A Hodgepodge of New Studies

Making Sense of Two Recent Testosterone Studies:

I am always trying to make sense of the studies I come across. In the past couple of days, I came across two studies involving testosterone, the male hormone. One study showed that overweight men who suffered from hypogonadism (a medical term which describes a diminished functional activity of the gonads, the testes in males) who received testosterone lost weight; the other study showed that men who suffered from hypogonadism who lost weight increased their testosterone to a level where they no longer had hypogonadism (incidence of hypogonadism went from 20% to 11%, about a 50% improvement).

After reading the two studies, I had to ponder for a while how they related to each other and then it came to me. Although I claim no absolute certainty in these conclusions, it seems that for certain overweight men, increasing testosterone, either endogenously (from within) or exogenously (from outside) helps them lose weight. Given the choice, it would seem better to naturally increase a hormone as opposed to getting it from some other derived source. The best way to do so if you are overweight is to change your diet to the a mostly plant-based diet, increase your exercise to moderately-intense 150 minutes per week, and get at least 7 hours of sleep a night.

Are Vitamin D Blood Tests Always Accurate?

Apparently not. A recent study showed that 40% of the time, blood-labs misdiagnose Vitamin D deficiency by reporting lower than actual levels. This may not be true for all labs or all types of equipment used. The equipment/tests that seemed to be the worst offenders were the Architect and Centaur-2 tests. The liquid chromatography/mass spectrometry (LC/MS) test is the gold standard and can generally be relied upon. So the next time you have a test, ask what equipment they are using and consider going to another lab with LC/MS equipment for greater peace of mind.


Is There A Link Between Vitamin B6 and Heart Disease?

A new study shows a link between low Vitamin B6 levels and increased risk for heart disease. The study does not show causality, which means it isn't clear if the low Vitamin6 causes the heart disease or the heart disease causes the low Vitamin B6. It is possible that the inflammation often seen in heart disease may decrease blood levels of the vitamin. Nevertheless, it is important to maintain adequate levels of all vitamins, including B6, so I include the reference table below for your edification.

This table is not meant to be a recommended diet; rather, it is meant to give you a representative sample of sources of Vitamin B6 in regularly available foods.  A healthy diet is one that contains fruits, vegetables, nuts, legumes (beans), whole grains, and fat from fatty fish like Wild Salmon and Wild Cod. It can also include some olive oil, limited red wine, and very occasional chicken or meat. This is often referred to as the Mediterranean Diet and it still seems to pack the most bang for the buck.
Food	Milligrams (mg) per serving	Percent DV*
Chickpeas, canned, 1 cup	1.1	55
Tuna, yellowfin, fresh, cooked, 3 ounces	0.9	45
Salmon, sockeye, cooked, 3 ounces	0.6	30
Chicken breast, roasted, 3 ounces	0.5	25
Breakfast cereals, fortified with 25% of the DV for vitamin B6	0.5	25
Potatoes, boiled, 1 cup	0.4	20
Turkey, meat only, roasted, 3 ounces	0.4	20
Banana, 1 medium	0.4	20
Marinara (spaghetti) sauce, ready to serve, 1 cup	0.4	20
Ground beef, patty, 85% lean, broiled, 3 ounces
Waffles, plain, ready to heat, toasted, 1 waffle	0.3	15
Bulgur, cooked, 1 cup	0.2	10
Cottage cheese, 1% low-fat, 1 cup	0.2	10
Squash, winter, baked, ½ cup	0.2	10
Rice, white, long-grain, enriched, cooked, 1 cup	0.1	5
Nuts, mixed, dry-roasted, 1 ounce	0.1	5
Raisins, seedless, ½ cup	0.1	5
Onions, chopped, ½ cup	0.1	5
Spinach, frozen, chopped, boiled, ½ cup	0.1	5
Tofu, raw, firm, prepared with calcium sulfate, ½ cup	0.1	5
Watermelon, raw, 1 cup	0.1	5

*DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration (FDA) to help consumers compare the nutrient contents of products within the context of a total diet. The DV for vitamin B6 is 2 mg for adults and children age 4 and older. However, the FDA does not require food labels to list vitamin B6 content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.

