Wednesday, March 31, 2010
The issues are colon cancer screening and radiation from medical testing.
I am very concerned about exposure to radiation and do not believe that we should submit ourselves to a CT scan every time something hurts nor do I think that CT scans or x rays should be used as preventative devices or screening tools. This has long been my stance – five years at least.
It has only been in the past year however that the concern about use of radiation and the adverse consequences – cancer- has been gaining momentum. The FDA has been called upon to look into this matter, especially after the incidents of acute radiation poisoning that occurred in California this past year. The FDA began an exploratory review this week. As I have said before, of great concern is the frequency of scans that occur over a lifespan. The current under age 30 population has had and will have a lot more access to this type of radiation than the over 60 population. Because the scans begin earlier, are used more often and are used over lifetimes, the risk of cancer (and that cancer does not occur immediately after an Xray, but often in the next decade) is significant. We do not have time to wait until our children are middle aged and terminally ill before addressing the issue. The FDA can weigh the evidence and make a statement with regard to the use of CT scan and other medical radiation.
As you know, the FDA has to approve medications and medical devices. They usually convene expert panels to review a new product and then take those recommendations into consideration when making a final decision. After which, that medicine or device can be used as a clinician sees fit, but can only be advertised or marketed to treat what the FDA approved it to treat or test. I had known this, but had not made the same “off label” connection in my mind when it comes to devices.
This brings me to the second issue. Colon or colorectal cancer is one that can be prevented if polyps that might turn cancerous are found and removed. The gold standard for this screening is the colonoscopy. In case you haven’t heard, that involves being sedated while a tiny camera searches your colon or intestines – the day before your test you are told to drink a beverage referred to as bowel prep – in other words, you clean yourself out. The day before is said to be worse than the procedure itself. The colonoscopy is generally recommended at age 50. Enter the virtual colonoscopy – I have described it elsewhere. I have been vocal in my hopes that the virtual colonoscopy or something like it will be perfected and accepted for use prior to my 50th birthday. I have, in my explanation of it, promoted it – in a way. but for the small fact that it involves a CT scan.
Back to the story. The FDA began addressing the radiation issue as a former FDA employee spoke out about his job loss possibly related to his refusal to go along with a recommendation for the CT scanner to be used for colon cancer screening. The device maker would be the one asking for the new FDA approval so that they could begin marketing the machine for this test. Dr. Julian Nicholas has been vocal in his concern that the amount of radiation that people are exposed to is NOT an acceptable amount. He contends that we certainly do not need to add another source, especially because we have an accurate test for this condition that does not use ANY radiation. He has also stated that 1.5 to 2% of all cancers are related to CT scanning. I was pretty shocked because in reading the story, it seemed that the manufacturer of the device had been putting a lot of pressure on the FDA in general, to get it approved.
I expect that we will hear more about radiation in medical testing as the year progresses and the scientists, under additional scrutiny for possible industry ties and bias, look into the matter.
At this time, I do want to clarify that I would NOT take the virtual colonoscopy over the standard version unless it did not involve any radiation.
Also, I have spoken out against airport scanners and tanning beds, but not laser therapy. Why would I? I am not sure, but when I was at a “spa” to get a message, I saw a sign on a door behind which people were getting laser hair removal and the sign warned of radiation! So I have to look into that one.
The FDA does have information on all devices that emit radiation and I invite you to check it out. I have to say that I was unaware of the link until today and am just fascinated by all the different devices that emit radiation. Click on some of the tabs when you go to this site. There are tables that divide the products by use and by radiation type. You can learn about risks and benefits of each procedure as well. I have forgotten about cell phones, but they are here. Also you can find information on laser therapy and laser lights, like in an electronic pointer. Tanning beds and MRI machines are also on the list. In fact, I noticed that ultrasounds were listed as well and that made me wonder if the traditional colonoscopy did expose us to some amount of radiation. I still am unclear – in that I do not know what is used to see the “movie” during the colonoscopy. However, the ultrasound machines use non ionizing radiation which is not the kind linked to cancer. Of course, in light of what Dr. Nicholas was offering today, I can’t be confident that the safety information provided here is trustworthy.
Tuesday, March 30, 2010
I have lauded Senator Charles Grassley in the past and continue to see this man as a friend to consumers of medicine. He was instrumental in starting the conversation about the influence of drug companies on prescribers and patients. Because of his efforts, the health care legislation will require what we in Florida call, sunshine.
There will be searchable database that allow you and I to review industry ties of our doctors. There have been rules in the past – there are rules now, but they were written in ways which allowed some abuses and led to the accusations of bias, greed and fraud.
One specialty, psychiatry, has the distinction of having more drug ties than others. The heads of both the American Psychiatric Association and the National Institute of Mental Health have come out with statements regarding their intention to end these relationships.
If you are wondering, the practices can be as simple as a free lunch, and as elaborate as tickets to a playoff game. Companies fund research for scientists and thus bring money into colleges. Scientists may have stock portfolios and use of private jets. Also, education and office materials with the name of the drug being promoted are often given free of charge to various practices.
I remember making a note of all the objects I saw with drug names during my last doctor visit.
I am not a fan of pharmaceuticals - period. Thomas Insel is the NIMH president and he has a current commentary in the Journal of the American Medical Association. JAMA does not offer free access to all its content and I cannot link it here. Dr. Insel did make a very important statement however and I was encouraged by it. He said that many times the ties that psychiatrists have with industry can lead them to prescribe name brand drugs over cheaper generic ones AND that the ties also influence treatment decisions – often preferring meds to some amount of behavioral therapy. It is nice to see that in print.
Medications, especially these new psychotropic meds that are advertised to the point of absurdity, have serious side effects. Talking to someone may be time consuming and oh yes, uncomfortable, but it will not make you fat or cause insulin resistance.
The next challenge? Get health insurance companies to cover the cost of “therapy” at the same rate they cover medicines!
Monday, March 29, 2010
In January I mentioned research that supported this assertion and in fact, suggested that even daily runners were at risk for heart disease and other health problems if they spent the rest of their hours being relatively still.
