The average person doesn’t think very much about clotting problems, but this is something that all surgeons have to think of on a daily basis. If 100 random patients come into a surgeon’s office for consultation and if you study them carefully and get a good history, you will discover that 10-20 percent of them have potential problems associated with too little or too much clotting.

Problems with excessive clotting causing venous thromboembolism (VTE) or blood clots going to the lung are responsible for 300,000 deaths a year in the U.S. and 500,000 deaths a year in Europe. Of patients in the hospital who have a VTE, one in eight will die. The chance of having a death from VTE is five times greater in a hospital than as an outpatient. Note that deaths from blood clots are greater in number in one year than the total deaths from all breast cancer, all prostate cancer, all AIDS, and all traffic accidents in the U.S.

Unfortunately, VTE can remain silent until a patient is discharged from the hospital, and then at home it can appear as a clot embolism to the lungs. This risk increases in a patient with cancer, those over age 65, or those with other cardiovascular problems. In addition, 25-50 percent of people who have deep leg vein thrombosis will develop a “post-thrombotic syndrome” with chronic swollen legs due to leg and pelvic vein blockage.

Venous thromboembolism is the third most common cardiovascular disease after heart attack and stroke. With VTE, a clot will form in the legs from immobility or a predisposition to clotting, and then the clot can break off and travel to the lungs and lodge in the blood vessels, which can cause sudden death. About 30 percent of the lung vessels have to be occupied with clot before there is a major problem.

Additional factors tied to excessive clotting include smoking, being overweight with a BMI over 30, hormone replacement therapy with estrogen, or a combination of these factors. A family history of deep vein thrombosis or a past history in the patient of having had a blood clot in the leg or the lung increases risk for the patient. Having pancreatic, ovarian, or lung cancer or being treated on tomoxifen for follow-up after breast cancer treatment is also an increased risk factor. Pregnancy, prolonged immobility after leg or hip surgery, being in a wheelchair or in coma, or long travel times during which the legs are in a cramped position can cause deep vein thrombosis. A family history of any type of clot is important and can include multiple genetic clotting problems such as lack of anti-thrombin 3, proteins S and C deficiency, and factor V Leiden anomaly. In atrial fibrillation, clots can go to the legs, abdomen, eyes, or brain and cause stroke, leg gangrene, or blindness.

These problems are common and can affect you and your family. Problems with clotting are responsible for some of the most serious complications after a surgical procedure. Whether you or your family member is at risk for clotting can be detected by history and laboratory testing. You should make your doctor aware of any positive family history of this. A high level of awareness on the part of you and your doctor can lead to lower risk levels for you.

Hypercoagulation or excessive bleeding can also be problematic. As a surgeon operating on minor and major cases, I sometimes see excessive bleeding and bruising in patients who either forgot to stop their aspirin or were not told to do so prior to their surgery. NSAIDs such as Aleve, Motrin, Advil, and others can cause this type of problem as well. These drugs combine with a protein on the surface of the platelet and prevent it from forming a clot. It takes about 4-6 weeks for your body to get rid of the effects of the drug and to make enough new platelets that clot normally. We have patients stop these drugs 4-6 weeks prior to their surgery. In some cases, however, patients are required to stay on aspirin or Plavix to prevent cardiovascular problems. In those patients who are on Coumadin for atrial fibrillation, aspirin is not a good substitute for prevention of thromboembolism to the brain, which can cause a stroke. Coumadin must be carefully monitored in the pre- and postoperative periods in order to make sure that we can guide the patients safely through the surgery.

In the case of a patient on Coumadin, we have to stop this before surgery so that the bleeding will not be excessive. After surgery a type of heparin called Lovonox is often given by subcutaneous injection to prevent clotting while the Coumadin is being restarted. Also, in patients who are undergoing abdominal surgery, abdominoplasty with liposuction, or other combined procedures, giving Lovonox injections after surgery reduces their risk of problems to the miniscule level. No matter what is done, there is always some slight risk of complications after surgery, but the bleeding and clotting problems can be some of the worst. Compression garments and early ambulation also can help reduce the risks.

You can be very effective in helping reduce risks as a knowledgeable patient or family advocate by staying aware of all that is occurring during and after surgery. Stay informed and ask questions of your doctor as needed. 

Dr. Carraway is the director of the Plastic & Cosmetic Surgery Center of EVMS. Call 757-557-0300 for more information.

Even though time relentlessly moves on, there are many things we can do to slow down the aging process. For example, to protect your car or bike, you can prevent oxidation of the paint and metal simply by not exposing it to ultraviolet light and moisture. So it is with our bodies. We can make changes in our lives to protect our bodies from the aging process.

The average lifespan of men and women in this country is about 78 for men and 81 for women. In that period of time, we utilize all of the vital elements that help us rejuvenate and regenerate cells, joint surfaces, retinal chemicals, and brain cells. Each gene in your body has the ability to use telomeres, the small fractional portions of DNA protein which help give new life to cells. But when you use them up, the body’s perpetuation of vitality ceases to be present.

Your body’s ability to regenerate cells is dependent on many things—genetic structure, your body’s hormonal level, the nutrients that come into your system, the damage which occurs with exposure to UV light, chemicals, the hormones of stress, and simple wear and tear. Normal aging changes occur in all parts of our body and at different rates for different people.

Everything makes a difference in the way that we age, and we are capable of changing some of these factors to alter our aging pathways. You were given the greatest gift possible on the earth: a human body with the potential to live a lifetime with extra healthy years added if you agree to take care of it. By making yourself aware of the factors that cause aging, you can change the direction of your life as far as health and longevity are concerned at any point along the way, be it at 21, 51, or 81. Let us consider some of the things that you can do to enhance this aging process.

Your appearance is an important part of your whole presentation as a person, and it is the first appraisal that people make of you. If your health is bad, your appearance may reflect this. Smokers have relaxed skin of their face and deep wrinkles around the mouth area. Cushing’s syndrome patients have a flushed or bronze appearance, while anemic persons may look very pale. Looking good is usually related to good health. If you have managed to look good most of your life, there is more personal interaction with others, and this tends to keep you sharper, on your toes, and motivated to stay in good shape, to keep your body weight good, and to engage in social and group activities such as dancing, bowling, or exercise.

The next step is to understand your health pattern. If you have a strong family history of coronary disease, there is testing available to determine the actual status of your cardiac vessels. If they are diseased, surgery can be done to improve them. If your cardiac vessels are good and you have controlled your lipid levels, you have a good chance of not being susceptible to heart attack. The same is true about testing and treatment for cancer and diabetes. Once you determine your risks, you can make improvements that really matter in your lifestyle.

Your skin, particularly of your face, is a real indicator to others of how youthful and alert you are. There are many things you can do to improve the status of your skin including nutrition, restriction of UV light, reduction of alcohol intake, and avoiding active or passive smoking. Additionally, moisturizers and sunscreen also help. There are products available that actually reverse skin aging, and these include nutritional supplements and topical vitamin C. Also topical laser or skin care systems such as Obagi, which is coupled with Retin-A, can give dramatic and youthful changes to facial skin.

The question also arises, does cosmetic surgery help turn back the clock? Certainly, if you have cosmetic procedures of your eyes, brow, face, or neck, you can look five-to-ten years younger. People do respond to you better if you look good, and certainly you feel better about yourself, particularly if you are in competition in your workplace with younger people. Plastic surgery is usually not difficult to go through. Of course, it is expensive. However, there are things that can be done in your ‘40s and ‘50s at less cost which would change the course of aging in your face. You can go as far as you wish with improving your appearance, which is the basis of a question that I often ask my patients: “How good do you want to look?” If someone wants to know why he or she can’t look as good as this or that movie star, I tell them that they may be able to, but it takes a certain level of investment. Most people don’t need a lot of procedures done, just the important ones.

It is possible to “turn back the clock,” to look and feel better, and to live longer and healthier lives. Anything that makes you healthy makes you look better, and it also makes your lifespan longer. Keep this in mind each day. Write down some of the things mentioned in this article and see how you can improve on them every day. Some lifestyle changes take longer, and sometimes they can be very dramatic. I like to use both of these for my patients to improve their enjoyment of life’s journey each and every day and to help make it last a long time! 

Dr. Carraway is the director of the Plastic & Cosmetic Surgery Center of EVMS. Call 757-557-0300 for more information.

In Paleolithic times, there was no source of grains that could be harvested. Prehistoric peoples ate nuts, seeds, vegetables, meat, and fish. It was not until about 10,000 BC on the fertile plains of Jericho that grain was harvested. According to Jacob Bronowski in his book, The Ascent of Man, goat grass mutated into emmer wheat, which could not be harvested. But then emmer wheat mutated into bread wheat, which had fuller and larger grains. The grains would stay on the wheat stalk and not be blown off by the wind until the wheat was “thrashed.” It could then be used to make bread or fermented into beer. Chronicles of the pyramid builders showed that most of the workers were fed with either bread or beer. Human population growth thrived once grains could be grown and harvested in large quantities.

The many types of grains include millet, corn, barley, rye, wheat, quinoa, oats, triticale, buckwheat, and others. However, when there is much food available, we eat more than is necessary to sustain us and the excess carbohydrates are stored quickly, often as fat. This was not such a problem in the past when food was less plentiful, but today we have access to many grain-based food choices that tempt us to over-indulge and which cause weight gain. Look around in our society today, and you will see that about 80 percent of people are overweight, with many experiencing heart disease, diabetes, autoimmune problems, and joint disease. Most of this can be attributed to grains in our diet. Increased body weight combined with arthritis has greatly increased the need for joint replacement.

Unfortunately, harvesting grains is really a double-edged sword because while the grain-based diet feeds the world’s population and sustains population growth, it also causes many of these diseases. Refined grain availability and eating too much of it is a sure formula for a shortened life. One of the problems with grains is that in their refined form, the starchy part (flour) contains amylopectin-A, which raises your glucose levels very rapidly after being eaten. This stimulates the body’s insulin level to be higher and creates a swing in blood sugar from high to low, at which time you begin to feel hungry again. If you eat something like a bagel or muffin (almost all carbohydrate), you will surely be hungry again in about two hours when your blood sugar swings back down. Of course, our body runs on glucose and we have to then have more carbs to satisfy us. Eating a large portion of grain-based carbohydrates is like pouring gasoline into a furnace to get a burst of flame, which is then followed by a small flame, which doesn’t heat your house.

However, if you modify your intake by eating low glycemic carbohydrates that don’t raise your blood glucose quickly and mix them with protein and some type of fat (olive oil, etc.), you get a slower sustained level of absorption of the food which helps maintain a normal blood glucose level. You can literally eat a “balanced meal” in the morning and not be hungry until later afternoon, at which time you can be satisfied with another balanced small meal. Eliminating wheat and other grain-based foods helps you stabilize your blood glucose levels, which is a much healthier pathway.

The glycemic index of food refers to how quickly it raises the glucose in your bloodstream. For example, the glycemic index of protein is low, while the glycemic index of cereals, bagels, and bread is quite high. Check on the internet to research the “glycemic index” of foods so that you can learn to avoid the high glycemic ones. In addition to this, there is also a protein in grains called gluten, which is not good for us; it causes allergies, stimulates antigen-antibody diseases in humans, and can cause fluid retention and joint problems.

A major disease associated with wheat and other grain foods is Type 2 diabetes. When I attended medical school, I did not see a single case of Type 2 diabetes either in adults or children because the obesity level was not high at that time. Since then the obesity level in the US has risen, causing an increase in Type 2 diabetes, as well as additional medical problems that have increased medical costs greatly. This in turn raises insurance premiums. I don’t think that it is possible to become obese and develop Type 2 diabetes without eating a high level of carbohydrates, which are mostly grains. We do know that people who give up eating all grain-based foods can lose weight naturally and quickly and end up with better overall health.

Did you know that white bread has the same glycemic index as a candy bar? Whole wheat bread also has enriched white flour in it, which makes it just as bad for your blood sugar as white bread. Bagels, pasta, muffins, and even corn bread have enriched white flour. Probably the only true type of bread is one that contains stone-ground grains, but that may even have a higher glycemic index than you would like. One option is to buy whole grain bread that has no “enriched” flour in it, such as Ezekiel bread.

The commercialization of foods has been very successful, and everything has been made so tempting that it’s difficult to turn down carbohydrates. We all grew up eating bread, and we were told that it was good for us, but if you will think of it as a sugar equivalent, which uses hydrogenated fat to preserve it, it doesn’t sound so good. If you combine it with sugary jam or jelly, it becomes even more toxic. However, bread is so tasty that you can allow yourself to eat it occasionally for “recreational” purposes, but not for its food value.

In summary, if you will refrain from all enriched white flour for the rest of your life, you will more likely be free of disease and live longer and you won’t have to worry about your weight as long as you are reasonably careful to eat a balanced diet and get some exercise. 

Dr. Carraway is the director of the Plastic & Cosmetic Surgery Center of EVMS. Call 757-557-0300 for more information.

During the holidays, I noticed that the running conversation at parties was about “I’m going to eat like I want to now, and come January 1st, I’m really going on a diet.” This was expressed by so many people that it seemed to be the single most important topic. How is it that this was something on everyone’s mind? Yet when I questioned people in detail, no one had a good idea as to what kind of diet to be on. Some wanted to take appetite suppressants, some were considering Weight Watchers and Jenny Craig, none wanted to be on restricted caloric dietary intake, and many believed that exercise was the key to losing weight. Not one single person talked about going to a nutritionist, and no one talked about the purpose of a diet to build muscle, help prevent cancer, improve heart health, or prevent Alzheimer’s disease.

One of the major problems I found in talking to people, including my patients, is that no one knows exactly what the best kind of diet is to be on or which one they could comply with long term. Should they do low fat, high protein, high carbs? Should it be medium carbs, low fat, and moderate protein? How about all fat and protein only? Or high carb and nearly zero fat? If you feel that you are still in the dark about which diet is the one for you, don’t feel embarrassed. What is really disturbing is that few medical specialists agree on which diet is best. However, some of the common features of all diets that really work and can be sustained have to do with adding increased activity to your daily routine, reducing the number of daily calories, and eating a somewhat balanced and nutrient-rich diet.

Fifty years ago and before, there was less food available. Today there are thousands of new food items to think about, but most are “processed foods,” usually having no nutrients and not being good choices. In times past, for our meals we ate a protein, a starch, some fat, and something sweet, and then went out and did a day’s work, walking to many of the places we went. Now, we wake up in the morning and pull something out of a box, add low-fat milk, drink our coffee, and head out the door. These are usually such nutrient-poor choices that some people have gone to whole grain cereals, which unfortunately may still be highly processed. Even oatmeal, the healthy choice, is a grain that has been pounded flat, denuded of nutrient oils, and dried for months in a box before getting to the consumer. It furnishes fiber but almost zero nutrients.

In addition to having all these food choices, most people still don’t know which kind of diet to choose. If you are on the Weight Watchers diet, you can pretty much eat what you want, but hopefully make good nutrient choices. One aspect of a lifestyle change in your food intake is reduction of calories, and this can be accomplished by this diet or by following a reduced-calorie plan. Most people burn 1600 to 2000 calories a day without exercise. If you are down to 1000 calories per day and increase your activity, you will definitely lose weight. Another option is the Zone Diet, which I have advocated for many years because it simply has all the needed aspects of normal food contained in it—carbohydrates, protein, and fat—in an even distribution. The Zone Diet also encourages you to choose food with the highest quality nutritional value. By eating this well-rounded and balanced diet, you will not be hungry until hours after you eat.

What about the DASH Diet, considered by most physicians to be the healthiest? Couple this diet with low sodium, and it does reduce hypertension, may decrease LDL, and reduces the risk of coronary heart disease. It is high on vegetables and fruits and advocates low-fat dairy products, lean meats, and smaller portions. This diet emphasizes fish intake along with lean meat. If you can comply and see your numbers improve, this may be the diet for you. Another diet which is excellent in terms of building up your body health and helping lose weight is the alternate-day fasting diet. On one day you can pretty much eat what you want (it’s obviously better to eat healthy food), while the next day you will be on a very low caloric intake of about 200-400 calories, with nothing sweet or starchy. This increases your human growth hormone level and thyroid hormone level, improves your energy level, and is in fact a pretty good diet. You will also lose weight. You need to be in good health prior to starting this diet or be under the care of your physician.

The Jenny Craig diet makes it easy to approach eating without having to count calories. You eat balanced meals that come in packages. Not a bad way to do it, but more expensive and not one you would want to do for the rest of your life every day. Or you could simply go to the “no white” diet and eat no sugar, no processed food, no bread, bagels, baked foods, or wheat-based foods. This way you will increase your energy, reduce swelling in your tissues, lose weight slowly, and set up a lifestyle pattern which empowers you to always be thinner. Another option is to stay on your same diet, but exercise frequently and burn more calories, but this is a slow process. However, it’s good for your heart, good for preventing cancer and Alzheimer’s disease, and is not a difficult diet to follow. The last resort is seeing a good nutritionist who can instruct you according to your specific needs and your compliance ability.

Compliance is the key to the process. It has to be a diet that fits you, it has to be something that you will follow, and it should be something you can adopt as a lifestyle practice for the rest of your life. If you do this successfully, you will look better without having to have plastic surgery. Go for it! 

Dr. Carraway is the director of the Plastic & Cosmetic Surgery Center of EVMS. Call 757-557-0300 for more information.

Much of the time, life seems to be pretty smooth. We can move along with a little stress, a little digression from a good diet, an occasional cold, and the occasional whiff of carbon monoxide fumes from another car at a stoplight. However, if you analyze all of the various types of contacts our bodies have throughout the days and years, it seems almost overwhelming. There are free radicals, lipid overloads, excess insulin, excess sugar intake, toxins absorbed by the colon from over-nutrition, and an inability to burn calories because of muscle loss secondary to non-use. There are ultraviolet lights, external toxins, parasites circulating in your body or your GI tract, viruses, bacteria, toxic and oxidized food products, and an acid pH in your body in addition to microwaves from cell phones and kitchen microwave units.

Lack of adequate vitamins and minerals in food grown in depleted soil, an often inadequate response of the body to form good antibodies, and lack of immunity to many of these elements that attack us are a reality. As we age, the cells learn how to divide on their own without any direction and can become cancerous, and our mechanism for preventing this breaks down primarily because of a lack of nutrients, too much stress, and a depleted immune system.

In addition to these assaults on our health and longevity, there can be other things as well. Your genetic makeup may predispose you to illnesses such as diabetes or stress which is overwhelming. Inability to avoid toxic substances in your job or environment or poor knowledge of what to eat can be real problems. However, with the right information, you can reduce your risk of exposure to these negative assaults. You must be vigilant by gaining as much knowledge as you can and then perpetuating what good health you have by promoting healthy alternatives. For example, even if you have a small muscle mass genetically and you are in a sedentary job, you still have the ability to exercise and build your muscle mass so that it can burn calories and help reduce your risk for developing disease.

So, what are some of the things we can do to really make a difference? I received an email from a friend, which prompted me to give her the “full picture” about how some of these factors were really affecting her health. Her question was about a company that advertised a product which is supposed to help maintain the length of the body’s telomeres. Telomeres are small particles at the tail-end of our chromosomes that break off into component parts due to aging. Unfortunately, we only have a certain number of these telomeres, and their preservation is important for a long and healthy life. Now, make no mistake about this, any product which helps to nurture telomeres is a good product. However, there are many, many other factors which need to be dealt with first before you decide to take this supplement.

What we find, however, is that people want an easy and quick solution like taking a pill or getting a shot to solve the problem of aging without doing their homework on understanding all of the other assaulting agents which cause aging. For example, if you have a genetic predisposition to heart disease, stroke, or diabetes, you need to stay on a low-glycemic diet, keep your body mass index down on the lower end of normal for your age and sex, so that you can prevent the “penetrance” of the gene and ultimately developing the disease process.

We also know that in spite of all the studies that have been done, there is only one real factor proven to extend lifespan. This is relative caloric restriction with adequate nutrition. That means keeping your body weight stable, reducing your food intake, and always having a nutrient spectrum of food. The nutrient spectrum of food includes proteins, carbohydrates, fat, and water. It also includes 30-odd minerals and vitamins that are not produced in the body and which you cannot live without. In addition, there are the phytonutrients (green chemical nutrients) that nurture cellular function and growth. For example, in green vegetables there are anti-cancer chemicals and chemicals that nurture your brain. In spices, there are many antioxidants, and in chocolate the same is true. Coffee, tea, cumin, or curry powder have huge amounts of antioxidants that can help reduce the onslaught to your body by free radicals, which are produced from minute to minute in your body day and night.

In addition to thinking of these very basic things, being aware of ingesting hydrogenated or trans fat or excess sugar would be next on the list. Ingesting excess food and in particular the “bad” fats cause a problem in your body which relates to the deposition of AGEs (Advanced Glycation End Products). These compounds are produced in your body from a combination of fat and protein. It is very similar to the glaze on your ham, and when found in the body, they are able to crystallize in your muscles and joints. This is one of the things that causes stiffness with aging. Most people who are on a caloric-restricted diet and mind their intake of fat and protein don’t have this type of stiffness and are able simply to get up in the morning and start moving without having to have that stretching period to get their joints working. In laboratory animals, the consumption of AGE-rich diets causes increased elevated circulation and tissue diseases such as arthrosclerosis, kidney disease, and decreased wound healing.

Some of the worst offenders for elevated AGEs include broiled steak, pan-fried steak in oil, margarine, fried eggs, and American cheese. Others include butter, sesame oil, and fried bacon. Marinating with lemon juice or vinegar before cooking can limit the AGE-generation potential of foods. We know that these techniques have long been a feature of Mediterranean and Asian foods, two cultures which have traditionally had longer life spans and freedom from heart disease and diabetes. Also, even though these particular foods have high AGE-factors present, eating smaller quantities of them helps reduce the incidence of these negative factors in the foods absorbed into the body. Although Advanced Glycation End Products have been studied for quite a while, there is a lot of new information evolving, particularly in regards to dietary intake. Keep your eyes open for this concept or go on-line and learn more about it so that you can protect yourself even further.

In addition to all of the other negative factors, viruses, bacteria, parasites, microwaves, and even excess ultraviolet light can attack us or reduce our immune system to the point that it is not very responsive. The immune system can be nurtured by eating a well-rounded diet such as the Zone, which includes protein, good carbohydrates, and good fat at every meal and snack. It really goes back to the same old story: don’t eat too much, be careful of what you eat, take your supplements (but remember that they don’t do everything), and always be aware of the factors lurking in your environment, your body, and your lifestyle which can prevent you from having a long and healthy life. Studies have been shown that people in their 60s, 70s, and even 80s are some of the happiest people, as long as they are in good health. Here’s to your good health in the New Year! 

Dr. Carraway is the director of the Plastic & Cosmetic Surgery Center of EVMS. Call 757-557-0300 for more information.

Much has been written about the action of chromium in your body to help improve your health and aging process and enable you to lose weight in a more efficient manner. Dr. Barry Sears’ initial work on nutritional factors and the body’s response (Enter the Zone) discusses the connection between inflammation, chronic diseases, and blood insulin levels. He was the first to talk about the fact that insulin levels are better predictors of heart disease than cholesterol levels. He showed how restricting calories along with a well-balanced diet decreased blood sugar levels and made your body insulin more efficient.

Dr. Sears also noted that chromium is known to help blood sugar (glucose) move from the bloodstream into the cells, where it is able to be utilized in energy production. Of course, glucose is the one “fuel” that keeps our body energy going, but it must enter our body’s cells for this fuel to be used. Everything we eat is either directly metabolized from carbohydrates and protein to become sugar or is stored as fat which can later be converted to sugar.

How important is chromium in maintaining our body at its optimal level, losing weight, and keeping on an anti-aging pathway? As you have seen from previous articles and from your own reading and research, the only pathway that has been proven for certain to be “anti-aging” is adequate nutrition with caloric restriction. Everything else including chromium supplements is simply adjunctive to this. In other words, the basic essential for all diets is to follow that pathway. A diet which includes too many calories and too many high-glycemic carbohydrates simply won’t keep you full of energy and looking good to the level that you desire.

Chromium also seems to improve insulin levels by lowering blood sugar. If your blood glucose is high because it is unable to enter the cells, your body’s homeostatic system calls for more insulin to be produced. Insulin levels are unhealthy when they are high and better when they are low. The stimulation of insulin levels secondary to high blood glucose levels is also an important factor in creating the craving for carbohydrates that develops only a short time after you have eaten carbohydrates. If your insulin level goes too high, a rebound drop of blood glucose may cause you to develop hypoglycemia, which will give you dizziness, precipitate headaches including migraine, and cause muscle weakness or confusion. Early research work done on rats fed a diet lacking in chromium showed that the rats developed an intolerance to glucose and were not able to keep blood sugar levels normal. Once chromium was reintroduced, the diabetes-like symptoms disappeared.

Even though chromium is “hyped” as a weight loss and muscle-building supplement, you need to look closely at these claims. Some of the weight-loss/fat-burner claims are based on research done years ago by those who used that information wrongly to promote profitable marketing schemes. Claims may say that their product is anabolic or muscle building, but studies have shown that this is not true. However, in adequate amounts chromium helps maintain your body homeostasis and enhances your body’s metabolism.

For example, the collagen proteins and glucose in your body have the ability to combine to create a glycosalate which precipitates in your collagen; it creates muscle stiffness and tightness of the joints with arthritis. It also does the same things to your heart muscle. Chromium is able to help glucose cross cell barriers and enter cells where it can be burned, thus reducing the level of these A.G.E.s. (Advanced Glycation End Products) in your tissues, thus reducing inflammation. While it moves the glucose out of the bloodstream and into cells, chromium also acts on your hypothalamus to improve its function. With fasting, caloric restriction, and adequate levels of chromium, your hypothalamus is able to perform its functions such as keeping your body temperature level up, maintaining good sleep, maintaining your libido, and stabilizing your moods. If your blood sugar level is too high due to diet and low chromium levels, then the hypothalamus simply signals the body that it’s time to eat or drink something else.

Where do we find chromium? We need to look at real foods as usual. It has been noted that asparagus, beef, liver, diary products and eggs, fish, seafood, whole grain products, and fresh fruits can get more chromium into your blood stream. In addition, grape juice, broccoli, whole grains, and garlic offer increased amounts over other foods. Polished rice and white bread are very poor sources for this, and eating a lot of sugary foods burns up the chromium needed to metabolize it. Staying on a low-glycemic, low-calorie diet helps you maintain your adequate chromium levels. Too much exercise (probably above 3,000 calories of aerobic exercise a week) actually causes more excretion of chromium in your system and increases your needs. Calcium supplements may also decrease the ability of your body to absorb chromium.

The recommended dietary intake of chromium is about 50-200 micrograms a day, and about 9 out of 10 Americans, Canadians, and British are eating less than 33 micrograms a day. The usual chromium level in a multivitamin such as Centrum Silver is 45 micrograms and is listed as 38 percent of the daily value. This probably speaks for taking a multivitamin daily because not only is chromium present in trace amounts in a multivitamin, but also boron, nickel, vanadium, magnesium, silicon, and many other minerals. In other words, supplementing your diet with a multivitamin daily is a good idea.

In summary, it’s probably useful to maintain your chromium levels with a low-level supplement, not in mega-doses. Remember that it is only one of the many nutrients needed for your body, so don’t let it become the “major thing.” In other words, chromium supplements are not going to make you lose weight. You can help yourself to lose weight, and chromium can be an adjunct to that. Stay in the “Zone” with a balanced diet of carbohydrates, protein, and fat, all of which should be selected carefully for the best nutritional and insulin-controlling features. 

Dr. Carraway is the director of the Plastic & Cosmetic Surgery Center of EVMS. Call 757-557-0300 for more information.

Most people in their middle or later ages are acutely aware of what they might face in terms of brain function deterioration or mental decline for their coming years. This is one of the most dreaded things that can happen to us because it makes us dependent on others and creates a burden, both emotionally and financially, for ourselves and our families.

I recently read the book by Dharma Khalsa, M.D. on Brain Longevity and noted that the principles of aging of the body in general also apply to aging of the brain. Interestingly, Dr. William B. Grant, Ph.D., a NASA scientist whose mother developed Alzheimer’s, was able to contribute dynamic research in this field. He noted that countries with the highest intake of total calories and fat seem to have more loss of brain function and that some aspects of nutritional intake, such as eating fish and whole grains, are helpful in the brain-aging process.

There are approximately 5.4 million Americans living with Alzheimer’s disease or other types of cognitive decline; 3.4 million (two-thirds) are women. Alzheimer’s was one of the top six causes of death in the US in 2009. By 2050 as many as 16 million Americans will have the disease. Although we have discussed this topic in the past (April 2005 & May 2009), it bears discussing again because of the tremendous implications of not following a good pathway to brain health.

As with other programs for antiaging, nutritional intake is probably the most important consideration, followed by adequate levels of vitamins and added nutrients, stress modification, and plenty of exercise. We know that developmental problems in our bodies often take many years to be manifest. For instance, the incubation period for cancer can be up to 25 years, and this can be true for heart disease, chronic lung disease, and some types of renal disease. The same can be said of Alzheimer’s and other diseases causing cognitive decline. The question is, can Alzheimer’s disease and other diseases causing cognitive decline be delayed or prevented?

By the time we reach early middle age, we exhibit some age-related cognitive decline. When you see changes on the external body such as gray hair and wrinkles, you can imagine there are changes taking place inside the body as well. This is true in the heart, liver, and kidneys, and also the brain. We have many millions of nerve cells or neurons in the brain, which are sensitive to genetic signals that allow some to die on a timed basis. Each cell has the ability to react negatively to free-radical damage. An example of what can cause this damage is the ingestion of “bad fats” such as hydrogenated or transfat. Also, the body makes free radicals every day, and if you have less antioxidant protection, you will have more rapid cognitive decline.

In John Robbins’ book, Healthy at 100: The Scientifically Proven Secrets of the World’s Healthiest and Longest-Lived Peoples, he quoted the authors of the Okinawa Centenarian Study, noting that the elders “have remarkable mental clarity, even over the age of 100.” We know that this group drinks the least milk, eats the most fish, and keeps the best body mass index level of just about any culture in the world. They are lean, active with exercise, eat a lot of fish and seafood as well as seaweed, and take their vitamins regularly.

Some of the people involved in research for Alzheimer’s disease are looking for drugs to slow progression of the disease, but this research has not been very fruitful, even though a lot of research funding and hours have been spent. But no matter how much we study age-related cognitive decline including Alzheimer’s, the more we see that it is related to continued lifestyle habits over the years preceding the actual decline.

Exercise has been known to improve the statistics for cancer and heart disease, as well as for age-related cognitive decline. A five-year study in the Archives of Neurology showed that people with the highest activity levels were only half as likely as inactive people to develop Alzheimer’s and were substantially less likely to suffer other forms of dementia. Those who had even some light or moderate exercise had significant reductions in their risk. The Journal of the American Medical Association produced a series of studies confirming that regular exercise helps preserve clear thinking even at advanced ages. Women over 70 who have higher levels of physical activity scored better on cognitive performance and had less age-related cognitive decline.

Like every other aspect of our health, it is important for us to be on a program that is specific to our own age, medical history, genetic inheritance, and other risk factors. The question is where to start? I would say that being aware of all the information related to your own particular pathway is the best place. According to Dr. Khalsa, the best pathway is a lifestyle pathway and not a drug-based one. Your lifestyle program should include nutritional therapy, stress management, exercise, and vitamin supplementation. Note that certain nutrients such as folic acid and vitamin B12 reduce the homocysteine levels in the body, and this in turn reduces the incidence of Alzheimer’s disease. Vitamin B12 can only be obtained by the sublingual route, intramuscular route, or by eating small amounts of red meat

In summary, if you eat a diet high in meat, hydrogenated fat, excess saturated fat (fried foods), cholesterol, sugar, and white flour, you will almost certainly accelerate the appearance of age-related cognitive decline. But if you are eating fresh vegetables, whole grains, fresh fruits, and legumes along with omega-3 fatty acids and vitamin supplementation, you will be in the company of healthy individuals, including the extremely healthy Okinawans. So, eat well, minimize your caloric intake, take your supplements, exercise, and you will be able to think more clearly in your later years and avoid the mental decline we all fear. 

Dr. Carraway is the director of the Plastic & Cosmetic Surgery Center of EVMS. Call 757-557-0300 for more information.

In recent articles, we have discussed heart disease and cholesterol levels in women. We have also touched on the need for treatment based on cholesterol numbers and how sometimes this treatment can be over-prescribed if good analysis of cholesterol numbers is not done. In general, a good diet will include a combination of the three food types with every meal and snack: protein, carbohydrates, and fat. About 30 percent of your caloric intake should be fat, as this helps maintain your body processes, reduces your overall blood sugar level and insulin stimulation, and furnishes nutrients for your body to use in the production of hormones and other useful body chemicals.

Much research has been done regarding the ability of fats to either improve your health or make it worse. For example, studies reveal that total overall fat intake and high vegetable oil intake is associated with a higher cancer risk than with animal fat. In other words, when there is more natural saturated fat in the diet, the cancer risk is lower than if so-called healthy vegetable fat intake is high.

Vegetable fat is partially or poly-unsaturated, but is chemically treated to prevent spoilage. In its raw form as an omega-6 fatty acid, it can be healthy in limited quantities. However, in order to store this fat without it going rancid, it has to be hydrogenated. In chemical terms, hydrogenation implies that the “open spaces” (double-bonds) are saturated with hydrogen ions, which make it an artificially saturated fat. There is a difference between real saturated (animal) fat and hydrogenated saturated vegetable oil. Hydrogenated fat and trans-fat are definitely unhealthy for you and should be avoided, whereas saturated animal fat in reasonable quantities is healthier.

In our culture, the problem is that we eat too much partially hydrogenated vegetable oil, which is included in everything from salad dressings, baked goods, and snacks to the whole gamut of processed foods. One by-product of altering poly-unsaturated fat into hydrogenated fat is that some of it becomes trans-fat. Trans-fats are dangerous because they attach to cell walls and interfere with the movement of nutrients through these cell walls. A trans-fat has the same chemical compound as hydrogenated fat molecules, but it is a molecular “mirror image” of that and is just different enough that the body doesn’t know what to do with it.

Research at the University of Maryland showed that consumption of trans-fatty acids and partially hydrogenated acids increased the risk of heart disease, cancer, and diabetes; decreased immunity; and caused poor reproduction and obesity. Interestingly, the consumption of trans-fatty acids lowers HDL (healthy) cholesterol and raises LDL (bad) cholesterol by a significant amount. A study at Harvard University that included 85,000 women over a long term showed there was a significant relationship between trans-fatty acids and heart disease. The same is true about the development of cancer in people who eat partially hydrogenated fats. Trans-fats also decrease red blood cells’ response to insulin and thereby create an undesirable effect in diabetics. Trans-fats also significantly affect the immune system by lowering the efficiency of the B-cell (immune) response.

Monounsaturated fatty acids are chemically different and only have one double-bond linkage. This fat is usually healthy and occurs in nature as olive oil, avocado, and canola oil. Canola oil is genetically-modified rapeseed oil and was developed in Canada (Can + oil = Canola). When Dr. Ansel Keyes did the original studies on saturated fat intake and heart disease in 1958, he claimed that “partially hydrogenated vegetable oils with their trans-fatty acids were the culprits in heart disease.” The edible oils industry (which sells hydrogenated vegetable oil) was very quick to squelch that information and shifted the emphasis over to natural “saturated” fat which included meats, tropical oils (coconut oil), and dairy fats. I was recently shopping in the grocery store and noticed so many items that were “no-fat” or “low-fat.” I could not find plain Greek yogurt that had not had all of the fat extracted from it. This is not good because fat helps stabilize the body’s management of blood sugar and insulin, which is very important for our total body function.

It’s not difficult to relate this to your blood cholesterol levels and to the development of heart disease, cancer, and immune problems. Cholesterol is an oil and won’t mix with water, and so it travels in the bloodstream with protein particles that “carry it” and help it move about. HDL helps remove cholesterol from the body by transporting it to the liver whereas LDL does not aid in the transportation of cholesterol, but deposits it onto the vessel wall.

There is a very sensitive mechanism in your body for determining what the LDL cholesterol level will be. In familial hypercholesterolemia or excessive blood cholesterol levels, a mutant gene is responsible for the absence of LDL receptors, which then prevents the body from controlling its levels of cholesterol. Very high cholesterol levels leads to heart attacks even in the young. The cholesterol/HDL ratio is more indicative of cardiovascular disease than the total cholesterol (total cholesterol is HDL plus LDL totals).  The ratio of these two is what is important, and if your cholesterol is 250 while HDL is 60, you are at an average risk for cardiac disease. So, you can divide your HDL into your total cholesterol and note that if the number is 5 or less, you are at an average or lower risk for heart disease. If you are at average or low risk for heart disease, you can improve your risk level by exercise, aspirin, and fish oil.

To increase HDL, performing aerobic exercise, cessation of smoking, avoiding passive smoke exposure, and reducing your weight can be effective. Decreasing LDL can be immediately accomplished by eliminating foods that contain hydrogenated fat, including baked goods and salad dressings, and by adding dietary fiber to your diet, increasing aerobic exercise, and taking niacin as a supplement. In general, you can improve your cholesterol levels and ratios with diet and exercise. However, people with familial high cholesterol cannot do this and must rely on statins to keep their blood cholesterol levels down to a less dangerous point.

So, improve your levels of HDL and LDL and avoid having to take powerful drugs such as statins, which may not help and may cause side effects. Also, you may eat saturated animal fat (bacon), tropical oils (coconut oil), or monounsaturated fat (olive oil). As usual, the more processed the food is that you eat, the less healthy it is for you. 

Dr. Carraway is the director of the Plastic & Cosmetic Surgery Center of EVMS. Call 757-557-0300 for more information.

Are you among the more than 40 percent of women who don’t realize that the Number 1 killer of women is heart disease? The fact is one woman in 25 to 30 dies of breast cancer while one in two dies of cardiovascular heart disease. A recent article in The Virginian-Pilot noted that there is a remarkable difference between men and women when it comes to heart disease.

“A woman’s heart is her major health threat,” the article stated. While the article pointed out clearly that heart disease is the leading killer of men, the time of greatest risk for men is about 10 years sooner than for women. Women have an abrupt change of their hormonal levels with loss of estrogen at about age 50, and this immediately increases their risk 2 to 3 times of having coronary artery disease and myocardial infarction.

Women’s symptoms are different from men’s, so it is important for you to know how heart disease affects you. Since heart disease occurs at a younger age in men, women may overlook a myocardial infarction or severe coronary artery disease in themselves because it doesn’t quite “fit the pattern.” A heart attack may have occurred without their knowledge just because the symptoms weren’t typical. Good information is a powerful tool in diagnosing and treating heart disease. The first step is awareness of the information, followed by diagnostic intervention, prevention appropriate to your current cardiac status, and finally treatment of heart disease based on your particular risks and severity of the disease.

You will note from your other readings about prevention of breast cancer in women that the similarities for the prevention of heart disease are striking. If you can keep your body healthy in terms of your immunity to cancer, you can do the same in terms of your prevention of heart disease. How is this possible when you sometimes feel that you don’t really have any control over the direction that your body takes? We tend to focus on one area of diagnosis and treatment, such as high cholesterol. However, body weight (BMI), the time you spend exercising, smoking, and elevated blood pressure affect the progression of this disease to a remarkable degree, and each one is important. As the Pilot article pointed out, there are problems with diagnosis because even if major heart arteries are not blocked, coronary microartery disease can be serious enough to cause a myocardial infarction.

In regards to prevention, a recent article in the July issue of Journal of the American Medical Association revealed that sudden cardiac death accounts for more than half of all cardiac deaths in women. The majority of these are the first manifestation of heart disease. This article was estimating the degree to which a healthy lifestyle may lower this risk. It stated that a low-risk lifestyle was defined as non-smoking, BMI less than 25, 30 minutes exercise a day, and good adherence to the Mediterranean Diet which emphasizes fruits, vegetables, nuts, beans, grains, and fish. The study involved 321 patients who were followed for 26 years.

The study found that even if you haven’t adhered to a low-risk lifestyle over the years, your risks can change as soon as you incorporate lower risk factors into your overall health pattern. The article concludes by noting that 81percent of these deaths could have been avoided had the women embraced a low-risk lifestyle.

While smoking is the leading preventable cause of cardiac death, hypertension comes in as a close second. Elevated cholesterol is overrated, but you can take a pill to at least improve the appearance of the numbers. Another risk factor is trans- or hydrogenated fat intake, which tends to have a specific negative effect on cardiac vessels. If you undergo an early menopause either surgically or naturally, hormone replacement therapy helps maintain your cardiac status. It is helpful also to look at the statistics regarding heart disease in postmenopausal women. Some of the death rate is due to increased aging or other diseases, which might affect the overall death rate.

In regards to cholesterol, an LDL of less than 100 is the best, and is only high if it is about 150 or over. HDL is best at 50 or over, and triglycerides are best at less than 150. Interestingly, a change in lifestyle focused on exercise and improved nutrition can change both of these without taking statins. Supplementation with niacin, a simple B vitamin obtainable at health food stores, can improve the LDL level, which statins cannot do.

Women have different heart symptoms than men. Angina in men is manifested by tightness of the chest or arm pain, while women have more vague chest or abdominal pains. Fatigue and sleep disturbances are a common precursor to myocardial infarction in women, but not so in men. Because of this difference, women often ignore their symptoms. One study noted that two-thirds of women who die of myocardial infarction had no “true” symptoms of heart attack.

Diagnostically speaking, an electrocardiogram in women is not as good for diagnosis as an echocardiogram. Elevated cholesterol over the age of 65 may not be associated with increased cardiac risk. Aspirin does not seem to be as effective in women for prevention of coronary disease as it is in men. Hormone replacement therapy benefits become negative as a woman ages, probably around the age of 60 and over. A coronary artery scan has predictive value in men and women, but is less specific for women in the under-60 age group. In over-60 women, the test is 90 percent accurate for predictability of heart disease. One interesting final note is that after CABG (coronary artery bypass graft), women tend not to take care of themselves as well as men. This may be because they don’t have a wife to prod them to take better care of themselves.

Overall, a heightened awareness of the factors causing heart disease, lifestyle changes which can put you in a lower risk category, and the availability of excellent diagnostic testing can change your incidence of heart disease and give you more good years to live. Remember, your heart is working hard for you every day, beating 60-80 times a minute 24 hours a day. The least you can do is take good care of it! I’ll see you at the gym. 

Dr. Carraway is the director of the Plastic & Cosmetic Surgery Center of EVMS. Call 757-557-0300 for more information.

Each day we make choices—from early morning until late evening. Some are family or business decisions, and some affect our health and well being. Important choices include the type and volume of food eaten, activity level, social interactions, and your state of mind. At the same time on a parallel course we must consider our health status and what choices we make which will affect our long-term health.

It is difficult to make the best choices, as some are decided on an emotional basis, some on a factual basis, and some on the advice of others close to us or from the media. One way to approach decision making is to look for more than one option or solution in our daily decisions. When you have choices, it becomes easier to select the best one. Certainly food is at the top of the list of daily choices in terms of frequency and importance and can probably have more impact on our health than most of the other ones.

In deciding which choice is the best alternative, always set up one choice beside another. This could be regular food versus junk food, exercise versus immobility, eating less versus eating more, taking supplements versus none, or even styling and coloring your hair versus leaving it natural.

Probably the most difficult choices we make have to do with nutrition. For example, when you are tempted in a restaurant to order something like a piece of carrot cake from the Cheesecake Factory, remember that it is around 1,000 calories. Alternate possibilities include 3 cups of broccoli (160 calories), 12 large shrimp (300 calories), one glass of wine (150 calories), one sweet potato (112 calories), and 3 cups of strawberries (146 calories). That total is 860, which means you can still eat 100 calories of some other nourishing food which will not increase your insulin levels and be stored as triglycerides and on to fat.

You could also think in terms of whether to eat a sweetened cereal in the morning or unsweetened oatmeal with some milk or cream and fresh fruit on it. For lunch, instead of a sandwich with a lot of bread, perhaps choose a salad with cut vegetables and a small amount of protein, such as chicken. The need to make these choices continues all day and into the evening as we are constantly tempted with processed foods that have no food value but look and taste so good to us. Look at everything you are doing and select an alternative choice so that you can make the best decision between the two. If you’ve only given yourself one choice, then you have nothing with which to compare it.

Exercise versus immobility is a big item in our agenda of daily living. If you choose not to have any fitness activity, you are no doubt aware that it increases your risk for heart disease, Alzheimer’s disease, breast cancer, and obesity. However, if you exercise as little as 60 minutes a week, it provides health benefits. Up to 150 minutes a week of moderate activity lowers the risk of the diseases mentioned and will give you more overall energy. If you combine increased activity with good food choices, you have improved your health and well being over the long run. Within this choice area, there is a subset of choices such as whether to play soccer with your kids, ride a bicycle, walk or jog on a treadmill, for example.

Another important area of concern is the health choices which we make. First of all, you can acquire knowledge from the Internet or media about any medical conditions you have versus just leaving it to your doctors. If you make the choice to become involved in your own personal medical care and health pathway, you will benefit and be a better patient for your doctor to guide. If you have diabetes, for example, you can read about insulin resistance, the effect of increased high glycemic carbohydrates on the disease, and what the complications are if a better pathway is not followed.

You have the choice to increase mental stimulation every day. You can watch television three hours a night or you could work a crossword puzzle or read something challenging, which tends to make your brain function better.

You have the choice of gaining weight with aging, as many people do, or staying the same. Although it may seem difficult, making the right choices in terms of nutrition and exercise helps you keep the same weight. The average woman tends to gain about one-half a pound a year after the age of 40. Eighty percent of us are overweight, and a good portion is truly obese with a BMI over 30. Reducing your food portions and eating only those foods that have nutrient value will help you avoid weight gain. Save your “temptations” for the occasional celebration or birthday. If you attend an all-you-can-eat restaurant, start with veggies and fill up on those before you start eating meat. This is because meat is seven times more dense calorically than vegetables, so you can get your fiber and phytochemicals versus just a lot of increased protein and calories.

You always have a choice. Think about which one would be the best. If you choose an option that is not the healthiest or best, think of it in terms of entertainment value. Is it worth the amount of entertainment or pleasure I get out of this to do something negative to my body?

Think about these choices every time you decide on an activity, a food, or even a medical treatment pathway. Remember: you are (mostly) in control of your life in terms of your health pathway. 

Dr. Carraway is the director of the Plastic & Cosmetic Surgery Center of EVMS. Call 757-557-0300 for more information.