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, 18 Apr 2014 16:26:00 -0400 Foodborne Illness Stable; Salmonella Down Though salmonella rates fell, cases of food poisoning overall have remained steady in recent... Campylobacter was close behind, with 35% of the cases. Salmonella bacteria caused 15 cases per 100,000 people. That's down 9% from 2010-2012. The CDC hopes to cut the rate to 11.4 by 2020. Campylobacter rates have been stable for the last 5 years. Vibrio bacteria are a lesser known cause of illness. These bacteria, found in shellfish, produce an infectious toxin. Vibrio accounts for only about 1% of foodborne illness. However, rates increased by one-third in just the last 3 years, the CDC said. The journal Morbidity and Mortality Weekly Report published the study. HealthDay News wrote about it April 17. What Is the Doctor's Reaction? This report only tells us about trends in confirmed cases of food-related infections. It covers only those caused by certain bacteria and parasites. But that's only the "tip of the iceberg." For every case of foodborne illness confirmed by laboratory culture, 30 more cases don't get cultured.  Many more people are affected but never get tested. The Centers for Disease Control and Prevention (CDC) estimates that 1 American in every 6 contracts a foodborne illness each year. These illnesses cause 128,000 hospital stays and 3,000 deaths per year. The Foodborne Diseases Active Surveillance Network (FoodNet) regularly collects information on laboratory-confirmed infections caused by nine different germs. FoodNet works with 10 states that have a total of 48 million people. Seven of the germs are bacteria and 2 are parasites. Of these 9, salmonella and Campylobacter bacteria together cause 73% of the cases FoodNet tracks. But FoodNet does not track the most common cause of foodborne illness. That dubious honor goes to norovirus (Norwalk-like viruses). The virus causes an estimated 58% of all food-related illness. Norovirus is highly contagious. As few as 10 viral particles can cause infection. Of course, it spreads through contaminated food. But it also spreads easily from person to person. Not everyone who comes in contact with any of these germs gets sick. For those who do, the symptoms are usually very similar. They include crampy pain in the belly, nausea, vomiting and diarrhea. Most people recover within a few days. Norovirus infections can lead to dehydration. Otherwise, severe effects are very rare. Some of the other infections have the potential to cause fever, bloody diarrhea and kidney failure. Infants, older people, pregnant women and those with weakened immune systems have a higher risk of these more serious problems. What Changes Can I Make Now? There's a lot you can do to prevent food poisoning. Food shopping:
  • Buy your produce and poultry from clean, reliable sources.
  • Be sure all dairy products and juices are pasteurized.
Storing foods:
  • Once at home, bring your bundles in and refrigerate or freeze perishables right away.
  • Keep meat, poultry, seafood and eggs separate from each other and other food items in the refrigerator.
  • Thaw foods in the refrigerator, not on the counter or in the sink.
Preparing foods before cooking or eating:
  • Wash hands with warm water and soap for 20 seconds before preparing food.
  • Wash fruits and vegetables under running water just before eating, cutting or cooking.
  • Wash produce even if you are going to just peel it or slice it. The knife can transfer bacteria from the outside to the inside as it slices through.
  • Remove the outer leaves of leafy vegetables before preparing.
  • Use separate surfaces and utensils when preparing raw meat or eggs.
  • Always use a food thermometer to make sure you have cooked food to these temperatures:
    • 145° F for meat (whole cuts of pork, veal, lamb and beef)
    • 160° for ground meat (beef, veal, lamb and pork
    • 165° for poultry (including ground turkey and chicken)
  • Cook egg yolks until they are firm, not runny.
  • When reheating, make sure that foods reach 165° F. Soups should boil.
Cleaning up after eating:
  • Wash surfaces or utensils after each use.
  • Refrigerate or freeze leftovers within 2 hours of cooking.
What Can I Expect Looking to the Future? There were fewer cases of salmonella infection last year. But just one outbreak could send the numbers much higher this year or next. Overall, the rates of foodborne illnesses have not changed much in the last several years. Food safety must continue to be a public health priority. But even if we could afford to double our efforts to monitor and enforce food safety, risk of foodborne illness will always exist. That's why prevention at home is so important.]]>
Fri, 18 Apr 2014 16:26:00 -0400
Related Health Problems Drop for Diabetics Americans with diabetes are much less likely to develop further health problems than they were 20... What Is the Doctor's Reaction? Diabetes has been in the news a lot in recent years. And nearly all of that news has been bad. For example:
  • The rising obesity rate has led to a dramatic increase in type 2 diabetes. This is the type that is strongly linked with excess weight. Type 2 diabetes accounts for 95% of diabetes cases.
  • Once nearly unheard of, type 2 diabetes is being diagnosed in children at an alarming rate.
  • Diabetes is an enormous source of suffering and early death. It places a burden not only on those with the disease, but on their loved ones as well. 
  • The estimated costs of caring for diabetes increased by more than 40% -- from $174 billion to $245 billion -- between 2007 and 2012. 
Despite all of this, people in the United States with diabetes and their doctors have been taking better care of the disease in recent years. And that has some trends moving in the right direction. A study just published in the New England Journal of Medicine explains this more positive trend. Researchers analyzed U.S. data on diabetes and some of the most important health problems (complications) it can cause. The study covered the last two decades and millions of people with the disease. Here's what it found:
  • The number of people with diabetes more than tripled,  from 6.5 million to 20.7 million. Meanwhile, the U.S. adult population increased by only 27%.
  • The heart attack rate among people with diabetes decreased by 68%.
  • Stroke rates decreased by 53%.
  • Leg and foot amputations among diabetics decreased by 51%.
  • Kidney disease requiring dialysis decreased by 28%.
The reductions were greater among people with diabetes than among people without the disease.  What accounts for these improvements? The study's authors suggest that it was a combination of:
  • Better medical care of diabetes and the other health problems it can cause
  • Better treatment of other conditions that increase heart and stroke risk,  such as high blood pressure and high cholesterol
  • Less smoking
  • Improved coordination of care among health care professionals
  • Education programs that promote better diabetes care
Still, the impact of these improvements was reduced by the rising number of people with diabetes. For example, the actual number of diabetics with stroke, amputation or severe kidney failure didn't change. That's because the falling rates of these problems were offset by the rising number of people with diabetes. What Changes Can I Make Now? If you've been diagnosed with diabetes, this new study shows how important it is to get good medical care. This includes taking steps to prevent further health problems and getting treatment for those that occur. Here's what you can do:
  • Keep track of your blood sugar levels.
  • Take your sugar-lowering medicines exactly as prescribed.
  • Don't smoke.
  • Keep track of your blood pressure. If it's high, adjust your diet, lose weight and/or taking medicines to bring it down.
  • Exercise regularly.
  • Wear shoes that fit well, and examine your feet each day.
  • Meet with a nutritionist, and stick with a heart-healthy, diabetic diet.
  • Don't skip doctor visits. That includes your primary care doctor, foot specialist, eye doctor and any other specialists to whom you are referred.
Most people with diabetes also should take other medicines to help prevent heart attack, stroke and kidney disease. Ask your doctor whether you should take a baby aspirin, statin and/or angiotensin converting enzyme (ACE) inhibitor each day. Keep track of all of your medicines, and update your doctors about any changes in your condition. These are two of the most important things you can do.  Many people find it helpful to keep a folder with a summary of their medical problems, an updated list of medicines and their doctors' contact information. Bring the folder with you to each doctor visit. Play an active role in your own care. For example, if you have kidney disease, make sure every doctor you see knows about it. Some medicines are dangerous when taken by a person with kidney disease. Or the dose may need to be adjusted.  Speaking up can prevent problems. Preventing diabetes is the best way to prevent the other health problems it can cause.  Maintaining a healthy weight is the key toward reversing the rising rates of diabetes. What Can I Expect Looking to the Future? This latest research provides a clear and encouraging message to those with diabetes:  careful medical care makes a difference. It should inspire everyone with diabetes to continue to do those things that we know will keep blood sugar in good control and reduce the rate of further problems. But the advances shown by this latest research should not slow efforts to get at the real problem: obesity. You can expect to hear much more in the coming years about how to help people lose excess weight and avoid obesity. I hope you will also hear that the rate of new diabetes cases is dropping.]]>
Thu, 17 Apr 2014 14:29:00 -0400
Sleep Apnea May Increase Osteoporosis Risk People with sleep apnea are more likely to develop high blood pressure, heart disease and stroke.... What Is the Doctor's Reaction? Obstructive sleep apnea is the most common type of sleep-disordered breathing. During sleep, it's normal for our muscles around the upper airway to relax. In people with obstructive sleep apnea, the relaxed muscles block the airway. This results in abnormal breathing during sleep. A person with sleep apnea has frequent, short episodes when breathing becomes very shallow or stops. Obstructive sleep apnea can cause a wide variety of symptoms, such as:
  • Loud snoring
  • Headaches, especially morning headaches
  • Daytime drowsiness (for example, people with sleep apnea often fall asleep while driving, in meetings, on the telephone, etc.)
