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Advice from Doctor's Mehmet Oz, Scott Lynch, Otis Brawley, and Larry Newman

Aired January 15, 2005 - 08:30   ET


DR. SANJAY GUPTA, HOST: Good Morning. Welcome to HOUSE CALL. I'm Dr. Sanjay Gupta.
Thousands of people made New Year's resolution just a couple of weeks ago. Promises of getting back to the gym, watching their diet, or finally going for that physical.

We're here today to arm you with the information you need to stick to those plans. Throughout the year, we get hundreds of e- mails from our audience with great health questions. Unfortunately, it's many more than we can use on our shows. So we're answering some of them today, everything from weight loss to headaches. Let's start with heart disease.

Rohiff from New Jersey asks one of the most common and most important questions. "What's the best way to prevent heart disease?"

Well, Rohiff, we consulted Dr. Mehmet Oz. He's a cardiac surgeon and the director of the Cardiovascular Institute at Columbia University in New York.


MEHMET OZ, CARDIAC SURGEON, DR.: Well, the best ways to eat are diet, which you already knew, exercise, specifically 30 minutes a day of some type of activity, plus a half hour of weight lifting. And don't forget the role of the mind. In fact there was a great study at the American Heart Association with yoga, which showed that people who had heart disease got to get their arteries bigger by doing about 90 minutes of yoga a week. So combine that three.


GUPTA: And heart disease is the leading cause of death of all Americans, no matter your gender or your ethnicity. This year alone more than a million people will have a heart attack. And as Dr. Oz pointed out, there are things you can do to prevent heart disease, like diet and exercise.

Also, if you smoke, stop. It's the number one preventable cause of serious illness.

There are factors you can't control, like your age. Your risk automatically increases as you get older. Also your sex. Men are at higher risk than women. And heredity. If you have heart problems in your family, you're at higher risk.

And that's something that Mary in Arkansas is struggling with. "Heart disease runs in my family," she writes. "I'd like to know what it will take to avoid getting heart disease. Both my father and mother have it." Again, Dr. Oz.


OZ: Well, Mary, first of all, you may have bad genes. And that's a good reason to go see a doctor, to see if there's something that's simple that we can help fix, like high homocystene (ph) levels, which are a breakdown product of protein or folic acid, a cheap simple pill can take care of.

But fundamentally, even though your parents have the problem, it might be that your ancestors living a 1,000 years ago didn't. So go back to the basics. Try to eat food that looks the way it looks when it comes out of the ground, so it's not preserved and processed in any way. And walk. It's one of the best ways to lose weight and stay healthy and keep your heart in shape.


GUPTA: And other ways to keep your heart in shape, keep your blood pressure and cholesterol levels in check. Now that's something we get a lot of questions about as well.

Here's one from Janine in New Jersey. She writes, "What alternative approaches can one take to lower cholesterol? I've heard there's a combination of certain vitamins and a plan protein that is making a difference."


OZ: There are lots of products that are marketed as lowering cholesterol. But probably the most valuable thing you can do are soy products, fiber, and by fiber I mean about 25 grams of fiber. Metamucil three times a day, for example. Keep some good Omega-3 fats by your bedside. And most importantly, get your HDL levels up. Now one of the best ways of doing that is Vitamin C, not by pill, but in your diet.


GUPTA: Now we often hear experts say an aspirin a day helps prevent heart disease. But who should take it?

Nancy from Florida wanted some clarification. "I don't have a history of heart problems in my family, and my blood pressure and cholesterol are normal. I have been taking low-dose aspirin each day. Is this harmful?"

Dr. Oz?

(BEGIN VIDEO CLIP) OZ: Well, Nancy, I don't mean to get personal, but how old are you? That's really the key to the answer. It turns out that aspirin taken in folks who are over the age of 45, is probably beneficial. But don't take one baby aspirin a day. You need to take at least two baby aspirins a day, or even a large adult aspirin because if lots of people don't respond appropriately to the lower dose of aspirin. If you're younger than the age of 45 we don't have any data to support taking aspirin.


GUPTA: Getting lots of good advice from Dr. Oz. We're going through our inbox here on HOUSECALL. Next up, trying to win the battle of the bulge.


UNIDENTIFIED FEMALE: Coming up on HOUSECALL, staying heart healthy and losing weight all year long. Resolve to stay here and answer this question -- today's daily dose quiz. How many calories do you need to burn to lose one pound of fat, 1,500, 2,500, or 3,500? The answer when we come back.




UNIDENTIFIED FEMALE: Before the break we asked, how many calories do you need to burn to lose one pound of fat, 1,500, 2,500, or 3,500?

The answer -- if your body uses 3,500 calories more than you take in, you lose a pound of fat.


