Saturday, October 25, 2008

Wellness Weekly

A Good Change: I am a big supporter of expanding food labels or at least making them clear and mandatory. As much as I like and use them, many people are not comfortable with them. Many folks do not read them nor understand what they are reading. Even if what the person reads makes sense, they may not know how to apply it in his or her choice of foods. There is a place on the sidelines of this blog to learn more about label reading. For instance, it is important to know the calorie, sodium, sugar and fiber content of the food you are eating in the amount that you are eating. This week there is news that a few large food manufacturers are making this information available to you in a much easier to read format. What I think is especially neat about this new voluntary act is that the same Smart Choices symbol will be used across different companies and even retailer Wal-Mart. The symbol means that the foods have already met the criteria for a healthy product in regards to low cals, fat, sodium and TFAs while also being higher in fiber. The label will include calorie per serving info and number of servings in the package. Begin looking for this new symbol next year and then USE it.

Junk Food and Heart Attacks: So the foods that have the Smart Symbol should not be in the same category as these foods. An article this week reports that eating certain foods can increase a persons overall risk of having a heart attack. Another study has been completed that compares the types of foods a person eats on a regular basis and the risk of heart attack in that population. For instance a diet heavy in tofu and soy and sauces that are of high sodium content was not protective probably because of the salt. It was rather a neutral or average heart attack diet. The Western diet or one similar to the old USA plan of high meat, high fat and junk food had the highest link to heart disease and heart attack while the lowest is in what is considered a Prudent diet, or the way I eat. High fruits, veggies, fiber etc. Where as the Western diet increased risk by 35% the Prudent one REDUCED it by 30%. Here is the thing though – we already know this.

Healthier Life Steps: In large part due to the study referenced above which included 52 countries, the AMA is increasing its efforts to assist people in attaining and maintaining a health promoting and or disease preventing weight. Their intention is noble and their materials are helpful but they may not be accessible to the people who need them the most. The steps are spelled out on a website and website tools are used to motivate persons to NOT smoke, drink appropriately, exercise daily and eat a diet that is Prudent. There is a growing voice amongst health professionals that there needs to be more effort on preventing obesity than just trying to treat it. Obesity can lead to life changing, debilitating disease and almost every related disease is treated with medications, chemicals. Medications have side effects; they come with a financial and physical cost. Please, take control, insulate yourself from disease. It seems hard at first sure, but YOU CAN quit tobacco if you use it, eat smart if you don’t and move more.

Physical Activity Guidelines: The USDA has written several versions of a food guide pyramid and recommendations on how much of what foods to eat based on certain individual characteristics. (personal nutrition information should be provided by a registered dietician) The latest guide even recommends physical activity. Now the Department of Health and Human Services has written the first physical activity guideline. I mentioned this not long ago. The recommendation is about 76 pages long and I have read most of it. There are one page handouts as well. The main point is this; the new “enough” is “MORE”. The guidelines do not ever support inactivity. They note a low threshold for when health benefits, including disease prevention, can occur but they say they have not found an upper limit. In other words, more is better. A minimum is about 2 and a half hours a week, five hours is better, seven hours even more so. The guidelines are almost the same across age groups. Children should do an hour a day, adults and those over age 65 should do the minimum of three days. Activities promoted include, walking, swimming, biking, running, jogging and aerobic dance. Weight or resistance training is also recommended. Everyone should do some thing. Anyone who does not have a chronic disease should begin immediately and those with illnesses should touch base with their docs and then GET MOVING. Interesting that they noted that there is a risk of injury with some exercise and there is even a risk of heart attack for some people but any and all risks they said are far less than the benefit that one gains from regular daily activity. To note, the activity should be at least ten minutes long but can be accrued over the day. In fact, the guidelines discuss how long, how intense and how often. The single most important factor was how long and again, longer is better. They separate moderate and vigorous activity and say that if you do something moderate, like walk, you can do something vigorous like running, for half the time and have equal benefit. Note: cycling and running are only vigorous at certain paces. Most of my activity is at the moderate pace as I can easily carry on a conversation even when running. When I do intervals of course, I have moved into vigorous territory. I also found it interesting that the DHHS said that they see one injury in every 1000 hours of walking and four injuries in every 1000 hours of running. But you would have to walk twice as long as run to get same benefits so the risk is really only half of running not ¾. It is an interesting read actually, REALLY.

