Dr. Joe Galati's Blog

Hepatitis C Update: A Video Blog Entry

The AASLD has released "Diagnosis, Management, and Treatment of Hepatitis C: An Update, in the April 2009 edition of the journal Heptology. It can be downloaded here:  Download HCV Updates

I have for you a brief video of some of the highlights of the article, though due to the exhaustive nature of the article, it is best to download and read yourself when you have an hour. It covers just about every aspect of hepatitis C, and will serve as the foundation for management in the years to come.

Click here for video blog: Download AASLD Update 2009

Cancer of the Esophagus Linked to Drinking Hot Tea

Here is a new report published in the British Medical Journal regarding the link between drinking very hot tea and the developemnt of cancer of the esophagus. A video report is presented below.

http://www.medpagetoday.com/Medpage-Player/13453/

Hepatitis C and India

A recent report states that every 15th carrier of the Hepatitis C virus (HCV) is an Indian and 12.5 million Indians suffer from HCV, with the death rate exceeding over 100,000 per year, a doctor's conference here was told. This clearly is a large public health concern, considering the number of immigrants from India moving to the Unites States.

Proximity to Food and Obesity: Guest Blog by Chuck Garcia

The New York Times reported today a study by the University of California at Berkley which has interest to all those fighting the obesity war.  They concluded that if fast food outlets are within a block of high school freshman, those students are more likely to be obese than students who have to walk farther to buy a greasy cheeseburger and French fries.  The study was quite an effort by economists (who study people’s behaviors in addition to the economy) to determine what role proximity to fast food outlets contributes to obesity.   

Vaccine Schedule for 2009

Most adults have the idea that vaccines are just for kids. Wrong! There are a number of vaccines that adults need, and some new ones that are now available, such as the Shingles (Herpes Zoster) vaccine. Listed below is a great pdf file outlining the vaccine schedule you all need to follow. Download it and show it to your family physician, internist, or gynecologist (if that's who provides your well women care).  Download 2009 Vaccine Schedule now.

For those with liver disease, vaccination for hepatitis A and hepatitis B are required. The last thing someone with any sort of liver condition needs is an acute bout of hepatitis A or B. It could be deadly. The vaccines are safe and effective.

The article is listed below for on-line reading.

A Shame: No Beets in the White House

Chuck Garcia posts another guest colums.

 

In yesterday’s health section of the New York Times, they reported that the White House garden will be planting 55 varieties of vegetables.  Sadly, there will be no beets.  President Obama doesn’t like them.  This news has triggered a whole wave of bloggers intent on trying to spread the word that the President is missing out. 

The Obesity War: Gaining Mainstream Media Momentum

Here is another post from Chuck Garcia-Guest Blogger.

 

Recognizing that 2/3 of the American public is overweight, what a pleasure to see yesterday’s cover of the Sunday New York Times Business Section (March 23).  The article poses a very daunting question:  “Is a Food Revolution Now in Season?”  I pose to our readers another question, “Can we win the war on obesity without a revolution?”  Not likely. 

Alcohol and Cancer: A Podcast

There is growing research pointing towards alcohol intake and cancer-especially in women. The recommended allowance daily is one alcoholic beverage for women, and two for men. Download Alcohol cancer .

A look at data for over 1 million women in the UK indicates that drinking alcohol -- even low amounts -- increases the risk of certain cancers in women.

According to the data released today, about 13 percent of the cancers of the breast, liver, rectum, and upper respiratory/gastrointestinal system may be related to alcohol use.

In their analysis of 1,280,296 middle-aged women from the so-called Million Women Study, Dr. Naomi E. Allen and colleagues from the University of Oxford found that 24 percent of participants reported no alcohol consumption. Women in the study who did drink alcohol consumed, on average, one drink per day. Very few drank three or more drinks per day.

During an average follow-up time of more than 7 years, 68,775 women were diagnosed with cancer.  Read more.

Colon Cancer Awareness

March is colon cancer awareness month. Dr. Howard Monsour joined my for a brief discussion of colon cancer screening strategies. Download the audio segment and listen along. Download Colon cancer segment .

