Cartoons for the holidays I

Next week: Three more cartoons

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Food supplements: a big debate

The December 2013 issue of Annals of Internal Medicine published an editorial titled “Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements.” The authors were from Johns Hopkins University and other august institutions. The researchers performed a thorough investigation of  clinical trials that tested the usefulness of supplements. Their conclusion: “We believe that the case is closed— supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful.”

On the whole, I agree with this conclusion. If you’re a normal well-fed person, you don’t need supplements. I don’t take any myself. But I have. When I started getting arthritis in my thumb, I tried glucosamine-chondroitin. I did it because a friend of mine had given it to her dogs and they stopped limping! Anyhow, I tried it for many months and noticed no difference. I have since learned that a randomized trial of more than 1,500 people showed no improvement through using this supplement.  I also tried fish oil supplements, but later found out that studies have definitively proved that it has no value. Ditto for calcium and vitamin D: they don’t reduce the risk of fractures. And so on.

But there’s still plenty of debate about this among researchers. Various studies show that some people may be deficient in certain vitamins or minerals. On the other hand, scientists also say we don’t really know the threshold for deficiency. Plus the vast genetic variation among people affects an individual’s requirements for vitamins and minerals. It’s all very complicated.

Here’s my favorite story about mineral deficiency: A man suddenly found that everything smelled and tasted either rotten or very strong. “All I could do was stand in the woods all day.” He could eat only a few things, mostly cold and white. He went to doctor after doctor until finally one figured out his problem: his saliva had no zinc in it. He was cured with a prescription for zinc sulfate. This condition, by the way, is usually triggered by a bout of flu or a stay in the hospital. Go figure.

While I don’t take any supplements, in the past I have found that a mineral supplement containing calcium, magnesium, potassium, etc. prevented muscle cramps, which, for some reason, I don’t get anymore. But my husband and friend Susan take two a day. It has reduced my husband’s cramps considerably; it has eliminated Susan’s cramps entirely. It’s called Skeletal Strength from Nature’s Sunshine.

Next week: Cartoons for the holidays (I)

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

In defense of fat people

In researching and writing my book, Fat—It’s Not What You Think, I became even more sympathetic towards fat people than I already was. Sadly, I appear to be in the minority. Most people—even those I consider friends—think that people are fat because they don’t exercise or eat properly. As The Scientist Magazine reports, “This antiquated view of the cause of obesity is still widespread, even among medical professionals.” According to scientific research, “poor lifestyle choices” account for only about 15 pounds of weight gain.

Look at yourself and those about you: as the years go by your weight stays about the same. I have fat friends and thin friends. We all exercise and eat sensibly. My fat friends stay fat; my thin friends stay thin (and I remain somewhere in between). The system that regulates our weight is a highly complex one that keeps our weight within a narrow range. Our fat cells maintain equilibrium between the forces that deposit fat and the forces that release fat. The filling and emptying is regulated by feedback systems, chiefly the nervous system and the endocrine (hormone) system. Neither eating less nor exercising more will lead to long-term weight loss because our bodies naturally compensate.

For most obese people, an equally complex system is at work to maintain an overweight condition. Scientists have been studying this for years. For example, researchers hospitalized a 348-pound woman to study the relationship between her food intake and her obesity. For weeks, they fed her exactly the number of calories they calculated would keep her weight at 348. Instead, she gained twelve pounds in two weeks.

Generally speaking, lean people are more active than fat people because a greater proportion of the food they consume is made available to their cells and tissues for energy. With energy to burn, they’re more inclined to be restless and impelled to be physically active. The opposite is true of obese people: the calories they consume go to making fat rather than to burn for energy.

Like much else, having a body that tends toward obesity is simply bad luck. As for the rise in obesity world-wide, Dr. Rudy Liebel, a long-time obesity researcher and fellow sympathizer says, “We simply do not know what environment factors account for the increased prevalence of obesity.”

Next week: Food supplements: a big debate

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

A dose of radiation for health?

Sixteen hundred people died following the Fukushima nuclear accident. But scientists have recently found that none of the deaths were caused by radiation. “It was the fear of radiation that ended up killing people” says Dr. Mohan Doss, a medical physicist. “The government basically panicked.” Many of those who died were evacuated from intensive care units and other health facilities and did not survive the move. Some deaths were suicides.

If people had stayed put, they would have been OK. Even in the hottest spots, their exposure would have been roughly comparable to receiving a high-resolution whole-body scan each year. But most residents would have received far less radiation. Below a certain threshold, according to Dr. Doss and other scientists, low doses are harmless and possibly even beneficial. The phenomenon of beneficial radiation is called radiation hormesis, which means that weak radiation can have favorable effects. Life evolved in a mildly radioactive environment. What’s more we’re all exposed to a natural “background radiation” from the earth (an amount less than half of what most Fukushima residents received).

Some laboratory experiments and animal studies have shown that low exposures unleash protective antioxidants and stimulate our immune systems, conceivably protecting against cancers. Thirty years ago in Taiwan, authorities discovered that about 200 buildings housing 10,000 people were constructed from steel contaminated with radioactive cobalt. Over the years residents were exposed to double the average for the people of Fukushima. Yet a study in 2006 found fewer cancer cases among these folks compared with the general public. More recently, a study of radon by Johns Hopkins scientist suggested that people living with higher concentrations of the radioactive gas had correspondingly lower rates of lung cancer.

I like the idea of hormesis—the notion that low exposure to toxins and other stressors can be good for you. While scientists don’t know the exact biochemical mechanisms by which it works, the general belief is that low doses of otherwise toxic substances can stimulate our bodies’ natural repair mechanisms. I like the theory because it fits with my overall approach to health: don’t worry about it.

Next week: In defense of fat people

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Sleep update: some new information

I have written several posts about sleep (see the Topics menu for a list), the gist of which is not to worry if you don’t get eight hours of uninterrupted sleep. New research, published in Current Biology, underscores that message and adds new information.

Researchers studied the sleep habits of three hunter-gatherer societies, two in Africa (The Hadza and San tribes) and one in Bolivia (the Tismane people). These tribes live much as their ancestors have for tens of thousands of years. By studying these people, the researchers could determine how early humans were “programmed” to sleep, and, by extension, what normal sleep might be for us. (Of course, manufacturers of Ambien and Lunesta would have you believe that less than eight hours of sleep will have dire consequences.) Like early humans, the hunter-gatherer people sleep outside or in crude huts and their only light at night comes from fire.

What the researchers found is that, on a typical night, these people sleep slightly less than the average American. In the US, most adults sleep seven hours or more a night--although many sleep significantly less. Members of these hunter-gatherer tribes slept just six and a half hours. About like me. Researchers also found that the presence or absence of daylight is not the primary factor in their sleep patterns.

