Odds and Ends

No Stir - Trickery:  First - the use of the term All Natural is not regulated by a clear definition - according to the FDA labeling law, it only has to mean minimally processed.  This is not news to you, I have said it in the past.  It is also not news to most of you that I am a devout fan of Smucker's All Natural Peanut Butter which actually IS all natural in that it is peanuts and salt - period.  This means it does not stay solid at room temperature - it separates.  That is a VERY good sign - the fat in that peanut butter is the good kind.  It requires stirring.  So this weekend I saw brands that said "natural peanut butter - no stirring required."  I turned the jar over to the NFP and read the ingredients, which included palm oil and ADDED SUGAR.  Don't be tricked!  The stirring is what makes it healthy - and don't be afraid to stir - I even You Tubed the stirring  - to help you out.

Age of Diagnosis:  A story that I glanced over this week regarded breast cancer in older women.  I believe that the women were over aged 65 when they received a diagnosis of breast cancer (and I believe that the study referred to a specific type of BCA - a more common type).  In these women, the cause of death, when they died, was not breast cancer but heart disease. Again, heart disease is the number one killer of Americans and it is related more often to saturated fat intake and being overweight.

What's Your Doctor Prescribing?  This blurb regards a supreme court decision that was made this week.  It has been awhile since I blogged about my disdain for drug companies but my disdain is very much alive.  Still, I was not really aware of the practice that the Supreme Court defended this week.  Pharmacies keep records of what medicines are prescribed by each physician - (physicians have a number - a DEA number maybe- that they have to write on the Rx form).  After removing all patient information, the drug stores can sell these lists to drug companies who use them to target doctors.  Here is an example this practice in action.  One state, Vermont, outlawed the transfer of information and the supreme court overturned their law.  Medical organizations are upset about this as they profess to not want  direct to doctor marketing. Perhaps it is less fun now that they cannot also receive free meals and greens fees.

Why I am Anti Craisons:  I may not have gotten to this in my Dietary Guidelines for Americans (DGA) overview, but it supports my advocacy for low energy dense foods.  Actually, I am pretty sure I discussed LED foods last night.  Well, Craisons - a dried fruit snack that keeps ending up as a free sample in my high fiber, low sugar cereal, are NOT a low energy dense food.  They have 3.6 calories per gram, where as melons have 0.37 per gram, apples 0.51, and much the same with most fresh, whole fruit.

National Prevention Strategy - Yes We Have One:  Actually, I think I will give this a separate blog day, but so you know, the focus of our strategy is prevention of disease and  promotion of wellness.  In this report, the latest numbers on obesity are given - adults  34% and children 16%.  How can children be obese?

Forget the Carrots, Your Eyes Need D:  The information I am sharing with you here is NOT to be taken as fact as I heard only a smidgen of the story.  The gist of it was that children have vitamin D deficiency (which the DGA supports as true) and that the lack of D is leading to increased cases of near sightedness.  An eye doctor and or researcher was saying that kids needed to spend more time in the sunlight.  I am sure that the show went on to cover sun protection.  What I want to add is the importance of protecting the EYEs themselves - are eyes, selves?  Well, remember the pinguecula post?  Put shades on those kids!

The Dirt on Grapes:  EEK- literally dirt.  I clean my grapes by placing them in a strainer that is inside a bowl of water.  I swish them around vigorously and then lift out the grapes and water my plants with the liquid (if they need it) and then do it again, and then rinse them just in the basket - after all that,  I eat them.  Both batches of rinse water are dirty, but the first is remarkably so.  Why am I telling you this?  In case you are one of the people who tastes grapes or any produce while shopping. (unless you are at the fancier stores that have washed and cut samples in a covered dish with toothpicks even).

Added Sugar:  Just to be clear, when the DGA suggest that we limit added sugar, they are not necessarily talking about table sugar.  Instead they mean sugar in processed foods and beverages.  So sugar in an actual orange (with its naturally occurring fiber) is the intrinsic kind - sugar is natural in whole pieces of fruit.  Sugar in a orange flavored snack - is added sugar.  (and as I was saying above, sugar in your peanut butter is ADDED)

No Interpretations Needed

I am going to link to two stories tonight because they are both spot on things that I believe and have written about and would write about again.  There is no need for me to regurgitate, or qualify them -


The first regards the rationale behind a sugar tax - though I have written about soda taxes, I am just as comfortable with this approach and will be passing this article around the community obesity coalition that I am a part of in Greensboro NC.


