To screen or not to screen

If you haven’t heard by now the United States Preventative Services Task Force released their most recent guidelines on prostate cancer screening. The verdict is a first: they recommend against routine screening for prostate cancer in men who don’t have symptoms.

The USPSTF has been tiptoeing around this recommendation for years, with the recent past being a recommendation that screening (typically a PSA and rectal exam) be optional.

The reason is that most men die with prostate cancer than because of prostate cancer. The workup and treatment for a condition that most often does not lead to major problems can often lead to major problems.

The vast majority of physicians have come out to refute the recommendations, as have the cancer organizations. Their argument is that they have seen cases where a screening PSA test picked up a previously undiscovered cancer and patients were able to have therapy right away. It is certain that some of these men would have suffered significant morbidity and even mortality as a result of their cancer, and the screening test in these individual cases was a success. But what the USPSTF is saying is that more men with a positive PSA wind up suffering from lifelong, quality of life destroying impotence, urinary/bladder issues or chronic pain; all for treating a condition that was likely to never be an issue.

It’s a tough call, but the evidence would support men with no symptoms and no family history to pass on screening for prostate cancer.

I recently saw a man who was suspected of having prostate cancer due to an elevating PSA. Before doing a biopsy, he wanted to focus on lifestyle change and appropriate supplemenation and track the PSA. Two months after eating whole foods, kale-loaded smoothies, tomato sauce (lycopene), green tea, AHCC (from mushrooms) and genisten (component of soy), his PSA dropped to almost nothing!

My advice, if you’re a man with no urinary/prostate symptoms, pass on the prostate cancer screening and start focusing on lifestyle measures that will help your body either keep the cancer cells at bay or from not showing up at all. Have a green tea on me!

 KevinMD wrote a great blog on this very subject: http://www.kevinmd.com/blog/2011/10/uspstf-prostate-cancer-screening-guidelines-emotion-resonate.html

How I Read a Food Label

I was thinking about food labels recently as I scanned yet another new food product at the grocery store. It's become something of a hobby. "Oh, second ingredient evaporated cane juice (AKA sugar) and then at the end 'natural' (my quotation marks) flavors." The verdict: processed food. I don't need to know any more than that. Don't care about calories or fat grams or the other things we have been told to focus on.

I cannot remember the last time I cared how many calories were in the food I was eating. I didn't count them when I finally lost weight for real, I mean real fat burning, mind-stimulating weight loss that stayed off. I certainly counted them like crazy in many previous unsuccessful attempts. Dr. Robert Lustig has an amazing video on why a calorie is not a calorie.  They're not worth counting. Matter of fact, they are likely to create a problem as most of the folks counting them do so in a way that creates malnutrition and stunted metabolism by trying to keep the number too low.

I also don't care about the fat grams.  That ship sailed long ago. Ever since the low fat craze started, we've only increased in size and worsened in health. When you take fat out of a food, you are processing it.  Strike one. Strike two is that the food tastes poorly when the fat's gone. Ever taste heavy whipping cream? What a rich taste in a small dose. Strike three? How do you think you get a food to taste good after you remove the fat? Evaporated cane juice, brown rice syrup, or agave, or any of the other fancy names for our health's enemy: sugar.

So I don't bother with the top half of the label. All the numbers and percentages are the food industry's way of trying to justify an unhealthy, processed food as something you can feel good about. They can manipulate these franken-foods to meet any percentage they want, but the problem is the more they do this the more your food is processed.

If there is anything I look at on the label, it's the sugars and fiber numbers. That gives you an idea of how sweetened and processed a food is. Aim for the lowest grams of sugars with highest fiber grams when comparing between several brands. Better yet, just skip to the ingredients. That's where the money is. Here's your priority list:

1. Can't find the ingredients label? Place in cart.
You are holding a whole food (ie. tomato, broccoli, avacado, chicken breast).

2. Ask yourself, if given the time and the skill, could you go to the market and make that food today after finding each individual ingredient? If you answer yes, proceed to #3.
Hint: Monosodium glutamate cannot be found in the spice aisle. Nor can you find a good jar of hydrogenated oil or red dye 40.

3. Is there more than one sweetener in the ingredients? If yes, save for a rare treat or just move on. If there is only one, move to #4.
This is the way that food makers make heavily sweetened foods seem like there isn't much in there. You see the ingredients list is in order of quantity of the ingredient. So when you don't see sugar as the first one or two ingredients, you start to feel better about it. The truth of the matter is you may be eating more sugar and therefore spiking your fat-storing hormone, insulin, even higher by eating a food that contains: whole grain, almonds, honey, walnuts, evaporated cane juice, oats, or molasses than one that lists sugar as the first ingredient.

4. Is the sweetener at the bottom of the list of ingredients? Chances are you've got a relatively low processed food that is mildly sweetened (as long as the sugar grams are low, less than 10 per serving).
The exceptions to this are whole foods that have added sugar. Ice cream and yogurt fit this category. Few ingredients, most of them recognizable and things we could make at home. But they are so sugar-laden as to better be placed in the candy aisle than the dairy case. Avoid all of this sugar and make them at home! Add 1/4 of the sugar a standard recipe would suggest and you can enjoy with real fruit knowing your insulin levels aren't shooting through the roof.

Does this help? Need more help with label reading and grocery shopping? Leave a comment...

Victory for Patient Empowerment

Consumers Could Get Test Results Themselves...

Patients may soon be universally able to view their lab results thanks to a new rule proposed by the Department of Health and Human Services. This means getting access without permission or release by their providers. This is a victory toward patient empowerment and a step in the right direction.

Classically patients do not see their lab results. The busy primary doctors are often left with nothing more than a "no news is good news" approach to reviewing labs with patients. Or they stamp the lab report "normal" as long as they do not fall outside of the gigantic reference ranges the labs have set. So patients do not get to see how "normal" they are or how things have trended in the past. This means that patients who are not contacted are left to assume things are "fine". The data shows that 20% of labs are lost and not reviewed by physicians and so patients sit at home believing things to be okay when that may be far from the truth.

The blame should not be placed fully on physicians. Often, they are overburdened by having to maintain a busy day of patient visits in order to generate revenue for the practice and keep the doors open, and still need to spend a significant part of their day doing things that do not pay the bills or bring in revenue to pay their staff: reviewing patient messages and questions, reviewing consult notes on their patients, and the expectation to review every lab, test and procedure on their patients. With this much on their plates, things are bound to be overlooked or just flat missed. This is a system issue, not a physician issue. A healthcare system that only rewards patient visits means one of three things happen with labs: either you meet face to face with your doctor, you get the "everything looks fine" from their staff, or they just get flat ignored.

Enter the patient, who is starting to understand the vital role they must play in their health. It's up to them to navigate their path. Now, they're helping to play a role in determining which therapies or lifestyle roads are taken, interacting with their provider to maintain a regular relationship, staying on top of regular monitoring and screening and now controlling their data to ensure things are on track.

There are few systems and practices that are supporting the enabled and empowered patient well. More and more physicians are realizing that the empowered patient is actually a relief for their practice and not a burden. Their questions are more focused and appropriate, they stay on top of their labs and screening so you don't have to, and generally they are making better lifestyle choices to increase the health of themselves and subsequently your practice. It's time to truly embrace them and provide them with tools to connect with you and attract more of them. Take a look at the Hello Health platform, built to empower patients and take some of the daily burden off of physicians. We'll all be a little healthier.

Patients with a story of how they have become a more empowered patient? Enjoying the Hello Health platform with GladdMD? A physician trying to create your ideal practice? Leave a comment below...

Laughter IS the Best Medicine

Looking to make your day a bit better? Lower your blood pressure? Feel less pain? Find a way to laugh today.

A recent study shows that laughter increases the body’s release of endorphins, those little chemicals in the body that promote pleasure and feeling good. It’s essentially a reflex of the body when the muscles responsible for laughter are triggered. 

People in the study who laughed while viewing a comedy show sensed less pain than those watching a regular show. We’ve known that laughter is the best medicine for a long time, but are we really seeking ways to laugh daily as a health strategy? We should.  Even fake laughter shows to decrease blood pressure!

So go rent or watch a good comedy, play with a child or call and old friend and talk about some humorous memories. If not, go look in the mirror and make funny faces or laugh out loud for the heck of it.

Need some inspiration? Watch this short film and appreciate the infectious nature of laughter, hard to not smile during this.

Have a story about the joy of laughter or a funny story? Please leave a comment below...

Laughter is the Best Medicine