Food Allergies

How many times have you heard someone say that they are allergic to a specific food? Food allergies are indeed common, affecting roughly 8% of kids and around 4% of adults. A true food allergy is an immune reaction to a food protein. There are many food REACTIONS (such as lactose intolerance, for example) that are not true allergies.The most common allergens are PEANUT, FISH, SHELLFISH and other TREE NUTS.

What are signs and symptoms? Food allergies show up within minutes to a couple hours after exposure to even small amounts of the offending protein. Itchy, red rashes, swelling, flushing, nausea, abdominal cramping and diarrhea, stuffy nose, wheezing, racing heart and metallic taste in your mouth are some of the possible presentations.

How do we diagnose food allergies? Mainly by history, to be honest. We combine the history with either skin or blood testing for more accuracy. Skin testing CAN be helpful, but there are many false-positives (which means the test says there IS an allergy, but there is not.) NEGATIVE results on a skin test, however, are very accurate that there is NO food allergy, so that can be very reassuring. Blood tests are also poorly predictive, being accurate only roughly half of the time. We do know, though, that high levels of blood tested antibodies are very suggestive of an allergy to that food.

We do not have a CURE for food allergies, but we can use antihistamines and epinephrine to treat acute reactions.
Of course, the mainstay of treatment is prevention through avoidance of that food protein.

BOTTOM LINE: If you think you may have a true food allergy, discuss it with your doctor and consider additional testing before permanently restricting your diet.

What a Chef! Sicola's in Austin

I need to take time today to have a "commercial" for Sicola's: A Culinary Experience in Austin, TX. Last night I was at a Journal Club meeting there, and the before our talk, the waitstaff was circulating with luscious looking appetizers. Since I am still GF (Gluten Free), I will admit to feeling a bit deprived as I politely passed them up. Not wanting to appear rude for turning down multiple choices, I told one of the waitresses that if I were not gluten-free, I'd grab them in a moment.

Within a few minutes, the same lovely waitress returned, letting me know that indeed, the rest of the evening's menu was completely GF. I was pleased she would go to that trouble, and happily sipped my wine. However, that was not all. A little bit later, another waitress came over and told me that the chef was excited to CREATE a GF appetizer just for me! Can you believe that? In the throws of preparing a gourmet meal for fifty people, he stopped and literally experimented simply to allow someone with a special diet to enjoy an appetizer. Amazing!

I wish I could tell you exactly what the appetizer was, but I CAN tell you that it involved goat cheese and a non-wheat crumb coating, and it was DELICIOUS! I have never felt so pampered. Apparently, Stephen Sicola (the amazing chef) is creating specialized dishes to cater for all kinds of special diets, including youth with diabetes. Very cool!

BOTTOM LINE: If you live in Austin and have a private dining party to plan, call Sicola's and book it now!
PS. If you follow a special diet, it never hurts to ASK for something a bit off the menu when you dine out, so give it a try!

The Flu: When to Treat?

Yesterday, I had a discussion with some friends about whether or not to treat the flu with antiviral medications (Tamiflu or Relenza). Conveniently, today the CDC posted expert commentary on the latest guidelines, so I thought I'd share them with you.
Basically it boils down to this:

People at risk of more severe illness should definitely be treated: pregnant women, the very old or very young, people with underlying medical issues that suppress their immune system (cancer, HIV)
People with severe or rapidly progressive flu symptoms should be treated.
Anyone hospitalized should be treated.

For the rest of the public- the otherwise healthy, non-pregnant population- the CDC has wisely left it up to the DOCTOR's discretion, as long as treatment is started within 48 hours of the onset of symptoms.

The antiviral medications have been shown to shorten the course of the flu by one day, and can limit the severity of the flu. However, side effects often include significant nausea or vomiting, as well as headache. It really depends on how sensitive you are to side effects as to whether or not it is "worth it" to treat for the flu.

Don't forget, though, that prevention with the flu vaccine and consistent hand-washing are your best first lines of defense!

