Saturday, November 29, 2008

Wellness Weekly

General Motors: As Americans we are reluctant to make changes that will improve our health. I do not know why this is so, and yet it is. Americans do not like hard. Americans like to have their cake and pie and chips and dip and eat and eat and eat them too. Respected scientists and physicians like Dr. Willett, as well as popular ones, like Dr. Oz, will tell us that it is about eating well and moving more, but even our heros we do not believe or if we believe, we do not follow. We root for the drug companies and the scientists who study obesity in search of the “I can eat what ever I want and do nothing pill.” Instead, we adopt healthy behaviors sometimes because we have no choice and I admit that the more I study this issue the more I believe that is necessary. You know, you can’t eat trans fats if they stop putting them in your food and you are more likely to quit tobacco if it is illegal to purchase. Along these lines, you are more likely to take the stairs at General Motors if they turn OFF the escalator. Seriously. During certain shifts they are turning it off to save money. Lord how I love it. Obviously we have handicap issues, and it is not my intent to overlook that, just to make a point that the company will do something to save money that might coincidently save a life. See below for more.
McDonalds: The economic crisis is also affecting portion sizes when we eat out. I have already mentioned this irony. Last week though, McDonald’s made another move. They have taken there regular double cheeseburger off the value menu and replaced it with a burger that only has one piece of cheese. That cost saving trick will shave off more than 100 calories.
CEOS: The Wall St Journal recently facilitated a meeting of top CEOs regarding the problems that face our country. With regard to health care, this panel was united in claiming that our number one problem was obesity. Not lack of health care or health insurance, though they were on the list, but of utmost concern was this apparent epidemic of a controllable risk factor that leads to preventable but dire outcomes. How is it controllable? Again, due to what one eats and what one does. You can blame you genes if you want to, but not matter what your genes are programmed to do, you have a brain and you have choices. If you are prone to put on weight just by looking at certain foods, well, that SUCKS, and you have to work harder than those who do not have that genetic make up. If you want to be healthy then you will choose that option. The CEO panel stated that in America we spend more than any other country and have worse outcomes. They also stated that the three best strategies for increasing our longevity and active aging are to ban tobacco, list nutrition info and educate on weight and health. AMEN. I am trying in my small way to do just that.
Melamine: We have found traces of melamine in our infant formula. Some people are outraged and demanding that the formula be removed from shelves. Some are telling us that the amount found is so minute as not to be harmful. The FDA in fact is not making a recall. I just find it enlightening that we would become incensed over one chemical and immune to the fact that cigarettes, when lit, contain about 4000 chemicals including green house gases, toxic metals and carcinogens. What is UP with THAT?
Tar etc: Speaking of tobacco. The claim that a cigarette is low in tar and or nicotine is no longer an option according to the FTC. The machines that test these levels are not accurate, which has been true and known for sometime. People and robots do not hold the cigarette nor inhale it in the same manner. And though the FDA may tell you there is a safe level of melamine, they are NOT telling you that there is a safe level of tar. There is not. Tar coats lungs and causes emphysema and chronic bronchitis. It is found in second hand smoke as well and can affect the lung development of children… there is no safe cigarette nor is there ANY safe level of cigarette smoke and it does NOT matter who is holding the cigarette.

