Super Food You Say?

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What exactly is a super food? A super food is a food that is high in nutrients and contains high amounts of phytochemicals.  A phytochemical is a chemical compound found in plants. They naturally help protect the plant from certain diseases but also have been recently noted to protect and prevent our body from certain diseases. They are touted to have some anti-aging, anti-heart disease and anti-cancer properties. These substances help protect our cells from damage.

Journey with me as we explore some of these super foods and how to add them to your daily diet!

Let’s start with my favorite food…dark chocolate! Dark chocolate is high in antioxidants which help free your body of substances that can damage cells and increase aging. Flavonoids are also in abundance and help improve vascular health including decreasing the risk of stroke or heart attack and lowering cholesterol. In some populations dark chocolate may even help lower blood pressure. Dark chocolate also has a lower glycemic index than milk chocolate and as a result, does not cause the rapid spikes in blood sugar that milk chocolate can. All this great news about dark chocolate, unfortunately, does not mean that we can eat this as our main dish every day. We only need a little two to three times a week.

How can you enjoy your chocolate?

  • Grate some over your morning oatmeal
  • Try some shaved dark chocolate on your favorite fruit such as strawberries, peaches, or pears
  • You could nibble straight from the bar as dark chocolate also has some caffeine and may help wake you up during that mid day slump
  • Do you like mocha? Try grating some in your morning coffee
  • Make your own trail mix with your favorite, dried fruits, nuts or seeds and add some dark chocolate chips
  • Try melting some dark chocolate and dipping graham crackers in it then let cool on some waxed paper

Gardasil (The HPV Vaccine): For Your Information

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Most of you have probably heard something about HPV (Human Papillomavirus). The importance of being well informed about the HPV virus and Gardasil cannot be understated. I encourage all my patients to be an active participant when it comes to their body, especially on topics of preventive medicine like HPV and Gardasil. The HPV/Gardasil topic touches on many important issues like adolescent/young female gynecologic care, disease prevention, and future long-term health that you as a patient can really take charge of and dictate.

HPV (Human Papillomavirus) is a common virus that is spread by skin-to-skin contact during sexual activity. Unlike other sexually transmitted infections, HPV-infected individuals are almost always without symptoms, so most who are infected don’t even know they have it! In fact, according to the CDC (Center for Disease Control and Prevention), the most common newly diagnosed sexually transmitted disease is genital HPV. Over 14 million new cases of HPV were diagnosed during the last year. To compare, the second most common newly diagnosed STD was Chlamydia with only 2.8 million new cases. In fact, newly diagnosed HPV was more common than Chlamydia, Trichomonas, Gonorrhea, Herpes, Syphilis, HIV, and Hepatitis B combined! The risk of acquiring HPV by age 50 for women is over 80%, and the most susceptible females are from ages 18-24 with infectivity rates more than 40%! In short, most women will be infected with HPV at some point in their lives.

So what’s the big deal you might ask? Well now we know that HPV is a known cause of certain cancers as well as non-cancerous conditions in both females and males. In females, these include cervical cancer, vaginal cancer, vulvar cancer, anal cancer, as well as genital warts. In males, penile cancer and genital warts have been linked to HPV. Even certain oropharyngeal cancers have been associated with the virus. The virus has the ability to actually infect body cells and change them in such a way that they transform into cancer.

Specific HPV genotypes are more dangerous than others. For example, HPV types 16 and 18 are known to cause ~70% of all cervical cancers and 50% of precancerous cervical lesions. In addition, 90% of all genital warts are linked to HPV types 6 and 11.

Luckily, a vaccine against HPV was created to combat these specific HPV genotypes. It is called Gardasil. The Gardasil vaccine is a powerful preventive tool in the fight to stop the spread of HPV. It is effective against the specific types of HPV that are known to cause majority of cervical cancer and genital warts, specifically HPV types 16, 18, 6, and 11.

