Health Education: disease prevention and wellness

Showing posts with label disease prevention and wellness. Show all posts

First, Second, Third - Smoke and Chemicals

Probably a year ago, a MassGeneral pediatrician coined the term third hand smoke or THS. He was quoted on this in several national publications at the time and I continue to be asked about this during my presentations. I tell my audiences and classes that I absolutely concur with him on the concept and the harm from THS, but not the name. Third Hand Smoke, as he refers, is the chemical residue left behind in buildings and cars, on upholstery and skin. It is not smoke at all, but a dirty noxious film. Dr. Winickoff has spoken again. He was interviewed and quoted by the Boston Globe on July 12, 2010 after a joint letter from he and colleagues was published in the New England Journal of Medicine. The letter was a call to ban smoking in Public Housing complexes. Super YAY for that. We are working on such an initiative in Manatee County Florida. Dr. Winickoff explains how the smoke seeps through doors, cracks, air and heat systems and can harm the most vulnerable citizens (youngest and oldest). Massachusetts bans smoking in cars with kids, so he may "get er done." On a personal note, I just agreed to pay an additional 20 dollars in rent for my new place in North Carolina - for a totally tobacco free building!

First, Second, Third - Smoke and Chemicals

Probably a year ago, a MassGeneral pediatrician coined the term third hand smoke or THS. He was quoted on this in several national publicati...

4:10 PM

Retro Post!

This is a copy of a news story I wrote in March of 2007 when I was still an employee of Wake Forest University Baptist Medical Center. I tried NOT to edit it too much :) You can see that some of the issues have remained in the press and that maybe, my writing skills have improved since this was written! News Notes Special Edition The information in today’s newsletter is derived directly from a conference I attended earlier this week. This was part of the research series brought to us by the Women’s Health Center of Excellence. I did attend sessions on weight loss surgery, diabetes, fad diets and most importantly life style factors and disease. In fact, the reason I took the day off from work was to hear the man, the physician and doctor of public health whom I esteem above all others, speak on the prevention of the chronic diseases that are affected by life style and diet. He is Walter Willett, Harvard professor and researcher. This is my best representation of what I heard during his lecture. He also has a new book for the public titled Eat, Drink and Weigh Less. I highly recommend any and all of his publications. There were pearls here and there in his lecture. But I will begin with the bottom line. Based on careful analysis of two large, rigorous and scientifically valid prospective cohort studies,[ one the Nurses Health Study, the other the Physician’s Health Study] ….it is believed that the following life style choices are protective against heart disease and diabetes… Moreover, as much as 80 to 90 % of the cases of these diseases could have been prevented…. [ NOTE: Dr. Willett did not provide a presentation out line and I am fallible. There could be error here, by misunderstanding or even a typo… check the facts ok!] Okay, the LIST of things to DO!!!!! To prevent heart disease 1) be a nonsmoker 2) keep the BMI (body mass index) below 25 and lower is better (to 20) but he is choosing a number that more persons might be able to attain. [realism…] 3) exercise more than ½ hour a day every day. He suggested brisk walking though he said running is better. Again he said he is being realistic for the majority. 4) choose what you eat! Low to no trans fats, high ratio of polyunsaturated/saturated fats, low glycemic load foods, high CEREAL fibers, high fish intake (3x/week), consume the recommended daily allowance of folate 5) alcohol (any kind not just wine, it’s the ethanol stupid – little joke there, but yes, it is the ethanol that appears protective as long as the folate intake is not lacking. Very important that you hear that part, FOLATE + ½ glass per day of alcohol o prevent heart disease For diabetes Dr. Willett said it was the same but not the fish and folate recommendations. He said that prevention for colon cancer also adds that one should not have more than two servings of red meat a week (serving is 3 oz which is NEVER the size a restaurant provides!). Alcohol and Folate rule does apply and I think the alcohol recommendation was slightly higher. Screening for this cancer is strongly recommended in the literature. Dr. Willett does not recommend dairy products or calcium overmuch. He noted some bad outcomes with too much calcium, regardless of fat content in the dairy products. He notes that we are the only country that consumes so much dairy. Some use none. He noted research that does NOT show that calcium protects against fracture. A new to me "factoid". Height is a risk factor for fractures… long bones.. Also the hormones in milk accelerate growth in our kids leading not only to early puberty, but breast cancer and fracture risks because of the growth… He promotes Vitamin D… I hinted at that a few weeks ago and now I am going to make changes because of it……. All he recommended in regards to supplements is Vit D 1000 IU a day and the RDA for Folate…. He suggested a multivitamin with 1000 D, but I haven’t seen one (yet) [actually I went shopping between the above and the below, I did not see any multivitamins with more than 400 IU of D but the D tablets came themselves in 400 and a 1000. Be careful you don’t over do it if you are taking multiples, i.e. your calcium might have D and your Multivitamin, so don’t add 1000 of D if they both already have some] Dr. Willett reviewed research that helped us track down why some countries had more rates of certain disease than others. He spoke about the mistakes made with fat free diets and the error of the original food guide pyramid. He addressed the butter v margarine and Trans Fat issue. He believes that the biggest issue and the one that has had the most impact on this increase in obesity, heart disease, diabetes and some cancers is the failure to differentiate between the types of fats and the types of carbohydrates in our diets. He supports the positive aspect of fats in olive, canola, and soy bean oils. He encourages consumption of food with poly unsaturated fatty acids or PUFA and of foods with Omega 3 and 6. These fats are correlated in the rigorous research with decrease in heart disease where as trans fats those in processed, and until recently, fried foods as well as saturated fats in red meats, etc are related to increase in heart disease. Though both are health promoting Omega 3 is better than 6 in this regard: A real pearl for me: Omega 3 fatty acids, often found in fish are the only ones that in research have been shown to control or prevent heart arrhythmia, ( irregular heart beat ) and though they do not stop heart attacks from occurring, they decrease DEATH from the heart attack.. My father’s death certificate states arrhythmia and acute MI… so hmmmm. Food for thought isn’t it. Oh yes, on that same note. He said that dietary changes such as he proposes are good at ANY age and with any heart disease history. He states that the Mediterranean type diet, low in sat fat, higher in fish and veggies and monounsaturated oils will increase life expectancy. His best quote I thought, “the hydrogenation of oils that leads to the TFAs is done to increase the shelf life of products, but it decreases OUR shelf lives!” Do you all remember a couple years back I brought up a type of inflammation in the blood that might indicate heart attack risk. The CRP or c reactive protein? WELL he mentioned it and said that trans fat could double it! Oh dear, I notice I am on page three. Better wrap this up. Gosh it’s hard to not repeat everything he said. I suppose the most important thing would be the pyramid that I mentioned earlier. It was a lovely slide. Shoot. I didn’t get to the carbohydrate issue. Basically it’s the same as I’ve already written. He said that white potatoes should not be in the vegetable category.. He said that white flours, rice, pasta, bread etc are high glycemic foods and he did give credence to the issue that these foods should be avoided or limited. This is especially so if one has an increased BMI. In other words, lean all day active people, like the Chinese of a generation ago, they can eat white rice and not get diabetes! In July of 2009 I did include Dr. Willett's food pyramid in a post. You can see it <a href="http://yourhealtheducator.blogspot.com/2009/06/recommended-daily-intake.html">here</a>.

Retro Post!

This is a copy of a news story I wrote in March of 2007 when I was still an employee of Wake Forest University Baptist Medical Center. I tri...

3:30 PM

It IS Outrageous

With regard to drugs and pharmaceutical companies I have gone from skepticism to cynicism and now I think I am approaching outrage. I feel this might be repetitive but to err on the side of caution I will reiterate a point. For the most part, drug companies are focused on making money. They do spend a lot of money on research and development and a great many times that money is lost with no cure or treatment actualized. When they do have a breakthrough however, it seems to go something like this. The company gains approval to use the drug for a certain condition in a certain population – say adults – or adults who have had one heart attack. They can market their drug to the doctors who prescribe them, to the nurses who might suggest them and to You – who might request them. When a drug for heart disease seems to help with something else, that is a bonus for a drug company, but unless they complete another, albeit abbreviated drug study, they cannot market it for the new condition. Usually a drug gets patent protection for many years and generic forms are not available during that time. Drug companies do many things to maximize revenue for their products. Researchers are often funded to explore after market options for drugs. I feel the effects of this when I see drugs like those used to treat osteoporosis being suggested to prevent it and then panels of scientists or health experts calling for more bone scans in younger and younger people. My skepticism is that it is not because those women or even men are going to have fractures but that the company making the drug is seeking additional money. Pharmaceutical conglomerates, as they seem to be becoming, have other strategies or tactics in this regard. Even years before a drug is to come off patent they work to change the formula from say short acting to long acting and they may do a little research into other disease conditions and other populations, as well. So often we hear about drugs to treat one cancer site that are being tested for other cancers. My post today is triggered by a new indication for Pfizer’s Lipitor. Unfortunately, the same thing happened in the US several years ago, I happened to miss it. The European Union, which I consider stricter on drug applications and acceptance than the US FDA, is allowing Lipitor prescriptions for children aged 10 and older. This is wrong on so many levels – in my educated opinion. The reason the children would be placed on a statin medication is because they have dangerously high cholesterol levels. The answer is not to place them on a medication that could cause muscle wasting, liver problems and possibly diabetes. The answer is to get the kids healthy with nutrition and exercise. It is an outrage to me that we would think it best to medicate our children.

