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Archive for the ‘Publications’ Category

“Diet and Nutrition Recommendations have a History of Being Wrong”

Jun 03, 2018

Most people try to eat a so-called “healthy diet”, which is presumably based on solid scientific studies. Sadly, the history of dietary recommendations has a long history littered with errors. In the 1940s, the USDA was emphasizing the Basic Seven, with a focus on bread/flour/cereals, butter or margarine, and at least 2 cups of milk a day. The 1984 Food Wheel and 1992 Food Guide Pyramid still relied heavily on bread, grains, and cereals (6-11 servings per day), but increased emphasis on fruits and vegetables (5-9 servings per day) while warning that fats and oils should only be eaten sparingly. Not until 2005 did the USDA transition to diet personalization, moderation, and proportion, with a first-time emphasis on the value of oils. Currently, the entire concept of a healthy diet has been flipped on its head. Cholesterol, once definitely labeled as bad, can now be good or bad. Carbohydrates, once the foundation of food recommendations, now might be implicated in the increased prevalence of obesity and diabetes, though whole grains still provide a variety of potential health benefits. And, in a complete turnaround, certain fats and oils, once considered among the greatest of food evils, have demonstrated cardiovascular benefit.

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“Crash Diets May Affect The Heart”

May 20, 2018

Diets of every genre are available, but many are not considered to be healthful or safe. Such is the case for the so-called “crash diet.” Please remember that there is no such thing as a “miracle diet.” The constant barrage of published diet and nutrition information makes it difficult for clinicians and patients to separate the wheat from the chaff, but research tells us that nutrition is a critical component to human health. Crash diets, also called meal replacement programs, have become increasingly fashionable in the past few years. Crash diets, also known as low-calorie diets, are very appealing to those wishing to lose weight fast—and that is most people. The National Institutes of Health (NIH) has warned that they could be dangerous, depriving the body of essential nutrients, and that these effects are particularly worrisome in children and teenagers. Other adverse health effects that scientists have warned about include the slowing down of the metabolism, the weakening of the immune system, and the increasing chances of dehydration and arrhythmia. New research looked specifically at the effects of crash diets on heart health. Researchers say that these diets have a very low-calorie content of 600 to 800 [calories] per day and can be effective for losing weight, reducing blood pressure, and reversing diabetes, but the effects on the heart have not been studied until now. The crash diet revealed some important health benefits after just one week: better insulin resistance and healthier levels of total cholesterol, blood sugar, and blood pressure. But surprisingly, heart fat levels rose by 44%.

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“Medical Myths Need Clarification”

May 13, 2018

Medical myths are unbelievably common and have been handed down from generation to generation. These fantasies and old wives’ tales need to be debunked and clarified. Many have been repeated so many times that they have taken on an air of truth. But, let’s look at five of the most common myths. Myth one: ‘Eggs are bad for the heart’. New research suggests there is no link between eating lots of eggs and cholesterol imbalance or increased risk of heart problems and type 2 diabetes. People who eat more than seven eggs per week have increased LDL-C, or “bad” cholesterol, but this is almost always matched by a similar increase of HDL-C, which has protective properties. The evidence suggests that eating even as many as two eggs every day is safe and has either neutral or slightly beneficial effects on risk factors for heart disease and type 2 diabetes. According to the CDC, eggs are one of the “most nutritious and economical foods” that nature can offer us. Myth two: ‘Drink eight glasses of water per day’.

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“Shingles Vaccine (Shingrix) Now Available”

May 06, 2018

Shingles is a reactivation of an original chickenpox infection that travels down a nerve dermatome and causes rash and pain. It’s a common infection and roughly 1 in every 1000 people every year in the United States will suffer shingles, and about 1 in 3 people in the United States will suffer shingles in their lifetime. Usually, shingles occurs in those > 65 years of age. The pain of shingles is severe. It’s right up there with corneal abrasions, labor and delivery, and kidney stones. The first shingles vaccine was licensed and recommended in 2006. It’s called Zostavax® and is a live, weakened form of the chickenpox (varicella) virus. The efficacy of Zostavax against rash was about 51%; the efficacy against postherpetic neuralgia (the pain associated with shingles) was about 67%. In October 2017, another shingles vaccine, called Shingrix, was licensed and recommended. The efficacy of Shingrix against rash, is in the mid- to high 90% range. The side effect profile for systemic side effects (fever, myalgia, chills) is somewhat worse for Shingrix than for Zostavax. In clinical trials of more than 30,000 people, Shingrix was not associated with serious adverse events. About 1 in 10 people who got Shingrix reported systemic effects that limited activity, such as myalgia, fatigue, headache, shivering, fever, or gastrointestinal illness. CDC recommends Shingrix® (recombinant zoster vaccine) as preferred over Zostavax® (zoster vaccine live) for the prevention of herpes zoster (shingles).

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“Lead Exposure May Be as Deadly as Cigarettes”

Apr 29, 2018

Lead exposure may be killing as many Americans as cigarettes. A new analysis using data from the Third National Health and Nutrition Examination Survey (NHANES-III) showed blood lead levels in adults not currently considered to be harmful are associated with an increased risk of death from cardiovascular disease, as well as a greater likelihood of dying from any cause. Lead exposure is a leading, but largely ignored, risk factor for cardiovascular disease. Chronic lead exposure is a known contributor to hypertension and cardiovascular disease. Lead exposure occurs when lead dust or fumes are inhaled, or when lead is ingested via contaminated hands, food, water, cigarettes or clothing. Lead particles or dust can be brought into the home and family vehicle on work clothes and equipment. This is called “take home” lead and it can harm anyone who is exposed. Lead entering the respiratory and digestive systems is released to the blood and distributed throughout the body. More than 90% of the total body burden of lead is accumulated in the bones, where it is stored. Lead in bones may be released into the blood, re-exposing organ systems long after the original exposure. The toxic nature of lead is well documented. Lead poisoning in children is especially dangerous because it can cause learning problems and serious illness. Lead affects all organs and functions of the body to varying degrees.

