Low-tech choices beat high-tech treatments for keeping our tickers ticking: study shows coronary artery stent no better than placebo for stable angina

A 2018 randomized controlled trial [1] compared placing a coronary artery stent to open up a severely clogged artery to a placebo procedure for stable angina, and found that the stent procedure made no difference to the outcomes and was potentially harmful.  (Angina is typically chest pain or other symptoms due to clogged arteries in the heart.)  In contrast, randomized controlled trials [2] have shown the Mediterranean diet reduced cardiac events by up to 70% and deaths by 56% in patients with heart disease; in similar head-to-head trials, [3] exercise has been better than stents for patients with heart disease.

My recommendation:

Medications, coronary artery stents, and surgery all have an important role to play in treating heart disease, and have contributed to a dramatic reduction in heart disease risk over the last 30 years. However, remember that our food and activity choices are likely even more important than the high-tech approaches for both preventing and treating heart disease.  For information and references on using a whole food Mediterranean diet, weight management, and exercise to help keep our tickers ticking and trouble-free, see pages 59-92 in Good Food, Great Medicine, 3^rd edition.

Miles Hassell MD

 

[1] Al-Lamee, R. et al. Lancet 2018;391:31-40

[2] Lorgeril, M. et al. Circulation 1999;99:779-85
[3] Hambrecht, R. et al. Circulation 2004;109:1371-8

Get up and move! You’ll live longer and feel better

Are chairs the new cigarettes?  It looks like it.  A 2017 study links sedentary behavior to increased death from any cause, regardless of our exercise habits or time in the gym.  The longer we sit, the higher the risk – and it rises by over 50% if you sit more than 12 hours a day. [1]  Whoa! 

My recommendation:

If our job requires us to spend most of our working hours sitting in front of a screen, we simply need to remind ourselves to

• Stand up and (if possible) walk around every hour or so
• Make use of the stairs (if any) where we work
• Think about having “walking meetings” rather than sitting around a table

At home, carve out 30 minutes of screen time each day to do something active (hmm. . . about the length of our favorite show?) – perhaps several short bursts of low-tech high-intensity activities like skipping rope or climbing stairs, which may even be more effective.   In any case, get a little short of breath and sweaty every day.  For suggestions on how to make exercise work for you, and some impressive evidence for the health benefits of staying active at any age, see pages 50–55 in Good Food, Great Medicine, 3^rd edition.

Miles Hassell MD

[1] Diaz, K.M. et al. Ann Intern Med 2017;167:465-75

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 (3^rd edition).  For additional GERD-fighting suggestions see our January 2017 newsletter.
 

Miles Hassell MD

 

[1] Cheung, K.S. et al. Gut 2017;doi:10.1136

[2] De Bortoli, N. et al. Dis Esophagus 2016;29:197-204

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 (3^rd edition) or see our free weight loss handout at goodfoodgreatmedicine.com.
 

Miles Hassell MD

[1] Caleyachetty, R. et al. J Am Coll Cardiol 2017;70:1429-37

 

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

[1] Ríos-Hernández, A. et al. Pediatrics 2017;139:doi:10.1542

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, 3^rd 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

[1]Donnelly, K. et al. PLoS One 2017 Apr 27;12(4):e0174730

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