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MEDICAL. So, What About Sugar?

Posted in Medical topics, tagged on August 25, 2012| 3 Comments »

By Paul Goldfinger, MD, FACC, Fellow on the Clinical Council–American Heart Association.

In the 1980’s I started getting interested in nutrition and prevention in relation to atherosclerotic cardiovascular diseases. The focus on lowering cholesterol, especially with drugs, was supported by scientific research, and Lipitor (atorvastatin) became the most widely used medication in history. Low fat diets were embraced as the most healthy way to eat. It was also in the 1980’s that the obesity epidemic was first noted.

In the 1990’s, some of my patients went on the Atkins diet, on their own, which emphasized eliminating dietary carbohydrates. I was impressed with their weight loss, although the increased dietary fat that Atkins suggested did not seem like a good idea. My advice to them was to continue their usual heart-healthy eating, but cut down on carbs to get the weight loss advantage.

Now there is evolving information about the role of sugar in promoting a variety of chronic diseases.

Here is a 2012 basic understanding regarding sugar:

1. Sugar is needed by the human body. It’s OK to have some sugar, but we eat much more than we need. Excess sugar intake, obesity and high caloric intake are new developments in the evolution of man.

2. Sugar comes in a variety of forms including processed table sugars made from cane and beets, corn sugars, honey, and natural sources from food. Carbohydrates are converted to sugar in the body, so we can include carbs as part of the sugar problem.

3. In recent years, Americans have increased their intake of sugars to about 130 pounds per person per year, contributing to the “obesity epidemic.” Being overweight or obese are risk factors for chronic health problems including heart disease, diabetes, high blood pressure, sleep apnea and metabolic syndrome*. The risk of some cancers also increases with obesity.

4. Of the 600,000 food items sold in this country, over 80% contain added sugar. Look for hidden sugars in processed foods — read the labels. Excess sugar in the body is converted into fat which accumulates in a variety of places — especially around our bellies and abdominal organs, but also inside our liver and our arteries.

Sugar induces disturbances in our metabolism, such as increased insulin release which in turn results in weight gain.

Sugar also stimulates pleasure centers in the brain which release dopamine and cause increased desire for more sugar. In this regard, it is similar to addictive substances such as cocaine and alcohol.

5. Half of our sugar intake is derived from corn in the form of cheap high fructose corn syrup. This HFCS is much less expensive than regular sugar and it is sweeter. It is often added to foods such as hamburger rolls, baked goods, salad dressing, ketchup (Heinz “original”), frozen foods, fruit flavored yogurt, ice cream and sodas. It also keeps breads soft and prevents freezer burn. The other half of our sugar intake is from sucrose, i.e. table sugar. The ingredient in these sugars that is most damaging to the body is fructose, which is about half the content of table sugar.

Some carbohydrates are considered to be much less harmful than pure sugar. These include complex carbohydrates found in fiber, whole grains, fruits and vegetables. But any excess eating that results in more sugar in your body may cause harm by promoting obesity.

6. Sugar is sugar, whether it is from sugar cane/beets or from corn. The corn industry says that the name HFCS is misleading the public, and they want a new name for their product: “corn sugar.” A law suit has resulted over this.

7. Read labels: One gram of sugar contains 5 calories. One teaspoon of sugar contains 5 grams, i.e. 25 calories. A 16-ounce soda has 60 grams of sugar — 300 calories (i.e. 12 teaspoons of sugar).

Total added dietary sugar should be about 30 grams per day which is 6 tsp. or 150 calories. This doesn’t include carbs that you eat in fruits, vegetables and dairy products.

When you read labels, look for “sugar” and “carbohydrate.”

8. “Metabolic syndrome:*” includes truncal obesity (around the middle), hypertension, type II (“adult onset’) diabetes, and high blood fats (LDL “bad” cholesterol and triglycerides.) This syndrome is associated with the development of cardiovascular disease.

REFERENCES: Drs. Marian Nestle and Malden Nesheim: “Why Calories Count — From Science to Politics.” Also: Michael Pollan, “The Omnivore’s Dilemma.” And Dr. Robert Lustig, “The Real Truth About Sugar.”

“Prevention Does Work — A Guide to a Healthy Heart” by Paul Goldfinger MD and Eileen Goldfinger, BA.

Blogfinger article: Fat people–Why?

