Category Archives: Women’s Health

Websites for Wellness: Health Information in the Digital Age

Which websites do you turn to for health information? There are thousands of healthcare sites offering advice, but a sizable portion are either trying to sell you something you don’t need or simply do not provide evidence-based recommendations. I’ve researched many websites throughout my career as a physician, and I’d like to share with you my favorite websites for health and wellness information.

General medical information

My favorite sites for everyone

  • www.familydoctor.org – My first stop for general health information would be the patient website of the American Academy of Family Physicians (AAFP).
  • www.nlm.nih.gov/medlineplus – Also good are several websites run by various U.S. government agencies, especially the National Institute of Health’s MedlinePlus database.
  • www.cdc.gov – I also love the United States Centers for Disease Control’s (CDC) site.
  • www.mayoclinic.com – Lastly, the famous Mayo Clinic website is extremely user-friendly.

All of these sites provide well-written, straightforward articles, videos and slideshows on thousands of topics, many with an emphasis on wellness and prevention.

For the medically-minded

  • www.uptodate.com/patients – Those who want more detailed and technical articles can find outstanding patient handouts from the UpToDate group. The website is probably the medical world’s most esteemed source for medical information and is, by far, my most valuable website for my practice. All of United Family Healthcare hospitals subscribe to this essential database. The Pro version is expensive, but their patient handouts are free and very detailed, even though it is less user-friendly than other websites.
  • www.medscape.com – You can also find free doctor-level articles at the physician website Medscape which is an umbrella group of the consumer-oriented WebMD.com.
  • www.cochrane.org/cochrane-reviews – If you want pure evidence-based data, you can peruse the world’s top collection of meta-analyses at the Cochrane Collaboration’s website.

For medical site rankings

When you’re looking for trustworthy websites, one tip to screen out the biased sites is to use the HonSearch engine at Health on the Net (www.hon.ch). This Swiss non-governmental organization independently rates thousands of websites for trustworthy, evidence-based content, and their search results only highlight approved sites.

For parents

General

  • www.familydoctor.org – My favorite, parent-friendly website is still the AAFP.
  • www.healthychildren.org – My second choice is the American Academy of Pediatrics’ (AAP) excellent, new, family-friendly website that focuses mostly on wellness and prevention at different ages. Their main website (www.aap.org) also has a large list of “Health Topics” that provide authoritative answers to many basic questions.

Vaccine Information

Those of you looking for vaccine information should avoid the thousands of distracting anti-vaccine websites and go straight to the trusted sources: governmental centers for prevention and disease control.

  • www.cdc.gov/vaccines – At the U.S. Centers for Disease Control’s website you can find the latest official schedules for vaccines for all ages, as well as valuable information on vaccine safety. The AAP and AAFP websites above also have extensive information on vaccines.
  • www.cdc.gov/parents – Other top sites for parents include the CDC’s special “Parents” section.
  • www.nlm.nih.gov/medlineplus/childrenshealth.html – MedlinePlus also has an informative section on vaccines and children’s health.

Medicines and supplements

For basic information on both prescription and over-the-counter (OTC) drugs, the Mayo Clinic’s website is a great choice, as is MedlinePlus (both links above). If you’re searching for credible information on supplements and vitamins, I trust very few websites.

  • http://naturaldatabase.therapeuticresearch.com – My first choice, by far, is the Natural Medicines Comprehensive Database. This website is the best source of evidence-based and unbiased data on every herb, supplement and vitamin you would ever use. There’s a small monthly fee, but they also have a huge list of free and incredibly useful articles on the front page (look for “Clinical Management Series”). You can also find much of their information for free at MedlinePlus, which licenses access to their data.
  • www.consumerlab.com – Once you know what OTC medicines and supplements you want, you can search for the best brands from the independent testing center ConsumerLab. Their website is full of useful tidbits on all supplements and vitamins. There is a fee to access their detailed reports, but it’s definitely worth it for anyone interested in supplements.
  • www.iherb.com – When you’re ready to buy supplements, my favorite online shopping site is definitely iHerb – a one-stop shop for supplements with a well-earned solid reputation. Many expats in China use this U.S.-based website to order not just supplements, but other natural products like Tom’s of Maine toothpaste. The prices are extremely reasonable, and items are delivered door-to-door within two weeks from the U.S. via EMS at very reasonable shipping fees and no customs hassle that we have heard of to date.

