Men’s Health: A Work in Progress

URMC is sponsoring a “Journey to Healthy Living” on Thursday, June 13, at the 9^th Men’s Health Day at Mario’s Italian Steakhouse. Scripts sat down recently with event organizer Dr. Jean Joseph for an interview about the state of men’s health. We regret that tickets to the event have recently sold out (as of June 4), but still thought it important to share his perspectives with you.

 Scripts:  Why an event focused solely on men’s health?

Joseph:  More than 10 years ago, we recognized that it’s not enough just to treat illness; we wanted to help men avoid it in the first place. So we came up with the idea of Men’s Health Day. Those of us in the medical profession see far too many patients who have waited until the last minute before seeking medical care – many of whom are suffering from an illness that could have been entirely avoided in the first place. Most of these patients are men. Heart disease, stroke and cancer take an alarming toll every year on men in our country. There is a reason why women in nursing homes significantly outnumber men: because men are dying five years earlier, leaving their friends and families to cope without them.

Scripts: What is it that men aren’t doing – and women are – that makes the difference?

Joseph:  If you discount genetics or environmental factors, there are many things men can do to live longer that they’re not doing now. What many are doing is indulging in a variety of self-destructive behaviors like smoking, unsafe sex, not wearing a seat belt, excessive drinking, and generally not getting regular checkups and ignoring their health until it’s too late. We’re not blaming guys. Some of the reasons for these are cultural; men are conditioned from an early age to understand that being reckless is “typical boy” behavior and that excessive partying and ignoring their health is manly. Women, on the other hand, have an advantage. Most have had regular checkups with a gynecologist since puberty and view being proactive about their health a positive thing.

Scripts: Are there simple steps that man can take to make a difference?

Joseph:  Education and self-awareness are the first steps to reversing the statistics. Getting regular checkups and adopting a healthier lifestyle are the next. With rising health costs and competition for services, it’s more important than ever for men to stay healthy and vigorous in order to live satisfying and active lives for as long as possible. And today, as long as possible could mean 90 to 100 years of age – or even more.

By presenting Men’s Health Day, we are aiming to provide an informal forum where men will receive solid information and feel free to ask questions. If you are a man age 45 or older, I encourage you to attend. And if you are a woman who cares about an older man, please pass this information on and urge him to attend.

Again, here are the details:

Men’s Health Day, open to men ages 45 and up

Thursday, June 13, 2013, 11 a.m. to 3:30 p.m.

Mario’s Italian Steakhouse, 2740 Monroe Avenue, Rochester, New York

Attendees will learn more about:

• Back pain
• Heart health
• Low testosterone
• Memory and nutrition
• Health care reform and how it will impact our community

Admission is free but space is limited and reservations are required. Call (585) 275-8762.

Jean Joseph, M.D., M.B.A., is a professor in the department of Urology and the Wilmot Cancer Center at the University of Rochester Medical Center. He is the head of the section of urologic laparoscopy and robotic surgery. Joseph is also the medical director of Patient- and Family-Centered Care at URMC.

This St. Patty’s Day: Hoist a Pint for Your Health?

We’re not suggesting that you overdo it this St. Patrick’s Day—but if you do enjoy a drink with your corned beef and cabbage, we want to share some heartening news: Moderate alcohol consumption might actually be good for your health.

We spoke to URMC investigator Dr. John Cullen, whose research found that moderate drinking decreased atherosclerosis, or hardening of the arteries, in mice. This narrowing and stiffening of blood vessels is a serious condition that can pave the path to a heart attack or stroke. With St. Patrick’s Day nearing, we thought it was timely to present facts on the link between alcohol and heart health. We met with Dr. Cullen to learn more.

Scripts: Your research is good news for folks who enjoy drinking.

Cullen: It is, but we must be clear. In our study, we found that moderate, daily alcohol consumption was cardioprotective. By moderate, we mean two drinks per day for a total of 14 per week. How you pace yourself clearly matters, because we also found that binge drinking—say, those same 14 drinks per week, only over a two-day period—actually increased the development of the disease.

Scripts: Can you explain what you mean by “cardioprotective?”

Cullen: We observed three groups of mice that were all put on diets mimicking high-fat Western fare, to encourage the development of fatty deposits – also known as plaque – in the arteries. In the daily, moderate-drinking mice, LDL (or bad cholesterol) plummeted 40 percent. Surprisingly, levels of HDL (or good cholesterol) went up in both the moderate and binge-drinking groups. The volume of plaque also decreased in the moderate-drinking mice, compared to the no-alcohol mice group.

