EMOTIONAL STATUS AND SURVIVAL: WHAT DO WE KNOW?

 

emotions

All of us have heard the expression, “I am worried to death!” But is this merely a figure of speech, or is there any literal truth to such a statement? So let’s take a look at what science has to offer:

Multiple studies have shown that people who are lonely and depressed are over three times more likely to get sick and die prematurely—in contrast to people who are not depressed, and especially those who have a stronger sense of love, connection, and community. For example, one report disclosed that 6 months after a heart attack, people who were depressed were four times more likely to die than those who weren’t depressed. This was independent of the usual risk factors like cholesterol, blood pressure, weight, and even smoking. Consistent with that observation, there have been hundreds of studies showing that people who are lonely and depressed are many times more likely to get sick and die prematurely—from all causes as well as heart disease—when compared with those who have a strong sense of love, connection, and community. Such observations are consistent with studies that have shown that being married—at least happily—are actually good for your heart. In one recent survey out of New York University’s Lagone Medical Center, researchers found that married men and women had a five percent lower chance of cardiovascular disease compared to single people. We aren’t entirely sure why, but it’s possible that since marriages typically offer a person emotional support, physical and intellectual intimacy, as well as deeper social ties to family, they might improve overall health.  Consistent with this concept, one study found that people in a bad marriage were actually more likely to experience negative cardiovascular effects, compared to people in good marriages. Thus it’s not necessarily about whether you’re married or not, it’s all about how happy it’s making you.

This raises the question of whether the adverse outcomes are due to the emotional disruption or to the poor lifestyle choices made by those who are depressed or nervous. It is true that some people who are lonely and distraught are more likely to do things that are self-destructive, for example, smoke excessively or fail to take medicines as prescribed. But these explanations seem to fall short of the real truth, as explained below.

There are ways that mental health issues can directly affect heart disease, as reflected in the growing belief that depression and anxiety are risk factors that are even more dangerous than others such as diet. Stress can increase hormones like adrenaline and cortisol, and can impact one’s blood pressure and heart rate in an unfavorable way. Moreover, people with depression have been found to have uncommonly sticky platelets, the tiny cells that cause blood to clot. In patients with heart disease, this can accelerate atherosclerosis (hardening of the arteries) and increase the chance of heart attack. Some studies suggest that treating depression makes platelets less sticky again.

Even animal studies have demonstrated that positive emotional support can foster better health. One study dealt with atherosclerotic rabbits.  Rabbits were put on a high-cholesterol diet with the assumption that they would all get heart disease. The rabbits were stacked in cages up to the ceiling, and the ones up high got heart disease a lot more than the ones in the lower cages, which made no sense. What they found was that the lab technician, who was short, would come in to feed the rabbits and would play with the ones in the lower cages because she could reach them, and she would ignore the ones in the higher cages. The study was repeated with genetically comparable rabbits fed the same diet, and they randomly divided the rabbits into two groups. With one group they would take the rabbits out of the cages, play with them, and love them They found that the rabbits that were touched, talked to, petted, and played with had 60% less atherosclerosis than those that were ignored, even though their serum cholesterol levels, heart rate, and blood pressure were comparable.

Similar findings have been reported with male monkeys, for those that were stressed had significantly more extensive coronary artery atherosclerosis compared with a control group of monkeys that weren’t stressed, even though their cholesterol, blood pressure, blood sugar, weight, etc. were not different.

In medicine, we focus on what we can see and measure easily. We can measure cholesterol and blood pressure easily so we tend to focus on those things. The American Heart Association still doesn’t list emotional stress in their seven key modifiable risk factors. There is a saying that not everything that counts can be counted. In other words, not everything that is meaningful is measurable. We tend to focus on what is easily measurable, even though these psychosocial factors are probably as important—and in some ways, even more so.  Scientists are getting more innovative at measuring these factors. In a recent study, researchers analyzed 148 million Twitter messages (tweets) across the United States and found that language patterns reflecting negative social relationships, disengagement, and negative emotions—especially anger—were risk factors for heart disease at a county level and were even more predictive than smoking, diabetes, hypertension, and obesity. In contrast, positive emotions and psychological engagement were protective.

Maintaining a positive attitude about treatment and holding the belief that our actions can have a beneficial effect on our own health are very important. A person’s attitude seems to have a powerfully favorable effect on their ability to make behavior and lifestyle changes that are often necessary to reduce the risk of having future health problems. A person’s attitude also influences the response to treatment.

So what can we do about these emotional problems, and can countermeasures alter one’s odds of survival?

Although treatments such as psychotherapy and drugs are often used to improve emotional status, the results of such measures are complicated and difficult to measure, leaving us in doubt about their individual effects on survival. Regular exercise, however, has been proven to reduce both depression and risk of disease. Various studies have shown that participation in exercise training programs was comparable to treatment with an antidepressant medication (a selective serotonin reuptake inhibitor) for improving depressive symptoms in older adults diagnosed with major depression.  Exercise per se also offers significant protection against heart disease and many cancers as well.  Included among the many benefits of regular exercise is the lessening of the likelihood of upper respiratory infections and reduction of the severity of symptoms if you do get one. The reason for this protection is unclear, but exercise’s demonstrated reduction of inflammation and its boosting of general immunity in the body may play a role.

Conclusion

Although it’s difficult to separate and determine the effects of pure emotional support on survival, it is highly likely that such countermeasures are effective. Regardless, however, combating depression and anxiety and promoting more social interaction that include love and respect are beneficial goals in themselves, making for a happier and healthier individual, and hopefully, a longer life as well!

