Wednesday, September 30, 2009

Living Disease Free

Yesterday the results of a study were published in the on line version of research journal BMJ. The research involved the Nurses Health Study that began in 1976. (BMJ 2009;339:b3796) The average age of the all female nurses when they entered the study was 50. The women have been followed over time while lifestyle factors and disease conditions were measured. Most recently, scientists at Harvard analyzed the data to determine if being overweight in middle age would have an impact on disease status as well as functionality in older age. Their study doesn’t answer all questions but it certainly should give us pause and motivate the country to work to prevent overweight and obesity.

The scientists looked at weight and disease status not weight and disease causality, we already know that weight and disease are related. Here the scientists learned that for every two (plus) pounds of weight gained since age 18 the odds of healthy survival beyond age 70 were reduced five percent. (the study was on women but previous studies have told us the same type of information for men)

If you weighed 120 at age 18 and at age 50 you weigh 160 that is 20 pounds. The data was calculated with kilograms, so that is really 2.2 pounds. So divide that 20 pounds by 2.2 and get 9 and 9 times 5 = 40% The persons chances of living past age 70 disease free just dropped 40 percent.

If a person was already overweight at age 18, saying they weighed 160 then (they aren’t tall or athletic!) and gained 22 pounds as they aged, there odds of reaching 70 in good health were quite slim.

The scientists also tracked outcomes by BMI numbers. For every point that the subjects BMIs increased they lowered their chance of a healthy older age by 12 percent. That is substantial. The researchers define this “health” as being free of chronic disease and ALSO having the ability to live independently doing ones own activities of daily living which includes physical and mental function.

The end of the study found only about 10% reached age 70 disease free where as 90 percent had at least one chronic disease condition, some had two and others three. Thirty seven percent had chronic disease as well as physical and mental declines.

The research does not answer the question about weight gain and weight loss (they did see an improvement but the amount of women who lost weight was so SMALL that the results are not considered statistically significant), but certainly other studies have demonstrated the effects of weight loss on disease conditions and thus life expectancy. Beyond that, we also know that we have treatments for diseases that keep people alive longer and we have the concept of “compressed morbidity” that we would like to make a reality. We do not want to die longer but to LIVE longer.

I feel this is important to drive home because when the weight control experts or pundits get passionate, the “accept your body” activists get louder. This is NOT about aesthetics… this is about disease and disability. Do you know what the study listed as the most common diseases associated with the weight gain? I will tell you – in this order; cancer, heart disease and diabetes. I understand that food can be comforting, believe me I DO understand, but living well as I live longer is the comfort I aspire to.

Maybe think of it this way. Anything could happen, but most of us are given strong odds to live into our eighties or even nineties. In other words, medicine may give you an extra ten years but what are you getting for that? Will you be able to live those extra years?

It is like your boss saying that everyone gets two more weeks of vacation - but no one can take time off. It is a useless benefit.

I read an article about this study and then read the study. The article had a few things wrong - so always keep that in mind.

Tuesday, September 29, 2009

A Different Vaccine

This should not be a long post as there is not too much to report or explain. The reason I want to address the recent “breakthrough” in HIV (human immunodeficiency virus) vaccine research is to bring attention to the field.

HIV was first discovered the year I graduated from high school – 1983 -though it had been in existence since 1981. It took many years to figure out what we were dealing with and much misinformation and fear spread through the country and the world. HIV is linked to AIDS, acquired immune deficiency syndrome, which is terminal. Many people who were infected with HIV contracted AIDS and died quickly, in the early years.

Much research and time has gone into this disease, at first the funding seemed to come from celebrities more than governments. When we learned that it wasn’t a “gay” disease the research got a little more investment and attention, which it deserved regardless of the population it affected most. People live long, productive and even healthy lives with HIV in some countries and in some conditions (access to care!). In other countries it continues to spread unheeded and no cure nor HIV vaccine has been found.
How very different this is than say, oh, H1N1.
Bing, bang, boom, expect your shot next month.

In the chart (right) for the US you can see that we have less new cases, but larger numbers of persons who are living with the disease.

Some 65 million persons world wide have been infected with the virus and 25 million or more have died from it. The disease is not evenly spread through the world with many more cases being found in sub Saharan Africa than the US or UK.

We have learned a lot about the transmission of the disease and our safe sex campaigns have had a great impact especially in countries were condom use is considered “the norm.” Some cultures and some political platforms have thwarted these efforts. For example, in some countries it would be a great insult to a man to ask him to wear a condom and in others, funding for programs has been tied to (impractical) abstinence only programs.

Now my little history lesson has made my post longer than I had anticipated and I must get to the point.

We have had many trials of vaccines that have had no impact on preventing the transmission of HIV or protecting a person from it. Just this week however, scientists in Thailand report positive results from a United States funded study.

The study involved a combination of two previously ineffective vaccines and was given to approximately half of 16,000 volunteers. The others received placebos. The two meds work differently. One introduces a deactivated virus that carries three HIV genes into the body. The body recognizes those and in theory, creates T cells that will find and destroy the virus. The other drug introduces a protein of the HIV virus into the body so that the body will make antibodies that can neutralize that protein, thus stopping an infection.

Together these medicines had a protective effect in 31% of the experimental group. Or to say this right, there were 31 percent less infections in that group than in the group that did not get the vaccine. There were infections in both groups during the three year study.

I often wonder who would volunteer for this and what do scientists do, tell them to have unprotected sex with an infected person? As best I understand this study, the persons were put in their groups and all were advised on safe sex practices and then left to do what ever it is they did.

The researchers had hoped that if the vaccine did not stop the virus it would at least lower the viral load. That did not happen in the study. Those infected had what ever the usual potency of virus is. Also know that HIV has different strains just as our flu does. This is by far the end of the story, but it certainly offers hope.

The scientists now have to determine by what mechanism the vaccine did work so they can duplicate it. There is some irony that our country paid for the study in another country by a vaccine made in part by a French company and in part with a San Francisco non profit. Still the whole world will benefit from results.

Monday, September 28, 2009

PAD aka Peripheral Artery Disease

Peripheral Artery Disease or PAD is a type of Peripheral Vascular Disease (PVD), in fact, the most common type. I can tell you what PAD is, but it makes more sense if I explain PVD first. Peripheral of course means the outer part of something and vascular has to do with the circulatory system and blood vessels specifically, so PVD would be a disease of the blood vessels outside of the heart and brain. (cardio and cerebral vascular)

In PVD there can be two main causes. One is functional and therefore intermittent. Functional peripheral vascular disease does not involve damage to the vessels themselves. The other type is organic and is most often related to cell tissue (endothelial) and vessel damage like atherosclerosis.

Though we often think of PAD as affecting the arteries in the limbs especially the legs, it really is a narrowing of the arteries (from fatty deposits) of the limbs and organs not counting the heart and brain. In the early stages of PAD, a person often does not feel pain at rest or while sitting because the blood flow is not as strong and vibrant as it would be if they were walking or doing more taxing activity and their arteries are not completely occluded. When a person with PAD does walk any distance however, they may have what is referred to as claudication. Claudication is a really big word for pain in the legs because the blood flow is restricted. The pain isn’t constant though. When the person stops walking the pain will abate.