Happy Weekend
Don’t smoke!
Eat Well
Move more

Saturday, November 22, 2008

Wellness Weekly

What Drug Companies Do: Well, they aim to make money and never have I seen this clearer than while reading an article in the WSJ this week. The article, by Jonathon Rockoff, discusses plans by Cephalon as it braces for a generic version of its narcolepsy drug Provigil. Narcolepsy is a sleep disorder. Provigil is sometimes misused by people who need an artificial means to feel rested and alert. Cephalon is only able to market it for narcolepsy, sleep apnea and shift-work sleep disorder. Anyway, the patent is about to expire and people who use Provigil would likely switch to the less expensive drug. I am not someone who thinks that generics are second class drugs, I think that they can be a bargain and if no contraindication exists, a better option for the over prescribed public. Anyhoo, if a company changes something in their drug to make it, longer lasting for instance (that happens A LOT) then they can get a new patent. Cephalon is indeed making a longer lasting version which they call Nuvigil. Patients are being switched to it now and it costs less than Provigil. When the generic comes out people will likely stay on Nuvigil. So instead of losing all the revenue they are losing a smaller percentage.
Tri’s: No not triathlons, triglycerides. A cardiologist/researcher speaking at an American Heart Association meeting this week reported on a review of the literature from several decades of NHANES statistics. What is noted is a drop in the numbers of persons who have high bad cholesterol, probably due to more low fat eating and definitely more medication. What was not so good is that the numbers of persons who have high triglyceride levels has really gone up. It is important that people lower the amount of fat or triglycerides in their blood. Dr. Cohen is concerned about the staggering rates of overweight and obesity in this country and was quoted in this article, saying, “….it’s weight loss, weight loss, weight loss.” He said exactly what I say every week, move more, eat better, and eat less. He also noted that our pill popping had reached its limits.
Memory: Results from a multi state multi year research project on Ginkgo Biloba has ended. The supplement was not found to enhance memory or prevent memory loss. The scientists involved advise that taking it for such an effect would be a waste of money. I just wanted to mention this study because my dad was part of it. Sometimes when you read the actual journal articles on these studies you can see how they break people into study and control groups. Also the authors will explain how many people got the pills versus placebo, what the drop out rate was and about adverse events. Sometimes it will say that a person died of a heart attack and that it was not considered to be from the study medication. I just wanted to note that because my Dad was such a person. He was very excited about being in the study though. I was his proxy or something. They asked him memory questions and separately asked me the same ones so they would be able to ask again later and see if he retained true memories, etc. I also remember that I had to turn in all the study medicine when he died. I do not know if he had the supplement or placebo. I do know this, he was pretty damn sharp for an eighty year old and now, my mom is too.
Cholesterol: Some members of my family have high bad cholesterol. Most of them are like me and do not want to take medications, especially not as a first line response. Well truthfully, one is like me, one is stubborn and won’t go to the doctor and the other takes the pills. One member has lost weight and exercises regularly but her LDL did not come down. That sent me looking for research on diet and cholesterol as compared to statins. Her doctor mentioned fish oil supplements and I thought that though fish oil helps with inflammation it is not usually recommended for cholesterol lowering. I also think that for some people the statin may be necessary, I mean, it beats a heart attack. Good news from a 2003 study may help my medicine adverse family member. Eating a low fat diet with certain specific cholesterol lowering foods did match the effect of a statin drug in the study group. Foods include fiber, plant sterols, soy and phytochemicals. Oh yes, the diet included almonds. Also, in the study everyone ate six times a day……… Yes SIR.

It is cold here in the South, but the sun is bright and it is the Weekend

Be Well

Saturday, November 15, 2008

Wellness Weekly

CRP: Yes this is still in the news and I am continuing to try to wrap my mind around it all. To help, there was an NPR show this week that had the lead researcher from the JUPITER study as well as a physician who was not involved in the study. I also read a WSJ on the article and the actual journal with the research results. To review. Two indicators for heart disease risk and risk of heart attack or stroke are cholesterol levels and levels of inflammation. One inflammation marker is known as C Reactive Protein. Lowering total and LDL cholesterol levels is protective in persons who have high levels. Some individuals do not have high LDL but do have high CRP. If I remember correctly, it is best to have CRP less than 1. When mine was checked it was .5. That number is mg per deciliter. There has been a lot of success in reducing cholesterol levels with statin drugs. Now the question has become, what if any benefit would statins provide to people who have normal cholesterol but high CRP. Could taking a statin reduce the number of adverse health outcomes like heart disease and stroke? According to the JUPITER study, yes. I still believe that diet and exercise are the first defense AND offense for people and that is exactly what the physician on NPR said. It is important to know that all medications have side effects and putting everyone on a drug is costly both physically and financially. The JUPITER study was paid for by the maker of Crestor, however, it was a double blind placebo controlled study, which should mean that no one knew who was getting the statin and who was getting a sugar pill, so to speak. Also, the makers of Crestor were not privy to the results of the study until the manuscript had been written by the independent researchers. There are some interesting points in the study. First, it involved a lot of people and there were things that would allow someone into the study and things to keep them out. They did have to have elevated CRP and the average was 4mg. I notice too that they asked about smoking status and the majority of people in this study were not smokers nor did they have a family history of heart disease. So two groups of relatively healthy people, matched for similarities and given a drug randomly, had two significantly different outcomes. There were lower adverse events in the Crestor group AND their CRP levels came down where as the study groups did not. What we don’t know is if we had two groups of 8 thousand each and one group ate a Mediterranean diet for example and exercised five days a week if they TOO would have the same positive outcomes. Because as was said by both physicians on the NPR show, the problem is the increase in obesity and diabetes which contributes significantly to heart disease.

