Monday, February 25, 2013

You Are What You Eat

Two news stories in the past two days caught my eye, reinforcing my belief that you are what you eat. The benefits of the Mediterranean diet have been widely touted but now there is good statistical evidence that a diet rich in olive oil, fruits, vegetables, beans and nuts will reduce the risk of heart disease and strokes. The merits are there even if one doesn’t lose weight and adds to the benefits of taking medications to lower blood pressure and cholesterol. The participants in the study avoided commercial cookies and pastries and limited their intake of red meat and dairy products. Wine could be enjoyed with meals.

Gluten intolerance, once rare, is now becoming almost commonplace. There is a growing body of evidence that manufactured food given to infants and small children may play a role. Breast-feeding beyond six months seems to convey life-long protection from celiac disease along with many, many other benefits. It appears that sticking with simple grains that are minimally processed is a good idea for people of all ages.

In my opinion, food comes out of the ground. What emerges from a factory wrapped in plastic is not food. Animals should be treated with respect. If you choose to eat meat/fish/chicken, those animals should be well-fed, be allowed exercise and slaughtered humanely.

Michael Pollan: "Eat food. Not too much. Mostly plants."

Monday, February 11, 2013

One in Eight

One is eight American women will have a personal encounter with breast cancer. A young woman far more clever than I is blogging about her experience. For PG-13 to R rated real time reports, read this.

Sunday, February 10, 2013

Should the Annual be every year?

The ‘yearly’ physical examination is an opportunity for the patient and physician to spend focused time on health maintenance and disease prevention. If a recommended preventive service is missed one year we can catch up at the next visit. The visit also nutures the patient-physician relationship.

For women, there are 21 measures that earn a A or a B rating as showing evidence for effectiveness in maintaining health or preventing disease.  Mammography is the 22nd measure. What is NOT effective is an annual pelvic examination.

As we attempt to better allocate our health care dollars, we need to think about what procedures are supported by evidence and which are performed merely out of habit. There no clear reasons to perform a yearly pelvic examination in women who have no symptoms and for whom a Pap test is not due. In 2012, Pap test guidelines were resolved to recommend a standard cytology examination every three years. In women between the ages of 30-65 the testing interval can be increased to every 5 years if the HPV test (done at the same time as the Pap test) is negative. No need for testing in the asymptomatic woman after age 65.

Many women believe that that pelvic examination screens for ovarian cancer; sadly, this is not true. Also, pelvic examinations are not needed to start or continue oral contraceptives.

There is evidence that many women avoid routine care because of the dreaded pelvic examination. These women are denying themselves the chance of obtaining a personalized program to help stay well. 

Monday, February 4, 2013

Iron Deficiency

Iron deficiency is the most common nutritional disorder worldwide; the low blood counts that result can be caused by inadequate iron intake, decreased iron absorption, increased iron demand and increased iron loss. Iron is a building block for making new red blood cells.  

The diagnosis of iron deficiency is quite straightforward with some simple blood tests. Once the deficiency is identified, the goal is to determine the cause. Excessive menstruation is a common cause in premenopausal women. In men and postmenopausal women blood loss via the gastrointestinal tract is suspect. The first step in evaluating the GI tract includes upper endoscopy and colonoscopy. These tests will both look for source of blood loss and celiac disease. The tests will need to be repeated if initially negative and the patient doesn’t respond to treatment. 

The initial treatment is oral iron, which can truly be a tough pill to swallow. Common side-effects are chest pain, nausea, diarrhea and constipation. Side-effects are less when iron is taken with food, but the iron may not be as well absorbed. Certain medications (stomach acid blockers) are associated with decreased absorption as well. Intravenous iron may be considered if oral therapy is not effective in raising the blood count. 

Since the red blood cells carry oxygen, a very low blood count can be life-threatening and the patient will be transfused. There is no universal guideline as when to transfuse – the clinical condition will determine the threshold. In pregnancy, the health of the fetus is a concern.