Fish Consumption and Reduction of Risk of Developing Breast Cancer

Fish v2MedPage, the online medical journal of the University of Pennsylvania School Of Medicine reviewed an article published in the British Medical Journal concerning a relationship between consumption of marine fish oil from fish and a reduction in the risk of developing breast cancer. The study was published by Duo Li, MD, a professor of nutrition at Zhejiang University in Hangzhou, China. They reviewed data from 21 “prospective cohort studies involving nearly 900,000 people”. According to their data, eating just one or two portions a week of salmon, sardines, mackerel or other fish rich in marine n-3 polyunsaturated fatty acids is associated with a 1 % reduced risk of breast cancer in later life. Their data came from questionnaires that asked about patients’ intake of fatty acids and from blood levels measured in several studies. When they looked at similar fatty acids which come from plants not fish, such as alpha linoleic acid, they could not see a similar protective effect.

The study was critiqued by Alice H Lichtenstein, DSc, director for the cardiovascular nutrition lab at Tufts University. She had numerous questions and concerns about the methodology and conclusions but did support the need for future prospective studies to examine this question. While I have neither the credentials nor experience of Dr. Lichtenstein in evaluating this type of data I believe strongly in the KISS (keep it simple stupid) principle. Fleshy fish provides fish oils which are felt to be beneficial to our health. The same cannot be said for fish oils which you receive in pills and preparations.

My advice is to eat fish two or three times per week. Prepare it simply in a Mediterranean diet style and obtain the benefits that research seems to consistently show for this eating pattern.

Exercise May Protect Against Memory Loss of Aging

Senior Citizens, exercise v2Dorothy Edwards, PhD of the University of Wisconsin in Madison and colleagues presented a study at the Alzheimer’s Association International Conference this week that implies that physical exercise and activity slows down or prevents age related memory loss in patients considered high risk for developing Alzheimer’s disease or Minimal Cognitive Impairment. The data was presented in the University of Pennsylvania’s School of Medicine on line journal MedPage.

The study showed that the brain hippocampus was more resistant to the memory loss effects of aging in a population that had first degree relatives with dementia and who exercised aggressively. Past research has shown that physical exercise stimulates “neurogenesis “in the hippocampus.

Maria Carrillo, PhD, vice president of medical and scientific relations at the Alzheimer’s Association said, “We already know that exercise is important in terms of all sorts of health measures. Now it appears that over time, it also had benefits in preserving memory and other aspects of cognition, even in high risk people.”

The study of 317 patients is one more supporting piece of evidence that should be encouraging us all to get out and walk, cycle, swim, run and participate in whatever physical activities we find enjoyable to do. The health benefits are too important to ignore.

Women and Cardiovascular Disease – There is A Difference Between Men and Women

Front view of woman holding seedlingThe American Society of Preventive Cardiology presented an educational seminar recently in Boca Raton, Florida to educate physicians, nurses and health care providers that cardiovascular disease in women can be very different than in men.  Failure to recognize these differences has resulted in women being under diagnosed, under treated and suffering worse outcomes.

The difference is first noticeable in pregnancy when the development of elevated blood pressure, super elevation of lipids and the development of gestational diabetes predispose young mothers to earlier, more serious, cardiovascular risk later in life. The faculty noted that women of child bearing age tend to use their obstetrician as their primary care doctor.  They suggested that women with pregnancy related diabetes, hypertension and lipid abnormalities should be referred to a medical doctor knowledgeable in preventive cardiology, post-delivery, for ongoing care.

For reasons that are unclear, women are less likely to be treated to recommended guidelines for lipids, diabetes and hypertension.  Diabetic women have a far worse prognosis with regard to cardiovascular disease as compared to men. They are less likely to be treated with aspirin, which while not as effective in preventing MI in women, is apparently protective against stroke.

Women about to have a heart attack have different symptoms the weeks, to months, before the event. They are more likely to have sleep disturbances, unexplained fatigue, weakness and shortness of breath than the standard exertional angina seen in men.   When they do have a heart attack they are as likely to have shortness of breath and upper abdominal fullness and heartburn as they are to have chest pain. They are more likely to have neck and back pain with nausea than men are.  

Since women have different symptoms than men they are more likely to be sent home from the emergency room without treatment.  They are less likely to have bypass surgery than men, less likely to be treated with the anticoagulants and antiplatelet medications that men are treated with and, they are less likely to be taken to the catheterization lab for diagnosis and intervention as compared to men.

The faculty was comprised of world-class researchers, clinicians and educators who happened to be outstanding speakers as well, bringing a vital message to our community.  They pointed out the different questions and diagnostic tests we should be considering in evaluating a woman as opposed to a man.

This was my first educational seminar through the American College of Preventive Cardiology and I thank them for the message they delivered to the medical and nursing community at probably one of the finest seminars I have had the privilege to attend.

Flu Shots Are Coming

ShotWe recently ordered our influenza prevention vaccine. The official public health kickoff to the influenza 2013 prevention campaign is September 1, but in order to have an adequate supply you have to order it long in advance. Once again the price per dose has increased. Once again we will be competing with Walgreens, and CVS and every country club association for the right to immunize you against a potential lethal but preventable disease. I would prefer that all my adult patients receive the flu shot and I do not care where you get it. Yes I would like to administer enough vaccine to cover my costs but the most important aspect of the flu shot campaign is to vaccinate as many people and protect as many patients as you can.

What’s different about the flu shot campaign this year? Jennie McCarthy, the beautiful and outspoken ex–Playboy playmate and well known almost evangelical opponent of vaccination programs, has now been given a pulpit on the television show “The View.” Her anti-vaccine opinion will certainly be heard loud and clear as the local public health departments get out the word to get your shot. There is a new egg free vaccine for adults 18- 49 years old with a history of severe allergy to eggs. Flublok or RIV3 is not grown in eggs but is made through recombinant DNA technology especially for individuals with egg allergy. I have no information on pricing or availability of the RIV3 vaccine yet but it will be administered to individuals with documented severe egg allergies not just anyone. At the current time any patients in the practice who require RIV3 or Flublok will be referred to a center that stocks it.

The other piece of new but positive news is that a study by Roger Baxter, MD of the Kaiser Permanente Vaccine Study Center in Oakland, California and published in the online version of the Journal of Clinical infectious Disease showed that there is no relationship between the administration of inactivated influenza vaccine and the development of Guillan-Barrre’ Syndrome ( GBS). The study originated after the 1976 vaccination against the Swine Flu virus was found to increase the risk of GBS. Since then in a review of 32.7 million person-years of follow-up there were 415 cases of GBS. Of those 415 incidents ONLY 25 were associated with vaccination in the previous weeks.

We urge our adult patients especially those with chronic health conditions to get flu shot this season. While you are making your plans for a flu shot make sure you are current on tetanus vaccine, shingles vaccine and pneumovax. Keep in mind our peak local flu season occurs in January and February with most adults requiring two weeks after the vaccine is administered to develop complete immunity.



Should You Reduce Your Salt Intake?

SaltThere has been a resurgence of the controversy over the effect of sodium chloride or salt on blood pressure and disease. The theory is that by reducing salt intake you reduce blood pressure and ultimately reduce cardiovascular risk. That theory was questioned recently by a researcher who suggested that salt reduction had adverse effects on human hormones and lipids which offset the benefit of the blood pressure drop.

The Cochrane Library compiles and analyzes scientific and medical research and reports on what the data really shows. They reviewed 34 studies of salt reduction and its effect on blood pressure which included 3230 participants. They found that a modest reduction in salt intake for four or more weeks resulted in a significant drop in both systolic and diastolic blood pressure in both hypertensive and normotensive patients regardless of their sex or ethnicity. They examined the effects of the salt reduction on hormones and found that there was an increase in plasma rennin activity plus aldosterone and noradrenaline. There was no change in lipid levels. They felt that the drop in blood pressure associated with decreasing your salt intake was not offset by the change in any of these hormone levels.

The authors of the Cochrane Library study concluded that we need to decrease our salt intake. This will likely lower our BP and reduce our risk of heart attack and stroke.  Current recommendations call for us to reduce our salt intake to the 5-6 grams per day level. They suggest cutting it to 3 grams per day.  I will remove the salt shaker from my table and make sure that I advise my patients to do the same.