Friday, October 29, 2010

Teething Tabs Recall. Science: 1 Quackery: 0

Natural does not mean safe. Repeat after me. Natural does not mean safe.

Myself and my colleague have repeated this mantra to patients many times. They come in wanting something "natural" for a relatively serious medical condition like high blood pressure or high cholesterol. We warn them that these herbal medications do not have scientific evidence supporting their effectiveness and may in some cases be as harmful as prescription medications. We're almost always met with a look of complete disbelief as though there must be some hidden agenda tainting our advice.

The most egregious example of this logical fallacy so prevalent in the laity is homeopathic medicines. Homeopathy is a pseudoscience that aims to dilute compounds in a preparation so much that there is no actual active ingredient remaining. The method of mixing the ingredients is said to impart the "energy" of the substance into the preparation. They use substances that would cause the symptom you're trying to treat if that substance were given in a sufficiently large dose. By diluting it down they attempt to trigger the body to heal itself.

There are many problems with this. First, theoretically, there is nothing in the preparation as homeopathy aims to dilute each substance down to a level where no molecules of the substance remain in the preparation. So you're essentially buying expensive distilled water. Second, homeopathy has not a single shred of evidence supporting its effectiveness in treating medical conditions. Third, people develop a false sense of security with these products. If done correctly there really should be no harm to these products. But this field is loosely regulated and inconsistently enforced, so you don't necessarily know what you're getting. Case in point: Hyland's Teething Tabs.

These absolutely useless sugar pills were just pulled from the market in Canada after their manufacturer received word from the US FDA that children given the products experienced belladonna toxicity. Belladonna is a plant native to Europe and also extremely toxic. We have taken many medications from it including atropine, hyoscyamine, and scopolamine. All of these drugs are useful if used appropriately but can also be extremely dangerous. Hyland's Teething Tabs contain 3X belladonna, or a 1:1000 dilution. Turns out they put more in there than they should have. Symptoms of belladonna toxicity include but are not limited to blurred vision, rapid heart rate, slurred speech, urinary retention, constipation, confusion, hallucinations, delirium, and convulsions.

Can you imagine being a frustrated parent looking for some solution to your child's incessant teething and instead of using something effective like Advil or Tylenol or non-drug treatments like cold cloths and gum massaging you get lured in by the marketing from the makers of Hylands? "A Safe Solution To Every Problem" It's fairly obvious now that this is NOT a safe solution

So next time you think you might want to try something "natural" because it'll be better for you and much safer, think of Hylands Teething Tabs. Or morphine. That's natural. So are arsenic, strychnine, and cyanide. And lots of cancer meds. And digoxin....nicotine, alcohol, marijuana, magic mushrooms, peyote, mescaline........................................

Monday, October 25, 2010

This makes me weep

I've been seeing this for years in my practice and am sure so have many other health professionals. I've seen 12 year olds with high blood pressure and 10 year olds on diabetes medications for obesity-induced diabetes, not Type 1. And people wonder why I'm so concerned with maintaining a healthy body weight, encouraging my patients to do the same, and teaching my children to eat and live healthy.

Sunday, October 24, 2010

Weight update

I weighed in at Weight Watchers on Thursday. Came in at 174. That means I'm 5 lbs down in 2 weeks. Not too bad for being half crippled the whole time because of my knee surgery. The thing that's been quite welcome is I haven't felt like I've been depriving myself and I haven't been too obsessively tracking things. Just not getting out of hand if I slip. Seems to be working okay right now. We'll see what two weeks from now brings. For information sake, I have posted two pictures below, and will continue to take pictures at each weigh in to chart my progress. I also took some shirtless pictures but those shall remain on my computer only! The picture on the left will always be from last Thanksgiving. I was at 158 lbs then, my slimmest in 10 years. The picture on the right will be right after the most recent weigh in. Keep wishing me luck!

PS-I'm going to kick my wife's butt for not telling me my glasses were insanely crooked in the current shot. Whatever. I don't have the energy to walk upstairs and take another picture.

Monday, October 18, 2010

If only we were all so passionate

I'm a big believer in exercising my democratic right to vote and I believe everyone else should be as well. I'm trying to raise my children to hold this principle dear. So far it seems to be working. I've voted in every election since I turned 18, federal, provincial, and municipal, so this year was to be no different.

In order to justify an excursion from the house, I told Sacha all about voting and that it would be fun. He really bought into it. He was so excited to go voting this morning.

When we arrived at the voter's station to register he asked the lady if he could have a paper so he could vote. She had to inform him that he couldn't vote. Just so we're clear, the impression I gave him is that he would be helping me vote, not voting himself. But he wanted to go one step further. Oh, he was mightily ticked when he was told he couldn't.