TOY ALERT: Please note a serious issue that may affect your children this year. There is a class of chemical in some plastics called Phthalates which has been found harmful in some research studies. (We actually had a class assignment on this when I was getting my MPH so I know it is a real deal). I recall that there were actual cases of reproductive problems in animals exposed to this chemical and apparently the science supports that these reproductive and hormonal side effects could be found in children exposed to the chemical that is often used to make plastics harden. There are at least six types of phthalates and three are banned altogether and three are to be temporarily banned while additional research is gathered. Most importantly we do not want this chemical in products that children will put in their mouths. Here is the important alert. The law removing these phthalate containing products from the market doesn’t take place immediately. So not only are things like rubber ducks which contain the chemical still on the shelves, they are being discounted so that store owners can get rid of them and still make some money. I do not think there is anyway for you to know which products have them either.

Have a great weekend and don’t buy any rubber duckies!

Friday, October 17, 2008

wellness weekly

Vitamin D: Two things about this amazing vitamin. One is that pediatricians have come out with a statement on increasing the recommended daily intake of Vitamin D, not only because more seems to be better, but because what we have been consuming may not be adequate. The recommendation was 200 IU a day beginning at two months of age, but now it is 400 IU a day at an even younger age. If you are a parent, please discuss this with your child’s pediatrician or physician before making any changes. For adults, Walter Willett has been recommending, as have others, up to 1000 or more IUs a day. I was going to mention something about Vitamin D this week before the AAP recommendation was released, so that was a nice segue. I had begun consuming additional vitamin D over a year ago. I added one 400 IU and had 400 in both my calcium and multivitamin. I just bought another bottle of each and was dosing them out when I checked the labels, just to be sure and good thing I did, the multivitamin now has MORE vitamin D (800 iu), more than I feel comfortable consuming. So I have a bottle of Vitamin D if anyone needs it J.

Cancer Prevention (for women): When reading an article regarding a health awareness survey, I took note of the study author’s suggestion that people in public health should help to get this message out. So here it is. Endometrial cancer is also associated with lifestyle factors and is significantly correlated to weight. Endometrial cancer is the most common gynecologic cancer and few women understand that excess weight can increase the risk for it. Additionally, obese persons with endometrial cancer have a higher risk of death from the cancer. The good news is that there is a cure for this cancer, through surgery, as long as it is caught in time. (prevention would be the best case scenario of course). Two signs for the disease were noted in the article by A. Harding and they are bleeding after menopause or and possibly between menstrual cycles. The study was a survey of professional women and asked if they thought obesity increased the risk of breast, colon and or endometrial cancer and the lowest response was the endometrial. The sample isn’t representative of the general public because the respondents had at least a 4 year degree. This means that it is likely that less people know of the risks than more.

Selective Fear: I was in the office complex gym one evening this week. (weight training !) Two guys were also there and one of them I had seen before and had spoken to several times in the gym. I had also seen this man smoking around our complex. It is odd that I see him working out and taking his walks as he obviously wants to maintain his health, but that is the way it is. Anyway, we were all working out and one guy was sweaty and was cleaning off the equipment with a bottle of stuff that looked like Windex. My smoker friend said he wasn’t so sure about using that stuff as it might cause CANCER! Well, of course I said something……….. And isn’t it just the way we are! We worry about things that have yet to be proven to be harmful when continuing to do all the things that science has pretty much confirmed will kill or debilitate us.

