Category: Medicine Hat News

Posted on

Bittersweet Reality About Chocolate

Sunset at Sunshine Village Ski & Snowboard Resort in Banff National Park, Alberta. (Dr. Noorali Bharwani)
Sunset at Sunshine Village Ski & Snowboard Resort in Banff National Park, Alberta. (Dr. Noorali Bharwani)

Christmas is not a good time to give you bad news about the health benefits of chocolates. I am a chocolate lover myself and I have written about the apparent health benefits of chocolates, especially dark chocolates.

Chocolate is a food produced from the cocoa bean. It is fermented, roasted, ground to form a paste of cocoa liquid that is extracted fat called cocoa butter. A mixture of cocoa paste, of cocoa butter and sugar, constitutes chocolate. Chocolate has been with us since 1700.

In general, cocoa is considered to be a rich source of antioxidants such as procyanidins and flavanoids, which may impart antiaging properties. Cocoa is also a stimulant containing theobromide and caffeine.

Panama’s Kuna people are heavy consumers of cocoa. It is reported that the Kuna people living on the islands had significantly lower rates of heart disease and cancer compared to those on the mainland who do not drink cocoa as on the islands. Is this true or just a myth? A myth, according to a report in CBC News Health (Jan 5, 2015).

Health benefits of chocolates are promoted based on antioxidants present in the chocolates. An antioxidant is a disease-fighting molecule.

Cocoa beans are rich in antioxidants. But the process to turn them into chocolate bars diminishes those disease-fighting compounds. Milk chocolate has lower levels of antioxidants than dark chocolates because the percentage of cocoa beans is lower when milk and other additives are added.

Scientists who are interested in knowing the health benefits of chocolates are not sure if increasing antioxidants levels in chocolates really has any clinical benefit.

“The whole concept behind antioxidants and whether increasing antioxidants levels in something like chocolate really has any measurable clinical benefit I think is an open question. And it’s almost like it’s being used as marketing strategy,” says Timothy Caulfield, a professor at the University of Alberta’s faculty of law and school of public health speaking to CBC News.

Caulfield says he is a chocolate lover and would be glad to see some scientific evidence supporting health benefits of chocolates.

What about cocoa flavanols?

Research suggests flavanols can relax blood vessels, improve blood flow and, increase activity in a part of the brain involved with age related memory loss. But those flavanols largely disappear once the cocoa bean is heated, fermented and processed into chocolate. In other words, making chocolate destroys the very ingredient that is supposed to make us healthy.

Mars Inc. is about to join forces with Brigham and Women’s Hospital in Boston and the U.S. National Institutes of Health in a public-private partnership to discover whether cocoa flavanols reduce the risk of heart attack, stroke and death. In a randomized controlled clinical trial, 18,000 men and women will take a high-flavanols cocoa capsule, supplied by Mars Inc., for five years. We will see if that proves anything.

In the meantime have a wonderful Christmas and Holiday Season and enjoy chocolates but in moderation.

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

Posted on

Antibiotics Aren’t Always the Answer

Al-Azhar Park in Cairo, Egypt. (Dr. Noorali Bharwani)
Al-Azhar Park in Cairo, Egypt. (Dr. Noorali Bharwani)

Are we prescribing too many unnecessary antibiotics for cold, cough and sinusitis? Yes, says an article in the Journal of the American Medical Association (Internal Medicine: May 3, 2016).

The article is titled, “Prevalence of Inappropriate Antibiotic Prescriptions Among U.S. Ambulatory Care Visits, 2010-2011,” by Fleming-Dutra, Hersh and others.

The research comes amid ongoing concern about antibiotic resistance, which has been blamed for at least two million illnesses and 23,000 deaths annually, according to the US Centers for Disease Control and Prevention (CDC).

People with sore throats, ear infections and sinus infections get the wrong antibiotic at least half the time. When that happens patients are not cured and it helps drug-resistant “superbugs” evolve, says the article.

What is the most commonly misused drug?

Zithromax, also known as “Z-Pack” or azithromycin. “Z-Pack” is a name easy to remember, so patients ask for it.

“Overall, only 52 per cent of patients treated with antibiotics for sinus infections, middle ear infections and pharyngitis (sore throat) received the first-line treatments recommended by prescribing guidelines,” Dr. David Hyun, an infectious disease specialist at the Pew Charitable Trusts, told NBC News.

Research also shows at least a third of people who get antibiotics don’t even need them. There is lot of bad prescribing of antibiotics. Ear infections, sore throats and sinus infections generate 44 million antibiotic prescriptions a year.

Antibiotics are essential to treat certain conditions. Strep throat is easily treated with antibiotics, and if a child with a middle ear infection has pus oozing out, a pediatrician will usually give an antibiotic. Sinus infections that linger may be helped with antibiotics. Experts do not disagree on that.

Quite often infection is caused by viruses. In that situation, antibiotics will not help. When an antibiotic is called for, it should be a basic one – usually amoxicillin, according to Pew researchers. However, that’s not what people usually get.

If you are allergic to penicillin and have pharyngitis then Zithromax should be tried. But Zithromax is not recommended for sinus or middle ear infection.

The reason doctors end up prescribing Zithromax is because of the pressure from patients and the convenient dosage. Not to mention sleek packaging.

To prevent misuse of antibiotics, doctors and patients should ask whether antibiotics are really necessary and if yes then what is the correct antibiotic. Medical experts have been complaining about the misuse of antibiotics for two decades, but the message still is not getting through, says one of the experts.

“Antibiotics are lifesaving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” said CDC Director Dr. Tom Frieden.

Sinusitis was the single diagnosis associated with the most antibiotic prescriptions. Drugs are not usually needed to treat sinus infections, which are often caused by fungi that are not affected by antibiotics. Up to 70 per cent of people with acute sinusitis recover without any prescribed medications, the American Academy of Allergy, Asthma and Immunology says on its website.

