Archive for the Preventive Medicine Category

Want some breast milk in that ice cream?

Posted in humor, Preventive Medicine with tags , , on September 24, 2008 by Dr. CJ

In a typical throw-all-rational-thinking-out-the-window approach, PETA sent a letter to the founders of Ben & Jerry’s Ice Cream requesting that they use human breast milk rather than cow’s milk in their products.

Read letter here.

Wow.  [said with complete lack of emotion, or is it utter (no pun intended) disbelief]

That is so over-the-top ridiculous – that all I can say.

OK, maybe one more comment because it irked me:  You want to prevent obesity and diabetes?  Quit coddling your child – force them to do something other than play video games and surf the internet.


Extreme Lipids I

Posted in Heart Disease, Preventive Medicine with tags , , , , , on September 22, 2008 by Dr. CJ

I saw a woman a few months ago who had concerns about a strange sensation in her chest.  She had had her cholesterol panel checked a few months prior by her gynecologist at her yearly female exam.  The gynecologist communicated to her that her total cholesterol was too high at 240 and that she should follow-up with my clinic.

Sure, 240 is high for a total cholesterol is high, but the details of the individual lipid measurements are far more telling than a “total”.  This woman’s lipid panel is a perfect case in point.

  Here’s the panel – refer to this post for details on the significance of each value.

Total Cholesterol    240  (normal < 200)

LDL                         111  (normal < 130)

HDL                        117  (normal >39)

Triglycerides            61  (normal <150)

So what?  This panel achieves one of my fantasy goals for cholesterol numbers – an HDL greater than the LDL [without cholesterol medication].  There was one other patient who came close.

Her total cholesterol is high in part due to the very high HDL cholesterol, but if you’re going to have a high total cholesterol, this is the way to do it.

Why is a high HDL a good thing?  HDL protects the heart and brain by it’s “scavenger” effects on plaque in blood vessels.

That’s no easy task, although favorable genetics certainly help.  The hightest HDL’s I’ve seen are generally in alcoholics – unfortunately, the HDL-raising benefits of alcohol are outweighted by its deleterious effects.

The best way to raise the HDL is through regular, intense exercise.  There was a study from years ago that analyzed HDL’s in runners: the more miles they ran in a week, the higher their HDL.

Lifestyle recommendations to lower your risk of cancer

Posted in Preventive Medicine with tags , , on April 20, 2008 by Dr. CJ

For what it’s worth, here is a summary of an updated report issued jointly by the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR), titled Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective

  1. Be as lean as possible within the normal range of body weight.
  2. Be physically active.
  3. Avoid sugary drinks and limit consumption of energy-dense foods.
  4. Eat mostly foods of plant origin.
  5. Limit red meat and avoid processed meat.
  6. Limit alcohol drinks.
  7. Limit consumption of salt.
  8. Aim to meet nutritional needs through diet alone.
  9. Exclusively breastfeed infacts (no other liquids) for up to six months.
  10. Cancer survivors should follow the recommendation for cancer prevention.

Being overweight or obese was found to impose a much higher risk of cancer compared to lean individuals.

I offer #11: Pick your parents wisely – family history is a big factor.

The Dalai Lama goes to Mayo

Posted in Preventive Medicine, Rants and Raves with tags , , , , on April 16, 2008 by Dr. CJ

Here’s the type of news piece that gives me a good, long laugh – another worldly figure travels across the world to get an annual physical exam at the Mayo Clinic

No doubt, the Mayo Clinic is capable of doing great things – they have specialists so specialized that they have forgotten how to treat a common cold.  Who wouldn’t want an “expert” to manage an unusual condition?  Few people have unusual conditions, though.

I’ve seen patients in my clinic who go there for their annual exam.  For some reason, they feel that getting a clean bill of health from Mayo is some kind of blessing for eternal wellness.  Mayo is, in fact, good at coordinating a ridiculous number of labs, imaging, diagnostic tests, and doctor visits into a comprehensive day-long physical exam.  They are masters at communication and planning, apparently.  However, is there any benefit to this kind of overwhelmingly thorough evaluation?

This shotgun approach to an annual health exam is a dangerous venture for a few reasons. 

  1. It’s expensive.  I’d hate to be your insurance company staring at a list of charges you rack up on that one day.
  2. It cultivates a sense of urgency to “do everything” all the time.  People love to feel pampered – talk to your insurance company or whoever is actually paying for those charges.
  3. It leads to unnecessary follow-up testing.  Not all “abnormal” results are necessarily abnormal.  But, if you go fishing for everything when there’s no focus on a particular problem, you’re going to find a lot of junk, and you won’t know how to interpret it.
  4. It’s a poor use of resources.  Common things being common, most people don’t have “rare” diagnoses that require an expert on minutiae.  In an ideal world, we could find a way to maximize the efforts of the highly-specialized physicians who really don’t need to be dealing with routine conditions that could be managed by any other competent physician.  Do you need a world expert on obesity and metabolism to tell you that you need to eat better and exercise more? 