Scripts: So naturally, we wonder: What might we drink, and how often? There’s a lot of information in the news about the health benefits of red wine. Is that better than a martini?

Cullen: The resveratrol ingredient in red wine is a polyphenol, with antioxidant properties that are inherently good for you; there are published studies showing the cardioprotective effects of resveratrol.  However, our recent study results are based on the ethanol (the alcohol itself) present in these drinks. That’s the substance we found (again, in the right amounts) protects arteries. So if you want to help your heart, Irish whiskey works just as well as wine. Just keep it in moderation.

The National Institute on Alcohol Abuse and Alcoholism has a great program called Rethinking Drinking, which explains low- and high-risk drinking, and suggests appropriate amounts to consume. Based on their data they recommend no more than four drinks in any one day and for a total of no more than 14 drinks per week for men. Recommendations for non-pregnant women are no more than three drinks per day and seven drinks per week.

Dr. John Patrick Cullen received a Ph.D. in Cardiovascular Pharmacology from the Queen’s University of Belfast, Ireland. He is currently a Research Associate Professor in the Department of Surgery’s Basic and Translational Research Division. His research interests, among other things, include the effects of alcohol consumption patterns on the development of atherosclerosis.

Folic Acid Part of Fight Against Autism?

New research out of Norway suggests that taking vitamin supplements containing folic acid before conception is linked with a reduced risk – perhaps by as much as 40 percent – of having a child who develops autism.

Folic acid is found naturally in foods like dried beans, peas, nuts and leafy greens, and celebrated for its work helping the body manufacture healthy new cells. It’s also regarded as highly important for soon-to-be-pregnant women, thanks to its power preventing major birth defects related to babies’ brains and spines (like spina bifada, where the two sides of an embryo’s spine fail to join, leaving an incomplete or exposed cord).

Eager to know more, NPR tapped URMC autism expert Dr. Susan Hyman for her take on the new research that included more than 85,000 women. We’re deviating from our traditional Q&A approach and instead pointing you directly to the full NPR report (you can also read a transcript), here.

Susan. L. Hyman, M.D., has three decades of experience treating and researching autism spectrum disorders and is the chair of the American Academy of Pediatrics committee on autism, often acting as a spokesperson for the organization. Hyman’s recent research has focused on the diet and nutrition of children with autism and on the most effective behavioral treatments for the developmental disorder.

URMC’s Division of Neurodevelopmental and Behavioral Pediatrics – in collaboration with the Strong Center for Developmental Disabilities – houses one of the largest Autism Spectrum treatment and research programs in New York State. In addition to diagnostic assessment and clinical treatment, school and community education and consultation, the Division also provides Information and Referral Services and web-based resources, all designed to aid people affected by Autism and those who care for them.

For more information about autism treatment, research and assessment at URMC, click here.

Morning Sickness a Royal Pain – And Not Just for Duchess Kate Middleton

Morning sickness can be a royal pain for pregnant women – but when it escalates to the point of extreme nausea, dehydration and  weight-loss, all common symptoms of hyperemesis gravidarum, it can be downright miserable. Duchess Kate Middleton’s hospitalization has shined a spotlight on this unfortunate side of pregnancy.

Researchers estimate that 50,000 women with extreme morning sickness require hospitalization each year and they lose just over 200 hours of time at work during a pregnancy. And that doesn’t count the emotional toll of feeling horrible during what is supposed to be one of the happiest time of their lives.

Obstetrician Dr. Loralei L. Thornburg, knows just how the Duchess feels because she experienced the extended nausea and vomiting, ultimately losing 20 pounds with each of her pregnancies. As a specialist in high-risk pregnancies, she also sees lots of patients with this condition, and shared some more information:

Scripts:  How do you know when it’s extreme morning sickness?

Thornburg: It’s not uncommon for pregnant women to experience some nausea and vomiting in the first few weeks. Sometimes it’s the first sign of a pregnancy.  But when it doesn’t subside, no matter what you do, and you’re unable to keep any food down, losing weight and feeling debilitated, that’s extreme.  Obstetricians look for both weight loss and signs of dehydration in the urine before diagnosing hyperemesis (severe morning sickness), separating this condition from more common mild nausea and vomiting during pregnancy

Scripts: How do you treat hyperemesis? 

