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March 26th, 2010

Try switching to espresso...

Kallo kallay: you know how so many people who drink coffee complain that they suffer fromn gas or indigestion or reflux as a consequence?

And many others, like moi, do not and in fact, we drink strong coffee, the stronger the better, in fact, and we also believe that those complainers are just coffee wimps?

Well, turns out that researchers have determined that there's something in strongly-brewed coffee that actualy turns down the production of stomach acid.

So hey, if, like so many Canadians, you get symptoms from drinking the watery brown goo that passes for coffee and which seems to be all you can get from most "coffee" stores, then perhaps you might want to try switching to espresso blends and cappuccinos and such, and see if your symptoms don't improve.

You may also get jittery and more anxious, but hey, you'll be wider awake, more alert, and your stomach may thank you most of all.

I’m Dr Art Hister

March 25th, 2010

Seasonal Allergies

If you suffer from seasonal allergies, like me and millions of you do, there's a pretty sad survey out today from Consumer Reports, but it won't surprise most of you at all.

Basically, it says that most allergy sufferers have a tough time with allergy season, no matter what they try or take.

The most common treatment - and this surprised me - is avoidance, that is, locking oneself inside with air conditioning to avoid external allergens.

I was surprised because it seems to me that this would be hard to do for any length of time, especially if you have kids.

Over-the-counter meds were the 2nd most favored treatment, but clearly most people weren't getting much relief from them since the average user was using 3 OTC meds used in this survey, so despite the ubiquitous ads you see on the tube at this time of year, those drugs have pretty limited benefit (plus according to most allergists, they work best if they're started well before the allergy symptoms kick in).

Nearly 60% of people were also using prescription meds, and those people actually claimed to have the most relief.

The study didn't ask about immunotherapy (allergy shots), which I've been getting for 3 years and I believe they have helped me quite a bit.

Bottom line: allergies take a large toll (lost work, poorer quality of life), so keep pursuing the stuff that's out there, but be prepared to be disappointed in any one approach, no matter how highly it's recommended.

I’m Dr Art Hister

March 24th, 2010

Mammography Screening

Yet another study from Scandinavian researchers has found little benefit from mammography screening.

In fact in this study, which compared areas in Denmark where mammography screening was routinely done with areas where it wasn't, found no difference at all in the death rates from breast cancer over 10 years.

So how to interpret this data, given that mammography screening is so highly promoted here?

Well, it could be that the study period was too short to find much difference, although you would think if there was going to be a significant benefit from screening in terms of lives saved, that trend should have been established early in this study.

Second, you could take the view, as most North America mammography experts seem to do, that there is something uniquely inadequate in mammography screening programs from that part of the world, which is at best, a highly debatable point.

Or you could say, as I think is becoming more and more clear, that the benefits of mammography screening have been much oversold and that although it's likely that screening mammography does save some lives, it's also very much the case that there's a large cost to be paid for doing it on every woman who hits the age when it's supposed to start, and that those costs are not discussed nearly enough with women who qualify for the screening.

Bottom line: if you want to follow a mammography screening program, educate yourself thoroughly both about the pros and perhaps even more about the cons.

Then decide for yourself how that balance shakes out for you.

I’m Dr Art Hister

March 23rd, 2010

Prostate Cancer

This bit of news is going to affect a lot of younger men, who unfortunately, generally don't like to believe that they have bodies that may fail them one day.

According to a study that tracked over 20,000 men who'd registered with IVF clinics in California, men who had trouble getting their partners pregnant (i.e. men diagnosed to have fertility problems) were not only much more likely to eventually be diagnosed with prostate cancer than men who were not "infertile", but probably even more important, "infertile" guys were over twice as likely to be diagnosed with the most aggressive form of prostate cancer, that is, the form of prostate cancer than definitely requires treatment (as opposed to so many prostate cancers that can safely be treated with watchful waiting).

No one still knows why that link, of course, but the important consequence is that men who have fertility problems should probably be screened with the PSA test (the blood test for prostate cancer) from a younger age than the generally recommended starting age of 50.

Guys who are not "infertile"? Whether or not you should get tested with PSA remains a controversial issue - no formulaic answer, I'm afraid but every man has to make his own mind up (in consultation with his significant other, of course, just like all decisions that men make).

I’m Dr Art Hister

March 22nd, 2010

Low-fat dieters

Hey, low-fat dieters, joke's on you: low-fat diets don't lower cholesterol levels.

I've long believed that we are focussing on the wrong end of things when we tell people not to eat certain food groups, specifically that telling people to lower their fat intake so that in turn, they can lower their LDL levels.