GUPTA: Thirty-five hundred calories. And that would take 150 pound person nearly five hours of running to burn. If you're looking to lose weight this year, though, don't let that fact scare you. Exercise isn't your only option. Cutting back on portion sizes and eating healthier foods are also great ways to trim fat. And we get tons of e-mail traffic on food and weight related topics all year round. Here are some we thought deserved another look.

Steve in Virginia wants to know, "Since I only get a chance to do a cardio workout once a week, what are some quick and easy things I can do to keep up my cardio fitness?"

Well, we consulted Dr. Scott Lynch. He's medical program director of Bariatrics at Emory University.


SCOTT LYNCH, DR., WEIGHT LOSS EXPERT: One thing that you can do is to purchase a pedometer and use the pedometer to count up steps per day with the goal being to achieve 10,000 steps per day. This has been shown in research to actually improve your health, independent of cardio training on a walker or an exercise machine at a gym.


GUPTA: Another common question has to do with supplements. John in Illinois asks, "Are there any safe supplements to help curb appetite?"


LYNCH: That's a very common, question, John. Actually the FDA Food and Drug Administration does not regulate supplements. And so, we don't really know what the supplements do, whether or not they're effective by evidence, and whether or not they're safe to take over the long term.

There are some things that you can do, however, to help decrease your appetite during the day. And that's eating smaller meals and snacks throughout the day about three meals and two to three snacks a day comprised of fresh fruits and vegetables, whole grain breads, and also eating protein -- a lean protein source earlier in the day.


GUPTA: Now, when diet and exercise have failed, and you're severely overweight, some people consider weight loss surgery, like gastric bypass surgery, where surgeons actually reduce the size of your stomach so it can only hold an ounce of food.

They then bypass part of your intestines so you can eat less. And your body also can't absorb as many calories.

The number of weight loss surgeries performed has soared in recent years. And Bernice from Ohio is considering the possibilities. "I'm considering laproscopic bypass surgery," she writes. "Are there questions I should ask to assure a good outcome?"


LYNCH: Great question, Bernice. There are four basic things you need to know before having a laproscopic gastric bypass. One, you want to know about the surgeon and the facility. How many of they done? What are the complications? How do they handle those complications? How do they compare to other facilities in the region?

You also want to know how are you going to be prepared for the surgery by the office. Are you going to have classes with a registered dietician? Are you going to learn what to expect after the surgery? Are you going to be taught about nutrition guidelines after the surgery and supplementation that may be necessary afterwards?

Also, you're going to want to know follow-up. When are you going to see the surgeon? And lastly, you want to know what are your local support options? Are there support groups in your area of other patients that have had the surgery you can answer questions for you and be there for you when you need someone who's not a medical provider?


GUPTA: All surgeries have risks, obviously. And that's something that concerns Laura in West Virginia, who's also considering weight loss surgery. "Besides infection," she writes, "what are other dangers in gastric bypass surgery? Also, at what point does your weight qualify you for this operation?" Again, Dr. Lynch.


LYNCH: Gastric bypass surgery is not for everyone, that's for sure. And let me take the last part of that question first. The National Institutes of Health has set up guidelines for bariatric surgery. And they are someone with a BMI of greater than or equal to 40, that qualifies for the surgery. And also someone with a BMI greater than or equal to 35 with co-morbidities of obesity, such as hypertension, hyperlypodemia, arthritis, also qualify for the surgery.

It's a very personal decision. It needs to be worked out between you, your surgeon, and your primary care physician as to whether or not the surgery is for you.

Some of the dangers associated with gastric bypass surgery are like any other surgery -- incisional hernias, bleeding during the procedure. But more specifically to the bypass, you may have problems with the anastymosis (ph) or where the parts of the intestine are put together may leak, or they scar down and require stretching by your surgeon or a gastroenterologist.


GUPTA: Dr. Scott Lynch put some good advice there. When our special edition of HOUSECALL continues, the risks and benefits of hormone replacement.

UNIDENTIFIED FEMALE: Can testosterone therapy be dangerous? What about links between HRT and cancer? More of your questions on the fight against cancer coming up on HOUSECALL. Plus...


UNIDENTIFIED MALE: It's a very fashionable crowd and a very fashionable movement.


UNIDENTIFIED FEMALE: The newest rage in healthy eating. It's all about keeping it raw.

But first, today's edition of the pulse.

(BEGIN VIDEOTAPE) HOLLY FIRFIR, CNN CORRESPONDENT (voice-over): Resolving to be healthier this year? The government has some tips for you in their just released 2005 dietary guidelines.

They remind Americans to eat more whole grains and fruits and vegetables, while limiting consumption of trans-fats and alcohol. Also, exercise 30 to 90 minutes a day, most days of the week.