PAD like other vascular disease, is very often related to diet as well as smoking. People with diabetes, high cholesterol and hypertension are at high risk for PAD. Not getting these diseases and or controlling them is very important. Because PAD IS atherosclerosis (thickening of the artery walls) it is very important that lifestyle changes be made to prevent cardio and cerebrovascular disease, or narrowing of the arteries to the heart and brain. People with PAD are at high risk for heart attack and stroke because of this likely progression.

According to the American Heart Association and the American College of Sports Medicine, people with PAD (and the rest of us) should limit intake of fatty foods and should exercise. YES> It is recommended that people with PAD which causes pain when they walk, be counseled to walk 3-5 times a week, with physician supervision (guidance) in the early stages or stage 1 and 2 of PAD.

Goals of the walking program are interesting. With repetition and consistency, the time to claudication and duration of walking before pain becomes intense should both increase. The ACSM has a level four pain scale, minimal-moderate-intense-unbearable.

There are also four stages of PAD. In the first stage one is not likely to have symptoms while in stage two the intermittent claudication (or pain while walking – like bad cramping) begins. If PAD is not managed and continues to progress, stage three leads to pain at rest and stage four can lead to complete loss of circulation in the limbs. Stage three and four patients are at very high risk for heart disease and surgical interventions.

Indeed the healthy eating and physical activity program can prevent heart disease but the physical activity in this case can also limit loss of functioning and increase a persons ability to continue with their activities of daily living or things that we do that allow us to live independently.

This message was brought to you by someone who is not selling anything – exercise is free medicine!

ACSM Certified News. April May June 2009. N. Markil, BS.

Sunday, September 27, 2009

Odds and Ends

Yes it is the week's end again. I have to admit that all my tidbits for the week seem to have come just this afternoon. Most of these are from my time spent in front of the TV. What?!? Yes, I do watch some TV and today it was the NY Giants-Tampa Bay Buccaneers football game. GO GIANTS. Because tobacco use was front and center during the game, I start with something from earlier this week, but about tobacco.

This past week one of the new Family Smoking Prevention and Tobacco Control Act mandates was instituted. That is the banning of flavored tobacco or flavorings being added to cigarettes. Unfortunately, that really doesn't impact the industry much. Clove cigarettes may be smoked by some artsy types who will now have to switch to clove cigars, but the majority of flavoring is in smokeless tobacco products and those are targeted increasingly to women and children. Since the FDA regs do not allow for the ban of menthol, cigarette users really are not affected by the flavoring stipulation.

Today, while watching the game I saw a commercial for Chantix, not that you'd know and promotions for our State of Florida Quit Line. The Pfizer ad was subtle. Ask your doctor about prescription medication that can help you quit. The ad talked about all the times "you said" you would quit and that now is "my time to quit."

Tobacco Free Florida is our state website, funded by tobacco settlement monies and DOH grants. I was THRILLED to see at least two different Tampa Bay players promote quitting. They said, "I am tobacco free" and then said the number of our quit line. Celebrity spokespersons can be very effective, however, it works best when coupled with an anti tobacco message.

Oh and during the game the announcers discussed that we had the oldest coach in the NFL and the youngest, at today's match up. So the age of the oldest coach? No not 70 - He is only 63.

Not regarding today's TV watching, but I am excited about news of a possible break through in a vaccine for HIV and hope to study that more this week.

Okay that is that then.

Saturday, September 26, 2009

Breast Cancer Aromatase Therapy

The research I am doing for tonight’s blog is a little overwhelming. I of course, call myself to task to be able to read and comprehend the research well enough to say it here in layman’s terms. Let me begin then by telling you why I am reading about adjuvant hormone therapy for the treatment of breast cancer.

Breast cancer does run in my family, and someone who is very dear to me is now being treated with a medicine called anastrozole or Arimidex, and is upset that this medicine costs more than an older aromatase inhibitor called tamoxifen. She did not want to take any medicine after her mastectomy so the fact that she is taking one is very positive, but before she switches, something her doctor vehemently opposes, I thought I would research the issue.

Let me start by explaining some of the terms I have just thrown at you. An adjuvant is a treatment that is secondary or one that assists. If a person has surgery and then has chemotherapy that is considered adjuvant chemotherapy. Some women, especially post menopausal women, will benefit from hormonal therapy instead of chemotherapy. The purpose is to stop production of estrogen for those with breast cancers that are fed by estrogen. (please see for details about different types of breast cancer) The incidence of recurrence in breast cancer can be high and is most difficult to treat if that recurrence occurs with in the first 3-5 years. A common problem is breast cancer in the opposite breast or contra lateral breast cancer and distant metastasis. A goal, the goal, of course is DFS or disease free survival.

In researching this issue I learned that recurrence is more common in survivors than breast cancer incidence is in the general public. I also learned that genetics aside, weight, HRT and smoking are risk factors for breast cancer initiation and recurrence. Further more, alcohol in excess of seven glasses a week or any alcohol in combination with tobacco use increase first and recurring risk. My risk factors then are family and past history of smoking.

Now, back to the issues of tamoxifen vs anastrozole. The article that I spent the most time reading included reference to several other peer reviewed scientific studies that are published in scholarly journals. This one is from the J Cancer Res Clin Oncol (2007) with lead author Stefan Paepke.

It is important to know that tamoxifen has been the standard of care and is effective in preventing local recurrence but not distant metastasis which means overall survival is not necessarily improved. Tamoxifen also comes with risk of serious side effects which include stroke, endometrial cancer and blood clots which can lead to pulmonary embolism. The side effect profile is much worse for patients over age 50. The most significant side effect noted for anastrozole is bone loss and patients on this drug may also take a drug like fosomax.

What I am seeing in the literature now is not a question of whether or not AI or aromatase inhibitors are better, but how and when to use them. Some say they should be used immediately after surgery or even instead of surgery in some cases, and studies have shown that switching from tamoxifen after three years is effective in preventing that early recurrence or distant metastasis. It is NEVER suggested that one go from a newer AI to tamoxifen.

The research article I read which again included the results from past trials, wants to answer the question of whether these new AIs are more effective in increasing overall survival by preventing early distant metastasis. Tamoxefin alone for five years has been found in at least one study to reduce that outcome by 41% and mortality by 34%, compared to not taking any adjuvant drug. But again, the side effects related to tamoxifen are serious. The results of the study and the reason I would like my loved one to continue on her medicine are thus:

The AIs, especially aromatase and letrozole are more effective in preventing early distant metastasis. Though the study authors said that there is no good data yet to determine which AI is better, they are all better for this outcome than tamoxifen and should be started as soon after surgery as possible. They did note that letrozole does appear more effective at stopping distant metastasis if used first or initially.

The side effect profiles are worth noting. Oncologists consider AIs safer but they do increase risk of fractures in person who have below normal bone mineral density at start, they also can cause hypercholesterolemia or high cholesterol and thus effect cardiovascular health.

Wow. Again, I am just overwhelmed. The article does not address cost difference between the older tamoxifen and the AIs which can be 400 dollars. With my public health hat on, however, I believe that the AI is the better medicine for estrogen positive breast cancer survivors.

Friday, September 25, 2009

Addressing the Issue of Obesity

I have been thinking about the field of obesity prevention, especially with regard to children. I began my career as a child abuse and neglect investigator some years ago and it dawned on me this week that there is a commonality here. I don't necessarily mean that the parents of overweight and obese children are mistreating them (though in some ways they may be) but that the interventions or treatments must involve the same systems.

