Wednesday, June 30, 2010

A New Cancer Mindset

We have made significant progress over the years in regards to cancer prevention, identification and treatment. With the help of technology, we are able to diagnose more cancers so the absolute numbers of cases may have gone up. However, the actual death rate for most, but not all, cancers has gone down. The hardest cancer to treat is still lung cancer (and possibly pancreatic), the hardest to differentiate appears to be prostate while the cancer with the greatest cure rate is breast cancer.

Here is something else that has had an almost 360* change – lifestyle recommendations for prevention of initial cancer, during acute and or chronic treatment of cancer and to prevent cancer recurrence in original or distal site. By that last bit I mean that sometimes a person is seemingly cured of one cancer only to have it reappear in another part of the body.

I wonder if you are going to be surprised by the newer medical advice – maybe it will depend on your age. The research continues to grow and a body of evidence exists to support that what one eats, how much one eats, the weight of a person and the amount of exercise they engage in will affect all of the situations noted earlier. Being overweight WILL increase the risk of cancer in all locations. Eating high fat and high salt foods can affect the inner mechanisms or metabolism of a body and put it at risk for cancerous conditions and exercise is something that is protective. In other words, regular daily exercise creates a system that is better able to fight off disease.

Thus, overweight persons with cancer are often encouraged to lose weight – I KNOW – we have the old image in our heads of people getting chemo and losing a bunch of weight – wasting away, but the treatments have changed and even those that do cause loss of appetite are mediated by drugs that treat the side effects. All of us, cancer patients or no, are encouraged to eat a diet that is more plant than meat based and low in saturated fat, processing, simple carbs and salt. As soon as possible after any invasive treatment, cancer patients are encouraged to begin an exercise program. Research exists to support that this lifestyle change can prevent recurrence of cancer. It is therapeutic. It is a change in thinking but it works.

Tuesday, June 29, 2010

Popchips !

Back in April, I mentioned a few new products that I thought were very tasty. You can see that blog post again by clicking here.

One of the items was Popchips. They are a less bad version of potato chips and they taste very good. They are lower in calories than potato chips and not fried. A friend of mine really liked them, so much so she decided not to buy them anymore. She had to apply the principle, rightly, that too many calories will always be too many calories and if you can't moderate than you should just skip it.

Now the maker of Popchips has a new stakeholder. He is the actor Ashton Kutcher. Mr. Kutcher was in the hilarious sitcom That 70s Show and runs the MTV show Punkd. He is going to have a role in marketing the snack food. He probably won't do commercials but will use social media and all of his Twitter followers will get a text message about these chips.

I just wanted to take a moment to once again tell you, YOU heard about these chips BEFORE Kutcher's 5 million followers did!

Monday, June 28, 2010

those darn blood fats

From my website:

Triglycerides are another type of blood fat. Having high triglycerides, over 150 mg/dl can increase heart disease risk and also worsen other health conditions. Being overweight and inactive, drinking too much and smoking are all risk factors you CAN control.

I note this because the newest research and development craze for pharmaceutical companies is finding a chemical or biologic compound to lower triglycerides in much the same way that statins can lower low density lipoproteins or LDL.

I ask the same type of question I usually ask – will lowering a persons blood fats reduce the adverse outcome of heart attack and death caused by heart disease? But I have more questions. How low is low enough? Wouldn’t it be more cost effective to educate persons on the dangers of high triglycerides and how to avoid them?

The drug companies and financial analysts are referring to progress in this area as a potential to gain a HUGE market share and to profit substantially from treating this self instigated disease. I want that to bother you. Some of the drugs that are in development have the same properties as Omega 3 fish oil supplements. What is wrong with eating salmon and taking regular fish oil supplements? Well, they are expensive and insurance doesn’t cover supplements so many people do not take them. If they were a medicine and insurance covered them – and doctor’s prescribed them – (because isn’t it easier for the doctor to say and you to hear, “take this pill twice a day” then “exercise five days a week?”) then the companies could make a lot of money.

With regard to increasing your risk for high triglycerides food high in saturated fat is surely an issue but so is just plain eating too much of any kind of food. When we eat more than we need, the body stores it and stores it as fat. Calorie moderation is the only answer – sorry – the truth hurts sometimes. To learn more about this and from a trusted source, please read the information on the AHA page

Sunday, June 27, 2010

odds and ends

My left over notes for the week are as follows:

SWSD - Ok, at first I was skeptical that the condition even existed. Seriously, when you hear things advertised on the radio they just seem cheap. The become like the disease of the day - the disease de jour. I am especially wary of any disease that is marketed - as this one is - with catchy phrases and an acronym. The other two that quickly come to mind are RLS and FMS. SWSD stands for Shift Work Sleep Disorder. Yet Web MD and the Mayo Clinic both acknowledge its existence and recommend special attention to sleep hygiene. The best treatment for this syndrome, which includes irritability and difficulty concentrating, is to get adequate rest. The commercial I heard this week encourages people to go to a website, take a little test, print a handout and then - well - go to the doctor and ask for medicine. DUH.

Global Expansion - Ouch. Merck was quoted in the WSJ as saying that they were looking to expand their business (selling prescription medications) globally. They feel that the outlook is good as countries begin to do well and have an increase in middle class citizens. Yes, they note that the people would then be more likely to have health insurance, but they also note and probably gleefully, as people have more income they also seem to engage in more lifestyle behavior that leads to chronic disease. Well - good for you Merck - but wait, if we KNOW that people are at risk for chronic disease conditions in the situation just described, why don't we get the health promotion folks out there to PREVENT those negative lifestyle changes. Oh, no money in that - gotcha.....

Wildlife - Great sign seen today while I was out running. Something like, "Please do not feed the wild life - It is harmful to them and harmful to people. The wildlife can become dependent on these food sources and forget how to hunt AND they can become aggressive." I must say we have some very aggressive seagulls at our beaches and it is the fault of people who feed them. Plus they probably have diabetes - just saying.....

Again with the "do we really seem that stupid"? - Products are now being made not with HFCS - or high fructose corn syrup - which we all attempt to avoid, but HMCS - That would be high maltose corn syrup. Most research has been done on the fructose type and it is true that maltose is a little different chemically speaking, but come on - corn syrup - SYRUP - super sweet sugar - not good for you...

See Sugar Is Bad - I do like the Kellogg Co but have to note that the four cereals that they had to recall this week - all sweetened ones; Fruit Loops, Honey Smacks (wait oh my gosh - didn't they used to be called Sugar Smacks!!!! ok this needs to go up to the do we really seem that stupid spot, Corn Pops and Apple Jacks.

Saturday, June 26, 2010

All Smokeless Tobacco is NOT the Same

I received an email from a colleague with a link to an online magazine piece about re: evidence on the dangers of smokeless tobacco (ST). When I read the brief article I felt the need to see the actual published study. This is because one of the things said in the ScienceDaily press release was that the tobacco was commonly used in other parts of the world. I had to ask myself, “What does this scientific finding mean to us – the USA?” I expected that I would find that the tobacco analyzed, which did cause some cellular changes that could lead to cancer, was NOT a product used in this country. That has happened before, both with good and bad outcomes, and it is important as a health educator that I know what I am talking about- yes?

I was able to access the journal article in Chemical Research in Toxicology.
Well of course I was blown away by the technical nature of the study and it was somewhat (ok very much so) over my head. Very basically an enzyme abbreviated as CYP and its protein subtypes will break down (in phases) the cancer causing agents in tobacco and other products. Often in tobacco we are referring to tobacco specific nitrosamines or TSNAs. In this instance the metabolism of the TSNAs or the breakdown of them by the enzymes can affect the cells in such a way as to change DNA. When DNA is changed, cells can mutate and become cancerous. This study showed that there are several organ systems affected by this toxic metabolism and thus smokeless tobacco could lead to several types of cancer. This is not a study to say that ST causes cancer, only that the processes that were seen are the same that in other situations have created a cancerous condition.