Alternative medicine

Many of us are interested in complementary treatments – such as acupuncture and traditional Chinese medicine – but it’s very difficult to find credible sources online. One trustworthy start is the U.S. government’s National Center for Complementary and Alternative Medicine at http://nccam.nih.gov. The Cochrane Database also has excellent meta-analyses of many alternative treatments. Of course, for any herbal information, the Natural Medicines database is another great resource.

Travel information

When planning your next big Asian vacation, it’s always important to quickly find out which vaccines you may need, or whether you may need pills, such as malaria prophylaxis. Before seeing your doctor, first go to the website most of us use: the CDC’s travel website at www.cdc.gov/travel. Choose your country from the pull-down menu, read their comprehensive reports discussing vaccines or medicines you may need, and your visit with the travel doctor will be much more productive and efficient.

Public health issues

Many of us have more China-specific questions about air quality, food safety and other environmental issues.

  • www.cfs.gov.hk – For food safety, my favorite website is the Hong Kong Centre for Food Safety. It has an enormous collection of useful bilingual reports and newsletters on food safety, most of which is just as relevant for mainland China as for Hong Kong.
  • www.myhealthbeijing.com – For information on air pollution as well as other expat-specific health and wellness information, especially in Beijing, I humbly recommend my own website. As China’s most popular expat health website over the past three years, I provide an easily searchable collection of hundreds of articles focusing on evidence-based tips for wellness and disease prevention. I’m very proud that my website is officially certified by the above-mentioned Health on the Net Foundation as a trustworthy source of health information.

 


This article was originally printed in the summer 2012 edition of Health Matters, my hospital’s quarterly magazine. You can access our archives here. To instantly read that summer edition, click here

Pain Relief For Kids: A Guide To Proper Dosing

Treating a fever in a child still uses the same two medicines for decades: ibuprofen (Motrin, 布洛芬) and paracetamol/acetaminophen (Tylenol, Panadol, ). But dosing is actually really tricky, as there are different concentrations for infants and toddlers, and it’s all too easy to give too much or too little. This was such a problem in America that those separate mixtures were banned a couple years ago, and now there is only one size. But in China we still have the issue of the two concentrations. Plus, there’s the added problem that the recommended dosing on the boxes is a bit on the conservative side, compared to recommended doses from the manufacturer or most Western pediatricians.

In general, the rules are fairly easy: think 10. As in 10 milligrams per kilogram per dose (which again is fairly easy, at 4-6 hour intervals for both). That’s the general dose for both medicines, although the range varies (4-10 mg/kg for ibuprofen, 7-15 mg/kg for acetaminophen). The problem then lies with each mixture, which offers different milligrams per milliliter. Instead of explaining each level, here’s a much better guide: I’ve uploaded a big image below with exact dosing of both medicines at most weights, provided by the great pharmacy team here at BJU. You can click on the image to get a larger, printable image and keep a copy in your medicine cabinet. Please note that our pharmacists recommend acetaminophen at 15 mg/kg and ibuprofen at 10 mg/kg.

As for which one I prefer, I’ve mentioned a few times that reviews show that ibuprofen lowers fever better than acetaminophen, and for longer duration. Here’s the conclusion from the research review:

CONCLUSIONS:
In children, single doses of ibuprofen (4-10 mg/kg) and acetaminophen (7-15 mg/kg) have similar efficacy for relieving moderate to severe pain, and similar safety as analgesics or antipyretics. Ibuprofen (5-10 mg/kg) was a more effective antipyretic than acetaminophen (10-15 mg/kg) at 2, 4, and 6 hours posttreatment.

