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Monday, June 28, 2010

ask for the brown rice, not the white

It has been known for some time that brown rice has a much better glycemic index (that is, they cause blood sugar to rise more slowly) than white rice. Similarly, whole wheat flour has a ower glycemic index than white flour. Nutritionists and doctors and the American Diabetes Assocation have been recommending for years that diabetics choose foods made with whole grains over those made with refined grains. Now a new study by Harvard School of Public Health researchers confirms that those who eat brown rice have a lower risk of developing diabetes than those who eat white rice. The researchers estimate that if 50 grams of white rice were replaced by 50 grams of white rice daily, a person would have a 16% lower chance of developing diabetes.

The other day I ate in a Chinese restaurant in San Francisco. I asked the waiter if I could get brown rice, but the restaurant did not serve it. Given the large number of people of Asian origin in San Francisco who frequent such restaurants, perhaps the city should develop an education program for restauranteurs about the benefits of brown rice and other whole grains.

coffee and Alzheimer's

A recent study commented on by NPR today indicates that mice who ingest large amounts of caffeine (equivalent to 5 cups of coffee a day for humans) develop a lot fewer of the characteristic brain changes of Alzheimer's disease, suggesting that caffeine may be protective against the disease. There are also some studies of humans which suggest that caffeine may be protective against Alzheimer's disease. However, before you decide to drink 4-5 cups of coffee a day, you may wish to consider the negative effects of caffeine, including increased anxiety and nervousness, tremor, faster bowel movement, and diuretic action. Nonetheless, these studies should make heavy caffeine drinkers feel better about the fact that they never really get to sleep very well....

Monday, June 21, 2010

Dr. Oz and Roizen's Real Age website

I checked out Dr. Oz and Roizen's Real Age web page. Lots of very nice stuff for risk and health assessment. Not everything is 100% accurate and up to date (for example, the program dinged me for a "cholesterol problem" because my total cholesterol was over 200, although my HDL cholesterol was 80...whereas according to my reading of the literature, my risk is not elevated with this combination. But it's pretty good. The ads also seem to be filtered so that good products are featured. My only problem with it is that taking the questionnaire can only be done in the context of setting up an identified account, and doing that means that personal health information is linked to identifiable data. If such data are not encrypted in transmission, and on their server, it would seem to me that it would violate HIPAA. In addition, the program had a link saying "switch to SSL (secure socket layer)", but when I tried to do even this, it didn't work. This is my only concern about the site. They will have to do a better job of security before I would feel comfortable recommending that you fill out any of their questionnaires unless you can fill out something without identifying yourself.

That said, the Qi Gong video was extremely nice, and there's lots of other stuff to jumpstart your diet and exercise changes!

Molasses - healthier than sugar

A friend of mine likes to make his own licorice with anise, molasses and whole wheat flour. It tastes absolutely delicious, and bears absolutely no relationship to the processed junk sold as licorice commercially these days. I wondered whether there was anything to recommend this as a healthy carbohydrate serving. The whole wheat flour is a good start. The anise is fine for most people (licorice and other anise containing foods have a mild diuretic effect and can cause a "metabolic alkalosis", that is too much base in your blood, particularly if you are taking certain medications, so if you do take medications regularly, you should ask your doctor about it). So, I began to explore the nutritional value of molasses.

It turns out that blackstrap cane molasses (a byproduct of making sugar from sugar cane, the stuff that's left after cane is twice boiled to remove sugar), may be the healthiest form of sweetener containing sugar that there is. 2 teaspoons of molasses has about the same number of calories as 1 teaspoon of sugar, but also has healthy amounts (about 25% of the FDA's recommended daily values) of iron, potassium, calcium, and manganese. Sugar and even raw honey have nothing like these quantities of healthy minerals.

So, molasses seems like something you could enjoy like jam - in small quantities as an occasional treat or dessert on some whole wheat or whole multigrain bread - and you'll get some nice nutrients when you do. Just watch the total amounts, and eat it together with something less sweet, because its biggest component is sucrose (table sugar) and diabetics and people on weight loss diets should avoid it because it has a low "glycemic index" (that is, it makes your blood sugar go up quickly and gets insulin to kick in, leading to the quick drop in blood sugar that gives you hunger pangs and makes your body want to eat more sweets). So if you do indulge, try to eat it together with other things, like whole wheat bread or some protein, that have a lower glycemic index and will ofset that quick peaking with a more gradual rise in blood sugar that will prevent the insulin from kicking in.

Modifiable factors in stroke risk

The INTERSTROKE study, an international study of stroke risk factors was recently published in the Lancet, and shows as you might have expected the modifiable risk factors which play the greatest role in stroke risk. The number one factor is high blood pressure, which can be reduced by reducing salt intake and exercising more, and if that doesn't work, taking medications to reduce blood pressure. Smoking, abdominal obesity (fat around the middle!), diet, and reduced physical activity were other factors which together with high blood pressure accounted for 80% of ischemic stroke risk (ischemic stroke means a stroke that happens because of a reduction of oxygen flow to the brain, usually due to a clot in a blood vessel), and 90% of the risk of having a hemorrhagic stroke (due to bleeding into the brain) in the study.
Additional risk factors for a clot-type stroke included diabetes, alcohol intake, psychosocial factors, the ratio of apolipoproteins B to A1, and other heart diseases (arrhythmias such as atrial fibrillation or atrial flutter, previous heart attack, and valve disease). Hypertension, smoking, abdominal obesity, diet, and alcohol intake were the most important risk factors for a stroke due to bleeding into the brain. '

Anything new here? No! But it's interesting to note that these results were the same all around the world.

