Wednesday, March 21, 2012

Medicine and Fast Food

No, the practice of medicine is not like fast food.

We live in a society of fast cars, fast food, instant messages, and instant pictures.  We want it our way and we want it now.  This is evident by the fact that the average American household has $16,000.00 in credit card debt (2011 Household Statistics).  We want it now and well worry about payment or consequence later. This is also evident by the successes of instant messaging services, cell phones and fast food restaurants.

As a family practitioner, I feel pressured by both patients and insurance companies to serve up a diagnosis and a low cost generic pill with the same speed.  No, the practice of medicine is not like fast food. If it were, then I would install a drive up window next to my office desk, and place a large marquee with a clown wearing a stethoscope at my front door.

Medicine is an art.  A picture is painted of the patient by what is seen, heard, felt and understood through the eyes of the practitioner.  This can't be done over the phone or through a drive-through window. It requires a patient who is willing to place his or her history, symptoms, feelings, private concerns and trust upon the examination table It requires the astute observer to see all the reflections of light and shadows and all the highlights.  It requires the observer, the doctor, to recognized that many times this is difficult for the patient.  That trust is built through a relationship that occurs over a period of minutes and a period of years.  The beauty of the art occurs when the practitioner and the patient understand one another and application of healing can begin.

The art of medicine paints a different picture every time. That's why art isn't sold under the golden arches, or at the corner pharmacy.  No, the practice of medicine is not like fast food.

Friday, March 16, 2012

Vitamin D Effect on Weight

Vitamin D plays an interesting role in may aspects of human health. It plays a role in disease prevention including osteoporosis, some cancers, autoimmune disorders, hypertension, diabetes and has recently been found to effect weight loss.
What is Vitamin D?  It is an oil-soluble (fat-soluble) vitamin that helps in the absorption of calcium and phosphorus in the intestine and suppresses parathyroid hormone (PTH), the hormone that stimulates bone resorption (breakdown). Vitamin D also plays a role in muscle function and in the immune system, but our understanding in these roles are still limited. (1)
Vitamin D can be found in fatty fish, cod-liver oil and eggs. In the United States, cow's milk is supplemented with Vitamin D and this is often the source from which most people obtain it. Deficiency in Vitamin D often occurs from lack of sun exposure, inadequate intake, surgery to or damage of the intestines ability to absorb, or from kidney or liver damage resulting in problems processing Vitamin D. Recent studies reveal that obesity is a major factor in altering the way the body uses Vitamin D and stimulates PTH.
I find that about 30-40% of my patients are Vitamin D deficient.  Many researches claim this is due to poor sun exposure or the use of sun screens, however, I live in Arizona.  Sun over exposure is usually the problem here, yet I still find that 30-40% of my patients are deficient.  My patients should be able to get enough sunlight walking from their cars to the grocery store entrance.  I disagree that "lack of sun exposure is the cause."  Although our current labs claim vitamin D levels should be above 20 ng/dl, I find people do not get the needed effect until 25 Hydroxy-Vitamin D levels should are greater than 32 ng/dl.
Poor Vitamin D intake is usually the problem.  Our bodies convert 25 Hydroxy-Vitamin D into the active molecule 1,25 Dihydroxy-Vitamin D.  Recent studies reveal that higher Body Mass Index (BMI) leads to lower conversion of 25 Hydroxy-Vitamin D to 1,25 Dihydroxy-Vitamin D. (2,3)  Simply adding 25 Hydroxy-Vitamin D as a supplament frequently helps with weight management in many of my patients. Supplementation with 1000-2000 IU is often adequate.  Higher doses should be discussed with your doctor.


1C P Earthman, L M Beckman, K Masodkar and S D Sibley. The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications.International Journal of Obesity (2012) 36, 387–396; doi:10.1038/ijo.2011.119; published online 21 June 2011.

2. Frost M, Abrahamsen B, Nielsen TL, Hagen C, Andersen M, Brixen K. Vitamin D status and PTH in young men: a cross-sectional study on associations with bone mineral density, body composition and glucose metabolism. Clin Endocrinol (Oxf) 2010; 73: 573–580.

3. Konradsen S, Ag H, Lindberg F, Hexeberg S, Jorde R. Serum 1,25-dihydroxy vitamin D is inversely associated with body mass index. Eur J Nutr 2008;47: 87–91.