He did his trademark "I'm unhappy with the world" stance: shoulders raised, big frown, furled eyebrows, hands under his armpits closed in fists and stomped off to the voting booth. "I don't like that the lady told me I couldn't vote. I really want to vote." I told him he only had to wait 14 more years and then he could vote. He seemed happy to help me mark my X's, a difficult task given his inability to stay in the lines which could have spoiled my ballot. But it worked just fine. He even got to put the little papers into the ballot box.

On the way out, he said, "I thought you said this was going to be fun. It was boring instead." Then he talked all day about how he wasn't allowed to vote.

My wife's friend came up with a great idea. For the kids that come to vote with their parents, have colorful little ballots with felt pens and their own voting station. They could put it into a colored box with some colorful decorations on it. It'd get them excited about the process.

Weight Update

Staying true to my promise, I'm here to update you on my weight loss goals. However, I'm a firm believer in sticking to the same scale. So since Weight Watchers pegged me at 179, I'd like to believe my new scale is correct when it says 172, but I'll have to wait until Thursday to give you the right number when I weigh in.

In the meantime, here's another interesting obesity fact.

3500 calories is roughly the energy equivalent of 1 pound of fat. Therefore, if you were to consume, on average, 100 less calories a day for a whole year you'd lose 10 pounds. 100 calories per day X 365 days in a year=36500 calories. There are 3500 calories in 1 pound of fat so 36500/3500=10.4 pounds. So you can see the significant impact of making a very small change in your diet. For example, if you're someone who drinks a can of Coke or Pepsi every day, cutting that out would put you down 150 calories, or 15 pounds in a year, assuming you changed nothing else in your diet.

So, next time you see that tasty cookie at Timmie's, realize that if you added one of those to your work week coffee stop for a whole year you'd gain 16 pounds. Surely a Fruit Explosion Muffin would be a better choice, right? Wrong! 360 calories. 130 more than the chocolate chunk cookie. It would put 26 pounds on your frame in a year of 50 work weeks. While we're on the topic, how about your extra large double-double? 280 calories my friend. I know some people that get one every day. 28 pounds in a year. Ouch. I find this more useful than calories because it gives you a number you can envision. And the mental picture you get is not pretty!

Next time you go to pick something up, divide the caloric value by 10, and think about yourself that many pounds heavier a year down the road. It'll make you wonder whether you really need it.

Saturday, October 9, 2010

On the upswing

Last week I was lucky enough to attend a talk by the internationally renowned obesity expert, Dr. Arya Sharma here in little Peace River. Although I was one of the main people involved in arranging the talk and have taken additional training in obesity management, I was still amazed and delighted by the talk.

For those of us in the crowd that struggle with overweight and obesity there were many statements he made that, although true and backed up by research, were very depressing. For example, there is a substantial body of evidence showing that exercise plays very little role in helping people to lose weight. It is important for preventing regain of weight, but the biggest impact that one can make on their lifestyle when wanting to lose weight is in the diet. I won't get into specifics, but suffice it to say that once Dr. Sharma finished his explanation, we all agreed.

The other statement he made that I love is that obesity and overweight is not a problem of the individual or a sign of sickness of the human body. In fact, it is quite the opposite. The reason modern North Americans are overweight and obese is precisely BECAUSE our body is so good at regulating our caloric inputs and outputs. We're designed for handling long periods of famine, not perpetual abundance. His conclusion: "Obesity is the response of a very healthy natural system to an unhealthy environment."

This helped me mentally prepare for a later statement: over the long-term, weight loss efforts are only moderately successful. At best, with lifestyle change alone, long-term weight loss will be roughly 3-5%, meaning that someone like myself starting at 200 lbs when I started on Weight Watchers can expect, at best, a 10 lb weight loss long-term. Of course, this is based on population studies so you cannot predict any individual's success. Looking at long-term studies, roughly 50% of weight loss from behavioral interventions is regained after 1 year.

And this brings me to "on the upswing".

As the chart above so sadly shows, I started Weight Watchers in October 2008 at roughly 200 lbs. In roughly 5 months I was finally a healthy weight (164 lbs). I maintained that weight for almost 7 months. In October 2009, my wife and I went to Edmonton on a weekend away from the kids. I let loose. Put on like 3 lbs in a week. Ever since then I have not been below 164 lbs once. But until recently I've been hovering close enough to the mark that I've only had to pay at Weight Watchers two months. (As a Lifetime Member, as long as I weigh in once a month at no more than 2 lbs above my goal weight (=164 lbs for me + 2=166) I don't have to pay to attend). But then this September we went to New Brunswick to visit friends and I ate an unhealthy amount of seafood. This week when I weighed in at Weight Watchers for the first time since that trip, I was devastated to see that I was threatening 180 lbs (179 to be precise).