The second is another expert's advice to adopt the Mediterranean style diet - and by diet I mean foods that you eat every day - foods that fill your plate, not a plan that you employ for weight loss.  I eat a plant based diet that is Volumetrics based....


PS  - I have just read about terrible storms in the south with many lives lost.  The weather system is moving east through ALA, GA, parts of Fl, SC and NC even to VA by tomorrow - my heart is saddened by the losses and I hope that the advance warning will protect those in the path of these storms.  Apparently, the devastation is related to a phenomena called straight line wind, which comes out of a thunderstorm as opposed to the circular winds from  tornados - which are also a part of this system.  Be safe.

and the doctor said

Every now and again, I veer off the public health track and tell you a little personal story. That usually resonates well with readers and today I add to that.

With my impending - looming- move to NC on my mind, I scheduled a visit with my dentist, optometrist, and my primary care physician. I let them each know that I was leaving town for a while and after my visit I asked for a copy of my medical record to take with me. I will be so happy when that is an electronic record that I can access by password through some Internet portal. Anyway, they have all obliged and been very cool about it. Only one office wanted to charge me, but the doctor took care of that :)

Today I want to talk about the check out I had with my primary doc. I remember very well the first meeting I had with him. It seems that both my first and last visit was more talking than anything else. As the three years passed, I may have had one sick visit and one or two sports injury visits. I met with him in October of 2007 after I did some research (it was almost an interview, to see if we fit with each other.) I found a listing of clinicians that were accepting my insurance and then, as I have done for my last two or three docs, I found one that was a doctor of osteopathy who had also completed a fellowship (extra education/internship) in sports medicine. NOw if I had a chronic condition of some sort, like a heart problem, I might search for a DO with a cardiac speciality. In other words, this was about ME!

It has been a great relationship and many times we had dialogue that led to diagnosis and treatment suggestions. He knows, as have all my doctors, that I prefer clinical exams to Xrays and rehab or ice to medications. I was prescribed two medications during this time frame. One was for migraines, but after taking ONE of the sample, and finding relief, I have never taken any of the prescription. I do keep them in my purse because the day that I did take that pill I thought I was going to die. The migraines last summer were triggered by dehydration and I have been able to prevent a recurrence. My doctor also advised me to take one of the bisphosphonates for low bone density and I did, for about six months.

So when I saw him this past week, we touched base. He was very glad that I had added two serious weight training days to my routine. He feels that the muscle mass is important and running doesn't build it. He supports my running very much, and tells me to run as many miles as my body will let me, but ONLY running isn't necessary going to make me the fittest. He is also very pleased with my swimming. I too see the benefit of that in that it gets me off my feet and works my upper body really well. He thought that my taking 1000 IU of Vitamin D was exactly the right thing to do. He was not upset that I stopped the Fosomax because some people who take it don't have fractures and some people who take it do. (he said that the low bone mass and the risk for osteoporosis was pronounced in small framed whites and some Asians and there wasn't any way to prevent those risk factors) He supported the eye doctor's direction to protect my eyes from the sun and to use eye drops. My doctor said that with my running I needed wrap around sunglasses. I do not have those just yet. $$$$$$$$$$$ Oh and he told me to protect my eyes from the glare that I might get in NC from the SNOW!

I told him that I wanted to have one of those head to toe skin checks for precancerous spots etc. He thought that was a good idea and that I might get it done at one of the medical schools in NC - probably my former employer WFUBMC. And I was happy to hear him collaborate what I have said here, in regards to sunscreen. I should wear it of course, but there was evidence to suggest that anything over 30-50 SPF did not raise the protection level and wasn't necessary.

I think that is about it. He referred to me as fit and healthy and didn't examine me at all. The nurse had taken my vitals.

