Friday, April 25, 2008

wellness weekly

Busy week for me, but some interesting news bits, so let my highlight that which caught my attention:

Cereals: Research indicates that the cereals most highly marketed to children are in fact the ones that are not good for them. A shocker. The scientists categorized the cereals as childrens if they had a cartoon character on the box and or a prize inside. Also, some companies have websites that state which cereals are for kids and which for adults. The kids cereals tend to be too high in sugar, salt and calories. Interestingly, the article I read quoted the study's lead researcher as advising that there be no more than 4 g of sugar per serving. I had trouble last week finding any under 8! Remember this as well, the label may have all sorts of good news; low fat, low sugar, whole grain etc, but too many calories is too many calories. To compare, you can divide the calories per serving by the weight in grams. Choose the cereal with the smaller number.

Generics: The Wall St Journal had a feature in their health section this week regarding the use of generic medication and why that sometimes doesn't go so well for people. One thing to know is that for a medicine to be sold as a generic it must contain the same active ingredient as the brand name. The difference is that it can have inactive ingredients that the other does not have. People may have individual reactions to the inactive ingredients and this may affect the way the pills are metabolized and or absorbed. The need for generics is great. This is because we are taking a lot of medications and we can't afford the price.
The more that we rely on drugs, the greater the demand, the greater the chance problems can occur. There have been concerns about side effects or lack of intended effect, and one explanation offered in the press is that the proliferation of medication dependence has led to a globalization of manufacturing. I appreciate that the drug companies are looking to make the pills in a cost effective way and that they have found that cost effectiveness off shore, but not only does regulation of the process become an issue, but also why it is okay to make them over there, but not buy them from over there. If it is not safe it is not safe. Period.

NJ does it again: NJ has one of the lowest state smoking rates in the country. They are also home to the University of Medicine and Dentistry where I received my tobacco training. This past week a law was passed, a law that was battled out for a year, to prohibit smoking in casinos, nearly completely. The casinos have an option to build a separate unstaffed smoking lounge which would contain no gaming. The law was passed to protect the health of others as it is now clear that second hand smoke, at any level, can cause disease and death. NJ joins about 24 states which also have full or partial smoking bans in their casinos. Seems to me the message is, "you can gamble with your money, but not my health"

Omega 3: We have touched on the benefit of omega 3 fatty acids in the past and that food manufacturers are adding omega 3 to things like cereal, yogurt, eggs, etc. This is not the ideal way to get Omega 3 and research hasn't supported an health benefit from foods that are fortified with Omega 3 fatty acids. Additionally, much of the time the food in question is said to have x mg of omega 3 and the amount we need, or benefit from is over a gram a day. That being said, I tried to find something wrong with a new Country Crock product that is said to have 5oo mg of Omega 3 per serving. I guess if you need a spread with roughly 100 calories, that is as good as any. I myself use fat free cream cheese with 5 to 15 calories and get my omega 3s in fish (actual fish) and flax seed oil.

Viagra: Interestingly, a recent adverstisement for this erectile dysfunction treatment failed to list the side effects associated with its use. WHAT? There are side effects? The ad which was animated and set to music was supposed to have a PRINT message noting that men who take nitrates to treat high blood pressure should not take the pills. The FDA caught the ad and sent a written warning to Pfizer which pulled the ad. The mistake was on the part of CNN which had some techinical glitch. Either way, it is often a blood flow problem that leads to impotence and that is often associated with lifestyle choices, such as eating high fat diets and not exercising.

Life Expectancy: IN the US after several years of gains, some states are not only stagnating but losing ground. It would appear that the folks at Harvard did a fantastically thorough job of reviewing our stats, county by county. Where they found LE decline and I mean, five years lost, they also found>>>>>>>>>> drum roll please... diseases that are related to obesity and smoking. Diseases that lead to early death.