It IS Outrageous

With regard to drugs and pharmaceutical companies I have gone from skepticism to cynicism and now I think I am approaching outrage. I feel t...

5:51 PM

What to Wear

Hats V Visors Deciding which is best to wear has a lot to do with your sport or the purpose for wearing the covering. Here are my thoughts on the issue. If you are engaging in an indoor sport and want to keep hair and sweat out of your eyes, a visor should do the trick. If you are outside and it is raining, visors are great to keep the water out of your eyes. For any other sport or activity, including beach and mountain escapades, a hat is best. The hat will protect your hair and scalp from the burning and radiating rays of the sun AND can protect you from ticks. I understand that some people think that hats are not cool. Maybe you can reframe this and make it one of long term vanity by considering the hat as a way of keeping your hair healthy looking and preserving your natural or costly color. All of this applies to young and old, male and female. What about people without hair? All the more reason to cover that scalp – skin cancer risk should trump style when deciding whether or not to cover up. Ah yes, I just remembered one of the skin cancer prevention slogans I heard some years ago – slip, slap, slop – I think it was. Slip on a shirt, slop on sunscreen and SLAP on a hat.

What to Wear

Hats V Visors Deciding which is best to wear has a lot to do with your sport or the purpose for wearing the covering. Here are my thoughts o...

5:06 PM

A Call to (Imaging) Action

If you have been following along over the years or even the last few months, you are aware of my concerns regarding over radiation from medical testing or imaging. I blogged about it most recently after the President's Cancer Panel released an annual report and that post can be found <a href="http://http//yourhealtheducator.blogspot.com/2010/05/chapter-four.html">here</a>. On June 23, 2010 an editorial written by Rebecca Smith-Bindman (MD) from the University of California called for regulation of the radiation or imaging industry. The recommendation is based on much of the same information that I have shared with you over this past year. Dr. Smith-Bindman does mention the actions that some organizations have begun to take to protect patients from over radiation but notes that there is no standardized method to do so and that there should be. A few points from her article are powerful enough to repeat in full. She said that sometimes the scans completed and the doses of radiation that they impart may not be based on "scientific evidence of improved clinical outcomes." In other words, sometimes the clinician or the company that made the machine is using a lot more radiation than necessary to enhance the quality of the image, but the image with less quality and thus less radiation would show the same clinical indication. In that case, there would be no treatment difference from using the SAFER scan. She also said, "Studies have consistently shown that physicians know little about radiation doses or cancer risks from medical imaging." Because of this I implore you to be mindful of your own health and ask about these tests before you succumb to them. There are times when a CT scan is absolutely necessary to save your life please understand that. Also understand that the machines are not always calibrated and even calibrated ones may offer doses of radiation that exceed what is necessary. In fact, there isn't a recognized notion of what IS necessary. I agree with Dr. Smith-Bindman that the FDA should have a mandate to cover this issue but I also urge that the mandate come with authority to enforce the regulations and a budget with which to do so. The article is only three pages long and the beginning tells a story that is worth a read. Please check it out <a href="http://http//content.nejm.org/cgi/reprint/NEJMp1002530v1.pdf">here</a>.

A Call to (Imaging) Action

If you have been following along over the years or even the last few months, you are aware of my concerns regarding over radiation from medi...

