Myth: Dr. Oz Can Be Trusted To Consistently Provide Reliable Information

It's been a while since I commented on the Dr. Oz show, but yesterday proved too much to bear.

On yesterday's Dr. Oz Show, the theme was how to lose weight and look good in a bathing suit. One of the schemes Dr. Oz put forth was to consume grapefruit juice mixed with apple cider vinegar three times a day before each meal because "it burns fat."

According to the Weight Control Information Network, operated by the National Institute of Diabetes and Digestive and Kidney Diseases, one of the National Institutes of Health,  it's simply not true. To quote:

"Myth: Certain foods, like grapefruit, celery, or cabbage soup, can burn fat and make you lose weight.

Fact: No foods can burn fat. Some foods with caffeine may speed up your metabolism (the way your body uses energy, or calories) for a short time, but they do not cause weight loss."

I know it's a free country and we can all say what we want, but give us a break. Why do we permit a licensed medical doctor to propagate nonsense to the masses that is wholly misleading and potentially dangerous? Why is there no outcry from the medical community regarding the endless stream of nonsense that pours out of this show, presented as science? People trust him because they don't know better, but a little investigation and research will show that many of the products he recommends have no reliable science to support them.

You may ask why do I even bother watching this science-fiction show presented as science? The reason is because Dr. Oz has emerged as one of the most respected public voices of health and wellness. His show is watched by many and he is ubiquitous; he is quoted across many media platforms from magazines to websites. He influences many with his words. People trust him and believe that the information he is providing is reliable and actionable. Accordingly, they buy the products he recommends because he is a trusted doctor. That's why I need to know what he is saying so I can counter the misinformation for my patients.

For example, on episodes that have aired over the past week or so, he recommended suma extract and astralagus for stress, griffonia simplicifolia as an appetite suppressant, and then 5-hydrotrptophan (5htp), which is also essentially griffonia simplicifolia, to be added to two baby aspirins every night for pain.

Ignoring the fact that none of these products have been clinically proven to be effective for the reasons he recommends and some haven't been proven to be effective for any valid medical use, it is irresponsible for him to recommend 2 aspirins every night as aspirin increases risk for bleeding and can cause ulcers. First, it should not bet taken without fluids at night because it can be corrosive to an empty stomach (he did not recommend any fluids), second, its long-term use should be carefully evaluated before taking due to its anticoagulant effects, and third and most importantly, if you are having pain every night before going to bed, that pain should be evaluated by a medical professional instead of self-prescribing pain medications.

I know that eventually people will come to their senses and recognize him as purely a showman and not a doctor that can be relied on for good medical product information.  In the interim, I'll keep banging my drum whenever he gets really out of line like he did the past week.

For more about Dr. Charlap or MDPrevent, please visit mymdprevent.com.

 MDPrevent

Doctors Need Help Tackling Their Patient's Weight Problems

An article appearing today at www.gantdaily.com  titled, Doctors And Insurers Are Key To Fighting Obesity, discusses the role that doctors must play in fighting the obesity epidemic.
Here is a quote from the article in reference to why doctors are not dong more.


"Many harried physicians are unprepared to advise people about how to change their behaviors, unconvinced they have time to do so, and therefore look skeptically at screening," said Dr. Robert Kushner, clinical director of the Comprehensive Center on Obesity at Northwestern University.

If doctors are overweight themselves, they’re less likely to recognize the issue in their patients, research shows. What’s more, doctors aren’t trained in medical school to handle weight issues. They also often aren’t convinced obesity treatments work, and many believe there aren’t good community programs to which they can refer patients.

 “The question is, how many programs are out there for primary care doctors to refer to in the community, and answer is – not many,” said Dr. Ned Calonge, a Colorado physician who is the immediate past chairman of the U.S. Preventive Services Task Force."

The writer reports these facts as if they are a revelation. They are not. In fact, they are at the very core of precisely why I founded MDPrevent.

