Wednesday, December 29, 2010

MORE Losing Holiday Weight

Tip number two for losing that holiday weight is another common sense solution- GET SOME REST! A study published in the Annals of Internal Medicine this year compared weight loss between a group that followed a low calorie diet and had only an average of 5.5 hours of sleep per night versus a group that followed the same diet and averaged 8.5 hours of nightly sleep.
It may surprise you that not only did the people with more sleep had more weight loss, but they also had greater reduction in body fat and in HUNGER.

Scientists are not sure of exactly how more sleep resets your hunger thermostat or changes your metabolism, but we certainly know that less sleep stresses your body, which is not conducive to better health. If you struggle with INSOMNIA as the reason for your lack of sleep, make sure you are having good sleep hygiene (keeping a regular bed time, not watching tv or doing computer right before bed, etc.) and limiting or avoiding caffeine and alcohol. Check out my blog on covering the clock, and make an appointment with your doctor if you cannot restore good sleep on your own.

BOTTOM LINE: Make sure you are getting at least 8 hours of sleep to maximize your success with losing those extra holiday pounds!

Calcium: Adequate serum calcium is needed for fecal fat excretion. Observational data has shown that those who supplement their diet with calcium have lower levels of body fat. This systematic review found supplementation of about 1,200 mg of calcium per day leads to an increase in fecal fat excretion. Obes Rev 2009; 10(4): 475-86

Sleep: A very small pilot study compared a low calorie diet and either 5.5 hours of sleep vs 8.5 hours over 14 days. Those who slept more had greater loss of weight and body fat, and, among other things, less hunger. The authors postulate it was due to the neuroendocrine changes decreased sleep induces. Ann Intern Med 2010; 153: 435-441

Chronic PPIs: When used chronically, PPIs are associated with pneumonia, C. diff infection and other problems. This case control study found obesity developed in patients with GERD who were treated chronically with PPIs vs other treatments World J Gastro 2009; 15(38): 4794-4798.

Tuesday, December 28, 2010

Losing that Holiday Weight

Borrowing from my editor-in-chief's blog (Dr. Frank Domino) at the 5-Minute Consult, I'd like to share some tips this week to help you lose that extra weight you picked up over the holidays. Remember, the average American unfortunately gains close to 10 pounds between Thanksgiving and New Year's, so if your pants are fitting a bit tootight, you are not alone!

First of all, a simple trick models have known for years: DRINK WATER!! A trial of obese adults (published in the journal Obesity this year) showed that people who drank 16 oz of water before each meal along with following a low calorie diet lost >4 pounds MORE than the group that simply followed the same low calorie diet.

Often, we think we are hungry when we are really thirsty, so focusing on this simple tip of drinking a couple glasses of water with each meal will help you recognize what your body is really craving.

BOTTOM LINE: Add TWO 8 oz glasses of water to breakfast, lunch and dinner to help lose some of that holiday waistline!

Monday, December 27, 2010

Skier's Toe

Ever been skiing and noticed your toenail had turned black and incredibly painful at the end of the day? Was it black in part or all of the nail? This is a very common injury from skiing, and in fact, is often referred to as a "skier's toe".

The medical term is a subungual hematoma, which simply means bleeding under the nail. This can occur from a single instance of trauma like dropping something on your toe, or from small, repetitive trauma like a too-small or too-big (so your foot slams back and forth) ski boot.

The good news is that this can be quickly remedied in a clinic if you head in within hours or a day of noticing the black nail. If you wait several days trying to tough it out, we have less success treating the nail. The doctor typically burns a tiny hole in the nail, which allows the drop or two of blood to come out. (Sorry for the yucky description, but that's what we do.)

The BETTER news is that again, PREVENTION is key! Make sure your ski boots fit properly- don't cram your foot into a friend's boots- and be sure your socks are not bunched up. This painful injury does NOT occur if your shoes/boots fit correctly!

BOTTOM LINE: Make sure your ski boots and socks fit properly, and avoid getting skier's toe!

Thursday, December 23, 2010

Going Skiing?

Are you headed to the mountains for some skiing this winter? The powder is definitely calling, especially after the huge storms we've had this week! One unexpected and unhappy surprise of a mountain vacation can be the development of symptoms of altitude sickness.

When does it start?
-usually within the first 24 hours, and often as early as the first few hours after arrival.

What are the common signs?
-MIld to moderate:Headache, decreased appetite or nausea, insomnia, and lightheadedness
-Severe: All of the above plus vomiting and shortness of breath

Ultimately, going to a lower elevation will relieve symptoms, but rest and hydration will alleviate most mild symptoms. For persistent or worsening symptoms, head to a clinic for possible oxygen and medications.

Hydration and avoidance of diuretics like CAFFEINE and ALCOHOL, especially the first few days.
SLOW ASCENT if possible (driving up to the mountains is lower risk than flying).
If you have had altitude sickness previously, see your doctor and consider prophylactic medications (acetazolamide or steroids).

BOTTOM LINE: Don't let the mountains take your breath away- plan ahead to prevent altitude sickness!

Wednesday, December 22, 2010

Mixing Drinks & Medications?

People have become increasingly cavalier about mixing medications. In our age of polypharmacy, we think nothing of taking this pill for our heartburn, plus this one for ADD, and that one for anxiety and depression. In fact, our doctors prescribe these combinations all the time, usually with good reasons and positive effects.

Why am I writing about this? Because there are (at least) two major problems that result from this mindset.

1. People like to SHARE. We want to help our friends, and often people share their PRESCRIPTION medications-from saved up antibiotics, to cough suppressants, pain pills and anxiety medications. When you remove the medical professionals (both providers and the pharmacy team) from the equation, there are no checks and balances to watch out for drug interactions.

2. People forget ALCOHOL is a drug. Especially this time of year, alcohol is offered and consumed without a second thought to whether or not it might interact with prescription medications. The most DANGEROUS combinations are ALCOHOL, NARCOTICS (pain pills and cough suppressants) and ANXIETY MEDICATIONS (like Xanax/Valium, etc.) Please note- your SLEEPING PILL falls into this category as well!
In this case, 1 +1= 3 or more, as the additive effects are much greater than the individual effects simply combined. In particular, you can STOP BREATHING when you combine these drugs. And BREATHING is good, right?

PLEASE, before you toast the season, picture your prescription bottles sitting in your drink. Is this MIXED DRINK safe?

BOTTOM LINE: PLEASE, do NOT share prescription medications, and do not COMBINE alcohol, narcotics, and/or other sedatives!

Tuesday, December 21, 2010

Gluten-Free Christmas Wish

WOW! My Christmas came early this year, when Disneyland (gotta love the Mouse!) actually replaced a fast food restaurant (Mc D) with-get this- a DELICIOUS BAKERY called Babycakes NYC that is completely GLUTEN-FREE and vegan, to boot! While perhaps this bakery belongs in the Magic Kingdom's Fantasy Land, it is actually located in Downtown Disney. What a wonderful addition for all the patrons who have celiac disease (remember, it's 1 in 100 Americans!) or are gluten-intolerant, as well as those who have opted for a vegan diet.

Looking at the Babycakes NYC website will definitely stir up your appetite, as you drool over delicious appearing donuts, cupcakes and assorted pastries. This is an ideal time to remind everyone, though, that "vegan, gluten-free, and organic" do not equate with LOW CALORIE! Babycakes offers TREATS AND SWEETS, which are DESSERTS and should be enjoyed in appropriate portions.

BOTTOM LINE: Cheers to Disney for welcoming a delicious bakery for their health-conscious (and/or special health needs) Disneyphiles!

Monday, December 20, 2010

Caffeine, Alcohol and Peppermints, Oh My!

