Healthy People

Farewell and Stay Well

Mon, 04 Jan 2010 11:39:18 GMT

Happy New Year! 2009 is gone, and I've decided that this blog should come to an end as well. I hope you've found some useful wellness information and tips along the way.

Thank you. Stay well.

Dr. Bob

Cook and Eat Like "Julie and Julia"

Tue, 08 Sep 2009 11:45:33 GMT

"Julie and Julia" is a wonderful film, filled with high praise for great food and strong women. Everyone should see it. And everyone should cook and eat like Julie and Julia. The food does not have to be French, but it does have to be cooked at home with fresh ingredients.

America would be a much healthier place if everyone cooked and ate as Julie and Julia do. Buying fresh and cooking at home gives you complete control of what you feed your family.

Cooking at home does not mean buying a frozen pizza and cooking does not mean heating the darn thing in the microwave. Buying fresh means buying from the “perimeter of the grocery store” ( from Michael Pollan’s book “In Defense of Food”), the areas where ingredients such as broccoli do not have a marketing department or a bar code.

Buying fresh means you know what you are eating. Buying fresh or fresh frozen (e.g., frozen green beans with no added sauces) means one ingredient that a farmer grew. Buying frozen prepared foods means that the ingredients were shipped to the factory in a truck. Buying a prepackaged frozen dinner almost certainly guarantees that you do not have a clue what you are really eating.

Cooking at home does not necessarily mean hours in the kitchen or butter in everything. From scratch cooking can be done simply and in a way that is good for your heart. I was trained to cook by a Cordon Bleu graduate, and for the past 34 years, have cooked virtually all of our dinners while working 50 hours a week. (I am proud to say that I bought my now taped-together, and tattered two-volume “Mastering the Art of French Cooking” in 1977.)

First, always start with fresh or unprocessed ingredients. As above, I agree, frozen green beans are still just green beans, and almost as good as fresh. Second, find recipes that do not stress you. Third, plan a meal that gives you some healthy protein, two or three veggies, a good carb like yams, and cook the food in good oils.

Just to get you started, here is a wonderful, Julia-like, from-scratch dinner that can be done in a legit 30 minutes.

Tonight we are doing a simple salad with scratch dressing, pork medallions (you can use chicken breasts but they take longer to cook), oven roasted veggie (almost any will do, tonight it is asparagus), and, for dessert, sautéed apricots with yogurt and mint.

First, the asparagus. Turn oven to 350. Chop off the bottom third of the asparagus and discard. Place asparagus on a baking sheet and lightly toss in a tablespoon plus of olive oil, salt and pepper. Pop this into the oven for a full 30 minutes. If your asparagus is thin enough, the asparagus will turn into a delightfully sweet, almost candy-like crunch.

Next, the pork medallions. Heat your skillet (medium high heat) and add a couple of tablespoons of olive oil. Cut a pork tenderloin into ½ to ¾ inch thick slices and toss in flour. Cook the medallions about 3 or 4 minutes per side and remove to a serving plate. You may need to cook the pork in two batches. Deglaze (pour liquid in and scrape up the bits and let thicken for a few minutes) the pan with dry white wine (vermouth works well) or water. Flavor the deglazed liquid still in the pan with lemon juice or tarragon or capers or nothing (your choice), and slide the medallions back in to absorb the flavors over low heat.

Now a salad. Either quickly chop a head of good lettuce (remembering that iceberg lettuce is a nutritional desert) or open a back of mixed baby greens. Make a salad dressing by mixing a third of a cup of olive or canola oil with ¼ cup of vinegar (yes, you can guess at the portions here), add a dollop of Dijon mustard and whisk with a fork.

Dessert. Halve the apricots and remove the pits. After dinner as the dishes are being cleared, warm another sauté pan, add a bit of oil, and quickly sauté the apricots (cook until they start to turn color on the bottom). Flip another minute or two to warm through and put on plate with a dollop of quality, non-flavored yogurt. You may top with mint or a drizzle of honey. Serve.

You cooked, your significant other cleans the kitchen and dishes.

And that is how you eat a healthy meal quickly. You know exactly what you ate. And you ate some good protein cooked in good oil, two or three veggies (depending on size of the salad), and a fruit. The American Heart Association and both Julie and Julia would approve.

Eat well to stay well.

Dr. Bob Gleeson

What is meant by Mediterranean Diet?

Mon, 31 Aug 2009 08:38:45 GMT

The “Mediterranean Diet” is widely, and scientifically, associated with excellent health. But dunking your bread in olive oil before eating a humongous plate of double-sausage, double-cheese lasagna is not a Mediterranean Diet.

