Remember back a few years when you used to walk out of the medical office with recommendations to take a whole handful of vitamins? I remember emphasizing to my patients how important  it was to at least take daily doses of Vitamin C and Vitamin E for their antioxidant effects and to prevent heart disease.

Then the studies came out showing that these two vitamins did nothing to prevent heart disease, and along with this came recommendations that taking these vitamins as supplements was not necessary.

Now it appears that taking those two vitamins regularly may have some unexpected negative effects.

A recent study in the May issue of the National Academy of Science Proceedings USA (Proc Natl Acad Sci U S A 2009 May 26; 106:8665) showed that Vitamins C and E actually may block some of the beneficial effects of exercise. That’s right – you can be exercising regularly and not getting the good physiological effects of it if you are taking these vitamins.

This study should do away with what many people think: that though vitamins may not help the body, they certainly can’t hurt. Now we know that they can.

So, back to our usual mantra: discuss with your primary care clinician what supplements you really need to be taking; eat nutritiously; exercise regularly; and stop taking unnecessary vitamins!

We’ve all heard that hormone replacement therapy (HRT) with Premarin and Provera has been found to increase the risk of breast cancer, and increase the risk of heart attack and stroke. However, there may be some good news about HRT. In a study that has been ongoing since 1986, doctors at the Mayo Clinic have found that HRT reduced the risk of colon cancer by 28%. Another study done at City of Hope Hospital found that HRT reduced the risk of colon cancer by 27%. We also know that HRT reduces the risk of fracture due to osteoporosis by as much as 38%.

When considering hormone therapy,most important for you to know are your risks for common adult diseases and conditions. If you are a person who is at more risk for colon cancer or for osteoporosis than for heart disease, stroke, or breast cancer, then you might want to discuss taking HRT with your doctor. Also remember that those studies showing that HRT increases the risk of heart disease, stroke, and breast cancer were done using Premarin and Provera only. There are other, potentially safer, options for HRT using more natural compounds of the hormones.

The North American Menopause Society just this month updated its position statement on the use of HRT in postmenopausal women which is in keeping with the above. They say that recent data support the initiation of HRT around the time of menopause to treat menopause-related symptoms; to treat or reduce the risk of certain disorders, such as osteoporosis or fracture in certain women; or both. They also say that the benefits of HRT right at the time of menopause outweigh the risks; but that the benefits of HRT decrease (and the risks increase) with aging and with the length of time since menopause began.

Bottom line: Consider the use of HRT right at the time of menopause for certain indications, but do not stay on them indefinitely (or greater than 5 years); also, the further in time you are away from the start of your menopause, the more risk there is in starting HRT.

When it comes to your doctor’s office and your test results, it’s time to rethink the old adage, “No News is Good News.”   

A recent study published in the June 22 issue of the Archives of Internal Medicine revealed distressing findings concerning this commonly used saying. The authors of this study reviewed 5.434 randomly selected charts of patients between the ages of 50 and 69 in twenty-three primary care offices. Out of 1,889 abnormal test results, they found 135 apparent failures in informing the patient of the abnormality, or in documenting in the medical record that the patient was informed. That’s 1 out of every 14 abnormal tests, or 1 out of 14 patients who was not told of abnormal test results!

Interestingly, in this study,those offices that had electronic medical records did no better than those with paper charts. This makes sense because the problem is usually due to the lack of a system to inform patients of abnormal lab results, not the type of medical records used. In fact, the offices that had the highest failure rates used a combination of electronic medical records and paper charts, rather than solely one type or the other.

Yes, this is just one study. And we always tell you that before you can draw conclusions about results in medical studies, the findings need to be repeated in many well-designed studies. However, those words of wisdom don’t give us much comfort in this particular instance because if you are the one patient that doesn’t receive notification of your abnormal lab results in a timely manner, it could literally be bad for your health. Disastrous, in fact.

So what’s the message you should take home from this study? If you haven’t heard from your doctor’s office – either via a phone call or a written report – within several weeks of taking medical tests, CALL (or email if that is the mode of communication your doctor prefers). These medical tests include bloodwork, Pap smears and mammograms, among others. And if the medical test results will determine your treatment, such as urine or throat culture, don’t wait several weeks, CALL two-three days after having the test done.

Yes, doctors and other primary care clinicians are overwhelmingly busy these days, as are their office staffs. And though many offices do have a system in place in notify patients of  lab results, others – as seen in this study – do not.  And yes, they may get snappy with you, or even repeat the saying that you would’ve been called if there was a problem. But pay no mind that. JUST GET YOUR RESULTS.

Don’t be shy – speak up. It could save your life.

For some tips on enjoying this summer weekend safely, please reread our June blogs.

For our readers in the U.S., have a wonderful July 4th weekend; for our readers in other countries, enjoy this midsummer weekend!

