I hope you are enjoying the transition into fall.  The weather has been beautiful the past few days.  The transition I am most looking forward to right now is getting past this divisive election so that Americans can begin to work together again in a constructive way.
 
Hopefully those of you who customarily take flu vaccines for convenience rather than serious health risks will find some reassurance in the fact that over 1/3 of the time the experts have been picking the wrong virus.  In other words, the flu vaccine is often ineffective, so missing it this year probably won’t be as bad as some fear.
 
This newsletter includes part of the information I promised on weight loss.  It is too long for one email.  My web designer will post the entire article as soon as he can (go to my website - www.carlstonmd.com) and look for it through the NUTRITION and LIFESTYLE links.  If you just can’t wait, email me at [email protected] with a request and I will send you the whole article.

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

Medical research is very expensive and laborious.  One consequence is that most research is funded by those with something to gain (i.e.. pharmaceutical companies).  Several problems arise.  One is that simple inexpensive treatments are not studied.  A second is that the investigators have a financial incentive to achieve a certain outcome.  For this reason, authors of articles submitted to peer-reviewed medical journals must disclose their funding sources, and when I review articles for medical journals, I always consider the potential bias. 
 
A third and more subtly difficult problem is that currently there is no requirement for results to be published or reported.  This means that a pharmaceutical has no requirement to report a problem or ineffective result from one of their drugs.  For example, a US government supported expert panel recently reviewed the safety of antidepressant drugs in children.  To make the most reasonable assessment they reviewed all the data they could find, but drug companies did not release their studies that had found increased risk of suicide among children taking these medications.
 
The editors of the most important American and European medical journals are calling for a unified registry of clinical trials to eliminate this third problem.  That way we will know when a study was not reported.  I urge you to do your part to help.  Probably the easiest way for you to do that is to follow this link to the Consumer Reports website Congressional petition.
http://cmet.cr-mail.org/data/14225240/Key=788.FcBV.C.Gc6sx

A couple of studies were recently reported as demonstrating ill effects of vitamin use.  Those conclusions are unwarranted.
 
One survey of children found an apparent correlation between vitamin taking and allergic disease, including food allergy and asthma.  Unfortunately, the investigators overlooked some well-known confounding factors which make the results quite unreliable.  They ignored family size, preschool attendance, antibiotic use, animal exposure and other well-established risk factors.  In fact, they also found that breastfeeding was associated with an increased incidence of food allergy, which is bizarre, because, as any physician who treats children can tell you, we have a massive amount of data showing that breastfeeding REDUCES food allergies.  Furthermore, US government surveys consistently show vitamin deficiencies in American children.
 
The other big splash came from a review of 14 trials of patients with gastrointestinal cancers.  The authors found a very slight rise in the rate of esophageal, stomach, pancreatic, colon, liver and rectal cancers, associated most strongly with beta carotene.  Again, I think you have to carefully examine this study and not jump to conclusions. 
 
First, people who do not feel well are more likely to take something to try to help themselves before they see a doctor.  So, some patients in the study probably had their disease, but it had not been diagnosed as yet.  This is especially likely because the cancers they list are metabolically very different, and so adverse effects of vitamins (or anything, for that matter) should vary.  They, however, reported a 6% rise in risk for each of them.
 
Second, many studies have found a connection between synthetic beta carotene and illness, especially cancer. However, many times that number of studies have found a protective effect from dietary beta carotene.  This is why I always encourage patients to eat healthily and take a supplement of natural mixed carotenoids (alpha, beta, gamma, etc., carotenoids).  We know that synthetic beta carotene (used in the great majority of supplements) appears to behave differently from the natural form, and isolating it from the other carotenoids with which it is found in foods is unwise.
 
Even the editorial accompanying this article (LANCET 10/2/04) decried the authors’ conclusions.  The editorial conclusion was first that vitamin C and selenium both decrease the risk of gastrointestinal cancer and, properly analyzed and interpreted, the data in this meta-analysis show no positive or negative of the other antioxidants investigated.

Any of you who have experienced a head lice infestation in a member of your household knows how stubborn a problem this is, and the expressive accuracy of the term “nit picker”.  As head lice become increasingly resistant to conventional treatments, even toxic medications and laborious nit picking are often unsuccessful.  Several years ago Israelis began slathering the head of infested children with petroleum jelly (i.e., Vaseline), which actually works.  It is obviously VERY messy.  Now a new treatment is becoming available that works also by smothering the little critters, and is even more effective.  NUVO lotion is over 95% effective in the first clinical trials.  It is both nontoxic and effective.

Americans are getting fatter and fatter.  Sorry to be blunt, but this is not a minor problem, and we aren’t just putting on a few pounds as we age.  If you think you can stand the shock, go to http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/.  The most informative/frightening visual is slide four of the Powerpoint presentation (posted on the wall in my office and on my website). The latest data are from 2002.  In just 11 years we have gone from having 4 states with an obesity rate of 15-19% of the adult population to a point where now every US state has that level of obesity or more.  In fact, by 2002, 28 states had obesity levels of 20-24% and in 3 states 25% or more of the adult population was obese.  Fully 65% of American adults are overweight or obese.  The consequences of this are big time for our health - increased risk of diabetes, heart disease, cancer, kidney disease, arthritis, etc., etc.  It is hard to come up with many diseases for which a higher weight lowers our risk.
 
How did we get this way?  While no one has been rushing to claim responsibility, it is pretty easy to point fingers.  A number of factors are to blame, most of which are in our power to change.
 
The US government campaign to educate us about fat led to a dietary cultural perversion - Fat is bad, anything else is fine.  Low fat this.  Low fat that.  Less fat in our food, but lots more fat inside our clothes.  The food manufacturers make a profit by creating quick easy, tasty morsels to pop in our mouths all day long.  They do a great job.  Leaving fat out, they pumped up the carbohydrates (read SUGARs) to make their products taste good.  The American consumer thought “No Fat.  Great!  I’ll eat two!”  The processing dropped out important nutrients (especially B vitamins, which would have balanced things out a bit), and left us hungry for something we didn’t know.
 
This bad dream wouldn’t have been so nightmarish had we not been simultaneously mutating into a nation of couch potatoes.  Exercise not only burns calories, but after exercise your body continues to burn calories at an elevated rate.  Exercise makes muscle.  The higher your percentage of muscle mass, the more calories you burn while sitting in a chair or sleeping.  Exercise makes your body more sensitive to insulin, so it drives the sugars into cells  that you can use for energy, instead of storing it as fat.
 
The American equation has been:
More calories in + fewer calories out = WEIGHT GAIN
 
How can we change this?  The first step is to understand this simple formula:
Energy in - Energy out = Weight change
If you eat more calories than you burn, you gain weight.  If you eat less or burn more, you lose weight.
 
The first step  is to work on creating the best numbers you can for this equation.  
 
 
EXERCISE
Build your activity.  Wear a pedometer to gauge and then increase your activity.  Walk more.  Take stairs instead of the elevator.  Park your car further from the door of the mall.  Little steps add up.  Make it more enjoyable by building an exercise program around activities you enjoy.  If you are social, join or start a walking club.  Dig out your tennis racket.  Train for your first marathon (or first mile!).
 
Although aerobic exercise is more important because of its many health benefits, lifting weights will improve your body composition by turning that energy storing fat into energy burning muscle.  Body composition is also influenced by diet and hormonal factors.
 
 
EAT GOOD FOOD
Similarly, little food choices can add up to big positive effects. Eat a little bit less.  Allow yourself some ice cream, but not a big bowl.  Choose whole grain foods ALMOST always.  Eat only when you are hungry  Eat slowly. If you eat too fast you will start feeling full after you have already eaten too much.  Eat while you eat. Pay attention to your food.  Don’t watch the television or read.  Enjoy your food.
 
There are many more subtle changes you can make that are likely to have positive effects.
 
(The material under these headings is in the full article)
NUTRIENT TIMING
WATER
STRESS
SUPPLEMENTS
CARBOHYDRATES VERSUS PROTEIN
FEEDBACK
EATING DISORDERS
TOXIC THOUGHTS
 
 
CONCLUSION
Obesity is an important problem.  Like any important problem it should be addressed and addressed thoughtfully.  Each person is different.  One person can respond to a supplement that does not help others with the same problem.  Although ineffective for others, it can change that individual’s life.  One person might do better with a type of exercise that someone else hates.    Find something you like, some exercise that fits into your life.  Even if you don’t lose a single pound or inch, exercising makes you healthier and reduces your risk of many diseases.
 
Often my job as a physician becomes that of a coach.  I help patients sort out their strengths and weaknesses.  Then we set reasonable goals together, leading them into better health.  Doing the things you should do to better your health almost inevitably improves your body composition.  The point is working to become stronger and healthier.  I applaud ANY and ALL efforts. Make the effort and you will feel better.  My task is to help you direct your efforts most effectively. 

Link to Weight Loss document: Weight Loss