  • Not feeling refreshed after a night’s sleep
  • Nighttime restlessness
  • Difficulty concentrating
  • Decreased sex drive
  • Bizarre dreams, or absence of dreams altogether
The disorder has been associated with multiple other medical problems. People with sleep apnea are more likely to:
  • Be obese
  • Have high blood pressure
  • Develop heart disease
  • Have a stroke
  • Be depressed
This study found that people with obstructive sleep apnea also appear to be at increased risk of thin bones (osteoporosis). However, this was an observational study. This kind of study shows links between factors. The results, therefore, don’t prove that sleep apnea directly causes osteoporosis. What Changes Can I Make Now? For most people with sleep apnea, doctors recommend:
  • Losing weight if you are overweight.
  • Getting more exercise.
  • Cutting way back on sugary foods and drinks.
  • Sleeping on your side instead of your back. This may take pressure off your upper airway.
  • Avoiding alcohol, sedatives and muscle relaxants.
It’s interesting that sleep apnea is much more common in people who are overweight. But it’s just the opposite for osteoporosis. Lower weight people, especially women, have a higher risk of osteoporosis. The best treatment for obstructive sleep apnea is CPAP (continuous positive airway pressure). You wear a mask at night. The mask is connected to a small machine that creates steady air pressure and sends it into the mask. The air pressure makes your airway less likely to collapse. Up to 80% of people benefit from using a CPAP device. To maintain bone health, you should make sure you get enough calcium in your diet and enough vitamin D. There are plenty of foods rich in calcium. But few foods contain natural vitamin D. So, you may need a daily vitamin D supplement. Also you need to do regular weight-bearing physical activities to keep bones strong. Examples include walking or jogging, and resistance training using free weights or machines. What Can I Expect Looking to the Future? Currently, most experts recommend bone density testing to screen for osteoporosis in women age 65 or older. Future studies will be needed to determine if younger women and men with sleep apnea should routinely be screened with bone density testing.]]>
Wed, 16 Apr 2014 14:03:00 -0400
More Pregnant Women Prescribed Opioid Pain Pills The number of pregnant women in the United States being prescribed narcotic pain medicines has... What Is the Doctor's Reaction? I was at a dinner last week. One of my colleagues, expecting a baby in July, sent back the swordfish she was served in favor of a vegetarian option. She was appropriately worried about the mercury levels in the fish. She drank decaf. Pregnant women worry about the best way to take care of their health and the health of their fetuses. Doctors worry about the best way to care for pregnant women, especially when they need to prescribe medications.   When I counsel women who are newly pregnant, we always discuss medication. Drugs in pregnancy range from the rare class A (safe) to the less rare class X (definite harm to the fetus). We review the patient's medicines and discuss which medicines are safe to take, which are not safe, and which need more consideration.   Painkillers are an important part of that discussion. For most women, acetaminophen (Tylenol) is safe in pregnancy. Many medicines like oxycodone, opiates, are considered class B in pregnancy: They are not expected to harm a fetus. That's different than saying that they are safe for pregnant women and their fetuses!  The New York Times article reviews two recent studies that show that nearly one quarter of pregnant women filled an opioid prescription in 2007, which is a significant increase over the previous 10 years. Another study with a different population of women found lower, but still large, numbers. Most women took the medicine for a week or less.   Is this ok? It's hard to say. Tremendous regional variation exists. For women on Medicaid, 4 in 10 women in Utah received opioids during pregnancy. That compares with 1 in 10 women in Oregon and New York. Since it is hard to imagine that pregnancy in Utah is different than pregnancy in Oregon, regional variation helps physicians and researchers to say that this kind of care is not based on clear guidelines or good science.   While most people consider that opiates are relatively safe in pregnancy, some recent studies have suggested that neural tube defects, like spina bifida, are slightly more common in the children of women who took opioids early in pregnancy. Consistent opioid use at the end of pregnancy can cause addiction and withdrawal in the newborn.  Pregnancy is uncomfortable. Some physicians in the New York Times article speculated that rising obesity rates might be part of the reason for increased back pain during pregnancy. Experts speculate that it is often easier for physicians to prescribe a pill (and for patients to take one) than to engage in a more time-consuming process, such as physical therapy.   What I keep returning to as I read this article and considered these studies is the sense that we — doctors and patients alike — don't really know the answer to this question: What is the right way to ensure that we treat pregnant women's pain appropriately and what is too much?  
What Changes Can I Make Now?
Over half the pregnancies in this country are unplanned. Preconception planning is really important to ensure a healthy pregnancy and healthy baby. Things to consider with your doctor before you get pregnant include: 
  • How will your overall health, medical history and surgical history impact you during pregnancy?
  • What medications do you take? Is it safe to become pregnant on those medicines or should they be altered?
  • Are you up to date on your vaccinations?
  • Are you exposed to environmental risks at home or at work? Can those be changed or made safer?
  • Are you taking prenatal vitamins, especially folic acid?
  • Is your fetus at risk for any particular genetic diseases? Can you be tested for those? Does your husband or partner need to be tested as well?
These are all things that are easily done and can contribute to a healthy pregnancy. If you have an unplanned pregnancy, don't worry too much. But do talk with your doctor about these issues as soon as possible.  When you do become pregnant, talk with your caregiver about which over-the-counter medications, including ones like Tylenol, are safe for you to take. If offered stronger pain medicines, consider whether you need them or whether lifestyle things like a heating pad or physical therapy might help as well. Ask your doctor! If you have surgery or an accident, you might really need to take opioid medicines. In that case, the benefit will likely outweigh the risk, but ask good questions to ensure that you understand the pros and cons. 
What Can I Expect Looking to the Future?
I hope we can expect lots of women to have lots of healthy babies! But there is this trend that more pregnant women are taking prescription pain drugs. We need to know how these drugs affect pregnant women. That's why more research is paramount.]]>
Tue, 15 Apr 2014 13:57:00 -0400
Report Questions Need for Flu-Fighting Drugs A new report questions the practice of governments stockpiling drugs to prepare for wide-scale flu... What Is the Doctor's Reaction?
Governments like to be able to name a solution for every problem. That way the people you are leading feel secure. When President George W. Bush saw us facing terrorists, he said every household should keep an emergency supply kit. He said "duct tape." And when we faced the 2009 flu pandemic, the magic word was "Tamiflu."  I remember the frenzy to stock up that went on in that year. Some of my patients asked me for prescriptions so they could keep a bottle on hand. The U.S. government apparently spent $1.3 billion buying doses. Even this year, a much milder year for flu, I have had many patients bring up Tamiflu as flu season hit its full swing. But does Tamiflu work? Not well enough to bother with. That's what I have been telling my own patients for years. But it has been hard to break the public perception that Tamiflu is a wonder drug. Now a highly respected review group, the Cochrane Collaboration, has looked at the evidence about Tamiflu's effectiveness. The Cochrane report says Tamiflu is unhelpful for most people who get the flu. The report was limited to adults without long-term (chronic) illnesses. It adds that a similar medicine -- Relenza (zanamivir) -- is no better for otherwise healthy adults who get the flu.   What happens if you take Tamiflu to fight flu? Your most significant flu symptoms -- the typical aching, cough, headache, dripping nose and fever -- may be shortened by roughly half a day. People who take Tamiflu recover from the flu in about 6½ days instead of 7. This benefit only occurs if you start taking the medicine within 48 hours of your first fever from flu. But despite this small benefit, there is no proof that Tamiflu lessens your chance of developing further health problems from flu, such as pneumonia. There is also no proof that Tamiflu can lower your risk of landing in the hospital because of your flu. And the trade-off for this very small benefit is significant. This drug has side effects. The pharmacist that I work with estimates that about 1 patient out of 6 is unable to finish the course of Tamiflu because of nausea and vomiting. It is possible that you may have some silent kidney injury from this drug. It is also possible that you may have some psychiatric effects, such as hallucinations. Zanamivir did not show any better benefit than Tamiflu. Zanamivir, an inhaled medicine, can cause nose or throat irritation, cough or wheeze. It should not be used by a person with lung disease. What this report does not review is whether Tamiflu has a better balance of benefits and risks in people with chronic illnesses, such as lung disease, heart failure or diabetes. These people have a higher than average risk of further health problems caused by flu. The report also does not check for benefit in the sickest patients with flu -- those who end up staying in a hospital to treat severe pneumonia from the flu. In my opinion, it is very reasonable to use this drug in hospital patients. When the flu is that severe, any way of reducing the virus's power is a welcome treatment. So Tamiflu will still have a role in flu season. What Changes Can I Make Now? I do not recommend keeping a back-drawer stockpile of Tamiflu. I do recommend that doctors consider prescribing it if a patient with severe flu is hospitalized. Most people do not use antiviral medicines to treat the flu. For almost anyone with flu, acetaminophen (Tylenol and others) is helpful. It can improve fever and chills, reduce body aches and help headaches. Be sure to wash your hands frequently and wear a mask if you are coughing in public. This will help you to avoid spreading your flu to other people. What Can I Expect Looking to the Future? For flu, our best strategy is still prevention. Get your flu vaccine every year. A lot of inventive thinking has gone on in recent years with the development of flu vaccine products. One product, the high-dose flu vaccine for older adults, is being studied now so we can see if it does a better job at preventing flu than a standard vaccine does. The study will likely be published this fall or soon afterward.]]>
Fri, 11 Apr 2014 00:00:00 -0400
High-Fat Diets Linked with Breast Cancer Diets high in saturated fat may increase the chance of developing 3 common types of breast cancer,... What Is the Doctor's Reaction?
