P.H.A.T or Fat?

“Doc, I just don’t understand”, said Patient X, one of my long-time patients. “My blood pressure is okay, I’m taking my medicine as prescribed and my blood work is normal. Look at my weight. It’s almost the same as last visit. Did you check my thyroid? I think my hormones are all out of order. I need that weight loss pill. Those television potions that I spent hundreds of dollars on aren’t working to rid me of my cellulite and baby fat. My knees are aching, I get short of breath walking up and down the stairs. I snore all the time, and I’m always tired. I’m going to start exercising this week, I promise. Doc, can you help a sister out with some of those weight loss pills? I need to lose 30 pounds this month for my daughters wedding, class reunion, cruise… These guy where looking at me and said I was P.H.A.T.” Or did they mean fat?

“Patient X” has the same story each visit and despite being a regular and loyal client, taking charge of her life has taken a back burner to quick fixes for weight loss. She’s probably one of the nicest people I have ever met; however she seems to be in denial when it comes to her health and the hard cold facts. Her blood pressure was elevated at 130/85 (normal is 120/80 or less), her cholesterol and fasting blood sugar was also mildly elevated, and wrapped around her waist was an excess of fat that had increased by several inches over the last year creating a cute, but deadly “jiggle” as she walked. My patient, Patient X, has what we call the metabolic syndrome, which is a group of risk factors found in one person. The risk factors for the metabolic syndrome include an increased waist circumference, elevated cholesterol (specifically the triglycerides), a low HDL (the good cholesterol), elevated blood pressure (130/85 or greater), and an elevated fasting blood sugar (greater than 100 mg/dl). It is estimated that over 50 million Americans have the metabolic syndrome and one of the dominant underlying factors is abdominal obesity (excess fat around the stomach).

The disease obesity, which can be simply defined as excess in body fat, is not the same as being overweight. “A person who is overweight is running a definite health risk, but an obese person is loudly and insistently asking for trouble”, says Stacy Mitchell, M.D. co-author of Livin’ Large: African American Sisters Confront Obesity. Overweight and obesity are labels for ranges of weight that are greater that what is considered healthy for a given height. When discussing adults, the Body Mass Index or BMI determines overweight/obesity. In my practice, I consider the BMI a vital sign as it helps me to assess my patient’s risk for obesity and the diseases that come along with it. So by simply taking one’s height, weight, and waist circumference, not only can your doctor determine your BMI and risk for obesity, he/she can also gain some insight on your risk for heart disease, the number one killer of all Americans.

In the past 20 years there has been a significant increase in obesity in the United States and African American’s are under attack. Obesity does not discriminate as the Food and Drug Administration (FDA) estimates that almost two-thirds of (64%) of all Americans are overweight; almost one-third are obese. Conservative estimates by the Centers for Disease Control (CDC) show that 65% of African American women and 33% of African American men are overweight. Childhood obesity is on the rise and we are now seeing shocking increases in diabetes, heart disease, and hypertension in this previously active and healthy population. Overweight/obese individuals are at risk for developing many conditions including diabetes, heart disease, strokes, high blood pressure, arthritis, hypothyroidism, high cholesterol, sleep apnea, gall bladder problems, gout, cancer of the kidney, endometrium (lining of the uterus), breast, colon and rectum, esophagus, prostate and gall bladder; depression, anxiety, etc… Obesity is now considered the second most preventable cause of death in the United States, preceded only by smoking. Four hundred thousand deaths a year are estimated to be associated with obesity.

There are treatment options for this disease; however, we must first accept that there is a problem, especially in the African-American community. While some medications have been approved for treatment (orlistat and sirbutamine) and there are surgical options, which are reserved for extreme cases, proper diet and nutrition coupled with regular and consistent exercise and modification of behaviors associated with overeating is the mainstay of treatment.

She’s P.H.A.T (pretty, hot, and tempting), “big boned”, full figured, pleasing plump, or thick! That can be a compliment to some ladies, but it could also mean she’s fat, obese, or overweight depending on the messenger. Remember, being overweight/obese is not an issue of aesthetics. “You can be overweight and still stop traffic”, says Teri Mitchell who also co-authored Livin’ Large. The reality is it’s still unhealthy. For more information on obesity visit http://www.cdc.gov/, pick up the book Livin’ Large by Teri and Stacy Mitchell.

