Cartoons for the holidays--II

Cartoons for the holidays--I

The post-diet age

Dieting is out. It is now considered tacky and anti-feminist. It’s been replaced with “body acceptance,” “fitness,” “mindful eating,” “wellness,” “intuitive eating,” and so forth. Because of diet fatigue, Weight Watchers watched its membership decline. In January 2015 the company’s chief executive noted that, “We’re having one of the worst Januaries that anyone could have imagined.”  What to do? Call Oprah! Ask her to be their spokesperson!

She had turned them down  in the past, but they caught her at a good time. She had just gained 17 pounds. So she said yes and bought a 10 percent stake in the company for $43 million, after which the stock shot up. Her investment is now worth $110 million. At the same time, people were disappointed that Oprah was on another diet.  As Taffy Brodesser-Akner, the author of the article from which I got this information, commented, “It was hard not to suspect that she was trapped, like so many of us are, in a culture that says one thing about fatness and means something very different.”

 Apparently, Oprah doesn’t care if she’s ever skinny again. But she said yes to Weight Watchers because “It’s a mechanism to keep myself on track that brings a level of consciousness and awareness to my eating. It actually is, for me, mindful eating….” In particular, she worries about her cardiovascular health and the fact that diabetes runs in her family.

Weight Watchers is designed to be successful only if you can stay on it forever, which, apparently Oprah is willing to do. Sounds like dieting to me.

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Opioid alternatives--maybe for me

According to a randomized study, reported in the Journal of the American Medical Association, a combination of Tylenol and Advil worked just as well as opioids for pain relief in the emergency room. I’m sure such studies are looking for alternatives to opioids as a way to combat the epidemic of opioid addiction. But what about me?

Before reading about this, I never considered taking Tylenol plus Advil for my joint and muscle pain. I take two Advil fairly often, usually before golf or Jazzercise. But I’m going to give the combination a try. It makes sense, as the two drugs work in different ways. Advil (ibuprofen) is a nonsteroidal anti-inflammatory drug (NSAID). It works by inhibiting the synthesis of a group of compounds called prostaglandins that cause inflammation. (Aspirin and Aleve work in a similar way). Experts aren’t sure exactly how Tylenol (aceaminohen) relieves pain. It doesn’t suppress inflammation, but blocks pain in the brain.

As to dosage, Consumer Reports says to take the combination only occasionally and to stick to one pill of each per day: 325 mg of Tylenol and 200 mg of Advil. (The FDA set the maximum 24-hour dose of acetaminophen at 3,000 mg; the maximum dose for Advil is 1200 mg.) From what I understand, higher doses can give you more pain relief, but side effects of overdosing can be dangerous. Tylenol can be toxic to the liver, especially if you drink heavily. In fact, acetaminophen is the most common cause of acute liver failure in the United States. One-fifth of all patients who need a liver transplant sustained their injury using Tylenol. Advil is hard on your stomach and intestines. Plus, I’ve learned from experience, heavy doses suppress your immune system.

OK. I gave the combination of Advil plus Tylenol a try, one time before golf and another time before house cleaning followed by yoga. Meh. I think for me two Advils work better.

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New blood pressure guidelines: I'm ignoring them

The American Heart Association and American College of Cardiology are now recommending new blood pressure guidelines for anyone who has at least a 10 percent risk of a heart attack or stroke in the next decade. (Apparently simply being 65 or older puts you in that category.) Now high blood pressure is defined as 130/80, down from 140/90. This new level means that nearly half of all American adults and nearly 80 percent of those 65 and older will be considered to have high blood pressure, and, presumably, to need medication for it.

Dr. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, is my go-to guy for sensible advice. While he acknowledges that very high blood pressure is dangerous and should be treated, he questions the new guidelines—not only the numbers also the study that produced the guidelines.

For one thing, he notes that blood pressure is an “exceptionally volatile biologic variable,” meaning that it varies depending on what you’re doing, your stress level, and your surroundings. My blood pressure is always high in a doctor’s office—a common phenomenon called the “white coat syndrome.” I’ve tested my blood pressure at home and have also noticed that it varies from time to time. I just sit there testing until it reaches a level I like.

Welch says that “a national goal of 130 as measured in actual practice may lead many to be over-medicated—making their blood pressure too low. More medications and lower blood pressures are not always better for everyone.”  For one thing, he thinks that lowering blood pressure by too much makes people lightheaded and leads to falls and fractures. Moreover, intensive drug treatment in so many more patients may increase the rates of kidney disease. (In the trial, incidence of acute kidney injury was twice as high in the group receiving drugs to reduce their blood pressure to 120).

I may be sorry, but I’m just ignoring the whole business and still not taking blood pressure meds, even though I have a ten percent chance of having a heart attack or stroke—probably higher at age 81.

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How we got into this health insurance mess

In 1903, The Baptist Church founded a hospital at Baylor University Medical Center in Dallas, Texas. By the 1920s, more and more people were coming for treatment, many of whom were unable to pay their bills. To address this problem, Baylor’s vice president offered insurance to the local teachers’ union. For $6 a year, teachers were entitled to a twenty-one-day stay in the hospital, all costs included.

Within a decade, the model spread across the country and the program was given a name: Blue Cross, a not-for-profit organization at that point. By 1939 three million people had signed up for insurance. However, most people—including my family—did not have health insurance. At that time, treatments were unsophisticated and cheap. We paid out of pocket. But as technology and treatments became more complicated, costs began to rise. At this point, we could have filled the need with a publicly-funded system, as the Brits did in 1948, or even with private insurance sold direct to customers, like car insurance. But a quirk of history nudged us toward employer-based health insurance.

