Saturday, October 31, 2009

Medical Testing Monopoly?

Most women refer to their annual cervical cancer screening as their Pap test. IN fact, most of us are no longer having the traditional test that was created just after the Second World War. We are instead being tested with the Thin Prep. The main difference between the two tests appears to be how they are read in the lab. Also, the sample taken from the woman for the ThinPrep can also be used to test for human papillomavirus or HPV, but a second sample would be needed if the traditional test was used.

The problem is that the new test is much more expensive to use and not more effective in detecting precancerous cells. Many labs in the US have stopped accepting the traditional test samples because it is more difficult to examine them, forcing many providers to use the newer, more expensive, but not more effective test. This is unfortunate but what’s worse is what the medical director of the company that makes the newer test had to say in an USA Today interview. And oh do let me quote Mr. (doctor) E. Evantash, “I’m not sure cost was such a great consideration in this country.” Dr. Evantash works for Hologic. And his statement is just what one would expect in a country where medical testing is OUT OF CONTROL and a health care crisis looms.

The newer test is said to be used 70% of the time in the USA. The National Cancer Institute still endorses the older test, which is actually called the Papanicolaou test (that has to have been someone’s name) and a study now released from some Dutch scientists supports that the less expensive test is still a good buy. The Dutch government has been far more reluctant to switch to the new test because of a lack of evidence, but it is allowed for use in Holland. Our NCI notes that research on the two tests has not yet told us if one of them prevents more deaths from cervical cancer than the other, which is of course, a good measure of a tests worth!

It is not clear why our FDA allows Hologic to market their product as better at detecting the abnormal cells, it has to say that or else we wouldn’t NEED another test would we.

But here is a question for you… Which test puts the woman at the most discomfort? I searched for that answer and found that the procedure used to collect the cells is the same for both tests. I don’t know which test I had recently, but according to Mr. Hologic – only 10% of the US market is for the traditional test. I bet that makes his stock holders happy, eh? The stocks, BTW, sell for around 15 bucks each.

BTW, the Pap part comes from the developer’s name, but the smear part comes from the smearing of the cells on a slide to be viewed under a microscope. Both tests collect the cells the same way and smear them on a slide, so as I said at the beginning, the difference really is in the lab.

I wrote about this because I am always questioning the HPV vaccine promotion as I believe most ardently in the Pap test for prevention of cervical cancer. I had no idea that there was competition in the test market as well. I believe I am going to become cynical. And yet, PLEASE women, if you are or have been sexually active, an annual or every three year test is recommended. Check with your doc for specifics.

Friday, October 30, 2009


After reviewing research, comments of experts in physical activity and sports and considering my own history, I am going to choose a side on the "to stretch or not to stretch" debate. Actually, it is less definitive. I am taking a side on whether or not stretching is significantly important to prevent injury. It is not.

There has been debate for probably ten years or more on whether or not stretching is helpful or even if it could be harmful The most current research and my opinion belie the common wisdom regarding stretching. Instead consider the following:

Warming up is protective and can simply involve doing leg swings or arm circles or walking. Stretching out a cramp may be helpful, but bouncing is never recommended and static holds that exceed 20 seconds are not necessary and could be harmful. Regardless of length of time, one should never feel pain when stretching.

The best thing to do to prevent injuries is to strength train. The muscles, joints and ligaments become healthy and strong when one follows the ACSM/DHHS/AHA recommendations of twice a week resistance training. This involves lifting weights, or using ones own weight for resistance training. Some fitness centers offer group classes in resistance training. Also I have 8 exercise videos posted on YouTube that are on muscle toning and strength.

Now as a very wise friend told me recently, people who use their bodies on a regular basis, according to physical activity guidelines, no less, are GOING TO pull or strain muscles from time to time. Better to work out now and have a sore muscle from time to time than to not work out and become non ambulatory at age 70.

So do your aerobic exercise, warm up your muscles and limbs and follow a strength training program. When you do stretch keep it short, do not bounce and do not induce pain. [gymnasts and dancers may have different requirements, this is more for runners, swimmers and cyclists and the rest of us]

More about this can be found in a recent USA Today article by Janice Lloyd.

Thursday, October 29, 2009

Change of Plans

First I was going to write about the fact that there are TWO different Pap tests, or cervical cancer screening tests... but I haven't finished reading about them... So I was going to write about research into the benefits of stretching, which are limited.....but THEN I heard the news - local Florida news, and so I will write something very simple tonight instead:

Creating jobs and improving the economy is NOT justification for harming the environment. I am aghast that someone would even say such a thing out loud.
(of course it has to do with oil)

[tomorrow I will write about one of the above mentioned topics!]

Wednesday, October 28, 2009

Curry in the Lab and Kitchen

Curcumin is in turmeric which is in curry. Obviously then, curry is a spice blend, not an herb itself. Scientists in Ireland have recently completed an in-lab study of how this spice compound affects esophageal cancer cells. Cells communicate in intricate fashion to either multiply, or die. The scientists found that this compound did not trigger the usual suicide message but in some other fashion, led to the destruction of the cancer cells. More study will follow.

Esophageal cancer is not our number one cancer but it is a lethal one.
World wide it is one of the top ten new cancers and cancer killers but not in developed countries, though it makes the top ten list for cancer deaths in men (#9). It is not on the top ten at all in the USA. Still, it is a lethal cancer.

Most persons who have tumors will die within five years. The main risks for esophageal cancer can be reviewed on the National Cancer Institute website. It is laudable that the information found there includes a distinction between solid evidence and fair evidence. It is also important to know that there are two distinct forms of esophageal cancer and the risks for them are not the same. One is a squamous cell cancer and the other an adenocarcinoma.

There is solid evidence that the squamous cell type is caused by smoking and alcohol use and that eating a diet high in cruciferous vegetables (fibrous) can reduce the risk of this cancer. For the adenocarcinoma, the evidence for risk is less strong. There is some association between GERD and this cancer though it is not known if surgical treatment of GERD would decrease the risk. Protective factors are not offered, however, in my past study of GERD, it was learned that preventing symptoms was imperative as those symptoms, i.e. burning in stomach and chest area, were signs of gastric fluid back up and the fluids are caustic.

Hard for this lay person to explain squamous cell carcinoma and adenocarcinoma though it comes up with several cancers. Basically a squamous cell is a thin flat cell and cancer can begin there. It can be squamous cell carcinoma (SCC) it situ or in place, or invasive, meaning it spreads outside of the original location. I believe that squamous cells are in tissues and skin. Adenocarcinoma involves the tissues in our glandular organs, or organs that secrete mucus or other fluids. Again, this is to the best of my understanding. Many cancers can take either form.

(Help from NCI, Wikipedia, the American Cancer Society and Medical Dictionary)

All this being said – I wanted to share a video recipe of an AWESOME curry infused dish. Enjoy.

Tuesday, October 27, 2009

Eat Them F&Vs

There is an organization whose members are weight loss professionals and researchers. The organization is called the Obesity Society. The annual meeting is this week and some of the topics were recently discussed in a USA Today article.

The gist of the presentation was the need for kids to eat more fruits and vegetables, with more of the later, and how to make that happen.

It goes back to something I said some blog posts back – a twist on the “don’t buy it and they won’t eat it” philosophy my mother likes to promote. (she doesn’t follow it, but she promotes it)

I am the “bring the healthy food and they WILL eat it” girl and that is what the researchers were saying at this conference. If we give our kids fruits and vegetables they will eat them. They may not like all of them, but they are much more likely to eat them if they are in front of them. (ya think? )

I have already let you know that there are recommendations for policy in regards to getting more produce into our school lunch programs. This article reminds us of something else. If you want your kids to eat healthy you best do the same.

