When I see otherwise healthy patients in the office and review their medications, I often find that they are taking a daily aspirin.  When I ask them why, I often get a puzzled look. When I ask who suggested that they do so, they often say, “Well, nobody.  I just heard it was a good thing to do.”  So is it true? Actually, there recently has been a flurry of articles on the subject.

For starters taking a daily aspirin has been heavily promoted as a way to prevent heart attacks, strokes, and even cancer.   However, a recent review of over a hundred studies shows minimal, if any, such benefits in otherwise healthy people.  What about harms?  Even though aspirin is available without a prescription, it still is a drug; and, like any drug, it can have serious side effects as well as adverse interactions with other medications.  For instance it can decrease the effectiveness of certain blood pressure medications.

The most serious side effect is bleeding of the stomach and intestines which can begin suddenly and without any prior warning.  Such bleeding can be life-threatening and require emergent hospitalization, blood transfusions, and need for emergency procedures or even surgery.  The anti-clotting effects of aspirin can also lead to bleeding in other parts of the body such as the brain.  Concerned about your hearing?  Aspirin use has been linked to loss of hearing.  Concerned about your eyesight?  Aspirin use has been linked to progression of macular degeneration.

So who should take a daily aspirin?  People who have known heart problems such as atrial fibrillation and who are not already taking more effective blood thinners such as coumadin, pradaxa, xarelto and others; and people who have vascular stents, who are exhibiting stroke symptoms such as TIAs and or who have otherwise been so directed by their physicians.  In those cases the benefits may outweigh the risks.  However, for the rest of us, its daily use remains unproven and has the potential to do more harm than good.

There are many arguments to make in regards to the benefits accrued by insuring more Americans.   One of the anticipated benefits is to decrease the use of emergency room services by the uninsured, who often do not have  a primary care physician.  A recent study published in ” Science” magazine  by Taubman  (no relation) and others studied the effect of expanded government – sponsored health insurance in Oregon on emergency room usage.  What they found was just the opposite.  Newly insured patients used the emergency room 40% more than their uninsured counterparts.  The increase in visits was across a broad range of conditions, and the vast majority of the increased visits could have been treated in lower cost primary care physician offices.  An accompanying editorial states,  “It is possible to argue that this represents greater access to necessary  care, or that it shows that insurance serves as further encouragement to seek unnecessarily expensive treatment……Based on this paper’s findings, we have a good reason to anticipate a large increase – and almost surely not a decrease – in traffic to already overburdened emergency departments across the country.”

The reasons for the observed increases in ER use are likely many.  One reason may be that patients are just doing what they were told;  many busy primary care practices who already have schedules filled with non-emergent cases may tell patients to go to the emergency room so as not to disrupt their schedules.   In addition  more and more primary care practices employ physician extenders such as nurse practitioners and physician assistants who do not have the training or experience that allows them to comfortably see and treat sicker patients in an office setting.  By contrast, in our unique practice model we always keep slots open for sick visits and whenever possible attend to people the same day.  Finally, many hospitals (for profit and non- profit) incessantly advertise that patients should come and utilize their emergency rooms by instilling fear that a routine flu might be something more serious.  While this may be good for the hospital’s bottom line,  that calculus may be changing in Maryland (see previous post on Maryland Medicare Waiver).

Regardless of the causes, the health care system has to deal with the consequences.  Warns  the editorial,  “Whether or not you think universal coverage is a good idea, we had better start planning for it.”

Results of the New Dietary Interventions to Enhance the Treatments for Weight Loss (NewDIETs) Study

ATLANTA, GA – Most weight-loss interventions focus on reducing calories, but a new study shows that vegan and vegetarian dietary patterns can result in more weight loss than those that include meat without emphasizing caloric restriction.  Results of the study were presented at a special session of The Obesity Society  Annual Meeting. 

“Many researchers agree that vegan eating styles are tied to lower BMI, lower prevalence of type 2 diabetes, and less weight gain with age,” said lead researcher Brie Turner-McGrievy, PhD, of the University of South Carolina.   “We found that participants consuming vegan and vegetarian diets lost an average of 8.2 to 9.9 pounds over eight weeks while those consuming some meat lost 5.1 pounds.”  At 6 months the vegans had lost 7% of their body weight, and those consuming meat 3%.

The reason for greater weight loss in the vegan and vegetarian groups remains to be studied, but may be due to changes in macronutrient content.  In addition  participants in this study most likely ate fewer calories as a result of the dietary changes they made to consume more vegan or vegetarian meals.

Said author Dr. Turner-McGrievy,  “Diets that focus primarily on calorie restriction are a cornerstone of weight loss programs; however, they usually involve dietary self-monitoring, which many individuals find burdensome and can limit adherence.”

Because weight loss achieved by patients following plant-based diets in this study occurred without emphasizing caloric restriction, some individuals may find these types of dietary patterns easier to follow over the long term, according to the researchers.

This study validates many of the principles incorporated into the weight loss program run by our own nutritionist, Rick Weissinger R.D. M.S.  Our program includes experts in yoga, exercise, psychotherapy, and even includes cooking lessons by a local chef.  To learn more about our multidisciplinary weight loss program and how to get on our waiting list for our next informational open house,  click here

According to the CDC an estimated 97 million adults in the United States are overweight or obese, a condition that substantially raises their risk of  hypertension, high cholesterol, diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and cancers of the breast, prostate, and colon.  CDC data show that about a third of adults are overweight, an additional 36% are obese, and 6% are classified as extremely obese.

Do physicians practice what they preach when it comes to diet, nutrition, and maintaining a healthy weight?  In a recently published study the percentage of physicians who are overweight were compared by specialty.  The surgeons topped the scales – is it because they spend a lot of time standing and don’t have time to plan meals?  The dermatologists and plastic surgeons were lightweights – maybe they are more self conscious of the image they need to project. And what about those gastroenterologists……

Overweight is defined as a BMI (Body Mass Index) between 25 and 30.  Obesity is a BMI of 30 or more, though some think the number should be 27 or 28 as that’s when significant adverse health consequences start to kick in.  Curious how you compare?  Click here to calculate your BMI

Losing weight and then keeping it off can be difficult.  Need help? – We’ve put together our own multidisciplinary program Click Here For Details