July 2010

IS ALL RED MEAT BAD FOR YOU?

We’ve been told for years now to avoid red meat if we want to stay healthy. This recommendation has largely been based on the amount of fat in red meat, and the bad effects that a diet high in animal fats can have on our cardiovascular system, which includes the heart, brain, and the circulatory system. However, we have learned over the years that not all dietary recommendations are based on adequate and irrefutable scientific evidence. Take, for example, the old recommendations to avoid all fatty foods. Or the “food pyramid” recommended by the US government, which was based on limiting fats and largely ignored the unhealthy effects of some carbohydrates. We now know them to be not true.

So it is with red meats. Are all red meats bad for you? A recent study in the journal Circulation* looked at the associations between eating unprocessed red meat and all processed meats and the risks for coronary heart disease, stroke, and diabetes. The study was performed by doing an analysis of 17 prospective cohort trials, and 3 case-control trials, and found that the consumption of unprocessed red meat was not associated with coronary heart disease, stroke, or diabetes. Eating processed meats was associated with a 42% increased risk for heart disease, and a 19% risk for diabetes, but no risk for stroke.

Although this analysis included only a few studies and thus, there is some question of complete reliability, the finding of an increased risk of heart disease and diabetes with eating processed meats makes sense and reinforces other available evidence. The high salt content and preservatives in processed meat are known to be unhealthy.

So, should you now let up on your restriction of red meat in your diet? Not so fast. More studies need to be done. But you definitely should be cautious about eating processed meats based on this study and others. And… you should still limit your intake of unprocessed red meat.

 

* Micha R et al. Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: A systematic review and meta-analysis. Circulation 2010 Jun 1; 121:2271.

 

ARE YOU ADDICTED TO…TANNING?

Most of us know that excess sun exposure, or use of tanning beds or sunlamps, is associated with an increased risk of getting melanoma, which can be deadly, and of getting nonmelanoma skin cancers, which can lead to disfigurement. And yet, many of us continue to seek out that sun or go to tanning salons regularly, even while watching our friends slather on sunblock  and hide from the sun like vampires. This is similar to those of us who drink too much alcohol, smoke cigarettes, or use recreational drugs regularly even though we know that those behaviors can be unhealthy at best, and deadly at worst. 

The question is WHY? Why do we continue to engage in behaviors that can eventually harm us? We know now that alcohol and drug abuse are considered to be medical diseases known as substance-related disorders, or more commonly as addiction.  These disorders by definition involve bodily drives and psychologic underpinnings that are quite difficult to control.

A recent study in the Archives of Dermatology* looked to determine if tanning is an addictive or substance-related disorder. The investigators applied the methods used to determine alcohol or drug addiction, only they modified these questions to ask about tanning behavior. The two sets of questions used came from the commonly used “CAGE” questionnaire, and  from the criteria used to diagnose substance-related disorders in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR).

Of the 421 participants, 229 had visited tanning salons in the prior year and were eligible for analysis. Of  those 229 people, 30% met the criteria of the CAGE questionnaire, and 29% met the DSM-IV criteria for addiction to tanning. This group that met the criteria for addiction also reported more anxiety as well as greater alcohol and marijuana use than did those subjects who were not addicted to tanning.This study shows that there are psychological aspects of repetitive tanning behavior similar to addictions to other behaviors/substances, and leads to the conclusion that excessive indoor tanning involves the same drives as other forms of substance abuse, and thus may be considered, in some people, to be an addiction. 

Does this mean that since tanning behavior well may be an addiction, you should give up trying to stop doing it and give in to your desire to do it? In other words, should you take no responsibility for your actions since you can’t control addiction? Absolutely not. It means that you should discuss this behavior (and any other behaviors that you can’t control) and your concerns about it with your physician. And, you should try to stop scheduling those tanning appointments.

*Mosher CE and. Danoff-Burg S. Addiction to indoor tanning: Relation to anxiety, depression, and substance use. Arch Dermatol 2010 Apr; 146:412.

 

What is Integrative Medicine?

My father was very proud of me. He told everyone what I was doing. He told his very conventional kidney specialist that I was practicing Integrative medicine. His doctor responded by telling my dad that he hadn’t realized that medicine had become segregated! At first, I just let the comment go, but then I realized that he pointed out a very important aspect of modern medicine. Medicine has become segregated! In the new age of specialization, our bodies have become segregated from our mind and spirit. This brings me to the answer of the question, what is Integrative medicine?

Integrative medicine addresses the entire patient mind, body and spirit. We honor the concept that to be healthy, all of these aspects need to be nurtured. We also realize that when given the opportunity, the body will heal itself. When you break your arm, is it the orthopedic surgeon that heals your bone? No, your bone heals itself. The doctor sets the bone so that it heals without becoming deformed. When you cut yourself, is it the ointment you put on the cut that heals it? No, your body heals the cut and the ointment may keep it from becoming infected. If you get an infection, is it the antibiotic that cures the infection? No, the antibiotic knocks the level of bacteria down to a low level so that your body can cure the infection.

