Drug Holidays – what are they and when to consider

A drug holiday is a conscious decision to stop a medication.  The reasons to do so usually revolve around “seeing if I still need it” and side effects.

I was interviewed by Sara Klein in Prevention Magazine on this topic.

Click here for the story!

http://www.prevention.com/health/drug-holiday-facts

The path to wellness begins with a proper diagnosis

Tell Me What You Want

I am asking readers to tell me what you want.  Not in general, but at a health or wellness talk.  A few weeks ago I was asked to speak at a wellness seminar given at a company for its employees about heart health.  The talk was well received, and we had a good discussion after my presentation.

What struck me was how willing people were, in a room full of co-workers, to ask questions about their personal health.  In the office, we have safeguards to protect privacy at check-in, in the waiting room and at check out.  Yet in this conference room, with people they know listening, I was told about cholesterol results and other tests, treatments they were given, etc.  Granted, we were talking about heart disease, which may not seem as socially or professionally awkward as some other topics, but it still surprised me.

It also made me wonder – what did they want?  My professional interpretation and opinion of their situation, or validation that the choices they had made in their own care were “good choices”?

I did my best based on the information people gave me to address their concerns, while encouraging them to speak to their doctors.  Some had questions understanding what they were treating or how to interpret their results.  Others had decided to try a different therapy (often homeopathic) than what their doctor recommended and wanted my approval – so the answer to my initial question is “both”.

I found it to be a little uncomfortable being asked to approve someone’s decisions with limited information, especially if I didn’t “approve.”  However, the talk and Q&A are for the attendees, not me, so I did my best to give a recommendation and encourage discussion between the person and their doctor.

This is a copy of the talk I gave – I want to thank TheVisualMD for the image support in the talk.

My question to you – if you went to a talk like this what would you prefer?  A general Q&A or time at the end to make a mini-appointment to discuss your questions one on one with the speaker?  Tell me what you want!

The path to wellness begins with a proper diagnosis

Winter Has Come – Snow Safety Tips

Winter has come – with a vengeance!  After 70 degree weather in NYC on Christmas we are being hit with one of the 5 worst blizzards in NYC history.  As the snow piles up, how can you safely clear paths and get the supplies you need?

Common Sense

  • Don’t drive – accidents maim and kill
  • Walk carefully – sidewalks and roads will have ice, snow and salt.  Footing will not be secure
  • Sled in known areas only
  • Any non-electric space heaters can emit carbon monoxide – which can kill.  Make sure to use heaters properly, and check the batteries in smoke and carbon monoxide detectors

Shovel Properly

Snow is heavy, and heart attack inducing!  Shoveling uses muscles not used on a regular basis, plus the temperature extremes cause blood vessels to constrict, which increases the risk of a heart attack.  If you have heart disease, you should minimize shoveling – hopefully there is a neighborhood kid who is willing to shovel!  If you must shovel:

  • push the snow, don’t lift
  • if you must lift the snow, don’t fill the shovel
  • use your legs, not your back
  • take frequent breaks

Other tips

Remember that walking, sledding and shoveling are strenuous activities in the snow.  Stay hydrated.  Snow is natures air cleanser – it absorbs the pollutants in the air as it falls.  So the first snow flakes that fall are dirtier than those a few hours later – but the pollutant levels are very low in general.  Catch snow on your tongue, but never plowed snow – that has sand and other chemicals mixed in.  And of course avoid the yellow snow!!

IMG_1538 image

Stop Counting Cholesterol? New Dietary Guidelines say so

At the end of 2014, The Dietary Guidelines for Americans Council issued its 2015 guidelines and analysis of what we should eat, what we do eat, and what the consequences of what we eat are.  Many of the recommendations and observations are what we expected – we eat too much sodium and sugar, not enough fruits, and are overweight.  What was surprising is that they do not recommend watching cholesterol intake any longer – saturated fat yes, but cholesterol, no.

What did the report say?

The main thrust of the report emphasizes a diet with lots of fruits and vegetables, whole grains, low in saturated fat.  Limiting processed meats, refined grains (white bread) and drinks with added sugar is also recommeded.  Good food such as seafoods, nuts and legumes, as well as low-fat dairy are emphasized.
Notably, the report for the first time removed the recommendation to limit cholesterol intake.  Prior recommendations were to limit cholesterol intake to under 300mg daily.  Instead, it is recommended to limit saturated fat and empty calories such as processed sugars.  It is these foods that are contributing to obesity and its consequences much more that dietary cholesterol.  Added sugars and saturated fat should be < 10% of total calories in a day.
Saturated fat has 9 calories per gram.  So in a 2000 calorie diet, saturated fat should be limitied to 22 grams daily.  Sugar has 4 calories per gram.  In the same diet, sugar should be limited to 50 grams daily.
For a real world example, a Snickers bar has 250 calories.  That is over 10% of a 2000 calories diet.  It has 4.5 grams of saturated fat, which is 20% of daily recommendation, and 27 grams of sugar, which is 54% of the daily recommendation!  By contrast, 2 scrambled eggs has about 200 calories and the same amount of saturated fat, but only 2.1 grams of sugar, or about 4% of the daily recommendation.

So what does this mean?

The report brings dietary guidelines more in line with current research.  We have seen several studies showing the benefits of a Mediterranean style diet – high in fish, nuts, vegetables and good fats such as olive oil.  The guidelines now support those findings.  It means a heart healthy diet can include some fats, and should limit the empty starches – those made with refined flour that add little nutrition but many calories.  It means that moderate intake of eggs and lean meats is healthier than meals based on breads, rice and pasta.
Perhaps the best news in the report (at least for me) is that up to 5 cups of coffee a day does not seem to be harmful!!!

