Friday, February 27, 2009

Wellness Weekly

Okay, here is a little story. Today while I was running I came upon another woman runner. We were going in opposite directions and sharing a sidewalk. We did the hi and nod and as soon as she passed she said, “bitch.” NOW. For real. The funny thing is, I am pretty sure a lot of us runners have thought that from time to time. It is usually when a really fast young person passes us, but we don’t say it OUT LOUD. So when she did, I yelled back, “hey, that’s not nice!”. As I ran on though I kept thinking, “what the hell?!” And it is real funny too because I am 1) still getting my legs back under me after my first marathon, 2) have tight hamstrings from last night’s Yoga class and 3) have one wicked head cold… so I was running at a ridiculously slow 11 minute pace when she passed me. Anyhoo… so there you go… your health educator is apparently a bitch.

Calories Key for Weight Loss NOT Heart Health: Research released this week supports my tag line that it is about energy in and energy out, or calories. Another study compared diets and found that the food isn’t the primary factor in weight loss, but the amount of it. I do not doubt this at all. What I want to make very clear however is that the study ONLY looked at who lost weight and what those individuals had in common. There were not a lot of long term losers by the way. Exercise appeared to help with maintenance. So yes, if you want to lose weight and if you are overweight then you should, the key is eating less calories and before you can eat less, you have to know what you are eating now. Chances are you have no idea. [this is why I support all legislation on including calorie content on menus!] If you want to reduce your chances of heart disease and many cancers, however, it is WHAT you eat that matters. Again and Again, the experts tell us.. while watching your calories, you should be consuming lean proteins, very little red meat, lots of certain fruits and vegetables, legumes, fiber and some fish!

Off Label and Off the Mark: Another drug company is under scrutiny and facing charges for encouraging doctors to use a medication to treat an illness that the medication was not approved to treat. Again, the use of it is not illegal, the encouragement or marketing of it for something besides its approved us is. This time though the issue is more alarming as the company, Forest Laboratories is accused of pushing adult antidepressant medications Celexa and Lexapro to treat pediatric depression. It is worse because a study found the drugs to be ineffective and they come with significant side effects. This case also involves doctors being paid fees for what appears to be kickbacks. Some government insurance programs, i.e. Medicare/Medicaid paid for the medicines, which would be ok if a physician independently determined that the medicine would be beneficial, but that is not what happened here, the Justice Department alleges. The company and a host of others are being sued for illegal promotion.

I was excited to read a report on this recent research study from the National Cancer Institute and Duke University (run by NIH and AARP). This is not the gold standard for research where you take two like groups and offer a treatment to one and a placebo to another and try to control for everything else and follow for years, but it was not an observational study either. These scientists reviewed the histories of almost a half a million people who were enrolled in a study for seven years. Throughout the study the participants filled out food questionnaires and the scientists reviewed them when they followed up on new cancer cases in the population. What they found is that calcium in FOOD is protective for several diseases while calcium in pills only protects men from colon cancer and women from the very rare, liver cancer. There was a significant reduction in colon cancer for both genders who consumed the highest amount of food based calcium. There is ample calcium in low and no fat milk, cheese and yogurt products. I was dismayed by the newspaper writer’s statement that one could get the calcium in a few glasses of milk or from calcium fortified orange juice. NO NO .. the orange juice, holy cows, four glasses… loaded with sugar.. not a good idea.

Alcohol: Geez is it or is it not health promoting. Even in the one drink a day recommendation it seems that problems can occur. I failed to keep a copy of the story I read this week but I do recall that some oral cancers are much more common in smokers who add alcohol to their daily routine. Alcohol can also increase blood pressure so people and apparently women, need to be very mindful of alcohol intake.

Mediterranean Diet: I had not intended to discuss this study today because I pretty much recommend this type of eating all the time. However, this study from Harvard and reported in journal Circulation tells us something new. This study confirms that people who eat this way are less likely to DIE from heart attack and stroke and ADDS that people who eat this way are less likely to get the diseases that cause those outcomes (fatal heart attack and stroke). That is true prevention and prevention is my passion. Also in this Heartwire story the lead researcher, Teresa Fung, describes the types of foods one should eat with an extra twist, it may sound like something I would say, but I will quote the quote, “a minimally processed, mostly plant-based diet, with an abundance-not just in terms of quantity but in terms of variety – of different plant foods and fish.” So that is my point in regards to the first blurb… calories are one thing, what you eat is another. Both are needed to prevent disease and improve quality life years. Furthermore, having a great metabolism and not gaining weight does not mean one is healthy if they do not consume health promoting foods!

