Park Ave. Medical Weight & WellnessBloghttp://www.parkavenueweight.com/blog/2011-03-25T22:17:20ZSquarespaceRetrying To Get Rejected Obesity Drugs FDA Approvedhttp://www.parkavenueweight.com/blog/2011/3/25/retrying-to-get-rejected-obesity-drugs-fda-approved.htmlDr. Kane2011-03-25T15:12:28Z2011-03-25T15:12:28Z“Obesity experts” met with FDA representatives on March 22 in a seeming attempt to push the passage of three new medications that were recently rejected by the FDA Contrave, QNexa and Lorquess seeking answers for what type of supplemental information would be required to get these drugs FDA approved. 

Here is a brief overview of the three meds in question:

Contrave is a combination of two existing medications (bupropion – an anti-depressant and naltrexone).  64.9 percent of the patients who took Contrave lost at least 5 percent of their body weight after 56 weeks, and 39.4 percent lost at least 10 percent of their body weight in pre-release studies.  Bupropion is a metabolite of diethylpropion (more commonly known as tenuate) and as such carries some weight loss potential.  In fact, there is a dose-dependent weight loss with bupropion ranging  from 5-10% on average.   Presumably, the naltrexone was designed to help with cravings, although it seems as if the results really weren’t much of an improvement.  While this was the closest of the drugs to being passed, it was put on hold pending further cardiac outcomes. Frankly, I can’t see what the big deal is with this drug and why it represents any improvement over bupropion alone.

Qnexa is the most intriguing of the three of these medications as it combines two medications that can have relatively potent weight loss effects. Phentermine is that last remaining FDA approved weight loss drug with potential for dramatic weight loss.  It is a stimulant that revs up metabolism and decreases appetite.  As a stimulant, though, the side effect profile can include increased heart rate, increased blood pressure, anxiety, insomnia and dry mouth.  Some people are willing to tolerate these side effects to get pounds off.  My biggest concern with it, is that a percentage of people who take it quickly regain the weight they lost.  Topiramate is an anti-seizure drug that is also quite effective in treating migraine headaches.  It was found at higher doses to produce fairly significant weight loss.  The side effect profile on this drug, though, is not clean either, including fatigue, memory loss and word-finding difficulties, peripheral nerve issues and in less common, but serious cases, vision problems involving glaucoma.  The potential for side effects, not questions of efficacy blocked this combo pill from coming out on the market. 

Lorquess is the only new compound that was up for review and also got rejected for potential ill-effects (a number of heart-valve problems and even tumors in rat-brains).  It’s mechanism of action is the targeting of appetite controlling serotonin receptors in the brain, similar to Meridia (sibutramine) which was removed from the market recently for concerns over cardiac risks.  The effects of Lorquess would likely not be as dramatic as Qnexa, although the rejection was over safety, not efficacy. 

One of the problems I have always had with obesity drug studies is that they determine efficacy of the drug by percentage of weight loss usually with a cutoff of 5% total body weight loss and sometimes comparing to 10%.  For most obese patients, though, this is a drop in the bucket, particularly if the weight loss is medically induced.  A good suggestion proposed by Dr. Louis Aronne, one of the representatives meeting with the panel and the former president of NAASO/The Obesity Society, is looking at obesity-related disease modification rather than just weight.  If someone could improve their obstructive sleep apnea , diabetes management or cardiovascular risk through weight loss, does it really matter what percentage of body weight is involved?  This is probably a good metric for many drug studies.  It is quick and easy to judge how much a blood pressure is lowered by an agent in days, weeks or months, but blood pressure leads to serious complications – heart attack, stroke, kidney disease, etc.  Long term outcomes are why we modify the modifiable (such as blood pressure, blood sugar or in this case excess weight).  I just don’t think these drugs are potent or new enough to warrant necessarily passing them through.

I will write more soon on my take on weight-loss drugs, but my experience to date is that very few people who need to lose a significant amount of weight get and stay at their healthy target via weight-loss medications.  Proper diet, increased physical activity and an eye towards calorie balance are what is called for in most cases.  The tougher question for physicians is not what medication to prescribe, but how to help people adapt their lifestyle accordingly.

