Tag Archive for: JAMA

Body Roundness Index

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The Body Mass Index (BMI) has been used to provide an indication of whether someone is under weight, normal weight, overweight, or obese and the degree to which they are obese. There’s no measure of percentage of body fatness implied, but physicians and other medical professionals have used it for that purpose for a couple of decades. Why? It can be used to assess the potential risk of developing cardiovascular disease, pre-diabetes, and other metabolic conditions.

I happened upon a commentary in JAMA on the Body Roundness Index or BRI for short. It was published in response to a recent study published in a JAMA Network Open by researchers who examined the relationship between BRI and mortality.

Let’s start with this: what is the BRI? The BRI was developed by a mathematician. The reason was interesting; the developer told the commentator that the BMI is based on a “cylindrical” model but when she looked in the mirror, she felt she was more egg shaped. What she did, as a mathematician, was develop a model based on an “ellipse.” Why? She gave a couple of reasons.

The first reason is that BMI can misclassify individuals because it fails to distinguish between individual amounts of fat-free mass (FFM) and fat mass (FM). BMI also does not provide information about the distribution of body fat—specifically, visceral fat versus subcutaneous fat. She developed a mathematical model, to assess body fatness which would indicate where the fat is distributed. With some very complicated math, she developed the BRI. It uses only two measurements: height and waist circumference. The benefit of using the BRI is that it may be a better predictor of body fat than the BMI. Is it? We’ll check out the research study that began this examination of BRI on Saturday, because as Shaq famously said about getting in shape, “Round is a shape.”

The Insider Conference Call is tomorrow night. If you become an Insider by 8 p.m., you can participate in the call to get your questions answered.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2024; 332(16):1317-1318. 10.1001/jama.2024.20115
2. JAMA Netw Open. 2024; 7(6):e2415051. 10.1001/jamanetworkopen.2024.15051.
3. https://doi.org/10.1002/oby.20408

News on Food as Medicine

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As a conventional medical journal and one of the leading medical journals in the world, The Journal of the American Medical Association doesn’t often publish reviews of the impact of food on health. However, a recent edition of the Journal included a summary of three such studies, and that’s the topic for this week.

The first study examined whether mushrooms, which are full of vitamins, minerals, and phytonutrients, decrease the risk of cardiovascular disease (CVD) or type 2 diabetes (T2D). The researchers re-analyzed the data from the Nurses’ Health Study and the Health Professionals Follow-up Study. When they compared more than five servings of mushrooms per day with less than one serving per day, they found no differences in the rate of symptoms or markers associated with CVD or T2D. One interesting note was that if mushrooms were substituted for meat, there was a decreased risk of T2D.

This is one of the first studies to acknowledge the problems with nutrition data in these types of studies. The data on mushrooms were only collected at the beginning of the studies; that doesn’t allow for comparisons over time. Further, the questionnaire didn’t allow for data on a variety of types of mushrooms. The best observation at this point is that we don’t know whether mushrooms or specific types of mushrooms are beneficial for reducing the risk of disease until more research is done.

We do know they’re good for you, so enjoy your mushrooms; sautéed mushrooms are a great addition to many dishes. Here’s another way to enjoy mushrooms: Creamy Mushroom Soup from the Health Info page at drchet.com. Check out the other recipes while you’re there.

We’ll look at another study on Thursday.

What are you prepared to do today?

        Dr. Chet

P.S. Don’t forget to complete the survey on Dr. Chet’s Traveling Health Show. I could be coming to a city near you in 2020! Click the link below to go to the survey.

Survey

Reference: AJCN https://doi.org/10.1093/ajcn/nqz057.

Finding Your Health Partners

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I finished Thursday’s Memo by saying there may be hope for physicians when dealing with overweight patients. It was another viewpoint written by two clinicians. They say learning about diet and nutrition and how to interact with patients were not priorities in medical school; I’ve confirmed that with physicians I know. The authors put together ABCs of steps to treat obesity in patients. The very first one was the most important.

A stands for Ask for Permission: permission to speak to an overweight patient about his or her weight before discussing ways for the patient to begin to address excess weight. I’ll take that any day as the best first step. If physicians will do that, it shows respect for the patient. They further recommend addressing the purpose of the visit first and then asking if they could address excess body weight. That’s the way it should be. You can read the full article at the link below.

Paula, my family, and I have been blessed with some pretty special physicians and healthcare professionals who always listen to us and work with us to reach our health goals. Based on the feedback from the Thursday Memo, so have some of you. Too many haven’t, but there’s hope based on recognizing that it’s a problem in medical training as expressed in the article I cited.

