About Me

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I am a primary care physician with an integrative style joining Naturopathic, Chinese and Western medicine. To Your Health provides you the reader with up to date health information to provide education, current standards of care and alternatives to support your health. I hope you find this site useful and beneficial to your well-being.

Monday, April 29, 2013

Foundations of Health


The 4 Pillars 

Our health seems to have become a complicated subject. With endless information and education that's available, where do we start with applying it to maintaining wellness? From the latest research to fad health claims and internet suggestions, matters can be quite confusing as to what to do for preventative health and maintaining a healthy lifestyle. 

The foundation of our health depends on us engaging in activities that promote well being and diminish harmful effects on the body. Promotion and diminishing effects are simply two sides of one coin. When you engage in a healthy behavior it often coincides with stopping a harmful one. The basis of health really comes from 4 fundamental practices. Engaging in these 4 practices is health promoting and when we don't can be harmful to maintaining our health.

1. Proper Nutrition
2. Adequate Sleep
3. Exercise
4. Stress Management

NUTRITION
We all know we need to eat well but the definition of "well" or "eating healthy" isn't always so simple. 
You are what you eat has some merit as it so happens. With obesity on the rise as well as diabetes and heart disease, we have learned that eating a diet high in sugar, unhealthy fats, processed foods, and excess total calories leads to detrimental effects on our body. The USDA and US Department of Health and Human Services updates the Dietary Guidelines for Americans every 5 years. 

Current guidelines recommend monitoring dietary intake and replacing foods high in calories with nutrient-dense foods and beverages relatively low in calories. Specific examples of this include(1):
  • Increase intake of whole grains (particularly those high in fiber), vegetables and fruits 
  • Reduce intake of sugar-sweetened beverages
  • Monitor intake of 100% fruit juice for children and adolescents, especially those who are overweight or obese
  • Monitor calorie intake from alcoholic beverages for adults
Well researched and established diets that promote good nutrition and prevention of chronic illness are the DASH diet (Dietary Approaches to Stop Hypertension) and the Mediterranean diet. See links below for more information about these diets, recipes and a comprehensive paper on the 2010 Dietary Guidelines for Americans.





SLEEP
Inadequate sleep due to lifestyle, shift work, medications, insomnia, light pollution and other causes has become an epidemic in our society and not without consequences. In 2007 the Journal of Pediatrics reported 15 million American children are affected by inadequate sleep. It was noted that these children and adolescents experienced more problems in school, had an atopic skin condition, frequent or severe headaches and depressive symptomology(2). 

The National Sleep Foundation indicates 48% of Americans report insomnia occasionally while 22% experience insomnia every or almost every night. A lack of sleep can increase your risk of chronic disease such as diabetes, high blood pressure, heart disease and obesity. Physiologic changes that have been studied using sleep deprivation show increase in blood pressure, impaired blood glucose control and inflammation, all precursors to chronic illness(3). 

How much sleep do I need?(4)
Children ages 5-10 require 10-11 hours daily
Adolescents ages 11-17 require 8.5-9 hours daily
Adults 7-9 hours daily.

To aid in sleep consider sleep hygiene such as a very dark room, minimal noise, comfortable room temperature, and no pets in the bedroom. Building a routine around bedtime can assist in falling asleep. Go to bed at the same time each night, by 10pm is optimal, avoid stimulating activity such as work and watching certain TV shows one hour before bedtime. Avoid alcohol, caffeine, large meals and nicotine before bed. Instead try listening to calming music, taking a warm bath, reading or meditation.

EXERCISE
Some physical activity is better than none, and participating in any amount of physical activity results in gaining some health benefits. The US Department of Health and Human Services Physical Activity Guidelines for Americans recommends the following for substantial health benefits(5):

Children and Adolescents
  • 1 hour or more of moderate to vigorous intensity aerobic activity with at least 3 days of vigorous activity a week.
  • Included in this 1 hour should be muscle-strengthening activity at least 3 days of the week.
  • Included in this 1 hour should be bone-strengtheing activity at least 3 days of the week.
Adults
  • 2.5-5 hours per week of moderate-intensity to vigorous-intensity (or an equivalent combination) exercise divided throughout the week.
  • Muscle-strengthening activities of moderate-high intensity involving all major muscle groups on 2 or more days a week.

STRESS MANAGEMENT
Not all stress is bad but the management of routine stress cannot be underestimated. The National Institute of Mental Health explains routine stress such as work, home life and daily responsibilities can have health risks related to cardiovascular disease, hypertension, diabetes, depression and anxiety disorders(6). When our body continues to react as if a threat is always there then a constant presence of hormones in our body exists such as elevated cortisol and adrenaline. 