And here is my last thought for the day. We (the government, states, and people) can SAVE billions of dollars by preventing obesity. They (pharmaceutical and diet product companies) can MAKE billions treating obesity. Wonder who has the most incentive and the most start up money.

Monday, October 26, 2009

What not to do for Menopause

I have not experienced menopause. I cannot begin to know how severe my symptoms will be nor how well I will tolerate them. I do not expect that I would take any hormone replacement as evidence exists to discourage that practice. I have read research on some alternative medicines or herbals and the results did not convince me of efficacy, safety or purity in those products. I am imagining that I will have to find ways to cope much in the way that women did long before the condition was named and treated. What I am pretty certain about, however, is that I will not look to Suzanne Sommers for my medical advice.

Ms. Sommers, of Three’s Company fame, uses pills and creams that are categorized as the undefined “bioidenticals” (meaning there is no real definition for that term). In other words, the substances are compounds of “natural” products that are supposed to mimic the bodies own hormones. Well respected medical organizations and the FDA have spoken out against any compounding, as it’s called. This includes ACOG and the AMA. (American College of Obstetricians and Gynecologists and the American Medical Association)

In an article from AP writer M. Marchione it was said that the women most likely to use “bioidenticals” which may be as harmful as traditional HRT, are well educated, affluent, professionals. WHAT? Well, one reason is clearly cost. They can afford it. Another given was that they do a lot of research into alternative treatments (me too, I call it prevention) and they believe that if it is natural it will not cause harm. That last part really dropped my jaw. I expected that college educated women would be aware that natural does not mean safe. The words are not synonymous for heaven’s sake. Natural means natural, simple as that. In fact, it is simple in nature but not in commerce because there isn’t a legal food or product definition for “natural”, other than the broad expectation that it be minimally processed. But I digress.

There are things that occur naturally that are plainly lethal. Radon gases anyone? Ok, how about mushrooms? Ever have blowfish for dinner?

There is no scientific evidence that any of the alternatives offered for menopause are safe or effective. That being said, a headline just this morning is accusing the FDA of not doing its job to make sure our pharmaceuticals are safe and effective either, so my best advice, (which can’t apply to menopause unfortunately) is don’t get SICK and my second best advice is do your research before you adopt a treatment method. NO ONE cares more about your body and your health then YOU and it is about time we all figure that out and do our homework.

Sunday, October 25, 2009

Odds and Ends

Another week has passed, hard to believe. And for sure this time I did jot down a few notes to revisit today. In brief, here they are:

Muffins: This should be the outrage of the week. I have been kicking myself since I bought them, but I had been looking... I cannot remember the company now, but one makes a 1oo calorie pack blueberry muffin and it isn't Hostess, which makes a lot of the 100 calorie cupcakes. I keep thinking it is Bird something.. any way. I have seen these Little Bites products from Entenmann's but they are not low calorie. I then saw that they did have the Little Bites in 100 calorie packs. I tried to see how many muffins were in a package, but the box did not tell. I bought the chocolate chip and was DISMAYED I tell you, this big plastic bag with two muffins in it. Crazy! And I couldn't figure out why my zucchini and pumpkin mini muffins have so many less calories.. Seriously, mine have 15 0r 20 and these had 50. The Hostess cupcakes have just under 35. I looked at the Lite Little Bites label and saw fructose and other sugary words, some fat and just a bunch of crap. Shame on me for buying them. I want to throw them away, but that shames me too. Blah.

Walden Farms: This near calorie free product line that I often reference in my You Tube videos
offers dips, dressings and syrups for under 5 calories a serving size. I have found them at Food Lion stores in the south, in Publix Markets in Florida and now in Super Target! Wow. Oh and at Richard's Whole Foods. The Target is new, and they were a few cents cheaper than the grocery stores I mentioned. Would love to see them at Wal-Mart where I see all kinds of blog worthy behavior if nothing else. (I cannot believe what people feed their families.)

Inhalers: Some people with COPD or Chronic Obstructive Pulmonary Disease (AKA smoker's lung, smoker's cough) are prescribed inhalers. COPD is an irreversible condition and includes the debilitating respiratory illness, emphysema. These inhalers can help a person to breath better by relaxing the lungs to some extent. They work best when one does not CONTINUE to smoke. My nearest apartment neighbors are smokers. When leaving for work one day this week, I saw an inhaler in their window sill.

Soy: A report on a recently completed research study came across my desk this week. It indicates that some soy supplementation can improve bone health. I have not vetted the study and I nearly always shy away from supplements. I do use soy flour in my recipes from time to time. My baked goods usually have three flours, well, whole wheat flour and oat bran and then another flour, like millet or quinoa OR soy. After seeing that study, I will use SOY as the third ingredient on a regular basis. My no knead bread and muffins and dessert cake can all be made with soy. BTW, those damn mini muffins, no whole grain flours in them. Dratz, I cannot believe "Your Health Educator" fell for that.

NFL: Well, the NYG are about to play the Sunday Night Football prime time game and so, let me say, the NFL is supporting physical activity in children with this promo , "Play 60." Please check this out. The goal is to get all children active for at least 60 minutes a day.. continuously active...

Saturday, October 24, 2009

Food Packages too?

Ah dear, I had so much hope.

A few years ago, the smart spot or smart choices label made its debut. This green circle with a check mark in it was supposed to alert consumers to healthy products.

In fact, during my internship at the local health department I did research on what items might be considered healthy enough for such a label and then reviewed the vending machine wholesale options to find foods that would meet this standardand and get that special label. The vending machines do currently have said labels. Again, WE used a particular criteria.

It is a very good concept and I continue to support it. At the same time, I understand the concern of the FDA and others in that the lable is being misused by some food companies, AND there are additional labels out there adding to the confusion and misinformation.

The label is used to denote low calorie products and often non TFA foods, but what is happening now has happened before - sugar is getting promoted, inadvertently. A snack that is only 100 calories but also only sugar, is really not GOOD for you. Empty calories are never health promoting. However, calorie and sugar moderation are very good things!

The FDA is now considering making some statement on the standards that should drive these labels and I have read that some manufacturers have recently pulled back from using the smart choices label until further guidance is offered. That makes sense.

In the meantime, do let me encourage you to visit the Alliance for a Healthier Generation, a joint effort between the AHA and the Clinton Foundation.

Here you can find specific guidelines for healthy food and beverages for yourself and your children. And as always, read the label - don't let a symbol stop you from reading the label!

Also, I have been seeing this one lately, No High Fructose Corn Syrup. That is surely a good sign. It is also a sign of progress that this is an issue at all.

Friday, October 23, 2009

Big Pharna Eats em Up

When you get a notion about something, you tend to stay on alert for any article that will support or debunk that notion. I have recently been expressing my thoughts on how Big Pharma is similar to Big Tobacco. Well, even I am surprised at how true my presumption appears to be. This was supported a few days ago by a headline regarding one big pharmaceutical company buying another. In fact, two companies have bought companies that were pretty big themselves and the profits for Big Pharma appear to be pretty consistent, just like tobacco.

Merck bought Schering- Plough and Pfizer bought Wyeth. That would put Merck against Pfizer and GlaxoSmithKline. Also this week, the FDA noted that the labels on many drugs were misleading and did not tell consumers the whole story.

Now I have cautioned you about commercials that tell you a drug or product or DIET PROGRAM was clinically tested, as that doesn't tell you anything, and I have also warned you about ads that say that people on a diet, for example, lost more weight than people not on it, because if it wasn't statistically significant, than it could be related to chance. But even pharmaceutical companies are guilty according to doctors speaking in the New England Journal of Medicine. One example they give is telling people that the drug is more effective than placebo. Ok, it is better than nothing. Is it better enough to change a disease outcome?

