Friday, December 23, 2016

Can Frankincense Treat Cancer?

Frankincense oil is derived from the Boswellia tree. It has a long history in myth and folk medicine. In the Bible, it is one of three gifts offered to Jesus by the wise men, possibly because of its apparent healing powers.

Some supporters of herbal medicine argue that frankincense offers numerous health benefits. These supposed benefits include controlling bleeding, speeding up the wound-healing process, improving oral health, fighting inflammatory conditions such as arthritis, and improving uterine health.

Its most promising use may be as a cancer treatment. Cancer is a leading cause of death, killing 8.2 million people worldwide in 2012. Current research on the effectiveness of frankincense is limited, but early results are promising.

A 2006 study published in Planta Medica uncovered a number of ways the boswellic acid in frankincense might fight infection. Boswellic acid inhibited 5-lipoxygenase, a chemical involved in inflammatory processes. Researchers also found that boswellic acid might target free radicals and cytokines. Both of these play a role in inflammation. By disrupting inflammatory processes, frankincense could stop cancer before it starts.

The anti-inflammatory properties of frankincense suggest that it might also be effective in the treatment of diseases such as Rheumatoid arthritis, Crohn’s disease, Bronchial asthma and ulcerative colitis.

Some evidence suggests that frankincense might target cancer cells directly without harming health cells.

A 2009 study of bladder cancer studies how frankincense affected cultures of normal and cancerous bladder cells. The oil targeted cancerous cells, but it did not destroy healthy cells.

A 2015 study found similar effects in breast cancer. The researchers found that frankincense could kill breast cancer cells and disrupt the growth of future cancer cells.

Wednesday, December 21, 2016

Serum Vitamin D

There are many misconceptions about vitamin D. Although the nutrition board still considers it a vitamin, it is actually a steroid hormone like testosterone or estrogen. Vitamins are considered essential to the diet but we can convert cholesterol in the skin to vitamin D when activated by sunlight. However, we also obtain vitamin D in our diet from eggs, fish, cheese, okra and kale.

Whether from the diet or the sun, vitamin D2 or D3 is transported to the liver. There a hydroxyl group is added to the twenty-fifth carbon on the cholesterol ring making 25-hydroxy vitamin D. This compound is released into the blood stream where it circulates in this inactive form.

This is the chemical we measure most frequently on laboratory testing. The normal range is 30-100, but I like to see levels of a least 40 for optimal health. Some physicians promote pushing the serum levels to a minimum of 80 with high supplementation.

The nutrition board allows me to supplement up to 5,000 IU of vitamin D per day with no laboratory testing to verify the need. However, supplements above 5,000 IU daily must have lab tests to document the need.

Vitamin D supplementation became very popular about 10 years ago following a study that showed significant health benefits from supplementation. Unfortunately, they used 50,000 IU, given once a week in that study and that has become the gold standard for prescribing vitamin D. The study used that format to verify compliance, having test subjects come to the facility once a week and watch them swallow the supplement. They also discarded data showing liver toxicity from the published report.

Monday, December 19, 2016

1 in 6 U.S. Adults Takes a Psychiatric Drug

Researchers found that in 2013 nearly 17% of adults said they filled one or more prescriptions for antidepressants such as Zoloft; sedatives and sleep drugs, including Xanax and Ambien; or antipsychotics, used to treat schizophrenia and bipolar disorder.

“From a drug safety perspective, I am concerned that so many of these drugs have withdrawal effects and that some of the overwhelming long-term use may reflect drug dependence,” said study co-author Thomas Moore.

“These questions need further investigation,” added Moore, a senior scientist for drug safety and policy at the nonprofit Institute for Safe Medication Practices in Alexandria, Va.

Because most prescriptions for these drugs are written by primary care physicians, not psychiatrists, patients aren’t getting the mental health care they need, one specialist said.

“The use of psychotropic medication has become an issue of increasing concern in the U.S, both due to lack of clarity of the medical target of some psychotropic treatment, as well as the rising costs of health,” said Dr. Shawna Newman, who wasn’t involved in the study. She’s a psychiatrist at Lenox Hill Hospital in New York City.

“Access to psychiatrists and appropriate mental health treatment is a vital issue in U.S health care,” Newman said.

