For me this is an exiting and interesting story. As I have said in earlier posts, exercise is important. This just reinforces the notion that exercise, even if started later in life, does help health. I won’t wax poetic about how exercise is a “veritable fountain of youth” as I try to avoid being overly dramatic with health care claims.
Recently there was something in the news about roughly half of the information in the shows “The Doctors” and the Dr. Oz show was correct (actually it was 63% of the time in “the doctors: and correct about 49% on the Dr. Oz show). See an article reporting on this here. Often times people will have looked things up on the internet when they come into the office.
Now I’m not bringing this up to knock Dr. Oz or the doctors who appear on “The Doctors”, nor looking things up the internet. However it’s important to ask several questions when evaluating health claims.
1) Does the claim have any scientific basis?
2) Has the study (if a study is being quoted) been replicated with the same or similar results?
2a) Who funded the study? Was it reported in a reputable journal?
2b) If it is a product being touted, did the company making the product fund the studies of the product?
3) Does the person ‘reporting’ the results, or pushing the product have a connection with the company? If there is, what is the connection? Just because someone is employed or funded by a company doesn’t necessarily mean they’re biased, but it is something to take into account.Well you get the picture.
Looking up things on the internet may be just as hard, given that websites may not be what they seem. If a patient asked where to look for information I’d give the following advice:
Lean toward sites that end in .edu, .org (though it doesn’t totally eliminate the possibility of bias..) or .gov
Examples of places like this to start include:
WebMD does appear to be a commercial site with decent information
When on a site, look for a statement that indicates if they get funding from a source, and where that source is. Ask where is someone getting his/her data from (or if they’re willing to say).
Perhaps the best place to start is with your own physician.
Of note, I think when you click on the link above, you will have to download the PDF.
I remember reading this article abut the time it came out. Though I don’t think it necessarily has all of “The Answers”, it does bring up some interesting points. I’ve often why some health insurance plans won’t pay for some preventive care when it would benefit the patient. When I’ve asked colleagues this the answer I often get is “because the patient will be on different insurance [ie, medicare or a managed care product from a private insurance].”
However many private insurances also have a managed care product for seniors. people may not ‘graduate’ into a plan from insurance they have while working. However there are people that might go from Having Harvard Pilgrim Health Care to AARP’s program (through united health care). however, some might go from United healthcare to HPHC’s product (or an equivalent insurance in a different part of the country). This might even things out a bit.
Anyhow, I sugges you read the article and make your own conclusions.
In this post I’ll be talking about Strokes (also known as Cerebral Vascular accidents). It is the fifth leading cause of death in the United States. It also is a major cause of disability and in terms of treatment, missed work, etc costs an estimated $34 billion dollars a year in the U.S. alone. Although the risk for stroke rises as we age, according to the CDC website 34% of strokes were in people younger than 65.
There are two kinds of stroke. One is hemorrhagic, meaning that is caused by bleeding. The other is ischemic, meaning that it is caused by a a blockage in a blood vessel. The symptoms, however are determined by the location and size of the stroke. Symptoms include: Facial Droop, double vision, confusion, garbled speech, limb weakness (especially if it occurs on one side of the body), numbness, and headaches.
It is important that if one suspects he or she is having a stroke that medical care be obtained quickly. There is a 3 hour window of opportunity from the start of symptoms that ischemic strokes can optimally be treated with clot dissolving medications. More than three hours after the start of symptom and the likely hood of poor outcomes increases – and the riskier it is to use medications to try and unblock arteries.
An acronym used to keep in mind regarding stroke is the word FAST (Face – is the face symmetrical: is one side drooping? Arms – weakness in one arm. Speech – is it normal? Time – call 911 immediately if it seems someone’s having a stroke).
Ischemic strokes are the most common. Based on symptoms one can’t tell if a stroke is ischemic or hemorrhagic, so it’s better to get to a hospital quickly. At this point in time there may be fewer acute treatments to stop hemorrhagic strokes, but even then supportive treatment is available.
Sometimes symptoms resolve quickly (within a few minutes). This is called a Transient Ischemic Attack, or TIA. This should not be ignored because people who have had a TIA are at increased for having a major/bigger stroke.
Although there isn’t anything that can be done about some risk factors such as age, there are many things one can do to reduce the risk of having a stroke:
1) Control your blood pressure if you have high blood pressure.
2) Lower your cholesterol if you have high cholesterol.
3) Control your diabetes if you are diabetic.
4) If you smoke, stop. If you don’t smoke, don’t ever start.
5) if you have an irregular heart rate, talk to your doctor about whether you need to be on blood thinners as certain irregular heart rhythms increase your risk of ischemic strokes.
