-- Will Rogers
"If everything is under control, you're going too slow."
-- Mario Andretti
December 31, 2009
New Year's Resolution: Don't Just Sit
"Even if you're on the right track, you'll get run over if you just sit there."
-- Will Rogers
"If everything is under control, you're going too slow."
-- Mario Andretti
-- Will Rogers
"If everything is under control, you're going too slow."
-- Mario Andretti
December 30, 2009
Inner Beauty: A Healthy Colon
Does your colon really need cleansing? Few issues divide the worlds of conventional and alternative medicine quite so starkly.
According to a profusion of Web sites, clinics and wellness spas, the typical American diet of processed foods, pharmaceuticals, stress and lack of exercise is clogging up our lower intestinal tracts, leaving them inflamed and lined with waste-and leaking toxins into the body that cause problems ranging from headaches and chronic fatigue to arthritis and cellulite. All that "stubborn fecal matter" also contributes to bulging bellies and expanding waistlines, cleansing proponents claim. Eliminating the buildup, either with supplements or laxatives, or by flushing the colon with warm water-a practice known as "hydrotherapy" or "colonics"-can dramatically improve a person's health and well-being, proponents claim. "Colonics help people get rid of what's in there, so they have a sense of 'Wow! That's what I should feel like,' " says Kim Dupre, who is owner of Wellville Healing Arts Center in Durham, N.C., and certified by an international organization of colon hydrotherapists.
Gastroenterologists pooh-pooh many of those claims. Healthy colons are self-cleaning, they say, and evacuating the colon via other means can do serious harm, even causing the sluggishness the cleansing purports to fix. "I've seen a lot of colons and the notion that people have pounds of feces and evil toxins built up in there is pure fantasy," says John I. Allen, a Minnesota gastroenterologist who has performed more than 20,000 colonoscopies, including many in patients who haven't drunk the traditional medical cleansing preparation beforehand. Claims for colonics and other forms of cleansing, Dr. Allen says, "just play to people's fears and desire to lose weight."
The notion of emptying the intestines to cure illness was common in many ancient cultures, too. Egyptians performed enemas in rivers using hollow reeds. Colonic irrigation was been a staple of European spas for centuries, and it was all the rage in 17th-century Paris to have several enemas a day.
In the U.S., colon cleansing was common until the early 19th century, when conventional physicians began to challenge the lack of scientific evidence and condemn some practitioners as quacks.
In recent decades, colon cleansing has ridden a wave of interest in alternative medicines. Hydrotherapy spas-from storefront clinics to luxury resorts-have sprung up, especially in the South and West. And the Internet has fueled a boom in sales of at-home cleansing products. Generally combinations of fiber, herbs, vitamins and stimulants, they often make enticing claims ("Ever wonder how the stars lose weight so quickly?" "Flush out up to 30 pounds!"). Some Web sites feature photos of long strands of rubbery-looking goo that customers claim they have expelled. ("I have lost some of the most horrific things you could imagine, and I have proof!")
Some Web purveyors even suggest that cleansing can cut one's risk of colon cancer; there is no such evidence, medical experts say. Attorneys for Oprah Winfrey and Mehmet Oz, a cardiologist and author, filed a suit last month in federal court in Manhattan accusing 40 Internet marketers of implying that their colon cleansers and dietary supplements have received the celebrities' endorsements. The U.S. Food and Drug Administration has warned some makers of colon cleansers about unsubstantiated claims, and some consumers have complained about being lured in by "free" trial offers for products, only to find themselves
charged $80 or more per month for shipments that are difficult to cancel.
Even within the colon-cleansing community, there is a wide spectrum of practices and competing claims. Steven Horne, a past president of the American Herbalist Guild, says use of home-cleansing products can result in startling results. But the expelled goo shown in online photos is most likely the mucilaginous fiber in the purging products themselves, combined with black bile from the liver, he says. "People do pass this stuff, but it's a myth that it's coming off the lining of their colon." Still, Mr. Horne says modern diets can irritate the lining of the GI tract and allow toxins to invade the body and cause illness-what he and others call the "leaky gut syndrome"-and that cleansing can help eliminate many health problems. He advocates a combination of natural fiber, digestive enzymes and herbal supplements.
