Monday, December 29, 2014

Health Benefits of Dark Chocolate (just in time for the holidays!)

In the past, chocolate has been considered an indulgence without benefits beyond pleasing our taste buds. Recent evidence, however, has shown that there may be significant health benefits to eating chocolate. The key to receiving these health benefits appears to be the type and amount of chocolate being consumed.
What is the origin of chocolate?
Chocolate comes from seeds ("beans") of the fruit of the cacao tree. Cacao trees flourish only in the hot, rainy tropics of the equatorial region. Chocolate's origins can be traced back to Mayan and Aztec civilizations in Central America who roasted cocoa beans to make a bitter drink called "chocolatl". It was introduced into Europe by Spanish conquistadors returning from the Americas. Many years later a process for making chocolate into a solid was developed. Modern production of chocolate involves roasting and grinding cocoa beans in order to make a paste (chocolate liquor). The paste, mixed with sugar, milk, and other ingredients is heated and cooled resulting in solid chocolate. Different forms of chocolate have different percentages of cocoa. Dark chocolate is approximately 70% cocoa, whereas "white" chocolate has practically none of the cocoa solids.

What is it about chocolate that makes it healthy?
Dark chocolate and cocoa are particularly high in flavonoids, a subgroup of antioxidants known as polyphenols. Flavonoids are also present in higher concentrations in tea, red wine, and certain fruits and vegetables. Recent research has found evidence that when these flavonoids undergo fermentation by bacteria in the human gut, anti-inflammatory compounds that improve blood vessel function are produced.

What are the suggested health benefits of chocolate?
  1. The greatest health benefit of consuming chocolate appears to be its ability to reduce the risk of heart attack and stroke. In their Nutrition Evidence Library , the U.S. Department of Agriculture states that "moderate evidence suggests that modest consumption of dark chocolate or cocoa is associated with health benefits in the form of reduced cardiovascular disease risk." The ways that dark chocolate could affect the risk of cardiovascular disease include:
    • Antioxidants in chocolate prevent LDL cholesterol from becoming oxidized, the process that turns it into "bad" cholesterol.
    • Studies from several countries have found that dark chocolate can lower blood pressure. The effect on blood pressure, however, is modest and wears off unless chocolate is eaten on a regular basis.
    • Dark chocolate reduces the activation of platelets, a step in the formation of blood clots. Most strokes and heart attacks occur after clots form in blood vessels.
    • Flavonoids in dark chocolate appear to reduce inflammation and plaque formation in the bloodstream that can block an artery, leading to a heart attack or stroke.
  2. Dark chocolate also appears to help the body use insulin more efficiently in controlling blood sugar. Insulin resistance, a condition in which the body doesn't use insulin effectively, is associated with type 2 diabetes.  By improving insulin sensitivity, eating dark chocolate could delay or prevent the onset of diabetes and pre-diabetes in certain individuals.
  3. Cocoa and dark chocolate may also help improve brain function. Researchers at Harvard Medical School found that older adults who drank two cups of cocoa a day had improved blood flow to parts of their brain involved with memory and thinking. Dark chocolate may also improve mood and pleasure by boosting serotonin and endorphin levels in the brain.
Are all types of chocolate equally beneficial?
Definitely not! Since its discovery, chocolate has morphed into a variety of products---powdered cocoa, dark chocolate, semi-sweet chocolate, baking chocolate, milk chocolate, white chocolate, etc. The FDA has established standards for each of these, depending on the percentage of cocoa solids that they contain.  The higher the percentage of cocoa, the more flavonoids and potential health benefits will be found in the chocolate. Dark chocolate typically contains around 70% cocoa, whereas most milk chocolate has a much lower percentage of cocoa solids. White chocolate, which contains no cocoa solids, contains none of the health-promoting flavonoids. The "dark side" of all types of chocolate is that they contain a large amount of fat and are relatively calorie dense.
So, for now, even though the amount of chocolate necessary for optimal health ben efits has not been determined, it appears that eating an ounce of dark chocolate, up to 7 ounces a week, can not only please your taste buds but may offer real health benefits. Look for dark chocolate with around 70% cocoa or "chocolate solids" and keep portions at a moderate level to avoid expanding your waistline.
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Friday, December 19, 2014

Medical Myths Abound During the Holiday Season

Medicine is not an exact science, but one that repeatedly shoots at a moving target in an attempt to eventually hit the bull’s-eye.  During this process, widely held medical “truths”, on further review, may turn out to be inaccurate.  Maintaining a certain level of skepticism and continuing to question even the most commonly held “facts” is an appropriate role of medical science.

