My 2 Cents

Saturday, May 25, 2013

Friday, May 24, 2013

Fluke or Trend? Calcium vs Heart Disease Part 5

Snap! Ouch! That's from my head doing a double take. All these years, I thought the calcium vs heart disease thing was a conspiracy arranged by one researcher & publication. However, 3 months ago, I stumbled upon some corroborating studies by other researchers in other journals. Even the US Preventive Services Task Force recently came out against low dose calcium (less than 1,000mg/d) in post-menopausal women because they could not find conclusive evidence of benefit in the face of a small risk of harm from kidney stones.

So you can only imagine my surprise when a population-based longitudinal cohort study was published early online yesterday in the Journal of Clinical Endocrinology & Metabolisim in which the authors concluded that both dietary calcium & calcium supplementation up to 1,000mg/d may actually be associated w/lower mortality in women. To arrive at their conclusion, the authors followed 9,033 community-dwelling participants in the Canadian Multicentre Osteoporosis Study for 10 years.

What does this mean for you & me? Is calcium good or not? Is there a specific population or demographic that could benefit more or sustain greater risk? As much as we'd like to be able to simplify complicated studies in to 15 second sound bites, it's not going to happen any time soon. As we gain more & more knowledge, we'll get into a better situation to put the blocks in place. Until then, dietary calcium seems like a safe bet. But as for calcium supplementation, the jury's still out. It could go either way. Stay tuned!

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Thursday, May 23, 2013

Mediterranean Diet vs (Loss of) Memory Part 2

Pop quiz: what's better than a population-based cohort study? A randomized controlled trial! So think back to just 3 weeks ago when a population-based cohort study was published in Neurology concluding that the Mediterranean diet was linked to lower risk of cognitive impairment. But if you'll recall, such studies fall under the rubric of observational trials. As such, the conclusions are only useful in developing hypotheses, as they can't & don't prove cause & effect. For this, you need randomized controlled trials, ideally double-blind. Be that as it may, reach deep into your memory banks from 3 months ago when a randomized control trial (PREDIMED) was published in the New England Journal of Medicine in which the authors demonstrated that the Mediterranean diet plus either extra virgin olive oil or nuts was able to prevent 1st heart attack in high risk patients.

Well, in another analysis of that very same PREDIMED trial published early online this month in the Journal of Neurology, Neurosurgery & Psychiatry, 522 men & women avg 75yo at high risk for vascular disease were randomized to low fat control diet vs Mediterranean diet plus either extra virgin olive oil or mixed nuts and then followed for 6+yrs. Cognitive function was assessed by Folstein's Mini-Mental State Examination (MMSE) and the Clock Drawing Test. The authors concluded that the Mediterranean diet plus either extra virgin olive oil or mixed nuts lead to improved cognitive function compared to typical low fat diet.

Bottom line, I haven't found anything bad associated with the Mediterranean diet, aside from the fact that I can't trademark it and make a profit. Therefore, there's no true commercial or capitalistic motive in promoting it, unlike all the other fad or better known diets out there. So I have nothing to gain by telling you to eat this way but you have everything to gain!

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Tuesday, May 21, 2013

Sex Hormones vs Body Composition: Chicken or Egg?

It's taking me a while to get caught up on my journal reading (which has been described as drinking from a fire hydrant). In the process, I stumbled, not unlike a blind squirrel finding a nut, a cross-sectional, longitudinal study published early online last month in the Journal of Clinical Endocrinology & Metabolism in which the authors concluded that body composition affects hormone levels but not vice versa. Apparently the authors followed 821 men for close to 5yrs after initial measurements of hormone status and body composition via dual energy xray absorptiometry were performed. Because no change in body composition was noted over this period of time, they concluded that body composition affects hormone levels but not the other way around. In other words, they claim that the chicken laid the egg.

Granted, I'm not any where near their level of expertise but I beg to differ. While baseline body composition may affect hormone levels, there's also plenty of evidence that hormone levels will affect body composition. For instance, those men who receive androgen deprivation therapy have a tendency to gain weight, especially central adiposity, while losing muscle mass. Furthermore, a randomized controlled study published 3yrs ago in the same journal showed that supplementing low to borderline low testosterone levels in frail elderly men lead to an increase in lean body mass & decrease in fat mass. In other words, this study suggests that the egg hatched the chicken.

Bottom line, life's complicated and our bodies even more so. It would appear that we can accept ourselves for what we are (body composition affects hormone levels) or we can do something about ourselves if we're not satisfied (hormone levels affect body composition). What you choose to do is obviously up to you. Just remember that this isn't a do it yourself project, if you elect to boost your testosterone level.

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Monday, May 20, 2013

Breast Cancer Genetics: The Role of Your Family Physician Part 2

So now that the furor over Angelina Jolie's disclosure has died down, I thought I'd take a closer look at the US Preventive Services Task Force evidence review published last month in Annals of Internal Medicine in which they concluded that selective estrogen receptor modulators can reduce the risk of breast cancer. However, if you'll recall that there's no such thing as a free lunch, then it shouldn't come as a surprise that use of tamoxifen was associated w/greater risk of thromboembolism & endometrial cancer than raloxifene, albeit tamoxifen reduced breast cancer risk better than raloxifene.

The authors arrived at their conclusions after finding 89 fair-to-good quality trials in which both SERMs reduced risk of invasive breast cancer w/tamoxifen getting the edge over raloxifene but at the cost of the above noted complications. Of note, taking one of two SERMs did not reduce either cancer-specific nor all-cause mortality. On the other hand, both medications lowered the rate of fractures.

So what should you do? Start w/your family doc who should know your medical history & family history. Then use one of several online calculators to determine your risk for breast cancer. Consider genetic testing if your risk is high eneough. And finally ask your doc about chemoprophylaxis vs prophylactic mastectomy if your genes demonstrate high enough risk.

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Sunday, May 19, 2013

Q&A Session at HealthTap.com

What age can u start taking birth control pills?

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Q&A Session at HealthTap.com

I have allergic rhinitis and i am taking muntelukast and zyrtic , nasonex sterimar for almost 3 months , still i have nasal congestion what can i d0?

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Q&A Session at HealthTap.com

My blood pressure has been too low and I've been having daily headaches can I just stop taking toprol xl for a few days to see if my headaches go away?

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Q&A Session at HealthTap.com

Im always feeling Loss of energy and I don't have interest in any work even in sex.

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Q&A Session at HealthTap.com

I had a two foot long bowel movement and like two inches wide. Could something be wrong?

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Q&A Session at HealthTap.com

After taking pyridium for two days.. I still have to pee alot. And with septra when shall i notice a change in my uti. On septra for 7 days. So far 3?

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Q&A Session at HealthTap.com

What happens to my penis when i lose my virginity?

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Q&A Session at HealthTap.com

So my dr cant figure out what to put me on.i need something to put me to sleep that wont make me grogy in the morning but shut my brain off at night?

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Q&A Session at HealthTap.com

My bf fingered me and I just got off my period he used the hand he cum with could I be pregnant?

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Friday, May 17, 2013

Crystal Ball: Diabetes vs All-Cause Mortality

Get out your crystal ball. An analysis of the 679 patient Gargano Mortality Study and the 936 patient Foggia Mortality Study was published earlier online this month in Diabetes Care in which the authors noted that all-cause mortality can be predicted based upon a model that includes age, body mass index, diastolic blood pressure, LDL cholesterol, triglycerides, HDL cholesterol, urine albumin:creatinine ratio, and blood pressure & insulin therapies, with validated accuracy. A web-based online version of this calculator is available. While it may be intuitive, use of this model might assist a patient or family about the appropriateness of any given procedure. Or it might provoke a patient into improving some aspect of his/her life in order to reduce all-cause mortality. Just something to ponder . . .

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Saturday, May 25, 2013

Friday, May 24, 2013

Thursday, May 23, 2013

Tuesday, May 21, 2013

Monday, May 20, 2013

Sunday, May 19, 2013

Friday, May 17, 2013