Among the 1 in 6 people who reported use of these drugs, 12% said they had taken an antidepressant, and 8% reported filling a prescription for anxiety medicine, sedatives or sleep aids. Nearly 2% had taken antipsychotic drugs, the investigators found.

Among all adults using these drugs, eight of 10 reported long-term use, meaning three or more prescriptions were filled in 2013 or they were continuing a prescription started in 2011 or earlier.

Also, use of these drugs increased with age, with one-quarter of those 60 to 85 reportedly taking them compared to 9% of 18-39-year-olds.

Among the 10 leading psychiatric medications were six antidepressants Zoloft, Celexa, Prozac, Desyrel, Lexapro and Cymbalta. Also in the top 10 were three anxiety drugs, Xanax, Klonopin and Ativan; and the sleep aid Ambien, according to the study.

The results were published online Dec. 12 in the journal JAMA Internal Medicine.
These estimates of usage may be low, the study authors said, because the prescriptions were self-reported by the users, leaving the door open for inaccurate memory or misrepresentation.

My Take:
One psychiatrist goes on the say that more Americans likely need these medications. This attitude and the trend to prescribe these drugs for aging patients is alarming at best. While 25% of Americans may have a mental health issue, they require counseling, not drugs.

The PCP (primary care physician) might feel justified prescribing these drugs short term and then referring the patient for mental health counseling, but 80% of adults report long term use that often spans several years. That’s drug abuse.

The Bottom Line:
most of these medications have low value and high cost. The benefits are short term at best and the long term side effects are numerous and severe. If you are taking one of these medications talk to your PCP about weening off the medication and seeking appropriate mental health counseling.

Source: December 12, 2016 National Institutes of Health

Friday, December 16, 2016

U.S. Doctors Still Over-Prescribing Drugs

Despite evidence that certain drugs aren’t always necessary, doctors are still prescribing these treatments, a new survey of doctors reveals.

Antibiotics are by far the drugs most frequently used in situations where they’ll provide no value for patients. The survey found that more than a quarter of doctors surveyed (27%) said that antibiotics are often administered to patients when the drugs will do no good.

In most cases, the antibiotics are prescribed to treat upper respiratory infections even though these are most often caused by viruses unaffected by the medication, said Dr. Amir Qaseem. He’s vice president of clinical policy for the American College of Physicians (ACP) and chair of the ACP’s High Value Care Task Force.

Other treatments that doctors use frequently despite their questionable value include aggressive treatments for terminally ill patients (9%), drugs prescribed for chronic pain (7%), and dietary supplements such [as] fish oil and multivitamins (5%), the survey revealed.

“There is a lot of waste in our health care system, and we need to acknowledge that,” Qaseem said.
The results are from a random survey of 5,000 ACP member physicians. The survey asked doctors to identify two treatments frequently used by internists that were unlikely to provide high value care to patients.

“Value is not the same as cost,” Qaseem said. “High value is a function of the benefits, harms and cost of an intervention all together. Just because something is very expensive does not make it a poor value. There are expensive treatments that provide high value.”

Wednesday, December 14, 2016

Wisdom Wednesday: The Thyroid Profile

The TSH (thyroid stimulating hormone) is the gold standard for evaluating thyroid health. TSH is a pituitary hormone that directs the thyroid to make T4. The normal lab range is 0.4 – 4.5 ulU/L. However, the functional range is much narrower from 1-2 ulU/L. This functional range has been recommended by the American Board of Endocrinology since 2003, but has been ignored by most physicians.

As a minimum, I also recommend running a T3 and T4. Approximately 97% of the thyroid hormone produced by the thyroid gland is in the form of T4. This is the inactive, stable form that circulates in your blood stream. It is called T4 because it is a cholesterol ring with four molecules of iodine attached to it.

When the body’s basic metabolism requires stimulation, the liver removes one molecule of iodine from T4 making T3, the active form of thyroid hormone. This is under the direction of the adrenal glands which take their orders from the hypothalamus and pituitary (home of TSH).

Most thyroid issues are related to poor conversion of T4 to T3, so including these tests when evaluating the thyroid is a must.

Under high levels of stress, the liver can remove the wrong iodine molecule creating ‘reverse T3’. It is indistinguishable from normal T3 and must be measured directly. This is a common occurrence in American Indians and those of Irish decent. Reverse T3 does not have any metabolic function and appears to be a safety valve when stress levels are so high that excess T3 might be released from the liver. Again, this test is seldom run in traditional medical practices.