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“Johnson and Johnson Facing Devastating Lawsuits”

Apr 22, 2018

J&J, based in New Brunswick, New Jersey, faces talc-related lawsuits by 6,610 plaintiffs nationally, largely based on claims of developing ovarian cancer by using its products for feminine hygiene. J&J, which had $76.5 billion in sales in 2017. In February of 2016, a jury found J&J talcum powder contributed to a 62-yr old woman’s ovarian cancer and awarded her $72 million for compensatory damages. Another $62 million in punitive damages was awarded to her family members, as she died last fall. Then, in May of 2016, another woman was awarded $55 million in damages after talc imbedded in her ovaries was found to have contributed to her cancer. Still, manufacturers of talc-containing products, such as J&J and its Baby Powder and Shower to Shower products, have refused to acknowledge the link between talc and ovarian cancer and have failed to adequately warn consumers of the risks. In five trials in Missouri involving ovarian cancer lawsuits, juries found J&J liable
four times and awarded the plaintiffs a total of $307 million. In California, a jury awarded a now-deceased woman $417 million. But in October, a Missouri appellate court threw out the first verdict there for $72 million and a California judge tossed the $417 million verdict. J&J is seeking to reverse the other verdicts. Asbestos claims are a more recent challenge for J&J.

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“Prostate Cancer of High Risk is Increasing”

Apr 15, 2018

Epidemiologic evidence indicates that more men are now presenting with higher-grade, more invasive prostate cancer in the wake of 2012 recommendations from the US Preventive Services Task Force (USPSTF) not to routinely screen asymptomatic patients to detect early disease. There has been a consistent, stepwise increase in cancers of higher Gleason score, as well as a stepwise increase in the median level of prostatic-specific antigen (PSA), in the 4 years after the USPSTF recommendations were released. At the same time, both surgical volume and the proportion of low-grade cancers have been dropping. Experts say, “Treating high-risk disease has its limitations, because you are not going to cure the majority of patients no matter what you do, so the better answer is to diagnose prostate cancer earlier.” They also say, “If our data are correct, the most important thing to do is to start screening more intensely again.” According to the American Cancer Society (ACS), in the United States, there will be nearly 61,360 new cases of prostate cancer diagnosed this year and about 26,730 deaths from the disease.

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“Sinus Infections May Not Require Antibiotics”

Apr 08, 2018

Most people prescribed antibiotics for sinus infections are treated for 10 days or longer, even though infectious disease doctors recommend 5 to 7 days for uncomplicated cases. But, is this necessary or recommended? A sinus infection, called acute rhinosinusitis, is inflammation of the nasal and sinus passages that can cause uncomfortable pressure on either side of the nose and last for weeks. Most sinus infections develop during or after a cold or other upper respiratory infection, but other factors such as allergens and environmental irritants may play a role. Nearly one in seven people are diagnosed with a sinus infection each year. The vast majority of sinus infections are caused by viruses and should not be treated with antibiotics, suggest new guidelines released by the Infectious Diseases Society of America (IDSA) in 2012. Although sinus infections are the fifth leading reason for antibiotic prescriptions, 90 to 98 percent of cases are caused by viruses, which are not affected by antibiotics. Used inappropriately, antibiotics foster the development of drug-resistant superbugs. Common side effects of antibiotics can include rash, dizziness, nausea, diarrhea, and yeast infections. More serious side effects may include life-threatening allergic reactions and Clostridium difficile infection.

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“Bread, Health and a Slice of Confusion”

Apr 01, 2018

For decades, we have heard that whole grain bread is healthier than white bread. But, is this true? A new study reveals that there is no difference between the health effects of “wholesome” and white bread. Bread occupies a unique place in our diet: it accounts for about one–tenth of the calories many people in the West consume and up to 40% of the caloric consumption in some non–Western countries – more than any other food product. In the past few decades, since white bread has acquired a bad name, bakeries have been going out of their way to produce high–quality whole grain breads. But, a new study conducted at the Weizmann Institute of Science and published recently in the journal Cell Metabolism reveals that these “wholesome” choices are not necessarily the healthiest for everyone. Tests revealed that eating bread of any kind affected the blood levels of sugar, minerals, liver enzymes and other substances. But when the scientists compared the effects of the two types of bread, they were surprised. “We were sure that the sourdough bread would come out a healthier choice, but much to our surprise, we found no difference between the health effects of the two types of bread,” said Prof. Eran Segal of Weizmann Institute’s Computer Science and Applied Mathematics Department.

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“Burnout Suffered by 42% of Physicians”

Mar 25, 2018

A recent Medscape survey found that 42% of physicians report burnout. Physicians face “assembly-line medicine pressures,” merciless scheduling demands, battles with insurance companies, increasing regulations, and an explosion in scientific literature with which their knowledge must remain current. Their debt burdens often total hundreds of thousands of dollars, and they struggle in constant fear of malpractice suits. In medical school, professors teach their driven young students to put their own emotions aside, even as they attend to tragedy. A Mayo Clinic study showed an association between burnout and declining professional satisfaction with physicians reducing the number of hours they devote to clinical practice. Tragically, an even greater problem is the high rate of suicides amongst physicians and at least 400 doctors kill themselves annually, as of 2015. The current body of knowledge suggests burnout is driven by external factors, such as inefficient work processes, long work hours, heavy workloads, work–home conflicts, and organizational culture considerations. In 2018, 1,528 physicians at the Cleveland Clinic Health System were surveyed with the medical personnel version of the Maslach Burnout Inventory.

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