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THE “DEATH” OF THE DEATH PENALTY?

      executions

For a host of legal and political reasons as well as the scarcity of lethal drugs for injection, the number of executions has declined in the U.S. to just 28 in 2015, compared with a recent peak of 98 in 1999. Because of difficulties in obtaining lethal drugs, some states have approved alternative means such as firing squad or gas chamber as more “delectable” means of dispatching wrongdoers. Methods by state are summarized below:

  • Electrocution in Florida, Oklahoma and Tennessee.
  • Gas inhalation in California, Missouri, Oklahoma and Wyoming.
  • Hanging in Delaware and New Hampshire.
  • Firing squad in Oklahoma and Utah.

But this controversy invites the larger question of whether there is any overall justification for this, the severest, of penalties. (Full disclosure here: I am firmly opposed to the death penalty under any circumstance, which is in agreement with a total ban by most civilized western societies!)

Although my reasons for opposition to executions are complex, they can be boiled down to a few simple principles: 1) Some condemned persons are, by virtue of later evidence, proven innocent, 2) It is impossible to apply equal justice to many disadvantaged individuals representing minorities or the poor 3) No credible scientific studies have ever shown that capital crimes can be reduced by this threatened means, 4) It is not only more humane, but also less expensive to levy life sentences in preference to forcing inmates to sit endlessly in death rows while progressing through a seemingly endless sequence of appeals.

As a physician, I have always been committed to preventing both death and suffering, and in this capacity, have tried to avoid either of these events as much as possible. As I explained in a previous post: http://www.mortontavel.com/2016/05/01/. However, in the case of extreme suffering, I believe that physician assisted suicide is acceptable when patients request it, are of sound mind, and no better alternatives to sparing life are available.

By contrast, I do not believe that physician assisted murder (AKA execution) is ever permissible, and that is why most of my fellow physicians are unwilling to participate in such a repugnant and gruesome spectacle. So by default, the actual practice of execution by lethal injection often is relegated to medical surrogates who are less well trained and more apt to botch these procedures, especially when they are supplied with inferior or unproven drugs.  Adding to this problem, corrections officials often conceal how drugs are obtained, and, therefore, lawyers for condemned inmates have challenged these efforts to mask this information, saying this makes it impossible to know if drug concoctions meet quality standards or might cause undue suffering. “States are shrouding in secrecy aspects of what should be the most transparent government activity,” said Ty Alper, associate director of the death penalty clinic at the University of California, Berkeley, School of Law

Before Missouri put to death a prisoner recently, for example, it refused to say in court whether the lethal barbiturate it used, pentobarbital, was produced by a compounding pharmacy or a licensed manufacturer. A majority of the 32 states with the death penalty have imposed secrecy around their drug sources, saying that suppliers would face severe reprisals or even violence from death penalty opponents. In a recent court hearing, a Texas official argued that disclosing the identity of its pentobarbital source “creates a substantial threat of physical harm.”

Recently, the giant pharmaceutical company Phizer decided against provision of drugs for executions. This move followed its acquisition last year of Hospira, a company that has made seven drugs, including barbiturates, used in executions, a combination of agents that cause paralysis and heart failure. Hospira had long tried to prevent diversion of its products to state prisons but had not succeeded; and its products were used in a prolonged, apparently agonizing execution in Ohio in 2014. They are stockpiled by Arkansas, according to documents obtained by reporters. Because these drugs are also distributed for normal medical use, there is no way to determine which of the agents used in recent executions were produced by Hospira or Pfizer.

Campaigns against the death penalty, and Europe’s strong prohibitions on the export of execution drugs, have raised the stakes for pharmaceutical companies, and many, including Pfizer, say ethical concerns have also guided their policies. “Pfizer makes its products to enhance and save the lives of the patients we serve,” the company said in Friday’s statement, and “strongly objects to the use of its products as lethal injections for capital punishment.” Pfizer said it would restrict the sale to selected wholesalers of seven products that could be used in executions. The distributors must certify that they will not resell the drugs to corrections departments and will be closely monitored.

Despite all this controversy, however, it seems probable that the Supreme Court will soon have the final word, and given its likely makeup coming soon, we may see the end of the barbaric death penalty for all future generations, which is a positive step for this nation, if not for all humanity! And to that I would say let’s allow this penalty to suffer a natural death, in contrast to the many deaths that are ended unnaturally!

For further information about this issue, especially costs to the taxpayer, please visit the following website: https://www.sheilakennedy.net/2011/03/death-and-taxes-2/

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A Donald Trump Pyramid (Ponzi?) Scheme: Now Including “Snake Oil”

trump

In 2009, Donald Trump started The Trump Network as a multi-level marketing (MLM) company to sell nutritional supplements and weight loss products in addition to home business marketing packages designed to recruit affiliates and earn commissions off their sales. The business was essentially rebranded by purchasing Ideal Health, Inc., a Massachusetts-based company that already sold health products through a vast pyramid structure.

The most effective way to profit as a member of The Trump Network was not to sell individual products, but to get others to sign up as members to sell more products and recruit more members. One could make lots of money by not selling any material products, but only by recruiting sellers and earning commissions off their sales.

The Federal Trade Commission has come down hard on pyramid schemes, but has run into trouble with ones that actually sell products within a pyramid-referral structure. There are differences between an MLM company and a pyramid scheme, but the distinction can be subtle and seems to depend on the proportion of revenue that comes from recruitment versus real product sales. The Trump Network, however, appears far less of a MLM and more of a pyramid scheme.

