PSA Testing May be More than a Pain in the Ass

Written by: Dr. Jeffrey Barke

PSA testing has been the standard testing mechanism for the detection of prostate cancer for many years. It stands for prostate specific antigen and is a simple blood test that has been relied upon by primary care and specialty physicians alike. However, this standard test is under attack and rightfully so.

The U.S. Preventive Services Task Force (USPSTF) has recently published a draft recommendation AGAINST prostate specific antigen or PSA screening for prostate cancer in asymptomatic men. The USPSTF gave PSA screening in asymptomatic men a D recommendation, which means there is a moderate or high certainty that the test has no net benefit or that the harms outweigh the benefits. The benefit, of course, would be detecting prostate cancer early. The harm is that the vast majority of those diagnosed with prostate cancer will never be harmed by this mostly very slow growing cancer; you get the risks associated with treatment but no benefit.

According to Dr. LeFevre, a professor at the University of Missouri, Columbia, for every 1,000 men treated for prostate cancer, five die of complications from the prostate surgery; 10-70 suffer significant complications but survive; and 200-300 suffer long-term problems including urinary incontinence (think lifelong Depends), impotence (inability to get an erection) or both.

USPSTF noted that the majority of men who have asymptomatic cancer detected by PSA screening have cancer that either will not progress or is so slow-growing that it will not affect the men’s life spans.

So what to do? The USPSTF, although well respected, is but one authority that makes recommendations. The American Urological Association continues to support the use of the PSA test. At minimum you should have a conversation with your doctor about the USPSTF recommendation and how that applies to you. Family history, age and current symptoms all play a role in determining whether to screen or not. The art of medicine is in part, knowing how to apply the latest research and data to an individual patient.

This Blood Test Could Save Your Life

Written by: Dr. Jeffrey Barke

If you can’t measure it, you can’t improve it. Measure the ratio of AA:EPA in your blood and you have an accurate account of your future health.

We all try to take good care of ourselves with the belief that if we do so we will reduce the chances of serious illness. We make attempts to eat healthy, we exercise, we don’t smoke, and we try not to drink too much. Our bargain is if we do these things we are less likely to get: cardiovascular disease, diabetes, and maybe even cancer. Are we sure? How do we know? What can we measure?

The answers to these questions are difficult and imperfect. Here’s my thesis. Cellular inflammation is the foundation upon which our genetic expression of disease occurs. Control inflammation and we reduce the chances of disease. Full disclosure: Much of my statements are supported by research. However, I take common sense liberty in broadening what the research shows.

Inflammation in our body can be seen by measuring fatty acids. Fatty acids are the building blocks of eicosanoids. Eicosanoids are hormonal messengers in the body that control inflammation, and are produced in every living cell in the body. Manipulating eicosanoids through nutrition and supplements can change cellular inflammation. The ratio of AA (arachidonic acid an omega-6 inflammatory fatty acid) to EPA (eicosapentaenoic acid an omega-3 anti-inflammatory fatty acid) is a measure of “Cellular Inflammation.” This term cellular inflammation was coined by Dr. Barry Sears. Yes, the Barry Sears that wrote the nutrition book “The Zone” and the more recent book “Toxic Fat.” Control cellular inflammation and you control the development of chronic disease.

The AA:EPA ratio can be altered by changing our nutrition and by taking fish-oil. AA (arachidonic acid) is found in processed foods, egg yolks, and animal fat. It can also be produced by the over-consumption of cheap refined carbohydrates and vegetable oils. If you minimize or eliminate these food sources you reduce inflammatory arachidonic acid in your body. EPA (eicosapentaenoic acid) is found in fatty fish such as salmon and sardines, and in fish-oil supplements. If you increase these food sources you increase the levels of anti-inflammatory EPA in your body.

The easiest way to reduce your AA:EPA ratio is to take fish-oil. A caution is in order however. Not all fish-oil is created equal. Fish, in general, is polluted. Eat too much fish and you are likely to get too much mercury and other pollutants like PCBs. Take too much impure fish-oil and the same is true. The fish-oil I take and recommend is the product produce by Zone Labs (Dr. Sears’ company) called OmegaRx.

I take this product for three reasons:

1. I believe it is the purest fish-oil on the market and every batch is verified by an independent 3rd party lab.
2. It has an EPA:DHA ratio of 2:1. Most of us get plenty of DHA but lack EPA therefore this ratio is important.
3. If I’m going to spend a fair amount of money on fish-oil I might as well support Dr. Sears as I believe his research into nutrition and inflammation is important work.

