Yesterday at the gym, a woman I know asked me if she should stop exercising because of the recent article in Time Magazine.  She was actually kidding, but her question got me to thinking. 

Basically what the article says is that exercise does not help us to lose weight. That it’s the type and amount of food we eat while trying to lose weight that determines our success – not exercise. Well, duh!  It shouldn’t surprise any of us to learn that we can’t lose weight even with extensive amounts of exercise IF, at the same time, we eat anything we want.  What this article also says is that exercise in fact can stimulate appetite such that we become more hungry after being physically active and eat more than we normally would.

So, the overall impression from the article is that regular physical activity is not all it’s been cracked up to be. BUT, losing weight is not the only reason exercise is so heartily recommended by the medical profession. In fact, its other benefits are especially important for us as we age.  To remind you of those other benefits, here’s an article Robin and I wrote about a year ago, which is relevant today as it was then. After you read it, hopefully you will do 2 things: 1) Continue your regular exercise (or begin it!) and 2) Answer NO to anyone who asks you if they should stop exercising!

The Time Magazine article: http://www.time.com/time/health/article/0,8599,1914857,00.html

Our article:

Melanoma, a deadly form of skin cancer, is now the leading cancer diagnosed in British women in their 20’s.We know that in England it probably isn’t because of the intensity of the sun. Anyone who has watched a movie made in England or visited the country knows that sun exposure isn’t likely to cause much harm due to the fact that the sun doesn’t make an appearance very often. What is the cause is the use of tanning beds that is popular especially in those under 30 years of age.

A recent analysis of skin cancer found that the risk goes up by 75% when people start using tanning beds prior to that age. (The Lancet Oncology,Vol. 10 No. 8 pp 751-752) There is no question that tanning beds along with excessive sun exposure is a cause of cancer. Other comparable causes of death include cigarette smoking, exposure to mustard gas and arsenic.

Even now young people are reluctant to stop the risky behavior of going to tanning salons. They think they are invincible. Now that the tanning beds are being equated with things that we all know can be deadly, there seems to be a glimmer of hope that they might understand the risk. Young people who regularly use tanning beds are eight times more likely to get melanoma when compared to those who have never used them.

I think it is time to consider spray on tans. The quality is good and there is no risk. The price is well worth having healthy skin and decreasing the chance of developing melanoma. Share this information and advice with all the young people in your life it can save theirs.

 In a recent article of the Journal of the American Geriatrics Society, researchers report that adults aged 50 and older account for increasing proportions of HIV/AIDS cases. Specifically, when the trends of people infected with HIV were studied in the state of New Jersey, it was found that in 1992, people aged 50 and older accounted for only 6% of the HIV/AIDS cases; in 2004, this had increased to 26%! The conclusion of the authors of this article states that health care providers need to routinely discuss HIV and other STI’s with this “older population” (that’s us) in order to be able to offer prevention or care earlier. And we all know that getting care early in any disease means a better long term prognosis, or a better chance for a cure.

In addition to the above infections, you could be at risk from a more recent sexual encounter of acquiring other of the STIs, such as Chlamydia or gonorrhea. Although infection with gonorrhea usually presents itself with a discharge from the vagina or urinary symptoms – as can Chlamydia – infection with Chlamydia can also remain silent. Also important to know is that you can become infected with gonorrhea even if you’ve had a hysterectomy; in this case, the major symptoms would be urinary and would include burning or frequency. Although these latter symptoms are usually due to a plain old run-of-the-mill urinary tract infection, if your urine cultures are negative and your clinician cannot find a reason for your symptoms, think back on any recent sexual activity.

So what can you do to protect yourself if you are newly dating after a divorce, or if you just realized that you don’t know your partner(s)’ sexual history?

1) Ask your gynecologist to test you for STI’s when you get your routine pelvic exam or sooner as the need dictates (ie you are having symptoms; or you have a new partner; or are thinking about a new partner). Diagnosis of STIs is easy: it simply involves extra samples taken from your cervix at the time of your Pap smear and blood tests.

2) Be open and honest with your partner(s) about this issue, and ask directly about their sexual history; if they have not been tested recently (or ever), ask them to get tested for STIs;

3) Use protection during sexual activity; although in recent years it has been found that unfortunately condoms do not protect 100% against getting infected, they do lessen the risk, as do vaginal/dental dams. Only latex and polyurethane condoms should be used.

For further information, go to the CDC’s website on STIs:

http://www.cdc.gov/std/default.htm

All the talk about this August being the 40^th anniversary of the famous Woodstock Music Festival got me thinking.

