Saturday, December 29, 2007

Weekly Wellness

Alzheimer’s Nursing Homes and Psychotropcis: There has been some press regarding off label use of anti psychotic medications in the elderly, especially older persons with Alzheimer’s disease. AD is a progressive, debilitating, brain illness. Basically the brain degenerates. Tissue actually dies and on a SPEC or PET scan one can see black spaces where brain matter should be. For whatever reason, some patients with dementia have significant behavioral problems. [Well, it actually makes sense in the same way that people who have brain trauma and lose brain matter often act out]. Sometimes in the AD cases, the behavior is related to an acute illness, like a delirium. Many times persons not familiar with geriatrics mistake these acute symptoms for a progression of the Alzheimer’s or even a chronic Alzheimer’s feature. There are actually so many things that can be happening which do lead Assisted Living Facilities or Nursing Homes to bring these residents to the ER. I say all this because I was one of the people on a multidisciplinary psychiatry in patient team who sought to stabilize these people. Our role was to manage their symptoms and return them to long term care. It was often a fight to return them to the SAME facility. It is absolutely not as simple as some consumer groups would have us think. I whole heartedly agree that zyprexa, risperdal, haldol, abilify and the like should NOT be used. I argue that acute illness be ruled out first, upon examination, i.e. bowel and bladder disturbance, renal disease, and blood sugar extremes. Just because an 80 year old has a diagnosis of dementia does not mean they don’t have a urinary tract infection. I fully support efforts to change the environment in the facilities as well. Add staff to redirect wandering, excitable, confused and scared persons. Yes, more staff. Another problem is that hospitals and facilities are scared to death of falls and thus a medicated person who won’t get up is a lot better on so many levels than a frail walking un medicated one. But I digress. That kind of hands on, low resident to staff ratio seldom occurs, in doesn’t occur in Medicare Medicaid facilities. In the hospital, physicians are pressured to get the patient out as soon as possible and the long term care facilities won’t take an aggressive restless person back so the only solution is overmedication. Family members often agree to the meds because they have no other choice for “placement” as they call it. Thus now you know, it is NOT that simple. What is simple is this. Dementia is NOT a normal part of aging.

Fish – Fish OIL: Ironically, the health benefits associated with the Omega 3s in fish include heart and brain health. The question is yet unanswered as to if the fish oil capsules are as protective as the fish itself. A recent study still leaves room for doubt. It is very important again that one read beyond the headline. The study involved a small group, two groups, of women. Less than 30 people total and that is too small to allow for any type of population generalization. Any way. One group took capsules while the other got the same mg of Omega 3s in actual fish. Afterwards both groups had the same blood level concentration of Omega 3s. That does not answer the question, “ Is the effect the same?” A long term study would be needed for that and frankly; you don’t have time to wait for that. Eat your fish. They contain additional elements, protein, minerals, and yeah, well ok, a little mercury, cadmium…….. Oops.

SWEET! Oh I like this study from a place called Kaleida Health in Buffalo NY. Actually more than one study and the results are also more suggestive than causal. Oxidative stress and inflammation occur often in our bodies. Bad things like smoking cause it. But good things like exercise also cause it as do necessary things like eating. There appears to be an inflammation process to all cellular activity and free radical release. The accumulation of free radicals is quite harmful and inflammation in the blood (c reactive protein, homocystiene) can be a marker of heart disease. We also have a built in clean up effect, the antioxidant process which can be enhanced when we eat foods like blue berries and fruits and vegetables. Obese persons generally have more inflammation and high fat foods themselves increase oxidative stress, acutely. A healthy, active person of normal weight may still have an oxidative response when they eat, but it abates quickly. The researchers found that normal vs. obese subjects who ate the same high fat high calorie (1800) meal [meal? That is what I eat in a DAY] had the same spike but it lasted much longer in the obese group. That will increase their already higher risk of heart disease, and heart attack. However, there was also a study in which the same 1800 calories was in high fruit and high fiber and there was NO SPIKE. I don’t recall if that included both normal and overweight persons.

Radiation: It has been said that X-rays should not be used with reckless abandon as radiation exposure can change cells and damage DNA which is one way cancer can initiate. Now there is a concern about warning people who have been given radiopharmaceuticals. This would be chemotherapy as well as perhaps dyes used in bone scans. Apparently it leaves the patient a little radioactive themselves. Enough so that days and months later the person will set off an alarm at the airport. Doctors are being asked to warn persons of this possibility. Geez.

Saturday, December 22, 2007

Weekly Wellness

Eating Out: Most of us realize that fast food is not typically low calorie and is sometimes ridiculously high in fat. The same can be said of fine dining establishments as recently highlighted by R. Sokolov in the WSJ. Chef’s generally cook with out consideration of the obesity epidemic and expect instead, that the diner will limit the amount they eat. Ah not so. We eat with the same reckless abandon with which they cook. That is ok – sometimes. It is also okay to request your food be prepared a little lighter. In the end, you live with the body you feed. You age and die with it too.

Dieing Too Soon: Speaking of lifestyle. A website related to tobacco use and cessation named has a statement that is very much representative of why I write this newsletter and have the passion I have about your being sagacious and salubrious. No author is listed for the statement, which is thus: “Dieing in old age is inevitable, but dieing before old age is not.”

Cancer and Lifestyle: The American Cancer Society released some global cancer numbers this week which they projected by using WHO resources. Differences in type, incidence, and survivability are seen between developing and developed countries with some overlap. Researchers are seeing changes in developing countries. There is less death and disability from infectious disease and there is less child mortality. That is the good change, the bad is that there is more of death and disability related to cancer. The cancers are associated with a rise or continuance of tobacco use (I make that distinction because in many developed countries smoking bans as well as prevention and cessation services are in place which have reduced tobacco use) as well as “fattier diets, “ says ACS epidemiologist Ahmedin Jemal.

1 in 3: One in three children and adolescents are overweight and obese. That is a rather staggering number. Two studies regarding the effect of this phenomenon were part of a Medscape CME activity I completed this week. Most importantly, these children will have risk factors for coronary heart disease, CHD, such as HTN and high cholesterol before they reach adulthood and will have CHD in their 30s and 40s. That, as my coworker likes to say, “Is Crazy.” It was also noted by the scientists that the drugs available to treat some of the conditions are first, intended for adults and secondly, untested for long term effects. I.E. we must get ahead of this with prevention.

Drugs: Everyday it seems there is something in the press about a prescription drug. Drugs changing formulas, drugs used off label, drugs losing patents, drugs causing unacceptable side effects, drugs not being approved, drugs having block buster sales… People rely on so many pills and drug companies depend on that. Especially interesting to me this week was information on a vaccine that will compete with Merck and Sanofi-Aventis’ Gardasil. The drug (vaccine) is from GSK and called Cervarix (geez these names). It is in use in some 45 countries but our FDA has requested additional information on it. The drug is supposed to protect people from the 2 HPV strains (there are 14+) that cause most of the cervical cancer cases. Gardasil does offer protection against four strains, two of which are often related to genital warts. I want to emphasize or reiterate something I have said before, the vaccines may protect against the virus, they do not necessarily stop the spread of the warts and they do not prevent cervical cancer directly. These vaccines do NOT obviate condoms and pap smears. Pap smears prevent cervical cancer.

Wishing you wellness and joy!

Saturday, December 15, 2007

Weekly Wellness

Byetta: In a commercial for this drug which I believe is intended to treat diabetes, the announcer notes that the pill effects appetite and thus one may eat less and lose weight. Well, yes. Usually we do lose weight if we eat less, that is how weight loss works, through an energy imbalance. You can achieve weight loss and maybe even make an impact on your blood sugar (recommended for pre diabetics), by eating less and moving more without the side effects of nausea and vomiting that accompany Byetta.

$350, 000 Test: If you paid that kind of money for genetic testing and were then told that you should eat better and increase your physical activity to reduce the chance of contracting whichever disease your genetic profile pointed to, would you listen? In other words, if one needs to pay an exorbitant amount of money to accept the message that I happily provide for free, if that is what it takes, by all means, spend the money. It might save you some health care expenses down the road.

Living Longer: Research continues to confirm the health benefits of eating a Mediterranean diet. This study from NIH and AARP used people ages 50 -71 who live in America and had them eat a diet more lean than most of us choose. The diet was higher in fish, fruits, vegetables and monounsaturated fats like nuts and olive oil. This style of eating, hey I like that, “style of eating”, not dieting, is low in red meat and dairy foods. People in the study were less likely to die of any cause in the 5 year follow up period. I did not read the study itself so I am not sure how long the people ate that way before the five year follow up. The group was however, compared to one similar in all ways but the foods ingested.

No OTC for Mevacor: The FDA panel put together to explore whether or not Merck’s cholesterol lowering drug should be available OTC voted against it this week. Two strikes. The FDA can still approve the sale, but it is unlikely. The reasons the panel offered for its decision are not necessarily ones I’d mentioned and are interesting. The concerns which arise from focus group type research of 1500 people, is that too many people who do not need this medicine would take it. There was also concern that some who take higher dose prescription statin, or cholesterol lowering drugs, would switch to this OTC which is of a lower dose. (Hey remember my thoughts a few weeks ago, is this stuff even effective at a lower dose?). Anyway. It was noted too that the prescription statins would be cheaper for people with prescription drug benefits than this OTC med. While doing this research, the panel found that 30% of that pool of 1500 people actually had very high risk factors for disease risk and complication, i.e. they may have already had a heart attack or stroke, and were not being seen by a physician. Now Merck might argue that those people would take the drug and benefit, but those are the very ones that need the prescription strength drug. Further, there is no way to tell if you have high cholesterol beyond having a lab test. Most OTC meds are for ailments which are symptomatic. In other words, we don’t generally use wart remover if we don’t have warts!