Thornburg:  We can ease the symptoms with antiemetic medications like Zofran, phenergan and raglan, as well as Vitamin B6 and over-the-counter Unisom.  TUMS or other antacid medications can also be helpful if there is a component of reflux. Ginger has soothing properties that can quell the nausea too, and is available as a variety of candy, drinks, and foods.   This is why hospitals always serve ginger-ale to patients who’ve had surgery. (URMC scientists studied the use of ginger to ease nausea from chemotherapy that offers some clues to the healing power of this amazing root.)

If those medications don’t work and a woman becomes dehydrated or malnourished, intravenous fluids and a feeding tube could be required, but these carry risks and should be avoided whenever possible.  If a woman has underlying medical conditions such as diabetes, then the treatments can be more complicated.

Scripts:  What can a pregnant woman do to manage less severe forms of nausea and vomiting?

Thornburg:  Some easy tips:

• Consider taking your prenatal vitamin at night, finding one without iron in it for a few weeks, or trying other forms of prenatal vitamin such as a chewable or gummy vitamin (you still only need one).
  • Stay hydrated and get plenty of rest. Frozen juice bars/popsicles can be helpful and provide water, sugar and electrolytes.  Use small, frequent sips of fluids to avoid overwhelming a sensitive tummy.
  • Eat smaller meals five to six times a day. Eat carbohydrate-rich foods, like bread or saltines, before getting out of bed in the morning.  Avoid spicy or acidic foods that can worsen heartburn and increase nausea.
  • Try ginger; some evidence shows that ginger may help to subdue symptoms.
  • Consider the use of pressure point wrist bands (sea bands) to provide relief.
  • B6 is available over the counter, and when taken routinely can help reduce nausea symptoms.  It is not affective for acute nausea symptoms.
  • Sour and salty are often flavors that are tolerated well in nausea, but eat what sounds good to you.  Typically a low-residue diet (like pasta, potatoes, bread, and other simple foods) are better tolerated that foods that have heavy sauces or strong flavors.

Loralei L. Thornburg, M.D., is assistant professor of Obstetrics and Gynecology, specializing in high-risk pregnancies.  She is an active researcher, focusing on maternal obesity, ultrasound and premature birth.

Afraid you’re packing on too many pregnancy pounds? Dr. Thornburg also spoke to Scripts about how pregnant women can eat healthy and work out (even when they’re only craving french fries and pickles, and are outright exhausted from growing a tiny human). Learn more in her video, linked here.

Banning Big Soft-Drinks: Expert Says It Could Work

New York City Mayor Michael Bloomberg’s ban on soft drinks bigger than 16 ounces found more solid scientific footing last week, thanks to number of newly published clinical studies linking sugar-sweetened drinks to thicker waistlines.

The plan to can too-large soft drinks (passed by the city’s Board of Health in September) cracks down on the sale of super-sized sodas, sports and energy drinks, sweetened teas, coffees and fruit drinks containing less than 70 percent juice.

But will the move ultimately make for a healthier city? Or will it just disgruntle thirsty Americans? For some insight, we spoke to pediatric cardiologist Rae Ellen Kavey. Daily, she and her team help obese kids make the lifestyle changes needed to wrangle run-away blood pressure, unhealthy lipid levels, and more.

Scripts: The city’s ban demonizes soft drinks bigger than 16 ounces. Why are we quick to point a finger at soda?

Kavey: For starters, because there’s a huge amount of sugar in it. 16-ounce soft drinks can pack more than 50 grams – that’s about 13 cubes, if you’ve ever tossed one or two in a cup of tea. Somehow, because we’re drinking them, the calories tend to be under-appreciated. To make matters worse, they’re “empty” – they offer no nutritional merit to offset all that sugar.

What’s more, there’s a considerable amount of evidence – including three new articles out just last week in the New England Journal of Medicine – suggesting that by limiting sugary drinks, we can help individuals lose weight (or avoid becoming obese in the first place). And in clinical practice, among families we work with, we’ve absolutely witnessed this firsthand.  Limiting your primary beverages to fat-free milk, water, and – if you must – diet sodas, is a powerful starting point.

Scripts: Do you think the ban, if left in place, will make New Yorkers healthier?