As if the cough last week weren't enough, are you now plagued with with heartburn? Yes, in our commercial-literate world, we may call it GERD (Gastro-Esophageal-Reflux Disease), but heartburn is still a great descriptor. December is often a very tough month for health! We are fully into cough and cold season, and at the same time, we are frantically running around in crowded public areas...touching the same escalator handrail, doors, etc. as the sneezing, coughing folks ahead of us. In addition, we are meeting old friends for our annual "catch up" coffee, drinks or meals, and burning the candle at both ends.

Caffeine, alcohol, and peppermints (did someone say candy canes?) abound, and ALL THREE of these have one common side effect in the body- they loosen the sphincter between the esophagus (food tube) and stomach that is supposed to function to keep acid down south in the stomach. Instead, these substances allow it to relax, and acid can slosh back up into the esophagus, and voila- HEARTBURN FOR THE HOLIDAYS!

What to do? Okay, first things first, stop the burn by popping a few antacid tablets. Not enough relief? Add in an OTC acid relief product like cimetidine (Tagamet) or ranitidine (Zantac) or even the next level up of acid blockers such as omeprazole (Prilosec). Still no relief? Time to see your doctor! Of course, it SHOULD go without saying that you need to STOP THE OFFENDING CAUSE (yes, the coffee, drinks and mints) if your symptoms are persisting beyond the occasional event!

I'd be remiss if I didn't add NICOTINE to the the list of irritants for GERD, by the way, so here is my chance to beg you to make QUITTING SMOKING your number one New Year's Resolution!

BOTTOM LINE: Caffeine, alcohol, peppermints and nicotine all cause HEARTBURN- watch out for the symptoms and recognize the cause!

Friday, December 17, 2010

Hospice at the Holidays?

Okay, I know what you're thinking...why talk about HOSPICE at the holidays? Isn't that kind of depressing? While Hospice care can be a tough subject, I actually ALWAYS think of Hospice at the holidays, for several reasons.

1. I believe everyone who works at Hospice is an ANGEL. Period.

2. Hospice provides a tremendous service that is a beautiful gift not only for the patients themselves, but for the families, too. Their job every day is to help with the physical and emotional needs of people passing from this life on to the next, and they are comfortable with this transition in a way most of us are not. Their confidence and capabilities are amazing.

3. Holidays are especially tough for families who have lost someone in the past year, so remember to reach out in a special way to your family and friends in this situation.

4. One of my favorite gifts is our local Hospice's ANGEL. Each year, a local artist designs a new angel ornament, and these can be purchased on line and sent directly to your loved ones. Hospice benefits from the profits, your recipient gets a lovely angel, and everyone benefits!

BOTTOM LINE: Thinking of Hospice at the Holidays is fully in keeping with the peace and goodwill of the season. Please reach out to anyone you know who has lost a loved one in 2010.

Thursday, December 16, 2010

Christmas Gift of HEALTH!

'Tis the season of giving, and many of us are trying to find the perfect gifts for our friends and families. Before you choose gift baskets loaded with wine, chocolate, and other delicious goodies, though, stop and think. Is this the right gift for your friend who is struggling with her weight? What about your mother-in-law who has high cholesterol and "borderline" diabetes? Well, maybe not, but hey, it's the holidays, right? Doesn't everyone deserve a little treat? And they LOVE chocolate...

Well, yes, I agree that everyone deserves a treat, but is it really a treat if we're giving them something that works against their health goals? If your friend is fit and healthy, knock yourself out with edible treats with a clear conscience. BUT... if they are NOT, why not focus on gifts that encourage health? Mind you, I'm not suggesting sticking a bow on a bag of carrots, either. How about fun workout socks or a new top? Buy matching pedometers for you and a buddy or two for some friendly competition or at least mutual encouragement. How about a gift certificate for a massage or manicure or pedicure? Or a new healthy cookbook? Or-gasp- a plain old BOOK book-by your favorite author? Need a suggestion? Try ANY of Jeff Abbott's thrillers! Out of money (and who isn't?) Make a gift certificate for a outing to a park or walk around the lake or a bike ride. Be creative!

BOTTOM LINE: Think twice before sending out edible treats to ALL your friends and family this year, and show you really care by giving gifts that promote physical, mental or spiritual health! Happy Holidays!

Wednesday, December 15, 2010

FDA Warning: Cough Medication DANGER!

Yesterday the FDA issued a warning regarding a medication that has frankly NEVER been on my radar as a dangerous drug- Tessalon (benzonatate). Sadly, there have been five deaths reported in children under the age of 2 after accidental ingestion of this medication, which is a gel capsule and looks like candy or a bath bead.

Is the medication safe for adults? Yes. Tessalon perles are indicated for cough suppression in patients over the age of 10. In my practice, I have found that the drug has a high variability in effectiveness, but rarely has any side effects. Many patients love this drug because it works well to suppress their cough without making them feel goofy or sedated, like the stronger narcotic cough syrups tend to do.

I think the real take home message here is that ALL medications, ESPECIALLY those that "look pretty", need to be in CHILD-PROOF containers AND put away out of reach from little hands. There are far more accidental poisonings from common over the counter medications and vitamins, and ALL PILLS should be stored behind locked cabinets when you've got children in your home (living there or visiting!)

BOTTOM LINE: Please have a special, truly CHILD-PROOF medicine storage area in your home, and realize kids always have and always will stick things in their mouths without thinking!

Tuesday, December 14, 2010

Too Scared to FLY?

Do you have travel plans for the holidays? Any fear of flying? If you do, you are not alone. Many people, especially since 9/11, are very nervous flyers. I know that I never had any issues about flying until I became a mother, at which point suddenly I was emotionally convinced I would die in a plane crash and orphan my child (despite my brain telling me the statistics say otherwise.)

So, what can you do? Well, there are many choices, but suffering in silence should not be one of them. First off, arm yourself with the facts that you are over thirty times more likely to have a fatal car accident than die in a plane crash. Most of the fear is not rational, however, so if the facts don't calm you, keep looking.

Plan ahead- create a diversion packet for yourself with an engaging book, music, or DVD. Get noise-canceling headphones (or at least good earplugs). It's amazing how when you can close your eyes and not hear the plane noises, you can relax much more easily.

Avoid stimulants like caffeine and decongestants
- no need to ramp up your heart rate before you even get on the plane!

If you have the luxury of time before you travel, consider biofeedback, hypnosis, or meditation training.

I mentioned yesterday that you might want to talk with your doctor. What can she offer? We have several choices, actually. For long flights, I will frequently prescribe a "sleeping pill" such as Ambien or Lunesta. Some patients do very well with medicines that simply control your heart rate, such as metoprolol (a beta-blocker). Others with more intense anxiety respond well to a rapid and short acting sedative such as Xanax.

Bottom Line: Fear of flying is common- plan ahead and talk to your doctor if you would like to consider a medication to lesson your stress.

Monday, December 13, 2010

Flying Somewhere this Holiday?

As the holidays are upon us and travel plans are ramping up, I thought I’d share some health-related flying tips. With all the emphasis on flu these days, I’d be remiss not to start with the basic advice that you should NOT fly if you have a fever or a productive cough (or other flu symptoms such as headache, sore throat, and body aches.) That being said, there are many times that you may need to fly when you have mild cold or allergy symptoms, and there are a few tricks that may be helpful.

The one time that I actually recommend OTC products such as nose sprays like Afrin is if you have a stuffy head/nose/ears and need to fly. Make sure to put it in ziplock bag for security, but then use it when you are seated on the plane to reduce ear discomfort upon takeoff. Gum, mints or any beverage will help clear your ears as well.

I also suggest sucking on the zinc lozenges- any variety- I happen to like the ones combined with vitamin C. Zinc oral dissolvable products have been shown to reduce acquisition of respiratory viruses. Unfortunately, simply taking a zinc supplement that you swallow has not been shown to provide equal benefit.