A few years ago, two Indiana-based physicians looked at a number of health-related beliefs that pertained to the holiday season.  Their analysis of these beliefs, “Festive Medical Myths”, was published in the British Medical Journal.  With the approach of the holidays this topic seems particularly relevant. See if you are surprised by some of their findings pertaining to these seven myths.

Eating sugar makes children hyperactive.    The authors reported that of 12 double blind randomized controlled trials examining how children react to diets containing different levels of sugar, none detected any differences in behavior between the children who had sugar and those who did not. This included studies that looked specifically at children with attention-deficit/hyperactivity disorder. These studies also found that parents who thought their children have been given a sugar-containing drink, even if it was really sugar-free, rated their children’s behavior as hyperactive.

Suicides increase over the holidays. This common myth has also been soundly debunked. A study from the United States that followed the suicide rate over a 35 year period found no increase in suicides before, during, or after the holidays. Studies performed in other countries have confirmed these findings. It appears that more people commit suicide in the warmer months of the year, rather than in the winter.  This does not mean, of course, that suicides do not occur during the holiday period, just that they do not occur at an increased incidence as compared to other times of the year.

Poinsettia plants are poisonous.  It is widely believed that poinsettia plants are poisonous to humans and pets, even though there is little evidence to support this. The authors found that in over 20,000 cases of poinsettia exposure or ingestion reported to Poison Control Centers, none resulted in significant poisoning. At most the poinsettia plant was responsible for causing a mild, itchy rash when the sap was exposed to the skin or mild stomach ache, vomiting or diarrhea when ingested. Of concern, however, is the potential for an allergic reaction, particularly in people with latex allergy since poinsettia plants and latex have similar potentially allergenic proteins.

Most of the body’s heat is lost from the head.  Many have heard the saying, “if your feet are cold, put on a hat”.  The rationale for this was the belief that most of the body’s heat was lost through the head.  Even a US Army Field manual for survival recommended covering the head in cold weather because “around 40 to 45% of body heat was lost through the head.”  More recently, however, it has been shown that any uncovered part of the body will lose heat and there is nothing special about the head and heat loss. A more accurate assessment is that approximately 10% of body heat is lost through the head and neck.

Eating late at night makes you fat.   Many people are under the impression that when food is eaten at night it is converted into fat, presumably because of the absence of physical activity while sleeping. It appears that this may be true in those in whom the night-time “snack” is more similar to an additional meal in terms of its caloric content. The authors found that people primarily gain weight because they consume more calories than they burn. Eating more meals, and taking in more calories makes you gain weight regardless of when calories are consumed.

Hangover cures are effective.  A variety of hangover cures, including eating bananas, vegemite, raw eggs, burnt toast and drinking black coffee, have been proposed.   Some people even believe that drinking more alcohol (“hair of the dog”) will ward off hangover symptoms.  The simple truth is that there is no scientific evidence that supports any cure for alcohol hangovers.  Anecdotally, people who consume too much alcohol may benefit from rehydrating with water or from over-the-counter analgesics, but the most effective way to avoid a hangover is by consuming alcohol in moderation or not at all.
Eating turkey makes people drowsy.   The relatively high content of the amino acid, tryptophan, in turkey is often cited as the reason for excessive drowsiness after eating a holiday dinner.  In fact, turkey does not have as much tryptophan as a number of other foods, such as chicken, pork, or cheese. It is thought that the drowsiness after eating is more likely to be related to overeating high calorie foods and drinking alcohol rather than to the turkey itself. One explanation for the drowsiness (although this could also just be a myth) is because that after eating, blood is shunted to the stomach and away from the brain.

Monday, December 15, 2014

'Tis the Season for Overeating

For many people, the holiday season is the happiest time of the year. But power shopping, visiting relatives and over-eating can also take its toll on the body. During this time of year, food seems to be everywhere. One explanation for how this got started is that in days of old, meals on a day-to-day basis were fairly simple, some would say even boring. Many people barely had enough food at all, particularly during the long winter season. On special occasions such as religious holidays, marriages and season changes, feasting became a way to celebrate the event and to break the monotony of their meager diets.

Fast forward to today.  Grocery stores offer a veritable cornucopia of foods from all over the world. Exotic fruits and vegetables, fresh seafood in even the most landlocked states, and a variety of ethnic foods are available on even the darkest, coldest days of the year. Restaurants are seemingly located on every corner, with more under construction. While hunger continues to be a problem throughout the world, for most of us in this country, food is no longer a luxury.

During the holidays, our more than adequate food options and supply can sometimes expand to near shameful proportions. The obvious problem with this is that we eat more than is necessary, and often the eating choices are not of the highest nutritional value. Here are some strategies to help you enjoy the foods of the season without overdoing it.

