That Health Rules

One of the highlights of the Mayo Endocrine Course in Mallorca Spain was the Clinical Pearls that we get after a case presentation.  And one of those cases that I found very interesting was a case of  lady who had a bone xray suggestive of a “strong” bone and a bone mass that was suggestive of a “thick ” bone.  She was therefore confident that she won’t fracture because she did not have any osteoporosis based on Xray and Bone mass measurement.

However upon review at the Mayo Clinic her bones were actually not normal.  So further evaluation was done and showed her to be drinking at least 10 tea bags of a commercial brand per day as a way of quenching her thirst.  Without her knowledge, she was taking in too much flouride into her sytsem coming from drinking too much tea!!!  She was developing a state of Flourosis which can cause a bone disease called Osteosclerosis.  From being told that she has strong bones to now being counseled to be careful not to fracture… was too extreme for her to understand!

Osteosclerosis can be due to taking in too much flouride in the body.  The problem with this disease is you have Brittle bones and therefore on Xray, you may have thick bones but the quality of the bone is poor!!!

Just how much flouride in is one tea bag?  In one study published in Amercan Journal of Medicine in 2005:

“Two independent testing laboratories determined that mean fluoride concentrations in 10 brand-name tea solutions ranged from 1.0 to 6.5 ppm. One tea exceeded the EPA safety limit of 4.0 ppm for drinking water, and several surpassed the U.S. Food and Drug Administration limit of 1.4 to 2.4 ppm for bottled beverages. “

So my frineds…please be careful with too much tea in a day.  I know of some chinese patients who use tea as their drinking water.  Just as the saying goes…

 Too much of a Good Thing can also be BAD!

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!