Why does this make me think of Big Tobacco?
Altria Group owns Philip Morris USA, maker of many top selling cigarettes, including Marlboro and Virginia Slims and US Smokeless Tobacco, AND John Middleton, which sells cigars and pipe tobacco. Philip Morris International sells some of the same brands of cigarettes abroad and has additional country specific brands, PLUS they just bought Swedish Match South Africa which sells smokeless tobacco and snus, Reynolds American owns RJ Reynolds which sells five of the top ten cigarette brands, including my old favorite, Winston as well as Conwood Co LLC which is the second largest smokeless tobacco company and sells roll your own tobacco and a company called Sante Fe which sells the American Spirit brand.

I don't think I need to tell you how fraudulent and unscrupulous their tobacco advertising has been.

So yeah, these are behemoths of companies with billions of dollars in revenue and people either desperate for the medication they sell to treat illnesses many times self perpetuated and people desperate for a product that they are addicted to and which is leading them down the road to having to rely on Big Pharma to get off the stuff or to stay alive or both.

Cynicism is on the menu tonight - sorry

Thursday, October 22, 2009

Neighborhoods and Wellness

Okay. This appears to be a no brainer but you can never be too sure, I guess. I read an article about a study that was begun in the year 2000 and finished by around 2007. I did not go to the study itself where I imagine some of my questions might be answered.

The study was of diabetes incidence in persons based on their access to walkable communities and fresh foods. It was recently published in the Archives of Internal Medicine.

The news article from Reuters tells us that people who live in health promoting neighborhoods have more than a third less chance of getting diabetes than those who do not. They defined these neighborhoods as better if they have access to fruits and vegetables, good transportation, parks and sidewalks.

That stopped me right there. I wondered if they did some type of prospective study over many years or if they did an experiment and randomly placed people in a “good” versus “bad” environment. (They did neither)

I don’t doubt that the finding is true, sort of. If you live in an area where healthy (fresh) food is available and opportunity for physical activity exists, you MAY eat better and exercise, thus reducing your chance of getting diabetes. But there is more to it than just having it there. People have to believe that eating well and exercising will benefit THEM and that they have the ability to eat well and exercise. It isn’t as simple as the article makes it sound.

But the beef I have with the researchers is more important. The article tells me that the scientists received baseline info from the subjects, including anthropometric data (weight, BP, blood sugar, etc) and their current intake of fruits and veggies and their exercise levels. The study lasted five years and the persons were questioned three additional times. At they end they compared disease outcomes with the data they collected.

My issue is that the three TEST neighborhoods (20 minutes from the person’s home) were different of course, but they should not have been apples to oranges different. The areas were Baltimore MD, the Bronx NY and Forsyth County, NC. So they compared a city, a borough and a county. Weird.

Upshot. Yes neighborhoods matter and access to healthy foods and safe physical activity could reduce the number of obese and diabetic persons in said community.

Wednesday, October 21, 2009

Mercury and Blood Pressure?

There are a few topics that I became attached to during grad school. They recur in the blog so you may already have a guess as to some of them. They include tanning, mercury (from coal) and fish, Gardasil, colon cancer and the environment. So when I see research on these subjects I usually take a look.

I read about a link between mercury and blood pressure in Medscape today. The research article is actually published in the journal, Hypertension. I have been concerned about mercury ingestion by way of fish and how it would impact someones neurological function, as mercury is a neurotoxin.

Mercury or environmental mercury, gets in our food chain when it is emitted from coal fired power plants, leached from coal ash and also from the degrading of products that contain mercury (like some light bulbs, batteries, medical supplies). Bacteria and algae transform inorganic mercury into this methyl mercury.

From my past posts and my linked presentation on mercury and fish, you may be aware of the concern for the amount of mercury in certain types of marine life. We are cautioned to avoid the bigger fish, the predator fish, such as swordfish, shark, tuna (not light canned), tilefish, marlin and more.

We also hear that eating fish can be good for us, especially fish high in omega 3s. The fish listed above are not necessarily high in the good stuff, but are certainly high in the bad.

I learned two things I had not expected in the article today. One is that in the study subjects, there was a significant increase (it was small, but the difference was statistically significant as to support a cause and effect relationship) in systolic or top blood pressure number with regard to amount of mercury in the blood. Scientists believe that the mercury leads to inflammation and inflammation is a marker of heart disease.

The scientists also took other anthropometric measures (measures of the human body, like weight, blood pressure, pulse, etc). They found that of all the weight measures - BMI , waist circumference and WHR - explained in previous posts- a persons waist circumference was most accurate in identifying who would have high blood pressure.

So do eat fish, but watch which kind and don't deep fry it!

Tuesday, October 20, 2009

Gym Intimidation

Not everyone belongs to a gym. You certainly do not NEED to belong to one in order to engage in a well rounded physical activity program. If you choose to join one however, you would want to get the most out of it, yes?

My most recent fitness center history would be four or more years at Fitness For Her in North Carolina and then a year or so at Fitness 2000, a coed gym, and then several years not going to a gym at all, but working out at home. My time at Fitness For Her included my becoming a personal training and an aerobics teacher. I can remember my first days at both gyms, but only if I stop to really think about it. My more readily available memories are ones of feeling very comfortable, competent and fit.

Now I have joined another gym and I REMEMBER the intimidation factor. Because I spend so much of my time encouraging others to be active, I have spent some recent time exploring my feelings while at the gym, especially this evening.

First I think it doesn't really matter if it is a co ed facility or a same sex one, the feelings of self consciousness and the development of cliques are a factor. Sometimes I think that for men the intimidation is more internal and for women it is both what we tell ourselves and the vibes we get externally. Women (some women), from my female perspective, seem to be more purposefully unwelcoming.

It does us no good however to walk around gyms feeling bad about ourselves, especially when a good workout can boost endorphins and other feel good chemicals so that you are not only burning calories and toning muscles, but improving your mental health.

There are plenty of warm and helpful people at fitness centers, so keep your eye open for them. Sometimes we are the ones that look unapproachable. Also arm yourself with competence. Do pay 40 dollars for a workout routine. Make sure that includes instruction on exactly HOW to use the equipment and to execute the moves. Three months later, pay for a new workout. Also you can use this website
and you can view some of my at home exercises on You Tube. You can do them at the gym too. (I didn't renew my certifications, but I still remember how to work muscles!)

Try out the classes as well. The spin class awkwardness is mostly about how to position the bike. The instructor will certainly help you, but I have found people in spin classes to be a little less frightening than people at weight machines or aerobic classes.

Even with a weight training background, I was intimidated by the muscle strengthening area, but I had the staff show me enough that I can walk over there and do my routine with confidence (it waivers to be sure) that I am doing my exercises correctly. (also you can find out which are the most popular weight training times and go at off times until you are more secure)

But it is the aerobics classes that really led me to write this tonight.

Some are just crazy new to me, like Zumba. Zumba is pretty awesome but my little classical ballet body has so much trouble loosening UP that I want to cover my face somehow. Hmmm, take the class in disguise, yeah... that's the ticket. But I don't and I don't run away. Most of the women wear these little skirt like wraps with lots of jingling things on them... I guess they are a clique, but they aren't too stand offish. The "jazz" dance class is just HARD, but I love it because it reminds me of my youth. There are some VERY good dancers and then a whole lot who aren't and I am neither great nor horrible.

Oh but things have changed because now the guys are not just at the bench press and free weights, but the treadmills, ellipticals and DANCE classes. There are even guys in the step classes.