I will be getting health insurance through the University in Greensboro and will definitely take advantage of student services. I have my records should they be needed and I have my knowledge about health (which grows every day) and I know my own limits and strengths and am ready for this new journey.

whoop whoop

Whooping Cough:
(as it so often happens, while investigating this disease, I learned something about vaccines too) Firstly, I heard on the news and confirmed with the CDC and WHO that the respiratory infection pertussis also known as Whooping Cough is increasing in frequency in the USA and other parts of the world. The disease at one time effected over 100,000 persons a year but with the DTaP vaccine, that incidence came down as low as 3000 a year. The CDC has the rate back into five digits. One reason could be lack of vaccination. The illness, which affects the lungs and begins much like a cold, is very contagious. Pertussis is a bacterial infection and it has a three stage progression. I wanted to look into it when I heard it referred to as a serious and sometimes fatal respiratory infection. I had just not thought it so serious, perhaps because of the common name. It is also true that I received all my vaccines in the late 60s before we were all afraid to get them. My cohort, in other words, didn’t get this disease. The second phase of the disease is the worst and can last for weeks if not months. The person, usually a child, has uncontrolled, frequent, explosive coughing events. Antibiotics can be used. When I read that the illness was a bacterial infection, thus treated with antibiotics, I got confused. I have only recently truly absorbed that viruses or viral infections are NOT treated with antibiotics. I took that further to mean that vaccines were for viral diseases and not bacterial ones. The herpes VIRUS, the Flu, human pappillomaVIRUS, but alas, it is not true. Vaccines are created for both types, it is just that the medicines to treat the actual infections are different.

Pertussis is a serious and contagious disease that is better prevented than treated. The whoop sound comes between coughing spasms as the patient gasps for breath. Recovery is long and has its own phase. A person does not suffer the coughing spells in the first or last phase, but during the last phase a person is lethargic and weak.

Odds and Ends

Lollipops - I presented a tobacco prevention program to a summer camp class recently. In the kit of goodies I brought along were a bag of lollipops that had no-smoking symbols on them. I had not realized they were in the box or I would have left them behind. I said to the teacher, HOPING she'd decline, "Do you mind if I hand these out?" She didn't mind at all and after my presentation I gave the children a new pencil AND a chance at a Lollipop. I walked to each of the four tables with my open ziplock bag and said, "Would you like a Lollipop? It is okay if you don't." No one turned them down - dang it!

Leaving the Gym one morning a man slightly older than I walked out behind me. He said, "Now if I can just stay out of the refrigerator." Of course, if any of you had been along you would have thought - oh boy - great person to mention that to! So indeed, I said, "Well, best not to put things in there that you don't want to eat." He said, "My problem is sleep walking. I get up at 3 am and go for the fridge." I said, "That's a hard habit to break." Then he said, "Some people just have such fast metabolisms." WHAT?!?!??! Of course the "person" me - as opposed to the health educator me, was thinking, "DUDE stop eating so much." But I said, "Really few people have that issue. I certainly don't."

Standing Tickets- Some people were shocked when an airline, I believe out of Ireland, proposed to offer less expensive tickets for standing room only - i.e. no seats. I thought it was a marvelous idea. One thing we are advised to do while traveling is to get up and walk. One thing that too much sitting can lead to is deep vein thrombosis - or clotting. So this to me was a grand idea and I would be the first to get a standing ticket if a US airline offered one.

Chlorine Indeed - In a recent post I mentioned showering before and or after the pool. Just the next day on NPR's Science Friday the issue came up. There really is an interaction between chlorine and other chemicals that people bring into the pool as well as micro organisms and bacteria. So, it is paramount to shower both before and after entering. I now do both whether anyone is watching or not!

Lung Cancer Still kills the most. Recent CDC data highlighted incidence of breast cancer and colon cancer but the leading killer of both men and women - with regard to cancer is cancer of the lung. The main cause of lung cancer is cigarette smoking. At this time, we have more tools for prevention and treatment for colon and breast cancer and the CDC urges everyone to have mammograms and colon cancer screening when age or gender appropriate.

Speaking of Cancer. In a recent post I iterated on the pharmaceutical industry's quest to have drugs created for one condition approved to treat another. One such drug, Avastin, is approved for lung and colon cancer. The company that makes it was able to get it fast tracked for breast cancer also, but with continuing studies and final approval pending. The studies of Avastin in combination with chemotherapy are not showing a survival benefit. Without much change in the outcomes, but a slew of unwelcome side effects, the drug may lose its breast cancer indication and a billion dollars in sales.

