I Will Never Tell You To Relax

When I was in medical school some 30 years ago, I was taught never to tell a patient to relax. Nothing seems to make someone less relaxed than being told to do so. The alternative advice was to tell them to clench their toes and then slowly let go and feel the sense of relaxation sweep up your legs into the rest of your body. Showing them how to relax proves much more effective than telling them. That actually seems to work and I've tried it on myself numerous times.

I share this anecdote because it is a good prelude to today's topic. How do you tell someone about the dangers of stress without stressing them out?  That would seem to defeat the purpose of alerting them. I'll come back to this paradox later.

It's been an acceptable axiom for some time now that stress wreaks physiological damage on our bodies, even perhaps on the chromosomal level. I've seen references to a study that revealed that the telomeres which are the end of our chromosomes, shorten secondary to stress. Scientists generally believe that when a telomere shortens to a certain length, typically a cell undergoes apoptosis or cell death.

Along comes a meta-analysis study by Tom Russ, MRCPsych, of the National Health Service Scotland, and colleagues that reviewed 10 British cohort studies that showed that the risk of all-cause mortality or reasons for death in adults with the lowest level of psychological distress -- termed subclinically symptomatic -- was significantly higher than that of asymptomatic adults at an age- and sex-adjusted hazard ratio of 1.20 (95% CI 1.13 to 1.27). In other words, stress increases your likelihood to die from any number of reasons.

To quote medpagetoday.com, "The study measured the association of psychological distress with death by any cause, cardiovascular death, cancer death, and deaths from external causes using data from the Health Survey for England. The survey included data from 1994 to 2004 on 68,222 adults ages 35 or older, mean age 60 years, who were free of cardiovascular disease and cancer, and who lived in a private household in England at baseline."

As an observational study, in which results are observed as opposed to created, the study has its limitations. For example, we don't know the cause and effect relationship. Did people who became unhealthy develop more stress and therefore die at higher rates or did people who became more stressed thereby became unhealthy, which led to their death? There is no good way to do a high quality study of this kind because you can't have a group that you stress out to see if the stress will kill them. So, we are left with correlative studies such as this one as our best science. Notwithstanding, I think we can all agree that stress is not a good thing.

I know that whenever I hear about the dangers of stress to my health it raises my stress. It's like someone telling you not to think about something and you start thinking about it incessantly. The mind is a wonderful machine that still escapes our full understanding. Still, we have to work with what we know and that is it is better to be somewhat relaxed than somewhat stressed. In the book, The Longevity Project, by Doctors Friedman and Martin, we learn that a little bit of neuroticism is a good thing. I wrote about this some time ago. It's healthy to be aware of your surrounding and potential dangers. It's normal to worry about finances and relationships. It becomes unhealthy when you are consumed by such thoughts.

So how do we find a healthy balance between legitimate worries and irrational thoughts? I think the answer is focus. Ask yourself what is the focus of your life? Is it on potential and possibilities or what has gone wrong? Is it on tomorrow or yesterday? Is it on things you have to be grateful for or things that bother you? For some people making these choices is easy. If you are one of them and your focus is on the positive, I suspect that you enjoy life more than most. If you are hampered by a continuous stream of consciousness that accentuates the negative, you need to address this proactively. You can't ignore it; you need a plan. Speak to your clergyman, a doctor, or anyone you think may help.

I share these concerns about stress because despite the fact that it may raise you stress in the short-term, you will be better off in the long term by developing effective ways to lessen its toll on you.

As the studies suggest, living with stress means dying early from stress. Don't let yourself become a statistic.

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.

Another Benefit of Wild Salmon

To say I am a wild salmon fan would be an understatement. The more I learn about it, the more excited I get. The other day I wrote about how I was in heaven consuming it in the great Northwest.

Here's another reason (for some a caution) to ingest wild salmon. Interestingly, I just learned about this not very well known benefit.  It's why I say you can never stop pursuing knowledge.

The omega-3 fatty acids in Salmon, eicosapentaenoic acid (EPA, 20 carbons and 5 double bonds), docosahexaenoic acid (DHA, 22 carbons and 6 double bonds), in addition to their positive anti-inflammatory, cholesterol lowering, and brain health effects, also have apparent anti-coagulant benefits that can prevent blood clots.

For most people that's a really good thing to have a natural source of blood thinning as protection against heart attacks and strokes. However, for people on anti-coagulants such as Coumadin, aspirin, Plavix, etc. this may be problematic. If you are on any anti-coagulant(s) and commonly consume salmon, my favorite food, please check with your doctor to determine if your medication needs to be adjusted.

Do not take fish oil pills for this purpose because they are not processed similarly in the body. Flax seeds, which also contain the α-linolenic acid (ALA, 18 carbons and 3 double bonds) omega-3 fatty acids are also noted to have similar benefits.

This is not intended as medical advice and consulting with your own physician is always advised.

Wild Salmon Country

Regular readers of my blog know that I haven't written much of late.  There are two reasons for my literary absence. First, I recently returned from visiting Seattle and Vancouver, Canada. For a wild salmon lover,  I had died and gone to heaven. I was in Wild Salmon country.