Ah the step classes. I have noticed that there is a definite group there that is downright huffy in their hoity toity ness - how is that spelled really? Anyways, I have noticed this group recently. Two men and about four women. I don't like them. I don't like snobby people. I don't really dislike them, but you know what I mean.

Well, there they were tonight all grouped together near to me. I guess I must be encroaching. This step class is harder than the other one (there are two a week). They come to both, but not the dance class. This afternoon as we waited for class to begin, I made small talk with a few ladies. That took a while also (striking up a conversation), but they were just as nice as I hope people think I am. Then the class started and I thought, I am going to pay very close attention to this teacher. I am going to get these steps right tonight. (I primed myself for success you know)

So I did, I got it. I got every combination this week. This is like my fourth class with this teacher and I have to admit, HIS stuff is pretty complicated. Well, we did the routine many times and I'll be darned if most of the cliquey people couldn't get it. Now they are a clique that thinks they are better than everyone, so this was just the cat's meow for me. The more they messed up the more I concentrated on doing it right and I was smiling SO BIG when I left the gym that I had to come home and tell you!

So get out there, it'll be OK.

Monday, October 19, 2009

Cholesterol is Better On then In


Exactly. In a popular magazine article about skin care, I read that though water was a great hydrator for the body, it was not what one should turn to for acute dry skin issues. The benefits of sufficient water intake are numerous, but include proper care for our vital organs and assistance with digestion. And without water, we will die.

I know from my work in health care that the skin can be used as a test for dehydration. Doctors or nurses may pinch the skin on a person's forearm and watch to see if the skin goes immediately back in place or puckers for a moment. Go ahead, try a little pinch on your arm....

Being dehydrated and having dry skin however, are a little different. In the article I read, it was suggested that the best care for skin was a moisturizing lotion BUT the better lotions have fatty acids, even cholesterol, in them. Apparently, (and a bit of Internet research confirmed this) we have surface lipid on our skin (lipid is a fat - including triglycerides and cholesterol) and if it is depleted, the lotions can help replenish. It was also said that this lotion based cholesterol would not enter our blood stream - so that is cool.

Look at your labels, of course cocoa butter contains lipids as do lotions with stearic acid, or probably any "acid" words. There are oils in plants, plant sterols are lipids, but also know that some come from animals (esp. most stearic acid), so if you are a vegan, you might watch out for your lotions. I am guessing that "not tested on animals" doesn't mean they weren't made from animals.. eek.

I found something positive to say about triglycerides and cholesterol.... but no where did I read that trans fatty acids were essential to good skin, so they are still EVIL.

By the way, other environmental factors can effect ones skin. These include sun, wind, cigarette smoke and even hot water. (in the winter it is possible to bathe every other day and still keep your friends - unless you are getting your daily moderate to vigorous exercise and sweating alot)

Sunday, October 18, 2009

Statement of Intent

Statement of Purpose, Intent, Disclaimer

Hello. As you may know, my name is Deirdre. I am a health educator and I have a great passion for promoting behavior that can increase the odds of healthy active aging. I have been writing about wellness for almost ten years and recently incorporated videos on cooking and exercise into my program. As my blog and You Tube channel are growing and comments are increasing, I realize it is time for a statement of purpose, intent and liability.

First my credentials: My education is in child development, social work, gerontology, public health and tobacco. I have a master’s degree in public health and am a certified health education specialist. I am also a certified tobacco treatment specialist and have a certification for physical activity in public health from the ACSM. Additionally, I received a certificate on Health Promotion from the esteemed Cooper Institute in Dallas Tx. My additional training includes specialties on exercise, nutrition, and obesity prevention.(Note: in December 2013 I received my doctorate degree in Public Health)

I am NOT a nutritionist. I am qualified and capable of providing information on health, fitness, diet and tobacco cessation to broad audiences but am not licensed to give individual nutrition advice.

All of my research based information is still going to have my own slant to it and I take no personal responsibility or liability for what you choose to do or NOT do based on my content and links.

A special note for my food videos: they are for the specific purpose of teaching the volumetrics approach. Volumetrics involves choosing low energy dense (ED) foods over high ED foods and though penned by Dr. Barbara Rolls, it is being promoted by many nutrition professionals.

I promote calorie awareness. I advocate for nutrition labels on menus and vending machines. Please know that I focus on calories in the videos because of this belief and not for calorie micromanagement. (I do not endorse dieting or calorie restriction)

I cannot guarantee that a healthy lifestyle will prevent a specific disease, only that research supports that people who eat a mostly plant based diet, exercise daily and don’t smoke are much less likely to be obese and much less likely to have diabetes, heart disease or cancer.
Personally, I am a little extreme. It works for me and to be clear, that’s about ME.
So please read, learn, process and do what is best for YOU.  (updated March 27, 2014)

This information is presented in video format as well.

Saturday, October 17, 2009

A Crock...

I was not sure what I would write today until I saw an advertisement in a magazine I read during breakfast. The ad was for several products from GNC, a so called health and wellness store. One product boasted not only increased calorie burn but rigorous clinical trials to attest to this claim. According to the ad and website, people who take this supplement (and the ingredients are not listed in the magazine or website, so I guess you have to go to the store to read the label) burn more calories before, during and after exercise. [ you know that I diligently searched for the actual research study - nowhere to be found ]

The ad states that it was a double blind randomized placebo controlled study, that of course is what we would hope for, HOWEVER, one test of 25 people does not equal RIGOROUS scientific study. For goodness sakes - yes, we are all so desperate to find these quick and painless cures that we don't apprise ourselves of the small print. The ad also does not say if the difference was statistically significant... and you know why... because it CAN"T be if there were only 25 people.

Supplements can contain any number of fillers and can contain any amount of whatever ingredient the scientists think caused this increase calorie burn. I.e. they are not safe nor guaranteed pure. If you think I am perhaps being too cautious, just remember this.

Obesity and weight loss are BIG BUSINESS, billions of dollars will be made when someone figures out how to give us the metabolism of birds or Olympic runners... if a clinical trial proved something effective, it would NOT be buried in the pages of Real Simple magazine.

Friday, October 16, 2009

Prostate Cancer Discrimination

Today’s post seems to leave me and will leave you, with more questions than answers, but at the least it will raise your awareness and perhaps encourage you to seek answers.

I am reviewing some mini grant proposals at my day job. We fund local programs that use community health workers to take messages of health promotion and disease prevention to the medically underserved. Today I reviewed one about prostate cancer. It was a great proposal, and in the rationale for the program the grant seeker noted that there was a disparity in prostate cancer risk and mortality for black men.

While at work I looked up the statistic and found that MORE than double the rate of blacks then whites had the cancer. I could not find that same statistic these evening, I am not sure why. (but just now I did find this link from the CDC and it shows the great disparity)

I was intrigued by the information I found tonight as well. As all the research I have reported here to date has been involving the controversy of the PSA test. What I keep reading is that the test’s value is questionable because most men die of other causes before that cancer can progress and kill them. Few cases are aggressive and debilitating and the screening may find them early and save lives, but often the screens find benign growths and the treatment is more disabling than the disease. That is what I always read.

To find the information about black men, and this is world wide not just black men in the USA, you have to look specifically for it. It shouldn’t be that way.

Here is what I found from the American Cancer Society. Both blacks and whites and males and females die most from lung cancer which is responsible for about 30% of all cancers. Next for men of both races is prostate cancer and for both races of women it is breast. Here the disparity shows, 9% for white men and 12% for black. For women and breast cancer it is 15 for whites and 19 for blacks. (but this is later data then above, so maybe the gap has closed a bit)

I found several research articles and the hypothesis is that there may be some hormonal difference that triggers a gene expression or more aggressive form of both the prostate and breast cancer diseases. Black men are being screened and black men have heard the message that they are at greater risk than whites.