Blogfinger article: “Looking for food in all the wrong places”

Also — the quotes of the day, from Marion Nestle, PhD: “Don’t eat anything artificial.”

And, from Michael Pollan: “Don’t eat anything your grandmother wouldn’t recognize as food.”

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MEDICAL: More physicians leaving private practice for hospitals.

Posted in Medical topics, tagged on July 25, 2012| 6 Comments »

The Washington Times (7/24, Devaney) reports, “As if the problem weren’t already bad enough, several medical professionals told a House panel that the Obama administration has made things worse with the Patient Protection and Affordable Care Act, among other health care reforms.” The Times notes that “doctors are finding it increasingly difficult to run private practices and are fleeing to hospitals,” and “the trend is likely to continue as doctors’ preferences have changed.” Notably, “Lawmakers on both sides of the aisle appeared interested in solving the problems that plague medical professionals”    

Blogfinger Medical Commentary:  By Paul Goldfinger, MD, FACC

The medical profession is currently in a state of high anxiety. The entire healthcare industry has been strategizing as to how to deal with the new healthcare law.  Even though much of the law’s  contents has yet to be revealed, the deck is currently being reshuffled by healthcare providers.

One of the changes is for large health systems to be organized so as to incorporate hospitals, labs, doctors practices, electronic medical records and even insurance coverage as they worry about staying afloat under the new system.

Doctors are particularly concerned about reimbursements. Medicare payments for doctors, especially specialists, may be severely cut. Increased practice regulations will put pressure on doctors to change their ways.  Doctors fear government interference with the doctor patient relationship.  Many doctors do not see how they can make a profit if new regulations force them to increase their business costs, such as with increased paper work and data entry.

My own doctor is an internist who said that he may not be able to continue running his office due to increased costs of doing business.  I found this shocking since he is a very good physician, but he is not the type to look for gimmicks to increase his income. Another doctor I know is a member of a large private heme-oncology practice which is under pressure to join a giant hospital system where he works. So far his group is resisting, but they may be forced to sell out.   Also, new med school graduates have lowered expectations and don’t mind working for a salary in exchange for an easier lifestyle.

Many doctors will reluctantly leave practice, and the promises made by Obamacare will be stifled by shortages of doctors and other providers. I never thought I would see the day where doctors drop out due to business failure;  but it is happening.

So if your doctor seems grouchy, give him a hug and lend him a few bucks.

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MEDICAL EDITORIAL: Why the annual physical examination is important

Posted in Medical topics, tagged , on June 13, 2012|

By Paul Goldfinger, MD

As I have previously stated, an annual medical exam  offers a number of advantages for patients including a careful physical examination by the physician.  If he uses what he learned in med school rather than relying on expensive tests, he may pick up clues that will provide a diagnosis.

In this example, from my files when I was practicing medicine, is a case where a patient had a pain in his arm , and I solved the problem at no cost to the healthcare system (except for my fee, which was $8.75):

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TOO MANY FAT PEOPLE. WHY? A Blogfinger Medical Report

Posted in Medical topics, tagged on May 31, 2012| 14 Comments »

Storm clouds over Jersey fats. By Paul Goldfinger

By Paul Goldfinger, MD, FACC

We all have heard that there is an epidemic of fat people in this country: 1/3 of the adult population is obese, and 1/3 is overweight. 18% of children are obese.  This trend has been rising since 1980 and continues to go up.  Obesity causes chronic diseases such as hypertension, heart disease, sleep apnea, and diabetes. These conditions in turn result in death and disability from a variety of complications such as heart attack, stroke and cancer.

Anatomically modern Homo sapiens appeared about 200,000 years ago.  During most of that history, food was scarce.  At first, modern man would forage for food, but later, farming was invented which created a more predictable food supply.

Around 1970, in the US,  government subsidies and scientific advances created a huge increase in  production by our farms.  The end result has been an oversupply of cheap food.  We eat too many calories, too often, and in too many places.*  The caloric intake of Americans has gone up along with our weight.  Now, obesity has become a norm in our society, and the image of obesity seems to be acceptable.  This phenomenon of excess food intake is, according to experts, new in human history, and our species has so far adjusted poorly.

The food industry has been making huge profits by marketing foods that are high in sugar, salt and fat. These cheap foods contain excess calories and are tempting because they stimulate centers in the brain which release chemicals such as dopamine which reward the pleasure receptors that make us want more. We tend to underestimate our caloric intake and we eat more than our bodies require for normal function.  And now we know that over-processed foods can add to the risks of eating poorly.