BOTTOM LINE: If you develop flu symptoms (fever, chills, cough, sore throat, runny nose, muscle aches and headaches), see your doctor quickly so if you ARE a candidate for antiviral therapy, you can start it with 48 hours of your symptoms.

Cranberry Juice and Your Bladder

Once again, cranberry juice and its role in possible prevention of urinary tract infections is in the news. Several studies published recently tried to address whether or not cranberry juice or cranberry extracts are effective in prevention of recurrent bladder infections. The results? Not too impressive...and the jury is still out.

Urinary tract infections are relatively common, especially in women. Once you have an infection, the relapse rate is nearly 30%, so we are always looking for non-antibiotic methods to reduce that number. Cranberry juice is known to decrease the ability of bacteria to stick on to the surface of the bladder lining. If fewer bacteria stick, they are less likely to multiply to the point of establishing an infection. Scientists have tried to narrow down the active ingredient that yields this result, and most believe it to be the PACs (proanthocyanidins). However, recent trials based on this theory have not demonstrated success in reducing the number of infections.

What CAN you do to reduce bladder infections?
1. Stay well-hydrated by drinking plenty of WATER.
2. Limit caffeine (it is a diuretic).
3. Women, make sure you wipe front to back after urination (to avoid bringing the rectal bacteria forward)
4. Urinate soon after sex (again, don't leave the moisture for the rectal bacteria to float forward)

Signs and symptoms of urinary infections are burning when you urinate, and urgency and/or frequency of urinating. As the infection progresses, you could develop back pain, nausea, vomiting and fever- all serious signs that it's past time to see your doctor!

Should you drink cranberry juice if you think you have an infection? Sure! But not to CURE it, just drink it because you ought to really hydrate with anything that does not have caffeine. It might help you (along with an antibiotic) to cure the infection, and it does no harm unless you don't like the taste.

BOTTOM LINE: Cranberry juice may slightly help to clear urinary tract infections, but there is not solid evidence that it helps prevent recurrences if you take it daily as a preventative treatment.

Doc, Have You Heard of This New Drug?

Often patients ask me about a new drug they heard or read about, and would like a prescription to "try it out". Sometimes, the new drug works wonders, but most of the time, there is no such luck. Obviously pharmaceutical companies are spending more money on direct advertising to the public, and it's working! Our country spends staggering amounts of money on drugs.
Today I'd like to share a pneumonic from the AAFP that helps doctors assess new medications: STEPS.

S: Safety- what are the drug interactions and side effects?
T: Tolerability- how many people stop taking the drug because of side effects?
E: Effectiveness-this may seem obvious, but really: does this drug not only change a LAB VALUE (or blood pressure, etc.) but DOES IT IMPROVE PATIENT QUALITY OF LIFE or HELP PATIENTS LIVE LONGER?
P: Price: Is it worth the cost?
S: Simplicity: How many times per day is it required? With or without food? Can it be taken with other medications?

BOTTOM LINE: Together with your doctor, discuss these issues before you add another medication to your daily routine. </span>

To Pap, or Not to Pap...

When I was in medical school (not THAT long ago), there was no question about when women should get Pap smears. We knew that this valuable test to screen for cervical cancer saved lives, and every woman should be tested at her annual exams. Subsequently, we learned that all cervical cancer comes from HPV- the Human Papilloma Virus, which is transmitted by intimate skin-to-skin contact, primarily through sex. With that knowledge, we modified the Pap requirements to only those women who had become sexually active.
Now we know that the majority of HPV infections occur upon initiation of sexual activity, and that most of these infections are cleared by the immune system within a couple years, and do not result in cancerous changes. We also realize that invasive cervical cancer is very rare in women younger than 21, and so the current guidelines tell us that women should start having Pap smears when they turn 21 (and have had intimate relations.)
Happily, we also have vaccines to help our immune systems fight off the HPV more effectively, so with Gardasil and Cevarix immunizations, we should be seeing even less cervical cancer!
What if you are over 21? Women aged 21-29 without high risk factors (HIV, organ transplant patients, DES exposure or previous abnormal Pap smears that showed early cancerous changes) should get screening Pap tests every other year in their twenties, and every third year beyond their 30's.
Women over 30 will be tested with both the traditional Pap test and a specific test that checks for the strains of HPV that cause cancer. If you test positive for these high risk strains, your screening will be more frequent (annually.)
When can we STOP? By 70, if you have had a decade of normal results, you are done. Yea!
BOTTOM LINE: Pap tests do not need to be an automatic part of your annual pelvic exam- but YOU STILL NEED ANNUAL PELVIC EXAMS to check for sexually transmitted diseases and other gynecologic concerns (ovaries, etc.)