Image courtesy of alainu on flickr 

 

]]>The Obesity Environment: Population Dynamics and Food Qualityhttp://www.parkavenueweight.com/blog/2011/1/18/the-obesity-environment-population-dynamics-and-food-quality.htmlDr. Kane2011-01-18T13:55:00Z2011-01-18T13:55:00ZMy high school European history teacher, Dr. McLintock, introduced me to the works of Thomas Malthus, the 18th century author of An Essay On The Principle Of Population.  In a nutshell, Malthus proposed that while food supplies increase arithmetically (in small increments – think addition), populations increase geometrically (think multiplication). The result is that at some point we will outgrow our food supply, leading to natural checks on our population via hardships and suffering, as people deal with the shortage of supplies and competition for resources.

While a very compelling view centuries ago, what Malthus did not account for is technology, which post-industrial revolution, has increased geometrically to keep up with our population. You can even argue that, given the fact that our country produces far more calories than need to be consumed and given the extent our obesity epidemic, our ability to feed ourselves has charged ahead of the need to feed a growing population.  For instance our agricultural industry now produces genetically altered, subsidized crops that are easier to manufacture in bulk and more resistant to bugs, disease and spoiling than ever before.  The result is that we have an over-abundance of corn and soy that gets altered and fed into almost all commercially produced foods from junk foods to condiments to our livestock in unnatural ways.  Another example is how we have learned how to raise cows almost twice as fast as when they simply grazed and grass in an open field.

While technology has helped us overcome some of the fears of Malthus, his ultimate concern holds true (even if for another reason).  The second half of his theory was that the discrepancy between our earth’s population and sustenance would ultimately put a cap on population growth through the suffering of man.  While populations continue to grow and the struggle for food in industrialized nations is not what he would have predicted, we are suffering some of the negative consequences of this struggle in obvious ways even as it pertains to the few advances I have illustrated.

  1. The production of excess crops (corn comes to mind) has encouraged obesity in more ways than one.  High fructose corn syrup is dumped into countless commercial food products (even those that would not be thought of as sweet such as ketchup and pickles).  Additionally, there is more energy produced in our country than is expended.  In other words, there is more food in our country than is needed – with this excess clearly showing on our bodies.
  2. The potential harms of genetically modified crops (even genetically modified fish is on its way) and the pesticides that they can tolerate have yet to be fully illustrated.  At the very least there are associations between pesticide levels in the urine and hormones such as testosterone.
  3. The unnatural feeding of our livestock (and inhumane conditions in which they are raised) has necessitated the use of antibiotics and toxic substances that kill microbial infestation that would otherwise not be the case (cow’s that are grass fed are less susceptible to E. coli as the bacteria cannot thrive in a basic environment. Grain fed cattle’s stomachs have an acidic environment like humans, and therefore E. coli proliferates. So when we eat beef and dairy we are consuming antibiotics.
  4. In order to make more of the meats we want and quicker, our livestock is pumped with hormones leading to a myriad of known (and unknown) health complications.  This might be the case in anything from meat, to cheese, butter, milk and anything else with dairy.
  5. The emphasis on creating large amounts of food (calories) quickly has created a situation where the focus of technology, profit motive and our own genetic susceptibilities perpetuate a system where calorie dense, nutrient-poor and health deteriorating foods have flooded our supermarkets and homes.

What to do?

1. Avoid obviously genetically modified foods (like GMO soy products) until we know for sure what the long term consequences are.

2. If you can afford it, stick to organic meats and poultry

3. Buy local.  Small local farms are far less likely to engage in the practices that might harm your health.  If we don’t buy local, the small farmer will completely disappear in the future.

4. Avoid food with high fructose corn syrup or gratuitous corn or sugar added to the ingredient list.  If you are going to buy pre-packaged foods or snacks, make sure the ingredient list is short.

5. Eat fruits and vegetables instead of processed grains and fats.

Tune in to my next entry for a brief overview of the food industry and how it is contributing to our obesity epidemic.

 

Image courtesy of Miller Info Commons on Flickr

]]>New Year’s Resolutions: A Chance For a Revolutionhttp://www.parkavenueweight.com/blog/2011/1/10/new-years-resolutions-a-chance-for-a-revolution.htmlDr. Kane2011-01-10T13:57:00Z2011-01-10T13:57:00ZIt is now the second Monday in January, and for most, the dreaded first week back of work has passed;  time to get down to the business of fulfilling those New Year’s resolutions.  More than one third of New Year’s resolutions will be entirely ignored or dropped almost immediately with most of them ultimately going unfulfilled after several attempts.   Perhaps trying a systematic approach this year will yield better results.