Vigilance: There is a place for my kind of rigidity after all. A study released this week builds on some other studies regarding people who have lost an important amount of weight and maintained that loss. It is vigilance. The successful persons exercise almost an hour a day and do not overeat. They are conscious of calories in and out and they have fewer TVs then heavy people. Well. Oh and their exercise is of the high intensity variety which in the USA Today article was described as jogging, aerobics, and cycling. More proof that it is a lifestyle not a DIET. And yes I am talking to you, person who will not be named here…

STENTS; Stents are the little, ok teeny tiny tubes, if you will, that are used to prop open arteries that have become clogged. We have talked about this a few times, recalling, they have drug eluting stents and plain metal stents and studies compete to prove one safer than the other as it is a multi million or billion dollar industry…….. OK good. Now there is another study about the number of stents. Apparently, not all surgeons or cardiologists complete the gold standard stress tests or artery volume scans (?) before placing stents. A company that sells a technology that can determine if an artery is actually clogged supported a study regarding the use of less stents. The persons with fewer stents had better outcomes over time than those with multiple ones. I>E they were still alive. So , are the results valid even though the study was funded by the medical device company? I don’t know, but it seems to me less would be better than more.

MCR and Home IV Infusion: I got a new perspective when I read an article in the WSJ this morning about the fact that Medicare does not cover the full cost of home IV infusion, for example, for antibiotics. I know this from my days as a hospital social worker. I also know, as the article states, that hospitals often have indigent funds that they use to pay for the home therapy. The therapy can be very expensive but not as expensive as a hospital bed. Hospitals can save money if a person is discharged on home IV meds and it used to be my job to try to make that happen. The WSJ article didn’t say that Medicare usually pays a prearranged fee for a condition and if the person needs more service than the money covers, too bad. Hospitals are also in a bind to free up beds, in certain departments anyway. AND, some diseases are worth more money than others. SORRY< but this is true. What I didn’t wrap my mind around before are two things that I should have. One is that it is a good idea to get the hell out of the hospital as fast as you can because of those ever increasing and now talked about GER MS. But most importantly, don’t most people WANT to go home?! (ok, in my case, a lot of the people did NOT want to leave the hospital, but they had oh so many other issues as to not make them the average person.) Ok, so now I know, pushing to get patients out of the hospital isn’t poor patient care after all.

OK, remember vigilance and diligence. You are worth the effort, EVERY day.

Friday, October 10, 2008

wellness weekly

The Changing Brain: In my recent studies of addiction I learned exactly how drugs affect the brain and that nicotine for instance specifically causes neurotransmitter release and a host of “feelings” in response. Now that I am “off running” do to an injury, I know too that running causes certain “feelings” that I have come to crave. Drugs and running aren’t the only things that can cause the central nervous system to change. Overeating does as well. When one consumes an abundance of calories, as many a person does, and that person’ becomes obese, a certain chemical that is not usually active becomes so. It is like the appendix. We have one, but we do not need it. We also have a compound in the hypothalamus that when activated, causes an immune response and inflammation. As you may recall, inflammation is often an indication of heart disease and is associated with obesity. This news is from a study recently completed in mice and it is just one of many that are being conducted in order to better understand and treat obesity. The study author is Dongsheng Cai and she is with the University of Wisconsin-Madison. While waiting for the magic pill it would be a good idea to stay active and maintain a health promoting weight.

Advair: I heard a commercial for this medication where the announcer suggested that YOU ask your doctor if Advair would improve your lung function. And the commercial states that Advair is used to treat COPD. Now COPD includes emphysema and chronic bronchitis and is often associated with smoking. In fact, 90 percent of emphysema is caused by smoking. So in my mind, the person with COPD would be better off asking their doctor how quitting smoking could improve their lung function.

