Sunday, January 16, 2011

A New Type of CPR

Do you know how to do CPR? It’s easy, right? Just compress someone’s chest and then give them mouth-to-mouth resuscitation. That’s all there is to it. But, if somebody does collapse where there are witnesses, studies show that there is only a 1 in 3 chance that they will receive CPR. There are many reasons for this, but one is that a lot of people, fearful of communicable diseases, will not perform mouth-to-mouth resuscitation, and therefore will not perform CPR, even if they know how to do it.
So, after much deliberation, the American Heart Association has begun to promote a new type of CPR, called “Hands-OnlyTM CPR” (http://handsonlycpr.org/).
Hands-OnlyTM CPR is CPR without mouth-to-mouth breaths. It is recommended for use by people who see an adult suddenly collapse in the “out-of-hospital” setting (like at home, at work, in a park). It consists of two steps: First, call 911 or send someone to do that. Second, begin providing chest compressions by pushing hard and fast in the center of the chest with minimal interruptions. That’s it. No mouth-to-mouth, just chest compressions. Doing this can save a life, and it is extremely easy to learn.
Any attempt at CPR is better than no attempt. Hands-OnlyTM CPR has been shown to be as effective as conventional CPR when given in the first few minutes of an out-of-hospital sudden cardiac arrest. Conventional CPR may be better than Hands-OnlyTM CPR for certain victims, such as infants and children, victims of drowning and adults whom you did not see collapse.
CPR AnytimeTM
The AHA has produced a 22-minute CPR training program where you can learn how to perform high quality chest compressions, all in the comfort of your own home! (http://www.cpranytime.org/). You can also find information about instructor-led CPR courses by going to www.americanheart.org/cpr or calling 1-877-AHA-4CPR.
Conclusion
There is a new type of CPR which is easy to learn, can save lives, and does not involve mouth-to-mouth breathing. This should allow bystanders to overcome some of their reluctance to perform CPR on a stranger if they witness someone collapse. We urge you to learn how to perform Hands-OnlyTM CPR as soon as possible. You never know when it might be your turn to save someone’s life.

