Wednesday, February 18, 2015

Live Long and Prosper Newsletter February 2015

This newsletter was compiled from the latest research on health and longevity, by David Donohue, MD, FACP.

1.   Adiposity rather than BMI determines metabolic risk.
   The Body Mass Index (BMI) has come under some fire for painting an inaccurate picture of a person's "fatness" and risk of disease. Probably better to measure body fat, which can be done with a special DEXA machine (used more commonly for determining bone mineral density/osteoporosis). Stay tuned.
February 13, 2014

2.   Association of low serum 25-hydroxyvitamin D levels and sepsis in the critically ill.
   Low vitamin D levels correlate with all sorts of bad things. For example, 80% of obese people are "vitamin D deficient". Most studies that test whether a vitamin D pill cures what ails you come up blank. It seems that vitamin D deficiency is more a marker for suboptimal health than a quick-fix. That said, vitamin D supplementation has been found to be of small benefit for some conditions, like bone thinning and frailty.
February 20, 2014

3.   The Mediterranean-style dietary pattern and mortality among men and women with cardiovascular disease.
   Another study testing the Mediterranean Diet against death from heart disease. This one found a 19% reduction in mortality rate for those who ate the Mediterranean Diet. Add this to the growing list of pro-Mediterranean Diet studies.
February 25, 2014

1.   Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association.
   Stroke (brain attack) has moved down on the list of top killers in the US, from #3 to #4. Chronic lung disease is now #3. Whi did they swap? Because stroke rate has dropped greatly over the last half century, probably due to improved control of blood pressure.
February 24, 2014

2.   Effectiveness of home-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials.
   Do you know someone who have COPD or emphysema? Pulmonary Rehabilitation has been found to be quite helpful. This study found that it also works when done at home.
March 8, 2014

3.   The Role of Health Behaviours Across the Life Course in the Socioeconomic Patterning of All-Cause Mortality: The West of Scotland Twenty-07 Prospective Cohort Study
   We have long known that one of the most reliable predictors of how long a person will live is their socioeconomic status. More disadvantaged generally have more than double the death rate of wealthier people. This study tried to identify what aspects of socioeconomic status impact lifespan. Their findings: smoking accounted for 49% of the higher death rate of the disadvantaged, diet 43%, alcohol 13%. Want to live as long as a rich person? Don't smoke, eat a healthy diet, and don't drink much.
March 31, 2014

1.   Pooled cohort study on height and risk of cancer and cancer death
   Controlling for weight, taller people get more cancer. For each 5cm (2 inch) of extra height, your body packs on extra cancer risk (7% in women per 5cm, 4% in men per 5cm). Which cancer was most affected? Melanoma unsurprisingly.
January 31, 2014

2.   Vitamin D and the Cardiovascular System: An Overview of the Recent Literature
   Vitamin D levels definitely correlate with better health and longevity. However that does not mean that taking a vitamin D supplement will "curewhatailsya" as we say in internal medicine. "there is no clear evidence for a role of vitamin D other than that strictly associated with bone health". Stay tuned, more studies are being done.
January 31, 2014

3.   Marital status shows a strong protective effect on long-term mortality among first acute myocardial infarction-survivors with diagnosed hyperlipidemia - Findings from the MONICA/KORA myocardial infarction registry.
February 1, 2014

1.   Telomere length loss due to smoking and metabolic traits.
   We have known for years that the length of the telomeres in your cells (the tips of the chromosomes) is a predictor of how much you have aged and how long you can expect to live. Here is evidence that 2 risk factors increase the rate of shortening of your telomeres/aging of your DNA: smoking and the metabolic syndrome. Metabolic syndrome is a constellation of risk factors: abdominal overweight, elevated blood pressure, low HDL, and high triglycerides.
March 14, 2014

2.   An increase in the incidence of hip fractures in Tangshan, China
   With its rapid pace of industrialization, Chinese are seeing steep increase in the rates of all Western diseases, including heart disease, cancers, diabetes, and (per this study) osteoporosis.
March 31, 2014

3.   What should we tell prostate cancer patients about (secondary) prevention?
   Has you or a loved one been diagnosed with prostate cancer? The investigators of this study reviewed the literature and conclude "Patients should be counseled not to use tobacco products; to engage in daily physical activity; to minimize sedentary behavior; to consume plenty of healthy fats (i.e. fish, nuts, vegetable oils, soybeans, avocados, and flaxseed) and vegetables; to focus on getting nutrients from foods rather than supplements; and to limit refined grains, sugars, processed meat, and high-fat dairy."
March 17, 2014

Wednesday, February 4, 2015

Measles Outbreak- Vaccinate the kids!

