Just in time for Easter, a new study has found that healthy people who eat chocolate regularly are slimmer than those who eat chocolate less often–good news for those of us with a sweet tooth! The study assessed data from more than 1000 people aged 20-85. The subjects reported eating chocolate an average of 2 times a week, while exercising an average of 3.6 times a week and following a healthy diet. Those who ate chocolate more frequently (5 times a week) had a body mass index which was one point lower than those who did not eat it as regularly. Body Mass Index, which measures body fat from a person’s height and weight, is optimally between 18 and 25. For the average American woman, who is 5’4″, a 1-point difference in BMI translates to a difference of about 6 pounds–pretty significant!

This study comes on the heels of other research over the past couple of years which has suggested a variety of additional health benefits related to chocolate. Last summer, a British study which analyzed data from over 100,000 people concluded that those who ate the most chocolate on a regular basis had a 37% lower risk of heart disease, a 31% lower risk of developing diabetes, and a 29% lower risk of stroke than the others. Earlier studies by researchers at Harvard showed associations between chocolate or cocoa consumption and decreased blood pressure, deceased LDL (bad) cholesterol, increased HDL (good) cholesterol, and decreased insulin resistance (a hallmark of Diabetes).

These positive health benefits can be traced to powerful antioxidants called Flavonoids which are found in the cocoa bean. Flavonoids help fight inflammation, improve blood vessel flow, and may have effects on metabolism. Chocolate with higher cocoa content has more flavonoids, and presumably, confers more of the benefits everyone is talking about.

A caveat of the above studies is that they did not identify the optimal amount of chocolate necessary to confer benefit, nor did they specify what type of chocolate the study subjects were eating.   And of course, much processed chocolate is loaded with sugar, fat and calories. So what is the takeaway here–how to make use of this exciting news? The answer is somewhat elusive for now, but for those who are looking for a DAILY chocolate fix, an ounce of either dark or unsweetened chocolate, with respective cocoa contents of 70% and 100%, seems to be a smart choice. An alternative is pure cocoa powder, which can be added to coffee or other foods once a day. The key is to choose chocolate with a high cocoa content–and enjoy it in moderation.

I love September, it reminds me of the excitement I felt as a kid at the start of every school year. As September begins, it’s a great time to plan for the weeks and months ahead. For me that means planning the workouts and scheduling the doctor’s appointments now. What is essential?

• Vigorous aerobic exercise at least 75 minutes weekly plus weight strengthening twice weekly
• Annual physical
• Flu shot
• Tetanus Booster (every 10 years)
• Gyn exam/ pap smear (at least every 3 years), annually if you’ve had an abnormal pap or gyn cancer
• Dental exams/ cleanings at least twice a year
• Eye exam (frequency depends on age)

Over 40:

All of the above plus:

• Mammogram (every 2 years between 40-50)

50+:

All of the above plus:

• Annual Mammogram
• Colonoscopy

60+:

All of the above plus:

• Shingelles (Zostax) vaccine
• Dexa scan
• Pneumovax (age 65) you may need this earlier

Have a great fall.

Dr. Saltzman

As you head outdoors to get the most out of these last few weeks of summer mosquitoes aren’t the only biting insects you have to worry about; ticks are also looking to make a meal out of you. Ticks can get on you if you walk through areas where they live such as tall grass, leaf litter or shrubs. Ticks are more than just a creepy nuisance, they can also transmit disease. Though most tick bites will not make you sick, you do want to remove any tick as soon as possible. Ticks can be as small as a poppy seed so when you come in from the outdoors be sure to examine you scalp and skin carefully. Don’t forget to check your ears and belly button. If you find a tick the following steps can help you remove it quickly and safely.

Gently clean the area with an antiseptic solution or soap and water. Take care not to scrub the tick too hard, just clean the skin around it.

Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible. Do not grab the tick around its belly, you could push infected fluid from the tick into your body if you squeeze it.

Gently pull the tick straight upward with steady, even pressure. Do not twist; this can cause the mouth parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with tweezers, leave it alone as they will normally be expelled spontaneously.

After the tick has been removed, wash the area of the tick bite and your hands with soap and water.

You can put the tick in a dry jar or ziplock bag and save it in the freezer for later identification.

Do not try to smother a tick that is stuck to your skin with petroleum jelly, nail polish, or rubbing alcohol. Do not burn the tick while it is stuck to your skin. These methods don’t get the tick off your skin and can cause the insect to burrow deeper and release more saliva which increases the chances of disease transmission.

