Health care

By John H. Sklare, Ed.D, Lifescript Personal Coach
Today I would like to address the idea of resilience, the ability to recover from or adjust easily to misfortune or change. You probably understand how important this quality is for living a happy life in today’s volatile world. We’re all dealing with a lot of change, disappointment and misfortune, so it’s imperative that one learns to deal with the realities of a fast-moving and ever-changing world.

With that said, how’s your resilience? Are you able to quickly get on your feet, recover and move forward when misfortune or change knocks you on your backside? Or, once confronted with this kind of situation, do you just lie quietly on the mat and wait for the ref to count to ten? If you tend to lie on the mat, I suggest you make today the day you change that behavior. Boosting your resilience will improve your life in more ways than you can imagine. So if you find yourself in the middle of that 10 count today, I say get up and get on with it!

Wishing You Great Health,
Dr. John H. Sklare
www.innerdiet.com

Are you dating the wrong person? Got an unhealthy addiction? Need motivational advice? Email your question! Ask Dr. Sklare

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Need fitness advice? Ask Jorge Cruise

Got a diet dilemma? Ask Joel Marion

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By John H. Sklare, Ed.D, Lifescript Personal Coach
Technology can be a wonderful thing; it allows us to perform tasks quicker, organize things better and gather vast amounts of information in a heartbeat. I appreciate and take advantage of technology in most areas of my life. However, there’s one area that I would like to focus on today where I believe technology is creating an issue… your penmanship, or personal style of handwriting.

With the onset of email, Twitter and all other forms of electronic messaging these days, we’re losing contact with the beauty, emotion and personal touch that handwriting delivers. I don’t know about you, but I love getting a handwritten card or letter in the mail. When was the last time you sent a personally handwritten message to someone dear to you? I recommend you send someone one today before your personal penmanship goes under. Perhaps today is the perfect day to start writing this ship!

Wishing You Great Health,
Dr. John H. Sklare
www.innerdiet.com

Are you dating the wrong person? Got an unhealthy addiction? Need motivational advice? Email your question! Ask Dr. Sklare

Relationship troubles? Ask Dr. V

Need fitness advice? Ask Jorge Cruise

Got a diet dilemma? Ask Joel Marion

What’s in your stars? Ask the Saturn Sisters

Check out Health Bistro for more healthy food for thought. See what Lifescript editors are talking about and get the skinny on latest news. Share it with your friends (it’s free to sign up!), and bookmark it so you don’t miss a single juicy post!

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By Edward C. Geehr, M.D., Lifescript Chief Medical Officer

Remember when your parents told you that sitting too close to the TV was bad for your eyes? Well watching too much boob tube may be even worse for your health.

It’s no surprise that TV and computer time are contributing to the current obesity epidemic. Americans watch about 5 hours of TV a day, averaging over 150 hours each month. Add to that additional time in front of the computer. No doubt, we’ve become an increasingly sedentary culture.

Those who fit in some exercise each week figure they are counteracting their time spent vegging out in front of a screen, right?

Not necessarily.

We know there are lots of good reasons to exercise: weight management, improved mood, cardiovascular health, lowered risk of diabetes and osteoporosis, improved energy levels, better sleep, improved sex life, reduced cancer risk, elevated good cholesterol, and even improved brain function. Now, an alarming new study determined that even for regular exercisers, the risk of death increased the more TV they watched.

Published in the American Heart Association journal Circulation, the study tracked 8,800 people for an average of 6.6 years to compare health outcomes with self-reported TV viewing times. The participants averaged 50 years of age and 30-45 minutes of exercise per day. After six years of follow-up, 284 participants died, including 87 from cardiovascular disease and 125 from cancer.

Risk of death for those who averaged less than 2 hours of TV time per day was compared to the risk resulting from each additional hour of viewing time; results were adjusted for factors such as age, sex, waist circumference, and exercise. For those who boob-tubed greater than 2 and less than 4 hours, the increased risk of death from all causes was 13% higher, compared to those who watched TV more. If participants logged greater than 4 hours a day, their risk increased by 46% compared to TV-watchers clocking less than 2 hours. Compared to all causes, cardiovascular disease was the most likely cause of death.

So how can this be? What is it about watching TV that creates such risk even among those who exercise? Study researchers feel that it’s not the loss of vigorous exercise that’s the issue. After all, study participants had regular vigorous exercise. Rather, it’s the lack of moving around experienced in our daily activities – which is lost in front of the TV – that increases risk for death. It seems humans weren’t designed to sink inert into a couch for hours on end staring at a point in space.