  1. Take a thorough look at the resolution.  Does it make sense?  Does it fit into the larger scheme of what you are trying to accomplish.  Given the amount of effort required for more involved behavior changes, makes sure that there is a purpose behind what you are doing.  There is no sense in wasting your time on a theoretical goal that won’t accomplish anything.  If you do believe in what you are doing, that is the first step in accomplishing it.
  2. Make a plan if you have not already done so.  It is one thing to say you are going to lose weight or start to exercise or eat a certain way, but think about how much more complicated it is to add another dimension to your life that has previously been lacking even if you knew it was good for you.  This requires time, space and discipline, but also a realistic review of the logistics of the plan. Put pen to paper if need be.
  3. No matter what the resolution or plan, resolve to create more space.  Packing more into your day might add more stress and ultimately doom you to failure. Space can come in many forms.  Take time in between tasks.  Get to bed on time so that you can wake up more early.  Try to avoid adding complicated or unnecessary tasks and avoid or minimize exposure to toxic relationships.  With the proper space, the world around slows down and allows more time to accomplish what you feel is important.
  4. Try to get support around your resolution, but do not depend completely on it. Engage in activities, discourse, and relationships with people who are like-minded or at least support your new efforts.  The corollary to that is try to avoid people that will drag you down.  If you are used to hanging out with the same happy hour crowd every Thursday night which leads to excessive beer drinking and late night eating, you can imagine what will happen if you keep going to happy hour.  That said relying exclusively on external support can also set you up for failure.  Just because your buddy doesn’t go with you to the gym as promised on New Year’s eve doesn’t mean you still can’t go.
  5. Finally, be mindful.  You will notice that virtually every one of my blogs includes this phrase but ultimately these tips are really only a starting point.  In the end, the work that is put in day-to-day will yield your results.  It helps to be thoughtful in preparation but also mindful of your surroundings, your feelings and your impulses.

Making a realistic plan, creating a healthy environment with more space and being mindful will all help aid the discipline you are looking for.  If all goes well, you might find that other good habits come from the fulfilling the one that was pledged, making it a New Year’s Revolution.

Join me and ultramarathoner, fitness enthusiast and insipirational speaker, Sarah Staley on a twitter #wellnesschat this Thursday, January 13 at 8:00 EST.

Image courtesy of vagabond_in_the_sky on flickr.com

]]>The Obesity Environment: Evolution, Genetics and Metabolismhttp://www.parkavenueweight.com/blog/2011/1/6/the-obesity-environment-evolution-genetics-and-metabolism.htmlDr. Kane2011-01-06T13:58:00Z2011-01-06T13:58:00ZOne of the common questions asked by my patients is why me?  Why is It that my friends or my sister or my husband can eat whatever they want and don’t have to starve themselves and go to the gym to maintain their weight?  There are often two answers to that question.  First I explain that if their friends and family are overeating and under-exercising, it will ultimately catch up to them.  Yes there are those few who live seemingly indulgent lifestyles, yet remain slender.  However, living with a positive calorie balance almost always catches up to people (some early in life and others as they reach middle-age).

The second part that I explain to them is that they are likely evolutionarily advanced.  While that might sound backward we likely have stopped evolving (or at least not as quickly) as technology has been developed faster than our ability to adapt naturally.  Just as some people are more apt to run long distances (those packed with slow-twitch muscle fibers) than sprint or lift heavy weights (those with a predominance of fast-twitch muscle fibers), the same holds true for metabolism.  As a culture, we think of big eating slim people as advantaged.  That probably was not so in the distant past when food sources were unreliable.  At that time those people who could store their energy for longer (who knew when the next heard of buffalo would pass by) likely had a competitive advantage over those who burned quickly and needed frequent refills to keep going.  In the modern era, where we have readily available food supplies (including foods higher in fat and sugar than in the state of nature) the ability to metabolize slowly has become a liability as it predisposes people to the diseases of excess nutrition: diabetes, heart disease, strokes, obesity and metabolic syndrome.

To illustrate this I like to use an analogy I once heard from Dr. David Katz at Yale.  He compared  a human in the modern era to a polar bear in the desert.  With its thick white coat of fur (to keep it warm and hidden in the snow) and its layer of fat and non-porous black skin (to absorb heat and trap it inside) it is the perfect evolutionary design…that is for an arctic environment.  Imagine that same animal trapped in the desert (where releasing of excess heat is at a premium).  Its ability to absorb and retain heat now is a potentially lethal liability, and its white fur hides it from no one .

