Alan L. Rubin

Cheat Sheet / Updated 02-27-2024

The first step to dealing with high blood pressure is understanding your blood pressure measurement — those over and under numbers. When you know what your blood pressure is, you need to know what to do next. The good news is, you may be able to prevent high blood pressure or reduce your blood pressure by making some lifestyle changes. You also need to look for signs of resistant high blood pressure, and if you need high blood pressure medication, consult a physician to find the right medication for you.

Article / Updated 04-27-2023

The American Diabetes Association (ADA) updates its guidelines for standards of medical care annually. These are the 2022 guidelines for screening: People with symptoms of thirst, frequent urination, and weight loss are tested immediately. Starting at age 35, all people without risk factors should be tested for prediabetes and type 2 diabetes every three years if tests are normal. (The ADA changed this from the previously recommended age of 45.) Women planning to become pregnant should be screened with a fasting glucose test, especially if they have risk factors. People should be tested at a younger age and more often if: They are obese. They have a parent or sibling with diabetes. They are from a high-risk group, such as African American, Hispanic, Asian, or Native American. They have delivered a baby more than 9 pounds or had gestational diabetes. They have high blood pressure. They have low HDL cholesterol or high triglycerides.

Cheat Sheet / Updated 04-18-2023

Diabetes, which is excessive glucose in your blood, leads to serious health problems if left untreated. You should follow the American Diabetes Association screening guidelines to get tested for diabetes at the earliest possible time. If you have diabetes, this Cheat Sheet is a handy reference to screening guidelines, rules for living with diabetes, and continuing your diabetes care to better control the disease.

Cheat Sheet / Updated 04-26-2022

Thyroid problems affect around 30 million people in the United States, says the American Association of Clinical Endocrinologists. If you suffer from a thyroid condition, this Cheat Sheet is here to help you to recognize and manage your symptoms, and avoid the triggers that can cause a flare-up of thyroid problems.

Cheat Sheet / Updated 03-10-2022

Living with type 1 diabetes can be difficult. To verify a diagnosis, a sample of blood is taken and its glucose level is measured. This Cheat Sheet provides a quick reference to the necessary regular doctor's office visits and tests, how to recognize and treat hypoglycemia in children with type 1 diabetes, and what to do if diabetic ketoacidosis strikes.

Step by Step / Updated 04-24-2017

Following a nutritional plan sometimes seems so complicated. But really, if you follow the few simple rules outlined here, you can make the process much easier. None of them cost anything other than time. Doing them one at a time makes a big difference in your calorie and fat intake. Adding one after another makes the results huge. Your weight, blood pressure, and blood glucose all fall. Who could ask for anything more?

Step by Step / Updated 03-09-2017

Children don’t hate vegetables any more than they hate ice cream. It is what you teach them that determines their feelings about food. If you show them that you love vegetables and consider them delicious, that’s how they will feel about vegetables. They love to follow your example. The best time to do this is at family meals. Following are ten of the numerous things you can do to encourage your child to eat vegetables.

Article / Updated 02-07-2017

Ovarian cancer may arise in the ovaries, oval-shaped organs found in pairs in the female reproductive system. Studies suggest that vitamin D plays a role in preventing and treating ovarian carcinoma. In 2009, about 21,550 cases were diagnosed and 14,600 women died of ovarian cancer in the United States. Ovarian cancer is usually a cancer of women older than age 60. Within the ovaries, eggs are produced, along with estrogen and progesterone. The following diagram shows the location of the ovaries. Location of the ovaries and other female reproductive organs. Ovarian cancer risk factors and symptoms Several factors increase the risk for ovarian cancer: Infertility Endometriosis, in which cells of the uterus are found outside the uterus, such as on the ovaries, causing pain and bleeding, especially during menstruation Postmenopausal estrogen supplementation Factors that decrease the risk for ovarian cancer include use of combined estrogen/progesterone oral contraceptives and contraception by tubal ligation (tying off the fallopian tubes). Ovarian cancer is associated with a number of signs and symptoms, but none that are specific to ovarian cancer. Consider the most important: Back pain Bloating Digestive symptoms, including constipation and lack of appetite A feeling of being full early Irregular menstrual cycles Pain in the pelvis or abdomen Swollen abdomen Vaginal bleeding Vague lower abdominal pain Ovarian cancer diagnosis and treatment Ovarian cancer isn’t usually diagnosed in its early stages because it tends to cause symptoms that aren’t specific to the disease. When ovarian cancer is suspected, a pelvic examination and CT scan can diagnose it. A definitive diagnosis requires a biopsy of the mass in the ovary. Treatment of ovarian cancer starts by surgically removing the ovary and fallopian tube. If the cancer has spread, chemotherapy is added to the treatment. Radiation therapy isn’t usually used because the ovaries are located near other vital organs. The prognosis for ovarian cancer is poor because the diagnosis is generally made so late in the disease. Complications that may occur include fluid in the abdomen, intestinal obstruction, and spread to other organs. The five-year survival rate is 45 percent. Vitamin D’s role in ovarian cancer The evidence that a lack of vitamin D plays a role in the occurrence of ovarian cancer is interesting; however, this relationship isn’t secure yet. Evidence that vitamin D plays a role in preventing and treating ovarian carcinoma includes the following: Calcitriol slows the growth and increases apoptosis (death) of cultured ovarian cancer cells. Drugs designed to act like calcitriol inhibit the growth of ovarian cancer in animal models. Results from several smaller studies suggest that higher 25-hydroxyvitamin D levels might be protective against ovarian cancer; however, a recent study that combines several smaller studies shows this may be limited to overweight women.

