Go Purple- Help End Alzheimer's Disease!

The heart remembers...Today, September 21, 2012, is Alzheimer's Action Day- so put on your PURPLE and help to raise awareness for this devastating disease. Over 35 MILLION people worldwide and 5.4 MILLION Americans are living with Alzheimer's disease (AD). $200 BILLION will be spent in the US alone this year caring for people suffering with AD. This disease slowly invaded my amazing mother's brain, creeping along for over a decade, steadily pulling her away from our family. As we don our purple today, we stand together with every other family who has helplessly witnessed this "long goodbye". I hope and pray we are in the last decade without a cure or full prevention for Alzheimer's.

Significant memory loss is NOT a normal part of aging. Misplacing your keys, forgetting a friend's name at a chance meeting or not being sure why you walked in to a room are frustrating events- but usually a sign of a busy mind focusing on other things. Missing multiple appointments or bills, not knowing how to drive home from your neighborhood store or losing the ability to balance a checkbook (when that used to be a straightforward process) ARE worrisome signs.

Major advances are being made in understanding how Alzheimer disease affects the brain, and the sequence in which it progresses. The hope is to find a way to block that progression, and research dollars donated today will help scientists find that barrier.

BOTTOM LINE: If Alzheimer's disease has touched YOUR life, join in the fight to find a cure and start with wearing PURPLE today!

New Study Offers Hope for Alzheimer Prevention

A glimmer of hope shines in the devastating world of Alzheimer's Disease (AD), as this week a study published in the Archives of Neurology journal reveals that a class of blood pressure medications (Angiotensin Receptor Blockers, known as ARBs) may reduce the risk of developing Alzheimer's.
Although the mechanism of Alzheimer's is not fully understood, we do know that abnormal deposits of amyloid (a protein) occur early in brain as an early stage in the disease process. This new study, the Impact of Angiotensin Receptor Blockers on Alzheimer Disease Neuropathology in a Large Brain Autopsy Series, looked post-humously at the brains of 890 people who had suffered from AD and high blood pressure, and found that those patients who took ARBs (for their blood pressure) had significantly LESS of these amyloid deposits built up.

The hope is that if we can find ways to prevent the build up of these amyloid deposits, then this will halt the progression of Alzheimer's both pathologically and clinically. Prior studies have shown    some clinical evidence that patients on ARB's for their blood pressure have a lower risk of developing AD, but this is the first study to show us the actual physical changes in the brain- very exciting news!

So, if you have a strong family history of Alzheimer's disease and/or are experiencing progressive memory loss, should you ask your doctor to prescribe you an ARB today? Well... yes and no. I would NOT prescribe an ARB for a patient in this situation who had normal blood pressure. However, if she had newly diagnosed high blood pressure, I would certainly consider starting her on an ARB (rather than a diuretic or beta-blocker, our other first-line medications), and I would be open to a discussion about changing her to an ARB if she had hypertension and was already being treated with another class of medications. Of course, when choosing a medication, there is a range of different issues- from side effects and drug interactions to cost (and health insurance preferences), but potential "side"benefits such as this are absolutely part of the decision process.

BOTTOM LINE: Alzheimer's research is critical to help us find a cure for this debilitating disease, and this new study offers encouragement that ARB's may play a role in slowing the development of AD.

It's BACK- the Cursed Halloween Candy

Yes, we've just got our kids starting to settle into their school routine, and yet what has already appeared in the grocery stores? That's right- Halloween Candy. I swear this is the start of the fall fattening project...

Don't get me wrong, I love Halloween! I adore seeing all the kids in costumes and frankly, I pull out a witch or Mrs. Incredible costume for myself each year. But here is the catch- candy to the max on one night per year is no big deal (brush & floss those teeth afterwards, of course.) Unfortunately, what happens in many households and work sites is that those "sample size" candies start showing up in a convenient drawer near you, handy for daily snacks and pick-me-ups. Before you know it, you've got a candy habit that is truly tough to break, not to mention that the extra 500 calories per day that you are innocently consuming is adding on a full extra POUND per week!!

If you think I am exaggerating about this, check the calorie count and serving size on your favorite candy. Hershey's miniatures, for example, are only 42 calories per mini, but most of us don't stop at one- even the "serving size" is 5 minis at 210 calories.




BOTTOM LINE: If you don't want to literally increase YOUR "bottom line", save the Halloween candy for HALLOWEEN and don't buy it till October 30th. Trust me, the stores will still have it in stock.

Breaking News: Fish Oil Supplements "Out"?

Today the Journal of the American Medical Association (JAMA) published a study about the Association Between Omega-3 Fatty Acid Supplementation and the Risk of Major Cardiovascular Disease Events. The popular media has picked this up and many headlines are focusing on removing these fish oil supplements from your medicine cabinet- is that the take-home message? Maybe not...

