Dr Bob's Newsletter - November 2004

Family Members Should Know Their Family's Medical History

Yes, this is a great time to be sure that you are up to date with your family's history. This includes not only your immediate family but your grand parents and aunts and uncles. This history needs to be updated on a regular interval and then cataloged. Organizing this gives your doctor an upper hand to look for more clues of your susceptibility to any of these diseases.

The US government last week (and very quietly) unveiled a new software that you can use where you enter this information and get a prints out in graphic form a family tree that can help your doctor to assess your risk.

Up to 96% of us know more or less our family history but only 1/3 have tried to catalog. This is according to the CDC. Dr Francis Collins stated last week "family history is central to taking advantage of the new genomic information..". The program is neat and should help your physician.
Here is the site where you can download this for your family:
http://www.hhs.gov/familyhistory/ Dr Bob's Take: do it, please.

Vitamin E Update

This study has concluded that taking more than 200 international units of vitamin E can worsen your chances of heart disease. Dr Edgar Miller of Johns Hopkins University has analyzed 19 previous studies involving a total of 130,000 people who took vitamin E alone or with other vitamins.

The findings showed that people taking 400 IU or more had a 10 times the risk of dying from heart disease as compared to those taking 200IU or less. Most multivitamins contain about 35 - 40 IU. The benefits of anti-oxidants like vitamin E was first demonstrated in test tubes but never has been seen in scientifically based human studies.

Dr Bob's Take: I have not seen a study in the medical literature which was scientifically sound show that vitamin E prevented heart disease. Initially, when the first studies (test tube) came out that vitamin E was worth taking I was a proponent but as other studies never proved it I told folks not to take them. It may be that anti-oxidants only work if taken from food. (more on that to come)

Fruits and Veggies Update

Here is a very large study over 100,000 participants of which 71,000+ were female and the rest males. It was conducted under the auspices of Dr Walter Willet of the Harvard School of Public Health. The participants answered mailed out questionnaires and the study was following participants from mid 80's until 1998.

The outcome showed that if participants ate five or more servings of fruit and vegetables per day there risk heart disease was slightly decreased but it did not show any effect on cancer reduction that was statistically significant.

There were several ideas about why fruits and vegetables did not provide a cancer decrease including that the protective mechanism may take longer to see an effect or that the individuals studied ate more fruits and vegetables normally. The participants included health professionals primarily.

Dr Bob's Take: this was a large study and I believe does show that eating more fruits and vegetables does have some heart protection. I do not believe this should be considered that the end of the controversy over the effects on cancer reduction.

Omega 3 Fish Oil - New Claims

Coming in a fish counter near you. Yes, you heard me right. The FDA has issued a new label that can be added to certain fish that contain Omega 3 oil. It basically states that research has shown that these oils MAY reduce the risk of coronary disease (hardening of the arteries). The amount of the oil will also be given on the label.
Dr Bob's Take: Yes, it well known that certain fish like lake trout, salmon and tuna, have significant amount of the omega 3 oils and these are good for us. Olive oil is also another oil that is beneficial.

Cholesterol - How Low Shall We Go

There has been a great deal of discussion in medical circles about the current published target for our cholesterol levels (see below). We are now seeing that there is more improvement noted if the cholesterol total is below 200mg.

Of other significance are the levels of LDL (bad cholesterol) and HDL (good cholesterol). We are seeing more evidence that the lower the LDL goes the better off we are. Once again it is important that you know your own levels and what the current normals should be. Here are the current recommendations from the American Heart Association (AHA).
Risk Total Cholesterol LDL (bad cholesterol) HDL (good cholesterol)
desireable at or below 200mg at or below 129mg 40 - 50mg male 50 - 60mg female
moderate risk 200 - 239 mg 100 - 129 mg below 40 male & female
high risk 240mg and above 130 - 159mg = borderline 160 - 189mg = high 190mg or more = very high below 40

Dr Bob' Take: I am a firm believer of the science that states we are what we eat and where we are from. We have both genetics and food that represent our cholesterol. It is very important for all of us to get within the goals of the treatment regimen set up by your physician. The final goals are not written yet but will be over the next several years. Here is a "Heart Profiler" that you may find useful from the AHA.
http://www.americanheart.org/presenter.jhtml?identifier=1516

NEW NEWS Potential Warning with Bextra

On Nov 10th there was a suggestion by the FDA that there may be some unwanted cardiac events with this medication. This medication is another "cox2" meds which is somewhat similar to Vioxx. There was small study where Bextra was given intra-venously and then followed with oral Bextra where the death rate was higher than it should have been.
Dr Bob's Take: it is too early to have a definitive call on this but I would err on the side of caution.