Mediterranean diet can help prevent premature death.

Posted on October 11, 2013 by drlesliegreenberg

It’s true!  About 30% of heart attacks, strokes, and deaths from heart disease can pre prevented (in high-risk people) if they switch to a Mediterranean diet.  This diet is rich in olive oil, beans, fish, fruits and vegetables, and nuts.  Wine ( in moderation, of course) is even encouraged.

The New England Journal of Medicine published a study showing the magnitude of the diet’s benefits.  The study ended early (after almost 5 years) because the results were so clear that it was considered unethical to continue.  Low fat diets have not been shown in any rigorous way to be helpful.  Low-fat diets are also hard for patients to maintain.  This is different than the Mediterranean diet which allows you to eat a nicely balanced diet with fruits and vegetables and olive oil.

I’ve added my hummus recipe.  It’s easy to make and such a hit at parties.  Pair it with some vegetables and you are incorporating the Mediterranean diet in your day.

Hummus:

.flickr.com/photos/ jericho1ne/1314130848

.flickr.com/photos/ jericho1ne/1314130848

Put all ingredients into a food processor.

  • one can (15 ounce) chick peas (garbonzo beans) drained
  • 1/3 cup tahini (sesame seed paste)
  • 1 Tbsp. olive oil
  • 1/4 cup lemon juice
  • 1 tsp sea salt
  • 1/8 tsp cumin

Food process for 3 minutes.  Add water until it’s the right consistency.  Enjoy!

Posted in food, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , , | Comments Off on Mediterranean diet can help prevent premature death.

Should Tylenol be given before vaccines?

Posted on October 8, 2013 by drlesliegreenberg

Probably not. Here’s why…

There was a 2010 study that showed that Tylenol given before vaccines can actually BLUNT the immune response to the given vaccine.  The CDC has since released a statement that there are basically no good studies supporting the use of Tylenol as pretreatment.  Some parents think that the Tylenol beforehand will make the poke hurt less.  I doubt this is a significant savings in pain and may decrease the ability for the body to respond to the vaccines.  If a fever occurs due to the vaccine, then Tylenol may be given, but in many cases should not be needed.  As a mom, I think that a hug and kiss do more to alleviate the “pinch” of a shot.

Of note, most patients have a fever on day 5 after their MMR vaccine.  This is the measles, mumps, rubella vaccine that is given routinely at the well-child checks at 1 year and 4-5 years.

Hope this helps.

flickr.com/photos/e n321/55331295/

flickr.com/ photos/en321/55331295/

Posted in Pediatrics, Uncategorized, Vaccines | Tagged , , , , , , , , , , | Comments Off on Should Tylenol be given before vaccines?

Beware of medications that can impair your driving

Posted on September 26, 2013 by drlesliegreenberg

Legal medication can impair judgment and motor skills.  A National Highway Traffic Safety Administration study named a range of drugs (see below) which can potentially impair driving.  Past research on prescription drugs and driving has centered on narcotic medications.  Scientists have long believed that patients on stable long-term regimens of opioids develop a tolerance that allows them to drive safely.  But, recent studies have complicated this picture.

We also know that frequently more than one medicine (that can impair decision-making or fine motor skills needed to drive) are taken together.  Many medicines have what’s called a synergistic effect.  This is like one plus one equals three.  One medicine plus another one amplifies the impaired symptoms.

Drug class: possible side effects

  • Anti-diabetic medicines:  Low blood sugar
  • Anti-spasm:  Blurred vision
  • Narcotic painkiller:  Tiredness/sedation
  • Anti- high blood pressure:  Low blood pressure/foggy thinking
  • Sedatives/hypnotics:  Impaired reflexes
  • Antidepressant:  Sedation/dizziness
  • Anti-allergy: Sedation/dizziness
  • Heartbeat regulator:  Fainting
  • Anti-convulsant:  Dizziness/sedation/instability
  • Skeletal muscle relaxant:  Dizziness/sedation

flickr.com/photos/ alabadrock/ 444496369Consider the possible result of your actions—for yourself and everyone else on the road.

Posted in General Medicine- Adults, medication issues, Uncategorized | Tagged , , , , , , , , , | Comments Off on Beware of medications that can impair your driving

A medicine may delay type 2 diabetes by up to 10 years?! Yes.

