Friday, February 29, 2008

Wellness Weekly

World Tobacco Use: Recently and perhaps frequently, I have mentioned the growing use, sale, marketing and consequences of tobacco in developing nations. It is even said that the amount of persons in China who smoke is greater than the number of persons living in the USA. What I have not noted is that many of the countries’ with the increasing numbers of tobacco users also have government owned tobacco companies and do not have public smoking bans. There are other differences too between countries whose tobacco use rose fifty some years ago and countries where it is only beginning to take off. In our country, those who still smoke are often undereducated, white and poor. In other countries, it is the upper middle classes who, earning more money in booming economies, are beginning to smoke. They will learn not from our evidence and our mistakes, but from the passage of time. In forty years when their people begin to die of lung cancer they too will begin the studying and the review of research and learn what we know here. One of five deaths is related to cigarette smoking. For those who don’t die from a fatal smoking related illness, the chances of chronic, debilitating disease, such as lung infection, is a given. Heart disease is rampant in smokers as well and often kills them before lung cancer develops or is detected. I wish we could tell them. I wish they would listen. In time they too may have $250 fines for smoking in nonsmoking hotel rooms, but for now, they will light up with freedom and not only increase their risk of disease but the risk of all those around them.

Lung Cancer: It seems appropriate to follow with a story about cancer. My discussion here is not about the development of the cancer but its treatment. That being said, ninety percent of lung cancer is attributed to cigarette smoking both active and passive. This past week I read articles that provided information on the progress of some pharmaceutical companies. Some drugs for instance, are created to shrink existing tumors, while others are met to cut off blood supply to keep them from growing. Some are meant to add a few more months to a person’s life. A company who successfully creates a drug to do any of those things with a particular cancer, say breast, and has FDA approval to market the drug to consumers and providers as a breast cancer treatment, will next try to prove its worth to treat different cancers. It makes a certain sense in that cancer is abnormal cells and or tumors that grow and drugs that can stop that process might do so universally. One such case that did not work out is Nexavar which was recently approved to treat liver cancer. It failed in lung cancer trials however when the subjects had higher death rates while on it. The article I read in the WSJ had phrases such as these, “lung cancer was a future growth driver,” and the “lung cancer market.” Since cigarette smoking is the main cause of the disease that drives the companies’ profits, I imagine that they would be a friend of big tobacco. They do seem dependent on each other and dependent on the nicotine addict to keep smoking. It isn’t just lung cancer and smoking however. Avastin which was created for colon cancer is being groomed for the breast cancer arena, or as the article said, “breast cancer niche.”

Lipitor: This drug is meant to help lower cholesterol which would lower ones risk of heart disease. There are about six known risk factors for heart disease, high cholesterol is one. Lipitor has sales of 12 billion a year and its spokesman is credited with creating an artificial heart. That may be the only true thing about Robert Jarvik. He does not practice medicine nor prescribe it and one ad that showed him exercising used a body double. So when the drug company suggests as it does in its commercial, “diet and exercise” as a first line treatment for lowering cholesterol and risk for heart disease, let’s be clear, It is your OWN exercise that is health promoting.

Anti Depressants: Most of the stories this week did relate to smoking or drugs. We’ll end with this latest in a batch of research that questions the effectiveness of antidepressant medications. I’ve already shared my opinion. The research out of Britain did compare placebo to some of the big drug sellers, such as, Prozac, Paxil, and Effexor. Most persons in the study had the same response. The drugs were only marginally effective and that was in the severely depressed category of person. I.e., people making self diagnosis based on TV commercials who ask their doctors to medicate them have flooded the system with people who do not need these drugs and thus do not benefit from them. That is my opinion, not that of the researchers!

Wishing you Wellness

Saturday, February 23, 2008

wellness weekly

Bottomless Xpress: In an example of how food companies and restaurants do contribute to our current weight crisis, Chili’s offers a lunch that is bottomless. Just for the record, eating the bottomless lunch will lead to you having more not less bottom.

Heparin Follow Up: It is an ingredient in the Baxter product that was manufactured in a Chinese plant not the entire drug. For that matter, makers of this type of blood thinner all use factories in China for this particular part of the drug which just happens to be pig parts. Intestines I believe. It is still odd that our drug companies can cut costs by using a foreign factory but we pay higher costs for drugs as we are not allowed to get them from international pharmacies.