When we entered WWII, a huge part of the workforce was sent off to fight, causing labor costs to rise. To keep the costs from skyrocketing, the Roosevelt Administration imposed a wage freeze—a move that made it more difficult for companies to attract workers. So the Administration permitted increases in health-insurance benefits and made them tax exempt. Ever since, we have been trying to figure out how to cover the vast portion of the country that doesn’t have employer-provided health insurance. No other country in the world has built its health-care system this way. As Dr. Atul Gwande says, we have an “unhnoly, expensive mess that leaves millions unprotected.”

“In a country where pretty much everyone has trash pickup and K1-12 schooling for the kids, we’ve been reluctant to address our Second World War mistake and establish a basic system of health-care coverage that’s open to all.” Seems like a no-brainer to me.

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

Iranian-style heath care in Mississippi

An organization called HealthConnect in Mississippi has adopted an Iranian health care model as a way to address a health care crisis. In the early 1980's, Iran created 17,000 “health houses” to care for the rural poor. The houses are within walking distance. If people need more complex care, they go to a regional center or to a hospital. 

Mississippi has some of the worst health statistics in the country: uncontrolled diabetes, hypertension, stroke, heart disease, asthma, and infant mortality—diseases born primarily of poverty, obesity, and lack of access to healthful food. Because of a shortage of doctors as well as primary and preventive care, sick people in rural Mississippi go to the emergency room for care. HealthConnect tries to prevent such visits by providing both at-home health services as well as primary care at nearby clinics, using Iran’s system as a model. In Mississippi, many rural people now have access to care. 

But clinics and in-home care don’t address the food problem, which may be the underlying cause of the crisis. In parts of rural Mississippi, an adequate grocery store might be 30 miles away, and the local gas station is the only convenient place to buy food. I don’t have the data at hand, but I’m pretty sure that in the past, many of the rural folks in Mississippi grew their own food. People lived into their nineties. Now, the life expectancy for a black man is lower than it was in the ‘60s.

The reason I’m pretty sure that people from the rural south used to grow their own food is that, in the early 80s, I was the director of the urban gardening program in Detroit. Among other things, we plowed vacant lots and provided seeds.

Me on the left.

Most of the people who took advantage of these resources were experienced gardeners—Detroiters who were part of the Great Migration (1916-1970). One time I had a load of elephant manure from the Detroit Zoo dropped onto a vacant lot. The idea was to plow it into the lot. But within minutes, people—mostly elderly—were coming with buckets and wagons to haul the manure home to their own gardens. Those folks knew how to grow food!

It ain’t easy.

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

“Earthing:” Never heard of it!

When researching my post about the side effects of blood thinners, I stumbled across a concept called “earthing” or “grounding.” The source said that “grounding thins your blood, making it less viscous.” Inquiring minds need to know!

Earthing is “direct physical contact with the vast supply of electrons on the surface of the earth” (from an article in the Journal of Environmental and Public Health, written by five bona fide scientists!). In other words, earthing is going outside and walking barefoot or lying down on the grass. The surface of the Earth is negatively charged. When you touch the earth, you pick up some of this electric charge and transfer the energy from the ground into your body.

According to the scientists, many important processes take place on cell tissue surfaces. When we’re not grounded, which is almost all of the time for most of us, “electrical gradients, due to uneven charge distribution, can build up along tissue surfaces and cell membranes.” When you’re grounded, you pick up this negative charge and create a stable internal bio-electrical environment for all organs, tissues and cells.

The scientists performed a bunch of experiments to prove the effects of earthing. One effect, as mentioned above, is blood thinning (the more negative charges on the surface of your red blood cells, the less your blood coagulates). In addition, they also found that earthing reduces stress levels, increases healing responses, reduces muscle soreness, improves cardiovascular health, improves glucose regulation and immune response. The journal authors offer scientific measurements for each of these effects, but it’s too complicated to discuss here.

The authors say that going barefoot as little as 30 or 40 minutes a day “can significantly reduce pain and stress.” If that’s not practical, you can buy “conductive systems” such as chair pads and sheets that will do the job. Deepak Chopra is into earthing and offers a chair pad. It’s available on his Web site. Skeptical people have tried some of these devices and admit that they help them relax and sleep better.

I would like to try earthing. But we don’t have a nice lawn or any other outside surface that I could use for an experiment that wouldn’t cause pain. And I’m too cheap to buy something. Maybe I can think of something.

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

A warning about blood thinners, such as Plavix

A friend of mine went to the doctor complaining that she was gasping for breath at the slightest exertion, such as walking upstairs. She also had blood in her stool. The doc, a GP, discovered she was severely anemic and sent her to the hospital for a transfusion. To me, it was clear that she was bleeding internally.

My friend had a heart attack in 2002 and had been on Plavix (clopidogrel) ever since. Plavix is a blood thinner that is used to prevent clotting, especially after a stent has been inserted. She’d also been taking aspirin.  After she got to the hospital, the nurses and other staff named Plavix as the culprit and she was immediately taken off of it. (This diagnosis of drug-induced bleeding was never formally acknowledged in written form.)

My friend had the transfusion on a Friday, then languished in the hospital over the weekend waiting to be seen by a gastroenterologist. The idea was to look for ulcers. An endoscopy showed no ulcers. “They must have healed,” the doc concluded. She saw her cardiologist a few days later. He took her off the aspirin but put her back on Plavix as a stroke-prevention measure.