When addressing abuse and neglect especially when moving into the treatment of substantiated cases, we work to protect the children, educate the parents and provide opportunity for new skills to emerge and behavior to change. To do this, we rely heavily on the school system for access, support and protection. The community is another protector and watchdog for child abuse prevention.

Do you see where I am going with this? Children are at great risk when they are overweight. Research supports that they will carry this extra weight into adult hood and by so doing, have adverse outcomes related to weight.
These outcomes, sometimes beginning in childhood, are hypertension, diabetes, arthritis, hyperlipidemia and so much more. Being overweight also limits ones physical activity or mobility and can be mood altering.

In order to significantly impact this issue, parents have to be educated on nutrition. Schools have to supplement this with classroom and lunchroom interventions and communities should support it all with healthy options at restaurants and access to recreational facilities and walkable and cyclable roads. It would not hurt to throw in a key celebrity or community figure to role model the use of these supportive programs.

Parental education and skill building is essential. I work with people everyday who think that they are doing the right things when in fact they are making disease promoting mistakes. Many inadvertently, give children very high amounts of sugar and fat in foods and beverages. If we only removed sweetened beverages and whole milk, we would save hundreds of calories from each child's day. Another big issue is cooking and a third is access. Vegetables are meant to be eaten with abandon, but not if they are fried or cooked in butter and heavy sauces. Processed foods are often if not always cheaper than fresh ones and pack many calories into small serving sizes.

If you are reading this blog you may already know this and even share my desperation. I don't have any good handouts from the Volumetrics program I love, but my second favorite is the We Can program and materials from the National Heart Blood Lung Institute are available. You can see them here and can print and share them. You may even bring them to work:)

Happy Weekend!

Thursday, September 24, 2009


In response to an article regarding biofuels, a person wrote a letter to the editor opposing the use of corn as ethanol. It wasn't just any person. It was the CEO of Smithfield Foods. I read his letter and was being swayed against corn as an alternative fuel product, especially as he argued that the price of corn has risen significantly because of federal policy that drives its use. Mr. Pope argues against using a food crop in this manner. Well, that does make sense. It made more sense though when he noted the adverse effect this has on livestock who have corn as a staple in their feed. I do not want to deprive cows, horses, pigs and even chicken, of their food. Also, I do not myself eat those animals. Actually, I eat very little corn (only those baby corns) and no meat or poultry.

In the end however, Mr. Pope's rationale made me like the idea of using corn for fuel. He indicated that our current policy and those that increase ethanol mandates would adversely effect price, sales and I know he also meant consumption of cereals, meats and sodas!

Ah so Mr. Pope. Using corn for fuel could reduce the obesity rate (less red meat and foods sweetened with high fructose CORN syrup) in this country - and I thank you for pointing that out!

Wednesday, September 23, 2009

Lesson Learned

I feel the need to share a thing or two just now. The first is that I wrote my blog post on the plane, but on my work lap top and I don't feel like turning it on, so I am starting over. Second, when I sit down in this particular chair each night to write my blog, my cat seems to somehow sense this from the other room. He will show up at the foot of my chair and often jump in my lap to be loved, while I am trying to type. But he ran away about a week ago, during the night while I was asleep. I just returned from Wisconsin and sitting in this chair now is rather breaking my heart.

Oh well, and though I made it home from Wisconsin, my luggage did not. I have classes to teach or lead tomorrow morning and I am generally cranky.

All that being said, here is what I wanted to tell you today.

Recently I noted that a new vaccine for the prevention of human papillomavirus or HPV had been approved. I noted that the vaccine hit some of the same strains as Gardasil (merck) but was supposed to have an immune response for a longer period of time. All good, but still, why do we need two vaccines. Then I noted that the new vaccine, Cervarix (GSK) was also supposed to be protective against oral cancer. I opined on that as well. Why does the vaccine for a sexually transmitted disease affect oral cancer?

Here is the irony. In one of the breakout sessions of the 5th Annual Smokeless and Spit Tobacco Conference Iwas attending, I learned that the biggest rise in oral cancer cases was coming from those caused by HPV. Isn't that weird that the article that said Cervarix protected against oral cancer didn't also say that HPV was a risk factor for it. So now you know and if that IS true, then I guess it would behoove men to get the Cervarix vaccine as they DO have a mouth, lips, cheeks and a throat!

Tuesday, September 22, 2009

Pregnancy Outcomes and Fish Intake

Today I completed an online CME activity from Medscape. The research reviewed for the article was published in the Journal of Clinical Nutrition and involved a study of 550 newborns in Spain. The researchers were looking at the impact of fish consumption on birth outcomes with regard to mercury content. As we promote fish consumption for positive neurological benefits we must also weigh the risk of toxicants now found in fish, such as mercury and polychlorinated biphenyls. Mercury is a neuro toxin and has been found to affect fetal growth.
This study measured the amount of mercury in fetal cord blood and reviewed the mothers’ history of intake of fish; type and amount. The outcomes were low birth weight and low birth length for gestational age. The overall impact that the scientists were reviewing was whether or not fish consumption or type of fish consumption would lead to SGA babies or small for gestational age.

The study was not ideal and is not conclusive but gives us food for thought, as it were, and direction for further study.

Intake of canned light tuna was found to be protective. It increased birth weight. Intakes of large oily fish such as sword and tuna, was related to higher mercury levels and low birth weight and low birth length.

Intake of lean or smaller oily fish, such as mackerel, salmon and sardines reduced the risk of short in length for SGA.

All of us should be mindful that swordfish, shark and tuna can be high in mercury and other toxicants and may be harmful to our health, where as fish like salmon are health promoting and fish like tilapia and mahi mahi are less toxic.

Monday, September 21, 2009

Direct from Wisconsin

Some highlights from the Smokeless and Spit Tobacco Conference that I attended today:

I had been aware that the nicotine absorbed from smokeless or spit tobacco was not uniform. Just as there are different amounts of cancer causing agents in products, the nicotine level can vary. The nicotine absorption is also affected by the user. In other words, nicotine absorption can be affected by how long the product is kept in the mouth and if the dip or quid moves around in the mouth. But much more than that, nicotine content can vary by as much as 14mg per 2 gm pinch. Knowing this, I now understand why trials of nicotine replacement therapy have failed to increase cessation rates in smokeless tobacco users. You have to substitute the same amount of nicotine that you were receiving in your tobacco product when you quit and use NRT. If some people were getting 30 to 40 mg a day of nicotine but using a 21 mg patch, well there you go, failure. It would be and is hard then for tobacco cessation specialists and physicians to know what dose of NRT to recommend unless we have the data on nicotine level at our disposal.

When discussing whether or not smokeless tobacco (SLT) use would be better than smoking we have to look at context. If someone uses NO tobacco and then starts using SLT because it was marketed as “safe” it certainly is NOT harm reducing. No tobacco use is far safer than any SLT use. If a person is smoking and also using SLT it is not harm reduction. However, if a person switches completely from smoking to SLT only, it does reduce harm for that smoker.

I was surprised by a statistic today. We were looking at several variables and in those variables the number of smokeless users, concurrent users , smokers and non tobacco users and in all categories but one there were more non tobacco users YEAH! The only category that had more smokers than non smokers was in the unemployed. Now we can play with that statistic. For example, is it that smokers are not hired, or that smokers are fired? Or is it that people lose their jobs and become smokers? Whatever it is, the persons that can least afford the financial and probably health effect cost (no insurance or Medicaid) are the ones using the most!