This study once again reopens the question of whether fat in our diets influences breast cancer risk. Prior studies have reached different conclusions. Some show that women who regularly consume a high-fat diet have an increased risk of the disease. Other studies show no link between fat intake and breast cancer. The link between breast cancer and dietary fat depends on the type of breast cancer, according to this research. And it also depends on what types of fat a woman eats, not just the amount. Breast cancer samples are now routinely tested for the presence or absence of three tumor markers:
  • Estrogen receptors
  • Progesterone receptors
  • Human epidermal growth factor (HER2) receptors
Tumors that have each type of receptor are called positive for that receptor. Those without it are said to be negative. Women with breast cancer that is positive for estrogen and progesterone receptors and negative for HER2 generally have a better prognosis. Genetically, these tumors resemble normal breast tissue more closely than breast cancers with different markers. Breast cancer that is HER2-positive is more likely to grow faster and spread beyond the breast more often. So the prognosis is not as good. The prognosis is even worse if a woman's cancer is negative for all three receptors. This is known as "triple negative" breast cancer. In this study, eating a diet rich in saturated fats increases the risk of breast cancers that are estrogen and progesterone-positive and HER2-negative. These are the breast cancers that tend to have a better prognosis. But saturated fat did not increase the risk of breast cancers with other receptor patterns. What Changes Can I Make Now? For decades, we have been warned of the dangers of saturated fats. Study results such as these add to the concern. However, other recent studies are beginning to question whether the scare has been overstated. You could just think, "Forget about it. Until the experts figure this out, I'll eat what I want." But let me suggest why I will continue to limit saturated fat and advise my patients, both male and female, to do the same. Saturated fats may not be as harmful as we previously believed. But there is no evidence that they are good for you. And there is plenty of evidence to remain concerned about links between high saturated fat intake and increased risks of heart disease and some types of cancers, including breast cancer. Although this study doesn't discuss it, the source of saturated fat might be important. For example, eating lots of red meats and processed meats appears to increase breast cancer risk. Here are other ways you can help decrease your risk of breast and other types of cancers:
  • Maintain a healthy weight or lose weight, if necessary. In particular, watch your portion sizes and avoiding sugary foods and drinks.
  • Don't smoke or use other tobacco products.
  • Get at least 5 servings of fruits and vegetables daily.
  • Aim for 30 minutes of activity daily. Set a long-term goal of 60 minutes of activity most days.
  • Drink alcohol in moderation, if you drink it at all.
   What Can I Expect Looking to the Future? More and more experts recommend Mediterranean-style eating. The main components are lots of vegetables, fruits, whole grains, healthy fats and non-meat protein sources. It makes sense. It's not a specific diet and therefore offers flexibility. Based on research done so far, eating Mediterranean-style surely can't hurt, as long as you keep total calories in check. And my bet is it will help keep your heart and the rest of your body healthy.]]>
Thu, 10 Apr 2014 14:09:00 -0400
Aspirin Recommended to Prevent Preeclampsia A daily low-dose aspirin may help prevent preeclampsia in women at high risk of this dangerous... What Is the Doctor's Reaction? Many of us imagine that pregnancy should always be simple and straightforward. But problems can indeed arise. And doctors and researchers continue to search for simple ways to prevent these problems during pregnancy. One condition that can occur during pregnancy is preeclampsia. Women typically develop preeclampsia after 20 weeks of pregnancy. The signs and symptoms include:
  • High blood pressure
  • Protein in the urine
  • Swelling (in the legs, hands or face)
  • Headache
  • Vision changes
  • Nausea and abdominal pain
  • Difficult breathing
  • Seizures
Preeclampsia can be a dangerous condition for mom and baby, especially if it leads to seizures. At that point, the condition is called eclampsia. Some of the dangers of preeclampsia include:
  • Preterm delivery (partly because the only cure for preeclampsia is to deliver the baby)
  • Stroke or other organ damage in the mother
  • Low birth weight in the baby
  • Pregnancy loss
We still don't know why preeclampsia develops in the first place. So doctors and researchers have struggled to find ways to prevent it. However, new guidelines may be changing that. The guidelines come from the U.S. Preventive Services Task Force, which makes recommendations about preventive medical care. The guidelines say that taking a baby aspirin (81 milligrams) once a day may reduce the odds of developing preeclampsia by about 24%. And they suggest that for women who already have preeclampsia, aspirin may lower the chance of problems such as preterm birth or low birth weight.   What Changes Can I Make Now? 1.  Understand what factors increase the risk of developing preeclampsia. Preeclampsia affects about 4% of pregnancies. Strong risk factors include:
  • Prior history of preeclampsia -- If you've had it before, you are more likely to have it again.
  • High blood pressure, diabetes or kidney disease before pregnancy.
  • Being pregnant with twins, triplets or more.
Other factors that increase risk include:
  • Obesity
  • Older age (above 35) or younger age (under 15)
  • African-American or Hispanic race/ethnicity
  • Family history of preeclampsia
  • First pregnancy
2.  Talk to your health care professional. There are risks and benefits to taking any medicine, especially during pregnancy. Be sure to talk to your doctor before starting any new medicines, including aspirin. 3.  Stay healthy during pregnancy. There are many important ways to keep healthy during pregnancy.
  • Maintain a healthy and appropriate body weight.
  • Remain physically active.
  • Don't smoke.
  • Eat a well-balanced diet.
4.  Stay healthy after pregnancy. Many women don't realize that complications that arise during pregnancy can lead to health problems later in life. These include high blood pressure and heart disease. Preeclampsia may increase your risk of future problems, so it's important to take care of your health after pregnancy. What Can I Expect Looking to the Future? Researchers are learning more and more about why women develop preeclampsia. For example, there are clues that it may arise because of a problem with the placenta. The odds of developing this problem might be influenced by the mother's or father's genes or immune system. Understanding what lies behind preeclampsia will allow for development of better treatments in the future.]]>
Wed, 09 Apr 2014 14:11:00 -0400
Milk May Help Protect Women with Arthritis Women who drink more milk may be able to fend off severe osteoarthritis longer, a new study... What Is the Doctor's Reaction?

The news that drinking milk might help arthritis certainly got my attention. I'm an arthritis doctor. My patients often ask if there's anything they can eat or drink (or avoid) to improve joint health.  For the most common type of arthritis -- osteoarthritis -- there is a link to obesity. So choosing a diet that helps you maintain an ideal body weight can reduce the risk of osteoarthritis. But there is little convincing evidence that specific foods matter.  A new study could change that. Researchers enrolled more than 2,000 people with knee osteoarthritis. Each person answered a survey about 60 foods. They also had knee X-rays each year for 4 years. The study found that:
  • Over time, the knee joint gradually narrowed in most study subjects. This indicates that the arthritis was growing worse.