Get sick already - don't you know that drug stores need you to buy flu and cold medicine. Yup, one of them, Walgreens I think, recently stated that they did not have as much revenue as expected because less people got the flu.

HATS OFF to the HATS ON. In this past week's season opener for The Closer on TNT, the detectives had to visit a sunny roof top to examine a crime scene. Lead character Brenda had on a lovely straw hat and one of the guys made a show of putting on a white hat, sailor type hat. NO visors, hats! AWESOME.

Understanding Triggers

I am 100% against tobacco in its current disease causing form. This includes cigarettes and much smokeless tobacco. There may be nicotine containing nontraditional tobacco products do not cause harm and I will keep a lookout for them. As it stands now, I am against smoking. I find the act and the emissions from it to be quite rebarbative. Smoking harms everyone who is exposed to it. It is bad for the environment and the individual.

I support all smoking bans and I want to tell you why. Other peoples' smoke is a significant trigger to light up or relapse to a nicotine addict. Even seeing tobacco products acts as a trigger to smoke. This trigger is something that manifests itself physically – it is NOT a controllable factor or an absence of willpower. It is a physiological response to access or availability. Let me provide a non-tobacco example so those of you who have never used tobacco can understand – really understand.

Imagine that you have to use the bathroom – to urinate. You have a subtle urge to go, maybe this feels like a 3 on a scale of 1-10. You say, “Well, I can wait a bit.” “I may even be able to wait an hour. Yes, I can wait an hour.” The first half hour the “urge” is steady at 3 or 4. The second hour, the “urge” is beginning to feel like pressure. Now you are at a 5 maybe a 6. (You should absolutely think about this the next time you have to go to the bathroom, so you really get what I am explaining). Okay time to find that bathroom – or that rest stop. You are getting physically closer to the bathroom and then you are there – you SEE the toilet – the “urge” is now an acute, pain in your bladder, at least an 8. You did not do anything, you did not THINK, you saw the toilet and your body, your mind, your neurotransmitters, reacted to it. That is what happens when someone is trying not to smoke and he or she sees cigarettes or people smoking. The smoker or quitter goes from not really thinking about a cigarette to “I must have one.”

Anything that we can do to make smoking harder, WILL make quitting easier.

Off Label Complications

It has been mentioned here that many drugs are created for one condition and used for another. Drugs CAN usually be used for an indication beyond their original market approval, but not advertised as such. This is one way for drug companies to earn more revenue off their existing formulary and it is also sometimes a legitimate next step.

For many years, one such quinine drug, sold as Qualaquin, has been used off label for muscle cramps. The drug is intended for use in acute malaria - only. Though the drug has been effective for the cramps, the adverse events related to its use have concerned the FDA and public health experts for several years. The FDA has warned physicians NOT to prescribe it off label and this July came out with a more serious and concentrated effort to stop this off label prescribing and use. This directive would include any medicine/supplement containing quinine.

The FDA has issued a risk management plan which will include a medicine insert that strongly advises anyone against taking this drug outside of its original intent. From the FDA website :

Additional Information for Patients

Qualaquin is only approved for the treatment of a certain type of malaria (uncomplicated) caused by the parasite Plasmodium falciparum—a rare infection in the United States (approximately 1500 cases per year) primarily resulting from travel abroad.


Qualaquin is not approved for the treatment or prevention of night time leg cramps. Patients using Qualaquin for this condition are at risk for serious side effects.


If you are taking Qualaquin for night time leg cramps, you should discuss other treatment options with your healthcare professional.


If you experience easy bruising, severe nose bleeding, blood in your urine or stool, bleeding gum, or the appearance of unusual purple, brown, or red spots on your skin, contact your healthcare professional immediately.





As you can see above, the drug itself is not a blockbuster by any means. It would do the drug company well if people could take it for other indications, but I must say in this case, they will just have to let it go.

Ping WHAT?

