Thursday, April 28, 2011

Once Again, Atkins was Right

A study published in the September issue of the Annals of Internal Medicine confirmed many other studies that a low carbohydrate diet not only is superior to other diets for weight loss but also may reduce the death rates from all medical causes. In the December issue of US News & World Report, many diet gurus who previously opposed the Atkins diet acknowledged that Atkins might have had something with his emphasis on the toxic effects of carbs. David Jenkins from the University of Toronto has proposed the Eco-Atkins diet, which substitutes healthier protein sources, such as beans, for the animal fats suggested by Atkins. Not a bad idea, if you can do it. The problem is that vegetable sources of protein don’t give you a lasting source of energy, and sometimes make you crave carbs. Some people thrive on a vegetarian diet, but others need to mix in some animal protein, without too much fat mixed in.

See US News and World Report, December, 2010, p. 16-19.

Tuesday, April 26, 2011

Cardiac CT Scanning is Becoming More Popular

A report issued by 8 organizations, including the American College of Cardiology, states that CT scanning should be more widely used. Calcium scanning without the use of dye is now considered appropriate in patients who are at intermediate risk or low risk with a positive family history of heart disease. If the test is negative, the incidence of coronary artery disease is unlikely. CT angiography with dye is a much more expensive test that can replace catheterizations and angiograms in patients that are not at high risk. Both of these tests are safe to perform, but they do involve the radiation exposure equivalent to hundreds of chest x-rays.

See Family Practice News (click here), November 15, 2010, p. 34.

Wednesday, April 20, 2011

Decreased Use of Hormone Therapy Linked to Rise in Hip Fractures

Harvard’s Women’s Health Initiative reported in 2002 that hormone replacement therapy increased the risk of coronary artery disease and cancer. In the ensuing six years, the use of synthetic hormones in middle-aged and older women decreased from 85% to 18%, and the incidence of hip fractures increased sharply by 55%, as reported from a study of 80,995 women in the Kaiser Permanente group in California. In my reading of the data, the culprits for increased coronary and cancer risks were primarily progestins and secondarily Premarin, both synthetic drugs. Natural progesterone and estrogen from soy and yams were not implicated in the WHI study. It is important to check with your doctor on such matters, but we often use bio-identical hormones to relieve menopausal symptoms and prevent osteoporosis for limited periods of time when indicated.

See Family Practice News(click here), November 15, 2010, p. 42.

Tuesday, April 19, 2011

Family History Re-emerges as a Key Risk Factor

Having a least one parent who has had a heart attack doubles the person’s own risk for having one too. This risk is in addition to other factors such as hypertension and high cholesterol, according to INTERHEART, an international study. Family history was cited as a risk factor in the 1950’s, but Harvard’s classic Framingham study beginning in the 1970’s omitted family history from its risk score. This is a good example of how prescription drugs have dominated medical therapies in recent years. Getting answers from research depends on the questions one asks. Drug companies sponsor the majority of our research. That research serves their own interest. Common sense can be left behind.

See American Journal of Cardiology (click here). 2011;57:619-27.

Thursday, April 14, 2011

Adult Women with Acne

Dr. Hilary Baldwin from the State University of New York, Brooklyn presented a paper at a seminar in San Francisco on Women’s dermatology that showed an increasing incidence in resistant acne in adult women. Topical treatments do not work very well in adults, and oral antibiotics are notorious for causing vaginal yeast infections. Spironolactone is an off-label treatment that is pretty effective but carries a black box warning because of developing tumors in mice. I find that the Smoothbeam laser is very effective for this problem, and also can reduce previous acne scarring as well as unsightly wrinkles in the face. Pantothenic acid at 500 mg twice a day can be very helpful.

See Family Practice News (click here), November 15, 2010, p. 52-3.

Tuesday, April 12, 2011

Vitamin K and Osteoarthritis

A study reported at the World Congress on Osteoarthritis looked at 1200 patients without arthritis at baseline followed for 30 months. Those who developed osteoarthritis in both knees had a twofold incidence of vitamin K deficiency. Those who developed osteoarthritis in only one knee had a threefold incidence in vitamin K deficiency. There is no study yet that determines that taking vitamin K prevents osteoarthritis, but it might be a prudent thing to do, especially if you are at risk. Vitamin K can be measured with a simple blood test. Deficiency in vitamin K has also been linked to osteoporosis.

See Family Practice News (click here), November 15, 2010, p. 65. Dr. Tuhina Neogi(click here) from Boston University and the MOST study (click here).

Tuesday, April 5, 2011

Diet Sodas Appear to increase the Risk of Strokes and Heart Disease

The Northern Manhattan study followed 2500 adults over a ten-year period, ending in 2010. Those who drank diet soda or even a mixture of diet and regular soft drinks had a significantly higher risk of developing heart disease and strokes than those who did not drink sodas at all. Those who just drank regular soda were not mentioned in the article, but their risk would definitely be significant at least in a subgroup with diabetes. Ingestion of diet sodas appeared to be an independent risk factor for vascular disease, taking its place alongside inactivity, obesity, excessive alcohol, hypertension and smoking. What should you drink instead? Lots of water. Maybe some fruit juices now and then, but it is better to eat an apple than to drink a glass of apple juice.

See the Northern Manhattan study, reported by the Associated Press, February 10, 2011.