Would you Like Mevacor with that? However, if one were to sell Mevacor without a prescription, perhaps Hardee’s would be a good place to start. I.e a “Philly Cheese Steak Thick Burger.” Are these people insane? The sandwich alone, without fries or a drink, has 930 calories and 63 grams of fat of which 24 are saturated. Far from being Mediterranean, eh. So I ask, “And would you like a cholesterol lowering drug with your order today? How about something to prevent that colon cancer you’re working on there buddy?”

Fructose: One of our country’s (USA) obesity experts was interviewed on Australian radio this past week, Dr. Robert Lustig. I was able to listen to the interview on my IPOD (whilst running :)) and though I cannot give you the same detailed explanation of this obesity explosion that Dr. Lustig offers, I can recap some very interesting, research based points. He refers to insulin, leptin and fructose in his lecture. It has been some years since we (in this newsletter) explored the appetite regulators grehlin and leptin, but you may recall that grehlin, from the stomach stimulates appetite and leptin, from fat cells turns it off. These hormones are often studied in the big quest for an obesity pill. That is NOT what Dr. Lustig is doing. He explains that our insulin resistance has led to leptin resistance and because we do not get the message that we are full we continue to eat and we pretty much feel listless and do not expend energy either. That was very simplistic and Dr. Lustig might fall off his chair if he read it. He said that the job of insulin is to get sugar out of the blood stream and to store it as energy. It is stored in fat cells. Because we have somehow overloaded our delicate metabolic and endocrine systems with the foods that we eat (processed) we release more and more insulin to get the energy into the cells. That is insulin resistance. When we need more to do the same job that less used to do. Diabetics can become completely immune to insulin. Okay, once the energy is stored in the fat cells, leptin is released. It goes in the blood stream and is taken to the brain which is told that we are full. More insulin, More Leptin and thus, leptin resistance occurs as well. Dr. Lustig said that we don’t “see the leptin.” Cycle goes on and on. He notes that the problem could in large part be do to fructose which has been added to our foods. Fructose is also in HFCS and sucrose. He talks about foods that are low fat that are anything but because they contain this fructose. Fructose is fruit sugar without the fruit, i.e. without the fiber. That is very important. Fructose is metabolized in the liver and has adverse effects on the liver, such as alcohol does and does increase fats in the blood as well. It also impairs an insulin receptor in the liver. In the end, fructose also causes insulin resistance and then leptin resistance and obesity. This is due to day after day of fructose intake. Fructose is in so many of our foods it could be called the nicotine of the food industry. It triggers eating behavior because our appetite suppressant mechanism is no longer working. Dr. Lustig was asked a question about the glycemic index which he did not discount but qualified with the glycemic load (so you may want to read about that on your own). In this part of his discussion, low carb diets were compared with low fat diets and he told the story about low fat diets not being low at all because the sugars were increasing blood fats, and increasing eating behavior. He also spoke about the way Japanese people ate white rice but did not get fat. He stated that the carb part is ameliorated by the high vegetable intake that Japanese people consume. I.e. they add fiber to their simple carb intake, further, until recently, there was NO fructose in the foods available in Japan. Now older persons in Japan eat the way they always have and young people eat more western meals and are themselves becoming obese. Take home message: Fiber yes, fructose no. I.e. eat the fruit don’t drink the juice, eat the whole grains and leave the Twinkies. Now you may be wondering if eating a Twinkie with an apple would be helpful and truthfully I do not know.

Wishing you Wellness

Saturday, December 8, 2007

Weekly Wellness

Children: That I’ve been able to sit on this all week is a shock even to me. In fact, as it occurred, I had to call a friend to vent as I was so flabbergasted. Later in the week when an article regarding 2 studies reported in JAMA on children’s expected disease outcomes was published, I was anything but surprised. Children, people, hell, animals, don’t generally gain weight without a significant energy imbalance. Something causes weight gain and as the studies suggest, that weight gain can causes disease and that disease can significantly decrease one’s life expectancy. (In rare situations weight is related to genetics and disease processes more than EIEO). How do children end up so heavy? Here is a real life example. A family came to the pool; mom, grandma and two young boys. One boy may have been two and the other four. The four year old was a chubby fellow. None the less, I was excited by the idea of kids coming to swim and be active. Both boys got right in. They were not speaking English so I don’t have audio with this case history. Anyways. Mother calls repeatedly to the chubby kid who has begun splashing around in the pool. He goes to her finally and she gives him hard CANDY to eat. Oh yeah, it is a choking hazard but geez he was playing not asking for sweets! So a ½ hour later I leave the pool and by all I hold dear, I kid you not, the children were sitting in the pool on the steps eating fast food burgers. I SAW the bag. And that is why there is such a thing as an obesity program at Children’s Hospital of Boston and why it is far from the only children’s hospital that treats obesity.

Lies: More stunning behavior. A pharmaceutical company was highlighted in a little WSJ article this past week. The company, Sirtris, is developing a drug that might mimic a protein in our bodies called sirtuin enzyme one. People who eat low calorie diets seem to make more of this protein (enzyme) and Sirt1 seems to be protective of disease. Another compound that seems to activate the release of sirtuin is resveratrol, which is found in small, ineffective, quantities in red wine. This company and some others are working to create a chemical or pill out of resveratrol or one that acts like resveratrol but has none that will reduce disease by generating more sirtuin in the body. Still with me? They are trying to make a pill that does what the body will do on its own if one eats a low (probably reasonably low) caloric diet. That bothers me for all the reasons you already know, but it isn’t the lie. Here is the lie: In the WSJ, K. Winstein writes that the company Sirtris is doing this to make a drug to prevent diseases of aging such as: diabetes, Alzheimer’s and cancer. The FDA won’t call aging a disease so I guess the company can’t sell a drug that “treats” aging. Hear me now: diabetes, Alzheimer’s and cancer have all been repeatedly found to be most often caused by these things: overweight, too few fruits and vegetables, too little physical activity, too much inactivity, as well as genetics and environmental toxins. The above diseases are not caused by getting older! Damn it.

Heart Attack: There are more heart attacks and more fatalities related to them this time of year. The holiday months. In the past I have reiterated this at Thanksgiving. This year I did not. I read a long time ago that eating large meals, a lot at one time, could increase the risk of heart attacks. It is one of those things that I never forgot. This week a reminder comes from several cardiologists, including a past president from the American Heart Association. I trust you will believe them. Heart attacks are more common for several reasons. They are more fatal at this time because people are more reluctant to seek assistance when experiencing the symptoms of a heart attack during a holiday family time. There may be less medical staff on hand as well. You can certainly make a commitment to seek help if you experience the symptoms of a heart attack. Here are some other things that you have control over. Taking your meds if you are prescribed them, continue your exercise program and watch the fat, calorie and salt content of each meal. Seriously. I am not saying to diet at Christmas, hell, diets don’t work ever, but surely not at this time of year. From L. Neergaard of the AP, I quote, “a heavy meal stresses the heart AS it is digested, salt causes immediate fluid retention which means the heart has to pump harder, same with excess alcohol”. High fat meals may actually affect the lining of arteries and many Americans have clogged arteries which already have poor blood flow. Eat wisely, now and always. You can always eat that great meal in two sittings!

Fosomax: A class action lawsuit is pending as some users of this bone drug have had jaw bone degeneration. Isn’t that odd. A pill that is supposed to prevent further bone loss causing jaw bone to die. I think about the people who have osteonecrosis of their jaw with some sympathy and angst. I was on fosomax a year or so until I told my doc, the same one who gave me Vioxx, (and I really liked that doc better than any I’ve ever had), that I didn’t want to take something indefinitely which may or may not prevent a fracture if I happened to fall down sometime in the future. Especially because, I told him, we don’t know what the long term side effects may be. He said ok. I am so NOT the girl drug companies market to with their TV commercials, i.e. I ask my doctor if I can NOT take a pill.

CTs: Computed Tomography. Hmm, well, it’s a scan that docs use that can help them diagnosis internal problems and it exposes the patient to radiation. This is often an unnecessary risk and I know we talked about it last year. The practice of ordering CTs too quickly continues unabated. Researches supports that these scans could increase the lifetime risk of cancer by 2%, remember that several other things we do or are exposed to also increase that risk. If you think 2% is ok you probably haven’t been diagnosed with cancer. Still, this second study confirming the risk ends with encouragement for doctors or other health care providers to try alternative diagnostics when possible.

Wishing you wellness.

Saturday, December 1, 2007

Weekly Wellness

Beta Carotene and Memory: I thought that this study was cancelled years ago when it was found that smokers who took the supplement were more likely to be diagnosed with lung cancer. That being said, the results of a near 20 year study are reported in November’s issue of the Archives of Internal Medicine. I haven’t read the article but saw a little story about it in the local herald-tribune here in Florida. What I liked was the journalist’s synopsis which included who was in the study and thus who the results would relate to, where the actual study can be found and the admonition that you not change anything in your life based solely on this study. In her report it is noted that some men took beta carotene supplements every day for 18 years, while others took them every other day or for less years and some took placebo. One test for memory at the end of the study showed a little improvement in the every day, long term group. I am not at all convinced then that taking a supplement for 18 years is helpful.

Alzheimer’s and Mild Cognitive Impairment: Ironically, this week there were other stories about memory as well. One is a report that the three main Alzheimer’s drugs, when used not to treat behaviors associated with the illness, but to prevent mild memory impairment from becoming a progressive dementia, were not effective. They of course have side effects, the drugs, and thus should be used only out of necessity. Further, research continues to build that memory and intellect can be preserved (in fact, improved) in the same way that stamina and balance can be preserved. By doing things now to keep the blood flowing to the brain, i.e. exercise and by always striving to learn knew things.

More Exercisers? A confusing bit of survey results this week. More Americans appear to be exercising but obesity rates are not declining. Some ideas on that disconnect? One, people say they are exercising when asked because they know they should be. Two, people describe vigorous and moderate activity differently. And three, (this one is making its way through the expert pipeline), people are eating too many calories still and maybe even more when they exercise. Here is another thought on the calorie front, sports drinks and bars. Really, walking around the block does not make one an athlete. It’s GOOD to walk around the block, and then, have some water.

