April 17th, 2008 by Dr. Val Jones in News
No Comments »
I first became aware of the potential link between a chemical found in some plastics (bisphenol A) and health effects in humans a little more than a year ago. I was concerned enough by the preliminary data collected by the NIH to blog about it, and it seems that many others are voicing concerns as well.
In fact, Canada has decided that the evidence is sufficient to label the chemical “dangerous” and will be announcing this shortly:
In Canada, the Globe and Mail newspaper said the Canadian health ministry was ready to declare BPA a dangerous substance, making it the first regulatory body in the world to reach such a determination. The newspaper said the ministry could announce the decision as soon as Wednesday.
Environmental activists long have warned about health concerns regarding the chemical. They praised the draft findings of the National Toxicology Program, which cited more potential worries about the chemical than did a panel of experts that advised the program last year.
At this point we don’t have enough information about how the chemical impacts humans to be sure of its level of risk. But what we do know is that:
1. The chemical is ubiquitous (most Americans have trace amounts detectable in their urine).
2. Animal studies appear to have demonstrated a causal relationship between bisphenol A and fertility, behavioral, and immunologic disorders in rats.
3. Human breast cells exposed to bisphenol A in a Petri dish developed a more aggressive form of cancer.
4. There is a plausible biologic mechanism by which the chemical could exert clinical, endocrine-mediated effects.
For these reasons, I think we should certainly view bisphenol A with suspicion. I will continue to follow the research with interest and concern.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 7th, 2008 by Dr. Val Jones in Expert Interviews
5 Comments »
Celiac disease (also known as celiac sprue) is an autoimmune intestinal disorder that affects millions of Americans, but is often misdiagnosed and misunderstood. I interviewed Revolution Health’s gastroenterologist, Dr. Brian Fennerty, to help set the record straight. I highly recommend that you listen in to the entire conversation here, but I’ve captured the highlights in written form below.
Dr. Val: What is celiac disease?
Celiac disease is a genetically determined sensitivity to gluten, which is a protein component of wheat and other cereal grains. Some people think of it as an allergy to gluten, but it’s not a true allergy because it causes symptoms through a different biological pathway. Allergies respond to anti-histamines (and involve IgE antibodies released by eosinophils and mast cells) whereas gluten sensitivity involves IgA and IgG antibodies (released by different types of cells called lymphocytes) and do not respond to anti-histamine treatments. So the treatment for celiac disease is largely avoidance of gluten containing foods rather than directly treating the immune response.
Dr. Val: Is celiac disease under-recognized by physicians?
About 1-2% of adult Americans actually have a gene for celiac disease. However, many people with the gene don’t have symptoms. And there are others who don’t have the gene who do have celiac disease. This makes celiac disease both common, and commonly misdiagnosed.
Dr. Val: Why do some people with celiac disease have symptoms and others don’t?
That’s the million dollar question. It’s probably due to the relative vigorousness of their immunological response to gluten, and how much of their bowel is involved. Symptoms of celiac disease can range from a severe gluten intolerance in a child who stops eating (due to pain and bloating) and ceases to grow due to malnourishment, to an elderly person who has no intestinal symptoms whatsoever but is found to be iron-deficient on a screening exam – which leads eventually to the diagnosis of celiac disease.
Dr. Val: How do you diagnose celiac disease?
Doctors often misunderstand how best to diagnose this disease, and because of that patients are often misled. Nowadays we screen for celiac disease with a blood test called “tissue trans-glutaminase” (TTG) to determine whether or not this enzyme is present in an abnormal form (which is the case in patients with celiac disease). However the test has an 80% sensitivity, which means that 80% of the people who have celiac disease test positive with the TTG test, but 20% of the people who test positive do NOT have celiac disease. When only 1 or 2% of the population has the disease, a positive test is given so frequently that most people who test positive don’t actually have the disease. A negative test, on the other hand, is more helpful to exclude the diagnosis of celiac disease. So anyone with a positive celiac blood test should assume that they don’t have celiac disease until it has been confirmed with a duodenal biopsy.
