Natural Sugars and Diabetes

Fruits have many different sugars, and can be quite high in calories. However, as many studies have suggested, natural and unprocessed sugars are healthier for us.

In a recent study, this was once again confirmed. Using a group of women who are at higher risk for diabetes during pregnancy (gestational diabetes) they found that those fed myo-inositol, a sugar found in many fruits, developed 30% less diabetes than a similar group of controls given a placebo.

Another reason to eat natural foods and stay away from artificial and processed sugars.

Robert L. Barbieri, MD Reviewing D'Anna R et al., Obstet Gynecol 2015 Aug 126:310

Tumeric for Arthritis

Recently our 12 year old Shih Tzu developed arthritis in one of his legs. He was given an anti-inflammatory (similar to Ibuprofen or Motrin) by his vet. This worked great but gave him an upset stomach and vomiting.

That was when our friend Ria suggested tumeric. I had never heard of these properties - but there was actually a good study last year that showed, in people, that it is equivalent in efficacy to ibuprofen! And it worked! Our dog is doing much better

In that study patients were given 1500 mg of the extract daily. This is not a huge amount - and probably corresponds to about 1/2-1 teaspoon of organic tumeric daily.

Clin Interv Aging. 2014 Mar 20;9:451-8. doi: 10.2147/CIA.S58535. eCollection 2014.

I don't know why this study has not had more publicity. I have many patients who cannot take ibuprofen and need something to help their joints.

New Cholesterol Drug - Caution Advised!

The FDA just approved a new drug for cholesterol, Praluent which is an inject-able medication which lowers LDL (or "bad" cholesterol) through a different mechanism than other drugs.

However, there are no studies yet that show that this drug can lower the risk of heart disease, even though it decreases the cholesterol. In the past, other medications that had similar effects, such as Zetia, did not stop arteriosclerosis and therefore are ineffective.

Lipitor and other "statins" have been clearly shown to lower the risk of heart attacks in at risk patients. Many physicians believe that they do this through an anti-inflammatory effect and that the lowering of cholesterol is essentially a side effect. It this is true we might expect Praluent not to help.

You may see a media blitz as Sanofi-Aventis tries to convince everyone that this is the best option! It has only been tested in about 2500 patients; far too small a population to discover serious adverse effects.

I would use Praluent only as a last ditch medication in patients with known high risk factors who cannot take any statins and may be unable to change their lifestyle habits sufficiently. And with no promises of success!

Are Obese Patients Wasting Their Time dieting?

Anyone who is significantly overweight knows that it can be difficult or impossible to lose the weight and maintain the loss.

Unfortunately, a recent 10 year study confirms this. In the UK, researchers studied over 175,000 obese adults who had at least three BMI ( a more accurate way of determining obesity) measurements over a 10-year period.

For participants with simple obesity (BMI, 30.0–34.9) at baseline, the annual likelihood of attaining normal weight during follow-up was 1 in 210 for men and 1 in 124 for women. Among those who were initially morbidly obese (BMI, 40.0–44.9), the annual likelihood was just 1 in 1290 for men and 1 in 677 for women.

This is less than 1% for moderately obese individuals (about 40 pounds overweight) and close to .1% for those about 75 pounds or more overweight.

http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2015.302773

We are all failing on this epidemic and need to find new ways to approach it.

I always used to tell my patients that obesity is probably an evolutionary advantage in the days when food was scarce. Those who could maintain a low metabolic rate and store food more efficiently lived longer. Who knows?

Even if you don't lose weight, your health will be much much better on a proper diet and exercise regimen, and avoiding fast and sugary (and diet) foods.

Ultrasounds and antibiotics - Use Only When Needed!

As modern medicine advances, we often marvel at the technological and pharmaceutical wonders. While they seem miraculous, we must only use these when indicated and generally shown to be useful!

A good example is ultrasound in pregnancy. This can be used to diagnose many fetal abnormalities, as well as growth issues (aside from sex of the baby, twins, and position). However all this can be achieved with two regular ultrasounds during pregnancy.

Many women routinely get an ultrasound at every visit, and often have an incredible 3-D ultrasound which can show features clearly. But this may not be without its dangers!

Most safety studies were performed on equipment made before 1992. Today's equipment emits much stronger acoustic waves than older versions. In addition, animal studies have suggested ill effects from ultrasound exposure, such as neurologic abnormalities and hyperactive behavior. And there's always the concern that too many ultrasounds can lead to false-positives.

Get your one or two ultrasounds. That's enough!

http://www.wsj.com/articles/pregnant-women-get-more-ultrasounds-without-clear-medical-need-1437141219

And again more news about antibiotics. In the past we used to give children antibiotics quite freely. Now we are seeing evidence that this can change the normal bacteria that grow in their intestines and have deleterious long term effects.

In a study in the UK researchers looked at 152 children with Juvenile Rheumatoid Arthritis, and compared them with 1520 without. The arthritis children were twice as likely to have received antibiotics, with an even higher correlation of having received these in the past year! As well another study has shown that certain cases of Ulcerative Colitis respond to "fecal transplants" which change the bacteria in the colon.

http://pediatrics.aappublications.org/content/early/2015/07/15/peds.2015-0036

Again, treat only when necessary, not when convenient!

Kale Scare Tactics!!

Recently there has been some talk on the Internet (must be true) that Kale is unhealthy and causes buildups of dangerous heavy metals.

http://www.delish.com/food/a43162/kale-poison-thallium/

But is this true? Actually, there is NO evidence that Kale is unhealthy, and as usual, these scare articles are full of mis-quotes and exaggerations.