Pinguecula –

Another reason to wear those sunglasses! This noncancerous growth or film like fatty deposit may impair vision (unlikely) and is a discoloration on the white part of the eye, usually to the inside of the cornea. I learned about this from my eye doctor as I noticed a slight discoloring in this area on both of my eyes. I was taken aback thinking it could be the start of cataracts. He said that it was really nothing, just like a callous. Of course, he said, “just a fatty deposit” and I heard FAT??!! Ha ha. But the condition can progress in rare circumstances and is then called pterygium. Removal of the pinguecula is usually only considered when the callous moves across the colored part of the eye. It is a little tricky to remove, according to the doctor that I see. I was concerned about my vision but at the same time I am quite distressed over the cosmetic effect. He did say that it is sometimes associated with natural aging and more often with sun and wind damage. It is seen more often in states with much sun. I LOVE the sun and have not been consistent with eye protection over my life. I do always wear my sunglasses now – running, cycling, walking, driving, shopping etc. My optometrist also told me to use eye drops each evening. Cool thing was that I DID start the eye drops when I noticed the discoloration. I thought, what the hell, worth a shot. It is nice to be intuitive from time to time. So please, protect your eyes from damage by wearing sunglasses and such. If you do a Google search for these terms you will find that there is not a clear cause and effect for the condition, but sun damage is strongly suspect.

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!

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?

Odds and Ends

Parental Behavior - I really am not sure what I observed this morning but it appeared to be two tween aged (12ish) girls applying sunscreen to their pale skin bodies. I was at the beautiful tobacco free Lido Beach in Sarasota Florida. The girls were standing and their mother was lounging in a chair not far from them. She started carrying on in such a way that it disturbed my reading so I looked up and "attended" to the situation. The mother was yelling for them to move away from her because they were getting the sunblock on HER. Now it could have been tanning oil, but I do not think so. I hope that the message regarding sunburns and cancer has reached the children as they were diligent in their sunscreen application. I have to say that the Mother - who really carried on about it - looked the fool, not the children.

Parental Oversight - I noticed another positive thing which involved a protective factor but this time, the protective factor was absent and it has to be the Mother's FAULT. I observed a woman pushing a stroller, canope over the infant, and two young boys (six to eight years old) ahead of them on their bicycles. They had been walking/riding on the sidewalk, but the boys were now at a crosswalk, waiting for the light to change and the stick figure to 'walk.' I was in a car at the stop light. I worried because I have almost been hit a time or two crossing that same side street (running). The boys were NOT wearing helmets.

A Smoker Speaks - Today I was back at my tobacco free beach for an hour or two (wearing sun screen and a hat!) and a lady a few fit in front of me, talking on her cell phone lit up a cigarette. I had to wave at her when she looked over and I said, "Ma'am - this is a tobacco free beach." I said it nicely. She said oh, and told the person on the phone and put out her smoke. (she stubbed it in the sand, but did NOT leave it there) After she got off the phone she asked me about the ordinance etc. I let her know that the rule was actually over a year old but we were only recently able to purchase the signs and set up the ashtrays in the parking lot etc. She said, "Well, okay - it is sort of good, then I won't be smoking while I am at the beach." So again I say to YOU and policy experts - anything we can do to make smoking harder will make quitting easier.

Average Weights - This is something I wanted to get to yesterday when I was speaking of average weights in the USA. The CDC has a FastStats page on body measurements and on that page they offer the average male height, weight and waist circumference and the same for females. I used those numbers to calculate the BMIs of each. To learn more about these and other health related biometrics or measures, click here. Accordingly, a male should have a waist measurement under 40 inches to have less risk of adverse health outcomes and a woman should have one under 35 inches. According to the CDC the average male, who is about five foot nine inches tall has a measurement of 39.7 inches. Way too close to unhealthy to be our AVERAGE. Women fare worse! The average woman, these days, is about five foot four inches tall with a circumference of 37 inches - two inches over. The BMIs come out to OVER 28 for both sexes. Recall that over 25 is overweight and obese is 30 and higher. This is a sad state and must explain why the economics of obesity will be discussed in a prime time CNBC special in a week or two.