Let’s take a look at how the Trump Network concept was advertised. On the former Trump Network website in 2009, there was a letter posted by Donald Trump himself who pitches economic opportunity for families who were suffering financially from the Great Recession:

     At no time in recent history has our economy been in the state that it is today. The economic meltdown created by Wall Street greed, financial industry ineptitude and the mortgage crisis has hijacked the dreams of millions of people. We need a new plan to achieve financial independence. My experience in real estate has taught me that the greatest opportunities emerge when economic times are at their worst. That’s why, after the real estate crash of the 90’s, I came back stronger than ever. The first thing I learned is that when times are tough you need to hedge your bets. You need to diversify. The good news is: The Trump Network can provide you with a solution to help you and your family create a more secure future. Diversifying is a way to protect your income so that you can continue to do what you know and love, and still make money. The second thing I learned is that the economy goes in cycles. When some industries fail, others take off. For example, when the real estate industry was challenged in the early 90’s, the network marketing industry exploded. During hard times, people with an entrepreneurial spirit flock to network marketing opportunities. That’s why I have put my name and expertise into supporting this opportunity. The team at The Trump Network have phenomenal products, provide easy to follow training and have a great support network available to all their members. The Trump Network offers you a financial solution that you can believe in. The Trump Network offers products that help make people healthier, an opportunity for you to make as much money as you want, based on your own efforts, and the support of a great company. Join me in this worthwhile endeavor.

     Thus Trump pitched directly to suffering families by casting the venture in terms of success, money, and security. Potential customers are told to join him and prosper by selling health products through “network marketing,” which is a less loaded term than “pyramid scheme.” Although it may sound great to an economically desperate family member, a pyramid scheme cannot offer success to everyone in the affiliate network. The people at the top always win, and those at the bottom always lose.  To compound matters further, in this instance one is actually peddling junk, as explained below.

What was Trump Selling?

The company’s flagship product was called the PrivaTest, which supposedly relies upon a mail-in urine test to determine one’s individual nutritional needs and create a custom vitamin formula (about $140 for the test; $70 per month for the vitamins; $100 to retest every 6 months). From a scientific viewpoint, urine tests do not provide a legitimate basis for recommending that people take dietary supplements. Moreover, even if they could, the nutrients in the so-called customized formulas can be obtained far more inexpensively in retail stores. The Trump Network also acquired a weight loss program called The Silhouette Solution, which consisted of a book promising to lose the weight you want and have the silhouette you choose, which was included in the starter weight loss kit, all for a whopping $1,325. The package was marketed as “a complete eight-week program that contains everything you need to achieve your short and long term weight loss goals.” In it, they send you eight weeks worth of low-calorie food.

I could provide solid information on why this approach won’t provide benefit, especially in the long run, but as the skeptical nutritionist Janet Helm put it in 2009: “This [fake-food fad diet] is not only expensive, but an approach I certainly can’t support.”

But one more payoff: To make money in addition to losing weight, one could purchase the $400 business kit to market the product to their friends and family, or even be entrepreneurial enough to hold community seminars or purchase television ads to recruit more sellers.

Interestingly, Donald Trump’s foray into this sordid world of dietary supplements and weight loss products ended in 2012 when he sold The Trump Network to Bioceutica, LLC. Trump appears to have been concerned about the liability of being associated with a MLM (a.k.a. pyramid scheme) selling bogus products. As far as we know, however, Bioceutica is still operating and continues to sell the PrivaTest and the Silhouette Solution.

In 2016, the Washington Post reported that Trump claims that his involvement with Ideal Health merely allowed them to use his name for marketing purposes and that he was not involved in the company’s operations. But the paper noted that “statements by him and other company representatives—as well as a plethora of marketing materials circulating online—often gave the impression of a partnership that was certain to lift thousands of people into prosperity.”

In light of this illustrative example (and many others), if Donald Trump becomes president, the American people can continue to count on a lot of hyperbolic talk with very little intelligent leadership. There’s always money to be made selling snake-oil, maybe even to the entire world. Thus as the old cliché goes: Buyer Beware!

 

 

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SHOULD WE SANCTION “AID IN DYING”?

Dying As a physician, I originally supported the dictum that death should be prevented at all costs. But more recently, I have come to realize that perhaps we should also more seriously consider suffering as well as dying.

These thoughts have directed my attention to the so-called “aid in dying” laws that are in force in the U.S. states of Oregon, Washington, Montana, Vermont, and California. They are sometimes referred to as “Physician-Assisted Suicide”. These examples often require that a patient’s death be expected within six months, and they compassionately offer a voluntary, self administered end to suffering at an individual’s own preferred time. Since 2014, aid-in-dying bills have been introduced in Washington, D.C. and several states. Canada is also considering such a bill. Other countries, including Switzerland and Belgium, allow aid in dying for people who are not even terminally ill.  All these laws provide freedom for a physician to prescribe a lethal drug to a patient for self administration. At present, such a practice is unlawful in 46 states..

In the example of Oregon, which has had such a law in effect since 1997, subsequent study has uncovered no abuses, and, interestingly, about a third of patients who receive medication to end their lives never actually use it, meaning that many are likely reassured by the simple knowledge that they will be able to end their lives at any time of their choosing.

Although such laws are humane and sensible, they can be abused and result in wrongful deaths. We physicians commonly encounter severely depressed patients without life-threatening physical maladies who, on their own, might opt to commit suicide. In such instances, many can be encouraged to receive effective psychiatric care, and they can be restored to happy and productive lives. Obviously, in such cases a caregiver’s assistance in suicide would represent a serious disservice. Moreover, some individuals suffering from emotional illnesses that result in painful sensations can also be deterred from suicidal acts, receive proper medical treatment, and often enjoy a happy outcome.