Still, the type of tobacco used in the region of study, Southeast Asia and India, is not the common tobacco used in the USA or even Western Europe. The researchers studied the effects of the tobacco metabolites from a certain blend called gutkha which according to Wikipedia and other sources is a mixture of tobacco and crushed betel nut, catechu, lime and other flavorings. What is catechu you might ask? It is some type of palm plant that grows in India and similar areas.

The ScienceDaily article did not at all note the type of tobacco or more exactly, tobacco juice (tobacco mixed with saliva), that was studied. This gutkha is not Copenhagen, Skoal or Redman and it is known to be worse than the Swedish brand of snus – so the article is good and as someone concerned with global health it is relevant, but as a US tobacco educator I would be wise to make the distinction of which tobacco causes which harm in my presentations as the one thing I want to be sure of is that I, unlike Big Tobacco, tell the truth!

Friday, June 25, 2010

Bullshit Detector

That is me - a true sleuth. You know that I detest diets, in the popular sense. The true definition of diet is what a person consumes on a daily basis. Recall hearing anthropologists say that early humans subsisted on a diet of grains and berries - or some such thing. They do not mean that they were ON A DIET. So on a diet, that is what I am referring to when I say I abhor diets.

I do endorse the concepts of Volumetrics and the Weight Watcher program and I like some of the constructs of what is referred to as South Beach - but only because it seems to encourage lean proteins and quality carbs - but if someone wanted my opinion on a true diet - what one should consume on a daily basis - I would say the prudent or the Mediterranean diet. You can Google them!

What I will NEVER recommend is the Nutrisystem plan. I have already complained about their misleading commercials and alerted you to phrases like "clinically based" or "clinically tested" as that is not the same as "clinically proven." So, just this month a magazine I read had a full page ad for the Nutrisystem Silver plan - sliver- gold- D- for men - whatever the version, they are all misleading.

In this print ad it discusses the 55 pounds that Martha lost and the 93 that Brian lost and the 50 that Annette lost. Then at the bottom it says - of course, in small print- "results not typical." You know what it really should say? Well, I will tell you. It should say , results are atypical." In that they are not at all what you should expect. You should expect what the fine print says - "most people lose one to two pounds a week." And what is the safe way to lose weight? One to two pounds a week through calorie control and exercise. But it gets better. The small print also says that "individuals are remunerated." I read that and said to myself, "does that mean what I think it means?" So I looked it up and indeed so. The people in the ads who have these very atypical results are PAID. And you know what else, it doesn't say anywhere how long it took those people to lose their 55,93 and 50 pounds.

Nutrisystem does offer a money back guarantee - on the food - not the promises. If the food sucks, you can get your money back.

Want to lose weight - check this out. Calorie Balance.

Thursday, June 24, 2010

A Call to (Imaging) Action

If you have been following along over the years or even the last few months, you are aware of my concerns regarding over radiation from medical testing or imaging. I blogged about it most recently after the President's Cancer Panel released an annual report and that post can be found here.

On June 23, 2010 an editorial written by Rebecca Smith-Bindman (MD) from the University of California called for regulation of the radiation or imaging industry. The recommendation is based on much of the same information that I have shared with you over this past year. Dr. Smith-Bindman does mention the actions that some organizations have begun to take to protect patients from over radiation but notes that there is no standardized method to do so and that there should be. A few points from her article are powerful enough to repeat in full. She said that sometimes the scans completed and the doses of radiation that they impart may not be based on "scientific evidence of improved clinical outcomes." In other words, sometimes the clinician or the company that made the machine is using a lot more radiation than necessary to enhance the quality of the image, but the image with less quality and thus less radiation would show the same clinical indication. In that case, there would be no treatment difference from using the SAFER scan. She also said, "Studies have consistently shown that physicians know little about radiation doses or cancer risks from medical imaging." Because of this I implore you to be mindful of your own health and ask about these tests before you succumb to them.

There are times when a CT scan is absolutely necessary to save your life please understand that. Also understand that the machines are not always calibrated and even calibrated ones may offer doses of radiation that exceed what is necessary. In fact, there isn't a recognized notion of what IS necessary. I agree with Dr. Smith-Bindman that the FDA should have a mandate to cover this issue but I also urge that the mandate come with authority to enforce the regulations and a budget with which to do so.

The article is only three pages long and the beginning tells a story that is worth a read. Please check it out here.

Wednesday, June 23, 2010

Diabetes Numbers

(thank you to those who have commented on my recent posts, I appreciate your feedback)

Diabetes Numbers

No I am not going to talk to you about incidence (new cases) or prevalence (all current cases) of diabetes. Not going to talk about how the rate of new cases is trending upwards while new cases in the young are threatening the life span of an entire generation. I am not even going to talk about how diabetes is related to blood sugars that run higher than normal for extended periods of time because the body is unable to produce enough insulin or has a resistance to the insulin that it does produce. (Insulin is the trigger that tells the body to move the sugar out of the bloodstream)

No. I am talking about different numbers. I mean the kind that end in lots of zeros and start with this lovely symbol $. Money Money Money.

Now I suppose you are expecting me to tell you how the rising cost of obesity and its subsequent diseases is straining our health care system - nope. If you REALLY want insight into disease - sometimes you have to look at the profit side.

According to an article from the AP and published by Yahoo Finance, global sales of both treatment (medication, insulin pumps) and testing devices (glucometers, strips) is up double digits year after year starting in 2004. The article also specifically notes sales of products from Johnson and Johnson which have topped two billion each of the last four years. It seems to me that some companies would have a lot to lose if we (health promotion folks) could prevent diabetes. Oh by the way, the article notes global sales for diabetes treatment to have been OVER 30 billion dollars in 2009.

See the numbers yourself here as I am not supposed to republish their info. :)

Tuesday, June 22, 2010

Your Reflection

My personal life experience, my educational background and my career have given me significant insight into the interactions of people. I know that over the years I have worked on my own presentation and how I react in all the spheres that one might have personal exchanges. If you have known me for any length of time, you know that I am most fond of saying that the way people treat you is almost always – 99% of the time, about them and not you. This morning as I was deep in thought (on a run) I realized that our actions can also set the stage for how the other(s) will respond. I think we all know that on a surface level, but I am always interested in the deeper processes.

Let me start from the other side, the messages we project about ourselves, not the behaviors or responses we hope to generate in a deliberate sense but the more subtle nuances of our body language.

I was having dinner with a friend recently and she noted how she first perceived me. Basically she described seeing a person that was very closed off (arms crossed over my chest) and someone nearly tremulous with nervous energy. I seemed bored or anxious to be somewhere else. WOW. That is what my outside was saying and not at all what my insides were feeling. Instead, I was physically uncomfortable – i.e. cold and without a sweater, and I was fearful.
The people around us are not going to respond to what we are thinking or feeling, but what we are showing. It is an important take home message. I take this kind of feedback seriously and try to change myself accordingly. I am going to have similarly challenging new situations in my future and in preparation I am going to practice this little mantra, “check yourself.” Is my body projecting the message I want to convey? I may still be scared or uncertain and that is okay – at the same time it is probably NOT what I want to share, instead I can project confidence. It isn’t that hard really and of course, if I am cold, I can acknowledge that.

On this same subject of people responding to your outsides, it is also true that if you are nice to people, 99% of the time, they will be nice back. I am going to try this the next time I have a big transitional challenge – which you will learn soon is not that far into the future. And at that time, I am going to approach people as if our interactions WILL be positive, balanced, respectful etc. My hypothesis is that I will create a positive environment because the others will be reacting to this energy, much the way people have reacted to my “fear” or “intensity”. There are very few people who just interact due to having agendas and even fewer who put a lot of thought into their projections as I am today, so I can be reasonably comfortable that my expectations will pan out. Which reminds me of another thing I like to say – I own my expectations and no one has to meet them, it is just nice when they do!

