A Vitamin D Study Worth Ignoring and Good News at MDPrevent

It seems like everyone wants in on the Vitamin D hoopla. A study published in Mongolia (not sure if it's Outer Mongolia-the place many often refer to as a wasteland) shows that children who increase their Vitamin D levels suffer fewer cold symptoms. The only problem is that it only works with children who are Vitamin D deficient due to lack of sun during their winter (maybe it is Outer Mongolia).

There is no one, including me, that will argue that the body needs Vitamin D and without an ample supply your body will not function properly. And by not function, that includes an immune system incapable of warding off even the simple and ubiquitous cold virus. But the real debate is what defines a clinical relevant deficiency and what's the best way to treat it. I vote sun, wild Salmon, and almond milk in that order over supplements. Nevertheless, while the question of deficiency still begs an answer, with all the studies now underway, I hope the question won't stay unanswered for long. For the moment, I encourage patients to consciously raise their levels if it is below 30.

On another note, it's turned out to be an unexpectedly busy summer. Without warning, MDPrevent is suddenly inundated with patients wanting access to our medical care, particularly our weight loss and diabetes education services. Word of mouth has generated excitement about our drug-free, fully paid for by Medicare approach to successful weight loss. Even doctors such as cardiologists and endocrinologists we've never met are now referring patients to us because they are witnessing first-hand the weight loss success their other patients are enjoying.  It's both exhilarating and exhausting at the same time. It's actually getting tough to schedule new patients.

Why is it working? What have we discovered that seems to elude others? The answer is simple. Teamwork. Our program combines the skills of a physician, a registered dietitian, and a clinical psychologist. Each of us works in unison to guide, encourage, and cheer each patient on. The result is that patients are steadily losing weight, lowering cholesterol, and starting to enjoy their former selves again.

For those of you who have referred friends, relatives, and neighbors, we say thank you. I suspect so do the people you referred.

Finally, someone asked me the other day if I enjoy what I do. I said of course because what can be more gratifying than seeing people turn their lives around and feel in control again for the first time in many years!  It really does feel good to do good!

I hope you all have a wonderful and relaxing Labor Day weekend.
 

The Only Thing I Know For Sure Is That We Need To Keep Learning

About 30 years ago, I read an article about agriculture that had a profound impact on my thinking. The article was about soil erosion and basically stated that what had long been considered an incontrovertible truth about how to avoid soil erosion turned out to be the exact opposite. The idea that something held as an absolute truth could prove to be absolutely wrong has given me pause to think about such 'truths' to this day.

Thirty years later, a new study about exercise emerges that reminds me of what we consider absolute truths may not be so. For as long as I can remember, exercise has been associated with increasing your metabolism. It's been widely believed that exercise contributes to weight loss by burning calories and increasing your metabolism, which is believed to keep revving and burning calories even during the cool down phase.  While certain people argued that exercise was not an effective way to lose weight because they were unsuccessful losing weight despite much exercise, it was still a tenet of the weight loss movement. For example, Weight Watchers allows you to add extra "points" based on the amount of exercise you do.

The new study, which is a wonderful study, titled Hunter-Gatherer Energetics and Human Obesity, (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0040503) studied the Hadza tribe of hunter-gatherers in Tanzania. Strapping members of the tribe with a GPS device and having them swallow so-called doubly labeled water, a liquid in which the normal hydrogen and oxygen molecules have been replaced with versions containing tracers, researchers were able to quantify their levels of physical activity, energy expenditures and metabolic rates. What they discovered is groundbreaking!

The study showed that contrary to popular belief, exercise slows down one's metabolic rate so that calories burned are actually far less than expected.  What's amazing is that this is intuitive and yet for so long everyone believed otherwise. Think about it for a moment. If your body doesn't eat for several hours, we think (I'm now officially afraid to say anything for certain any more; well, maybe some things) your metabolic rate slows down as your body tries to conserve energy, as it doesn't know when energy will be replenished. Applying that same principle to exercise, when the body senses a loss of energy consumed by increased activity, it makes sense that it will slow down its burn rate to conserve energy.