One clue comes from an emerging field of research. Prolonged periods of inactivity appear to affect how the body processes fats. An enzyme that removes fat from the blood and converts it to fuel shuts down within hours of cessation of activity. Consequently, fat accumulates in the blood where it can damage the lining of our arteries. It’s possible that simple periodic moving around, getting the muscles moving and picking up our heart rate may provide some measure of protection from this shut down in fat processing.

So if you can’t give up the tube, then make sure you get up and occasionally shuffle about to get the blood flowing. Of course, you can always try to replace TV time with something a bit more active and productive.

See All House Calls by Dr. Geehr.

By Edward C. Geehr, M.D., Lifescript Chief Medical Officer
Have you or your child ever experienced a full-blown allergic reaction to food? It’s called anaphylaxis, where the skin flushes, the face swells, the heart races, breathing becomes labored and the throat starts to close off. Unless epinephrine is promptly injected, unconsciousness and even death may ensue.

People with food allergies are vigilant about what they eat. So it’s no wonder that parents whose children have food allergies want to know which foods are sensitizers and which are safe.

For about 5% of young children and 3%-4% of adults living in Western countries, food-induced allergic reactions lead to a variety of health problems. These include skin rashes, abdominal cramping and diarrhea, chronic cough, wheezing, and other disorders including anaphylaxis. Most any food can trigger an allergic response, but those responsible for the most significant reactions include milk, egg, peanut, tree nuts shellfish, wheat, and soy. Surprisingly, allergy to additives and preservatives is relatively uncommon.

Most food allergies diminish as we age. About 80% of egg and milk allergies resolve by the age of 16. But only 20% of peanut, tree nut, and shellfish allergies resolve by that age. The prevalence of milk, egg, peanut, and tree nut allergy in infants and children is 2.5, 1.5, 1, and 0.5%, respectively. Whereas in adults, the allergy prevalence drops to 0.3, 0.2, 0.6, and 0.6%, respectively. Peanut allergies seem more persistent over time, and even if successfully suppressed through therapy, can reemerge over time.

Unfortunately, the most common tests for food allergy may not be able to pinpoint which food is causing a person’s adverse reaction, leading to over-diagnosis or misdiagnosis in some instances. Blood tests are used to measure the level of antibodies, called immunoglobulin E (IgE), we make to a particular food. But the presence of IgE doesn’t always mean that a person will have an allergic reaction to the food triggering the IgE response.

Skin testing is thought to be more predictive: A small amount of the food allergen is poked into the skin with a needle. If there’s swelling and redness of a certain amount, the test is positive. But as with elevated IgE levels, it doesn’t mean the person will develop allergic symptoms to the food. This can make it difficult for parents to determine what foods to withhold from their children.

A sampling of blood and skin testing from 2005-2006 found that 12% of U.S. children were sensitive to milk, 9% to peanuts, 7% to egg, and 5% to shrimp. However, many experts believe that as few as one-tenth of those children will have an allergic reaction to those foods. So how can you be sure of your child’s risk to specific foods?

The most reliable test is a food challenge under highly controlled circumstances given to children over the age of three. Administered in a doctor’s office or hospital with life support equipment, foods are typically given orally in capsule form with the identity blinded to the patient, with some placebo capsules included. One by one, over the course of several hours, the capsules are consumed and the child is closely observed for signs of allergic reaction. A negative response may lead to food challenge by a full-sized portion of the food in question.

Of course, not every adverse reaction to food represents an allergic reaction. The food may have been spoiled, or the child might be lactose intolerant or have other digestive disorders. If you suspect your child has a food allergy, consult a specialist to decide on the proper approach to diagnosis, diet modification and even therapy.

See All House Calls by Dr. Geehr.

Nothing is as confusing and ever changing in the world of sports and fitness as the question of supplements. Which should you take, and why? Which are essential, which provide only a minimum benefit, and which are a complete waste of time, money, and potentially your health? Should you be taking fifteen pills a day, [...]

By Edward C. Geehr, M.D., Lifescript Chief Medical Officer

Is your teen overweight and having a hard time dropping pounds? As a parent, it can be equally as frustrating for you as it is for them. So what’s the answer

Gastric bypass surgery is one option.

A new report in the Journal of the American Medical Association (JAMA) showed that a clinical trial of bariatric surgery on obese teens was much more effective at shedding weight than a diet and exercise regimen. Twenty-four surgery subjects between the ages of 14 and 18 who completed the study lost an average of 76.3 pounds, or about 28% of their body weight. By contrast, the 18 subjects who completed the diet and exercise program lost just 6.6 pounds on average, or 3% of body weight.

Adolescent obesity is a problem in the U.S. The percentage of adolescents (ages 12-19) who are obese was approximately 7% in 1980, and it increased to about 15% in 2000. Today, more than 17.4%, or more than 5 million, are obese. Those extra pounds put our youth at risk for severe, even life-threatening health problems.

Over the past two decades there has been a 10-fold increase in the prevalence of type 2 diabetes in adolescents. Diseases once considered rare or unknown in teens are now commonplace, such as metabolic syndrome (a pre-diabetic condition), obstructive sleep apnea, hypertension, elevated lipids, and fatty inflammatory infiltration of the liver (steatohepatitis), along with a host of psychosocial disabilities.

Sadly, multiple reviews of lifestyle programs for teens targeting diet, exercise and behavioral modification, such as those recently promoted by the first lady Michelle Obama, show mostly poor results. One review of 17 randomized controlled trials of lifestyle programs showed modest weight reduction for up to 12 months followed by packing back on the pounds.

Bariatric surgery is commonly used to help obese adults lose weight. Several studies have shown the benefits of gastric banding, a minimally invasive procedure, over lifestyle changes alone. But gastric banding has rarely been used in adolescents: Fewer than 1,000 such surgeries are performed in the U.S. each year, less than 1% of the number done on adults.

Previous reviews of teenage bariatric surgery have been inconclusive because the trials were observational and not randomized and controlled. And that’s why the current study is so important. It’s the first prospective, randomized controlled trial of gastric banding compared to lifestyle interventions in severely obese adolescents.

A total of 24 adolescent surgery patients with an original Body Mass Index (BMI) of greater than 35 (extremely obese) completed the two-year Australian study. All received the Allergan LAP-BAND adjustable gastric banding system. (Seven surgery patients required follow-up procedures including replacement of the band or the access port under the skin used to adjust the band’s fit around the stomach.) There were no serious complications, such as stomach perforation or herniation, as have been reported in some adult patients.

The lifestyle program was focused on reduced food intake through an individualized diet plan; increased activity with a target of 10,000 or more steps per day as measured on a pedometer; a structured 30-minute exercise program of at least 30 minutes per day; and behavioral modification. Parents and families were involved where appropriate and consultations occurred every 6 weeks with a dietician or exercise consultant and a study nurse coordinator.

These results are both encouraging and profoundly discouraging. Further studies will be necessary to confirm these results on such a limited number of patients. But the fact that any therapy exists to help morbidly obese adolescents lose considerable weight is encouraging.

However, it’s very discouraging that a well-designed lifestyle modification program with regular coaching and follow-up was so ineffective. It doesn’t bode well for current national initiatives.

See All House Calls by Dr. Geehr.

By Edward C. Geehr, M.D., Lifescript Chief Medical Officer
In 1998, the MMR vaccine was linked to a “syndrome” of autism and bowel disease, reported the medical journal Lancet. The triple vaccine was released in Britain in 1988 and had been in use in the U.S. since 1971. The vaccine was credited with reducing the incidence of measles, mumps and rubella-related illness and death.

These findings led to concerns about the safety of vaccines, particularly regarding the preservative thimerosal that contains mercury. Several newspapers and celebrities jumped on the story and stoked fears about vaccine safety.

Twelve years later, the Lancet has totally retracted the MMR-autism research. The journal’s editor says parts of the report were “utterly false” and that he feels “deceived.”

If you think it’s unusual for a medical journal to print such a complete and unqualified retraction, you’re right. And the background story is interesting, if not disheartening.

In the 1998 paper, Andrew Wakefield, M.D., a British physician, and colleagues described 12 children with gastrointestinal problems, eight of which were thought related to MMR vaccination. Nine of the 12 exhibited autistic behaviors. The children were allegedly selected through a random process from those who showed up at a hospital with certain symptoms.

A series of events behind the scenes would cast doubt on the findings. According to published reports, Wakefield, the lead author of the 1998 paper, didn’t disclose that he had been hired two years before as a consultant, allegedly to support a planned legal attack on MMR manufacturers. He also didn’t disclose that he and attorney Richard Barr requested funding that same year from the UK Legal Aid Board in order to show a link between MMR and a new “syndrome” of autism and bowel disease.

