Waiting for cancer?

Let me tell you a very personal story. About three weeks ago, I got a phone call in the evening from a close relative. During the call, I was informed that this person had been diagnosed with cancer. A week later the person called again and notified me that a second cancer had also been diagnosed.  I was devastated and I am still reeling from the news. I love this person very much and can only imagine how dreadful it is for someone to be diagnosed with cancer and what fear it must invoke. Of course, when a close relative develops a serious illness, other family members are surely also concerned about the risk to their own health of developing a similar disease.  Such news brings pain to all quarters.

According to the American Cancer Society, the risk of a man developing cancer is 1 in 2 and of dying of cancer is 1 in 4. The risk of a woman developing cancer is 1 in 3 and of dying of cancer is 1 in 5. You have to be a Luddite not to be concerned about such odds and the personal risk to you of developing this horrific illness.

Although there is clearly a genetic basis for some people to develop cancer, most cancers are random mutations.  In general, it is now believed by credible scientists that virtually all people have cancers cells of one type or another in their bodies at all times due to such random mutations. However, their properly functioning immune system is often capable of dispatching with most of these fledgling cancer cells before they develop into life-threatening tumors.

At this point you may be thinking that if it's only a question of odds, then why not just hope that you will be lucky because what else can you do?  Well, I am here to tell you that there may be a lot to do.

It's well known that professional gamblers using a variety of techniques are able to improve their odds in casinos. For example, counting cards while playing the card game black jack shifts the odds in one's favor over the house. Such subtle shifts can make the difference between vast losses and gains.

In life, can there be any greater loss than the loss of health?

As with gambling, certain human behaviors shift the odds in favor of avoiding or even curing cancer.

Dr. Dean Ornish, in a landmark experiment, demonstrated that a change in diet could stop the expression of prostate cancer. In a limited study, he showed that with certain men, he could arrest the progression of the disease.

It is well established that breast cancer survivors who are overweight have a much higher rate of recurrence of their cancer than comparative normal weight ladies.

There are countless credible studies that support the role of diet and lifestyle in cancer development and death and at this point, almost all doctors agree that lifestyle, including diet, plays a major role in one's health and risk of dying from cancer.

Let's get back to my painful story. After researching the specific types of cancers that my relative had developed, I offered directed recommendations regarding changes in diet and lifestyle that offered hope for improved health and survivability.  After sharing a number of suggested changes, my close relative suddenly uttered that he/she was not prepared to go crazy about his/her diet.

What prompted this response?  My suggestion to eliminate all processed sugar products from the diet.

There has developed a growing body of evidence that sugar stimulates the growth of cancer. It does so by causing the release of insulin which binds to insulin receptors on the surface of solid tumors and stimulates them to grow faster.

When I shared this with a friend yesterday, she asked me why she hadn't heard about the role of sugar in cancer before?  She said her father had died from cancer and one of the country's leading oncologists had never mentioned the need for her father to avoid the sweet stuff.  Unsure of how long it had been since her father passed, I queried and she said that it was about ten years ago.  My response to her question was that scientists did not have as clear an understanding ten years ago as they do today about the dangers of sugar and other dietary intakes on their role in cancer development, progression, and survivability.

As fate would have it, a patient gave me an article two days ago that recently appeared in Mother Jones magazine chronicling the efforts of the sugar industry to suppress the alarming facts regarding the dangers of sugar not only for cancer development, but for heart disease and diabetes as well. Like Big Tobacco before it, the sugar industry has been very successful in confusing the general population into being unalarmed and apathetic about the dangers that sugar poses.

It's gotten so bad that most people actually believe that eating sugar 'in moderation' (however they define moderation) poses no threat to their health. Yet, our country suffers from an epidemic of obesity, heart disease, diabetes and dementia, with a rising tide of metabolic syndrome in which people have elevated blood pressure, sugar and cholesterol.

It may be unfair to single out sugar and its precursors (high glycemic index carbohydrates) as the worst culprits, but the label may actually be accurate. Clearly there are numerous other protagonists responsible for our health problems, including trans-fats, saturated fats, food additives, etc., but sugar laden products such as those containing High Fructose Corn Syrup, deserve special attention.

