Weight Loss Reduces Breast Cancer Risk

Are you tired of me talking about weight loss yet?  LOL!  I just came across yet another reason for women to lose and maintain their weight after menopause.  Weight loss reduces breast cancer risk!

There was an study recently published in Cancer that looked at breast cancer risk in women who gained weight, maintained their weight and lost weight after menopause.  The authors found that weight loss of at least 5% body weight after menopause did significantly decrease the risk of breast cancer over the 11 year follow up period.

In this study, women lost an average of 19 pounds.  While not a small amount of weight, it isn’t a crazy amount either.  They were able to maintain their weight loss for the most part too.

We know that breast cancer risk is higher in women who are overweight and obese.  Since over 1/3 of women in the United States are obese, this is a significant risk factor for breast cancer in this country.  According to NHANES survey data from 2013-2014, 40.4% of women in the US are obese.

Let’s do some math.  Approximately how many American women are obese?  In 2010 (according to census data) there were just under 157 million female Americans.  53.2 million were over 50, and 40.4% are obese.  That’s 21.5 million obese female Americans over age 50.  (Since we’re talking about breast cancer I want to focus on the population most at risk, and the study focused on women after menopause.)

In the study just published in Cancer, they found that 5.09% of women who maintained their weight got breast cancer, and 4.27% of the women who lost at least 5% of their body weight got breast cancer.  That’s an absolute risk reduction (ARR) of 0.82%.  This translates to a Number Needed to Treat (NNT) of 122.  (Remember that NNT = 1 / ARR)  This also assumes that the breast cancer risk reduction was caused by the weight loss.

If 122 obese women have to lose at least 5% of their body weight (and maintain that loss) to prevent one case of breast cancer…

That is over 176,000 women that could be spared breast cancer over approximately a 10-year time frame.  With about 266,000 women diagnosed every year with breast cancer, that’s a 7% reduction.

Will you be one of the women who suffers a potentially preventable case of breast cancer?  Now that you know weight loss reduces breast cancer risk, will you make sure to lose weight and get closer to your ideal body weight?  Your heart, your liver, your brain, your pancreas, your joints, your back, and even your breasts will thank you!

QUESTION: Do the numbers in this article surprise you?

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Surgery Type Matters In Cervical Cancer

Cervical cancer screening is a routine part of women’s health care.  I do Pap tests and HPV screens every week to check for this problem.  Luckily I rarely make a cancer diagnosis (although abnormal Pap tests are fairly common).

Cervical cancer is one of the most common cancers in women worldwide, with over half a million cases diagnosed per year.  About 13,000 new cases are expected to be diagnosed in the US in 2018.  Approximately 4000 American women will die of cervical cancer this year, according to the American Cancer Society.  Women are most commonly diagnosed in their 30s and 40s, but it can happen in women over age 65 as well.

It’s important to realize that this disease is more common in black and Hispanic women, but much less likely to occur in women who get regular screening.  Cervical cancer is preventable with vaccination, regular screening and treatment of abnormal cells found on Pap tests.

Once a diagnosis of cervical cancer is made, surgery is the most effective treatment.  Hysterectomy and removal of lymph nodes in the pelvis is necessary.  What hasn’t been understood until recently is whether the TYPE of hysterectomy mattered.

In this country, most surgery that CAN be done in a minimally invasive way IS done in that fashion.  Laparoscopic and robot-assisted surgeries are associated with less pain, shorter recovery, less blood loss and less risk of infection.  However, recently it has been found that these minimally invasive surgical techniques are actually associated with a HIGHER death rate from cervical cancer.

Two articles (1, 2) published in the New England Journal of Medicine this week showed that open abdominal hysterectomy was much better as far as survival goes than laparoscopic or robot-assisted hysterectomy for cervical cancer.  The number needed to harm in one study was 19 which is really low.  This means for every 19 patients who were treated with a minimally invasive rather than open procedure, one went on to die of cervical cancer who would have survived with the open procedure. In the other study the number needed to harm was 26.