The path to wellness begins with a proper diagnosis 

Got Milk? Too much of a good thing?

The USDA recommends 3 cups of milk or dairy a day.  This is mostly to promote bone health.  However, it has also been linked to increased cancer risk in some studies, others have supported health benefits.  A recent study tried to sort out these conflicting results by separating milk from other dairy products and looking at death rates, heart disease, cancer rates and fractures.
What they found was surprising – adults who drank 3 or more glasses of milk a day died sooner, had more fractures as well as heart disease and cancer.  Those with similar dairy intake, but from fermented dairy like yogurt, cheese, sour milk, etc. had a lower incidence of death and disease.  The difference?  Lactose content.

What is lactose?

Lactose is a sugar found in milk.  When digested, it is broken down into glucose and galactose.  Galactose has been linked to oxidation and inflammation – triggers for disease.  The study authors hypothesized that the difference in lactose, therefore galactose intake with milk versus other dairy products is the cause of the difference if death and disease

What did they do?

The researches used 2 health registries of residents in Sweden where records are centralized, totaling over 61,000 women and 45,000 men and sent them questionnaires that looked at milk and dairy intake.  They then followed their records from the early 1990’s until now, looking at death and disease rates.  What they found was that women who drank 3 or more glasses of milk daily were:
  • 1.9x more likely to die
  • 1.4x more likely to get cancer
  • 1.6x more likely to fracture a hip
In men, the effects were less pronounced:
  • 1.1x more likely to die, mostly from cardiovascular disease
  • no increase in fractures
They also messed marks of inflammation and oxidation in the blood of participants and found higher levels of both in those with higher milk intake.

So what does this mean?

There are some interesting associations based on this study.
  • ingestion of milk, with it’s higher lactose content, may be linked to increase risk of disease
  • ingestion of low lactose dairy products (yogurt, cheese) is associated with a decrease of disease
  • moderate intake of milk is not associated with increased disease risk

There are some limits to this study

  • the data is based on 1 or 2 food surveys, and subject to people’s memory and answers
  • the population studied was very uniform – 2 or 3 counties in Sweden – which may limit generalizing to the population at large
  • All subjects were over 39 years old so no conclusions can be made about children and young adults
  • Lactose free milk was not evaluated

What can we take away from this?

  • High amounts of lactose may contribute to disease based on its breakdown into oxidation and inflammation promoting compounds
  • Dairy foods with low lactose contents are associated with lower death rates and illness
  • Moderation again seem to be the word of the day – it is possible to have too much of a good thing!

The path to wellness begins with a proper diagnosis

Flu shots – Don’t Believe the Hype

It’s that time of year again – just after Labor Day when Flu Season begins! Flu shots are in stock in my office, most chain pharmacies and starting to make the rounds at companies that offer them to their employees. It is also the time of year when I explain to many a worried patient that you CAN NOT get the flu from the flu shot.

There are several myths about flu shots and vaccines in general – that persist because people with loud voices propagate falsehoods despite overwhelming evidence to the contrary. Perhaps it is, as was recently written in the Wall Street Journal  that people today, especially parents of young children, have never seen the consequences of the diseases vaccines prevent.

Some facts about the flu

  • Influenza is a virus spread like any other cold
  • You can be contagious about 1 day before you get sick, and for 4-7 days after
  • Anywhere from 5-20% of the US population gets the flu each year
  • About 200,000 people are hospitalized each year from the flu
  • In 2009, we saw the first new flu virus without a vaccine – H1N1 or “Swine Flu”
    • 60.8 million people in the US were infected
    • Almost 275,000 people were hospitalized
    • 12,469 people died from H1N1 flu that year – when no vaccine was available
    • Those most severely affected were pregnant women and children
    • When the vaccine was introduced the following year, rates returned to normal

Some facts about the flu shot:

  • You can not get the flu from the flu shot
  • Flu vaccines do not contain dangerous preservatives
  • Flu shots (or other vaccines) do not cause autism
  • Flu shots decrease hospitalization due to the flu by 70%

So where did the myths come from?

  • The flu shot is made from killed flu virus, and a mix of 3 or 4 different strains of the viral components
  • Because the viral components are killed, they can not cause an infection
  • The vaccine stimulates the immune system which can cause a mild fever, congestion and body aches
  • If you have a cold when you get the vaccine, this reaction can be stronger
  • Vaccines used to contain a preservative called thimerosal, but have not for years, which contained mercury, although the quantity was much less than your average can of tuna
  • No study of any vaccine has been linked to autism – the only study that showed that position was retracted for falsifying data and the physician who wrote the study stripped of his medical license.  I reviewed this information in an early post about the HPV vaccine

What do I advise my patients?

I offer the flu shot to all my patients. I highly recommend it for all my patients over 65, pregnancy women and those with young children in the house. In addition, anyone with a weaker immune system, such as diabetics, or asthmatics who are at higher risk of lung complications should get a flu shot every year.

The flu causes people to miss work (this is why employers have flu shots in the office), children to miss school, and unnecessary misery.  The flu feels worse than any cold – with fever, cough and severe body aches.  It feels like you’ve been hit by a Mack truck – and it can be prevented.

Don’t believe the hype, get your flu shot – I’m getting mine – and its much more pleasant in the office when you get your shot than when you come to see me because you are sicker than you’ve ever felt!  

The path to wellness begins with a proper diagnosis