World wide: And the same can be said of the world. Different researchers looked at metabolism and blood pressure across the globe. From that research comes this statement, reported by Maggie Fox at Reuters, that factors affecting blood pressure were not based on genes, but >>>>>>>>>>>>>>>>another drum roll.... what people eat.

And do YOU smoke? Better be honest or it could cost you your job. Several persons employed by Whirlpool who had stated on their employee risk assessment that they did not use tobacco were caught doing so. Persons who use tobacco must pay higher insurance. These people were suspended. I agree that smokers should have different coverage than nonsmokers. In fact, my job required that I sign a nonsmoking agreement.

Lastly: On the way to work today I listened to NPR discuss the just passed legislation that will protect persons from "discrimination" based on having a genetic predisposition to a disease. The genetic scientists had been concerned that they could not find willing research subjects needed to advance the field of genetics because of the fear of recrimination. In the story, a researcher discussed how important it could be for a person to know that they might be more at risk for a certain disease so that they might do what they could to prevent the expression of that gene either by life style or medication. I find his thinking rather optimistic after the information I have blogged about today. Obesity and Smoking cause disease. Not smoking and maintaining a healthy weight prevent disease. Do I need to say that some other way?

Wishing you wellness and action

Friday, April 18, 2008

wellness weekly

On a Plate: Not the first time you have heard me say that, but research continues to support the benefit of nutrients obtained through foods, not special pills, powders or liquids. A meta analysis (or review of multiple studies on the same subject, over 800 for this case) was conducted by researchers at the Cochrane Collaboration. They found that few rigorous studies show a benefit from supplements for protection against oxidative stress or inflammation. Remember, we have residue that can accumulate in our bodies which causes disease and wear and tear. We have an automatic immune response that can create antioxidants that destroy these molecules( free radicals) which are produced daily, and this response is enhanced by certain foods. Foods that contain antioxidants include fruits and vegetables which contain vitamins A, C, E etc. Some of the studies showed no benefit from supplements and some showed harm. It is important to note that we do need these vitamins. We need them as they occur naturally. In the BBC article on this research, a supplement company representative advised that we not expect supplements to undo a life of unhealthy choices or habits. Amen.

Prevention: Along the same line, what you eat now can greatly impact the amount of inflammation you have as well as your rate of aging and the onset of disease. Disease is not a normal part of aging. Disease can be prevented and physical decline forestalled. A growing pool of evidence supports the notion that a diet low in fat and high in vegetables, fruits, grains and lean protein is life promoting. One such diet, the DASH, which was created to help people lower their blood pressure has been found to lower the incidence of heart disease and stroke in persons who eat it regardless of their blood pressure status. Specifically, persons in a study were tracked and when looking at the low incidence of heart attack and stroke in a portion of the 88,000 women, those who ate this way were the healthiest. The research began in 1980 and in my opinion, has scientific validity. Moreover, it was funded by the NIH. In the article I read, a doctor, Nieca Goldberg was interviewed and she noted that her patients most often prefer taking a pill to changing their eating habits. Dr. Goldberg said that there should be a “greater emphasis” on the way people live their lives. Prevention. I agree.
The eating plan is free, please do not pay for it elsewhere.

In Class: It gets better. Research, perhaps less scientific than the above, now shows that it isn’t just eating breakfast that improves a child’s performance in school, but what they eat all day every day. Students who were enrolled in a lifestyle and performance study were followed by researchers. When looking at test results of the 4500 plus fifth graders who took a certain literacy assessment, they noticed that 19 % of them failed. They had the children’s food histories on record and matched the students. They found that the ones who had more fruits and vegetables while getting less calories from fat, did better on the tests. This is important research and if duplicated might trigger more money spent on school nutrition programs. If, as some cynics say, the only thing school boards or admin is interested in is getting scores up, well this is a way to do that. Notice though that this wasn’t an experiment. The scientists did not divide the kids into like groups and then have some eat well and some eat poorly to see what would happen. That of course would be unethical because as stated above, we know what happens if we eat too much fat and not enough fruit and veggies.

