• Jan17

    JAMA has a section called “100 years ago” in which the Journal of the American Medical Association (JAMA) quotes a column from its archives, verbatim.

    Last week, it was

    January 13, 1912

    WATER-DRINKING WITH MEALS

     ”…While the ingestion of moderate quantities of water with meals may be harmless in persons with good gastric motility, since the excess of water is rapidly expelled into the intestine, it is likely to be harmful in persons whose motor power is below par: and it is probable that there are many such who do not consider themselves ill enough to consult a physician.

    Furthermore, nothing that has been said is intended to lend any support in the American custom of drinking water that is ice-cold…”

    I do think we’ve made progress since them. There’s Vitamin Water, Noah’s Spring Water (pH 8.4, sparkling and delicious), cold water to help you use lose weight, and water to hydrate athletes.

    But it just goes to show: doctors, in all our wisdom, come to conclusions slowly. And that’s what most of us get paid for: slow conclusions and caution.

    I get paid for something different: trusting patients own experiences with medication, supplements, food and beverage; and their own observations of what works (and doesn’t work) for them.

    Informed by the best modern science, and that’s what it is, people can actually lower cholesterol, triglycerides, blood pressure, blood sugar, weight, obesity, overweight; eat an optimally anti-aging diet and the best foods, beverages and dietary supplements and minimize interactions between them;  and wipe out back pain, allergies and much more.

     
  • Jan11

    Treadmills and elliptical trainers are some of the best aerobic exercisers available for weight loss 2012, and Consumer Reports picked its top models this month (reviews to come).

    But if you already have a treadmill or an elliptical, or want to start more simply, select a pedometer (around $30) or a GPS watch (around $200) or both.

    Consumer Reports rates equipment as follows:

    Top 3 pedometers: Mio Trace Acc-Tek, the new Omron GOsmart Pocket HJ-112 (or get the tried and true Omron HJ-112) and the Yamax Digi-Walker CW-701.

    (I especially like both Omrons)

    Top 3 GPS watches: Nike+ SportWatch GPS, the Garmin Forerunner 210 and the Timex Ironman Global Trainer GPS Speed + Distance T5K267F5.

    (I especially like the Garmin)

    These are less expensive than a treadmill: I tell my patients to get 3 pedometers, because inevitably one is lost, and one is always somewhere you meant to put it on, but forgot. They’re invaluable, especially when you’re trying to get to 10,000 steps!

     
  • Dec13

    I got my annual increase in health insurance premium last month with no increase in coverage. “Starting with your January invoice…(we will bill you) an increase of $38 or a 14 percent increase from your previous monthly rate.”

    Ouch. So I started shopping for alternatives.  I have no health problems except a chronic battle to avoid overweight, work at being fit, and try to practice the lifestyle I preach.  Luckily, I haven’t had to use my health insurance in 20 years.

    I found another, similar plan from the same large national health insurance company. The new plan provides comprehensive coverage and is nearly identical, for $68 less than the new rate.

    I thought: $800+ saved annually is certainly worth the hassle of a re-application and documentation of any and all health concerns encounters I could remember. I assumed the health insurance company wouldn’t or couldn’t transfer my data from one of its plans to another of its plans (though it would lower healthcare spending).

    So I re-applied online, and got a call from MaryAnn RN.  She informed me that I could continue with the application if and only if I had a physical examination, lipid and diabetes tests, height, weight, blood pressure and a documented past medical history.

    Why? Not because I was sick.  But because I was not sick.  “It’s because nobody has eyeballed you in the past two years”, MaryAnn explained.  I actually had seen an optometrist…but “they don’t count”,  she said. “Besides, even healthy people can get sick.”

    Indeed they can: acute illness does often arise unannounced, though chronic diseases often suggest themselves well before you get one.

    Interestingly, the U.S. Preventive Services Task Force recommendations suggest a lipid test every five years and a diabetes test every three years, not every two years, as now required by the insurer.

    Hmmm. An insurer leveraging its offer of insurance outside of professional guidelines for clinical testing? Unheard of.

    Yet there it is: the insurance company penalty for being healthy. Healthcare spending wastefulness 101.

    My triumph of being healthy enough to avoid having to see a clinician for 24 months is not rewarded by the disease treatment system that is most health care today.

    Our disease treatment system values medical and surgical intervention.  It doesn’t value eating well, exercising, avoiding tobacco, sensible drinking, managing stress and getting enough sleep: behaviors that aim to prevent disease and actually do.

    MaryAnn suggested walking-in to a walk-in clinic.  I’ve long supported these clinics: I like the idea of democratizing care for those who cannot afford it. Nurse practitioners do a great job of staffing these centers, which could also teach nutrition and give out my ChefMD recipes: many Walgreen’s still do, after I co-hosted Health Corner TV.

    I haven’t decided whether to walk-in yet: a visit to a clinic will cost $100 and half a day (the nearest one is over an hour away). If my exam and lab work are acceptable and if the insurer doesn’t raise rates mid-year, not accounting for the time off work, I could still save money. So, I’m thinking about it.

    But what really ticks me off is the stupidity.

    *I could have been seen for a blemish within the past two years by a physician assistant, been told that it was a blemish, and qualified for the cheaper, nearly identical health care plan, without any of these crazy new requirements.*

    The insurer’s algorithms of  “insured person eyeballed” apparently don’t care who does the eyeballing or what they eyeball.  Any clinician (except an optometrist, I guess) will do.

