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

Latest Posts

Dr. Val’s Health Tips: Causes And Cures For Childhood Insomnia

Thanks to support from OTCSafety.org, I’ve created a series of health tips for common medical concerns. This week’s article is about how to diagnose and treat sleep difficulties in children and adolescents. There are many possible causes of insomnia, which include everything from emotional distress to bad dreams, breathing problems, stomach pains, medical conditions or behavioral problems.

In my article I discuss how you can work with a healthcare professional to determine the cause of your child’s sleep difficulties (this includes details on how to keep a sleep diary). I offer instructive do’s and don’ts to promote healthy sleep, and offer examples of symptoms that may require medical intervention.

For the full article, please click here. I promise it won’t put you to sleep! ;-)

GMO Paranoia And The Hollow Health Claims Of Cheerios

Make no mistake about it. General Mills’ introduction of Cheerios sporting the label “Not Made With Genetically Modified Ingredients” is a mere marketing ploy and has nothing to do with health or nutrition. Let’s start the dissection of this blatant attempt to capitalize on the anti-GMO paranoia by looking at the main ingredient in Cheerios, namely oats. Samuel Johnson, the 18th century writer who compiled the first authoritative dictionary of the English language whimsically defined oats as the grain “eaten by people in Scotland, but fit only for horses in England.” A clever Scot supposedly retorted “that’s why England has such good horses, and Scotland has such fine men!”

Modern science, as it turns out, supports the ancient Scotch penchant for oats. A form of soluble fiber in the grain known as beta glucan has been shown to reduce levels of cholesterol in the blood which in turn is expected to reduce the risk of heart disease. You couldn’t tell this by the Scottish experience, though. Scotland has one of the highest rates of heart disease in the world. It seems all that haggis, refined carbs and a lack of veggies is too great a challenge for Scotch oats to cope with. Actually you need at least 3 grams of beta glucan daily to have any effect on blood cholesterol and that translates to roughly a cup of cooked oat bran or a cup and a half of oatmeal. Or about three servings of Cheerios. And that makes the cholesterol lowering claims prominently featured on the Cheerios box ring pretty hollow. There are far better ways to reduce cholesterol than gorging on Cheerios.

At least, though, the cholesterol lowering claim has some scientific merit. The “no GMO” claim has none. To start with, there are no genetically modified oats grown anywhere, at least not in the current sense of the term which refers to the splicing of specific foreign genes into the DNA of a seed. Such “recombinant DNA technology: is generally used to confer resistance to herbicides or protection from insects, but resistance to drought and enhancement with nutrients hold great potential. Although it is this new-fangled technology that garners attention these days, the fact is that virtually everything we eat has been genetically modified in some fashion over the years, either by traditional crossbreeding or through the use of chemicals or radiation both of which can scramble the genetic material in crops. The latter processes are based on the hope that a useful mutation will occur by chance, but basically it comes down to a roll of the dice. Just do enough experiments and a valuable mutant may surface. Radiation breeding has produced many varieties of rice, wheat, peanuts and bananas that are now widely grown. If you are eating red grapefruit, or sipping premium Scotch whisky made from barley, you are enjoying the products of this technology.

So if “genetically modified” oats do not exist, what sort of monsters is General Mills protecting us from? As is the case with any commercial cereal, Cheerios contains a number of ingredients with nutritious whole grain oats at the top of the list. Next come modified corn starch and sugar. It is to these two ingredients that General Mills refers when it talks about “GMO-free.” Much of the corn and some of the sugar beets grown in North America are genetically modified to resist herbicides and ward off insects. But by the time the highly processed starch and sugar extracted from these plants reach the food supply, they retain no vestige of any genetic modification. There is no way to distinguish the starch or sugar derived from genetically modified plants from the conventional varieties. The GMO-free Cheerios will not differ in any way from the currently marketed version except that the price may eventually reflect the greater cost of sourcing ingredients from plants that do not benefit from recombinant DNA technology.

The reason for the addition of sugar to Cheerios, actually in small doses compared with other cereals, is obvious. But why is corn starch added, and why is it modified? Nobody likes soggy cereal, and a thin layer of modified starch sprayed onto the little “O”s helps keep the interior dry. The modification in this case has nothing to do with genetic modification. Starch is a mixture of essentially two “polymers,” or giant molecules, both composed of units of glucose joined together. In amylose, the glucose units form a straight chain, while in amylopectin, the main glucose strand features many branches of shorter glucose chains. The properties of any starch depend on the relative proportion of amylose and amylopectin as well as on the degree of branching.

