Wednesday, December 31, 2014

Wisdom Wednesday: Tribulus

This is my favorite herb. I use other herbs, like ginger and Ashwaganda, much more frequently but I love this herb. Good quality Tribulus is quite expensive and much of what is available, especially in the US, is ineffective. However, when used properly, this herb can correct hormonal imbalances quickly and completely.

The herb Tribulus terrestis should be made from the aerial parts (leaves and stems). It contains steroidal saponins, mainly furostanol glycosides (including protodioscin and protogracillin) and small qualities of sprirostanol glycosides, sterols and other compounds. Quality extracts are standardized by the furostanol glycoside content.

While that seems very technical (spell check hated most of that last paragraph), these are the chemical compounds that make this herb work. Tribulus terrestris is endogenous to many different geographical zones – the Mediterranean, India, China, 
South Africa and Australia. Research indicates the phytochemical profile of the herb depends on the geographical origin and the part of the plant utilized. Only Tribulus terrestis sourced from the central region of Bulgaria and Slovakia have been shown to contain protodioscin, an important indicator of efficacy and quality.

Medi-Herb, the company I use for a vast majority of my herbs, is based on Australia. They purchase the raw herb from Bulgaria, test the marker compounds, including protodioscin prior to extraction then standardize the final product. The Bulgarians are able to charge a high price for this export; as a result Tribulus is the most expensive herb I use.

Monday, December 29, 2014

2014 in Review

I posted 136 blogs during 2014, quite an increase from the 17 posted during the last few months of 2013 when I began this process. I reviewed them all this week, picking the top four topics for the year. If you would like to catch up on any of these areas of research, I have listed the related blogs following each area.

The fourth most popular topic was stem cell research. I my mind I thought it was number one and next year, and maybe for years to come, it might be. Stem cell research holds great promise to heal damaged tissues and organs of the body. Although readily available in children, as we age, stem cells radically decrease. Hospitals are already offering to store stem cells from the umbilical cord at birth for possible future use. The biggest hurdle is reproducing stem cells in sufficient numbers from an aging population that needs them. The political environment that delayed stem cell research for so many years appears to have faded. Please review my blog “Stem Cell Research Expanding” posted on Wednesday, February 26, 2014.

In third place is the shifting perception on high cholesterol and statin drugs. With the exception of general practitioners and cardiologists, most physicians have long admitted that there are several myths that have been perpetrated by the drug industry about statin drugs. This year was a continuing dichotomy. Respected cardiologists and cardiac research scientists began to speak out against the widespread use of statins while the new guidelines for the use of statins would dramatically increase the number of people taking this drug. Here are the blogs on this topic:

  • Friday, March 21 Saturated Fat is Not Bad for Health, Says Heart Expert
  • Friday, June 13 High Statin Doses Increase the Rick of Diabetes
  • Monday, December 8 Most Seniors Could Use Statins under New Guidelines

Second place was occupied by research on the digestive tract. A new term, the ‘microbiome’ became popular as a description of the vast variety of life that lives in our digestive tract. We learned that virtually every illness in the body is somehow connected to this microbiome. DNA mapping of all existing microbes in the gut is ongoing with close to 15% having been identified and verified with the Centers for Disease Control (CDC). Fecal implants, a cure for C. difficile, have become popular with implant clinics popping up all over the country. We are still early in this research, certainly too early for these clinics to properly identify and treat patients correctly. I fear the widespread use of probiotics by Americans will create more dysbiosis as we do not yet know what probiotic(s) are needed by any one individual. Please review the following blogs:

  • Friday, March 14 Serious Diarrheal Infection in Kids Linked to Antibiotics
  • Wednesday, April 23 Probiotics Revisited
  • Wednesday, April 16 Gut Associate Lymphatic Tissue (GALT)
  • Friday, June 20 Exercise May Spur More Varied Gut Microbes
  • Friday, August 5 Experts Issue Guidelines for Treating Irritable Bowel Syndrome

The number one topic of research interest this year was testosterone and male sexual dysfunction. Fifty percent of men over the age of 40 have some form of sexual dysfunction. Testosterone is routinely prescribed for these men despite studies showing increased risk of heart attack with use. The following blogs are available for review:

  • Friday, March 7 Higher Risk of Suicide and Autism in Children Born to Older Dads
  • Friday, April 25 Study Question Safety Thresholds for Hormone-Disrupting Chemicals
  • Friday, May 30 Toothpaste, Sunscreen Chemicals ‘Interfere with Sperm Function’
  • Friday, June 27 Sperm, Semen Defects May Be Tied to Shorter Lives
  • Monday, August 11 New Drug Could Treat Low Testosterone with Fewer Side Effects
  • Friday, October 24 Practice Guidelines Nixes Testosterone Therapy for Women

Please take some time to review some of these blogs. It is vital to your own health that you be an educated participant in your own health care.

Friday, December 26, 2014

U.S. Health Care lags Worldwide for Those Over 65

The Commonwealth Fund has been publishing surveys comparing health care in industrialized countries since 1998, a continuing report card in which the United States has usually fared poorly because of its high proportion of uninsured people.

But its latest report focuses on those over 65, the one segment of the American population with nearly universal coverage and access to care. How did we fare?

“It’s definitely a better picture than when we look at the U.S. population generally; that’s a pat on the back for Medicare,” said Robin Osborn, director of the fund’s International Health Policy and Practice Innovations program and lead author of the study. Previous research has shown that “Medicare is more protective than all the different insurance plans people have under age 65,” she said.

But the survey of 15,617 respondents – published in Health Affairs – reveals, we still have mortifying lapse and problems, despite spending more on health care than any other country in the world.

Our older population is sicker. We lead the list in the proportion of people over 65 who have two or more chronic diseases (68% report hypertension, heart disease, diabetes, cancer, etc.) and who take four or more prescription drugs (53%). Only a third of seniors in the United Kingdom have multiple chronic conditions.

“One thing we know contributes to this is not having an ongoing, stable source of health insurance throughout your life," Ms. Osborn said. Before they became Medicare-eligible, American seniors may have forgone preventive treatments or let conditions worsen because they couldn’t afford care.

Older Americans still struggle to pay for health care. Nineteen percent said that in the past year, cost was a barrier that prevented their seeing a doctor, undergoing a recommended test or treatment or filling a prescription. In only one other surveyed nation (New Zealand, at 10%) did that proportion reach double digits.

Wednesday, December 24, 2014

Wisdom Wednesday: Holiday Cheer

My family is celebrating Christmas this year with a cruise to the Southern Caribbean. I had to write several blogs prior to our departure. Typically, I write them early in the morning, before the rest of the family is awake. My fourteen year-old daughter, usually the second one to wake, asked about the blog to be posted on Christmas Eve. She suggested I write about how bad Christmas cookies are for you. So here goes………………..

Christmas cookies are bad for you. They are refined carbohydrates (sugar) that are calorie dense and devoid of micronutrients (vitamins and minerals). They contribute to obesity, heart disease, and diabetes. There Cara, I did it. But boy, do they taste good.

As I’m writing this blog, my wife and daughters are baking dozens of Christmas cookies. Peanut butter are my favorite, oatmeal scotchies are second.

From Thanksgiving through the holidays we “loosen the reins a bit”. We eat less healthy food, drink socially at numerous events, and just consume more calories. Our schedule is very hectic, but very fun. It is, after all, the season of celebration.

For the past five years, my wife and I have ridden our bikes from Miami to Key West, 165 miles in two days. We’ve also been training hard for three months, logging 1,500 miles to prepare for the ride. The ride is held early in November, a week or two prior to Thanksgiving. After completing the ride, we really need a break and I think we’ve earned it.

Monday, December 22, 2014

Poor Sperm Quality May Signal Health Issues

Defects in sperm within semen may be linked to a variety of health problems, including high blood pressure, heart disease, and skin and glandular disorders, a new study suggests.

The defects probably don’t cause these problems. It’s more likely that semen quality reflects overall health, the researchers said.

“It may be that infertility is a marker for sickness overall,” said lead researcher Dr. Michael Eisenberg, an assistant professor of urology and director of male reproductive medicine and surgery at the Stanford School of Medicine in Palo Alto, California.

Semen is the fluid that’s released when a man ejaculates. Within that fluid are sperm. Sperm defects can affect the quality of semen. Sperm defects include too few sperm, sperm that don’t move well (motility) or low-quality sperm, according to the American Society for Reproductive Medicine (ASRM).

“There are a lot of factors that involve a man’s overall health that turn out to impair sperm production,” Eisenberg said.