Smoking Vs. Obesity: Interesting that the smoking rates are now down to 17 % give or take for age group and state, while the obesity rate is double that at about 34%, nationally. Cigarettes are highly toxic as I have mentioned. Cigarette smoking contributes to if not directly causes, lung and other cancers, heart disease and death and respiratory illness and subsequent death. Cigarettes should be banned. Current smokers can receive the quit smoking counseling and NRT products available by way of tobacco settlement money. New money and New efforts should be spent on the obesity epidemic. No ONE needs to smoke a cigarette to live. Everyone needs to learn how to eat in order to live longer, well.

Wishing you wellness.

Saturday, November 24, 2007

wellness weekly

It’s NOT a Small World After All: At play, vibrant and energetic, children were at one time the epitome of health, full of vim and vigor. Childhood was a time of learning achieved in fun and active ways. Disney World a place to take these precious children for a little more fun and adventure. Now doctors are diagnosing hypertension and hypercholesterolemia in children while Disney World remodels to make its rides capable of handling the ever expanding girths and heft of its visitors young and middle aged alike. As parents, teachers, health care professionals and a society, we MUST do more to make a healthy weight possible for our children or they will die before we do.

Fitness: In an article explaining the benefits of yoga, cardiovascular health was not found to be one. Researchers studied the practice which involves stretches, poses and balances to learn what health impact it does have on those who do it. The benefits do include balance, stability and flexibility but not increased cardiovascular fitness, as yoga was not found to increase heart rate through exercise or if so, not to sustain it long enough to meet the recommended duration. Cardiovascular exercise is noted to improve health by improving blood and oxygen flow but also by reducing weight and increasing HDL or healthy cholesterol. Instead, the well respected Kenneth Cooper of the Cooper Wellness Clinic suggests that a moderately fit 35 year old RUN 20 minutes four times a week. Less fit persons are encouraged to begin a walking program of 30 minutes a day most days of the week. He did not say we should not do yoga by any means, only that for heart health we needed the cardio exercise separately.

Women and Disease: Heart disease is our country’s number one killer. It kills more women than lung or breast cancer. What is interesting is that just as lung cancer has increased for women (taking more lives than breast cancer) while it has decreased for men, so has heart disease. Many health experts attribute rises in lung cancer in women to cigarette smoking. Lung cancer takes years to develop, not so long to kill however, and women started smoking and smoking more years after men did. Many people mistakenly believe that the number one smoking related illness is lung cancer, it is not. The number one smoking related disease is also the number one killer of Americans. It is heart disease. So when research came out this week showing an unexpected rise in coronary heart disease among women ages 35-44, not just disease, but death at those ages, I thought again of smoking. The authors of the study noted genetics, obesity and diabetes as risk factors for heart disease and I add cigarette smoking. Nicotine and carbon monoxide play off each other here, but nicotine in cigarettes causes the release of fat and cholesterol. (coronary heart disease IS clogged artery disease) and nicotine in cigarettes narrows arteries. Those overweight young women who smoke are at significantly high risk for heart attack and death. Add a birth control pill to that mix and you are toast.

Global Unwarming Melts the Pounds?: The American Public Health Association, or APHA, is pushing efforts to reduce green house gasses and emissions in order to help us improve our health in myriad ways. Spokespersons and CDC experts agree, if we drive less and walk and cycle more, we cut the emissions and lose the pounds. It is also suggested that we eat less meat because it is more taxing on the environment to produce than fruits, vegetables and grains. Amen to that! This is supported by the UN Food and Agriculture Organization as well and a Dr. Lawrence from the Johns Hopkins’ School of Public Health who notes that men, in general, eat 1.6 x more meat then recommended. Remember, red meat consumption is consistently correlated with colon cancer.

Reality: In a novel I just read, a character notes that humans can’t stand too much reality and in fact, flee from it. In regards to wellness, I believe that is exactly what a large percentage of us do. Reality is this. The major causes of death and significant disability are controllable and related to lifestyle choices. The medicines we depend on instead, medicine to control the diseases such as hypertension and diabetes which cannot be cured, cause additional health problems. Recently we have heard about heart attack risks with diabetes drug Avandia. Now it is said that a physician raised those concerns in 1999 and was muzzled by GSK which makes and or markets Avandia. Eight years later and the drug gets a black box warning. Think that will matter? Not really. My years working in a hospital saw many doctors blow off the warning labels even when I brought them to their attention. So if they want to keep those meds away from people they’ll have to vioxx them. You, on the other hand, might try eating wisely and moving more.

ICE: Once again I must extol the virtues of ice. Ice is a wonderful anti-inflammatory and can be used to treat injuries sometimes instead of medicine. And here again ice is offered as a treatment in lieu of medicines. [why do we need an alternative, well, that is spelled out above]. Anyway, I have two sisters. Both are experiencing hot flashes these days. One of them has the experience in response to menopause while the other is having them as a side effect of a medication she must take. I overheard their recent lamentations. Middle sister’s wisdom is now offered to you all. She takes lunch box ice packs and wraps a towel or cloth around them, or one of them and places in at the base of her neck as she is falling asleep. When she feels better she places it beneath her pillow. If she wakes later in the night with another heat rush or flash, she flips her pillow which is now very cool to her face and neck. You may respond to this idea the same way big sister did. “Oh, I am so going to do that.”

I did indeed write this Thanksgiving Weekend and enjoyed doing so. Hope you are all invigorated by the holiday break and doing your part to stay well.

Saturday, November 17, 2007

weekly wellness

Proof: It is ingrained in our culture that high calorie high fat food is cheap and healthy options are not. I participated in a great fundraiser a week ago. At the end of the motorcycle ride, they served a free lunch. Well, the food ( BBQ on refined white bun, mayonnaise based coleslaw and baked beans) was, the bottled water cost a dollar. (?)

Go Slow Whoa: Holy cows this is great. You know this traffic light program as I bragged about Sarasota County Schools and it’ GSW lunch menu much of last year. Green is go; healthy low cal foods are green. ETC (you can learn more at the NHBLI WECan website Well the nutrition folks at Sarasota County educate the students that Whoa is a food to eat in small amounts and only on rare occasions. This includes educating the kids on which foods outside of school fall into the different categories. Lo and behold, a McDonald’s on a main road in Sarasota has a tag line running the perimeter of its building. It says something like this, “WHOA- kids, stop in …..” My great hope is that the kids will see the big WHOA which IS in bigger letters than the rest of the sentence, and remind their parents that McDonald’s has red foods and they should eat somewhere else.

The goal of big pharma one would hope is to save lives, extend lives, ease suffering. It may well be, but to read the paper and listen to financial news shows, it doesn’t appear to be the main goal. I am not naive to think that drug makers do not aspire to make a profit. It just feels hard to “swallow” at times. Sort of like a horse pill. Particularly shocking to me recently were two separate stories I read. One regarded the upcoming release of a generic version of a best selling HTN drug. The company that makes the name brand was bracing for a loss in sales that worried investors. I get that part. However, the brand name company was upset more because the generic version may be approved sooner than expected (good for the millions of people on the drug) and the company’s plan to offset the loss wasn’t ready. It is the offset plan that angers me because so many companies do the same thing. The drug, Altace, is in capsule form now and the company was trying to get a tablet form out before the generic which could extend the patent. Anytime they “change” the formula, like making it a longer acting form or switching to a one a day instead of two a day dose, they can extend their profits. I think it isn’t fair to the consumer to be gouged and tricked that way. There isn’t anything new about the drug because it looks different. The second story, regarded a change in the labeling for the anemia drugs we have heard a lot about lately, The statement in the article that was most disconcerting indicated that the black box labeling would make it hard to curtail losses from this “blockbuster drug’s sales.” This same issue got worse later in the week when I read about the drug’s maker setting up a website where cancer survivors and their family members could write in praising the drug so that the US Congress and the FDA might be swayed to change their warning that at high doses and in certain populations the drug was inappropriate and had high adverse event risks. The company in other words was trying to back door lobby and their reason was, to stop the loss of sales!

What Does Vermont Have? Vermont just ousted Minnesota out of the top spot of health in the USA according to a nonprofit group, United Health Foundation. The group uses sources like the CDC, the AMA and the Census Bureau to compare certain criteria. They look at obesity rates, and also the number of persons living in poverty, number of uninsured and similar issues. Vermont claims a systems change approach to health. This is a model to emulate. Health promotion, policy and physician involvement. For instance, a campaign to tell us that we should eat more wisely, and move more supported by a policy that mandates restaurants to list nutrition info and employers to offer fitness opportunities. During which doctors tell their patients that they are overweight and refer them to a health educator, nutritionist or exercise specialist to receive support to change. [vote for me for president J]

Lack of Use: Lack of use causes more pain and more atrophy (wasting of muscles) than over use. Exercise improves mobility, balance, mood, and health while reducing pain associated with arthritis and fibromyalgia or FMS if you prefer. The latest study to support this assertion comes from Brigham and Women’s Hospital and Harvard Medical school. This is probably not the kind of message Pfizer wants out there since it recently received FDA approval to market its drug Lyrica to FMS sufferers. Ah, well TOO BAD

Living Longer not Better: We have increased the options for treating disease and we have learned what causes those diseases. We know that the majority of these debilitating illnesses can be prevented but we’ve made little progress in actually preventing them. In other words, little progress has been made in motivating people to adopt healthier lifestyles. Policy makers too lag behind in pushing the issue of prevention over treatment or at least insurance coverage for the same. The newest rise in illness is for peripheral artery disease in women. This happens when arteries narrow due to plaque buildup and blood flow to ones limbs is reduced. Any time the blood flow is impaired it’s a bad thing. It is the same when clogged arteries slow blood flow to the brain. It is significantly related to the rise in obesity. The rise in obesity rates is directly related to eating too much of the wrong foods and doing too little daily activity.