Starch has many uses in the food industry. It can thicken sauces, prevent French dressing from separating, substitute for fat or keep cereals dry. But these uses require starches of specific composition, either in terms of the length of the glucose chains or the degree of branching. In other words, the native starch has to be “modified” by treatment with acids, enzymes or oxidizing agents. There is no safety issue here, modified starches are approved food additives. Of course that doesn’t prevent scientifically illiterate alarmists from scaring the public by blathering on about modified starch being used as wallpaper glue and insinuating that any food made with it will literally stick to our ribs. The modified starch used in glue, namely a “carboxymethylated” version, is not the same as used in food, but even if it were, so what? Just because water can be used to clean garage floors and is found in tumours doesn’t mean we can’t drink it. Talking about washing garage floors, Cheerios also contains tripotassium phosphate, a powerful cleaning agent. It is added in small amounts to adjust the acidity of the mix used to formulate the cereal. This too has raised the ire of some ill-informed activists who do not realize that we consume all sorts of naturally occurring phosphates regularly in our diet. Quacking about the dangers of tripotassium phosphate in Cheerios makes about as much sense as hyping Cheerios that are “Not Made With Genetically Modified Ingredients.”

***

Joe Schwarcz, Ph.D., is the Director of McGill University’s Office for Science and Society and teaches a variety of courses in McGill’s Chemistry Department and in the Faculty of Medicine with emphasis on health issues, including aspects of “Alternative Medicine”.  He is well known for his informative and entertaining public lectures on topics ranging from the chemistry of love to the science of aging.  Using stage magic to make scientific points is one of his specialties.

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics, partly because I grew up in Canada (where most kids can ski and skate before they can run) and partly because I used to participate in Downhill ski racing. Now that I’m a rehab physician (with a reconstructed knee) I’m thrilled to have the opportunity to interview Team USA’s Chief Medical Officer, Dr. Gloria Beim. As we enjoy the Sochi Olympic games via our TV sets, keep an eye out for Dr. Beim! Please read on to get her behind-the-scenes account of what it takes to care for and keep Team USA Olympians in tip top shape.

Dr. Val: How did you become the Chief Medical Officer (CMO) for the U.S. winter Olympic team?

Dr. Beim: My practice, Alpine Orthopaedics, is located in an area of Colorado that attracts all levels of athletes, especially elite athletes. I initially entered the elite sports arena in a volunteer capacity at major ski and cycling competitions. Fortunately, my skills and knowledge were noticed at these competitions, which resulted in my servicing a number of medical teams that parlayed me into the world games and Olympic arena. I believe my collaborative, tireless work ethic led to being part of the 2004 and 2012 Olympic Games and as CMO of the 2011 Pan-American Games. Most recently, I was a physician at the World Cup Ski Championships in Beaver Creek, Colo.  Between my private practice and my volunteering, I am honored to have been appointed CMO for the Sochi Olympic Winter Games.

Dr. Val: What does being CMO mean?

Dr. Beim: It means overseeing 77 other health care professionals and taking care of 228 U.S. Olympians. As CMO, I work in tandem with a team to deliver the highest level of care to our athletes. We are using the latest technology, evaluating a mix of treatments to ensure peak performance, and are ready to respond to whatever might come our way. It means working long and busy hours during the Games, where the team is faced with everything from common colds and illness to traumatic injury. It also means having compassion and understanding while applying your medical expertise in a fast-moving environment. The days can be long, but it is always rewarding to see our athletes rebound and put their best performance forward. It’s an honor to be a part of that process.

Dr. Val: Give me a “behind-the-scenes” description of what the medical support of the athletes looks like.

Dr. Beim: Well, it looks pretty much like any medical clinic you might be familiar with. There have been dozens of boxes shipped to Sochi in preparation for caring for our athletes. Our doctors can see everything from coughs and flu to sprains and breaks. As a result, we have a very comprehensive team assembled to address whatever health-related need might come through the door. We look at the mix of care providers, such as athletic trainers and physical therapists or chiropractors and massage therapists, to assess and provide the best solution to the problem. Our goal is to have our athletes back on the slope, track or rink as fast as possible, performing at their peak.

I have been learning to speak Russian to interact with local hospitals and facilities. We need to be able to communicate our needs quickly and accurately. At other Games, I have found learning the local language to be valuable in the overall care we can access for our athletes. In addition, it is a lot of fun! I really enjoy communicating with the locals and I know they enjoy it, too.

Dr. Val: Does each country bring their own EMS/MDs/coaches?