Afterthought: I wrote this before I was ready to post and set it aside for awhile. I had forgotten that I had in some aspect already proven my theory. For the last two years, one of my professional responsibilities has been teaching an hour long class that meets for 4 weeks to a group of people who are compelled to take the class for a work place benefit, but who are angry about this requirement. (I have probably completed 50 series of classes) I have turned that class into something that the “students” do not mind attending and even enjoy at times. I framed it – I chose to go in positive and they replied in kind. I highly recommend this approach to life! (Of course, we all get to have our moments of foot stumping and pouting, but seriously – you should do that alone or in the company of those who love love love you dearly!)

Monday, June 21, 2010

Keep It Tart

As in the sour cherry. Word on the street and in Runner's World magazine is that this fruit is loaded with nutrients and even has analgesic or pain reducing properties. This is something you want in your diet, but as with other functional foods, we are encouraged to eat them not in addition to everything else but in place of something perhaps less healthy. For example, a twinkie. If you are of the oh say, less than one percent of the population who actually gets all their nutrients in an abundance of whole foods and has the calorie equation worked out perfectly for your lifestyle, then just switch off one good food for another on a rotating basis. I might actually eat more cherries than pineapple, kiwi and banana due to the fructose involved, but that is my personal preference.

Mind you, the sour cherry is a great addition as a sour cherry, not as a cherry pie, and not even as cherry juice as that decreases fiber content and concentrates the sugar.

So what exactly is the nutritional detail for the sour cherry? I went to my favorite database to find out. The USDA Nutrient Database let me down. They did not have the information for this or any fresh cherry. To be clear, I am referring to fresh sour or tart cherries, not the more popular sweet or Bing cherry. This tart cherry is hard to find, but it is the right time of year. Try local farmer's markets or Whole Foods Grocery. The tart cherry has the greater antioxidant and nutrient properties. And to reiterate, I am not suggesting drinking juice. It is easy to double the calories and loose sugar content when you juice something. The fruit sugar needs to be with the skin of the fruit to retain the slower release of glucose.

Here is one link to a webpage that offers very minimal nutrient information on the sour cherry. It does not break down the individual antioxidant properties but a cup of these sour cherries would do a body good!

Sunday, June 20, 2010

Odds and Ends

It occurs to me that though I end my Sunday by writing the odds and ends, you may not read them until Monday. So whether you are ending a week or starting one - here they are - my leftover points from a busy news week.

Cenegenics – I have heard and seen a commercial about men who are 70 but have the bodies of 30 year olds – well, healthy fit 30 year olds. “How do they do it?” the announcer asks. The commercial says that Cenegenics is not a fad diet and doesn’t use pills and such, but alas, it DOES. I went to the website today to see just what the Cenegenics program was and learned that it does involve supplements and in some cases, hormones. Well, let me just tell you there is plenty of evidence that those things do not work and could in fact cause harm, while there is not evidence to suggest that they help in any way. The website and commercial also talk about the program being created by a doctor. Well, whoop tee do. Almost anyone can get a medical degree – but not just anyone can get it from an accredited and prestigious institution and furthermore, she said with passion, just because a person is a doctor doesn’t mean they are a good one. You might also note that the DHHS is going to release a new food guide and food guide pyramid next year that does NOT recommend even a multi vitamin for most persons. IN fact, nutrition is best received from your plate – from whole foods, and aging with grace and sluggishness is more about what you do, not about what you take.

Marriott – Hurray! This hotel chain is joining the restaurant owners who post calorie content on their menu. Marriott has already begun to do so in some of the lobby bistros and I am looking forward to taking advantage of this needed information.
Here is their webpage in case you want to give them a word of kudos or thanks.

Oil spill – A few weeks ago when the USA began to hear all about tar balls on the local and cable news, we were told NOT to touch them without protection. There has been a lot of coverage regarding clean up crews and their work collecting these remnants of the tragic Deepwater Horizon oil spill. Imagine then this NPR story I heard the other day. A woman in Florida, near the panhandle, was swimming and saw these spheres under the water. She collected them in her hands and mashed or squished them between her fingers and in her palms. Oh my – they were tar balls. YES – what part of don’t touch them didn’t she quite understand.

HSDD/Drug failure – Here is another one for the “are they crazy?” section. Or maybe the “do they think we are that stupid?” blog. I am referring to the application for new drug status on a medicine that is supposed to reverse or cure or ameliorate the lack of libido that some women appear to have after a certain age. In fact, we call this Hypoactive (hypo is low, hyper is high) Sexual Desire Disorder. We don’t really call it that – drug companies call it that. Because if you can make it a disease then you can make a drug for it. The FDA panel reviewing a German drug company’s offering quickly gave it a thumbs down – unanimously. As I was doing something around my house this week, I heard a pundit on TV saying something about drug companies creating illnesses so they could make something to treat them and my thought, actually, my out loud response was, “Ya Think?”

Vitamin D – Okay – Vitamin D is a supplement that HAS been well received by esteemed nutritionists and physicians, so much so that the RDA or recommended daily allowance is likely to be increased. Most experts now recommend 1000 IU of D-3 per day. I take this for my bones and because as some suggest, it might be protective of health overall. At the store today all I could find were pills for the old dose of 400 IU and then bottles and bottles and bottles of pills that were 2000 IU each. Also there was some gummy, flavored Vit D with sugar added. Sometimes I get so frustrated…. I didn’t buy any.

Tampons – Sorry, but they were right by the Vitamins. I was sort of struck by the boxes of a certain brand. A black box with different but sharp colors, pink, blue etc. Reminded me of the Camel No 9 cigarette packs that are targeted at young women. Too funny – the competing world of menstruation products. We are certainly a long way from when the pharmacy wrapped the boxes in brown paper, eh?

Friday, June 18, 2010


Eight years ago today (June 18) I woke up to plan a funeral. Well, truthfully, I had not really slept the night before having arrived home from the emergency room near two or three a.m. with my Mother, newly widowed. It was a black day.

It is surreal to imagine that this many years have passed since my father’s death from a heart attack. Seven birthdays, Thanksgivings, Christmases and Easters. A college graduation he did not attend and professional acclaim he has not seen. It does not hurt today, like you might think that it does, because time truly takes that away. Though the time takes away pain, it takes some memories too and it certainly gives nothing back.

I am using my loss as a teaching or motivating point for the men reading my blog today. My father died in 2002; in 2003 the amount of men living with any form of coronary heart disease in the US was over seven million. Over 245 thousand died from the disease with 89 thousand due to heart attacks. In that ONE year. This information is found in an American Heart Association report published in 2006. The CDC tells us that one in five deaths in the USA are related to heart disease and that heart disease is the number one killer of both men and women. It is said that persons with heart disease lose about 14 years of their life. That would have a person dying at 64 instead of 78 – and in my family, we had a couple of those losses as well.

Here is the most important message from the CDC and the American Heart Association. Heart disease is almost always preventable. It is almost always related to things that we do or do not do. My father lived as long as he did not because he was healthy but because he was medicated. Cholesterol, blood pressure and arrhythmia pills – he did exercise and eat right – after his first attack and his lifestyle improved intermittently – but he could not change that his arteries were clogged from many decades of not exercising and not limiting the meats, starches and gravies. OK and YES – he once smoked and he drank too much. He had had an aortic aneurysm at one point, also a cardiovascular disease indication and causally linked to smoking.

In reading about sudden death today, I learned that heart attacks leave scars and that the scars can lead to an electrical instability – in other words the heart doesn’t beat correctly. It can beat very slow or very fast. My father died when his was beating so fast it was fluttering instead of pumping.

My father was funny, smart, entertaining, gregarious, supportive, loving, compassionate and a few less positive things – but he was MY DAD.