6) Exercise (this will help with numbers 1-3 above)
If there was a medication that you could take that would help reduce weight, reduce the chances of developing disorders such as diabetes, dementia, and osteoporosis, I think most people would take it. If the side effects of this medication (even in the absence of dementia, depression, fatigue, etc) were a better mood, a better ability to concentrate, less fatigue, even more people would probably clamor to take it.
There is such a medication: exercise. Some medical societies, such as the American College of Sports Medicine state that “exercise is medicine”. The current recommendations for the minimum amount of exercise is 150 minutes a week of moderate exercise. This comes out to 20 minutes 7 days a week or 30 minutes 5 days a week. Walking is an example of moderate exercise often used to give people an idea of what the effort level of moderate exercise is. One should be walking slowly enough that one could talk and not be out of breath, but fast enough that one couldn’t sing. When my patients state they can’t find the time to do 20 minutes a day, I encourage them to find 10 minute periods through the day to walk. Obviously for some forms of exercise (swimming, playing a game of basketball, etc), this would be impractical to do.
Some research indicates that exercise has an anti-inflammatory effect in the body. Other research seems to indicate increased sensitivity to insulin, increases in various other hormones (or decreases in others), it is likely the mechanism for the beneficial effect of exercise is due to more than one pathway. That is to say that rather than, say deceased inflammation is the cause for improved mood or a decreased risk of dementia, it is likely that improved insulin sensitivity, anti inflammatory effects, etc all act in concert to improve health in people who exercise regularly. When talking with my own patients I tend to avoid talking about why it works and prefer to talk about the kinds of exercising they could/should be doing.
Though I encourage people to do weight bearing exercises such as walking, jogging, basketball, etc, I also realize that there needs to be some accommodation. For someone who’s morbidly obese or has severe arthritis that limits, at least initially, how much they can walk I might suggest stationary bicycles, water aerobics or something like tai chi (which is a weight bearing exercise, but because one isn’t jumping around as much as with things like basketball) the stress on joints is lower. I also realize that if someone doesn’t like a particular form of exercise, that person’s less likely to do that than a form of exercise they enjoy doing. Prescribing exercise isn’t a “one size fits all” solution to promoting health.
For people who’ve read many of my earlier posts, have probably noticed that I’ve focused less on medication and more on lifestyle issues such as diet. This post is no different. Many of the most common diseases I see in the office are most commonly caused by, for lack of a better word, poor lifestyle choices.By this I mean having a poor (read “western”) diet and not exercising enough. Once one has hypertension, type two diabetes, obesity, etc, lifestyle changes might not be enough to totally reverse or cure a particular problem in a specific patient. However even if one needs an antihypertensive, diet and exercise don’t become less important.
With this blog post, I realize I run the risk of sounding like one of those people that touts a new food every day or month (drink pomegranate juice for it’s high anti-oxidant content. You’ll live to 100!! it’s the next superfood!!!!). As I’ve pointed out, when evaluating health claims for foods/pills/etc it’s probably better to evaluate the claims as how they relate to endpoints such as decreased risk for disease, death, etc. rather than take something just because it’s a good antioxidant or has other reputed health benefits.
Anyhow, if someone were to ask me what kinds of foods should I eat/have handy, here are a few things I’d probably suggest. It is not an exhaustive list by any means. Of course if one has allergies to any of these foods, then they shouldn’t be on that person’s list of foods to have:
#1) Olive Oil. This makes my list because of the health benefits associated with intake. There is an inverse relationship with olive oil intake and the risk of dementia (that is, the more you take, the lower your risk of developing dementia). I has a lot of anti-oxidants in it as well as healthy fats. It’s good for heart health as well. It is important to mention that it’s important to use it IN PLACE of other fats, not just add it to a bad diet. That is, use olive oil in place of animal fats, coconut oil and other saturated fats.
#2) Canola oil. It’s high in Omega-3 fatty acids which are associated with lower risk of death due to heart disease, dementia, etc. It has a higher flash point than olive oil so can be used to cook at higher temperatures (and has a less strong taste which can be important with some foods).
#3) Flax seed/flax seed oil/ground flax. Flaxseed is also a good source of omega-3 fatty acids. However these are medium chain omega-3 fatty acids (as opposed to the long chain omega-3 fatty acids which are found in fish. It is the longer omega-3 fatty acids which have been shown to have health benefits). Not all of the fatty acids are converted to long chain omega-3 fatty acids in the body, but any little bit helps, and any that takes the place of fully saturated fatty acids or trans fatty acids is a good thing. Fish such as tuna, salmon, and sardines, to name a few, are better sources for long chain omega-3 fatty acids.
#4) Legumes, any combination of them you might want (legumes include peanuts, lentils, any type of bean). In combination with a cereal (e.g. rice or wheat) will provide all the essential amino acids (make up a “complete protein”). The health benefits get even better if it’s a whole grain you pair the legumes with.
