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