Not everyone is a father – I get that, but if you are – as Father’s Day approaches – please, take care of your heart because your little girls and boys, no matter their age, really want to celebrate with you. And so, here goes Father’s Day number seven without my dad, as he died the Monday night after Father’s Day in 2002.

And don’t think you men without kids are off the hook either – eat right, exercise, don’t smoke, watch the salt, and slow down on the booze – 14 years is too many too give up.

Thursday, June 17, 2010

Are Statins for Everyone?

There is some discussion amongst health care professionals in regards to the use of statin (i.e. Lipitor, Zocor, Cresor, Vytorin, Simcor) medications to lower cholesterol. A panel is considering making the recommendations more personalized which could add people to the list of medicated and also remove them. You can read more about these recommendations and why they are being suggested elsewhere. My post today is more general.

I can’t remember the exact date or year that cholesterol numbers and medication became a household subject, but they are now. My first memories are of my father mixing up some powdered medication that he had to drink two or three times a day because he had high cholesterol levels. This may have been before his first heart attack, but certainly after. I don’t remember my primary care doctor talking about cholesterol levels before the year 2000. It is around then however, that health fairs began to offer cholesterol screenings on a pretty routine basis as did employee wellness programs. In fact, most personal wellness profiles or risk assessments include them now.

It also seems to me that at first the only thing they had us focus on was the ratio of good to bad cholesterol and that is discussed less often now. Then there was the whole thing about the good cholesterol or HDL and how to get it higher. Oh yes, and the great egg debate and whether cholesterol in food was the evil or if saturated fat led to cholesterol in the blood and was the real bad guy. Ah – nostalgic isn’t it?

Of course, the drug companies have blessed us with many more options for lowering our cholesterol – no more messy, yucky-tasting powders! And as the drugs have improved, it seems the target numbers, especially for that pesky LDL, have been lowered and lowered again. People with no additional risk factors get one goal number and people with any variety of other risk factors get others. It has even been proposed that everyone get on the statin medications regardless of their cholesterol status. Ah but you see – these medications are not without side effects and do require routine blood work to check for damage to other body systems.

What I like to ponder and hope that you will as well is the outcome question. This has come up in the public health discourse with more frequency in the last few years and that is a good thing. It is not enough for a medication to limit or reverse a condition that leads to a more serious disease or disease outcome; it also needs to reduce the number of those adverse events. (You can think this through with many a risk factor or condition and a disease)

So let us take high cholesterol. The reason we want to lower cholesterol in the body is because too much of it can lead to atherosclerosis or plaque build up in the arteries. This makes the walls of the arteries thicker and they can become so thick that blood won’t pass through them. Pieces of plaque can also come off the wall and clog the artery. Sometimes clots travel through and clog veins as well. The outcome of these scenarios is a heart attack or stroke and possibly death. So the question is – regardless of whether the medicine lowers the cholesterol number- do these drugs stop heart attacks?

I am sure that the information to my research question below is available to some extent, however, I do not have the liberty, i.e. time, to explore that and will just offer it as food for thought. If someone were suggesting that I take one of these medications, however, I WOULD make the time to find the answer.

Question: Which of the following interventions reduces the number of heart attacks, strokes, surgeries, death – etc in patients with high cholesterol?

Statins alone
Statins with low fat calorie controlled diet and daily exercise
Low fat calorie controlled diet and daily exercise alone

And yes, you already know what I think the answer is – though it may depend on other factors of a particular set of people as well.

Wednesday, June 16, 2010

Men's Health

Though I believe in the campaign goal, I am not certain if the methods for reaching it are appropriate.

I am referring to a health promotion campaign that is a joint effort by the Agency for Healthcare Research and Quality and the Ad Council. Using recommendations offered by the US Preventative Services Task Force with regard to screening for and preventing disease in men, the AHRQ has posted a checklist on their website and a printable chart to be used to keep track of screenings. This is in response to the fact that men in general die sooner than women and have much more incidence of preventable conditions than women do. It is also known that men visit the doctor less often than women. There is some speculation as to why this might be based on social and behavior theory, but to my knowledge, there has not been a study or broad survey of men to find out what is keeping them away. Behavior experts suggest it has to do with feelings of invincibility and pride. Either way – it would behoove everyone, especially the men, if they did get routine care and screenings. That is the goal of the ad campaign – the intermediate goal. The long term goal is less disease and increased life expectancy for men.

Please see the checklist and recommendations here.

The Ad Council has some print and TV spots that I do not think are going to be effective. I wonder if the ads were pilot tested and created by health communication or social marketing experts. I haven’t a chance to research that just now, but do want to know the answer. The ads seem to use humor or sarcasm in referring to a man’s early demise because they didn’t have screenings etc. But my educational and professional experience point away from that strategy so we’ll see.

Another thing that the proposal doesn’t seem to address is that some men and women for that matter are skeptical over the screenings, prevention methods and medications. I have had many people, especially over age 60 say that they think the tests are needless and just ways to get more money from the patient or insurance company. Now if that is really the perception for a plurality of men, then this campaign won’t work because it is hitting the wrong obstacle.

You can see some of the ads on the Ad Council webpage.

Tuesday, June 15, 2010

The Get Sick Later Die Quicker Plan

An article regarding company Navistar’s retirement benefits plan caught my attention. Shortly after reading it, I saw another article on retirement plans in general and it appears that they are headed the way of the dinosaur. The Navistar case is not an uncommon one, but it is more specific to changing drug benefit coverage than to axing the plans altogether. Many benefits managers do want people to switch to Medicare part D drug coverage as soon as possible. It is suggested that the Medicare drug plan has improved and will be less of a burden to retirees than it currently is with the infamous donut hole. Medicare D, however, may not cover all drugs or the most expensive ones – of course, that is fine by me, but I am not reliant on those drugs.

In Navistar’s case, again, they are one of many who receive government subsidies because they provide drug coverage. Those subsidies are also going to end with Health Care Reform but even with the subsidy, the cost of buying meds for former employees as well as current ones has just become unsustainable. According to the article that is published in Monday’s WSJ, this subsidy has been 600 dollars per year per person in the plan. Holy COWS. That is about 55 dollars a month on prescription drugs – a lot of drugs if they are the ten dollar generics and one very expensive drug if not.

Here are my main thoughts on this. First, the perk of having lifetime insurance from an employer is fading fast and probably will become extinct. Why it worked and why it won’t work have to do with health, health care and aging. The same issue plagues the Social Security system which had the same business model. People were NOT supposed to live this long. It would be great if they lived long well, but they don’t. We have made advances with medications and testing, which means the younger employees cost a lot of money to insure and the older retirees cost a lot of money to insure and do NOT die.

We must find a way to condense all this sickness into five or ten years, preferable after age 90, instead of living with disease from age 35 to 95. We must also address the incredibly high costs for medication and the use of medication that does not have any direct impact on health. Imaging is another area where too much is received and can actually lead to other unrelated health problems.

As I pondered my blog idea for today out loud to a friend, not yet 65- she brought up still another point. Forget Medicare part D – she doesn’t want A – B or any other letter because she keeps seeing signs that say, No New Medicare Patients…. Well – Medicare and Medicaid don’t pay much – and are riddled with fraud anyways….

There has never been a greater need or reason to pay for prevention. We cannot afford to test, treat and medicate all of these people for diabetes, hypercholesterolemia, heart disease, other obesity related illnesses, chronic lung disease and the like. The only way to salvage these health plans is to prevent the diseases that drain their coffers.

Monday, June 14, 2010

Beyond Staging

Staging is a strategy that I have used and recommended in that past. It can also be called visualizing. People use it to prepare themselves for difficult situations. The situations may be ones in which the person has previously experienced a bad outcome, i.e. drinking or drugging when trying to be sober, or drawing blanks during important testing or interviews. It could also be that someone has never been through the experience before and is very worried to try the new thing, worried of failing. In either case, the object is to see yourself, see yourself in that situation, succeeding if not excelling and hence, staging the result. Ah, to be the “star” of your own little drama – and you the screen writer too!

