Aetna Latest Healthy Living News Latest Healthy Living News from Aetna en Aetna Latest Healthy Living News Latest Healthy Living News from Aetna TYPO3 - get.content.right Fri, 23 Jan 2015 19:50:00 -0500 Authors Urge Less Focus on Exercise Amount It may be a mistake to urge people who are inactive to aim for 150 minutes a week of exercise, 2...                    What Is the Doctor's Reaction? Like so many other doctors and fitness experts, I have advised patients to strive for the standard exercise goal. That is at least 150 minutes of moderate-intensity exercise spread out over a week. Most often that means 25 to 30 minutes, 5 to 6 times per week. But only 10% to 15% of older adults actually do that much exercise. As the authors of these articles recommend, it makes sense to change the message. Doing any amount of physical activity during the day is better than sitting or lying in bed. In fact, there is no proof that 150 minutes of exercise per week is the ideal amount for an average adult. But we do know that spending more time on our feet and moving improves our health. It's what's known as a dose-response relationship. The more time we spend not sitting, the greater our chance of maintaining good health. That includes a reduction in the risks of:
  • Type 2 diabetes
  • High blood pressure
  • Heart disease
  • Stroke
  • Certain types of cancer
Our muscles and bones also will stay stronger if we just stand and walk slowly often throughout the day. What Changes Can I Make Now? I plan to change my approach to patients when discussing the importance of physical activity and exercise. Normally I just ask, "Are you physically active?" and "How much time do you dedicate to exercise?"  Then I usually advise the standard goal. Now I plan to ask a different first question: "How much time do you spend sitting and lying during the day?" I suspect most of us would underestimate that number. For people who do not exercise and sit or lie down much of the time, I will suggest that they track their "up" and "down" time on a couple of different days. You don't need to wait to see your doctor. Start tomorrow morning. Here's the plan:
  • Write down the time when you get out of bed. Write "UP" next to the time.
  • Every moment you sit or lie down during the day, write down the time. Next to it, write "DOWN."
  • Each time you get up, write the time again. Next to it, write "UP."
  • Add up all the minutes between each "up" and "down" time. This equals your total number of minutes doing "light activity" for the day.
Do this on two different days -- one day at work or school, and one day at home. Instead of reaching a specific goal, try to gradually increase the number of minutes per day you are "up" during the next several weeks.  Another option: Consider buying a fitness tracker that you wear like a watch. Or download a fitness-tracker app for your smartphone. They can keep track of your physical activity. Some will vibrate or beep if you've been sitting too long. What Can I Expect Looking to the Future? A different study, published earlier this week, showed that sitting for a long time -- more than 8 to 12 hours per day -- increases your risk of developing a health condition that can shorten your life. This is true even if you exercise every day. The Annals of Internal Medicine published the study. Time spent daily in "light activity" is probably just as important as dedicated exercise time. You can expect this new approach -- tracking "up" time -- to catch on.]]>
Fri, 23 Jan 2015 19:50:00 -0500
Possible Risk of Stomach Sleep for Epileptics If you have epilepsy, sleeping on your stomach may increase the risk of sudden death, a new study...                    What Is the Doctor's Reaction? Perhaps you've heard that babies should sleep on their backs. But did you know the same advice may apply to some adults? According to a new study, adults with epilepsy who sleep on their stomachs may have a higher rate of sudden death than those who sleep in other positions. These findings are surprising. They could lead to new advice for people with epilepsy. People with epilepsy have repeated seizures caused by abnormal electrical activity in the brain. The seizures may affect one or many parts of the brain.  Depending on which parts are affected, a seizure may cause different problems. People might lose consciousness, move in an uncontrolled way or stare into space. It's striking how the findings of this new study parallel those of babies with sudden infant death syndrome (SIDS):
  • Many of the sudden deaths among people with epilepsy occur during sleep.
  • The risk of death seems to be affected by sleep position.
  • It's unclear why these deaths occurred or why sleep position matters.
This new study reviewed the results of 25 prior studies and more than 250 unexpected deaths among people with epilepsy. The authors found that:
  • For almost three-quarters of the deaths, the victim was found in the prone position (on the stomach).
  • At the time of death, 86% of those younger than 40 were found on their stomachs. About 60% of those ages 40 or older were in this position.
  • About 82% of those who died during sleep were on their stomachs.
  • Eleven cases of sudden death occurred while people were having their brainwaves recorded. All of them died on their stomachs. Most had been sleeping in that position.
It's possible that younger adults are at higher risk of death because they are more likely than older adults to be single and sleeping alone. As a result, they may not get medical attention as quickly. We'll need more studies to understand why body position might matter for people with epilepsy and how to reduce the risk of sudden death. These are important issues because deaths related to epilepsy are usually unexpected. They often follow a seizure that occurs during sleep when a person is alone. What Changes Can I Make Now? Epilepsy affects up to 50 million people worldwide.  It may not always be curable, but you can make changes to help control your disease and reduce the risk of injury or death. Here's what you can do:
  • Take your medicines as prescribed.
  • See your doctor regularly.
  • Avoid recreational drugs.
  • Avoid driving or operating dangerous machinery for six months after a seizure.
  • Wear an identification band so emergency crews will know you have epilepsy.
Perhaps sleeping on your back should be added to this list. There seems to be little risk in recommending a change in sleep position. Of course, people often change position during sleep. It may be difficult to avoid stomach sleeping if that's what you're used to doing. Positioning pillows around you before going to sleep may be helpful to encourage sleeping on your back. And we may see the development of phone apps or bed sensors that could alert people with epilepsy that they are sleeping on their stomachs.
  • If you are a family member or loved one of someone with epilepsy, know what to do in the event of a seizure:
  • Move furniture and other objects away from the person having a seizure.
  • Loosen clothing around the neck.
  • Gently roll the person onto his or her back or side.
  • Place a soft object under the person's head.
  • Try to be calm and reassuring. Most seizures last a short time (seconds to minutes). The person is likely to be sleepy or confused for a while afterward.
  • Call the person's doctor or family for advice about how to proceed. Usually there's no need for a visit to the hospital or doctor's office. Describing what you saw just before, during and after the seizure may prove helpful to caregivers.
What Can I Expect Looking to the Future? In the future, I hope that we will have:
  • A better understanding of the causes of epilepsy.
  • Better drugs to prevent and control seizures.
  • A better understanding of why lying on the stomach may increase the risk of sudden death among people with epilepsy.
  • More widespread use of helpful technologies for people with epilepsy. These include phone apps, wristwatches and bed alarms that alert medical personnel when a seizure has occurred during sleep. These may be especially helpful for those who sleep alone.