Control cellular inflammation and you control the genetic expression of disease. Measure the AA:EPA ratio in your blood to know your level of cellular inflammation. Most importantly, you can change it and your blood will tell within 30 days.

Pancreatic Cancer: What is it?

Written by: Dr. Jeffrey Barke

With the loss of one of the greatest minds of our generation to pancreatic cancer, it raises questions about the disease that claimed the man who has changed the way we talk, compute, listen to music or even read.

Steve Jobs passed away on Oct. 5 after suffering respiratory arrest resulting from pancreatic cancer that had spread to other organs. The co-founder, and former chairman and chief executive officer of Apple Inc. was 56.

Everyone has known someone with one of the more common types of cancer of those that receive more attention and funding – breast cancer, prostate cancer, leukemia – but the full weight of pancreatic cancer seems a bit more difficult to grasp. Most people can identify the affected body parts or understand a disease that attacks the blood, however, most Americans have a difficult time pointing to where their pancreas resides, let alone what it does.

What is the pancreas?
The pancreas is a six inch long organ surrounded by the stomach, small intestine, liver and spleen in the upper middle of the abdomen. It looks like a thin pear and is responsible for creating pancreatic juices to help digest food and produce hormones for the body, such as insulin.

he pancreatic juices contain enzymes through a system of ducts. The main duct joins with the common bile duct with the liver and gallbladder, which carries bile to digest fat before emptying out into the first part of the small intestine. The hormones produced by the pancreas help the body use or store energy for food.

What goes wrong?
Pancreatic cancer occurs with cells in your pancreas begin to grow out of control and continue to live after normal cells would typically die. The extra cells can form a tumor.

There are two primary types of pancreatic cancer, one that forms in the ducts that produce digestive juices and another that forms in the hormone producing cells, with more cases of the former, instead of the latter.

Pancreatic cancer typically spreads rapidly and is rarely detected in its early stages. Unfortunately, it is the fourth leading cause of cancer death in the country.

What are the symptoms?
In its early stages, pancreatic cancer may present itself with a yellowing of the skin, mucus membranes or the eyes, called jaundice. Besides the pigmentation change, you could experience a change in digestive habits, loss of appetite and weight loss, fatigue and weakness, nausea and vomiting or pain in the area where the pancreas is located. Other possible symptoms include back pain, blood clots and indigestion.

Are you at risk?
According to the National Cancer Institute, in the past year 44,030 new cases of pancreatic cancer were diagnosed and there were 37,660 deaths. Although a rare form of cancer, risk increases with age, especially over the age of 60, those of African American descent, being overweight or obese, chronic inflammation of the pancreas, diabetes, family history and smoking.

Prevention and outreach
November is the designated awareness month for pancreatic cancer, but with current events, there is nothing wrong with starting early. The earlier a diagnosis is made, the easier it is for your physician to determine a proactive and effective plan of care. Treatment depends on the type of cancer, the stage of cancer, age and well-being, and pancreatic cancer is usually only curable when found in its earliest stages. Surgery, radiation, and chemotherapy are the most common treatment types and are to remove the cancer and relieve painful symptoms that the cancer is causing if possible. Besides living a healthy lifestyle, the best defense is to avoid smoking.

The Pancreatic Cancer Action Network works to educate the public about the disease to better identify the symptoms to catch and diagnose the cancer in its earliest stages.

Pancreatic cancer has the lowest relative survival rate of all the cancers tracked by both the American Cancer Society and the National Cancer Institute, according to the network. It is the only cancer with a five-year relative survival rate in the single digits at just six percent. 94% of patients will die within five years of diagnosis – only 6% survive more than five years and 74% of pancreatic cancer patients die within the first year of diagnosis.

To learn more, visit the Pancreatic Cancer Action Network or become an advocate for additional federal funding for education and research for the fourth leading cancer killer.

Unfortunately there is much about cancer that we do not understand. My belief is that we are all dealt a genetic hand. Some are dealt four aces and can live to 110 despite very poor self-care. Others, despite almost perfect self-care, need to bluff their way to get to age 60. Most of us are somewhere in the middle; that is how we take care of ourselves will determine the genetic expression of disease. I further believe that inflammation in our body is the foundation upon which our genetic expression of disease occurs: cardiovascular disease, diabetes and even cancer. Control inflammation and you control the genetic expression of disease. Inflammation is best controlled by our nutrition and secondarily by exercise and supplements. See my previous blogs to better understand anti-inflammatory nutrition.

The pancreatic cancer that plagued Steve Jobs was the rarest form of the disease and affects only 5% of those with pancreatic cancer, but his passing serves as a reminder of the lack of early treatment and screening options.

