Increasing Dietary Fiber Decreases Your Stroke Risk

Fruits and vegetables v2Diane Threapleton, MSC, of the University of Leeds, England, and colleagues reported in the online version of Stroke that eating more dietary fiber may modestly reduce your chances of having a stroke. Additional grams of dietary fiber intake was associated with a 7% lower risk of hemorrhagic or ischemic stroke.  She said a 7 gram per day increase in fiber is easy to achieve being the equivalent of two servings of fruit like apples or oranges or an extra serving of beans.

United States guidelines call for the average man to consume 30 – 38 grams of fiber per day while the average women should consume 21-25 grams.  We fall far short of that with the average male consuming only 17 grams of fiber per day and the average woman only 13 grams.

Researchers note that soluble types of fiber form gels in the stomach and bowels, slowing the rate of absorption of foods and slowing gastric emptying. This slowed emptying increases our feelings of being full so we consume less food. They additionally noted “bacterial fermentation of resistant starch and soluble fibers in the large intestine producing short chain fatty acids which inhibit cholesterol synthesis by the liver and lowering serum levels.”

Once again, nutritional common sense prevails. Eating healthy, including more fresh fruits, vegetables and whole grain products results in more fiber ingested and fewer health issues occurring.

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Aspirin Holiday Carries Its Risks

A recent publication in the British Medical Journal looked at the risk of stopping aspirin therapy and taking a drug holiday from it if you are taking aspirin as secondary prevention for heart disease. The study, conducted from 2000 – 2007, looked at almost 40,000 participants aged 50-84 who were taking low dose aspirin (75- 300 mg per day) for secondary prevention of cardiovascular outcomes. They followed the patients for 3.2 years.

Researchers determined that individuals who stopped aspirin for 1-6 months had significantly more myocardial infarctions (heart attacks) and cardiovascular deaths than individuals who continued the aspirin.  Most of the patients who stopped the medication just stopped it on their own for no particular reason.

The study has implications for patients who have known coronary artery disease, have had a heart attack or stent placed or have survived bypass surgery. It says that if you stop the aspirin you increase your risk of having a cardiac event.

As a physician I am always faced with phone calls from patients going for minor dental work and the dentist insists on stopping the aspirin. I have patients going for elective cosmetic procedures who are required to stop their aspirin.  The message must be “is the risk of excessive bleeding from the elective procedure greater than the risk of having a heart attack?”  This is a question you should ask your cardiologist, internist or family physician before stopping the aspirin. You and they will need to ask your dentist or surgeon the same question before you stop the aspirin.

There will be times when you will have no choice but to accept that increased risk to have work done which may be necessary.  By informing your physician of the problem, and discussing it with the surgeon or dentist, we can determine if stopping the aspirin is essential and if there are other measures we can take to prevent a cardiac event.

The Importance of an Annual Physical Exam

I have listened to health economists debate the value of an annual physical exam.  Is it cost effective?  Does it prevent disease?  It doesn’t matter.  It is an essential part of the development and continuation of the doctor patient relationship.

The annual physical exam is a form of benchmarking. It allows the doctor and patient to review all the pertinent aspects of your health history and physical exam and use the data to coordinate a care plan for you which is personalized.

The history of present illness illustrates any immediate and current concerns. The past history reviews previous illness and how those problems may affect your current and future health. A family history presents genetic data which may affect you and your loved ones in the future. It updates your physician on what changes have occurred in your family’s’ health that may affect you. The social history looks at your school and employment history as well as lifestyle choices. Are you working with industrial toxins or in a field prone to certain predictable and preventable disease?  Are you smoking?  How much alcohol is in your diet? Are you partaking in physical exercise?  Are you in a stable relationship?  All these factors influence your health and choices.  Do you have a living will?  Who is your health care surrogate and who are your emergency contacts?  It is a great time to review your allergies and medications both prescription and over the counter vitamins, minerals, herbs and supplements.  Last but not least we look at checkups, vaccinations and immunizations.  Are you current on tetanus shots?  Do you know about pneumonia vaccine and zostavax for shingles?  Have you had your eyes checked for glaucoma?  When did you last see a dentist?  What about skin checks, colonoscopies, mammograms, pap smears and bone densitometry?   The history session ends with a complete review of all your body systems. By asking a laundry list of questions we hope to jog your memory to discuss all those little items you meant to ask about but may have forgotten to bring up.

The physical exam is used to support the hypothesis and answer the questions raised during the history taking session. It should be thorough looking at you from the top of your head to the bottom of your feet without skipping any orifices in between. The findings of the exam, coupled with the history session, will determine which laboratory tests, if any, your doctor will choose to order.  In thirty years of practice, I am rarely surprised by the results of a blood test if I have done a thorough and complete history and exam. Patients seem to feel something magical about lab tests but the truth is that a thorough and experienced clinician usually knows what the findings will be before he orders the test.

The complete exam should be followed by a consultative review session during which the doctor explains the findings of the history, exam and lab and makes suggestions. A care plan should be established at that session and a defined follow-up plan suggested and scheduled.

During your physical exam the doctor is learning a great deal about you. From the way you dress, to the way you carry yourself to your speech pattern; the physician is seeing you while you are healthy. It is much easier to diagnose a problem if you have had the opportunity to see the patient when everything is normal.  This knowledge of your normal appearance is what allows your doctor to find a problem in its initial stages rather than a crisis requiring a visit to a hospital emergency department. It is all part of the concept of longitudinal long term care and relationship.

Find a doctor. Schedule your yearly checkups.  If you find a physician you trust and respect stick with them. It may save your life.

It’s Proven – High Activity Levels Keep Us Healthy and Slim

A recent article in the Journal of the American Medical Association clearly pointed out that those individuals who maintain a high activity level over a twenty year period gain less weight than individuals with a low activity level.  The Association followed 3,554 men and women in Chicago Illinois, Birmingham Alabama, Minneapolis Minnesota and Oakland California over twenty years.  They found that men with a high activity level gained about 12 pounds less than inactive men. The weight difference in women was more profound at 25 pounds.

This study clearly pointed out that the reduction in weight gained was extremely significant as adults entered middle age. The duration of daily exercise required to obtain this benefit was only about thirty minutes. Walking twenty minute miles provided the benefit.

If staying thin and trim isn’t a strong enough incentive to stay active, then avoiding colds and flu is an additional incentive. A recent study cited that individuals who exercised regularly for thirty minutes a day five days a week had fewer colds than sedentary individuals. When they were unlucky enough to catch a cold, the illness was shorter and less intense. The researchers hypothesized that exercise moved the blood and cells responsible for immunity through the system more frequently and this contributed to the protective effect.

There is currently an epidemic of obesity in the United States.  According to the National Health and Nutrition Examination Survey, as published on the Centers for Disease Control and Prevention web site, 73.7% of American adults are either overweight or obese.

  • 34.2% are overweight
  • 33.8% are obese
  • 5.7% are extremely obese

Staying active, making good choices concerning portion size and food groups is all part of the strategy to keep Americans healthier. It is all part of a formula to stay healthy that you should talk to your doctor about annually.

Cold and Flu Season: Prevention / Treatment

Cold (upper respiratory viral infection) and flu season is upon us again   What can you do to prevent a cold?

Studies have shown that increasing your vitamin C intake before developing cold symptoms greatly helps. In the American College of Physicians Guide to Alternative and Complimentary Medicine they cite a series of studies that looked at highly stressed athletic and military personnel residing in cramped quarters in extremely challenging and cold environments. Those who made sure to ingest extra vitamin C by various routes including increasing their fresh fruits and vegetables had fewer colds which were less intense.

Recent studies published in the British Medical Journal and performed at Appalachian State University showed that brisk exercise for thirty minutes a day at least five days a week prevented colds. By mobilizing your immune cells during exercise you tend to stay healthier longer.  Previous studies in pregnant women and older adults confirm the cold fighting benefits of regular exercise.

The flu shot works to prevent influenza.  It is safe, inexpensive and readily available this year.  This year’s seasonal influenza vaccine contains protection against traditional influenza strains and the H1N1 virus. It is recommended in all adults.

If you catch a cold we suggest you try common sense, rest when fatigued, consume extra fluids especially warm fluids such as chicken soup and give thought to trying zinc lozenges.  Zinc lozenges taken every two hours may prevent viral particles from attaching to cell surfaces in mouth, throat and nose and cut the intensity and duration of your infection.  Taking the zinc tablet every two hours for the first twenty four hours is apparently the key.