Saturday, January 26, 2008

Weekly Wellness

Pregnancy Concerns: When pregnant, anything a woman does or consumes will impact the child she is carrying. Of course, many positive acts on the mother’s part will promote a healthy pregnancy and safe outcomes. While research this week cautioned on caffeine and pregnancy, a far greater threat to a child is cigarette smoke both active and passive via the mother. In a 2003 study the national prevalence of “smoking pregnant women” was about 12 percent with a drastic variation by state. Cigarette smoking while pregnant has serious consequences. The US Surgeon General reported in 2004 that there is sufficient evidence to say that cigarette smoking causes Sudden Infant Death, Low Birth Weight, placenta previa, placenta abruption and premature rupture of membrane. Second hand smoke is causally linked to SIDS, LBW, respiratory infections, acute and chronic ear infections and decreased lung function in children who breathe it. If you are pregnant the best thing to do for your baby is to stop smoking. People in your life would receive a great health benefit if they quit smoking as well. All persons should commit to not smoking in the presence of others, especially children – ever.

In re: Your Mental Health: Though I’d like to take this time to rail against the drug companies who market directly to consumers, I should give that a rest. Instead, I want to share a thought with you, a little psychotherapy if you will, as life is short and mental health is an integral part of total wellness. Here it is then: “There is no path back. (Dean Koontz writes that in his latest novel). When you try to find this path back you stand still instead. You stagnate. It is also possible that in trying to go back you may lose all that you were able to take with you that is good. Choose to go forward.” An effective therapist, in my opinion, validates your past but does not have you relive it or worse, reinvent it. A good therapist helps you live your life to its fullest right NOW. Live for this day lest the past rob you of a future.

Yogurt: As recently pointed out with another product remember that containing an ingredient that has been found to be health promoting does not necessarily a health promoting product make. Dannon is being sued for its claim that its yogurt has health promoting probiotic benefits. I am not positive what that means and only bring this to your attention to iterate that product labels and marketing can mislead you.

HMO v Big Pharma: Medical groups and consumer organizations are vocalizing discontent with the practice taken by some health insurers to monetarily reward doctors when they switch a patient from a brand name drug to a generic. This act can save millions of dollars for the health insurance company but ALSO for employers and plan holders. In my opinion it is a good move. A better move than doctor’s prescribing a brand name because they were treated to dinner and educated about the med by the company selling it. Paying the doctors to switch however, that does feel a little smarmy. Worse, at least one doc said he deserved the 100 bucks for taking the time to tell the patient about the drug change. Hey, isn’t that part of the visit anyway?

Diabesity Stocks: I first heard the term diabesity about a year ago to explain the drastic rise in type two diabetes and its relation to the explosion of obesity. This past week, my favorite financial educator, Jim Cramer of Mad Money on CNBC spoke to the lay investors about taking advantage of this incredible market because profit was to be made. I still like Jim. I find this hard to take as a public health educator but maybe people who are overweight and being diagnosed with diabetes will stop hearing “accept your body size” and start hearing, “address your body size” and in that your HEALTH. Listen, the companies that make the devices for treating diabetes, for dialysis and for bariatric surgery are poised to make profits, big profits and their stocks were recommended as BUY BUY BUY.

Krispy Kreme: I don’t suppose I have anything against donuts. They are bad for you but a donut here and there in an otherwise healthy and active life should be okay. A donut I said. Here instead is a race in NC at NC State. The participant will run two miles to KK eat a DOZEN, yup 12, donuts and run back. They raise money for children. For children’s health. Fine example there. No delusions are offered though. The race website offers the nutritional content of the dozen donuts. This includes 2400 calories and 144g of fat. Let us say that a 150 pound guy runs a 9 minute pace for four miles. He will burn 446 calories. Did you see that, not even 500 cals. Now I get it. It is for fun and it’s once a year, what’s the big deal …etc etc. I can live with that but here is what is going to happen. When a person eats that kind of meal it significantly increase the risk of an adverse event. The heart and pancreas are absolutely traumatized by the sugar (120g) and fat. While the body tries to deal with this, the person goes and RUNS some more. When someone has a heart attack after or during this little race, some damn fool is going to say “running causes heart attacks.” That is what I have a problem with.

I have added to the files at the Media Mix site to include some recipes if you are interested. There are none for donuts.

Wishing you Wellness

Saturday, January 19, 2008

Weekly Wellness

New Hearts: When hearing a CNN story about scientists who were able to generate heart growth from the cells of rats, I couldn’t help but wonder. Are these the same rats (or their descendents) that have been coated with cigarette tar and dosed with sweet n low? [just kidding!]