Treating conditions such as high blood pressure might improve sperm quality, he noted. However, Eisenberg said he isn’t sure whether the condition itself is linked to sperm defects or if drugs used to treat health problems are to blame.

“Many things we didn’t know about or think about may impact a man’s fertility,” he said. “It might be treatment for high blood pressure that is causing sperm problems.”

Genetics may also play a part, Eisenberg suggested. “About 10% of the genes in a man’s body are involved in sperm production, so it is possible that some of these genes may have overlapping effects on other functions,” he said.
In the study published December 10th in the journal Fertility and Sterility, Eisenberg’s group compared the health of men who had semen defects with men who didn’t.

Friday, December 19, 2014

BPA Can and Bottle Lining Could Increase Blood Pressure

Biphenol A (BPA) is a common chemical, found in products such as plastic bottles and the inner lining of food cans.

According to the authors of the study, BPA exposure has been detected in more than 95% of the US population.

The research, published in Hypertension, follows up on previous work associating BPA with cardiovascular disorders such as high blood pressure and heart rate variability.

There is also evidence that BPA can leach into food and drinks from the lining of containers. An earlier randomized crossover trial demonstrated that eating canned soup for 5 days running increased urinary BPA concentration by more that 1000%, in comparison with eating soup made from fresh ingredients.

Study authors Dr. Yun-Chul Hong of Seoul National University College of Medicine in South Korea and Dr. Sanghyuk Bae conducted a new randomized crossover trial, whereby participants would be given soy milk to drink, provided in either cans or glass bottles.

Two hours after drinking the soy milk the participant’s blood pressure, heart rate variability and urinary BPA concentration were measured. Participants were asked not to eat or drink any other food for the 2 hours after drinking the soy milk, and for at least 8 hours before each trial.

The researchers chose soy milk as it does not contain any ingredients known to elevate blood pressure.

The participant’s urinary BPA concentration rose by up to 1,600% following the consumption of canned soy milk, compared with consumption of soy milk from glass bottles. Additionally, systolic blood pressure increased by approximately 4.5 mmHg. No statistically significant differences in heart rate variability were observed.

Wednesday, December 17, 2014

Wisdom Wednesday: The Doctor-Patient Partnership

I recently reviewed the Targets and Self-Management for the Control of Blood Pressure in Stroke and at Risk Groups (TASMIN-SR). This study was published by Professor Richard McManus and colleagues in 2013.

The study documented the value of patients adjusting their own medication through self-monitoring of blood pressure in addition to the standard medical supervision.

This was a follow-up study to two previous studies that documented the value of monitoring blood pressure at home and then providing that data to the primary care physician. Both of those studies failed to change the standards of medical practice for the treatment of hypertension. In fact, the “gold standard” for screening, diagnosis and management of hypertension remains conventional office BP (blood pressure) measurement.

The question now being asked of the medical community: Are patients and providers ready to partner? Unfortunately, in most medical practices, the answer remains no.

Physicians often talk about poor patient compliance and I must admit, I have been one of those physicians. However, compliance is not the issue. Patients are not bound to comply with “doctor’s orders”.

Too often I see patients that blindly follow the doctor’s recommendations without question. This is how patients end up on 16 prescription drugs, many of which have detrimental interactions and are contraindicated. It is estimated that fully one-third of the diagnosed cases of dementia in this country are just over medicated patients who would recover their faculties if some or all of their medication was discontinued.

Monday, December 15, 2014

Study Casts Doubt on Low-Dose Aspirin for Women Under 65

Although low-dose aspirin may curb the risks of heart disease and colon cancer, the downsides appear outweigh the benefits for many women, a new large study suggests.

For women younger than 65, researchers found taking low-dose aspirin for years lowered the risks of heart attack, stroke and colon cancer by a small amount. But they also found that the benefit was countered by an increase in the risk of major gastrointestinal bleeding – serious enough to land a woman in the hospital. For women 65 and over aspirin boosted their risk of bleeding too – but the benefits against heart disease and colon cancer were bigger, researchers reported. The study appeared online on December 4th in the journal Heart.

Many people have heard that low-dose aspirin is good for the heart, and may feel like it’s a good idea to take some every day. But the reality is much more complicated, said Dr. John Erwin, a cardiologist at Scott & White Memorial Hospital in Temple, Texas.

“There’s no question that aspirin can be a lifesaver for people who’ve already had a heart attack,” said Erwin, who was not involved in the study. For those people, he explained, a daily aspirin – if recommended by a doctor – can help prevent a repeat heart attack or other cardiovascular complications.

When it comes to preventing a first-time heart attack, or any other disease – what doctors call “primary prevention” it’s still unclear which people stand to gain a benefit that will outweigh the risks of aspirin.
The American Cancer Society advises people against popping the drug solely to ward off cancer. Similarly, the American Heart Association recommends only that people at “high risk” of heart attack consider taking aspirin. Meanwhile, the US Food and Drug Administration (FDA) recently came out against using aspirin for preventing first-time heart attacks and strokes – citing the potential harms.

The findings are based on a clinical trial of nearly 28,000 women, average age of 55 at the start of the study. They were randomly assigned to take low-dose (100 mg) aspirin or placebo pills every other day.

Friday, December 12, 2014

Auburn University: ‘Bama Secret Weapon

The Auburn University football team is claiming beet root improves their athletic performance. It’s not pregame hype, a study from Kanas State University supports the claim and they say it also benefits heart failure patients.

“Our research, published in the journal Physiology in 2013, has shown that the nitrate found in beetroot concentrate increases blood flow to skeletal muscles during exercise,” said David Poole, professor of exercise kinesiology and anatomy and physiology at Kansas State University. He and Scott Ferguson, doctoral student in anatomy and physiology, latest research “Microvascular oxygen pressures in muscles comprised of different fiber types: Impact of dietary nitrate supplementation,” was published in the Journal of Nitric Oxide, Biology and Chemistry this month. This work provides the basis for how beetroot juice may benefit football players by preferentially increasing blood flow to fast-twitch muscle fibers – the ones used for explosive running. In addition to improving athletic performance, the research also found that beetroot juice can improve the quality of life for heart failure patients.

“Remember, for every football player in the United States, there are many thousands of heart failure patients that would benefit from this therapy,” Poole said, “It’s a big deal because even if you can only increase oxygen delivery by 10%, that can be the difference between a patient being wheelchair-bound versus getting up and walking around and interacting with his or her family.”

The benefits of beetroot come from the nitrate found within it. The amount of nitrate in one 70ml bottle of beetroot juice is about the same amount found in 100 grams of spinach. “When consumed, nitrate is reduced in the mouth by bacteria in nitrite,” Ferguson said. “The nitrite is swallowed again and then reduced to nitric oxide, which is a potent vasodilator. The nitric oxide dilates the blood vessels similar to turning on a water faucet, and allows blood to go where it needs to go.”

Wednesday, December 10, 2014

Wisdom Wednesday: American Clinical Board of Nutrition

The American Clinical Board of Nutrition (ACBN) is a certifying agency in nutrition. It is accredited by the National Commission for Certifying Agencies (NCCA).

The ACBN is the first and currently only certifying agency in nutrition to offer Diplomate status to all professionals in the health care field, beyond the doctorate level in the United States and internationally. Certificants of the ACBN hold the distinction of Diplomate, American Clinical Board of Nutrition (DACBN).

Founded in 1986 the ACBN is a professional certification organization acting in the public interest by establishing education, examination, experience, and ethics requirements for certification.

Currently there are ten universities that offer nutrition courses that can be applied toward the 300 hours of nutrition required by the ACBN as part of board eligibility. I took a vast majority of my course work at the University of Miami, Miller School of Medicine.

Monday, December 8, 2014

Most Seniors Could Use Statins under New Guidelines

Most older Americans qualify for treatment with cholesterol-lowering statins under new guidelines intended to reduce the risk of heart attack or stroke, a new study shows.

Guidelines for the treatment of blood cholesterol released late last year by the American College of Cardiology and the American Heart Association target people most likely to benefit from taking statins such as Zocor (simvastatin) and Crestor (rosuvastatin).

The new study of more than 6,000 black and white Americans age 66 to 90 found that 70% were eligible for stain therapy, including 97% of those 66 to 75 years of age and all of the men. The findings appear in a research letter published November 24th in the journal JAMA Internal Medicine.

“The guidelines are a significant change from prior guidelines that relied heavily on levels of bad cholesterol to determine who to treat,” letter author Dr. Michael Miedema, a research cardiologist at the Minneapolis Heart Institute Foundation, said in a foundation news release.

“Instead, the new guidelines recommend focusing statin therapy on the individuals that are at the highest risk for heart attack and stroke, even if their cholesterol levels are within normal limits,” he explained.