Laws addressing such issues should be clearly defined. First, I believe a specific time for life expectancy need not be spelled out, for misery without hope doesn’t necessarily conform to a distinct number of days or months. For instance, someone suffering from a severe progressive neurologic disease such as Lou Gehrig’s disease (ALS) can continue suffering for many months prior to death. On a personal level, I witnessed the suffering and death of a patient/friend of mine from a similar neurologic disorder called progressive supranuclear palsy (PSP), a disease that also claimed the life of actor Dudley Moore, which is an uncommon progressive fatal brain disorder that affects movement, control of walking (gait), balance, speech, and many others. Given the choice, and if it were legal, my friend would have gladly opted to end his life by assisted suicide. Even various terminal cancers can behave for variable durations, and can also cause prolonged pain and suffering.

Using the successful example of Oregon, let’s examine its basic requirements: First, the patient must make two oral requests to the attending physician, separated by at least 15 days, accompanied by a written request, signed in the presence of two witnesses, at least one of whom is not related to the patient. The attending physician and a consulting physician must confirm the patient’s diagnosis and prognosis and determine whether the patient is capable of making and communicating health care decisions for him/herself.  If either physician believes the patient’s judgment is impaired by a psychiatric or psychological disorder (such as depression), the patient must be referred for a psychological examination. The attending physician must inform the patient of feasible alternatives to the act, including comfort care, hospice care, and pain control. The attending physician must request, but may not require, the patient to notify their next-of-kin of the prescription request. The attending physician will also offer the patient an opportunity to rescind his/her request at the end of the 15-day waiting period following the initial request to participate.

In most cases, the drug used for this purpose belongs to a group of so-called “barbiturates”, commonly used in lower doses for the induction of normal sleep. In large doses, however, death is painless, peaceful, and will occur within a matter of minutes to hours.

A death in this fashion is often far better than other, less desirable, alternatives. Thus I might conclude with a simple question: Isn’t it more humane to deal with one’s own species in a manner at least as appropriate as the smooth and painless exit we provide to our beloved animal pets?

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MISGUIDED POLITICIANS AND UNWANTED PREGNANCIES

 

PP

Recent medical research, as reported in the highly respected New England Journal of Medicine, has provided us with both good and bad news about unwanted pregnancies:

First, the good news: The rate of unintended pregnancies in the U.S. has recently diminished. Less than half (45%) of pregnancies were unintended in 2011, as compared with 51% in 2008, declining by 18% overall in women between the ages of 15 to 44 years. While this reduction is not eye-popping, it represents progress, especially when compared with a minor increase between the years 2001 and 2008.

But now the bad news: Rates of unintended pregnancies during this last period among those who are below the federal poverty level are two to three times higher than the national average noted above.

Although the study explored several possible explanations for the reduction of unintended pregnancies, they concluded the most likely was an increased use of contraceptives, especially long-acting types such as intrauterine devices (IUDs) and hormonal injectable implants, both of which are relatively expensive. Although birth control is a basic and essential health care need for most women in all socioeconomic categories, those least able to afford these methods are placed at the greatest disadvantage.

Fortunately, the Affordable Care Act (ACA) requires that health insurers cover women’s preventive care services with no out-of-pocket costs. Although the ACA has brought the establishment of health insurance marketplaces nationwide and Medicaid expansions in 32 states, low-income women are disproportionately affected by limited information and access to the preferred methods. To fill this need, Planned Parenthood has constantly advocated for health care reforms and provided publicly funded programs that support expanding women’s access to all forms of birth control.

But here is where politics becomes the “fly in the ointment”. Those politicians with extreme views on reproductive health—often based upon incomplete facts and specious arguments—are trying to cut public funding for family-planning services through programs such as Medicaid and Title X, which have been critical in reducing costs and expanding access to preferred and effective contraceptives for low-income women.  Medicaid sources provide a range of methods that are twice as successful in comparison with those provided by similar providers that do not receive such funds.

But can we verify the negative consequences of such public fund withdrawals? The state of Texas provides a good (or bad?) example. Beginning in January, 2013, Texas withdrew support for Planned Parenthood affiliates from a Texas Medicaid fee-for-service family planning program. After the funding exclusion, there was a 35% reduction of provision of long-acting—the most preferred—forms of contraception, and during the same period, the number of pregnancies increased by 27%. The inescapable conclusion is that the vast majority of these births were unintended.

Sadly, withdrawing funds from Planned Parenthood has occurred in many states, including Ohio (Governor Kasich can bear responsibility there).  Unfortunately, Indiana is attempting similar action. Government agencies, such as local and county health departments, would be prevented from funding Planned Parenthood affiliates or abortion providers for services that include birth control as well as cancer screenings. Importantly, since the Hyde amendment was passed many years ago, Planned Parenthood has been denied the use federal funds to provide abortion services anywhere.

All these measures are obviously affecting those vulnerable women who are least able to provide support for unwanted children, or even their own health. Regardless whether one is for or against abortion—legal or otherwise—these data indicate that the numbers of these unfortunate souls seeking abortions by any means in states such as Texas are likely to increase in the future. Obviously, pregnancy, delivery, and early post-natal care are far more costly than preventive measures.

Sooner or later, the taxpayers will be penalized—directly or indirectly—and I for one subscribe to the old adage, “An ounce of prevention is worth a pound of cure”!

Our lawmakers would be well advised to stop the ill-informed decision to defund Planned Parenthood!

 

 

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TEA, COFFEE AND HEALTH: THE LATEST FACTS

Tea 2

Tea, especially green tea, is often said to be good for your health. But if tea is good for you, how good? And why?

It turns out that tea does contain substances that have been linked to a lower risk for heart disease and even cancer. But if you just don’t like tea, take heart: Tea drinking alone will never come close to the most potent health promoter we know of—a healthy lifestyle. And coffee may also provide a similar health boost, as we discuss below.

Tea consumption, especially green tea, may not be a panacea, but it can be provide extra dividends when incorporated in an overall healthy diet with whole grains, fish, fruits and vegetables, and less red and processed meat.

