Monday, March 12, 2012

Pop Tart and Candy Diets

Ready to lose weight? Step up to the newest diet craze- the Peanut M&M diet! Can you imagine a diet that will let you eat this delicious candy and still lose weight? Okay, hold on right here. I could go on and actually give you details of how my new Peanut M&M diet will work- but be prepared to hear something like eat ONLY the green ones- then clip on your pedometer and don't eat the yellow ones till you've walked 2500 steps. So what's my point?

Last week, I was at a wonderful talk by registered dietitian, Daniela Knight, and one of the participants asked what she thought about the "Pop Tart Diet". (BTW, for fun, I googled pop tart diet and sure enough, came up with not only a diet but a youtube video explaining the supposed health benefits of pop tarts.) I loved her response- "Oooh, doesn't that sound enticing? Wow! A diet where you eat pop tarts! Way more fun than eating more fruits and vegetables, right?" But the audience was hooked, and all wanted to know details of the "diet". So here's the thing- ANY weight loss program CAN include pop tarts (or donuts, or peanut M&Ms), but if that is the mainstay of the calories in the diet, you are not going to feel so great. Your body (obviously) needs a balance of nutrients and vitamins that ideally comes from multiple colors of produce plus a protein source. Weight loss occurs when you consume fewer calories than you burn off. Period. So yes, you COULD eat six strawberry pop tarts per day, with as much water and diet sodas as you can hold, and you would be on a 1200 calorie per day diet. For most people, that would result in weight loss- BUT- you would be seriously lacking in protein, fiber, calcium, B Vitamins, Vitamin C...get the picture? No energy. None!

Am I saying NEVER eat a pop tart? No! Daniela (my favorite dietitian) would tell you immediately that NO food is "bad". Treats like pop tarts and M&Ms we need to limit, not ban. What IS a healthy way to lose weight? Fruits & veggies galore, with enough protein (eggs, meat, chicken, fish or nuts) at each meal to equal a daily total of roughly one gram per kg of your body weight.

Now, if I wanted to get RICH, I'd go back to my color-coded peanut M&M diet...but don't forget walking the mile in between color changes...

BOTTOM LINE: Yummy treats like pop tarts or peanut M&M's can be INCLUDED in any healthy diet- but should be the occasional bonus, not the mainstay!

Sunday, March 11, 2012

Quitting Smoking- Set Up for SUCCESS!

The Surgeon General's report on smoking in young adults has spurred me to blog sequentially about quitting smoking. Yesterday, I talked about "7 Ways to leave your Cigarettes" Talking with your doctor is a great first step, but don't underestimate how important setting yourself up for success can be! Include as many of your friends and family in on your plan- the more, the better! Including one teenage child counts double, by the way- they are usually the toughest on their parents! What can you do?

1. PUBLICIZE your QUIT DATE. Believe me, your friends & family will love to ask you how you are doing and lavish praise on you- but they have to KNOW about it!

2. Stock up on healthy, crunchy, orally-gratifying snacks. Carrots, apples, popcorn, pretzels- all are good choices.

3. Super-sour hard candy- sucking on these (instead of nicotine) seems to really help curb cigarette cravings.

4. CLEAN- your house, your CAR, and your clothes- splurge on someone else to come in and deep clean. Your sense of smell heightens along with your taste buds when you quit smoking, and the positive feedback from the clean, fresh smells are a wonderful reinforcement.

5. MONEY- a clear jar works great to show off money growing daily! Place the money you would have spent on packs of cigarettes into the jar each day, and decide what "splurge" you will reward yourself with each month!

BOTTOM LINE: Just as SMOKING is usually a social activity, QUITTING SMOKING will be far more successful if you involve your friends & family, so set yourself up for SUCCESS!

Saturday, March 10, 2012

7 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! QUITTING SMOKING is the single most important thing you can do to improve your health. 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!

Friday, March 9, 2012

"Just" a Social Smoker?

Stop and think- do you know a teenager who is smoking? Or one you THINK is starting to smoke? If you start smoking in junior high or high school, there is an astounding 80% chance you will be a smoker the rest of your life. Today, the Surgeon General released a report about smoking habits of our American youth. Despite tons of warnings and educational programs, one in FIVE high school students are smoking. Can you believe that for every American who dies annually from cancer-443,000- there are now TWO youths just beginning to smoke? If you do the math, you'll see that an average of 1,213 Americans die every day as a result of this deadly, intensely addictive habit.

Yes, there are those rare adults who can simply walk away from a pack per day smoking habit- God bless them! The majority of smokers, however, tell a different story. I have many men and women patients in their 30's and 40's who are incredibly frustrated that they cannot seem to permanently quit smoking. The typical story is that they started smoking "socially" along with drinks and happy hours during college, and never intended to become a "real" smoker. Many only still smoke on weekends, but they are so habitually tied in with a group of friends or co-workers that use smoking (and often drinking) as their social bond, that it feels rude and counter-culture to quit. Other smokers started out as "social" weekend users, but found more and more that stress was "relieved" with a quick cigarette, and that it served as a legitimate reason to step outside and take a break from work, home, or kids. Women tell me that they CAN"T quit because they will "get fat". There are a million reasons offered as reasons not to quit, including the fact that some simply enjoy it. BUT...there is simply no amount of nicotine & cigarette smoking that is good for you. We can rationalize an alcoholic drink per day, as there truly can be medical benefit from that, but absolutely none from smoking.