In 1996, the first autistic child to enter the study was admitted to Royal Free Hospital. But the children enrolled weren’t impartially selected. Of the 12 who entered the study, most were referred by Barr or related anti-MMR campaigns, and 11 turned out to be litigants against the vaccine manufacturer.

Just one year later in 1997, Wakefield filed for a patent on his own supposedly “safer” single measles vaccine and for other products intended to treat autism and related bowel disease. In 2001, the Daily Mail and other British national daily newspapers launched campaigns backing Wakefield, who published a review of his evidence and repeated calls for single vaccines.

In 2004, it was revealed that Wakefield had been paid to conduct his study on children who were Barr’s clients. The Lancet held firm and declined to fully retract the study, commenting that it had been correct to “raise new ideas.”

The effect on vaccination rates was dramatic. Child vaccination rates dropped below 70% in some communities, down from more than 90% in the mid-1990s. Waves of measles outbreaks ensued, growing from 56 cases in 1998, to 1370 in 2008. In 2006, the first British child died of measles in more than a decade. In the U.S., as many as 2.1% of children weren’t immunized with the MMR vaccine in 2000, up from 0.77% in 1995, according to a 2008 study published in Pediatrics.

In light of the 2004 revelations, British journalist Brian Deer uncovered the manipulation behind the study findings. He found, for example, that the hospital’s clinicians and pathology service had found little to implicate MMR in the study findings. The pathology service had repeatedly reported bowel biopsies to be normal and all 12 cases had major discrepancies between actual clinical records and the 1998 study results. Deer reported that Wakefield had changed and misreported diagnoses, histories and descriptions of children that made it appear the syndrome had been discovered and not fabricated.

According to a report in The Sunday Times in 2009, the effect was to give the appearance of a causal link between MMR and autism and bowel disease where none existed. Some of the children showed signs of autism before vaccination and some didn’t have autism at all.

The Lancet story is a lesson of how even reputable publications can become conduits for unscrupulous conduct, particularly when research is aligned with popular consumer or political causes. In this instance, children are still suffering the consequences of the Wakefield’s manufactured autism scare.

See All House Calls by Dr. Geehr.

By Edward C. Geehr, M.D., Lifescript Chief Medical Officer

There are many good reasons to exercise – weight management, improved mood, cardio-vascular health, lowered risk of diabetes and osteoporosis, improved energy levels, better sleep, improved sex life, reduced cancer risk, and elevated good cholesterol. Now we have another reason – brain fitness.

In a recent study published in the Annals of Internal Medicine, researchers in British Columbia found that older women who did 1-2 hours of strength-training exercises each week had improved cognitive function a year later.

Researchers randomly assigned 155 women ages 65-75 either to strength training with dumbbells or weight machines once or twice a week or to a balance and toning exercise group. The strength training group had improved their performance on tests of selective attention and conflict resolution, so-called executive functions, by 10%-12%. The balance and toning group actually experienced a slight deterioration in the same measures by 0.5%.

The researchers note that older women are less likely than others to do strength training, even though it improves bone strength and counteract muscle loss. Elaborate equipment isn’t necessary to conduct a well-designed, strength-training exercise program for senior women 1-2 times per week.

This study is one of many recent articles that demonstrate the value of exercise on the brain. Another study published in 2008 in Nature Review Neuroscience found that intense bouts of aerobic exercise improve immediate cognitive performance. And the more intense, the better the results.

In this study, 21 young adults completed 30 minutes of either resistance training or intense aerobic exercise on a treadmill. Study subjects were tested before and immediately after training sessions for reaction time and accuracy. Both measures were improved in the aerobic exercise group compared to the resistance training and resting controls. Further improvements in cognitive testing were observed with more intensity of exercise.

The researchers reasoned that intense exercise on a treadmill carries certain growth factors from the periphery of the body to the brain that may trigger a molecular cascade on new neurons and brain connections. This transport of growth factors probably requires a dramatic change in blood flow to the brain only observed with vigorous exercise.

It was felt that the weight-lifting routine was not vigorous enough to maximally stimulate flow of growth factors which may stay in the muscles. However, we know from the Annals study that weight bearing does improve cognitive function in older women over time, but it’s likely not as efficient as intense aerobic activity over the short term.

See All House Calls by Dr. Geehr.