely consumed. These fats raise blood LDL (bad cholesterol) levels, which increase the risk of heart disease. There is no reference value for sugar, either. Be aware that the sugars listed include both naturally occurring sugars (as in fruits), as well as processed sugars. Diabetics and others among us who are concerned about sugar intake should be certain that sugars are not listed as one of the first few ingredients. Processed sugars may appear as corn syrup, high fructose corn syrup, fruit juice concentrate, maltose, dextrose, sucrose, honey, and maple syrup.
We also find sodium information located in this middle section, rather than with the other minerals down at the bottom of the label. You can see that only a single serving of condensed chicken noodle soup has 37% of the daily value for sodium. If you consume the entire can, you will have eaten almost the entire recommended amount of sodium for the whole day!
Glance at the amount of fiber contained, and you may not be surprised to see that chicken noodle soup from a can contains very, very little.
The bottom portion of the Nutrition Facts label displays the vitamin and mineral content. The FDA requires that information on calcium, iron, vitamin A, and vitamin C be included. Food manufacturers may add information about other vitamins like niacin or folic acid if the product contains any significant amounts. This bottom portion is not always present on smaller items, but it is a good reminder of our general needs, based on that 2,000 or 2,500 calorie per day diet.
The information contained on these tiny labels is imperfect. It doesn’t break down our dietary needs by gender, by age, or by particular health condition. It doesn’t address conflicting research and current opinions in the nutrition and health care field. However, if your goal is to use this limited information as a guideline, then it can be a great tool to help find the foods that fit into a balanced and healthful diet.
Read carefully, and eat smart!
Organ Donor
March 15th, 2011Every one of us has the opportunity have our organs donated upon our death. How do we make that decision? What factors should we consider? There is a clear need, but bioethical concerns cloud the issue. Interestingly, organized religion poses few obstacles. Let’s explore together.
Organ transplants save lives every day. If a transplant is not possible due to organ condition or match failure, the organ can still be used forresearch or education. Researchers use normal as well as diseased organs and tissues for study, and vast numbers of people benefit from the resulting medical advancements.
The world’s major religions accept the concept of organ donation in at least some form. Most religions, including the Catholic Church, support organ donation on the grounds that it constitutes an act of charity and provides a means of saving a life. Some religions impose restrictions on the types of organs that may be donated, or on the means by which organs are to be harvested or transplanted.
For example, due to their prohibition of blood transfusions, Jehovah’s Witnesses require that organ be drained of blood prior to transplant. Muslims require that the donor provide written consent in advance. Orthodox Judaism considers organ donation obligatory if it will save a life, as long as the donor is considered dead as defined by Jewish law.
A few groups do oppose organ transplantation or donation, including many who follow Shinto practices, and Gypsies.
There is an enormous shortage of donor organs.This could not be truer than with the increasing need for kidneys. Kidney failure is brought on by rising age, diabetes and hypertension, and all three of these categories are growing in size. Spain boasts the highest organ donation rate in the world, with 35.1 donors per million people. This rate compares to 24.8 donors per million in Austria, and 22.2 donors per million in France. The Spanish transplant system is one of the most successful in the world, but it still can’t meet the demand, and 10% of those needing a transplant die while still on the transplant list. Under Spanish law, every death can provide organs unless the donor expressly specified otherwise (while still living!).
Organ donation is becoming an important bioethical issue. For example, prisoners here in the United States are not discriminated against as organ recipients and are equally eligible for organ transplant as the general population. In 1976, the Supreme Court ruled that withholding health care from prisoners constituted “cruel and unusual punishment.” Of course, many are uncomfortable that an organ transplant and follow-up care can cost the prison system up to $1 million, and that an organ transplant to a prisoner may well deprive another citizen of that organ and a possibly life-saving surgery.
Another ethical issue involves whether to give liver transplants to alcoholics who may be in danger of relapse. Should organ transplants be allowed for drug abusers, those with reckless lifestyles, older patients, etc.? With a limited supply of organs to transplant, these become complicated and difficult bioethical social issues.
Because demand for organs far outpaces supply, a black market, often referred to as transplant tourism, exists. Black markets are, by their nature, unregulated, and not surprisingly the rich take advantage of the poor. Those who support a black market argue that the poor are in desperate need of the money. Follow-up studies have actually been conducted on those donors who sold a kidney in countries where organ sales are legal. These studies show that a majority of donors have extreme regret, and if given the chance to repeat the procedure, they would not.
In addition, many study participants reported an actual decline in economic status following the procedure, despite income from the donated organ.
Even more frightening black market cases have involved suspected cases of organ theft, including murder. Supporters of a legal organ market claim that the black-market system encourages such tragedies, and that regulation could prevent them. Opponents claim that such a market could encourage criminals by making it easier to claim that a stolen organ was legal. Needless to say, this issue is far from resolved.
In 1999, eBay was involved in an organ scandal. An auction for “one functional human kidney” reached a bid of $5.7 million before it was blocked by eBay. In the United States, the sale of human organs is punishable by up to five years in prison and a $50,000 fine.
An exciting but hugely controversial new field has arisen with great potential for providing organ supplies: cloning. A cloned organ would run no risk of rejection, since it would be a perfect match. However, the use of cloning to produce organs with an identical genotype to the recipient has issues all its own.
Consider the ethics of cloning an entire person for the express purpose of being destroyed for organ procurement! Currently, stem cell research is investigating using cloned stem cells to grow only a new organ. This research shows enormous promise, despite the bioethical and religious issues still unresolved.
There is simply no replacement for having available a real human body when it comes to teaching and research. I would urge all of us to give organ or full body donation serious consideration. It will truly help in the discovery of cures for many debilitating conditions such as cancer and Alzheimer’s disease, in the development of new medicines, in the study of human anatomy, and in perfecting new surgical procedures.
As a medical student, one of my most important classes was Human Anatomy and Dissection, and I clearly recall that each donation was highly valued, and treated with the utmost humanity, compassion and respect. Many years have passed, and my oldest daughter just finished the very same human anatomy course in her own medical school. She describes a ceremony held before the course began, attended by both medical students and donor families, where the donor families were personally thanked for their amazing and precious gift.
Here are some steps you can take to become an organ donor:
•Register with your state donor registry: www.DonateLifeCalifornia.org/register/
•Sign a donor card and carry it with you until you renew your driver’s license, at which time your decision can be designated on your driver’s license.
•Talk to your family now about your decision to donate. Help them to understand your wish to be an organ and tissue donor, before a crisis occurs.
I wish you and future generations the gift of a long and healthy life!
Laughter
January 27th, 2011As the cliché goes, laughter is the best medicine. But is it really? Is there evidence to support such a claim?
It turns out that the research is full of good hard evidence that too much stress results in increased levels of ACTH, cortisol, epinephrine, and norepinephrine; the so-called “stress hormones”. This is not normally a good thing. The question remains as to whether humor can decrease stress, positively impact the stress hormones, diminish pain, improve the strength of the immune system, and consequently improve quality of life. This has been a persistent topic of discussion for decades in both the lay and professional medical literature. Certainly, laughing is more affordable than medication, herbs, massage, or lengthy therapy!
Unfortunately there is little conclusive evidence that laughter specifically changes these body chemistries. However, the data is encouraging:
Laughter has been shown to reduce pain, in at least two ways. It serves as a distraction, and causes the release of endorphins, which reduce the sensation of pain.
Laughter may boost the immune system. There appears to be an increase in “killer” antibodies and t-cells – both of which fight infection.
Laughter relaxes the muscles and even tones the facial muscles.
Blood pressure has been shown to decline following bouts of laughter.
Finally, apparently no researcher has found a single harmful effect from laughter. It’s cheap, and available.
So, it is highly likely that laughter boosts immunity, lowers stress hormones, decreases pain, relaxes muscles and lowers blood pressure. Laughter adds joy and zest to life, eases anxiety and fear, relieves stress, improves mood, strengthens relationships, enhances teamwork, helps to defuse conflict, promotes bonding, and likely attracts others to us.
Here are some strategies for all of us to work on during this upcoming year:
•Don’t avoid dealing with your stress. Stress is a major impediment to humor and laughter.
•Laugh at yourself. Share embarrassing moments and take yourself less seriously.
•Laugh more at situations rather than bemoan them. There is often humor to be found even in bad situations. See the irony and absurdity of life!
•Surround yourself with reminders to lighten up. Put up a funny poster, or keep toys on your desk. Choose a computer screensaver that makes you smile.
•Pay attention to children and emulate them. They are truly the experts of play, taking life lightly, and laughing.
•Keep things in perspective. Many things in life are beyond your control. Remember the Serenity Prayer, and that you do not control the behavior of others. I always appreciate my patients’ willingness to carry the weight of the world on their shoulders. It is admirable but unrealistic, unhealthy, and perhaps even egotistical!
Good health and humor to you all, and have a very happy New Year!
I wish you the best of health.
Water
January 18th, 2011Doctor, how much water should I drink? I hear this question every day. We all know that enough water is essential for good health, yet everyone’s needs are different. It’s a simple question, with a not so simple answer!
Water makes up about 60% of our body weight and is the principal chemical component in the body. Every system depends on it. Water flushes toxins out of vital organs; carries nutrients to the cells; and moisturizes the nose, ears, throat, blood vessels, and tissues. Minor dehydration will result in thirst, loss of appetite, dry skin, skin flushing, dark colored urine, dry mouth, fatigue, weakness, chills and head rushes. More dehydration leads to increased heart rate, increased respiration, decreased sweating, decreased urination, increased body temperature, extreme fatigue, muscle cramps, headache, nausea, and tingling in the limbs. Once dehydration reaches 10%below normal levels, fluid loss becomes an emergency and can be fatal. Signs include muscle spasms, vomiting, racing pulse, visual changes, painful urination, confusion, difficulty breathing, seizures, and unconsciousness.
We lose water through breathing, perspiration, urine and bowel movements. Clearly, there is some ideal amount of water needed to replace these fluids and keep the system running correctly. The simplest approach is known as the eight by eight rule. Drink eight glasses of eight ounces of water per day. This is based on the replacement method: an adult urinates about six ounces of water per day, and we lose roughly an additional four cups each day through breathing, sweating, and bowel movements. Food accounts for roughly 20% of our total fluid intake, so if we consume about eight cups of water or other beverages a day along with a normal diet, we will typically replace the fluid lost. This is pretty general, but will normally suffice.
Another method is to look at the toilet bowl! If you drink enough fluid so that you rarely feel thirsty and produce about six cups or more of colorless or slightly yellow urine a day, your fluid intake is probably adequate. Since we don’t typically measure our urine output, simply check the color.
Now that we have a general rule of thumb, let’s explore factors that may change our specific requirement. Regular exercise, whether or not we sweat, demands that we drink extra water to compensate for the fluid loss. In general, drinking 1 ½ to 2 ½ extra cups of water should suffice for short bouts of exercise, but intense exercise lasting more than an hour requires more, and if you tend to sweat heavily, even more fluid replacement is required. Sport drinks are more useful than water after heavy exercise.
The environment affects fluid requirements. Hot or humid weather will increase sweating. Spending time in heated buildings causes the skin to lose moisture. High altitudes (over 8,200 feet) may trigger increased urination and more rapid breathing, using up more fluids.
Women who are pregnant or nursing require more hydration. Pregnant women are advised to drink about 10 cups daily and women who are nursing need about 13.
Illness and various health conditions change the formula for fluid replacement substantially. Fevers, vomiting, diarrhea, bladder infections and kidney stones are examples of conditions that require us to drink more. On the opposite end of the spectrum are congestive heart failure, liver failure, and kidney failure, where fluid restriction is often necessary.
Remember that milk, juice, soup, and fruits and vegetables all contain some of the water that we need. Alcohol and caffeinated beverages (some sodas, coffee, tea, etc.) act as diuretics, however, and cause some fluid loss as well.
Is it dangerous to drink too much water? There is actually a condition known as water intoxication, which can be caused by a psychological condition known as psychogenic polydipsia. When too much water enters the body’s cells, the tissues swell with the excess fluid. The result is a potentially dangerous decrease in sodium concentration.
Here are some simple guidelines to help avoid dehydration:
• Drink a glass of water with each meal and between meals
• Hydrate before, during and after exercise
• Try substituting sparkling water or other beverages for alcoholic drinks or sodas
• Work with your physician to determine the proper amount of fluid consumption for your specific needs.
I wish you the best of health.
Tussis
November 28th, 2010Tussis: It’s Latin for cough; a bodily function we can all relate to. Typically it’s merely a simple reflex due to allergies, a cold, or asthma, but it can unfortunately be one of the symptoms of something much worse, like pneumonia or lung cancer. Coughing can be voluntary or involuntary. It is a sudden and often repetitive reflux, and it helps to clear our large breathing passages from secretions, irritants, foreign particles and microbes.
Allergies account for nearly 90% of coughs. Those with allergy cough typically have clear phlegm and some fatigue, but otherwise feel normal. These coughs are triggered by postnasal drip, and may be seasonal (typically mold in the fall, or pollen in the spring). Alternatively, allergies may be a response to specific exposures such as dogs or cats, and occur throughout the year. It often takes extensive testing to determine which specific allergens are responsible. Asthma, which may or may not be accompanied by allergies, leads to a productive or non-productive cough, often with wheezing and shortness of breath. The airways become overly reactive, inflamed, and spasm, which triggers these symptoms.
Coughing is also caused either by a viral or bacterial infection. This is actually an evolutionary advantage for germs, since coughing helps to spread them! Although a cough is frequently caused by viral or bacterial bronchitis, the most likely infection to cause a cough are the common cold viruses. The common cold resolves in a matter of days to a few weeks, after the viral infection has cleared. However, the infected person may be left with a residual dry, non-productive cough that can last up to six weeks. The irritating cough can cause inflammation, which leads to discomfort, and in turn causes yet more coughing. Helpful remedies include drinking lots of water and other fluids to loosen up the phlegm, gargling with salt water to relieve a sore or scratchy throat, saltwater nasal sprays to decongest, and of course, chicken soup.
Generations of parents have fed chicken soup to their sick children without really understanding why. Now scientists have put chicken soup to the test, and discovered that it does help relieve cold and flu symptoms in two ways. First, it acts as an anti-inflammatory by slowing the movement of neutrophils (immune system cells that aid in the body’s inflammatory response). Second, because it is a warm liquid, it temporarily speeds up the movement of mucus, which helps to relieve congestion and limits the amount of time viruses are in contact with the nose lining.
Over-the-counter cold and cough medications do help to relieve symptoms when a cough is caused by the common cold. Note, however, that acetaminophen (Tylenol) can cause liver damage when taken in excessive doses, so it is dangerous to take Tylenol alongside cold medicines that also include Tylenol. Zinc lozenges have been heavily marketed as a cold-fighting medication, but recent studies don’t support these claims (in fact, intra-nasal zinc may result in permanent damage to the sense of smell). Antibiotics are effective at treating bacterial infections but are of no help whatsoever in fighting a cold virus.
When Gastro esophageal Reflux Disease (GERD) is the cause of a cough, it can be difficult to make the diagnosis. The acidic contents of the stomach come back up into the esophagus and the patient can feel heartburn, a sour taste in the mouth, or a feeling of acid reflux in the chest. Unfortunately, more than half of those with cough from GERD do not have any other symptoms, so doctors sometimes try treating GERD when no other solution has worked.
Other causes of cough include smoking, air pollution, emphysema, lung tumors, heart failure, choking, and medications (a cough is, for example, a frequent side effect of ACE inhibitors, commonly used to control blood pressure). Generally, when more serious diseases cause cough, we find other significant symptoms present as well.
Keep in mind that any persistent cough warrants a proper work-up. Seek the advice of your doctor.
I hope you had a warm and joyous Thanksgiving. Good health to you all!
Cancer Screening
November 21st, 2010Doctor, do I have cancer? Can you run all of the tests to check?
These are questions I hear regularly. The answers are more complicated than you would think. Science has indeed come a long way in discovering “markers” to follow the progress of cancer treatment in the body, but how much do we know about early detection? What can we do as part of a routine exam to discover hidden cancers?
Tumor markers are substances that can be found in abnormal amounts in the blood, urine, or tissues of some patients with cancer. Different markers are found with different types of cancer, but scientists have not found markers for every type of cancer. Tumor markers are produced by tumor cells, or by other cells of the body in response to the tumor.
However, tumor marker levels are not altered in all people with cancer, especially if the cancer is in early stages. Markers may be used to help diagnose cancer, predict a patient’s response to a particular treatment, or determine if the cancer has returned. To date, researchers have identified more than a dozen substances that appear to be abnormal when some type of cancer is present.
At the present time, the use of tumor markers in clinical medicine is limited. Although an abnormal tumor marker level may suggest cancer, this alone is usually not enough to make the cancer diagnosis. Therefore, this information is usually combined with a patient’s history, other blood tests, x-rays, and biopsies.
After the diagnosis, tumor markers may be measured before a cancer treatment to help doctors plan the appropriate therapy. In some cancers, the level of tumor marker may reflect the stage of the disease. During treatment, decreasing levels of tumor marker can reflect a good response to treatment.
But, in terms of screening for the presence of cancer, tumor makers thus far have limited usefulness. A screening test is a way of detecting cancer early, before there are any symptoms. For a screening test to be helpful, it should have high sensitivity and high specificity. Sensitivity refers to the test’s ability to identify people who have the disease. Specificity refers to the test’s ability to identify people who do not have the disease. Unfortunately, tumor markers are neither sensitive nor specific enough to be used for cancer screening.
For example, prostate-specific antigen (PSA) levels are often used to screen men for prostate cancer, but this is controversial. It is not yet known whether early detection using PSA screening actually saves lives. Elevated levels of PSA can be caused by prostate cancer or by benign conditions, and most men with elevated levels turn out to not have prostate cancer. Further, it is not known if the benefits of PSA screening outweigh the risks of follow-up diagnostic tests and cancer treatments.
Another tumor marker, the CA 125, is sometimes used to screen women who have an increased risk for ovarian cancer. Scientists are currently studying whether measurement of CA-125, along with other tests and exams, is useful to find ovarian cancer before symptoms appear. Thus far, CA-125 is found to be neither sensitive nor specific enough to justify screening all women. At this point, CA-125 is used to monitor responses to treatment of ovarian cancer and check for recurrence.
For now, we doctors spend most of our cancer-fighting efforts working with our patients to eliminate underlying risks that are known to cause future cancers, such as cigarettes, excessive alcohol, too much exposure to the sun, obesity, diet, and environmental exposures. Actual cancer detection more typically happens as a result of listening to a patient’s complaints, performing a physical exam, and then performing tests to confirm any suspicions. But, stay tuned. As science advances, health professionals constantly have more tools at their disposal.
In the meantime, prevention is key. Good health to you all!
Anxiety Disorders
November 3rd, 2010If you tend to have feelings of panic, fear, and uneasiness, it’s possible that you are suffering from an anxiety disorder.
Anxiety disorders affect at least 19 million adult Americans, and tend to begin in childhood, adolescence, or early adulthood. They occur slightly more often in women than in men, and appear with similar frequency among whites, African-Americans, and Hispanics.
The many symptoms of anxiety disorders include excessive worry, tension, restlessness, nightmares, irritability, muscle tension, headaches, uncontrolled obsessive thoughts, repeated thoughts or flashbacks of traumatic experiences, ritualistic behaviors, sweating, difficulty concentrating, fatigue, frequent urination or defecation, nausea… and the most common symptom: trouble falling asleep and staying asleep.
We all get feelings of anxiety from time to time. Anxiety is a normal human emotion, and a quite normal and appropriate response to many situations that life throws at us. We may feel anxious or nervous when faced with a problem at work, before taking a test, or when making an important decision. It becomes an anxiety disorder, however, when the response to everyday life events is exaggerated or excessive. The resulting level of distress can interfere with the ability to lead a normal life.
Do not underestimate: an anxiety disorder is a serious mental illness. Worry and fear can be constant, excessive, overwhelming, and even crippling. Anxiety becomes dominant and interferes with health, work, school, social activities, and relationships.
There are many types of anxiety disorders, including:
Panic disorder: People with this condition have feelings of terror that strike suddenly and repeatedly without warning. A panic attack includes sweating, chest pain, palpitations (irregular heartbeats), and a feeling of choking.
Obsessive-Compulsive Disorder (OCD): People with OCD are plagued by constant thoughts or fears that cause them to perform certain rituals or routines. The disturbing thoughts are called obsessions, and the rituals are called compulsions. An example is a person with an unreasonable fear of germs who constantly washes his or her hands.
Post Traumatic Stress Disorder (PTSD): PTSD is a condition that can develop following a traumatic and/or terrifying event, such as a sexual or physical assault, the unexpected death of a loved one, involvement in a war, or a natural disaster. People with PTSD often have lasting and frightening thoughts and memories of the event, and may tend to be emotionally numb.
Social Anxiety Disorder: Also called social phobia, this disorder involves overwhelming worry and self-consciousness about everyday social situations. The worry often centers on a fear of being judged by others, or fear of embarrassment or ridicule.
Specific phobias: A specific phobia is an intense fear of a specific object or situation, such as snakes, spiders, heights, or flying. The level of fear is usually inappropriate to the situation and may cause the person to avoid common everyday experiences.
Generalized Anxiety Disorder: This disorder involves excessive, unrealistic worry and tension, even if there is little or nothing to justify the anxiety.
The precise cause of anxiety disorders is unknown; but anxiety disorders – like other forms of mental illness – are not the result of personal weakness, a character flaw, or poor upbringing. What is becoming clear is that the tendency to anxiety is likely “pre-wired” in the brain due to genetics. Studies are showing that anxiety disorders tend to run in families, and can be inherited from one or both parents, like hair or eye color.
Anxiety has been associated with chemical imbalances of certain neurotransmitters in the brain. This alters the way the brain reacts to life situations. Other studies demonstrate that people with certain anxiety disorders have changes in the actual brain structures that control memory or mood.
Environmental factors including trauma and stressful events, emotional abuse, the death of a loved one, divorce, change of job or school, or the use of chemicals (such as alcohol, caffeine, nicotine, and other recreational drugs) may trigger an anxiety disorder in people who have an inherited susceptibility.
It is apparent that many anxiety disorders are caused by the interplay between genetics, changes in the brain, and environmental stress.
A diagnosis is made by a doctor’s clinical exam; there are no laboratory tests. The doctor will make sure that the symptoms are not related to some other physical disorder, such as an overactive thyroid. A final diagnosis of anxiety disorder requires a demonstration that anxiety is causing problems in the functioning of daily life for an extended period of time.
Most people gain substantial relief from their symptoms with proper treatment. The most effective treatments usually involve a multi-pronged approach. Eliminating caffeine, alcohol, excess sugar, and eating a balanced diet can be a great place to start. Physical activity helps a great deal; adding yoga, meditation, or aerobic exercise (such as a brisk walk four or five times a week), and focusing on sleep can make a substantial difference. Therapy is often valuable. Medication may be recommended.
For short-term anxiety, there are potent but potentially highly addictive drugs known as benzodiazepines that give the patient a great sense of calm. For longer-term treatment, non-addictive anti-depressant/anti-anxiety drugs include Lexapro, Prozac, and Zoloft. Buspar is also used for chronic anxiety, with no addictive qualities.
Anxiety disorders are difficult to prevent. However, if you feel that you are susceptible, or if anxiety runs in your family, here are some things that you can do to control or lessen symptoms:
•Stop or reduce your consumption of products that contain caffeine, such as coffee, tea, cola and chocolate.
•Exercise daily and eat a healthy, balanced diet.
•Practice stress management techniques like yoga or meditation.
•Speak with your doctor or pharmacist before taking any over-the-counter medicines or herbal remedies. Many contain chemicals that can actually increase the symptoms of anxiety.
•Seek counseling and support after a traumatic or upsetting experience.
May you live a low-stress and healthy life!
Weight Loss
September 23rd, 2010Many of my patients believe that if you are born heavy, then heavy you shall stay. The corollary, of course, is that thin people will always be thin, no matter what.
While it is true that people born with the propensity to be large may never be thin, they can be thinner. More importantly, however, they can be healthy.
The variety of diets we could explore is practically unlimited, but here we will simply discuss the principles of weight loss. This subject is complex and as I discovered in my years of practice, emotional. I do intend, however, to leave you with some tools you can use to start your new program today.
Let’s start by assuming that you have already seen your doctor and ruled out medical reasons for obesity, such as hypothyroidism, polycystic ovary syndrome, or weight gain due to drugs such as steroids or antidepressants.
It’s my experience that most of my patients know how to lose weight, but for one reason or another find the required lifestyle changes extremely difficult. Why has this stumped so many? Weight loss can be such a struggle that many are convinced that they have to do something drastic to see results – extreme diets, weight loss pills or exercise gadgets marketed on infomercials. Clearly it would be easier to take a few pills, drink acai shakes, and have the pounds just melt away. The massive weight loss industry makes a fortune selling these types of false promises.
The facts show that you simply do not need to spend huge quantities of money on special equipment or weight loss products to succeed. In fact, eating out is costly and often extremely unhealthy. When we prepare our foods at home, we can control exactly what goes into our mouths.
Losing weight isn’t a mysterious process; it’s a straightforward matter of burning more calories than we eat. There are really only three steps to successfully losing weight: 1) consume fewer calories 2) exercise more 3) repeat steps one and two.
Studies have found that the true secret to weight loss is this: Make small changes each and every day and you’ll slowly but surely lose those extra pounds. Don’t step on the scale every day, but rather look at the big picture, down a long but safe road.
Let’s start with consuming fewer calories.
• Drinking more water is simple and effective, and most of us should be drinking more anyway, in order to better hydrate our bodies. Drink one or two glasses of water before every meal, and you will feel more full before you start.
• Make a list of foods you eat, and decide which ones to cut out, cut back on, or replace. I suggest to my patients that they select one major area of abuse first, before moving on to the next. This can be emotionally complicated, as some of these foods may be considered reward foods. Going after the “low hanging fruit” can give the most benefit, and it can do so quickly. A common example would be that morning latte, bearing up to 500 calories. Since a pound of weight (lost or gained) is roughly 3,500 calories, switching to black coffee can help you lose a pound a week.
• Lifestyle changes are hard: instead of simply cutting out some of your worst food choices, try replacing them with healthier choices. Replace your soda with water. Replace chips, crackers and candy with vegetables or lower fat/lower sugar alternatives.
Note that eating small meals and snacks throughout the day has been shown to aid weight loss by stimulating the metabolism. Graze on healthy snacks that are low in calories and fat, and high in fiber. Fiber slows the body’s absorption of carbohydrates, keeping us feeling full longer. You can generally find high levels of fiber in nuts, rice cakes, fruits, and vegetables. (Note that fruit juice has no soluble fiber, and is high in sugar and thus calories.)
• Eat slowly, and watch your portion size. Eating an entire bag of rice cakes, dried fruit or nuts will not help with weight loss. One effective but costly trick to reduce portion size is to buy the item in a single-serving packet. You may wish to make up your own single-serving packets.
• Plan your meals. Look for healthy, tasty meals online or in a cookbook, and create a menu for the week. When meals are planned, you are more likely to consume a balanced diet and less likely to eat haphazardly or at fast food restaurants. You are less likely to consume on impulse. Set up an achievable plan – if it’s not practical, you can easily get disheartened and stop following your regimen.
• Choose lean meats like turkey, chicken or fish, as opposed to red meats or hot dogs. Salmon, sardines, and fresh tuna are excellent sources of antioxidants and omega-3 fatty acids. Replace high calorie side dishes with healthier alternatives. Side dishes like macaroni and cheese, French fries and potato salad can add a massive number of calories. Replace them with fresh vegetables and mixed green salads. Pre-made salads can help make this change effortless.
• Write down everything you eat. Carry a small notebook and write down every snack, every drink, and the contents of every meal. In my opinion, it is not necessary to know precisely how many calories are in everything you eat, but the process of writing things down will help you become aware of the food you consume, and help to keep you honest as well. What about exercise?
• For cardiovascular health, 30 minutes three to four times per week is sufficient. For weight loss, guidelines suggest about 50 minutes five days per week. Of course, if you are a beginner, start with less and build up gradually. Remember, you can lose weight either by decreasing your calorie intake or increasing the number of calories you burn. Any health strategy should include both, especially if you want to lose weight faster.
• Make your aerobic activities low impact. Moderate exercise incorporates brisk walking, cycling, aerobic machines, or swimming, in order to burn calories and to keep your heart healthy as well. Swimming has the added advantage of putting less stress on your joints. Pumping iron helps you stay lean by building muscle and raising the metabolism. Remember that exercise can be fun; it doesn’t have to be boring and it shouldn’t be painful. For example, Nintendo’s Wii Fit can be highly motivating, and includes running, yoga, aerobics, strength training, and balance.
Be realistic. Don’t expect miracles. Speak with your doctor about a correct and realistic weight target. Your goal is to have a healthy body, not a skinny one. Aim toward this healthy objective and remember that you are creating a sustainable healthy lifestyle. You may find that your first approach is not realistic or fun; be open to making adjustments in your exercise or caloric intake along the way. Be confident and believe in yourself. Remind yourself that your plan will make you feel better about yourself, physically and emotionally. Work to avoid the temptations of all those old reward foods. Be consistent, disciplined, and self-motivated. Surround yourself with systems and people who will keep you on track.
My best advice: Start NOW! Now that you are finished reading this, get up and take a 20-minute walk. Do not wait one more day!
I wish for you thoughtful and healthful eating and exercising.
Sneezing
September 12th, 2010What’s the best way to spread up to 100,000 germs 150 feet, at up to 100 miles an hour? Through “sternutation,” of course…more commonly known as sneezing.
You would not want to be the record holder for sneezing: 977 days in a row, producing over a million sneezes. Let’s take a look at this fascinating body function. What triggers it? What is its purpose?
A sneeze is above all a protective mechanism for the body. It actually serves as a part of the immune system, protecting the body by clearing the nose of bacteria, viruses, or any other nasal irritant. When something enters your nose, it sets off the “sneeze center” in the lower brain stem. This triggers a signal to tightly close the throat, eyes, and mouth. The chest muscles vigorously contract, and the throat muscles quickly relax.
The result is that air, along with saliva and mucus, is forced out of the mouth and nose, and…you have sneezed.
Considering the velocity and force of a sneeze, it’s not advisable to try to stop one in progress. If you must try to stop a sneeze before it begins, try breathing through your mouth and pinching the tip of your nose.
There are many triggers for a sneeze, including the obvious ones such as pepper, dust and pollen. Each of us tends to have our own particular triggers.These include pungent aromas, temperature fluctuations – and eyebrow plucking! A very common trigger that I experience is working out. When we hyperventilate due to over-exertion, the nose and mouth dry up. As a result, the nose compensates by starting to drip, triggering a sneeze.
Having sex can be a trigger. Researchers believe that the stimulation of the parasympathetic nervous system fires off signals in some people to not only cause pleasure, but to sneeze. About one in three people sneeze when exposed to bright light, an inherited trait called photic sneezing. The syndrome, known as ACHOO (Autosomal dominant Compelling Helio-Ophthalmic Outburst syndrome), involves sneezing in rapid succession two or three times.
Another genetically linked sneezing disorder is called “Snatiation,” which causes multiple sneezes after a large meal. A rare syndrome of intractable “pseudosneezing” has been linked to psychological stress.
One thing we all have in common is that our eyes close during a sneeze. The scientific explanation is unclear. Some claim that we evolved this way to protect our eyes from whatever comes flying out of our nose and mouth. Others believe that it is simply a related muscle contraction. A commonly held myth holds that the eyelids close to keep our eyes from popping out of their sockets!
According to body language expert Patti Wood, how we sneeze says something about our general personality traits. In her research for a Benadryl-sponsored study, she divided “sneezers” into four categories:
The “Correct” carries tissue and is careful to cover the mouth when sneezing.This implies respect for others and a dignified disposition.
The “Supporter” tends to hold in sneezes rather than risk sneezing on someone, indicating a quiet and caring character.
The “Expressive” makes a big production out of sneezing and often sneezes multiple times at once, indicating a showy and dominating person.
The “Driver” sneezes loudly but quickly, indicating a direct and forward thinking person.
The literature is filled with superstition involving sneezing. In ancient Roman and Greek times, a sneeze to the right was a sign of luck and a sneeze to the left was ominous. A biblical interpretation is that a sneeze is the soul’s attempt to leave the body, because it is written that Adam came to life when God breathed into his nose.
Most cultures have an appropriate response after someone else sneezes. I grew up with “Bless you.” In Spanish it is “Salud”, and in German it is “Gesundheit.” The response typically translates as a wish for the sneezer’s good health; likely hearkening from the time of the Bubonic Plague, when one sneeze might signal a person’s assured demise.
Good health to you all, and bless you!
Tattoos
August 22nd, 2010It’s inevitable that my columns are often a product of personal experience – typically regarding my three daughters. So far, today’s topic has not affected my life at home, but I’ll bet that it has had an impact on many of you! The subject is tattoos. Personally, I want to be prepared when the question comes my way. You should be too.
Just a generation or so ago, most Americans associated tattoos with sailors, bikers and sideshow artists. They have become far more popular with the mainstream in recent years, and those who get them are as diverse as are the styles and designs they choose. Tattoos are even used as very long-lasting makeup. A tattoo can be acquired in a matter of hours, but it is a permanent statement. Take steps to protect yourself from possible risks, in order to ensure that what seems like a cool idea at the moment does not become a source of regret down the road.
A tattoo is a permanent mark or design made on the skin by having pigment inserted through pricks into the skin’s outer layer, the epidermis. The tattoo artist uses a hand-held machine that behaves much like a sewing machine, with one or more needles piercing the skin repeatedly at a rate of 50 to 3,000 times per minute. With every puncture, the needles insert tiny ink droplets into the dermis, the second layer of skin. Cells in the dermis are far more stable than cells of the epidermis, so the tattoo ink stays in place.
The procedure, which is done without anesthetic and may take several hours, causes a small amount of bleeding and pain that ranges from slight to significant. This process has not changed since its invention by Samuel O’Reilly in the late 1800’s.
The physical risks of getting a tattoo are related to problems that arise when you puncture the skin. The tattoo machine creates an open wound every time it injects a drop of ink.
•Tattoo dyes (red in particular) can cause an allergic reaction in the form of an itchy rash at the tattoo site. This rash can even occur years after getting the tattoo because the body may take that long to develop an allergy to the chemical.
•Skin infections can develop if the needle or needles that breach the skin are contaminated with bacteria, or if the open skin later gets exposed to bacteria. The result will be a red, swollen, tender lesion.
•Granulomas can develop around the tattoo (more often when red dye is used). This results in raised areas with overgrowths of scar tissue, known as keloids.
•The tattoo may become swollen during magnetic resonance imaging (MRI) due to metallic pigments. Tattoos can also interfere with getting a proper image.
•Blood-borne diseases are easily the most serious complications from getting a tattoo. If equipment is contaminated with infected blood, numerous diseases can be contracted, including Staphylococcus Aureus (including MRSA), Hepatitis B, Hepatitis C, Tuberculosis, and HIV. (The Center for Disease Control (CDC) does not have a documented case of HIV to date from a tattoo, but reporting is imperfect and the risk is real.)
What about the emotional risks? Ask yourself this question: Would you want your rock group passion or romantic interest from three years ago, or 10 years ago, on your body today? When you put permanent art on your skin, it is, for all intents and purposes, permanent. The lengthy and expensive process of removing a tattoo is not completely effective. Do not seek a tattoo while under the influence of social/peer pressure, alcohol, or drugs.
Tattoos are removed using several different methods: laser removal, excision or dermabrasion. The cost varies for each technique. Laser tattoo removal is the most common method and usually the best. Costs range from $200 to $500 per session. Multiply that by the five to twenty sessions it takes to remove a tattoo!
If you want a tattoo, what can you do to protect yourself?
Go to a reputable tattoo studio. Regulations and licensing standards vary from state to state. Check with the local health department to see what the standards are in a given city.
The tattoo artist should wear gloves, wash his or her hands, and change gloves with each new procedure and person.
The tattoo artist needs proper sterile equipment. Watch that the artist removes needles, tubes, pigment trays and containers from sealed packages. Non-disposable equipment is to be sterilized before each new customer. Instruments that cannot be sterilized must be disinfected with a commercial disinfectant or bleach solution.
So, what is my closing advice to you today regarding tattoos? As a parent…the answer is NO!!! But as your local medical columnist, my parting words are…think long and hard about it, make sure it is something that you’ll want to see on your skin in 30 years, and if you must, go to a reputable artist. (Sigh) Good health to you all!
Sex
August 18th, 2010Today’s topic is near and dear to most of us: It’s been scientifically demonstrated that it is healthful to have sex. However, before we proceed further, I must say that many of my patients are not currently in a mutually loving, safe relationship where sex is advisable. Some of my patients are not in a state of health where sex is advisable (or possible). Some of my patients are simply too young to have sexual relations. Putting these groups of people aside, I’ll address whoever is remaining!
The literature is filled with studies on the health benefits of having sex. Participating in regular and mutually enthusiastic sex confers a host of measurable physiological advantages for both men and women. Perhaps you’ve noticed the stress in our society! Sex helps to relieve stress. Studies show lower blood pressure following intercourse, as well as lower blood pressure in women simply in response to affection. In one study, traditional intercourse resulted in a greater stress reduction response than did other forms.
