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!

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!

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.)

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!

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.

BYOB Until You Get One of THESE New Machines!

Yea! Let's here it for vending machines selling...brace yourself... HEALTHY SNACKS! I was delighted to see "The Great Banana Challenge: How to dispense healthy snacks from a vending machine: design a fruit elevator" in the Wall Street Journal this week. It's hard to imagine walking up to a vending machine and expecting food to be, well, FRESH- but that's exactly what happens in these new machines.

Apparently, they've developed technology that allows for different refrigeration temperature zones as well as gentle "elevators" to lower the food and padded retrieval bins to avoid bruising. New packaging for the fruit itself extends the shelf life to nearly double its life outside of the wrapping.
For all of us who do not have these delightful new machines yet, don't worry! When in doubt, BYOB...Bring Your Own BANANA, that is!

BOTTOM LINE: The MORE we demand fresh fruits, vegetables and healthy snacks, the more innovative solutions our free market will create!

Can You Hear Me Now??

Have you noticed that you've got the tv or radio volume all the way up, but it still sounds muffled? Or are your friends and family getting annoyed that they need to repeat anything they say to you? Don't ignore this issue! It may be something as simple as a buildup of wax (cerumen is the medical word) in your ear.

What can you do about ear wax buildup yourself? Do NOT, repeat, DO NOT use Q-tips! All that q-tips manage to do is to pack the wax down harder against your eardrum. Additionally, while people do not intentionally shove the q-tip in too far, often they are startled by a kid, dog, or other distraction, and accidentally jab the q-tip in deep, often damaging their ear drum or canal. Please, save the q-tips for putting on makeup!

Instead, you MAY flush out your ear with water. Use a bulb syringe (pictured above with friendly witch) and luke-warm water. (If you make the water too hot or too cold, you will get very dizzy!) Lean over the sink, gently pulling your outer ear back and out, and insert the tip of the bulb syringe in your ear canal and squeeze the water. Repeat this up to a dozen times if necessary- you will see the wax pieces flush out into the sink (sorry, I know that sounds yucky.) Do not persist beyond roughly a dozen, though, or again- you can cause more irritation and feel off-balance.

When you are done, put a few drops of homemade ear solution- half alcohol/half vinegar- in your ear. This will dry out any remaining water (step away from those q=tips!) and also help reduce any fungal elements.
Can you hear me now? If not, schedule an appointment with your physician!

BOTTOM LINE: Ear wax is a common cause of muffled hearing- try flushing out your ears and stay AWAY from q-tips!

Trick or Treat? Kid Stuff!

Before I move off of our Halloween treats topic, I want to make a few suggestions for KIDS. Yesterday, I mentioned healthy fall food snacks (apples and pumpkin muffins) and today I'd like to make a pitch for a NON-candy treat to hand out on October 31st. Absolutely, part of the fun of trick-or-treating for kids is going door to door and collecting CANDY. You know you've scored when you go to that one house that hands out the FULL SIZE chocolate bars, right? Agreed. But there are plenty of inexpensive and still COOL treats you can hand out...

1. My kids' favorite: glow in the dark ANYTHINGs- bracelets & necklaces; some wear them as head bands! I love these, because they increase the kids' visibility, especially if they are a dark costume like the ever-popular vampire! These often come in a tube of a dozen, but it's fine to hand them out as a "single".
2. Stretchy stuff- skeletons, black cats & ghosts.
3. For girls: nail polish! (and yes, you can find glow in the dark nail polish, if you want to combine ideas...)
4. Halloween pencils & erasers or stickers- always a hit with the elementary school crowd!
5. Silly putty/slime/playdoh- all these come in cute Halloween "flavors"- including, you guessed it- glow in the DARK!

These all can be purchased on line or at your local craft stores or possibly grocery stores, but THINK NOW, especially if you are ordering on line!

BOTTOM LINE: Be creative this year, and hand out the coolest non-edible TREAT on the block!!

MORE Trick or Treat!