If you have no contraindication to taking aspirin, a baby aspirin taken the day of your flight will reduce your risk for blood clots that can occur with prolonged sitting. Try to get up every hour or two and walk to the bathroom- that will help, too.
Nervous about flying? Talk to your doctor about a short-acting mild sedative or sleep aid (if the flight is long enough.) No need for embarrassment, as fear of flying is very common. I’d estimate I get this request close to once per week (and more often this time of year!)

Should you wear a mask? I suppose if either YOU have a cough or your seatmate does, that is reasonable.

BOTTOM LINE: If your travel plans include flying, create your own "flying first aid" kit to take with you!

Friday, December 10, 2010

Colorful Diet does NOT mean M&Ms!

In the rush of the holidays, are you grabbing handfuls of red and green M&Ms more than handfuls of strawberries and grapes? How can you keep up your 5-10 servings of fruits and veggies per day during the holidays?

Not surprisingly, the answer is the same as the rest of the year- PLAN AHEAD. Start your morning with a smoothie (the picture above was from our breakfast)- frozen fruits like strawberries stay the same price year-round, even though they are out of season. Do you notice the banana is over-ripe? No worries- in a smoothie, it doesn't matter!

BEFORE YOU HEAD OUT TO A PARTY, have a large healthy snack and a big glass of water. If you're not starving when you enter the party, you will be way less likely to overload on high calories offerings.

TAKE SNACKS TO WORK. Apples are still cheap and plentiful, so I take a couple to work each day, along with a small container of my nuts of choice (cashews or almonds, usually.) If I don't eat these, I will be way to tempted by chocolate-covered everything at the office!

BOTTOM LINE: This time of year more than any other challenges our time and waistlines; PLAN AHEAD and PUSH UP the vegetables, fruit and water in your day!

Thursday, December 9, 2010

Can't stop coughing?

Cough, cough, cough...argh! Is there any point in seeing your doctor when all you have is a left-over cough after an upper respiratory infection? YES! While it is rare that you will need antibiotics, there are other medications that your doctor may recommend to help you quiet that cough.

Often, after a viral infection, we are left with a cough. Untreated, that cough might last up to six weeks. Frequently, it is worse at night and may keep you (or your spouse) from sleeping- which adds fatigue and grumpiness to the picture. At a minimum, your doctor may choose to prescribe a narcotic cough syrup (assuming the OTC dextromethorphan-containing products are not working) so that you and your loved ones can get some rest.

Additionally, it is very common to develop a transient asthma-type of reaction in your lungs after a cold. We call this reactive airways, and the extra mucus production as well as spasm can lead to some wheezing and/or cough. The good news is that this is not a permanent change, AND we can use a couple different types of inhalers to improve your cough and shortness of breath.

Traditional home remedies such as cool mist humidifiers and topical menthol products can also provide good symptomatic relief.

If you have a cold, then seem to recover, and then get broad-sided with an intense cough and fever a week later, you may indeed need an antibiotic because you have become secondarily infected. In this case, an antibiotic may be recommended, but the mainstay of treatment will still include rest, fluids, and over the counter cough suppressants such as dextromethorphan, which is designated "DM" in most combination cold products.

BOTTOM LINE: Got a tickling cough? Use OTC meds and hydration. Stuck with a nagging, lingering cough? Go see your doctor for some extra help, but don't expect antibiotics.

Wednesday, December 8, 2010

Beyond Chicken Soup- What Helps the Common Cold?

This week I've been talking about colds and the role of vitamins can play in treating them. We know that the common cold is caused by a virus, so therefore antibiotics (which kill bacteria, not viruses) do NOT help. What DO I recommend for my patients?
Much of what your parents may have offered you works well, by the way...

1. Oral decongestants- phenylephrine or pseudoephedrine- work well to relieve nasal stuffiness, but can have significant side effects of raising blood pressure, causing palpitations/jitteriness or insomnia
2. SHORT TERM (3 days) use of nasal decongestant sprays; also relieve nasal congestion with less side effects
3. Nasal saline sprays and washes often relieve congestion as well as the medicated versions
4. Aromatic oils (menthol, camphor, and eucalyptus) used topically provide subjective improvement in nasal congestion- don't forget about the topical "vaporub" or the forms of these oils that you add to a warm bath!
5. Analgesics: acetaminophen (tylenol) or ibuprofen (Advil/Motrin) help with headache and body aches
6. HYDRATE! Remember chicken soup? ANY liquid helps, but drinking warm broth often has the double benefit of sore throat relief along with hydration. The more you hydrate, the less headaches and looser mucus (so it will de-congest) you will have.
7. Salt water gargles ease sore throats as well; repeat several times a day for the first day or two, and don't be shy with the salt: use 2 tablespoons per 8 oz of water- it wont even all dissolve, but that's how much you really want to increase effectiveness.
8. Cough suppressant: try OTC products with "DM"- dextromethorphan. More on this tomorrow...

BOTTOM LINE: Symptomatic relief of the COMMON COLD is important, but antibiotics are NOT part of the equation.

Tuesday, December 7, 2010

Zinc for Colds?

If Vitamin C is not the answer to prevention or treatment of colds, what about zinc? Around 25 years ago, studies showed that zinc lozenges could significantly reduce the duration of the common cold. Since that time, the medical literature has been conflicting, with roughly half of the studies showing benefit, and half appearing equal to placebo.

Zinc nasal preparations were then released, but in 2009, the FDA issued a warning that these intranasal zinc preparations had the potential to cause permanent loss of smell, so they are no longer recommended.

It turns out that you need to have ionic zinc in the lozenges to be effective, and the vast majority of products out there do not have this type of zinc. Taking zinc supplements in pill form doesn't work either, so don't be fooled into swallowing yet another pill.

What DOES work? Well, the best prevention is what your mom most likely taught you growing up: WASH YOUR HANDS! It doesn't matter if you use the hand sanitizer or old-fashioned soap and water, but whatever you use, scrub for 20 to 30 seconds, and try not to touch your face or eyes.

BOTTOM LINE: If you are going to use zinc to try to shorten the duration of your cold, get an ionic zinc lozenge preparation. More importantly, however, WASH YOUR HANDS!

Sunday, December 5, 2010

Vitamin C for Colds?

Okay, since I talked again about vitamin D last week, why not talk about a few more vitamins? What about Vitamin C for colds? Should it be taken as prevention, or as a cure? Can you get too much?

Honestly, the medical literature has gone back and forth on vitamin C and colds. Large studies have shown little benefit in prevention, unless you are an extreme athlete or living in very cold temperatures. For people in those categories, it appears Vitamin C in doses greater than 200mg per day can indeed decrease the frequency of upper respiratory infections. Skiers, perhaps you should start your morning with a big glass of juice instead of hot chocolate or coffee!

Where there does seem to be benefit across the board is when Vitamin C (again in doses greater than 200mg per day) is taken once you develop cold symptoms. At that point, Vitamin C seems to decrease the duration of symptoms.

How much is too much? The RDA is 75mg for women and 90mg for men. Supplements come in 100, 200 and 500mg tablets, plus I'm sure you've seen and maybe taken the mega-dose vitamin C packets that come in powder packets. These typically have 1000mg of Vitamin C (along with a handful of other vitamins). While C is water-soluble, which means that "extra" vitamin C not used by your body will simply exit in your urine, it is possible for megadoses (often exceding 2000mg per day) to cause kidney damage by precipitating a special type of stone formation in the kidneys.

What type of Vitamin C is best? As always, you are better off getting your vitamin C from whole foods-fruits like berries, red peppers, guavas, kiwis, and yes, oranges. You will NOT overdose from these natural sources!

BOTTOM LINE: Vitamin C may help shorten the duration of a cold, and could help with prevention for those in cold climates or if you will be doing "extreme" physical activity.

Thursday, December 2, 2010

Vitamin D: Front Page News!