Sex boosts immunity. Having sex once or twice per week has been linked to higher levels of the antibody immunoglobulin A. IgA can protect us from colds and other infections.
Sex burns calories. It is a great physical and psychological workout. Thirty minutes can burn 200 calories, which is the equivalent to running 15 minutes on a treadmill or playing a spirited game of squash. The pulse can rise from a resting pulse of 70 to as high as 150 beats per minute. One calculation shows that you can burn off six Big Macs by having sex three times per week. One popular (men’s) health magazine opines that sex is the single best exercise equipment ever invented.
Sex can reduce pain. Immediately before orgasm, levels of the hormone oxytocin increase by a factor of five. This in turn releases endorphins, which have been shown to help to alleviate the pain of arthritis, headache, and even migraine. In women, sex also prompts production of estrogen, which can reduce the discomfort of PMS.
Sex reduces the risk of prostate cancer. Frequent orgasms, especially in men in their 20’s, appear to reduce the risk of prostate cancer later in life by a factor of up to one-third.
Sex improves pelvic floor muscle tone and urinary incontinence in women. Kegels (pelvic floor muscle exercises) can help to develop these muscles, as can intercourse. Women who develop this muscle tone gain benefits including more sexual pleasure as well as strengthened muscles that help maintain continence later in life.
Sex can improve cardiovascular health. Various studies have confirmed that having sex twice a week or more reduced the risk of fatal heart attack by half for men, as compared to those who had sex less frequently than once a month.
Sex improves the sense of smell: After sex, production of the hormone prolactin surges. This in turn causes stem cells in the brain to develop new neurons in the brain’s olfactory bulb, the smell center.
Sex helps you sleep better. The oxytocin released during orgasm promotes sleep. Being well rested, or course, is linked to numerous health benefits. The next time you are having trouble falling asleep, you may wish to try this non-chemical assistance.
Other benefits linked to having regular sex, of course, include increased self-esteem and better trust and intimacy with your partner. I wish you all good health and a wonderful relationship!
Heart Attack
August 2nd, 2010You think that you are having a heart attack! What are the symptoms? How do they show themselves? What brings them on?
It’s actually not at all unusual in my daily practice for a patient to come in with some type of chest pain, believing that they are experiencing a heart attack. Sometimes, they are!
This remarkably common killer is the leading cause of death for both men and women. Approximately 1.1 million Americans suffer heart attacks each year, and close to half of them die. While heart attacks can occur at any time, 4:00 to 10:00 in the morning is the peak time, most likely due to higher levels of adrenaline in the blood.
What is a heart attack, also known as a myocardial infarction? It usually begins with the rupture of an atherosclerotic, cholesterol plaque on the inner wall of a coronary artery. A blood clot forms there and completely obstructs the artery, which should be supplying blood to the heart muscle. Because of the resulting lack of oxygen, the heart muscle is injured, and it is this injury that may lead to chest pain or pressure.
If the blood flow is not restored within 20 to 40 minutes, irreversible death of the heart muscle will begin. Muscle continues to die for the next six to eight hours, at which time the heart attack is usually complete.This dead heart muscle is eventually replaced by scar tissue.
Who gets heart attacks? This discussion needs to be all about risk factors. Just as it is extremely rare to hear about a drive-by shooting in Beverly Hills, it is extremely uncommon to hear about a heart attack in a 35-year-old woman without risk factors. Both scenarios are possible, of course, but not likely. If you are having symptoms, your doctor will evaluate these symptoms in the context of your own unique risk factors.
There are essentially six major risk factors for getting a heart attack, and many other “softer” risk factors. You do not need to have all of the major risk factors to experience a heart attack, but the more you have, the more likely a candidate you become.
High Blood Cholesterol (Hyperlipidemia): Cholesterol is the major component of the plaque deposited in arterial walls, so elevated cholesterol levels are associated with higher risk. Cholesterol can only dissolve in the blood if combined with the proper lipoproteins. Otherwise, it turns into a solid substance and clogs the arteries.
Note, however, that the cholesterol that is combined with low-density lipoproteins (LDL cholesterol) is the “bad” cholesterol. The cholesterol that is combined with high-density lipoproteins (HDL cholesterol) is the “good” cholesterol, which actually removes cholesterol from arterial plaques. Therefore, both elevated levels of LDL cholesterol as well as low levels of HDL cholesterol are associated with an increased risk of heart attack.
High Blood Pressure (Hypertension): High blood pressure, both systolic and diastolic, is a major risk factor for developing atherosclerosis and heart attack. Controlling hypertension with medications and the proper lifestyle can reduce this risk.
Tobacco Use: Tobacco (including second-hand smoke) contains chemicals that cause damage to blood vessel walls, accelerate the development of atherosclerosis, and consequently increase the risk of heart attack.
Diabetes: Diabetes Mellitus is associated with accelerated atherosclerosis throughout the body, regardless of whether insulin or pills are being used to treat it. Therefore, diabetics are at risk for reduced blood flow to all arteries, including the heart (coronary artery disease), legs (peripheral vascular disease), brain (cerebral vascular disease leading to stroke), and genitals (erectile dysfunction) at an earlier age. Diabetics can lower their risk through rigorous control of blood sugar levels.
Being Male: At any age, men are more likely than women to develop atherosclerosis and coronary heart disease. There is much speculation and the reason is not completely clear. Women do have higher HDL (“good”) cholesterol levels than men.
A number of secondary risk factors for heart disease are observed more often in men than in women, including stress, inactivity and obesity.
Family History of Heart Disease: Individuals with a family history of coronary heart disease have an increased risk of heart attack, especially if there is a heart attack or sudden death before age 55 in a male first-degree relative (father or brother), or before age 65 in a female first-degree relative (mother or sister).
The classic symptoms of a heart attack typical for men are listed below. They are generally (but not always) related to exertion, and often subside with rest.
•Chest pain, fullness, and/or squeezing sensation
•Jaw pain, tooth pain or headaches
•Shortness of breath
•Sweating
•Dizziness
•Heartburn and/or indigestion
•Arm pain (more commonly the left arm)
•Upper back pain
•General malaise (vague feeling of illness)
Despite knowing the warning symptoms listed above, note that between 40% and 60% of all heart attacks are unrecognized! In other words, a heart attack may show either no symptoms at all (a “silent” heart attack) or vague symptoms that can easily be mistaken for a different problem. Women and diabetics are more likely to have unusual presenting symptoms, and therefore take longer to be accurately diagnosed. These symptoms seen more often in women and diabetics include neck and shoulder pain, abdominal pain, nausea, vomiting, fatigue, coughing, and restlessness. To further complicate matters, women are more likely to have chest pains that are not due to the heart, such as spasms of the esophagus; are less likely to have typical findings on an EKG; and are more likely to have misleading, or falsely positive stress tests.
How is a heart attack diagnosed? Accurate tests can be performed quickly. An electrocardiogram (ECG) records the heart’s electrical activity. ECG abnormalities can (but not always) appear when a heart attack is occurring and heart muscle is deprived of oxygen. Blood tests measure levels of cardiac enzymes, which are elevated in the blood several hours after the onset of a heart attack. Their levels correlate with the amount of heart muscle that has died.
Time is of the essence. Prompt medical attention allows for early treatment, and the more rapidly the blood vessels are re-opened, the more heart muscle is saved. Interestingly, the most common actual cause of death from a heart attack is ventricular fibrillation, which occurs when the heart’s electrical system malfunctions, causing a fatal heart rhythm.
Prevention is key to avoiding a first heart attack, as well as for subsequent heart attacks. There are so many heart-healthy measures you can take! Get your blood pressure under control, and if you are a diabetic, get your blood sugar under control.
You can lower your LDL and raise your HDL by losing excess weight, exercising, and taking medication for cholesterol. Most patients at high risk for a heart attack should be on cholesterol medication (statins), no matter what their cholesterol levels. Your doctor may recommend that you take aspirin, beta-blockers, or ACE inhibitors, and multivitamins high in folic acid and omega-3 fatty acids. Quit smoking!!!
Remember, everything you did leading up to the heart attack earned you that heart attack, so it is high time for major change. Good heart health to you all!
Drug Abuse
July 25th, 2010Have you ever taken a prescription medication for a purpose other than it was intended – perhaps hoping to lose weight, feel better, improve focus at work or at school, or simply experience an escape? Why do some of us abuse medications, while others take them exactly as prescribed and stop when they are no longer medically needed? Which drugs are the most abused?
What begins as an appropriate use of a medication can for some become a dangerous addiction. The National Institute on Drug Abuse (NIDA) calculated that there are approximately nine million Americans who use prescription drugs for non-medical purposes. More than 50% get their drugs from a friend or relative for free, and another 20% get a prescription from a physician. Prescription drug abuse isn’t necessarily about bad drugs or bad people. It involves a complex group of factors including the power of addiction, misperceptions about drug abuse, and the difficulty for both patients and doctors to talk honestly about the problem. As a doctor who loves to talk to my patients, I still experience the occasional visit with an enormous elephant sitting with us in the room; an issue that the patient just cannot or will not speak of. Doctors face a major challenge to ensure that legitimate pain/anxiety issues are addressed, while doing our best to weed out the actors. Our medical licensing board recognizes the gravity of this issue and now mandates that a doctor’s required ongoing medical education include a 13-hour course be taken on proper pain management skills.
Just what are the dangers of abusing medication? Whether we are discussing street drugs or prescription medications, drug abuse brings trouble at school, at home, with friends, at work, or with the law. The likelihood that someone will commit a crime, be a victim of a crime, or have an accident is far higher when that person is abusing drugs. Using drugs for the wrong reasons can pose serious health risks. These risks are multiplied when drugs are taken with other substances like alcohol, antihistamines, and central nervous system depressants. The dangers of prescription drug abuse include seizures, heart and lung problems, and even death, but the most common danger is addiction.
Addiction can be defined as a pattern of compulsive drug use characterized by a continued craving for drugs despite physical, psychological or social harm. Addicts will claim that they are using these drugs to feel “normal”. I believe we are all seeking this goal; sometimes we find healthy ways to do this, and sometimes ways that are harmful. A recent government report found that among 12 to 17 year olds, roughly two million had experienced a major depressive episode in 2007 – representing about 8% of that age group. Illicit drug use was roughly twice as high, or 35%, among those youths who had experienced depression than among those who hadn’t.
What are the signs of addiction? Foremost is the need to have a particular drug or substance, and the inability to stop that urge. An addict commonly experiences relief from anxiety, changes in mood from well being to belligerence, false feelings of self-confidence, increased sensitivity to sights and sounds including hallucinations, altered activity levels such as excessive sleep or wakefulness, and unpleasant or painful symptoms when deprived of the substance.
The risk for addiction is greatest among women, the elderly, and adolescents. Other risk factors include having a medical condition requiring pain medication, family history of addiction, excessive alcohol consumption, fatigue or overwork, poverty, depression, dependence, poor self-concept, and obesity. Many become addicted to prescription drugs quite by accident, at first using the drugs for medically prescribed reasons, and gradually increasing the dosage and becoming abusers. Interestingly, women are two times as likely to become addicted to sedatives, but receive two to three times more prescriptions for sedatives then do men. Seniors are more at risk, perhaps because they receive more drug prescriptions. The fastest growing group of addicts, however, is 12 to 25 year olds.
The most abused prescription medications fall into three classes:
- Opioids, also known as narcotic analgesics, include oxycodone (OxyContin), hydrocodone (Vicodin), and meperidine (Demerol) and are prescribed primarily to treat pain. They work by attaching to opioid receptors in the brain and spinal cord to prevent the brain from receiving pain messages.
- Central Nervous System Depressants, including pentobarbital sodium (Nembutal), diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan). These drugs treat anxiety, tension, panic attacks, and sleep disorders. They work by slowing down the brain activity by increasing the activity of GABA, a neurotransmitter.
- Stimulants, such as methylphenidate (Ritalin), amphetamine/dextroamphetamine (Adderall), and dextroamphetamine (Dexedrine). They are used as stimulants to treat narcolepsy and ADHD. They work to increase brain activity, resulting in greater alertness, attention, and energy.
When we look at all abused substances, these are the biggest problems in order of frequency of emergency room visits: alcohol, cocaine, marijuana, heroin, alprazolam (Xanax), hydrocodone (Vicodin), oxycodone (OxyContin, Percocet, Percodan, Tylox), methadone, clonazepam (Klonopin), propoxyphene (Darvocet and Darvon), amphetamine (Dexedrine), lorazepam (Ativan), carisoprodol (Soma), diazepam (Valium), methamphetamine (speed), and trazadone (Deseryl).
Withdrawal occurs when the body no longer receives the outside source of the substance it has grown to expect and depend on. If withdrawal is from a stimulant like an amphetamine, the person will become groggy or excessively sleepy. If the withdrawal is from narcotics or alcohol, the person loses the calming effect and becomes irritable, unable to sleep, and may suffer seizures.
Treatment is usually behavioral and/or medical detox. For those who seek it, treatment can be quite effective: Studies by the National Institute on Drug Abuse show that 40% – 50% of those entering treatment programs remain drug free for three to five years. Another 30% significantly reduce their drug use.
Clearly, we would love to know why some people become addicted and other do not.
Imagine how useful it would be for doctors and patients to know this before prescribing. Perhaps this will be one of the many leaps in medicine made as a result of the mapping of the human genome.
Please remember:
- Always follow medication directions carefully and precisely.
- Do not increase or decrease your dose, or stop taking your medication without speaking with your doctor.
- Do not crush or break pills. This can dramatically increase the potency of some drugs.
- Be certain that you clearly understand the drug’s effect on driving and other daily activities.
- Learn about the drug’s potential interactions with alcohol, cigarettes, prescription medications and over-the-counter medications.
- Inform your doctor about any past history of substance abuse.
- Don’t use other people’s prescription medications, and don’t share your own.
For further help, contact:
The Substance Abuse Treatment Facility Locator, which covers more than 12,000 treatment centers. 1-800-662-HELP (1-800-662-4357), or www.findtreatment.samhsa.gov
The National Institute on Drug Abuse: 310-443-1124, or www.nida.nih.gov
Energy Drinks
July 25th, 2010Are you hooked on a daily energy drink? Does it increase your get-up-and-go, boost your concentration and alertness, improve your sports performance, stimulate your metabolism, and improve your stamina?
They come in a variety of flavors, colors and ingredients designed to tempt the taste buds and imaginations. Red Bull, Impulse, Dark Dog, Shark, Hype, Jolt, SoBe Adrenaline Rush, Piranha, AMO, Red Rain, Red Dragon, Diablo, YJ Stinger…Let’s take a closer look at these drinks. Are they safe? Are they effective? What are they made of?
Energy drinks can easily be distinguished from sodas and sports drinks. Soda contains water, sugar, flavoring and sometimes caffeine. It tastes good (to some) and provides a sugar and sometimes caffeine kick. Sports drinks (Gatorade, Powerade, etc.) contain water, sugar and electrolytes, and are intended to replenish fluids lost during activity.
Energy drinks are intended to supply mental and physical stimulation for a short period of time. They were popular in Asia and Europe before they reached the United States. In 1962, the Japanese pharmaceutical company Taisho released Lipovitan. It was designed to help employees work hard well into the night, and contained taurine, still often found in drinks today. An Austrian businessman tried a drink while in Thailand on business, and found that it cured his jetlag. He developed a less sweet, carbonated version, and with Thai business partners, marketed Red Bull to Europeans in 1992 and to the U.S. in 1997. In 2006, over a billion cans were sold worldwide, and Red Bull remains the market leader today. However, it is currently banned in Norway, Denmark, and Uruguay, and between the year 2000 and just last April of 2008 it was banned in France as well.
These drinks use various combinations of ingredients, including
- Caffeine: a popular stimulant found in coffee, tea and chocolate, that blocks the effects of adenosine, a brain chemical involved in sleep
- Taurine: a natural amino acid produced by the body to help regulate heartbeat and muscle contractions
- Epinephrine: a central nervous system stimulant, commonly found in weight loss products, injections to treat anaphylaxis and heart disease, and decongestants. Epinephrine is tied to potentially harmful effects on the heart when used incorrectly
- Ginseng: a root believed by some to have several medicinal properties, including reducing stress and boosting energy levels
- B-Vitamins: a group of vitamins that can convert sugar to energy and improve muscle tone
- Inositol: a member of the Vitamin B complex
- Guarana seed: a stimulant that comes from a shrub native to Venezuela and Brazil
- Carnitine: an amino acid that plays a role in fatty acid metabolism
- Creatine: an organic acid that helps supply energy for muscle contractions
- Ginkgo Biloba: made from the seeds of the ginkgo biloba tree, and thought to enhance memory
Although manufacturers claim that energy drinks can improve endurance and performance, many health experts disagree, claiming instead that any boost you get from drinking them is solely due to the caffeine and the sugar.
So, what are the dangers of energy drinks? They are generally safe for most of us, but like most things, should be consumed in moderation. In 1999, an 18-year-old athlete died after consuming three or four cans before a basketball game. In published reports of adverse reactions, problems encountered include disturbances in electrolytes, nausea and vomiting, and heart rhythm problems. Caffeine is a stimulant, and consuming too much can lead to heart palpitations, anxiety, insomnia, tremors and jittery feelings. Over time, caffeine can become addictive. It is also a diuretic, so it can actually lead to dehydration, the very opposite of what we need after exercise.
It has become very popular to use energy drinks as alcoholic mixers. Recipes are plentiful on the Internet, including many of the websites of the energy drinks themselves. Combining these stimulants with alcohol is quite dangerous; the drinker may feel a false sense of well-being and alertness – while he or she may actually be quite drunk.
Clearly, however, if you are a caffeine lover, energy drinks may be right up your alley. Instead of coffee or soda, many enjoy one as an afternoon pick-me-up. The amount of caffeine is similar to that in a cup of brewed coffee.
How do you minimize the risks inherent in energy drinks?
- Do not consume excessive amounts
- Do not mix energy drinks with alcohol
- If you engage in intense physical exercise or activity, drink enough water to help re-hydrate your system, since energy drinks can actually act as diuretics
- Pregnant women and children should avoid them
- If you have an adverse reaction to an energy drink, stop consuming them immediately, and inform your physician.
Drink safely, and use common sense.
MRSA
July 25th, 2010In recent years we have experienced an unprecedented new epidemic of skin infections caused by the bacteria staphylococcus aureus, commonly known as staph. Even tougher, deadlier, and more expensive then staph, however, is MRSA. What are these skin infections and how can we avoid getting them?
Staphylococcus aureus (staph) are bacteria commonly carried on the skin or in the nose of healthy people. It is estimated that as many as 30% of us are colonized (bacteria are present but not causing infection). When staph do cause an infection, it usually results in minor pimples or boils on the skin. Sometimes, however, these pimples or boils can become major abscesses. Staph can also cause serious infections of the bloodstream, infections of surgical wounds, or pneumonia in susceptible people.
MRSA (pronounced “mersa”) stands for methicillin-resistant staphylococcus aureus. It was discovered in 1961 in the United Kingdom and is now found worldwide. According to the CDC (Center for Disease Control), annual MRSA deaths in the U.S. grew from 11,000 in 1999 to 18,650 in 2007, a number greater than U.S. annual deaths from AIDS!
Of the 30% of people who are colonized with staph (as determined by swabbing the nostrils), 1% are colonized with MRSA. While staphylococcus aureus is a common and treatable bacterium, MRSA is resistant to antibiotics in the beta-lactam and penicillin families, which include methicillin, oxacillin, cephalosporins, and penicillin. This resistance makes treating MRSA infections very difficult. Healthy people may carry MRSA without symptoms for weeks or for many years. People with compromised immune systems (including the elderly, and those suffering from AIDS, diabetes, and various cancers), are at a significantly greater risk of developing symptoms from the MRSA they have been carrying. Other people at risk include athletes in contact sports, children, and prisoners.
Staph/MRSA infections occur most frequently (about 88% of the time) in hospitals, nursing homes, dialysis centers, and other healthcare facilities where people have weakened immune systems. The initial presentation of MRSA is small red bumps that resemble pimples, insect bites, or boils and may be accompanied by fever. Within a few days the bumps become larger, painful and eventually develop into deep, pus-filled boils or abscesses. Occasionally, it is necessary for a doctor to open up a MRSA abscess with a scalpel to let it drain properly.
When infection occurs outside of hospitals and healthcare facilities, it is known as community-acquired MRSA. Community-acquired MRSA typically occurs in an otherwise healthy person. The ultimate infection tends to be much milder. Factors that are associated with the spread of MRSA skin infections include close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded living conditions, and poor hygiene.
Treatment for MRSA infections involves the use of costly non-resistant antibiotics. While the gold-standard treatment has been the antibiotic vancomycin, new resistant strains of MRSA are no longer responding to it. These new strains are termed vancomycin intermediate-resistant staphylococcus aureus (VISA), and as you can imagine, are even more difficult to treat.
Unfortunately, a MRSA infection can return; staph may continue to colonize the body even after the initial infection is cured. When there is a new skin break, the bacteria may create a new infection. To remove staph from the body and prevent recurrent infections, patients use an antiseptic soap and apply an antibacterial ointment to the nostrils.
The key to controlling staph infections is prevention:
- Keep your hands clean by washing thoroughly with soap and water, or use alcohol-based hand sanitizers
- Keep cuts and scrapes clean and covered with bandages until healed
- Avoid contact with other people’s wounds and bandages
- Avoid sharing personal items such as towels or razors
- Speak with your doctor if you develop a skin infection that does not heal.
Good health to you all!
Twinkie
July 25th, 2010I cannot imagine how many times in my professional career I’ve made fun of the Hostess Twinkie.
Everyone knows them; the Twinkie has become a cultural icon. It is a food (if I may be so bold to call it that) that anyone who cares about nutrition just loves to bash. When I talk about whole foods, the Twinkie is the example I use as the polar opposite. It is time to do the research and come up with the scientific reasons…or lack thereof…for never, ever, eating a Twinkie.
What is a Twinkie? It is a sponge cake-like ladyfinger filled with a cream filling that packs 150 calories. In spite of its lack of healthful credentials, 500 million of them are made each year. It is the source of myths and legends. Because they are always found on the shelf still spongy and soft, rumors spread that they were made entirely of artificial ingredients, and that Hostess made billions of them years ago that are still in storage, waiting to be sold! As the rumor goes, they have an infinite shelf life. As is so often true, this legend is false. Now let’s explore the facts.
Twinkies were created in Pennsylvania in 1930 by James Dewar, and were sold two-for-a-nickel. The filling started out as banana-flavored, but during World War II, banana rationing led to a change to vanilla. No, Twinkies do not stay fresh forever – they have a shelf life of 26 days, which is nonetheless quite a long time for a baked product to stay fresh. The secret to this extended shelf life is their lack of dairy products. After the sponge cake portion is baked, the filling is injected through three holes along the top. Hostess estimates that it uses eight million pounds of sugar, seven million pounds of flour and one million eggs to bake them each year. Which Americans consume the most Twinkies? Per capita, citizens of New Orleans are number one.
Twinkies gained quite a bit of notoriety in 1979, when Dan White stood trial for murdering San Francisco mayor George Moscone and city supervisor Harvey Milk. The media created the infamous term “Twinkie defense” when White’s depression and consequential consumption of junk foods such as Twinkies was linked to his diminished capacity to reason. (In all fairness, note that that the Twinkie was never specifically mentioned inside the courtroom.)
So what’s up with the 39 ingredients that make up a Twinkie? Note that you can bake a cake at home with as few as six ingredients, but a Twinkie uses 39! In Steve Ettinger’s Twinkie Deconstructed, he explains that cellulose gum, lecithin, and sodium stearoyl lactylate are used to replace milk, cream and butter, which would spoil far too quickly on a store shelf. You will find corn dextrin, a common thickener, also used as the glue on postage stamps and envelopes. Ferrous sulfate is used as the iron supplement in enriched flour and vitamin pills, but is also a disinfectant and weed killer.
Your Twinkie originated from phosphate mines, gypsum mines, and oil fields, rather then from the four basic food groups.
It has been repeatedly proven that a diet made up of whole natural foods is good for our bodies. In what manner consumption of a Twinkie’s 39 ingredients affects us may not be known for generations to come. It is your choice as to whether you wish to consume them.
We are what we eat – good health to you all!
Food Poisoning
June 2nd, 2010A few hours after eating something suspicious, you develop nausea, vomiting, abdominal cramps and diarrhea. You may be suffering from food poisoning. Let’s discuss how it happened, how to get healthy again, and how to prevent it from happening in the future.
Although food poisoning can be deadly, it is quite common and usually mild. It occurs when food or water contains bacteria, viruses, parasites or toxins. Infants and the elderly are at the greatest risk, and travelers to developing countries may experience traveler’s diarrhea (“Montezuma’s revenge”). The Centers for Disease Control (CDC) estimates that in the United States, food poisoning causes about 76 million illnesses, 325,000 hospitalizations, and up to 5,000 deaths each year. Of course, many cases are mild enough that they are never reported; the sufferers stay home and eventually get better without any intervention.
Frankly, when a patient comes to me, I look for the cause only if there’s a particular outbreak, or when the illness is quite severe. The specific cause makes no difference (most of the time) in how I treat it. However, a good reason to be concerned about the source of the food poisoning is to identify whether a particular case needs a specific treatment, or to prevent it from spreading further. This is why government agencies monitor outbreaks.
When a specific infectious cause is found, it’s most often a virus. Noroviruses are a group that causes a mild illness, and the illness is frequently mislabeled “the stomach flu”. This is the most common cause of adult food poisoning, and classic symptoms include nausea, vomiting, abdominal pain, headache, diarrhea, and a low-grade fever. Symptoms appear one to two days following exposure and last for two to three days. It is transmitted through contaminated water, shellfish, and vegetables, and then spread person-to-person from contact with their contaminated feces.
Outbreaks are seen in crowded places like nursing homes, schools and cruise ships.
The second most common virus is the Rotavirus. This causes a moderate to severe illness with vomiting and watery diarrhea and fever after a two-day incubation period. It is the most common cause of food poisoning in infants and children and is transmitted from person to person when fecal matter contaminates food or play areas.
Hepatitis A is actually another infectious form of food poisoning, and is also transmitted when food comes into contact with contaminated feces, or from person to person. It causes a mild illness with sudden onset of fevers, loss of appetite, and a feeling of tiredness followed by jaundice (yellowing of the eyes and skin). These symptoms appear after a three to five week incubation period, making it difficult to trace the source. It resolves completely in nearly all cases.
Among bacterial causes, Salmonella has been well publicized, and causes nausea, vomiting, diarrhea, abdominal cramps, and headaches five to 21 days after exposure. It is transmitted in raw or undercooked foods such as eggs, poultry, dairy products, and seafood.
Campylobacter is the most commonly identified food-borne bacterial infection in the world. It is transmitted by raw poultry, raw milk, and water contaminated by animal feces. Symptoms appear about five days following exposure.
Staphylococcus aureus is a bacterium that produces a toxin in foods such as cream-filled cakes and pies, salads (mainly potato, macaroni, egg and tuna salad), and dairy products. This is the organism responsible for the classic food poisoning at the family picnic. Symptoms appear one to six hours after eating contaminated food.
Escherichia coli (E. Coli) has many strains, with the worst causing kidney failure and death. It is transmitted by raw or undercooked hamburger, un-pasteurized milk or juices, contaminated produce, or contaminated well water. Symptoms appear in two to five days.
Shigella (travelers’ diarrhea) is transmitted in water polluted with…you guessed it: feces. Symptoms appear in ½ to three days.
Parasites rarely cause food poisoning. They are swallowed in contaminated or untreated water and cause long-lasting but mild symptoms. Giardia, one of the most common parasites, causes watery diarrhea, one to two weeks after exposure, and typically lasts for one to two weeks. It is found in contaminated water from lakes or streams in cool mountain climates. It can also be spread from person to person by food or other items contaminated with feces.
What can you do at home if you develop food poisoning?
•Start by taking small, frequent sips of clear liquids in order to stay hydrated
•Avoid alcohol or caffeinated beverages. Gatorade-type drinks are a good choice, but are best diluted with water, as heavily sugared fluids can worsen diarrhea. If you are taking diuretic medications, you may need to stop them – but only after consulting with your doctor.
•Avoid eating solid foods. After any vomiting and diarrhea have stopped, begin with the standard “BRAT” diet: Bread, Rice, Applesauce, dry Toast, crackers, gelatin, pudding, yogurt, and soup broth. Over-the-counter anti-diarrhea medications, such as Imodium AD and Pepto-Bismol, are generally helpful and safe when used as directed. Consult your physician for advice.
When is it time to seek out medical care?
•The nausea, vomiting, or diarrhea lasts for more than two days without improvement
•The patient is under three years old
•There is an accompanying fever
•The illness begins after foreign travel
•The infected person cannot keep liquids down
•The patient has a chronic disease as well
•The symptoms make it impossible to take normal prescribed medications
There are associated neurological symptoms such as weakness, double vision, slurred speech, or difficulty swallowing.
If you do see a doctor, the focus is generally on getting re-hydrated. You may be given anti-vomiting and anti-diarrhea medications, and any fever will be treated. Sometimes, antibiotics will be prescribed, but remember that many forms of food poisoning are viral, and antibiotics will be of no help!
Prevention is the key when it comes to food poisoning.
•Shop safely. Bring refrigerated foods home quickly, don’t buy torn or leaking packages, and don’t buy foods past their “sell-by” or expiration date.
•Store foods safely. If a food requires refrigeration, put it away immediately. Place raw meat, poultry, and fish in the coldest part of your refrigerator. Check your refrigerator’s temperature: it should be set to 40 degrees, and the freezer to zero degrees. Cook or freeze fresh poultry, fish, and meats within two days.
•Thaw foods safely. The refrigerator allows slow, safe thawing. Prevent the thawing juices from dripping onto other foods. To quick-thaw, place the food in a leak-proof plastic bag and submerge it in cold tap water. When thawing in a microwave, cook meat and poultry immediately afterwards.
•Prepare your food safely. Keep everything very clean: wash your hands, cutting board, knife, and counter tops with hot, soapy water before and after handling raw meat and poultry, and sanitize cutting boards often in a solution of one teaspoon chlorine bleach in one quart water. Do not cross-contaminate: keep raw meat, poultry, fish, and their juices away from other food. Marinate meat and poultry in a covered dish in the refrigerator, and then discard any uncooked or unused marinade.
•Cook foods safely, and use a meat thermometer. Cook ground meats to 160 degrees, ground poultry to 165 degrees, beef, veal, and lamb steaks, roasts and chops to 145 degrees, and whole poultry to 170 to 180 degrees. Bacteria grow rapidly at room temperature, so never leave food out for more than two hours, and use cooked leftovers within four days.
•Of course, not all of the food we eat is under our control. The Center for Science in the Public Interest (CSPI) reports that on a typical day, 44% of American adults eat at a restaurant, and that 41% of all food borne illness outbreaks can be traced to restaurant food. A single food safety mistake in a restaurant can cause far more illnesses than a single mistake in our kitchen at home. Choose your restaurants carefully.
•You’ve probably gathered that, when discussing food poisoning, the two key words are feces and hands! Wash your hands often and carefully, and enjoy your good, contamination-free food.
Mammogram
June 2nd, 2010You are a woman who is over the age of 40, and your doctor recommends a routine mammogram. What do you do? Are mammograms helpful? Can they harm you in some way? And, why didn’t one catch the cancer that ultimately killed your aunt? Let’s explore.
One in eight women will be diagnosed with breast cancer at some point in her life, making breast cancer the most frequently diagnosed cancer among women. The American Cancer Society currently recommends that women over the age of 40 have an annual mammogram. The guidelines from the United States Preventive Services Task Force, however, suggest that women not be routinely screened in their 40s, but that they discuss the pros and cons of the test with their physician. Their new government guidelines suggest that women should get routine mammograms far less frequently: every other year between the ages of 50 and 75.
In fact, neither of these recommendations actually happens in the real world. In 2005, only 72% of women between ages 50 and 74 had received a mammogram within the past two years. The reasons varied, with the biggest one being limited access to doctors, followed by lack of healthcare coverage, the presence of co-pays, indirect costs such as transportation and lost wages, and most interestingly, myths, misconceptions, misinformation, and fear and distrust of the test. Advocates of the new and less frequent screening guidelines argue that women should be aware of the very real harm and limitations of mammography. The main argument against mammography is that cancer is over-diagnosed, leading to over-treatment.
Indeed, no test is perfect at finding everyone who may have a particular disease (the statistical term for this is “sensitivity”). If that were the case, then every woman who had breast cancer would have a positive mammogram result. Estimates of actual mammography sensitivity range from 75 to 90% (100% sensitivity would mean that every case of cancer was correctly found). Nor is every test perfect in showing that everyone who does not have a disease comes out negative (the statistical term for this is “specificity”). Estimates of actual mammography specificity range from 90% to 95% (correctly not finding cancer where none exists). If specificity were equal to 100%, then every woman who did not have breast cancer would have a negative mammogram.
In reality, many women who have mammograms are told to come back for follow-up mammograms, ultrasounds and even MRIs. In the end, they may be told that everything is OK. Others end up with biopsies that turn out fine. In addition, some women actually have breast cancer, but after all the additional tests and even biopsies, are still told that they are fine. Unfortunately, the cancer eventually makes itself apparent.
So, given the missed diagnoses, over-diagnoses and extra tests, biopsies, costs, etc, are mammograms worth it? Now that cutting health care costs is such a high priority, this question is being examined more vigorously. One study out of England concluded that women are not being properly informed of the harms of mammography. They claim that of 2,000 women screened regularly for 10 years, one will benefit and avoid dying from breast cancer, while 10 healthy women will be diagnosed with the disease, have part or all of their breasts removed, and may go through radiation and chemotherapy treatments. Another 200 women will receive false alarms and experience psychological stress until they eventually learn that they do not have breast cancer.
It is a reality that a patient’s experience will depend on where the test is being done, by the quality of the machine, the skill of the radiologist, and even more, on the aggressiveness of the surgeons and invasive radiologists who choose how to interpret and act on results. In our local community, we are blessed with high quality radiologists and surgeons.
Some woman are at heightened risk for breast cancer, including those who have a first-degree relative who has been diagnosed with the disease, a history of breast or other gynecological cancer, early menses, late menopause, no children or a late start on having children, and a host of other less significant factors. These women should have annual mammograms regardless of age.
Overall, however, data indicates that mammography is most valuable for those aged 50 – 69. For women under age 50 and over age 69, the data is still conflicting as to the benefit of routine mammograms.
My recommendations:
•Get the newer digital mammograms if possible.
•Don’t panic if there is a callback. This happens frequently and means that the radiologist is being cautious.
•Make sure that the mammography facility uses experienced radiologists, who read a lot of mammograms.
•Make an effort to frequent the same facility, so that previous films will be available for comparison.
•Get your mammograms routinely. Your personal physician can keep you up to date when recommendations change.
I wish you all the best of health!
Fibromyalgia
June 1st, 2010There are diseases that many doctors just love to avoid: they do not lend themselves to easy diagnosis. Neither blood tests, nor x-rays, nor special exams will help to identify them. For these types of illnesses, the doctor will ask a series of questions over time, and arrive at the diagnosis through a process of elimination. Even once the diagnosis is made, it is difficult to determine whether the patient is getting better or worse, since there is no objective way to measure such change! It is not a precise process; welcome to the “art of medicine.” Here, then, is one such disease…fibromyalgia.
Everyone seems to know someone who believes that they have fibromyalgia, and it may even be you. Fibromyalgia is a Greek word that literally means “pain in the muscles and fibers.” It is a medical disorder characterized by chronic widespread pain with tender points in joints, muscles or tendons, and is especially unusual in that there may be exaggerated pain from normal touch.
Fibromyalgia may mimic the pain of arthritic-type diseases, but these patients don’t display the swelling, redness, joint destruction, or deformity of joints found with arthritis. They do describe a soft-tissue pain that is radiating, gnawing, shooting or burning, and ranges from mild to severe. Sufferers tend to wake up with body aches and stiffness. The tender points in fibromyalgia occur without even touching them, with pain radiating in all directions. For some, the pain tends to improve during the day and then increase at night. The pain can be continuous and unrelenting, and can get worse with activity, cold or damp weather, anxiety, and stress. Patients report:
•bodyaches
•chronic facial pain or aching
•fatigue
•irritable bowel syndrome
•memory difficulties and cognitive problems
•multiple tender areas (muscle and joint pain) on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows, and knees
•numbness and tingling
•palpitations
•reduced exercise tolerance
•sleep disturbances
•tension or migraine-type headaches
There is a high likelihood of also having psychiatric conditions such as depression and anxiety, and stress-related disorders such as post-traumatic stress syndrome. Fibromyalgia may develop along with other musculoskeletal conditions like rheumatoid arthritis or lupus. It’s possible that 2-4% of the population has it, with women outnumbering men 9:1.
The formal diagnosis of fibromyalgia requires a history of at least three months of widespread pain, and pain with tenderness in at least 11 of 18 specific sites. These sites include fibrous tissue or muscles of the arms, elbows, buttocks, chest, knees, lower back, neck, rib cage, shoulders, and thighs.
