Pre-diabetic musings

prediabetesI got a rude awakening last week. I had taken just maybe my most comprehensive blood test ever. Disturbingly, my A1C was 5.9, although my fasting glucose was 96.

I’ve known for two years I’m pre-diabetic, but 5.9 is a new threshold for me. Not long ago, through careful eating and nearly daily elliptical machine stints, I had whittled it down to 5.4, though I admit my previous scores have nearly always been from finger sticks rather than lab tests, which my endocrinologist says are more accurate.

Anyway, I’m scratching my head, asking myself, What’s going on? Why should I be even pre-diabetic?

Hey, I’m slender at 175 on a 6’1 frame.

I’ve been a vegetarian for 18 years; in fact, nearly vegan.

I’ve been careful to avoid foods with high sugar content–pastries, cakes, candies, etc.

I don’t eat much fat, at least the bad kind like saturated and trans. I admit, however, to liking nuts. (I eat about 4 ounces daily, mainly to keep my weight up, especially as I’m trying to reduce carbs, the main source for blood sugar and weight gain.)

My nemesis, I think, has been indulging in starchy foods, especially In restaurants, compounded by their normally large portions. I used to have trigs in the 150 range. Giving up potatoes, I find my trigs have stayed below 100. Potatoes, like other starchy foods, are a high GI food, meaning they turn into glucose quickly.

At home, I still indulge in other starches–pasta, rice, and bread–though I always follow the formula for whole wheat sources only and brown rice.

While unrefined grains have lower GI and GL, they can peak your blood sugar several hours later, so you need to check your glucose beyond the usual two hour post meal regimen

My thinking is that if I can eliminate the grains, I can reduce the glucose. But I also know l like these foods so much that I haven’t watched my portions.

It would be easier in all of this if if had the usual excess weight problem. Eighty percent of diabetics do, and when they shed the pounds, the blood results can be impressive.

Skinny diabetics have twice the mortality rate of heavy diabetics. No one really knows why.

The problem with such diets is that confining yourself to greens and beans gets old really fast.

Before closing, I want to mention a recent book on diabetes by endocrinologist Sarfraz Zaidi, called Reverse Your Diabetes. It recommends a five step approach, which includes overcoming stress and using key supplements in addition to the traditional lifestyle changes through diet, exercise, and medication as needed.

His section on supplements is the best I’ve come upon in books dealing with diabetes, with extensive reviews, backed with research findings. Zaidi focuses on reducing insulin resistance foremost in managing diabetes and argues some supplements can help.

I found his take on vitamin D especially good in keeping with his wisdom throughout the book. He points out how the effects of vitamin D are “astounding,” extending to all the organs.

Low vitamin D contributes to insulin resistance.

Nearly all Type 1 and Type 2 diabetics show vitamin D deficiency.

In a landmark Finnish study (2001), later published in the prestigious medical journal, Lancet, children receiving 2000 IU of vitamin D in their first year were then tracked for 31-years for the development of Type 1.

These children showed an 80% reduction in risk for developing Type 1 compared to other children not given vitamin D supplements.

As for Type 2, while being sedentary, obese and over 65 contributes substantially to developing diabetes, all of these factors contribute to vitamin D deficiency as well.

This doesn’t mean that overcoming vitamin D deficiency will right your diabetes, but it can help reduce insulin resistance and thus help you manage it better.

If you’re pre-diabetic like me, there are extensive studies, Zaidi says, that suggest it can help prevent full blown diabetes up to 50%

Though not everyone may agree with Dr. Zaidi, I find his extensive review of the research on vitamin D compelling.

–rj

 

 

 

 

 

 

 

Say it isn’t so: Fast foods in hospitals

Cleveland Clinic
Cleveland Clinic

A McDonald’s in a hospital cafeteria? Say it isn’t so!

According to McDonald’s, it has 27 franchises In hospitals.

One of them is in the world renowned Cleveland Clinic, in the top tier for treating heart disease and former home base of Dr. Caldwell Esselstyn (Prevent and Reverse Heart Disease).

This isn’t to say the Clinic hasn’t tried to rid itself of this glaring contradiction to its public embrace of lower fat and sodium foods. While it succeeded in shedding Pizza Hut, McDonald’s remains out of contractural obligations agreed to more than a decade ago.

The watchdog Physicians Committee for Responsible Medicine (PCRM) did a survey of 110 hospitals across the country and found that some of them feature as many as 5 fast food outlets:

The Five Worst Hospital Food Environments

St. Luke’s Episcopal Hospital/Texas Heart Institute/Texas Children’s Hospital Complex (Houston, Texas) 4 fast-food outlets and fried-chicken bar in the cafeteria

Medical University of South Carolina University Hospital Complex (Charleston, S.C.): 5 fast-food outlets and a cafeteria serving country-fried steak and other high-fat fare.

Naval Medical Center San Diego Hospital Facility Complex (San Diego, Calif.):3 fast-food outlets; patients order from menu featuring pork chops, meatball sandwiches, and other high-cholesterol fare.

Duke University Hospital Complex (Durham, N.C.): 3 fast-food outlets; patients order from cafeteria menu featuring spicy pork loin and other high-fat items.