And a study in "The Journal of the American Medical Association" warns red meat lovers of an increased risk in colon cancer. Researchers found people eating high levels of bread and meat, the equivalent of about a hamburger a day over many years, had a 30 to 40 percent greater risk of developing colon cancer. Those eating processed meat were at 50 percent greater risk. Experts say moderation of these foods is key.

Holly Firfir, CNN.



GUPTA: Welcome back to HOUSECALL. It's that time of year - people taking stock of their health, checking their medications and scheduling check-ups.

If you're like thousands of people on hormone therapy, you may be questioning the safety of these drugs after last year's warnings about possible links between hormone replacement therapy and certain cancers.

Shirley in Canada is concerned. She writes, "I've been on hormone supplements since having a hysterectomy in the early 90s. I am on a low dosage, but am I at greater risk of getting breast cancer?"

Well, Shirley, we posed your question to Dr. Otis Brawley. He's an oncologist and associate director for cancer control at Emory University's Winship Cancer Institute.


OTIS BRAWLEY, DR., ONCOLOGIST: Well, Shirley, the women's health initiative is a randomized study looking at estrogen plus progesterone. And I'm answering the question specifically for women who have had a hysterectomy who are getting only estrogen, not estrogen plus progesterone.

That study actually demonstrated that estrogen use alone does not increase your risk of breast cancer. It does increase your risk of stroke. It does not affect the risk of heart disease, however. And it also may decrease your risk of getting osteoporosis just a little bit. We still worry that there is not enough benefit to outweigh the risk of estrogen therapy alone, however.

(END VIDEO CLIP) GUPTA: Looking to boost your memory and energy levels this year? Well, for many older men, testosterone therapy is just how they plan on doing that, by pumping up dropping testosterone levels.

Now these drugs could help sharpen memory and mental focus, increase sex drive, and improve energy levels. But with those claims come worries about the effect of this hormone.

And that brings us to a question we got from Stan in Texas. He writes, "Are there any cancer risks associated with testosterone replacement? What are the alternatives?"

Again, Dr. Brawley.


BRAWLEY: We don't know if it causes prostate cancer. There's some evidence to suggest that it may. It is still advocated by many. But the answer to your question is we really don't have solid evidence that it causes cancer, but we worry that it increases risk of prostate cancer.


GUPTA: And a traditional test for prostate cancer, the PSA test, is becoming more and more controversial with some experts even advising men not to bother getting the test as all, while others caution better to test than not to. So where do we stand?

That's what Pete from Virginia wants to know. "Are there really any reliable tests for colon and prostate cancer?"


BRAWLEY: Pete, we'll start out with prostate cancer. Indeed, prostate cancer screening is one of the greatest controversies in all of medicine. PSA screening, which has been advocated, is now being questioned. It finds a lot of disease which doesn't need to be treated. It misses a lot of disease.

Most organizations don't necessarily say men should be screened. They say men should know the potential risk and potential benefits and make an educated guess or an educated decision.

Doctors, too, need to be informed about the potential risks and benefits, so they can offer it to patients.

In terms of colon cancer, we have a number of good studies that show that colon cancer screening, either with stool gliac or a fiber optic tube looking up into the colon, actually saves lives. And that's to be advocated. Stool gliac or stool blood testing for people in their 40s and then the fiber optic study starting for people in their 50s.

(END VIDEO CLIP) GUPTA: Let's move on to another much talked about cancer -- melanoma. We get a lot of questions about this deadly type of skin cancer.

And here's an important one. John from Louisiana wonders, "Is it possible to get malignant melanoma in an area that is not exposed to the sun?"


BRAWLEY: John, that's a very good question. We actually find that melanoma usually occurs in sun exposed areas. But yes, you can get melanoma in areas of the body that are not traditionally sun exposed and have never been sun exposed.

We also see melanomas in the eye, melanomas on the palm and sole of the feet, as well as in melanomas in the genital areas, which are usually not exposed to the sun.


GUPTA: Skin cancer is the most common type of cancer diagnosed with about a million Americans getting that news each year, which leads to obviously to lots of questions like Colleen's in Virginia. She writes, "I'm a fair-skinned redhead. When I was a kid, I had severe sunburns and skin cancer is in my family. Am I at risk for skin cancer, even if I am better at protecting myself now?" Dr. Brawley?


BRAWLEY: The greatest risk for melanoma is sun exposure. The second greatest risk is being light skinned. The third greatest risk is having had severe skin damage while a child. Children who get sunburn are at increased risk of developing melanoma later in life, even in your 20s, 30s and up into their 50s and 60s from the area of their body that was sunburned in childhood.


GUPTA: Great advice from Dr. Brawley. Thank you so much.

