What the Heck Has Been Going on in My World?
By Mark A. Moyad, MD, MPH, University of Michigan
article #70 – Fall 2015
Note: A total of 70 (YES THAT IS 70 – I get tired just saying the word “Seventy”) times in a row (and for 15+ years!) I have written and volunteered for this newsletter. I have yet to receive any personal financial compensation or personalized classic timeless gifts such as; a PAACT complimentary hightechnology toilet with dual flush handles and/or dual back-toback toilets, which means you can flush the toilet comfortably whether your left or right-handed or ambidextrous like me and/or you can go to the bathroom with the one you love, who you never want to be separated from even for a single second (twisted but I know some folks that would like this) or a PAACT bad manners alert alarm that makes a really, really loud noise when someone does something obnoxious and stupid like uses their cell phone in an elevator or presses the elevator retrieval button in the lobby more than once or someone tries to back their car into a parking spot to make it easier to exit at a later time while countless cars have to wait for this Bozo the Clown (aka derogatory term in this sense but otherwise a happy term when used to refer to my childhood) to pull this silly selfish parking move or when someone parks in a Handicap Spot that is not handicapped, but since they will “only take a minute” then somehow it is okay or someone decides that their big dog is so special he/she DOES NOT need to have their droppings cleaned up by their owner with a bag! Remember this Moyad saying “Big Dog=Big Droppings & Small Dog=Small Droppings!” This is why I own a small dog people! Yes, I am still waiting for all of these free PAACT gifts (oh and a box of macadamia nut cookies – love those things, along with a couple hundred dollars that has a note on it that says “we love you so much just keep the money and use it for whatever you want because you are so dedicated”).
I WANT TO THANK YOU AGAIN FOR CONTINUING TO MAKE “THE SUPPLEMENT HANDBOOK” – my semi-new book a best seller. YEAH!! THANK YOU!!! Second, if you have not picked up a copy please get one on Amazon (the cheapest place to procure a copy) to support my beer and macadamia nut cookie fund! For about 20 bucks (the cost of only 20 one dollar lottery tickets) you get 512 pages of material on over 100 medical conditions and when not using this amazingly big book it also functions as a nightstand or coffee table book topic of discussion or a fly swatter or an awkward but effective Frisbee or Boomerang.
320) DONALD TRUMP!!!! (Actually he has nothing to do with this article but I just wanted to get your attention).
ALCOHOL IS A MASSIVE PROBLEM, is a clear carcinogen and increases the risk of countless diseases and disease recurrence. New research suggests it might even increase the risk of prostate cancer like it does with breast cancer and could make some prostate drugs less effective if you drink in excess. And, more fiber a day may keep the prostate cancer away! (Reference: Chhim A-S, et al. Am J Clin Nutr 2015, epub ahead of print. Moyad MA General Knowledge and The Supplement Handbook….)
Alcohol is a big problem and could increase the risk of prostate cancer especially in men with a low fiber intake, and new research suggests more than moderate alcohol intake could reduce the efficacy of some prostate drugs!
WHAT ELSE DO I NEED TO KNOW?
What has 7 calories per gram and is arguably associated with more health problems than almost anything else in the U.S. that is legal? ALCOHOL!!!! I have often joked about my beer fund in the PAACT newsletter (as I did earlier) but somehow as funny as these jokes are I am beginning to feel guilty about them. Why? It’s because alcohol has become such a massive problem here in the U.S. and around the world. Let’s first talk about this study and prostate cancer and then talk about all the damage that alcohol does today. You may find yourself shocked at how much space I utilized on alcohol in this column, but after reading the whole story you shouldn’t be shocked.
Alcohol is now a known risk factor for BREAST CANCER, but its impact on the risk of other hormone dependent cancers such as prostate cancer is unknown. There was a recent well-done prospective observational analysis, which included 3771 women and 2771 men that participated in a randomized multivitamin trial (SUVIMAX) and completed a minimum of 6 valid 24-hour dietary records during the first 2 years of follow-up. After a median follow-up of 12.1 years there were 123 prostate cancers diagnosed. Alcohol was not associated with the risk of prostate cancer overall. In a stratified analysis, alcohol intake was directly significantly associated with prostate cancer (37% increase, p=0.02) risk among men with low dietary fiber (less than 15 grams per day) intake but not among those with higher dietary fiber intake. Thus, the researchers concluded that dietary fiber intake could influence the association between alcohol intake and the risk of prostate cancer. It is for this and 1000 other reasons I have pushed for people to get 20-30 grams of fiber per day! Fiber is the “GREATEST INTERNAL BOTOX EVER INVENTED!” What do I mean by Botox? People use Botox to reduce the appearance of external aging but how do you reduce the internal feeling of internal (inside the body) anti-aging? As we get older the inside of the body ages just as much as the outside and includes problems such as the following:
• Acid Reflux Increases
• Blood Pressure Increase
• Blood Sugar Increase
• Cancer Increase
• Cholesterol Increase
• Constipation Increases
• Diverticulitis Increases
• Heart Disease Increase
• Inflammation Increase
• Insulin Increase
• Unhealthy Gut Bacteria Increases
• Waist/ Weight Increases
BLAH, BLAH, BLAH! So, what has been known to reduce the risk of all those things mentioned above? Give me an F! Give me an I! Give me a B! Give me an E! Give me an R? WHAT DOES THAT SPELL? FIBER! FIBER! FIBER! I know you wanted to say “Go Blue” but that would have been a shameless plug and I am not known for shameless plugs (DON’T FORGET TO BUY A COPY OF MY LATEST BOOK ON AMAZON “THE SUPPLEMENT HANDBOOK”).