Thu, 22 Jan 2015 14:09:00 -0500
Study Questions Strict Salt Limit after 70 Adults over 70 might not need to tightly restrict salt, a new study suggests. U.S. guidelines...                    What Is the Doctor's Reaction? We worry about salt because it is 40% sodium. You need some sodium for your body to function. Sodium is needed to maintain the body's balance of fluids, send nerve impulses, contract and relax muscles, and more. But too much sodium can increase blood pressure and cause your body to hold on to fluid. High blood pressure (hypertension) is a major factor that increases the risk of heart attack, stroke and other blood vessel diseases. Excess fluid can cause swelling in the legs and make heart failure worse. But how much sodium is too much? According to the results of this study, it may depend in large part on your age. In the United States, guidelines for the average adult recommend getting no more than 2,300 milligrams (mg) of sodium a day. That's the amount in a teaspoon of salt. The American Heart Association and other groups recommend a lower target of 1,500 mg a day, especially for certain groups. Those groups who should aim for the lower target include:
  • Anyone over age 50
  • African Americans
  • People with high blood pressure, chronic kidney disease, diabetes or heart failure
Over age 50 was chosen because that's when high blood pressure, strokes, heart attacks and heart failure occur more commonly. But is there an older age when a very low sodium intake no longer has health benefits? The researchers designed this study to look at that question. They looked at sodium intake and health among adults ages 71 to 80. They found that people did just as well over 10 years whether they took in an average of 2,300 mg or 1,500 mg of sodium per day. The rates of death, stroke and heart disease were similar. Of note, both groups ate less sodium than the average U.S. adult (3,400 mg). We should interpret the results of this study with caution. The researchers used data obtained from diet surveys. Also, this is an observational study. It compared health results for older adults who chose to eat different amounts of sodium. It can only show that there were no observed worse outcomes for those who followed more moderate rather than strict sodium restriction. It does not prove that 1,500 mg or 2,300 mg of sodium per day is better or worse for your health. Some unknown factor besides sodium could have affected the results. What Changes Can I Make Now? The more moderate goal of 2,300 mg of sodium daily makes sense for older people, even those with mild high blood pressure. Given all of the salt in prepared foods, it's difficult enough to reach even this goal. Another reason for not restricting salt too much is taste. Many older people already have problems getting enough nutrition. Without a little salt, food might be so bland they might eat less and skip meals. Also, as we age, blood vessels get stiffer. In our later years, blood pressure tends to drop a little when we stand up. With strict salt restriction, blood pressure can get so low when standing that it can lead to falls and fractures. Moderate salt intake is only one of the choices that influence heart disease and stroke risk. Just as important are:
  • Not smoking
  • Eating more fruits, vegetables and whole grains
  • Staying physically active
  • Keeping alcohol use to an average of no more than two drinks per day for men and one per day for women
What Can I Expect Looking to the Future? The ideal amount of daily sodium will continue to be debated. As with so much in medicine, one size does not fit all. This is true even if advice is based on better scientific evidence. The right amount will be determined based on your personal health.]]>
Wed, 21 Jan 2015 14:14:00 -0500
FDA Backs Weight-Loss Device to Curb Hunger U.S. regulators have approved a device to help control appetite in very obese adults by...                    What Is the Doctor's Reaction? This week, the U.S. Food and Drug Administration (FDA) approved a device similar to a pacemaker that may be able to help obese people lose weight. The  device, about the size of a small pager, delivers electrical impulses to the stomach through two wires.  This treatment sounds simple. Just distract the stomach so it does not feel hungry. Interested news followers have snapped to attention. But don't get your hopes up. The device may disappoint us. It is frankly too early -- and the evidence too weak -- for doctors and patients to be excited about this treatment. I have been following along for the last 10 years as small studies have looked at devices like this and their possible role in obesity treatment. Some studies have shown no clear weight loss at all. Others have shown a very modest benefit, and many side effects. Published in September 2014, the largest study of this new device treated 162 people. Another 77 patients had a device implanted that did not shock the stomach. This was the comparison group. The outcomes didn't match what the researchers had hoped for. People in the treated group lost an average of 22 pounds in 18 months. In the group with the "sham" (nonworking) pacemaker, people lost an average of 16 pounds. Overall, then, those with the gastric pacemaker lost extra 6 pounds compared with the sham group. That was about 2 extra pounds for every 6 months of pacemaker use. The pacemaker required recharging sessions of up to 90 minutes at a time, twice a week. It also was linked with quite a few unpleasant side effects. About  38% had pain at the pacemaker site, and 25% had heartburn or indigestion pain. Many patients had pain elsewhere in the abdomen. Many reported nausea, burping or problems with swallowing. Because of side effects, some people asked that the device be removed. There are a variety of theories about how these small shocks might affect eating and digestion, but none are proven. Possibly the shocks interrupt signals that travel between the stomach and the brain. Possibly they change the mix of digestive hormones. In theory, the device could slow down the stomach. A slow stomach feels full after you eat only a small meal. That could lead people to lose weight because of a reduced appetite. What Changes Can I Make Now? Don’t rush out to get a stomach pacemaker. Keep up your diet and exercise efforts instead. Pacemakers have been an interesting trend. Now they are being used to treat conditions ranging from Parkinson's disease to obstructive sleep apnea. But they don't work for everything. For example, researchers tried treating gastroparesis (a slow stomach) with a gastric pacemaker. They really couldn’t show a convincing benefit. What Can I Expect Looking to the Future? This new device was approved with conditions. The company that is marketing it will need to do a 5-year safety study to satisfy the FDA that the device is not harmful. At first, the device will be offered only to people who are very obese, with a body mass index of at least 35. They also must have a condition linked with excess weight, such as obstructive sleep apnea or diabetes. I continue to think of this treatment as experimental. For the time being, it is probably not worthwhile to have a device implanted when it has this many side effects.]]> Fri, 16 Jan 2015 12:38:00 -0500 Spit Test May Help Find Lung Cancers A new test of that gunk you cough up from your lungs may help to tell which lumps found in a lung...                    What Is the Doctor's Reaction? If you search hard enough for something, you may find what you're looking for. But you may find something else instead.  This happens frequently with medical screening tests. Consider the mammogram. Its purpose is to find small, curable breast cancers. But a mammogram often leads to a "false positive" -- an abnormal result that is not due to cancer. It may be scar tissue or a calcium deposit. False-positive results often lead to more tests, such as a biopsy. You also may have a lot of anxiety while you are waiting for test results. For these reasons, a good screening test should have a low false-positive rate. In recent years, CT scanning of the lungs has been recommended for older adults who are current or former smokers. Studies show that these scans save lives by detecting lung cancers at a stage when they are curable. However, false-positive results are common. Benign nodules (non-cancerous lumps) may look like cancer on the CT scan. So it's not easy to know whether they are cancers or not. And the lung is not an easy place to biopsy. That's why news about a new way to evaluate lung nodules may be important. In the journal Clinical Cancer Research, researchers describe a new test. It detects microRNA in the sputum, a mixture of saliva and mucus that is coughed up from the lungs. MicroRNA is a tiny bit of genetic material. Certain types of microRNA are present in lung cancer cells. This study included 122 people with lung nodules detected by a CT scan. About half of these nodules turned out to be cancerous when they were removed or biopsied. The new sputum microRNA tests:
  • Correctly detected 83% of the cancerous nodules
  • Correctly identified 88% of the non-cancerous nodules
  • Were just as accurate in testing nearly 300 other people with lung nodules
As encouraging as these results are, the test still missed nearly 20% of cancers. It also raised an alarm about cancer in 12% of people who didn't have cancer. That's still not accurate enough to solve the problem of false-positive CT scans. But the test could represent a step in the right direction. What Changes Can I Make Now? The new microRNA tests described in this latest research are not yet available for widespread use. They will need to be more accurate before they become widely accepted. However, a yearly lung CT scan may make sense if you are between the ages of 55 and 80 and smoke (or have a long smoking history). Talk to your doctor about whether you are a good candidate for this test. It's true that CT scans do expose people to more radiation than a chest X-ray. However, the screening CT scans use a lower dose of radiation than regular CT scans. You can make several changes to reduce your risk of lung cancer. The most important is to not smoke. If you smoke now, commit to quitting. If you have not been able to quit on your own, talk to your doctor about smoking cessation programs.  You also can take other steps to reduce your risk of lung cancer:
  • Avoid secondhand smoke. If smoking is allowed in restaurants in your area, choose those that have a no-smoking policy. Insist that smokers in your home smoke outside.
  • Have your home inspected for asbestos. If asbestos is found, have it sealed or removed by professionals. Follow safety rules to limit your exposure to asbestos at work. This will also limit exposure to those at home who may inhale asbestos you bring home on your clothing.
  • Follow recommended safety procedures at work to limit your exposure to other chemicals that cause lung cancer, such as vinyl chloride or uranium.
  • Reduce your exposure to radon gas. Place detectors in rooms that are at or below ground level. If radon levels are high, install a ventilation system and have cracks in the floor or walls professionally sealed. If there are high radon levels in your water, have it treated before it enters the home.
  • Choose a diet high in vegetables and fruit and exercise regularly. The overall impact of these measures on the risk of lung cancer risk is uncertain. However, they may provide other health benefits as well.
What Can I Expect Looking to the Future? When you are looking for early cancers, it's important to find what you're looking for -- and nothing else. That's why researchers are trying to develop a test that doesn't involve surgery to find out which lung nodules are cancerous. The tests described in this new research may prove useful. But we'll still need even better tests for detecting lung cancer. Future research could refine this test or develop totally new tests to help doctors know which nodules require a biopsy and treatment.]]>
Thu, 15 Jan 2015 00:00:00 -0500
Study Links Optimism with Heart Health Optimistic people may have healthier hearts, a new study concludes. The study included 5,100...                    What Is the Doctor's Reaction? Optimism is good for your health. The results of this study confirm what researchers have found in other studies. For this study, researchers compared optimism with heart and blood vessel health. They used data gathered in a study called the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis starts when fatty deposits called plaques build up in arteries. The plaques get hard because they attract calcium. The more calcium seen in arteries, the more atherosclerosis is present. These hard, calcium-containing deposits are called plaques. For the MESA study, heart health was defined by the amount of calcium deposited in arteries around the heart. This was measured by CT scanning. The researchers found that people who were more optimistic had lower calcium scores than those who were more pessimistic. Optimism was measured by expectations for the future, based on a series of questions. The most optimistic people always thought positively about the future. The most pessimistic never thought that things would be better down the line. Scientists really don't know why optimism is linked with better health. Here are some possible explanations:
  • People who are healthy are likely to have a brighter outlook than people who are ill. So optimism could be the result of good health instead of the other way around.