Kavey: It just might. Whether or not it’s within the mayor’s purview to be making such decisions is certainly up for debate – but there is science behind this kind of approach. We have research showing that limiting access (say, removing soda vending machines from schools) can be an effective way of shaping healthier habits. It doesn’t have to be a perfect roadblock to work. It just has to deter folks.

In that sense, as a physician, I’m thrilled that the ban – and the flood of news surrounding it – is creating such a powerful educational moment. It’s opening our eyes to soda’s excessive sugar content. It’s spurring conversations around the issue of portion size. But it can’t stop there.

Scripts: What more needs to happen?

Kavey: I think that we need to make clear that this isn’t just about soda. It’s about a whole class of drinks that are, for all intents and purposes, flavored sugar-water.

Take sports drinks. High school athletes and weekend warriors have no need for electrolyte-charged drinks in their duffel bags. A water bottle is more than sufficient, unless you’re a high-performance athlete training several hours a day. And fruit juice? Many people feel almost virtuous sipping a glass of orange juice with breakfast, or giving their kids “100 percent” juice. But at the end of the day, juice is essentially just sugar-water too. It’s a way to consume far more sugar than you would if you enjoyed fruit in its natural state. Case in point, a cup of orange juice packs the calories of three to four medium oranges. Can you imagine consuming that many in one sitting? If you want to have your fruit, eat it in its whole form, the way it comes on the vine, the bush, or the tree. You’ll get some satiating fiber, that way.

Dr. Kavey was a member of both the NIH Obesity Task Force and the American Heart Association’s Pediatric Obesity Working Group, and is past Chair of the AHA’s Committee on Atherosclerosis, Hypertension and Obesity in Childhood. She divides her time between clinical pursuits, mainly in preventive cardiology and the Children’s Heart Center’s exercise lab, and expanding the division’s clinical research program.

To learn more about the Children’s Heart Center at URMC’s Golisano Children’s Hospital, click here.

More Blame for BPA? Plastics Chemical Found in Heavier Kids

When we think of the drivers behind America’s obesity epidemic, sugar-laden beverages, such as soda and sports drinks, and too little exercise might come to mind. Efforts like First Lady Michelle Obama’s “Let’s Move” campaign are being implemented nationwide to help rein in the childhood obesity rate, which has tripled over the past three decades.

But parents beware – a recent study in the Journal of the American Medical Association adds another potential offender to the list: the chemical Bisphenol A, or BPA, commonly found in canned food, bottled liquids, and other consumer products. Researchers found that children and teens with higher concentrations of BPA in their body were more likely to be obese.

We asked Dr. Emily Barrett, a scientist (and parent!) who studies the influence of various chemicals on development, to shed some light on BPA and what the findings mean for moms and dads trying to raise healthy kids.

Scripts: Studies show that most of kids’ exposure to BPA is through food. Are we exposed mainly through canned goods and other packaged foods?  What about fresh fruits and vegetables?

Barrett: Food does appear to be a main source of exposure to BPA, and several studies have now shown that BPA levels drop when individuals avoid processed foods.  Many studies suggest that cans are a major source; the linings are often made with an epoxy resin containing BPA.

But BPA is probably lurking in a lot of other foods as well, since the food can be exposed to the chemical during processing. And unfortunately, environmental chemicals like BPA might even be found in foods that we typically think of as unprocessed, like fresh meats and dairy. That said, fresh fruits and vegetables are unlikely to be a major source of BPA and remain a smart choice.

Scripts: Why might higher levels of BPA be tied to obesity in kids and teens? And why was a link only found among whites – not blacks or Hispanics?

Barrett: At this point, we don’t understand much about the mechanisms by which current BPA levels might be connected with obesity, as most of the research so far has focused on prenatal exposures. One possibility, though, is that kids who are obese eat greater quantities of foods that are high in BPA, such as fast food, than slimmer kids.

Another possibility is that higher consumption of BPA might actually change metabolism in some way that promotes obesity.

Still, another possibility is that BPA is stored in and released from fat tissue, and since obese kids have more fat, the levels they excrete will be higher.  Further study is needed to better understand these possibilities.

As far as racial differences in the relationship, it may simply be due to different eating patterns and behaviors across cultures. It could also be due to genetic or metabolic differences, but again, more research is needed.

Scripts: What is your advice for parents raising kids and teens? Should they work hard to avoid foods containing BPA? Or should they focus more on common sense recommendations, like eating more fruits and vegetables and getting more exercise?