The guideline recommend statins for people with heart disease, diabetes or high cholesterol levels, but also recommend the drugs for people who don’t have these conditions but do have a higher than 7.5% risk of heart attack or stroke in the next 10 years based on a risk calculator.

“Older individuals will likely cross the 7.5% threshold based on age alone, even if they have normal cholesterol levels and no other cardiovascular risk factors, and our study confirms this notion,” Miedema said.

Friday, December 5, 2014

Want Kids to Eat Better? Get Them Cooking

Getting kids involved in the kitchen, through cooking classes or at home, may make them more likely to choose healthy foods, according to a recent review.

Cooking programs and classes for children seem to positively influence children’s food preferences and behaviors, according to the new research. And, although the review didn’t look at long-term effects of such programs, the findings suggest that such programs might help children develop long-lasting healthy habits.

“It’s important to expose children to healthy foods in a positive way,”vsaid Derek Hersch, the lead author of the study who also works with a cooking education program called Food Explorers at the Minnesota Heart Institute Foundation.

This research comes at a time when childhood obesity rates have been rising rapidly. More than one-third of adolescents in the United States were obese in 2012, according to the US 
Centers for Disease Control and Prevention (CDC). This trend has been caused, at least in part, by a significant decrease in the amount of meals that people consume at home since the 1980s, according to background information in the study. People are more likely to eat at restaurants, where meals are more calorie-dense and less nutritious, the study noted.

Sara Haas, a spokesperson with the Academy of Nutrition and Dietetics, noted that time is a factor. “It has a lot to do with eating more convenience foods because parents are lacking time, and may not have learned to cook healthy meals,” she said.

Cooking education programs, such as Food Explorers, teach children about new healthy foods and how to prepare them. They also stress the importance of eating five fruits and vegetables every day. A volunteer parent explains a new food to the group, and the kids make something based on the lesson, such as fruit skewers or spinach salad. Depending on the program, kids may be sent home with information about healthy food to bring to their parents, the review explained.

Hersch and his study team reviewed eight other studies that tested different types of cooking education programs. Children in these classes were between 5 and 12 years old, according to the review. Hersch’s goal was to learn more about developing an efficient program to encourage healthy food choices that last a lifetime.

Wednesday, December 3, 2014

Wisdom Wednesday: Male Hormonal Issues

There has been a dramatic increase in male hormonal health issues over the course of the past ten years. It has an eerily similarity to the hormonal issues women have had to deal with for the past fifty years.

Fifty percent of all men over the age of 45 suffer some form of impotence – ED (erectile dysfunction) or low libido. Low testosterone is now routinely supported with HRT (hormone replacement therapy). We even nickname it “Low T”, running ads on television to sell testosterone to our middle aged male population. Please review my blog “New Drug Could Treat Low Testosterone with Fewer Side Effects” posted on Monday, August 11, 2014. Some physicians have been going “off label” and prescribing testosterone for women. I posted a blog entitled “Practice Guideline Nixes Testosterone Therapy for Women” on Friday, October 24, 2014.

Contamination of our environment is the core of all these hormonal issues, both male and female. Estrogens were introduced as pesticides 40 years ago when their predecessors were banned as carcinogenic. The concept was spraying our growing food with estrogen would disrupt the reproductive life cycle of the insects, effectively killing future generations. There was little or no concern about the potential effects on our reproductive life cycle as these products were incorporated in our food and water supply. Of course, the insects quickly adapted to estrogen based insecticides, we unfortunately can not.

Today estrogen is found in most of our food, in our drinking water, and even in the air we breathe. Municipalities are not required to test for estrogens in the water and therefore do not list this contamination on their water analysis reports.

Plastics also contribute to our hormonal crisis. Biphenyls are estrogen disruptors found in many plastic products. There are over 800 estrogen disruptors currently identified in every day household items like baby formula bottles, toys, and food storage containers. Please review my blog “Study Questions Safety Thresholds For Hormone-Disrupting Chemicals” posted on Friday, April 25, 2014.

Monday, December 1, 2014

Could Your Job Preserve Your Aging Brain?

Jobs requiring intellectually challenging tasks may help preserve thinking skills and memory as workers age, a new study suggests.

The researchers compared IQ scores obtained around age 11 from more than 1,000 Scottish people with their memory and reasoning scores around age 70. The scientists found that those who had mentally stimulating jobs appeared to retain sharper thinking even years after retirement.

“We see that those in more complex jobs generally do better on a range of cognitive ability measures,” said study author Alan Gow, an assistant professor of psychology at Heriot-Watt University and the Centre for Cognitive Aging and Cognitive Epidemiology in Edinburgh, Scotland.

“That’s not necessarily surprising … but we were able to add an interesting twist [because] we had data on our participants’ cognitive ability in childhood,” Gow added.

Dr. David Knopman, vice chair of the Medical and Scientific Advisory Council at the Alzheimer’s Association, praised the “very nice and unique” new research, but pointed out that it was an observational study that could not prove that job complexity leads to better thinking skills as people age.

“But it says that the things we do during our lifetimes can make a difference for risk reduction for dementia, and that’s a good thing,” added Knopman.

The study was published online November 19 in the journal Neurology.

Friday, November 28, 2014

Treating Irregular Heartbeat with Digoxin May Come with Risks

The widely used heart drug digoxin is associated with increased risk of death and hospitalization among patients who have the heart rhythm disorder atrial fibrillation but no evidence of heart failure, a new study shows.

Atrial fibrillation is a common form of irregular heartbeat that has been linked to a rise in risk for stroke among older Americans. Digoxin has been widely used for more than a century to help treat irregular heartbeat, the authors of the new study said, and many guidelines recommend the drug for the treatment of atrial fibrillation.

However, the new findings “suggest that the use of digoxin should be re-evaluated for the treatment of atrial fibrillation in contemporary clinical practice,” study co-author Dr. Anthony Steimle, chief of cardiology at Kaiser Permanente Santa Clara Medical Center, said.

“In my experience as an electrophysiologist, specializing in heart rhythm, I’ve seen time and again that digoxin can be toxic to atrial fibrillation patients, proving useful in only a tiny subset who are bedridden,” said Dr. Soad Bekheit, director of electrophysiology services at Staten Island University Hospital in Staten Island, N.Y.

The new study involved nearly 15,000 adults who were recently diagnosed with atrial fibrillation and had no prior history of heart failure or digoxin use. During the three-year study, more than 4,800 of the patients began taking digoxin.

Those who took digoxin had a 71% higher risk of death and a 63% higher risk of hospitalization that those who did not take the heart drug, according to the study published November 21 in the journal Circulation: Arrhythmia and Electrophysiology.

“Given the other options available for heart-rate control, digoxin should be used with caution in the management of atrial fibrillation, especially in the absence of symptomatic systolic heart failure,” Steimle believes.

“Digoxin remains commonly used for rate control in atrial fibrillation, but very limited data exist to support this practice – mostly small, older clinical studies with very limited follow-up that did not assess the long-term effects of digoxin on mortality or hospitalization,” added study senior author Dr. Alan Go, a research scientist at the Kaiser Permanente Division of Research in Oakland, California.

Digoxin is one of the derivative drugs produced from the herb Foxglove. The discovery of Foxglove is attributed to Dr. William Withering who published a paper on its’ use in 1785. However, the use of Foxglove goes back hundreds of years in Europe where it was commonly used to treat “dropsy” (congestive heart failure). All parts of the plant are poisonous and it is not considered to be a “safe herb”.

Apparently, the drugs derived from Foxglove are not very safe either.

Atrial fibrillation is a common issue. In fact, I have developed atrial fibrillation over the course of the past year. I also manage several cases in the office. In the early stages, eliminating caffeine and chocolate often eliminates the symptoms. Over time however, dietary restrictions are not enough. Most cases will resolve when we increase the riboflavin (vitamin B2) and niacinamide (vitamin B3) while limiting the thiamine (vitamin B1). I believe that the large amounts of thiamine added to grains and other processed foods are responsible for most cases of atrial fibrillation.

Personally, I have not had an incident since adding vitamin B2 and B3 to my supplements several months ago.

If shifting the B-complex is not successful, increasing the magnesium to calcium ratio often is effective. Most calcium supplements contain a 2:1 ratio of calcium to magnesium. If your supplement has 250mg of calcium, it generally will contain 125mg of magnesium. Switching to a 1:1 ratio, or even a 1:2 ratio often will eliminate the symptoms of atrial fibrillation.

If you suffer from atrial fibrillation, consult your physician about the use of digoxin. Refer them to this study (there are others with similar findings) and convince them to help you get off this medication.

Eliminate caffeine and chocolate from your diet. Consider working with a nutritionist to alleviate your symptoms with simple vitamin and/or mineral supplementation.

Source: National Institutes of Health –Friday, November 21, 2014

Wednesday, November 26, 2014

Wisdom Wednesday: Constipation

Constipation is the most common digestive complaint in the United States. It is a symptom, not a disease.

However, diagnostic workup generally does not occur until medical management of the symptoms fail. Even with a diagnosis, treatment is aimed at alleviating symptoms with a bulk laxative, a stool softener, and/or drug that increases peristaltic action of the bowel.

The medical definition is a having at least two of the following symptoms over the course of the past three months:
  • Fewer than 3 bowel movements per week
  • Straining
  • Lumpy or hard stools
  • Sensation of anorectal obstruction
  • Sensation of incomplete defecation
  • Manual maneuvering required to defecate

If you are not having a bowel movement every day, preferably twice per day, you are constipated.
The most common cause of constipation is a sluggish gallbladder. The gallbladder stores bile manufactured in the liver. When the food bolus moves from the stomach to the small intestine, the presence of HCl lowers the pH of the small intestine and stimulate the gallbladder to contract. The released bile travels down the common bile duct, stimulating the release of all the pancreatic digestive enzymes. The bile emulsifies the fat while the pancreatic enzymes breakdown our food for absorption.

If the fat is not broken down, the ileocecal valve will close, trying to prevent the fat from entering the large intestine resulting in constipation. Fat does not belong in the large intestine as it feeds the harmful bacteria in the bowel.

Enter the protein pump inhibitors (PPIs). Nexium is the third most commonly prescribed drug in the US, behind Synthroid and Creastor. Twenty million people in America take Nexium to prevent acid reflux, effectively stopping the normal digestive process. In addition to constipation, PPIs cause anemia, osteoporosis and a host of malabsoption syndromes.

Of course eating excessive fat will also cause a sluggish gallbladder. Americans eat too much fat. They just eat too much – too much protein and refined carbohydrates as well. The only thing well don’t eat too much of are fruits and vegetables.

Monday, November 24, 2014

Nearly 3 in 10 Americans with Diabetes Don’t Know It

Almost 8 million Americans have diabetes but don’t know it, a new study shows.

That’s despite the fact that about two-thirds of those with undiagnosed diabetes have seen a doctor two or more times in the past year, according to the researchers.

The study also found that among those who were diagnosed with diabetes, only about one –quarter met three important goals for people with diabetes: managing blood sugar, blood pressure and cholesterol levels.

“Out of 28.4 million people with diabetes, more than a quarter don’t know [it],” said study author Dr. Mohammed Ali, an assistant professor of public health at Emory University School of Medicine in Atlanta.

“About 80% of those people are linked to a health care provider, and two-thirds are seeing them twice a year or more. So, through whatever means, they aren’t being identified with diabetes,” Ali explained.

Symptoms of type 2 diabetes, which may be subtle and come on slowly, include fatigue, blurred vision, slow-healing cuts and scrapes, and the need to urinate more often, according to Dr. Robert Ratner, chief scientific and medical officer for the ADA.

Despite greater awareness in recent years, diabetes remains a major cause of death and disability in the United States. It’s a leading cause of adult-onset blindness, kidney failure and limb amputations, according to the researchers.

This is a prime example of a failing heath care system – over 5 million undiagnosed diabetics are seen by a physician a least twice a year, but not properly diagnosed.

As a clinician, you are responsible for the total health of your patient, regardless of their chief complaint on entry. If a patient seeks my help for acute low back pain and they also happen to be an undiagnosed diabetic, I am responsible to diagnose, properly treat, and/or refer that patient for their diabetes.

Diabetes is an easy diagnosis. Occult cancers like breast, lung, and prostate are much more challenging. This is why a good history is so important. I recently had a new patient who was being treated for anemia with iron supplementation by her MD. She had a microcytic anemia, so iron probably would be effective. However, her history included breast cancer. As a clinician, you must assume this patient has metastatic carcinoma until you prove otherwise. You can not just treat the anemia and ignore the potentially fatal diagnosis. My new patient was referred to her oncologist for further evaluation and treatment.

Every patient in my office is evaluated for signs of metabolic syndrome, the precursor to diabetes and heart disease. The signs are central obesity (weight gain around the belly), high blood pressure, high serum lipids, low thyroid function, and insulin resistance. I see these signs all day long. Look around you or maybe look at yourself and you will see them too.

The fasting glucose only shows how well your body handles sugar without the stress of food for the past 8 hours. You are diabetic long before the fasting glucose is elevated on your lab test.

I recommend all my patients have laboratory testing each year as a preventative tool. Included in that panel of tests is a glycohemoglobin A1c. This test measures the percent of RBCs (red blood cells) that are saturated with glucose. That number should be below 5.7%. Please ask your physician to run an A1c. Don’t wait for your MD to diagnose you as a diabetic.

Source: National Institutes of Health -Tuesday, November 18, 2014

Friday, November 21, 2014

B Vitamins May Not Boost Memory or Thinking

Taking vitamin B12 or folic acid supplements may not reduce seniors’ risk of memory loss, according to a new study.

Past research hinted that taking vitamin B12 and folic acid might help protect memory and thinking skills, according to background information from the study. But follow-up trials have yielded less convincing findings.

The current study included nearly 3,000 people with an average age of 74. Half took a tablet daily with 500mcg of vitamin B12 and 400mcg of folic acid daily for two years. The rest took a placebo. All participants had high levels of homocysteine, which has been linked to memory loss and Alzheimer’s disease.

Memory and thinking skills tests were given at the start and end of the study. Results of the study were published in the November 12 issue of Neurology.

“Since homocysteine levels can be lowered with folic acid and vitamin B12 supplements, the hope has been that taking these vitamins could also reduce the risk of memory loss and Alzheimer’s disease,” Rosalie Dhonukshe-Rutten, of Wageningen University in the Netherlands, said in a journal news release.

Dhonukshe-Rutten and her colleagues found that people taking the vitamin B12-folic acid supplements had larger decreases in homocysteine levels than those taking the placebo. Despite the decrease, there was no difference between the two groups on the thinking and memory tests.

Wednesday, November 19, 2014

SmartRide 11

Last Friday morning at sunrise, my wife and I joined over 400 cyclists on a journey from Miami to Key West. This is the fifth year we have made the 165 mile trek and by far it was the hardest.

SmartRide is a charity event that raises money for those suffering with HIV/Aids. This year we raised 1.1 million dollars and that will be distributed to seven organizations, all in Florida. One hundred percent of the money raised goes to the charities. In fact, as a rider, I will decide where 50% of the money I raised goes.
It is a great event and the need is even greater. However, for the purpose of this blog, I would like to focus on the health aspects of the ride.

Typically, we train for 3-4 months prior to the ride. That involves a long ride each weekend and a couple of spinning classes during the week. We start with a 26 mile ride as a base and build from there. By the time the ride is over, we’ve ridden over 1500 miles in preparation for the event.

This past year, I tried to ride offseason as well and was able to log an additional 1000 miles on the bike. Our base began with a 40 mile ride, rather than 26, and we fared better than most riders during the event.

For the past four years, the ride was difficult for the first 50 miles as we work our way south and east to Key Largo against a strong head wind. However, once we made the turn west on Card Sound Road, that head wind became a tail wind and carried us all the way to Key West.

Monday, November 17, 2014

Can Video Game Play Help Young Minds Learn?

New research suggests that action video games like ‘Call of Duty’ can teach young adults new skills while also improving the way the skills are learned.

It’s not clear how the improved learning abilities may translate to life outside of the screen and joystick. There’s also no evidence that endless playing of video games is a good idea.

“Our studies are no excuse for binging on video games,” said study co-author Daphne Bavelier, a research professor with the department of brain & congnitive sciences at the University of Rochester in New York. Still, she noted, the research reveals the “beneficial effects of playing action video games on vision, attention, and now learning.”

At issue is a phenomenon known as “perceptual learning.” In particular, the small study examined the kind of perceptual learning that’s involved in detecting the subtle differences between things – “the process whereby one person might be able to taste the difference between wines because he has had perceptual practice, but to another person they taste the same,” said Felice Bedford, an associate professor emeritus of psychology at the University of Arizona who’s familiar with the study.

The study involved several different experiments with young adults, average age of 22, both skilled and unskilled, playing various video games.

In one experiment, they trained 26 players for 50 hours on the action video games ‘Call of Duty 2’ and ‘Unreal Tournament 2004’ and then compared them to players of non-action video games like ‘The Sims.’ Those who played the action games showed improvement in not just their skills but also their abilities to learn in certain areas, the test showed.

“I think they are learning how to better apply themselves to certain types of tasks,” said Aaron Seitz, a psychology professor at the University of California, Riverside. The brain, he said may be adjusting to using certain skills.

This kind of learning is important in real life, he added. “Many tasks that we do involve understanding what to look for. This ranges from finding the cereal that we are looking for at the grocery store to the skills of radiologists and even athletes,” Seitz said.

Friday, November 14, 2014

Spinal Surgery Varies by Region in U.S.

“Nearly 80% of Americans will experience low back pain at some point in their lives, and about 30 million people a year receive professional medical care for a spine problem,” co-author Brook Martin, of the Dartmouth Institute of Health Policy & Clinical Practice, said in a college news release.

In spinal stenosis, thickening of tissue surrounding the spine affects the spinal nerves, resulting in pain, according to background information in the study. Treatments include surgery, medication, physical therapy and steroid injections, the study said.

The two types of surgery of surgery for spinal stenosis are spinal decompression and spinal fusion. In spinal decompression, doctors remove the tissue compressing the spinal nerves. In spinal fusion, surgeons join two or more vertebrae to stabilize the spine.

Spinal fusion has a higher risk of infection and readmission to the hospital, and there is no evidence that it provides greater benefit to patients, according to the news release. Even so, its use increased 67% among Medicare patients from 2001 to 2011 and it’s now more common than spinal decompression, the researchers said.

The study’s analysis of Medicare data revealed that rates of spinal decompression varied eightfold across the United States, from about 25 procedures per 100,000 patients in Bronx, N.Y., to nearly 217 procedures per 100,000 patients in Mason City, Iowa. In general, rates of spinal decompression were higher in the Pacific Northwest and northern Mountain states.

Wednesday, November 12, 2014

Wisdom Wednesday: Glandular Therapy

A basic concept of glandular therapy is that the oral ingestion of glandular material of a specific animal gland will strengthen the corresponding human gland. The early Egyptians are credited with this concept of “like cures like”. People with liver ailments were encouraged to eat liver. Those with kidney disease were fed animal kidneys.

The concept really dates back many thousands of years and is still practiced in its original format in primitive cultures throughout the world. If you killed your enemy in battle and especially if he was brave, you ate his heart to absorb his courage. This might be the heart of a lion, other ferocious animal or maybe the leader of a rival tribe.

Glandular extracts were in wide use all over the world until the early 1940s. With the discovery of antibiotics, modern medicine turned from the use of glandular extracts to research in developing antibiotics and other pharmaceutical drugs.

Purified extracts from the endocrine glands of animals are used today in alternative medicine to treat a host of illnesses. The most common extracts are thyroid, thymus and adrenal. However, pituitary pancreas, heart, liver, kidney, prostate, ovary, and other glandular extracts are readily available.

Protomophogens are specific extracts from the nucleus of the cells of specific glands. The process for extraction was developed in the 1940s by Dr. Royal Lee, using sea salt to concentrate the nuclear material. He stated that protomorphogens are tissue specific, not species specific. That is adrenal protomorphogen will support any adrenal gland, human or otherwise. Dr. Lee had two theories to explain the benefits of protomorphogens.

Monday, November 10, 2014

High-Fat, Low-Carb Diet May Help Treat Epilepsy

A review of five studies found that a ketogenic, or modified Atkins, diet, that focuses on foods like bacon, eggs, heavy cream, butter, fish and green vegetables, could help reduce seizures in adults whose condition doesn’t improve with medication.

“We need new treatments for the 35% of people with epilepsy whose seizures are not stopped by medications,” study co-author Dr. Pavel Klein explained in an American Academy of Neurology news release. “The ketogenic diet is often used in children, but little research has been done on how effective it is in adults.”

In conducting the review, the researchers analyzed five studies on the ketogenic diet with a ratio of fat to protein/carbohydrate of 3 or 4 to 1. They also reviewed five more studies on the modified Atkins diet, which has a 1 to 1 fat to protein/carbohydrate ratio by weight.

The researchers found that 32% of the patients on the ketogenic diet and 29% of those following the modified Atkins diet had reduction in their seizures of 50% or more. Meanwhile, 9% of those in the ketogenic diet group and 5% of the modified Atkins group had drops in their seizures by 90% or more, according to the study published October 29 in Neurology.

The benefits of these high-fat diets happened quickly – just days or weeks after the patients began following them. The results persisted, but only if the adults continued to follow the diets. Once the patients stopped following the diets, the benefits also stopped, the researchers noted. None of the side effects of the diets were serious, and most often the patients experienced weight loss, not weight gain, the researchers said.

Friday, November 7, 2014

Almost 1 in 5 Americans Plagued by Constant Pain

The poll of roughly 35,000 American households reveals almost one-fifth of Americans experience daily crippling, chronic pain according to a new report published in the October issue of the Journal of Pain.

“I wasn’t particularly surprised by our findings,” said study author Jae Kennedy, a professor of health policy and administration at Washington State University in Spokane. “But I found it sobering that so many American adults are grappling with persistent pain.”

The study authors analyzed responses to a 2010 National Center for Health Statistics survey. Those who said they had experienced serious continual pain during the prior three months were the focus of the poll, rather than participants who said they had experienced short-term pain or pain that was intermittent or moderate in nature. Overall, 19 percent of the adults polled were deemed to have experienced “chronic” and severe daily pain.

That grouping did not, for the most part, include adults who said they struggled with arthritis or back and joint pain, as those people tended to say their pain was not constant and persistent, the study authors noted.

The chronic pain figure exceeded 18% among specific groups of respondents, including those between the ages of 60 and 60, women, those who said their health was fair or poor, those who were obese or overweight, and those who had been hospitalized in the prior year.

Kennedy suggested that for those experiencing chronic, crippling pain there are a variety of potential interventions including physical and occupational therapy, exercise, dietary changes, weight loss, massage and psychotherapy, alongside alternative interventions such as acupuncture, yoga and chiropractic services.
Medicines, including narcotic painkillers like hydrocodone, oxycodone and morphine, can also be helpful, but only if long-term use is avoided, Kennedy said.

“We are clearly overusing opioids [narcotics],” he noted. “The US consumes about 60% of the world’s opioid supply, and 99% of the hydrocodone supply. These medications are effective in the short term for managing postoperative pain, but long-term use often leads to dependency or addiction.”

Wednesday, November 5, 2014

Wisdom Wednesday: The Shoulder

Pain and limited motion in the shoulder is a very common musculoskeletal complaint. Its frequency is second only to low back pain. The onset is usually insidious but there is usually some history of a past injury. Most of us tear the rotator cuff of the shoulder at some point in our youth and most of us have forgotten the injury. As we age, this old injury often comes back to haunt us.

The rotator cuff is a group of muscles that support the shoulder and create movement. They are, in order of importance, the supraspinatous, infraspinatous, serratus anticus, teres minor, and subscapularis.

The shoulder is an unusual joint in that there are no ligaments to hold the humeral head to the glenoid fossa of the shoulder. So it is the rotator cuff muscles that hold the arm into the socket. To facilitate this process, the supraspinatous contracts constantly, even in your sleep. It is the only skeletal muscle in the body that does so. If the supraspinatous is weak, the arm actually dislocates from the shoulder. This commonly occurs during sleep and is often the cause of chronic shoulder pain. Strengthening the supraspinatous is the key to resolving most shoulder problems.

Constant contraction of the supraspinatous requires ongoing input from the nervous system, so weakness of the supraspinatous can be an indicator of brain imbalance. The supraspinatous is used in Applied Kinesiology (AK) to evaluate the limbic portion of the brain, specifically its relationship with the endocrine system.

In similar fashion, the teres minor is related to the thyroid gland. So weakness of the teres minor may indicate thyroid imbalance. Monitoring teres minor weakness is also used in AK to evaluate the endocrine system.

The shoulder is also a common site for referred pain. In cardiac insufficiency, pain is often referred from the heart to the left shoulder and down the left arm. Gallbladder inflammation will refer pain to the right shoulder in a similar fashion. When evaluating shoulder pain these referred pain pathways must always be considered, even when there is a strong history of injury.

Monday, November 3, 2014

Exercise as the Best Medicine

Sports cardiology researchers from Texas Presbyterian Hospital recently published their new study in the journal Circulation.

They wanted to demonstrate that cardiac adaptation to regular exercise is based on the training load, not just genetics. They enrolled 12 sedentary human volunteers in a 1-year training program. All participants underwent supervised training, frequent MRI scans, and even cardiac catheterization at the beginning and end of the study.

