Newsletter 06/01/18 – An Ounce of Prevention…

To My Patients and Friends,

Here’s a summary of some of this week’s medical news… enjoy!

Shingles increases stroke risk

According to a study recently presented at the annual meeting of the American College of Cardiology, the risk of stroke or TIA (transient ischemic attack, or mini-stroke) is significantly increased during the period surrounding a diagnosis of shingles, particularly in younger adults.  Anyone who has had chickenpox at some point in his or her life (typically during childhood) is at risk for having shingles.  Both are caused by the varicella zoster virus (VZV).  Shingles, which occurs as a result of the reactivation of VZV (which remains dormant in the nervous system after chickenpox resolves), is characterized by a painful rash which arises on one side of one part of the body (versus chickenpox which is usually a diffuse, itchy rash).  In severe cases, the pain can be debilitating and may linger indefinitely.  Shingles vaccines can reduce the likelihood of a viral reactivation (the newer, more effective version of the vaccine- brand name Shingrix– is a series of two shots and is recommended for most people age 50 or older, regardless of chickenpox history).  A vaccine that reduces your risk for shingles and for stroke is a win-win in my playbook.

An important colon cancer update

The American Cancer Society just released updated guidelines indicating that for people at average risk for developing colon cancer (that means most of us), screening should begin at age 45.  Formerly, their recommendation was to start at age 50, but we are seeing an increase in cases of colon cancer in younger people, for reasons which have yet to be explained (some researchers speculate that it may have to do with certain foods or environmental chemicals that change our microbiome (the critically important population of bacteria in our intestinal tract)… for example, read about how a common toothpaste ingredient called triclosan may be implicated.  I personally avoid Colgate brand toothpastes for this reason (but most Crest brand toothpastes, and these others, are triclosan-free).

It’s worth noting that other key organizations have yet to fall in line with these new guidelines.  For instance, the United States Preventative Services Task Force, the American Academy of Family Physicians and the American College of Gastroenterology still recommend initiating colon cancer screening at age 50 for average risk patients.  But there’s a good chance that this will change… so my advice is: “think 45 to stay alive!”

Those at increased risk for colon cancer, including African Americans, Alaska Natives, people with certain genetic conditions and those with a family history of colon cancer or of certain types of colon polyps, should consider beginning screening at age 40.  If it’s time for you to start thinking about colon cancer screening, I encourage you to speak with your physician about his or her recommendations.

A fading fad?

In a recent report published in the American Heart Association’s journal, Circulation: Heart Failure, it was determined that high protein diets may pose increased risk for heart problems.  Additionally, it appears that animal protein and dairy may be more problematic than plant-based proteins.  High-protein diets have been promoted over the years as a means of losing weight and/or staying healthy (recall the Atkins Diet).  However, these results call those theories into question.  Earlier studies have already linked high protein diets- especially those that incorporate proteins from animal sources- with chronic disease.  For example, a few years ago, one study found that eating a high-protein diet was linked to an increased risk of cancers, diabetes, and death.

Adults who aren’t especially active are generally advised to eat roughly 0.34 grams of protein per day for each pound they weigh. On average, this is about 55 grams for men and 45 grams for women – about two palm-sized portions of protein sources.  Obviously, for people who are more active, protein requirements are a bit higher.  But as it turns out, we require less protein for optimal function than many Americans typically ingest… so it’s better to round out the plate with vegetables, fruits, whole grains and legumes!

Hormones and the heart

Why does the risk for heart disease rise so dramatically for post-menopausal women?  A study recently published in the Journal of the American College of Cardiology helps to provide some clarity.  This large study evaluated the link between fasting sex hormone levels and heart attacks, strokes and heart failure.  They found that, for post-menopausal women with higher male-to-female sex hormone (testosterone-to-estradiol) ratios in their blood, the risk for cardiovascular disease was increased.  More research is needed to fully understand how hormones affect hearts and blood vessels, and it has yet to be shown that hormone therapies actually reduce risk.  However, a hormonal blood panel- although not something physicians regularly check- may help to identify a post-menopausal woman who is at increased risk for cardiovascular disease and who may benefit from other risk reduction measures, such as more aggressive cholesterol- or blood pressure-lowering and lifestyle changes.  Stay tuned… more on this to come.

That’s enough for now… be well and enjoy the weekend!