Friday, June 18, 2010

Insurance Companies Invest in Fast Food

Interesting article in American Journal of Public Health (click here for an abstract of the article) describing insurance company investments in fast food companies. The surprise is that this even makes the news. First, is anyone still under the impression that health insurance companies care if you live longer or are healthy? They are basically just claims processing outfits. In fact, the higher health costs and therefore health insurance costs, the more they grow their own organizations, since they pay themselves as a percentage of premium.

Second, I experienced myself as a member of the Board of Trustees and a member of the Fund Management Committee at a health-related nonprofit that most companies are not watching carefully what their financial advisors are investing their money in. Unless an external group makes a fuss about it, even the top leadership of the company may not realize what these investments consist of. Investment and fund management committees tend to be run by finance folks and treasurers, and for these people getting the best return is the most important thing. The meetings are dominated by concern about the financial state of the organization. In the ones I was involve in, they are not paying much attention to the mission of the organization as they make their investments, beyond their basic thought that they can do better with their mission if they make money on their investments.

So this did not come as a surprise to me. An analysis of the investments of endowment at our universities, and investments of endowment by other health related organizations such as health care foundations and medical provider organizations would show exactly the same thing, I am sure.

Of course our government is also ignoring our health in the companies it subsidizes...

Monday, June 14, 2010

sign up to receive tweets

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Getting Physicians in your Family Involved in Your Care

Back to one of my favorite topics...(take our poll at the top left of the blog page)...whether it is a good idea for a physician in your family to be involved in your medical care. Clearly for people with physicians in their families, this occurs a lot. See, for example, this study about neurologists, most of whom prescribed for themselves and their family members. Or the 1991 study by LaPuma, showing that physicians on staff in a community hospital reported frequently treating family members. It is interesting that despite the commonly held ethical guideline that physicians should not treat their family members or should exercise care in doing so doing to many reported pitfalls, there has been no empirical data on this topic telling us if people tend to do better or worse than expected if treated by family members. Will someone do a study about this, please?

Whether we believe that physicians should actually administer treatment, such as prescription, or do surgery on family members, or actually do diagnostic tests, a physician in the family can often provide excellent advice about what to do next or whom to see or where to go for treatment. It is simply foolhardy not to take advantage of medical expertise in your own family, particularly if the physician is a relative you are close to and there is mutual familial feeling and caring between you.

Retinyl palmitate in sunscreen

Although we do not have definitive evidence, it seems best to avoid sunscreens with retinyl palmitate as you head out to the beach.


Tuesday, June 8, 2010

low fat and sugar frozen dessert treats for summer

For those who can tolerate ice milk, here's a recipe that's low fat and sugar:
2 cups organic milk (use whole milk)
1 cup blueberries
1 banana
1 tbsp sugar
Mix all ingredients in blender.
We used an ice cream ball with ice and rock salt, tossed it around a little, and in 15 minutes had a very lovely ice milk for dessert. Makes 3 servings.

By the way, frozen bananas make a lovely dessert too, all by themselves. Peel bananas and freeze them in a freezer safe container. You can microwave them on defrost for 1 minute when you take them out if they are too frozen to eat. They taste delicious, just like banana ice cream. I serve them with berries.

get your children to eat their (dark green & yellow) veggies

Another study about dark green and yellow vegetables...in brief, surprise, surprise, they're good for you. In particular, children get less fat and have better bone health.

Thursday, June 3, 2010

Vitamin D insufficiency and deficiency

Vitamin D deficiency is less than 20 but 20-30 is considered "vitamin D insufficiency". I've not found very impressive data on how prevalent various symptoms are with vitamin D insufficiency as opposed to vitamin D deficiency. A National Institutes of Health fact sheet is available. http://ods.od.nih.gov/factsheets/vitamind.asp#en13It appears that "insufficient" folks can have cognitive problems, mood problems, and reduced calcium absorption, so it seems best to get more Vitamin D if your level comes back in this range. Current guidelines say to aim for a level of 50 to 80, so if you're below 50 you may wish to take a Vitamin D supplement to get your level up.

What's the right supplement? You should take Vitamin D3 since Vitamin D2 does not bind as well to the binding proteins in the blood and does not store as well in the body to increase total body stores. If you are insufficient, take 2000 IU per day of Vitamin D3 until your level comes up to the desired region. A recent study showed that people who were given one high dose of Vitamin D3 instead of a daily dose to bring up their level actually had more falls and fractures than a control group. So high single dose supplmentation is not recommended.

How can you increase it in your diet? Sardines and wild salmon are two good sources.

And, of course, 20 to 30 minutes of sunshine between 10 and 2 on bare skin, especially if you live in a climate like California's, will give you a nice dose of Vitamin D. Be careful not to burn, and if you don't want wrinkles, put it on your face and the back of your hand, and let the Vitamin D metabolism happen in the arms and legs.

What's too high? In the study in which people fell more after high doses, their levels were up to 120, and as their levels came down, the fall and fracture risk came down too. So it's recommended to keep the level between 50 and 80.

This post was written on 6/3/2010. New information may come available, so this information should not be relied upon as state of the art. A blog is no substitute for a doctor. Before acting on advice on any post on this website, check with your physician. If you wish to consult me for advice, please go to www.myadvicedr.com and follow the instructions to get a free 15 minute consultation and subscribe to the practice.