Thursday, November 16, 2017

Got heartburn? Long-term use of proton pump inhibitors appears to raise risk of stomach cancer – explore alternatives!

Heartburn and gastro-esophageal reflux disease (GERD) describe a common group of symptoms that lead to more serious problems.  One of the most common treatment approaches is to suppress the stomach acid with drugs, typically proton pump inhibitors (PPIs) such as omeprazole and many others.  While these drugs do not stop the abnormal sloshing of stomach fluids into the esophagus where they don’t belong, they can certainly reduce the discomfort and help prevent some of the complications of GERD. However, there is increasing evidence that PPIs can have serious side effects, as well.  A 2017 study published in the journal Gut followed 63,000 patients over an average of 7.6 years, and found that chronic use of PPIs significantly increased stomach cancer risk, and the risk increased the longer patients were on the medications. [1]
 
My recommendation:
For patients with heartburn, I try to prescribe acid reducing drugs for as brief a time as possible, and take time to discuss the many evidence-based alternatives for treating GERD without medication, including vigorous lifestyle changes.  80-90% of GERD sufferers who overweight are able to eliminate or reduce their reflux drugs just by losing 10% of their body weight. [2]  To create a personalized action plan see pages 59-92 in Good Food, Great Medicine (3rd edition).  For additional GERD-fighting suggestions see our January 2017 newsletter.
 
Miles Hassell MD
 

Thursday, November 9, 2017

Tackling myth of “metabolically healthy obesity:” excess waistline is risky even if blood pressure and cholesterol are OK

“Metabolically healthy obesity” is a common medical classification of people with obesity (BMI>30) who have a normal metabolic profile, such as normal blood pressure (BP) and cholesterol levels. Some schools of thought suggest that these individuals are therefore not at significant risk; however, in a 2017 study following 3.5 million participants for an average of 5.4 years, researchers found that individuals with obesity and no metabolic abnormalities had a 49% increased risk of coronary heart disease and 96% more heart failure than their normal-weight counterparts.

My recommendation:
Anyone with an excess waistline needs to lose weight, and it can be very motivating to consider the impact weight loss has on future independence and quality of life. When faced with the myriad of weight loss options available, we should always choose the option with the best evidence for improving overall long-term health rather than focusing only on short-term weight loss.  The most sustainable and evidence-based weight-loss program to date is a whole food Mediterranean diet, portion control, and a daily habit of physical activity.  Start now!  For a wealth of practical strategies to help incorporate these choices into your own life and transform your health trajectory, see pages 60-61 and 69-92 in Good Food, GreatMedicine (3rd edition) or see our free weight loss handout at goodfoodgreatmedicine.com.
 
Miles Hassell MD


 

Thursday, June 29, 2017

Reducing attention-deficit/hyperactivity disorder (ADHD) with – the Mediterranean diet!

In a 2017 study of children and adolescents with ADHD compared to matched controls, adhering to a Mediterranean diet pattern was associated with almost one-third of the risk of developing ADHD.  The study noted that a “higher frequency of skipping breakfast and eating at fast-food restaurants” were associated with a higher prevalence of ADHD diagnosis.   

My recommendation:
Whether for ADHD, depression, or dementia, it looks like the Mediterranean diet is the choice to make to reduce your risk.  This is a particularly important consideration for parents: the food habits we model and teach our children have a profound impact on their long-term health – including mental health.

Apply evidence-based non-drug approaches first – regardless of other concurrent treatments.  Here are my top three strategies for minimizing risk of ADHD:
  1. Eat a whole food Mediterranean diet low in refined carbohydrates (like sugar, white flour, sweet drinks – including ALL fruit juice) and high in healthy fats (like extra-virgin olive oil, avocados, oil-rich fish).  Eat breakfast and skip the fast food!
  2. Structure your day and keep to your schedule as much as possible; including 30–60 minutes of vigorous activity, preferably outdoors (brisk walking or energetic yard work), and adequate sleep.
  3. Reduce screen time: use the computer for work and the smart phone for phoning – and minimize screen-based entertainment.  
Miles Hassell MD

Thursday, May 18, 2017

Even short term use of sleeping pills more than double risk of hip fracture. Pursue alternatives!

Medications such as benzodiazepines (like lorazepam, alprazolam, etc.) and non-benzodiazepines (like ambien, zolpidem, etc.) have many potential harmful side effects, one of which is hip fracture.  A recent systematic review and meta-analysis of 18 high-quality studies showed that short term use (less than 14 days) of these medications was associated with an increased risk of hip fracture 2–3 times normal. [1] These findings are significant in view of the short and long term disability, loss of independence, and much higher risk of dying associated with hip fractures.