Ah yes, I am reminding you about MORE again...but really, the time to think about "New Year's Resolutions" and optimizing health and losing weight is NOW, BEFORE you weigh, well, MORE at the end of the holiday feasting season! (pardon the pun)
Today, though, I'm writing in response to yesterday's blog, where I suggest that we-gasp- SAVE THE HALLOWEEN CANDY for HALLOWEEN! I am ALL ABOUT Halloween, in fact, it may be my favorite holiday. My birthday is right after Halloween, so I grew up having costume parties and I have nothing but wonderful associations surrounding this festival. Our house is decorated with ghosts, pumpkins and skeletons from October 1st. I want to be clear that I am NOT saying "don't enjoy Halloween"- I am merely saying let's choose a HEALTHIER way to extend the celebration beyond one day!
So, what can you do if you are a Halloween candy fan? Number one: enjoy Halloween candy ON HALLOWEEN. This year, Halloween falls on a Sunday, so splurge all weekend if you'd like. Just do NOT buy the candy now, and have it sitting on your desk at work or out as "decoration" in your home. How about using some delicious pumpkin spice scented candles to liven up your surroundings instead?
If it's fall FOOD you are craving, whip up some healthy, delicious pumpkin muffins from a Cooking Light recipe, for example.
Enjoy the crisp apples of the season- maybe ONE with caramel wrapping and placed on a stick- but savor the season's fruit every day! We adore kitchen gadgets in general, and literally have three different apple slicers (pictured above). A knife will do the trick, but an inexpensive peeler/slicer makes apples so fun that every kid who visits our house asks to have an APPLE!
BOTTOM LINE: Celebrate HALLOWEEN with healthy TREATS, so you don't have to work to find new TRICKS to lose weight come New Year's.

Trick or Treat?

Can you believe that Halloween is right around the corner? We are officially in "treat yourself" season, as we hit the trifecta of food oriented holidays: Halloween, Thanksgiving and Christmas/Hanukkah. We tend to celebrate with nonstop EATING, and then what do we do every January? That's right, make New Year's resolutions where LOSING WEIGHT tops the list!
This year, let's THINK AHEAD...
The great news is that the weather is generally BEAUTIFUL in the fall (at least here in Texas!) What better time to head OUTSIDE and go for a walk? If you're here in Austin, make time to head down town and stroll, walk or jog around Lady Bird Lake. Wherever you are, respond to that sweet tail wagging of man's (and woman's) best friend, and grab your dog's leash and start WALKING.
Now, here's the "hard" part- which really is not so hard. Let's SAVE THE HALLOWEEN CANDY for...yes, HALLOWEEN! Start in the grocery store. Do NOT BUY the candy till the DAY BEFORE Halloween. It's way easier not to eat it when it is still sitting on the shelf in the grocery store, rather than sitting on your desk at work or your kitchen counter top. And forget the excuses here: "if I don't buy it now, they wont have my favorite kind", "I wont remember, then we wont have candy to give out", or "but I LOVE those little Reeses cups- how many calories does just one have?"
For a great list, check out Daniela Knight, R.D.'s list on her website, http://www.austinnutritioneducation.com/Halloween-Treats.html, but the ones that matter to ME are Snack Size Butterfinger: 170 kcal, Fun Size Kit Kat- 50 kcal, and ONE plain M&M-4 kcal. Now, if you stop at ONE, it's really no big deal. but if you eat a handful of M&Ms each DAY for the next few weeks, or grab a couple fun size chocolate treats, BOOM-you will gain a pound right there. (Remember one pound is 3600 kcal- do the math.)

BOTTOM LINE: Don't wait for NEW YEARS to make a resolution for better health- start NOW by limiting Halloween CANDY to HALLOWEEN DAY!

Excuse Me, Was that a BURP?

Do you suffer embarrassment from inopportune burping? Shrek says "Better Out than In", but that's not always a good thing. While many men seem to find this a national past-time, I have had many women patients complain to me about burping.

What causes it? Well, pretty much what you think- excess air in your stomach. However, you may not realize things that contribute to swallowing air, so here is list of common causes:
1. Carbonated beverages (this one is pretty obvious)
2. Using a straw for ANY drink- you suck down air before the liquid.
3. Anxiety or stress can cause you to swallow rapidly, including air
4. Sucking on hard candies/mints
5. Chewing gum (same principle)
6. Eating rapidly (remember what your mom said about wolfing down your food?)
7. Ill-fitting dentures or retainers

Burping is rarely a serious problem medically, but can certainly be a serious social issue. Check with your doctor if changing these habits doesn't clear the air!

