Dr. Kevin Most: News From Last Week

Dr. Kevin Most

Diabetes- Impact on modest weight loss

We have talked in the past about the epidemic of diabetes in this country. The vast majority of the new cases are actually due to our epidemic of obesity in this country as well. Type 2 diabetes is a condition where the body cannot process glucose and as a result the blood sugar levels remain high and damage occurs to our heart, kidneys and even our eyes. There are over 30 million people in the US with this condition. Treatment is with medication, diet changes and recommendation for exercise. We know that we can put diabetes into remission for many patients with bariatric surgery, or placing individuals on an extremely low caloric diet, of 700 calories a day. This would place their diabetes in remission but often this was short lived as the diet is not sustainable.

A study out last week suggest that we do not have to see extreme measures to obtain the remission of Diabetes. In fact modest weight loss of 10%, that occurs within the first 2 years of diagnosis of Diabetes and sustained may also lead to the remission of Diabetes for at least 5 years. They say five years as that is when the study was presented. The impact may actually be for decades. This should be very encouraging news for individuals struggling with obesity and want to help their health. The goal of a 10% weight loss is often within reach of many without drastic measures and the benefits to the body as well as your health costs is easily in reach for many patients.

Patients in the past hit a feeling of weight acceptance as the thought of losing a large amount of weight or undergoing surgery was not practical or appealing. However a disciplined approach to a loss of 10% of body weight may have a huge impact on ones health as many are seen to have their blood sugars normalize just with that modest weight loss. This has also been seen as a great encouragement factor for a chance to make an impact in the long term health of these patients. Eliminating Diabetes and normalizing your blood sugar will extend your life, increase the quality as well. It lowers the chance of diabetes, heart disease, stroke and need for dialysis.

I think you will now see doctors encouraging the 10% goal, hoping the diabetes goes in remission and is an encouragement to continue with smaller weight loss goals. The downside is as one would expect if the weight loss is not sustained the Diabetes will return. Regaining the weight that was previously lost will in most case deteriorate the benefits noted.

6 Minutes of walking a day- impact

We talk about the importance of exercise, especially in seniors. A simple walk can help our heart, our lungs, our brain and our blood pressure to name a few. Everyone talks about the goal of 10,000 steps, we are constantly looking at our phones or fit bits to see if we hit that goal. What if I told you a new study has come out that shows that 6 minutes of walking will give you improved feelings of energy, less fatigue, less depression. The study showed that a six minute walk at a pace chosen by the patient will decrease mental fatigue, decrease anxiety and also make the individual more motivated to do more physical activity thru the day. The pace of walking also was beneficial and those with a higher pace had more feelings of energy and less fatigue.

No drinks or Pot for dad’s to be

A study came out last week that showed both parents should avoid drinking alcohol for the six months before conception. This was found in a study that looked at congenital heart defects in in newborns and the alcohol consumption of the parents leading up to conception. Now many may be saying that they have not heard of congenital heart defects in children, yet it is the most common congenital defect and impacts 40,000 babies every year. The study showed that parents drinking in the three months before pregnancy had a 44% increased risk for fathers who were drinking and 16% increase for mothers who were drinking , when compared to nondrinkers. Binge drinking, five or more drinks in one setting had even higher rates.

The researchers looked at study data between 1991 and 2019, including 55 different studies that looked at close to 350,000 babies, over 40,000 who had heart issues. The researchers conclude that a women should refrain from alcohol for the year leading up to her pregnancy and that men should refrain from alcohol for the 6 months leading up to conception. The study does not ascertain that paternal drinking is more harmful than maternal drinking, nor does it identify a cut off level where alcohol consumption that might be considered safe.

Another study came out that showed that men that used marijuana at least once a week are twice as likely to see their partners pregnancy end in miscarriage, when compared to those who use no Marijuana. The miscarriage associated with male smoking of marijuana appears to happen within 8 weeks of conception. The actual cause is unclear at this point, but the data supports that it is the marijuana that is the factor causing the miscarriage and mainly from the male use. More research is being done on this and the studies will expand and become easier to complete with the legalization of marijuana occurring across the country.

