Paging Dr La Puma

Aug19

When Omega-3s? After Bypass, During Fatty Liver, Before Eye Disease

Posted in: Aging and Costs of Aging, High Cholesterol, Uncategorized, Wellness and Health

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.

2 Comments
Aug9

Do Statins Raise Diabetes Risk?

Posted in: Aging and Costs of Aging, Diabetes, High Cholesterol, Vitamins and Supplements, Wellness and Health
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.

2 Comments
Aug2

Response to Bittman’s “Tax Bad Foods”

Posted in: Aging and Costs of Aging, Diabetes, Food FAQ's, High Cholesterol, Obesity and Weight Loss, Wellness and Health

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.

2 Comments
Jun22

Diet Smart Not Hard…And Check Your Sex

Posted in: Aging and Costs of Aging, Common Conditions, Diabetes, High Cholesterol, Hypertension, Obesity and Weight Loss, Stroke, Wellness and Health

Dr Oz says “break it down and make it simple”. Dr. Roizen says “diet smart, not hard: small changes make a big difference.” They recommend in their new YOU: Losing Weight

* Recruit your team. You need someone to cheer for you and take the fries from you.
* Plan Your Plate.
* Take a You-Turn. We all make mistakes: take an authorized U-turn and turn things around.
* Keep moving! Walk just 30 minutes a day.

They’re right, especially for women who want to lose weight.

But for men and women, there’s something to add to this advice, which I also give often to my own patients.

It taps into something we all care about: sex, sex drive, performance and looks. Not to mention hormones.

I’m for it. Whatever my patients care about most will help them make the changes that are best for their energy level, heart, liver, kidneys and their family.

Here is a clip I’ve shown at recent talks: it’s a little risque, but it’s national TV.

When I show it to audiences, I ask people if they think it is frivolous, unprofessional, meaningful or important.

I also ask whether it changes their view of belly fat. Does it for you?

1 Comment
Jun15

Losing Weight Knocks Down Knee Pain…But How?

Posted in: Aging and Costs of Aging, Arthritis, Obesity and Weight Loss, Uncategorized, Vitamins and Supplements, Wellness and Health

If the US had the obesity rate it had in 2000 (not 2009), we might prevent 111,206 total knee replacements.

If you have arthritis, you are twice as likely to be obese than if you don’t. About 50 million adults (22% of the US population) has arthritis—principally osteoarthritis, or wear and tear arthritis. Joint pain is the most common symptom.

2000 median obesity among adults with arthritis: 33.2% (range 25.1% in Colorado to 40.1% in Ohio).
2009 median obesity among adults with arthritis: 35.2% (range 26.9% in Colorado to 43.5% in Louisiana).

Why do arthritic knees hurt? Is it because the knee bears 4# of stress for every pound of body weight? Is it inflammatory cytokines and adipokines that degrade cartilage? Is it something else?

I’ve long been interested in improving quality of life in arthritis. A RC trial of omega-3s helped arthritic and neck pain; extra virgin olive oil has ibuprofen-like activity.

Medical costs are estimated at $147 billion for obesity and $128 billion for arthritis each year, but the real, human cost which cannot be quantified is much greater.

A systematic, careful, personal approach which looks at drugs and side effects, as well as diet and lifestyle, is what I recommend for my own patients.

2 Comments