Life or Death Advice! (& Another Medication Recall)

No need to panic. There is nothing terrible or scary going on, but McNeil Consumer Healthcare is recalling certain batches of Tylenol 8 hour, Tylenol Arthritis Pain, and Tylenol respiratory products (Tylenol Sinus, Allergy, etc.) as well as some lots of Benadryl, Sinutab, Sudafed and Rolaids. Go to McNeil's Product Recall Information site to check lot numbers on any of these products that you have in your medicine cabinet. These recalls are an admirable part of the company's internal scrutiny upon discovery that in some instances, cleaning procedures were considered insufficient or poorly documented. There have been no complaints of any adverse medical consequences...and goodness knows in our legal climate, we'd be aware of them if there were!

However, I wanted to use this medication recall as a REMINDER TO CLEAN OUT YOUR MEDICINE CABINET! Along with the bevy of New Year's resolutions, fresh starts should include your basic home pharmacy. It will do you little to no good to reach for your pain reliever or topical antibiotic cream if they are out of date. Just like your pantry (surely a topic for another day), I'd bet you will find old prescription medications along with numerous expired OTC cough and cold products. TOSS THEM OUT!

I think the most critical medication in the cabinet is diphenhydramine (Benadryl). If someone in your house is stung by a bee, or eats the wrong food or has another trigger for a severe allergic reaction, you want that Benadryl to be CURRENT! Now, this literally can be a matter of life and death.

BOTTOM LINE: Take a half hour TODAY and clean out your medication cabinet, checking expiration dates (and lots, if it is one of the meds noted above) and then head to the store and REPLENISH your supply!

Stress Fractures- the Runner's Bane

How do you end up with a fractured bone without knowing you "broke" it? STRESS FRACTURES are common injuries, especially in athletes (not necessarily professional athletes, mind you, but anyone jumping into serious exercise programs...often as part of New Year's resolutions!) The stress fractures show up as a persistent tender spot or swelling, most commonly in the shin (tibia), foot bones, and upper leg; rarely they also occur in the arms, spine and pelvis.

The typical story is someone who recently had a marked increase in their activity level, or very repetitive activity (running every day) without significant rest. This is why I am a huge fan of CROSS TRAINING! If you are going to start jogging, for example, run on Mondays, Wednesdays and Saturday, and try biking or swimming on the other days.

Stress fractures are OFTEN NOT found on initial xrays (up to 90% of the time). If your symptoms persist, however, a follow up xray a few weeks later has a much higher likelihood of detecting a fracture. Sometimes additional imaging, such as an MRI, may be needed to identify the fracture.

Risk factors include having > 10 alcoholic drinks per week, being female (can't change that!), smoking, low Vitamin D levels, and excessive or repetitive physical activity.

Treatment? REST- stop the activity that causes pain. This sounds simple, but is the most difficult part to enforce, especially in committed runners. Pain medicine is usually just acetaminophen (Tylenol) or possibly ibuprofen, though there is debate whether the ibuprofen may delay healing.

BOTTOM LINE: CROSS TRAIN to PREVENT stress fractures, and see your doctor if you have a persistent tender spot (especially your shins or feet) after starting a new exercise program.</span>

Can Hormone Therapy Prevent Dementia?