WHY IS TEA BENEFICIAL?

     Tea contains certain substances linked to better health, including chemicals called polyphenols, in particular catechins and epicatechins found in tea—especially green tea. The fermentation process used to make green tea boosts levels of polyphenols. Black and red teas have them, too, but in lesser amounts that are less strongly tied to improved health. Although we’re not quite sure why polyphenols are beneficial, they have “antioxidant” properties that may neutralize potentially harmful chemicals called oxidants, and elevated levels of oxidants can cause harm by attacking artery walls and contributing to cardiovascular disease. Unfortunately, in studies of antioxidants in humans, as opposed to experiments in rodents and test tubes, this effect has not been substantiated.

Polyphenols seem to provide additional help by lowering the risk of diabetes, lowering blood pressure and improving cholesterol, all of which contribute to heart disease and stroke.

             WHAT’S THE EVIDENCE OF BENEFIT?

Some of the best circumstantial evidence on tea and health has come from large, long-term studies of doctors and nurses based at the Harvard School of Public Health: the female Nurses’ Health Study and the male Health Professionals Follow-up Study.

By following these groups for long periods, researchers determined that tea drinkers are less likely over time to develop diabetes, compared with people who drink less tea. That makes sense, in light of research showing that polyphenols help regulate blood sugar (glucose).

Further support is provided by a study presented at the American Heart Association’s Epidemiology/Lifestyle 2016 Scientific Sessions. In it, researchers studied available information on 6,212 adults to determine how tea drinking might be associated with coronary artery calcium progression, a marker for blood vessel disease, and heart attacks, angina (chest pain), cardiac arrest, stroke and death from other types of heart disease. They divided the participants into those who never drank tea, less than one-cup-a-day drinkers, one cup-a-day drinkers, two to three cups a day and four or more cups a day tea drinkers. The study followed patients for an average 11.1 years for major cardiovascular events and more than five years to determine changes in coronary artery calcium scores. The researchers found that adults who drank one and two to three cups of tea daily had more favorable coronary calcium scores than those who never drank tea. They also noted a graded relationship between the amount of tea a person drank and a progressively lower incidence of major heart-related events starting with the one-cup-a-day tea drinkers, versus never tea drinkers.

            WHAT’S THE BOTTOM LINE?

Drinking tea of all types regularly seems to be associated with better health. However, it remains unclear whether the tea itself is the cause and, if so, how it works its magic. The studies attempt to rule out the possibility that tea drinkers simply live healthier lifestyles, but it’s difficult to be sure. Nevertheless, tea itself appears to have no harmful effects except for an occasional case of the jitters if you drink too much caffeinated brew. It fits in perfectly fine with a heart-healthy lifestyle. So if you drink tea, keep it up, but don’t take up the habit thinking it will have a dramatic impact.

But in any event, stay away from processed sugar-sweetened tea beverages. These products may be loaded with extra calories, and consuming more than the occasional sweetened tea drink may be counterproductive. If there are any health benefits to tea consumption, it’s probably completely offset by adding sugar, as I have pointed out in a previous post.

         BUT WHAT ABOUT COFFEE?

Coffee contains a complex mix of chemicals with known biological effect including polyphenols that may account for coffee’s purported health benefits. Animal studies suggest the polyphenol chlorogenic acid, which is abundant in coffee, could reduce risk of diabetes. Recent research pooled 36 studies involving over 1.2 million people and found that, when compared with coffee abstainers, people who drank three to five cups of coffee per day had a lower risk of heart attacks and strokes. Complete coverage noted on http://www.mortontavel.com/2013/10/07/

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Vertigo, and How to Combat it

Vertigo2

         Have you ever experienced a spinning sensation, sometimes causing nausea and vomiting, typically aggravated when you change the position of your head? If so, you’re not alone, and here are the facts.

This condition is typically short-lived, bearing a long name: benign paroxysmal positional vertigo, or BPPV. This benign ailment, whose vertigo symptoms are usually worsened by a change in the position of the head—such as rolling over in bed or tilting the head to the side, for example—is quite common, affecting about 5 percent of the population each year. The blanket term “dizziness” is often used to describe a variety of different feelings and sensations—from lightheadedness or near-fainting to vertigo to imbalance—and can mean something different to everyone. In this instance, however, we are referring specifically to vertigo, i.e. a spinning sensation unassociated with changes in—or loss of—consciousness.

         Vertigo and “Ear Crystals”

Tiny calcium carbonate crystals are thought to be behind the vertigo of BPPV. When these crystals, sometimes called stones, come loose from their normal home in the utricle (part of the ear’s balance system) and travel into the inner ear’s fluid-filled canals, their movement sends false messages to the brain, causing that spinning feeling or sensation of being off-balance.

For many people, this inner ear problem causes nausea and vomiting and temporary equilibrium problems. The sensations generally resolve quickly (an episode usually lasts less than one day, but can last three to five days). Exceptionally, the vertigo may come and go for up to a couple of weeks, rendering life miserable and even causing driving to be dangerous.

The older you get, the more likely you are to experience BPPV. And the disorder can come on after a blow to the head—which can knock inner ear crystals loose. People also seem to get it more when they are flying or lying down doing exercises like yoga and Pilates, where the head can be far back for an extended period of time. Some research suggests that allergies and respiratory infections can precede BPPV episodes. It is uncertain whether fatigue and stress can also trigger this disorder.

Experiencing Vertigo for the First Time?

If you think you might be experiencing BPPV for the first time, try sitting quietly for a few minutes. This gives the vertigo a chance to diminish and allows you to pay close attention to the sensations you’re experiencing and take the appropriate steps.