  • For women in the study, the more milk consumed, the slower the arthritis got worse. Compared with women who drank the least milk, those who drank seven or more servings a week had about one-third less narrowing of the joints.
  • Women who ate seven or more servings of cheese each week had worse arthritis than those who ate no cheese.
  • For men, there was no link between milk or cheese consumption and the course of knee osteoarthritis over time. 
It's important to note that this study did not find that drinking milk prevented osteoarthritis. Everyone already had the disease. The study found that drinking more milk seemed to slow the rate at which women's osteoarthritis grew worse. Despite the findings of this new research, I'm skeptical that simply increasing milk consumption will slow the progression of osteoarthritis. Here's why:
  • There is no obvious reason that drinking milk should affect osteoarthritis differently in men and women. This raises the possibility that the findings for women occurred by chance.
  • Several factors are thought to contribute to the development of osteoarthritis. They include body weight, genetics and trauma. Therefore, it would be surprising if consuming more of a single food would slow it down.
  • A study of this type cannot account for every factor that might contribute to worsening arthritis. It's possible that something other than drinking milk could explain the findings of this study. 
  • This study relied on the recall of study subjects about how much milk they drank. Such memories can be unreliable.
  • X-ray results may not be the most reliable way to assess how quickly knee osteoarthritis gets worse. MRI may be better.
One study rarely changes doctors' advice. We need confirmation of these findings in larger studies. What Changes Can I Make Now? For osteoarthritis, the most important change you can make now is to lose excess weight. Obesity is a well-recognized and important factor that increases the risk of osteoarthritis. You also can take these other measures to reduce your risk of osteoarthritis:
  • Protect your joints. Preventing joint injuries can reduce the risk of osteoarthritis. So train well and wear appropriate gear during exercise or work activities that put stress on your joints.
  • Stay active. Keeping your joints moving can prevent stiffness, maintain motion and, perhaps, lessen the risk of osteoarthritis.
  • Avoid osteoporosis. This disease causes thin bones that break easily. Fractures caused by osteoporosis may lead to osteoarthritis. Exercise and adequate intake of vitamin D and calcium are the first steps.  Your doctor also may recommend other medicines, such as alendronate (Fosamax, Binosto and generics) or risedronate (Actonel, Atelvia and generics).
  • Get appropriate treatment for any conditions that might contribute to joint damage.  Examples include hemochromatosis (a condition marked by excess iron in the body), gout and rheumatoid arthritis.
  • See your doctor if you have joint pain that is major or won't go away. For many types of arthritis, early diagnosis and treatment may prevent disability.
Drinking milk may be helpful. But we'll need more research to be sure about that. What Can I Expect Looking to the Future? If other researchers confirm the findings of this latest research, new questions will emerge. For example:
  • Why is milk good for women with osteoarthritis? Why does cheese seem to worsen it?  The answers could provide a new understanding about its cause and how it gets worse.
  • Why doesn't milk help men with osteoarthritis?
  • Are the benefits of drinking milk limited to knee osteoarthritis, or is it also helpful for other joints?
  • Can drinking milk help other types of arthritis? (Prior studies show that a diet high in dairy products can reduce the risk of gout. But there's little information about whether a high-diary diet can help previously diagnosed gout.)
You can expect future research to address these and other questions regarding the relationship between diet and arthritis.]]>
Tue, 08 Apr 2014 13:39:00 -0400
Diet, Exercise Cut Death Rates in Pre-diabetes People with blood sugar just below diabetes levels may live longer with diet and exercise, a new... What Is the Doctor's Reaction? An estimated 79 million adults in the United States have pre-diabetes. If you have pre-diabetes, your blood sugar is higher than normal. But it's lower than the number used to diagnose diabetes. How is pre-diabetes diagnosed? Here is what the American Diabetes Association says:
  • Normal blood sugar means having a fasting blood sugar below 100 milligrams per deciliter (mg/dL) or a hemoglobin A1C below 5.7%.
  • Pre-diabetes means having a fasting blood sugar between 100 and 125 mg/dL or an A1C between 5.7% and 6.4%.
  • Diabetes is diagnosed when you have at least 2 fasting blood sugar readings of 126 mg/dL or higher or a single A1C of at least 6.5%.
A fasting blood sugar is measured by a simple blood test. Before the test, you must have nothing to eat or drink other than plain water for at least eight hours. But it's just one snapshot of what's happening to your blood sugar levels. That's why more than one test is needed before diagnosing diabetes. An A1C is also a simple test. It looks at your red blood cells. It measures the percentage of oxygen-carrying hemoglobin molecules on these cells that have glucose attached to them. The test can be done any time of the day. It does not require fasting or any other changes in diet. The advantage of an A1C test is that it reflects your average blood sugar level during the last two to three months. That's why it needs to be done only once to make a diagnosis. Most people with pre-diabetes will develop type 2 diabetes. But it's well known that serious lifestyle changes can lower the risk. And if you do stay physically active and maintain a healthy weight, that will do much more than just lowering blood sugar levels. If you have pre-diabetes, diet and exercise greatly increases your chance of living longer. In this study, some people were assigned to a 6-year lifestyle change program. Over 20 years, they had a 10% lower death rate than those in a group that made no changes. What Changes Can I Make Now? Get tested for pre-diabetes. The American Diabetes Association recommends either a fasting blood sugar or an A1C test every 3 years for people ages 45 and older. People who have a higher risk of diabetes should begin testing earlier and repeat the tests as often as yearly. Factors that increase diabetes risk include being overweight, having a parent or sibling with type 2 diabetes, or having high blood pressure or high cholesterol levels. Watch your diet. Most important is maintaining a healthy weight. Ideally this means a body mass index (BMI) of less than 25. But at least make sure you keep it under 30. (Obesity is commonly defined as a BMI of 30 or more.). There is no best diet to prevent diabetes. Reducing total calories and limiting simple sugars matter the most. Recent studies suggest that a Mediterranean-style diet might be the way to go. Get active. The more you move, the better your chance of avoiding pre-diabetes and diabetes. Set aside at least 30 minutes every day as dedicated exercise time. Work your way up to 45 to 60 minutes most days of the week. What Can I Expect Looking to the Future? These study results were to be expected. It's well known that the same lifestyle choices that help prevent diabetes also reduce the risk of heart attack, stroke and early death. Is the message being heard? Surely not often enough. But recent estimates that show a potential slowdown in rising obesity rates do offer hope.]]>
Fri, 04 Apr 2014 13:12:00 -0400
Early Fitness May Help Keep Brain Agile Physically fit young adults may have more nimble brains later on, a new study suggests. The study... What Is the Doctor's Reaction? Here's something you've probably heard before: exercise is good for you.  But it may be even better for you than previously thought. A new study reveals how physical fitness in early adulthood may help to preserve mental fitness.  The medical journal Neurology published the study. Researchers enrolled more than 2,700 young adults (average age 25). They were all given treadmill tests, similar to a stress test. They were asked to walk or run as long as they could while the speed and incline of the treadmill were gradually increased. The treadmill test was repeated 20 years later. Each person had tests of thinking skills 25 years after the first treadmill test. The findings suggest that physical fitness during early adulthood could have a profound effect on brain function decades later. For example:
  • Performance on the treadmill test did decline during the 20 years between tests. But those who declined the least had the best scores on tests of thinking skills. These included tests of memory, planning and speed of transforming thoughts into action (psychomotor speed).
  • Those who were most physically fit as young adults had the best verbal memory and psychomotor speed scores 25 years later.
  • The link between exercise capacity during young adulthood and future brain function held up even after accounting for factors that increase the risk of heart and blood vessel disease. These risk factors include diabetes, smoking and high cholesterol.
  • What makes this study particularly important is that the measures of brain function it assessed are among the best predictors of future dementia. It's still unproven, but this study raises the real possibility that physical fitness from early adulthood through middle age might help prevent dementia in later years. Ways to prevent dementia are essential because we don't know the causes or have good treatments for the most common types of dementia.
What Changes Can I Make Now? Review your current exercise capacity. For example:
  • Can you climb 2 or 3 flights of stairs without difficulty?
  • Can you easily walk, jog or bike for 10 minutes or more?
  • Has your stamina or speed diminished in recent years?
Now review how physically active you are. For example:
  • Do your hobbies, work or home life require you to be physically active?
  • Do you walk (or sit) for much of the day?
  • Do you exercise most days of the week?