It is clearly a controversial disease, badly lacking in scientific consensus. The absence of physical or objective laboratory findings causes many physicians to not even believe it exists, or to chalk it up entirely to psychiatric problems.
While the cause of fibromyalgia is unknown, physical and emotional trauma may play a role in its development. Some have theorized that the sleep disturbances so common in this disorder may actually be the cause. Another theory purports that the disorder may be associated with abnormal muscle metabolism caused by decreased blood flow, which then leads to chronic fatigue and weakness. Some propose that the disease is inherited. Others suggest an infectious cause, possibly from a virus. When little is known, theories appear.
Treatment varies, depending on the severity of the symptoms. For mild symptoms, the pain may go away when stressors diminish or lifestyle changes are made. Further treatment involves medications, education, physical therapy, counseling, and support groups. Currently there are a few drugs approved for the treatment of fibromyalgia, including Lyrica, Cymbalta, and Savella. Anti-inflammatory medications, such as ibuprofen, naproxen, and a host of others, can help with pain, as does Neurontin, or even narcotics for severe pain. Antidepressants in low doses have been shown to decrease depression, decrease pain, improve sleep, and release pain-relieving endorphins. Fish oil, magnesium with malic acid, and vitamins have been beneficial. General good health measures including diet, stress reduction, and exercise are highly recommended.
The course of the disease varies. It is common and it is chronic. Symptoms can improve, or may worsen and continue for months or years. In fact, the only comforting news is that there is no proof that fibromyalgia actually kills anyone.
If you feel you may have symptoms suggestive of fibromyalgia, see your doctor. Good health to you all!
Milk
April 24th, 2010Is it true that milk “does a body good”? I was raised on plenty of milk, and continue to drink a fair amount. I have always held that milk contains a well-balanced mix of nutrients, including calcium for my bone health. So what are the facts? There are pros and cons; let’s take a look.
Milk is a great source of calcium, providing about 300 mg in each cup. Of course there are other sources of calcium, such as yogurt, nuts, turnips, broccoli, watercress, sunflower seeds, sesame seeds, soy products, and calcium-fortified products like orange juice and margarine. However, milk is one of the best nutritional sources of calcium, as it contains vitamin D, and lactose to aid in calcium absorption.
Milk provides a complete source of protein. The protein is high quality, which means that it contains all of the essential amino acids. In addition, milk is a good source of phosphorus, magnesium, vitamin A, vitamin D and riboflavin (a B vitamin).
The primary role of milk in nature is to nourish and provide immunological protection for newborns. Drinking milk in childhood and adolescence is strongly associated with increased bone mass and density in adulthood. It is essentially one-stop shopping because it contains nearly all the basic nutrients that a growing child needs, including fats, carbohydrates, proteins, vitamins, and minerals (except iron). Whole milk is loaded with saturated fat, which can increase cholesterol levels, so low-fat or non-fat milk is your best bet.
On the negative side, many people, especially as they grow older, have difficulty digesting milk because they lack enough of the lactase enzyme. This condition is known as lactose intolerance and causes bloating, gas, and diarrhea. It is estimated that milk products lead to roughly 50% of these symptoms in adults. For most, it is easy to control lactose intolerance by taking a lactase tablet while consuming dairy products.
Milk may contain the antibiotics given to cows to treat inflammation. When we consume the milk, we absorb these antibiotics, potentially making us more resistant to them in the future when we need them to fight infection.
Milk is, on rare occasion, a cause of food allergies due to the various proteins it contains. common symptoms include vomiting, diarrhea, abdominal pain, hives, rashes, cough, watery eyes and stuffy nose. While these symptoms are more commonly seen in young children, they are also found in adults.
Hormones are used to enhance milk production in cows. One such hormone is rBGH, made by Monsanto. This hormone leads to higher levels of an insulin-like growth factor IGF-1, which a Harvard study has linked to an increased risk of prostate cancer.
Some sources discuss a possible link between milk consumption and iron deficiency anemia in young children, as well as to a risk for breast cancer and heart disease. Current data is still sparse, but emotions run high, and research is continuing.
There is debate concerning whether organically-reared cows yield milk with higher levels of nutrients. The advantages of going organic are still being investigated. Proponents claim that these cows eat large quantities of fresh grass and produce milk which is on average 50% higher in vitamin E, 75% higher in beta carotene (converted to vitamin A in our body), and has two to three times higher antioxidant levels than non-organic milk. Others claim that government standards are strict and that these standards ensure that non-organic milk is just as pure, safe and nutritious.
Milk consumption certainly shows a disturbing trend. By the time the average American girl, for example, reaches her 19th birthday, she’ll be drinking three times more soda and 25% less milk than she did when a child. This bodes poorly for that average girl’s future risk for osteoporosis. Is this trend related to current concerns over milk, or a greater desire for soda? Surveys indicate the latter.
Overall, I recommend that milk should play an important part in our diet, regardless of age. Low-fat and non-fat milk are low in fat and clearly do the body a great deal of good. At the recommended level of consumption of three eight-ounce glasses per day for growing children, and less for adults, we are providing our bodies with needed calcium, protein and vitamins.
I wish you great nutrition and bone health. Bottoms up!
Diet Soda
April 24th, 2010When I first met my wife, she was a slender 18 year-old, drinking diet cola and eating chocolate. My obvious question was “Why the diet drink, if you’re eating chocolate?” Her answer: “You have to choose your calories carefully!”
Soda manufacturers have spent billions of dollars trying to convince us that diet soda is a healthy, light choice. With so many in our country struggling with weight gain, who can blame us if diet soda seems like a dream come true? Soft drinks are the most heavily consumed beverage in the United States (although they are losing some ground to bottled water, sports drinks, and energy drinks). An average of about two and a half cans of regular or diet soda are consumed every day for each man, woman and child. Even without any in-depth analysis, it’s terribly obvious that soda consumption is a significant problem in our country.
As we all know, diet sodas have no calories. Many overweight people drink them heavily, believing that they will aid in weight loss. But is that actually true? It will come as no surprise that studies have linked consumption of sugar-laden sodas with multiple risk factors for heart disease. However, it is fascinating that the same link exists for diet sodas! More than one reliable study has now shown that those who drink one or more diet sodas per day have a 50-60% increased risk for developing metabolic syndrome, a cluster of risk factors including obesity around the waist, low levels of the good cholesterol HDL, high blood pressure, and elevated sugar levels. Those who have metabolic syndrome markedly increase their risk of having a stroke, heart attack, and diabetes. On average, all soda drinkers, whether diet or regular, tend to have similar eating patterns and consume more calories, more saturated fats and trans fats, eat less fiber, exercise less, and be more sedentary. Even when researchers adjusted for dietary habits, a significant link was still observed between diet soft drink consumption and the risk of metabolic syndrome.
A University of Texas study looked at artificial sweeteners and weight. Again, it was no surprise to find a correlation between the daily consumption of large amounts of all soft drinks and obesity. What was surprising was that those who only drank diet sodas had an even higher risk of obesity. Theories abound. The most common is that when the body tastes something sweet, it then craves more sweet-tasting foods. Another theory reminds me of my wife’s philosophy from years ago. When we drink diet sodas, we are actually making a deal with ourselves that if we avoid calories in our drink, we allow ourselves the luxury of eating something else. (Thank goodness that every rule has exceptions. My wife still drinks diet coke, still loves chocolate, and is still slender.)
Let’s not forget that diet soda has a laundry list of suspicious ingredients that likely work against our body’s effort to achieve a healthy balance, including caffeine, artificial sweeteners, sodium, and phosphoric acid. This is particularly worrisome when parents allow their overweight children to drink diet sodas instead of a nutritionally rich drink like non-fat milk.
• We’ve discussed caffeine in previous articles. It gives us an often-useful energy “buzz” along with potential addiction, fatigue, anxiety, insomnia, tremors, palpitations, and exaggerated mood and hormonal swings. It is a diuretic, so it can actually work against hydration.
• Soda contains sodium, which quenches thirst, but can raise blood pressure and cause water retention.
• Studies done on nurses who drank two or more diet sodas per day had a two-fold increase in risk of kidney disease. The reason is likely due to the sodium and artificial sweetener.
• Experts aren’t certain why drinking soda is linked to osteoporosis and risk of fracture. Perhaps it is simply that the soda is displacing healthier drinks, like milk or fortified orange juice in the diet. However, new research indicates that there may be more to this connection. Researchers at Tufts University, studying several thousand men and women, found that women who regularly drank three or more cola-type sodas per day had almost 4% lower bone mineral density in the hip, even though these women were no different in their calcium and vitamin D intake. However, women who drank non-cola soft drinks, like Sprite or Mountain Dew, didn’t show this lower bone density. Phosphoric acid, a major component in most sodas, may be to blame. Phosphorus itself is an important bone mineral, but a disproportionate amount of phosphorus compared to calcium could lead to bone loss. Another possible culprit is caffeine, which experts have long known can interfere with calcium absorption. Both caffeinated and non-caffeinated colas are associated with lower bone density, but the caffeinated drinks appeared to do more damage.
Much of this data is preliminary and begs for further study. However, the facts are piling up. Here are some strategies for dealing with soda, whether diet or regular:
• Replace some of your soda with water. A general rule of thumb is that we should drink, in ounces, about half of our body weight in pounds. A 140-pound person should have about 70 ounces of water every day.
• Take a daily multivitamin if you choose to drink diet sodas. This will help balance some of the missing nutrients inherent in a poorly balanced diet.
• Explore why you are drinking diet soda. Is it a stress reaction, a (misguided) weight loss strategy, a habit from boredom, or for social reasons? If you can’t answer this, try stopping and observe your reaction. The reasons will become apparent.
Let’s put more conscious effort into what we put into our bodies. Drink water! Good health to you all.
Healthier Life
March 21st, 2010How can we live a healthier life? In recent columns, I’ve been concentrating on health promotion for different groups of people. Let’s take a look at the current major health recommendations for men who are over 50, beginning with recommendations that are critically important for everyone:
•Be tobacco-free. The first step is making that serious decision to quit, and for some, that’s all it takes. Many, however, find success with various medications. The old standards typically involve some form of nicotine, whether administered through a patch, gum, or cigarette-type device. Chantix is the newest medication; work with your doctor to choose the best treatment for you.
•Be physically active. If you aren’t already, begin today. Start slow, and advance gradually. Park your car further away from your destination…Use the stairs instead of the elevator…Take your children or grandchildren for a walk or to the park. Think of yourself as an active person. This may involve a significant shift in your mind-set!
•Consume a healthy diet. Simply put, consume “real” food, not processed food. The more real the food, the more nutritionally valuable it is. Make sure that these foods are a major part of your diet: beans, nuts, fruit, vegetables, soy, low or no-fat dairy, fish, chicken, turkey, and 100% whole grains. Just say no to saturated fats, trans fats, fast foods, snack foods, salt and sugar.
•Stay at a healthy weight. If your weight is rising, you are consuming more calories than your body, genetics, and level of activity demand. Balance the calories you consume with the lifestyle you lead.
•Drink alcohol in moderation. If you are over 65, consume no more than one drink per day. If you are under 65, two drinks is the maximum. Remember that one 12-ounce beer has the same amount of alcohol as either five ounces of wine or 1.5 ounces of hard liquor.
•Take baby aspirin IF it is indicated for you for the prevention of atherosclerosis-related diseases such as stroke and heart attack. Ask your doctor whether your own unique risk factors justify taking a medication that does have side effects, such as the possibility of bleeding ulcers.
•Get the annual flu vaccine; it is recommended for men over 50. Vaccinations are also available for pneumonia and shingles, and a tetanus vaccine is recommended every ten years. Ask your doctor which immunizations are appropriate for you.
Part of prevention is keeping up with relevant screening tests. Here are the main ones to look for:
•Screening for abdominal aortic aneurysm may be recommended if you are male, between the ages of 65 to 75, and have a history of cigarette smoking and hypertension. The aorta is our largest artery, and the section that passes through the abdomen is particularly prone to dilating and rupturing. Speak to your doctor about whether this test is appropriate for you.
•After the age of 50, have a screening colonoscopy to check for colorectal cancer. If you ever notice blood in the stool, let your doctor know immediately. Your annual physical exam also typically includes a rectal test to detect blood. Early detection of colorectal cancer saves lives.
•Diabetes is easily screened through a blood test for fasting blood sugar levels. Common symptoms of diabetes include frequent urination, excessive thirst, always feeling dehydrated, weight loss, and fatigue.
•Have your blood pressure checked each time you go to the doctor. Since hypertension is a risk factor for many diseases, including heart attack, stroke, blindness, and kidney disease, it is critical to know whether you have it, and to have it treated.
•High cholesterol can be detected through another simple blood test. High cholesterol is a risk factor for atherosclerosis, which leads to clogged arteries, heart attacks and stroke. It can be treated and controlled.
•Sexually transmitted diseases including HIV, syphilis, gonorrhea, chlamydia, and warts can all be detected with appropriate tests. If you (or your partner) have been sexually active outside of a monogamous relationship, inform your doctor and be tested.
•Obesity screening compares your weight to your height (and accounts for bone structure). Being overweight is a risk factor for many conditions including arthritis, hypertension, diabetes, heart disease, stroke, and lung disease. It can be tough, but achieving proper body weight is very important for disease prevention.
•Don’t neglect your eyes. Glaucoma, and some types of macular degeneration can be treated if detected early on. Schedule periodic eye exams.
•Chest x-rays and EKGs, once a standard part of the physical exam, need not be done routinely. For smokers, however, an annual chest x-ray may be a good idea, especially if you have respiratory or heart complaints.
•Finally, men have a major problem area that women do not: the prostate. We can screen for prostate troubles through the rectal exam, the PSA lab test, and from urinary symptoms. What to do with that information is a complex issue, and becomes more controversial with age. Discuss this with your physician.
I always recommend that you make a checklist, bring it with you to your doctor’s office, and make sure that everything that is appropriate gets done. Remember, an ounce of prevention is worth a pound of cure. I wish you good health!
Health Promotion Women 50+
January 31st, 2010As promised, my current series of articles are devoted to specific health promotion plans for different groups. Health issues that may afflict us depend to an enormous extent on our gender and age, as well as genetics, environment and health habits.
Today, let’s address recommendations for women over 50. Of course, many of these basic measures are strongly suggested for anyone:
•Be tobacco free. The first step is deciding to quit, and for some, that’s all it takes. Many, however, have more success with various medications. The old standards typically involve some form of nicotine, whether it be administered through a patch, gum, or cigarette-type device. Chantix is the newest medication; work with your doctor to choose the best treatment for you.
•Be physically active. If you aren’t already, begin today. Start with small steps and advance gradually. Park your car further away from your destination…Use the stairs instead of the elevator…Take your children or grandchildren for a walk or to the park. In order to be physically active, you must think of yourself as an active person. This may involve a significant shift in your mind-set!
•Consume a healthy diet. Simply put, consume “real” food, not processed food. The more real the food, the more nutritionally valuable it is. Make sure that these foods are a major part of your diet: beans, nuts, fruit, vegetables, soy, low or no-fat dairy, fish, chicken, turkey, and 100% whole grains. Say no to saturated fats, trans fats, fast foods, snack foods, salt and sugar.
•Stay at a healthy weight. If your weight is rising, you are consuming more calories than your body, genetics, and level of activity demand. Balance the calories you consume with the lifestyle you lead.
•Drink alcohol in moderation. If you are over 65, consume no more than one drink per day. If you are under 65, two drinks is your maximum. Remember that one 12-ounce beer is the same as either five ounces of wine or 1.5 ounces of hard liquor.
•Take baby aspirin IF it is indicated for you for the prevention of atherosclerosis related diseases such as stroke and heart attack. Ask your doctor whether your own unique risk factors justify taking a medication that does have side effects, such as the possibility of bleeding ulcers.
•Some women have such a significant family history of breast cancer (multiple close family members) that they may consider taking medication for prevention of breast cancer. Again, speak with your own physician.
•Menopausal symptoms such as hot flashes, depression and fatigue can be debilitating. Estrogen replacement therapy (ERT) can combat these symptoms, but has become unpopular due to recent data suggesting greater cancer, stroke, and heart attack risk. Discuss this with your doctor.
•The annual flu vaccine is recommended for women over 50. There are also vaccinations for pneumonia and shingles. Tetanus vaccines are recommended every ten years for everybody. Ask your doctor which immunizations are appropriate for you.
Screening tests are extremely important:
•For breast cancer prevention, you should perform a breast self-exam at least once per month. If you are unclear about how to do it, ask your doctor for instructions. In addition, your doctor will do a breast exam at least once per year. Mammograms should be performed every year or two.
•To screen for cervical cancer, Pap smears are recommended every one to three years until age 65. After that, the recommended frequency is controversial, however a history of abnormal Pap smears will certainly increase how often you should have one.
•Colorectal cancer is now screened in a few different ways. A rectal exam will be performed at your annual physical. If blood is found, or a mass is felt, then a colonoscopy will be performed. In addition, at age 50, it is recommended that everyone get their first screening colonoscopy.
•Diabetes is screened through a blood sample taken after fasting. This test is typically part of routine labs taken by your doctor during your physical.
•High blood pressure can be detected when your doctor measures your blood pressure. Remember that regular exercise lowers blood pressure, and that salt, weight gain, and stress raise it. Your genetics are probably the most important factor in causing elevated blood pressure.
•Cholesterol levels are screened by a blood test. This too is typically part of the routine labs taken during your yearly physical. Many factors affect cholesterol, including genetics, diet, and exercise. Foods rich in omega-3 fatty acids such as fish, nuts, and dark green vegetables have shown promise in improving your cholesterol levels.
•Your doctor will order a Bone Mineral Density or DEXA scan to screen for osteoporosis. The risk of osteoporosis becomes more significant during menopause. Until age 25, bone is built, and after age 25 it begins to break down. This process accelerates after menopause due to the loss of estrogen. Exercise is very helpful, and be sure you are taking calcium and vitamin D as recommended by your doctor..
•If you are sexually active outside of a monogamous relationship, you should be screened for sexually transmitted diseases such as HIV, gonorrhea, chlamydia, genital warts and herpes.
If you wish, make up a checklist of these screening tests, and fill it in during your yearly physical. Your doctor will comment on the tests results, and what measures need to be taken to correct any problems found.
Remember what they say about an ounce of prevention. Good health to you all!
Glucosamine
January 31st, 2010“New Miracle Relief Formula eliminates even the worst pain…almost instantly.” “Soothe away joint pain and watch as your skin regains a nourished, youthful appearance.” “It’s like oil for the joints – it helps promote full range of motion and flexibility.” “Patented ingredients help support, ease, and rebuild joints.”
Glucosamine chondroitin is the most popular dietary supplement for the treatment of osteoarthritis, the most common form of arthritis. It is also used often for acute inflammatory musculoskeletal conditions – those sore, inflamed muscles or joints where the pain just doesn’t seem to go away. Your doctor, chiropractor, or physical therapist may have (sometimes reluctantly!) recommended it. Are you one of those who are sold on it? Does it really work? Is it harmful? How are we, as consumers, to evaluate the potential benefits of such a product – other than by trying it?
The Food and Drug Administration (FDA) classifies dietary supplements as a subcategory of “food”, providing manufacturers with greater leeway and less oversight than with products classified as “pharmaceutical”. This leads to the asterisk syndrome. After claims, such as those in the opening paragraph above, are made on packaging or product inserts, an asterisk is used with the following disclaimer: “*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”
Nevertheless I will, on occasion, recommend this product to my patients. This is what is currently understood:
Glucosamine is available in many forms, including glucosamine sulfate, glucosamine hydrocholoride (HCL), and N-acetylglucosamine (NAG). There appears to be no conclusive evidence that one form is better than another. Chondroitin is typically sold as chondroitin sulfate.
Glucosamine is an essential component of our cartilage, mucous membranes, and synovial fluid. It can be manufactured synthetically, but commercial producers often extract it from lobsters, crabs, shrimp, and other sea creatures.
Chondroitin is also an essential component of cartilage. It can be manufactured synthetically, but is commonly extracted from cow and shark cartilage. It is believed to promote the production of new cartilage and delay the breakdown of existing cartilage. Study participants have generally reported a decrease in pain and increase in joint movement when taking chondroitin, but good controlled studies taking into account aspirin and other arthritis medication taken simultaneously have not been done. Study results vary widely, but are even more positive when chondroitin is taken in combination with glucosamine.
No serious side effects have yet been found from either glucosamine or chondroitin. The most common side effects of glucosamine are mild gastrointestinal complaints such as constipation and diarrhea, and sometimes headache. There have been no major reports of allergic reactions, but glucosamine is made from shellfish, and people allergic to seafood should be cautious. With chondroitin, hair loss and minor gastrointestinal complaints have been seen. Chondroitin can decrease the blood’s ability to clot, so if you are taking blood thinners such as aspirin, plavix, or coumadin, it is not advisable to take chondroitin.
Quality evidence for the efficacy of the joint supplements glucosamine and chondroitin is hard to find and often contradictory. The combination of the two appears to have the most benefit based on existing studies, but not all researchers are yet in agreement. My recommendations are:
- Get a good diagnosis before treating the problem
- Explore the pros and cons of all treatment options with your physician
- If you wish to try glucosamine chondroitin, have your physician guide you
- Remember that all dietary supplements are subjected to less strenuous scientific review then are pharmaceuticals, so be wary of “miracle cures” and keep a healthy skepticism.
As always, I wish you good health and easy, pain-free movement!
Hearing Loss
January 31st, 2010Can you hear me now?
By age 65, one out of every three people will live with a hearing loss. It is one of the most common physical ailments.
Many who have become hard of hearing are unaware of their hearing problems; it typically develops gradually, and often we are in denial and refuse to even acknowledge the problem. Ask yourself (or your loved one) the following questions:
- Do you ask people to repeat what they say?
- Do you give inappropriate responses to questions?
- Do you watch a speaker intently to understand them?
- Do you frequently mispronounce words?
- Do you fail to hear someone talking behind you?
- Do you find that you keep turning up the volume on the TV or radio?
- Do you sleep through your alarm clock? (teenagers need not answer this question)
There are two main types of hearing loss. Conductive Hearing Loss (CHL) is the result of a mechanical problem in the external or middle ear. The three smallest bones in the human body (the ossicles) are found in the middle ear. Hearing problems occur if they fail to conduct sound to the cochlea in the inner ear, if the eardrum doesn’t vibrate properly in response to sound, or if fluid accumulates in the middle ear.
Sensorineural Hearing Loss (SNHL) results from troubles in the inner ear; most often when the tiny hairs (cilia) that transmit sound are injured. This type of hearing loss is sometimes called “nerve damage”, although that is not an accurate description.
Conductive Hearing Loss may be reversible, while Sensorineural Hearing Loss is not. Factors that may lead to hearing loss include:
- Aging, which leads to cell damage in the inner ear from normal wear and tear over the years. Of our five senses, hearing is the most sensitive to age. As noted above, one of three of us are affected by hearing loss once we hit 65 – but that number rapidly rises to one in two, once we’re 75!
- Sounds above 90 decibels for an extended period of time will lead to hearing loss. This can include occupational exposure, environmental noise, music, and shooting guns. One-third of the 30 million people with hearing loss can blame loud noise.
- Researchers fear that the growing popularity of portable music players, cell phones, and other items that attach directly to the ear will be contributing to more hearing loss among younger people. Time will tell.
- Genes certainly contribute to the likelihood of suffering some types of hearing loss. Otosclerosis is a hereditary disorder in which a bony growth forms around one of the ossicles in the middle ear, preventing it from vibrating when stimulated by sound.
- Some medications may lead to hearing loss. The antibiotic Gentamicin, for instance, can damage the inner ear, lead to hearing loss and tinnitus (ringing in the ears).
- Infections can lead to hearing loss. Otitis media is an infection of the middle ear in which an accumulation of fluid may interfere with the movement of the eardrum and ossicles. Fortunately, this is reversible. Any infection that results in high fever can lead to a more permanent damage to the cochlea, however. Childhood infections that can lead to permanent hearing loss include meningitis, mumps, measles, and scarlet fever.
- Meniere’s Disease is a disease of the inner ear that can lead to hearing loss, usually in only one ear.
If you suspect hearing loss, see your primary care doctor first. A simple evaluation may reveal an uncomplicated answer. It’s seldom that a physician has the opportunity to cure a significant problem easily, but sometimes restoring hearing can be as simple as removing earwax or a foreign object from a patient’s ear! Allergies are another common cause of hearing loss. Simply treating sinus congestion with nasal sprays, antihistamines or decongestants can restore hearing.
The next step may be to see an ear, nose, throat (ENT) doctor or an audiologist. If indicated, an audiologist will test your hearing, determine the frequency and severity of loss, and plan, with the ENT, the best approach to dealing with it. Surgery can be curative in a small number of cases, but more typically, hearing aids can help one learn to live with hearing loss, just as those of us with poor vision wear glasses. Hearing aids are far less visible and far more effective than in Grandma and Grandpa’s time. Other devices are also available to make everyday life easier, including special telephones, headphones or subtitles for watching TV, and headsets for live theater. There are a number of nation-wide informational and advocacy organizations for the deaf and hard of hearing, including the American Association of the Deaf-Blind and the National Association for the Deaf.
Of course, wherever possible, prevention is the best strategy. Keep the volume turned down on those iPods and cell phones, and bring earplugs to your next rock concert!
As always, I wish you good health, and good hearing.
SAD
January 31st, 2010One of my daughters is on the verge of making a monumental decision about where to attend college, and an important factor under discussion is the weather. Here in Southern California, we certainly enjoy an abundance of sunshine. We’re all well aware that winters are far longer, colder and darker just about everywhere else. During the winter months, and especially in more severe climates, doctors observe a type of depression referred to as Seasonal Affective Disorder, or (appropriately) SAD.
Also known as “seasonality”, or the “winter blues”, SAD is a type of depression that tends to recur year after year as the days grow shorter and colder. There is most definitely a statistical increase in the occurrence of depression during the winter season. In psychiatric circles, it is still under discussion as to whether this is a separate distinct disorder, or if people who are already prone to one of the depressive disorders simply have flare-ups during winter months. It is also unclear whether the depression is caused by decreased sunlight, colder weather, or by the increased isolation and stress that comes with winter months. There is some indication that sunlight, entering through the retina, stimulates the production of chemicals in the brain that have an antidepressant effect.
The primary sign of seasonal affective disorder is a pattern of depressive episodes that occurs with the onset of winter. Sufferers may eat more, crave carbohydrates, sleep excessively, experience chronic fatigue, have crying spells, irritability, body aches, loss of sex drive, gain weight, or exhibit significant social withdrawal.
The second sign of the disorder is the tendency for these symptoms to abate once the days become longer and warmer in the spring. For a doctor to make the diagnosis, the pattern of seasonal depression must be present for at least two consecutive years, without any occurrence of non-seasonal depression.
Who gets SAD? There are clearly more cases among those who live farther north, where there is less daylight and less warm weather. Younger people tend to be diagnosed more frequently with SAD. Women are far more likely to be diagnosed than men (in general, women are diagnosed at higher rates for major depression than are men).
Light therapy, while unproven, is often recommended. Daily exposure to a full spectrum fluorescent light appears to significantly improve depression in those with a tendency to SAD. These lamps are easy to find (try the Internet) and cost roughly $200.00.
Traditional treatments for depression are also recommended, including both therapy and antidepressant medication. Spend time outdoors when possible, and take vacations in warm, sunny places.
Fortunately for my local readers, we live in paradise. (Just ask my daughter, who was delighted to come home from that college visit and exchange her down jacket for flip-flops.) Most of us, however, have loved ones who live in colder, darker climates and may suffer from SAD. Or, you may be considering moving to colder climates for a job, finances…or college. Consider the weather when making your decision, as it may play a significant role in your seasonal happiness.
As always, I wish you the best of health.
Fertility
December 17th, 2009Have you or a loved one had trouble getting pregnant? If so, read on. Today we are exploring the field of infertility.
If you and your partner have not been able to get pregnant despite having regular unprotected intercourse for at least one year, then you are considered an infertile couple. You would not be alone; up to 15% of couples in the United States are infertile. The male partner is responsible in roughly 25% of infertile couples, 25% are unexplained, and the remaining 50% have problems that can be traced to the woman. Most pregnancies occur during the first six months of unprotected intercourse, and after 12 months, approximately 85% of couples will become pregnant. Half of the remaining 15% will conceive, with continued effort, within the next three years. Age is a huge factor: when the woman is over 35, the infertility rate more then doubles, yet 20% of women now have their first child after that age.
The causes are many because the human reproductive process is so complex. There must be normal ovulation of a healthy egg, safe transit of this egg from the ovary to the uterus, healthy sperm to swim up to meet the egg and fertilize it, and then a healthy uterine environment for the fertilized egg to grow into a viable baby.
More than 90% of male infertility cases are due to low sperm counts, poor sperm quality, or both. Men most likely to be fertile have a sperm count of over 48 million, with more then 63% of the sperm moving, and more then 12% having a normal shape and structure. Many factors can affect sperm health, including chronic illness (cancers, heart disease, diabetes, etc.), malnutrition, obesity, genetic defects (mainly Kleinfelter’s syndrome), environmental factors, structural defects of the body (undescended testicle and varicocele), and age. Lifestyle choices can also harm sperm development, including the use of anabolic steroids, drugs and alcohol, or exposure to sexually transmitted diseases (chlamydia and gonorrhea). If mumps is contracted after puberty, it can lead to permanent changes in a testicle and forever impair sperm production. Even the use of lubricants may affect the health of sperm. Finally, a host of sexual issues that lead to difficulties with intercourse will increase infertility. These include problems with erections, premature ejaculation, painful intercourse, stress, or other relationship issues.
And what about women? Exposure to chlamydia and gonorrhea can lead to fallopian tube damage and blockage. Endometriosis occurs when uterine tissue implants and grows outside of the uterus; this affects the function of the ovaries, uterus and fallopian tubes. Ovulation disorders due to hormone imbalances (including elevated prolactin levels) lead to infertility. In polycystic ovary syndrome (PCOS) the body produces too much androgen (a male hormone), which affects ovulation. Fibroids, a common benign growth of the uterus, can grow in the wall of the uterus and block the fallopian tubes. Some medications may lead to temporary infertility. Thyroid disorders, either too high or too low, can disrupt the menstrual cycle. Cancer and its treatment may have a profound affect on fertility. Age is, of course, a significant factor; it leads to fewer eggs being released from the ovaries, poorer egg health, higher risk of miscarriage, and poorer health in general. Finally, and I add this with fear of retribution from my coffee-loving readers, even excessive caffeine consumption reduces fertility.
What is the medical work-up for infertility? Both partners will want to see their family doctor for a general evaluation, including a medical history and a physical exam. The first step for men is much simpler and cheaper than for the woman; a sperm analysis will be run. For the woman, lab tests will likely include checks on diabetes, thyroid function and hormone levels. From there the couple may be referred to a fertility specialist for further tests, including a hysterosalpingogram for the woman to ensure that her fallopian tubes are open and capable of delivering the egg to the uterus.
Treatment has advanced remarkably. If the male sperm are of good quality, and the women’s reproductive apparatus healthy, treatment will begin with medication aimed at ovarian stimulation, commonly known as fertility drugs. If conservative medical treatment fails, the physician may suggest in-vitro fertilization (IVF). IVF is an assisted reproductive technology (ART) technique, which generally begins with stimulating the ovaries to increase egg production. Eggs are then surgically removed from the ovary and fertilized with sperm in a laboratory, in order to produce one or more embryos. An embryo transfer procedure then reinserts the fertilized egg(s) into the woman’s uterus. The current success rates for IVF depend on the center and on the doctor performing the procedure, but overall, the Center for Disease Control reported success rates in 2005 of 43% for women under the age of 35, 36% for women aged 35-37, 25% for women aged 38-40, 15% for women aged 41-42, and 6% for women over 42 years old.
Clearly, infertility can be caused by a number of issues outside of our control. However, certain lifestyle choices do maximize the chances of getting pregnant. What can you do, starting today, to improve your chances? Most of these recommendations are helpful for both partners:
- Work on reducing stress
- Eat a healthful and nutritious diet
- Exercise regularly
- Control your weight
- Do not smoke cigarettes
- Do not consume excessive amounts of caffeine
- Drink alcohol in moderation and not at all during pregnancy
- Do not use recreational drugs
- Limit your exposure to multiple sexual partners, and protect yourself when you do
- For men, avoid exposure to excessive heat (baths or Jacuzzi-type tubs). Heat is deadly to sperm.
- Start your family at a younger age
- Diagnose and control any health problems immediately; do not put this off until you start “trying” to conceive.
I wish you great health and a wonderful family!
Exercise
November 29th, 2009One of the most frequent questions I hear from my patients is: “What can I do to feel better?” The answer is usually quite simple: combining a healthy diet (as I’ve addressed in prior columns) with regular exercise will help to improve practically anyone’s general well being.
A wealth of studies have established the benefits of exercise. They lead to two very important questions: What is the best kind of exercise? How much exercise do I need?
Regular exercise or physical activity can do everyone a world of good. It will help maintain proper cholesterol levels, help to cope with arthritis, treat depression, and decrease high blood pressure. It will also prevent heart disease, diabetes, osteoporosis and accidental falls which result in bone fracture. Lastly, of course, it is a key factor for weight loss and maintenance.
Exercise is beneficial to weight control for several reasons. Clearly, it burns calories while you participate. In addition, it speeds up your metabolism 24 hours per day simply by doing it regularly! This causes you to burn more calories on an ongoing basis. Finally, it turns fat into muscle. Muscle, as it turns out, is biologically active. It performs actions that require energy, and thus burns calories. Fat just sits there and requires very little energy. Given all of this, it is truly mind-boggling that only a minority of Americans get enough exercise. A Harvard School of Public Health study estimates that the cost of inactivity to the United States is at least $24 billion a year. How is this possible? Not only is there a much higher health care cost involved in taking care of inactive people, but that group also misses far more work, resulting in lower productivity.
If you don’t currently exercise and you lead a fairly inactive life, then ANY increase in activity is good for you. Some data suggests that simply walking (plan to cover a mile in 30 minutes) for one to two hours per week (try breaking it down to 15 to 20 minutes a day) will yield noticeable benefits. This would be considered mild exercise, which also might include playing the piano, canoeing, golfing with a golf cart, or slow ballroom dancing. More worthwhile is moderate-intensity exercise. This level of exercise will cause a slight but noticeable increase in your breathing and heart rate. If you are able to exercise hard enough to break a sweat but are still able to comfortably carry on a conversation, then you can consider it moderate-intensity. Examples would be brisk walking (3-4 miles per hour, or a mile in 15 to 20 minutes), cycling, swimming slowly, and golfing without a cart. A vigorous level of exercise includes tennis, fast cycling, skiing, and jogging.
How much exercise do most of us need? The U.S. Surgeon General, Centers for Disease Control and Prevention, and the American College of Sports Medicine all recommend that you get moderate exercise on most days of the week for at least 30 minutes. You can do all 30 minutes at once or break it up into 10 to 15 minute periods. Keep in mind, however, that 30 minutes of moderate-intensity activity is an excellent starting point, not an upper limit. Exercising longer, harder, or both can bring greater health benefits.
Strength training, also known as weight training or resistance training, includes any workout that uses resistance – like weights – to strengthen and condition the musculo-skeletal system. It includes weight lifting, resistance band workouts, cycling, climbing stairs, and pushups. These types of exercises can improve coordination, balance, and muscle strength. These are precisely the skills that older people need to help maintain their ability to perform functional tasks such as walking, rising from a chair, climbing stairs, and carrying groceries. Finally, don’t forget your bone health: weight-bearing exercise has been shown to help fight osteoporosis.
Let me leave you with some tips to help include exercise in your life:
-Make it fun! Try a new sport like tennis or rollerblading. The more you enjoy exercise, the more likely you are to stick with it.
-Make it sociable. Walk with a friend, your spouse, or your family in the morning or evening.
-Keep an exercise log. It will help to make you more accountable.
-Use 20 minutes of your lunch hour to take a walk.
-We can’t all afford a full-time personal trainer! Try hiring one for a session or two to help you plan your weight and flexibility training. Use their expertise to give you the confidence you’ll need to continue on your own.
-Whenever possible, use the stairs instead of elevators and escalators.
-Park your car or get off your bus a stop or two before your final destination. Walk the rest of the way!
-Consider buying a piece of cardiovascular equipment for your home such as a treadmill, bike, or elliptical machine. Then, don’t use it as a clothes rack.
-Combine normal activities with cardiovascular exercise. Get on your home equipment while watching TV, reading the newspaper or returning phone calls.
-If you have not been exercising up until now, PLEASE consult your physician before beginning.
-And remember, ANY increase in physical activity will improve your health. Your body will thank you.
Pyramid
November 21st, 2009More than a decade ago, the U.S. Department of Agriculture created a powerful and enduring icon – the Food Guide Pyramid. Virtually all of us remember being taught what a healthy diet was at school, in countless media articles, and of course on cereal boxes. However, science has recently concluded that the information embodied in this pyramid doesn’t point the way to healthy eating after all. Faculty members in the Harvard School of Public Health have now built a new pyramid, the Healthy Eating Pyramid. This takes into consideration the wealth of research conducted during the last ten years about healthy eating.
The Healthy Eating Pyramid literally rests on a foundation of daily exercise and weight control. These two related elements strongly influence your chances of staying healthy.
