health education | wellness

Author: Amy

  • Why basic cholesterol testing may not be good enough

    Why basic cholesterol testing may not be good enough

    Basic cholesterol testing may not be enough

    According to lipidologist Dr. Tara Dall, we may not be understanding our risk of heart disease and diabetes with the basic cholesterol testing that many of us have during our annual physical.  Here is the video and below is our synposis.

    Synopsis and Key points

    Here is our take on this video…

    It is better to understand your risk for diabetes and heart disease sooner rather than later

    Cholesterol and HBA1C tend to diagnose disease too late in the game. By the time someone is diagnosed with a borderline or elevated cholesterol and HbA1c much valuable time that could be focused on prevention has already passed

    • Cholesterol is a fat that is used to make hormones and cell membranes.
    • Our bodies make cholesterol. We also get cholesterol from our diets. Since cholesterol and triglycerides are fats they can not travel in the bloodstream alone.  It goes back to high school chemistry, oil and water don’t mix.

    Lipoproteins are needed to transport cholesterol.

    Lipoproteins package cholesterol and triglycerides so they can travel in the blood.

    Types of lipoproteins include Chylomicrons, VLDL, IDL, LDL, and HDL.  Dr,Dall does a good job explaining how cholesterol and fats are “packaged” in lipoproteins.

     

    Apolipoprotein B (ApoB) is the major protein found on all potentially atherogenic lipoprotein particles, i.e. very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and LDL (particles that increase the risk of plaque formation, heart disease and strokes).   ApoB is strongly associated with increased risk of developing cardiovascular disease and is a better predictor than LDL.

     

    Again, Apolipoprotein B (apoB) presents as a single molecule in all potentially atherogenic lipoprotein particles, (very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and LDL).

     

    A better title for this video could have been “The need to go beyond standard cholestrol and diabetes testing”.   While the title statement is true, What Is Insulin Resistance: Fat around the gut? Insulin resistance was not discussed in the video.

     

    Dr. Dall is a renowned lipidologist. She has deep knowledge in cardiac primary prevention and is a diplomate of the American Board of Clinical Lipidology.She is considered an expert on advanced lipoprotein testing and especially the role it plays in early detection of insulin resistance and cardiovascular risk. She has lectures to numerous physicians on lipidology and cardiometabolic disease.  You can learn more about her work on her website, http://www.taradall.com .

    This video was found on Youtube

     

    References:

    J Biomed Res. 2011 Jul; 25(4): 266–273.doi:  10.1016/S1674-8301(11)60036-5 ApoB/apoA1 is an effective predictor of coronary heart disease risk in overweight and obesityMin Lu, Qun Lu, Yong Zhang, and  Gang Tian*

     

  • Are you at risk for insulin resistance and why you should care

    Are you at risk for insulin resistance and why you should care

    Insulin resistance effects more people than you think. In fact, obesity and insulin resistance are closely connected. This is a summary of a well-rounded video by the respected lipidologist, Dr.Tara Dall.

    Synopsis and Key points:

    Metabolic syndrome, insulin resistance and prediabetes are the same thing.

    • This video is a great explanation of how insulin should work. After a meal, insulin is secreted by pancreas in response to high blood sugars in the blood stream and brings the blood sugar level back to normal.
    • With metabolic syndrome, the cells are resistance to insulin so the pancreas secrete more insulin to bring the blood sugar levels back to normal
    • The mechanism of action of insulin is to bring glucose transporters located inside the cells to the surface. This is the way glucose enters the cells.

    Insulin is a very inflammatory protein and causes weight gain especially around the belly.

    Interesting.

    • Dr.Dall states that if you exercise 60 to 90 minutes a day you can overcome insulin resistance
    • If the pancreas secretes too much insulin, your blood sugar drops and you crave simple carbohydrates such as white bread and processed foods

    Dietary Recommendations

    A low sugar and reduced carb diet is more beneficial for insulin resistance.  The key point is that you want a reduced carbohydrate diet not a no or very low carbohydrate diet.

    Once insulin resistance is corrected people start to lose weight.

    Dr. Dall is a renowned lipidologist. She has deep knowledge in cardiac primary prevention and is a diplomate of the American Board of Clinical Lipidology. She is considered an expert on advanced lipoprotein testing and especially the role it plays in early detection of insulin resistance and cardiovascular risk. She has lectures to numerous physicians on lipidology and cardiometabolic disease.You can learn more about her work on her website, http://www.taradall.com

    This video is from a presentation she gave to GE employees  and was found on YouTube.