Here are some important points that will hopefully answer any remaining questions you have about Gardasil.

Who can get the Gardasil vaccine?

Gardasil is a licensed, safe, and effective vaccine for all young women and men aged 9-26. Why those specific ages you might ask? Well, all of the original Gardasil trials were performed on thousands of people worldwide between these ages. Therefore, it has been approved for this age range only.

What is the recommended schedule for the vaccine?

3 injections are recommended over the course of 6 months. The first dose is given, then the second dose is given 1-2 months after. Lastly, a third dose is given 6 months after the first dose.

When is the absolute best time to get the vaccine?

The optimal time to get the vaccine is actually around 11 or 12 years old because the potential benefit is the greatest at that age. The reason for this is that the HPV vaccine works best before any sexual activity has begun. Higher antibody titers are produced in this age group too. Also remember, it IS possible to get infected during your first sexual contact.

How effective is Gardasil?

Gardasil is very effective as evidenced by its nearly 100% efficacy in prevention of primary infection from HPV types 16 and 18. In fact, a recent study by the CDC has shown a 56% decrease in the HPV strains covered by the vaccine in the first four years after the vaccine’s introduction in 2006. The vaccine is highly immunogenic and has shown maintenance of protection for at least 5 years after vaccination. It also has great immune memory with great potential benefit lasting even beyond 5 years.

What if I already have an abnormal Pap smear, genital warts, or tested positive for HPV?

Gardasil does not treat or get rid of an already established HPV infection or any cervical abnormality that has already occurred. However, even if you have been infected with the virus, you can still obtain some benefit from the vaccine. Plus, most of the time you don’t know exactly which HPV type you may have and most of the time young women tend to clear the HPV infection all by themselves anyway! So evidence of prior HPV infection does not preclude you from getting the vaccine or deriving any benefit from it.

Is Gardasil safe? Are there any side effects?

The FDA has licensed the HPV vaccine as safe. Thousands of people worldwide were tested and no major side effects were seen. Minor side effects do include pain at the injection site, headache, and nausea.

Do I still need Pap smears?

YES! You still need regularly scheduled Pap smears. Getting the Gardasil vaccine does not mean you can skip your cervical cancer screening (which should begin at age 21). Again, the vaccine does not treat pre-existing HPV infection. Plus, there are a small number of other HPV types can also cause cervical cancer that Gardasil does not cover.

What other things can I do in addition to vaccination to prevent HPV infection?

There are other ways to prevent or decrease the risk of transmission of HPV infection. First of all, protecting yourself is the most important thing and avoiding high risk behaviors is key. These include trying to limit your number of sexual partners and avoiding sex during early ages (13-18 years of age) when one is most susceptible to HPV. Using condoms whenever possible has also been shown to help prevent transmission (although not all skin-to-skin contact can be prevented by condoms).

Hopefully, this information has been helpful and informative. HPV is an incredibly prevalent disease, but we have the unique opportunity to still control its spread with the Gardasil vaccine. I encourage everyone to pass this information along to your family and friends (especially teens and their parents). Prevention of any disease involves action and self-motivation by patients, but even more importantly, it requires education and knowledge. So spread the word about Gardasil because HPV is spreading fast as well.

Nuts for You

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Walnuts have been around since about 7,000 B.C. Walnuts contain much higher amounts of omega-3 fatty acids than any other nut. Omega-3 fatty acids are very important for brain and nerve function. They help build new cells and keep them strong, as well as help with normal growth and development. Our body does not make this particular fatty acid so we must get it through our foods. Walnuts also have tons of fiber, B vitamins, magnesium, and antioxidants.

Incorporating walnuts in your diet may help lower your LDL “bad cholesterol” and help increase your HDL or “good cholesterol”. Walnuts may also improve the elasticity of blood vessels because of their anti-inflammatory action thus may help lower blood pressure, decrease coronary artery disease, decrease strokes and lower your risk of some cancers such as breast, colon and prostate.