This doesn't mean that you aren't burning calories and you can't lose weight by exercising. It simply means that you burn less than you think, which means don't think you can eat a lot more because you had a good exercise session.

By now you couch potatoes are turning to your spouses or friends and smugly telling them you were right all along about exercise. Well not so fast.  Exercise is still critical to good heart and brain health. Exercise keeps the heart functioning well and exercise has been shown to be as effective as anti-depressants in treating many cases of mild to moderate depression. But that's not all. Two new studies published online in the Archives of Internal Medicine support the tremendous impact of exercise on lowering the risk of death among diabetic patients, and that weight training may reduce the risk for the disease even without aerobic activity.

Quoting medpagetoday.com, "In a large prospective trial, moderately active patients with diabetes had a lower risk of total mortality compared with those who were completely inactive...according to Diewertje Sluik, MSc, of the German Institute of Human Nutrition in Potsdam, and colleagues. And in a separate prospective study, men who did weight training only at least 150 minutes per week had a 34% lower risk of developing diabetes to begin with ...according to Frank Hu, MD, PhD, of the Harvard School of Public Health in Boston, and colleagues."

I also previously wrote about a study that shows that exercise can return the inflexible blood vessels of pre-diabetics to normal as well.

So while exercise is not the great weight loss panacea it was once thought to be, it is still a critical component of a healthy lifestyle. Keep exercising, but more importantly, if you want to stay slim or lose weight avoid the four whites--white sugar, white flour, white pasta, and white rice. If you watched 60 Minutes this past Sunday, you now know that some scientists view sugar as toxic and cancer causing. Just another good reason to choose whole foods like fruits, vegetables, nuts, beans, and whole grains. And of course, don't forget my favorite, Wild Salmon.  Bon appetite!

What A Difference A Day Makes

Over the past few months, the big health related news was the Institute of Medicine's report regarding the increasing percentage of obese Americans. The expected increased girth of the nation raised alarms because of all the other medical problems that are likely to ensue.  Unfortunately, we will not have to wait because a new medical report by Virginia Fried and colleagues was just released by the U.S. National Center for Health Statistics, part of the U.S. Centers for Disease Control and Prevention. The report titled, NCHS Data Brief, "Multiple Chronic Conditions Among Adults Aged 45 and Over: Trends Over the Past 10 Years," is truly frightening. 

According to new research, between 1999-2000 and 2009-2010, the number of Americans aged 45 and older with two or more chronic conditions has grown, with senior citizens especially at risk of developing both diabetes and high blood pressure. The study reveals that the percentage of Americans in the 45 to 64 year age group with two or more of the conditions grew from 16 percent to 21 percent and in the 65 and older age group, the percentage increased from 37 percent to 45 percent.

The report also revealed that 23 percent of adults aged 45 to 64 with at least two chronic conditions -- out of the list of nine -- either didn't receive necessary medical care or delayed it because of cost. That's up from 17 percent a decade earlier. The percentage of people in that group who didn't get necessary prescription drugs due to cost also grew from 14 percent to 22 percent over the period. Isolating individual conditions in people aged 45 or older, high blood pressure grew from 35 percent to 41 percent, diabetes from 10 percent to 15 percent, and cancer from 9 percent to 11 percent.

The most troubling part is that these numbers are expected to get even worse.  But I have reason for hope because of someone I spent time with today.

I met with a patient of MDPrevent today who has been participating in our LEAN Weight Loss program.  Prior to starting the program, her cholesterol was about 230, her fasting blood sugar was around 120, and her body mass index (BMI) was over 30. In the span of a few months, she has shed 16 pounds, dropped her BMI to 27.5, dropped her cholesterol to the 160s, and her fasting blood sugar to around 105. She accomplished this without any medications, surgery or supplements. She did it simply by changing the way she eats based on what she learned in our program. The best news is that her program was covered 100% by Medicare so it didn't cost her a penny.

