Q: What diagnostic test should I have that my doctor and I may have overlooked?
A: It’s the ankle-brachial index test (ABI), says Sharonne N. Hayes, M.D., a specialist in cardiovascular diseases. “ABI is a quick, noninvasive but underutilized way to check your risk of peripheral artery disease, a condition in which the arteries of your legs or arms are narrowed or blocked, which implies a high risk for heart attack and stroke.” Another useful measurement is waist circumference: A high-risk number for a man is more than 40 inches; for a woman, more than 35 inches. Where you accumulate fat is probably more important than the amount of fat; too much belly fat puts you at high risk for type 2 diabetes and heart disease, even if you have a normal body mass index. “And no,” says Dr. Hayes, “liposuction or a tummy tuck does not reduce risk. The problem we’re talking about is called visceral fat inside the abdomen, unlike the subcutaneous potbelly or saddlebags that could be removed with cosmetic surgery. That is the fat that increases risk, and the only way to get rid of it is to lose weight.”
Q: Will doing crossword puzzles or other brain activities protect against dementia?
A: “The lifestyle factor that has the most evidence for preventing dementia is exercise,” says Donald D. Hensrud, M.D., chairman of Preventive, Occupational and Aerospace Medicine. Some studies have shown that brain-challenging activity helps preserve cognitive function, but there’s not a lot of real proof that it works or which types of challenges are best. Anything that’s good for the heart—like exercise and proper nutrition—is generally good for the brain, says Brent A. Bauer, M.D., director of the Complementary and Integrative Medicine Program. “But I also encourage my patients to develop a formal stress management program—meditation, guided imagery, yoga or one of the many mind-body practices widely available. Intriguing studies show that people who engage in daily, long-term stress management practices actually have less brain shrinkage with aging. While I don’t make any promises that it will prevent dementia, it is something that has good science behind it, is inexpensive, can be done by anyone, and even if it doesn’t help the brain, there are lots of other documented health benefits.” One other thing that Dr. Bauer recommends is to have your vitamin D level checked. “There are several trials that suggest low vitamin D may be associated with increased risk of dementia,” he says, “and since low vitamin D is related to other health risks such as osteoporosis, it’s worth taking.”
Q: Why does it seem that some people lose weight on a high-protein diet while conventional wisdom says that a calorie is a calorie?
A: “The vast majority of data does support that a calorie is a calorie, with some caveats,” says Dr. Hensrud. “People tend to underestimate the calories they consume, and this effect may be more pronounced among those trying to lose weight. One recent study showed that there may be small differences in energy expenditure—how many calories you burn—depending on the type of food you eat. And protein does seem to have an effect of increasing satiety.”
Very low-carb/high-protein diets cause water-weight loss and put the body into a different metabolic state called ketosis, so that it burns its own fat for fuel; that reduces appetite and helps someone adhere to a diet, says Dr. Hayes. In several studies comparing different diets, early weight loss is sometimes faster with the high-protein diet, but long-term loss (after six months) is similar. “It’s an initial advantage that isn’t maintained,” says Dr. Hayes. “And unfortunately, neither a high-protein nor a low-fat diet is sustainable for most people. The quit rates for all diets are the same.”
Q: Does stress really cause ulcers?
A: “Only very rarely,” says Dr. Hayes. “And it’s usually in people who are already very ill, on multiple meds or in the hospital. The vast majority of ulcers are caused by an infection called Helicobacter pylori. The next most common cause is the use of drugs that damage the stomach lining such as aspirin or ibuprofen.”
And yet it’s not surprising that Dr. Bauer has another answer from the world of integrative medicine. “What we can say with some clarity is that the mind and body are clearly connected. For a long time, science tended to think of the two as separate entities, but we now know that stress can suppress immune function, increase inflammation, slow wound healing, raise the risk of heart disease and diabetes and even impact our genes. What is interesting is how stress manifests so differently in different people. One person may develop migraines, another may experience a heart attack, while another gets more colds. In this milieu of responses, that some people develop ulcers in part due to stress is very probable.”
Q: Are multivitamins good for you?
A: Not really, says Dr. Hayes. “If someone has a vitamin deficiency, or a very poor diet, there may be some benefit or indication. But the vast majority of studies that have looked at multivitamins—or even higher doses of individual nutrients and vitamins like beta-carotene, calcium, vitamin E or folate—have shown no benefit and, in some cases, harm. It all comes down to reemphasizing the need to eat a wide variety of fruits and vegetables and to get one’s nutrients from food, not supplements.”
“This is a controversial area,” says Dr. Hensrud. “One recent trial showed some protection against cancer, although not against any specific cancers. Overall, the evidence seems to suggest more harm than benefit, while a healthy diet is associated with a very large potential to prevent disease.”
Q: Should I refuse those new airport scanners and opt for a pat-down?
A: “At this point, there is no direct evidence that they cause harm,” says Dr. Hensrud. “The amount of radiation is miniscule for an individual and much less than the radiation experienced at altitude when flying.” But he is looking forward to the results of a study about the health effects of these scanners (called backscatter machines) being conducted by the TSA with the National Academy of Sciences.