April 30, 2015

SUPPLEMENTS RIDDLE: Sales Skyrocket as Controversies Intensify

Posts about dietary supplements are the most popular on this blog. Essentially unregulated, supplements represent a gigantic business in America. Together, vitamins and supplements generated nearly $25B – BILLION – in sales during 2013.

This graph from Euromonitor International shows 2013 U.S. sales via the blue bars with dollar figures at left. The orange dots represent percentages -- shown at right -- of projected sales growth between 2013 and 2018. (Example: protein supplements show greatest sales growth potential, about 18%.)

This next graph (same source) shows the specific health issues for which Americans bought supplements in 2013:

April 29, 2015

Want to Reach and Maintain a Healthy Weight? Track Glycemic Load, not Calories

If you’re interested in achieving or maintaining a healthy weight, a new study reports that you should be tracking “glycemic load” (GL), not just calories.

Put simply, GL tracks the amount of dietary carbohydrates we consume, as well as the quality of those carbohydrates. 

The study – reported  online in the American Journal of Clinical Nutrition and picked up on April 25 by CBS News – showed that adults gained more weight as the glycemic loads of their diets increased. Specifically, the study revealed that every 50-unit increase in one’s daily GL was associated with gaining one pound every four years.

One pound every four years doesn’t sound like much, but a daily 50-unit increase in GL isn’t much, either.

Those glycemic loads vary more than we may think. Some GL examples:
  • Serving of white rice: 43 units
  • Serving of unsweetened apple juice: 30 units
  • Serving of instant oatmeal: 30 units
  • Serving of raisins: 28 untis
  • A white-flour bagel: 25 units
  • Serving of cornflakes: 23 units
  • Serving of whole grain quinoa: 13 units
  • Serving of canned tomato juice: 4 units
  • Serving of chick peas: 3 units
  • Serving of grapefruit: 3 units

See Harvard Medical School’s roster of glycemic loads for more than 100 foods, below.

The Study's Large Sample
With his team, senior researcher Dr. Dariush Mozaffarian -- at Boston’s Tufts University and the Harvard School of Public Health -- collected 24 years of diet information from about 212,000 American healthcare professionals. At the beginning of the data compilation, the subjects were healthy, with weights generally considered normal.

April 28, 2015

Bits & Pieces of This & That

Often I read something interesting but not worthy of a full blog post. I save and use these items when I need a quick, easy post. These past two days, I've been focused on the Nepal earthquake, so it's a good time to dip into this miscellany file.

Good News on My Cancers
I get so absorbed in matters of aging and Parkinson's, I forget I also have prostate cancer and have been treated twice for skin cancer. Last week, I had checkups with my urologist and my dermatologist, and heard good news from both doctors.

Dermatologist: This meeting turned out to be unusual and enjoyable. I arrived a few minutes early for my 11am appointment to find an empty waiting room. My doctor examined me right away, zapped a few spots on my forehead, said I was doing fine, and sent me on my way. I was out of the office by 11:15.

April 27, 2015

Nepal Earthquake: Here's How You Can Help

Many of my pals have called or sent emails expressing concern about my friends from Nepal. Fortunately, everyone is okay. The Kathmandu families are all sleeping outside at night, fearing continuing aftershocks. Supplies of food and water are dwindling.

Even though the earthquake's epicenter was closer to Pokhara, my Nepali "home away from home," the damage there was much less than in Kathmandu because it isn't as congested.

Naturally, my primary concern is for the people of Nepal, whom I greatly admire. The destruction of the centuries-old temples is also tragic.

Here are photos of Patan Durbar Hall, a UNESCO world heritage site in Kathmandu, taken one hour apart before and after the earthquake.

Embedded image permalink

One of my fondest memories is being in Durbar Square during Teej, the Hindu festival for women, and seeing the women, wearing their red saris and gold jewelry, dancing in front of this temple. Now it's gone.

Image result for teej durbar square 

Here's How You Can Help

April 24, 2015

Dr. Oz Defends Himself on the “Today" Show. But I prefer John Oliver’s Take on the Wizard of Oz.