Here are some basic facts on colon cancer from the American Cancer Society:

In most people, colorectal cancers develop slowly over a period of several years. Before a cancer develops, a growth of tissue or tumor usually begins as a non-cancerous polyp on the inner lining of the colon or rectum. A tumor is abnormal tissue and can be benign (not cancer) or malignant (cancer). A polyp is a benign, non-cancerous tumor. Some polyps can change into cancer, but not all do. The chance of changing into a cancer depends upon the kind of polyp:

• Adenomatous polyps (adenomas) are polyps that have the potential to change into cancer. Because of this, adenomas are called a pre-cancerous condition.
• Hyperplastic polyps and inflammatory polyps, in general, are not pre-cancerous. But some doctors think that some hyperplastic polyps can become pre-cancerous or might be a sign of having a greater risk of developing adenomas and cancer, particularly when these polyps grow in the ascending colon.

Another kind of pre-cancerous condition is called dysplasia. Dysplasia is an area in the lining of the colon or rectum where the cells look abnormal (but not like true cancer cells) when viewed under a microscope. These cells have the potential to change into cancer over time. This is usually seen in people who have had diseases such as ulcerative colitis or Crohns disease for many years. Both ulcerative colitis and Crohns disease cause chronic inflammation of the colon.

Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. The American Cancer Society estimates that about 108,070 new cases of colon cancer (53,760 in men and 54,310 in women) and 40,740 new cases of rectal cancer (23,490 in men and 17,250 in women) will be diagnosed in 2008.

Overall, the lifetime risk for developing colorectal cancer is about 1 in 19 (5.4%). This risk is slightly higher in men than in women. A number of other factors (described in the section, "Risk factors for colorectal cancer") may also affect a person's risk.

Colorectal cancer is the third leading cause of cancer-related deaths in the United States when men and women are considered seperately, and the second leading cause when both sexes are combined. It is expected to cause about 49,960 deaths (24,260 men and 25,700 women) during 2008.

The death rate (the number of deaths per 100,000 people per year) from colorectal cancer has been dropping for more than 20 years. There are a number of likely reasons for this. One is that polyps are being found by screening and removed before they can develop into cancers. Screening is also allowing more colorectal cancers to be found earlier, when the disease is easier to cure. In addition, treatment for colorectal cancer has improved over the last several years. As a result, there are now more than 1 million survivors of colorectal cancer in the United States.

One of the most powerful weapons in preventing colorectal cancer is regular colorectal cancer screening or testing. Regular colorectal cancer screening can, in many cases, prevent colorectal cancer altogether. This is because most colorectal cancers start as polyps, which are non-cancerous growths in the lining of the colon or rectum. From the time the first abnormal cells start to grow, it usually takes about 10 to 15 years for them to develop into colorectal cancer. Testing often finds these polyps, and allows them to be removed before they have the chance to turn into cancer. Screening can also result in finding colorectal cancer early, when it is highly curable.

There are several tests used to screen for colorectal cancer in those with an average risk of colorectal cancer. Ask your doctor which tests are available where you live and which option is best for you. People who have no identified risk factors (other than age) should begin regular screening at age 50. Those who have a family history or other risk factors for colorectal polyps or cancer (see below) should talk with their doctor about starting screening at a younger age and/or getting screened at more frequent intervals.

Carbohydrates and Diet: Chuck Garcia - Guest Column

It’s high time we stop vilifying this word and start thinking differently.  Not all carbohydrates are created equal.  Why all the fuss?  If you are overweight, don’t blame it on carbohydratess.  Carb is not a dirty word and didn’t cause your problem.  It is the junk you chose to eat that caused the problem.  Carbohydrates are simply the form that junk food tends to appear on the supermarket shelf. 

Even though carbohydrates have been demonized, much is misunderstood about this basic nutrient.  Along with water, protein, and fats, it is a basic building block of a proper nutrition plan (notice I didn’t use the word DIET…more on that on subsequent postings).

Carbs have a required place at the dinner table, if only we knew which ones?

