Probabilities

I have just returned from a wake - saying goodbye to an outstanding community member who touched my life in a way that can never be forgotten -  or undone.  I am blessed by having known her.
She did not die of natural causes.  She died of Lung Cancer.  I do not know what "caused" her cancer.  We don't really know what causes anyone to end up with a disease because so many factors interplay.
A person can smoke and get lung cancer or not get lung cancer.  A person can not exercise and stay healthy or exercise and stay mobile into their very late years.  But it is not a crap shoot at all.
We have known risk factors and probabilities.  It is possible to stack the deck in ones favor.
 That being said:

• maintain a normal weight
• exercise daily (including strength training on 2-3 days)
• limit saturated fats, sugars, salt and empty calories (and sometimes calories in general)
• add fruits, vegetables, fish, whole grains and healthy oils to your diet
• don't smoke
• limit radiation (sun and medical)
•  avoid environmental toxins

I want to add that we learn new things every day.  It may be that what we thought was a risk factor turns out not to be and vice versa.  I hope that you won't take that to mean that no one knows what they are talking about and instead take it as learning and getting better at things.  You can only act on the information available to you today, but that does not mean that it won't change.  You should act accordingly.

What's Your Diet Style?

After just a few sentences, I am going to link you to a newsletter that I received from WebMD.  The newsletter gives an over view of research that was presented at a recent American Heart Association conference.

It appears that scientists conducted some type of survey research, but from the newsletter I do not know if this was on line, in person, through the mail or by telephone.  I only have this statement:

"21,000 adults aged 45 and older completed a questionnaire containing 110 food items"

In the article, the reporter suggests that there is strong evidence that links gender, race, age and region to certain dietary styles.  The research itself is not available - it has not been published, so it is hard to know what they consider strong evidence and whether or not I would also consider it strong.

We really need to know about the design of the study and who those 21,000 people were before judging or applying the evidence.  So that stated - get your grain of salt and read about the 5 most common dietary styles here. 

Odds and Ends (1 of 3)

As it turns out, I kept quite a few little notes over the past week - enough in fact - to maybe split the O&E into three days.  This is a good thing as the O&E are my most popular posts and since they are just snippets, I have more time to study.  I have 12 at last count, so here is the first 4.

Hormones and Cancer – New studies continue to support the existing evidence that connects hormone replacement therapy to adverse health consequences in women.  Frequently used to treat the symptoms of menopause, HRT should be avoided if possible and if it cannot be avoided,  used for the shortest amount of time in the smallest dose possible. 

Black Women and HPV – In reading about a study (small, more work is needed) that showed sustained HPV virus in black women as compared to white, I learned a new thing about HPV and cervical cancer.  The body can clear itself of the virus in some amount of time.  The study compared clearance at two years.  It is when the body does not clear it out that the risk for cervical cancer increases.  Black women maintain the virus in their system longer than white women.  This difference may be an indicator of who needs pap smears more often and perhaps who is in greater need of the vaccine. 

Burger King and Food – The fast food company is updating its menu to appeal to adults and to try to catch up to Wendy’s and McDonald’s in “ratings.”  The company says it will add “healthier choices” which they refer to as salads, chicken and wraps.  Just remember, it's not the name the determines the healthiness but the content.  Also – “healthy” can mean different things to people.  For me, a food is healthy if it is low in calories and high in nutrients.  I doubt BK has anything to offer me.

Health Insurance and Health Status – More companies are tying insurance premium, deductibles and co pays to an employee’s health status.  The health status is often determined by a health risk appraisal (HRA).  For instance, being overweight and smoking are risks that would be identified in a HRA.  Having conditions such as high blood pressure and diabetes that are not controlled might put a person in the higher premium category.  A person who follows physician advice and improves their health measures could see a reduction in premiums.  Though not perfect (risks discrimination), I am in support of these efforts.

Odds and Ends

Label Policy : First, a great thanks to Jennifer Pomeranz at the RUDD Center for getting back to me so fast on the labeling law update.  She gave me some information that comes from the Center for Science in the Public Interest, or CSPI.  I have mentioned them before and am a fan.  Here is the email content from Hannah Jones, Nutrition Policy Project Assistant:

As you may know, a number of policy issues are holding up the final rule for national menu labeling.  
The key policy issues to address are:

 
Definition of Retail Food Establishments

• The final rule should cover all retail food establishments that sell restaurant-type food, including movie Theaters, supermarkets, and convenience stores.

