Howard LeWine, M.D.
Posts by Howard LeWine, M.D.
A strong or weak hand grip carries more than just social cues. It may also help measure an individual’s risk for having a heart attack or stroke, or dying from cardiovascular disease. As part of the international Prospective Urban and Rural Epidemiological (PURE) study, researchers measured grip strength in nearly 140,000 adults in 17 countries and followed their health for an average of four years. Each 11-pound decrease in grip strength over the course of the study was linked to a 16% higher risk of dying from any cause, a 17% higher risk of dying from heart disease, a 9% higher risk of stroke, and a 7% higher risk of heart attack. Interestingly, grip strength was a better predictor of death or cardiovascular disease than blood pressure. What’s the connection? It’s possible that grip strength measures biological age.
Switching from a “Western” diet with lots of fat and meat to a fiber-rich diet for just two weeks makes conditions in the large intestine less favorable to the development of colon cancer. The opposite switch may promote the formation of cancer. That’s the conclusion from a small but elegant study done in urban Pittsburgh and rural KwaZulu-Natal, South Africa. In the study, 20 volunteers from each area switched diets. For two weeks, the Americans ate a traditional high-fiber African diet rich in fruits, vegetables, nuts, and beans, while the Africans ate a Western diet with more fat, protein, and meat. In just two weeks, significant changes occurred in the lining of the colon and in its chemical and bacterial make-up in both groups, but in different directions. Those following the African diet showed improvements in colon health likely to protect against colon cancer, while those following the Western diet showed changes that could lead to colon cancer.
Atrial fibrillation is a heart rhythm disorder that affects millions of people. It can lead to potentially disabling or deadly strokes. Researchers from Johns Hopkins University School of Medicine adding motion-tracking software to standard MRI heart scans of 149 men and women with atrial fibrillation. The scans revealed specific changes in the muscles of the left atrium that increased stroke risk in some of the volunteers. These changes were not associated with age or other risk factors for stroke. This could help many people with this condition to avoid taking warfarin or other clot-preventing medications for life. But it is much too early to include MRI as part of the standard evaluation of people with atrial fibrillation — not to mention that such scans would significantly increase the cost of these evaluations. For now, doctors will continue to use standard tools to help determine stroke risk.
One type of lower back pain, called lumbar spinal stenosis, can be painful and potentially disabling. An operation known as laminectomy or decompression is sometimes done to ease the pain of lumbar spinal stenosis. Physical therapy can also help. Researchers compared the results of laminectomy to those of a special physical therapy program among nearly 170 Pittsburgh-area men and women with lumbar spinal stenosis. The two approaches worked equally well — pain declined and physical function improved. There were more complications in the surgery group. Since there are no hard and fast rules for choosing the right treatment for lumbar spinal stenosis, the results of this study offer some guidance — try a well-designed physical therapy program first.
Older adults with new back pain usually end up getting a CT scan or MRI. That’s often a waste of time and money and has little or no effect on the outcome, according to a new study from the University of Washington. The results of the study contradict current guidelines from the American College of Radiology. The guidelines say that it’s “appropriate” for doctors to order early MRIs for people ages 70 and older with new-onset back pain, and many doctors do just that. The study, which followed more than 5,200 men and women over the age of 65 who saw a primary care physician for a new bout of back pain, found that people who got early back scans did no better than those who didn’t have scans. The scans added about $1,400 per person to the overall cost of back pain care — with no measurable benefit.
Some years the flu vaccine works quite well. Other years it doesn’t. It has done a particularly poor job this year against the main flu virus. The CDC reported yesterday that this year’s flu vaccine has been just 18% effective. The estimate for children is even lower. And it looks like the nasal spray vaccine may not have worked at all among children. One reason for this year’s mismatch between virus and vaccine is that experts must decide months in advance which of the hundreds of flu viruses to include in the vaccine. What became the dominant flu virus this year, a new strain of H3N2 influenza A, wasn’t around last year when experts were determining this year’s vaccine.
Medications can do wonderful things, from fighting infection to preventing stroke and warding off depression. But medications don’t work if they aren’t taken. Some people don’t take their medications as prescribed because they forget, or are bothered by side effects. A new report from the National Center for Health Statistics shines the light on another reason: nearly 1 in 10 people skip medications because they can’t pay for them. Other strategies for saving money on drug costs included asking doctors for lower-cost medications, buying prescription drugs from other countries, and using alternative therapies. Not taking medications as prescribed can cause serious problems. It can lead to unnecessary complications related to a medical condition. It can lead to a bad outcome, like a heart attack or stroke. It can also increase medical costs if hospitalization or other medical interventions are needed. Safe money-saving options include using generic drugs when possible, pill splitting, shopping around, and making lifestyle changes such as exercising more and following a healthier diet, which can sometimes decrease the number and dose of drugs needed.
The standard recommendation for exercise is at least 150 minutes of moderate-intensity activity each week. But that may not be the best recommendation for everyone, especially those who are older and have trouble exercising, or those who don’t exercise at all. If we think of exercise as a spectrum, with no activity on one end and 150 minutes or more a week on the other end, there’s a continuum in between. Getting individuals to move along that continuum, from no exercise to a little, a little to more, and so on, is an important goal. New research on the hazards of sitting for prolonged periods should get all of us to sit less and stand or move more.
Ninety years ago, type 1 diabetes was a death sentence: half of people who developed it died within two years; more than 90% were dead within five years. Thanks to the introduction of insulin therapy in 1922, and numerous advances since then, many people with type 1 diabetes now live into their 50s and beyond. But survival in this group still falls short of that among people without diabetes. A Scottish study published this week in JAMA shows that at the age of 20, individuals with type 1 diabetes on average lived 12 fewer years than 20-year-olds without it. A second study in the same issue of JAMA showed that people with type 1 diabetes with better blood sugar control lived longer than those with poorer blood sugar control.
Getting up at night to use the bathroom is often thought of as a problem mainly for older men. Not so—two in three women over age 40 wake up at least once each night because of a full bladder. And nearly half of them make two or more nighttime trips to the bathroom. Factors that increased the likelihood that a woman woke at night to urinate included older age, having had a hysterectomy, having hot flashes, and using vaginal estrogen. Many of the women had no other urinary problems, such as an overactive bladder or leaking urine when coughing, and many weren’t especially bothered by having to get up at night to urinate. Getting up once or more each night to urinate may not be “bothersome,” but it can still cause problems. It can interfere with sleep. It can also lead to falls and injury.