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.