Monday, January 10, 2011

The HCG Diet

As a physician, I know how desperate people can become when they want to lose weight. Over the years, there have been so many popular and wondrous (and unfortunately, also worthless) diet programs, it is impossible to remember all of them. One that I have heard about lately involves my field of Ob/Gyn, so I thought it wise to research this latest “miracle” weight loss program. It is called the hCG diet.
The hCG diet is all over the Internet. It is amazing. You can lose 1-2 pounds per day, and thus lose 20 pounds in 3 weeks! And it is so simple! All you need is a single daily injection of the hormone hCG and then just stay on a low calorie diet. You do not even need to exercise. Isn’t that incredible? Amazingly, there is also oral hCG that you can drink!
Let’s look closer.
What is hCG?
hCG stands for human chorionic gonadotropin. This is the hormone produced by a woman when she becomes pregnant. It is made by the placenta, and can be isolated from the urine of pregnant women. There are many functions of hCG in the woman’s body during pregnancy. The most critical function is that this hormone tells the ovary to keep producing the hormone progesterone, because progesterone is required for the body to hold on to the early pregnancy.
Without progesterone, the pregnancy will not survive and a miscarriage will result. hCG keeps the progesterone level very high in early pregnancy. Together, these two hormones bring on the many symptoms of early pregnancy such as decreased appetite, sensitivity to odors, nausea, vomiting and fatigue.
hCG diet proponents will tell you that hCG also allows your body to mobilize and metabolize stored fat, something that nature requires during pregnancy. More on this later.
Other uses for hCG
The hormone hCG is very similar to the female hormone known as LH. Ovulation is preceded by a surge in LH. This is how urine ovulation kits work, they detect high levels of LH in the urine, indicating the LH surge which is followed by ovulation. During fertility treatments hCG acts as a substitute for LH. By giving it at the correct time of the cycle, ovulation will occur about 24 hours after the hCG injection. The dosage for this is about 10,000 units, given as an injection. Protein hormones such as hCG (and insulin for example), must be given by injection. If these hormones are swallowed, the body will digest them the same way we digest steak.
The hCG diet
In the 1950’s, a British physician named Dr. A. T. W. Simeons claimed that hCG injections of 125 units daily plus a diet of 500 calories per day achieved significant weight loss. He also claimed that hCG suppressed hunger and enabled the body to burn fat beyond the normal daily needs resulting in a guaranteed weight loss of 15 pounds in 26 days using 23 daily injections.
A 150 pound low-activity person burns about 2200 calories per day. To lose one pound a person has to burn or reduce calorie intake by about 3500 calories. On a 500 calorie per day diet, the maximum biologically plausible weight loss would be 10 pounds in 3 weeks.
But, a 500 calorie per day diet is a starvation diet. It is almost impossible for anyone to adhere to this voluntarily. It is so low in calories and protein, the body will digest it’s own organs to obtain protein necessary for the body to function and this low calorie intake will quickly lead to exhaustion. Furthermore, the body can go into a dangerous state called ketosis from burning too much fat. When a person is starving, they will burn their own body fat for energy, hCG or no hCG!
History of the Simeon’s diet
Numerous studies showed that the addition of hCG to the diet was worthless. The only reason people lost weight was because they starved themselves. There was never any scientific proof that the hCG added any benefit, other than a financial benefit for the practices selling this diet to gullible and desperate patients. Critics say that as early as 1962, the Journal of the American Medical Association warned against the Simeons Diet.
In 1976, clinical research trials published by the Journal of the American Medical Association and the American Journal of Clinical Nutrition showed that hCG was ineffective as a weight-loss aid. There were “no statistically significant difference in the two groups” and that “hCG does not appear to enhance the effectiveness of a rigidly imposed regimen for weight reduction.”
In 1976, the Federal Trade Commission (FTC) ordered the Simeon Management Corporation, Simeon Weight Clinics Foundation and hCG Weight Clinics Foundation to stop claiming that their hCG-based programs were safe, effective, and/or approved by the FDA for weight-control. Although the order did not stop the clinics from using hCG, it required that patients who contract for the treatment be informed in writing that:
“HCG has not been demonstrated to be effective adjunctive therapy in the treatment of obesity. There is no substantial evidence that it increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or "normal" distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restricted diets.”
So the hCG diet basically disappeared after that until 2007, when it came roaring back into public consciousness, propelled by a sensational infomercial guru/criminal named Kevin Trudeau, who published the book “The Weight Loss Cure They Don't Want You to Know About.”
Kevin Trudeau
Trudeau's activities have been the subject of both criminal and civil action. He was convicted of larceny and credit card fraud in the early 1990s, and in 1998 he paid a $500,000 fine for making false or misleading claims in his infomercials. In 2004, he consented to a lifetime ban on promoting products other than his books via infomercials.
His book describes a three-phase plan originally made by Dr. Simeons in the 1950s. The first phase involves switching to all organic foods with repeated colonics (enemas) and “liver cleansing”. This is followed by a second-phase period of daily hCG injections under the direction of a health care provider. In phase three, use of hCG stops, but food must continue to be 100 percent organic. Other recommended activities include walking an hour a day or more and doing breathing exercises.
Additionally, the Trudeau version had a list of over 50 different supplements, food avoidances and prescribed behaviors that had to be strictly followed. These including taking bizarre supplements such as raw apple cider vinegar, heavy metal cleanse, laxatives and digestive enzymes. The dieter had to use an “Electromagnetic Chaos Eliminator,” listen to “destressing CDs” and no microwaved food was allowed.
On November 16, 2007, Trudeau was found in contempt of his 2004 court order for making “patently false” claims in his weight loss book. U.S. District Court Judge Robert W. Gettleman ruled that Trudeau “clearly misrepresents in his advertisements the difficulty of the diet described in his book, and by doing so, he has misled thousands of consumers.” In October 2008, Trudeau was fined more than $5 million and banned from infomercials for three years for continuing to make fraudulent claims pertaining to the book.
But wait, there’s more!
No, this did not put an end to the hCG diet craze. It has now evolved to the point where you do not need the injections. Numerous web sites promote the use of oral hCG instead of the injections. You can drink it or just place a few drops under the tongue and get the exact same benefit as the injectable hCG. Isn’t that amazing? No prescription needed, no medical clinic needed. You can do all of this online and through the mail.
But, is this possible? As stated earlier in this article, adding hCG to water and drinking it will result in the hCG being swallowed and then digested. So how can this be promoted and believed by so many people? The answer is one word…homeopathy.
hCG in water is so wrong for so many reasons
“Modern homeopaths actually preach that liquid chemical solutions (minus the chemicals) are as powerful as the chemicals themselves, because of water's powerful ability to 'remember' what it was supposed to do.  Confused yet?  In some parallel dimension, it actually makes sense.  On the bright side, homeopathic preparations usually have the same side effects as water does.  Go figure.”
(ref: http://healthwyze.org/index.php/component/content/article/449-the-hcg-diet-scam-exposed.html)
It turns out that hCG is a prescription drug and cannot be sold to consumers directly. So oral hCG is actually homeopathic hCG. It is a solution that used to have hCG in it, but through a series of increasing dilutions (which homeopathic believers claim actually make their product stronger), a type of water is created that has no measurable quantity of hCG in it any longer, thus no requirement for a prescription. The water remembers the hCG and when introduced into the body, will provide the same benefits as hCG injections. Of course it will.
Someone, please pick me up off the floor, please someone help me! This is absolute nonsense! How can any reasonable, logical person believe this garbage? The battle for the hCG weight loss patient has gotten so bad that the hCG clinics who promote the useless injection method are now attacking the hCG clinics who promote the even more worthless oral hCG preparations! (http://www.diet-hcg.com/).
Enough said about the hCG diet!

