Fresh health advice explained

Debbie Blank | The Herald-TribuneDr. Mary Robertson observed, "Not all pills are bad. We want to use everything we can not to use pills, but if we have to use pills in a very selective and smart way, they can help us live longer."

“New Looks at old Health Tips” was Dr. Mary Robertson's presentation topic April 27 at the Southeastern Indiana YMCA. She discussed "one great big topic and four or six small topics, small bites of information that I think are kind of new and useful tips."

"We all know that, especially in Batesville, people don't want to take medicine. Here's our alternative" – diet and exercise as medicine.

The Batesville internist bases her recommendations on evidence-based medicine. Some advice comes from "very, very scientific trials," while other health suggestions are derived from her long-term practice and common sense.

With a great diet, "what we have found out is about half of all deaths and diseases in the world are potentially preventable or delayable. One hundred percent of us will die,... but what you can do is delay the onset of these diet-related diseases: heart, diabetes, chronic obstructive pulmonary disease, sleep apnea, cirrhosis of the liver, stroke. That's pretty incredible. That just tells you how good diet is as a medicine."

She distributed a simple chart that put foods in three categories:

• healthful: whole grains, legumes, fruits, vegetables, nuts, seeds

• debatable: poultry, eggs, dairy, fish

• unhealthful: processed meats, red meat, added sugar, refined grains, ultraprocessed foods

Robertson admitted some of the foods listed in the debatable column were "a real surprise. Use with caution and do not overdose on them."

She considered the unhealthful list as a red light. "Stop, try not to eat those." Processed meats include bacon, ham and sausage.

"If anybody would have asked me what the best diet is, I would have said Mediterranean."

The physician asked attendees what they thought the top diet was. Answers ranged from Weight Watchers and Nutrisystem to Atkins. Of the last one, she said, "I never thought that was any good – high fat, high protein, high carbs... which we now know increases the risk of diabetes."

"Forget all those" diets, Robertson advised. "Forget the types of foods, the proteins, the carbs" and percentages of each.

"In 2015 the American Dietary Guidelines Advisory Committee came out with this recommendation: a diet that is highest in plant-based foods and lower in calories and animal-based foods" is best.

She observed there are unhealthy plant-based products. "What about potatoes – the french fries all our kids are raised on and I cannot figure out how to get them to stop eating them ... How about fruit juices" with added sugar?

"A high-protein diet leads to an increased risk of diabetes ... Americans eat really too much protein. When you're preparing a meal, think of the vegetable and fruit portion ... make that 60 to 75 percent of your meal." The specialist recommended using a little meat as a condiment, adding flavor and texture to the meal.

"What are our struggles with a diet?" the speaker asked. "What I think we're searching for is some satisfaction in our food." She asked attendees what excites them about eating. Taste, texture, smell, appearance and feeling full were their answers.

"How about getting energy from food?" she questioned. "I love crunch. I found out maybe I should get my crunch from radishes, not pretzels."

Socializing over a meal is another plus. Robertson listed three habits that can help defer dementia: socializing, reading nonfiction and, believe it or not, lower body resistance exercise, such as stair climbing and walking.

"What do we do about this genetic testing – 23 and Me? It was one of the top gifts teenagers asked for this year. Whoa. This is kind of scary ... they can actually tell you what diseases you might have or be susceptible to," such as risk for breast cancer. "I'm going to try to sway you away from that."

Results could falsely overreassure someone. "Let's say you don't have the gene for Alzheimer's ... It's not only the gene that makes you susceptible to losing your memory." Many other factors play a part: diet, exercise, smoking, weight and education level.

On the other hand, "genetic testing might overscare people and make them paralyzed with fear. 'Oh, I'm going to get that.' I am really against this genetic testing right now." She refers those who have done it to a genetic counselor.

What does excite the internist is pharmacogenomics, precision medicine and its cutting edge concepts. "Right now I'm seeing it in psychiatrists." One with a patient suspected of having depression might order an inner cheek swab. The analyzed saliva will determine what family of drugs the patient may respond to. "These kinds of things are in the experimental phase."

Robertson presented the latest research on other health concerns:

• "I would estimate 95 percent of us in this room, including me, have diverticulosis," outpockets in the colon. "Not everybody who has diverticulosis gets diverticulitis," an inflammation or infection. "It's definitely pain, usually in the left side." Younger men and older women typically get it. "What has drastically changed is this recommendation against (eating) seeds, nuts and popcorn" if diverticulitis is diagnosed. "I probably would still recommend not eating popcorn" or at least skipping the big kernels. She's skeptical a strawberry seed would get stuck in a pocket. What about prevention? "People who have the highest fiber diets over the years probably have fewer diverticuli."

• New hypertension (high blood pressure) guidelines are over 120/80, stage 1; over 130/80, stage 2; over 140/90, stage 3. Robertson urged making lifestyle changes first – healthy eating, a low-salt diet and exercise – before medicine. Controlling hypertension is important to lessen the risk of stroke and heart disease.

• To avoid type 2 diabetes, "the lower the better in blood sugar." A new test, hemoglobin A1c, has "revolutionized the evaluation of who has diabetes." Persons are at risk with a 5.7 score. "We're starting to do intensive counseling with diet and exercise," suggesting a plant-based diet with fewer calories. "It's controversial whether to use medicine at that point. That has a little bit to do with age." She added, "The numbers of people who are diabetic are increasing with our obesity epidemic. We're seeing type 2 diabetics at 16 and 18... These kids coming out of high school already have plaque in their coronary arteries."

• "Breast density is kind of a big deal" because the denser the breast, the lower the mammogram's sensitivity. Persons with dense breasts and inconclusive reports "should probably have additional testing," such as MRIs or ultrasounds, if their lifetime risks are more than 20 percent.

• In 2013 the American College of Cardiology and American Heart Association introduced a risk calculator for having a heart attack in the next five to 10 years. It takes into account age, total cholesterol, good cholesterol, blood pressure, whether on blood pressure medicine, a smoker or diabetic. If the patient has a 7.5 percent risk or higher, "you could possibly benefit from taking a statin" in addition to a good diet most of the time. In addition to lowering cholesterol, a statin can decrease the inflammation in blood vessels. "You want your blood to clot and flow. You can't have it both ways. The aspirin helps keep that blood clotting down a bit, and the statins help decrease the stickiness of your blood vessels," which can lead to heart attacks and strokes.

Debbie Blank can be contacted at debbie.blank@batesvilleheraldtribune.com or 812-934-4343, Ext. 113.

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