The message is for the optimal health of a baby refraining from both alcohol and marijuana helps

I would assume we will hear more about both of these studies in the future as they are socialized

Pregnancy and Vaccines

We have talked in the past about the importance of women who are pregnant or are planning on getting pregnant get the flu shot. This shot protects not only them thru the pregnancy but also protects the unborn fetus. We have also discussed the importance of getting the whooping cough booster for not only moms to be but also for dads to be. Influenza and Whooping cough are very serious infections, and newborns are not protected from those illnesses nor can they receive vaccines at that young age as their immune system is still developing. The CDC last week shared a few sobering facts. Only 35% of women who are pregnant receive these vaccines, and some estimate that those trying to get pregnant have lower rates.

Mothers may not know but the vaccine protects them as well as the baby. Antibodies from the mother are transferred to the fetus so that when the baby is born they have protection. This is important as newborns cannot receive the whooping cough vaccine until 2 months of age and influenza vaccine until 6 months of age. Having the mother vaccinated passes on that protection to the baby, as well as minimizes the chance of influenza being in the home.

Parents need to know that vaccines for both influenza as well as whooping cough are safe but unfortunately the illnesses can be deadly for babies. Women who decline the vaccine cite 3 reasons, one is they don’t think the vaccine works, two they did not know it was recommended and the third was that they felt it may not be safe for the fetus. The vaccines have been shown to be effective, especially for whooping cough, and we know not only are they safe for newborns they actually extend protection to the newborn during those first few months of life when the child is the most vulnerable.

Pregnant women with Influenza have increased risk for both, preterm labor and premature delivery. Any women listening who are pregnant or considering pregnancy soon should be receiving the vaccines.

Brain scans predicting if antidepressant will work

We have discussed depression many times in the past. We have seen the prevalence of depression increase not due to environmental or genetic reasons but early identification, awareness and acceptance of the condition. We have also discussed in the past one struggle that doctors and patients have is choosing the correct medication. For many with depression a medication will be started and we will not see an impact or effectiveness for 4-6 weeks at which time the medication is continued or stopped due to not working and another medication may be tried. Studies have shown that over 50% of individuals fail to respond adequately to their first depression medication. Estimates are that over 50 million adults suffer from depression and anxiety in the US

Two studies that came out last week that show that performing a functional MRI may help maximize the chance of choosing the correct antidepressant. A functional MRI is a MRI that looks for changes in the function of the brain when it is active, it looks at blood flow and oxygen consumption. Researchers are looking at MRI’s of patients on medication as they put them thru some emotional testing and comparing that to individuals who are not on medication. They are taking those results and comparing it after 8 weeks on the medication to compare the findings of the MRI with the outcome of the effectiveness of the medication.

If this is validated we may see patients with depression starting a medication, receiving a MRI and having good data as to whether or not that specific medication will work. This would make a huge impact in the treatment of those with depression by achieving results earlier with the correct medication. The impact this will make on those with depression is huge and also it will take the “guess” out of which medication to use first.

Skin Cancer and tanning beds beyond Melanoma

We have discussed the impact tanning beds have on your chance of developing melanoma, the most deadly skin cancer. Most studies focused on melanoma and did not track the impact tanning beds have on other forms of skin cancer. Obviously the main concern is the cancer that can kill an individual, however we need to understand that there are other forms of skin cancer, and the impact tanning beds may have on those cancers.

A study published in JAMA Dermatology last week highlighted the impact tanning beds have on other types of skin cancer. It also looked at the impact of extended exposure of the skin from tanning beds. This study looked at close to 160,000 women who participated in a large cancer study in Norway. The study ran from 1991-2015 and looked at many forms of cancer.

The study showed not only an increase in the incidence of melanoma in those using tanning beds but also a large increase in the risk for Squamous Cell Carcinoma, (SCC). When women who used tanning beds were compared to those who had never used tanning beds they saw a 83% increase in the risk of developing SCC. The study also showed that as the use of tanning beds increased the risk increased as well, it didn’t show that an early age or longer use had much of an impact but the number of sessions was the most important.

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