The idea for the Mediterranean Diet started with the Seven Countries Study. In the 1950s, Dr. Ancel Keys traveled the world looking for populations that had varying risks of heart disease and then studied their diets, exercise habits, and cholesterol levels.

Crete was among the countries with the best health, greatest longevity, and best risk markers. So, when you think Mediterranean Diet, think of the diet eaten on the island of Crete some 60 years ago. Fish, olives, whole grains, fruits and vegetables from the garden. Not too much, eaten preferably with family and friends, and certainly without a television blaring in the background.

The best diet markers of excellent health in the 100,000 strong Nurses’ Health Study and the 100,000 strong Physicians Health Study help us identify a modern “Mediterranean Diet."

So when I say, “Eat a Mediterranean Diet,” I mean you should eat:

At least five colorful fruits and vegetables every day. OJ for breakfast and berries on your cereal, a salad at lunch is usually two, an apple for snack, veggie with dinner is six. Have a piece of blueberry pie for dessert and you are at seven—just eat the berries and leave the crust.
One or two whole grains every day. Oatmeal, wheaties, shredded wheat, Cherrios, whole wheat bread for your sandwich, quinoa for dinner.
Nuts. Yes nuts. A handful or two every day. Lowers heart disease by 30 percent.
Ocean fish a couple of times a week. Salmon, tuna, sardines. Tilapia and cat fish just don’t have much omega-3.
Use olive and canola oil and avoid saturated fats (e.g., the white fat on a steak). The healthiest diets get about a third of their calories from fat. (Stay tuned, I’ll blog about the evils of the low fat diets soon.)
And some, but not too much, alcohol. This means a glass of wine or two.

A Mediterranean Diet does not require perfection. In my opinion (not scientifically studied that I know of), the best diet includes the above foods because their provide a marvelous package of health-promoting nutrients. And once you eat all the good stuff, you can indulge moderately without much guilt.

Stay well.

Dr. Bob

Know Your Numbers

Tue, 11 Aug 2009 10:09:53 GMT

Over the last week or so, I've given you links to some good health-assessment Web sites. Now I'm going to share with you where your numbers should be. It's important to know your numbers.

You know how much money is in your checking account, don’t you? Your savings account? Your 401K ? Your mortgage? Your net worth (total assets minus total liabilities)?

Knowing your health numbers is a lot like knowing your financial numbers. Both are important.

Great health is pretty simple. Don’t smoke; don’t be fat; eat a diet of lots of fruits and veggies with good proteins, good carbs, and good fats; and be active all day long.

Sometimes people who do all of these good and healthful things, yet still have funky blood pressure or lipids. Then it is time for medical therapy because maintaining good health numbers can keep you healthy for a long time.

I am not trying to give everyone a medical diagnosis to perpetuate the medical-industrial complex. I am trying to define optimal health. So here are your target health numbers for great health, even if you do everything else right.

Your body mass index should be between 20 and 27.9. If your BMI is above 35 or even near 40, your weight carries the same risk as smoking a pack of cigarettes a day.
Your blood pressure should be near 120/80. If it is 130/85, you should start to think about adopting a healthier diet and exercise plan (more exercise, less alcohol, less salt, less prepared, frozen or fast food), and if above 140/90, it is time to consider seeing your primary care provider for some medical treatment.
Your fasting blood sugar should be below 100. Diabetes starts at 125 and prediabetes is the area between 100 and 125. Trust me, you don’t want to be diabetic. Next week I’ll blog about what you should do if you are prediabetic.
Your total cholesterol should be below 200.
Your HDL cholesterol should be above 40 if you are a man and above 50 if you are a women. No exceptions here — low HDLs are a huge marker of increased cardiac risk.
Your LDL cholesterol should vary by your risk. Go to heartdecision.org to get your cardiac risk scores. If you are low risk, then your LDL goal is less than 160; if moderate risk, your goal is less than 130; if high risk, your goal is less than 100; and if very high risk, your goal is less than 70.
Your triglycerides should be less than 150 by national guidelines. I think this number is way too high and would like them to be below 100.

So by now, you probably want to know where I keep my own numbers; do I live up to my own standards? Well, I try (aside from eating ice cream out the carton). I have a BMI of 24.5, a BP around 120/80 on medication for the past 25 years; a fasting blood sugar of 88; and on low dose statin, a total cholesterol of 180, an HDL of 55, an LDL of 113, and triglycerides of 60.

