Dr. Art Hister

An intriguing report that will soon be published in the Journal of the American College of Cardiology is a look at 30-years’ worth of studies on the effect that stress might have on the heart and the conclusion of the author, a well-known psychologist, seems to be, if you pardon the term, inconclusive, by which I mean that according to this reviewer at least, the link between heart disease and stress is not nearly as clear as most of us believe is the case.

It all has to do with the way we determine the effects of stress in humans which can really only be done from observational or epidemiological studies, most of which are done by taking a group of people and following them for a few years, and then after that period of time, trying to extract some of the factors that have made a difference in the health outcomes that are found.

It’s, of course, hard enough in large observational studies to isolate specific factors in the first place, but the main difficulty comes from one of the major (and often insoluble) questions that always plagues observational or epidemiological studies: when two phenomena happen together in the same people, when they are said to be linked, as for example, when we say that say stress is linked to more heart disease, how can you really tell which effect is the cause and which effect is the result, that is, does stress lead to heart disease or does early heart disease (perhaps at a sub-clinical or not-yet-diagnosed level) somehow increase stress levels.

It’s not simple to do, which is why there is always so much argument about epidemiological findings: for example, do people who exercise live longer or do people who are programmed to live longer do more exercise?

Do people who live healthier lifestyles end up with less dementia, or do people who are at lower risk of dementia in the first place end up living healthier lifestyles?

And the same problem plagues studies that link stress to any “bad” health outcome, even whether stress raises the risk of heart disease, although I think (and this review seems to agree) the weight of evidence is that it does, although clearly it has a much worse effect in some people than in others.

One other interesting observation made by this reviewer is his feeling that the evidence indicates that lowering stress levels through some form of treatment also lowers the risk of heart disease, something that makes sense but which I think is not nearly as provable as we’d like it to be, although I do believe that self-treatment – exercise, lowering stress levels, more sleep – does work.

You know how so many people (nearly every one, I think) who has a problem with weight control is very quick to say that they actually have a “glandular problem”.

“it’s not me, it’s my glands” is the common lament, especially among middle-aged spreaders, who are likely to swear that they’re not eating any more than usual yet they still seem to be putting on poundage..

And by “my glands” what they really mean is their thyroid gland, that bit of tissue that lies at the front of the neck, and the gland that is vital in controlling metabolism and hence weight, too, so that when the thyroid gland becomes underactive (what’s called hypothyroidism), one of the first signs is steadily increasing weight (as well as fatigue, another symptom that plagues middle-aged spreaders).

The problem, however, with blaming the thyroid gland for weight problems is that in the vast majority of people who claim their thyroid is underactive, when such people get their thyroid hormone levels measured, those levels invariably turn out to be within “normal limits”, that is, the levels are not considered to be low enough to warrant treatment, so doctors have always told these people it couldn’t possibly be that their gland was to blame for their increasing weight.

But according to a recent study published in the Archives of Internal Medicine, a lot of people who claim that “it’s not me, it’s my thyroid” may actually be right.

In this study, which the researchers claim confirms several other study findings as well, the researchers followed 2400 men and women for roughly 4 years and found that even small changes in a hormone called TSH (a measure of how well the thyroid gland is working) were co-related with weight changes in some individuals, even though many of the TSH levels were still within normal limits.

In other words, even a small change in TSH, the kind of change that would be reported as normal and a change that wouldn’t send the TSH level into the “abnormal level” category, was co-related with weight gain in some people.

The trouble with this finding is that it’s pretty hard to figure out what to do with it.

It could be argued, for example, that everyone get their TSH measured regularly (perhaps once a year) and if there was any change in TSH and a corresponding increase in weight, then that person should go on thyroid hormone replacement therapy.

This is unlikely to be the case for many years, if ever, though.

The more immediate application might be that someone in middle age who’s gaining weight yet swears that they’re not eating any more than usual and still exercising as much as ever should have their TSH level measured and if it’s in the low-normal range, they might benefit from some thyroid hormone.

This is in theory only, of course, because we have no study yet that shows that treating a low-normal thyroid state has any beneficial effect on weight control.

Why is medicine so complicated?

According to no less a venerable organization than the Mayo Clinic (that’s not unlike God speaking to mortals), if more American women could be convinced to follow 5 easy health prevention steps, we could save 100,000 lives a year in the US (in discounted Canadian terms, that would equate to 10,000 Canuck lives saved yearly).

Specifically, say these researchers, if we could get 90 % of vulnerable (at-risk) women to undergo these 5 preventive steps, we would save 100,000 female lives annually.

1) Flu shots in the over-50-year-olds:  12,000 lives

2) Mammograms and breast cancer screening in 90 % of women over 40: 4000 lives

3) Colo-rectal cancer screening in women over the age of 50: 14,000 lives

4) Smoking cessation: 42,000 lives

5) ASA therapy: 45,000 lives

Sounds great, of course, but hey, I must say that I am pretty sceptical that we can ever get anywhere near such numbers.

First, I really don’t believe that we can ever reduce the smoking rate to less than 10 % of the population.

I wish we could, but I doubt we can, even if we were to completely ban cigarette sales.

Second, I’m also very sceptical that universal adoption of flu shots would make that much of a difference in lives saved.

For one, to make a huge dent in flu mortality, it would require that the people who make the new flu shot formulation every year become much more adept at making sure the flu strains in the flu vaccine match much more exactly the flu strains that are actually circulating in the public than they have in the past few years, and even if they got it way more right, seems to me that there will always be a substantial proportion of the population that just doesn’t feel they need to get a flu shot.

But most of all, I’m highly sceptical about those ASA numbers because I firmly believe that we routinely and significantly downplay the serious risks associated with the use of ASA therapy (bleeding disorders, ruptured ulcers, hemorrhagic strokes) at the same time as we significantly over-estimate the potential benefits.

From my perspective, and I know it’s a tired refrain, but hey! It’s still true: we would save far more lives – and make for far happier and healthier populations – if we spent nearly as much time and energy and resources an persuasive power to convince more people to move more and eat better as we spend on trying to convince people to use some of our therapies and interventions.

Overall, the French weigh less than Americans and many reasons have been proposed for that difference.
Thus, for example, while Americans treat food as fuel that has to be consumed mostly because it will allow them to get to the next game, meeting, conference, event, or whatever, the French make a meal of every meal.
The eat much more slowly than Americans generally do, they enjoy food for the sake of the food not as fuel, they relish variety, they enjoy freshness, and so on, all of which I think is true.
Another obvious difference to anyone who spends even a few days in France is that the French eat much smaller portions than Americans do, particularly in restaurants, where the servings are often just a fraction of the servings that you get in a typical American restaurant.
True, you might say, but hey, you can still get fat from eating lots of small portions, which is true, of course, so it’s interesting to read about another theory for the weight differences that’s been proposed by researchers from Cornell University.
In a survey that they did on 133 Parisians and 145 Chicagoans, the researchers determined that the French use different cues than Americans to tell themselves when to stop eating.
Thus, while Americans generally eat everything on their plates, no matter how much that is, the French use “internal” cues to tell them when to stop eating, that is, the French stop eating when they feel full while Americans stop eating only when there’s nothing left to eat.
I, for one, can buy that theory but I also believe that you can change your response to food, your attitude to eating, your cue-reading, which is something I’ve done.
You see, as a post-war child of Holocaust survivors, I grew up with the admonition that food was holy, that you never knew when your next meal, indeed your next morsel, would come, so you had to eat everything – and then some – that you were served, which is why I was a roly-poly kid and a fat adult who never knew when to stop eating no matter how full I became.
About 10 years ago, though, I decided it was time to change my attitude to food, to learn to read signals that tell me that I’m full, which I managed to do although it took a long time, but I now eat far, far smaller portions than I used to eat, and consequently, I’ve dropped nearly 40 pounds of unneeded fat, which I’ve managed to keep off (I also exercise a lot).
Anyway, the point is that you can un-learn early unhealthy patterns – but you must be patient and persistent.
Some ice cream to celebrate your new attitude?

Data recently released from the (US) Centres for Disease Control and Prevention (still, happily, most commonly referred to as the CDC, although I really like that they’ve added the word “Prevention” to their title) is pretty disheartening for middle-aged folks because the data points out that midlifers are killing themselves in uncommonly large numbers.

Specifically, a five-year analysis (1999-2004) of death rates concluded that there was a 20 % increase is suicides among people aged 45-54 over those 5 years, and among midlife women, the rise in the suicide rate was a staggering 31 % over the same period, both of which, according to the CDC, were far higher increases in suicide rates than were seen among any other age group.

For example, in comparison, the CDC found that the suicide rate among teens, a group that’s always singled out as being particularly vulnerable for suicide, rose only 2 % over those 5 years, and the suicide rate even dipped somewhat in seniors (another group that’s often cited as being particularly vulnerable).

Now clearly no one really knows the exact reason for this rather startling increase in suicide among people who are commonly said to be at an age where they’re on top (or at least as close to the top as they’re ever going to get) and at a point in life when surveys find that people claim to the happiest demographic group alive, and it may all still be a statistical fluke, but if it’s not, one of the intriguing possibilities raised by a few commentators about this study is that it may be a consequence of age discrimination.

In other words, although lots of attention is thankfully finally being paid to prevention programs and education about suicide in young people, and increasingly in seniors, too, there are few, if any, programs about suicide prevention geared to midlifers, a group of people who are always assumed to be able to take care of business on their own.

The other intriguing possibility is the huge spike in prescription drug use in young and especially in middle-aged adults.

Could these drugs (the anti-depressants, the analgesics, the psychotropics and others) have still unrecognized subtle emotional effects that increase the risk that a vulnerable person might decide to commit suicide?

We certainly know that anti-depressants increase suicide thoughts in kids and teens, so it stands to reason, if you ask me, that they might also do that (but perhaps more subtly) in adults, too.

Bottom line for me; if you are on any drug at all, but especially a psychotropic, and you develop any changes in your thought patters or any mood disturbance, please discuss those changes with a health professional.

Fatigue in young adults seems to be rampant. In fact, if you ask around among young folks, you’re likely to find that many, perhaps, most of them claim that they feel tired much of the time, in large part of course, because they stay up too late and get up too early (well, hey, if you don’t do that when you’re young, when are you going to do it?) 

Most young people would also likely add that they’d do just about anything not to feel so tired most of the time (within reason, of course). So the next time someone says that to you and you are either fed up with hearing their laments or you just feel like offering them some friendly middle-aged advice about what to do that doesn’t sound completely like a lecture (“grow up and just go to sleep early, dude”), then tell them about this recent study from the University of Georgia that concluded that healthy young adults who are “tired all the time” are easily treated with a light intensity workout. 

That’s right – working a bit harder and feeling a bit more tired in the short-term leaves you feeling a lot less fatigued in the longer term. In other words, the weakest excuse for avoiding exercise is the oldest one in the book, namely, “I’m too tired to exercise.” 

No, you’re not.