Very few adult smokers are thrilled with their habit. Most would like to quit, just as most overweight people would like to lose weight. If you are a smoker, PLEASE schedule an appointment with your doctor to discuss a plan to quit smoking. There are numerous ways your physician can help. The average long term smoker takes at least 5 serious attempts to permanently quit- and many take more than that, but you CAN be successful. Please don't wait for you or your loved one (smoking is rarely a solo sport) to suffer a heart attack, stroke or cancer to get serious about quitting.

BOTTOM LINE: SMOKING is addictive and deadly. Period. Don't let anyone you know START smoking, and help encourage those smokers you to to seek help from their physician to quit.

Sunday, March 4, 2012

Want a Bargain on Vitamin B12?

Image from:
I was surprised and disappointed to see this add in my email's inbox this morning. Really? If you need a quick pick-me-up, come on in for a B12 shot? I realize this is not dramatically different than the many supplements on sale at your local grocery or pharmacy, but somehow the invasive nature of a shot takes it to a higher level for me. Not to mention that B 12 shots are actually a PRESCRIBED medication...
So, it begs the question, who really NEEDS B12 shots? The obvious answer is those people who are severely deficient in B12. Why DO people get B 12 shots? As always, the answer is not exactly straight-forward. Many people get them because, well, they ask for one! There is a myth out there, quite popular with the entertainment industry, that getting a B 12 injection gives you a "shot" of energy. This idea has been around for many decades, and there are patients who absolutely swear it works. Additionally, many people believe if they are really stressed and run down- say at finals time in college- then a B 12 shot seems to keep them from getting sick. Is this true?
There are not any current evidence-based medical studies that support this theory. There is one recent study that showed high intake of Vitamin B12 (and of B6) is protective against depression in older adults living within the community. (Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time.)
What we primarily use B 12 shots for, however, is the obvious- true B 12 deficiency. Why do people get this? A few get it as a side effect from bariatric surgery (a stomach bypass), but most get B 12 deficiency from making antibodies to B 12 receptors in your stomach. When this happens, you can no longer ABSORB Vitamin B12 from your diet, so the only ways to get B 12 is from a shot or from a medicine that can be absorbed under your tongue, or more recently, a prescription medicine you squirt in your nose (in the same manner as allergy nose sprays.) When you bypass the stomach receptors, the B12 can then enter your body effectively. Who is prone to getting B 12 deficiency? Anyone with other auto-immune diseases, where the body starts making antibodies to other organs or receptors. This includes adult onset diabetes, vitiligo, thyroid disease and other diseases in the rheumatic family such as lupus.
How about symptoms of B 12 deficiency? There may be none. In severe cases, the patient develops anemia. Often, we see nonspecific symptoms such as brittle fingernails, fatigue, and forgetfulness.
If you have a family history of true B 12 deficiency, that is also a risk factor.
The good news is that B12 is easily replaced, and though it will take a few months to get tanked back up, you should completely recover with time as long as you are consistent about your method of B 12 replacement. Additionally, extra B12 should not be harmful to anyone, as it is a water soluble vitamin (which means you may have lovely, expensive, bright yellow/green urine if you over-replace, but no other worries!)
BOTTOM LINE: B 12 replacement is only really necessary if your levels are low- check with your doctor if you are concerned!

Thursday, March 1, 2012

Worried about your STATIN?

The FDA has updated the labelled recommendations on statins, the class of drugs most commonly used to lower cholesterol. Like many things medical, there was "good news & bad news". On the plus side, doctors are no longer obligated to check routine blood tests to see if the liver is behaving properly on the statin. We know that there is the potential for a rare, severe liver complication, but it turns out that the routine screening of the liver enzyme levels are ineffective in detecting or preventing it. On the negative side, the FDA now warns against the possibility that statins may raise blood sugar levels, because in several large trials there has been a marked increase in diabetes in patients taking statins (compared to those receiving placebo.) Additionally, the FDA has noted that statins might cause some "minor and reversible cognitive side effects". What does that mean? Basically, there is a subset of people who notice significant short-term memory loss or difficulty concentrating when they take statins. The good news is that those mental changes seem to revert back to normal (or at least, pre-statin levels) once you stop the drug. AND that this side effect occurs in less than 1% of patients.

What does this mean? Should we pull statins from the market? Why take a drug to help your heart when it hurts your liver, muscles, and brain, and could cause diabetes? Well, obviously we feel that in most cases, the benefits far outweigh the risks for this class of medication. Statins have been shown to decrease the risk of DEATH from cardiovascular disease by up to 25% in certain populations- this is a good thing! But- here's the rub-statins are not a substitute for a healthy diet and daily exercise, and not everyone with elevated cholesterol needs to take them. My own father used to chase down his cholesterol pill with chocolate and butter (though in fairness, he exercised every day of his life until his Parkinson's disease robbed him of balance and flexibility in his early 80's). But I digress...

How should we decide if a patient needs a statin? Number one, everyone initially diagnosed with high cholesterol should have dietary counseling on a high fiber, low cholesterol diet and see if they can improve their numbers through the behavioral modification of diet and exercise. Two, there is a wonderfully useful tool called the Framingham risk scorethat will help predict your risk of a cardiovascular event in the next ten years. Plug in your cholesterol, blood pressure & smoking status, and see if adding a statin will significantly lower your risk.

BOTTOM LINE: As with EVERY medication you take, be sure you understand the true anticipated benefits as well as possible risks of statins, and stay tuned...what we rave about today (in medicine), we shake our heads about next year.