September 2010

POPEYE WAS RIGHT

Remember Popeye? And his massive deltoid muscle that literally popped up every time he ate a can of spinach? Turns out he was on to something good.

We already know from many studies that a high dietary intake of fruits and vegetables causes you to be at lower risk for heart disease, strokes, and cancer. Now comes a study attempting to show that eating fruits and vegetables also put you at lower risk for Type II diabetes.* This paper was based on an analysis of six prospective studies looking at this question, lasting well over 15 years, and involving more than 220,000 people aged 30- 74.

The results? Interestingly, eating high levels of fruits only, vegetables only, or fruits and vegetables did not show a decrease in the risk of getting Type II diabetes. But in the four studies that looked specifically at leafy green vegetables (spinach, kale, and lettuce), those people who ate at least 1.4 servings of these per day had a 14% less chance of getting Type II diabetes than did those who ate only 0.2 servings or less of leafy green vegetables. This finding was statistically significant.

Despite a couple of problems with the design of the analyzed studies, this large analysis does show that basing your diet on plants in general, and leafy green vegetables specifically, is a definite way to promote good health and prevent certain diseases. Leafy green vegetables have this effect probably due to the high levels of antioxidants contained in them.

BOTTOM LINE: Have a fresh green spinach, kale, or lettuce salad every chance you get. Maybe with a bit of “Olive Oyl”?!  (sorry, couldn’t resist)

 

* Carter P et al. Fruit and vegetable intake and incidence of type 2 diabetes mellitus: Systematic review and meta-analysis. BMJ 2010 Aug 19; 341:c4229. (http://dx.doi.org/10.1136/bmj.c4229)

 

CONFUSED ABOUT HEALTH CARE REFORM AND ITS EFFECTS ON YOU?

As we are currently in a period of time of huge changes in our healthcare system, it’s no wonder if you’re confused about how the Affordable Health Care Act is going to impact on you and your loved ones. 

Knowing that this is the case, Katherine Sebelius – the Secretary of Health and Human Services – and her department have launched a new website to explain the recent reforms to our healthcare system.  Quite comprehensive, it:

1)    Explains the basics of the new law

2)    Helps you to find insurance options

3)    Helps you to learn about disease prevention

4)    Allows you to compare quality of care at different healthcare sites

5)    Gives specific health information based on the group you are in

(ie, families with children, individuals, seniors, young adults, employers)

 

Since it’s so new, it may have some kinks in it yet, but it still is an excellent resource. Here’s the link:

www.healthcare.gov

EVERYTHING OLD IS NEW AGAIN: GIRDLES

My mother always wore a girdle. In fact, she was absolutely rabid on the subject. She thought that all women – skinny minnies or not – needed to wear them in order to look ladylike. In her view, jiggling was not only not sexy (a word she never used), it was downright tacky (a word she used a lot).

So it was that when I came of age and began to jiggle*, the topic of girdles was an ever-running battle between us. For me, coming of age in the late 60s like the rest of you, wearing one was not even in the realm of the possible. After all, we didn’t even wear bras some of the time.

Fast forward to the present time. You can’t pick up a catalogue, turn on a shopping channel on TV, or hear an interview with a celebrity on the Red Carpet without hearing about Spanx.**  I won’t be totally surprised if you haven’t heard of Spanx because when we were writing our book a couple of years ago, our editor – who lives in California – asked what they were when she came upon a reference to them in our book. (I just figured that maybe California gals don’t jiggle).

Spanx is the popular brand of the underwear item now known as “shapewear.” They come in all styles from regular panties to those that are long-legged or high-waisted; to tights and stockings; to bras (that get rid of back fat) and slips; to actual clothing items such as tee shirts,turtlenecks, pants and skirts.  And exactly what does shapewear do? It shapes, compresses,firms,tightens – you get the picture – those places on your body that jiggle. (It can also make you look happily thinner).

In other words, Spanx is the modernday version of the girdle.

Since this is a blog on health, I would be remiss not to say something about any health effects of shapewear.  It’s rather obvious that knowing that you look better in your clothes leads directly to a positive self-image, and you know how important that is and how powerful that makes you feel. 

As for negative health effects, there are two. The first may occur when wearing shapewear for the bottom half of your body. If the elastic band where the shapewear ends -be it on your thighs or on your calves – squeezes so much that it actually causes a constriction in the area, this may lead to swelling and even blood clots below the elastic area. I can only speak to Spanx shapewear, but  these pieces are made so well that they don’t cause the constrictions mentioned above, especially if you wear the proper size.  

The other potential negative health effect is that you may stop exercising regularly because you look so good in your shapewear! Just remind yourself that you need to exercise for health reasons other than looking great.