I have two take-home points from this frankly shocking finding.  First, if you know anyone with cervical cancer make sure they know a “keyhole surgery” approach is not as safe as an open procedure.  We can’t assume that an operation that’s right for one condition (like gallbladder removal and appendectomy) is the best for all problems.

The second point is that there needs to be more research done on minimally invasive surgery in cancer patients.  There must be some reason for the difference.  Neither of these studies really addressed WHY there is such a difference between open and minimally invasive operations for cervical cancer.  There are any number of possibilities.  Minimally invasive surgery is as safe for uterine cancer as an open procedure, for instance.

Could it be because cervical cancer is caused by a viral infection?  Or because affected  lymph nodes in cervical cancer are smaller or more subtle or harder to see through the laparoscope?  I really don’t know, and clearly no one else does either.

But with less pain, shorter recovery time, less bleeding and less risk of infection, minimally-invasive surgery is best IF scientists can figure out how to make it safer for cervical cancer patients.  That would be the best result of all.

QUESTION: Do you know anyone who has or had cervical cancer?  What was their experience like?

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Reduce Your Breast Cancer Risk

October is breast cancer awareness month!  My mother, aunt and grandmother all had breast cancer, so reducing MY breast cancer risk is of pretty high interest to me.

Lots of women don’t think about their breast cancer risk except when they get their yearly mammogram.  Early detection makes treatment easier and more successful, so it’s definitely important, but getting your mammogram will not reduce your risk of getting breast cancer.

So what WILL reduce a woman’s breast cancer risk?

Exercise

Even 30 minutes of walking will reduce your risk.  In fact, 30 minutes of brisk walking 4 days per week reduced breast cancer risk by 30-50%.  That’s a huge reduction from just a little effort!

Maintain your weight

Obesity significantly increases a woman’s risk of all cancers including breast cancer.  There is an enzyme called aromatase that is present in fat cells.  It changes male hormones into female hormones.  Even after menopause women’s adrenal glands still make male hormones.  The more fat cells you have, the more aromatase and the more estrogens.

Breast cancer cells are often responsive to estrogens, and so obesity increases the stimulation and growth of these estrogen-sensitive breast cancer cells.  Achieving and maintaining a healthy weight decreases breast cancer risk.

Alcohol

Increasing alcohol intake raises the risk of breast cancer.  Even 3-4 glasses of wine per week has been shown to raise the risk.  The more you drink the higher the risk, but there is no evidence of a “safe” level of alcohol intake.

The most important risk factors for breast cancer are, of course, age and gender.  Women get breast cancer 100 times more often than men, and the risk goes up as we get older.  There are inherited genetic risk factors as well, and there are links to how early menstrual periods started, how many children you’ve had and how late menopause occurred.  Breastfeeding also decreases the risk.  Some of these, like age, are things we can’t control.

But there ARE risks that we can control!  Don’t smoke or drink, exercise regularly and maintain a healthy weight and you will be doing a lot to control your breast cancer risk.

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ER Visit Denials

Imagine you just flew home from a dream trip to Europe and after getting a good night’s sleep in your own bed, you wake up with chest pain and trouble breathing.  Now you’re a young woman so heart attacks really aren’t on the top of your list of worries, but you’re really uncomfortable and a little scared.  A quick call to your doctor’s office and, once informed of your recent airplane flight and the fact that you take birth control pills, you are told to head to the ER.

The ER staff and doctor are very kind and you get an exam, some labs and a scan of your chest which show your pain is from a rib that’s out of place and NOT from a blood clot.  That’s a relief!  Sleeping in funny positions on trains and planes isn’t good for you!

Anti-inflammatories, heat and rest are just the trick to settle the pain and you’re feeling better in just a few days.  However, a different kind of pain starts about 6 weeks later when you get the bill for your ER visit.  Your insurance company has denied the claim, stating that they won’t pay for you going to the ER for a “non-emergent” visit.