Pregnancy Notes:
This week I learned that smoking during the last trimester of pregnancy was the most related to smaller gestational size of the fetus. All smoking is detrimental to the fetus both due to neural effects from nicotine and toxic effects of cigarette smoke. Smoking can lead to premature birth and SIDS as well as many other things. It was a surprise though to learn of something being worse in the last trimester, as it’s usually the first. This means that it is never too late in pregnancy or in life to STOP smoking. In regards to quitting, nicotine replacement therapy is recommended for most smokers, though not usually pregnant ones. If one is unable to quit smoking without NRT the risk to the baby is far greater than with NRT which is clean nicotine. Therefore, if a woman does need the NRT to stop smoking, the best option is gum or lozenge instead of patch. This is because the patch dispenses a constant flow of nicotine over time. The others could deliver a dose of nicotine only at the time the mother chose and hopefully only in crisis situations. Lastly, about pregnancy, did you know that gum disease can increase the risk of infant mortality? Independent of other factors, research found that a mother with gum disease has a greater risk of experiencing a fetal or infant death, I am sorry I forget which it was. The inflammation from the disease gets in the blood stream as it does with all of us and where it increases heart disease risk in the general population it also adversely affects a pregnancy. Brush your teeth!

Wishing you wellness… may or may not write next week. If not, enjoy family and friends and remember to increase your activity and don’t eat TOO much at once, its bad for the heart. (I mean it is immediately bad for the heart, not that it leads to heart disease)

Saturday, November 10, 2007

Weekly Wellness

Antidepressants: Many drugs exist which are prescribed to treat depression. Atypicals, SSRIs, XR, ER, and MAO inhibitors. There is even electroconvulsive therapy for those resistant to medications. Why we need any new ones is a mystery to me. Many of the drugs lead to increased appetite and or decreased metabolism and thus weight gain and in some cases diabetes. Many also have been found to be equally as effective as exercise or placebo. Or in other words, exercise has been found in clinical studies to reduce rates of depression with the same efficacy of pills. Sometimes the pills make one unhealthy physically which in my opinion, contributes to depression. So when the FDA did not approve company’s FKP and GSKs new drug application for gepirone ER I didn’t shed any tears.

Supplement Xcess: Ok, why would you buy a supplement to improve bone or joint health that also boosts energy? I can see why you might add energy boosters to your long acting Cialis or erectile dysfunction drug of choice, but your joint pill?

TFA: Months ago we reviewed the need to be cautious when buying these “new snacks” which may be trans fat free but still high in fat or calories. Funny the Wall Street Journal just this week warns of over consumption of these not necessarily low calorie foods. The writer also reiterates, zero does not always mean zero. See the side panel to your right and always read your labels for the actual ingredients. Well you might not ALWAYS have to scrutinize your labels but you might consider it now and again.

Oregon Rocks: Taxing a product that has no business being sold, in order to pay for preventative and sick care for children, who pray God, never get an option to buy said product is pretty ingenious in my book. People argue about cigarette taxes in that they seem to imply we need the smokers to keep smoking in order to keep that revenue stream. Others say, well, if those 20 to 25 % of the US population stop smoking and one in five people stop dying slow painful deaths from the consequences of smoking……. Well, we might just have more money for health care without having to make a special tax. I’m with that group! Might I just add here that the surgeon general of the USA has stated that there are 250 chemicals in second hand cigarette smoke that are considered toxic or cancer causing. One of them is lead. Now if cigarettes were toys from China, well, they would be recalled wouldn’t they?

Golden Wheat:
NOT> Enriched wheat buns made the menu at a local Chik filet (I think). An alert ready told me this story. She ordered the sandwich with the “golden” wheat bun but later learned that it was enriched wheat, not whole wheat. (Hey Ellen, you were right about those little toastie breads thought they ARE whole wheat J) . Anyhoo, my friend was upset and rightly so. For many people that bun is going to be one of their main sources of whole grains for the day. Myself, I usually just use bread to hold my protein and get my whole grains elsewhere so I choose which ever bread has the lowest calories, like merita lite wheat. I have whole grain fiber in abundance and I do not have diabetes. If however, you are diabetic and must limit your high glycemic and processed, refined grains an enriched flour product is not an acceptable substitute for whole grain whether they call it golden wheat or not.

Weights and Health: Oh my, give people a little leeway and they are off to the races. This refers to hearing the HEADLINE that overweight doesn’t increase death rates over normal weight. There is a lot more to that research than the headline would imply. But right away, the airways were rife with stories about how model thin is a scourge and being overweight was better than being rail thin……. Hello? Does the general public realize that the number of model thin and likely unhealthy because of it people, is a MINISCULE percent of the population where as, the overweight obese category has become a public health crisis? This research does not in any way debunk the science behind exercise and caloric moderation. What it says is, overweight people, 25 lbs was the research number, do not die at greater rates. What they do have at greater rates is chronic illness and disability. Being overweight leads to diabetes, hypertension, arthritis and cancer as does sedentary behavior. So let’s just not fool ourselves into thinking that models are to blame for the admonishment to maintain a health promoting weight. It is just as dubious a response as saying I am not going to lift weights twice a week because I don’t want to bulk up…… give me a break.

Drug Trials: An article I read this week about a drug trial gave me something to consider. It regarded the recent news about Pfizer’s drug that was in a stage 2 trials I believe, 2 or 3, where the target population was taking the drug in a controlled fashion compared to two other similar groups taking nothing or a different drug. Anyways, the new drug is meant to not only lower LDL but to increase HDL. It is an interesting new drug compound actually that other companies are also working to make into a super cholesterol drug. There is a protein in the body that takes the HDL we have and turns it into LDL and if they can turn that mechanism off, the HDL might go higher. Otherwise, you might have to ……………………EXERCISE>>>>>>>>>> scare me. So the drug was really having a significant effect, on both LDL and HDL, the way we’d like, but some people died or had another adverse event. The independent board that oversees that study halted it. Now Pfizer is thinking that the drug is good, but it’s the dose of the drug that needs to change. (wait, didn’t’ they say that about Vioxx at first?!) So if they lower the dose and then sell the drug, will they say it was 40% effective in clinical trials over placebo, but not tell us that they mean the OTHER dose. That is my contemplation.

Wishing you wellness and a life with the least amount of pharmacotherapy possible!

Saturday, November 3, 2007

Weekly Wellness

Killing Dolphins: A bulletin board near my home cautions people to not feed the dolphins. It says that feeding them will kill them. I wonder what they mean exactly. It could play out several ways, but I suspect that dolphin’s systems cannot handle what people might throw to them, bread and sweets for example. I think it’s not so good to give that stuff to ducks either. Actually, the more processed a food is the worse it is for ALL our systems.
Mid Day Breaks: Just out. A midday nap may boost productivity. May be, but there is much more research that suggests exercise breaks boost productivity, in that it improves blood flow to the brain and hence, the ability to concentrate is improved. The studies I have read were conducted in school settings where the children had exercise breaks during the day and then were observed as to staying on task or not. They also studied children not given the exercise breaks and indeed the exercisers did much better. YES! That is what I am talking about. Movement
Plant Sterols: In food, the commercial says, plant sterols have been found to reduce cholesterol levels. This is true. The commercial then tells you that their product with these added to it, will lower your LDL as well. I am going to tell you my reaction and then I am going to admit I am wrong. GOSH, I hate that. I thought, the research does NOT support that. The research always says that getting things from their natural source as opposed to a supplemented form is better, or near always better. I still say, why would I buy margarine with plant sterols to reduce the level of LDL in my body when using spreads like that is really not good for me? That may remain true, but the benefits of eating these functional foods with plant sterols, stanols and esters may in fact be health promoting. The AHA however, states that they are not needed if you DO NOT HAVE high LDL. In other words, they are not a preventative sort of thing. Here are the links to two reputable sites that I have to say support the dang commercial. (scroll down the page) and (this is from July!)
Calorie Aware: NYC has not folded in its fight to have calorie and other nutrition content listed on menus. This is one of my policy favs along with SHS initiatives. That would be Second Hand or Environmental Tobacco Smoke. Remember some cooks are notorious about their disregard for restraint when using oils, butters and sugars. NO ONE needs an entrĂ©e with over 1000 calories in it, but they are everywhere. Sometimes the name of the food and its description sound healthy, like a red sauce over a white one, or baked instead of fried, or even, a vegetable plate. Yet you get 30 grams of fat and over 1000 calories for your seemingly healthy choice. I know, not everyone who eats out gives a darn about eating a healthy meal. But because health organizations across the WORLD keep telling us that our gluttony intentional or not is killing us, those of us who’d like to moderate our calories ought to be able to do so without ordering plain food all the time. So there, I guess I have an opinion with a little passion to boot. So the NYC Board of Health is pushing to make eateries that have franchises and standardized foods list the calorie, fat and sodium content of those foods, right there on the menu where customers can see it before they order. This includes places like McDonalds, Starbucks, Apple Bees, Red Lobster, Bone Fish… get it? It is a start and my fingers are crossed for them. Here is an example or two so you get the idea of what eating out without this info can cost you: Shrimp Portofino at Macaroni Grill 1130 calories, okay well that’s it. Guess what? that info is hard to find. They really need to pass that law!
Obesity-BMI-Doctor Visits: Hmm. What can these three things have in common? They can all be associated with disease outcomes. Obesity is directly linked to diabetes, heart disease, hypertension and some cancers. The BMI, or body mass index, can be used in many cases to determine if a person is overweight or obese. And a doctor? Well, a doctor has an ethical obligation to tell his or her patient that their weight is a problem. The state of West Virginia is implementing a program that includes the use of a little BMI wheel. The doctor can line up values, weight and height; say you are five foot one and weight 150 pounds, then the wheel will show your BMI at about 28, near obese. This is sort of ingenious in that the doctor can say the wheel indicates a problem not “I” see a problem. Hey if it gets the issue some attention which West VA hopes it’s fine by me. West Virginia with Medicaid and its public employee insurance spent over 193 million on obesity related illness last year. I would LOVE to be part of a group that encourages health care providers to talk to their patients about weight. From my hospital days, I see quite the need for this attention. Want to know your BMI before someone spins the wheel at your next MD visit? Check it out here
A Proposal: Former NC senator John Edwards is proposing government control over drug company ads. He believes there should be a delay between drug approval and drug ads. He also believes the FDA should approve the ads and that more disclosure on side effects should be provided. He asserts that the ads are misleading and should not speak for doctors or evidence based research. With a four billion dollar expenditure for advertising per year, the drug companies have lots of money to fight him on this.
Speaking of: On opposite sides of the page in a national paper, I saw an article regarding how to make diabetes education culture specific and an ad form Sanofi Aventis (drug c0) pushing insulin. Hello? The culturally specific article was cool. Tailoring the food message to Asian, Mexican, and Italian etc.. families, was very smart. Encouraging people to ask for insulin as a first line treatment for diabetes is invasive and cruel.