The conventional thinking has been that the artificial light throws off our biological clocks and that if we could live like early humans, going to bed when the sun goes down and getting up when the sun comes up, we’d be much better off. It turns out that the people in all three of these tribes do not follow that sundown/sunup scenario. Instead, they stay awake several hours after the sun goes down and do not wake at sunrise. What does determine their sleep habits is temperature. They almost always fall asleep as the temperature begins to fall at night and wake up as the temperature rises in the morning. This habit suggests that humans may have evolved to sleep during the coldest hours of the day, perhaps as a way to conserve energy.

From what I can observe, most of us modern humans like sleeping in a cool bedroom. In the 20 years we have lived in our house, we have never turned the heat on in our bedroom (it has its own heat zone). We also open windows at night. Most people I know do the same thing. We seem to have figured it out ourselves.

Next week: A dose of radiation for health?

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Messing with your microbiome

As I discussed last week, your microbiome consist of the trillions of microorganisms that live in and on your body (three pounds of them). These resident microbes exert a powerful influence on our health, including training and modulating our immune systems. Because of our war on bacteria, we have impoverished our microbiomes in a way that has led to the rise of chronic diseases that were virtually unheard of 75 years ago.

Researchers are now trying to figure out ways to refurbish our microbiomes. So far, there’s not been much progress on that front. Fecal transplants (transplanting fecal matter from a healthy donor to a sick patient) have been successful in treating people who have been infected with the Clostridium difficile bacteria, a life-threatening condition. Unfortunately, C. difficile is the only disease for which fecal transplants are approved by the FDA. Plenty of people with intestinal problems (count me in) would like to try this therapy. Many have tried to do it at home (count me out). You can find instructions for this on the internet.

“Probiotics”—substances containing “good” bacteria—don’t actually help much. In fact, most scientific studies have not found any health benefits from consuming probiotics—either in supplements or in foods such as yogurt and sauerkraut. Considering that 99 percent of our gut bacteria are anaerobic (they function in an oxygen-free environment) and that probiotics are exposed to oxygen, it’s not surprising that the probiotics we eat don’t easily colonize our guts. However, there is some indication that consuming probiotics may help with some kinds of diarrhea. This may be because the one percent of gut bacteria that are aerobic live in the cecum, a cul-de-sac at the beginning of our large intestines where bacteria work on the partially digested food that become feces.  For myself, I can say that probiotics haven’t done anything for me, and I’ve tried lots of them.

A company called AOBiome sells a spray containing live cultures of Nitrosomonas eutropha, an ammonia-oxidizing bacteria commonly found in dirt. Before we started washing it away, it occupied our skin, feeding on the ammonia in our sweat and, in the process serving as a built-in cleanser, deodorant, anti-inflammatory, and immune booster. Studies have shown that restoring N. eutropha populations has helped people clear up acne, rosacea, and eczema.

Here’s my favorite do-it-yourself story: a man suffered from ear infections in one ear and had been treated with antibiotics in that ear. One day, he inserted ear wax from his good ear into his bad ear. He was cured (this is true).

In the future, scientists may discover therapies that will reinvigorate our feeble microbiomes. Until then, you might try playing in the dirt.

Next week: Sleep update: some new information

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Your microbiome: it's who you are

You may already know that about 90 percent of the cells on your body are not your own. They belong to the more than 100 trillion microorganisms—such as bacteria and fungi—that live in your gut, mouth, skin and everywhere else. Your gut alone contains about 40,000 species of bacteria. For every one of your own genes you have 100 genes from the microorganisms. It’s kind of a creepy idea, but in fact these microbes help you digest food, synthesize essential nutrients and vitamins, and prevent disease-causing pathogens from invading your body. Together, these organisms are called your microbiome and it is unique to you.

Your microbiome plays a critical role as a filter between the environment and our body’s own cells. Substances must first pass through layers of microbiota on the skin, gut, and airways at which point they may be sequestered, excluded, or metabolized before they enter our cells. At the same time, the microbiota are training our immune systems.

We pick up the critters that make up our microbiomes beginning at birth with our trip through the birth canal. From that point on, we are “seeded” with microorganisms through our continuing contact with our home environment. Apparently, our microbiomes becomes stabilized at about age three.

Recent advances in DNA sequencing has brought much of this information to light. Scientists are now looking at the ways in which our microbiota affect our health. Some have suggested that changes to our microbiomes over the last 75 years account for the rise in diseases such as diabetes, heart disease, asthma, autism, inflammatory bowel disease, obesity, and many more. Many—if not most—of these diseases were virtually unknown 75 years ago.

For example, a bacterium called Heliobacter pylori once occupied the stomach of nearly every person in the world, having been intertwined with our species for at least two hundred thousand years. Now it is found in just five percent of children born in the US. H. Pylori plays a role in regulating stomach acid and in quieting the inflammatory response. While it can cause ulcers, the near-eradication of this bacterium has now been shown to have a serious downside. Many Americans now suffer from acid reflux, and the rate of a certain type of esophageal cancer has soared. What’s more, researchers have found the lack of H. pylori to be implicated in the rise of asthma and allergies.

The heavy use of antibiotics may be the main culprit. Also, scientists believe that moving from dirty rural environments to clean urban environments also account for the change in our microbiomes. Because we are less exposed to microbes than in the past, our immune systems are not being challenged in the ways they once were.

There’s not a lot you can do to change your microbiome, although some efforts are being made in that regard. I’ll discuss this next week.

Next week: Messing with your microbiome.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Stress and illness

Recently several people close to me have become ill as a result of stress. Depending on the person, the illness has taken the form of skin rashes, sore joints, swollen eyelids, and the flu. Each of these people have been in long-term stressful situations. Even though the relationship between stress and illness is common knowledge, it seem that people who get sick don't usually make the connection. I think many--if not most--illnesses are stress-related.

When stressed your body releases cortisol and other hormones that cause a complicated cascade of bio-chemical events that suppress your immune system. In the words of one scientist, “the immune cells are being bathed in molecules which are essentially telling them to stop fighting.” Normally cortisol regulates inflammation—lowering or raising inflammatory responses depending on the circumstances. But if you are undergoing a prolonged stressful event, your immune cells lose their ability to respond to the signals that regulate inflammation. Consequently, they produce levels of inflammation that promotes disease.

As you’ve probably heard, cortisol is the “fight or flight” hormone. It surges when you’re in potentially harmful situations and promotes short-term inflammation to fight infection. After the onslaught, all returns to normal. Your body can deal with the kinds of short-term stressful situations that come and go. After all, you don’t fall ill after being stuck in traffic or rushing to meet a deadline. It’s the long-term or chronic stress that gets you.