  • Perhaps optimists enjoy better health and longer lives than pessimists because they have healthier habits, stronger social support networks and better medical care. Some studies report that optimists are less likely to smoke and more likely to exercise than pessimists. They also are more likely to live with a spouse and follow medical advice, the studies found. 
Optimism may have biological benefits that improve health. Some studies show optimistic people tend to have lower levels of stress hormones and less inflammation. Their immune systems also may work better. What Changes Can I Make Now? Positive or negative attitudes are formed over a lifetime. Is it possible to change them? Admittedly, it's a challenge. You cannot simply will yourself to have a positive attitude. Change is possible, though, if you directly confront the causes of a downbeat attitude. Sometimes feeling negative is caused by depression, anxiety or stress. These problems can often be solved, or at least improved, through treatment with counseling, talk therapy, medicine or all of these. It may seem odd to think about ways to improve your attitude. But it can be done. Here are some suggestions:
  • Be grateful. Keep a journal. Each day, write down those things that make you feel good or thankful, even if they seem very minor. Perhaps it was just a small compliment about something you did for someone.  
  • Be aware of your attitude. This is not always easy if you tend to go toward the negative. But each time you find yourself thinking that something won't work out, take a breath and reconsider. How can you look at it in a positive way?
  • Appreciate what you have. Too often we spend our time comparing our own lives to the lives of others. Look at what you do have and take pleasure in those things.
  • Smile and laugh. Take joy in things you find funny or things that just make you feel good. It's actually hard to stay negative if you are smiling and laughing.
  • Get moving. Exercise releases brain chemicals that can counteract stress and low mood. It can also make you feel better about yourself.
What Can I Expect Looking to the Future? For the near future, I don't expect scientists to find a specific biological link between a positive attitude and better health. So don't look for an optimism pill any time soon.]]>
Wed, 14 Jan 2015 14:05:00 -0500
Study Questions Goals for Older Diabetics Many older diabetics are following "tight control" of blood sugar, though it may do them...                    What Is the Doctor's Reaction? Until recently, primary care doctors were graded on blood sugar control in their patients. This was promoted as an improvement in health quality. The American Diabetes Association recommends striving for a hemoglobin A1C blood level of less than 7%. A1C reflects a person's average blood sugar during the last 2 to 3 months. A 7% A1C translates to an average blood sugar of 150 milligrams per deciliter. Doctors call achieving the goal of 7% or less "tight control." Doctors responded to being graded on whether their patients achieved this goal.  Many more people with diabetes had their blood sugars tightly controlled. For people with type 1 diabetes, tight control clearly improves health outcomes. However, for some people with type 2 diabetes, tight control might cause more harm than benefit. According to this report, that's especially true for many older people. In type 1 diabetes, the pancreas stops making insulin. In type 2 diabetes, the pancreas at first makes plenty of insulin. But the body's cells don't respond normally to the insulin to allow sugar to flow into cells for energy. So blood sugar levels rise. In the United States today, an estimated 11 million adults age 65 or older have diabetes. More than 95% of them have type 2 diabetes. In the next 20 years, the number is expected to double. Almost half of older adults with diabetes have poor health or complex health. For this study, the researchers defined poor health as at least one of the following:
  • Receiving dialysis
  • Needing help with two or more activities of daily living
Activities of daily living include getting in and out of bed, dressing, feeding and walking from room to room. Complex health was defined as at least one of the following:
  • Having three or more long-term medical conditions besides diabetes
  • Needing help with preparing meals, managing money and doing household chores
These older, less-healthy adults are much less likely than younger adults to get any benefit from tight blood sugar control. Health benefits from tight control come many years later. But the dangers of low blood sugar (hypoglycemia) start happening right away. Those dangers include:
  • Falls
  • Fractures
  • Seizures
  • Head injuries
  • Increased chance of needing a hospital stay
  • Problems with memory and thinking if hypoglycemia happens often
Fifteen years ago, doctors were graded on tight blood sugar control for all their patients. It did not matter how old or sick they were. So, it is not surprising that in this study more than 60% of older adults with poor or complex health had tight control. They had A1C levels of less than 7%. And the study results suggested that it led to more harms than benefits. What Changes Can I Make Now? Aiming for tight blood sugar control makes sense for almost everyone when they are first diagnosed with type 2 diabetes. In large part, that's because it often can be achieved with diet and exercise and little or no need for drug treatment. For people with diabetes who are older or middle-aged, with poor or complex health, a more modest goal may make more sense. Moderate control means keeping an A1C level between 7.0% and 8.9%. This translates to average blood sugar between 150 and 200 milligrams per deciliter. When drug treatment is needed for blood sugar control, the best first choice is clearly metformin. It does not cause hypoglycemia. It is available as a generic. The cost is relatively low. In the past, there was concern about metformin's safety in people with more than mild kidney disease. But recent evidence suggests it can be used, except in people who have severe disease. The two drug classes that are most likely to cause hypoglycemia are the insulins and the sulfonylureas. Examples of sulfonylureas include glipizide, glyburide and glimepiride. People often need these drugs to attain moderate blood sugar control.  But they require frequent home blood sugar testing and a consistent diet to avoid hypoglycemia. If you take one of these drugs, review with your doctor what you should do if you get sick and cannot eat. You may need to lower or skip a dose. A blood sugar that is a bit high generally is less dangerous than a very low blood sugar. What Can I Expect Looking to the Future? The message has already changed regarding blood sugar goals for people with type 2 diabetes. Experts recommend an approach that is based on each person's age and general health.]]>
Tue, 13 Jan 2015 00:00:00 -0500
Crimes May Be a Sign of Dementia Some people with dementia, especially one type, may commit crimes as a result of their disease, a...                    What Is the Doctor's Reaction? Most causes of dementia start with short-term memory loss. Impaired thinking and problem solving often occur as well. These are certainly found in Alzheimer's disease, the most common type of dementia. But sometimes the first symptoms of dementia are changes in behavior or mood. The person's memory and thinking skills could appear to be completely normal. For example, an older adult might start acting out in a new way. Or there could be an abrupt personality change. For example, sometimes the person may become hostile, withdrawn or depressed. And sometimes behavior changes lead to unlawful conduct. This study looked at how often people with dementia broke the law.  For this study, criminal behavior included:
  • Theft
  • Traffic violations
  • Inappropriate sexual advances
  • Trespassing
  • Public urination
The researchers discovered a major difference depending on the type of dementia. More than one-third (37.4%) of people with frontotemporal dementia showed criminal behavior. But this occurred in only 1 out of 14 (7.7%) of those with Alzheimer's disease. Frontotemporal dementia is the result of damage to the brain's cerebral cortex. The damage occurs in the frontal lobes (front) or temporal lobes (sides). This can cause someone to lose inhibitions and have problems with impulse control.   Alzheimer's disease generally does more damage to other parts of the brain, behind the frontal lobes. Damage to these areas tends to cause more problems with memory and thinking. However, in later stages of Alzheimer's disease, problems with impulse control can surely happen. What Changes Can I Make Now? There is no test that can confirm someone has frontotemporal dementia, rather than another type. So it can be very challenging to diagnose. This is especially the case in early stages, when the major symptom is a change in personality or behavior. But certain features do suggest that frontotemporal dementia is the more likely diagnosis:
  • Change in behavior is a common first symptom. In this study, criminal behavior was one of the first symptoms in about 14% of patients. This occurred in only 2% of those with Alzheimer's disease.
  • Most often the symptoms of frontotemporal dementia start at an earlier age, between 50 and 70. Alzheimer's disease gets much more common with age, especially after age 70.
  • Memory loss comes later in frontotemporal dementia. It is usually the first symptom with Alzheimer's disease.
  • A brain MRI that shows shrinkage of the frontal and temporal lobes suggests that someone may have frontotemporal dementia. But these changes might not be seen until the disease is more advanced.
There are no proven ways to help prevent or treat frontotemporal dementia. But it seems prudent to consider the same lifestyle choices that are known to help maintain brain function with age.
  • Stay physically active in everyday life.
  • Get regular dedicated exercise.
  • Eat a healthy diet, such as a Mediterranean-style diet.
What Can I Expect Looking to the Future? You can expect research to find better ways to distinguish frontotemporal dementia from Alzheimer's disease. This is important because the usual drugs used in Alzheimer's disease do not help in frontotemporal dementia. Scientist will work to develop an accurate early way to diagnose frontotemporal dementia. Such a test will help in testing of potential treatments. A perfect genetic test that detects the disease before there are any symptoms would be ideal.]]>
Fri, 09 Jan 2015 18:35:00 -0500
Study: Avocados May Help Cut Cholesterol Eating avocados may help improve cholesterol levels, a small study suggests. The study included 45...                    What Is the Doctor's Reaction? Here's a saying you've probably never heard before: An avocado a day keeps the doctor away. Could eating an avocado each day really improve your health? It's possible, according to a new study in the Journal of the American Heart Association. Researchers put 45 adults on an "average American diet" for 2 weeks. This diet was relatively high in fat. All of the people were overweight or obese, but otherwise healthy. After the first 2 weeks, each person spent 5 weeks on each of the following diets:
  • A low-fat diet without avocados
  • A moderate-fat diet without avocados
  • A moderate-fat diet with an avocado each day
Here's what the study found:
  • LDL ("bad" cholesterol) levels dropped the most for those who ate an avocado each day.
