Health Across America

Understanding the big picture

A recent report by the National Cancer Institute, and reported in USA Today, has stated that cancer death rates have been falling for at least 25 years. Cancer is the second leading cause of death in America behind cardiovascular disease. This sounds like good news, but let’s unpack what lies behind the headlines. Does this represent the big picture?

Lower smoking rates are translating into fewer lung cancer deaths. Lung cancer is the leading cause of cancer death in America. Early detection has also helped reduce deaths due to lung cancer. In USA Today headline, the most important factor in helping lower the death rate was stopping the leading cause of our most deadly cancer. Intuitively, getting at the cause is what is lowering cancer rates, specifically lung cancer. 

In 2017, increasing death rates were reported in 7 of the 10 leading causes of death. Is cancer really a bright spot? Why is the rate of lung cancer still high in some states? Is the rate of cancer dropping? What about the other types of cancer?

Dr. Rob Headrick, one of my partners and chief of thoracic surgery at Memorial Hospital, shared this on lung cancer with our group in Tennessee:  “We’ve got a terrible cancer death issue in our state, and people in our communities are hurting worse than others in the rest of the country.” Smoking prevention would help Tennessee catch up with the rest of America.

Many types of cancer have increasing death rates. These include the cancers associated with obesity. Obesity is associated with many physiologic changes increasing the cancer risk. Pancreatic, uterine, liver, and breast cancer have links to obesity. It may take decades to see the full effects of obesity on cancer.

The take […]

We do not know

This last month there have been quite a few articles in the media regarding artificial sweetener. Much of the information has been on the negative side. Some has been defending the artificial substances. I have an opinion for what it is worth. The opinion is, I do not know.

Artificial sweeteners are basically substitutes for sugar. These are found in many products. They are much sweeter than traditional sugar without the caloric load. Diet colas, cereals, and many processed foods contain artificial sweeteners. They may taste good and have few calories, but there are risks.

Aspartame is 200 times sweeter than sucrose. Our brain likes sugar and many with susceptible genetics can become addicted to sugar. We need more and more sweetness to keep the pleasure pathways in the brain happy. Our bodies want to feel good. Our receptors down regulate and we need more sugar to make the dopamine and natural opioids are body craves. With the additional sugar come more calories. Traditional sugar has a cost in calories and may lead to a plethora of health problems. Aspartame was developed to help with the caloric burden.

There has been much in the media about aspartame. It has been implicated in Attention Deficit Disorder, birth defects, cancer, behavioral problems, and interactions with medications. In reading through the articles, the elephant in the room is that we just do not know what these artificial substances do to the body. These substances have very complex bio-chemical breakdown pathways that may vary from person to person.

For example, aspartame breaks down into phenylalanine, methanol, aspartic acid, formaldehyde and formic acid. Aspartame may deplete the neurotransmitter, serotonin, which has many implications in brain health.

Aspartame breaks down to phenylalanine. Tyrosine, another amino […]

DNA Study Announced

The U. S government is currently seeking one million people from all walks of life willing to share their DNA, environment, and health habits with researchers. The goal is to evaluate how lifestyle changes our genes.

This ambitious 1.45 billion dollar study by the NIH will give new and valuable information on the importance of lifestyle factors in health. Frances Collins, director of the NIH, describes the All of US Research Program as “A national adventure that is going to transform medical care.”

We know that stress from certain lifestyle habits can age our genes. Pending our genetic hardware, these stressors eventually may cause damage with the resulting symptoms. The terms telomere shortening and methylation are just some of the mechanisms that attempt to explain these changes. Our current medical system focuses on evaluating symptoms and treating them.

This study hopes to quantitate the role of various lifestyle factors on physiology. Why do some people stay healthy despite smoking, poor nutrition, or other environmental stressors? Could lifestyle changes be more important than medications? How do nutritional interventions, and mental stress change our genetics? I am particularly interested in the physiology of worship.

This NIH study aims to be the largest and most diverse of its kind. This study will need to enroll a diverse group and plans to follow one million for ten years. I applaud those initiating this important study. This study has enrolled 25,000 to date. Finding those one million to study will be no easy task. This is a story we will want to follow.