It’s simple.  Take your thoughts back to the definition of God Food versus Man Food.  Unfortunately, a great deal of Man Food is comprised of carbohydrates, thus giving the word a bad name!  However, what if carbs were found in God Food?  Would you still consider them to be in the axis of evil?   No way!  In spite of all the fuss about a “no carb diet,” a “low carb diet” and all the other nutty weight loss methods, keep this in mind:

Carbohydrates are found almost exclusively in plant foods, such as fruits, vegetables, peas, and beans.  Milk (and milk products) is the only food derived from animals that contain a significant amount of carbohydrates. 

Here’s the rub about this topic.  Man Food (i.e. Junk that we eat) is predominantly composed of carbohydrates.  Those foods are not bad just because they are laced with carbs, they are bad because they contain lots of calories with no nutritional value.  To the contrary, an apple or orange contains calories that are loaded with carbohydrates as well…the difference is they transport necessary vitamins and minerals needed to sustain good health.  Junk food delivers none of that.   That does not mean you can eat an unlimited supply of fruit simply because it comes from God.  A quick lesson:

Carbohydrates are divided into two groups – simple and complex.  Simple, sometimes called simple sugars, include fructose (fruit sugar), sucrose (table sugar) and lactose (milk sugar) as well as several other forms of sugar.  Fruits are loaded with simple sugars.  Complex, on the other hand, include fiber and starches (think oatmeal and whole grain bread).   Stay tuned for a future posting that explains why we should not eat an unlimited supply of carbs. 

When choosing carbohydrates-rich food, stay away from the refined carbs that constitute junk that has been processed such as soda, candy, etc.  We are not designed to ingest junk.  Instead, if you think of eating only carbs that come from the Earth (fruit, vegetables, beans) you will come to understand that CARB is not a 4 letter word. 

Stay focused on God Food.  Stay off the junk.  Your health will improve dramatically not with the elimination of CARBS, but with the elimination of JUNK. 

New Hepatitis C Drug Disappointing

For those of us on the front line treating heaptitis C, the hope of new therapies that will provide our patients a better response rate is our dream. With the current FDA approved therapies, we are seeing a 45-55% response rate, with some slight variation based on race, genotype of the virus, and liver damage noted on liver biopsy.

Protesase inhibitors, a new class of antivirals for hepatitis C, are currently being investigated (including at our site), and the initial results are very impressive.

Unfortunately, and new compound, manufactured by Human Genome Sciences, Albuferon, was no better in response rate when compared to standard FDA approved therapies we already have.

Human Genome Sciences' (HGSI.O) drug to treat chronic hepatitis C met the main goal in a late-stage trial, but failed to show numerically better efficacy compared to standard-of-care, raising questions about the drug's adoption and sending shares crashing to an all-time low.

Analysts had expected the trial to meet its main goal of non-inferiority compared to Pegasys, but they had also said that the trial must show numerically better sustained virologic response (SVR) rates to convince the market of the drug's commercial viability.

In the trial, named ACHIEVE 1, patients were either given the drug Albuferon every two weeks or standard-of-care Pegasys once weekly and the company said the rate of SVR among the two groups "was comparable."

"This means that you have a drug that is statistically comparable but for the vast majority of prescribers who have used Pegasys for ever, they are not going to change their prescribing trends based on this data," said Piper Jaffray analyst Edward Tenthoff.

The current standard of care for hepatitis C is antiviral ribavirin in combination with an interferon. Human Genome's Albuferon, which is a type of interferon, was also being studied in combination with ribavirin. Read more

For now, it's back to the drawing board. There are indeed new therapies that will improve upon the current drugs we have available. Stay tuned...help is on the way.

Thoughts on Weekend Meals: Chuck Garcia

Overfed and Undernourished: 
Thoughts for your weekend meals shopping spree

  The multi million dollar food processing companies would like to keep you overfed and undernourished. It’s good for business.  They love to doll out words on their packaging advertising “vitamin fortified” “low fat” “lite” blah, blah, blah.  Unfortunately, those foods that are packaged and sitting on the shelves have been stripped on any nutritional value.  In spite of their clever packaging, you are ingesting empty calories that go directly to expanding the size of your waistline.  You will be eating Man food that is not fortified with anything but chemicals and preservatives. 