Of course, I had to get in on the act and start researching all of this. Here’s, what I found:

•  Plavix, when combined with aspirin, doubles the chance of gastrointestinal bleeding as well as fatal hemorrhaging.    
• Compared to aspirin alone, Plavix users are twelve times more likely to develop ulcers, gastrointestinal bleeding, and cerebral bleeding.
• Several lawsuits accuse the manufacturers and marketers of rushing the drug to market, aggressively advertising Plavix as more effective than aspirin for preventing strokes and less harmful to the stomach — all while minimizing the serious risks.
• For people who have had stents inserted following a heart attack, a drug regimen of Plavix plus aspirin is advised for only one month for patients with bare metal stents and for six to 12 months in patients with a medicine-coated stent. (My friend was on this regimen for 15 years!)
• For stroke prevention, the recommend treatment for women ages 55-79 is a daily aspirin if you have a history of cardiovascular disease (but men in this age group shouldn’t take it); for both women and men age 80 or over, it’s not clear if the benefits of taking aspirin outweigh the risks for bleeding in the digestive tract or brain.

Here’s a fun thing: In an alternative medicine Web site, I found that instead of taking blood thinning drugs you can just walk barefoot! It’s called “grounding” or "earthing." I will research this and let you know the details! 

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

Medical treatments for the poor (not)

Medical treatments for the poor (not)

I recently finished reading a book by a newly-minted doctor called No Apparent Distress: a Doctor’s Coming-of-Age on the Front Lines of American Medicine, by Rachel Pearson. As the blurb says, it’s “a brutally frank memoir about doctors and patients in a health care system that puts the poor at risk.” Pearson is a good writer.

While she was a medical student, the author volunteered at a free clinic in Galveston, Texas. One man, who lived at the Salvation Army shelter, came to the clinic with cancer of the esophagus. The local hospital had diagnosed the cancer but did not treat it because he was uninsured. He was 61, ineligible for Medicare, and, as an adult with no dependent children, he was also ineligible for Medicaid in Texas. At the clinic, all the staff could do was try to get him something for pain, which was extremely difficult because of the clinic’s non-opioid policy—even though opioids are the “standard of care” for cancer pain. They managed to get him a prescription for methadone, which his brother helped pay for. But not all pharmacies always carry methadone, and he’d have to ride his bike all over Galveston to find a pharmacy that had it on hand.

The clinic staff also tried to get him treatment by applying for indigent care, filling out endless paperwork and applying to hospitals all over Galveston County. The applications were denied over and over again. After eight months, the patient was finally accepted into the Galveston County indigent care system. But the county said he had to live within walking distance of the hospital that would be treating him. It was nowhere near the Salvation Army shelter. The patient’s brother came through again and bought him a trailer near the hospital. The patient was scheduled to begin chemotherapy. But the treatment never occurred. The county told the patient that he no longer qualified for indigent care because he owned a trailer. He was too wealthy.

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My opinions are supported

Here are a couple of research studies that support my opinions.

Fat versus carbs: A seven-year international study of 135,335 people, ages 35 to 70, showed that the people with the highest 20 percent in total fat intake—an average of 35.3 percent of calories from fat—had about 23 percent reduced risk of death compared with the lowest 20 percent, who consumed an average of only 10.6 percent of their calories from fat. The fats could be saturated, polyunsaturated and monounsaturated. What’s more, the higher fat diets were also associated with a lower risk of stroke. As to carbs, those who ate the highest 20 percent had a 28 percent increased risk of death, but not necessary from heart disease. This study was reported in the journal Lancet.

Over-treatment: A survey of 2,106 physicians, indicated that, on average, they believed that 20.6 percent of all medical care was unnecessary, including 22 percent of prescriptions, 24.9 percent of tests, and 11.1 percent of procedures. For example, they believe that a quarter of all spine surgeries may not be necessary as well as half of all stents placed in arteries. About 60 percent of doctors said patients demanded unnecessary treatment. They also said there are too many operations done for narrowed blood vessels in the legs. What the heck is that? I’ve never heard of such a thing. (I had painful varicose veins stripped from my leg when I was in my 20's and am glad I did. Pain went away. Plus the doc discovered I had an extra vein, which I guess can come in handy.)

Anyhow: eat fat! Avoid medical procedures (mostly)!

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

Improve brain function (maybe) with low carb eating!

Most of the time your body burns glucose for energy. The glucose comes the carbohydrates you eat. If you don’t eat carbohydrates, your body burns fat for fuel—including stored fat. This process is called lipolysis. The byproducts of lipolysis are ketones—the fuel your body uses instead of glucose. In this situation, your body is in a state called ketosis. (Getting your body into this state is the basis of the Atkins diet.)

Recently, an article in The Scientist, had this headline:  “Studies: Ketogenic Mice Live Longer, Healthier Lives,” with the following subhead “High-fat, low-carbohydrate diets are shown to increase lifespan and preserve memory in two independent mouse experiments.” I knew that you could lose weight with a ketogenic diet, but live longer? Preserve memory?

Two independent studies on mice (published in Cell Metabolism) showed that the mice “avoided obesity and memory decline and displayed reductions in midlife mortality” and also showed “improvements in motor function, grip strength, and other indicator of muscle mass.” One of the researchers also noted that “The older mice on the ketogenic diet had a better memory than the younger mice. That’s really remarkable.”  While these are just mice we’re talking about, I wouldn’t be surprised if the same effect could occur in people, which the researchers will go on to study.

