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

Wednesday, May 6, 2015

Chili (con Beans and con Carne)

Chili (con Beans and con Carne) Page 235

This can be simple or complex, fancy or plain, vegetarian or not.  You can use whatever beans you like.  I cook my own beans (see page 198) or use canned pinto beans.  You can make it hot, or tame like this version.  You also may prefer a soupier chili than this one.  We generally serve chili over brown rice, but a decadent alternative is to serve it over Easy, Cheesy Polenta (page 217).   

(Serves 4 – 6)

¼ cup extra-virgin olive oil
2 medium-large onions, ¼-inch dice (6 cups)
1–2 bell peppers, diced (1½–3 cups)
Optional: 1–2 jalapenos, seeded, finely diced

1–2 tablespoons freshly crushed garlic
 2 tablespoons chili powder
1 tablespoon ground cumin
1 teaspoon oregano
1 fat tablespoon honey
2 teaspoons salt
1 teaspoon freshly ground pepper

1 pound ground or chopped meat (see note)
-or- chopped leftover cooked meat, especially leftover Ono Oven Smoked Pig (page 240)

1 can (28 ounces) crushed tomatoes    
3 cups cooked beans (15-ounce can is about 1½-cups drained beans)

Optional:  1 cup chopped cilantro, if available

Onions, bell peppers, and jalapenos sauteing
in extra-virgin olive oil.

Sauteed vegetables cooking with garlic
and an assortment of spices.

This chili is hearty and delicious with the addition
of flatiron steak.

Here I am quickly browning the meat.

This is the finished chili after simmering for
30 minutes over very low heat.

1.     Heat oil in 6-quart heavy pot over medium high heat and sauté onions briskly for about 8 minutes, then add peppers (and jalapenos, if you have them) and cook for 5 more minutes, or until onions and peppers are tender.  Stir in garlic and seasonings and cook for another few minutes.

2.  Keeping heat at medium-high, push vegetables to the sides of the pot and add meat.  Sauté briskly until browned. 

3.  Add tomatoes and drained beans.  Bring to a simmer and cook very gently, uncovered, for about 30 minutes, stirring from time to time.  Avoid letting the chili boil.  Keep in mind that the longer you cook it, the drier it gets.  Taste for flavor – the chili may need a dose of bottled fire of your choice, depending on the amount of beans and/or meat you ended up using. 

4.  Add cilantro within an hour of serving, to maintain color and flavor, or serve on the side.  (If made in advance, let cool completely, uncovered, before storing in refrigerator.)

4 I like to either serve chili with sides of Pico de Gallo and Avocado Salsa (both on page 175) or with side dishes of topping options like grated sharp cheddar cheese, sliced green onions or diced mild white onions, diced avocado, extra chopped cilantro, and minced fresh jalapenos.

Chopped meat versus ground meat
Ground beef or pork (or whatever meat you like) works fine, but I like to chop my own – the texture is completely different than ground meat.  My choice is flatiron steak, which is fairly tender and rich, and I use a very sharp chef’s knife mine is 11 inches, which makes easy work of it.  I ignore the tough connective tissue that always seems to run across the underside of the steak – I chop it finely and it is unnoticeable.  The meat is even easier to chop if you put it in the freezer until it’s semi-frozen – at least 30 minutes.  (The flatiron steak I get is sold in handy vacuum packs, which makes it easy to just slip it in the freezer.)  The almost-frozen meat is steadier under the knife and faster to chop.  It’s worth the extra work, in my opinion.