There are a few separate issues to discuss. First of all, note that the reason there was a study to begin with is that it has long been established that populations with primarily fatty fish-based diets have lower rates of heart disease. Being Americans looking for a quick fix, we'd rather pop a pill than change our behavior, so rather than add fish to our diets, we look to taking a capsule filled with fish oil. Supplement studies, however, have not been as robust in demonstrating the same heart benefits as simply changing your diet. This study was a meta-analysis that examined over 3600 previous studies, ultimately including 20 of them that met criteria to eliminate bias and make them truly "evidence based". This included nearly 70,000 patients and their rates of heart attack, stroke, and death. Ultimately, fish oil supplements by themselves were NOT shown to lower the risk of death, heart attack or stroke. Do omega-3 supplements lower triglycerides? Yes- but if you are focusing on patient outcomes and not simply lab numbers, the benefits are not there.

Are there other reasons to consider taking fish oil supplements? Probably so, although I will continue to argue that you are better off adding salmon, tuna, trout or sardines to your diet several times per week. Beyond lowering triglycerides, Omega 3 Fatty Acids have been been recommended for potential benefit against numerous cancers, inflammatory bowel disease, dry eyes, rheumatoid arthritis and even dementia. If you are NOT willing to add fish to your routine diet, then taking fish oil supplements for any of these reasons may be beneficial, and there appear to be no serious negative effects (except for a shrinking wallet.)

BOTTOM LINE: If you are taking fish oil supplements to improve your cardiovascular health, you may be improving your lab values but not decreasing your risk of heart attack or stroke- go for a jog or go fishing (and eat your catch) instead. 

Was it Food Poisoning or a "Stomach Flu"?

All this talk about fruits and vegetables reminds me of...food poisoning. In the recent past, we've had several outbreaks of food borne illnesses that have caught our attention- first the E-Coli in hamburgers, then the Salmonella outbreaks from eating tuna (or perhaps from handling small turtles), and let's not forget the Listeria-infected cantaloupes!  As such, I thought it would be helpful to go over some facts about food poisoning.

First of all, you are unlikely to know if your last bout of intense stomach upset was the result of food poisoning rather than a "stomach virus", unless there was a specific, easily identifiable source and obvious consequences (four coworkers had egg salad, the other ten had ham sandwiches, and only the four egg-eaters were sick that night). For every one case of food poisoning that is reported, the CDC estimates there are at least another 30 cases that went unreported for this very reason.

The good news here is that the treatment really is the same, regardless of the source of the stomach upset (nausea, vomiting and/or diarrhea). The vast majority of food poisoning does NOT require specific treatment such as an antibiotic. In general, the best treatment is to gently stay hydrated (watered down sports drinks seem to work the best), rest, and avoid irritating your stomach for a few days by sticking to a relatively bland diet free of caffeine, alcohol, dairy or spicy foods.

Food-borne illnesses are very common, with over 38 million cases of gastroenteritis , over 70,000 hospitalizations and over 1600 deaths per year in the United States alone. The agents that are the most lethal (cause the greatest number of deaths) are Salmonella, Listeria, Toxoplasma and norovirus, although in healthy adults, these diseases are only occasionally severe. Additional food poisoning culprits include the bacteria Campylobacter, Shigella, Yersinia, Clostridium botulinum (causes botulism) and Staph. Stay tuned this month for more details on these illnesses.

BOTTOM LINE: Food poisoning is common, but identification of the source or causative agent is much less common and not usually medically significant. Prevention is definitely worth a pound of cure for these illnesses!

Doctor, How Do YOU Stay Thin? My Not-So-Secret Revealed...

"But Dr. Grimes, YOU don't have to worry about YOUR weight- you're tiny! You don't know what it is like to struggle with your weight." 

Every time I hear this from a patient, I am not sure if I should laugh or cry. While yes, there are some people out there who seem to be able to eat whatever they want and never exercise, and yet stay thin, healthy, gorgeous, rich and let's throw in perfect in every way (ha!), MOST people who appear healthy make very conscious choices to keep themselves there. As my close friends can attest, I love to eat delicious foods of all categories- nutritious or not.

Unfortunately, after having an exceptionally active metabolism up until age 25, I am now (& have been for over two decades) fully capable of packing on the pounds with the best of them. In my first pregnancy, despite delivering a month early and enduring over seven months of morning sickness that lasted day and night, I was mortified to gain forty pounds. I'm sure eating nonstop pizza & burgers (because nothing else appealed to me) might have had something to do with that...but I digress. The point is that if I do not keep a close eye on my weight, I gain more than I would like. I can lay the blame wherever I would like- blame medications, injuries, stress, or whatever- but that doesn't change the end result. If I gain weight, I have to lose it the same way everyone else does, by burning more calories than I consume. So what exactly do I do?

1. RECOGNIZE THE PROBLEM- I try to weigh every morning, aware that everyone has a natural up and down flux of a couple pounds. When I hit 3 pounds higher than my average, that's my ceiling and it's time to get serious before it gets out of hand. (This may be the most important step. When I skip this step, it's 5-10 pounds up, which is much tougher!)

2. START WITH A SEVERAL DAY "CLEANSE"- I'm not talking about an enema here! I simply go back to basics and eat ONLY fruits, veggies, and a simple protein (nuts, beans, fish, chicken or lean meat.) I also drink as much water as I can stand (about 6 glasses in a day), and no other beverages. The picture above is my lunch- large portioned, delicious and 90% veggies.

3. RAMP UP MY EXERCISE- for the record, I walk our dogs around two miles per day every day. This is both for the dogs & for me to MAINTAIN my weight. If I need to lose, this is not enough, because this is my baseline- I need "MORE". I typically add in a second walk or get on the exercise bike for 30 minutes in addition to the daily walk.

4. TRY TO HAVE REALISTIC EXPECTATIONS- good weight loss is 1/2-1 pound per week. I am as guilty as the next person that after two days of being "perfect", I am disappointed when my weight has not miraculously jumped back two or three pounds to baseline. By the end of a week (Mon-Friday) I have typically seen the scale budge at least a half pound, and once I know I am headed back in the right direction, I start to loosen up the diet by allowing some processed foods back in, but at restricted portions. Truth be told, I let in dessert first- but make healthy choices such as some whip cream on strawberries or chocolate syrup on a banana. Next I might bring back corn chips (I'm gluten-free, so less likely to choose cereal, breads, or crackers). I very slowly add in other foods until I am back to my healthy baseline, which includes some high calorie treats ONCE I am back where I want to be.

BOTTOM LINE: Virtually EVERYONE needs to be conscious about their weight and health choices for nutrition and exercise- don't assume thin people are just "lucky".

What's YOUR Blood Pressure?

Today the Center for Disease Control and Protection (CDC) released their report "Vital Signs: Awareness and Treatment of Uncontrolled Hypertension Among Adults- United States, 2003-2010), and what did they find?

• 30.4% of American Adults have high blood pressure - over 66.9 MILLION of us!!!
• 14.1 million people HAVE high blood pressure, but do not KNOW it
• 
  Of those that have high blood pressure, over HALF are NOT CONTROLLED.
• 5.7 million people KNOW they have HBP but don't take medicine
• Of the 35.8 million people who have UNCONTROLLED high blood pressure, the VAST MAJORITY (89.4%) have a usual source of health care & (85.2%) have health insurance

The media is all abuzz with this information, and with good reason. Hypertension (high blood pressure) is a disease that is easily diagnosed- just a blood pressure cuff is needed. We have a plethora of medications that treat hypertension, the mainstay of which are older, effective drugs that should not be expensive. High blood pressure, however, is a silent disease- potentially no symptoms until that big heart attack, stroke, kidney or heart failure. It is challenging to convince patients to take a medication when they have no obvious symptoms that will improve by taking the medications. 

With one in three Americans being obese, it should come as no surprise that roughly that same number of Americans have high blood pressure. As a nation, we have got to start reversing these trends, and MEDICATIONS ARE NOT THE ANSWER. Yes, we need them to control pressures (and some hypertension exists in skinny, fit bodies, independent of weight), but the real focus should be on improving our exercise and food choices. The good news is that with even very modest weight loss (of as little as 5-10 pounds), much of high blood pressure resolves! So, back to M.O.R.E. on nutrition!

BOTTOM LINE: High blood pressure is a SILENT disease that will cause serious damage if not discovered and treated, so CHECK YOUR BLOOD PRESSURE today!

What About the HCG Diet?

If I had a penny- okay, maybe a dollar- for everyone who asked me about the HCG diet, I'd be ready for retirement! Locally here in Austin, we had a couple people within our medical community do the HCG diet and lose a dramatic amount of weight, which fueled the fire. In my practice, I have had multiple patients try (outside my advice) different versions of the diet- some shots, some sublingual, some pills- and though all lost weight quickly, virtually all regained it in the same time span. Reading the medical literature to find some evidence-basis for the diet, here is what I found:

1. First of all,  HCG is NOT FDA APPROVED for  weight loss, and in fact, the FDA ordered the removal of all homeopathic OTC HCG products from the market back in December 2011 (because not only do they not work, but they promote a dangerous diet.)

2. HCG diets "work" because along with the supplement, patients are restricted to a dangerously low 500 kcal/day diet. Most people consume around 2500 calories per day, so a deficit of 2000 calories per day would mean a 1/2 pound or more of weight loss per day. So YES, anyone who managed to limit themselves to 500 calories a day will lose weight, but at what risk? This amount of caloric restriction can lead to heart arrhythmias, gall stone formation and electrolyte imbalance.

3. The idea behind the HCG is that it will suppress your appetite so that you can stand the severely restricted diet. HCG is the "pregnancy hormone"- if you had morning sickness (which I can first-hand attest does not simply last in the morning) you can certainly believe HCG would make you not hungry. Interestingly enough, however, in the majority of controlled studies, HCG injections showed no benefit over placebo injections- the test subjects lost no more weight on HCG than placebo, and there was no magical "redistribution of fat" (that is often touted as a potential result.)

BOTTOM LINE: HCG diets "work" because of the severely restricted calories in the diet, not from HCG "magic". Talk with your doctor or  registered dietician to find the optimal weight loss plan for you. 

PS. Happy new month- change those AIR FILTERS!