Vol. 2, Issue 3
A BATTLE OF THE BONES Page 16
DIABETES Safety First!
Recognizing and Preventing Low Blood Sugar Page 2
Music for your
HEALTH Page 22
From the football field to Capitol Hill:
Congressman
Heath Shuler’s
Story Page 4
Can You Live a Healthy Lifestyle in the 21st Century?
Can You Live a Healthy Lifestyle in the 21st Century?
Page 4
20 Rome Wasn’t Built in a Day Read about how Power of Prevention helped inspire 17-year-old Patrick Brennan to turn his life around.
Ta b l e o f C o n t e n t s 1 A Note from
the Guest Editors
8 How to Select
a Blood Glucose Meter
18 Letters from Readers
You will notice something different about this issue of Power of Prevention Magazine.
Now that you have decided to monitor your blood glucose, find out how to choose the right meter for you.
20 Rome Wasn’t Built in a Day
2 Diabetes Safety First! Learn how to recognize and prevent low blood sugar and its complications.
4 Can You Live a Healthy
Lifestyle in the 21st Century? Congressman Heath Shuler shares his story, from the football field to Capitol Hill.
6 What Does the New
Health Care Law Do For Me? Find out more about the changes in our country’s health care system.
10 The Many Roles of Testosterone Discover the not-so-obvious functions of testosterone in your body and learn more about treatments for low levels.
13 Going Through The Change? Know the facts about menopause and what to do when your body changes.
16 Osteoporosis:
A Battle of the Bones Learn why osteoporosis occurs, the common side effects and what you should do to treat it.
Meet Patrick Brennan, a teenager who says the Power of Prevention program changed his life.
22 Music for Your Health Find out how music affects your health and the history behind it.
THE Magazine
P
Power of Prevention, published by the American College of Endocrinology (ACE), the educational and scientific arm of the American Association of Clinical Endocrinologists (AACE), is dedicated to promoting the art and science of clinical
AMERICAN COLLEGE OF ENDOCRINOLOGY Bill Law, Jr., MD, FACP, FACE President, ACE Daniel S. Duick, MD, FACP, FACE President Elect, ACE
endocrinology for the improvement of patient care and public health. Designed as an aid to patients, Power of Prevention includes current information and opinions on subjects related to endocrine health. The information in this publication does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other
AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS Daniel Einhorn, MD, FACP, FACE President, AACE Yehuda Handelsman, MD, FACP, FACE President Elect, AACE DONALD C. JONES Chief Executive Officer, AACE
acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.
The ideas and opinions expressed in Power of Prevention do not necessarily reflect those of the Publisher. ACE is not responsible for statements and opinions of authors or the claims made by advertisers in the publication. ACE will not assume responsibility for damages, loss, or claims of any kind
Power of Prevention Editors Donald A. Bergman, MD, MACE Executive Editor Etie S. Moghissi, MD, FACP, FACE Editor Dace L. Trence, MD, FACE Co-Editor
arising from or related to the information contained in this publication, including any claims related to products, drugs, or services mentioned herein.
Material printed in Power of Prevention is protected by copyright. No part of this publication may be reproduced or transmitted in any form without prior written permission from Power of Prevention, except under circumstances within “fair
AACE PUBLIC & MEDIA RELATIONS Bryan Campbell Director of Public & Media Relations and CAP Representative Sarah Senn Public & Media Relations Coordinator for Power of Prevention Casey Jones Public & Media Relations Coordinator
use” as defined by US copyright law. © 2008 ACE.
Power of Prevention is published by the American College of Endocrinology, 245 Riverside Avenue, Suite 200; Jacksonville, FL 32202 • 904-353-7878 • Fax 904-353-8185 • E-mail info@aace.com, Web site www.aace.com.
AACE is a professional medical organization with more than 6,000 members in the United States and 84 other countries. Founded in 1991, AACE is dedicated to the optimal care of
DESIGN DEPARTMENT: AACE IMPACT GRAPHICS
patients with endocrine problems. AACE initiatives inform
TRAVIS CHEATHAM Director of Graphic Design
the public about endocrine disorders. AACE also conducts
JEFF HOLLOWAY Graphic Designer
physicians whose advanced, specialized training enables
AMY OGLESBY Graphic Designer
as diabetes, thyroid disorders, growth hormone deficiency,
Contributing Editors Nathalie A. Turner, MS, ELS Medical Literacy Editor Power of Prevention Magazine
continuing education programs for clinical endocrinologists,
them to be experts in the care of endocrine diseases, such
osteoporosis, cholesterol disorders, hypertension and obesity.
ACE is a scientific and charitable medical organization dedicated to promoting the art and science of clinical endocrinology for the improvement of patient care and public health.
A Note from the Editors:
Something Old Something New
Dear Reader, You will notice something different about this issue of Power of Prevention Magazine. In the past, the magazine has dealt with a single theme. Recent issues have dealt with diabetes, thyroid disease, and obesity. In this issue, something new is being offered. A much broader range of topics is being presented to you, so you can learn about many different disorders of the endocrine system. You may ask “what is the endocrine system”? The endocrine system consists of several glands in different parts of the body that secrete hormones directly into the blood circulation. Hormones have many different functions and modes of action. One hormone may have several effects on different target organs, and, conversely, one target organ may be affected by more than one hormone. A Clinical endocrinologist is a physician who specializes in the diagnosis and management of hormonal conditions. In this issue of Power of Prevention Magazine, you will read about many important aspects of a variety of endocrine conditions and the latest research, as well as tools and technologies which are helpful in the management of these conditions. Many of the authors who have contributed to the magazine are endocrinologists with expertise in taking care of individuals with endocrine conditions. Many of the authors have contributed to research in furthering knowledge of disease management and a majority are members of the American Association of Clinical Endocrinologists (AACE), a community of experts in diabetes and hormonal disorders. The individuals who have shared their perspectives on making lifestyle changes have done so to inspire and motivate others to take charge and live healthier lives. You will read about how Power of Prevention’s simple plan for healthy living helped a teenager lose weight and live better. Remember that the Power of Prevention program offers you other things. With a host of free resources, Power of Prevention educates patients on endocrine conditions and the importance of prevention. Our website offers you information about endocrine and metabolic disorders such as osteoporosis, diabetes, lipid disorders, women’s endocrine health, Dr. Donald Bergman is in private practice in New York City and is men’s endocrine health, and a special section for board certified in internal medicine and endocrinology and metabolism. children. It also offers practical advice about nutrition. He has been Clinical Professor of Medicine at Mount Sinai School of For more information, visit www.powerofprevention.com and www.aace.com. We hope that you will find the information provided in this issue of Power of Prevention Magazine helpful as you strive for the best of health!
About AACE and ACE The American Association of Clinical Endocrinologists (AACE) has more than 6,000 members in the United States and around the world, and is dedicated to improving the lives of individuals with diabetes and hormonal problems. The American College of Endocrinology (ACE), joined with AACE, provides education to healthcare professionals and administers the Power of Prevention (POP) program, which is focused on education and motivation of individuals with diabetes and hormonal problems to have healthier lives.
