Breakfast Dessert

I am a devoted breakfast eater. Since I don’t snack after dinner, it’s been many hours since I last ate and I am famished in the morning. My usual breakfast is a slice of whole-grain bread with a protein, such as peanut butter or cheddar. I do sit down and enjoy my food, but I have just enough time to get out the door to make sure that I get in front of the school bus. However, on leisurely Sundays I add a second course: breakfast dessert.

Breakfast dessert ranges from pumpkin pie in November to birthday cake in the summer to cookies at any time. Tastykakes are a given down the Jersey shore. I suppose that pain chocolat could also be considered breakfast dessert as well.

It turns out that I have been on the forefront of nutritional science. Researchers in Israel studying weight loss strategies reports that obese participants who ate a breakfast high in protein and carbohydrates that included a dessert were better able to stick to their diet and keep the pounds off longer than participants who ate a low-carb, low-calorie breakfast that did not include sweets.

In the study, all participants ate the same number of calories and lost about the same amount of weight. However, during a follow-up period in which participants were advised to stick to the diet, but could eat more if they were motivated by hunger cravings, the small breakfast group gained 24 pounds, while the big breakfast group lost 15 pounds, on average.

Those who ate the big breakfast with the dessert had lower levels of the "hunger" hormone ghrelin, and fewer food cravings than those who ate the small breakfast, without dessert. When we diet, we're hungrier, ghrelin levels rise and there's a decrease in our metabolism. A larger breakfast that includes protein, carbs and sweets may counteract these changes.

Enjoy breakfast dessert! As always, moderation is key: make wise choices and control portion sizes.

Osteoporosis

The FDA released a review this week that indicates that certain osteoporosis medications (bisphosphonates) may not provide additional fracture prevention benefit if taken for more than five years. Patients with less severe osteoporosis are most likely not to benefit from additional therapy. The information comes in the wake of previous studies showing troubling side-effects from such medications.

A hip fracture can be a life-changing event; it is too often a life-shortening event. An ounce of prevention is worth a pound of cure! The most important interventions to prevent osteoporosis are diet, exercise and not smoking. These recommendations apply to both men and women.

Experts recommend that premenopausal women and men consume at least 1000 mg of calcium per day; this includes calcium in foods and beverages plus calcium supplements. Postmenopausal women should consume 1200 mg of calcium per day (total of diet plus supplements). Adequate vitamin D intakes reduces bone loss and fracture rate when the calcium intake is adequate. Blood tests can measure the vitamin level; generally a daily supplement of 800 to 1000 IU of Vitamin D3 will ensure a good blood level.

Exercise may decrease fracture risk by improving bone mass in premenopausal women and helping to maintain bone density for women after menopause. Furthermore, exercise may decrease the tendency to fall due to weakness in both men and women.

Stopping smoking is strongly recommended for bone health because smoking cigarettes is known to speed bone loss.

One can read further information about preventing osteoporosis in Up to Date. The National Osteoporosis Foundation has a response to the bisphosphonate controversy and is an excellent resource for bone health for men, women and children. 

Appendicitis

A recent article in the British Medical Journal delivered the surprising news that not every case of appendicitis requires surgery. The authors followed 900 patients and found that patients treated with antibiotics had the same rate of complications versus good outcomes.

Early appendectomy has been the norm when the diagnosis of appendicitis is suspected or confirmed at admission in the belief that this may prevent complications such as perforation or peritonitis. This practice stems from the belief that appendicitis is a progressive disease and any delay in treatment increases the risk of complications. Increased diagnostic accuracy with CT scans and the better patient tolerance of laparoscopic surgery has reduced the threshold for surgery for appendicitis that may have resolved spontaneously. Initial use of antibiotics to treat appendicitis may delay an appendectomy in patients who are not improving, but this delay does not lead to an increased risk of complications. The overall risk of complications is lower, as appendectomy is avoided in two-thirds of the patients.

Starting antibiotics when the diagnosis of uncomplicated acute appendicitis is made, with reassessment of the patient, will prevent the need for most appendectomies. Oral antibiotics can be continued after discharge, allowing potentially shorter hospital stays.

This information is interesting, but preliminary and needs to be more widely tested. Appendicitis is not a do it yourself item! The usual symptoms of appendicitis include severe pain the right lower part of the abdomen, often starting near the belly button and then moving to the right lower side, loss of appetite, nausea and vomiting and fever. These symptoms warrant a prompt medical evaluation.