Sunscreen: yes and no

A consortium of public health groups in Australia, whose predominantly white population has by far the world’s highest rate of skin cancer, issued a new position statement: “Completely avoiding sun exposure is not optimal for health.” Too much shade can be just as harmful as too much sun. That’s because sun exposure triggers vitamin D production in the skin, and low levels of vitamin D are associated with increased rates of stroke, heart attack, diabetes, cancer, Alzheimer’s, depression, osteoporosis, and many other diseases.

Vitamin D in a pill is no solution. In fact, it has turned out to be a spectacular failure. In a five-year trial of 26,000 older adults, The New England Journal of Medicine reported no benefits whatsoever in any of the health conditions that the study tracked, including cardiovascular disease, prevention of falls, age-related macular degeneration, and a host of other diseases. The final word: “People should stop taking vitamin D supplements to prevent major diseases or extend life.” You must get your vitamin D from the sun.

People at higher latitudes (less sun) suffer from higher rates of many diseases than people living at low or middle latitudes. This difference is most pronounced in autoimmune disorders, especially multiple sclerosis. That’s because UV light retards the immune system’s attack on cells, tamping down inflammation. Diseases now believed to be connected to chronic inflammation, including cardiovascular disease and Alzheimer’s, are often less prevalent in regions with more sun exposure. Also, bright morning light, filtered through our eyes, helps regulate our circadian rhythms, improving energy, mood and sleep.

Bottom line: UV light is both harmful and beneficial, so the trick is to find a balance between too much sun and not enough. In Australia, experts have come up with an approach that divides its sunscreen recommendations into groups according to skin color and susceptibility to skin cancer. Depending on your skin type, length of exposure, and the UV index for the day, you may need a lot of sunscreen or you may need none. It’s a customized solution.

Health authorities in some countries are beginning to follow Australia’s lead. In the U.S., dermatologists are sticking with their always sunscreen approach. As for myself, I never use sunscreen, mostly because of laziness. Of course, I’ve had plenty of skin cancer, but I don’t have the other diseases associated with a lack of vitamin D—yet.

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Caffeine and you

Coffee is good for you! It contains thousands of chemical compounds, many of which may influence health. Studies suggest that coffee drinkers live longer and have lower risks of Type 2 diabetes, Parkinson’s disease, cardiovascular conditions, and some cancers! As one scientist states, “Overall, coffee does more good than bad.” (For what it’s worth, the FDA cites 400 milligrams—about four or five cups of coffee — as a safe amount for adults.)

Coffee (caffeine) is a stimulant that enhances mental sharpness and physical performance. Here’s how it works: throughout the day your body produces a chemical called adenosine, which binds to receptors in your brain and makes you feel drowsy. Caffeine perks you up by blocking those receptors. It takes about 20 to 30 minutes for caffeine to be absorbed into your bloodstream and reach your brain. Because adenosine levels in your brain decrease while you sleep, they’re at their lowest immediately after you wake up.

Everyone responds to caffeine differently. It makes some people jittery and anxious. Others require more caffeine to feel its stimulating effects. That’s because its effect depends on your genetics. Your genes influence the rate at which you metabolize caffeine. According to the experts, it could take anywhere from two to ten hours to clear half a dose of caffeine (200 milligrams) from your blood. You’re probably aware of caffeine’s effect on you and adjust your consumption accordingly. If you begin to experience symptoms of having too much, you cut back. If you need a pick-me-up, you have another cup.

I probably don’t drink enough coffee to get its health benefits—or any benefits, for that matter. I make a six-ounce cup in the morning and drink about half of it. Must be my genes. Holding that thought, I went to my 23 and Me account and looked it up.  Here’s what I got: “Constance, based on your genetics, you are likely to drink less caffeine than average, if you drink caffeine at all. This report is based on genetic variants near two genes that play a role in how your body handles caffeine.” Freaky!

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

Perusing my medical records

On March 20 and again on May 1, I had “transforaminal epidurals,” a procedure whereby the doc injected corticosteroid medication into spaces between my spinal column and spinal cord in the lower lumbar/sacral area. The idea was to relieve pain by reducing inflammation and swelling caused by my “radiculopathy” (pinched nerve in my spinal column). The treatment, which is temporary, helps lots of people, but not me. According to the doc, the area was too “tight” and the meds couldn’t get through.

The first time I was aware of a problem was about ten years ago when I was having pain in my right calf just below the knee. An orthopedic guy said it was because my knee wobbled. Not. I certainly never associated it with my spine. After the pain became more widespread, an MRI showed that I had “severe spinal stenosis”: a narrowing of the spinal canal that puts pressure on the nerves. (The nerves run from spine to feet.) Anyhow, the point of this discussion has to do with the records of my treatment. Medical records are now available through the “portals” of the big medical conglomerates to which most of us belong (mine is Dignity).