Turns out insurance companies like Anthem are trying to control costs by denying claims for ER visits for what they consider non-emergency reasons.  A report published in JAMA recently analyzed what percentage of visits would not be covered and how that relates to the symptoms patients are experiencing.

The researchers found that about 15% of ER visits would be denied with the retrospective review policy.  The problem is that these denied claims had the same symptoms (chest pain, abdominal pain, etc.) as claims that were not denied.  The insurance companies expect patients to distinguish between different types of chest pain and abdominal pain without the benefit of medical training.

This is a mistake.  The researchers in this study noted that patients are going to be hurt by this policy.  If patients with chest pain are afraid their ER visit isn’t going to be covered if it turns out to NOT be a blood clot or heart attack, they will be less likely to get checked out in a timely fashion for problems that could be very serious.

I have a hard enough time getting patients (especially women) to go to ER for chest pain or stroke symptoms.  If insurance companies start denying claims for chest pain that turns out to be bad reflux, or stroke-like symptoms that turn out to be from migraine, people are going to be more likely to ignore their symptoms until it’s too late.

People should NOT go to ER for problems that aren’t emergencies.  Someone who goes to the ER for a sore throat (unless they are directed to go there by their primary care doctor) should have the option of an urgent-care level of care.  Too many non-emergency visits to the ER slows down care for those who have a true emergency.

It’s often hard for us with medical training to be sure someone isn’t having a serious problem.  I send folks to the ER all the time to be evaluated when I can’t reassure them in the office that nothing life-threatening is wrong.  Asking patients without medical training to make those decisions is going to lead to people being hurt.

QUESTION: Have you been to the ER for something that seemed serious but turned out not to be?  What do you think of this new policy?

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The Danger Of Adulterated Supplements

When swimmer Jessica Hardy set two world records in 2008 and was getting ready to compete in the Olympics in Beijing, she had no idea her world was about to come crashing down.  She tested positive for a banned substance right before the Olympics.

Turns out she had taken adulterated supplements that contained the banned substance, undisclosed by the supplement company.  Because she was able to prove the supplement she took contained the substance, her suspension was reduced to one year instead of two.  Still, she missed the Beijing Olympics.

Given the danger of adulteration, why would ANYONE risk taking supplements?  In the United States the supplement industry is only lightly regulated so companies are free to make all sorts of outlandish claims about their products.  My personal feeling is that people are so desperate for a “quick fix” they’re susceptible to too-good-to-be-true product claims for weight loss and other problems.

A report was recently published in JAMA about adulterated supplements.  Turns out almost 800 supplements have been found to have drugs in them, including sildenafil (Viagra), sibutramine (Meridia) and anabolic steroids.  The adulterated supplements are most often marketed for – unsurprisingly – sexual enhancement, weight loss and muscle building.  You can access the database yourself here at the FDA website.

Whether you’re an Olympic swimmer like Jessica Hardy, a world-class wrestler like Narsingh Yadav or Vinod Kumar, or a runner looking to PR your next half marathon, SHOULD you use nutritional supplements?  Which ones should you choose?

If you’ve been following my blog for awhile you probably know my answers to these questions 😉  Good nutrition improves athletic performance, that much is very clear.  And supplements are an efficient way to make sure the body’s nutritional needs (for vitamins, minerals, electrolytes, carbohydrates and protein) are optimally met.

So given this information, taking supplements make sense.  But before choosing a nutritional supplement, you have to ask yourself some questions.  If you have access to a representative for the company (especially if it’s a direct sales company) here are some good questions to get answered.