You can reduce the likelihood of getting bit by avoiding tick-infested areas, walking in the center of trails while hiking, using an insect repellent with DEET, and wearing long sleeves and tucking your pant legs into your socks if you are going to be in high brush or hiking. Ticks can ride into the home on clothing and pets then attach to a person later so carefully examine pets, clothing, and bags. Put your clothes in the dryer on high heat for an hour to kill any hidden ticks.

If you find a tick that you think has been attached for more than 36 hours please contact the office, antibiotic prophylaxis to prevent Lyme disease may be appropriate. Though most ticks do not transmit disease be sure to come into the office if you develop symptoms such as a rash, fever, headache, fatigue, muscle aches, joint pain, or flu-like symptoms after a tick bite.

Most of us have experienced heartburn at one time or another–or know someone who has.  A tight or burning sensation develops in the center of the chest, usually in response to overindulgence of certain trigger foods, and is resolved with antacids–nothing to worry about, right?  Not necessarily.

Acid reflux occurs when stomach contents, including stomach acid, wash back into the esophagus.  This is caused by weakness of the lower esophageal sphincter, which separates the stomach from the esophagus.  When this happens, people experience symptoms such as heartburn, regurgitation, or trouble swallowing.  Less well-known symptoms of acid reflux can include airway spasm, cough, laryngitis, nausea, and “globus”, which is a constant foreign body sensation in one’s throat.

Many people will experience some “physiologic” reflux which is brief and without adverse consequences.  But for a number of others, reflux can be more persistent, and cause other complications over time if left untreated.  These may include ulcer, esophagitis (inflammation of the esophageal tissue), stricture (narrowing of the esophagus), and Barrett’s esophagus, which increases the risk of cancer of the esophagus.  Asthma and sinus infections have also been linked to uncontrolled reflux symptoms.  Reflux which produces mild symptoms 2 or more times a week, or moderate to severe symptoms at least once a week, needs treatment.  In this situation lifestyle modification, as well as a trial of an antacid medication, is indicated for a period of time. The two types of medications commonly used are H2 blockers and proton pump inhibitors–both are available over-the-counter, but should be taken under a doctor’s supervision so that therapy can be adequately monitored and adjusted as needed.  If reflux symptoms cannot be controlled with a trial of lifestyle changes and medication, then the American Gastroenterological Association recommends endoscopy with biopsy to rule out other conditions and to look for worrisome changes in the esophagus that may result from chronic acid exposure.

Individuals can minimize their symptoms of esophageal reflux by avoiding trigger foods, such as chocolate, fatty or spicy foods, and alcohol.  Acidic beverages such as red wine or orange juice may also exacerbate reflux symptoms.  Remaining upright after eating and elevating the head of the bed has been shown to be helpful, as well as weight loss and smoking cessation (to promote more salivation, which neutralizes the stomach acid).  But the most important thing is recognizing the symptoms of reflux and seeking treatment early to prevent complications from this common condition.

An endocrine disrupter is a chemical that can disrupt or interfere with the proper functioning of the endocrine system. The endocrine system consists primarily of glands that produce hormones that help to guide the development, growth, reproduction, and behavior of human beings and animals. Hormones work by attaching to specialized receptors on cell surfaces. A problem can occur if a chemical (instead of a natural hormone) binds to the receptor and blocks the action of the hormone. Consequently, normal biological function can be blocked by the presence of endocrine disrupting chemicals.

These days there is growing evidence linking this class of chemicals to problems in humans. These include breast cancer, infertility, low sperm counts, genital deformities, early menstruation and even diabetes and obesity.

Endocrine disruptors are everywhere. They’re in thermal receipts that come out of gas pumps and A.T.M.’s. They’re in canned foods, cosmetics, plastics and food packaging. Test your blood or urine, and you’ll surely find them there, as well as in human breast milk and in cord blood of newborn babies.