Saturday, January 8, 2011

Emergency Contraception

also referred to as the “morning after pill”
[Portions of his article are from the May, 2010 ACOG Practice Bulletin (American College of Ob/Gyn, Practice Bulletin number 112, May 2010)]
A single act of unprotected intercourse -- if it occurs around the time of ovulation -- is associated with about a 1 in 6 chance of the woman becoming pregnant. If pregnancy is not desired, then one option is the use of the morning-after pill, also referred to as emergency or post-coital contraception.
The two most common reasons to consider post-coital contraception involve condom failure (it broke, or was used incorrectly, during intercourse) or not using contraception at all (unprotected intercourse).
There are 2 FDA approved products that can be used for emergency post-coital contraception. One is the original Plan B, which is being phased out and replaced by the company with a newer version called Plan B One-Step.
Plan B One-Step is a single pill containing a high dosage of a progesterone-like hormone (called a progestin). Plan B One-Step can be taken up to 72 hours after the act of unprotected sex and is about 85% effective in preventing a pregnancy that would otherwise have occurred. One study showed effectiveness even when taken up to 120 hours after unprotected sex. It is thought to work by changing the uterine lining so that the fertilized egg will fail to implant or by delaying ovulation but experts disagree on the mechanism of action.
There are possible side effects, usually mild, that include: cramping, bloating, breast tenderness, spotting, headache and nausea. There is also the possibility of a continuing pregnancy, and the rare chance of an ectopic pregnancy. If you do not get your period about 2 weeks after taking Plan B One-Step, you should perform a home pregnancy test. If you remain pregnant, it is important to know that Plan B One-Step is not known to be a cause of birth defects.

If you are 17 or older, Plan B One-Step can be purchased without a prescription, but usually you have to request it at the pharmacy counter. Persons under age 17 are required to have a doctor’s prescription. The original Plan B is the same product except there are 2 pills. They are taken 12 hours apart and together contain the exact same dose of progestin as the single pill of Plan B One-Step.
The “morning after” Pill should not be used as a routine form of birth control due to the higher failure rate compared to other forms of birth control such as the birth control Pill, condoms and IUD’s. This approach also provides no protection from STD’s or HIV. For the rest of the cycle, you should use condoms to prevent the chance of becoming pregnant later in the same cycle.

Friday, January 7, 2011

Is Vitamin D the Next Big Thing?