A NY Times journalist (Olivia Judson) offered a similar post in February, but she graciously ended her piece with a bibliography of several research studies. One of those studies, Role of Low Energy Expenditure and Sitting in Obesity, Metabolic Syndrome, Type 2 Diabetes, and Cardiovascular Disease. Marc T. Hamilton Deborah G. Hamilton and Theodore W. Zderic, offers insight into what exactly happens when we spend all this time on our bottoms. Ms. Judson suggests that we have 15 hours of time not spent sleeping that we can spend active or inactive.
The researchers mentioned above actually did a little reverse science. There is ample data to show what happens to us physiologically when we exercise. We know about heart rates and endorphins, oxidative stress and oxygen consumption, as well as calorie expenditure and sleep stasis – we have no doubt that physical activity, especially frequent and intense exercise – prevents disease and disability. What about the opposite? What happens on a molecular level – what happens inside our cells, tissues and organs – when we are still for extended periods of time?
As it turns out – our metabolism changes and we actually use and store sugars and fats in ways that cause harm. I like the phrase that the researchers use when discussing their study – they call it “inactivity physiology”. They admit that there is not a lot of study into this phenomena and that it is a great place to spend some research time and dollars.
Hamilton, et al offer four tenets of inactivity physiology – The first is the idea that there is a curve of wellness associated with extra physical activity. We may be at the middle (an average, fit persons) and our health improves or shifts to the right, when we exceed the 30 min of activity/day that is often recommended – but does it shift to the left if we do not even do the 30 mins? (most of us agree this has been shown to be true) . The second tenet is that the episodes of sitting and the episodes of focused physical activity have very distinct effects on our bodies. Meaning, even the most active person’s body has an adverse biological response to being still. The third tenet suggests that the adverse effects of sitting for too long are not simply the reverse of the positive effect of a 30 minute walk. That sounds like tenet two, but I think it to mean something a little different. There may be a specific way that exercise boosts HDL which does not mean that sitting just prevents higher HDL – sitting too long may affect cholesterol in a completely different – but harmful way. The fourth tenet has to do with large groups of people, or cohorts, who are aging together in this sedentary mode and the increases in heart disease, diabetes, obesity and more that will occur in large numbers. It is of vast importance to get these people moving, especially if we are talking about a cohort of third graders!
The article is a big read – you are welcome to view it here. The take home message however is this – get up and stretch or move about every hour that you are not asleep and you will reduce the negative metabolic actions that sitting too long can activate.
Sunday, March 28, 2010
FAT: I reviewed a study that I did not set aside, so you will have to trust me on this one. I hope my past use of valid resources will persuade you. With regard to heart disease risk and adverse outcomes, persons who eat little to no fat, have more heart related problems than those who consume mono and poly unsaturated fats. These fats are considered the good fats or the heart healthy ones and do include olive and canola oil as well as peanuts and peanut oils and omega three fatty acids like those found in fish, or PUFAs. Saturated fat continues to be a risk factor for atherosclerosis and heart disease. Remember however, that the good fats should be incorporated into your daily diet not just ADDED on top of whatever calories you now consume - unless you want to gain weight.
Physical Activity: A study that made press this week, and involved only women, could be somewhat overwhelming in that it calls for at least 60 minutes of physical activity a day - or 420 minutes a week instead of the 150 minutes previously promulgated. First note this - if you are a sedentary person, becoming active for any minutes on any number of days a week is going to give you a HUGE benefit. If you are however, doing the 5 days of 30 minutes and wondering if you are going to gain weight as you age, the answer is likely to be YES, unless you change things up. According to the research out of Harvard, women who are of normal weight going into middle age can avoid adding pounds with the 30 minutes of activity a day if it is vigorous (see friday's blog!) activity - this is usually described as running, swimming or cycling at a certain pace. If that intensity is too much, than 60 minutes a day is needed. Of course, if weight loss is the goal, calorie reduction AND activity increase is key. Here is the study summary.
Diabetes in China: Much of the time we consider our Western country to be the source of all evil - including, obesity and it's disease outcomes, among other things. When people emigrate to America - they eat our food and live our sedentary lifestyle becoming unhealthy just like us natives. The UK has similar problems, and they too are considered a Western country. Not long ago, I mentioned the very high rate of obesity in Mexico and this week a high rate of diabetes in China was disclosed in a NEJM study. With one out of ten adults in China diabetic, they are knocking at our door. In the USA it is just over that, perhaps 1.1 out of ten. It is all about eating high calorie foods and living low activity lives. Much of diabetes is preventable - by staying a normal weight.
Soda Sales: Yes! Soda sales have declined as have fruit and sports drinks, coffee drinks, bottled water and "supplement" water. Unfortunately energy drinks have gone up, but not by much. According to a WSJ story, the greatest bottled beverage increase ( of which energy drinks was the only other increase) was in ready to drink teas. ( I believe the analyses was only of non alcoholic beverages)
Sin Taxes: I am a supporter of taxes on alcohol, tobacco, junk food and soda. I buy alcohol. I think that these are things that we do not NEED and in some cases, things that are harmful to us. It is argued by some that raising the price of these items will dissuade people from buying them. At the same time, the money generated is used to support state and local economies - so there in lies a dilemma, doesn't it? Well, tobacco has no known identified safe use, so I think it should just be banned - and yes, the tobacco company employs many people, to which I think that they can be tapped for a new industry - perhaps biofuels. But this week I was intrigued by a legal suit in Texas where a hefty tax is levied on strip clubs. Because the politician pushing or supporting the fees stated that the establishments were associated with assaults on females, I considered that a public health issue, and thus blog appropriate. I just wonder why the article I read didn't suggest the validity or lack of - for that claim. I, at first, could care less about the clubs and the taxes, tax 'em! Or if they cause crime, close 'em! Then I have to consider that it is an industry - many people would lose jobs and income and the county - city budgets would lose revenue. It makes the politician look somewhat shallow in my opinion. If she really cared about the status of women, she would work to close the clubs, not to tax them and run a city from the profits - yes? Which does make me realize that if marijuana IS legalized anywhere this year - it is surely because of the state and local economic problems - and if it is legal and more people begin to use it - well I guess we will have to hire more cessation experts (create jobs!) because marijuana also causes lung problems and is apparently addictive. ( I seriously and strongly oppose the legalization for the same reason I oppose tobacco - health consequences. No amount of smoke inhaled into the lungs is considered safe - not from any source)
Saturday, March 27, 2010
In the video you will see my past with brussels sprouts and I have to say - I was wrong - they are delicious!