Article / Updated 02-07-2017

Pancreatic cancer generally has a poor prognosis because of its location in relation to other critical organs. Studies suggest that vitamin D may play an important role in fending off pancreatic cancer. The pancreas has two major functions: Producing hormones, insulin, glucagon, and somatostatin to control the glucose (sugar) in the body Producing enzymes that go into the small intestine and help to break down food into particles that the body can absorb Most of the pancreas lies behind the stomach, as shown in the following diagram. Any tumors that grow can’t be felt until they’re so large that the cancer is very advanced. For this reason, pancreatic cancer has a high mortality rate. About 42,500 new cases occur in the United States every year, and 35,250 deaths occur from pancreatic cancer. The location of the pancreas. Pancreatic cancer risk factors and symptoms Pancreatic cancers usually arise from the tissue that makes the enzymes for the small intestine rather than the tissue that makes the hormones. This cancer is called a “silent killer” because of a lack of early symptoms and nonspecific later symptoms. Other pancreatic cancers arise from the hormone-producing cells of the pancreas, called the islets. These cancers can be silent or they may cause low blood sugar (hypoglycemia) due to an insulin-producing tumor (insulinoma). Pancreatic cancer has many risk factors, some of which can be avoided and others that can’t. The most important are listed here: African American background Diabetes mellitus Excessive red meat in the diet Lack of vegetables and fruits in the diet Family history of pancreatic cancer Male sex Obesity Older age (older than 60) Smoking (responsible for 30 percent of pancreatic cancers) The most common signs and symptoms include the following: Diabetes, as the tumor replaces the tissue that produces insulin Dark urine from jaundice Loss of appetite, with nausea and vomiting Loss of weight Pain in the upper abdomen and back Painless jaundice (yellow eyes and skin) Pancreatic cancer diagnosis and treatment The diagnosis of pancreatic cancer is usually made at a late stage, when a patient complains of pain in the abdomen, has experienced weight loss, and has jaundice. The patient then usually has a computed tomography (CT) scan to find the location of the cancer. If the tumor is still localized to the pancreas, the first line of treatment is surgical removal of the tumor. Next, chemotherapy is given, but this is usually just to give the patient a few more months to live. Because pancreatic cancer is usually diagnosed late and the recovery from the disease is rare, some think that prevention is more feasible than treatment. Up to 30 percent of pancreatic cancer may be prevented by stopping smoking. Vitamin D’s role in pancreatic cancer Some evidence suggests that vitamin D may play an important role in pancreatic cancer. Consider these points: The amount of ultraviolet B irradiation from sun is inversely associated with the occurrence of pancreatic cancer worldwide. Calcitriol and drugs designed to act like calcitriol can slow the growth of pancreatic cancer cells in culture and in animal models. In a few studies, pancreatic cancer risk was higher when vitamin D intake was lower than 150 IU per day. Protection due to vitamin D was maximized when intake was over 300 IU per day. Although these findings are promising, there are a number of studies showing that high blood levels of vitamin D might be harmful! One study pooled the results of seven other studies and found that serum 25-hydroxyvitamin D levels greater than 40 ng/ml [100 nmol/L] doubled pancreatic cancer risk. Another one saw an even higher risk in smokers. It’s studies like these that make some vitamin D experts cautious about blanket recommendations to raise vitamin D intake to high levels. If the cancer-preventing effects of calcitriol are real, it may be that the doses currently recommended for bone health are all that’s needed to achieve them. The evidence for pancreatic cancer is consistent with other studies that show it’s important to avoid becoming vitamin D deficient (serum 25-hydroxyvitamin D levels less than 10 ng/ml [25 nmol/L]).