Dietary fiber appears to be able to reduce concentrations of higher circulating testosterone or estrogen by products or metabolites. Dietary fiber might also simply increase the number of healthy bacteria that can go on to reduce the impact of testosterone on some cells. Dietary fiber through many of the benefits listed above from lowering insulin, blood sugar, cholesterol, weight, etc… appears to have anticancer effects especially when alcohol itself can increase the risk of many cancers. Now let’s review the MANY MOYAD A to Z REASONS WHY ALCOHOL IS BAD ESPECIALLY IN EXCESS (buckle up I am about to suck up a lot of space and your time but please read the whole thing to understand why you had to read the whole thing to appreciate it)!
A=”ALCOHOL IN MODERATION”???-SIZES INCREASED & SO DOES WEIGHT/WAIST SIZE.
I often semi-joke, but it’s really not a joke when I say that if kids and adults cut their consumption of sugary soda and/ or alcohol down to nothing, the obesity epidemic would be impacted almost immediately and dramatically. Some of the largest sources of calories in adults are now coming from regular alcohol consumption and many of us do not even realize it! This is because the definition or appearance of moderation has changed. Let me give you an example – I had a beer on tap yesterday and the bartender gave me a glass and DANG it was good! However, I noticed that the glass seemed a bit larger than many bar glasses and I asked the bartender how many ounces in that glass and she said “20-ounces”! This means while I thought I was consuming 150 calories of beer at 12-ounces, I was actually getting 250 calories of beer! Yikes! In one glass! Now, if you look at many of the common beer glasses at a bar they are no longer 12 ounces and in fact 12-ounce beer glasses are becoming obsolete. Most of them today are 16-ounces, which means it is providing 33% more calories per glass of beer compared to just 10 years ago! So, moderation with beer has always been 12-ounces of moderate alcohol beer but today most beer glasses are 16- or 20-OUNCES and ALCOHOL CONTENT OF MOST BEER HAS INCREASED WHICH MEANS THE CALORIE CONTENT OF BAR BEER HAS DOUBLED (combine the increased glass size with greater concentration of alcohol=more calories)! This is crazy! In the old days (10- 20 years ago) if you had 1 drink at a bar it was anywhere from 100-150 calories per drink. No big deal! Today, it is more like 200-300 calories per beer! Now, imagine you have several beers that night and a few times a week for 52 weeks and you are now drinking massive amounts of calories per year that could easily increase weight 5-10 pounds or more! THEY CALL IT A BEER BELLY FOR A REASON!
Okay, now let’s look at wine consumption! The last 5 times I have been out to dinner around the U.S. and someone poured a glass of wine for someone at my table and then I measured it (sounds annoying that I’m measuring a friend’s glass at the table but this was for science) guess what?! IT WAS 8 to 10 OUNCES OF WINE. Remember 4-6 ounces of wine in moderation from the old days. Today, it’s now 8-10 ounces, which means you are now DOUBLING YOUR CALORIE CONTENT PER 1 GLASS OF WINE!!!
Now, let’s talk about a shot of hard liquor like vodka. When I go out with friends (not that I have that many friends because most people think I am a bit crazy because I like to do stuff like measure the fluid content of glasses at restaurants) I notice that a shot has become more like 2 to 2.5 ounces in many drinks in combination with something sweet such as a concentrated juice, which means the CALORIES FROM HARD LIQUOR HAVE ALSO DOUBLED! What the he double toothpicks is going on here! What’s going on is that we have allowed a new standard for portion sizes when it comes to alcohol, so many of us are getting twice the number of calories from our drinks than we used to get just 5-10 years ago! Say Hello to WEIGHT and WAIST GAIN. So, what can you do about it? Just be aware of it and use the MOYAD METHOD! What is that? Is that where you let other people buy your drinks after you give them some relevant medical advice (that is one method)? It’s where you go out and buy Italian size (as I like to call it) small glasses of wine that are only 4-5 ounces per glass! If you have been to Florence or anywhere in Italy and many places in Europe these small glasses are very common at restaurants and in homes. A quick look on Amazon and other locations allows you to find the kind that you like and they will help control your intake and the intake of your guests. Also, you can purchase 12 ounce beer glasses and get used to that again as well as 1.5 ounce shot glasses. Again, when you have these in your home you REBOOT or become sensitive to glass and portion sizes when it comes to alcohol!!!
B=BLOOD PRESSURE INCREASES WORSE THAN SODIUM
Alcohol in moderation or small amounts can actually help to increase blood flow in the body by acting as a vasodilator (something that increases the size of the blood vessel to allow more blood flow), but in excess it acts as a VASOCONSTRICTOR – actually reducing blood vessel size and increasing blood pressure. It is for this reason that every 10 grams of alcohol (less than a serving size) increases blood pressure 1 point!!! So, several drinks and blood pressure increases can be quite staggering. Interestingly, this blood pressure increase is the SAME REGARDLESS OF THE TYPE OF ALCOHOL CONSUMED! This is why drinking above moderation especially if you have blood pressure problems is “DIPUTS” spelled backward!!!