Take a look at the ingredients in the package.  If you can’t pronounce the ingredients, don’t buy it.  Think about the implications of eating chemicals.  Would you knowingly eat chemically fortified food?  Is it any wonder our society’s rate of heart disease, diabetes and cancer continue to grow? 

What to do?  In prior entries I articulated the philosophy to eat only food that comes from the earth and ignore all the packaged goods that come in a box or a bag.  Though I will continue the educational series on the power of proteins, carbohydrates, and essential fatty acids in subsequent entries, I am providing some counsel on what to stock when you go to the supermarket this weekend.

There are up to 50 aisles in the large mega-supermarkets.  You will ignore most of them and spend time only on the periphery.  Notice when you walk in on the extremes of the store you will enter aisles for fruits and vegetables (God food).  As you traverse the rear of the store you will see beef, fish, and other fresh protein sources.  If it walked on a farm or swam in the lake or ocean, eat it and enjoy! 

All other aisles with food product (Man food) will be out of bounds…off limits!  Short of cleaning products and whole grain bread, every item in that shopping cart should have come from the side and back aisles.  Why?  Because it is food!  Anything from the aisles in between is produced in a factory and is junk food.  Do you want to eat food that comes from a farm or that has been processed in the factory?  It’s up to you!

On yourhealthfirst.com there is a tab for 15 Super foods for super health.  What do they all have in common???  They are God food naturally fortified with the vitamins and minerals you need to sustain good health.   Take your pick from the list and find a combination of fruits, vegetables, proteins and essential fats (flaxseed) that will make it to the dinner table this weekend. 

Guest Column: Chuck Garcia

Why the urgency?

“Let food by thy medicine, medicine by thy food.”  Hippocrates

Consider this on the obesity crisis:

• Two-thirds of American adults are overweight
• Close to 30 percent of

  U.S.

  children are overweight
• Childhood obesity has doubled in the past 20 years
• Childhood diabetes has increased dramatically over the years.

These statistics reflect a very dangerous situation.  It’s not difficult to see what is going on here:  People made absolutely terrible eating choices over a very long time.  How did we get we get here? 

We ate our way into this crisis!   How do we solve it?  We need to eat our way out of it!  

Poor eating habits and a sedentary lifestyle increase the risks of heart disease, diabetes, and cancer.  In short, eating poorly compromises your immune system.   Our terrible habits, which led to these startling statistics, are the result of a compromised immune system.  It doesn’t have to be that way.  To put this into perspective, consider that God gave us an immune system and all of nature’s bounty (God Food) to support it.  However, it’s important to understand a bit about this system and how we can help overcome this daunting and scary obesity crisis. 

The immune system we are born with is a marvelous machine.  Like many other machines, we take it for granted every time we put a piece of Man food into our bodies.  The bodies (like our cars, houses, etc) begin to break down when not properly cared for.  When you combine fast food, drug dependencies, air pollution, and stress, these are all factors that work against the body’s natural ability to stave off sickness and disease. 

However, nature intended us to fight maladies by fueling our inner healing self with the right natural substances to ensure our internal systems work up to their potential.  The way you fuel your body is up to you.  You can fuel it with junk (and work against your own immune system), or you can fuel yourself with God Food; nature’s intended fuel. 

What does that fuel consist of?

1.    Water

2.    Proteins

3.    Carbohydrates

4.    Essential Fats

5.    Vitamins and Minerals

For now, I’ll focus on number 1, water:  I’ll comment on the other elements in subsequent entries.  Trying to explain it all in one shot is counterproductive.  Like overeating, you can only digest so much at one time.  Today’s lesson then:  Stop drinking soda, juice, Red Bull, etc.  Start drinking water only!  Why?

The human body is 2/3 water.  Water is an essential nutrient that is involved in every single system of your body.  If nothing else, it transports nutrients and waste products in and out of our cells.  It is necessary for all digestive, absorption, circulatory, and excretory functions.   It sounds so simple, yet you are buying diet soda and all kinds of other beverage concoctions at the convenience store.  STOP! 

What will you do today to change your eating habits and improve your immune system?

