Archive for the ‘Life’ Category

Organ Donor

Tuesday, March 15th, 2011

Every 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!

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Anxiety Disorders

Wednesday, November 3rd, 2010

If 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!

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Tattoos

Sunday, August 22nd, 2010

It’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!

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Sex

Wednesday, August 18th, 2010

Today’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!

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Drug Abuse

Sunday, July 25th, 2010

Have 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:

  1. 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.
  2. 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.
  3. 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


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Organic Food

Saturday, May 30th, 2009

Organic 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.

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Sunburn

Saturday, May 30th, 2009

Take 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!

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Longevity

Saturday, May 30th, 2009

As 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…

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Fingernails

Tuesday, May 26th, 2009

Do 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?

  • Keep your nails clean and dry

  • Avoid nail biting

  • If necessary, apply moisturizer to your nails and cuticles on a daily basis. Creams with urea, phospholipids, or lactic acid can help prevent cracking

  • File your nails in one direction and round the tips slightly

  • Don’t remove the cuticles or clean too deeply under your nails

  • Don’t dig out ingrown toenails. See a dermatologist or podiatrist if they become a problem

  • Avoid nail polish removers that contain acetone or formaldehyde

  • Bring your own instruments if you get frequent manicures or pedicures

  • If you have artificial nails, check regularly for green discoloration, a sign of bacterial infection

  • Consult your doctor if you have any concerns

Happy New Year!

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Caffeine

Tuesday, May 19th, 2009

It 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!

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Bottled water

Tuesday, May 19th, 2009

When 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!

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Alcohol

Friday, May 15th, 2009

To 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!

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Air Travel

Friday, May 15th, 2009

Do 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!

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Hello world!

Monday, May 4th, 2009

Welcome to Dr. Alan Frischer official blog! Dr. Alan FrischerThis blog is about everyday healthy lifestyle.

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Body shape

Friday, February 27th, 2009

A 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. 



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Fast Food

Friday, February 13th, 2009

It 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!

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Halitosis

Friday, January 9th, 2009

Do 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.

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