The following is feedback received for this blog:

Dr. Bob -- Thanks for writing these articles -- very helpful to someone like me trying to keep healthy. I just got my blood numbers back and I'm very frustrated. I try to do what you say with eating and exercise, yet my total cholesterol is still high. I have a total of 211, but my LDL is 124 and my HDL is 69. Can HDL be too high? Is my high HDL, which I thought was a good thing, making my total too high? BTW, my BMI is about 25 and I'm otherwise healthy.

- Don

Part 4: Best Health-Assessment Sites

Fri, 07 Aug 2009 13:47:46 GMT

How long are you going to live? Calculate your life expectancy at this site from Northwestern Mutual. If you don’t like the answers, you can change them as you go and watch your health improve.

In the interest of full disclosure, I need to tell you that for the last 25 years, I was the physician-owner of this site at Northwestern Mutual.

Next week, I'll tell you where I think your numbers should be ... and I'll share with you my numbers.

Part 3: Best Health-Assessment Sites

Thu, 06 Aug 2009 09:50:06 GMT

Cool site #3: What is your 10-year risk of a heart attack?

Go to heartdecision.org to assess your future risk of a heart attack. In the bottom row, click yes on “Display CHD + Angina Algorithm."

This results can be a bit confusing because the authors tried to combine the criteria of both the Framingham Risk Score and the National Cholesterol Education Program Adult Treatment Panel III on one chart. But you can take the results as accurate. A new version is due out soon to clarify the confusing results.

Part 2: Best Health-Assessment Sites

Thu, 30 Jul 2009 12:01:17 GMT

What is your 10-year risk of developing diabetes?

We are facing a true epidemic of diabetesity, the obesity caused diabetes and all of its inherent ugly complications. Are you at risk? Find out at qdscore.org. This is a British site based on an eight-year study of 2.5 million Brits so it is quite accurate. You’ll love the graphic if nothing else.

If your score is too high, then I’m guessing you weigh too much, so redo the test as though you weighed 11 pounds (5 kg) or 22 pounds (10 kg ) less. You’ll really be able to see the benefit of losing weight.

Some of my Favorite Health Self-Assessment Web Sites

Tue, 28 Jul 2009 10:14:38 GMT

My patients really value seeing their health as a whole and understanding their current health status and future risks. Over the next few days, I am going to list some very cool Web sites to assess your current health and future risks and then after that I will identify the optimal criteria for your current health risk assessment — and tell you why your results matter.

Cool site No. 1: How fit are you?

Go to adultfitnesstest.org to assess your current fitness and benchmark yourself against national age- and sex-adjusted percentiles. The tests are clearly explained, quite simple, and very reliable.

The Value of a Good Physical Exam

Thu, 16 Jul 2009 11:16:09 GMT

In my preventive medicine, executive health practice, there are three kinds of patients: (1) the “healthy," (2) the "here's-hoping," and (3) the "hear-no-evil, see-no-evil.”

I see only the first two groups. I do not see the "my-health-problems-do-not-exist-unless-a-physician-finds-them” group. This last group stays “healthy” by avoiding my office — at least they were healthy until they ended up in the coronary care unit.

Guess which group I most need to see.

Why should and how can you convince those important in your life to see me or a good primary care physician for a really good history, exam and lab work? Tell them that our primary task today is to keep people as healthy as possible for as long as possible.

Thirty years ago the purpose of a medical exam was to find bad disease early. A scary thought.

No more. Today, the entire focus is to prevent future disease by identifying treatable risk factors.

A good physician can help a patient prevent 90 percent of type II diabetes, at least 50 percent of all future heart attacks and strokes, 90 percent of lung cancer, maybe 80 percent of colon cancer, and more.

Preventing a heart attack is much easier, and a whole lot cheaper, than treating it well.

The Longer You Live, the Healthier You Have Been

Mon, 13 Apr 2009 14:15:11 GMT

We vastly underestimate the benefits of a healthy lifestyle. People who follow the relatively simple rules of good health (no smoking, 30 minutes of daily activity, a Mediterraneann diet, no obesity, and perhaps a little wine) prevent disease, live 7 to 14 years longer than average, and, importantly, both reduce and delay end-of-life disability.

