Friday, July 29, 2022

Foods as medicine

As you know from reading earlier posts, the effects of different foods on health can be difficult to interpret. Rarely do studies get to compare people who are exactly alike except for their consumption of the substance of interest. Avocados may be good for your heart, or it may simply be that people who eat avocados eat a healthier diet overall. Hence the often contradictory headlines - coffee is good for you/coffee is bad for you – that populate the press.

I have thus been very interested to find several recent studies with robust data behind the health claims.

First bananas. A British group treated almost 1000 people with a hereditary tendency to colon cancer (Lynch syndrome) with a “resistant starch” powder made from bananas or a placebo for 4 years and followed them for at least 10 years. The supplement group had a similar rate of colon cancer but dramatically fewer cancers of the pancreas and upper GI organs: 5 vs. 21.

Another study looked at the value of cocoa-based chocolate compared to white chocolate and placebo in elderly patients with advanced cancer in palliative care. After 4 weeks, the group given dark chocolate had better calorie and protein intake and overall better nutritional status than either the white chocolate or no chocolate groups. They also had improved functional status.

Finally: prunes. Prunes are known to contain large amounts of antioxidant compounds. Researchers at Penn State gave post-menopausal women 55 to 75 either 6 prunes/day, 12 prunes/day or no prunes for 12 months. All 3 groups were given daily calcium and Vitamin D. Not surprisingly, the group assigned to 12 prunes/day had a high (41%) drop-out rate, presumably because of excess bowel movements, but only 10% of the 6-prune group and 15% of the no-prunes group left the study.

After a year, the groups taking prunes had much lower levels of inflammatory markers in their blood. More important to the women in the study, the placebo group had a significant fall in their bone mineral density while the group who took 6 prunes/day had no drop.

So, good data showing that bananas, dark chocolate and prunes have proven health benefits. Enjoy!

Prescription for Bankruptcy. Buy the book on Amazon

Thursday, July 14, 2022

Do I really need that test?

A 2019 study estimated that overtreatment and “low value” testing costs the U.S. between $75 and $100 Billion annually. Why should you care? You should care because this means that the cost of your health insurance and your out-of-pocket costs go up to pay for this unnecessary treatment and testing.

We will leave treatment to another post and focus on over-testing. Unnecessary or low-value tests are those which are very unlikely to make you live longer or feel better.

Such over-testing is ubiquitous, but one area is “routine” pre-operative testing. Clearly if you have evidence of bad heart or lungs and are being asked to have a risky surgery, your doctor may need tests to determine if you can safely undergo surgery. That, however, accounts for only a tiny fraction of pre-op testing.

The vast majority of pre-operative testing is done on relatively healthy people who are about to have low-risk surgery such as hernia repairs or cataract extractions. Decades ago, the American College of Cardiology and the American Heart Association, in conjunction with the anesthesiology societies, published guidelines recommending against pre-op stress testing for most patients, and even advised against routine ECGs. While some hospitals have tried to reduce such testing, the overall impact of these recommendations has been minor.

In many cases, asking a few questions, such as “can you walk up 2 flights of stairs without problems” will avoid the need for most heart and lung testing before surgery.

Why do so many unnecessary tests continue to be ordered? Some of the incentive is financial. Doctors and hospitals are paid more when they do more. As long as this perverse incentive continues, there will be pressure to do more. Research has demonstrated that doctors who own MRI machines order many more MRI studies. If I were paid by the word to write, you can bet this post would be much longer.

The other factor is cultural. Doctors have been conditioned to believe that “It cannot hurt to get more information.” While an occasional extra blood test may not cost much or harm you, some invasive tests carry risk, and the added cost and inconvenience of any test is not trivial if you take off time from work or drive a distance. Another under-appreciated factor is that many “routine” tests turn up unexpected minor abnormalities that are not significant, but which require other tests to prove this.

What can you do? Before agreeing to any test, ask how the results will change your treatment.

For anything but blood tests or plain X-rays, ask if there is any risk to the test.

Ask if there are simpler alternatives.

Ask if there is any harm in waiting a bit. Many illnesses are self-limited, and the doctor will often be certain you have nothing serious but orders tests “to be sure.”

If the recommended test is invasive, such as cardiac catheterization, consider asking for a second opinion before you agree to have it.

Prescription for Bankruptcy. Buy the book on Amazon

Wednesday, July 6, 2022

Protect your brain!

Dementia is probably the most feared illness to which older adults are prone. While we cannot do anything about the biggest risk factor, aging, there are many other risk factors that are under our control.

I mention aging because the likelihood of dementia rises rapidly as we get into our 70’s and beyond, and the only way I know of to prevent getting older is to die young, which I do not recommend.

So-called “mind games” have been much touted but there is little evidence they do any good.

The “modifiable” factors that increase the odds of dementia include physical inactivity, cigarette smoking, depression, low education, obesity, diabetes, high blood pressure and hearing loss. It has been said that anything which is good for the heart is good for the brain, and that certainly applies to many of these factors.

Stopping smoking if you are a smoker will add years to your life and improve the quality of your life. Treating hypertension and diabetes will lower your risk of both heart attack and dementia. Losing weight obviously helps numerous health issues, from heart disease to arthritis, as well as dementia. If only I had a magic bullet to make this easy.

Depression and hearing loss share the common factor of increasing isolation. Treating depression and getting hearing aids both allow more social participation, which in turn decreases the risk of dementia.

I have saved the best (studied) for last. Innumerable scientific studies have shown that regular physical activity lowers the risk of dementia and pushes it out later if it occurs. This does not mean you have to run marathons. Walking, gardening, pickleball or line dancing are all helpful.

How exercise works is becoming clearer. Studies in mice have shown that exercise creates more neurons and synapses (the connections between neurons). There is also evidence in mice that exercise reduces the inflammation that harms brain cells. More recently, a study of older Chicago residents followed closely over decades has found similar benefits in the human brain. There was a strong correlation between being more active physically and healthier brains with less inflammation. None of these seniors formally “exercised,” but activity monitors were used to see how often they moved versus sat.

Bottom line: get off the couch and walk, do housework or play with the grandchildren. Move that body for at least an hour a day. Your brain will thank you.

Prescription for Bankruptcy. Buy the book on Amazon