Alcohol is a known carcinogen. Long-term exposure increases the risk of numerous cancers! It is well known that breast cancer increases with alcohol consumption and the latest evidence also suggests that prostate cancer or drugs that could prevent high-grade prostate cancer might be reduced by alcohol consumption. In the famous REDUCE trial using the drug dutasteride (aka Avodart) to prevent cancer in high-risk men, alcohol consumption (more than 7 drinks per week) actually appeared to eliminate the drug’s ability to prevent prostate cancer!!! This is somewhat similar to what was observed in the PCPT trial with the drug finasteride! Yikes! So this is what we now know that alcohol might or probably increases the risk of the following cancers:
• Breast Cancer
• Colon Cancer
• Laryngeal cancer
• Liver Cancer
• Oral Cavity Cancer
• Prostate Cancer or at least reducing the efficacy of some anti-prostate cancer drugs
BLAH, BLAH, BLAH…this is enough of a reason to drink alcohol in moderation or not at all!
D=DEMENTIA or DESTRUCTION OF BRAIN CELLS
Dementia can occur from a variety of disorders including Alzheimer disease, vascular (such as a stroke) and from trauma such as a head injury. It is also well known now that excessive alcohol intake can cause permanent damage to the structure and function of the brain. This can be caused by reducing levels of thiamine or altering vitamin brain cells! Light to moderate drinking might reduce the risk of dementia, that’s the good news, but in excess look out because the risk of dementia or at least memory problems increases dramatically.
E=EXERCISE PERFORMANCE DROPS including worsening EF (erectile function)
Alcohol delays the ability to recover from workouts and skeletal muscle injury or in other words for those work out fanatics out there or for those that exercise regularly (that should be all of you reading this column right now) it blocks the full benefits of exercise and delays recovery from injury! This is a bad combination! So, if you want to get the most from your exercise investment then don’t drink in excess (or at all for some of you).
A number of studies already point to excessive alcohol consumption reducing sperm concentration and other potential fertility parameters, so if you want to have a baby then be careful with the adult bottle, baby!
G=GUT MICROBIOME GOES WACKY! Also don’t forget GOUT!
New evidence is emerging that alcohol in excess can wipe out some good bacteria just like what is observed with long-term antibiotic usage! Yikes! So, with all this talk about improving your gut health through probiotics it’s possible that one of the best ways to improve gut health is not to drink in excess! And, if you have ever suffered from an attack of gout you probably know that alcohol can increase your risk of a first and subsequent attacks of this inflammatory arthritis!
Many alcohols today either contain compounds similar to histamine or activate histamine receptors or increase IgE levels (antibody that binds to the mast cell that helps trigger the allergic reaction)! In other words, it is summer time, spring time or any time of year and you are sneezing, your nose is running and your eyes are watering more than a Barbara Walters interview and you think it’s due to an allergen like pollen from the outside! Well, it could be due to the alcohol that you are drinking!
I3=INSULIN SURGES! IMMUNE SUPPRESSION! INFECTIONS! (The 3 biggies!)
Okay, diabetes increases the risk of many cancers and heart disease and increasing insulin may be the factor that feeds some tumors. So, it’s interesting that alcohol, when it hits the pancreas, can increase blood flow to the beta cells that produce insulin so that more insulin is actually made and released! This is part of the reason that alcohol is associated with HYPOGLYCEMIA or lower levels of glucose temporarily! It’s also this insulin release that increases the risk of weight gain and other health problems. And, if that was not enough of a reason to control your intake, it’s also well known that alcohol can suppress immune function (why alcoholics have higher risk of pneumonia for example) and thus infections! Nasty infections too! Many folks are always looking for added ways to boost their immune system against cancer and one very good way is not to drink in excess.
What does this mean? Well, a J-shaped curve or relationship suggests that in moderation there could be a slight reduction in some diseases (think about writing a capital letter “J”) and after a certain minimum amount, increasing exposure leads to more and more health risks or diseases! It’s for this reason that alcohol is known as the best example of a J-shaped disease risk curve or another way of saying that something has a J-shaped risk curve is the old saying “everything in moderation.” However, instead health care professionals use words like “J-shaped curve” to make us or at least me sound more intelligent than I actually am.
K=KILLS TOO MANY
Alcohol is involved in about half of all traffic fatalities and it’s otherwise estimated to be responsible or associated with 100,000+ deaths in the U.S.
Enough said on this one!
M & N=MALNUTRITION/NUTRITION
Magnesium, thiamine, folic acid, potassium, vitamin C….is a list of nutrients that are reduced or that are metabolically impacted by alcohol consumption so they are not as effective, continues to grow! In other words, one of the best ways to reduce the effectiveness of a healthy disease preventing diet is to drink alcohol in excess. So, think of this another way, which is – alcohol in excess reduces the efficacy of your exercise and healthy diet!
O=OSTEPOROSIS & ORGANS DAMAGED FROM HEADTO-TOE
Alcohol is unique because it gets into cells by simple diffusion, which is why it’s absorbed so rapidly from the stomach and intestine and can reach maximum blood concentrations in one hour or less! This is also why it’s so toxic to almost every cell in the body and organ from the brain to bone cells and it’s also why any freaking pamphlet you read today on osteoporosis will say that alcohol in excess increases the risk of bone loss and bone fractures. The cells that help produce bone are known as the osteoblasts and they get inhibited with excess alcohol exposure!
Alcohol is the number 1 known preventable cause of developmental and physical birth defects in the U.S.!
Q=QUE or LINE OF SIDE EFFECTS FROM CANCER TREATMENT
You name the side effect of cancer treatment and it can get worse with excess alcohol. Bone loss? Yup! Weight gain? Yup! Anxiety, Stress and Depression? Yup! Yup! Yup! Hypertension? Yup! Cholesterol and blood sugar problems? Yup and Yup! Hot flashes or night sweats? Not well-studied but in my experience? Yup! Fatigue? Yup! Insomnia? Yup! Do I really need to continue? Nope!
R=RUNNING TO THE RESTROOM?
Alcohol is a diuretic and inhibits a hormone that helps you retain and absorb water. Whether it’s an overactive bladder (OAB) or stress incontinence, you name it…you might find yourself running to the bathroom more at night with alcohol. This has become very common because alcohol makes it hard for the bladder and urine to stay put so to speak in the middle of the night.
S=SLEEP CYCLE DISTURBANCES
It’s well known now that alcohol is a sleep inducer, so it helps you to fall asleep, but once you are asleep it disrupts your sleep cycle and doesn’t let you spend as much time in the deeper phases of sleep. This is the reason many drinkers use alcohol to fall asleep and get plenty of sleep, but they don’t feel well rested the next day! Imagine if there was a commercial on TV about a drug and the advertisers claimed that it helped you fall asleep faster, but did not allow you to sleep better overall and actually made you drowsier the next day, would you buy that drug? If you would, I have swampland in Michigan with gold in it that I want to sell you! And, if that was not enough, alcohol can also increase nasal and pharyngeal resistance, which can make breathing more difficult and is why sleep apnea can also get worse in those that drink alcohol.
T=THIRD LEADING CAUSE OF PREVENTABLE DEATH & THIRTEEN!
Alcohol and alcohol abuse are now the third (smoking and overweight/obesity are number 1 and 2 but obesity is arguably number 1 now) leading cause of preventable death in the U.S. and one out of every 13 Americans abuse alcohol or are addicted to alcohol. Yet, alcohol is associated with tobacco use and weight gain, so this is a bad problem.
U=UNDERAGE DRINKING INFLUENCES
Research in the past suggested that parents that give their kids alcohol underage might be reducing the glamour of drinking so that when the kid becomes an adult they are less likely to abuse alcohol. However, more extensive and recent research suggests otherwise. Parents that permit underage drinking appear to increase the chances that kids will abuse alcohol. I agree with this because so many parents and grandparents are now abusing alcohol and appear to be SELF-MEDICATING with alcohol and, in time, the kids could be doing the same thing because it becomes so permissive in the household. So when parents drink in excess, the kids have a greater chance of drinking in excess.
Over half of the violent incidents involving adults are alcohol-related!
Alcohol is a central nervous system depressant and just like drugs that have the same action (like Xanax…) they cause the release of a compound in the brain known as GABA (relaxing compound – reduces excitability and calms things down in the brain). However, with repeated hits or exposure to alcohol the brain begins to adapt to this alcohol intake, which results in HIGHER DOSES OF ALCOHOL needed to get the same result. It’s for this same reason that when individuals begin to drink more and more over time, it takes or intoxicated. And, when alcohol is slowly or quickly removed, it then causes symptoms that are the opposite of GABA or relaxation effects. It’s for this reason that alcohol withdrawal can lead to anxiety, insomnia, increased pulse, respiration, blood pressure, body temperature and even a hand tremor. Withdrawal symptoms usually begin 8 hours after blood alcohol levels decrease, peak after 3 days and are reduced from days 5 to 7 of quitting. In a small percentage of people (3-5%) grand mal seizures and severe delirium can also develop. So, if you don’t think that alcohol abuse is classic drug abuse, then please reread this paragraph.
We worry all the time about radiation from x-rays and other devices causing harm (and they can) or increasing our risk of cancer or cancer returning, but this doesn’t come close to the number of people injured or killed daily from alcohol or from the number of people that increase their risk of cancer daily from alcohol ingestion.
Y=YOUNG (& OLD)
One of the greatest gifts you can give to young people is to set an example and show responsible alcohol intake or no intake. Alcohol and UV light are the 2 carcinogens that young people have a tough time appreciating and being thoroughly educated on, which is why melanoma rates are at an all-time high in the younger population and so is binge drinking. Binge drinking is a pattern of drinking that brings a person’s blood alcohol level to that of being legally drunk (4-5 drinks in less than 2 hours). And, although it’s more common in younger age groups, it’s arguably getting to be as bad in those age 65 and older. So, the age group with the most binge drinkers in 2015 is 18-34 years but the age group that binge drinks most often is 65+ years! Yikes!
Z=Zorro Zero Alcohol Moyad Challenge!