#5) Tree nuts such as almonds, walnuts, cashews, etc. Though relatively high in calories – they tend to be high in fats – they are healthy. They contain some fiber. The fats they have tend to be the healthier types of fats and tend to be high in fat soluble antioxidants. Using a handful of nuts such as almonds to stave off hunger pains can help keep someone from consuming even more calories at dinner due to hunger. And they’re better for you than sugary/starchy foods such as crackers.
#6) Eat many different fruits and vegetables. The greater the variety the better. One study showed that blueberry intake reduced the chance of developing diabetes by 40 % (however this is only one study. Whether this is close to the “real number” blueberry intake reduces risk would be determined by looking at/doing more studies). Other fruit intake also reduced risk of certain diseases, for example, apple intake is associated with a lower risk of developing emphysema. Rather than relying on one “super food” or whatever fruit is the fad of the day, having a variety of fruits is probably better. Each fruit and vegetable has a different mixture of antioxidants and phytochemicals. The different phytochemicals probably have different affinities for different tissues (this is my supposition here. I have no proof to back it up other than a feeling it might be the case) and by having a variety of foods, it’s likely that more parts of the body will be protected.
#7) A variety of spices. I would put turmeric high on the list of spices to have as it appears that the curcumin (a substance found in turmeric) is a rather potent anti oxidant and anti inflammatory agent. However, I would make the same argument about spices that I make about fruits and vegetables above. The greater the variety the better.
Notice I have not put on the list meat, poultry, milk or other sources of animal protein.I wouldn’t say avoid them, unless you have a particular cultural or moral stand on eating animal products. I only mention fish because of the healthy fatty acids some fish contain. Limiting the amount of meat one has is important for maintaining health. However the amounts of each, frequency of using these in diet is a topic for another time.
For this post I thought I would write about staying healthy, but in a slightly different manner than I’ve done in previous blogs. In older blogs I’ve written about screening, vaccinations, etc. In this one I thought I’d talk about using a medication to stay healthy, and in this case talk about aspirin.
Aspirin has been around for more than 100 years, and perhaps is a bit under appreciated since it is an over the counter medication (meaning one can buy it without a prescription). It is also something that is derived from a natural product. Willow bark had been used to treat fevers and it was eventually found that salicylic acid was the active ingredient. Salicylic acid was then derived from this. I won’t go into the chemistry of this (I figure if you’re a bit of science nerd like I am you probably already know, and if not I don’t want to bore you).
Most people probably think of it as a pain killer or a headache medication. It is much more than that. Aspirin plays an important role in treatment of patients who’ve had heart attacks – it helps treatment and also helps decrease the death rate from heart attacks. It is used in primary prevention heart disease as well. In the past high dose aspirin was used in the treatment of Rheumatoid Arthritis. It’s use in this latter population (at least for treatment of Rheumatoid Arthritis) has been eclipsed by other medications. However it still should be used to treat/prevent heart disease in this group of patients.
Use of aspirin in ischemic stroke patients is advised as well.
Though less studied at this point, aspirin use to prevent recurrent deep venous thrombosis, is a consideration (this is after someone has been treated with coumadin for an acceptable length of time). A link to a review on this subject can be found here: http://www.ncbi.nlm.nih.gov/pubmed/24745726
There is some evidence linking aspirin intake to a decreased chance of developing colon cancer. At the moment there is not enough evidence to routinely suggest people take aspirin solely to prevent colon cancer. There is also some evidence that it only helps prevent colon cancer in certain groups of people – those that have a particular form of a particular gene. The only recommendation is for aspirin to help reduce the risk of heart disease.
Aspirin, like any other medication, has its downside as well. It can cause stomach ulcers. If the ulcers are large enough they can cause a lot of bleeding. It should not be used in children, except in rare circumstances and even then only then under the guidance of a pediatrician or other health care provider who provides a lot of treatment to children (EG pediatric rheumatologists, family practice physicians, etc).
One thing that sometimes crosses my mind is whether physicians and other health care workers should also be environmentalists. After all the environment does play a role in people’s health. Contaminated water lead to outbreaks of water born diseases (John Snow, a London physician in the mid 1800’s is credited [at least in part] for ending a Cholera outbreak by convince authorities to block use of a water pump at the center of the outbreak). The cholera outbreak following the earthquake in Haiti several years ago is another example. Polluted air leads to increased respiratory disease.
Though in the U.S. and other developed nations with functioning governments, the chances of contaminating water with sewage is low. The one exception could be when severe weather overloads the septic systems in an area. However even in the Northeast U.S. where I live, beaches are monitored for coliform bacteria (this is a generic term for bacteria that live in our guts) and closed when the counts are too high.
