Monday, September 29, 2014

Healthy Lifestyle May Prevent 80% of Heart Attacks

Middle-aged and older men were much less likely to have heart attacks over an average of 11 years if they drank moderately, didn’t smoke, exercised regularly, ate right, and control their weight, a new study has found.

Only about 1% of the men involved in the study fit into this ultra-healthy-living category. But they were 86% less likely to have heart attacks than those who ate poorly, were overweight, exercised too little, smoked and drank too much alcohol, the researchers said.

The healthiest men could still eventually die of a heart attack, of course, and the study didn’t say if they live longer than others.

Still, “there is a lot to gain and money to be saved if people had a healthier lifestyle,” said study lead author Agnete Akesson, an associate professor with the Institute of Environmental Medicine at Karolinska Institute in Solna, Sweden.

For the study, published in the Journal of the American College of Cardiology, the researchers examined medical records and surveys of more than 20,700 Swedish men who were 45 to 79 years old in 1997. At the time, they had no history of cancer, heart disease, high blood pressure or high cholesterol. The researchers tracked them until 2009 to see how they fared.

8% of the men – 1,724 – did not practice any of the 5 healthy behaviors, and 166 of that group suffered heart attacks.

Of the 1% of men – 212- who practiced all 5 healthy behaviors, only 3 had heart attacks.
Based on their findings, the researchers concluded that all 5 healthy behaviors together could prevent 79% of first heart attacks in men.

Also, each behavior by itself reduced the risk for heart attack. For example, eating a diet rich in beneficial foods, such as fruits, vegetables, nuts, reduced-fat dairy and whole grains was associated with a nearly 20% lower risk compared to those who practiced none of the healthy behaviors, the study found.

Friday, September 26, 2014

Common Painkillers Tied to Blood Clot Risk, Study Suggests

People who use nonsteroidal anti-inflammatory drugs (NSAIDs) – which include aspirin, naproxen (Aleve) and ibuprofen (Advil, Motrin) – may be at increased risk for potentially deadly blood clots, a new study suggests.

But the study only showed an association between the use of NSAIDs and higher clotting risk, it did not prove cause-and-effect.

The researchers analyzed the results of six studies involving more than 21,000 cases of a type of blood clot called a venous thromboembolism (VTE). These clots include deep vein thrombosis (a clot in the leg) and pulmonary embolism ( a clot in the lungs).

Reporting in Rheumatology, the analysis found that people who used NSAIDs had an 80% higher risk for venous clots.

“Our results show a statistically significant increased VTE risk among NSAID users. Why NSAIDs may increase the risk of VTE is unclear,” said study lead author Palompoog Ungprasert, of the Bassett Medical Center, NY.

“Physicians should be aware of the association and NSAIDs should be prescribed with caution especially in patients already at a higher risk of VTE,”
the researcher added.

Ungprasert stated that all types of NSAIDs were evaluated as a group, but not all NSAIDs may boost the risk of VTE.

Two experts said the findings are in keeping with prior research.

“It is not entirely surprising that NSAIDs are again implicated in causing clot related illness” said Dr. Steven Carsons, chief of the division of rheumatology, allergy and immunology at Winthrop University Hospital in New York. He pointed to the case of Vioxx, a powerful NSAID that was withdrawn from the market in 2004, after studies found a higher risk of heart attack and stroke in users.

The new study “makes a compelling case for further study and clinical surveillance for venous clotting events in those patients taking NSAIDs,” Carsons said. However, he stressed that the study could not pinpoint which types of NSAIDs might pose the greatest risk, or which type of patients might be most vulnerable.

Wednesday, September 24, 2014

Wisdom Wednesday: Chronic Low Back Pain

This new patient has been suffering from left sided sciatica for three months. About six weeks ago, he was hospitalized and treated for sciatica. During the hospital stay, he developed a perforated large intestine and had surgery, removing about a foot of large intestine and installing a colostomy bag. Subsequent surgery to remove the colostomy bag was successful. However, he developed C. difficile as a result of antibiotic therapy. After a few weeks, they were able to control the diarrhea well enough to send him home. He still has radiating pain down his left leg, his bowels are still inflamed with frequent diarrhea, and he now notes body wide aches.

Compare this history with the case of acute low back pain from last week’s Wisdom Wednesday. Obviously, this case is much more complex. On reviewing his history, he describes the pain as running down the anterior aspect of the left leg to the knee with occasional radiation into the groin. This is not the course of the sciatic nerve and, in fact, he was suffering from femoral neuralgia rather than sciatica. I have no clear information on the cause of the perforated intestine. However, I do comment on the relationship between these illnesses in my conclusions.