Drink water.  Several glasses a day!  No more beverages that come from a factory.  Ignore diet soda, fruit juice (artificially sweetened), and anything else that isn’t H2O.  Start now, don’t delay.  It took you a while to become overweight, it can take a while to lose that weight and achieve optimal fitness.  Keep the sugar, chemicals, and any other processed component out of your body!  Water is a gift from God, soda is man made.  Are you beginning to understand the distinction between God and man food???

While I am calling for urgency in fighting this crisis, you don’t have to make huge dietary changes at all once.  Sustaining change tends to work better through evolution rather than revolution.  My objective is to help you with a plan to gradually get on the path to good health through better dietary choices. 

In subsequent blogs I will expand on the macronutrients (protein, carbohydrates, fats) as well as the micronutrients (vitamins/minerals) and help you to start changing your eating habits a little bit at a time.  Before you know it, you’ll have evolved into a completely different kind of eater.  You will notice improve health through a stronger immune system.  All of that can be accomplished through eating right.  Stay tuned for more. 

Guest Column: Chuck Garcia and "God Food"

GOD FOOD

Chuck Garcia

Welcome to the first entry of GOD FOOD.  I chose this title because no matter what God you may believe in, he/she intended us to eat food that was present on Day 1.  When the world was born, there were no food processing plants that could turn corn into corn starch.  Who knew how much we would abuse that concept in the 20^th century?  Our creator intended us to eat and drink what was readily available from our planet.  As I have stated many times on Dr. Galati’s radio show, let’s break what we eat and drink into 2 camps:

1.     God Food:  Food that comes from the earth.  What we consume is in its raw form, with no notion of processing or refining any of it.  Example:  Vegetables and fruit.  

2.     Man Food:  It is a misnomer to call it food.  It should be called food product, only because food product is actually based on something that was once God food.  Consider that potato chips actually originated from potatoes…go figure!!  By the time the potato is sent to the food processing plant, stripped of its nutrients, loaded with preservatives and artificial flavors, put inside a bag and sealed, only to sit on a supermarket shelf for months, how is that food???  It’s food product.  It has no nutrients and is laced with chemical additives.  Have you read the ingredients?  It should scare you when you consider what is about to pass into your digestive system! 

Bottom line:  The only food you should eat either grows out of the ground or has a mother (beef, chicken, fish…you get it).  Man Food is off limits and should be put into the Axis of Evil. 

I have been a health enthusiast my entire adult life.  I hope that my passion for good health leads others to think about the importance of nutrition and how taken for granted our dietary habits have become…leading to a terrible obesity crisis in this country.   I firmly believe that a path to sound nutrition (we seem to have lost the concept of nutrition) will lead our population to happier, healthier lives. 

Given my enthusiasm for achieving excellent health, I have the good fortune of being able to help many people who are totally stressed out and confused when trying to answer a simple question, “What should I eat?”  Given how confounding that question has become, I have concluded that when it comes to this subject, people are looking to me and other health professionals like Dr. Galati for two things:

1.     Advice

2.     Inspiration.  People ask me all the time, “How do I stay focused on God Food given the numerous temptations to eat Man Food?  Staying focused comes with being inspired!

Going forward, I will provide both advice and inspiration (God willing).  My goal is to inform, educate, inspire, and, maybe, just maybe entertain.  We need some comic relief to help keep us stay focused and to remind ourselves that this should not be a chore.  Eating right should be fun, pleasurable, and worth sharing with your friends. 

For those of you who don’t know me, I am not a physician or a trained nutritionist.  I am a regular guy, married, with 4 children and have worked in skyscrapers in  New York City for 25+ years.  I was a very fat kid and know what it is like to struggle with food choices.  I left that fat kid in the dust years ago and made up my mind that I would never look back.

I have learned a great deal about health and nutrition over the years and can relate to you in what I hope are very pragmatic, concrete examples of how to attain good health.  It’s up to you!  You are in charge on your health.  With advice and inspiration, you can achieve great health! 

I dedicate myself to fighting the obesity crisis and hope my enthusiasm is contagious.  I will post this blog with many different entries in response to the nutritional challenges we face every day.  Thank you for taking the time to share this journey with me.  I welcome you to the initiation of GOD FOOD and look forward to your comments. 