Well, weeks ago I dropped a jar of my most beloved Smuckers All Natural Peanut Butter on the top of my bare foot. My foot turned purple and swelled despite the IMMEDIATE application of ice. But then I sucked it up a day or so later and went back to my regular running routine. Yeah Me! It improved right up until the day it got worse, HA> I am cross training these days… dumb me smartens up… … I still love that !@#^*&^^% peanut butter.

Wishing you Wellness in a world of attacking food products

Saturday, October 27, 2007

Weekly News

  • Anesthesia: A very good article involving a side effect of surgery was offered in the Wall Street Journal. Many of you may have heard that after surgery people may have some confusion. In fact, it is more delirium, a very serious and expectedly reversible condition. what researchers are finding is that the condition is related to duration and depth of sedation. It is also less fleeting that originally thought. I have seen the phenomena in my professional work and it was as if the person described in the article was the person I had worked with, when in fact, it was not. Some best practice guidelines are promoting a change in the ICU in response to increased problems. What I wanted to add here is that when the statement was made that the problem is worse with older patients it was NOT because they were older it was because they - "multiple risk factors such as high blood pressure, diabetes, chronic heart failure...." That is just one more reason for you to choose a health promoting life style. The pills or interventions may keep you alive but that doesn't mean you'll feel like being here.
  • Healthy Everywhere: How can you eat well where you live, work, worship, learn and play? By setting the example yourself. We do model the behavior of those around us, especially if the “others” are esteemed by us. It’s a simple bit of social norming and you might as well be the one to start. If you’re a program manager it is almost derelict not to. People can eat poorly if they choose, however, if meetings and office events provide fruits and veggies then it will likely permeate church and social events as well. So eat low calorie high nutrient foods in reasonable amounts through out the day vs. sitting down to high fat high cal meals once or twice a day that leave you overloaded, lethargic and lazy.
  • Continued Physical Activity: The major players in sports medicine are gearing more services towards older persons who are physically active and wish to remain so. Persons like my mother (78) and many of my running pals who are 60+. Some colleges and health organizations are looking at those over 50 even some 40 somethings. The goal is to keep this already fit cohort in the shape they are used to. It will certainly reduce health and nursing home costs for them! It is in keeping with my personal goal to live an active life until I am dropped into the grave. I do not aspire so much to run marathons or win races, but to avoid an early death or an incapacitating slow one. What appears to be a common theme in the field is that cardio activities should continue, balance training should be added and attention to the messages from ones body adhered to. That last bit is to avoid injury because apparently no matter the fitness level, the older body does need more time to recuperate.
  • Social Marketing: Here is interesting food for thought from a presentation I attended this past week. More often than not, when a company presents a new and improved version of its well known product we run out and buy it. Think Windows Programs, new running shoes, shampoos, etc. (we get pissed when it’s a new version that costs a fortune and the other one has barely been used, but that is the exception yes?) We don’t generally get MAD at them for using the newest science and advances in technology right, because we want the better product. So how come we get so damn bent out of shape when the researchers tell us that they learned the key for longer life and it’s eating this food and exercising this way. So what it was low carb yesterday, they LEARNED more about that, they were wrong, this is better… Would you rather that the nutritionists didn’t tell you that meat and potatoes could be related to heart disease? Would you rather not know that wheat bread is easier on the pancreas and that smoking in fact will kill you? Maybe you would rather be oblivious, but then, well, why the heck are you reading my blog! Ha ha
  • The Pilling of America Rages On: Before I go off on this again, I have to tell you that people I love very much take pills to keep their blood thin, their cancer away and their blood pressure down. These medications may protect their system from the damage that high blood pressure and plaque could cause and I am grateful to the scientists who created these drugs. Would they and I wish they rather not need them, OF COURSE> They are expensive, they interact with other things and they have side effects. This week we hear more about Avandia (diabetes drug) and heart attack risk, we hear that the anti clotting or blood thinning drug that would compete with Plavix is stuttering in trials. Plavix itself is doubling the net income for its maker. The drug makers are working on drugs that one takes FOREVER, to prevent that second heart attack for example. I cannot promise you that watching your weight AND your nutrition, (choosing what you put in your body) while also engaging in daily exercise of some sort will keep you from getting ill, but I can tell you that in aggregate, that in groups of people, that is exactly what proper nutrition, weight and exercise does. It prevents the FIRST heart attack. And if I have one, don’t you dare use that to keep you from living well, because my point is still that in general and in groups, the norm is NOT that people who live well have heart attacks.

    Well? Get up and go do something. :)
    As I wish you wellness

Saturday, October 20, 2007

Weekly News

Not meaning to stay on the anti drug company train, I begin there regardless:
  • Earn the $$$$: Some countries which have national health programs such as France and the UK as well as some health insurers (Cigna, Aetna) are requiring or considering requiring satisfaction guarantees from big drug companies. In other words, if a company tells us that X drug will lower cholesterol and people who take X drug will be less likely to have a heart attack but the people on the drug do have normal rates of heart attacks, the NHS or Cigna, get some amount of money back. I like this because what happens in a good random clinical trial doesn’t necessarily play out in the real world. I would hope that agencies and insurance companies would get 100% plus back if they agreed to use a drug for example which turned out to kill people instead of save them, you know, like Vioxx. What would be really cool is if we could also demand that companies not sell us stuff that kills us, I’m thinking cigarettes, for example. Hey what do you think kills more of us a year lead or cigarette smoke? Both are bad, both should be regulated.
  • Hormone Treatment and Breast Cancer: I was surprised to read about a recent verdict, one out of seven, regarding Wyeth’s HRT and breast cancer incidence. This one found Wyeth guilty of negligence. This is not unlike what we are talking about in the above example, except that it is. This is not the company guaranteeing the safety of its product but the courts calling the company out for what they feel is a faulty product. I was surprised as much about the verdict as my own response to it, which is HUH? In this case it seemed to me, from the sidelines, that doc’s and women’s groups themselves exploded the market for this compound by their own demand. Even today HRT is sought and prescribed, though some caution has been applied.
  • EIEO: Running with a new group these days (thanks Lee Ann) and one fellow mentioned his second career as a personal trainer and cardio instructor. He too said that his clients want the magic pill or even surgery and refuse to change the way they eat. Even when his clients were adding resistance training AND cardio (step aerobics, cycling, running etc) their weight didn’t change because they were eating all the wrong stuff and way too much of it. Let me remind you here, a health promoting way of eating does NOT involve hunger or deprivation. It doesn’t require cardboard tasting food. It is neither bland nor monotonous – heck, variety and bulk are the cornerstone of Volumetrics. If you want to eat and promote your disease fighting capacity don’t go on a diet for goodness sakes, READ Barbara Rolls and Walter Willett, these two are esteemed, degreed individuals at premier academic institutions…. They are NOT Susan Powter (remember her?)
  • DID: DID stands for disassociative identity disorder, it’s a newer, but not new term for multiple personality disorder. As you may know, my previous employment was in clinical mental health. My opinion is that you are who you are. There is only one of you and as a clinician I am only going to work with that one person. That is where I stand and stood before I read about a review of studies noted in Scientific American. That publication discussed studies that found some evidence of false memories resulting from therapies used with DID patients. The idea is to get back to the traumatic event that triggered a defense response of creating different personalities. My issue was seeing this type of thing in patients who really had a different disorder, Border Line Personality. (think glen close in fatal attraction) Anyway, I digress. Some clinicians and others use things like hypnosis and drugs to get into the memories. I believe that if a true event was so devastating that it led to a buried memory, there is a reason for that. That is a self preservation mechanism. When I began my career many years ago, my brother told me that sometimes a person doesn’t want to relive their childhood but to live in the adult hood that they have. That to me is a normal healthy response. Many Borderline patients have no present and that is where the psychotherapy might be better used.
  • DIETS: Several websites, okay, hundreds if not thousands, offer suggestions for losing weight. Some are crazy, some are dangerous, many are fad based and a few are legitimate and associated with valid nutrition organizations such as the USDA and the ADA. The Wall St Journal noted how some people benefit from the social networking aspect of sites like Calorie Count. What I did like about that one is that people are encouraged to be conscious of their calories. Anyone who supports the science of EIEO is on the right track. One person in the article mentioned being a professional dieter and that indeed has been my beef all along….. No No No.. Diets don’t work. Your body needs optimal fuel, the right kind, the right amount. every day all the time. Consistently.
  • YEAH! Fat! I should research this more because I do not know what rendering fat from livestock (from processing livestock) really means, or I know and don’t want to think about it. It could be that I mean to say, BOO FAT BOO. Here is the point though, fat is used as fuel, as biodiesal instead of corn or soybean oil and this can be economically good on several levels. However, when I was thinking of reused fat I thought of fat used after something was cooked in it. I think that is the concept behind Willie Nelson’s biofuel. This article about the expansion of fat as fuel may be talking about extracting fat in the slaughtering process which is quite frankly, gross and well, we don’t have to talk about my vegetarianism right now. Here is the bigger question, if that is indeed what they are doing, can someone “render” fat from us? Yeah that’s it……. Can we use the fat from liposuction to fuel our Hummers!
  • Soda and Calcium: Quick note from late story. The question really is, does something in soda keep calcium from being absorbed, or do people drink soda and not take in enough calcium from dairy and other food products? I think that is what it is, but that is because I love my diet soda!
  • Overheard: This was priceless. A man was walking near my office building and eating an ice cream. This man was overweight. Another man who wasn’t so overweight came out and chided the ice cream eating man. I assume they were friends. He says, “ Hey so and so, what do you have there a no calorie ice cream. “ WELLLLLLLLLLLLLL (as my friend Angi says). The man being sarcastic was Smoking a cigarette…….. What would DEEDEE Do indeed, I would have said, “Hey, Mister, is that a no cancer cigarette you’re smoking!”
  • Diabetes: Very quick story from today. A man went to the doctor a few years ago. Doctor told the man who then weight 350 pounds, you have diabetes and if you do not doing something you’re gonna be dead in a year. That man did what so FEW others do. He changed the way he ate, lost 100 pounds and then began running. I met him recently, I would guess 5’10 170 lb. He runs marathons and also has a cute girlfriend. Oh, no drugs either. Sweet.