Evidence is actually mounting to suggest that hormones play a role in this.  A relatively new concept, known as fullness resistance syndrome suggest that many obese people have an insensitivity to satiety hormones (that ordinarily would make you full) much in the same way that diabetic patients have an insensitivity to the action of insulin. Sure, there is some information gained by those who have always struggled with their weight.  Someone might have relatively sluggish thyroid function or polycystic ovarian syndrome that has previously been undiagnosed.  And sticking to a lower-glycemic diet with increased exercise is a must for those who have always struggled with their weight.  For the most part, weight gain and the diseases that come with it are phenomena  of people who once were adept and surviving and are now more susceptible to the western diet and lifestyle.  The part that people don’t want to hear, this evolutionary advantage often means you just have to work harder today.

Image courtesy of luxnatura on flickr.

]]>Obesity In America: Our Broken Medical Systemhttp://www.parkavenueweight.com/blog/2010/12/16/obesity-in-america-our-broken-medical-system.htmlDr. Kane2010-12-16T14:18:00Z2010-12-16T14:18:00Z

As a nation, the U.S. spends more money on healthcare than any other country  (over $5700 per capita annually and over 15% of the GDP) crushing all other developed nations– and yet we rank 37th in the world according to the most recent World Health Organization report.  What is the cause for this?  Is the environment in which we live so toxic that we need to spend our way back to health, or is the system simply too broken?

Sure, if you have a serious medical illness, or one that involves obscure or esoteric treatment, you’ll want to look no further than a major American university hospital for cutting edge treatment and research.  Most of the disease burden in America, though, deals with preventive issues that we as a nation have a difficult time with.  No problem in our healthcare system is better illustrated than the disconnect between primary care medicine and the management of overweight and obesity.  I touched on this issue in a previous entry.  Here are some of the following reasons the system is rigged against success:

  1. the incentive in our medical world, just like it is in all sectors of our economy is to turn a profit, where you can argue that healthcare and profit don’t mix
  2. too many hands in the pot – not enough money to go around for health insurance companies to be turning profits (10% margin)
  3. drugs are too expensive (sometimes randomly so if you compare drugs of similar efficacy).
  4. incentives lie in procedures and new drugs, not in maintaining the overall health of patients
  5. not enough emphasis on primary care medicine (#4 means that is where the money is, so most of the best and brightest will go towards procedure-oriented medicine)
  6. Law suits – not just defensive medicine, but precious time taken away fluffing up notes to prevent against law suit even though 75% of documentation has little to do with genuine patient care

What does this mean for you?

It means that your primary care physician cannot, for logistical and financial reasons, help assume responsibility for doing something about your conditions that are so effected by lifestyle an environment and are not solved by a simply test.  It means that there is no funding on the way that is going to change this any time soon.  This problem is here to stay and I fear that in spite of some of the good that will come from health care reform (expanded coverage for the sick and uninsured) ultimately the insurance companies, societal litigiousness and financial incentives are drawing physicians into mega-practices that lower the level of care as it pertains to obese, lifestyle issues and chronic disease prevention.

What can you do about it?

All things being equal, try to opt for insurance plans with out-of-network benefits giving you freedom to see doctors you think are better.  Opt to see people that will spend time with you and have a reputation for doing so.  Don’t simply accept “you must lose weight” from your doctor, but don’t blame them either.  Realize that managing overweight and obesity is a crucial part of primary care medicine but just isn’t built into the system. Ultimately you are responsible.  If you need to see a specialist or someone you can help, speak to your doctor about it or seek it out yourself.  Take steps to initiate the process on your own changing eating and exercise habits and a safe way.

Image courtesy of rosmary on Flickr

]]>A Dieter’s Guide To Navigating The Holiday Party Circuithttp://www.parkavenueweight.com/blog/2010/12/14/a-dieters-guide-to-navigating-the-holiday-party-circuit.htmlDr. Kane2010-12-14T13:52:00Z2010-12-14T13:52:00ZIn my last holiday season blog I gave some tips on how to navigate through the beginning stretch of the holiday eating season: Thanksgiving.  By now, many people are already entrenched in the holiday season party circuit.