Children’s Memorial Hospital Complex (Chicago, Ill.): 1 fast-food outlet; patients’ menu has chicken wings, quesadillas with bacon, and grilled hot dogs.

 McDonald’s says it offers a diversified menu that offers many options like salads.

Bull shit!

There are 14,000 McDonald’s in the U. S. Not one of them offers offers a veggie hamburger (unlike in Europe where it’s a government mandate)!   By the way, of all the fast food franchises in the U.S. and Canada, only Burger King offers a vegetarian burger, though it comes with a white flour bun.

Unfortunately, while some hospitals are trying to rid themselves of these outlets, others are adding still more, according to National Public Radio:

 Chick-fil-A recently set up shop in several facilities, including the Texas Medical Center’s St. Luke’s Episcopal Hospital and the Medical University of South Carolina University Hospital in Charleston, S.C. (Elana Gordon, April 2012).

 (We already know about Chick-fil-A’s strident anti-gay bias.)

Let’s face it: Fast foods are a money maker for some hospitals, quite willing to betray their ethics–forfeiting the well-being of their constituents along with it–for the wrong kind of green.

Perhaps we shouldn’t be all that shocked by such blatant hypocrisy, considering medicine’s Faustian trade off with Big Pharma. (See “Doctors And Hospitals Raking In Billions From Big Pharma, Huge Data Trove Reveals”: http://www.huffingtonpost.com/2014/09/30/doctors-big-pharma_n_5908350.html)

But that’s another subject for another day.

–rj

 

 

 

 

 

 

 

 

 

Mindful Walking Brings Joy

anextrarodinaryday-net-birches-in-the-woods-john-muir-quote-about-natureI just finished a two mile walk in a quiet, woody area close to where I live. I especially enjoy it because I keep company with a wide landscape of greenery, manicured gardens and, quite nice, I may see only one or two cars the whole way. Walking in the early morning makes me mindful of the gift of life and its cornucopia of sensory delights.

Even when you walk, I think you’ll find your mind keeps trolling, often in miscellanea you might miss in the course of your day heavy with things to do, choices to make and, not infrequently, problems to resolve. I haven’t any doubt about it–walking can unleash a spirit of meditation, leading to a stilling of troubled waters. Still more, it can endow us with a wisdom to discern between the wheat and the chaff, providing an equilibrium taking us through the hard places.

Of all things, as I was walking, appreciating the pristine beginnings of a new day with its abundant promise, my thoughts turned to a short poem that Tennyson wrote, called “Tears, Idle Tears,” a poem quite opposite in its mood to the joy I felt while walking this morning:

Tears, idle tears, I know not what they mean,
Tears from the depth of some divine despair
Rise in the heart, and gather to the eyes,
In looking on the happy autumn-fields,
And thinking of the days that are no more.

Fresh as the first beam glittering on a sail,
That brings our friends up from the underworld,
Sad as the last which reddens over one
That sinks with all we love below the verge;
So sad, so fresh, the days that are no more.

Ah, sad and strange as in dark summer dawns
The earliest pipe of half-awakened birds
To dying ears, when unto dying eyes
The casement slowly grows a glimmering square
So sad, so strange, the days that are no more.

Dear as remembered kisses after death,
And sweet as those by hopeless fancy feigned
On lips that are for others; deep as love,
Deep as first love, and wild with all regret;
O Death in Life, the days that are no more!

It isn’t my intent to give a full analysis of this poem, but simply to make several observations about the mindset that informs the poem and a lesson to be learned from it.

If the first stanza is thematic in its nostalgia, the next two stanzas clothe the poet’s lament in a series of similes that make for exquisite eloquence and a lingering pathos of melancholy.

The speaker’s unsolicited tears are as fresh as a ship’s sail that arises above the horizon, glittering in the first sunbeam of early dawn, tears elicited by recall of deceased friends now in the Underworld, who have suddenly sailed into his awareness. But they also vanish again into darkness similar to when the sun drops below the horizon, for memory can never render mortals corporeal again, given the finality of death. Tennyson, the great classicist, is drawing here, of course, upon legendary lore of the Underworld and the voyage of the dead.

But I like the third stanza best with its analogy to the last, sad day of a dying man, who in the early summer dawn awakes to hear the “earliest pipes of half-awakened birds” and sees for the final time the growing light upon the window casement. Ending with its consort of alienation from the vibrant world of the present–“so sad and strange”– is the import here, reinforcing the poem’s trenchant mood of nostalgia for happy days revoked by time and mortality.

All of this makes way for the final stanza where still more similes appear, the past being like remembering those we once kissed, now dead; or imagining kissing those we love, but who don’t reciprocate, underscoring yet again the irrevocability of the past and the frustration of human wish.

Tennyson had said his visit to Tintern Abbey near Wales had inspired this poem, as it had the great Romanticist poet, Wordsworth, who recalled the place in his famous “Tintern Abbey” poem. Wordsworth’s poem, however, recalls the past with joy, giving hope for future years.