Dr. Oz, Green Coffee Extract, and Dietary Supplement Beliefs

In September 2011, John Cloud, a writer for Time Magazine, published an article about his own experience with dietary supplements titled: "Why Most Dietary Supplements Aren’t Worth the Money." Using himself as the subject of his home-based experiment, he took 3,000 pills over a 5 month period to see what effect it would have on his health. Checking his blood at the beginning and end of the the trial period revealed that the "lab rat experiment," as he referred to it, changed nothing except for his weight.

As a result of consuming some twenty pills a day, which he thought must provide some protective health benefits, he rationalized that he had a license to eat poorly, and as a result, gained 15 pounds.  Obviously, this one man study is not extrapolatable, but it is a curiosity.  What effect would these same pills have on the health of others?  The comments posted online in response to Mr. Cloud's article were generally negative. Most responders railed at how he basically proved nothing and failed to recognize the true value of taking supplements.

You may remember my blog on March 18, titled A New Religion Is Sweeping America. I called this religion Supplementum, and it referred to the unshakeable belief that many people hold that the dietary supplements they take are what is keeping them healthy. They have a fervent religious faith in these pills that rivals any other possible religious belief. They often refer to the studies that prove that their supplements are the right ones. By refer, I mean state that there are such studies, but of course, can't produce them.

Everyday, I try to read studies and articles from reliable, and sometimes not so reliable sources about dietary supplements. Often, there are comments associated with such articles, and as with the John Cloud article, the comments almost always vigorously defend the use of supplements based on purported studies. However, I can't usually find such studies (most don't exist!?).  More importantly, when I do, the studies are usually worthless.

For example, Dr. Oz recently promoted Green Coffee Extract as an effective weight loss supplement. It has become a rage on the internet as the next great weight loss product. Oz did so based on quoting a recent study. I believe I found the study to which he was referring. The study involved sixteen people and was performed in Bangalore, India (with some involvement from the chemistry and psychology departments at the University of Scranton).  I found discrepancies in the study and emailed specific questions to the author in India. He actually responded to write that he will be in touch again. I am still waiting.

However, the author of the study made passing reference that upon follow-up (time period not given) to the study, the subjects who had lost weight had kept it off. This doesn't make much scientific sense as the effects should wear off after the study is done. It was also presented as a double-blind randomized control study, but was in fact, a cross-sectional study, which means that all study subjects both received the product (in two different doses) and the placebo at one point, which means that they all lost weight when they took the highest amount and apparently kept it off, regardless of what they received first.  At least a third received the full dose first, and another third received the half dose first.

Ignoring the fact that a 16 person study is essentially nonsensical for scientific validity, other aspects of the study also were illogical. The argument for the green coffee extract is that it prevents absorption of glucose thereby reducing calorie intake thereby resulting in weight loss. By description, it works actively to prevent such absorption. It should work as an active ingredient similar to the short-term effects of drinking coffee.


Again, this makes no sense because if they received the product first, and kept off the weight, what effect did the placebo even have? The study also states that the study subjects may have figured out when they got the placebo and when they got the coffee extract. Not quite a blind study then, huh? Finally, there was no actual description of what the subjects ate during the study.  I think everyone can agree that would make a huge difference on weight gain or loss.

Today, a patient of mine that regularly corresponds with me responded to my advice for her to take a vacation from her daily supplements. She is a true believer in supplements. Her response was that she does for a month whenever she goes for blood work and when she stopped it one time, the pressure in her eyes increased so much she needed surgery from which she is still recovering. Pressure in the eyes is referred to as Glaucoma, and based on my research there is no body of good evidence that any supplements have any effect on this medical condition. (There are studies that show some benefit with macular degeneration, another eye condition, but that's a subject for another day. I also recently heard a leading ophthalmologist trained at the University of Pennsylvania state the same conclusion.)

Nevertheless, she believes wholeheartedly that stopping the supplements caused the increase in pressure. Of course, I can't know for certain that it didn't, but I suspect that it was happenstance because if it happened once, it should have happened every time, and again, there is no science to support her assertion.

As my wellness and preventive medicine practice grows, I often encourage patients to take these supplement holidays and I will tell you that the feedback has been nothing less than euphoric. The blood-work I perform after a month of supplement holiday, just as with John Cloud, generally show no difference. Why?  Because most of what my patients were taking is treated by the body as excess and is excreted away.  (The old joke is that people who take costly dietary supplements have the most expensive urine.)

