Friday, June 27, 2008

Wellness Weekly

Vitamin D: Nothing more to say really except that it was in the news again this week and continues to be the vitamin of the month. Get some.

Genes: Happy to report that some states are trying to get in front of the problems that can occur from DTC (direct to consumer) marketing of genetic testing. Because having a certain gene may or may not = disease in much the same way NOT having it may or may not = no disease, California has sent cease and desist letters to approximately 13 companies. My only hesitation (I agree that the tests are misleading) is this – If a person really needs to pay upwards of 1000 dollars to hear “eat right and exercise” and actually DO it, well, maybe they are on to something.

Drugs: Speaking of DTC advertising, pharmaceutical companies and their trade organization PhRMA have been busy lobbying congress this year and one agenda item was to block legislation to curtail their ads. According to an article written by M. Asif Ismail which quotes the Center for Public Integrity, the pharmaceutical industry spent 168 million in 2007, just on lobbying. Not to worry, they can afford it. They can make more than a billion off just one drug. And we are helping because we sure like our pills.

Risk Vs Benefit. Prostate, Lung and Breast Cancer are three diseases for which invasive and expensive tests have been developed. This includes Xrays, ultrasound and MRI. No test is 100% predictive of disease and all have some rate of false positives. False positives at the very least increase stress and often result in even more invasive and costly testing and can lead to life changing surgery. The medical community and health insurance companies grapple with these issues for us. This week the attention was on breast cancer prevention. When is a mammogram sufficient? When does one add ultrasound which may still miss a cancerous lesion, should all women instead be given the 1000 dollar MRI? Last year the ACS updated their screening recommendations and based them on individual risk factors. These risk factors put a woman in average, elevated or high risk and advised testing accordingly. See their website for more.

Stents: Stents are very small metal wires used to prop open arteries that had become clogged with plaque. This is often done after a first heart attack or sign of heart disease, usually after an angioplasty or bypass surgery. Once upon a time there were only bare metal stents and in 2004 a drug coated stent was approved by the FDA. Since then, the stent market too has been a billion dollar battlefield. ( Keep eating those fatty foods, the markets need you. ) Anyways, there has been controversy and concern. The bare metal stents often reclog and repeat procedures are needed. That would make the drug coated stents a better option except there are issues with them as well. They can cause clotting and a person needs to be able to tolerate the anticlotting drugs. Previously there was concern of heart attack death being more common with the new stents, but additional research has not bore that out. A study from the NIA and Robert Wood Johnson foundation did not report more adverse events with either group. The overall mortality rate is also the same for both groups. The bottom line then is not having to have this done twice. MY BOTTOM LINE< not having to have it done ONCE.

Milk Update: Last week I learned that there was the equivalent of x tsp of butter fat in milk. The poster gives the info per HALF gallon. So, one percent milk has 4.5 tsp of butter fat and two percent milk has 9 tsp of butter fat, per ½ gallon.

Wishing you Wellness

Friday, June 20, 2008

Wellness Weekly

Chemicals: This past week there was an article in my local paper which told of toxic shower curtains. An organization which advocates for environmental protection and justice commissioned a study to determine what chemicals were used in polyvinyl chloride shower curtains. PVC in and of itself has implications of harm but the study found 106 other chemicals as well. Of note, seven of them are designated as hazardous air pollutants. The Center for Health, Environment and Justice has sent letters to several retailers requesting that they not sell the curtains. I feel that the organization has valid concerns and I expect that the retailers will oblige. What I also know is that these same toxic chemicals, as well as poisonous gases and cancer causing agents have been found in cigarettes for 50 years and no one has stopped selling them.

Coffee: Another study has been completed and this one adds to the pool of positive results of coffee drinking. In this study, persons who drank 2-3 cups of coffee a day had lower death rates from heart disease. The effect was more pronounced in women. There were no increased adverse events in the coffee drinkers. One theory regarding the protective effect is that the antioxidants in coffee clean up the free radical damage that occurs naturally in our bodies. The accumulation of that reside otherwise damages and changes cells.

Babies: A disturbing trend is underway according to the NIH. The percentage of babies born prematurely has risen 20% since 1990. One cause is smoking. Others include alcohol use, obesity, in vitro fertilization(multiple birth risk), high blood pressure and diabetes. The current rate is one of eight babies are born prematurely. Preterm babies have higher risks of medical and developmental problems. If I did the math right, the old rate was one in ten.

Health Fair: Agh. At a health fair which aims to improve the health of the underserved population, the population more often diagnosed with hypertension and diabetes, the vendors served ice cream, hot dogs, veggies in butter, candy and salty snacks. I was aghast. We MUST role model the change we hope to see. Period.