Chronic elevation of these and other hormones over time is what causes the risk of the above mentioned health concerns as well can contribute to insomnia, weight gain, digestive issues and memory impairment.
Consider the following suggestions to help decrease your stress load:
  • Attend a weekly yoga, tai chi or qi gong class.
  • Take 100 slow deep breaths daily. See video on belly breathing. http://www.youtube.com/watch?v=H5H_Qrcmxdg
  • Try to do a 5 minute meditation before you get out of bed in the morning and before you fall asleep at night. 
  • Go for a 10-15 minute walk during your lunch break.
  • Take a 1 minute stretching break every hour while at your computer.
  • Phone a friend or family member.
  • Remember to laugh everyday!

References
6. http://www.nimh.nih.gov/health/publications/stress/fact-sheet-on-stress.shtml

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Monday, April 22, 2013



Primary Care Screening

                                                  

An ounce of prevention

Screening recommendations are made to assist us in assessing our risk of developing disease and identifying pathology that has arisen in our bodies. The goal is to "catch" any abnormalities in early stages or before the body develops physiologic changes into disease. For instance by monitoring a cholesterol panel we can see if levels are starting to elevate and address this with simple changes such as diet and exercise. Maintaining normal cholesterol levels and addressing changes early may prevent the development of coronary heart disease, heart attack or stroke later on. Identifying abnormalities early allows for better opportunities for most effective treatments with fewer side effects and generally better outcomes.

Screening recommendations can be confusing at times. They may vary based on gender and age as well by which association is making the recommendation. For best insight I make comparisons between some of the leading organizations including:

American Cancer Society                    
American Gastroenterological Association
American Heart Association
American Medical Association
Center for Disease Control and Prevention
National Institutes of Health/National Cancer Institute
National Osteoporosis Foundation

Primary care screening should include the following: (Variations in screening recommendations vary with a current or past history of disease. Discuss screening guidelines with your doctor.)

Breast
  • Starting at age 40 yearly mammograms continuing until a woman is in good health.
  • Clinical breast exam every 3 years for women 20-39 years old and annually thereafter.
  • MRI in addition to mammogram may be recommended for women at higher risk due to genetic alterations, family history or other factor. Discuss this with your doctor.
Cervical
  • Women ages 21-29 should have a pap every 3 years. HPV test should be added if there is an abnormal pap.
  • Women ages 30-65 should have a pap test plus an HPV test every 5 years. A pap alone can also be done every 3 years.
  • Women over age 65 who have had regular cervical cancer testing with normal results should not be tested for cervical cancer. Women with a history of serious cervical pre-cancer should continue to be tested for at least 20 years after that diagnosis, even if testing continues past 65.
Endometrium 
  • By age 35, if high risk, a woman should be offered an endometrial biopsy.
  • Each year a woman should be informed about the risks and symptoms of endometrial cancer, and about the potential benefits, risks, and limitations of early endometrial cancer detection. 
  • At menopause women are strongly encouraged to report any unexpected bleeding or spotting to their doctor. 
Prostate
  • Starting at age 50, men should talk with their doctor about the pro's and con's of testing. 
  • Testing includes a PSA blood test with or without a rectal exam. Frequency of testing will depend on their PSA level.
Colorectal

Beginning at age 50, both men and women should follow one of the following:
  • Flexible sigmoidoscopy every 5 years, or
  • Colonoscopy every 10 years, or
  • Double-contrast barium enema every 5 years, or
  • CT colonography (virtual colonoscopy) every 5 years
  • Yearly fecal occult blood test or fecal immunochemical test
Lung

Discuss with your doctor the benefits, limitations, and potential harms of lung cancer screening with:
  • Individuals ages 55-74, in fairly good health, with at least a 30 pack-year history of smoking (estimated by number of packs per day x number of years smoked), and are still smoking or have quit within the last 15 years.
  • If screening is indicated, a low-dose CT scan of the chest yearly through age 74 as long as you remain in good health is recommended. 
http://www.cancer.org/healthy/findcancerearly

Type 2 Diabetes

Clinical judgement and patient preference will determine diabetes screening.
  • Beginning at age 45, every 3 years particularly in those with a BMI >/=25kg/mg2  
  • Consider testing at a younger age or be carried out more frequently in individuals that are overweight and have one or more other risk factors.      
http://www.care.diabetesjournals.org/content/27 

Osteoporosis

Bone Mineral Density (BMD) should be performed:

  • In women age 65 and older and men age 70 and older.
  • In postmenopausal women and men age 50-69 based on risk factor profile.
  • BMD and vertebral imaging to those who have had a fracture, to determine degree of disease severity.
  • At DEXA facilities using accepted quality assurance measures.
http://www.nof.org/files/nof/public/content/file/950/upload/523.pdf

Cholesterol
  • Adults aged 20 years and older have their cholesterol checked every 5 years.
http://www.cdc.gov/features/cholesterolawareness/ 

General Screening

Additional screening includes blood pressure, weight, dental, vision, hearing, immunizations, infectious disease, tobacco, alcohol, depression and physical exams. Based on age, gender and risk factors recommendations vary.

For more details go to:  http://www.nlm.nih.gov/medlineplus/ency/article/002125.htm


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