Should You Get an Annual Health Check-Up?

What are the risks and benefits of getting an annual check-up from your doctor?

Physicians and patients have come to expect the annual check-up as a routine part of care. “However, considerable research has not demonstrated a substantial benefit,” so a “revolt is brewing against the tradition of periodic” check-ups. “Even the Society for General Internal Medicine advised primary care physicians to avoid ‘routine general health checks for asymptomatic adults.’”

As I discuss in my video Is It Worth Getting Annual Health Check-Ups?, routine check-ups do seem to make sense. But, historically, medical practice has included all sorts of interventions that seemed to make sense, such as hormone replacement therapy for menopause—that is, until it was put to the test and found to increase risks of breast cancer, blood clots, heart disease, and stroke. “History repeatedly shows that good intentions and ‘common sense’ kill in the name of prevention (for example, prone sleeping recommendation for infants).” Indeed, doctors killed babies by making the so-called common sense recommendation that infants sleep on their tummies, whereas we now know “Face Up to Wake Up.” “We should always demand evidence rather than succumb to delusion.”

“We check our cars regularly, so why shouldn’t we also check our bodies…?” Well, unlike cars, our bodies have self-healing properties. To see if the benefits outweigh the harms, researchers decided to put it to the test.

“What are the benefits and harms of general health checks for adult populations?” The bottom line is that check-ups were “not associated with lower rates of all-cause mortality, mortality from cardiovascular disease, or mortality from cancer,” meaning they weren’t associated with living longer or a lower risk of dying from heart disease, stroke, or cancer. So, general check-ups may not reduce disease rates or death rates, but they do increase the number of new diagnoses. And, the “[h]armful effects of some tests and subsequent treatment could have balanced out possible beneficial effects of others.”

Possible harms from check-ups include “overdiagnosis, overtreatment, distress or injury from invasive follow-up tests, distress due to false positive test results, false reassurance due to false negative test results, possible continuation of adverse health behaviours due to negative test results, adverse psychosocial effects due to labelling, and difficulties with getting insurance” (now that you have a pre-existing condition), not to mention all of the associated costs. 

Take diabetes, for example. Wouldn’t it be great if we detected cases of diabetes earlier? Perhaps not, if you were one of the people given Avandia, the number one diabetes drug that was then pulled off the market because instead of helping people, it appeared to be killing them. Adverse drug events are now one of our leading causes of death. When it comes to lifestyle diseases like type 2 diabetes, maybe we should focus instead on creating healthier food environments. This is what one of my favorite organizations, Balanced, does to help prevent the diabetes epidemic in the first place.

How many times have you tried to inform someone about healthy eating and evidence-based nutrition, only to have them say, “No, I don’t have to worry. My doctor reassured me I’m fine. I just had a check-up, and everything’s normal.” As if having a normal cholesterol is okay in a society where it’s normal to drop dead of a heart attack, the number one killer of men and women. It would be one thing if you went to see a lifestyle medicine doctor who spent the check-up giving you the tools to prevent 80 percent of chronic disease, but given the way medicine is currently practiced, it’s no wonder why the history of routine check-ups “has been one of glorious failure, but generations of well meaning clinicians and public health physicians struggle to allow themselves to believe it.” But, “policy should be based on evidence…” 

Poor diet may be “on par with tobacco smoking as the most common actual causes of death,” yet the medical profession is inadequately trained in nutrition. Worse, nutrition education in medical school appears to be declining. If you can believe it, there is actually a “shrinking of formalized nutrition education” among health professionals, so the advice you get during your annual check-up may just be from the last tabloid your doctor skimmed while in the supermarket check-out line.

“And screening appointments should not be regarded as a form of ‘health education,’” read one medical journal editorial. “People who are obese know very well that they are, and if we have no means of helping them…then we should shut up.” Well, if you really have nothing to say that will help them, maybe you should shut up, especially those doctors who say they “have no idea what constitutes a ‘healthy’ diet”—although we do know that veggies and nuts are a good start.

Won’t a check-up allow your physician to do a comprehensive physical exam and routine blood testing? I discuss that, as well as the pros and cons, in my vide Is it Worth Getting an Annual Physical Exam?.

Did I say lifestyle medicine? Yes! Learn more about this exciting growing field in Lifestyle Medicine: Treating the Causes of Disease and Convincing Doctors to Embrace Lifestyle Medicine. Make sure your doctor is a member of the American College of Lifestyle Medicine (and even better certified by the American Board of Lifestyle Medicine).