People need a resource to turn to for weight help and by and large, doctors aren't a good one. But even doctors in the know can't do it alone. They need the help of others like nutritionists/registered dietitians. Yet, most nutritionists/registered dietitians are either hospital-based or working in solo practice. Very few are employed in physicians practice even though close integration with a doctor would ensure clear lines of communication. Even fewer nutritionists/registered dietitians work along-side a health psychologist and a fitness instructor. The combination of a primary care practitioner, nutritionist/registered dietitian, health psychologist and fitness instructor are at the epicenter of the solution to the problems that cause obesity. People need help with this disease and this type of dream team can offer such focused, integrated help.

The good news is that at MDPrevent it is not a dream because we have brought together these four quintessential provider types. We have also implored the government to fund our efforts to grow this model so instead of keep talking, writing, blogging about the problem, we can actually do something about it.

I hope the government is listening because the problem will not go away on its own and MDPrevent has a viable, cost-effective solution.

Another Reason To Go Wild Over Wild Salmon

Too many doctors have bought into the hyperbole regarding vitamins and other dietary supplements, often recommending them without all the facts. Some even go so far as to sell them without regard to consequences. Don't even get me started again about Dr. Oz.

For example, there has been such a preponderance of media coverage about Vitamin D deficiencies that you would think that everyone has a Vitamin D deficiency. It's simply not true. We often search without success.

Nevertheless, by now, unless you have been living in a cave, you've most likely heard the Vitamin D Story. If not, it goes like this. We need Vitamin D and we can get from 15 minutes a day of sun exposure. However, because some people don't get much some exposure for good parts of the year based on their geographic location, or because of they are afraid of sun exposure due to skin cancer, or because as people age they produce less Vitamin D from sun exposure, we need to supplement with Vitamin D.

Although products like Almond milk and regular milk are fortified with Vitamin D, as are a number of other processed foods like cereals, many still recommend supplementation in case we are not getting enough.  I do not recommend supplementation in the absence of known deficiency and because there is a viable alternative.

There is a great source of Vitamin D that also offers other potent nutrients and that is Wild Salmon. I sing the praise of Wild Salmon so much you'd think I owned a fish company. Well, I don't. But I am a huge fan because of the medicinal benefits of Wild Salmon. First, the wild variety has 4 times the Vitamin D than the farm raised variety. A 3.5 ounce Wild Salmon steak also has over 200% of the recommended daily allowance of Vitamin D.  In addition, Wild Salmon also has the omega-3s (EPA and DPH) which have cholesterol lowering, anti-inflammatory, and apparent pro-brain health effects. Finally, Wild Salmon is a great source of protein for your diet.

Cod liver oil is another great source of Vitamin D, but it has its own set of issues so I recommend Wild Salmon any day over it. In fact, consuming Wild Salmon 3 to 4 times a week would be wise.

So isn't it time you got rid of your Vitamin D pills and consumed a natural source of it?

Surprise! You're Dead!

A number of my blogs evolve around weight and for good reason. A new study shows that carrying too much weight in the belly -- having an apple shape -- may increase the risk of sudden cardiac death.

Researchers at the University of Minnesota and the VA Medical Center in Minneapolis showed in a cohort study (an observational study that includes an analysis of risk factors and follows a group of people who do not have the disease, and uses correlations to determine the absolute risk of subjects achieving a particular outcome) that the risk of sudden cardiac death increased along with waist-to-hip ratio (WHR).

Here are two graphics to illustrate how one measure WHR.

 

Measurement of waist hip ratio: In a lean person (above, left), the waist can be measured at its narrowest point, while for a person with convex waist (above, right), it may be measured at about one inch above the navel. The hip is measured at its widest portion of the buttocks at left, and at the great trochanters (part of your femur that protrudes) at right.

According to Dr. Selcuk Adabag, the lead researcher, the WHR, when it comes to the risk for sudden death, was the greatest determinant, ranking even higher than body mass index and waist circumference.

The general rule of thumb for WHR is lower numbers are better.