Brussels sprouts are also low calorie and contain the antioxidant lutein as well as vitamins A and K and beta carotene. Brussels sprouts are a good source of potassium with far fewer calories per gram then potatoes because they are not as starchy. They contain 3g of fiber per 100g and are a source of protein as well. Interestingly, brussels sprouts have sucrose, fructose and glucose. This is an example of a naturally occurring sugar which is NOT empty calories.
If you roast them as described above - you will keep all the good that comes naturally without adding fat from frying them. Monounsaturated fat is heart healthy, however, so you might consider drizzling a teaspoon (olive, canola, peanut oil) over your finished product!
Friday, March 26, 2010
Thursday, March 25, 2010
What the researchers did next was to take a population of women, in this case, French women, and consider the percent of those women who were, overweight/obese, who had used HRT, who drank 2+ a day and who were inactive. Each condition raised their risk for breast cancer and the quote that made the papers was that 30% of new cases could be avoided if women were lean and active.
A lot of number crunching is going on not just in the research article but with reporters - but even so....
Women have about a 12% risk of getting breast cancer and the American Cancer Society states that obesity in and of itself increases the risk of getting any cancer by 60% . I believe I have my math right when I say that an obese person would then have about a 20% risk of breast cancer.
I have breast cancer in my family. A grandmother, aunt and sister - one had a terminal or fatal case. Genetics cannot be dismissed on an individual level, but a scientist responding to this research noted that genes are not causing the increase cases, something else is and that has to be environment - or exposure to hormones and possibly toxins as well as what has been mentioned.
At the time of diagnosis, the women in my family would not have been described as lean (though none obese either) and to the best of my knowledge, none of them had a regular exercise routine. I am certainly not overweight and have not taken HRT - so I suppose I have just the 12% risk with a little extra for family history. But I have another sister and she would medically be described as obese. She also smokes. She is inactive. She is at increased risk because of this, but even if it were DOUBLE it would still be less than 25% risk. Hypothetically, she has a 75% chance of not getting breast cancer and she may not. Of course, I pray that she does not - surgery is not so safe for smokers! I use her for an example for another reason however.
There are many people who do not get a disease that they are at high risk for - smokers and lung cancer for example. That NEVER means that the risk does not exist or that the behavior is safe. It has to do with odds.
If the outcome is simply- breast cancer diagnosis - okay, but it isn't. Not having a disease does not make one fit and healthy - it does not make them well.
Regardless of the chances for specific disease outcomes, not exercising and being overweight can significantly reduce the quality of the years that you live.
The abstract of the article noted in the press and presented in Barcelona.
Wednesday, March 24, 2010
Today I am happy to note that the bill included a provision to force fast food and other restaurant chains to list calorie content of their menu items at point of ordering location. A company that has more than 20 stores is considered a chain, so your Apple Bees, Red Lobsters, TGIFridays etc – will be included.. Oh, I bet there are more than 20 Bonefish Grills – yay! This means that you have to see the total calories BEFORE you place your order. There will be places to view other nutrient information, but the calories must be “in your face.”
Yes, we did have some reports earlier this year that people didn’t always pay attention to the content information and that it wasn’t always accurate – but this is still a step in the right direction.
What I hope to see next is health communications that target the consumer and teach a skill. The skill is to understand the menu and how the numbers can impact health. This will NOT make a difference in our obesity crisis if people don’t know about calories – it would be like putting SPF numbers on all the sunscreen but not telling anyone what SPF stood for OR that sun itself was a risk factor for skin cancer.
So – we (public health folks) have a lot to do to enhance this policy, and when we do, the chefs are going to respond to the consumers need for lower calorie options and in ten or twenty years – we may reduce the prevalence of obesity in this country.
I am very excited about this – knowledge is power….
Tuesday, March 23, 2010
For my social work practice, the ecological perspective was used to assess a person’s positive and negative relationships in all their domains of functioning. From there, we used the positive relationships or connections to build self confidence and courage to either work to improve the negative ones or to sever them.
I no longer see myself as a social worker. I am a most ardent public health educator. In public health we use the ecological perspective as well. In this sense we are looking into the areas of a person’s life where behavior can be influenced. I do want to stress that word, influenced. I have learned my social work lessons well and do not hold any false perception of changing people.
With regard to either field, or any – a person teems with opportunities for impact. A few that you might think of are intrapersonal (our inner thoughts, beliefs, doubts, moods – what we say to ourselves about ourselves and about others), interpersonal (exchanges between one or more people – outside behaviors influenced by our inner selves, the others' inner selves, the context, the place), environments (home, neighborhood, local, national, geographical, etc) our institutions (school, work, church, government) or social or recreational outlays (clubs, groups, gyms, churches/synagogues/temples)… And the list can go on… and cannot leave out our social networks both in person and on line.
It is with this background that I read an article on Health Communication and Marketing found in BMC Public Health 2007, 7:88 – lead author Is Edward Maibach from GWU.
I wanted to mention some interesting concepts/constructs from the article – just the idea of them will give you fodder for contemplation.
The authors propose 5 Fields of Influence which they put into two categories. They are either People-based or Place-based. It is then suggested that health messages be targeted in various ways to these specific fields.
People – individuals, social network, population or community
Place – local level, distal level
Here is the figure as provided in the journal article –
Maibach et al. BMC Public Health 2007 7:88 doi:10.1186/1471-2458-7-88
If you look at this chart and then think about things that we need to do or not do to be healthy or injury free – you can think of how a health communication could be specifically tailored and used based on a field and ALSO that many times we have to target multiple fields at once to see a positive outcome.
Or as I have become fond of saying, we can’t just make it acceptable on the individual level but also possible on the environmental or place level.
