One of the common responses that I encounter when I ask my patients about diet is that the ideal diet is essentially a low fat diet. What this means varies to some degree but often people characterize this "ideal diet" as consisting of low-fat yogurt, bread, cereal, fruit, and a lot of chicken. But is the high sugar, high meat, and low fat diet described above the ideal? Does it actually result in lower levels of fat in the blood? In my view the answer is clearly no. When I tell patients that the "ideal" diet they are consuming actually leads to higher levels of fat in their blood even though it is a low fat diet they are puzzled. The reasons for this are complex and beyond the scope of this article. Needless to say, Triglycerides and Serum Fatty Acids (SFA), which represent the majority of the fat that floats in our blood, tend to rise when patients have more insulin resistance and are eating a higher carbohydrate diet. The serum Triglycercide level is a component of the typical "lipid panel" or cholesterol panel. It is one of the most important numbers you should look at in your cholesterol panel. The higher the level of triglycerides in your blood especially when compared to your HDL ("good" cholesterol) level the higher your risk for heart disease. Ideally, the ratio of your triglycerides to your HDL should be less than 1. See the figure below. The strength of this correlation is much stronger than the correlation between you total cholesterol or LDL and your risk for cardiovascular disease. So what dietary intervention helps you lower the TG/HDL ratio, SFA level, Triglycerides, and abdominal fat the best? While this is not a completely settled issue, the vast majority of studies that I have reviewed show something similar to the figure below. The participants in the study below followed either a very low carbohydrate ketogenic diet (Low-carb/High fat diet) compared to a conventional low-fat (High-carb) diet. The results are interesting. The high fat diet dramatically lowered body mass, abdominal pain, triglycercides, TG/HDL, glucose, insulin, and total SFA compared to the conventional low-fat diet. This also means that the "ideal diet" may not be that ideal after all. I think it is pretty clear that our diet is one of the most crucial elements that we can control to ensure our health. However, I don't think there is an "ideal" diet for everyone. That is because what the "ideal" diet may be for one person may not be appropriate for another. Diet should be individualized and based on objective and subjective measures such as the measures I described above.
If you are looking to improve your health and diet and to get an individualized approach I am happy to help. Your doctor may also be able to help but in many cases my fellow doctors are not always familiar with dietary literature and may not be good guides. If you have health issues please consult with your physician before making any significant changes in your diet.
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"Doc, I think I have a sinus infection and need an antibiotic," is a common patient complaint that I hear at this time of year.
With the ups and downs of the weather around Spring time and with the allergy season in full force it is common for me to see patients who have significant sinus and allergy problems. Many patients associate sinus symptoms with sinus infection. Sinus pressure or inflammation of the sinuses (Sinusitis) can actually be caused by many things. These include viruses, allergies, and bacteria. The most common cause is a viral infection associated with the common cold. Bacterial sinusitis, which is treated with antibiotics, complicates viral sinusitis in only about 0.5 to 2 percent of cases. (1) In theory, this means that the vast majority of patients that present with a "sinus infection" should not be treated with antibiotics. However, it is not always so clear when someone has a bacterial sinus infection. So what are some criteria that are more suggestive of bacterial sinusitis. The Infectious Disease Society of America suggests the following three criteria (2):
Fortunately, if you do have a sinus infection or sinus symptoms there are some traditional treatments that may help. These include anti-inflammatories, saline irrigation, intranasal steroids like Flonase, antihistamines, mucolytics (guaifenesin), and decongestants. If these treatments are not helping or symptoms are worsening than antibiotics are often necessary. Antibiotics that are commonly used in adults include Augmentin, Doxycycline, Clindamycin, or a Levofloxacin. Steroids may also help and have been shown to shorten the time to resolution. Some natural treatments that may help include colloidal silver, essential oils, and natural antihistamines. If you are experiencing significant sinus or allergy symptoms please feel free to give me a call or see your doctor. References: 1. Fokkens W, Lund V, Mullol J, European Position Paper on Rhinosinusitis and Nasal Polyps Group. EP3OS 2007: European position paper on rhinosinusitis and nasal polyps 2007. A summary for otorhinolaryngologists. Rhinology 2007; 45:97. 2. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012; 54:e72. At my family practice I frequently see lacerations and put in stitches. I also take out cysts and other lesions. One of the questions I frequently get asked is when it is appropriate to get stitches.
