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

Tuesday, November 29, 2016

Extra-virgin olive oil appears to lower cancer risk substantially

There are plenty of good reasons to use extra-virgin olive oil as your main kitchen oil, and one of the lesser known ones is a reduced risk of cancer of all causes.  In Mediterranean countries where olive oil is used generously and frequently, cancer is less common, and it doesn’t appear to be a coincidence.  A review of 19 observational studies following about 37,000 people found a consistent relationship between olive oil use and cancer incidence: a 34% lower risk of any cancer in those who used the most olive oil!  (The benefit was strongest for breast and colon cancers.)  We are not aware of any data suggesting comparable benefit for other vegetable oils. [1]
 
My recommendation:
Use extra-virgin olive oil as your main kitchen oil and avoid hydrogenated oils and highly-processed vegetable oils.  For more information on the health benefits of olive oil and why we should avoid highly-processed oils see pages 26, and 47-48 in Good Food, Great Medicine (3rd edition).  You’ll also find tips for choosing an extra-virgin olive oil on page 115 and about 100 recipes to get you started. 

Miles Hassell MD
 

Tuesday, November 22, 2016

Can drinking alcohol help prevent and treat type 2 diabetes?

It is commonly believed that drinking alcohol will worsen blood sugar control in type 2 diabetes but the evidence shows otherwise.   In an analysis of the available randomized studies that compared patients with diabetes who drank alcohol with those that did not, alcohol was found to make no difference to blood sugar control [1].  Furthermore, there are important potential benefits for moderate alcohol intake (up to one drink daily) in patients with type 2 diabetes:

§  Better sleep and improved markers of cardio-metabolic risk control, especially with red wine [2]

§  Less risk of death from any cause [3]

§  Less heart disease and stroke [3]

§  Less risk of kidney disease [4]

In addition, for people without type 2 diabetes, moderate alcohol consumption significantly reduced the risk of developing diabetes [5] and has anti-inflammatory benefits. [6]

My recommendation:
For those who can avoid drinking to excess, with or without type 2 diabetes, one 5-ounce serving of red wine with a meal remains a reasonable choice. For more information on alcohol and health, see Good Food, Great Medicine (3rd edition) page 39.

Miles Hassell MD
 






 

Wednesday, July 1, 2015

Strange but true: heart disease and cancer rates are falling!

An interesting trend has come to light that definitely seems surprising: less people are dying from heart disease and cancer, and the incidence of cancer is dropping!  According to a recent study in the New England Journal of Medicine [1] age-specific heart disease deaths worldwide dropped by 39% between 1990 and 2013 and the SEER database reports that over the last 10 years of records, cancer incidence in the U.S. has fallen an average of 0.9% per year.  Also, cancer death rates have trended down and 5-year survival has improved. [2]  

The reason these diseases are becoming less common is most likely multifactorial: better lifestyle choices, better diagnostic abilities, and better treatments probably all play a role.  However, it’s important to note that one of those factors is patient-powered – better lifestyle choices.  The most profound impact we can have on our own heart disease or cancer risk is what we choose to put in our shopping carts and on our table, and our choice to stay active and get enough sleep.  For a wealth of practical strategies to help incorporate those choices into your own life and transform your health with lifestyle medicine, see Good Food, Great Medicine. 


Miles Hassell MD

[1] Roth, G.A. et al. NEJM 2015;372:1333-41
[2] http://seer.cancer.gov/statfacts/html/all.html

Thursday, May 28, 2015

Over-the-counter pain relievers: don't assume they're harmless

A commonly underrated hazard is the use of pain medication, including over-the-counter favorites like acetaminophen (Tylenol and others).  Patients often take them for fairly minor pain, sometimes with the idea that the “anti-inflammatory” or some other effect will improve healing.  However, a new study [1] in the Annals of the Rheumatic Diseases (ARD) warns that even standard doses of acetaminophen (or paracetamol, as it’s known in the UK) taken regularly can damage kidney function, especially with higher dose levels.  This doesn’t mean we shouldn’t take any pain medicine for an injury, or that acetaminophen is especially harmful compared to other pain relievers; it does remind us to be respectful of harmful side effects from these medications, and to only use them when necessary.  (Although this 2015 study only looked at acetaminophen, most pain relievers have been found to have comparable risks.)  Some steps to consider are applying heat, ice, massage, physical therapy, supplements, or activity modification – for example, if something hurts when you move, rest it as much as possible.  Any persistent pain needs appropriate medical evaluation, but talk to your physician about other alternatives to over-the-counter pain medications. 


Miles Hassell MD

[1] Roberts, E. et al. Ann Rheum Dis 2015;0:1–8. doi:10.1136/annrheumdis-2014-206914 

Wednesday, May 20, 2015

Read this only if you’re getting older

We all want to maintain healthy brains and well-functioning bodies as we age.  So how do we do it?  The most powerful tool available to us appears to be a Mediterranean diet rich in good fat, and yet another 2015 study agrees. [1]  In a four-year randomized controlled trial studying age-related cognitive decline, participants 55–80 years old were divided into three groups.  Two groups followed a Mediterranean diet supplemented with either 1 liter of extra-virgin olive oil per week or 30 grams of mixed nuts (walnuts, almonds, and hazelnuts) daily, and the third group followed a careful low-fat diet.  Those on the Mediterranean diet with nuts or olive oil had better brain function at the end of four years than those on the low-fat diet.  This builds on 60 years of high-quality studies supporting an omnivorous Mediterranean diet pattern.  The low-fat doctrine has dominated the past half-century, but it’s time to face the good fat facts!  Want a quick Mediterranean diet summary?  See Fat Is Good, Bagels Are Bad.  For a practical and easy-to-read resource on the day-to-day application of Mediterranean diet principles see Good Food, Great Medicine (3rd edition – especially pages 15-16 on Aging Gracefully).  It also includes 185 recipes featuring plenty of raw nuts and extra-virgin olive oil. 

Miles Hassell MD


[1] Valls-Pedret C. et al. JAMA Intern Med 2015;doi:10.1001/jamainternmed.2015.1668

Thursday, May 7, 2015

Know anyone with atrial fibrillation?

You might – atrial fibrillation (AF) is a heart rhythm disorder we are seeing more and more frequently.  AF carries a high risk of stroke, and there are many treatments to lower this risk and reduce symptoms; the most common treatments include anticoagulants to make the blood less likely to clot.  While these blood thinners reduce stroke risk, they have their own dangerous side effects (including, not surprisingly, a bleeding risk), often require frequent blood tests for monitoring, and do not completely eliminate the stroke risk.  Happily, our chance of developing AF is much lower if we choose to eat well and stay active.  There is also good news for those who have atrial fibrillation and are overweight: if you make sensible food choices and do moderate exercise to achieve at least 10% weight loss, and maintain those habits, you are 76% more likely to have AF disappear without using drugs or other interventions!  This is based on the results of a 5 year study of 355 overweight patients with AF, published last month in the Journal of the American College of Cardiology.[1]  It reminds us that good lifestyle choices are critical in treating disease as well as preventing it.  Using lifestyle medicine, people can often not only reverse AF and many other diseases, but also avoid the cost and side effects of drugs and medical procedures.  What a deal! 

Miles Hassell, MD
 



[1] Pathak, R. et al. J Am Coll Cardiol 2015;doi:10.1016/j.jacc.2015.03.002