Still don’t understand how there can be risks? See Why Prevention Is Worth a Ton of Cure. Unfortunately, physicians and patients alike wildly overestimate the benefits of pills and procedures. See, for example, The Actual Benefit of Diet vs. Drugs.

The fact is Physicians May Be Missing Their Most Important Tool.


And what about mammograms? See my video series:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Lead Contamination in Hot Sauces

Given the lead contamination found in candies containing chili imported from Mexico, 25 hot sauces were tested for heavy metals.

“Lead toxicity is prevalent and a major concern of public health,” especially for babies. “One of the important sources of lead exposure for the fetus and infant is maternal blood. Lead in the maternal blood”—that is, in pregnant and nursing women’s bloodstreams—“readily crosses the placenta and mammary glands,” leaching into breast milk. Where does the lead come from? Most may originate from the mother’s skeleton, where lead from past exposures builds up. Past exposures to what? “The FDA reports that reproductive age women in the U.S. are exposed to lead through food (43%), dust (31%), water (22%), and air (4%).”

Among the more atypical sources of childhood lead poisoning in the United States are “lead-tainted candies,” including, ironically, brands with names like “Toxic Waste.” (The FDA recalled the “Nuclear Sludge” variety of Toxic Waste’s candies, but not its others.) Many of the tainted candies were imported from Mexico, “especially those containing chili and salt as major ingredients.” It’s not clear whether “the chili additives were being contaminated during the open-air drying process. Other potential sources of this contamination might be the grinding stones involved in preparation of chili powder, or the possible use of lead arsenate as a pesticide agent.” They just don’t know.

Wait a second. There’s something else in grocery stores containing imported chilis and salt as major ingredients: hot sauce. I discuss this in my video Lead Contamination in Hot Sauces.

“In the last decade, the U.S. Food and Drug Administration (FDA) has issued several warnings and recalls for food products that exceed FDA standards for lead. Products containing chili peppers and salt”—such as the candies—“were often suspected as sources of lead contamination….However, products such as hot sauces that contain similar ingredients have not been the focus of evaluations” until this “first known investigation of lead concentrations in hot sauces,” that is.

As you can see at 1:52 in my video, researchers tested 25 different hot sauces, and about 9 out of 10 “contained a detectable level of lead,” though only four brands exceeded the FDA’s action level of 0.1 parts per million. But, that 0.1 ppm is the candy standard, so, technically, none of the hot sauces can be recalled from U.S. shelves. Although candy and hot sauce contain common ingredients, there simply is no hot sauce standard.

The most contaminated hot sauces had about a microgram of lead per teaspoon, which may be more than young kids should be getting in their daily diet, but how many six-year-olds are consuming hot sauce by the spoonful? “Although hot sauce would not be intuitively counted amongst food products highly consumed by children, ethnic and cultural practices must be considered. Chili peppers and salt are commonly used in Mexican-style candies, condiments, hot sauces and everyday cuisine.” So, the researchers want to see the same stringent candy standard of 0.1 ppm lead applied to hot sauce—or at least have some limit put in place. 

Without enforceable standards for hot sauces, what motivation do manufacturers have to even look into the problem? It could be the soil, for example. The soil where the peppers grow may be so contaminated with lead that just washing off any residue on peppers after picking may cut lead levels fourfold in the final product—but why bother taking the extra step to rinse off dirt if no one’s checking?

Are there any other imports we should be concerned about? I talked about the heavy metal contamination of herbal supplements in my video Get the Lead Out, but not this kind of herbal supplement: marijuana. “Several hundred people suffered lead poisoning presumably resulting from the desire of drug dealers to maximize profits.” Lead is heavy—about 50 times heavier than oregano—so it is “particularly useful for driving up profits” when the product is sold by weight. And it wasn’t subtle. You can see the little lead particles in the product at 3:48 in my video. Why was there an epidemic of lead poisoning among young students with “body piercings”? Because dealers could make an extra $1,500 per kilogram of marijuana.

Want to make your own hot sauce? I have a delicious recipe for Healthy Hot Sauce with all green-light ingredients in my How Not to Die Cookbook!


Interested in learning more about lead? Take a deep dive:

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In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

How Much Arsenic in Rice Is Too Much?

What are some strategies to reduce arsenic exposure from rice?