Thank you,
Donald Bergman, MD, MACE
Etie S. Moghissi, MD, FACP, FACE
Medicine in New York City. Dr. Bergman is past president of AACE and ACE. In 2003, during his AACE presidency, Dr. Bergman founded Power of Prevention, a program that encourages people to partner with their physicians in establishing healthy lifestyles and demonstrating the importance of primary and secondary prevention. He serves as Executive Editor of Power of Prevention Magazine. Dr. Etie Moghissi is board certified in endocrinology, diabetes and metabolism and is in private practice in Marina del Rey, California. She is a Clinical Associate Professor of Medicine at UCLA. Dr. Moghissi is a recognized expert in the field of diabetes and is actively involved in direct patient care as well as in professional medical education. She has published in peer-reviewed medical journals, including Endocrine Practice and Diabetes Care. She serves as Vice President of the American Association of Clinical Endocrinologists. Dr. Dace Trence is Director of the Diabetes Care Center and Associate Professor of Medicine at the University of Washington Medical Center in Seattle. She is also the University of Washington Endocrine Fellowship Program Director and Director of Endocrine Days, a medical education program for endocrinologists practicing in the Pacific Northwest. She is on the American College of Endocrinology Board of Trustees, and chairs the CME Committee.
Dace L. Trence, MD, FACE
POWER OF PREVENTION • Vol. 2, Issue 3
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DIABETES SAFETY FIRST! Recognizing
and Preventing Low Blood Sugar
B Y E t i e S . M o g h i ss i , M D , FAC P, FAC E
B
lood glucose (sugar) goes up and down in a small range throughout the day. In people with diabetes, the range can be much wider. It is important to understand the fine balance between treating the high sugars and avoiding the low sugars. If you have diabetes and take certain diabetes drugs or insulin, you may experience low blood sugar (hypoglycemia [hy-po-gly-SEE-me-uh]) from time to time. Hypoglycemia is a blood sugar of less than 70 mg/dL. However, some people have symptoms of low blood sugar even at higher blood sugar levels. This can happen when blood sugar is dropping too quickly or if the person has had very high blood sugars for a long time. Severe hypoglycemia means the person needs someone to treat them, which is a very serious condition! Even mild hypoglycemia symptoms are hard on your body and on your emotions. By learning more about the signs and causes of low blood sugar, you can take steps to keep it from happening again. Frequent low blood sugars are serious because the body becomes less able to show the warning signals of a low blood sugar. The blood sugar can then fall to dangerously low levels.
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POWER OF PREVENTION • Vol. 2, Issue 3
What causes low blood sugar and what are the symptoms? Low blood sugar is usually caused by eating less or later than usual, changing your physical activity or taking a diabetes medicine that is not right for your needs. Even mistakes in dosing can lead to hypoglycemia. For example, you could mistake one insulin for another or forget that you had already taken your diabetes pills! A recent large study showed that the most common causes of hypoglycemia were smaller than usual food intake, delay in eating, or skipping a meal. Common symptoms of low blood sugar are: • Feeling dizzy, shaky, or lightheaded • Feeling nervous or anxious • Having a fast heart beat • Sweating or having clammy skin • Feeling tired or confused • Having a headache • Feeling irritable
Low blood sugar feels different to different people, so learn to know your own symptoms. Symptoms from low blood sugar may be mild at first but may worsen quickly. If it’s not treated quickly, you could pass out or have a seizure.
What should I do if I have symptoms of low blood sugar? If you think you have any low blood sugar symptoms, check your blood sugar right away. If your blood sugar is less than 70 mg/dL (or below the level set by your doctor) take one of the following right away (15 grams of carbohydrates [carbs]). • 3-4 glucose tablets (4-5 grams glucose each) • One-half cup fruit juice or soft drink (not diet) • One tablespoon sugar, jam, or honey • 7-8 Lifesaver candies • 1/2 to 1 tube of gel cake icing (not frosting) • 8 Sweet Tart candies • One fruit roll-up (tuck it into an exercise bra or bike shorts for easy carrying) If you feel your blood sugar is low and you can not test it, take one of the above items anyway. It’s better to be safe than sorry!
Why worry about hypoglycemia? Clearly the symptoms of hypoglycemia are unpleasant, and feeling tired and out of sorts can continue for hours even after the low blood sugar returns to more normal levels. If severe low blood sugar is untreated, seizures, coma or even death can occur. In fact, many traffic accidents involving people with diabetes may be related to untreated hypoglycemia (so always check your finger stick glucose BEFORE putting your key in the car ignition!). New evidence shows that hypoglycemia can include changes in heart rhythm and electrical problems in the heart. Heart attacks can occur later in life in people with diabetesassociated nerve function loss. Should you then give up on controlling your blood sugar? Please, NO! But discuss your blood sugar goals with your doctor, your endocrinologist [endoh-krih-NAH-low-jist], and your diabetes team, to decide what blood sugar targets are the best and safest for you.
Important: • If you often have episodes of low blood sugar, talk to your doctor. You may need to have the dosage or the type of your diabetes medication adjusted or changed • Always wear or carry diabetes identification • Teach your family, friends, and coworkers about symptoms and treatment of low blood sugar P
After treating your low blood sugar wait 15 minutes then test your blood sugar again. If it is still low, eat or drink another 15 grams of carbs. Waiting to treat low blood sugar is not safe. Not treating symptoms quickly can cause you to faint and lose consciousness, which would then require emergency treatment.
How can I avoid low blood sugar? To help avoid low blood sugar: • Stay close to your schedule of eating, activity, and medication • Don’t skip meals • Carry snacks and carbs that have sugar (like hard candy or glucose tablets) so you can treat low blood sugar levels at any time • Test your blood sugar on schedule and anytime you feel different • In general: • Carry identification: a bracelet, necklace, or ankle bracelet that has a medical alert message stating that you are taking diabetes medication
Dr. Etie Moghissi is board certified in endocrinology, diabetes and metabolism and is in private practice in Marina del Rey, California. She is a Clinical Associate Professor of Medicine at UCLA. Dr. Moghissi is a recognized expert in the field of diabetes and is actively involved in direct patient care as well as in professional medical education. She has published in peer-reviewed medical journals including Endocrine Practice and Diabetes Care. She serves as Vice President of the American Association of Clinical Endocrinologists.