If your doctor isn’t a partner to you, find a different one; that goes for specialists, dentists, physical therapists, and others. (Maybe not surgeons—I don’t care if he’s a jerk, I want the best I can find.) Ask friends and family for recommendations and check reviews online; as with anything online, take it with a grain of salt and read as many reviews as you can. If you’re staying in the same practice, find a graceful way to explain your desire to switch; you’d feel more comfortable with someone older (or younger), someone male (or female), and so on. Don’t be rude and demanding, but you’re the customer and if your optimal health isn’t the goal of the practice, maybe it’s time to start over.


The Bottom Line

I’ve spent the past two weeks addressing a different way to look at our health based on the books of Jane Austen and learning to love and respect ourselves. I’ve talked about healthcare professionals changing how they treat obese patients. But make no mistake about it: part of learning how to love yourself the way you are is to gain the confidence to address the issue to improve your health—not with the idea of being rail thin or running marathons, but by becoming the best version of yourself you can be, because that’s also a part of loving yourself.

What I envision is finding the physician or healthcare professional who will be your partner in the journey toward better health. You both have the responsibility to put forth your best efforts to try to do that. In every audio I record, I always say your physician should be your partner in reaching better health. I mean just that. So when you find that doctor, do your part; keep an open mind, do what you say you’ll do, and don’t make promises you know you won’t keep.

It all comes down to one question: what are you prepared to do today?

        Dr. Chet

Reference: JAMA Online. doi:10.1001/jama.2019.2352

2018’s Worst Most-Read Paper

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In March of last year, the Journal of the American Medical Association published a viewpoint written by two experts in public health titled “Vitamin and Mineral Supplements. What Clinicians Need to Know”; it was one of the nutrition papers most read and most shared last year. The only problem is that clinicians really won’t find out much by reading it.

I’m going to pick one recommendation because everything after it won’t matter. The authors recommend that all clinicians recommend that patients get their nutrients from food. I absolutely agree with that. They go on to advise clinicians to tell their patients there’s no need to take any dietary supplements if they eat a healthy diet. That’s plain wrong.

We already know that over 90% of all adults do not get enough servings of vegetables, fruit, and whole grains every day—and it’s proven that food contains less nutrition than in the past—yet the authors did not recommend doing a nutrition analysis for the patient. With little to no information about the patient’s diet, clinicians are to tell their patients to eat a healthy diet, don’t take any supplements, and go on their way.

These are exceptional researchers; they know how poor the American diet is because they’ve done much of that research. To publish this opinion was incomplete in my opinion and thus it ranks as one of the worst papers of 2018. With almost a quarter million reads and shares passed along through social media and news feeds, millions read what they wrote, and it will influence millions. My opinion is that millions will be less healthy because they accepted these recommendations and dropped their nutrition insurance: their multivitamin and omega 3s and so on.

That doesn’t mean you take every dietary supplement that comes along. The rule is simple: know what supplements you take and more important, exactly why you’re taking them. And work on eating a healthier diet in 2019 as well.

What are you prepared to do today?

        Dr. Chet

Tainted Supplements: Buyer Beware

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There was a big problem with the papers that were published in JAMA and the resultant media headlines: the authors and commentator lumped the tainted products into a single category of dietary supplements and categorized these questionable manufacturers and their tainted products with all manufacturers of dietary supplements. That was simply wrong, and people in health news know better. There will always be unscrupulous companies out to make a quick buck and laughing all the way to the bank.

Some of the tainted products are still on the market today. Most are available only online, and their websites contain no information about the company who makes them or how they were made. They might simply be the same product sold under different names; there’s no way to tell.

The everyone-in-the-pool approach used by the authors reflects an underlying belief that the FDA should give approval to every dietary supplement. There are healthcare professionals who don’t like supplements of any kind. With this kind of news, they make the leap that all supplements are equal, and thus all require more restrictive oversight to stem the tide of tainted supplements. That’s just foolish. Quality manufacturers that want to continue to be in business follow the rules set out by the FDA for dietary supplements. Fly-by-night companies won’t, no matter what the laws say.

Buyer Beware

The articles do raise an important concern: how do you know whether the products you’re buying are made by a reputable manufacturer or not? After all, you’re going to be putting them in your body. Do your homework, just as you might do with any other consumable product. Check out the company online to the extent you can. The more information you can find, the better. If there’s not much info, consider that a red flag.