Dr. Mehmed Oz -- TV host and heart surgeon  -- has been getting a lot of flak recently. I've been critical of him on this blog, mainly for jumping on Dr. Mary Newport’s bandwagon to support the unsubstantiated claims that coconut oil can cure Alzheimer's. You'll find other posts critical of the TV celebrity; just enter "Dr. Oz" in the search box at right.

I've not been alone in criticizing him. Oz got grilled last year by a Senate Commerce subcommittee for promoting dubious miracle weight-loss supplements on his popular show.

Dr. Oz has also received lots of well-deserved recognition as one of the nation's leading heart surgeons. He was hired by Columbia University in 2001 as a professor in its Department of Surgery because of his skills as a physician. He is now vice chairman of the department.

Last week, a group of ten prominent physicians sent a sharp letter to Columbia's Dean of the Faculties of Health Sciences and Medicine, writing that Oz "has repeatedly shown disdain for science and for evidence-based medicine." The letter said Oz had "misled and endangered" the public by touting unproven remedies for serious ailments.

During an interview this morning with Matt Lauer on NBC's Today show, Oz expressed confidence that his TV show will outlast the current controversy. 

April 23, 2015

Levodopa Gel Pump Relieves Symptoms for Parkinson's Patients

A headline I saw this morning on “Eureka Alert” -- one of many sites that pick up and share the latest stories -- got my attention: “Parkinson's patient experiences symptom relief with new medication.” The report appeared in the current issue of the Journal of Parkinson's Disease.

Among other things, the story describes one person’s remarkable success using CLES (Duopa®), a gel delivered directly into the small intestine by a portable infusion pump, providing continuous levodopa dosing.

The FDA approved the CLES gel in January, 2015. Its boosters believe this direct delivery system will be in much wider use later this year, particularly because the safety and efficacy of levodopa have already been clearly established.

Working with a team of international investigators, John Slevin -- MD and Professor of Neurology and Vice Chair of Research at University of Kentucky's Neuroscience Institute – tested the effectiveness of the new levodopa gel on patients with advanced symptoms of Parkinson’s disease (PD).

Dr. Slevin characterized his group’s findings: “We were extremely pleased with the results. Patients with advanced Parkinson Disease treated via this new method demonstrated marked improvement in symptom fluctuations with reduced dyskinesia.”

Pump or Pill
Why did the levodopa gel pumped directly into patients’ small intestines bring greater relief from PD symptoms than pills they’ve taken by mouth?

Slevin explained that the CLES gel pump creates more stable plasma concentrations of levodopa, in part because it avoids the patients’ erratic gastric activity. Especially for people with advanced PD, the muscles that control digestion are compromised like all the body’s muscles. That deterioration makes the levodopa dosing – both the amount and the timing – challenging.

No question: levodopa remains the “gold standard” med for treating the motor symptoms of PD, particularly in the disease’s earlier phases. But in time, its efficacy may dwindle.

April 22, 2015

Cost-Saving Tips for Prescription Drugs

I've spent some time lately checking advice on reputable healthcare sites about saving money on prescription drugs. The guidance I’ve found is sometimes confusing. A site might recommend online searching, then later counsel to stay with the same pharmacy for all prescriptions. Another site might suggest asking the doctor for free samples, and then later warn that Big Pharma gives doctors those samples to promote expensive meds.

In a post last week, I tried to untangle some confusing recommendations regarding discount drug programs. Today I want to share cost-saving tips that seem generally accepted.

Talk to your doctor about costs. Unless you bring it up, your doctor might assume that money isn't a factor for you. Many doctors think only about results, not costs.

Ask your doctor for generics. Generic drugs can cost up to 95 percent less than comparable brand names. Nearly 80 percent of all medications now have generic versions. The FDA regulates generics and brand names in the same way. I've been surprised how often doctors have prescribed brand names without letting me know generics were available. It pays to ask. Even if there’s no generic for the specific prescribed drug, ask whether another generic in the same class might safely and effectively do the trick.

