Have you had a milky day today?

Valley of the Kings, on the west bank of the Nile in Egypt. (Dr. Noorali Bharwani)
Valley of the Kings, on the west bank of the Nile in Egypt. (Dr. Noorali Bharwani)

Is milk good for you?

The answer depends on who you talk to. If you have milk allergy then of course it is not good for you. If you have no allergy then why wouldn’t you drink milk?

“America’s iconic ‘Got Milk?’ campaign was pulled this year (2014) after a successful run of over 20 years. Graced by the likes of Bill Clinton, Naomi Campbell, Elton John, David Beckham, and Angelina Jolie sporting a milk moustache, the campaign garnered wide recognition. Yet milk was losing favour against a growing variety of breakfast and drink options,” says Dr. Anita Jain, India editor of the British Medical Journal (BMJ October 29, 2014).

Now the dairy industry is focused on promoting milk as rich in protein content. Protein is good for you. Milk has long been promoted as a source of protein and calcium essential for bone health. The evidence, though, on the health benefits of milk consumption is scant and divided, says the BMJ article.

Milk continues to be a controversial dietary recommendation. There are not just health risks and benefits to be considered, but often also the availability and feasibility of consuming milk against deriving necessary nutritional value from other foods.

With growing public interest in a vegan diet, the morality of consuming dairy products presents a new angle too, says Jain. A vegan diet is one that consists of only plant-derived foods. Vegans do not use or consume any animals or animal products including milk.

Many asthmatics perceive their asthma is worsened by drinking milk. There is no scientific evidence to confirm that.

There is no evidence that milk leads to excessive mucus secretion. It does not make saliva thick. These unscientific controversies make people forget that milk is an important source of calories, calcium and vitamins for children.

What is the difference between milk allergy and lactose intolerance?

Milk allergy usually shows up early in life. It’s one of the most common food allergies in children. Cow’s milk is the usual cause of milk allergy, but milk from sheep, goats, buffalo and other mammals also can cause a reaction. Milk allergy is a true food allergy caused by an allergic reaction to the protein in milk.

Lactose intolerance is caused by not having enough of the enzyme lactase, which is needed to break down lactose, the sugar found in milk and other dairy products.

Why is it important to drink milk?

Government of Canada food guide website says having milk or fortified soy beverages every day provides the nutrients that you need for healthy bones and optimal health. It recommends the following:

  1. Drink skim, one per cent or two per cent milk each day.
  2. Have 500 mL (2 cups) of milk every day for adequate vitamin D.
  3. Drink fortified soy beverages if you do not drink milk.
  4. Select lower fat milk alternatives.
  5. Compare the Nutrition Facts table on yogurts or cheeses to make wise choices.

Yes, milk is good for you. Bill Clinton, Naomi Campbell, Elton John, David Beckham, and Angelina Jolie cannot be wrong! Every day ask yourself: Have I had a milky day today?

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Food wastage is costing Canadians billions of dollars.

The Mike O'Callaghan–Pat Tillman Memorial Bridge, a key component of the Hoover Dam Bypass project. (Dr. Noorali Bharwani)
The Mike O'Callaghan–Pat Tillman Memorial Bridge, a key component of the Hoover Dam Bypass project. (Dr. Noorali Bharwani)

More than $31 billion worth of food is wasted every year in Canada. When energy, water and other resource costs are factored in the true cost could be up to three times that much (CBC News, Dec 11, 2014).

The Canadian Food Inspection Agency produces a Guide to Food Labeling and Advertising that sets out a “Durable Life Date”. The authority for producing the guide comes from the Food and Drugs Act. The guide sets out what items must be labeled and the format of the date.

It is expensive to throw away food. A family of four loses $1,500 each year on food it throws away. But the damage is global as well when you take into account how much water, energy, and labor it takes to grow, package, and transport the food that never gets eaten. What’s more, food that has been tossed is the biggest component of landfills, and as it decomposes, it produces the greenhouse gas methane.