My recommendation:
Sleep problems are generally fixable, and the goal should be both improved sleep with better long-term health.  For some suggestions for better sleep see pages 56–57 of Good Food, Great Medicine, 3rd edition.  If your insomnia doesn’t improve, schedule a consultation with a health professional.  Finding a drug-free solution to a good night’s sleep is worth the effort! 


Miles Hassell MD


Monday, May 1, 2017

Even short-term and low-dose corticosteroids (like prednisone) carry significant risks – explore alternatives!

Steroids are commonly prescribed for all kinds of health issues like allergies, back pain, joint pain, as well as respiratory problems including sinusitis and a variety of lung diseases.  Sometimes they are essential to recovery, but most of the time they are surprisingly optional.  Although the serious risks of long-term steroid use are well known, the short-term use of even low-dose corticosteroids also carries significant risks.  For example, within 30 days of beginning steroids at modest doses (such as less than 20 mg of prednisone daily) the risk of a major complication such as serious infections, broken bones, or blood clots (venous thromboembolism) increases by 2–5 times normal.  Once steroids are stopped, the risk rapidly decreases. [1] 

My recommendation:
Whenever steroids are recommended, don’t assume they are essential; ask your doctor exactly how important they are and whether you can recover without them.  Most of the time steroids are prescribed for problems which are self-limiting, so will get better (eventually) even without steroids. 
  1. If you must take steroids, ask for the lowest reasonable dose for the shortest possible time.
  2. Explore all possible alternatives, and take extra care to make the food and lifestyle choices that will give your body the best chance to heal.  For information about anti-inflammatory steps to take, see our August 2016 newsletter.
Miles Hassell MD

[1] Waljee, A. et al. British Medical Journal 2017;357:j1415
 
 

Thursday, April 13, 2017

Avoiding naturally-occurring gluten might lead to more type 2 diabetes

Gluten-free diets usually lead to grain free diets.  However, eating more whole grain food is associated with less inflammation [1] and fewer infections as well as less cancer, cardiovascular disease, mortality from any cause, obesity, and type 2 diabetes. [2]  In addition, foods advertised as “gluten free” are usually very high in refined carbohydrates such as flours made from potato, rice, and tapioca.

In a recent analysis of 199,794 participants studied for over 20 years in the Nurses Health Study (NHS II) and Health Professionals Follow-Up Study (HPFS), those with the highest consumption of gluten had the lowest levels of type 2 diabetes. [3]

My recommendation:
Unless you have a compelling reason (such as celiac disease) to avoid gluten, I recommend including minimally-processed whole grains (whole wheat, rye berries, whole hull-less barley, etc.) in your diet on a daily basis.  The health benefits are inescapable; don’t get caught up in the gluten-free fad!  However, I suggest avoiding products with ingredient lists that include added gluten, which always refers to refined gluten; naturally-occurring gluten will not be on the ingredient list.  To read more about gluten see pages 40-41 of Good Food, Great Medicine (3rd edition).  We talk about the health benefits of eating whole grains on pages 23-25 and why we all should avoid highly-refined grains on page 46.   

Miles Hassell MD



Thursday, April 6, 2017

Fighting depression with a one-two punch – food and activity

For many people antidepressant medications often have very limited benefit [1].  However, two of the most powerful antidepressants available surprisingly don’t even need a prescription! 
  1. The Mediterranean diet has been shown to be effective for moderate to severe depression.  In a recent randomized controlled trial, patients randomized to a Mediterranean diet (with red meat 3 to 4 times a week and red wine with meals) had a significantly greater remission of their depression than the control group [2] who received no dietary instruction.
  2. Exercise also has excellent antidepressant benefits, especially when outdoors in fresh air and natural light.
Yet more evidence that the food and lifestyle choices we make each day are critically important for the health of our minds and our bodies!  

My recommendation:
Eat a whole-food Mediterranean-style diet with plenty of vegetables, high-quality protein (including red meat), and good fat, but avoid refined carbs.  Also, make room every day for some kind of outdoor exercise: a brisk walk, vigorous gardening, a flight or two of stairs – whatever you can manage.  

Miles Hassell MD
 
[2] Jacka, F.N. et al. BMC Medicine 2017;15:23