Author: noorali

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Polypill and Polymeal

How much do you know about Polypill and Polymeal?

If you are like me, then not much. So I did some research. Allow me to share this with you. It may give a new meaning to the word prevention and may stimulate your taste buds as well!

It is no secret that cardiovascular disease (CVD) is a leading cause of death and disability in the affluent societies. There are several risk factors which cause heart disease and stroke. Four of these risk factors (LDL cholesterol, blood pressure, homocysteine, and platelet function) account for most CVD and can be reduced by drugs or vitamins.

So, in 2003, two Professors from the University of London, England published an article in the British Medical Journal (BMJ) titled, “A strategy to reduce cardiovascular disease by more than 80 percent.” And they introduced the concept of the Polypill.

The Polypill will be one pill containing six pharmacological components of commonly used drugs to prevent CVD. These are the drugs used by people at high risk for heart problems and stroke – a statin (to lower cholesterol level), aspirin (as a blood thinner), folic acid (to lower homocysteine), and three anti-hypertensives (a thiazide, a ß blocker, and an angiotensin converting enzyme inhibitor), all at half dose.

The authors proposed that the Polypill should be taken by everyone aged 55 and older and everyone with existing CVD. And they felt that it would be acceptably safe and with widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention.

Recently, BMJ reported that at a meeting of experts organized just before Christmas by the US Centers for Disease Control in Atlanta generally supported the idea of a Polypill but would like to see a series of trials to test its safety and efficacy before it is given to the whole population without screening. Sounds like a good idea!

What about the Polymeal? Sounds tastier than Polypill? May be!

From Netherlands comes a paper (BMJ DEC 18, 2004) titled “The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75 percent.”
The authors of the article say that pharmacological interventions are not the only option for preventing heart disease. A healthy diet and an active lifestyle reduce CVD as well. Certainly, they have a point. Many experts feel that the side-effects and cost of Polypill may be prohibitive. Polymeal may be a safer and tastier alternative.

They looked at the scientific literature and felt that the evidence based recipe should included wine, fish, dark chocolate, fruits, vegetables, garlic, and almonds. This variety of food has been enjoyed by humankind for centuries.

They calculated that a daily consumption of 150 ml of wine, 114 grams fish four times a week, 100 grams of dark chocolate daily, 400 grams of fruit and vegetables daily, 2.7 grams of fresh garlic daily, and 68 grams of almonds daily could reduce CVD by more than 75 percent.

The authors feel that the Polymeal and active lifestyle will bring us happiness and spare us a future of pills and hypochondria. That may be so. Only time will tell. In the meantime, I better learn to pronounce those names on the wine bottles! I don’t want to be left out.

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MSG

Dear Dr. B: I was wondering if you could write on allergies to MSG.

Dear reader: MSG stands for monosodium glutamate also called monosodium L-glutamate, or sodium glutamate. It is white crystalline substance, a sodium salt of the amino acid glutamic acid.

MSG is used to intensify the natural flavor of certain foods. According to Encyclopedia Britannica, MSG was first identified as a flavor enhancer 97 years ago by Kikunae Ikeda of Japan, who found that soup stocks made from seaweed contained high levels of MSG. His discovery led to the commercial production of this substance.

National Institute of Nutrition’s website says MSG is produced on a massive scale by fermentation of beets. North Americans consume more than 25,000 tons of MSG every year, mostly as a food additive. It is present in wide variety of canned, packaged and prepared food.

About 36 years ago, reports appeared to suggest that some people who ate at Chinese restaurants developed symptoms such as headache, flushing, sweating, sense of facial pressure or swelling, numbness or burning in or around the mouth and chest pain. This is called Chinese Restaurant Syndrome. It was believed to be caused by MSG.

It is estimated that 15 to 25 percent of diners suffer from some of the these symptoms after eating food that contains MSG.

Subsequent investigation has shown that MSG is not solely responsible for these symptoms. In the United States, the Food and Drug Administration has classified MSG as generally safe. MSG continues to be used in some meals as a food additive.

There have been reports where MSG is supposed to have triggered asthma attacks, headaches and it may cause retinal damage and blindnes. Some reports have suggested that MSG may cause brain damage.

A study published in the Journal of Nutrition in April, 2000 says, “The present study led to the conclusion that Chinese Restaurant Syndrome is an anecdote applied to a variety of postprandial illnesses; rigorous and realistic scientific evidence linking the syndrome to MSG could not be found.”

How do we know what food contains MSG?

This is difficult to know. Food labels generally use the terms “natural flavor,” “flavoring,” or “hydrolyzed vegetable protein (HVP)” which may mean presence of MSG. HVP typically contains 10-30 percent of MSG.

It may be easy to remember that MSG is generally found in oriental and processed foods. And if you think your symptoms are triggered by MSG then try and avoid these types of foods. For most people, MSG in small amount does not seem to be harmful. But we haven’t heard the last word on it yet. If you have food allergies then you have to be careful what you eat and where you eat.

Thought for the week:

“A new year is not really new if we just live the same old life”.

-Unknown Author.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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New Year’s Resolution

Ring out the old, ring in the new,
Ring, happy bells, across the snow:
The year is going, let him go;
Ring out the false, ring in the true.

-Lord Alfred Tennyson (1809-1892)

Somebody asked me the other day, “Eh, doc, what is going to be your new year’s resolution?”

“Good question, I haven’t given it a thought yet!” I replied.