April 21, 2015

Dogs Detect Prostate Cancer By Smelling Urine

My prostate cancer diagnosis came over 20 years ago, but not like this.

As reported in the April 2015 issue of the Journal of Urology, two specially trained female German shepherds – formerly bomb-sniffing dogs – detected the presence of prostate cancer with remarkable accuracy simply by smelling men’s urine.

The study is particularly significant because the current diagnostic process – screening the blood for the presence for the prostate-specific antigen (PSA) – leads to many false positives, and subjects healthy men to unnecessary stress and additional tests.

Researchers from the Humanitas Clinical and Research Center in Milan, Italy, collected urine samples from 362 men at different stages of prostate cancer, and from 540 healthy controls.

Zoe and Liu
The two German shepherds bomb sniffers – Zoe and Liu – were retrained to detect the specific volatile organic compounds in urine associated with prostate cancer.

Once their training was completed, Zoe and Liu were presented with batch after batch of urine samples from the prostate cancer patients, placed at random among among samples from the control group.

One dog correctly identified all of the prostate cancer urine samples and misidentified only seven of the non-prostate cancer samples, or 1.3%.

The second dog correctly identified 98.6% of the prostate cancer urine samples and misidentified 13 of the non-prostate cancer samples, or 3.6%

Dr. Gianluigi Taverna, chief of the prostatic diseases unit at the Humanitas Research Hospital, summarized the importance of his organization’s work:

April 17, 2015

Michael J. Fox Discusses Accepting Parkinson's Disease with David Letterman

Michael J Fox appeared on the Late Show with David Letterman last night to discuss Parkinson's Awareness Month (April), his own diagnosis, and steps his foundation is taking to find a cure. It's been 22 years since his diagnosis, and Michael looks and sounds great.

Here's the remark I liked best:
To be kind of corny about it, once you accept it, and you learn about it... and realize you're in a position to do something about it, and to make a difference, and to help, well then just, like, quit your bitching and get on with it.
Since 2000, the Michael J Fox Foundation for Parkinson's Research has funded more than $450 million to speed a cure. About 52% of that total has gone toward altering the disease (developing a treatment that could restore function to damaged dopamine neurons in the brains of people with PD), and 22% toward defining the disease (indentifying biomarkers). Fox explained to Letterman that identifying those biomarkers is a promising way to spot the disease before it develops.

April 16, 2015

To Live Longer, What Amount and Type of Exercise is Best?

Two just-released studies underscore the importance of exercise. Published last week in JAMA Internal Medicine, they define how much exercise might be enough, quantify the risks of getting too little, and suggest there’s no real harm in getting “too much” vigorous exercise.

How Much Exercise is Best?
The first study -- Leisure Time Physical Activity and Mortality: A Detailed Pooled Analysis of the Dose-Response Relationship -- assembled data about people’s exercise habits from six large health studies still in progress. Researchers from Harvard, the National Cancer Institute, and several other institutions placed over 661,000 adults – mostly middle aged – into categories based on the amount of time they spent exercising each week.

Those subgroups ranged from people who didn’t exercise at all to people who exercised moderately for 25 or more hours every week. Somewhere in between were those people who actually followed the 2008 Physical Activity Guidelines for Americans: a minimum of 75 minutes vigorous-intensity or 150 minutes of moderate-intensity exercise each week.

After stratifying all those people into their appropriate exercise categories, the researchers examined the death records for all groups. Here’s what they found:
  • Hardly a surprise: people who did not exercise carried the highest risk of early death.
  • People who exercised just a little – even well short of the recommended 150 minutes per week – reduced their risk of early death by 20%.
  • People who hit that recommended guideline exactly were 31% less likely to die early than those who didn’t exercise.
  • People who tripled the recommended guideline (3 x 150) – logging about 450 minutes of moderate exercise each week – showed the best results of all, reducing their risk of early death by 39%.
  • The super-exercisers – people who went at it for 25 or more hours each week – experienced early death rates similar to those who simply met the 150-minutes-each-week guideline. “More” wasn’t necessarily “better,” but “more” didn’t hurt, either… contrary to much of the conventional wisdom out there.