This week Vitamin D (aka. the Sunshine Vitamin) made front page news this week when the Institute of Medicine tripled the recommended daily dose from 200IU (International Units) to 600 IU. Interestingly enough, there were polar opposite slants on the same story. The TIMES said that extra Vitamin D and calcium are not necessary, while the Wall Street Journal quoted experts saying that that this increase is not nearly enough.

What should we believe at this point? Well, like everything in medicine, it depends. Seriously. If you are elderly or otherwise decreased in mobility; if you have increased risk of cardiac disease or cancer; if you have dark skin or live in northern locations with limited sunlight; then I think the medical evidence is solid that you likely will need Vitamin D supplementation.

I practice medicine in Austin, Texas, which is clearly a sunny locale. Despite that, I have found in the last year or two that I have been more aggressively checking vitamin D levels that 90+% of my patients were deficient. Interestingly enough, a good chunk of these patients (I would estimate a third) have had clinical improvement in some fashion after a few months of vitamin D replacement. Often it is with mood and energy, and other times it is with very nonspecific "aches and pains" that the patient previously was attributing to "aging." Initially I gave simply over-the-counter doses, but within 6 months saw minimal improvements and switched to supplementing with prescription weekly Vitamin D (at 50,000IU per week doses.) This is the dose that has yielded results both in lab tests and far more importantly, in patient symptoms.

BOTTOM LINE: The jury may still be out on Vitamin D supplementation, but we do know that replacing Vitamin D in people who are proven to be deficient can potentially improve their health in multiple organ systems (bones, cardiac, neuro/psychological.)

Wednesday, December 1, 2010

Are you SAD?

While everyone around you is humming Christmas songs, pulling out their Hannukah decorations or making ski vacation plans , are you left feeling sad? Perhaps it's not the holiday blues, but SAD- Seasonal Affective Disorder. This depressive disorder was formally named only a few decades ago, in the 1980's. It affects over half a million people each winter, including some symtoms in up to a third of patients seeing their primary care physicians during this season.

Who gets seasonal affective disorder? It's most common in women (3:1 over males) and young adults 20-30 years old, but it is seen in across the board. January and February are the most common months that SAD is diagnosed.

What are the complaints? Often fatigue, weight gain and recurrent illness are the primary issues, rather than simply "sadness".The simples range from a mild case of "winter blues" to serious depression.

What is the cause? There are different theories, most of which are linked to hours of sunlight. There is disruption in our circadian rhythms as well as decreased seratonin secretion during winter months, and of course, less Sunshine vitamin (Vitamin D).

Prevention? Light therapy (using full spectrum light bulbs in your home and work) or consciously spending more time outside in the sunlight can help prevent S.A.D. Of course, moving to a more southern location can help, especially if you are far north, but that is not typically feasible for most people.

Treatment? Light therapy, anti-depressant medications (Buproprion is the only one FDA indicated, but SSRI's are also used), and Vitamin D replacement (if low) all have shown effectiveness in improving symptoms.

BOTTOM LINE: If you recognize a pattern of feeling sluggish every winter and perking up in the spring and summer, talk to your doctor and see if together you can change "S.A.D." to glad this year!

PS. Happy December 1st! Change those air filters!!

Tuesday, November 30, 2010

Cyberbullying- Same Old Problem, Magnified Beyond the Schoolyard

What is "cyberbullying"? It's pretty much what it sounds like: bullying via use of technology, whether that is over a cell phone through texting, or emails or facebook or any other form of social media. The scary parts to me are that (A) the bully can feel or actually be anonymous, which promotes more vicious attacks and (B) the potential audience is unlimited.

We need to remember that true bullying exists when there is INTENT to cause harm or pain to the recipient. Unfortunately, there are many opportunities these days for kids (and adults) to unintentionally cause pain via the internet. With facebook or gmail alone, kids post their "status" as attending this or that party, or making an amazing grade, or simply noting an immediate change in relationship status. These comments are floating out in cyberspace and causing plenty of tears on their own, though they lack the malicious intent of true bullying.

What can parents do about cyberbullying? Most importantly, we need to be aware of what our kids are receiving AND sending- remember, your kid might be the bully or the victim. Let's teach them more "digital citizenship" so they really understand what is appropriate online etiquette.

Dr. Gwen O'Keeffe's new book, Cybersafe: Protecting and Empowering Digital Kids in the World of Texting, Gaming and Social Media, is a great place to start- read it now.

BOTTOM LINE: Let's teach our kids better online "digital citizenship" and make sure they can protect themselves from cyberbullies.

Monday, November 29, 2010

Stuffed from the Turkey?

Welcome to the Monday morning after the long Thanksgiving food festival-oops- holiday weekend! Did you step on the scale this morning? Well, if you saw higher numbers than you would like, you are not alone. Past studies have shown that the average American gains between seven to eleven pounds between Thanksgiving and New Year's Day!
I would much rather address this TODAY than after New Year's, though, because this weight gain is not mysterious nor automatic, and CAN BE AVOIDED or at the very least, reduced!

I think we all know that there seem to be a plethora of parties and increased social activities this time of year. Virtually every one includes high calorie treats and drinks. Often families dash from one kid recital, play, concert or sporting event to the next, zipping through fast food drive-throughs along the way.

Let me encourage you to PLAN AHEAD, and haul out your slow cooker from the back of the cupboard! Healthy food does not have to be a huge time commitment, but absolutely does require thinking ahead. Toss a pork tenderloin in the slow cooker with some salsa, and after work/school you're ready for easy pulled pork sandwiches or tacos, for example. Really, it's only TWO ingredients to toss in, so it's simple! Of course leftover turkey (or chicken or beef) along with some cut up onion, carrots, potatoes or other veggies will make a lovely meal as well. The point is not specifically WHAT to make as much as to remind you that you WILL be rushed, and planning ahead makes it possible to have "grab and go" healthier choices.

As for parties, start off with a large glass of WATER in your hand, rather than mindlessly downing that immediately offered alcoholic beverage (which not only adds calories, but often reduces your judgement/motivation regarding healthier choices along the buffet...)

BOTTOM LINE: Check your weight TODAY and PLAN AHEAD for your meals during December so you don't have the extra pounds to begin 2011!

Wednesday, November 24, 2010

Why Visit Someone with Alzheimer's?

Please, I am BEGGING you, if you have a friend or family member with Alzheimer's disease, STAY IN CONTACT with him or her! The saddest part of my mother's Alzheimer's struggle was that many of her friends seemed to drop off the face of the earth. I understand that they were uncomfortable, worried that she might not remember them. What would they talk about? What if they brought up something she didn't remember- would that upset her or make her feel bad?

So here is the real deal. Yes, it's awkward. No one wants to see a dear friend struggle for words, or looking at you with a blank stare. On the flip side, even once someone who has dementia no longer recognizes you for the relationship you once shared, he or she still can sense the so-human link of affection. A big smile and laugh as you are "reminding" them of an old story involving the two of you will bring a moment of joy and often a real connection. Know that in the early and moderate stages, when the Alzheimer's patient no longer initiates conversation, she may still have full recall of remote events.

Pictures and music are also very powerful bonds. Think of that commercial jingle you can't shake out of your head. Similarly, old songs from the radio or traditional religious or patriotic songs pop right back into an otherwise confused brain. Simply flipping through old photo albums or singing songs can also turn on that faulty switch in their brain.

Finally, if there is a spouse, keep in touch with them as well. Pick up the phone and give them a call, and don't worry about what you are going to say. Saying ANYTHING is a million times better than nothing!

BOTTOM LINE: This Thanksgiving week, reconnect with any friends or family members who have been struggling with the non-glamorous challenge of dementia, and give thanks if your brain is still healthy!