Sunday, September 20, 2009

Odds and Ends

I observed a beach cleanup this weekend which involved a group of children who appeared to be middle school aged. They did a great job and obviously learned about our environment and the effects of littering and pollution. The cleanup occurred at one of Florida’s tobacco free beaches. I was dismayed however when I saw that their reward included French fries, Fritos and soda. I bet they would have loved some water melon and a cool water bottle.

Speaking of food! I made it through airport security in Tampa with all my food this time. I did not try any freezer pack but was happy to eat my Wasa crackers and Laughing Cow 35 calorie cheese wedge on the plane. Other items in my lunch bag included, grapes, an orange, veggie lunch meat, string cheese, two or three cookies (low cal of course), a granola bar and self made peanut butter crackers. Well… I was going from Tampa to Madison WI. Oh and there is a grocery store one half mile from my hotel.

Speaking of traveling J I was rather stunned at the amount of disabled persons at the airport. I guess because it was the second time I have traveled recently and have seen a lot of older persons in wheel chairs. I do not remember it this way. I guess itI could be for a number of reasons. There are more older persons and there are more diseases related to poor lifestyles that can lead to disability. I read today that there were 12 million persons aged 65 and older who were considered disabled.

To follow up on my breastfeeding blog yesterday I want to give the definition of exclusive breastfeeding that is used to conduct the studies. Exclusive breastfeeding, based on the WHO definition , refers to the practice of feeding only breast milk (including expressed breast milk) and allows the baby to receive vitamins, minerals or medicine. Water, breast milk substitutes, other liquids and solid foods are excluded. Also, I failed to mention yesterday that the issue with the infant formula in Vietnam also included advertisements that allude to outcomes of intelligence and height in children who are given the formula……….

In regards to disability, much can be prevented by adopting an exercise routine. The Physical Activity Guidelines for Americans includes recommendations for every single age group and the disabled. Even older persons are encouraged to do 30 minutes of moderate intensity activity 5 days a week. There is no UPPER limit, the guidelines states that more is better. The minimal 30 x 5, the better 60 x5 and the exchange is vigorous activity instead of moderate at 25 x 3 or 25 x 6. (that is minutes per day but 150 minutes or 300 minutes total of moderate, 75 to 150 vigorous, it is better to spread it out though)

Health Care Reform bills are promoting measures to include wellness programs and disease prevention. It is hoped that after passage of a bill, insurance companies will cover these types of programs and providers will be compensated for encouraging weight maintenance and physical activity. Now, to overcome the providers’ reluctance to “hurt your feelings” we may have to pay a lot… plus an additional reward for providers taking their own advice!

Saturday, September 19, 2009

Breastfeeding: USA vs Vietnam

As a lay person, I know that breastfeeding is important. As a health educator, I understand that it is something to be encouraged. Before seeing a story about the state of breastfeeding in Vietnam this morning, I knew that breast milk was so health promoting that even smoking mothers were encouraged to do it. The benefits of breast milk outweigh the effect of nicotine or the other chemicals in cigarette smoke.

I did not know that our Healthy People 2010 had established goals for exclusively breastfeeding infants up to three months (60%) and six months (25%). These numbers are similar to global targets put forth by the World Health Organization.

To learn more about Healthy People goals, objectives and progress see link below

We have made a lot of progress in the percent of mothers who EVER breast feed, but not so much with the exclusive or continuous breastfeeding. Breast feeding is encouraged for at least the first year and on through the second year if possible.

The article about Vietnam was eye opening on several levels. The first is that the country’s rate of continuous, exclusive breastfeeding up to six months is only 17%. A real problem in the country is the aggressive marketing of infant formula. Interestingly, the formula makers, even ones from the USA are treating doctors, hospitals, health care workers and clinics in much the same as our drug reps treat them here. They encourage them to promote the formula, through lunches, office furniture and even commissions. It is illegal to do so, but the fines for breach are very low. The economy there is worse than ours and the doctors are paid very little.

The benefits of breastfeeding are not limited to the child. Breastfeeding improves the mother’s health and also is economically beneficial. According to the CDC and other sources, like WHO and UNICEF, the benefits include:

Less risk for ear infections and skin conditions, like eczema, less gastric upset and diabetes, decreased risk of sudden infant death, obesity and chest or lung infections – there is much less risk of chronic disease and diarrhea also - all lowers infant mortality rates

For the mom who breast feeds, there is less risk of diabetes, ovarian and breast cancer

I guess what strikes me the most from exploring this more today is the numbers. Ever breastfeeding numbers have increased throughout the world and this is a fantastic thing. They are high in the US and high in Vietnam - over 75%. The goal for all countries however, is to increase the rate of exclusive breastfeeding for the first six months. The goal of the US is again, 25% and of Vietnam, 50%. And my most interesting find is that the US rate is at 11% for the continues exclusive up to six months and Vietnam’s rate, the rate that was so alarming as to warrant the investigation on the infant formula companies, is 17%. I guess we need to do a little better oursevles USA.

Friday, September 18, 2009

Investing in Obesity

This is a follow up to a post earlier this week that mentioned the standards that obesity drug makers had to meet for FDA approval of their drug.

There are three drugs that are showing promise these days. They are all in late stage trials and so have proved safety, minimal side effects and efficacy. They now have to meet the FDA standard of at least 5% weight loss in a third of the study group and a doubling in the number of weight loss experiment “losers” compared to the placebo group.

Recently Arena Pharmaceuticals had noted some success and were due to release results of their most recent trial, today. Yesterday there was a lot of buying of the company’s stock, ahead of the report.

I tell you this because obesity is big business and investors go nuts over the thought of owning shares of that true block buster drug.

It is said that the results related to lorcaserin were not as significant as hoped and some shares were promptly sold this morning. The problem being that the placebo group also lost weight with a comparison of 6.5% body weight lost in subjects to 3.9% in placebo. Perhaps too close to get FDA approval.

What I found interesting in the Miami Herald article I read was this statement, “a program of moderate diet and exercise is standard for all patients in late-stage studies of obesity drugs.” REALLY? Why will a person participate in this safe and effective weight loss “concept” in a drug trial but not in real life?

The other two drugs that are vying for market share and FDA approval are Contrave and Qnexa. Where do these names come from?

Thursday, September 17, 2009


It was a landmark year with tobacco. The federal government and many states raised their taxes on cigarettes and the Family Smoking Prevention and Tobacco Control Act was signed into law. I guess it was too much to expect for landmark obesity prevention action at the same time.

An article appears in the New England Journal of Medicine currently which is authored by seven esteemed health, wellness and economic experts. They are calling for a one cent per ounce tax increase on soda and sugary beverages.

In the summer this issue was addressed by some of the same authors. Certainly Kelly Brownell of Yale and NYC health commissioner Thomas Farley were in the spot light with a plan to raise the soda tax in NYC so that the tax would be 18 percent. The national average sales tax on soda is just about 5 percent now. Probably the threat by PepsiCo stopped the tax from happening in NYC. They were going to move their corporate head quarters.

Hope held out that one or more health care reform bill would call for the increase which could fund some of the programs that health care reform will likely call for, i.e. obesity prevention in schools.

Like tobacco taxes, there will be a fight and the states will probably act before the federal government does, but seeing Walter Willet on the list of experts recommending this tax has encouraged me. Yale, Harvard, governors and health commissioners, seems a formidable bunch.