BOTTOM LINE: If burping too frequently has become an issue for you, pay attention to these habits and see if changing these behaviors will make the burping go away.

"Break a Leg"- No, Please do NOT!

At the risk of sounding like an alarmist, today's post, like yesterday, carries a warning from the FDA. Today's concern regards the medications we prescribe to help INCREASE your bone strength- the bisphosphonates- commonly known as Fosamax, Fosamax Plus D, Actonel, Actonel with Calcium, Boniva, Atelvia, and Reclast. The FDA Drug Safety Communication: Safety update for osteoporosis drugs, bisphosphonates, and atypical fractures was issued today regarding unusual leg fractures that see to be occurring in women who have been on these drugs for five years or more.

Do the medications CAUSE the fractures? How common is this? Well, we're not really sure yet. What we do know is that the fractures are located either just below the hip joint or in the long bone of the thigh, and these types of fractures represent less than 1% of leg and hip fractures. However, 94% of the people with these fractures had been taking the bisphosphonate medications. Of course, there are huge numbers of people taking these drugs, and the study found only 310 cases of these fractures, so each person's individual risk of getting a fracture is quite low.

What should you do if you take a bisphosphonate? Number one- don't worry! There is a much greater chance that your medication is PREVENTING you from getting a fracture than potentially causing one. Have a discussion with your physician about your risks and benefits, and make a decision together at your next exam.

Remember the things YOU can do to strengthen your bones: get enough calcium in your diet (especially when you are young, so help your daughters!), enjoy weight-bearing exercise like walking and jogging, limit your caffeine, get your sunshine vitamin (D) and make sure your thyroid medication is not over-replaced!

BOTTOM LINE: Be aware that medications taken for thin bones may carry some extra risk, and as always, focus on what you can do to improve your bone strength!

Lipitor RECALL! Smelly news...

Okay, in the last week, I've talked about STATINS and SMELL, but never thought they'd be related...

It turns out that Pfizer has issued a recall for 191,000 specific bottles of Lipitor 40mg (see http://lipitor.com/recall.aspx) because patients noticed an "uncharacteristic smell" in the bottles of this medication. Rest assured, there have been no complaints of any adverse outcomes, and I applaud the company for being proactive and issuing this recall. Additionally, the company does not believe this recall will affect the supply of this or any other dosage of Lipitor.

If you take Lipitor in any other dose, there is no concern at all. If you take the 40mg dose, simply contact your pharmacy if you notice any unusual odor.

The FDA publishes a current list of all recalls and safety alerts at: http://www.fda.gov/AboutFDA/ContactFDA/StayInformed/RSSFeeds/Recalls/rss.xml If you want to be automatically informed, you can sign up for an RSS feed. We are fortunate to have such a watchdog service in our country!

BOTTOM LINE: Yes, there is a limited Lipitor recall, and no, there is no need for panic, but if you catch a whiff of an unusual odor in your bottle of Lipitor, take it back to the pharmacy.

But It's Too EXPENSIVE to Eat Fruits & Veggies!

Okay, this is one of the top excuses I get from patients when we start talking about improving their diet, and getting them to focus on MORE fruits and vegetables. (Keep in mind, our goal is 5-10 servings per day, and a serving is what you can hold in your hand.) So back to the discussion- is the perimeter of the grocery store really more expensive than the boxed, processed junk in the middle?

Of course, if you look at the BIG picture, it's easy to see that no matter what, you are better off buying the fruits and vegetables. Diabetes, blood pressure and cholesterol medicines cost a small fortune, even if you are "only" paying the co-payments. Part of the incentive to improve your health (and yes, lose weight in the process) is that MANY people can reduce or even eliminate these medications, which will save them a very significant amount of money!

In the short term, though, what is the cost? Obviously it depends on what you choose. My friend and excellent dietician, Daniela Knight, RD, recommends that her patients check out the weekly ads. "If bananas are on sale, load up on those and skip the $5 per carton blueberries that week." Lettuce, carrots, onions, apples, oranges and potatoes are typically inexpensive year-round. Frozen fruits and vegetables are packed with the same nutrients as fresh ones, yet often cost much less. Additionally, there is nothing wrong with canned vegetables or fruit, either, despite the incorrect notion that they are vastly inferior. Yes, watch for sodium in canned goods, but the nutrients are fine!