Worried About Heart Disease?

Written by: Dr. Jeffrey Barke

As part of the yearly, comprehensive physical that we deliver for each of our clients, we always run an extensive blood panel review.  But, for clients that have an increased risk for heart disease we also have the ability to conduct an advanced lipid profile test from either Berkeley Heartlab or the VAP (vertical auto profile, offered by several labs).  These types of tests provide an in-depth analysis of your cardiovascular risk and it gives us far more information than is available from a traditional cholesterol test. Think of it as a high definition view of your cardiovascular risk. We use this information to help direct risk reduction in order to prevent cardiovascular disease.  As heart disease is the leading cause of death in the United States and coronary artery disease (CAD) is the most common form of heart disease, we believe it is critical that you are educated and able to ensure your physician is giving you the best available care options.

Traditionally, risk of developing CAD has been assessed with a standard calculation of LDL (low-density lipoprotein) and measurement of HDL (high-density lipoprotein) quantity. However, only 50% of coronary artery disease is associated with high cholesterol or any of six additional classic risk factors: advanced age, male gender, and positive family history of premature heart disease, high blood pressure, diabetes, and smoking. Obviously, today’s routine cholesterol tests are failing to identify the vast majority of people at risk for heart attacks. In fact, a recently published study showed a surprising number of people with low LDL cholesterol levels still developed heart disease. Looking at good and bad cholesterol calculations simply is not enough.

Wondering why this is important?  Your coronary arteries carry life-sustaining oxygen to your heart muscle. If you have plaque build-up, you are at risk for a rupture, or a clot that could block the coronary arteries.  From this your heart muscle does not get enough oxygen and is unable to function correctly. Robbing the heart muscle of oxygen for even a brief period of time will result in the death of some of the heart muscle tissue (otherwise known as a heart attack) or potentially cause an arrhythmia which can lead to sudden death.

Utilizing an advanced lipid profile test, we can create a comprehensive and personalized plan for each individual, assessing a variety of risk markers as well as environmental, genetic, and lifestyle factors that may contribute to heart disease progression.

If think you are at risk for heart disease please talk to your primary care physician about these types of tests to determine if it might be beneficial to your long term health strategy.

Sun Protection

Written by: Dr. Jeffrey Barke

Yes, the dreaded summer sunscreen warning. We wouldn’t be a true medical partner if we didn’t remind you of the dangers of the sun. Did you know that skin cancer is the most common form of cancer? That melanoma is the fastest growing cancer in the US? Or, that the year-round average UV index for Orange County, California, is a Level 9? According to the EPA, a Level 9 index is categorized as “very high” and means “Protection against sun damage is needed. If you need to be outside during midday hours between 10 a.m. and 4 p.m., take steps to reduce sun exposure. A shirt, hat, sunglasses and sunscreen are a must, and be sure you seek shade. Beachgoers should know that white sand and other bright surfaces reflect UV and can double UV exposure.”

We all know how wonderful it is to be outside. Whether you love to play golf, take the family on a bike ride, enjoy fun at the beach, or skiing in Mammoth (in June, no less), outdoor fun is truly nature’s gift for all of us. But, the dangers of sun exposure are a very serious matter and we want to remind you of the few small things you need to know to protect yourself and your loved ones. Ultraviolet radiation (UV) can cause long term damage to the skin and eyes. To best protect yourself and your family, please consider wearing the following each time you head outside…

1. “Broad spectrum” sunscreen that will filter both UVA (wrinkles, sun spots) and UVB (DNA damage, skin cancer). If you are going to spend extended time outdoors an SPF of at least 30 is recommended.

2. Protective clothing. Covering the arms, legs, back of neck, ears when possible.

3. A hat. Wide brimmed is best. Visors still expose the top of your skull which is a commonly hidden spot for skin cancer.

4. Sunglasses or goggles that provide 100% UV protection

Other great safeguards to invest in are umbrellas for all occasions and window tint for windows where you might have extended exposure during the day.

In addition to protecting your skin 100% of the time, commit to frequently checking your skin for changes. We know that changes in large freckles or moles can be signs of a skin cancer starting to develop, but even small changes in the skin such as small scaly patches or red lesions that don’t seem to heal can be signs of cancer as well. Additionally, make sure that a skin check is done yearly as part of your routine medical physical.

Just to put an exclamation point on the topic, according to the Skin Care Foundation and the American Cancer Society, each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon . One out of every 5 people will develop skin cancer in their lifetime. If this isn’t enough, please visit the Skin Care Foundation website for more facts on this tremendously serious topic.