Those who are exposed to the most arsenic in rice are those who are exposed to the most rice, like people who are eating plant-based, gluten-free, or dairy-free. So, at-risk populations are not just infants and pregnant women, but also those who may tend to eat more rice. What “a terrible irony for the health conscious” who are trying to avoid dairy and eat lots of whole foods and brown rice—so much so they may not only suffer some theoretical increased lifetime cancer risk, but they may actually suffer arsenic poisoning. For example, a 39-year-old woman had celiac disease, so she had to avoid wheat, barley, and rye, but she turned to so much rice that she ended up with sky-high arsenic levels and some typical symptoms, including “diarrhea, headache, insomnia, loss of appetite, abnormal taste, and impaired short-term memory and concentration.” As I discuss in my video How Much Arsenic in Rice Is Too Much, we, as doctors, should keep an eye out for signs of arsenic exposure in those who eat lots of rice day in and day out.

As you can see at 1:08 in my video, in its 2012 arsenic-in-rice exposé, Consumer Reports recommended adults eat no more than an average of two servings of rice a week or three servings a week of rice cereal or rice pasta. In its later analysis, however, it looked like “rice cereal and rice pasta can have much more inorganic arsenic—a carcinogen—than [its] 2012 data showed,” so Consumer Reports dropped its recommendation down to from three weekly servings to a maximum of only two, and that’s only if you’re not getting arsenic from other rice sources. As you can see from 1:29 in my video, Consumer Reports came up with a point system so people could add up all their rice products for the week to make sure they’re staying under seven points a week on average. So, if your only source of rice is just rice, for example, then it recommends no more than one or two servings for the whole week. I recommend 21 servings of whole grains a week in my Daily Dozen, though, so what to do? Get to know sorghum, quinoa, buckwheat, millet, oatmeal, barley, or any of the other dozen or so common non-rice whole grains out there. They tend to have negligible levels of toxic arsenic.

Rice accumulates ten times more arsenic than other grains, which helps explain why the arsenic levels in urine samples of those who eat rice tend to consistently be higher than those who do not eat rice, as you can see at 2:18 in my video. The FDA recently tested a few dozen quinoa samples, and most had arsenic levels below the level of detection, or just trace amounts, including the red quinoas that are my family’s favorite, which I was happy about. There were, however, still a few that were up around half that of rice. But, overall, quinoa averaged ten times less toxic arsenic than rice. So, instead of two servings a week, following the Consumer Reports recommendation, you could have 20. You can see the chart detailing the quinoa samples and their arsenic levels at 2:20 in my video.

So, diversifying the diet is the number-one strategy to reduce exposure of arsenic in rice. We can also consider alternatives to rice, especially for infants, and minimize our exposure by cooking rice like pasta with plenty of extra water. We found that a 10:1 water-to-rice ratio seemed best, though the data suggest the rinsing doesn’t seem to do much. We can also avoid processed foods sweetened with brown rice syrup. Is there anything else we can do at the dining room table while waiting for federal agencies to establish some regulatory limits?

What if you eat a lot of fiber-containing foods with your rice? Might that help bind some of the arsenic? Apparently not. In one study, the presence of fat did seem to have an effect, but in the wrong direction: Fat increased estimates of arsenic absorption, likely due to the extra bile we release when we eat fatty foods.

We know that the tannic acid in coffee and especially in tea can reduce iron absorption, which is why I recommend not drinking tea with meals, but might it also decrease arsenic absorption? Yes, by perhaps 40 percent or more, so the researchers suggested tannic acid might help, but they used mega doses—17 cups of tea worth or that found in 34 cups of coffee—so it isn’t really practical.

What do the experts suggest? Well, arsenic levels are lower in rice from certain regions, like California and parts of India, so why not blend that with some of the higher arsenic rice to even things out for everybody?

What?!

Another wonky, thinking-outside-the-rice-box idea involves an algae discovered in the hot springs of Yellowstone National Park with an enzyme that can volatize arsenic into a gas. Aha! Researchers genetically engineered that gene into a rice plant and were able to get a little arsenic gas off of it, but the rice industry is hesitant. “Posed with a choice between [genetically engineered] rice and rice with arsenic in it, consumers may decide they just aren’t going to eat any rice” at all.


This is the corresponding article to the 11th in a 13-video series on arsenic in the food supply. If you missed any of the first ten videos, watch them here:

You may also be interested in Benefits of Turmeric for Arsenic Exposure.

Only two major questions remain: Should we moderate our intake of white rice or should we minimize it? And, are there unique benefits to brown rice that would justify keeping it in our diet despite the arsenic content? I cover these issues in the final two videos: Is White Rice a Yellow-Light or Red-Light Food? and Do the Pros of Brown Rice Outweigh the Cons of Arsenic?.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations: