Too Many Doctors: what about gastrex and betafood

I like my doctors. There are only two - the Primary Care Practitioner or GP [General Practitioner] as the British call them and the Gastroenterologist. Some people have many more than two doctors and I feel sorry for anyone in that situation.

You'd think that the two doctors they'd communicate and work together ? Not a bit of it !

When the gastroenterologist prescribed Omeprazole, at no time did he try to deal with any threat of osteoporosis. He could have told me to get my calcium and vitamin D intake up high but he did not. After I was diagnosed with osteoporosis my GP said to talk to the gastroenterologist to find out if the omeprazole prescription needed changing. No suggestion about calcium, vitamin D or anything else.

Of course I did wonder why the GP didn't discuss directly with the gastro but apparently they don't like to do that !

I tried an experiment while on vacation. I stopped taking omeprazole for 18 days just to find out what the result would be. The answer is that food started to catch in my throat again. So I need to keep on with omeprazole. The theory when I started on the medication that by stopping the acid reflux my esophagus would heal. The experiment showed that had not happened and possibly will never happen.

So what to do ?

The next step might be the craziest yet - I'm trying an alternative nutritionist.

So now, as well as the prescriptions from the main-stream doctors, I'm taking the prescription from alternative medicine : Gastrex; Betafood; Spanish Black Radish. None of these has any clear action. You can search the web until Google runs dry and still not know if a supplement has any particular action.

So I'm hoping that you do not have to believe in these supplements that alternative medicine prescribes.

Regular drinking: good idea or bad idea ?

A lot of research, and I mean hundreds of studies, seem to show that alcohol is good for you but is this really true. I joined in with this happy piece about increased bone density with moderate drinking - and a longer life as an additional bonus.

Scientific American summarized it "Three decades of research shows that drinking small to moderate amounts of alcohol has cardiovascular benefits. A thorny issue for physicians is whether to recommend drinking to some patients."


The New York Times Roni Rabin had a really good article putting the other side of the argument:

1. Alcohol is addictive and if you are prone to addiction that alcohol is highly dangerous
2. Alcohol might not be processed at all well by your body
3. The studies might be biased in favor of alcohol because of confounding factors
   
4. Researchers might be biased in favor of alcohol because the source of their research funding.

The Annals of Epidemiology published the results of a serious symposium.
Their words: "Debate on harms and benefits of moderate drinking continuesThe Annals recently published the proceedings of a symposium on the health effects of moderate alcohol. A summary of the symposium was written by the organizers and sent to the readership of several other journals. Others at the symposium had a differing view of the conclusions. In particular, there is disagreement over interpretation of the epidemiological data that support or refute the contention that moderate alcohol consumption has health benefit, and over whether that issue was resolved at the Symposium. Also available is a response from guest editors to the commentary. Readers of The Annals will find the arguments of considerable interest, since they invoke fundamental epidemiological issues of bias and misclassification that are at the center of so much epidemiological work, and we would welcome any further commentary from the readership on these issues. – The Editor "

The summary paper " The Harms and Benefits of Moderate Drinking" has some blockbuster quotes (in large and unmissable type):

• New research has clearly indicated that the frequency of drinking is as important as, or even more important than, the amount of alcohol consumed.
• It is important that the effects of alcohol consumption, moderate or otherwise, not be viewed in isolation, but as part of broader social, cultural, and lifestyle issues. There are differences among drinkers and the range of outcomes they are likely to experience.
• There is evidence that moderate alcohol consumption may modify the risk of developing type 2 diabetes. Meta-analytic reviews of the data have shown a U-shaped relationship between moderate drinking and the risk for type 2 diabetes for both men and women.
• There is a need for greater attention to the positive aspects of alcohol consumption, which are closely related to its psychosocial effects. Current research is largely devoted to assessments of harms, often neglecting the benefits, despite the fact that the vast majority of those who drink do so moderately.
• Communication between patients and their health-care providers is an important mechanism by which individual behaviors and perceptions about health may be changed. Provided with the proper tools, physicians and other practitioners can tailor their messages, depending on the patient’s age, sex, past alcohol use experience, cardiovascular risk, and other factors.
  

Luckily, for science, there are people who argue that research on alcohol and its impact is fraught with difficulties to classification and associated behaviors. For instance, wine drinkers seem to have healthier habits ( food, exercise, life-style) than beer drinkers who in turn have healthier habits compared to spirits drinkers.

Any classical medical double blind trial on alcohol is going to difficult, dangerous and probably unethical. How could you give someone 60 grams of alcohol and expect them not to notice - let alone drive home afterwards. However it is time for someone to find a way forward because at the moment alcohol in moderation seems to have many benefits (and of course like all medication some undesirable side-affects).

Back in 2003 Scientific American published a special edition titled "Eating to live". A digital download costs $7.95. Within the edition is an article "Drink to your health" - Three decades of research shows that drinking small to moderate amounts of alcohol has cardiovascular benefits. A thorny issue for physicians is whether to recommend drinking to some patients. The article has a graph showing health benefits going up in a straight line to 5 drinks a day (if your body can tolerate that amount of alcohol).

Save Now

Alcohol has 7 calories for every gram. So if you take 12 grams as a "drink" then you have at least 84 calories in there (more if it's mixed with something sweet). Five drinks a day is 420 calories. So you are probably going to have to forgo dinner unless you exercise hard every day. Jogging a mile burns about 110 calories. So 4 miles of easy jogging burns off 440 calories - so you are back in balance - easy.

Richard Lehman's Medical Blog

Richard Lehman's Medical Blog is a gem.

He's writing for other doctors (primarily other British doctors working in Britain's National Health Service).

For average idiot's, like me, he is always a challenge to follow with any real understanding but if you have a continuing interest in medicine but no formal education - read every one of Richard's Blogs - they appear about every two weeks (fortnightly in British) and for me they are must reads.

A quick feel for his writing:

"So I was strongly inclined to pass over this Danish study, but I’m glad that I didn’t. It is quite an intellectual tour de force as well as a logistic feat, combining three types of study within the population of Copenhagen, and it shows how the deft use of genomics can obviate the need for a randomised controlled trial.

The key element here is mendelian randomisation, the reshuffling of genetic material which happens each time we make a baby. I won’t go into further detail here, but if you are interested in such cutting edge stuff, I would strongly recommend a look at this paper and its accompanying editorial (p.2386)."

Of course he can sound a little condescending but I'm sure he is not:

Cardiac computerised tomography exposes patients to large amounts of radiation for large sums of money and often negligible clinical benefit. In the USA, you can apparently get it done in “small community hospitals”, which were lumped together with larger centres in this exceedingly unsophisticated before-and-after study.

Before these centres participated in the Advanced Cardiovascular Imaging Consortium in Michigan, they used twice the dose of X-rays that they did afterwards. But if you really need to know how furred-up your coronary arteries are, and want much smaller doses of radiation, it’s best to wait for the arrival of prospectively triggered sequential scanning in your area, or even better, single heartbeat acquisitions.

Week-end Sport: 100 meters in stilettos and naked bicyle riding

Just back from Brazil these two photos caught the eye.

The first shows really intense competition. The women are competing in a 100 meters race with a prize of 10,000 Euros (around $13,000) shopping trip. The women are running very hard in stilettos - you have to admire the desire to win.

Of course they should have had a men's event as well. The race was in Sweden, so no doubt next year there might well be a men's stiletto event.







The naked bicycle ride in London, England was not competitive - unfortunately. The riders were protesting the ever rising traffic congestion in London and that bicycling needs to be encouraged. Well done to all the participants.