If what you notice is primarily a spinning feeling that seems to be triggered by a change in the position of your head, you can probably wait a few days before consulting a physician—the BPPV is likely to subside in that time. But if your dizziness is accompanied by symptoms such as severe headache, double vision, weakness of one side, slurred speech, chest pain, ringing in the ears or hearing loss, you’re likely experiencing something much more complex than BPPV—such as stroke or a heart problem—and should get immediate medical attention.

Treating This Type of Vertigo

If the distressing symptoms last more than a few days, see your doctor, who will ask about symptoms and may put you in positions that bring on the vertigo to confirm that you have BPPV—there are other types of vertigo as well.

The gold standard for treating BPPV is the Epley Maneuver, in which involves moving your head into specific positions designed to move those wayward ear crystals into a less sensitive spot in the inner ear. This maneuver can be self-administered or conducted by a health care provider. It generally has a 90 to 95 percent success rate after one or two treatments. If unsuccessful, however, your healthcare provider may move on to other maneuvers, which position the head in slightly different ways. After a successful maneuver, the problem should be fixed for at least a year, though we have a few, usually older people, who seem to get it back every three to four months. And in the event that the BPPV recurs—as it does for 30 percent of people in the first year after their initial experience with it and in 50 percent of people over five years—it can usually be managed successfully at home. What’s really important for people to realize is that this is a benign condition that can be fixed quickly; it’s not something you have to suffer with—it’s pretty easy to figure out what you have and pretty easy to fix.

The Epley Maneuver

This maneuver is used to treat benign paroxysmal positional vertigo. It seems to work by allowing free floating particles from the affected semicircular canal to be relocated, using gravity, back into the utricle, therefore terminating the bothersome vertigo. It is often performed by a caregiver such as a medical doctor, audiologist, or physical therapist, after confirmation of a diagnosis of BPPV with the Dix-Hallpike test (a positional maneuver that provokes specific eye movements) that has a reported accuracy of between 90–95%.

Self Administered Maneuver

Although often performed by a therapist, the Epley maneuver can be self-administered at home. The procedure is as follows:

  1. Sit upright.
  2. Turn your head to the side causing the majority of symptoms at a 45 degree angle, and lie on your back.
  3. Remain up to 5 minutes in this position.
  4. Turn your head 90 degrees to the other side.
  5. Remain up to 5 minutes in this position.
  6. Roll your body onto your side in the direction you are facing; now you are pointing your head nose down.
  7. Remain up to 5 minutes in this position.
  8. Go back to the sitting position and remain up to 30 seconds in this position.

    The entire procedure may be repeated two or three more times, in the same or reversed direction. During every step of this procedure, some vertigo may be provoked.

          Post-treatment phase

Following the treatment, one should be cautious of bending over, lying backwards, moving the head up and down, or tilting the head to either side. In addition, one should perform periodic horizontal movements of the head to maintain normal neck range of motion. This should prevent neck muscles from stiffening.

It is uncertain whether activity restrictions following the treatment improve the effectiveness of the canalith repositioning maneuver. However, patients who were not provided with any activity restrictions needed one or two additional treatment sessions to attain a successful outcome. The Epley maneuver appears to be a long-term effective conservative treatment for BPPV that has a limited number of complications (nausea, vomiting, and residual vertigo) and is well tolerated by patients.

To most individuals, this simple program will seem like a godsend!

 

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MEDITERRANEAN DIET: NOW IT MAY EVEN PROTECT YOUR EYESIGHT!

Medit D Blindness

It is well known that the so-called Mediterranean diet is an effective way to ward off vascular diseases of the heart and brain, but new information suggests that it may even protect against the leading cause of blindness in older Americans—age-related macular degeneration. A recent study analyzed dietary patterns on 2,525 participants in the Age-Related Eye Disease Study. They evaluated individual intakes of most food categories, comparing the highest consumers of vegetables, fruits, legumes, whole grains, nuts, fish, and monounsaturated fats (e.g. olive oil), with those that consumed a plethora of saturated fats, red and processed meats. Those who scored highest for intake of the former constituents were 26% less likely to progress to advanced age-related macular degeneration.

This information accorded well with previous research that linked high consumption of the Mediterranean foods with reduced visual loss. By contrast, previous work has also indicated that consumption of red meat and trans fats—avoided in the Mediterranean diet—have been associated with an elevated risk.

Uncertainty surrounds reasons why the Mediterranean diet is protective, but speculation centers on its tendency to reduce inflammation and oxidative stresses, the factors that are believed to promote arterial disease (sclerosis) in general.

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IMPROVE YOUR BRAIN POWER (AND PREVENT DEMENTIA) THROUGH DIET

brain

   In a previous post, I have referred to the importance of exercise in protecting mental function (http://www.mortontavel.com/2016/01/07). Now we focus on dietary constituents that also contribute to preserving brain function. Again, however, do not be seduced by the so-called dietary “supplements” that blatantly and falsely promise to improve mental function and memory—either immediately or over the long run. None of these products have been backed up by creditable scientific proof and are a waste of money.

The so called “MIND” diet, however, is backed up by sound science and is a hybrid of the heart-healthy Mediterranean and the blood-pressure-lowering DASH diet (http://www.mortontavel.com/2013/05/02/). (MIND actually stands for Mediterranean-DASH Intervention for Neurodegenerative Delay). Not surprisingly, it limits red meat, butter and stick margarine, pastries and sweets, fried and fast food, and cheese. But we all know that while these foods should be avoided, what should we be consuming in their stead?

After a research team from RUSH University followed the diets of almost 1,000 elderly adults for an average period of over 7 years, they found that, in comparison to elderly individuals deviating completely from the MIND diet, those whose foods were most strongly in line with it had brains that functioned as if they were over 7 years younger. A follow-up study also showed that those following this diet also cut their risk of developing Alzheimer’s disease in half, and even those who only partially followed this plan still had a 35% lower risk. Truly amazing! So, below we list food types you should seek.