Let’s take a look at the specific recommendations:
-Whole Grain Foods (at most meals). The body needs carbohydrates for energy. The best sources of carbohydrates are whole grains such as oatmeal, whole-wheat breads and pasta, whole grain cereal, and brown rice. The body doesn’t digest whole grains as quickly as highly processed carbohydrates such as white flour. Slower digestion prevents blood sugar and insulin levels from rising and falling too quickly. Better control of blood sugar and insulin can keep hunger at bay.
-Plant Oils. The Healthy Eating Pyramid puts some fats near the base, indicating that they are okay to eat. The average American gets one-third or more of their daily calories from fats. Specifically mentioned are plant oils, but not other types of fat. These plant oil fats include olive, canola, soy, corn, sunflower and peanut as well as the fatty fish salmon. These healthy fats improve cholesterol levels and protect the heart.
-Vegetables (in abundance) and Fruits (2 to 3 times per day). A diet rich in fruits and vegetables can decrease your chances of having a heart attack or stroke, lower blood pressure, and be protective against many other diseases.
-Fish, Poultry, and Eggs (0-2 times per day). A wealth of research suggests that eating fish can reduce the risk of heart disease. Chicken and turkey are also good sources of protein and can be low in saturated fats. Eggs, which have long been demonized because they contain fairly high levels of cholesterol, aren’t as bad as they were once cracked up to be. Egg whites are a good alternative for fat-conscious eaters.
-Nuts and Legumes (1 to 3 times per day) Nuts and legumes are excellent sources of protein, fiber, vitamins, and minerals. Legumes include black beans, navy beans, soy beans, and garbanzo beans. Many kinds of nuts contain healthy fats, and packages of some varieties (almonds, walnuts, pecans, peanuts, hazelnuts, and pistachios) can now even carry a label saying they are good for your heart.
-Dairy or Calcium Supplements (1 to 2 times per day). Building bones and keeping them strong requires calcium, vitamin D, and exercise. Dairy products have traditionally been Americans’ main source of calcium. However, you will want to look for healthy ways to get calcium which aren’t necessarily from whole milk and cheese (which can be loaded with saturated fat). Three glasses of whole milk, for example, contain as much saturated fat as 13 strips of cooked bacon! If you enjoy dairy foods, try to stick with no-fat or low-fat products. If you don’t like dairy products or are lactose intolerant, calcium supplements offer an easy and inexpensive way to get your daily calcium.
-Red Meat and Butter (use sparingly). These sit at the top of the Healthy Eating Pyramid because they contain a lot of saturated fat. If you eat red meat every day, switching to fish or chicken several times a week can improve your cholesterol level. So can switching from butter to olive oil, or plant oil based margarines.
-White Rice, White Bread, Potatoes, White Pasta, Soda, and Sweets (use sparingly). Note that some of these all-American staples have moved all the way from the bottom of the old pyramid to the undesirable top of the new Healthy Eating Pyramid! Why? They can cause rapid changes in blood sugar that can lead to weight gain, diabetes, heart disease, and other chronic disorders. On the other hand, whole-grain carbohydrates cause slower, steadier increases in blood sugar that don’t overwhelm the body’s ability to handle these much needed carbs.
-Multiple Vitamin. A daily multivitamin offers a kind of nutritional backup. While it doesn’t in any way replace healthful eating, or make up for unhealthful eating, it can fill in the nutrient holes that may sometimes affect even the most careful eaters. You don’t need an expensive name-brand or designer vitamin; a standard, store brand meets the requirements of the US Pharmacopeia.
-Alcohol (in moderation). Lucky for us, scores of studies suggest that having a glass of wine at dinner can lower the risk of heart disease. Moderation is clearly important, since alcohol has plenty of risks as well as benefits.
Does a careful diet work? When studied by the Harvard School of Public Health, men who most closely followed the diet were 20% less likely to develop a major chronic disease and were 40% less likely to develop heart disease. Women reduced their risk by 11% of contracting a major chronic disease and lowered their risk of heart disease by almost 20%.
This is a lot of information to digest. As always, let me leave you with some simple clear recommendations:
-Emphasize fruits, vegetables, whole grains. These foods are rich in nutrients and fiber
-Consume fat-free or low-fat milk and other dairy products
-Include lean meats, poultry, fish, beans, eggs, and nuts
-Avoid saturated fats, trans fats, cholesterol, salt (sodium), and foods containing refined sugar
Bon appetit!
Diet
October 10th, 2009Try taking two vegetarians out to lunch and see if they can agree on what to order. It’s quite possible that the diets they follow differ substantially.
Today’s column will be another (probably welcome) change from some of our more serious topics. Discussions about diet so far have talked about the full range of foods available to us: which ones to avoid, which ones to focus on, and which ones to limit. Some people begin this process already defining or limiting what they are willing to eat. Today I will define for you the vegetarian, vegan, macrobiotic, and raw diets.
Vegetarian diets include lacto-ovo-vegetarian (includes both dairy products and eggs, and is the most common), lacto-vegetarian (includes dairy but not eggs), and vegan. Vegan diets do not include dairy products, eggs or any other animal products.
Veganism, often referred to by its followers as strict or pure vegetarianism, is based on a philosophy and lifestyle that excludes the use of animals for food, clothing or any other purpose. Vegans do not use or consume meat, fish, poultry, eggs, or other dairy products. Some of the most common reasons for practicing a vegan lifestyle include ethical concerns for animal rights or the environment, perceived health benefits, and spiritual or religious concerns.
The standard American diet is high in fat and low in fiber and vegetables. It is now widely recognized that this is not a healthful diet! Vegetarians and especially vegans avoid consuming artificial substances such as growth hormones and antibiotics, which are given to farmed animals in some countries. Also, diets that avoid meat tend to have lower levels of saturated fat, cholesterol, and animal protein, and higher levels of carbohydrates, fiber, magnesium, potassium, folate, antioxidants, and phoytochemicals. People who avoid meat are reported to have lower body mass than those following the average diet. As a result, we see lower death rates from heart disease, lower cholesterol levels, lower blood pressure, and lower rates of hypertension, type 2 diabetes, and stroke.
It’s not easy to get all of the proper nutrients while observing a vegetarian diet – proper planning is necessary to avoid deficiencies in Vitamin B12, Vitamin D, calcium, iodine and omega-3 fatty acids. Vitamin and mineral supplements are especially recommended for vegan diets.
The macrobiotic diet is a dietary regimen that involves eating grains as a staple food supplemented with vegetables, brown rice, seaweed, beans and bean products, fish, soy products, seeds, nuts and fruit. Macrobiotics dates back to the time of Hippocrates. Ohsawa, a Japanese philosopher, formalized modern day macrobiotics. He brought his macrobiotic teachings to North America in the late 1950′s. Followers of the macrobiotic approach believe that food and food quality powerfully affect health, well being, and happiness. The macrobiotic approach suggests choosing food that is less processed and more natural, combined into meals according to the principle of balance known as yin and yang. Since Japan is the cradle for contemporary macrobiotics, followers of this diet often use Japanese ingredients. However, the philosophy of macrobiotics suggests that people should use foods grown and found locally. This diet also addresses the method of eating. One should eat until full, chew well before swallowing, and avoid sugar, coffee, and all processed and non-ecologically produced food. You can see how this set of recommendations very closely matches up with the ideal diet outlined in our previous articles. More details such as time of year, method of food preparation, age, sex, health conditions, etc. are also part of this diet and will not be covered here.
It is interesting to note just how similar the macrobiotic and vegetarian diets are. They differ in that the macrobiotic diet may include fish, and pays special attention to the preparation of food and the principle of balance (yin and yang). As with vegetarianism, critics state that certain nutrients may be deficient, so proper planning and vitamin supplements are important.
Finally, let’s take a look at raw foodism. This is a movement promoting uncooked, unprocessed, and often organic foods as a large percentage of the diet. A raw food diet consists fully of foods which have not been heated above 92 to 118 degrees, depending on the food. Raw foods may include fruits, vegetables, nuts, seeds, whole grains, eggs, fish, meat and un-pasteurized dairy products such as raw milk, cheese, and yogurt. A raw foodist consumes primarily raw food, or nothing but raw food. They believe that the greater the percentage of raw food in the diet, the greater the health benefits, and that raw food prevents and or heals many forms of illness and chronic diseases. Freezing food is generally considered acceptable. Some people believe that prehistoric humans were largely vegetarians, and thus the ideal for the human digestive system is raw vegetarianism. Those who follow this diet believe raw foods contain enzymes which aid in digestion. When these enzymes are destroyed by the cooking process, digestion becomes more difficult. Raw foods also contain bacteria and other micro-organisms that stimulate the immune system. Raw foods have higher nutrient values than cooked foods. The benefits of the diet are said to include a stable body mass, clear skin, more energy, and minimizing a range of common illnesses.
As you can see, there is a vast diversity in the types of diets people choose to follow. Eat healthfully in whatever manner supports your own health and personal beliefs.
As always, I wish you good health.
Computers
October 10th, 2009Can you remember when you first used one? They have become a big part of our everyday life. We communicate with loved ones and friends on them, we shop with them, buy stocks with them, conduct research with them, and do homework on them. We play games and meet new friends; even future spouses. Computers. They have revolutionized our lives in more ways than we will attempt to address in this column. Are they a blessing or a curse? Given that we spend so much time in front of them, are there health consequences that we should be aware of?
When I was a child, playtime meant going into the front yard with a sibling or a friend, and generally a ball was involved. Games were on boards or with cards, and required the players to spend time together…in the same room. We met new friends at our homes, while participating in activities, and at school. It’s now clearly a different world, and we’re certainly not returning to the way things were. We now spend a great deal of time sitting in front of a computer, and this has lead to a major new body of research on RSI (Repetitive Strain Injuries). How do you know if you are suffering from computer-related RSI? Here are the most common symptoms:
- Tightness, discomfort, stiffness, soreness or burning in the hands, wrists, fingers, forearms, or elbows
- Tingling, coldness, or numbness in the hands
- Clumsiness or loss of strength and coordination in the upper extremities
- Feeling the need to massage your hands, wrists, and arms
- Pain in the upper back, lower back, shoulders, or neck.
What causes these symptoms, and what can we do about them?
Consider the chair on which you may spend hours every day. Lower back pain can be a consequence of using a chair with no separate back to adjust for lumbar support, or no arms to adjust for height. Don’t sit on the edge of the seat and lean forward, and never cross your legs. Have your keyboard positioned centrally in front of you. A chair seat that is too long can put pressure behind the knees, causing rear pain radiating from the thigh. Are your feet resting firmly on the floor? If not, try a footstool.
Working in a cold room can cause muscle spasms. If your drink of choice is coffee or tea, you might suffer from dehydration and loss of potassium, another source of muscle spasms.
Neck pain is a common side effect of working on the computer. Is your screen positioned too high? Your head and neck should be fairly straight, with your gaze at a slightly downward angle when viewing the screen. Take frequent posture breaks to prevent overusing one group of muscles. Is your telephone tucked under one ear? Try using a head set to give those muscles, tendons, and vertebrae some relief.
Painful wrists and fingers can be another source of problems. Does your desk have edges that push into your wrists and impede circulation? A gel wrist guard can be used for protection. Wrist and finger pain can also result from the wrong chair height: the height should allow for a perfect L-shape between the shoulder, elbow and wrist. If your chair has arm rests, adjust them to preserve this L-shape. Your wrists should be fairly straight, with the fingers horizontal to the keyboard. Relax, and strike the keys gently.
Do you have a dirty mouse? (!) Dirty mice result in unnecessary repetitive actions, which can lead to overuse syndrome. Research has shown that overuse of the mouse is more likely to cause painful symptoms than is typing on the keyboard. Place your mouse directly in front of your shoulder, and consider alternatives to the traditional mouse, including optical mice, tracker balls, joystick (eraser head) mice and touch pads.
Many computer users suffer from eyestrain and resulting headaches. These might be the consequence of glare from the monitor or overhead lights. Your desk should be placed between lights and not directly under them. If your light is directly overhead, try turning it off and using a lamp instead. Eyestrain may also result from window glare – experiment by closing those blinds. Clean your screen, adjust the contrast or brightness, and don’t sit too far back. If problems persist, have your eyes examined, tint your glasses, or try a larger and brighter monitor.
What about the affects of radiation on health? Computer screens, like television screens, emit radiation called VLF and ELF (very low frequency and extremely low frequency). While nothing has been proven, for now common sense tells us not to over-expose our bodies. It is interesting that more radiation is actually emitted from the sides and rear of the screen than from the front! A wise rule would be to keep a safe distance (more than 24 inches) from the front, sides, and back of your monitor, and from any other monitor in the room. Also of interest is that computers continue to emit radiation for a few hours after turning them off, so if your computer is in your bedroom, make sure that it sits at least 24 inches from your bed. Keep in mind that laptop technology is different: instead of CRT (cathode ray tube) monitors, they use liquid crystal monitors, which do not emit radiation. Flat screen monitors can also be a good alternative, as they also emit much less radiation.
Finally, I have not addressed the incredibly complex psychosocial issues that arise when we spend less and less time interacting with our fellow humans and more and more time behind a computer screen. I’ll address this issue in the future. For now, strive to keep balance in your life.
As always, I wish you health. Happy surfing!
Jennifer – the following paragraph is in response to the e-mailed question that you received from a reader. Since you didn’t print a letter, I don’t think that this needs to appear in the paper, but would you like to email this response directly to the person who emailed the question?
…what is a “nalgene-type” bottle? This polyethylene plastic material was first used in the laboratory. It was then popularized by the Boy Scouts, and now is in common use in summer camps, among backpackers, and the general public. It is virtually indestructible and does not react to heat. It is, therefore, a perfect water bottle.
Dizziness
October 7th, 2009Have you ever visited your doctor complaining of dizziness? Dizziness is a common description for many different sensations. It can be quite mild or extremely debilitating. You might feel light-headed, faint, weak, confused, tired, woozy, giddy, fuzzy, helpless, off-balance, wobbly, or that the room is spinning or twirling around. It might be accompanied by nausea and vomiting. Medical terms for dizziness include vertigo, disequilibrium, or pre-syncope.
Dizziness accounts for more than seven million doctor office visits per year in the United States. It is painless discomfort in the head with many possible causes, and patients are often left dissatisfied with treatments offered. This is because the cause of the dizziness is often not clear, making it difficult to arrive at the correct treatment. However, it is most often a benign and self-limiting disorder; that is, it typically goes away by itself!
What, then, are some causes of dizziness?
- Lightheadedness is the result of too little blood reaching the brain. This occurs with sudden drops in blood pressure; dehydration from diarrhea or vomiting; getting up suddenly from a laying or sitting position leading to a temporary drop in blood pressure; fever; spending too much time in the heat, or lack of fluid consumption/replacement; and musculoskeletal problems, especially focused in the neck.
- Low blood pressure can cause dizziness. This can be caused by multiple conditions (including those mentioned above), ranging from diseases of the heart such as bad heart valves, weak heart muscles or bad heart rhythms; brain disorders such as tumors; hyperventilation from various causes – both physical and emotional; gastrointestinal disorders leading to bleeding that causes anemia; and adverse reactions to medications.
- Ménière’s Disease is a condition that causes fluctuating pressure of the inner ear fluid and results in severe vertigo (dizziness), ringing in the ears, and progressive hearing loss.
Your doctor’s exam for dizziness will begin with detailed questions in an attempt to pin down the cause. Your description will be the most critical step in reaching a diagnosis. A detailed physical exam will start with blood pressure and pulse readings, and will include careful neurological testing such as checking your muscles, senses and gait (walking). Tests may include a brain MRI, EKG of the heart, or blood tests for anemia, diabetes, hypoglycemia, sodium, potassium and vitamin B-12.
Treatment for dizziness will vary, depending on cause. If your complaint is of dizziness when standing, or low blood pressure when standing, the cause is likely dehydration, and the answer can be as simple as increased fluid intake. Certain medications (like diuretics) cause loss of fluids and may need to be stopped. Blood pressure medication can lead to dizziness and may need to be decreased or stopped. If your complaint is poor balance, the problem might lie in the middle ear and the vestibular system. The goal of treatment will be to minimize vertigo and prevent falls, and some types of physical therapy, known as vestibular rehabilitation therapy, may be useful. Often, doctors find no specific cause and simply treat the symptoms with medications like Antivert or Meclizine.
If you find yourself suffering from dizziness, your first simple home remedies will be to drink plenty of water to prevent dehydration, eat frequent meals to prevent hypoglycemia, and move to a standing position more slowly. When, however, should you seek help from your doctor? There are dangerous and life-threatening diseases that can begin with symptoms of dizziness. Here is what you should look out for:
- Any severe first-time imbalance or dizziness
- Dizziness without a cause
- Dizziness after taking newly-prescribed medication
- Any change in an established pattern of dizziness
- Dizziness that is accompanied by loss of neurological function, including loss of strength, feeling, speech, or consciousness. If this is the case, call an ambulance.
I hope that you enjoyed your summer. As always, I wish you continuing good health!
Dementia
October 7th, 2009Does Grandma keep asking the same question over and over? Does Grandpa appear confused and disoriented? They are most likely suffering from dementia, which is the progressive decline in mental function beyond what might be expected from normal aging. This ultimately results in the limitation of daily activities, and in the long term, the need for full-time care.
Dementia usually appears later in life, most often after the age of 65. The frequency of dementia increases with age, with an incidence of less than 2% for ages 65-69, 5% for ages 75-79, to more than 20% for ages 85-89. By the time we reach age 90, our odds of developing dementia rise to one in three, and half of those 1/3 suffer from Alzheimer’s.
Dementia is not actually a disease, but rather a group of symptoms. It affects the areas of the brain involved with learning, memory, language, and decision-making. What are the most important early indications of dementia?
- Forgetfulness
- Difficulties with familiar activities
- Language problems
- Problems with spatial and temporal orientation leading to confusion about one’s whereabouts, or the time or date
- Impaired capacity for judgment
- Problems with abstract thinking
- Tendency to leave things behind
- Mood swings and behavioral changes
- Personality changes
- Loss of initiative
There are several causes of dementia:
- Diseases that cause degeneration or loss of nerve cells in the brain, which include Alzheimer’s, Parkinson’s and Huntington’s
- Diseases that affect blood vessels, such as stroke, which can cause multi-infarct dementia
- Toxic reactions, including those caused by excessive alcohol or drug use
- Nutritional deficiencies, like vitamin B 12 and folate deficiency
- Infections that affect the brain and spinal cord, such as AIDS dementia complex and Creutzfeldt-Jacob disease (a close cousin of Mad Cow Disease)
- Hydrocephalus (an accumulation of fluid in the brain)
- Brain tumors
- Head injury – either a single severe head injury or longer term smaller injuries such as those accumulated by professional fighters
- Illness in organs other than the brain, such as kidney, liver and lung disease
While dementia’s most common cause is Alzheimer’s disease, there are at least 50 other causes. Some of the ones noted above can be cured or partially treated, so it is important not to miss a potentially treatable condition. These are known as pseudo-dementia (false dementia), and 10% of dementia cases fall into this category.
Alzheimer’s disease causes over half of all cases of dementia. The physician Alois Alzheimer first described the disease that bears his name in 1907. The most common known symptom is confusion. This may cause estrangement from loved ones and unpredictability. Confusion may be short term, triggered by a hospital stay or other trauma in one’s life. People with Alzheimer’s suffer from problems with concentration, planning, and judgment. They display personality changes, and eventually perceptual, speech, and walking disorders, and loss of control over bodily functions. They lose their independence in managing everyday life. They become more and more dependent on care, and inadvertently place tremendous hardships on family and loved ones, straining both emotional and financial aspects of their life.
Sadly, dementia caused by Alzheimer’s disease is increasing faster than all other types of dementia. The cause of Alzheimer’s disease is unknown, but the result is the destruction of nerve cells in the brain. Losing nerve cells during aging is normal, but this loss occurs much more rapidly in Alzheimer patients.
The physician makes the diagnosis of dementia clinically. While there are no formal tests to confirm the diagnosis, a diagnosis can be given through use of a questionnaire called the Mini Mental Status Examination (MMSE). More formal mental status assessments are also available.
Unfortunately, in most cases true dementia is incurable. At this time, the best we can do is to prevent it from developing in the first place, and the best way to do that is to live an active life, both mentally and physically. Controlling hypertension and diabetes are important. There are prescription medications that appear to slow down the process of dementia, such as Aricept, Exelon, Razadyne, or Namenda. Gingko biloba, an herb purchased without prescription, appears to help the function of memory as well.
In parting, I try to leave my readers with specific instructions and hope. Unfortunately, for this condition, no specific causes have yet been confirmed. Theories come and go through the years, but none have been proven. Remember, however, that keeping your mind and body active makes a real difference. Some causes of dementia are treatable, and I am confident that rapid advances in medical treatment and overall understanding of the disease are occurring. There are many resources in the community, including daycare, caregiver education, and in-home support, that can help with the burden of dealing with dementia. Locally, we are fortunate to have Rancho Los Amigos Hospital as one of those outstanding resources. Consult your physician, and don’t lose hope.
Hand Washing
October 4th, 2009What is the simplest way to avoid getting sick? Wash your hands!
Despite the proven benefits, you will be shocked at how many people don’t perform this simple act regularly. The American Association for Microbiology conducted both a telephone and public restroom observational study in 2000. 95% of Americans stated by phone that they washed their hands regularly. When nearly 8,000 subjects were observed in a restroom (don’t ask how they did this!), 67% of them actually washed their hands. Breaking down the data further, 75% of females and 58% of males washed. Chicago had the most hand washers at 83%, and New York had the fewest at 49%. In another study, middle school kids in Minnesota were observed, and 33% of the girls and 8% of the boys used soap while washing their hands.
Where do we pick up germs? Germs accumulate on our hands by touching people, surfaces, sponges, pens, foods, animals, doorknobs, railings, elevator buttons, books, money, and even the towel you use to dry your clean hands. We spread germs by touching our own eyes, nose, and mouth, as well as by touching others with contaminated hands. Infectious diseases such as the common cold, flu, many viral illnesses including hepatitis A, and other intestinal diseases are commonly spread through hand-to-hand contact. Improper food handling also contributes to food-related illnesses, such as salmonella and E coli infections. As many as 76 million Americans contract a food-borne illness each year.
Let’s talk about a typical fellow who uses a public restroom. He opens the bathroom door with a bare hand, and already he has more germs on that hand then before. He uses the toilet and then reaches for the lever to flush. This too is loaded with germs, and now it also contains the ones he just added. This is repeated when he turns on the faucet at the sink. He then likely washes his hands for a few seconds – probably without soap. Then he turns off the water, using his sort-of washed hands. He dries his hands off with a paper towel and leaves the bathroom, reaching for the interior door handle with his bare hands again.
So what is the proper way to wash your hands? You must use soap and water or an alcohol-based hand sanitizer. Antimicrobial wipes are just as effective as soap and water but are not as good as alcohol-based sanitizers. Antibacterial soaps have become popular lately, but have not been shown to be more effective, and may in fact be detrimental (more on this later). It is the process of scrubbing your hands with soap and then rinsing them with water that loosens and removes bacteria from the hands.
- Using warm water, wet your hands thoroughly, including the palms, back of the hands, and wrists. Nails are another source of potentially harmful germs.
- Apply liquid or clean bar soap to the palm of your hands and lather well
- Rub your hands vigorously together, cleaning palms, fingers, between fingers, the back of hands, thumbs and wrists for at least 15-30 seconds
- Thoroughly rinse off soap
- Some experts recommend turning the tap off with elbows or using a paper towel – especially if it you are in a public restroom
- Dry your hands with a clean or disposable towel and wash reusable towels often, especially if they are shared with others
When should you wash your hands? Although it is not always possible to keep your hands germ-free, and arguably not even desirable to, there are critical times when you must be sure to wash your hands in order to limit the transfer of bacteria, viruses, and other microbes. (Note that the point of hand washing isn’t necessarily to remove the dirt that you can see. These germs that can make you sick are invisible.) Here are some times to always wash your hands:
- After using the toilet
- After changing a diaper
- After touching animals or animal waste
- Before and after preparing food, especially when handling raw meat or fish
- Before eating
- After blowing your nose
- After coughing or sneezing into your hands
- Before and after treating wounds or cuts
- Before and after touching a sick or injured person
- After handling garbage
- Before inserting or removing contact lenses
- When using public restrooms
But let’s pause to discuss why it is important to not be obsessive about hand cleaning. First of all, there are actually good germs on and in the body that protect us. Some of them help digest food; others help maintain defenses against and compete with more harmful germs on the skin. Further, anti-bacterial soaps may ultimately lead to the death of some friendly or necessary germs, which can lead to the reproduction of more dangerous germs.
Hand washing doesn’t take much time, effort, or expense, but it offers great rewards in terms of prevention. Help your children and yourself avoid getting sick by washing hands and using soap. Without soap, we are simply rearranging the germs on our hands. Teach by example! Make it a priority to always wash your hands and protect your health and the health of people around you.
Ice or Heat
October 4th, 2009Ice, or heat? How many times am I asked this question? This simple issue continues to be hotly debated among experts. Here’s the latest consensus.
Injuries vary, and time to heal may naturally range from days to months. When pain is not improving, or when there is an obvious fracture or serious injury, you will need to see a doctor. However, for simple sprains, strains and other minor injuries, you will likely treat it yourself with heat or ice. How do you choose?
Cold decreases blood flow, lessens inflammation, and blocks pain by numbing. Heat increases blood flow, increases elasticity of tissue, decreases stiffness, relaxes muscles, and promotes healing.
When injuries are new, and there is swelling present, immediate use of ice is the best choice. Fractures, sprains and even muscle spasms benefit highly from the speedy application of a cold compress. Swelling and inflammation are the result of blood leaking into ruptured capillaries. When you apply ice to an injured area, you help to constrict the blood vessels, thereby restricting the flow of blood and reducing the amount of blood and fluid that leak into the tissue.
Consequently, ice is effective in reducing bruising, reducing pain and swelling, and should be used for the first 48 to 72 hours or until the swelling has gone away. For example, if you sprained your ankle five days ago and there is still swelling, you should still use ice. Some injuries come from overuse. For example, you may have pain in your knees after skiing, or in your elbow after playing tennis. Use ice after activities that cause discomfort.
Ice packs can be made by placing ice cubes or crushed ice into a zip lock bag, or by using a frozen gel pack. The length of time you apply cold to a wound is important. Ice compresses should be applied to swollen or new injuries for about 15 to 20 minutes and then off for 30 minutes. You may do this as often as possible.
What are the precautions to consider when using ice?
- Do not place ice directly on the skin; always place a towel, washcloth, or piece of fabric over the skin before applying ice. Never leave ice on the skin for more than 20 minutes. Frostbite may occur; the skin and tissue underneath (muscle, nerves, and fat) may be injured, either temporarily or permanently. Certain parts of the body (the elbow, outside of the knee, and outside of the foot) can be injured by cold more easily because they do not have as much padding or insulation.
- Do not apply ice prior to workouts or athletic events. Cold works to restrict circulation to injured areas, which is why it is be used after exercise to reduce swelling or pain.
- Do not use ice if it produces welts or a rash. You can actually be allergic to it!
- Stop using ice if you experience tingling or burning radiating into fingers or toes that are not actually in contact with the ice.
- Never apply ice directly over the eyes.
What about heat? Heat can reduce muscle spasms, improve joint stiffness, and make soft tissue more limber. Heat is used to help loosen tight muscles and joints during warm-ups. Examples of this include using moist hot packs on tight leg muscles before a run, or on a shoulder before a baseball game, or on chronically tight back or neck muscles. Heat is used for stiff muscles and joints in order to make them more limber.
Moist heat is more effective than dry heat, as it penetrates deeper for muscles, joints, and soft tissue. It should be used for 15 to 20 minutes, or longer if recommended by your doctor. Towels soaked in hot water or warmed in a microwave are useful, but usually lose their heat within five to ten minutes. Commercial moist heat packs are convenient and provide longer therapy. Hot tubs or whirlpools are useful. Ultrasound is a form of deep heat that is used by therapists and trainers. Heat creams and ointments are popular; while they do not provide very deep heat into muscle tissue, the massaging effect of applying the cream is helpful.
What are the precautions to remember when using heat?
- A heat pack should feel warm but not hot; you can get burned.
- Spending too much time in a hot shower or hot tub can lead to dizziness, nausea and loss of consciousness. Don’t sit in hot tubs without supervision.
- Heat increases blood flow to an injury. It is important not to use heat in the first few days after an injury or while an injury still has any swelling.
Use these quick and simple guidelines regarding ice and heat:
- Use ice immediately after an injury, after activity or competition when you have a chronic injury, after rehabilitation exercises for an injured area, and whenever there is pain or swelling after activity.
- Use heat for tight muscles before stretching or participating in an activity or competition, as long as the injury is not acute (the first three to four days) and is not swollen.
- As always, discuss any questions or concerns with your doctor.
I wish you safe exercise, and when necessary…rapid healing!
Flu Vaccines
September 13th, 2009Everyone knows that the flu season will soon be upon us. The news about the H1N1 Swine Flu and just how serious an epidemic we may face this fall is relentless. So far, swine flu is not much more threatening than regular seasonal flu. However, more people are susceptible to it because it’s new, and we lack immunity to the strain. ´An ounce of prevention is worth a pound of cure, Ben Franklin said. How do we avoid the flu when one in four Americans is expected to become infected during this flu season? What can we do to protect ourselves?
Vaccinate: Vaccines are the most powerful public health tool for the prevention of the flu. Government agencies are working closely with manufacturers to develop a Swine Flu vaccine. The new vaccine is expected to be ready for the fall, but no specific date has been announced. This year’s regular flu vaccine does not include the H1N1 strain, but since multiple strains of the flu are expected, it’s important to get both types of vaccines. (If you received the Swine Flu vaccine of 1976, note that the current virus is different enough that you will need a new vaccination.)
It is important that specific groups be vaccinated just as soon as the vaccine is available. Immunity may take some time – you will not be protected immediately, and it is likely that two shots will be necessary. The CDC (Center for Disease Control) target groups include:
•anyone under the age of 25, but over six months old;
•25 to 64 year olds who are at higher risk because of chronic health disorders such as asthma, diabetes, and heart disease, or compromised immune systems;
•pregnant women;
•people who live with or care for children under six months old; and
•those who work in healthcare or emergency medical services.
While the swine flu epidemic has so far focused primarily on the young, it is often the elderly who also have asthma or other chronic lung disease, heart disease, and/or diabetes. Therefore, as is usually the case for flu vaccines, many over the age of 65 should be vaccinated. Also note that the vaccine is being recommended for pregnant women, and I am watching the literature to ensure that initial tests will confirm that it is safe.
It’s possible that there will initially be a shortage of supplies, but five different companies are working hard to meet the expected demand. The vaccines will likely be available from the government at no cost. It is likely that you will be given this vaccine, not from your doctor, but rather from centralized distribution centers in your community.
Treat your symptoms: Antiviral drugs (such as Tamiflu) are used to treat the flu and work by preventing the viruses from reproducing in the body. They are prescription medicines and come in different forms including pills, liquid and an inhaled powder. If you get sick, antiviral drugs can make your illness milder, make you feel better faster, and help to prevent serious complications. However, these antiviral drugs have been overused in many who probably did not actually have H1N1. The over-prescribing of any infection medication can lead to the development of resistant strains of the virus. In the coming epidemic, antivirals are likely to be more tightly controlled. They will be available and effective for those with severe illness or documented swine flu.
Control the Spread: The flu, like other respiratory diseases, is spread from one person to another. Droplets from the nose and mouth of an infected person land on surfaces or directly enter another ´host.¡ Here are some specific tips to remember:
•Hand washing is especially important during pandemics, both for the healthy and for the ill. Wash your hands frequently, using soap and water, or an alcohol-based hand sanitizer. (An antibacterial soap is no better than regular soap, since a virus, not bacteria, causes the flu.) Washing without soap does not help!
•Avoid making contact with potentially infected surfaces (e.g., door knobs, railings, desk tops, elevator buttons, telephones, etc.).
•Frequently clean surfaces where germs can sit, using an antiseptic wipes.
•Even when you’re careful, germs end up on the hands. Avoid putting your hands anywhere near your eyes, nose or mouth.
•Do not directly share food with others, and avoid shared serving utensils.
•Stay home if you get sick, and limit contact with others. This fall and winter will be good times to purposely avoid crowds or gathering places.
•Keep tissues on hand. Cover your mouth and nose when coughing or sneezing with either a new tissue, or with the crook of the elbow or upper arm and shoulder. Do not use your hands, because that will spread your own germs. Throw the tissue away after using it once.
•See your physician early if you should become ill with flu-like symptoms, which include fever, cough, headache and bodyache.
As always, be well, and please take extra precautions during this upcoming flu season!
Antioxidants
September 13th, 2009Can we prevent or delay diseases of aging? We know that fruit, vegetables, and whole grains are good for us. It is becoming clear that these foods, as part of an overall healthful diet, have the potential to delay the onset of many age-related diseases. Current research is attempting to identify specific bioactive components in foods, including antioxidants.
Foods rich in antioxidants are often easy to identify by their bright and distinctive colors – the deep red of cherries and tomatoes; the orange of carrots; the yellow of corn, mangos, and saffron; and the blue-purple of blueberries, blackberries, and grapes. Foods with the strongest antioxidant activity are rich in components including vitamins A, C, and E; the mineral selenium; and the carotenoids.
An antioxidant is a molecule capable of slowing or preventing the oxidation of other molecules. Oxidation is a chemical reaction that transfers electrons from one molecule to another. Oxidation reactions can produce free radicals, and it is free radical damage that is thought to contribute to the cell damage and body-wide deterioration that accompanies aging.
For example, recent studies have shown that LDL cholesterol, the so-called “bad” cholesterol, is changed through oxidation from a form that circulates freely in the blood to a form that clogs the walls of arteries. Antioxidants stop these chain reactions. Although oxidation reactions are crucial for life, they can also be damaging. Antioxidants may prevent the formation of these free radicals before they can react and cause harm.
Oxidation is likely involved with age-related diseases such as cancer, cardiovascular disease, Alzheimer’s Disease, immune dysfunction, cataracts, and macular degeneration.
Unfortunately, it is still unclear whether oxidation triggers, or is the result of, these disease processes.
One thing is certain: Belief in antioxidants has led to an explosion in the production of antioxidant supplements. Millions of people concerned about preventing heart disease, cancer, and other age-related diseases have turned to them in the belief that they will provide protection against both self-inflicted and environmental insults. Many “neutraceutical” and health food companies are now selling supplements containing a wide variety of antioxidants in a great variety of doses. Although antioxidant vitamins and minerals are required for good health, we don’t actually know whether the beneficial effects of fruits and vegetables and grains are related to their antioxidants, or to other properties of these foods. Research is just not conclusive as to whether supplementation is beneficial, and if so, which antioxidants, for who, and in what quantities.
In summary:
* Antioxidants obtained from food sources, not supplements, including fruits, vegetables and whole grains, have been proven beneficial in disease prevention. The benefits of antioxidant supplements are not yet well understood.
* Current recommendations by the U.S. government and major health organizations are to consume a varied diet with at least five servings of fruits and vegetables and 6-11 servings of grains (preferably whole grains) per day.
* Consult with your doctor when considering antioxidant supplements.
We are constantly finding that the results of studies and research come back to the same message: eat a sensible and balanced diet of natural foods.
Good health to you all!
Sleep
August 23rd, 2009We spend one third of our lives doing it. The world record for doing it the longest was 14 and a half days straight. They say that some artists in the Italian Renaissance were able to do it for 15 minutes every four hours, for a daily total of one and a half hours! I am referring, of course, to sleep.
Incredibly, the precise function of sleep remains a mystery, and yet it is critical for every normal body function. It is not just something to fill time with when you are inactive; sleep is an active process involving every major organ system. These processes may slow down, but they don’t shut down. Sleep is required for survival; in fact, rats who underwent sleep-deprivation studies died within two to three weeks.
How do you feel when you’re behind on sleep? Lack of sleep has been associated with difficulty concentrating, memory lapses, loss of energy, fatigue, lethargy, emotional instability, dangerous driving, workplace accidents, poor school performance and even difficulties with relationships. A large percentage of our population appears to have a problem with sleep. Researchers have classified more than 70 sleep disorders, the most common of which are sleep apnea, insomnia, narcolepsy, and restless legs syndrome. A very high percentage of those suffering from these disorders remain undiagnosed.
Problems with sleepiness can be deadly. Approximately 100,000 automobile crashes each year are a result of drivers who fell asleep at the wheel. In one survey of drivers in New York State, approximately 25 percent reported they had fallen asleep at the wheel at some point. These types of crashes are especially common among young men; one large study found that in over 50 percent of fall-asleep crashes, the driver was 25 or younger. When clocks are turned back at the start of daylight savings time in Canada, the extra hour of sleep is actually tied to fewer road accidents!
Our lack of information about sleep may be due to the fact that sleep research has only recently gained widespread attention. A great deal remains to be learned through scientific studies, including an answer to the key question: What is the function of sleep? Although the answer remains unclear, research is now providing a glimpse into to what happens in the brain and body during sleep and how the body regulates sleep. Further detail on this will need to remain a topic for a future column.