Starting a new practice over the past couple of years has had its challenges. However, today it all came together when I witnessed first-hand again what a profound effect a change in lifestyle can have on someone's health. I am so proud to be part of such an effort and take great satisfaction in knowing that our team of Preventioneers are truly making a difference one life at a time. The best news is that our program is covered 100% by Medicare for those who qualify.

Is Obesity A Problem?

You probably think you know the answer to this question. From a medical perspective, your answer probably evolves around the fact that obesity leads to the development of chronic diseases such as diabetes, heart disease, cancer, dementia, arthritis, etc. These diseases lead to costly medical care which still leads to premature death. That sounds like a problem.

Well, based on a new study from the University of California Davis published in the Journal of the American Board of Family Medicine, you may be wrong. The study, which tracked 50,994 Americans between the ages of 19 and 90 for a total of six years, suggests that obesity itself may not be a harbinger of impending death; rather, hypertension and type 2 diabetes, which are often associated with obesity, are what leads to an early meeting with the grim reaper.

You may ask isn't that a question of semantics? Aren't obesity, diabetes, and hypertension so closely related that they may be considered one and the same? Isn't diabesity, as some call it, the right name for it? The answer may surprise you.

The study showed that obese people without these conditions were no more likely to die than non-obese people, and non-obese people with these conditions were more likely to die than obese people without them. So it's not weight per se that kills you, but the diseases that often, but not always, accompany excess weight.

In fact, in my practice I have seen many people who did not suffer from a weight problem, but were still struggling with diabetes. Well, that seems to make sense because weight itself is not the main factor in the development of diabetes and some people who are naturally heavier than others, still seem to enjoy good health.  (I remember many years ago when I worked in a summer sleep-away camp that there was a rather heavy young man that was an incredible athlete. He moved faster and stronger than most of his leaner peers. One would be hard pressed to say that he was unhealthy.) 

Nonetheless, this California study is consistent with a new movement that advocates HAES, which stands for Healthy At Every Size. The HAES camp believes that your health is more important than your size or body mass index (BMI) and I agree.

From the inception of MDPrevent, I have been telling patients not to focus on their weight loss; rather, I have been teaching, begging, exhorting, cajoling, and a number of other words ending in 'ing' to improve their health by eating certain foods and avoiding others, by staying more physically active all day long, by taking steps to ensure a good night's rest, and by developing strategies to manage stress effectively. My lectures often also focus on the need for a strong social network, the benefits of engagement and purpose, and the value of surrounding yourself with like-minded individuals. So, yes, one study doesn't prove anything, but it's not the first study to show the wisdom of focusing on your health and not your weight.

So now you may be thinking that obesity is not a problem, but you would be wrong. Obesity is still often associated with the predominance of chronic disease development. Even in the Albert Einstein College of Medicine study that identified Eastern European Jews who seem to have a longevity gene and who claimed to eat whatever they want, the results showed that those who survived into their 90s were almost always lean. Perhaps they had a genetic predisposition to being lean, but again, lean won almost every time.

I think the most serious reason obesity is a problem is because we don't as a society really seem to understand it. Quite frankly, my head is spinning from reading all the studies and books that purport to have defined, if not offered the perfect solution, to the problem. The list is almost endless.

Here's my abridged version of solutions offered (not saying they work or don't work; just listing to make a point):

Don't eat processed foods that contain white sugar and flour, avoid almost all carbs even the complex ones in fruits, eat more proteins, be a Vegan, eat more meat, drink more dairy, avoid saturated fats, avoid gluten, drink more water, balance your energy intake and output, don't live near fast food restaurants, eat more smaller meals, snack, don't snack, use small plates, eat breakfast within 30 minutes of waking up, don't eat breakfast until after you exercise, don't eat past seven at night, take dietary supplements that speed up metabolism, avoid anything other natural foods, stay physically active all day, go to Weight Watchers, follow the Adkin's diet, the South Beach Diet, the Zone Diet, the Cookie Diet, the grapefruit diet and countless other diets, take HCG and other appetite suppressants, take medications like Orlistat or Tenuate, have lap-band or stomach bypass surgery, etc.