• Food and drink storage: Avoid plastic:
  • Use refillable stainless steel or glass water bottles when on the go;
  • Store and heat food in glass, ceramic, or paper; not plastic
• Food packaging: Avoid BPA Opt for:
  • Fresh or frozen fruit and veggies;
  • Dry beans;
  • Food and drink packaged in glass, not cans;
• Fish: Avoid mercury, dioxin, and PCBs in fresh water fish and ocean fish:
  • Trim fat from all fish to minimize dioxin and PCBs;
  • Choose small non-predatory fish (salmon, perch, trout, tilapia, whitefish, pollock, etc) to minimize mercury;
• Pesticides: Teething toys: Give babies teethers made of natural materials: cotton, wood, etc.;
  • Opt for organic food (especially meat and dairy when possible) or food consistently low in pesticides (Get the list);
  • Use non-toxic strategies to fend off pests inside the home, on the yard, and on your pets;
  • Encourage non-toxic alternative to pesticides in your child’s school;
• Personal Care Products: Check cosmeticdatabase.org for a safety rating of over 69,000 personal care products. There’s a special section for “babies and moms” that lists baby wipes and diaper creams to avoid;

Body mass index, or BMI, is a quick, inexpensive tool designed to determine how healthy a person’s weight is for their height and help determine risk for obesity related health issues. BMI is calculated by dividing weight in kilograms by height in meters squared. A healthy BMI is 18.5-24.9, 25-29.9 is considered overweight, and over 30 is considered obese. BMI has long been criticized as an inaccurate assessment as it does not distinguish between body weight due to muscle (which weighs more) versus fat. Percentage body fat a more accurate assessment but cannot be easily measured in the office. The American Society of Bariatric Physicians defines obesity in women as >30% body fat. A recent study published in PLoS One, an on-line scientific journal, compared rates of obesity based on BMI and percent body fat with some surprising and concerning conclusions, particularly for their female participants.

Dr. Eric Braverman and co-author Nirav Shah, New York State’s health commissioner, compared a person’s BMI with body fat percent as determined by DEXA scan (Dual-energy X-ray absorptiometry) which has the ability to differentiate between bone, fat, and muscle tissue. (The usual DEXA scans used to screen for osteoporosis do not routinely measure fat and muscle tissue as was done in the study). They found that nearly half of women categorized as overweight by BMI were found to have >30% body fat, consistent with obesity. This misclassification in women increased with advancing age.

Obesity versus overweight; this is not simply an issue of semantics. The larger issue raised by this study is there is a large group of women where BMI, the most commonly used assessment of obesity, is underestimating their risk of future disease. These so-called “normal weight obese” may have an increased risk for conditions such as high cholesterol, coronary artery disease, high blood pressure, and diabetes but may not be getting the appropriate focused counseling to improve their health.

Does this mean everyone should go out and get a DEXA scan? Cost and inconvenience make this less than ideal. Though we are still in search of a perfect screening test for obesity it is important to remember that weight is only one factor related to risk for disease. Healthy lifestyle habits, such as regular exercise and a diet rich in fruits and vegetables, are important for everyone regardless of what the scale says.

Affordable Travel Preparation

For preventive medical care no matter where you’re headed, RWWC is ready to help. We’ll review your itinerary and medical history, provide the necessary vaccinations and prescriptions, and give you advice for staying healthy throughout your trip. You should plan to see us six weeks before your departure to allow ample time for vaccinations.

If your insurance does not cover travel medicine, the cost of the visit is $75 plus the cost of any vaccinations that you may require. Routine vaccines including Hepatits A, Hepatitis B and Tetanus/ Pertussis/ Diptheria are routinely covered by insurance. The typhoid vaccine costs $75.

Special Vaccinations

Certain vaccinations, including those against rabies, Japanese encephalitis and Yellow Fever are only available at specialized travel clinics. We’ll help you determine whether you need any of these vaccines and direct you to the appropriate clinic. Note that travelers to equatorial Africa and parts of South America will require proof of vaccination against yellow fever. For more details, visit the CDC travel website.

A recent study published in the February 23, 2012 issue of the New England Journal of Medicine provides evidence that colonoscopies cut the risk of death from colon cancer by over 50%.

Despite good data supporting the efficacy of colon cancer screening, many patients are still not being screened.

Worldwide colon cancer is the second most common cancer diagnosed in women, and the second most common cause of cancer death. For most patients, an initial colonoscopy is recommended at age 50. Patients with a family history of colon cancer, colon polyps or inflammatory bowel disease (Crohn’s Disease or Ulcerative Colitis) may require screening at an early age.