  • LDL levels dropped only half as much for those in the low-fat, no-avocado group.
  • Other measures of blood fats, including total cholesterol and triglycerides, were also better among those eating avocados.
These results are intriguing. But they should be taken with a healthy dose of skepticism. Here's why:
  • The study was small, and it only included people who were overweight or obese.
  • Each diet lasted only 5 weeks.
  • Improvement was based on changes in cholesterol results among people on "an average American diet."
  • People in the study cycled through strictly controlled diets every few weeks. Results for highly motivated research subjects on controlled diets may differ from those in "real-world" settings.
  • The study did not assess actual heart and blood vessel disease. It looked at the impact of different diets on factors that increase the risk of this disease.
  • An avocado is a high-calorie food. The avocados used in this research provided about 250 calories each. A large Florida avocado may contain up to 360 calories. People who eat avocados may need to reduce other foods they are eating or exercise more to avoid weight gain.
  • The study was funded by the Hass Avocado Board. This organization promotes avocado consumption. One of the study's main authors is an adviser to the board.
What Changes Can I Make Now? I'm not ready to recommend that my patients eat an avocado each day. Before I did that, I would want to see long-term studies showing a reduction in heart attacks, stroke or other events among those eating avocados. Then again, other than the added calories, there's likely little risk involved in eating more avocados. Heart and blood vessel disease is a leading cause of death in the United States and worldwide. Therefore, we should all do what we can to reduce well-known factors that increase risk and can be changed. For example:
  • Don't smoke.
  • Choose a heart-healthy diet, such as the Mediterranean diet. The diet should be rich in whole grains, vegetables, fruits, fatty fish and monounsaturated fatty acids ("good fats"). It should be low in saturated and trans fats. Avocados can be part of this diet.
  • Increase your physical activity.
  • Avoid excess weight, which increases the chances you will develop diabetes, high cholesterol and high blood pressure.
  • Get your blood pressure and cholesterol levels checked regularly. If they are not in ideal ranges, work with your doctor to improve them. Diet changes and more exercise may be all that you need. But when they are not enough, your doctor may recommend medicines.
  • If you have diabetes, work with your doctor to keep it well controlled.
Advancing age and a strong family history of heart disease also increase risk, but they can't be changed. If you have these risk factors, attention to other factors that you can change becomes even more important. If you have already had a stroke, heart attack or other heart or blood vessel problem, see your doctor regularly. Your doctor may recommend medicines and other treatments to reduce the chances of future events. What Can I Expect Looking to the Future? Clearly, there is a powerful link between diet and health. I am sure we will learn much more about it in the years to come. But I am skeptical that we will discover specific foods (such as avocados) that are vital for heart health. It seems much more likely to me that a combination of healthy habits will be most helpful. These should include a balance of heart-healthy foods across food groups, portion control, regular exercise and not smoking. Will an avocado a day really keep the doctor away? I'm not convinced. For now, I'd stick with apples.]]>
Thu, 08 Jan 2015 14:02:00 -0500
Study: Type 1 Diabetes Cuts Lifespan People with type 1 diabetes lose an average of 12 years of life because of their disease. But...                    What Is the Doctor's Reaction? In type 1 diabetes, the body stops making insulin. Before the discovery of insulin in 1922, people with type 1 diabetes often died within months of their first symptoms. During the last 90 years, the life expectancy for people with this disease has improved dramatically. Major reasons why people with type 1 diabetes now live longer:
  • Better insulins are available, and they are easier to use. People with diabetes also have better ways to self-monitor blood-sugar levels. Keeping levels close to normal is linked with longer life.
  • New drugs have helped to prevent and treat heart and kidney problems related to diabetes. Heart disease and kidney failure remain major causes of early death.
However, there remains a major gap in life expectancy between people with type 1 diabetes and those who don't have it. For men, it's a loss of about 11 years of life. Women lose about 13 years of life. These are among the results of one of the studies reported in today's Journal of the American Medical Association (JAMA). A second report in JAMA looked at the effect of intensive management to keep blood sugars close to normal. It found that people who do this live longer than those receiving usual care. Two common reasons for deaths in people with type 1 diabetes are heart disease and cancer. The other most common causes of death are problems directly related to diabetes management. They include life-threatening low blood-sugar levels (severe hypoglycemia) and diabetic ketoacidosis (DKA). In DKA, the body's chemical balance becomes very deranged because there's not enough insulin to move sugar into cells. What Changes Can I Make Now? Not everyone with diabetes should strive for near-normal blood sugar levels. It depends on the type of diabetes you have and how long you have had it. If you have type 1 diabetes, you always want to strive for tight blood-sugar control. But you also need to avoid low blood sugars. An insulin pump may be the best way to achieve this challenging goal. But type 1 diabetes is much less common than type 2. In type 2 diabetes, the problem is insulin resistance. The pancreas makes plenty of insulin. But the body's cells don't respond normally to allow the sugar to get in to provide energy. Tight control is important when you are first diagnosed with type 2 diabetes. But if you have had type 2 diabetes for many years, tight control might lead to frequent dangerously low blood-sugar levels. Studies have compared death rates for people with longstanding type 2 diabetes who use different approaches to blood-sugar control. They have shown a higher death rate for people who have tight blood-sugar control than for those whose blood-sugar management is less intense. With both types of diabetes, preventing heart disease and kidney failure help to maintain quality of life and reduce the risk of early death. This requires much more than just managing blood-sugar levels. You also need to:
  • Not smoke.
  • Keep blood pressure in the normal range.
  • Usually take a statin, even if your cholesterol level is normal.
  • Be physically active, with dedicated time for exercise most days of the week.
Get your urine checked regularly for a protein called microalbumin. If it is high, you need to be on a medicine that protects the kidneys. This should be either an angiotensin-converting enzyme inhibitor (ACE inhibitor) or an angiotensin receptor blocker (ARB). What Can I Expect Looking to the Future? Ideal management of type 1 diabetes requires a lot of engagement and effort. Without it, the very best medical care and all the technology in the world can't improve your health. For people who have a mental illness or lack motivation, this can be an almost impossible task. Addressing these situations will not be easy. One possibility is wider use of life coaches to help with diabetes management. They need only a small amount of medical training to be effective. This model has worked well in many developing nations, such as Haiti.]]>
Wed, 07 Jan 2015 00:00:00 -0500
Study Links Whole Grains with a Longer Life People who eat more whole grains may live longer, a large new study finds. The study was based on...                    What Is the Doctor's Reaction? It's a familiar message -- eat more fruits, vegetables and whole grains. Fruits and vegetables continue to get top billing, with whole grains running third. But it's time to give them the attention they deserve. Whole grains reduce your risk of heart disease, stroke and type 2 diabetes. But they do even more. Eating more of them reduces your chance of dying earlier than you should. Some previous studies have suggested that people eating the most whole grains tend to live longer. But other studies have not shown similar results. This latest report provides very convincing evidence that whole grains help people live longer.  All grains grow as kernels. Each kernel has three layers:
  • The inner germ contains many of the vitamins, minerals and healthy oils.
  • The middle layer is called the endosperm. It is primarily starch and makes up most of the kernel. It provides the energy the kernel needs to start growing.
  • The outer coating, known as bran, contains most of the grain's fiber.
In the 1880s, millers became very adept at separating the layers, especially for wheat. The starchy middle layer was ideal for baking. These new refined grains became very popular. White bread crowded grocery store shelves for the next 100 years. Goodbye to the germ and bran, along with their nutritional value. The strengths of this new study include its large size, more than 118,000 people. The researchers also recognized that people who eat more whole grains are more likely to choose healthier lifestyles. For example, they are more likely to avoid smoking, watch their weight and be physically active. Therefore, the researchers accounted for these factors in their analysis. However, we still need to interpret the study results with caution. The conclusions are based on an observational study. This type of study looks at what happens when people choose different behaviors or treatments. It cannot prove that eating more whole grains will definitely make you live longer. Some other factor that researchers did not identify could be the reason that people who eat more whole grains tend to live longer. What Changes Can I Make Now? When you eat a whole grain, you're getting more than just the fiber from the outer layer. You also get all the vitamins, minerals, good fats, protein, antioxidants and other healthful parts of the grain's inner layers. It's easy enough to decide between brown rice and white rice. But selecting whole-grain breads and cereals often requires a close reading of the food label. Don't be fooled by terms such as "wheat flour," "unbleached wheat flour" and "enriched wheat flour." They can refer to refined white flour. The same goes for "stone-ground," "multigrain," "fortified," "stoned wheat," "cracked wheat" and "organic." None of these terms guarantees that the product is whole grain. To be sure that you are really getting whole grains, look for the word "whole" or "whole-grain" before the grain's name as the first ingredient. And it's not enough that "made with whole grain" appears somewhere on the list of ingredients. That grain may have been refined. Again, the key is the word "whole" in the first ingredient listed -- for example, "stone-ground whole wheat." To be more certain about home much whole grain you get per serving, look for the Whole Grain stamp. There are two different stamps:
  • The 100% Stamp means that all grains in the product are whole grains. Each serving must contain at least a full serving of whole grain (16 grams).