This topic is very complicated, but here are some factoids that represent the latest knowledge in the field:

—Weight gain and weight loss are usually  slow processes.  If you reduce your caloric intake by perhaps 200 calories a day, you will lose some weight, but it can take a year or more.

—Our agriculture industry is producing massive amounts of corn and soy beans.  These are used to feed cows instead of hay, oats and alfalfa. Cheap animal food results in inexpensive  fatty meats.  Processed foods contain huge amounts of corn derived sugar, in the form of high fructose corn syrup. Such carbohydrates are concealed in foods such as cereals, yogurt, and peanut butter.

—Cheap sugary drinks are sold to kids in 64 ounce cups of soda which contain 800 calories. Many other foods  are now sold in bigger portions including cookies and bagels.  Portion sizes, in general, at home and in restaurants, have become larger than ever before.  The ready availability of inexpensive and highly profitable high calorie foods has enabled the omnipresent and generally unhealthy fast food industry.

—25% of Americans get no exercise at all.  Our jobs and life styles are sedentary.  This is a change which continues to get worse, as we burn less calories. This is one of many modern trends which have come together to produce the obesity epidemic.

–There is little profit in growing fruits and vegetables.  The agriculture industry is not interested in this kind of farming. There are no federal subsidies for growing apples or spinach.

–How to combat the epidemic? Mostly it’s a question of knowledge and self control.  Government policies can help, especially in the area of subsidies.  Parents need to get serious about this issue for their kids.

References:

“Weight of the Nation,”   HBO documentary , May 2012

“A Mathematical Challenge to Obesity,”  NY Times, May 15, 2012

“Calories are everywhere, yet Hard to Track,”   NY Times, March 20, 2012

Blogfinger articles  (links):

Getting fatter in America

Looking for food in all the wrong places.  *

“Prevention Does Work:  A Guide to a Healthy Heart” (2011) by  Paul Goldfinger, MD and  Eileen Goldfinger, BA.  Available at the Comfort Zone, Amazon.com, iUniverse.com   and BarnesandNoble. com.

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MEDICAL. Only 13% Of US adults age 20 and older have high cholesterol. The percent has been dropping since 1999.

Posted in Healthcare Topics @Blogfinger, Medical topics, tagged on April 25, 2012| 1 Comment »

From the American College of Cardiology:    The AP (4/24, Stobbe) reports that according to a report released today by the Centers for Disease Control and Prevention, “only 13 percent of US adults have high total cholesterol.” Health experts theorize that “it’s largely because so many Americans take cholesterol-lowering drugs, but dropping smoking rates and other factors also contributed.” CDC researchers released the report after examining data from “interviews and blood tests of nearly than 6,000 US adults in 2009 and 2010.”

Blogfinger Medical Commentary:    by Paul Goldfinger, MD, FACC    (Note: Cholesterol levels are written as 240 mg/dL, but we will just write the number.)

This data from the National Center for Health Statistics is a big thrill for those physicians who have been active in promoting cardiovascular  prevention.  The CDC was surprised by this result, since they expected that 17% of the adult population would have high total cholesterol  (i.e. over 240,) whereas the result came out to be 13.4 %.  In 1999-2000, the result was 18.3%.    This change since 1999 represents a decline of 27% in total cholesterol levels.  (Total cholesterol refers to all the cholesterol in the blood—good and bad)

There were other observations that were of interest when the data was broken down into sub-categories.  Given the lifesaving potential of cholesterol control, it is worrisome that 1/3 of adults were not screened with blood tests for high cholesterol over the last 5 years.

When the total cholesterol numbers were checked according to sex and age, in the age group of 40-59, the trend downward occurred for men, but not for women. This finding requires further analysis. Women came out better after age 60.

As for the reasons for the declining cholesterol numbers, this is complicated and was not discussed in the CDC report.

There is one caveat:

This trend analysis uses 240 as a cutoff, saying that levels above 240 are “high”  and that 87% of adults over age 20 have levels that are not high.  But that doesn’t mean that any number under 240 is “low” or “safe.”  The average cholesterol level in the US has dropped from 222  to about 200 in recent years. The American Heart Association says that anything over 200  carries an increased risk.  The average cholesterol level for patients with coronary heart disease is 225.

