Physicians tell what you must do to take charge of your health
Jan 26,2007 00:00 by R.J. Ignelzi

Thanks to modern science and an abundance of research, staying healthy has never been easier. Or more confusing.

Medical studies, most often presented to the public in 30-second sound bites, frequently seem to contradict each other, adding frustration to an already perplexed consumer.

TAKES DISCIPLINE - There is a long list of health advice out there for the average consumer. What is a health-conscious person to believe? CNS Illustration by Cristina Martinez Byvik.
First we heard: Hormone replacement therapy is good for women. Then: HRT is bad for women. And, now: Sometimes, it can be good in limited doses.

For years we were told: Vitamin E may prolong your life. More recently: High doses of vitamin E may kill you.

Who or what is a health-conscious person to believe?

Start with your doctor, preferably one who's familiar with you and your health history. Instead of jumping on a trendy bandwagon, get your health care practitioner's opinion and interpretation of the latest medical research, and ask if any of the new information can be of interest or benefit to you.

To get you started on the right track, 11 physicians in the San Diego area offer what each considers crucial advice for good health:

- Be a proactive patient.

Dr. Mimi Guarneri, cardiologist and medical director for Scripps Center for Integrative Medicine.

"Don't wait for someone else to tell you something's wrong. Pay attention to your health," Guarneri says. "Be aware of what foods you eat. Get the weight off. Exercise. Take charge."

It's important to "know your numbers," she adds.

Know your blood pressure; total cholesterol; good (HDL) and bad (LDL) cholesterol levels. Get screened for diabetes and get a colonoscopy when you're 50.

"Take ownership. Be an active and responsible participant in your health and well-being," she says.

- Participate in a clinical trial.

Dr. Michael Lee, Scripps Clinic endocrinologist

"We can only get better treatments to market if we have more studies to test them," Lee says. "It's a win-win situation for the patient. They get good dietary advice, good follow-up care and have a chance of getting the medication."

He noted that a growing number of studies today are "crossover" studies in which the patient may get the placebo for the first half of the study, but will be assured of getting the real medication for at least the second half of the trial. To find a trial that you may be eligible for, ask your physician or check the National Institutes of Health Web site,

- Get frequent cardiovascular exercise.

Dr. Denise Barnard, cardiologist and director of UCSD's Women's Cardiovascular Health Program, and Dr. William Norcross, chief of family medicine at the University of California San Diego Medical Center.

"If I could give you a prescription for something that does all of the following, would you take it?" Barnard asks.

Her "prescription" reduces stress, lowers blood pressure, lowers bad cholesterol, raises good cholesterol, fights osteoporosis, induces weight loss, improves bowel regularity and is a natural and non-addictive sleep aid. It also lowers blood sugar, reduces joint stiffness, improves mental alertness and is a mild antidepressant. Plus, when taken regularly, three to five times a week, it reduces your risk of having a heart attack or stroke.

"Sound too good to be true? It's not. It's called physical activity and it's free," she says. "It's been tested repeatedly and always comes out showing health benefits."

Even if you're a smoker, diabetic or overweight, "doing something as simple as 20 minutes of brisk walking can help," Norcross says. "It will encourage a smoker to quit, help bring diabetes under control, and move a person in the direction of losing weight."

- Eat more fiber.

Dr. Thomas Savides, gastroenterologist at the University of California San Diego and professor of clinical medicine at UCSD School of Medicine.

"If everyone would just have a half-cup of a high-fiber cereal, like Fiber One, every day, it would take care of most of our GI problems," Dr. Thomas Savides says.

The average adult needs about 25 grams of fiber a day, but most of us get a measly 12 grams.

"You can't get as much fiber as you need based on just fruits and vegetables. In the United States, we don't have enough fiber available to us, since all the fiber is milled out of breads and other foods," he says, noting that even bran muffins or grainy, whole-wheat breads aren't enough.

Gastrointestinal problems that can result from not enough fiber include constipation, irritable bowel syndrome, hemorrhoids and diverticulosis.

- Hydrate and protect your skin.

Dr. Hugh Greenway, chairman of dermatologic surgery at Scripps Clinic.

"The skin is the largest organ of the body and protects everything else inside, so it's important to hydrate it both inside and out and protect it," Greenway says.

He recommends drinking six to eight glasses of fluid a day and using a topical moisturizer on the skin, focusing on those areas that are most exposed, including the face, neck, hands, arms and legs.

For the face, he also advises an exfoliating "topical retinoid-like product to help peel off the outer layer" of skin.

Additionally, he urges everyone to wear a broad-spectrum (UVA and UVB protection) sunscreen with an SPF of at least 30.

"We live in a Mediterranean climate, and we love to be outdoors. But, we need to use common sense," he says. That means staying out of the sun between 10 a.m. and 3 p.m., and wearing protective clothing, a wide-brimmed hat and sunglasses.

- Maintain your optimal weight.

Dr. John Willems, director of gynecology at Scripps Clinic and Dr. Homer Chin, director of obstetrics and gynecology at the University of California San Diego Medical Center

Staying at a healthy weight is good advice for anyone, but it's particularly important for women at certain ages, the two San Diego gynecologists say.

"It's well-established that if a woman varies too much in her weight, a slew of abnormalities can occur (because of fluctuating) hormone levels," says Chin, who recommends that women stay within 10 percent to 15 percent of their ideal weight.

For older women, weight gain during the postmenopausal years can lead to an increased risk of breast cancer. New research reported in the Journal of the American Medical Association shows that if a woman gains 22 pounds or more after menopause, her risk of breast cancer goes up by more than 20 percent. It's believed that the fat stores act as amplifiers for any estrogen in a woman's system, Willems says.

"Women often gain weight after menopause, not because of the drop in estrogen but simply due to the aging process," Willems says. "It's that time of life when your metabolism tanks and there's a drop in estrogen, so you may not be feeling great. So what do you do? You eat."

To live a long healthy life, "don't worry about estrogen. Worry about your weight," he says.

- Get screened for diabetes.

Dr. Michael Lee, Scripps Clinic endocrinologist.

Approximately 21 million Americans are believed to have Type 2 diabetes.

And about one-third of those with the chronic disease don't know it, because it's most often asymptomatic.

"One of the scary things is that once you're diagnosed with Type 2 diabetes, about 50 percent of your pancreas is not working anymore," Lee says. "While we have good treatments to keep people healthy for a long time, it'd be nice to get ahead of the game and prevent or delay diabetes."

While everyone should talk to their physician about their risk for diabetes, certain people need to be checked out early and frequently. Risk factors include: A family history of diabetes; being overweight or obese; being sedentary; women who have had a baby weighing more than 9 pounds; and certain ethnic groups, including African-American, Asian, American Indian and Hispanic.

- Embrace yoga to strengthen your core.

Dr. Robert Afra, orthopedic surgeon, division of sports medicine at University of California San Diego Medical Center.

"We used to work only the show muscles. But when it comes to function, that's only part of the equation," Afra says.

To keep the body strong and help prevent all kinds of injury, it's important to work the core muscles, those of the upper and lower trunk and the pelvic area. And, one of the best ways to do that is to practice yoga.

"Yoga is great for the core because it does a good job at balancing strengthening and stretching," he says. "A weak core is a huge source of back pain that so many people get. Practicing yoga regularly is a different way of stretching those muscles, which may ease or prevent many back problems."

- Properly train for a physical job.

Dr. Don Herip, occupational medicine physician and medical director of corporate health services at Palomar Pomerado Health Foundation.

Frequently neglected and too often injured on the job are what Herip calls the "worker or industrial athlete."

This is anyone who performs physical labor as part of his or her job. It can include a warehouse employee who lifts heavy boxes, a hospital nurse who must reposition patients, or a construction worker who hoists heavy equipment.

Just as professional or college athletes must train regularly to perform their best on the field or court, "worker athletes must also be trained for their work and ease into their work activity," he says.

"The worker needs to prepare for a physical job beforehand by practicing aerobic, flexibility and strength training," he says. "Their bodies must be prepared and conditioned for the physical work they do."