New Hypertension Guidelines

Dr. Paul Whelton and a large number of experts in hypertension have recently published new guidelines for the treatment and prevention of hypertension. These guidelines have been published in many scientific journals and the media has covered this release extensively. The new guidelines replace JNC-7 guidelines. Why are the new guidelines getting so much attention?

The new guidelines lower and change the definition of hypertension. The new blood pressure number is 130/70. If your blood pressure is above this, you have high blood pressure. This will increase those with high blood pressure to over 45% of the adult population. I was recently asked to present a perspective on hypertension at a cardiovascular symposium.

The new guidelines are just that, new guidelines. Our bodies were not designed to be exposed to prolonged high pressures in our arteries and organs. Pending our genetic make-up, this leads to damaged organs and the resulting problems such as heart attacks, stroke, aneurysms, kidney disease, dementia, organ dysfunction and the list goes on.

According to a study by the Health Care Cost Institute, those with high blood pressure spend three times more on health care than those without and about two times more on out of pocket. From 2012-2016 spending for those with hypertension grew 18.3 percent.

The new guidelines ask clinicians to define the measurement more accurately and assess risk. The recommendations also emphasize treating the cause of high blood pressure including the myriad of lifestyle factors including too much sodium, too much fat, inactivity, and stress.

One major problem persisting through all previous guidelines is that our culture does not reward lifestyle changes, nor do we stress the importance. There have been numerous guidelines and yet the problem, hypertension, continues to escalate. Clinician […]

Opioids: Looking at Cause

Darlene Superville of the Associated Press has joined the many journalists nationwide in pointing out the dangers of the opioid epidemic. In her article, she focuses on the economic implications. In 2015, the crisis as it is now being referred, cost 504 billion dollars. This is a far higher estimate than previous estimates.

I want to focus on a few points today in this column. More than 64,000 died from overdoses last year. We as a society are becoming more and more dependent on medications. Medications are needed at times and they have a place, but as we see with the opioid crisis, we, in the health care world, need to look at the cause of problems.

This is a major challenge as our cultural values, marketing efforts, and society in general wants a quick fix to our problems. There is so much money and lobbying involved, this problem will linger for a long period of time. We are now in the, “Oh we have a problem phase.”

A few years ago I felt so strongly about the problem of deaths related to medication, I wrote the book, “Medicines that Kill”. This book was intended to give individuals another source to educate themselves. I still feel the number one cause of death in America is the misuse of medications. The opioid crisis is just more evidence. As this is such a problem, we need to continue to speak out in the media. Individuals need to hear other voices that have no financial interests in the industry.

If you are taking an opioid or other medications, ask yourself if this is treating the cause. Is there anything you can do to address the cause of the symptom or the […]

Are stents the answer?

The New York Times has reported in November 2017 on a new study in the journal Lancet. This study found that while cardiac stents can be lifesaving in opening arteries in patients having a heart attack, the devices are ineffective in relieving chest pain.

Stents are tiny wire cages to open arteries. They are useful when patients are having heart attacks or unstable symptoms, however, they are often deployed when patients have no symptoms just blockages. More than 500,000 had stents placed last year. Stents do carry risk. They are expensive.

This study placed stents in some and had sham procedures in others. The study found no real difference in the groups who all had blockages and symptoms related to these blockages.

Of course, this has raised a bit of controversy in the cardiology world. There have long been questions regarding the effectiveness of stents. A 2007 study led by Dr. Boden and published in the New England Journal of Medicine found stents did not prevent heart attacks or deaths from heart disease. Yet stent procedures continue. Cardiovascular disease is not being cured by stent procedures.

Cardiovascular disease is a diffuse, complicated disease. Stents do damage blood vessels. I tell my patients our goal is to halt or reverse disease and not merely treat a symptom, though this may be necessary in some situations. The sham procedure also raises the question about belief systems in the treatment of disease. The mind plays a large role in the physiology of cardiovascular disease.

Many are now rethinking how they practice. This has just given me more evidence to use in educating and motivating patients to be more proactive and treat the causes of cardiovascular disease. Ask your cardiologist about all treatment […]

Media is stressing me out!