Low Cal Snacks: Oh gosh, the food companies I just admonished in the first item are also catering to the calorie conscious among us is what is said to be a 200 million dollar industry. Wow. It’s the rise of the 100 calorie snack packs except now its 90, 80, and less. I know they grab my attention. However, the reason it is a multimillion dollar business is the ridiculous high price of these items. I imagine that packaging may be a part of it as is the fact that we will shell out the money if it makes us FEEL smaller. You can make your own less than 100 calorie snacks you know. Read the labels of products and then make your baggies according to how many calories you want them to be. Here is an awesome snack: Use, little “Toastie” crackers that the sell in the deli, mini toasts, they look like tiny sandwich slices. Ten of these have 80 calories, spread a tablespoon of hummus on them and you have well, 105 cals. This snack is very healthy and that is worth noting. Much of the problem with the 100 calorie snack pack industry is that it offers us low calorie, but low calorie junk. Excluding maybe the puddings, yogurts and cheeses.

Cancer Deaths: I have read about this report more than once this week and still have difficulty understanding what the researchers are trying to say. It sounds like there are less overall deaths from cancer, but that the rate of decline, expected because of medical advances, has slowed. When reviewing the statistics, scientists take into account that there are more people alive than there used to be and come up with a rate per 100,000. It make also be meant that less people die of cancer but people are still getting cancer. One explanation for a decrease in overall number is that less people smoke now and more people get prevention screening like mammograms. I think that initially we saw the effect from those things and recently it has stalled. Now we are seeing more cancers related to other factors, such as obesity and inactivity. Other stories this week discussed cancer and diet. Another study supports the Mediterranean diet as health promoting and a high processed, simple carb diet as cancer causing.

Health Care: While listening to a stump speech by Barak Obama I very much appreciated his plan to make sure that our country would focus on caring for health, for prevention of disease as opposed to what he termed “disease care.” I agree that prevention of disease is not only cost effective but humane. Meaning, just because we can treat heart disease, diabetes and cancer doesn’t mean we shouldn’t try to prevent it from occuring.

Starting to Exercise: When do you need a doctor’s approval to begin an exercise program? It is not always necessary to see your doctor and even less necessary to have a stress test according to the director of the American Heart Association. People without obvious risk factors, such as hypertension, diabetes and family history of heart disease can usually begin walking on their own. What is not recommended is going form coach potato to jogger or tennis player. Work up to vigorous exercise. Stress tests can identify blocked arteries but not plaques. Be mindful of your health and certainly let your doctor know what you are up to.

Saturday, February 16, 2008

Wellness Weekly

Overweight and Cancer: Another study is released that supports an association between gaining weight and being at greater risk for many cancers. This is not sufficient for cause. Still, scientists suggest maintaining a healthy weight. Because my recent work has been in tobacco where there is no question of a causal link between smoking and cancer, I am not encouraged that this study will lead to any change in eating behavior. Oh, that is very pessimistic of me. What I mean to say is that knowing something is harmful does not always lead to a change in behavior. Smoking of course is different as it is an addiction and there is no SAFE way to smoke. There is a safe way to eat. And after this study broke, the great Walter Willett noted that obesity was actually going to be more of a detriment to health than tobacco is and he calls for change as do I. A book out about Mindless Eating may be worth adding to the good read list. The book is by Brian Wansink.

Japan Tobacco: Japan Tobacco is a company similar to our older RJR Nabisco and Altria which at one time had their food and tobacco businesses under one flagship company. Now we have Reynolds American and Phillip Morris which I believe are solely in the tobacco business. Japan Tobacco continues to have its food and tobacco products in the same publicly owned company and reported its revenue results recently. This story from the Wall St Journal noted that the company’s profit would be down this quarter due to having to recall tainted dumplings that sickened 10 Japanese. Tobacco use in Japan, of which JT has the biggest market, actually KILLS 113,000 Japanese citizens each year. (

Calcium and Vitamin D: Research to add to the growing body of data on whether or not calcium and calcium +D is truly effective in reducing rates of osteoporosis and osteoporatic fracture, was available this week. This is actually a meta analysis of several studies and the scientists offered the following conclusion: Calcium with or without vitamin D is protective of bone density and reduces fracture if one consumes about 1200 mg a day. The bright spot for vitamin d is not so much in bone health as in reduction of cancer mortality. That is reduction in mortality for some cancer and in some studies in mortality overall. The amount of vitamin d that was protective was 800 IU. FYI: there was one study which showed increased myocardial infarction with calcium caltrate specifically. The authors of the study stated that the increased risk could be explained by other factors but should be addressed in additional research. I have always used calcium carbonate myself and many of the studies with positive results also used that kind.

Pains: A fentanyl patch made by Johnson and Johnson has been in the news on and off since problems began in 2004. Some people have misused or abused the patches while others were given defective patches. The most recent news is about the defects. Fentanyl is more potent than morphine and overdose potential exists, especially as people take other medications. An attorney that is suing J&J wonders if the product itself, Duragesic shouldn’t be removed from market. I have seen instances that lead me to support his assertion.

