• You Don’t Have to Live With Urinary Incontinence
• Making Sense of Food Labels
• How Many Bypass Surgeries Are Unnecessary?
• Easy Salad And Dressing

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Dear Health Conscious Individual,

Welcome to House Calls with Dr. Cutler™!

In this week’s issue I will discuss a matter that is usually discussed behind closed doors. There are more than 13 million men and women suffering from this disorder, but often embarrassment and shame stop people from talking to their physicians. If you are one of these people, I’ll help you recognize the symptoms and get you on the right track!

Plus, do you know what’s in your food? Read an article to find out how to analyze the labels of your favorite treats and discover that just because it may taste good—it may not be good for your body!

AND, how many unnecessary bypass surgeries are performed each year? Keep reading to find out the answer…

Yours for healthy living,

Michael Cutler, M.D.
Medical Advisor, True Health™

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You Don’t Have to Live With Urinary Incontinence

Interestingly, urinary incontinence (UI), or over active bladder (OAB) syndrome, is NOT just an issue for those who are more senior in age. The definition is not being able to control urination, and it can occur to people at any age.

The reasons are numerous, and the number of people who suffer is larger than most would think. According to recent statistics, more than 13 million men and women suffer from this disorder in the United States alone.

Unfortunately, many experts believe that this number only reflects about half of what the number really is, because many do not believe they suffer from UI. This is because of embarrassment, or through an assumption that this is just a temporary condition. Yes, older people seem more susceptible to UI, but not because of age.

In this issue, I want to educate and advise you concerning this topic and a few ways you can fight back. I would recommend a qualified urologist for anyone suffering from UI. Male and female sufferers of UI may feel symptoms such as:

• A lack of bladder control…
• the urgency to urinate with or without urine release…
• the accidental release of urine while sleeping—or awake—without any warning…
• the release of urine during sudden movements such as laughing, sneezing, coughing or even bending down…

In many cases, the ability to socialize and be part of a group is reduced as sufferers do not want the embarrassment of an accident, or to be too far from a convenient bathroom. There are some general categories of UI:

Stress UI—generally attributable to poor bladder support by the pelvic muscles or due to the inability of the sphincter muscle to work properly. This is usually the cause of movement triggered urine release.

Urge incontinence—responsible—the feelings of urgency in getting to the toilet regardless of whether or not urine is released. Specialists attribute this form of incontinence to either nerve damage or overactive bladders that suffer from infection, but the causes are not clear.

Overflow incontinence—occurs when the bladder overflows, and urine leaks out. This generally occurs due to insufficient voiding of the bladder during normal urination, brought on physically by a weakened bladder, or a blocked urethra that does not enable the bladder to fully empty. The blocking of the urethra can be caused by an enlarged prostate gland, or in people suffering from diabetes, nerve damage or heavy alcohol users.

So what are some of the solutions and treatments that can address UI?
Behavioral therapy that enables the person to learn/re-learn the ability to control their bladder, to exercise their sphincter muscle, and to learn how to balance their fluid intake such that all three elements prolong and manage the time between bathroom visits. Pelvic muscle exercises, including Kegel exercises, to manage the release and restraint during voiding is a normal part of this therapy.

Medication can also be administered to help between bathroom visits by relaxing the bladder or tightening the sphincter muscles. Medication is also available to help with the management of acetyl choline, which is the chemical that helps in the transmission of neural messages between nerves. Though all medications have some form of side effects, newer meds are able to minimize side effects.

The majority of the issues causing UI can be addressed with the help of a urologist. Again, I stress that most people don’t even approach such a specialist or even mention their UI problem to their general doctor because of shame. I encourage you to seek help if you suffer from these symptoms.

Though the wearing of incontinence pads can be inconvenient, the more difficult issue concerning this is the loss of self worth for the majority of silent sufferers, and how their families and friends become distanced on purpose in case an ‘accident’ occurs.

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Making Sense of Food Labels

Food labels are how we know certain facts about packaged foods. There are two areas to look for: The “Ingredients” and the “Nutrition Facts.”