Daniela also reminds her patients that you can buy an entire BAG of potatoes for less than the cost of a bag of potato chips, which are up to $3-$4. Pre-washed, packaged vegetables like broccoli and green beans are simple to pop in the microwave, and now you've got quick AND reasonably priced veggies.

BOTTOM LINE: Fruits and vegetables are worth every penny for your health, and can save you money in BOTH the short and long term if you buy frozen, canned and seasonal fresh produce!

Weight Loss Drug REMOVED from Market

Ah yes, it's becoming the all-too frequent headlines: Drug X removed from the market! This week, it's MERIDIA (sibutramine ), a weight loss medication by Abbott that has been available in the United States since 1997. A research study called SCOUT- Sibutramine Cardiovascular OUtcomes Trial- revealed a 16% increase in the risk for serious cardiovascular events such as nonfatal heart attack or stroke, the need for resuscitation (after the heart stopped), and even death, in patients who took sibutramine compared with those patients on a placebo.

Isn't obesity a risk factor for heart disease, though? Are you better off losing weight using a drug that might increase your cardiovascular risk versus simply staying overweight and being at risk from that? Researchers in this study say no. They believe the drug itself caused more increased risk than any benefit that might be derived from the weight loss itself. This was a large study, with over 10,000 men and women over the age of 55, who were significantly overweight and had a history of heart disease, diabetes, or other cardiovascular risk factor. As such, if you took Meridia and are overweight but have NO other risk factors, we do not know how much this drug might increase your risk.

What should you do if you took Meridia in the past? Let your doctor or FDA's Medwatch program know if you have developed any cardiovascular complications. If you are currently taking Meridia, you will need to discontinue it, and discuss an alternative weight loss program with your physician.

For the record, people in the study who received the real drug (not placebo) lost 2.5% more of their body weight over the five years of the trial. I would like to point out that following the MORE principles of increasing your fruit and vegetable intake plus adding in daily exercise will get you to the same or greater endpoint, with NO increase in cardiovascular risk!

BOTTOM LINE: The weight loss drug Meridia has been recalled- see the FDA report for further details, and contact your doctor if you are now or in the past took this medication.

Does PAP = "Pelvic" ?

You may be aware that in 2010, the recommendations for Pap smears (to detect cervical cancer) have changed. Many women grew up being told that they should have a Pap smear once they started menstruating, or perhaps before they head off to college. It turns out, what MATTERS is simply whether or not you have had sex.

Cervical cancer is caused by a virus- the human papilloma virus, or HPV for short. We know that the vast majority of people who have sex will at some point in their life be infected with HPV. Certainly, the more partners you have, the higher the risk of contracting it. If two people are together, and neither has ever had their clothes off and been intimate with anyone else, there should be no risk of HPV. Otherwise, even if only one partner has had previous intimate contact with another person, there is risk, and most of the time this is a silent disease.

The GOOD news is that most people who are infected never develop adverse consequences. The BAD news is that over a million Americans see their doctors for genital warts each year, and that 12,000 women per year develop cervical cancer (not to mention the other cancers also caused by HPV.) More GOOD news, though- we have vaccines that can help. Gardasil protects against the strains that cause 90% of genital warts (types 6 & 11) and those that cause 70% of cervical cancers (types 16 & 18). Cevarix protects against the cancer causing strains as well.

So, back to the Pap smear. Yes, we recommend them, and the timing has changed (first Pap now recommended at age 21.) However- this is ONLY the recommendation for PAP SMEARS that screen for cervical cancer. If you wait several years to get ANY pelvic exam, and you have had new sexual partners, you risk developing complications from numerous other sexually transmitted diseases such as chlamydia, gonorrhea, trichomonas, syphilis, HIV and herpes.

BOTTOM LINE: MOST SEXUALLY TRANSMITTED DISEASES can be SILENT, so do not wait till it's time for your Pap smear to get a pelvic exam and/or get tested (which may only be a urine and blood sample)!

Compression Only CPR! (aka., "Annie, Annie, can you hear me now?")