In general nuts tend to be high in fat so should be consumed in moderation in order to not add excessive calories to your daily intake. Walnuts contain monounsaturated and polyunsaturated fats which are healthier fats and very little saturated fats which are not so healthy. Walnuts have no cholesterol.

Nutritional Information for Walnuts
Serving Size: 14 halves
Calories: 185
Fat: 18.5 grams
Carbohydrates: 3.9 grams
Protein: 4.3 grams
Fiber: 1.9 grams
Low glycemic index

They should be eaten as a protein replacement food such as:

  • Sprinkle some chopped walnuts into your oatmeal in place of bacon or sausage
  • Add to a muffin or pancake batter
  • Enjoy as a snack
  • Add some chopped walnuts to your yogurt
  • Use them in a trail mix made with your favorite dried fruits
  • Use them as a protein replacement in a salad

These salads are favorites of my sister and myself. If you are counting carbohydrates, read your label. A serving of dried cranberries is about 1/3 cup and have 33 grams of carbohydrates. Each section of grapefruit has about 1 gram of carbohydrate and 1 ounce of Mandarin oranges is 3.5 grams carbohydrates.

Spinach Walnut Salad

1 bag of fresh spinach
Shredded purple cabbage
Quartered mini carrots
Grape tomatoes halved
Mandarin oranges, chopped
Grapefruit slices chopped
Walnuts
Lite Lime Dressing

Broccoli Slaw

1 package Broccoli Slaw
Dried cranberries
Chopped celery
Walnut halves
Lite Ranch Dressing

Look Into Their Eyes

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When I look in the eyes of a pregnant teenage patient, I see my wife. My wife was a teen mother. She was a teen mother who beat the odds. She is NOT a statistic. She is an example of the tremendous potential that lies before each and every teen facing the challenges of teen pregnancy. Pregnancy did not stop her from succeeding. My wife tells the story of riding her bicycle to her doctor’s appointments. She raised her child, graduated high school and worked her way through college and nursing school. Her determination created a successful life for herself and Jaclyn, her daughter. This is what I see when I see young pregnant patients — potential and opportunity. I know that as a doctor I can make a difference that not only helps them but also the lives of their children. For this reason, I dedicate my time and energy working with teens in the office and educating Irving ISD teens about teen pregnancy.

In 2003 I joined  MacArthur OB/GYN, a medical practice in Irving, Texas. I began seeing a large volume of young teenagers in my practice and was surprised at the prevalence of sexually transmitted disease, teen pregnancy and an overall lack of knowledge regarding sexual health. I reached out to the local school nurses and offered myself as a resource. Over time this relationship evolved. Navigating through a politically charged issue like teen pregnancy was a challenge, but after gaining the support of Irving ISD administration I began giving lectures and presentations on Teen Pregnancy and STD prevention. I have spoken to countless Irving ISD students over the past 10 years providing information about sexual choices, personal responsibility, sexually transmitted diseases and pregnancy prevention.

I work closely with the Teenage Pregnant and Parenting students program, TAPPS, a district wide program that meets the needs of pregnant and parenting students. While the national high school graduation rate for teen parents hovers around 40%, the graduation rate for our TAPPS students is over 90%. By creating a partnership between the TAPPS program and MacArthur OB/GYN  we extend the reach of the program beyond the four walls of the classroom. The physicians at MacArthur OB/GYN not only care for the pregnancy, but also work with the student to make sure they are enrolled in the TAPPS program. We enroll them in the YWCA Nurse Family partnership which provides mentorship, prenatal and parenting education. We schedule visits around the school day. We empower the students to be ready to parent and aggressively educate on contraception to avoid a second teen pregnancy. We have demonstrated that identifying the pregnant students and meeting their specific needs can change lives. We see successful pregnancies and help the students achieve success in the classroom. The payoff for these efforts will be seen for generations to come.

