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Would You Be Able To Recognize Chest Pain As Heart Disease?

Most people are pretty good judges of what’s going on with their own bodies. But telling a heart attack from other causes of chest pain is tough stuff—even, it turns out, for highly trained doctors. That’s why I thought this personal story, written by a Harvard doctor who has heart disease, would make an interesting read. It’s an excerpt—the full version can be found in Heart Disease: A guide to preventing and treating coronary artery disease, an updated Special Health Report from Harvard Medical School.

Early one spring, I noticed a burning sensation high in my abdomen whenever I walked up a hill or worked out on the treadmill. I felt perfectly healthy otherwise. I had lots of energy and could do high-level exercise on the treadmill—once the burning sensation went away—without becoming short of breath. I thought it was just heartburn, so I started taking powerful acid-suppressing pills. They didn’t help.

Sometimes when I would feel the burning in my chest, I would remember an old saying to the effect that “A doctor who takes care of himself has a fool for a patient.” Still, I hesitated; I didn’t want to waste the time of a cardiologist if all I had was heartburn.

But one morning as I walked across the street from the garage to my office in the hospital, Read more »

*This blog post was originally published at Harvard Health Blog*

What To Include In Your Diet To Lower Harmful LDL Cholesterol

Low-fat diets, move over. When it comes to lowering cholesterol, a “portfolio” diet that includes cholesterol-lowering foods such as oatmeal, nuts, and soy products is better.

Several years ago, researchers at St. Michael’s Hospital and the University of Toronto created what they called a “dietary portfolio of cholesterol-lowering foods.” It went after cholesterol by adding to a heart-healthy diet specific foods known to lower cholesterol: margarine enriched with plant sterols; oats, barley, psyllium, okra, and eggplant, all rich in soluble fiber; soy protein; and whole almonds.

In a head-to-head test against the low-fat diet traditionally recommended by the American Heart Association, the portfolio approach was the clear winner. (You can see the makeup of the test diet here.) After 24 weeks, it lowered harmful LDL cholesterol by 13%, while the low-fat diet lowered LDL by only 3%. As an added benefit, the portfolio approach also lowered triglycerides and blood pressure, and did not depress the level of beneficial HDL cholesterol. The results were published in the Journal of the American Medical Association.

What I appreciate about this study is that it Read more »

*This blog post was originally published at Harvard Health Blog*

Painful Bladder Condition Often Goes Undiagnosed In Women

Woman-stomach-painMillions of Americans—most of them women—suffer from a bladder condition known as interstitial cystitis. According to a new study of this disorder, fewer than 10% of women with symptoms of interstitial cystitis are actually diagnosed with the disorder, even though it severely affects their lives. Without a proper diagnosis, women with interstitial cystitis are missing out on treatments that might bring them some relief.

As I describe in an article in the August 2011 issue of the Harvard Women’s Health Watch, interstitial cystitis is a chronic bladder condition that causes recurring bouts of pain and pressure in the bladder and pelvic area. Individuals with the condition usually have an urgent and frequent need to urinate—sometimes as often as 60 times a day. The pain and discomfort can be so excruciating that only about half of people with interstitial cystitis work full-time.

Researchers with the federally funded RAND Interstitial Cystitis Epidemiology (RICE) study surveyed nearly 150,000 households in the United States between 2007 and 2009. Based on data gathered during follow-up interviews, the RICE researchers estimated Read more »

*This blog post was originally published at Harvard Health Blog*

NSAIDs Might Be Risky For People With Heart Problems

As if people with the combination of high blood pressure and heart disease don’t already have enough to worry about, a new study suggests that common painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) pose special problems for them.

Among participants of an international trial called INVEST, those who often used NSAIDs such as ibuprofen (Advil, Motrin and others), naproxen (Aleve, Naprosyn, and others), or celecoxib (Celebrex) were 47% more likely to have had a heart attack or stroke or to have died for any reason over three years of follow-up than those who used the drugs less, or not at all. The results were published in the July issue of the American Journal of Medicine.

Millions of people take NSAIDs to relieve pain and inflammation. They are generally safe and effective. The main worry with NSAIDs has always been upset stomach or gastrointestinal bleeding. During the last few years, researchers have raised concerns that Read more »

*This blog post was originally published at Harvard Health Blog*

Why Are Humans So Drawn To Sunlight Despite Its Negative Consequences?

Sunny-beachIt doesn’t make sense: If sunlight causes cancer, why are human beings so drawn to it, flocking to sunny beaches for vacation time and hoping for sunshine after a rainy spell?

One answer, says David Fisher, chief of dermatology at Harvard-affiliated Massachusetts General Hospital in Boston, may be that humans are literally addicted to sunshine so our skin can make vitamin D. New evidence suggests that we get the same kick out of being in the sun that we get from any addictive substance or behavior. It stimulates the so-called “pleasure center” in the brain and releases a rush of feel-good chemicals like endorphins.

So there may be more than a desire to look good in a tan behind the urge to soak up the sun’s rays. This craving may be a survival mechanism that evolved over thousands of years because humans need vitamin D to survive. Skin makes this crucial vitamin when it is exposed to sunlight. There isn’t much vitamin D in food (except in some of today’s fortified foods) so the human brain rewards us with a rush of pleasure when we seek out the sun and get vitamin D.

Seeking sunshine can be downright dangerous. As Fisher points out, Read more »

*This blog post was originally published at Harvard Health Blog*

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…

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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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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…

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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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