Here are some facts from forbes.com about the benefits of healthy life:

"Researchers at the University of Cambridge in England followed 20,000 middle-aged men and women in England for 11 years and found that nonsmokers with the healthiest eating and exercise habits at the outset had a 14-year-life-expectancy edge over the people with the worst habits.
A 2001 Loma Linda University finding that Seventh-Day Adventists who kept good habits lived to an average age of 88, versus 78 for those who behaved less well. ... Seventh-Day Adventists [have] a life expectancy four to seven years longer than that of average Americans, probably because their faith preaches a vegetarian diet and exercise. ...
Researchers at the Pacific Health Research Institute in Hawaii who followed 5,820 Japanese American men for 40 years found those who avoided risk factors such as obesity, heavy drinking, smoking and high blood pressure in middle age had a 69% chance of living to be 85, versus just 22% for men with six or more risk factors."

Remember, the older you get, the healthier you have been.

- Dr. Bob

Stay well.

What is Your Risk for Diabetes?

Wed, 25 Mar 2009 09:59:48 GMT

The American diabetes epidemic continues to grow. More people are at risk, and perhaps more risk than they think.

So what is your risk of developing diabetes and what happens to your risk if you lose 20 or 30 pounds?

Now you can calculate your risk of developing diabetes in the next 10 years at qdscore.org. The results are based on a study of 2,500,000 Brits followed for 8 years (a very reliable 16,000,000 person years of follow-up). Don't you love the clarity and simplicity of their graphic?

The study uses BMI so you can go to the National Heart Lung and Blood Institute's Web site to find your BMI. And then you can redo the calculation process assuming that you lose 20 or 30 pounds.

I find this an extremely valuable educational tool with my patients.

Show a 55-year old man with a BMI of 35 that he has a 20 percent chance of diabetes in 10 years and then show him that by losing 30 pounds he can lower his risk to 10 percent and by losing another 20 pounds he lowers his risk to 7 percent. Very powerful stuff.

The modern diabetes epidemic is the failure of prevention. Knowledge and tools like qdscore.org is the first step toward personal understanding of our risks. And that first step is necessary to start the process of change.

Stay well. Dr. Bob

Take Mom's Advice

Mon, 23 Mar 2009 09:29:50 GMT

Sure we are living longer — but should that be our primary objective? I think not. Our goal should be live in better health and with more meaning while we are alive. How do we do that?

"Better health" is quite simple and builds on the advice that your mother told you when you were a child.

She told you, "Eat your fruits and vegetables." To that, we should all add "all five of them and some whole grains and nuts every day and some fish a couple of times a week; cook with olive oil, and enjoy some red wine with dinner (but not breakfast)." Every day, your mother sent you outside to play, which is not a bad way to think about exercise. And she took you to get your "shots," which is a great example of preventive medical care, a large bucket that includes cancer screening, treatment of cholesterols and blood pressure. And she told you to get enough sleep and enjoy life. In reality, when all is said and done, she was right and there is not a whole lot more that you need do to stay healthy.

Meaning. We spent the middle 30 years of our life working for success; now is the time to work for meaning, to give back to the world. As boomers we have always changed our world — usually, but not always — for the better. We certainly face a world of problems, locally and globally. What a wonderful opportunity to make a difference.

Enough preaching about my philosophy, but I felt it important to put all of us on the same page.

Live well while you are alive. Dr. Bob

This blog post was originally publisehd at my former blog, "Healthy for Life."

Obesity in Late Adolescence Increases Mortality in Adulthood

Wed, 25 Feb 2009 09:49:24 GMT

Here is a fabulous study based on a huge amount of data with a disturbing result given today’s obesity epidemic: being obese in late adolescence increases mortality in adulthood as much as smoking.

In this study, the researchers followed 45,920 Swedish military recruits, average age 18.7 years for 38 years. Over 1,700,000 person years, 2,987 men died. After 38 years of study, the data showed that the mortality rates in

normal weight (BMI 18.5 to 25) was 1.7 per 1,000 per year
overweight (BMI 25 to 30) was 1.33 per 1,000 per year
obese (BMI > 30) was 2.14 per 1000 per year

This study started in 1950; three decades before the obesity epidemic began. This message is sobering given the huge increase in adolescent obesity and consistent with the projections of Olshansky that the obesity epidemic might, for the first time in a century, decrease the next generation's life expectancy.

Obesity in America is a serious epidemic that began in the early 1980s. As this study highlights, the serious effects of this epidemic will be with us for many, many years to come.

Your Medications Will Not Work if You Do Not Take Them

Mon, 23 Feb 2009 10:37:07 GMT

Shalev and Chodick have just published a great study (see "Continuation of Statin Treatment and All-Cause Mortality" in the Archive of Internal Medicine - 2009;169(3):260-268) that supports your mother’s good advice: medicine won’t work if you don’t take it.