  • Does the company sponsor Olympic athletes?  How many medals have the sponsored athletes won?  If there are no Olympic athletes, do they sponsor athletes competing in “clean” events – i.e. subject to drug testing?  If not, steer clear.  Many sports supplements have disclaimers in the product literature stating they are not meant for athletes subject to drug testing.  Don’t take those!
  • What research has been done with the company’s products?  Ask to see the publications.  Are they peer reviewed?  You can search in the NIH’s research database to see if it’s a “legit” research article or not.
  • What are the company’s quality procedures?  Is there a money-back guarantee?  How are recalls handled?  Who do you call with a problem?

Ultimately, with supplements the reality in the United States is “let the buyer beware.”  Customers are responsible for doing their own research because the industry isn’t well regulated.  If the product is advertised to produce results that seem too good to be true, they probably are.  Do NOT buy products advertised to improve sexual performance.  No supplement has ever been shown effective for that problem – only pharmaceuticals work.

If you aren’t aware of the company I chose to partner with, I have easy and transparent answers to these questions.

  • Yes, Shaklee sponsors Olympic athletes.  We have nearly 100 athletes and a total of 144 medals to our team’s credit.  That’s a lot of hard work (and a lot of supplements)!  Learn more about the Shaklee Pure Performance Team at this link.  No athlete ever has, or ever will, fail a drug test due to a Shaklee product.
  • Over 100 publications is a LOT of science to Shaklee’s credit.  Published in respected journals like Nutrition, Journal of Clinical Endocrinology and Metabolism, and Journal of Gastroenterology.  You can check out research Shaklee has sponsored about athletic performance, weight management, blood sugar support and other topics at this link.
  • Every lot of raw materials is tested for 350 different contaminants like pesticides, molds, heavy metals and other toxins before it is accepted to make Shaklee products.  Shaklee is BETTER than organic, since organic products can still become contaminated in many ways.  In addition, over 100,000 quality tests are done every year on finished products before they head out to customers.  Shaklee has never had a recall.  They don’t need to!  And if you have a problem, everything is guaranteed, even if you just don’t like a flavor.  You call me, or your distributor if it’s not me, and it gets fixed.  Period.

Again and again, we see in the news reports that supplements aren’t safe, that supplements don’t work, that supplements are at best a waste of money or at worst dangerous to your health.  This isn’t true.  Nutritional supplements are a vital part of supporting health and optimizing outcomes for athletes as well as for the rest of us.  It’s just important to make sure you know what you’re buying!

QUESTION:  Do you take supplements?  Why or why not?  Is this information surprising to you?

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The Power of Optimism

Do you know anybody who seems to walk around under a black cloud of doom?  Everything is always horrible, nothing good ever happens, and worse, nothing good ever WILL happen.

Are you one of those people?  Do you find yourself assuming there will be a bad outcome?

It turns out that ASSUMING there will be a bad outcome tends to lead to HAVING a bad outcome, in terms of health.  There is a lot of new research that shows pessimism is associated with negative health outcomes.  Studies on such different problems as unplanned C-section, cardiovascular health, quality of life after stroke, and sleep quality in children show an association between health and optimism/pessimism.

So what is optimism?  The dictionary defines optimism as “hopefulness and confidence about the future or the successful outcome of something.”  It is the tendency to look on the bright side, to assume things will work out for the best.

Some people are natural optimists, they seem to have a sunny disposition from childhood.  However, most of us have to consciously choose to look for the silver lining.

Are you a pessimist?  Do you tend to imagine terrible things, to assume things will turn out badly?  If so, you are probably not only living with anxiety and depression but you may also be hurting your health.

How does someone overcome their tendency to be a pessimist?  Is it possible to change?  Turns out the answer is yes!

Shawn Achor, a researcher at Harvard, has devoted his career to the study of happiness and optimism.  His book The Happiness Advantage: The Seven Principles of Positive Psychology That Fuel Success and Performance at Work talks about how optimism leads to success.  More importantly, it also details HOW TO BECOME AN OPTIMIST.