Alcohol labeling

• Alcohol should be required to be labeled in the final rule.  According to the Dietary Guidelines, alcoholic beverages are the fifth largest source of calories in American adults’ diets.

Vending Labeling

• Vendors should not be allowed to post a sign next to a vending machine instead of posting calories beside each individual item or the selection button.  Nutrition information needs to be easy to see, find, and use.

Colace: At some point this week, I heard a commercial for the OTC product Colace.  I don't even remember what was said, only that I thought - No No - these pills are just not the best way to maintain regularity.  So I wrote down Colace on my O&E list and today I looked it up.  I found  information on a PubMed website.  Colace is a type of stool softener that should be taken on a temporary basis by people who need to avoid "straining" to have a bowel movement.  Oh, let us all avoid straining - don't you think?  Whole grains and fiber - unless you are unable to eat actual foods (and some people really can't) - are a much better way to maintain your constitution.  Food is so much better than pills, powders and enemas! 

Heinz/TGIF -REALLY?:  Heinz Co has a business relationship with TGIF - at least the TGIF frozen food items that you can buy at a grocer.  This week a business wire story proclaimed the benefit of this relationship ($250 million for Heinz) and highlighted a new product.  I had a bit of a jaw drop over the product - macaroni and cheese wedges.  (Who is it that thinks the food manufacturing industry cares about obesity?)
The snack is pasta and cheese that is made into a wedge, breaded and then baked? fried? - who knows.  A 3 wedge serving, just 81grams, has 240 calories and 3.5 g of saturated fat.  The ingredient list is HUGE and certainly would not qualify as minimally processed!
Here is a paragraph from the Business Wire article published 3-7-2012.

T.G.I. Friday’s frozen Mac & Cheese Wedges combine macaroni pasta with a creamy cheddar, Parmesan and Romano cheese sauce and are coated in a crispy breading. This innovative new product that embodies the fun and flavor of the T.G.I. Friday’s brand begins shipping this month and will be available at major retailers in a 15.5 oz box for a suggested retail price of $5.99.

Grown Ups and Milk: I will attach the story that caught my eye, especially because Marion Nestle is quoted there in and she says some things that I have said.  (I always like that!) The gist of it is that schools are under order to limit the amount of sugary sweetened beverages students have access to, and the percent of fat in the milk served(good changes based on efforts to reduce overweight and obesity in our children).  This however, leads to a reduction in sales for the milk industry and so  - adults are the new target for chocolate milk.  And make no mistake, those Milk - It Does a Body Good campaigns are NOT from a health organization - they are from a retail organization. And because they are coming after you, you might want to read the story here. 
I will leave you with some great words of wisdom from  Marion Nestle (from the attached article).

"As the pressure on schools has grown to get chocolate milk out, they're looking for any new marketing," says Marion Nestle, nutrition professor at New York University. "I'd never recommend drinking a sweetened drink. People shouldn't drink their calories."

Funny that she also advises that after a workout one should eat a sandwich.  I was just telling my friend today that I don’t drink sports drinks (w/ sugar – or calories) and that I actually have gone on long runs with peanut butter sandwiches in my running belt!  

 

Odds and Ends

This week's edition may have a little bit of a travel theme as the day after the "size matters" post, I returned to NC.  I had been on a short visit with family and friends in the most awesome state of Florida.  Since getting back, I have been busy with conferences, meetings and proposal writing and spring break wasn't even over yet!  That explains my recent absence and classes resume tomorrow which will explain this weeks sparsity of blogs.

Foods: Blogging during my travels has often been a pleasure of mine though I did not give a play by play this time I do have something to share regarding meals.  Uncharacteristically, I had only packed a couple of things for my trip home. I then was laid over in Atlanta for hours and hours.  I arrived home (after flying to a different city and renting a car) eight hours later then scheduled.  Interestingly,  earlier in the evening while waiting for my connecting flight I noticed that a lot of foods in the stores and kiosks actually had nutrient labels.  The foods were not always low calorie, but some healthier options were available.  Later,I did cave in and buy a tuna fish sandwich.  It was labeled as having 300 calories.  The turkey and cheese sandwich had twice as many - weird.  The labels allow us to make the better choice even if the choices are the best ones.