They studied 230,000 men and women, average age 58, in an Israeli HMO, comparing how often prescriptions for statins were filled at the pharmacy and then followed them for four years in the primary prevention arm and five years in the secondary prevention arm of the study. (Primary prevention is a heart attack has not yet happened and secondary is a heart attack has occurred and they are trying to prevent the second).

The study looked for all-cause mortality.

The results are crystal clear: People who take their statins more than 90 percent of the days were half as likely to die as those who took their medications less than 10 percent of the time in both the primary and secondary arms of the study. Further, people who took their medications half of the time were 50 percent more likely to die than those who took their medications more than 90 percent of the time.

Some people worry about what statin they are taking. Perhaps they would be wiser to be certain that they actually take their prescribed pill every day.

Activity, Obesity and Diabetes — an Unexpected Result

Mon, 16 Feb 2009 08:03:05 GMT

Regular physical activity has important and wide-ranging health benefits. People with at least a moderate level of fitness have less chronic disease, and, importantly, when moderately fit people do have a chronic disease they live longer lives.

Church and Blair followed 2,316 men with type-2 diabetes for 15.9 years. They sorted the results by into three groups of BMI (18.5 to 25; 25.1 to 30; and 30.1 to 35) and by fitness level (low, middle, and high).

The expected result is that in every BMI group, the mortality of people with low fitness was two times higher than people with even moderate fitness.

The unexpected result is that obese men (BMI 30 to 35) who were moderately or highly fit had less than half of the risk of dying as normal weight men (BMI 18.5 to 25) who were unfit.

Wow, that's an impressive result. The recommendation could not be clearer: being active lowers mortality rates, even for obese diabetics.

Stay well.

Dr. Bob

Why an Executive Physical at Froedtert?

Wed, 04 Feb 2009 18:12:01 GMT

A recent New England Journal of Medicine article criticized executive physicals as being excessive, inefficient, and elitist. An executive physical at Froedtert & The Medical College of Wisconsin, I would argue, is the opposite: it is cost-effective, efficient, and good basic medicine.

I agree with Dr. Rank that some executive physical programs are excessive and elitist: whole body scans without cause are bad medicine and monogrammed terry cloth bathrobes belong in a spa, not a medical clinic. And some exams are an exorbitant waste of money. Recently a patient brought me a hardcover, 50-page book describing some 250 blood tests they had as part of an executive physical — I'd never even heard of most of the tests.

But the executive physical program at Froedtert & The Medical College is efficient: We meet you at the information desk and escort you to all of your appointments so you do not waste time.

The exam is targeted and individualized to your needs, your past history, and your recent medical tests, even if they were done elsewhere.

Our exam offers 75 minutes of physician face time for a full review of your medical issues and your wellness issues (diet, exercise, sleep, stress, alcohol).

Thanks to Froedtert & The Medical College technology and speed of service, most of your lab results will be ready for review with the physician 90 minutes after the blood is drawn.

You end with a review and recommendations of your medical problems, a written assessment of your medical risk factors, and easy referral to leading specialists if necessary.

The Executive Physical Program of Froedtert & The Medical College is efficient, cost-effective, personalized, and valuable. I'll bet Dr. Rank would praise our program.

How to Eat the Optimal Diet to Prevent Disease

Tue, 13 Jan 2009 08:04:59 GMT

Based on abundant scientific evidence (look here for a New York Times article and here for a New England Journal of Medicine article) , we can identify the optimal diet for optimal health. The question for most people is how to fit these eating habits into their already too busy life.

The optimal diet for optimal health, a diet to prevent heart disease, diabetes, and at least some cancers, is quite simple. Follow the five steps below and everything else will fall into place.

Every day, eat five or more colorful fruits and vegetables, a whole grain or two, and some nuts;
Every week, eat a couple servings of ocean fish and a bean dish or two;
Make olive oil your primary fat;
Limit red meat and saturated fats; and
Avoid foods like pre-packaged, frozen dinners, chips, and energy bars.

I explain this to patients and they often wonder just how can anyone possibly eat 5 fruits and veggies — let alone 7, 8, or 9. So let me give you a brief review of my diet (both good and bad) for the past week. I was not perfect, but you need to remember that great health does not require perfection, tofu, or spandex.