There are many ways to die, but I can't imagine a much worse way that wasting away from cancer. I still vividly remember as a medical student when I was asked to see a patient in the hospital.  As I entered the room, I saw a very jaundiced looking man with the outlined remains of what I could only imagine were once extremely good looks, who had wasted away and was now close to death from cancer. After addressing his immediate concern for which I had been summoned, I asked if there was anything else I could get him. I still get chills thinking about his response. He answered softly, but assuredly, that I could give him back his health. Then he smiled at me, apparently resigned to his fate.  He died a few days later.

As scientists now know about the major role that food plays in the cancer story, it would be a shame not to take heed of preventive measures that could very well save your life and allow you to enjoy many more years of disease-free living.  I wish I knew in medical school what I know now and I wish I had been able to do more for this stranger. He is long gone, but there are many more than can be helped now.

Let me start by suggesting some basic rules of staying healthy. The top rule is to eat mostly foods that have no labels, such as fruits and vegetables.  Enjoy large amounts of beans, lentils, chickpeas, nuts, and seeds. Consume whole grains on a regular basis particularly the ancient grains such as spelt, quinoa, and millet. Make Wild Salmon a staple of your dinner table, consuming it even every other day if possible.

Of course, you can ignore this advice and gamble with your life and the increased risk of developing cancer.  Or maybe, you now understand the risks and aren't willing to play the odds.

In addition, make sure that you stay physically active by walking at least 7,500 steps (3.75 miles) per day with at least 15 minutes of more intense exertion each day. Get at least 7 hours of sleep a night with at least 3-4 hours of uninterrupted sleep. Manage your stress by learning techniques to deal with life's inevitable stressors such as relatives informing you that they are ill.

The great American poet Robert Frost once wrote that "two roads diverged in the woods" and he "took the one less traveled by, And that has made all the difference."

Are you going to stay on the road traveled by most people of eating whatever they want blinded to the dangers of developing cancer and other horrible diseases that prematurely shorten their lives or simply make life far more difficult OR will you take the road less traveled by, by eating healthier and see if that makes all the difference?

Are you waiting for cancer? Please don't. It's not worth the wait.

Do Multivitamins Prevent Cancer? Part 2

The media is having a field day with the recent study titled Physician Health Study II (PHS II) which claims that multivitamins may slightly decrease cancer rates among men.  If you simply read the headlines and you are a man that wants to decrease your risk of developing cancer, you would think that you should immediately run out and buy a multivitamin, and if you are taking one, you should keep taking it.

Don't!

The results are not quite living up to all the hype.

According to the study, after 11.4 years of taking multivitamins, only men, predominantly older than 70, showed mild decreases in certain cancers. In fact, this study included men who had previously been diagnosed with cancer, among whom for some unknown reasons were found the best results.

This study, paid for by the multivitamin manufacturers, including Pfizer, actually showed the following:

Slight increases in prostate cancer (662 placebo takers versus 667 among multivitamin users) and melanoma (89 increased to 100).
Slight decreases in total cancer (1253 to 1195).
Slight decrease in colon cancer (95 to 88).
Total mortality (death) slightly decreased from 1,134 to 1,092. That means for over 13,000 total men in the study, there were still over 2,200 deaths and only a decrease of 42 total deaths.

Get this. By my calculation, over 26,000,000 (million) pills over 11 years were taken by 6,660 men to spare 42 deaths. Ouch!  No wonder the drug companies want to push the results of such a study.

Basically, the men who took a daily multivitamin for over 11 years so no improvement in prostate, colon, and bladder cancer and no change in their overall cancer mortality. Also, a careful review of the study shows that the multivitamin users were also slightly less likely to smoke and slightly more likely to eat fruits and vegetables.

Finally, the study did not identify if any of the men had vitamin deficiencies prior to the start of the study. As they focused on physicians, who generally work long hours, there is a high probability that these men spent little time in the sun and therefore had an increased risk of Vitamin D inadequacy or deficiency.

Ladies and gentleman, overall, this study and the numbers presented basically prove nothing. With the overall cancer rate decreasing from 18.4 to 17.6 for every 1,000 years, there remains no reason to believe that multivitamins offer any benefit in the absence of deficiency.

The bottom line is that most importantly, despite taking a multivitamin every day, about 20% of the men still developed cancer and about 20% died.  Save your money!


So once again you are chastened to remember, Caveat Lector! (Let the reader beware).

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.

Press Release For Thursday July 5, 2012

MDPrevent & Consumer Reports Agree 
On The Need For Preventive Medicine

MDPrevent Offers The “Prevention Attention” 
Advocated For By July 2012 Issue

MDPrevent, a primary care medical practice focused on preventive medicine and wellness offers the full range of preventive medicine and wellness services desired by patients.