Funny You Should Call - What are the chances that a person would dial MY office number by mistake to follow up on her order for the weight loss product Zantrx-3? When she said that she was calling because she ordered a diet pill - before I could stop myself, well, I chose NOT to stop myself, I said, "That is unfortunate." This product markets itself as the next best thing to the outlawed ephedrine products. Here is the disclaimer from the diet product's website, "*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. Use in conjunction with any sensible diet and exercise program. Individual results will vary." Indeed.

Oil Spill - Just a note to say that I have grave concern about the environmental effects not only of the oil but of the chemicals being used to break it up. The chemical process appears to consume oxygen and thus creates pockets of ocean without oxygen - oxygen, for many species, including marine life - equals life.

Diet Coke v Diet Mt. Dew - Special for you, friend Jim - there is less than 10 mg difference in caffeine between the two, but Mt Dew is indeed the higher one.

Odds and Ends

That's right - it is the week's end and time to keep it simple and brief.

Frequency vs Intensity vs Duration: A very small study but none the less an interesting one - showed that the amount of days one exercised per week were more indicative of fat loss than either the intensity of the session or the length of it. Upshot - more often is more productive.(lead author is FB Willis)

Dining Out: Took Mom to movie and dinner over the weekend and I wanted to show you the beautiful salmon and steamed veggies - so you get the idea in pictures. Remember - it is YOUR money so order what you are going to feel good about eating. The dish I had was supposed to be glazed and oiled - I opted for neither.

Radioactive water: Apparently one of our nuclear power plants has a leak and some radioactive water has escaped. It is in a water supply and the company stated that it was nothing to worry about at this time. So here is my thought, "I understand that many corporations consider the average public to be uneducated - but seriously, do they think we are all STUPID?" When can nuclear waste ever NOT be harmful.

Ads: I have to tell you that all these commercials for weight loss, aging prevention, physical performance and sexual enhancement are just making me tired. If the products worked the way that the ads said that they do and if there were no risks what so ever - don't you think that a legitimate health organization would be the one telling you so.

Obese Children: I had an hour to myself on Anna Maria Island this morning after my run. I took a little stroll and saw a boy walking to the shore - he may have been between 8 and 10 years old. He had breasts bigger than mine and rolls of fat. It wrenched my heart to see this. He is the example when our health experts tell us that our children will be on medications for diabetes and hypertension in their twenties and will die at younger ages than their parents. It is Mother's Day - let us do some mothering - perhaps Michelle Obama should be the role model. [you can see a map of my run by clicking on the garmin link on the left]

Wind Farm: No the Nantucket mill isn't breaking ground - but a European company has already indicated that it is going to purchase x amount of kilowatts of energy for the UK. What? No offense to the UK - I have Scottish genes! but don't we need to use our alternative energy here first!

Odds and Ends

Tobacco News - First quarter results were released this week for both Phillip Morris and Reynolds American. In spite of a national tobacco tax increase last year and a nearly universal state tax increase that followed - both companies are reporting profits. According to a WSJ piece, PM made over a billion in profit from last year and Reynolds, the second biggest of the two, made about 82 million. At the same time, sales of smokeless tobacco products are showing an increase while cigarette sales are down, but less than one percent. Tobacco control experts continue to argue on whether or not smokeless tobacco, including the new non traditional Orbs, Strips and Sticks, have a place as reduced harm products.

NOP- This stands for National Organic Program. If you live in the USA where labeling of organic products is a little less strict than in some other countries, I encourage you to look for the words USDA /Organic on the product, if you are choosing to buy organic. At this time, there is not substantial evidence to support that organic foods provide a health benefit over non organic, though some produce have been deemed to be the type of food that is worth the extra cost.

Green - If the organic standard is lax, the eco friendly one is almost non existent. Currently the Federal Trade Commission is evaluating some companies for labeling that seems to imply environmentally safe or friendly products which aren't There are also some law suits pending over misleading advertising on products. Stay tuned for more - or research the company before you spend the extra dollar.

Drug Trials - I believe that I have shared here that drugs that are sold in the USA must first be approved by the FDA which can occur after a certain number of drug trial PHASES. Phase 1 involves testing the drug on generally healthy people to see if it is tolerated. Phase 2 and 3 are used for efficacy, dosing and more intense side effect evaluation. Though I had told you that drugs can only be advertised and marketed for that which was approved, I did not realize that the studies that provide new indications are Phase 4 trials. An example of a drug that went through a Phase 4 study is wellbutrin or buproprion. This is an anti depressant that is also sold as Zyban to treat tobacco dependence.