There are countries where the average cholesterol levels are 150, and those places have the lowest risk of coronary heart disease.  There is no number which is “normal,” and each person who is assessed for cholesterol risk has a target number which the physician chooses by looking at all the risk factors and medical history of a particular patient.  The graph below, from the current CDC study, shows the percent of men and women who have “high” cholesterol plotted against the years.  Note that female levels are higher than males across the board.

This graph is part of the CDC report. Below is a link to that report.

Undoubtedly, one reason that these numbers have improved is that Americans are more conscious of eating “heart healthy.”  I do believe that the widespread use of statin drugs is also affecting the results. Diet, especially including reductions in saturated fats, will improve total cholesterol numbers, but the results are often  not dramatic. The quote below is from our 2011 book “Prevention Does Work: A Guide to a Healthy Heart” by Paul and Eileen Goldfinger:

“It is important to realize that most low fat diets generally lower cholesterol levels by only modest amounts (usually in the 10-20% range). The amount of cholesterol lowering that occurs with diet is quite variable, depending largely on genetic factors and patient compliance. Diets form the foundation of efforts to correct abnormal blood lipids, but often medications must be added in order to achieve excellent results.”

CDC report on cholesterol trends in adults

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MEDICAL. Physicians work to utilize technology without losing human connection.

Posted in Medical topics, tagged on April 2, 2012| 7 Comments »

The AP (3/30) reports, “As the United States moves to paperless medicine, doctors are grappling with an awkward challenge: How do they tap the promise of computers, smartphones and iPads in the exam room without losing the human connection with their patients?” Georgetown University’s “medical school is developing one of a growing number of programs to train new doctors in that balancing act, this one using actors as patients to point out the problems ahead of time.” Meanwhile, “at Stanford University this summer, medical students will bring a school-issued iPad along as they begin their bedside training – amid cautions not to get so lost in all the on-screen information that they pay too little attention to the patient.”

Blogfinger Medical Commentary, by Paul Goldfinger, MD, FACC  (actually, my degrees are 98.6)

Older doctors complain that time-proven methods in medicine are falling by the wayside as more and more technology intrudes into the interaction of doctors with their patients.  Taking a good history is one such method—invaluable in making diagnoses. There is an old axiom: “Listen to the patient; he is telling you the diagnosis.”   I have seen skillful clinicians unravel difficult cases by following that advice, but younger doctors often take short cuts due to time constraints and due to computer distractions.

In the recent past I went to a local ER. A physician assistant came into the room to take a history, but she turned her back on me so that she could make entries into her computer. She asked questions without looking at me, and, in the end, she got the diagnosis wrong.

A physician friend told me that he found it awkward to use a computer while he was interacting with a patient. He did say that new devices are coming in with stands that allow the doctor to look at the patient while making entries.  Although the promise of   electronic medical records is significant, the art of medicine should not be lost in the process.

Aside from the distraction of computers, I think that it is regressive and potentially harmful for doctors to be entering information into a computer while conducting an office or hospital visit.   It wastes time and doesn’t allow for detailed and nuanced expression of the physician’s analysis.

In my own practice, I scribbled reminder words on a sticky-note in the patient’s chart and  handed each patient a handwritten check list reminding them of the salient instructions and facts that they needed to  have when they walked out of our office.

After the visit was over, I went back to my consultation room, alone, and  dictated a detailed note which would be typed later and inserted into the chart. It was expensive to pay three transcriptionists, but it was well worth it.   Maybe voice recognition software will solve the problems inherent in data entry by the doctor.

Meanwhile, during the transition to computerized medical records, while everyone gets it right, and that will take quite a while, there will be a stage where errors occur.  Be careful and watch out for yourself as you navigate an imperfect medical world.

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MEDICAL. Red meat consumption may be linked to increased risk of premature death.

Posted in Blogfinger News, Medical topics, tagged on March 16, 2012| 3 Comments »

A study from the Archives of Internal Medicine linking red meat to a higher risk of early death generated significant coverage online and in print, and was also featured on ABC World News (3/12, story 6, 2:10, Sawyer), which reported that a “major medical study from the Harvard School of Public Health” is “raising a giant red flag about eating red meat.”

The Los Angeles Times (3/13, Brown) reports, “Eating red meat – any amount and any type – appears to significantly increase the risk of premature death, according to” the study.

USA Today (3/13, Hellmich) reports that investigators “analyzed the diet, health and death data on 37,698 men and 83,644 women. Participants completed questionnaires about their diets every four years.”