There may be good reasons that you aren't as active as you would like. Medical conditions, such as lung or heart disease, may limit your exercise capacity. Some medicines can affect your stamina. And clearly there are challenges to getting regular exercise if your circumstances (for example, working two jobs or caring for kids) leave you little free time. Even so, there may be changes you can make to increase your physical activity and improve your exercise capacity. Here's what you can do:
  • Take the first step. Commit to becoming more physically active.  
  • Make physical activity a routine part of your day. Small changes, such as taking the stairs instead of the elevator, can add up.
  • Choose an activity you like. If you are inactive now, walking, swimming or riding a stationary bike are good places to start. Set realistic goals, and don't try to do too much too soon.
  • Vary the activities. "Cross-training" will reduce the chance that boredom or injury will get in the way of regular exercise.
  • Get an exercise partner. You can encourage each other to exercise when you might be tempted to skip it. Exercise that includes a social aspect also tends to be more fun.
If you have any major medical conditions or aren't sure how much exercise you can safely handle, review your options with your doctor. What Can I Expect Looking to the Future? If physical fitness can stave off dementia, researchers will try to figure out why. Understanding the connections between physical activity and brain function could lead to new insights into the causes of dementia. And that could lead to new preventive strategies and treatments. Experts predict that dementia will become dramatically more widespread in the years to come. I hope that we also will see physical activity become more of a priority for everyone. This will be especially important if physical fitness can prevent dementia, as this latest research suggests.]]>
Thu, 03 Apr 2014 13:44:00 -0400
2 Studies: Vitamin D Benefits Still Not Clear Current evidence still doesn't show any clear benefits from taking vitamin D pills, 2 new reports... What Is the Doctor's Reaction? Vitamin D has developed a reputation as a wonder vitamin. But we've seen this sort of enthusiasm before, about vitamin E and other micronutrients. And it appears that once again the accolades probably have been more than this vitamin deserves. In this week's British Medical Journal, two studies thoroughly evaluated hundreds of  "well done" studies on vitamin D. The general conclusion: There's just not enough evidence to say that vitamin D pills prevent heart disease, cancer or many other medical problems. Even as a way to help prevent thin bones (osteopenia and osteoporosis), taking vitamin D alone may not be effective. It's become a widespread practice for doctors to order vitamin D levels as a routine screening test. The authors of one of the studies question the value of routine testing. They say their findings don't show a major difference in outcomes for young and middle-aged people if they have lower levels of vitamin D.  But the authors did find that older people who take vitamin D3 supplements are likely to live longer. While the evidence doesn't meet the high standard of proof for most health claims, many studies do suggest potential benefits. And low-dose vitamin D supplements are clearly safe. These studies just add more controversy to the questions experts already debate:
  • Who should have a blood test to determine their vitamin D levels?
  • Who should take vitamin D supplements?
Expert opinions now vary widely. Here are some common recommendations:
  • Test only people who are clearly at high risk of vitamin D deficiency. Examples would include people with thin bones (osteopenia or osteoporosis) and people who never go in the sun and don't eat or drink vitamin D-fortified products.
  • Test everyone and advise people based on the result of the blood test.
  • Test only those at very high risk of deficiency and have everyone else take a daily vitamin D supplement.
  • Use the amount of sunlight exposure and dietary history to determine who should take a supplement.
What Changes Can I Make Now? For now, I am going to advise my patients based on the recommendation of the Institute of Medicine.
  • 600 international units (IU) of vitamin D a day for everyone ages 1 to 70
  • 800 IU of vitamin D a day for those 71 and older
Food is the best way to get most vitamins. But not vitamin D. Only a few foods --salmon, tuna, sardines, milk and fortified cereals -- can give you more than 100 IU per serving. But what about the way humans got vitamin D for millions of years -- from the sun? It's a hot-button issue. Too much exposure to the sun causes skin cancer. That's why so many experts recommend that people take a daily vitamin D supplement. If you are uncertain that you are getting 600 to 800 IU of vitamin D daily, you could take a supplement. A pill containing 400 to 1,000 IU daily is safe, low-cost insurance. Some studies suggest that vitamin D3 is better than D2. What Can I Expect Looking to the Future? Future studies will continue to show varying results on the potential health benefits of vitamin D. But I don't suspect any will show harm from taking low-dose vitamin D pills. Even 2,000 IU daily is well within the safety range.]]>
Wed, 02 Apr 2014 13:52:00 -0400
Stiff Arteries May Raise Risk of Alzheimer's Artery stiffness may increase the odds of developing dementia, a new study suggests. People are... What Is the Doctor's Reaction? Alzheimer's disease continues to be more difficult to understand than we hoped. Alzheimer's disease is the most common type of dementia. The risk of developing it increases with age. As people live longer than ever, the numbers of those affected will increase dramatically during the next couple of decades. The main features of Alzheimer's disease are impaired memory and thinking. The symptoms come on gradually and get worse over time. Alzheimer's disease develops over many years. Changes in the brain may start to happen as much as 25 years before symptoms occur. Those changes include a build-up of a protein called beta amyloid. There is a definite link between having more beta amyloid in the brain and having Alzheimer's disease. But amyloid deposits are found in up to 30% of elderly people with normal memory and thinking. And there is no direct proof that it's the amyloid that causes Alzheimer's disease. Researchers have tried to reduce amyloid deposits in people with early Alzheimer's disease. This has not improved outcomes. So scientists continue to search for other causes. What else could be happening in people with Alzheimer's, other than just the buildup of amyloid in the brain? Perhaps it's injury to the smallest blood vessels that feed oxygen and nutrients to the brain. In fact, some studies support this theory. Small blood vessel damage seen on brain scans, combined with the amount of amyloid deposits, may be a better way to predict who will get dementia than the amount of amyloid alone. This new study suggests a major reason for small vessel damage in the brain. It's stiffness in the arteries. As we age, our blood vessels become more rigid. This is especially true of the aorta, the largest artery. The aorta supplies blood to the entire body, including the brain. When the heart pumps blood into a stiff aorta, blood shoots up to the brain under higher pressure. It's known that bursts of high pressure damage the tiny arteries that feed brain cells. In the new study, researchers measured artery stiffness in 81 adults. All of them were 83 years of age or older. None had clinical dementia. They also received positron emission tomography (PET) scans at the beginning of the study and again 2 years later. PET scan images help to show how an organ functions. The people with greater artery stiffness showed larger increases in beta amyloid deposits. We don't know yet whether those with more amyloid deposits and higher artery stiffness will develop more memory and thinking problems. What Changes Can I Make Now? You can help keep your arteries from getting stiff the same way you decrease your risk of heart disease, stroke and blood vessel diseases. And now we also know that this reduces your risk of dementia.
  • Stay physically active, and dedicate time every day to exercise. Ideally, aim for 45 to 60 minutes of exercise most days of the week. But any and all physical activity helps to reduce risk.
  • Maintain a healthy weight, which also helps lower your risk of developing type 2 diabetes.
  • Don't smoke.
  • Eat plenty of fruits and vegetables. Choose healthier protein sources, such as fish, beans and soy products.
  • Keep your blood pressure in the normal range.
What Can I Expect Looking to the Future? More research is needed to determine whether artery stiffness could actually be one of the causes of dementia. If it is, then the prevention of Alzheimer's disease and other dementias may become more focused on artery health, rather than what's happening within the brain.]]>
Tue, 01 Apr 2014 13:31:00 -0400
Brain Stimulation Helps Some Fibromyalgia Symptoms Magnetic brain stimulation improved symptoms and quality of life in people with fibromyalgia.... What Is The Doctor's Reaction? Fibromyalgia is a curious disease.  It is among the most common causes of widespread, chronic pain, affecting an estimated 5 million people in the United States alone. The typical patient is a young or middle-aged woman who suddenly develops a host of symptoms, including: 
  • Body-wide pain, especially in muscles and joints
  • Numbness or tingling in the hands and feet
  • Profound fatigue, including feeling unrefreshed in the morning
  • Feeling "foggy" with difficulty concentrating
  • Depression, anxiety or both
  • Headaches
And yet, despite decades of research, the cause of fibromyalgia and a reliably effective treatment remain unknown.   Now comes word of a curious treatment for fibromyalgia: transcranial magnetic stimulation. With this treatment, a magnet is applied to the outside of the head that stimulates nerve cells in the brain.  Researchers publishing in the medical journal, Neurology, treated study subjects who had fibromyalgia with transcranial magnetic stimulation on 14 occasions over 10 weeks. Their response was compared with otherwise similar people who received "sham" (fake) transcranial magnetic stimulation. While those getting the real transcranial magnetic stimulation reported feeling better, the improvement did not include a reduction in pain. Instead, after 10 weeks of treatment, study subjects reported modest improvement in quality of life due to:
  • Better mood
  • More joy; less anger and anxiety
  • Improved social interactions and work performance
In addition, each study subject underwent a PET scan of the brain. This provides pictures of the brain based on its metabolic activity. The researchers noted changes in the appearance of PET scans in areas of the brain involved in emotion, including the emotional aspects of pain.  It's not at all clear why magnetic stimulation should be helpful for fibromyalgia. Still, if it is confirmed by other research, this study could lead to changes in how fibromyalgia is treated. And it could lead to a better understanding of the disease.   However, we aren't there yet. While the findings are encouraging, the study was quite small. The study had only 38 subjects; nearly a quarter of them did not complete the study treatments. While fibromyalgia tends to be a lifelong condition, this study only lasted 10 weeks. And the improvement was not large: On a 100 point scale assessing quality of life, those receiving transcranial magnetic stimulation improved by only 10 points.  Still, for a condition with no highly effective treatment options, a new approach that provides even a small improvement can be a big deal.