What the heck is this?! If you have read this entire article congratulations. Now I want to challenge you for a second. Try stopping all alcohol intake for just 1 month and see what happens! Many people can’t do it, but many that have taken this challenge have told me they lost weight, sleep better, have better memory, better sex and more erections, enjoy life more…. I will never quit my moderate alcohol intake, but when I stopped for a month I quickly realized that my energy levels especially in the morning skyrocketed! Conversations were more pleasurable and sleep was an absolute pleasure. I thought well since I challenge people and patients to quit all alcohol for one month then why shouldn’t I try it! You should too! Let me know what happens! YOU MAY BE ASKING YOURSELF BY NOW WHY MOYAD SPENT SO MUCH SPACE OF HIS PRECIOUS FABULOUS AND FANTASTIC COLUMN WRITING ABOUT THE BAD IMPACTS OF ALCOHOL ON HUMANS. IT’S BECAUSE WITH ALL OF THE EMPHASIS ON MEDICAL MINUTIAE TODAY AND LESS COVERAGE OF HEALTH ITEMS THAT REALLY CAN MAKE OR BREAK THE LIFE OF AN ADOLESCENT OR ADULT IN A SHORT PERIOD OF TIME, I SIMPLY DECIDED AFTER 30 YEARS SOMEONE NEEDS TO ADDRESS THIS EPIDEMIC OF ALCOHOL ABUSE IN THE U.S. AND, IT’S A PROBLEM IN SOME CANCER PATIENTS, SO IF AFTER READING MY A-TO-Z LIST OF ALCOHOL-RELATED PROBLEMS IT HELPED YOU OR SOMEONE YOU LOVE OR SOMEONE YOU DON’T LOVE AT ALL, THEN IT WAS WORTH IT (actually I already know it was worth writing about alcohol, so I was just being somewhat rhetorical folks). Take the Moyad Challenge! Try to eliminate all alcohol for 1 month of your life and see what you learn from this experience because mentally and/or physically it may change your life forever! Thank you and now back to my regularly scheduled and twisted column (actually the next story is also somewhat related to the alcohol story we just covered)!
321) There are now more obese Americans compared to overweight Americans for the first time in American History! (Reference: Yang L & Colditz GA. JAMA Internal Medicine 2015)
We did it! There are now more obese Americans compared to overweight Americans for the first time in American History! New U.S. statistics shows nearly 70% of adults are at an unhealthy weight.
WHAT ELSE DO I NEED TO KNOW?
This was data derived from the National Health and Nutrition Examination Survey or NHANES (conducted by CDC – basically you the tax payer paid for this study so read on in order to get your money’s worth), which are cross-sectional estimates which included only adults who were 25 years or older. A total of 67.6 million Americans were obese (BMI of 30 or greater) and 65.2 million were overweight (BMI of 25-29.9) as of 2012. Approximately 40% of men and 30% of women were overweight, and 35% of men and 37% of women were obese.
This report documents for the first time in American history that Americans who are obese currently outnumber those who are overweight. Approximately 75% of men and 67% of women ages 25 and older are currently overweight or obese versus 20 years ago when it was 63% of men and 55% of women. This situation is becoming chaotic in a sense, because a quick review of some of the greatest epidemics in the U.S. that utilize most of the health care dollars and arguably medication spending/utilization is riding on the heels of this epidemic. Whether it’s fatty liver, low testosterone, high cholesterol, hypertension, gout, stones, sexual dysfunction, and most other prevalent conditions, are all dramatically impacted by weight gain. IN FACT, RESEARCHERS ARE BEGINNNING TO AGREE THAT OBESITY INCREASES THE RISK OF AGGRESSIVE PROSTATE CANCER AND OF PROSTATE CANCER RETURNING AFTER TREATMENT! Perhaps it’s time to increase the education and options delivered to patients and bring back mandatory physical education classes for K to 12th grade in all 50 states. The bottom line is that we are at the bottom line and need help.
PS. There are now medical conditions in 2015 that we never thought would be associated with obesity and now appear to be even more of a problem with weight gain. What are those issues? I’m glad I asked myself that question! An increased risk of IOP or intraocular pressure, which could then lead to eye damage! Even recent studies of “blehparoptosis”=droopy upper eyelids and sagging eyelids. What’s next? Oh yeah, by the way it also reduces life expectancy (did I mention that important point?). It’s funny that prostate cancer researchers argue the impact of obesity on cancer risk and have disagreements on whether it greatly increases the risk of cancer recurrence or moderately increases blah, blah, blah. However, this is like arguing whether or not a bee in your car is more likely to sting you while you are driving 100 MPH toward a cliff?! What?! The point is that you are in a car driving 100 MPH toward a cliff! It’s like arguing whether or not you jump out of an airplane with no parachute, with a storm nearby, will increase your chances of getting hit by lightning?! What?! The point is that you just jumped out of an airplane with no parachute! Okay, these are crude and sick examples but since I am crude and sick, I love these analogies.
322) BeetRoot Juice – the new legal exercise enhancing drink?! Maybe, so why not try it! It might have mini- Viagra-like effects – YEAAAHHHHH!!!! Party time! AND, using lots of dietary supplements can actually reduce the beneficial effects of exercise! 2 FREE STORIES FOR THE PRICE OF 1 (wait does that make cents?). (Reference: Lee J-S, et al. Am J Physiol Regul Integr Comp Physiol 2015)
15 days of drinking 70 ml of beetroot juice per day increased blood levels of nitrates and nitrites, appeared to reduce systolic and diastolic blood pressure and could delay the onset of fatigue in those that exercise! If this helps anyone reading this column then I’m one happy dude! Oh and by the way, if you are taking lots of supplements to enhance your exercise workout you may be hurting yourself!