Yes, there are quite a number of pundits that feel they have the solution, and that's a huge problem. Given so many choices, analysis paralysis sets in and we end up doing nothing or a little of this and a little of that, and that my friend is what I think is the biggest problem with obesity.

At this point, after reading countless books, articles, and studies, watching documentaries, attending conferences,  speaking to thought leaders, and working with patients, my solution is simple. Pick something that you think you can live with that has at least some decent science supporting it and STICK WITH IT. Getting healthy and losing weight takes time to do it right. It takes effort and concentration and it doesn't happen overnight. For many it will be a life-long struggle. Sacrifices will have to be made. Favorite foods may need to be given up perhaps forever. Trade-offs will be made and battle-lines drawn. That's the reality of the situation for most and I challenge anyone to prove otherwise.

If you need support, get it. If you are a do-it-on-your-own type of person, that's fine, but have a plan and follow it religiously.

If you are looking for some direction and/or insight, here's my suggestions: avoid processed foods, stay active during as much of the day as possible, drink fluids to keep your urine a pale yellow, don't take any pills you don't absolutely need to take, make fruits, vegetables, beans, nuts, and whole grains the bulk of your diet, eat some wild salmon at least 2-3 times a week, get at least 7 hours sleep a night, learn how to manage stress better, nurture relationships, and find something that gives you pleasure to engage in consistently both physically and mentally.

If you follow this advice, I can't promise what weight, if any, you will lose, but I'm pretty sure you will be healthier than you are now. In the final analysis, I hope you agree that being healthy is the most important goal.

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!

Can We Prevent Aging? National Institute of Aging Speaks

On Sunday, I wrote that I would soon discuss reseveratrol. Resveratrol was one of the products that Dr. Oz had inappropriately touted last week as an anti-aging dietary supplement.

Here’s an excerpt from his website about resveratrol:

“You can further protect your body from the harmful effects of inflammation by taking a resveratrol supplement. Resveratrol is a compound found in plants such as the Japanese knotweed, blueberries, peanuts, red grape skins, and others. While resveratrol has been recommended for fighting the physical effects of aging, a brand new study shows it reduced inflammation of the heart in the study's participants by 26%. Taking one 500 mg capsule of resveratrol daily with food will help you maintain a strong, healthy heart.”

By the way, after an hour of searching, I can find no reference to any human “brand new study” regarding resveratrol. In fact, if you examine his words carefully, he doesn’t refer to humans. He only refers to ”participants.” How misleading is that?

After initiating my research into the facts about resveratrol, yesterday, I received a publication from the National Institute of Aging, part of the National Institutes of Health, titled ‘Can We Prevent Aging?’

 

This publication offers a succinct review of all the current “anti-aging regiments available to us beyond a healthy lifestyle. It’s a fairly long publication, so I’ve taken the liberty to excerpt certain key sections under headings that I think would be helpful to my patients.

The headings include:

Antioxidants

Resveratrol

Hormone Therapy and “'Anti-Aging' Supplements”

Hormone Replacement Therapy

Testosterone

Bioidentical Hormone Therapy

Dehydroepiandrosterone, or DHEA

If you read anything I’ve sent you, read this. It’s an excellent up to date summary of the science regarding a number of popular, but unproven methods to decrease or reverse aging. For those of you who don’t have the time or inclination to read it, here’s the National Institute of Aging’s summary:

Until more is known about antioxidants, resveratrol, and hormone supplements, consumers should view these types of supplements with a good deal of caution and doubt. Despite what advertisements on television, the internet, and magazines may claim, there are no specific therapies proven to prevent aging. Some harmful side effects already have been discovered; additional research may uncover others.

On Antioxidants:

Antioxidants protect the body from the harmful effects of by-products known as free radicals, made normally when the body changes oxygen and food into energy. The discovery of antioxidants raised hopes that people could slow aging simply by adding them to the diet. So far, studies of antioxidant-laden foods and supplements in humans have yielded little support for this conclusion. Further research, including large-scale epidemiological studies, might clarify whether dietary antioxidants can help people live longer, healthier lives. For now, although the effectiveness of dietary antioxidant supplementation remains controversial, there is positive evidence for the health benefits of fruits and vegetables.