VEGETABLES AND LEAFY GREENS

Eat at least one cup raw or one-half cup cooked greens and one-half cup of other cooked vegetables per day. All types of lettuce and greens seem to count, but darker greens such as collards, kale, and spinach, possess more nutrients. We’re not quite certain of why these greens help, but possibly through their high levels of vitamin K, folate, and beta carotene and lutein.

NUTS 

    Eat at least five one oz. servings per week. Although all nuts seem to be beneficial, Brazil nuts contain copious amounts of selenium, believed to be especially beneficial for better verbal abilities and spatial skills. One nut supplies all the selenium you need in a day.

 

BERRIES

     Eat at least one cup twice weekly. This should include either blueberries or strawberries. Frozen berries are just as nutritious as fresh, and can cost half as much.

BEANS

Eat at least one-half cup cooked beans, four times weekly. This can include black beans, kidney beans, lentils, white beans, and others, all of which provide a healthy dose of folate, a B vitamin that may be instrumental in preventing dementia later in life. Canned beans are fine, but rinse them before using to remove some of the sodium.

FISH/POULTRY

    Eat at least three oz. of fish and six oz. of poultry per week (not fried). In comparison with red meat, both are low in undesirable saturated fat. Moreover, the omega 3 fats in fish may improve learning and memory by increasing the brain’s ability to send and receive messages. One study showed that older adults without dementia who ate 3 to 5 oz. of fish weekly for one year experienced less brain shrinkage, a common occurrence with dementia. However, limit intake of the larger predatory fish that contain mercury; better options include haddock, sardines, tilapia, and wild salmon.

OLIVE OIL

     According to some research, the phenolic compounds in extra-virgin olive oil may help prevent toxic protein deposits that can lead to the progression of Alzheimer’s disease. This oil may also reduce inflammation and improve blood-vessel function, both of which can benefit the brain.

WHOLE GRAINS

Eat at least one-half cup cooked grains or a slice of whole-grain breads three times daily. Whole grains, like bulgur and quinoa, were associated with higher levels of brain function in one study that evaluated the diets of people over the age of 65.

WINE

This might be the best part, making it all worthwhile! But women may consume only one glass per day, and men, 2 glasses. But beware of consuming more than that, for, according to one study, those who consume more than double that amount are actually at an increased risk of developing dementia.

We hope this information will provide the reader with some “foods for thought”!

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UNDETECTED SUGAR MAY BE LURKING IN YOUR DIET BEYOND JUST SOFT DRINKS AND DONUTS

 sugar

   All research indicates that excess sugar in the diet is unhealthy, increasing one’s risk of type 2 diabetes, heart disease, and obesity. For instance, a recent study disclosed that people who got 17 to 21 percent of their calories from added sugars had a 38% higher risk of dying from cardiovascular disease than those who kept their intake of sugar at or below 8%. Results of this type have prompted the American Heart Association to recommend that sugar intake be kept in this latter range, amounting to a daily intake in women of to more than 6 teaspoons (24 gms) daily, and in men, 9 teaspoons (36 gms).

But at this time, achieving these targets is challenging. For example a frozen stir-fry dinner can contain the same amount of sugar as 16 gummi bears (5 teaspoons). Or even whole-wheat bread can have almost a teaspoon of sugar per slice. As a matter of fact, food companies add sugar to almost three-quarters of all packaged products, including nutritious-sounding items such as instant oatmeal and peanut butter, or even into apparently “unsweetened” items such as tomato sauce and crackers.

Some Guidelines

 In general, the sugars found in dairy products and fruits such as sweet potatoes and beets come in small doses and are packaged with fiber, protein, vitamins, and minerals and they don’t affect one’s blood sugar greatly, and, when consumed in moderation, they are not of great concern.

The main challenge, however, is to try to avoid those unnecessary added sugars.  Usually nutrition facts on labels designate added and naturally occurring sugars together under “total sugars.”  But, unfortunately, the amount of undesirable added sugar is usually not clearly indicated. In the effort to ease this burden, the FDA has proposed that added sugars have their own line on food label, similar to the way total fat and saturated fat are listed separately. This should also include the percent contributing to the total daily limit. But until food labels change, we can make some suggestions: 1) Know the code words for sugar. Ingredients on the list that end in “ose”, i.e., fructose, maltose, and sucrose, are added sugars that should be minimized or avoided. Even healthier-sounding sugars such as brown rice syrup or honey aren’t any better than other types. 2) Scan the entire ingredients list. Since ingredients are usually listed in order of weight, the higher up a substance is, the more sugar it is likely to contain. But many manufacturers use more than one type of sugar in a product, allowing them to list them separately, leading to the false impression that a food possesses less sugar than it actually contains. 3) Compare nutrition labels.  Find the “plain” version of foods such as yogurt or oatmeal and compare the nutrition facts label against the same brand’s sweetened versions. The difference in the amount of sugar between the two products is almost always added sugar. So, instead of purchasing the “sweetened” version, opt for the plain version and, for sweetness, add fresh fruit.

For more information and a general lowdown on the best and worst natural sugars, the reader should consult the Consumer Reports website: ConsumerReports.org/naturalsugar2015.

