Monday, January 23, 2012

Is Your Dog Eating Better Than You Are?

The line between pet and people food continues to blur as manufacturers promote human grade food. The market for organic pet food accounts for 7% of sales and households are not trading down even as household budgets become tighter. In fact, the market for bottled vitamin-infused mountain spring water for dogs is burgeoning.
The New York Times wondered if pets are healthier for this trend. Tony Buffington, a professor of veterinary nutrition at Ohio State University, says his students have studied the diet history of thousands of animals and have not yet determined that one pet food brand is better than another. “We have been unable to distinguish an outcome in healthy animals eating a wide variety of foods,” he says. 
America’s pets are joining their owners in the obesity epidemic. Obese dogs (15% than their optimal weight) are at risk for diabetes and joint and locomotion problems, as well as an increased incidence of cancer and high blood pressure. The leading causes of obesity in pets are unlimited access to food and overfeeding of highly palatable foods.
People truly consider their animals to be part of the family. Every member of the family – including the humans – should be offered reasonable portions of high quality food, limit the junk and take long walks many times a day.

Wednesday, January 18, 2012

Too Much Information?

Physicians are constantly interrupted – it’s a part of the job to respond to staff questions, pharmacy messages and calls from other physicians. Now there is concern that electronic devices cause distractions that could harm patients.

More than 80% of physicians carry smartphones and almost as many use iPads and other tablet computers. Many health professionals are using mobile devices while delivering care: looking up pharmaceutical references, accessing patient information, educating patients and communicating with colleagues. The problems arise when non-clinical messages interrupt – one can’t predict what that buzzing is about.

Even the most mentally facile don’t have the unlimited ability to pay attention to many things at once. No matter how well trained the physician, it is better to complete a task than try to engage in parallel tasks. But mobile-tech devices do allow us to work more efficiently and more accurately – it’s far easier to determine complex drug interactions with computer assistance.

Some health care organizations will only allow the use of employer-supplied mobile devices that restrict access to social networking and personal email sites. We physicians manage competing demands for our attention. It’s important that we don’t become overwhelmed by outside information.

Adding to the fray – it’s very disruptive when a patient’s cell phone erupts during a visit. The patient become distracted if he answers and equally distracted if he doesn’t answer and wonders what he missed.

Saturday, January 14, 2012

Diabetes FAQs

Q:        When should we screen for diabetes?
A:        In the following circumstances:
Family history of diabetes mellitus
Cardiovascular disease
Being overweight or obese
Sedentary lifestyle
Nonwhite ancestry
Previously identified glucose intolerance, impaired fasting glucose or metabolic syndrome
Increased levels of triglycerides, low concentrations of high-density lipoprotein cholesterol, or both
History of gestational diabetes mellitus Delivery of a baby weighing more than 4 kg (9 lb)
Polycystic ovary syndrome
Antipsychotic therapy for schizophrenia and/or severe bipolar disease

Q:        What is the target glucose?
A:        No one answer; the target should be individualized and take into account:
Residual life expectancy
Duration of disease
Presence or absence of microvascular and macrovascular complications
Other cardiovascular risk factors
Other medical conditions
Risk of severe hypoglycemia
The patient's psychological, social, and economic status

Q:       Does close blood sugar control really matter?
A:       Although it is uncertain that the clinical course of established CVD is improved by strict glycemic control, the progression of microvascular complications clearly is benefitted.

Q:       What is the target blood pressure?
A:       The blood pressure goal for persons with DM or prediabetes is less than 130/80 mm Hg.

 For more information: AHRQ Research on Diabetes Care

Wednesday, January 11, 2012

Drink Water

Two professional snowboarders are garnering support in their campaign to eschew energy drinks in favor of water. Austin Smith and Bryan Fox say that their opposition to energy drinks is due to the ingredients. In addition to sugar and caffeine, the drinks contain guarana (a plant with caffeine), taurine (an amino acid) and ginseng. The Food and Drug Administration does not regulate energy drinks. (It does regulate traditional soda drinks.)

Caffeine in particular is not recommended for youngsters. In anyone, excessive caffeine intake can increase blood pressure and the heart rate. In some people, excessive caffeine can cause irregular heart rates, hyperactivity and anxiety. Few people in the United States are in need of more sugar.