Before I get to more details on when a cut should be stitched I think it is important to review a few basics. To start off, the basics of laceration repair have not really changed significantly over the past one hundred years. The goals of laceration repair is to help prevent wound infection, assist in stopping bleeding, and to produce an aesthetically pleasing scar. The skin is composed of the epidermis, dermis and subcutaneous layers. The two outer layers of the skin are the epidermis and dermis. These two layers are clinically nearly indistinguishable from each other. The subcutaneous tissues are mainly composed of fat tissue, muscle, blood vessels, and nerves. Interesting, the top layer of skin or the epidermis closes over a wound within 48 hours after suture closure. Collagen (scar) formation starts after 48 hours and wounds continue to heal for up to 12 months. Things that impair wound healing include diabetes, poor nutrition, poor vascular supply, and medicines such as steroids. So when are stitches appropriate? Wound repair with sutures is appropriate when the depth of wound extends through both the epidermis and dermis layers into the subcutaneous layers. Basically if you see fat (yellow) or muscle a wound should be closed. How should a wound be closed? Some wounds such as those on the scalp or when longer than 5 cm may be closed faster with staples. Some wounds that are not under tension and less than 5 cm may be closed adequately with skin adhesive. All other wounds should be closed with stitches. How long do you have to get stitches? I often have patients come into the clinic several days after a wound has happened and they are surprised to learn that I cannot put stitches in. In general, clean, uninfected wounds can be closed up to 18 hours following the injury without increasing the risk of infection. Facial and neck wounds may be closed up to 24 hours later or longer if there are no signs of infection. Wounds that are grossly contaminated, infected, or don't come to medical attention early enough should not be closed. Other wounds that are not generally closed include animal bites, deep puncture wounds, wounds with too much tension, or superficial wounds. Also, for any wound and especially ones that will be closed with sutures it is key to irrigate the wound thoroughly and remove any debris and dead tissue. Irrigation can be performed with normal saline. Many people use Hydrogen Peroxide (H202) or Iodine but it is important to remember that H202 and Iodine are toxic to healthy issues and may impair wound healing. For those with any questions about proper wound care or when a laceration should be sutured feel free to reach out to me or come into the clinic. I typically charge about half of what you would pay at other clinics. In the U.S., the spring allergy season can begin as early as February and last until summer. Seasonal allergies may affect up to 8 percent of the U.S. population. In Texas, the number of people that suffer from allergies seems to be particularly high.
Seasonal allergies commonly present with symptoms such as runny nose, watery eyes, and itchy eyes. People also report itching in other areas such as their nose, mouth, and ears. While it may be helpful to avoid going outdoors when pollen counts are particularly high it may be also prudent to prepare yourself to tackle allergy symptoms regardless of what the pollen count may be. Allergy symptoms develop when the body develops antibodies to common harmless substances such as dust, pollen, or mold. The body releases an antibody called immunoglobulin E (IgE) which leads to the symptoms associated with seasonal allergies. So what can you do to survive the allergy season? 1. Limit exposure It only makes sense that if you are suffering from allergies that you try to limit exposure as much as possible. Some common ways to limit exposure is to do outdoor work before dawn or in the late afternoon when pollen counts are the lowest. It can also help to wear gloves and/or a mask when gardening or mowing the lawn. 2. Natural Remedies There are some natural remedies that may help. These include hot peppers which may act as natural decongestants, Butterbur, Goldenseal, and Eucalyptus oil. 3. Nasal Irrigation A common suggestion that can help relieve nasal congestion and flush out allergens is to use nasal saline irrigation. A Neti pot is an ancient form of nasal irrigation that is commonly used. 4. Healthy Lifestyle Eating a healthy diet and focusing on limiting stress can also be helpful. I have personally found that when I eat a lower carbohydrate diet that I tend to have less allergies. It may also be beneficial to limit foods that tend to cause inflammation and/or allergies. 5. See a Doctor When allergies become particularly severe it can sometimes may be necessary to try other treatments such as antihistamines, nasal steroids, systemic steroids, or allergy shots. While these options are not preferred they may be the only option for some with more severe symptoms. For those that need help dealing with their allergy symptoms this spring feel free to reach out to me or schedule a visit. I have seen quite a few patients for the flu and much like in previous years just because you have had the flu vaccine doesn't mean you cannot get flu.
Fortunately, there are treatment options available if you have the flu. According to the CDC "elevated" influenza activity is expected for a few more weeks in much of the United States. As of February 4th, the CDC's Morbidity and Mortality Weekly Report (MMWR) notes that Influenza activity began to increase in mid-December and has remained elevated. The predominant virus has been influenza A (H3N2) viruses but influenza A (H1N1) pdm09 and Influenza B viruses were also identified. So far "influenza activity has been moderate so far this season", the researchers report. The CDC also reports that so far this year the vaccine has been about 48% effective in preventing influenza-related medical visits. The flu vaccine has been only 43% effective for influenza A (H3N2) and 73% for influenza B viruses. Besides the flu vaccine there are effective medications including oseltamivir that can treat the flu. However, these medications can sometimes be expensive and usually need to be taken within the first 2-3 days to be effective. They are definitely recommended for individuals for severe, complicated, or progressive influenza illness and for those at higher risk for influenza complications, including adults aged 65 years and older. For those that have flu like symptoms please give us a call at Murdock health or visit your doctor. |
Doctor/Telemed/Sick Visit $60
PREMIUM $45-60/MO
WEIGHT LOSS $60 HCG DIET $399 HORMONE VISIT $60 BLOOD WORK $60 LACERATION $150 STEM CELL $999 Testosterone Visit $69 Vitamin B12 $25 Archives
June 2022
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