Recent research has shown that genes are also involved in suppressing your immune system. In this case, scientists study people with long-term psycho-social stress, such as loneliness or facing the death of a loved one. Chronic stress affects whole networks of immune-related genes, such that genes that promote inflammation are over-expressed and those that are anti-inflammatory and anti-viral are suppressed. As reported in The Scientist Magazine, “Social stress seems to reach deep into cellular control centers to shape key aspects of the immune system—and, as a result, can impair one’s ability to avoid or fight off disease and psychiatric disorders.”

Next week: Your microbiome: it's who you are

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Public toilet seats: have no fear

This is a rather indelicate subject. It’s about one of my pet peeves: coming into a bathroom stall and seeing that the toilet seat is spattered with pee. You see, I choose to sit on an uncovered seat. But before doing so, I must take some toilet paper and wipe the seat until it’s dry. Studies vary, but one study found that 85 percent of women said they crouched over public toilets, and 12 percent papered the seat. Only 2 percent sat all the way down. I’m one of the minority who is not afraid of toilet seats.

There’s no reason to be afraid. As Dr. William Schaffner, professor of preventive medicine at Vanderbilt University Medical Center says, “toilet seats are not a vehicle for the transmission of any infections agents—you won’t catch anything.” There’s no medical evidence that anyone has ever picked up a venereal disease from a toilet seat. Any bacteria found on toilet seats are common skin microbes that we all carry around on our bodies. In fact, when studying bacteria on various surfaces in the bathroom, the toilet seat proved to be the cleanest surface.

Some experts define a sanitary surface as something clean enough to eat off of, with no more than 1,000 bacteria per square inch. On a 20/20 news program, Dr. Schaffner measured the bacteria on various surfaces, including those in a nearby bathroom as well as in the newsroom. They found that the toilet seat passed the sanitary test, but the anchorman’s desk did not.

Dr. Chuck Gerba, professor of microbiology at the University of Arizona measures bacteria in a variety of household objects. His studies found that the average toilet seat contains about 50 bacteria per square inch. “It’s one of the cleanest things you’ll run across in terms of micro-organisms. It’s our gold standard—there are not many things cleaner than a toilet seat when it comes to germs.” A sponge, for example, has about 10 million bacteria per square inch.

You can’t avoid bacteria—they’re part of you and part of our environment. I don’t worry about sponges or toilet seats. I wish other women didn’t.

Next week: Stress and illness

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

"Sell by" dates: Ignore them

It will probably not surprise you to know that I never pay any attention to the “sell by” dates printed on food packages. I just don’t care about such things. But I know that other people do examine those labels, so I decided to find out who was right: me or other people. Turns out it’s me.

A couple of years ago, the Harvard Food Law and Policy Clinic produced an exhaustive, sixty-one-page report on the subject called “The Dating Game: How Confusing Food Date Labels Lead to Food Waste in America.” Here’s what I learned (quoted phrases come from the report):

Regulations: There are no uniform federal regulations that control these date labels. Each state comes up with their own. Some states require the labels; others don’t. For example, New York does not require date labels to be put on any food products, but neighboring New Jersey does. What’s more, there’s no legal definition for the “sell by” and “use by” terms.

“Sell by” date: “There is no direct correlation between food safety and date labels.” As a rule, it merely “provides information to retailers for stock control…The use of these dates does not advance public health in a meaningful way.”

“Use by” or “best if used by” dates: Typically, these labels are an “estimate of a date after which food will no longer be at its highest quality.” Manufacturers and retailers are “free to define shelf-life according to their own market standards…The fact that consumers and stores throw away products unnecessarily can lead to increased profits for manufacturers if consumers are purchasing more products and doing so more often…some manufacturers may artificially shorten stated shelf lives for marketing reasons.”

Wasted food: As is obvious from the title, the report concludes that those labels may be a leading reason why Americans throw out tons of perfectly good food each year. In the US we toss out about 40 percent of the food we produce, which amounts to a $165 billion in wasted food each year. For a family, this waste costs the average American family of four $2,275 a year.

If you want a copy of the report, click here.

Next week: Public toilet seats--have no fear

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

"Hydration" foolishness

I’ve always believed that this obsession with “hydration” was silly—everyone running around with bottles of water. There is absolutely no scientific evidence that drinking eight glasses of water a day has any health benefits. But it seems to be a persistent myth. In the words of Dr. Margaret McCartney in the British Medical Journal, it’s “thoroughly debunked nonsense.” My feelings exactly.

Basically, your body well tell you when you need to drink. And the drink needn’t be water. It can be anything, including beer and coffee. (The idea that coffee is a diuretic is also a myth.)  Fruits and vegetables also contain a lot of water.

If I sweat a lot, I drink a lot. If not, I don’t. As Dr. Aaron E. Carroll, professor of pediatrics at Indiana University School of Medicine says, “the human body is finely tuned to signal you to drink long before you are actually dehydrated.” Dr. Heinz Valtin, from Dartmouth University tells us that a large body of published experiments “attest to the precision and effectiveness of the osmoregulatory system for maintaining water balance” (i.e., if we need water, we get thirsty; if we have excess water, we get rid of it.)

You can actually die of excess water (a condition called hyponatremia). Since 2008 several high school football players are known to have died from drinking too much fluid during and after a practice. In cases like these, the body can’t rid itself of the surplus fast enough through sweating or urination. In trying to equalize sodium levels by drawing water from the blood and into the surrounding cells, the cells begin to swell. If this process occurs in the brain, it can be lethal.

The benefits of drinking extra water accrue mostly to the purveyors of bottled water, an industry worth more than $15 billion annually. They help keep the myth alive by sponsoring “public service” messages and programs to promote more water drinking. For example, an initiative called Hydration for Health, is sponsored by the manufacturers of Evian. Nestle sponsored a study that concluded that almost two-thirds of children in New York and Los Angeles weren't getting enough water. Give me a break. 

But here are some things you should know about these water bottlers:

• Half the leading bottled water brands get their water from drought-stricken California (my state).
• Twenty-five percent of the water sold in the US comes from a municipal source.
• Fans of bottled water pay more than a 4,000 percent markup to buy a product that’s virtually free.
• Manufacturers use 17 million barrels of crude oil in their bottle production.
• Americans buy 29 billion water bottles a year—an environmental problem.

So just say no. If you’re thirsty, get a drink from your tap.

Next week: "Sell by" dates: ignore them

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Cortisone shots--maybe think twice

About a year and a half ago I was having a lot of pain in my hips—the left, especially. Because I was 78 at that point, I reasonably assumed that the problem was arthritis and that I may be in need of a hip replacement. So I went to an orthopedic surgeon prepared to go under the knife. As it turns out, x-rays showed that arthritis was not the problem. He said I had bursitis and prepared to give me a cortisone injection—a common treatment. Even though my chiropractor had said that having cortisone shots was like injecting acid into your bones, I didn’t resist. I knew that lots of people had the shots. How could one hurt?