What Kind of Exercise is Best?

April 15, 2015

Saving on Drug Costs: Pros and Cons of Discount Programs

Surfing the web, I came across a link to "7 Tips for Saving Money on Prescription Drugs" featured on Next Avenue, the PBS website created for people 50+.

Author Bart Astor, an expert on life transitions for seniors, relayed a personal anecdote about his health insurer's refusal to pay for an expensive drug prescription. Why wouldn't his carrier pony up? He didn't have the specific disease the drug is supposed to treat.

Astor says his subsequent effort to resolve this issue uncovered a potential "happy ending for all of you who are stuck paying for an expensive drug without the benefit of having prescription drug coverage or if you're one of those with a prescription drug insurance doughnut hole."

Drug Discount Programs
A pharmacist at Costco suggested he check for coupons available online that offer discounts up to 70%. Astor then Googled his drug's name and the word "coupon" and got many links. He clicked on internetdrugcoupons.com and found that the company provided a free pharmacy discount card good for every FDA-approved drug. He ordered the card.

When he took it to his local CVS, the pharmacist told him that the drug would cost $432, about 70% less than the regular price of $1,600.

The pharmacist also said she often tells patients to check for coupons online, and to ask their doctors for free samples.

Astor then created his list of seven tips to save money on prescription drugs. Tip number two: "Ask your doctor for free samples." Tip number four? "COUPON!"

Others Advise Differently
I thought Astor's seven tips would make a helpful blog post. But first -- since I wasn't familiar with online coupons -- I wanted to do a little more research.

April 14, 2015

Novel Blood Signature Analysis May Enable Earlier Parkinson’s Diagnosis… and Treatment.

In recent weeks, we’ve heard promising news on several fronts in the battle against Parkinson’s disease.

Two weeks ago, we learned about apparent progress in the development of an anti-PD vaccine. Then last week, we heard that researchers had developed a novel process they felt could enable doctors to diagnose PD  much sooner by evaluating the way people typed on a keyboard.

It’s now axiomatic that the timing of diagnosis is paramount in the treatment of this disease. PD is often not diagnosed for ten years after the damage begins. Estimates suggest that up to 80% of the dopamine-producing neurons are already destroyed by the time someone receives a proper diagnosis of PD. For treatment to be truly meaningful, diagnoses must come much sooner than they do now.

A Novel Blood Signature Analysis
Now, in a study published in the journal Movement Disorders, we learn that PD might be identified earlier using a new blood signature analysis. This new research was conducted by the Mount Sinai Medical Center and – like so many others --- funded by the Michael J. Fox Foundation for Parkinson's Research.

The Mount Sinai team used a new approach to search for biomarkers – or at least “blood signatures” -- in the blood of PD patients who carry a known genetic risk factor for the disease, and in the blood of PD patients who do not.

At this point in the effort to ID the disease sooner, there’s only one blood feature that might signal an increased likelihood of developing PD: the presence of a mutation in a gene identified as leucine-rich repeat kinase 2, or LRRK2. (The mutation doesn’t carry a PD sentence; only some people with the mutation get the disease.)

Still, it’s a start. Less than two percent of all people with PD actually carry the LRRK2 mutation. It would be a big leap forward if science could find another similar bio-marker.

April 10, 2015

A Gathering of the Schappi Clan

Isn't this a good-looking group? Most of us old fogeys find that as our age increases so does our focus on spending more time with families and friends. We usually can remember their names.

For many of my contemporaries, those get-togethers mean spending  lots of time traveling around the country or the world. I'm fortunate that my son and daughter, my three grandchildren, and my four great-grandchildren all live in the Baltimore-Washington area.

Our Thanksgiving and Christmas get-togethers used to happen at my house in Washington. Now I travel over the hills and through the woods to my son's house in the forest near Camp David, Md. Fortunately, my daughter Ann lives in Alexandria, Va. and does the driving.