Recently Wallet Hub has released their most and least stressed cities.

The stressors in these cities could be commuter stress, unemployment stress (mental), divorce stress (social), poor physical health, pollution etc.

I do not know about you, but the media is stressing me out. With negative stories and a constant bombardment of trivia my epigenetics are changing.

Stress, no matter the source, is not good. Every input affects the body. Inputs from food, lifestyle habits, medical conditions, and even food, change the body. Stress can shorten telomeres causing our DNA to age triggering mutations and malfunctions. Next come symptoms and a trip to the doctor.

Everyone has a genetic hard drive given to us by our parents. The stressors of life make up the software, which changes the hardwiring. We want inputs that improve the hardwiring.

If everyone in your family loses their hearing at age 70 and you are exposed to the stress of excessive noise, your hearing may worsen sooner. The hardwiring is stressed by the noise.

The same can be said for other parts of the body. If your genes are prone to dementia and your brain is stressed by alcohol, lack of sleep, pain, poor nutrition, lack of movement or whatever, the brain may age sooner. Medications may treat symptoms but do not address cause.

The point I want to make is to pay attention to the stressors in your life and limit stress related damage to your DNA. Remembering that all inputs affect the body to some degree.

The body is much more complicated than we can even imagine. The more I learn, the less I know. As technology progresses, the complexities are being uncovered. Don’t forget, too much media can also be a source of stress. […]

Brain Pains – Is it worth it?

In August every year, I am inundated by football. High school young men getting ready for the season, hype on the upcoming college season, and professionals getting prepared for the season are the stories in the media. Everyone has a story, comment or opinion on the upcoming games. Remember these are games. Yet we cannot get enough media coverage about football.

A study published July 25, 2017 in the Journal of the American Medical Association examined the brains of deceased, former football players ranging from youth to pros. 88 percent of the individuals had chronic traumatic encephalopathy, or CTE. This is a degenerative brain disease caused by repeated trauma to the skull. Trauma to any body part is not a good thing. Trauma to the organ responsible for controlling the body, including higher levels of thinking and functioning is a major stress.

The three-pound brain with 80-90 billion neurons and quadrillion interconnections enclosed in a protective casing needs to be protected. It is too valuable to be “banged around.” At younger ages as the brain develops, the impacts are more pronounced.

The latest study is the largest study to date and again suggests that football players may be at the greatest risk of developing neurologic disease. Of those pros examined 110 of 111 brains studied had CTE, of college brains examined 48 of 53, and 3 of 14 of high school brains had CTE.

Genetics, years played, amount of force and hits, hydration, and a host of other factors could affect the disease’s progression. Years ago, we did not fully understand the dangers of cigarettes, the same can now be said of football. We are just beginning to understand the impact on health that football is having.

Nationwide over […]

It takes time. Let’s make time.

If I were part of the physician led team treating George Washington years ago and suggested leeches were “not a good idea”, there is a good chance I would not be invited to the next meeting of the local medical society. Similarly if I were practicing dentistry and suggested that cocaine might not be the best anesthetic agent, dentists from that time would have thought that idea, “strange.”

Throughout the course of history new ideas and discoveries have often taken time to be accepted by leaders. This is not unique to medicine. This has been the case for scientific advancements, new business ideas, and even political discoveries. Unfortunately, taking time has cost lives. Even though new ideas took time to be accepted, did individuals make time to evaluate the evidence?

Smoking has been going on for years. In the 30’s it was suggested that smoking be used as a treatment for asthma. Now, years later, it is well known that smoking is a risk factor for heart disease, lung disease, and cancer. Smoking shortens life. Even thought this is well established, people still smoke. The good news is, we know the truth, and individuals can decide. Those promoting smoking cessation are no longer being looked on as strange. It just took time.

The American College of Cardiology has recently released new recommendations that urge hospitals to improve patient menus by adding plant-based options and removing processed meats which have been linked to 60,000 cardiovascular deaths a year (JAMA, online March 7, 2017).

This recommendation of one plant-based main dish at each meal with a variety of vegetables and fruit is not a new concept. Many have been recommending this for years and now those voices and research are […]