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Can Supplements Compensate for an Unwholesome Diet?
Tweet Share on Facebook June 15, 2009 CommentI'm a young woman with a fast-paced life and a heavy traveling schedule. Sometimes that takes a toll on healthful eating habits. Can supplements help compensate?
Supplements can never substitute for a healthful diet based on whole foods. This is really important to remember. That said, it certainly makes sense to take a multivitamin (with iron if you are a menstruating woman) as a safety net for a less than ideal diet. I recommend taking a basic multivitamin with 100 percent of daily recommended doses, but not megadoses, of vitamins. This allows you to add higher doses of specific vitamins if there is a rationale to do so, and it avoids the risk of being on high doses from multiple sources—a situation I see very frequently.As a young woman, the additional supplements you may want to consider include calcium (500 milligrams twice a day) and magnesium (200 mg twice a day), both for bone health and for menstrual symptoms. Most gynecologists are unaware, as I was, of research showing that calcium and magnesium can significantly alleviate many symptoms of PMS and cramping. Also, vitamin B6 (50 mg a day) or a B complex can help with some of the mood swings. Do not take more than 100 mg a day, as this can in rare cases cause neurological symptoms.
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Is it Safe to Exercise with Chest Pains?
Tweet Share on Facebook June 2, 2009 Comment (4)
Anginal (chest) pain itself is not a contraindication for exercise. In fact, a certain amount of regular exercise may help develop new blood vessels to the area of the heart with blocked arteries. However, the level of exercise and heart rate achieved should be discussed with your physician. This is especially important if the degree of blockage is significant. The oxygen requirement of the heart muscle increases during exercise and can cause an imbalance between the demand and supply of oxygen in the diseased part of the heart. If you are truly having anginal-type pains, you need to make sure that you are on an optimal medical and lifestyle regimen and that you are in close touch with your primary-care physician and cardiologist. -
How Can People Weigh Aspirin's Risks and Benefits?
Tweet Share on Facebook June 2, 2009 Comment (1)A 77-year-old woman with mild coronary heart disease also suffers with diverticulitis. Her cardiologist wants her to take a blood thinner for her heart disease, but her gastroenterologist does not favor any medicine that might irritate her stomach or intestines. What to do?
Balancing the risk and benefits of any medication for an individual is often more art than science. The scenario presented in this question is one often confronted by physicians; while each situation is unique, some additional facts may be helpful. While any dose of aspirin will increase your risk of bleeding, the higher the dose, the higher the risk for bleeding. But only a small dose of aspirin is needed to obtain its cardiovascular benefits: 81 mg per day or possibly as little as 81 mg every Monday, Wednesday, and Friday may be all that is needed. Additional protection against aspirin-induced gastrointestinal bleeding can be afforded by taking a proton pump inhibitor medication like omeprazole or a protective medicine called misoprostol. Sometimes an H-2 blocker such as ranitidine may be recommended. -
Can Diet and Exercise Help People Get Off Statins?
Tweet Share on Facebook June 2, 2009 CommentA 60-year-old woman who has been taking a low-dose statin for 15 years wants to stop because of side effects. Her cholesterol is below 200, she eats a prudent diet, keeps her blood pressure under control with medication, and exercises for 30 minutes four days a week. Is it possible to go off statins under those circumstances?
Statins are not necessarily for life if changes and diet and activity are sufficient to keep cholesterol under control. However, many people who think they are on a "prudent" diet are often focusing on reduction of overall fat in the diet. This is not the best way to improve blood cholesterol levels because unsaturated fats actually reduce LDL (bad) cholesterol.It would be good to get a detailed consultation about diet, possibly with a dietitian, to be sure that the dietary strategy is really on target, both for control of blood cholesterol levels and for control of blood pressure. Also, total cholesterol level is not really a good guide to the need for medication. Risk of heart disease really depends on the amounts of LDL and HDL (good cholesterol) in the blood, and it is possible that this woman really has perfectly healthy cholesterol fractions. It would be good to ask her physician to check LDL and HDL and review these numbers. Even more important is to know whether this woman smokes (much more important than blood cholesterol numbers) and what her BMI is (based on weight and height), because this strongly predicts risk of diabetes, cancer, and many other outcomes in addition to cardiovascular disease.
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I'm Not Overweight. But Am I Fit?
Tweet Share on Facebook May 20, 2009 Comment (1)I have a normal body weight, eat modestly, exercise a little, and feel healthy. How do I know that I am fit?
The best and safest way to determine the fitness of the cardiovascular system is to be evaluated by treadmill or bicycle stress testing with EKG monitoring in a physician's office. In the past, being physically fit was described as there being an absence of disease. Over the years, that definition has changed to imply adequate cardiovascular fitness. In a clinical setting, we determine cardiovascular fitness by treadmill stress testing.In addition, our studies have shown that in predicting future coronary events, these three measurements from treadmill stress tests are very important:
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How Can Older People Get Active?