Holiday parties are particularly difficult. My general advice is to pick and choose when to deviate from routine. If you overindulge at every party, then the holiday season will be one of significant weight gain. It isn’t easy but the two things to be real careful about are alcohol and sugar. For some it requires completely abstinence, and for others it means moderation. You have to know what type of personality you have.  

 

Here are some suggestions:

1. Try to limit the number of parties you are going to. I am not suggesting being a hermit, but it can be east to get caught up in the holiday spirit.  One party leads to another and each one presents an excuse to delay the healthy lifestyle until January.  If you are going to a party on a diet, and it is not socially or politically necessary, make sure it is really worth going.

2. Try to limit your “exposure” when you are at the parties.  This sounds a little like my first suggestion, but the idea is that the total amount that you consume (whether it is calories, sweets or drinks) is more important than whether you have anything or not.  So while this suggestion leans towards the anti-social, showing up late or leaving early can allow you to get the necessary face time without indulging in excess.

3. Alcohol can be a diet-killer at parties and seems to be even more of a factor during the holiday season and New Year’s celebrations.  You might have noticed that I have established alcohol as one of a dieter’s chief enemies throughout my blogs.  Simply put, there are too many empty calories and defenses are dropped.  It is almost impossible to drink and take pounds off at the same time.  Easier said than done, but keep this in mind when heading to your parties.

4. Sugar in alcoholic beverages and dessert items is ever-prevalent in this holiday season.  While I always suggest avoiding alcohol, this is a case where a glass of champagne (as little as 100 calories) beats a glass of egg nog (can be over 300 calories) all things being equal.   Obviously staying away from the rest of the sweets is a good idea, but you have to know who you are.  If you can have one cookie and not stray from your plan otherwise, it probably isn’t a big deal.  If the slightest hint of sweet sets you off, complete abstention is advised.

5. Make sure you have an emotional outlet/support.  Part of the difficulties people have during the holidays are not just related to their food and alcohol exposure.  The holiday season is a time for family and close relationships which are not exclusively positive.  For some, baggage from family old  affairs can get in the way of a blissful season.  For others the lack of close family and friends can be a time of longing.  Try to avoid feeling alone and lapsing into old habits.

6. As always, remember that the laws of physics apply whether it is the holidays or not, so even if there is deviation from routine one night, get back on track the next morning, by eating a healthy breakfast, drinking plenty of water and exercising.

Look out for my next holiday season blog in which I will talk about things New Year’s Resolutions.

]]>My Take On Korean Foodhttp://www.parkavenueweight.com/blog/2010/12/10/my-take-on-korean-food.htmlDr. Kane2010-12-10T14:17:00Z2010-12-10T14:17:00Z

After spending 2 weeks in Korea, I became quite familiar with the Korean diet. The food of Korea might be the world’s most flavorful.  While calling it the best would clearly be a matter of individual discretion, it is tough to deny the absolute magnitude and intensity of taste: packed as it is with loads of salt, garlic and hot pepper which form the basis of most dishes.   I was absolutely amazed at the food that I had in the countryside (a spicy soft-tofu stew and a steamed-chicken stew in a sweet, non-spicy sauce were the highlights for me), although the foods was pretty good in Seoul as well – just without the same freshness.  In this blog I intend to discuss the benefits and drawbacks of the Korean diet.

What’s Good In Korean Food?

  1. Pro-Biotics: Long touted for the boosting the immune system and preventing disease several staples of Korean food contain probiotics, none more popular than Kimchi (a fermented cabbage dish served with EVERY meal, including breakfast,) The quality of kimchi and its nutritional content vary from place to place (even Asiana airlines served tolerable kimchi on the flight over), but we would probably all benefit from the combination of the nutrition packed cruciferous vegetables (usually cabbage) and the probiotics generated through the fermentation process.
  2. Total Calorie Consumption/Limited Snacking: In America people tend to get fixated on the notion of eating many times per day to keep metabolism boosted.  And I do mention to my patients that while total calories matter, too much in any one sitting can undo some of that benefit.  Nonetheless, the lack of snacking and customary snacking habits on junk/fast food items, sugar drinks, sodas, etc. keeps total calorie consumption down.  Consequently, even with fewer gyms the obesity rates don’t even come close to America’s.
  3. Lack of Sweets/Refined Sugar The food generally reflects this.  Outside of a few starchy staples, the typical western high-glycemic foods, or typical desserts just don’t exist or are, at least, not frequently consumed. The major exception, of course, is sticky white rice.
  4. Relatively Healthy Side Dishes (Panchan): Korean side dishes are scattered across the table during most meals.  Usually consisting of tasty vegetables, often fermented or doused in hot pepper.  The consumption of these dishes decreases the proportion  you eat from what we in America would call the feature items of (meat and starch)
  5. Chop Sticks: can lead to slower eating.  This one might be a bit of a stretch.  It is much tougher to grab large amounts of food at one time, even for the most experienced users, as you would with a fork and knife.  This slowing down of the eating process allows your satiety hormones to kick in earlier in meals.