While I appreciate Tennyson’s poem for its sincerity of lament and chiseled eloquence, I think we do better in light of the ephemerality of human experience to seize the day, or practice the wisdom of my favorite quotation from Helen Keller that I carried in my wallet for many years:

Use your eyes as if tomorrow you would be stricken blind. Hear the music of voices, the song of a bird, the mighty strains of an orchestra, as if you would be stricken deaf tomorrow. Touch each object as if tomorrow your tactile sense would fail. Smell the perfume of flowers, taste with relish each morsel, as if tomorrow you could never smell and taste again.

 Walking this morning, I celebrated the vibrancy of the present. Better, I took possession of it.

I think both Wordsworth and Keller would approve.

-rj

 

 

A Court decision with deadly consequences

pigsWe should all be concerned about Thursday’s 2-1 decision by the U.S. Court of Appeals for the 2nd District that the FDA needn’t consider the banning of antibiotics in healthy food producing animals.

Given the growing menace of antibiotic resistant infections among humans and the inveterate use of antibiotics in the meat industry to promote weight gain or combat disease, we draw closer to a pandemic in which even a minor wound or infection could prove deadly.

As is, the Centers for Disease Control and Prevention (CDC) informs us that at least two million Americans are sickened with anti-resistant pathogens annually

I may have been one of them, having just recently recovered from an extended bout with a staph infection that ultimately required daily IV.

I naively had told my infectious disease physician that I didn’t really want to leave the hospital until I was over the infection. His rejoinder was that a hospital wasn’t the safest place to be, given the infection rate incurred among patients (one out of three).

The Centers for Disease Control and Prevention comments that “much of antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe.”

More than 70% of all antibiotics are administered to animals, even when healthy.

To be fair, I can’t say what all the factors were in the court’s split decision, except that it imperils all of us.

I do know that according to the World Health Organization (April 2014), antimicrobial bacteria resistance increasingly threatens public health worldwide, “a problem so serious that it threatens the achievements of modern medicine. A post-antibiotic era, in which common infections and minor injuries can kill, far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century.”

Consider that Carbapenem antibiotics used as a fallback in treating life-threatening infections from a common intestinal bacterium are now ineffective for nearly half of those treated in some countries. This bacterium is a major source of hospital acquired infections such as pneumonia, bloodstream infections and infections among newborns and intensive care patients.

Likewise, our best antibiotics for treating urinary tract infections caused by E. coli are now ineffective in more than half the cases.

Ten countries are now reporting that their last resort antibiotic for gonorrhea no longer works.

Unfortunately, while the FDA did ask pharmaceuticals, animal producers and vets to  exercise restraint in employing antibiotics that are also used for humans, the FDA appealed an earlier court ruling banning penicillin and two kinds of tetracyclides promoting growth, unless users can provide evidence it won’t produce drug resistant microbes. Thus, the Court’s decision in favor of the FDA’s appeal.

Overseas, the EU has banned the use of antibiotics in animal feed (2006) and now South Korea has done the same. In China, however, the use of antibiotics in animal production is widespread.

That animal and human health are linked was decisively demonstrated in outbreaks of multi resistant Salmonella in 2011, 2012 and 2013, traced back to ground beef and poultry sources (National Antimicrobial Resistance Monitoring System).

As physician David Angus admonishes in his best selling The End of Illness (2011),

Wealthy countries take for granted the triumph of science over bacteria, but increasingly doctors are battling infections that can only be quelled by the most powerful antibiotics known to medicine–or, at worst, by none of them at all. In the United States alone, antibiotic-resistant infections cause roughly 100,000 deaths a year. Imagine a world in which antibiotics produce toxic effects and unpredictable outcomes instead of the guaranteed cures we have come to expect–and you can understand what keeps epidemiologists awake at night (298-99).

 The Court’s decision brings that day much closer.

–rj

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medicine discovers meditation

stressFunny how the poets I read and taught in college have a way of popping up in my mind, even though I’ve been away from that scene for seven years now.  Take, for instance, the English poet Wordsworth.  He’s famous for his nature poetry and talks about “wise passivity,” by which he meant suspending the thinking part and simply letting the senses imbibe the stillness we often find in nature and arriving at the things that really matter. I’d say he was right on the mark, especially with our modern way of living crowding our space to be ourselves, muffling the intuitive stream that fosters coherence and confers tranquility.

A few days ago I was rummaging through the Tao Te Ching, which I like to do every now and then, since it’s densely packed with wise counsel, and came upon this passage that got me started on this present blog entry:

Act by not acting,
Accomplish by not straining
Understand by not knowing. (63)

 Simple but profound, such counsel promotes understanding and, with it, healing.  We need to teach ourselves to be still that we may intuit the essentials and practice mindfulness, something the East with its contemplative traditions discovered several millennia ago, anticipating poets like Wordsworth and, now, contemporary medicine.  The ancients were right all along about meditation as essential to our best selves.  In a time of ever increasing stress, we need its solace more than ever.  Consider this sober warning in the Harvard Newsletter (March 2011):

Over the years, researchers have . . . gained insight into the long-term effects stress has on physical and psychological health. Over time, repeated activation of the stress response takes a toll on the body. Research suggests that prolonged stress contributes to high blood pressure, promotes the formation of artery-clogging deposits, and causes brain changes that may contribute to anxiety, depression, and addiction. More preliminary research suggests that chronic stress may also contribute to obesity, both through direct mechanisms (causing people to eat more) or indirectly (decreasing sleep and exercise).