Then came an e-mail from a gentleman who wants to meet with me. He liked my column titled “Walking and my Grandma”. He wants me to take this subject one step further.

So, I met him last week. His name is Rob Gardner. He is a soft spoken, persuasive, enthusiastic, Community Education Coordinator for Canadian Diabetic Association (CDA). Currently, he is enrolling Medicine Hatters into CDA’s diabetes prevention program called “Keep Your Body in Check.”

“Rob”, I asked, “why do I need to enroll in this program? I don’t have diabetes.”

Gently, he put a small colorful flyer on my hands. He said, “Doc, this was mailed to everybody in Medicine Hat. Did you get one?” I could not recollect getting one. Have you looked at all the flyers which have come to your mail box this month? I haven’t!

Rob asked me to look at the question on the other side of the flyer. The question is: Are you at risk for type 2 diabetes?

The pamphlet says yes, I am at risk for type 2 diabetes if I am over 40, overweight (especially around my middle), or am of aboriginal, Hispanic, Asian, south Asian or African descent.

Yes, I am at risk if I have a parent or sibling with diabetes, if I have high cholesterol level, or I have high blood pressure or heart disease.

Yes, I am at high risk if I have given birth to a baby over four kilograms or had gestational diabetes.

I realized immediately that I had more than one risk factor for type 2 diabetes. I didn’t have to be a rocket scientist to know that. So, I enrolled in the diabetes prevention program.

Just like a good Santa, Rob gave me a box full of goodies – all free. Like an excited little boy, I opened the box. I was pleasantly surprised to see a pedometer (step counter), with a log book, a nice t-shirt, and a measuring tape to measure my waist. All free!

So, I knew what my New Year’s resolution was going to be – to keep my body in check and prevent type 2 diabetes. You can do the same, whether or not you have any risk factors. It is a good program to stay healthy. It is very easy to enroll and the gift box will arrive by mail. Use one of the following options to enroll:

-toll free number 1-866-533-7462 or
-the website www.keepincheck.ca or
-phone Rob Gardner at 403-529-4729 or
-e-mail him at rob.gardner@diabetes.ca

Mention that you read about this program in “What’s up doc?” column then Rob will give you an extra gift! Unfortunately, this program is only for people with Medicine Hat postal code. So, hurry up!

In case you missed my column, “Walking and my Grandma” then you can find it on my website: www.nbharwani.com and search under “Articles” or phone my office 527-0099 for a copy. In 2005, this column will run on Tuesdays.

Have a happy and wonderful 2005. And don’t forget Rob Gardner and keep your body in check!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Looking Back to 2004

If you believe the doctors, nothing is wholesome:
If you believe the theologians, nothing is innocent:
If you believe the soldiers, nothing is safe.
Lord Salisbury – (1830-1903).

It is time to look back to 2004.

Most of us are worried about our health. What did 2004 do for us? Did we make any significant gains to achieve good health? Did medical science make any progress in that direction?

Viox has gone off the shelves after initially being promoted as the magic drug. Looks like Celebrex and other painkillers will go the same way. These events remind us once again that medicine is an imperfect science, clouded with uncertainties

We have experts in all kinds of fields. But experience of life teaches us that we should be careful of what the experts have to say. An article in the British Medical Journal (BMJ) says, “Despite the exponential growth of medical information, the effects of healthcare interventions are often uncertain or controversial.”

I cannot recollect any major scientific breakthrough this year that changed medical practice in a positive way. Most headlines related to medical practice were of negative nature – withdrawal of Viox, outbreak of diarrhea in Calgary and Montreal, shortage of flu vaccine in US etc.

We continue to fight the old battles against obesity (including trans-fatty acids), smoking, cancer, heart disease and trauma. These are the big five causes of most diseases and disabilities in our society. This has not changed in 2004.

The editors of the journal Science have put out a list of top 10 scientific achievements of 2004. But the list does not contain any medical breakthrough to improve our health in the immediate future. For example, here are the top three scientific achievements of 2004:

The most important scientific achievement was the landing and discovery of water on Mars by NASA’s two rovers, Opportunity and Spirit.
The second was the discovery on the Indonesian island of Flores of fossils from a species of tiny humans. These humans were one meter tall with a brain less than one-third the size of modern humans. They lived about 18,000 years ago.

Third most important scientific achievement was the cloning of human embryos by South Korean researcher Woo San-hwang and his colleagues.

Why progress in medicine is so slow?

According to the BMJ article the major hidden barriers to better health care:

-uncertainty as a result of lack of convincing evidence because of delayed or obsolete data from clinical studies;

-uncertainty about applicability of evidence from research to the patient’s bedside;

-and uncertainty about interpretation of data.

Because of these uncertainties, there is overuse, misuse and sometimes underuse of medical technology with associated errors. Patients undergo excessive investigations and sometimes inappropriate treatment.

The BMJ article asks, “Can the fog that enshrouds the medical practice be lifted?”

Yes, the article says, if we can find evidence that is judged to be important for practicing doctors. Unfortunately, most existing evidence is irrelevant or unreliable.

Yes, if we can train doctors to make decisions under uncertainty.

Yes, if our leaders and the public understand the inherent limitations of medical knowledge and the role of research in reducing uncertainty.

Unfortunately, uncertainty influences virtually all of medical decision making. And this has not changed in 2004. So, we just have to keep fighting the old battles!

Thought for the week:
To like and dislike the same things, that is indeed true friendship.
-Sallust 86-34 BC

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!