What’s Unhealthy in the Korean Diet?

  1. White Rice: Along with kimchi, sticky, white rice is the most common feature of a Korean meal. You very well might get spared white rice if you are eating noodles.  In healthier establishments with a dedication to “wellbeing” you might get a combination of rice with a small amount of beans and sesame seeds that creates a more nutritious balance.  Nonetheless, conversion to a whole grain version (like brown rice) would result in a lower-glycemic load, more nutritional content (thiamine in particular) and more fiber.
  2. SALT!!!: While sodium is a necessary part of one’s diet, virtually every taste consumed in Korea is overwhelmingly salty.  If you have normal blood pressure and normal functioning kidneys, it should not make a big difference if you eat low to moderately heavy salt loads.  Once things are off in the least, though, sodium loads raise blood pressure (and can cause a pronounced amount of fluid retention).  This culturally-expected sodium content has two main effects: One, it trains taste buds to expect things to be saltier (otherwise they are difficult to taste compared to other items).  More importantly as people age and are still used to this food they will have a difficult time controlling blood pressure putting themselves at greater risk for strokes.
  3. Increased Availability of Western Junk Food: Unfortunately,  the accessibility to western style junk is increasing In Korea, and while firm data is hard to come by, my perception was that the population segment that had the greatest weight issues were early adolescents.  The more western eating habits creep in, the bigger the western problems ultimately will be.

Image courtesy of adactio on Flickr

]]>Are We Getting Real Information? Part 2http://www.parkavenueweight.com/blog/2010/12/8/are-we-getting-real-information-part-2.htmlDr. Kane2010-12-08T14:15:00Z2010-12-08T14:15:00Z

Yesterday I introduced the notion of how difficult it is to decipher and trust  the variety of sources that provide us with medical and weight loss information.   I would like to return to that topic in this blog starting with how we are all affected on a personal level.

On a personal level

  1. Traditional Media: The traditional media just doesn’t cut it when delivering medical information. Beyond the fact that these media sources are sponsored by powerful business interests and journalistically neutered by threats of lawsuits. Additionally, mass media institutions have become sloppy and are often more interested in being the first to report an idea or event without bothersome tasks like fact-checking. Ill-conceived ideas are spread like fact in a convincing manner. I often have patients come in to my office with complete misconceptions. Carbs are all bad or fat is all bad, or exercise is worthless, or calorie burning cardiovascular exercise is worthless because they saw that in the news. What they did not see was the actual study where a 59 year old, post-menopausal woman in Australia failed to lose a significant amount of weight with a moderate intensity brief exercise program and no dietary modifications. Not exactly convincing once you know the details (but that wouldn’t make much of a story).
  2. Beware of Bias: Certain studies are more likely to be published based on results. Even under ideal circumstances of reporting what comes out, the information provided can be highly biased. A research study is much more likely to be published if the results match the original intention of the study. People (or companies that sponsor them) generally try to avoid publicizing that their life’s work has been proven wrong or that their product does not work as originally advertised.
  3. …And of Profit Motives: Information is also biased by profit motive and our existing technology’s ability to turn profit for big business. An example is the perceived level of importance dedicated to HDL (good) vs. LDL (bad) cholesterol studies. Although the impact of low HDL on vascular disease might be as great as high LDL, because drugs that seriously impact good cholesterol are lacking, studies tend to focus more on LDL lowering medications. The sponsors of these studies are, to nobody’s surprise, the producer of these medications. When the first HDL-raising drug hits the market, it will seem like a revolutionary breakthrough in our understanding of how cholesterol affects heart disease, but some of this information we already know.
  4. Knowing where to turn for information is tricky: People might be distrustful of traditional media or of modern Western medicine, but at least there, we have some degree of regulation. The FDA, though flawed and biased, has the authority to block a new drug from coming to the market that might be unsafe or ineffective or both (a bevy of new weight-loss drugs are not getting approved) or they can even take a drug off of the market if research proves that it is unsafe (the weight-loss drug Meridia has been taken off the market) The alternative/integrative health field, a booming industry in its own right, remains largely unregulated, with claims (specifically claimed not-to-be-claims) that are unsubstantiated but have people trusting nonetheless simply because they have lost faith in traditional medicine. The truth about medicine lies somewhere in between (or maybe somewhere outside the profit-driven box where both of these monsters lie).