Rather, I've always thought that (aside from telling people to minimize their trans-fat intake, and that's easily done by just avoiding lots of prepared and fast foods, which you should do for many reasons), you'd achieve better cholesterol goals - and other nutrition goals - by simply encouraging higher intake of healthier foods, such as fruits and veggies and legumes and nuts and fish.

And I do as I say since I eat lots of cheese and full-fat dairy products and bacon (don't tell my rabbi) but living with a vegetarian, I focus on a healthy overall diet, so most of my intake is what you'd call healthy foods.

So, it was neat to learn that according to the massive Women's Health Initiative (that's the study that first discovered that hormone replacement therapy for menopause was linked to lots of bad outcomes), a low-fat diet did not improve cholesterol levels in the women who'd been randomized to try eating that way.

Now it could just be that these results are merely a reflection of the fact that although they didn't admit it to the researchers, most women in this study who'd been told to lower their fat intake simply couldn't do it (people on low-fat diets are notorious cheaters, and tons of them generally drop out of the studies that require eatring low-fat meals).

But I prefer to believe, as did the researchers, that the explanation for these results is that low-fat diets don't really make much difference in cholesterol levels.

So hey, treat yourself and in your next latte, make it full-fat milk. You'll love it, trust me.

I’m Dr Art Hister

March 19th, 2010

Seniors and medication...

A Canadian survey of trends in 6 provinces found that most seniors are taking at least 5 medications. In fact, 21 % of seniors are taking 10 or more prescription drugs.

There are several reasons that are easy to come up with for this flood of medication use: way more drugs than ever out there, way more people wanting to be medicated for every conceivable symptom, doctors wanting to treat every condition that brings a person into the office and not wanting to admit that in many cases the drugs don't do a whole lot, wider definitions of illness so that, for example, 60 % of seniors are now said to have high blood pressure, a much greater trend to use multiple medications to achieve standard goals (lower blood pressure, lower cholesterol levels, etc).

But the big question is this: is it a good thing or a bad thing that seniors are now using more drugs than they ever have?

Depends on a lot of factors, some of which are not easy to measure.

So if as a result of all those drugs, seniors are living longer than ever (they are) and better (that's iffy) and happier (just as iffy), then I suppose it's a good thing.
If, however, they're spending way more of that extra time dealing with side effects and drug interactions, then it's not a good thing.

My rules for using a drug on myself are these: for me to take a new drug (I am on 3), it has to easily and quickly prove its benefit (I take Nexium for my reflux, for example and without it, my life is quickly miserable), I have to believe that the condition I am treating with this drug will have a significant negative impact on my life if I don't treat it wih this drug, the drug has to be easily tolerated (life's too short to put up with uncomfortable extra side effects and I certainly don't want to take any other drug to treat side effects from the first one), and there also has to be some pretty good evidence out there that the drug is not dangerous in the long-term (that's always a bit of a crap shoot).

Not always easy to decide on the balance, but at least it's a bit of a guideline.

I’m Dr Art Hister

March 18th, 2010

Baby boomers are probably at special risk...

A timely reminder to all baby boomers from 2 American studies that claim there's an "epidemic" of non-melanoma skin cancers in the US right now.

Non-melanoma skin cancers include basal cell carcinomas, and squamous cell carcinomas, and although both are pretty slow-growing cancers, they can cause a great deal of misery from the cosmetic conequences of having to treat them, not to mention that although they are generally slow-growing, they can metastasize, so they must be treated to ensure than they don't go on to kill the person who develops one of these malignancies.

Baby boomers are probably at special risk of coming down with these malignancies because so many of us were so sun-unwise when we were younger: Indeed, many of us used absolutely no protection from sun exposure, and even worse, we spent inordinate amounts of time outside trying to get a perfect tan.

So we are now paying the price of all that sun exposure: wrinkles, aging skin, and a higher risk of all types of skin cancer.

Common sense bottom line: if you notice a change in your skin and you''re not sure what it might be, get it checked out.

Just as important, if you are told that "it's nothing", yet that skin change continues to grow or change or bother you, get it re-checked because it's not uncommon to make an error in diagnosing a skin change.

I’m Dr Art Hister

March 17th, 2010

It's not all bleak for balding men; the other end may benefit

If you're a balding male, and hey, all men are balding but some just do it quicker than others, you may be cheered a bit by a recent study that found that men who bald prematurely (starting at around age 30, which is an age by which most men have already started looking in the mirror every day to see just how far their hairline retreated overnight) are less at risk of developing prostate cancer than men who do not begin to go bald prematurely.

