MD Stein
Thirty million Americans have insomnia, trouble falling or staying asleep. Chronic insomnia predisposes people to depression, missed work, drug and alcohol use, accidents, and frequent medical visits in search of relief for the fatigue of sleeplessness. Sleeping fewer than 5 hours a night on a regular basis is demonstrably dangerous. Persons reporting this level of insomnia are at an increased risk of dying over the next decade compared to those who sleep longer. After trying over-the-counter remedies, many seek treatment for chronic insomnia by asking for prescription sleeping pills. Is there evidence that these pills work? And what are the risks?
Beginning at around age 40, everyone starts to lose muscle mass, a process known as sarcopenia. Adults who are sedentary can expect muscle loss of up to 0.4 pounds a year and lose 30% of their strength between 50 and 70. This process accelerates after age 75, limiting activities, and putting the sedentary at risk for falls and disablity.
Unlike cigarette smoking, cigar smoking rates have not declined over the past decade. This is primarily due to the use of cigarillos, a type of cigar growing more popular among teenagers and young adults. While cigarillo use increases, detailed scientific data about its absolute risk—the amount of tar, nicotine, carbon monoxide and tobacco specific nitrosamines inhaled—remains minimal.
Dietary fiber consists of the edible parts of plants that are resistant to absorption in the small intestine. Fiber-rich foods—whole grains, vegetable, fruits—are recommended in all dietary guidelines. But what are the health benefits of fiber intake, how much needs to be consumed, and is fiber beneficial if ingested in tablets and powder form instead of through food consumption?
Only a small percentage of people who try an addictive substance wind up addicted. Is a new user more likely to become dependent on nicotine, alcohol, or cocaine?
Fewer and fewer of us are deemed healthy it seems. We have “pre”-diabetes (also called glucose intolerance) and “pre”-hypertension. On the verge of osteoporosis, we have osteopenia, or thin bones that are “pre”-fracture. In the past decade, doctors have regularly redefined clinically desirable test results across a variety of biomarkers (blood sugar tests, blood pressure measurements, bone density scans). In doing so, they have created whole new medical categories characterized by the absence of physical symptoms and the presence of undesirable test results. More and more of us have become one of the “pre-bies.”
Radiologic scans (CT, MRI, ultrasound, PET) startle us with images of the internal and clinically unseen. The display of three-dimensional anatomic structures that can be enlarged, rotated, and enhanced by dyes and digitization, is fantastic and now commonplace. Imaging is the fastest rising service in health care; MRIs have increased tenfold in the last two decades.
In the future, the reports of our recent blood test results should and will look very different from the way they do today. Because our results will be “personalized,” we will have a far clearer understanding of our health and what we might do to improve it.
Cholesterol, Health, And Disease: A National Experiment In What's Clinically Desirable
For blood test results, reference ranges set by the testing laboratory define health and disease. Health (that is, not having a disorder like diabetes or hypothyroidism) is defined as any test result for a specific condition that falls within the middle 95% of the millions of values reported to the lab for that test in that year. Disease means your lab value is at the margins, the top 2.5% or the bottom 2.5%. Unless some external authority decides to tinker with this reference range (and sometimes they do—check the blog on diabetes I wrote three weeks ago) to redefine normal as a “clinically desirable range,” one would think that reference ranges should be relatively stable across an entire population over time. The word reference, after all, suggests solidity, fixity, nearness to truth; think of reference books. They’re not reformulated every few years. Nor would we think that our definitions of health and disease can be dramatically altered.
Do you have diabetes or don’t you? It’s hard to know if you don’t have the classic symptoms of high blood sugar (frequent urination, blurry vision, constant thirst). For the asymptomatic, the diagnosis is based on blood tests, the values of which are constantly being updated. The thresholds used to define abnormal keep changing, and new questions about clinical care keep arising.
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