Long time readers will know what that stands for, newer readers let me say just briefly, it is the initials for an idea I came up with during my master’s program and stands for the Obesity Prevention Project. I still think that many of my concepts and constructs are correct in addressing the problem of obesity in our children. I bring it up today as I just reviewed a power point presentation by a Dr. Lawrence Cheskin of the Johns Hopkins Weight Management Program. He talked about prevention and treatment and the amount of kids who just don’t keep the weight off with the current strategies. He ended by saying that “the education of children is critical.” Yes sir, yes sir it is and I know how to do it.

Happy Weekend!

Saturday, February 21, 2009

Wellness Weekly

Almost a week ago, I ran a marathon. I am hard pressed to remember anything that I wanted more than to finish that run. I stayed high for days. I hope to run one again, but more importantly I hope to keep up the distance running in the meantime (not 26 mile runs but in the high teens). I am grateful that I accomplished my goal.

Strange Police: Just yesterday evening a story caught my eye. I saw that a class action suit was being brought against a drug company. This was not about someone getting diabetes because they took Zyprexa or a widow suing over a heart attack caused by Vioxx. It was shareholders suing because the company misled them about a drug in development. The drug had not proved effective and certain individuals had adverse health effects during the trial. The company did not mention any of this and the stock price went up and people bought the stock and then at a health industry meeting, the truth about the drug trials was revealed and of course, the price of the stock crashed. Well, if the FDA isn’t equipped for due diligence it is nice to see that Wall Street is. (yeah I know…)

Department of Justice: Another odd source for a law suit and yet here it is. Recall that drug companies themselves cannot market a drug or device for a use that it was not intended for but a clinician on his own, can prescribe something off label. In the news these days, Johnson and Johnson’s congestive heart failure drug, Natrecor. The company is accused of encouraging doctors to use the drug for less serious heart problems and in those instances the drug did not improve health and exposed persons to significant adverse outcomes. The DOJ comes in because Medicare paid for some of this off label IV drug treatment. Here is where I want to remind you of the provision in the stimulus bill about effectiveness research. It is exactly the two examples that I just provided that make that a worthwhile clause.

Genetic Testing: Here is a different spin on genetic testing. For the record and to reiterate, I am not a proponent of the testing in regards to seeing if one has for instance, a predisposition to heart disease or even breast cancer. In my mind, for those specific illnesses knowing family history and risk factors is enough to guide one in making lifestyle choices that might protect against the illness. If one has a gene say that is related to heart disease incidence, the recommendation will be the same as if they don’t…. exercise daily, avoid high fat foods and eat an abundance of certain fruits and vegetables. In a new twist however, genetic testing is being studied to determine if ones body is going to get any or a sufficient benefit from certain drug treatments. The latest study regards using ones genetic profile to determine appropriate warfarin or coumadin dose (a blood thinner). Other medications have been tested in this way and recommendations have followed. This seems to fall into the line of best treatment. At this time however, the cost benefit is still being considered. The genetic tests can cost 400 dollars. Still, I see more reasons to use genetic testing this way than to see if one might be at risk for a disease.. we are ALL at risk for disease and have tremendous power over what we choose to do to protect ourselves.

Flu Vaccine: Each year there are questions regarding whether or not the flu vaccine that is available is going to protect us against the actual flu we are exposed to. I have never taken the vaccine… this week a comedian, Bill Maher (sp), referred to the flu vaccine as a scam. I don’t know about that… but I do wonder about the fear that the government evokes in people and the waste of vaccines every year.

Colon Cancer Screening: Here it is again, that ugly little life saving test that I keep hoping is going to get better before I have to endure it. No news on the less invasive option this week, but on the sedation option. I am certainly against full sedation in general and cautious on anesthesia as it has short and long term cognitive consequences. In much the same way that I tell the dentist to use the least amount of Novocain possible, others are recommending little or no sedation for colonoscopies. It is safer and one is not rendered useless for the 24 hours post test. A Wall St. Journal reporter tells us that she went this route last year and had only mild discomfort and some cramping. She also talks about watching the little video camera make its way through her intestines on a little TV monitor. In other words, she is not normal. Just kidding. The non sedation or little sedation option is not very common in the USA and is a matter of debate for physicians. There is concern that the patient will stop the procedure because of the discomfort. I do not think that I can handle this without sedation and seriously pray for the virtual colonoscopy to gain acceptance for effectiveness before I turn 50.

Colon Cancer: I was going to end with the above and thought better of it. So you know, there are things that you can do to lower your risk of this cancer. This includes limiting red meat and processed meats while enjoying a diet high in certain fruits and vegetables as well as whole grains and you know, fiber. A healthy bowel is a healthy bowel. Note to self: don’t increase your fiber intake without being mindful of your water intake J

Happy Weekend!