Also, don’t forget to use official measuring spoons and droppers as studies showed a wide range of dosing errors when parents rely on teaspoons and tablespoons.

Pediatric Acetaminophen and Ibuprofen Dosing Guide By Weight
Pediatric Acetaminophen and Ibuprofen Dosing Guide By Weight

 

 

 

What’s All The Fuss About Sunscreen Danger?

oxybenzone skin cancer safetyI’ve noticed a big increase this summer in news reports about “dangerous” sunscreens, so I’ve been digging around to find out what the fuss is about. Apparently this media fuss starts each spring with the annual sunscreen report from the Environmental Working Group. They’ve claimed for years that two of the most common ingredients in sunscreens, oxybenzone and vitamin A (retinyl palmitate), are harmful to health and thus shouldn’t be included in sunscreens. But these allegations have been vehemently denied by many professional groups around the world. So what’s the real story here?

The main issues are the research studies that the EWG sources as evidence of the chemicals’ dangers. For example, on their web page describing oxybenzone’s dangers, they state toxic issues with “hormone disruption 19-22; reproductive effects and altered organ weights in chronic feeding studies 23; high rates of photo-allergy 24; limited evidence of altered birth weights and increased odds of endometriosis in women.” You can slowly use Pubmed to check their references: 19 – Schlumpf 2001. 20 – Schlumpf 2004. 21 – Schreurs 2007. 22 – Ma 2003. 23 – NTP 1992. 24 – Rodriguez 2006.

But the bottom line is that the EWG’s interpretation of this collective data from their handful of articles are not endorsed by any large group of physicians or scientists , and there are many more articles, especially in human trials, which provide far more proof of safety than harm.And no matter how many press releases the EWG gets, I am definitely not in agreement with the EWG’s allegations, and their opinion is far from medical consensus. Both these chemicals have been, and continue to be, approved as safe by the US, the EU and Canada even after 20+ years of usage. The American College of Dermatology has a new statement this summer restating their support of these two ingredients:

Oxybenzone provides effective broad-spectrum protection 
Oxybenzone is one of the few FDA-approved ingredients that provides effective broad-spectrum protection from UV radiation, and has been approved for use since 1978. “Available peer-reviewed scientific literature and regulatory assessments from national and international bodies do not support a link between oxybenzone in sunscreen and hormonal alterations, or other significant health issues in humans,” stated Dr. Siegel. “The FDA has approved oxybenzone in sunscreen for use on children older than six months, and dermatologists continue to encourage protecting children by playing in the shade, wearing protective clothing and applying broad-spectrum sunscreen.”

Retinyl palmitate helps protect against aging
Retinyl palmitate, is a form of vitamin A (retinol), but is not an active drug ingredient in sunscreen. When used in sunscreen, retinyl palmitate serves cosmetic purposes as an antioxidant to improve product performance against the aging effects of UV exposure, or to enhance product aesthetic qualities. Despite recent concerns from in vitro (test tube) studies and one unpublished report using mice, “topical and oral retinoids are widely prescribed to treat a number of skin diseases, such as acne and psoriasis, and there is no published evidence to suggest either increase the risk of skin cancer in these patients,” said Dr. Siegel. “In fact, oral retinoids are used to prevent skin cancers in high-risk patients such as those who have undergone organ transplantation.”  Dr. Siegel also added that “unlike more potent prescription forms of vitamin A, there is no evidence to suggest that use of sunscreen with retinyl palmitate poses comparable risks.”