The point is we should use antibiotics only when we really need it. Otherwise it’s just a waste of money. And dangerous to our health.

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

Posted on

Our Seductive Desire for a Magic Pill

Sunset on a desert tour of Dubai. (Dr. Noorali Bharwani)
Sunset on a desert tour of Dubai. (Dr. Noorali Bharwani)

There are so many pills in the market that are touted as “magic pills” to keep you healthy, make you strong and boost your physical and sexual powers. But are they any good? Are they safe?

Health supplements are a $1.4-billion industry in Canada, but product testing is questionable, says a CBC report. Supplement products have increased dramatically, from about 4,000 types in 1994 to more than 55,000 in 2012. Roughly half of all US adults say they have used at least one supplement in the past month, most commonly vitamins.

Health Canada confessed to CBC’s Fifth Estate program that most herbal and vitamin supplements are approved for sale in Canada on “weak evidence”. The report also says more than 90 per cent of new products are approved within 10 days.

There is intense pressure from the supplements industry, anxious to cash in on the latest health-care trends. About three-quarters of Canadians regularly take natural health products such as vitamins, minerals, fish oil and herbal remedies, a 2010 Ipsos-Reid survey found.

Research in New Zealand published earlier this year found that 83 per cent of fish oil supplements tested exceeded maximum industry standards for rancidity. And recent tests by CBC’s Marketplace showed that four of seven fish oil supplements tested showed signs of rancidity.

Products for weight loss or increased energy accounted for the most ER visits. These products caused 72 per cent of problems involving chest pain or irregular or too-fast heartbeats, and they were the culprits in more than half of visits among patients ages 5 to 34. Bodybuilding and sexual-enhancement products also led to cardiac symptoms in many seeking ER help.

Marketplace (November 12, 2015) also found Vitamin C products make illegal claims. Canadians are constantly misled into thinking Vitamin C fights colds. Marketplace found Vitamin C products that make health claims are not allowed by Health Canada. While independent testing is done in the US to verify the accuracy of supplement ingredients, similar testing is not done in Canada. So what you take may not be safe.

University of Guelph botanist Steven Newmaster and his team conducted DNA tests on 44 herbal supplements bought in Canada and the US. Their study, published in the journal BMC Medicine in October 2013, found that nearly 60 per cent of the supplements contained ingredients not listed on the label and 32 per cent were outright frauds.

Subsequently, New York Attorney General Eric Schneiderman commissioned his own DNA tests of supplements sold by four major chains in the US. His study produced even more disturbing results, and Schneiderman ordered the retailers to stop selling the supplements, says CBC report. But no action by Health Canada.

The New England Journal of Medicine (October 2015) says supplements send 23,000 people to hospitals each year in the US. Products for weight loss or increased energy accounted for the most ER visits. So be careful before you consume any supplement not ordered by your doctor.

Best thing you can do for yourself is to exercise regularly, eat lots of fruits and vegetables, eat fish, meditate and do yoga. Don’t be seduced by a magic pill!

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

Posted on

Low Testosterone in Aging Men

Joggers near the Washington Monument, an obelisk at the National Mall in Washington, DC. (Dr. Noorali Bharwani)
Joggers near the Washington Monument, an obelisk at the National Mall in Washington, DC. (Dr. Noorali Bharwani)

After the age of 40, testosterone levels in men go down by 1% each year. Testosterone boosts mood, libido and muscle mass. It’s a $2 billion industry in the US, with millions of men buying testosterone gel, pills or getting injections.

Clinically, there is only one indication for prescribing testosterone. A man suffering from hypogonadism. Examples of this include failure of the testicles to produce testosterone because of genetic problems, or damage to the testicles from chemotherapy or infection.

Hypogonadism is a medical term for a defect of the reproductive system resulting in loss of function of the gonads. In men, it is the testes. The testicles have two functions: to produce hormones (testosterone) and to produce sperm.

Many men have been prescribed testosterone to boost sexual performance. A blood test will tell when testosterone is low. But doctors do not know what is a normal level for that individual or when the individual is getting too much testosterone.

The concern is that high testosterone level can cause heart attacks. Recently, the Food and Drug Administration (FDA) in the US has stepped up warnings for testosterone and other steroid drug prescribers and users. Testosterone is approved to treat men with medically diagnosed low levels of testosterone. The FDA does not approve the use of testosterone to treat the effects of aging.

The FDA says, “Not only can the drugs cause heart attacks, personality changes and infertility, but people can easily abuse them.”

There is a long list of reported serious adverse side effects including heart attack, heart failure, stroke, depression, hostility, aggression, liver toxicity, kidney failure, baldness and male infertility from shrinking testicles.

Individuals abusing testosterone have also reported withdrawal symptoms, such as depression, fatigue, irritability, loss of appetite, decreased libido and insomnia. It can also raise the risk of blood clots.

An article “Predicting low testosterone in aging men: a systematic review,” by Adam C. Millar and colleagues published in the Canadian Medical Association Journal (CMAJ June 20, 2016) says in men over 40, clinical signs and symptoms thought to be associated with low testosterone correlate poorly with testosterone levels.

Miller and his colleagues conducted a systematic review to estimate the accuracy of clinical symptoms and signs for predicting low testosterone among aging men. They found among 6053 articles identified, 40 met the inclusion criteria. The prevalence of low testosterone ranged between two per cent and 77 per cent. Threshold testosterone levels used for reference standards also varied substantially.

Authors of the CMAJ article found weak correlation between signs, symptoms and testosterone levels.

CMAJ editor’s comment: Until we know more about hypogonadism in older men, it’s prudent to be cautious in making the diagnosis and initiating treatment in this group.

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