Sometimes our thoughts propel us into panic and defeat – perhaps we take the bad scenario from above and in our fear of repetition set ourselves up for that very same trauma. As I may have mentioned in the past, I knew a psychologist, Dr. Loretta Sylvia, who worked with patients who suffered from PTSD – stress from past trauma. In a presentation, she noted that the brain remembers the way things were headed, not necessarily the way they turned out. Her example was a person in a war situation who thought they would die. The person was rescued and yet when triggered, the recall from the past is “death is at hand” and panic can be extreme. The brain forgets the part of rescue and safety.

My thoughts today are not so grave and people with PTSD would do best with a licensed professional – but I do believe most ardently, in the power of the mind. Buddha is credited as saying something to the effect of, “we are our thoughts.”

My very simple real life example of the power of self talk – to defeat or transcend defeat- comes from a recent run. I was challenging myself and I was nervous because last summer around this time many things transpired to result in my not running for several months. The start of my downfall was the heat. I recall one or two long runs where I had to find shade and stop and regroup, every mile! So a few weeks ago as I was running along, that memory struck me. I began to think that I was going to get dizzy and then the cascade would begin. Everything would fall apart because that is what happened in the past. I then engaged in this self talk which is transferable to any situation really and here it is:

Stop thinking about how you FELT and start thinking about how you FEEL, even better – think about how you WANT to feel… It worked. And you know, every time you add a success to your story – you can build on that.

Here is another example – blood draws. For most all of my life I have fainted when I had blood taken from my vein. I do not faint as in dainty swooning, but go full out – eyes to back of the head, often requiring ammonia salts to the nostril and 24 hours of bed time to recuperate. It was like that until it wasn’t anymore. What changed? I talked myself through it – depending on this steel trap of mind that I have and blind faith.

I won’t forget the first time either. I lay on the table, facing the wall with my arm rather slung over me, behind me, i.e. I could not see my arm, the phlebotomist or anything. I still do it that way. But I remember thinking to myself and saying to myself, (I was in my 30s) – today is the day that I am going to call my Dad and say, “I got my blood taken and did NOT faint.” Other messages I sent to myself involved how much I had to do that day and how fainting was not an option. It worked! And from then on, I set the stage and I KNOW I can do it because I have done it before – first time, blind faith, the other times, build on past success.

The very first time you do not smoke after you quit is the hardest – dealing with every other craving can be accomplished by reminding yourself, “I have done this before.” Same with your first day not eating the cupcake. Your first time going to the gym – etc etc.

The mind – use it, don’t let it use you.

Sunday, June 13, 2010

Odds and Ends

First I have to tell you that one of my dearest friends recently sent me her version of Odds and Ends which nearly had me rolling in the floor with laughter – I am absolutely going to let you all read it – however, it tells a little secret that I can’t share yet – so maybe next week!

For now – you are stuck with my not so funny brief points from the past week.

Positive Note on Drug Studies: Wow, yes I am going to admit that kudos is due several big Pharma companies – Pfizer not being one of them for some reason. The good news is based on a great many failures, which is ironic, but instead of just having a bunch of failed drugs, we may be able to put all that time and effort already spent, to another use. I am referring to the unfortunate truth that no company has found a drug to reverse or even reasonably treat the disease of Alzheimer’s. It does not appear that any advance has occurred since my years of working with this population (2000-2007). Then it was more a matter of treating symptoms and trying to modify behavior both environmentally and sadly, chemically. Alzheimer’s Disease is also a condition that leads to progressive despair for loved ones. Now several companies have agreed to put it all on the table. Scientists will be able to see what was tried, what affect the treatments did have and how. Perhaps in the failures will come a greater understanding of the disease.

Negative Note on Drug Company: Geez Johnson and Johnson – it is alleged that you paid people to go buy medicines on the down low so you wouldn’t have to recall them on the up and up – You know what happens when they do that in China? Let’s just say it is slightly worse than a blogger curling her nose at you.

Drugs again?! Sorry, but I heard this on the beach today. (Gulfcoast in SW Florida – still beautiful). Two women were chatting and one asked the other if she had seen the commercial that talks about depression. The one that says maybe if your medicine isn’t working you should add Abilify. AACK! How in the world two psychotropic or mood altering drugs could be better than one completely escapes me, however the real point is what she did NOT say. She did not say, “has your doctor ever suggested a different medication or a different approach to treatment?” Of course, the IDEAL statement would be “has your psychiatrist…” and the perfect-world statement would be, “hey, have you ever tried exercise for treating your depression – I hear it works wonderfully and has no adverse side effects.”

Illusions: A David Shaywitz reviewed a book called the Invisible Gorilla and the book is probably great, but the review was awesome! I was reading along thinking how well written the article was and then saw that the person writing was actually a professor so his grasp of the subject and ability to write about it was less surprising. Let me just say that the book discusses many misperceptions or illusions that we all seem to have. We remember things inaccurately and believe less in our faults and more in our abilities and even attractiveness. The book authors may be looking to knock us down a peg or two, but Dr. Shaywitz argues the opposite, and I so agree. It is better, maybe to think yourself more capable then you are because without that confidence you may never try to do something that you actually CAN do. Several years ago, a friend in NC, Beth, told me that my mind was a steel trap – I would do what I said I would do – I think that a strong sense of belief, illusion or no is a great tool to have!

Saturday, June 12, 2010

9/11 Settlement and Cause

I want to revisit this issue today – the issue of lung damage in the first responders to the tragic crash at the World Trade Center on 9/11/01. Some months ago I explained the results of a seven year study, led in part by Thomas Aldrich. You can read the study here. I bring it up again because it is important enough to, but also because this week another proposed settlement is being offered to those brave men and women – fire fighters and emergency medical service personnel, as well as police and others. Today, I can understand the results of the study better – and explain it better. The results have helped establish that real, extensive and permanent harm has occurred. The settlement may best be explained elsewhere, but I will attempt to get the gist here.

Tens of thousands of persons have sued the City of New York, the Port Authority and others for what they feel – or their attorneys’ feel- is negligence with regard to supervision and protection after the crashes. The hearings and negotiations have been going on for some time. One bone of contention is lawyer fees and compensation. There is also a fund set up already, from a federal grant that addresses some of the payout. Workers are concerned about diseases that they currently have and ones they may develop. To be clear, though Dr. Aldrich’s team only studied the lung function of fire department and EMS workers, similar outcomes would be expected for some of the plaintiffs. It looks like there is an option for a one time payout, for payouts based on severity; chronic, acute, progressive, disabling – and also access to medical care – though that may be included in the federal grant as it is referred to as an insurance fund.

In rereading the NEJM study, I see that the subjects in that study had a significant and severe loss of lung function in the first year after 9/11 and those that responded earlier and longest had the worst outcomes. Here is what I didn’t know so well when I first read the story - lung function testing by spirometry!

So the FEVone – Forced Expired Volume – A person blows ALL of the air out of their lungs (measured in liters) and the amount that comes out in one second is captured and compared. The rescue workers had at least normal function before 2001 – (Normal is to expel about 5 liters in the total exhale and the FEVone predicted would be at least 70% of 5 liters. Most responders were between 3.5 and 4.5 at baseline). There was a significant decline in the first year and this did not rebound. The results continued to stay below the baseline over the years, with EMS workers starting with the lowest values but FDNY losing the most. It appears that each set lost a whole liter w/ regard to FEVone in six years. I mean that if their baseline FEV was 4.5 liters, after six years, the same test results in a 3.5 liter FEV one. [There are 1000ml in one liter]

An average person – non smoker- loses around 30 ml a year. Though the average ml /year lost by these persons was similar – the first year they lost an incredible 267 to 585 ml. Remember you and me, who do not smoke or have other lung impairing exposures only lost 30 ml that year! So though the rate of decline has not kept accelerating for these people, the loss from baseline has remained. The loss of function in smokers was not as drastic at first because they had poor baseline numbers – but their over all outcomes were worse.