I couldn’t find one article by any reputable source or medical journal which supports any of the EWG’s allegations. But I sure found a lot of support for these chemicals. For example, there’s a 2011 review paper which showed that “topical use of sunscreen protects against squamous cell carcinoma, does not cause vitamin D deficiency/insufficiency in practice and has not been demonstrated to adversely affect the health of humans.” The Skin Cancer Foundation, a worldwide group of doctors, also has an excellent rebuttal of the EWG’s findings:

Oxybenzone may be a carcinogen

Old research on rodents suggested that oxybenzone, a synthetic estrogen, can penetrate the skin, may cause allergic reactions, and may disrupt the body’s hormones, producing harmful free radicals that may contribute to melanoma. However, there has never been any evidence that oxybenzone, which has been available for 20 years, has any adverse health effect in humans. The ingredient is FDA-approved for human use based on exhaustive review. The Foundation’s volunteer Photobiology Committee reviewed the studies on oxybenzone and found no basis for concern.

Retinyl palmitate (a form of vitamin A) causes skin cancer

The Environmental Working Group cites an FDA study for this data, and faults the FDA for not releasing the study. However, the FDA is yet to release the study precisely because it has not gone through proper peer review. Thus, the EWG based its criticisms on an unapproved 10-year-old study of mice that has never been published in any journal. To date, there is no scientific evidence that vitamin A is a carcinogen in humans. What’s more, only trace amounts of retinyl palmitate appear in sunscreens, and some evidence suggests that it is actually protective against cancer.

Sometimes the EU is “ahead” of the US in terms of consumer health, but the EU also allows both these substances, as does Canada. Yet another source, this time from the European Commission’s scientific committee review of oxybenzone, in their wonderfully geeky and detailed 2008 review of the best research, officially concluded that “the use of benzophenone-3 as a UV-filter up to 6% in cosmetic sunscreen products and up to 0.5% in all types of cosmetic products to protect the formulation does not pose a risk to the health of the consumer, apart from its contact allergenic and photoallergenic potential.” To be even geekier, the same review does confirm that some oxybenzone is absorbed:  “under the experimental conditions reported, around 3-4 % (between 7-18 μg/cm²) of BP-3 (depending on the concentration in the formulation) penetrated the skin samples during 24 hours and therefore can be considered as bioavailable.” But the key is that there was no harm found from this: their cytotoxic study showed “the human viable epidermal levels of sunscreens were too low to cause any significant toxicity to the underlying human keratinocytes.” As for the EWG’s accusation of hormonal problems, a study in humans found “there was no biologically significant effect on hormone levels (TGB, TSH, T4 total, T4 free, T3 total, T3 free), indicating that the concentrations of sunscreen compounds absorbed were not capable of disturbing the homeostasis of thyroid hormones in humans.” As regards the reported estrogenic potential, the EU’s 2001 review of studies concluded “no estrogenic effects that could potentially affect human health.” They also quote a 2004 study on humans which concluded that “exposure of the sunscreen containing 10% Benzophenone-3 caused no effect on either of the examined hormones (FSH, LH, SHBG, estradiol, inhibin B, testosterone).”

My Bottom Line

I’ve worked hard to earn and keep my website’s HONCode status as a trustworthy source of evidence-based health information, so there’s no way I could support the EWG’s unproven allegations of sunscreen danger from oxybenzone and vitamin A. My favorite sunscreens are Neutrogena’s Dry Touch series which include oxybenzone, and I have no intentions of switching brands, nor do I tell my patients to do so. I’m far more worried about the extremely well documented risks of no sun protection, and I continue to believe that oxybenzone is an excellent and safe broad-spectrum lotion against UVA and UVB. If you’re still worried, especially for your child, you can stick to brands which only have zinc or titanium, which all agree are safe and effective.

I’m not always against the EWG’s campaigns and I’ve often promoted their “Dirty Dozen” list of pesticides in produce. Nor am I against the concept of hormonal disruptors as I’ve often blogged about the dangers of some plastics as endocrine disruptors. But I must agree with my colleagues that the EWG is scaremongering, and I find it hard to accept other doctors blogging that “scientists recommend not using sunscreens containing oxybenzone on children because of this hormone disruption” when there is absolutely no such warning from the American Academy of Pediatrics, the American Academy of Family Practitioners, or the US FDA.  I’m especially astonished that the EWG would allege that vitamin A is bad for the skin, since every primary care doctor and dermatologist knows that prescription vitamin A skin creams and pills are an essential tool which have helped millions of people with their acne, with no reports of increased skin cancers.