A WHR of 0.7 for women and 0.9 for men has been shown to correlate strongly with general health and fertility. Women within the 0.7 range have optimal levels of estrogen and are less susceptible to major diseases such as diabetes, cardiovascular disorders and ovarian cancers. Men with WHRs around 0.9, similarly, have been shown to be more healthy and fertile with less prostate and testicular cancer.


The study showed that for individuals in the top quintile of waist-to-hip ratio (0.97 and higher for women and 1.01 and higher for men), the risk of sudden cardiac death was a relative 40% greater  compared with those in the lowest quintile (less than 0.82 for women and less than 0.92 for men).

The lead researcher speculates that the reason for this correlation may have to do with the inflammatory markers produced by abdominal fat. Those markers result in fibrosis in the heart muscle, which could ultimately lead to arrhythmias and sudden cardiac death. Abdominal fat is composed of the more harmful white fat cells.

So if you didn't have enough reasons, motivation, incentives until now to lose weight and get into shape, maybe avoiding sudden death may help?


Here's a WHR calculator so you can calculate your own WHR:


http://www.healthcalculators.org/calculators/waist_hip.asp

What Are We Waiting For?

I've participated in many discussions about why people would prefer to treat medical problems as opposed to preventing them. Opinions have ranged from that people are often in denial that something bad will happen to them to they think that genetics plays such a big role that it doesn't really matter what they do within reason. Others believe in the strength of our medical system so that if something bad does happen, the system will fix it. The most common opinion is that is just tough to change bad habits developed over many years and they will hope for the best.

Unfortunately, they are wrong on many counts. Everyone knows someone who died prematurely and so we know bad things can happen to anyone. Genetics plays a relatively small role, less than 30% in our health. The health care system is strong on science, but weak on miracles. Letting your health deteriorate and relying strictly on health care providers is a risky bet. Habits may be hard to break, but they are not impossible to change. Support, guidance, and good knowledge can help.

I think the real problem why we don't focus on prevention is because there is a perverse incentive for the health care system to allow you to get sick so it can treat you. And by health system I mean pharmaceutical companies, health insurance companies (they charge premiums based on a cost plus basis), and of course health care providers, which include hospitals, doctors, and suppliers, who are generally only paid for treating a problem, not preventing it.

A number of year ago, I read an article about how the pharmaceutical industry hardly ever works on developing preventive medicines because it doesn't think there is a market for it.  Some may think that Statins, the cholesterol lowering drugs, are of a preventive nature, but they would be wrong. Statins are only prescribed (and at that, at an excessive rate) only when you already have elevated cholesterol. I don't blame the pharmaceuticals. Why create something for which there is little demand?

So we know the problem, what should we do about it?

My answer is education. education, education. Let's expose our citizenry to a series of self-administered quizzes about their health. Let's open their eyes to the consequences of their behaviors likely to lead to the development of chronic diseases. Let's require schools to school our children to a level where they can demonstrate a fundamental knowledge of what eating properly looks like, the importance of physical activity, and how to best manage stress.

Let's require that every insured patient submit to an annual wellness visit within 90 days of their insurance renewal to stay insured. Let's require during that visit a specific review of medical and family history and dietary, physical activity, sleep, and stress patterns. Let's also do a thorough review of medications and dietary supplements to make sure that they are being used sensibly.  In its totality, this visit will force, yes force, people to take stock of their health before something goes wrong. I believe that while all may not respond well to such a requirement, enough will benefit for it to make a huge difference.

As a society that insures every person over the age of 65, we can no longer afford to hope for the best when it comes to the future of our health care system. We need to get serious about propagating wellness and lifestyle modification and it all starts with education.

This week, Centers for Medicare and Medicaid Services (CMS) announced the first round of grants for its Health Care Innovations Challenge Program. There are certainly a number of meritorious applications among them that will improve our health care system. But sorely lacking among the first group was any real focus on education and primary prevention. Does our government appreciate that an ounce of prevention is really worth a pound of cure? One can only hope that in the next round, to be announced in early June, this absence will be remedied.

We will all be better served if we stop, or even slow down, the progression of avoidable chronic diseases among our populace.  For that, we need our government to help fund such efforts.

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.