Losing even one hour of sleep per night has a significant impact on how we function while awake. When we don’t sleep enough, a “sleep debt” develops. Even relatively modest daily sleep loss can accumulate over time. If the debt becomes too great, it can lead to “problem sleepiness”. Although we may not be aware of it, sleep debt can have powerful effects on daytime performance, thinking and mood.
We all know that our bodies do not adjust to different sleep schedules easily. The biological clock that times and controls our sleep/wake cycle will attempt to function according to a normal day/night schedule even if we try to change it. Those who work night shifts naturally feel sleepy when nighttime arrives. Similarly, when we travel across time zones, we experience jet lag.
How much sleep do we need? On average, most adults need seven to nine hours of sleep each night. The amount of sleep needed decreases with age. A newborn baby might sleep for 20 hours a day, and the requirement drops to roughly six hours for elderly people. The problem is that as we grow older, it becomes difficult to get even this reduced amount. That is because the ability to sleep for long periods of time and to get into the deep, restful stages of sleep also decreases with age. Many older people have what is known as “fragile” sleep and are more easily disturbed by light, noise, pain, various health issues…and the need to run to the bathroom.
Try some of these tips to help get a better night’s sleep:
-Exercise regularly (but not immediately before bed). Exercise helps to tire and relax your body.
-Don’t consume caffeine or even sugar after 4:00 PM. This time varies for each of us. Avoid other stimulants like cigarettes as well.
-Avoid alcohol before bedtime. Alcohol disrupts the brain’s normal sleep patterns.
-Allow your body to find a pattern with a regular bedtime and wake up time.
-Try to avoid using your bed for activities other than sleep, such as eating, reading, or watching TV.
-Stress is a major cause of insomnia. Leave your worries behind. Write them down before retiring for bed.
-Counseling and medications may be necessary. Consult with your physician.
I wish you all a good night’s sleep, and pleasant dreams!
Pharmacogenetics
August 23rd, 2009In medicine, one size does not fit all. Two people suffering from the same disease may be given the same drug, yet react quite differently. Pharmacogenetics is the extremely exciting new field of medicine that asks why.
Each of us has a unique genetic make-up. It is this gene variation that can lead to different responses to medication. Pharmacogenetics examines these inherited differences in genes, which then dictate our body’s responses to drugs, and it explores the ways in which these variations can be used to predict whether we will respond well or not to a particular drug. The potential of pharmacogenetics can lead to not only safer drugs, but also will enable physicians to tailor their treatments in a scientifically targeted way to be more successful for each individual patient on the first try.
Why is there a need for such a field? A 1998 study of hospitalized patients published in the Journal of the American Medical Association reported that in 1994, there were 2.2 million cases of serious reactions and 100,000 deaths due to adverse drug reactions. This was not necessarily due to bad medicine. There was and still is simply no good way to predict which drug is most appropriate for each individual case.
How exactly will understanding gene variation be used to predict your response to a particular drug? Currently, scientists are racing to catalog as many genetic variations as possible. 99.9% of all human genes are actually identical. The other 0.1%, making each of us unique, is made up of three million Single Nucleotide Polymorphisms, or “SNP”s. A single SNP is a variation of one nucleotide between the DNA sequences of individuals. Pharmaceutical companies and academic institutions, together with the Wellcome Trust, have set up the SNP Consortium to better understand and compile these variations. It is these variations that are at the heart of understanding any individual’s response to drugs, and therefore SNPs can be used as a diagnostic tool to predict how you or I will react to a given drug.
However, in order for SNPs to be used for this purpose, an individual’s DNA must be examined and sequenced for the presence of specific SNPs. The problem is that currently, this process is slow and expensive. Ultimately, as technology and therefore the cost and efficiency in evaluating SNPs evolves, doctors will be able to sequence a patient’s DNA and look for these SNPs in a quick, affordable, and routine way right in their office. This will give the doctor an indication of a patient’s response to a specific drug, prior to prescribing it.
How will this affect the care you receive from your doctor? In the future, physicians may use “SNP-chips”, tiny microarrays designed to detect your own unique collection of SNPs. Your DNA will be washed over the chip and, with computer analysis, your doctor will know which gene variations you carry, which diseases you are predisposed to, and which medications you may best respond to. So picture yourself one day, possibly soon, entering your doctors office, having a simple, rapid DNA test, and enabling your doctor to select precisely the correct drug the first time, avoiding trial and error, avoiding serious side effects, and helping you get better much sooner.
If this new technology has downside risks, they concern the ethical issues of just who will have access to your DNA code and thus knowledge of your future risk of getting particular diseases. Your insurance company? Your employer? Your government? How about your family, or potential spouse? This raises far too many legal and ethical issues for today’s column…
Welcome to the future of medicine. As always, best of health to you all!
Osteoporosis
August 23rd, 2009One out of every two women over the age of 50 will have an osteoporosis-related fracture in her lifetime. For men, it will be one in four. Just what is osteoporosis, and why does it creep up on us as we age?
Osteoporosis is a disease characterized by low bone density and structural deterioration. Bones become fragile and more likely to break. Osteoporosis is a major public health issue for 44 million Americans. It changes lives forever and is deadly. One in four hip fracture patients, aged 50 or older, die during the year following their fracture. One in five hip fracture patients eventually end up in a nursing home.
Osteoporosis is often called a silent disease because bone loss occurs without symptoms. We may not know that we have osteoporosis until our bones become so weak that a sudden strain, bump or fall causes a fracture, or a collapsed vertebra. (Collapsed vertebra may initially be felt or seen in the form of severe back pain, loss of height, spinal deformities, or stooped posture.) Of the one and a half million fractures that occur every year, 300,000 affect the hip, 700,000 are vertebral (back), 250,000 wrist, and 300,000 affect other sites.
So, who’s at risk? As you look this over, you will find some factors that you can’t do much about, but others which are certainly under your control:
- Women
- Caucasians and Asians (studies show, for example, that Caucasian women age 65 or older have twice the incidence of fractures as Black women)
- Thin people (or those with a small frame, or low bone mass)
- Those with a family history of osteoporosis or fractures among family members after they reach the age of 50
- Older people
- Women with an estrogen deficiency as a result of menopause
- Women with an abnormal absence of menstrual periods
- Sufferers of anorexia nervosa
- Those with a lifetime calcium deficiency
- Those with a vitamin D deficiency
- Users of certain medications such as corticosteroids or anticonvulsant drugs
- Men with low testosterone levels
- Those who follow an inactive lifestyle
- Those with poor nutrition
- Excessive soda drinkers (phosphoric acid binds to calcium, preventing calcium from being available to build bone mass)
- Current cigarette smokers
- Excessive alcohol drinkers
Osteoporosis is detected through a bone mineral density (BMD) scan. This scan can detect osteoporosis before a fracture occurs, predict chances of future fractures, and determine the rate of bone loss. Medicare currently reimburses for a BMD test every two years.
So what is the best strategy for preventing osteoporosis?
- By about age 20, a woman has acquired 98% of her skeletal mass. Building strong bones during childhood and adolescence is the best defense against developing osteoporosis later. It is critical that girls under 20 consume adequate calcium in their diet in order to build up bone density to last for the rest of their lives.
- Consume foods rich in calcium, including dairy products, broccoli, figs, almonds, calcium-fortified orange juice, cereals, and breads.
- Women over age 30 should consider taking calcium supplements (plus vitamin D) of about 500 mg daily. Women over age 40 should increase their calcium supplement to 1,000 mg daily. Menopausal women with osteoporosis need a calcium supplement of about 1,500 mg per day.
- Remember that calcium is easier to absorb when consumed in smaller doses throughout the day.
- Find the calcium supplement that is right for you. No one brand or type of supplement has been shown to be better than another.
- Stay active with weight bearing and resistance-training exercises.
- Refrain from smoking or excessive alcohol consumption.
- In addition to calcium and vitamin D supplements, there are several medications used to treat osteoporosis. Consult with your doctor to see whether you should have a bone mineral density (BMD) scan and whether medication might be right for you.
As always, good health to you all!
Obsessive Compulsive Disorder, or OCD
August 23rd, 2009Do you go to great lengths to avoid stepping on cracks in the sidewalk? Do you wipe the doorknobs in your home each time they’re touched? Do you feel compelled to wash your hands so often that they’ve become raw and chapped?
If you perform such rituals over and over, then you may have obsessive compulsive disorder, or OCD. These ritualistic behaviors can take over your life. OCD is characterized by unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Although the thoughts associated with OCD can be bizarre, it’s their recurrence that creates the distress and anxiety. Performing the ritualistic behavior gives only temporary relief until the next obsessive thought occurs.
OCD is a type of anxiety disorder that is much more common than one would imagine. It affects both adults and children. Studies show it is almost 50% more common in women (2.9% of the population) then in men (2.0%). The onset is usually between the late teens and mid-twenties. It actually appears to be positively correlated with education: more education leads to a higher likelihood of having OCD! Other factors that can increase the risk of developing OCD include:
- Family history – Having parents or other close family members with OCD can increase your risk of developing it.
- Stressful life events – Reacting strongly to stressful events may increase your risk of OCD.
- Pregnancy - Pregnant women and new mothers tend to be at a higher risk for OCD.
Obsessions revolve around fear of contamination or dirt, repeated doubts, having things orderly and symmetrical, and aggressive or horrific impulses. Examples of things you may observe in someone with OCD include:
- Avoidance of shaking hands or touching doorknobs or other objects because of fear of contamination.
- Repeatedly checking that a door is locked or that an appliance or light switch is turned off.
- Intense distress when objects are not orderly, lined up properly or facing the right way.
- Inflamed hands from repeated hand washing.
- Sores on the body from repeated picking at the skin.
Perhaps some of these behaviors sound familiar. How can you tell the difference between someone who refuses to touch a bathroom doorknob (and who would really want to touch a public bathroom doorknob anyway, since such a relatively small percentage of people wash their hands?) and someone with OCD?
Here are some key symptoms of someone with OBSESSIONS in OCD:
- You experience recurrent and persistent thoughts, impulses or images that are intrusive and cause distress.
- These thoughts are not simply excessive worries about real problems in your life.
- You attempt to ignore or suppress these thoughts, images or impulses but cannot.
- You recognize that these thoughts, images and impulses are a product of your own mind.
Here are some key symptoms of someone with COMPULSIONS in OCD:
- You feel driven to perform repetitive behavior such as hand washing, or repetitive mental acts such as counting silently.
- These mental or physical acts are intended to prevent or reduce distress about unrealistic obsessions.
Because the cause is unknown, there is no specific way to prevent OCD from developing. However, getting treatment as soon as possible may help to keep it from worsening. It’s a chronic condition, which means that learning to live with it may be necessary. Keep in mind that psychotherapy as well as medication can help control the symptoms of OCD.
You may wish to note that OCD occurs over a large spectrum, from the very mild to the severe and debilitating. Many very successful and famous people not only survive but thrive with OCD traits. For those of you who read this article and are now worried, take heart that this condition may actually be a contributing factor to your successes in life.
Let me leave you with a list of suggestions:
- Join a support group in order to share experiences with others in similar situations.
- Enlist the support of loved ones (unless they are a cause of your problem!) who can offer encouragement in tough times.
- Remember that if your loved one has OCD, you cannot simply wish or nag away their repetitive behavior.
- Avoid using alcohol or recreational drugs as coping mechanisms.
- Get involved with social activities and community service, instead of isolating yourself.
- Learn about your disorder so that you understand it better. Educate the people around you, so that they can help.
- Stick to your treatment plan, no matter how difficult or uncomfortable.
- Consult your health care professional. If medications are prescribed, take them as directed.
I wish success to those of you afflicted by OCD.
I wish success to those of you afflicted by OCD.
I wish success to those of you afflicted by OCD.
Macular Degeneration
August 16th, 2009What is the leading cause of visual impairment in people over 65? If you said age-related macular degeneration (AMD) you were correct. An estimated 15 million people in the United States have it, with two million new cases diagnosed each year. Tragically, macular degeneration is currently an incurable disease.
The central portion of the retina in our eye is responsible for recording images and sending those images to our brain via the optic nerve. When one suffers from AMD, the light-sensing cells in the central area of vision (the macula) deteriorate and eventually die. Central vision is damaged, and it becomes difficult or impossible to read, drive, or even recognize faces. Peripheral vision is not affected, so AMD does not lead to total blindness.
Fewer than one in a hundred people under 60 develop AMD, but at 80, there is a 22% chance of getting the disease. If it already exists in one eye, there is a 39% chance of the other eye becoming affected. This is an age-related disease, and it gets progressively worse as time passes.
Why do we get AMD? Apparently, both genetic as well as environmental factors are responsible. Genetic factors, which are not under our control, probably include being white, female, and having a family history of AMD. Environmental factors likely include being a smoker and obese.
The “dry” form of macular degeneration is the most common. The retina develops yellow deposits called “drusen”. In a healthy eye, these deposits would be carried away by the actions of blood vessels. “Wet” macular degeneration occurs in about 10-15% of cases. Immature blood vessels grow and leak. If caught early enough, there are various treatments that might help some of those suffering from wet AMD. These treatments are aimed at attacking these fragile, leaky new blood vessels.
How would you discover that you or a loved one is getting AMD? There is no pain. For dry AMD, the most common early sign is blurred vision. Often the blurred vision will go away in bright light. For wet AMD, the classic early symptom is that straight lines appear crooked. This is caused by fluid from the leaky blood vessels lifting the macula and distorting vision. A small blind spot may also appear in wet AMD, resulting in the loss of central vision. An ophthalmologist would make the diagnosis using fluorescein angiography, which identifies problems with blood vessels in the eye.
What can you do about AMD?
* If you have lost sight, especially in your central vision, see an ophthalmologist immediately. It is important that treatment for wet macular degeneration begin as early as possible.
* If you have AMD, don’t be afraid to use your eyes. This will not lead to further deterioration.
* If you have AMD, seek low vision services and devices that make the most of your remaining vision. Such services are available in most communities. The Braille Institute is a good place to start.
* If you have dry AMD, get frequent eye exams, as it can turn into wet AMD at any time – and wet AMD may be treatable.
* If you have AMD, take a daily vitamin supplement which includes vitamin C 500 mg, vitamin E 400 iu, vitamin A 25,000 iu, zinc oxide 80 mg, cupric oxide 2 mg, and beta-carotene 15 mg. This combination is marketed in a vision formula called AREDS.
* Promising research indicates that eating rich leafy green vegetables, wearing a hat and sunglasses to protect against UV rays, not smoking, controlling weight, and taking daily doses of antioxidants and zinc may make a difference.
May we all do our best to protect the precious gift of sight!
Health Care System
August 4th, 2009Our health care system has evolved into a huge, complicated monster. How do we, as consumers, best utilize it?
In the old days, we would select a local doctor, most likely a general practitioner. That doctor would deliver babies, take care of Mom and Dad, Grandma and Grandpa, and perhaps treat the family horse as well. The doctor might be paid in IOU’s, homemade preserves, chickens, or cash. He (and a “he”, it was) routinely made house calls. There were no hospitals to speak of, no insurance companies, nor Medicare, PPO’s, HMO’s or IPA’s. There were no CT scanners, PET scanners, ICU’s, or drug formularies. When hospitals came along, they cost very little to stay in because there wasn’t much that they actually did – they were basically a place to rest.
Along came more powerful drugs, sophisticated lab tests, and computers to assist in making diagnoses. Of course, people wanted the latest and greatest of what was available, and that started costing a lot of money. In 1965, President Johnson, realizing that health care costs were rising, signed Medicare into law, a guaranteed insurance to cover health care costs for all citizens over the age of 65. (Ex-President Truman, who first asked Congress for a national health insurance plan 20 years earlier, was the very first to enroll.) Government estimates for health care costs, however, were far too low. The system was set up as an open checkbook: exams, tests, x-rays, and surgeries were simply paid for by the government. This new government system made spending and utilizing too easy, and led to skyrocketing costs.
The first HMO’s (Health Maintenance Organizations, better described as group prepayment plans) were started in 1929, decades before Medicare, in response to the Depression. Kaiser Permanente and Ross Loos were among the early pioneers of this cheaper vehicle for health care delivery. After the government realized that the new Medicare system was far more expensive than predicted, they started encouraging HMO plans as an alternative to the pay-as-you-go system for seniors. In the Medicare HMO system, the government gives an insurance company a fixed amount of money each month to pay for all of the enrollee’s health care costs.
For those under age 65, HMO insurance works in a similar manner, but it’s generally the employer, rather then the government, who pays the fixed monthly fee. Note the sharp contrast to the original system of the open checkbook, where costs were anything but fixed. Soon, most health insurance companies began offering their own version of HMO coverage for non-seniors as well as for seniors. Here in our own community, IPA’s (Independent Practice Associations) such as Applecare, Caremore, Pioneer, and Alliance Physicians offer HMO-type plans where each individual selects their own private practice physician.
Let’s take a look at how each type of insurance works. Whether over or under the age of 65, there are a number of options, including HMO, PPO, Medicare and Medi-Cal, depending on your particular situation.
Those 65 and older, or permanently disabled, who paid into the Medicare system, may choose one of the following:
- Keep your Medicare and buy supplemental insurance (from companies such as Blue Cross, Blue Shield, and AARP) that cover the roughly 20% balance not paid by Medicare,
- Keep your Medicare and buy no supplemental insurance, instead being responsible for your own 20% balance, or
- Turn your Medicare over to an IPA, which manages various HMO insurance products.
If you choose options 1 or 2, choosing not to turn your Medicare over to an IPA, you are buying the freedom to go where you please and see whom you wish. You may essentially use any hospital and any doctor who participates with Medicare, and most do. You may also buy a Medicare Part D plan to cover pharmaceuticals. This is the most expensive option, and allows for the most choice.
On the other hand, should you choose option 3, you are turning your Medicare over to an IPA, and choosing one of the Medicare HMO insurance products. In this scenario, you first choose your doctor, from among those who belong to the IPA. The IPA works with one or more of your local hospitals. Next, you select which HMO insurance product has the package of benefits that best fits your needs from among the products offered by the IPA.
If you are under the age of 65 and employed, your employer generally will determine your choices. You may be offered PPO (Preferred Provider Organization) insurance, costing more but giving the health care consumer far more flexibility in choosing doctors, medications, testing facilities and hospitals. Selecting an HMO option is less expensive and, as discussed above, is managed through one of your local IPA’s. If you are unemployed, self-employed, or your employer doesn’t offer a health plan, you will spend more for your health coverage, but your choices will follow these same general rules.
Right about here, most of us are longing for the uncomplicated good ol’ days of the GP. Note, however, that the key to good medical care still comes down to one thing: the doctor – patient relationship. No matter what form of insurance you have, the right doctor within a given system will find a way to make it work for you.
Find a knowledgeable and caring doctor who you can relate to. It won’t do you any good to find the smartest doctor if he or she is incapable of communicating with you and listening to your concerns. It is a very special and critical relationship of caring and trust. My grandmother played a significant role in my decision to enter medical school. She wasn’t too fond of doctors, and rarely listened to their advice. When she returned from seeing a doctor, she would invariably criticize his intelligence; he just couldn’t seem to figure out what was wrong with her. As my grandmother aged, my mother accompanied her to the doctor, and couldn’t believe her eyes. My grandmother would take a seat in the corner of the exam room, as far from the doctor as possible. She would turn away, cross her arms and legs, and say very little. She was clearly expecting the doctor to be psychic. Trust me on this…the vast majority of us are not psychic. Find a doctor with whom you can communicate!
How can you best use your time with your doctor? Come in prepared. Have a list of concerns, well thought out. Ask questions, and play an active role in your own health care. Remember, the two of you are part of a health care team. Your job is to bring in your concerns, and your doctor’s is to listen carefully so that together you can solve a mystery, reach a diagnosis, and plan the best treatment. Choose a doctor whose philosophy and approach towards treatment matches your own.
As always, I wish you good health – and infrequent use of our complicated and imperfect system!
Varicose Veins
August 4th, 2009They’re twisted and enlarged, they’re purple and blue, and sometimes they swell and ache by the end of the day. Everybody knows someone with varicose veins. This makes sense; over half of American women and just under half of American men suffer from some sort of vein problem. Let’s explore together what varicose veins are and why they occur.
The heart pumps blood through the body, which carries with it oxygen and nutrients. Arteries carry the blood from the heart toward the different body parts, and veins carry the spent blood back to the heart. Thus, arteries act as a high-pressure hose, but veins must rely on muscle contractions in order to pump the blood back to the heart. Varicose veins develop when the valves in the veins become faulty, and the walls become weakened. Normally these one-way valves act as flaps to keep blood flowing efficiently, usually against gravity. When the valves malfunction, however, they leak backward and blood pools. This causes pressure to build up, which weakens, enlarges, and twists the vein. Spider veins are caused in a similar manner, but are a milder problem. Although most varicose veins are found in the legs and feet, any vein can become varicose.
The causes of varicose veins are many. Unfortunately, the biggest risk factors are out of your control: having a family history of the problem, aging, and being female. Hormonal changes also increase the risk, including entering puberty, taking birth control pills, pregnancy, and menopause. Pregnancy also leads to more varicose veins because the increased amount of blood flow causes veins to enlarge. The expanding uterus puts pressure on the veins in the pelvic cavity, which increases pressure on circulation in the lower extremities. Each additional pregnancy can lead to more and worse varicose veins. Obesity, prolonged standing, and leg injuries can all increase risks. Even excessive sun exposure can increase spider veins in those of us with fair complexions.
The most common symptoms are legs that feel achy, tired, heavy, or numb; burning, throbbing, muscle cramping or swelling in the lower extremities; darkening of the skin; and an itching or irritated rash in the legs.
Aside from being unsightly, what dangers do varicose veins present? While spider veins don’t pose a medical risk, varicose veins usually get bigger and can cause health problems. They can affect the general circulation of the body, causing pooling of blood in the lower extremities and poor blood return back to the heart. This in turn can increase the risk for blood clots, infection, skin sores, and ulcerations.
A doctor’s evaluation will begin with a good history and physical. The discussion will include any injury to the legs, symptoms, history of blood clots, and the story of how the problem progressed. In order to make the diagnosis, the doctor will examine the legs and feet. Varicose veins are easy to see, especially when standing. The doctor will also note any tender areas, swelling, skin color changes, ulcers, and other signs of skin breakdown. An ultrasound test may be indicated to see if the valves are functioning normally, or to check for blood clots.
The most common treatments for varicose veins are support hose, leg elevation, and weight loss. These non-invasive therapies may be sufficient. However, whether for medical or for cosmetic reasons, many people pursue more invasive options. The methods described below are effective but, as with all surgeries, may also be expensive, painful, and have side effects such as bleeding and infection.
- Sclerotherapy can be very effective and is the most common invasive treatment for both spider and larger varicose veins. A solution is injected into a vein, causing its walls to swell, stick together, and seal shut. This stops the flow of blood and turns the vein into scar tissue. In a few weeks, the vein fades. Since the procedure does not involve anesthesia and can be done in the doctor’s office, many people start here.
- Laser surgery is a newer technique for smaller spider veins. The vein is exposed to strong bursts of light, causing it to slowly fade and disappear. This treatment takes 15 to 20 minutes, and is done two to five times.
- Endovenous techniques have replaced old surgical methods for some patients with severe varicose veins. It is also performed in the doctor’s office. A very small catheter is inserted into the vein, which emits a radiofrequency or laser energy that shrinks and seals the vein.
- Finally, surgical ligation and stripping is the old technique of tying off and removing the bad vein. Blood flow shifts to the remaining veins. The surgery is done under anesthesia in an operating room.
I encourage you to reduce your risk of developing new varicose and spider veins, and to make any symptoms you may feel milder and more manageable:
- Wear sunscreen to protect your skin from spider vein formation.
- Keep your weight as close to your healthy target as possible.
- Maintain a low salt diet to decrease water retention in the legs.
- Eat a high fiber diet to reduce the risk of constipation. Straining increases the risk of varicose veins.
- Cross your legs at the ankles, but not higher up.
- Elevate your legs when resting as much as possible.
- Avoid standing or sitting for significant amounts of time. When you stand, shift your weight from one leg to the other every few minutes. When you sit, stand up and move about frequently, or wiggle your feet to keep the muscles contracting.
- Wear elastic support stockings if necessary, and avoid tight clothing that constricts around the waist, groin, or legs.
- Exercise regularly to improve leg strength, circulation, and vein strength. Walking or running is excellent.
- Consult with your doctor if you have questions or concerns regarding your varicose veins.
As always, I wish you good health!
Pollution
August 3rd, 2009While on a recent vacation to China. I was shocked to see thick yellow air filling the city of Beijing. I noticed that my eyes became irritated, my nose started to run and my breath was short.
It reminded me of growing up in the San Fernando Valley in the 1960’s, when it was common to wake up to smog alerts. Progress has since been made: in 1976, there were 102 Stage 1 smog alerts (when the air is considered “very unhealthful”), and by 1998, there were only 12. Ozone levels, however, were above standards during 62 days in 1998, and we all know that views of thick haze obscuring downtown skylines remain a familiar sight today. Our South Coast Air Basin maintains the unfortunate distinction of having the worst air quality in the country for both particulate matter and ozone.
Air pollution is made up of gasses, droplets and particles. Cars, buses and airplanes, industry and construction all contribute. Ground-level ozone, the major part of air pollution in most cities, is created when engines and fuel gasses already released into the air interact when hit by sunlight. Ozone levels increase when the air is still, the sun is bright and the temperature is warm.
What are the health consequences of our dirty air? Common symptoms include eye, throat and lung irritation. Exercise tends to increase the symptoms since air-intake is increased. People with heart or lung disease are often more sensitive. Generally, symptoms go away soon after exposure ends.
Air pollution is linked to multiple adverse health effects in children; their small bodies and developing lungs are especially susceptible. Doctors observe increased respiratory symptoms and hospitalizations for respiratory illnesses, more severe asthma episodes, decreases in lung function, and longer-lasting lung infections. Most studies do not show that air pollution causes asthma, but it can exacerbate it.
Air toxins are an emerging area of concern. There are thousands of chemicals in the air we breathe every day. Other than the six major air pollutants monitored – ozone, particulate matter, carbon monoxide, nitrogen dioxide, sulfur dioxide, and lead – there are a number of other chemicals found in the air that are linked to cancer, neurological damage, genetic mutation, birth defects, and other chronic illnesses. There have also been associations in the literature between long-term exposures to ambient air pollution and cardiovascular morbidity and mortality. The contribution to atherosclerosis that underlies many cardiovascular diseases has not yet been investigated. Animal studies suggest that particulate matter may contribute to atherogenesis. These are early studies and further evaluation will follow.
What can you as an individual do to protect yourself?
- Stay indoors as much as you can on days when pollution levels are high
- If you must go outside, limit your activity to the early morning hours and after sunset
- Don’t exercise or exert yourself outdoors when air-quality reports indicate unhealthy levels of air pollution. The faster you breathe, the more pollution you are taking into your lungs
- Always consult your physician if you are having problems with local air pollution.
As always, good health to you all!
Marijuana
July 30th, 2009Let’s take a look at marijuana, the most commonly used illegal drug in the world. Though surely none of my readers use it, or even know anyone who does, let’s explore its social and scientific implications. Is marijuana safe? Is it addictive? Should it be legalized?
We live in a world that has become quite tolerant of substance abuse. It is almost fashionable for our social icons to be pasted across covers of magazines and newspapers, getting in trouble for some form of substance abuse. College students across America pride themselves on outdoing one another with alcohol-laden parties. Tobacco and alcohol companies market heavily to our youth.
Drug use is not new, and people have used a wide variety of substances throughout history to satisfy a desire for pleasure enhancement, to relieve stress, and to cope with long working hours. Young people abuse substances for the same reasons that adults do. However, additional social pressures are placed on the young, including the search for identity, the yearning for acceptance, and the need for escape, and those pressures help to explain the popularity of marijuana.
Teens are most often introduced to this drug by friends, and use it for the first time to be sociable. While the majority of teens do NOT smoke marijuana, the trends are disturbing. Drug and alcohol use among American youth showed substantial increases among eighth, tenth, and twelfth graders from 1992 to 1997. Between 1991 and 2001, the percentage of eighth graders who used marijuana doubled from one in ten to one in five. At the same time, the percentage of students who thought that using marijuana was harmful declined. The average age of first use, for those who use it, is around 14. Those who don’t start using marijuana during their adolescence tend not to do so in the years that follow.
Commonly cited reasons for marijuana use among the young include:
* Demonstrating independence
* Developing values distinct from parental and societal authorities
* Developing strong peer bonds
* Seeking novel and exciting experiences
* Taking risks and satisfying curiosity
Some of the signs of marijuana use are dizziness and trouble walking, red bloodshot eyes, trouble remembering things that just happened, and silly behavior for no apparent reason. Quite often, marijuana increases hunger (the munchies) and thirst. Marijuana can induce several additional responses such as relaxation, introspection, feeling “in tune” with the world, and irrationality. Negative effects can also include severe paranoia and anxiety.
Over time, regular marijuana users often develop breathing problems, such as chronic coughing and wheezing. It affects the lungs since it is, after all, an unfiltered cigarette. There are more than 400 chemicals inhaled when taking a puff, including roughly four times the amount of tar as in a tobacco cigarette. Regular use affects memory, judgment, and perception. Those who smoke marijuana regularly start to lose interest in their appearance and how they are doing at school, work or home.
Little is understood about the physical mechanisms of addiction and withdrawal. Research has now established that marijuana is habit forming. However, whether this is an addiction or dependency, and if an addiction, whether it is a psychological or physical one, is still unclear. Every year more teens enter treatment with the diagnosis of marijuana dependence than for all other illicit drugs combined.
Note that since it’s not produced in “legitimate” factories with quality control, marijuana may not be what the buyer thinks it is – it may be laced with other dangerous drugs, such as cocaine or PCP. While there is no proof that smoking marijuana leads to using stronger drugs (the “Gateway Theory”), teens who smoke marijuana are nevertheless statistically more likely to, perhaps due in part to increased interaction with people whose lifestyle includes drugs.
So what is the argument for using marijuana as a legitimate medicine and not recreationally? The active ingredient in marijuana is tetrahydrocannabinol, or THC.
Medical literature cites four common uses:
* THC acts as a very effective anti-nausea medicine. It can improve mild to moderate nausea caused by chemotherapy for cancer and for AIDS patients. Thousands of people with AIDS smoke marijuana daily for control of nausea and to increase their appetite. There is, in fact, an FDA approved drug for appetite stimulation called marinol, made from marijuana.
* THC reduces pressure in the eye caused by glaucoma, thereby helping to prevent blindness. Glaucoma is the third leading cause of blindness in the United States.
* THC has been used for treating pain, and is as effective as codeine as a pain reliever.
* THC seems to be effective in treating the tremors, spasms and pain of Multiple Sclerosis.
Why is marijuana illegal? This subject is incredibly complex. First of all, the legal ramifications of buying, using, or selling marijuana vary significantly from state to state. The federal position, which overrides the state, is that it is illegal to use, buy or sell. Marijuana has, in fact, been illegal for approximately 1% of the time it has been known and used. Evidently, it has been around since 7000 BC, and was last legal during the childhood of President Ronald Reagan. America’s first marijuana law was not what you would expect it to be: in 1619, the law mandated that farmers in Jamestown Colony, Virginia had to grow the hemp plant. They were allowed to pay their taxes with hemp (don’t try this today!). The United States census counted 8,327 plantations growing cannabis hemp for cloth and canvas, one of which belonged to our first president, George Washington.
The reasons for marijuana being legal or illegal have not been strictly rooted in the medical or scientific facts. For now, we live in a country where marijuana is illegal, and we should all respond accordingly.
What steps can you (especially parents) take to help avoid a marijuana problem in your home?
* Be aware of your own relationship with intoxicants, and show a readiness to make healthy choices
* Strive for parenting down the middle, without being overly restrictive nor overly lax
* Look for natural opportunities to discuss substance use issues
* Help your children with their decisions by weighing perceived benefits with risks
* Young people base their decisions on their perception of what is “normal” – point out that in fact most adolescents do not use illegal drugs
* Be alert to problems in their life
* Watch for declining grades in school, declining performance at work, changes in social groups, changes in appearance, etc.
* Be aware of available community resources
* Listen and try to understand their perspective
I wish you health, happiness…and good judgment.
Massage
July 30th, 2009Everybody knows that getting a massage feels good. But is a massage actually good for your health? Science has not managed to keep up with the multitude of goods and services claiming to be healthful. What hard scientific data is available on the health benefits of massage therapy?
During a massage, soft tissues (including muscles, skin and tendons) are manipulated, using fingertips, hands and fists. It can be given by a variety of health care professionals, including a physical therapist, occupational therapist or massage therapist. Different types of massage are performed in a variety of settings for a range of purposes, including achieving relaxation, relieving soft tissue injury, lessening muscle tension, and a host of other reasons.
Major medical institutions including the Mayo Clinic and the Sloan-Kettering Cancer Institute have invested significant resources in order to understand the benefits of massage. In a key study performed by Sloan-Kettering, massage therapy was given to a group of cancer patients. Patients rated their levels of pain, fatigue, stress/anxiety, nausea, and depression, both pre- and post-massage. The three-year study included 1,290 patients and various types of massage therapy. Symptoms were reduced by approximately 50%, including for those patients who were suffering the most. Outpatients improved 10% more than inpatients. The benefits appeared to continue for at least a two-day period. Sloan-Kettering concluded that massage therapy is indeed associated with substantial improvement in the symptoms of cancer patients.
More research is clearly called for, but various studies have shown improvement in:
*Pain: Pain decreased in patients with fibromyalgia, migraines, recent surgery, back pain, and cancer pain.
*Cancer treatment: People with cancer who received regular massage therapy during treatment reported less anxiety, pain and fatigue (note the Sloan-Kettering study, above).
*Sports-related soreness: Some athletes receive massage after exercise, especially to the muscles used most in their sport. Massage may improve circulation to those muscles.
*Children with diabetes: Children who were massaged every day by their parents were more likely to stick to their medication and diet regimens, thereby helping to regulate their blood glucose levels.
*Anxiety: Massage has been shown to reduce anxiety in depressed children, anorexic women, and in adults trying to quit smoking.
*Alcohol withdrawal: When combined with traditional medical treatment, massage has shown benefits, perhaps by increasing feelings of support, safety and engagement in therapy.
*Labor: Massage during labor appears to lessen stress and anxiety, relax muscles and reduce pain.
*Immune system: HIV patients who participated in massage studies showed an increased number of natural “killer cells”, which are thought to defend the body from viral and cancer cells.
*Infant growth: Massage encouraged weight gain in premature babies and reduced their hospital length of stay.
*Self-esteem: Massage involves direct physical contact with another person, and can make one feel cared for. That special attention can improve self-image in people with physical disabilities and terminal illnesses.
So why exactly might massage be beneficial? The data supporting the findings above tell us that massage or some component of it is beneficial to many aspects of our health. What we still do not know is exactly how or what massage does to the body to bring about these benefits. It is possible that the majority of the medicinal effect is simply due to human touch. Studies are now underway to examine what happens when humans touch one another. Do chemicals in the body and brain, which modulate the immune system, the stress response, or mood, actually change? The scientific community expects to be seeing more concrete medical data soon.
Are there risks to massage therapy? It is not for everyone. We all know people who simply do not like to be touched. If performed by a trained therapist, risks are minimal, but there are some people for whom massage could actually be dangerous, including those with:
*A recent heart attack
*Deep vein thromboses (blood clots)
*Unhealed fractures
*Rheumatoid arthritis in the area being massaged
*Cancer in the area being massaged
*Severe osteoporosis in which the bones are so brittle that massage could cause a fracture.
Contact your physician if you question whether massage is safe for you. I wish you good health, and peace of mind and body!
Fats
July 30th, 2009We are what we eat. So true. In terms of personal health habits, nutrition is perhaps the area I get the most questions about, with the major focus on FAT. But are all fats unhealthful?
I know that many of my patients come in quite confused. Let’s demystify this today.
Fats have a bad reputation. It’s important to understand that there are different types of fat, and some are necessary for good health. Note, by the way, that every fat has the same number of calories, which means they can all make you equally…fat. If weight loss is your goal, then you need to limit all of them, but not completely avoid them. More on this later! Saturated fats, however, can not only cause that dreaded weight gain, but are also a major cause of arteriosclerosis (clogging of the arteries) and coronary heart disease.
So which fats are good? Fats fall into two categories: Saturated fats and unsaturated fats. In a nutshell: Saturated fats are bad, unsaturated fats are generally OK in moderation. Saturated fats come from animal foods (meat, cheese, ice cream, butter, eggs, and other dairy) and a few oils like palm kernel. These fats are not necessary for health, and they are a major cause of arteriosclerosis-related diseases. Saturated fats also include the trans-fats or hydrogenated fats. These are fats that started out unsaturated but the food manufacturing process cooks them and turns them into saturated fats. They are found in margarines, shortenings, fast foods (especially fried foods like French fries and fried chicken) and are especially unhealthful.
The unsaturated fats include mono-unsaturated and poly-unsaturated fats. Mono-unsaturated fat is considered to be one of the most healthful types of general fat. It is found mainly in olive oil, avocados, peanut butter, rapeseed oil, canola oil, nuts and seeds. It actually helps to reduce harmful low-density lipoproteins (LDL) which can cause blocked arteries. So, to further refine our nutshell (so to speak), saturated fats are bad, and some unsaturated fats, namely mono-unsaturated fats, are good.