Delray Beach, FL July 3, 2012

According to Consumer Reports on Health (CR), “Immunizations, cancer screenings, lifestyle counseling, and other wellness measures can save lives. But your doctor may be falling short when it comes to making sure you’re up to date on the services you need.” CR cites a January 2012 study published in the American Journal of Preventive Medicine to support is conclusions.

CR is spot on. In 2011, Medicare implemented new coverage for Annual Wellness Visits (AWV) as part of a growing menu of preventive services. As with many other preventive services, the AWV requires no co-payment or deductible.  Yet, in 2011, only 6% of patients received this service from doctors who performed it and many did not receive the proper service. Why? As CR writes, “wellness gets squeezed” because “it doesn’t pay for doctors” to do it, for many doctors “its awkward territory,” and “most doctors don’t have the time.” Wellness, according to CR, when even done, is typically not the “focal point”; rather, “wellness gets squeezed into visits when people have a problem.”  

Working within Medicare’s guidelines for AWV, MDPrevent, a primary care, preventive medicine, and wellness center was launched to fully address the wellness needs of Americans. MDPrevent’s innovative medical practice combines in one location the expertise needed to provide the full spectrum of wellness services. With a team consisting of a physician, nurse practitioner, nutritionist/registered dietitian, health psychologist, fitness and yoga instructor, and health educator, MDPrevent can uniquely help patients enjoy life to the fullest, free of disease.

The MDPrevent model is sure to become the future of integrative medicine enabling patients to draw on the full expertise and guidance they need from their primary care office to avoid, delay, or mitigate chronic diseases and improve their current quality of life.

As one part of MDPrevent’s offerings, it custom developed the LEAN program, a medically supervised 12 week personalized lifestyle modification program that includes initial medical assessment, coupled with private consultations with a nutritionist/dietitian, psychologist, fitness and yoga instructor, and health educator, and rounded out with a final medical assessment. Patients then continue with private consultations as needed or join support group and educational group sessions. The program aims for slow, but steady and sustainable lifestyle modification and weight loss by focusing on healthy living and well-being. In addition, MDPrevent is also a Certified Diabetes Education Center catering to the nutritional and educational needs of diabetics.

MDPrevent was founded by Dr. Steven Charlap, a pioneering physician with an MD from New York University, an MBA from Harvard, and general surgery training. In 1989, he founded HealthDrive, which grew it to be the largest U.S. medical and dental practice serving the extended care industry. Over twenty years, HealthDrive cared for over 5 million seniors and Dr. Charlap witnessed first-hand what happens to people who don’t take adequate care of their health, are institutionalized and become dependent on the kindness of strangers. According to Dr. Charlap, “It is sad to see people end their lives in a nursing home. You realize that in such a setting relatively little can be done to improve health at that point. Even more frustrating was that one couldn’t even try because Medicare and Medicaid basically shunned preventive services.”

In 2010, after Dr. Charlap learned that Medicare was initiating coverage for wellness services that can positively impact people’s lives while saving Medicare money, he founded MDPrevent to create an innovative preventive medicine, primary care, and education center focused on providing community based services to help people change their lifestyles to avoid and mitigate chronic diseases. Dr. Charlap states, “The scientific evidence shows that the longer you live, the healthier you’ve been.” After extensive research and consultations with the experts in the field of primary prevention, an interdisciplinary dream team of Preventioneers was assembled.

Testimonials from patients include comments like, “I finally have my head on straight” or “it’s changed my life.” (See www.mymdprevent.com, Testimonials). According to Dr. Charlap, “I see the smiles on people’s faces when they complete a session for the day. They feel empowered and for the first time in a long time, in control of their health and their weight. I know we are really on to something that can change the future of healthcare.”

About MDPrevent

MDPrevent is a new concept in primary care that seamlessly integrates primary care, preventive medicine, and wellness. The healthcare practice helps American’s prevent problems before they happen, reduce healthcare costs, stay healthy, and enjoy a life well lived through free Annual Wellness Visits (paid 100% by Medicare and most major insurances) The Annual Wellness Visit includes a comprehensive health risk assessment, biometric measurements, review and analysis of prescription, supplement and vitamin use, nutrition review, and development of a five- to 10-year prevention plan.