2:31 PM

Odds and Ends

Okay I have five issues with brief comments this week Osteoporosis and Drugs: I have two things to say about this. The first is that a new drug has been developed that is supposed to be better tolerated and perhaps more effective than the more common bisphosphonates and secondly, I heard a commercial last night for one of the four or five drugs we already have for this “condition” and in that ad, an actress said, “ one out of four women are at risk for osteoporosis.” I have blogged about the concern of some scientist physicians on treating at risk conditions. Recalling that one researcher referred to osteopenia as being at risk for being at risk for breaking a bone. All that aside, 25% of all the women in the world over age 40 is a gazillionmillion – or a lot. And that is why drug companies refer to their new medicines as blockbuster drugs instead of the more appropriate life enhancing, saving, improving, etc Empty Stomach and Fat Burning: A study published recently is causing a bit of an uproar in the exercise physiology arena. People who exercised on empty stomachs burned calories a little differently. The study subject burned more fat. Anytime you say that people burn FAT everyone gets excited but burning fat during exercise and immediately thereafter does not always and in this case did NOT equal losing fat as in weight loss. There are many reasons why one should not do intense cardio work on an empty stomach and just as many for why one should not do it on a full stomach. As a somewhat educated person in this field I offer my two cents. The very first question to ask when planning for your next preworkout snack is “when was the last time you had anything to eat?” If it was two hours ago or so – fine go on ahead and run, cycle, take a cardio class. If it was before you went to bed then I suggest a small bit to eat. In my personal experience, if I am running over 3 miles I need a little something. But also be mindful that sometimes when you are REALLY pushing yourself – food in the stomach is your enemy. Bottom line – think about it and make your own decision. Performance will always be affected by what you do and do not eat – but weight loss will always be about the calorie differential over time. Lung Cancer Blood Test: A test is now commercially available in the US and UK to detect a certain type of antigen or inflammatory marker in the blood stream that could tell if a person has lung cancer. In my reading about this, I saw that at least one physician uses it in people who have been smoking for at least 15 years. Not everyone is excited about the test and I found it interesting that a clinician in Australia, where it is not yet available, thought it would benefit them to watch and see if this test is accurate and meaningful with the USA population before they start using it. Sounds like a plan! There is some debate on whether or not this will be any more useful that the PSA test for prostate cancer (will it prevent death) and from the test companies perspective, they also want to find markers for all the other cancers so the test can be used for those as well. At this time, insurance coverage for the test is uncertain. Age of the Artery: Funny thing about those arteries – they tend to clog up as we get older. Some cardiologist are using test results and risk factors to calculate a persons artery age. Sure does remind me of the lung age I recently mentioned. The artery age formula is a bit different and in my opinion, less scientific than the research that has gone into determining a persons projected lung age. The problem being that very few people would have normally aging arteries as the plaque that builds up and occludes the artery wall is related to smoking, fatty acids, hypertension, diabetes and the subsequent inflammation and endothelial dysfunction. One can have normal arteries but they are referred to as “young” or atypical because so many other peoples are significantly older than they are. It is true that our lifestyle (activity and consumption) has changed so much over the last 30 years that our 40 years olds have the arteries of what would have been an 80 year olds. This is sadly true of younger and younger persons. The flip side is that an 80 year old can have much clearer arteries than a 20 year old if that 80 year old eats well, exercises and doesn’t smoke. I am not sure why we need another test to make that point. Physical Fitness/Shape: Observing people around me – friends and strangers – as well as professional athletes and fitness leaders, has led me to feel somewhat better about myself. WHAT?! I know – comparisons usually lead to plummeting self esteem but let me explain. I take the physical activity guidelines or recommendations to heart. The <a href="http://www.yourhealtheducator.com/physical-activity-guidelines.html">recommendations</a> suggest that we incorporate cardio activity, weight training, core and balance work into our weekly routine. Because I do, as do some of my friends, my body has some shape to it – some definition. My hard work actually pays off. I have noticed that some runners, shorter distance runners, who cross train with pool work and weight training, also have really fit looking bodies. At the same time, I have noticed others who run – only or walk only, for that matter – who look soft in the middle and lack definition. If your goal is just to burn off calories then I suppose it doesn’t matter, but if you want to be FIT – it takes more than that.

Odds and Ends

Okay I have five issues with brief comments this week Osteoporosis and Drugs: I have two things to say about this. The first is that a new ...