Monday, March 22, 2010
I was reading over one of a gazillion news stories that are addressing health care reform looking for the pieces that are going to affect prevention - when I saw this... and I am paraphrasing -
Expect new taxes or fees to hit a number of industries - including tanning.
Really? Tanning?? That is AWESOME - maybe the businesses will have to fold up shop and we will save on health care costs related to treating skin cancer caused by the lamps.
Think I am exagerating? Click here to learn more about skin cancer from UV radiation - which comes both from the sun and the lights used in tanning beds.
Sunday, March 21, 2010
Points I pondered this week are as follows:
Popcorn, Cotton Candy, Soda: I went to an awesome event this weekend that I find hard to explain. It is a production called Cavalia - part circus, part rodeo, part gymnastic expo, part ballet. It is all about horses and phsyicality. It is an amazing show with insanely fit artists. So I have to wonder, WHY - Why oh Why do people need buckets of popcorn and sticks of spun sugar during this two hour splendor? What do you think parents say when the children ask if they can ride horses or swing on a trapeze just like that? "Sure you can - as long as you are not obese , hypertensive, arthritic and diabetic, and could you please pass the soda?"
Property Tax Cometh and I am glad!: I saw an article regarding a court case from Illinois where a nonprofit hospital was found to be NON exempt from property taxes. That is good news to me. Why does it matter and why is it mentioned in this blog? Well, I believe that we need our personal, city, county, state and federal budgets to be in good shape in order to function at our best. In NC I remember thinking that the city would do well to tax one of our local hospitals that kept buying up all the property around it - for which the city would LOSE revenue. And since the hospital had gift shops and pizza joints - well - it was only fair. (btw, the hospital never referred to the money they made each year as a profit, but excess revenue - as it was a nonprofit entitity). I hope this Illinois case sets a precident.
The Bake Sale Dilemma: Okay, we all know that I am not the biggest fan of cakes, cookies and brownies and certainly do not think that they should be in our schools and offices, and I am not alone. However, the state that was highlighted on NPR one day this week has got the argument all wrong. I do not remember where this occured, but the "mom's" staged a protest and brought all their baked goods to the school board or city council or some such thing, to voice their outrage on the bake sale ban. They did make some good points about school snacks not always being healthy themselves (though they are calorie controlled). Anyway, right, wrong or indifferent - all one has to say to squelch the debate is that the goods are not allowed because of concerns on hygiene and food borne illnesses. DUH>
Eat with Intelligence: Diets never have been and never will be the way to maintain a health promoting weight. Calories absolutely matter and they matter all the time. The best thing a person can do is learn about food - energy density, nutrients, blood sugar, fiber, antioxidants, caloric demand, calorie expenditure, Volumetrics, whole foods - how to eat the best foods with the least calories and most nutrients - nutrients being protein, carbs, vitamins and minerals - and mono or poly unsaturated fats - Knowledge is Power - Knowledge is Satisfaction - Knowledge is NOT going hungry OR gorging - it is eating in a health promoting, palate pleasing way.
Women at 30: OKAY, I heard someone describe a woman with these words, just this morning. "She is a 30 year old YET slight woman." Excuse me? YET? Are 30 year olds not typically slight? What the heck was that about?
The Number of Pills: I have said this before, but the commercials are back at it and I cannot let it pass by. Less pills does not automatically mean less MEDICINE - the dose and the milligrams - they have to be considered as well. I say this so that you don't let the ONLY factor the influences your choice be the number of pills you can take in a day - less is not always less.
A Multivitamin Claim: I only caught the tail end of this commercial, and only once - but multivitamins do NOT improve your blood pressure or cholesterol levels - that is a misleading claim.
Dadblame-it - Fooled Again: Okay, dang it. I have been tricked by those 100 calorie packages before - and again today. You know, those super expensive 100 calorie packs are really taking off - they are everywhere - and many snacks are covered. To be clear, the 100 calorie serving size does not make it a HEALTHY food, only a calorically moderated one. So I have learned that the package itself might contain two itty bitty muffins (i.e lite bites) or contain two little cakes (the chocolate rolls) and the 100 cals refers to ONE, and today - the package said 100 calorie bars - one per package, but when I got home and opened it, it was nearly half the size of most 100 calorie bars - ridiculous waste of calories and NOT a volumetric food!
Saturday, March 20, 2010
The new drugs do not seem to cause TD, but they have been associated with significant weight gain and subsequently, diabetes. The concern about blood sugar and insulin resistance is not new and is listed as a side effect on the medication labels. It is something that psychiatrists are encouraged to consider when choosing a medication.
There are active court cases for which both Zyprexa and Seroquel are alleged to have caused plaintiff specific cases of diabetes. In the most recent finding, AtraZeneca was NOT found at fault. Though I am not a fan of medication, nor drug companies, this finding would be acceptable to me, in that, I do not believe drugs make people fat - which is the number one risk factor for the type of diabetes of which these persons are susceptible - but that food does.
There is a chance that these new medications (not so new anymore) do independently cause some amount of insulin resistance - but I expect if that were proven, AstraZeneca would have lost their case. What I do know, because I SAW it with my own eyes, is that people who are put on these medications gain a LOT of weight.
When I worked in the hospital with people who suffered mental illness, I did so as a social worker, not a health education specialist, but I WAS going to graduate school for my MPH at the time. I kept thinking to myself that these patients whom I would see when they returned to the hospital, as they always did, they needed to be TOLD that the medication either slowed their metabolism or increased their hunger, or maybe even turned off the hormone that told them they were full - what ever was happening, the patient HAD to be mindful and change the way that they ate. I don't remember any patient education about this possible side effect.
If nothing else comes from these lawsuits, maybe someone will have the foresight to make educating the patients about calories, physical activity and how attending to both can prevent both weight gain and diabetes a mandatory part of prescribing the medication.
Friday, March 19, 2010
There is an initiative however, to incorporate Exercise Is Medicine into our cultural infrastructure so that health care professionals make exercise a recommendation for prevention and treatment of disease. I have joined the initiative and will also link the page so that you can see the many others who have become part of the EIM network.