As our population ages and more members are developing dementia (primarily Alzheimer's), scientists are constantly on a quest to look for ways to prevent dementia. In the past, we felt the data supported that estrogen ("HRT"- hormone replacement therapy-given to women in menopause) might prevent Alzheimer's. Subsequently, the tide turned and evidence showed that not only did it not prevent, but it may worsen your risk. What do we think today?

A recently published study in the Annals of Neurology, Timing of hormone therapy and dementia: The critical window theory revisited, represents hope and a bit of a compromise. This study suggests that women who take HRT WHEN THEY BECOME MENOPAUSAL (but not later in life) have a significantly reduced risk of developing dementia!

The study was a good size- around 5500 women. Their pharmacy records were used to verify HRT use in their mid-life (average age around 49) and then evaluated again roughly 30 years later, when the women were in their late 70s and 80s. Over a quarter of these women developed dementia (27%) which may sound shocking, but is consistent with the growing incidence of dementia.

The analysis showed that women who TOOK HRT ONLY IN THEIR MIDLIFE had a 26% reduction in their risk of developing dementia compared with women who never took HRT, whereas those who took HRT only in their later life had a 48% INCREASED risk. Interesting, those women that took HRT BOTH midlife and later life had the same risk as those women who NEVER took it.

BOTTOM LINE: Current evidence-based medicine suggests that taking HRT at the time of menopause may DECREASE your risk of developing dementia, but starting HRT late in life can INCREASE your risk. Women, please factor this in when you have your discussion with your physician regarding pros and cons of HRT!

BRR! Frostbite!

Recently our family had the occasion to be in gorgeous Crested Butte, CO. While typically the days "warm up" to the 20's and provide fabulous skiing weather, with fresh powder and sunny skies, we happened to hit a couple days with severely cold weather. Note that the picture shows my car's dashboard reflecting a MINUS 20 degrees outside!

With that in mind, I'd like to talk a bit about FROSTBITE. Frostbite shows up when it the thermometer reads in the negative in Celcius or below minus 17 in Fahrenheit. One day we foolishly thought we'd ski when it was "only" a couple degrees below zero, but the wind chill took it cold enough that the slopes were empty and the lift signs all sported frostbite warnings!

What are the signs and symptoms? Pain, severe cold, redness, and did I mention PAIN? Typically it occurs in extremities- fingers, toes, and noses. Ice crystals literally form within the tissue, and this can damage and even kill the cells in the skin.

Risk factors include temperature below minus 17, alcohol use, smokers, previous cold injury, low calorie intake, lean body mass and history of Raynaud's phenomenon (where the blood supply to the hands gets restricted and your hands turn red/purple and ache terribly.)

PREVENTION: Dress in LAYERS, cover all exposed areas, avoid alcohol (or any drugs that can alter mental status), and AVOID ELECTIVELY GOING OUTSIDE WHEN IT IS TOO COLD!

Treatment: Immerse in warm water and take NSAIDS (ibuprofen) and SEEK MEDICAL CARE. Do NOT rub affected areas, as this may actually increase tissue damage.

BOTTOM LINE: Watch the temperatures, especially if you are traveling to an area that is much colder than you are used to experiencing, and make sure you have gloves, socks, and face gear that is made for sub-zero weather challenges if you plan to be outdoors in below zero weather!

Do-Over! New Year's Resolutions: Take 2

Welcome to the second Monday in January! Have you "blown" your New Year's resolutions already? If so, you are not alone, and better yet: take a "Do-Over"! Why not let January 10th be another January 1st?

Quite honestly, I'd rather you start over EVERY Monday than simply chunk your resolutions. However, this time, really focus on something SIMPLE and CONCRETE that you can definitely attain. If you have been inactive, for example, don't commit to heading to the gym 5 days per week! Instead, if you have joined a gym, commit to going "on Wednesday mornings, with your buddy, who joined with you." Mind you, I'm not saying to AVOID the gym the other days, but make sure your resolution is something that is possible to keep, so you can feed on your success.