  • Harness the Power of Epigenetics …you will be amazed

    Harness the Power of Epigenetics …you will be amazed

    It was not long ago that conventional wisdom told us that our genes basically determine who we are. Having “bad genes” meant we were doomed. The concept of epigenetics – the study of how external factors turn genes on and off – has challenged this conventional wisdom and rewritten aspects of scientific knowledge on human genetics. I love it when old theories are dispelled and new information emerges.

    The Power of Epigenetics

    For a brief history ….

    At the end of the last century the Human Genome Project set forth to map out the human genome. It was completed in 2004 and approximately 20,500 genes were identified. This is the same amount of genes found in mice. It turns out there were non-coding proteins that were labeled as “junk DNA.” These proteins, however, were not junk and quite important. They actually modulate or regulate our genes. Simply stated, our actions (or in-actions) influence how we express our genes.

    This knowledge is great power. Genes are the blueprints cells rely on to grow, repair, and rejuvenate. We have influence over our genes by what we choose to do in our everyday lives. This is the power of epigenetics. We can choose to be more physically active, eat more greens (a huge powerhouse of energy), and  to rest and relax. But this is just the tip of the iceberg. Science has recently shown that actions such as volunteering, being more loving and kind, spending time with family and friends and having an optimistic attitude all have a positive influence on our health.

    Even in these uncertain times we have the choice to make simple decisions that have tremendous impact. Let us not forget this important truth. So as the warmer weather arrives, take time to exercise, enjoy healthy meals, be kind to one another and ourselves, and most importantly have fun!

  • Thyroid disease in women

    Thyroid disease in women

    Types of Thyroid Disease in Women

    Women are far more likely to have problems with the thyroid than men. Studies have shown that one in eight women tend to develop thyroid disease during her lifetime. Sometimes, menopause symptoms can be mistaken for thyroid problems, but thyroid disease is more likely to develop after menopause.

    The most common thyroid diseases are:
    •    Thyroiditis and Postpartum Thyroiditis
    •    Goiter or Thyroid Enlargement
    •    Thyroid Nodules
    •    Cancer of the Thyroid
    •    Hypothyroidism
    •    Hyperthyroidism

    We have already established the definition and the effects of hypothyroidism and hyperthyroidism in previous articles.
    Let’s briefly describe the above conditions: Thyroiditis is the inflammation of the thyroid gland. This inflammation may be caused by several factors that includes autoimmune diseases, infection and certain medications. Postpartum thyroiditis is a type of thyroiditis that develops during pregnancy or after childbirth. It is thought to occur from an underlying autoimmune condition that gets triggered during pregnancy. Thyroid nodules are the abnormal growth of cells that forms into a lump in the thyroid gland. Generally this lump is non-cancerous or benign.  Sometimes however, nodules can be malignant and thus become a sign of thyroid cancer. Goiter, on the other hand, is general enlargement of the thyroid gland. It can be associated with either hypothyroidism or hyperthyroidism.

    Thyroid Hormone Imbalance and Reproductive Health

    When the thyroid gland is enlarged, it affects the production of the thyroid hormone in the body. The levels can either become too high (hyperthyroidism) or too low (hypothyroidism). As already discussed, imbalance of the thyroid hormone level affects major bodily functions that can disturb both your physical and mental health.
    Since the thyroid hormone is very important for a number of metabolic processes, a malfunctioning thyroid can cause several potentially dangerous problems specifically in women. These problems include:

    Menstrual Problems
    An unbalanced thyroid hormone production can result in light, heavy, painful or irregular periods. It can also make your period stop for more than several months. This is a condition called amenorrhea.

    Problems Getting Pregnant
    Thyroid disorders can cause many reproductive problems in women. Scientific studies have established link between hypothyroidism or hyperthyroidism, and infertility.  These thyroid diseases can affect the ovulatory cycle of women.
    The two main hormones that affect ovulation are LH (luteinizing hormone) and FSH (follicle stimulating hormone). However, when either hypothyroidism or hyperthyroidism is present in the body, the misbalanced thyroid hormone level can alter the balance of FSH and LH.
    Hypothyroidism may also cause your body to produce more prolactin. Prolactin is another hormone that tells your body to make milk. Too much prolactin can also prevent ovulation.