There was also a small percentage of persons with the classic less than .7 FEVone that could be indicative of COPD and probably is, as Dr. Aldrich told me that there was coughing and shortness of breath in the study participants. We know now what this could mean - years of long and short acting bronchodilator therapy, corticosteroids, oxygen, pulmonary rehab, lung volume reduction therapy. There is every reason to believe that the responders will have some limited amount of functioning, possibly a debilitating condition and even death.

This does not even begin to address the risk of cancer that these same people face and the significant increase for both that smokers already had and have – who will sort that out?? I believe that the plaintiffs have a lot to think about and now we can all understand WHY, a little better.

Friday, June 11, 2010

Live Long

This morning I told one of my friends that I was going to ready about this new website I heard about called The commercial I heard made it sound like a public health type of program from the state of Florida, but once on the site I felt that wasn’t the case. It is a hospital generated website and it does have interesting tools and features, including a questionnaire you can take to see what age you might reach. The questions are not all the usual suspects so you might give it a whirl. It does give you a conservative and potential age along with the expected. My numbers ranged from 83-100. I do hope that those would be healthy years! So you can check out the site and see what you think – they have a registration feature – if you like. I am less than enthusiastic because they have their own blog and why would I want to send you away!

Thursday, June 10, 2010

Tobacco Summit

Alright then - back home and ready to give a brief update. The points below regard the subjects I mentioned yesterday and are related to the presentations of the following persons, in the order listed. Danny McGoldrick from the Campaign for Tobacco Free Kids, Michael Campos, pulmonary physician and researcher with the University of Miami, Tracey Barnett, researcher and professor at the University of Florida and Victor DeNoble, scientist who formerly worked for Philip Morris.

FDA Regulation of Tobacco: I have mentioned the new law in many past posts, today I just want to add that the changes that are mandated in the Act are occurring over a period of time, not all at once. The first change was the ban on flavored cigarettes. On June 22, the changes related to smokeless tobacco labels and the words light and low tar on cigarette labels goes into effect. I did not realize that the law that mandates a cigarette warning label that takes up 50% of the package was to include graphic images and that it would be required on both the front and back of the top half of the package. Cool beans. But the law provides two years to create the warning and another 18 months to institute it - so it may be 2012 before that happens. Bear in mind that regardless of where the cigarettes or smokeless tobacco products are made - when they enter this country and are sold here - the rules apply.

COPD Dr. Campos was pretty true to everything that I had read and described in my recent postings on this disease. I do not remember reading about the alpha1 antitripson deficiency but learned today that it is a condition in which the body does not make or make enough of a certain protein released from the liver. This protein protects the lungs from damage. People who have this condition and who smoke, will have COPD. The test for the condition is just a finger stick and it is available for free in Florida. The treatment is an injection of the protein and it is VERY costly. From Dr. Campos also comes these words - the number one thing to do for COPD is to quit smoking and to undergo pulmonary rehab. The recommendation for rehab was not news to me, but what is taught in rehab was new AND important. The patient is taught to breathe differently. Usually the COPD patient breathes in but has difficulty breathing out, so some air is trapped in the lungs - this is the hyperinflation that increases lung volume. In rehab the patient is taught to take small breaths in and to exhale longer. This can increase their exercise capacity which is crucial in reducing mortality rates.

Hookah If I have not mentioned it before - the Hookah is a water pipe that is commonly used in middle eastern countries - if you watched the movie Sex In The City 2 - you saw a Hookah pipe. They are used to smoke tobacco - sometimes flavored tobacco - or sometimes flavored water is used. The pipe has coal on top and a bowl underneath which contains the tobacco which is most often imported. The pipe looks a little like the I Dream of Genie bottle and has water on the bottom. A tube comes from the bottom and people take turns inhaling tobacco smoke from this shared tube or hose. Hookah bars or cafes are showing up in the USA, especially near colleges. The clientele is usually aged 18-24 and most often white. Dr. Barnett shared fascinating research on the amount of carbon monoxide people in these bars absorbed - whether using the Hookah or not. (since it is heated with coal, it is a little like barbecuing indoors) Most disconcerting are the ads - either on the store fronts or in college newsletters for things such as "All You Can Smoke" nite or "Smoke Till You Choke." Hookah smoke contains tar and carbon monoxide and cancer causing nitrosamines - it is not a safe alternative to cigarette smoking. (this presenter also talked about Snus - American vs Swedish, Orbs and the other smokeless products I have mentioned to you.) Oh with regard to the Orbs, strips and sticks - they are for sale in limited cities and they appear to be displayed with the candies or mints. No one seems to understand how this is happening. The label states that it is a dissolvable tobacco product. There has been concern about toxicity with the products because they seem to attract children and children have gotten sick on the Orbs. For that reason, a study was done and it was determined that nicotine, at least in this form, is toxic at 1mg/kg body weight. Well that sounds off but I still have my slides here and that is what it says. It also suggests that 16-27 Orbs is likely a fatal dose for a 4 year old. I do not know if they mean our overweight 4 year olds or normal weight ones!

Now I am glad to be home and wish you a good night!

Wednesday, June 9, 2010

On the Road

Hello! Just arrived in Orlando for an all day work related conference on June 10th. I am excited about the topics which are:
the Hookah pipe
the E or electronic cigarette
FDA regulation of tobacco updates
the neurobiology of addiction -
these are all topics on which I educate so I hope to have some new things to teach by the end of the day. If time allows, I will share the most interesting things with you tomorrow night.

Tuesday, June 8, 2010

Take Charge

I have to give kudos to journalist Lauren Neergaard from the AP for a great article published on Yahoo! News June 7th. She discussed a matter very close to my heart and had references to organizations and groups that were working on the issue. The issue to which I refer is unnecessary medical tests or services.

An interesting phenomena with people and MOST especially people in the USA, is that they believe more is always better. In fact, having a test or drug that you don’t need can be as harmful as not having those that you do need. Knowing the difference is challenging, but you know what, it really is YOUR job to figure it out.

I would call your attention to the American College of Physicians, the Foundation for Informed Medical Decision Making and the Dartmouth Atlas of Health Care. The last mentioned has information on the vagaries in health care spending by location. Ms. Neergaard noted the difference spent on care between Idaho and Miami – with regard to hospital days in the last six months of life. The literature is rife with examples of little to no benefit for much of the extra testing, medicating, cutting and hospitalizing.

When politicians get involved in this – which really calls for an overhaul in the way we do things- then the accusations fly and fear tactics begin. Less care may in fact ADD days to your life not take them away. I am telling you that the over radiation issue is NOT going away, but gaining clout. We (the patient and the clinician) have GOT to understand that just because a medicine or a test exists does NOT mean that we need it. Of course the companies that have made the test or the drug or the imaging machine – or hospital for that matter, want you to USE it and the more users and uses the better – but the people who make cigarettes want you to smoke them too, that doesn’t mean you should!

I would hope that all physicians are conscientious people who not only want to do all the research necessary to provide the best and the necessary care but have the TIME to do so. It isn’t likely. The American College of Physicians has some great guidelines for care and testing on their website and the Foundation for Informed Medical Decision Making is working to provide patient friendly materials to guide us. I have a good physician – I have chosen him and my last two providers with great care – in the last ten years, I have been very discerning in this regard. So must YOU be.

I will tell you some truths. Truth one: Your most valuable possession is your body and your mind. Truth two: No one has a more vested interest in the health of your body and mind then YOU do. Truth three: You are the BOSS of YOU – the KEEPER of YOU – the GUARDIAN of YOU. Truth four: In the end, you own your actions and inactions. Health care cannot be a passive activity – get informed.