Eating a very low carbohydrate diet isn’t easy (fruits and vegetables are carbohydrates, not just bread, cakes, and pasta). I tried it for a while. You can get these special paper strips to test your urine to see whether your body has gone into a state of ketosis (burning fat for energy). Even though I was quite strict, mine never turned the color it was supposed to—although it did get part way there. But a friend of mine said it happened instantly for her. People are different!

Because I believe in low carb diets, that’s the way we try to eat around here. But my brain function hasn’t changed, nor has my weight. I'm not strict enough.

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Questioning inflammation’s role in cardiovascular health

In last week’s post, I wrote about studies that showed the role of inflammation in cardiovascular disease, particularly atherosclerosis (plaque in arteries; also called hardening of the arteries). But what about the Tsimane, a group of subsistence farmers and hunters living in Bolivian jungles? Scientists have been studying these people for 15 years. The Tsimane have frequent infections and show chronically elevated levels of inflammation. Nevertheless, they have very little atherosclerosis.

Their diet consists of 72 percent carbohydrates (corn, rice and plantains that they grow), 14 percent saturated and unsaturated fat, and 14 percent protein. Scientists recently gave 705 of these people cardiac scans to look for the presence of plaque buildup in their arteries. A score of 0 means no buildup; 0 to 99 indicates low levels; 400 or greater indicates high levels. Eighty-five percent scored 0, and only 3 percent exceeded 99. Even among those older than 75, only 8 percent exceeded 99. As a group, their scores were less than one-fifth the scores of people in the United States. Those who did develop some atherosclerosis developed it 25 years later than those in the US.

Their secret? You guessed it: they are constantly on the move, farming, hunting, and gathering. The men spend seven hours or so every day hunting, fishing and poling their canoes. The women gather nuts, farm rice, corn and plantains. Both men and women cover roughly eight miles a day! Goodness! That’s a lot of walking!

After my parents died of heart disease at ages 79 (father) and 85 (mother), I had one of those scans that were all the rage for a while (Oprah was promoting them). Mine was not whole body; just heart. My score was zero: no plaque whatsoever. That was 15 years ago when I was 66. Oddly, it didn’t make me feel immune. I still figure heart disease will do me in. I suppose I could walk eight miles a day. Not.

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Reduce inflammation for just $200,000 a year!

A new study has shown that a drug, originally used to treat juvenile rheumatoid arthritis and other rare disorders, reduces the risk of heart attacks and strokes in people with cardiovascular disease. The drug treatment does have a couple of drawbacks, such as the cost ($200,000 a year) and the risk of death. In fact, in the study, deaths from infection appeared to match any lives saved by the drug, so there was no difference in mortality. (The medicine suppresses part of the immune system, hence the deaths caused by infections.)

The drug, called Ilaris, reduces inflammation by inhibiting interleukin-1β, a substance that triggers inflammation in response to infection. The study report hints at the fact that lowering cholesterol may not be the answer to reducing heart attacks (half the people who have heart attacks have normal cholesterol). People with heart disease have high levels of inflammation, which is measured by the level of C-reactive protein in your blood. The importance of the study is that it’s the first real evidence that if you inhibit inflammation you reduce the risk of heart attacks.

Let me just say this: in my book, Fat: It’s Not What You Think, I say “Because atherosclerosis begins as a lesion and inflammation, the presence of C-reactive protein may be a more important indicator of heart disease than high cholesterol…C-reactive protein is released into the bloodstream in response to inflammation and plaque buildup in the coronary arteries.” I also quote a cardiologist who says, “Inflammation is emerging as the alpha and omega of heart disease.” My book was published in 2008. Just sayin’…

But how to reduce inflammation without paying $200,000 a year and suppressing your immune system? Some people swear by an anti-inflammatory diet, but research hasn’t proven the efficacy of that method. I don’t know the answer. Drugs such as Advil or Aspirin also don’t get the job done (they don’t work on interleukin-1β,) Maybe there’s nothing you can do. (On the other hand, my post next week questions the role of inflammation.)

If you haven’t read my first posts, you don’t know that I haven’t had a checkup or had my cholesterol checked in about 14 years. Not my thing. But it would be interesting to get checked for C-reactive protein. I’ve considered doing it just out of curiosity.

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

“Good cholesterol” not that great; “bad cholesterol not so bad”

Supposedly you want your HDL cholesterol level to be high and your LDL cholesterol level to be low.  HDL is supposedly the “good cholesterol” and LDL is the “bad cholesterol.” Doctors knock themselves out trying to raise their patients’ HDL levels and lower their LDL levels. This is looking to be misguided (as I’ve said all along). A recent study in the European Heart Journal followed more than 116,000 men and women for an average of six years. They found that men with an HDL level of 73 milligrams per deciliter had the lowest all-cause mortality; those with a level of 97 to 115 had a 36 percent increase risk for death. That is, those with the lower level were less likely to die than those with the higher level. This is the reverse of what we’ve been told (although if your HDL is very low—under 39—that’s not a good thing either).

LDL cholesterol is supposedly the “bad” cholesterol. In a systematic review of studies that looked at mortality of people over 60 found an inverse relationship between the level of LDL cholesterol and mortality. “We didn´t find any study having shown that high LDL-cholesterol is a risk factor for elderly people.”   In other words, those people over 60 with high LDL lived the longest.

Well, some studies have shown you can prolong your life by taking statin drugs—by about four days. Researchers from the University of Southern Denmark did a systematic review of all statin trials that compared statin treatment to a placebo. For people who were treated as a preventive measure, the average postponement of death was 3.2 days; for people who had already had a heart attack, death was postponed by an average of 4.1 days. The trial that showed the longest postponement of death, that postponement was 27 days. In the trial with the worst outcome, life was shortened by an average of 10 days.