POWER OF PREVENTION • Vol. 2, Issue 3
3
Can You Live a Healthy Lifestyle in the 21st Century? B y C o n g r essma n Hea t h S h u l e r
E
ver since I was a kid I knew I wanted to play in the National Football League. I knew that my athletic ability was no guarantee that I could become an NFL football player. I knew I’d have to work hard to be in the right shape to be a pro football player. Although my pro football days have come and gone, many aspects of the game have greatly influenced the way I live my life. Most important is keeping healthy. In being a husband, father, and a United States Congressman, it is often hard to find time to exercise, but I make it a priority. I started using the P90X workout platform, which I find fun to do and a challenge for my body. To maintain a healthy regimen, it is important to enjoy the exercise I do. Finding a fun form of exercise helps me stick to my routine, which also makes me choose to eat healthier foods. In today’s fast-paced society, people are finding it harder and harder to eat healthy meals on a regular basis. As obesity rates continue to rise, people, especially children, need to know the benefit and importance of health and fitness. I have been part of camp programs and other volunteer events for children. These events gave me a firsthand look into the benefits that an active and healthy lifestyle can bring. By educating and inspiring Americans to live healthy lifestyles, we can help prevent a number of illnesses like heart disease and diabetes. More than 20 million Americans have diabetes. We must increase efforts to treat those who have this disease. We must also make sure that our most
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vulnerable populations have access to preventive measures. Certain types of diabetes are caused or worsened by poor dietary and fitness habits. So, raising awareness about the importance of active lifestyles and healthy food choices will greatly reduce the number of Americans affected by this chronic and often debilitating disease. A ground-breaking program designed to manage various illnesses, including diabetes, asthma, and
depression, has been developed in North Carolina. The Asheville Project, which started in 1996, is designed to lower health costs by helping people manage their health conditions correctly. This keeps health care costs down. The program educates employees of the city of Asheville and guides them to become an active part of managing their chronic diseases. Employees who are enrolled in the program work closely with trained pharmacists to better manage their conditions. By creating close relationships between patients and healthcare providers, the program has been able to dramatically increase the health of patients.
As we move forward, new health care policies must target the true cost of health care sickness. Our health care system should not only care for those that are ill, but should also be more effective at keeping people healthy. By promoting accountable care and rewarding responsible health care professionals who help keep patients from requiring special care in the first place, we can fix a wasteful, broken system. The first step in fixing our health care system is building a healthier America. P
The Asheville Project has been successful in improving patient health and decreasing health care costs. Since the Asheville Project started, over 80 similar programs have been adopted across the country. These programs service thousands of patients. On average, employers spend much less on employee health care, and employees pay less in co-pays. In cost savings, employers get a Return on Investment (ROI) of at least 4:1 in the second year. Also, employee sick days are cut by about half, and workers compensation claims are reduced or eliminated. I believe that programs that are holistic, patient driven, and cost efficient, such as the Asheville Project, will help our nation progress toward more effective health care services. The Asheville Project is based on personal responsibility. We all bear the burden of taking care of our bodies. As individuals, family members, and role models, we must promote wellness activities such as exercise and healthy eating. Also, our elected officials need to support programs that support and assist those who fight illness on a daily basis; and, they must initiate programs that promote preventive approaches to help people avoid chronic disease.
POWER OF PREVENTION • Vol. 2, Issue 3
5
What Does the New
Health Care Law
Do for Me? B y J i l l Rat h b u n
O
n March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA). This is also known to many as the health care reform law. Much of what this is about is health insurance coverage and whether all Americans should have it. A major goal that members of Congress and the President wanted to accomplish was to allow the public to achieve the goal of good health. To do this, the Act is designed to create more resources and tools for prevention of disease that could help individuals, health care providers, states and communities. Some of these new activities and programs will be available this year. Others will start over the next few years.
Co-payments People often do not get the recommended screenings and preventive care for many diseases, such as diabetes, heart disease, and osteoporosis. This can be because they are worried about having to pay for part of the service themselves. This “cost-sharing” is often called a “co-pay or co-payment.” This payment is what you have to pay out of pocket. It is usually a flat fee or a percentage of the overall payment for cost of the service. As of 2010, the health care reform law states that all new health plans are required to cover proven prevention services without asking you or your family to pay for any part of the service. To learn what services will be available to you at no cost, contact your human resources department or your health plan. If you are 65 years of age or older and your primary insurance is Medicare, you will have to wait till January 1, 2011, to not have to pay a co-pay for proven preventive services.
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Annual Wellness Visit with Personalized Prevention Plan for Those Over 65 The health care reform law allows those with Medicare (people over 65 years old or disabled) to receive personalized prevention planning services at no cost to the patient. This annual wellness visit would allow Medicare patients to receive a personalized prevention plan. This plan includes a health risk assessment and other elements, such as updating family history, listing of specialists, body mass index measurement, and tracking of regular screenings and other risk factors. This new service will be available starting January 1, 2011, for those with Medicare.
Prevention and Health Promotion The new law states that a fund must be created to support programs at the state and local level. These programs must support prevention research and health screenings and initiatives. For example, funding could be given for education and outreach campaigns for preventive benefits and immunizations. For 2010, this fund has $500 million to spend on Federal, state, and local programs. By 2015, the size of the fund is scheduled to grow to $2 billion a year. One possible outcome of this fund is a national education and outreach campaign to raise public awareness of health improvement across a person’s life. Also, an Internet-based tool may be developed that would allow people to create their own prevention plans.
Obesity and Diabetes Prevention Health care has been focused on “sick care” and is changing to a system of “well care.” As part of this new direction, as of 2010, the health care reform bill has set up and is funding programs to help with fighting childhood obesity. The plan is to provide money to schools, community health groups, and health care systems to develop programs to help children and their families to reduce childhood obesity. If the programs that get funded work well, then they may be expanded to other communities in 2015. Also, under a section of the health care reform law entitled “Better Diabetes Care,” the Federal government will be required to issue a report card regarding prevention and care for people with diabetes. Every two years the country will get a “national diabetes report card.” This will educate all of us on how we are doing regarding the number of people who have diabetes and how well we are getting people with diabetes appropriate care and resources. People need help to control their weight and manage complications such as diabetes and heart disease that come from being overweight or obese. Starting in
2011 the health care reform law states that there must be nutrition labeling of standard menu items at chain restaurants. The nutrition labeling will reveal calories, amount and types of fats, cholesterol, sodium, carbohydrates, sugars, dietary fiber, and protein in the menu items. So, look for this type of information at your favorite local restaurant starting later this year.
Learn More About New Resources for Prevention and Wellness Many resources are available to you to look up all the new programs that were created by the health care reform law. You can find out if they have been funded and when they will be starting. Please visit the web sites below to stay up to date. http://www.whitehouse.gov/issues/health-care http://www.cdc.gov/HealthyLiving/ http://ndep.nih.gov/ http://healthreform.kff.org/ http://www.prevent.org/ http://healthyamericans.org/
P
Ms. Jill Rathbun has more than 19 years experience in consulting with life sciences (including biotechnology) and healthcare organizations, from start-ups to Fortune 500, both the public and private sector. Her areas of expertise include research and development funding, reimbursement strategy and pricing, market development, product launch and positioning, government and regulatory affairs, and strategic alliances. Ms. Rathbun is a published author and noted facilitator in health care policy and delivery, market development, communication, leadership and team building, formal and informal power, and customer relationship management.
