Monday, October 29, 2012

How much physical activity should I get?

How much physical activity should I get?

That depends. 
Exercise is good for everyone.

But first, let’s use the term physical activity here.
Physical activity appears to not be so bad a word as exercise.
It seems very few people want to exercise but many more are willing to be physically active.

In general, the more physical activity you get, the better. And all adults should avoid being inactive. The American Heart Association strongly endorses this view.

Perhaps the most evidence for benefit from physical activity relates to the risk of coronary heart disease.

Coronary heart disease causes about 1 in every 6 deaths in the United States
Of course, there are other forms of heart disease such as heart failure but coronary heart disease is the most common type of heart disease.

Coronary heart disease causes heart attacks.
The medical term for heart attack is myocardial infarction.

Okay, so how much physical activity should you get to reduce your risk of coronary heart disease?

A recent analysis of 33 studies appears to confirm that the more leisure time physical activity, the lower the risk of heart disease. All of these studies were epidemiologic studies not randomized controlled trials. Randomized controlled trials would be better but for many reasons are not possible to address this question.

So in this analysis, a 14% reduction in risk of heart disease was seen in those who had engaged in about 150 minutes of moderate intensity exercise each week. That risk compares to those who are inactive.

Double that amount of activity and the risk of coronary heart disease was reduced about 20% as compared to inactive persons.

And those who already have coronary heart disease appear more likely to survive if they participate in a cardiac rehabilitation exercise program.

So what is moderate intensity physical activity?

Brisk walking like walking 2 miles in 30 minutes, or bicycling, raking leaves, gardening or sex with your usual partner are examples of moderate physical activity. See this link for other options.

And physical activity helps in so many other ways

So start moving, stay active and stay well.


Sunday, October 21, 2012

Does Eating Soy Affect Your Thyroid?

More people are eating soy products these days. Some eat soy because they avoid all animal products. Vegans know that soy is an excellent source of protein.

Some post-menopausal women are eating soy to help their bones. 
But recent long term, randomized, controlled clinical trials do not show bone benefit from soy. 
And, in most trials,  hot flashes do not improve with soy.
And the earlier trials with soy also failed to show bone benefit from soy. 
Although a recent study suggested that there might be a slight positive effect on bone strength.

Many people who eat soy are concerned that high soy intake can affect their thyroid.

So what do the controlled, clinical trials show with respect to soy and thyroid?

One of those trials looking at bone effects of soy in postmenopausal women showed no effects of soy on thyroid hormone levels.

In most men or women who have normal thyroid function to begin with, soy has no effect on thyroid activity. Trials in women were published in 2003, 2007, and 2011.

The exception regarding soy and thyroid:  in those who are deficient in iodide or who have a failing thyroid, high soy intake is three times more likely to lower thyroid hormone levels further. The mechanism of this effect has been studied.

So high soy intake could make the thyroid more underactive if the thyroid is struggling to make enough hormone to begin with. 
Iodide deficiency is simply not an issue in most developed countries. 
See my previous posts on thyroid.

A failing thyroid is most commonly caused by the autoimmune condition called Hashimoto’s thyroiditis. Underactive thyroid is called hypothyroidism. Borderline hypothyroidism can be considered to be a failing thyroid and is usually called subclinical hypothyroidism.

So besides Hashimoto' disease, who else is more likely to have subclinical hypothyroidism? 
Those who have only part of their thyroid because of surgery.
And those who have been treated with radioactive iodide for an overactive thyroid. 
Both of these groups of people should be getting regular blood tests to monitor for hypothyroidism. 

The best test to follow for those with hypothyroidism is the TSH. 
TSH stands for thyroid stimulating hormone.
TSH is increased in those with inadequate thyroid hormone levels. 
As the hormone production by the thyroid gland goes down, the TSH from the pituitary gland goes up. Check this out to learn more.

If you are already taking thyroid hormone for hypothyroidism it's no big deal if you eat soy. 
Your TSH level ought to checked regularly by your doctor. 
Your thyroid dosage should be adjusted according to those blood tests. 

So be reassured that soy intake should not cause thyroid problems unless you are more likely to have untreated hypothyroidism to begin with. 
If you have not had thyroid surgery and never was treated for overactive thyroid and do not have Hashimoto's disease, then eating lots of soy should cause no problems. 
And if you are taking thyroid hormone for hypothyroidism, again no problem.

Ask your doctor if you are concerned. Your TSH level can be checked. 

In general, if your TSH level is below 3, you are okay. 
Above 3, generally means your thyroid hormone levels are not quite enough.
Go ahead and enjoy your soy in any case.

I hope this update helps those soy consumers out there. 
Now please excuse me while I prepare my tofu stir-fry.


Sunday, October 14, 2012

How do you prevent leg cramps?

Leg cramps are common. Most involve the calves. Most occur at night while sleeping.
How do you prevent those painful leg cramps?

Now, I am not talking about cramps that happen with exercise, like running in a marathon; those are a completely different problem. And they are far less common than nighttime leg cramps.

First keep in mind that some medications can make cramps more likely.
Those medications that reduce the concentration of potassium or of sodium in your blood may increase your risk of leg cramps.
These include certain diuretics and probably certain inhalers for asthma called beta agonists.

But most people with leg cramps have no electrolyte imbalance.
Their serum levels of potassium, sodium, calcium and magnesium are fine.  
Low thyroid hormone levels, hypothyroidism, can also cause muscle cramps. 
Once the thyroid hormone levels are normal, the cramps should go away.

Statins can cause muscle aching, but muscle cramps on the other hand, in my experience are not usually an issue with statins.
So, if my patients on statins have muscle cramps at night, when taken off the statin, they usually still have those cramps just as badly.

Some drugs cause leg cramps for unclear reasons. A few of these are estrogen, teriparatide (Forteo) and raloxifene (Evista).

So how about preventing leg cramps.
Non-drug treatments are always preferred. But it seems most don't work.

Fortunately,  recent evidence confirms the benefit of calf stretches at night to reduce calf cramps.

But for goodness sake don't drink pickle juice!
That's another goofball idea one of my patients heard from Dr. Oz.
Pickle juice has been studied for treating exercise associated muscle cramps
It might work for treatment of those cramps, but not prevention.

Quinine clearly works to reduce calf cramps as confirmed in a recent review. Around 300 milligrams is the dose that seems to have shown benefit.
Since 1994, in the U.S., quinine has only been available with a prescription.
Qualaquin is the only quinine available in the United States. The FDA warns patients and doctors about Qualaquin.
And Qualaquin is not approved for prevention of nighttime muscle cramps. By the way, the amount of quinine in tonic water is so low,  don't expect that to help.

Other treatments, like gabapentin or verapamil, have less convincing data to support their benefit. But they are safe and may be worth a try.

So, sadly, I do not have any great ideas to prevent leg cramps besides avoiding electrolyte imbalance and doing calf stretches.

What have you done that works? I'd like to know.


Tuesday, October 9, 2012

Electronic Medical Record Scam

The electronic medical record (EMR) is a scam. 

EMR is the most expansive and expensive scam foisted on the public by the federal government. 
And the EMR scam is funded by billions of our taxpayer dollars. Those who have read my previous posts on EMR will understand.

A recent New York Times piece restates my concerns with the EMR and highlights safety issues of the EMR.
As I have stated, there is no solid evidence of patient benefit from use of an EMR. Security and privacy issues are worrisome. The EMR destroys the patient narrative and disrupts the physician-patient relationship. Humans do not speak “template”. As psychiatrist Dr. Scott Monteith has stated, “it really affects how we think”.  
Read the comments of health information technology expert Dr. Scot Silverstein to learn more.
It is time for the Centers for Medicare and Medicaid Services (CMS) and the federal government to call a halt to further implementation of this costly, inefficient and potentially dangerous intervention.