• Sep13

    Dr. Oz debuted his 5 Step Plan for Women Over 40 Who Need to Lose Belly Fat last night, and I spoke with Shirin Rafaee of KEYT, our ABC affiliate, about it.  No surprise here: women’s needs are different from men’s weight loss needs.

    Belly fat in men and women poisons your liver, blocks muscle from using sugar, and squeezes on your kidneys.

    And the perimenopausal loss of testosterone, thyroid hormone and melatonin make it harder for women to build muscle, burn calories and sleep well.

    His 5 step plan:

    1. Eat dinner for breakfast (i.e., eat more calories in the morning than late at night):

    The usual pattern is runway eating: start off with a small meal, and eat all your calories at the end of the day.

    2. Have a glass of red wine daily (i.e., the resveratrol may interfere with fat synthesis, and other red wine polyphenols may inhibit aromatase, an enzyme made by belly fat that converts androgens to estrogens).

    Men typically add alcohol to what they eat, whereas women are more likely to substitute alcohol for food.

    3. Get 25 grams of mixed fiber daily: psyllium husk, oranges, bananas, Kashi cereals.

    Men need 38 grams per day. Both men and women need a lot of water to hydrate that fiber, so it’s not concrete.

    4. Use a belly band (aka tape measure) to get your waist under 32″: inexpensive on ebay.

    For men, the optimal number is 37″.

    5. Confuse your muscles (aka mix it up: Tuesdays for arms and Fridays for legs dumbbells; a few weeks later, use kettle bells or resistance bands; a few weeks later, pilates)

    In women, the loss of estrogen is the main reason it’s hard to lose belly fat after 40: plus, your metabolism winds down 5% every 10 years, unless you work at it.

    But with a systematic, structured program, belly fat can be belly flat.

     
  • Aug19

    Omega-3 fatty acids are powerful: with vitamin D, they’re something that almost everyone needs to supplement, no matter how good your diet.

    Why?

    Because people with heart disease who just had a coronary artery bypass graft (CABG) had a 49% lower risk for dying 30 days after their CABG than those who didn’t take 882mg of EPA and DHA (in a 1:2 ratio) after their surgery.

    That means extra DHA, and pure DHA is hard to find. Look for Thorne DHA and Thorne Super EPA Pro: molecularly distilled, no contaminants, pure, concentrated and as above and below, powerful.  To read more or to purchase, click “My Account” in the top right; and then enter the access code HCP1028244 to create a “Personal Account”.

    Because kids with fatty liver disease (the most common liver disease in kids, and pretty soon, adults) had a 99% lower chance of severe fatty liver if they took 250 mg/day of DHA than those who did not…and improved insulin sensitivity.

    And because omega-3s, especially DHA, can protect your eyesight and prevent AMD, the leading cause of blindness in people over 55 by protecting the nerves in your eyes and reducing inflammation..

    DHA is responsible for most of the heart-healthy benefits of fish oil, and gets transformed into EPA if you are short of EPA. Check with your doc before taking extra EPA: it can interact with other drugs.

     
  • Aug9

    Probably, in higher doses.

    A study of 18000 people without heart disease, called JUPITER, shows that Crestor (rosuvastatin) 20 mg showed that for every 1000 patients on high dose (40mg and up) statins, there are 6 more cases of new diabetes over 2 years.

    Crestor also prevented 11 cases of heart attack, stroke, arterial revascularization, hospitalization or death from heart disease, in that 1000 patients.

    The newest study includes 32,752 patients without heart disease.  Again, 2 cases of diabetes, versus 6 or more cardiac events prevented in a 1000 people over 5 years.

    If you actually have heart disease or angina, then the numbers for taking a statin are different.

    • 1 in 83 life saved
    • 1 in 39 prevented a non-fatal heart attack
    • 1 in 125 prevented stroke
    • 1 in 167 developed diabetes

    Is that worth the trade-off?

    I try to find ways for my own patients to get off high doses of statins, especially 80mg doses, because of myopathy and pain.

    A cholesterol registry can chronicle how people control cholesterol naturally.

    I suggest that any patient 40 and over get screened every 3 years, and make sure they don’t suffer from abnormal lab test syndrome.  And I help them make lifestyle changes that help them reduce their need for cholesterol medication.

    Statins can be important medications, and their benefits can be greater in diabetics than nondiabetics.

    But there’s no sense in tempting fate. Let’s enjoy life, and avoid getting diabetes in the first place. Lower your cholesterol with what you eat.

     
  • Aug2

    As a physician and professionally trained chef, I write recipes on prescription slips. I try to practice what Mark Bittman of the New York Times eloquently preaches in Tax Soda, Subsidize Vegetables.

    Yet a healthy diet is like penicillin–simple, powerful, and with increasing rates of resistance, from physicians.

    Physicians are not trained to speak with patients about diet and nutrition, much less cooking and food shopping.

    Physicians are also better paid to prescribe medication and do procedures than to ask patients to switch from soda to water.

    Writing recipes on prescription slips changes this dynamic.

    Putting foods, recipes and meals in pharmacies and on managed care and hospital formularies might help patients get the food and health care they need, economically.

    Healthy hospital food, like that at Planetree’s New Milford Hospital is a good start.

     
  • Jul12

    Recently I’ve seen several patients with terrible looking numbers: 260 LDL cholesterol, 35 HDL cholesterol, 375 triglycerides, 180/85 blood pressures, 222 blood sugars, 9% glycohemoglobin.

    The standard treatment for such numbers is clear: prescribe the right medicine in the right amount, and recheck in a few days or weeks.

    People with metabolic syndrome are up to 2.5 times more likely to die of heart-related causes and to have heart disease, a heart attack or stroke, compared to people without the syndrome.

    But these data don’t move people to action, even though they have Abnormal Lab Test Syndrome. I think it’s because they don’t know how good they can feel…and they usually feel ok.

    In my office, having one or two numbers as goal posts is very helpful for people who like to measure.  It gives us something to shoot for.  I usually gather my own numbers too: pedometer counts, body fat percentage, waist:hip ratio ( your waist should be half your height, as well).

    But people come to see me for a healthy direction and, usually, nonpharmaceutical approaches to their problems.  So writing recipes and exercises on prescription slips, recommending websites and books, and culling useless supplements are part of my job.

    The real challenge, now especially seen in companies that aim to create a culture of wellness, is how to motivate people to create real lifestyle change.

    For me, the key is finding out what people love to do–dance, build kites, plant trees, read–and then driving their individual program so that they have more energy for what they love, not less of a number they don’t.

    Getting to know patients as people instead of numbers is its own reward–and usually rewarded with less body fat, lower blood pressure and blood sugar, and less prescription medication.