POWER OF PREVENTION • Vol. 2, Issue 3
7
How to select a blood glucose meter by M y r i am Z . A l l e n de - V i g o , M D , M B A , F A C P, F A C E
Congratulations! You have decided to monitor your blood glucose (“sugar”) and so take control of your diabetes. You have heard about the benefits of controlling your blood sugar levels. You know that you are going to feel better and delay or even stop complications that may arise from having high blood sugar. Now you need supplies to monitor your blood sugar levels. Where do you start? How do you select a blood sugar meter?
approve the meter. Blood sugar meters are capable of measuring the blood sugar by a reaction between blood and chemicals in the testing strip. Because the chemicals can vary between meter types, specific blood sugar monitors will be required if you have certain conditions, such as being on dialysis through a catheter in your abdomen. This should always be discussed with your diabetes specialist.
This is not a one-size-fits-all issue. Blood sugar meters each have different features. But they all have something very important and crucial in common; they measure the blood sugar fairly accurately, especially between 100-240 mg/dL. The measurement that you get by any meter needs to be consistent with actual blood sugars, otherwise the Food and Drug Administration (FDA) will not
Some blood sugar meters require calibration to check that the meter is reading correctly. If the reading of a drop of a “control” solution gives a value within the manufacturers’ expected values, the meter is working well. Certain meters will also need coding calibration, while others do this coding calibration automatically. If the meter requires coding calibration with test strips, the test strip container will come with a number on the strip box or a chip that will show a number, and a code. It is critical that the code on the strips or chip and the code that appears on the screen of the meter must match. If the codes don’t match, the blood sugar reading is not accurate. Some meters use blood from the fingertips (you have to prick your fingertip to obtain a drop of blood). Other meters allow you to use other sites to obtain the drop of blood, such as the forearms, earlobe, thigh, or palms. Various meters have large screens with big numbers. Some meters have small screens with small numbers. Most meters have a memory feature that can record in the machine’s memory the blood sugar value and date and time the test was done. The meter’s memory may hold from a few dozen measurements to several hundred values. A number of meters are downloadable into a computer spreadsheet. Make sure that the date and time on your meter really is accurate before you first use it to test your blood sugar levels. After that, a good time to check the accuracy of your meter’s entered date and time is each time you change the battery.
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POWER OF PREVENTION • Vol. 2, Issue 3
Most meters can give you a reading within a few seconds; some meters are faster than others. Some meters can talk to you and tell you the blood sugar level, and date of the reading, which can be especially useful if your vision is limited. Certain meters speak and can even give directions in several languages, such as English or Spanish, on the visible screen. Please check that the designation of meter’s units of blood sugar matches the units used in your country. In the United States, “mg/dL” is used, in other countries “millimoles” are used. These are very different number designations!
fingerstick will be more accurate if your blood sugars are suddenly dropping or rising. These would not be times to check at sites other than the fingertips. So, how do you choose a blood sugar meter among the hundreds available? You have to do your homework, then check with your diabetes specialist to review your final choice to choose the best one for your needs. P
The meter is a machine, so it could malfunction. The control solution should be used to check the validity of your meter at least once a month. It is also important to collect the correct amount of blood; some strips make this easier by just absorbing the amount needed. Humidity may affect the strips and the reading. Even altitude can interfere with fingerstick accuracy. Meters differ on what they can read; some start as low as 40 and read up to 600. Hi or Low readings can mean different things on different machines. Some meters turn on or off automatically. Instructions, for how to use the meter, may come printed or on videos. The instruction manual will state the properties and capabilities of the meter at different temperatures and different altitudes. Most meters offer toll-free telephone numbers with around-the-clock support. The instruction manual will state the properties and capabilities of the meter at different temperatures, and different altitudes. Do not expect to find exactly the same number if you test on different parts of your body, use different strips, or get results from or in the laboratory. What you can expect is to have a fairly good idea of the levels of blood sugar in your blood at the time tested if the procedure was properly done. Blood sugar levels checked by
Dr. Allende-Vigo is a Puerto Rican physician who has dedicated her professional life to taking care of patients with endocrinologic disorders. She has lectured and researched in the fields of diabetes mellitus, lipid disorders and osteoporosis. Dr. Allende-Vigo has been involved in academics as Professor of Medicine at the University of Puerto Rico (UPR), contributing to the formation of medical students and residents in Internal Medicine, Family Medicine and Endocrinology. She has been very active as member of the AACE Board of Directors and Chair of the International Membership Committee of AACE. Dr. Allende-Vigo is also past president of the Puerto Rican Society of Endocrinology and Diabetology (SPED).
POWER OF PREVENTION • Vol. 2, Issue 3
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The Many Roles of TESTOSTER ON E B y M i c h ae l I r w i g , M D , F A C E
Y
ou’ve heard people say, “You are what you eat.” Well, it turns out that your hormones also play a part in who you are. Many differences between men and women have to do with the different levels of testosterone and other sex hormones, such as estrogen.
Many people know that testosterone is important for a man’s sexual desire. Yet, testosterone has numerous other important functions throughout the body, several of which are not so obvious. For example, testosterone is important
Dr. Michael S. Irwig is a board certified endocrinologist with a special interest in andrology. He completed medical school at Cornell University, an internal medicine residency at the University of Virginia and an endocrinology fellowship at the University of Washington. He currently practices at the Medical Faculty Associates/George Washington University where he is an Assistant Professor of Medicine and Director of Andrology. Dr. Irwig enjoys teaching and has lectured nationally and internationally on low testosterone and use and abuse of steroids. He serves on AACE’s Continuing Medical Education Committee and on the Board of the Mid-Atlantic chapter of AACE. He lives in Dupont Circle and has two kittens named Andro & Gen.
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for strong bones. Low levels of testosterone can lead to osteoporosis and broken bones. Testosterone also causes men to have higher red blood cell counts than women. After puberty, testosterone in men causes them to develop more muscle mass and less body fat compared with women. And this is only the tip of the iceberg — testosterone may have other important effects relating to heart disease and even how our brains are wired from birth.
TESTOSTERONE LEVELS In men, nearly all testosterone is produced in the two testicles from the molecule cholesterol. Yes, this is the same molecule related to fatty food and heart health. High levels of testosterone are produced in boys going through adolescence and the levels remain high throughout a man’s life. On the other hand, after men reach about age 40, their testosterone levels begin to gradually decline. The levels of testosterone decline more rapidly in men with medical conditions. Men under age 50 tend to have higher levels of testosterone in the morning. Levels of testosterone don’t vary much with the time of day in men over age 50.
In a typical day, a man’s blood level of testosterone bounces up and down quite a bit. This is due to chemical signals from a gland below the brain called the pituitary. As you can imagine, measuring one level of testosterone can be tricky for your doctor to interpret because testosterone levels bounce around so much. It is therefore very important for a man with one low level of testosterone to have it rechecked to confirm that it is indeed really low. For a younger man, the blood test should be done between 7 a.m. and 10 a.m., when testosterone levels are often highest. Speaking of low testosterone, this is a very controversial area within the medical world. Nobody agrees what number determines whether a guy has normal or low levels. Every study is somewhat different and each lab measures testosterone differently. The measurement of testosterone is also complex because men with certain conditions tend to have higher or lower levels of testosterone. For example, overweight and obese men often have lower testosterone levels than do thinner men. On the other hand, men with liver disease may have higher levels of testosterone.