How old are your arteries? Just as scientists have discovered a way to determine a lungs age, so have they figured out how to assess the age of one’s arteries. I imagine that as we age, even under the best of circumstances, our arteries will have some hardening. So the doctors can determine the level of hardening or thickening that most 30 year olds or 40 year olds have for example and then test people to see if their arteries are aging appropriately. This is important because with the aforementioned obesity epidemic children’s arteries are ageing at an accelerated rate so much so that some ten year olds are said to have the arteries of 45 year olds. OF course, I would like to think that if they were THIS 43 year old writer’s arteries they would not be so bad off!

HPV: In this past year I have mentioned the Merck vaccine named Gardasil and have offered my two cents worth on its value. Of course I am concerned about giving this to everyone because we do not know what long term consequences there may be. I am also concerned that it is marketed by Merck as a cervical cancer vaccine and that is not what it is. Pap smears and the removal of precancerous lesions or cells is what prevents cervical cancer. I am concerned that Merck wants ALL women to take the vaccine when ½ of all adults have been exposed to the human papillomavirus virus already. The vaccine is best for girls who have not yet had sexual activity and that is the group that may be most at risk for any long term consequence. ACK! But here is the real kicker. Now a study has found a protective effect of this vaccine for men. Well…….. You can’t call it a cervical cancer vaccine if you want men to get it can you. So NOW, Merck is calling it a genital warts vaccine, which it is, to an extent. Bottom line… use caution, use a condom and don’t have sex with everybody!

What I am 100 percent in favor of is calorie and nutrition content available for any food that I might eat at a restaurant. The state of NY began this requirement and the news this week is that it may become a national trend. This is good. We should all be aware of what we are eating. You can choose to eat 3000 cals a day instead of 2000 but you need to know that you are.

Ok, last weekend I made spaghetti sauce, today I made sugar and nearly fat free biscotti. I hope they came out okay! (the fat would be from the eggs, 15 grams)

Happy Day

Saturday, November 8, 2008

wellness weekly

METS: Okay, I said that I would tell you about METS this week and so now I have to do it. This means I have to finish reading the section on them. Geez. What I am about to share with you is my interpretation from the Physical Activity Guidelines. A MET is the metabolic equivalent of energy expenditure used to describe exercise. If you are not doing any activity then your MET is one and anything above one can be catalogued and counted towards your better health. Scientists determine the MET of each exercise, though one activity will have different METS based on how you do it. For example a slow pace in walking might have 2 MET while a brisk walk could have 4. Running will obviously be higher in METS. However long you do that activity, for example 30 minutes, times the MET level will equal your MET minutes. A thirty minute activity that equals 4 MET will be worth 120 MET minutes. The people who worked on the guidelines offer us a number of MET minutes for which we will improve health. And it comes with a range. There is no upper limit. They do suggest at least 500 MET a week to improve health, but more than that is necessary to lower disease risk for breast cancer. Remember too, that you can do an 8 MET activity for half the time you do a 4 MET activity and still have the same MET total. Some examples offered in the guidelines include a ten minute mile pace for runners being equal to 10 MET and a twenty minute walking mile (three miles per hour) as being a 3.3 MET. IF you do fifteen minute walking miles your MET would be higher. A cyclist would need to be able to do a 6 minute mile to be considered vigorous. These are all the low end of vigorous BTW. It seems that 1000 MET is a good goal. (PS your exertion and your fitness levels change, for instance my running is more often moderate than vigorous)

Forty is NOT the end: I found it surprising that an article would say that it is difficult to find world class athletes over the age of 40. Surely the author is aware of the 2008 Summer Olympics. The article regarding some research about the body and brain’s decline in motor control that begins, perhaps, at the age of forty, explains. A healthy brain or central nervous system is one that sends and receives messages very quickly. One way to test this is to count how many times an average person can tap their finger in ten seconds. I ALWAYS wondered why doctors tell people to tap their finger really fast! Anyway, the brain circuitry (nerve fibers) works best when in is coated in myelin. The researchers in this study found that the slower tappers had broken down or frayed myelin in the finger tapping area of their brain. We do have a system that can repair myelin and the more physically and mentally active we are and remain, the healthier our brains will be. This is assisted also by preventing disease processes associated with sedentary lifestyles and malnutrition.

C Reactive Protein: When an article came out in the WSJ this week on the same topic we discussed last week, it had exactly the opposite conclusion. CRP is a very important heart disease indicator and should be addressed with medicine. I am sticking with the news from the week before however, that the inflammation level is a marker and the problem is a disease process that yes may be medically treated but more importantly lifestyle prevented.