French Fries - I usually talk with my Aunt Lyna on the weekend. She is my father's only living first degree relative (he isn't living either). I think I said that right. My dad used to call her every Sunday. Now I think our talking together helps us to both feel close to him and to each other. My Aunt is nearly 85 years old and the opposite of my 81 mother who continues to waitress five days a week. My aunt is one of the frail elderly. She is in significant pain from rheumatoid arthritis, is a breast cancer survivor, has osteoporosis, takes more pills that I can count and is a recent widow. She does still live independently however and meets all her own needs, including transpiration and shopping. Oh, she is in CT and I am in FL. She may weigh 110 pounds. When I called her today, she said her dinner was almost ready. I asked what she was having and she said, slowly - w/ martini induced speech ( :)) Lamb chop..... Asparagus.... French Fries. I laughed out loud. She said, " I knew you would laugh." I am sure they are baked fries, but you know what? If anyone gets to eat french fries, it is my Aunt Lyna.

good night - hope your week starts well...

Drug Industry Influence (is this subtle?)

This morning I had a doctor's appointment - (I am fine!)

I usually entertain thoughts of blog postings early in the day so that in the evening I will have a focus for writing. I was actually thinking maybe there would be a magazine or newspaper in the lobby that would get my attention when I noticed a wall board with the heading Healthy Advice.

There were eight pamphlet holders on the wall board and each had some literature. Two of the slots held coupons for CEREAL with the suggestion that by eating these cereals, Cheerios and Fiber One or some thing like that, you could lower your cholesterol. [ I believe that this is one of the health claims that is currently being evaluated. Not because what you eat and what you do are not important, but because letting someone with high cholesterol think that a bowl of Cheerios will keep their arteries from clogging is dangerous.]

Then there was a pamphlet about a medication that could treat your OAB. Yes, you know, you name the disease, make a cute acronym for it, create a pill and then sell the hell out of it. The acronym stands for Overactive Bladder.

Another pamphlet promoted Yaz for your birth control needs, while Sally Field smiled at me from a Boniva brochure. Next to Sally was one for a drug called Evista that has something to do with breast cancer, though I read on the front of the pamphlet that Evista doesn't prevent or treat it (?) Oh I get it. Some times being treated for breast cancer can put you at risk for osteoporosis and this drug can help with treatment related osteoporosis. AH....

Then there is the ubiquitous Lipitor, perhaps the best selling drug in the world. [an article at Forbes.com states that last year the world wide sales were over 12 billion and 7 billion of that 12 was from the USA]

And there was something about an antacid, but the name of the pill was not on the cover of the pamphlet and I did not OPEN any of these :)

There was one about Insulin. Apparently, too many diabetics have switched to the newer drugs and sales for good old insulin must be down. The healthy advice on this pamphlet encouraged people to "rediscover" insulin.

Oh, the drug I railed about in a recent post had a pamphlet too. Trilipix. This is another cholesterol lowering medication that is also supposed to raise HDL and lower triglycerides. This drug is meant to be taken with another statin drug, oh, I think that Lipitor is a statin!! Anyway, the reason I got myself in a knot was that the outcome, reduced heart attack or heart attack death, was NOT changed by adding this drug which does bring side effects to the party.

Is that eight?

THEN, in the bathroom there was a cup that held markers (WHY? You had to ask. I am guessing it is to write your name on your pee cup, but since I was not there for THAT I am only assuming this to be so) Anyways, the cup said, Lexapro. Lexapro is an antidepressant.

I had to look hard for something in the exam room, which comforted me. But there it was, the little knee knocker tool - it said Bextra. Ah Bextra, you went the way of Vioxx because people who take you DIE - apparently its a good knee knocker, but I wasn't there for that either!

And that is all about my enlightening visit to a primary care office. Oh, then there was the TV, and lucky for them - I only got to see the part about replacing whole milk with skim milk and butter for olive oil before they called my name, because you KNOW , the next part would be how you should take a drug when those things didn't lower your cholesterol!! [because on the frame of the TV were those same words, Healthy Advice. Anyone want to wager on WHO bought that TV?]