Breakfast: Five of seven days I started the day with three cups of coffee, a glass of OJ, a bowl of McCann’s Irish oatmeal topped with raisins and sliced banana or Wheaties mixed with Cheerios topped with blackberries or a banana. One day was OJ, two eggs, bacon, and cinnamon toast and the remaining day was coffee and a pastry (actually two pastries) from my favorite French bakery. On five of the seven days, I had one-plus whole grain and two fruits, a decent start.

Lunch: When I am at the hospital, I eat soup or chili and a salad made with dark lettuce and topped with sliced eggs, pickled beets, sunflower seeds, and Ranch dressing. I want olive oil and vinegar, but I have not yet convinced the cafeteria to make this available (give me time). Also note that I avoid the “low-fat salad dressings", because I believe a healthy diet needs the polyunsaturated fat. When not at the hospital, lunch is usually something like shrimp curry, or a ham or tuna sandwich, and once a week maybe a good hamburger. And five of seven days, I eat either an apple or an orange for dessert. The salads count as two veggies, the orange is another fruit. And, I got a couple of fish (tuna) already.

Snack time: Nuts, really good quality cheese, or guacamole.   Sometimes all three in one day.

Dinner: For dinner, I really like to cook ocean fish (fast and simple and really good tasting), or I might roast an organic chicken on Sunday and then extend the gravy and add vegetables for a chicken a la king, and then chicken soup (again quick), or a good home-made meatloaf. We often have two vegetables for dinner or a veggie and sweet potato, rarely white potato. Dessert is a fruit (rhubarb cooked with orange or an apple pie (eat the apples, not the crust). At the end of the week, just during dinners, I have at least two more ocean fish, and averaged another three veggies and fruits.

For the week, I had five to seven whole grains, 45 to 50 colorful fruits and veggies, probably five fish servings, 10 servings of nuts, two legumes (beans), limited red meat, cooked only with olive oil and used olive oil on my salads or to dress my veggies. And no factory-produced, cellophane-wrapped food. Not a bad start.

We all have failings. Mine is dairy. As a good Wisconsin kid, I abhor skim milk, and love ice cream. Preferably Ben and Jerry’s. My wife just rolls her eyes at me when I eat Ben and Jerry’s out of the pint container. What, a pint is not a single serving size?

Next week, I post about how I eat in restaurants. Until then, enjoy the healthy food that you eat. Eating a Mediterranean diet will definitely make a positive difference in your health.

Dr. Bob

The Three-Legged Stool of Great Health

Tue, 06 Jan 2009 09:56:13 GMT

Great health requires three nearly equal components: (1) Genetics and luck, (2) a healthy lifestyle, and (3) good preventive medical care. You control two and half of these.

Genetics and luck.

Genetics and luck — for both good and bad — account for no more than a third of our health. And, here's the control part: knowing your family history (the single best and cheapest genetic test around) can lead us to take steps to prevent, stop, or reverse the health effect of the genetic dice. For example, if your father and two paternal uncles had heart attacks in their early 50s, you know you are at risk. But you can use that knowledge to aggressively manage your cardiac risk factors and prevent or even stop your own heart attack.
A healthy lifestyle.

Many people make the serious mistake of underestimating the tremendous benefit of a healthy lifestyle. Walking two miles a day can lower your risk of a heart attack by 30 percent, eating a Mediterranean diet can lower your risk of cancer, diabetes, and heart disease, and doing both can lower your risk of type-2 diabetes by 50 percent, and not smoking can lower your risk of lung cancer by 90 percent. Big pharma does not have any pills more powerful than a healthy lifestyle.
Preventive medical care.

Prevention is very powerful medicine. Primary prevention works to prevent disease by treating risk factors (treating high blood pressure lowers the risks of stroke) while secondary prevention works to prevent the complications after a disease has already been diagnosed (aggressively lowering cholesterols to prevent a second heart attack).

Unfortunately, our medical system gives short shrift to good primary prevention — a physician and hospital earn more money putting in cardiac stents than in telling people to take their statins, let alone telling people to take a brisk two-mile walk.

But you know the value of asking about your family history, the tremendous benefit of a brisk walk every day, and the advantage of taking your blood pressure pills every single day. You know you want to be a healthy, active, and vibrant 85-year old.

Coffee and Heart Disease

Wed, 31 Dec 2008 11:22:01 GMT

The Swedish Heart Epidemiology Program has followed for eight years 1,369 people who had their first heart attack between 1992 and 1994. 276 participants died during the study. After a multivariant analysis, coffee consumption showed a "strong inverse relationship with mortality."

People were categorized by the number of cups consumed per day: less than 1, 1 to 3, 3 to 5, 5 to 7 and greater than 7. Compared with those who drank less than 1 cup a day, mortality was 32 percent lower for those who drank 1 to 3 cups, 48 percent lower for those who drank 3 to 5 cups, and 42 percent lower for those who drank more than 7 cups. Sorry, I cannot find a link to the study, but my source is the Internal Medicine News, Dec. 1, 2008, page 40.

Then, if you like coffee, you simply must read this delightfully illustrated op-ed piece from today's New York Times online.

A Wonderful Link for You

Mon, 22 Dec 2008 11:32:37 GMT

Here is a link to a wonderfully written weekly post about a better, more sane life. "Spiritual Wealth" is a soul-satisfying, stress-reducing, life-affirming essay, a reminder of what is important. Please check it out; it's free and without advertising.

What Part of Preventive Medicine Do We Not Yet Understand?

Fri, 12 Dec 2008 12:56:06 GMT

Americans are less healthy today than four years ago.

That is the astonishing conclusion of a report of 23 measures of America's health done by the huge health insurer United Health Group. The leading problems are the number of uninsured, the exploding obesity epidemic, and the 20 percent who still smoke.

What part of preventive medicine do we not yet understand?

"An investment of $10 per person per year in programs to increase physical activity, improve nutrition, and prevent smoking would cut national healthcare costs by $16 billion annually within five years, according to the Robert Wood Johnson Foundation. That is a return of $5.60 for each dollar spent." That quote is from the Minneapolis Star Tribune article, which captures the problem nicely.

Click through these CDC obesity maps to watch the obesity epidemic explode over the past 28 years. (I am talking about obesity, not overweight.)   Then consider that obesity causes 90 percent of all type-2 diabetes, 20+ percent of cancers of the breast and colon, that obese teenagers have the arteries of 40- or even 50- year-olds. Then remember that 90 percent of all lung cancers and maybe 50 percent of oral cancers are caused by cigarette smoking. Think about the fact that Americans spend more on health care than any other nation, but rank only about 50th in life expectancy.

Ouch. We can, and indeed must, do better.

Dr. Bob

The Drip, Drip, Drip of Stress in 2008

Tue, 09 Dec 2008 14:54:01 GMT

Recently, I read an article saying that Americans are more stressed today than in 1980. Like that's a newsworthy article?

Give me a break — we're drowning in a constant ourpouring of stress hormones right now. Every evening, the broadcast news breathlessly reports that there is a new war in Darfour/the Congo/Zimbabwe/the Thai airport/Mombai/Kandihar/Baghdad, or a family five states away was murdered, and, oh, by the way, the stock market is still in free-fall, and the number of unemployed is rising — including maybe, just maybe, us too. Your Blackberry is demanding your attention, the television is reporting your neighbor's foreclosure, and your teenage daughter wants to marry a 38-year-old biker dude with more tattoos than you care to count, and your 12-year old has just announced that he/she wants to be goth.

The Creator gave us stress hormones to increase our chances of survival when the tiger was prowling right outside the cave: Fight or flight. Historically and evolutionarily, we spent the vast majority of our time quietly picking berries, catching fish, making babies, looking at the stars. Until the tiger appeared and then our stress hormones kicked in.

But today we are bombarded with constant and stressful and instantaneous announcements of pending doom (tigers outside the cave).  Our stress response is not a once-a-year thing, it is a minute-by-minute thing. Our stress hormones are dripping constantly into our blood.

Constant stress is not healthy. We have to learn to chill.

Here is my recipe for refuge from stress:

Make and take 30 minutes for yourself every day. Just you, no one else. Turn off the cell phone, turn off the television, turn off the iPod, turn off the world. During this time, do something that is just for you in a manner that would appeal to your great-great grandparent. Take a quiet walk in the park, bake bread, meditate, chop wood (Grandpa's version of exercise), or practice abdominal breathing.

What? Grandpa did not do abdominal breathing? Well, maybe not, but he should have. Abdominal breathing resets your inner biological rhythms by calming the sympathetic and parasympathetic nervous systems.

Here is the deal: Start by lying down and put your hands on your belly. For the next 10 minutes, you are going to raise those hands on your belly every time you inhale and lower them when you exhale. Concentrate on making each exhale and each inhale the same length. Concentrate on your breathing. Feel the air go in and go out.

Once you get the action, you can do this sitting up; but do start lying down. Now, do this twice a day for 10 minutes each time. Do this for 3 or 4 minutes before a stressful meeting. Do this to reset your biological stress level.

I don't quite understand why, but I can almost guarantee that abdominal breathing works.

What is your secret for lowering your stress levels? Write me and we can share ideas.

Thank you. Stay well.

Dr. Bob

What Diet is Best to Lower the Risk of Heart Disease?

Thu, 04 Dec 2008 16:33:16 GMT

I recently saw a young, delightful gentleman, who was in perfect health — except for a sky-high coronary calcium score (an indicator of severe coronary artery disease). He was fully medicated with all of the correct medications and his lipid values were enviable. He exercised 45 minutes five days a week. He had never smoked.

We got into an energetic discussion about the best diet for him. He was following an American Heart Association diet that emphasized low fat, low carb, fish (he ate salmon but preferred fresh water fish like tilapia and walleye), a couple of vegetables and fruits, a whole grain cereal every morning, and 2 glasses of red wine a day.

Thinking of the Lyon Heart Study here, here (look at the graph on slide 3), and here, I proposed that a Mediterranean diet would be healthier. This diet, nicely described in this Wikipedia article, and the Old Ways Web site emphasizes olive oil, deep water fish, legumes, fruits and veggies, and nuts; while de-emphasizing saturated and omega 6 fats, and processed foods.

The articles all support the healthful benefits of this diet, and conclude with requests or suggestions for more research on the topic. I agree. And until then, I will continue to promote the Mediterranean diet. Stay tuned because the health benefits of a Mediterranean diet will be a major topic of this blog.

My dinner tonight was two handfuls of nuts as an appetizer, pork tenderloin sauteed in olive oil, green beans with rosemary dressed lightly with olive oil, a salad of mixed greens dressed with, you guessed it, olive oil and apple cider vinegar, red wine to drink, and a pear claufoti for dessert. Something like sauteed monk fish would have been better, but I did pretty well.

Eat well to stay well.

Dr. Bob Gleeson

Eat Well, Live Better

Mon, 01 Dec 2008 09:10:50 GMT

The Mediterranean diet wins again — and again and again. In fact, I have never read an article or scientific report where the Mediterranean diet was even remotely linked with higher mortality. Most studies show a 30 percent decrease in mortality for people and populations who eat a Mediterranean diet.

The western diet of steak, hot dogs, and french fries promotes disease, while a Mediterranean diet of fruits, vegetables, and olive oil promotes health. The choice is simple, and the results clear.

In future blogs, I will work to define this diet. Suffice it to say, anytime you choose vegetables and fish over fish and chips you move to a healthier place.

Make life simple, choose health.

Stay well.

Dr. Bob

Healthy Tidbits From the 2008 European Society of Cardiology

Mon, 24 Nov 2008 09:18:48 GMT

Stairs, Sex, and Wine — You have to love the European Society of Cardiology.

The Geneva Stair Study asked 70 sedentary employees to use the stairs instead of elevators for 12 weeks. At the end of 12 weeks, the total flights of stairs, up and down, increased from 5 to 23. Making this one little lifestyle change increased their VO2 max by 8.6 percent, or 1 MET, which other studies have shown is enough to cause a 15 percent decrease in all-cause mortality. Other favorable results were a decrease in waist measurement, weight, fat mass, diastolic blood pressure, and LDL.

Another reason to avoid heart disease: It makes for a less than wonderful sex life. This study reports that in a small group of women with serious ischemic heart disease 83 percent reported their sexual interest was much lower than before the illness.

Dr. Giovanni de Gaetano reports on a study of 209,000 people showing that those who drank up to 150 cc (5 ounces) of wine had 32 percent less vascular disease than nondrinkers. A group of 208,000 beer drinkers had a 22 percent lower risk of vascular disease. No reports on the effect of liquor.

The take-home lessons? To have a better sex life, avoid heart attacks by climbing stairs and drinking a glass of wine with dinner.

Stay well.

Dr. Bob Gleeson

Happy Music is Heart Healthy

Wed, 19 Nov 2008 10:02:57 GMT

Listening to happy, joyous, upbeat music of your choice is good for your heart. As good as laughter, dark chocolate, exercise, and red wine. The study, although small, showed a 25 percent increase in the diameter of blood vessels in the upper arm — a large difference. Trust me, you want relaxed and happy blood vessels.

Listen to the podcast from the NPR show "Science Friday" or read the Los Angeles Times article.

I am fascinated with the endothelium, the inner lining of our blood vessels, and consider them key to great health. Stay tuned, I'll write more about the endothelium soon.

I wish you great health and a very happy life.

Dr. Bob