Diabetes: A large study conducted by researchers at Johns Hopkins University School of Medicine found a link between depression and later onset of type 2 diabetes. I only read about the results, not the actual study which is published in JAMA. There was a 42% likelihood that depressed persons who also ate more, exercised less and smoked would get the life changing disease, but when those factors were controlled for in the analysis, there was still a 23% increase in diabetes cases between depressed and not depressed persons. What the Reuters article doesn’t disclose is whether or not these depressed persons were being treated or what that treatment was. Two points. One, antidepressant medications have been associated with both weight gain and new onset diabetes. Two, people who exercise and eat well often have better moods than those who do not.

Genetics: This past week Tim Russert died. He was a great facilitator and a seemingly kind man. A Wall St Journal article regarding heart disease quoted a physician from Cornell suggesting that people not rely on medications and procedures but on life style, even in the face of genetic predisposition, in order to prevent heart disease. It was a good article. Later in the week, a report based on a study with a very small sample size of 30 was published. The sample was of men only and honestly, the one involved are not representative of the general population, and still, the results are cart wheel turning good. Dean Ornish, who you may recognize from wellness literature, led a study of men who had prostate cancer and chose to engage in significant lifestyle changes instead of medical treatment. The men engaged in these new activities for three months after which lab work and biopsies were repeated. The behavior, eating a diet high in fruits, veggies, grains, legumes and soy PLUS daily exercise and meditation not only led to weight loss and lowered blood pressure, but actual gene changes. Disease promoting genes were turned off and health promoting ones were expressed or turned on. Pray this research is able to be reproduced because it is awesome.

PS: I had the opportunity to do my job this week sandwiched between some nutritionists at a health department. They had posters about milk that included one that said 2% Milk is NOT low in fat and another that showed all the milks, whole, 2%, 1% skim and their amounts of fat. The poster had pats of butter to depict the butter fat in milk. One percent milk had the equivalent of 4 ½ pats of butter!

Wishing you wellness.

Thursday, June 12, 2008

Wellness Weekly

Vitamin D: What did I tell you? This may be the wonder vitamin. Of course, be careful because sometimes adverse outcomes result from over the top supplementation. Still, a report this week indicates that men who have lower than normal levels of vitamin D in the blood were more likely to have heart attacks that were fatal then men with normal levels of vitamin D. Vitamin D is found especially in salmon and milk, even skim milk. Sun light also helps as it processes the vitamin D through our skin. You can have your level tested at the doctor’s office and in the meantime be sure that you are getting the recommended amount of Vitamin D. There have been calls to have the RDA increased so I do not know what current consensus is. For me, the addition of 400 IU seems appropriate. Very few foods contain vitamin D. Dr. Walter Willett is one of the health experts who advises upwards of 800 IU.

Memory: This and the blurb that follows is regarding cigarette smoking as reported this week. One report of a research study found that persons who smoke in middle age have cognitive impairment. In the study through the NIH in France, smokers also had impaired reasoning ability. This would be another reason for a company to not hire smokers. These persons are also more likely to be diagnosed with Alzheimer’s in the future. At the least we know that smoking, with carbon monoxide as a main culprit, inhibits blood flow to all cells, tissues and organs in the body. Other toxins in cigarette smoke will impair health as well. Quitting smoking can increase your chances of living longer better.

Early Death: That being said, persons who continue to smoke will age at greater rates than those who do not and also have greater risks of dying from disease as compared to nonsmokers. Here are the examples offered in a story from the AP regarding a study from the National Cancer Institute. Pretty much in keeping with the notion that smokers on average lose about ten years of life because they smoke, this research states that a 55 year old smokers risk of dying in the next ten years is the same as the risk of someone ten years older who has not smoked. That doesn’t seem as scary to me as the rate of certain diseases in smokers compared to non smokers. And this goes back to one of the first lessons I learned in my epidemiology class. For any illness, being a smoker significantly increases the risk you’ll get it. Smoking is synergistic with all other risk factors; it’s a sort of accelerator. So from the NCI study we learn that between the ages of 60 and 70, 7 of 1000 women die of breast cancer, but 14 of 1000 die of heart disease. If the women smoke, 31 of 1000 die of heart disease. The news story then says 41 of 1000 will die from lung cancer, but not how many smoking women die of breast cancer. Intuitively, it would be higher though. What I did find was a very thorough analysis of the literature and research to date in 2002, the scientist behind that study felt that there were too many intricacies involved with smoking to know if and how much it was related to breast cancer risk. In that report the risk factor most concerning for breast cancer was obesity because fat tissue and estrogen are rather synergistic themselves.