If weight loss is your goal, make sure that you have set realistic goals. It takes a negative 500 calories per day (either eating less or burning off more) to lose ONE POUND PER WEEK. And that is excellent weight loss! I can't tell you how many of my patients feel dejected if they "only" lose 2 or 3 pounds in a month, despite the fact that medically, this is terrific weight loss. Shows like "The Biggest Loser" are motivational, but realize that those participants are more than 100 pounds overweight to begin with, and have chefs and trainers round the clock. If you are only 20 or 30 pounds overweight, plan to lose that in ONE YEAR.

BOTTOM LINE: Keep prioritizing healthy food choices (MORE Fruits and Veggies) and MORE exercise, and 2011 will be a year of success and good health!

Pedometers- Cheap, Easy & Effective!

Yesterday I mentioned getting a PEDOMETER, and I'd like to expand on that a bit. Here are a few things that I love about pedometers (and thanks to my walking buddy, Lorna, for my new one in the picture!);

1. They give only POSITIVE FEEDBACK: the more you walk, the more steps you get to count!

2. They are inexpensive (anywhere from a FREE app on your iPhone to around $35 for a really fancy one.)

3. There is NO special clothing to start exercising (though of course, I'd put everyone in comfy sneakers if I could!)

4. They are often a surprising wake up call that your lifestyle truly is "sedentary." From home-bound seniors to cubicle-dwelling techies, many of us don't realize how little we move, until we measure it. The great news here is that it becomes FUN to see how many extra steps you can sneak in during the day by spacing out or expanding routine chores (delivering laundry to the kids rooms, walking across the building instead of emailing, etc.)

How should you use one? To be most accurate, you will typically need to calibrate your steps by walking 10 paces and measuring the distance, then entering that in. However, most pedometers will accurately count STEPS (even if the distance is a little off) and you can set your GOAL based on increasing your total step number each day. I suggest adding 100-200 steps per day until you reach the often recommended 10,000 steps per day.

Pedometers come in clip on or slip in your pocket styles- find one that works the best for your everyday clothing styles, and wear it all day, every day, till you are consistently reaching your goal.

BOTTOM LINE: Purchase a PEDOMETER and GET MOVING in 2011!

Which Exercise is Best?

ANY exercise can be the "BEST"- really, it's the exercise that YOU will COMMIT to doing! That being said, I will tell you my recommendations.

1. If you have done NO exercise for the memorable past, start with WALKING. Put on a pair of good sneakers, dress for the weather (or head to an indoor mall) and MOVE! If you feel there is simply not a spare half hour in your day to schedule exercise, then get a pedometer (more on them tomorrow), strap it on, and push yourself to increase your step number each day.

2. I am a big fan of EXERCISE BIKES because they are the easiest way to allow cross-training. If you walk, jog or run a few days per week, and hop on your exercise bike the other days, you will nicely balance the strain on your muscles and avoid injuries.

3. Join a GYM...IF IT IS VERY CONVENIENT and/or you will commit along with a PARTNER. Gym memberships are wonderful, IF YOU USE THEM, but many of them are simply a way to open your wallet and dump out money each month.

I'm going to spend the next few blogs expanding on these ideas, so stay tuned!

BOTTOM LINE: The GOAL should be DAILY EXERCISE, so set yourself up for success by choosing the right exercise for you!

MORE Dieting Tips!

As we launch into 2011, many people are motivated to work on weight loss. Yesterday I mentioned a few simple dietary changes that can add up to BIG RESULTS when they become a permanent change. Today, I'd like to focus on my "MORE" concept. I have found that the majority of my patients (and friends and family) have an easier time improving the quality of their diet by focusing on INCREASING the amount of veggies and fruit they consume, rather than focusing on eliminating "bad" food.