Do I wear them? Absolutely. What changed my mind from my younger days? I no longer think that jiggling is sexy, perhaps because nowadays everything seems to jiggle as opposed to the discrete jiggling areas when I was younger. I’ll take that firm look anyday.

So, it looks like I finally gave in and wear a girdle. My mother would be so pleased.

 

*Please excuse the recurrent and relentless use of the word “jiggle.” Try as I might, I could find no synonym that worked.

**DISCLAIMER: As with the personally-used products that are mentioned in our book, neither of us has been paid – or otherwise convinced or asked – to mention any brand-name products.  We actually use the brands we mention.

GOT WATER?

Do you remember the Stillman Diet? It was an early form of the high-protein, low-carbohydrate diet that was created by Dr. Irwin Stillman in 1967. Unlike the still-popular Atkins diet, it was also low-fat, so that your food choices were really limited; you could only eat lean meats, eggs, cottage cheese, and coffee, tea, or noncaloric soft drinks on this diet. Condiments such as butter or any kind of oil were forbidden. Talk about feeling like you were eating cardboard after a few days! AND, you had to drink at least eight 8 oz glasses of water a day.

This diet was quite popular when I was in college. You wanted to lose 5 pounds in the 5 days before your hot date? Go on the Stillman diet. I remember one college friend whose version of this diet was a quart of lowfat cottage cheese and several Tabs for each meal, in addition to the requisite water.

But… it did work. And we all thought that there was something magical about drinking all that water.

Now comes a recent study showing again that drinking water can aid in weight loss; although the directions for drinking water in this study are much more reasonable (and doable) than in the diets of old.  Funded by the Institute for Public Health and Water Research, a nonprofit, independent science and education organization, this study was presented at the 2010 National Meeting of the American Chemical Society held in Boston on Aug. 22-26, 2010, by its lead author and researcher, Brenda Davy, PhD, on faculty at Virginia Tech.

The study followed adults ages 55-75 who were placed on a low calorie diet. One group drank two glasses of water before each meal, and the other group did not; both groups were on the same low calorie diet. At the end of 12 weeks, the group that drank water before meals had lost nearly 5 pounds more, and kept it off for 12 months, than did the group that had not drank water before meals. The author noted that those who drank sugary drinks before each meal, and not water, did not lose the same amount of weight as those who drank water.

The hypothesized reason for this “magical” property of water on weight loss? The author says that other of their studies have shown that those who drink 2 glasses of water before each meal consumed between 75 and 90 fewer calories during the meal, leading to the assumption that people who drink water before meals are actually fuller when they begin to eat food, and thus eat less. Nothing magical about that!

The next question that always follows any discussion of the role of water in good nutrition is exactly how much water should you be drinking daily? The truth is that there is not a set amount that every person should drink per day; in other words, it depends on many things, such as how much activity you do, how much you sweat, and how balanced your fluid intake and output has been over the prior few days. What makes up your “output”? It includes how much you urinate, how much fluid there is in your stool (this occurs only with diarrhea), how much you’ve sweat, and how much you bring up if you vomit.  So you can see that how much fluid you need depends on what your day has been like. If you’ve worked out a lot and sweat heavily, obviously, you need more fluid than you do on days you haven’t worked out. Same goes for if you’ve had diarrhea. And in the specific case of menopausal women (us), we almost automatically need more fluids than earlier in our lives because of those hot flashes and night sweats.

So, again, how much fluid do you need in your diet? Some experts say that you should let thirst be your guide.  But thirst is not always the best indicator because some people may not notice their thirst until they are very dehydrated. Other symptoms of mild dehydration may occur before thirst, such as dizziness, headache, or very concentrated urine.

What do I usually recommend? I tell my patients that they should get in about 8  eight ounce glasses of fluid per day – including water, coffee, tea and other non-sugary beverages. Can you drink too much pure water? Not usually IF you have normal kidney and heart function; although with excessive amounts of pure water (more than about 8 glasses a day), even with normal kidneys and heart, one can get an unusual syndrome known as “water intoxication.”

Bottom line: Do drink fluids before your meals and do try to get in around 8 eight ounce glasses of fluids per day. This intake should include water, but not be limited to water. Drink more than this only if you are thirsty or if you have recently been very active or sweating a lot. And know that the added benefit of drinking water before you eat is that it can help you to lose or maintain your weight by causing you to eat less, especially if you are watching your calories. 

 

 

 

BACK TO SCHOOL SHOTS: HAVE YOU GOTTEN YOURS?

It’s that time of year again. With all the fall back-to-school preparations comes the medical check-up, including those routine immunizations –  making sure all those “shots” are up to date. 