With available electroencephalogram testing of alpha brain waves along with pulse rate monitoring and even MRI brain scans focusing on “gray matter” in the brain areas responsible for memory, self-awareness and empathy, we now have empirical data gathered by professionals that can be replicated.  In sum, we know meditation works, which means that it can assuage pain and prevent or heal some of our entrenched ills, whether physical or psychological. The paradigm of medical reliance on medication, surgery, diet and exercise is expanding.  In short, a quiet revolution is underway as medicine discovers the ancient axiom that mind and body are one.

Perhaps its seed was planted most notably in the fascination the Beatles showed for Maharishi Mahesh Yogi, founder of  Transcendental Meditation.  Luminaries such as film director David Lynch; TV notables, Ellen Degeneres and Oprah swear by it.  Hey, George Stephanopoulos is into it too.  TM prides itself on research findings, at this juncture, some 700 plus, allegedly confirming its effectiveness in reducing stress, depression, high blood pressure and cardiac risk.

BensonMedicine started to look seriously at a supplementary role for meditation with Harvard’s Herbert Benson putting it to the test via the rigors of refined imaging, using TM volunteers.  As he put it, “Three decades ago it was considered scientific heresy for a Harvard physician and researcher to hypothesize that stress contributed to health problems and to publish studies showing that mental focusing were good for the body.”  Benson opened up medicine to meditation’s possible inclusion with his best selling (four million copies) The Relaxation Response in 1975.  “With meditation alone, the T.M. practitioners brought about striking physiologic change.”

Benson subsequently converted TM into a simple two step approach:  repeat a word or phrase of your own choosing and disregard distracting, every day thoughts by returning to your word or phrase.

Benson’s work was soon popularized in the public world through Norman Cousins, physician Dean Ornish, and a Barbara Walter’s ABC interview.  Still, the medical community for nearly 15 years dismissed Benson’s findings as largely a placebo effect.  That changed as other universities took up their own research, supporting Benson.  Today, Harvard has launched an endowed professorship dedicated to continuing research and treats thousands of clients seeking relief from stress with the Benson method.  Relaxation Response therapy is, in fact, incorporated into specialized programs at Boston’s Harvard linked Beth Israel and Massachusetts General hospitals, with fourteen affiliates nationally.

Today the meditation mainstream seems to be shifting to what’s called “mindfulness meditation,” an adaptation of the Zen approach to medication pioneered by Jon Kabat-Zinn at the University of Massachusetts to treat patients with debilitating diseases and chronic pain.  Like relaxation response meditation, mind-based stress reduction, or MBSR, is science centered, except it differs in how it approaches meditation.  Instead of a word, or mantra, and returning to it when your thoughts wander, you allow your thoughts, noting them, though not analyzing them, returning to focus on your breathing.  The idea is to objectify rather than personalize your thoughts, enabling you to better deal with them.  It’s been shown to activate the gray matter in those areas of the brain responsible for memory, a sense of self and empathy.  It inculcates self acceptance and helps us see that memory belongs to the past and isn’t real.

As such, it works well as a backdrop to the now widespread cognitive approach in counselingYou can actually practicemindfulness” anywhere, or while walking, listening to music, taking in conversation.  Allegedly, it can, with time, help  you become more empathetic through your heightened awareness of your own responses and thus a more diligent listener in social contexts

Whether you use a mantra or mindfulness approach doesn’t really matter since both result in a relaxation effect, though in my very limited experience I find the mantra version easier than mindfulness, which by its very nature can sometimes be distressing.  But there are many kinds of meditation formats, so you may want to search for what makes you most comfortable.  What’s worked especially well for me is known as Restorative Yoga, a derivative of Hatha yoga combining breathing, imaging, muscle relaxation and mild body postures.  I was introduced to it through Nurrie and Rick Stearn’s helpful book, Yoga for Anxiety:  Meditations and Practices for Calming Mind and Body.  Yoga might just be the most integrative of all approaches, administrating to both body and spirit.

I have to be candid: meditation does have its skeptics, some of them arguing that the alleged empirical effects can be attributed to advocate or placebo causes.  Personally, I’ve always found the latter untenable, since if it promotes healing, then the placebo response actually validates the psychosomatic power of the mind, which is ultimately what meditation is all about.

Others argue that random controlled trials (RCT), the gold standard, are lacking, and I’ve found this to have validity; for example, if you turn to the highly regarded Cochrane database, combing scores of medical journals, only one study turns up and it’s equivocal, recommending more randomized testing.

For all the claims that meditation can reduce the risk of heart attack and stroke, the American Heart Association has reserved judgment.  While its definitive report, published in April of this year, does indicate that TM can reduce blood pressure, it urges more research and assigns a lower rating to alternative meditation therapies.  I don’t see a problem here.  Meditation shouldn’t occur in isolation, but in concert with medication when needed, surgery when required, healthier food choices, and regular exercise as constants.