Bloomberg News (3/13, Ostrow) reports, “The researchers found that those who increased consumption of unprocessed red meat by one serving each day had an 18 percent higher risk of dying from heart disease and a 10 percent greater risk of dying from cancer…”

The New York Times (3/13, Bakalar, Subscription Publication) reports, “The increased risks linked to processed meat, like bacon, were even greater: 20 percent over all, 21 percent for cardiovascular disease and 16 percent for cancer.”

CNN /Health.com (3/13, Harding) reports, “Based on these findings, the researchers estimate that substituting one daily serving of red meat with fish, poultry, nuts, legumes, whole grains, or low-fat dairy products would reduce the risk of dying in this stage of life by 7% to 19%.”

Blogfinger Medical Commentary:  Paul Goldfinger, MD, FACC

Dean Ornish, MD,  is a cardiologist from California who advocates extremely low fat diets in preventing heart disease.  He commented on the above research saying that a consensus has developed as to the best diet for prevention. He summarized it:

  • little or no red meat;
  • high in “good carbs” (including vegetables, fruits, whole grains, legumes, and soy products in their natural forms);
  • low in “bad carbs” (simple and refined carbohydrates, such as sugar, high-fructose corn syrup, and white flour);
  • high in “good fats” (-3 fatty acids found in fish oil, flax oil, and plankton-based oils);
  • low in “bad fats” (trans fats, saturated fats, and hydrogenated fats);
  • more quality, less quantity (smaller portions of good foods are more satisfying than larger portions of junk foods)

Back in the 1980’s, many people decided to give up red meats, as if that were the only problem food. It turns out that their decision was good, but the situation is much more complicated than that as you can see from the Ornish summary where he wisely pointed out that it is not only about what you don’t eat  (like red meat), but also what you do eat instead (like good oils instead of no oils).

As you decide how to eat, for yourself and your family, don’t call it a diet; call it a life style change. The evidence that diet is important for good health gets stronger every year. Our book Prevention Does Work: A Guide to a Healthy Heart (2011) covers all aspects of  this subject.  (BarnesandNoble.com  and Amazon.com and iUniverse.com)

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MEDICAL: Low levels of omega-3 fatty acids (fish oils) associated with lower brain volume.

Posted in Eileen's Recipes, Heart healthy cooking, Medical topics, Preventive medicine, tagged , , , , on March 6, 2012|

NBC Nightly News (2/27, story 8, 1:45, Williams) reported a study suggesting that “people with low levels of Omega 3 fatty acids had brains with less volume compared with people who had higher levels of the same fatty acids.”

HealthDay (2/28, Storrs) cautions that the research “did not prove that omega-3 fatty acids prevent mental decline, merely that there may be an association between consumption of fatty acids and brain health.

WebMD (2/28) reports, “Previous studies have already shown that people who eat a diet high in fatty fish like salmon and tuna have a lower risk of heart disease, stroke, and dementia. Researchers say these results may help explain why.”

Blogfinger Medical Commentary  by Paul Goldfinger, MD, FACC:

My mother often told me that fish was “brain food” as she fed me, my brother and my father tuna fish sandwiches and frozen fish sticks.  I actually believed her, although in med school they never made that claim. Now, according to the Neurology Department at UCLA, she may have been right. They should put her name on that paper in the Feb 28 issue of the journal Neurology.

Many doctors are advocating fish oil capsules to achieve some anticipated health results having to do with protecting arteries from damage. But the bulk of fish oil clinical studies were done showing benefits from eating fish.  Presumably taking fish oil capsules will be just as helpful as eating fish, but fish has many nutritional advantages beyond merely swallowing a two pound fish oil capsule each day.

In our book “Prevention Does Work: A Guide to a Healthy Heart” we recount the fish oil story. In addition, in Eileen’s heart healthy cookbook section, we purposely stress sea food preparation. Out of her 34 original and easy-to-prepare recipes, 15 are for seafood. Below is her clam chowder (the red kind) recipe which is a variation on the “Seafood Chowder with Red Potatoes” which is in the book.

In addition, here are two Blogfinger seafood recipes: One is Vivian Huang’s Steamed Fish and the other is Eileen’s Italian Fish soup with Swiss chard.

Link for steamed fish recipe

Italian fish soup

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MEDICAL. Colonoscopies may help reduce deaths from colon cancer.