Just forget the whole business and don’t worry about your cholesterol.

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

Medical tourism: Dang! Why didn’t I think of that?

A while back I had a tooth implant. It cost me thousands of dollars out of pocket. I could have saved a lot of money and had a vacation by having the work done in another country. It never occurred to me to do that. Recently, my friend Donna mentioned that a friend of hers was considering this option. It turns out that, in 2016, 1,400,000 Americans traveled abroad for medical treatment—just nobody I know.

The most popular places are Costa Rica, India, Israel, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, and Turkey. The most popular procedures are cosmetic surgery, dentistry, cardiovascular, orthopedics, cancer, weight loss surgery, and reproductive treatments, such as in vitro fertilization.

You can find lots of information on this topic. A good Web site is Patients Beyond Borders. They have vetted the places they recommend, and the criteria include “successful adoption of best practices and state-of-the-art medical technology,” as well as international accreditation, quality assurance, transparency of outcomes, and internationally-trained, experienced medical staff. People typically spend $3,800-6,000 for such a trip, including medical costs, transportation, inpatient stay, and accommodations. The savings range from 20-30% (Brazil) 65-90% (India).

Accommodations can be fabulous, especially if you’re having cosmetic surgery in Costa Rica, as this photograph from Conde Naste Traveler magazine shows.

“Chetica Ranch resort offers...personal cottages that overlook 80 acres of lush tropical forest and mountains home to wild horses. Meals are made with organic produce and local meat is smoked in the outdoor barbecue pit. Guests can sign up for daily lymphatic massages.”

Julie Munro is president of the Medical Travel Quality Alliance, an international organization that evaluates and monitors medical standards at hospitals around the world. She notes, and I would agree, that “Quality of care is not nearly as good in America as we tend to think.” You can go elsewhere. One medical tourist writes, “It is hard to recommend taking a 19-hour flight with a toddler to get a root canal with a straight face. But after going on just such a mission in December, I will aim to get all future dental work done in Thailand.” I wish I’d thought of that for my implant.

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

Get thin by eating big breakfasts!

In an earlier post, I wrote that the old saw “breakfast is the most important meal of the day” was created by Kellog as a way to promote his breakfast cereals. In that same post, I said that research had shown that skipping breakfast does not promote weight gain. Now, I discover that making breakfast the biggest meal of the day has all kinds of health and weight benefits.

A study of 50,000 Seventh Day Adventists over seven years showed that you’re better off eating big breakfasts, then tapering off to a small lunch and light dinner—or no dinner at all. The people who ate their largest meal early in the day were more likely to have a lower body mass index (BMI) than those who ate a big lunch or dinner. Those with the lowest BMI finished lunch by early afternoon and did not eat again until the next morning—that is, they fasted for 18 or 19 hours.

In another study, obese and overweight women were all put on an identical 1,400-calorie-a-day diets. Half the women ate most of their calories at breakfast and half ate most of them at dinner. Those who ate the large meal in the morning lost two and a half times as much weight as those eating a large dinner. Plus they lost more body fat and had better glucose levels. One researcher notes, “We observed that the time of the meal is more important than what you eat and how much you eat.”

Our bodies are built to feast and fast. (See my post on fasting.) For one thing, the digestive process and the action of insulin are at peak performance early in the day. That is, our bodies use the nutrients most efficiently at that point. At night, your pancreas is literally sleeping. So if you eat late at night, you don’t have enough insulin to handle the glucose, and your blood glucose stays high up to three hours. It’s called “evening diabetes.”

All very convincing, but tough to pull off. Can you imagine eating a huge meal in the morning? And what happens to cocktail hour?

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Oops! Maybe you don’t need to take that full course of antibiotics after all

You know how the doctor tells you to take all the antibiotic pills he/she prescribes? That advice may be all wrong. Supposedly the point of taking the full course of pills is to kill off any bugs that may have developed resistance to the antibiotic. That is, you’ll be sure to kill off the tougher bugs if you take all the pills in the bottle.

That doesn’t make sense. Why would some of the bugs develop resistance if you stop taking your antibiotics? A biological engineer from MIT says “The risk you run,” he said, is that “the longer you use antibiotics, you increase your risk of developing resistance.” More bugs have more opportunities to develop resistance and those bugs proliferate.  

Current experiments on streptococcus have shown that the susceptible bugs were killed by antibiotics within three days of taking the drug. But the bugs that were resistant to the antibiotic were still hanging around in low numbers six months after the initial treatment. In Darwinian terms, this amounts to survival of the fittest.

It turns out that the medical community doesn’t really know the optimal dose required to kill off various pathogens. (Exceptions: if you have tuberculosis or a staph blood infection, take all the pills.) As one researcher says, the idea of taking a full course of antibiotics “has come down from our forefathers and is not based on modern scientific evidence.”

Apparently, not much research has been done to determine the optimal dosing for killing bad bugs and at the same time avoiding the development of resistance. Some scientists are now trying to figure this out. But it’s very tricky business. As another researcher says, “It’s a very complex relationship between antibiotic use and resistance, and every antibiotic has selection potential” (that is, the potential to encourage the growth of resistant bugs). To get it right, they have to do experiments with each bad bug to get the right antibiotic and right dose.

Sounds like right now it’s a bit of a crap shoot.

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Specialists aren't so special

Here’s what one doctor, a specialist, has to say about our health care system: it is  "...a colossal network of unaccountable profit centers, the pricing of which has been controlled by medical specialists since the mid-20^th century…Each specialist performs the procedures that generate income for them, then passes the patient along. …They are corrupting our health care system.”