WHAT ELSE DO I NEED TO KNOW?
Move over pomegranate juice!? There is a new juice in town that in very small amounts could improve exercise performance. As you know I am not a fan of many juices, especially fruit juices, because they are just LIQUID SUGAR, loaded with calories and are not generally associated with improved heart health. However, small amounts (even 2-3 ounces) of beetroot juice could be an exception to the Moyad rule (kind of like the exception to the rule I have of dogs sleeping on my bed unless it’s my dog Chauncey because he’s not only tiny but cute and cuddly. My wife loves him very much so I have no choice in the matter anyway)! You may remember from a previous column that beetroot juice was utilized by the Auburn football team to legally enhance their athletic performance. Some people thought they were a bit wacky, but it seems they might not have been so wacky overall!
As a quick review beetroot juice is one of the largest sources of dietary nitrate found in food, which means it can be converted in the body by bacteria to nitric oxide (NO), which can widen blood vessels and increase blood flow to various parts of the body including the sexual organs (aka penis and vagina for those that cannot pick up on ridiculous politically correct language) and skeletal muscles…and increase oxygen delivery to these areas. This was a small study of young men, but it’s essentially similar to what has been observed in older men (aka “seasoned men” for those that are offended by the term “older”)! Men were randomly assigned to 70 ml a day of beetroot juice or a placebo juice (nitrate reduced) for 15 days and then they crossed-over to the other group and drank the other juice for 15 days. A variety of measures showed improved potential oxygen delivery, which is what several past studies have found. Remember that the ability to exercise effectively is reduced with a variety of diseases such as heart disease and hypertension or anything that impairs adequate blood flow and nitric oxide to the muscles. Perhaps beetroot juice will be one of only several legal options to really enhance exercise! My favorite options right now are caffeine, protein powder and small amounts of sugar from tootsie rolls or jellybeans when working out! Now I may add an occasional sip of beetroot juice! Remember when working out for 30, 45 or more minutes the body needs some glucose (jellybeans), improved blood flow (beetroot juice), enhanced attention and performance and reduced muscle fatigue (caffeine from a few sips of diet cola or coffee), and also improved protein synthesis for muscle development (protein powder after the workout). Otherwise LESS IS MORE! Why? Keep reading my friends, family and enemies and lovers (actually I just have one lover and that is my wife and she only has one lover also, and that’s our dog because I am now convinced she loves that dog more than me – I mean she scratches his belly and calls him cute names constantly and that’s what she used to do for me – sorry I digress, but darn that dog! That dog is my nemesis and I must find a way to defeat him to win back the love of my wife!).
There is new research to suggest that contrary to previous thoughts that supplements could improve exercise performance. There is now a growing amount of evidence to show that most individual dietary supplements (C and E…) in large amounts on a regular basis could actually block or disrupt cell signals in muscle tissues, which could also block adaptations to training or essentially reduce the beneficial effects of exercise! I actually subscribe to this theory (not all supplements but many supplements). There are some studies now also suggesting that supplements not only shut down some important cell signaling pathways but they also decrease the production of new muscle mitochondria (the powerhouse energy producers of each cell) and blunt internal or body production of its own antioxidants! In the past, one way to get folks excited about taking supplements in many situations was to mention that exercise and many diseases create free radicals which can potentially damage cells of the body, but it appears that temporary free radical production from exercise is a good thing and is one of the triggers of the human body to begin to increase its own production of endurance and fitness molecules and cellular changes that are ultimately healthy. In other words, free radical generation from exercise is a key signal to tell the body that you are actually exercising and that intrinsic body mechanisms are activated in this manner to improve future muscle performance! So, a supplement that can “block free radicals” basically could also be telling your body that you are not exercising when you actually are exercising by soaking up all those free radicals needed to activate the intrinsic body mechanisms! YIKES!!!!! It’s for this reason I take few supplements for working out and instead take my jellybeans, caffeine from a beverage, protein powder and occasional beetroot juice when I exercise and leave the rest up to God (so to speak).
323) MEDICARE & MEDICAID turns the Dr. Moyad age of 50! Feel free to send gifts of money and praise to me and not MEDICARE for example. Why are we still happy but confused about MEDICARE and why are some cancer drug prices so ridiculously high? (Reference: Moyad MA, 2015)
People are still confused about Medicare. Reviewing the basic information now and in the future can make your life a lot easier and save you a lot of money that you can eventually just send to me! Oh, and the people will change drug prices and not the politicians in my not so humble opinion.
WHAT ELSE DO I NEED TO KNOW?
The Social Security Amendments of 1965 (the year I was born and my parents and brothers became the luckiest people on planet earth – no worries I remind them of this fact weekly and they also remind me weekly that I am delusional) helped to create Medicare and Medicaid in the U.S. Medicare is a federal program that provides health insurance to folks aged 65 years and older and younger people with permanent disabilities. So, let’s focus on Medicare a bit. Medicare turned 50 in July and over 90% of the over 55 million enrolled in the program (according to a recent Kaiser Family Foundation poll) say that their experiences with this program have been positive. However, the biggest issue it that folks are still confused as to what it does and does not provide. Remember the following when it comes to 4 parts of Medicare (A, B, C and D):
–Medicare Part A covers hospital stays, short-term stays in skilled nursing facilities, some home health care and hospice care. Most do not have to pay a premium for Part A.
