Sunday, October 26, 2008

Glycemic index

Bagels and cornflakes and jelly beans, oh my. These--plus baked potatoes--are the worst of the worst of food choices for those of us who do not want to develop diabetes. These foods not only have a high glycemic index but also a high glycemic load. So flakes in the a.m. may leave you flaky and foggy-brained long before lunch.

All carbohydrates are not created equally in that some raise your blood sugar more rapidly than others. The glycemic index (GI) is calculated by measuring the change in blood glucose level that occurs when a person who has been fasting consumes that food. The elevation is then compared to the blood glucose response associated with a standard highly refined, high-carb food such as white sugar (which has a GI of 100).

The higher the GI, the more the food acts in the body like pure sugar, stressing those balancing mechanisms charged with keeping our blood sugar in an ideal operating range. Cornflakes (GI=92) send blood sugar soaring, causing the pancreas to respond with the release of lots of insulin which then efficiently sweeps the carbs into the cells. This causes blood sugar to plummet, leaving Kelloggs consumers with a mid-morning blood sugar too low to sustain brain functioning. While a trip to the office jelly bean (GI=78) jar may restore the blood sugar briefly, this quick fix just perpetuates the vicious cycle.

But nothing is really all that simple. Milk (GI=27) on the cornflakes changes the cereal's effects in unpredictable ways. And some foods with high GIs may have low glycemic loads (GL) which measures the actual blood sugar response to typical servings of foods. So a low GL (considered to be less than 10) on a high GI food choice indicates that you'd have to eat a ridiculous quantity to raise your sugar in ways predicted by its GI. For instance, pineapple has a moderatly high GI of 66 but a low GL of 7. You would have to consume 1 ¾ pounds in a sitting to raise your blood sugar in the same way that a handful of raisins (GI 64, GL 28) would.

Is your head swimming as if you just ate a baked potato (GI 85, GL 26) without sour cream, butter, and a steak (GI 0, GL 0) on the side? Experts agree that this approach may be too complex for many of us, encouraging us instead to eat foods that are not highly processed--which generally increases GI--and a diet that includes a wide variety of fruits, vegetables, and low-fat dairy products.

Wednesday, October 22, 2008

LDL particle size

LDL stands for low density lipoprotein, a worthy protein that picks up cholesterol particles that have either been absorbed from your diet or manufactured by your liver and totes them out to the cells. And it's a good thing that we have LDL-C; our cellular membranes are made out of cholesterol as are our steroid hormones. But as you know, while a little LDL-cholesterol (LDL-C) is a good thing, a lot is not. In susceptible persons, excess LDL-C enters the arterial wall where it may become oxidized and set off a world of inflammation and cholesterol schmutz known as atherosclerosis.

Turns out, there's bad LDL-C and then there's really bad LDL-C, and the difference lies in the particle size. There's no improving on the metaphors of noted lipidologist Dr. Thomas Dayspring, so here's the scoop in his own words:

Large-sized LDL is a beach ball. It bounces off the artery and goes back to the liver. Small LDL is a bullet. It lacks vitamin E, is very prone to oxidation, and crashes right through the artery.

So how do you know if your cholesterol is bouncing or crashing? LDL particle size is measured in the pricey VAP test which stands for vertical auto profile, but the information is actually right there on your standardized lipid profile. If you've got triglyceride levels over 200 and HDL-cholesterol (that's high density lipoprotein or the good stuff) levels below 45 (35 for the guys) we're probably talking bullets in your bloodstream.

Any hope of changing bullets to beach balls? Well surprise surprise, it's the same old song as always--weight loss and exercise. But wait, there's drugs that help as well, including Tricor, gemfibrozil, niacin, and the diabetic medication metformin, Actos, and Avandia.

Sunday, October 12, 2008

"Happiness is a Serious Problem"

Current events make the pursuit of happiness even more of a challenge than usual. One of several books I'm juggling now is Dennis Prager's 1998 bestseller "Happiness is a Serious Problem." Perhaps we are missing some opportunities to increase our satisfaction with our personal situation. Here's Prager's take on health:

Take the expectation of health. For most people, the only time good health brings them happiness is when they do not expect to be healthy and then find out that they are. Imagine that you discover a strange new lump on your body. You go to the doctor, who tells you that it looks suspicious and that you should have a biopsy. After waiting a week for the results, you learn that the lump is benign. That day will be one of the happiest days of your life.

Now this is remarkable because the day before you discovered the lump you were not one bit healthier than you were on the supremely happy day you learned that your lump was benign. Nothing in the state of your health has changed, yet you are now profoundly happy. Why? Because on this day, you did not expect to be healthy.

...[I]deally, we should awaken every day and be as happy about our good health as if we had just received the wonderful news that a lump was diagnosed as benign.

Monday, October 06, 2008

No talcing please!

I first heard this one 30+ years ago, and I always wondered if it was an urban myth of the bizarre variety. But here it is again, this time backed by research from Harvard Medical School. Epidemiologists there sorted through years of data from the Nurses Health Study regarding who used talcum powder on their nether parts, and whether those who did were more likely to contract ovarian cancer compared with those who dusted not.

Turns out that those who took a weekly powder were 36% more likely to end up with ovarian tumors, and a daily dousing raised the risk 41%. Talcum powder is made from hydrous magnesium silicate which has properties similar to asbestos. Neither talc nor asbestos has any business on your bum!

Saturday, October 04, 2008

"Wild thing, I think you move me..."

"It is highly possible that estrogen modulates motion abilities..."
---Karl Grammer of the Ludwig Boltzmann Institute for Urban Ethology

Well, duh Dr. Grammer, just ask an aging postmenopausal woman as she gets out of a chair about the lack of estrogen and the consequent lack of ability to move. Anyway, that was a mini-rant and NOT what this post is about.

In the 'what WILL they study next' dept., we have the following information out of the University of New Mexico. Evolutionary psychologists there were wondering how human females attract mates at the appropriate time of the cycle to generate species-appropriate reproductive behavior. They recruited lap dancers from local clubs to collect data on tips earned as correlated with phase of the menstrual cycle.

Women, as opposed to say a lady chihuahua or chinchilla do not go into heat but rather have a 4-5 day fertile window mid-cycle called the estrous phase when they are highly fertile. The researchers compared tips generated during these ovulatory days compared with those brought in during the luteal phase (post-ovulation time when perhaps a woman might be more inclined to eat her mate rather than mate her mate) or while the dancers were menstruating.

Sixty days, 5300 lap dance incidents later, here's the scoop. Data from 11 women with normal menstrual cycles indicated estrous earnings of about $70 an hour whereas hourly income fell 33% to $50 for those in the luteal phase and plummeted to $35 an hour for those who were menstruating. The seven women on birth control pills earned less throughout the study period.

So there's apparently 'something in the way she moves' during estrous that attracts clients like no other time of the cycle. And no estrous? May as well move on to another profession because she's not moving up in this lap dancing business. All good for the future of pill-free couples, but no wonder that some of my patients lose that loving feeling whilst on birth controll pills.