Here on this east-side of the country, it is a foregone conclusion that unless stated otherwise, any salmon sold in a restaurant is farm-raised. In Seattle and Vancouver, it is just the opposite. In fact, I got tired of having restaurateurs and wait staff look at me strangely when asked if the fish they were serving was wild. "Of course," was the repeated response.

It was nirvana. I even visited a place where you can see the salmon leap up out of the water and swim against the current. It was an amazing sight to behold. I just couldn't get enough of the wild fish and its incredible nutritional contents. Rich with omega-3s, Vitamin D, and the healthiest saturated fat, it is the perfect source of fatty acids and protein for almost any diet.  In fact, I love wild salmon's bounty so much that I carried about six pounds of an assorted variety back home with me.

The other reason for my absence was my ongoing work on my two forthcoming books. One book is about eating and living for longevity based on centenarian diets and lifestyles, and the second book is on the dangers of taking medical advice from celebrity doctors and the mass media.

Much progress has been made on both books and one publisher has already offered to publish one of the books. So stay tuned and I'll keep updating you when something worth writing about comes along.

The Pain of Prescribing Pankillers

Pain is a terrible thing, but you know that already. It can make life unbearable and for some, it does. Having once ruptured a disk in my back that pressed on my spine due to a foolish maneuver in a gym, I can imagine what experiencing incessant horrible pain truly means. My pain was so severe, I couldn't think, I couldn't sleep, I could hardly breathe. I was in horrible agony. I finally understood why a terminal cancer patient in such pain may want to call it quits. So, yes, I can emphasize with someone suffering from pain. Nevertheless, we have an epidemic of painkillers being prescribed here in the U.S. and often times it is inappropriate and unnecessary.

In fact, one of today's headlines in the NY Times titled, "Rise In Pill Abuse Forces New Look At U.S. Drug Fight." The first paragraph reads, "America’s drug problem is shifting from illicit substances like cocaine to abuse of prescription painkillers, a change that is forcing policy makers to re-examine the long and expensive strategy of trying to stop illegal drugs from entering the United States."

In the practice of medicine, one invariably is confronted by a patient seeking pain medication. I am stingy with such medication, not because I lack empathy for it's need, but because I want to make sure that it's really needed and I am not trading pain for addiction. No doctor, myself included, can claim absolute expertise in determining who is telling the truth and who is malingering. We listen very carefully to the patient's complaints and concerns, and then use our knowledge and honed intuition to try to make the best judgements.

Prior to starting MDPrevent in Florida, I had read many articles about so called "pill mills." These are medical practices run by unscrupulous doctors who feed the painkiller market's need for easy access. Wary of being bombarded by painkiller seeking patients and concerned about not making proper differentiation between those truly in need and those looking to feed an addiction or resell the pills, I decided to enlist help.

Among the many other benefits of having a health psychologist on my team, this is one of them. When I am unsure if a patient is consulting with me only for drugs, I often ask him or her if they would be willing to see the psychologist. I find this appropriate because pain usually, but not always, has a strong emotional and mental health component tied to it. I also want the patient evaluated to see if there are healthy alternatives to pills. MDPrevent's psychologist, Dr. Jessica Kordansky (PhD, trained at Emory University) specializes in Mindfulness Meditation, a natural way to deal with stress, anxiety, pain, etc.

The key concept here is at the root of how I practice medicine. I prefer to find long-term solutions over quick fixes when appropriate. Writing a painkiller prescription requires no effort and often appeases the patient, but may not necessarily be the best thing for him or her. I know this will anger some of the patients who turn to MDPrevent for care; I also know that it will decrease the number of patients who return to the practice.

Nevertheless, I must follow what I consider to be good medical practice and do what is in the best interests of my patient. This doesn't mean I will never write a prescription for pain medicine, depression, anxiety, etc.; it just means I will think long and hard before I commit a patient to this course of action, and when possible, I will solicit the help of a trained professional to improve my decision-making and offer alternatives.  Too many patients have already come to my practice on such medications having long forgotten why they were prescribed it in the first place.  It is truly an epidemic. The insanity must stop and I will do my part.

Perhaps, if other doctors did the same, the U.S. could return to fighting drug imports and not have to use precious limited resources to stop our internal painkiller problem.

Nan Kathryn Fuchs Replies

On Wednesday, July 4th, you may remember I wrote a blog about a Dr. Nan Kathryn Fuchs, who writes a woman's health newsletter. The blog was titled,

Supplement peddlers, supplement peddlers every where, Nor any drop of truth to drink.

Paste http://mdprevent.blogspot.com/2012/07/supplement-peddlers-supplement-peddlers.html into a browser to read the blog.


I told you that I had inquired about her educational degree and if I ever got a response, I would share it with you. Today the response came and here it is:

"Nutrition, from Donsbach University, which is no longer in existence."

That's all there was. No salutation, nothing else.

Here's what I could find about this Donsbach University, now no longer in existence, and apparently for good reason. 

http://www.quackwatch.com/01QuackeryRelatedTopics/donsbachuniv.html

Not a pretty picture.  As I've written before, Caveat Lector, let the reader beware of advice offered by so called experts.  I find, in general, the advice offered by Fuchs and many of her so called self-proclaimed expert peers to be offensive. Nevertheless, they are protected under the laws of free speech so you are advised to simply ignore them. If you do, maybe they will go away. We can only hope.

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.