Obviously, I am telling you all this and have invested a lot of time and energy into creating the platform you see here because I care about your health. I want you to trust me.

I am a doctor and I’ve sworn an oath to Do No Harm. But because I see the effects of mis-information overload every single day in my office, I’ve taken it upon myself to add myself to the growing chorus of voices interested in finding a new way forward. Our health as a society is dependent on the free flow of information.

But what good is that if the information we use to make our decisions every day is flawed. I hope you’ll continue to come by, read my postings, sign up to watch our videos and interact with us online and in person. I want to raise the level of conversation about our health to a new level, one where we can all benefit.

Aside from simply informing you and providing my take on the news, I am committed to offering up solid suggestions that you can enact today. They will help you formulate a framework of understanding, and in the end, your health will improve. If you ever have any questions or comments, this is a completely open platform, so feel free to ask questions in the comments section, or on Twitter and Facebook. And of course, you can always email me or call our office.

What can we do:

  1. Pay attention: Everywhere we go we are bombarded not only by scientific half-truths, but also by claims (advertisements or product descriptions) that utilize these half-truths as facts. Slapping a picture of a heart (now synonymous with heart-healthy) on an orange juice container or some other low-fat item does not guarantee us a healthy heart – rather they have met some loose criteria involving low-fat content only without regard to other ingredients or actual outcomes. Realize that, because information provided to you is tainted by some bias or motive outside of your personal health, you need to look deeper before reacting immediately.
  2. Ask questions: Something might sound logical or appealing, but just because it is being said often, or loudly or dramatically does not make it necessarily true. If you see the heart healthy sign, ask what it means. Ask your physician or someone with knowledge of nutrition (as your physician might not know). Before running off and eschewing carbohydrates for the next three months seek further information on whether this is healthy or effective or appropriate for your particular situation.
  3. Find reliable sources: It is easy to bash the traditional media or large profit-driven businesses. The tougher part is actually finding reliable information so we know where to investigate further, what to do and how we live to maximize health. This might come in the form of a practitioner who is educated, credentialed and open-minded. The information might come from a media source whom you trust or some other expert in their field. The point is that you take a look at the bulk of the information out there, reassess and start building up again.
  4. My part: In blogging and turning to social media platforms I pledge to give forthright information, to interpret what others fail to in an unbiased fashion without profit motives. I will do so in a way that both questions establishment and anti-establishment alike while making it easy to digest.

Image Courtesy of edkohler on flickr.

 

]]>Are We Getting Real Information?http://www.parkavenueweight.com/blog/2010/12/7/are-we-getting-real-information.htmlDr. Kane2010-12-07T14:12:00Z2010-12-07T14:12:00Z

I start my evaluation of patients with open-ended questions. This provides them with an opportunity to tell me about their problems in a more abstract way that lets me, importantly, hear how they think and frame their concerns. I can also listen to how they have, successfully or unsuccessfully tried to adjust their behaviors to address these problems.

By far the most common response I hear in these patient interviews is that people have heard or read so many conflicting items, they just don’t know whom or what to believe. Unfortunately, I often have to agree with my patients about how hard it is to know what information to trust, and what to ignore and filter out. In fact, an annual Gallup Poll revealed that in 2010 a record 57% of Americans did not trust the mass media to deliver the news fully, accurately and fairly.

The information provided by the traditional media is tainted by pressures from sponsors and their profit motives and carefully guarded do to the potential for law suit. Instead what we get is sensationalism. Medical information is largely obtained from clinical research that is overwhelmingly sponsored by pharmaceutical companies or other profit driven-medical companies such as makers of medical devices or stents.

Especially now that the 24-hour cable news cycle requires pundits to fill up all that air time. Anybody can create their own blog for free and declare themselves an expert. In the age of viral media it is easier than ever to propagate misconceptions via the internet. Even when using old standby search engines, it can be nearly impossible to distinguish advertisements from objective fact.

