Health Pearls: Back Pain, Aspirin, Best Fruits

• For common low back pain, Tylenol (acetaminophen), even in high doses, may not be any better than placebo (recent article in The Lancet). Over the counter NSAIDS, such as ibuprofen, or Aleve (Naproxen), or prescription meloxicam (Mobic) are generally effective. Better still, drug-free therapeutic massage therapy may be very effective. It works by relaxing the low back muscles, and by stimulating the brain to release pain-relieving dopamine and serotonin.
• If you take aspirin to lower your risk of a heart attack, you would want to make sure that the aspirin you're taking works for you. A simple urine test which measures Thromboxane A2 levels is available through our office to make sure you are not "aspirin resistant." Ask me about this at your next office visit!!!
• Summer time is fruit-eating time. Some of the best fruits are those that have a low Glycemic Load, namely they only minimally increase your blood sugar level. The best include: Strawberries (one half cup), cherries (12 cherries), and peaches (1 medium size). All have a Glycemic Load of 3 or less, which is very low and good.
  
  If you want a reliable list of the Glycemic Index of common foods, call the office or send me an email → istaw@drstaw.com.

Take a walk in the cooler hours of the day, and stay hydrated.

Omega-3, What’s the Real Story?

Omega-3 fatty acids are “essential fatty acids” that are required by the body in order to perform a variety of metabolic functions, but which our bodies can not produce. Our body must get them from the food we eat. They are classified as polyunsaturated fatty acids (PUFAs) and are considered to be “the good fats.”

There are three important omega-3s: eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and alpha-linolenic acid (ALA). EPA and DHA are found primarily in fish, krill, and calamari, and in algae (algal oil). They are present in the highest concentrations in fatty fish such as salmon, tuna, sardines and mackerel. ALA is commonly found in plant sources like flax seed, soy, walnuts and canola oil.

While the function of omega-3s is not fully understood, these fatty acids definitely play a definite role in our health. Their role is the subject of extensive ongoing research, and even controversy.

People at risk for heart disease and stroke, and those who already have one or both conditions, do better when they consume fatty fish several times a week. Eating the fish may be more effective than taking supplemental fish oil, perhaps because the fish contains other helpful substances, but the jury is still out on this one.

People with inflammatory diseases may benefit from an increased consumption of omega-3s. The list is long, and includes rheumatoid arthritis, inflammatory bowel disease (Crohn’s disease and Ulcerative colitis), lupus, and some forms of immune kidney diseases.

Fish oil may play a role in the prevention of a variety of cancers, age related eye disease, dry eye symptoms (keratoconjunctivitis sicca), anxiety, depression aggression, age-related cognitive function, and even Alzheimer’s.

Much of the beneficial effect of omega-3s is thought to be due to its ani-inflammatory function. The reasoning is that many diseases are either caused by or made worse by inflammatory processes in the body, and the less inflammation there is, the easier it is to bring the condition under control.

There is no agreement about how much omega-3 is enough, and how much is too much. Some authorities place the minimum daily requirement for healthy women and men at 1,000 mg and 1600 mg a day, respectively. A prescription drug, Lovaza (used to treat high triglycerides, a cardiac risk), provides more than 3,000 mg of omega-3s a day.

Recommended doses for different conditions vary throughout a wide range.

A reasonable-size portion of salmon, approximately 6 ounces, contains a little more than 800 mg of EPA and more than 1,100 mg of DHA.

So what’s the bottom line?

Two to three portions a week of salmon or another fatty fish a week, plus a variety of ALA-foods (walnuts, soy, and flax seed) should suffice for most healthy people.

If you are not a fish or ALA-food eater, you may want to take a fish oil and flax seed oil supplement.

If you feel that you have a condition that can be treated, at least in part, with fish oil, don’t do it on your own. The subject is very complicated and in a state of flux. It may involve consideration of other supplements, dietary changes and prescriptions. Above all, it requires a thorough understanding of your condition and the potential benefits of omega-3s, and knowledge of its limitations. Discuss it with your doctor!

Cholesterol News, Again?

In November 2013, the American  Heart Association (AHA) and the American College of Cardiology (ACC) released new guidelines for cholesterol therapy in adults 20-79 years old. The guidelines were based on solid medical evidence but, nonetheless, generated a lot of controversy and even opposing opinions from experts in the field. On one hand, the guidelines argue for limiting some of the cholesterol testing we now use as a guide for therapy. On the other hand, the guidelines recommend therapy (the use of statin drugs) for certain groups of patients, regardless of their blood cholesterol levels. The controversy which evolved was covered in articles in the New York Times last November. The two titles convey the opposing messages: Experts Reshape Treatment Guide for Cholesterol and Don’t Give More Patients Statins.

Some of the best known statin drugs now in use include: Atorvastatin (Lipitor), Rosuvastatin (Crestor), Lovastatin and Simvastatin.

A study on the subject was published in the New England Journal of Medicine of  3/20/2014 by Michael J. Pencina, PhD, from the Duke Clinical Research Institute. It reports that the new guidelines would increase the number of U.S. adults eligible for statin therapy by almost 13 million, and that most adults between 60-75 years old would become candidates for treatment. I also refer to the guidelines in my blog of last November, Statins, To Take Or Not To Take.

The guidelines use a newly updated, computerized cardiac risk assessment tool, in deriving its recommendations. We use the same tool in our office.

Are You Walking Outdoors Yet?

Our citron is being acclimatized to the outdoors. Are you?

And The Cough Goes On...

Do you have an untreated cough that has lasted for several weeks? If so, you are not alone. Many patients in my practice have been complaining about a cough that does not seem to go away. I have seen more of it this year than in other years, and it started back in November of last year.

Typically, one would have an episode of bronchitis, sinusitis, or the common cold, which may have been treated with a course of antibiotics. The initial symptoms then partially or fully resolve. A few days or a week later, the nagging cough develops, and is commonly referred to as “post infectious cough.”

The cough may be “productive” (producing mucus), or it may be “dry.” It can occur during the day, when you’re lying down at night, or throughout the night. In more severe cases, the cough will come in “volleys” (paroxysms), and will awaken you, or even frighten you. It may be associated with a post nasal drip or gastric acid reflux. Some medications, particularly some of the medication used for the treatment of high blood pressure, can cause a persistent, dry cough.

The underlying reason for the cough is an inflammatory process which affects the linings of the bronchial tree leading to the lungs. It’s similar to the process responsible for bronchial asthma. It is thought by some authorities that, when left untreated, this condition can leave you predisposed to a recurrence, or even trigger the new onset of asthma.

When the cough lingers, you should be examined by a physician. This is especially important if you have a chronic condition such as asthma, chronic bronchitis or heart disease, and even more so if you have an impaired immunity, take immune suppressing medications, or are a smoker.

In treating the persistent cough, the physician must make sure that conditions other than post infectious cough are ruled out, such as pneumonia, asthmatic bronchitis and the whooping cough (pertussis).

Once other causes have been ruled out or treated, the post infectious cough will resolve on its own. But it may take weeks, and I have seen it last for months. Treating it will generally shorten the duration and severity of the post infectious cough, and should make you feel better much faster.

So, when you develop a lingering cough, don’t just tough it out, have it evaluated medically, and treated if necessary.