Move More: The Department of Health and Human Services made a statement this week that is intended to reduce the confusion surrounding how much physical activity, how many minutes a day, a person needs to maintain health. As soon as I saw the words, reduce confusion I prepared myself for the opposite. So, I hope that I can give you the recommendations with less if, ands or buts. Sigh. First, it depends on if you are already active, sort of active or just plain sluggish and then if you are young or old and then….. See what I mean! The government put a panel of experts together and they support the research that physical activity may be the most important thing you can do to prevent many diseases, and this includes, heart disease, colon and breast cancer, hypertension and diabetes. Regular physical activity, the kind that increases your heart rate, can lower you heart attack and stroke risk by 20% and can also help to prevent fractures and depression. This is NOT NEW NEWS; it is just getting the official seal. The recommendations don’t seem any different to me either, but here they are. First and foremost, ANY amount is better than NONE and MORE is better. The amount of time you need to spend depends on the intensity of the exercise. You can walk an hour or run for 30 minutes, for example. Children should exercise an hour a day and adults about 2 and a half hours a week, minimum. If you are doing nothing, then you start with ten to twenty a day or every other day and build on to that. Like I said, the recommendation is dependent on where YOU are now, at baseline. Feel free to post comments if you want more personal direction.

Do You Really Need that Drug? Okay, a study in the journal Neuron tells of mice who were trained to equate a sound that they hear with positive sense of self, safety, will to live. And I totally understand the conditioning piece of this experiment because it is like Pavlov and the dog. It is about strong, powerful, primitive associations. The horror of this is how the study was done and that this is HOW studies are done. For many scientists, and apparently many pharmaceutical company researchers, the way to see if a drug can improve mood is to first cause an animal to feel really hopeless. They use learned helplessness in that they have mice swim until they are exhausted and then they give up as if to drown. They just turn over and float and then the researcher might give them the drug in question, it acts on the brain, stimulates a will to live and the mouse begins to swim again. So in this new experiment, the mice were taught first to fear a sound and then to welcome the sound. I guess the first way was a test. They shocked the mice at the exact time the sound rang, then another conditioning experiment was for the mouse to be in pain except when they played the sound. OMG, it seems so very cruel to me. In this experiment the researchers used just the tone and also used a drug. They both caused a neurotransmitter response, but not the same one. Interesting! The conditioned sound response was dopamine and the pill was serotonin. (these are the two of the chemicals released by nicotine, BTW) So maybe we can condition people to meditate or associate some calming thing, music for example, with happiness and obviate at least some antidepressant meds as they are crazy full of side effects. Dr. Eric Kandel led this research.

That’s all for now, happy weekend.

Saturday, October 4, 2008

wellness weekly

Mexico: Many local, state and federal governments are concerned about the obesity rates in their populations. In fact, a number of them, including my city, Sarasota; state, Florida; and my country, USA encourage mindful eating and exercise. We have a goal to reduce our rates of overweight and obesity by 2010, but almost across the board and certainly in the Southeast, the rates are up, not down. I often thought that people who moved to my country from Mexico for example, gained weight because of us, but I learned that it is not necessarily so. In Mexico, they have a problem of their own making. The new national campaign in Mexico is called Vamos Por Un Million Kilos – Let’s lose a million kilos. They have the same issues as the USA. That is, less activity and more processed and fat laden foods. About 50 percent of their population is overweight or obese whereas, about 66 percent of the US is. In reading about the start of this campaign, it was noted that the health experts in Mexico are fearful of their people becoming as fat as those in the US. This would be because of the health care costs associated with treating obesity related illnesses.