PS. Our family is TREMENDOUSLY thankful for all the friends and family who continue to love and support first our Mom and now our Dad in their battles with Alzheimer's and Parkinson's dementias. God bless you!

Tuesday, November 23, 2010

Thankful for My Mother-In-Law...Seriously!

Getting ready for Thanksgiving? I know I am. Today my mother-in-law was sharing her fabulous fresh yam and green bean recipes with me, so I can begin to make some of "her" dishes. However, I am SO grateful that she is still here on earth to be on hand as I prepare them, because as I was dutifully typing them into a word document, her quantities were "just enough", and "till it looks right", and "well, it depends!"

Isn't it amazing how dependent we've become on prepared mixes or at a minimum, google'd recipes? Truthfully, in the kitchen I tend to alter the vast majority of recipes that I use, even the first time. I substitute apple sauce for oil, or change up flours to make things gluten-free, or create some other "healthy" modification. When it comes to family traditions, though, I usually defer to the high-fat, full calorie version, which is FINE. Not EVERYTHING we eat needs to be pure nutrition! It's perfectly fine within the confines of healthy living to splurge on treats now and then. The trick is to remember that every day or week should not be "that" special occasion!

I have learned from my patients (by doing 24 hour dietary recalls) that what people believe is an unusual day is often a frequent occurrence. Do you grab fast food before every soccer practice or music lesson? Well, I'm guessing that is EVERY Tuesday (or whatever day or dayS your kids have that activity.) Look at your schedule now, and recognize those days that present a challenge every week, and then PLAN AHEAD. Sandwiches, slow cooked meals, and even "breakfast for dinner" might be healthier choices.

BOTTOM LINE: Enjoy your traditional holiday treats this season, but recognize patterns of unhealthy choices in your everyday schedule and make pro-active changes to improve your health!

Monday, November 22, 2010

Alcohol and Arthritis- Cheers!

Okay, after a week of discouraging one habit, I thought I'd start of Thanksgiving week with an interesting study about alcohol. As opposed to nicotine, which we know is NEVER beneficial, there is absolutely medical evidence that small amounts of alcohol can be beneficial for different aspects of our health. Now, the key words here are SMALL AMOUNT and BENEFICIAL. When we pour our own glass of wine, for example, chances are that it may not be that small 4oz glass that doctors recommend...
The new study I'd like to mention today is from the journal Rheumatology, and is entitled "Alcohol consumption is inversely associated with risk and severity of rheumatoid arthritis."There were around 900 patients with rheumatic arthritis (RA) in the study, along with around 1000 people without RA. Basically, with trying to account for other variables such as gender and age, those patients with RA who consumed more alcohol reported less severe symptoms of their arthritis.
Why is this? We're not sure, but possibly because of the role that alcohol plays in suppressing the immune system (and RA is basically a result of the body's immune system over-reacting.) Evidence already supports that small amounts of alcohol decrease the risk of heart attacks and strokes via similar anti-inflammatory and anti-blood clotting effects.
Keep in mind that this study is not suggesting people with RA need to drink heavily, but simply that patients who report drinking alcohol fewer than 10 days per month reported more pain.
BOTTOM LINE We can now add reduction in the severity of rheumatic arthritis to the list of potential benefits of consuming SMALL amounts of alcohol.

Friday, November 19, 2010

Quitting Smoking...a WEIGHTY Issue

Why do people who quit smoking gain weight? Does it always happen, or can it be avoided? Do we really care that weight gain is really less detrimental to our health than smoking?
As a physician, I have found that women in particular choose to keep smoking because they simply do NOT want to gain weight. Period. I will confess that I will occasionally try to appeal to their vanity by discussing the yellow teeth or bad breath that tend to accompany cigarettes, but the reality is that what is important in this situation is helping patients understand why smokers gain weight with quitting, and how it can be avoided. So here are some things to remember:

1. Nicotine is an appetite suppressant, so obviously, when you initially take it away, your appetite is up.
2. Smoking KILLS taste buds, so just about the time the extra appetite from quitting is going away (around a week), suddenly food begins to TASTE better, because now you've actually got healthy taste buds!
3. Happily, ALL FOODS taste better, not only the high fat/high calorie ones.
4. Yes, oral gratification is a habit, so STOCK YOUR FRIDGE with some low calorie, crunchy and delicious snacks like carrot sticks with hummus, or apple slices, or ANY fruit or vegetable. Additionally, suck on sour hard candies the first week or two.
5. Don't forget EXERCISE! Getting and keeping your heart rate up for 30 minutes per day is equal to a low dose of an anti-depressant medicine, so exercise will not only balance extra calories consumed, but will make you HAPPY and less irritable!

BOTTOM LINE: Be proactive with your available food choices and exercise, and you will NOT pack on a bunch of weight when you quit smoking.

Thursday, November 18, 2010

Seven Tips to Quit Smoking!

This week I'm focusing on QUITTING SMOKING, the absolute most important thing you can do for your health if you smoke. I've talked about prescription aids, but what can you do on your end? Lots! Here are seven tips that patients have had the most success with over the years:

1. Set a QUIT DATE and TELL EVERYONE YOU KNOW (helps keep you accountable!)
2. Right NOW, only smoke the cigarettes you REALLY want (typically around 6 per day for a pack per day smoker).
3. Do NOT smoke the "trigger" cigarettes-phone rings, starting the car, turning on the tv or finishing a meal.
4. Have your car professionally cleaned the day before your quit date (if you smoke in your car.)
5. Clean out your "smoking area"- throw out or give away ashtrays.
6. Pick a splurge reward and earmark your cigarette money to pay for it! Cigarettes cost a ton of money, so toss those $5 and $10 bills into a large glass jar on a counter top each day and have a fun visual reminder of your savings, or post a picture of your prize and make a money "thermometer" that you can color in as the money grows.
7. Grab some really sour hard candy to suck on the first week as a non-smoker; the sour nature stimulates your salivary glands and really helps with the oral craving portion.

BOTTOM LINE: Start with these seven tips to insure that THIS time you will be successful QUITTING SMOKING!

Wednesday, November 17, 2010

SEVEN Ways to Leave Your Cigarettes

SEVEN seems to be the magic number for habits of successful people, right? SO...smokers, step on up to the SEVEN choices to help with QUITTING SMOKING! In alphabetical order, here they are:

1. Bupropion SR (Wellbutrin SR)- this is an antidepressant that works via unknown mechanisms to decrease your desire for smoking; you start it a week or two before your quit date, and it significantly shuts down that craving for a cigarette.
Common side effects- insomnia and dry mouth.
2. NIcotine gum- do NOT chomp it like regular gum! It's chew, chew, stash it.
3. Nicotine inhaler- used every hour or two during the day; may cause throat/mouth irritation and cough
4. Nicotine nasal spray- 2-4 sprays per waking hour as needed; may cause local irritation in nose and throat
5. Nicotine patch (now OTC, but ask your doctor which dose)- may cause skin irritation; remove at night so no sleep issues
6. Nicotine lozenge- may cause mouth soreness and nausea
7. Varenicline (Zyban)- blocks nicotinic receptors and sharply decreases cravings; Common side effects: very vivid dreams and nausea.

Are they expensive? Puh-lease! Are cigarettes expensive? YES! These aids are money well spent, and will pretty much equal what you are already spending on your habit.

BOTTOM LINE: If you think you've tried everything to quit, double check the list and head to your doctor for a new cessation aid!

Tuesday, November 16, 2010

Attention SMOKERS: Get Ready to QUIT!

If you found yourself anxiously scanning yesterday's blog about CT scans for lung cancer screening in smokers, hoping for reassurance that we now have means to detect lung cancer early enough that you'll have time to quit before it's too late, then read on...

If you are a smoker today, then the SINGLE MOST IMPORTANT THING you can do for your health is to QUIT. Period. While we are learning to detect and treat smoking-related cancers better each year, believe me, you don't want to count on a CURE. Often times the surgeries and chemo are devastating, though life-sparing.