Barrett: The good news is that by following already tried-and-true recommendations, you’ll likely avoid foods that contain high levels of BPA. We know that highly processed foods tend to be bad for you nutritionally, and those foods are also more likely to have high levels of BPA. So, if you’re encouraging your kids to eat fresh, minimally processed foods, you’re already doing the right thing.

Parents who want to go a step further may think about reducing their use of canned goods – fresh and frozen alternatives are likely to be better for you, plus they taste better, too. They may also want to check their food packaging, plastic food storage containers, and water bottles; those marked with 1, 2, 4, 5, and 6 recycling codes are unlikely to contain BPA. Those marked with 3 and 7 might.  One final tip: Avoid putting plastics in the microwave, as they might release toxins under high heat.

Up to 80 percent of children who are obese remain overweight as adults, according to the National Institutes of Health (NIH). Learn more about child obesity in URMC’s health encyclopedia, linked here.

Emily Barrett, Ph.D., is an assistant professor in the Department of Obstetrics and Gynecology at URMC.

Settling the Burn: URMC Implanting New Reflux ‘Ring’

A full-bodied wine. Bold pasta sauce. Punchy vegetables like garlic, peppers and onion.

For the 1 in 10 Americans grappling with heartburn at least once a month, each meal poses a new threat. With your “throat on fire,” sleep is fitful, resulting in miserable mornings, a shorter fuse, and less productive workdays.

In the worst case scenarios, some reflux sufferers even face trouble with coughing and choking; others experience changes in their esophageal lining, a condition called Barrett’s that can up one’s risk for esophageal cancer.

Fortunately, there’s new hope for people plagued by heartburn: Just last week, we at URMC announced that we’ll be one of 13 U.S. surgery sites to offer the LINX™ Reflux Management System, a new implantable magnetic “ring” that promises relief to the estimated 25 million American adults who suffer daily heartburn. The device won FDA approval in late March.

Chronic heartburn (a.k.a., gastroesophogeal reflux disease, or GERD) occurs when the stomach’s acidic juices backflow into the esophagus, rousing an uncomfortable burning sensation just below the breast bone. Though a round muscle, or sphincter, usually tightens to clamp off this backsplash, this natural “plumbing” is faulty in some people: The seal is weak, or the sphincter relaxes when it shouldn’t.

The LINX device – a nickel-sized loop of magnetic beads – can be inserted through tiny incisions in less than an hour. The beads separate slightly to allow food and drink to pass down through the esophagus, then compress back together, reinforcing weak esophageal muscles and limiting acidic backwash from the stomach (and beyond!).

To learn more the device and its power to help, hear what esophageal surgeon Dr. Jeff Peters and Rochester-area patient Mike Gerlach (who’s been living with the implantable ring for more than two years) have to say.

Peters and with thoracic surgeon Dr. Thomas Watson, M.D., anticipate installing as many as 30 to 40 new devices in the first year, drawing patients from across New York, Ohio, Massachusetts, and Vermont. The next-nearest device implantation site is the University of Pittsburgh.

Patients interested in being screened for the device can self-refer (call 585-275-2725) or be recommended by their primary care provider or GI specialist. Patients will be asked to complete an initial screening, followed by pH, motility, and other GI function testing, before being declared eligible candidates. Current procedures require patients to be admitted to the hospital for a day or two, but in the coming years, Peters hopes to offer the implant as an outpatient procedure.

* Of note, Peters has served as a consultant to the device’s parent company, TORAX Medical, and received nominal compensation for sharing his clinical expertise at meetings over the past three years.

‘120 Over 80’: Frank Facts about Hypertension

One in three.

That’s how many local adults are milling about, living daily life with the kind of high blood pressure that paves the path for heart attacks, heart failure, stroke and kidney disease.

Fortunately, our region’s also rich in treatment and support resources. In fact, just last week, the American Society of Hypertension (the largest U.S. professional organization of scientists and healthcare professionals committed to eliminating hypertension) announced that we at URMC were first in the nation to earn its top-tier recognition for our evaluation, diagnosis and treatment of high blood pressure.

Of course, these terrific resources won’t be tapped unless people first “know their numbers” and appreciate their own risk, says cardiologist and hypertension clinic director Dr. John Bisognano. Below, we asked him to debunk some deep-seated myths surrounding high blood pressure.