Honestly, how can the EWG get so much press every year and keep pushing this issue with so little hard evidence, and in stubborn refusal to reassess the much stronger evidence against their position?

High Cholesterol: Which Diet Tips Actually Work?

Fast Food

I do a lot of health checks in my family clinic here at BJU, and a large percentage have problems with their cholesterol tests. Since high cholesterol is one of the major risk factors for heart disease, I focus a lot of my time with them on proper diet. But what is a proper diet, exactly? We hear so many crazy diet tips from so many sources, but what are the proven high-yield foods that people should focus on?

First, most sources agree on the most high-yield foods: nuts; fish; fiber; olive oils; and plant sterols/stanols. How much does each group benefit? Find out in the graph below from the Natural Medicines Comprehensive Database, my perennial favorite website for evidence-based supplement research:

Summary of the Lipid Effects of Various Drugs on Hyperlipidemia
Summary of the Lipid Effects of Various Drugs on Hyperlipidemia

The NMCD has written a great free article on which natural products work to improve cholesterol. As you see below on their Recommendation Chart, their green area of “Likely Safe + Effective/Likely Effective” has quite a few products, including fish oil; barley, beta-glucans, blond psyllium, niacin, oat bran, and plant stanols and sterols:

Natural Medicines To Treat High Cholesterol
Natural Medicines To Treat High Cholesterol

My personal tips for anyone who has high cholesterol, even if they take medicines, are these:

  • Eat more nuts — a few servings a week can help more than you think. Look at the chart above: walnuts can lower total cholesterol by 8-16%
  • Eat fatty fish (salmon or sardines) at least twice a week, more if you can get it. Fish oil can lower triglycerides an amazing 20-50%, and most likely has overall benefit to your heart. I’m a big fan of fish oil for everyone in the family.
  • Fiber, fiber, fiber! Fiber can lower total cholesterol 5-26%. Fiber is especially important for breakfast: even the fiber from Cheerios can help, but oatmeal, muesli, or dark breads also are a better source. And don’t forget that fruits and vegetables also have a lot of fiber.
  • Improve your breakfast. The worst offenders usually have a very American breakfast of eggs and meat. A far healthier choice would be some fiber (dark bread, muesli, oatmeal) with a cup of yogurt and fruit. Want some sugar? Pour honey into non-sweetened yogurt. Did you know a yogurt a day also helps keep your weight down?
  • Think brown over white. If you must eat your pasta, rice and breads, at least try to switch from lily-white versions to the darker ones. Pick any, I don’t care — all brown grains have more fiber and nutrients than the ultra-processed white grains. This also has the added benefit of decreasing your risk of getting diabetes.
  • Switch to olive oil. We all need some fat in our diet, but there are good fats and bad fats, and it’s hard to beat olive oil for better health.
  • Avoid trans-fats. Trans-fat definitely tops the list of bad fats. This issue fortunately has received a lot of media exposure, but many cookies and snacks still contain a lot of this unnatural and artery-clogging fat. Take a look at your labels, which now require details about trans fats.

If you want more information, you can read a lot of healthy tips at the Mayoclinic website, as well as a patient handout from UpToDate.

Red Meat: Not So Good For Your Heart. Here’s More Proof

Red meat cow cardiac disease

A couple years ago I wrote a post discussing data showing how some red meats are bad for your heart; now a major new study again confirms this concept. This huge study from the Harvard School of Public Health analyzed data from 2 studies which followed 120,000 people over 20 years. They found that the more red meat people ate (especially processed meats) the more people died from heart disease. Here’s a nice summary from the very cool Meatless Mondays website:

…They discovered just one 3-ounce serving of red meat daily (about the size of a deck of playing cards) was associated with a 13% greater chance of dying over the course of the study. What’s more, participants who consumed daily servings of processed meats like hot dogs and bacon were at 20% higher risk of mortality. As the amount of meat consumed increased, so did the risk of death.