J&R

The National Safety Council (NSC) has designated this month as National Safety Month, and this week as “Distracted Driving Week.”  Were you aware that 80% of all motor vehicle crashes are the result of driver inattention? Many studies have shown that use by the driver of wireless communication devices (talking on a cell phone, texting messages, or reading your email, for instance) is one of the main distractions affecting drivers, and also one of the most common. This is so often the case that the NSC has just launched a new advertising campaign on billboards across the country called “Death by Cell Phone.”

Bottom line: If you’re truly focused on your driving, and more importantly, on the other guy’s driving, you should never get bored and need to talk, text, or read. Or eat and drink. When you or a member of your family or one of your friends is driving the car, just drive the car.

Of course, being safe in the car also requires that you wear seatbelts.

In addition to motor vehicle safety, you should take this opportunity to think about safety in all areas of your life. Walk through your house and look for potential dangers – that electrical cord in the middle of the floor that could be tripped over; the rug that slides when you step on it; that bedside table on which the books are stacked way too high. Regularly check all your medications – over the counter and prescription, and your foods for expiration dates. (And your eye makeup as well.) Look around your yard and your neighborhood for hidden safety hazards. Start doing this now and do it on a regular basis throughout the year. Go to the NSC’s website for other good ideas about keeping you and your family safe: http://www.nsc.org/

I’ll end this reminder about safety by telling you that it is also “National Goat Trauma Awareness Month.”  This is important for you to know even if you don’t have a goat, or do not know a good goat therapist. (Sorry about that but you can see what I initially thought “goat trauma” meant.) The Childhood Goat Trauma Foundation says that most trauma occurs at petting zoos, and therefore to be careful there, or better yet, avoid them. They also say that, because loose goat attacks mostly occur in less populated areas, you may not be safe even in civilized areas as there have been reports of “roaming urban goats.” Be forewarned.

If you’d like more information on this, go to: http://www.goat-trauma.org/news.shtml

In honor of this, let me tell you some things you may not know about two popular fruits. They taste great and may even help you to lose weight. Let’s start with my favorite, grapefruit. Then we will move on to raspberries.

Grapefruit has many of the vitamins of the other citrus fruits but is has a lower Glycemic Index. That means that sugar is released slowly in the body rather than in one quick rush.

The results of a 12-week study linking grapefruit to weight loss done at the Scripps Clinic in 2004 put 100 men and women on a diet that included half a grapefruit or grapefruit juice three times a day with a meal. The average weight loss was 3.6 pounds for those who ate their grapefruit, 3.3 pounds for those who drank it. However, many reportedly lost more than 10 pounds. Grapefruit has chemicals that may lower insulin levels and expedite weight loss. The only problem with it is that it can interact with certain medications. It is important to check with your doctor or pharmacist to find out if you are on any of these medications. If so, you need to avoid it. (Sorry about that)

Raspberries are rich in antioxidants. Eating three or more servings per week have been found to lower the risk for age related macular degeneration. The anthocyanins (important antioxidants) in raspberries have been found to delay the effect of aging. Although raspberries contain sugar it does not seem to affect blood sugar in a significant way. Red raspberry ketones are currently being used in Japan as a weight loss supplement. Red raspberry seed oil has attracted the interest of the cosmetic and pharmaceutical industries because it is rich in Vitamin E, omega-3 fatty acid and has a sun protection factor (SPF) of 24-50.

Celebrate this month by eating your favorite fruit or vegetable and enjoy!

Today I was distressed to find out that my all-time favorite munchy, that least exotic of foods, Toll House chocolate chip cookie dough has been recalled. Chocolate chip cookie dough?!  Is nothing sacred?

Since March, the FDA reports that there have been 66 people in 28 states infected and ill with E. coli, and 25 hospitalizations, from this prepackaged refrigerated product. The FDA recommends throwing away any and all products of this type that you may have bought. Even cooking the dough before eating (which I have never done ) is not recommended, as the bacteria can contaminate hands or cooking utensils/surfaces.

It seems that every week another medication or food product is recalled. If you’re like me, you usually assume that the recall of those contaminated products doesn’t affect you. So you don’t pay close attention to these reports. After all, we’re healthy and young and don’t need those exotic medications that keep being recalled; and we buy our food from reputable places and are good about keeping clean when we prepare it so that it won’t be contaminated.

Not so fast. About the only certain truths in that last statement is that we may be healthy and that we may buy our food from reputable places. Many of the medications that are recalled are not particularly exotic; remember the over-the-counter appetite suppressants recently found to be dangerous, as well as the cold medications? Even acetaminophen (Tylenol) has come under recent review by the FDA because the doses always recommended are now thought to be too high for everyday use; new dosage recommendations are pending.

Even if you buy food from reputable grocers and are meticulous about keeping the countertop and utensils clean as you are preparing, you still may have unknowingly brought home something contaminated . Look at the peanut butter recall recently.

So I guess this is a lesson learned. We all need to keep informed of food and drug recalls and of reports of contamination. And we need to be aware that the most mundane of medications and the least gourmet of foods can be part of this group.  But, even after cookie dough is deemed safe again, I do not intend to ever cook it; it’s too good raw. Old habits die hard.

(In the interest of truth, I have not indulged in my favorite treat, raw chocolate chip cookie dough, in many years – since changing my diet to eat mostly nutritious foods. But – I still remember the deliciousness.)

Things that I miss from summers past: Basking in the sunlight in unsunblocked skin; The smell of the pool; Diving into the cold wetness and feeling the water in my eyes, ears, nose, and mouth; Not wearing a hat in the sunshine; Walking barefoot in the grass.

Since we are usually referring to the bodily effects of aging in this blog, I have to say here that, in my case, the loss of the above summer pleasures does NOT have to do with growing older. The restrictions on enjoying sunshine have to do with the negative effects of sunlight on the skin at all ages. My problems with swimming have to do with a chlorine allergy, and with adult-onset sinus problems; in the case of the latter, I have to wear goggles, and nose and ear plugs in order to swim without getting sick afterward.

And what about walking barefoot in the grass? What happened to me last summer will explain that one. I missed the freedom and feel of grass on my bare feet so much then, that I said the heck with covering up every inch of my body – including shoes – and sat, lolled, ate, and walked in the grass in crop pants and naked feet all summer. Loved every minute of it.

Then one morning last September I noticed a distinctive red rash on my arm, followed by several more identical rashes on other body parts. Target-shaped, or looking like a bullet. You know what I’m going to say next. Yes – I had gotten Lyme disease. Since the places that I like to go are also well-liked by deer, this did not come as a surprise. And then I remembered why I had always been so careful about insect repellant on my legs especially and about wearing shoes.

I was lucky because I caught the infection in its earliest stages; I took the recommended antibiotic and am fine now. But it could’ve been otherwise since Lyme disease is notoriously so sneaky – sometimes not even causing a rash but just infecting, and then laying dormant in, the body, only to cause serious problems months and years later. And  there are many other tick and insect-borne diseases that you can get besides Lyme. That is, if you don’t wear insect repellant when you are outside this time of year, especially in locations where these diseases are common. Insect repellant and sunblock – the necessities of summer.

So, the moral to the story? These days, some of those past summer pleasures are just that – past. And not because we’re older but because we know how better to protect our good health. Or, in my case, SHOULD know better.

A recent article in the news claims, “$2.5 billion spent, no alternative cures found” in reference to the National Center for Complementary and Alternative Medicine (NCCAM). For the last ten years the NCCAM has been conducting research on a variety of treatments including acupuncture, energy and herbal medicine.The article states that the only positive findings were that acupuncture helps osteoarthritis of the knee and supports the use of ginger capsules for nausea related to chemotherapy.

It does not mention the studies showing that acupuncture can help nausea related to chemotherapy or that there are promising results in lab animals for prevention of pain in those with cancer. Although it points out the fact that Gingko biloba and Echinacea are no more effective than placebo for memory and treating the common cold, the article does not discuss the value of fish oil for treating elevated triglycerides and for the use in prevention of heart disease. Nor does it mention the possibility that grape seed extract may help in the treatment of some neurodegenerative diseases. It fails to mention that massage is an effective treatment for chronic neck pain, a very common condition.

Although many of the studies have not produced positive results, when studying complementary medicine, maybe it is time to look at the study models. Does it really make sense to use a placebo-controlled trial when looking at acupuncture and massage? I know from my own experience that acupuncture is different depending on who is administering it. Massage and chiropractics are similarly provider dependent when it comes to quality. As far as the study of herbal supplements, they might have consulted with a panel of botanical experts to find out what part of the botanicals to use for the studies. For Echinacea, they apparently did not use the correct part of the plant. For many of these products it is not just the part of the plant that is important but also how it is prepared. For some the best form to use is a tincture or a tea. For others a tab will do.

I don’t believe it is fair to call for the end of the NCCAM and their studies.What they are doing is finding ways to determine the benefits and (most importantly) the risks to complementary and alternative therapies that are widely used in our country and the world. I think that they may need to find better ways to study these therapies by using more creative study designs. To write off therapies that have been found effective for the world (some for over 3000 years!) is arrogant and ignorant in my opinion. In the scheme of things, ten years of study is a really small amount of time.The NCCAM is just getting started.

Want to lose weight? Think about what you are drinking!

A recent study conducted in over 800 adults has found that the major culprits in weight change (up or down) are liquid calories. Liquid calories include sodas, sweetened fruit and high calorie drinks.

When adults in this study reduced their sugar sweetened drink intake by one a day,they lost an average of 1 pound at 6 months and 1.5 pounds at 18 months.The results of this study point out the importance of liquid calories contributing to weight gain in many people. Conversely, cutting out liquid calories can make it much easier to lose weight.

You may not realize that fancy coffee drinks can contain as may as 700 calories.Soda has no nutritional value, only calories. Sweetened fruit drinks don’t usually contain much fruit. It is better to eat the actual fruit rather than have sweetened juice.

If you are someone who is hooked on soda or high calorie drinks, you might want to think about switching to the old-fashioned drink……water. It has no calories and is endorsed by your doctor!