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

Thursday, February 23, 2017

Using extra-virgin olive oil even reduces your risk of breaking a bone!

To add to the growing collection of health benefits for extra-virgin olive oil (for example, reducing heart disease, stroke, and cancer), it appears that using more extra-virgin olive oil may also lead to about 50% fewer broken bones!  In a study in which participants with high cardiovascular disease risk were randomized to either a Mediterranean diet or a low-fat diet and followed for 8.9 years, those with the greatest intake of extra-virgin olive oil had about half the risk of fractures compared to those with the lowest intake. [1] Interestingly, using olive oil other than extra-virgin was not associated with any reduction of broken bones.

My recommendation:
Use extra-virgin olive oil as your main kitchen oil!  To make sure you are using oil with genuine extra-virgin qualities we recommend choosing a domestic olive oil rather than imported, and with the seal of the California Olive Oil Council on the label, like the widely available California Olive Ranch.  Better still, buy locally-squeezed olive juice from Oregon Olive Mill in Dayton, Oregon.  If you are interested in buying imported extra virgin olive oil we suggest consulting with a knowledgeable local importer like Jim Dixon at Real Good Food.  We include about 100 recipes using extra-virgin olive oil in Good Food, Great Medicine (3rd edition), and discuss the many reasons to choose it instead of other vegetable oils on pages 26 and 47-48. 

Miles Hassell MD

[1]García-Gavilán, J.F. et al. Clinical Nutrition 2017;doi: 10.1016/j.clnu.2016.12.030














 

Tuesday, December 20, 2016

Is treating your acid reflux increasing your risk of dementia?

Prilosec, omeprazole, Nexium, and other proton pump inhibitors (PPIs) suppress stomach acid, reduce symptoms associated with esophageal reflux and peptic ulcer disease, and assist in ulcer healing; short term (days to weeks) use for diagnosis and treatment often makes sense.  However, that pesky stomach acid also happens to be a key component of a healthy metabolism, so it shouldn’t surprise us that suppressing it long term may have side effects.  Weigh the pros and cons of PPIs carefully with your physician and explore the alternatives.
  • Benefits of PPIs:  Prilosec and other PPIs ease the discomfort of gastroesophageal reflux (GERD) and may reduce the risk of esophageal cancer in patients with Barrett’s esophagus, which is a serious complication of GERD.
  • Potential harms from long-term use of PPIs:  The downside of chronic use of PPIs include dementia [1]; stroke and heart attack [6]; kidney disease [2]; infections including pneumonia and C difficile diarrhea [3]; low magnesium and B 12 levels [5]; altered gut microorganisms [4]; stomach cancer [7]; and broken bones [3]. 
My recommendation:
Carefully consider the risks from this group of medications when deciding whether to take them for more than a few weeks.  Schedule a visit with your physician to discuss the risks and benefits as well as alternatives.  For most GERD sufferers there are some fundamental lifestyle steps that can both reduce symptoms and risks – including risk of esophageal cancer – while minimizing medications: avoid sugars and starches; increase intake of high fiber foods such as vegetables; get daily exercise; eat probiotic foods such as fresh sauerkraut, kefir and yogurt; and reduce weight around the middle.  Some traditional folk remedies can also be effective. 
 
If you decide to tackle GERD head on, and eliminating medications is a reasonable option, it’s important to taper PPIs rather than stopping them cold turkey, coordinating with your physician as you do this.  As well as reducing or eliminating the need for PPIs and feeling better, you will enjoy the added benefit of improved blood pressure, cholesterol, and cancer risk!
 

Miles Hassell MD 







Tuesday, December 6, 2016

Osteoarthritis: Keep your joints in good shape – avoid sugar, watch your waist, and stay active

Healthy joints are critical to enjoying life as we get older.  Three important steps we can take to prevent painful osteoarthritis of the hips, knees, thumbs, spine, and shoulders are:
  1. Reducing excess waistline and weight
  2. Avoiding added sweetening and refined grains (especially white flour and white rice)
  3. Staying active 
These choices protect the joints from excessive mechanical forces while also improving the ability of the joint to repair itself.  Too much weight around the middle combined with excess sugar and refined grains plus too little activity create a cascade of metabolic effects that accelerate wear and tear on joints. [1]  They start to hurt, and next thing you know your doctor is talking about joint replacement.

So, take action as soon as you get the first hint that you are developing “metabolic syndrome,” a condition notable for three or more of the following:
  1. Fasting blood sugar greater than 100 or being treated for high blood sugar
  2. Waistline greater than 35 inches for women and 40 inches for men; less for small framed people
  3. Blood pressure greater than 135/85 or being treated for high blood pressure
  4. Triglycerides greater than 150 mg/dl
  5. HDL cholesterol lower than 40 mg/dl for men and 50 mg/dl for women
Once “end-stage” osteoarthritis of a joint is diagnosed, is it too late for lifestyle choices to make a difference?  We’re glad you asked.  Even in the case of “end-stage” or “bone-on-bone” joints facing replacement surgery, we have seen dramatic improvement in joint pain when overall health is improved.  (Some nutritional supplements that can occasionally help with osteoarthritis are worth considering and can be discussed during a consultation.)

An example of these lifestyle choices at work is one of our patients who at 75 had previously had one knee replacement surgery and was scheduled to have the other replaced.  He decided to try a non-surgical path and reduced his intake of sugar and other refined foods.  With his healthier diet and resulting weight loss,
  • he was able to reverse his type 2 diabetes,
  • his blood pressure (BP) improved and he was able to stop his BP medications,
  • his knee stopped hurting, and he felt better than he had for decades.
Five years later he still has his original knee and still needs no blood pressure or diabetes medications!
 
My recommendation:
If you have the metabolic syndrome, reverse it using the 14-step Risk Reduction Action Plan on pages 59-92 of Good Food, Great Medicine (3rd edition).  Target the following lifestyle choices to get a jump start:
  1. Reduce excess waistline and weight (see page 60-61).
  2. Avoid added sweeteners and refined grains (see pages 42-46 and 73-77).
  3. Keep active.  You’ll also find tips for daily exercise on pages 50-55, especially the tips for arthritic joints like trekking poles on page 53. 
Miles Hassell MD