C. difficile kills about 1600 people in the US each year as the result of electrolyte imbalances associated with the diarrhea. It is an opportunistic infection that overgrows following the use of antibiotics. Please see my blog “Serious Diarrheal Infection in Kids Linked to Antibiotics” posted on March 14, 2014. Adults commonly develop C. difficile during hospital stays.

QA evaluation revealed impairment of Autogenic Facilitation (AF). Therapy Localization (TL) was to the surgical site of the perforated colon. This was corrected by Injury Recall Technique (IRT) restoring AF. Testing for inflammation was negative for prostaglandins, leukotrienes, cytokines, and histamine. However, nitric oxide was positive with a good response to L-glutamine, a particular probiotic (Saccharomyces boularidii), and folic acid. Challenge of the ilio-lumbar ligament was positive on the left, and after IRT correction, it returned again in weight bearing. TL was positive to the L4 vertebra, but no manipulation was performed.

Monday, September 22, 2014

Could Artificial Sweeteners Promote Diabetes and Obesity?

For those who are diabetic or dieting, you may think artificial sweeteners are your best friend.

They allow you to get the taste of sugar from foods and beverages without the elevated blood sugar levels or calories. But a new study suggests this may not be the case; artificial sweeteners could actually promote obesity and diabetes.

The research team, including Eran Elinav of the Department of Immunology at the Weizmann Institute of Science in Israel, recently published their findings in the journal Nature.

Because artificial sweeteners are low calorie and do not contain carbohydrates, they are often recommended to help with weight loss or to treat or prevent metabolic disorders, such as type 2 diabetes.

However, Elinav and colleagues note that, although some studies support such recommendations, others have indicated that artificial sweeteners actually increase weight gain and raise the risk of metabolic disorders. A study from the Washington University School of Medicine published last year claimed the artificial sweetener sucralose is linked to increased glucose and insulin levels.

“Despite the controversial data, the FDA approved six NAS (non-caloric artificial sweetener) products for use in the US,” the researchers note. These are saccharin, sucralose, aspartame, advantame, neotame and acesulfame potassium.

In this latest study, the team investigated how artificial sweeteners affected the metabolism of mice. For 11 weeks, some mice were supplied with drinking water supplemented with an artificial sweetener – either saccharin, sucralose or aspartame – and glucose, while others drank just water alone or water containing only sugar.

The team found that the mice that drank the water containing glucose and an artificial sweetener developed glucose intolerance – elevated blood sugar levels, whereas the mice that drank water alone or water containing only sugar did not.

Friday, September 19, 2014

Apple Watch Takes Tech Giant into New Territory

Apple unveiled a new product category – a smartwatch designed to provide consumers with a variety of technology services including comprehensive health and fitness apps to help them lead healthier lives.

Called Apple Watch and available in early 2015 starting at $349, the device includes an activity app designed to help motivate users to be more active, and a workout app that provides metrics during workout sessions. Billed as bringing together the capabilities of “an all-day fitness tracker and a highly advanced sports watch in one device,” Apple Watch uses an accelerometer, a built-in heart rate sensor, GPS and Wi-Fi from an iPhone to provide an overall picture of a person’s daily activity. (Photo via

The activity app measures three separate aspects of movement: calories burned, brisk activity and how often a user stands up during the course of a given day. The workout app allows users to set specific goals for popular session-based workouts, such as running and cycling. And, the companion fitness app on iPhone collects activity data to provide activity history in order to suggest personal foals, reward fitness milestones and motivate users.

“Apple Watch is the most personal device we’ve ever created,” said Tim Cook, Apple’s CEO. “Apple builds great products that enrich peoples’ lives and arguably we can take that to a whole new level with Apple Watch.”

At the same time, Cook said that Apple Watch “requires the iPhone because it’s been designed to seamlessly work together…This means that over 200 million people already can use Apple Watch.

However, Niharika Midha, medical device analyst at GlobalData, argues that the significant dependence of the health and fitness trackers on the iPhone’s Wi-Fi and GPS capabilities in comparison to other vendors is a drawback. For example, Midha said the Samsung Galaxy Gear S has a built-in GPS and can be used to tract activities without the phone.

Wednesday, September 17, 2014

Wisdom Wednesday: Acute Low Back Pain – A Brief Case History

This is the first in a series of typical case histories taken from my office notes. They will appear in the Wisdom Wednesday blog slot intermittently. I hope they will give the reader some insight into managing and guiding a patient through a health issue.