What to do with food that has passed expiry date? The U.S. Food and Drug Administration (FDA) web site says expiry date matter. Do not ignore it.

According to Wikipedia, shelf life is defined as the length of time that a commodity may be stored without becoming unfit for use, consumption, or sale. Most expiration dates are used as guidelines based on normal and expected handling and exposure to temperature.

Consumer Reports (July 24, 2918) says, “Confusion over expiration dates leads Americans to throw out food when it might still be good.”

The report says there are several reasons why we throw away food that may be good to eat – picky kids, overstocked pantries, or even leftovers that sit in refrigerators too long.

But another major factor is the misconception about what all of those dates on food package labels – “sell by,” “use by,” and “best if used by” – really mean.

Statistics show 90 per cent of Americans misinterpret the dates on labels and throw out food that could still be consumed or frozen for later use, says Consumer Reports.

That raises the question: If expiration dates aren’t a reliable gauge of food spoilage, how does a consumer know what to keep and what to toss?

Consumer Reports gives the following guidelines:

  1. With the exception of baby formula, there are no federal regulations on date labeling.
  2. Often the “best if used by,” “sell by,” and “use by” designations are just manufacturers’ best guesses about how long their food will taste its freshest.
  3. Supermarkets may also use the dates as a guide when stocking shelves. But the dates have little to do with how safe the food is.

It is a tricky situation. How confident would you be to eat food that has passed “expiry date”?

Here is what Consumer Reports says: As a general rule of thumb, most canned foods (for example, canned tuna, soups, and vegetables) can be stored for two to five years, and high-acid foods (canned juices, tomatoes, pickles) can be stored for a year up to 18 months, according to the USDA. Watch out for dents and bulges in cans, though. That might be a sign it’s time to toss those products.

Important thing is to be safe. Follow good food handling and storage practices. This will prevent unnecessary spoilage and ensure food safety.

The U.S Congress is trying to define what dates on food labels mean. One Congressman said, “It’s time to settle that argument, end the confusion, and stop throwing away perfectly good food.” In the meantime be safe. Buy what you need so you don’t waste food.

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Hip Fracture in the Elderly: Early Surgery Improves Survival

Aswan, Egypt (Dr. Noorali Bharwani)
Aswan, Egypt (Dr. Noorali Bharwani)

This month marks 20-years of writing this column. My thanks to the present and previous editors of the Medicine Hat News and of course the readers. Without readers there is no column. Thank you all.

Today, I want to discuss about a very debilitating problem amongst seniors. This is about seniors with hip fractures and what is the best time to operate on them.

In Canada, hospitals admit 30,000 older adults with hip fracture each year.

These patients face an increased risk of death, with up to five per cent of women and 10 per cent of men dying within 30 days. These statistics are published in the Canadian Collaborative Study of Hip Fractures published in the Canadian Medical Association Journal (CMAJ August 07, 2018).

Treatment for hip fracture usually involves a combination of surgery, rehabilitation and medication. Physical therapy and rehabilitation focus on range-of-motion and strengthening exercises. Depending on the type of surgery and whether you have assistance at home, you may need to go from the hospital to an extended care facility.

Timing of operation is very important. Surgery on admission day or the following day was estimated to reduce postoperative death rate among medically stable patients. That is why it is important for hospitals to expedite operating room access for patients whose surgery has already been delayed for nonmedical reasons, says the CMAJ report.

It is generally accepted early operative intervention improves survival by reducing patients’ exposure to immobilization and inflammation.

In 2005, the federal, provincial and territorial governments established a benchmark of 48-hours from admission for 90 per cent of hip fracture surgeries to prevent potentially harmful delays.

However, delays to hip fracture surgery remain common. Patients who are medically stable at presentation may have to wait until a surgeon or an operating room becomes available.

If the hip surgery is done on the day of admission then the cumulative 30-day death rate was 48.9 deaths per 1000 surgeries.