Todd's house is a short drive from Smithsburg, Md. for the family's largest contingent -- the Dreisonstoks. They comprise Todd's daughter Jessie, her husband Dan, and their daughters Kaylee (8) and Kenzie (4 in a few weeks), and son Camden, born on a memorable Christmas Eve, 2013.

Baltimore is home to an increasing number of Schappis. Todd's daughter Emily married Jerrod Fuller in February, 2014, and the happy event became the subject of a major post on the blog. Their daughter Emarie was born in November.

Todd's son Colin remained in Baltimore after his graduation from the Maryland Institute College of Art there. He's appeared at the last few family gatherings with the lovely Michelle. This fall, they'll travel to China to teach English for six months or more. I don't know where else the relationship might be headed.

April 9, 2015

Will How People Type on their Keyboards Become a Revolutionary New Tool to Detect Parkinson’s – and Begin Treatment -- Sooner?

A new study draws an intriguing conclusion: the WAY people type on their keyboards could become a new clinical tool for much earlier diagnoses of Parkinson’s disease (PD).

Now, there’s no effective way to diagnose PD in its early stages… a delay that carries a big price. Study leader Luca Giancardo said: “People are usually diagnosed five to 10 years after the beginning of the disease, and a lot of the damage has already been done.”

A product of the Madrid-MIT M+Vision Consortium, the study was published last week in the online journal Scientific Reports. Its conclusions are based on a simple premise: the attributes of a person’s keystrokes provide lots of potentially useful information. Of particular interest was a feature the research team called “key hold time,” which measures how long a key is pressed before being released.

These measurements somehow gauge the complex mechanisms that generate movement, as the brain’s primary motor cortex sends signals through several other brain regions, including the supplementary motor area, cerebellum, and basal ganglia. That process then activates spinal neurons which stimulate muscles, creating the movement.

First, the Impact of Fatigue
The initial phase of this study was designed to assess the effects of fatigue on motor ability, but it became apparent it might have broader implications.

To determine the impact of sleep deprivation, the researchers recruited 14 healthy Boston-area volunteers and asked them to type a randomly chosen Wikipedia article.

The subjects were informed they’d be awakened during the night to type another article. About 80 minutes after they had dozed off -- when they’d likely be in the deepest part of their sleep cycle – the volunteers were awakened to complete their next typing assignment.

April 8, 2015

What To Eat: Ten Best Foods

Yesterday's blog post carried the headline "We're Eating Smarter and Still Getting Fatter." What's missing, of course, is exercise. But there's nothing wrong with eating smarter.

My favorite source of information on eating smarter is the Nutrition Action Health Letter, published by the Center for Science in the Public Interest, a consumer advocacy organization. Claiming two million readers, it's the largest health and nutrition newsletter in the country. I subscribe to both the newsletter and the daily email from NutritionAction.com.

Here's  an example of the healthy eating tips from the CSPI:

April 7, 2015

We’re Eating Smarter and Still Getting Fatter. Solution? More Exercise!

If there’s a theme that runs through this blog, it’s this: as far as achieving and maintaining good health is concerned, there is no substitute for exercising regularly and eating wisely. Although countless millions of us might wish otherwise, there is no easy pill fix available that can replace the benefit of making the smart -- often challenging -- lifestyle choices.

A new report published in the April 2015 edition of the journal Medicine & Science in Sports & Exercise suggests we might need to list those two key lifestyle elements in a different order -- (1) exercise, and (2) diet.

We already know how much easier it is to pack on the pounds as we age. Waist measurements increase, and body mass index (BMI) gets higher and higher. Nearly 70% of Americans – of all ages -- are either obese or overweight. That percentage is higher among seniors.

We also know that being overweight carries risks, including diabetes, hypertension, cardiovascular disease, and certain cancers.

This new study analyzed physical activity, diet and weight among nearly 5,000 American adults from age 20 to 70 and above. The data provide an intriguing snapshot of how Americans are aging, and how their diet and exercise change through the years.

There’s lots of information in the report, but there's a paradox that's especially interesting -- while we age and gain those extra pounds, our diets are actually improving. We’re eating smarter and still getting fatter.

