• Archives

  • Sep3

    Helping Men Lose Weight: 10 Year Review

    Posted in: Obesity and Weight Loss, Wellness and Health

    I’ve been looking at my patient records from Chef Clinic over the last 10 years (yes, I’ve kept them all, in all their manila folder glory). Especially interesting are the men.

    In a weight loss practice, most patients are women. Women have more societal pressure to achieve a healthy weight than men, often have tried many different diet programs, and want to work through why they’re overweight.

    But few diet programs exist for men. Those that do seem to rely either on powerful physical programs (P90X, Insanity) where the food is not the focus; or hormone prescriptions (testosterone and growth hormone help men build muscle, especially supplemental hormones, but they can have nasty side effects if men are not truly deficient…i.e., 97% of men).

    But what does appeal to men, at least in my practice, are simple, clear rules; specific planning and cooking skills; environmental control; hormonal enhancement with diet and food timing not drugs; and a minimum of discussion and process.

    I think this sort of approach may also appeal to some women. In fact, I know it does. But for men who are ready to lose the gut, it rings true in a whole new way.

    Last night told a female colleague I was working on this idea, and she said: “About time.” I hope so. It seems like it to me.

     

  • 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.

     

  • Jul12

    Prescription for Abnormal Lab Test Syndrome

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

    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.

     

  • May2

    E-Patients: Are You Already One?

    Posted in: Aging and Costs of Aging, Common Conditions, Drug Food Safety, Environmental Health, Wellness and Health

    I don’t take care of patients on the web, yet.

    Most of my patients are, however, e-patients. And I didn’t even know it.

    E-patients are real, not virtual. They’re networked, curious, want to be well-informed about and take better control of their health, confused about what info is accurate and in need of people and information they can trust.

    They usually know something about their condition from the web, like not being alone with their condition, and like learning from others…from how to remember pills to how much time the doctor spent with them at the last visit.

    @EpatientDave, a cancer survivor and scientist, spoke compellingly at TEDx on this and is the ambassador for e-patients. People’s Pharmacy founders the Graedons are hugely supportive in this one hour podcast, free for the next few days.  Mark Bittman recently wrote that e-patients (though he just said “we”) could save the U.S. a trillion dollars in the next 10 years.

    E-patients sometimes join communities–specific ones, like those considering bariatric surgery or just having had it, or broader ones like ShareCare, www.patientslikeme.com and www.organizedwisdom.com.  I often recommend an online community for patients with celiac disease, for example, with the new diagnoses generated by http://glutenfreequiz.com and the lab testing that a high score encourages.

    This movement has supporters in medicine, media, tech and among consumers. There’s a Journal of Participatory Medicine, an e-patients.net site, and many trends feeding it: medical errors; healthy food; tech; social media; health reform; and shifting of responsibility to individuals.

    E-patients should be a huge boon to better health. I can’t wait to see it grow.

     

  • Jan27

    What Doctors Should Say to Patients Who Want to Lose Weight

    Posted in: Child Obesity, Obesity and Weight Loss, Wellness and Health

    I was interviewed recently by the American College of Physicians about best practices for physicians who find it uncomfortable to speak with their patients who want to lose weight.

    The resulting article focused on “motivational interviewing”: I just think about it as how to speak with patients.

    Here is a video on motivational interviewing about weight loss. The actors are clumsy and the advice is imperfect (artificial sweeteners are not the solution, there is no motivation elicited, the patient probably feels deprived, and the doctor is still directing instead of listening well). But this type of conversation is a first step.

    The real problem is that people don’t know how to do what physicians (may) tell them to do.

    The lack of training for physicians about what to say and how to say it doesn’t help. I got 4 hours of nutrition in medical school, and 2 hours in cooking school. None were about obesity.

    Finally, most physicians aren’t paid to have these conversations. They need to code a visit about weight management as something else, so they can be paid. I hope this changes with health reform. And it may.

    Motivational interviewing is a good tool–with enough time, compensation, evidence-based content and practice it will help. We can do it: POLST has done it for care near the end of life. Obesity could actually be easier.

     
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