Interestingly, people who stop the supplements report that they have more energy than they have had in a long time. This is a subjective report and I also don't put much faith in it.  My thinking, albeit not fully confirmed, is that most supplements usually have little to no short-term effect, despite the subjective reports, and mostly negative or also little to no long term effects.  

My biggest concern is for those patients that have become so psychologically dependent on these pills that they have been taking for so long that they are truly afraid to stop them. I really feel for these patients and pray that they ultimately don't do themselves any real long term harm. In the interim, I am delighted to report that the number of patients who wisely are stopping these wasteful and potentially harmful pills continues to grow with no appreciable difference noted in their health or blood-work.

If you are taking such pills, please allow me to prove to you that you also probably don't need most of what you are taking under any circumstances and definitely less so if you make some tweaks to your diet.  As the cartoon above humorously depicts (this was proved in actual study conducted by Cornell University), marketing can be very persuasive. Don't let the supplement marketers and their TV pitchmen have their way with you.  I'm not sure they really have your best interests at heart.

Take This With A Grain of Salt...

Iodine is not something Americans often discuss, but maybe they should more often. 

Iodine is an essential trace element needed for humans to sustain life because of its main role is as a constituent of the main thyroid hormones, thyroxine (T4) and triiodothyroxine (T3).  The thyroid gland needs no more than 70 micrograms per day of iodine to synthesize the requisite amounts of T4 and T3, but higher amounts (~150 micrograms per day) are needed for optimal function of a number of body systems, including milk-producing breasts, the lining of the stomach, the salivary glands and lining of the mouth, your thymus that produces you’re the key cells of the immune system, your skin, etc.

Worldwide, iodine deficiencies are common and can cause brain development issues. That is why here in the U.S., even though seafood is a good source of iodine, the government requires that our table salt be iodized (iodine is added) so the American public can maintain healthy levels of this essential element. 

That’s great except there is one problem. Just like with the warnings to avoid sun exposure to avoid skin cancer has increased Vitamin D deficiencies, warnings to avoid salt may be causing iodine deficiencies.  The problem is that very few doctors these days test for iodine deficiencies.  I did the other day for the first time.

Let me tell you why I ordered this rather uncommon test.  A patient came to me complaining of fatigue.  As part of the work-up for fatigue, I did what are called thyroid function tests (TFTs). These tests included measuring her T4, T3 and Thyroid Stimulating Hormone (TSH) levels. The tests came back slightly abnormal and as a next step, I ordered a test for thyroid antibodies, which if positive would further indicate thyroid disease. They also came back slightly positive. I then ordered a thyroid ultrasound scan to see what was going on with this patient’s thyroid and it came back negative.  I was confused as there were indications of thyroid disease, but the results were inconclusive. I decided it was best to refer the patient to an endocrinologist, the specialty doctor with expertise in endocrine diseases such as thyroid disease. 

However, before the patient left, I decided to test one more thing—her iodine level. I did so because I remembered that the patient had previously told me that due to her elevated blood pressure she had completely refrained from adding any salt to her diet for a number of years.  She also told me she had distaste for seafood.  I wondered if the combination of her refraining from salt and almost never eating seafood had prevented her from getting sufficient iodine in her diet.  The iodine test is uncommon and the results take five days before they are available. In the meantime, the patient had booked visits with two different endocrinologists, one who told her to take thyroid medicine (synthroid) for her thyroid disease and another who told her it was unnecessary because her thyroid was fine (no wonder I was unsure).

Meanwhile, the iodine test came back and guess what--that’s right, she had an iodine deficiency.  I immediately researched other natural sources for iodine beyond seafood and iodized salt, and found out that there were not many good sources (milk products and egg yolks are a source, but I don’t generally recommend consumption of them for other reasons).  Cranberries are another source, but not a great one.   

So, given my unease with starting her on a iodine pill that can have some nasty side-effects,  I suggested that she should instead add a teaspoon of iodized salt to her daily diet to correct the deficiency.  I will obviously need to watch her blood pressure due to the added salt, but I hope this will correct her iodine deficiency and return her thyroid hormones to completely normal levels.

It's often said that when doctors hear hoof-beats, they should think of horses not zebras. In the case of abnormal thyroid tests and fatigue, checking iodine levels may actually turn out to be a horse.

Pressure Rising...

Although the rising obesity epidemic has become a hot topic, it should not be the only widespread concern. There is another health phenomenon that does not get enough attention. It is the incidence of high blood pressure, or hypertension (HTN). The most common reference to high blood pressure usually comes in the form of warnings to curtail your salt intake.

