Wednesday, June 29, 2011

Gallstones

Every year, more than one million Americans discover that they have gallstones, pebble-like deposits in the gallbladder that can grow to the size of a golf ball. Sludge or thick gritty secretions may also be present within the gallbladder, either alone or in conjunction with gallstones (calculi). About one half of people diagnosed with gallstones end up having their gallbladder removed. These stones, formed in the gallbladder, may pass into other parts of the biliary tract such as the cystic duct, common bile duct, pancreatic duct, or the ampulla of Vater. When this happens, other more serious complications may arise.

The most common symptom of gallstones is pain in the upper right quadrant of the abdomen, under the ribs. The pain may start suddenly and spread to the right upper back or shoulder blade area. It is then usually very hard to get comfortable. The pain will often occur after meals, especially greasy ones. The pain may last minutes to hours and cause difficulty taking normal or deep breaths. Gallstones can also cause nausea and vomiting, which may relieve some of the pain or pressure. Pain that occurs with a fever, nausea  and vomiting or loss of appetite may be a sign of inflammation or infection of the gallbladder (acute cholecystitis) and must be treated quickly. There are other conditions that cause similar symptoms, including heartburn, heart attack, liver problems, a stomach flu or food poisoning. 


Gallstones can be divided into the following types:
1. Cholesterol stones: light-yellow to dark-green and are generally 2 to 3 cm in length. To be classified as such, they must be at least 70-80% cholesterol by weight.
2. Pigment stones: small, dark stones made of bilirubin and calcium that are found in bile. They contain mostly bilirubin and about 20-30% cholesterol.
3. Mixed stones: typically contain cholesterol, calcium , palmitate phosphate, bilirubin, and other bile pigments. Because of their calcium content, they are often radiographically visible (seen on x-ray).

Risk factors for getting gallstones include:
 Obesity
 Estrogen
 Ethnic background (Native Americans and Mexican-Americans)
 Gender and age (women, over 40yo)
 Cholesterol lowering drugs
 Family history
 Diabetes
 Rapid weight loss

Helpful ideas to prevent gallstones:
 Lose weight
 Drink plenty of water
 Take supplemental calcium
 Take supplemental vitamin C
 Eat a low fat diet, 25% or less (but not extremely low-fat)
 Limit sugar in your diet
 Increase your fiber intake
 Consider soy protein for animal protein

Treatment:
Removal of the gallbladder: Generally done laparascopically and most patients recover within days.
Medications; Ursodeoxycholic acid (Actigall) or chenodiol (Chenix) can both help dissolve gallstones; however, this treatment can take months and stones may reoccur.
Lithotripsy: uses sound waves to break up gallstones. However, this procedure is used only for patients who cannot undergo surgery and works best on smaller single stones. Risks include pain and inflammation of the pancreas and possibly a return of the stones.

Friday, June 24, 2011

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS or spastic colon) is a bowel disorder characterized by chronic or intermittent abdominal pain, bloating, gas, and diarrhea or constipation (or both) in the absence of any detectable cause. The symptoms are generally relieved by bowel movements. IBS is more common in women (about 1 in 6) and often begins in the teens or early 20s. It is the most common intestinal complaint in a physician's office. Also, IBS is not the same as inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis. You must also "rule out" food allergies or gluten sensitivity as the cause of bowel symptoms, as the incidence has risen dramatically in recent years. Milk, eggs, peanuts, tree nuts (ie, walnuts), shellfish, soy and wheat account for 90 percent of all food-allergies.

It is not clear why people develop IBS. There are many possible causes such as a problem with muscles in the intestine, the nerves or an increased sensitivity to stretching or movement. A combination of factors, including stress, hormones, the immune system, and chemicals called neurotransmitters are probably involved. Stress can worsen IBS as the nerves become more active during times of stress and can cause the intestines to squeeze or contract more. Despite the variety and often severity of symptoms, IBS doesn't cause permanent damage to the colon.