Spit Tobacco: Smokeless tobacco causes cancer and may be associated with heart disease. It is not a safe alternative to smoking as long as it contains nicotine and carcinogens. Nicotine is what addicts a person to tobacco (it is found naturally in the tobacco plant). Nicotine also increases heart rate, blood pressure and pulse. Spit tobacco has more milligrams of nicotine per “dip” than a cigarette – much more. This is concerning and it is concerning that people are not aware of the adverse effects of this product. It is true that there are no second hand spit diseases, but that is no reason to use it. There are changes in consumption and that is why I bring it up. Cigarette use is down about 3- 4% in the past year, while spit tobacco use is up 6 - 7%. This is likely to continue as Phillip Morris parent, Altria has just bought UST which owns the SKOAL brand. PM is the largest US cigarette maker and Skoal had a revenue of almost 2 billion last year. (according to a September WSJ article)

Supplements: I continue not to endorse them because few have the research to support efficacy and none have regulation to enforce purity. Here is another popular duo that may not be worth the money. Glucosamine and Chondroiton. Many people take the supplements to treat pain associated with osteoarthritis and to slow the loss of cartilage in knee joints. In fact, I considered using them before but I realized that the cost of them (if by a reputable company) would be over 30 dollars a month and the presumed benefit only comes after continuous monthly use. I realized that the only thing guaranteed by using them would be expensive pee. Research recently analyzed supports my hypothesis. The supplements did not increase cartilage or conserve it and it did not reduce pain. The information is in the journal Arthritis and Rheumatism. Also note that OA is most often associated with age, gender, genetics, weight and previous injury. (in other words, not exercising is much more likely to lead to bad knees and joints then exercising!)

No Smoking Here: Another country, yes, there are whole countries with public smoking bans, has opted to ban smoking. In the US, we with have several local bans and two states have banned it. India, where approximately 19% of persons over age 15 smoke, enacted such a law yesterday, 10/3/08. Persons who do smoke in public will be fined. No business, restaurant, pub, school, hotel or hospital will allow smoking in or just outside their buildings. I learned this from a WSJ article which included some additional stats from the WHO 2005. What startled me the most, and this is my professional field, is that the country of Greece has a 52% over age 15 smoking rate. Russia is just a few points below this and the USA is between 19 and 24, depending on the source year. (later this week an article came out regarding the expecting explosion of lung cancer disease in China within the next 25 years, mostly due to smoking). But back to India. Because a good portion of the country is illiterate the government is using pictures on the cigarette pack to educate about the dangers. For example, they are using a picture of a skull and crossbones. Well, if they are POISON, why are they for sale? The only entity with the kind of moxie needed in regards to cigarette bans appears to be the Himalayan kingdom of Bhutan which has indeed banned the SALE of cigarettes.

Pharmacy and Tobacco: I, more often that not, have ill will towards both industries. There is a place for at least one of them, I must admit. Medicine can save lives and / or increase the quality of life by ameliorating disease symptoms or slowing progression. My issue is our dependence on meds to solve non medical problems. Like the bad knees we sometimes get because we ate too much and did too little. That dependency on meds is in large part due to the direct to consumer marketing by the pharmaceutical companies. Add to that, the direct to clinician marketing and I’d say, lobbying (wining dining and greens fees). This week I have more direct angst towards Pfizer and Merck. Pfizer for saying that they were going to significantly reduce the amount of time and money they put towards medications for the treatment of heart disease in order to spend more of both on the “much more profitable” oncology or cancer market. (not notable or desperate, but profitable) And with Merck. My issue with Merck, besides trying to kill me with Vioxx, is the Gardasil vaccine. Again, the vaccine may stop some HPV cases that would lead to cervical cancer, but only in a certain at-risk population. NOT The entire male and female population of the United States, but much younger women. Also, it does not obviate pap smears or condoms. So the fact that the US has added the Gardasil vaccine to the REQUIRED immunizations for permanent LEGAL entry into the US (i.e. citizenship) just burns my butt. This is the real mind blower though, because I was talking about big Pharma AND big Tobacco…
One group, Pharmaceuticals, gets people to take medications that may or may not improve their health but costs the user and the insurer a LOT of money while exposing the drug taker to side effect risks – and for cervical cancer anyway, could only save 4000 lives a year….while the other, Tobacco is scientifically proven (US Surgeon General, CDC and the WHO) to kill 438,000 persons a year and is sold legally every where except perhaps the Bhutan kingdom!

Eat Smart Move More
Use condoms :)