All the best,

Chuck 

Hepatitis C and Coffee? Make it a Latte.

Over the years, a lot has been written about the potential health benefits of drinking coffee. Recently, there was a study published showing that women who consume two to three cups of coffee a day have a significant drop in the incidence of stroke.

 

At last year’s annual meeting for the American Association for the Study of Liver Diseases, a paper was presented showing that coffee intake is linked to lower risk of hepatitis C related liver disease progression. Moderate coffee consumption may help slow the progression of liver disease related to hepatitis C according to an observational study.

Among patients with established liver disease who drank at least three cups of coffee daily, had a 50% lower progression over three and a half years according to Dr. Neal Freedman, Ph.D., from the National Cancer Institute. His research is consistent with prior studies showing that coffee intake decreased the liver enzymes with an associated risk of cirrhosis and progression of liver disease. There is also some suggestion that hepatocellular carcinoma is also reduced. The exact reason why coffeeintake is associated with less progression of liver disease is unclear. Is it the actual coffee or some habit that coffee drinkers participate in that actually causes the decreased risk of liver progression. 

In reviewing the cases, the investigators found that coffee intake was associated with a decrease in ascites, death, hepatic encephalopathy, spontaneous bacterial peritonitis, variceal bleeding, and a decrease in the progression of the fibrosis noted on baseline liver biopsy. It is interesting to note that drinking tea had no influence on liver progression.

What is a patient to do? Well, it appears if you have chronic liver disease coffee may be helpful but certainly there does not appear to be any downside to consuming coffee. It iswell known that coffee is an antioxidant, and this may be the ultimate beneficial effect. 

For many Americans, coffee intake is the number one source of antioxidants in their diet. Until further research is conducted, I would say it would be fine to continue to have your morning cup or two of coffee. In addition to coffee, it is clear that a diet free of alcohol certainly is protective as well.

Your Health and Natural Disasters

Here on the Gulf Coast, we are in the midst of the hurricane season, and with every impending storm, I have been asked to comment on how you need to prepare for such acts of nature. Protecting the personal safety of you and your family is the topic of great discussion during this time. Here are a few points to remember.

Regarding medications, you should always have a least 5-7 days of extra supply of your required medications. These include needed over the counter medications. Make sure you have a list of both the name and dose of the prescriptions you take, and if possible, a copy of the prescription. Your pharmacy should be able to supply this for you. In case you need to relocate temporarily, having the proper information will allow you to get the necessary refills, and avoid gaps in therapy. Critical medications such as diabetic medications, high blood pressure therapy, and medications to control psychiatric problems are especially critical.

Making sure you have enough safe water should also be a priority in planning. The Centers for Disease Control make the following recommendations:

If the water is clear

• Add 1/8 teaspoon of household liquid bleach to 1 gallon of water. Use bleach that does not have an added scent (like lemon).

• Wait 30 minutes or more before drinking.

If the water is cloudy

• Add 1/4 teaspoon of household liquid bleach to 1 gallon of water. Use bleach that does not have an added scent (like lemon).

• Wait 30 minutes or more before drinking.

Clean the inside of things that hold water (like cans, jars, bottles, glasses).

• Use 1 teaspoon of household liquid bleach in

1 cup of water. Use bleach that does not have an added scent (like lemon).

• Pour in.

• Shake.

– Let soak for 30 minutes.

– Rinse with clean water.

Never mix bleach with ammonia or other cleaners. Open windows and doors to get fresh air when you use bleach. 

a

More Bad News on Fatty Liver in Kids

Once again, fatty liver disease is in the news, and again, it's about kids. A recent post I had discussed fatty liver disease and the obesity epidemic we are facing in kids. A new article posted yesterday repeats the concern-our kids will die of liver failure if we don't wake up and face this problem now.

"In a new and disturbing twist on the obesity epidemic, some overweight teenagers have severe liver damage caused by too much body fat, and a handful have needed liver transplants.

Many more may need a new liver by their 30s or 40s, say experts warning that pediatricians need to be more vigilant. The condition, which can lead to cirrhosis and liver failure or liver cancer, is being seen in kids in the United States, Europe, Australia and even some developing countries, according to a surge of recent medical studies and doctors interviewed by The Associated Press.

