To cure the effects of jealous knee syndrome (JKS) I will be out of the office until next Tuesday.  For those of you unfamiliar with JKS it is a condition brought on by one knee getting irritated because of all the attention the other has been getting;-)   Yes, I did have surgery on the other knee in April and now I am having surgery on my, until quite recently, "good" knee.  The Greek god of healing walked with a limp, which showed his experiential wisdom in overcoming illness.  Although I appreciate the lessons, I hope I have learned enough in this vein for a while.

So, if you need help yourself during the coming days you will have to seek it elsewhere.

The weight loss/body composition piece is coming along and I have lost over 10 pounds in the past month, but neither process is at an end yet, so please be patient a bit longer.  I am asking my web master to add the slides from a talk I been giving to soccer referees on injury prevention and recovery.  The information is easily adapted to other athletic injuries so look for it.  Along those lines I will also add some other athletic injury prevention materials quite soon.

Best, Michael Carlston, M.D.
www.carlstonmd.com 
707-545-1554

I always promote the wisdom of a  healthy diet over reliance on "making things right" with supplements.  Although taking vitamin/mineral supplements is an excellent idea, you must not overlook the importance of eating well.  One reason for this is that there is a great deal we do not know about nutrients and interactions of those nutrients. 

An example is recent evidence about betaine.  This is a minor nutrient that has not gotten much attention.  It is found in small amounts in many food sources with the greatest concentrations in seafood, spinach and wheat (germ and bran).  It protects the liver and kidneys apparently reducing risk of a wide variety of diseases (heart, vascular and liver disease as well as stroke).

Another example is the result of a very simple but carefully designed study of dietary intakes and coronary artery disease (heart disease - CAD).  The "bad" category was meat, margarine, poultry and sauce.  The "good" category was vegetarian dishes, wine, vegetables and whole-grain cereals.  Controlling for other known CAD risk factors, there was a very clear direct correlation between the percentage of foods subjects selected from these categories and the likelihood of developing CAD.  The 40% who ate the lowest proportion of "bad" food had the lowest risk.  The 20% who ate the average amount of "bad" food were 3.6 times as likely to develop coronary artery disease. Those in the top 21 - 40% range were 6.2 times as likely as those in the best group. The 20% who ate the most of those foods had 12.3 times the risk.  So, a modest amount of these high risk foods is not a problem but as the diet shifts more extremely, the risk soars.

A review of over 1,000 studies of hypertension recently concluded that physicians should not treat systolic hypertension aggressively in people aged 60 or older.  While it is clear that reducing the resting systolic blood pressure (upper number) is a good idea, the target of lowering the systolic pressure to 140 currently in vogue is unwarranted based upon this considerable body of evidence.  The authors of the review suggested that physicians should be more sensitive to the preferences of patients with systolic pressures in the 140 - 159 range and also weigh heavily the adverse effects of medication on these patients.

Proponents of CT scans for health screening suggest they are a safe and effective way to screen patients for some cancers (lung and intestine particularly) and coronary (heart) artery disease.  In medicine we evaluate interventions by looking at the risk-benefit ratio. 

On the benefit side, there is no evidence so far that these tests improve quality of life for patients.  These tests would have to find disease early enough so that treatment would help patients significantly.  That has not been shown so far. 

We have many examples in medicine where finding a disease does not help the patient in any way so this must be demonstrated.  Of course merely finding a problem diminishes a person's quality of life because of the fear thus created.  Ask any elderly man who has been told he has prostate cancer and, hopefully not too much later, told that many man his age have prostate cancer and it should not cause him any trouble during his remaining years.

This lack of supporting evidence is why the American Academy of Radiology and the US Food and Drug Administration oppose these scans.

What about risks?  Limiting our consideration to the ill effects of radiation, there is very good reason to doubt the wisdom of getting a scan.  A study published in May conducted at Yale found that too few radiologists and emergency room physicians even knew how much radiation patients receive from these tests.  Now, investigators from Columbia write that the average person who has one of these scans receives a dose of radiation 100 times that of a mammogram and just a bit less than that received by atomic bomb survivors 1.5 miles away from ground zero.

This translates into a 1 in 1,250 risk of dying from a radiation-induced cancer.  Furthermore, if a 45 year old began getting such a scan annually, by age 75, he or she would have a 1 in 50 chance of dying from a cancer caused by radiation from the testing.

No thanks.  I'll take my chances.