Not only is optimism helpful at work, it improves your life in many other ways.  Most importantly, as shown in Dan Buettner’s book The Blue Zones, Second Edition: 9 Lessons for Living Longer From the People Who’ve Lived the Longest, optimism is one determinant of long life.

Being healthy, living longer and being successful are goals that most of us have.  Optimism helps make achieving these goals more likely.  Get and read these two books, I promise you will be glad you did!

You are important to me, and I want you to be happy, healthy and successful.  Optimism is a choice, a skill that anyone can learn.  Make the choice to learn it, practice it and make it YOUR happiness advantage!

QUESTION:  Are you an optimist or a pessimist?  Why do you say that?

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Is Marijuana Use Bad For Your Health?

Over the last few weeks I have had several young patients (and some older patients too) admit freely to smoking marijuana regularly.  When asked if they have considered stopping, they answer “No, why would I stop?”

Ohio has recently legalized medical use of marijuana, and this morning I had some education on the controversy and realities of marijuana use for medical purposes.  It was easier for us doctors when it was illegal, LOL!

Does marijuana have good effects?  Yes, there are therapeutic reasons to use marijuana, which is the basis for legalizing the medical use.  However, it’s important to realize that the medical marijuana law does NOT allow smoking pot.  Legal forms include vaping, edibles, tinctures, oils and patches.

Marijuana helps patients with seizures, anxiety, post-traumatic stress disorder, chronic pain, nausea and vomiting from cancer therapy, fibromyalgia, inflammatory bowel disease, multiple sclerosis, and a host of other medical problems.  Ohio’s medical marijuana program should be deployed later this year (there have been logistical problems).

Doctors have to undergo education before they can be certified to recommend medical marijuana.  Marijuana can NOT be prescribed – it is a schedule I narcotic and if doctors prescribe it they will lose their DEA certification.  Doctors who are certified to recommend medical marijuana use can sponsor patients to get a card which will allow them to buy marijuana at a dispensary.

We have been informed that our medical malpractice insurance carrier will not cover us if we recommend marijuana.  All three large health systems in Cleveland and most (if not all) of the health systems in Ohio are in the same situation.  There are almost 300 physicians in Ohio (as of today) who do have certificates to recommend.  You can find the up-to-date list at this link.

What are the health risks if you do choose to use marijuana?  Smoking a joint increases the heart rate and slows coordination, interferes with thinking and remembering and increases appetite.  States with legal recreational marijuana use have recorded an increase in car accidents attributable to people driving while stoned.  I’ve seen a number of young women who smoke marijuana regularly and complain about weight gain.  (Go figure!)

Marijuana IS addictive.  It is the most commonly used drug of abuse in the United States.  Research has shown that 9% adult habitual users of marijuana  and 17% of teenage users will become addicted.  Signs of addiction include inability to stop using marijuana, continued use in spite of negative social and health consequences and difficulty maintaining relationships with others that don’t smoke pot.

Marijuana causes changes in the brain, specifically in areas related to learning and memory.  It’s worse when teenagers smoke pot, because their brains are still developing.  Pregnant women who use marijuana have children with higher rates of attention, learning and behavior problems.  Secondhand marijuana smoke also contains THC so parents who smoke pot around their children are exposing them to an addictive substance that affects their growth and development.

While it’s not proven that marijuana use causes lung cancer, it definitely causes problems with the lungs, including cough and phlegm production and an increased risk of bronchitis.  Also, most people who use marijuana also smoke tobacco, with all the risks tobacco smoking brings.

Even though use of small amounts of marijuana (the equivalent of one or two “hits” on a marijuana cigarette) can alleviate anxiety, using more actually can worsen anxiety.  Marijuana users are also much more likely to develop mental disorders like schizophrenia.  Teens in particular are more likely to have depression, anxiety and suicidal thoughts if they smoke pot.  It’s not clear whether this is a causative relationship (i.e. do they smoke pot because they’re depressed and anxious, or the other way around).