While we are on the topic of hearts, I want to share the results of a study recently published in JAMA: Chest Compression–Only CPR by Lay Rescuers and Survival From Out-of-Hospital Cardiac Arrest
What are the results? Basically, that laypeople performing simple chest compressions were actually MORE effective than laypeople doing traditional CPR (with compressions and breaths).

Why is this good news? Many people shy away from performing CPR, even if they are trained, because of the whole mouth-to-mouth part. If we can encourage people to simply do chest compressions and not worry about the breathing part, I believe we will have more volunteers when the occasion of a "sudden death" arises.

There has been much chatter about this study within the medical community. Only roughly 10% of people who receive CPR survive after resuscitation (in the out of hospital setting.) It is believed that merely a third of people who NEED CPR receive it, so we need to do whatever we can to increase that number. Please, if you see me clutch my chest and pass out, and I'm on the ground out cold with no heartbeat, try SOMETHING!

BOTTOM LINE: Don't shy away from performing CPR just because you are afraid of mouth-to-mouth; start those chest compressions while someone else calls 911, and keep 'em going till the EMS arrives!

To Statin, or Not to Statin- That is the Question!

Okay, in this day and age of fixing everything with pills, we are often faced with whether or not to start a patient on a cholesterol lowering drug (a statin.) How can we decide if the benefits outweigh the risks? How much improvement can we expect from a medication?

Often, simply educating the patient about a high fiber diet will do the trick, especially if it is his or her triglycerides (the smallest breakdown product of fat) that are really high. Eating a diet with more than 25g of fiber per day will often lower lipid levels to our goal range. How do we do that? At the risk of beating a dead horse, it's MORE fruits and vegetables, plus some extra sources of high fiber such as beans, nuts, more berries, or high fiber cereals such as Fiber One or Bran Buds.

What is HIGH? Total cholesterol >200, triglycerides > 150, LDL (bad cholesterol) > 130 [or >100 if other heart risk factors such as diabetes, high blood pressure or smoking], or LOW HDL (the good cholesterol that takes away plaques) which is <40 in men and <50 in women. If you have more than one number above normal, it's time to consider either serious dietary modification or perhaps medications.

Luckily, we have a tool that can help us decide whether or not to start medications. The Framingham Risk Score looks at your lipid levels and calculates your risk of an adverse cardiac event in the next decade. You can plug in "improved" numbers (that you would get with a drug like Lipitor, Zocor, or Crestor) and see how much, if any , it lowers your risk.


BOTTOM LINE: If you are deciding whether or not to start (or continue) a statin medication, consult with your doctor and discuss your Framingham risk score!

My Metabolism STINKS!

Do you feel like no matter what you do, you simply cannot lose weight? Many people ask there doctors what is wrong with their metabolism. Physicians run many thyroid function tests trying to find an answer for their patients, but the majority of the time, those tests are normal. In addition, even if your thyroid is sluggish, starting on thyroid medication does not guarantee that the pounds will melt off!

There are certainly other factors that go into your metabolism. Co-factors such as vitamin B12 and adrenally produced steroids play a role as well. However, most of the time, our science is not advanced enough to detect subtle changes. We cannot give people thyroid medications to "speed things up" unless they are truly low thyroid, because excess thyroid causes medical problems such as irregular heart rhythms, osteoporosis, and anxiety.

So what can you do? There are only two behavioral modifications that YOU can do to help speed up your metabolism. Ready? Here they are:
1. NO SKIPPED MEALS, especially BREAKFAST (because you have already "fasted" while you slept.)
2. DAILY AEROBIC ACTIVITY (walking, biking, hiking, dancing- anything that raises your heart rate)

Additionally, realize that it has been proven that when we record or recall our food intake and exercise, people always UNDERestimate what we eat, and OVERestimate our exercise. Recognize that you (like all of us) have that bias! If you are frustrated with your metabolism, try a different approach. Obviously, what you are doing now is not working, right? So talk with your doctor, your registered dietician, and/or your personal trainer and find ways to step it up a notch!

BOTTOM LINE: Naturally speed up your metabolism by making sure you don't skip meals and you DO increase your daily exercise!

Metabolic Syndrome- What's That?