While salt levels in your blood stream are one mechanism that affects your blood pressure, it is not alone.

Here's a quick primer on high blood pressure and its common causes.

It all starts with your heart and your arterial blood vessels. HTN is affected by how your heart is pumping, how much it is pumping, and what it is pumping against. So if your arteries, which are the blood vessels your heart pushes blood through to get it to your organs, are narrowed because of arteriosclerosis or spasm, your pressure goes up. If your blood volume is increased because of water retention, your pressure also goes up.

Blood pressure is also affected by neurological systems called the autonomic system, which is controlled by the brain.  Although it's role is not perfectly understood regarding its contribution to HTN, it is known that the system can raise and lower your blood pressure by sending signals to blood vessels to narrow or dilate. This system is also called the "fight or flight" system because it controls your body's reaction to external factors.

Your kidneys are believed to play a major role in HTN. First, kidneys regulate fluid balances in your body by controlling how much fluid and salt is excreted to maintain a good circulating fluid volume. If you ingest more salt, the kidneys are suppose to excrete more salt to keep the balance.

The kidneys also release a hormone and enzyme called renin, which perhaps plays a very significant role in fluid maintenance and blood vessel control as part of the renin-angiotensin-aldosterone axis. This axis is the body's system that ultimately controls one of the kidney's main functions--to excrete excess sodium and potassium. The amount of two elements in your body affects how much water the body retains. This axis also controls the flexibility of blood vessels walls and has the ability to narrow the blood vessel when beneficial to the body. Obviously, if the system malfunctions and blood vessels narrow inappropriately, this can cause HTN.

HTN is deadly to your body because of the extra strain it puts on your always pumping heart to work harder. This can lead to the growth of heart-muscle, which is not a good thing. As the heart works harder, it can grow larger and actually become flabby and dysfunctional. Untreated, this often leads to heart failure and eventual death.

So when a doctor confronts HTN, the first instinct, if not rule, is to lower it with medication(s) to prevent any damage. There are many types of medications to treat HTN, including diuretics which simply cause the kidneys to excrete more fluid, calcium channel blockers,beta-blockers, vaso-dilators etc.  Unfortunately, many doctors do not effectively address many of the root causes of the rising blood pressure such as stress, eating the wrong foods and avoiding the right ones, weight gain, etc. This brings to mind one of my favorite childhood anecdotes.

My father drove an old car and one day a red light went on in the dashboard. We drove to a gas station and my father asked if they could address the problem. They said sure, we can "disconnect the red light."  It seems that when it comes to high blood pressure, doctors often disconnect the red light with medication rather than address why the red light went on in the first place.

This morning, I received an email from a website called REALAGE.com.  The website is now owned by sharecare.com, which is partially owned by Dr. Oz (yes, him again).  Clicking on the link and probing around the website, I found an article titled Reduce High Blood Pressure with Yogurt. The article claims that yogurt and low fat dairy can reduce high blood pressure. To quote the article, "In a recent study, a diet that was rich in low-fat dairy seemed to help curb the risk of high blood pressure by as much as 31 percent."

Wow, that sounds pretty good, but it couldn't be more misleading. I previously blogged about that study (Want Milk?, Friday April 20, 2012, http://mdprevent.blogspot.com/2012/04/want-milk.html). It showed that compared to eating dairy with a higher fat content, there was a decrease in blood pressure by eating low-fat dairy. The study did not look at how low fat dairy compared to no-fat dairy and no dairy altogether. Telling you something is the lesser of two evils without telling you what it is compared against I believe is misleading.

I guess by now, you may not be surprised that health information provided by anything connected to Dr. Oz may be misleading.  If you want to lower your blood pressure, learn what foods to eat and which to avoid, and most importantly get the right type of exercise, a good night's rest, and manage your stress effectively. All of these affect blood pressure. Either way, always consult a doctor if you have high blood pressure, rather than a website or TV show that may be misleading. Accurate information allows you to make informed choices. Isn't that what you want?

MDPrevent

Don't Take Two Aspirins...

We all grew up with the old adage of "take two aspirins and call the doctor in the morning." This saying referred to the advice doctors often gave patients who bothered them by phone late in the day with what the doctor perceived to be a triviality that could wait until the next day or forever, for that matter. Today, when you try to call you doctor later in the day, you often get a voice message that states, if this is an emergency, please call 911 or go to the nearest emergency room. So was it good advice?