But how do you know what to look for? I’ll cover that in next week’s Memos, so make sure you don’t miss them.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.3337.
2. JAMA Network Open. doi:10.1001/jamanetworkopen.2018.3329.
3. FDA Database: http://bit.ly/2Pyq0B3

 

Can Probiotics Prevent C. Diff?

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Probiotic research is hot right now. Researchers are trying to figure out what these beneficial microbes can do for our health for a number of reasons. What types of infectious diseases can be prevented, whether food-borne or not? What are the best microbes to treat specific conditions? After all, there are estimated to be around 5,400 different bacteria, yeasts, and fungi. Which ones are best for an E. coli infection? Or salmonella? How about inflammatory bowel disease? Can probiotics benefit other organs in the body by not allowing negative bacteria to enter the blood stream? The questions are almost endless at this point.

We may be starting to get some answers. This week I’m going to focus on the role probiotics may play in preventing clostridium difficile, commonly known as C. diff, infections in people who’ve had to take antibiotics for different diseases. Antibiotics are beneficial when we need them but they do not discriminate; they kill microbes whether they’re beneficial or not. As a result, our gut bacteria—our microbiome—can be decimated. As a result, people who are on heavy doses of antibiotics are prone to C. diff infections. While treatable in most cases, it can have devastating effects on some people including severe pain, cramping, and uncontrolled diarrhea. Not fun!

The authors of a recent paper examined whether probiotics, administered with courses of antibiotics, helped to reduce the rate of C. diff in patients. A Cochrane Review paper examines all available studies from around the world, ranks the quality of the research, and analyzes all the data. Some of the authors of that paper published a summary of that review in JAMA. We’ll take a look at the results on Thursday.

DrChet.com

Tomorrow is the anniversary of the launching of the new DrChet.com website. This past weekend I was speaking in Texas, and several people who are Insider members said that the free monthly Insider Conference Calls were very informative and helped their personal health and the health of their family and clients. Think about becoming an Insider as we begin our second year of memberships.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.

 

Physicians as Teachers

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As the interview in JAMA continued, Dr. Devries continued talking about the lack of training and why it was a problem in his mind. He cited a study published in 2013 by the U.S. Burden of Disease Collaborators which concluded that the leading risk factor for degenerative disease and mortality was a poor diet. A poor diet! He suggests that because physicians are so poorly trained in nutrition—meaning not at all—their patients are suffering the consequences.

Dr. Devries became frustrated and together with others formed the Gaples Institute for Integrative Cardiology, a non-profit that aims to teach the public and physicians about diet, exercise, and the mind-body approach to heart health.

For the rest, it’s not just giving a patient a couple of handouts with healthy diet guidelines. Physicians have to somehow become the teachers. For that, they need training. But even before training can be addressed, insurance companies must be willing to pay for this type of physician-patient time—or any time beyond the 15-minute consultation limit imposed by many healthcare businesses. While the insurance companies may provide websites and materials and even some training with dieticians, it doesn’t carry the power the physician would have.

No real nutrition training of physicians, no hands-on nutrition training by physicians, yet what physicians say resonates with their patients in ways they don’t realize. On Saturday I’ll tell you the four most powerful words I hear about health.

What are you prepared to do today?

Dr. Chet

P.S. The fiber drink recipe I talked about last week is now available on the Health Info page at DrChet.com.

 

References:
1. Arch Intern Med. 2011;171(14):1251-57.
2. JAMA. 2013;310(6):591-606. doi:10.1001/jama.2013.13805.

 

A Doctor’s Nutrition Training

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“Essentially zero.” That’s the answer a physician gave in an interview when asked how much nutrition he received in medical school. The lack of substantive training continued all through his internal medicine residency and specialty training. His expertise? Cardiology. What’s worse is that he said that nothing has changed since.

The interview with Dr. Stephen Devries was recently published in JAMA. He goes on to talk about how he was well-trained to deal with cardiac events when they happened. His frustration came with his inability to do much to help his patients. They would return with the same serious cardiac problems. Why? Because nothing changed in their lifestyle to help prevent reoccurrence. They didn’t learn anything because he didn’t teach them anything about how to do that.

I’m going to talk more about this interview, but here’s a challenge for you. The next time you have a doctor’s appointment, whether general practitioner or specialists, ask them what type of nutrition training they had when they were in medical school or in their residency. It will be interesting to find out their answers.

Reminder to all Insiders: the monthly Conference Call is tomorrow night. If you’re not an Insider yet, there’s time to join before the call.

What are you prepared to do today?

Dr. Chet
Reference: JAMA Online. 4/11/2018.