Posted in Medical topics, tagged on February 25, 2012|

From the AMA:   A study touting the benefits of colonoscopy received significant coverage, with the findings discussed on two national television news broadcasts, and in several online and print sources. Most sources portrayed the finding as confirmation of the screening tool’s ability to prevent colon cancer deaths, although some experts were skeptical of the findings.

In a front-page story, the New York Times (2/23, A1, Grady, Subscription Publication) reports, “A team of researchers led by Dr. Sidney J. Winawer, a gastroenterologist at Memorial Sloan-Kettering Cancer Center in New York City, followed 2,602 patients who had adenomatous polyps removed during colonoscopies from 1980 to 1990.”

Bloomberg News (2/23, Langreth) reports, “Through the end of 2003, 1,246 of the patients who had adenomas removed had died.” Just “12 of those deaths were from colon cancer, far lower than the 25.4 colon cancer deaths that would have been expected in otherwise similar patients in the general population, according to the study results.”

Blogfinger Medical Commentary.   By Paul Goldfinger, MD, FACC

The development of the flexible colonoscope was the Holy Grail for gastroenterologists.  Before that, they had no way to directly visualize the interior of the entire colon.

Now, magnificent images are obtained at colonoscopy of the actual interior walls of the large bowel. The quality is so good that an Oscar should be awarded for cinematography in medicine. For the first time, patients could be accurately screened for colon cancers as well as precancerous polyps (adenomas), the latter of  which could be snared and removed, providing a diagnostic tool and a treatment combined.  Removing the polyp offered the chance to prevent colon cancer, and everyone rejoiced in that advance.

But in medicine, we prefer to know if a treatment not only treats a disease, but actually saves lives.  That is the essence of successful preventive medicine at its loftiest.

Believe it or not, despite the colonoscopy juggernaut currently going on, we have not, until now, had proof that preventing colon cancer by this approach would actually save lives— although it seems intuitive that it would.   Hats off to those doctors at Sloan Kettering in New York who had the patience (it was a 20 year trial) and the patients  (2,602 individuals whose polyps had been removed by colonoscopy) to enable completion of this trial.

Now, in the New England Journal of Medicine (Feb 22, 2012), they have published the result:  a 50% reduction in colon cancer mortality. Note that there are some “buts” including the fact that the study did not compare colonoscopy to some other testing techniques, but to most experts, colonoscopy screening is the way to go.

If you are a person who has foolishly ignored the colonoscopy guidelines, perhaps this new research will convince you to call your friendly gastroenterologist and make an appointment now for this potentially lifesaving procedure.

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MEDICAL. Survey: Just one in three people advised by physician to exercise. And what about exercise stress testing?

Posted in Medical topics, tagged , , on February 10, 2012| 1 Comment »

Do this and look like them. Exercise for health.

USA Today (2/9, Hellmich) reports that just “one in three people in the USA say their doctor advised them to start exercising or continue doing so during an office visit over the course of a year, a new government study shows.” These “findings are based on interviews with more than 60,000 people as part of the CDC’s National Health Interview Survey.” The survey indicated, “In 2010, 56% of adults with diabetes were advised to exercise; 44% of patients with high blood pressure; 41% with heart disease; 36% with cancer.”

Blogfinger Medical Commentary by Paul Goldfinger, MD, FACC.

It’s funny, but just about everybody, not only doctors, knows that exercise is good for one’s health. The medical literature is replete with studies that show benefits for heart disease, diabetes, lung disorders, obesity and other issues. But probably the most widespread potential usefulness is in the area of preventive medicine for apparently healthy individuals, including children.

So, despite the ready availability of this important, safe, beneficial and low cost modality, doctors do not usually discuss exercise with their patients. My cardiologist always asks me about it, but my other doctors do not. What is the reason? It’s complicated.

This failure on the part of doctors is inexcusable, but it is no different from the failure to deal with other prevention issues such as nutrition, smoking, psychological factors and weight. A number of clinical studies have shown that even cardiologists may not achieve target blood cholesterol goals with heart patients. The reasons for these failures in the area of prevention are multifactorial and deserve more study.

I think that many physicians, including some cardiologists, don’t know much about exercise physiology and they do not know how to write an exercise prescription. I saw a talking-head doctor on TV last week who was asked why physicians order too many exercise stress tests. He was quick to answer, but his answer was nonsense. He said that physicians did too many stress tests on “normal” people, implying that the test was useless unless the patient had heart disease.