Red Bull dominates 40% of the energy drink market. None of its products contain substances banned from performance sports events. Red Bull’s official position is that “athletes should combine plenty of water with physical activity and energy drinks.” The best liquid for hydration, even at high-level athletic activity, is water. As fellow citizens of the planet, we should lessen our footprint by avoiding one-use drink containers.

Much of the world does not have access to clean water and sanitation. Learn more at 

Sunday, January 8, 2012

Hip Fracture

Hip fractures can have life-changing consequences in the elderly. The acute mortality from hip fracture is 3%-5%; the lifetime risk for death from hip fracture is similar to that from breast cancer. Fewer than half the patients with hip fracture fully recover the ability to perform all the basic activities of daily living. Outcomes are even more grim for those who have post-operative complications.

About 70% of fractures occur in women; osteoporosis is the main risk factor. Surgery is usually required for repair.

To prevent a hip fracture:
·         Keep bones strong with a nutritious diet, adequate amounts of calcium and Vitamin D and stay physically active.
·         Consider taking medication to treat bone loss associated with osteoporosis.
·         Reduce the risk of fall remedying household hazards such as slippery floors, poor lighting and cluttered walkways.
·         Wear well-fitting, low-heeled shoes and use walking aids correctly.
·         Review all medications with your doctor and take only as directed.

An excellent review is about hip fracture is available from the American Academy of Orthopedic Surgeons. Even better: how to prevent osteoporosis from the National Institute of Arthritis and Musculoskeletal and Skin Disease.

Friday, January 6, 2012

Less Sodium as a Goal

High dietary sodium intake can increase blood pressure and the risk for heart disease and stroke. The current recommendation is to limit daily intake of sodium to 2300 mg daily, but persons older than age 51, African-Americans and persons with hypertension, diabetes or chronic kidney disease should limit intake to 1500 mg daily. This group, which tends to more responsive than others to the blood pressure-raising effects of sodium, is more than 47% of the US population.

Approximately 75% of sodium consumed is added to commercial foods during processing or to restaurant foods during preparation; only about 25% occurs naturally or is added at the table or during cooking by the consumer. The Institute of Medicine has outlined strategies to set mandatory sodium content for processed and restaurant foods as well as improved labeling.

The United Kingdom has reduced sodium intake by 9.5% over the past eight years via a government-manufacturer partnership. If a similar reduction were achieved in the United States, there would be a $4 billion health care savings per year.

For more information about the National Health and Nutrition Examination Survey at the CDC.

Guidelines for low-sodium diets.

Tuesday, January 3, 2012

Dairy Avoidance

The National Dairy Council has sponsored a monograph on the unintended consequences of dairy avoidance. Dairy consumption in the United States has been declining steadily since the end of World War II, both due to personal choice and reduced availability and inconvenience. (Fast food meals most often come as a “package” that includes a carbonated beverage rather than milk and milk is seldom an option in vending machines.)

Dairy products are good sources of calcium as well as many other micronutrients. Especially in low-fat options, dairy products have high nutrient-to-calorie ratios. The protein in dairy products is the richest source of the branched chain amino acids needed for muscle metabolism and insulin responsiveness. In weight reduction diets, high intake of branched chain amino acids help preserve lean muscle mass and encourage weight loss from fat tissue.

Lactose, the sugar found in milk, is broken up in the small intestine by the enzyme lactase. In all people there is a progressive physiologic decline in intestinal lactase activity that begins sometime after weaning and continues into old age. This incomplete loss of enzyme activity is especially prominent in individuals of East Asian, Hispanic and African ancestry. Not everyone who has lactose maldigestion has lactose intolerance and there are easy adaptive steps that one can take to tolerate dairy products. Lactose-free dairy foods are widely available and lactase enzyme supplements (Lactaid) can be taken with the first bite or sip of dairy foods. Dairy foods are best tolerated if taken with other foods (other proteins and fats). If there has been some distress with eating dairy products in the past, dairy foods should be slowly introduced and gradually increased as tolerated. In response to today’s typical diet, the National Medical Association, the voice of African-American physicians, has urged the inclusion of dairy products in the adult diet.

When choosing dairy products, do make wise choices: ounce for ounce, skim milk has more of a nutritional punch than frozen yogurt.

Sunday, January 1, 2012