It is our mission to help our clients and community to be healthier and sun protection is an easy commitment that will change your life forever.

Aging For Men: How Your Body Changes

Written by: Dr. Jeffrey Barke

Did you know that after age 25-30 the average man’s maximum heart rate declines by one beat per minute, per year and that your aerobic capacity to pump blood drops by 5%-10% every 10 years? A healthy 25 year old heart can pump 2 ½ quarts of oxygen a minute, but a typical 65 year old heart can’t get above 1 ½ quarts. At 80 the average male is down to less than a quart. This diminished aerobic capacity is exactly what makes us fatigued and breathless as seniors.

Most men begin to gain weight in midlife, usually 3-4 pounds a year without significant lifestyle change. Since men start to lose muscle in their early 40s, that extra weight is all fat. This extra fat contributes to a rise in your LDL (bad cholesterol), a fall in your HDL (good cholesterol) and increases in silent inflammation within the body. It also explains why blood sugar levels rise by about 6 points per decade, making type 2 diabetes increasingly common as we become senior citizens.

Eventually, a typical man can lose up to 50% of their muscle mass which will significantly contribute to weakness and disability in your later years. One reason for this drop is the drop in the male hormone testosterone, which declines about 1% per year after the age of 40. Most men will continue to have normal testosterone levels and reproductive capacity throughout life, but many will also experience a gradual decline in libido and sexual vigor.

Yes, it all sounds grim, and these changes happen to healthy men, but you can slow the pace of or stop many of these changes. As many of my patients know, my favorite quote is:

“Those who think they have not time for bodily exercise will sooner or later have to find time for illness”  by Earl Edward Stanley (1799 – 1869)

Exercise is not the fountain of youth, but is one of the biggest steps you can take to slowing or even reversing every one of the physical issues described above. The other critical step is proper nutrition. Wondering what it takes to make this happen? Keep reading.

Yes, it’s true, even just 30 minutes a day of brisk walking will go a long way toward enhancing your health. Furthermore, men at 50 respond to exercise training just about as well as a 20 year old. Men will benefit from exercise at any age, just make sure you talk to your doctor first if you haven’t been active for some time.

Thinking about doing a little more? Wondering what the best exercise is to ward off all of these looming realities? If you are ready to commit to a lifelong fitness program that will positively change your physical health in your later years, you will need to design a program that includes the following to be most effective:

• Endurance training – this is the best way to improve cardiovascular function. This keeps your heart muscle strong and supple, your arteries flexible, and boosts the heart’s ability to deliver oxygen rich blood to the body’s tissues. Your cholesterol and blood pressure will lower as well. Endurance training is any activity that gets your heart rate up, and keeps it up for sustained or interval periods. Biking, running, swimming, fitness classes, commit to getting that heart pumping!
• Resistance training – Otherwise known as weight training. Weights or exercise machines will enhance muscle mass and strength and preserve bone calcium. You will need to learn what to do and instructors can help. There are many options here, including home programs with easy to use equipment.
• Flexibility training – This will keep you mobile as you age. Stretching is an ideal way to warm up and cool down after endurance exercise. 20 minutes of dedicated stretching two or three times a week is ideal. Make sure to include in this poses that work on balance as well, utilizing balance balls, Bosu devices, and Yoga can be great tools for this as well.

Using your body will keep it young. Following a life-long program of exercise will make a difference in how you age. Reflecting back on the initial data shared earlier in this article; if you exercise you will experience the following benefits.

We are all aging, but we do have the ability to control what our later years will be (or are). Regular exercise, a good diet, good medical care and commitment to health will help you to live the life you deserve for a very long time.

Carbs, a Not So Simple Subject

Written by: Dr. Jeffrey Barke

Did you know that from a weight-loss standpoint nutrition is more important than exercise?  You could exercise every day, but if you are not committed to healthy eating there is a good chance you will not lose any weight.  You simply cannot exercise your way out of poor nutrition. 

A typical meal at your favorite restaurant would take several hours on a spin bike to burn off an equal amount of calories.  If you eat out several times per week you would need an extreme amount of exercise to counter the calories.  80% of the effort of weight loss should come from nutrition and 20% from exercise.
 
The most important nutritional change that the majority of us should make is to reduce the amount of simple carbohydrates we consume.  Some simple carbs are easy to identify such as sugary foods like cookies, ice cream, or candy.  Other simple carbs such as bread, pasta, and rice can have just as much impact, but we don’t always consider them as unhealthy.  Although brown rice is better than white and whole wheat pasta or bread is better than their white counterpart, you should still look at all of them as simple carbs that can cause weight gain or lack of weight loss because of the effect they can have on your insulin.
 