(c) 2007 Rani Whitfield. This article was published September 2007 at www/eurweb.com

Alcohol: Is it Good or Bad For You?

Despite what most people thing alcohol is the second most commonly abused legal drug in the United States after tobacco. There has been some debate over whether alcohol is good or bad for those who do drink. The difference between what’s “good versus bad” is in the amount and frequency that one drinks. To date, there has been no universally accepted standard drinking definition. Alcohol abuse is a major cause of preventable death in the United States. Heavy drinking can damage the liver and heart, cross the placenta and harm and unborn child, increase the chance of developing certain cancers, plays a role in depression and violence, and is a major cause of problems with relationships. The assumed benefits, if one drinks in moderation, include improving cholesterol, reducing one’s risk of heart disease, potentially protecting against type 2 diabetes and preventing gallstones.

But before we get all excited about the rum and cola you had last night, lets take a look at the numbers: 14 million Americans meet the criteria for alcohol abuse or alcoholism; alcohol plays a role in 1 in 4 cases of violent crime; more than 16,000 people die each year in automobile accidents in which alcohol was involved; alcohol abuse costs more than $180 billion dollars a year. Alcoholism cuts across gender, race, and nationality in the United States. 17.6 million people, about 1 in 12 adults, abuse alcohol or are alcohol dependent. In general, more men than women abuse alcohol and problems are highest among young adults age 18-29 and lowest among adults ages 65 and older. There is research that shows that the risk for developing alcoholism runs in families; however, lifestyle plays a major role as well.

Ethanol, the active ingredient in alcoholic beverages can affect the body in many ways. It is classified as a sedative significantly impairs judgment the more you consume. Long-term users of ethanol are often defined as problem drinkers or alcoholics. Alcoholics are both physically and psychologically dependent on the drug, while problem drinkers are only psychologically dependent. Heavy and binge drinking overtime can cause inflammation of the liver called hepatitis and eventually lead to scarring of the liver called cirrhosis. Cardiomyopathy, an enlarged and poorly functioning heart, is also a major long-term side effect. Cancers that have been linked to alcohol abuse include those of the mouth, throat, esophagus, colon, and breast. Certain individuals should never drink and they include pregnant mothers, recovering alcoholics, those with diseases of the liver, and individuals taking medicines that interact with alcohol. As mentioned earlier, ethanol can cross the placenta and put an unborn child at risk for Fetal Alcohol Syndrome. These children are born with facial deformities, abnormal behavior, and mental retardation, just to name a few.

In most cases, alcoholics deny that they have a drinking problem. Signs and symptoms of alcoholism include binge drinking; drinking alone; nausea, sweating, shaking, and seizures if some one is coming off a binge drinking session; depressed mood, irritability, and legal problems. Unfortunately, there is no cure for alcoholism, but the good news is that it is treatable. Treatment programs use a combination of both counseling and medications to help people stop drinking. The bottom line is that if you don’t already drink, there is no reason to start. You can get similar if not better benefits for your heart by exercising and eating a healthy low fat diet. If you already drink alcohol, do so in moderation. Men should drink no more than two drinks a day and women no more than one. Women have less total body water than men, so therefore it takes less alcohol to have an effect on women. The principles of good health for the most part have not changed. A good diet, regular exercise, and seeing your doctor on a regular basis is the key to longevity. If you don’t already drink, don’t start. If you do, do so in moderation and remember to never drink and drive.

For more information on alcohol visit www.niaa.nih.gov. (c) 2007 Rani Whitfield. This article was published September 2007 at www.eurweb.com

Drugs of Abuse Steroids:Fact or Fiction

By the time you read this article, Barry Bonds may have already broken the home run record. On July 20, 1976 Hank Aaron hit the last and final homerun of his very successful, yet tumultuous career in the Major Leagues. Much like his predecessors, Satchel Paige, Jackie Robinson, Willie Mays, and many others African American players during that era, he played the game under extreme racism, scrutiny, and ridicule because he was African American and because he seized the home run record of America’s white hero, Babe Ruth. So we should be applauding the efforts of the African American Barry Bonds, right? He has great hand-eye coordination, he is the winner of eight Gold Glove Awards, he was the Most Outstanding Player in Baseball in 1993, and he holds the record for the most home runs in a single season- 73! Something, however, “just ain’t right”, and the accusations of his use of anabolic androgenic steroid (steroids or AAS) to help achieve these goals have not only tarnished his image, but the image of successful African American athletes.

