Arthritis and Diet

Posted on Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

older-black-woman-rubbing-her-hands-arthritisThere are more than 100 different types of arthritis, and, therefore, no single diet will work for every person with arthritis.  However, studies have found that green tea, green leafy vegetables, dried plums, and kiwi fruit are all vitamin-rich and have powerful antioxidant properties.  Diets which include large quantities of fruits and cruciferous vegetables have been shown to have a beneficial effect on preventing the development of rheumatoid arthritis.  In addition, it is clear that carrying extra weight can put significant stress on the joints, and even a small reduction in weight can have an effect on the severity of arthritis symptoms.  Studies have shown that losing weight can significantly ameliorate the effects of osteoarthritis.  Significant weight gain prior to age 35 — as well as excessive alcohol consumption — has been linked to the development of gout.

Other contributing factors are certain foods and nutritional supplements (vitamins, minerals, and omega-3 fatty acids) which may play a role in preventing and reducing symptoms in some types of arthritis, such as gout, osteoporosis, osteoarthritis, rheumatoid arthritis (RA), and reactive arthritis.  Fish oil, particularly when ingested in conjunction with a diet low in arachidonic acid, reduces inflammation in some patients with rheumatoid arthritis.   Regular intake of fish has been shown to have a beneficial effect.  Consumption of excessive dietary fat, however, appears to exacerbate arthritis symptoms.

WEIGHT LOSS AND THE ARTHRITIS PATIENT

Weight loss for overweight arthritis patients is very important for several reasons.  First, as mentioned previously, loss of even a few pounds can significantly reduce stress on weight-bearing joints.   Research demonstrates that exercise and combined weight loss — as well as exercise regimens — result in decreased pain and disability and increased performance levels in patients with osteoarthritis.  Biomechanical data suggest that exercise in combination with diet may also result in improved gait when compared with exercise alone. Secondly, patients of all ages who have arthritis are much healthier, have an improved sense of well-being, and are less likely to suffer arthritis-related depression when they follow a nutritious, well-balanced diet.  The Arthritis Foundation recommends following a balanced diet that includes plenty of fruit, vegetables, and whole-grain products, while limiting consumption of sugar, salt, and saturated fat (i.e., a diet low in fat, high in fiber, and low in sugar).

By Mary O’Brien, MD

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Avoiding Holiday Weight Gain

Posted on Posted in Continuing Education, Homestudy, Psychology, Seminars

pumpkin-pie-520655_640Turkey, stuffing, mashed potatoes, gravy, sweet potato casserole, cranberry sauce, more mashed potatoes, pumpkin pie, pecan pie, cherry pie, triple chocolate cheesecake, cookies, fudge, fruitcake. Okay, pass on the fruitcake. Is it any wonder why the vast majority of exercise equipment is sold in the month of January? This year, with a little foresight and planning, things could be different.

Prevention has always been preferable to cure. A few weeks of “preventive dieting” is not a bad way to avoid the shock and horror of stepping on the scale in January. It need not be as stringent as clear liquids and lettuce from Thanksgiving to New Year’s. That would be cruel and unusual punishment. However, a few, simple, common sense measures really can make a significant difference:

  • Have a healthy breakfast with some protein and whole grains. People who routinely eat breakfast (not a crème-filled doughnut) consume an average of two hundred calories less per day than people who skip breakfast.
  • Try not to drink calories. Avoid sugary beverages such as sodas, sweetened tea, lemonade, juice drinks. Diet sodas may be tempting, but they can actually cause an increase in appetite.
  • Cut back on alcohol for several weeks. Save the wine or cocktails for the really special meals. Alcohol consumption generally increases significantly from Thanksgiving through New Year’s. Unfortunately, alcohol is loaded with empty calories and can slow metabolic rate. It also disrupts normal sleep architecture.
  • Preserve and protect sleep. Multiple studies now confirm that sleep deprivation in both children and adults is associated with weight gain. There is no mystery. Even one night of inadequate sleep can adversely affect numerous hormones, including cortisol, thyroid, growth hormone, leptin, and ghrelin. Metabolic rate can drop and appetite increases. The result is weight gain. Ease up on the late nights and parties.
  • Aim for 30 minutes of exercise every day. There’s no need to wait for January 2. The benefits of exercise are legion. Apart from the improvement in conditioning, strength, and flexibility, exercise is a terrific way to cope with holiday stress, improve sleep quality, and possibly escape annoying relatives for a while.
  • Have a light, high-protein snack before heading off to a party. Working all day, skipping dinner, and arriving at a party in a state of semi-starvation is a recipe for overindulgence. Some yogurt, a little cottage cheese, or a small bowl of cereal before leaving the house can boost self-control in the face of tempting treats.
  • Downsize plates, bowls, glasses, and mugs. Most people will eat whatever food is presented on a plate, whether it’s 10 inches or 6 inches. Use small luncheon plates or salad plates at home for every meal. This is a great strategy for year-round weight control.
  • Split dessert with a friend even at the “big event” meals. TUMS will not be required as the after-dinner mint.

Avoiding holiday weight gain is not the impossible dream. It’s entirely possible with a little planning and discipline. Besides, no one will really miss all that fruitcake.

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Managing Holiday Stress

Posted on Posted in Continuing Education, Homestudy, Nutrition, Psychology

They’re coming: Thanksgiving; Hanukkah; Christmas; and New Year. Weeks of potential, nonstop stress are right around the corner. And, all of that is followed by seemingly endless bills, three or four months of miserable weather, and tax season. What could be better? Medically speaking, all of this can lead to a perfect storm of illness. Too much stress and too little sleep can set the stage for everything from colds, flu, and pneumonia, to hypertension, heart disease, and diabetes out of control. The discussion about holiday stress aggravating anxiety and depression could fill a book.

The reality is difficult to deny. During this wonderful but weird time, millions of people will go places they really don’t want to go. They will do things they really don’t want to do. And, in many cases, they will visit people they don’t even like. This is not necessary. Too many activities, too much chaos, noise, and stress, not to mention too many calories and too little sleep, combine to create a physiologic disaster. Before the madness begins, a few principles of prevention may help:

  • Minimize caffeine and alcohol. Alcohol is loaded with empty calories and will disrupt normal sleep architecture.
  • Avoid holiday exhaustion. It’s okay to decline invitations. Try not to go out two nights in a row and schedule some quiet time instead.
  • Make time for exercise. It will help dissipate stress, boost energy, and facilitate better sleep.
  • Avoid unrealistic expectations. Don’t try to recreate a Norman Rockwell scene. It puts too much pressure on everyone.
  •  Aim for a few lovely memories—not a credit card extravaganza. Overspending is a major contributor to holiday stress.
  • Be prepared to overlook a lot. Everyone has annoying relatives. We can’t control what they say or do, but we can control our response to it. Don’t let a thoughtless remark ruin the day for everyone.

In short, managing holiday stress involves a healthy dose of common sense. Don’t overeat, overindulge, overreact, or overspend. Do try to have a healthy routine with a little less food, a lot less chaos, and for more rest. That’s a good plan for any time of the year.webinarsSeminars-CTA

 

A Brief History of Pain

Posted on Posted in Continuing Education, Homestudy, Pain, Seminars, Webinars

first-aid-908591_640Early humans explained the mystery of pain by associating it with evil, magic, and demons. Relief was the responsibility of sorcerers, shamans, priests, and priestesses, who treated their clients with herbs and rituals.

On stone tablets, ancient civilizations recorded accounts of pain and the treatments used, including pressure, heat, water, and sun. The Greeks and Romans were the first to advance a theory of sensation, the idea that the brain and nervous system were involved in the perception of pain. During the Middle Ages and into the Renaissance, evidence began to accumulate supporting these theories. Leonardo da Vinci and his contemporaries came to see the brain as the central organ responsible for sensation, with the spinal cord transmitting sensations to the brain.

In the 19th century, pain came to dwell under a new domain—science—which paved the way for advances in pain therapy. Physician-scientists discovered that opium, morphine, codeine, and cocaine could be used to treat pain. In the late 1800s, research led to the development of aspirin, to this day the most commonly-used pain reliever. Before long, anesthesia—both general and regional—was refined and applied during surgery.

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. There are two basic categories of pain, acute and chronic, and they differ greatly.

Acute pain usually results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly—for example, after trauma or surgery—and may be accompanied by anxiety or emotional distress. The cause of acute pain can generally be diagnosed and treated, and the pain is self-limiting—confined to a given period of time and severity. In some instances, it can become chronic.

Chronic pain is widely believed to represent a disease in and of itself. It persists over a longer period of time than acute pain and is resistant to most medical treatments. Chronic pain often persists longer than three months, or longer than expected for normal healing. It can be made much worse by environmental and psychological factors. It can—and often does—cause severe problems for patients, as pain signals keep firing in the nervous system for weeks, months, or years. There may have been an initial mishap such as a sprained back or serious infection, or there may be an ongoing cause of pain such as arthritis, cancer, or infection. However, some people suffer chronic pain in the absence of any past injury or evidence of illness.

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Estrogen and Cancer

Posted on Posted in Continuing Education, Homestudy, Seminars, Webinars

486321414_XSThe word “estrogen” actually refers to a family of related molecules that stimulate the development and maintenance of female characteristics and sexual reproduction. The most prevalent forms of human estrogen are estradiol and estrone. Both are produced and secreted by the ovaries although estrone is also made in the adrenal glands and other organs. Estriol is a third form of estrogen that is produced by the placenta and is only synthesized in significant amounts during pregnancy.

The breast and the uterus, which play central roles in sexual reproduction, are two of the main targets of estrogen. The estrogens normally promote healthy cell growth in the breast and uterus. Yet, this same propensity to stimulate cell proliferation can also increase the risk of developing breast or uterine cancer.

The apparent connection between breast cancer and estrogen has been noted for over a century, beginning with the publication of a paper in 1896 by Scottish physician George Beatson. The article, which appeared in the British medical journal, The Lancet, reviewed the case of a 34-year-old woman with advanced breast cancer who lived for four years after her ovaries were removed, a treatment now known as ovarian ablation.

Breast cancer risk increases with menstruation at an early age, late age at menopause, later age at first full-term pregnancy, and few or no pregnancies. Research suggests that the reason may be that these situations result in longer lifetime exposure to estrogen, which promotes cell division in breast tissue and possibly unregulated cell growth, leading to mutations.

BODY FAT & ESTROGEN

According to some studies, body fat and menopause appear to be important factors in the estrogen-cancer connection. Obesity has a complex relationship to breast-cancer risk that differs depending upon menopausal status. In one study published in the International Journal of Cancer, which included 176,886 European women between 18 and 80 years of age, researchers found a 65 percent increase in the risk of breast cancer for

After menopause, the adrenal glands continue to produce small amounts of a steroid called androstenedione, which is converted into estrogens by aromatase in fat tissue. Increased levels of this steroid may be the reason why menopause and obesity are associated with higher estrogen levels and increased risk of breast cancer. It is also believed that excess fat may cause the body to produce more estrogen than is necessary for normal cell growth.

In addition, fat cells secrete the pro-inflammatory chemicals, TNF-alpha and IL-6, either of which can act to increase the production of aromatase, which is directly related to increases in estrogen. Obesity is also associated with greater tumor burden in women diagnosed with breast cancer, higher-grade tumors, and poorer prognosis and/or increased mortality. Weight gain and obesity have been identified as the most important risk and prognostic factors for breast cancer in postmenopausal women. Moreover, the association between obesity and cancer has also been established for colorectal and prostate cancer.

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Breast Cancer

Posted on Posted in Continuing Education, Homestudy, Webinars

breast_cancer_000014453948Over 60 studies have been published that have examined the relationship between physical activity and breast-cancer risk. Although the majority of studies indicate that physically-active women have a lower risk of developing breast cancer than inactive women, the amount of risk reduction varies widely (from 20 percent to 80 percent). Most evidence suggests that physical activity reduces breast-cancer risk in both premenopausal and postmenopausal women. Women who increase their physical activity after menopause may also experience a reduced risk compared with inactive women.

High levels of moderate to vigorous physical activity during adolescence may be especially protective. For example, a recent prospective study of the activity levels of adolescent girls in relation to their subsequent risk of benign breast disease (a risk factor for later development of breast cancer) found that adolescent girls who — as young women — walked the most were at the lowest risk. The association between adolescent physical activity and breast cancer risk was also examined among women enrolled in the Nurses’ Health Study II. An inverse association was observed between physical activity at ages 14–22 and premenopausal — but not postmenopausal — breast cancer. The association was strongest for women

Awareness may have played a role in the findings of the association between diet intake and breast cancer among Polish women who were ranked according to their level of regular physical activity. The results suggested that a higher intake of vegetables and fruits may be associated with a decreased risk of breast cancer among women who were ranked in either the lowest or highest quartiles of lifetime physical activity. In addition, there was a positive association for sweets and dessert intake among women in the lowest quartile of PA. These findings could be interpreted to suggest that a high intake of antioxidant-rich foods could confer protection in the presence of either a sedentary or extremely active lifestyle. Furthermore, the high intake of sweets in those ranked as least active could be associated with a higher risk for breast cancer.  One additional study found that physical activity performed either before or after cancer diagnosis was related to reduced mortality risk for both breast and colorectal cancer survivors.

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The Zika Virus: A New Warm Weather Worry

Posted on Posted in Pain, Seminars, Webinars

mosquito-542156_640It’s odd to think about mosquitoes in the middle of winter. However, in Brazil, it’s not the middle of winter.  The Zika virus, a potentially devastating illness, has captured medical headlines around the world.  Carried by mosquitoes, the Zika virus has been documented in Central and South America, the Caribbean and several southern states.  Apart from causing miserable flu- like symptoms, this unusual and worrisome virus can cause catastrophic birth defects.  In fact, as of January 31, 2016, the Brazilian government has traced over 3,000 birth defects to Zika virus exposure in utero.

Patients with Zika infection may experience high fevers, severe musculo-skeletal pain and profound malaise.  Symptoms are often similar to those caused by another warm weather mosquito-borne culprit, Chikungunya virus.  The word, “Chikungunya,” is a tribal word describing the acute, contorted, bent-over posture of people doubled-over with pain, as the illness strikes.  An intense, maculo-papular rash on the trunk and extremities is often present early on. Encephalitis, myocarditis, and hepatitis can develop.  The most recent outbreak of Chikungunya virus flared up in October, 2013 on the island of St. Martin.

Researchers believe the current outbreak of Zika virus can be traced to large crowds and warm weather at the most recent World Cup events.  The illness has now been confirmed in 24 countries. Nearly 40 cases are being evaluated in the United States, however, all of these cases are apparently related to exposure while traveling.

Zika virus in the expectant mother can result in severe birth defects, neurologic deficits, and even anencephaly in newborns.  The Brazilian government has taken the unprecedented measure of warning women not to get pregnant until the situation is controlled.  This is an extreme policy designed to prevent extreme tragedy.  The best advice for everyone combines current science and common sense:

  • Women who are pregnant or may become pregnant should avoid travel to endemic areas of infection.
  • Be careful around upcoming Mardi Gras and Carnivale celebrations.
  • If travel is essential to these areas, avoid camping, “jungle expeditions,” dense tropical vegetation, standing water, or other obvious exposures to mosquitoes.
  • Minimize outdoor exposures at dawn and dusk.
  • Keep arms and legs covered and use insect repellants properly.
  • If symptoms develop, seek medical attention promptly and give a precise travel history.

For now, staying informed and exercising common sense and good judgment is everyone’s best bet.

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Understanding Blood Pressure

Posted on Posted in Continuing Education, Homestudy, Nutrition, Seminars, Webinars

blood-pressure-monitor-350930_640Blood pressure (BP) is a measurement of the force exerted against the walls of the arteries as the heart pumps blood to all the tissues and organs of the body. The more blood the heart pumps and the narrower the arteries, the higher the blood pressure.

BP is measured using an inflatable arm cuff and a pressure gauge. The reading is given in millimeters of mercury (mmHg) and includes two numbers: an upper number (systolic pressure) that reflects the pressure in the arteries when the heart contracts and pumps blood into the arteries [comma deleted] and a lower number (diastolic pressure) that is a measure of the pressure in the arteries as the heart relaxes after contraction (between beats).

When BP readings are found to be consistently elevated, a diagnosis of high blood pressure (hypertension) can be made. Chronic hypertension increases the risk of serious health problems, including heart attack, heart failure, kidney failure, and stroke. These complications are often referred to as end-organ damage because damage to these organs is the end result of long-standing hypertension.       Unfortunately, hypertension may be undetected for many years because it is typically slow to develop — and quite often asymptomatic. It has been estimated that one out of every five U.S. adults with high BP does not know that she has it.

The American Heart Association (AHA) estimates that hypertension affects approximately one in three adults in the United States. However, the prevalence of elevated BP that is either below the cut-off point for hypertension or undetected is much higher. For example, in 2012, 31 percent of all U.S. adults aged 18 years and older were hypertensive, and an additional 31 percent had pre-hypertension (blood pressure that is higher than normal but not yet in the high BP range).

Moreover, among individuals with hypertension, only about half (47 percent) have their condition under control even though seven in 10 hypertensive U.S. adults use medication to treat the condition.  These numbers are consistent with the most recent National Health and Nutrition Examination Survey.

Despite recent advances in the medical treatment of hypertension, and the introduction of public health campaigns designed to increase awareness of this condition, hypertension remains a significant public health problem in the United States. Our home-study course will address the definition, symptoms, causes, risk factors, complications, and treatment options for hypertension. Information about these components can provide the necessary tools to reduce the prevalence of hypertension and related health problems.

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Chocolate: Friend or Foe?

Posted on Posted in Continuing Education, Homestudy, Nutrition, Webinars

chocolate-1220655_640By Mary O’Brien, M.D.

Research suggests that chocolate is the most widely craved food. There is a special questionnaire designed with the sole purpose of assessing chocolate cravings. While only 15 percent of men report craving chocolate, approximately 45 percent of women do, and 75 percent of the women indicated that only chocolate would satisfy their food craving. Explanations of why chocolate is desired by so many are numerous and include the possibility that chocolate is addictive, replaces deficient nutrients,  triggers the release of mood-altering chemicals, and  stimulates the pleasure centers in the brain.

The desire for chocolate appears to be increased by visual cues, such as looking at pictures of chocolate  or holding a chocolate bar.  Persons who have been subjected to dietary restriction prior to encountering these cues are more likely to experience cravings combined with feelings of guilt, anxiety, and depression. Findings have demonstrated that exercise is effective in reducing chocolate cravings in persons exposed to chocolate cues.  Exercise, by reducing stress, may also be effective.

While the reasons behind chocolate cravings may be unclear, the fact that chocolate is a highly desired food is certain. This raises the question of whether giving in to the chocolate urge is harmful. One could certainly argue that a daily dose of chocolate could add to an already precarious calorie balance in some people — or that responding to the craving is establishing a habitual pattern that could manifest in other, more deleterious cravings.

