Wise Thoughts . . .

Johann Wolfgang von Goethe once said that all truly wise thoughts have already been thought thousands of times; but to make them ours we must honestly ponder them and apply them till they take root in our personal experiences.
My first question is who thought them? Second, how do we honestly ponder a wise thought?
King Solomon implied that the Lord gives wisdom (1) and the mouth of the just brings forth wisdom (2). Wisdom and knowledge will bring stability in times of turmoil (3).
Let no day, therefore, pass you by without some intellectual gain . . . Let the hope of new discovery, as well as the satisfaction and pleasure of known truths, animate your daily industry.

The Dalai Lama, when asked what surprised him most about humanity answered, "Man. He sacrifices his health to make money. Then he sacrifices money to recuperate his health. Then he is so very anxious about the future that he does not enjoy the present; the result being that he neither lives in the present nor the future. He lives as if he is never going to die, then dies having never really lived."
The wise thought then comes as inspiration and will be applied bringing value. The application of these thoughts brings you and I the greatest happiness.

1. Proverbs 2:6
2. Proverbs 10:31
3. Isaiah 33:6

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.

References:

1. C 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.

What Would Your TSA X-ray Say?

Cholesterol Drugs Increase Risk for Diabetes?

A recent article in the January 9th edition of the Archives of Internal Medicine (1) found that post menopausal women had a 48% increased risk of getting diabetes if they used any of the STATIN type cholesterol medications. The Women's Health Initiative, an observational study of over 153,000 post menopausal women found this increased risk. This is a significant finding and a worrisome claim.

In a time when STATIN medications like Crestor, Lipitor, Zocor, and Pravachol are being used more frequently to decrease risk of coronary heart and vascular disease, this poses a significant risk and raises a number of questions.  Is the increased risk actually due to the cholesterol lowering medication, or is the progression to diabetes a component of the patient's heart disease risk due to other genetic factors?  Is the mechanism of action in these cholesterol medications contributing to diabetes risk or are these patients already in the progression to diabetes and cardiovascular changes were identified and treated prior to progression to diabetes.
What should you and I make of this data?  Well, first, don't stop your cholesterol medication. Talk to your doctor about this study and your risk of diabetes.  Second, realize that cardiovascular changes and elevation in cholesterol starts up to 20 years before diabetes is diagnosed in many patients with insulin resistance and metabolic syndrome. Third, further evaluation and research needs to be done and we shouldn't base our decisions on just one observational study.
More to come on this subject I'm sure . . .

Reference:
1. Culver AL, Ockene IS, Balasubramanian R, et al. Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative. Arch Intern Med. Published online 2012 Jan 9. doi:10.1001/archinternmed.2011.625

What's For Breakfast?

Many of my patient's ask me what I eat regularly.  I thought that I would document my meals for a few weeks to give you ideas and include recipes when pertinent.  Here was this mornings breakfast . . . and, Oh, was it tasty!

Said Hippocrates . . .

"Let food be your medicine, and let medicine be your food."

Colon Cleansing? Yea, Right.

I had a few patients ask about an article I read published on the Men's Health blog today: "Ashton Kutcher's Plan to Survive the Apocalypse." I had to laugh. It's quite entertaining to read about his plans to thwart the apocalypse with colon cleansing. 
I'm not quite sure how cleansing your colon will protect you from the apocalypse, at least the the apocalypse I envision and have read about in the Bible's Book of Revelations.  Either way, there's only one problem with colon cleansing including the Master Cleanse diet. Colon cleansing is a sham.  Yes, a sham. 
The body was designed to clean itself and to heal itself, especially the colon and liver. There is a constant turnover of colon cells and liver cells each week and each month.  There is no need to plug yourself full of "detoxifiers" or use a combination of  "fresh lemon juice, rich maple syrup, and cayenne pepper into pure water" (Master Cleanse recipe) acting as a laxative to cleans your colon.  A simple fast for 18-24 hours does the same trick.  The only reason to clean yourself out in this way would be to prepare for a colonoscopy where the gastroenterologist needs to see a colon that is "spic and span" clean.  Now, if you are just worried that at the time of the apocalypse you'll need clean underwear and you think you would just feel fresher with a clean colon, then be my guest, more power to ya!
So what do you need for the end of the world?
Well, for starters, studies show that many of us are not really ready for an emergency including the worlds demise. But here are a few things to think about having ready just in case the need arises:
Water. You'll need at least a 3 day supply for each person in an emergency and enough to last up to 2 weeks if you're at home. 
Food.  Fresh lemon juice and maple syrup will only last you a week before the diarrhea is so bad you would wish you died from the apocalypse.  So I would suggest at least a 3 day supply for evacuation and at least a 3 month supply for your home. 
First Aid Kit. Hey, I'm a doctor, and you're reading my medical blog, so the first things I think about are food and band-aids. 
Medications for 7 days. Having a 7 day supply of medications on hand is essential, especially for those with significant heart or lung diseases. 
Personal Hygiene Items. Placing all of these items in an emergency 3 day pack or bag that can be easily grabbed on your way out the door is a very good idea.
Emergency Blankets. You never know where a good blanket could come in handy in an emergency.
Batteries.  These are self explanatory.
Extra Cash.  In an emergency, the last place you want to be is at the bank (cause everyone else will be there too).   So it is a good idea to have a little stash of cash available for emergencies. 
Flashlight. Self explanatory.
Radio (battery powered or handcrank). 
Hopefully, you are already prepared.  If not, you should consider the above list along with any other items you think may be handy.  Regardless of what Ashton Kurcher or Demi Moore says,  the colon cleanse really won't do you much good at the worlds end. 

Health

Healthy citizens are the greatest asset any country can have.