Soda and sugary drinks are largely blamed for the obesity and diabetes epidemics that we are experiencing, of course, eating too much is also an issue.

Wednesday, September 16, 2009

Exercise Equipment Claims

In the ACSM Health and Fitness Journal an article similar to the ones I have been writing about claims on meds, diets and supplements discusses claims for exercise equipment. The first point made is one we hear often. If it sounds too good to be true then it probably is not true.

You may have seen advertisements for machines that claim to burn more calories than a treadmill. According to the ACSM these claims are rarely justified. The ad may say for instance that there was a clinical study, but that tells you no more than a clinical study about a medicine tells you. That it was done does not mean it found anything to be true. Often times the promotion states that the two machines were used at the same speed and the one burned more calories than the other, but it doesn't add that the intensities of the two machines were different.

It is also said in this article that machines that boast being low impact are not really the machines that we would want to use unless we had a medical condition such as osteoporosis. In fact, the ACSM states, "most clients should be encouraged to judiciously include impact-generating exercise."

The ACSM also clarifies that "fat burning" exercise is not the answer to weight loss, but that the number of calories burned from any source are what matters. The formula for weight loss that the ACSM advises is this: intensity X duration X frequency. If you can do a low impact activity longer and more often then it may be best for you, other wise, moderate intensity activity is best.
Also validated or invalidated as the case may be, are the calorie burned amounts offered by machine readouts. Even when you can enter your weight and age and your heart rate is monitored the machines can be off by as many as 1000 calories! Remember what has recently been said, calories are hard to burn. Do not expect 30 minutes on the treadmill to burn 200 hundred calories.
Any machine that claims to reduce the size of a specific body part, like your abdominal area, should signal warning bells. No one can spot reduce. Often when an ad claims inches off your waist the fine print includes that results are not typical and that results are dependent on exercise AND diet.
Look for peer reviewed research if you are on the fence about one of these claims. And remember, you want something that is clinically proven with statistical significance. The research should involve a large group of people and have a comparison group that did not use the same equipment.

Tuesday, September 15, 2009

Cervical Cancer "Vaccines"

I have expressed my reservations regarding Merck's Gardasil vaccine from its debut. When Gardasil was first released, I was still in grad school and in one of my classes we had to discuss being for or against it and explain why we chose that stance. I was against it more for the message it might send about cervical cancer prevention than anything else and that the marketing was in my opinion misleading. By this I mean, regular screening exams by a physician who can do a pap smear will detect any abnormal cells that may be pre cancerous. Having the vaccine does NOT mean that one can avoid the illness altogether, that condoms are not necessary or that PAP smears are not necessary. The vaccine may protect against some strains of the human papillomavirus which is one of the main risk factors for getting cervical cancer. There are numerous strains. If one already has been exposed to the virus, the vaccine does not protect against it. That being said the vaccine is best for people before they begin sexual activity.

So initially it was meant for young girls. Obviously, men do not get cervical cancer. (BTW when it was being targeted to women Merck called it a cervical cancer vaccine, but when they wanted to persuade the FDA to approve it for boys they called it what it really is - an HPV vaccine). It is unsettling to think of vaccinating the young against a sexual transmitted disease, but then most vaccines are given to children. Merck tried to make the vaccine mandatory by law, like some of our other vaccines, for school admittance etc. They lobbied Congress pretty heavily but lost. Then Merck wanted to give it to older persons and then to men and now to boys. Certainly they have a lot to gain if the FDA approves those indications.

The thinking is that an older person may have been exposed to one strain, but not another, so the vaccine can help with that. And men would not realize that they had the virus and could infect women and so men should be vaccinated. Of course, it is better still that little boys get the vaccine as opposed to men for the same reason it is meant for little girls (pre exposure - pre sex).

Even if I agree with all of those arguments, we still need to practice safe sex and have annual screenings for the detection and removal of precancerous lesions.

So this was all I was already thinking before today. Today I scratch my head wondering why we need TWO HPV vaccines. Especially as we have discussed recently that there has to be some new indication before a second medication is approved to treat an already treated disease.

Enter Cervarix by GlaxoSmithKline. Cervarix is close to FDA approval for the same HPV prevention in young women or children. It proposes to hit the same strains as Gardasil plus a few more and to work longer and also to protect against one type of throat cancer.

You have to make your own conclusions... I am just pondering out loud and as I do not have a young girl in my care and really don't see the vaccine necessary for my non promiscuous condom carrying self, I do not have to decide. (though I must say again, condoms are not 100% effective in preventing any STD)

Monday, September 14, 2009

Obesity Drugs

I have never held back my concerns about the treatment of obesity. I feel that the best treatment is weight loss that occurs naturally from energy intake and expenditure changes. Still, treatment for the morbidly obese and those close to it, often does involve invasive, and I mean, life changing, invasive surgery or some type of prescription medication. The medications often involve some type of neurotransmitter activation or metabolism adjustments and to date have lacked efficacy or have been effective but lethal.

You must know that publicly traded and independent drug companies are constantly at work trying to find the chemical compound that will take calorie reduction out of the equation. Pills do not, or have not, come without a price and I mean more than a dollar price, but we want the easy way.... It saddens me. I see all these ads, "is your job making you fat?", " is stress making you fat?" NO ... food is making you fat.... and I am digressing from my point.

In a recent article about a drug that looked promising in a previous trial but less so in a current one, additional information about obesity drug qualifications was explained.

In past posts, I have explained that everyone cannot make drugs and sell them without showing the FDA that there is a need. To meet this need, the drug must treat a condition that there is no drug for, or treat it much more effectively than an existing drug, or treat a condition with less side effects than an existing drug does. With obesity drugs there are a few more elements.

The subjects in the clinical trial must lose 5% of their body weight over those taking a placebo. OR 35% of the experimental group has to lose 5% of their body weight and double the proportion of the placebo group. At least we have some high standards here. Also the results have to be statistically significant and not just something that could be seen through chance. (there are statisticians who figure that part out)

It is important to note that last piece because some commercials that say " X was effective in a clinical trial" do not clarify if that was statistically significant. Also, those that say their product was developed with clinical trials are not saying anything about efficacy!

Sunday, September 13, 2009

Odds and Ends

Here we are again at week's end. I have a few left over bits to share.

I saw a commercial on line last night while watching a TV show. It was a little dog explaining that he used to have good poop but now it was superior. YUP that is what I said. I wish I could find it now, but a quick google search didn't draw it out. It did involve a cute canine saying how he used to be a good pooper but now he was a super pooper and this was owed to some brand of dog food. Well, I do get it. Colon health is important and a high fiber diet is one strategy for maintaining it. I guess dogs don't need my cereal bars as they have that special dog food, but you do not have to eat dog food for super poop! (ah, I make myself laugh out loud sometimes) my cereal bar recipe is here

Ah, I am a bit dejected. I, as you know, am a big fan of Kenneth Cooper, MD. Recently a newspaper story attributed a comment to him and when I contacted the reporter I was told that Dr. Cooper had made this comment in his book the Antioxidant Revolution. I did get the book from the library and was reviewing it this weekend. I am frustrated because the book was published in 1994 and many of the things that Dr. Cooper is advocating have since been either disproved as effective or found to be harmful. I worry because many people who read the book now would not know that! The important part is this however. Every action that occurs in our bodies as well as assaults that occur from without, like smoking and pollution, lead to free radical expression. Free radicals in small numbers are good and in a slight excess our bodies own (endogenous) antioxidants can manage the extra. Unchecked and abundant free radicals can lead to heart disease and cancer as well as aging. Research continues to support that exogenous antioxidants from FOOD can help, but supplements do not. Dr. Cooper's book is heavy on supplement promotion. It is a 15 year old book!