For a week or so, I felt great. My usual aches and pains had vanished and I felt 20 years younger. Then it all came to a crashing halt. I was on the golf course and suddenly could hardly move because of the pain in my hip. I hobbled off the course. (I’m much better now, given time, orthotics, some exercises, and Advil.) For over a year after I had the shot, I had pain in the spot where he’d given the injection. Fortunately, the pain occurred only when I did certain yoga postures.

Cortisone is a hormone produced by your adrenal glands. It is released when your body is under stress and works by reducing inflammation. The cortisone you get in a shot is similar to your body’s own cortisone.

Apparently cortisone injections do work well for some people. A major study that looked at the efficacy of cortisone injections on thousands of people with tendon injuries—especially tennis elbow—found that the injections did bring fast pain relief that sometimes lasted for weeks. However, they also found that, after 6 and 12 months, those who had received cortisone shots had a much lower rate of full recovery than those who did nothing or who underwent physical therapy. Those who received the shots also had a 63 percent higher risk of relapse than people who took the wait-and-see approach.

I did have a good experience with prednisone many years ago. I had a serious case of poison ivy and sought help from the doctor, who gave me a shot of prednisone—a type of cortisone. I remember feeling the effect by the time I got to the elevator. It felt like the sores were drying up. Similarly, my husband had excellent results with prednisone pills for pain in his neck.

The side effects of cortisone and prednisone can be pretty horrific and the list is long. For one thing, repeated cortisone shots may cause deterioration of the cartilage within a joint. Also, both cortisone and prednisone suppress your body’s own immune system, making it harder to fight infections. These are not medicines you’d want to take regularly.

Next week: "Hydration" foolishness

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Plantar fasciitis--an easy home remedy

It seems that at any one time someone I know has plantar fasciitis. At the moment, that person is my roommate from college—an old lady like me. I’ve also had it, and fixed it on my own. (Plantar fasciitis is inflammation of the plantar fascii, a thick band that connects your heel to your toe. When it’s inflamed, it’s quite painful.)

Here’s how I fixed mine: I was at an exercise class about 15 years ago and complaining about the stabbing pain on the bottom of my foot. A guy overheard me and said he fixed his plantar fasciitis using tape. He swore by this method. So I got on line and found the taping instructions in a Runner’s World article. I applied athletic tape, as instructed, and in a few days the pain was gone. It has never returned.

Recently, when my friend had the problem, I looked up the taping instructions again and noticed that the technique had changed somewhat. Anyhow, you can get the instructions from the internet. Here’s one site: 

Many, if not most, people see a doctor about the problem. The doctor may give you a cortisone shot. Cortisone shots often provide only temporary relief. As happened with my friend, she got the shot and a couple of weeks later the pain was back. She has now taped her foot and reports much improvement. I had a bad experience with a cortisone shot and wouldn’t do it again.

Next week: Cortisone shots--maybe not such a good idea

For an introduction to this blog, see I Just Say No.

Osteoporosis: maybe not worth worrying about

In 1993, a World Health Organization study group established clear-cut definitions of osteoporosis and osteopenia. (Osteoporosis is a thinning of the bones due to depletion of calcium and bone proteins; osteopenia is bone density that is below "normal.") Their definitions are based on the bone density of healthy young adult women. Thus, if your bone density doesn’t measure up to that of a young person, you either have osteopenia or osteoporosis.

As it turns out, the WHO study was funded by three drug companies: the Rorer Foundation, Sandoz, and SmithKline Beecham. These companies stood to benefit greatly if bone mineral density testing was adopted into routine medical care—which it has been. Because loss of bone density is a normal part of aging, millions of woman use drugs hoping to prevent and treat osteoporosis.

The most dangerous result of falling for an older person is a hip fracture. But bone mineral density tests identify only a small part of the risk of hip fracture. For women between the ages of 60 and 80 only one-sixth of their risk of fracturing a hip is identified by bone density testing. Just as important are muscle weakness, the side of effects of other drugs, declining vision and cigarette smoking.

What’s more, the osteoporosis drugs don’t protect women from hip fractures. It’s true that Fosamax and other drugs used to treat osteoporosis do increase bone density. But the real reason for taking the drugs is to reduce fractures, especially hip fractures. They do not. (One study, for example, showed that the risk of hip fractures actually went up with Fosamax treatment.) The reason drugs like Fosamax are ineffective is that they act on only one of the two bone types—the outer, hard cortical layer. They do not add bone to the internal structure called the trabecular bone, which works like a three-dimensional geodesic dome to provide additional strength to the areas of the skeleton most vulnerable to fracture, such as the hips, wrists, and spine. 

A new class of drugs, such as Evista, are designed to protect bones the same way that natural estrogen does, but without the risk of hormone therapy. But research shows that in women with osteoporosis, Evista reduces only vertebral fractures, not fractures of the hip or wrist.

The best protection against hip fractures is—you guessed it—exercise. Example: The NIH conducted a study of osteoporotic fractures in which they followed 10,000 independently-living women aged 65 and older. Over the seven years of the study, women who exercised moderately had 36 percent fewer hip fractures than the least active women. In this case, the reduction of hip fractures among those who exercised was twice that achieved with Fosamax.

It will come as no surprise to you that I’ve never had a bone mineral density test. Thank goodness my bones seem pretty good, because I’ve taken some pretty spectacular falls.

Next week: plantar fasciitis--a home remedy

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Prostate screening: yes or no?

There’s a big debate over the value of PSA testing, which refers to tests for prostate-specific antigen, a protein produced by cells in the prostate gland. It’s present in small quantities in the blood of normal men and is often elevated in men with prostate cancer and other prostate disorders. But other conditions can also cause an elevated rate. The annual bill for PSA screening is at least $3 billion, much of it paid for by Medicare and the Veterans Administration

Prostate screening is now out of favor. In 2012, the US Preventive Services task Force recommended against routine screening, having found that the benefits do not outweigh the risks, which include a high rate of false positives. Men with false positives undergo painful biopsies that found no cancer. And even when a biopsy finds cancer, there is no way to know if it's aggressive or slow growing, in which case it would never be a problem. Autopsy studies have shown that approximately one third of men aged 40 to 60 years have the slow-growing prostate cancer; for men older than 85, the proportion is three-fourths. In other words, the men die with the cancer, not because of it.

The risks of surgery to remove the prostate include death, urinary incontinence, impotence, and bowel dysfunction. What’s more, the two largest studies of screening produced contradictory results; one showed a slight decrease in prostate-cancer-related deaths and the other showed no advantage. Both tests were found to be flawed.

The most outspoken critic of the tests is Dr. Richard J. Ablin, who says he “discovered the prostate-specific antigen, or PSA, which is now the most widely used tool in prostate screening.” It turns out that, while he did discover an antigen in the normal prostate, he neither developed the PSA test nor discovered the PSA on which the current test is based. That credit goes to cancer researcher T. Ming Chu. That factoid is neither here nor there, although Ablin gets a lot of press. He fiercely maintains that “testing should absolutely not be deployed to screen the entire population of men over the age of 50,” and that the test is still used because “drug companies continue peddling the tests and advocacy groups push “prostate cancer awareness by encouraging men to get screened.” He's probably right about that.