Eating tricks
  • Before going to parties or family get-togethers, eat something that will suppress the tendency to overdo it at the table. A piece of fruit, a small carton of yogurt, or some cheese and crackers should do. The worst thing that you can do is to “save up” for a meal. Being famished makes it very difficult to moderate your food consumption.
  • If you can’t eat before you arrive, start with salad or veggies which will help with your portion control later.
  • Fill your plate with lower calorie foods initially such as lean meat, vegetables and fruit. Limit butter and high-fat salad dressings and gravies. Once you have taken the edge off of your hunger, you will be less likely to go back for those high-calorie offerings.
  • Use smaller plates or limit portion size. You may need to politely insist on serving yourself.
  • Stand away from the food table. The closer you are, the more likely you are to nibble.
  • Delay dessert. If you wait a while, your craving for sweets should lessen.  
Think before you drink
  • Not only can overindulging in “Christmas Cheer” cause a painful morning after, but it racks up the calories as well. Mixed drinks are especially high in calories, with the liquor alone weighing in at more than 100 calories per shot. Note the caloric content of other common alcoholic beverages: 12 oz beer = 150 calories, 12 oz lite beer = 110 calories, 5 oz wine = 90 calories.
  • Alcohol can also contribute to overeating by making you hungry and impairing your good judgment. Eating before you drink alcohol will help.
  • Consider toasting the occasion with a lower-calorie non-alcoholic drink or sparkling water.
  • Try to limit special holiday drinks such as eggnog and mulled cider which are loaded with calories.
Don’t forget to exercise
  • If you exercise regularly, stick to your exercise routine as much as possible. It will burn calories and you’ll feel better about yourself, even if you occasionally overeat.
  • If you are unable to exercise on one day, add some extra time to your workout the next day. If you are pressed for time, remember that it is better to do a shortened version of your workout rather than skipping it entirely.
  • Integrate exercise into family gatherings.  Take an after-dinner stroll together. When visiting neighbors, walk instead of driving.
  • Try taking several walks during the work day. Getting your usual amount of exercise in shorter periods of time throughout the day burns just as many calories and is almost equally beneficial to your health as a longer, single workout.
  • Park in the back of the parking lot and walk to the mall instead of parking as close to the door as you can.
  • Try to take the stairs instead of elevators or escalators whenever possible.
  • Don’t let the weather serve as an excuse for not exercising. Rather than giving up on your activity during inclement weather, seek out an alternative location for exercise such as shopping malls or gyms. With proper clothing, walking outdoors can be enjoyable almost any time of the year.
Focusing on friends, family, and the less fortunate can take the emphasis off of food during this time of the year. Moderating your eating practices and continuing to exercise during the holidays will help you to avoid having to address the results of overeating later as a New Year’s resolution.

Monday, December 8, 2014

Growth Plate Injuries

Growth plates are narrow sections at either end of children’s long bones where growth in length occurs.  Examples of bones in the developing skeleton with growth plates include the femur (thigh bone), the humerus (upper arm bone), the ulna and radius of the forearm, and the tibia and fibula in the lower leg.  The growth plate (also known as the physis) is made of cartilage which is weaker than actual bone. This makes them particularly susceptible to injury or fracture.  With closure of growth plate at skeletal maturity, the bone is no longer capable of further lengthening.

How does a growth plate injury occur?  Up to one-third of all fractures in children and adolescents involve a growth plate.  Being the weakest link in the bone-joint-bone chain, an injury that would break a bone or sprain a ligament in an adult would more likely result in a growth plate fracture in a child. Most growth plate injuries are caused by a blow or twist of a limb.  Accidents during recreational activities such as biking, sledding, skiing, or skateboarding are responsible for a large percentage of growth plate fractures. They can also occur from repetitive stress or overuse. For example, a young baseball pitcher with poor throwing mechanics risks the development of a growth plate injury to the shoulder or elbow.
How Are Growth Plate Fractures Diagnosed?   Fractures involving bones typically show up well on x-rays.  Cartilage, however, lacks the calcium content of bones and does not show up on x-ray.  Since growth plates are made of cartilage, the diagnosis of growth plate fractures with standard x-ray can be challenging.  Signs or symptoms that would suggest the presence of a growth plate injury include:
  • Persistent pain near the end of a long bone (in the area of the growth plate)
  • A visible deformity, such as angulation or bend in the limb
  • Swelling, warmth and/or tenderness near a joint
If a growth plate fracture is suspected but the initial x-rays appear normal, several measures can be taken to further investigate the injury. Taking a “comparison view” of the uninvolved limb may demonstrate a difference in the injured vs. uninjured limb.  For example a widened growth plate on the injured side suggests that there is a fracture through the growth plate. If the initial x-rays are negative, doctors may also choose to splint or protect the injured limb and repeat the x-rays in a few weeks.  Since the body’s response to a growth plate fracture is to deposit calcium at the site of the injury, this may be seen on follow-up x-rays.  When an immediate diagnosis is required, special imaging, such as CT scanning or MRI scanning may reveal the presence of a growth plate injury not seen on x-ray.