Dr. Val: How invasive is a biopsy for celiac disease? Are there risks involved?
The biopsy involves an upper endoscopy (NOT a colonoscopy) so there is no bowel prep requirement so it’s much more comfortable. The biopsy itself is very shallow, so there’s no risk for bleeding. The only risks are those associated with a regular endoscopy. It is a sedated exam, so you may lose time from work, but it’s not painful or as involved as a colonoscopy.
Dr. Val: Could you still miss celiac disease on a biopsy?
It’s possible though quite unlikely. The test is very accurate, but there are some mild cases of celiac disease where the part of the bowel that we biopsy is not involved in the disease process and may not be visible under the microscope. If the disease is still strongly suspected in someone with a negative biopsy, a second biopsy can be done with a longer scope (called an enteroscope) to get a sample of tissue from farther down in the small intestine. A second option would be for the patient to swallow a camera capsule so that we can take photos of the bowel wall to see if there are changes in the lining of the intestine suggestive of celiac disease. A third option is to try a gluten-free diet and see if the patient’s symptoms improve.
Dr. Val: Is there any new research or potential therapies for celiac disease?
Because this is an immunologic disorder (where the intestine’s immune system is reacting abnormally to a normal dietary constituent and causing inflammation) we can try to control the inflammatory response. In the past we tried very potent immunomodulators like chemotherapy, or anti-inflammatories used in other auto-immune diseases like rheumatoid arthritis or Crohn’s disease. However, these are very strong medications with many unwanted side-effects. There are targeted therapies being developed that will help to block the gluten response without exposing the patient to the potent general anti-inflammatory properties of chemotherapy-type agents, but we don’t know yet if this approach will be successful.
Dr. Val: What’s your advice for patients with celiac disease?
I have three pieces of advice that I generally give my patients with celiac disease:
1. Become as informed as possible about your disease. Websites such as the Celiac Sprue Association and NFCA are excellent sources of trustworthy information. At the same time, the Internet is an extremely dangerous place for celiac patients because there are a lot of websites that are not science-based, but driven by marketers who are trying to sell products to patients. So the patient has to learn to filter the information they’re getting off the Internet.
2. Consult with a dietician or nutritionist who understands celiac disease. Not all dieticians are skilled at counseling people with gluten sensitivity, so be sure to find one who has expertise in this area. A good dietician or nutritionist is the most important part of the healthcare team for a patient with celiac disease.
3. Make sure your diagnosis is accurate. There are many tens of thousands of people walking around with a diagnosis of celiac disease who do not have it. If you’ve been diagnosed on the basis of a blood test alone, and your symptoms don’t correlate perfectly with gluten sensitivity, you need to question that diagnosis.
Dr. Val: Do people with celiac disease have higher risks for other gastrointestinal disorders?
Yes. Celiac disease is associated with diabetes, so people with celiac disease should be screened for diabetes. Some people believe that patients with celiac disease are at higher risk for irritable bowel syndrome, though it’s unclear if that’s because of overlapping symptoms and not an actual increase in IBS. Patients with celiac disease are at higher risk for iron and calcium deficiencies (due to absorption problems in the intestinal lining) which can lead to anemia and osteoporosis. There is also a higher risk of small bowel lymphoma, which is a very rare form of cancer. A celiac patient’s risk (like anyone’s risk) of breast cancer or prostate cancer, of course, are far higher than the very small (but increased) risk of intestinal lymphoma.
So there you have it folks, all you ever needed to know about celiac disease. I’m going to be participating Washington DC’s Gluten Free Cooking Spree this Friday, April 11th. I’m teamed up with the chef from Cafe Atlantico to create a gluten free meal that’s going to be out-of-this world delicious. If you’re local, I hope I see you there!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 25th, 2008 by Dr. Val Jones in Expert Interviews
5 Comments »
Women in their 40’s are at an advantage when it comes to weight control and fitness. How so? I asked three of my favorite medical experts to explain what it means to be fit and forty, and how you can get there.