There is also a risk of poisoning with edible marijuana products.  Absorption through the GI tract is unpredictable and it can take 30 minutes to 2 hours to take effect.  It is easy to over-indulge if it takes that long for the drug to make itself felt.  Also, children can easily overdose if they get into marijuana edibles.  In states where marijuana is legal, ER visits for accidental overdoses in children have gone up significantly.

Marijuana use is on the rise.  Both adults and teens are using marijuana and have the mistaken impression that because it has been legalized for recreational and medicinal use that means it is safe.  Marijuana use is NOT safe, it has real and significant health and social consequences.

QUESTION: Do you think marijuana use should be legal?  Why or why not?

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Statins And Diabetes Risk

I’m an integrative physician.  I get a LOT of people coming to see me thinking that I will tell them they don’t need to take meds for this or that problem.  One of the most common is statins.  Recently more and more people have been concerned about the link between statins and diabetes risk.

Statins are drugs that are prescribed to lower cholesterol and prevent heart attacks and strokes.  It is very clear that they are effective in reducing the risk of a second heart attacks in people who have already had one.  However, many doctors prescribe them regularly for those who have no evidence of an increased heart disease risk.

Statins are generally very safe, but more recently there has been a growing awareness that they are linked to an increased risk of type 2 diabetes.  They also seem to make blood sugar control a little bit worse in some people who already have diabetes.

So what is the actual risk?  Before people flatly refuse to discuss them (or doctors blindly prescribe them) we should know the risks we are talking about.  I have been using an evidence-based medicine website called thennt.com to review treatments.  NNT refers to Number Needed to Treat.  How many people do we have to treat to benefit one patient?  Conversely NNH is Number Needed to Harm.  How many people do we have to treat to HURT one patient?

Low Cardiovascular Risk

Patients who have less than a 20% risk of a heart attack over the next 10 years did not seem to benefit from taking a statin.  It did not prevent overall deaths, and the NNT for preventing nonfatal heart attacks was 217 (313 for nonfatal stroke)

On the other hand, one in 204 patients treated with statins in the low-risk group developed diabetes, and one in 21 developed muscle pain bad enough they had to stop or switch medications.

High Cardiovascular Risk

Patients who already have had a heart attack or who have documented coronary heart disease are another story altogether.  These patients are usually treated with higher doses of statins (the highest available or highest tolerable dose, typically).

Over 5 years, one in 83 high-risk patients avoided a fatal cardiovascular event due to taking statin drugs.  One in 39 avoided a nonfatal heart attack, and one in 125 avoided a nonfatal stroke.  For those who have had a heart attack or stroke or have known heart disease, statins are lifesaving drugs.

On the other hand, because of the higher doses involved, they also have more risks.  One in 10 had significant muscle pain.  One in 50 developed diabetes (that they wouldn’t have developed if they hadn’t taken the drug).

So one in 50 developed diabetes, but one in 83 DIDN’T DIE from a cardiovascular death, due to taking a statin.  Having diabetes is NOT a fate worse than death.

Other options?

What else can we do for preventing heart attacks, instead of taking statins?  As I tell everyone, CHANGE YOUR DIET!  In fact, diet is MORE effective than statin drugs for preventing some cardiovascular events.

The Mediterranean diet (about which there are gazillions of websites, books, cookbooks, how-to’s, etc.) is effective for preventing death and cardiovascular events.  One in 61 patients avoided death or a nonfatal heart attack or stroke by following the Mediterranean diet.

In short, statins are effective in those who are at high risk of cardiovascular events, but not in those who are at lower risk.  There is a link between treatment with statins and diabetes risk.  However, in high risk patients the benefit (reducing death and nonfatal cardiovascular events) seems to outweigh the risk (diabetes and muscle pain).  In all patients, diet and lifestyle change is an integral part of cardiovascular risk reduction.