The American Liver Foundation and other experts estimate 2 percent to 5 percent of American children over age 5, nearly all of them obese or overweight, have the condition, called nonalcoholic fatty liver disease.

"It's clearly the most common cause of liver disease," said Dr. Ronald Sokol, head of public policy at the liver foundation and a liver specialist at Children's Hospital and University of Colorado Denver.

Some experts think as many as 10 percent of all children and half of those who are obese may suffer from it, but note that few are given the simple blood test that can signal its presence. A biopsy is the only sure way to diagnose this disease."   Read the full article

For both adults and children, obesity needs to be curbed. The thought of our children having a shorter life expectancy than their parents is child abuse.

Listen here for a recent KTRH interview I did with JP and Lana during the Morning News.

 

 

Coney Island, Brooklyn, New York

On the list of 1000 places to visit before you die, I wonder if they considered Coney Island, located in Brooklyn, New York.  A photo album of Coney Island I took from 2006 is available here.  A blog featuring Coney Island is available as well. Share your Coney Island memories for those who have experienced this one of a kind location.

A Misunderstood Point About Chronic Hepatitis C

Hepatitis C is a chronic infection. Once exposed through the usual risk factors, there is a better than 85% chance the virus will stick with you, avoiding clearance by the immune system. That's it.

As a reminder, the Centers for Disease Control list the risk factors for hepatitis C:

Who is at risk for hepatitis C?

Some people are at increased risk for hepatitis C, including

• Current injection drug users (currently the most common way hepatitis C virus is spread in the United States)
• Past injection drug users, including those who injected only one time or many years ago
• Recipients of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
• People who received a blood product for clotting problems made before 1987
• Hemodialysis patients or persons who spent many years on dialysis for kidney failure
• People who received body piercing or tattoos done with non-sterile instruments
• People with known exposures to the hepatitis C virus, such as
  • Healthcare workers injured by needlesticks
  • Recipients of blood or organs from a donor who tested positive for the hepatitis C virus
• HIV-infected persons
• Children born to mothers infected with the hepatitis C virus

Less common risks include:

• Having sexual contact with a person who is infected with the hepatitis C virus
• Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person

The misunderstood part is that there is the belief that those newly diagnosed with chronic hepatitis C have been infected recently, but in reality, the vast majority of the patients were exposed the better part of 20 years. Experimentation with IV drugs and blood transfusions are the two major risk factors I see on a daily basis. For all of these years, they have had hepatitis C. The test for hepatitis C is not always part of routine screening. In other words, if it is not specifically requested, it will not be done by your family physician during your annual exam. If you don't look, you won't see it. That simple.

It's incredibally difficult for patients to comprehend how they "could have this for all these years" and not know about it. For many, they are free of symptoms and enjoying life.

Take home message: most patients with HCV have had it for many years. If you have any of the risk factors you must ask to be tested. Amen.

Fatty Liver in Children: Another Growing Health Concern

A recent article in the journal Hepatologydiscussed Non-Alcoholic Fatty Liver Disease (NAFLD) in children, and addressed the role of lifestyle modifications in correcting this serious public health threat we are now facing. The article in full can be read here.

Obesity is a national emergency. While adult obesity has been on the radar screen for more than a decade now, childhood obesity is now a problem on its own. Let's do the math on this. Obese adults are prone to developing "adult onset" diabetes, usually after the age of 50. This will lead to complications related to increased cardiovascular mortality, as well as renal failure, nerve problems, and blindness. The cost of all this in adults is in the billions of dollars yearly.

Now we are seeing children develop these very diseases their parents or grandparents develop-at age 15. These children will develop premature heart disease, and all of the problems mentioned above, decades earlier. I cannot even begin to dream of what this will cost. If you are upset with the cost of the war in Iraq, buckle in for the price tag to pay for this. I am still looking for the protesters demanding the immediate pullout of excessive calories and fatout of the menus of chain restaurants across America.

The good news in this article is that lifestyle modifications do help reduce some of the obesity related liver issues that arise in NAFLD.