Conversely, replacing beef and pork with a serving of nuts, legumes, whole grains or low-fat dairy seemed to improve longevity. Nut consumption was linked to a 19% lower risk of dying during the study, whole grains with a 14% reduction, and beans and dairy with a 10% decrease in mortality.

“Any red meat you eat contributes to the risk,” An Pan, a postdoctoral fellow and lead author of the study told the LA Times, “If you want to eat red meat, eat the unprocessed products, and reduce it to two or three servings a week,” he said. “That would have a huge impact on public health.”

Dr. Dean Ornish, a UC San Francisco researcher and author of an editorial that accompanied the study in the Archives of Internal Medicine, agrees, suggesting that red meat lovers can reduce their risk by cutting meat one day a week. “Something as simple as a Meatless Monday can help,” he said. “Even small changes can make a difference”

I discuss this article on my March 14th weekly radio interview on EZFM’s Beijing Hour. Paul and I also discuss a Xinhua news report discussing the lastest campaign to decrease the massive overuse of antibiotics in Chinese hospitals.

Click on the arrow below to listen to this podcast, or click here.
[podcast]http://66.147.244.109/~myfamio6/myhealthbeijing/wp-content/uploads/2012/03/031407_CUT.mp3[/podcast]

More Podcast Information

You can listen to all my previous podcasts at my podcast archive. You can always listen live to my radio interview each Wednesday around 7:35am Beijing time, on the Beijing Hour program on EZFM 91.5, which is broadcast from 7-8am every weekday by host Paul James. EZFM is the popular bilingual radio station on the China Radio International network, broadcasting here in Beijing and on multiple stations all over the world, as well as live online.

There’s a Good Reason You Can’t Lose Weight: Your Hormones Won’t Let You

obesity leptin ghrelinObesity is a major health crisis all over the world now, and it’s clear both to patients and to doctors that losing weight — and keeping it off — is incredibly difficult. Unfortunately there’s growing evidence why this is so: when you diet, your body’s hormones go into a permanent “fasting” state which never really reset after the ideal weight is achieved. The balance of hormones leptin and ghrelin basically make a dieter feel permanently hungry, and over 90% of dieters regain the weight they had shed, returning to their “new normal”. What this means for most people is twofold:

  • they shouldn’t beat themselves up for not losing weight because it’s biologically difficult;
  • it’s so much better never to be obese in the first place, as once you’ve gained the weight you’ll have major troubles losing it.

This provocative idea now has some serious research,  including one study covered here by one of Gina Kolata’s many excellent articles on obesity in the New York Times. She also had an outstanding, moving article called The Fat Trap last year which I highly recommend for anyone concerned about their weight. I discuss this concept on my March 8th radio discussion on EZFM; you can click on the links below to listen.

In this podcast we also discuss a Xinhua article discussing yet another study linking air pollution to cancers; this large study focused on diesel fumes causing lung cancers in miners in the US. Diesel pollution is a major issue here in China as well, so the health implications are all too relevant for us.

Click on the arrow below to listen to this podcast, or click here.
[podcast]http://66.147.244.109/~myfamio6/myhealthbeijing/wp-content/uploads/2012/03/030707_CUT.mp3[/podcast]

More Podcast Information

You can listen to all my previous podcasts at my podcast archive. You can always listen live to my radio interview each Wednesday around 7:35am Beijing time, on the Beijing Hour program on EZFM 91.5, which is broadcast from 7-8am every weekday by host Paul James. EZFM is the popular bilingual radio station on the China Radio International network, broadcasting here in Beijing and on multiple stations all over the world, as well as live online.