Wednesday, June 29, 2011

Coronary CT Scans: Dangerous and Best Avoided

I am asked by many patients if they should get a coronary CT scan to evaluate the status of their coronary arteries. Coronary CT scans are a noninvasive way to visualize calcification in the coronary arteries. The only other way to visualize atherosclerotic changes in the coronary arteries is through an angiogram where a catheter from the groin is thread to the coronary arteries.

It must be better to do a coronary CT scan--versus an angiogram-- since it is non-invasive—right? The answer to this question is easy; coronary CT scans should be avoided.

As a population, we undergo too many CT scans. CT scans expose the body to a huge amount of radiation. A coronary CT scan can supply 100x the radiation of a chest X-ray. There are estimates that over two percent of all cancers in the U.S. are the result of too many X-ray procedures with CT scans being the leading radiologic cause of harmful medical radiation.
You would expect an effective medical screening test would lead to early diagnosis in order to improve the outcome of the disease—correct? In the case of heart disease, coronary CT scans should be able to safely diagnose atherosclerosis before a problem develops. Furthermore, the treatment plan should result in a lowered cardiac event rate (i.e., less heart attacks and death).

Researchers studied a group of 1,000 patients who underwent a coronary CT scan. In the 1,000 patients who had the coronary CT scan, 215 had a positive test indicating that they had advanced atherosclerosis. Compared to the group who did not test positive, the positive CT-scanned group were prescribed statins at a 700% higher rate. Furthermore, as compared to the negatively screened group, the positive CT-scanned patients also had four times as many secondary cardiac tests (including angiograms) as well as bypass surgeries at a 10x higher rate.

Since the positive CT-scanned group received the various medical interventions, you would hope that they would have a better long-term outcome. However, the opposite occurred. The researchers found that there was no difference (at 18 months) in cardiovascular events (e.g., heart attacks, cardiac deaths, and angina requiring hospitalization) between the two groups.

What can we conclude here? Coronary CT scans did not result in less cardiac adverse events but did result in more medication usage, surgery and testing. And, don’t forget, the positive coronary CT scans resulted in a lot of money being spent on therapies that did not change the outcome. Finally, all the patients who underwent the coronary CT scans were exposed to a large amount of damaging radiation.

There is no place for coronary CT scans. They are used as a diagnostic modality only. Coronary CT scans expose patients to excess amounts of ionizing radiation and they have not been shown to improve the cardiac event rate. They are not worth the risk.

Arch. of Int. Med. Online. May 23, 2011.

Sunday, June 19, 2011

Just Say "No" to Airport X-ray Scanners

I just returned from lecturing in Florida. As I was going through the security line at the airport, I was watching my fellow passengers to see if they would opt out of going through the x-ray scanner. Almost nobody did. When it was my turn, I told the TSA agent that I did not want to go through the x-ray machine. I was taken aside and given a pat-down.

When all of this was going on, I saw many people going through the regular metal detectors. I asked the agent if I could go through that instead and he said, “No. Those are for airport personnel only. Since they come and go frequently, they do not have to go through the x-ray machines.”

I would not recommend going through the x-ray machine. All ionizing radiation is damaging. These machines have not been properly tested and we do not know the long-term effects of being exposed to the radiation given off by them. And, if the TSA thinks the pilots and stewardesses need to be protected, well, so do the rest of us.

How much radiation are you exposed to from these machines? I have not been able to find a reliable source for this. In fact, I have seen information that the TSA is not doing the proper studies and is not releasing the information that would help us determine how much radiation is used by these machines.

So, when you are at the airport, remember to just say “no” to the x-ray scanner. It isn’t worth the risk.

Wednesday, June 15, 2011

More ADA Nonsense

I posted an article to my blog (September, 2010) about how the dieticians—RD’s—are trying to pass a law in each state which mandates that only RD’s can legally discuss nutrition with patients. This effort is being promoted by the American Dietetic Association (ADA). In September, 2010, I wrote, “The ADA claims that it strives to improve the nation’s health and advance the profession of dietetics through research, education and advocacy. If only that were true. It makes you wonder, since their corporate sponsors/partners include Pepsi-Cola, Coca Cola, Mars, Hershey’s General Mills and others.”

Well, I was being too nice to the ADA. As reported by the Alliance for Natural Health, the credentialing arm of the ADA has approved a program created by the Coca Cola Company Beverage Institute for Health and Wellness. This program will review the “urban myths” about the safety of food ingredients. RD’s who participate in the program will earn registered continuing professional education credits.
This program will teach dieticians that fluoride, sugar, artificial colors and artificial sweeteners have been “carefully examined for their effects on children’s health, growth, and development.”

Give me a break. The ADA is beyond repair. The ADA has sold out to corporate America and should not be trusted to provide any credible nutritional information. Unfortunately, the majority of RD’s toe the ADA corporate line. Thank goodness, there are a few (unfortunately, a very few) RD’s who think for themselves.

The take home message is that the ADA should be ignored or better yet, disbanded. It is important for all of us to oppose the state legislative bills giving RD’s the sole power to discuss nutrition with patients. Since most RD’s have no knowledge of proper nutrition, they should be the last group solely licensed to discuss nutrition with patients.

Sunday, June 12, 2011

Low Magnesium Levels Increase Risk of Sudden Death

Magnesium is a mineral that is very important for the body. Unfortunately, research has shown that the majority of Americans do not ingest enough magnesium. Some reports state that 80% of Americans are deficient in magnesium. What is magnesium needed for?

In fact, there are over 300 enzymes that are dependent on magnesium. Furthermore, magnesium is needed to maintain optimal bone health, as well as cardiac, neurologic, and immune system functioning. Both the thyroid and adrenal glands depend on adequate magnesium for optimal functioning.
I have been checking magnesium levels for nearly 20 years and I am still amazed at how many patients are severely low in magnesium.

A study in the American Journal of Clinical Nutrition (2011;93:253-60) found that, in women, the risk of sudden cardiac death was inversely related to magnesium intake and magnesium blood levels. In fact, there was a 37% increase risk of sudden cardiac death in women who had the lowest magnesium levels compared to women who had the highest levels.

Magnesium is an inexpensive mineral. Magnesium is found in unrefined salt, green leafy vegetables such as spinach and nuts. The only side effect with magnesium supplementation is loose stools. This is easily treated by lowering the dose. Average doses of magnesium for supplementation range from 200-600mg/day.