Friday, January 27, 2012

True Hormone Specialists are Endocrinologists

True hormone specialists are endocrinologists.
Here in Ohio you can find board certified medical doctors who are true hormone specialists.
By true hormone specialist, I mean an expert in diagnosis and treatment of hormonal disorders.

Anyone can claim they are a hormone specialist.
I have seen nurses, chiropractors and others including so-called naturopathic doctors claim they are hormone specialists.
But only endocrinologists are real or true hormone specialists.

Endocrinologists are medical specialists in internal medicine who go on to receive an additional 2-3 years of training specifically to diagnose and treat hormonal disorders. 
Endocrinologists all will have either M.D. or D.O. after their name.

In the United States, to become an endocrinologist you must first finish high school, then 4 years of college, then 4 years of medical school, then 3 years of internal medicine residency.
And after that, 2-3 years of in depth, specialized training is required.
The last 2-3 years is the fellowship in endocrinology.

To become board certified, this hormone specialist called endocrinologist has to pass an extensive exam after the fellowship.

You should check to see if the doctor you are thinking of seeing is board certified in Diabetes, Endocrinology and Metabolism. 
You should ask the office staff to be sure.

Of course, not all Board Certified Endocrinologists are the same, just as not all surgeons or accountants or attorneys are the same.
But being a Board Certified Endocrinologist is a good starting point to determine if your doctor is a true hormone specialist.

And his or her learning should not stop after the fellowship. 
All good physicians must continually read and think and analyze as new developments occur.
Knowledge changes. What we knew 2 years ago is not what we know now.

All endocrinologists like other physicians, with the M.D or D.O. after their name, must have a required amount of approved continuing medical education each year. 
If not, they can lose their license to practice. 
This is true not just in Ohio, but in all 50 states in the U.S.

All true hormone specialists will provide the most up to date treatment based upon the highest quality science. This science relies heavily on randomized, controlled clinical trials.  

Emphasis on randomized, controlled clinical trials helps ensure that endocrinologists minimize the risk and maximize the benefit for our patients.

Others who are not true hormone specialists either do not know about or care about randomized controlled clinical trials. That is why some of these people come up with gimmicks like bio-identical hormone therapy.
In my view, these gimmicks serve to promote their practice and are not based upon sound scientific principles.

Practicing the highest quality science appears to be unimportant to many of  these folks.
I think this is wrong and can hurt their patients who put their trust in them. 
I felt strongly enough about this that I wrote a recent letter to our Cleveland Ohio newspaper, the Plain Dealer.

The Cleveland Plain Dealer published an edited version of that letter this week.
I will provide the unedited version in an upcoming post.

Hormonal diagnosis should be based upon the most sound science.  
And treatment should, as much as possible, be proven to work.

See a board certified endocrinologist to get safe, sensible diagnosis and treatment.
Endocrinologists are true hormone specialists.

Friday, January 20, 2012

Does Diet Pop Make You Fat?

Does diet pop make you fat? Is diet soda just as bad as regular soda?

I am often distressed when my patients with diabetes are drinking regular pop because they believe that diet pop is just as bad!

Where did people get this idea?

The idea that diet pop may make you fat may have come from a study that looked at diet pop use in 1550 adults in San Antonio. They found that those who consumed diet soda at the beginning of the study were more likely to have gained weight or have increased their waist circumference over the course of 7-9 years follow-up.

Like all epidemiological  studies, this study shows only an association. It proves nothing. It does not prove cause and effect. Epidemiological  studies deal with health in large groups or populations of people.

As one of the researchers admitted at the American Diabetes Association meeting last year, the results could be affected by a number of other factors not measured. These other factors are called confounding factors.

Let me give you an example of a hypothetical study with a confounding factor. A researcher wants to see if coffee use is associated with the future development of lung cancer. So he determines the use coffee consumption in a large group of people and follows them over 10 years. At the end of the 10 years, he finds that there is much more coffee use in those who get lung cancer as compared to those who do not get lung cancer.
He is ready to send this to the TV so the anchorwoman can scare millions of viewers.
Viewers will think that if they drink coffee they will be more likely to get lung cancer.

But wait! His researcher friend, a smarter dude, points out that  he failed to consider that the heavy coffee drinkers were more likely to  smoke cigarettes. The tobacco use was the likely explanation for the lung cancer.
In this case, the tobacco use was the confounding factor.

Another example of confounding  can be found in the Wikipedia entry  on this subject. This entry describes an association between drowning and eating ice cream. There are more drowning deaths when there is more ice cream consumption. But eating ice cream is not a likely cause of drowning. The confounding factor here is that both ice cream consumption and drowning are more frequent in hot weather.

So what might be confounding factors in the study looking at diet pop use?
Well, those who were having the greatest trouble controlling their weight might select artificially sweetened beverages over sugar sweetened ones.
It might just be that those people who were tending to get fat, chose diet pop.

Or maybe even more important, some people who drink diet soda think, that it's okay to eat high fat foods or candy. After all they save on calories by drinking the diet pop.
So it would not be the diet pop causing the weight gain, it would be the person’s food choices.

So those are two possible confounding factors.

And in this San Antonio study, the researchers saw the least weight gain in those who drank regular soda only. The soda with the calories!
Now this finding is hard to make sense of  and it is contrary to other larger epidemiological studies. That finding alone should make any thinking person question the results of this study.

But an earlier study  also showed an association between all soft drink consumption, both diet and regular, and weight gain.
On the other hand, a  large study in over 90,000 nurses failed to show an association between the  consumption of diet beverages and future weight gain.

These studies in part point out how confusing and almost worthless these epidemiological studies are. They stimulate interest but do not prove anything.

How about more meaningful studies, like controlled clinical trials?

What do controlled trials show about the commonly used non-nutritive or so called "artificial" sweeteners, like aspartame (Nutrasweet or Equal) and  sucralose (Splenda)?
Do they affect appetite or food intake in carefully performed clinical trials?
Do they change the substances in our body makes that affect our satiety or hunger?

Sucralose is not absorbed into the blood stream. No effects have been seen with sucralose on blood sugars, appetite, gut peptides that regulate appetite, stomach emptying or blood glucose control in people with diabetes.

Aspartame has been even more extensively studied. It may be helpful in a weight loss program. Aspartame does not increase hunger or calorie intake in short term studies.
Aspartame does not affect children's behavior. And, by the way,  table sugar, which is called sucrose, does not either.
And aspartame appears safe in high doses.

And when it comes to weight control, drinking aspartame sweetened beverages is clearly better than regular pop.

Studies showing a correlation between sugar sweetened beverages, regular soda, and future diabetes and weight gain are numerous. Here are a few: in 200420072008and 2010

Although the exact role of sugar sweetened beverages in the obesity epidemic is controversial. Regular pop is very likely a contributor.

And in the United States regular pop is  sweetened with high fructose corn syrup which may have unique harmful effects . More on this in a future post.

In any case, a 12 ounce can of regular soda typically has  around 140-160 calories. These are calories almost no one needs, especially if you are overweight.

Other sugar sweetened beverages like flavored waters, "energy" drinks, fruit punches, all  should be avoided, whether they have vitamins added or not.

So, given all of the above, diet pop is clearly better than regular pop.
And there is no convincing evidence of harm from diet pop or other beverages which are sweetened with non-nutritive or so called artificial sweeteners.
The research continues.
If you're unsure, avoid both diet pop and the regular nasty stuff.

Saturday, January 14, 2012

What Does Natural Mean?

A recent article in the Wall Street Journal described how food companies are often promoting  their products as “natural”. 
I posted last year how my patients often feel somehow safe and reassured by using or eating products that are called “natural”. 

After all, fungi, bacteria, viruses, and cancer are all "natural".

It may surprise you that the Food and Drug Administration has no strict definition of "natural" for foods. The FDA does not feel this question of what is "natural" affects public safety so they have stayed away from this thorny issue. 

This means companies can call almost anything "natural". And that gets people to buy it since so many people think "natural" means "good for you". Oh, how easily people are fooled!

In the meantime, what you are buying and eating or drinking may or may not be particularly good for you, whether it’s called “natural” or not.

And remember high doses of even some vitamins can cause harm. 
Take a look at some facts on vitamin A
And read a little on the pro and cons of natural antioxidants.

4 pieces of advice before getting overly enthusiastic with any particular product:
Check the label carefully.
If you are not sure, consult your friendly registered dietitian, physician nutrition specialist or doctor.
And lastly, "buyer beware" while you enjoy your food.

Saturday, January 7, 2012

Exercise is Good Medicine for Diabetes

There is no doubt that exercise is good medicine for everyone but exercise is especially beneficial if you are at risk for diabetes or have Type 2 Diabetes.

A recent report described a study in which 73 adults with Type 2 Diabetes were randomly assigned to exercise or just counseling and followed over 12 months.
All these people with Type 2 Diabetes were using insulin for control of their blood glucose. 

The exercise group did both resistive and aerobic exercise. Resistive exercise strengthens muscles. The workouts were only twice a week although they lasted 75 minutes and were supervised.

Well what did the researchers find?

Exercise helped almost everything that was measured: blood pressure, cholesterol, weight, waist circumference and Hemoglobin A1c (abbreviated HgbA1c) and more.
Clearly, exercise is good medicine for diabetes. 

In fact the exercising group had an HgbA1c that was 0.74% lower compared to the other group. And the exercising group needed less insulin.

As endocrinologists and experts on diabetes, these findings do not surprise us.
Our team sees these benefits in all of our patients who start to exercise.

Even if the exercise is walking 3-4 times a week, benefits are seen. As people move more they need less medication to control their blood glucose. Exercise makes insulin work better. That includes insulin that you make and any insulin that you take.
And exercise helps keep off weight that you’ve lost.

The Diabetes Prevention Program showed a 58% reduction in the development of diabetes in those who were at high risk to get diabetes. Those adults walked 30 minutes five times a week and lost on average 12 pounds.

Now the term pre-diabetes is used to describe people who are at high risk of getting diabetes. And the Diabetes Prevention Program proved that the best treatment for pre-diabetes is exercise and a little bit of weight loss.

Exercise is good medicine. Exercise is medicine

Work with your doctors to develop a sensible exercise program. Don't forget to keep those muscles toned. And start moving today!