Scripts: Many folks think “I’m young and fit…there’s no way I could have high blood pressure.” What would you say to teens and young adults who consider themselves the picture of health?

Bisognano: Certainly, it’s great that they’re feeling so well – but it’s really important to remember that high blood pressure is often passed through generations. Our own health habits are important, but they’re just one piece of a complex puzzle.

If you have hypertensive relatives, it’s likely that your genetic make-up puts you at risk for high blood pressure at some point in the future.  So be vigilant about staying fit (exercising thirty minutes a day, five to seven days a week), watching your salt intake and keeping your weight under control. These preemptive strikes will help you best avoid hypertension down the road – or at very least, delay its onset.

Scripts: Other people with slightly elevated blood pressure might assume that, since they don’t exhibit any obvious symptoms (e.g., no nervousness, sweating, etc.), the condition really can’t be doing any damage yet.

Bisognano: And to them, I’d say that’s precisely why hypertension’s been nicknamed “the silent killer.” Most people with high blood pressure feel fine, even great, most of the time. But that doesn’t mean active damage isn’t occurring.

Left unchecked, your arteries – strong, elastic “piping” that ferries blood back to your heart – can grow thick, stiff, and narrowed by fatty plaque build-up, putting vital organs like the brain, heart, and kidneys at risk. And of course, you have to remember that your heart is a muscle – you can only imagine the way this added stress might tax your heart over time, sometimes even to the point of it giving out.

Scripts: Okay, so what do you say to people making the opposite claim: “My family tree is riddled with high blood pressure – it’s my genetic destiny. There’s nothing I can do to avoid it, so why bother?”

Bisognano: Again, I’d tell them that their risk for hypertension is the result of a constellation of factors. While it might be their “destiny” to some degree,  even relatives swimming in the same gene pool exhibit varying levels of risk. It is certainly possible to delay the “inevitable” by adhering to healthy lifestyle habits (again, limiting salt intake, maintaining a healthy weight, and keeping up with regular aerobic exercise). What’s more, modern medicine offers many good drugs – with few side effects, and low cost – so it’s worth meeting with your physician to discuss a prevention or treatment plan that suits you.

Scripts: Others might say “My numbers are only higher because I’m nervous/was in a hurry to my appointment. It’s probably a false read.”  

Bisognano: And you know, that could be true. But to be safe, your doctor will want to make sure your blood pressure isn’t high at other times, too.  If your readings are elevated at your appointment, it’s a wise idea to double-check them by taking your blood pressure at home with a personal monitor. If you find that it rises often, that’s really powerful information; you’re lucky to have discovered it (as opposed to writing it off as mere nerves), because this means you can take steps to start treatment before damage occurs to your arteries and kidneys.

As far as the readings go, they’re less complicated that they sound. If you’re over 50, your doctor will focus primarily on the top number – the “systolic” measure, which gauges peak pressure during the time when your heart is contracting.  This generally should be under 140 (ideally under 130 in some people with diabetes or kidney disease). The bottom number –the “diastolic” reading, measuring pressure “between beats,” or while the heart is pausing to rest – plays a role too. As doctors, we like to keep an eye on it, particularly in younger people.

Scripts:  One last question. A lot of people are reluctant to take drugs if their condition is on the mild end of the spectrum. “I only have stage 1 hypertension,” they say, ” so prescription drugs aren’t worth the hassle or side-effects.” What might you tell them?

Bisognano: When it comes to your health, you really don’t want to split hairs. Even a little bit of high blood pressure can lead to thickening of the vessels, heart muscles, and other problems. At any stage, hypertension demands our attention – and an action plan.

That’s precisely why, at the University of Rochester, we’re gearing up to study drug administration in adults with this lower level of hypertension. We know it can cause damage, yet many people don’t want to take drugs for these minor elevations – although they really should. We’re hoping to come closer to a solution that fits both their health needs and their busy lifestyles.

URMC’s hypertension clinic brings together a team nearly two dozen specially trained clinicians who treat the most challenging forms of high blood pressure and are hard at work exploring better therapies. Experts hail from Cardiology, Vascular Surgery, Endocrinology, Nephrology, Pediatrics, Community and Preventive Medicine and URMC’s School of Nursing. To make an appointment with the team or learn more, call (585) 275-2475.

Go Fish! Do Omega-3 Supplements Deserve a Spot in Your Medicine Cabinet?