Clearly, aspirin is an effective enough fever reducer, pain reliever and anti-inflammatory medicine for mild ailments. However, it's hardly used for such purposes anymore because of superior medications such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil, etc.) and other non-steroidal anti-inflammatories (NSAIDS).  Aspirin began to decline in usage for pain and fever not only because of the more potent alternatives, but also because an increasing number of people were having allergic reactions to it and it was discovered that children (and some adults) were at risk of developing Reye's Syndrome.

Reye's Syndrome is a deadly disease that strikes quickly and can affect people of all ages without warning. It affects the entire body, but the brain and liver are the most harmed. Although the exact cause and cure are unknown, there appears to be a link between it and aspirin and other salicylate containing medications, and it seems to affect people who have had a chicken pox infection at some point. As the use of aspirin declined, the incidence of Reye's Syndrome has also markedly declined to very rare occurrences. It should stay that way.

More recently, aspirin has regained center stage due to its anti-platelet, anti-clotting abilities. It has also been linked to possible benefit in reducing the risk of colon cancer.  Unfortunately, it also is responsible for most bleeding episodes in the U.S. and is reported to be among the top four reasons for emergency room visits. The bleeding risks are increased by concomitant use of other NSAIDS, and unfortunately, enteric-coated aspirin, does NOT appear to decrease the bleeding risk.  Aspirin can also cause gastric ulcers, and I can confirm that from personal experience.

Therefore, the recommendation to consume a baby aspirin (81mg) to prevent blood clots must therefore be balanced against the risk for bleeding, ulcer formation, and the long-shot Reye's Syndrome. A thorough discussion with your doctor can determine if it is the right choice for you based on your risk factors for blood clots. Taking it on your own would not be advised.

That's what most doctors agree is the prudent course, but then again Dr.Oz is no longer like most doctors. An article appearing in this week's People magazine quotes him as saying that everyone should take two baby aspirins every day. Without knowing your risk factors and apparently throwing caution to the wind, he appears to ignore the risk factors for bleeding and ulcers and continues to make this foolhardy recommendation. Sometimes he recommends a fluid with it, but I have heard him say on his show to take aspirin without mentioning the need for fluids. Fluids are said to decrease the corrosive nature of aspirin on the lining of your stomach. I wish he would add at least a whisk of caution to his recommendation, if not stop it altogether.

By the way, you may ask, why do I keep writing about Dr. Oz?  As I've said before, it's because he's everywhere I turn (everyone turns) and quoted widely. His words are taken seriously by many people and I fear for the consequences.

A reporter for a Canadian major newspaper, whom I wrote about previously and spoke to the other day, told me that when she was among other reporters interviewing Dr. Oz when he visited Canada, she was the only reporter who did not get a hug because she asked him tough questions he apparently didn't appreciate.  Her conclusions after interviewing him is that he rationalizes promising miracle cures and magic pills (which he knows don't exist) and pushing products that are potentially harmful by telling himself that people need false hope and emotion to drive change.

I say people need good information to make good choices in consultation with their doctors. On that point, Dr. Oz and I seem to be diametrically opposed and that is why I keep trying to educate the public. 

MDPrevent

Need Another Reason Not To Trust What You Read On The Dr. Oz Show Website?

This past Monday, I wrote a blog about the wastefulness of the NMR LipoProfile test recommended by Dr. Mark Hyman during his PBS appearance (and on his website and I suspect in his new book, etc.). He emphatically advocated for the test because he felt that it was an essential tool to identify people at risk for heart attacks. I opined that it was another expensive test expected to provide little additional information for most people.

Alas, along comes a new study that merits attention. According to the study, performed by John Danesh, FRCP, of the University of Cambridge in England, and colleagues belonging to the Emerging Risk Factors Collaboration, there was only slight improvements in cardiovascular risk prediction gained by adding more blood lipid-related markers to conventional factors. In fact, fewer than 5% of individuals would have their risk classifications changed by including such new markers.

According to the researchers, adding more lipid markers to the risk prediction equation brought, at best, only "slight improvement." The research, published in the June 20 issue of the Journal of the American Medical Association, showed that replacing the standard blood tests used today to determine cholesterol levels and cardiac risk markers with these new lipoprotein-associated factors reduced the accuracy of risk prediction.

