The "Flat Belly" Diet

Hope this finds everyone well! I noticed this week that there is a link from my Google homepage to this "flat belly diet." Funny, Web MD just happens to have an article about it too. I generally have a lot of faith in Prevention Magazine and I think that a lot of information contained in it is well researched and worth while, but sometimes I think they get swept up in the nonsense too.

This "diet" is one such example and I think that WebMD's registered dietitian (RD) does a great job of supporting what is right about this eating plan, as well as dispelling the myths about it. This plan is a healthy, Mediterranean-diet based plan, and you will certainly lose weight on on it, as well as probably lower your cholesterol and improve your blood pressure, but it won't melt away fat from any particular body location.

It is important to realize that any diet that seems to have a "magic" ingredient to melt away fat/pounds, no matter what the source of the information, is full of horse feathers! Please look to a trusted, well-researched source for your dietary information, such as your own RD, or a site such as WebMD or a university-based health site. The critical thing to ask yourself is, "does the writer of this diet article have something to sell, such as food items, food supplements, or a book?" If they don't, then you'll be more likely to get unbiased information.

On another note I have been away in Washington, DC this past week at the American Association of Diabetes Educators meeting. This was a mixed business and site-seeing vacation trip, and my traveling companion and I had a wonderful time. If anyone is going to DC and wants a recommendation for a place to stay, please check out the B&B called the Aaron Shipman House; you will not be disappointed!

Lovely hosts, fabulous food at breakfast, and a great neighborhood location (less than 15 min walk to the convention center at a moderate pace). While there I began reading Animal, Vegetable, Miracle by Barbara Kingsolver. If you are at all interested in the topics of eating locally (aka "relocalizing" food or being a locovore), and the environmental impact of our food choices, you'll want to read this book. Here is a factoid taken from her pages that amazes me: "If every US citizen at just one meal a week (any meal) composed of locally grown and organically raised meats and produce, we would reduce our country's oil consumption by over 1.1 million barrels of oil every week." That's not gallons - it's barrels! Think about how fast this would decrease our dependence of oil.

Eating well for our improved health and the environment are important. Be certain that the recommendations that you follow are from an informed, unbiased source.

Take care.

~Laurie

Related Topics:

• Diets that Don't Work
• Slideshow: Least Effective Exercises

Technorati Tags: healthy diet, belly fat

Women and Hypertension

Photo Credit: Lisa Brewster

As reported this week in HealthDay News, more than 73 million adults in the US have high blood pressure (hypertension); half of them are women.

As a group, women are more likely to be overweight and have elevated cholesterol levels, and they are less likely than their male counterparts to meet the target "goal numbers" for well-controlled blood pressure as set by various health organizations, such as the American Heart Association or the National Institute of Health. Women are less likely to have appropriate prescriptions written for them than men, such as blood pressure and cholesterol lowering drugs. This is partly because women aren't educated in the need to control their blood pressure to prevent an increased risk for developing cardiovascular diseases such as heart attack and stroke.

Simply put, women don't think it's going to happen to them, when statistics tell us a different story. Heart disease is the number ONE killer of both men and women, but annually it takes the lives of more women than men. Hypertension is so damaging to the inside of the blood vessels, that controlling it to 'goal' (top number less than 120 and less than 80 on the bottom) will cut a woman's risk of stroke and heart attack in by 25%!

Women should ask about there blood pressure measurements, and if they are high, ask for advice on how to improve them. This can be as simple as eating more calcium-rich foods, or more challenging, such as losing some weight or exercising more. Research has indicated that as little as a ten-pound weight loss will have a significant impact on blood pressure.

For more information, look to these WebMD resources:

• Hypertension/High Blood Pressure Health Center
• Hypertension / High Blood Pressure Guide
• Blood Pressure Rising in U.S. Women
• 5 Natural Ways to Lower High Blood Pressure

Take care.

~Laurie

Related Topics:

• Heart Disease and Women
• WebMD Video: Cholesterol Warning for Women

Technorati Tags: hypertension, high blood pressure, heart disease, womens health

Emergency Room Follow Up

I am very glad to see all the thoughtful comments on the last "Tales From the Emergency Room" post. I was inspired by your comments to post this follow-up, because I think there is a critical misunderstanding about the abilities of medicine to diagnose illnesses among those who have to be the recipients of that care.