The program was begun and is managed by the American College of Sports Medicine. They promote the 5A approach which is also used for treating tobacco dependence. This is basically to advise every patient at every visit to become physically active. (ask, advise, assess, assist, arrange)
Here is more information on Exercise is Medicine.
I bring this up today because as you must have deduced from my recent postings, things have been busy. As complicated and diverse as my work weeks have been I have continued to maintain no less than six days a week of exercise - including running, aerobics, dance, and strength training - I total upwards of ten hours a week of "planned" physical activity.
Recently my Mom, noting that I do A LOT - with the blogging and cooking AND working- suggested that maybe I could exercise a little less while things were so hectic. But you see, it is just the opposite! Exercise IS MY MEDICINE and if things are stressful I need more exercise (endorphins) not less :)
And that is what I want other people to understand. Not uber exercisers, but the people who tell me that they struggle to get 30 minutes of exercise on 3-4 days a week... (oh and let me just add, my MOM is no couch potato - she waitresses no less than 5 days a week and walks and rides her bike daily as well -)
So for the laggards and for me - it can NEVER be a matter of IF you will work out on a given day or within a given week - but, where, when and how. Because my boss requires us to write out our projected work schedule weekly (no 2 days are the same I assure you) it allows me to view my week and find my windows of opportunity. I am fortunate to have a friend who lets me choose our weight lifting days and for my runs, I just make them happen. Classes at the gym are hard to work around, but for the past two Tuesday's I went ahead to class as planned but left about 15 to 20 minutes early so I could go back to work. I.e. it doesn't have to be all or nothing.
The Exercise Wagon:
While I was writing this post a friend called. During the conversation she told me that she had to get back to her running. She has done this before - gets going good and then things happen and she once again finds herself sedentary. That got me to thinking - it is the opposite of the saying, "you can't have one cigarette or you will relapse." "You can't skip exercise days or you'll become sedentary again."
You don't have to exercise 7 days a week, but you do have to keep your schedule - if you miss more than two planned workouts - you are probably going to relapse and will find yourself months later feeling heavy and unfit only having to start the whole thing over. Exercise and calorie moderation cannot be temporary things - unless you want temporary health.
Thursday, March 18, 2010
So I will highlight just a few more points from the Vital Statistics Mortality report from 2006 and then call it a night.
- The rate of deaths per 100,000 persons in 2006 was 776.5 but the rate of death for whites alone was 764.4 and for blacks alone it was 982 - a pretty big difference.
- The diseases with the greatest discrepancy between whites and blacks are as follows:
homicide, hypertension, kidney disease, and diabetes
- When looking at heart disease, cancer and chronic lower respiratory disease, I cannot help but wonder, how many of those are tobacco related. This report does not show the sub causes, but as we know, all of those conditions will be linked to something on a death certificate. My father's, for example, declared cause of death to be myocardial infarction and also listed atrial fibrillation and hypercholesterolemia. SO he had a heart attack related to his erratic heart beat which might have been caused by his high cholesterol related atherosclerosis - I think the atherosclerosis was on there as well.
- According to most predictions, 30% of both heart disease and cancer deaths and 80% of chronic lower respiratory disease mortality is related to tobacco use or exposure. That would be 30% of 631,636 and 559,888 and 80% of 124,583. I can tell you that about 443,000 deaths per year are tobacco related, so do the math and see how close we are.
- Final note: I mentioned yesterday that injuries had specific criteria and classifications. The injury related deaths are determined by intent and manner. So the manner might be poison, firearm, falls, motor vehicle accident and then investigated for whether or not there was purpose or intent. If a person was harmed by a gun, was it an accident or was it intent. If there was intent, was it self intent or something done to another. That helps us differentiate between homicide, suicide and unintentional injuries.
And now those numbers:
189 490 + 167 966 + 99 666 = 457,122 OH that is darn close!
Wednesday, March 17, 2010
Today I will do bullet points on some things that got a highlight out of me.
- In the USA there are 15 leading causes of (adult) death which kill over 80% of our population. The 15 causes are the same as in 2005 and 13 of them saw a decrease in deaths, with the two exceptions being unintentional injuries and kidney disease. There is a separate section on the definition and classification of unintentional injuries (accidents). To note, in 2006, over 2.4 million people died. Over half of those deaths were attributed to heart disease and cancer. In 2006, 28,527 infants died.
- Almost every age group had a decline in deaths from all cause EXCEPT for those aged 25-34. With some exploration, I may learn that those are also the ages of the persons dying from the unintentional injuries.
- The life expectancy for Americans continues to rise and some gaps are closing. The overall life expectancy or LE is 77.7 years, which is a very slight increase of .3 years. Interestingly, blacks LE increased more - .4 years. The difference between blacks and whites gets interesting when you factor in gender. Women out live men by about 5 years. When you break it down in that way, the longest living to shortest living are - white women, black women, white men, black men. But when you compare white women to black men the difference is, in my opinion, unacceptable and one of the issues that I want to spend more time exploring. Here are the numbers in the order just explained : 80.6, 76.5, 75.7, 69.7.
- LE at birth, which is described above, is different from LE from a certain age. In this document it explains that a person who has reached age 65 can expect to live 18.5 more years while a person who is 50 or was in 2006, could expect to live only 30.7 more years, and would actually die at a younger age. An 85 year old could live to 91. Pretty cool.
- Living longer does NOT mean the same as living with limited morbidity. The morbidity report is separate and usually the CDC releases weekly mortality and morbidity reports. But as has been said here many times, we need to compress the years of disease into the last five of life, not the last twenty, as is now the case. For today's children, the diseased years could out number the healthy ones.
- One of the reasons that the numbers for the Mexican, Cuba, Puerto Rican and other Hispanic speaking populations are not considered valid has to do with two concepts proposed in this document. Both regard migrant populations. One is that only the healthiest of these groups travel to the states for work etc - this is referred to as the "healthy migrant effect". The other is that many will return home to die if they become ill, which is referred to as the "salmon bias."
- Infant deaths are calculated per 1000 live births - infant meaning under age one. In 2006 a slight decrease was noted and the rate is 6.69. There are 10 leading causes of death in infants which are responsible for almost 70% of all infant deaths. The second one has to do with low birth weight which has many causes, including, exposure to tobacco smoke.