I can’t remember why I decided to look at a couple of my records. One was of my follow-up appointment with the doctor's nurse practitioner. Her notes said that I had “lower back pain” that was expressed as “spasms and cramps.” No! I never said that because I’ve never had lower back pain, cramps, or spasms! (My pain is from hip to foot and is burning, as I told her.) I also looked at the record of one of my procedures. Among other things it said I was given oxygen through a canula (those things they stick up your nose). No! That never happened! There may be more errors. I only looked at a couple of records.

These errors make me mad because they make me feel unseen. Just another old lady with complaints. What's more, I think they exemplify the slap-dash, time-restricted approach used by medical practitioners to meet the institutional requirements of "Medicine Inc." Not only did I get lost in the process, but Medicare was probably charged for the oxygen I never got. 

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

 

Whole grains: what’s the big deal?

Nutrition advice almost always starts with “whole grains,” followed by fresh fruits and vegetables. I find this advice to be tiresome. What’s so great about whole grains? Whole grains are the seeds of cereal grasses, such as brown rice, bulgur, whole wheat, and oats. In their natural “whole” state, grains have a hard inedible husk that covers three edible parts: bran (fiber); germ (contains some B vitamins, minerals, fat, and protein); and endosperm (the major portion of the grain, which is mainly starch with a small amount of protein, vitamins and minerals).

Refined grains, such as white flour and white rice, have their bran and germ removed during milling, leaving only the endosperm. Most whole grains are also processed to some degree. For example, whole wheat is ground or crushed to create whole wheat flour; old-fashioned oats are steamed and rolled to make them more palatable and easier to digest.

Often, eye-catching messages on food products include terms such as “Contains 14 grams of whole grains.” Such products often contain high levels of added sugar. In fact, a review of more than 500 grain-based products found that those displaying a “whole grains” stamp contained more sugar than similar products without the stamp. What’s more, whole grains by themselves rank high on the glycemic index, the scale that measures how much a specific food raises blood sugar.

Studies that purport to show an association between whole-grain consumption and good health are examples of “healthy user bias”: those who eat whole grains are people who tend to engage in healthy behaviors such as not smoking, eating lots of fruits and vegetables, and exercising.

Nathan Myhrvold, former Chief Technology Officer for Microsoft, who holds a doctorate in theoretical and mathematical physics from Princeton University and did postdoctoral work with Stephen Hawking, turned his attention to food science. One of his studies compared whole grain bread with white bread. He found no evidence that whole grain bread is better for you than white bread. On a nutrient-by-nutrient basis, whole wheat bread might be slightly better because the bran contains manganese, phosphorus, and selenium, but, he says, “these components are not things that most people run a deficit of.” Plus, our bodies don’t absorb many of the vitamins and minerals in raw grain. Good to know. The only bread in our house is white.

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

Mind over matter

 For 45 years, a Harvard-related lab has been researching the ways in which the mind “has enormous control over health and wellbeing.”  Using elaborate experiments, researchers have found, for example, that—

• People’s perception of the passage of time influenced how quickly their wounds healed (wounds healed faster when participants believed more time had passed and slower when they believed less time had passed—even though their actual elapsed time was the same in every case).
• Expecting fatigue causes people to feel more tired.
• Thinking you will catch a cold is associated with an increased likelihood of doing so.
• People who expected certain benefits, such as weight loss, from daily exercise, did see those benefits, while those without the same expectations did not see the benefits, even though their activities were the same.
• Given a diagnostic label, such as “prediabetic,” affects people’s health outcome. This is the “borderline effect”: people above the prediabetic borderline score (5.7 percent) experienced significantly greater increases in their blood sugar levels than those with a 5.6 percent score, even though there’s no relevant difference between the two.

Then, of course, there’s the placebo effect. Under the right circumstances, a placebo can be just as effective as traditional treatments. For example, in one study on migraines, one group took a migraine drug labeled with the drug's name, another took a placebo labeled "placebo," and a third group took nothing. The researchers discovered that the placebo was 50 percent as effective as the real drug to reduce pain after a migraine attack. As one researcher noted, “The placebo effect is more than positive thinking — believing a treatment or procedure will work. It's about creating a stronger connection between the brain and body and how they work together."

 There’s now a product called Zeebo, in which “you are the active ingredient.” For $25, you can get 45 cellulose pills. You focus on what you want to treat, set your expectations for the treatment, design your own regimen, and follow it. Another chance to do science.

I have my own mind-over-matter trick. I’ve found that most people, if they’ve had a sleepless night, complain about being tired the next day. I never am, even if I’ve only had a couple hours sleep. I just assume I’ll be fine.

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