  • The Basic Stamp means that each serving of the product contains at least one-half serving (8 grams) of whole grain. But it may also contain some refined grains.
Aim for 50 grams of whole grains per day. What Can I Expect Looking to the Future? There are so many new whole-grain products to choose from. It is easier than ever to find tasty foods that offer a healthier alternative to those that are made with refined grains.]]>
Tue, 06 Jan 2015 00:00:00 -0500
'Bad Luck' Blamed for Some Types of Cancer Some types of cancers are known to be linked with genes or risky behaviors. But for many other...                    What Is the Doctor's Reaction? Some of my patients are not worried about cancer. "I don't think I need a mammogram," one patient recently said to me. "No one in my family has ever had breast cancer. I don't smoke, and I don't use estrogen. So I am certain I won't get it." I am glad she was not worried. But I still advised the mammogram. From my experience as a doctor, we all have a risk of cancer. Researchers at Johns Hopkins University looked at the causes of 31 different types of cancer. Their new analysis found that as many as two-thirds of these cancers can neither be blamed on family genes nor on smoking or other exposures. Two-thirds of cancers, the researchers say, are the result of bad luck. They are the result of an accidental mutation that occurs when cells divide. These researchers relied on sophisticated math to back up their thinking. Tissues in which stem cells divide often are at the highest risk for cancer.  For example, stem cells divide repeatedly in the bone marrow. This is the source of many cancers, such as leukemia, lymphomas and multiple myeloma. Stem cells divide constantly during the life of an ovary. And the ovary, especially considering its small size, is a common location for cancer. The researchers identified the rate at which stem cells divided in each type of tissue. Then they looked at cancer rates. Plain and simple, the more dividing stem cells a type of tissue had, the more cancer occurred in that tissue. Examples of these "bad luck" cancers include leukemia and cancers in the pancreas, bone, testicles, ovaries and brain. Some cancers these researchers studied were most heavily influenced by family history. Some were affected by sun exposure, smoking or other known cancer triggers. These included colorectal cancer, basal cell skin cancer and lung cancer. The study did not include a couple of important cancers (breast cancer and prostate cancer). That's because the researchers were uncertain about the amount of stem cell activity in these tissues. We can learn three important things from this report: 1)    Doctors can't tell most people why they got cancer. In most cases, cancer is the result of bad luck. 2)    Some cancers can be prevented with good habits and good health care. 3)    Since everyone is at risk for cancer, everyone should keep up to date on cancer screening tests. What Changes Can I Make Now? These are some of my top strategies for cancer prevention:
  • Don't smoke.
  • Keep your alcohol consumption light.
  • Have a colonoscopy to remove colon polyps. If the polyps are not there, cancers are less likely to form.
  • If you use estrogen replacement after menopause, stop taking it after five years. Short-term use is safer than long-term use.
  • Have regular Pap smears.
  • If you are between age 9 and 26, be sure to get the human papillomavirus (HPV) vaccine (Gardasil) to prevent cervical cancer. This vaccine also can prevent some rectal and throat cancers.
  • Wear sunscreen or sun-protective clothing.
  • Protect yourself against HIV or hepatitis C, conditions that can increase your risk for certain cancers. This means avoiding shared needle use and using condoms when you have sex.
When cancer is not prevented, it often can still be treated and cured if it is detected early. These are my top strategies for early detection of cancers:
  • Have a colonoscopy after age 50. If you have a family history of colon cancer, ask your doctor to recommend an age to start screening.
  • If you are a woman, have mammograms and breast examinations by a doctor every 1 or 2 years beginning at age 40 (or, for sure, by age 50).
  • If you are a heavy smoker or if you quit after being a heavy smoker, ask your doctor about screening for lung cancer.
  • If you have liver disease (cirrhosis), work with your doctor to find cancer early by repeating blood tests and liver ultrasound tests every 6 to 12 months.
What Can I Expect Looking to the Future? If you aren't caught up with your cancer screening tests, catching up would be a good New Year's resolution for you. In the next decade, I expect cancer prevention and early-detection strategies – rather than a breakthrough cancer cure -- to remain our strongest weapons against cancer.]]>
Fri, 02 Jan 2015 15:44:00 -0500
Ebola Vaccine Tested in African Adults Two experimental vaccines against Ebola and Marburg viruses are safe and produced an immune... What Is The Doctor's Reaction? Years ago, I read "The Hot Zone," by Richard Preston. It was a fascinating and chilling account of how close we came to having an outbreak of an Ebola-type viral infection in the United States. In the years since, I've read of sporadic Ebola outbreaks in places such as Gabon and Uganda. Given how far these places are from the United States, Ebola wasn't something I thought was a real threat to health here. Yet today, serious (and realistic) worries about Ebola have reached my front door -- literally.  On the front door of my office, an alert has been posted asking patients to report symptoms of infection (such as fever) and recent travel to certain countries in western Africa where Ebola has been reported. It's part of a program our hospital has implemented to screen for possible cases of Ebola infection. Those considered at high risk will be isolated from other patients and staff until testing can confirm or rule out Ebola infection. Similar programs are underway at hundreds of U.S. hospitals. Suddenly, the prospect of Ebola doesn't seem so remote.  Fortunately, there is progress to report. According to the World Health Organization, new cases of Ebola are declining in Liberia and the rising incidence in Sierra Leone may have slowed. In addition, a new study reports progress in the development of a vaccine. For a condition that has recently infected more than 18,000 people, killed nearly 7,000, and has the potential to spread worldwide, positive news about a vaccine for Ebola virus can't come too soon. Prior studies have shown that an experimental vaccine for Ebola was safe when given to healthy volunteers in the United States and that it triggered the production of antibodies that should protect against infection. This new research demonstrated similar findings among healthy adults in Uganda. These findings are important because:
  • Vaccinations may be safe and effective in one population but not in another.
  • Most cases of Ebola infection have occurred in Africa, so it's important to test the vaccine in people who may be most susceptible.
  • Prevention and other public health measures (such as tracing contacts and isolating infected persons) are currently the best options for dealing with the Ebola virus.
If proven effective in those exposed to Ebola, this vaccine could save many thousands of lives. What Changes Can I Make Now? The most important change you can make is in how you think about Ebola and infectious diseases that may pose a threat to public health. It's easy to be terrified about the news of the thousands of people infected with Ebola in western Africa. And the recent cases of Ebola among travelers and health care providers in this country. But it's important to realize that we know a lot about this virus and how to prevent its spread. In fact, Ebola is actually easier to prevent than many other infectious illnesses for two reasons. First, it takes close contact with body fluids to spread. And an infected person has symptoms (such as fever and body aches) before they are contagious. There are steps you can take to reduce the already low risk of developing this disease. For example:
  • Follow the news reports about where cases of Ebola have been identified -– it is unlikely you would become infected if no cases have been diagnosed nearby.
  • Take note of any recommendations made by local public health officials.
  • Avoid nonessential travel to places where Ebola has been reported. If you must go, check the CDC website for advice about precautions you can take.
  • If you're a health care worker, follow established guidelines to screen and care for potential cases of Ebola. This includes wearing protective gear and following strict protocols to avoid contact with an infected person's body fluids.