President’s Cancer Panel: I don’t know about you, but I was not aware that we had such a council. We do and they came out with a report recently that urges government to get on board with more funding and diligence. The council is afraid that the message is getting damped down when “every day 4000 people in the US are diagnosed with some form of cancer.” WOW. I read about this in a Washington Post article where I was also surprised to learn that 40 % of us will develop some form of cancer in our lifetimes. That is a very high number. In the article, which calls for direct White House action, Dr. M Kripke of the Anderson Cancer Center in Texas reminds us that many types of cancer can be prevented and she states that tobacco causes at least 15 types, accounts for at least 30% of all cancer death and 87% of lung cancer deaths.

Migraines: Ever have a migraine? I have had two for certain and I think a few sub migraines.. I say sub because now that I know what they feel like I would never minimize that suffering. I cannot imagine what life would be life to have one every day. In fact, I believe that true chronic pain can destroy a person’s soul. I was interested then in reading an article whose headline promised to ease migraines. This is what I learned. (nothing. I haven’t read it yet! I actually read this stuff while writing the blog more often than not as life has gotten busy!) There is a medication that helps with migraines now but it has to be used with caution in persons with high blood pressure, high cholesterol and blood flow diseases. A new medication, made by Merck, may be able to treat migraines without constricting blood vessels. I hate that it is medicine again and I hate that it is from the makers of Vioxx because I still have fears about having used that medicine. Still, I was happy to see at the end of the USA Today story that a neurologist recommended that one pay attention to lifestyle factors, including sleep, nutrition and exercise. AMEN. I do myself have more headaches when I am unable to run.

Vytorin: Another drug associated with Merck. As you may recall, I have been against this cholesterol lowering medication combo from the very beginning. The latest news comes rather full circle and addresses my initial point to a degree. The Vytorin had the commercials about having Aunt Martha’s genes and eating Aunt Sally’s pie or some such nonsense. The commercial could easily mislead a person into thinking that taking the medication would obviate the need for healthy eating. This in my most professional opinion is bullshit. Merck and Schering-Plough also claimed that this medication worked better than older generics, which research has proved untrue. There are investigations and inquiries in place on both issues currently.

Make them achievable and it will build self efficacy and self esteem. I have really been struggling with my running and was feeling pretty down on myself because I couldn’t meet the mileage goals in the training plan I had devised. I revised it and you know what, it feels better to come in and check off the four or six mile run than having to put an X on the ten mile one…………

Happy weekend. I think I will get up and make some spaghetti sauce now. I love to smell it simmering on the stove. I use diced up onions (and maybe green pepper and mushroom) and garlic, simmered/sautéed in a splash of wine, then I add chopped tomatoes and basil, oregano and a bay leaf. I let it cook for a half hour or so. When it is all done I remove the bay leaf and stir in one packet of sweetener.


Saturday, November 1, 2008

wellness weekly

Volumetrics: When I refer people to Barbara Rolls books regarding Volumetrics I am encouraging people to learn about a concept and to apply that concept to the way that they eat. I wanted to take a moment now to clarify. Volumetrics is NOT a diet or a meal plan. It is not at all like Atkins or Weight Watchers. Volumetrics is a concept. I only hope that you will buy or borrow the book and see what Dr. Rolls is referring to. I am not an expert on her program though I explain it this way. It is about eating foods that are high in nutrients and low in calories. It is a way to eat more without eating more. It is healthful and satisfying.

Supplements in Disguise: It is no secret that I do not endorse pills. I have long spoken out against taking most supplements when the research on the particular vitamin or nutrient is based on EATING the food that contains it. Some medications have substantial research behind them and FDA regulation. There are some medications that are truly necessary for health. Aspirin is one of those. It helps with pain and fever and even helps to prevent heart disease or heart attack. The problem for Bayer, the number one aspirin producer, is that it couldn’t just leave well enough alone. Bayer has received a warning letter from the FDA in regards to claiming that two of its products can offer health benefits beyond that scientifically proven and beyond which Bayer has received FDA approval to market. These products are for heart health and for bone health. They each add something to aspirin. Calcium for the bone health and phytosterols for the heart. The phytosterols are what in foods have been found to lower cholesterol levels. The bottom line here is that aspirin is for a specific medical indication and the rest of this is bunk and it is illegal for Bayer to claim or market otherwise.