Sorry for the inconvenience: Some weeks back, I read a short article by Howard Brandston who is a lighting consultant. He was discussing how the energy conservation efforts that call for compact fluorescent lights or CFLs over incandescent ones are not considering how uncomfortable Americans will be with this change. I am sorry, what? He talked about how our dimmer switches for ambiance and home theatre systems would not work well with the CFLs. What an incredibly spoiled group we have become.

I was intrigued by a show on NPR yesterday and wanted to mention the gist of the conversation to you. A scientist or professor from UCLA was saying that the elephant in the room of Health Care Reform was food. He discussed diabetes, especially diabetes 2 and that high fructose corn syrup had a lot to do with it. He said that diabetes was leading to costly treatments but that physicians received reimbursement to treat it and not to prevent it. He also noted that our government pays farmers to grow a lot of corn and this corn is used to make the very cheap high fructose corn syrup which is used most generously in sodas. Soda consumption is a big factor in our obesity and diabetes epidemics. I do hope that prevention programs become the norm. Expect the insurance companies to role out some fancy wellness programs when the reform passes. Maybe I can work for them!

You may not be aware, but the Family Smoking Prevention and Tobacco Control Act of 2009 bans all flavorings in cigarettes, except menthol. That means clove cigarettes will be banned. However, the ban on flavorings, which we feel entice children, does not include cigars. Get ready then for the Clove Cigar.

Lastly. A report about bacteria in our oceans, east and west and gulf coast, was scary. In the news story it was advised that we not avoid our oceans but that we rinse ourselves off when we leave. This advice is regarding the water AND the sand of our beaches. I just thought the irony should be noted. We have poisoned our waters and now they are poisoning us.

Might I just add - Go Giants

Saturday, September 12, 2009


I am comforted to see that I am not the only one who expresses concerns about the sale and use of supplements and herbals. In reading a story in the WSJ recently, I also learned that some laws or regulations have been enacted since I first began to express my concerns in the pages of my blog.

Just briefly, my concern has always been lack of evidence, lack of oversight, lack of disclosure and lack of purity. These are still my concerns and the concerns of others, but you have options for vetting the products you would like to try.

There is also a little more accountability in that the FDA does have manufacturing standards for supplement makers and there is a law from 2007 that mandates a report to the FDA for any serious side effect. Really the big difference between supplements, which include your mulit vitamin, calcium, fish oil and all those products that promise less osteoarthritis, bigger muscles and weight loss, is that the manufacturer is responsible for proof of efficacy and safety and does not have to have FDA approval to sell or market the product. It is only after the product is on the market that the FDA can respond to problems and false claims. And as you may know, the FDA is somewhat overwhelmed with oh, all the meds and medical devices that are causing us problems.

There are resources for the consumer and it is up to us to use them. I would recommend the FDA site to check on any reports of problems, and I would recommend Medlines’ supplement page for research, efficacy and side effects. Be more careful with a supplement company website. Consumerlab is good, but you have to pay for it and I think that is unnecessary.

One piece of advice offered in the article is one I would caution against putting much faith in. That is to ask your physician about a supplement. I DO think you should tell physicians and hospital staff of anything you take, but to expect a doc to have had the time to evaluate a supplement is a little idealistic. You really have to do this work yourself.

For me, I again stick with the supplements I have found the most research to support which are vitamin D and fish oil. I stay away from any supplement promising weight loss, enhanced performance or joint repair. Be mindful that many products making those claims have been found to have undeclared and harmful ingredients with adverse outcomes of liver and kidney damage. Oh, and as a tobacco educator, skip those all natural quit smoking products also.

Here are the links I feel you would be wise to use:

Friday, September 11, 2009

Clinical Trials

This post isn't really about clinical trials in general, but about the latest one for the H1N1 virus. This is of course, the strain of flu that was formerly known as swine flu.

Previously I blogged about the data that had been gathered from the first wave of this virus and how it seemed to effect pregnant women most significantly. One reason for that is the suppression of the woman's immune system during her pregnancy, but another is the decrease in lung capacity and oxygen flow during the final month or two as the fetus' size impinges on the lungs. For these two reasons at least, the CDC and others are putting pregnant women at the top of the vaccine list. Problem is, we do not yet have that approved vaccine.

The makers of the seasonal flu vaccine have created an H1N1 version that is showing efficacy and safety in animals and people, during the clinical trials. The NIH is now supporting a trial of the vaccine on pregnant women. They are testing dose strength and dose frequency. Women have enrolled in the trial.

Yesterday there was some discussion of this on NPR and someone asked why a woman would volunteer for the trial. The scientist being interviewed explained why pregnant women would benefit from the vaccine, but not why they would risk themselves and their unborn child in a clinical trial whose aim it is to prove safety and efficacy.

I continue to scratch my head over the same question. I realize that someone has to do it, but there is no way it would be me. Would you participate in clinical trials? A vaccine one? One during pregnancy?

Most drugs are not tested in pregnant women and instead are reviewed when we find pregnant women who have taken them. I imagine the need for a vaccine in this target group is great, and I still do not know why I would participate in the trial.

Thursday, September 10, 2009

Bone Health Across the Lifespan

I read an interesting article in the American College of Sports Medicine (ACSM) Certified News today. The article was about bone health and how to protect it at different times in a persons development.

Children or Youth would be building their bone density and it is crucial that they do this in their early years so that they can withstand the amount they will lose as they get older, even in the best of situations. We expect that kids are healthy and trim and if so, then high impact activities are recommended. Sports like tennis, gymnastics, basketball, soccer and also running are to be encouraged. Be careful with this however as it is also true that injuries in joints at early ages can lead to osteoarthritis later. (this is also true if joints lack of osteogenic stress.) Plyometrics are also good for building bone. This includes jumping, hopping, big jumping jacks, even skipping. Resistance training is also recommended though one is to be mindful that the only bones that benefit are the ones that are worked. Not a lot of bone stress occurs with weight training, but the hips can be targeted with leg presses, for example. So at this stage we are concerned with building bone mass.

In middle age we are concerned with preserving the bone mass we have attained at earlier ages. People who have been doing high impact exercise should continue to do so. Walking, swimming and bicycling are not considered high impact activity. Otherwise, moderate impact activity as well as resistance training can be used here. Moderate impact activity does include walking and jogging. People here can continue with sports such as tennis and can use stair climbing and elliptical machines in the gym. Here were want to maintain bone mass.

In some middle aged people and more older persons, bone mass decline can be enough to be considered either osteopenic or osteoporotic. Osteopenia is bone loss that is more than would be expected for age and more than is normal for the general population at that age. It is imperative that bone loss be stopped and bone mass preserved to avoid the very painful and debilitating osteoporosis. Weight bearing activities are still recommended but high impact sports are not. Resistance training is always recommended. People with osteopenia may be prescribed bone loss medicines, though they are not themselves without risk. There is not strong evidence that pills alone make a difference, but pills plus resistance training have been effective in restoring some bone mineral density. Calcium and Vitamin D supplementation is also used. I lean more towards calcium in foods and Vitamin D supplements myself. Again, this is preventing further bone density loss.