On Resveratrol:

In one study, scientists compared two groups of overweight mice on a high-fat diet. One group was given a high dose of resveratrol together with the high-fat diet. The overweight mice receiving resveratrol were healthier and lived longer than the overweight mice that did not get resveratrol. In a follow-up study, researchers found that, when started at middle age, resveratrol slowed age-related deterioration and functional decline of mice on a standard diet, but did not increase longevity. A recent study in humans reported that resveratrol may have some similar health benefits to those in animals; however, it is still too early to make any definitive conclusions about how resveratrol affects human health and aging. More research is needed before scientists know if there is a proper and safe dose of resveratrol or if it has any clinical applicability in people.

 

On Hormone Therapy and “'Anti-Aging' Supplements”:

Higher concentrations of hormones in your body are not necessarily better. And, a decrease in hormone concentration with age is not necessarily a bad thing. The body maintains a delicate balance between how much hormone it produces and how much it needs to function properly. Natural hormone production fluctuates throughout the day. That means that the amount of hormone in your blood when you wake up may be different 2, 12, or 20 hours later.

If you take hormone supplements, especially without medical supervision, you can adversely affect this tightly controlled, regulated system. Replacement or supplemental hormones cannot replicate your body’s natural variation. Because hormonal balance is so intricate, too much of a hormone in your system may actually cause the opposite of the intended effect. For example, taking a hormone supplement can cause your own hormone regulation to stop working. Or, your body may process the supplements differently than the naturally produced hormone, causing an alternate, undesired effect. It is also possible that a supplement could amplify negative side effects of the hormone naturally produced by the body. At this point, scientists do not know all the consequences.

Some hormone-like products are sold over the counter without a prescription. Using them can be dangerous. Products that are marketed as dietary supplements are not approved or regulated by the FDA. That is, companies making dietary supplements do not need to provide any proof that their products are safe and effective before selling them. There is no guarantee that the “recommended” dosage is safe, that the same amount of active ingredients is in every bottle, or that the substance is what the company claims. What you bought over the counter may not have been thoroughly studied, and potential negative side effects may not be understood or defined. In addition, these over-the-counter products may interfere with your other medications. NIA does not recommend taking any supplement touted as an “anti-aging” remedy because there is no proof of effectiveness and the health risks of short- and long-term use are largely unknown.”

On Hormone Replacement Therapy:
Here’s what scientists know:

• Endometrial problems—While estrogen helps some women with symptom management during and after menopause, it can raise the risk of certain problems. Estrogen may cause a thickening of the lining of the uterus (endometrium) and increase the risk of endometrial cancer. To lessen these risks, doctors now prescribe progesterone or a progestin, in combination with estrogen, to women with a uterus to protect the lining.
• Heart disease—The role of estrogen in heart disease is complex. Early studies suggested MHT could lower postmenopausal women’s risk for heart disease—the number one killer of women in the United States. But results from the NIH Women’s Health Initiative (WHI) suggest that using estrogen with or without a progestin after menopause does not protect women from heart disease and may even increase their risk.

In 2002, WHI scientists reported that using estrogen plus progestin actually elevates some postmenopausal women’s chance of developing heart disease, stroke, blood clots, and breast cancer, but women also experienced fewer hip fractures and cases of colorectal cancer. In 2004, WHI scientists published another report, this time on postmenopausal women who used estrogen alone, which had some similar findings: women had an increased risk of stroke and blood clots, but fewer hip fractures. Then, in 2007, a closer analysis of the WHI results indicated that younger women, ages 50 to 59 at the start of the trial, who used estrogen alone, had significantly less calcified plaque in their coronary arteries than women not using estrogen. Increased plaque in coronary arteries is a risk factor for heart attacks. Scientists also noted that the risk of heart attack increased in women who started MHT more than 10 years after menopause (especially if these women had menopausal symptoms). There was no evidence of increased risk of heart attack in women who began MHT within 10 years of going through menopause.