Recently, in an op-ed article called “Bring Back ProstateScreening,” Dr. Deepak A. Kapoor argues that prostate screening tests are now more refined than in the past and take into account age, race, the size of the prostate, how fast PSA levels rise over time, and how PSA circulates in the blood stream. Plus doctors can add other analyses including the presence of certain genes and M.R.I images. He strongly recommends that men get a baseline PSA test in their 40s, then participate in a “personalized screening regimen that considers risk factors and other indicators.”

I don’t know, if I were a man, I’d just forget it.

Update: new diagnostic tools.

Next week: Osteoporosis--maybe not worth worrying about

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

The new cholesterol-lowering drugs: Just say no

We now have two new drugs to lower our cholesterol: Praluent and Repatha. They cost $14,000 a year, a ridiculous sum (see my post on overcharging for drugs). The new drugs were developed as a substitute for statins, such as Lipitor, which many people quit taking because of the side effects—mostly muscle weakness and cramps (death is also a possibility). These side effects are a result of the way in which statins lower cholesterol, namely, by interrupting the chain of events by which your liver makes cholesterol. One substance that gets depleted in this process is co-enzyme Q10. Depletion of CoQ10 is the cause of the muscle problems, as I explained in an in an earlier post. 

So the new drugs lower cholesterol in a different way: they block a substance called PCSK9, which interferes with the liver’s ability to remove cholesterol from the blood. The new drugs have definitely been shown to lower cholesterol, but it’s not known whether they prevent heart attacks, strokes or death. The new drugs may have value for people with familial hypercholesterolemia (extremely high cholesterol), but otherwise I think that their only benefit is to the companies who manufacture them. Like statins, these are drugs for people to take for a lifetime—hence their importance to the drug companies.

A nonprofit organization called the Institute for Clinical and Economic Review evaluates pharmaceutical costs based on the health benefits the drugs provide. They concluded that the new drugs should cost “only” about $2,000. If you’re interested in this analysis, which is a bit complicated, this article explains how they do it. 

I would never take a cholesterol-lowering drug no matter how low the cost, as I explained in an earlier post. I don’t worry about my cholesterol and refuse to have it tested. I see no value in lowering it and don’t think it’s a good idea to mess with these finely-tuned processes. Our bodies make cholesterol for a purpose. Let it be.

Next week: Prostate screening--yes or no?

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Breast cancer: unnecessary surgeries

Every year about 60,000 American woman are diagnosed with an early stage of breast cancer, known as "Stage 0." As a result, nearly every one of these woman has either a lumpectomy or a mastectomy—often a double mastectomy. A new study has shown that most of these painful and deforming surgeries are unnecessary.

This particular kind of “cancer” is called D.C.I.S., which stands for ductal carcinoma in situ. It’s a small pile-up of abnormal cells in the lining of the milk duct. You can’t feel a lump, but the cell cluster can be seen in a mammogram (which I avoid.). A new study, reported in JAMA Oncology concludes that these surgical treatments make no difference in the patients’ outcomes. To arrive at this conclusion, the study analyzed data from 100,000 patients over 20 years.

Even though 60,000 cases of D.C.I.S. are now being found each year, the incidence of invasive breast cancer has not dropped (it remains at about 240,000 cases a year). Patients who had been surgically treated for D.C.I.S. had about the same likelihood of dying of breast cancer as women in the general population—about 3.3 percent. Those who died did so despite the treatment, not for lack of it. Some who died of breast cancer ended up with the disease throughout their body without ever having it recur in their breasts (those who had undergone mastectomies had no breasts).  In these cases, the cancer had already spread by the time of detection. As for the rest, they were never going to spread anyway. The cell clusters would either disappear, stop growing, or just remain in place and never cause a problem.

Dr. Steven Narod, the lead author of the paper and director of the Familial Breast Cancer Research Unit, Women’s College Research Institute (Canada) says “I think the best way to treat D.C.I.S. is to do nothing.” To choose to do nothing takes courage.

For another view on making this decision, see this article. For a breast cancer surgeon's view of this topic see this article.

Next week: Prostate screening--yes or no?

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Chiropractic--sometimes just what's needed

About 15 or 20 years ago I developed a muscle spasm in my back near my shoulder blades. It wouldn’t go away and was driving me crazy. I went to the doctor who hadn’t a clue what to do. I tried acupuncture, which didn’t work either. The only thing that worked was gin and ibuprofen, but I couldn’t keep up that regimen. Then I remembered my husband’s cousin talking about a chiropractor who he described as a “miracle worker.” I had never been to a chiropractor and was a bit suspicious, but at that point, I had nothing to lose. Besides, it made sense to me. The problem was probably structural. So I made an appointment.

I remember sitting miserably in his waiting room, feeling really uncomfortable. When he saw me and diagnosed the problem, he said, “I can fix that.” He adjusted my neck and, presto, the problem went away! I’ve never had it again. I have kept going to him with my various aches and pains. The problems don’t typically get fixed instantly the way my first one did. But over time, things eventually get straightened out. Now I go once a month for a “tune up.”

Given the fact that the spinal cord runs through the center of our vertebrae and that all the nerves in our lower bodies connect to the spinal cord, it seems logical that misalignment of the spine can have profound effects on different parts of the body, depending on the location of the problem. What’s more, the discs separating the vertebrae are also affected by a misaligned spine: they can rupture and swell. Setting the spine to rights relieves the pressure on the discs.

Most commonly, chiropractors manipulate (adjust) the spine by applying a controlled force into joints that have become restricted, either because of a single traumatic event or through repetitive stresses. Manipulation of the affected joints and tissues restores structural integrity and allows tissues to heal.

As far as I can see, doctors of traditional medicine don’t have many options when it comes to spinal or misalignment problems. They can prescribe medication or they can operate—fuse the vertebrae perhaps or insert a spacer between vertebrae. Chiropractic seems like the logical choice for structural problems. But, as with other medical professionals, chiropractors are not all the same. I just lucked out and got a good one right off the bat. A couple of times, when my regular chiropractor wasn’t available, I tried other people. One was good; the other not very good.

Next week: Breast cancer: Unnecessary surgeries

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Back pain: the mind over matter approach

Journalist Tony Schwartz cured his back pain by using the methods of Dr. John E. Sarno (now retired). In 1987 Schwartz had spent a year in “relentless pain, visiting orthopedists and chiropractors, osteopaths and acupuncturists, trying yoga, physical therapy and bed rest, all to no avail.” He attended Sarno’s workshop and learned that, with rare exceptions, back pain has no structural basis. Instead, it is caused by feelings, such as anxiety or anger, that you unconsciously shift from your awareness to the muscles in your lower back. It is "almost always a consequence of muscle spasm that prompts pain, which leads to fear, and then more spasm, and eventually creates a vicious cycle of pain.” Essentially, Schwartz learned there was nothing to worry about except the fear itself.

