Gerard E. Mullin, M.D.2013-05-23T08:46:56-04:00Gerard E. Mullin, M.D.http://www.huffingtonpost.com/author/index.php?author=gerard-e-mullin-mdCopyright 2008, HuffingtonPost.com, Inc.HuffingtonPost Blogger Feed for Gerard E. Mullin, M.D.Good old fashioned elbow grease.Healthy Eating for the Holidaystag:www.huffingtonpost.com,2012:/theblog//3.21556982012-11-19T12:30:52-05:002013-01-19T05:12:01-05:00Gerard E. Mullin, M.D.http://www.huffingtonpost.com/gerard-e-mullin-md/
Turkey Day may only come around once a year, but it is only the beginning. The merry months that follow are filled with family feasts, business buffets, and celebratory cocktails. This holiday season, get jolly but stay healthy -- here's how:
Getting Started
Whether your Thanksgiving feast is in the afternoon or evening, it is important to not starve yourself in anticipation. Those who enter with an empty stomach are more likely to overeat, so don't skip breakfast. Try to incorporate mindful eating techniques by eating slowly and chewing well will aid in digestion.
Turkey
Food coma? Don't blame it on the bird. Though turkey -- and specifically, the amino acid tryptophan -- has long been implicated as an agent of sleepiness associated with a big thanksgiving feast, the gobbler does not actually contain more tryptophan than meats such as chicken. Tryptophan absorption is limited when consumed with other food.
So if you're feeling sleepy, chances are overeating is to blame.
A healthy portion of turkey is about the size of the palm of an "average" hand. Among the plethora of options at Thanksgiving, skinless turkey meat is a safe bet -- as long as it is not deep-fried.
Gravy
High in salt and fat, gravy adds moisture and flavor -- but not without consequences. Try measuring your gravy out onto a tablespoon instead of pouring it straight from the bowl. Use this measurement as a portion size guide: Don't help yourself to more turkey and potatoes than your gravy can cover. Or be really bold and skip the gravy altogether.
Potatoes
Potatoes are loaded with heart-healthy potassium, but mashed potatoes are often loaded with cream, which is as bad for waistline as it is for your heart. This year, opt for a traditional baked potato or mix and mash it with chicken or vegetable stock to add flavor and moisture without adding fat. People with a sweet tooth can swap white potatoes for sweet ones for an additional nutrient boost. Packed with vitamin A and vitamin C, sweet potatoes also have a lower glycemic index than white potatoes (so they cause less of a blood sugar spike, and will keep you full longer). Try throwing just baked sweet potatoes in a baking dish with a can of unsweetened pineapple for a nutrient-dense, guiltless treat.
Cranberry Sauce
Vibrant in color and deliciously tart in flavor, cranberries are also packed with phytochemicals that have been shown to promote heart and dental health as well as help prevent cancer.
The many health benefits of cranberries are often offset by the sugar content of cranberry sauce. To limit the amount of sugar, try cooking fresh or frozen cranberries with orange juice and applesauce to infuse with extra flavor from natural sugars.
Vegetables
Fill up on vegetables. Green beans, Brussels sprouts, and kale are great options as side dishes this holiday season. All three of these vegetables are packed with antioxidant vitamins A, C, and K. Kale and Brussels sprouts are part of a family known as cruciferous vegetables, which supports our bodies' natural detoxification system and may be protective against certain types of cancer. Additionally, kale is a particularly good source of fiber and calcium. Considering a vegetarian meal? Switch it up this year, and make the greens the main course. Steaming or roasting with olive oil is a healthy choice, sautéing in bacon is not.
Stuffing
Instead of making stuffing with bread, try substituting a nontraditional grain such as quinoa. Quinoa is a gluten-free grain that doesn't cause a surge in blood sugar levels. It is an excellent source of protein and contains all of the essential amino acids (the building blocks of protein that we must get through our diet). The small grain also contains manganese, a powerful antioxidant, and magnesium, which helps relax blood vessels. Substituting white bread with quinoa is sure to stir up interesting mealtime conversation -- and adding this fiber-filled grain instead of the simple carbohydrates makes satiety strike faster.
Desserts
Hopefully following the healthy and tasty tips above is enough to fill up, but it is hard to pass up dessert altogether. Portions are key, so filling up the plate with fresh fruit so it looks full before adding a sliver of pumpkin pie will trick the brain into thinking you can have you cake and eat it, too. Canned pumpkin is a low-fat, low-calorie food, and with 40 calories in a half-cup, it still provides a good amount of fiber and vitamin A. Finally, a handful of pecans provides the satisfying flavor without added sugar. Pecans are an excellent source of a certain type of vitamin E (gamma tocopherol) that has been shown to reduce oxidation of cholesterol, which can help reduce inflammation -- a perfect way to top off the meal.
Kick off of a long, healthy holiday season this Thanksgiving. Give thanks to your friends and family with the gift of health-boosting foods.
For more on diet and nutrition, click here.]]>Concerns About Acid-Blockers Are Being Raisedtag:www.huffingtonpost.com,2012:/theblog//3.17446052012-08-08T14:19:14-04:002012-10-08T05:12:32-04:00Gerard E. Mullin, M.D.http://www.huffingtonpost.com/gerard-e-mullin-md/New York Times recently reported on the "Host of Ills" associated with the long-term use of Proton Pump Inhibitors. More than 50 million Americans experience heartburn frequently (two or more days per week), and Proton Pump Inhibitors (PPIs) such as Prilosec, Prevacid and Nexium are often prescribed as a first line of treatment. PPIs, which rank as the third highest selling drug class in the United States, work by drastically reducing the amount of acid produced by the stomach.
Despite the popularity of PPIs, a recent American Gastroenterological Association survey of 1,000 individuals who take these drugs to treat chronic severe heartburn (or gastroesophageal reflux disease -- GERD) found more than 55 percent of respondents to continue to experience heartburn symptoms that significantly disrupt daily life.