• Dementia—Some observational studies have suggested that estrogen may protect against Alzheimer’s disease. However, testing in clinical trials in older, postmenopausal women has challenged that view. In 2003, researchers leading the WHI Memory Study (WHIMS), a substudy of the WHI, reported that women age 65 and older who took one kind of estrogen combined with progestin were at twice the risk for developing dementia compared to women who did not take any hormones. In 2004, WHIMS scientists reported that using the same kind of estrogen alone also increased the risk of developing dementia in women age 65 and older compared to women not taking any hormones. What possibly accounts for the different findings between the observational and clinical studies? One central issue may be timing. The women in the WHIMS trial started treatment a decade or more after menopause. In observational studies that reported estrogen’s positive effects on cognition, the majority of women began treatment soon after menopause. This has led researchers to wonder if it may be advantageous to begin treatment earlier, at a time closer to menopause. Additionally, it appears that progesterone and progestins (progesterone-like compounds) differ in their impact on brain health.

Despite research thus far, there are still many unknowns about the risks and benefits of MHT. For instance, because women in their early 50’s were only a small part of the WHI, scientists do not yet know if certain risks are applicable to younger women who use estrogen to relieve their symptoms during the menopausal transition.

 

On Testosterone:

“The bottom line: there is no scientific proof that testosterone treatment in healthy men will help them age better. Until more scientifically rigorous studies are conducted, it is not known if the possible benefits of testosterone therapy outweigh any of its potential risks. NIA continues to conduct research to gather more evidence about the effects of testosterone treatment in aging men.”

On Bioidentical Hormone Therapy:

“Large clinical trials of these compounded hormones have not been done, and many bioidentical hormones that are available without a prescription are not regulated or approved for safety and efficacy by the FDA.”

On Dehydroepiandrosterone, or DHEA:

“[S]ome proponents claim that over-the-counter DHEA supplements can improve energy and strength and boost immunity. Claims are also made that supplements increase muscle and decrease fat. To date, there is no conclusive scientific evidence that DHEA supplements have any of these benefits.
The conversion of naturally produced DHEA into estrogen and testosterone is highly individualized. There is no way to predict who will make more or less of these hormones. Having an excess of testosterone or estrogen in your body could be risky.
Scientists do not yet know the effects of long-term (defined as over 1 year) use of DHEA supplements. Early indications are that these supplements, even when taken briefly, may have detrimental effects on the body, including liver damage.”
“Researchers are working to find more definite answers about DHEA’s effects on aging, muscles, and the immune system. In the meantime, if you are thinking about taking DHEA supplements, be aware that the effects are not fully known and might turn out to cause more harm than good.”



Conclusion:
Until more is known about antioxidants, resveratrol, and hormone supplements, consumers should view these types of supplements with a good deal of caution and doubt. Despite what advertisements on television, the internet, and magazines may claim, there are no specific therapies proven to prevent aging. Some harmful side effects already have been discovered; additional research may uncover others.

I  hope this information has been helpful and as always, please feel free to share your comments.

A New York State of Mind - Ban Soda!

The big health related headline today is that New York City is banning the sale of cups larger than 16 oz. of sweetened sodas. NYC's plan to enact a far-reaching ban on the sale of large sodas and other sugary drinks at restaurants, movie theaters and street carts, in the most ambitious effort yet by NY Mayor Michael Bloomberg to combat rising obesity.

The New York Times

"The proposed ban would affect virtually the entire menu of popular sugary drinks found in delis, fast-food franchises and even sports arenas, from energy drinks to pre-sweetened iced teas. The sale of any cup or bottle of sweetened drink larger than 16 fluid ounces — about the size of a medium coffee, and smaller than a common soda bottle — would be prohibited under the first-in-the-nation plan, which could take effect as soon as next March. 

The measure would not apply to diet sodas, fruit juices, dairy-based drinks like milkshakes, or alcoholic beverages; it would not extend to beverages sold in grocery or convenience stores."

