health

Living Healthy Means Eating Well and Eliminating Stress

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | September 9th, 2017

Dear Doctor: I just read that stress can cancel out the health effects of eating "good" oils, like olive oil. If that's true, why should I even bother trying to eat better?

Dear Reader: We knew when this study began making news last year that health care providers were in for some challenging conversations about diet. And while your reasoning does follow a kind of logic, we hope that a deeper dive into the facts can help add some perspective.

The study in question looked at the physical effects of two different types of fat on 58 women. Both groups ate a breakfast of eggs, biscuits with gravy, and turkey sausage. The food for one group was prepared with palm oil, which is high in saturated fats. The food for the second group was prepared with high oleic sunflower oil, which is considered to be one of the "good" fats. Each breakfast clocked in at a hefty 930 calories, with 60 grams of fat.

Researchers then measured the levels of inflammation markers in the blood of both groups of women. Inflammation is an immune response by the body to repair damage, and to protect it from infection and unfriendly organisms. However, when there is nothing to neutralize, the over-vigilant immune system can wind up doing harm to the body's own tissues. For example, chronic inflammation is a common denominator in conditions as diverse as diabetes, rheumatoid arthritis and heart disease.

The unexpected result of this particular study wasn't that the "bad fats" group had measurably higher blood levels of inflammation markers than the "good fats" group. That was pretty much expected. What surprised the researchers was that women in the "good fats" group who experienced significant stress in the previous 24 hours had blood test results similar to those in the "bad fats" group.

The study results are certainly interesting and add an intriguing new wrinkle to our understanding of the interplay of stress and diet. But it's important to note certain limitations. First, the sample size is quite small and the scope of the study covers a single meal. Also, that meal is high in both fat and calories. It would be instructive to see the results of a similar study that includes a group eating a healthful meal of lean proteins and a variety of vegetables. Take it a step further and see how vegetarians and vegans fare.

But back to your question, which we suspect is more exasperated than serious. Our answer is yes, please do stick to a healthful way of eating. Although the metrics of diet -- calorie counts, serving size, grams and types of fat and carbs -- play out on a daily basis, the truth is we're looking at years and decades. The long haul.

When it comes to eating habits that stretch over a lifetime, you're quite likely to reap benefits from choosing the fresh peach more often than the peach cobbler. And a deliberate timeout every day for a few moments of calm and quiet, along with a bit of deep breathing (how about right now?), can also do a world of good.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Whether Using Filters or Not, Smoking Is Still Harmful

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | September 8th, 2017

Dear Doctor: I smoked cigarettes for years, but I always used the filtered kind. (I've since stopped.) Now I'm hearing that people who smoke filtered cigarettes have increased rates of lung cancer compared to those who smoke unfiltered cigarettes. How can this be?

Dear Reader: First of all, let me congratulate you for kicking the habit. No doubt it was hard, but giving up smoking was the best thing you could have done for your health. By doing so, you decreased not only your risk of lung cancer and emphysema, but also your risk of a heart attack and vascular disease.

That said, I agree; at first glance, it doesn't make sense that filtering the tar from cigarette smoke can increase the risk of lung cancer. The cigarette industry, knowing the health risks of smoking tobacco, invented the filtration system in the 1950s specifically to reduce smoking-related injury to the lungs. In the late 1960s, only 7 percent of cigarettes had a filtering system, but by 1982, nearly 100 percent of cigarettes had a filtering device.

Prior to unfiltered cigarettes, the majority of lung cancers were squamous cell cancers. Because smokers at the time were predominantly male, these cancers were largely found in men. As filtered cigarettes became the predominant cigarette on the market, the rates of another type of lung cancer, adenocarcinoma, began to increase. During this same time period, women began smoking at greater rates, and these cancers were often the predominant type among female smokers.

In fact, rates of lung cancer in women have consistently been increasing since the 1970s, and the majority of these cancers have been adenocarcinomas. Further, while the overall rate of lung cancer in men has decreased over the last 40 years, the percentage of men with adenocarcinoma has increased.

Those facts establish a correlation between filtered cigarettes and adenocarcinoma of the lung. But a direct connection is less clear. After all, filtered cigarettes do substantially reduce the amount of inhaled tar. In 1954, a cigarette delivered 38 milligrams of tar; in 1997, it delivered 12 milligrams of tar. Cigarette companies even advertised the fact that filtered cigarettes delivered less tar, calling them "light" or "ultralight" cigarettes. That sounds good, doesn't it?

Note, however, that the filters themselves can lead smokers to take bigger inhalations to overcome the filters. Thus, they inhale more of the toxic substances and cancer-causing materials in the cigarettes. Additionally, filtered cigarettes burn more slowly, leading to more puffs per cigarette and the inhalation of more toxic substances. Also, without the high heat of unfiltered cigarettes, toxic substances are less likely to burn off. And finally, a cigarette filter -- based on where it sits upon a person's lips -- leads to increased water content within the filter, which enables toxic particles to move more easily into the lungs.

All these factors mean that toxic chemicals, such as nitrosamines and NNK, which have been linked to lung adenocarcinomas, are more likely to travel deeper within the lungs of people smoking filtered cigarettes than those smoking unfiltered cigarettes. Research has not yet proved that filtered cigarettes lead to higher rates of adenocarcinoma, but the Surgeon General's 2014 report suggested that cigarette design changes in the 1950s may indeed have led to the rise in adenocarcinomas of the lung.

Ultimately, the fact remains that cigarettes are extremely addictive -- and filters don't change that fact. With or without filters, cigarettes cause lung cancer. So the best course of action is to stop smoking (or to never start) and to not believe that a filter will decrease your risk of lung cancer.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Cross-Contact During Food Preparation May Trigger Allergies

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | September 7th, 2017

Dear Doctor: My boyfriend wants to take me to his favorite Thai restaurant, but I'm a little worried; Thai cuisine uses a lot of peanuts and I'm allergic. For people with food allergies, how dangerous is it to eat meals made with equipment also used to cook allergen-containing foods?

Dear Reader: Food allergies in the United States appear to be on the rise, which makes your question increasingly relevant. For individuals with allergies, even a tiny amount of the allergen can set off a reaction. This includes consuming food that doesn't actually contain the problem ingredient, but has been produced on equipment where the allergen is present in some form. This is known as cross-contact, and it can cause serious problems.

If you accidentally consume a food that your immune system has identified as dangerous, you're in for a physical reaction. This can be as mild and manageable as itchy skin, a headache or an upset stomach, or as severe as anaphylaxis, which can lead to death.

Although the steady uptick in allergies is worrisome, the newest research, which analyzed data from the medical records of 2.7 million patients, actually dials back the previous estimate of people with food allergies in the U.S. Instead of the widely quoted 5 percent, this study pegs the number at an average of 3.6 percent.

More women (4.2 percent) than men (2.9 percent) have food allergies. Asians had the highest incidence at 4.3 percent. Latinos had the lowest rates at 2.8 percent. Still, identifying and diagnosing a food allergy can be difficult, so all estimates are just that -- a researcher's best guess.

Your peanut allergy is in the top five of food reactions. Shellfish is first, followed by fruits or vegetables, dairy, then peanuts. Needless to say, the range of foods that can cause an allergic reaction is far more diverse.

To help people with allergies, the U.S. Department of Agriculture requires food labels to clearly identify the presence of any of the major food allergens. Also, if a product uses nuts, the specific nut must be named. But -- and this is important -- the "this product may contain" language on a food label, which warns of possible cross-contact, is voluntary. That means the absence of that warning doesn't necessarily eliminate the chance of cross-contact.

When it comes to dining out, where the preparation of your food is out of your control, your best defense is to be your own advocate. Call ahead to the restaurant and ask to speak to the chef or manager about your concerns. Ask for details about the precautions the restaurant takes to prevent any trace of an allergen from finding its way to your plate. (You'll get the most relaxed response when you call during off-peak hours.)

During spur-of-the-moment restaurant visits, enlist the aid of your server. Clearly explain what you're allergic to and how it may affect you, and ask him or her to let the kitchen know as well. Find out how the kitchen handles potential cross-contact. And, because we live in an imperfect world, please remember to always carry an EpiPen.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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