While PPIs can benefit a subset of patients, off-label usage, coupled with inadequate reassessment of need for continued use, leads to prolonged reduction of stomach acid. Because stomach acid helps to absorb important vitamins and minerals such as calcium, magnesium, zinc, iron and Vitamin B12 -- which, among other things, support good bone health -- prolonged reduction of stomach acid can result in negative side effects for individuals who take PPIs.
When used to treat GERD, PPIs are indicated for a treatment course of eight weeks. Many individuals, however, stay on these acid-reducing medications indefinitely. In addition to common side effects such as nausea and diarrhea, such prolonged use raises the risk of a myriad of other potential problems. For example, PPIs reduce symptoms of heartburn by limiting the amount of stomach acid that refluxes into the esophagus and damages the esophageal lining. Discontinuation after long-term use, however, can create a rebound effect as the acid secretion may increase once it is no longer being suppressed -- thereby aggravating the symptoms that PPIs had been intended to treat.
Since 2010 the Food and Drug Administration (FDA) has issued several warnings associated with long-term or high-dose use of PPIs, including: an increased risk of bone fractures, risk of low magnesium levels, and risk of Clostridium difficile-associated diarrhea -- a potentially life threatening condition that is of particular concern to the elderly and immunocompromised. A meta-analysis published online in the American Journal of Gastroenterology (1) takes this recommendation a step farther in indicating that the risk of Clostridium difficle in those who take both antibiotics and PPIs doubles as a result of drug interactions.
Since acid provides natural antibacterial properties, the lower stomach acid levels in adults over 60 already makes this group particularly vulnerable to infections. The combination of low stomach acid levels and daily PPI intake increases the risk of infections such as pneumonia, which can be very dangerous in older adults and other immune-suppressed individuals.
The naturally acidic environment in the stomach also provides a protective barrier against pathogens. Lowering acid production through the use of PPIs, however, can erode this barrier and increase the risk of gastrointestinal infections from food-borne bacteria.
Other complications associated with long-term use of PPIs may include potential cardiovascular events. There have been several large studies exploring the drug interaction between Plavix (clopidogrel), an anti-platelet medication used to prevent heart attacks, and PPIs. Though the results of these studies are not conclusive, some suggest that when using these drugs together an increased risk of cardiovascular events occurs (2,3).
Instead of PPIs, consider treating persistent heartburn with at-home remedies such as:
• Pay attention to your diet. "Trigger" foods that are commonly associated with heartburn include fatty, spicy, or acidic foods such as dairy products, coffee, peppermint, chocolate, alcohol, tomatoes, onions and high-fat foods. Any heavy meal can trigger reflux, though, especially if consumed late at night. Foods that aggravate symptoms are highly personalized, however, so keep a food diary and take note of when symptoms occur to identify food culprits. Also consider refraining from wearing tight fitting clothing around the waist -- give yourself room to breathe during meals.
• Try to reduce tension. Stress causes a condition called hypervigilance, which increases your sensitivity to pain. (4)
• Consider taking deglycyrrhizinated licorice (DGL). Chewing two tablets slowly before each meal or between meals may help to soothe the esophagus. (5)
• Eat smaller meals, try not to eat before going to bed, and when you do go to bed elevate your head with several pillows.
• If you do stay on a PPI on a long-term basis, be sure to have your magnesium, iron, and Vitamin B12 checked regularly. If necessary, discuss the use of supplements with your doctor. Bone density scans can be done to monitor the health of your bones.
• If symptoms persist, talk to your doctor, as this may be an indication of a more serious condition.
*PPIs may also be recommended for treatment of esophageal inflammation (esophagitis) and esophageal ulcers due to acid reflux as well as the treatment of gastric inflammation and ulceration.
References:
(1) Kwok, C.S. et al., 2012. Risk of Clostridium difficile Infection With Acid Suppressing Drugs and Antibiotics: Meta-Analysis. The American journal of gastroenterology, 107(7), pp.1011-1019.
(2) Wang, L. et al., 2012. Risk of Adverse Outcomes Associated With Concomitant Use of Clopidogrel and Proton Pump Inhibitors. JAMA, 301(9), pp.937-944.
(3) Heidelbaugh, Joel J et al. Overutilization of Proton-pump Inhibitors. Ther Adv Gastroenterol. 2012;5(4):219-232.
(4) Dickman, R and Fass R., 2006. The Pathophysiology of GERD. Gastroesophageal Reflux Disease, Chapter 2. F. A. Granderath, T. Kamolz, & R. Pointner, eds., Vienna: Springer-Verlag.
(5) Yarnell, E. & Abascal, K., 2010. Herbs for Gastroesophageal Reflux Disease. Alternative and Complementary Therapies, 16(6), pp.344-346.]]>Colorize Your Plate!tag:www.huffingtonpost.com,2012:/theblog//3.14273912012-04-24T20:00:54-04:002012-06-24T05:12:01-04:00Gerard E. Mullin, M.D.http://www.huffingtonpost.com/gerard-e-mullin-md/
That brings me to my tip of the month for April: Colorize your plate! Eat foods with a variety of color. The pigments of plant-based foods help fight disease and help you live a more vibrant life. Better known as phytochemicals, these pigments help protect us from the damaging effects of oxidizing pollutants, which impair function and prematurely age our cells. There are seven color categories in plants: red, red/purple, orange, yellow/orange, green, yellow/green, and white/tan/brown. For example, blue, black, and red-hued berries contain a high level of oxygen radical absorbance capacity (ORAC ) to counteract the damaging effects of oxidizing substances. Let's explore some the full rainbow spectrum of produce that can benefit health.
The blue/purple hues in foods are due primarily to their anthocyanin content. The anthocyanins that give these fruits their distinctive colors may help ward off heart disease by preventing clot formation. Consider deeper-toned berries, as the darker the blue hue, the higher the phytochemical concentration. Other examples in this class of "darker foods" include eggplant (especially the skin), prunes, pomegranates, purple grapes, plums, raisins, dried plums, purple asparagus and purple cabbage.