Monday, June 7, 2010

Insulin and Cancer

I was able to hear some of an interesting discussion on a local radio station (WMNF) this afternoon. The premise related to results released during the just completed American Society of Clinical Oncologist annual meeting. The shows guest was a nutritionist out of Sarasota Florida named Eve or Eva. The show is available in archives on the radio station website, but the guest's name is not spelled out - sorry about that. That particular Monday show (1-2pm) is related to alternative medicine.

I am most often not a fan of pills or alternatives to them if they include herbals and supplements, but that does not mean that I am closed "eared" to other views. A few interesting points were made by Eva and I would like to share them.
  • Sometimes the medications that are created to treat cancer can cost up to 80,000 dollars a year to use and cost BILLIONS to create. Often the drug is able to prevent progression of a cancer temporarily or add a few months of life - Eva suggested that the money be used to address ways to prevent disease, perhaps through nutritional programs and also to address the toxicity of our environment - as opposed to adding 16 weeks to a persons life. I tend to agree with her - though she was clear that situations are different. A mother of small children for example, would most benefit from the extra months.
  • Insulin in the bloodstream is fuel for many cancers. Though I wasn't able to follow the entire discussion, I understood this to mean that insulin was food for the blood vessels that are created in some cancers - tumors feed on these blood vessels and become larger. For this reason, the nutritionist advised that people, with or without cancer, be mindful of the amount of sugar in their diets AND the amount of sugar consumption at one time. She said that more than 2 teaspoons at once was going to trigger a significant insulin release. She noted the glycemic index and spoke of fruit sugars in the context of fiber. She was not promoting juice and suggested that any "juicing" of fruits be of the organic kind - instead of making a concentrated pesticide brew. Read more about the fructose connection here.
  • In regards to treatment of cancer, Eva/Eve did NOT come out against traditional treatments and did say that the first thing to do was shrink that tumor with any means possible (including surgery, radiation, chemotherapy). I believe she said "debulk" the tumor. What she is against is ingesting daily doses of poison which in her opinion(based in research), has NOT been shown to prolong life or cure disease. She did say that there was substantial research to show that the more fruits and vegetables consumed the less cases of cancer incidence and cancer recurrence there is. I did not fact check her statements.

That is all I have for today - I hope this blog made you want to eat an apple :)

Sunday, June 6, 2010

Odds and Ends

Okay I have five issues with brief comments this week

Osteoporosis and Drugs: I have two things to say about this. The first is that a new drug has been developed that is supposed to be better tolerated and perhaps more effective than the more common bisphosphonates and secondly, I heard a commercial last night for one of the four or five drugs we already have for this “condition” and in that ad, an actress said, “ one out of four women are at risk for osteoporosis.” I have blogged about the concern of some scientist physicians on treating at risk conditions. Recalling that one researcher referred to osteopenia as being at risk for being at risk for breaking a bone. All that aside, 25% of all the women in the world over age 40 is a gazillionmillion – or a lot. And that is why drug companies refer to their new medicines as blockbuster drugs instead of the more appropriate life enhancing, saving, improving, etc

Empty Stomach and Fat Burning: A study published recently is causing a bit of an uproar in the exercise physiology arena. People who exercised on empty stomachs burned calories a little differently. The study subject burned more fat. Anytime you say that people burn FAT everyone gets excited but burning fat during exercise and immediately thereafter does not always and in this case did NOT equal losing fat as in weight loss. There are many reasons why one should not do intense cardio work on an empty stomach and just as many for why one should not do it on a full stomach. As a somewhat educated person in this field I offer my two cents. The very first question to ask when planning for your next preworkout snack is “when was the last time you had anything to eat?” If it was two hours ago or so – fine go on ahead and run, cycle, take a cardio class. If it was before you went to bed then I suggest a small bit to eat. In my personal experience, if I am running over 3 miles I need a little something. But also be mindful that sometimes when you are REALLY pushing yourself – food in the stomach is your enemy. Bottom line – think about it and make your own decision. Performance will always be affected by what you do and do not eat – but weight loss will always be about the calorie differential over time.

Lung Cancer Blood Test: A test is now commercially available in the US and UK to detect a certain type of antigen or inflammatory marker in the blood stream that could tell if a person has lung cancer. In my reading about this, I saw that at least one physician uses it in people who have been smoking for at least 15 years. Not everyone is excited about the test and I found it interesting that a clinician in Australia, where it is not yet available, thought it would benefit them to watch and see if this test is accurate and meaningful with the USA population before they start using it. Sounds like a plan! There is some debate on whether or not this will be any more useful that the PSA test for prostate cancer (will it prevent death) and from the test companies perspective, they also want to find markers for all the other cancers so the test can be used for those as well. At this time, insurance coverage for the test is uncertain.

Age of the Artery: Funny thing about those arteries – they tend to clog up as we get older. Some cardiologist are using test results and risk factors to calculate a persons artery age. Sure does remind me of the lung age I recently mentioned. The artery age formula is a bit different and in my opinion, less scientific than the research that has gone into determining a persons projected lung age. The problem being that very few people would have normally aging arteries as the plaque that builds up and occludes the artery wall is related to smoking, fatty acids, hypertension, diabetes and the subsequent inflammation and endothelial dysfunction. One can have normal arteries but they are referred to as “young” or atypical because so many other peoples are significantly older than they are. It is true that our lifestyle (activity and consumption) has changed so much over the last 30 years that our 40 years olds have the arteries of what would have been an 80 year olds. This is sadly true of younger and younger persons. The flip side is that an 80 year old can have much clearer arteries than a 20 year old if that 80 year old eats well, exercises and doesn’t smoke. I am not sure why we need another test to make that point.

Physical Fitness/Shape: Observing people around me – friends and strangers – as well as professional athletes and fitness leaders, has led me to feel somewhat better about myself. WHAT?! I know – comparisons usually lead to plummeting self esteem but let me explain. I take the physical activity guidelines or recommendations to heart. The recommendations suggest that we incorporate cardio activity, weight training, core and balance work into our weekly routine. Because I do, as do some of my friends, my body has some shape to it – some definition. My hard work actually pays off. I have noticed that some runners, shorter distance runners, who cross train with pool work and weight training, also have really fit looking bodies. At the same time, I have noticed others who run – only or walk only, for that matter – who look soft in the middle and lack definition. If your goal is just to burn off calories then I suppose it doesn’t matter, but if you want to be FIT – it takes more than that.

Saturday, June 5, 2010

More Claims Face Sanction

It isn’t just herbal supplements that claim health benefits that are false, the FDA and FTC have also questioned Kellogg and General Mills on claims that they put on cereal boxes. To be certain, Cheerios are not an effective cholesterol lowering food and Rice Krispies do not improve children’s immune systems. Both companies have recently or in the past been admonished and sometimes fined for such falsehoods.

I can’t help but wonder why the NutriSystem company hasn’t been called out. The claims that companies make have to be backed by science and can not be misleading. I feel strongly that NutriSystem ads mislead people, especially when they promote a meal plan for diabetics that states it is “based on clinical studies” – what does that mean?

What you should be more inclined to believe is this – food in its natural form – fruits, whole grains, vegetables, legumes, some seafood – THEY are antioxidant rich and a diet that is based on them is better for you than one that contains a lot of processed foods. I do not CARE what they ADD to the box it is still food in a box and that means it is processed.

Remember, maybe it was last Sunday, the odds and ends note about those vegetables – immune, vision and digestive health – I wonder if the FDA/FTC is going to check on that one. I haven’t read the rest of the label though – if the name of it is the only leading thing I bet it passes by – but if it claims to improve those things – then it is apparently suggesting that it has medicinal properties and the FDA has to approve medicines and their outcomes – which must be proven in clinical trials!

Friday, June 4, 2010

it just doesn't DO that

It is no secret that I do not endorse the use of herbal supplements for any condition. I am not an herbalist or physician so my not endorsing something doesn’t really have practice implications, but as a health educator I will share my reasons. There is very little evidence to support that the use of herbal products has any positive effect on health. Instead there is research that indicates a risk for detriment – to say nothing of the impact on your bank account.