I have met very few smokers who do not WANT to quit, though yes (my friend who shall remain nameless) there are some out there who simply enjoy smoking and hope they don't live long enough to end up suffering poor quality of life because of chronic bronchitis or emphysema. MOST SMOKERS WANT TO QUIT, but have not found either the right motivation, medical aid, or family/friend support to do so.

First of all, let me say that it takes the average serious smokers multiple attempts to quit. Have you quit for a month, a year, a pregnancy or two, only to restart? That is COMMON, and NOT a reason that you "can't" quit!

There are SEVEN different medical aids that your doctor can recommend or prescribe to help you from the pharmacy end of things! Have you really tried them ALL?
There are numerous behavioral changes YOU can make NOW that will help you quit, too! Stay tuned for more blogs this week with more details...

BOTTOM LINE: NO amount of nicotine IMPROVES your health, so make an appointment with your doctor to find out which method might work best for you!

Monday, November 15, 2010

Breaking News for SMOKERS

Last week we had an encouraging development for smokers- the National Cancer Institute prematurely stopped a study because they felt ethically obligated to let all the participants know that a low dose CT scan of the lungs as a screen for lung cancer was yielding a 20% decrease in mortality (as compared with screening chest xrays). What does this mean? Should every smoker get a lung CT scan?

Hold your horses- CT scans for all smokers is NOT the answer- though I wish it were that simple. What we know so far is that in this group of smokers, which was an older group that had a greater than 30 pack-year smoking history (smoking a pack per day for 30 or greater years), the CT scans apparently allowed earlier detection of lung cancers, enough that they had a significant (20%) decrease in deaths.

Over the years I have had many patients who smoke ask for annual screening chest xrays. I explain to them that this is NOT a good screening method, though often I have ended up ordering the xray, in the hopes that they might at least see some noncancerous damage from the smoking that might be enough to motivate them to QUIT. Now, however, we may be changing our recommendations, at least for the older smoker with an extensive smoking history.

Ultimately, though, the real answer is to never start smoking, and if you ARE smoking at ANY amount, find help asap to QUIT!
I'll spend more time this week discussing smoking cessation, but know that there are seven medical aids available through your physician that can help you quit for good.

BOTTOM LINE: Smokers with a greater than 30 pack-year history of smoking may indeed benefit from CT lung scans to detect early lung cancer- check with your doctor (and QUIT TODAY!!!)

Friday, November 12, 2010

Gluten-Free Decadence

After talking about gluten-free diets and celiac disease this week, I want to be sure no one is left with the impression that you need to feel completely deprived if you must be gluten-free (GF). Can you ever eat at a restaurant? Is every GF food expensive?
No worries, there are plenty of delicious and reasonably priced choices out there!

Primarily, I want to again encourage you to take advantage of EVERY SINGLE fruit and vegetable, all of which are completely and totally gluten-free! Have a banana smothered in ice cream and topped with whip cream for dessert- yummy! Gluten-free chocolates are a bit more challenging to find, but absolutely out there.

Dining out? Last night, I had a business dinner at a lovely French restaurant...where most dishes appeared to be topped with a white sauce (that usually has flour in it.) Yes, I had to pass up the fragrant loaves of French bread, but I simply enjoyed my glass of wine and ordered a salad by asking for lettuce, tomato and a vinagrette-no croutons- (which was delicious!) and trout grilled and topped only with butter and lemon. The waiter and chef didn't flinch a bit when I asked for these off-menu choices, and I think I was possibly the only one who left the table not stuffed to the gills! I also could have chosen the steak, and had a baked potato instead of the french-fried version. Admittedly, I passed up dessert, but could have asked for strawberries and whipped topping- but I was pleasantly full.

Craving pasta? This was challenging, but I found a spiral pasta that is a quinoa blend that I can truly say I PREFER to regular pasta. Pizza is still leaves a bit to be desired, but I have even found a delivery pizza service that has very passable GF dough for only $5 extra- well worth it for me, though I order regular dough for my family.

I have blogged earlier about some wonderful baking GF products and cookbooks, and without a doubt, you can find all sorts of GF bagels, donuts, cakes, cookies.

BOTTOM LINE: Never fear, you can consume deliciously decadent GF foods and drinks with a little thought and willingness to venture off the printed menu- ASK THE WAITER/CHEF!

PS. The chef in this picture, Michael Marchitelli, is ironically an ITALIAN chef in Crested Butte, CO- Eat at his Gourmet Noodle for some AMAZING food! I'm not promising GF pasta, but I can attest from my pre-GF days that every item on the menu is delicious, and there are definitely GF options!

Thursday, November 11, 2010

Gluten-Free for Weight Loss?

Many people think going gluten-free is a great way to diet in order to lose weight. Not surprisingly, it can be a pleasant side effect if you are overweight and diagnosed with celiac disease. It makes complete sense that if you simply ELIMINATE breads, cakes, pastries, pastas, cookies and breaded or coated foods (think chicken nuggets, french fries, meatballs) your calories will shrink dramatically!

I would likely approve any diet that reduces processed foods and complex carbohydrates, but I am MORE excited about diets that not only decrease those items, but INCREASE fruits and vegetables. Here is the trick with not only a gluten-free diet, but a vegan or vegetarian diet. Keep it HEALTHY by upping the produce (veggies and fruit) and NOT merely replacing everything you are "giving up" with a manufactured version that is GF (or CF, or Veggie-free).

For example, there are many gluten-free breads, crackers, cookies and treats out there. Very few of them happen to be low calorie and/or "good" for you- BUT- saying gluten-free somehow implies healthy and nutritious, doesn't it? It's that health-food store seal of approval when we see labels proclaiming a food item is "free" of something "BAD".

Ultimately, however, in the battle of the bulge, it still comes down to calories IN vs. calories OUT, regardless of the quality of those calories. So, enjoy those GF pancakes and breads in moderation, but don't pursue the search for the GF Twinkie, okay? Push up the produce and reap the rewards.

BOTTOM LINE: Eating gluten-free CAN be an incredibly healthy diet, rich in nutrients from fresh vegetables and fruit plus a protein source and GF carbs in moderation, but gluten-free does NOT equal low calorie!

Wednesday, November 10, 2010

Gluten-Free Diet

This week I am talking about celiac disease, which requires a life-long commitment to a gluten-free diet. So, what the heck does that involve? Well, gluten is a protein found in all forms of wheat, as well as related grains such as barley and rye. What is made with wheat? At first glance, it feels like EVERYTHING has wheat.

Most cereals, breads, cookies, muffins, cakes, dough (think pizza), buns, and pastas, etc. ALL are classically made using wheat flours. Happily, though, there are more and more foods in these categories that are made with rice, corn and potato flours- all of which are gluten-free. In almost every grocery, there is a small (and ever-expanding) section of gluten-free "bread" products and mixes. Check out my "commercial" for delicious gluten-free pancakes, for example- yum! And rice-flour cereals such as Rice Chex are still on the menu, though ones like Rice Krispies that sound gluten-free (GF) may not be (because of additives like malt.)

More importantly, though, there are tons of delicious, healthy foods that are naturally gluten-free. Practically the whole perimeter of the grocery store: every fruit and vegetable (think MORE!), dairy, nuts, and meat are all GF. Our bodies don't NEED gluten nor any of the treats/sweets/doughs that our MOUTHS or minds may crave...

I think the biggest challenge of GF eating is baking. There does not seem to be a simple recipe substitute- at least not "replace one cup of wheat flour with one cup of brown rice flour" style. Because of the TEXTURE, you need to make blends involving rice flour, potato starch and tapioca flours, for example. I have found a great baking cookbook that I would recommend: Gluten-Free Baking Classics, by Annalise Roberts- try the delicious lemon pound cake!