Do you remember those years? The invention and availability of “The Pill,” and the then-new practice of “free love” (remember, “Make Love, Not War?”) led directly to the sexual revolution for which our generation became famous.

What you maybe did not hear so much about was the increase in sexually transmitted infections (STIs) as a result of that revolution. Take genital herpes (HSV) infection for example. The levels of the total number of cases in the North American population increased by over 30% in the late 70’s, 80’s and 90’s. Similarly, data on first-time treatment-seekers for genital warts (caused by Human papillomavirus – HPV) show an increase (in their presenting for medical care) of about 500% over the past three decades.

What does that mean for us now? We came of age sexually at the same time that many of the STIs were increasing; therefore, there’s a good chance that we may have been exposed to one of these infections in the past thirty or so years that we’ve been sexually active. And since several of these infections can stay in the body indefinitely but cause no symptoms, there’s also a chance we might not even know that we’ve been infected.

Which of the STIs am I specifically referring to in the above paragraph? The so-called “persistent viruses,” which include herpes virus, Human papillomavirus (HPV), the viruses which cause hepatitis B and hepatitis C, and the Human immunodeficiency virus that causes AIDS. Exactly how long can these viruses remain in the body after you become infected with them? Forever. And how long can they remain “hidden” and cause no symptoms? The first four of the viruses listed above may never cause symptoms, or alternatively, can cause symptoms at any time after you’ve been infected. The HIV virus can remain silent and cause no symptoms for up to 10-15 years. In addition, you can become infected with syphilis and have no symptoms for several years as well.

Think about the import of that. It means that if you don’t know your current, or past, sexual partner’s (or partners’) sexual history, you could be at risk for having one of these infections and not knowing it. Even if you haven’t seen the person who gave it to you in 15 years! This is especially worrisome to those of us who are just beginning new relationships now, after a divorce or break-up.

If you don’t think any of this applies to you, please read a list of the known factors which put people at risk for acquiring an STI. These have been extensively studied and are well known.

They include:

1) young age (teens and twenties),
2) a history of being sexually active with multiple partners, and
3) a history of having had even one STI in the past.

Even though the first risk factor doesn’t apply to us now, the other two definitely do. Even if you have not had multiple partners, do you know the answers to the 2^nd and 3^rd risk factors about your current partner?

Or do you know if your partner(s) knows of past exposure to an STI but doesn’t know if he/she acquired it?

Scary thoughts – but very important to think about. In the next blog, I’ll give you specific recommendations about how to approach these issues.

As a physician with conventional medical training, I often used to look at home remedies with skepticism. I have had several patients who have sworn that apple cider vinegar was good for whatever ailed them. Apple cider vinegar has been around for ages.Hippocrates used it to treat wounds; soldiers in the civil war used it for digestive problems and to prevent pneumonia and scurvy. Apparently Cleopatra used it to dissolve her pearls to make a love potion for Mark Antony.

Studies Showing Benefit

There have been recent studies done at the University of Arizona that have caused me to take a second look at apple cider vinegar. One study looked at 29 patients with either insulin resistance (prediabetes) or type 2 diabetes. They were given either a drink of vinegar, water and saccharine or placebo followed by a meal with 87 grams of carbohydrate. Compared to placebo, blood sugar decreased by 64% in the prediabetes group and 19% in the diabetes group.

Another study looked at weight loss in healthy women.The women were given a morning drink of vinegar or placebo followed by a bagel breakfast. Not only did the vinegar group have a 54% lower blood sugar one hour later, but they also consumed 11-16% fewer calories throughout the day.

Yet, another study found that taking a drink containing two tablespoons of apple cider vinegar along with eating one ounce of cheese before bedtime significantly lowered fasting blood sugars in the morning.

Some Cautions

There are potential safety and side effect issues. Obviously those allergic to apples need to avoid apple cider vinegar. Raw apple cider vinegar can contain bacteria, so it would be better to use the pasteurized form. Apple cider vinegar capsules can cause burning in the esophagus if they get lodged there. Apple cider vinegar can also irritate the stomach. There are potential drug interactions if a patient is taking digoxin, insulin or diuretics. Vinegar can lower potassium levels.

And…..

Of course, as with everything, moderation is the key. Taking a mixture of apple cider vinegar in juice or water in the morning may help with both blood sugar and weight control. It is important to discuss this with your doctor before you do it.

You’ve probably heard or read recently that acetaminophen – the generic name for the pain reliever, Tylenol – is in the news a lot lately. A Food and Drug Administration (FDA) expert advisory panel recently came out with recommendations for the FDA to put restrictions on the use of this very commonly used drug.

Why now? Because after reviewing studies done between 1990 and 1998, this panel of experts came to the conclusion that acetaminophen is not as safe as previously thought.  Due to overdose of this medication, there were 56,000 emergency room visits, 26,000 hospitalizations, and 458 deaths ANNUALLY over the time period of the reviewed studies. The most common problems seen were that of liver damage, liver failure and even death.

The interesting aspect of these findings is that not only did massive doses above the recommended dosages lead to illness, but even normally recommended doses could do the same, especially in people who already have liver disease. From this data, the expert panel came to the conclusion that restricting acetaminophen, and lowering the maximum doses advised, would protect people from the potential toxicity of this drug.

Since acetaminophen is so readily available without a prescription ( over-the-counter; OTC), and is so widely recommended for pain relief  by healthcare professionals, it almost goes without saying that a majority of people use this drug routinely. In addition, it is known that many people do not pay attention to the recommended doses listed in the package insert or on the bottle, and routinely exceed the highest recommended dose per 24 hours.  Besides being the main ingredient in Tylenol, acetaminophen can also be found in Excedrin, aspirin-free Anacin, and wide variety of OTC cold medications.

In addition to the OTC medications, acetaminophen is found in many prescription combination pain relievers, such as Vicodin, Darvocet, and Percocet, to name a few. The amount of acetaminophen in most of these prescription combination drugs often exceeds the maximum dosage recommended  for a 24 hour period.

It will probably take the FDA many months to put restrictions on the amount of acetaminophen that can be found in OTC medications as well as prescription pain relievers. So, what should you do until then? Look at the label for the amount of acetaminophen contained in both the OTC medications you buy, as well as the prescription pain-relievers prescribed by your clinician. The FDA recommends that the highest one-time dose (two tablets) of acetaminophen for adults should be no more than  650 mg. That means that the individual tablet should contain no more than 325 mg of acetaminophen. FYI – currently two tablets of Tylenol contain 1000 mg of acetaminophen.

In addition, the currently recommended maximum recommended dosage for an adult for 24 hours is 4000 mg (4 grams). The FDA thinks that this amount should be lowered as well, and definitely should not be exceeded.

Let’s do some quick math here. Say you have a headache or your old tennis elbow pain has flared up. Although people are supposed to take only 2 tablets every 6 hours (which would reach 4000mg per day), many of my patients have told me that they take this amount every 3-4 hours; that comes to 6000 mg per day IF they only take 2 tablets of Tylenol, and some people even take 3. That’s obviously way above the highest dose recommended per day, and definitely can lead to toxicity from this drug. Also, be aware that your health care practitioner may change your longterm prescription pain reliever by ordering one in which the amount of acetaminophen is lower. The narcotic portion of your combination medication may well stay the same.

Until the FDA officially restricts acetaminophen in OTC and prescription medications, here’s what you should do: 1) Remember the maximum safe dosage per day of acetaminophen (4000mg;4 grams); 2) Remember the maximum safe dosage for a one time dose of acetaminophen (625mg); 3) Read all labels of OTC medications you buy to see how much acetaminophen is contained; 4) Discuss with your clinician if you should change your prescription medication for pain relief if acetaminophen is in it.

Red yeast rice, a product used in China, is made by fermenting a type of red yeast called “Monascus purpureus” over rice.It has been found to reduce cholesterol when used as a supplement.

A recent study [Ann Intern Med. 2009; 150(12):830-9, W147-9 (ISSN: 1539-3704)] examined 62 people with elevated LDL cholesterol and put them on a 12-week lifestyle program. Half of the participants took 600 mgs of red yeast rice daily and the other half took placebo. After 6 months the treatment group lowered their LDL cholesterol by 35 mg/dl compared to 15 mg/dl in the control group.The side-effect profile was the same in both groups.

Red yeast rice is basically a natural statin drug. If you decide to try it, it is important that you let your doctor know, because your liver enzymes and muscle enzyme should be checked at regular intervals when you start therapy. It is encouraging that those taking the red yeast rice did not have muscle pain as a side effect and that it was relatively safe to use. Therefore, it may be a good alternative for you if the statin drugs caused muscle pain and damage.

It is important to point out, however, that natural does not always mean it is safe. It is still a drug and it is important to look at it that way.I also think it is important to take it with at least 100 mgs of Coenzyme Q10 which has been found to protect muscle. As far as which brand to use, that is a tough one.There is no regulation over supplements. I advise my patients to look for brands that have “GMP” on the label. That is used when companies comply with good manufacturing practice, a standard that is set by the FDA.

According to a new study in the journal Gastroenterology (Gastroenterology 2009 Jul; 137:80), the recurrence of symptoms can be a problem when you stop certain medications used for acid reflux or indigestion. This is known as symptom rebound. Prior studies have shown that when using the medications known as “proton pump inhibitors” (PPIs) to treat reflux, stopping these drugs can cause the acid-making cells in the stomach to go into high gear and make too much stomach acid, thus causing the original symptoms to reappear quickly. Examples of some of the PPIs include Nexium, Prilosec, and Prevacid.

In the above-mentioned study published this month, 120 volunteers who had no history of, or recent symptoms of, acid reflux, were divided into two groups, one group receiving  12 weeks of a placebo, and the other group receiving 8 weeks of a PPI followed by 4 weeks of a placebo. Neither the volunteers nor the researchers knew which group was on which regimen; this is known as a double-blind study. For the first 8 weeks, neither group had much in the way of symptoms. However, after going on a placebo after 8 weeks of treatment with a PPI, this group had significantly more symptoms of heartburn and reflux than did the group that had been on placebo the entire time, showing again that stopping PPIs leads initially to increased stomach acid production.

This is significant for a couple of reasons. One reason is that if you have been placed on a PPI to treat indigestion symptoms, you should expect to have an initial increase in symptoms right after you stop it. This is a temporary thing and should be treated with antacids.

The other reason this is important is that many of us buy over-the-counter (OTC) Prilosec or Prevacid and take it for only a short time or pop it when we think we need it. Then when we stop the medication, the symptoms return and may even seem worse. We then start the PPI again, stopping it when the symptoms are relieved, and on goes the vicious cycle. It is important to know that this does happen with PPIs and that it is temporary. Taking some antacids for a few days should relieve it.

Better yet – don’t take OTC meds, such as PPIs, willy-nilly!  Start with simple things to relieve your reflux symptoms: raise the head of your bed; take off those tight pantyhose; lose some weight; and use antacids first.

You may be hearing or reading a lot about Celiac Disease recently. Several celebrities have it and have been talking about it, and it seems to be all over the news.The results of a recent Mayo Clinic study have found that celiac disease is four times more common today than it was in the 1950’s (see reference below).

Celiac disease is a hereditary condition that is caused by an intolerance of gluten.This is a wheat protein. If a celiac patient is exposed to gluten it causes inflammation and destruction of the lining of the small intestine. This leads to malnutrition.

Symptoms can include:

* abdominal bloating and pain
* chronic diarrhea
* vomiting
* constipation
* pale, foul-smelling, or fatty stool
* weight loss
* unexplained iron-deficiency anemia
* fatigue
* bone or joint pain
* arthritis
* bone loss or osteoporosis
* depression or anxiety
* tingling numbness in the hands and feet
* seizures
* missed menstrual periods
* infertility or recurrent miscarriage
* canker sores inside the mouth
* an itchy skin rash called dermatitis herpetiformis

Although these symptoms can be a part of other diseases of the gastrointestinal track, the diagnosis of celiac disease is relatively easy to make with a series of blood tests. The treatment sounds easy, but it can be tough to stick to. A celiac patient must avoid gluten. When they do, the small intestine can heal and the symptoms abate.The problem is that gluten is in a lot of foods. It can be found as filler in medications and is commonly used in lip balms.

If you have many of the above symptoms, it would be a good idea to get checked out. Treating celiac disease early can help to avoid a lot of problems and the fix is pretty simple (well, sort of!)

Reference:

“Increased Prevalence and Mortality in Undiagnosed Celiac Disease.”
Alberto Rubio-Tapia, Robert A. Kyle, Edward L. Kaplan, Dwight R. Johnson, William Page, Frederick Erdtmann, Tricia L. Brantner, W. Ray Kim, Tara K. Phelps, Brian D. Lahr, Alan R. Zinsmeister, L. Joseph Melton, Joseph A. Murray.

CPR outcomes have not changed for hospital patients.

A recent study has found that the chance of survival after cardiac arrest and CPR in the hospital is about 18%. This rate of survival hasn’t changed over the last decade. One would think that being in a hospital should improve the chance of surviving but it has not. Men, older patients and those from a nursing home had an even lower chance of survival. African Americans had a lower survival rate when compared to Caucasians.

Outpatient rates of survival after CPR have improved substantially; it is time for the hospitals to catch up. These rates beg the bigger question, however. Shouldn’t we be focusing on preventing the underlying diseases that result in cardiac arrest? It is time to push for changes in lifestyle that include diet and exercise. Preventive exams are all essential to catch and treat problems before they result in serious disease.