A new report making waves this month says the jury’s still out on whether those big, fish-oil soft gels offer much benefit for persons already living with heart disease.

The latest analysis, which reviewed just over a dozen smaller studies, found that taking the supplements – or not – made little difference in whether 20,000 chronic heart disease patients suffered heart attacks or strokes.

But don’t toss your fish pills just yet, says URMC cardiologist Dr. Robert Block. There’s more to consider. Below, he helps make sense of the latest science – and its short-comings.

Scripts: Historically, have cardiologists advised cardiac patients (say, those with high cholesterol) to take fish-oil capsules – and if so, based on what research?

Block: It’s important to note that a fair number of older studies – many of which were conducted before the mainstream adoption of today’s aggressive medicines, like statins and beta-blockers – were quite conclusive. They suggested fish oil supplements indeed played an important role of protecting patients with heart failure.

Take the GISSI (Gruppo Italiano per lo Studio dells Sopravvivenza nell’Infarto Miocardico) trial, for instance, which found that these pills lowered the risk of fatal cardiovascular events by 10 percent for cardiac patients. So, conceivably, it could be that more recent trials (in which the bulk of patients were already taking powerful medications) might not accurately appreciate the role that fish oil actually plays – especially for people never diagnosed with heart disease to begin with.

To that end, many cardiologists do recommend fish oil supplements – or better yet, eating more real fish – since the known side-effects (other than the occasional potential for a fishy burp!) are negligible. What’s more, fish oil does not interact with other medications – a big problem we see with many prescription drugs.

Scripts: Some people assume that “supplements,” in general, are just as good of a substitute for consuming the real food. But does this study possibly suggest that the part of the benefit of fish oil, in its most natural form (that is, in actual fish!), comes because fish are eaten in place of other less-healthy meats?

Block: Certainly, fish are a wonderful dietary staple. The health benefits are well-documented, and the most current, 2010 Dietary Guidelines for Americans advise all of us (even pregnant women) to eat more servings of fish. And, even while the data supporting fish oil supplements is less cut -and-dried, the American Heart Association nevertheless maintains an official recommendation that patients with the metabolic syndrome (pre-diabetes) should eat more fish – or take fish-oil supplements.

But certainly, you raise a fair point – consuming nutrient-rich foods in their natural form is important, because theoretically, because it represents a smart trade-off: Chances are good that your fish-based meals are replacing other less-good-for-you protein sources, like pork or red meats.

Scripts: Many of the studies wrapped into this latest analysis didn’t follow patients for the long-term. Isn’t it possible that, especially for patients who have not developed heart disease, there still is some longitudinal benefit from supplements?

Block: Absolutely! This is a major limitation of the study, and a point that’s getting a good deal of press attention. When it comes to preventive cardiology, we’re keenly focused on long-term health risks – looking ahead 30 to 50 years, rather than shorter periods like these trials are studying.

What’s more, sample size really matters – and is often overlooked by the public. Frankly, many of the studies wrapped into this most recent meta-analysis (a “study of studies”) were probably too small to detect the modest but important risk-reduction role supplements likely play.

Scripts: So bigger, longer-term studies are warranted – that makes sense. But, are all fish-oil supplements created equal?

Block: Supplements definitely vary in quality – and of course, cost. Take Lovaza, for instance; it’s an FDA-approved prescription drug composed of about 85 percent EPA and DHA, the most important fatty acids in fish, and is commonly prescribed for diabetics and obese folks with high triglycerides (a major cause of pancreatitis—a very serious health issue).

On the other hand, cheaper, over-the-counter options generally pack only 30 to 60 percent EPA and DHA. Many people at high-risk for cardiovascular disease take them (including me) because they feel better doing so, and are banking on their potential for longer-term health benefits.

Of course, it’s important to note that improving heart health isn’t the only thing omega-3 fatty acids have been lauded for.  Other studies have found fish-oil supplements to reduce joint pain and stiffness, boost the effects of anti-depressants, and play an important, brain-building role in the womb (aiding babies’ neurological and visual development). So, it’s important that we take new studies in stride, looking closely at their design and asking how each fits into the bigger picture of all the science that’s gone before – as well as the science that’s currently underway.

Dr. Block specializes in the care of patients with high blood cholesterol levels. If you’ve been diagnosed with unhealthy cholesterol levels, and are you looking for help getting them under control, call URMC’s Lipid Clinic at URMC at (585) 341-7700.

