Saturday, January 26, 2019

Dogs and health: A lower risk for heart disease-related death

Many people don’t think of obesity as a disease, but rather as a moral failing. But Dr. Fatima Cody Stanford, instructor of medicine at Harvard Medical School and researcher and practicing physician at the Massachusetts General Hospital Weight Center, points out that obesity is a complex, chronic disease. Stanford’s recent fascinating and informative presentation explains how the body uses and stores energy, and describes the complex interplay of the genetic, developmental, hormonal, environmental, and behavioral factors that contribute to obesity.
Obesity isn’t just “calories in versus calories burned”

Obesity isn’t just about energy balance, i.e., calories in/calories out. “That’s simplistic, and if the equation were that easy to solve we wouldn’t have the prevalence of obesity that we have today,” Dr. Stanford explains. She goes on to say that not only is the energy balance theory wrong, but the focus on that simplistic equation and blaming the patient have contributed to the obesity epidemic. Stigma, blame, and shame add to the problem, and are obstacles to treatment. Indeed, over 36% of adults in the United States have obesity, and the world is not far behind.

She describes her research and experience in the treatment of obesity, including several cases from her own clinic. These are the cases that capture my attention, as they demonstrate most clearly the effects of different treatment approaches (and combinations) to obesity: diet and lifestyle (i.e. behavioral), medications, and surgery. Stanford has seen remarkable, long-lasting positive results with all, but she always emphasizes diet and lifestyle change first and foremost. The program (called Healthy Habits for Life) offered at the MGH Weight Center is a huge commitment, but it can help reframe a person’s relationship with food, emphasizing a high-quality diet, and not calorie-counting.
The components of a successful treatment for obesity

Abeer Bader is a registered dietitian and the lead clinical nutrition specialist at the center. She described the program to me in more detail: it’s a 12-week group-based education and support program with a structured curriculum and frequent contact with patients. The classes are 90 minutes long and led by a registered dietitian, and cover everything from the causes of obesity to healthy eating to debunking popular diet myths, plus recommendations for dining out, grocery shopping, meal prep, physical activity, and more. “The goal of the HHL program is to provide patients with the education, support, and tools to lead a healthy lifestyle.”

The diet they promote is loosely based on the DASH diet and the Mediterranean diet, as these eating plans are rich in vegetables, fruit, lean protein, and whole grains. They use the Harvard Healthy Plate to illustrate a healthy, well-balanced meal.

But it’s also a highly individualized program. “We work closely with the patient to put together realistic goals. I think the most important part of approaching goal-setting and behavior change is to first determine what it is that they would like to improve. Often as providers we tell patients what they need to do, but when you allow the patient to highlight an area that they would like to work on, you may see better adherence,” says Bader.

Other similar comprehensive programs have been shown to help patients achieve lasting diet and lifestyle change, lose weight — and avoid diabetes. The Diabetes Prevention Program helps those with obesity and risk of developing diabetes lose 5% to 7% of their body weight, and decreases their risk of diabetes between 58% and 71%.

As Bader states, “I think it’s important to note that the diet that “works” is the diet that a person will adhere to for the rest of his or her life. We really emphasize the importance of lifestyle change versus short-term diet fix in order to have the greatest success in achieving a healthier weight.” This statement is evidence-based, as a recent review of multiple research studies looking at different weight loss diets found that all worked about equally as well.
Medications to treat obesity

What can surprise people (including doctors) is how helpful weight loss medications can be, though it can take some trial and error to figure out what will work for someone. “These medications affect the way the brain manages the body’s weight set point, and how the brain interacts with the environment. But sometimes there’s no rhyme or reason why one medication works for someone, but another doesn’t.” Unfortunately, as research shows, weight loss medications aren’t prescribed often enough.

In summary, obesity is a complex, chronic disease with many contributing factors. Primary care doctors and obesity specialists can guide treatments that include lifestyle approaches like diet, exercise, and addressing emotional factors that contribute to obesity. For some people weight loss surgery may be an option (a subject for another post).
Teething can be hard on babies. It can hurt as teeth break through the gums. While some babies weather it fine, others are downright miserable. It’s hard to watch a baby be miserable, so it’s understandable that some parents and caregivers reach for one of the products that contain benzocaine, which can numb the gums and soothe the pain.

Except that it’s a really bad idea.
The problem with benzocaine for teething

Benzocaine is found in products like Baby Orajel, Anbesol, or Orabase, as well as products marketed for sore throats such as Cepacol or Chloraseptic. But along with numbing pain, benzocaine can change hemoglobin into methemoglobin and cause a dangerous condition called methemoglobinemia.

Hemoglobin is the compound inside the red cells of the blood that gathers oxygen from the lungs and distributes it to the tissue. When the iron in hemoglobin is exposed to certain chemicals including benzocaine, it changes to a form that holds on to the oxygen instead of letting it go — which means that tissues in the body don’t get the oxygen they need.

Because babies and toddlers are smaller, with less blood volume, they are at higher risk for this side effect. So are people with heart disease or lung disease, or the elderly: their oxygenation and circulation is already not working perfectly, so an additional problem with getting oxygen to their body affects them even more.

Symptoms of methemoglobinemia include pale or blue skin, dizziness, headache, and other pain. As the amount of methemoglobin increases it can lead to seizures, coma, and even death. There is an effective treatment if the condition is recognized and the person is brought to a hospital.

The Food and Drug Administration has been warning about methemoglobinemia for a long time, but they are now taking the additional step of asking companies who make benzocaine-containing products to stop making them for children under the age of 2.

Methemoglobinemia doesn’t happen every single time a person takes something with benzocaine. Since 1971, there have been 400 cases reported; even though this is likely an underestimate of the total cases, as many more than 400 people have used benzocaine. But the question is: why use a product that can be dangerous when there are other options for managing pain?
Other ways to help teething pain (without benzocaine)

When it comes to options for managing teething pain, simple is best. Just chewing on a cold teething ring or other teething toy (or even a cold washcloth) can make a miserable baby feel better — as can a dose of acetaminophen or ibuprofen (for children under 2, it’s best to check with the doctor for the correct dose for the child’s weight). A little extra cuddling and TLC can be comforting too.

There are many products marketed as natural teething remedies, with many different ingredients. Before you use one, check with your doctor as to whether the ingredients are known to be effective — and whether they are safe for your child. Are you a “dog person”? You know, one of those people who talks about their dogs all the time, shares photo after photo online (or, worse, in person), and considers their dog as a semi-human member of the family? (In the interest of full disclosure, I am a dog person.)

If you are, here’s a medical news story that may confirm what you’ve suspected all along. And if you aren’t a dog person, this may confirm your suspicion that researchers can prove just about anything they want. According to a recent study, your risk of having a cardiovascular event such as stroke or heart attack, and your risk of death, are lower if you have a dog. Some of the proposed explanations for this might surprise you.
Research finds a new connection between dogs and health

This new study reviewed the health and death records of more than 3 million people in Sweden ages 40 to 80 over more than a decade, and found that:

    Compared with people in multi-person households without dogs, people living in multi-person households with dogs had a risk of death that was 11% lower, and risk of death due to a cardiovascular cause that was 15% lower.
    These findings were even more dramatic for those living alone. Risk of death was 33% lower among dog owners, cardiovascular deaths were lower by 36%, and the risk of heart attack was 11% lower.
    The benefit was greater for owners of certain breeds of dogs, such as retrievers and terriers.

Why might dog ownership come with health benefits?

The most obvious explanation for why dogs might provide their owners with certain health advantages is that dog owners tend to be more active. For many people, taking their dogs out of the house or apartment several times a day to “do their business” and walking their dogs is far more physical activity than their dogless neighbors. And this could explain why more active dog breeds (such as retrievers) are associated with the greatest benefit, and why single people (who must shoulder all of the “burden” of walking the dog) benefit the most.

But there are other potential explanations that researchers have considered, including:

    Improved immune function. Believe it or not, having a dog that brings dirt and germs into the home could improve how the immune system functions and reduce harmful inflammation in the body.
    Modifying the microbiome. The huge number of bacteria in our digestive tracts changes not only with changes in diet, but also with pet ownership. It’s possible that having a dog alters the types of bacteria we harbor, which in turn could affect inflammation in the body and resultant cardiovascular risk.
    Social impact. Dog owners must, to at least some degree, focus outside themselves, which can promote social interaction. In addition, dog owners tend to bond with one another as their dogs play together and check each other out. Past research has found that social contact is linked with lower cardiovascular risk and rates of death.
    Improved mood. Some have proposed that the unconditional affection and companionship of dogs can improve mood, and through this effect improve health.

Will getting a dog extend your life?

Not so fast. This study only found that dog owners tend to live longer and have fewer heart attacks than those without dogs. But that does not prove dog ownership itself it the reason. Maybe healthier, more active people get dogs more often than sedentary people, and it’s that self-selection that accounts for the observations of this latest research. It’s also possible that economic factors play an important role. Dog ownership can be expensive, and those who can most afford to own a dog might receive better healthcare, have better health insurance, or have healthier lifestyles. While the researchers tried to account for some of these possibilities, excluding some contribution from other “non-dog” factors is challenging.

We’ll need to have a better understanding of whether dog ownership itself truly provides health benefits and just how it works. Naturally, similar questions will arise regarding cats and other pets. Until we know more, the apparent health benefits of dog ownership should be encouraging to dog people everywhere. And if you aren’t a dog person, this latest research might convince you to become one.

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