What Changes Can I Make Now? If you have unexplained pain, fatigue or other symptoms of fibromyalgia, see your doctor for evaluation.  A number of conditions can mimic fibromyalgia. Your doctor may look for these other explanations for your symptoms, including: 
  • Anemia
  • Thyroid, kidney or liver disease
  • Arthritis or muscle disorders
  • Vitamin D deficiency
  • An abnormal blood calcium level
  • Depression
  • A sleep disorder, especially sleep apnea
If one of these conditions is diagnosed, your symptoms may improve or even disappear with proper treatment. However, if no other cause of your symptoms can be identified, the diagnosis of fibromyalgia becomes more likely.  Once diagnosed, your doctor can offer you several treatments. The specific choice of treatment (or combination of treatments) depends on individual factors, such as other medical problems, other medications taken, and personal preferences. Common initial treatments include: 
  • Physical activity, especially low-impact aerobic exercise; biking, brisk walking or water aerobics are good choices
  • Medications, including amitriptyline, duloxetine or pregabalin
  • Pain relievers, such as acetaminophen or tramadol
  • Physical therapy
  • Alternative therapies, such as yoga or Tai Chi
  • Psychological counseling
While it is true that no single treatment is reliably effective in all people with fibromyalgia, a combination of exercise, medications and modifications in activities will often be effective enough to avoid disability and maintain a good quality of life.

What Can I Expect Looking To The Future? In the future, you can expect our understanding of fibromyalgia to improve. If future studies confirm that transcranial magnetic stimulation is effective, this could advance our understanding of how the disease develops and how best to treat it. Even if we never discover its cause, I think the number of treatment options for fibromyalgia will only increase in the future. Researchers are already working on new medications to treat this common condition.]]>
Thu, 27 Mar 2014 14:03:00 -0400
Study: E-Cigarettes Don't Help Smokers Quit Electronic cigarettes (e-cigarettes) aren't all they're touted to be, according to a U.S. study.... What Is the Doctor's Reaction? E-cigarettes have rapidly gained popularity. They are promoted as a safer alternative to regular cigarettes and a way to help you quit smoking. But neither of these claims is backed up by solid evidence. E-cigarettes (short for electronic cigarettes) are battery-operated devices shaped like cigarettes. They give off a flavored vapor that contains nicotine. They give the illusion and feel of smoking a cigarette without burning tobacco. Some e-cigarette users say that they are "smoking." Others call it "vaping," to distinguish the vapor from smoke. Some earlier studies suggested e-cigarettes might be an effective smoking cessation tool. But results of other studies did not support that claim. This report adds support to the "no help" side. It suggests e-cigarettes don’t help people smoke fewer tobacco products. They don't lead to quitting. Critics of this report say that it is not a well-designed study and has too few participants to make the findings valid. Those are fair criticisms. But noting the study has flaws does not mean e-cigarettes should be considered a safe, effective method to help smokers quit. What Changes Can I Make Now? It’s always a good time to quit smoking. The first step is to set a quit date. Make it public. Share the special date with your family, friends and doctor. The two main challenges to quitting are:
  • Overcoming the nicotine addiction
  • Breaking the smoking habit
Overcoming the nicotine addiction. Nicotine replacement therapy (NRT) doubles your chances of quitting successfully. It can help you get through the cravings. Nicotine patches, gum, nasal sprays, inhalers and lozenges are examples of NRT products. NRT delivers a low dose of nicotine into the bloodstream. This eases, or even erases, withdrawal symptoms. Unlike smoking, NRT produces relatively constant blood levels of nicotine without the toxic chemicals in tobacco. Some medications used to help people quit smoking do not release nicotine into the bloodstream. Instead, they act on the brain to decrease the cravings for nicotine, nicotine withdrawal symptoms or both. The two that doctors prescribe the most are varenicline (Chantix) and bupropion (Wellbutrin, Zyban). Varenicline works two ways. It partly imitates the effects of nicotine, thereby cutting 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 works by triggering some of the same receptors as nicotine. Breaking the smoking habit. When smokers quit, they need to finds ways to fill the void. 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 simultaneously commit to lessening the nicotine withdrawal symptoms and making changes in behavior to break the smoking habit. What Can I Expect Looking to the Future? More studies looking at the safety and effectiveness of e-cigarettes as a smoking cessation therapy are in progress.]]>
Tue, 25 Mar 2014 18:17:00 -0400
Value of Mammograms Over Age 70 Questioned Mammograms can help detect breast cancer. But these screening tests did not reduce the number of... What Is the Doctor's Reaction? Mammography has the potential to find small cancers early. Cancers that might become untreatable later on or cause premature death. However, most of the spots seen on mammograms are either not cancers or they are cancers that don’t hurt a woman’s health. The value of using this tool to screen all women for breast cancer continues to spur much debate. Most experts agree that routine (regular) mammograms are appropriate for women ages 50 to 75 with an average risk for breast cancer. The main controversy is:
  • How often should a woman have a mammogram, and
  • Whether screening should start at age 50 rather than 40
The U.S. Preventive Services Task Force publishes advice about health screening and disease prevention. The advice is based on evidence evaluated by experts from different specialties. This way, it is less likely to have a bias than advice from a single specialty group. For breast cancer screening, the task force recommends:
  • A mammogram every 2 years for women ages 50 to 74.
  • No routine screening mammograms for women in their 40s, unless they have an increased risk of breast cancer.
  • Discussion between a woman and her doctor about whether to screen for breast cancer before age 50. Decisions would be based on a woman's risk of breast cancer. And on what she prefers after learning about the benefits and harms of breast cancer screening.
The American Cancer Society and other well respected medical groups disagree. They say that the task force guidelines would miss too many early cancers. They say that this could cost lives. Instead, the cancer society recommends a mammogram every year. And they say it should start at age 40 for women at average risk for breast cancer. This new report suggests routine mammography might do more harm than good in women ages 70 to 75. The researchers found that mammograms don’t lead to a decreased risk of advanced breast cancer. But many women undergo unnecessary worry, testing and treatment as a result of spots seen on a mammogram. What Changes Can I Make Now? If you are 70 or older, talk with your doctor about the benefits and harms of breast cancer screening. If you are healthy and active, you may want to continue to get a mammogram every couple years, even beyond age 75. But if you are in poor health, it may not be worth your time, energy and resources to find and treat a cancer that may not affect how long you live. It's important to remember that mammograms detect early cancer. They do not prevent cancer. But there are some things you can do to help lower your breast cancer risk:
  • Maintain a healthy weight.
  • Don't smoke.
  • Either avoid alcohol, or drink an average of no more than one alcoholic beverage per day.
  • Avoid binge drinking, even if the average amount of alcohol you drink is moderate.
  • Eat a diet rich in vegetables, especially the green leafy ones. They are rich in folic acid. Folic acid may offset any increased risk of breast cancer if you drink alcohol.
  • Stay physically active. Try to find time every day for dedicated exercise.
What Can I Expect Looking to the Future? Experts will continue to debate what we expect from breast cancer screening. They will weigh the physical and emotional effects of treating non-threatening cancers against the value of finding some cancers early enough to save women's lives. For the near future, we will continue to struggle with these difficult questions. Further in the future, advances in genetic testing will help a woman make a more informed personal decision about the benefits versus the harms of screening mammography.]]>
Mon, 24 Mar 2014 14:46:00 -0400
Guidelines Would Boost Statin Use by 13 Million Under new guidelines, statin drugs could be recommended for up to half of U.S. adults between 40... What Is the Doctor's Reaction? If you are a man who is older (say, age 60-75), even if you don't have heart disease, you should be taking a statin. I can make that statement and I will be right almost 9 times out of 10, according to a new analysis. This study looked at new cholesterol guidelines that were released in November by the American Heart Association (AHA) and American College of Cardiology (ACC). The analysis applied the guidelines to a group of typical Americans. The goal was to see whether a statin drug would be recommended to prevent heart disease and stroke. Information about 3,773 Americans came from National Health and Nutrition Examination Surveys. Researchers first determined whether a statin would be recommended for each person  based on old cholesterol guidelines. They were used from 2004 until this year. Then they applied the new guidelines. They found that the new guidelines would increase the number of Americans eligible for statin drug therapy by almost 13 million. Almost all of the increase was among adults who did not have heart disease, but were at risk to develop it.
  • Among men ages 60-75 who are not already on a statin, and who have no heart disease, 87.4% are now eligible to take a statin.
  • Among women age 60-75 who are not already on statin, and who have no heart disease, 53.6% are now eligible to take a statin.
  • Among men and women age 40-59, 29.7% are now eligible to take a statin.
If patients go along with the guidelines, all of these added statins may prevent as many as 475,000 heart attacks and stroke (fatal and non-fatal)  over 10 years. But is this enough to convince Americans to start a statin? Not in my experience. I am a primary care doctor. I have been talking with my patients about these new guidelines. I am offering statins to almost all of my patients who are eligible. But so far, most of my patients are not ready to make this change. "No thanks, Doc." "Not today." "Maybe in a year or two." My patients want to reduce their heart attack and stroke risk. They are willing to plan exercise, to take aspirin, to talk about diet changes. But taking a statin drug sounds too commercial for some. For others, it is too costly or too risky. When doctors decide that all Americans should get a vaccine to prevent disease, this seems reasonable. But when doctors decide so many Americans should take a daily drug, it feels different. I don't think my patients are being unreasonable to have doubts about the guideline. This guideline is an aggressive way to prevent heart disease. It won't feel right for everyone. What Changes Can I Make Now? Statins are an opportunity. But then again, life is full of opportunities. Some have trade-offs involved. In this case, statins can prevent heart disease, but they do have potential side effects and they do cost money. For some people, statins do not seem "natural" enough to be an appealing way to prevent disease. If you are interested, talk to your doctor about the new cholesterol guidelines. Previously, doctors used statins to lower LDL (sometimes called "bad cholesterol") to a target number. But the new guidelines change that. Unless your LDL is extremely low (less than 70), guidelines now advise doctors to recommend statins for anyone in these groups:
  1. People with a history of atherosclerosis (coronary artery disease, stroke or other artery disease)
  2. People ages 40-75 who have diabetes
  3. People with very high LDL cholesterol (at or above 190 milligrams per deciliter (mg/dL)
  4. People who have a 10-year risk of heart attack OR stroke that is more than 7.5% without a statin. The AHA and ACC have developed a risk calculator that is available online. The calculator takes into account your age, race, smoking history, cholesterol levels and whether or not you have diabetes or high blood pressure.
The new guidelines also recommend that most people take a high dose of a statin drug, Exceptions would be people who:
  • Are over age 75
  • Have liver, kidney or muscle disease
  • Have side effects from statins
  • Have a relatively small calculated risk for heart attack and stroke
Examples of high doses are atorvastatin (Lipitor) 40 to 80 milligrams, or rosuvastatin (Crestor) 20 to 40 milligrams. What Can I Expect Looking to the Future? Doctors are still adjusting to the new guidelines. Some experts think that the calculator is not accurate. They say it may overestimate the risk for heart attack and stroke. Some experts think it is better to start statins at a low dose. And some are asking, should the amount of time a person stays on a statin be limited to a fixed number of years, or is there an older age at which we should stop these drugs?  These questions will be debated during the next several years.]]>
Fri, 21 Mar 2014 13:47:00 -0400
Middle-Age Diabetes Tied to Memory Issues Having diabetes or high blood pressure in middle age may increase the risk of memory and thinking... What Is the Doctor's Reaction? Diabetes and high blood pressure (hypertension) can have a profound impact on your health.  Both conditions raise the risk of heart attack and stroke. Diabetes also can threaten your vision, damage nerves and cause kidney failure. High blood pressure can cause heart failure. It is also a cause of kidney disease. And these are just some of the most common problems. A new study links diabetes and high blood pressure with "mild cognitive impairment." This is a form of poor memory and impaired thinking. It often leads to dementia. The risk appears to be higher if diabetes and high blood pressure develop during middle age (ages 40 through 64) than if they develop later. The study enrolled more than 1,400 elderly adults (average age: 80). They had either normal brain function or mild cognitive impairment. Each person had an MRI scan. Researchers also reviewed their medical records to determine if and when they had been diagnosed with high blood pressure or diabetes. Here's what the study found:
  • Those who developed diabetes during middle age had smaller brains (by nearly 3%) than those without diabetes. The hippocampus, a part of the brain involved in memory, was 4% smaller in those with diabetes.
  • Problems with memory and thinking were twice as common in those who had developed diabetes during middle age.
  • Those who had developed high blood pressure during middle age also doubled their risk of brain damage (as seen on their MRI scans).
  • High blood pressure or diabetes diagnosed after age 65 seemed to have less of an impact on brain function or appearance.
These findings suggest that diabetes and high blood pressure may be even worse for brain health than we had recognized. And the impact can take decades to develop. Unfortunately, this study did not examine the impact of treatment or changes in lifestyle on the risk of brain disease. It's possible that dietary changes, exercise and medicines could make a difference. They might offset the risk of brain damage for people diagnosed with high blood pressure, diabetes or both during middle age. What Changes Can I Make Now? These findings provide new reasons to avoid diabetes and high blood pressure  if you are able.  You can make changes now that may reduce your risk:
  • Maintain a healthy weight.
  • Exercise regularly.
  • Drink only moderate amounts of alcohol.
  • Don't smoke.
  • Eat less salt, especially if you have "prehypertension." People with this condition have blood pressure readings of 120/80 to 139/89 millimeters of mercury (mmHg). These readings are slightly high, but not high enough to meet the definition of high blood pressure.
  • If you have prehypertension, take medicines to lower your blood pressure.
  • If you have mildly high blood sugar levels (pre-diabetes), take medicines to lower your blood sugar.
For some people, it is not possible to prevent diabetes or high blood pressure. This is especially true when there is a strong family history of these conditions. Once you are diagnosed with diabetes or high blood pressure, close monitoring and treatment are of vital importance. With regular visits, your health care professional can adjust your medicines, check for side effects, and detect and treat any related health problems that arise. What Can I Expect Looking to the Future? We are now in the midst of an epidemic of obesity. So it is likely that in the near future we will see more diabetes and high blood pressure. If the results of this new research are confirmed, we could also see even higher rates of dementia than are currently predicted. Even so, I hope that in the future we will have better ways to prevent high blood pressure and diabetes. We should also know more about how these conditions affect brain function and, more importantly, whether treatment can prevent later problems with thinking and memory.]]>
Thu, 20 Mar 2014 14:15:00 -0400
Study Questions Advice on Fats for Heart Health A new analysis of research finds no evidence that saturated fat increases the risk of heart... What Is the Doctor's Reaction? How are we supposed to figure out what to eat when the research and the advice keep changing? Well, confusion strikes again. Doctors have long said that a healthy diet should contain low levels of saturated fats and higher levels of polyunsaturated fats. Saturated fats have long been considered the "bad fats." In contrast, polyunsaturated fats are considered relatively "good fats." A healthy, well-balanced diet has long been considered to have low saturated fats, high polyunsaturated fats and plenty of fruits, vegetables, whole grains and protein. But research released this week suggests that diets that are high in saturated fats may not be as bad as we thought when it comes to risk of heart disease. It's a conclusion that conflicts with both  popular belief and medical guidelines. The researchers reviewed information from numerous studies that together included more than 650,000 people. They found, surprisingly, that there was no increased risk of heart disease for people who had diets high in saturated fat. There was also no particular benefit to diets high in polyunsaturated fats. The researchers concluded that the evidence does not clearly support the current guidelines, which encourage eating more polyunsaturated fat and less saturated fat. So what can you do if you want to eat a healthy diet? The advice certainly is confusing. What Changes Can I Make Now? The more conflicting data that come out about what we should eat, the more we should probably fall back on the old saying "everything in moderation." What exactly makes a healthy diet?