Kids aren’t the only ones who need to keep up with routine immunizations.  We do too. Although there was a lull period after childhood and during young adulthood during which we didn’t really need any immunizations – other than perhaps tetanus shots – now that we’re in midlife and older, there are again many shots recommended to keep us healthy. 

One of the most effective and safest immunizations recommended for those of us 60 years old and beyond is the herpes zoster vaccine that protects against shingles, a disease associated with pain and disability that can last long after the acute stage is over.  In addition to those complications of the infection, having shingles may lead to a later stroke according to two studies.

One study* found an increased risk of stroke after an episode of shingles that occurred anywhere on the body. A more recent study** showed – in the one year follow up period after the episode of shingles – an even greater risk of stroke when the shingles occurred in one of the nerve roots supplying the eye, a disease known as Herpes Zoster Ophthalmicus (HZO). Furthermore, the risk of stroke remained the same whether or not the disease was treated with antiviral medication.

Bottom line: it is much better to avoid getting shingles than to get it and treat it.

The vaccine (Zostavax) lowers the chances of getting shingles by 50%, has been proven to be safe, well-tolerated, and is covered by Medicare.  But most of us are not getting it; one estimation states that only 7% of those eligible for the vaccine are actually getting it. Why is this?

One major reason is that we (your physicians) are not recommending it strongly enough, if at all. A recent survey*** of 598 family doctors and general internists in the U.S.,  showed that while 91% recommended influenza and pneumococcal vaccinations, only 41% strongly recommended vaccination against shingles. In addition, the perceived difficulty of reimbursement for the vaccine (from either Medicare or private insurance) was cited by over 30% of the physicians as a major barrier for recommending the vaccine.

If you’ve read our book, you know that we strongly advocate that we each take responsibility for our own health. This means educating ourselves about preventable diseases commonly associated with aging, and then advocating for ourselves.

Because this vaccine is officially recommended by the CDC, is safe and can prevent a painful and disabling disease in at least half of those receiving it, this is another of those instances where YOU need to ask your physician about it. I can tell you from my patients’ and from personal experience with the disease that this particular vaccine is every bit as important as the influenza vaccine or any of the others recommended.

Shingles is a disease that you’d rather not get if you have the choice. And in this case, you do.

 

* Stroke 2009; 40:3443

**Lin H-C et al. Herpes zoster ophthalmicus and the risk of stroke: A population-based follow-up study. Neurology 2010 Mar 9; 74:792.

*** Hurley LP et al. Barriers to the use of herpes zoster vaccine. Ann Intern Med 2010 May 4; 152:555

If You Were A Ferrari…..

I have a question for you. If you were a Ferrari, would you let a mechanic who only worked on Ford Focus models take care of you? The answer is no. Ok, with that in mind, if you needed a colonoscopy to screen for colorectal cancer should you go to a general practitioner?

If you have a gastroenterologist in your community, I suggest you have him or her do your colonoscopy. The reason for this is that they are trained in doing the procedure and they know what to look for and what to do if they find something. General practitioners are trained in many procedures and do not have the specialized training.

An equally important reason is that a recent study has found that if one of the generalists vs. a gastroenterologist does your colonoscopy you are 39% more likely to need another procedure in a year.

If you have had a colonoscopy then you know that the preparation takes almost an entire day and is a time when you get to know your bathroom really well. Do you really want to go through the ultimate cleansing the following year? It is also quite expensive. So, it would be more cost effective to have a specialist do the procedure.

There are some communities where there may be no option to use a gastroenterologist. However, when you can you really might want to think about using one. It will probably be less painful all the way around.

Am J Gastroenterol advance online publication 24 August 2010; doi: 10.1038/ajg.2010.344

LABOR DAY THOUGHTS

This is our third Labor Day to be writing this blog. At this bittersweet time  – bitter, because it’s the end of a hopefully restful summer; sweet, because it’s the beginning of the exciting activities of autumn  – we want to wish you an active, connected, peaceful, and meditative holiday weekend.

Active: so that you will begin, or continue, the regular physical exercise that is so necessary for the health of your body, mind, and spirit

 

Connected: so that you will begin, or continue, the relationships to others that are so all-important for the health of your body, mind,and spirit

 

Peaceful: so that you will begin, or continue, the intermittent periods of rest that are mandatory for the health of your body, mind, and spirit

 

Meditative: so that you will begin, or continue, the habit of setting aside time – in this hectic and rushed era in which we live – to reflect on issues that are important to you, a habit crucial to the health of your body, mind and spirit

 

We wish you a happy and safe holiday weekend.

 

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