Meditation enthusiasts will rave about its benefits, how it’s made them calmer, more relaxed, better able to deal with both themselves and others, etc., but this is the stuff of anecdote, not science,  Just how do you quantify happiness?  And yet if we see behavioral change such as freedom from drugs; a happier disposition; a gentler, more loving person, we may not be able to measure it, but we know something is going on.

Frankly, I’m impressed with what doctors like Benson and Kabat-Zinn have uncovered.  To be sure, it’s a new science with bumps that need smoothing out, but its future lies in its promise and the empirical base on which it rests.

It seems The American Psychological Association APA) is on board, giving a resounding endorsement to MBSR.  (See Davis and Hayes.  “What are the benefits of mindfulness?” Monitor on Psychology.  July/August2012.  Vol. 43, No. 7.)

Of course, you can resort to SSRIs like Effexor, Zoloft and Lexapro, or quick fixes through benzies like Xanax or Valium, but they come with baggage, or side effects, sometimes worse than any proffered cure.  By the way, research has demonstrated that MBSR is at least half as effective in treating stress as SSRIs.  It’ so effective that the UK’s National Institute for Health and Clinical Excellence has listed MBSR among primary therapies for depression.

As a final caveat, do you remember James Randi, skeptic extraordinaire, debunker of the paranormal?  Though he dismisses TM for its lavish claims that include levitation and psychic prowess to influence social behavior, he nonetheless can accept a relaxation response as ameliorating physical and psychological health, whether through meditation or some other means like music or just plain rest.

That makes sense to me.  After all, isn’t this what meditation comes down to–indulgence in time out?  We all need that.

Teach us to be still.

–rj

 

 

 

 

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Memory: Something to be Cherished

Do you ever get something tossing around in your head that seemingly you can’t get rid of no matter how you try?  I get that way when I listen to music, for example, the lyrics wearing down my synapses like “We had it all/ Just like Bogie and Becall/ Starring in our old late, late show/Sailing to Key Largo.”  But sometimes it’s a memory that pops up, crazy like, since there’s no triggering context, maybe reaching way back into early childhood’s opaque alleys.

Sometimes something sticks because we associate it with an event or person that brought us great happiness or, alas, considerable pain.   Maybe we never forget anything really, the mind simply archiving everything that makes us who we are. While time may soften the edges of past experience, its essence remains

Freud built his formidable psychological schema on memory, which he argued was always latent, and thus influential on what we do and say, want and fear.  His former protégée, Carl Jung, contended memory transcended time and individuals, ultimately taking on evolutionary status as archetype, or primordial pattern, shaping both our thinking and behavior.  According to Jung, the repository of memory is defined best in myth, which reenacts the human repertoire of experience.  Its roman a clef  lies in symbols compressing our individual and collective destinies.

On the literary front, some of our foremost fiction writers like Joyce, Proust and Faulkner have made a legacy of memory in works like Ulysses, Remembrance of Things Past, and The Sound and the Fury.  In poetry, the English poet Wordsworth famously defined poetry as “emotion recollected in tranquillity,” building his poetic artifice on reflecting past experiences.  Perhaps the bottom line modus operandi latent in literary creation is to keep memory, or human experience, alive.

Often memory over time embellishes or distorts as we add or subtract.  It’s a good reason to keep journals. Verbal photos I like to call them.  Poor recall is the nemesis in legal matters when witnesses can’t accurately recall what they saw or heard or when witnesses prove contradictory.

Too often we take our ability to remember for granted, when the truth is it begins to decline as we age and increasingly we can’t find those damned keys, or forget what we came to the store for, or that doctor’s appointment.  Nothing to be worried about, save when forgetfulness takes on habit such as:

1 .    We repeat the same questions.

2.    We struggle for common words.

3.    We find it difficult to follow directions

4.    We lose our way in our neighborhood.

5.    We put things in odd places.

6.    We can’t recall something recently learned.

If I lost my sight or hearing, this would be debilitating and surely grievous, yet I think not equal to the loss of recall, condemned to an eternal present and essentially returning me to an infantile state as in dementia and its acute species, Alzheimer’s, that wipes away everything defining my humanity and lending  my life significance.

I don’t know, nor do any of us, what Fate holds, but in the meantime, I choose not to take this gift of memory for granted but to cherish it by nurturing it through learning new things, exercising regularly and vigorously, and eating nutritious foods.

Doctors who specialize in aging increasingly report that dementia may not necessarily happen if we keep our brains healthy by doing the right things.  Dr.  Majid Fotuhi, Chair of the Department of Neurology at Johns Hopkins, informs us that Alzheimer’s has only a limited genetic factor.  It can be delayed and even prevented with lifestyle changes undertaken in midlife.