The endurance training began with exercising 30 to 45 minutes three to four times per week by brisk walking, jogging, swimming, or cycling. Then, after a couple of months of base training, exercise intensity and duration was gradually increased. After 9 months, a long run was added to a steady dose of interval training. At the end of the study, average exercise time per week was 7 to 9 hours.

The results were striking. The right and left ventricles of all participants underwent structural changes seen in elite-level athletes. RV mass and volume increased significantly and immediately. Months later, when more intense intervals were introduced, the researchers observed the same eccentric hypertrophy in the LV. VO2max surged by an average of 20%. Cardiac compliance, diastolic volume at a given pressure, increased significantly – but nowhere near as much as elite athletes.

At the end of the study, all the previously sedentary subjects completed their endurance goals: a marathon for 10 of them, an Olympic-distance triathlon for one and a cycling “century” (100 miles) for one.

Friday, October 31, 2014

Study Finds Kidney Stones Linked to Weakened Bones

Kidney stone patients may be at increased risk for broken bones and may require treatment to protest their bone health, a new study suggests.

Researchers led by Dr. Michelle Denburg, of the Children’s Hospital of Philadelphia, analyzed data from nearly 52,000 British kidney stone patients and more than 517,000 people without kidney stones.

During a median follow-up of nearly five years, kidney stone patients were at significantly higher risk for fractures, and this increased risk affected all bones, Denburg’s team found.

Overall, males with kidney stones were 10% more likely to suffer broken bones than those without kidney stones. The risk was highest among male teens – those with kidney stones had a 65% higher risk for fractures than those without kidney stones.

Among women, those with kidney stones had a 17% to 52% increased risk of fractures from their 20s to their 60s, with the highest risk among women age 30 to 39, according to the study published October 23 in the Clinical Journal of the American Society of Nephrology.

The findings only point to an association between kidney stones and fracture risk, and do not prove a cause-and-effect relationship. However, the researchers believe that efforts to boost kidney stone patients bone health might help shield them from fractures.

Wednesday, October 29, 2014

Wisdom Wednesday: Milk Thistle

Milk Thistle or silymarin is considered to be both hepatoprotective and hepatic trophorestorative. That is it protects and restores liver cells. I have used it for many years to treat various forms of hepatitis.

Hepatitis C often goes undiagnosed until someone has their liver enzymes checked for a routine physical or insurance quote and they come back slightly elevated. The SGPT and SGOT are liver enzymes that are released in the blood stream as liver cells die. When liver cell death is accelerated, the enzymes rise in the blood stream.

In active hepatitis, the enzymes can elevate ten to fifty times the medical norms. However, after the acute infection passes, the enzymes tend to stay just a few points above medical norms. This chronic, accelerated liver cell death can go on for 20 years or more. Then, without warning, the liver will fail. These patients require a liver transport or face certain death.

Milk thistle is extremely effective in bringing the liver enzymes back within medical norms. I have several patients with a history of hepatitis. We monitor their liver enzymes periodically. Every couple of years, the enzymes will start to creep back up again. A three month course of silymarin generally brings the enzymes back within the normal range.

Monday, October 27, 2014

Dangerous Dietary Supplements Return to Store Shelves

The FDA frequently recalls dietary supplements that are found to contain banned substances. But a new study suggests that many of these products return to store shelves months later with the same dangerous ingredients.

The study, published in JAMA, the Journal of the American Medical Association, found that out of more than two dozen supplements that were pulled from shelves after that were found to contain anabolic steroids or powerful prescription drugs, roughly two-thirds were back on the market a year later with the same illicit ingredients.
Most of the supplements were marketed for weight loss, exercise and sexual enhancement, and they were sold across the country at convenience stores, in health food shops and over the Internet. They were found to contain steroids and prescription drugs like Viagra and Prozac, an antidepressant.

The study also found that several of the weight-loss products contained Sibutramine, an amphetamine-like drug that was removed from the market in the US, Asia and Europe after a clinical trial showed it increased the risk of heart attacks and strokes.

In recent years, research has shown that herbal supplements such as echinacea, Ginkgo biloba and St. John’s wort are frequently mislabeled or diluted with cheap fillers like powdered rice.

Jennifer Dorren, a spokeswoman for the FDA, said that supplement companies “are legally responsible for marketing a safe product that is not adulterated.” But because companies do not need approval to sell their products, she said, the agency cannot identify tainted supplements before they reach consumers.

Friday, October 24, 2014

Practice Guideline Nixes Testosterone Therapy for Women

New clinical practice guidelines issued by the Endocrine Society were published in the October issue of the Journal of Clinical Endocrinology and Metabolism.

The guideline is an update from 2006. “We don’t have any data to support the use of testosterone or DHEA (dehydroepiandrosterone) in women, and there’s no evidence for an androgen-deficiency syndrome,” says Margaret E. Wierman, MD, from the University of Colorado. She is the writing chair and Endocrine Society vice president.

Specifically, testosterone is not recommended to treat women with infertility or cognitive, cardiovascular, metabolic, or sexual dysfunction (other than hypoactive sexual desire) or to promote bone health or well-being, she added.

Limited evidence suggests that postmenopausal women who are upset by and diagnosed with hypoactive sexual desire disorder might benefit from a 3-to-6 month trial dose of testosterone, according to the guideline. But these patients would have to be closely monitored for signs of androgen excess.

Moreover, “the next bump in the road…is that currently, there are no FDA-approved preparations [of testosterone for women] in the US,” and the testosterone patch for women is no longer approved in Europe, Dr. Wierman explained.

However, some physicians still opt to prescribe testosterone therapy to otherwise-healthy women on an off-label basis, she noted. “If you’re going to use it off label – which we don’t recommend - you really have to carefully monitor [testosterone levels]…so that you’re not overshooting the normal range,” she stressed.

Wednesday, October 22, 2014

Wisdom Wednesday: The Patient Always Knows

I frequently reiterate this statement to my patients, “on some level, the patient always knows.” As a physician it is my obligation to listen to what my patient is trying to tell me.

Many years ago, during an initial consult, I had a new patient who confided to me, “I don’t know what it is, but I just feel like something is living inside of me.” Initially, I discounted her statement. I continued the history learning that she and her husband had been separated for six months and that her stress levels were quite high.

I ordered some routine lab work on her and scheduled a follow up visit. The lab work include a urine analysis which came back showing Chlamydia, an STD (sexually transmitted disease). Typically, Chlamydia doesn’t show on a UA but will on a vaginal smear. However, her infestation was so high that hundreds of thousands of these microscopic organisms spilled over into the urine. I was very fortunate to have stumbled across the correct diagnosis. Chlamydia looks like sperm, with a head and a tail swimming about. They are too small to feel yet she knew on some level, “something was living inside” of her. When I shared my findings with her she admitted that she had separated from her husband because he had a thing for prostitutes.

Patients live in their bodies 24/7. They know on some level what is going on. However, they often cannot express that information in a way that the physician will understand. Many times, the patient doesn’t really understand what they are trying to say either. That new patient taught me “the patient always knows.”

Monday, October 20, 2014

New Target for Treating Autoimmune Disorders

Researchers at University of California, San Diego School of Medicine have discovered that T-cells – a type of white blood cell that learns to recognize and attack microbial pathogens – are activated by a pain receptor.

The study published in Nature Immunology, shows that the receptor helps regulate intestinal inflammation in mice and that its activity can be manipulated, offering a potential new target for treating certain autoimmune disorders, such as Crohn’s disease and possibly multiple sclerosis (MS).

“We have a new way to regulate T-cell activation and potentially better control immune-mediated diseases,” said senior author Eyal Raz, MD, professor of medicine.

The receptor, called a TRPV1 channel, has a well-recognized role on nerve cells that help regulate body temperature and alert the brain to heat and pain. It is also sometimes called the capsaicin receptor because of its role in producing the sensation of heat from chili peppers.

The study is the first to show that these channels are also present on T-cells, where they are involved in gating the influx of calcium ions into cells – a process that is required for T-cell activation.

“Our study breaks current dogma in which certain ion channels called CRAC are the only players involved in calcium entry required for T-cell function,” said lead author Samel Bertin, a postdoctoral researcher in the Raz laboratory. “Understanding the physical structures that enable calcium influx is critical to understanding the body’s immune response.”

T-cells are targeted by the HIV virus and their destruction is why people with AIDS have compromised immune function. Certain vaccines also exploit T-cells by harnessing their ability to recognize antigens and trigger the production of antibodies, conferring disease resistance. Allergies, in contrast, may occur when T-cells recognize harmless substances and pathogenic.