Breast Cancer: Interesting note about a reduction in the incidence of breast cancer. This would be the number of new cases per year, not the number of women who have the disease at any given time. New cases have declined for white women but not other races. One reason suspected is that a certain type of breast cancer is promoted by hormone replacement therapy. More white women were taking the hormones when the government released its warning back in 2002 about an association between them and cancer. So, more white women stopped taking them. What I didn’t see in the article I read was the number of women per race by percent. I wonder if more of one race is afflicted by this cancer than another. Okay, I looked it up. Whites have had more incidence and now the gap is closing. The white rates are coming down and the black is either stable or slightly up.
We are beginning to target some preventable causes of this cancer and now we have to get the prevention message out as well as the importance of screening.

Wishing you wellness

Friday, April 11, 2008

wellness weekly

Eggs: Well how about that. Eggs are bad again. Eggs are bad if you are a physician enrolled in the Physician’s Health Study. And doubly bad if you are a diabetic physician enrolled in the study. If you were in the study and ate more than seven eggs a week, your risk of death from any cause was greater than those in the study who did not consume so many eggs. If you were a diabetic in the study, any eggs at all increased your risk of death. Eggs are high in cholesterol and have been said to be a risk factor for heart disease due to the clogging of arteries. Then we were told that cholesterol in foods was not so bad as long as we watched our saturated fat contact and otherwise led a healthy life. In this study, the doctors whose lives were cut short also smoked, drank to excess, ate too much and moved too little. That, whether you eat eggs or not, is a formula for early death. Nonetheless, I’d be mindful of how many eggs I eat.

More on Less Smoke in China: China is faltering these days. It does not look good. They may even be the reason that tobacco stocks were down this week. They are adding another place to their very short list of smoke free venues. The ban I talked about last week referred to Beijing but this is a cross country ban. What is really cool is that the government’s Health Ministry said, no smoking in this place, effective immediately. Wish we could do that, but then we might be like China in other ways that aren’t so cool. Anyway, starting now, you cannot smoke within “teaching regions”. I think it means all schools. They are also strongly encouraging all staff to quit and have agreed to add prevention programs to the school curriculum. Yes it is incredibly late and may only have to do with the Olympics, but it will improve health just the same.

Depression and Alzheimer’s: Not a study that I want to see confirmed. None the less, researchers tell us that people who have suffered chronically with depression are more at risk to develop Alzheimer’s in their later years. I am not surprised as I have worked with people who suffered with and died from Alzheimer’s and I know their past histories. How does one then protect against this particular risk factor? How do you not suffer from depression if depression is a biological condition that is more genetic than environmental? I do not know. Thus, I think we should concentrate on the depression, or theories on depression, that do relate to environment and lifestyle. Ironically they are the same as the ones for Alzheimer’s. I.e. maybe it is one set of risk factors not two. For the record, the study did discuss the stress hormone cortisol as possibly damaging some brain cells, but not affecting plaque buildup and tangles directly. The protective factors that you have control over are these: A diet rich in fruits, vegetables, lean protein, fish (low mercury), beans, nuts and such and monounsaturated fats. Exercise - at least twenty minutes every day and far more if you really want protection. Staying mentally active and engaged in society. Note pills alone will not cure or protect you.

Kudos in Philly: It looks like another healthy school initiative has paid off. Five elementary schools in Philadelphia followed the recommendations of the NHLBI in regards to clearing out soda, limiting snacks and banning candy. Teachers, students and parents were educated on nutrition. The school implemented this plan and evaluated the results. Compared to similar schools and students, twice as many students at the control sites became fat as those at the experiment school. Even so, the numbers were about 7 to 15 %. Seven percent is too high. One thing I would recommend is to ax the juices and make sure that the low fat milk is low enough. It also isn’t said that physical activity was addressed. I would certainly add that. They can do this, we all can. Obesity prevention MUST begin in the earliest years.