Obesity: Okay let’s wrap up this week’s news with a disturbing review of a story found in the Wall St Journal on June 10th regarding obesity in toddlers. Obesity prevention is my passion and it is what I intend to do as a career. Recently though I was struck by the craziness of it all and how wrong it seemed to focus on this health crisis of over nutrition when the under nutrition crisis was still very much alive in some parts of our world. More on that later. Here in America the rate of obesity in TODDLERS has risen from five percent to twelve. Some hospitals and obesity centers are creating programs that teach physical fitness to parents and children. This means nutrition and physical activity. The controversy over addressing the issue in this young group is mostly abated when you see that the message is not telling kids they are overweight but teaching kids and parents about food and activity. This is imperative and I only wonder how to get these types of lessons to all parents. In the story a mother is quoted as being concerned that if she addresses her child’s weight she will then become anorexic. This is not likely. Only one to three percent of Americans have the disease where as 66 percent of us are overweight/obese. Anorexia IS serious. Being negative about weight and appearance IS inappropriate. Role modeling fitness and serving healthy, proportioned foods is the proper course of action. All this being said, and all my passion for educating the public on how to achieve a healthy weight aside, I am struck numb by the state of affairs in Ethiopia. I am not referring to a Sally Struthers commercial, but a report from the BBC world news this week. The country is experiencing a severe famine and the children are wasting away before the lens of the camera. This is what I saw the night BEFORE the Wall St Journal article regarding obese toddlers. The same day I saw an Arby’s commercial advertising four sandwiches for five bucks. Just numb.

Sorry to end on a downer

Thursday, June 5, 2008

Wellness Weekly

Youth Behavior: The CDC does a telephone survey of both youth and adults in two year intervals. Recently the report on youth behavior was released and though the news is that many health risk behaviors are trending down, the numbers can be startling to those not used to reviewing the literature. For example, less high school students report having sex now than they did in 1991. However, 48 percent are having sex and have had multiple partners. Less youth smoke, but on average the rate is 20%. Youth continue to drink and do drugs but on a positive note, they ARE using condoms!

Health Disparities: In reading about a grant program for certain geographical areas I was not surprised to find another correlation. The Robert Wood Johnson Foundation is hoping to address the needs of the medically underserved. ( race or regional disparities). Some points noted were under treatment of vascular disease and diabetes in black Medicare patients in Memphis or lack of screening tests for some women in Mississippi. In fact, the AP article by Kevin Freking noted that some states are particularly challenged by hospitalizations for heart failure and diabetes related exacerbations. These illnesses can be controlled with proper health care. These illnesses are also especially hard to control in smokers. The article doesn’t mention smoking, but out of curiosity I compared the super ill to the super healthy states, in this article to the rate of smoking in them. True enough, the states with poor outcomes in the research are West Virginia, Kentucky, Louisiana and Mississippi. The lowest complications for these illnesses are found in Washington, Hawaii and Utah. For the record then, the average rate of smoking is 19%. The lowest state is Utah, Hawaii is ranked 43 and Washington is 46. The number one highest rate of smoking goes to Kentucky, second is West Virginia, Mississippi is seventh and Louisiana 10th.

Vitamin D: The last few years have been good to this vitamin. If it were a stock it would be BUY BUY BUY. Vitamin D is needed for strong bones, both in development and integrity. It is also associated with prevention of many diseases. I take extra vitamin D along with my calcium and MVI and I choose a few minutes of sun a day to create that vitamin D. In America, we fortify many products with vitamin D including milk. Surprisingly then, Catherine Gordon, MD of Children’s Hospital in Boston reports a 40% deficiency rate in children ages 8 months to 2 years. One cause could be that breast milk, which is absolutely the better choice for an infant, does not have vitamin D. Vitamins seem to be recommended in the article and being overweight is not. In fact one cause of vitamin d deficiency may be excess fat because the vitamin will dissolve in it and perhaps not be absorbed.

Baby Boomer Demise: Well I did not like this article out of a meeting of the American College of Sports Medicine at ALL. At this meeting a podiatrist, a runner, spoke and had a few things to tell Reuters (M. Rauscher). He cautions that as we age and even in our FORTIES we might consider sports and physical activity that is less stressful on joints. He recommends less marathons if you run them and attention to flexibility as well. He notes wear and tear, biomechanics, and again, inflexibility as reasons for muscularskeletal problems that he sees in his practice. However, he also cautions us on the effects that intense sports, like tennis, soccer, baseball and ballet have on children. I know my family is wondering what I am going to do with his advice to slow it down, and well, I don’t know, I am letting it sink in. Anyways, I don’t run marathons!

Wishing you wellness