In practical terms, this study showed it would be necessary to test from 800 to 4,500 individuals for these lipoprotein markers in order to prevent one major cardiovascular event over 10 years. Now that sure seems like a waste of time and money because even if you test positive, it doesn't assure that you will do anything different in terms of lifestyle or treatment. Even if you add a statin, there is no guarantee it will prevent a heart attack because plenty of people who take statins still have heart attacks. The key to good heart health remains lifestyle and you should live a healthy one regardless of what a doctor or diagnostic test tells you.


The NMR LipoProfile offers three case studies to support their product. Not surprising that the first case study, described as an overweight man, was found to be at greater risk of having a major cardiovascular event based on the test. Duh! Being overweight is clearly a risk factor and you don't need an extra blood test for confirmation.

The take-away here is the usual one. Don't wait for blood tests and diagnoses to force you to take stock of your life and make the changes that will both improve the quality of your life today and your enjoyment of life for years to come. Remember, the longer you live, the healthier you've been.

So once again, I searched the Dr. Oz website to see what it had to say on this matter and of course, there is a posted article written by Dr. Hyman strongly supporting this test.  Imagine that? 

We All Can Use A Little Help Sometimes...

I have always been a fan of psychologists. When I was in college, I was very distraught over a family situation. In a mere fifteen minute session, a college-based psychologist gave me advice that served me profoundly well. Sometimes, we get so lost in our heads that we need someone, trained and professional, to help us get some clarity. I did that day and it made me a believer.


Psychologists, particularly those with a PhD, spent as much as ten years, including postdoctoral internships and fellowships, getting the full range of their intensive education, and they can make a huge difference in your life.

That is why, before MDPrevent had it first patient, I hired a full time health psychologist for our team. Her name is Dr. Jessica Kordansky and patients rave about her. She offers the full range of health psychology services and also leads our Mindfulness Meditation classes each week.

What is a health psychology? It is a field of psychology concerned with understanding how biological, psychological, environmental, and cultural factors are involved in your physical health and illness. In other words, it takes all aspects of your life into consideration to help you maintain the best possible emotional and mental health. It helps you develop strong coping mechanisms to deal with the inevitable stress and anxiety that seems to accompany most people as they age.

New Study

Why do these matter? A recent population-based study showed that individuals scoring higher on a measure of general mental health had an increased risk of stroke mortality. Psychological distress predicted a significant 66% elevated risk of death from cerebrovascular disease, according to Mark Hamer, PhD, of the University College London. It's really simple. Stress kills.


"These [new] data suggest that the cardiovascular effects of psychological distress are not limited to coronary artery disease," Hamer's group wrote.

Scientists know one of the mechanisms by which stress kills is by shortening your telomeres, which are the tails of your chromosomes. Each time your cell divides, your telomere shortens and eventually when it reaches a certain length, the cell dies. Stress accelerates this process. Another mechanism by which stress induces great harm is by its affect on your blood pressure. Increased blood pressure damages both your heart and vascular systems thereby increasing your risk for stroke and heart attack.


I think that the overwhelming majority of patients would benefit from one-on-one time with a health psychologist.   It seems that as we live our lives, we accumulate a lot of mental baggage and it gets really crowded in our heads making and keeping sense of it all. A health psychologist can help you sort out the things that you should stop thinking about because they are not meaningful, the things that you need a plan to address, such as your finances, and the things that you can't stop thinking about, such as your children, that you can't change, but need a effective and useful way to cope with it.

I often quip that smart people always take advantage of psychological counseling because I learned in medical school from a family friend who worked in a local mental health center that many of my fellow medical students were taking advantage of the service available to us. I also once heard that Newton, Massachusetts, where I lived for ten years, has the highest per capita rate of counseling anywhere in the U.S. It's not surprising because it is also home to some of the smartest people in the country who are professors and doctors at local universities such as Harvard, MIT, Tufts, Boston University, Boston College, Wellesley, Brandeis, etc.


The best part of health psychology is that it is covered by Medicare and most other insurances.  So if you find yourself believing that your "thoughts are facts," which they are usually not, and would like to get some stress reduction, better sleep, less anxiety, and an overall better handle on life, maybe it's time you spoke to a health psychologist? At a minimum, it may help you avoid a stroke.