People with osteoporosis have to be careful.. Falls can break bones and broken bones can lead to further disability and decline in functioning. This is also a very painful condition. It is crucial then, that persons here reduce their fall risk and that can be done by exercises that improve balance and agility. Walking and stationary biking can be used in this group. Osteoporosis is an irreversible condition that affects both men and women. Smoking and lack of physical activity are risk factors, as are being thin and white. In this stage, usually in late late life, the focus is on preventing bone breakage.

okay, then.. get up and build those bones!

Wednesday, September 9, 2009

Health Care and Chronic Disease

This morning I read a story on line from USA Today. As much of the news these days, the article discussed our health care system. In this story, several respected medical groups expressed the need to prevent chronic disease conditions as treating them costs billions of dollars.

The reporter gave an example of a person with chronic disease conditions, named the man and quoted one of his physicians. This person has had four kidney transplants and is 54 years old. His kidney’s failed for different reasons, and not all were related to his choices.
Still, did you know that your kidneys could fail because of high blood pressure? Would you ever expect that to happen when you were in your forties? The gentleman’s physician said that he had really wished the man had stopped smoking. The man who was given kidneys from strangers and from his wife, continued to smoke from his early 20s until just recently.

Some experts in the article discussed the need for insurance companies to pay for quit smoking classes. The patient here has quit and is saving his five dollars a day. He stated that people should quit smoking and use the money for quitting as that is cheaper than the smokes.
Actually, no one has to pay to quit smoking. Most states have their own telephone quitline, but if not, there is a national quit line. My state, Florida, has free quit smoking classes throughout our 67 counties. Medicines sometimes cost, but not always. Insurance does pay for some meds and it also reimburses clinicians for addressing tobacco use during an office visit.

The person in this story is very likely on disability income and Medicare or Medicaid (some people get both). If I ruled the world, people who wanted expensive treatments to stay alive would have to stop killing themselves first. And I applaud the surgeons who will not operate on active smokers.

Tuesday, September 8, 2009

sudden death

Yesterday a person running the Virginia Beach half marathon (13 miles) collapsed and died. He was 23 years old and the cause of death is not yet known. In fact, his death is being investigated by the city's homicide division. He collapsed in front of EMS workers but died anyway.

The most common reason for sudden death is heart related. I do not know what caused the above persons death. I can tell you that heart related incidents occur about every 33 seconds and heart related deaths occur once per minute, in the US. As there are people running in every state, every day, one or two of those deaths is bound to happen to a runner.

The heart is a muscle and it pumps because of electrical stimulation. When something disrupts that circuitry the heart loses its ability to pump, blood doesn't go anywhere and within four to six minutes a person will die. You may have heard this term on TV, a patient goes into V fib or ventricular fibrillation. The heart muscle is fluttering. My dad died of that. He had underlying heart disease as do most people who die of sudden cardiac death.

There are specific things that cause this, like blood clots and inflammation as well hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy has been explained here before and is usually the reason behind the sudden death of young athletes.

Something else to consider about deaths at running and other sports events is the individual persons training and fitness history. We do have cases of weekend warriors whose bodies are not ready for these strenuous events and thus have adverse outcomes.

Heart disease is the number one killer in this country. Sometimes a person dies of a heart attack after doing every thing right to prevent one. Most of the time a person who dies of a heart attack did not.

BTW, a friend of mine told about her aunt today. Her aunt is in the hospital receiving treatment for a mild heart attack. Her aunt did not seek immediate medical attention, in fact, she sought it only after threats from her daughter. Speaking as a daughter of a heart attack victim.. very good advice there! Anyways, the point is that the aunt did not realize that the unexplained and peculiar pain in her jaw and neck was a sign of a heart attack.

more info on different heart conditions can be found here:

Sunday, September 6, 2009

Odds and Ends

Protect Your Feet: Ever notice people’s feet when they are wearing sandals? Well, you will now. Some people have very smooth looking feet while others have white looking dry skin, especially at their heels, layers of it really. I first began to notice this some years back and quickly changed my routine to prevent such an outcome for me. My Mom had always told me to apply lotion after a shower and I have done so, for years and years. I used to not apply it to the bottom of my feet, but as I said, once I noticed how bad feet could look, I made sure to go from face to feet with my lotion, EVERY day. Here is a tip for you. Have a bottle of lotion by your bed and apply to feet at night. Make this a routine, like brushing your teeth. Trust me on this one. Actually, you should trust me on all of this!

What People Will Say: I was out and about doing my paid job this week when an older person, a hospital volunteer actually, said quite loudly to me, “You are so little. What are you a zero?” I replied that I was, but only because they make clothes bigger than they used to so that heavy people don’t feel so bad. But her question, which didn’t really offend me, begs this question, “Why is that okay to ask?” Had she seen an overly large person would she have said, “You are SO big, what are you a 24?” Likely not.

Pfizer’s Trickle Down Effect: I didn’t think of this until my Mom mentioned it to me as we strolled along the beautiful Florida gulf beach this weekend. When Pfizer was at its most aggressive marketing and drug promoting, it often brought health care professionals to restaurants or brought food from restaurants to the hospitals and clinics. My mother said that some waitresses or cooks really began to rely on the 25 dollar tips and that since then some have actually had trouble paying their bills. I absolutely think Pfizer should pay up the 2.3 billion in settlement fees, but this shows how much of a ripple effect the behavior of one company can have.

Joints and Exercise: I heard a report on NPR this past Friday that supports previous research that the use of our bodies is a protective factor against arthritis. And again, injury of knees or ankles and such are the biggest cause of later life arthritis. IN other words, highly active people, even life long runners, do not develop arthritis from activity unless they have had injuries in certain joints. You can read about it here:

My last odds and ends have to do with some foods I recently saw advertised. The first I have noted before, OJ. I cannot find the ad online but suffice it to say, OJ is not the best way to get the nutrients that an orange offers because the juice is concentrated and thus high in sugar or fructose and low in fiber.

Things get worse from there. The other two food items that I became aware of this week are from IHOP and Bob Evans. I saw a mention of the IHOP NFL promotion of AFC and NFC stuffed French toast in the WSJ. The bit in the paper just noted that there was a 50 cent price difference between the two. IHOP’s website notes that it is their classic stuffed French toast but shaped like a foot ball and served either over some strawberry or blueberry concoction, not fresh fruit. IHOP doesn’t say, but other websites state that the meal has about 1500 calories, not counting orange juice (kidding). That is just about my entire calorie need for the day!

And lastly, I saw a commercial for a Bob Evans dish. I knew it was bad before I even looked it up. It is called a knife and fork sandwich. There are several varieties but I saw the ad for the meatloaf one. This is what I saw; meatloaf with a slice of cheese, on top of mashed potatoes, on top of a thick slice of bread, covered in gravy. That comes in at 820 calories and 37 grams of fat.$$TemplateforNutritionals?OpenForm&category=SANDWICHES

Oh and I should add this last thing that I heard. Frito Lay has decided to put MORE chips in its bags.

All this being said; who is it that thinks that the food and restaurant industries are going to voluntarily make their items healthier? And who doesn’t think having calorie info on the menu when you order is a good idea?

I believe this post might last two days with tomorrow being Labor Day so enjoy your picnic and remember those not cheeseburger salads on You Tube.