I think I will stop here for today. I do want to look at the age and or race specific disparities in death rates and type as well as some other causes of death, like alcohol, that were not in the top 15. Tobacco use is not singled out in this report, but do understand, tobacco use and obesity cause most of the deaths in this country - heart disease and cancer.
Tuesday, March 16, 2010
Since arriving home I have found that she has a website and I will link it at the end. I am just going to list these two or three things that I heard that very much fit in to the vision of this blog.
First let me say that the author, Lori Bongiorno, was giving examples on how to do things to reduce the amount of harmful environmental toxins that people consume. She contends that you can take one example and address it in a simple and inexpensive manner and/or a more significant and impactful one. (okay I made that up, but I mean one that has a greater impact) Listening to her today, I was reminded of my days at UNCg and my environmental health class. Her first example - produce - was one of my classmates' research topics and her second, mercury contamination - was mine. Here is what she had to say today.
It is true that chemicals, esp. from pesticides are on our produce. To use the green philosophy, a person could take special care to eat a large variety of fruits and vegetables to reduce the build up of any one particular toxin. A greener response would be to choose the produce that has the least contamination, like spinach and pears - from the regular produce section, and buy the most contaminated ones from the organic section. The worst are strawberries, peaches and apples (three of my favorites!). There are lists available that you can view on line. To be the greenest consumer - you might only shop at local produce stands, grow your own produce, or support policy for community, organic cooperatives.
With regard to getting enough fish while limiting intake of the harmful meyth lmercury that we find in them, she suggests this: For the least expensive green option, make sure that you choose chunk light tuna and NOT albacore tuna - in cans. Also choose wild salmon over farmed. She advised printing one of the lists of fish that categorizes them by low, medium and high mercury content and to bring that list with you to grocery stores and restaurants. I actually have one and brought some to work. I believe I got mine from the NWF or NRDC. And for the greenest, one could advocate for a reduction in coal powered plants that polute the environment and lead to mercury contamination.
Her last point, or the last I was able to hear, regarding meats and dairy. She said that if you want to avoid the toxins in these products, especially dioxin, she recommends avoiding FAT. Glad to hear her say that :) Her reason is that most of the toxins settle in fat - the same can be said of animal skins - or fish skin.
Here is the web page where you can learn more about the author and her quest.
Monday, March 15, 2010
I have educated people on COPD - Chronic Obstructive Pulmonary (lung) Disease - which includes chronic bronchitis and emphysema. Today I understand them both a little bit better because two things led me to investigate the diseases further. First, someone that I know, a former smoker, has COPD and her condition has worsened significantly though she stopped smoking some years ago, and second, I made a statement that quitting smoking can stop the progression of emphysema and was told that I was incorrect.
The two diseases affect different parts of the lung with different end results. The toxic chemicals and gases in smoke destroy lung tissue. The first response to the TAR is inflammation. Our bodies respond to invasions by trying to clean up the damage (free radicals), but some of that clean up (antioxidant activity) is itself impaired by the toxins in the smoke. Scarring can also occur on the lungs. Chronic bronchitis has to do with the larger airways and mucus buildup which obstructs airflow by narrowing the passages. Emphysema is a disease of the much smaller air sacs, the alveoli.
Lungs are often said to be like sponges with many little holes in them. If you think of a sponge and how it absorbs water and how you wring out the water, you get the idea of how important those small holes are. And think about a good sponge vs a cheap one - without small holes, the water doesn't stay in the sponge, the sponge doesn't inflate with it. So in emphysema, where alveoli are destroyed, the lungs begin to lose their shape and a person cannot fully expire air. This means that oxygen cannot be delivered efficiently and carbon dioxide can not be expelled. This process can lead to other disease conditions. Emphysema is almost always (80-90%) caused by cigarette smoking and if a person does not quit smoking, the prognosis is swift and poor.
In many cases, stopping smoking CAN slow if not halt progression to other air sacs, but there are types of emphysema that trigger an autoimmune response which causes continued damage regardless of smoking status.
Treatment includes, but is not limited to, oxygen and inhalers. The absolute first thing and most important thing a person can do is quit smoking. It is also said that persons who are under or overweight have worse outcomes. It is important to exercise and eat well so that the lungs and body can be conditioned.
The longer one smokes the greater the risk for this disease. I have come to believe that this is the far bigger threat to a smoker than lung cancer. There is just no way to breathe in smoke every day and not damage your lungs. Not all lung damage is COPD, however. In other words, you can impair your breathing without contracting this incurable disease. It is also possible that COPD may be genetically inspired, but the gene may not be expressed unless one smokes. BTW, people often have both chronic bronchitis and emphysema.
In one of my classes today a person talked of seeing a smoker's lungs during an autopsy. The lungs were black like coal and much smaller than non smokers' lungs. My "student" said that he could not imagine how the person had been able to breathe.
Sunday, March 14, 2010
Testing, testing, testing So we are having too many diagnostic tests. DUH. I am glad anyway to see some popular news sources note that the Xrays, CTs and even blood work have gotten out of hand. I was speaking with a physician this week after that story made the headlines and he agreed with my thought, which is this - before having a "test" one should know the answer to this question, "How will that Xray, Blood Test, Ultrasound, etc - change the treatment ?" If it isn't going to change what the doctor would do, then it is an unnecessary test. Remember, some of those imaging complexes are actually OWNED by the doctor's who send you there. BTW, my aunt and I were talking today about mammograms - and though she is a breast cancer survivor - she too thinks they are over used.
Bone Loss Drugs This week a study and an FDA warning were released in regards to long term use of drugs that are meant to slow or reverse bone loss - Fosomax and Actonel are popular examples. The drugs already carry an unusual warning of esophageal damage and jaw bone problems, now there is concern that FRACTURES can occur in the thigh bone of people on these drugs longer than five years. Here again, an example of a drug causing what it is supposed to prevent. The FDA is looking into this matter and persons on the drug are to discuss long term use with their physician. I wrote about the issue of prescribing a medication to prevent a condition that can lead to another condition, some time ago and this is exactly the kind of thing one must worry about. If the medication is given to 30 or 40 year old women because they are at risk for getting osteoporosis which would then mean that they are at risk for getting a fracture (hip and spine) - they will be on the drug for 20-40 years!!! Read more about the osteopenia debate here.
