• 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.

     
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  • May31

    Food Lowers Cholesterol: New Studies

    Posted in: Aging and Costs of Aging, Food FAQ's, High Cholesterol, Vitamins and Supplements, Wellness and Health

    Wayward cholesterol levels are some of the easiest labs to treat with the right foods: I help my patients do it here in the office, have taped ChefMD videoblogs and spoken with journalists about it.

    And the research continues to mount.

    Last week, an Australian meta-analysis of 14 studies showed that, on average, the equivalent of 5 ounces of tomato sauce (25 milligrams of lycopene) or 2.5 ounces of tomato paste (ditto) lowered LDL cholesterol as much as small doses of statins–about 10%.

    Lycopene from tomatoes is 4x better absorbed if the tomatoes are cooked, and eaten with a drop of luscious oil, btw. Thus, sauce and paste.

    Two other studies which Katherine Hobson highlighted last week in the Wall Street Journal suggest that medication for this purpose, well, may not be all it is cracked up to be.

    One found that extended release niacin (Niaspan, a form of vitamin B3, available only by Rx for raising HDL) didn’t protect against heart attacks when added to statins.

    The other found that a fibrate called Tricor, also by Rx, didn’t prevent heart attacks and strokes, also when added to a statin.

    These are, individually, multi-billion dollar drugs.

    Studies like these make me think there should be a cholesterol registry– a place where the best natural approaches to lowering cholesterol can shine.

     
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  • May7

    What Can I Eat to Heal and Recover from Surgery?

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

    Last year, my Mom had her first operation: a total knee replacement.

    Active and curious, and having recently celebrated her 29th birthday again, her mother was turning 100 shortly and needed assistance.  Mom wasn’t able to get around well enough to help, with her osteoarthritis and pain.

    A month before the operation she asked me, “What can I eat to heal and recover from the surgery?”

    It turns out that there’s a good answer to this. It can be divided into wound healing, building bone, rebuilding muscle and guarding against weight gain.

    A blog is too short to cover each category in depth, but fortunately, there is a largely untapped literature about nutrition and post-operative care.

    The key: wounds heal from the inside out. Many patients need additional arginine and vitamin C, just to name two nutrients, pre-operatively and post operatively.  Lowering oxidative stress improves healing.  The peri-operative period is the most critical.

    Building bone is a function of vitamin D, calcium and magnesium, and the right hormones.  Smoking prevents bone from being built. And food can facilitate it.

    Rebuilding muscle is something that has nutrition, and dietary protein, at the center. I often encourage my patients to have a little protein-rich food at every meal, especially breakfast.  Omega-3 fatty acids, especially DHA (almost solely from fish and from algae, which is where fish get their DHA) improve muscle building post-op.  My Mom took them.

    Recent data have shown that total knee patients gain an average of 14 pounds post-op, and it’s not all muscle.  Gaining that much weight post-op delays recovery and increases instability.

    Post-op patients need satisfying, lower calorie recipes written on prescription slips: high calorie, high sugar foods that are highly processed should never appear, and would never be reimbursed.  But strategic nutrition can improve strength, healing, flexibility and stamina. And should.

    Although my grandmother passed away just after reaching 100,  my Mom has recently returned from Hawaii, Carmel, New York City and points unknown, without a cane or a pain pill, nearly as good as new.  In fact, better.

     
    1 Comment

  • Nov30

    Expert Report: Vitamin D/Calcium: The Right Stuff?

    Posted in: Aging and Costs of Aging, Vitamins and Supplements, Wellness and Health

    The IOM expert report on Vitamin D and Calcium suggests two changes: increasing your vitamin D intake from 200IU (under age 50) to 600IU daily, or 800IU if you are 71 or older; and not supplementing with calcium.

    The new safe daily upper limit of vitamin D is 4000IU; for calcium it’s 2000mg, which increases kidney stone risk.

    The IOM believes this much of each is best for bone health. Much of the public and many physicians believe that vitamin D is needed for more than that. People love supplements– and almost half of U.S. adults take them.

    Especially in Winter, especially for dark-skinned Americans, vitamin D helps the body’s own immune system fight flu virus and improve multiple sclerosis.

    I recommend few supplements, because high quality meals can contain everything you need. But pregnant and nursing women, newborns and the elderly on restricted diets need specific supplements.

    Few foods, except wild salmon, mackerel, herring and caviar(!) have much vitamin D; the dairy adds vitamin D to milk, just enough to prevent rickets.

    The smartest and safest approach is to have your 25-hydroxyvitamin D level measured. Your doctor can order it, or you can with this vitamin D kit. The test uses radioimmunoassay, the most accurate testing available.

    The IOM thinks your level should be 20ng/ml; many vitamin D experts think it should be 30ng/ml; an independent group of vitamin D researchers (not vitamin sellers) thinks 40ng/ml. Ask your MD.

    And check out a new national federally funded Vitamin D/Omega-3 study testing 2000IU daily, for optimal health.

     
    2 Comments

  • Oct8

    Two Ways to Improve Your Flu Immunity: D3 and Vaccines

    Posted in: Aging and Costs of Aging, Drug Food Safety, Vitamins and Supplements, Wellness and Health

    Earlier this month, I got a flu shot. I also took 2000IU of vitamin D3.  Some people see this as redundant.  Not me.

    The recent news that pregnant women who get flu shots protect their fetuses and themselves meshes perfectly with the recent news that vitamin D3 is more of a (helpful) steroid hormone than a vitamin. Too little vitamin D means more fatal infections.

    Almost two thirds of the U.S is deficient in vitamin D. That’s nothing to sneeze at. Some scholars believe Vitamin D deficiency is the “seasonal stimulus” for flu epidemics.  In fact, 2000 IU daily prevented nearly 100% of the flu in an excellent RCT study of post-menopausal women.

    Epicurious asked me for a list of flu-fighting foods: I came up with six (actually six categories):

    Quercetin Powerhouse Produce, Vitamin D–Rich Foods, Chicken Soup, Green Tea, Yogurt/Kefir, and Chilies.

    But even these foods should be used in addition to vitamin D3, and a flu shot.

    The more people learn about the relationship between what they eat and their personal health, the fewer medications and devices they are likely to need, and the less disease they are likely to have.

     
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