Tweet Share on Facebook May 20, 2009 Comment (3)I'm an older adult, and I've heard (and heard) the message that I should have a regular exercise program, but I've just never gotten into it. How do I seriously get started? And what should I hope to accomplish?
Exercise can be used in three general ways: (1) rest and relaxation, (2) muscle building and body shaping, and (3) cardiovascular/pulmonary conditioning. For older people, I would recommend focusing on Nos. 1 and 3. Consider the known benefits of exercise when you are contemplating starting into a program. The most common reason people continue exercising is that it "makes them feel good." Studies show that regular exercisers are less depressed and less hypochondriacal, have an improved self-image, have a more positive attitude toward life, and have fewer somatic [physical] complaints. -
How Can You Build Bone Mass?
Tweet Share on Facebook May 19, 2009 Comment (6)My 88-year-old mother has been taking glucosamine and chondroitin twice a day for joint pain, along with vitamin D once a day, but her doctor says that her bone mass is worse than when she began treatment. Does she have other options?
To my knowledge, no studies have documented adverse side effects from these two substances. And most other treatments for joints, such as aspirin, nonsteroidal anti-inflammatory agents, and even Tylenol, have their own associated risks. The most important initial test for your mother would be to check her level of vitamin D3 and administer 2,ooo to 4,000 international units of vitamin D3 a day. Vitamin D increases calcium absorption from the intestines and stimulates osteoblasts to make new bone in the bone marrow. -
Why Isn't There a Gardasil for Men?
Tweet Share on Facebook May 18, 2009 Comment (19)Why was the vaccine against the cancer-causing, sexually transmitted HPV virus not approved for men at the same time it was for women? Is there any reason to think that men and women would react to it differently?
Interesting question. First, a little background.Gardasil is a genetically engineered vaccine to immunize girls and women ages 9 to 26 against four types of human papillomavirus (HPV). HPV is the name given to a family of viruses, many of which can be transmitted from one partner to another through sexual activity. HPV may represent the most frequent sexually transmitted infection in the United States. It is estimated that over 6 million people become infected by a sexually related form of HPV every year. Some estimates suggest that over half of all sexually active males and females become infected at one point or another in their lifetimes.
Certain types of HPV can sometimes evade the body's immune system and, when they do, establish a state of persistent infection. That in turn may cause certain cancers. Indeed, this is now recognized as the major cause of cervical cancer and related conditions, and vaccines that immunize people against HPV could make a dramatic impact against these diseases.
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Is Occasional Marijuana Use Bad for Adolescents?
Tweet Share on Facebook May 15, 2009 Comment (44)There is a big push to legalize or at least decriminalize recreational marijuana use, in part because it is so widely used among young people. What is your advice to young people who are occasional pot users? And, as a pediatrician, do you discuss an adolescent's pot use with Mom and Dad?
At the Children's Hospital in Boston, we are very fortunate to have the Center for Adolescent Substance Abuse Research. CeASAR expert Dr. Sharon Levy gave me this advice:We recommend that young people avoid use of marijuana entirely. While marijuana does not cause severe withdrawal symptoms seen with other drugs, the syndrome of marijuana dependence is well described in the medical literature, is every bit as powerful as addiction to other drugs, and causes great harm to young people. Marijuana addiction is characterized by lack of motivation, poor functioning in school and at work, disruption in family relationships and friendships, and loss of control over how much is used and how often. Several large scientific studies have shown those who use marijuana during adolescence are at much greater risk of developing depression and schizophrenia, and adolescents who become addicted to marijuana have poorer outcomes relative to education, career, and family goals than their siblings. Unfortunately, because of slow and insidious onset, symptoms are often not recognized. Recent research has demonstrated that, as with alcohol, adolescents who begin using marijuana early are much more likely to develop an addiction than fully mature adults. Parents should not permit their adolescent children to use marijuana—in the end, the messages they give have a greater impact on their children's behavior than the law. They should see the laws prohibiting marijuana use as a means to support them rather than an end in itself.
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Do Antidepressants Strengthen the Immune System?
Tweet Share on Facebook May 15, 2009 Comment (13)
Treating depression with medicines like antidepressants can help both your mood and your immune system. Depression can fuel inflammation, and data from several studies suggest that antidepressants may dampen inflammation. Drugs that treat depression may have other positive benefits that indirectly help inflammation as well; when people are depressed their sleep is poorer, they tend to eat high-fat diets, they exercise less, and they smoke and drink more—behaviors that can promote inflammation. Inflammation is associated with many age-related diseases, including heart disease and stroke, so treating depression may be one way to help heal the body as well.
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