C Reactive Protein: I have to come back to this issue because I was quick to talk about it when research first began appearing four or more years ago that said increased levels of inflammation were associated with heart attack and stroke risk. Blood protein levels were and probably still are additional indicators of cerebral or cardiovascular disease risk like high cholesterol and high blood pressure. I remember learning the level of CRP which indicated an increased risk and even having my doctor check my CRP though I had no other risk factors. It was of course at the ideal level. Except maybe the level itself is not the issue as a recent report might imply. This study of 50,000 persons which was led by Dr. Borge Nordestgaard in Denmark does not claim that high levels of CRP are not indicative of a problem only that it is not THE problem. The problem is atherosclerosis or plaque buildup which does lead to heart attack and stroke. The concern is that some drug companies latched on to the first studies and planned products that would reduce the levels of CRP, but CRP is an indicator that needs to be taken seriously and suppressing IT would lower your risk of heart attack if you still have a raging case of plaque buildup. The best thing for us is to eat well and exercise so that we do not develop atherosclerosis in the first place.

Colon Cancer: Did you know that the second leading cause of cancer death is colon cancer? The leading cause of cancer death for women is breast cancer and the cancer that may cause the most deaths (but not the highest cancer incidence) is lung cancer. I do not at this moment know the leading cause of cancer death for men (bet it is lung or colon). Anyway, colon cancer can be associated with what one eats or doesn’t eat, weight and smoking. One way to detect it is the ever dreaded colonoscopy. I have been following the press on the virtual colonoscopy or CT colonography because I very much do not want to have the old fashioned tube down into your intestine test! It is all a matter of time for me, seven years left! The problem these days is not so much with accuracy and even the insurance issue may soon resolve itself, the problem will be what to do if the CT scan does find a polyp. If a polyp is found under the standard test it can be removed immediately, not so for the other. There is not a consensus on how to handle this as of yet, especially if it is a small polyp that doesn’t necessarily warrant removal. At this point though, the recommendation on frequency is beginning at age 50, the CT every five years and if normal the colonoscopy would be repeated in ten.

Exercise: I am near completion in my reading of the Activity Guidelines for Americans and just read about the impact that regular, moderate activity can have on cancer recurrence and even the course of cancer. It is positive of course. Specifically noted in this report were breast and colon cancer. Exercising can reduce the chance for disease, disease recurrence and treatment complications. It can also help prevent the survivor of cancer from getting another chronic disease or cancer. Exercise is hands down the best tool you have for preventing disease, increasing longevity and improving the quality of all of your life years. Not to mention what it can do for your mood. (next week I will talk about MET)

Breast Cancer: I also read this week that persons who are thin and who exercise vigorously may have lower levels of estrogen which at least in the case of breast cancer, can be protective. A study found significantly less cases of breast cancer in that particular population.

Diabetes: News you may have seen this week. The rates of diabetes are staggering, especially so in Florida. The increase in new cases of type 2 is related to the increase in weight that this country has seen. The medications to treat diabetes are innumerable (well almost) and costly. Actually, the newer medications are the problem with regard to cost. Older meds are especially helpful when a person is mindful of what they eat and engages in regular and moderate to vigorous physical activity. Avandia is a newer drug which costs as much as 200 dollars MORE than the standard first line drug. Along with the extra cost of Avandia, are side effects so significant that some are calling for its removal from the market. Best thing to do here is prevent the disease, which means addressing the causes of obesity. Second best thing is to try to catch the disease before it progresses and treat it with diet and exercise. Thirdly, use medications that do not cost a fortune and do not cause more problems!

Headline Reaction: I saw the headline regarding the results of a study that I did not read. I have no idea about the validity or the methodology, but I shuddered none the less. The headline suggests that children who receive Zoloft and counseling have less anxiety and or depression. AACK>< Sorry, but again these medications may be necessary but they come with such a real cost and to begin using them on a young and developing body is in my opinion, the wrong thing to do, or at least it should be the last thing we do.

Fish Farms
: Jeez, I have to take my mother’s sentiments into consideration at this point. Maybe you read too much and maybe you tell us too much. My Mom thinks I scare people sometimes. Well, I just read an article I knew better than to read. It is an article about cod farming that was in the WSJ this week. IA guy my very age, an entrepreneur, is hoping to create a vast cod farm that can produce millions of this fish a year. He wants cod to be the new salmon. Farmed Cod, they say, will fetch a higher price than wild cod. The opposite is true of Salmon. This has to do with time to market. Anyways, there are many issues with fish of both environments. Pollutants are a significant issue that is not erased on farms, remember, ground water! In reading the article though, I learned details of catching, slaughtering, other uses, and preparing for market that make me wonder why I eat fish. I would like to do more research on farmed versus wild cod though because if memory serves me right, cod is a low mercury fish that does have a decent ratio of omega 3 and 6.

Happy weekend and for goodness sakes, stop eating that left over candy!