If you’re still with me, I’m truly impressed. Poly-unsaturated fat, though much better for you than saturated fat, is considered to be less healthful than mono-unsaturated fat. However, included in the poly-unsaturated fat group are two very important essential fatty acids (EFA) that have been prominent in the news lately. These are the Omega 3 and Omega 6 fatty acids. Both of these EFA are vital for good health and are the types of fat you need to be eating. So here, our metaphorical nutshell gets complicated: Poly-unsaturated fat has its plusses and minuses, but the Omega 6 and Omega 3 fatty acids, contained within that group, are highly desirable.
Now, as promised, let’s get back to that weight-loss issue. Did you know that fat contains more than twice the calories of carbohydrates and proteins? Each gram of fat is equal to 9 calories and each gram of carbohydrate or protein is equal to 4 calories. Note that an Original Glazed Krispy Kreme donut has 12 grams of fat (or, have a Glazed Kreme Filled for 20), a “vente” Starbucks Double Chocolate Chip Frappuccino has 25 grams and a Burger King Double Whopper with cheese has a whopping 64 grams of fat! If we assume that your total calorie intake should be 2000 calories per day, and that 20% of those calories should be from fat, then 400 fat calories or about 45 grams of fat should be consumed each day. That burger has 990 calories, and almost one and a half times what your day’s fat intake should be! So for the sake of your health and weight, become a fat-detective and reduce your total fat consumption.
Here are some practical suggestions:
-Reduce total fat consumption to 15-25% of your total daily calorie intake
-Restrict or eliminate saturated fat
-When you buy margarine, choose brands without trans-fats or hydrogenated fats
-Eat fish at least two times per week. Fatty fish like albacore tuna, salmon, lake trout, mackerel, herring, and sardines are high in Omega 3
-Eat foods such as tofu and other forms of soybeans, pumpkin seeds, dark green vegetables, canola beans, walnuts, almonds, and flaxseed, which convert to Omega 3 fatty acids
-If you are trying to lose weight, remember that all oils are high in calories, and should be consumed sparingly.
You’ll read more on diet and nutrition in my next column. Until then, bon appetit!
Smoking
July 26th, 2009Patients are often coming into my office saying “Doctor, I just don’t feel good. Can you give me something?” My mind immediately travels to their personal health habits. These include sleep habits, nutrition, exercise, emotional well-being, and, of course…smoking habits. Today, I am going to focus on cigarette smoking, because it is the major single cause of cancer mortality in the United States, and thus the most preventable cause of premature death in our country.
You may be astounded to learn that over one billion people smoke worldwide, nearly one in three adults. For a behavior that is purely voluntary, it has devastating effects on health. Cigarettes kill more Americans then alcohol, car accidents, suicide, AIDS, homicide and illegal drugs combined. They account for at least 30% of all cancer deaths. Smoking during pregnancy leads to under-developed babies, birth defects and even infant death. Women who stop smoking before pregnancy and even by the fourth month still reduce the risk of these complications. 440,000 people die each year from the effects of smoking cigarettes, and 3,000 more die each year from secondhand smoke.
As a physician whose goal is to help my patients become healthier, it is frustrating to realize that their worst enemies are often themselves. Cigarettes, cigars and pipe tobacco consist of dried tobacco leaves, as well as ingredients added for flavor and “improving the smoking experience.” These additives include tar and nicotine. Nicotine is a highly addictive drug. In fact, more than 4,000 individual compounds have been identified in tobacco. Among them are more than 60 that are known carcinogens (cancer-causing agents). Once a patient has found their way to smoking, it is tough to reverse that process.
Here are some tips for quitting smoking:
- Make a list of your reasons for quitting and say them often.
- Set a quit date and tell everyone that you are going to quit. This is not something you need to do alone. Remember, including your family and friends not only gives you much needed moral support, but raises your chances of quitting dramatically.
- Keep a supply of healthy snacks handy.
- Increase your exercise. Walk more.
- Make specific plans for what you will do when the urge hits. For example, take a deep breath, get up and walk around, call a friend for help, and keep your hands busy. Remember, the urge will pass in a few minutes.
- Remove all cigarettes, ashtrays, matches and lighters from your home, workplace, and car.
- Ask your doctor about medications such as nicotine products to help you quit.
- Contact your local American Lung Association or call 1-800-LUNG-USA.
It pays to quit smoking at any age. Even someone who has smoked most of their life can improve their lungs and prolong life expectancy. Quitting smoking will decrease the risk of lung cancer, heart attacks, stroke and chronic lung disease, compared to those who continue to smoke. Remember, the health benefits of quitting smoking far exceed any risks from the average five pound weight gain or any short-term nicotine withdrawal symptoms.
Good luck to all smokers out there who are traveling on the road to a smoke-free life.
It’s worth it.
Steroids
July 11th, 2009So, you want to use steroids to bulk up like your favorite athlete or superhero? Read this first…
Just what are anabolic steroids? They are a man-made, stronger version of the natural male hormone testosterone. They are taken orally or by injection, and are legally available only by prescription and primarily to treat conditions that occur when the body produces too little testosterone, either from a congenital or acquired disease. Steroids are also used to treat patients wasting away from AIDS or other debilitating diseases. More than 100 different anabolic steroids have been developed, and the vast majority of these are used illegally and smuggled into this country.
Testosterone is the hormone that triggers the male reproductive system to mature during puberty, which includes body hair growth and voice deepening. Its anabolic, or building, effect aids in the development of muscle mass and strength, and therein lies the appeal. It is not, however, only the football player, weightlifter, or sprinter who may be attracted to anabolic steroids, and it is not only men and boys. Women and girls are using them at increasing rates as well, in order to look, feel or perform better – regardless of the risk. The male body normally produces 10 milligrams of testosterone per day, and the female body far less. Some athletes, however, may use hundreds of milligrams per day, vastly exceeding natural levels.
What, precisely, are the risks of taking anabolic steroids? Even at prescribed doses, there is an extensive list of side effects, both physical and psychological, which can be irreversible. The dangers may not show up for months or even years.
* The psychological effects of steroid use are significant. Most noticeable are increases in irritability, aggressiveness, and violence. Psychosis, paranoid delusions, and grandiosity can be seen along with severe mood swings, forgetfulness, confusion, and depression. Sometimes, feelings of invincibility are present, with euphoria, increased energy, and sexual arousal.
* In men, even though anabolic steroids are derived from a male sex hormone, there is the possibility of a feminization effect: the decrease in normal male sexual function. This is because an increased level of testosterone can cause lowered levels of LH (luteinizing hormone) and FSH (follicle stimulating hormone), both of which are required to make sperm. The results are decreased sperm counts, shrinking of the testicles, development of breasts, and impotence.
* Continued use can result in acne, bloated appearance, rapid weight gain, elevated cholesterol, clotting disorders, liver damage, premature heart attacks and strokes.
* Women may experience a masculinization effect, including facial hair growth, deepened voice, breast reduction, and menstrual cycle changes.
* In adolescents, steroids may affect growth and maturation. Rising levels of testosterone and other sex hormones normally trigger the growth spurt that occurs during adolescence. However, when these hormones reach certain levels, they signal the bones to stop growing and can result in early closure of the bone growth centers.
* Because steroids can come in injectable form, needle sharing has transmitted HIV and Hepatitis B.
The latest data from the National Institute for Drug Abuse (NIDA) is shocking: 500,000 young Americans are currently using steroids, more than ever before, while fewer are worrying about the dangers. In 2007, steroid users ranged from 1.1% of 8th graders to 2.3% of 12th graders. Girls account for one-third of the high school student abuse; many of these girls have eating disorders, and use steroids to lose fat and gain muscle. How much of the blame for steroid abuse lies with the media and the image of perfection that constantly bombards our children?
This is a growing crisis. What can be done?
* It is clearly critical to improve education and public awareness of the potential dangers of steroid abuse, both for adults as well as for young people.
* Support and utilize school psychologists and support groups: these are valuable resources for our students who are battling peer pressure, body image, and a whole range of issues.
* If you feel that you should use steroids, talk to your doctor and get a medical opinion as to their risks and benefits. Lab tests can reveal whether you have a valid need for anabolic steroids.
As always, become knowledgeable about your body, take care of it, and be well!
Myths
June 30th, 2009After months of discussing fats, alcohol, and other serious subjects, let’s lighten up, have some fun and discuss some common medical myths. Through the years, many “facts” tend to become common knowledge…some backed up by science, some most certainly not!
Myth 1: Cracking your knuckles can cause arthritis. False. There is no evidence that the highly annoying habit of cracking your knuckles inflames the joints and leads to arthritis. The popping sound you hear is caused by bubbles bursting in the synovial fluid between the joints. It is estimated that about 1/4 of the population cracks their knuckles.
Myth 2: Staring at an eclipse can cause blindness. True. Viewing the sun directly without any optical filters can damage the light sensitive nerve endings in the back of the eye. This structure that is damaged is the retina, and this damage will lead to varying degrees of vision loss. The worst exposure occurs during a total eclipse, because the lack of sunlight gives false confidence. The sun’s rays can still get around a complete eclipse of the sun. Never count on regular sunglasses for protection during an eclipse.
Myth 3: You will catch a cold if you go out in the cold, rain, snow or wind. False. Colds are caused by viruses. Other infections, for that matter, are caused by other germs. You catch a cold by inhaling infected air droplets sneezed or coughed on you by an infected person. Of course, if getting chilled in foul weather compromises your immune system, you could become more susceptible to future infection.
Myth 4: Reading in dim light ruins your eyesight. False. As a rule, you cannot damage your eyes by using them. The few exceptions include looking directly into the sun (see above) or laser light. Reading in dim light will not change the health or function of your eyes. It is more difficult to focus in poor light, which might lead to eye strain. Fortunately, eye strain is only temporary.
Myth 5: Hair and fingernails continue to grow after death. False. Hair and fingernails may appear longer after death. This is not because they have grown, but rather because the skin around them has retracted. This is caused by dehydration, making the tissue shrink around them. The “growth” is only an optical illusion.
Myth 6: If you eat too many carrots, your skin will turn orange. True. Eating excessive quantities of carrots, a food containing a high level of beta-carotene, can cause a usually harmless condition known as carotenemia. Carotenemia leads to a yellowish discoloration of the skin, most noticeable on the palms of the hands and soles of the feet. The cure is to reverse the diet and make it low in beta-carotene.
Myth 7: Eating chocolate causes acne. False. Thank goodness this is untrue! In the past, acne diets typically excluded chocolate. However, over the years there has been no good evidence linking chocolate or other specific foods to acne. Proper modern acne treatment focuses on keeping the pores open and controlling oil production and bacteria.
Myth 8: Shaving hair causes it to grow back faster, darker and coarser. False. Shaving is merely a method of cutting the hair at the skin surface and has no effect on the hair shaft that lies below the skin surface. It is the hair follicle, located at the bottom of the hair shaft, that controls growth and pigmentation.
Myth 9: Stress causes ulcers. False. In 1983, scientists demonstrated a direct link between bacterial infection and ulcer formation. This bacteria, known as Helicobacter pylori, causes an infection responsible for the vast majority of ulcers of the upper intestinal tract. Specific things such as cigarettes, alcohol, various foods, stress, and some medications can contribute to the process. Once an ulcer is detected, these contributing factors should be avoided, but the primary treatment for ulcers is now antibiotics.
Myth 10: Chicken soup will help cure a cold. True. While your grandmother’s advice to “feed a cold and starve a fever” is untrue, her suggestion to eat chicken soup offers plenty of benefits to those suffering from a cold or upper respiratory infection. Hot liquids like chicken soup help to not only hydrate the sick person, but the warmth helps to open up the nasal passages. This allows the patient to breathe easier, and get necessary rest.
In parting, feel free to feast on chocolate, carrots, and chicken soup in the wind and rain, while annoying someone by cracking your knuckles, but avoid staring at the sun!
My goal is to address letters to the editor promptly. Following my last article about caffeine and coffee, one reader asks: What about tea?
Tea is an excellent alternative to drinking coffee. For those avoiding caffeine, note that a cup of black tea contains only about 50mg of caffeine, green tea 20mg, decaffeinated tea 2mg and herbal tea 0 mg. Compare that to the typical eight ounce cup of Maxwell House with about 110 mg of caffeine, and to a Grande Starbucks coffee which packs five times that amount! A significant additional benefit of tea may be that, like vegetables and fruits, tea has a high antioxidant content (also known as flavonoids). It even contains fluoride! Many herbal teas claim health benefits beyond these. Some of these benefits are backed up by medical science, and some are not. Be cautious when evaluating health claims, but in general, sit back and enjoy your favorite warm cup of tea.
Viagra
June 28th, 2009Way back in the 1990’s, a new drug being tested in England was an utter failure at treating high blood pressure and angina. It did, however, have quite an unusual side effect – it caused male erections. That drug is now known as Viagra, and the rest, as they say, is history.
Today, Viagra, Levitra, and Cialis are the only drugs approved by the FDA for Erectile Dysfunction (E.D.), a condition that affects as many as 30 million men in the United States. These drugs work by increasing the flow of blood into the penis so that, upon arousal, an erection is more likely to occur. They belong to a class of drugs called PDE5 (phosphodiesterase 5) inhibitors. They work by dilating the smooth muscles in the blood vessels that provide blood flow to the male genitalia.
For the most part, those helped by the PDE5 drugs are older and have a clear cause for erectile dysfunction that is not reversible. The immediate cause is inadequate rigidity of the corpora cavernosa, a chamber in the core of the male penis. This in turn can be the result of a lack of nerve signals initiating blood flow, impairment of the arteries filling the penis, ineffective closure of veins required for appropriate storage of blood within the erect penis, hormonal deficiencies, or psychological factors. Often the cause of E.D. involves both physical and the psychological factors. Issues related to E.D. also include loss of sexual desire, premature ejaculation, or inability to reach orgasm. Many common diseases and conditions are associated with atherosclerosis and thus poor blood flow (note that one of the early indicators of heart disease is E.D.), including high blood pressure, high cholesterol, diabetes, vascular disease, cigarette smoking, depression…and aging.
For a younger healthy man where there is no obvious cause of E.D., a full work-up should be undertaken to find a potentially treatable cause before beginning any of the PDE5 medications. In young men, sexual dysfunction is often caused by emotional problems, particularly if there are relationship issues. Drugs and alcohol interfere with sexual performance, and stress, anxiety and fatigue may also play a role.
While E.D. is certainly not a fatal condition, it does result in a withdrawal from sexual intimacy and a reduced quality of life, and even decreased work productivity and increased health care utilization. These three drugs are now considered first-line treatment for the medical treatment of erectile dysfunction. So, which one may be right for you?
Viagra is the first and most famous of the PDE5 drugs. Because food decreases its absorption, it should be taken on an empty stomach, at least 30 minutes after dining. Cialis seems to be the clear choice for spontaneity, since it lasts for 36 to 100 hours and taking two to three pills per week is now an acceptable treatment. For patients with difficult to treat erectile dysfunction, Levitra may be the best choice as it has the highest potency. It can last up to 24 hours, and onset is very rapid. Viagra, however, remains the “gold standard” of PDE5 drugs. It has the longest safety record, though they all appear quite safe. I tend to let my patients try all three, and choose the one that works best and is right for their needs.
Side effects from Cialis, Levitra and Viagra are unusual. They do include headaches, recent reports of sudden hearing loss (which is still under investigation), facial flushing, stomach upset, and unusual visual disturbances including bright vision or a blue-green halo.
Which men should NOT be taking any of these medications?
- Anyone who has exhibited an allergy to any one of these three drugs should avoid all of them
- Those with any surgery pending, including dental surgery
- Those taking any nitroglycerin products, either in the short-acting or long-acting form, or any “alpha blockers” for prostate problems. The combination of these with Viagra, Levitra, or Cialis could lead to dangerously low blood pressure
- Anyone who has suffered a heart attack, a stroke or a life threatening heart rhythm problem in the past six months
Discuss these medications with your doctor. Incidentally…a Viagra-type drug is coming soon for women…stay tuned. Good health to you all!
Whole Grains
June 22nd, 2009Wonder Bread, anyone? What is the difference between white bread and 100% whole grain bread? America has an unfortunate love affair with simple carbohydrates. Is there scientific evidence to support the value of eating whole grains?
Let’s start with some background. Soluble fiber and insoluble fiber do not digest, so they are not absorbed into the bloodstream, and when they leave our bodies they have not contributed energy. So what good does fiber do?
Insoluble fiber passes through our intestines largely intact, and provides bulk to move stool through the intestine. This promotes regular bowel movements. Examples of insoluble fiber include vegetables such as green beans and dark leafy vegetables, fruit skins and root vegetable skins, whole-wheat and oat products, corn bran, seeds and nuts.
Soluble fiber, on the other hand, binds with fatty acids in the stomach and forms a gel. This gel lengthens the time it takes for your stomach to empty, allowing sugar to be released and absorbed more slowly, lowering total cholesterol including LDL (bad) cholesterol, and regulating blood sugar (critical for diabetics). Examples of food sources for soluble fiber include oat and oat bran, dried beans and peas, nuts, barley, flax seed and carrots, and fruits such as oranges and apples.
Scientific studies have shown that eating whole grains can lower your risk for several serious conditions, and refined grains have no impact:
- Four major studies, encompassing over 150,000 people, showed a significantly lower risk of heart disease (18% to 36%) among those who ate at least one serving of whole grains per day. This is a result, as explained above, of lowering LDL (bad) cholesterol. Whole grains also appear to improve insulin metabolism, which lowers the risk of heart disease.
- Whole grains have been found to reduce the severity of diabetes by as much as 20% to 30%. The soluble fiber in whole grains keeps carbohydrates from entering the bloodstream too quickly. This puts less stress on the pancreas and insulin production. It’s important to note that the effect on blood sugar doesn’t depend on simply whether you’re consuming whole wheat or white flour. Rather, what matters is whether the grain is finely ground, or intact in its native form like bulgur or brown rice. Refined whole grain flour, although certainly more nutritious, doesn’t help to slow down digestion, and makes your pancreas work just as hard as non-whole grain (white) refined flour.
- Whole grains may have their biggest impact in the bowel. To put it simply, insoluble fiber keeps things moving along. The average American consumes about 16 grams of fiber per day, but should probably consume closer to 32 grams per day. Current research is investigating whether consuming insoluble fiber directly lowers the risk of colon cancer; stay tuned.
We all want to improve our daily diet. What should be a reasonable goal? Eating “100% Whole Grain Chips Ahoy” is healthier then eating refined flour Chips Ahoy, but it’s still a cookie and certainly not, say, a piece of broccoli. This may seem like a step in the right direction, but we need to make a shift toward natural whole grain products that are nutritionally dense (filled with good nutritional ingredients). Also, don’t be fooled by products that contain a small amount of whole grain mixed in with mostly refined flour.
So the next time you go shopping for food, try to select more natural products that contain fiber, such as fruit, nuts, vegetables, barley, oats, beans, and brown rice.
As always, I wish you healthful eating.
Sugar
June 16th, 2009Suger - average American consumes an astounding 2-3 pounds of sugar each week. Refined sugar is the world’s most popular and widely used drug. (Webster’s Dictionary defines a drug as a “chemical substance used to alter the state of body or mind”) We don’t usually think of sugar and caffeine (another favorite stimulant) as “drugs”, but they both have marked effects on the human body. The World Health Organization (WHO) has launched an international campaign to cut consumption of refined sugar. The WHO states that sugar is the principal culprit in the current epidemic of obesity and its associated diseases, diabetes and cardiovascular disorders. Americans, who comprise only 5% of the world’s population, account for a whopping 33% of total global sugar consumption – over 10 million tons annually. According to the WHO, over half of all Americans are overweight and nearly a third, or 38 million people, are obese. How did we Americans become a nation of sugar junkies and obese people? Part of the responsibility lies with highly refined sugar being included in everyday foods in the form of sucrose (table sugar), fructose (fruit sugar), honey, and malts. Over the past 20 years, our sugar consumption has skyrocketed from 26 pounds to nearly 150 pounds per person per year.
Perhaps the greatest threat comes from the soft drink industry. Americans consume gargantuan quantities of carbonated soft drinks. Companies produce enough soda pop to provide 557 12-ounce cans, or 52 gallons, to every man, woman, and child each year. (Consumption of carbonated soft drinks actually peaked in 1998 when consumption was 56 gallons per person.) The average teenage boy consumes 3 1/2 cans of soda per day, while the average teenage girl consumes about 2 1/2 cans per day. Carbonated soft drinks are the single biggest source of calories in the American diet, providing about 7% of our total calories. Note that this data doesn’t even include fruit drinks, sugared teas, etc. A 12 ounce can of Coca-Cola® has 10 teaspoons of sugar, while a large Coca-Cola® Classic at McDonald’s has 27 teaspoons. A 7-Eleven X-treme Gulp™ has about 43 teaspoons of sugar. Picture in your mind’s eye 43 teaspoons of sugar piled up in front of you. That’s 7-Eleven’s idea of a drink!
Keep in mind that soft drinks are a problem not only for what they contain, but also for what they push out of the diet. In 1977, boys consumed more than twice as much milk as soda, and girls consumed 50% more milk than soda. By 1994-96, both girls and boys consumed twice as much soda pop as milk.
Sugar in our diet comes in many other forms besides soda. Manufacturers may include sugar as “evaporated cane sugar”, for example, or even as “all natural citrus extract”. Some foods are naturally high in sugar such as honey, molasses, apples, and applesauce, but it still ends up as sugar. Remember that the source of added sugar makes no difference to its ultimate effect, and that most processed sugar ultimately comes from natural sources. Sugar cane on a Hawaiian plantation is natural. In fact, looking at it one way, drinking freshly-squeezed all-natural orange juice ends up providing the same sugar as if you had spooned it directly from a bag. However please note that fruit and its accompanying sugar does get metabolized more slowly and contains many nutritiously beneficial ingredients as opposed to pure refined sugar. Fruit plays a key role in a wholesome balanced nutritious diet. Fruit juice, made from 100% fruit, is a positive addition to a balanced diet as opposed to a fruit drink made from mostly sugar and water. It’s the unnatural concentration of sugar in food processing that is harmful, not whether the source is “natural” or processed.
Why add sugar to food? Very simple: it tastes so good and sells more product. Adding sugar to practically any food is a cheap and easy way to increase its taste appeal. The Coca-Cola Company is an example of one of the most stable and profitable companies in the world. They sell caffeinated sugar water. Even Phillip Morris adds sugar to its cigarettes.
Added sugar is actually completely unnecessary for health. There are six essential nutrients: water, protein, fat/oils, carbohydrates, minerals, and vitamins. Sugar is a form of carbohydrate; however, every other carbohydrate gets broken down into simple sugar by the body, making any extra sugar we consume unnecessary.
Here are some simple strategies to follow as you attempt to lower your dietary sugar consumption:
-Read dietary labels. Remember that refined sugar is unnecessary for good health, so your goal is to eat as little as possible.
-Avoid carbonated or non-carbonated sodas and fruit drinks.
-Limit cookies, candy, cakes, ice cream and other foods containing refined sugars.
-Though fruit has sugar (fructose), it is metabolized more slowly than other refined sugars and contains other useful nutrients. It is a good dietary choice.
Bon appetit!
Stress
June 9th, 2009Life is stressful! We all face challenges and obstacles. Sometimes the pressure is just too much to handle. When we become overwhelmed or unsure of how to meet the demands placed on us, we experience stress. How do we know when stress and burnout are about to get us? Today, I will delve into the classic signs of stress and how it affects our bodies and minds.
Chronic stress is so prevalent that I am actually amazed when a patient comes in and says that he or she has none. 75 – 90% of all physician office visits are said to be in some part stress-related. In an American Psychiatric Association survey, 43% of adults claimed to be suffering from adverse health due to stress. Stress is linked to at least six leading causes of death: heart disease, cancer, lung disease, accidents, cirrhosis, and suicide. Stress is expensive and debilitating; it is detrimental to our health, productivity and life in general. Frankly, it is just plain horrible living under the cloud of chronic stress.
On a positive note, acute stress is necessary, exciting, and even desirable. It can act as a motivator and give us the push we often need. The birth of a child, a graduation, marriage, completion of a major project, or a winning lottery ticket will produce considerable short term stress. Without it, life would certainly be dull.
So what is stress? Stress is defined as a psychological and physiological response to events in our life that upset our personal balance. Regardless of whether an event is good or bad, these “stressors” push us beyond our coping and adaptive limits. This leads to a feeling of stress and the body’s normal biologic stress response. Stressors include frustrations, conflicts, and pressures.
The body reacts to stress by triggering the “Fight-or-Flight” response. Hormones such as adrenalin and cortisol are released, which give the body a burst of energy and strength. These hormones travel to the heart and speed it up. They travel to the gastrointestinal system and slow digestion, sending the blood to our muscles instead. We can then use these “supercharged” muscles to run away from danger.
When faced with chronic stress, people begin to see physical and psychological symptoms. These often begin as mild symptoms such as chronic headaches and increased susceptibility to infections. Over time, more serious problems develop. They may be intellectual, emotional, behavioral, and/or physical. Stress is likely a contributing factor to any health condition for which you are susceptible. Studies conducted back in the 1960′s showed that laboratory mice exposed to excessive noise and lights all developed measurably weaker immune systems. Stress is or may be a contributing factor in backaches, insomnia, cancer, chronic fatigue, memory and judgment problems, depression and anger, eating disorders, teeth grinding, high blood pressure, heart disease, cancer, rashes and infections.
Stress may also be a result of other health issues, so you will want to consult your doctor to evaluate underlying medical problems.
What can be done about stress? I leave you with a short list of approaches that may help:
-Understand what situations make you feel stressed.
-Understand what situations you can and can’t control.
-Prepare for stressful events in advance by thinking and planning for the future.
-Keep yourself healthy with good nutrition, exercise and regular relaxation.
-Try to do happy things every day. Plan events or vacations so that you will have something positive to look forward to.
-Limit caffeine and sugar, since they tend to stimulate more anxiety.
-Avoid recreational drugs that might alter your brain’s ability to respond in a healthy manner. Remember that alcohol is a depressant, not an anti-anxiety medication.
-Engage in activities that bring relaxation and happiness, such as yoga, meditation, and hobbies, and spend more time with friends and family (unless they are the cause of your stress!).
-Finally, consult your doctor to rule out underlying medical problems or, as a last resort, for possible pharmacological solutions.
I wish for you peace, relaxation, and happiness!
Aspirin
May 30th, 2009Should I be taking a daily aspirin?
This is a question I am asked daily. Once again, as is the case for so many important medical issues, the answer is…it depends!
The first form of aspirin dates back at least 2,400 years, when Hippocrates prescribed willow tree bark and leaves to relieve pain and reduce fever. In 1897 the German chemist Felix Hoffmann, motivated to relieve his father’s rheumatism, synthesized salicylic acid. Bayer started manufacturing the new medicine called aspirin. The rest is…as they say….history! It was in California during the late 1940’s that its blood thinning properties were noticed, and in 1988 the FDA proposed its use to reduce the risk of heart attack. With the development of ibuprofen (Motrin, Advil), acetaminophen (Tylenol) and Naproxen (Aleve), its use for fever and pain relief has lessened in importance. Also, since the early 1980’s, it is no longer recommended for use by children, due to its association with Reye’s Syndrome.
Aspirin’s widespread use today is due to its ability to thin the blood, keep it from clotting, and thereby reduce the risk of heart attacks and stroke. In addition, there is promising data on the possible slowing of cancers including colon cancer. All of this, and it’s cheap, too!
Current guidelines urge adults at risk of having a first heart attack in the next five years to take a daily dose of aspirin. (The proper dose for heart protection is 81mg daily. No additional benefits were found at higher doses.) Research suggests that if 1,000 people who had a 3% chance of suffering a non-fatal heart attack in the next five years took aspirin daily, then four to twelve of them would likely avoid a serious cardiovascular event.
The downside, however, is that four out of 1,000 would also end up in the hospital with a major gastrointestinal bleed, and another one in 1,000 would have a life-threatening hemorrhagic stroke. Further possible side effects include bleeding in the brain, kidney failure, liver damage in chronic alcohol users, ringing in the ears and hearing loss, and potentially life-threatening allergic reactions.
Will you be among those who will avoid a heart attack by taking a daily aspirin, or will you instead be hospitalized with a gastrointestinal bleed or another terrible side effect? How can you determine the odds of whether you will be helped or harmed by taking aspirin? Calculate your personal risk of having a heart attack in the next five years. There are several excellent web sites (listed below) that can help you do this. You will input your age, blood pressure, cholesterol level, gender, and smoking and diabetes history. The higher your five-year risk of heart attack, the higher will be the benefit of a daily dose of aspirin.
Does aspirin help both women and men? Research out of the University of British Columbia, Vancouver found that aspirin cuts the risk of a second heart attack in both men and women, but reduces the risk of a first heart attack only in men. The data does suggest that aspirin offers more of a stroke prevention effect in women than first heart attack prevention. Regardless, aspirin is commonly used for both men and women who are at high risk of heart attack or stroke and who have multiple risk factors for heart disease – such as those who smoke, have hypertension, diabetes, or a strong family history of heart disease.
Current exciting research is examining how aspirin and other non-steroidal anti-inflammatory drugs (NSAID’s) such as Motrin and Advil might serve to block an enzyme (COX) involved in cancer development. The most conclusive evidence comes from research on colon cancer, with breast cancer studies also showing great promise. However, the benefits are not apparent until after more than a decade of use, with maximum risk reduction at very high doses. At these doses, aspirin’s side effects (gastrointestinal bleeding in particular) can become a very big problem. The final word is not in on NSAID’s and their potential for cancer prevention.
It is clear that aspirin is not appropriate for everyone. Let me leave you with these guidelines:
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Do not take aspirin if you are under the age of 16.
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Do not take aspirin if you have a history of uncontrolled high blood pressure, liver or kidney disease, stomach ulcers, heartburn, upset stomach, asthma, or bleeding problems.
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Do not take aspirin if you are currently taking an anticoagulation drug (blood thinner) unless your doctor tells you to do so, if you consume more than three alcoholic drinks per day, if you are pregnant or nursing, or if you have aspirin-induced asthma or other allergies to aspirin.
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Do take aspirin if you have none of the above problems and your calculated or physician evaluated risk of heart attack, stroke, or colon cancer warrants its use. Use a risk calculation website like one of the following to help evaluate your personal heart attack risk:
Consult with your physician if you think that a daily aspirin might be right for you.
Vitamins
May 30th, 2009Should you take a daily vitamin? The answer to this question is not straightforward. Some studies show that vitamins can reduce the risk of heart disease, cancer and other medical conditions. On the other hand, guidelines from government agencies and health organizations often recommend that healthy people get their vitamins from a balanced diet. There is no question that vitamins and minerals are essential. We need them to live. However, taking larger doses does not automatically produce better health. In fact, an overdose of some vitamins can lead to significant side effects, just as a vitamin deficiency can have damaging consequences.
Clinical trials comparing the health of people who take vitamin supplements and people who do not often give conflicting answers. Some have found that vitamin supplements protect against diseases, some have found no benefit, and – it just figures – other studies have found harmful results! One example often cited is a 1995 study which showed an increased risk of lung cancer in smokers who took extra beta-carotene. A 2002 Harvard study on Vitamin A done on more than 72,000 nurses showed that those who consumed high levels of Vitamin A from foods, multivitamins, and supplements had a 48 percent higher risk of hip fracture compared to nurses who had the lowest intake of Vitamin A. Even nurses who ate foods high in Vitamin A had higher risks, and many foods are now fortified with the vitamin, such as milk, margarine, and breakfast cereals. There was also an association found between high levels of vitamin A and a higher risk of birth defects.
The New England Journal of Medicine asked two world authorities on nutrition how they would advise patients about taking vitamin pills. Doctors Willett and Stampfer of Harvard University weighed scientific pros and cons in a report published in November of 2006. Their conclusion? Many people indeed do not consume adequate amounts of vitamins in their diet.
In spite of the great confusion in the press and medical literature, we Americans have placed great hopes on the power of vitamins for our health. In a current survey, about three out of every ten Americans state that they take vitamins on a regular basis. As a nation, it is approaching a ten billion dollar a year business. For an individual, costs range from a few dollars a month for generic vitamins to hundreds of dollars for designer vitamins. Is this a waste of money, or worse yet, is it dangerous to one’s health?
Some of the biggest problems in our country with vitamin deficiency include poor absorption of Vitamin B 12 in the elderly, pregnant women’s need for more folic acid to prevent birth defects, and the need for additional calcium and Vitamin D in older women and men to enable bones to stay strong.
The two Harvard doctors suggested that people take one multivitamin daily in order to get 100% of the daily RDA (recommended daily allowance) of 11 vitamins needed for good health. Multivitamins often contain minerals as well, but not necessarily at the levels required. For instance, they seldom include enough calcium for good bone health. This single pill, however, may have a big impact on health, at a cost of just pennies per day.
Remember, taking vitamins is not a substitute for a healthy diet. Nor does it eliminate the risks caused by unhealthful habits such as cigarette smoking, excessive alcohol consumption, lack of exercise, or a poor diet.
So, remember…
-Vitamins won’t fix a lousy diet or lifestyle. They do not neutralize fat, salt or sugar. They do not provide the nutrients and fiber found in fresh fruit and vegetables.
-If some vitamins are good, more are not better. Fat-soluble vitamins such as Vitamin A, D, E, and K can accumulate in the body and become toxic at high levels of consumption.
-Vitamins alone will not keep you healthy. It takes good genes, exercise, diet, avoiding poor habits and lots of luck.
-Science has not proven otherwise: a good balanced generic multivitamin will do just fine. You can add calcium, Vitamin D, iron, or other supplements as you and your doctor decide. I do not recommend that you spend a fortune on designer vitamins.
Good health to you all.
Organic Food
May 30th, 2009Organic or non-organic…how do you choose? What is organic, and is it worth the extra money? Is it safer, more healthful than “regular” food? Let’s take a look at these questions.
Organic foods are grown and processed according to certain production standards. They are grown without the use of conventional pesticides, artificial fertilizers, human waste or sewage sludge, or genetic modification, and they are processed without ionizing radiation or food additives. Livestock are raised without antibiotics and growth hormone. Organic food production is highly regulated, and producers must obtain certification in order to market food as organic.
Historically, organic food was produced on small family farms, which is why organic food was once found only in small stores or farmers’ markets. Since the early 1990’s, however, organic food production has experienced steady growth. In 2008, organic food represents 1-2% of food sales worldwide, and is projected to represent a much more significant percentage of total food sales in the future.
Many organic farming advocates question whether conventional farming is harmful to the environment. Scientific consensus on environmental impact is mixed. Organic farming certainly does leave fewer synthetic pesticides behind, and sustains a more diverse and healthier ecosystem for plants, animals and insects. However, it also uses more land then does conventional farming, and can potentially destroy a greater volume of rainforest.
Are organically grown foods more healthful than conventionally grown foods? Many studies have been conducted on pesticides and their potential harmful effects. One key argument for purchasing organic food has been the simple fact that organic foods contain less pesticide and pesticide residue; they generally contains only about one third the amount of pesticide of conventionally grown food (organic farming allows for certain plant pesticides, but no synthetic pesticides). However, the federal government sets strict standards for allowable amounts of pesticide residue, and legitimate conventional foods fall well below those levels. Needless to say, there is still ample controversy over the safety of certain pesticides. Studies continue to be conducted on this critical matter.
Do organic foods provide greater nutrition than conventionally grown foods? The Soil Association conducted a study to compare the vitamin and mineral content of organic foods vs. non-organic foods. The organic foods won out with higher levels of all 21 of the examined nutrients. The largest study to date of organic food was completed in 2007 and found that organic food had 40% more antioxidants than conventionally grown food.
Perhaps the most powerful reason for consumers to favor conventionally grown food over organic is simply cost. Organic foods typically cost 10% to 50% more than similar conventionally produced products and up to 100% more for organic meat and dairy products. This alone becomes a prohibitive barrier for most of us, especially in time of economic recession.
I can’t conclude without adding my mother’s memorable words regarding the nourishing yet non-organic diet of my own childhood: “I was raised on this food, and turned out just fine”! I will leave to you the task of working through the cost vs. benefit analysis regarding organic food. Remember to eat a balanced and wholesome diet, whether organic or not.
Good health to you all.
Sunburn
May 30th, 2009Take a good look at that photo – I happen to be blond-haired, blue-eyed, and have a fair complexion. Unfortunately, I also love the out-of-doors and my favorite activities do little to shield me from the sun.
Regardless of skin type, however, sunburn is bad for us. It’s a burn to living tissue due to overexposure to ultraviolet (UV) radiation, typically from the sun’s rays. UV exposure can also cause invisible damage and premature aging of the skin, including early wrinkles and splotchy pigmentation changes. Excessive UV radiation is the leading cause of skin cancer. Skin cancer is the most common type of all cancers in this country, and the number of cases continues to rise. It is the uncontrolled growth of abnormal skin cells, resulting in tumors, which are either benign (non-cancerous) or malignant (cancerous).
