Going Vegetarian?

I think we all know (or at least, assume) that eating more fruits and vegetables is a healthy choice. I have yet to find the person who thinks eating vegetables is BAD for you, although I do have many patients who are afraid that eating fruits will worsen their diabetes. With the recent media focus on the risks of eating red meat (and the link to increased risk of developing diabetes), many people are taking a critical look at their diet and wondering what to do.

My honest recommendation for the majority of us is to simply increase the color in our diet- focus on increasing all the fruit and vegetable servings you eat throughout the day. In addition to that, I encourage patients to try and eat at least one vegetarian meal per week- that's one out of 21- not too much to ask! More is not a problem, mind you, but getting Texans to restrict their red meat can be a challenge, especially in BBQ season...

For those of you considering jumping in full force and becoming vegetarian, there are a few things to remember.

Number one: vegetarian does not equal healthy.

Please remember that eating poptarts and chocolate chip cookies may be vegetarian, but that does not mean you are getting all the nutrients your body needs!

Number two: pay attention to PROTEIN.

When you give up meat, you need to be sure you are getting adequate protein from other sources. Some vegetarians add in seafood (pesco-vegetarians), others add in dairy and egg (lacto-ovo-vegetarians), while vegans consume absolutely no animal products. Protein is found in fish, dairy (cheese/milk) and eggs, but also in nuts, seeds, legumes (dry beans and peas) and some grains. Your daily protein needs are weight and age dependent, but women over 19 need roughly 46g of protein daily, and men >19 need roughly 56g. To give you a frame of reference, a cup of milk has 8 grams of protein, and a cup of dry beans has 21g.

If you are radically changing your diet, I highly recommend you book an appointment with a local registered dietitian to be certain your new food choices will meet all your body's needs.

BOTTOM LINE: Up those vegetables and fruits, and if you are going all-out vegetarian, pay extra attention to your protein!

Diabetes from Hamburgers?

Last week, the media was abuzz with a recent study: Changes in Red Meat Consumption and Subsequent Risk of Type 2 Diabetes Mellitus, published in JAMA. Since my last post was addressing knowing your diabetes risk, this is a nice follow up, so I will jump on the bandwagon.

The study involved several separate groups: over 26,000 men in the Health Professionals Follow Up Study, nearly 50,000 women in the Nurses Health Study and around 74,000 women in the Nurses' Health Study II. Dietary choices were tracked with validated food records updated every four years.

What did they find? People who increased their red meat intake during a four year interval had a significantly higher risk of developing diabetes in the next four years. In fact, adding only a half serving of meat per day was associated with a 48% elevated risk, and on the flip side- DECREASING your red meat intake by more than a half serving per day was associated with a 14% DECREASE risk of developing diabetes over the next four years.

Did eating those extra steaks and burgers (and maybe the baked potato and fries on the side) just make people gain weight, and because of the weight gain, then develop diabetes? Researches agree that this theory played a role, but only partly explained the significant changes.

BOTTOM LINE: Significantly lowering your average daily red meat consumption appears to decrease your risk of developing diabetes. Take it a step further, and REPLACE that red meat with some colorful vegetables, and you will really give yourself a healthy push!

Are YOU at Risk for Diabetes?

Although the internet is packed with misleading and erroneous medical advice, there certainly are a great number of medically accurate and helpful sites as well. Today I stumbled across an excellent tool to help people quickly assess their risk for DIABETES on the American Diabetes Association website:
The Type 2 Diabetes Risk Test. Their catch phrase is "It's Fast. It's Free. It's Easy."- and it IS all that!

The numbers of people being diagnosed with type 2 (adult onset) diabetes in this country are staggering. There are nearly 2 MILLION new cases of diabetes being diagnosed each year in the United States, and nearly 80 MILLION people thought to have Pre-Diabetes. To clarify, Type 1 Diabetes, previously known as Juvenile diabetes, is a condition typically diagnosed in childhood or young adulthood, when the person's pancreas is not able to produce insulin.

This type accounts for only around 5% of all diabetics. Type 2 Diabetes is the more common type, and in this disease the body makes insulin, but either it cannot make enough insulin or the cells in the body are resistant to the insulin. Either way, blood sugars rise and cause problems in the rest of the body (such as the kidneys, eyes, blood vessels and nerves) and that sugar is not being converted into energy.

Bottom Line: If you are overweight and/or have a family history of diabetes, or simply are wondering about your risk, please take a minute and jump to the ADA website and see where you stand. Then take that number with you and head to your family doctor to see how you can optimize your health and minimize your risk for developing diabetes!

Swimmer's Diarrhea?

Lovely topic, isn't it? But if you've got a persistent case of diarrhea, it's possible you picked up a parasite called Giardia during a summer swim. Giardia is transmitted by swallowing contaminated water (typically during a swim) or from other fecal-oral transmission (such as poor hand washing after changing baby diapers or using the restroom), or rarely, from contaminated food. Even if you are not a pool-water-mouth-squirter, it is very easy to accidentally swallow water while swimming- especially in a race! And diapered babies are supposed to be limited to a "baby pool" for a good reason, but think how often you have seen a busy mom change a diaper poolside (so she can multitask, watching her older child in the pool) and then hop right back in to the pool with her baby...probably thinking that the chlorine in the pool will "wash" her hands, if she is thinking about hygiene at all. Not infrequently we see clusters of giardia infections that can be traced to a public water source- a small lake or public pool, as well as deceptively pure-looking mountain streams.

Interestingly, only 25-50% of people who get infected notice any symptoms. If you do have symptoms, they tend to show up a week or two after exposure, and include persistent diarrhea (more than 5-7 days), bloating, flatulence, nausea and bad smelling stools.

Giardia infection is diagnosed most often by lab examination of stool samples, and often requires multiple samples to identify the parasite. The treatment is with antibiotics, and often people are treated based on clinical symptoms. Commonly people develop lactose intolerance following this infection, and therefore, avoiding dairy for a couple weeks after treatment is often helpful.

BOTTOM LINE: Watch your "bottom line" and remember not to routinely allow water in your mouth while swimming, plus don't count on chlorine to be your sanitizer if you have just changed a diaper.

Which Sunscreen Should I Use?

Speaking of melanoma (yesterday's blog), it's time for another review about the basics of sunscreens. Which one is the best? Sprays are so fast and convenient- but do they work? Which ingredients matter? 

Let's start with SPF. What does it mean? Sun Protection Factor is a measure of a sunscreen's ability to protect the wearer against UV radiation from UVB. Note that the sun produces both UVA and UVB, and BOTH cause damage that can lead to skin cancers. Right now, though, the SPF only addresses the UVB protection. So, SPF means that compared to bare skin, the sunscreen keeps you from burning X times longer. If it takes you a half hour to turn red with bare skin, a sunscreen with an SPF of 30 should in theory keep you from burning 30 times longer, which would be 900 minutes- 15 hours. Unfortunately, no sunscreen stays fully effective beyond two hours without re-application. Additionally, sunscreens with an SPF of 15 block roughly 93% of UVB rays, SPF 30 ~ 97%, and SPF 50 is 98%. Therefore, even with perfect application, no sunscreen blocks all UVB rays, and many block no UVA rays.

How much should you use to be effective? Surprise- would you believe it takes about an OUNCE (picture a shot glass), and that same amount should be reapplied every two hours. This means you will use roughly half of an 8 ounce bottle on ONE PERSON during a full day outdoors. (And no, I don't own stock or have financial interests in sunscreens.)

Which ingredients are important? Most dermatologists recommend combining the physical barrier ingredients that protect against the deep penetrating UVA rays, such as ZINC OXIDE & TITANIUM DIOXIDE (the ones that leave the white residue) along with the chemical barrier agents known to block UVBs, such as PABA, salicylates, cinnamates and benzophenones. Since nearly all sunscreens contain mixes of the chemical barriers, I grab a tube or bottle and scan to be sure it also lists either zinc oxide or titanium dioxide as well. Note that some people are sensitive to PABA or other ingredients, and may do best with purely barrier sunscreens and clothing (such as surf shirts.)

Back to the sprays...they are not my first choice. Why? Few have either zinc oxide or titanium dioxide, and those that do are very expensive and have these minerals broken down into "nanoparticles" to allow them to be in a light enough liquid to spray. In the medical literature, some debate exists as to whether these nano-sized minerals can potentially cause cancer, which is of course, the opposite of our intent. Regardless of these issues, probably the biggest issue with sprays is that people use TINY portions- picture that less than 10 second total body spray- and so they are not obtaining anywhere near the listed SPF. Would I prefer that over skipping sunscreen all together? Yes...which means I do keep some on hand.

What do I usually buy? Our family likes Banana Boat's "Baby" lotion. To it's credit, my kids complain that their skin is "way too white" because I never let them tan. I take that as a compliment! Probably more importantly, for extended sun exposure we all use swim shirts, and try to consistently wear hats and sunglasses.

BOTTOM LINE: Get a sunscreen that contains both chemical and barrier agents (think titanium dioxide) and realize an 8 oz tube should be used up by a family of four in ONE morning OR afternoon since each person needs ONE OZ every TWO HOURS.

Summer Skin Cancer Message

Recently a friend posted a very impactful message on her Facebook page (thanks, Lisa!) that I would like to recommend. The youtube video is called "Dear 16 year-old Me", and shows real people who lives have been deeply affected by melanoma, and the message they would love to go back in time and send to themselves (and their loved ones) before they started purposefully sun tanning to "look healthy".

Many people are unaware that the skin cancer MELANOMA is a very serious cancer. Because it looks like a simple little funny-looking mole on the skin, there is often the assumption that a quick skin biopsy will fully take care of the issue. Not so! While these cancers start in the pigment-producing skin cells, they can invade locally and then break off and metastasize to the liver, lungs and even the brain.

Melanoma skin cancers kill roughly 8000 people in the United States every year, and show up in an estimated 100,000 people annually. (Numbers on this vary greatly, partly because although melanoma cases should be reported to central cancer registries, many providers are unaware of this these reporting requirements.)  I know in my practice, I have seen younger and younger patients (not just because I am growing older!) with this scary diagnosis. Did you know that using a tanning bed before you turn 35 will cause a 75% increased risk of developing this cancer? Other risk factors include blistering sunburns in childhood, living at higher altitude (>2300 feet), family history of melanoma, fair skin, red or blond hair and more than 5 sunburns in your entire lifetime.

Remember the ABCDE's of Melanoma:
Asymmetry
Border (that looks irregular)
Color variation (including reds, blacks or blues)
Diameter (>6mm)
Elevation  (you can feel it as a bump above the skin)

And ultimately, remember this- if all your "moles" look the same, and ONE looks different- please go get that one checked out. Just like Sesame Street, if "one of these things is not like the others" then it "doesn't belong"!

BOTTOM LINE: Please, watch the video- the message is very effective. And remember to wear sunscreen and protective clothing this summer!

Modeling credit: A. Lampert (who will wear more sunscreen next time...)