Finally, it's important to put the Ebola story in perspective. While Ebola is the big news story now, common infections such as the flu and pneumonia pose much bigger health threats in this country. There are vaccines available for these conditions, so check with your doctor to make sure that your vaccinations are up to date. What Can I Expect Looking To The Future? You can expect to hear much more about the development of a vaccine for the Ebola virus.  Although this new study's results are encouraging, the researchers have not yet tested the ability of the vaccine to actually prevent infection. It's likely that the pace of research regarding Ebola will continue to accelerate. I am hopeful that such research will lead to an effective Ebola vaccine as well as more effective treatments for this devastating illness. Ebola is getting a great deal of attention now. But, it is unlikely to be the last epidemic to threaten international health. Increasing international travel and economic interdependence will continue to facilitate the spread of disease. The challenge going forward is to recognize and contain such outbreaks quickly. As the Ebola outbreak has shown, it's not easy.]]>
Tue, 23 Dec 2014 13:58:00 -0500
Sedatives Less Safe, More Used in Older Adults Despite the risks of sedative drugs for older people, they are more likely to take these medicines...                    What Is the Doctor's Reaction? Ask any doctor to name a group of drugs that should be avoided in older people. The first drugs that will come to mind are the sedatives known as benzodiazepines. All doctors know this. Common examples are alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin) and lorazepam (Ativan). Then ask the same doctors whether they have prescribed one of these medicines recently. Have they prescribed it to anyone over age 65? Almost all of us will get a mildly stressed look on our faces. Yes, we have. About 10% of women between ages 65 and 80 use benzodiazepines. Nearly one-third take them on a regular basis, for months or years. In fact, they are used more often in older patients (8.7% of those 65 through 80) than in younger patients (2.6% of those 18 through 35). These drugs are used to treat anxiety. And they do their job well. But they are seriously addictive. And they increase the risk of falling by about 50%. They also cause confusion and memory problems. They have an effect in the brain that is in many ways similar to alcohol. So why do we hand these drugs out to our older patients? Well, there are good reasons and bad ones. Sometimes these medicines are worth their risk for short-term use. They are helpful for "situational" anxiety. Examples include dealing with a cancer diagnosis or other serious stresses. Benzodiazepines can be used at the beginning of treatment for depression, while we wait for antidepressant medicines to begin working. They are also useful for predictable anxiety, such as the kind some people have when they fly on a plane. They may help ease claustrophobia in an MRI scanner. What are the bad reasons to use a benzodiazepine? Long-term treatment of anxiety with these drugs is almost always a bad idea. Treating insomnia with them is a bad idea, too. These drugs cause drowsiness the next day. They also may cause rebound awakening when they wear off in the middle of the night. Dementia and agitation related to dementia also respond poorly to these medicines. Sometimes they can even make anxiety worse instead of helping. What Changes Can I Make Now? If they have taken one of these medicines when they were younger, most people trust that it will always be safe for them. But if you are over 65 now, you are not the same person you were in your 30s, 40s and 50s. Older people have less blood circulating, and more fat relative to water. This means that the drug is more concentrated in their bodies, and the effect is stronger. Older people have less efficient kidneys. The liver clears drugs from the body more slowly. So drugs build up. Also, most older people take many medicines. This means there is a greater chance of drug interactions. If you are using a benzodiazepine long-term to treat anxiety, you have better options.
  • Have you tried sessions with a counselor (psychotherapy)? This can be very helpful.
  • Is there a chance your anxiety or agitation is a side effect of a medicine? If so, it is better to stop that medicine. 
  • Could your anxiety be a symptom of a medical problem? Make sure your doctor has checked you for low blood sugar, low blood pressure or low oxygen during your anxiety spells. These problems should be treated, but not with a benzodiazepine.
If you are using one of these drugs to treat insomnia, again you have better options.
  • Consider having a sleep study. If you have restless legs syndrome or sleep apnea, other treatments may help.
  • Talk with your doctor about how to improve your sleep environment and sleep habits.
  • Ask your doctor if any of your medicines can cause insomnia as a side effect.
  • Be aware that many other modern sleeping pills (Ambien, Lunesta and others) are closely related to benzodiazepines. They are not much better than the older drugs.
I have met many patients who have taken these medicines for 15 years or more. If this is your case, you will need to work with your doctor to stop the drug. I use the word "work" because it is hard work. I said "with your doctor" because that is the only safe way to do it. If you have taken the drug for a long time, it needs to be stopped slowly. Stopping abruptly could cause serious problems, such as a seizure. People commonly have temporary anxiety (a withdrawal symptom) after reducing their dose. What Can I Expect Looking to the Future? I tell patients who have been taking benzodiazepines for a long time that stopping them will require gradual, steady dose reductions over one to two years. This process takes a committed patient and a committed doctor. But it is always the best plan. If you take a benzodiazepine and your doctor is not talking with you about it, maybe it's time for you to choose a different doctor.]]>
Fri, 19 Dec 2014 00:00:00 -0500
Fitness Linked with Lower Blood Pressure; Being fit reduces the risk of high blood pressure, a large new study finds. The study included...                    What Is the Doctor's Reaction? High blood pressure (hypertension) is among the most common long-term (chronic) illnesses that can be cured or effectively treated without medicines.  And yet, much of what you hear about treatment is focused on medicines.  High blood pressure affects up to 40% of the population. So the drugs that help lower it are among those most widely prescribed worldwide.  Prevention and control are important because high blood pressure increases the risk of heart attack, stroke and other heart and blood vessel diseases. A new study makes the case that a high level of physical fitness dramatically lowers your risk of high blood pressure. The Journal of the American Heart Association published the study. The study was large. It analyzed data from more than 57,000 people.  Sixty percent of them had high blood pressure. Researchers measured people's fitness with a treadmill test. Then they looked at the relationship between fitness and the diagnosis of high blood pressure. Here's what they found out:
  • More than 70% of those with a low level of fitness were diagnosed with high blood pressure.
  • Less than 50% of those with a high level of fitness had been diagnosed with high blood pressure.
  • Those with a high level of fitness had a 20% reduction in the risk of having high blood pressure.
  • During the 18 years of the study, newly diagnosed high blood pressure was more common among those who weren't fit (49% of new cases) than among those who were highly fit (21% of new cases).
These findings remained even after researchers accounted for other factors that affect high blood pressure risk. The factors included age, ethnic group and excess weight. Of course, the idea that exercise might be good for blood pressure is not new. But this is among the best studies showing just how good it can be. The message of this research is clear: avoiding high blood pressure is one more reason to commit to being fit. What Changes Can I Make Now? The health benefits of exercise are many. Recent research has made the list even longer. Besides its impact on blood pressure, getting regular exercise has been linked with:
  • Improved mood
  • Higher level of energy
  • Better cholesterol levels
  • Lower risk of diabetes
  • Fewer heart and circulation problems such as heart attack or stroke
  • Lower risk of certain cancers, including cancers of the breast and colon
  • Better brain function in advanced age
  • Better sexual function (among men)
The ideal type and amount of exercise is not clear. But most experts suggest exercising most days of the week for at least 30 minutes. About 45 minutes to an hour might be even better. Exercise should be at least moderately intense. Brisk walking is a good example. With the New Year approaching, resolve to become more active. Consider making these changes:
  • Start slow. Then slowly increase how long or how intensely you exercise. For example, if you can walk half a mile in 20 minutes without difficulty, try to walk six-tenths of a mile in the same time. Or walk a few minutes longer instead. Each week, increase your distance or how long you exercise by no more than 10% to 15%.
  • Try to vary your exercise routine. This will reduce the chance that you will lose interest and quit.
  • Make exercise a routine part of your day, and make it a priority.
  • Get an exercise partner. This makes exercise a social activity, and you can encourage each other. Exercise will likely be more enjoyable, and you'll be less inclined to skip it.
  • Increase your "non-exercise" activity. For example, take the stairs instead of the elevator.