Thursday, February 12, 2009

Wellness Weekly

Effectiveness Research: There is an issue in the stimulus bill that I believe has not been axed as of yet which calls for research to determine which medicines and medical devices are actually effective. This will help insurance companies, including MCR/MCD; determine which treatments they should cover. The drug companies and medical device industries are very much opposed to this measure, and I support it. Their concern is that the outcome would be government rationing, or.. that they will make less money. I do believe that if a medicine does not work, we should not take it. Crazy I know. There has been more than one version of this bill. One of much debate includes comparing costs not just effectiveness and that scares a lot of people. I again, believe the most effective medicine should be used and if there are two that are equally effective, the cheaper one should be the gold standard. Now there may be individual cases where the more expensive medicine is better due to genetic or biological factors. I do believe there is a lot of waste in this system and we have to start somewhere.

Sugar: An Indian newspaper reported a story from the EU regarding the misconception about the deleterious effect of sugar. I agreed in theory with the concept that it is not so much sugar but total energy intake and output that affects weight and subsequently insulin resistance. The Comite Europeen des Fabricants de Sucre suggests that more study is needed but that lack of exercise and excess calories of any type are the causal factors for diabetes type 2. I have the occasional snack with sugar, less than 8 grams a serving though.. and I mostly eat whole foods and fruits and veggies. The end of this story offered a little bias; this CEFS is a sugar industry group!

Adverse Birth Outcomes: The issue of maternal obesity is staying in the news. This week a study offers more about what exactly can go wrong in this situation. I have to say that this is reminiscent of how scientists came to warn us on the dangers of tobacco smoke and pregnancy. For now, the JAMA has published a study that links diseases in newborns to obesity but does not yet explain the etiology of said diseases. The reported outcomes were spina bifida, heart problems, cleft palate and additional neural tube defects. I envision the country’s Healthy Start programs tackling this problem in the future.

Pain Meds: The fate of Darvon is still undecided but in the meantime, the FDA is addressing the issue of pain killer abuse and hopefully, the accidental deaths that have occurred because of misuse. The targets of the attention and an upcoming meeting are makers of opiates and especially long acting ones. These can be pills or patches, but their potency makes them especially dangerous. The FDA and the drug makers can work together to formulate a plan to increase safe use of these medications. On the table, stronger warnings, letters to prescribing docs and restrictions on who gets the meds. Good start.

Now starts the section of Oh Boy.. I was right about that… or Vindication Validation

Multivitamins: Let me reiterate.. When scientists and epidemiologists say that “these certain people are much healthier than others and they eat a lot of fruits and vegetables etc”, that does not mean that taking a PILL with the same ingredients or nutrients of that food will provide the same result. Nutrition is almost always best received from a plate not a package and not a pill and not a drink. Research this week was undoubtedly a disappointment for many, but vitamins failed to lower the incidence of heart disease and cancer in those who took them in this 8 year study of over 160,000 women. A similar study with men had the same outcome. In this AP story, an ACS epidemiologist was quoted as saying that his group “does recommend maintaining a healthy weight and eating at least five servings of fruits and vegetables daily, while limiting red meat.” The ACS believes that those lifestyle behaviors WILL reduce the risk of cancer and heart disease. I prefer Dr. Willett’s verbiage. He says to eat three or four servings of fruit and to eat vegetables with abandon. There is a difference in types and that is why I want to work in this area as a professional health communicator… it is not any fruit or any vegetable.. i.e. if you eat five servings of potatoes every day… you will get fat esp. if you fry them. (maybe)

Protein: For many years, I have told my friends who ask that I believe that refueling after or during vigorous exercise is important and that for me, a protein carb snack is most beneficial. Now Nancy Clark, RD, a respected sports nutritionist reports the same advice. She even recommended the very snack I eat on all my long runs… PBJ on wheat… yeah. Protein rebuilds muscle… My diet is absolutely high in carbohydrates as I eat complex whole grains and many fruits and veggies every single day, all day. Ms (DR?) Clark also noted milk, yogurt, lentils, tofu and tuna as good protein sources, and again, these are the foods that I currently eat.

Peanut Butter:
Ok, this is my last, I knew that item. For Christmas I received a subscription to a magazine called Real Simple. This month they have an article on the best natural peanut butters. They reviewed 56 products and came up with three winner s and three runners up. Don’t you know it; my Smucker’s All Natural was in each category. The other four were not major brands, i.e. no smart balanced or peter pan… etc. This is the PB I use for my running energy! PS this has not been recalled and you can make your own nabs with a whole wheat saltine…

OOPS: I was closing up my little newsletter folder and saw an article I forgot to report on. It regards the risk and lack of benefit with many X-rays and MRIs for back pain. The scans do not usually change the course of treatment and they expose the patient to radiation which is a risk factor for cancer. I for one have refused both on my back. I have done a back exercise program and used ice for flare ups (i.e. I did not take opiates for my back pain). Currently my back pain is resolved.. but it comes back and that is ok… I will deal with it.