A few weeks back I noted this company which is working to create a chemical form of resveratrol that might promote health in people who take it. I noted the company for its error in calling an illness a disease of “aging”. Recently the company released preliminary results of a small human trial where blood sugar levels were improved. The study is taking place in India, however, I do not know the ethnicity of the population in the study (sometimes it matters and it matters in order to make generalization outside of the study group). None the less, the point I wanted to share from the K. Winstein WSJ article was this quote from a cofounder of the company, “we chose diabetes because it’s a big market.” Sad but true.

Time for another commercial introspection. A man says that his doctor has told him he has high cholesterol so he watches what he eats, exercises and takes Garlique. Garlique, he says, contains an ingredient that has been found to lower cholesterol levels. Here is what he does NOT say, “My doctor told me to take Garlique or that this particular product, Garlique, has been found to lower cholesterol.” Remember savvy readers, at this point the law that addresses herbals and supplements does NOT include that they are tested for purity, effect or ingredient quantity. Many times they also contain additives that may be harmful. Tell your doctor about ANY meds, pills, tinctures or liquid supplements you take.

Vytorin: Anyone who reads this blog on a regular basis would expect I was going to blast this report. It happens to come in the same week that a NEJM study reported that the popular antidepressants so many people take may or may not be more effective than placebo. Both incidents regard drug companies not publishing all of their study results, or skewing their study results. With Vytorin the company took two cholesterol meds and combined them. They re branded them and raised the price. It was alleged that people who took the new drug would have less plaque buildup and less adverse events, but the research does not support that at all. It is not so much that this medicine is harmful, but that it is no more helpful than cheaper meds. With regards to antidepressant sales at 21 billion a year, must ask, “WHY are so many people depressed?” The study calls into question whether or not the meds are effective, but I want some accountability regarding the criteria of use in the first place. These drugs have perhaps the highest rate of side effects of any medication and viewing a commercial for Cymbalta while having a bad day does NOT make one clinically depressed.

Avoidable Days: For the hospital business, any extra time a person spends there can be costly in a number of ways. Insurance companies tend to pay a lump fee per condition whether it takes five or ten days to treat it, as they have a predetermined idea of how long it SHOULD take. Prolonged days in the hospital also increase the risk of illness not wellness and when hospital acquired illness does occur, treating it is considered to have been avoidable. It should not have happened. Some examples include bladder and blood infections, falls and bed sores. After Medicare declared that it would not pay to treat avoidable illnesses other big insurance companies began following suit. This can be good, i.e. less use of catheters, less time in bed, more hand washing, increased communication amongst staff. The fall issue concerns me the most. One way hospitals address fall risk is to stop the patient from moving around especially an older person. Hospitals usually have a protocol in place to prevent clots, also an avoidable incident. They administer drugs. ($$$$) Another way is to keep the person ambulating. I definitely argue for the ambulation which will require more staff. And there were days when I did hospital work that the only people what wanted to leave the hospital sooner than later were the NURSES! [no one blames them either!]

Kudos: Combining a few themes here. A hospital has changed its policy so that no drug company gift, promo, pens, notepads, coffee cups, etc etc are allowed and to initiate the policy, administration had ALL such products rounded up and removed. That is one awesome move from SMDC Health System, which has four hospitals and multiple clinics. They came up with nearly 19,000 items and are sending them to another country where the drugs advertised on the materials are not available to prescribe. Interestingly, one of the drugs promoted in that HUGE roundup, Vytorin!

Saturday, January 12, 2008

Weekly Wellness

Cancer Test: A test is in development which has had some success in detecting cells with cancer mutation specific to head and neck or oral cancers. These types of cancer are, like lung cancer, most often found in older smokers. Like lung cancer in smokers, the oral cancer is usually identified far too late for a curative intervention. To prevent lung and oral cancer one should never begin smoking or quit right now. Additionally, oral cancer is seen in heavy drinkers. This test, if improved and approved may lead to treatment and cures as the cancer could be detected sooner. The test involves spitting out saliva after rubbing on the cheeks, no big deal there. This does not appear to have any of the risk associated with the screening test for lung cancer which at this time is a CT scan of the lung. That test leaves radiation damage.