QUESTION: Do you take a statin?  Does this information make you more or less anxious about it?

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Plantar Fasciitis – Oh My Aching Heel!

I have been in pain for weeks.  Possibly for months.  I don’t recall when the pain started, it’s been so long.  The pain in the bottom of my left heel has ranged from a twinge to severe enough to make me limp badly.  I have plantar fasciitis.

Credit: drmoy.com

What is plantar fasciitis?

Plantar fasciitis is a mechanical problem that happens where the plantar fascia attaches to the front of the heel bone.  The plantar fascia is a tough band of tissue that supports the arch of the foot and acts as a shock absorber when we walk.  It runs from the ball of the foot to the front of the heel bone.

When the mechanics of the foot don’t work right, that attachment place gets inflamed and painful.  Typically the pain is worst first thing in the morning.  In fact if someone tells me their foot hurts on the bottom and the first step out of bed in the morning is the worst pain they feel all day, I know it’s plantar fasciitis.  Nothing else does that!

What causes plantar fasciitis?

The most common cause of plantar fasciitis is wearing the wrong shoes.  Flip-flops and other shoes with no arch support are the most common cause.  I bought some super cute Converse sneakers some months ago, and I think that’s when the pain started.  Tight calf muscles and Achilles tendons also contribute to the mechanical problems that start and maintain the problem.

What can be done about plantar fasciitis?

The first thing is to start wearing proper footwear.  If you have a high arch (like me) you are especially prone to this problem and should be very careful to wear supportive shoes.  Several people have advised me to never go barefoot, even in the house, especially on wood or tile floors.  I’m working on that!  It’s hard for me to wear shoes in the house, and most house slippers have no arch support.

Aggressive calf stretching is important to keep the calf muscles and Achilles tendons loose and limber.  My personal favorite stretch is to stand on the edge of a stair step on the balls of my feet and let my body weight pull me down into my heels.  Be sure to do calf stretches both with the knee straight and with the knee bent.  There are two big strong muscles in the calf and to stretch them both you need to stretch both ways.

Another measure to help heal the pain is ice.  Ice, ice, ice, and then when you’re done  ice some more.  A frozen water bottle is a good way to both stretch and massage the bottom of the foot while applying cold therapy.

What if it doesn’t work?

If I have a patient that comes in with persistent pain in spite of doing all the above simple things, it is usually time for a cortisone injection.  I haven’t done that yet, because I’m chicken, LOL!  It might be time for it soon, though.

In extremely resistant cases patients usually need to see the podiatrist (foot doctor).  Splinting, injections, massage, physical therapy, and sometimes even surgery may be needed.

Trust me when I tell you, good supportive quality shoes are definitely worth the expense!  It’s an investment in good pain-free foot health!

QUESTION: Have you ever had plantar fasciitis?  What did it take to get rid of it?

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Wound Healing And Nutrition

One of the most devastating complications of diabetes is chronic nonhealing foot wounds.  I’ve had many patients in the hospital for chronic wounds that become infected.  Unfortunately many of them are unable to heal their wounds and wind up with partial or complete amputations of their foot and lower leg.

Diabetics and other chronically ill older patients often have diets that aren’t healthy.  They don’t get enough healthy fats, protein and micronutrients from the food they eat.  These problems contribute to ill health and complications like poor wound healing.

Vitamin deficiencies are more common in older adults, especially those who don’t have a varied, healthy diet.  Inadequate intake, decreased absorption and use of medications  are among the causes of nutrient deficiencies.  Protein, vitamin D, folic acid, vitamin B12 and water are examples of nutrients that older adults may not get in adequate amounts.

In the case of diabetics, elevated levels of blood sugar over time result in the formation of advanced glycation end products (AGEs) which damage proteins and increase levels of inflammation in the cells and tissues.  This is one of the main ways diabetes contributes to end organ damage in just about every organ in the body.  AGEs are thought to contribute to a number of diseases, from Alzheimer’s disease to end stage kidney failure to cataracts to atherosclerotic cardiovascular disease.