Medicine is not black and white. There is no "x + y = z" to diagnosis. When faced with a diagnostic challenge a practitioner of medicine must take a thorough history, including all the details of the present illness, as well as the person's past medical and surgical history, and current and recent medication use (prescription and over the counter). He or she then synthesizes all this information and places it in the context of the "odds" of various things being wrong. Let's take a common example, chest pain (CP). As I approach the room in the ED with the CP patient I have a "differential" list in my head. A differential list is all the possible causes of chest pain I can think of: heart (ischemic heart disease/heart attack/angina), lung (congestive heart failure, pneumonia, blood clot, tumor, pneumothorax, pleurisy, dissecting aneurysm), musculo-skeletal (contusions, costochondritis, rib fractures), and GI (reflux, heartburn, esophagitis, ulcer, gastritis, referred pain from the gallbladder or pancreas).

When I go into that room I notice a few things right off:

• age (less than 40 vs. over 40), because a young person doesn't usually have heart attacks, dissecting aneurysms, angina, or CHF, but is more likely to have GI tract or musculo-skeletal problems.
• level of current distress and other clues, such as a low blood oxygen level or being short of breath, which pushes me in the direction of heart or lungs.
  

Then I get the story: 51 year old woman with not 'typical, heart-related' chest pain presents with waxing and waning discomfort all day, which she describes as "I just didn't feel right" and "I was restless, like I couldn't get comfortable, and a little short of breath." She is a smoker with high cholesterol and anxiety disorder and whose brother had a heart attack at under age 50. First heart enzymes are in the abnormal zone, but not high enough to suggest a heart attack. EKG is normal x's two; D-dimer (a measure of blood clots) is normal. The odds are that this is not pain from her heart, but she has too many risk factors to ignore and will spend the night in the hospital having serial heart enzymes just to make sure her heart is ok. My diagnosis: atypical chest pain, admit to rule out heart as source. Once that is cleared she'll face the diagnostic dilemma of, "if not heart, then what is it?"

Another one: 17 year old with 24 hours of chest pain that started after eating pizza quickly while at work at the pizza joint. Now feels that it hurts to swallow. No prior history of stomach problems, no significant heartburn in the past. Has also been away at camp and exposed to lots of other teens, and has a minor cough. Chest x-ray is normal and pain gets better with some Maalox mixed with lidocaine (a numbing agent), suggesting that there is a problem in his stomach or esophagus. My diagnosis: esophagitis, basically inflammation in the esophagus (swallowing tube between mouth and stomach), possibly after injury to the esophagus from hard pizza crust eaten quickly. Plan-home on antacids and acid-blocking pill, follow up with own MD. But if not better, then what? The patient is a little over weight, has a little chest wall tenderness but it Does the person actually have inflammation in the stomach or a stomach ulcer? Does the person actually drink alcohol with friends on the weekends, but won't admit it in front of mom? Is it really muscle pain from sports activities at camp? If my medicine doesn't work, the patient will be back to their own MD and "back to the drawing board" in terms of having a correct answer.

Third one: over weight mid-30's year old woman on birth control pills with sudden chest pain and increased heart rate; non-smoker, recent cross-country flight with layover of 1 hour in Philadelphia before changing planes. Asked for wheelchair ride between gates due to "pulled muscle" in her right calf that caused her to walk too slowly; she was afraid of missing her connection. No personal of family history of blood clots or clotting disorders; positive elevated D-dimer in her blood work, chest CT positive for blood clot in left lung. My diagnosis: pulmonary embolus (blood clot in lung) secondary to long plane trip, being overweight and on birth control pills. Admit to hospital until improved on blood thinners.

So the last patient is pretty clear-cut, but the other two are not. In this field you must put together a set of potential explanations, figure in the odds, test for the most likely scenarios, and then "pick a path and go down it," as my first mentor used to tell me. But there is always a chance that one can be wrong, and that is why follow up, with your own health care provider who knows your personal and family history well, is so important. This is the single biggest problem in medicine today in my opinion: people are uninsured or under-insured and thus they don't think they can have a personal health care provider. Many don't realize that there is someone in their community who will take care of them, or there is an option in the nearest large city. It takes some effort, but finding someone to have a relationship with, and getting established with them, is a much better source of care than you can get in the ED, unless it is a true emergency.

Stay cool and out of the midday sun.

~ Laurie

My definition of an expert in any field
is a person who knows enough
about what's really going on to be scared.