Friday, October 17, 2014

Simple Blood Test Could Be Used as a Tool for Early Cancer Diagnosis

Hypercalcemia is the most common metabolic disorder associated with cancer, occurring in 10-20% of people with cancer.

While its connection to cancer is well known, this study has, for the first time, shown that often it can predate the diagnosis of cancer in primary care.

The research, published in the British Journal of Cancer, analyzed the electronic records of 54,000 patients who had elevated levels of calcium and looked at how many of them went on to receive a cancer diagnosis.

Dr. Fergus Hamilton, who led the research from the Centre of Academic Primary Care at the University of Bristol, said: “All previous studies on hypercalcemia and cancer had been carried out with patients who had already been diagnosed with cancer – hypercalcemia was seen as a late effect of the cancer.”

“We wanted to look at the issue from a different perspective and find out if high calcium levels in blood could be used as an early indicator of cancer and therefore in the diagnosis of cancer.”

Analysis of the data found that in men, even mild hypercalcemia (2.6-2.8 moll/l) conferred a risk of cancer in one year of 11.5%. If the calcium was above 2.8 moll/l, the risk increased to 28%. In women, the risks were much less, with the corresponding figures being 4.1% and 8.7%.

In men, 81% of the cancer associated with hypercalcemia was caused by lung, prostate, myeloma, colorectal and other hematological cancers.

Wednesday, October 15, 2014

Wisdom Wednesday: Female Health Concerns

I attended a seminar last weekend in Miami and thought I would share some of the high points. My chiropractic license requires 40 hours of continuing education every two years. However, my nutritional diplomat requires 12 hours each year. Some of the hours can overlap, but for the most part I take different classes for each requirement. The nutrition classes are by far the more interesting.

The class composition is always quite eclectic when nutrition is the topic. We had MDs, DOs, acupuncture physicians, naturopathic physicians, registered dieticians, a few chiropractors, and some of the staff from the UM School of Medicine. The instructor, Michelle J. Pouliot, ND practices naturopathic medicine in Connecticut. She specializes in women’s issues and over 80% of her practice is comprised of adult females.

The seminar focus was on PMS, perimenopause, menopause, osteoporosis and female sexual issues.

On the surface all these health issues appear to be hormonal and to a great extent they are. Dr. Pouliot frequently uses botanical herbs like Chaste Tree, Black Cohosh, White Peony, and Wild Yam to treat her patients. She is even more enthusiastic about Chaste Tree than I am. However, she also provided great information about the neurological aspects of female health concerns.

Monday, October 13, 2014

The Evolution of Sleep: 700 Million Years of Melatonin

Scientists at the European Molecular Biology Laboratory in Germany study the activity of genes involved in making melatonin and other sleep-related molecules.

They have compared the activity of these genes in vertebrates like us with their activity in a distantly related invertebrate – a marine worm called Platynereis dumerilii.

As 2-day old larvae, these worms float near the ocean surface at night, feeding on algae and other bits of food. Then they spend the day at lower depths, where they can hide from predators and the sun’s ultraviolet rays.

Scientists discovered that cells on the top of the larvae make light catching protein – the same ones we make in our eyes to switch melatonin production on and off. These same cells also switch on genes required to produce melatonin.

They wondered if the worms were using this network of melatonin genes the way we do. To find out, Dr. Maria Antonietta Tosches and her colleagues tracked the activity of the genes over 24-hour periods.

They found that the worms didn’t produce melatonin all the time. Instead, they made it only at night, just like we do. In addition, the scientists found that this nightly surge of melatonin allowed the worms to move up and down in the ocean each day.

The worms travel by beating tiny hairs back and forth. During the day, they rise toward the surface of the ocean. By the time they get there, t he sun has gotten so faint that the worms start making melatonin.

The hormone latches onto the neurons that control the beating hairs and cause them to produce a steady rhythm of electrical bursts. The bursts override the beating, causing the hairs to freeze and the worm to sink. When dawn comes, the worms lose their melatonin and start to swim upward again.

Friday, October 10, 2014

Standard Treatment for Underactive Thyroid Gland Still Best

A expert panel reviewing treatments for hypothyroidism has concluded that the drug levothyroxine (L-T4) should remain the standard of care.

The updated guidelines from the American Thyroid Association were published recently in the journal Thyroid.

The thyroid gland produces hormones that control the way every cell in the body uses energy. For example, thyroid hormones control how fast you burn calories and how fast your heart beats. If the thyroid gland produces too little thyroid hormone to control these activities the condition is called hypothyroidism.

A task force convened by the thyroid association reviewed available medical literature and found no evidence that other types of thyroid hormone replacements are better than L-T4, which has long been the standard of care for patients with hypothyroidism. Brand names for L-T4 include Synthroid and Levoxyl.

However, while L-T4 is effective in most patients, some do not regain ideal health when taking L-T4 alone, the authors noted.

The guidelines “provide useful, up-to-date information on why to treat, including subclinical disease, who to treat, and how to treat hypothyroidism,” Dr. Hossein Gharib, president of the thyroid association, said in a journal news release.

“Information is evidence-based and recommendations are graded. I think they will be used extensively by all clinical endocrinologists, especially by our members,” added Gharib, a professor of medicine at the Mayo Clinic College of Medicine in Rochester, Minn.

Wednesday, October 8, 2014

Wisdom Wednesday: Ashwaganda

This is the most commonly prescribed herb in my office. I’m surprised that I have waited so long to write about its virtues. Ashwaganda is an Arevedic herb from India. Its use dates back 6,000 years. The name means “to have the strength of a thousand horses”.

In China, the same herb is called Withania. In TCM (traditional Chinese medicine), the herb is prepared as a tea. In India (western herbalogy) the active ingredients are extracted in alcohol over the course of several days. This is very important as alcohol is an organic solvent. Many of the organic compounds in Ashwaganda do not dissolve in hot water but will dissolve in alcohol. So although the names are interchanged frequently, they are not really the same herbal preparation.

Ashwaganda is an herbal adaptogen. Please review my blogs on The Endocrine System and Hidden Adrenal Issues. Adaptogens must be able to restore the adrenal cortex and medulla in addition to facilitating DNA repair. Only a few substances have been found on the planet that are capable of this level of healing and all of them are herbs.

The major components of the Ashwaganda are steroidal compounds and alkaloids. The plant stores these chemicals in the root which is the only part of the plant used in herbal preparations. It has no known interactions but is contraindicated the first trimester of pregnancy as studies with female mice have shown some antifertility effects.

Monday, October 6, 2014

New Clues to How Colds Can Spur Asthma Attacks

Scientists have pinpointed a molecule that may trigger potentially life-threatening asthma attacks brought on by colds.

The researchers say this finding could offer a target for new drugs to be developed to treat these attacks.

Most asthma attacks (80-90%) are caused by viruses that infected the airways, according to the British researchers. Most of these are rhinoviruses which are the main cause of the common cold.

The researchers found that a specific molecule called IL-25 may play a major role in asthma attacks caused by colds. The findings are published in the Oct. 1 issue of Science Translational Medicine.

“Our research has shown for the first time that the cells that line the airways of asthmatics are more prone to producing a small molecule called IL-25, which then appears to trigger a chain of events that causes attacks,” study co-lead author Nathan Bartlett, of the National Heart and Lung Institute at Imperial College London, said in a college news release.

“By targeting this molecule at the top of the cascade, we could potentially discover a much-needed new treatment to control this potentially life-threatening reaction in asthma sufferers,” he added.

Friday, October 3, 2014

Sense of Smell May Predict Longevity

A defective sense of smell appears to be a good predictor of longevity, a new study has found.

Researchers tested a nationally representative sample of 3,005 men and women age 57 to 85 on their ability to identify five smells: rose, leather, orange, fish and peppermint. The study appears online in PLOS One.

They controlled for many factors – age, sex, socioeconomic status, smoking, alcohol intake, education, body mass index, race, hypertension, diabetes, heart attack, emphysema, stroke and diet. But still, people who could not detect the odors were more than three times as likely to die within five years as those who could. The lower their scores on the odor test, the more likely they were to die. Only severe liver damage was a better predictor of death.

The researchers believe that the decline in the ability to smell is an indicator of some other age-related degeneration, and is not itself a cause of death.

The lead author, Dr. Jayant M. Pinto, an associate professor of surgery at the University of Chicago, said that loss of smell should not be ignored. “There are treatable causes of olfactory loss,” he said, “so if people have problems, they should get evaluated. This is a gross indication of your health, so if you’re having some trouble, you should see a doctor.”