Saturday, September 5, 2009

A Rose by Any Other Name

If Roses were called broccoli, would they still make us smile and blush when we were presented with them? I do not know the answer to that, but I can tell you that broccoli and other cruciferous and green leafy vegetables are the roses for our hearts and arteries.

It has been long recommended that we eat our vegetables. In doing so, we will have less chance of heart disease and cancer. A new study from London attempts to explain why.

Now this is a real deviation from my usual reports on epidemiological studies on nutrition. (studies regarding what populations do and the effects those behaviors have on their health)
This study involves mice taking a chemical basically. It was a lab experiment.

Some scientists believe that a chemical in broccoli called sulforaphane turns on a protective protein in our bodies that can reduce fatty plaque build up in our arteries (atherosclerosis).

The study that comes out of the Imperial College of London did the exact opposite of what I say people should do. Instead of the mice eating "broccoli" they were fed a purified form of sulforaphane that must have been synthesized some how. In the animal studies the protective protein, called Nrf2 was indeed activated. The scientists will now try giving the mice with hardened and clogged arteries the same chemical as it appears in broccoli.

It is said that if this does not have the same positive effect, the recommendation will be that people take sulforaphane in pills. OMG.. did I just say that on my blog?

Actually, the news article I read did not mention anything about drugs that reduce plaque buildup but other websites and articles note that the broccoli chemical worked as well as prescription statins, now that IS newsworthy!

BTW, this is a good reason that restaurants should offer sides of broccoli to our children instead of cucumbers and celery... which are really low in nutrients. Oh, but parents, be careful, just because they steam it doesn't mean they don't add butter. Ask and Decline!

Friday, September 4, 2009

Support from the NFL

Today I want to give a shout out to an NFLer who really doesn't get a lot of good press. The reason he gets kudos from me and on my health promotion site is because he is a big man who eats a whole lot of calories and does a lot of physical activity, including a very serious weight training routine, but still chooses to eat healthy to get his calories. In fact, he orders his food in much the same manner as I, and that, from a 6 foot 3 inch 223 pound man, is something to share with the world!

Terrel Owens, a wide receiver for the Buffalo Bills was featured in a WSJ article on "What's Your Workout" this week. In discussing his diet, or what he eats on a regular basis, he spoke of lean proteins such as chicken, grilled fish, low fat yogurt and egg whites. He is quoted as saying that he eats five to six small meals a day, hello, just like ME! He also eats whole wheat pasta and steamed or raw vegetables. When he gets a salad at a restaurant he tells them to hold the bacon and cheese, JUST LIKE ME!

If he is going to be on the road a lot, though, he brings a chef along who can prepare him healthy meals. I am my own chef, but he could hire me. He also avoids sweets. Oh and one of the best things he said is that he no longer drinks protein shakes or really any kind of liquid calories, preferring to eat real food to get the protein that he needs. Man oh Man.. he just validated years of what I have been saying.. Cool Beans.

If I ever get to do a community based obesity intervention and he stops pissing every body off, he can be my celebrity spokesperson!

Thursday, September 3, 2009

Pfizer Pays

In my paid work, I address (educate) health care professionals, students and groups of persons interested in the field of tobacco treatment. Because of this, I learned about FDA approval processes and guides for using medications. In my presentations, on some level or another, I explain that a medicine becomes available for use through a process that involves applications to the FDA, lab tests on animals and experiments on humans, phase I, II and III clinical trials, panel recommendations and final FDA approval. The FDA approval will be for a certain indication and whatever that indication is, is what the drug company can market and promote the medicine to treat. You have heard me say this here, but again, this is FDA approved use or first line use.

(As an aside, drug companies do have to create a drug to treat a condition that no other drug treats, or treat a condition more effectively than an existing drug, or do the same as an existing drug, but with less side effects, etc)

Once a drug is approved for a condition, the drug company can do its promotion, its commercials and such, for that FDA approved purpose. IF it turns out that the drug also treats another condition or one of its side effects is something beneficial to people without the disease condition, a physician can CHOOSE to prescribe that drug for an off label use. Legally.

A company cannot blatantly market the drug nor offhandedly promote it for any other use. This includes spending money on doctors and nurses with gifts and meals, handing out samples and mentioning that Geodon(antipsychotic) might also work on children, or Bextra ( NSAID like Vioxx)is good for a sprained ankle, or Lyrica (for epilepsy) helps with pain. Pfizer has just pleaded guilty to illegally marketing Bextra for acute pain and for promoting at least Geodon and Lyrica for off label uses. They have to pay 2.3 billion in settlement costs.

I was witness to these events. Drug reps from Pfizer came to the hospital with gifts and suggestions, they hosted dinners for interns and certain Attendings appeared to be educating others on these off label uses. I know that we prescribed Lyrica to treat pain, which was legit, but I don’t know how we figured out to try it. I myself was given samples of Bextra to take for an acute running injury, which was an off label use.

Pfizer is being watched more closely as this is the third time it has had to settle in court for such behavior. It is on a 5 year special scrutiny list and a reporting system is being set up so that clinicians can report when they feel a Pfizer rep was inappropriate. There were 13 drugs involved in this particular case

Wednesday, September 2, 2009

Lessons from Bears

Bears are getting ready for winter. Some bears are showing up in people's houses, breaking into their cars and rummaging through their trash. Bears are getting aggressive in their pre hibernation efforts, especially in Colorado. People have been told for years, not to feed the bears, but have not listened. Now people in some Colorado towns are being beseeched to scare the bears away.. yell, throw rocks, call the police, but do NOT encourage the foraging beasts.

Here are some things to be learned from the experience of Coloradans :

1) Processed foods that people eat are high in fat and calories
2) Berries, nuts and plants are low in both
3) To gain weight for the winter's rest, bears consume about 20,000 calories a day
4) It is easier and more efficient to eat the foods found in cars, trash and kitchens, then to eat hours and hours and hours of plant based foods
5) If you do not want to gain layers upon layers of fat like bears do, then eat the plant based diet!

Tuesday, September 1, 2009

Again with the Water

Seriously, I will be brief.

In a recent blog post I shared my story about addressing the fact that my tap water did not taste okay.

I ended up buying a pitcher that has a water filter in it and several people commented that they had done the same thing and were very happy with their choice.

I want to suggest that you do it too or something similar and refrain from buying actual single serving bottles of water. The main reason is the effect that plastic has on our environment, other reasons include the cost, the fact that it is, at times, just tap or public water that someone else put in a bottle and lastly, because they are heavy and you could hurt yourselves and your backs lifting those cases of water!

I do not feel as strongly about water bottles in vending machines, because I think we should have a healthy alternative to soda, and I am not 100% against the companies that sell bottled water. Many have reduced the amount of plastic in them.

I will say that US sales of bottled water, not counting Walmart, was over 7 billion last year. And that is down several percent.

I bring this all up today because there is a bit of a price war going and the cost of the 24 packs has come down from six bucks to three bucks and the companies are trying to get you to buy, buy, buy... I hope that you won't. The companies have also said that they are just cutting the prices because of the recession and because people are drinking their own tap water. Some of the reduced sales are due to people like you, I hope, who have taken the concern about our environment seriously. According to a WSJ article I read today, the Coca Cola, Pepsi, and Nestle cos, etc all plan to pump those prices right back up as soon as we start making more money again.