I used to think as I searched on Google that the sponsored sections were paid advertisements and the meat of the search (organic) section was genuine information. As time goes on, in spite of changing search engine algorithms, these concepts have blended. Other forms of media have also seen the line between advertising and editorial blur. Don’t believe me? Just open up the latest issue of…ANYTHING…and you’ll see advertorials and the suspicious activity of editorial features for brands that take out splashy and expensive ads.

OK I think I’ve made my point. But how does this affect you and your health?

Tomorrow I’ll be talking about how this misinformation overload affects you. So be sure to check back.

Image Courtesy of  edkohler on flickr.

]]>Obesity in America: An Introductionhttp://www.parkavenueweight.com/blog/2010/12/2/obesity-in-america-an-introduction.htmlDr. Kane2010-12-02T14:10:00Z2010-12-02T14:10:00Z

As my practice as both a general physician and obesity specialist has evolved, two seemingly independent streams of inquiry have dovetailed. The fields of primary care internal medicine is now intimately linked to overweight and obesity and their sequaelae.   In the following weeks and months, I’ll be launching a series of blogs, video podcasts, offline meetups and other media to help communicate what I have learned about the problem of Obesity in America.

 This series will deal with questions like:

  • How and why did we, as a country, get so fat?
  • What does it say about our society that our abundance that is killing us?
  • How much responsibility does the medical profession bear for this problem?
  • What role does our conventional food system play in this problem?
  • What about government subsidies for foods like corn, soy and sugar?
  • Is the information delivered to us by media trustworthy?
  • And finally, where are the sensible answers coming from?

But before we start to answer these questions, we must first accept the following premise: the environment we live in is conducive to unhealthy lifestyles and obesity. Virtually everything around us, from the way we work, to the food available to us, our genetics, our superannuated economy that rewards profit motives at the expense of public health, the stresses we place on ourselves and the misinformation that is a hallmark of our health system conspire against us.

While I am neither a conspiracy theorist nor an economist, I intend to use this space, in part, to show how various entities from big business, the media, the health and pharmaceutical industry collude, often unwittingly, to promote an unhealthy environment. Furthermore, these entities will continue to do so until we, the American people, understand it is our own responsibility to adjust our lifestyles and expectations accordingly.

This takes us to the second half of this series: the solution.

I know how difficult it can be to constantly feel we are being lectured to or patronized, especially by doctors and medical professionals who are seemingly immune to the health problems that plague ordinary Americans. I will, therefore, use the new tools of communication, including blogs and social networks like Facebook and Twitter, to start a recurring conversation about how we can all take steps to solve our problems. It is one thing to critique what is so clearly wrong, but quite another to present ideas and potential solutions. And to go even further, I want this space, this website, this blog, and all the other places where you can find me, to be a kind of support system. I want to be available to as many people as I can, not just my private patients in Manhattan.

The answers are not going to come fast and furious. There is no easy pill or magic cure. Surgery and medication can only get you so far, and they fail to address issues of personal accountability and mindfulness in our day-to-day behavior.

I will systematically demonstrate that the cure to what ails us lies in a combination of mindfulness and individual accountability.

By mindfulness I do not mean that the only way to stave off or overturn obesity is to join an ashram. Nor by accountability do I mean driving hybrid cars and exclusively using energy saver light bulbs. Instead, mindfulness refers to an active form of awareness concerning the relationship between ourselves and the toxic environment we’ve built.

It means being aware of our impulses before they turn into the self-destructive acts that have been established for our immediate gratification. It means taking a step back to give yourself the space to act in ways that you think you should.

Individual accountability is required, because our system that incentivizes profit above all else is not going to change. Although there are movements to bring vegetables to the inner city and restaurants to source food from local farms, it is ultimately each individual’s or family’s responsibility to choose what is best for them and act.. Throughout this series I will continue to provide trustworthy, peer-reviewed information, free from the bureaucratic constraints and terminology that distances people from good, common sense advice. And I will be available to respond to any questions or concerns you have, whether on the blog, or Twitter, or even by email should you want privacy.

As this is in a blog format, the order in which I lay things out will likely be flexible (in fact coming up with a brief overview of these theories was difficult and surfaces on a screen very differently than it does in my head), so I ask for patience and feedback. I look forward to the process.

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