Here is my specific recommendation:
Aim to eat 5 to 10 SERVINGS (what you can comfortably hold in your cupped hand) of vegetables and/or fruit per day.

That's it! Really, it's that simple. Don't freak out that there is "no way" to eat that many servings per day. I promise you that even young kids can easily follow this rule. Add in a banana or a handful of berries to your breakfast. Have your morning or afternoon snack include a serving (think an apple, carrots, raisins, etc.)
At lunch or dinner, include a generously portioned salad. If you have two handfuls of lettuce, plus one more handful of either tomato, shredded carrots, avocado slices, peppers, or your favorite vegetable, you've already got 5 SERVINGS! If you layer up the salad or simply add some vegetables to another meal (think yams, green beans, applesauce) then you are up to ten before you know it.

Ultimately, you'll begin to recognize that each meal should contain "color"- at least half the plate filled with vegetables and fruit. You end up filling up on these healthy choices, and eating less of all the extras (such as pasta, rice, bread) that have a much higher calorie count.

BOTTOM LINE: Focus on INCREASING your fruit and vegetable servings for a healthier 2011!

Realistic Resolutions for 2011

Welcome to the first Monday of 2011! Have you set any New Year's resolutions yet? Broken any yet? Let me encourage you to pick one or two HEALTHY resolutions that you can stick to-not just for 2011, but for your entire future.
Weight loss is a priority for the majority of Americans. However, often that means a strict, very low calorie diet (and the emotional misery that arrives as a side dish). Not surprisingly, this method rarely works. What might be a better choice?

How about committing to one of these simple changes:

1. Substitute a GLASS OF WATER for one other beverage (soda, coffee, etc.)
2. ADD one piece of fruit to your breakfast (a banana, or a handful of berries)
3. Eat FISH for at least one meal per week
4. Take a fruit or vegetable SNACK with you to work each day- and EAT IT (instead of vending food fare)

I realize these seem simple, but making these changes a HABIT will lead to a lifetime of benefit! For example, if you drink one can of soda per day, then swapping water for that can will create a caloric deficit that equals 14 POUNDS in one year! Now that is something to toast!

BOTTOM LINE: Set yourself up for success and make at least one CONCRETE HEALTHY CHANGE in 2011!

Amazing Weight Loss & the Acai Berry

Happy 2011! I hope your New Year's Resolutions include steps towards GOOD HEALTH this year! I am enjoying a snowy vacation in gorgeous Crested Butte, Colorado, this week. As I checked the weather report to decide on layers of clothing this morning, my attention was caught by a news headline by a Crested Butte health reporter.

The report was part of a series about effective weight loss strategies. I was immediately sucked in by the reporter's frank style and her admission that she was skeptical about different weight loss claims. She and the News 5 team decided to do their own trial, and guess what? She LOST 25 POUNDS in a MONTH, and looks slim and sexy with NO CHANGE in her diet! WOW!

Okay, wake up and smell the coffee! Of course, this is a SCAM and and AD to buy the berries. Unfortunately, it is SO CONVINCING that despite knowing the numbers and facts couldn't add up, I initially thought it was real, and that the reporter was simply exaggerating. The site looks amazingly valid, and she appears to be a legitimate health reporter. If you start to research the reporter, however, you quickly discover that no such reporter exists-ANYWHERE. This ACAI berry distributor simply created multiple websites under the names News5Health.com (and News6, and News7, etc.)

What is the truth?
1. You need a deficit of 3600 calories to lose a pound. Period. At burning (or not consuming) 500 calories per day, that is a pound of weight loss per week, which is terrific weight loss.
2. We do NOT have "gunk" lining our guts and creating "toxins". If we did, everyone who has a colonoscopy would be "cured" of obesity!
3. It's CALORIES IN vs. CALORIES OUT that creates weight loss or gain!

BOTTOM LINE: BEWARE OF WEIGHT LOSS SCAMS POSING AS NEWS REPORTS, especially the ACAI berry. Eat more fruits and vegetables and start moving more to lose weight in 2011!