MDPrevent’s Preventioneers, or Prevention Pioneers, include MDs, nurse practitioners, health psychologists, registered dietitians and nutritionists, fitness and yoga instructors, and health educators, offer private consultations and experiential group sessions, medically supervised weight loss (with no pills, injections or surgery - paid 100% by most insurances if you qualify) and other classes on health, diet and nutrition, fitness and exercise, stress management, mindfulness, relationship and social network building, and other key elements of a healthy life. The goal: to improve life and smooth out the effects of aging by identifying, preventing, delaying or mitigating the development of chronic diseases such as heart disease, diabetes, stroke, dementia and some forms of cancer. Learn more at http://www.MyMDPrevent.com. Read Dr. Charlap’s blog at mdprevent.blogspot.com

MDPrevent
5130 Linton Blvd. Suite H1

Delray Beach, FL 33484
(561) 807-2561

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? 

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.

Why We Live Longer Is More Important Than How Long We Live

I recently came across an article written by Michael Wolff that appeared in New York Magazine titled, "Mom, I Love You. I Also Wish You Were Dead. And I Expect You Do, Too." The gist of the article is that there is no good reason to live longer. The author paints a picture that living longer means a more painful, slow death.

It is a frightful article written by someone who is clearly in pain watching his mother suffer from a terminable illness. However, it is also just plain wrong. The fact that the author makes statements with reckless abandonment may be forgiven given his state of mind. But, I don't believe for one moment that what he has to say is true in most cases of extended longevity.  Why? Because the scientific facts speak otherwise.

A recent study from the Longevity Genes Project, launched by the Albert Einstein College of Medicine in New York City, supports my assertion. The results of the study, focused on near-centenarians, showed that the majority of  them were found to be "relaxed, friendly, conscientious and upbeat about life." Importantly, added the authors, "an easy laugh and an active social life were observed to be a group norm, while neuroticism was notably the exception. What's more, feelings were more commonly shared as they arose, rather than stifled and squelched." Not quite the doom and gloom reported by Mr. Wolff.

Mr. Wolff would have his readers believe that dementia strikes virtually everyone as we age. In fact, less than 50% of Americans over 85 develop dementia and about a quarter of all dementias are now directly linked to lifestyle, and thereby, may be preventable. What I think was missed by Michael is that why you live longer is as important as what that life looks like.

If you live longer only due to the miracles of modern science and technology, such a life may not be worth living. The goal is not to be alive at any cost, strapped to money machines that ka-ching with every passing moment. The reason to live longer is to enjoy more healthy years of life free of disability and pain.

A second recent study, that helps confirm healthy living can extend life even in the retirement years, demonstrates how to achieve such a life.  Led by Emily Nicklett, an assistant professor of social work at the University of Michigan School of Social Work, in Ann Arbor, the study, which was designed to explore the impact of exercise and nutrition together, found that women who were both the most physically active and the highest consumers of fruits and vegetables were eight times more likely to be alive after the study's five years of follow-up, compared to women who scored lowest on both counts.


There you have it. By living a healthy lifestyle, the women in the Michigan study avoided premature death and reported living quality lives. It's not surprising because exercise and good nutrition have been shown repeatedly to keep depression, dementia, falls, cancer, diabetes, heart disease, and stroke at bay for long periods of time.

The bottom line is we all eventually die and how we die is often unpredictable. But living a healthy lifestyle increases the probability of enjoying more good years. Michael Wolff ultimately misses the real point. If his mother had taken ill a number of years earlier, would the situation have been any less poignant and painful? Watching a parent suffer at any age is difficult for most children. Having a few more good years with the parent(s) before the process begins is a gift.

So if you want to live a longer, functional, and disease-free life, a word to the wise should be sufficient. Learn how to eat properly and get enough exercise to remain in good form and fitness. Michael Wolff may long for his mother's passing, but I long to keep my patients healthy and enjoying life for many more years because it beats the alternative.

Better Than The Alternative

It's often been said that laughter is the best medicine. Humor can also be a great way to communicate bad news in a less offensive manner. I love this cartoon because it really summarizes the reality of the situation for people who live sedentary lifestyles or hardly exercise.

Study after study now shows the dramatic impact that moderate physical activity has on your health. It reduces heart attacks and strokes, improves cognitive function and memory, alleviates depression, prevents and reduces the consequences of diabetes, etc.  The flip side is that lack of exercise increases your risk for osteoporosis and dementia. Bad things happen to people who don't move!