Is this a good thing? I am reluctant to criticize any measure or effort to combat obesity, but I am on the fence here. If this is merely the next salvo in the battle to incrementally decrease the consumption of unhealthy food by bringing attention to it and making its consumption more labor intensive, I vote thumbs up.  I applaud Mayor Bloomberg's desire to do something that is readily available to him without getting legislative consent.

My issue is that while sweetened sodas and drinks are an easy path to consumption of unhealthy calories, they may drive higher consumption of unhealthy fruit juices and smoothies (concentrated with fructose), which can also be counted as contributing to the excessive weight epidemic. I would prefer to see warning labels prominently displayed that identify foods that contain an unhealthy amount of simple carbohydrates of a processed nature with a viable alternative available. You can't sustain bans without making sure that a viable alternative is immediately accessible. 

I also prefer education and coaching over food bans (except in the case of the silent killer -- trans-fats.)  We need to educate the populace more explicitly regarding the harms perpetuated by all these sugar-heavy beverages. 

What's the big deal with high sugar consumption? In each of the past few days, I've diagnosed a patient with pre-diabetes. Everyone knows about the dangers of diabetes, but there is not enough discussion about pre-diabetes and that is a huge problem. Yesterday's blog covered the increased benefits of exercising while still pre-diabetic versus diabetic. With nearly 80 million pre-diabetics already in the U.S. and that number steadily climbing, we need to do a lot more than just force people to get refills (still allowed) of sweetened drinks.

Given the nature of this public health crisis, the government should declare war and wage battle as it would against any real enemy of this country. The threats to our nation based on the rising levels of obesity, diabetes, pre-diabetes, depression, dementia,etc. are as threatening to our safety and security as any faced by Homeland Security.  Isn't it time we treated it as such? 

Beyond Ecstatic!

I read something this morning that validates the value of prevention in a profound manner and reinforced my convictions and sense of mission. It started with some bad news, but it got much better.

The bad news was that a recent pilot study,  led by Sabyasachi Sen, MD, from Baystate Medical Center in Springfield, Mass., and colleagues, showed that prediabetics have similar micro-vascular dysfunction as diabetics. Prediabetes is generally defined as fasting blood sugar between 100 and 125. Vascular dysfunction refers to the changes to the flexibility of arteries that contributes toward stroke, heart disease, and death. The less flexible your arteries, due to factors such as hardening of the arteries, the greater the vascular dysfunction.  It's long been known that diabetics have vascular problems, but this study showed that so do prediabetics. This is bad news because it is estimated that  nearly 80 million Americans are already prediabetic and that number is expected to steadily grow as the obesity rate grows.

The good news was that unlike with diabetics, aerobic exercise can have a profound effect. It's not to say that exercise doesn't help diabetics; rather, exercise has a dramatic impact on prediabetics. The researchers found that "exercise improves vessel function almost back to normal status, which is not the case with diabetes. It's been shown that exercise only improves the vascular reactivity of diabetics by half of what was achieved during the study."

The implications of the study is that there is a therapeutic window (an ideal period to treat) for prediabetics to return their vascular function to normal with a non-pharmacologic (no drugs) intervention. Aerobic exercise can "reduce the cardiovascular risk in a patient population that is at risk of developing diabetes."

The patients involved in the study did not have high blood pressure and were fairly active but not undergoing any type of formal exercise program. The exercise consisted of 150 minutes per week at 70% of the maximum heart rate, which is considered moderate exercise by American Diabetes Association criteria. This leads me to believe that those who are hypertensive and live sedentary lives will garner even greater benefit from increasing their exercise.

The implication of this study is further support of the Ben Franklin adage, "an ounce of prevention is worth a pound of cure."  Don't wait until you are diagnosed with diabetes. Don't wait until you add the next few pounds and become further overweight and obese. Don't wait until you find out you have heart disease or suffer a heart attack or stroke. Get more exercise today when your efforts will yield far greater results. You only have one life to live and one body to live it in. Get up now and start exercising! You must do it and you can.