    Off to Key West

    Wishing you Wellness

Saturday, October 13, 2007

Weekly News

It has long been the assumption that your news writer does not know the meaning of brief, this week I prove otherwise!
- BTC: Last year I spoke out against one of the pharmaceutical company’s efforts to have a cholesterol lowering drug sold without a prescription or over the counter. The drugs have side effects and in my opinion, people should first attempt to lower bad cholesterol or LDL with diet and exercise. Exercise can also raise the good or HDL cholesterol. Now the FDA is taking comments on its website until 11/28 and is having a public hearing on 11/14 for something similar. The issue is not OTC but BTC. Behind the Counter access to some medications that currently require a prescription. The drugs would be dispensed by the pharmacist after he or she speaks with the customer and makes an assessment. Because I have know Pharm Ds who have impressed me with their knowledge of drug mechanisms and caution regarding drug company claims, I support this idea in theory. This is in no way a slur on MDs, DOs, GNPs, etc. They know the body and the Pharm Ds know medication. If however, the pharmacists end up the recipients of all the drug company wining, dining and gifting, we will have a new problem.
- Mercury Disposal: The number one source of mercury pollution is coal fired power plants and those emissions are not territorial. We are all affected. Other sources of mercury include light bulbs, electronics, batteries and computers. Please do not throw those items in the trash. They will poison the ground water and soil. Log onto Earth911 to find recycling options.
- Food Reviews: Oh my gosh. The Wall St Journal pondered the validity of restaurant reviews when the writers were 1) not anonymous diners and 2) treated to their meals by the establishment. HELLO… prescription drugs??? People will read the article in WSJ and say, true, I should temper my enthusiasm for a restaurant based on what could very well be a biased, paid for opinion. So why is this different from being prescribed a medication from a person who has been treated to, well all the things I noted in the first blurb? A doctor with a drawer full of samples from the company that just paid his green’s fees for the year might not be the best judge of medication use.
- Gary Taubes: Mr. Taubes has written several articles and now a book where he discusses the science of weight gain and offers his opinion. Though he leans away from my science based theory EIEO, he does support my qualifiers. That being, it is energy in energy out but certain foods wreck havoc on blood sugars and subsequently the pancreas, as well as blood vessels and then the heart. If your 1500 calories are all from burgers and Twinkies in other words, you are screwed. He does not promote exercise for weight loss, nor does he mention that it is beneficial in raising HDL. So, he does not get added to the list of awesome health gurus to the right there!
- Lastly: It appears that the FDA did pressure the makers of some cold medications marketed for kids, as was mentioned here last week. Some of the pills have been pulled by their own companies.

Wishing you Wellness

Saturday, October 6, 2007

Weekly News

Okay starting this week's blog while waiting for the moving Van, all packed up and sitting around, that is hard… but I guess less hard than the airport waiting was.

  • Colonoscopy: Early research is showing that a CT scan can detect polyps in the colon which may be or become cancerous. This is screening as is the stool sample kit and the colonoscopy. One is gross, and the other is quite invasive. The CT scan may be more expensive, but that is in debate just now. It could change if there became more demand for it and insurers covered it. For me, at 42, there is lots of time for this to get worked out before I need my first of either test. I really hope the CT is standard in eight years, however, I remain constantly wary of radiation and selective about when and how I allow myself to be radiated. Back to the important point. Colonoscopy and colon cancer screenings are effective in reducing incidence and death from this disease. Screens are usually recommended to begin at age 50 and to take place every ten years thereafter. A diet that is limited in red and processed meats is also health promoting.
  • Heinz: Hmm. The people at Heinz are currently cultivating and testing a new tomato to use in their ketchup. I use the one carb variety but only because it is lower in sugar and cals per serving. It tastes just great to me. I hope what they are doing doesn’t effect that type of ketchup. The reason that the company is trying to recreate the tomato has to do with the use of corn for ethanol. Again, many rippling effects have occurred and one is the increased cost of high fructose corn syrup, hfcs. Oh My, how can that be bad! Anyway, HFCS is in ketchup and the folks at Heinz are trying to make a tomato that is sweeter so they can do without it. It is a very secretive endeavor so not much is known about the new tomato or if they’ve even got one coming along. I wonder what the end result will be nutritionally speaking. Will their new tomato still have the same make up of lycopene that is health promoting and will the calorie and other nutrition info offered in say the USDA Nutrient Database apply to a Heinz tomato, oh and lastly, will the tomato go from a low GI food to a high one?
  • Parents: BOLO-Be On the Look Out for changes on the labels of cold and pain medications marketed for children. The FDA is working on changing the labels to include a warning for children under age 6, four years later than most parents expect. Several physicians are suggesting that children’s colds and pains be treated with non medicinal remedies when at all possible. This is of course a conversation you, as a parent, should have with your own doctor.
  • FDA: The director of the agency came out with an interesting statement the other day regarding the regulation of tobacco. He, I believe, said that it would send out the wrong message. And for this I am in stunned agreement. His point being that the purpose of the agency is to keep us all safe and to assure that the medicines we take, the products we consume, that they are safe as well. As all of you know, there isn’t anything safe about tobacco products and tobacco smoke. Thus if the agency regulates something that kills people, well…….. you get the idea.
  • FISH Again: A group of women came out at the end of the week with a recommendation for pregnant women to eat more fish. This is in strong contrast to the EPA and FDA suggesting that pregnant women and children limit their seafood intake. I continue to support the current FDA caution and the reason is detailed in my Mercury and Fish power point presentation that you can access on the side panel here. I understand the benefits of fish. I FEAR the effects of mercury and other toxins and I don’t think we know the half of it. Most certainly, choose the fish that is SAID to have the least of these poisons, smaller fish, like tilapia, shrimp and chunk light tuna.
  • Germ Fighting 3 to 1: A great story aired on NPR’s health matters some time ago. It discussed what products, techniques or methods might be best for cleaning your produce. To make a long story short, I mean that is why you read this right, fill a spray bottle with three parts water and one part vinegar. Spray the fruit or veggie thoroughly and then rinse with cool water. This works better than any of the products you buy. It works best on smooth fruits and veggies, as opposed to lettuce and or broccoli.
  • Omega 3s: Interesting article in this months Runner’s World taught me a couple of things about this most wonderful healthful fat, yes found in fish. It is most readily in Salmon, which is usually low in contaminants, and this form of the fatty acid is easily absorbed while that in vegetables and nuts is not. Omega 3s helps reduce inflammation and may reduce pain. Some people use fish oil capsules, I still shy away from almost any nutrient that is not on a plate………. Except for three things, which can be your quiz…………Any way. Omega 3s in fish are EPA and DHA and in plants it is ALA. If you eat something with 100 mg of ALA by the time it is changed to the other type and absorbed, you might get but a fraction of it. But here is an even more important point. The recommendations for Omega 3s are NOT in milligrams, but grams. So Salmon has say 1 to 1.8 g’s but those products you see that claim omega 3 added or fortified, etc, like eggs, that is milligrams………. Man oh Man, those food labelers are slick…….. Okay Dee’s three non food nutrients are a multivitamin with iron, additional vitamin D and calcium!

Ending this week’s news at poolside from my Sarasota Apartment. It has been a stressful three weeks and a difficult two days. Cat and I are fine though. Work starts Tuesday and wonderful friends in North Carolina have eased my transition. As has my most awesome sister and super brother in law.