So folks, what are you waiting for? If you don't like gyms, find a hobby that requires physical exertion. Take steps, park far away from your destination, mow the lawn, wash the car, wash it again, whatever you do just keep moving. Get up, get out, and live the one life you have to the fullest.

 You may find this cartoon amusing, but don't let it be you. 

You are only fooling yourself by pretending to exercise.

A word to the wise should be sufficient.

Prevention May Be The Best Path

Did you hear the good news? Yesterday, researchers at Duke University using a new model, predicted that by 2030, only 42% of Americans will be obese. Today that number is 36%, but the apparent good news is that a previous model predicted it would be 51%.  At the same time, the researchers predict that severe obesity would rise to 11% instead of the previously predicted 9%. 

The reasons for the discrepancy were described as the researchers taking into account factors such as unemployment rates; prices for alcohol, gas, and fast food; prices of healthy versus unhealthy foods; access to the Internet; and the number of fast-food and full-service restaurants per 10,000 people.

So is this really good news? Should we break out the champagne or the tissues? I find it hard to imagine that nearly half of all Americans will be considered obese in less than twenty years. But what is even more difficult to absorb is that our government is not obsessing about this problem.

This year, the Centers for Medicare and Medicaid Services (CMS) took a big step forward and initiated coverage of Intensive Behavioral Therapy for Obesity. They define obesity as a body mass index (BMI) of 30, which is about a 5 foot 4 inch woman weighing about 170 pounds or a 5 foot 9 man weighing about 200 pounds.  The problem is that if your BMI is 29.9, you are out of luck. At that number, you are entitled to no therapy whatsoever.

I can appreciate that there needs to be a threshold at some level, but I believe it should be several BMI points lower. Why wait until someone is already obese to intervene? Studies show that many things change including our gut bacteria, metabolism, and hormonal balances as we gain weight. Basically, it gets harder to lose weight the more you gain AND it gets harder to keep it off after we gain it and try to lose it again.

The other problem with CMS's obesity initiative is that the reimbursement is approximately $27 for 15 minutes up to 16 times spread across 6 months (6 more spread across the next 6 months if you lose 6.6 pounds after the first 6 months). That extrapolates to about $108 per hour, far below what the average primary care physician, which is the only type of physician that can offer the service, earns before overhead, staff, malpractice insurance, billing costs, etc.

Multiple google searches have failed to identify a single doctor or practice in the U.S. offering this service. I can find no practice marketing it. I also asked dozens of primary care providers and they have said they do not as well.

Is it the low reimbursement? Maybe. Is it the lack of knowledge necessary to provide intensive behavioral therapy? Maybe? Is it the reluctance of doctors to tackle their patients' obesity?  I can only say maybe again because I don't really know any of these answers as to why other doctors choose as they do. But I do know we have a problem and it's not just doctor engagement.

I think the real problem is the patients.  Tackling obesity with just primary care practitioner led therapy, instead of pills and surgery, requires real commitment on the part of patients. Obese patients know they have a health problem and that their long term health prospects are at play. Most also know that obesity is not particularly attractive. Yet, whether you believe it is a disease or a choice, these same people find it difficult to tackle their issue. Few prefer to be so overweight and need help to break out of their weight captivity.

So what do we do about this problem? Some may say financial incentives. I don't think that is a long term solution and I have previously explained why. While short-term incentives may work, weight is often easily regained unless fundamental changes to lifestyle are made and such changes can most of the time only be brought about by a concerted effort.

So how do we do that? I propose an integrated and interdisciplinary approach. In other words, I think it will take a team effort of motivated, committed, and trained practitioners to support, guide and educate patients to bring about real change. About 4 months ago, MDPrevent proposed such a model to CMS. MDPrevent asked for funds, to which I and others would contribute additional funds, to tackle not only the rising epidemic of obesity, but also heart disease, diabetes, dementia, and cancer.

MDPrevent's program, which we titled, Intensive and Integrated Behavioral Therapy for Lifestyle Modification would combine the talents of a primary care provider, a registered dietitian, a health psychologist, a fitness instructor, and a health educator to work with patients on both an individual and group (group success can be contagious) basis and help them tap into their own motivation to make change.

We anticipated that it would take a full year to bring about meaningful success and expected to be able to do so at a cost of slightly above $600 per patient. For this meager amount, we believe that we can change the course of someone's health and life trajectory.