Wednesday, October 1, 2014

Wisdom Wednesday: Visceral Referred Pain

Visceral referred pain (VRP) is an important concept in the evaluation and treatment of patients. In brief, it is a location on the skin of referred pain from an internal organ. Virtually all organs have VRP locations. Even though you may not realize it, you are familiar with some of them.

When someone is having coronary insufficiency or a heart attack, their heart does not hurt. The referred pain (angina) is generally into the left arm but can also include the left chest, mid-back and into the jaw and teeth. In appendicitis, the pain is referred to the skin over the pancreas. Gallbladder problems often refer pain into the right shoulder. When the kidneys are inflamed (think kidney stone) the pain is referred down the sides into the outer aspect of the thighs.

We use these VRPs initially as diagnostic tools. When a new patient comes in with right shoulder pain, the gallbladder is in the differential diagnosis. If they also note right sided abdominal pain late at night, especially after a heavy evening meal, gallbladder moves to the top of the list. Treating the right shoulder as a mechanical issue with manipulation and therapy will often provide good temporary relief. However, the pain will always return if the gallbladder is the real issue.

VRPs are also used in muscle testing challenges. Pinching a VRP stimulates the nociceptors (pain receptors in the nervous system) and stimulates the sympathetic system (fight or flight). Rubbing a VRP stimulates the parasympathetic system (increases digestion, calms everything else).

Challenging a VRP helps locate the source of a health issue. It can also be used to temporarily negate a reflex. If, for example, I find a histamine response to wheat sensitivity has an active VRP to the small intestine, I can stimulate the VRP, temporarily shutting the reflex off. This allows me to move forward in the QA (Quintessential Applications) protocol. Otherwise, I would have to wait weeks or even months until the histamine issue was resolved to test further.

Monday, September 29, 2014

Healthy Lifestyle May Prevent 80% of Heart Attacks

Middle-aged and older men were much less likely to have heart attacks over an average of 11 years if they drank moderately, didn’t smoke, exercised regularly, ate right, and control their weight, a new study has found.

Only about 1% of the men involved in the study fit into this ultra-healthy-living category. But they were 86% less likely to have heart attacks than those who ate poorly, were overweight, exercised too little, smoked and drank too much alcohol, the researchers said.

The healthiest men could still eventually die of a heart attack, of course, and the study didn’t say if they live longer than others.

Still, “there is a lot to gain and money to be saved if people had a healthier lifestyle,” said study lead author Agnete Akesson, an associate professor with the Institute of Environmental Medicine at Karolinska Institute in Solna, Sweden.

For the study, published in the Journal of the American College of Cardiology, the researchers examined medical records and surveys of more than 20,700 Swedish men who were 45 to 79 years old in 1997. At the time, they had no history of cancer, heart disease, high blood pressure or high cholesterol. The researchers tracked them until 2009 to see how they fared.

8% of the men – 1,724 – did not practice any of the 5 healthy behaviors, and 166 of that group suffered heart attacks.

Of the 1% of men – 212- who practiced all 5 healthy behaviors, only 3 had heart attacks.
Based on their findings, the researchers concluded that all 5 healthy behaviors together could prevent 79% of first heart attacks in men.

Also, each behavior by itself reduced the risk for heart attack. For example, eating a diet rich in beneficial foods, such as fruits, vegetables, nuts, reduced-fat dairy and whole grains was associated with a nearly 20% lower risk compared to those who practiced none of the healthy behaviors, the study found.

Friday, September 26, 2014

Common Painkillers Tied to Blood Clot Risk, Study Suggests

People who use nonsteroidal anti-inflammatory drugs (NSAIDs) – which include aspirin, naproxen (Aleve) and ibuprofen (Advil, Motrin) – may be at increased risk for potentially deadly blood clots, a new study suggests.

But the study only showed an association between the use of NSAIDs and higher clotting risk, it did not prove cause-and-effect.

The researchers analyzed the results of six studies involving more than 21,000 cases of a type of blood clot called a venous thromboembolism (VTE). These clots include deep vein thrombosis (a clot in the leg) and pulmonary embolism ( a clot in the lungs).

Reporting in Rheumatology, the analysis found that people who used NSAIDs had an 80% higher risk for venous clots.

“Our results show a statistically significant increased VTE risk among NSAID users. Why NSAIDs may increase the risk of VTE is unclear,” said study lead author Palompoog Ungprasert, of the Bassett Medical Center, NY.

“Physicians should be aware of the association and NSAIDs should be prescribed with caution especially in patients already at a higher risk of VTE,”
the researcher added.

Ungprasert stated that all types of NSAIDs were evaluated as a group, but not all NSAIDs may boost the risk of VTE.

Two experts said the findings are in keeping with prior research.

“It is not entirely surprising that NSAIDs are again implicated in causing clot related illness” said Dr. Steven Carsons, chief of the division of rheumatology, allergy and immunology at Winthrop University Hospital in New York. He pointed to the case of Vioxx, a powerful NSAID that was withdrawn from the market in 2004, after studies found a higher risk of heart attack and stroke in users.

The new study “makes a compelling case for further study and clinical surveillance for venous clotting events in those patients taking NSAIDs,” Carsons said. However, he stressed that the study could not pinpoint which types of NSAIDs might pose the greatest risk, or which type of patients might be most vulnerable.

Wednesday, September 24, 2014

Wisdom Wednesday: Chronic Low Back Pain

This new patient has been suffering from left sided sciatica for three months. About six weeks ago, he was hospitalized and treated for sciatica. During the hospital stay, he developed a perforated large intestine and had surgery, removing about a foot of large intestine and installing a colostomy bag. Subsequent surgery to remove the colostomy bag was successful. However, he developed C. difficile as a result of antibiotic therapy. After a few weeks, they were able to control the diarrhea well enough to send him home. He still has radiating pain down his left leg, his bowels are still inflamed with frequent diarrhea, and he now notes body wide aches.

Compare this history with the case of acute low back pain from last week’s Wisdom Wednesday. Obviously, this case is much more complex. On reviewing his history, he describes the pain as running down the anterior aspect of the left leg to the knee with occasional radiation into the groin. This is not the course of the sciatic nerve and, in fact, he was suffering from femoral neuralgia rather than sciatica. I have no clear information on the cause of the perforated intestine. However, I do comment on the relationship between these illnesses in my conclusions.

C. difficile kills about 1600 people in the US each year as the result of electrolyte imbalances associated with the diarrhea. It is an opportunistic infection that overgrows following the use of antibiotics. Please see my blog “Serious Diarrheal Infection in Kids Linked to Antibiotics” posted on March 14, 2014. Adults commonly develop C. difficile during hospital stays.

QA evaluation revealed impairment of Autogenic Facilitation (AF). Therapy Localization (TL) was to the surgical site of the perforated colon. This was corrected by Injury Recall Technique (IRT) restoring AF. Testing for inflammation was negative for prostaglandins, leukotrienes, cytokines, and histamine. However, nitric oxide was positive with a good response to L-glutamine, a particular probiotic (Saccharomyces boularidii), and folic acid. Challenge of the ilio-lumbar ligament was positive on the left, and after IRT correction, it returned again in weight bearing. TL was positive to the L4 vertebra, but no manipulation was performed.

Monday, September 22, 2014

Could Artificial Sweeteners Promote Diabetes and Obesity?

For those who are diabetic or dieting, you may think artificial sweeteners are your best friend.

They allow you to get the taste of sugar from foods and beverages without the elevated blood sugar levels or calories. But a new study suggests this may not be the case; artificial sweeteners could actually promote obesity and diabetes.

The research team, including Eran Elinav of the Department of Immunology at the Weizmann Institute of Science in Israel, recently published their findings in the journal Nature.

Because artificial sweeteners are low calorie and do not contain carbohydrates, they are often recommended to help with weight loss or to treat or prevent metabolic disorders, such as type 2 diabetes.

However, Elinav and colleagues note that, although some studies support such recommendations, others have indicated that artificial sweeteners actually increase weight gain and raise the risk of metabolic disorders. A study from the Washington University School of Medicine published last year claimed the artificial sweetener sucralose is linked to increased glucose and insulin levels.

“Despite the controversial data, the FDA approved six NAS (non-caloric artificial sweetener) products for use in the US,” the researchers note. These are saccharin, sucralose, aspartame, advantame, neotame and acesulfame potassium.

In this latest study, the team investigated how artificial sweeteners affected the metabolism of mice. For 11 weeks, some mice were supplied with drinking water supplemented with an artificial sweetener – either saccharin, sucralose or aspartame – and glucose, while others drank just water alone or water containing only sugar.

The team found that the mice that drank the water containing glucose and an artificial sweetener developed glucose intolerance – elevated blood sugar levels, whereas the mice that drank water alone or water containing only sugar did not.