However, if unsweetened chocolate is viewed strictly from a nutritional point of view, it can be described as a food consisting of saturated (palmitic and stearic) and monounsaturated (oleic) fats.  Chocolate can also be described as containing starchy and fibrous carbohydrates that have very few simple sugars and few flavonoid antioxidants.  Chocolate has several minerals, including magnesium, calcium, iron, zinc, copper, potassium, and manganese.  Chocolate has vitamins A, B-1, B-2, B-3, C, E , and pantothenic acid.  Chocolate has roughly 150 kilocalories per ounce. Unfortunately, the preferred form of chocolate for most people is not the unsweetened but the sweetened form, in which the amount of fats, sugars, and calories is increased.

Chocolate also contains the stimulants theobromine and caffeine.  Chocolate has the hormone precursors phenylethylamine and tryptophan, which are thought to have mildly anti-depressant effects. These chemicals are present naturally in the cocoa bean from which chocolate is derived. Cocoa products also contain pharmacological substances such as n-acetylethanolamines that have some chemical similarities to cannabis (marijuana), and compounds that stimulate the brain to release an opiate-like substance called anandamide. Despite the scary-sounding nature of these latter two compounds, the pleasurable effects of cocoa and chocolate do not appear to stem from their drug-like effects, but from the hedonic reaction of the mouth to the feel and smell of the combined fat and sugar. For example, when chocolate-cravers were given cocoa capsules they reported no satisfaction at all.

The moral of the chocolate story, like that of many other guilty pleasures in life, is that while a little is possibly acceptable and can even give a boost to physical and emotional health, too much pushes the pendulum in the other direction. The oft-quoted statement in this regard is “moderation in all things,” but perhaps we should also keep in mind the words of William Somerset Maugham: “Excess on occasion is exhilarating. It prevents moderation from acquiring the deadening effect of a habit.”

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Obesity and Heart Disease

Posted on Posted in Continuing Education, Homestudy, Nutrition

thick-373064_640Longitudinal studies clearly indicate that obesity predicts coronary atherosclerosis in men and in women. Hypertension, a leading cause of atherosclerosis, is approximately three times more common in obese individuals than in those who are of normal weight or less than normal weight.

Body mass index (BMI) is one of the most effective ways to measure obesity. Some studies show that a BMI that is between 25 and 30 confers as much as a 70 percent increased risk of coronary heart disease.

However, a high BMI may not entirely predict heart disease risk. In women, a BMI near 30 may still not be of major concern when the increase in fat tissue is distributed over the hips and not the abdomen.  Accumulating evidence indicates that an increased waist circumference, or waist-to-hip ratio (WHR), predicts complications and mortality from obesity.

Weight-reduction seems to be effective in reducing risks of coronary heart disease (CHD) and congestive heart failure (CHF), potentially preventing heart disease in obese patients. Evidence indicates that, for obese patients, a reduction of only five percent to 10 percent of body weight improves lipid profiles, insulin sensitivity, and endothelial function.  Such a reduction also reduces thrombosis and inflammatory markers.

Maintaining a BMI of less than 25 throughout adult life is a good strategy to reduce the risk of heart disease. For most patients with a BMI between 25 and 30, lifestyle changes in diet and exercise are appropriate.

Restricting consumption of fat to less than 30 percent of total calories should be recommended, because low-fat diets also promote weight reduction. Physical training programs can reduce body mass and help bring about gradual weight loss.

Medical therapy may be necessary in patients with a BMI higher than 30. However, the safety of long-term use of anti-obesity medications has not been established. When the BMI falls within the range of 35 to 40 (or above), bariatric surgery may be an option. Unfortunately, less than five percent of patients are able to maintain their reduced weight four years after surgery. Thus, the prevention of obesity with diet and regular physical activity appears to be the most dependable way to maintain cardiovascular health.

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