Can anyone argue that it isn't worth the effort given the obesity and other chronic disease projectories? There is no profit for MDPrevent in the amounts requested because we believe that we must first prove the success of such a program before profits can even be considered.

The goal of the program is to identify and tackle pre-obesity, pre-diabetes, pre-stroke, pre-heart attack, and pre-cancer situations and implement a series of lifestyle changes to prevent, delay or even mitigate the development of these life threatening conditions.

The decision from CMS regarding funding this initiative was originally due March 30. We are in overtime. I am told it will come shortly. This program could be a game-changer for the country at large. Wish us luck!

Look In The Mirror. Part 2. Better To Buy A Bike!

Yesterday, I wrote about the dangers of using the services of a mobile testing company. As fate would have it, after writing my piece, I received a solicitation from one such company.

The solicitation included a marketing flyer, which on one side was titled, "6 Reasons for Regular Screening." Let's analyze their reasoning.

1. Your health changes over time.

Based on this logic, we should be doing all sorts of testing all the time because we never know when our health changes.  Applying this principle, this should include blood tests, ekgs, x-rays, CT scans, MRIs, PET scans, ultrasounds, cardiac-stress tests, spinal-taps, endoscopies, etc. If you agree with their thought process, why exclude more elaborate tests that are better detectors of problems. The answer is because most of the tests they do are unnecessary, because the tests are not free, because you can't obsess about your health by constant testing (a little neuroticsm is ok), and most importantly, because you are likely to get many false positives that will lead to further stress and unnecessary testing.

2. Your physician usually cannot order these screenings unless symptoms are present.

That's an easy one. Good physicians don't go on wild goose chases looking for problems. When they hear hoof-beats, they think of horses, not zebras, and they use the proper tools to diagnose the problem(s) the patient shares with them.

That said, certain medical tests are covered and recommended in the absence of symptoms because the evidence for thier prospective use has been carefully evaluated by the United States Preventive Sevices Task Force (USPSTF) and determined to be of good use. However, these tests are generally covered by insurance and can be ordered by your doctor.

3. Your previous results may have revealed important risk factors.

This is a doozey. It reminds me of my experience with the pre-diabetes. Do they think (or hope) you ignored the previous abnormal results, did not bother to consult a medical professional, and should now return for another test only to keep repeating the process of excluding a medical consultation?  Apparently so. Testing in the absence of follow-up is dangerous. Do not be a doctient, a person who thinks he is both a patient and a doctor and can self diagnose and treat.

4. Screenings can help prevent stroke.

Screenings do not help prevent stroke. They may detect your increased risk for stroke after which you can consult a doctor for preventive measures. The issue here is that in the absence of sign and symptoms of stroke related disease, such as heart disease, diabetes, obesity, high blood pressure, high cholesterol, atrial fibrillation, etc., the probability of having a stroke is extremely low. If you have these medical issues, you are at higher risk for a stroke and you don't need a test to confirm the risk. You should take action immediately to decrease your risk by changing your lifestyle and seeing your physician for medical intervention.

5. Screenings can detect serious risk factors in just minutes.

If you have nothing better to do with your life, then by all means go for these unnecessary tests in the absence of sign and symptoms because maybe, just maybe they may find some abnormality that requires action you should have already taken anyway. But don't worry, they will confuse you fast.

6. You may suffer from Peripheral Arterial Disease (PAD).

That's a true statement. You may suffer from hardening of the arteries and about a thousand other diseases. Again, PAD itself is associated with heart disease, diabetes, obesity, high blood pressure, and high cholesterol. If you eat what you want and barely exercise, there is a high probability you will develop PAD at some point in life. You don't need this test, and in the absence of signs and symptoms, that is why it is not covered by insurance.

Many insurances today, including Medicare, offer a full range of preventive benefits, including screening tests, that have, based on the scientific evidence, been to be found worthwhile. Don't succumb to fancy marketing and be sucked into getting unnecessary testing.

If you have any concerns about your health, speak to your medical provider as soon as possible.

One final note, a study just published in the American Journal of Cardiology, focused on men who had at least one parent who'd had a heart attack before the age of 55. The study found that despite this apparent gentic predisposition to heart disease, those men with a healthier lifestyle were less likely to develop heart failure over two decades.

"Healthy habits included not smoking, exercising regularly, keeping a normal weight and drinking alcohol in moderation."

Many screening companies use your family history to scare you into unnecessary testing. The bottom-line remains that testing doesn't prevent disease--you do by the lifestyle you live. Save your money on testing and buy a bicycle or some other piece of exercise equipment. It will do you more good.

