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.