As to specialist societies, such as the American Association of Orthopedic Surgeons, another specialist says, “In the United States, physician specialty societies advocate not only for a higher volume of procedures for their members, but also for higher reimbursement per procedure.” In essence, specialists determine the services that are covered by insurance and the prices charged for them.

Both the physicians I have referenced (one at California's Permanente Medical Group, the other at New York's Mount Sinai Health System) believe we overvalue doctors who operate on people and undervalue the physicians who keep us off the operating table in the first place—our primary care physicians. The United States ranks first in the world in the proportion of specialists to generalists. In fact we have a national shortage of primary care physicians. Both the doctors believe that more resources and training should go for education and training of primary care physicians and that we should also pay them more. At the moment, they make less than half as much money as specialist.

In Switzerland, which ranks second in the world for health care quality, about 12 surgeons perform all total joint surgeries for the nation’s eight million residents. Because of this, they have about five to ten times the experience and expertise of their US counterparts. The US, with forty times the population of Switzerland, has about 5,000 surgeons who perform this procedure—which is more like one joint surgeon per 64,000 people compared to one per 650,000 in Switzerland.

As we all probably know by now, our health care system is the most expensive in the world yet ranks last out of 11 developed countries. Something is wrong with this picture.

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Paltrow's placebos

Gwyneth Paltrow sells stickers called Body Vibes. You stick them on your upper arms to “promote healing,” “rebalance energy frequencies,” “smooth out physical tension and anxiety,” and “boost cell turnover” (do you want your cells to turn over?).  For $60, you can get a pack of ten! Here are a few:

Paltrow says the healing power of Body Vibes came from NASA space science, using the “same conductive carbon material that NASA uses to line spacesuits…using a biofrequency that resonates with the body’s natural energy fields…” NASA debunked the claim, stating that spacesuits “do not have any conductive carbon material lining.” But the stickers work! Users say they feel better!

This, of course, is an example of the placebo effect, which is actually a rather complicated business and can be triggered in different ways. One has to do with your expectation that you’re going to feel better. Your expectation triggers the release of endorphins—natural pain-relieving chemicals. This endorphin release occurs even when you take a real painkiller. Studies show that painkillers such as morphine are markedly less effective if you don’t know you’re taking them—that is, the expectation is part of the pain relief effect.

Studies have also shown that people can learn to enhance and suppress their own immune systems—a kind of Pavlovian response. And the state of our minds also affect our health. Researchers found that, during a severe flu epidemic, depressed people who had the flu were sicker for longer periods than people who were not depressed. There’s no shortage of examples of the placebo effect, including sham surgeries that recipients were certain made them well.

As one placebo researcher remarked, “I think it’s connected to systems that generate emotional responses. It’s a window into ways in which psychological factors can affect brain and body factors that are related to health.” It’s that old mind over matter business. But I don’t know, I’d find it hard to put my faith in those stickers.

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Men acting hormonal

Apparently the sales of testosterone supplements are on the rise—from 1.3 million four years ago to 2.3 million now. I guess men think it will make them more vigorous or something. I don’t know about that, but many studies have shown that when men take testosterone they make impulsive—and often faulty—decisions. Even without an extra boost of testosterone, men tend to be more confident than women about their intelligence and judgments. They believe their decisions and solutions are better than they actually are and are less likely to see flaws in their reasoning.  One reason that testosterone leads to overconfidence is that it inhibits activity in the region of the brain (orbitofrontal cortex) that’s responsible for self-evaluation, decision-making, and impulse control. Those are not areas that you want to inhibit.

To study men’s tendency to be over-confident compared to women, college students taking final exams rated their confidence about each answer on a five-point scale, with one for a “pure guess” and five for “very certain.” Men and women both gave themselves high scores when they answered correctly. But when they’d answered incorrectly, women tended to be hesitant, but men weren’t. Most checked “Certain’ or “Very certain” even when their answers were wrong.

Also, compared with women, men tend to think they’re much better than average. They’re also less willing to collaborate. In one study, in which some women took testosterone and others took a placebo, the women who took testosterone were more likely to ignore the input of others and relied more heavily on their own judgment, even when they were wrong.  

In another study, 140 male traders were given either testosterone or a placebo. In an asset trading simulation, men with boosted testosterone significantly over-priced assets compared with men who got the placebo. They also were slower to incorporate data about falling values into their trading decisions.

Apparently, Donald Trump has had his testosterone measured--not normally part of a routine checkup, partly because nobody knows what an ideal testosterone level might be. The range is very wide. Trump’s is mid-range. Perhaps he takes supplements. I hope not.

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Is a fecal transplant right for you?

Sorry. You can’t get one unless you’re at death’s door with a gut colonized by clostridium dificile, a bad bug (bacterium). That’s the only condition under which the FDA authorizes fecal transplants. In case you can’t figure it out, a fecal transplant is the transfer of “stool” from a healthy donor to an unhealthy recipient. In a hospital setting, people with healthy innards are donors.

Of course, you could always do it yourself, as plenty of desperate people do. Case in point: an athletic woman, who is a research scientist, had “bad stomach” issues and chronic fatigue. She had been on a year-long regimen of broad-spectrum antibiotics to combat a serious case of Lyme disease. But the regimen had killed the good bacteria in her colon and, she learned, had allowed the growth of pathogenic bacteria. Because she couldn’t find a doctor who would give her a fecal transplant, she did it herself, using a six dollar enema kit from the drugstore (“not fun,” she says). For a donor, she enlisted a fellow athlete. “Within two months I was a new person,” she reports. “I had no more fatigue. I could ride my bike hard three days in a row, no problem.”

