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. 

"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.

Alzheimer's Biomarkers- What ARE They?

In yesterday's post about the new Alzheimer Disease (AD) guidelines, I talked about how Alzheimer's biomarkers represent hope for future early diagnosis and treatment of AD. But what the heck ARE biomarkers? Today I will clarify...

Biomarkers - short for biological markers-are any naturally occurring substances in the body that reliably predict or indicate a disease. Cholesterol, for example, can be considered a biomarker for heart disease. We know when cholesterol levels are very high, it is likely that plaques of cholesterol could be building up in the heart arteries, making it more likely that that person could have a heart attack. In the case of Alzheimer's disease, the pathological changes in the brain involve the buildup of certain types of protein around the nerve cells in the brain, as well as degeneration and breakdown of other nerve cells. The combination of these two problems makes it hard for the brain to function correctly, as messages can't be passed effectively from one part of the brain to another.

Biomarkers for AD include beta-amyloid protein (that builds up in plaques) and tau protein, which is part of "neurofibrillary tangles"- clusters of protein that block nerve conduction. Right now, these proteins must be measured in spinal fluid, which means the patient must have a spinal tap (aka. lumbar puncture) which involves a needle in your back near your spinal cord. The hope is that measuring levels of these proteins in blood or urine may also prove to be accurate predictors of AD, so the more invasive procedure is not needed.

Not all of today's biomarkers require spinal fluid. Genetic testing for APOE-e4, as well as other genes that increase risk for AD, can be done by a simple blood test. Additionally, imaging of the brain using MRI and PET scans can provide valuable information as well.

Unfortunately, the diagnosis of Alzheimer's disease is not black and white, even with use of biomarkers and the new guidelines. I'll delve more into the challenges of diagnosis tomorrow.

BOTTOM LINE: Biomarkers for Alzheimer's include blood tests, spinal fluid tests and brain imaging, and these procedures are primarily restricted to research settings in 2011.

Teen Pregnancy- New CDC Report has Good News & Bad News

The CDC released "Vital Signs: Teen Pregnancy" this week, which looks at teenage pregnancy statistics over the last two decades. On the plus side, the total national teen birth rate in the United States was the lowest we have recorded, down, in fact, by 37% from 1991. Unfortunately, we still had over 400,000 teenage births, which is 4% of female teens aged 15-19, and the annual estimated cost of teen childbearing is- gulp- over $9 BILLION. The USA birth rate is up to 9 times higher than most other developed countries.

Please note, my fellow southerners (Texas, Oklahoma, Arkansas, New Mexico and Mississippi), that we have the very WORST rates of teenage pregnancy in the country: >60/1000 females vs. <20/1000 for the best states, up in New England. Not something to boast about...

Today, and every day, 1,100 teenage girls will give birth in the US. That's 1 out of 10 new mothers. The cycle continues as 1/3 of kids born to teenage moms become teenage parents themselves. Not surprising, only half of teenage moms earn their high school diplomas- even by age 22.

The media is still portraying teen motherhood and sex in general as glamorous, fun, and enticing, which is far from the truth. Unpaid bills, screaming kids and exhausted parents are more the rule. We are slowly creeping in the right direction, but we've got much work to do to effectively educate our kids.

BOTTOM LINE: America has embarrassingly high rates of teenage pregnancy, costing our nation billions of dollars and heartache. We can do better.

Social Media Impact- from Disney to Facebook

The Journal of Pediatrics recently published a timely clinical report—The Impact of Social Media on Children, Adolescents, and Families. Kids are entering social media at earlier ages, logging on to Disney websites such as Club Penguin. Soon they progress to websites intended for more mature audiences, such as Facebook and Youtube. Once again, we need to be aware of a desensitization process- this time, in the parents! We are used to our kids being ON the computer, and may not be watching closely enough as they evolve beyond cartoons characters. The minimum age on Facebook is 13, but that doesn't mean all teens should have free rein on FB without supervision.

The report noted that up to 20% of teens log on to their favorite social media site 10 times per day. Most teens have smart phones that allow them constant access. Ever notice how few teens use their phones...to make PHONE CALLS? Cell phones are cameras and instruments to TEXT or IM (instant message). The significance is that a good chunk of teens emotional and social development is occurring through these screen communications.

There are absolute advantages to the social media for youth, including anonymous access to health education that they might not otherwise seek- depression, anxiety, and sexually transmitted disease, for example. This report did not offer shocking news, but is an excellent reminder for parents to stop, look and listen to our kids' social media. And I mean that- go on the sites, read what your child and their friends are saying, and follow up with real live conversation with your kids. BTW, this is a great time to remind everyone that the total recommended daily screen time (ALL screens, big and small) is LESS THAN 2 HOURS, and yet most youth are surpassing 6 or more hours.

BOTTOM LINE: Recognize the role social media is playing in your child's development, and play an active role in setting time and boundary (privacy setting) limits.

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!

World Alzheimer's Day

Today is World Alzheimer's Day, and a new report was released on Capital Hill that documents the global cost of Alzheimer's and related dementias to be more than $600 BILLION, and 70% of the costs occur in North America and Western Europe!! Dementia actually costs 1% of the entire world's GDP (gross domestic product.)

This disease affects all societies, and with our aging population, the cost is anticipated to increase drastically. "People with dementia, their families and friends are affected on personal, emotional, financial and social levels. Lack of awareness is a global problem. A proper understanding of the societal costs of dementia, and how these impact upon families, health and social care services and governments may help to address this problem."

On a personal level, my mother died after a twelve year struggle with Alzheimer's, and now my father is fading away from Parkinson's dementia. The emotional toll alone is devastating, but the financial and time consumption adds dramatically to the burden of this disease. If this illess has not affected your family or loved ones yet, be aware that chances are very high that it will. Increasing awareness of dementia should help focus more attention on research for both cure and prevention of this crippling disease.

BOTTOM LINE: Read the 2010 World Alzheimer's Report for a sobering look at the staggering costs of dementia.

Heartburn or Broken Bones?

Okay, I'm interrupting my summer tips with this "breaking" report. The FDA has issued a warning regarding proton-pump inhibitors (PPI's) which are medicines that stop acid production such as Prilosec, Nexium, Prevacid, etc. Six of seven studies showed that people, especially those over 50, who take these medications- whether they are the over the counter version or prescribed- for over a year or in high doses, have increased risk of fractures in their hips, spines, and/or wrists.

So what does this mean? Do you have to choose heartburn or broken bones?

Of course not. What it means is that these drugs, like every other class, have potential side effects. We need to use them judiciously, and not as a band-aid for a long term problem. GERD is typically caused by behaviors that can be modified: caffeine, alcohol, and nicotine are at the top of the list. Consider switching gradually to decaf, decreasing your alcohol intake, and quitting smoking instead of routinely grabbing your acid pill every day.

BOTTOM LINE: All medications have side effects; please review ALL of your medications with your doctor and see which, if any, can be reduced or eliminated if you are willing to make some behavioral changes.