There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma. Basal cell and squamous cell cancers are generally less serious and account for 95% of skin cancers. They are highly curable when treated early, although squamous cell cancers can spread internally if left untreated. Melanoma is far more serious and causes 75% of all skin cancer deaths.
Sun exposure today is indeed more dangerous then when we were younger. In recent years, the incidence and severity of sunburn has increased worldwide, especially in the southern hemisphere. Dangerously high levels of UV radiation are widely held to be due to the damage to the ozone layer.
Sunburn can occur in less than 15 minutes from the sun’s UV rays! Skin can turn red in as little as 30 minutes. Pain is usually at its most extreme between six and 48 hours after exposure. You may experience redness, swelling, blisters, fever, chills, weakness, and dry, itching, and peeling skin for days afterwards.
Sunscreen protects our skin from sunburn and minimizes suntan by absorbing these UV rays. In effect, sunscreen acts as a filter, keeping the harmful rays away from our skin. Choose a broad-spectrum sunscreen that filters out both UVA and UVB rays. Apply sunscreen to all exposed areas of the skin, including overlooked areas such as rims of the ears, lips, back of the neck and tops of the feet. If you will be getting wet, be sure to use a waterproof or water-resistant sunscreen. Keep in mind that no sunscreen blocks 100% of UV rays. The SPF (Sun Protection Factor) indicates the degree of protection. The higher that number, the better the protection, and that protection also depends on your skin type. For example, an SPF of 10 indicates that it will take ten times longer for your skin to burn then if you wore no sunscreen. If a fair-skinned person would burn in five minutes under the strong midday sun, an SPF 10 would enable her to remain outside for fifty minutes before burning — ten times longer than with no sunscreen. A darker-skinned individual who might burn in 20 minutes without sunscreen could stay out for 200 minutes before burning.
Contrary to popular belief, research shows that the best protection is achieved by application 15 to 30 minutes before sun exposure, followed by one reapplication 15 to 30 minutes after the exposure begins. Further reapplication is only necessary after activities such as swimming, sweating, and rubbing.
Is sunscreen really enough to keep us safe? While most sunburn can indeed be prevented through its proper use, scientists question the effectiveness of sunscreen in preventing malignant melanoma and believe that its use could actually be counterproductive. Here’s why: Sunburn appears to be directly related to the formation of basal cell and squamous cell carcinomas of the skin (the more easily treatable kinds), but the connection to melanoma is being questioned. Although UVA rays and repeated sunburn have been linked to melanoma, they are not the only risk factors: ethnicity, presence of moles, and family history may increase risk as well. The problem is that sunscreen is so very effective against sunburn, basal cell, and squamous cell carcinomas that it does allow us to spend more time in the sun. The longer the sun exposure, the more likely that free radicals will form within cells. Free radicals are known to destabilize molecules and thus whole cells, which in turn increase the risk for malignant melanoma. Therefore, the best skin cancer prevention is to limit sun exposure altogether.
What can you do to treat sunburn? Most important, avoid the sun while healing and take precautions to prevent future burns. The best treatment for most sunburn is time. However, there ways to help manage the pain and encourage the healing process.
* Start with a cool bath or use cool compresses on the sunburned area. One home remedy suggests applying a clean washcloth soaked with cool milk. In addition to the soothing cool temperature, a protein film will form to ease the pain, and the lactic acid will help reduce inflammation. A solution of diluted white cider vinegar (one cup in a tub of water) applied in a similar fashion may also reduce pain.
* Apply a topical moisturizer, aloe gel, hydrocortisone cream, or a topical pain reliever.
* If blisters are present, do not break them open; that will increase the risk of infection. A blister is the body’s way of protecting itself while new skin is forming underneath.
* Take Acetaminophen (Tylenol) Ibuprofen (Motrin, Advil), or Naproxen (Aleve) for discomfort.
Here in Southern California, we are fortunate to have our lovely long and sunny days, and hiding inside would be a shame. Here are measures that you can take to minimize the risk of sun damage.
* When possible, choose to stay away from the sun during midday, when its UV rays are at their most damaging.
* Wear protective clothing such as a long-sleeved shirt and hat.
* Use sunscreen with an SPF factor of 15 or higher on all sun-exposed skin. Most sunscreens wear off from sweating or swimming and must be reapplied. Remember that UV rays come through even on hazy or cloudy days.
* Wear sunglasses. UV absorption of 99 to 100% (or, “up to 400nm”) is recommended. Watch for the words “absorption” or “blockage”, rather then “protection”.
* Avoid sun beds and tanning salons. They significantly increase the risk of skin cancers as they emit UVA and UVB radiation.
* Be meticulous in providing sun protection for children. Caution them about the harmful effects of excessive sun exposure.
* Perform a monthly self-examination in front of a full-length mirror to inspect all parts of your skin, including palms and soles, back of the torso and back of the legs. Get some help – one out of three melanomas in men are on found on the back.
* See your physician if you observe any new, changing, or suspicious lesions.
Have a safe and sunburn-free summer!
Longevity
May 30th, 2009As a marathon runner, I simply had to find a way to work Buster Martin into a column. Buster is a 101-year-old Englishman. He is not only that country’s oldest workingman, but is the world’s oldest marathon runner. Just last month, he completed the 2008 London Marathon in approximately 10 hours. Mr. Martin promised to celebrate with a pint of beer and a cigarette. When asked what his secret is, he stated that he “hasn’t got one”.
Back here in the United States, average life expectancy has been continuously on the rise. This is the result of drops in infant mortality, effective public health policies, vaccinations, cleaner water supplies, improvements in the treatment of various diseases, and more healthful lifestyles. The increase in longevity has favored women: 100 years ago, women outlived men by only two years, and in 2001 they outlived us by five years. 1,000 years ago, a newborn’s life expectancy was 24 years. A baby born 100 years ago had a life expectancy of 51 years. By 1953, that life expectancy rose to 66 years for baby boys and 72 years for baby girls. And finally, if that baby boy was born in 2001, he could be expected to live to 74, and a baby girl to 79.
Centenarians observe interesting traditions around the world. Here in the United States, President Bush will send a greeting on their 100th birthday. The Today Show might announce their name on the air (a nice touch for someone who was 40 years old before even 2% of American households owned a television set!). In the United Kingdom, the Queen sends greetings on the 100th birthday and then on every birthday starting with the 105th. The Irish receive a 2,540 Euro “Centenarians Bounty” (that’s over $4,000) along with a letter from the President of Ireland. In Japan, they receive a silver cup and a certificate from the Prime Minister.
What can we each do to enhance our chances of living, like Buster Martin, a long and healthy life?
* Be active, both mentally and physically. You don’t have to be an exercise fanatic; just keep moving.
* Limit processed foods and eat natural whole foods such as fruit, vegetables, nuts, beans, and grains.
* Stay married. Many studies confirm that married people live longer than single people.
* Maintain your ideal weight. Being overweight will definitely limit your chances of becoming a centenarian.
* Drink alcohol moderately and don’t smoke cigarettes at all. Are there exceptions to this rule, like Buster? You bet. But as many of us have learned in Las Vegas, it is always better to stack the odds in your favor.
* Eliminate unnecessary stress – it shortens your life. According to Thomas Perls, Director of the New England Centenarian Study, one thing centenarians have in common is the ability to shed stress in a way that doesn’t let it get to them. “They don’t seem to internalize stuff”.
* Develop close and respectful relationships with your friends and loved ones.
* The most important factor of all? Have good genes. Extreme long life seems to run in families and may be based on common genetic and environmental factors. If you have had a centenarian grandparent, parent, or sibling, your chances of living past the century mark increase dramatically.
I wish you good health and long life! See you at the next marathon…
Sodium
May 26th, 2009“The number of deaths that occur because we eat too much salt is equivalent to a jumbo jet crashing every single day,” according to Stephen Hayas, professor of epidemiology at the University of Maryland School of Medicine. To me, this is unimaginable. These Americans die daily from heart attacks, strokes, and other diseases caused by the impact of salt on their blood pressure. Salt intake is a crucial issue for the 30% of Americans with hypertension, the 30% with pre-hypertension, and the 90% of Americans who will eventually get hypertension if they live to age 75.
We know that it is a major problem. So why don’t Americans care about their salt intake? Why do restaurants continue to put massive amounts of salt in our food? The Institute of Medicine recommends that we eat no more than 1,500 mg of salt each day. Most people consume at least 4,000 mg per day.
Scientifically, the evidence that links salt intake to elevated blood pressure is overwhelming. In industrialized countries, blood pressure tends to creep up gradually. The famous Framingham Heart Study followed 55 and 65 year olds with normal blood pressure for 20 years. By age 75 or 85, 90% of them had hypertension.
How can you prevent hypertension? Cutting back on salt may prevent or at least delay the upward trend of your blood pressure as you grow older. The precise cause of hypertension in most people, known as essential hypertension, is generally unknown. However, we do know that excess salt and weight, insufficient exercise, and inadequate consumption of fruits and vegetables contribute heavily to the process. It is interesting that in non-industrialized nations, where salt intake is far lower, blood pressure does not creep upward with age. Even a small drop in blood pressure of just two points has a profound impact on the prevention of heart attacks and strokes. A 50% drop in the sodium content of packaged and restaurant foods can lower the average systolic blood pressure by five points. That translates to a 20% reduction in the prevalence of hypertension and roughly 150,000 fewer deaths per year.
If you are already on medication for hypertension, as are one of every two people over the age of 60, is there still a reason to cut back on salt? It appears that blood pressure medication works better with lower salt intake. Cutting down on salt may also help get some people off their blood pressure medicine completely. When researchers in the TONE (Trial of Non Pharmacologic Interventions in the Elderly) study took 975 older people off hypertension drugs and had them cut their sodium by 1,000 mg per day, half were able to keep a normal blood pressure WITHOUT drugs for the rest of the 2 1/2 year study. The DASH diet (Dietary Approaches to Stop Hypertension) has proven to lower blood pressure. This is a low-fat diet rich in vegetables, fruits, and lower fat and fat-free dairy foods, and is high in potassium, which helps to neutralize sodium’s harmful effects.
As a patient, where do you go from here? Most important: Get your blood pressure under control. The new target is 120/80 or lower, depending on your other health issues. Nearly 60% of people with high blood pressure are being treated with medication, and fewer than half of those are at their correct target level. Next, check your diet. Cut your sodium to 1,500 mg – 2,000 mg per day. Look up information on the DASH diet and follow it. (Incidentally, this diet fits perfectly with my previous columns addressing nutrition.) Even if you have already stopped using that salt shaker, keep in mind that 75% of our sodium intake comes hidden in the processed foods we buy. We need to encourage food manufacturers to cut back on salt content, and the Food and Drug Administration to put pressure on them. At least two countries, Australia and England, are already ahead of us with a campaign to embarrass companies who fail to reduce sodium levels in their products and to educate their citizens on the evils of too much salt. Just a few weeks ago, Australia launched a five year salt reduction campaign called Drop the Salt. It unites health professionals, the food industry, government, scientists and consumer organizations in a commitment to reduce salt intake. Based on overwhelming scientific data…it’s about time!
Here is a strategy for reducing your sodium intake and thereby lowering your blood pressure and your risk for stroke and heart attack:
-Learn to read food labels. If your target is 2,000 mg of sodium per day, then you clearly must avoid fast food, since most hamburgers contain 1,100 to 1,800 mg. Note that two slices of Pizza Hut’s Meat Lover’s Stuffed Crust Pizza contain 3,380 mg of sodium!
-Eating out at restaurants is tough but manageable. Ask your waiter about low sodium dishes.
-Processed foods such as canned soups, frozen foods, lunch meats, salad dressings, soy sauce, marinades, tomatoes, chicken broth, rice and pasta mixes, and chicken are loaded with salt. Look for low sodium options. Again, read those nutrition labels!
-Eat a DASH diet rich in fruit and vegetables and low in fat.
-For those of you who are overweight, develop a strategy to lose it. Elevated blood pressure is just one more reason to finally start an effective weight loss program.
-Exercise daily.
-Limit alcohol. Excessive alcohol (generally, more than one or two drinks per day) will raise blood pressure.
-Find ways to lower your stress level. This will be a topic for a future column.
-As always, have a discussion with your physician. Your first priority will be to get your blood pressure where it belongs by any means available, including medication. Then, work on the items above.
As always, I wish you good luck and good health!!
Gas
May 26th, 2009Does milk give you gas? Between 30 and 50 million Americans are lactose intolerant, and some ethnic groups are far more affected than others. If your ancestors come from Asia, chances are more than 90% that you can’t tolerate dairy and other foods high in lactose. 80% of African Americans, and over 80% of Native Americans are lactose intolerant as well. Lactose intolerance usually appears after puberty and, unfortunately, it will never go away. While this diagnosis is unpleasant, it is relatively easy to live with.
Lactose intolerance is the inability to digest significant amounts of lactose, the major sugar found in dairy products. It is caused by a shortage of the lactase enzyme, which is produced by the cells that line the small intestine. Lactase breaks down milk sugar into two simpler forms of sugar called glucose and galactose, which are then absorbed into the bloodstream.
People who don’t make enough lactase to digest the amount of lactose they consume may feel very uncomfortable as they digest milk products. Common symptoms range from mild to severe, and include nausea, cramps, bloating, gas, and diarrhea. They begin about 30 minutes to two hours after eating or drinking foods that contain lactose. The severity of symptoms depends on many factors, including the amount of lactose you can tolerate, your age, ethnicity, and digestion rate.
Common tests used to measure how well lactose is absorbed in the digestive system are the lactose tolerance, hydrogen breath, and stool acidity tests. As a first step, however, save that trip to the doctor: simply eliminate dairy from your diet and see whether the symptoms go away.
To treat lactose intolerance, either eliminate lactose from your diet (dairy products) or supplement your diet with the lactase enzyme. Lactaid, for example can be purchased just about anywhere, and requires no prescription. Take the tablets or liquid with the first bite of that ice cream, or the first sip of that latte. It’s easy to find lactose-reduced milk and other dairy products in most supermarkets. They generally include the same nutrients.
For those who are lactose intolerant, it may take some effort to consume sufficient calcium. When planning meals, make sure that each day’s diet includes enough, even without dairy. Remember that the more a product is processed, the less lactose it contains. Fresh milk is very high in lactose, yogurt lower, cheese even lower and butter has hardly any lactose at all. Yogurt with active cultures is actually a good source of calcium for lactose intolerant people; although yogurt is high in lactose, the bacterial cultures used to make it produce some of the lactase enzyme required for proper digestion. Some dairy products that are lower in lactose are swiss cheese, cottage cheese, and ice cream. Non-dairy, calcium-rich foods include soymilk, dark green vegetables such as broccoli and lettuce greens, fish such as sardines, salmon, and tuna, oranges, and pinto beans.
Remember:
* Lactose intolerance is quite common, and is not a life-threatening health condition
* You can easily learn by trial and error which dairy products and other foods can be eaten without discomfort
* Many people can enjoy milk, ice cream, and other dairy products if they eat them in small quantities or eat other foods at the same time
* Try taking lactase (pill or liquid form) before consuming dairy
* Watch your calcium! Make sure that your diet includes greens, fish, and other calcium rich foods. Consider taking a calcium supplement as well.
* Always speak with your doctor before taking new pills or supplements
Healthy eating to you all!
Flu vaccine
May 26th, 2009Which disease was responsible for 50 to 100 million deaths worldwide in 1918? The flu! Not what you guessed? This common viral disease is now easily preventable by means of a yearly vaccination. Have you had the flu vaccine this year? For those of you who have not, is it because you’re worried about getting sick from the shot itself? Allow me to clear up any confusion.
The 1918 epidemic was by far the worst in recent history; two later major epidemics in 1957 and 1968 killed 70,000 and 33,000 Americans, respectively, but had nowhere near the fatalities of that earlier tragedy. Over the past 20 years in the United States, there have been 11 flu epidemics and over 20,000 have died each year.
Who dies from the flu? In most epidemics, 90% of those who die are older than 65 and the remaining deaths are primarily among children under the age of five. Otherwise healthy people between those ages usually have no serious or life threatening encounters with the flu. The 1918 epidemic is famous for a few reasons: It not only killed the most people of any flu epidemic, but the vast majority of the deaths were among young healthy people who normally do not die from the flu.
A flu epidemic occurs when the flu virus evolves significantly from strains that had circulated before. This occurs rapidly, and when the current vaccine is not effective against the new virus, the population does not have immunity, and there is no time to create a new vaccine. The result is that many people get sick. Scientists keep a close eye on new strains and patterns of global spread of the flu in order to anticipate and prevent potential major epidemics.
The flu vaccine is inactivated, meaning that it contains virus that has been killed. Killed virus cannot give you the flu! Each vaccine contains three strains of influenza viruses, which change each year based on international surveillance data and scientific estimations about which types and strains of viruses will circulate. It takes the manufacturers of flu vaccine nine months to create a new vaccine, so they have to predict early in the year which strains will be most prevalent. This is accomplished by sampling flu viruses from all around the world and basically voting on the three most likely to cause trouble.
The major side effects from the flu vaccine are possible fever, headache, and body aches that may occur from 8 to 24 hours after receiving the vaccine. Much less common, affecting people allergic to eggs or some other component of the vaccine, is hypersensitivity or allergic reactions ranging from rash to serious breathing trouble. Finally, approximately one in a million people vaccinated can get the very rare Guillian Barre Syndrome, a progressive and usually reversible neurologic disease.
The flu vaccine does not provide immediate protection, but takes about two weeks to kick in. At that time, antibodies providing protection against the virus infection develop. Even when the flu vaccine does not contain an exact match to the invading flu virus, it usually still provides some protection.
The best time to get vaccinated is during the months of October, November, and early December. Flu season can begin as early as October and usually goes on until May. Almost everyone can get vaccinated, and it is highly recommended if you are at high risk of serious flu complications or if you live with or care for someone at high risk for serious disease. People at high risk include children aged six months through five years, pregnant women, those who are 50 and older, people of any age with chronic lung or heart disease or various cancers, and people who live in nursing homes and other long term care facilities.
Whenever possible, take advantage of preventive measures, including vaccination. An ounce of prevention is always better than a pound of cure. I wish you all good health and happy holidays.
Fingernails
May 26th, 2009Do fingernails give clues about your health? Do you see differences in color or texture, bumps, ridges, or white spots? Is your child…or are you…a nail biter?
The appearance of your nails can be an indication of what is happening within your body. “Clubbing”, a painless buildup of tissue around the ends of the fingers, is a classic finding in chronic lung disease. Pale nail beds are seen in a person with significant anemia (low red blood cell count) because there is not enough blood circulating to that part of the body. Dark lines beneath the nail may represent melanoma, a skin cancer. White nails are often seen in chronic liver disease. Red nail beds can be a sign of heart disease. A thickened and yellow appearance is easily recognizable as a fungal infection. Beau’s Line is a horizontal groove in your nails, which may be a sign of diabetes, circulatory ailments, malnutrition or severe dieting, or high fevers. A single groove may represent a single traumatic event or injury to the nail. (Refer to WebMD.com for more details.)
Do doctors actually diagnose serious diseases by looking at the nails? In reality, a patient will present with other more significant or dramatic symptoms of a disease well before any nail changes occur. For instance, a patient with emphysema will complain of shortness of breath long before the nails start to club. Also, classic nail changes don’t necessarily occur to everyone with a similar disease, and not everyone with a particular nail change has the associated disease. In other words, the nails changes are not consistent or predictive of a particular disease. (If your nails look reddish, a classic sign of heart disease, first check to see if your nail polish has been fully removed!) Nonetheless, it is important to keep an eye on your nails, both to keep them healthy and because they can be an indication of changes in our bodies.
When should you see your doctor? When healthy fingernails or toenails begin to change color or texture, have irregular growth, pitting or holes, or dark brown streaks, you will want to seek help.
Parents can attest to the frustration of watching their children biting their nails 24/7. What we all want (or do…) say is that they will get their fill of bug eggs by consuming their nails! What is the reality? Fingernails are largely made up of the protein alpha-keratin, as are hair, wool and rhinoceros horn. Still, the nutritional benefits are pretty low. How about the negatives? Constant chewing on hard nails will certainly damage tooth enamel. As we’re all aware, the area under the fingernail is one of the dirtiest in our body. This is an excellent way to get sick by introducing unclean fingers and nail beds into your mouth. Compulsive nail biters also bite the surrounding skin and cuticle, breaking down skin barriers and transferring opportunistic microbes and viruses into the mouth. It is outside the scope of this article to explain the reasons why people bite their fingernails; it is clear that more healthful alternatives need be found to cure someone of this habit.
How can you keep your nails healthy and free of infection?
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Keep your nails clean and dry
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Avoid nail biting
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If necessary, apply moisturizer to your nails and cuticles on a daily basis. Creams with urea, phospholipids, or lactic acid can help prevent cracking
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File your nails in one direction and round the tips slightly
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Don’t remove the cuticles or clean too deeply under your nails
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Don’t dig out ingrown toenails. See a dermatologist or podiatrist if they become a problem
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Avoid nail polish removers that contain acetone or formaldehyde
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Bring your own instruments if you get frequent manicures or pedicures
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If you have artificial nails, check regularly for green discoloration, a sign of bacterial infection
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Consult your doctor if you have any concerns
Happy New Year!
Cellphones
May 22nd, 2009Is your cell phone dangerous? With more than two billion cell phone users worldwide (as of August 2005), concerns are growing regarding possible health risks. Today I will address the basis for these accusations and take a look at the two sides of this hotly debated issue.
If you ask the World Health Organization, cell phone use does not result in any serious health problems. They feel that the amount of radiation associated with normal use is to too low to produce significant damage. Still, the question of possible health consequences of exposure to long term, low level radiation has been raised by the international community. Some nations have already set guidelines limiting cell phone use. In Austria, Germany and Sweden, citizens are being told to use hands-free devices to limit radiation to the head, to keep mobile phones away from the body, and use them in the car only with an external antenna. So, in international circles, questions do remain about long term safety.
The problem is that there is no proof that these phones are absolutely safe. Long-term studies have not been conducted, since cell phones have only been in common use for a relatively short time. The research so far has produced conflicting results, and many studies are flawed and unable to be replicated. A few have suggested that low levels of exposure could accelerate the development of cancer in laboratory animals. However, many of these animals were already genetically engineered to develop cancer. Other studies exposed the animals to radiation from cell phones for up to 22 hours per day. Although these are extreme conditions, they’re too close for comfort! Three large epidemiological studies have been published since December 2000, and none of them found any harmful health effects from wireless phone exposure. However, none of the studies can answer questions about long-term exposure, since the average period of phone use in these studies was around three years. I suspect that future studies will focus on finding where the safest limits are in terms of duration and proximity of exposure.
What do cell phones actually do to us? They use electromagnetic waves in the microwave range, and release radiation, or radiofrequency energy. This energy can potentially be harmful due to thermal, non-thermal and genotoxic effects.
A Thermal effect is caused by cell phone microwaves heating living tissue. When a person uses a cell phone, their head is exposed to this heat, which causes the temperature of the head to increase by a fraction of a degree. This is much less then the increase in temperature caused by sitting in the sun. Blood vessels and active circulation are capable of handling this excess heat by increasing local blood flow. One area of concern is the cornea of the eye, which has little circulation and therefore is less able to regulate temperature. Premature cataracts are seen in engineers who work on high power radio transmitters at similar frequencies. To date, cataracts have not been linked to cell phone use; cell phones have a far lower power output than high powered transmitters. Temperature increases also can affect nerve fibers in the brain. Swedish researchers have noted a small increased risk of acoustic neuromas (a type of brain cancer) in people who use their cell phones continuously for a decade or longer.
Non-thermal effects of cell phone use result from the low-frequency pulsing of the carrier signal. No health problems have been observed.
Genotoxic effects are the most difficult to measure. Cancer data has been analyzed by several studies. A Danish study from 2006 observed over 420,000 citizens over a 20 year period. It found no link between cancer and cell phone use. This conclusion has been supported by studies from Britain, Germany and Sweden as well. Only one study, mentioned above, showed a relationship between acoustic neuromas and cell phone use. Research from Greece found a direct link between cellular phone use and damage to DNA. Twelve collaborating laboratories in several countries conducted research that yielded compelling evidence of DNA damage to cells in in-vitro cultures. (In-vitro studies are those done outside of the body in laboratory situations.) More studies will follow.
Finally, Electromagnetic Hypersensitivity Syndrome (EHS) has been observed among cell phone users. Some users have reported feeling several non-specific symptoms during and after use, including burning and tingling sensations in the skin of the head and extremities, fatigue, sleep disturbances, dizziness, loss of attention, reaction times and memory problems, headaches, malaise, rapid and irregular heart beats, and trouble with digestion. However, the World Health Organization has not supported this possible causal relationship.
What steps can you take if you are concerned about health risks from Radio Frequency (RF) exposure?
* Time is a key factor in how much exposure a person receives. Reduce the amount of time you are using your cell phone.
* If you must use wireless devices every day, place more distance between your body and the source of the RF. The exposure level drops off dramatically with distance. Use a headset and carry the phone away from your body.
* Remember that as soon as you turn on your cell phone, it is transmitting pulses of microwave radiation; this is how cell phones communicate with their network. Turn off your phone when you don’t need it.
* Finally, for your children and teens, do not buy cell phone plans with a lot of minutes. The more you give them, the more they will use. Put a cap on their use.
I wish you all short conversations and safe communication.
Caffeine
May 19th, 2009It is our favorite “psychoactive” drug (a substance which affects the mind or behavior). In this fast-paced modern society, this substance has become a means for the working world to get started early in the morning and to stay awake and alert throughout the day.
How safe is the caffeine in your coffee? You get no warning label with your cup of coffee other than that its contents could be extremely hot. Like other psychoactives, caffeine is undoubtedly best used in moderation. That means drinking one to two cups per day. It is primarily with excessive consumption of caffeinated beverages that the real health risks start to emerge.
Let’s start from the beginning. Caffeine is a drug. It acts by binding to adenosine receptors in the brain. Adenosine is a chemical that slows down brain activity. If your brain’s receptors bind to caffeine, then they will not be available to bind with adenosine, so activity is not suppressed, concentration is heightened, and fatigue is lessened. Simply put, caffeine tends to over-exaggerate the stress response.
Believe it or not, there are plenty of health benefits brewing in America’s favorite beverage. Caffeine happens to be a drug that could lower your risk of diabetes, Parkinson’s disease, and colon cancer. It can lift your mood and treat your headache. It can decrease fatigue, improve memory and mental functioning, and speed up reaction time. Caffeine increases your basic metabolic rate, so you burn more calories (although exercise is still better!). Caffeine may reduce the risk of developing gallstones. In very recent studies, it even looks like it reduces the risk of type two diabetes mellitus and liver disease, including liver cancer. Coffee beans even contain antioxidants. In study after study, these findings are confirmed and appear to be genuine. In fact, the findings suggest that the more you drink, the more the benefit.
Given all of this, are you surprised that 64% of Americans drink caffeine on a daily basis in the form of coffee, tea, soda, diet medications, and a multitude of energy drinks?
But…..everything has a price, and I’m not merely referring to the cost of that cup at Starbucks!
Let’s put your caffeine intake in perspective. One old-fashioned eight ounce cup of Maxwell House coffee contains about 110 mg of caffeine. Tea made traditionally from a tea bag might have about 50 mg. A can of soda contains between zero and 60 mg. You’ll find about 20 mg in an ounce of dark chocolate. A dose of two Excedrin contains 130 mg of caffeine. Now, compare that to a single grande coffee at Starbucks. For the handful of readers, including my mother, who have never been to Starbucks, “grande” is their medium sized, 16 ounce cup. It packs a walloping 550 milligrams of caffeine!
We are becoming an increasingly more caffeinated society. You may have heard of “Cocaine”, the newest energy drink, marketed so far in only Los Angeles and New York. Containing 280 milligrams of caffeine, this 8.4 ounce drink is 350% stronger than Red Bull! On an ounce-for-ounce basis, “Cocaine” has the same amount of caffeine as that grande cup of Starbucks coffee we discussed above. Our youth have become caffeinated beverage sellers’ favorite new target consumer group.
Caffeine is clearly an addictive drug. While this fact has been debated for many years, the bulk of evidence supports the notion that caffeine produces dependence for most people, and that withdrawal is a real syndrome. Ask anyone who has tried to quit cold-turkey, and you will hear about withdrawal headaches, fatigue, irritability, nausea, sweating, and/or attention difficulties.
Caffeine’s dangers involve elevating blood pressure, blood sugars, and blood cholesterol levels, decreasing bone density which can lead to osteoporosis, and over-stimulation effects including tremors, heart palpitations, insomnia, heartburn, hypertension, and anxiety. Caffeine is a diuretic, causing water to be flushed from the body, which could lead to dehydration and all of its associated health problems. Finally, doesn’t it bother you just a bit that approximately 64% of our society can’t face a day without their cup of coffee? More and more of those 64% are young people who have made it a daily habit to visit the various coffee houses, spending sizable chunks of change to support their habit.
So what is the bottom line?
-If you currently consume coffee without any adverse affects, then it is probably safe to continue your present level of caffeine intake.
-Have your blood pressure, fasting blood sugar, and cholesterol levels checked. If they are elevated, you should reduce your caffeine consumption.
-If you have tremors, palpitations, insomnia, or unacceptable levels of anxiety, you should reduce your caffeine consumption.
-If you have osteoporosis, you should reduce your caffeine consumption.
-If you are bothered by the fact that you require a dose of caffeine every day just to get by, you may…on principle…wish to taper off the drug. You may consider substituting green tea with approximately 30 mg of caffeine per cup as a safer alternative. Green tea has antioxidants as well.
-Finally, you may be fantasizing about a fabulous cruise vacation but just can’t afford it. Calculate how much you are spending on your daily coffee consumption, and then imagine how that money could be put to use on your next fabulous vacation! For example, if your favorite coffee costs $3.50 per day, then in one week you have spent $24.50. In one year that comes to an astounding $1,277 for your ONE coffee per day. In parting today, let me say…Bon Voyage!
Bottled water
May 19th, 2009When you drink your next bottle of water, will you picture the pure mountain spring from whence it came? Will you be stronger and healthier as a result of drinking that water?
In 2006, Americans drank about a billion bottles of water per week. That comes to 167 bottles per person per year in America. We have raised a generation that views tap water with suspicion, and is willing to pay three to four times the cost of gasoline for bottled water. Furthermore, the cost to society includes moving these bottles around every week in ships, trains and trucks. We purchase these bottles of water with the images of majestic mountains, beautiful glaciers, and crystal clear springs firmly implanted in our minds. Are we consuming something pure and healthful, or is the marketing misleading? Is bottled water indeed purer than tap water?
Bottled water seems like a pretty new idea – one born during this era of heightened awareness of fitness and pollution. However, water has been bottled and sold far from the source for thousands of years. In Europe, water from mineral springs was often thought to have curative and religious powers. In the late 1940’s, the office water cooler began to pop up everywhere. Today, there are dozens of brands of bottled water and many different varieties, including flavored and carbonated, which the FDA (Food and Drug Administration) is responsible for regulating. They classify bottled water into artesian well water, well water, mineral water, and spring water. However, don’t assume that bottled water is necessarily any purer, more regulated, or safer than tap water. Municipal water systems serving communities across America are subject to the federal Safe Drinking Water Act. As such, tap water is consistently and thoroughly tested for harmful substances. If a problem is found, consumers are notified. Further, tap water often contains fluoride and bottled water usually does not.
Some marketing is clearly and intentionally misleading, implying that the water comes from pristine sources when in fact it does not. According to the National Resource Defense Council (NRDC), a nonprofit environmental protection organization, one brand of “spring water” has a label picturing a lake and mountains, when in fact the water comes from a well in an industrial parking lot not far from a hazardous waste dump. Another brand claimed to be “Alaska Premium Glacier Drinking Water: Pure Glacier Water From the Last Unspoiled Frontier, Bacteria Free”, and comes from a public water supply. This label was changed after FDA intervention. Finally, Vals bottled water claims the following: “Known to Generations in France for its Purity and Agreeable Contribution to Health…. Reputed to Help Restore Energy, Vitality, and Combat Fatigue.” The International Bottled Water Association voluntary code prohibits health claims. Regardless of bottle labels, according to government and industry estimates, about 25-40% of bottled water is from the tap.
Taking one step forward, recently Governor Schwarzenegger signed a bill into law that requires bottled-water manufacturers to disclose the source of your bottled water on the label.
Both tap (or municipal) water and bottled water are considered safe to drink. The FDA regulates bottled water, and the EPA (Environmental Protection Agency) regulates tap water. The present regulations for the FDA and the EPA are similar. (During the 1990’s, FDA guidelines for bottled water were actually weaker than were the EPA guidelines for tap water.) Even with present guidelines being equally stringent, the argument has been made that bottled water policing is not a high priority for the FDA. If you are drinking bottled water instead of tap water because you are concerned about a specific contaminant, it is very difficult to assess the risk for a given brand. It is also fair to say that bottled water is often simply municipal water bottled and sold at a cost of over 400 times the cost of tap water. Also, for those of us who attempt to be environmentally conscious, bottled water uses more resources and produces more waste than does tap water.
Many of you have heard about the dangers caused by re-using plastic bottles or storing them in your car. E-mail has widely circulated the claim that the bottles contain DEHA, and label DEHA as a potential carcinogen. Another often-forwarded e-mail states that women should never drink from bottled water that has been left in a car because the heat releases chemicals from the plastic of the bottle that can lead to breast cancer. These e-mails were apparently based on a single Master’s thesis that has not been replicated. DEHA is in fact not found in the plastic used to make these bottles, and the EPA states that DEHA “cannot reasonably be anticipated to cause cancer, teratogenic effects, immunotoxicity, neurotoxicity, gene mutations, liver, kidney, reproductive, or developmental toxicity or other serious or irreversible chronic health effects.”
Other concerns circulating about plastic water bottles involve two additional chemicals, bisphenol A (BPA) and polyethylene terephthalate (PET). The debate rages on because heat DOES cause the release of some chemicals from plastic. Whether this is dangerous is still unresolved. The best I can say is that at this time there is no conclusive evidence linking re-used or heated water bottles and health dangers. Of course, simply re-using a water bottle too many times can cause your own germs to transfer from your mouth to the bottle, and then multiply into potentially disease-causing quantities.
What about problems with plastic water bottles and landfills? The largest bottled-water factory in North America is located in Maine. Stored there at any one time are 24 million bottles of Poland Spring water. They stretch across six acres, and are shipped off and replaced with new bottles on a regular basis. As noted above, we are consuming one billion plastic water bottles per week. Presently, we recycle some of those, but we bury 38 billion water bottles into landfills each year. Do note, however, that we also consume carbonated drinks at twice that rate. They too pose the same significant environmental issues. Practical solutions for recycling are necessary to solve many issues, not just water bottle disposal. The difference is that water is simply available from the tap, and soda is not.
So where does that leave us? While most bottled water is apparently of good quality, public awareness of data is scarce. Regulatory agencies have found numerous cases where bottled water has been contaminated at levels that exceed state or federal standards. Since municipal water is tested far more often than bottled water, it is found far more often to be in compliance with federal standards.
Given that tap water faces tougher regulatory guidelines, my suggestion is to install a water filtration system and use that water to refill a well-cleaned, durable Nalgene-type bottle. You’ll get good taste, a pure product, and your pocketbook will thank you. Good health to you all. Cheers!
Bad breath
May 19th, 2009Do you have bad breath? It’s certainly embarrassing. Where does it come from?
Halitosis describes noticeably unpleasant odors exhaled while breathing. It actually has just as large an impact – personally and socially – on those who think that they suffer from it (halitophobia) as it does on those who actually do. Clearly, it can have a negative impact on one’s personal, social and business relationships, and can lead to poor self-esteem and increased stress. It is a major reason for seeking dental care. Chronic halitosis affects up to 25% of us, and occasionally a more serious condition can be responsible.
Most often, bad breath originates in the mouth itself. Its intensity varies during the day, depending on oral dryness, which may be due to stress, fasting, or poor fluid intake, as well as consumption of certain foods such as garlic, onions, meat, fish and cheese. Other factors include obesity, smoking and alcohol consumption. Because the mouth is dry and inactive during the night, the odor is usually at its worst upon awakening (morning breath). This bad breath may be transient, often disappearing after eating, brushing teeth, flossing, and rinsing.
The most unpleasant odors come from proteins trapped in the mouth, which are processed by oral bacteria. There are over 600 types of bacteria found in the average mouth. Many of these can produce high levels of foul odors when incubated in the laboratory. Common regions of the mouth contributing to odor include the back of the tongue, between teeth, beneath the gums, abscesses, and unclean dentures.
The tongue is the most common location for mouth-related halitosis. Here, bacteria are undisturbed by normal swallowing activities, it is relatively dry and poorly cleansed, and bacteria can thrive on remnants of food deposits, dead epithelial cells and postnasal drip. The odors are mainly due to the anaerobic breakdown of proteins into amino acids and then into foul-smelling gasses.
The second major source of bad breath is the nose. Nostrils can emit a pungent odor, which differs from oral odor. Nasal odor may be due to sinus infections or foreign bodies.
The tonsils can contribute to halitosis. Perhaps 7% of us suffer from small bits of calcified matter in tonsilar crypts called tonsilloliths. This hardened matter has an extremely foul odor and when released can cause bad breath.