SIGNS OF LOW TESTOSTERONE If a man develops low testosterone, certain signs or symptoms may appear, such as • low sexual drive • erectile problems • fewer morning erections • less facial hair and shaving • osteoporosis/fractures • decreased strength • depression and depressed mood • tiredness • problems concentrating • problems with sleep • irritability • decreased interest in activities You’re probably reading this list and thinking “I may have low testosterone because I have some of these symptoms!” Though low testosterone can cause these symptoms, many other conditions
may also cause them. Some men have sleeping problems from being obese and having sleep apnea. Other men have difficulty achieving a firm erection due to aging, diabetes, heart disease, and other causes. Many of us are tired simply because of our busy and stressful lives! You therefore cannot assume a man with these symptoms has low testosterone. If you suspect that you might have low testosterone, speak with your doctor. He or she may want to measure your testosterone level. There are other reasons why men may want to have their testosterone measured, such as • breast pain and enlargement • very small testicles • problems with fertility • low red blood cell count • hot flashes
TREATMENT WITH TESTOSTERONE Men with low levels of testosterone may have a better quality of life if they are treated with testosterone. Testosterone may help increase their sex drive and sexual ability. It may also increase their muscle mass and strength. It may increase bone density and prevent osteoporosis. Testosterone should not be used for men with normal testosterone levels for “anti-aging” purposes. In the United States, there are two common ways to take testosterone. Neither of them is pill. The more traditional way is to receive injections of testosterone every two weeks into the muscle, typically in the thigh or buttocks. Men can be taught to give themselves these injections. Another way is for testosterone to be absorbed through the skin. Men can either place a patch or a small amount of liquid gel onto their chest or abdomen every day. Which type of testosterone to use depends on the man’s preference, the medication costs, and possible side effects. Like all medications, each one has its own pros and cons. The injectable testosterone is the less expensive form, but it causes more men to develop too high of a red blood cell count. Men who use the gel should be careful not to have skinto-skin contact with a woman or child because the testosterone gel can be transferred to them if it is not dry. Testosterone should not be given to men who have prostate or breast cancer, high red blood cell counts to start with, untreated obstructive sleep apnea, or severe heart failure. Continued on page 12
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For men who start testosterone replacement therapy, baseline bloodwork should be done for a red blood cell count (hematocrit) and for prostate specific antigen (PSA). Men over age 50 should also have a digital rectal exam to determine whether there are any prostate nodules, which could represent a prostate cancer. If nodules are present they should see a urologist for a possible prostate biopsy. The bloodwork is usually repeated three months after starting testosterone therapy and then yearly. Testosterone levels should also be rechecked to make sure that the levels are not too high and not too low. If the red blood cell count gets too high, testosterone may need to be stopped, the dose may need to be lowered, or the type of medication may need to be changed.
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THE FUTURE OF TESTOSTERONE There still is a lot unknown when older men with low testosterone are given testosterone replacement therapy. A large and long-term clinical trial is needed to answer some key questions. For example, would treating men with low testosterone change their risk for heart attacks? Would treatment reduce the number of fractures? Would treatment affect the prostate in any way? Until a testosterone trial is started and completed, doctors will have to rely upon the best available evidence from smaller and shorter studies to guide them. As with any therapy, there are always benefits and risks and treatment needs to be tailored to each patient. There is no one-size-fits-all when it comes to a blood level of testosterone or number of signs and symptoms. P
Going Through
The Change?
Know the FACTS B y R h o da H . C o b i n , M D , M A C E
If you are “in the change” or menopausal, you are not alone. There are about 35 million women in the United States who are over age 50. Many of these women have reached menopause by then, or will soon after. Symptoms of menopause include hot flashes, poor sleep, and vaginal dryness. Sex may not be as pleasurable, especially if there is pain during intercourse because of vaginal dryness. Once your menstrual periods stop your body undergoes many changes because estrogen is no longer produced in the ovaries. Actually the ovaries begin to “slow down” even before your periods stop, so many menopausal symptoms begin even while women are still having periods. It’s important to know that not every symptom is always related to a lack of estrogen. The time of menopause is also a time for many changes in women’s lives. Children are growing older, marital relationships change, work stresses may be difficult, and age itself changes the body. As women become middle-aged, other medical illnesses may develop. Women may be moody, irritable, depressed, and tired. They may notice differences in the quality of their hair and skin. Overall stamina might be reduced. Some of these symptoms may not be caused by menopause, but by aging itself, and by the effects of dealing with life changes. Despite all these processes, some symptoms seem to be clearly related to less estrogen, especially hot flashes, poor sleep, and vaginal dryness.
So what are women to do? First, have a good discussion with your doctor. Let him or her know all of the symptoms that are bothering you and how your body has changed. It is important to be thorough. A complete physical exam and a set of blood tests can make certain that you are healthy and that your symptoms are not because of an illness. Estrogen is the best and most effective treatment for symptoms that are a direct result of estrogen deficiency, such as hot flashes. Estrogen therapy is also excellent to prevent and treat osteoporosis [os-tee-oh-pore-OH-sis] (weakening of the bones that increases the risk of fractures), though there are other drugs available to fight this condition. In clinical studies, estrogen use is linked with a lower risk of developing cancer of the colon. But estrogen may contribute to the risk of developing breast cancer, as reviewed below. Continued on page 14 Dr. Rhoda H. Cobin was a member of the original board of AACE, a past president of AACE and of ACE. She has had a longstanding interest in reproductive endocrinology. For many years, she chaired the Reproductive Committee of AACE, overseeing many issues related to women’s health including PCOS, with an emphasis on cardiovascular and metabolic risk, issues related to amenorrhea, and menopause management. Dr. Cobin chaired the AACE Guidelines for the Management of Menopause, as well as the AACE position statement on Hormone Replacement Therapy and Cardiovascular Risk. Dr. Cobin is Clinical Professor of Medicine at the Mount Sinai School of Medicine in NYC and has practiced clinical endocrinology in New Jersey for over 30 years.
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Continued from page 13
You should discuss with your doctor whether estrogen treatment is right for you. Not everyone should take estrogen, but for many women it can be a safe and effective therapy. If you have not had a hysterectomy (removal of the uterus), estrogen treatment must be taken with another hormone called progesterone [pro-JESS-tur-ohn] because taking estrogen without progesterone can cause cancer in the uterus. If your uterus has been removed, taking estrogen alone is fine.
Smoking and hormone replacement therapy Smoking increases the risk of blood clots and heart disease. Women who smoke are at even more risk of developing these problems if they take hormone replacement therapy (HRT) while continuing to smoke. Smoking raises the risk for the development of cancers of the lung, mouth, tongue, and bladder. All women should discuss with their doctors how to stop smoking.
