Wednesday, January 17, 2018

Wisdom Wednesday: Complementary and Alternative Medicine

People have used complementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. However, rigorous, well-designed clinical trials for many CAM therapies are often lacking; therefore, the safety and effectiveness of many CAM therapies are uncertain. The National Center for Complementary and Alternative Medicine (NCCAM) is sponsoring research designed to fill this knowledge gap by building a scientific evidence base about CAM therapies - whether they are safe, whether they work for the conditions for which people use them and, if so, how they work.

Millions of American use CAM for health concerns and general wellness and spend tens of billions of dollars each year on such care. The 2007 National Health Interview Survey found that 38% of adults and 12% of children had used CAM in some form during the 12 months prior to the survey. The survey also revealed that Americans spent $33.9 billion out-of-pocket on CAM practices and products.

In 1999, NCCAM was established as the arm of the HIH to rigorously evaluate the safety and efficacy of CAM therapies, train researchers to conduct CAM research, and provide information to the public and health care professionals. Since its inception, NCCAM has funded more than 2,500 research projects to learn about how CAM therapies work as well as their safety and efficacy.

Studies have shown that spinal manipulation can provide mild-to-moderate relief from low-back pain and appears to be as effective as conventional medical treatments. Results from one trial that examined long-term effects in more than 600 people with low-back pain suggest that chiropractic care involving spinal manipulation is at least as effective as conventional medical care for up to 18 months.

In one of the largest clinical trials to date to test the safety and efficacy of acupuncture, NIH-supported researchers found that acupuncture significantly reduced pain associated with osteoarthritis of the knee when used as a complement to conventional therapy. Other studies and reviews demonstrated that acupuncture provides relief for vomiting and nausea from chemotherapy, shows possible effect for tension headaches, and that acupuncture and simulated acupuncture can both provide relief for those suffering from low-back pain.

Monday, January 15, 2018

Trump Said to Be in ‘Excellent Health’ After Annual Physical

President Donald J. Trump has just finished receiving his first physical since he entered the White House in January 2017, and has been declared in excellent health, though details have not yet been released.

At a press briefing immediately after the physical, Navy Rear Adm. Ronny L. Jackson, MD said the exam went very well, according to a statement tweeted by Sarah Sanders, the White House press secretary.

The last health information about Trump was released in September 2016 in the form of a five-paragraph letter from his personal physician, Harold Bornstein, MD.

The president was described as 6’ 3”, 236 pounds, with blood pressure of 116/70, a blood sugar level of 99, and lipid readings within the normal range – with an HDL of 63, LDL of 94, and triglycerides of 61. His coronary artery calcium score was 98, which is defined as mild heart disease, but an electrocardiogram and chest x-ray conducted in April 2016 were normal, Dr. Bornstein said.

The then-candidate’s PSA score was low. His last colonoscopy, in 2013, found no polyps. The one-page letter stated that Trump’s testosterone level – 441.6 – was in the normal range, as were liver and thyroid function tests.

At the time, Dr. Bornstein noted that Trump was taking rosuvastatin (Crestor, AstraZeneca), a low-dose aspirin for heart attack prevention, finasteride (Propecia) to treat male-pattern baldness, and antibiotics for rosacea.

Friday, January 12, 2018

170 Million Americans Drink Radioactive Tap Water

Drinking water for more than 170 million Americans in all 50 states contains radioactive elements that may increase the risk of cancer, according to an EWG investigation released today.

Radiation in tap water is a serious health threat, especially during pregnancy, and the Environmental Protection Agency’s legal limits for the most widespread radioactive elements are more than 40 years old. But President Trump’s nominee to be the White House environmental czar rejects the need for water systems to comply even with those inadequate standards.

The most common radioactive element in American tap water is radium. EWG’s analysis of test data from almost 50,000 public water systems found that from 2010 to 2015, more than 22,000 utilities in all 50 states reported radium in the treated water delivered to customers’ taps.

Only a small percentage of those systems exceeded the EPA’s legal limits for radium, set in 1976. But almost all exceeded California state scientists’ public health goals for two separate radium isotopes, set in 2006, which are hundreds of times more stringent than the EPA’s standard for the two isotopes combined. The elevated risk of cancer, as well as potential harm to fetal growth and brain development, decreases with lower doses of radiation but does not go away.

“Most radioactive elements in tap water come from natural sources, but that doesn’t take away the need to protect people through stronger standards and better water treatment,” said Olga Naidenko, Ph.D., EWG’s senior science advisor for children’s environmental health. “Millions of Americans are drinking water with potentially harmful levels of radioactive elements, but the outdated federal standards mean many people don’t know about the risk they face when they turn on the tap.”

California has the most residents affected by radiation in drinking water. From 2010 to 2015, about 64% of the state’s residents were served by public water systems that reported detectable levels of the two radium isotopes. In Texas, which has a smaller population, about 80% of the population was served by utilities reporting detectable levels of those elements.

Wednesday, January 10, 2018

Wisdom Wednesday: Diagnosis

This term has been in use since the early 1800’s to describe the “label” given to a particular disease process. Its use has gradually grown over time to be common place today.

The Mayo Clinic in Minnesota is self-proclaimed as the best diagnosis facility in the world. I’ve had a couple of patients evaluated there and I am impressed with their team approach to diagnostic evaluation.

Once evaluated by Mayo, they follow your medical history until death and then hope to be allowed to perform an autopsy. The sole purpose of which is to verify the diagnosis they gave you years earlier. No other medical facility in the world has this kind of follow-up protocol.

So how accurate are they? Mayo Clinic states that their given diagnosis is correct about one-third of the time. That’s really seeing the glass a third full. Others may say that Mayo Clinic is wrong two-thirds of the time.

If they are indeed the best and arrive at the wrong diagnosis twice as often as the correct diagnosis, where does it leave the rest of the health care profession?

The term diagnosis is a combination of two Greek terms, “di” meaning two and “agnostic” meaning to lack knowledge or not know. So, the literal translation of diagnostic is to be of two minds and not know.

Monday, January 8, 2018

Kidney Disease Can Lead to Diabetes, Not Just the Other Way Around

Kidney disease increases the risk for diabetes, a new study finds. Medical experts already knew that the reverse is true – that diabetes increases the risk for kidney disease. The authors of the new study, though, found that kidney dysfunction can lead to diabetes – and, that a waste product called urea plays a role in the two-way link between the two diseases.

Urea comes from the breakdown of protein in food. Kidneys normally remove urea from the blood, but poor kidney function can lead to increased levels of urea.

The study involved the analysis of medical records over a five-year period for 1.3 million adults who did not have diabetes. About 9% had elevated urea levels, a sign of reduced kidney function. That’s the same rate as in the general population, according to the researchers.

People with high urea levels were 23% more likely to develop diabetes than those with normal urea levels, the study found. The results were published online recently in the journal Kidney International.

“The risk difference between high and low levels is 688 cases of diabetes per 100,000 people each year,” said study senior author Dr. Ziyad Al-Aly. He’s an assistant professor of medicine at Washington University School of Medicine in St. Louis.

“When urea builds up in the blood because of kidney dysfunction, increased insulin resistance and impaired insulin secretion often result,” Al-Aly said.

The findings about the role of urea could help in efforts to improve treatment and possibly prevent diabetes, the researchers said. Urea levels can be lowered in a number of ways, including medication and diet.

Friday, January 5, 2018

Seniors Don’t Need Calcium, Vitamin D Supplements

Seniors are wasting their time and money taking calcium and vitamin D supplements to ward off the brittle bones of old age, a new review concludes.

It turns out there’s little evidence supplements protect against hip fractures and other broken bones in older folks, according to data gathered from dozens of clinical trials.

“The routine use of these supplements is unnecessary in community-dwelling older people,” said lead researcher Dr. Jia-Guo Zhao, an orthopedic surgeon with Tianjin Hospital in China. “I think that it is time to stop taking calcium and vitamin D supplements.”

Zhao and his colleagues combed through medical literature to find clinical trials that previously tested the usefulness of calcium and Vitamin D supplements. They wound up with data from 33 different clinical trials involving more than 51,000 participants, all of whom were older than 50 and living independently.

Most of the clinical trials took place in the United States, the United Kingdom, New Zealand and Australia Zhao said. The dosage of the supplements varied between the clinical trials, as did the frequency at which they were taken.

The pooled data revealed no significant association between calcium or vitamin D supplements and a person’s risk of hip fracture or other broken bones, compared with people who received placebos or no treatment at all.

Potential dietary sources of these nutrients prove one of the weaknesses of the evidence review, argued Dr. Daniel Smith, an assistant professor of orthopedics at the Icahn School of Medicine at Mount Sinai in New York City. “While this study addresses concerns regarding calcium and vitamin D supplementation, it fails to address or even consider whether the patients in question are obtaining either adequate calcium and vitamin D intake in their diets or sunlight exposure, obviating the need for supplementation,” Smith said.

Wednesday, January 3, 2018

2017 Blog Summary

I posted 147 blogs in 2017. I began writing my blog late in 2013 and will exceed 600 total posts sometime this month.

For me, the most important benefit is personal. Reviewing studies keeps me abreast of the latest health research. As a result, I’m a better physician, providing a higher level of service to my patients. I hope that you also glean information to guide you in making health decisions.

Reviewing my blogs for the past year always brings some surprises and some fond memories. I really enjoyed researching and writing the series on food allergies. I try to strike a balance between criticism of our current health care system and positive steps you can take to improve your own health.

This year it appears I’ve done a pretty good job in that department. Tied for first were blogs about diet and blogs about drugs. Together, they accounted for a full third of my blogs. Medical testing was the next most popular topic, followed by supplementation and hormone imbalance. Each accounting for 10% of my blog material. I also covered exercise, autoimmune disease, medical procedures, and cardiovascular disease repeatedly.

I was surprised that infection, genetics and toxicity in the environment were not more popular. Look for more blogs on these topics this year. In fact, emerging studies are showing a strong correlation with these factors and chronic diseases like ALS (Lou Gehrig’s disease), MS (multiple sclerosis), RA (rheumatoid arthritis) and AD (Alzheimer’s disease).

You can view any of my blogs since 2013 just by scrolling through the years and months in the right-side column. If you prefer, you can also search by key word. Just enter your topic in the left-hand upper corner and press enter.