The green color in leafy vegetables such as broccoli, spinach, and kale comes from the natural plant pigment chlorophyll. These green leafy vegetables are excellent sources of vitamin K, folic acid, and potassium, as well as antioxidant compounds called carotenoids and omega-3 fatty acids. Dark leafy greens such as spinach and kale are richer in nutrients than paler iceberg lettuce. Other green veggies include: asparagus, Brussels sprouts, green beans, peas, snow peas, spinach, and zucchini.
Cruciferous green vegetables like broccoli and Brussels sprouts not only contain chlorophyll, but are also rich in phytochemicals called indoles and isothiocyanates, which induce enzymes in the liver that assist the body in removing potentially carcinogenic compounds. There is an inverse relationship between cruciferous vegetables and cancer, especially colon and bladder cancers. Cruciferous veggies also contain the phytochemical sulforaphane, which detoxifies cancer-causing chemicals before they damage the body.
The color red is a flag for such health-promoting compounds as lycopene and anthocyanins. As with other colored produce, the darker and richer the tones, the more phytonutrients you'll get in return. The red pigment in tomatoes and tomato products comes from the phytochemical lycopene, a powerful antioxidant that has been associated with protection against cardiovascular disease. Cooked tomato sauces are associated with greater health benefits compared with uncooked versions because the heating process allows all carotenoids, including lycopene, to be more easily absorbed by the body. Cranberries, another red fruit whose color is due to anthocyanins, are also a good source of tannins, which prevent bacteria from attaching to cells. They have a relatively low glycemic index and can make a very healthy morning cereal topping or evening dessert. Other examples of red fruits and veggies include cherries, red grapes, raspberries, strawberries, watermelon, beets, and red peppers.
Yellow/orange colored vegetables are seen most commonly during fall and include carrots, sweet potatoes, pumpkins, butternut squash, yellow peppers, and yellow corn. Fruits that contain a mixture of yellow/orange pigments include apricots, peaches, mangos, oranges, tangerines, and cantaloupe. These foods contain the pigment beta-cryptoxanthin and are rich in vitamin C and beta-carotene, which are particularly good antioxidants. Beta-cryptoxanthin, beta-carotene, and alpha-carotene are all carotenoids that the body converts to vitamin A, a nutrient integral to vision and immune function, blood sugar regulation, and skin and bone health.
Bland colors like white/tan/brown still contain important nutrients, which promote heart health. Examples of fruits in this class include bananas, brown pears, dates, and white peaches. Vegetables in this class include cauliflower, mushrooms, garlic, onions, parsnips, turnips, white-fleshed potatoes, and white corn.
Picture your last meal: How did it stack up color-wise? Was the produce mainly one color, two colors, or three or more? By adding a variety of colorful fruits and vegetables to your plate, you can amp up the nutrient value of each meal. We should be eating right year round, but if you've been trying to find the right time to make changes, spring is the perfect opportunity to colorize your plate.
For more on personal health, click here.]]>Qnexa: A Magic Bullet for Weight Loss?tag:www.huffingtonpost.com,2012:/theblog//3.13396632012-03-21T11:07:36-04:002012-05-21T05:12:01-04:00Gerard E. Mullin, M.D.http://www.huffingtonpost.com/gerard-e-mullin-md/
In late February, an advisory panel to the Food and Drug Administration (FDA) voted 20 to 2 to recommend that Qnexa be approved for weight loss, which will likely happen in April. Qnexa is expected to facilitate a 10 percent reduction in body weight based upon clinical trials. It's already being predicted that annual sales of the drug could reach $1 billion to $3 billion.
Qnexa is a combination of two appetite-suppressing medications: phentermine and topiramate. Phentermine was previously combined with fenfluramine in the weight loss medication "Fen-Phen," which the FDA removed from the market in 1997 due to an increased risk of drug-induced fatal pulmonary hypertension and valvular heart disease.
Although fenfluramine was clearly the evil twin in that combination, phentermine is also riddled with potential adverse cardiovascular effects, including primary pulmonary, regurgitant cardiac valvular disease, palpitation, tachycardia, and elevated blood pressure. Topiramate was originally an anti-seizure medication that is also used to prevent migraine headaches. It has a number of adverse effects on the central nervous system, including forgetfulness, confusion, and incoherent speech. With risks like these, it should come as no surprise that in 2010, the same FDA advisory panel voted 10 to 6 to reject Qnexa.
So what's changed in just two years?
The drug's adverse effects that concerned the advisory committee in 2010 still remain and no additional safety data about Qnexa have been submitted to the FDA by its manufacturer, Vivus. Panelists did agree that Vivus should conduct additional studies to assess potential heart problems, recommending additional studies be conducted -- after approval.
I believe that the FDA panel probably reversed its opinion on Qnexa in part because of the current lack of medical treatments for obesity, which has reached epidemic levels. The only drug approved for the long-term treatment of obesity is Orlistat (Xenical), which blocks the absorption of fat but produces only a 5- to 7-pound weight loss, is riddled with unpleasant side effects (smelly stools, flatulence), and can potentially produce a whole host of nutritional deficiencies.
Qnexa might seem like a better option, but is it? We just don't know enough about its potential risks to say for sure whether this drug will be any safer than Fen-Phen or other pharmaceuticals.
A Better Way to Weight Loss
It's tempting to look for a quick fix for weight loss, but I believe that the best approach remains a sensible program of proper nutrition, exercise, and behavioral modification. We know that programs that combine this traditional approach to weight loss are successful, cost less than invasive procedures and pharmaceuticals, and are certainly less risky.
Unfortunately, many people are following the exact type of opposite lifestyle. We are becoming less physically active as a nation: In 1990, nearly 60 percent of the U.S. adult population reported little or no leisure-time physical activity. (1) By 2007, 78 percent of Americans weren't meeting basic activity level recommendations, while 25 percent were completely sedentary.
Another issue is our Standard American Diet, which promotes the over-consumption of poor-quality, calorie-rich fast foods that are addictive in taste and light on the wallet. Americans consume an average of less than one serving a day of whole grains, compared to nine servings of refined grains. Fresh vegetable consumption in the U.S. has declined by nine pounds per person over the past 10 years. Sweetener consumption is nearly tripledietary targets.
Americans are also eating more meals away than ever before, spending 47.5 percent percent of their food budget on meals outside of the home. Eating out can be convenient, but it's also caloric -- portions in restaurants just keep growing! Plus, foods eaten away from the home tend to be higher in fat. Just one additional meal away from home each week translates to roughly two extra pounds each year.
Our government also plays a role in obesity. The present farm bill legislation subsidizes farmers who grow corn, soy, and wheat, which provide raw material for highly processed, nutrient-empty foods. Unfortunately, subsidies make these less-healthy foods more economical, and therefore more attractive to many consumers. In the long run, however, these foods actually raise costs by promoting obesity. (2)
Obesity is a complex socioeconomic disease that is perpetuated by misguided food politics. They say it takes a village to raise a child -- and it takes a whole community to fight obesity, too. We can begin to stem the tide by passing legislation that makes whole foods affordable rather than subsidizing fast food commodities. We also need to encourage a slow but safe lifestyle transformation: Good nutrition, physical activity, mindful eating, and behavior modification should become first-line measures rather than risky quick fixes like pharmaceuticals. These medical interventions have become the proverbial finger in the dike and do not address the root cause of the obesity epidemic.
Desperate matters require drastic measures. Medical interventions have been lifesaving for many people and do have their place for those with severe obesity who have failed dietary and lifestyle interventions. That said, I still have many questions about the safety of Qnexa, regardless of its effectiveness. Do the potential risks outweigh the potential benefits? The jury is still out.
Yours in health and wellness,
Gerard E. Mullin, M.D.
REFERENCES:
(1) Siegel PZ BR, Frazier EL, et al. . Behavioral Risk Factor Surveillance, 1986-1990. MMWR 1991;1(40 (SS-4)):1-23.
For more on personal health, click here.]]>The Crucial Test That Can Save Your Lifetag:www.huffingtonpost.com,2012:/theblog//3.13183042012-03-09T16:30:12-05:002012-05-09T05:12:02-04:00Gerard E. Mullin, M.D.http://www.huffingtonpost.com/gerard-e-mullin-md/
colon cancer, which had already spread to her liver. She did not have a family history or other obvious risk factors for colorectal cancer, a disease that can strike without warning.
March is Colorectal Cancer Awareness Month, which gives me an excellent opportunity to remind you about the importance of prevention, as well as of colonoscopy, a test that can literally save your life.
Colorectal cancer (also called colon cancer or large bowel cancer) is the growth of cancerous cells in the colon, rectum and the appendix. It is the most common cancer of the digestive organs, accounting for more than 50 percent of all cases of cancer in the digestive tract. Cancers of the digestive system account for almost 25 percent of annual cancer fatalities in the United States.
Who is at risk for colorectal cancer? The following factors play a role:
Age. Colorectal cancer affects both men and women of all races and ethnicities. The risk of colorectal cancer begins at increase at age 40 but the disease is typically found in people age 50 or older. In fact, 90 percent of those who develop colorectal cancer are over the age of 50.
Race. African Americans have a greater risk of colorectal cancer than do people of other races.
Personal or family history of colorectal cancer and adenomatous polyposis of the colon. Approximately 25 percent of all colorectal cancers have a genetic component, while about 75 percent of cases are sporadic, or non-inherited.
Personal history of inflammatory bowel disease. Both Crohn's disease of the colon and ulcerative colitis increase the risk of developing colorectal cancer.
Genetic colorectal cancer syndromes. These syndromes include familial adenomatous polyposis (1 to 2 percent of cases) and hereditary nonpolyposis colorectal cancer (3 to 5 percent), which is also known as Lynch syndrome. People who have an inheritable syndrome develop colorectal cancer at a much younger age than the general population.
Radiation therapy for cancer. While there currently isn't conclusive evidence proving this potential risk factor, some previous studies have suggested that radiation therapy directed at the abdomen to treat other cancers may increase the risk of colorectal cancer.
While colorectal cancer is the third most common cancer in Europe and the United States, it is considered rare in both Africa and Asia (barring Westernized Japan). Why is it more common in the West? Diet and lifestyle differences play an important role. There are seven behavioral risk factors that have been consistently correlated with an increase in colorectal cancer. These are:
Fortunately, there's much you can do to prevent colorectal cancer. Good nutrition and physical activity play an important role in preventing colorectal cancer. Aim for at least 30 to 45 minutes of moderate-to-vigorous activity on most days of the week. The following nutritional factors have also been shown to help prevent colorectal cancer:
Increase your fruit and vegetable intake. Favor cruciferous vegetables such as broccoli and cauliflower. Cruciferous vegetables are high in fiber and contain chemicals such as indole 3-carbinol and crambene that rev up our detoxification system while protecting our cells against the damaging effects of oxygen free radicals. Fruits and vegetables contain cancer-fighting phytochemicals and vitamins.
Lower your intake of red and processed meats, and consider increasing your intake of fish. Women who eat at least three servings of fish per week have been found to be at lower risk for developing precancerous adenomatous polyps of the colon.
Consider using soy as a protein source. Soy isoflavones have many biological properties that appear to protect against colorectal cancer.[3]
Supplement with calcium. Researchers have found that increased consumption of calcium in women is related to a lower risk of colorectal cancer and recurrent colorectal adenomas.[4][5]
Maintain adequate levels of vitamin D. Studies have shown that inadequate levels (25 hydroxyvitamin D< 25 ng/mL) of vitamin D place you at a higher risk for developing colorectal cancer, while adequate levels are protective. Have your doctor check your vitamin D levels. Exposure to sunlight, milk products, salmon and vitamin supplements can all help boost vitamin D.
Consider a multivitamin/multi-mineral supplement. Vitamins such as A, B6, C, E and folic acid (no more than 400 micrograms), as well as the mineral selenium, have been shown to protect against colorectal cancer.[6][7][8]
Fiber up! Multiple studies show that a diet abundant in fiber protects against colorectal cancer. Eating three servings of whole grains per day has found to reduce the risk of colorectal cancer. Aim for the minimum U.S. dietary reference intake of 25 grams of fiber a day.
Spice up your food. Curcumin is a cancer-fighting nutrient derived from the spice turmeric, which is often used in curry. Research has shown that curcumin may help prevent colorectal cancer.
Early Detection Makes a Difference
The New York Times may have called it "the most unloved cancer screening test," but colonoscopy can save lives, as new research demonstrates: The study, published in the New England Journal of Medicine (NEJM), found that people who had adenomatous polyps identified and removed during a colonoscopy were 53 percent less likely to die from colorectal cancer than those who didn't have the test. That's strong evidence of what many doctors have long suspected: Colonoscopy is vitally important.
Today, colonoscopies are more mainstream -- and media-friendly -- than ever. News anchor Katie Couric underwent a colonoscopy screening on live TV; Ozzy and Sharon Osbourne (a colorectal cancer survivor) teamed up with CBS Cares Colonoscopy Sweepstakes to promote a three-day trip to N.Y. and a free colonoscopy; and Dr. Mehmet Oz brought attention to colonoscopy when he himself had a cancer scare. Such public discussion of a very private issue is raising awareness among millions of Americans in the hope of saving lives.
I want to add to that discussion here by emphasizing how important, effective, safe and valuable colonoscopy is as a screening tool. It's been estimated that more than 50,000 people die each year from colorectal cancer -- but no one should be dying from it, due to the easy access of a colonoscopy procedure, which is covered by most insurance companies. "Many people dislike having the procedure," write the researchers of the NEJM study. "However, a colonoscopy doesn't have to be completed each year." If no polyps are found, you need a colonoscopy just once every 10 years.
Screening for average risk individuals begins at age 50, though studies suggest that African-Americans should begin at age 45. The advice varies for those in higher risk groups:
People with a sibling, parent or child with colorectal cancer or an adenomatous polyp diagnosed at younger than age 60 or with two first-degree relatives diagnosed with colorectal cancer at any age should have a colonoscopy starting at age 40, or 10 years younger than the earliest diagnosis in their family, whichever comes first.
If you have a history of adenomas with advanced tissue histology or if your doctor has diagnosed you with more than three polyps during an exam, you should have your first follow-up colonoscopy in three years. Patients with one or two small adenomas should have their follow-up colonoscopy in five years.
If you have a strong family history of colorectal cancer -- especially if the cancers occurred before age 40 -- you should consider genetic testing for hereditary non-polyposis colorectal cancer and undergo a colonoscopy starting at age 20 or 25, or 10 years earlier than the youngest age of colorectal cancer in the family, whichever comes first.
Individuals with inflammatory bowel disease should undergo a colonoscopy beginning eight to 10 years from the time of diagnosis or at age 50, whichever occurs first.
Colorectal Cancer: Catch It Before It Catches You!
[1] Boyle P, Ferlay J. "Cancer incidence and mortality in Europe, 2004." Ann Oncol 2005;16(3):481-8.
[2] Rennert G. "Prevention and early detection of colorectal cancer--new horizons. Recent results in cancer research." Fortschritte der Krebsforschung 2007;174:179-87.
[3] Adams KF; Lampe PD; Newton KM, et.al.; "Soy protein containing isoflavones does not decrease colorectal epithelial cell proliferation in a randomized controlled trial".American Journal of Clinical Nutrition, 2005 Sep; 82 (3): 620-6
[4] Flood A, Peters U, Chatterjee N, Lacey JV, Jr., Schairer C, Schatzkin A. "Calcium from diet and supplements is associated with reduced risk of colorectal cancer in a prospective cohort of women." Cancer Epidemiol Biomarkers Prev 2005;14(1):126-32.
[5] Baron JA, Beach M, Mandel JS, et al. "Calcium supplements for the prevention of colorectal adenomas." Calcium Polyp Prevention Study Group. The New England journal of medicine 1999;340(2):101-7.
[6] Wei EK, Giovannucci E, Selhub J, Fuchs CS, Hankinson SE, Ma J. "Plasma vitamin B6 and the risk of colorectal cancer and adenoma in women." Journal of the National Cancer Institute 2005;97(9):684-92.
[7] Kim YI. "Folate and colorectal cancer: an evidence-based critical review." Molecular nutrition & food research 2007;51(3):267-92.
[8] Jacobs ET, Jiang R, Alberts DS, et al. "Selenium and colorectal adenoma: results of a pooled analysis." Journal of the National Cancer Institute 2004;96(22):1669-75.]]>New Year, New Diet Confusiontag:www.huffingtonpost.com,2012:/theblog//3.12325652012-01-27T15:52:44-05:002012-03-28T05:12:02-04:00Gerard E. Mullin, M.D.http://www.huffingtonpost.com/gerard-e-mullin-md/Journal of the American Medical Association most likely set you in a tailspin. Researchers led by Dr. George A. Bray of the Pennington Biomedical Research Center in Baton Rouge, Louisiana, conducted a study to determine whether a person's level of dietary protein independently affects body composition, weight gain or energy expenditure under highly regulated conditions.[1] The trial was carried out according to the highest scientific standards and included 25 healthy American adults. After the subjects followed matching, calorie-controlled diets for two to four weeks, they were randomized to receive diets that contained an additional 40 percent energy (954 calories) as either 5 percent of energy from protein (low protein), 15 percent (normal protein), or 25 percent (high protein) for another eight weeks.
People who consumed the low-protein diet gained less weight (6.97 lbs) than those who consumed a normal-protein diet (13.3 lbs) or high-protein diet (14.4 lbs). Lean body mass decreased during the overeating period by 1.5 lbs (0.70 kg) in the low-protein diet group, compared with a gain of 6.3 lbs (2.87 kg) in the normal-protein diet group and of 7 lbs (3.18 kg) in the high-protein diet group.
Here is my take on the researchers' findings: In this study, calories alone, and not protein, appeared to contribute to an increase in body fat. In other words, overeating leads to weight gain and increased body fat -- plain and simple. But not so fast! Diets higher in protein lead to more lean muscle mass. The higher a person's protein intake, the more lean body weight they gain. Likewise, the higher a person's protein intake, the higher their energy expenditure, because they gain more metabolically active, fat-burning muscle mass. This means that, if you are healthy and active, eating more protein than fat or carbohydrates is more likely to help you gain more muscle mass. Putting on more muscle mass is far healthier than putting on body fat -- but only if you are also physically active.
In the study by Bray and colleagues, the low-protein group didn't gain as much weight as the other groups, but this isn't necessarily a benefit. In fact, they lost 1.5 lbs of muscle mass while gaining weight as fat. The diet in the low-protein group was similar to the Standard American Diet (SAD), which is low in protein and high in unhealthy saturated fats.
The highest-protein diet might have added some muscle mass, but unfortunately it also added the highest amount (7 lbs) of non-lean body weight and 14 lbs total in only eight weeks, which is very unhealthy! The highest-protein diet in this study by Bray et al was also similar to the eating plan promoted by the French physician Dr. Pierre Dukan in his best-selling book The Dukan Diet. The Dukan diet is a low-carbohydrate, high-protein diet that promotes rapid weight loss by forcing the body to burn fat instead of carbohydrates. Many nutrition experts have warned about its potential hazards. For starters, the book warns that dieters may suffer from bad breath, constipation, dry mouth and fatigue -- all consequences of low carbohydrate-high protein diets. High-protein diets can stress your kidneys and, over the long term, lead to kidney damage, osteoporosis, gallstones and ketoacidosis, an unhealthy buildup of ketone bodies in the bloodstream. And remember, not all proteins are healthy. For example, red and processed meats are high in protein but are laden with saturated fats that are associated with a higher risk of several malignancies, such as colorectal and pancreatic cancer. Finally, a recent report by U.S. News and World Report ranked the Dukan Diet at the bottom of 25 top diets.
So, although the high-protein diet helped people in the study add muscle mass, it may not have done so in a healthy way. And, while people on the low-protein diet didn't gain as much weight as those in the other diet groups, they followed an eating plan that replicated many of the unhealthy food choices found in the SAD. This study was grounded in good scientific principles, but its results may only serve to further muddy the advice we give to people who need to lose weight and keep it off. And -- with nearly 35 percent of adults in the United States categorized as overweight, and an additional 33.9 percent as obese -- that's a problem. In fact, reports indicate that 41 percent of Americans are on a diet at any point in time for weight control. It's no wonder that so many of them struggle to find and understand dietary advice.
My own recommendation to those in search of the optimal diet is to consume about 15 percent of your total calories as protein (the same amount of protein found in the study's "normal-protein" diet), which should help you gain muscle mass without gaining significant amounts of weight overall, and without stressing your kidneys. When you do find yourself overeating (at a party or holiday celebration, for example), try to choose foods that are higher in lean protein, such as turkey and wild-caught fish, rather than those that are high in unhealthy fats, like dips and potato chips. (For more information on healthy food choices, see my New Year's blog.)
Weight management is an everyday struggle for many Americans and there is an abundance of quick-fix gimmicky diets on the market. When in doubt, seek consultation with a certified nutritionist, and consider programs and weight management centers that offer a personalized approach to your weight control. Finally, in addition to dietary changes, I recommend seeking out alternative therapies that have demonstrated benefit for weight control, such as behavioral therapy, dietary supplements such as green tea, acupuncture and mindfulness.
Yours in good health.
Gerard E. Mullin MD
References:
[1] George A. Bray, et. al. "Effect of Dietary Protein Content on Weight Gain, Energy Expenditure, and Body Composition During Overeating: A Randomized Controlled Trial." JAMA. 2012; 307(1): 47-55.
For more on new research, click here.
]]>Your Good Gut Guide to a Healthy New Yeartag:www.huffingtonpost.com,2011:/theblog//3.11582842011-12-31T15:43:27-05:002012-03-01T05:12:01-05:00Gerard E. Mullin, M.D.http://www.huffingtonpost.com/gerard-e-mullin-md/ 1. Manage stress. It's near impossible to eliminate stress from our lives: From busy work schedules, to family obligations, to financial worries, sources of stress and anxiety are everywhere. There's a solid connection between stress and illness: Stress promotes higher cortisol levels, which have been linked to weight gain. And stress can also play a huge role in many digestive problems, particularly GERD and IBS. Research shows that anxiety, depression and stress provoke symptoms in up to 60 percent of people with IBS, and that stress management tools such as deep breathing, relaxation and hypnosis are helpful. Likewise, GERD has been linked to underlying anxiety and stress is clearly associated with worsened symptomatology. These are reasons to be more cautious of managing stress if you have GERD and or IBS.
First, be realistic about what you can accomplish, rather than being overambitious with your schedule. Consider scheduling time for a massage, a hot bath with lavender oil and soothing music, or perhaps just a long walk while stargazing or some quiet time watching a movie or reading a book. And try to fit in seven to eight hours of sleep every night. Sleep is necessary to help combat stress, boost energy and regulate appetite.
2. Eat in moderation. Perhaps the most challenging resolution for many people is making healthy food choices while avoiding splurges that pack on the pounds and cause digestive symptoms to flare. First, keep balance, variety and moderation in your eating habits. Take your time and try not to eat too fast: Slowing down and eating more mindfully helps prevent overeating. You will feel full much sooner than if you will if you race through your meals. Remember, it takes your brain 20 minutes to realize that your stomach is full. Don't bring unhealthy food into your home and -- if you do indulge in occasional snacks or sweets -- put one serving on a napkin and leave the box or bag of treats in the pantry. If the food is out of sight, it is more likely to be out of mind.
And you can make healthy food choices while still enjoying a delicious meal. Select fresh vegetables and low-fat dips before a meal, and offer fresh fruit as part of your dessert. The combination of high-fat and acidic foods (pizza, lasagna, meatballs, fajitas) is particularly notorious for aggravating heartburn. Favor lean protein sources such as turkey, which also is high in tryptophan, an amino acid that helps combat anxiety and depression. Berries are high in antioxidants and don't cause excessive spikes in blood sugar. When cooking, think about using spices that help calm the gut and aid digestion such as ginger, fennel and mint.
Think about eating nuts as a snack instead of sweets, particularly if you have IBS: Sweets can cause gas and trigger IBS symptoms. If you're worried about the high fat content of nuts, don't be. Yes, they are rich in calories, but they increase your sense of fullness rather easily. In fact, women who consume two or more handfuls of nuts per week have a slightly lower risk of obesity than those who eat nuts less frequently or not at all, according to findings from the long-running Nurses' Health Study at the Harvard School of Public Health. When it comes to dessert, choose dark chocolate for its cardioprotective and mood-enhancing benefits. Try to limit alcoholic drinks, which are calorie rich and stress the gut, and keep hydrated with water or club soda with a twist of lemon or lime instead. Choose gut-calming herbal teas (i.e. chamomile) after dinner over caffeinated beverages, which can exacerbate IBS and GERD symptoms. Balancing your food intake will help you stay more in control of your digestion.
3. Exercise. It's easy to cut back on exercise when you're busy. However, getting physical activity will not only help shed the pounds you may have gained over the holidays, but it can also help moderate stress and boost mood, which help combat IBS and GERD. You don't need to wait until the weather improves. Many join a gym as a new year's resolution only to stop going after a few weeks. Wintertime activities include skating, sledding, skiing, walking in the mall or outdoors, dancing and working out in a gym or at an exercise class. Bundle up and take a walk around the neighborhood and you'll burn 324 calories in an hour. So choose some activities that you enjoy and get moving. Try to maintain a set schedule for exercise to help boost your metabolism, mood and energy.
I hope that these health tips help you ring in the new year in good gut health.
]]>10 Tips For Combating Irregularitytag:www.huffingtonpost.com,2011:/theblog//3.9277352011-08-22T07:51:33-04:002011-10-22T05:12:02-04:00Gerard E. Mullin, M.D.http://www.huffingtonpost.com/gerard-e-mullin-md/Constipation, according to the National Digestive Diseases Information Clearinghouse, means having fewer than three bowel movements per week. A panel of international experts cites difficulty during defecation (straining during more than 25 percent of bowel movements or having the sensation of hard stools), and the sensation of incomplete bowel evacuation as other symptoms of the problem.
If you've struggled with constipation, you're not alone: Studies estimate that constipation affects between 12 and 19 percent of Americans and 63 million people in North America. There are many reasons for developing constipation; however, in most cases there's no single, identifiable cause. As a specialist, I try to first look for "medical" causes for constipation, such as hormone imbalances (hypothyroidism), medications (diuretics, beta-blockers, antidepressants, etc.), concurrent medical illnesses (diabetes), poor bowel habits (erratic timing), structural (colorectal cancer) or functional (pelvic floor dysfunction) issues and habitual use of certain laxatives (senna). However, in my practice, diet (low fiber) and lifestyle issues (lack of exercise, stress) are the most common reasons for constipation. I find that the vast majority of patients that I see in consultation improve when they make a few lifestyle modifications.
If you have trouble with constipation, be sure to ask your physician for a colonoscopy to screen for colorectal cancer by the age of 50. In addition, try these tips:
]]>From Pyramid to Plate: How Healthy is the New USDA Nutrition Icon?tag:www.huffingtonpost.com,2011:/theblog//3.9001842011-07-25T15:55:10-04:002011-09-24T05:12:01-04:00Gerard E. Mullin, M.D.http://www.huffingtonpost.com/gerard-e-mullin-md/
Take Anthony, who came to see me in consultation for improved management of his indigestion. Anthony had been eating a steady diet of high-calorie fast foods but had been able to keep his symptoms at bay with medications until recently. We quickly went to work on his diet to provide him some relief. Of course, Anthony was aware that he should cut back on the cheeseburgers and fries. But when it came to making less obvious food choices, he -- like many Americans -- was in the dark.
The Internet has made nutrition information more accessible, but not necessarily more helpful -- even when that information comes from respected sources. Take the U.S. Department of Agriculture's food pyramid: Although some of the information it contains was updated in 2005 (and renamed "MyPyramid"), much of the advice hasn't changed since it was created in 1992. For years, I have received sharp criticism from patients (including Anthony) who have attempted to navigate the pyramid's website for wholesome eating tips. In 1992, the pyramid icon was considered advanced because it promoted physical activity, but its shortcomings stem from its failure to deliver on personalization and portion control. Today, the USDA pyramid is a dinosaur in the ever-evolving field of nutrition.
What's on Your Plate?
All that changed in June, when First Lady Michelle Obama introduced the USDA's MyPlate. The project, including the website (www.choosemyplate.gov) and related educational materials, cost about $2 million, which I think is money well spent. The archaic pyramid has been replaced with a round plate that is divided into four sections of foods -- fruit, vegetables, grains and proteins -- with dairy separated into a "beverage" section. The interactive MyPlate website is full of useful tools: Visitors can click on any section of the plate for information about that food group, including suggested portion sizes. To the left of the plate is a menu that links to a daily meal planner with calorie information and a food tracker.
Although the new website is easy to navigate and the plate icon provides some key improvements over the previous pyramid, there's still room for improvement. Here's my take on the plate:
• Visually appealing. A colorful plate is easier to understand than a pyramid.
• Portion control. MyPlate instills a sense of food group balance and illustrates the proportions of each food group. As Mrs. Obama has said, "Parents don't have the time to measure out exactly three ounces of chicken or to look up how much rice or broccoli is in a serving. But we do have time to take a look at our kids' plates."
• Emphasis on fruits and vegetables. These low-calorie foods are loaded with protective vitamins, minerals, and fiber, but most Americans don't eat nearly enough. The present recommendation for daily fiber intake is 20 to 35 grams per day, while the average American consumes just 15 grams of fiber daily. Produce now represents one-half of MyPlate -- but we still need to make smart choices within those groups. Avoid processed foods such as french fries and mashed potatoes. Instead, opt for dark leafy greens and cruciferous vegetables such as broccoli, cabbage and cauliflower, and bright orange produce like carrots and squash, which are rich in disease-fighting phytochemicals.
• Restriction of grains. Most Americans eat far too many refined grains. According to the USDA, US adults consume an average of 6.7 servings of grain products per day -- but just one serving of that is whole grains. Another USDA survey shows that only 7 percent of Americans are eating the recommended amount of three daily servings of whole grains. MyPlate does well by limiting all grains to just a bit more than one-quarter of the plate. Unfortunately, MyPlate doesn't emphasize whole grains, which are more nutritious. The body digests fiber-rich whole grains such as brown rice slowly, preventing elevations in blood sugar and insulin. Processed grains like white bread and pasta digest much more quickly, causing spikes in blood sugar and insulin levels that may lead to rapid fat accumulation. When it comes to grains, the vast majority in your diet should be whole grains.
• More varieties of protein. Overall, protein makes up just under one-quarter of MyPlate, replacing MyPyramid's meat section and encouraging varied sources of protein such as beans, fish, nuts, seeds, and plants. However, MyPlate could do a better job of steering consumers away from animal sources of protein such as red meat, which may be a risk factor for a number of diseases, including colorectal and prostate cancer. I recommend incorporating a variety of protein sources in your diet, especially vegetarian sources (lentils, beans) that include disease-fighting fiber and phytonutrients. I also favor wild fish (Pacific salmon) that contains healthy fats and, occasionally, organic grass-fed lean meats and antibiotic-free animal products.
• Too much dairy. MyPlate recommends consuming dairy products with each meal, something that may not be possible for many people, since 30 to 50 million Americans are lactose intolerant and millions more have milk allergies.
• Not specific enough. MyPlate does warn the public about consuming empty calories, high-sodium foods and sugary drinks in the fine print, but fails to provide guidance on which foods from each food group are healthy to eat and which are not.
Overall, the MyPlate food guidelines are a vast improvement over MyPyramid. While there are still areas that could use revision, coloring the plate with the right amounts of healthy fruits, vegetables and whole grains is the ticket to good health. Anthony found it to be a good resource for healthy eating on his journey to healing -- and I hope you will, too.
]]>5 Natural Remedies For IBStag:www.huffingtonpost.com,2011:/theblog//3.8864212011-06-29T08:24:49-04:002011-08-29T05:12:01-04:00Gerard E. Mullin, M.D.http://www.huffingtonpost.com/gerard-e-mullin-md/
Our bowel habits usually aren't cocktail party fodder, but some gastrointestinal problems are so common that several of your fellow partygoers are likely to suffer from one of them. Take irritable bowel syndrome (IBS), for example: This condition -- which affects an estimated 15 percent of Americans -- can cause uncomfortable changes in bowel habits, including diarrhea, chronic constipation or a combination of both. People with IBS may also experience bloating, gas and intense abdominal pain. No wonder no one wants to talk about it.
Living with IBS can be frustrating, especially if you rely on conventional measures to treat it. The condition can have a devastating impact on your happiness, your relationships and even your career. In fact, IBS is one of the leading causes of absenteeism from the workplace. True, some prescription drugs (such as rifaximin for gas and bloating, tricyclic antidepressants and antispasmodics for pain and lubiprostone for constipation) can help improve symptoms. But the Food and Drug Administration has banned or restricted the use of other medications, like Zelnorm (banned) and Alosetron (restricted), because of their potentially harmful effects. So what's a person with IBS to do?
Mother Really Does Know Best
Before I share with you my recommendations for easing IBS symptoms, I'd like to tell you about my mother. She's the reason, after all, that I became a gastroenterologist and developed an interest in complementary and alternative therapies in the first place.
You see, when I was in my high school, my mother suffered from IBS. Together, she and I went from doctor to doctor, looking for ways to treat the extraordinary pain that this condition caused her. The results were disappointing, to say the least. But my mother was a courageous and intelligent woman. So she began researching complementary and alternative therapeutic approaches to treating her gut problems -- reading books and magazines on natural healing, listening to radio shows on the subject: You name it, she learned about it.
Her healing became a team effort. So what happened? Six months after she began this treatment protocol, mom was a new woman. Her friends and family were amazed at how quickly her symptoms had eased -- and so was I. When I later became a physician, I began to incorporate complementary and alternative therapies into my own practice. The results have been impressive.
My Top Five Natural Remedies for IBS
When it comes to seeking relief from IBS, my mother wasn't alone: People with IBS are usually willing to try anything to improve their symptoms, and about 50 percent experiment with complementary and alternative approaches as a result. While not every natural therapy can treat IBS, research suggests that several can help ease symptoms -- in some cases, more effectively and more safely than conventional medications. Here's what I recommend to keep IBS at bay. Try one or more of these approaches to see what works for you:
As my mother knew only too well, managing IBS can be challenging. With some crucial lifestyle changes and a few key supplements, though, you can improve your symptoms and start on the path back to good gut health.]]>