First let me explain something about the ingredients. Ingredients listed on packaged foods are listed in descending order by weight, such that the most prevalent food is listed first and the least prevalent food is last. Therefore, be sure to avoid foods listing sugar, brown sugar, high fructose corn syrup, or some other refined sugar as one of the first three ingredients.

Also a hydrogenated oil or trans fat is not what you want to see in the top three ingredients. The healthiest foods are highest in fiber while being lowest in cholesterol and sugars. You may know that carbohydrates can be broken down into sugars in the body depending on their starch, cellulose or lignan content.

Consider what else is on the ingredients list (chemicals you cannot pronounce) and how far down the list these non-natural food additives are. In a packaged food, something closest to its original whole food form will always be the healthiest.

Next are the nutrition facts on the label. This gives the amounts of fats, carbohydrates, proteins and some of the micronutrients such as sodium and dietary fiber. But what the nutrition facts section doesn’t reveal is the micronutrient concentration relative to calories. This is called the nutrients to calories ratio.

Mostly, packaged foods don’t have much in the way of real whole complex vitamins, organic minerals, live enzymes, antioxidants, or phytochemicals to speak of. And they are high in calories. Therefore, while you may read the amount of fiber in a specific food, that fiber may have lost much of its health effect by having been cooked, marinated or broken down by sitting in the can for years.

So consider what you are eating, don’t just add numbers from the nutrition facts label and expect to be getting the real health effect of what once was a whole, fresh, high nutrient concentrated food.

For example, cold cereals are notorious for listing “whole grain” on their package. This gives the connotation that it is a healthy food. But ask yourself how healthy these sugar cereals are when they have obviously been refined and mixed with so much sugar that they crush into powder by stepping on them. And when the kids clamor for them as their dessert, you know they are not high in nutrients.

You should also know the “% Daily Value” is usually based on a 2,000- calorie diet. It is somewhat helpful to know the total calorie amount. Still you are left with relatively little knowledge about the micronutrient value and healthy effect of this food.

Here are some other totals to look for on your packaged foods:

Total Fat: Total fat tells you the sum of all the fats per serving. Fat is calorie-dense and nutrient-poor. If you are trying to lose or maintain your weight, the number of calories you eat counts. Fat has more than twice the calories per gram compared to carbohydrates or proteins. However, the relative amount of fiber and micronutrients is equally important. So, be concerned with nutrient density of food, not calorie density alone to determine your health! Said another way, empty calories put on weight and drive illness, but calories from nutrient-rich foods do not. Consuming 3,000 calories a day from green salads, fresh-juiced vegetables and fruits will NOT cause you to gain weight.

Sodium: There are only two important things to know about sodium. First, natural sea salt and organic salts found in vegetables, fruits and goat whey are much healthier than inorganic sodium chloride salt. The second is that if you have high blood pressure, heart failure or experience swelling from salty foods, then eliminate it. Use other organic seasonings that don’t adversely affect you.

Total Carbohydrate: The grams of sugar and fiber are counted as part of the grams of total carbohydrate. A fiber goal should be more than 75 grams daily for optimal health, NOT the 15 to 30 recommended by the FDA. Sugar-free foods still may have sugar alcohols, which are a lower glycemic sugar. Total carbohydrates will still be listed nevertheless.

Protein: Higher protein foods don’t necessarily mean better foods. Vegetable protein has been shown to be superior to animal proteins in various large studies. Once again, it is the micronutrients and fiber that make the protein work for your health and long-term optimal weight.

So next time you reach for your favorite packaged food, check out the label and see what you are really consuming. Is it worth it for your overall health? Probably not.

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How Many Bypass Surgeries Are Unnecessary?

Even the American Medical Association admits that 44 percent of coronary artery bypass surgeries are done for inappropriate reasons.

What is Bypass?
Open heart surgery, or CABG, is one commonly performed method to repair atherosclerotic arteries. It has become the “standard of care” for patients with uncontrolled angina or those at high risk for a first or subsequent myocardial infarction.

They became standard of care after the first successful surgery was performed at the Cleveland Clinic Foundation in 1967. It did not take long for this expensive, high-tech surgery to become a huge business, despite the lack of well-designed clinical trials to prove it.