Have you heard of "metabolic syndrome"? You should have, because almost one fourth of American adults- 47 million- have it! In fact, metabolic syndrome is passing smoking as the number one risk factor of heart disease in America. That's the BAD news. The GOOD news is that with lifestyle changes, you can reverse or at least delay onset of metabolic syndrome.

So, what is it? It is not your "metabolism", although it sounds like that. Metabolic syndrome occurs when you have three or more of the following:

A. Large waistline (>40” M; >35” F)
B. High triglycerides (similar to cholesterol)* (>150)
C. Low HDL* (the good cholesterol) (<40 men; <50 women)
D. HIgh Blood Pressure* (>130 top number or > 85 bottom)
E. High fasting blood sugar* (> 100)

The * means that if you are on medications for any of these conditions, it "counts", regardless of your current numbers.

What's the answer? Ultimately, weight loss is the answer. Start by moving MORE, and eating MORE vegetables and fruits.

BOTTOM LINE: If you have high cholesterol or are overweight, SEE YOUR DOCTOR and ask about metabolic syndrome, and what you specifically need to do to avoid or reverse it!

MORE- A Novel "Diet"

On this last day of the 2010 AAFP Scientific Assembly, I will be speaking about nutrition. As family physicians, we are all motivated to help our patients achieve the best health they can, and often the major issues stem from being overweight. We know excess weight leads to high blood pressure, elevated sugars and diabetes, and high cholesterol levels, which can lead to heart attacks and strokes. So why don't more family doctors talk to their patients about their weight?

Of course, there are many reasons, but here are a few:
1. The doctor doesn't want to insult or upset the patient by telling them they are overweight, especially if the doctor herself is overweight.
2. Weight loss counseling can be very time consuming, and we are already time pressured without opening this can of worms.
3. Many doctors lack knowledge or training regarding current nutrition, and are unsure of which "diet" to recommend.
4. Often patients want weight loss drugs, and most doctors are unsure of the risks and aware of the high percentage of relapse once the medication is stopped.

My goal today will be to teach primary care physicians some simple tools that they can use to help motivate their patients to lose weight. They will learn about BMI, 24 hour dietary recalls and exercise prescriptions, and learn about my MORE philosophy! We all know that MORE fruits and veggies will push us towards better health, but having a concrete plan for More fruits/veggies, Optimizing Snacks, Ramping up Fiber and Exercising daily will be a terrific start! In fact, our surgeon general, Dr. Regina Benjamin, emphasized that we need to stop focusing on what we CANNOT have/eat, and start focusing on what we can and should be eating, which is exactly the MORE message I have been sending the past few years

BOTTOM LINE: Focus on MORE fruits and veggies, MORE exercise, MORE fiber and stop the culture of restrictive dieting!

Dementia- Remember THIS!

Today I am speaking at the AAFP Scientific Assembly about DEMENTIA. Why? Because I know first hand what it is like to CARE for someone with dementia, and have experienced frustrations from the family member/care giver standpoint, and I want to help other family physicians gain some insight from our family's experience. Our mother faded for twelve years from Alzheimer's, and now our father is battling Parkinson's dementia. We have the unique view from both the provider and patient aspects, and I hope my talk can make a difference.

What are a few things I want to share?
1. How to recognize what is "normal" age-related memory change versus true dementia (see Do I Have Alzheimer's?)
2. Docs need to be the "bad guy" and say it's time to stop driving. (See Driving Safely while Aging)
3. Subtraction skills are used every day- figuring out change, recipes, and even counting backwards to see what time you need to leave the house to arrive on time for an appointment. When this SKILL goes, what you SEE is trouble with those activities.
4. Pills-especially with generics, pills can LOOK ALIKE and add to confusion of poly-pharmacy. Simplify, simplify, simplify!
5. Pill delivery- all pill boxes are not created equally. Finding one that works can make a beautiful difference.
6. Stopping medications- there comes a point when it is time to stop pills aimed to prolong life (statins, aspirin, etc.) If there are no side effects to the patient quality of life to STOP them, I do.

That tops the list, and we'll see what input others have today!

BOTTOM LINE: Primary care physicians can do more to help their patients facing dementia, and I hope to help them see how!

PS It's OCTOBER FIRST- Time to change those AIR FILTERS!