The test involves a bowel prep, which essentially means taking a few doses of laxatives and a clear liquid diet for a day before the test. To make it easier for patients, I recommend that patients schedule the test for early in the morning. Patients are given sedation through an IV and the test is painless, patients may experience mild cramping and gas for several hours after the test. If a polyp is found during your colonoscopy it can be removed, thus preventing colon cancer.

Lifestyle can also affect your risk of developing colon cancer. To lower your risk: Engage in regular physical activity; choose a diet high in fruits and vegetables; avoid processed meats; limit your consumption of alcohol and maintain a normal body weight.

Whooping cough is on the rise in the U.S., including the Philadelphia area. Staying up to date with your vaccinations can help protect you and your loved ones.

Whooping cough, also known as pertussis, comes as a vaccine in a combination with tetanus and diphtheria vaccines. The combo vaccination is known as tdap. Most people complete the initial series of vaccinations when they are young and the CDC now recommends a tdap booster every ten years for adults. Whooping cough can infect people at any age but those who are unvaccinated or are too young to be fully vaccinated are at most risk for serious complications, including death. It is important to make sure you are up to date with your tdap booster if you are spending much time around little ones as they most often contract the disease from a caretaker or family member. Expectant moms can get the tdap booster after the 20^thweek of pregnancy or may be offered it immediately after delivery.

Whooping cough is spread from person to person by respiratory droplets, such as through coughing and sneezing. Droplets usually don’t travel more than three feet so reasonably close contact is required. Initial symptoms are similar to that of the common cold: runny nose, sneezing, and a mild cough. The cough then worsens to bouts of spasmodic coughing sometimes followed by a deep forced inhalation which can sounds like a ‘whoop.’ This phase of coughing can last one to six weeks, though sometimes up to ten weeks. Being vaccinated reduces the risk of contracting whooping cough and can decrease the severity of symptoms. If you have close contact with some with a confirmed diagnosis of whooping cough please contact the office, prophylactic antibiotics may be administered regardless of vaccination status.

For more information visit http://www.cdc.gov/features/Pertussis/

Vitamin D has been in the news a lot lately. It plays a major role in calcium absorption but recent research suggests it may do much more. Scientists have discovered vitamin D receptors on almost all tissues of the body meaning it may have a much larger effect on our health and development of disease than previously thought. This discovery has prompted increased interest in vitamin D and lots of buzz in the media about the potential benefits. First, it is important to understand where vitamin D comes from and if you may be at risk for deficiency.

Vitamin D is the only vitamin that is also a hormone. It is sometimes called the “sunshine” vitamin because it is synthesized in the skin from direct exposure to ultraviolet B rays. This process requires direct sun exposure; indirect rays or light through a window does not contribute. Ten to 15 minutes of sunshine three times a week can be sufficient to prevent deficiencies. Your body’s vitamin D production can be hindered by being further from the equator, air pollution, cloud cover, and sunscreen use.

If you have been told your vitamin D levels are a little low don’t worry – you are in good company. A lot of women in our area have insufficient or deficient levels of vitamin D. This could be due to our latitude, responsible use of sunscreen to protect our skin, tall city buildings blocking direct sun rays, and working long hours inside. Other risk factors for low levels of vitamin D include advanced age, obesity, and having darker skin.

Vitamin D also occurs naturally in a few foods such as fish, oysters, and eggs. Because of this limited representation in the typical American diet, many foods are fortified with vitamin D. Vitamin D is often added to milk and other dairy products, soy milk, and breakfast cereals. Sometimes this is not enough and you may need to add a vitamin D supplement. Recommended daily value for adults under 70 is 600 IU a day; those over 70 require around 800 IU a day. You may be directed by us to take a higher dose for a period of time if your levels are low. Safety research supports an upper limit of a dose of vitamin D to be 10,000 IU daily. This does not mean that you should take 10,000 IU a day but that doses above that may be harmful. A dose of 1,000 to 2,000 IU a day is much more reasonable. If you are purchasing a vitamin D supplement look for vitamin D3, or cholecalciferol, over vitamin D2, ergocalciferol.

We have known for some time about vitamin D’s role in helping the body absorb calcium, in maintaining bone density, and in preventing osteoporosis. New research suggests it may also help protect against chronic diseases such as certain types of cancers, cardiovascular disease, high blood pressure, autoimmune diseases, and mood disorders. It is important to remember that further research is needed in these areas to confirm these associations and determine what the role of supplementation might be. There is a lot more work to be done in this area and taking mega-doses of vitamin D is not recommended and may be harmful.