Wishing you wellness

Friday, April 4, 2008

wellness weekly

China Bans Smoking: Okay, not really and not effectively. The government is attempting to reduce the places where people will smoke in order to have Beijing appear more health conscious and responsible before the Olympic games begin. Because China has such a great number of people to begin with and an incredibly high rate of smokers, it is a gold mine for tobacco companies. Businesses routinely disregard calls from the government to go smoke free and the citizens embrace the glamour of smoking, (circa USA in the 40s). Interestingly, China has allowed smoking in taxi’s and other public transport until just last fall. They are only now requiring hotels to provide nonsmoking rooms. This is truly frightening in that with hundreds of millions of smokers today, we can expect significant disease within twenty years. It is painful to see that our lessons have not protected them.

Blood Pressure: A conference was held this past week by the American College of Cardiology at which several research studies were discussed. It is true that there are times when studies are halted because of unacceptable amounts of adverse events, but it is also true that some are suspended early because the results are positive and significant enough rush into practice. One such event occurred this month when a study on the use of combination generic blood pressure treatment was concluded. The study was a double blind, which means no one knew which group received which combination of drugs. The drugs used a combo with either a calcium channel blocker or an ace inhibitor and both had a diuretic. The ACE inhibitor drug appeared to work better, and a good thing too because the company that sponsored the study, Novartis, made the drug that worked better. The group on that drug combo had 15 % less incidents of cardio or cerebral – vascular event. Another study showed a positive effect of treating blood pressure in persons over 80 years old. In that study, diuretics were quite effective in reducing strokes and deaths in general. It was noted that this is very good because the over 80 segment of the population is one of the fastest growing. I wondered who that was good for? The drug companies? Or the people who get to enjoy a longer life.

Nicotine: In a report that is connecting certain genes to increased risk for lung cancer in persons who smoke, an interesting hypothesis was noted. Actually, it is more than interesting it is alarming and needs to be addressed as soon as possible. Scientists have been quite busy trying to associate risk of disease to genetics so that they can find a way to protect someone from a particular illness even when that someone chooses to continue the risk behavior. I.e. eating poorly, not exercising, continued smoking… At least health educators are cautioning us against thinking that we should continue smoking if there is a way to turn off the lung cancer gene. For the record, the risk of getting lung cancer is about 15 percent if you smoke and 23% if you have this gene and smoke. Nine times out of ten, the lung cancer recipient is a smoker and 85% of the time, that person will die from the disease. All that being said, a smoker is more likely to die from emphysema or a heart attack. Now the comment that alarmed me. A researcher noted that nicotine receptors are involved in this predisposition for lung cancer and offered the suggestion that nicotine itself could be carcinogenic. If that turns out to be true, we are going to have a real issue with NRT and somebody needs to find out FAST.

Philip Morris x 2: Cigarette maker Philip Morris has split its tobacco company into two different brands. They are Philip Morris USA and Philip Morris International. Both are units of Altria. The reason for the split can be explained by the China example. In America, tobacco companies have many restrictions, in most part due to the Master Settlement Agreement between them and the state’s attorneys’ general, and this includes advertising. Whereas countries who have yet to experience the magnitude of death, disability, and productivity loss caused by the smoking of cigarettes, are open to crafty advertising without regulation. This way each company can work within its parameter. PMI will grow for now, but may pay later.

Genetics: This is rather an afterthought that came to me after I wrote this week's blog. Finding which genes are related to specific diseases and turning them off or creating drugs to block them is not a simple endeavor. If for example, a gene that leads to diabetes is turned off so that eating too many high sugar low carb foods is not a bad thing anymore, it doesn't mean that obesity is no longer a problem. If there was a condition that was isolated to one gene and one behavior the outcome of gene suppresion might be better. I am thinking, sun tanning. If the risk factor for skin cancer could be linked to a gene or two and laying out in the sun had no other ill effect, that would be COOL!

Wishing you wellness