Colon Cancer: Silent Killer is Gaining Voice

What did Audrey Hepburn, Ronald Reagan, and Peanuts’ cartoonist Charles Shultz all have in common?

Colon cancer.

This week, in light of March being Colorectal Cancer Awareness Month, we’re sharing a heartfelt message from URMC colorectal surgeon Dr. John Monson, who writes to underscore the importance of routine screenings and other health habits that can help protect you from the deadly disease. For his insights, read on.

Simple Screenings Save Lives

Colorectal cancer, which affects the colon (the large intestine) and/or the rectum, has historically been a ‘silent’ disease – both in the sense that it rarely manifests obvious symptoms, but also in that, until earlier recent years, it was little talked of. Not only did the subject seem taboo for dinner table conversation, but it affected an older population and failed to elicit the same attention enjoyed by other diseases, such as breast cancer – the awareness and prevention of which was enthusiastically championed by women’s magazines, pink-ribbon fundraisers, and a passionate surge of young survivors.

But the message about the danger of colorectal cancer is raising its voice, as it should. It will kill more than 50,000 Americans this year – more than die in car crashes. Three times as many Americans will be diagnosed, making it the third most common cancer (not counting skin cancer), and the second leading cause of cancer deaths nationwide. But perhaps what’s most staggering is that, despite these daunting numbers, the cancer is nearly 90 percent curable if caught early.

As visible public figures have battled the disease – including Sharon Osbourne, Audrey Hepburn, Ronald Reagan, and Peanuts’ cartoonist, Charles Shultz – its prominence has been lifted in the public eye, freeing the topic for more open discussion. In fact, in 2000, Katie Couric televised her first colonoscopy live on the set of the Today Show, having a powerful influence on viewers. Inspired by the premature death of her 42-year-old husband, who fought the cancer for nearly a year, Couric urged viewers to take these screening tests more seriously. The number of colonoscopies shot up 20 percent in the months that followed – a phenomenon dubbed the “Katie Couric effect.”

The encouraging news about this deadly cancer is that a little education and adopting a few healthful habits can go a long way in conferring protection. Consider the advice below:

• When you turn 50, schedule your first colonoscopy screening and repeat it every five years. If your primary care physician doesn’t suggest it, you should. Cancers caught early are five times as curable as those that have advanced (and possibly spread). In this preventive scan, you’ll be sedated while a small, lighted endoscope inspects your colon and rectum for polyps – mushroom-like growths at risk for turning cancerous. If discovered during the scan, the polyps can be removed immediately, greatly diminishing your future risk.
• Eat grilled meats in moderation, and avoid smoking and chewing tobacco. Whether inhaled or swallowed, carcinogens in charred/smoked meats, tobacco smoke and “chew” all eventually pass through the colon, where they can up your risk for cancer.
• Balance your diet between “red” and “green” foods. Over-indulgence in red meats (eating more than a pound a week) has been linked to increased risk for colon cancer; on the contrary, adding more green, leafy vegetables to your diet and reducing your intake of foods with high-carb, high-fat, high-cholesterol content, has been shown to reduce risk.
• Stay active. Incorporating more physical activity – walking a pet, taking the stairs over the elevators, cleaning your house – helps stimulate your body’s waste to keep moving along (the longer stool sits in your rectum or colon, the more time toxic chemicals have to leech out into the surrounding tissues).
• Maintain a healthy weight, and know your shape. Obese men and women are at greater risk for colon cancer; “apple” shapes, which gain weight around the waist and vital organs, tend to be at greater risk than “pear” shapes, which store fat in their thighs and hips.
• Know the obvious symptoms. Through colorectal cancer is a notoriously “quiet” killer, in the later stages, it can give undeniable clues. If you experience bloody stools, diarrhea, cramping and unexplained weight loss, call your doctor immediately.

Remember, as many as half of people diagnosed with colon cancer will die from the disease, usually because it is caught so late. Simple screenings practices, if implemented unilaterally (once every five years starting at 50), could wipe out more than 80 percent of these diagnoses.

Dr. Monson serves as the chief of the Division of Colorectal Surgery at URMC. His areas of expertise include minimally invasive technologies for colorectal cancer treatment, in addition to basic research exploring a broad range of cancer-related subjects.

For more information about colon cancer screening, talk to your primary care physician, or learn more at
http://www.urmc.rochester.edu/cancer-center/colon/
.