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How is HRT given? Many preparations are available that contain estrogen, progesterone, or a combination of both. The American Association of Clinical Endocrinologists, along with other professional societies, endorses the use of only those preparations that are regulated by the FDA, to ensure that the proper drug at the proper dose is actually being taken. So-called “bioidentical� hormones offer no advantage to FDA-approved drugs and may be associated with inconsistent dosing. Bio-identical hormones have not been shown by scientific studies to have medical benefit. Also, some preparations have been found to contain irritating substances or no hormone at all. Your doctor will recommend the best HRT program for you. He or she will determine whether a pill, a patch, or a vaginal preparation might be the safest and most effective form of treatment for you.
What if estrogen cannot be safely used? Some women cannot safely take estrogen but have severe symptoms of menopause. For these women, a number of non-hormone containing medications may be tried to reduce some of the symptoms. But, these over-the-counter preparations, including herbal and soy remedies, should be used with caution since some may act like estrogen in your body. While that might be a good thing in some cases, in women where estrogen might be dangerous, these chemicals could also be dangerous. You should discuss with your doctor the ingredients in all overthe-counter preparations you take or are thinking about taking.
HRT and blood clots Fortunately, the risk of clots in the legs or clots that travel to the lungs (a very serious condition) is very rare, but the rate doubles in women who take estrogen. Though the risk is still very low overall, you shouldn’t take HRT if you have had blood clots, especially when you were pregnant or taking birth control pills. Also, even if there is a history of clots in your family and not yourself, you should mention this to your doctor. In some cases, there is a simple blood test to find out if you have inherited an increased risk of clots, and this might be an important factor in the decision to use estrogen.
Hormones and your heart In general, if you are younger than age 60 and had your last period less than 10 years ago, the risk of heart disease is less if you took estrogen than if you didn’t. However, the risk of heart disease goes up as you age, so it’s generally best not to start estrogen treatment after age 60. Recent studies have suggested that taking estrogen early in menopause and before the age of 60 might actually help the heart. However, these studies are not definite and estrogen is not recommended as a prevention or treatment for heart disease at this time. More studies are being done to help us decide whether this recommendation will change in the future. Of course, women should have healthy lifestyles to reduce the risk of heart disease. This includes eating a heart-healthy diet, maintaining an ideal body weight, and exercising regularly. If your cholesterol is high, your doctor will likely recommend a “statin” drug. The use of hormone replacement will not interfere with the helpful effects of this drug.
estrogen because they have a uterus, there is a small increase in the risk of breast cancer. It is also possible that the kind of progesterone used may make a difference. It may also be true that taking estrogen, even with progesterone (using one of the progesterone agents which seem to have lower risk) for a short period, say, less than 10 years, may not pose a serious risk. Each woman, with her doctor, needs to decide if she is at high risk for the development of breast cancer. If you have already had breast cancer, have a strong family history of breast cancer, or have had other breast disease that your doctor tells you might later lead to cancer, estrogen should not be used. For other women, the small possible risk for the development of breast cancer should be weighed against 1) the improvement in symptoms, 2) the age of the woman, and 3) the number of years she might need to take hormones.
Stroke and dementia HRT slightly increases the risk of having a stroke. This effect is more important in older women than in younger women. Dementia (impaired brain function) is something that worries all of us. Some early studies suggested that the use of HRT reduced the risk of developing dementia, while newer studies are not so clear. Certainly, women who are having severe hot flashes and are sleep deprived during menopause may develop difficulty in thinking clearly. Also, some develop emotional moodiness and trouble concentrating. This does not mean that dementia is developing. It is interesting that men who are sleep deprived have been shown to have the same emotional moodiness and trouble concentrating. And in the studies where HRT was started at an older age in women, there seemed to be higher risk of developing dementia.
The decision: So should you take HRT? It certainly depends on whether you have symptoms related to estrogen deficiency. All of the currently available facts seem to point to the idea that there might be a window of time when HRT is most effective, and least likely to cause health risks. Your doctor will evaluate all of your factors to determine whether HRT can help your symptoms, improve your quality of life, and keep you healthy in your later years. P
Breast cancer and hormones What about breast cancer? It’s the disease most women fear the most. Some studies have linked the use of postmenopausal HRT to cancer. When estrogen can be used alone (without progesterone), these studies do NOT show an increased risk of breast cancer. For those who need to take progesterone with POWER OF PREVENTION • Vol. 2, Issue 3
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Osteoporosis: A Battle of the Bones
by H o n g S . Lee , M D , a n d P a u l i n e M . C amac h o , M D , F A C E
O
steoporosis [os-tee-oh-puh-ROW-sis] is a disease of bones that leads to low bone mass, increased bone fragility, and broken bones (fractures). Approximately 44 million Americanss age 50 and over (55% of Americans in this age group), have osteoporosis or low bone density that can lead to fractures. Of special concern are hip and spine fractures. People with a broken hip almost always need to go to the hospital and have major surgery. About 50% of patients with a hip fracture can never walk again without help, and 25% need long-term care. Spinal or vertebral [ver-TEE-bruhl] fractures are also serious and can cause loss of height, severe back pain, and deformity. Osteoporosis is most common in women after menopause. This is because bones break down without estrogen and new bone doesn’t build up as much. But osteoporosis may also develop in men. Osteoporosis may occur in anyone with hormonal disorders, such as an overactive thyroid gland or overactive parathyroid gland. Osteoporosis can also be caused by medications such as steroids (prednisone), certain blood thinners (Coumadin [warfarin]) and anti-seizure medications.
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Why Osteoporosis Occurs In normal bone, the bone constantly rebuilds itself. Bone gets absorbed or broken down by cells called osteoclasts [OStee-oh-klasts]. Other cells called osteoblasts [OS-tee-ohblasts] cause the bone to form. They follow osteoclasts and lay down new bone at the site. Osteoporosis is caused by an imbalance between bone breakdown and bone formation.
Denosumab: A New Therapy for Osteoporosis Bisphosphonates [bis-FOS-fuh-nates] have been the main treatment for osteoporosis since alendronate [uh-LENdro-nate] (Fosamax) was introduced to the U.S. in 1996. Since then, other bisphosphonates have become available, including risedronate [rih-SEH-droh-nate] (Actonel), ibandronate [eye-BAN-droh-nate] (Boniva), and zoledronic [zoh-leh-DROH-nik] acid (Reclast). They are different in their strength, how often they are taken, and how they need to be taken (by mouth or through the veins).
A new medicine, denosumab [de-NO-soo-mab] (Prolia) was approved by the United States Food and Drug Administration to treat osteoporosis in women after menopause who: • have a high risk for broken bones • cannot use another osteoporosis medicine, or other osteoporosis medicines did not work well. This is a new type of medication for osteoporosis treatment. Denosumab is a human antibody made by one type of immune cell. For the last two decades, human (monoclonal) antibody has been used for inflammatory [in-FLAHmah-toh-ree] diseases and cancers, including leukemia, lymphoma, asthma, Crohn’s disease, and rejection prevention for kidney transplants. Denosumab halts the growth of osteoclasts and keeps bone loss from happening.