As an Integrative medicine specialist, I help to nurture the mind, body and spirit by forming a partnership with my patients. In this partnership we honor the uniqueness of each individual. Some patients are interested in using complementary medical therapies others are not. What we do together is find what works for each patient.
Pure and simple; Integrative medicine is good medicine.

HOW BRUSHING YOUR TEETH MAY SAVE YOUR LIFE, or, THE TALE OF THE GIANT TOOTHBRUSH

Until I was in my 20s, I mistakenly thought that teeth brushing (tooth brushing?) was all about the teeth – preventing their decay and making them look good. And since I’d already had a lot of cavities by that time anyway, the main reason to brush, to me, was to assure that those whites glistened when I smiled. It wasn’t until the day my regular dentist was out, and I saw his newly-minted associate fresh out of dental school, that I learned differently. Expecting a quick routine oral exam, imagine my surprise when he walked in holding a giant toothbrush the size of an axe, and a giant set of plastic teeth and proceeded to tell me how and why to brush.

At first, I was insulted. I know how to brush to my teeth, I thought. But as he continued talking, an entirely new concept about oral hygiene emerged for me. Yes, we may be brushing to prevent decay – although the foods one eats and other factors have as much to do with that; and yes, we may be keeping those pearly whites gleaming – but, as we now know, real stain removal from teeth requires a whitening method done over time. But, the main reason we should brush is to keep the gums clean, healthy, and free of infection. The gums?! Who had ever even considered taking care of the gums?

It turns out that oral hygiene and keeping the gums healthy is all about the normal bacteria that live in the mouth. Give those microbes food – they especially love sugar – and don’t brush or floss – and they will go to work wreaking havoc in the gums. They use the food, especially that remaining between the teeth, which allows them to multiply and burrow down into the gums, setting up housekeeping. And that’s how a gum or dental abscess starts. Continue to skip your oral hygiene for longer, and the plaque (that sticky, clear substance coating your gums and teeth) entraps the bacteria, holding them close to the gums and causing even more infection.

Nowadays we take for granted what that young dentist with the giant toothbrush was trying to tell me so many years ago. We know we should brush our teeth AND floss (or use the apparatus with a jet stream of water between the teeth, like a WaterPik) at least once daily, and if at all possible, twice daily and after eating. This is basic oral hygiene to keep us from getting gum or dental infections.

But what’s so bad about having a gum infection once in awhile, you may wonder? Especially since it can be easily treated with antibiotics? Besides the fact that using antibiotics too often can lead to antibiotic-resistant bacteria, it turns out that allowing inflammation and infection to fester in the mouth may lead to other more serious diseases. It has been thought for awhile now that inflammation in the mouth can lead to inflammation elsewhere in the body. Makes sense since the mouth is the gateway to much of the body. Prior research has actually shown an association between gum inflammation (periodontal disease) and cardiovascular (CV) disease.

Now comes a recent study in the British Medical Journal* that found that self-reported poor oral hygiene, defined as never or rare tooth brushing, is associated with a higher risk for CV events, such as a heart attack. In the 12,000 people (average age of 50) who were surveyed over 8 years, those who reported never, or rarely, brushing their teeth had a 70% higher risk for  CV events than did those who reported daily tooth brushing. Whether or not good oral hygiene actually prevents CV events is unknown at this time.

Though the fact that the participants in this study self-reported their habits, which could mean those that reported good oral hygiene may have been fudging, the association between gum inflammation and CV disease backs up prior research and bears further study. But remember that once upon a time many years ago, we only thought that smoking cigarettes might be bad for our health based on initial studies like these. And look how that has played out.

Bottom line: Good oral hygiene is a must, not only for your mouth alone, but potentially to keep your body healthy in general. Based on what we know thus far, it could be lifesaving. So, whenever you’re in a hurry and decide to skip your oral hygiene, think about a giant toothbrush and head back into the bathroom!

 

* de Oliveira C et al. Toothbrushing, inflammation, and risk of cardiovascular disease: Results from Scottish Health Survey. BMJ 2010 May 27; 340:c2451.  

Healthy Aging: Why Don’t We Know More?

Last week a study was presented that claimed to have found a blood test (anti-mullerian hormone) and statistical model that can predict menopause within four months. I found the news very exciting. For baby boomers like myself the idea of knowing when we can use our Tampax and Kotex budget for something else is really exciting. When I mentioned it to younger women, they were surprised that I found the news so wonderful. When I pointed out the relevance to their lives they realized that it is also important for them. When you are in your 20’s, the idea of having children is often just a passing thought. As women move into their 30’s and the biological clock starts ticking loudly, it is a different matter. The beauty of knowing when you will go through menopause will allow women to plan when they might want to think about having children. Some women go through menopause early and for them the information could be invaluable.

As part of this discussion I was asked why we (in medicine) do not know more about aging. It took me a second, but the truth is that this whole concept of aging is a relatively new one. In 1900 the average life span for men was 46 years and for women was 48 years. Living beyond that into the 70 and 80 year range was an anomaly. Is it any wonder that we don’t know everything there is to know about aging? We are only one of a few generations who are experiencing it. As we all go through it we are learning more and more. One thing remains true as it has throughout the ages and before modern medicine. There is no substitute for the benefits of a healthy lifestyle. Exercise, healthy eating, managing stress, maintaining fitness and a healthy weight are the keys to healthy aging.