What to Eat? Well, it is the time of year when many people take a look at their health and commit to improving it. One way is to eat a more nutrient but less caloric diet. By diet I mean, “the sum of food consumed by the organism” [wikipedia} and NOT some type of temporary restriction of certain foods. In this country we pretty much choose what we eat from a near infinite menu that is only restrained by certain religious or disease states. To eat healthy, you can adopt some of the practices expressed in a recent USA today article. I note this because the article uses information from Barbara Rolls, PhD and her Penn State department of nutrition. The key is to replace empty or simple carbs and high fat foods with high fiber veggies and lean low calorie proteins while also bulking up ones meals, or maximizing the amount of food on a plate based on energy density. You can get her book about this from the library and it is called Volumetrics.

10 Worst: A coworker forwarded an email list of the top ten worst foods of 2007 where the reader is challenged by John McGran to see how many of them they have eaten. Of course, I have eaten none primarily because they all have meat in them. I must say, the names of some of them are enough to cause atherosclerosis, i.e. the Baconater from Wendy’s. It has 830 cals and 51 g of fat. Also on the list to start your day, a little breakfast burrito from Hardee’s with 60g of fat and 920 calories. So choosing to eat this type of food will NOT improve your health.

Scream not for Ice Cream: Actually, there are plenty of ice cream brands or flavors these days that are better for you than others, but this blurb refers to an elementary school in some city USA where the principal, god bless him, decided that since the students were tossing their lunches and heading straight for ice cream and cookies an executive decision was in order. He banned the stuff. Now dessert is fruit. And we all know kids (ok all of us) do not get enough fruit and vegetables. Actual fruit and vegetables, not juice. I wish that employers would be so brave. Not saying you can’t eat the bad stuff, just eat it elsewhere so that people who do not want to eat it, or worse, are challenged by it, can avoid the temptation and awkwardness of being faced with it at every work meeting and celebration, eh> Ok, I never said I wasn’t radical. Maybe I can teach health class at that school!

Fish Oil: The health benefit of consuming Omega 3 fatty acids does not need to be rehashed in this newsletter every week. I add it today because a January 8th article in the WSJ discussed the benefits and compared consuming fish [which included noting the mercury and other toxin warning - see media link on right for PPT on mercury in fish] to fish oil capsules. The article also addressed the supplementation of everyday foods with the compound. It said as we’ve said here, what is done in the labs is not done in real life so we don’t know if the results will carry over and that is still under study. Interesting however is that the only source of Omega 3 discussed was fish and fish oil capsules. You may remember that last week I noted Flaxseed Oil which I have added to my “foods consumed” daily. If time allows I will do a research review next week on Omega 3 in flaxseed vs. Omega 3 in other sources. All the health benefits noted in last week’s blog were iterated in this WSJ article.

Shingles: I did not know that shingles was something that could happen to anyone who has had chicken pox. I learned today that it was a very painful condition and required treatment with antiviral meds. It is important to detect and treat quickly. There is a vaccine available to protect against it. The vaccine is expensive but I think that at 300$ it is half the price of the HPV vaccine. It is covered by some MCR D policies and well, I’d recommend that older persons especially check it out. For those with weakened immune systems the consequences can be quite serious.

Wishing you wellness

Saturday, January 5, 2008

Weekly Wellness

Stents: Quite disturbing news from a coworker. Stents, which are usually of two types, plain metal or drug eluting are used to keep vessels, arteries, passageways if you will, open. We are most familiar with stents used to keep arteries open after angioplasty of clogged or thickened arteries. This allows oxygenated blood flow to reach all the tissues and organs of the body. The main reason that stents are needed is heart disease and the main risk factor for heart disease is lifestyle, mostly what you eat and what you do or do not do with your body. Believe me, it is a lot safer to eat well then to get a stent placed. Stents were in the news a lot last year with several complications noted, including, re stenosis, blood clots and excess bleeding. There was a scandal-like damning of the drug eluting stents which increased heart attacks in the population that received them. This all played out quite interestingly in the stock market for companies like J&J, Boston Scientific and Guidant. It is a very confusing topic actually. Stents are meant to prevent narrowing or stensosis. As stated above, the devices themselves can cause clots and excessive bleeding. Some argue that the problems are not the stents but the vascular surgeons who place them and on it goes. Obviously, your best bet is to avoid coronary heart disease. The disturbing news brought to me by my partner in crime in the tobacco field, is direct marketing to consumers. Can you imagine? “Hey doc, do you think invasive heart surgery is right for me?” To which the doctor might reply, “Why yes Mr. Smith, it’s a whole lot easier than that diet I recommended at your last visit!”