I wear me out ... but I already know what tomorrows blog will be so everyone else is safe for another day.

Odds and Ends

The purpose of the week’s end odds and ends is to give myself a little research break and just hit the highlights. I don’t always achieve my goal, but at least I have one!

Cholesterol Test – this regards a commercial I heard on the radio, maybe yesterday. The company was encouraging people to order the at home cholesterol test that would tell you your total cholesterol number. The company would also send you some free fish oil supplements with your purchase. Well, just knowing your total cholesterol is of little use and free supplements that are not regulated by the FDA for purity don’t impress me much. SAVE YOUR MONEY and let you doctor order your blood work.

Working Out is important. While I was doing my strength training today, I observed some mistakes that may be common and should certainly be addressed. I was working out at a coed gym, but the error was made by a woman. There are two very important things to remember when working out with weights and they are form and speed. Go slow! If the weights are causing you to lose form, for example, your shoulders are by your ears and you are going fast, then they are TOO heavy. Try to think of the muscles you are working and the body you would like to have. Keep your shoulders down or you are going to build them up so that they stay at your ears.

Staying Fit during the holidays can be a challenge. There are many demands on our time and there are many temptations to eat high calorie foods and skip our workouts. Interestingly, this is addressed in the current issue of Runner’s World magazine. Also interesting is how many times this issue cautions runners not to eat too much. But I digress. The advice to runners about keeping fit can be adapted to other types of physical activity as well. If you are working out every day, YOU GO, that is so cool, and pressure from work and family threatens to overwhelm you, then knock it down to five days. If you get mental as well as physical benefit from your exercise program, SAY SO. Advice from a sports psychologist in the magazine is noteworthy. Dr. M Sachs advises not deciding to quit running during the most stressful time of the year! And again, that applies to any positive coping skill. Do not give it up when you need it the most. Sachs also suggests that you tell people that you are a better, calmer, more relaxed person after your workout and everyone will be the better for it if you stick with your routine. Heck, he even suggests that you round your family up and head out the door to walk or run together.

Arthritis is inflammation of joints. There are 100 different types of arthritis. Most of us are family with osteoarthritis and rheumatoid arthritis. However, lupus and gout are also forms of arthritis. Inflammation also has several different manifestations and is the body’s natural response to injury, assault, or disease. Signs of inflammation can include fluid, swelling, heat, redness or stiffness. Sometimes inflammation goes away on its own or with treatment of ice and anti inflammatory medicine. When it stays or recurs, then it is considered arthritis. Osteoarthritis is the one most familiar and probably the most common. It is also referred to as degenerative joint or disc disease (back). This is the wearing away of cartilage and happens most often from being overweight and or inactive, as well as aging and from injury. Most knee osteoarthritis for example is found in overweight persons or persons who played high impact sports that may trigger knee injury like football or basketball, while ankle OA may be more common in tennis and hip OA in dancers. (Side note: the systemic types of arthritis like rheumatoid are indications for the H1N1 vaccine)

Killers to worry you. The World Health Organization came out with another of its reports on what is killing most of the people in the world. There should be no surprises in this. We are being killed most often by what and how much we ingest and how little we do. Too much alcohol, any tobacco, too many calories and too many fat and sugar calories and not enough activity. The WHO points out high blood pressure, high cholesterol, obesity and inactivity as major mortality risk factors. This crosses the borders of all income levels. Additionally, poorer countries suffer from diseases related to unsafe water and sanitation, unprotected sex and undernutrition.

And that ends our week and begins our November.

Disease Mongoring

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

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

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

http://yourhealtheducator.blogspot.com/2009/09/bone-health-across-lifespan.html

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

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

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

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

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

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

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

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

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

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

oops and now MNF!

when Brief Really Means Brief

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

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

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

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

Odds and Ends

Okay, just a few closers for the week.

The first I think I may have already covered.

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

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

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

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

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

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

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

Botox Indeed

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

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

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

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

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

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

CRC-screening

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

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

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

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

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

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

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

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

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

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

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