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Bonnie Modugno, MS, RD

Nutrition Consultant, Author, Speaker
Bridging the Gap Between Knowledge and Behavior

530 Wilshire Blvd Suite 310
Santa Monica, CA 90401
(ph) 310-395-4822 (fax) 310-917-2274
(email) bonnie@muchmorethanfood.com
You are here: Home / Archives for skin cancer

What Happens When I Health Screen Myself

October 18, 2011 by

I am a Kaiser patient, now for over 20 years. I like my physician but often get tired of navigating the system. It feels like swimming upstream. The system is designed to provide the maximum range of health care to meet the median need. I’m sure it is far more cost effective than most health care models. I don’t like feeling like another peg in a hole.

I opened email today to learn of a new digital health screening tool and linked education resources offered through Kaiser. Before I could stop rolling my eyes, I decided to fill out the initial questionnaire. I wanted to see what questions they are asking. I wanted to find out what they would recommend for me.

THE REPORT
With 17 pages of feedback, I find that I ranked 84, very good but not excellent. I’m taken aback, but already know a few of the issues. I just happen to view things differently. What was recommended? Here’s the short list.

1. Lose weight

2. Decrease cholesterol and LDL cholesterol levels

3. Get counseling for my depressive symptoms

4. Decide if I want my skin to be safe from the sun

On every other issue I received a bright green check mark and a hearty “Good job!” I exercise regularly, sleep adequately, and manage stress pretty well.

I eat a healthy diet. I drive safe, I have been faithful for 27 years with the same man and I am up to date with my pap smear, mammography, colonoscopy and immunizations.

BUT I DISAGREE

Too bad the screening tool is not sophisticated enough for a patient to address why digital counselor’s recommendations are off the mark. My number one complaint is that the tool doesn’t offer any place for the patient to explain their position.

The assumption is that anything other than willingness to go along with the algorithmic recommendations indicates someone who is not motivated to take care of their health.

Why does a tool that is supposed to help makes so many assumptions that feel paternalistic and patronizing?

Up next–my responses to each of the recommendations.

Filed Under: Blog Tagged With: cholesterol, health, health screening, healthcare, Kaiser, LDL cholesterol, skin cancer, stress, sun, sunscreen, therapy, weight

Kaiser Recommends: Take Better Care of Your Skin

October 18, 2011 by

I recently completed a health questionnaire on the Kaiser website. Here is the 5th of 5 blogs on the findings.

Kaiser’s last recommendation is only mildly irritating. Directives to lose weight, lower cholesterol and get counseling struck far more sensitive nerves. The issue of sun exposure is challenging because the recommendations don’t really address the full scope of the issues regarding vitamin D.

VITAMIN D and IMMUNE FUNCTION

It seems risk of skin cancer is Kaiser’s primary concern. The risk is real and I appreciate the warning. At the same time, my vitamin D status is low and the there are far scarier risks associated with inadequate vitamin D status.

The immune system is intensely compromised when Vitamin D status is insufficient. I first learned this years ago at a seminar sponsored by D-Action , a grassroots coalition of scientists and clinicians looking to address a global epidemic of inadequate vitamin D status. Soon I learned the benefits of enough Vitamin D for myself.

Last winter I bumped my vitamin D supplements up to 5000 IU per day. I was taking 2000 IU per day for over a year and watched my vitamin D status barely budge. Since I bumped up the dose I have not been sick in any significant way. This is a significant turn of events.

WISHING FOR JUST A COLD

Over my lifetime I have been incredibly vulnerable to every cold, sniffle and cough. I could feel bronchitis settling in my chest within days. I always chalked it up to a childhood of allergies and asthma bad enough to keep me home up to 2 months during any one school year.

Thankfully I grew out of the allergies and asthma, but I can still get really sick. I have lamented for years that I can never just catch a cold. I always end up with some kind of secondary bacterial infection. After suffering for weeks, I finally get a prescription and feel relief in hours.

Last winter I finally had just a cold–barely. I felt a dry cough and it was gone in less than two days. A couple of cups of tea, a nap or two plus getting to bed earlier than usual was all it took. Unbelievable.

VITAMIN D AND RISK OF DISEASE

The benefits of adequate Vitamin D attract plenty of attention today. When I studied nutrition 30 years ago the research drew a big yawn. I learned about Vitamin D as one of four sleepy fat soluble vitamins. Vitamin D was supplemented in milk to prevent rickets. Warnings alerted everyone to the risks of an overdose. There was little other attention. Today we realize Vitamin D is more of a hormone than a vitamin.

A review of Vitamin D status and risk of disease by Holick and Grant summaries the benefits of adequate vitamin D. Vitamin D receptors are found on most tissues in the body. The range of impact is significant, from diabetes, cancer and heart disease to multiple sclerosis and more.

Studies list a range of maladies that are associated with vitamin D deficiency and insufficiency. Work by Garland and associates identifies an inverse relationship between vitamin D status and other cancers. This means the lower the Vitamin D status, the higher the risk for both breast and colon cancer.

Despite this insight, health warnings about sun exposure are everywhere. Kaiser’s directive to start taking care of my skin is case in point. Ironically scientists studying vitamin D insufficiency point to use of sunblock as a primary factor increasing vitamin D insufficiency and deficiency.

WHAT ABOUT THE SUN

Ten minutes of unprotected sun exposure is enough time to produce more than adequate active Vitamin D as long as the right UVB rays are available.

In Southern California that means between March and October when solar UVB 290-315 rays reach our skin. During the other months of the year, there is no conversion. We don’t access the appropriate UVB rays when we are tilted away from the sun no matter how much sun exposure.

I knew I always felt healthier, stronger, leaner during the summer months growing up. I certainly wonder if Vitamin D was the unknown factor.

While I don’t need to worship the sun as I did during my youth, I hope Kaiser can figure out that modest unprotected exposure to the sun is worthwhile. A recent editorial in British Medical Journal sums up my position best:

Dermatologists should soften their stance on sun exposure. 5-10 minutes of daily sun exposure is considered a judicious dose of sun rays for vitamin D production.

Filed Under: Blog Tagged With: breast cancer, bronchitis, cold, colon cancer, D Action, Garland, Holick, immune function, Kaiser, multiple sclerosis, rickets, skin cancer, sun, sun block, vitamin D

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