For surgery carried out later, the death rate was significantly higher: 57.0 deaths per 1000 surgeries done on inpatient day three and 69.1 deaths per 1000 surgeries done after inpatient day three.

The study also found patients undergoing the procedure on inpatient day two rather than the day of admission did not change the risk of death.

If all surgeries were done on inpatient day three rather than the day of admission, there would be an additional 5.8 deaths for every 1000 surgeries, and the number of deaths would increase further, to 10.9 deaths for every 1000 surgeries, if all surgeries were done after inpatient day three.

What to expect in the future? Up to 10 percent of adults age 65 or older that have a hip fracture will have another hip fracture within two years. Bisphosphonates and other medications for osteoporosis may help reduce the risk of a second hip fracture.

The study recommends that all medically stable older adults with hip fracture undergo surgery on the day of their admission to hospital or the following day. This approach places the emphasis of managerial efforts on expediting operating room access for patients whose surgery might be delayed for nonmedical reasons.

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What is the best test for breast cancer screening?

A bird on a fall day. (Dr. Noorali Bharwani)
A bird on a fall day. (Dr. Noorali Bharwani)

Is MRI test better than mammography for early detection of breast cancer?

This question applies to women who are at average risk of breast cancer. They have no personal or family history of breast cancer. The controversy over the best way to screen for breast cancer among women at average risk continues.

Regular screening for breast cancer with mammography, breast self-examinations and clinical breast examinations are widely recommended to reduce mortality due to breast cancer.

Unfortunately, the available evidence does not support the use of MRI scans, clinical breast examination or breast self-examination to screen for breast cancer among women at average risk. But we continue to use these investigations.

Recent publications have again questioned the use of MRI alone or in combination with mammography for breast screening. There are more false-positives resulting in more negative biopsies.

Some researchers (JAMA Intern Med. 2018 Apr 1) have concluded that screening with MRI is not for everyone. Women who undergo breast cancer screening with MRI are much more likely to be referred for biopsy – that will ultimately be negative – than if they have screening mammography alone.

The authors of the article warn, “This is even true of women with a personal history of breast cancer. The benefit of possible early detection of breast cancer with MRI has to be carefully weighed against unnecessary additional diagnostic manoeuvres.”

Other authors have concluded that more studies are required to identify women who will benefit from screening MRI to ensure an acceptable benefit-to-harm ratio.

The experts have to determine whether a screening test would benefit or harm the patient. There is risk of harm and cost of false-positive results, overdiagnosis and overtreatment. How many unnecessary biopsies will be done to find one cancer? How many women will have to anxiously wait for days, weeks or months to find out if they have cancer? Not easy questions to answer unless you are sailing in the same boat.

Any positive result from screening has emotional costs such as anxiety and worry for patients and their families, and financial costs to both the patient and the health care system as a result of additional and potentially unnecessary diagnostic tests.

For women with positive results on screening tests, additional diagnostic tests will usually be recommended, such as further mammography, ultrasound and/or tissue sampling with core needle biopsy.

You may ask, “Doctor, what is the best way to screen asymptomatic women with no personal or family history of breast cancer?” The answer lies in the following recommendations from the Canadian Cancer Society:

If you are 40–49: Talk to your doctor about your risk for breast cancer, along with the benefits and potential risks of mammography. The benefits of regular mammography to screen for breast cancer in women younger than 50 are still unclear.

If you are 50–69: Have a screening mammography every 2 years.

If you are 70 or older: Talk to your doctor about how often you should have a mammography.

There is some radiation involved in having mammography. The benefits of mammography and finding breast cancer early outweigh the risk of exposure to the small amount of radiation received during mammography.

Now, here is the good news. The average 5-year survival rate for people with breast cancer is 90 per cent. The average 10-year survival rate is 83 per cent. If the cancer is located only in the breast, the 5-year relative survival rate is 99 per cent. Sixty-two percent of cases are diagnosed at this stage.

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