Article / Updated 02-07-2017

Prostate cancer is the most common cancer in men in the United States. Some scientists think vitamin D may help protect against prostate cancer. Prostate cancer generally occurs in men over the age of 50; however, it is slow growing in most men and takes a lifetime to develop. Prostate cancer has been found in the prostate gland of more than 80 percent of men over the age of 70 who died from an entirely unrelated disease. Some doctors are concerned that the major test for detecting prostate cancer, the prostate specific antigen or PSA test, is overused. Its major weakness is that it not only picks up prostate cancer, but it also detects another prostate condition that isn’t cancer called benign prostatic hypertrophy (BPH). Unfortunately, when men get a positive PSA test, many of them may have had radical prostatectomy (surgical removal of the prostate) and then suffered from problems with erections and urinary incontinence. Dr. Richard Ablin, who developed the PSA test, thinks that prostate cancer is a disease that many men can live with and that can be managed. They’re concerned that the side effects of prostate cancer removal (prostatectomy) aren’t worth it. Prostate cancer risk factors and symptoms Prostate cancer occurs in the prostate gland, a tiny gland that surrounds the urethra, the tube that carries urine and semen through the penis out of the body. The prostate is only 20 grams in size, and its function is to make seminal fluid to carry sperm from the testicles. The following figure shows the location of the prostate gland. The location of the prostate and other male reproductive organs. Prostate cancer is linked to many risk factors beyond gender, including the following: Age: The older you are, the more likely you are to be diagnosed with prostate cancer. Race: African Americans are 60 percent more likely to develop prostate cancer than Caucasians. Family history: Men whose fathers or brothers develop prostate cancer are more likely to develop it. Smoking: This bad habit is probably a risk factor for more aggressive prostate cancer. Most prostate cancers cause no symptoms, but when they’ve grown to become clinically important, they may cause these issues: Pain in the pelvic area Difficulty urinating (this is also seen in the non-cancer condition BPH) Difficulty having an erection Bone pain if the cancer has spread to bone Prostate cancer diagnosis and treatment Prostate cancer is diagnosed with a biopsy of the prostate gland. Finding cancer in the prostate doesn’t mean that the cancer is deadly, however. Because prostate cancer grows very slowly in most men, many men can live long, normal lives with prostate cancer. But for some men it can be a rapidly growing, deadly disease. Treatment of prostate cancer follows several paths: Active surveillance (sometimes called watchful waiting), in which the patient is monitored for symptoms or growth of the tumor but no treatment is performed until clear evidence of danger arises, such as rapid growth or obvious symptoms (the PSA test is useful during this time because it’s already understood that the person has cancer) Surgery, in which the prostate is entirely removed Radiation therapy Cryosurgery (freezing of the tissue, which leads to death of the prostate tissue, including the cancer) Chemotherapy with drugs that kill the cancer Hormone therapy to block the effect of testosterone to stimulate growth of normal and cancerous prostate cells Some combination of these treatments Vitamin D’s role in prostate cancer Although scientists think vitamin D affects prostate cancer, there are more gaps in the evidence. Here is evidence that makes scientists think vitamin D may be protective: The risk of prostate cancer appears to be higher in people who live in places where sunlight is limiting. Interestingly, if you have high sunlight exposure when you’re young, you may be protected from prostate cancer throughout your life, even if you move more north. African American men have the lowest levels of vitamin D in their blood and the highest levels of both prostate cancer and death from prostate cancer in the United States. In men with prostate cancer, PSA levels rise more slowly in the spring and summer, when vitamin D production in skin is normally highest. Calcitriol and drugs designed to function like it reduce the growth of prostate cancer cells and slow the growth of prostate tumors in animal models. Prostate cells can make active vitamin D from 25-hydroxyvitamin D. These studies suggest that higher intakes of vitamin D could protect men from prostate cancer. Unfortunately, when researchers have looked for a relationship between serum 25-hydroxyvitamin D and the risk of prostate cancer, the results have been confusing. Some studies show that near deficient levels of vitamin D status increase prostate cancer risk, some show that serum 25-hydroxyvitamin D levels don’t relate at all to prostate cancer risk, and others show that high serum 25-hydroxyvitamin D levels may lead to higher levels of prostate cancer.