Heparin: News this week relates 4 deaths to a bad batch of heparin, the anti clotting drug. This issue is under review and there has been mention of problems in the Chinese factory that manufactured the medicine for Baxter International. This leads me to ask. Why do we allow United States companies to produce drugs in other countries, countries with less regulation or different safety standards but do not allow importation from countries that are similar to ours such as the UK and Canada?

Pain/Tobacco/Tolerance: There is a big disconnect in the pool of smokers who quit smoking say 10 and 30 years ago to the ones quitting smoking in the most recent ten years and today. Research supports that the people who have quit and stayed tobacco free did so cold turkey without support groups, quit lines or nicotine replacement therapy. Certainly there was no such thing as Chantix back in the day. I am one of the people who quit that way, in 1997. Now we have a best practice guideline for treating tobacco dependence and it advises that the most important thing for quitting is a doctor’s advice to do so, along with counseling to teach behavior skills, support facilitation, and in almost every situation the use of a quit smoking drug. Research now states that having nicotine replacement therapy or some other medicine can double the success rate from cold turkey. What happened? Most will say, nicotine levels in cigarettes have been manipulated and dependence is much worse for today’s smoker. I do NOT doubt that nicotine levels have been tampered with by Big Tobacco. Yet, let me say. I was significantly wedded to my cigarettes. I was a die hard smoker. When I stopped smoking the first three days, just like now, were pretty damn hard. The next couple of weeks were challenging and then eventually life went on. I DO NOT believe people are more addicted today. I believe that people are LESS tolerant. People have become less willing to experience any physical or psychological discomfort. It may be a generational thing. It may be a result of a cultural change spawned by Big Pharma. We are now told that there is always a pill to make it better. We now tell our doctors which pill to prescribe us. This is what I want to say about quitting smoking and withdrawal. It is HARD, it is uncomfortable, BUCK up and deal with it already.

Wishing you wellness, ey?

Saturday, February 9, 2008

Wellness Weekly

Cholesterol: The recent news that questions the efficacy of Vytorin over older generic statins has brought attention to an earlier concern. This is the question of whether or not the use of statins should be as ubiquitous as it is. In fact, this supports the argument against OTC cholesterol lowering drugs. Though I have long been against trying to medicate away every risk factor for disease, I was pleasantly surprised to see that there is some support for this among the medical community. The concern from some doctors is regarding whether or not there is any positive effect from these drugs in persons who are not at the high risk end of the high cholesterol, previous heart attack spectrum. These doctors seem to get a lot less airplay then the docs who do support the use of the drugs however. Their message remains important. Besides the lack of effectiveness we are beginning to hear about there is also the false sense of security people may embrace while on the drugs. In other words, it is unwise to continue the high risk lifestyle and expect normal cholesterol levels. The patient must assume some responsibility and the physician ought to be the one saying so.

Prudent: As I’ve said, when determining the amount of faith to place in the latest health related claim it is important to consider replication. Here then is another study in a growing pool of research that relates a western diet …."the Western diet was heavy on refined grains, processed meat, fried food, eggs, red meat, and soda, but skimpy on fish, whole grains, and fruits and vegetables…” to risk factors for heart disease. Risk factors that are classified as the Metabolic Syndrome or Syndrome X include large waists, high blood pressure, high blood sugars, increased blood fats and lower good cholesterol. The study included something else, for a second time that I’d rather hoped would NOT resurface. That is the association of diet soda with an increase in the metabolic syndrome. The reason that this may occur is still unknown as there is no sugar or calories involved. The main hypothesis are these, 1) a chemical in the soda is effecting blood sugars or 2) people who drink the sodas may also consume extra sugar thinking that they have made allowances for it. I do hope it’s the latter! The study author did recommend that people follow the recommended eating style of the American Heart Association. You can find it on their website. If you are wondering, the study did compare the western diet eaters to those that consume what is called a prudent diet.
Those categorized as adhering to a prudent diet ate plenty of vegetables, including cabbage, radish, broccoli, carrots, pumpkin, red peppers, and spinach, as well as fruit, fish, seafood, poultry, whole grains, and low-fat dairy products.” [also known as the deedee diet]
Lutsey PL, Steffen LM, Stevens J. Dietary intake and the development of the metabolic syndrome. Circulation. 2008;DOI:10.1161/circulationaha.107.716159. Available at:

H20 and Weight Gain: You may have expected a little note about how water can help you suppress your appetite, or flush your system, or how it is possible to blame a few pounds on water weight, but No, I really mean, gaining weight from drinking water, real weight. Weight that can become stored fat. How? Well, I may have my best spokesperson in the new Propel water ads which advise against drinking other water based sports or fitness drinks as they are loaded in calories, mostly sugar cals. I have offered this caution many times; however, you may be more likely to listen to the TV. Fair enough, Propel at 20 calories a serving (not necessarily per bottle!) is better than 150. I still prefer my elete water additive. There you get the electrolytes you may need without the calories you may not need. This information is meant for the average person who does exercise but not the athlete, that’s a whole different ball game. By the way, most of us are NOT athletes.