Dr. Beim: Many countries bring their own medical team, but not all. The athletes do have access to a polyclinic located at the villages, which can address most of the medical issues that can arise during the Games. These polyclinics are generally staffed with excellent physicians and specialists in many areas, as well as a lot of diagnostic equipment and a full pharmacy. Team USA also will have access to these great polyclinics; however, it is quite efficient and simple for our athletes to receive care and recovery modalities in our own sports medicine clinics.

Dr. Val: Who cares for the athletes if there is a life-threatening injury?

Dr. Beim: There would be a team effort between doctors/specialists/emergency providers from the Olympic Organizing Committee and our Team USA doctors. We feel confident that through our collaborative efforts, we will be able to care for our athletes in just about any situation.

Dr. Val: What kinds of on-site medical facilities are there (one at each event or just a centrally located area)?

Dr. Beim: We are fortunate to have a very comprehensive medical area to treat our athletes. There is a polyclinic at both the coastal village and the mountain village, which will have some imaging capabilities and several specialists as well as a pharmacy. We always will have one of our physicians with the team during training and competitions at the various sites. This gives us the flexibility to provide immediate care should the situation arise.

Dr. Val: How are injuries being prevented?

Dr. Beim: Preventing injury is part of the support we provide. Aiding athletes and coaches to condition appropriately and prime their bodies with good nutrition and recovery efforts while in Sochi is all part of the “whole” care we provide to Team USA. We can use technology to assess and evaluate to ensure our athletes are at their peak to perform. The travel and extreme competition can take a toll on a body. We do our best to keep the athletes healthy in every respect.

Dr. Val: Are there any new technologies being used by the US medical team in Sochi?

Dr. Beim: One of the tools we use is GE Healthcare’s Centricity software. This tool is really amazing and provides our physicians and athletes the ability to communicate health information instantaneously and securely. The software maintains diagnostics, treatment evaluations and test results, and it can all be accessed virtually. This is especially critical when you’re traveling from venue to venue in another country. I have implemented this same software in my private practice through Quatris Health. Now, no matter who is involved in the patient’s care, the health care professional has easy access to all the critical information and can respond accordingly. We also have several GE ultrasound machines that we travel with, which is an incredible diagnostic tool for many musculoskeletal injuries.

Dr. Val: How might other young physicians follow in your footsteps?

Dr. Beim: I would encourage any physician that aspires to this kind of appointment to begin connecting with officials in their area of interest. My work with the U.S. Cycling Team helped build my reputation among other elite sports organizations, where I was able to establish relationships and convey my interest in working with them. It can take a lot of time volunteering, but the work is invigorating and stimulating because you learn so much in the process. I really believe I am a better physician and surgeon because I have had the chance to work in these situations. I can bring that experience back to my private practice, which elevates care for everyone.

More Evidence That The Mediterranean Diet Is Healthiest

We’ve known for quite some time that weight loss can reduce the risk of developing insulin resistance and type 2 diabetes. However, a healthy diet alone (without weight loss) may also help to reduce risk. In a recent Spanish study (published in the Annals of Internal Medicine), 3,541 men and women ages 55-80 at risk for diabetes were followed for an average of 4.1 years. Those who ate a diet rich in fish, whole grains, fruits, vegetables, and olive oil were less likely to develop diabetes than those following other diets of similar caloric value.

This is interesting for a few reasons. First of all, it provides us with insight into the importance of what we eat (and not just how much we eat) for optimum health. When considering how to follow a Mediterranean diet, I think it might be easiest to focus on what is NOT on the menu, rather than what we need to add to our diet. Notice that the Mediterranean diet has very low sugar, refined carbohydrates, processed foods and animal fat (with the exception of fish oil). This is not a low carb or low fat diet. It is a low glycemic-index and unprocessed food diet.

Secondly, calorie-restriction alone may not be the optimal way to reduce the risk of developing type 2 diabetes. In the past we have focused primarily on fat loss for diabetes prevention – through calorie restriction and exercise. We’ve often heard that “a calorie is a calorie” and that folks can lose weight effectively on a low-carb, low-fat, or high protein diet. While it’s true that studies have been equivocal regarding the most effective type of diet for weight loss, and people have been able to lose weight on everything from a bacon and grapefruit to a cookie diet, a deeper look suggests that certain diets really are healthier for us in the long run.

