A 2020 Vision For Health
Hang on to your resolutions. After taking a close look at medical news and wellness trends, EVMS experts share their guidance for a happy and healthy new year.
Eat this, not that. No, wait
Keto. Paleo. Mediterranean. Plant-based.
Raw foods. Whole foods. Locally grown. Farm to table.
Food deserts. Food farmacies. Culinary literacy. Nutrition as medicine.
It’s enough to send anyone running for the Haagen-Dazs.
So, what the heck should you eat?
EVMS nutrition expert Cynthia Cadieux, PhD, RDN, says that a whole-food, plant-based eating pattern — she’s careful not to say “diet” — has the best outcomes over time.
“There’s science behind it,” she says, “not wishful thinking.”
An Associate Professor in the School of Health Professions, Associate Dean for Education Assessment and Evaluation, and Director of Distance Education, Dr. Cadieux also is a Registered Dietitian Nutritionist and fellow in the Academy of Nutrition and Dietetics, which makes her the go-to person at EVMS for all things nutrition-related.
But as with most schools of medicine and health professions, when it comes to nutrition education at EVMS, Dr. Cadieux is a world of one.
To that end, she points to a report issued last fall by Harvard Law School’s Food Law and Policy Clinic, which explains why the shortage of nutrition educators needs to be addressed.
“Doctoring Our Diet: Policy Tools to Include Nutrition in U.S. Medical Training” says the lack of nutrition education for physicians is “a missed opportunity for doctors to promote good health, illness prevention, and treatment of chronic diseases. . . . Physicians are less likely to recognize the importance of dietary problems, include nutrition assessments during patient exams, offer accurate basic nutrition advice, or be equipped to provide referrals as needed.”
Healthcare providers are getting on board, as well, Dr. Cadieux says. Emerging trends include rooftop produce gardens atop hospitals, such as the one at Boston Medical Center that supplies its Preventative Food Pantry; and Food Rx, a food prescription program in Chicago that was developed by a University of Chicago research team, a farmers market, Walgreens and six health centers.
“The Physicians Committee for Responsible Medicine is also putting a tremendous emphasis on whole food, plant-based eating,” Dr. Cadieux says. “And environmental nutrition, which connects health and nutrition with environmentally sustainable diets, is gaining momentum.
All of this is leading to more research in areas like preventive eating, tooth-friendly foods, and the gut microbiota and its relationship to health.”
Now the question is: When will a plant-based Haagen-Dazs hit the shelves?
Myths about vaccinations bring measles back
It may be 2020, but a recent rash of measles outbreaks has healthcare providers feeling like we’ve stepped back in time.
According to the Centers for Disease Control and Prevention , before the U.S. measles vaccination program started in 1963, about three million people nationwide got measles each year. Of those, 400 to 500 people died, 48,000 were hospitalized, and 1,000 developed encephalitis (swelling of the brain).
Thankfully, widespread use of the vaccine in the U.S. led to a 99% reduction in measles cases. And on a global scale, the measles vaccine is estimated to have saved 21 million lives between 2000 and 2017.
So why all the fuss now?
Vaccination rates in the U.S. are down, making more people — especially children — susceptible to the highly contagious viral infection. In fact, the CDC reports that the vaccination rate for measles has fallen below 80-85% in some areas of the country.
Officials have attributed this largely to a growing number of parents who refuse to vaccinate their children due to either religious reasons or concerns that the vaccinations have a link to autism — a link that research has discredited.
“Most if not all of this is related to misinformation and a misunderstanding of the benefits of vaccination,” says John Harrington, MD, Professor of Pediatrics at EVMS.
Vaccination rates in the U.S. are down, making more people — especially children — susceptible to the highly contagious viral infection. In fact, the CDC reports that the vaccination rate for measles has fallen below 85% in some areas of the country.
“Public health requires the public to be knowledgeable about the dangers of being duped by online misinformation that provides some type of conspiracy theories,” Dr. Harrington says. “The problem is that sometimes they sprinkle a nugget of truth that gets twisted into some secret reason we should not vaccinate.”
So what do people need to know?
“The measles vaccine is safe,” Dr. Harrington says.
Research has shown that the measles vaccine does not cause autism or other permanent neurologic or developmental problems. It does, however, provide 99% protection rates.
In the U.S., the vaccine is not given to babies under 1 year of age because they are too young to be immunized. It is also not given to those with immune system deficiencies.
And since measles is highly contagious, that’s a really important factor to take into account. The virus can linger in the air for about two hours after a contagious person has left the room, and 9 out of 10 unvaccinated people will contract measles if exposed.
Meaning those who can vaccinate, should.
Does social media put teens at risk for mental health issues?
Today, nearly 90% of teens have their own smartphones, and the majority of them are logged into social media. According to a study by media nonprofit Common Sense, about 70% of them visit social media sites multiple times a day.
As social media commands a measurable span of teens’ attention, many parents and researchers are concerned about how it could be impacting their mental health.
“There are benefits and risks when it comes to social media and teens,” says Serina Neumann, PhD, Professor of Psychiatry and Behavioral Sciences at EVMS. “While it does expose them to early learning, knowledge and opportunities to access information, it can cause negative health impacts as well.”
Among those are sleep problems, attention issues, a higher incidence of obesity and depression. The access to knowledge and information that Dr. Neumann mentioned as a positive can also be considered a negative for giving teens access to information that may make them feel bad about themselves.
Another cause for concern is the trend of social comparison. “When teens constantly compare themselves to other people on social media, it can cause negative feelings, thoughts about self-worth and not being good enough. This can lead to internalizing issues.” In those situations Dr. Neumann advises parents to look out for signs that teens are withdrawing from activities, passing on being with friends to be online and have sudden changes in personality.
Moving forward, Dr. Neumann says more research is needed on the topic. “We need better designed long-term studies to clarify the ways we can help prevent negative impacts.”
Until then, she recommends monitoring screen time and setting up a family media use plan to create a balance between screen time and other activities.
“With so many teens having phones,” she says, “it’s inevitable that they will be using social media. But if you have clearly communicated boundaries about privacy and what’s age appropriate, you will be much more prepared.”
HPV vaccinations are having a big impact
Just 10 years since the Gardasil vaccine was first recommended, the number of human papillomavirus (HPV) infections has dropped significantly.
A recent study using data from the National Health and Nutrition Examination Survey showed that vaccine-preventable HPV infections among 14- to 19-year-old women decreased by 86% in the 10 years since the vaccine’s approval.
HPV is a common virus that can lead to cancer. According to the Centers for Disease Control and Prevention, nearly 80 million people are infected, and another 14 million people become infected every year.
Clinical trials have shown that the vaccines, now recommended for preteen girls and boys, provide close to 100% protection against pre-cancers and genital warts.
EVMS researchers have seen similar positive results in a rare and serious disease in young children caused by HPV infection in the respiratory tract. Juvenile onset recurrent respiratory papillomatosis (JORRP) causes wart-like growths around the larynx and on the vocal cords. The growths can spread all the way to the lungs. In children, it is most commonly acquired during vaginal delivery.
After the HPV vaccine’s approval, physicians around the country began noticing a decline in new cases. The Centers for Disease Control and Prevention chose EVMS researchers to organize the effort to validate these anecdotal observations. Craig Derkay, MD, the Fine Family Professor in Otolaryngology and Professor of Otolaryngology – Head and Neck Surgery, is leading the five-year project.
“We recruited colleagues from around the country to help us with this research,” Dr. Derkay says. “Our preliminary results show a dramatic effect from the vaccine, and we are seeing it earlier than expected.”
Over a 10-year period, researchers found the number of JORRP case-patients and incidences declined by about 80%.
“If my legacy is that I can have a hand in preventing any new cases of this from being managed by the next generation of doctors,” Dr. Derkay says, “then I will have achieved a career goal. Finding something that prevents this devastating disease and wiping it out of the United States would be great.”
Dr. Derkay says the decline is most likely the result of a herd immunity, meaning that if enough people in a population are vaccinated, the circulation of the disease is reduced.
“I’ve been doing this for 30 years, and I’m ecstatic about the results,” Dr. Derkay says.
“I would be happy to put myself out of business.”
A friendly battle with dementia
Can friends help us stave off dementia as we age?
There’s no definitive proof, but observational studies suggest that social interaction is a strong deterrent to one of the most insidious side effects of aging, says Robert Palmer, MD, MPH, the John Franklin Distinguished Chairs for Geriatrics, Professor of Internal Medicine and Director of the EVMS Glennan Center for Geriatrics and Gerontology.
“Social activity itself, even when considering age, sex, race, physical activity and so forth seems to protect people from cognitive decline and possibly a diagnosis of dementia,” Dr. Palmer says.
Social activities, he says, can help the aging brain “maintain nerve networks and support the concept of cognitive reserve capacity,” a process that can benefit individuals with Alzheimer’s or other dementia.
The beneficial effect can be enhanced when combined with regular exercise, such as walking.
Six common types of activities that involve social interaction may include:
Going out to dinner, playing bingo or card games
Taking day or overnight trips
Participating in community or volunteer projects
Visiting friends or relatives at their homes
Participating in groups, such as senior centers and community organizations
Attending church or religious services
Studies have shown a clear relationship between the level and degree of social support and the maintenance of normal or even improved cognition.
“It seems,” Dr. Palmer says, “that the quality of social support relationships with a network of friends and family is most important.”
Breast implant illness — more questions than answers
Tens of thousands of women who say they’re living in pain are choosing to have their breast implants removed. And they have plenty of questions.
Many of them have turned to Facebook support groups to share how they feel about their implants. Some women are concerned that their breast implants are causing a variety of problems, including chest and joint pain, headaches, neurological disturbances and unexplained fatigue.
Over 50 years ago, the medical community grew concerned that silicone breast implants were associated with various health conditions. In 1992, the Food and Drug Administration removed them from the market and required breast implant manufacturers to conduct studies to evaluate their safety.
“When I first started practicing 25 years ago, I participated as an investigator for silicone gel implants”, says, Lambros Viennas, MD, Chief of Plastic Surgery and Assistant Professor of Surgery at EVMS. “There was a nationwide effort to collect data on these implants to determine the safety efficacy.”
Seven years later, after reviewing the scientific literature, the Institute of Medicine concluded that women with silicone gel implants were not more likely than the rest of the population to develop cancer, immunologic diseases or neurologic problems.
“Since the silicone breast implant moratorium was lifted 20 years ago,” Dr. Viennas says, “there has been ongoing monitoring with many scientific studies published. To date there is no scientific evidence that breast implants are associated with cancer; connective tissue diseases such as rheumatoid arthritis, lupus and scleroderma; fibromyalgia; or neurologic disease. However, most recently a rare condition called anaplastic large cell lymphoma has been associated with a specific type of textured breast implant that has been removed from the market.”
Dr. Viennas recommends that patients who have problems related to their breast implants talk with an expert. “Patients may have local symptoms related to the breast implants, such as pain, deformity, infection, swelling or rupture. Therefore, it is very important to have a board-certified plastic surgeon evaluate your implants if there are any problems.”
Because of their concern for symptoms of systemic illness, some women have decided to have their implants and surrounding scar tissue removed through a procedure called a capsulectomy.
“This is a decision a patient has to make,” Dr. Viennas says. “If the patient wishes to have the breast implant removed, I would also recommend removal of the surrounding breast capsule. If the capsule is adherent to the chest wall, then I would not attempt removal of this portion because of the high risk for complications.” However, he warns that if a patient has been diagnosed with anaplastic large cell lymphoma, the entire capsule must be removed.
He adds that the American Society of Plastic Surgeons is actively engaged with breast-implant patient advocates to collaborate on improving patient safety and welfare.