There are many excellent health psychologists. I am impartial and think I have one of the best, who by the way trained at Emory University. If you are interested in speaking with Dr. Kordansky, you may reach her at (561) 807-2561.

Either way, if stress, anxiety, difficulty sleeping, strained relationships, loneliness, depression, or anything else is affecting your health or your life, consider speaking to someone. It doesn't really matter why, but if you you think you would benefit from such support, you should do so because we can all use a little help sometimes...

Dr. Oz and Dr. Hyman Make Quite A Pair of Showmen!

The other night, I happen to catch Dr. Mark Hyman on a local PBS affiliate. Having heard Dr. Hyman speak at the American College of Preventive Medicine conference in February 2012 in Orlando to a group of doctors, I was keen to hear what he had to say to a layperson TV audience.

It started out innocently enough. He spoke about the dangers of diabetes and obesity, the need to eat well, get plenty of exercise, etc.  Then the garbage started. He started touting the need for special blood tests like the NMR LipoProfile test for cholesterol particle size, the need for a special blood test to identify insulin resistance, and the need for everyone to take dietary supplements. My recollection of his speech at the convention to doctors was that he made no mention of the need for these tests or for dietary supplements (other than to me when I questioned him about his own usage).

I'm not surprised that he didn't do so in front of a sophisticated audience; but, I was flabbergasted why he was now singing another tune to a raptly attentive and susceptible TV audience. I didn't have to wait long for my answer. As the show ended, there was a reference to organizations that had helped fund the show.  Among the sponsors were NMR LipoProfile, the company that sells the cholesterol test, and Metagenics, a company that sells supplements.

I was so disappointed that Mark Hyman had essentially sold out his audience. People don't need more blood tests than the conventional tests to tell them that they have a cholesterol or blood sugar problem. Does it really matter if you have a 33% versus a 38% relative risk of developing diabetes or heart disease? Either way, you should make lifestyle changes to avoid them.

These tests are by and large, in my opinion, just plain ridiculous and unnecessary and they only serve to line the pockets of the companies that sell the tests and the doctors who order them with reckless abandonment.  Patients don't need more tests from doctors; they need more time, guidance, and support from them. In my opinion, for whatever it's worth, Mark Hyman is another doctor gone astray by the lure of fame and money.

Of course, he's not the first, and he's not alone. He has his good friend Dr. Oz to keep him company.

Today, I was contacted by a Canadian reporter doing a story on Dr. Oz. She let me know that she had cited my blog in a previous story she wrote about Oz and directed me to the story.

I have often wondered if Dr. Oz actually believes it when he says that a supplement he promotes is as good as he claims or it is all showmanship. If the Dr. Oz quote from her article is accurate, it appears that he doesn't truly believe in his "miracle cures" and "magic pills." For example, in regards to raspberry ketones, he believes that it may have, at best, a marginal benefit.  He is actually quoted as saying that raspberry ketones have the value of a "nudge."  A "nudge" does not quite match the characterization of raspberry ketones as an amazing weight loss product as he claimed on his show.

The article goes on to reveal Dr. Oz's main excuse for pushing so many different products on an unsuspecting audience--which is to give people hope. After reading the article, I can only conclude that he makes such pronouncements at best to make himself seem like  a savior by giving people hope, albeit false hope at that, and at worse to make some money by promoting the sale of a product.  

Read his own words in describing himself. I couldn't make this up:

"There are three words to describe what I do. I’m a doctor. This comes from the Latin docere, teacher. I’m a physician, which comes from the Latin, physica, science. I’m a medicine man, which means healer. To help someone else, you have to have science, you have to be able to heal, and you have to be able to teach. They all work together. In Western medicine, we put a disproportionate (emphasis) on the science part."

Did he really say a "disproportionate (emphasis) on the science part." Really? What should we rely upon when it comes to your health? Opinions? Anecdotes? Marketing? 

Here's another Latin word that seems to be lacking in Dr. Oz's vernacular.  It's veritas, which means truth. Used in the motto of many leading universities including Harvard, Yale and Duke, it is the essence of education to seek and find truth.  If he were a true teacher, he would espouse the truth. It is a shame that Dr. Oz feels his audience doesn't deserve or can't handle the truth.  Instead, he gives them false hopes in the name of good TV and money-making.

May I speak for others when I say we all would like some veritas from Oz and Hyman if they wish to be considered true teachers?