Planning on tackling those nagging headaches this year? Well, stay with us for some great tips to ease those throbbing temples.

UNIDENTIFIED FEMALE: From migraines and sinus problems to caffeine withdrawals, your best bets for getting rid of that nagging headache, coming up on HOUSECALL.

First, our bod squad checks out the newest trend in eating well.


ELIZABETH COHEN, CNN CORRESPONDENT (voice-over): Have you had your five a day today? Besides providing a wide assortment of vitamins, minerals and fiber, fruits and vegetables are the new "it" food in Tinseltown. According to Chef Sumara Malingalis (ph), raw food with no meat, no dairy, and no cooking is all the rage in Hollywood.

UNIDENTIFIED FEMALE: There's something very sexy about it. So I think that that's something of the appeal.

UNIDENTIFIED MALE: It's a very fashionable crowd and very fashionable movement.

COHEN: That movement is growing rapidly with raw food options exploding into health food stores and online Web sites across the nation. Raw foodists say it's the easiest way to remove fat from the diet and lose weight. And they proclaim benefits, such as reducing allergies and extending life. They say cooking leeches vital nutrients, but...

BONNIE TAUB DIX, NUTRITIONIST: There could be a lack of Vitamin B-12, Vitamin-D because they don't encourage dairy products.

COHEN: So be sure to check with your doctor before embarking on any restrictive diet.

Elizabeth Cohen, CNN, Atlanta.



GUPTA: We have all experienced this, the throbbing, stabbing pain of a headache. Whether you're concerned about the causes or just looking for some relief, we've got answers to some of your best questions on headaches, like Lori in Nova Scotia, who wonders, "In a healthy adult, how many headaches per month is considered too many and deemed necessary to see a doctor?"

Well, Lori, we consulted Dr. Larry Newman. He's director of the Headache Institute at Roosevelt Hospital Center in New York.


LARRY NEWMAN, HEADACHE SPECIALIST: If you are asking me, and I get migraines, how many headaches is too much, I think any headache that I have is too much for the month.

In general, we tell patients, if the headaches occur once a week or more, that would be a reason to see a doctor. If they occur just a few times a week or a few time as month even, and they're interfering with your social life or your ability to take care of yourself or your family, that's a reason to seek care also.

So it's not the frequency, it's what the headaches are doing to your life.


GUPTA: And headaches come in many different forms. Migraines, which are characterized by sharp throbbing pain, tension or stress headaches which have more of a vice-like pain, and clusters. They also have sharp pain, but they can last weeks or months.

Denise from Pennsylvania had this question about migraines. "I'm a long time migraine sufferer and wanted to know what advances have been made in treating migraines?"


NEWMAN: Well, Denise, there's a number of things that are available now to treat headache, both the acute headache, the attack when it occurs, and the preventative agents.

Most eventually, Topamax, which was originally and anti-seizure medication, was approved by the FDA as an agent to stop the migraine headaches. And then we have a whole host of medications called Tryptans, which are available to stop the headache cold. These agents get rid of the headache, the nausea, and a light sensitivity, typically in under an hour.


GUPTA: So there are plenty of medications available to stop your headache pain. But what causes these attacks in the first place? Melissa from Texas wonders if food might be the culprit?

"Do you believe that a person's diet and overall eating habits can have a direct effect on whether he or she suffers from headaches on a regular basis?"


NEWMAN: Well, Melissa asks a very good question. In fact, there are a number of food triggers in patients who have migraine, chocolate, cheeses, aged cheeses, red wine, nitrate containing foods like hotdogs and sausage. Nutrasweet or Equal can do it for some people as well.

So we usually have our patients keep a diary and try and look for those foods. And if they're present, eliminate those from the diet. If not, let them eat them at will.


GUPTA: Thinking of cutting back on caffeine this year? Well, be careful because cutting back too quickly can be painful.

Nadine in Virginia is looking for help with her love of java. "What is the best way to combat head pain brought on by caffeine withdrawal?" Again, Dr. Newman.


NEWMAN: What we tell our patients to do is slowly decrease the amount of caffeinated beverages, whether it's coffee or tea or sodas or other soft drinks. Gradually decrease the amount of medication until they're on very little of it so that the headaches disappear. Don't do it cold turkey or you'll have a headache for days at a time.


GUPTA: Lots of good advice today. Our thanks Doctors Mehmet Oz, Scott Lynch, Otis Brawley, and Larry Newman for helping us answer some of your best questions.

Last year, we got lots of questions about our new you resolution participants. Well, tune in next week. We're going to introduce you to CNN's own Fab Five. Follow along as they struggle to fulfill their 2005 healthy resolutions.

Thanks for watching. I'm Dr. Sanjay Gupta. More news now on CNN.


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