I don’t question their value in managing rare or difficult-to-treat conditions, but for the average individual it’s a complete waste of time and money.  It’s all about perspective – the things that are going to kill you are staring you in the face every day and are simple to manage.  There’s nothing glamorous about searching high and low to come up with weird explanations for common problems. 

Then again, I don’t know Buddha’s take on health.

Further thoughts on my lipid panel

Posted in Preventive Medicine, Transformation on March 1, 2008 by Dr. CJ

First, I forgot to mention the family history of abnormal cholesterol profiles – I added that to my theories for why my lipids are so stubborn.

Second,  I’ve decided to change things around a little bit.  I’m going to turn it up a notch with my elliptical work – still doing HIIT on the weekdays, but then HIIT + LISS on the weekends.  For example, this morning I did 60 minutes on the elliptical, 20 of which were HIIT.  (Almost sweat-soaked my entire shirt)

Finally, I’ve made some dietary adjustments.

  • increase my morning oatmeal consumption, one of the few proven dietary methods to reduce cholesterol, primarily LDL cholesterol
  • increase walnut and almond intake (again, has evidence in reducing cholesterol)
  •  cut out my little vices (I’ve suddenly become a chocolate addict since cleaning up my diet – no more)

I probably have an upcoming insurance exam again, which will serve as my next target date to get the lipid numbers in range.  No medication for me – I’m doing this the hard, honest way.

Analysis of my new lipid panel

Posted in Preventive Medicine, Transformation on February 29, 2008 by Dr. CJ

The results are in. I have to admit, I expected better numbers compared to my lipids measured 1.5 years ago, but here goes:

– – – – – – – – – – – – – – – – – – – – 5/2006 – – – – – – 2/2008

  • Total Cholesterol – – – 197 – – [<200] – – – – – 191
  • HDL-C – – – – – – – – – – – 34 – – [>39] – – – – – – 36
  • LDL-C (calculated) – – 140 – – [<130] – – – – – 146
  • Triglycerides – – – – – – 113 – – [<150] – – – – – 44
  • TC/HDL ratio – – – – – – 5.8 – – [<5.0] – – – – – – 5.3
  • Fasting glucose – – – – – 71 – -[<100] – – – – – – 78

My observations:

  1. HDL is slightly higher, not to goal.
  2. LDL slightly higher (OUCH . . . really can’t explain this one).
  3. Triglycerides are considerably lower – I don’t know if I’ve ever seen one this low. At least one portion of my lipid panel changed considerably – too bad it was already normal.
  4. TC/HDL ratio is slightly improved, but still not to goal.

I have a couple theories to explain the less-than-stellar improvements in these numbers.

  1. Family history – there is definitely a history of low HDL/high LDL on my maternal side.
  2. Labs were performed at different labs – hard to estimate the impact of this one, but certainly can be a factor.
  3. Last year, I really only stuck to my solid regimen for 4 months. After that, I had a tremendously busy, stressful year that precluded a good fitness routine. Thus, these numbers probably reflect only a solid 6-7 weeks of my regimen from this year, following a 7-8 month period of relative inactivity prior to that.
  4. I discovered a study that demonstrated the HDL responding less to exercise in individuals with low Triglycerides compared to individuals with high Triglycerides. This article highlights a possible explanation for why the HDL did not increase as much as I expected. This finding is news to me – never heard/read about this concept before.
  5. Last year, I was taking a protein supplement that had quite a bit of fat, including saturated fat. That may have accounted for the higher LDL. I’m currently using a pure protein supplement with no fat. That’s the only supplement I will use. [That’s a topic for another day.]
  6. HDL probably increases better as a result of longer-duration endurance training workouts than I get with High-Intensity Interval Training (HIIT) workouts on the elliptical. Could this be one limitation of HIIT?

Regardless, this just serves as another motivator for me to turn everything up a notch. I’m not a fan of long-duration endurance training, but I will probably incorporate more into my training. At least in the summer, I will do a large amount of biking.

I’ll be checking these numbers again in a year. I refuse to depend on medication, so I’ll be working hard.

My old lipid panel – pre-transformation

Posted in Preventive Medicine, Transformation with tags , on February 28, 2008 by Dr. CJ

Back in May, 2006, I last had some blood work done, for an insurance exam, that included a lipid panel. I, of course, held onto those results, because I obsess over my risk factors for heart disease. Here they are, in their unimpressive glory.

  • Total Cholesterol – – – 197 [<200]
  • HDL-C – – – – – – – – – – – 34 [>39]
  • LDL-C (calculated) – – 140 [<130]
  • Triglycerides – – – – – -113 [<150]
  • TC/HDL ratio – – – – – – 5.8 [<5.0]

And, of course, as part of metabolic syndrome, one must be concerned about the fasting glucose . . .

  • Fasting glucose – – – – – 71 [<100]

My HDL had actually been worse a few years before that, in large part due to some bad habits learned in college and carried into med school.

Stay tuned for the current lipid panel results. We’ll see how much progress I was able to make since cleaning up my diet and starting an exercise regimen.  I’m nowhere near my fitness goal, but I’m hoping to see some progress.