Performance enhancing drugs like steroids are not new to the arena of sports. They date back to the early Olympic Game’s, which started in Greece and has now evolved into a multimillion-dollar industry due to marketing and advertising. As early as 1969, journalist Bill Gilbert was quoted in Sports Illustrated as saying, “The pill, capsule, vial, and needle have become fixtures of the locker room as athletes increasingly turn to drugs in the hope of improving performance.” The desire to win and to gain the edge over one’s opponent is innate. Who could argue with a young man or woman whose business contract becomes more lucrative if he/she can out run or out bench press more than his/her competition? The facts, however, still remain: steroids are illegal and are associated with short and long term side effects, some of which are very damaging to the body. The question I am often asked is why do athletes use steroids.

Anabolic (tissue or muscle building) androgenic (the development of masculine characteristics) steroids or AAS are the man made or synthetic versions of the male hormone testosterone. Testosterone, a hormone found in men and in women in much smaller amounts, is responsible for the development of males during puberty. The original purpose for the use of steroids by physicians included: replacement of the hormone in men born with low levels; treating individuals who suffered injuries during war; treating those who are malnourished, such as HIV and cancer patients. There are also veterinarian uses for these drugs to treat certain medical problems in cows and horses. When used properly, these medicines can be very successful in treating illnesses and definitely have a place in the medical arena.

Unfortunately, there is a phrase used by some professional athletes: “If you are not using steroids, then you are not trying hard enough!” The quest for supremacy at the expense of one’s health has taken over and the all-mighty dollar is more important than longevity and loved ones. Steroids have been used and proven to build strength and endurance in competitive athletes for decades. Weight gain, weight loss, increased speed, increased strength, and physical appearances are all reasons for the use of these illegal concoctions. Steroids have become much more complex as proven by the “designer” steroids, some of which are undetectable with the latest technology in urine, blood, or hair samples. Steroids are administered in many ways including pills, needles, patches, or creams. Once in the system they are soaked up my muscle cells from the blood stream. Once inside the muscle cells they promote the production of protein, which stimulates muscle growth. Athletes often take doses two to three times the normal amount of steroids required on weekly basis. They mix or stack different types of steroids to achieve various effects: more muscle mass, decreased weight, leaner appearance, etc…. None of these “protocols” used by the athlete have been tested on humans and at best are experimental.

Side effects of steroid use/abuse include high blood pressure, strokes, elevated cholesterol, nausea, sleep disturbances, acne, increased aggressiveness, and mood disorders including anxiety and depression. Women can experience reduced breast size, increased body and facial hair, a deeper voice, and menstrual problems. In men, reduced sperm count; impotence, breast growth, and decreased testicular size have all been documented. Some of these are irreversible and require surgical treatment.

It still amazes me, however, that I get request frequently for these drugs to improve performance. To win at any and all cost is the main reason. A poll taken in 1995 of 198 sprinters, swimmers, power lifters, and other Olympians and aspiring Olympians asked if the athletes would take a performance-enhancing substance if they knew it would help them win there event and they would not be caught- 195 out of 198 said yes. The poll went further to ask if under the same conditions they would take the substance knowing that in five years they may die- 80% still said yes!

Educating our youth on proper nutrition, exercise, and the consequences of steroid use/abuse is the key. Commitment to the sport on all levels is the only way to be successful. Steroids are illegal, potentially harmful, and are viewed as cheating. Is Barry Bonds guilty; unfortunately many believe that he is, despite being one of the most talented individuals to ever play the game of baseball and one of my personal favorites. My advice to him is to never take or rub something on his body without doing a little research. I surely will celebrate the day he breaks the record, but for some, his success will always be in question.


For more information on steroids visit (www.nida.nih.gov) or visit my website (www.h2doc.com), view the Steroid Man, and shoot me a question at DrRani@h2doc.com. (c) 2007 Rani Whitfield. This article was published September 2007 at http://www.eurweb.com/