I guess my biggest question was why they die of a cancer that is not supposed to be that aggressive and after reviewing the research I think I am not the only one that doesn’t know the answer. If however, the cancer is more aggressive and PSA tests will find it and black men will improve their outcomes from treatment, then in them it may be a more valid test.

BTW, the ACS has some 2009 data projections on its website and lung cancer cases incidence (new cases) is actually going DOWN, it is being displaced in the top seat by the two cancers mentioned today while colon cancer, another killer of both sexes and races, is third. We can thank the tobacco control experts for that lung cancer decline. It takes 20 or more years for lung cancer rates to rise in countries after cigarettes are introduced. We had a nationwide smoking rate of about 42% in 1964 and it is down to 19% nationwide today. No matter the cancer, being a tobacco user will increase a persons risk of getting and dying from it.

here is the overall chart for both races from the ACS

Thursday, October 15, 2009


This morning I heard about a study from UCLA which I have not personally reviewed. The preliminary findings are far from scientific conclusion, but they give us something to think about and the rationale offered does make sense.

The study involved the brains of normal weight, overweight and obese persons. The initial study was small, only 94 persons, but an additional 200 were scanned to see if the findings would be repeated. Unfortunately, the outcome was the same.

This research like other new research, offers us a hypothesis to test and risk factors to explore but not a conclusion. Ah, you want me to get to the point don’t you? I hesitate because it is a scary outcome for a very common ailment and if it is substantiated with further research we could be in for a heap of trouble and despair.

The subjects underwent brain scans, likely PET scans and these scans were studied for brain tissue loss, or shrinkage. This shrinkage or brain degeneration is a hallmark of memory loss, cognition problems and diagnosis of dementia, including Alzheimer’s Disease.

Indeed there was degeneration in both overweight and obese person’s brains as compared to the normal weight subjects. The initial findings were showed substantial loss. The overweight brains were 8 years older than should be and the obese persons 16. I believe that it was said that as much as 8% of brain matter was lost and that a 10% loss was a marker for dementia.

Alzheimer’s specialists note that it is not a surprising finding as they have long suspected that lifestyle is related to disease onset. Also it was said that one reason for the degeneration could be a lack of oxygenated blood flow to the brain due to plaque buildup in ones arteries.

Take home message. A healthy diet and weight as well as exercise can improve or maintain both heart and brain health. And again, this is why weight control is NOT about physical attractiveness, it is a measure of disease probability not beauty. I have many beautiful overweight friends, their weight isn’t making them any more or less beautiful, but it is making them less healthy.

Wednesday, October 14, 2009

Day Care?

The popular press article I read today was written by Lauran Neergaard from the AP. I have read her before and she doesn't write about junk science so I didn't personally review the research and statements that she noted.

The issue was childhood obesity, no news there. This time though, the weight control experts are talking about intervening at the preschool level and in daycare centers where as many as 75% of this (USA) country's 2-5 year olds spend some part of their day. Experts are now advocating for earlier intervention because even by elementary school it can be too late. Remember that obese children often turn into obese adults and obesity can significantly shorten life expectancy while also raising health care costs for everyone.

When tobacco control experts began targeting youth in the late 1980s early 90s, we went to the high schools. Now the intervention targets middle school aged kids, so in this way, the two causes seem similar. And to repeat a statement I use often in my trainings, "It is so much easier to never start smoking than it is to quit."

It is so much easier to NOT become overweight than it is to LOSE weight.

I applaud these new ideas, even as the notion of "20% of 4 year olds being obese" drops my jaw. Surely that research is flawed. And then, if over 30% of adults are obese and they usually had weight problems as children... well...

The recommendations are sound, positive, feasible. Some are calling for actual mandates to be written into the Child Nutrition Act when it is renewed this year. But did you ever think that we would have to TELL child care workers the following:

Start providing calorie smart menus, with low energy density foods - LOW fat milk (1% or fat free IN daycare!)
Provide 60 minutes of exercise and another 60 minutes of free active play
Do not let the kids sit at an activity longer than 30 minutes
Teach kids about FOOD and that a colorful plate is a healthy plate
No sugar sweetened beverages (ZERO)
No more than 6 ounces of 100% fruit juice per day

We cannot feed our kids junk food, tell them to be still and then expect them to be normal weight healthy adults. Ain't going to happen. I would be thrilled to be a part of this new wave of obesity prevention.

Tuesday, October 13, 2009

Not So Positive

Heard on NPR today:

Is positive thinking a problem? On this afternoon's show (3pm Florida time), an author spoke about her book Brightsided and her experience while being treated for breast cancer. I did not catch all of the show but heard a bit from the guest and some of the callers. Most of the discussion was about cancer and specifically breast cancer but overall it was a statement against reframing life circumstances to the better. For example, NOT forcing oneself to make lemonade out of lemons. The book author does not promote negativism mind you, but realism.

Ouch! This is the very opposite of my practice and preaching. Some people expressed the view that there is a forced sense of "be cheerful and look at the bright side" when dealing with hard life events - like cancer diagnosis and treatment. The show also referenced all this PINK business and being a survivor and fighting battles. In other words, not everybody believes that is the right way to go.

I hadn't looked at it that way, so here is the other side.

For me, I still like reframing things to the positive.

Monday, October 12, 2009

Disease Mongoring

Bother, bother, there are not enough hours in the day!

Today I am going to make a mention regarding the treatment of osteopenia based on an article I read in the online journal BMJ. I want to highlight a couple of statements from the research that was conducted by scientists who are also health care practitioners, in Spain. This article was published last year.

In a recent blog post I discussed an ACSM article that explained different ways of promoting bone health and tailoring fitness programs to the clients stage of life. The article did cover osteopenia and osteoporosis. In the latter, careful attention is paid to preventing falls.

The number one risk factor for fracture is NOT osteoporosis, but falling. That being said, balance and core strengthening activities are always warranted.

The authors of the BMJ article offer some points to ponder. Their concern is one of disease mongering. Interesting term that! What they refer to is taking a risk factor, and calling it a disease. Once it is a “disease” it should be treated, yes? They say that the purpose is to market tests and drugs to persons with this risk factor. My my my. That could cover a lot couldn’t it? And we see it happen here every day and it may also be one of the reasons our health care costs are out of control.

Other conditions mentioned in this article are pre hypertension and pre diabetes. They call this being at risk for being at risk. For example, people with hypertension are at risk for a stroke while prehypertensive persons are at risk for hypertension which would THEN put them at risk for a stroke. And there has to be a cut off somewhere right. 120 over 80 is normal… 140 over 80 or 90 is treated with meds, well what about 130 over 80?

A study group of the World Health Organization which these authors refer to as small and not uninfluenced created a measure for bone health. They determined an average number for healthy younger women and decided that any standard deviation 2.5 below that, was osteoporosis and between 1 and 2.5 degrees was osteopenia – or a risk for getting osteoporosis. It is also noted that the measurement scale was meant for disease evaluation of populations (epidemiology) not individual risks. The score in other words should not be the determinant for treatment.

Drugs like Fosomax are absolutely advertised to women who do not have osteoporosis and fear messages are used by drug and device companies. Many doctors suggest that women who are very thin or post menopausal have a DEXA scan to measure their bone density for example and if the person is pre osteoporotic then medications are dolled out.

The drugs do seem to help with true osteoporosis, but the research that supports use in women who are at risk for it was not conducting independently. Drug companies used existing data, the same data that these researchers reviewed.