Without the Calories??? I almost did a post about the crazy things I heard people say or saw people do this week. Here is one. I was at another doctor's office (this is work related, I am NOT sick :)) and as I waited for the doctor, his office manager, nurse was talking with me. She offered me some cracker like chips out of a large bag( kept on her desk). I think they were some kind of Ritz baked something or another - she said that they were just like chips without the calories !! What? Too funny that she would say that to ME. I had already said, thanks but no I just had my lunch, blah blah blah, when she said that about the calories - to which I had to respond, "Well, I wouldn't quite say that!"
Treadmill Grip Hmm, If the incline is so high that you have to hold on to the treadmill for dear life - you are not really working your legs. Additionally, if you run and hold on to the treadmill, well, I don't know - how do you run without your arms? Is it too fast - is it painful? I don't know, but it just can't be right.
Weight Machine Mistakes As I said, I saw a lot of quizzical things this week. This one was a lady sitting at a machine where you hold a long bar over your head and out wide, you pull the bar down towards your chest and then release. This is a lateral pull down. Form is so very important in weight training. If you cannot do the exercise while keeping your form, the weight is TOO heavy. This is a mistake most often committed by men, but this woman was all over the place with her body, nearly rocking back and forth hard enough to catapult herself off a runway. So um, that is not effective.
Smoker's Say the Darndest Things I am the first person to frown on the use of medication for almost anything, however, it is my job to educate people on the 7 FDA approved medications that are effective in helping people to quit smoking. This week I was discussing one of them called Zyban (wellbutrin/bupropion) and one of the persons in the group said that the medicine had made her hair fallout. Well - everyone else in the room, ALL smokers, gasped and declared that they would NEVER take that pill. (that really isn't one of the reported side effects, but anyways). Cigarette smoking causes lung cancer, heart disease, stroke, insulin resistance, emphysema, wrinkles, SIDS , impotence, infertility, oral cancer - and more and more - which apparently isn't near as scary as hair loss.
Do Not Add Salt I am 100% in favor of banning trans fats and of reducing the amount of sodium in processed foods. I am an advocate for getting nutrient content information on every product and dish, store or restaurant, I think that sugary drinks should be taxed to the max, but now I think NYC might have gone too far. Some politician has proposed making it illegal for restaurants to add salt during cooking. Then again, I don't add any when I cook - but seriously, the biggest problem we have is eating too many calories - and though salt can add to blood pressure problems, is it really the cause of most?
Saturday, March 13, 2010
I agree with just about every word written in their expose` on weight loss myths, and my agreeing with somebody else, well, that is news in and of itself! I do have a little commentary to go along with many of the points they make, so I will state them now and then again, you MUST read the article if you want some serious and factual information about calorie intake and burn.
- Small, frequent meals - the magazine seems to dismiss their effectiveness, but then again not really. I just want to say that it is TRUE - the amount of calories you consume in a day vs the amount that you burn, no matter what kind - IS the final answer for WEIGHT control, but for optimal health, energy, mood state, etc - research DOES support that small, frequent, nutritious (calorie controlled) meals are better! And I must add, when they give an example of a day of eating, the example contains SIX meals.
- Timing - the magazine notes that eating at night does not in and of itself cause weight gain, but that eating too many calories in any given day - does. I eat almost half my total intake after six p.m.
- Popcorn - my most favorite night time snack gets a nice shout out as a healthy food to add to your daily intake.
- The Weekend - READ the piece on Surviving the Weekend. It does NOT include permission to overindulge. Instead, the article warns that eating with abandon on the weekend will only cancel out the hard work you did all week. But other points in this piece are very Your Health Educator -ish. It discusses traveling and eating well and cooking on the weekend! Here is something I have decided to offer up - and may repeat in another post - much of the successful weight loss literature or evidence suggests that persons keep a food diary. We are consistently encouraged to write down what we ate - I challenge you to expand this think ahead approach offered in the magazine and write it down FIRST. I almost always know what I am going to eat in a day and I swear, I look forward to MY meals and am not the least interested in the high calorie snacks or lunches that others parade about the office.
- Weight training - two of my favorite myths - and counter arguments are offered as well. More weight, less repetitions and lifting weights improves our fitness and calorie burn withOUT bulking anyone up.
- Diet soda - the mag speaks against it by noting one of the studies that showed increased weight in those who drink it, but if I remember correctly, it isn't the diet soda causing the weight gain, but the cheeseburger and twinkie that went along with it. (just saying)
- Two a days - YEAH! my favorite. Instead of working out for an hour in the a.m. there is much science to support a better overall calorie burn if you do 30 minutes twice or even two 40s if you prefer, but you will likely expend more energy because you have more and can apply more effort.
- Fat/Carbs- this is addressed on two fronts. What nutrients you take in and what type of calories you burn (long and slow, vs high intensity) and guess what - AGAIN it is total number that you should worry about - if you eat more than you need you will gain weight - period - if you exercise with effort you will burn more.
- It's a forever thing - lastly, this is not a time limited diet "thing". To maintain a healthy weight one must always moderate their calories and exercise daily. [give a take a day or two :)]
As I said, RW did a great job with this article and it is evidence based and written by people who KNOW this stuff... Here is the link..........
Friday, March 12, 2010
What we hear less about is maternal mortality. A death of a mother during pregnancy, delivery or within 42 days of delivery that is directly related to her being pregnant; such as, hemorrhage, infection, unsafe abortion, eclampsia (very high blood pressure leading to seizures), and obstructed labor (WHO).
This issue is not just happening in third world countries and in fact, it has gotten worse in the USA, not better. The CDC had reported this in 2009 - in its report on Vital Statistics from the year 2006, but it made the news this week after being reviewed and analyzed by Amnesty International. It took me some time to find the CDC data, but I did and the report itself is enlightening so I linked it for you.