My mother started exercising, eating healthy, avoiding red meat and maintaining her fitness at an early age before it was fashionable and before there were gyms to go to. No one would ever guess her age (don’t you dare try either!) and few can keep up with her. We can all learn from her experience. The secret to a healthy life is to maintain a healthy lifestyle, which is simple yet for some hard to do. No matter how old you are it is never too late to turn it around. The key is to just do it!

Mushroom Magic!

I often will recommend mushrooms to my patients. Many (especially those who were children of the 60’s) start laughing. Of course the mushrooms I recommend are medicinal not the magic mushrooms from our youth. Mushrooms and mushroom extracts have been used as medicine for thousands of years. Mushrooms are fungi and many drugs have been discovered from them. These include penicillin, cephalosporin, and even the statin drugs (just to mention a few).

There is quite a bit of ongoing research looking at the healing properties of mushrooms. There are studies that have shown that they can modify the immune system to boost our defense against cancers, they have antioxidant properties, and certain mushrooms such as reishi mushrooms can lower blood sugar and cholesterol. Mushrooms also contain large amounts of vitamin D. They have antiviral and antibacterial properties.

In Japan, the mushroom coriolus versicolor or turkey tail also know as Kresin is used as an anticancer drug. It is commonly used as a supplement during radiation and chemotherapy. There are ongoing studies looking at the extract from this mushroom as an anti-cancer drug in the US. I often suggest turkey tail to my patients who are healed from cancer and those with a strong family history of cancer.

Oyster mushrooms contain the natural compound that is found in the statin drug lovastatin. In the test tube this mushroom has also been found to decrease the growth of breast and colon cancer cells.

There is a mushroom called Lion’s mane that has been found to have a potential anti-dementia activity. It also has been found to stimulate nerve growth. In one study it improved cognitive ability. I often will suggest its use to my patients with back pain as well as brain fog.

Cordyceps is one of my favorite mushrooms. It has a long history in Chinese medicine. It has antidepressant properties and possible anti-cancer activity. It also gives an energy boost and may promote general cell health. Whenever I feel tired in the afternoon I will take a capsule of cordyceps. I also was able to find a chocolate bar that contains this powerhouse mushroom covered in dark chocolate and it tastes surprisingly good.

Since there are so many wonderful things that the different varieties can provide I often recommend a blend of many of them. There are many companies that grow and sell mushrooms. I have found that the company Fungi Perfecti does a wonderful job. If you are interested in more information you can go to: www.fungi.com.

Body Fat Now Comes in Different Colors?

What if I told you that your body fat comes in different colors? And what if I also told you that the fat in one of those colors could actually help you lose weight? Would you think I was crazy?

Well, both those statements are true (and possibly that I’m crazy too – but that’s a separate issue). You may have already heard that there are two types of fat that our bodies can have – white fat and brown fat. The difference between them is not just a matter of color. White fat cells store lipids (fats) and brown fat cells actually burn lipids. So it follows that having more brown fat cells could help control obesity by causing us to use up more energy and  lose weight.

In recent times, it has been found that people of all ages have brown fat cells, which was not known previously. Even more recently, a study in the prestigious journal Science* showed that in genetically-engineered mice, a specific enzyme – known as cyclooxygenase-2 (COX-2) – has an important role in making more brown fat cells in the body. The mice that were genetically-engineered (bred to have certain qualities) to have more of COX-2 in their bodies, and thus more brown fat cells, were 20% lighter in body weight than ordinary mice.

Since the bone and muscle mass of each group of mice were the same, this difference in body weight was completely accounted for by the fact that the mice with more brown fat had less total body fat. And since both groups of mice had the exact same amount of food intake, the lesser amount of body fat was due to the fact that the mice with more brown fat were burning more fat than the others.Even more interesting is the fact that the mice with more brown fat seemed to be protected against gaining weight.  When these same mice were fed a diet with a substance that inhibits the COX-2 enzyme, which them caused them to have less brown fat, they gained weight.

If you’re wondering where you’ve heard of the enzyme in the body that inhibits COX-2, remember that many of the anti-inflammatory drugs known as NSAIDS that are used for joint and muscle pain are COX-2 inhibitors, such as Celebrex.

So, what does that mean for us humans? The new knowledge that the enzyme COX-2 can stimulate the formation of more brown fat will hopefully lead to new medications that will do the  same thing, and thus help us to control weight gain.  And what about the thought that those anti-inflammatory drugs may be causing us to make less brown fat, and thus gain weight? That needs to be studied in humans, especially the doses that may do this. So don’t stop your NSAID pain reliever if it is helping you BUT stay tuned. Oh, and remember that even though it is summer – white is out and brown is in!

* Vegiopoulos A et al. Cyclooxygenase-2 controls energy homeostasis in mice by de novo recruitment of brown adipocytes. Science 2010 May 28; 328:1158.

 

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