Wishing you wellness

Saturday, September 29, 2007

weekly news

- HDL: Recently, maybe last week, it was noted that Niacin is helpful in controlling the effects of cholesterol. I may not have realized this at the time, but Niacin is known for increasing the HDL which is the good kind of cholesterol and the one often associated with exercise or being from a certain region in Italy. There had been some hope in the medical and pharmaceutical industry that the need for high HDL could be reduced by having the lowest possible LDL. Research out this week did not support that theory. Instead, it is heart protective for a person to have both low bad cholesterol and high good cholesterol. The story on this research noted that at this time the best way to do that is by maintaining a low weight and by exercising daily. Things you might already be mindful of.
- Nicotine: A very important and health related bit of education for you. Nicotine in cigarettes is what leads to addiction. Nicotine in cigarettes is associated with an increase in heart rate. Nicotine in nicotine replacement therapy does not usually increase heart rate as it is a lower dose and less quickly absorbed. Nicotine in NRT is rarely addictive, though nasal spray NRT is more so then say, the patch. What kills smokers and nonsmokers in cigarettes is NOT nicotine, it is TAR and Carbon Monoxide. Tar is the substance that changes DNA’s instructions and leads to cancerous mutations and CO is the component that leads to Heart Disease and other lung conditions. This is extremely important. Nicotine does not kill you, the combustion, the smoke, will. That being said, please considers quitting smoking today and using NRT to assist you with the cravings and withdrawal. Cigarette smoke does not physiologically decrease stress, the reason persons who quit return to smoking may be because they are experiencing unpleasant withdrawal symptoms. Those symptoms can be addressed with NRT and pharmacological assistance; the symptoms of withdrawal will abate and all together disappear in time.
- Alcohol and Breast Cancer: HMMM, this is related to a recent research study that I have not had the chance to read. So this really is more based on the headline than on my review of the study. That being said, a study states that alcohol use has already been related to breast cancer when this use is more than one drink per day. A study that looked at breast cancer patients who drank reviewed WHAT they had been drinking. The results are that any alcohol, a beer, a mixed drink or a glass of wine, consumed over one drink per day is related to breast cancer incidence. A very important note in the article that I read however is that WEIGHT, AGE and GENETICS are far more predictive factors. So the message to you, as a woman is this, WHAT of those do you have power over. The answer is, weight and alcohol intake.
- Smoking: This information was shared with me from an instructor with the University of Medicine and Dentistry NJ on this date actually. I trust that this fact was culled from the research and so I share it with you. For every year that one smokes past the age of 30 (not that one should smoke before the age of 30), three months of life is lost. This means that quality life years are lost, not that you die a year or two earlier than you might have. It is very important that smokers understand, that all of us understand, our life choices can lead to slow, painful and debilitating deaths. It is not something to blow off, saying so what, I die two years earlier, instead it is oh no, you die ten slow years when you could have been living the good life.
- Exercise and Intake: Many people are concerned about increasing the amount of time they spend exercising which is awesome. Sedentary lifestyles contribute to disease and early death for more than the weight reason. Remember exercise increases HDL. In this past week, I heard several people bemoan their aversion to exercise; something they know is good for them. However, I watched the same people eat significant portions of food and food that even in small portions is calorically dense. This seemed an astounding disconnect to me. It really has to be both weight control AND exercise.

Okay friends, I have been in training on tobacco cessation treatment for this full work week and am now in the airport terminal waiting my twice delayed flight home to NC, where I will be spending a few short days before moving to Florida. Hope the news still makes sense in spite of my crazy schedule!
Yours in Wellness

Friday, September 21, 2007

Weekly News

  • FMS: Here is another example of taking a condition, making it common and treatable and marketing a drug to address it. I don’t like it and it goes back to the direct to consumer marketing that raises healthcare prices for all of us. It relegates a physician to no more than the guy/gal who fills your order. Doctor, I have FMS (fibromyalgia syndrome) and need that pill I heard about on TV. Oh, and I’ll take that to go, thank you very much.
    Drugs: They’re on my mind this week. Niacin is often recommended as a more natural and reasonably priced option for preventing heart disease through reduction of blood cholesterol. So, I believe it is an alternative to statin drugs. Anyway, sometimes niacin causes flushing of the skin and a burning sensation, or it always does in some people. A drug company is now working on a niacin compound that has shown a decrease in these symptoms for a certain percent of their study group. So the niacin option will become an expensive prescription treatment in the future. This begs the question; why not just take the generic statin drug?
  • Anemia Drugs: These drugs, or class of drugs, are in the news a lot these days. There is more than one kind though they may all be injectable. The risks associated with these drugs include cardiac problems and a link to cancer. Ironically, one of the approved groups for the pills are those receiving chemotherapy. The drugs are also used in kidney disease treatment. While some insurers are pulling back on coverage and makers of the drugs are trying to improve them, this statement struck me as a little off putting, but reality can be so. The statement, read in the Wall St Journal on 9/4/07 is attributed to a spokesman from pharmaceutical company Roche. She said, “Anemia is still a large market.” Well, I thought it was a blood disorder that led one to feeling weak and tired.
  • Labels: Remember that label reading is important. I’ve said this for years and want to reiterate a past admonition. Keep Looking at them. Nutrient info can change. For example, this week I noticed my same old yogurt, flavor, size, brand, etc now has ten more calories. Also, my same old calcium brand now has two tabs as a serving size and claims more vitamin D. My separate vitamin D has fancy new bone health proclamations on the label. On a positive note, it is good to see that Dr. Willett’s message as supported by research is being mainstreamed. That is the case for vitamin d supplementation and bone protection.
  • Kids: Hot news. That Go Slow Whoa program out of Sarasota Food and Nutrition Services (School Board) continues to ROCK> No meals offer whole milk and only skim milk is on the green or go list. I am really happy to report this next tidbit but sort of miffed as well. The FDA and some ADA representatives are encouraging children to read nutrition labels. Tweens, those in middle school are the target of this incentive. Listen, I said exactly this over a year ago when I worked out my OPP, or Obesity Prevention Project aimed at middle school children. UGH! I included social influence and self determination theory which would empower the children to know why they wanted to read the labels and what to look for when they did. That would encourage them to make the choices that would keep them at a healthy weight. The more they did this the more likely it would be, will be, that food companies and even establishments, will provide more nutrition content on labels and menus! Who do I have to work for to be heard for goodness sakes! Lastly in this section, toddlers are increasingly overweight and iron deficient. How in the hell does THAT happen? (rhetorical)
  • In Treatment/Colon Cancer: Many cancer patients are advised to eat health promoting, nutritious and low fat, low calorie foods to maintain a healthy weight in treatment and beyond. This is true for colon cancer patients as well. Because there is a growing body of research to support a link between diet and colon cancer and studies now confer an IMPACT on treatment and survivability with the same foods, the following is noted. Refrain from or limit red meats and processed meats and foods high in fat as well as high sugar foods like desserts. Protective factors on the other hand include not being overweight and staying active. Sometimes people will say, YES But, I am too tired to exercise. I say to them……. You are NOT too tired to exercise; you are tired because you don’t exercise.
  • Did you Know: Tobacco farming is having a resurgence and not for biofuel either but to meet the needs of smokers in China, for example. There are no more tobacco quotas in the US after a buyout a few years ago and this may turn lucrative for the farmers past and new. I do wonder what effect if any, this will have on the funds that some states have set aside from the Master Settlement Agreement that funds programs to help displaced tobacco farmers become something different. The story that I read about this increased demand for tobacco also noted that the cigarette makers are courting the farmers in order to meet current and future demand. That future demand is new smokers and people don’t generally start smoking in their thirties and forties, no, those new smokers are YOUR children. Talk to them, check out, or have them check out Students Working Against Tobacco.
    Another bit of news this week about tattoos noted that about 25% of us have them, which is about the same percent of US smokers. Well, I am one of the first 25% --- J

    I will be in NJ next week at the University of Medicine and Dentistry and if all goes well, I will be a Certified Tobacco Dependence Treatment Specialist when I come home…… oh man, do I need more ammunition or what.
    Wishing you wellness

Friday, September 14, 2007

Weekly News

  • Hydration: Caffeine vs sugar. In listening to a Health Matters show from NPR recently, I learned that sugar in beverages can actually decrease the amount of hydration or water that is absorbed much more so than caffeine does. This news supported my own choice of using eletewater electrolyte replacement over Gatorade. Sugar is not helpful for hydration. This news story did not address energy needs. Caffeine does decrease absorption but not as much as we expect. For example, the story noted a 100 ml difference, say from 400 intake without caffeine and 300 with. That is not such a big loss. Sugar has to be metabolized and that depletes your water stores further.
  • Drink Wars: Ironically, Pepsi Co is preparing for battle with Coca Cola which has bought the company that sells Vitamin Water. I used Vitamin Water before I found Elete because some of them have fewer calories than Gatorade. Pepsi is about to roll out G2 with 25 calories per eight ounces. Interestingly, they mean to target athletes when they are not working out. Again, it is the non carbonated drinks that have the biggest potential for growth in the beverage industry. Before you buy any of them, consider what you really need in terms of nutrients, hydration and calories and buy accordingly.
  • Doctor... Is _____ right for me?: Here is a thought. Let's use the drug industry's very successful marketing strategy to address smoking. For kids, the anti tobacco groups use truth campaigns and empower youth to fight back against the lies and the glamorization of tobacco. For current, adult and long time smokers, how about a commercial that goes like this..."Do you find yourself smoking when no one else is? Are you forced to stand outside buildings as if you have the plague? Do you wake coughing, have tired old skin and stained fingers, but smoke anyway? You may have an addiction. We can help. Ask your doctor if quitting smoking is right for you. Side effects may include fresh smelling clothes, better taste and a longer life."
  • Smoking and Weight: Let me say, cigarettes no more make you skinny then pills make you fat. Many people who smoker, 20 to 24 % of the US adult population, fear weight gain when they consider smoking cessation. They fear this weight gain more than they fear cancer. Some people do gain weight and contrary to what some will tell you, weight gain IS a health risk. Smoking and overweight are both detrimental. Two things to know then, 1) while preparing to quit, read up on Volumetrics (see link on right) so you can have low calorie high volume foods available and 2) a recent study noted on Medscape Public Health did NOT show a significant increase in obesity with smoking cessation. It will always be a matter of EIEO.......
  • From my Brother In Law's Desk: My BIL left the Sarasota Herald open to a news story on food labeling and the FDA. (yes I am in Florida again) The story lamented and celebrated the food industry's current efforts to get nutrition info that you need on the package. One of the problems is that different benefits are being promoted and consistency does not exist. The FDA wants to change that. Some of the information is on this blog site already, regarding ingredient lists and label words. One item up for consideration is changing the way the package notes serving sizes so that the information offered is for the amount you are really eating. I always know this, even when it takes a little math. Here is my big question though. As the FDA is pondering this next big label change, possibly a regulation, are they going to take this one very important step and ASK US what we want?