–Medicare Part B covers doctors’ visits and other outpatient services such as medical equipment, laboratory tests and some preventive care including vaccinations and some cancer screenings. It usually requires you to pay a monthly premium.
-Both Part A and B (also called “original or traditional Medicare”) could have co-payments or deductibles, so if you are still working and receiving insurance coverage from your employer, you should think about delaying your enrollment in Part B because your current income could essentially lead to higher premiums. So, essentially you pay for Part B and you pay if you want to add supplemental insurance, for example to help cover the cost of prescription drugs or dental or vision services. And, keep in mind that Medicare does not cover long-term care (despite the fact that the majority of folks my age will eventually need it and are not looking into their options on this now)!
–Medicare Part C is also known as “Medicare Advantage” and it allows folks to enroll in private health plans, such as HMO to receive Medicare covered benefits. These Medicare approved private plans provide all benefits covered under Parts A and B, and many plans offer other benefits like vision and dental services. The majority of these private plans also provide prescription drug coverage (Part D). Also, Medicare Part C plans are required to place a ceiling or limit on beneficiaries’ (for example out-of-pocket expenses for A and B covered services of 6700 dollars in 2015). However, there is no out-of-pocket limit in traditional Medicare (A and B). Some of the disadvantages of Medicare Part C are the potential for restrictions to doctors that are only in the network, requirements for a primary care doctor referral before being able to see a specialist, and the potential for a higher monthly premium versus traditional Medicare.
–Medicare Part D covers outpatient prescription drugs for those who enroll in Medicare-approved private drug plans (either stand alone for those in traditional Medicare or Part C-Medicare Advantage drug plans).
-Medicare only pays for medically necessary nursing home care such as help with IV medications and wound care. In order to qualify for skilled nursing home care patients need to have had a recent inpatient stay of 3 or more days, be in need of skilled care for a medical condition associated with their hospitalization, and then obtain the skilled care from a facility that is Medicare certified.
-Again, Medicare does NOT pay for LONG-TERM nursing home care for assistance with daily activities, such as using the bathroom or eating. Patients needing these services could qualify for financial help from Medicaid. A good source on paying for long-term nursing home care is found at longtermcare.gov (THIS IS A REALLY GOOD SITE).
Talk to a financial advisor or look into the many apps that insurers now have where consumers can put in their medications and compare coverage costs! Also Medicare.gov is a decent web-site folks!
Hopefully this has helped a little bit with Medicare. Here is an interesting fact – many doctors and most medical students from surveys were opposed to Medicare when it came out but this was based on bad education. In fact, only a small percentage of students even read the act and understood what it did and did not do, and were responding to outside informational sources. I hope the Affordable Health Care Act ends up with the same fate despite all the initial negativity (who knows? Now, does this mean I was for or against Obama Care? Good question…OOPS – sorry folks we have run out of time on this issue so perhaps next time we can address it).
So, why do some cancer drugs cost so much and cannot be reduced in price like in some other countries? Please read the next story and find out why you are the only major hope of bringing drug prices down to an affordable level!
324) Melanoma rates have doubled over the past 10 years! What does this mean for prostate cancer? A lot, because immune therapy drugs are getting approved in metastatic melanoma that are now being tested for prostate cancer in clinical trials. (Reference: Melanoma review articles. Kwon ED, et al for CA184-043 Investigators. Lancet Oncol 2014;15:700-712.; http://www.usatoday.com/story/opinion/2014/04/20/medicare-part-d-prescription-drug-pricesnegotiate-editorials-debates/7943745/ ;
and http://www.medscape.com/viewarticle/845707 )
Right now, melanoma immune therapy drugs are being tested in prostate cancer and show a lot of promise, so talk to your doctor about the ongoing research and clinical trials. However, the catch – the prices of these drugs, are not borderline insane but COMPLETELY INSANE! And, do you pay less if you are not obese?
WHAT ELSE DO I NEED TO KNOW?
Prostate tumors are often observed by pathologists to be surrounded by human inflammatory cells, which suggest the body did mount some kind of personal immune response to this tumor. And, this is also observed with some standard treatments that are not considered immune drugs. For example, LHRH or hormone suppressive drugs also seem to create some kind of moderate immune response by the body! Amazing! So, if researchers can amplify that response or help the body fight cancer even more, perhaps this could be a big breakthrough. Let’s look at some of the melanoma drugs in clinical trials and the ones you should talk about with your docs, because clinical trials keep opening up and new research on some of these drugs will appear this year. Ipilimumab (also known as “Yervoy®” from the company Bristol-Myers-Squibb. By the way “Yervoy” sounds like the name of a Pirate Ship or something that a Pirate says that is going into the ocean to collect or seize “booty” from innocent people) is FDA approved for metastatic melanoma. Ipilimumab is a fully human monoclonal antibody that binds to something known as “CTLA-4,” which then allows greater anti-cancer activity by your immune system. However, there was a phase 3 trial of this drug compared to placebo of men with CRPC that had failed docetaxel treatment and it did not appear to work better than placebo. Still, to say it failed is really not fair because it did find improved survival but the statistics were not significant, but about as close as I have seen in a trial of being significant (it was p=0.053 and if it was less than p=0.05 it would have been significant or looked at in another way there needs to be a more than 95% chance the results were accurate and showed a benefit with the drug and in reality there was a 95% chance but not a 96% chance, etc…SO, SO CLOSE!!!).