I choose to run with that hope,

–rj

Proceed with Caution: Acid Suppressants and Mortality Risk

Scanning electron micrograph of Clostridium di...
Scanning electron micrograph of Clostridium difficile bacteria.. Obtained from the CDC Public Health Image Library. Image credit: CDC/ Lois S. Wiggs (PHIL #6260), 2004. (Photo credit: Wikipedia)

I’ve been on omeprazole for eighteen months now and don’t like it one bit.  Like all drugs, it’s a trade off in risk.  Along the way to a cure or relief, side effects can work misery for you.  Omeprazole is what we call an acid blocker, designed to relieve the symptoms of too much acid in the stomach, often resulting in heartburn, a key symptom of GERD, or acid reflux.  More formally, we call them PPIs, an acronym for proton pump inhibitors.  Millions of us take them, sometimes for gastritis, esophagitis, and ulcers as well as for heartburn.  In fact, they’re the second most prescribed medication in America.  You can get omeprazone over the counter

Acid blockers are potent, altering the normal balance of acid and alkaline in your stomach, a balance critical to sound nutrition.  They mug, for example, needed vitamins and minerals like B12, vitamin D, calcium, iron and zinc.  They can make you anemic.

They may also do damage to your bones when taken for a protracted period, leading to hip fractures, though research, sometimes contradictory, hasn’t provided a clear-cut finding on this.

It’s universal, however, that PPIs can lead to a Clostridium difficile infection.  The FDA has been so concerned that it issued an alert on the danger in 2010 and of its consequent, severe diarrhea.  C. difficile is especially menacing to the elderly.

You diagnose it through a stool sample.  If confirmed, they put you on a round of antibiotics.  It isn’t, however, easy to get rid of, as it’s highly resistant.  C. difficile can survive a lack of moisture and collects on many surfaces, then spreads through hand contact.  It’s resistant enough that even alcohol containing hand sanitizers can’t kill it.  For the most part, you get it in a hospital or nursing home.

One of the perils of PPIs is that they do their job so well in reducing stomach acid that C. difficile can ravage your stomach with impunity.  But the real kicker is in the findings of a recent study:  C. difficile is especially hard on PPI users.  In fact, they’re five times more likely to die from it than those not taking PPIs, or its cousins, H2 blockers.  This study, published in the Clinical Infections Diseases journal (Oct. 5, 2011), included 485 patients with the infection at the Naval Medical Center (2004-2008).  Half of those infected were on acid suppressants, with the  majority on PPIs.  Of the 485 infected, 23 died from C. difficile.  19 of the 23 were on acid suppressants.

This has led Dr.  Edith Lederman, an infectious disease expert at the Naval Medical Center, to caution that “stomach acid is a very important defense mechanism against pathogens.  It kills them.” Although there isn’t “enough data that people should forgo use of acid suppression, clinicians and patients need to be aware of the potential consequences.”

As the saying goes, “Sometimes the cure is worse than the disease.”  Doctors often prescribe medications indiscriminately, not taking in the patient’s medical history, contraindications, age, and sensitivity.  This behooves you and me to always do our own research and proceed with upmost caution.  Our lives may depend on it.

–rj

Meditation Goes Mainstream: Western Medicine says Yes

meditation

It’s just me in the sunroom before breakfast, sprawled out on my yoga mat, doing meditation for 15 or 20 minutes.  A series of deep breaths and letting my limbs go slack, a visualizing of a good moment.  The hard part is getting the habit, but having a time and place helps a lot..

The best motivator, however, is how relaxed it makes me feel, and coming from, me, I don’t say that lightly.  As a child raised in an alcohol ravaged home, security wasn’t a given and each day meant finding my place under the sun.  I used to think I was simply a chronic worrier and worried even about that.  Children of alcoholics often try to control their environment to maintain stability.  They find it difficult to tolerate loss or uncertainty.  They like their parameters tightly drawn.

You can take benzies like Valium or Xanax for anxiety and while they’ll work in the short run, they treat symptoms only and, worse, are often addictive.  As for anti-depressants, they may work for some, but then how intact do they leave the user?  I prefer taking a different route, sovereign over my psyche rather than pharmaceutically lobotomized.  I suspect they’re overly prescribed anyway.  And then there are the side-effects that sometimes make matters worse.

Anxiety is triggered by our perceiving danger.  This needn’t be limited to a threat to our safety, but losing our financial way through job loss, investments turned bad, the sudden onset of illness.  Sometimes it’s the loss of a friend or loved one that pulls the trigger.  The common denominator, no matter the source, rests within the mind, or the way we think about things.  Nothing can threaten us unless we give it permission.  We are what we think about.  Anxiety is future saturated, or our thinking fearfully about what may happen to us; depression is present tense.  We think the worst has already happened.

Meditation quiets our panic, producing a mindfulness that can sort out, clarify and more cogently respond to what troubles us.  When we’re stressed fear takes ascendancy, preempting alternative, positive ways of responding to crisis.

Meditation has now increasingly become a part of the medicinal arsenal that had traditionally been limited to pharmaceuticals and surgery in Western medicine.  We know that meditation has restorative benefits for the body when we incorporate the mind into our notion of the corporeal.   In fact, we can measure its physiological results in lowered metabolism, heart and breathing rates and replicate those results.  For a fascinating exploration and summary of the empirical data, pick-up The Relaxation Response by renowned Harvard cardiologist, Herbert Benson.

