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MD Stein - What To Expect From Your Sleeping Pills

Wed, 31 Aug 2011 00:00:00 -0500

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?

Visualization is courtesy of TheVisualMD.com

MD Stein - Weight Training: Making it Last

Thu, 11 Aug 2011 00:00:00 -0500

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.

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MD Stein - Cigarillos: What's Up With The "Hype"?

Tue, 02 Aug 2011 00:00:00 -0500

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.

Visualization is courtesy of TheVisualMD.com

MD Stein - The world according to fiber

Tue, 19 Jul 2011 00:00:00 -0500

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?

Visualization is courtesy of TheVisualMD.com

MD Stein - Just One Look, That's All It Took

Thu, 07 Jul 2011 00:00:00 -0500

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?

Visualization is courtesy of TheVisualMD.com

MD Stein - Health and Prevention in the 21st Century: The "Pre-bies"

Tue, 28 Jun 2011 00:00:00 -0500

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.”

Visualization is courtesy of TheVisualMD.com

MD Stein - Be Careful What You Scan For

Tue, 21 Jun 2011 00:00:00 -0500

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.

Visualization is courtesy of TheVisualMD.com

MD Stein - The Future Of Personalized Test Results

Tue, 14 Jun 2011 00:00:00 -0500

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.

Visualization is courtesy of TheVisualMD.com

MD Stein - Cholesterol, Health, And Disease: A National Experiment In What's Clinically Desirable

Tue, 07 Jun 2011 00:00:00 -0500

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.

Visualization is courtesy of TheVisualMD.com

MD Stein - Who Has Diabetes? It's Hard To Know Anymore

Tue, 31 May 2011 00:00:00 -0500

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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MD Stein - Expert Patients and Shared Decision-Making

Tue, 17 May 2011 00:00:00 -0500

Our dominant medical ethic is one of shared decision-making. These days, the internet provides medical information about disease and treatment through authoritative sites (like the CDC) or through access to primary sources (NIH library) that can supplement the traditional doctor-patient relationship.

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MD Stein - Personalizing Your Health: The Trending of Test Results

Wed, 11 May 2011 00:00:00 -0500

Receiving the lab report with your baseline blood test results offers only the beginning of an understanding of where you stand health-wise, but it is not fully personalized. Your glucose level, for example, is compared to results from across the general population and should, if “normal” (meaning it falls within the middle 95% of all values), give you the reassurance of health. But knowing that your glucose falls within the reference range is only useful to a certain degree. What’s more useful would be knowing yourpersonal reference range, established by the history of your results over time. Through this longitudinal description, you could see trends, and these trends might direct you to where to put your health behavior change energies.

Visualization is the courtesy of TheVisualMD.com

MD Stein - What's Normal?The Strange Story Of Reference Ranges

Tue, 03 May 2011 00:00:00 -0500

Worried that you may have diabetes, your doctor sends you to have a blood glucose test. It’s 8 in the morning, you haven’t eaten since dinner the night before—it’s a “fasting” glucose, a simple and accurate way to determine your diagnosis. At your appointment later that day, your doctor shows you the report from the lab. There are two columns: on the left is your glucose (91) and on the right is the reference range of “normal” glucose values (67-99). The reference range for glucose (and every blood test) is established by one of a few reference laboratories, large corporations in the U.S. that dominate the blood drawing and testing market.

Visualization is the courtesy of TheVisualMD.com

MD Stein - Are E-cigarettes Lung Candy?

Tue, 26 Apr 2011 00:00:00 -0500

It’s the fifth American anniversary of electronic cigarettes, battery-powered nicotine atomizers that look like tobacco cigarettes. Lip pressure on the mouthpiece activates an electric circuit, nicotine is vaporized, and flavors are added to offer the sweet feel of smoking. E-cigarettes are marketed as substitutes for tobacco cigarettes, but without the combustion that produces high cancer risk. The truth is we really don’t know much about e-cigs, their safety, whether they can be used to quit smoking, or even whether their nicotine is delivered to the lungs (as with tobacco smoke) or only to the cheeks and throat (which means lower bodily concentration); what we do know is that they’ve been priced to be less expensive than a pack a day habit.

MD Stein - Sleep Trouble: Too Little or Too Much

Tue, 19 Apr 2011 00:00:00 -0500

Is there an optimal number of hours that we should sleep every night? Or put another way, is conventional wisdom that adults should sleep 8 hours actually good advice? In fact, it’s not: across the population, those who report 7 hours of sleep live longer than those who regularly sleep 8 hours or more.

MD Stein - Hookah Is Here

Tue, 05 Apr 2011 00:00:00 -0500

Hookah use dates back more than 500 years to Asia and the Middle East, but still relatively new in the United States, it has taken hold among young adults. Most college towns now have hookah lounges where meter-high water pipes stand among deep-backed sofa and overstuffed chairs, colorful hoses snaking. Along with smokeless tobacco (chewed or wedged inside a cheek), and electronic cigarettes, hookah is thought, by producers and users, to be a less harmful alternative to cigarettes. Distressingly, the majority of the collegiate hookah users I’ve talked to have no idea that hookah use even involves nicotine. But in fact, hookah exposes users to higher concentrations of carbon monoxide, nicotine and other toxic tobacco products than cigarettes.

MD Stein - Past The Salt

Wed, 23 Mar 2011 00:00:00 -0500

The Food and Drug Administration designates salt as a food additive that is “generally regarded as safe.” But at the amounts used by the average American, it is anything but safe. If you’re eating fast food, Chinese take-out, deli meats, anything in a can, mustard/mayo/catsup/relish, anything that tastes salty, you’re overdosing. And if you eat these most days, you’re setting yourself up for a medication-filled cardiovascular future.