  1. Seek balance. More and more research tells us we should aim for balance in our diets. Not too much of one thing, and not too much of another.
  2. Eat real food. So much of what we eat is processed in some way. We need to spend more attention on eating real food, before anyone else has the chance to get their hands on it.
  3. Know your dietary restrictions and needs. It can be very challenging to know how to balance all the foods you should eat and those you should avoid. One doctor tells you to eat more fruits and vegetables to stay heart-healthy. Perhaps another doctor tells you to stay away from sugary foods because your diabetes is out of control. Before you can figure out what to eat, talk to your health care professionals. Find out what's important for you. What's right for you may well be different from what's right for the next person. It's important to get guidance on how to balance both the macronutrients (such as fats, carbohydrates, and protein) and micronutrients (vitamins, minerals etc.).
  4. Limit total calories. Whatever we are eating these days, one thing is clear -- most of us are eating too much. In this era of "supersize," it has become easy to consume far too many calories. Again remember, "everything in moderation."
Lastly, don't forget to live healthy. Maintaining a healthy diet is really important. But don't forget physical activity. If you smoke, quit. And get your medical conditions (such as diabetes, high cholesterol or high blood pressure) under control. Together, these lifestyle changes can help prevent disease. What Can I Expect Looking to the Future? Figuring out what to eat is one of the hardest things we do on a daily basis. Conflicting research can certainly add to the confusion. Just remember to eat a balanced diet and eat everything in moderation. I hope that in the years to come we will have more information on the components of a healthy diet. And I suspect we will actually find that there is no "one-size-fits-all" approach. Rather, it's likely that the unique needs of individuals will be the guide to understanding which diets are right for them.]]>
Wed, 19 Mar 2014 14:40:00 -0400
Colon Cancer Rates Drop in Older Adults Colon cancer rates have fallen 30% for Americans age 50 and older, the American Cancer Society... What Is the Doctor's Reaction? In 1950, colorectal cancer was the most common cause of U.S. cancer deaths. Today it is the third most common. Lung cancer is the No. 1 cause of cancer death for both sexes. For women, breast cancer is No. 2. And for men, it's prostate cancer. The decreased death rate from colorectal cancer has occurred along with a similar decline in the number of new cases diagnosed each year. During the period from 2001 to 2010, both new cases and colorectal cancer deaths decreased more than 30%. Even larger declines occurred in people ages 65 and older. The most likely reason for the dramatic decline is screening. Colonoscopy is considered the best method because it can detect small cancers before they grow and spread. It can help prevent cancer by finding polyps before they turn into cancers. Other things that potentially have influenced the fall in colorectal cancer include:
  • Dietary changes, such as Americans eating less meat and more fish and chicken. Some studies show a lower risk of colorectal cancer among people who eat less red and processed meat and more fish and poultry. However, this is not proof that meat causes colorectal cancer or that fish and poultry protect against it.
  • Widespread use of daily aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). These medicines appear to decrease risk of colorectal cancer in some people.
  • The continued decline in the number of smokers in the United States. Colorectal cancer has joined the list of many other cancers caused by tobacco use.
Despite the progress, the war on colorectal cancer is still in the early stages. An estimated 135,000 people will be diagnosed with colon cancer this year. About 50,000 will die from the disease. What Changes Can I Make Now? To help detect colon polyps and early stage cancers, get tested. Here are the choices:
  • Colonoscopy -- It's considered the best screening test. A doctor inspects the entire colon from inside, using a flexible tube with a light and camera at its tip. If a cancerous or precancerous tumor is seen, it can be removed. You will need someone to drive you to the test because you will get medicine to make you sleepy and more comfortable.
  • Sigmoidoscopy -- This is similar to a colonoscopy. However, only the last portion of the colon is inspected. You don't need anyone to drive you home.
  • Stool testing – It's the easiest test, but the least effective. A sample of stool is tested for tiny amounts of blood. You do this at home and send it in to the lab. Blood in the stool may indicate the presence of colon cancer.
Two other screening tests are available. However, they are not covered by Medicare and most other health insurance:
  • Virtual colonoscopy -- This is a special type of CT scan. It's less invasive than regular colonoscopy, but you still need the prep to clean the colon. If the scan finds a polyp, you will need a regular colonoscopy to have it removed.
  • DNA stool testing -- This is another easy test. Stool samples are sent to the laboratory to be analyzed.
Only colonoscopy helps prevent colorectal cancer. That's because the doctor can remove polyps that could become cancerous. But you can take other steps to help prevent colorectal cancer:
  • Stay physically active and dedicate time to exercise each day.
  • Don't smoke.
  • Use alcohol in moderation or not at all.
  • Maintain a healthy body weight.
Although it's not proven, some other steps may help reduce your colorectal cancer risk. Here's what else you can do:
  • Eat a diet rich in fruits and vegetables.
  • Limit intake of red and processed meats.
  • Get enough vitamin D through sunlight, diet, pills or all of these.
  • Choose whole-grain products that provide more fiber.
What Can I Expect Looking to the Future? Not everyone has access to colorectal cancer screening and treatment. Social factors or cost can stand in the way. If we could provide access to all adults over age 50 and younger people at higher than average risk, some experts predict that death from this disease could be cut in half by 2020.]]>
Tue, 18 Mar 2014 13:11:00 -0400
Study: Stroke Risk Up with Prehypertension Even slightly high blood pressure can increase the risk of stroke, a new review of evidence... What Is the Doctor's Reaction? Normal blood pressure used to be anything below a reading of 140/90. But during the last 15 years we have come to realize that "normal" does not mean "healthy." Blood pressure higher than 120/80 increases your risk of having something bad happen, compared with having a lower blood pressure. To address this, a new category was defined: prehypertension. Prehypertension is a blood pressure reading between 120/80 and 139/89. The definition of high blood pressure (hypertension) has not changed. It is still 140/90. The creation of a category called prehypertension has raised many eyebrows. Is it an actual disease? Have we now taken people who thought they were healthy and made them wonder if they had an illness? The numbers are huge. An estimated 25% of Americans have prehypertension. Let me be clear. Prehypertension is not a disease. But it does put you at a higher risk of developing heart disease and stroke than someone who has blood pressure readings below 120/80. In this new study, researchers used data from multiple, high-quality studies. They found that the stroke risk from prehypertension was even higher than previously reported. The study collected information about 760,000 people. This allowed the researchers to break down prehypertension into 2 categories:
  • Low-range prehypertension: Blood pressure between 120/80 and 129/84
  • High-range prehypertension: Blood pressure between 130/85 and 139/89
People with high-range prehypertension had a 95% higher stroke risk than people with blood pressures lower than 120/80. Even those in the low range had a 44% higher stroke risk. What Changes Can I Make Now? Perhaps we should get rid of the notion of normal blood pressure as a set of specific numbers. Instead, you need to consider whether your blood pressure is desirable for you. For example, if you have high cholesterol and smoke, you definitely want to have the lowest blood pressure you can achieve. There is no specific goal for how low your blood pressure should be. However, I am not suggesting that you start drugs to lower blood pressure if your reading is less than 140/90. Lifestyle changes are the way to go. First, if you smoke, quitting is the top priority. You hear it over and over, but diet and exercise do work.
  • Strive to maintain a healthy weight.
  • Make vegetables and fruits half of every meal. Potatoes don't count as a vegetable.
  • The other half of your plate should contain healthy protein and whole-grain carbohydrates.
  • Reduce salt intake. Use a little less salt every day. Soon you will enjoy food just as much as before.
  • Drink water instead of sugary beverages.
  • Stay physically active as much as you can all day.
  • Get at least 30 minutes of moderate-intensity exercise most days of the week.
These changes will lower your blood pressure. They also will almost surely lower your total cholesterol. Most importantly, these changes will reduce your risk of stroke, heart attack, heart failure, diabetes, kidney disease and some cancers. What Can I Expect Looking to the Future? This report and previous studies have shown a link between prehypertension and stroke. But that doesn't mean that the higher stroke risk was directly caused by somewhat higher blood pressure. Could other factors in people with prehypertension have even more influence on their stroke risk? Future studies will try to answer this question.]]>
Fri, 14 Mar 2014 14:17:00 -0400