P. J. Plauger, Computer Language, March 1983

Related Topics:

• Do I Need to Go to the Emergency Room?
• Heart Attack: What to Expect in the Emergency Room

Technorati Tags: emergency medicine, chest pain

Cold Weather and CVD Risk

Summer's here and so is the heat. Last week on the day that I read about this study it was 91 degrees Fahrenheit and 57% humidity in my surroundings, and I found myself thinking about winter heart attacks. This is because of a research announcement that may explain why there is an increase in cardiovascular disease (CVD) related deaths in the winter months. Apparently cold weather stimulates inflammation in the body, a factor that was demonstrated in the levels of inflammatory markers in the blood in the study subjects.

In this study researchers observed that 5 consecutive days of colder weather lead to an immediate increase in levels of the inflammatory markers C-reactive protein (CRP) and interleukin-6; levels of a third marker of inflammation, called fibrinogen, rose 3 days later than the other two markers. The research team measured levels of these markers in nearly 6,000 blood samples from 1,000 adults who had had a heart attack within the last 6 years. These adults were located across a wide range of climate zones.

The study, reported in the May issue of Epidemiology, suggests that one mechanism by which cold weather increases cardiovascular mortality is by increasing the body's inflammatory response. The investigators report that a 10 degree decrease in Celsius temperature (1 °C = 1.8 °F, so 10 x 1.8= 18 degrees F) over a 5 day average temperature before subjects blood was tested resulted in a 4% increase in CRP, a 3.3% increase in interleukin-6, and a 1.3% increase in fibrinogen levels in the blood.

The researchers suggest that this may indicate a biological mechanism for the observed seasonal increase in death from heart disease and stroke in the elderly. Since it is known that cold temperatures increase blood pressure and this leads to additional strain on the heart, this increase in inflammation may be an additional risk factor in patients already susceptible to cardiovascular events. Since fibrinogen is directly involved in clotting in acute heart events, cold stress may be a trigger that leads to events that thicken the blood, making clots more likely.

This is interesting research that needs additional study, since it is my understanding that we still aren't sure whether the CRP factor arrives as a marker of increased CVD risk or appears only after CVD is established. Despite this information, I'd given anything for an 18 degree drop in Fahrenheit temperature at the moment, but I guess I'll have to settle for a cold glass of iced tea!

Take care,

Laurie

Related Topics:

• WebMD Video: The Immune Systems Role in Heart Disease
• Salary, Schooling, Inflammation Linked

Technorati Tags: heart disease, inflammation, C-reactive protein, CVD, cold weather, heart health

Tales from the Emergency Department: Seriously??

Fans of Gray's Anatomy will recognize the mantra of the show, stated when a character really can't believe what they are seeing in front of them and says, "Seriously. Seriously?" Frequently in the ED I have these moments where I want to say "Seriously. Seriously, you came to the ED because of THAT?"

Of course one never says that to a patient because it would be insulting to them, but having this blog allows me to vent a bit about how silly the human race can be! So here's my favorite from the day: a middle-aged person drives 45 minutes in the hot car (no AC, windows down) to the beach, where it is 90 degrees in the baking sun. She proceeded to sit on the beach for four hours in that hot sun, drinking an iced coffee. When she and her friends decided that it was time to head home, she jumped up from her beach chair, gathered her belongings, and started up the beach for the car.

Suddenly, to her surprise, she feels "a little dizzy," and sits down in the sand. Now, what do you think she does next? Does she have someone get her some water? Does she get out of the sun? No, she calls "911" and comes to the ED! Where, before I enter her room to evaluate how dehydrated she is, I say to the EMT's who have delivered her to our doorstep, "Seriously. Seriously?"

Please, learn something about dehydration and heat-related illnesses. For every 30 minutes of outdoor activity that you do, you should be drinking 8 ounces of water or other hydrating fluids. This doesn't mean iced coffee, because caffeine (and alcohol) containing drinks increase urination, and this will make your dehydration worse. Whether you go to the beach, the ballpark, the kid's soccer or softball games, or go for a walk in the midday sun, take a periodic break from being in the direct sunlight by getting into the shade somewhere and have your cool, hydrating drink. If you get dizzy, sit or lie down, and again, have something to drink. When you think you are ready, get up slowly...and have someone else drive the car home.

Should you fail to follow these instructions, please feel free to come to see your friendly ED staff, but don't be surprised if we say with a smile, "you didn't drink your water, did you?"

Stay cool and don't forget your sun screen!

~Laurie

Related Topics:

• First Aid Center
• Beach Safety 101

Technorati Tags: heat, heatstroke, dehydration, beach, summer safety