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Drug Shown To Protect Obese Mice From The Diseases Of Obesity

I usually choose not to write about the “new new scientific thing” that gets picked up by the press,  because early research is usually not reproducible and good science takes a long time to validate as true.  But since we know that mice and rats that are kept on low-calorie diets live 30% longer (and healthier) than their fat cohorts, I was interested in a new research compound, SRT-1720,  that was shown to protect obese mice from diseases of obesity.  Fat mice lived 44% longer if they were given this drug.

The “designer” drug works by Read more »

*This blog post was originally published at EverythingHealth*

Antioxidant Potential: Spices Shown To Reduce Triglycerides

Spice_Bazaar by jefield via Flickr and a Creative Commons licenseThe Mediterranean diet has a new competitor, the spicy diet. Antioxidant spices may reduce the triglyceride response of a high-fat meal by 30% compared to the same meal without them, concluded a study.

The antioxidant potential of spices stems from their phenolic compounds, the authors wrote. Also, some spices increase the blood plasma concentrations of others, and spices are typically eaten as blends, making them good targets to study. Turmeric, cinnamon, rosemary, oregano, black pepper, cloves, garlic powder and paprika were on the short list that researchers examined.

The study compared results in Read more »

*This blog post was originally published at ACP Internist*

Study Shows That Processed And Unprocessed Meats Pose A Diabetes Risk

Red Meat! by ThisParticularGreg via Flickr and a Creative Commons license

There’s a strong association between daily servings of red meat, especially processed meat, and a nearly 20% increased risk of type 2 diabetes, researchers found.

Replacing red meat with healthier proteins, such as low-fat dairy, nuts, or whole grains, can significantly lower the risk, according to a study was published online at the American Journal of Clinical Nutrition.

Researchers reviewed questionnaire responses from 37,083 men followed for 20 years in the Health Professionals Follow-Up Study, from 79,570 women followed for 28 years in the Nurses’ Health Study I, and from 87,504 women followed for 14 years in the Nurses’ Health Study II. Diet was assessed by validated food-frequency questionnaires, and data were updated every four years. Diabetes was confirmed Read more »

*This blog post was originally published at ACP Internist*

Book Review: Food Truths, Food Lies

Food Truths, Food Lies, written by family physician Eric Marcotte, M.D., may be the most refreshingly evidence-based diet book of the decade. You will not find a single mention of super-foods, magical berries, or supplement “must-haves” in the entire book. What you will find is the cold, hard truth about why many Americans are overweight, and what it takes to become a healthy eater.

Marcotte writes for the average American – his simple language, matter-of-fact tone, and regular reminders of what the reader has learned, make for a quick and memorable read.  Although it’s clear that Marcotte has carefully distilled his dietary advice from the scientific literature, he refrains from burdening the reader with too many footnotes and references. Instead, he has created a kind of Cliff’s Notes of nutrition, having done the “heavy sifting” for us. What remains are the most basic principles underlying all healthy eating, such as:

*You can’t exercise your way to weight loss (i.e. you can’t outrun your own mouth – it’s much easier to eat more calories than you burn) Read more »

Research Shows That A Pregnant Woman’s Diet Might Influence Baby’s Palate

Attention, pregnant women!  The foods you eat now might influence your babies’ palates after they are born.  New research published in the journal Pediatrics, shows that the fetus actually drinks amniotic fluid in the womb.  The amniotic fluid is flavored by the foods the mother has recently eaten and flavors can be transmitted to the amniotic fluid and mother’s milk.

It makes sense that as the baby is developing, memories are being created by a sense of taste.  Could what a mother eats influence food preferences and odor preferences for life?  Researchers fed babies cereal flavored with carrot juice vs. water.  They showed that babies who experienced daily carrots in amniotic fluid or mother’s milk ate more carrot-flavored cereal and made less negative faces when eating it.

Julie Mennella studies taste in infants at the Monell Chemical Senses Center (Philadelphia) and she says Read more »

*This blog post was originally published at EverythingHealth*

Latest Interviews

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…

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How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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Click here for a musical take on over-testing.

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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…

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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…

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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…

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