    I know I’m lucky.  I haven’t fallen off a ladder or driven a nail through my hand at my urban mini-orchard, or ballooned 75# up despite being embraced by treats, great cooks and frequent travel, or developed a bump, rash, bleed or bruise that wouldn’t go away.  And I work at staying healthy.

    Too much, according to the health insurer. Never mind that helping people take control of their own health with what they eat and how they live is what matters most!

    The insurance system in America penalizes the healthy if they want to have even catastrophic insurance…just like it penalizes those with chronic disease and pre-existing conditions, who want to have any insurance.

    If you want to stay healthy, and see the doctor only when you choose, you might just have to choose a DIY health care plan, or be subjected to tests that you might not really want or might be  unnecessary.  In my opinion, that’s no way to care for people.

    Now I’d like to hear from you.

    Have you tried to stay healthy enough to avoid having to see the doctor?

    Has your health insurance company worked with you, or against you?

    What strategies have you tried to get the health insurance you want to have?

     
  • Dec8

    Our ABC station (KEYT, and former CNN editor Shirin Rafaee) asked me about Dr Oz’ 4 Secret Reasons Women Are Exhausted (previously, we spoke about belly fat)(footage to come). Here they are:

    1. Carb Coma: a catchy way to sum up the sharp drop in blood sugar and shunting of blood to your stomach (not to your brain!) when you have a breakfast of pastry, or just high sugar fruit.  To gain energy, Oz reminds us to eat oatmeal and one fruitStress Free Quiz, not two, and to eat a hardboiled egg before leaving the house, and add vegetables to keep feeling full.

    This is good advice, generally. Too many of us just have cereal or nothing for breakfast, and skip the protein. I’d add nuts and avocado, and make the oats steel-cut. I like my patients to aim for 30% of their daily calories at breakfast, and 60% by 2 pm.

    2. Hormone Hell: Oz tests for high levels of cortisol and low levels of testosterone, which is suppressed by too high cortisol. Cortisol keeps spiking during the day in stressed and exhausted people, instead of its normal pattern; women need (and make) testosterone too.

    In men, I think that testosterone actually is the weight loss hormone (even more than leptin), and knowing that, women can make a huge difference for men who need to lose weight.

    In women, it depends on age:  women over 65 who have insulin resistance and metabolic syndrome often have high (not low) testosterone levels. In other women, testosterone gradually declines. One (unaccepted) theory is that their adrenal glands can’t keep up with chronic fight-or-flight arousal of chronic stress, and don’t produce enough of the hormones needed, including testosterone.

    To help, Oz suggests getting 8 hours of sleep and 18 minutes of exercise daily, a balanced diet, and taking supplements, including Tongkat Ali (a Malaysian herb, now a protected species from overharvesting, made into a tea which improves sexual performance in male rats and mice), also available as a powder and an extract.  Claims about Tongkat Ali are sensational: I could find no studies of effectiveness in women, and only one in men (for infertility).

    3. OTC Pain Meds can cause sleepiness.  Yes, they can–between 3 and 9% of people taking naproxen, for example, report just that. Oz suggests taking them just once weekly, and trying peppermint oil compresses instead.  I think less reliance on medication is a good thing.

    4. Don’t sleep with your pets.  I think this is good advice: Oz notes that if a pet is restless at bedtime, they might need more exercise during the day, and might be keeping you up at night. Oz suggests giving a pet her own bed, and making the transition if you’ve slept (or tossed and turned) that way for years.

     
  • Nov16

    Last week’s WSJ story called “When Everyday Foods Are Hard to Digest” describes the Specific Low Carb Diet, also known as the low-FODMAPS diet (described below), for irritable bowel syndrome (IBS). In IBS – Free at Last, dietitian Patsy Catsos describes the diet and its treatment.

    It’s very clear that for some conditions, food works as well as prescription medicine, and in some cases, better.  For many people with IBS (and for everyone with Celiac disease…do you have it?) it’s the difference between feeling well and feeling sick.

    FODMAPs are:

    1. Fermentable
    2. Oligosaccharides (eg. Fructans and Galactans)
    3. Disaccharides (eg. Lactose), Monosaccharides (eg. excess Fructose) and
    4. Polyols (eg. Sorbitol, Mannitol, Maltitol, Xylitol and Isomalt)

    Some people who make the change find that their IBS diarrhea stops within 7-days…for the first time in years.

    Eliminating most complex carbohydrates from grains, starches, and table sugar can reduce symptoms dramatically: only monosaccarides (simple sugars) are easily digested. In Recipes for the Specific Carbohydrate Diet, Raman Prasad makes it delicious.

    If you’re not sure whether food makes a difference to your condition, try an elimination diet. This is best done with a physician who can look for drug-food intersactions, and make sure it’s safe to do, and perhaps determine whether you have vitamin, protein or other deficiencies.

    But the basics are simple: first, rate your symptoms on a scale of 1-10. Write them down, with their scores, and put the paper in a drawer.  Then, eat nothing but innocuous foods for a month. Rate the same symptoms after a month.

    Then, try add a few foods back, one at a time weekly, while listening carefully to your body and re-taking your symptom quiz.

    Many people with IBS have trouble absorbing certain carbohydrates in their small intestines. Large molecules of those foods travel to the colon, where they are attacked by bacteria and ferment, creating gas, bloating, constipation or diarrhea.