In addition, I have served on the Irving ISD Health Advisory council since 2004. We evaluate and recommend programs on sexual health to be adopted by the district. Teens rate sexual health information as the number one issue they want to learn about in health class. Through our efforts we have implemented evidence based, effective and factual information on sexual health district wide.

In my school presentations I give fact based information from a health perspective. The students understand the type of diseases, the methods of transmission and how to avoid them. We also discuss the impact of teen pregnancy. Beyond the health information, I relay a message of individual responsibility. I empower the students to understand that they have choices. Teen pregnancy and STDs are not inevitable but rather a decision that they have control over.

During the presentation I always ask the students to write me a letter in 10 years telling the story of their life. I paint a realistic picture of what most of their stories will be. Statistically speaking the outcomes are not pretty. The sad truth is most of the young students in the office will not have an inspirational story to tell. I challenge these young people to be different. I challenge them to overcome the statistics and to tell me a story like my wife’s — one where they lifted themselves up, overcame the obstacles and created a wonderful, successful life for themselves and their child. At the end of an office visit a few years ago a patient of mine said “I have 4 more years.” I was not sure exactly what she meant. She clarified that six years before  she was sitting in a high school auditorium listening to me speaking at Union Bower High school. She was telling me in 4 more years she will write me a letter telling me how she has graduated college and nursing school. You could see and feel the pride and determination as she told me this. Knowing that my words stuck in her head motivating her to succeed caused me to tear up on the spot. Students like this reinforce to me the importance of having health care providers meet the special need of these young patients. Community leaders must continue to work with the school district to impact the lives of young people. I am not naive. I know that teen pregnancy will continue to be a challenge in Irving, Texas and across the world. But I also know that a health care provider can touch lives. Each day we can serve as one stepping stone helping a young patient along the pathway to a successful life. The physicians at MacArthur OB/GYN are committed to playing our part. Together we can make a difference.

The New Face of HIV

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For too long, the public face of HIV has mirrored that of Andrew Beckett, the character played by Tom Hanks in the movie Philadelphia. In this movie, Andrew is a frail appearing gay man fighting in a law suit against his employer who fired him due to his disease. They assumed that due to his weakened appearance and visible sarcoma skin lesions that he was a victim of HIV infection. During the 1980’s, this was the face of HIV. It was as easy to notice as a disheveled and dirty homeless person or someone fighting the battle of addiction to crack cocaine or heroin. There were floors within the hospital known as the “AIDS” floor filled with people fighting for their lives and losing their battles far too often to a premature death. Every so often, you would hear about the new diagnosis of a famous person like Magic Johnson, or a death like Rock Hudson, Eazy E or Arthor Ashe. Lately, HIV has been out of site and out of mind. This article’s purpose is to bring it back out to the forefront of reader’s minds.

Since the first recognized case in June 1981, there have been ~1.7million people in the United States who have been diagnosed and ~619,00 people have died. Every 9.5  minutes, someone in the United States, not the world, is infected with HIV. That means, in about the time it takes you to read this article, someone in the United States has been infected with HIV.

So what should you do to protect yourself?

  • Use latex or polyurethane condoms for latex allergy consistently with water based lubricants to prevent condom breakage. Polyurethane condoms are available in Trojan Supra or Durex brands.
  • Receptive anal sex without a condom greatly increases the risk of HIV transmission so use a condom with lots of water based lubricant.
  • Male circumcision reduces transmission of HIV.
  • Get tested every year regardless of your marital status and every 3-6 months if you have more than 1 sexual partner.
  • Know your partner’s HIV status.
  • Be monogamous.

One in five people living with HIV is not aware of their being infected. Patients with HIV are now healthier, maintaining a healthy weight and having less opportunistic infections. They are living longer and living more normal lives and, therefore, appear more normal which increases opportunity for spreading the disease. So, to see what the new face of HIV is today, you should look in the mirror. The face of HIV in America today looks like and me. Be safe my friends.