Why can insulin levels be a problem?  Insulin is a hormone that lowers the level of glucose (a type of sugar) in the blood. Insulin is made by the beta cells of the pancreas and released into the blood after you eat.  Simple carbs cause more insulin to be secreted.  Insulin helps glucose enter the body’s cells, where it can be used for energy or stored for future use.  High levels of insulin can lead to weight gain because if the body cannot burn it off, it will store the extra glucose as fat.  In addition, insulin prevents the body from releasing stored fat even when you’re hungry and need energy.

The good news is there is a solution!  By reducing your intake of simple carbs you will reduce insulin spikes and your body will then utilize calories more effectively.  If you are going to eat carbs, try to include some protein with it to control the insulin response.  Even a piece of fruit such as an apple should be combined with some protein like a few almonds or a piece of low fat (or non-fat) mozzarella cheese.
 
Educating yourself on how to properly combine carbohydrates with protein, healthy fats, and vegetables can be the first step to changing what you eat, how you feel, and your weight forever.  Controlling your carb intake is not only critical to maintaining a healthy insulin response and weight control goals, it can also help to prevent Type 2 diabetes, high blood pressure, poor cholesterol, and chronic inflammation.

Hitting the Slopes Soon?

Written by: Dr. Jeffrey Barke

Ski and snowboard season is here and I know that many of us just can’t wait to hit the slopes!  I’ve been an avid skier for over 40 years including a stint as a ski instructor in Mammoth and this is a great opportunity for me to share with you a few action items to keep you and your loved ones out of the emergency room this season.

Before you click or strap in….

• Get in shape!  Following a regular fitness and strength training program will help you to build the endurance you will need to prevent injury.  Cardiovascular capacity and muscular strength are essential to a pain free day on the slopes.  Stretch/warm up for 10-15 minutes before hitting the slopes.
• Check your equipment and invest in safety.  Old equipment (more than 5 years), poor fitting boots, and old binding settings significantly increase your risk for injury.  Get your equipment serviced, upgrade those 1987 boots, bindings and skis and don’t buy too big for your kids.  Proper fit and adjustment is essential to being safe and a great excuse to convince your spouse you need new equipment. 
• Helmets.  I know they can be undesirable, but they are a necessity.   Correct fit is critical.

Once you are on the slopes…

• Don’t ski or snowboard alone.  If you do fall or have a problem with your equipment, having a buddy with you will be the key to getting the help you need.
• Know your limits.  Always ski at your level and avoid advanced runs until you are absolutely ready.  Instructors will want to teach you the most skills in the shortest time which can lead to you wanting to ski in areas for which you might not be ready.  Take your time, enjoy a safe and slow ride until you are ready to progress.
• Learn to fall, it’s going to happen so learn to do it right. Fall uphill when you can and don’t throw your hands out to stop yourself.  Don’t try to stand if you are still sliding.  Take your time getting up.
• Hydrate.  Dehydration can lead to fatigue and hypothermia.
• Never drink alcohol.  Alcohol causes vasodilation (widening of blood vessels) and thereby causes increased heat loss putting you at risk for hypothermia even if you do not feel cold.
• Know when to quit for the day.  If your legs are feeling heavy or soreness is kicking in, head to the lodge!

Implementing these tips can be the key to keeping you and your loved ones out of the emergency room.  If you are injured, don’t hesitate to seek medical attention, call your Personalcare Physician and give yourself plenty of time to recover.

Wondering if you’re getting enough Omega-3 in your diet?

Written by: Dr. Jeffrey Barke

We tend to believe that Orange County is more health conscience than many other parts of the world (or the country, for that matter).

In our casual (non-doctor-mode) asking around, we have found that most health-conscience people know that “Omega-3’s are good for you” – but, from what our informal research shows, that’s about where the knowledge for most stops.

The key metric for knowing your Omega-3 level is called The Omega-3 Index. Knowing your Omega-3 Index helps us to understand the potential silent inflammation that you might have.  Inflammation that can eventually lead to illness and long term disease.  We encourage our clients to get tested for their Omega-3 level so we can then work with them to improve it and support long term health.

Earlier this year, we began offering a proprietary test called The HS-Omega-3 Index from OmegaQuant . We are one of the first Orange County concierge medical practices to offer this test.  The test, is generally not covered by insurance, but only costs about $100.00 for our existing clients (less than the home-test, and more accurate).  Check out our own Dr. Jeffrey Barke talking about this industry leading test.

Come see us today if you would like to learn more about your Omega-3 Index and our industry leading, private medical services.