Of course the Web has all kinds of information on do-it-yourself fecal transplants. For example, a Web site called PowerofPoop provides instructions and even helps connect people to potential stool donors. The HBO show, Vice, did a segment on them, which you can watch on You Tube. If you’d like to have your poop analyzed and at the same time contribute to science, go to the American Gut Project Web site. They’re a citizen science project. As their site says, “You get some cool information about the microbes that call your body home while supplying us with priceless data…about the connections between our microbes and our health.” I might do it.

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What the heck is a FODMAP?

I just learned that FODMAP is an acronym that describes a group of carbohydrates that are not well absorbed in the small intestine. If you eat too much of them, they cause all kinds of trouble once they get to your colon. The acronym stands for Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols. While you may have never heard of a FODMAP, you may have discovered the effects of one or more of these foods through trial and error.

The list of such foods is long. The oligosaccharides include wheat, onions, garlic, legumes, and artichokes; the disaccharides are milk products, including yogurt and ice cream; the monosaccharides include watermelon, honey, apples, high-fructose corn syrup; the polyols are sugar-free sweeteners, such as sorbitol, maltitol, and xyltol, although sorbitol is also found in a wide variety of fruits.

In addition to being poorly absorbed during the digestive process, these foods are rapidly fermented by bacteria that live in your gut and are capable of pulling fluid into the gut. The fluid load plus the gas produced by the bacteria are what usually cause the discomfort.

As I said, the list of FODMAP foods is long. You can find them on the internet, of course. Here’s a link to one list—a paleo diet one. For my part, I can only be certain about one of these foods causing me problems: maltitol. I discovered this while trying sugar-free candy, such as chocolate. There may be plenty more. I can’t tell because my gut problems are chronic and I choose to ignore them. I just figure my gut microbiome is out of whack.  

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Fear of food

According to the CDC, as reported in recent article in the New York Times, “acute gastrointestinal events” (vomiting, diarrhea, cramping, etc.) are commonly caused by bacteria and viruses hanging about on food. Apparently some foods are more problematic than others: “leafy greens, culinary herbs, melons with textured surfaces, tomatoes, cucumbers, jalapeno peppers, nut butters, shellfish, frozen peas, cheese and ice cream.”

The article might make you afraid to eat. For example, in discussing juices and smoothies: “Just one speck of contaminated dirt in your detox drink could upend your gut. And think of all the hands that necessarily touched the produce from the time it was picked in the field to when it was chopped and crammed into the Vitamix.”  Also, “restaurant food tends to be riskier in general.”

Even though I’ve had a few “acute gastrointestinal events," I’m still not about organize my eating life based on fear of pathogens. I don’t want to live like some of the germophobe readers who made online comments about the article. For example:

My local Starbucks staff knows me as the nutty guy who reminds them to please use tissue from the pastry case or a glove to put the lid on my coffee. 

At the least all ground beef in the US should be irradiated.

…alcohol strips the mucosa of the stomach, making for good sites for organisms to get a party of their own.

…we do not eat while swiping the phone that we held while on the toilet.

NEVER get a salad while dining out. Let me repeat that, NEVER.

As always, I say, don’t worry about it! Bad stuff might happen, but you can't insulate yourself from the microscopic universe. I did learn about a group of foods with the acronym FODMAPs that commonly cause intestinal trouble. It’s worth looking into, which I’ll do next week.

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Bunions

We got to talking about bunions in Jazzercise the other day and realized we didn’t know much about them. I have bunions on both feet, similar to the illustration below. Rather ugly, but they don’t hurt, so I’ve never paid much attention to them. I just figured they were another consequence of old age, which is why I knew nothing about them until I started doing a little research for this blog post. In case you don’t know, here is what a bunion looks like:

A bunion is the result of a condition called hallux valgus—and it’s more than just a bump on the side of your big toe. It’s a progressive, biomechanical deformity. The bump reflects changes in the bony framework of the front part of the foot, as you can see in the diagram on the right. It’s actually quite a complicated condition that’s not easy to fix. (No need to fix it unless it hurts.)

In the progression, your big toe starts to lean in and over the years it gradually changes the angle of the bones. It’s caused by a faulty mechanical structure of your foot—one that you inherit, which can include excessive pronation and an imbalance of the foot muscles and ligaments. The problematic foot structures vary from person to person.

Bunions occur in about 23% of adults, 35% of people over 65, and mostly in women (30% females compared to 13% males). Wearing pointy, high-heeled shoes exacerbate but do not cause the condition.

There’s not a lot you can do about bunions. Shoes with a wide toe box and orthotic inserts can help (I use both). Exercises that strengthen the ankle and lower leg muscles might also help. Here is one I'm trying, but with an imagined towel.

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The even newer cholesterol-lowering drug

You may have read about a new injectable cholesterol-lowering drug that’s got everybody all excited because, in a large trial, it lowered LDL (so-called “bad” cholesterol) by 59 percent. Plus it lowered the number of various types of heart attacks by 1.5 percent. Here is what my trusted source, Uffe Ravnskov, M.D., PhD, has to say about this.

• Based on the trial’s statistics, to prevent one heart attack per year it is necessary to treat 140 patients.
• Most heart attacks heal with no or few aftereffects.
• The cost for one year’s treatment is about $14,000, meaning that the cost for preventing one heart attack per year is more than two million dollars.
• The number of deaths from heart disease and other causes actually increased! Of the 30,000 patients in the trial, 444 of those who were treated with the drug died. Of those who were not treated, 426 died (if the trial had gone on longer, that number may have increased). In other words, the number of heart attacks may have been reduced a bit, but the number of deaths increased.
• The three main authors of the research paper are employees of Amgen, the drug manufacturer.

