That Health Rules

Nowadays, physicians just dont have the time to talk with their patients. Patients feel shortchanged when they have been waiting outside our clinics only to be seen for 5 minutes. 

The lesson I’ve learned from my training at the Mayo Clinic was the importance of patient – doctor relationship that should go beyond treating a disease.  But more so to provide comfort to an anxious patient not knowing what she or he has and the need to listen and care!  The words of advise from a doctor’s mouth is more than worth their time in seeing you and these patients see us because they trust us to help them lead a better healthy life.

Now comes a new study that confirms my practice in my clinic published in the Archives of Internal Medicine this 2/2008.

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Background  Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits.

Methods  We conducted a randomized controlled trial of a 12-month intervention at 2 large community health centers, enrolling 310 patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 25 or greater. In the intervention group, self-management goals for nutrition and physical activity were set using a tailored computer program. Goals were then reviewed at each clinic visit by physicians. The control group received only printed health education materials. The main outcome measures included change in physical activity and body weight.

Results  In the intervention group, recommended levels of physical activity increased from 26% at baseline to 53% at 12 months (P < .001) compared with controls (30% to 37%; P = .27), and 32% of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9% of controls (odds ratio, 2.2; P = .006).

Conclusion  A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss.

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This study confirms my belief and practice of spending more time with the patient in trying to help them understand how one can implement the standard of care in dealing with chronic diseases like obesity, high blood pressure, high cholesterol and diabetes.  If one understands the concept of why exercise and nutrition are important then the pressure is with the patient to comply otherwise he will suffer the consequences.

Compliance to medications and behavioral therapy is a must if one aims to reach the goal of preventing complications like stroke and heart attack!  I am always asked if I am successful with behavioral modification and in letting patient follow my dietary guidelines.  I guess I am because I spend time with them.

This has been my standing principle and guide in my practice and thus this website to help educate my patients and the public because I believe that….

“Understanding One’s Disease Is Key To Better Health”. 

Do you take multivitamins daily?  Why? Out of habit? or because you believe they can prevent illneses especially cancer?

Well a new study refutes the claims that multivitamins can prevent cancer.  Recently published in the American Journal of Respiratory and Critical Care Medicine suggest that in fact the contrary maybe true and that is… it can be harmful!!!!__________________________________________________________

Rationale: Lung cancer is the leading cause of cancer-related mortality in the United States. Although supplements are used by half the population, limited information is available about their specific effect on lung cancer risk.

Objectives: To explore the association of supplemental multivitamins, vitamin C, vitamin E, and folate with incident lung cancer.

Methods: Prospective cohort of 77,721 men and women aged 50–76 years from Washington State in the VITAL (VITamins And Lifestyle) study. Cases were identified through the Seattle–Puget Sound SEER (Surveillance, Epidemiology, and End Results) cancer registry.

Measurements and Main Results:

• Supplemental vitamin E was associated with a small increased risk of lung cancer (HR, 1.05 for every 100-mg/d increase in dose).
• This risk of supplemental vitamin E was largely confined to current smokers (HR, 1.11 for every 100-mg/d increase) and was greatest for non–small cell lung cancer (HR, 1.07 for every 100-mg/d increase).

Conclusions: Supplemental multivitamins, vitamin C, vitamin E, and folate were not associated with a decreased risk of lung cancer. Supplemental vitamin E was associated with a small increased risk.

Patients should be counseled against using these supplements to prevent lung cancer.

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We have been disappointed with studies looking at whether multivitamins are beneficial or not.  Almost always they turn out to be negative and sometimes even do harm.  And yet we continue to take MVI as supplements to our diet for hope that they may replenish what have been lacking in our diets.  I even have patients who continue to show me their MVI preparations bought by their loved ones in the US whether they can take them or not.

What we know is that foods rich in vitmains have been proven to reduce the risk of cancer…BUT once these vitamins are packaged as pills…then the benefit is nowhere to be found!  And what is worst…in the above published study…Vitamin E was noted to increase the risk of lung Cancer especially among smokers!

The best option for us is not to rely on shortcuts to health packaged as pills…its in our lifestyle..the food we eat , the physical activities we do and the way we live our lives that matter most!

Health Shortcuts Packaged As Pills Are Of No Benefit!

If cough and colds medicnes are not that effective such that the US FDA recently made an announcement not to use these medications among children less than 6 years old… then what is our altrernative as parents with children arriving from school with cough and colds?

I have long heard about honey and its supposed “healthy” properties so I was not surprised when in a recent article published in Archives of Pediatric and Adolescent Medicine, Dec 2007 , honey was assessed to be a safe alternative to cough and colds medicine which for me is just timely!!!! 

In this study the, the children with cough and colds were given either honey, honey-flavored DextroMethorphan ( a cold remedy), or no treatment 30 minutes before bedtime.  ______________________________________________

Results:  Significant differences in symptom improvement were detected between treatment groups, with honey consistently scoring the best and no treatment scoring the worst.