The reason, the researchers speculate, has to do with higher testosterone levels in men who lose their hair sooner, and higher testosterone levels in the younger years may protect against prostate cancer (as oppposed to older men in whom higher testosterone levels are presumed to increase the risk of prostate cancer).

Now, there are a lot of weaknesses with this study not the least of which is that 1) this runs counter to the findings from several other small studies, and 2) the results (which were gathered when some of these men had already developed prostate cancer, up to decades after they had been 30 years old) were gleaned from these men's recall as to what their hairlines were like many years prior to their cancer, and since most men can't easily recall what they had for breakfast the same day they're asked about it, clearly these results have to be taken with a huge dollop of salt.

Nonetheless, if you're a balding male feeling bad today and you're seriously contemplating either wearing a hat in public from now on or having your hair shaved off (it's supposed to make you look younger and more virile, but if you ask me, it just makes you look like an ugly version of yourself with your hair gone) this news should at least give you a bit of hope that there's a reason that God has this plan for your hairline.

I’m Dr Art Hister

March 16th, 2010

Beware of jumping to conclusions (part 2)

Yesterday, I wrote about the fact that doctors had jumped to the conclusion that for Type 2 diabetics, the lower the blood pressure the better, but a terrific study called ACCORD revealed that Type 2 diabetics who lowered their BP the most were no less likely to suffer a stroke or heart attack (or even sudden death) than diabetics who didn't lower their BP as much.

Now, a study that is getting lots of attention found that compared to people over the age of 50 with low vitamin D levels, people with the highest levels of Vitamin D in their blood were much less likely to end up with diabetes, a heart attack, kidney failure or depression. In this study, researchers took the charts of 41,000 patients in their clinic, broke those charts into groups according to the vitamin D levels, and then looked at what these people had been diagnosed with.

Even mroe intriguing, the researchers then took those people with the lowest vitamin D levels, and told them to take supplements to raise their vitamin D levels, and those who were able to raise those levels the most had a subseuent lower risk of Type 2 diabetes and heart attack comapred to those who didn't raise their blood levels of viamin D.

So what could be wrong with the interpretation of this study that we should all raise our vitamin D levels as much as we can? Well, perhaps nothing.

But before we all become too giddy about the upside of vitamin D, remember that this study was done in Utah - I've been to Utah several times, and it's a very "outdoors" state, so seems to me that since most of us get a lot of vitamin D from the sun, people with low vitamin D levels probably don't go outside as much nearly as much as people with higher vitamin D levels: they probaly don't exercise as much, I would be pretty sure they don't walk as much, perhaps they aren't as happy (sunshine sure makes me feel good) and so on, and it's those factors that probably make a big difference in disease outcomes). And as for the 2nd part of that study, perhaps again, those people who managed to raise their vitamin D levels were also more likely to follow other healthy lifestyle practices better than people who persisted with a low vitamin D levels.

Vitamin D may turn out to be the miracle cure for every health ill, but I think we should wait till we have much better data before jumping on that bandwagon.

I’m Dr Art Hister

March 15th, 2010

Beware of jumping to conclusions

Once again, what seemed so seductive in theory hasn't worked out nearly as well in practice, very much like what happened with hormone "replacement" therapy for menopause (and isn't "replacement a weird word to use in medical practice?)

This time, what's gone down in flames that the lower the blood pressure, the better, which is what a lot of doctors have been pushing on people with Type 2 diabetes, namely that despite the difficulty in getting BP down to low levels (for BP to come down sufficiently, a person must often take 2 or 3 medications and is then subject to all those side effects and drug interactions), people with Type 2 DM are so at risk for complications from elevated blood pressure (especially strokes and heart attacks), that they must nonetheless strive diligently to get their BP down as low as possible.

Well, according to a pretty shattering study (known as ACCORD), people with Type 2 diabetes have little to gain (no reduced risk of heart attack, stroke, or sudden death) from getting down to very low BP levels.

In fact, some of them - quite perversely - even had a bit of a raised risk of some of those "events".

Bottom line: there are actually 3.

1) Do everything in your power to lower your risk of getting Type 2 diabetes because we are simply not very good at treating it

2) If you do get Type 2 diabetes, the mainstay and proven therapy to reduce the risk of cardiovascular "events" must start with weight control, diet and exercise.

3) We must be periodically reminded that the first principle of therapy is "First, do no harm" and an intervention, a therapy, an approach should only be used after it's been proven to work, not when the theory says it should work.

I’m Dr Art Hister