Okay then, been a busy week of job hunting and apartment searching or job searching and apartment hunting........ anyways, I think I have both accomplished and fly back to NC Sunday..... until next time, I am always

Wishing You Wellness

Friday, September 7, 2007

weekly news

Weekly News Notes

There is a slew of news this week so maybe I'll just hit the highlights.

  • Cosmetic Vaginal Surgery: Huh? A procedure that is said to tone the vaginal area after it's been stretched from childbirth and time (use?) is getting a big thumbs down from the American College of Obstetricians and Gynecologists. It’s dangerous; could lead to nerve damage, infections, loss of sensation and has no evidence based data to support a benefit.
  • Go Slow Whoa: You may recall that I really like this traffic light labeling system which encourages people to eat more foods identified as green. There is a lot of this in Sarasota Co Florida and it really helps people make healthful eating choices. (I prefer actual nutrition content labels for my meal choices which can be used in conjunction with this method). A country is introducing this labeling system for foods. New Zealand has quite the problem with half of its population at overweight or obese levels. A government panel, called the Obesity Action Committee, advised mandatory labeling be enacted if the food industry doesn’t do it voluntarily. They mentioned energy dense foods as well. { long term reader note: Volumetrics will be the new Atkins}
  • Plastic Progress: Because the H2O industry, or the beverage industry which sells bottled water has taken such a hit lately (bottled tap water and ruining the environment), the top sellers are changing the way they make the bottle. Pepsi, Nestle, and Coca Cola are making lighter bottles, bottles with recycled and more recyclable plastic and are encouraging the consumer to recycle. Some states have deposit laws which encourage people to return their bottles for reuse while also reducing litter. This is in most part for glass and aluminum and is now being considered for plastic. Stay tuned for more environmentally friendly changes because on a positive note, soda sales are down and these companies want you to buy water. (you really CAN skip the protein infused water however, it's highly unlikely that most of us are lacking protein).
  • Soda Ad: Never missing an opportunity to blast an ad, here is another. I do drink diet soda, I know it has chemicals or some such nonnutritive ingredients that I could do without, but it's about my only such recklessness. I drink diet drinks without any misconceptions and so manufacturers only perturb me by adding vitamins and minerals to my diet coke. I am not an idiot. Those extras don't make my diet coke suddenly good for me. What is next, fiber? Geez.
  • Donuts!: Remember that I shared with you the concept of reciprocal determinism. It means that we shape our environment and it shapes us. We respond to each other. Well the fact that TFAs are seen as bad and people can remember that, if nothing else, has not escaped the food industry. Packages are now sporting trans fat free labels and we are buying. Shame on us for not noticing the 30 grams of sugar in the same product! Oh I digress. Also with NY City law, frying oils changed and no one much complained. So it is now safe (profit wise) and even noble to go transfree. Thus we have influenced Donkin Donuts. Donkin Donuts brands will be virtually trans free. I do laud them for being honest that their foods with less than 1/2 g per serving of TFA are not literally transfree but legally it is. Labels can say TFF when it is less than .5. So be very mindful of the serving size in comparison to the amount you are actually eating and look for TFA code words, like partially hydrogenated oils. Same rule applies with calories except the cut off to call it zero cals is 5.
  • Diabetes x 2: Yes, times two. One, my friend the PharmD gave me great info on diabetes and meds to treat it. I believe it all pertains to type 2 in which case your body is resistant to insulin. The first thing I noticed about the various classes of medicines, which act differently, is that they all have side effects. Some drugs increase sensitivity to insulin so that it does its job, some encourage production of insulin and some slow down the digestion or breakdown of starches so that blood sugar levels are more stabilized. Most are oral medications. Some type two diabetics eventually have no or nearly no insulin production and require pills plus insulin coverage. Second part: Last week I responded to the news about weight loss after bariatric surgery and thus decreases in chronic disease like diabetes. I wasn't the only one that saw the key factor as a healthy weight. In other words, obesity can for all intents and purposes, cause diabetes and weight loss can cure it. Dr. Richard Amerling of Beth Israel Medical Center wrote to the Wall St. Journal and included in his letter is this great statement. "A less obsessive preoccupation with normalizing blood sugar coupled with a greater emphasis on carbohydrate restricted diets and exercise will lead to more cures for type 2 diabetes, without surgery." I will add that he means simple carbs. Anyone who reads this newsletter on a regular basis would know that this man gets a top spot with Drs. Willett and Rolls for that comment.
  • Prevention: I will just combine the last few news stories to save time. Obesity rates have risen across the country, exercise improves survival after angioplasty (cleaning the arteries) and Medicare is making a push for preventative programs. All of this led to some intuitive pondering. Fear vs complacency? Relevancy? Urgency? Misconceptions? Instant gratification? Denial? What is going on here____ Without a doubt, research has given us a mound of evidence that our bodies cannot handle the influx of processed, high fat, high sugar foods and that there is a certain threshold at which excess weight becomes a serious, significant threat to ones health. The consequence is hypertension, diabetes, heart disease, chronic pain, depression and disability at the least, and there is strong evidence that it affects cancer incidence. We must stop this epidemic that is now endemic through prevention. Our children are not going to be able to ride any rides at theme parks for goodness sake (no one with HTN is supposed to ride!). To help the kids we have got to role model. The denial is entrenched and dangerous. This is one of my most passionate and blunt assessments but here it is:
    This fervent refusal to accept that overweight and obesity is caused by any thing but too much of the wrong food and too much food in general has taken on a near schizophrenic level of delusion.
    A person’s weight is a direct consequence of energy in and energy out. One might have a genetic predisposition that requires special attention to that concept, but the concept always holds. Same for pills. Pills do NOT make a person fat. They might change metabolism and or increase appetite, but they do NOT cause one to eat. Nor do pills cause sedentary behavior. Those things can be controlled.
    It's time to accept the science and start doing something different in our lives.

    People want to live here and now and readily rely on HTN, DM, and cholesterol lowering meds. I am grateful that they exist and they do save and extend lives, but people take them as if it were a natural thing to do. Twenty years from now will people take chemo drugs with the same alacrity? Think about it. Heart disease is as deadly as cancer. Yes yes, you want your sweets, you DESERVE them. Sweets are considered a RED food item; the Go Slow Whoa or WeCAN program from the NHBLI tells us this:

    WHOA foods are the highest in fat and added sugar. They are "calorie-dense" (high in calories), and many are low in nutrients as well. Have WHOA foods only once in a while or on special occasions. And, when you do have them, have small portions.
    If you do not follow the above recommendations then you may get a bad result.

    As always, I wish you Wellness

Sunday, September 2, 2007

weekly news

News notes

  • Energy Boost: It is counterintuitive, I know, yet fatigue can often be contributed to lack of activity. You may sit at your desk all day and feel exhausted but you haven't exerted yourself physically nor have you done anything to improve your cardiovascular fitness. Exercise, time after time, has been shown to increase energy, focus and concentration. Exercise is far more invigorating than any caffeine drink and safer too. Energy drinks do not improve your health and new ones that include alcohol are the focus of a wide ranging Attorneys General request for safety and marketing investigation. [I am not against caffeine in general, just in excess and in alcohol]
  • Pain: In recent weeks reports surfaced regarding the staggering increase in the use of pain medications, including narcotics and mostly Oxycodone/Oxycotin. Two reasons for the increase could be, people request these drugs because they heard about them on TV or doctors suggest them because they heard about them at a Pharm dinner. We have an increase in chronic pain cases in large part due to an aging population of people whose lifestyle choices may have increased their risk for degenerative disk and joint disease. These factors include inactivity and overweight. The past is done. Lose weight and become active now, in your present, for your future. Try ice or heat and movement to address your current pain as a first response. Mediation should be second line and in lowest effective dose for the shortest amount of time. [all according to your doctor's rec's of course]
  • Look Younger, Feel Younger, Live Longer: Stop smoking and tanning today, results in six months. Boost these results by also adopting a Mediterranean life style. Eat lean meats and fish, monounsaturated fats (oils), fruits, vegetables, and whole grains. Walk a lot. Be mindful of calories in and out.
  • Disability: Oh my, best quote of the year comes from former governor and current presidential candidate Mike Huckabee. This man has lost 110 pounds and consistently advocates for health promotion at work, home, and community. Mr. Huckabee works with others to especially address the fattest section of the USA, the South. I often note that wellness programs can decrease disability, here is his quote regarding who will be available to fight global acts of violence. "Who is going to fight it in the future if we are a generation so sick we don't have the capacity to show up for work." Amen
  • Obesity Surgery: People often ask my opinion on bariatric or gastric bypass surgery of which there are a few types. I think……… well, I think that the Gastric is Drastic. Ok. And yet, I cannot deny that some long term research studies do show that persons who receive the very invasive and expensive procedure do have a better outcome percentage wise than similar individuals that do not. First though, the risk of death with the procedure is higher than most would like and it’s a vague number, anywhere from 1 in 100 to 1 in 500 cases. Also, there are surgery complications and in many cases, depending on the type of bypass surgery, a life long need to take supplements and to eat like you have an egg sized stomach, because you do. I would so much prefer that people take steps now to prevent themselves from ever having a BMI of 30+, but I'd also rather people be well. So if this is your choice you go for it and you be well. [research note. The better outcomes were attributed to less death and heart attack related to weight loss. In other words, the control group didn't lose the same about of weight (they may or may not have been on a weight loss program)]
  • Risperdal: This drug, an antipsychotic medication, just received FDA approval to treat schizophrenia and bipolar disorder in children has the following side effects; weight gain, new onset diabetes 2, increased bad cholesterol and thus decreased life span. The decision is one of quality over quantity. To note however. A physician interviewed by the Wall St. Journal advised that docs be mindful of the weight gain and counsel their clients. I can tell you, it isn't happening in adults and it isn't going to happen in kids unless someone forces that kind of accountability. Very few people have the comfort level needed to say, "hey… we have to get your weight down." NOT telling your patient that they are at risk for an obesity related illness is far from best practice.

    Wishing You Wellness