Thirdly, what we eat can have a profound effect on our health, and food is an easily modifiable risk factor for illness. Unlike many diseases and conditions (such as type 1 diabetes and other autoimmune disorders) where we have little to no control over whether or not we contract them, it is exciting to know that a healthy diet is a powerful weapon against disease that does not rely on pharmaceutical products or medical interventions.

And finally, I found this study interesting because it confirms what I have noticed in my own life recently – that cutting out refined carbohydrates and sugars can have a very positive effect on body composition and overall health. I have always had a very difficult time with hunger during calorie restriction, and I finally realized that it had to do with being sensitive to blood sugar spikes and drops from too many refined carbs. Once I cut out all added sugars and white flours from my diet (replacing them with lean protein and whole grains) my chronic hunger resolved and I could settle in to a comfortable relationship with food without constantly battling the scale.

If you haven’t tried the Mediterranean diet, there’s no time like the present. While evidence suggests you’ll be healthier for it, my experience tells me you’ll feel a whole lot better too. Say goodbye to the food craving and hunger cycle, and hello to a new way of healthy eating that can be comfortably maintained for a lifetime.

Social Media May Be Better Than Tests And Credentials At Identifying Good Doctors

I am consistently bemused by those who recommend more rigorous or more pervasive standardized testing as the primary means for insuring physician quality. The vast majority of physicians have already passed through a complex gauntlet of multiple choice exams, extended credentialing and certification processes, and lengthy tests of knowledge and skill. And yet, some physicians (to put it bluntly, sorry friends) are very bad at what they do.

Intellectual intelligence is necessary, but not sufficient, for doctoring. It is emotional intelligence (EI) that is sorely lacking – because it has neither been cultivated, nor selected for, by many training programs. Some educators openly acknowledge the problem, pointing to “extra-curricular activities” as their primary means of distinguishing equally qualified applicants. The disappointing reality is that non-academic performance may be a tie-breaker for students with similar standardized test scores, but raw scores almost always trump any other factor. In the end, we have a physician work force that is highly adept at assimilating and regurgitating facts, but is only accidentally good at human interactions.

Is there hope for change in this arena? I believe that the prognosis is guarded. As our culture becomes more and more digital data-driven, a tsunami of “meaningless use” threatens to drown us all in false quality measures, electronic medical record documentation “quality assurance” requirements, and analysis of trends without comprehension of context or influencing variables outside the scope of the measuring instruments. Lies, damn lies, and statistics. We can’t get enough! And guess who are the biggest proponents of these methods? Why, people who only excel at standardized testing – mostly because their true flaws also lie outside the measuring instruments. Bad doctors (sometimes turned-administrators) themselves are often fueling the onslaught of fruitless quality improvement initiatives.

Dr. Howard Luks, orthopedic surgeon and social media activist, wrote a provocative blog post on the subject of why physicians don’t engage more in social media. He suggests that many avoid it because they lack people-skills in the first place and don’t genuinely enjoy engaging with patients. If you’re a “jerk” in real life, he argues, then what advantage is there to making that more obvious on blogs, Facebook, Twitter, etc.? Better to stay socially quiet.

The interesting thing is that social media might be the most reliable way to discover whether or not your doctor is kind, thoughtful, observant, and detail-oriented. Reading a physician’s thoughts online can help you get to know their true personality and work ethic. In the future it would be nice if medical schools and residency training programs took the time to read applicants’ blogs (for example) instead of crunching their test scores for admission via the path of least resistance. An extra hour of reading up front could save our medical system from a new wave of low EI providers.

As Seth Godin put it, “Uncaring hands are worth avoiding.”

We all recognize the importance of this statement intuitively, but have a hard time quantifying “caring” with standardized tests. That’s why admissions officers and patients alike must use their judgment when selecting doctors. We pay verbal homage to the importance of “clinical judgment” in medicine but in reality are culturally afraid of straying from numbers to support our decision-making.

How will you know a good doctor? You’ll know him [or her obviously] when you see him. And sometimes you can see him best on social media platforms.

***

A few caveats of course:

1. Social Media is a sensitive but not specific test. Meaning, you can probably accurately identify caring doctors from their blogs, etc. but if they don’t have one, it doesn’t mean they aren’t good/caring.

2. It may not matter if you find a great doctor online if they’re not in your limited ACA network. :-?

3. Direct primary care is a potentially excellent way to get connected to exceptional doctors. I am a fan of this movement and have been actively involved in a practice in VA. The practices can reduce costs and enhance quality care, though recent caps on Health Savings Accounts (initiated by the Obama administration) have reduced consumer freedom to spend pre-tax income on direct primary care.

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

Read more »

How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

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 »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »