CDC Now On Board for GARDASIL for BOYS

This week the Advisory Committee on Immunization Practices (ACIP) unanimously voted to recommend that 11-12 year old boys be vaccinated against HPV (the Human Papilloma Virus)- hooray! Girls have NO monopoly on genital warts, which affect over one million Americans each year. They are COMMON. Sadly, in my clinical experience, little harms self-image like a young person developing these genital lesions, especially because we cannot simply cure them and make them go away forever.

Genital warts are transmitted by direct skin-to-skin contact, and though this usually occurs during sex, actual intercourse is certainly not required to pass them on. They are very contagious, with transmission rate of up to 65%. Warts typically recur despite treatment, and frankly, the treatment is unpleasant at best- we burn the warts chemically or with liquid nitrogen. If you've ever had a wart frozen/burned off your knee, you know what that feels like, and the genital area has more nerve endings. Enough said!

The Gardasil vaccine immunizes recipients against the two strains of HPV (6& 11) that cause 90% of genital warts. Additionally, Gardasil protects against the two strains of HPV that cause the majority of cervical cancers. While males don't have a cervix to get cancer, they do have other parts that get HPV-related cancers (anal & penile, as well as some head and neck cancers,) although certainly these cancers are less common.

Gardasil was approved for use in males over two years ago, but the public has mainly been aware of the use in females. I'm glad the CDC and ACIP are on board, and hope that with increased education, we can help protect the next generation against HPV-related diseases.
BOTTOM LINE: Gardasil- it's not just for girls! Talk to your family doctor about immunizing ALL your kids.

PS. I am NOT on anyone's payroll for this vaccine- but I absolutely do recommend it.

Sunscreen Labeling Update from the FDA

Hooray! The FDA issued a press release this week that will only allow sunscreen products that protect against BOTH UVA & UVB rays to be labeled as "Broad Spectrum" and they must have SPF values of 15 or higher to state that they reduce the risk of skin cancer and early aging. Previously, SPF only addressed UVB rays, which are the primary cause of sunburn. Both UVA & UVB cause skin damage and skin cancers.

Earlier this month, I blogged about "which sunscreen is best", but let me review a couple key issues. SPF- Sun Protection Factor- measures the amount of solar energy required to cause a sunburn on protected skin versus unprotected skin. While in general terms that means a sunscreen with an SPF of 30 should allow you to be in the sun for 30 times the sun exposure before causing damage, realize there are two major qualifying factors. One, the UV radiation is more intense at different times in the day. Fifteen minutes at noon may equal an hour early in the morning. Two, no sunscreen- even when applied correctly- stays fully effective more than a couple hours. What's correct application? A full OUNCE per person, applied thoroughly and reapplied every two hours. Of course, altitude, latitude, cloud coverage and skin type all factor into the degree of solar intensity required to cause damage as well. With this in mind, the FDA is additionally proposing to limit the maximum SFP to "50+" as there is no evidence to show that products with SPF's higher than 50 provide any additional protection beyond those labeled as 50.

What does all this mean for the average consumer? For now, keep reading sunscreen labels more closely, making sure that the product you are choosing protects against BOTH UVA and UVB radiation. Typically, if you look at the active ingredients and see zinc or titanium dioxide along with several other chemicals, you've got the right product. The new labeling wont be obvious on the shelves till next summer, so while this announcement is a step in the right direction, don't assume products labeled "broad spectrum" this year are truly that. Also, please don't forget about hats and protective clothing, especially if you are going to have extended time outdoors.

BOTTOM LINE: Double check your sunscreen to be sure you are protecting your skin from BOTH types of UV radiation- UVA & UVB- because they BOTH cause skin damage that can lead to skin cancers.

Breaking News about ALZHEIMER's

Over 5.4 million Americans suffer from Alzheimer's dementia (AD), and we believe that an equal number of people are in the early, yet UNdiagnosed stages of Alzheimer's. If you don't know someone affected yet, you will soon. My mother battled AD for over a decade, so I have a very personal face for this disease. For the first time in nearly three decades, there are new criteria for the diagnosis of this challenging disease. What's new?