It is common knowledge that Vitamin D is important for strong bones. We have heard this since we were kids. Drink your milk, it’s fortified with Vitamin D! But the past few years has witnessed an outpouring of new information and new claims for Vitamin D such as: “it will boost your immune system” and “it can help prevent cancer” and the universal “most Americans are Vitamin D deficient."
Vitamin D is Big Business.
In 2008, consumers bought $235 million worth of vitamin D supplements, up from $40 million in 2001. Some experts, though, are starting to sound alarms about the boom in testing, which has been increasing by 80 to 90 percent per year, with several million people expected to be checked in 2010.
Here are some useful facts about Vitamin D. Once you know the facts, you may not be surprised to learn that (oh my!) there has been a lot of hype about this essential but unfortunately, not miraculous vitamin.
What exactly is Vitamin D?
There are 2 forms of Vitamin D in the body. Vitamin D2 (called ergocalciferol) and Vitamin D3 (called cholecalciferol). Both of these forms still have to be converted by the liver into the biologically active form, called calcitriol. Direct sun exposure to our skin enables humans to produce Vitamin D3 (not D2).
How do we measure Vitamin D in the blood?
In the blood we test for a form of Vitamin D called calcidiol (also called 25-hydroxy Vitamin D). Calcidiol is converted into calcitriol, the active form of Vitamin D (also called 1,25-hydroxy Vitamin D). Levels are reported as nanograms per milliliter (ng/ml). The normal range varies depending on the lab. Low Vitamin D might be less than (<) 18 ng/ml in one lab or < 30 ng/ml in another lab.
What does Vitamin D actually do in the body?
Vitamin D is necessary for the body to be able to absorb calcium in the intestines. It is also needed to help regulate the blood levels of calcium and phosphorous in the body. A deficiency of Vitamin D causes rickets; a disease characterized by extremely soft bones and bent legs. In the U.S. this is a rare disease, but it's not so rare in poorer countries.
What is the daily dose of Vitamin D supposed to be?
The recommended daily dose of Vitamin D is 400-600 units (higher for the elderly and lower under age 1). High doses can lead to toxicity, characterized by nausea, vomiting and hypercalcemia (elevated calcium in the blood that can cause seizures and kidney stones). Doses of 1,000 units per day given to an infant can lead to toxicity in 1 month. Units are also called IU for International Units.
Sun-exposure Vitamin D production
If you're fair skinned, experts say going outside for 10 minutes in the midday sun -- in shorts and a tank top with no sunscreen -- will give you enough radiation to produce about 10,000 IU of the vitamin. But in winter there is not enough UV-B radiation for most people to produce Vitamin D, even with good sun exposure.
Naturally occurring Vitamin D
A great source of both Vitamins A and D is cod liver oil (1 Tbsp. contains 1,400 units!). Fish such as salmon, catfish, sardines and tuna are rich sources, providing about 300 units of Vitamin D per 3 oz. portion. Interestingly, a quart of milk provides only 400 units of D. Human breast milk is naturally quite low in Vitamin D. Also, almost no vegetables, fruits or nuts contain Vitamin D (small amounts are in mushrooms).
Can Vitamin D prevent cancer?
Many studies have looked at this. Vitamin companies heavily promote this and advise people to take high doses, 1,000 to 2,000 units a day, to try and prevent cancer. The boring truth…there is no proven cancer protection benefit from high Vitamin D, and there IS a proven risk.
What are the other supposed benefits of Vitamin D?
Some studies showed a lower risk of dying from cancer, any kind of cancer. Some showed a boost to the normal immune system, and a lower risk of getting the flu. Others show reduced risk of diabetes and heart disease and high blood pressure. None of these studies are considered proof.
What is proven about Vitamin D?
When Vitamin D supplements were given to elderly nursing home residents, along with a calcium supplement, there were fewer bone fractures in the treated group. Vitamin D and calcium can help prevent osteoporosis, likely due to fixing a deficiency, rather than any benefit from megadoses.
Psoriasis Treatment
A team of scientists at Boston University School of Medicine, determined that topical Vitamin D could be used for the treatment of psoriasis. Initial experiments with vitamin D hormone have shown that topical applications of the hormone are remarkably effective. In 1994 the U.S. Food and Drug Administration approved a vitamin D-based topical treatment for psoriasis, called calcipotriol (Dovobet).
The hype
The promising benefits of high vitamin D amounts were demonstrated in studies that simply looked at vitamin D levels in various populations and then correlated them with disease. But, people need to realize that high levels of vitamin D in the bloodstream may just be due to good genes or some other factor beyond sun exposure or dietary intake. This is not proof of any beneficial effect.
Experts advise us not to “...jump on the bandwagon and take megadoses before we have results from research trials.” After all, a host of supplement studies—on vitamin C, vitamin E, selenium, beta carotene—found that those who were given supplements fared no better, and sometimes worse, than those who took placebos.
Summary
Yes, we all need adequate Vitamin D intake, but the evidence for additional health benefits from taking high doses is just not there. Food can provide enough Vitamin D but supplements work just as well and vegans have to take supplements. Milk is actually a poor source of Vitamin D because very few people will drink one quart of milk per day to get their 400 units! Be wary of the "emergency" need to supplement with 50,000 units of D just because your blood level is below 30 ng/ml. Many experts believe that levels above 18 ng/ml should be considered normal.