Besides, as shown by a systematic study of 69,000 elderly people (over 60), a high level of LDL-cholesterol is beneficial.

As I’ve said many times, our bodies make cholesterol for a reason. I don’t think you should mess with it.

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The benefits of fasting

I have always dismissed the idea of fasting as kind of faddish and new agey. Plus self-denial doesn’t appeal to me. As far as I know, people mostly choose to fast for weight control. (One 456-pound man fasted for more than a year and lost 276 pounds.) But I’ve just found some interesting research that shows other health benefits of withholding food.

Because we probably evolved to endure periodic bouts of starvation, our organ systems may be programmed to function optimally in intermittent fasting-type conditions. At the very least, our early ancestors’ eating patterns were probably restricted to the daylight hours. Now we eat all the time—night and day, probably throwing off some delicate mechanisms. (One of the mechanisms has to do killing damaged cells and replacing the dead cells with newly regenerated cells.)

Here are the benefits, way over-simplified here (the mechanisms that cause these effects are wildly complicated, some having to do with gene expression and altering metabolic pathways):

• Liver: increases insulin sensitivity, decreases insulin resistance, lowers blood glucose levels. Also, the liver’s glycogen stores become depleted and our bodies start burning visceral fat.
• Immune system: reprograms T-cell populations, tamping down autoimmunity; also reduces pro-inflammatory substances.
• Heart: lowers blood lipid levels and blood pressure.
• Brain: improves memory, learning, and neuron repair.

Fasting regimens vary, such as every other day, two days a week, or periodic, such as once a month or once a year. But there’s also one called “time-restricted feeding”: you confine eating to a window of 8, 10, or 12 hours a day. How hard is that? At our house we do that all the time: we eat dinner at 5:30 (we’re old) and break our fast at 7:00 in the morning. That’s easily 12 hours of fasting. It counts!

So wait a minute. Most of us fast every day without thinking about it. Forget I said anything (although it's nice to know that our bodies put our fasting periods to good use; also that you don't have to go to any extremes to get the benefits).

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Eat butter, not margarine!

On May 31^st of this year, Fred A. Kummerow, a professor at the University of Illinois, died at the age of 102. For 50 years, he had spoken out about the dangers of trans fats, publishing his research as early as 1957. Not only was his work criticized, it was dismissed. In those days, the prevailing view was that saturated fats, such as butter, were responsible for heart disease (which we now know is not true). People were encouraged to switch to margarine—advice that turned out to be a big fat mistake.

Trans fats are a man-made unnatural fat produced by hydrogenating vegetable oil. Think Crisco and margarine. Until recently, most baked goods were made with trans fat products. The problem with trans fats is in their molecular structure, which compromise many bodily functions, including hormone synthesis, immune function, insulin metabolism, and tissue repair. They also dramatically increase a subclass of LDL cholesterol which is composed of small dense particles and is associated with an increased risk of heart disease. Some studies show that they may also cause diminished mental performance. And that’s only part of their damaging effects!

Walter Willis, an influential scientist at the Harvard School of Public Health, was among those who dismissed Kummerow’s work. Later, he saw the error of his ways and conducted studies that supported Kummerow’s views. Now, he says, that by advising people to eat margarine instead of butter, as he did in the 1980s, “…we were often sending them to their graves prematurely.”  

In 1911 the average American ate about 19 pounds of butter a year and one pound of margarine. By 1976, they were eating 12 pounds of margarine a year, with a concurrent rise in heart disease. Now the Harvard School of Public Health is saying that eliminating trans fats from the American diet would prevent 250,000 heart attacks and related deaths every year. (Denmark restricted trans fats in 2004; by 2010 the incidence of heart disease and related deaths dropped 60 percent.) The US ban on trans fats goes into effect in 2018—a long time in coming.

Before he died, Dr. Kummerow reported that his own diet included red meat, whole milk and eggs scrambled in butter. We eat like that at our house. Maybe we'll live to 102!

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Beware of new drugs

New prescription drugs have a one in five chance of causing serious reactions after they have been approved. For this reason, expert physicians recommend not taking new drugs unless they have been on the market for at least five years. It takes that long to determine whether they are safe.

What’s more, most of the new drugs offer few advantages over old ones. Independent reviews by expert teams in France, Canada, and the Netherlands have concluded that of the 946 new products released between 2002 and 2010, only two were breakthroughs and 13 represented a real therapeutic advance. The remaining 85 to 89 percent of the new drugs offered little or no clinical advantage. And yet these new drugs continue to flood the market.

The reason that new drugs offer few advantages over old ones is that companies just tinker a bit with their existing drugs, then begin pushing these “new drugs.” (I read about one man who pried the coating off a “new” drug to find the old drug underneath. The “improvement” was merely the coating.) Nevertheless, their sales and profits are soaring, largely as a result of raising prices and getting more physicians to prescribe more drugs. Naturally, the new drugs are far more costly than the drugs they replace.

To make sure that the new drugs show some benefit, the companies design their clinical trials with the marketing departments. Scholarly studies have shown that they design the trials in a way that skew the results and distort the evidence by selective reporting or biased interpretation. The FDA accepts these biased trials and uses them to approve drugs. By the way, the FDA receives fees from the drug companies. In 2010, these fees amounted to $529,276, 543. I guess it makes sense for them to charge a fee; but it makes you wonder. 

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