A 66-year old female returns to my office for the first time in six years with complaints of acute low back pain. She has been struggling with chronic bilateral knee pain and has had a couple of orthopedic opinions on treatment ranging from medication management to total joint replacement. She denies radiating pain from the back to the legs and believes the onset is related to compensating for the knee pain. She is currently on the following medications: Atenolol, Celexa, Benacar, Zyrtec, Eliquis, Prempro, Simustatin, Armour Thyroid, Flecainide and 2 baby aspirin per day. (The average American takes 4 prescription medications daily, so this patient is taking twice that amount. I commonly see patients taking 16 different prescription medications on a daily basis).

Autogenic Facilitation (AF) was intact, using a weak left gluteus medius as an indicator muscle. (This indicates no body wide injury response by the nervous system. Her body has either resolved the injury neurologically, or there was no body wide injury stimulation to begin with - the later fits her history) Oral challenge with a mix of NSAIDS resulted in strengthening of the weak muscle. A favorable response to oral challenge with fish oil was noted. (These tests indicate that her primary inflammatory response is the production of prostaglandins despite taking aspirin daily which tends to block this pathway) Challenge of the left ilio-lumbar ligament was positive in weight bearing only, corrected by Injury Recall Technique (IRT). (This is a local injury reflex and is the most common source of ongoing neurological stimulation in low back pain) Gait assessment was intact. (Despite her contention that this low back episode is the result of compensating for her knee pain, no altered gait mechanism was indicated)

Monday, September 15, 2014

A Deficiency of Nutrition Education in Medical Training

We do not need to wait for more studies on nutrition and health. Although additional research will add refinements to current knowledge, we need more action on what we already know.

A 2013 report on the state of US health identified dietary factors as the single most significant risk factor for disability and premature death. Despite the wealth of knowledge linking food and health, nutrition receives little attention in medical practice. The reason stems, in large part, form the severe deficiency of nutrition education at all levels of medical training to be described in this commentary.

The Lyon Mediterranean Diet Heart Study, published in 1999, showed a 72% reduction in cardiovascular events attributed to diet (an effect approximately twice that of most statin trials). A whole foods, plant-based diet low in refined carbohydrates and animal products has been proven to reverse coronary heart disease and confer potent protection against type 2 diabetes and cancer.

How has this knowledge affected medical education? A recent survey of medical schools revealed an average of fewer than 20 hours over 4 years devoted to nutrition education.

Friday, September 12, 2014

Use of Medications of Questionable Benefit in Advanced Dementia

Advanced dementia is characterized by severe cognitive impairment and complete functional dependence. Patients’ goals of care should guide the prescribing of medication during such illness. Medications that do not promote the primary goal of care should be minimized.

To estimate the prevalence of medications with questionable benefit used by nursing home residents with advanced dementia, identify resident-and facility-level characteristics associated with such use, and estimate associated medication expenditures.

Design, Setting, and Participants
Cross-sectional study of medication use by nursing home residents with advanced dementia using a nationwide long-term care pharmacy database linked to the Minimum Data Set (460 facilities) between October 1, 2009, and September 30, 2010.

Main Outcomes and Measures
Use of medication deemed of questionable benefit in advanced dementia based on previously published criteria and mean 90-day expenditures attributable to these medications per resident. Generalized estimating equations using the logit link function were used to identify resident-and facility-related factors independently associated with the likelihood of receiving medications of questionable benefit after accounting for clustering within nursing homes.

Of 5406 nursing home residents with advanced dementia, 2911 (53.9%) received a least 1 medication with questionable benefit. Cholinesterase inhibitors (36.4%), memantine hydrochloride (25.2%), and lipid-lowering agents (22.4%) were the most commonly prescribed. High facility-level use of feeding tubes increased the likelihood of receiving these medications. The mean 90-day expenditure for medications with questionable benefit was $816, accounting for 35.2% of the total average 90-day medication expenditures for residents with advanced dementia who were prescribed these medications.

Conclusions and Relevance
Most nursing home residents with advanced dementia receive medications with questionable benefit that incur substantial associated costs.

Wednesday, September 10, 2014

Wisdom Wednesday: Supplementation Made Easy

Every textbook I own on nutrition begins by making the statement that a good diet provides all the nutrients needed to “prevent clinical signs of deficiency.” However, that statement assumes we know and will recognize any and all signs. If you have dry skin is that a clinical sign of vitamin A deficiency, maybe vitamin D? How about a lack of essential fatty acids? That’s also a classic sign of hypothyroidism. Could it be a lack of iodine or tyrosine?

Lack of signs of deficiency is also a long way from healthy. Recommended daily allowances (RDA) are minimums that, when met, will prevent those clinical signs. For example, the RDA for vitamin D is 400IU. However, supplementation levels vary from 400IU per day to 50,000IU per week. What is the margin of safety?

Many clinical conditions require supplementation at levels much higher than the RDA. Macrocytic anemia often requires high doses of folic acid and vitamin B12, frequently in synthetic forms, to stimulate adequate red blood cell (RBC) production. This can be a genetic issue, requiring life time supplementation.