What have I done wrong? Sadly, my scientific mind jumps to all the above data and concludes that I'm really just abiding by population statistics. The graph of my weight loss and subsequent regain is eerily similar to that shown by Dr. Sharma to chart weight regain in large populations of obese and overweight patients. My emotional side does not want to accept that though. It seems much too defeatist.

So, in some soul-searching with myself, my wife, and my glorious sister Andi, (who has managed to stay within a 2 lb window all summer despite no longer explicitly tracking what she eats and being injured and unable to run), I have identified the following character flaws that lead me to gain weight.

1. Although tracking what you eat has been shown to aid in weight loss and maintenance, it is honestly something I cannot see myself doing for the rest of my life. I've been doing it for 2 years now, and I've just had enough. It's so exhausting. And as Dr. Sharma and his colleague, Dr. Freedhoff, say in their newly published incredible book Best Weight, "If you do not like the way you are living while you are losing your weight, you will almost certainly re-gain the weight when you go back to the way you were living before you lost it." ie. anything you do to lose weight must be sustainable...FOREVER.

2. I am a grazer. When I'm bored, tired, excited, depressed, anxious, happy, or just generally alive, I enjoy grazing our kitchen. My mind shuts off, all my tracking mechanisms go to sleep, and I consume. I need a hobby to replace it.

3. I hate wasting food. As such, I almost always clean off the food my children leave behind. Not into the garbage. Into my mouth.

4. I am a consummate offender in the all-or-none department. My Weight Watchers leader explained this nicely once. "If you were taking an egg out of a carton to make an omelet and accidentally dropped it would you throw up your hands in despair and smash the other 11 on the ground? No. You'd clean up the broken one and continue on as before." But when I slip and have a piece of cake that really wasn't worth it, my natural response is, "Well, I've shot today all to hell now. Might as well pig out and make it worth my while". Or if I decide that running would be a good way to burn some calories and keep off the weight but then realize for it to make an appreciable difference I'd have to do it 5-6 days a week my response is not to still do it when I can because something is better than nothing, but to plant my tush on the couch.

So here I am, telling you that I'm kicking my own ass back into gear. I'm going to recognize these character flaws and work with them to achieve my goals. I'm only going to weigh myself once a week. I'm going to try and go for a walk whenever I can but not beat myself up if I don't get the chance every day. I'm going to start tracking what I eat again, not so much to make a lifelong habit of it, but to regain awareness of the cumulative effect of consuming small amounts of unhealthy foods over prolonged periods of time. I'm not going to do celebratory Dairy Queen Thursdays anymore. I will still go to Dairy Queen and get a small treat if the scale proves to me I've done well. However, it will stop there. I got in the habit of celebrating just a little too much on Thursday nights after weigh-in. I think my Thursday night consumption was starting to approach 2 days worth of calories. Calories don't follow calendars. Speaking of calendars, I'm going to stop making excuses for special occasions. You'll see if you start to do this that every weekend has a special occasion of some sort or another. I will limit special occasion culinary celebration to Christmas, Thanksgiving, Easter, our anniversary, and my birthday. That is all that is necessary, really. When you're starting to use Victoria Day as an excuse to eat more food, you know you have a problem.

Most importantly, I'm going to start publishing regular updates of my progress on this blog. Not only is tracking what you eat an incredibly effective way to lose weight, but so is having a strong social support system. I figure the more I divulge about my struggles here, the more likely I am to succeed. As payment for subjecting you to this, I will focus each week on something interesting about obesity management. You'll be surprised to find out how little you actually know about this incredibly complex topic.

Here's a teaser.

Many people want to know the secrets to long-term weight loss maintenance. Thankfully, the work has already been done for us. The National Weight Control Registry has, for many years, been tracking roughly 5000 individuals who have lost 30 lbs or more and kept it off for 1 year or more. From this incredible study have come key behavioral components necessary to successfully maintain weight-loss (after all, losing weight actually isn't that hard; keeping it off is a real pain in the ass). Some of the most interesting findings from the study are:

1. Registry members have lost an average of 66 lbs and kept it off for 5.5 years.
2. Almost half of the members lost the weight on their own; the other half used a program of some type.
3. The most frequently reported form of activity is walking.
4. Almost 80% of them eat breakfast EVERY DAY.
5. 3/4 of them still weigh themselves once a week.
6. 90% exercise, ON AVERAGE, about 1 hour per day.
7. Most of them continue to consume low-fat, low-calorie diets.
8. They consume regular meals (less than 3 out per week and less than 1 fast food per week)

Sunday, October 3, 2010

Compounding our problems

I did a guest post for Scott over at Science-Based Pharmacy on problems with specialty compounding. Enjoy!