The US currently has the largest measles outbreak since it was considered eliminated in 2000.  Currently there are no reported cases in Delaware.  The CDC recommends vaccination with the MMR vaccine for all eligible children or adults that did not complete the vaccination schedule as a child.  Adults born before 1957 do NOT need vaccination as they are considered immune due to an extensive outbreak of measles that year.  So, the message is.... get your kids vaccinated with the MMR vaccine.  As adults, you most likely do not need a vaccine.  

Friday, January 9, 2015

Live Long and Prosper Newsletter December 2014

This newsletter was compiled from the latest research on health and longevity, by David Donohue, MD, FACP.

1.   Body-mass index and mortality among adults with incident type 2 diabetes.
   This study refutes the so-called "obesity paradox" for diabetics. A previous study suggested that for diabetics, it is healthier be overweight or obese. This study found that the optimal BMI for diabetics is in the upper limit of the "normal weight" bracket (BMI 22.5 to 24.9). Stay tuned for round 2, fans of diabetes-obesity controversy!
February 5, 2014

2.   Processing of meats and cardiovascular risk: time to focus on preservatives.
   Processed meats are strongly associated with heart disease and cancer. Most of the harm is due to extra sodium causing higher blood pressure. Unprocessed meats (all types considered together) have no such association. Fish, nuts, legumes, and vegetables are associated with lowered rate of heart disease.
February 5, 2014

3.   Dietary patterns and total mortality in a Mediterranean cohort: the SUN project.
   Bor-ing. Another study looked at Mediterranean Diet (in Mediterraneans of all people). Those who ate it had close to half the death rate relative to those who did not.
February 11, 2014

1.   Intake of Long-Chain ω-3 Fatty Acids From Diet and Supplements in Relation to Mortality.
   Should I take omega-3 supplements like fish oil? This is a question I hear a lot. This smaller study finds that those who consumed the most DHA and/or EPA (the 2 key essential omega-3 fatty acids), had an 18% reduction in overall mortality. The effect on cancer reduction (23%) was greater than the possible benefit for heart disease. Of course, in correlation-finding studies like this you cannot be sure the correlation implies causation! So here is some evidence that you want to at least be the kind of person who would consume more omega-3s.
February 6, 2014

2.   Lifestyle modification programmes for patients with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials.
   For people with known coronary heart disease, do programs to modify lifestyle help? Yes! "Lifestyle modification programmes were associated with reduced all-cause mortality". Reduction was 34%.
February 14, 2014

3.   Do all health care professionals have a responsibility to prescribe and promote regular physical activity: or let us carry on doing nothing.
   The title says it all. This I believe is the direction we are headed with promotion of physical activity. In the near future, a sedentary lifestyle will be widely recognized to be almost as harmful as smoking.
February 20, 2014

1.   Dietary fiber intake and risk of type 2 diabetes: a dose–response analysis of prospective studies
   This is interesting. So the theory is that our highly refined, low-fiber American diet causes diabetes. The authors looked at all high quality studies to date on fiber and diabetes. Sure enough they found all types of fiber reduce diabetes significantly, like 20%. But interesting when they looked at the 5 studies that provided dosing data. They found that as your fiber intake goes from 0gm per day to about 20gm/day, we see not much reduction in diabetes. But as people's intake increases from about 20gm/day to 40gm/day, there is a steep reduction. So my takehome lesson is when we say fiber is important to help prevent diabetes, we mean you need to eat a lot of fiber. Shoot for 40 grams per day or more.
January 4, 2014

2.   Role of Bariatric Surgery in Diabetes
   Bariatric surgery (gastric banding, gastric bypass) may be our most effective treatment for diabetes. Studies have found that in 57% to 95% of cases, diabetes will reverse with such surgery. We have no nonsurgical treatment that is remotely as effective.
January 9, 2014

3.   Dairy products on metabolic health: Current research and clinical implications.
   Here is a study favorable toward dairy. They cite some evidence that dairy might reduce tendency to diabetes, obesity, or the metabolic syndrome which usually precedes diabetes. There is some research on each side of the issue, and it is not conclusive. But chalk 1 up in favor of dairy.
January 22, 2014

1.   Dietary dairy product intake and incident type 2 diabetes: a prospective study using dietary data from a 7-day food diary
   This trial found that top consumers of lowfat yogurt had 28% lower rate of diabetes compared with lowest consumers of lowfat dairy. Not clear what those who did not eat lowfat yogurt were eating instead. That's the key question.
February 7, 2014