 

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HONEY’S NATURAL AURA PUNCTURED!

honey   For all those who succumb to the fantasy that “natural” foods are safer and healthier than those that are synthetic, let’s look at honey, felt by many to be crowned with a “health halo.” Most people believe that products containing honey are healthier than their sweet counterpart, namely high fructose corn syrup or just plain sugar. These claims are based upon the vague notion that honey might have antioxidant, anti-inflammatory, or antibacterial properties. That’s why so many products bear the name, honey, in their titles. For instance, Kellogg’s, joining this bandwagon, renamed its Sugar Smacks cereal as “Honey Smacks.”
But let’s look at the facts: When the National Honey Board set out to substantiate honey’s healthy image by funding a clinical trial comparing it to sugar and high-fructose corn syrup, the results backfired—the metabolic effects of honey and those other mundane sweeteners emerged as essentially the same! The controlled study involved serial trials in which 55 volunteers underwent successive two week test periods, comparing honey to sugar and high fructose corn syrup. Testing numerous markers such as blood sugar, insulin, cholesterol, inflammatory markers, body weight and blood pressure, they came up with no significant differences in any of these measures, meaning that honey possessed no superiority, or could we say that it was a “cereal bust”.
What does this mean for the individual? Although honey contains trace amounts of various phytochemicals derived from the beehive, the nectar it’s made from is basically sucrose, i.e. table sugar. The enzymes in the bees’ stomachs break down the sucrose into two simpler sugars, namely glucose and fructose, but when combined together, they are biologically identical to the original sucrose.
So don’t kid yourself, and try to limit all types of sugars, including honey. The 2015 Dietary Guidelines Advisory Committee recommended consuming no more than 10% of total calories from sugars, and that includes sugary soft drinks as well! Interestingly, honey is denser than granulated sugar, so one teaspoon contains 21 calories compared to 16 calories in a similar volume of sugar. By foregoing honey, you are not only enhancing your well-being, but the bees will take no offense!

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LOWERING CHOLESTEROL WITHOUT DRUGS

Cholesterol         According to the American Heart Association, 102.2 million Americans age 20 and older (almost 50 percent of American adults) have elevated blood cholesterol levels, a key risk factor for heart disease. Lifestyle changes such as improving diet, losing weight and increasing exercise are often effective. Various medications, such as the”statin” drugs and niacin, may be used to lower cholesterol, but various supplements may also be helpful as well, lowering low-density lipoprotein (LDL or “bad cholesterol”), sometimes raising high-density lipoprotein (HDL or “good cholesterol”), and improving the LDL/HDL ratio. Some supplements may also reduce triglycerides, which pose additional, although lower, risks.
As I have indicated previously, dietary changes that are useful in controlling cholesterol levels are spelled out in the following posts:
.    http://www.mortontavel.com/2015/12/07/polyunsaturated-fats-support/
http://www.mortontavel.com/2013/05/02/high-blood-press
After changing one’s diet, however additional measures are often needed, which can be considered before resorting to drugs. Supplement ingredients that have been used to reduce cholesterol include sterols and sterol esters (produced in the normal refinement of vegetable oils, or alternatively as a byproduct of papermaking from the oil of pinewood pulp), stanols and stanol esters (substances closely related to sterols that are derived from the same sources), red yeast rice (a yeast grown on rice), garlic, fish oil, and soy protein. Soluble fiber such as oats in the diet as well as moderate intake of alcohol can also improve cholesterol levels. :
The evidence supporting the various cholesterol-lowering supplements varies. The best evidence is for sterols, stanols and their esters, soy protein and high dose-niacin (sold as a supplement as well as a prescription drug). These are sometimes associated with certain risks, which should be understood. ..
This review will be limited to the stanols and sterols, which constitute groups of agents that are inexpensive and possess a good safety profile. It should be noted, however, that while sterols and stanols can lower cholesterol and likely cardiovascular disease risk, no study thus far has shown a direct risk reduction by this means..

                 Phytosterols:
Scientific studies have shown that a dose of 800 mg or more of free sterols per day is required to produce effective reductions in cholesterol, usually around 10%. According to Consumer’s Lab, most of the supplements contain their claimed amounts of sterols other than Pure Encapsulations CholestePure, which. at the dose of one capsule, would provide only 450 mg of free sterols.
• Enzymatic Therapy Cholesterol Shield also includes pantethine, which may cause a modest decrease in total cholesterol, LDL, and triglycerides. In addition, HDL will rise at a dose of 300 mg 3 to 4 times a day
• Source Naturals Cholesterol Rescue includes Sytrinol™ (300 mg per day) which, may also modestly lower cholesterol.
             Phytosterols at Lowest Cost
Comparing the cost to obtain an equivalent amount of free sterols (800 mg), the lowest cost is from Nature Made CholestOff, amounting to 33 cents, while the cost for the same amount of ingredient from other products ranges from about 40 to 60 cents. CholestOff Plus is also supported by a successful clinical trial.

List of Phytosterols: This following presents a compilation of effective products (capsule or tablet form): CholestaCare, Cholesterol Shield, CholestOff, CholestePure, Shaklee Cholesterol Reduction Complex CholestePure, and Source Naturals Cholesterol Rescue.

Butter-like spreads: Plasma total- and LDL-cholesterol concentrations are reduced by margarines enriched with free plant sterols. Results are effective at an intake of 1.5gm or more of plant sterols per day, but they have little apparent effect on HDL-cholesterol or triacylglyceride concentrations. One prime example of this group is Benecol, which is provided in the form of a spread, but it is also produced in a yogurt drink, cream cheese spread, and Dobrogea Benecol Rye Bread. Another spread that has between 0.85 to 1.3 grams of sterol esters per serving is Smart Balance HeartRite Light. Just 2-4 servings of this spread per day also can fulfill your daily recommended dose of phytosterols. In order to consume enough amounts of these spreads, try adding them to such foods as steamed broccoli and oatmeal.

Conclusion: Whether you have cardiovascular disease or are presently normal, consider including the strategies above in your diet, especially make use of the spreads on your bread or in your cooking.

 

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