Scanners:  You might recall from my last visit to Florida that the airport there has a full body scanner.  It was working this time - the person who checked my license said.  I told her that I did not want to do that and she said that when I got over there, if I was sent to that line, I could simply opt out.  As I approached I asked, "is that the full body scanner "- actually, I might have asked, "is that the X Ray scanner?"  The employee told me that it was fine that it was the wave one and did not have any radiation.  I went in and turned this way and that as the door closed and swirled.  Later I wondered about the veracity of the employee.  Last night I saw that the radiation tests that have been done on the airport scanners are being questioned and all machines will be reevaluated.  If someone such as me, who is concerned about this stuff, was ill equipped to make a decision I imagine that others will be confused as well.  I did review this today and the millimeter wave machine is not supposed to have radiation and the back scatter devices are the ones that are problematic.  In the story I am linking you to here, and in the one I read last night, it is noted that the amount of radiation in a machine is the same that one gets during two minutes of air travel.  This is quite upsetting to me as most flights are hours in length.  If I am concerned about a two minute dose, why in the heck am I flying??  Here is a list of the airports and their scanners.

Image: When I was waiting to board the plane to Atlanta, I was in full people watching mode.  Airports and shopping malls are the best for this.  As I looked at the people in the gate area- OH! side note- at both airports I found it disturbing that people would sit in their seats for hours and then get on the plane to sit a few more.  Sitting is bad people, sigh.-  I noticed that many of the people were overweight, plain, imperfect.  Their hair was not always 'just right" and even the prettiest or handsomest had flaws.  This was an important observation because I am very hard on myself and I suppose I am also vain.  I had talked to my Mom about this during my vacation (dissatisfied with my appearance) and as I looked at these normal every day people - amongst whom I fared pretty well, I realized that I had been doing something Mom had warned about years ago.  Can you guess what it is?  A lot of us do it... Comparing ourselves to the famous people who themselves don't even look like they look!

Genes: I've said it before and will say it again, but because my colleagues at an obesity conference this weekend were discussing the impact of genes on obesity, I will say it today.  If there are genetic implications to a condition or disease that ONLY means that lifestyle factors - or things that we CAN control are that much more important if you have the gene.  As far as I am concerned, we all need to act like we have the obesity gene (we do) and eat less and move more.

Helmets:  I saw two children roller blading in the park today and they had on helmets :)

The Wrong Product

You may be familiar with the Yogurt commercial that "stars" Jamie Lee Curtis and suggests that the product helps with digestive issues.  If I recall correctly, I used that commercial as a way to direct you to my You Tube video for cereal bars, as they are high in whole grains and fiber which also helps the digestive track.

But the marketed ingredient in this particular yogurt is probiotics (a bacteria).  There are substantiated health claims regarding active cultures in yogurt, but there is not evidence that Activa and  DanActive (a dairy drink) are by and of  themselves health promoting.  So the company settled a claim with the Federal Trade Commission regarding their false advertising which includes a 21 million dollar fine.

It appears that the FTC is paying more attention to product claims, as this is not the first company to take a hit this year.  Many times the products are claimed to improve health or prevent a condition, like a cold.

According to a USA Today article, the yogurt industry brings in billions.

We have some problems in the country that is certain.  We have a national chronic disease burden that is epidemic in scope and cost to treat.   But to be honest, Omega 3s and probiotics are not going to change that.  

The true need, the one the food makers really ought to put their might into, is fat, sugar and calorie reduction.  We need foods that are less energy (calorie) dense.  Let them make and market those.

The FTC report on the yogurt can be read here.

Catfish from China?

I was going to do a little number crunching to give you some points to ponder but I quickly realized two things.  One, you really cannot get numbers about anything in China and Two, if you do, they are probably inaccurate.

Here is what we know - China is the country with the most people.  This source, lists China as the number two oil consumer, (second to USA) and the number two electricity generator and consumer.  

China is the number one producer and user of coal and this is where I was going with my post.  If not the greatest source of mercury and other green house gases,  coal fired power plants are at the top.  China has the most coal fired power plants in the world - we believe.  China is listed as the number one polluter - the greatest producer of carbon dioxide emissions.