Here are some rebuttals:

http://m.snopes.com/kale-not-safe/

In a study dating back to 2001, watercress, radish, turnip and green cabbage were found to be the worst culprits in absorbing thallium form the soil.

http://www.kiwiscience.com/JournalArticles/JPlantNutrition2001.pdf

Like anything else, overindulging is probably not good for you; but moderation, as usual, is the way to go!

Delayed Umbilical Cord Clamping

There have been a lot of proponents for delayed umbilical cord clamping after childbirth. In theory this will allow more of the baby's blood to return from the placenta into their body. It would seem that this could only help oxygenation.

However, we should always be careful in coming to conclusions not based on science, as sometimes the intuitive result can be false.

In a recent study researchers studied some 250 children who had been randomized to delayed cord clamping (at least 3 minutes after delivery) or early clamping (no more than 10 seconds) at birth. At roughly 4 years of age, children underwent tests measuring IQ and fine motor skills, and their parents reported on their behavior and social development.

Although there was no difference in IQ, they found that, in boys only, some measures of fine motor skills (e.g., drawing within a bicycle trail) and personal-social skills were significantly better in the delayed-clamping group. Boys are known to have a higher incidence of iron deficiency as infants, and this could be a reason.

But as important, there were no adverse effects; so there is no reason to discourage this in parents who prefer it.

JAMA Pediatr. 2015;169(7):631-638. doi:10.1001/jamapediatrics.2015.0358.

Refined Sugars, Diet and Autism

There is a lot of discussion about refined sugars, and other rapidly absorbed sweets such as corn syrup being unhealthy. They rae associated with increased risk of diabetes.

The glycemic index of a food refers to how fast the sugars in the food get absorbed. Refined sugars get absorbed very rapidly; while most naturally occurring sweeteners are found in foods that have more fiber, and so have a lower glycemic index and are associated with a slower rise in blood sugar. I believe these are much healthier.

Researchers have found that higher levels of inflammatory factors, such as CRP in mothers are associated with autism. Since high glycemic foods can cause elevations of CRP, they looked at  mice that have been bred to simulate autism in humans. They found that a higher glycemic diet was associated with increased activation of autism genes and behavior.

Perhaps this is one of the reasons for the increasing incidence of ASD (Autism Spectrum Disorder). As more mothers adopt organic diets with less highly processed foods maybe we will see a change!

Barbara Geller, MD Reviewing Currais A et al., Mol Psychiatry 2015 Jun 9

Does Breastfeeding help Prevent Leukemia

A recent study looking at almost 30,000 children showed that breast feeding resulted in an 11-19% decreased incidence of childhood leukemia.

The authors speculate that antibodies, lactoferrin, oligosaccharides, or stem cells present in breast milk could contribute to a protective effect, as could the pH in the stomachs of breast-fed infants.

Even children who had been briefly breast fed had a significantly lower incidence. Nature knows bets!

JAMA Pediatr. 2015;169(6):e151025. doi:10.1001/jamapediatrics.2015.1025

Using your immune system to fight cancer

There have been some recent rather dramatic advances in the treatment of cancer, mostly using targeted immunotherapy.

Checkpoint Inhibition
Cancer cells are immunologically different than our regular cells, and should provoke an immune response. Scientists have discovered that the immune system is actually activated, but the body produces checkpoint proteins that inhibit the response. By using pharmaceuticals that inhibit these proteins researchers have actually induced remissions in stage 4 cancers, such as melanoma, lung, kidney and colon cancers!

Adaptive Cell Transfer
Even under normal circumstances, the body often wages a feeble fight against cancer. Scientists have developed ways to extract these killer cells, grow them in culture, enhance them and re-infuse them with often dramatic success.

Creating Un-natural attackers
Using viruses that have been modified to look like tumor cells, scientists have managed to induce an immune response against the tumor. This has especially been effective in recurrent childhood leukemias.

These techniques are still somewhat in their infancy, and have had limited success against some of the major cancers, such as breast. As well, there is occasional some breakthrough mutation in the cancer. However, when they do work they can treat previously fatal stage 4 cancers! Steps in the right direction!

Unscrupulous Profits in Medicine

Less scrupulous Physicians and Entrepreneurs have always found ways to make money in the system without providing the care needed.

When Medicare was first approved, many doctors (especially in Miami) opened clinics where they would have patients come in for no real reason, and then bill for a visit even if they did not see a doctor. I once met a physician who was "proud" to tell me he was generating over a million dollars in revenue working only 3 days a week!

Currently many physicians move from helping patients, to opening pain clinics, weight loss, or cosmetic centers.

Now, entrepreneurs have found a way to warp a good rule in the ACA into medically useless profit centers.

As reported in the New York Times:

The Affordable Care Act requires insurers to pay for obesity screening and, for some patients, counseling. This provision, according to the Times, has "created a financial opportunity for a corner of the diet industry that has often operated on the fringe of the medical establishment: for-profit diet clinics overseen by doctors."

Physician oversight at many of these clinics, the Times contends, simply means reviewing patient charts remotely, while assistants without much training do most of the counseling. In addition, unproven — and even dis-proven — weight-loss methods are often used. For example, a Long Island weight-loss clinic advertises vitamin injections to increase metabolism. The physician at the clinic's helm "acknowledged that the treatments are not scientifically proven, but he said they do not hurt, and patients have come to expect them as an option," the Times reports.

In a separate report, the Times also reports the continues use of an amphetamine like drug, phentermine (which in my opinion should be off the market) for weight loss; in spite of its effects not being long lasting and many dangers.

The political climate, probably influenced by money, has not allowed proper oversight if these abuses. It is a sorry state.

Clinics

Phentermine

From the New York Times article: Dr. Michael Kaplan with a patient at the Long Island Weight Loss Institute in Smithtown, N.Y., which sells meal replacements and supplements. Kevin Hagen for The New York Times