Belching, of course, can bring up unpleasant odors from the stomach to the mouth. While reflux disease does cause stomach contents to rise to the mouth, the esophagus is an alternating open/closed tube, so there is no continuous flow or opening to the mouth. Therefore, reflux disease doesn’t tend to cause chronic halitosis.
There are some general systemic conditions that can cause bad breath, including chronic liver disease, lung and kidney infections, kidney failure, diabetes and certain cancers.
The best way to make the diagnosis…believe it or not…is to simply ask a close friend or family member whether or not your breath smells bad. Relying on oneself to make the diagnosis is unreliable due to habituation (we’re used to the way we smell!).
There are commercial breath clinics that claim to diagnose and treat bad breath. They use a “Halimeter”, a portable monitor used to test for levels of hydrogen sulfide and other emissions. Results are confused by the presence of garlic and onions, which produce sulfur for up to 48 hours and lead to false positive readings. Tests are also run to measure different enzymes in the saliva. My personal recommendation is to stick with the admittedly old-fashioned, but effective, “sniff” test.
See your doctor or dentist to rule out any treatable diagnosis. These suggestions should make a difference:
* Go to the dentist regularly and maintain good oral hygiene. This includes brushing, flossing, and hygienist visits. Dentures should be properly cleaned and soaked overnight in antibacterial solutions
* Maintain proper hydration by drinking several glasses of water per day
* Chew gum to keep the mouth moist and to help prevent bad breath from dryness. Some gums contain special anti-odor ingredients. Folk remedies include chewing on fennel seed, cinnamon sticks, mastic gum or fresh parsley
* Eat a healthy breakfast that includes roughage to help clean the back of the tongue
* Gently clean the tongue surface twice daily with a tongue brush to scrape off bacterial biofilm, debris and mucous. Some people use an inverted teaspoon, but be gentle so as not to damage the taste buds
* Gargle at bedtime with a mouthwash. Mouthwashes often contain antibacterial agents, which can be effective. Avoid those that contain alcohol, since this is a drying agent and may worsen the problem. Do not use a mouthwash just after tooth brushing, as many toothpastes will counteract the active ingredients of mouthwash
* As always, seek the help of your primary care physician when necessary
I wish you good health and pleasant breath.
Bacteria vs Virus
May 19th, 2009Well, the sniffle season is upon us yet again, and it seems as though everyone is sick and miserable. Although it may be difficult to think beyond our boxes of tissues and soft blankets, let’s explore the two culprits that could be causing your distress: bacteria and viruses. How can doctors tell the difference between these two nasty buggers when making a diagnosis? Once we do know which one is at fault, how is it relevant to your treatment and recovery?
Let’s start with some of the basic differences on a cellular level. Bacteria are completely self-contained and self-reproducing units. They are organisms made up of just one cell, with the ability to multiply by cell division. Bacteria exist everywhere; they cover the surface of our bodies and live inside. 99% of these bacteria are completely harmless, and some are quite useful. Others, however, can cause diseases, either because they end up in the wrong place in the body, or because they are designed to be harmful to us on contact.
Viruses, on the other hand, can’t multiply without assistance. They invade our cells and hijack their reproductive capabilities. A virus consists of genetic materials (DNA and RNA) surrounded by a protective coat of protein. It may lie dormant (preserved in hibernation) for mere moments or for thousands of years before coming into contact with a suitable host. The virus then finds and penetrates cell walls, where it does its damage.
The cells of our mucous membranes, such as those lining the respiratory tract, are particularly susceptible to viral attacks because they are not covered by protective skin. Once inside a living cell, a virus replaces the cell’s original DNA or RNA instructions with its own genetic instructions, which then command the cell to make copies of the virus. When the host cell is no longer useful to the virus, the cell explodes and sends out thousands of copies of the virus to other cells.
Viruses are not considered independent living creatures. They cannot be “killed” in the same sense as bacteria. In fact, the usual treatment for viral infections is no treatment at all. The disease runs its course while the body mounts a defense on its own. Anti-viral treatments are still largely experimental, and the most deadly viral diseases such as AIDS and Ebola still kill huge numbers of people worldwide every year.
As noted above, a vast majority of all known bacteria (99%) are harmless, or even perform useful functions, such as breaking down organic matter or protecting the body from harmful parasites. Most viruses, on the other hand, serve no beneficial purpose. Their sole mission is to reproduce, creating more viruses to ensure the survival of the strain. The harmful or even deadly effect a virus may have on its host is merely an incidental byproduct of its survival.
Because viruses and bacteria are so different, the way we treat them differs considerably. Doctors prescribe antibiotics in order to kill bacteria. Bacteria, however, can eventually develop a tolerance, so the prudent use of antibiotics is a critical social and medical issue. Remember that antibiotics, while effective for most bacterial infections, have no effect upon viral infections such as colds or flu. Overuse of antibiotics for non-bacterial infections has led to resistant strains of bacteria, including staphylococcus. Many of us are familiar with the growing global threat posed by MRSA. There are only a few antibiotics that can kill this resistant bacterial infection. By limiting the use of antibiotics and letting the body rid itself of viral infections, we can help prevent bacteria from becoming even more resistant to antibiotics.
So just how does your doctor tell the difference between a viral and a bacterial infection? The only absolute way is to take a culture of the infected site (a throat culture, for example) and wait three days for growth and identification by a lab. Clearly, it is not practical to get cultures routinely in your doctor’s office and wait for the results. Instead, the type of complaints and symptoms a patient presents generally give enough clues to determine whether it is a virus or bacteria causing the problem.
For example, viruses cause colds and flu. Runny nose, achy muscles, headaches, dizziness, dry cough and laryngitis are all likely to be caused by viral infections and are rarely caused by bacteria. A fever can indicate either a virus or bacteria, but rapid onset of fever likely indicates a bacterial infection. A cough with thicker and darker phlegm is more likely to be bacterial. Viruses cause most sore throats, but strep throat is bacterial. Ear or sinus infections often require antibiotics, but bacteria do not cause all of them. Urinary and lung infections are often bacterial, as are many skin infections. Your doctor’s diagnosis relies on experience and educated guesses.
For all of their differences, bacteria and viruses are essentially spread in the same way: through coughing, sneezing, touching or shaking hands with people, touching food with dirty hands, or through bodily fluids such as saliva, blood, or semen. Prevention is the key:
* Wash your hands frequently
* Don’t shake hands with someone who is obviously ill
* Store vegetables and meat separately and prepare them on separate cutting boards
* Cook meat thoroughly, preferable well-done
* Remember that food containing these invisible organisms may not have any particular “bad” smell.
While treatment for bacterial infections involves choosing the appropriate antibiotics (selected by your doctor), a virus is fought by the body’s own immune defenses. Help your body fight either type of infection:
* Drink plenty of water
* Stay home when you are sick in order to avoid spreading your infection to others or exposing your weakened immune system to another infection
* Get vaccinated against viral diseases.
* Keep your body strong and resistant by following my advice from earlier articles, especially those that addressed good nutrition, sleep, exercise, stress reduction, and diligent hand washing.
I wish you all the best of health this winter season!
Alcohol
May 15th, 2009To drink or not to drink….that is the question. Allow me to “distill” some data on alcohol to help you make an informed decision.
Alcohol may be the world’s oldest drug. It has been made from fermented grain, fruit juice, honey, potatoes, and other natural resources for thousands of years. Americans drink the equivalent of about 500 million gallons of pure alcohol each year. It is BIG business and has become an expected part of today’s world of business, family and celebration. The abuse of alcohol has become a major public health problem, with nearly 10% of adults suffering from some degree of problem drinking. Alcohol consumption by college students is linked to 1,400 student deaths and 500,000 unintentional injuries each year. Alcohol has destroyed jobs, families, and lives. It is the cause of 30 to 45% of fatal car accidents, depending on the study quoted.
Alcohol is primarily absorbed through the walls of the small intestine, goes to the brain and has its associated impact, and then travels to the liver where it is oxidized at a rate of 1/2 ounce per hour. It is ultimately converted to water, carbon dioxide and energy. The effects of alcohol depend on the dose taken. In low doses, it relaxes, reduces tension, lowers inhibition, impairs concentration, slows reflexes, impairs reaction time, and reduces coordination. In higher doses, you see slurred speech, drowsiness and altered emotions. In very high doses, it leads to vomiting, breathing problems, and unconsciousness. Chronic alcohol consumption can lead to dependence and addiction, and ultimately to other neurological problems including memory loss, ulcers, cirrhosis, and ultimately death. Withdrawal symptoms from alcohol include tremors, sleep problems, nausea, hallucinations, and seizures.
There are clearly groups of people who should simply not drink. Those about to drive a motor vehicle should not drink at all. Any woman who is pregnant should not drink at all; there is no known minimum safe level of consumption to prevent Fetal Alcohol Syndrome (a condition that affects the growth of a fetus). Those with a family history of alcoholism are at a much greater risk of becoming an alcoholic, so they should not imbibe. Any person with liver disease should not drink alcohol, since alcohol is processed in the liver. If you have a history of pancreatic disease, do not drink alcohol. Alcohol has been linked to cancers of the esophagus, larynx, pharynx and mouth, so if you have a history of precancerous changes in these areas, do not drink alcohol. Anyone with a history of hemorrhage, especially in the brain or gastrointestinal track, should not drink.
Further complicating matters, alcohol interacts with or interferes with the functioning of many medications, so it should be avoided if you are consuming medication from the following classes: antibiotics, anticoagulants, antidepressants, diabetes medications, antihistamines, anti-seizure medications, beta blockers, pain relievers, and sleeping pills. Tylenol and alcohol, for example, put a double whammy on the liver. Combining aspirin and alcohol raises the risk of gastrointestinal bleeding.
Now that I have reduced the number of potential drinkers to five, let’s address alcohol’s good side. Healthy drinking is defined as moderate consumption of alcohol. A drink of alcohol is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80 proof distilled spirits. A moderate drinker of alcohol is a male under the age of 65 who drinks one to two drinks per day, or a female of any age or a male over the age of 65 who drinks one drink per day.
Moderate alcohol consumption may provide health benefits. Many studies have shown that alcohol consumption reduces the risk of heart attacks, peripheral vascular disease and strokes by as much as 40% in both men and women. It is still unclear whether the benefit is from red wine, white wine, or any alcohol at all. It does appear that alcohol lowers the level of the “bad” cholesterol LDL and raises the level of the “good” cholesterol HDL. These improved cholesterol levels would cause plaque to be removed from arteries and help to stave off the diseases mentioned above. Alcohol consumption reduces the risk of gallstones. Very recent findings suggest a reduced risk of developing diabetes. Hmmm… looks like your daily cup of coffee as well as a drink of alcohol both seem to reduce the chances of developing diabetes. Who would have thought I would write such a thing?
What advice do I leave you with this week?
-If you already are a “moderate” drinker of alcohol, and you do not belong to the groups above who absolutely should not drink, please continue to enjoy your drink.
-If you drink but fall into any of the groups above who should not drink, it is strongly advised that you stop. Help is available; consult with your physician.
-Finally, if you are presently a non-drinker, the American Heart Association recommends that you do not start drinking in order to improve your cardiovascular health. The benefits are not worth the risks!
Air Travel
May 15th, 2009Do you often feel that the hazards of summer air travel are crowded parking lots, long lines, and dealing with security? These occur before we even set foot on the airplane! Let’s take a look at health issues associated with the flight itself.
The most common consequence of air travel across time zones is that fuzzy, out-of-sorts feeling known as jet lag. Its most common symptoms include daytime drowsiness, fatigue, irritability, difficulty concentrating, headaches, insomnia, and swelling of the extremities. Its severity, naturally, relates directly to the number of time zones crossed. Jet lag is caused by the disruption of our circadian rhythm, the body’s clock mechanism. Once the cycle is disturbed, it can take several days or longer to get back in sync. To minimize jet lag, get plenty of rest before your trip and keep your schedule light upon arrival. (Note that this is the very opposite of the typical sleepless night spent packing before a big trip, and the first hectic day at your destination!) Don’t rely on caffeine to wake you up or alcohol to put you to sleep. A controversial treatment for jet lag is melatonin, a synthetic human hormone that promotes sleep. Another treatment under study uses artificial light to help adjust our internal clock.
It’s quite common to catch a respiratory infection a few days after a flight. This is due to infected particles that circulate and re-circulate about the cabin from that coughing and sneezing passenger elsewhere on the plane. If that person happens to be your seatmate, keep your overhead vent on “high” to maximize air exchange at your seat.
If you are prone to motion sickness, travel on an empty stomach, and avoid drinking alcohol or eating heavy or greasy foods. Keep your seat upright, and don’t read or watch the movie screen. As a long-time boater, I have seen just how well a deeply engaging conversation or other distraction technique works!
Changes in cabin air pressure often cause middle ear problems. Prevent sinus and ear problems by chewing gum and swallowing often. If you have a cold or active nasal allergy, take a decongestant or use a prescription nasal spray prior to take-off, in order to prevent pain, hearing problems, and infections.
Various factors on a flight contribute to dehydration: dry air, low fluid intake, and drinking alcohol and caffeinated beverages (which act as diuretics). The aircraft environment is very dry, with humidity ranging from 10% to 20%. The low humidity can also cause the drying of your skin, eyes and airways, which is a problem if you are already suffering from a respiratory disease. Drink early and often, and stick to water or juice.
Although not a disease exclusively related to air travel, Deep Vein Thrombosis (DVT) is one of the best-known complications associated with long flights. In the late 1980’s, the term “Economy Class Syndrome” was coined; it’s the result of long periods of inactivity and dehydration, and leads to the development of a clot in a leg vein. If a piece of this clot should travel to the lungs, this becomes a life-threatening pulmonary embolism. To prevent blood clots, mobility is key. Book an exit row or aisle seat for more legroom. Don’t cross your legs, stretch and walk often, and stay hydrated. Take aspirin and wear compression socks if you’ve been told that you are at risk for DVT.
When the cruising altitude reaches 30,000 feet, the aircraft is pressurized to roughly 8,000 feet. Unless you are accustomed to this altitude (think Peru’s Machu Picchu!), it’s possible to develop a form of altitude sickness, leading to headache, nausea, fatigue, dizziness, and insomnia. Stay hydrated and move about, and the symptoms should pass.
Clearly, stress has become a major hazard of flying. Not only do many people feel anxiety about the flight itself, but hectic airports, increased security, and delays certainly do add to the stress. Plan to arrive early to give yourself plenty of time, dress comfortably, and keep your travel documents organized.
I wish you all a safe and healthy trip – bon voyage!
Hair loss
March 13th, 2009Have you or has someone close to you experienced hair loss? What causes it? Can anything be done to prevent it, or to reverse this non-life threatening yet nevertheless distressing condition? Every hair on our head follows a cycle of approximately one year: it grows, rests, and then falls out. About 90% is growing at any one time, with the balance resting for a period of two to three months. After resting, the hair goes through a shedding phase. It is normal to shed 50 to 100 hairs per day. Once a hair is shed, a new one starts growing from the same hair follicle, and grows about ½ inch per month. Hair is made of protein, the same material that is found in fingernails and toenails. Note, therefore, that eating adequate amounts of protein can aid in hair growth. Among other food items, protein is found in red meat, chicken, fish, eggs, cheese, beans, soy products, grains, and nuts. For many men, hair loss is inevitable. It is hereditary and progresses with age. These genes may be passed from either the maternal or paternal side of the family. Male pattern baldness, or common baldness, is by far the most typical cause of hair loss, and in our country alone approximately 40 to 65 million men suffer from it (depending on the criteria used). Often in the late twenties, the hairline begins to recede and the hair on the top of the head becomes thinner. There are other conditions that can lead to hair loss:
•Three to four months after a major stress (emotional or physical) such as an accident, surgery, or illness, people of either gender may experience significant hair loss. This hair loss is temporary.
•Hormonal problems may cause hair loss. Disorders of the thyroid gland, whether over or under active, can cause hair to fall out. Hair loss can also occur when male or female hormones (androgens and estrogens) are out of balance. Correcting these hormonal imbalances may stop the loss.
•Pregnancy can be a factor. Many women notice hair loss three months post partum (after the baby’s birth). This is again a hormonal problem, and is temporary. High levels of female hormones cause hair to stay in longer than normal, and when levels fall back to normal, hair goes back to its old cycle.
•A number of common prescription medicines have side effects that cause hair loss. The most common culprits are blood thinners, gout medicines, chemotherapy agents used for treating cancer, birth control pills, antidepressants, and even too much (nonprescription) vitamin A. The problem will reverse itself if the medication is stopped.
•Infections also may cause hair loss. For example, fungal infections of the scalp are treated with an antifungal medication to reverse the problem. Of course, any significant infection that causes major physical or emotional stress (see above) can also cause a reversible hair loss.
•Certain diseases such as lupus or diabetes can cause hair loss. Hair loss can serve as a valuable early warning sign, so it is important to diagnose the cause as early as possible.
•Hair loss may even be the result of wearing pigtails or cornrows! Pulling tightly on the hair causes a type of hair loss called traction alopecia. This type of damage must be halted early on or it will become permanent. In addition, the hot oils used in “permanents” may cause hair loss due to the inflammation and swelling of hair follicles.
In order to determine the cause of your hair loss, your doctor will ask you about your diet, if it is balanced, and whether it contains adequate nutrition – especially protein. You will want to list your medications in order to determine whether one might have resulted in hair loss as a side effect. The doctor will take a health history, in order to reveal whether you have undergone unusual stress or illness in the past three to four months. If you are a woman, you will discuss your menstrual cycles, pregnancies and menopause. A physical exam should be done, including looking specifically for scalp infections. Lab tests may be taken to determine whether there are any hormone imbalances, diabetes, thyroid disease or rheumatologic diseases. Treatment for common inherited male pattern baldness is complex. There is no cure at present, but finesteride (Propecia) is a prescription hair loss medication (for men only) and has been analyzed in a five-year study. An impressive 77% showed scalp hair growth verses only 15% of test subjects taking a placebo. Side effects of Propecia appear to be minimal: They include decreased libido in 1.8% of subjects, and decreased volume of ejaculate, impotence, or breast tenderness in less than 1%. Minoxidil (Rogaine) is an over-the-counter medication rubbed directly into the scalp and may work for both men and women. In a study published in 2005, one-year follow-up data showed that areas of the scalp with hair loss became smaller in 62% of the patients, unchanged in 35% and larger in 3%. Finally, hair transplantation is a surgical approach that has made great advances in recent years. Healthy hairs with follicles intact are harvested from an area of the scalp with normal hair growth and the individual hairs are re-implanted into areas of the scalp with hair loss. The results can look very natural. Costs run roughly five to six dollars per hair, or $3,000 to $9,000 for the procedure. Allow me to “part” with some suggestions:
•Eat a balanced and nutritious diet for hair health.
•Treat your hair carefully. Be careful with foreign chemicals, heat and tight hairstyles (ponytails, buns, etc.).
•Avoid compulsively pulling, twisting, or rubbing your hair. Rogaine and Propecia have proven efficacy for growing new hair and preventing further hair loss. Other over-the-counter products have not yet been proven.
•Many find success with a natural looking wig or hairpiece…or by developing a fondness for the bald look. See your doctor to ensure that there are no infections or other underlying problems responsible. Where feasible, work together to eliminate or alter medication that may be causing the hair loss. It is crucial that you get a proper diagnosis, and treatment when possible. There may be a reversible cause to your hair loss. I wish you good health!
Dr. Alan Frischer is former chief of staff and current chief of medicine at Downey Regional Medical Center.
Body shape
February 27th, 2009A hot topic in health literature concerns pears verses apples. I am referring, not to fruit, but rather to body shape. Are you a pear or an apple? How does your body accumulate fat? How does this affect your long-term health? Let’s explore this together. These two basic body shapes differ in the way they distribute fat. The apple-shaped person carries most of their excess fat around their abdomen, in the middle portion of the body. This type of fat is known as visceral or intra-abdominal fat, and it surrounds the organs, which can contribute to inflammation. The pear-shaped person carries most of their excess body fat lower than that, on their hips, buttocks, and thighs. Their fat is called subcutaneous fat. What determines body shape? Genetics get most of the blame, but your age and gender also play an important role. Women typically collect fat on their hips and buttocks, resulting in a pear shape, while men generally collect weight around the belly, giving them an apple shape. After menopause, as women’s estrogen levels drop, they start storing fat around the abdomen as men do, and become more apple-shaped. Those who are apple-shaped are more likely to develop health problems related to obesity. The shape is closely associated with type 2 diabetes and heart disease, as well as to sleep apnea, anxiety, and depression. In women, there is an increased risk of hormonal cancers such as breast, ovary and uterine cancer, menstrual irregularities and fertility problems. Clearly, those with apple shapes need to pay extra attention to their weight. Pear-shaped women have their own set of health issues, such as osteoporosis due to a lower level of androgen (a male hormone), varicose veins due to fat compressing their veins at the thighs, and cellulite (a cosmetic problem). How do you know whether you are an apple or a pear? To find out, all you need is a tape measure. Calculate your waist to hip ratio by dividing your waist measurement by your hip measurement. If you are a woman and your waist to hip ratio (waist inches divided by hip inches) is more than 0.8, or if you are a man and it is greater than 1.0, then you are considered an apple, and are at increased risk for the associated health complications. Another way to check is to simply measure your waist. If you are a woman with a waist greater than 35 inches, or a man with a waist greater than 40 inches, you can likely be considered an apple. While any overweight person should lose weight regardless of their body shape, here are some specific tips to follow depending on body type:
Apples
• Get regular exercise in order to maintain body weight and improve insulin resistance
• Due to a tendency toward diabetes, eat whole grain foods with a low glycemic index and avoid simple sugars and starches with a high glycemic index
• Monitor your blood sugar and fat levels with assistance from your doctor
• If you are a woman, have regular gynecologic exams which address issues of breast, uterine and ovarian cancer
• Be cognizant of sleep problems and daytime fatigue: they may be signs of sleep apnea
Pears
• Because you are more prone to osteoporosis, be tested with a bone density scan
• If your bone density is poor (osteopenia or osteoporosis), do resistance training, take calcium and vitamin D, and talk to your doctor about possible prescription medication
• Because pear-zone fat can accumulate easily, maintain a low-fat diet
Regardless of whether you are a pear or an apple, if you are overweight, follow the guidelines I’ve outlined in prior columns for diet and exercise.
As always, contact your doctor for guidance, questions, or concerns.
Fast Food
February 13th, 2009It is once again time to attack (I mean…discuss) fast food. Even as I counsel my patients as to how they can find healthful food even at a fast food restaurant, I am astounded at how just plain awful some of the menu choices can be.
Let’s begin with some nutritional target goals. For simplicity, we’ll assume that we need 2,200 calories per day, a reasonable target for an “average” adult.
• We all need some fat in our diet. Ideally, approximately 20% of our calories should come from fat, so 20% of our goal of 2,200 daily calories means that 440 calories should come from fat. Since each gram of fat has 9 calories, we should eat no more than 49 grams of fat each day. Less then half of that should be saturated (as is the fat in a hamburger, cheese, mayonnaise, and other common components of fast food).
• The target for protein is around 20%. Typically, this is not difficult to reach.
• It’s also necessary to have sodium in our diet. For our “average” adult, let’s target about 2,500 mg each day maximum. (A brief reminder: too much salt can raise the blood pressure, put some people into congestive heart failure, and give many others swelling throughout their body and especially in the legs.)
• Sugar, a refined simple carbohydrate, has no nutritional value, and ideally none of our calories should come from it. A perfect goal would be to eat only complex carbohydrates. Nevertheless, sugar surrounds us, is very difficult to avoid (read those labels!) and very few of us choose to steer clear of it completely. The World Health Organization suggests that a maximum of 10% of our total calories be sweeteners. 10% of our 2,200 daily calorie goal is 220 calories, and at 4 calories per gram, that results in a limit of 55 grams of simple carbs each day.
With fats representing 20% of the calories in our diet, protein representing another 20%, and simple carbs (sugar) representing a maximum of 10%, the remaining 50-60% should be complex carbohydrates, such as fruits, vegetables, and whole grains.
Now, let’s examine some common fast foods!
• I have recommended that patients go to Quizno’s for the low fat items on the menu, but I would hate to discover that they ended up ordering the “Tuna Melt” (regular). It has 1,420 calories, 118 grams of fat, and 1,535 grams of sodium. Note those targets, above. This single sandwich has more than double the fat and ¾ of one day’s calories.
• Everyone loves In and Out Burger. If you order a hamburger with onions, tomatoes, and lettuce you will consume 650 mg of sodium, 19 grams of fat and 390 calories. It may not be considered health food, but it’s not too far out of the target range for a meal. Now, add some french fries, along with their 245 mg of sodium, 27 grams of fat and 400 calories. If you are brave enough to order a hamburger, fries and a shake, you will consume 1,245 grams of sodium, 101 grams of fat, and 1,480 calories, and your pretty decent fast food choice has turned into a nightmare.
• I have also referred people to Subway for reasonable fast food items. They offer eight six-inch sandwiches that have 6 grams of fat or less, 370 calories or less, and 1,260 mg of sodium or less. However, if we chose the “Sweet Onion Chicken Tempura” sandwich, we would end up consuming 2,400 grams of sodium (our target is 2,500 for the day) and 750 calories.
• I like El Pollo Loco for fast food. They promote their “Pollo Bowls” as a healthy alternative. These offer 543 calories and 10 grams of fat, but 2,159 mg of sodium (nearly an entire day’s target amount). Compare these to their “Chicken Tostada Salad” at 990 calories, 52 grams of fat (your full day’s amount) and 1,755 mg of sodium.
• Many of McDonald’s salads will run around 300 calories, under 10 grams of fat and under 900 mg sodium. As another nutritious alternative, try their “Fruit ‘n Yogurt Parfait” at 160 calories, 2 grams of fat and 85 mg of sodium. On the other hand, how about their “Deluxe Breakfast” (without syrup and margarine)? It has 1,140 calories, 59 grams of fat, and 2,250 grams of sodium, nicely covering your dietary needs for fat and sodium for the entire day. At least it’s not the “Chocolate Triple Thick Shake” (32 ounces), with 1,160 calories, 27 grams of fat and 510 mg sodium. That’s half your daily fat and caloric requirements in just your drink for one meal!
• Outback Steakhouse prepares a “Steakhouse Aussie Cheese Fries with Ranch Dressing”. This is a french fries appetizer…with 2,900 calories and 182 grams of fat, more than a day’s calories and three day’s fat – before the meal?
• Domino’s “Deep Dish Extravaganza” (two large slices) contains 860 calories, 46 grams of fat, and 2,260 grams of sodium. You’ve got the hang of these calculations by now: that’s enough fat and sodium for the day.
• We all know people who visit Starbucks (or their favorite coffee house) daily. If you try their “Peppermint White Chocolate Mocha with whip” (medium size) at 560 calories, 22 grams of fat and only 240 mg sodium, then your daily Starbuck’s run ends up costing you a quarter of your desired calories and half of your desired fat (and saturated, at that!). We won’t discuss here the dollar cost for this treat. (Does anybody out there still drink black coffee or tea?)
• Fast food restaurants make a huge portion of their profits on the sale of soda. A 12-ounce serving (equal to a can) contains between 22 to 32 grams of sugar. Drinking two cans of soda will meet that 55 gram daily maximum target for sugar, all in liquid form. (Note that teenagers drink “on average” 1.4 cans per day!)
• Let’s wrap up with an indulgence that will neatly take care of roughly 100% of your goal for calories and sodium, and 200% of your goal for fat (saturated, naturally), all in one. Now, that’s convenience. We would all expect a Baskin Robbins shake to be loaded with fat and calories, but could you have guessed just how much? Their “Heath Shake” (large) has 2,310 calories, 108 grams of fat, and 1,560 grams of sodium!
So what does this all mean? The typical American eats fast food every four days on average, which makes it quite difficult to achieve our goals to limit sodium, sugar, and fat. Making one poor selection from a fast food menu will put us near or over at least one of our targets before we even eat a whole meal, much less satisfy our hunger for the rest of the day.
Every fast food restaurant offers an enormous variety of food with just as enormous a range of nutritional content. Nutrition information is readily available on restaurant websites, and increasingly available at the fast food restaurant itself. I strongly advise you to research what you are eating, read labels, and be knowledgeable about the calories and fat, sodium and sugar grams in common foods. It is just too easy to go way over reasonable goals and never even know it.
I wish you healthful and SMART eating!
Herpes
January 23rd, 2009This week’s article concerns an incurable disease that afflicts about one in every five people (approximately 67 million) in the United States! Every year there are 500,000 new cases. This disease is preventable with common sense and some specific protective behaviors.
I am referring…of course…to genital herpes.
What is herpes, and how do you get it? Two viruses, herpes simplex 1 (HSV1) and herpes simplex 2 (HSV2) are responsible. In its most common form, an HSV infection involves the face and mouth, the lesions are cold sores, and it is considered oral herpes. Most typically the cause of oral herpes is HSV1, although HSV2 is possible. Genital herpes is the second most common form of herpes, and is typically caused by HSV2 (although HSV1 is possible).
Genital herpes is contracted through direct contact with an infected person’s active lesion or body fluids. The virus then travels through tiny breaks in the skin or mucous membranes (which include the genital area). Genital herpes is mostly asymptomatic (without symptoms), but note that even when asymptomatic, disease transmission can still occur through viral shedding (the virus can still reproduce and cause infection). Passing along herpes when symptoms are not apparent is most likely during the first year of having the virus.
What about toilet seats? In theory, the virus can indeed live on a toilet seat for two to four hours. However, evidence of transmission from this source has never been well documented.
Herpes cycles between periods of activity and remission. Triggers for a herpes outbreak include physical as well as psychological factors. Common physical factors include being run down, suffering from other genital infections, menstruation, drinking large quantities of alcohol, exposure to sunlight, other UV light exposure such as tanning booths, and any disease that weakens the immune system. Psychological factors include prolonged stress and anxiety.
Infections occur 2 to 12 days after exposure to the virus. Symptoms include tingling, itching, burning or pain, followed by the appearance of the classic blisters. That first outbreak of lesions is called the initial or primary infection, and tends to be the most severe. The blisters contain infectious viral particles and last between 2 and 21 days, followed by a remission period during which the sores go away. There may be fever, fatigue, body aches and headaches. In women, the sores for genital herpes most often involve the vulva and entrance to the vagina. In men, sores are most commonly seen on the glans (end), foreskin and shaft of the penis. While some people never experience a recurrence of this initial infection, for those who do, the episodes over time tend to be less severe and less frequent.
A herpes diagnosis, practically speaking, is made by a visual inspection of the sores. To confirm the diagnosis, the doctor may perform a swab test, in which a sample of the fluid is taken from a blister, ulcers, or a genital secretion. While many who are infected will develop the classic skin lesions, for others the first clue that they have the disease is when their partner develops it. Up to 60% of people who have genital herpes show NO SIGN. Occasionally, one partner in a long-term relationship may develop symptoms of herpes for the first time because one or both of them were unaware of being carriers of a silent HSV infection. The sudden appearance of herpes does not necessarily imply recent transmission from someone outside the relationship. However, it makes the task of controlling the spread of herpes extremely difficult when those infected may be unaware that they have the disease.
There is no cure for herpes, and no vaccines available to prevent the infection. The current focus is on treatment to reduce viral reproduction and shedding, preventing the virus from entering the skin, and lessening the severity of symptomatic episodes.
What else can the herpes virus do to the body? In addition to the common oral and genital infections, there are more serious infections that can infect and damage the eyes (herpes keratitis), or invade the central nervous system and cause brain damage (herpes encephalitis). Recurrent skin infections can occur anywhere on the body where contact has been made, causing blisters and pain. Bell’s Palsy has been linked to the presence and reactivation of the herpes virus inside the sensory nerves of the face.
Prevention is the best policy, and for genital herpes, condoms are highly effective in limiting transmission. The virus cannot pass through a condom; however, the condom may not completely cover all the sores or protect all of the skin. As is true for all STD’s, women are at higher risk of getting the disease from men then vice-versa. On an annual basis, without the use of condoms or antiviral medication, the transmission risk from male to female is 8-10% per year. The transmission risk from female to male is 4-5%. Taking an antiviral medication cuts that risk in half. Condom use also cuts the risk in half. Using both cuts the risk by 75%.
Treatment for the symptoms of an outbreak includes taking salt baths, wearing loose underclothes, and using common analgesics such as Tylenol or Advil. Antiviral medications such as Valtrex or Zovirax reduce the length of an outbreak as well as the severity. Those who suffer from frequent and painful recurrent episodes typically take the antiviral medicine daily, and it can also be used on an episode-by-episode basis.
What does it mean to have genital herpes?
• Have open and honest discussions with your partner(s)
• Refrain from sexual activity during an active outbreak of the disease
• Use condoms to lessen the risk of transmission
• Consider using an antiviral medicine to lessen the risk of transmission
• In an on-going relationship, where both partners fully understand the chance of transmission, they may wish to consider the choice to use condoms
• Become a member of a support group
• Speak with your doctor regarding the diagnosis, prevention, and treatment of this disease
Be well, and be safe!
Halitosis
January 9th, 2009Do you have bad breath? It’s certainly embarrassing. Where does it come from?
Halitosis describes noticeably unpleasant odors exhaled while breathing. It actually has just as large an impact – personally and socially – on those who think that they suffer from it (halitophobia) as it does on those who actually do. Clearly, it can have a negative impact on one’s personal, social and business relationships, and can lead to poor self-esteem and increased stress. It is a major reason for seeking dental care. Chronic halitosis affects up to 25 percent of us, and occasionally a more serious condition can be responsible.
Most often, bad breath originates in the mouth itself. Its intensity varies during the day, depending on oral dryness, which may be due to stress, fasting, or poor fluid intake, as well as consumption of certain foods such as garlic, onions, meat, fish and cheese. Other factors include obesity, smoking and alcohol consumption. Because the mouth is dry and inactive during the night, the odor is usually at its worst upon awakening (morning breath). This bad breath may be transient, often disappearing after eating, brushing teeth, flossing, and rinsing.
The most unpleasant odors come from proteins trapped in the mouth, which are processed by oral bacteria. There are over 600 types of bacteria found in the average mouth. Many of these can produce high levels of foul odors when incubated in the laboratory. Common regions of the mouth contributing to odor include the back of the tongue, between teeth, beneath the gums, abscesses, and unclean dentures.
The tongue is the most common location for mouth-related halitosis. Here, bacteria are undisturbed by normal swallowing activities, it is relatively dry and poorly cleansed, and bacteria can thrive on remnants of food deposits, dead epithelial cells and postnasal drip. The odors are mainly due to the anaerobic breakdown of proteins into amino acids and then into foul-smelling gasses.
The second major source of bad breath is the nose. Nostrils can emit a pungent odor, which differs from oral odor. Nasal odor may be due to sinus infections or foreign bodies.
The tonsils can contribute to halitosis. Perhaps 7 percent of us suffer from small bits of calcified matter in tonsilar crypts called tonsilloliths. This hardened matter has an extremely foul odor and when released can cause bad breath.
Belching, of course, can bring up unpleasant odors from the stomach to the mouth. While reflux disease does cause stomach contents to rise to the mouth, the esophagus is an alternating open/closed tube, so there is no continuous flow or opening to the mouth. Therefore, reflux disease doesn’t tend to cause chronic halitosis.
There are some general systemic conditions that can cause bad breath, including chronic liver disease, lung and kidney infections, kidney failure, diabetes and certain cancers.
The best way to make the diagnosis…believe it or not…is to simply ask a close friend or family member whether or not your breath smells bad. Relying on oneself to make the diagnosis is unreliable due to habituation (we’re used to the way we smell!).
There are commercial breath clinics that claim to diagnose and treat bad breath. They use a “Halimeter”, a portable monitor used to test for levels of hydrogen sulfide and other emissions. Results are confused by the presence of garlic and onions, which produce sulfur for up to 48 hours and lead to false positive readings. Tests are also run to measure different enzymes in the saliva. My personal recommendation is to stick with the admittedly old-fashioned, but effective, “sniff” test.
See your doctor or dentist to rule out any treatable diagnosis. These suggestions should make a difference:
Go to the dentist regularly and maintain good oral hygiene. This includes brushing, flossing, and hygienist visits. Dentures should be properly cleaned and soaked overnight in antibacterial solutions
Maintain proper hydration by drinking several glasses of water per day
Chew gum to keep the mouth moist and to help prevent bad breath from dryness. Some gums contain special anti-odor ingredients. Folk remedies include chewing on fennel seed, cinnamon sticks, mastic gum or fresh parsley
Eat a healthy breakfast that includes roughage to help clean the back of the tongue
Gently clean the tongue surface twice daily with a tongue brush to scrape off bacterial biofilm, debris and mucous. Some people use an inverted teaspoon, but be gentle so as not to damage the taste buds
Gargle at bedtime with a mouthwash. Mouthwashes often contain antibacterial agents, which can be effective. Avoid those that contain alcohol, since this is a drying agent and may worsen the problem. Do not use a mouthwash just after tooth brushing, as many toothpastes will counteract the active ingredients of mouthwash
As always, seek the help of your primary care physician when necessary I wish you good health and pleasant breath.