Air quality effects health of populations – there were reduced hospitalizations in parts of Ireland after there were bans placed on burning coal. When lead was taken out of gas (well, actually prevented from being put in gasoline…), blood levels of lead dropped. It’s a neurotoxin and high blood levels can affect brain development in children (hence the ban of lead in paint in the U.S.), and function in adults. For water, it’s not just bacterial contamination/pollution that is important. Chemical pollution can also affect health. Toxins can build up in the food chain – this is part of the reason why it’s suggested that pregnant women limit their intake of certain fish, for example. Mercury builds up in fish at the top of the food chain, such as in Tuna, and can adversely affect people neurologically and adversely affect developing brains. Studies continue to show an association between air pollution and respiratory deaths.
Given the number of of medications that are derived in whole or part from the plant and animal world (aspirin, reserpine, taxol, digoxin, penicillin, streptomycin, are all plant and fungal products), an argument could be made that making sure plant and animal species don’t become extinct because it might affect future drug discovery. Before you say “but wait,….” think of this: heparin is derived from the linings of Pigs. ACE inhibitors were discovered through research on snake venom. There are some newer medications for Type 2 Diabetes which are derived/grew out of research on saliva from a lizard known as the Gila monster.
My previous post was about women’s health. In this post I am going to review a couple of aspects of Men’s health. Most of the things men should be doing are things people of both genders should be doing to stay healthy: stop smoking, exercising, eating a healthy diet, maintaining a healthy weight (or loosing weight if overweight). Staying up to date with immunizations, such as yearly flu vaccination, is also important. Getting screened yearly for hypertension is important. Skin cancer screening is also important, though this might only need to be done every 2 years depending on whether you have any suspicious moles or lesions, prior history, you and your dermatologist’s comfort levels for yearly vs every other year screening. Cholesterol screening at appropriate intervals is important (a healthy male in his 20’s with no risk factors for heart disease only needs his cholesterol checked every 5 years or so. Older men and those with risk factors require monitoring more frequently and perhaps yearly if risk factors are present or if on treatment to lower cholesterol). I won’t get into more details about screening or other issues covered already in other posts.
Perhaps the biggest controversy in mens health is prostate cancer screening. The U.S. Preventive Services Task Force actually recommends against routine screening for prostate cancer in healthy men of all ages. Even the American Urological association recommends against screening for prostate under the age of 64 and in men with life expectancy of less than 10 years. For screening, a conversation with your primary care doctor is warranted before getting the test. The main reason it is controversial is that one runs the risk of finding a prostate cancer which is indolent (slow growing), non aggressive that one is likely to die with than of – meaning one is likely to die of some other disease before the prostate cancer becomes a problem. At this time we don’t have enough information to know what low grade/early prostate tumors are going to become aggressive and turn into problems. One therefor runs the risk of over treating something that would not be a problem.
Occasionally I’ve had patients ask for testosterone levels and had to talk to patients about testosterone replacement. Testosterone levels are not something routinely checked unless there is a clinical reason (if there is loss of libido, erectile dysfunction, and so forth, then it’s worth getting). Testosterone replacement has been associated with an increased risk of heart disease so replacement benefits needs to be worth the increased risk.
Although I probably run the risk of repeating myself by saying this, but reducing the risk of heart disease, lung cancer, colorectal cancer by exercising, watching what one eats and getting appropriate screening applies to men’s health as well.
I’m dividing this post into two parts. The first is on the recommendations for screening in females. The other part is some general thoughts on women’s health in general (and are somewhat generalizable to anyone’s health, male or female). The recommendations are taken from USPSTF related sites.
If you’ve read any or all of my earlier posts, you know I’m into screening and catching diseases early, especially if there is treatment for the particular disease.
Women should get pap smears every 3-5 years with HPV testing. The frequency depends on a woman’s age, whether the pap smear is negative and the results of HPV testing. It is important that the HPV testing be done via one of the five tests that are FDA approved: the unapproved tests from what I understand are more prone to error. Ask your doctor if he or she knows whether the lab he or she uses is FDA approved.
Screening for STIs (sexually transmitted infections) is suggested. This includes syphilis and HIV in high risk individuals.
Breast cancer screening (mammography) is done every 1-2 years starting at 50 (the old recommendations were every two years starting at 40, then yearly after age 50). BRAC testing should only be done if there is a family history of breast, ovarian, peritoneal cancer.
Bone density should be done at least once after age 64. However one can consider doing bone densitometry at an earlier age.
As much time and energy that people put into screening for breast cancer, cervical cancer, etc I think there a tendency forget about screening for heart disease and colorectal cancer, things I think people tend to see as “a man’s disease”. However in 2010, 23.5% of deaths in women were due to heart disease, and 22.1% were due to cancer deaths (this includes all cancer deaths, not just breast cancer). Lung cancer killed 70,000 women whereas breast cancer killed 40,000 women that same year. These are for the most part “lifestyle diseases” in as much as most lung cancer is caused by smoking; diet, lack of exercise, obesity contribute to heart disease. These are all things that are modifiable to a great extent.