"Not everybody needs to do this," Mr. Horne says, "but people who have chronic sinus problems or weak immune systems or general aches and pains seem to benefit a lot." He concedes there are few scientific studies to support the practice but adds, "I'm comfortable with that, because I've seen it in clinical experience."
Dr. Allen, who is on the American Gastroenterological Association's board of governors, says there is some scientific basis for leaky gut syndrome, but the problem is rare and primarily affects the small intestine. "If you biopsy a normal colon, there is no inflammation," he says. And there are illnesses, like inflammatory bowel disease and liver failure, in which toxins do affect the whole body. But cleansing proponents, he says, "have taken literature on disease states and tried to extend it to normal people."
Practitioners of colonics say their procedure is natural, because it avoids the use of laxatives and exercises colon muscles. A therapist inserts a rubber tube into the rectum and infuses up to 20 gallons of warm water into the colon (a traditional enema uses far less water and involves only the last few inches of the colon). When the water is drained out, it brings fecal matter with it. The procedure often includes an abdominal massage.
"We are like personal trainers for the colon-we help re-educate those muscles about how they should be moving," says Ms. Dupre, who adds that many of her clients are constipated and need to change their diets. "Otherwise, colonics are just a band-aid." She usually recommends a series of three to five weekly sessions (at $85 each), and monthly after
that. Gastroenterologists say that about 15% of the population suffers from constipation at some point, and some conditions and medications increase it. The best remedies are to increase dietary fiber, ideally from whole grains, fruits and vegetables, and to consult a physician before trying other measures.
Some gastroenterologists worry that colonics can wash out beneficial bacteria and create infections, abscesses and electrolyte imbalances; there have been cases of rectal perforations. That is one reason that some hydrotherapists are pushing states to have formal licensing procedures. As of now, only Florida licenses colon hydrotherapists. Texas requires patients to have a doctor's prescription; Rhode Island prohibits the practice.
Brian Landzberg, a Manhattan gastroenterologist, says people's notion that they have pounds of backed-up stool in their colons is helping to feed distorted body images. He says he frequently sees patients who have abused laxatives in an effort to lose weight or flatten their stomachs. "Those are some of my toughest patients to treat," he says, because overuse of some bowel stimulants can damage the nerves and walls of the colon and prevent it from functioning properly.
Some patients, he says, are so convinced they are constipated that only transit marker studies-which follow the passage of small markers through the intestine via X-ray-can persuade them that their "transit time" is normal. "There is a degree of obsession that goes along with this," says Dr. Landzberg. "You can't just accept a patient's report that they are
constipated."
Even "natural" laxatives, such as the plants senna and cascara, can harm the bowel, Dr. Landzberg says, adding, "The public has grown increasingly wary of the side effects of pharmaceuticals. I would like to see people bring that same degree of healthy skepticism to 'natural' products."
Where practitioners of conventional and alternative medicine do agree is in recommending improvements in the average American diet, to avoid gastrointestinal problems and lower the risk of colon cancer.
"We do see a lot of constipation in Western civilization," says Dr. Landzberg. "We don't drink enough fluids. We are too sedentary, we have weakened abdominal muscles, and we don't take enough fiber in our diets. But the answer to that is not artificial colon cleansing. A
well-balanced diet with a good portion of soluble fiber-with lower fat and a calcium supplement
-makes a happy colon."
From The Wall Street Journal, by Melinda Beck
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP
According to a profusion of Web sites, clinics and wellness spas, the typical American diet of processed foods, pharmaceuticals, stress and lack of exercise is clogging up our lower intestinal tracts, leaving them inflamed and lined with waste-and leaking toxins into the body that cause problems ranging from headaches and chronic fatigue to arthritis and cellulite. All that "stubborn fecal matter" also contributes to bulging bellies and expanding waistlines, cleansing proponents claim. Eliminating the buildup, either with supplements or laxatives, or by flushing the colon with warm water-a practice known as "hydrotherapy" or "colonics"-can dramatically improve a person's health and well-being, proponents claim. "Colonics help people get rid of what's in there, so they have a sense of 'Wow! That's what I should feel like,' " says Kim Dupre, who is owner of Wellville Healing Arts Center in Durham, N.C., and certified by an international organization of colon hydrotherapists.
Gastroenterologists pooh-pooh many of those claims. Healthy colons are self-cleaning, they say, and evacuating the colon via other means can do serious harm, even causing the sluggishness the cleansing purports to fix. "I've seen a lot of colons and the notion that people have pounds of feces and evil toxins built up in there is pure fantasy," says John I. Allen, a Minnesota gastroenterologist who has performed more than 20,000 colonoscopies, including many in patients who haven't drunk the traditional medical cleansing preparation beforehand. Claims for colonics and other forms of cleansing, Dr. Allen says, "just play to people's fears and desire to lose weight."
The notion of emptying the intestines to cure illness was common in many ancient cultures, too. Egyptians performed enemas in rivers using hollow reeds. Colonic irrigation was been a staple of European spas for centuries, and it was all the rage in 17th-century Paris to have several enemas a day.
In the U.S., colon cleansing was common until the early 19th century, when conventional physicians began to challenge the lack of scientific evidence and condemn some practitioners as quacks.
In recent decades, colon cleansing has ridden a wave of interest in alternative medicines. Hydrotherapy spas-from storefront clinics to luxury resorts-have sprung up, especially in the South and West. And the Internet has fueled a boom in sales of at-home cleansing products. Generally combinations of fiber, herbs, vitamins and stimulants, they often make enticing claims ("Ever wonder how the stars lose weight so quickly?" "Flush out up to 30 pounds!"). Some Web sites feature photos of long strands of rubbery-looking goo that customers claim they have expelled. ("I have lost some of the most horrific things you could imagine, and I have proof!")
Some Web purveyors even suggest that cleansing can cut one's risk of colon cancer; there is no such evidence, medical experts say. Attorneys for Oprah Winfrey and Mehmet Oz, a cardiologist and author, filed a suit last month in federal court in Manhattan accusing 40 Internet marketers of implying that their colon cleansers and dietary supplements have received the celebrities' endorsements. The U.S. Food and Drug Administration has warned some makers of colon cleansers about unsubstantiated claims, and some consumers have complained about being lured in by "free" trial offers for products, only to find themselves
charged $80 or more per month for shipments that are difficult to cancel.
Even within the colon-cleansing community, there is a wide spectrum of practices and competing claims. Steven Horne, a past president of the American Herbalist Guild, says use of home-cleansing products can result in startling results. But the expelled goo shown in online photos is most likely the mucilaginous fiber in the purging products themselves, combined with black bile from the liver, he says. "People do pass this stuff, but it's a myth that it's coming off the lining of their colon." Still, Mr. Horne says modern diets can irritate the lining of the GI tract and allow toxins to invade the body and cause illness-what he and others call the "leaky gut syndrome"-and that cleansing can help eliminate many health problems. He advocates a combination of natural fiber, digestive enzymes and herbal supplements.
"Not everybody needs to do this," Mr. Horne says, "but people who have chronic sinus problems or weak immune systems or general aches and pains seem to benefit a lot." He concedes there are few scientific studies to support the practice but adds, "I'm comfortable with that, because I've seen it in clinical experience."
Dr. Allen, who is on the American Gastroenterological Association's board of governors, says there is some scientific basis for leaky gut syndrome, but the problem is rare and primarily affects the small intestine. "If you biopsy a normal colon, there is no inflammation," he says. And there are illnesses, like inflammatory bowel disease and liver failure, in which toxins do affect the whole body. But cleansing proponents, he says, "have taken literature on disease states and tried to extend it to normal people."
Practitioners of colonics say their procedure is natural, because it avoids the use of laxatives and exercises colon muscles. A therapist inserts a rubber tube into the rectum and infuses up to 20 gallons of warm water into the colon (a traditional enema uses far less water and involves only the last few inches of the colon). When the water is drained out, it brings fecal matter with it. The procedure often includes an abdominal massage.
"We are like personal trainers for the colon-we help re-educate those muscles about how they should be moving," says Ms. Dupre, who adds that many of her clients are constipated and need to change their diets. "Otherwise, colonics are just a band-aid." She usually recommends a series of three to five weekly sessions (at $85 each), and monthly after
that. Gastroenterologists say that about 15% of the population suffers from constipation at some point, and some conditions and medications increase it. The best remedies are to increase dietary fiber, ideally from whole grains, fruits and vegetables, and to consult a physician before trying other measures.
Some gastroenterologists worry that colonics can wash out beneficial bacteria and create infections, abscesses and electrolyte imbalances; there have been cases of rectal perforations. That is one reason that some hydrotherapists are pushing states to have formal licensing procedures. As of now, only Florida licenses colon hydrotherapists. Texas requires patients to have a doctor's prescription; Rhode Island prohibits the practice.
Brian Landzberg, a Manhattan gastroenterologist, says people's notion that they have pounds of backed-up stool in their colons is helping to feed distorted body images. He says he frequently sees patients who have abused laxatives in an effort to lose weight or flatten their stomachs. "Those are some of my toughest patients to treat," he says, because overuse of some bowel stimulants can damage the nerves and walls of the colon and prevent it from functioning properly.
Some patients, he says, are so convinced they are constipated that only transit marker studies-which follow the passage of small markers through the intestine via X-ray-can persuade them that their "transit time" is normal. "There is a degree of obsession that goes along with this," says Dr. Landzberg. "You can't just accept a patient's report that they are
constipated."
Even "natural" laxatives, such as the plants senna and cascara, can harm the bowel, Dr. Landzberg says, adding, "The public has grown increasingly wary of the side effects of pharmaceuticals. I would like to see people bring that same degree of healthy skepticism to 'natural' products."
Where practitioners of conventional and alternative medicine do agree is in recommending improvements in the average American diet, to avoid gastrointestinal problems and lower the risk of colon cancer.
"We do see a lot of constipation in Western civilization," says Dr. Landzberg. "We don't drink enough fluids. We are too sedentary, we have weakened abdominal muscles, and we don't take enough fiber in our diets. But the answer to that is not artificial colon cleansing. A
well-balanced diet with a good portion of soluble fiber-with lower fat and a calcium supplement
-makes a happy colon."From The Wall Street Journal, by Melinda Beck
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP
December 29, 2009
H1N1 Vaccine Update
We have received our supply of H1N1 vaccine from the State of Texas. We'll contact member patients over the next week or so to arrange vaccination. In the interim, feel free to call if you've questions or concerns.
Quotes from Soldiers
"You've never been lost until you've been lost at Mach 3."
-- Paul F. Crickmore
(SR71
test pilot)
"'Whoever said the pen is mightier than the sword, obviously never encountered automatic weapons."
-- General Douglas MacArthur
"You, you, and you ... Panic. The rest of you, come with me."
-- US Marine Corps
Gunnery Sgt
-- Paul F. Crickmore
(SR71 test pilot)"'Whoever said the pen is mightier than the sword, obviously never encountered automatic weapons."
-- General Douglas MacArthur
"You, you, and you ... Panic. The rest of you, come with me."
-- US Marine Corps
Gunnery Sgt
December 28, 2009
MacArthur Genius Award: Reducing Falls in the Elderly
For a 75-year-old with high blood pressure, the risk of death or serious
disability resulting from a fall is just as high as the risk of death or
serious disability caused by a stroke. But a generation ago, doctors
thought of falling as an inevitable risk, not something they could do
anything to prevent as part of caring for patients.
That's how Mary Tinetti, a geriatrician at Yale med school, laid things
out for us when we got her on the phone to chat about the MacArthur
genius grant she just won. (Here's a complete list of this year's
winners, including several health-care geniuses.)
In the decades since Tinetti did her first research on the subject, she
and her colleagues have gone on to show that there are clear factors
that increase the risk of falls - things like muscle weakness, balance
problems and taking multiple medications. What's more, they found, by
addressing these issues, doctors can reduce seniors' risk of falls by
about 30%.
Still, not all patients get screened for these risk factors. Doctors
don't get paid much for spending time diagnosing and treating these risk
factors. And they don't fit into the disease/specialist model of health
care, which tends to focus on things like heart attacks and strokes.
"What needs to be done is very simple," she told us. "Figuring out how
to do it is the complex piece."
As a MacArthur Fellow, Tinetti gets $500,000 with no strings attached.
She says she plans to use the money to look more broadly at how to look
beyond single diseases to try use broader measures of well-being to
guide treatment of the elderly.
"What became obvious to me as I was doing the work on falls is the big
problem with older people is they don't have a single disease, they have
multiple diseases," she said. "All of our decision-making is based on
what's best for a single disease, not what's best for an individual
patient. What I'm interested in is how we can figure out what's best for
patients with multiple diseases so we can maximize benefits and minimize
harms."
From: The Wall Street Journal, by Jacob Goldstein
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP
disability resulting from a fall is just as high as the risk of death or
serious disability caused by a stroke. But a generation ago, doctors
thought of falling as an inevitable risk, not something they could do
anything to prevent as part of caring for patients.
That's how Mary Tinetti, a geriatrician at Yale med school, laid things
out for us when we got her on the phone to chat about the MacArthur
genius grant she just won. (Here's a complete list of this year's
winners, including several health-care geniuses.)
In the decades since Tinetti did her first research on the subject, she
and her colleagues have gone on to show that there are clear factors
that increase the risk of falls - things like muscle weakness, balance
problems and taking multiple medications. What's more, they found, by
addressing these issues, doctors can reduce seniors' risk of falls by
about 30%.
Still, not all patients get screened for these risk factors. Doctors
don't get paid much for spending time diagnosing and treating these risk
factors. And they don't fit into the disease/specialist model of health
care, which tends to focus on things like heart attacks and strokes.
"What needs to be done is very simple," she told us. "Figuring out how
to do it is the complex piece."
As a MacArthur Fellow, Tinetti gets $500,000 with no strings attached.
She says she plans to use the money to look more broadly at how to look
beyond single diseases to try use broader measures of well-being to
guide treatment of the elderly.
"What became obvious to me as I was doing the work on falls is the big
problem with older people is they don't have a single disease, they have
multiple diseases," she said. "All of our decision-making is based on
what's best for a single disease, not what's best for an individual
patient. What I'm interested in is how we can figure out what's best for
patients with multiple diseases so we can maximize benefits and minimize
harms."
From: The Wall Street Journal, by Jacob Goldstein
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP
December 18, 2009
Dallas Providence Homes
Dr. Yates,
I appreciate the opportunity to share with you our work at Dallas Providence Homes and appreciate your personal involvement with our women and children.
Our Mission is to break the cycle of domestic violence for women and their children through long term transformational care that seeks to restore faith, hope and health. We accomplish this through our unique "transformational housing ministry" whereby we make a two-year commitment to our women and children.
We are NOT a shelter, which typically allows women to stay for 30, 60 or 90 days; we are a transformational housing ministry: we are the BRIDGE from the shelter back into the community. It is during the 24 months that we provide acontinuum of care, counseling, housing and life skill training that will enable our women to become self sufficient.
Recent statistics for our ministry:
I appreciate the opportunity to share with you our work at Dallas Providence Homes and appreciate your personal involvement with our women and children.
Our Mission is to break the cycle of domestic violence for women and their children through long term transformational care that seeks to restore faith, hope and health. We accomplish this through our unique "transformational housing ministry" whereby we make a two-year commitment to our women and children.
We are NOT a shelter, which typically allows women to stay for 30, 60 or 90 days; we are a transformational housing ministry: we are the BRIDGE from the shelter back into the community. It is during the 24 months that we provide acontinuum of care, counseling, housing and life skill training that will enable our women to become self sufficient.
Recent statistics for our ministry:
-1 in 4 residents who enter our program will graduate
-64% of our residents overcame their addiction before leaving
-100% of residents increased self esteem
-70% of residents did not know Christ when they entered, yet over 50% of them became believers before leaving
-Average wage earnings increased 77% upon leaving our program
-We reach our residents at a cost of less than $40 per day
One of our most recent success stories was a lady and her 8 year old son who came to us after having stayed at theSamaritan Inn, McKinney for almost 4 months. When she entered our program, she had an interest in the nursing profession, but no formal training, and her son was failing in school. After completing our program which provided stability as well as education for her and her son, she accepted a job at M.D. Anderson in Houston and her son has been selected to attend two gifted classes, one in math and one in science.
There are a lot of good causes, however, If you have some interest in learning more about our ministry or how you can get involved in helping change the life of a woman or a child, please visit our website at www.dallasprovidence.org email Lori Conley, Executive Director, at execdirector@dallasprovidencehomes.org. or me at mw.hagan@tx.rr.com
One of our most recent success stories was a lady and her 8 year old son who came to us after having stayed at theSamaritan Inn, McKinney for almost 4 months. When she entered our program, she had an interest in the nursing profession, but no formal training, and her son was failing in school. After completing our program which provided stability as well as education for her and her son, she accepted a job at M.D. Anderson in Houston and her son has been selected to attend two gifted classes, one in math and one in science.
There are a lot of good causes, however, If you have some interest in learning more about our ministry or how you can get involved in helping change the life of a woman or a child, please visit our website at www.dallasprovidence.org email Lori Conley, Executive Director, at execdirector@dallasprovidencehomes.org. or me at mw.hagan@tx.rr.com
Thanks so much for your interest in our ministry as it is through community that we are able to truly impact the lives of our residents.
Sincerely,
Mark Hagan
Founder, Dallas Providence Homes, Inc.
December 7, 2009
Link Between Successful Weight Loss And Vitamin D Levels
Vitamin D levels in the body at the start of a low-calorie diet predict weight loss success, a new study found. The results, which suggest a possible role for vitamin D in weight loss, were presented at The Endocrine Society's 91st Annual Meeting in Washington, D.C.
"Vitamin D deficiency is associated with obesity, but it is not clear if inadequate vitamin D causes obesity or the other way around," said the study's lead author, Shalamar Sibley, MD, MPH, an assistant professor of medicine at the University of Minnesota.
In this study, the authors attempted to determine whether baseline vitamin D levels before calorie restriction affect subsequent weight loss. They measured circulating blood levels of vitamin D in 38 overweight men and women before and after the subjects followed a diet plan for 11 weeks consisting of 750 calories a day fewer than their estimated total needs. Subjects also had their fat distribution measured with DXA (bone densitometry) scans.
On average, subjects had vitamin D levels that many experts would consider to be in the insufficient range, according to Sibley. However, the authors found that baseline, or pre-diet, vitamin D levels predicted weight loss in a linear relationship. For every increase of 1 ng/mL in level of 25-hydroxycholecalciferol - the precursor form of vitamin D and a commonly used indicator of vitamin D status - subjects ended up losing almost a half pound (0.196 kg) more on their calorie-restricted diet. For each 1-ng/mL increase in the active or "hormonal" form of vitamin D (1,25-dihydroxycholecalciferol), subjects lost nearly one-quarter pound (0.107 kg) more.
Additionally, higher baseline vitamin D levels (both the precursor and active forms) predicted greater loss of abdominal fat.
"Our results suggest the possibility that the addition of vitamin D to a reduced-calorie diet will lead to better weight loss," Sibley said.
She cautioned, however, that more research is needed. "Our findings," she said, "need to be followed up by the right kind of controlled clinical trial to determine if there is a role for vitamin D supplementation in helping people lose weight when they attempt to cut back on what they eat."
The National Institutes of Health, the University of Minnesota, and the Pennock Family Endowment at the University of Minnesota funded this study.
Source: Aaron Lohr, The Endocrine Society
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP
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