I was going to track automobile emissions in China and realized that auto ownership per capita would not include everyone who drove - but when I tried looking for vehicle miles traveled by country - China was never on the list. China doesn't like to share.  In fact, I think that if you look  too hard they charge you with spying.

So, let us never mind about cars. 

China is reported to have the most coal production and use.  In 2006, I wrote a lot about mercury contamination of fish.  (mercury from coal fired power plants)  I looked into the fish that I like to eat, salmon, tilapia, mahi mahi, shrimp etc  -all good.  I noted shark, swordfish and tuna steak as being risky.  Any of this ring a bell?  I may have encouraged you to check out the EPA/FDA research on mercury and fish, here.

To be honest, I do not know where the fish that the EPA samples comes from - our oceans, our fish farms, or our stores.  I can tell you that the assessment for catfish was completed from 1990 to 2004 and the 2004 numbers are much higher than the 1990 - so the number you see as the average is not a recent number.

This is all about what I heard on the radio today - the USA does not get catfish from the USA - it is imported from China.  We get our catfish from the most polluted country in the world - makes you pause... actually, they are the leading seafood importer for the USA - so I'd check  all those fish packages if I were me.  Oh I AM me, so I will check them.

Odds and Ends

Because the NFl Pro Bowl is just beginning and playing in the background, let me start with injuries.

Sports Injuries Three things lead to this blurb. Today a running friend mentioned that another friend was out having surgery. Someone said, "oh his knee?" and another said,
" no, his shoulder." Last night my niece mentioned that she had re injured her meniscus and might have to have surgery again. Both of these persons had these issues from tennis. SO I decided to research which sport had the most injuries. It appears to be football, which is exactly why the men in next week's Super Bowl have opted out of the Pro Bowl. Interestingly, the top two sports for injuries are football and basketball and the top injury for both is the KNEE. Otherwise, injuries are definitely related to contact, to improper form, improper equipment, lack of warm up and over use. Over use injuries are probably more common in tennis and running.

Zyprexa Zyprexa is a medication that is considered an anti psychotic and is in the psychotropic class. This means it is a mood altering drug. It is also one of the many drugs in this class that have been shown to cause weight gain. (personally I think we need to educate the patient on weight control if and when prescribing the medicine, but I did not ever see that happen when I worked in the field of psychiatry) Because Zyprexa, made by or sold by Lilly, has been approved for use in adolescents (scare me!) the FDA has now put out a warning about the weight gain and the increase in levels of blood fats. If you are on Zyprexa and develop hyperlipidemia, you are likely to be prescribed ANOTHER drug to treat that condition. That my friends is how polypharmacy gets started. Anyway, the new alert advises that other meds be tried before Zyprexa. We especially do not want our kids on meds for chronic disease conditions before they even graduate high school!

Tobacco and Heart Disease February will bring us heart health month again and I will likely write more about that. In the meantime, I have been studying for a February 4th community presentation on smoking and heart disease. Seriously, I have a great article that was forwarded to me by the author, Neal Benowtiz, MD. I have had to look up about 40 words, repeatedly, and feel like I need another couple initials after my name to understand it. But , I can say that chemicals in the tobacco smoke have a significant effect on hemodynamics, viscosity, thrombosis, and endothelial function. Just kidding - well , I mean it is true, but it means that the blood of smokers is thicker, that atherosclerosis (plaque build up) is activated from the chemicals and that platelets are also activated and clump together, putting smokers at significant risk of thrombosis, or blood clot. Smokers have heart attacks and sudden death at much younger ages than non smokers and are more likely to die during heart surgery. Their stents are more likely to clog and blood flow is likely to become impaired a second time. People who live with smokers have a 30% higher risk of heart disease themselves and only breathe 1% of the smoke that smoker's inhale. Crazy right! And heart disease kills 30% of smokers. The other top diseases of smokers are lung cancer and COPD.

Walking with Weights No doubt you know that weight training should NOT be done at the same time as the cardio portion of your workout, but can be done alternately. Well, yesterday I saw my favorite local really super gorgeous scuba instructor walking on our popular Sarasota Bridge (only hill in town) carrying two 8-10 weights in his hands. I was aghast.

Okay I believe that is it for now...... and for January ... ba bye...

Managed Care

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

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

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

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

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

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

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