    Problems during Pregnancy
    Two pregnancy-related hormones cause increased thyroid levels in the body. These hormones are hCG (human chorionic gonadotropin) and estrogen. hCG is made by the placenta and acts very similar to the function of the hormone TSH (thyroid-stimulating hormone).
    TSH, made by the pituitary gland in the brain, is the hormone responsible for stimulating the thyroid gland to produce the thyroid hormone. Increased TSH therefore stimulates extra thyroid production.

    Similarly, the presence of increased estrogen in the body (due to pregnancy), produces higher levels of a certain protein that transports the thyroid hormone into the blood. This protein is better known as thyroxin-binding globulin, or thyroid-binding globulin due to its binding capacity.

    Although these hormone changes are completely normal, they can sometimes make it difficult to interpret thyroid function tests during pregnancy.  These tests are important for the pregnant women because the level of thyroid hormone in the mother’s body affects the growth of the fetus.

    Regular thyroid hormone production is vital for the normal development of the fetal brain and nervous system. During the first trimester, the mother’s thyroid hormone acts as the unborn baby’s source of thyroid hormone.  This happens because the baby’s thyroid gland doesn’t begin to function on its own, until the fetus is 12 weeks old.

    It is normal for thyroid levels to elevate slightly and for the thyroid gland to slightly enlarge during a healthy pregnancy. However, when the thyroid is significantly enlarged, this can be a sign of thyroid disease and it is essential to be evaluated. Due to higher levels of thyroid hormone in the blood, along with increased thyroid size, fatigue, and many other symptoms typical of pregnancy, thyroid problems can be difficult to diagnose during pregnancy.

    Medical Insight

    Being aware of the above conditions helps to avoid possible complications.   The presence of certain predisposing factors like family history or past medical history of thyroid disease, should make you more vigilant to look out for the mentioned symptoms. It is never too late to take care of yourself. Seek the help of your health care provider so that you may understand what has gone wrong, what needs to be avoided and what you can do to correct the situation.

    References:

    National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services 
http://www.niddk.nih.gov/health-information/healthtopics/endocrine/pregnancy-and-thyroid-disease/Pages/fact-sheet.aspx

    U.S. National Library of Medicine 
http://www.nlm.nih.gov/medlineplus/thyroiddiseases.html#cat7
    Office on Women’s Health, U.S. Department of Health and Human Services
http://womenshealth.gov/publications/our-publications/fact-sheet/thyroid-disease.html

    Climacteric. 2013 Oct; 16(5):555-60. doi: 10.3109/13697137.2012.717995. Epub 2012 Oct 1.
    Comparison of the symptoms of menopause and symptoms of thyroid disease in Japanese women aged 35-59 years. Oi N1, Ohi K.

    Br Med Bull. 2011;99:39-51. doi: 10.1093/bmb/ldr030.
    The epidemiology of thyroid disease.
    Vanderpump MP1.

  • Four Ways to Improve Physician Listening Skills

    Four Ways to Improve Physician Listening Skills

    Being a good listener is cited in numerous patient feedback surveys as one of the main things that people value in a physician. Here are four simple ways to improve physician listening skills:

    Stop, Look, and Really Listen

    If you want to do anything right, you have to pay attention and do it correctly the first time. Otherwise, your efforts may be counterproductive. That’s definitely true with listening, which is not a multitasking type of skill. So when it’s time to talk with a patient, stop everything else. Look them in the eye, and concentrate only on that specific listening task.

    Be Warm and Cordial

    During a busy and stressful day, it is easy to lose sight of the fact that patients aren’t just problems you need to solve but are sensitive people who want to be heard. They are often scared or emotionally raw since they are not feeling well. So use a calming voice. Be warm and cordial. Let them know that you are a friendly face and a helpful ally, not just an experienced physician.

    Engage in Active Listening

    Never forget that unless you ask and then listen, the patient may not reveal the information you want and need most in order to make your own job easier and more successful. When a patient explains something to you, paraphrase and summarize it back to them. For example you might reply “Is this what I hear you saying? You feel exhausted and have a sore throat?” That kind of active listening ensures that there is no miscommunication.

    Use Nonverbal Communication

    Improve Your Bedside Manner

    Be sure to also listen to nonverbal communications from your patients. If a patient appears anxious, for example, that could be the reason for a higher blood pressure reading. But it may be that they are only nervous about being in the doctor’s office, and as soon as they return home their blood pressure may fall. So also try to read between the lines. But don’t guess. If you read something in a patient’s body language then ask more questions to see if your assumptions are correct.