Just Look In the Mirror

I read an interesting article yesterday on the Fox Business website titled DIY health care: The trouble with direct-to-consumer health screenings. DIY stands for Do It Yourself.

The gist of the article describes the dangers associated with participating in unsolicited screening tests offered by commercial, usually mobile, companies. The article states that if "you get a letter in the mail inviting you to participate in a simple, potentially lifesaving screening to assess your risk for stroke, abdominal aortic aneurysms and other scary stuff, you should probably toss it out with the rest of the junk mail."

The article gives several reasons. One reason is the perils of self-diagnosis. (See my blog from March 14 titled, Are You A Doctient?) The article states, "People might buy direct-to-consumer health screenings for their own self-diagnosis and self-treatment for symptoms of disease. "It's difficult for the lay public to really appreciate the nuances and wholly understand the difference between screening and diagnostic testing. Many patients seek screening tests for symptom diagnosis. These patients can be dangerously falsely reassured by normal results if they have chosen the wrong test, or even led in the wrong direction with abnormal results."

The article adds, "Additionally, many of the medical screening tests are not supported by evidence-based guidelines and therefore expose patients to tremendous and unnecessary harm. "The data has shown that many of these tests [when used for disease screening] will produce far more harm than benefit for most patients." (See my blog on April 5 about unnecessary tests).  

One more consideration. According to Linda Sherry, director of national priorities for Consumer Action, agrees. "These tests have limited or no diagnostic value and may trigger stress [and] fear, and encourage further, more expensive testing to rule out false positives. Insurance won't pay for them unless they are ordered by a doctor for diagnostic reasons, not preventive reasons."

If you're looking to save money, "you can take your own blood pressure at most pharmacy chains and many communities have health screening days designed to educate people about symptoms that might require follow-up," says Sherry.

Read more: http://www.foxbusiness.com/personal-finance/2012/05/02/diy-health-care-trouble-with-direct-to-consumer-health-screenings/#ixzz1toa6ivop

On a personal note, I participated in such a screening program about a year ago offered by Lifeline Screening. I went for the whole megilla. I did so as part research and part curiosity. A routine blood sugar measurement revealed that I had a 105 level. Such a level is construed as elevated. (by the way, I noticed the tech eating a fruit shortly before th test and contact witht eh fruit could have skewed my result.) 

When sharing the blood results with me, the concerned technician told me that I was pre-diabetic and I should "watch" my number. The absurdity of the statement struck me immediately. What did "watch" my number even mean? He didn't tell me to consult with a physician. He just told me to "watch." Did he mean for me to use his services again to see how the number changed? He didn't say, but I suspect as much. Being pre-diabetic is a warning sign that requires intervention before you progress to full blown diabetes. Telling me to "watch" my number was worthless.

So what's a person to do?  I say instead of relying on marketing solicitations for tests that you probably don't need and should generally only be ordered by a physician when you do need them, let me offer some practical alternatives.

First get on a scale. Then calculate your BMI. Here's a good site to calculate it:

http://www.nhlbisupport.com/bmi/  

If your BMI is over 25, you are in unhealthy territory. Over 30 you are in a real danger zone. Over 40, start saying your goodbyes if you don't do something immediately about it.

Next measure your waist circumference. If you have a bulge around your waste, that typically means you are accumulating the unhealthy type of fat cells called white fat cells. They predict problems and just like with an elevated BMI, you should initiate changes to your lifestyle to improve your health prospects.  I recommend starting with a physician consultation and then moving on to a nutritionist and fitness instructor. If stress and/or sleep are a problem, consult a psychologist as well.

Finally, take a long, hard look at your naked self in the mirror. Do you see a healthy, vibrant, relaxed, age appropriate person in the mirror or a tired, slumped, over- or under-weight, stressed-out individual? Be honest with yourself. If you look good, you probably feel good and you are probably doing well. But if you look worn-out, haggard, depressed, older than your age, I think it's time to get serious about your health and to develop a personal wellness plan.By the way, while you are looking, check for any abnormal growths on any aspect of your body front and back, top and bottom.

Try doing this once a month to take stock of your life and health. It's free, it's easy and it will provide much valuable information that will not lead to unnecessary and expensive testing. So the next time you get a solicitation from a testing company, try making an airplane out of it for fun. Nevertheless, listen to your body and if you have any concerns, consult a physician.