2.   Adherence to the WCRF/AICR cancer prevention recommendations and cancer-specific mortality: results from the Vitamins and Lifestyle (VITAL) Study.
   6 major recommendations to prevent cancer were put to a 7 year test. The results? "Cancer-specific mortality was 61 % lower in respondents who met at least five recommendations compared to those who met none... Cancer-specific mortality was 10 % lower on an average with each additional recommendation met". What are the recommendations that might cut your risk of cancer by over half? (1) Stay as lean as possible without becoming underweight. (2) Be active for at least 30 minutes a day. (3) Limit consumption of calorie-dense foods and avoid sugary drinks. (4) Eat a plant-based diet that includes a variety of vegetables, fruits, whole grains and beans. (5) Limit intake of red meat (beef, pork, lamb) and avoid processed meat (ham, cold cuts, bacon, sausage). (6) If you consume alcohol, limit yourself to one drink/day for women, two drinks/day for men. Which of these had the biggest effect? #4, with an 18% reduction in cancer mortality risk.
February 24, 2014

3.   Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study.
   What's better - exercise or drugs? This study looked at the available evidence, and concluded that "exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes". In other words, exercise is about the same as effective as drugs for the diseases listed. And yes, typically the benefits are additive when you combine them both.
February 25, 2014

Thursday, January 1, 2015

Saturday, December 6, 2014

Phone System Down Saturday December 6, 2014

We are transitioning our phone system to Verizon Fios today.  If you need to reach the on-call doctor, please call 302-319-3414

Thursday, December 4, 2014

Knee or Shoulder Arthritis?

Having some knee pain that is limiting your exercise program?  Dr Zarek and our Physician Assistants, Abbe Jackson, PA-C and Ashley Kontra, PA-C, are skilled at joint injections.  We have helped patients with knee or shoulder pain by a simple injection in our office.  Please call for an appointment if you need to get moving again. 

Friday, November 21, 2014

Live Long & Prosper Newsletter November 2014

This newsletter was compiled from the latest research on health and longevity, by David Donohue, MD, FACP.

1.   Lack of health insurance increases all cause and all cancer mortality in adults: an analysis of National Health and Nutrition Examination Survey (NHANES III) data.
   "There was a 70% increase in risk of all cause death and almost 300% of all cancer death for people without any health insurance coverage". We need to be mindful that those who lack health insurance are in that unfortunate state because of some root causes, which also impact mortality rate. Namely, they tend to be of lower socioeconomic status, and they tend to be sicker. Because that is how the health insurers earn large bonuses - keep sicker, more expensive patients off the books. Let's hope this improves with the Affordable Care Act.
October 23, 2013

2.   Meat consumption and diet quality and mortality in NHANES III.
   This large study found no association between consumption of red or processed meat with mortality. Men who ate more white meat were in a category that had lower overall mortality. For women, white meat was not correlated with mortality.
October 24, 2013

3.   Calcium intake and serum concentration in relation to risk of cardiovascular death in NHANES III.
   You might have read that calcium pills might increase your risk of a heart attack. This study, looking at 1 particular large data set, found no association. However it did find that women with highest levels of calcium (upper 5%) have almost double the risk of heart disease.
October 25, 2013

1.   High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis.
   High-intensity interval training "significantly increases CRF [Cardio-Respiratory Fitness] by almost double that of MICT [moderate-intensity continuous training] in patients with lifestyle-induced chronic diseases." So if you have high blood pressure, pre-diabetes, heart disease, then you might consider asking your doctor about switching from the occasional grind on the treadmill, to a program involving periods of high intensitiy activity. You will likely need to have a screening test to make sure your heart is up to it first though.
October 23, 2013

2.   Effect of increased fruit and vegetable consumption on physical function and muscle strength in older adults
   Since fruits and veggies are not protein sources, they might divert your diet from important protein sources (meat and dairy), right? This randomized trial showed that eating more fruits and veggies for 12 weeks actually increased grip strength, though the finding was not quite statistically significant. So we can infer at least that fruits and veggies do not make you weaker.
November 30, 2013

3.   Exercise: Putting Action into Our Epigenome.
   How do we prevent age-causing methylation of your genome? Exercise! "Six months of aerobic exercise alters whole-genome DNA methylation in skeletal muscle and adipose tissue"
October 29, 2013

1.   Moderate Physical Activity as Predictor of Weight Loss After Bariatric Surgery
September 30, 2013

2.   Changes in fish consumption in midlife and the risk of coronary heart disease in men and women.
   "Our results suggest that increasing fish consumption to at least 2 servings per week in mid- or later life may lower CHD risk in women but not in men."
September 27, 2013

3.   Mortality among African American women with sarcoidosis: data from the Black Women's Health Study.
   Sarcoidosis kills. African American women with this disease have a 2.4 x risk of death compared with those who do not.
September 29, 2013

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