I happen to be a subscriber to Mind, Mood & Memory, a newsletter put out by one of the world’s internationally acclaimed medical facilities, Massachusetts General Hospital.  In its most recent issue (September 2013), Ann Webster, PhD., Director of MGH’s Program for Successful Aging at Benson-Henry Institute, informs us that “among these strategies for successful aging, perhaps the most effective is engaging in practices such as meditation, yoga, deep breathing, or repetitive prayer that help elicit the relaxation response.  Regular experience of the RR helps counteract stress and other factors linked with higher risk for illness and aging, and causes enormously positive physical, emotional, and cognitive changes.”

This doesn’t mean a trained counselor becomes superfluous.  A good psychologist can target needs and offer ameliorative insights to enhance reduction of stress and promote physical and mental health.  The best medicine is always integrative.

And what do I feel like when I open my eyes and put my mat away?  Hard to put into words, but something similar to the snowflake calm that descends when I play Enya and  find my bullying ghosts have fled..

–rj

Intolerance: Medicine’s Nemesis

Medical Statue at Semmelweiss Medical Museum
Medical Statue at Semmelweiss Medical Museum (Photo credit: Curious Expeditions)

I had grown up thinking medicine was free of the prejudices, if not sheer ignorance, rampant in the everyday world where resistance to anything new seems a given.  Let’s face it:  we humans don’t like having the security of our assumptions challenged.  The truth is that the history of medicine shows the same proclivity for stubbornness or subordination to the weight of custom as elsewhere.

In his riveting study, Doctors: The Biography of Medicine, physician Sherwin Nulan recounts the story of Ignac Semmelweiss, a young Viennese physician in the 1840s, who observed that women delivering their babies in hospitals died of puerperal, or bed fever, considerably more frequently than those delivering at home.  He did his own research to find out why, ultimately discovering a link between medical student routine and maternal deaths.

Each day,  students and profs would examine cadavers in between visiting patients. Although they didn’t have any notion of germs back then, Semmelweiss ultimately concluded that “invisible cadaver particles” on the hands of students and attending physicians was the source.  In short, he had discovered the role of infection in promoting illness.  

Instituting a protocol of his students’ washing their hands in a chlorine solution, he saw a dramatic drop-off in mortality.  His colleagues, however weren’t amused by this young upstart, whose research implicated them in so many deaths.  Consequently, Semmelweiss didn’t publish his research for fifteen years.

Dr. Joseph Lister
Dr. Joseph Lister

By the 1860s,  Louis Pasteur’s germ theory had entered into medicine, though it initially wasn’t widely accepted.  In Britain, Dr. Joseph Lister decided to apply the notion to post surgical infections, which were nearly always fatal.  Discovering that a neighbor city had poured carbolic acid down its drains to eliminate a potent sewer stench, he concluded that the acid had killed microorganisms similar to those Pasteur had identified.  Applying this concept to surgery, he employed wound dressings saturated in carbolic acid.  Later, he added spraying the entire surgical area with the solution.  Ultimately, he expanded the solution to washing his hands and instruments.  Lister published his successful results in 1867, inaugurating the formal beginnings of antisepsis.  It would be another generation, however, before Lister’s innovations became universal.

It was only in the 1880s that doctors had finally moved beyond a solely antiseptic solution to changing their clothes and boiling their instruments, sutures, towels, and sponges and adopting a ritual of vigorous hand washing.  In 1893,  Dr. William Halsted  became the first surgeon to wear a surgical mask.  In the 1920s, white garments and linens became universal, though the former now seems to be giving way to darker shades again.

Infection still remains a serious threat and the shorter your hospital stay, the better your odds.  Each year, nearly 2 million patients experience infection and 100,000 die.

Even with today’s antibiotics, infection looms as a serious menace, complicated by the increasing rise of resistant, highly contagious bacteria strains.

The bottom line in medicine is that what we don’t know often governs more than what we know.   After several thousand years, we overwhelmingly treat symptoms, not causes.  Now and then, however, a Semmelweiss or Lister appears like some new Columbus, charting a vastly different terrain leading to a New World.  Thus, it behooves medicine to be open to self-scrutiny, forfeit vested authority, tradition, and prejudice.  Only in this way can we find the breakthroughs that advance our safety, promote our healing, and perhaps offer sovereignty over some of our most chronic diseases like cancer.

–rj

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Looking, Thinking and Feeling Young

Nicoya Peninsula seen from space (false color)
Nicoya Peninsula seen from space (false color) (Photo credit: Wikipedia)

In my last post, “We are all Ponce de Leon” (August 13), I noted the robust euphoria increasingly prevalent in medical circles that perhaps in the next 25 years, given science’s increasing sophistication in manipulating the DNA’s genetic formulae, many of humanity’s worst diseases like cancer and arteriosclerosis will be harnessed, if not eliminated.  One of its principal advocates is Dr, David Augus, whose best selling book, auspiciously titled, The End of Illness, aggressively pursues this notion. In Hamlet mode, it’s something to be doubtfully wished, but unfortunately untrue.  Served up in a specious brew, it trivializes the idiosyncratic nature of disease, its pernicious fall out in anguish and grief; above all, the individuality of each victim.