In their opinion, the risk of osteoporosis and fracture is over emphasized, the benefits of the drugs are not as great as consumers are led to believe and the risks of side effects are GREATER than we are led to believe. The authors stated that osteopenia is said to affect half of the white post menopausal women in the USA. Quite a money maker that would be. Basically, for these women, they would be taking an expensive medication that has side effects, which might reduce the risk of a fracture IF they fall down. I say, don’t fall down! Well, and eat wisely, exercise often and don’t smoke.

Again, this isn’t just about osteopenia, but about health care, pharmaceutical companies and diagnostic labs.

Be mindful now and see what other disease mongering and “medicalising” is taking place in our society. In fact, why don’t you see how many NEW diseases you can list that developed in the last ten years? Here is a start – RLS (gotta have a catchy abbreviation) or Restless Leg Syndrome, and Fibromyalgia. Not weighing in here, just saying that they are NEW diseases.

I expect that my brother in law is going to be thinking about cholesterol lowering medications because cholesterol numbers are another set that keep being revised down.

oops and now MNF!

Sunday, October 11, 2009

Odds and Ends

The first O&E is an odd that should be ended! A product called, Cholest Off. It is not a medicine but falls in the very broad, not well defined and NOT regulated supplement category. The problem is that these products are not under FDA guidance and do not have to be proven effective. They of course have to meet some level of safety, but not the same level as medications. If the makers falsely advertise them or undeclared items are found in them, or people start having problems, then the FDA can do a cease and desist order. I do not know a thing about this product. I just heard the commercial and almost threw something at the TV. If you want to keep yourself from getting high cholesterol and do not have a significant family history of it, watch what you eat. If you want to treat high cholesterol, exercise and watch what you eat. If your cholesterol level is putting you at risk for atherosclerosis and subsequent cardiovascular events, talk to your physician about a medicine that has been proven effective in rigorous clinical trials. And THEN, get the generic version.

We had a guest speaker at work this week and he was from the county waste management and green business department. It was actually a very good presentation. The most important message being that we cannot just recycle everything and think that is enough. The mantra is really reduce, reuse and THEN recycle. Reduce for example, by buying a water filter jug and not water bottles. Reuse, by not buying new disposable plastic wear every week, but using the ones you have again and again ( I reuse my plastic baggies). Finally, recycle plastic, glass, aluminum, cardboard etc. Different cities, counties and states have different rules on what is recyclable and it is often related to the “market”. Some places pay for plastics numbered 1-7 while others only 1 and 2, etc. One of the biggest waste makers that I have become more in tune to as I mature are CARS. We do not need a new car because there is a new model out there. Appliances may be similar. When both have more environmentally friendly versions it makes more sense to recycle or remove your version. The gentleman who spoke to us also showed pictures of and explained our landfills. Landfills are very different from dumps and though burying things in the ground disturbs my senses, they are least are doing in with a great deal of engineering and environmentally protective measures. Oh and lastly, there are three reasons why plastic bottles should NOT be capped when recycled. One is that the cap plastic is often not worth any money, two the caps can get stuck in the machines and three, when the bottles are squished; the caps can be lethal (well disfiguring) projectiles. Oops, one more. I did not know this, but cereal boxes are NOT recyclable.

Do you fish for the answers that you want? I had a voice mail message this week from someone who had attended a tobacco education class of mine. The caller said that she had spoken to several people and read a few things regarding the E Cigarette and was still trying to determine if the product was safe or not. She decided to call me because she thought if anyone would know, it would be me. Right indeed! I called her back and explained that the product had not been tested for safety before being marketed and that recently there had been some reports of human toxins being found in the e cigarette vapor. Of course not all E Cigarettes are the same so whether or not the one you buy has ethylene (or diethylene) glycol or other substances is not a certainty. The FDA is currently investigating. My advice to the caller was NOT to use the product. If she was interested in quitting smoking, then nicotine replacement therapies that had been vetted were available. She was more interested in using the product long term, instead of smoking. She argued around me as I spoke until I finally told her that she could keep calling people if she wanted to, but the answer is, the product is not proven safe. She was very much looking for someone to tell her it was and kept trying to rationalize the danger away.

Oh and my favorite for the ends of the odds and ends! Gym memberships are cost effective! This bit of info did NOT come from the DHHS or CDC or anyone interested in you joining their gym or getting your BMI down. It came from a financial program on Fox or CNN over the weekend. The financial advisor stated that people who are overweight spend 1500 dollars more per year than those who are not and that gym memberships generally cost less than half that, per year. Sweet news!

and NOW - SNF -Sunday Night Football

Saturday, October 10, 2009


Alrighty then. The question tonight is whether or not I should explain the research study or just cut to the chase. The conscientious part of me won't allow the bottom line without at least a little back ground, so here goes.

I read a study from the American Journal of Epidemiology regarding whether or not Intense Domestic Physical Activity, or IDPA was protective against all cause mortality and or cardiovascular related events or death. CVD related events being a heart attack and CVD death being a fatal heart attack, etc. To the best of my knowledge, cerebral vascular events or disease is a sub category. This involves strokes. A CVD event could then be a heart attack or a stroke as well as a complication of congestive heart failure or angina. This is all involving blood vessels, arteries etc.

The study I reviewed is from Scotland where they too have a prospective research study going on. Theirs is aptly titled, the Scottish Health Study. The research involved questionnaires, biometric measurements, and matching disease and death outcomes. I can tell you that the report that I read included details about the inclusion and exclusion of participants, the variables that were controlled for and the statistical analysis program that was used. The program was one that I had to learn about in Grad school. All this being said, I feel that the outcome or conclusion of the cross sectional survey of 1995, 1998 and 2003 is valid and worth highlighting.

We have heard in the USA as they have heard in the UK, physical activity is important and can be health promoting and disease preventing. Some health pundits emphasize the benefits of every day activity and go as far as to imply that house hold chores can provide the same benefits as say brisk walking, running, step aerobics, sports and cycling. The scientists from several UK universities used the existing data to test that hypothesis.

First you should know what they considered to be IDPA. Intense domestic activity includes walking or cycling as a means of transport, stair climbing as an activity of daily living, gardening and heavy housework like scrubbing floors and cleaning windows or do it yourself activities like gardening, raking, shoveling snow, digging, building, etc as compared to leisure time sports activities of cycling, swimming, aerobics, football, raquet ball, etc. The scientists looked at type as well as duration and frequency.

The upshot is this: Being more physically active than other people is a good thing! The people who did any intense domestic activity weekly did have a lower rate of death from any cause. The IDPA did NOT protect against cardiovascular events or deaths however. It appears that the IDPA is not moderate to vigorous enough to improve heart function and cardiovascular health. The scientists think that many of the activities associated with domestics engages smaller muscles and does not significantly raise heart rate. Many of the activities are done in place for example. Still, they also saw a difference between walking to the store (not preventing heart disease) and walking at pace (is protective) for exercise.

The take home message: Be as physically active as you can be and ALSO get some exercise - :)

Here is a reference for the study:

American Journal of Epidemiology 2009 169(10):1191-1200; doi:10.1093/aje/kwp042

Friday, October 9, 2009

Training Error add on

Later tonight when I would usually be composing my post, I will be attending one of the dance performances at the Ringling International Arts Festival in Sarasota Florida. Instead of writing at 11 or not writing at all, I thought I would just do a short bit about an AHA moment I had sometime after I posted on over training and over use injury in youth. Also, I am currently reading a research article about the benefits of IDPA - any idea? Okay I will tell you, Intense Domestic Physical Activity. I look forward to telling you more about that one tomorrow.