If you are committed to a GF diet, make an appointment with a registered dietician to really learn all the nuances of this meal plan. Here in Austin, I recommend Daniela Knight, RD, to help you with this transition.

BOTTOM LINE: Gluten-free diets are rich in fruits, veggies and protein, and can be supplemented with carefully chosen gluten-free baked goods.

Tuesday, November 9, 2010

Celiac Disease: Do I Have It?

This week I am talking about celiac disease, a very common problem that affects 1 in 133 Americans. With non-specific symptoms such as fatigue and abdominal bloating, how can it be diagnosed? As is often the case, it is not as clear cut as you might think.

The first caveat is that you must EAT wheat (gluten) for the whole month before you are tested to get the most accurate evaluation. Blood tests are performed that check your antibodies, including the most sensitive test (meaning it will miss the fewest cases, but may have some false positives) anti-tTG (anti-tissue transglutaminase antibody.)

The doctor must also test your IgA levels (immunoglobulin A) because if you are not making adequate IgA, you could test negative for celiac disease even though you have it. Additional blood tests include anti-endomysial antibody (EMA-IgA) and anti-deaminated gliadin peptide (DGP – IgA and IgG).

Ultimately, the diagnosis will need to be confirmed not only with a blood test, but with a small bowel biopsy which is done through endoscopy. The biopsy will look directly at the lining of the gut and determine what level of damage exists.

Alternatively, you can choose to follow a strict gluten-free diet, and if your symptoms resolve, it is likely you have celiac disease (or at least gluten-intolerance.) This is obviously less specific and accurate, but is certainly a good starting place.

BOTTOM LINE: If you are concerned you may have celiac disease, talk with your doctor about getting a simple blood test to help determine if you should go gluten-free.

Monday, November 8, 2010

Celiac Disease and GF: What is it?

You may have noticed a new section cropping up on menus in restaurants these days- the gluten-free choices. What's up with that? Celiac disease. This disease is very common in the United States, affecting 1 in 133 people. In people with this disease, eating gluten (the wheat protein) causes an auto-immune reaction that damages the small intestine, causing poor absorption of food and nutrients.

What symptoms show up? Diarrhea is the classic symptom, but it turns out there are probably more cases of celiac disease without diarrhea. The symptoms are often rather nonspecific: fatigue, irritable bowel, anemia, vitamin deficiencies, and osteoporosis. There is, though, one symptom that is 85% specific for celiac disease-a rash called dermatitis herpetiformis, DH for short. This rash has nothing to do with herpes, however (nope, no STD talk in this topic!) This rash is intensely itchy, symmetrical eruption on the face, buttocks, elbows and knees.

The good news is that celiac disease can usually be treated with dietary changes alone-no medications required! The bad news is that gluten is found in many products beyond the obvious wheat breads and cereals, so to completely avoid gluten requires significant effort and education. Stay tuned this week for more about Celiac disease diagnosis and diet.

BOTTOM LINE: Problem: Celiac disease, a very common challenge. Answer: Gluten-free diet.

Friday, November 5, 2010

Vitamin D- the Sunshine Vitamin!

Vitamin D has long been known as the "Sunshine" vitamin, because we literally can obtain Vitamin D from the sun (it is converted to an active form in our skin.) We also are realizing that Vitamin D appears to play a role in MOOD- so that if you are deficient in Vitamin D, you may be more prone to depression.

A large study was done in England a few years ago and recently published: Relationship Between Vitamin D Levels and Depressive Symptoms in Older Residents From a National Survey Population. They looked at over 2000 adults over the age of 65, and assessed the incidence and prevalence of depression by use of a depression inventory scale- a set of survey questions. They also checked blood levels of Vitamin D. It turns out that in people with severe Vitamin D deficiency (levels less than 10ng/ml), there was a 35% prevalence of depression, while in the whole sample, the prevalence was only 25%.
So, does taking Vitamin D prevent depression? Well, we can't tell from this study, but it certainly looks promising enough to investigate.

BOTTOM LINE: Low Vitamin D levels play a role in a variety of medical problems, and now we can add depression to that list. Check your level and see if you need a little more "SUNSHINE" in your life!

Thursday, November 4, 2010

Supplements for Alzheimer's Disease

Bummer- another study that shows a specific supplement does NOT, in fact, delay or halt progression of Alzheimer's Disease. This study is titled Docosahexaenoic Acid Supplementation and Cognitive Decline in Alzheimer Disease, better known as DHA. We believe that DHA, a fatty acid used in the brain, has beneficial effects when taken as a supplement in humans. The question was whether or not taking this supplement would help to delay the progressive memory loss and other dysfunctions in Alzheimer's.

The completed study involved around 300 people with mild to moderate Alzheimer's disease. They randomly received either a placebo or 2g of DHA daily for eighteen months (it was randomized and double-blinded- our gold standard in research.) Cognitive tests were given at the onset and a year and a half later. Unfortunately, the people in the trial who received the DHA supplements were no better off on cognitive tests nor on brain atrophy at the end of the study.

We have been through this same process with Vitamin E, estrogen, and a number of other over the counter supplements. I remain optimistic that there may be a dietary or behavioral modification that does make a difference, as well as new medications that will not only stop the progression but some day reverse the dreaded decline of dementia with Alzheimer's.

BOTTOM LINE: Let's continue to support Alzheimer research, as we now have yet another supplement (DHA) proven to NOT be successful.

Wednesday, November 3, 2010

Best Birthday Present!

Today is my 45th birthday (or the 16th anniversary of my 29th birthday, however you want to look at it ;0) Personally, I love my age, and am happy to celebrate the full 45! I am blessed with an amazing family and the opportunity to pursue my ever expanding academic interests. I'd like to share today, though, what I am giving myself for this birthday. I'm giving myself...a PUSH!
I always make it a priority to have some exercise each day, but due to our hectic schedules, I have slipped into a low level of either simply walking the dog a couple miles each day or maybe jumping on the exercise bike. Now, there is NOTHING wrong with that, and I'd be thrilled if every one of my patients would commit to exactly that routine!

However, like everyone in my decade and beyond, I'm waking up to more aches and pains and stiffness each morning. It's time for a shake up in my exercise routine, so I'm giving myself a PUSH to bump it up a level. For me, I purchased a set of DVDs from an infomercial that I watched while I was on my exercise bike last month. The set has a great mix of weights and basic calisthenics, in thirty to sixty second chunks (which appeals to my limited attention span.) The first week, I felt like a truck had run over me...multiple times! I'm now in my third week, though, and excited to see huge improvement as I go through the routines. I can actually do a REAL pushup for the first time in my life!

BOTTOM LINE: Give YOURSELF the gift of a PUSH and bump up your level of exercise!

Tuesday, November 2, 2010

Halloween Hangover


Okay, tell the many times did you grab a piece of Halloween candy yesterday? If it's sitting out in a bowl (or in your kids' pumpkins) easily accessible, chances are you nabbed a piece or two each time you walked by. I will be the first to confess that I managed to top off my completely nutritious breakfast smoothie (yogurt, banana, and frozen strawberries, mangoes & peaches) with both a Reeses cup AND a "fun size" Milky Way. And all that before 6:30am.

Now, is it the end of the world that I had a breakfast dessert? Of course not! But, if that happens three or four times per day until that whole bag of candy is polished off, I'll be wearing several new unwelcome pounds around my belly. What's the solution? In our house, we let the kids have a few pieces of candy per day for a few days, then we donate the rest of the candy to a food distribution charity. I'm actually always surprised how this is really "NBD" (no big deal) to our kids, especially since we do not keep any candy in our house on a regular basis. Mind you, we always have homemade cookies on hand, but we do not stock candy.