Using Dr. Sarno’s “talking cure,” Schwartz was completely free of back pain for 25 years. Then it came back. It started with a twinge, then kept getting worse. “It lodged in my lower back, and I could feel the sciatica all the way down to my knee. Within a week, I couldn’t walk more than 100 yards without severe pain.” Assuming it was the same as his earlier diagnosis, he thought about current anxieties in his life, trying to remind himself that the pain was “essentially harmless—much the way any muscle spasm is.” But days passed and he became preoccupied with his pain and could feel his fear intensifying. After about 10 days, he went to see Dr. Sarno’s successor who told him, “You’re going to be fine.”

Even though the pain was severe, Schwartz decided to face his fear and started to resume his walking and jogging. He started walking just three minutes on the treadmill, even though it hurt a lot. But he was determined not to quit. Each day, even though the pain was significant, he felt more confident that he could bear it. Each day the pain was excruciating at first, but he found that the longer he ran, the more the pain receded. Even though it would reappear when he tried to walk, “the pain no longer prompted much fear.” After about five weeks, the pain had disappeared.

Schwartz reports that he’s sent “dozens of people to Dr. Sarno, including ones who had suffered from back pain for years, had visible herniated discs on their MRI scans, and in some cases, had gone through multiple surgeries. Nearly all of them had the same experience I did: complete relief.”

Next week: Chiropractic--sometimes just what's needed

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Back pain: try postural changes

Alert readers (my family) informed me about an NPR program that featured an acupuncturist, Esther Gokhale from Palo Alto, who has, she maintains, found a solution for pack pain. She herself had suffered from such pain and had traveled around the world studying back pain in many cultures. She found that many indigenous people, such as the Ubong tribes in Borneo have no back pain.  She also found that these people and others like them have straighter spines than we do. Their major spinal curve is the one at the base of their spines (a J shape), while our spines have an S shape--with an additional curve further up. Watching them move, she contends that their straighter spines account for the regal way in which they move and hold themselves. 

She has worked out a series of posture-improving exercises that have apparently helped a lot of people (including Joan Baez!). Rather than trying to describe them here, I've found that it's really best to check out her many videos, one of which is a TED talk. Just Google Gokhale and you'll find plenty of them.

                          

I attended one workshop locally (she has instructed others in her approach) and am trying some of the new postures. For one thing, you have to let your butt stick out a little, which shifts your weight a bit and makes for the J curve. I'm also trying to change my walk by using my glute muscles and propelling myself from my back foot. It's too early to tell, but I seem to be having less joint pain. 

Next week: Back pain: a mind over matter approach

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Back pain: best to avoid surgery

I don’t have much experience with low back pain, but I have read that it is the number one cause of disability throughout the world. That’s a pretty big deal. I have two friends who have had back surgery: in neither case did the pain go away. In 2007, 27 million US adults reported back problems. More than 1,500,000 opt for back operations each year. The record of success is pretty dismal.

One study looked at the records of 1,450 patients diagnosed with disc problems. Half had two or more vertebrae fused; the other half had no surgery. After two years, only 26 percent of those who had the surgery returned to work while 67 percent who'd not had surgery returned to work. What’s more, 41 percent of those who'd had the surgery increased their use of opiates.

Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. Between 1995 and 2010, there was an eight-fold jump in this type of operation. For some patients, there is a legitimate need for spine surgery and fusion, says Dr. Charles Burton, medical director for The Center for Restorative Spine Surgery in St. Paul, Minn. “But the concern is that it’s gotten way beyond what is reasonable or necessary. There are some areas of the country where the rate of spine surgery is three or four times the national average.”

Dr. William Welch, chief of neurosurgery at Pennsylvania Hospital, admits “We are less successful at treating back pain” than leg pain. The reason, Welch says, is that it’s often hard to pinpoint the exact cause of someone’s back pain. Even MRIs can be misleading because abnormalities, such as degenerating discs, can be seen on scans for virtually everyone over the age of 30 regardless of whether they have pain.” In other words, we all have degenerating disks.

Here are the common types of back surgeries.

Diskectomy: removes the herniated portion of the disk; requires removal all or part of the back part of the vertebra to access the ruptured disk.

Laminectomy: removes the bone overlying the spinal canal to enlarge it the canal.

Fusion: fuses two or more bones in the spine to eliminate painful motion between vertebrae.

Artificial disks: implanted to replace an injured disk; a treatment alternative to spinal fusion.

Next week: Back pain: try postural changes

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Some dermatological rip-offs

I have never felt ripped off by my dermatologist, not even the first one whom I didn’t like. My current dermatologist and dermatological surgeon perform only necessary procedures and are conservative in their approaches. Everything is done in the office.

This is not always the case. The New York Times tells the story of a woman whose dermatologist (actually it was a physician’s assistant) took a biopsy of a tiny white spot on the side of her cheek, which did turn out to be cancerous—a small, slow-growing basal cell carcinoma. After removing the cancer, using the Mohs treatment, the patient was sent across the street to a surgical center to have the wound closed by a plastic surgeon. The patient protested that she didn’t want a plastic surgeon and didn’t care about having a scar, but the doctor told her she had no choice. This patient had to don a hospital gown, was given an IV, and was sedated by an anesthesiologist. Her bill included $1,833 for the Mohs surgery, $14,407 for the plastic surgeon, $1,000 for the anesthesiologist, and $8,774 for hospital charges. Ridiculous!

Because it is more expensive than other techniques and highly profitable, some say that Mohs surgery is overused. The incidence of Mohs surgery increased by more than 400% in 10 years, which may be due in part because of our aging population. In a sample of 100 Mohs surgeries, the cost ranged from $7,594 to $474,000 with the higher costs for hospital-based physicians. When the surgery is performed in different steps by different specialists, each specialist can bill for his or her own procedure, such as the surgery itself, closing the wound, anesthesiology, and facilities fees. This can total more than $25,000 for a single procedure, as in the case of the patient in The New York Times article.

I recently had a basal cell carcinoma removed from my chin (Mohs method) and chose not to have stitches. I now have a bit of a dimple. Because skin cancers tend to be slow growing, I've toyed with the idea of ignoring them. But I don’t have the nerve.

