Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Sleep your way thin?

Yes my friends, I’m afraid it’s true… lack of sleep can pack on the pounds! In 2004 a couple of researchers were analyzing the NHANES database, and noticed that sleep deprivation was an independent risk factor for obesity. Since that observation, more studies have confirmed that sleep debt is associated with weight gain. It’s not completely clear how this works – but one writer summarizes:

“Sleep causes changes in the brain, leading to abnormal secretion of hormones which can result in several body disturbances that include excessive daytime sleepiness, mood changes such as depression or anxiety, altered hunger and eating patterns, and ultimately further sleep disturbances. It’s a vicious cycle!… Throw out the diet bars, and fluff up the pillows.”

I bet my sleep expert colleague, Dr. Steve Poceta, has some further thoughts on this. Let’s ask him!

This post originally appeared on Dr. Val’s blog at

Metabolism: does exercise boost it?

Well, I always hoped that the rumors were true – that gaining muscle mass would increase one’s resting metabolism. How many times have you heard fitness gurus tell you that if you bulk up with muscle you burn more calories even when you’re sitting around, watching TV?

Unfortunately, the truth is that even the most impressive muscle gains result in only a tiny increase in resting metabolic rate. In one case I recall a man who lost ~40 lbs of fat and gained ~20 lbs of muscle. His metabolism increased by a mere 50 calories/day.

In my experience, metabolism seems to be more a factor of nature rather than nurture. You’re born with a certain internal engine – and not much changes that (at a given body weight). However, exercise burns calories – and that can lead to weight loss, etc. It’s just that the baseline metabolism doesn’t change all that much.

Stay tuned for my next blog entry where I’ll explain why metabolism may be linked to diet failure.

This post originally appeared on Dr. Val’s blog at

Gastric Bypass Surgery – Gain Weight To Get It?

In Britain, the National Health Service used to pay for gastric bypass for individuals with BMIs greater than 35, but a new rule has raised the qualifying BMI to 45 and above. So many people were having gastric bypass, that it was overburdening the system. In response, some people are trying to gain weight to qualify for the surgery!

Here’s what a couple of British folk have to say:

“It’s grossly unfair and incredibly short-sighted. There are hundreds of other people like me who can’t afford private surgery, and the message seems to be pay up or pig out.”

“Instead of surgery and rehabilitation my only option is McDonalds and ice cream”This post originally appeared on Dr. Val’s blog at

Homeopathy or Big Pharma – Choose Your Poison?

Wow, this was one of the best rants I’ve heard in a while (thanks to Kevin MD for linking to this article in his blog) – looks as if this writer is neither friend to homeopathy nor big pharma:

“Some homeopaths [say] that their cures are not amenable to scientific proof. That’s fine, if you want to call the multimillion dollar industry what it is: faith healing…

Homeopathy rests on three unproven tenets: First, ‘Like treats like.’ Because arsenic causes shortness of breath, for example, homeopaths prescribe its ‘spirit’ to treat diseases such as asthma. Second, the arsenic or other active ingredient is diluted in water and then that dilution is diluted again and so on, dozens of times, guaranteeing—for better and worse—that even if the dose has no therapeutic value, it does no harm. And third, the potion is shaken vigorously so that it retains a ‘memory’ of the allegedly curative ingredient, a spirit-like essence that revives the body’s ‘vital force.’

So what about the fact that some homeopathic patients get better? Part of the effect comes from the ritual of consultation with a practitioner who treats the patient like a person rather than a body part on an assembly line. And just taking anything can help; the placebo effect is real. In gold-standard, double-blind studies, placebos presented as possible cures sometimes rival pharmaceuticals for effectiveness, or beat taking nothing at all.

Nor are the effects simply psychological. When volunteers took a placebo that they were told contained painkillers, they experienced relief, while researchers watching PET scans of the subjects’ brains tracked increased levels of the body’s own pain-relieving endorphins. In other studies, research subjects given placebos instead of antidepressants also showed chemical changes in their brains. FDA data for six top antidepressants showed that 80 percent of their effect was duplicated in placebo control groups.

Which brings us to the patient’s dilemma: Have faith in 19th century magic or rely on a pharmaceutical industry that suppresses negative outcomes (including death), promotes drugs for nonexistent diseases, repackages old drugs in new bottles to circumvent patent expirations, bribes doctors with perks and cash and hires ghost writers to author favorable studies? Given the hype, toxicity, and expense of many drugs and Big Pharma’s snake-oil tactics, the side effects of water (laced with “memory”) start looking pretty damn good. If your condition is relatively minor, self-limiting or untreatable, you may be a lot better off drinking homeopathy’s Kool-Aid-less Kool-Aid.”

Ouch. What do you think of Mr. Allen’s remarks?

This post originally appeared on Dr. Val’s blog at

Medical errors may be reduced by redundancy?

One of the great advantages of electronic medical records (EMRs) is that they can reduce unnecessary repeat testing. Without an EMR that is accessible to all physicians taking care of a single patient, there’s no way for them to know what the other one is prescribing. Expensive tests like MRIs are often ordered by two different physicians (a neurosurgeon and a rehabilitation medicine specialist for example) because one didn’t know that the other had already ordered it. Alternatively, they may be affiliated with institutions that don’t share data, so previous MRI images are not available for viewing by the new specialist – so she just orders another one.

However, an interesting question is raised by Dr. Perloe’s post to my last blog entry: what if all specialists taking care of a patient had access to one medical record – and there was a lab error? They would all rely on the same erroneous record, and this could spark a whole host of inappropriate tests and procedures. Even second opinions (based on one single record) would be less helpful – because they would be misled by false results.

So, the irony is that the redundancy in our system has its benefits. We should be mindful of the checks and balances that we are unwittingly removing with EMRs. Occasional lab errors will always be with us – let’s make sure we catch them early, and not commit them to a permanent record relied upon by all.

This post originally appeared on Dr. Val’s blog at

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »