Jun 222015
 
Fruit made of marzipan

Fruit made of marzipan

If you find yourself feeling confused by the many and contradictory messages about food and diet and supplements, you’re not alone. It’s a maze!

Believe it or not, medical students do get training in nutrition. Here are some general guidelines to help you figure out the weird and wacky world of food and supplements today!

1. Eat as broad a variety as you can. Include as many vegetables and fruit as you can. It doesn’t need to be fresh vegetables. They can be frozen or canned, or even processed. But the variety helps you get vitamins and minerals, and is tasty too.

2. Don’t bother with organic. There’s no nutritional difference or health benefit. You’re better off saving the money and using it to buy more vegetables.

3. Be reasonable with salt and fat. Don’t go on a very low salt/fat or very high salt/fat diet. Your body needs both, but too much of either may increase your risk of heart disease.

4. Unless you’ve been told otherwise by your doctor, don’t take multivitamins, vitamins, or supplements. Not even antioxidants! They don’t do healthy people much if any good, and may cause harm. Exceptions to this rule include calcium for women who don’t get enough calcium in their diet and iron/folic supplements for pregnant women to prevent anemia and birth defects.

5. Eat less and move more. You don’t need to run a marathon unless you want to. But moderate exercise is definitely good. So is being a “normal” (not overweight, obese, or underweight) weight.

6. Try eating less meat. Eating lots of meat is associated with cardiac disease. Try eating a little less and getting your protein from lentils, beans, tofu, nuts, dairy, or plain ol’ whole wheat. Besides, meat is expensive.

7. Ignore fads. Yes, this includes low-carb, high-carb, low-fat, high-fat, no-gluten, many food intolerances…and the list goes on!

8. Tell your doctor about your nutrition and if you take any supplements, including herbs. Some foods may interact with your medications (grapefruit is notorious for this). If you’re trying to change a habit for the better, consider mentioning it to them. They may know some resources that would help.

Got any more? Let me know your thoughts in the comments!!

Jun 152015
 

Mortier_PillonTestosterone replacement therapy has become nearly common place recently. Marketing of testosterone creams is everywhere. In addition to the big pharmaceutical companies, compounding pharmacies are now making and selling testosterone creams too. Compounding pharmacies are typically small local pharmacies where the medications are made and mixed on site. A compounded medication can be helpful to someone who, for example, is allergic to a filler used in a commercial product. Compounded products are often cheaper than commercial non-generic products. Compounded products are supposed to be standardized just like commercial products are. But are they?

The Federal Food and Drug Administration (United States) produced a report back in 2006 that showed that somewhere around 33% of compounding pharmacies were not making or selling standardized products.

Now a Canadian study confirms that compounding pharmacies may not be well standardized either. The researches took samples at two different times from ten randomly selected compounding pharmacies in Toronto. The samples were then analyzed and compared to two different commercial forms.

The commercial forms were consistently within 20% of the prescribed dose. Only 50% of the compounded forms in the first batch were within those limits. Worse, only 30%  of the second compounded batch were within that limit. Yikes! One pharmacy even had no testosterone in its product at all. The consistency within a pharmacy’s products also varied wildly. One pharmacy had 91% of the of the testosterone it was supposed to have in one sample, and only 8% in another sample.

The compounded testosterone was generally cheaper than the commercial testosterone. Compounded testosterone ranged from $57-161 for a 30-day supply, averaging around $105. The commercial stuff was $140-150 for 30-days.

This has very serious concerns for patients. Wild swings in testosterone level are not safe. For their safety and health, a patient should receive the dose that was prescribed. Not “half the dose one month” and “double the dose the next”. The lower price of the compounded products could easily lure a lower income patient into purchasing the compound instead of the commercial.

What can you do as a patient? Make sure that you get your prescriptions from a non-compounding pharmacy. If cost is an issue, talk with your pharmacist about using a generic. Generics are held to the same standards are brand-name drugs and are often made by the same company. Alternatively, consider discussing medication options with your physician and/or pharmacist.

Want to read the study for yourself? The abstract is publicly available!

Jun 122015
 

450px-Bone_density_scannerOne of the worries about hormone therapy for transgender people is over bone density. Cis women are at higher risk of osteoporosis (brittle bones) than cis men are. Sex hormones are needed for good bone health. Specifically — estrogen is known to encourage bone health. The loss of estrogen during menopause is what’s thought to cause osteoporosis in cis women. Does the change in sex hormones involved in hormone therapy change bone density?

We have a little more data on that now, thanks to a study out of Europe. This was the same data set as a previous study on weight. So we’ll skip the study details for now.

The question this part of the study asked can be summarized as: After 1 year of hormone therapy, with no surgery, was there a change in the bone density of adult trans women and trans men?

And the answer? For trans women: Yes. Trans women gained bone density after a year of hormone therapy. They gained as much as 4.5%, depending on the measurement location. For trans men?: No. There was basically no change in their bone density.

Promising news, in either case. There was no loss over one year on hormone therapy.

If you’re concerned about your bone density, talk with your doctor! Making sure that you eat enough calcium (in food form, not supplements) is also helpful. Most important of all, make sure you get good weight bearing exercise like walking, running, and jumping.

As a final note: this was a European study. The hormones used in Europe are different than the ones used in the United States. The results may not be applicable in the United States.

Want to read the study for yourself? The abstract is publicly available!

Jun 052015
 

ZAYİFLAMA-İP-UCLARİHormone therapy for trans people has long been known to change body shape and body fat percentage. But by how much? And how much can be expected in the first year? A European study of 77 trans women and 73 trans men found out!

On average over the first year of hormones…

  • Both trans women and trans men gained weight overall. On average they gained around 4-6 pounds (2-3 kg). Both groups started with a BMI around 24 (just barely between normal weight and overweight). For trans men, this weight gain tipped them into the “overweight” category. Trans women stayed in the “normal” weight category.
  • Trans women gained body fat and lost muscle mass. Their body fat went up from 24% to 28%. They lost a kilogram (2.2 pounds) of muscle mass.
  • Trans men lost body fat and gained muscle mass. Their body fat went down from 34% to 30%. They gained 5 kilograms (11 pounds) of muscle mass.
  • There wasn’t much of a significant different in waist sizes.

It may be helpful to remember body fat percentage numbers. For cis women, 21-31% is considered a fit or normal range. For cis men, 14-25% is the fit or normal range. So the trans women in this study started out at an average body fat percentage and stayed there. The trans men in this study started off with too much body fat and stayed there.

During the first year of hormones it seems that around a 4% change in body fat can be expected. Trans men can gain quite a bit of muscle. Trans women will lose some muscle.

As a final note: this was a European study. The hormones used in Europe are different than the ones used in the United States. The results may not be applicable in the United States.

Want to read the study for yourself? The abstract is publicly available!

Mar 162015
 

170px-Rod_of_Asclepius2.svgBeing a gender or sexual minority (GSM) is not only difficulty and tricky for patients — it can also be a challenge for medical providers. Medicine can be a particularly conservative field, depending on location and specialty. Lives are, after all, often at stake.

Despite recent advances it appears that some 40% of lesbian, gay and bisexual medical students are hiding their sexual minority status in medical school. Among transgender medical students, 70% were hiding their identity. All because of fear of discrimination.

That fear has been, and still is, warranted. From medical providers transitioning and losing their practices, to medical students losing their residency slots, to LGBT health student organizations fighting to exist, LGBT providers face similar discrimination as our patients.  Similar happens for other gender and sexual minority health care providers, though we lack statistics. At a meeting of kink-identified mental health care providers, one attendee noted a high level of vulnerability for the clinicians. Being “outed” could lose them their jobs or even trigger legal action.

To some extent, discretion among health care providers is warranted. Most people don’t want to know about their clinician’s (or coworker’s) personal lives. And most GSM providers don’t actually want to share those most intimate details. It’s where the line is that can be distressing — how much information is too much? Can I discuss my wife when other women clinicians are discussing their husbands? How exactly do you notify your fellow clinicians or patients about a change in gender pronouns or name? How can a clinician use information gained from intimate encounters to help patients, without revealing too much? It’s a balance we constantly seek. Sometimes mentors are there and can help. Other times we figure it out as we go along.

Yet we bring a lot to the table, as minorities. Like many racial and ethnic minorities, there are pressures and issues that affect GSM people more than the majorities. We bring that knowledge with us to the research we choose to perform, the communities we participate in, and each and every patient encounter.

We as clinicians and future clinicians need to have the support in order to be appropriately open about our gender and sexual minority status. Our patients and clients must know they can be safe and honest with us so they can receive the most complete and respectful care possible.

Some progress has been made already. There’s an association for LGBT medical professionals. There’s an association for kink psychological research. There’s an association for transgender health. All of which allow student members and provide mentoring. Many other organizations exist too. Some US medical schools are working with their students to provide a safe and welcoming environment where these issues can be explored. The American Association of Medical Colleges recently launched a program to enhance education surrounding LGBT and intersex health care. The American Medical Association also has an LGBT Advisory committee.

I’m proud to say that my medical school has been accepting and supportive of its gender and sexual minority patients, and that clinics in the area of my medical school are seeking to expand their care to be more inclusive of LGBT patients. Support exists for both those seeking medical care, and those seeking to provide that care. It’s only the beginning.