If you have any concerns about whether it's safe for you to exercise, ask your doctor. It might be best to meet with a physical therapist before getting started. Together you can design a safe exercise program filled with activities you enjoy. Finally, get your blood pressure checked. High blood pressure usually causes no symptoms. So the only way to know if your blood pressure is in a good range is to have it measured. This is true even if you are physically fit. In this latest research, a full 20% of the newly diagnosed cases of high blood pressure were among those with the highest levels of fitness. What Can I Expect Looking to the Future? You can expect researchers to continue to look at the relationship between exercise and blood pressure. For example, it would be helpful to know if the exercise itself prevents high blood pressure. It's possible that people who exercise have other healthy habits that protect them. As scientists continue to analyze the impact of exercise on health, I believe the list of benefits will get even longer. What's harder to predict is whether we will respond by doing what it takes to become more fit.]]>
Thu, 18 Dec 2014 13:47:00 -0500
Studies Suggest E-cigarettes May Aid Quitters E-cigarettes may help smokers to quit, a new report concludes. But it noted that there's not much...                    What Is the Doctor's Reaction? Smokers know well that the best thing they can do for themselves and the people around them is to quit. But the nicotine in cigarettes is viciously addictive. People who have been hooked on both nicotine and narcotics commonly say cigarettes are the harder habit to kick. E-cigarettes have been suggested as a potential therapy to help current smokers quit. These battery-operated, cigarette-shaped devices give off a vapor that contains nicotine. E-cigarettes don't have all the toxic ingredients found in tobacco smoke. So they are generally perceived to be a healthier choice than regular cigarettes. Nicotine replacement with a vapor would seem to be as safe as nicotine in a patch or gum. A Cochrane review published today suggest that, in the short term, e-cigarettes may indeed safely help people to quit smoking. Cochrane is nonprofit international group. It regularly evaluates the best evidence regarding health questions. This is done by panels of researchers, health professionals and patients. They are selected based on expertise and interest. They must have no commercial bias and no conflicts of interest. The Cochrane conclusion about e-cigarettes was based on just 2 clinical trials. They included 662 smokers. People were randomly assigned to use either e-cigs or devices that had a similar look and taste but contained no nicotine. The trials compared smoking quit rates after a year. About 9% using the real e-cigarettes were not smoking after a year. Only 4% of those who used the fake e-cigs remained nonsmokers that long. Some people could not quit completely. Among this group, the ones who used the real e-cigs were more likely to cut way down on regular cigarettes than people who used the nicotine-free devices. The Cochrane analysis also looked at observational studies. These studies look at what happens when people choose a particular behavior or treatment. The studies also suggested that e-cigs could safely help smokers quit. Observational studies don't offer the same high level of evidence as clinical trials. What Changes Can I Make Now? The two main challenges to quitting smoking are:
  • Overcoming the nicotine addiction
  • Breaking the smoking habit
Overcoming the nicotine addiction. Nicotine replacement therapy doubles your chances of quitting successfully. It can help you get through the cravings. Nicotine replacement therapy delivers a low dose of nicotine into the bloodstream. This eases, or even erases, withdrawal symptoms. Unlike smoking, nicotine replacement produces relatively constant blood levels of nicotine. It doesn't have the toxic chemicals in tobacco. I would still recommend the more time-tested nicotine replacement products
  • Patches
  • Gum
  • Nasal sprays
  • Inhalers
  • Lozenges
If you do opt for e-cigs as a nicotine replacement tool, you must use them much as you would use other nicotine products. That means not smoking traditional cigarettes. Keep in mind that e-cigs are meant only as a transition to NO nicotine. For most people, nicotine replacement therapy is not enough. They also need a prescription medicine. These medicines act on the brain. They decrease the cravings for nicotine and reduce withdrawal symptoms. The two that doctors prescribe the most are varenicline (Chantix) and bupropion (Wellbutrin, Zyban). Varenicline works in two ways. It partly imitates the effects of nicotine. This cuts down cravings and withdrawal symptoms. It also partially blocks the effect of nicotine, causing a smoker to get less of a reward. Bupropion is an antidepressant that also helps reduce the desire to smoke. It likely works because the bupropion and nicotine both stimulate the release of the same brain chemicals. Breaking the smoking habit. When smokers quit, they need to finds ways to fill the void. They need ways to break the rituals, daily habits, social encounters and emotionally charged moments that can trigger the impulse to light up. Behavioral therapy, smoking cessation programs and support groups can help. Your best chance of success is to commit to doing both things at once:
  • Lessen the nicotine withdrawal symptoms.
  • Make changes in behavior to break the smoking habit.
What Can I Expect Looking to the Future? Recently, great concern has been raised about potential harmful effects from some of the flavor enhancers and other chemicals in e-cigarettes. The Food and Drug Administration currently does not regulate e-cigarettes. More studies also need to be done to look at even the short-term safety of these devices to help smokers quit.]]>
Wed, 17 Dec 2014 13:56:00 -0500
Study: People Care about Uses of Medical Data People may be more willing to share their health records for research than for marketing, a new...                    What Is the Doctor's Reaction? Often, when I read or listen to the news, I hear about electronic breaches of privacy. Recent issues have come up from big box stores, social networks and credit cards. Many people are attuned to this fact of modern life. So they do what they can to protect their privacy. But few of us think about these issues with respect to our own health information. The Affordable Care Act encouraged most doctors to use electronic heath records. They contain a huge amount of information. Using data from electronic records can be a boon for medical researchers. They can get a lot of data about a lot of people. Not surprisingly, corporations are interested in this information, too. It can help them better target and sell their products to groups of people. How do people feel about the privacy of their medical records? Is it OK to use this information, combined with that of others, for research? Is it OK to use the information, combined with that of others, for marketing? When would you want to give consent to a researcher or a university? A company? The authors of a new study set out to find the answers.  Researchers from the University of Pennsylvania and Parkland Health System in Dallas did the study. They wanted to find out what really mattered to people about the use of their health information. They began the project by considering two points of view:
  • Some people will think that no health information should be shared without consent.
  • Others will feel that the value of what we learn from large numbers of records might trump a person's right of privacy.
They study included a diverse group of people. The authors gave them several different scenarios for potential use of health information. They reacted to scenarios involving consent for the use of patient information for research or for marketing.  Not surprisingly, people felt that privacy was important. Yet they had a nuanced response, possibly more so than the authors expected. They felt that the reason for the use of the information mattered. They considered the use of information for marketing without consent least appropriate. They felt that using information for research and obtaining consent was much more appropriate.  Views about consent were similar for whites, Hispanics and African Americans. Minorities felt that use of health information for marketing was more appropriate than whites did. This study furthers our national conversation. Previous research and editorials have focused largely on obtaining consent. This study tells us that consent remains important. But patients are clearly interested in the reason for use of their information. They feel that it is more appropriate when the information is used for research -- arguably of higher social value -- than for marketing. What Changes Can I Make Now? Do not fear your doctor's electronic health record. Research shows that electronic records can help improve both patient safety and communication between health professionals.  Our medical world has become ever more complicated, with information from many sources. Keeping it in an electronic record makes sense.  Records are set up to remain safe and confidential. They do an excellent job of that.  To learn more about how your health system uses its records, you can ask your doctor. Chances are that you signed a consent form for receiving care at your doctor's office or hospital. Those consent forms state whether or not your information might be used for research purposes. This will be grouped together with the information of others, not identified as yours. The most important thing to do now is to be aware that researchers, people interested in medical ethics and even companies are talking about this topic. Speak up if something is important to you. What Can I Expect Looking to the Future? I think we can expect to see more discussion and debate about the use of collected medical information.  I suspect we will also see some missteps and errors as we move toward an understanding of whether and how to share medical data for research and marketing purposes.]]>
Tue, 16 Dec 2014 00:00:00 -0500
Compound May Help Reduce Weight Gain In early testing, a new compound appeared to help reduce weight gain, researchers said. The...                    What Is the Doctor's Reaction? Many overweight people who go on a diet are successful in the short term. But almost all of them gain back those pounds one to two years later. Often they end up even heavier than when they started. After weight loss, it's important to maintain a lower-calorie diet and get more exercise. Except for surgery, there is no other proven safe and effective way to prevent weight gain. But results of a study done at the Imperial College in London suggest there may be such a therapy in the future. When bacteria in the lower intestine (colon) break down fiber, short-chain fatty acids are produced. One of them, called propionate, triggers the release of two hormones that suppress appetite. Propionate alone, taken by mouth, is not an option. Even in large doses, it would get absorbed rapidly in the small intestine. So it would never make it all the way down to the colon.  These researchers developed a compound containing propionate that is not absorbed by the small intestine. They combined it with inulin, a plant fiber. Once the compound reaches the colon, the bacteria easily break it apart to release the propionate. The researchers first confirmed that the inulin-propionate compound did result in a higher blood level of the hormones that suppress appetite. Then they studied the short-term effect on healthy human volunteers. The volunteers did not notice a decreased appetite, but their meal sizes were smaller. The researchers next did a 24-week study of 60 overweight adults. Half took the inulin-propionate compound. The other half took an inulin-placebo compound. In the longer-term study, the people taking the propionate did report decreased appetite. They also were less likely to gain weight than those taking the placebo. The possibility of a safe supplement to prevent weight gain is very exciting. However, it's important to point out the limitations of this early study. It included only a small number of people. Those who got inulin-propionate in the short-term study did not notice an appetite change. (Those in the 24-week study did, however.) It's also possible that weight-gain differences between the two groups occurred by chance and were not related to the compound. What Changes Can I Make Now? High-fiber diets have been promoted to help decrease weight gain. And eating more fiber and drinking extra water surely does help some people avoid weight gain. The current theory is that fiber helps control weight because you fill up with food that has fewer calories per ounce. But this new report suggests there may be a more significant effect of eating more fiber. Could just eating more fiber lead to higher amounts of propionate in the colon and less weight gain? Theoretically, it's possible. But you would need to eat would be much more than the usual high-fiber diet provides. This almost surely would cause belly pain and too much gas. Also, the amount of propionate produced in each person would be unpredictable. I recommend a modified diet both for weight loss and weight maintenance:
  • As many vegetables daily as you want. They are a great source of fiber.