We live continuously in a biological world fraught like life at large with unknowns, randomness and the onset of new specters replacing those we’ve vanquished.  While the incidence rates for heart attack and stroke have indeed lessened, high blood pressure and diabetes are way up and cancer abounds (Merck Institute of Aging and Health).  If longevity has increased, it’s primarily due to the drop in child mortality and not medical breakthroughs.

Children still get cancer, a disease that we usually associate with aging,  along with other afflictions.  I lost two siblings, mere babes, from heart disease.  I lost an older brother, doomed quickly by a brain tumor within a few months of his initial symptoms.  He was 47.  I love baseball.  My favorite player, Lou Gehrig, succumbed to ALS at 41.  I noted that Augus contradicts his own optimism in forecasting–“inevitable” is the word he uses–a pandemic that like the Spanish flu of 1918, will kill millions.

It’s good to dream, so long as it’s tempered by reality.  While we’ve made progress in some areas of medicine, our best bet is probably a preventative approach, especially through lifestyle changes such as giving up smoking, monitoring our calorie intake, and exercising more.  Ironically, though we live in an information age that staggers with its seeming infinitude, we still know relatively little as to the etiology of most of our diseases, treating symptoms, not causes.

All of us want to look, think, and feel young–the Ponce de Leon quest again–but let’s not promulgate nonsense.  Aging is a fact we must live with, but it doesn’t have to mean a cane, incontinence, dementia, cancer, heart disease or stroke.  The most recent research indicates that 70% of the ills of aging lies within our control.  We can learn to live with it and live well and for a very long time.

I have some pointers, though not a panacea, that can help us in preventing or delaying many of our ills.  They’re confirmed by recent studies of demographic specialists on longevity and you can find a succinct probing, in layman’s terminology, in Dan Buettner’s Blue Zones, 2nd ed., an analysis of five global hotspots for centenarians, places where men and women still toil in the fields though in their eighties and even nineties and cancer, heart disease and diabetes are rare.

The locales, by the way, are Sardinia, Okinawa, Loma Linda, CA (large Seventh Day Adventist population), the isle of Ikaria in Greece, and Costa Rica’s Nicoya Peninsula.  I should add that these biblical paradises are quickly succumbing to outsiders who bring fast foods and sedentary living with them, eroding aeons of life-enhancing routine and a quality of existence salient in simplicity and minimal stress.

Diet:  In all of these Blue Zones, little meat was consumed, usually once a week or just on a festival occasion due to economics rather than choice.  With Seventh Day Adventists, it was a conscious choice to exclude meat.  Beans, whole grains, garden vegetables, nuts and fruit characterize the several cuisines, not processed or refined food products.  I’ve always found it a good axiom:  “If it’s white, don’t take a bite.”  If giving-up meat isn’t a palatable option for you, then eat less of it and when you do, lean portions only, avoiding red meats in particular.  Or try cutting out meat altogether two days a week.  One other thing, but central: be careful about not only what you eat, but how much.  Centenarians are far and away thin people.

Movement:  People who work physically demanding jobs tend to live longer.  New studies show that sitting more than two hours regularly can shorten life expectancy.  For those of us whose lives are largely sedentary, it’s important to engage in aerobic exercise 30-minutes, 5 times a week, to lower bad LDL and raise HDL, the good kind.  But even brisk walking (3 miles in 45 minutes) counts.  Along with aerobic exercise, it’s wise to add weights to your regimen to protect and strengthen your muscles.  Walk more, sit less.  If space allows, do a garden.  When traveling, use the motel’s exercise room or bring along resistance bands.

Connection: Those who have friends and a support network such as religion can provide are consistently happier people living longer lives.  Pursue something you can commit yourself to.  Find a congregation, book club or lodge; discover a cause; volunteer.  Hang out with positive friends.  Find something that makes you want to jump out of bed each morning.

Serenity:  Those living long lives seem to have found mastery over stress.  It isn’t that they don’t suffer stress, but that they’re able to transcend it, living lives of daily, defined routine, with simplicity a cornerstone.  We help ourselves by reducing overload and unshackling ourselves from the wrenching worry synonymous with materialism, competition, and hurry.  Yoga, Tai Chi and meditation–traditional staples of the East–reduce tension and lower blood pressure, that silent source of many of our diseases.  Tranquil music muffles our pace; a good book provides timeout; a walk along a bubbling  brook restores.  Study quietness and discover peace and with it, longer life.

Family:   Most centenarians center their lives around their families, marrying young and having children.  There is a ritual of togetherness and mutual obligation that informs their lives.  The elderly usually live with their children and thus fare better in their physical and mental capabilities.  America, however, has been trending in the opposite direction, with active families finding quality time together difficult.  Shared activities and  a daily meal spent together are increasingly atypical now.  Mobility often spaces family members widely apart.  On the other hand, those living long, happy productive lives have made family a priority, live in proximity, and exhibit a we-ness in their interaction.

While there aren’t any guarantees, given life’s caprice, individuals mirroring these trademarks tend to fare much better in living long and healthy and productive lives.

–rj

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