Herbals include ginger, ginkgo biloba, garlic and ginseng to name a few. And the reason I name these few is because they were the target of a pretty interesting undercover operation of the Government Accountability Office (GAO) in the USA.

As you may be aware, the FDA does not approve supplements but is responsible for evaluating complaints on adverse outcomes and contamination if such issues come to light once the pills are on the market. The FTC has the responsibility of assessing label claims, which are really not allowed in anything more than a general sense. So the GAO sent investigators to several retail sights and also contacted website sites that sell these products – under cover of course.

Several misleading claims were made in print and verbally for which the FTC is now involved. Contaminants were also found in 37 of the 40 products that were independently tested. Of course, the lead, mercury, arsenic, cadmium and pesticide residue was NOT found at a level that the FDA and EPA think are harmful – “hello? I’ll take mine without the lead please and thank you very much.” [note that McDonald’s has just today recalled its plastic Shrek tumblers because they contain cadmium”

The study was commissioned in large part due to the marketing claims made towards the aging population – oh those baby boomers and their quest for memory enhancement and cholesterol control – the GAO wants you to know:
Gingko biloba does not treat or prevent Alzheimer’s, erectile dysfunction or depression. Garlic does not treat obesity, heart disease or hypertension and ginseng does not cure cancer. There is much more to read in this report, which as a government document, is available in full here.

Thursday, June 3, 2010

Motor Vehicle Accidents

I apologize that the idea for this post formed in my mind late in the day and I seem to lack the energy and time to process it fully. Instead it may be more a post of what I am curious about then what I have gleaned from the research or data bases. (which by the way, were not very friendly with me today - all my searches pulled up variants of my query but not direct responses - sigh)

As it were, a few days ago I saw a print piece that discussed the time when adult children should take the keys away from their aging parents. In that article there was mention of a higher rate of traffic accidents in the older population - really beginning to become serious after age 65. The article also mentioned resources available to assist the compromised parent in keeping driving and when that was no longer appropriate - to assist in remaining independent through other transportation options. Today, a report came out regarding the nations most dangerous highways and three of the top twenty were in Florida!

However, the highest rate of accidents, per 100,000 persons, is NOT in the older population but the younger. There are different reasons for the accidents between the two groups.

There are several sources of information available and then there are other people's reports on the numbers. I am trying to stick with the real numbers and in that the NHSTA has a recent report which includes 2008 data. In that report they estimate just over 50,000 drivers were involved in fatal crashes . Now the numbers per age group are also going to be related to the total number of drivers per age group - but in this raw data, there were more fatal crashes in the 20 - 29 category than in the over seventy group. The report then breaks down fatal crashes caused by a distracted driver and in that area, the group with the highest percent of distracted driver was the under 20 group at 16%. The lowest was the 50-59 age group at 9%.

It appears that of the over 34,000 (I know this doesn't match with the 50,000 drivers but I don't know why) fatal crashes for 2008, 16% were related to distracted drivers. That made me wonder what were some causes of traffic accidents and I came up with these - to which you can add I am sure:
driver error

A driver could be distracted for many reasons, the NHTSA does differentiate them and that is how they come up with reports on how many accidents could be avoided if cell phone use while driving was banned. There are some interesting subcategories in the "driver distracted by" heading, such as:
other occupant
cell phone
navigation system
moving object in car (animal/insect/cargo)
outside person
etc etc etc

One might also consider which age group "in general" is more likely to engage in behavior that puts them at risk for a crash. Younger drivers may speed, fail to look and yield, may be more likely to use cell phones and ipods and to drink and drive. That puts them in the highest risk category. And it would seem the highest fatality category.
The eldest driver is not as likely to do those things, but is more likely to be visually, reflexively and cognitively impaired. Elder drivers are more likely to go too slow and in fact, are more often the cause of accidents than an accident fatality.

With regard to the elder driver - these websites may be helpful:
driver rehabilitation
passenger services for seniors
independence related services

Wednesday, June 2, 2010

Oral Health

I had my regular dental checkup – cleaning – exam this week and the dentist said a few things that I thought, as he was saying them, would be good to share in the blog.

Firstly, the hygienist said that it was time for X-rays to which I said, “no thank you.” Then she cleaned my teeth and all was fine. The dentist poked around, all was still fine. “Everything is looking good. Any sensitivity… here?”, he asked. “OUCH – yes.”

Funny that it wasn’t an issue until he stuck that sharp probe against it. So it turns out that on one or two of my teeth the enamel is worn off near the top. When can you remember ever having a dentist say this, “You just need to back off the brushing a little bit there.” To which I replied, “Okay!”

I then stated with some uncertainty, “Guess I shouldn’t use those whitening strips again.”

His response was the “light bulb” moment for the blog. He said in fact that it was not the bleaches that were harming my teeth, but the toothpaste. He said that these days the whiteners are found in the strips but also in toothpaste. As he said, the strips use bleach but the toothpaste contains abrasives. He used the word, silica something or another and said, “But for you and me, that means sand.”

So I should go a little easy on the spots he noticed – okay. Then another question struck me – so, which is better a manual or electric toothbrush? He said that in “my” situation, the manual. I said that would be fine, I would get rid of my electric if they gave me a free toothbrush J

The dentist also said that I should concentrate on my gums with my toothbrush and maybe use a fluoride rinse as well to protect my teeth and to ease any pain. (Really I have NO pain under normal – not being poked with sharp objects- situations).

So that is a little anecdote about MY mouth – the only real take home message for you is to see your dentist regularly. Do take good care of your teeth and gums as gum disease or periodontitis can have systemic effects. Periodontal disease has been linked to heart disease and pregnancy complications.

Tuesday, June 1, 2010

North Carolina to China - Rice Paddies to Tobacco

I saw on line and in print, that Reynolds American – one of the top four tobacco companies in the world- was shuttering one of its oldest cigarette making factories. It meant something to me because the RJReynolds factory is/was (for as long as I can remember) operating in Winston Salem NC. My parents, a sister and I, moved to Winston Salem in 1973 and for years when our family would visit, we would tour this cigarette factory. Reynolds American has been most famous for the Camel, Winston, Pall Mall and Salem brands of cigarettes. I smoked Salems just briefly because my sister smoked them – but for most of my smoking “career” I smoked Winstons in the red and white box. Cowboy killers we called them and indeed the man who was the face of Winston in magazine ads is said to have died of lung cancer. Not too long ago I wrote about Susan Ivey the CEO of Reynolds American, which owns and controls RJR. She has the company focused on smokeless tobacco products as RA recently purchased the company that makes Grizzly and Kodiak moist snuff. They are also marketing nontraditional products such as tobacco containing snus, orbs, sticks and strips. The move by the company is in direct response to the significant decline in cigarette consumption in the USA and some other countries.

Ironic then, that as I was reading about this, on my TV the PBS show News Hour was airing a piece on China which has the highest rate of cigarette use in the world – 60% of the men in China smoke. Even though the other big American tobacco company Philip Morris spun itself into Philip Morris International to get a piece of the less regulated tobacco industry pie, they aren’t getting the benefit here. This is China and the government pays it’s people subsidies to grow tobacco and it makes the profit on the sales. The Campaign for Tobacco Free Kids, a research and advocacy group, has a page on China that you can view

According to the News Hour show, which did have a spokeswoman on camera from TFK, 1 million Chinese die each year from a smoking related disease. It is projected that 2 million will die in 2020. The deaths usually associated with tobacco are from heart disease, COPD and cancers. The lung illnesses and cancers develop quietly over the years and treatment options are very limited. Heart disease and stroke will happen more quickly. China is introducing some of the same antitobacco policies that have been a thorn in the side of RA and PM however, it is government vs. government there and right now – the tobacco is generating a great income – 20 years from now it will generate great expense.