Now there are THREE stages, with the first stage existing before there is any memory loss, called PRE-Clinical AD. This is based on research settings ONLY, where levels of biomarkers can be measured. The second stage is Mild Cognitive Impairment (MCI), where there are early memory and other cognitive changes, but these developments do not significantly impair the person's ability to perform daily tasks. The final stage is Dementia, where there are not only memory, orientation and judgement difficulties, but they are to a level that affects the patient's daily life.

Biomarkers represent a very exciting FUTURE for Alzheimer's disease research and treatment. Right now, these tests are not readily available to those of us in private practice, and even if they were, we have not established solid reference points to allow for accurate interpretation of the data. The importance is THIS- just like we can measure and treat cholesterol levels BEFORE someone has a heart attack, or see rising blood sugars before full diabetes, elevated AD biomarkers may warn us of impending AD. Obviously, the next step is then to develop medications that will PREVENT the full development of dementia, if they are started during the earliest stage.

We're making progress! Go to the Alzheimer Association website and see how you can help make a difference.

BOTTOM LINE: We are learning more and more about the early stages of Alzheimer's disease, and biomarkers represent an exciting new diagnostic tool...but they are still ONLY IN RESEARCH protocols.

Heart Disease in Women- New AHA Guidelines

The American Heart Association has recently published an update to their Guidelines for the Prevention of Cardiovascular Disease in Women, so I thought I would highlight a few issues that may surprise you. Did you know that women are more likely to have a stroke than a heart attack? My patients with risk factors such as high blood pressure or high cholesterol worry far more about having a heart attack than having a stroke, yet at every age, women truly are more likely to suffer a stroke. (The opposite is true for men.) Sadly, in the United States, one woman dies every minute from cardiovascular disease.

The numbers of young women (aged 35-54) dying from cardiovascular disease is rising, paralleling the rise in obesity in our country. Now 2 of 3 women over the age of 20 are overweight or obese. This is why I spend so much time counseling patients and blogging and talking about weight loss and healthy lifestyle changes!

Women who had any pregnancy related complications such as premature birth, pre-eclampsia or gestional diabetes are now known to have higher risk of future cardiovascular events- possibly doubling their risk- despite blood pressures and sugars returning to normal after childbirth. We need to treat these women more aggressively to reduce their risk factors both with behavior modification and with medications.

BOTTOM LINE: Women, recognize that YOU are at risk for strokes and heart attacks as much, if not more than the men you are worrying about! Schedule a check up with your family doctor today.

New USDA Guidelines

On January 31, 2011, the United States Department of Agriculture (USDA) released their updated guidelines for the American diet. A panel of 13 nutritional experts, chaired by Linda Van Horn (who has a doctorate in addition to being a licensed and registered dietician) reviewed the available evidenced-based data regarding the impact of diet on wellness and disease prevention. Their findings come as no surprise, with an emphasis on MAINTAINING a HEALTHY WEIGHT (through calorie balance- energy OUT equalling or exceeding energy IN) and focusing on consuming NUTRIENT DENSE foods and drinks.
What does this mean? In short:
MORE: vegetables, fruits, nuts, seeds, seafood, low- or no-fat milk products, eggs, poultry and whole grains.
LESS: Everything else. Seriously! Less solid fats, complex/refined sugars (crackers, cookies, breads, sweets), fatty meats, and drinks with empty calories like sodas, many fruit drinks and alcohol.

So none of this is shocking. Perhaps the one controversy is the level of salt recommended. The USDA okays up to 2300 mg of sodium for the general population, but the American Heart Association (worried appropriately about high blood pressure) suggests that really everyone should max out their salt around 1500mg. The reality is, however, that if people change their diet from highly processed foods to more plant-based and whole foods, their sodium content will fall as well.

WIth more than 1/3 of American children and 2/3 of our adults falling in the overweight or obese category, the USDA is rightly shifting the emphasis of their guidelines towards calorie balanced diets and LIFETIME weight maintenance, through increasing activity as well as increasing vegetable and fruit consumption. Tomorrow I'm going to return to focusing on the MORE philosophy that has successfully helped many of my patients reach their healthy weights.

BOTTOM LINE: (Straight out of the USDA's Press Release)"The bottom line is that most Americans need to trim our waistlines to reduce the risk of developing diet-related chronic disease. Improving our eating habits is not only good for every individual and family, but also for our country." Cheers.