In paired comparisons, honey was significantly superior to no treatment for cough frequency and the combined score, but DM was not better than no treatment for any outcome. Comparison of honey with DM revealed no significant differences.

Conclusions :  Honey may be a preferable treatment for the cough and sleep difficulty associated with childhood upper respiratory tract infection.

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The study used buckwheat honey which contains more phenolic compounds than other varieties.  Apparently these substances have been shown to have antioxidant properties whihc may have contributed to the improvement of the symptoms of cough and colds.   The question therefore whether the effect is limited to this kind of honey only remains unanswered.

For me honey is easy to get and safe to drink.  Based on the study… it worked. I would definietly try it on my kids and then let’s all share experiences once we have tried it.

Bring Home The Honey! 

I eat meat…. who doesn’t?  I know of few friends that are purely vegetarians but I can only count them with my one hand.  I try to introduce veggies to my kids as often as I can but food is finished faster if there is meat especially red meat from fried chicken!!!!

Now comes a new study linking red meat consumption to increased cancer risk.  This study was recently published online in PLOS Medicine, December of 2007 with a conclusion from the editorial below:

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…Red and processed meat intake appears to be positively associated with risk of cancer of the colon and rectum, esophagus, liver, lung, and pancreas in a new, large US cohort study of 500,000 men and women.

….However, this study provided little support for an association with other cancer sites. Current dietary guidelines recommend selecting meats that are lean, low-fat, or fat-free, thus promoting limited consumption of red and processed meats.

…..Overall, the strongest risk factors for cancer in the US are smoking and obesity. However, understanding the complex interaction of diet with smoking and obesity, and how specific foods and nutrients are metabolized, may provide further clues into the etiology and, most importantly, the prevention of cancer.

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It is also important to note that while red meat is indeed a risk factor for cancer…majority of patients on red meat are also taking processed foods which are high in fat and therefore associated with obesity which in itself increases ones risk to develop cancer.  And therefore the interaction of the different risk factors is in itself a matter of importance.

For this holiday season…let us therefore examine the way we lead our lives … the way we eat and the way we take care of our health. It is really up to us to interpret and practice the things we know that are healthy and avoid or shy away from the things we know that are harmful. 

….Which way to go and adopt the practice in our lifestyle is up to us!….

Be Informed! and Live Well!

More and more studies have found new reasons for us to enjoy dark chocoalate this holiday season… or we are just looking for excuses to indulge in one. 

But a new study published in the Journal Circulation in November of 2007 showed the potential mechanism why Dark Chocolate especially the 70% cocoa can be healthy:

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Conclusions— Dark chocolate induces coronary vasodilation, improves coronary vascular function, and decreases platelet adhesion 2 hours after consumption. These immediate beneficial effects were paralleled by a significant reduction of serum oxidative stress and were positively correlated with changes in serum epicatechin concentration.

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The above conclusion points out that indeed dark chocolate can increase blood flow to the heart and more so in patients who are already on medications like ACE inhibitors and Beta blockers. Therefore beneficial to prevent blockage of blood vessel that can lead to heart attack!

But caution to those who will start indulging in Dark chocolate.  Remember the color of the chocolate does not necessarily mean its dark.  It’s the content of the cocoa and more so the content of the flavanol.  This study was done using 70% cocoa.

But before grabbing a chocolate…make sure you are careful not to over do it.  Remember …chocolate is rich in calories and fat! But at least we now have reasons to take a bite before and after a meal without feeling too much guilt!

A Bite of Dark Chocolate for the Holidays!

If you think of peanuts… you dont associate them with health food but rather… a kind of junk food? or an unhealthy snack alternative? and pretty salty!!!!

But the FDA has considered nuts as a healthy snack alternative based on the data that nuts have lots of protein and fiber and contain a lot of the good fat called monounsaturated fats as well as certain  antioxidants. 

BUT not all nuts are created equal:  the health claim recognized by the FDA only includes peanuts and certain tree nuts like:

• walnuts because of its omega 3 fatty acids
• almonds,
• hazelnuts,
• pecans,
• some pine nuts,
• pistachios, and
• walnuts.  

These nuts carry with them several studies lowering LDL or bad cholesterol while improving HDL or good cholesterol and as aresult may actually have beneficial effects in protecting heart ailments.

Other nuts that did not get the qualty health claim from the FDA because they contain high saturated fat include: Brazil nuts, macadamia nuts, cashew nuts, and some varieties of pine nuts.

So for your next meal or snacks…dont feel guilty grabbing some nuts from the can and enjoy them.  Nuts are rich in protein and fiber and therefore can be very filling.  But again in moderation because even if they have health claim…they still contain calories and too much of which can also be harmful!

Let’s Go NUTS!