TESH not Best: Ok, I do myself offer you much advice, opinion and admonition. I like to think that my education and certification as a health education specialist allows me to do that with some authority. What exactly qualifies John Tesh to offer health related advice on his radio show? Anyone?

Mpower: There is a new effort underway from the World Health Organization which has been made possible by a grant from the Bloomberg Foundation. Mayor Bloomberg’s philanthropic organization may actually be named something different from that, but he is behind it. (oh please run for president, please please please) The WHO is addressing the effect of tobacco use on the world and is especially concerned about the increase in marketing efforts towards nations that are becoming more developed and having increasing incomes. These include China and India where billion dollar profits are expected. We of course, having had our surge in tobacco use some forty plus years ago, know exactly what is going to happen to those smokers and to the governments who will have to pay for those health consequences. The WHO notes that 2/3 of the world’s smokers live in just ten countries. The US is one of them. Twenty percent of the annual deaths in the USA are related to cigarette smoking. Worldwide there are 8 leading causes of death, six are related to smoking. The WHO expects over a billion deaths from cigarettes within this century. The letters in the WHO endeavor, mpower, stand for different strategies to combat the problem, including policy, monitoring efforts and offering services to treat the dependence. I, being a tobacco treatment specialist in the trenches, offer this. With regard to tobacco over other lifestyle risk factors, I believe the efforts to address it should be 90% policy. I also believe that among tobacco users there is a select group for which the access to quit smoking services is NOT the answer. For this group the only action that will lead to smoking cessation is to prevent access to the product. In other words, cut off the supply!

Wishing you wellness and fresh air to breathe

Saturday, February 2, 2008

Wellness Weekly

Heart Disease: Missed my chance to alert you about National Wear Red Day yesterday. The event brings attention to the number one killer of Americans; heart disease. Heart disease is most often associated with lifestyle and is therefore preventable. The first indicators of trouble are high LDL cholesterol, hypertension and low HDL cholesterol. What you can control is the type and amount of food you consume, the amount and type of exercise you engage in, your weight (YES you can), and your time spent being still or sedentary. For many people, salt should also be monitored and limited. You have the power to prevent an illness, use that power.

Aging: Aging, as it is, beats the alternative, in my book. Still there are ways to age gracefully and ways to age actively. Neither is the result of cosmetic lotions, drugs or surgery. The way to most safely and effectively reduce or slow the effects of getting older i.e. physical and mental decline, is exercise. As much as being sedentary increases heart disease and obesity risk, it also adversely affects your body on a cellular level. This is news from a study published in the Archives of Internal Medicine. The qualification from the study author is as always, duplication is needed but also, that those who do exercise and have the healthier cells, if you will, should be studied as a group.

Diabetes: A Medicare review on diabetes prevalence was reported by Reuters and the report was confusing. Well, maybe the headline was the problem. It stated that more elderly develop diabetes. Though the number of persons over age 65 who have type two diabetes has risen 10 percent, the doctors quoted in the story didn’t associate it with new cases but an increase in prevalence. (more people are alive with the illness at the time of the review than at a time of a previous review) The rise in incidence as we know is in the young. The concern expressed by researcher Frank Sloan of Duke University is that persons do not manage their illness and have complications such as heart disease, neuropathy, blindness, and kidney problems. This cascade of diabetes related illness can lead to premature aging and death.

Guidelines: The following info is exactly why I write this newsletter and advocate for health education to the general public. A study in the Journal of Preventative Medicine reports on the risk of obesity since US Dietary Guidelines suggested a low fat diet. The science is correct, the message is insufficient. Replacing saturated fat with high sugar snacks has caused the epidemic. The study authors are spot on when advising that persons be given complete information instead of sound bites! Giving the consumer complete scientific info may be too much and my passion is actually providing people with sufficient info. This research also makes me more confident about Walter Willett’s food guide pyramid and recommendations.

Germs: Oh My, got that one wrong didn’t they. A recent push by the CDC and the accreditation agency for hospitals is hand washing. The main reason for hospital acquired infections, it has been asserted, is lack of hand hygiene. Yup, doctors and nurses, ok and social workers and other health care professionals, not washing their hands between patients has been a real issue in hospitals. In recent years hospital initiatives have included mandated staff training (how to wash your hands videos), people spying on doctors and reporting them for not washing their hands and putting alcohol hand sanitizer stations up all over the place. The recent research contradicted earlier research and intuitive thinking that increased use of the gels would cut down on infections. However, that is no reason for anyone to stop washing their hands!

Wishing you Wellness!