Myth-busting With Dr. Dickerson
Dr. Val: I know that many women in their 40’s complain of having gained weight. What causes that weight gain? Is it inevitable?
Dr. Dickerson: Many women don’t gain weight in their 40’s so it’s certainly not inevitable. There are a few common misconceptions about weight gain and aging that I’d like to address.
First, hormone supplements don’t cause weight gain – menopause, in general, with or without hormones, is associated with about a 10 pound gain. This often starts in perimenopause so it could occur as early as the 40’s.
Second, lean muscle mass decreases slowly from mid-30’s probably until menopause when it decreases more steeply. So women in their 40’s don’t experience too large a change in their metabolism.
Third, the weight that women have in their 40’s is often about how many babies they have had. Data show us that women retain about 10 pounds per pregnancy. Weight begins to shift as the perimenopause era begins – more towards the abdomen and the hips and thighs.
And finally, weight gain is not due to hormonal or metabolic changes, but may be more about emotional eating. Women often experience the empty nest syndrome in their late 40’s and change their eating habits to constant “snacking” – they tend not to count these calories when adding things up
Dr. Vivian Dickerson, Past President of the American College of Obstetricians and Gynecologists, Medical Director, women’s health programs and care, Hoag Hospital, Newport Beach, CA.
Increasing physical activity is the key to success
Dr. Val: How can women in their 40’s counteract potential weight gain? What’s the most effective strategy to stay trim and fit?
Dr. Hall: While it is true that body remodeling and loss of muscle mass probably starts in the late 30’s it is almost completely a matter of now much physical activity is taking place. Much of the perceived change in body image, (gravity-dependent “sagging”) is also accentuated with decreased muscle tone in the sedentary woman. Weight gain, on the other hand is quite related to caloric intake. It is greatly modulated by the degree of physical activity as well.
My general feeling is that most diets do not work, and the older you are, the truer that is. After age 40 women cannot consistently lose weight and keep it off without a plan of regular physical activity (aerobic) plus some resistance work (weights, bands) to improve body tone.
Dr. Bill Hall, Past President of the American College of Physicians and Director of the Center for Healthy Aging, Rochester, NY.
The 40’s: no better time to get trim and fit
Dr. Val: Do women in their 40’s have an advantage in losing weight?
Dr. Dansinger: Your 40’s are a great time to take lifestyle changes to new heights. Whether for weight loss, or prevention of diabetes or other related medical problems, many women who struggled in their 20’s and 30’s finally find success in their 40’s. For many women at this age, previously insurmountable logistical barriers such as raising preschool age children, or inflexible work schedules, often improve somewhat. Such expertise in schedule-juggling, when combined with a renewed commitment toward preventing health problems, often gives such ambitious women the strength and experience to finally achieve consistency with an effective exercise and healthy eating routine that produces long-lasting results.
Although the metabolism slows gradually throughout adulthood, the effectiveness of lifestyle changes for health improvements remains strong throughout life, and may actually become most beneficial as we grow older. Gaining muscle and bone strength through weight-lifting type exercise may help a woman in her 40’s reduce the risk of muscle and bone loss that typically affected women of her mother’s generation.
Dr. Michael Dansinger, Lifestyle Medicine Physician/Researcher, Tufts Medical Center, Boston. Nutrition and fitness advisor to NBC’s Biggest Loser.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 21st, 2008 by Dr. Val Jones in Uncategorized
No Comments »
This week I was honored to be featured as the first post in the line up at Polite Dissent’s Grand Rounds. Over the past couple of weeks Revolution Health’s bloggers have been doing their part to contribute to health knowledge. Here’s my round up of the best of their recent posts:
Health tips
Spring break is coming up for millions of children and teens. Dr. Stacy Stryer has some health tips for sun and water safety.