Are all growth plate injuries the same?  The Salter-Harris classification system defines five basic types of growth plate fractures.  These range from the least severe (Type 1) that affects only the growth plate itself to the more severe types (Types 2 through 4)  that involve both the growth plate and a segment of adjacent bone. The most severe (and least common) growth plate injury is the Type 5 fracture that occurs when the growth plate is compressed or crushed. While the prognosis for eventual normal bone development is good in the less severe growth plate fractures, stunting of eventual bone length is more likely with the more severe types. 

How Are Growth Plate Injuries Treated?   Treatment of growth plate injures depends on several factors such as the Salter-Harris fracture type, the specific bone that was injured, and the age of the individual that was injured.  With less severe injuries that are not out of place (non-displaced), immobilization with a cast or splint may be adequate.  If the bone fragments are out of place, surgery to restore the alignment (reduction) and to maintain that position with the use of screws or plates is often required. Healing can take anywhere from a few weeks to several months, depending on the severity of the injury and whether surgery was necessary.
What is the long term outlook for a growth plate injury?  With prompt identification of the injury and appropriate treatment, most growth plate fractures heal without any lasting effects. The most frequent complication of a growth plate fracture is premature arrest of bone growth.  If the growth plate fracture involves an arm or leg, this could result in a significant shortening of the extremity.  With any growth plate injury, follow-up care is important to make sure bones are healing and continuing to grow normally.

Monday, December 1, 2014

Avoiding Type 2 Diabetes

Of the 24 million Americans with diabetes currently, fewer than 10% are Type 1 diabetics. The great majority have Type 2 diabetes, the form that typically develops in adulthood and does not require taking insulin. Type 1 diabetes, previously known as "insulin-dependent" diabetes, is an autoimmune disease in which genetics plays an important role in its development. The development of Type 2 diabetes, on the other hand, is much more related to the effect of certain lifestyle issues, such as what you eat and your physical activity.

Several studies have looked at factors related to the development of Type 2 diabetes.  One study conducted over 16 years, looked for the occurrence of type 2 diabetes in 85,000 female nurses.  During that period of time, 3,300 of the women developed type 2 diabetes.  In 90% of the cases, five factors were found to be responsible for the development of the disease: 1) being overweight, 2) not getting enough exercise, 3) eating an unhealthy diet, 4) smoking cigarettes, and 5) abstaining from drinking alcohol. 
A second study followed over 42,000 healthy adult male health professionals for 12 years to assess for the development of type 2 diabetes.  Factors that were associated with the development of type 2 diabetes in this study group were: 1) eating a "western diet" (characterized by higher consumption of red meat, processed meat, French fries, high-fat dairy products, refined grains, and sweets and desserts), 2) obesity, and 3) low physical activity.
When the findings from these two studies were combined, some encouraging results regarding the opportunity to prevent the development of type 2 diabetes emerged.  Key points from this analysis were: 
  • In subjects whose weight was above the healthy weight range, losing 7 to 10 percent of their current weight cut their chances of developing Type 2 diabetes by 50%.
  • Swapping out red meat or processed red meat for a healthier protein source, such as nuts, low-fat dairy, poultry, or fish could lower diabetes risk by up to 35%.
  • In someone who rarely eats whole grains, eating two to three servings of whole grains a day reduced the risk of developing Type 2 diabetes by 30%.
  • Walking briskly for a half hour every day reduced the risk of developing Type 2 diabetes by 30 %.
The bottom line is that, for the most part, Type 2 diabetes is a preventable disease.   Eating a healthy diet, keeping one’s weight in a healthy range, and getting regular exercise are the most important factors in avoiding this disease.
It is estimated that around 57 million adults have a condition known as "pre-diabetes." These people have somewhat elevated blood sugars, but not in the range for the diagnosis of diabetes. In this group of people, addressing lifestyle issues offers the real possibility of avoiding the development of Type 2 diabetes altogether. Likewise, people who are "at risk" (overweight, sedentary, eating an unhealthy diet, etc.), but currently have normal blood sugar values can drastically reduce their risk of developing Type 2 diabetes through attention to lifestyle measures.
To see if you are at risk, take the American Diabetes Association's Diabetes Risk Test.  Helpful suggestions for lowering your risk of developing diabetes through diet and exercise are also available through the American Diabetes Association.