  • Lots of fruits, but more vegetables than fruits.
  • Olive oil for salads and cooking.
  • One handful (about 1½ ounces) of nuts, 2 to 3 times per week. Nuts are healthy, but if you eat too many the calories add up quickly.
  • Plenty of legumes (beans, peas and lentils), at least 3 times per week.
  • Whole grains as your main carbohydrate source.
  • Three or more servings of fish (especially fatty fish) a week. A serving is 4 ounces.
  • A cup of low-calorie yogurt daily.
  • If you enjoy alcohol, limit yourself to 1 (for women) or 2 (for men) drinks a day. One drink is 5 ounces of wine, 12 ounces of beer or 1½ ounces of liquor.
Specifically avoid:
  • Soda and sugary drinks
  • Sweets, pastries and commercial bakery goods
  • Red and processed meats (eat white meats instead)
  • Margarines and most tub spreads
What Can I Expect Looking to the Future? A larger, long-term study is needed to confirm whether this inulin-propionate compound is safe and effective as part of a weight-management strategy.]]>
Fri, 12 Dec 2014 13:21:00 -0500
Study: Gout Attacks Increase at Night Gout attacks are more than twice as likely to occur overnight as during the day or evening, a new...                    What Is the Doctor's Reaction? It's rare that your doctor can predict the time of day your illness will start. But with gout, it is possible. Gout develops because of the buildup of a normal waste product, uric acid. Crystals of uric acid can deposit in the joints. This causes a sudden attack of arthritis. Other problems linked to excess uric acid include kidney stones and lumps of uric acid (called tophi) that deposit in the skin or elsewhere. Many people think gout is a disease of antiquity, yet it is still quite common. It affects an estimated 4% of the U.S. adult population. That's more than 8 million people. A new study found that gout attacks are more than twice as likely to occur during the night or early morning as during the day. The idea that gout may attack in the middle of the night is not entirely new. In fact, doctors noticed this centuries ago!  Consider this classic quote from the noted 17th century doctor Thomas Sydenham: "The victim goes to bed and sleeps in good health. About two o'clock in the morning he is awakened by a severe pain in the great toe; more rarely in the heel, ankle or instep. This pain is like that of dislocation. . ." However, the timing of gout attacks has not been well-studied until now. This new study is remarkable for two reasons. It not only studied the question of when gout attacks occur, but it did so by using the Internet. People with gout (previously diagnosed by a doctor) signed up online. Then they provided information about their attacks through the research study's website. The researchers found that among 724 people with gout:
  • An attack of arthritis caused by gout was 2.4 times as likely to happen overnight (midnight to 8 a.m.) as during the day (8 a.m.  to 4 p.m.).
  • An attack of arthritis was 1.3 times as likely to occur during the evening (4 p.m. to midnight) as during the day.
  • The risk of a gout attack at night was higher even among those who avoided known triggers (such as alcohol) in the 24 hours before the attack.
Is this information helpful? That's hard to say (and it's not something that this study can answer). These findings could lead doctors to recommend that their patients with gout take preventive medicines late in the day or in the evening. It's possible this approach would be more effective than standard treatment. What Changes Can I Make Now? You can make changes to reduce your risk of gout. Some health factors increase the risk of gout. These risk factors include:
  • A high intake of certain foods and drinks. Examples include organ meats (such as liver), seafood, alcohol and high-fructose corn syrup. Consuming less can lower the risk of developing gout.
  • Obesity. Excess weight loss is strongly linked to the risk of gout. Weight loss can reduce this risk.
  • Certain medicines. A common example is diuretic medicines for high blood pressure or leg swelling. Stopping these medicines or switching to a different drug (with the approval of your doctor) may lower the risk of gout.
  • Kidney disease. Taking measures to keep your kidneys healthy can lower gout risk. Good control of blood pressure is one important measure.
If you have already been diagnosed with gout, you can take medicines to treat attacks. They include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
  • Colchicine
  • Corticosteroids
For those with frequent or severe gout attacks, medicines to lower uric acid may be recommended. They include:
  • Allopurinol
  • Febuxostat
  • Probenecid
  • Pegloticase
With lifestyle changes and these medicines. most people with gout can put a stop to the arthritic attacks. But the first step is diagnosis. So let your doctor know if you have painful swelling of a joint. The sooner you are evaluated, the more likely it is that a diagnosis can be confirmed. What Can I Expect Looking to the Future? You can expect future research to show why gout attacks tend to occur in the middle of the night. The authors of this research suggest several possible reasons. They include:
  • Lower body temperature at night
  • Mild dehydration during sleep
  • Reductions in the hormone cortisol during sleep
  • Lower oxygen levels related to sleep apnea (a common condition among people with gout)
Each of these could contribute to increased formation of uric acid crystals in joints. These crystals cause gout attacks. Finding out why gout tends to flare up at night could lead to better ways to prevent or treat the disease.]]>
Thu, 11 Dec 2014 14:03:00 -0500
Flu May Be Severe, Shots Less Effective A strain of influenza that often causes severe disease is the one seen most often so far in this...                    What Is the Doctor's Reaction? The only thing constant is change itself. This was the wisdom of Heraclitus, a Greek philosopher. But the idea of change is enough to make flu vaccine manufacturers crazy. Constant change of the influenza (flu) virus makes it hard to provide a perfect flu shot. This season, the standard flu vaccines are made to protect against 4 strains of flu. The high-dose flu shot for adults over 65 has 3 strains. The U.S. Centers for Disease Control and Prevention (CDC) just issued a report about early cases seen in this flu season. Just over half (52%) of the 85 virus samples collected had a flu strain that was not included in any of this year's vaccines. The "interloper" strain is H3N2, part of a family called influenza A. In the past, H3N2 strains have been capable of causing fairly severe flu illness. This strain of flu isn't going to match the antibodies that people make after getting this year's flu shot. So it is possible that the shots will fail to prevent many cases of flu this year. How did we go wrong? Really, researchers and vaccine makers can't be blamed. Staying ahead of the flu is in some ways a game of odds and guessing. There is careful science behind the vaccine, but the flu can surprise us in any year. Scientists from the World Health Organization (WHO) plan each year's vaccine. Scientists in 83 countries keep track of flu infections around the world. They sample and analyze the strains that are causing infections. In order to plan a vaccine for the Northern Hemisphere, scientists track flu between September and January. This shows which strains have caused the most widespread and severe infections. Scientists also know which strains are the newest. This is important, because few people are likely to be immune to these strains. By February, the scientists issue a report. Vaccine makers use it to develop updated vaccines. In most years, the flu shot protects against 70% to 90% of circulating flu virus infections. In particularly bad years, the flu shot is less than 50% effective. What Changes Can I Make Now? If you have not yet received the flu shot this year, should you skip it? No, get the vaccine. Most flu seasons have several strains of flu that create trouble. It is still very early in flu season. The strains included in this year's vaccine may begin to circulate more widely. The vaccine will allow us to prevent at least those strains. Should we lose faith in the process for updating the vaccine each year? No, it truly is an incredible accomplishment that we can protect ourselves against the flu virus as well as we do. Flu vaccine has saved many lives. If you do get the flu this year or any year, please try to avoid exposing others. Take a few days off work, wear a mask and wash your hands. Most people who develop the flu do not need to visit their doctors. If you are short of breath and have flu symptoms, you should be examined. Before you arrive, tell the doctor's office staff that you may have the flu. They may be able to advise you about your symptoms over the phone, with no visit. If you come in to the office, you may be provided with a mask for the time you are in the waiting area. Antiviral medicines such as oseltamivir (Tamiflu) don't help much to shorten flu symptoms in people who are otherwise well. But they might prevent a hospital stay or severe illness from flu. Antiviral medicine for flu is recommended for people who are under age 2, over age 65, have weaker immune systems or have chronic (long-term) illness. Tamiflu must be started within 48 hours of when symptoms start. It is not likely to help if you don't have a fever. About 17% of people who take Tamiflu have a side effect of vomiting. It is reasonable to take this drug if you get the flu. However, it is reasonable to go without it, too. What Can I Expect Looking to the Future? Some parts of the flu virus vary less from strain to strain than others do. "Conserved proteins" on the virus surface seem to carry forward even when a strain mutates. These proteins are found in almost every strain of flu. Researchers are racing to develop a universal flu vaccine. If a vaccination could target these conserved proteins, it may prevent all types of flu. A universal flu vaccine might protect us longer than a year, and might require boosters only every few years. Progress toward a universal vaccine is being made in Italy, Israel and California. Early tests are promising. The Food and Drug Administration has not yet granted approval. It will probably be several more years before a universal flu vaccine is available.]]> Fri, 05 Dec 2014 00:00:00 -0500