If someone develops a chronic wound, what nutrients are needed to help in healing?  Protein, carbohydrate, fat, vitamins and minerals are all needed.  The best sources of these nutrients come from a healthy balanced diet of course.  However, studies have shown that 95% of Americans are not getting enough of one or more vitamins or minerals in their diet.  Especially if someone is trying to heal a wound, getting enough nutrients is critical and the patient likely will benefit from a supplement.

Protein

People who are sick or have a wound to heal need extra protein.  Estimates are that such people need about 1.5 grams per kilogram of body weight.  So a woman who weighs 70 kg (155 pounds) would need about 105 grams of protein per day.  One ounce of animal flesh (beef, poultry, pork or fish), one cup of dairy milk or one ounce of cheese contains about 8 grams protein.  One egg contains 6 grams, 8 ounces of Greek yogurt contains 23 grams, one cup of navy beans contains 20 grams and 4 ounces of tofu contain 16 grams of protein.

Fat

Getting extra fat in the diet helps provide energy and calories for healing and also provides building blocks for making new cells.  Omega 3 fats help mute inflammation and encourage healing, and omega 6 fats balance things out.  Fish oil has been shown to be helpful in patients with pressure ulcers in the ICU setting.

Carbohydrates

Complex carbohydrates provide fiber which feeds the healthy bacteria in the gut, as well as calories for energy.  Our gut bacteria help support a healthy immune system.  Healing wounds and getting well is hard work!  Depends on how malnourished someone is (and how sick they are) a patient may need up to 40 calories per kilogram of body weight.  That 70-kilogram woman above would need up to 2800 calories per day, plus more if she is doing more than just lying in bed.

It’s important that these carbohydrates should be whole-food complex carbohydrates like fresh fruits and vegetables, beans and whole grains like oatmeal.  Refined carbohydrates like white bread, bagels, bakery and the like are NOT helpful and increase the production of AGEs.

Vitamins and Minerals

Vitamin A, vitamin C, vitamin D, zinc, selenium and antioxidants have been investigated as being helpful in wound healing.  While supplementation with high doses of single nutrients has not been shown to help, using a good quality well-balanced multivitamin is smart.  After all, if only 5% of Americans get all the nutrients they need from their diet, who doesn’t need a multivitamin?  And if deficiencies slow down wound healing, those with slow-healing wounds would benefit even more!

Unfortunately many Americans are badly malnourished.  Those with very low or very high body mass index (BMI) are most at risk of significant malnutrition.

How do you know if someone is malnourished?  They may or may not lose a lot of weight, especially if they were obese to start with.  Low blood albumin levels are a clue, as is swelling (edema).  The edema may be mostly in the legs, but the arms and abdomen may be puffy and swollen too.  They are weak, and there may be a big change in their strength and ability to take care of themselves.

People who are malnourished will have loss of muscle and fat tissue.  A good place to look is at the temples.  If the temples look bony and it’s easy to feel the skull bones and see the bones of the eye sockets, it is suggestive of malnutrition.

If you know anyone with a chronic wound, especially if they are diabetic, encourage them to see their doctor and work hard to get their blood sugar under control.  Good blood sugar control slows the production of AGEs and decreases inflammation.

Also, make sure they are getting plenty of protein and taking a high-quality multivitamin.  Antioxidants and fish oil may be helpful as well.  If your doctor isn’t able to make recommendations about specific supplements, you’re welcome to reach out to me or get a quick assessment at jenniferwurstmd.com/healthprint.

Chronic wounds are tough to heal.  In addition to careful wound care and avoiding pressure on the wound, attention to a healthy diet and smart supplementation are practical steps you can take to speed up the healing process.

QUESTION: Have you known anyone with a chronic wound?  What did it take to heal it?

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