• Had parathyroid or thyroid surgery (glands located in your neck) • Have been told you have trouble absorbing minerals in your stomach or intestines (malabsorption [mal-ab ZORP-shun] syndrome) • Have kidney problems or are on kidney dialysis • Plan to have dental surgery or teeth removed • Are pregnant or plan to become pregnant • Are breast-feeding or plan to breast-feed In summary, osteoporosis is very common and can cause many serious problems. You and your doctor can determine what treatment is right for you! P
In a study of almost 8,000 patients, denosumab reduced the risk of new spine fracture by 68%. It also lowered the risk of hip fracture by 40%. Treatment with denosumab also greatly increased bone mineral density (BMD) after the patients were treated for three years. Denosumab is injected under the skin (like insulin) in the upper arm, upper thigh, or abdomen every six months.
Side Effects The most common side effects of denosumab are joint pain, inflamed nose and throat, back pain, headache, and arm and leg pain. An inflamed pancreas may also occur. Denosumab can cause serious side effects. These include low calcium level, serious infection, skin problems, and severe jaw bone problems. People with kidneys that are not working normally are more likely to end up with a low calcium level. Since denosumab is a human antibody, it may affect the immune system. Patients with immune systems that are not working normally or those on immunosuppressant [ih-mune-oh-suhPREH-sent] agents (like those used for cancers, rheumatoid arthritis, and Crohn’s disease, for example) may have a higher risk for side effects. Lastly osteonecrosis [ah-stee-ohneh-CROW-sis] of the jaw, or “dead jaw,” is a rare but serious side effect. It occurs when there is a loss of blood flow to the jaw. This leads to death of the tissue and collapse of the jaw bone. It can occur on its own, but it usually happens when a tooth is pulled or if there is a local infection that takes time to heal. Your doctor and also your dentist should examine your mouth before you start denosumab. If you are considered for this treatment, make sure to tell your doctor if you: • Have low blood calcium
Dr. Hong S. Lee is a fellow of endocrinology and metabolism at Loyola University Medical Center, Illinois. He received his doctoral degree at University of Minnesota Medicine School and finished post-graduate training at Loyola University Medical Center. His clinical interests include bone health and hypogonadism. Dr. Pauline M. Camacho is an Associate Professor of Medicine at Loyola University Medical Center and Director of the Loyola University Osteoporosis Metabolic Bone Disease Center. Her clinical endocrine practice and research is focused on osteoporosis and metabolic bone disorders. She has had two books published: Osteoporosis: A Guide for Clinicians (published in 2007) and Evidence Based Endocrinology (latest edition published in 2006). Dr Camacho is on the national board of the American Association of Clinical Endocrinologists (AACE), and is on the Editorial Board of Endocrine Practice and the Journal of Clinical Densitometry.
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Letters
from Readers Question: I was just diagnosed with hypothyroidism by my primary care physician. He said that I need to find an endocrinologist. How can I find a list of endocrinologists in my area who specialize in thyroid dysfunction? Answer: It’s easy! Just visit www.aace.com and click on resources and go to “Find an Endocrinologist.” This tool will allow you to search for an endocrinologist by location (either City/State or ZIP code) and/or by specialty (such as “thyroid dysfunction”). Question: I was diagnosed with type 1 diabetes when I was 17 and think it’s very important to talk to others about overcoming the challenges of diabetes. I have read other issues of Power of Prevention Magazine, and I’m passionate about getting involved with the program. How can I share my story?
Answer: We’d love to hear from you! Simply e-mail us at feedback@powerofprevention.com and tell us your success story. Question: I picked up a copy of the Power of Prevention Magazine at my endocrinologist’s office last week and wondered if I can add my name to the mailing list. Is the magazine free and can I subscribe? Answer: Yes and yes! Power of Prevention Magazine is a free publication. To subscribe, simply send your full name and mailing address to subscribe@powerofprevention.com. Thank you for your interest! Question: Where can I find previous issues of Power of Prevention Magazine and read more about endocrine conditions? Answer: Visit www.powerofprevention.com, the onestop-shop for health information from the American College of Endocrinology. Here you can download issues of the magazine and link to resources about diabetes, thyroid dysfunction and many other endocrine conditions.
Power of Prevention is a public health awareness initiative dedicated to giving patients the resources they need to live healthier lives. For more than five years, Power of Prevention has been educating patients about a variety of endocrine conditions, including diabetes, thyroid dysfunction and obesity.
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novo nordisk: from our first patient to our latest innovation Imagine your loved one, sick from a disease that the world doesn’t fully understand. What lengths would you go to in finding a way to make them better? For our founder, Nobel Prize-winning scientist August Krogh, it was to the edge of discovery with his pioneering work in insulin treatment for diabetes. And his wife, Marie, was the first beneficiary– and our first patient. Novo Nordisk has since become a world leader in diabetes care, driven by that same deeply human approach to everything we do. Our patient-centric philosophy has led to many innovations, including: • Insulin analogs, the latest advancement over human insulins • Revolutionary delivery devices that are simple to use • Research, education and partnership initiatives that are pushing diabetes to the forefront of global health—and giving patients a voice Together, we can defeat diabetes in our lifetime.
For more about us, visit novonordisk-us.com Photo: The Royal Library, Copenhagen, Departments of Maps, Prints and Photographs. Photographer: Albert Schou jun. ©2010 Novo Nordisk A/S
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May 2010
Rome Wasn’t Built in a Day B y Pat r i c k B r e n n a n
My name is Patrick Brennan and I am 17 years old. Three years ago I was very overweight and decided to begin a new venture. I read about Power of Prevention and applied its suggestions and tips. I ended up losing 40 pounds and changed my life. I was successful in adopting a new healthier lifestyle with the help of the Power of Prevention program. When I was 7 years old, I was tall and the appropriate weight for my age. That spring I broke my arm. Even though I was not able to play sports I continued to eat the way I always had, which was not exactly healthy. During my recovery from my broken arm I put on a lot of weight, until the point were I became very overweight. I remained overweight until I turned 14 years old. Being overweight caused several problems for me. First, I had terrible balance and was always bumping into things. Second, my self-confidence was very low; this made me shy around new people and affected my
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self-esteem. Last, because of my weight I was never considered a real competitor in the sports that I played and I was mocked behind my back about my weight.
Power of Prevention has changed my life. My grandmother and other family members would always tell me how I would be so good looking if only I dropped a few pounds. This did not help—in fact, it was hurtful. I now know that they were just trying to motivate me, but in order to succeed you must motivate yourself. I am by nature an impatient person. One of the things that drove me crazy was thinking about how long it would take to lose the weight and see the benefits.
THEN
NOW
I will never forget the day my mom told me that her generation might have a longer life span than mine because of childhood obesity. That is a big jump from saying, “You should lose a few pounds” to “I will probably outlive you because of your weight and your unhealthy lifestyle.” I started taking the concept of losing weight seriously and put a plan into effect. After reading the Power of Prevention web site, I began what I realize now was the beginning of a new way of life. I started with baby steps. I first limited sweets to once per day for a week, then to every other day until I no longer ate sweets. I then did the same thing for fast food and unhealthy carbohydrates. I incorporated a simple workout program of aerobic exercise (treadmill or jogging) for 30 minutes three times a week. The next thing I knew my face started to thin out, my clothes fit better, and I was faster at my sports. It seemed all the pieces came together—I even felt more energized! The better I felt, the more excited about the changes I had made. I was eating fruits and vegetables instead of inhaling junk food. I learned to read labels at a glance and made an educated decision about what I chose to eat. I could see my body changing, I continued my exercise, and then started lifting weights. My sports ability soared and my confidence grew tremendously. I was proud about how I looked, but more importantly, about what I had done. The suggestions and the motivation from the Power of Prevention web site was a tremendous help. I began eighth grade a new person; some of the teachers did not even recognize me! It was great having teachers, parents, and even other students complimenting me on what I accomplished. Even though at first it took time to get used to my new body, I played well in both basketball and
lacrosse that year. However, as much good as there was that year, there was also some bad; some of my teammates and friends became jealous of what I had done. It was hard to lose some of my best friends over something as silly as me losing weight. I never let this bother me and continued my healthier lifestyle. The friends that were supportive of me became even better friends. Maintaining the weight loss has not been hard to do. Every once in a while I slip into bad habits and have to remind myself how much work I put into this, and not to destroy it. Even now, I do watch what I am eating and just as important, I watch how much I am eating. Power of Prevention has changed my life. They will never know how truly grateful I am. In April 2010, I had the privilege to run in the Power of Prevention 5k run in Boston. While there, I met Dr. Donald Bergman, founder of Power of Prevention and a member of the Board of Trustees of the American College of Endocrinology, and Sarah and Bryan, staff of the American Association of Clinical Endocrinologists. These people are trying to help cure a great problem in the United States. I just want to let all kids that feel like they need to change their diet or lose a few pounds know that it takes time. You have to be patient. There is an old quote that says, “Rome wasn’t built in a day,” which is great. But I think “Everyday they worked on building Rome” should be added to the end of that quote. Please take pride in your accomplishments, stay motivated, and know that you are not just working on shedding a few pounds, you are working on a healthier lifestyle. Good luck and feel free to e-mail me if you have any questions: shaqapat51@yahoo.com. P
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M U S IC FOR YO U R H EA LT H B y R. M ac k Ha r r e l l, M D, FAC P, FAC E, E C NU
Human beings are innately musical. Our biology demands it. Every human heart beats in its own unique rhythm. The accent patterns of our speech identify us city folk from South Boston or Midwestern farmers from South Dakota. Scientists are convinced that the recognition of specific “danger” sounds (a baby’s cry, a woman’s scream, a sabertoothed tiger’s growl) has had great survival value for our species. Given the evolutionary pressure to develop a keen sense of hearing, it is not surprising that over millions of years, we humans have also developed our own sonic language that transcends the function of human speech. Our creation of sound for sound’s sake is called “music.” In 2008, scientists digging up a huge granite cave over 1700 feet above sea level in Germany found a 5-holed flute made from vulture wing bone. This flute was carbon dated to about 35,000 BC. This monstrous cave was probably the site of the first human “rock”
concert. Scientists think humans have been actively making music since about 50,000 BC. Thus, music is an art form that defines our species from the dawn of pre-history. It continues to have nearmagical powers over human behavior to this day. If you don’t believe this, just go with your pre-teen daughter to a Justin Bieber concert. Music’s healing properties have been suspected since the first tribal shaman shook a gourd over the death bed of a fallen warrior. Despite this longstanding healing history, modern medicine has been slow to adopt music as an important tool of the healing arts. Nevertheless, modern medicine is slowly changing. In his book, Musicophilia, noted Columbia University neurologist Dr. Oliver Sacks observes that music therapy can treat the loss of expressive language in patients following brain injury from stroke. In addition to restoring normal speech, music can also trigger the release of brainaltering chemicals called endorphins that revive lost memories and emotions. Dr. Sacks states that Parkinson’s and stroke patients respond to music therapy because the human brain is uniquely programmed to respond to rhythmic sound. More than any other mammals, humans are pre-wired to tap their feet while listening to music. In patients with Parkinson’s disease who cannot walk or move in a coordinated fashion, scientists believe that music triggers undamaged networks of nerve cells that allow translation of the beat into organized body movement. Dr. Concetta Tomaino, co-founder of the New York City Institute for Music and Neurologic Function, notes that “someone who is frozen (from Parkinson’s or stroke) can immediately release and begin walking. They can coordinate their steps to synchronize with the music.” Dr. Gottfried Schlaug, a Harvard University neurologist, thinks music provides an alternate entry point to the brain, bypassing portions that are blocked by injury or disease. Various aspects of music engage many regions of the brain that are also devoted to speech, movement, and social interaction. Dr. Schlaug suggests that if disease or trauma has disabled a part of the brain needed
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for these human activities, music can sometimes get in through a “back door” and restore function through an alternate route, teaching the brain “new tricks.”
Whether your preference is Mozart or Lady Gaga, make it a point to enjoy a few minutes of your favorite “beats” on a daily basis.
Mozart. As expected, the patients’ blood pressures and heart rates became more stable while they listened to the music. But patients also had a 50 percent spike in pituitary [pihTWO-ih-tear-ee] growth hormone, which can stimulate healing. Dr. Conrad now asks his patients (or their families) what music they’d like to hear before he begins surgery; if neither can provide an answer, he usually plays Mozart. In summary, enjoying music is a uniquely human trait that makes our lives better and contributes to brain health. Our ancestors have used music and rhythmic sound as healing tools for over 50,000 years. Given this fact, it is ironic that modern physicians should only recently have rediscovered the healing power of music. Whether your preference is Mozart or Lady Gaga, make it a point to enjoy a few minutes of your favorite “beats” on a daily basis. You’ll be healthier and happier for it. P
At the Cleveland Clinic’s Center for Neurologic Restoration in Ohio, Director Dr. Ali Rezai describes the science of music therapy as being in its infancy. During a surgery called deep brain stimulation — done while patients with Parkinson’s disease are awake — Dr. Rezai and his team play classical music while measuring the brain’s electrical response to those notes. “We know music can calm, influence creativity, can energize. That’s great. But music’s role in recovering from disease is being ever more appreciated.” Dr. Claudius Conrad at Harvard Medical School is a gifted pianist and a lead investigator in a study looking at the effects of music on the sleep patterns of critically ill patients. He notes that “research has already shown that if you play a classical piece of music — like Mozart — at a certain slow beat, the listener will adapt their heart beat to the beat of the music.” At the University of Munich, Dr. Conrad was able to show that critically ill patients required fewer sedative drugs when they listened to one hour of
Dr. R. Mack Harrell’s life is centered around sound. By day, in his Fort Lauderdale, Florida endocrinology practice, he uses sound above the range of human hearing (high resolution ultrasound) to locate tiny parathyroid and thyroid tumors in patients preparing for minimally invasive endocrine surgery. By night, in his music studio in Boca Raton, he creates sonic experiences (songs) for the pop and country markets and is actively pursuing his first Nashville cut.
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special thanks
The American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE) would like to thank Amgen Inc. and Novo Nordisk Inc. for their support of the Power of Prevention initiative.