Posted on September 23, 2013 by drlesliegreenberg

This is a great feat!  Although I should place a caveat that TWICE as effective as this medicine for preventing diabetes is lifestyle modification with diet and exercise (see below for specifics).

Metformin is a medicine that reduces the risk of developing diabetes in “at-risk” adults when compared to taking placebo pills.  This effect is likely effective for up to 10 years.

Who is  “at-risk”?  Those with…

  • Elevated fasting glucose (more than 100 on a fasting lab test),
  • Hemoglobin A1c test result 5.7-6.4,
  • History of gestation diabetes with a pregnancy,
  • Obesity (BMI of more than 25),
  • Polycystic ovary syndrome,
  • Family history of diabetes,
  • Hypertension,
  • Peripheral Vascular Disease,
  • High cholesterol.

Lifestyle modification is harder than taking a pill every day, but may also positively affect many other areas of your life.  This study showed that a modest weight loss of 7% body weight and exercising 150 minutes per week was greatly effective in decreasing the risk of converting to overt diabetes.

flickr.com/ photos/ widezoom/ 4627134131//

flickr.com/ photos/ widezoom/ 4627134131//

Why not take out your walking shoes today?

Posted in Diabetes, General Medicine- Adults | Tagged , , , , , , , , , , | Comments Off on A medicine may delay type 2 diabetes by up to 10 years?! Yes.

Well, med school was wrong again!

Posted on September 19, 2013 by drlesliegreenberg

flickr.com/photos/ axis/8743610464/We hear in med school that half of what we learn we will later find out is wrong.  But, which half?  We know future studies reveal different “truths” and I appreciate the need to debunk old theories if indeed they are not correct.

What is the latest debunking?  Omega-3 fatty acids have been prescribed to help cardiovascular protection and possibly help decrease all-cause mortality, heart attack, sudden death and stroke.  Well, that’s wrong.  The latest (according to a meta-analysis of over 68,000 patients) is that taking omega-3 supplements does NOT lower cardiovascular risk.  There are, however, no harmful effects of omega-3 supplements.  This brings up a point that sometimes advice we give to help actually (upon further experimentation) is found to harm.  But, omega-3 is not thought to harm.  So, if you’d like to continue to take them that’s okay!

Certainly eating two servings of fish per week may be helpful (as you may substitute this instead of greasy cheeseburgers).  Hope this helps.

Posted in General Medicine- Adults, heart, medication issues, Uncategorized | Tagged , , , , , , , , , , , | Comments Off on Well, med school was wrong again!

Is there a magic bullet for weight loss?

Posted on September 16, 2013 by drlesliegreenberg

flickr.com/photos/johnkay/ 5528593758 /sizes/o/i n/photolistYes, we have one.  But, it seems too simple. . . not glitzy enough.  We do have a multitude of interventions, tips, tricks, tools which MAY help combat weight challenges.  Interventions vary in cost to the individual and to the health care system.  At one end is bariatric surgery (like gastric bypass), and at the other. . . water!  Yes, the treatment is water!

The increasing preference for sugar-sweetened drinks has primed the world for an obesity epidemic.  Research suggests that low- (or no-) calorie sweeteners may actually “prime” you to consume more  calories at the next meal.

Unlike other beverages, water has been shown to reduce total energy intake, increase the feeling of fullness, increase energy expenditure, and reduce the feeling of hunger.  Premeal water consumption (16 ounces is a good amount) may reduce caloric consumption due to earlier satiety.

It’s an easy to incorporate, free, and accessible treatment. . . Water.  Enjoy!

Want more information?  Check out American Journal of Clinical Nutrition, 2013; 98: 282-299.

Posted in General Medicine- Adults, Uncategorized | Tagged , , , , , , , , | Comments Off on Is there a magic bullet for weight loss?

More maternal guilt. . .

Posted on September 13, 2013 by drlesliegreenberg
flickr.com/photos/ jessandcolin/ 4155145700

flickr.com/ photos/ jessandcolin/ 4155145700

If you smoke and are considering a pregnancy, stop smoking!

There is evidence emerging that smoking during pregnancy (and how many cigarettes smoked per day) is correlated with developmental outcomes after the children are born.  The children of smokers were found to have more conduct problems like getting into fights or having difficulty paying attention.

This study was performed on three continents (in New Zealand, UK, and USA) and compared children’s behavior between ages 4 and  10.   Behavior was scored by both parents and teachers.  They reported on children’s conduct problems and gave them a score.