Happy Weekend…

Saturday, February 7, 2009

Wellness Weekly - guest blog

This week I am proud to offer a guest entry from a dear and cherished friend who thinks I should take a rest. When I read her words I of course wanted to offer empathy and an action plan, that is who I am and what I do, but I didn't go past the empathy.. yet . Please reflect on her words and offer your thoughts, she and I would appreciate this.
I will be back soon with my usual opinionated opining.. Until then, I do want to note that I am extremely pleased with the federal tax increase on cigarettes believing that this measure will reduce the number of teens who begin using tobacco. The tax may save the life of someone you know.

Without further ado then, the words of my friend, Lee Ann Manning.

I have body image issues. I will say, not proudly, but very humbly, that I do not suffer from bulimia or anorexia, nor am I obese, or even overweight. The last time I calculated my body mass index using one of those nifty web sites, I was well within a normal range for my height and weight.
So why am I not happy with my body? Good question. Seems like lately, I’ve found myself pondering the mixed messages about my body that come from so many places, whether medical reports, advertisements, television shows, or even web diets.
I believe it’s important to eat a healthy, varied diet, with plenty of vegetables and fruits. I’m not vegetarian, so I eat my share of chicken, seafood, pork, and yes, even red beef! (Love me a good burger!) I understand the importance of fiber, protein, and calcium, so try to include lots of those in my daily intake. I don’t overeat. (Well, not usually.) And with full confession, I will tell you that I also love chocolate, French fries, and wine. In moderation.
So if I’m not overweight, is there a problem? Most people would say “no!” That I’m healthy, not too skinny, not fat. So, why complain?
The problem is in my perception. Let’s go back a couple of years, to a time in my life when I had too much going on … one full time job, one part time job, a budding romance, volunteer commitments, and increased training for a half-marathon. There was so much going on in my life, I couldn’t seem to eat enough to keep my body nourished. Not only was I physically pushing my body beyond what it had done to that point, my mental state kept me constantly moving and worrying.
My weight, which I thought was perfect at 115 pounds, fell to 112. I loved it! I loved the skinny me. I loved wearing the skinny clothes. I loved the feeling. Until one night, I almost passed out.
I wasn’t consciously starving myself; I just had too much going on in my life to realize the impact on my body.
Soon after that night, my body began to readjust itself. I fed it more to meet the demands of the training schedule; the stress of working two jobs began to ease, and as I became more comfortable in my personal life, the constant fidgeting and worrying went away. I gained some of the weight back. Life got back to normal.
Or so I thought. About the time life got back to normal, my body went to abnormal, as in perimenopausal. (Funny, my spell check thinks the word “perimenopausal” is abnormal, as well!)
So here I was, finally finished punishing my body with long runs every week, thinking now I could go back to gentle, 5-mile runs two or three times a week, and that I would stay in shape. Or even better, since I was pretty burned out on running by this point, I thought about swimming, biking, spin classes, Zumba classes, etc. It was time to try something new.
But the problem was -- my body wasn’t responding the way it used to. Suddenly, my once (almost) svelte thighs were ungainly and, horror of horrors, had the beginnings of cellulite! Around my waist, I could see the beginnings of … oh, no … a spare tire!
To make things worse, now when I run, I have hip and knee problems. So I don’t enjoy running like I once did. I cannot run for long distances (that’s now 3-5 miles!) without taking walk breaks. And running is the ONE THING that used to help me lose weight.
My weight is now at 130 pounds. It’s been that for almost a year, so it’s not really getting worse. It’s just sitting there. I absolutely hate thinking that I weigh 130 pounds. Everyone tells me I look fine. I don’t feel like I look fine.
What exactly is “fine?” Who decides?
About the time I started having these body image issues, I saw an advertising campaign that promotes “real” beauty. The campaign includes photos of women I consider overweight, but the entire campaign is directed at helping women feel good about themselves.
So here’s part of my confusion:
I applaud programs that help girls and young women feel good about themselves; that promote healthy body images and issues. There is nothing so sad as a pre-teen starving herself so she can look like a movie star, or to help her feel that controlling her hunger is the only issue in her life over which she has control. I believe that teaching good eating habits and healthy exercise are the best ways to promote the kind of self-esteem that makes everyone feel “good in their skin,” in other words, a healthy body image.
So why am I so frustrated about my own body image? Am I being stupid when I feel like suddenly I can’t (shouldn’t/wouldn’t/don’t want to) parade my 47-year old body down the beach in a bathing suit, simply because my thighs don’t look the way I’d like them to look?
I am healthy. I eat what I want. I exercise. Maybe I just need to grow up and realize that I’m not a teenager any more, that my body is going to change, but that as long as I’m healthy, it really doesn’t matter how I look?
I don’t have the answers. I’m simply sharing the questions. Probably because I hope someone else will give me the answers.