I have a wire basket on my desk stacked with medical articles that merit my muttering, “This is useful. Might be handy for a future health tip.” On the plus side, they’re all undeniably of interest. On the minus, there’s not enough material in each article to merit a complete health tip.
So this week I’m emptying the basket. Starting at the top:
Greed is not good: treating mild high blood pressure probably harmful
An editorial in this week’s JAMA Internal Medicine finally acknowledges what many doctors suspected all along: that treating mild high blood pressure (systolic 140 to 159, diastolic 90 to 99) is unnecessary and probably harmful. When I was first in training, the starting point for initiating medication was 160/100. The editorial reminds readers that these numbers were changed in 1983 after three World Health Organization symposia on high blood pressure concluded that starting treatment at lower levels earlier was not only better, but lifesaving.
Retrospectively, it was noted that each of these gatherings was financially underwritten by multinational pharmaceutical companies, all manufacturers of the recommended blood pressure meds. The symposia were successful beyond any Big Pharma CEO’s wildest dreams. It’s estimated 13 million people in the US alone are probably taking unnecessary blood pressure medication. The article states, “The waste, in terms of medication costs, investigations, and time of both patients and health care professionals is enormous.”
Not to mention side effects. 9% of patients taking these meds discontinue them because of side effects, while countless others endure the side effects or worry that their marginally elevated blood pressure will kill them early. Thirty years later, we learn the recommendation was predicated on sheer greed.
Sunscreen slows skin aging
An article in June 4, 2013, Annals of Internal Medicine actually made the newspapers and, I’m told, the TV news as well. Middle-aged and older adults can very definitely slow down signs of skin aging with daily, year-around application of a broad-spectrum sunscreen. Researchers in Sweden gathered more than 900 adults under 55, giving half sunscreen and half a placebo. The daily sunscreen users showed no detectable increase in skin aging after 4.5 years. Skin aging from baseline to the end of the trial was 24% less in the daily sunscreen group than in those who used sunscreen only as needed. (Here’s the Environmental Working Group report on choosing a safe sunscreen.) The study also wanted to find out if a daily antioxidant would retard skin aging. They used beta carotene–a poor choice to my mind–and it did nothing.
Importance of healthy D levels
A pair of articles in The American Journal of Medicine (AJM) are worth your attention. First, yet another study on the importance of healthy levels of vitamin D. This time researchers examined more than 10,000 participants who had opened their health data to research. Their average age was 46, and they represented a broad demographic base and a typical array of health risks for chronic disease. Findings? There was a direct correlation between blood levels of vitamin D and death from early heart disease. If a person’s blood level of D was 21 ng/ml (nanograms per milliliter) or less, there was a dramatic increase in the risk of cardiac death. Interestingly, higher than 21 was not necessarily better, but reaching the magic 21 was key. At WholeHealth Chicago, we routinely measure vitamin D levels and are astonished by how many patients score below 21. Ask your doctor to measure your D. If you’re a WHC patient and don’t know yours, simply call and schedule a lab only. To boost levels, I recommend Bio-D-Mulsion Forte drops (which we carry in the apothecary) as liquid D seems to be absorbed better than tablets.
Antioxidants and heart disease
The second AJM piece was finally able to document a significant factor in heart health that you may have suspected intuitively. Starting in 1997, a food-frequency questionnaire was given to more than 33,000 women in Sweden. Researchers then analyzed the dozens of foods listed in the questionnaire based on their total antioxidant capacities. A diet rich in antioxidants consists predominantly of fruit, vegetables, and whole grains. In the 11 years that followed, women who consistently ate a high-antioxidant diet had a dramatically lower incidence of ever developing significant heart disease. Head for the farmers market.
Calcium for women?
In The Cleveland Clinic Journal of Medicine, yet another editorial surfaces discussing the pro’s and con’s of supplemental calcium taken by otherwise healthy adults to prevent osteoporosis. First, and this has been known for quite a while, men don’t need to take extra calcium, and in fact taking calcium may increase men’s heart attack risk. Women don’t risk heart disease by taking calcium, but the question remains: do you really need it?
The author concludes “probably not,” provided women eat a diet that provides approximately 1,000 mg of calcium daily. This link will help you see what you’ll need to choose each day to meet your total (scroll down to view the chart showing calcium-rich foods in milligrams). Based on the food diaries I see among my patients, I think most women will find eating 1,000 mg of calcium a consistent challenge, so I recommend a supplement. Our favorite, OsteoPrime Forte, was designed by Alan Gaby, MD, author of Preventing and Reversing Osteoporosis.
How often do I need a Pap smear?
After much agonizing, the American College of Obstetricians and Gynecologists (ACOG) released its new guidelines on Pap smear frequency, which take into account human papilloma virus (HPV) infection that can (but doesn’t always) lead to the s-l-o-w development of cervical cancer. Contrary to popular belief, HPV is not like herpes, which stays with you forever. When women under 30 become HPV-positive, the infection usually goes away by itself within three years. For women over 30, the infection is more persistent and can lead to cervical dysplasia. However, dysplasia is not cancer, and it usually takes five to seven years of untreated dysplasia before cancer cells start appearing in a Pap smear.
Here are the new ACOG guidelines:
Under 20: no Pap smear or HPV testing.
21-29: Pap every three years and no HPV testing.
30 to 65: Pap and HPV every five years or Pap alone every three years.
After 65: if three previous Paps have been negative, no further Pap tests needed.
After hysterectomy: (1) if cervix was removed and there is no history of cervical cancer then further Paps are not needed; (2) if there is a history of cervical cancer, regardless the patient’s age, then Pap testing of the internal surgical scar is needed.
Add these useful foods to your diet: cinnamon and nicotine
An Israeli study (not funded by the pharmaceutical industry) shows that cinnamon can delay the progress of Alzheimer’s disease. Based on animal models, the researchers believe cinnamon’s anti-inflammatory effects dissolve the amyloid plaques in the Alzheimer brain. Although it’s premature for conventional US physicians to start recommending cinnamon as an Alzheimer preventive, I’d start now sprinkling cinnamon on food as frequently as possible. Cinnamon tea would work well or, if you have a family history of Alzheimer’s, add a cinnamon capsule to your daily vitamin regimen. In addition, separate studies have shown cinnamon to be helpful for polycystic ovary syndrome (PCOS) and mild diabetes.
It’s been known for years that cigarette smokers have a lower risk of Parkinson’s disease than non-smokers. For obvious reasons, the medical community is loathe to recommend smoking to prevent Parkinson’s. However, now we understand just why smoking works: it’s the nicotine. You can get plenty of nicotine in certain foods–red peppers especially, but also those in the nightshade family, which includes eggplant and tomatoes. Since Parkinson’s is such a devastating neurological disease and red peppers so delicious, pick some up today (hot sauces, like Tabasco, are included here as well).
Pasta comes from animals?
A recent British study evaluated how much elementary and high school students knew about good nutrition. Happily, 75% of elementary students (ES) and 88% of high school (HS) students knew that good nutrition was important. Unfortunately, 25% of HS kids reported never eating breakfast, and 20% never eating fish. Just 20% of both groups had ever visited a farm, explaining why 30% of the ES think that cheese comes from a plant and 20% think pasta comes from animals. 10% of HS students think tomatoes grow underground, and 20% of the ES think fish sticks come from chicken.
You could dismiss this, but I dare you: if you have children at home, ask them about the cheese tree.
David Edelberg, MD