Other physical and psychological issues include: loss of control over affected individuals lives, restricted activities (an average, they have to restrict their usual activities up to 25%) and a higher incidence of depression and mood disorders. These sufferers will often try multiple medications with variable effects.

Common symptoms of IBS:
Abdominal pain: is the main symptom and 25% will have chronic pain, 75% will have intermittent pain
Alternating bouts of diarrhea and constipation.
Bloating
Gas (flatulence)
Mucus in the stool.


Natural remedies for IBS:
Avoid caffeine.
Avoid alcohol.
Limit fatty foods.
Limit dairy products, fruit, and artificial sweeteners (for diarrhea).
Increase fiber (for constipation).
Increase water intake (constipation).
Avoid beans, cabbage, cauliflower or broccoli (causes
bloating or gas).
Increase exercise.
Quit or decrease
smoking.

Natural therapies:

Probiotics: supplements containing "friendly" bacteria.
Digestive enzymes: contains amylase, lactase, protease, and lipase to enhance the digestive process.
Peppermint: for its antispasmodic effect.
Chamomile: has antispasmodic properties.
Stress management.

Medical therapies:


For diarrhea:
1) Antidiarrheals: diphenoxylate (Lomotil) and loperamide (Imodium).
2)
Bile acid binding agents: cholestyramine, which prevent bile acids from stimulating the colon, slowing the passage of stools and relieving diarrhea.
3) Alosetron (Lotronex): slows the movement of stools through the bowels and decreases abdominal sensitivity. It has been shown to relieve symptoms in some women who have severe diarrhea and have failed other treatments. This medication was previously discontinued when its use was linked to ischemic bowel disease (when there is not enough blood flowing to the intestines); however, now it is approved for limited use in IBS. Be careful with this medication.


For constipation:
1) Polyethylene glycol (MiraLax): helps the stool hold on to more water, making it softer and easier to pass. This medication is popular, considered safe and can be used on a regular basis.
2) Lubiprostone (Amitiza): works by increasing the amount of fluid in your intestines, making it easier for stool to pass.
3) Laxatives (Milk of Magnesia and lactulose): work by increasing fluids in the intestine making the stool softer and easier to pass. Use osmotic laxatives sparingly.

5) Stimulants (Correctol, Dulcolax, or Senokot): speed up the intestines by irritating the lining of the colon. Use stimulant laxatives sparingly as you can become dependent on them.

For pain and cramping:

1) Antispasmodics (anticholinergics): such as dicyclomine (Bentyl), which helps prevent the cramping or spasms in the intestines.
2)Antidepressants: tricyclic antidepressants such as desipramine (Norpramin) or amitriptyline (Elavil) have been effective in controlling pain and diarrhea. SSRIs (Prozac, Zoloft...) may be preferred in older patients or in those with constipation because they have little or no anticholinergic effects.


Irritable bowel syndrome can be a chronic and debilitating condition. A diet high in fiber and water, low in fatty foods, caffeine and alcohol will have a positive effect on improving the symptoms of IBS. A combination of natural therapies with specific medications tailored to the symptoms will also help improve IBS.

Saturday, June 18, 2011

Metabolic Syndrome

Metabolic syndrome is actually the term for a combined group of risk factors: high blood pressure, high blood sugar (insulin resistance and diabetes or pre-diabetes), high lipid levels, and abdominal fat (central obesity). These risk factors double your risk of heart disease, heart attacks and strokes. They increase your risk of diabetes by five times (500%). The two most important risk factors are obesity and insulin resistance, which are generally tied together. Metabolic syndrome is becoming more and more common in the United States: approximately one fourth of adults met the criteria for metabolic syndrome and almost 50% of those over age 50 have it.

Metabolic syndrome can cause:
Damage to arteries leading to heart disease or stroke.
Decrease in the kidneys' ability to function, leading to kidney disease
and high blood pressure.
An increase in triglyceride levels, resulting in an increased risk of heart disease.
An increased risk of blood clot formation, which can cause heart attacks and strokes.
Worsening function of the eyes, nerves, and kidneys.

According to the American Heart Association and the National Heart, Lung, and Blood Institute, there are five risk factors that make up metabolic syndrome. (from WebMD)

Large Waist Size (height dependant)
For men: 40 inches or larger
For women: 35 inches or larger

High Triglycerides
150 mg/dL or higher
or on
a cholesterol medicine

Low Good Cholesterol (HDL)
For men: Less than 40 mg/dL
For women: Less than 50 mg/dL
or on
a cholesterol medicine
High Blood Pressure
Having blood pressure of 130/85 mm Hg or greater or
Using a high blood pressure medicine

High Fasting Glucose Level
100 mg/dL or higher

To be diagnosed with metabolic syndrome, you would have at least three of these risk factors.

Associated Risk Factors:
Sedentary lifestyle
Stress
Aging
Diabetes
Heart Disease
Lipid disorders
Rheumatic disorders
Schizophrenia: due to a sedentary lifestyle, poor dietary habits and limited health care.

Treatment:
Get some exercise.
Eat healthy.

Lose weight.
Stop smoking.

Medications:
High blood pressure medications: such as ACE inhibitors, ARBs, diuretics and beta-blockers.
Cholesterol lowering medicines.
Diabetes medications.
Low-dose aspirin.

Prevention is key in metabolic syndrome. This disease usually preventable and reversible. A healthy lifestyle including weight loss, stress management and medication therapy, when necessary, will prevent the long term negative effects of metabolic syndrome.

Thursday, June 16, 2011

Total Calories Matter Most

While nutrients are extremely important, a focus on calorie counting should trump restricting fat or carbohydrates. Dietitians recommend a diet rich in fruits, vegetables, whole grains, lean protein, low fat dairy, beans and nuts. Tracking calories, though, is the key to successful weight loss. Keep a diary in order to calculate your usual calorie intake. There are many free online and phone app calorie counter programs such as "myfitnesspal.com". A diet no lower than 1200 calories per day with a consistent exercise program will help you lose up to 1 pound per week.
Although total calories matter most, balance out your diet and know where your calories come from. Depending on your activity level, 50 to 60 % of your calories should come from carbs, 20 to 25 % from protein and 20 to 25 % from healthy, unsaturated fats. Limit foods with too much sugar or too much saturated fat. Keep portions small for high caloric foods that are sugary, fatty and otherwise unhealthy.
Diet alone is not enough to promote significant weight loss. In the beginning, start slow with your exercise program, then ramp up your efforts. The heavier you are, the more calories you burn. Most experts recommend at least 30 minutes of physical activity on most days in order to shed the weight.
To make the most of your exercise sessions, try short bursts of high intensity exercise, which burn more calories than consistent exercise like jogging on the treadmill. High-intensity interval workouts lead to greater reductions in total body mass compared with steady-state exercise. Don't forget to get your 10,000 steps per day. Take the stairs.

Tuesday, June 14, 2011

Calcium and Vitamin D

Recent focus on vitamin D has revealed a large percentage, up to 25%, of people appear to be deficient. The main source of this fat soluble vitamin is usually from sun exposure. As little as 15-20 minutes per day should provide adequate levels. Calcium, the most abundant mineral in the body, is found in some foods, added to others and is available as a dietary supplement. Most, 99%, of the body's calcium supply is stored in the bones and teeth where it supports their structure and function. The body uses bone tissue as a reservoir and source of calcium to maintain constant concentrations in the blood, muscle, and intracellular fluids. You should try to consume a recommended amount of calcium and vitamin D (especially if you lack sun exposure) to maintain bone health. Many people do not know what a reasonable supplement dose should be or what is too high of a dose. Kidney stones have been associated with taking too much calcium from dietary supplements. Very high levels of vitamin D (above 10,000 IUs per day) are known to cause kidney damage. Please take a moment to review the recommended daily dosing for these two very important nutrients.
                                         