Exercise testing is a complicated subject, and he shouldn’t have attacked the profession on this issue. I was afraid that he, single handedly, might cause the death of someone who saw the show and then tore up a doctor’s script for an ET (exercise test).

For a person who wants to embark on an exercise program, especially if they have been sedentary and/or are in certain high risk groups, a doctor should order a stress test in order to get a baseline as to physical conditioning, to look for issues such as breathing difficulty or leg cramps and to see if there are any worrisome cardiovascular indicators involving blood pressure, heart rhythm , symptoms like chest pain or ECG changes. The test is not 100%, and yes, someone can have a heart attack after “passing” a stress test, but the test is, nevertheless, important in the hands of a doctor who knows how to interpret the results.

Patients need to get involved in their own care. If their doctor fails to mention exercise, then the patient must bring it up.  Exercise can be dangerous for some individuals, and the physician should provide guidance.

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MEDICAL. Statins may benefit women as much as men.

Posted in Medical topics, tagged on January 28, 2012| 2 Comments »

Three brands of statin drugs; there are others


ABC World News (1/30, story 8, 2:15, Sawyer) reported that “for the first time a study proves statins are as effective in preventing heart attacks in women as well as men.”   (Editor’s note: statins are widely used drugs to lower cholesterol and prevent heart problems—PG)

On its website, ABC News (1/31) reports that investigators “reviewed 18 randomized controlled trials that included more than 140,000 patients.”

HealthDay (1/31, Reinberg) reports that the research, published in the Journal of the American College of Cardiology, indicated that “for both males and females,” statins “lowered the risk of a heart attack by about 20 percent.” In the past, some believed “that statins…benefited women less than men.”

Blogfinger Medical Commentary:  By Paul Goldfinger, MD, FACC

This is what they are saying in this report:  “For the first time a study proves statins are as effective in preventing heart attacks in women as well as men.”  Well that is not exactly true, because there is no original new research involved in this pronouncement. Instead, the researchers took 18 pre-existing trials on this subject and performed sophisticated statistical analysis. In other words, they threw all the data into an academic pot, stirred them up, fed them into a computer and came out with this.

In our book “Prevention Does Work:  A Guide to a Health Heart  2011, 4th edition,” there is this sentence:  “In a review of 5 major trials, benefits [with statins] were seen for women and for the elderly, in addition to the well documented benefits in men.  (JAMA. 12/22/99.)” As you can see, the study cited is from 1999. We also mention other trials that included women, so it’s not like women were totally ignored in past statin trials.  What is true is that most of the large trials consisted mostly of men, because research trials become difficult to interpret without sharply defined study groups.  Then, what usually happens, is that the next generation of trials begins to pull back the covers to check out subgroups like women, elderly, children, etc.  It takes many trials, many study subjects, many years and many dollars to sort out the issues that are revealed when a simple truth is discovered—ie statin drugs save lives.

In our practice, we never excluded women from receiving statins. For years, there has been enough evidence for most cardiologists to offer the same treatment to women as to men. If you wait for the final verdict from professors, you would deny all sorts of excellent treatments to patients.

Doctors always have used approved drugs for purposes that hadn’t yet been convincingly proven  (such as prescribing statins for women)  but were reasonable to do.  Now the numbers have been crunched and the fact is “proven.”  But I am sure that most informed docs have been doing the right thing for years in terms of prescribing statins to women.  If there are some physicians out there who have denied the treatment to women because of doubts about the data, well they had better change their tune now.

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MEDICAL: Estrogen may be best remedy for hot flashes.

Posted in Medical topics, tagged on January 17, 2012|


USA Today (1/17, Painter) reports that “when…things don’t work, and when women are miserable (not everyone is), most doctors will offer a prescription” and “the first choice – except for women with a history of breast cancer or other health conflicts – is still hormone therapy (estrogen, often combined with progestin).” According to Michelle Warren, medical director of the women’s health center at Columbia College of Physicians and Surgeons, New York, “it reduces hot flashes by about 90% and ‘it’s actually very safe, but that’s not getting across to the public.'”

“In a review published recently in the journal Climacteric by the International Menopause Society, the Times notes that “the report is bluntly dismissive of non-prescription remedies, saying: ‘Substantial funding from the National Institutes of Health and other non-pharmaceutical sources has failed to show any benefit of over-the-counter therapies compared to placebo for (hot flashes), and the safety of these compounds is not confirmed.'”