Stretching is an important healing technique for some injuries and conditions. Dr. Jim Herndon explains what we know about the use and value of stretching exercises.
Does an affair mean your marriage is over? Mira Kirshenbaum has some suggestions for healing after infidelity, and a group to help you do it.
Some people feel regret after prostate cancer surgery. Dr. David Penson offers some empathy and advice.
What’s new in prostate cancer treatment? Dr. Mike Glode give a short synopsis.
Meditation might decrease your sleep requirements. Dr. Steve Poceta reviews this claim.
Did you know?
Men hate to apologize. Relationship expert Mira Kirshenbaum has some ideas as to why that might be.
Teen scientists are contributing to colon cancer research. Dr. Heinz-Josef Lenz discusses what his daughter and a Junior Nobel Science Award-winning teen have in common.
Toenail fungus is very common in the elderly. Dr. Joe Scherger explains why this is so, and why it’s so difficult to treat.
Overweight menopausal women may suffer more severe hot flashes. Dr. Vivian Dickerson explains why.
An anti-snoring shirt has been developed to help people remain on their sides while asleep. Dr. Steve Poceta explains how sleep position is related to snoring.
Human growth hormone doesn’t actually strengthen your muscles, it just makes you retain water. Dr. Jim Herndon reviews the latest research.
There’s a new clinical trial designed for women with metastatic colon cancer. Dr. Heinz-Josef Lenz explains what the scientists are hoping to learn from the research study.
Baby-naming is an art. Dr. Stacy Stryer discusses the history of finding just the right name for your child.
Patient advocate Robin Morris discusses her opinion of Larry King’s recent autism-focused show.
How should a doctor share bad news with a patient? Neurologist Larry Leavitt explains.
***
Happy Easter weekend everyone!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 20th, 2008 by Dr. Val Jones in News
1 Comment »
About a year ago I had the chance to speak with the founder of Micromedex Inc. about his views on the potential differences between brand name and generic drugs. He expressed some concern about the allergenic potential of filler substances in both brand name and generic drugs, and I was quite interested in the clinical impact of these differences.
Just recently, an article in the LA Times has shed more light on the debate about drug equivalency, and my fellow bloggers Abel Pharmboy and Joseph (at Corpus Callosum) have summarized the issues very well. As it turns out, the FDA allows for a fairly broad interpretation of equivalency when it comes to the rate at which the bioactive ingredients are released into the bloodstream.
To use an imperfect analogy – let’s pretend that water is the drug you’re taking. You can access water from a drinking fountain or a fire hydrant, and the amount you get in your mouth all at once may vary between the two sources, though the water itself is the same “drug.” This is the sort of difference that exists between some generic drugs and their brand name “equivalents.” The rate at which they get into your system can differ by as much as 36% and still be considered identical drugs by the FDA.
Now, imagine that someone offered you water in a paper cup or in a water balloon. The water’s container (analogous to the “inert filler” used to hold the medicine together in a pill or liquid form) is made of different substances (paper versus latex) and doesn’t make that much of a difference in quenching your thirst… unless you’re allergic to latex.
So there are true differences between generic and brand name drugs, though most of the time these differences are not clinically important. But in those special circumstances where people are allergic to fillers, or need a constant or regular concentration of their drug in the bloodstream, generic vs. brand name really does matter.
However, I think that in general generic drugs are terrific and have substantially reduced costs and increased access for millions of people. It is reasonable to save money by switching to generic drugs when possible. It is also important to resist the urge to believe that higher drug prices guarantee more effective products. In a recent JAMA article it was demonstrated that people believed that pain medication placebos were more effective if they were told that they were also more expensive.
But, if you’re one of those patients who tried switching to a generic drug and found it less effective – don’t let your doctor tell you you’re imagining things. There could be a real difference that you need to explore.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