Next week: Back surgery--best to avoid

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Skin cancer whack-a-mole (II)

This is part two of this week’s skin cancer post. The firstpart describes my experiences with skin cancer. This part explains the difference between actinic keratosis and the three types of cancers:

• Actinic keratosis: a pre-cancerous patch of thick, scaly, or crusty skin. Though they are considered pre-cancerous, less than 1% develop into squamous cell cancers per year (per person). The usual treatment for actinic keratosis is to freeze them off with liquid nitrogen. 
• Basal cell carcinoma: the most common kind of skin cancer and the most common kind of cancer in humans. Basal cell carcinoma is simply cancer of the basal cells in the skin—the cells in the lowest layer of the epidermis. (See illustration below.) They grow slowly, but should be treated because they can grow into nearby areas and invade the bone or other tissues beneath the skin. Basal cell cancers are surgically removed.

• Squamous cell carcinoma: like basal cell carcinomas, they are cancers of a layer of skin cells—the squamous cells. Squamous cell cancers are more likely to grow into deeper layers of skin and spread to other parts of the body than basal cell cancers, although this is uncommon. At any rate, they’re considered more dangerous than basal cell carcinomas. Apparently 60% of squamous cancers arise from pre-existing actinic keratosis. These cancers are surgically removed.
•  Melanoma cancers: develop from melanocytes, the pigment-making cells of the skin. Melanocytes can also form moles--benign (non-cancerous) growths. Melanomas are much less common than basal and squamous cell cancers, but they are more likely to grow and spread if left untreated.

You can find plenty of pictures of these kind of cancers on the internet, but I don’t recommend it.

Next week: Some dermatological surgery rip-offs

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Skin cancer whack-a-mole (I)

The one and only doctor I see about once a year is my dermatologist, darn it. In fact, I have both a dermatologist and a dermatological surgeon! I’ve gotten quite good a diagnosing the various types of cancers—some, even, that are barely visible. So far, I’ve only been wrong once in my diagnoses.

My skin is awful and it’s entirely because of sun damage, probably because, as a teenager, I was intent on having a fabulous tan. I still tan easily and rather like being tan, but it’s a dumb thing to do. I get the cancers in places where my skin has been exposed to the sun—face, legs, ears, etc.

Me, getting started.

 The “whack-a-mole” reference has to do with my own skin cancer situation. I’ve got tons of those crusty pre-cancerous actinic keratosis all over the place, plus recurring eruptions of basal cell and squamous cell cancers (never melanoma, thank goodness). The cancers keep popping up and the docs keep whacking them. (This week I’ve posted two entries, I and II. The second one explains the difference among the cancerous conditions.)

The treatments I’ve received have been various. My first surgery was on my nose. After determining that the spot was basal cell carcinoma, the dermatologist (not my current one) sent me off to a plastic surgeon to have it removed. After removal, however, an examination of the tissue showed that the edges were not clean. In other words, they had not gotten it all. So I had radiation on my nose—two weeks of daily treatments, as I recall. Incidentally, this dermatologist mentioned a treatment called Mohs surgery but said he didn’t know how to do this. Then he warned me that, should I find someone who would use the Mohs procedure, I might end up with a big nostril. That was the last time I went to that dermatologist (who now regularly performs Mohs surgeries).

Mohs surgery is one in which the doctor removes little bits at a time, checking the bits under a microscope between each removal while you wait. This process continues until the edges are clean. In this way, the surgeon removes just what’s necessary. I now have an excellent dermatological surgeon. He has performed four Mohs surgeries on my face, but doesn’t use this method on other parts of my body. For cancers not on my face he just performs simple incisions. 

Because I have so many incipient cancers, I have also used topical creams, which are quite effective in getting rid of pre-cancerous lesions (which may or may not turn into cancer). Two products work for this: Efudex and Aldara (these are trade names, not generic, which are really hard to spell). Efudex attacks problematic cells and prevents them from producing daughter cells. Aldara stimulates your immune system within the skin to attack the offending cells. After a few days, I start getting sores then scabs, after which the spots disappear.

Next week: dermatological surgery ripoffs

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Blue light and sleep

The information in this post comes from a newsletter sent by friend of mine, Enid Fox, who is a fitness and nutrition guru. She is a careful researcher and I trust her information.

Our sleep/wake cycles are regulated by the hormone, melatonin, which is produced by the pea-sized pineal gland located in the brain. The melatonin it produces circulates in the blood. Production of melatonin is triggered by darkness, and its level in the blood usually peaks in the middle of the night. The highest levels of melatonin are between midnight and 8:00. One reason teenagers have trouble getting up is that, for this age group, the nightly schedule of melatonin release is delayed, a situation that leads to later sleeping and waking times.

The thing is, melatonin not only regulates our sleep, it is also a powerful anti-oxidant and anti-inflammatory chemical. One study has shown that people who work the graveyard shift have an increased rate of cancer. So you want to keep your levels of melatonin up. Unfortunately, melatonin production decreases as we age—like so much else, dang it.

What’s important for melatonin production is not sleep itself but darkness. The pineal gland responds to signals transmitted by our optic nerves. When it gets dark, a cascade of nerve signals from the eye to the pineal gland triggers the release of melatonin. But if we bombard our eyes with bright light at night we inhibit the usual surge of melatonin at night, thus lowering the overall production of melatonin.

Dim light has little effect on melatonin, but bright lights, especially the blue lights emitted from electronics can stop the pineal gland from releasing melatonin. One study looked at how melatonin levels were affected by looking at an iPad at night. Researchers found that one hour of exposure to the light didn’t significantly curtail melatonin release, but two hours did. Here’s something else to think about: red-lighted alarm clocks don’t disturb melatonin production very much. But clocks with bright light should never be placed at your bedside.

For a while now I have started reading books on my iPad. Now I’m thinking I need to get out my ancient Kindle, which is not back-lit.

Next week: skin cancer whack-a-mole

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A sleep survey

My mother, Margaret Stoppel, who died in 1991 at the age of 85, wrote a weekly column for her local newspaper, the Sequoia Sentinel. In the year that she died she wrote a column that describes her own sleep habits as well as those of her friends. I think they'll be familiar to many of you. Here’s the column:

"I recently asked a few of my friends about their sleep patterns—my women friends. It didn’t seem proper for me to ask my gentlemen friends.

The principal fact that surfaced was that not a great deal of sleeping was going on among my age group. Most of them sleep four or five hours, with wakefulness plaguing at different times.

A couple of my friends doze off around eight o’clock, just when they want to watch television and then are bright-eyed later when their favorite shows are over. All of them, with one amazing exception, make one or two trips to the bathroom during the night.

Some of them fall asleep promptly only to be wide awake later for two or three hours. Most of them read during their wakeful hours, some play solitaire, but one, who usually is awake between two and four o’clock finds that she does her best thinking at that time.

Some take naps in the afternoon, varying in duration from 15 minutes to two hours. I am a fifteen minute napper. I have been doing this for many, many years. It has become such a fixed habit that when I am socializing in the afternoon I yawn and my eyes glaze over.