Before I leave the whole Halloween scene, let me point out that candy now comes in a ton of different sizes, so beware of "serving size" when you are assessing calories! There is bite size, fun size, snack size, mini-size, regular, king and movie!

BOTTOM LINE: Enjoy the Halloween treats for a day or two, then if you don't need the extra calories, pass it on so your Halloween candy hang over doesn't increase YOUR "bottom line"!

Monday, November 1, 2010

Show Me Your Teeth!

Cheers! It's November 1st, the fresh start of a brand new month. Do you know what I love about the first of each month? I treat each one like January 1st, and choose new "resolutions" to work on for the next four weeks. Don't worry, I'm not making any resolutions that involve Lady Gaga, but what IS up for today? Well, with Halloween nipping at our heels, I think TOOTH CARE needs to head up our list!

I'll bet you don't know a single dentist that does NOT floss their teeth, right? Why is that? Because nothing replaces flossing for cleaning your teeth and promoting healthy gums as well. We are hearing more and more that oral hygiene has implications for the rest of our body's health, especially cardiac, so we really need to focus more on prevention.

Make sure that you are brushing your teeth with a pea-sized amount of flouride toothpaste, and TAKE YOUR TIME- you should brush for a full two minutes, at least twice per day. Add in flossing once per day, and that extra 30 seconds is very well spent! Limit carbonated and other sugary beverages, and when you drink them, try not to nurse them over several hours (this is a weakness of mine.) Dentists recommend drinking a soda in less than fifteen minutes- treating it like a dessert. Then, go at least rinse your mouth with water if you can't brush those teeth!

So, remember that it takes up to twenty-one days to create a HABIT. On the way there, find some way to record your progress- use an app for habit making, write it on your calendar or stick it in your day planner; whatever it takes! We know recording CHANGES behaviors, so let this work for you! Consider scheduling a dentist appointment for a month from now...that should help motivate you! And YES, dentists CAN tell when you start flossing like crazy just a few days before your appointment, so save your poor gums that trauma and start TODAY!

BOTTOM LINE: Make THIS the month you start flossing your teeth regularly!

PS. Like the first of every month, it's time to CHANGE YOUR AIR FILTERS!

Friday, October 29, 2010

B 12 Shots Revisited

It's time to talk about B12 replacement again, this time, because I'm reminded that people who take PPIs- Proton Pump Inhibitors- which are acid blockers such as Prilosec and Prevacid, decrease the acid in their stomach as intended, but often this causes LACK of absorption of the vitamin B !2. As a doctor, if I wait to see enlarged red blood cells and low total red blood cell count (macrocytosis and anemia, in medical language), I will be way behind the game. We should NOT wait till we see lab verification beyond an actual low B12 level to start replacement.

What are signs of B12 deficiency? Fatigue, memory loss, and funny sensations- paresthesias- often on the feet or hands. Does it hurt to get too much Vitamin B12? Not really- just your pocketbook. B 12 is a water-soluble vitamin, so if you get too much, the main danger is expensive urine. All the same, I don't advice OVER-replacing any vitamin.

If you DO need B12, you've got a variety of options. Many times you can simply take a daily oral supplement, and that will be enough. If absorption is impaired by change in stomach acid or by antibodies blocking receptors, then you will need a different form of replacement such as a shot, sublingual, or intranasal B12.

BOTTOM LINE: If you take acid blocking medications daily, and are feeling run down, ask your doctor to check a vitamin B12 level and see if you need to get tanked up!

Thursday, October 28, 2010

Here Come the Holidays!!

Okay, Halloween weekend is upon us. Enormous spiders cling on most houses in our neighborhood, and the number of Halloween lights rivals that of Christmas. (Yes, we love Halloween in Austin, don't we?) But it's what I'm seeing at work that is really SCARY.

Patients are already "giving up" and telling me that they will focus on healthy choices come January first.

What? We've got two full months left of 2010! The weather is crisp, and we should be excited to head outside and get active, not get ready for a long winter's nap.

I hear the excuse "but I love to bake for the holidays". Me, too! Bake away, but make some healthy menu choices and/or really kick up your exercise.

Have the pumpkin- chocolate chip muffin, but skip the latte and grab water. Take a second lap around the block or jump on the exercise bike for ten or fifteen minutes after the walk.

BOTTOM LINE: PLEASE do not postpone healthy choices till New Year's Eve! Start now and head IN to 2011 on the upswing!

Wednesday, October 27, 2010

Shampoo, Condition, and Blood Pressure??

Okay, you've got to love this! A new study,Effectiveness of a Barber-Based Intervention for Improving Hypertension Control in Black Men, recently published in the Archives of Internal Medicine, showed that barbers were effective in performing blood pressure screenings and referring clients with elevated pressures to medical care.

I think this is a wonderful example of thinking outside the box to reach patients. Virtually everyone gets their hair cut, and has one-on-one time with that barber or stylist. What a great use of an extra minute to add on a quick blood pressure check! I'd bet my lowest blood pressure readings come right after a wonderful shampoo at the salon. People are less likely to be stressed, which would help avoid "white coat" high blood pressure that we often see as patients become anxious in our office.

Bottom Line: Let's take this study one step further, and on your next trip to the grocery store, be your own advocate and take an extra minute to check your blood pressure as you pass by the pharmacy section (many offer their customers a wonderful, high quality cuff that you simply slip your arm into and press start.)

Tuesday, October 26, 2010

Raise a Glass for the Mediterranean Diet!

Cheers! We have MORE good news about the Mediterranean Diet. A recent study (Reduction in the Incidence of Type 2-Diabetes with the Mediterranean Diet: Results of the PREDIMED-Reus Nutrition Intervention Randomized Trial) showed a "52% reduction in the incidence of diabetes" whether or NOT the participants lost weight! We have known for years that weight loss will reduce your chance of developing diabetes if you are overweight, but this is the first significant study to show that simply a change in the types of foods you eat-regardless of the total calories- can make a difference.

The study took place in Spain, and consisted of around 400 non-diabetic adult patients aged 55-80. They were randomly placed on either a low fat diet or a mediterranean diet. Those in the control group (the low-fat dieters) had a 17.9% incidence of diabetes at four years, whereas those on the mediterranean diet had 10-11%.

So, what does the Mediterranean diet consist of? LOTS of olive oil, fruits, vegetables, legumes, nuts & fish, moderate red wine, and less meat (using white meats more than red.) Also, they recommend avoidance of butter, cream, fast-food and sweets. Hmm. Sounds like MORE, doesn't it?
Once again, we find that eating more whole foods like fruits, veggies, and nuts, while reducing processed stuff like fast food and instant boxed meals (think mac & cheese) is good for you.

BOTTOM LINE: Pump up the olive oil, fish, nuts, fruits and vegetables to help decrease your risk of becoming diabetic!

Monday, October 25, 2010

Baby Stroller Recall!

Attention parents of infants and toddlers! In case you hadn't heard about this yet, Graco has issued a recall on its Quattro and MetroLite Strollers due to potential risk of entrapment and/or strangulation, especially for infants less than a year old and not harnessed. Very sadly, there were four reports of strangulation and several of entrapment, but it was enough for the company to voluntarily recall roughly 2 million strollers to prevent any further potential risk.

This is why it is important to register the products we buy for our homes, especially those for our children. If your stroller was registered with current address information, you should have received notice of this recall already. I'll admit to often forgetting to register items I have purchased, but this should serve as a reminder for all of us.

On the flip side, I LOVED my baby joggers and highly recommend that new parents invest in a nice stroller that will allow THEM to get some exercise and fresh air and sunshine while their baby enjoys new sights and sounds (or more likely, takes a nap!) This post is in no way to discourage strollers, and I applaud Graco for its voluntarily recall.

BOTTOM LINE: If you have a GRACA Quattro or MetroLIte Stroller, check with your retailer asap, as it has likely been recalled.