Such patients are enrolled into surgery by eager surgeons who do not give favorable consideration of the alternatives to surgery to handle their heart disease. Originally the procedure was done on relatively younger and healthier candidates, with a death rate from surgery at 1 to 2 percent.

With older patients being encouraged to have this surgery, mortality rates have increased to 4 to 8 percent in older patients or those who have had a prior CABG operation. Since 2005, according to the American Heart Association, more than 325,000 CABG surgeries are performed on men and at least 145,000 are performed on women each year.

This surgery involves first harvesting the vessel to be used as the graft and then putting the heart on “bypass” so the diseased section of artery can be removed and replaced by the healthy graft. The graft vessel section is taken from the large saphenous vein that runs down the inside of the lower extremity.

Alternatively, the internal thoracic artery (or the internal mammary artery) is another option as a graft. This is located under the chest wall.

During the CABG operation, your heart is temporarily stopped while your body is pumped with warm oxygenated blood from a heart-lung bypass machine. Then the intricate work of replacing the vessel graft is done in about 30 minutes. The entire operation is a two-to four-hour process. Many patients need multiple blockages repaired and therefore undergo multi-vessel bypass.

Since the early 1990s there has also been growing success with the “off-pump bypass” surgery. In this case the heart is stabilized to provide a nearly still area to work on while allowing the heart to beat. This has been found to give better overall results with fewer post-operative complications, yet studies are still not clear on this.

Another problem with this surgical approach is that patients often do little to change their unhealthy lifestyle that promoted the atherosclerosis in the first place. Therefore, many patients return for a second and even third CABG.

Bypass surgery and other expensive and painful procedures can be avoided by taking steps in the healthy direction, and making lifestyle changes that can actually help prolong your life!

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Dr. Cutler’s Nutrition and Recipe Corner

I want to share some healthy and delicious recipes from my kitchen to yours. These recipes can be enjoyable for the whole family to join in making, and can help you on the way to a nutritious lifestyle today! This recipe and more can be found in my monthly advisory newsletter, Easy Health Options™. For more information on Easy Health Options™, visit www.easyhealthoptions.com.

Easy Salad & Dressings

Salad

• 1 lb dry red beans
• 2 quarts water
• 1-1/ 2 cups chopped onion
• 1 cup chopped celery
• 4 bay leaves
• 3 tbsp chopped garlic
• 3 tbsp chopped parsley
• 2 tsp dried thyme, crushed
• 1 tsp salt
• 1 tsp black pepper
• 1 cup chopped sweet green pepper

Tear the lettuce and spinach over large bowl. Add all your ingredients and top with plenty of Italian dressing with extra amounts of olive oil (In place of Italian dressing you can use olive oil mixed with fresh lemon juice, too!)

Here are some other healthy dressings you can use as well:

Lime Dressing

• 1 tsp. minced garlic
• 1/4 cup fresh chopped cilantro
• 1/4 cup lime juice
• 1/4 cup virgin olive oil
• 1/2 tsp. salt*
• 2 shakes hot pepper sauce

Combine ingredients in container and shake.

*Sea salt, Celtic salt or Kosher salt are recommended. Celtic is known for its mineral-rich taste, Kosher contains no additives or preservatives and is mined from underground deposits.

Almond Ranch Dressing—a family favorite!

• 2 cups almond milk
• 3 Tbsp. ranch dressing seasoning mix
• 3 Tbsp. Ultra Gel (or other thickening agent such as cornstarch or cream of tartar)

Combine in container and shake. Let sit five minutes to thicken. Serve. For thicker dressing, add more Ultra Gel.

Cucumber and Dill Dressing

• 1 large cucumber
• 2 Tbsp. lemon juice
• 1 Tbsp. dill
• 1 tsp. minced garlic
• 2 Tbsp. Grade B maple syrup
• 1 tsp. cold pressed oil (olive, flax, grape seed, macadamia nut)
• 1-2 celery stalks, chopped as needed

Peel and remove seeds from cucumber. Blend all ingredients until smooth. Add chopped celery to thicken.

All the best!
Michael Cutler, M.D.