When I was working and knew that I had to get up by six, hours of sleeplessness distressed me to no end, which, of course, compounded the problem.

At that time I read an article that suggested saying aloud, or in a whisper, over and over again, the word, “hemlock,” the theory being that the breathing required to do this would induce sleep. I tried it but it didn’t work. It only served to depress me, because the word evoked pictures of Socrates drinking hemlock and dying."

Next week: Blue light and sleep

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The dangers of sleeping pills

People often worry about sleeplessness—which is exactly what drug companies encourage. Using their influence, five pharmaceutical companies managed to establish a National Sleep Foundation that labeled sleeping problems as “public health crisis” and a “national emergency.”  The primary pharmaceutical sponsors of this so-called non-profit organization, founded in 1990, all manufacture sleeping pills.

Naturally, the pharmaceutical companies launched ad campaigns to deal with this “public health crisis.” Their campaigns were wildly successful: between 2001 and 2005 sleeping pill prescriptions grew by 55 percent, to 45.5 million; by 2011, the number was 60 million.  By 2012, 4% of our population was taking sleeping pills.

But here’s the thing: Sleeping pills, such as Ambien and Lunesta aren’t even especially helpful. In a 2007 study financed by the National Institutes of Health, these “hypnotics” reduced the average time to fall asleep by 12.8 minutes and increased total sleep time by only 11.4 minutes. One drug, Sonata, did not extend sleeping time at all. (Test subjects slept six hours and 20 minutes whether they had taken a sleeping pill or a placebo.) Such a paltry benefit doesn’t begin to compensate for the dangers of sleeping pills—which are considerable.

In a 2012 study reported in the British Medical Journal researchers compared medical records of 10,529 people who used hypnotic drugs with 23,671 who used none during the same period. They found that patients taking the sleeping pills on a regular basis were nearly five times as likely as non-users to die over a period of two and a half years. Heavy users were more likely to develop cancer. Previous studies performed in Norway, Canada, and Sweden had also found a link between sleeping pills and increased risk of death. The Swedish study, which followed people for 20 years, found that regular users of hypnotics were 5.6 times as likely to die during the study period, while women were twice as likely to die.

Best to count sheep, I think.

Next week: A sleep survey

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Broken sleep is normal

I rarely sleep through the night or get the recommended eight hours. Though I fall asleep quickly and I’m in bed for eight hours, I’m only asleep for about six of those hours. I use the wakeful time to get my thinking done. Sometimes this wakeful period is productive; sometimes it’s boring. At any rate, I always feel fine the next day and don’t worry about it. I do take a ten-minute nap after lunch.

I figure that my sleep pattern is normal. When talking to friends, I’ve learned that nearly all of them have similar experiences. It turns out that the “lie down and die” model of sleep, in which we attempt to lie perfectly still for a solid eight-hour block, is a relatively new model that coincides with the industrial age. Like me, pre-industrial people experienced a similar “broken” pattern, splitting their slumber into “first” and “second” periods. Kroger Ekrich, author of At Day’s Close: Night in Times Past, says “there is every reason to believe that segmented sleep, such as many wild animals exhibit, had long been the natural pattern of our slumber before the modern age, with a provenance as old as humankind.” When you look at the conditions under which humans evolved, it doesn’t make sense that they’d basically go unconscious for eight hours in a row. There were too many pressures and predators to contend with. What’s more, some non-Western peoples, such as the !Kung hunter-gatherers in Africa or Balinese farmers in Indonesia have no specific bedtimes. Rather, they drift in and out of slumber depending on what’s happening on any given night.

In the early 1990s, Dr. Thomas Wehr at the National Institute for Mental health conducted an experiment to duplicate sleep patterns before the invention of gas or electric lights. He did this by placing volunteers in an environment lit with only natural light. After a while, his volunteers drifted into a pattern in which they slept for a few hours then awoke for a period of “meditative wakefulness” then fell back asleep again. Sounds just like me.

Of course, we do live in environments of artificial stimuli—lots of it. But we adjust. As Dr. James J. McKenna, an anthropologist who studies sleep says, “Our bodies move toward adaptation, not pathology. Given the sensory context [the stimuli of modern life] our sleep is probably appropriate to the challenge.”

Yet, we’re told that if we don’t sleep eight hours, we’re killing ourselves. Actually, just the opposite is true. Studies have shown that people who sleep between 6 and 7 hours live the longest. More than seven hours of sleep is associated with progressively increasing risk of death, especially from heart disease. Men who sleep more than eight hours a night have been found to have twice the risk of overall death and about three times the risk of dying of heart disease as those who sleep less. Yet, we worry about sleeplessness and look for remedies; exactly what the drug companies encourage.

Next week: The dangers of sleeping pills

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Mammograms: Just say no

I’ve had two or three mammograms. The last one was in 2008. I don’t remember why I quit having them. At any rate, I’m glad I did. They’re pretty useless and can be damaging.

In spite of three decades of widespread screening mammography in the US, the breast cancer rate is unchanged. In other words, the number of women who are found to have metastatic breast cancer when they first contact the health system is the same now as it was before we screened for breast cancer. As one breast cancer surgeon said, “If mammography was a treatment, we’d never do it. The effect is too small.” That is, breast cancer screening lowers breast cancer mortality on the order of one person per one thousand over ten years--essentially an insignificant number. A ten-year Canadian study of 6000,000 women, half of which were being screened and half of which were not, found that the mammogram group were just as likely to die as the non-mammogram group. So why bother? The Swiss Medical Board has suggested the screening be halted.

There are plenty of other reasons not to have mammograms, the main one being they lead to false alarms, which then lead to more testing: another mammogram, an ultrasound, an MRI, a biopsy. Among 1000 American women age fifty screened annually for a decade, somewhere between 490 and 670 will have a false alarm, and 70 to 100 will be biopsied to prove they don’t have cancer. Research has shown that the psychological effects of false alarms, such as stress and anxiety, often persist for three years. Not good for your health.

What's more, screenings find cancers that would otherwise not be found—harmless cancers that would never develop into anything serious. It’s true that there are plenty of people who think their lives were saved by screening. As Dr. Gilbert Welch says it’s entirely possible that such people “would have done just as well had their cancer been diagnosed following the appearance of signs and symptoms. It’s also possible they were overdiagnosed: the cancer was never destined to kill them or even make them sick.” Eighty percent of breast lumps are non-cancerous. Seventy percent of breast cancers are found through breast self-exams. At least 30 percent of tumors found on mammograms would go away if you did absolutely nothing. 

You can get as much radiation from one mammogram as you would from 1,000 chest X-rays. I suppose that if the radiation were seriously dangerous, the practice would be curtailed, which, of course, it hasn’t. So maybe it’s safe. But it seems creepy to me. Just leave me out of it.

Update: Here's the latest study (2017) that supports what I have written above.

Next week: Broken sleep is normal

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