So here is my little light bulb from the other day. When people like me are sports specific and have to stop that activity for some reason, most of us want to stay as in shape as possible and will cross train. This is recommended, as I have said before, but here is the thing. If someone is a cyclist and has to stop cycling for some reason or length of time, and they jump in the pool and swim at the same LEVEL of intensity and duration as they did CYCLING they are going to have an injury because that is a training error! I believe that is what I did when I took a spin class and an aerobics class a couple months ago. I didn't approach the classes like the newbie I was, but like the runner I am. Well, that didn't go so well. I was so frustrated about pulling more muscles, but now I see, as my sister would say......."whoops". Actually she says it different than that, but you don't really need that back story! :)

Last night a coworker and I took a dance class at the gym. I DID hold back and so, we are both very sore this morning, in unusual places! but we are not injured. Gotta pay your dues, can't start at the high end. Got that! I sure do.

Until tomorrow then. Go do something fun....

Thursday, October 8, 2009

Managed Care

There has been a lot in the news about health care and how to reform or improve it. It can seem like the only issue is whether or not everyone gets insurance, but there are many more issues within the various proposals. Unfortunately, a poll released by some organization today, indicates that we, the citizens, don't really care about this right now.

Yesterday I received a letter from my insurance company and today I heard about a Medicare beneficiary multi state study on NPR. Those two things prompted tonight's thoughts, which are:

In the health care reform battlefield, commercials are launched that present management of services, tests, medicines and the like as a bad thing. I have NEVER thought that case management, especially from the physician's office, is a bad thing. I had reservations about managed care from insurance companies, but have become more understanding of the need for this.

My insurance company just sent out a letter to say that starting next month certain things, like MRIs, would have to have prior authorization for payment. The research discussed on NPR discussed fragmentation of care and how that does not improve health outcomes, and could worsen them.

With fragmented care, a person with a symptom may be sent to several different specialists who see the patient for just the one problem, order tests and prescribe meds and no one sees the whole patient and the whole picture. I DO want someone to care about the whole of me. I want that person to be my primary car doctor and I want him to have time and compensation enough TO care.

I don't mind that my insurance company wants in on this management. I want to preserve health care dollars myself. I do believe that we are over tested and over prescribed.

And you know, I don't think there is really any more that I need to say. Oh except this one thing, we already have people deciding which tests to order and medicines to prescribe.. they do not always do so with the best interest of the patient in mind. I am bothered by the scare tactics in some of the anti reform ads in this regard.

Wednesday, October 7, 2009

Too MUCH Physical Activity?

WHAT?! Is that possible? Would I ever say so? Well, this little post regards over training in our children and adolescents. Ah so, the rarety of maladies as lack of activity is by far the greater problem.

Still, there is enough of a concern as to warrant several pages of text in a recent ACSM journal. The article discusses over reaching, over training, over use injury, burnout, compensation, acute fatigue, adequate and inadequate recovery and training error.

There are some children who are very active in school sports and train very hard for them. There is concern that parents, coaches and inner competition can lead to over training without ample time for recovery. Some controversy exists also as to the benefit of sport specific activities for younger athletes. No official guidelines exist but some suggest no more than 5 days of training in a row, with a complete rest day from organized sports. Others say that special medical monitoring should occur if children are spending more than 18 hours a week involved in these sports activities. It isn't only interscholastic sports however, there has been about a 50% increase in gym membership for those under the age of 18, since 1990. Obviously, all youth is not at the gym, the latest number is about 4 million enrolled.

So what do you need to know? Over reaching can be a technique that improves performance. It is a period of intense training that causes acute fatigue but is followed by adequate recovery (the body compensates and comes back stronger) . This is sometimes referred to as a taper. This is seen in some marathon training programs for example. Over training starts the same, but there is not adequate recovery. Over training can lead to negative attitude, loss of pleasure in the activity and most seriously, an over use injury. Over training is also called burnout.

Over use injuries can be caused by bio mechanics, history of previous injury, lack of conditioning, improper foot wear, and training error. However, training error is the main cause of most.

Training error is either too much for too long OR too much too soon. I.e. some are fit and train too hard and some begin training when they are in poor condition and train too hard.

Sometimes when athletes young or old are driven, from within or without, they think off days are lost days, but it is far from true. The body needs that day off to compensate, to rebuild and restore. I have read many an Olympian quote in my Runners World magazine which promote the sanctity of the rest day.

Tuesday, October 6, 2009

Drug Abuse

As a tobacco treatment "specialist" I concentrate much of my drug research or research review, on nicotine. I have been keeping my eye out for any news on the nicotine vaccine research I came across late last year or was it early this year... wow.. it is all a blur. Anyway, a newstory came out today regarding a COCAINE vaccine and in that story I did get a little update on my nicotine vaccine, but here's more>

What do we know about the actions of these drugs and treatment to assist the addicted?

Cocaine, Heroine and Nicotine - because they are not the same.

To the best of my comprehension, I share this:

Cocaine acts in the brain my inhibiting dopamine reuptake. Cocaine binds to the chemicals that cause the reuptake and thus blocks the re absorption of dopamine. The user feels that happy high as the neurons continue to be stimulated. The same occurs with the neurotransmitters serotonin and nor epinephrine.

Nicotine acts in the reward center of the brain too, but it does not prevent re uptake of neurotransmitters (NT). Nicotine actually binds directly to a certain kind of receptor and turns it on, releasing seven different NTs including dopamine.

Heroine is a bit different. It is an opioid and when it gets to the brain it is changed to morphine which attaches to opioid receptors that release endorphins. Apparently, morphine mimics endorphins which can help us to feel happy and to reduce pain. Again, the heroine causes this indirectly.

It seems that only nicotine is doing the direct receptor binding.

Anyways, heroine addicts can be given regularly scheduled long term methadone which many believe is a better option than the unpredictable and dangerous highs and lows from the street drug. There are over 1200 Methadone clinics in the US.

Nicotine addicts are given nicotine replacement therapy for less time than heroine addicts get methadone. To the best of my knowledge, cocaine users get help with detox and behavioral treatment but there is no FDA approved medication treatment for cocaine addiction.

The proposed vaccine for both cocaine and nicotine aims to keep the drugs from ever reaching the brain. It is in the brain that the dopamine is manipulated and the reward system high jacked, so theoretically, keeping the drug out of there would prevent any euphoria or positive association and thus cancel out the addictive process. I am hopeful for both.

I am sure you're wondering but I cannot explain as confidently - alcohol. I know that alcohol is a central nervous system depressant and that it also has a neuro chemical effect. It does interrupt regular neurotransmitter actions, but I do not know if it binds to receptors, inhibits them, weakens, them or all of the above. I only know that there is some safe level of alcohol use, but no save level for the other drugs mentioned here.

Monday, October 5, 2009

when Brief Really Means Brief

Here is a brief word on something that we probably did not need a research study to determine.

Wearing high heeled or no heeled shoes over time can lead to foot pain that can limit your activity in later life…. AND … this condition is more common in women than men.

I remember telling you recently that researchers can review long term data from prospective studies and manipulate the information for associations for diseases and conditions that may not have been the original focus of the study. This information was delineated from the very famous Framingham Study.

One out of four people who wore these types of shoes had some foot pain in the ankle, Achilles or heel. Researchers have determined that it is better to wear shoes like tennis or athletic shoes most of the time. They also recommended that people who do wear the other type engage in some foot strengthening and stretching program.

Sunday, October 4, 2009

Odds and Ends

Okay, just a few closers for the week.

The first I think I may have already covered.

Gardasil: This vaccine, one of two found effective, is used to prevent some strains of the human papillomavirus which can lead to cervical cancer which is detected through the Pap smear, for females. I believe my intention was to note that of the 26 million doses administered there have been nearly 16000 reports of adverse events. The adverse events are usually non life threatening (93%) but there have been 44 deaths. We cannot know for sure what caused the deaths, but when a death does occur after a vaccine and it is reported to VAERS even if causality has not been determined, it is counted. Other serious adverse events include the GBS I noted recently and blood clots. I did not make a note of this because I intended to scare people away from Gardasil, but because I had wanted to contrast it against Cervarix and Chantix. I have to say, I cannot find the same type of simple data for Chantix as it is not a vaccine. This is just the odds and ends post so I think I will look into that later. Cervarix has been discussed.

Breast Cancer: Earlier in the week I talked about preventing a second occurrence of breast cancer and that the most common second case was a distant metastasis. Because I had studied that and you read it, you might not be surprised by a rather sad and startling statistic I read later in the week. Numbers aside, the issue was a significant percentage of women who had had a mastectomy because of a tumor in one breast then had the other breast (disease free) removed. The article discussed how this had no impact on long term survival. And you know why.

Also this is Breast Cancer Awareness month. Get your mammogram if you are a woman over 40 or if you have a reason to have it sooner. Did you notice that the NFL is in support of breast cancer awareness and research? Look for pink shoes, wrist bands and the like during the games this month.

Slender Life: Okay just please tell me you won’t do this. Lose 20 inches in one hour. Find 20 inches in the next 24.

Natural and Organic: There may be some benefit in choosing foods that are organic and natural though research isn’t really backing that up. What I do want to bring to your conscious thought is this: A natural or organic food is not necessarily a LOW calorie or safe or healthy food. Read your labels.

Conservation, etc: I do not recall the news program, but some pundit was going on about how saving energy or switching fuels was going to cost more money and take more time and was quite plainly inconvenient. YES and losing weight and having good health are hard work... what seems to be the problem here? Sacrifice, people. It’s the new in thing!

Two friends, readers even! Alerted me to valuable links this week:
This one is so that you can see the health reform agendas or platforms, of which there are several, yourself -
This link can aid you in protecting YOURSELF from adverse events due to medication interactions -

Saturday, October 3, 2009

Botox Indeed

Allergan, maker of Botox, is involved in a little bit of a role reversal in regards the practice of off label use of its product. (off label is a used not approved by the FDA, but legal – as long as the drug maker does not market the drug for said off label use)

Most people have heard of Botox and know that it is used for a wrinkle treatment (scary as that is). The FDA has approved Botox for other conditions as well and these include eye twitching and being cross eyed, muscle spasms in the head and neck area and profuse sweating.

Botox is made from a bacteria and it is toxic even in small doses. It is used as a medicine however in even smaller doses. It is not without risk, in fact, the FDA just this year ordered not only a label change but specific education to physician’s about dosing and that though there are four marketed products, the dosing of each is DIFFERENT and that needs to be clearly explained to prescribing clinicians.

The odd twist is that after the FDA made this “order” to Allergan, Allergan sued them in order to be able to market the product to doctors for off label use! They feel that they need to tell the physicians how to use the product for other conditions so that off label use will be safe and effective. Well, if they KNOW that stuff, they must have some clinical data, some trials they completed , so why not apply to the FDA for the new uses!

I am confused though because the fuss seems to be over using the medicine or toxin, for treating muscle spasm. It is approved for cervical dystonia which is a muscle spasm condition, but of the head and neck area. I know that one use Allergan wants to market and explain is for muscle spasms in kids. On the Internet, I found reference to off label uses for neck and back pain as well as migraines.

Lord heaven, I cannot imagine any condition that would lead me to have botulinum toxin injected into my body. And if you detect bias in my post today, well you have very good comprehension skills!

Friday, October 2, 2009


I am way over my head in trying to read, understand and repeat this information on screening and surveillance for colorectal cancer or CRC also known more commonly as colon cancer. The cancer itself can affect the colon, rectum and appendix. In the reading, I was tripped up by the term proximal colon cancer and proximal neoplasms or adenomas. Proximal means distant and the neoplasms and adenomas are lesions or tumors that are not yet cancerous and may never be cancerous, but which part of the colon is the distant part? I thought it might mean distant from where the endoscope was searching. The colon, as you may remember from school, is huge. It has many sections. It has five sections and apparently the descending and redundant sections would be the proximal or distant ones.

Why the heck does that matter? Because many tests, i.e. the ones that might be the least intimidating, risky and expensive, don't find proximal polyps or abnormal growths, i.e these neoplasms and adenomas that can turn into cancer.

There is good reason to believe (research) that removing precancerous lesions can prevent CRC which according to D. Lieberman in Medscape is the second cancer killer in North America. I am going to imagine that Lung Cancer is the first.

Guidelines for screening (who, what and when) and surveillance (how often) have been established by the US Preventative Services Task Force and a combo group of the American Cancer Society, Multi-Society Task Force on CRC and the American College of Radiology. These two guidelines have some agreement and disagreement.

Unfortunately, at this time, the most effective at recognizing the adenomas throughout the colon area is the colonoscopy. The newest imaging test, computed tomographic colonography is pretty good at finding larger lesions or 10mm ones but there is no way to then remove them without scheduling another appointment and another bowel prep. There was also some concern about different clinicians reading the scans differently. But the biggest thing that I noted in reading what the guidelines offered as an area of uncertainty with this test was this:

Radiation exposure could increase the risk of developing cancer.. and some countries will not allow imaging for screening purposes. (see - and that is why I am against CT scans of the lungs as a screening tool)

There are fecal occult tests as well, but they do not find polyps and there is a lot of belief in the health community that removing polyps is protective.

I learned today that men are likely to get CRC sooner than women and that blacks of both sexes have a higher risk at younger ages. Though the recommendation for all persons for screening is now age 50, it could be said that blacks have their first one at 45 and women (white) at 55 or 60. However, the experts are afraid that multiple age dates will cause an overall drop in screening.

How often to test if negative is a debatable 10 years (10, 5, 0r 3 years if polyps found and removed) and when to stop testing is also in question, but some recommend stopping at 75 if there have been no symptoms over the years and at 85 even if there have been symptoms.

So there you have it. Get screened. At least the colonoscopy is done with sedation and I was recently told by a friend that she doesn't remember the procedure at all.

For prevention, avoid red and processed meats, consume a plant based diet, don't smoke , exercise and maintain a healthy weight. You know, same old same old!

Thursday, October 1, 2009

Serious Adverse Events

I have waited long enough to tell you the scary headline and the resolution at the same time. We have been talking about vaccines a bit lately as they have been in the news. In a few recent posts I introduced and explained the second HPV vaccine that has been proven effective and safe in clinical studies, Cervarix.

It was due to be reviewed by our FDA this past Tuesday, however that has been delayed. In the meantime, Cervarix has been in use in the UK for at least a year when the National Health Services began offering it to teen age girls. It is reported that 1.4 million doses have been administered. (in contrast, in the USA over 20 million doses of Gardasil have been released)

Earlier this week a young girl died within hours of receiving her first Cervarix dose. The vaccines were stopped momentarily but within days we learned that the girl had a malignant tumor on her heart and lungs that caused her death. The programs have resumed.

Cervarix appears to be as embedded in Europe as Gardasil is in the USA. Interestingly, a very recent posting on the FDA website notes over 15000 adverse event reports for Gardasil. Very few are considered serious, but 48 deaths occurred sometime after a person received the shot.

I wonder why we hear so much more about Chantix adverse events than Gardasil?