                                                                                                
                                      Calcium                                       Vitamin D
                                     Recommended      Max                 Recommended      Max
 1–3 years old                 700                    2500                 600                     2500
 4–8 years old                 1000                  2500                 600                     3000
 9–13 years old               1300                  3000                 600                     4000
 4–18 years old               1300                  3000                 600                     4000
 19–30 years old             1000                  2500                 600                     4000
 31–50 years old             1000                  2500                 600                     4000
 51–70 year old males     1000                  2000                 600                     4000
 51–70 year old females   1200                  2000                600                     4000
 >70 years old                 1200                  2000                600                     4000

Vitamin D deficiency may lead to:
Rickets (children)
Bone thinning (Osteomalacia or Osteoperosis)
Bone fractures
Muscle weakness
Muscle cramps
Memory and concentration problems
? Hypertension
? Depression
? Type 2 diabetes

Calcium deficiency may lead to:
Rickets (Children)
Bone thinning (Osteomalacia or Osteoperosis)
Bone fractures
High blood pressure
Fatigue
Brittle nails
Dry skin
Coarse hair
Muscle aches
Muscle spasm
Muscle twitching
Muscle pain

Wednesday, June 8, 2011

Good and Bad Fats

Have you heard the saying "fat doesn't make you fat"? That mantra is somewhat true. Total calories are really what make you gain weight. The total amount fat you eat isn't necessarily linked with disease; what really matters to your health is the types of fats you consume. The "bad" fats (saturated and trans fats) increase the risk for diseases such as strokes, high blood pressure and diabetes. The "good" fats, monounsaturated and polyunsaturated, should be the dominant type of fat in a balanced diet, because they reduce the risk of clogged arteries, hypertension, heart disease and so on. The key is to substitute good fats for bad fats. Although you still must limit the amount of cholesterol you consume, dietary cholesterol isn't really the villain it's been portrayed as. The biggest influences on your cholesterol level, besides genetics and lifestyle, are the types of fat and total calories in your diet..

The fats to limit are:
Saturated fat: found in meats, dairy, eggs and other foods with animal fat.
Trans fat: a man-made fat (hydrogenated) found in processed, baked and fast foods.

Fats and oils to consume in moderation include:
Monounsaturated fat:
  Olive, canola, and sesame oils
  Avocados, nuts, such as almonds, cashews, pistachios or peanuts (unsalted).
Polyunsaturated fat:
  Corn, cottonseed, and safflower oils
  Sunflower seeds and oil
  Soybeans and soybean oil
  Seafood

The American Heart Association (AHA) recommends that we get 20% to 30% of our calories from fat. Most Americans get 35% or more.

Saturated fat is concentrated in meats and dairy products. Animal products supply most of the saturated fat in our diet. They're also found in packaged foods such as cookies, crackers, and chips. Highly saturated vegetable fats such as coconut, palm or palm kernel oil, and cocoa butter can also be unhealthy in high levels. Coconut oil is used for movie popcorn, but some theaters have replaced it with canola. There's no need to completely avoid foods with saturated fat in the name of good health as they contain a multitude of nutrients such as protein, vitamins, and minerals. Fats also help your body absorb some nutrients and produce hormones. The bottom line: there's no actual dietary requirement for saturated fat because your body produces what it needs. Just try to keep saturated fat to less than 15 % of your total fat intake.

Trans fat contributes to clogged arteries and it's been linked to certain cancers, including breast and colon or rectal. Researchers from Harvard School of Public Health have estimated that eliminating trans fats from the American diet could prevent about a quarter of a million heart attacks and related deaths every year. Most of the trans fats we eat are the end product of hydrogenation. Hydrogenation (the addition of hydrogen) converts oil into a firmer, tastier product with a longer shelf life. Partially hydrogenated fat (trans fat) is gradually being removed from packaged foods, but it's still found in things such as stick margarine, shortening, fast food, cookies, crackers, granola bars, and microwave popcorn. There is no dietary requirement for trans fat and it should be avoided; although it's nearly impossible to do so unless you prepare all of your meals personally.

Here are simple ways to avoid bad fats:
Avoid packaged foods when possible. Instead, choose whole, fresh and foods you make at home. For example, make your own macaroni and cheese from scratch. Eat lean sources of protein, use low-fat dairy products, whole grains, legumes, fresh fruits and vegetables. Use healthy oils such as olive, canola, and sunflower oil or small amounts of tub margarine for cooking.

When it comes to good-for-you fat, seafood stands out. Seafood contains omega-3 fats (called DHA, docosahexanoic acid and EPA, eicosapentanoic acid) and unsaturated fat. They are considered central to a growth, development and for heart health. Omega-3 fats are linked to lower levels of blood triglycerides, reduced risk of clots and strokes, heart health among other benefits.

Here are some examples of healthy daily fat allowances:
1,800 calories diet:
  40 to 70 grams of total fat
  12 grams or less of saturated fat
  2 grams or less of trans fat  
2,200 Calories a Day:
  50 to 85 grams of total fat
  15 grams or less of saturated fat
  3 grams or less of trans fat

Fats supply essential fatty acids (Omega 3's and Omega 6's) since your body is incapable of producing them. In addition, fat transports vitamins A, D, E, and K, known as the fat-soluble vitamins, into and around the body. Fat is also necessary for maintaining healthy skin, and it plays a central role in promoting proper eyesight and brain development in children.

Tips to avoid the bad fats:
1. Use liquid plant oils for cooking and baking. Olive, canola, and other plant-based oils are rich in heart-healthy unsaturated fats.
2. Ditch the trans fat. In restaurants, steer clear of fried foods, biscuits, and other baked goods.
3. Switch from butter to soft tub margarine. Choose a product that has zero grams of trans fat, and make sure it does not contain partially hydrogenated oils.
4. Go lean on meat and milk. Beef, pork, lamb, and dairy products are high in saturated fat. Choose low-fat milk, cheeses in small amounts and lean cuts of meat.

Friday, June 3, 2011

A Common Cold or Something Else

I hope this post helps you to decide whether or not you should seek medical attention if you have a "head cold". Physicians see a lot of people for simple colds and often reassure them they just need a little more time and supportive therapy. A cold, which is generally caused by a viral infection, usually resolves after 3 or 4 days. Colds usually present with sneezing, watery eyes, a sore throat, headache, congestion or a watery runny nose. Usually, though, there is not significant fever. These symptoms will usually respond to over-the-counter (OTC) medications including decongestants, mucolytics such as Mucinex, Tylenol or Advil, antihistamines and time. Vitamin C is also helpful in higher doses along with lots of fluids. Rest and isolation are also recommended at the onset to prevent the spread through airborne particles. Also, a majority of people do not realize that most sore throats are most often viral in origin and therefore do not respond to antibiotics. Of course the cause may also be due to a strep (bacterial) infection, which will require a course of antibiotics. This may also be seen in those with inflamed or enlarged tonsils (tonsillitis).

The "flu" is quite different in that you will generally feel sick with aches, pains (especially muscle or joint), fever and occasionally rigors (tremors or shakes). People will often say their whole body hurts. Early treatment (first 48 hrs) with Tamiflu or Relenza can make a significant difference in the duration and severity. Otherwise, fluids, rest and the above OTC meds will also help. Flu shots will usually protect you from acquiring the seasonal flu, but that is not a guarantee as there are many strains.
Sinusitis presents with pain around the eyes, cheeks, nose or forehead, a headache, dry cough, or heavier discharge from the nose. Sinusitis may be a chronic condition and often requires prolonged antibiotic therapy. Nasal washing with a neti pot or NeilMed bottle may also be helpful.

When someone has a persistent and often deep cough that brings up yellowish or greenish mucus, this could be a sign of acute bronchitis or an upper respiratory infection that may require antibiotics. If these symptoms are associated with significant shortness of breath and fever, then pneumonia may be the cause. This condition is more serious and should be evaluated right away.

When symptoms do not improve in a few days or seem significantly worse, you should probably seek medical attention. Physicians can also prescribe other medications which may help to improve the symptoms and occasionally help you resolve a cold sooner.