If you want to insure adequate micronutrient intake start with a good diet. That means 5 servings of vegetables, 2 fruits, and 3 protein servings per day. About 50% of the fruits and vegetables should be raw. Now add a phytofood supplement rather than a multiple.

A multiple throws together as many different micronutrients as can possibly fit in the capsule or tablet, without regard to compatibility or dosage. For example, most multiples with contain zinc, copper, and iron. These three minerals compete for absorption and should not be taken together.

A phytofood is concentrated plant food. Wheat grass juice is an example. Pea vine juice, carrots, barley and many other plants can be processed to provide a concentrated form of micronutrients, in the ratios found in nature. There is no need to fortify these supplements. Greens Plus, Sun Chlorella, and Standard Process Catalyn are readily available phytofood supplements.

Monday, September 8, 2014

Sit Less, Protect Your DNA and Live Longer?

Spending less time sitting might increase your lifespan by keeping your DNA young, Swedish researchers say.

More time spent on your feet appears to lengthen bits of DNA called telomeres. Telomeres, which protect the end of chromosomes (like the tips that keep shoelaces from fraying), tend to get shorter and shorter until they can’t shorten any more, causing cells to die.

“Our data indicate that lengthening of our telomeres may be one mechanism that induces health benefits after lowering sitting time in elderly people.” Said lead researcher Per Sjogren, an associate professor in the department of public health and caring sciences at Uppsale University.

“One should, of course be careful with the conclusions, since our study is rather small and needs to be confirmed in larger trials,” Sjogren said.

However, this is the first study describing a possible relationship between physical activity and lengthening of telomeres, according to Sjogren.

“Telomeres have attracted a lot of interest in the last few years because they are situated at the end of our chromosomes and have shown to be important for DNA replication and cell survival. The interest of whether telomeres may affect health and longevity has increased,” Sjogren said.

Telomeres stop chromosomes from fraying or clumping together and scrambling the genetic codes they contain, the researchers noted.

Why spending less time sitting might lengthen telomeres isn’t known. “That is a valid question that remains to be resolved.” Sjogren said.

Friday, September 5, 2014

Are We Overdoing Salt Restrictions?

It’s long been known that eating too much salt in your diet will raise your blood pressure, but a comprehensive global study now says that too little salt in your diet also can harm your heart health.

There appears to be a “sweet spot” for daily sodium intake between 3 and 6 grams – equal to 7.5 to 15 grams of salt – associated with a lower risk of death and heart disease that either more or less, researchers report.
“We found that too high levels of sodium are harmful, but also earing a low amount of sodium is harmful,” said study co-author Andrew Mente, an assistant professor of clinical epidemiology and biostatistics and McMaster University in Ontario. “Having a moderate level of intake is associated with the least amount of harm.”

The findings run counter to current guidelines of heart disease prevention, which recommend a maximum sodium intake of 1.5 to 2.4 grams per day. That’s the equivalent to a maximum of just under half a teaspoon of table salt per day.

“Only one in 20 people in the world eat currently what is recommended,” Mente said. “It indicates that we are making recommendations that most people can’t meet. It’s not a practical recommendation. This suggests that rather than focusing on sodium, we should focus on eating an overall health diet and pursuing healthy lifestyle changes.”

Limiting salt consumption is difficult given that 80% of a person’s daily salt intake comes from the foods they eat, rather that the salt shaker, he said.

The researchers’ findings are included in papers published in the August 14 issue of the New England Journal of Medicine. One examines the relationship between salt intake and blood pressure, while another looks at salt and risk of death or heart disease.

Wednesday, September 3, 2014

Wisdom Wednesday: CAROTENOIDS

Beta-carotene is the one you all know. The human body can convert some carotenoids to vitamin A. In fact, there are 60 carotenoids that we can convert to vitamin A, beta-carotene is just the most common.

For most populations, carotenoids are the major source of vitamin A in the diet. Animal foods provide a rich source of retinol, which also has vitamin A activity in the body. The Native American Eskimo population derives most of its vitamin A from animal foods as their sources of plant food are somewhat limited.

Most of the carotenoids can not be converted into vitamin A. In fact there are over 600 known carotenoids, so less than 10% are used to make vitamin A.

Carotenoids give plants the colors yellow, red, and orange. They create the fall foliage as the chlorophyll production slows this time of year. Carotenoids facilitate photosynthesis and act as anti-oxidants. The non-provitamin A carotenoids also function as anti-oxidants in the human body. It has been suggested that the carotenoids may account for the protective benefits of diets high in fruits and vegetables against cancer and other chronic diseases.