Blogfinger medical commentary:  By Paul Goldfinger, MD, FACC.

I have two vivid memories from the first day on my med school rotation in ob-gyn.  The first is how to properly put on rubber gloves.  The second is that you don’t say “hot flash.”  You do say, “Hot flush.”  But judging from this article, common usage has won the battle of menopausal lingo.

For years physicians were urging women who were menopausal to take estrogen supplements (usually with progesterone) to relieve the hot flashes but also to prevent heart disease.  But the tables were turned nearly ten years ago. This segment is from our book  “Prevention Does Work: A Guide to a Healthy Heart,”  Fourth Edition 2011.

“Although many older trials had suggested that hormone replacement therapy (HRT) with estrogens, after the menopause, would reduce the risk of coronary heart disease by one half, (New England Journal 325:756, 1991), recent data has dramatically changed the guidelines.”

“The Women’s Health Initiative is a huge randomized trial which, in 2003, reported that the use of HRT increased the number of cardiovascular events. Subsequent results in the trial demonstrated that the issue is quite complex. Although doctors no longer prescribe HRT for most postmenopausal women, the use of estrogens seems to be protective in younger postmenopausal women and might still be used in selected patients. (HRT and the Young at Heart, NEJM 356:2639, June 21, 2007). This matter must be discussed with your physician.”

Aside from the  complicated situation described above , one thing has never changed:   estrogen therapy is the most effective treatment for hot flashes. The quote in the article says that now it (estrogen therapy) is “actually very safe.”  I freely admit that I am not an expert on this, but if you are suffering with hot flashes due to the menopause then at least ask your ob-gyn for the latest information.

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MEDICAL: CDC report shows high frequency of binge drinking.

Posted in Blogfinger News, Medical topics, tagged on January 11, 2012|

 

USA Today (1/11, Lloyd) reports that a Centers for Disease Control and Prevention report has found that “one in six adults in the USA is a binge drinker, consuming an average of eight drinks per occasion and doing so about four times a month.” The report’s author, CDC alcohol program lead Robert Brewer, remarked, “What is different with this study is we studied the frequency and the intensity, and the number of episodes by different groups. The frequency is very high and the amount consumed was also very high.”

Bloomberg News (1/11, Lopatto) reports, “Wisconsin had both the highest percentage of binge drinkers, with 25.6 percent of the population reporting they engaged, and the most-intense sessions, with an average of nine drinks,” while “the nation’s capital reported 21.9 percent of its population was binge-drinkers, tying it with North Dakota for third highest in a survey covering the District of Columbia and 48 of the 50 states.” Brewer commented, “We’re talking about a risk behavior that’s quite widespread in the population. And where people have the impression it’s not such a bad thing to do.”

The AP (1/11) quotes Brewer, who said, “I know this sounds astounding, but I think the numbers we’re reporting are really an underestimate.” The piece notes that while “binge drinking may be considered socially acceptable,” it “accounts for more than 40,000 deaths each year,” and “contributes to problems like violence and drunk-driving accidents and longer-term issues like cancer, heart disease and liver failure.”

The Wall Street Journal (1/11, Martin) reports that public health officials expressed surprise by the frequency of binge drinking occurrences, as well as the number of drinks consumed. Ursula Bauer, director of the CDC’s National Center for Chronic Disease Prevention and Health Promotion, remarked, “Binge drinking remains a common and largely unrecognized health problem.”

Blogfinger Medical Commentary:   By Paul Goldfinger, MD, FACC

It’s interesting that most binge drinkers are not alcoholics. The term alcoholism is usually associated with dependency.

The other end of the spectrum has to do with a potential health benefit from small amounts of alcohol. From our book on preventing heart disease:  “Heavy consumption of alcohol increases the risk of dying, but small amounts of alcohol seem to offer some protection against coronary disease. In the Physicians Health Study (Lancet 1998), 5,358 male physicians who had a history of heart attack were questioned as to alcohol intake. During a 5-year follow-up, small amounts of alcohol (from 2-4 drinks per week up to one drink per day) resulted in a reduction in cardiovascular mortality risk. Taking more than that resulted in less benefit. The benefits of alcohol are believed to relate to raising HDL levels, inhibiting LDL oxidation, and reducing blood clotting.”

“Individuals with a history of alcohol or drug dependency should not use alcohol in any form.”

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