MD Stein - The Vitaministas Hold On

Tue, 15 Mar 2011 00:00:00 -0500

Taking a daily multivitamin has become a symbol of taking care of yourself, of showing you’re serious about good health. Where did this idea come from and is there any evidence supporting it? Taking a daily multivitamin has become a symbol of taking care of yourself, of showing you’re serious about good health. Where did this idea come from and is there any evidence supporting it?

MD Stein - Nicotine Nonsense

Tue, 08 Mar 2011 00:00:00 -0500

For heavy smokers, good mood and clear-thinking begin to deteriorate within an hour after their last cigarette. These symptoms worsen over the next twenty-four hours. In daily life, there are more and more places where smokers are obliged not to smoke. To light up, smokers have to leave work, restaurants, and often their own homes. But sometimes they can’t leave to light up, and abrupt cessation of smoking can have meaningful effects on decision-making.

MD Stein - Cigarettes: Not Many is Too Many

Tue, 22 Feb 2011 00:00:00 -0500

With rising cigarette prices, a lousy economy, and fewer places to smoke, Americans buy fewer cigarettes than they did a generation ago. There’s been a dramatic fall in the percentage of Americans who smoke: in 1970, it was 40%, now it’s 20%. That’s good news.

MD Stein - Vitamin Confusion

Tue, 15 Feb 2011 00:00:00 -0500

Anyone on a diet reads the back of the package looking for calories per serving. But underneath the calorie count, you’ll find a list of nutrients (phosphorus, vitamin D, magnesium) and the % Daily Value of each. This percentage is based on the Recommended Daily Allowance (RDA), aka the Minimum Daily Requirement. The terms are confusing.

MD Stein - Health Goals Are Better Than Weight Goals

Tue, 08 Feb 2011 00:00:00 -0500

While Weight Watchers and Jenny Craig won’t show us their data (company executives argued to the Federal Trade Commission that disclosing effectiveness data would discourage Americans from dieting), university researchers have published theirs. In the controlled studies that have followed dieting participants for 2 years—most studies last only 6 months because they’re less expensive to complete and the results look better—the average weight loss is a mere 2 pounds (http://www.ncbi.nlm.nih.gov/pubmed/18377114).

MD Stein - Your Diet or Your Health

Tue, 01 Feb 2011 00:00:00 -0500

Even if you’ve never put yourself on a diet, you’ve probably spent time with someone who has, and it’s no damn fun. In fact, it’s incredibly stressful. You’re taking an official, often fee-paying step toward what you believe is a better silhouette, and perhaps even better health. What’s so stressful?

MD Stein - The Duchess Of Windsor Was Wrong

Tue, 25 Jan 2011 00:00:00 -0500

Before I go on in future blogs to discuss our misguided societal obsession with obesity, I want to turn my attention to the overlooked problem of being underweight. While extreme obesity is clearly a health risk, the thinnest among us may be at higher risk of early death as well.

MD Stein - Underage Drinking: Death or Taxes

Tue, 18 Jan 2011 00:00:00 -0500

If you’re reading this, you made it. On New Year’s day, underage drinking-related ER visits were more than 300% higher than on an average day in the last year. New Year’s is far more dangerous than July 4th (about 75% more ER visits than average) or Memorial Day (about 25% more).

MD Stein - The Idea(l) of Weight

Tue, 11 Jan 2011 00:00:00 -0500

How do we define a successful diet? It’s all in the eye of the beholder, and in this case, the beholder’s era. According to the epidemiologist Traci Mann, for more than half a century, we have used the Metropolitan Life Ideal Weight Table, an actuarial exercise in insurance prediction, to standardize our measurements and categorize Americans as small, medium, or large- framed.

MD Stein - The Weight of the World

Tue, 04 Jan 2011 00:00:00 -0500

We excel at obesity. Americans lead the world, collecting pounds like heavy Olympic medals hung from our necks during the national anthem. The US obesity prevalence has doubled in the past thirty years. There is a long list of partial explanations that add up. We have a ridiculously successful fast food industry. There’s a powerful corn lobby pushing high-calorie syrupy sweeteners. Our dinner plates are large and our portions fill them (the all-you-can-eat phenomenon). Our food selection is fat-laden. We are sedentary and the low (internationally-speaking) price of gas keeps us car-bound. The population decline in cigarette smoking has led to weight gain (even good news brings bad news!) We are amateurs at self-control.

MD Stein - Health as Equilibrium

Tue, 28 Dec 2010 00:00:00 -0500

We like to think of our health behaviors—I will go to the gym five times this week, I will quit smoking next week—as independent actions, subject to our will. Indeed, THEVISUALMD.COM divides Wellness into 9 Rules and presents them as if each rule stands alone. But the domains of Wellness interact. Our behaviors are inter-dependent, for better and for worse. The body is a masterpiece of equilibrium, of action and reaction.

MD Stein - Names and Behaviors

Fri, 17 Dec 2010 00:00:00 -0500

Over the next year, TheVisualMD will produce the 9 Visual Rules of Wellness, a beautiful and accurate display of imaging and scientific writing that will show how our behaviors—eating, sleeping, smoking, drinking, exercising—drive and damage our bodies and health. As a physician and researcher interested in behavioral medicine, I will blogging about patients and topics across these 9 Rules. Let me begin my first entry with some questions about a name.