You Can't Beat Breakfast!

The past few weeks I’ve reported on a number of studies related to preventing diabetes.

1.      Pre-diabetics who exercise at least 150 minutes a week can restore their dysfunctional blood vessels to normal; they get twice the improvement than seen with diabetics.

2.      A second study showed that a change of lifestyle that restores fasting blood sugar at least once in 3 years to a normal level below 100 mg/dl markedly decreases the probability of progression to diabetes.

Here’s a third study to give cheer about.

It has long been a staple of good nutritional advice to regularly consume breakfast. At MDPrevent, we practically shout it from the rooftops.  Still, there has been little research on the relationship between morning eating habits and developing diabetes -- until now.

3.      Eating breakfast is associated with a decreased chance of developing type 2 diabetes according to results of a new study presented by Andrew Odegaard, PhD, an epidemiologist at the University of Minnesota, Minneapolis at a poster session at the American Diabetes Association (ADA) 72nd Scientific Sessions.

The studied showed that for each additional day per week of breakfast intake, there was a 5% decreased risk of developing diabetes. When comparing participants who ate breakfast between 0 and 3 times per week and those who ate breakfast 5 times or more, the more frequent consumers had a 31% reduction in diabetes risk.

Still, there was even more good news. Paradoxically, the more regular breakfast eaters also gained less weight.  Now that’s having your breakfast and eating it too!

Even though those with superior diet quality had lower incidences of diabetes, it proved out that breakfast frequency was a more significant factor as it was shown to be more predictive of diabetes risk even when comparing different types of diets.  Now that doesn’t mean that butter pancakes, loaded with whipped cream and caramel are okay for breakfast.  It does mean that a healthy breakfast is both a great way to reduce your diabetes risk and start a wonderful day.

By the way, I start the day with the exact same breakfast every morning, which I try to consume within 90 minutes of awakening.  It’s comprised of a bowl of fresh blueberries, an added sliced banana, a combination of organic whole grain, high fiber, and low simple carbohydrate cereals, seduced with a cup of unsweetened almond milk. Yum, yum, yum.  I’m never hungry until lunch. Sweet!

Dr. Oz's Vitamin D Recommendation Doesn't Hold Up To USPSTF Review

Yesterday, a patient came to see me again because she was concerned that I had recommended that she stop supplementing with Vitamin D. I had previously told her that she should get her Vitamin D (and fish oil) naturally from eating Wild Alaskan Salmon and other fish rich in Omega-3 fatty acids such as halibut, cod, sardines, anchovies, herring, etc. at least three times a week, and from fortified foods such as unsweetened almond milk.

She had just been to another doctor for the thyroid disorder I had diagnosed who suggested she reinstate her taking Vitamin D. She wasn't happy in general with this particular endocrinologist, but wanted to discuss what to do next with her thyroid disease and his advice about Vitamin D.

I explained again that my recommendation was based on the prevailing science and the fact that she had a very good level of Vitamin D based on her bloodwork.

As fate would have it, in a draft recommendation released yesterday, the United States Preventive Task Force (USPSTF), confirming my recommendation, said there is no value for postmenopausal women in taking supplements up to 400 IU of vitamin D and 1,000 mg of calcium.

The USPSTF also found the evidence too scant to draw conclusions about vitamin D supplements, at any dose and with or without calcium, for cancer prevention in adults.

It was based on an evidence review finding that "in postmenopausal women, there is adequate evidence that daily supplementation with 400 IU of vitamin D3 combined with 1,000 mg of calcium carbonate has no effect on the incidence of osteoporotic fractures. However, there is inadequate evidence regarding the effect of higher doses of combined vitamin D and calcium supplementation on fracture incidence in postmenopausal women."

At the same time, the USPSTF found, doses at or below 400 IU of vitamin D and 1,000 mg of calcium increase the risk of kidney stones, albeit to a small degree.

But with no benefit from the supplements, even the small risk of harm is enough to tip the balance against them at these low doses, the group indicated.

The bottom line is there are no clear benefits of taking Vitamin D and calcium supplements and you can get all the Vitamin D your body needs, in the absence of deficiency, from natural sources including sun exposure, Wild Salmon, other fishes, etc.

Nevertheless, Dr. Oz repeatedly recommends Vitamin D as a top anti-aging supplement.

What are you going to follow: Science or marketing?

MDPrevent