April 3, 2015

How To Draft a VSED Advance Directive for Hastening Death in the Event of Dementia

In yesterday's post, we discussed an emerging debate about advance directives: Should people be able to request -- and count on -- VSED (voluntarily stopping eating and drinking) in the event of future dementia?

Today, let's consider several possible ways to draft such a directive.

Natural Dying Living Will
California psychiatrist Dr. Stanley Terman specializes in end-of-life decision-making. He has developed a "Natural Dying Living Will" that he describes as "an ironclad strategy" for dealing with advanced Alzheimer's dementia and unbearable end-of-life pain.

Dr. Terman explains his approach in this video:

April 2, 2015

Using Advance Directives To Hasten Death in the Event of Dementia, Stroke, Etc.

As an old man (86 next month) with Parkinson's, I want to maintain control over the way I die. Quality of life has always meant more to me than the length of life. My greatest fear is losing my cognitive function due to dementia, stroke -- or whatever -- and being unable to stop my medical care providers from putting my nearest and dearest through the emotional strain and financial drain of watching what's left of me slowly disintegrate.

Fortunately, a new way of dealing with this issue is being explored. Ethicists, lawyers, and older adults have begun a debate about whether someone can specify in an advance health directive that she wants to end her life by voluntarily stopping eating and drinking (VSED) if she loses her cognitive function.

How VSED Works
My introduction to VSED came as I worked on a post about the death last June of John Rehm, the husband of NPR host Diane Rehm. His Parkinson's had progressed to the point where he was no longer able to use his arms or legs. He checked into a hospice and signed a paper with these instructions: no food or drink. He was kept sedated and died nine days later.

Talking with several friends, I learned they had been at the bedside of a friend who went through the same process in hospice. He suffered from kidney failure and didn't want dialysis.

The Ethics of Assisting in VSED
Hospice and palliative care organizations are debating the ethics of responding to patient requests for help in VSED deaths. Some view intentionally hastening death by fasting an act of suicide that should be discouraged. Others regard VSED as an ethically appropriate decision to forego unwanted life-prolonging measures... that forcing people to eat is as objectionable as imposing some unwanted medical treatment.

A discussion of the ethical and legal pros and cons of this option was presented in an excellent article in the Journal of  Hospice and Palliative Nursing last year. That piece reviewed the case of a patient who requested hospice support for her decision to take the VSED exit.

The patient -- a nurse who works for a home hospice agency -- had a pelvic tumor that had metastasized throughout her abdomen. She was not in great pain or close to death. But she decided the burdens of living outweighed the benefits.

April 1, 2015

The National Psychological Association’s End-of-Life Care Fact Sheet

In addition to its many other functions, the National Psychological Association (NPA) produces a fact sheet that addresses the mental health needs of older adults who are nearing the end of life. The information it provides – reproduced here -- should be required reading for all seniors (preferably well in advance of dementia or other debilitating illness), their families, and caregivers.

In the interest of space, I have removed the many study references in the NBA’s piece. If you’d like to check the study citations, you’ll find them in the original document at the bottom of this post.

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The U.S. Supreme Court agreed that Americans should expect palliative care, which combines active and compassionate therapies to comfort and support individuals and families nearing the end of life. End of life is defined as that time period when health care providers would not be surprised if death occurred within about 6 months. Older Americans with chronic illness think about how they would prefer their lives to end, and want a “good death” without burdensome pain, symptoms and technology.

Most deaths (70 percent) occur in those aged 65 and older. Older adults want better discussions, information, and a chance to influence decisions about their care — whether to be at home or in the hospital and to have CPR (cardiopulmonary resuscitation).

Most Americans die in hospitals (63 percent), and another 17 percent die in institutional settings such as long-term care facilities. In addition, most people are referred too late to hospice or palliative care, so they are unable to get the most benefit possible from these specialized services.

What do older adults fear most?
People fear that their pain, symptoms, anxiety, emotional suffering, and family concerns will be ignored. Many critically ill people who die in hospitals still receive unwanted distressing treatments and have prolonged pain.