Denial and Premature Death: Weight is not a measure of wealth, attractiveness, status or intelligence. Weight is an indicator of wellness. A study out of UMichigan indicates that parents of children with BMI confirmed obesity more often than not, declared their children to be just right or only slightly over weight. As the pediatrician who led the study, Matthew Davis states, obesity is “something that can have health effects.” He notes that the health effects occur in childhood and include diabetes, hypertension and increased LDL. This is not okay and can lead to the above.

Free Samples: I caught a brief blurb on the local NPR station regarding the controversy of free drug samples in health care. The news story noted the concern that the drugs which proponents say will assist the poor, really do not go to them. A research study was completed to test this theory and found that in fact, the poor and or uninsured do not usually get the samples. It was also suggested that the doctors would be more likely to prescribe the drugs that they had on hand. (The drugs provided by drug companies when they visit doctor offices or treat doctors to catered dinners.) That did turn out to be true. It has happened to me in fact and this was when only the docs were being wooed by glamorous drug reps. (Zyrtec, Vioxx, Fosomax in my case, two of which have now been said to have serious risks and none of which do I take now.) The point of the study however was whether or not the underserved were getting the samples. Some reasons that they do not include that the clinics in which they are seen do not have the samples, secondly, intuitively, I would think the drug companies aren’t wining and dining those docs. But here is something that the report doesn’t say. It may in fact be better NOT to give the underinsured or Medicaid/Medicare patient those samples as they are brand new very expensive meds that may not be on the formulary. When I was in hospital work we began considering this in discharge planning. We then chose the best medicine (often it really was the better medicine) that was generic and could be obtained by the patient as long as they needed it. So, the whole free sample argument well it’s the wrong argument. The fact that drug companies are pushing meds IS the problem and free samples are a way of pushing them. (I still shudder when I think of the white paper bag full of 50 mg Vioxx samples that I took while also working out – oh, it scares me bad.)

UK V. USA The BBC news recently ran a story about the amount of fast food eaten in the UK and how that was leading to a staggering rise in obesity. The reporter seemed to say that they had a higher rate than the US, but when he offered figures it was not so. Either way, it was called “Globesity”. Guess we can add that to the Diabesity coined in this country. Interesting then the reporter noted the overweight and obesity rates in OUR country and said that one in three adults in America were obese. OMG. The reporter than began to talk about America’s fattest city at which time I changed the channel.

OILS: Well, I am going to replace my olive oil. Yes the one I brag about somewhere along the parameter of this newsletter. It is still very good for you of course and better raw than fried in, oh man did I say fried, I meant sautéed or simmer fried. Here is what I learned this week when reading about the good fats, mono and poly unsaturated and Omega 3s. My olive oil, which I pour on my dinner after I cook it and before I eat it :), in very modest amounts is still packed with good fat but apparently only .5 grams of Omega 3. At least we are talking grams though, not MGs. Well, I learned that Flaxseed Oil which many people already use has 7 grams of Omega 3s. It has less mono unsaturated fat, but for my muscles and such I want the Omega 3s. Omega 3s are also said to have healing or anti inflammatory properties. So, it’s on this week’s grocery list. [remember though there are still a lot of calories in these good oils so don’t be too generous with the pour]

Drug Ads V Be Well Ads: Because I am always pissed off about direct to consumer drug ads, I tend to pay attention to them. Here is what I noticed this week. If these ads, if these companies truly wanted to raise awareness and educate on health issues, they would say “ask you doctor about diabetes”, not “ask your doctor about Chantix, Lipitor, Cymbalta, Ambien, Zocor, STENTS….”. How about the commercial for Chantix end instead with, “Ask you doctor about quitting smoking?” Or the commercial for Avandia could say, “Ask you doctor about your blood sugar.” Hey and then there is this one, so we can role model for the UK, “Ask you doctor if your weight may be putting you at risk for disease.” Let the doctor decide if any one of those conditions warrants medication use.

Watch List: A study has linked restless leg syndrome or RLS as the commercials say, to heart disease. I must admit that I have been less than reasonable about this condition and have poo pooed it without doing any research. I see that the NHLBI and others give this condition a good deal of respect and so shall I. However, I will say that not everyone has it and it is not mere fidgeting. It is quite serious and painful. The research that noted a link with heart disease did use statistical analysis that allowed for other risk factors to be excluded and this condition independently was linked to heart disease. One hypothesis is that the person’s blood pressure and heart rate will spike repeatedly during the night with these episodes. Based on what we have been talking about for weeks now, I would expect oxidative damage and inflammation as a result and those factors are also related to the development of disease.

Wishing you a peaceful sleep and the wellness it promotes