The researchers in this study, published in JAMA Psychiatry, remarked that “it’s illuminating the prenatal period as having an ongoing influence on outcomes.”    It is thought that influences both prenatal and postnatal are clearly important.

Postulated explanations for this behavioral difficulty may be that the babies of mothers who smoke may be born smaller or have impaired brain development.

I am not a smoker. I do appreciate how addictive nicotine is.  There are innumerable reasons WHY to quit– this is one more.   Thankfully, there are good resources and medications to help stop smoking.

Ask your doctor for help today!

Posted in General Medicine- Adults, nicotine, Obstetrics, Pediatrics, Uncategorized | Tagged , , , , , , , , , , , | Comments Off on More maternal guilt. . .

Pneumonia vaccine has been a success!

Posted on September 9, 2013 by drlesliegreenberg
flickr.com/photos/ kevint/ 85911467

flickr.com/photos/ kevint/ 85911467

The seven-strain pneumonia vaccine used in the US since 2000 has been effective in decreasing infections caused by strep pneumonia.  We routinely give this Pneumococcal conjugate vaccine at 2, 4, and 6 months with a booster at age 12 to 15 months.  It is estimated that 73,000 hospitalizations annually have been prevented by the vaccine.

One important patient population that has benefited has been children under two years of age.  Pneumonia hospitalizations are estimated to be down 43% after vaccine introduction.  This number only reflects pneumonia reductions.  The vaccine is also preventing ear infections and clinic visits for illness.

Another patient population that has been greatly affected has been those 75 years and older.  It’s estimated that 12,000 deaths were prevented annually since this vaccine was released. The greatest decrease in deaths was among those aged 75 and older.  We know that pneumonia is fatal for 7 to 12% who contract pneumonia.  Adults did not receive this vaccine, so this benefit was a demonstration of “herd immunity.”  When one member gets vaccinated it can help others avoid infection.

More good news is that in 2010 the vaccine make-up was changed to include 13 strains of pneumonia.  It is postulated that this will further cause a big decline in pneumonia related infections.

Way to go, vaccine-makers!

Posted in General Medicine- Adults, infections, lung conditions, Pediatrics, Uncategorized, Vaccines | Tagged , , , , , , , , , | Comments Off on Pneumonia vaccine has been a success!

Aspirin has beneficial side effect

Posted on August 30, 2013 by drlesliegreenberg
flickr.com/photos/ mag3737/ 511834317/

flickr.com/photos/ mag3737/ 511834317/

Aspirin, when taken every other day for at least 10 years, decreased colon cancer in women by 20%.  Women who took 100 mg of aspirin every other day were found to have this benefit.  The study was specifically performed in women, so a male benefit is unknown.

This was published in Annals of Internal Medicine and is a follow up to an earlier study which didn’t find a cancer difference.  This shows that this benefit does not “kick in” until about 10 years after the start of regular use.  Of note, there are known side effects of taking aspirin.  Aspirin can cause serious, even occasionally fatal, stomach bleeding, even at low doses.

The American Cancer Society does not recommend that people use aspirin specifically to prevent cancer.

Interesting finding. . .

Posted in Cancer, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , | Comments Off on Aspirin has beneficial side effect

Obese mothers pass on risk to their babies

Posted on August 27, 2013 by drlesliegreenberg
flickr.com/photos / mestreech/ 1141289549

flickr.com/photos / mestreech/ 1141289549

New known fact: Children of obese women died earlier and had more heart problems later in life than those of normal weight mothers.

The offspring’s risk of death from any cause was 35% higher than individuals born to normal weight mothers.  This was even AFTER adjustment for demographics, gestational (during pregnancy) and socioeconomic factors.

This study of 37,000 newborns born from 1950 to 1976 suggests that interventions for obese mothers should start BEFORE pregnancy.  One of the researchers postulated that there are probably two reasons for this: both intrauterine metabolic programming (while still inside mother while the fetus is forming) and postnatal environment (exercise/diet patterns in the home after birth).

There are lots of health benefits, both physical and mental, for maintaining a healthy weight.  Consider losing weight to be within a BMI of 20-25 before conception.

BMI calculator link.  http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm

Hope this helps.

Posted in General Medicine- Adults, obesity, Obstetrics, Uncategorized | Tagged , , , , , , , , , | Comments Off on Obese mothers pass on risk to their babies