Yet, another look at this study showed something quite interesting. When researchers took a further look at the research there appeared to be a survival benefit for the patients that did not have prostate cancer in their body organs. Amazingly, there is another phase 3 trial (called “CA184-095; ClinicalTrials.gov NCT01057810) going on that is looking at the effect of this drug before chemotherapy and prostate cancer patients are asymptomatic or minimally symptomatic without visceral/organ disease. What all of this suggests is that the potential for a benefit with this immune drug appears to be greater in men with a better prognosis or cancer that has not spread as far around the body. In the ongoing prostate cancer trial with Yervoy, patients will receive an IV dosage (10 mg/kg) every 3 weeks for up to 4 doses (induction phase) and then every 12 weeks (maintenance phase). Results are expected any time! Currently for melanoma Yervoy (3 mg/kg) is given as an IV drug (over 90 minutes) about every 3 weeks. Still, the side effects of this drug are more serious compared to other drugs and these basically all evolve around the possibility (although fairly rare in terms of serious toxicity) that the body also attacks itself and not just the tumor. It’s for this reason past studies have shown that some patients experienced inflammation of the colon, liver, skin, nerve issues and other problems. However, it’s possible that developing a certain side effect with these drugs (we do not yet know about this one) could be a predictor of a better clinical response to the drug! There are other FDA approved drugs for melanoma and one is called “Keytruda®” (also known as “pembrolizumab” from Merck) and the other is known as “Opdivo®” (also known as “nivolumab” approved by FDA in December, 2014 for melanoma from Bristol-Myers Squibb) and these drugs are known as “PD-1 INHIBITORS” because they target the PD-1 receptor, which really means they also help improve the immune response to tumors and allow the body a better chance of fighting cancer. They may also have more or similar efficacy and less side effects compared to Yervoy, but this needs more research. Keytruda is also given as an IV drug (over about 30 minutes) and right now is usually given every 3 weeks for melanoma patients. And, Opdivo is also an IV drug (over about 60 minutes) that is given usually every 2 weeks. Interestingly, a recent publication found that for patients that had a cutaneous or skin side effect (itching, redness…) from the drug Keytruda for example there appeared to be a better response to the drug. The excitement and the great news is that the combination of 2 drugs for melanoma is far greater than either drug alone, so for example the combination of Yervoy with Opdivo! Amazing! And, I know some more desperate prostate cancer patients that are being treated with these drugs right now off-label and are willing to pay for it! Wow!
Now for the real catch! The cost! The cost of some of these drugs are insane, so it’s critical to have an open discussion in the future of how to control these costs so that the average American whose name does not end in Trump or Rockefeller or Gates, etc. can also afford them. Additionally, we need more patients and health care professionals to not be afraid to take some kind of stand on rising drug prices. This happened recently with a number of oncologists signing a document that basically said some (not all) of these drug prices are getting out of control. I am asked all the time why Medicare cannot negotiate drug prices like most countries around the world. This is due to a ruling put in place with Medicare Part D a while ago (Medicaid and VA can negotiate). However, this ruling now looks silly and needs to be reevaluated. I have found that many good pharmaceutical companies are open to this discussion and new ideas, but we have to get the conversation started and it will not help if we whisper but SPEAK LOUDLY AND WITH COMPASSION AND SENSITIVITY. So, I will help in leading a future effort with some of my friends and colleagues on requesting a reevaluation of some of the prices of cancer drugs! Stay tuned!
PS. Are you ready for another crazy Moyad observation (besides the fact that my nose is too big and I should leave my job and become an international male model or sex symbol)? Many drugs are given in milligrams per kilogram of body weight (mg/kg body weight), which makes sense, but insurance and/or you are charged for the amount of drug given in cents based on this weight. So, if you are given a melanoma drug in milligrams of drug per kilogram of body weight and you weigh 90 kilograms versus 70 kilograms then you could theoretically and realistically pay a heck of a lot more for your drug!!! I can’t make this S_____ UP! (Note the “S”____ used previously represents the word “Stuff”). For example, it costs roughly 28.78 per single milligram (mg) for Opdivo, 157.46 for Yervoy and costs 51.79 per milligram for Keytruda. And, say you are getting a 10 mg per kg infusion of Yervoy (standard used in prostate cancer clinical trials) then you cost 31,492 dollars more per infusion compared to a 70- kg person, but this is just the difference and not the total cost. For example, a 90 kilogram person would cost 141,714 dollars versus a 70-kilogram person at 110,222=total difference of 31,492 dollars! That seems crazy! All of this stuff seems crazy! I need a Dairy Queen Banana Split at 520 calories to relax and feel better and understand all of this stuff, because you have to be bananas to understand this stuff!
THAT’S ALL FOLKS…. See you in WINTER, when I will write about many other serious issues and give timeless advice in the next newsletter, such as; why it’s never good to be the man that jumps in Lake Michigan in January right before doing a nude photo shoot, unless you feel really comfortable with your manhood or why it’s not smart to eat a pound of asparagus before submitting a urine sample to your favorite health care professional that you never ever want to offend!