First, the USA lost 569 women in 2006 to maternal mortality while the WHO reports a global number of 529,000 per year, or one woman every minute.
Here is what caught my attention and in fact, dropped my jaw -The goal for maternal mortality is 4/100,000 persons - which has been attained in at least one other country.
In the USA, we are trending UP not down, having gone from just over 6/100,000 in the 1980s to over 13/100,000 in 2006. But that is not the worst part - that is an average for all races. The rate for white women is around nine while the rate for black women is over 32. Black women are about 3 and a half times more likely to die in childbirth or from childbirth than white women. The discrepancy for death and disease of all causes between whites and blacks continues to exist and though some areas have seen progress, if you take a look at this full report, you will be amazed. In fact, I meant to write a brief post today - but became engrossed in some of the data. I think I will print the whole thing later on so that I can explore it more fully.
On CNN this morning, the following reasons for this increase in maternal mortality for both races was offered- lack of prenatal care and health care in general, increases in Cesarean sections and obesity. Yes, obesity. I cannot stress this enough - it is not a matter of looks, obesity is a disease condition. As far as the c sections go, I had heard that more were being done, but because women - probably insured and wealthier ones, were actually demanding them because they wanted the pregnancy over.
A non-profit agency that strives to ensure that everyone has a healthy, full term pregnancy with positive birth outcomes is called Healthy Start - the national website is here - many states and counties have Healthy Start Coalitions and they are very helpful. The CDC report linked earlier also lists the causes of infant death.
Thursday, March 11, 2010
The researchers are from Department of Obstetrics and Gynaecology, University of Chicago, 5841 S Maryland Avenue, MC2050, Chicago, IL 60637, USA, and Chicago Core on Biomeasures in Population-Based Aging Research, University of Chicago Centre on Demography and Economics of Aging.
The scientists reviewed data from two different sources, surveys and interviews of two large groups of men and women in the USA. The purpose of the study was to investigate sexual activity and satisfaction as we age.
I am thrilled with a new concept that they present. You are familiar with the term active aging and active or healthy life expectancy etc etc. The purpose of my blog is to support and encourage healthy active aging. These researchers have determined markers of "sexually active life expectancy." How cool is that? And what exactly determines your sexually active life expectancy? According to the researchers any amount of sexual activity with a partner (snicker snicker) counts. So if you stop having any sex at all, your sexually active life years are over.
The researchers determined that on average, at age 55 - (life expectancy at that age is about 24 more years for men and 27 more years for women) men have about 15 more years of sexually activity and women have only ten. But there are MANY reasons why that might be. Let me also say that the study discusses any sexual activity, satisfying sexual activity, interest in sexual activity and frequency of sexual activity. Also, I did not read every word of this study, but in what I did read, I could not find any statement on whether or not this was only a heterosexual study, but it appears to be.
So, men who are healthy in middle age tend to live longer than men who are not. These men are usually married in later life and engage in sex with that partner on a pretty regular and satisfying basis. Men in this group have more interest in sex than women tend to at the same age, and also have options for enhancing their sexual ability through the use of pharmaceutical therapies.
On the other hand, many women who are in old old age, 80 and up - tend to be widowed and thus do not report sexual activity as it seems that in the group of people studied, having a partner (or being in a relationship) was one of the biggest predictors of sexual activity.
Men who are in poor health do not share the same sexually active life expectancy. Women, even unhealthy women, tend to live longer than men. Women's sexual health has not gotten the same attention as men's, but perhaps this study will provide some impetus for that. OF note, women have hormonal shifts in late middle age that lesson sexual desire and enjoyment - this is something that may be addressed in the future.
In this study they did find that men's attitudes now are very different than they were ten years ago and that this could be related to ED drugs.
Wednesday, March 10, 2010
It is a worldwide franchise gym that is almost exclusively marketed towards women. It is owned by a couple, Gary and Diane Heavin, but the franchises are independently owned. The company started in 1992. There are over 10,000 clubs in 73 different countries. The gym is set up so that the participants do a circuit of weight training while doing some type of cardio movement in between machines. (jog in place, jumping jacks, march) The machines are based on resistance and do not have adjustable weight amounts. The workout should take 30 minutes.
Is there research to support its efficacy or outcomes? Is it a successful program? It depends on what you are asking specifically. The owners have commissioned research and there are completed, ongoing and future studies. The research began at Baylor University and is now taking place through Texas A&M. Curves is funding the stuides. With 10,000 clubs you'd expect large sample sizes in the research and in some cases that is true, and in others the numbers are ridiculously small. Almost all the studies are about weight loss, not fitness.
What is right about Curves is that it targets and indeed affects the overweight or obese sedentary woman. There is little intimidation, little discomfort and a lot of camaraderie in the clubs. The question that I need to have answered is what it does for the more fit person and that is one of the ongoing studies - at least they are looking into energy expenditure of fit women during the workout, but past research will tell you, people not used to doing something will burn more calories doing it than the person who is used to doing it. The body adapts and then conserves energy. It is meant to.
There IS positive research about the Curves program in regards to weight loss, but ONLY when the people in the study are also reducing caloric intake. There is also evidence to support that the weight loss is maintained for as much as a year, IF the calories continue to be controlled and the exercise frequency continues.
There is not research available to answer what I feel is the most important question. Does the program challenge the muscles enough to build them, increase strength, prevent bone loss and improve functional fitness. One study that addressed bone loss only said that women who took calcium seemed to have more dense bones. Well yes.
I think that Curves is a phenomenal program and that it does indeed help millions of women. Some of my recent blog posts have addressed middle age plateaus and having to switch things up to see continued progress in physical fitness. I believe it was in that context that my reader asked about Curves and so, NO this program would not be enough if those were your challenges or aspirations. Curves can produce weight loss if coupled with a calorie deficit, but so do other exercise programs.
The Curves circuit is clinically proven to increase heart rate and thus would challenge and condition the heart, at least for a while. Most of the studies on Curves are ten weeks long, though long term studies are in place. Curves certainly has the potential to build ones self esteem and to keep them engaged in society - as it targets older women, this is a good thing.
For optimal health and fitness, Curves would be a first place to go on a journey that requires more effort over time.