Wednesday, December 7, 2016

Wisdom Wednesday: Lipid Panel Continued

This week we continue with the HDL, LDL, and triglycerides:

The HDL or high density lipoprotein laboratory range is 40-90 mg/dL while the functional range is above 55 mg/dL. It is produced in the liver and the intestines. HDL is a protein carrier which moves fats from the peripheral tissues to the liver.

HDL is often labeled as “good cholesterol” and it has a strong relationship with coronary artery disease (CAD). Levels below 25 mg/dL double the risk of CAD. Between 26-35, the risk of CAD is 50% higher. The average risk is from 45-59 and levels above that impart below average risk of CAD.

Smoking, excess weight and lack of exercise all diminish HDL levels. Typically, for every 3 pounds of weight loss, the HDL will increase by 1 mg/dL. Of note, high-fat diets consistently improve HDL levels. However, caloric restriction has been shown to lower HDL levels by 2-12 mg/dL although levels will improve again once a normal diet is resumed.

Steroids, diuretics and beta blockers all reduce HDL levels. Low HDLs are commonly seen with liver congestion or a fatty liver, high carbohydrate intake, sedentary lifestyle or exogenous estrogen use.
The LDL or low density lipoprotein is a protein carrier that moves fats from the liver to peripheral tissues. Generally, 60-70% of the total cholesterol is made up of LDL. The laboratory range is 60-130 mg/dL while the functional range is below 120. Most labs calculate the LDL rather than actually measure the level based on the ratios of the other lipids.

LDL is often mislabeled as “bad cholesterol”. It increases as carbohydrates (not fats) increase in the diet. Metabolic syndrome, liver congestion, exogenous hormones, hypothyroidism, oxidative stress and cardiovascular disease are all associated with levels over 140 mg/dL.

Levels below 100 are associated with low vitamin D levels, steroid hormone imbalanaces, hyperthyroidism, severe liver disease, chronic anemia sedentary lifestyle and, of course statin drug therapy.

Monday, December 5, 2016

Wider Low-Dose Aspirin Use Would Save U.S. $692 Billion

Taking low-dose aspirin daily can reduce older Americans’ risk of heart disease and cancer, and lead to significant savings in health care spending, a new study contends.

University of Southern California researchers used national data to assess the long-term benefits of daily aspirin usage. They calculated that taking low-dose aspirin every day would prevent 11 cases of heart disease and four cases of cancer for every 1,000 Americans ages 51- to 79.

“Although the health benefits of aspirin are well-established, few people take it,” said study lead author Dr. David Agus. He’s the founding director and CEO of the university’s Lawrence J. Ellison Institute for Transformative Medicine.

“Our study shows multiple health benefits and a reduction in health care spending from this simple, low-cost measure that should be considered a standard part of care for the appropriate patient,” Agus said in a university news release.

“The irony of our findings is that aspirin may be too cheap,” said study co-author Dana Goldman, director of the USD Schaeffer Center for Health Policy and Economics.

“Only 40% of Americans are taking aspirin when they should, and providers have little incentive to push that number up, despite the obvious health benefits and health care savings,” he noted.

“Until we figure out how to reward providers – and manufacturers – for long-term outcomes, no one is going to do anything about this problem,” Goldman said.

Low-dose aspirin isn’t a magic cure-all, however. The study revealed no significant reduction for stroke incidence. It also indicated that gastrointestinal bleeding would increase 25% from the current rate. This means two out of 63 Americans would likely suffer a bleeding incident between ages 51 and 79, the researchers said.

Friday, December 2, 2016

Hearts of Healthy People with Gene Mutations ‘Primed to Fail’

Certain gene mutations can increase the risk of heart failure in healthy people, researchers report.

It had been believed that gene mutations in a protein called titin affect only people with dilated cardiomyopathy, one of the most common forms of inherited heart disease.

But this study of more than 1,400 adults found that the hearts of healthy people with mutations in the gene may be “primed to fail” if affected by other genetic or environmental factors. About 35 million people worldwide may be at risk, the researchers said.

“Our previous work showed that mutations in the titin gene are very common in people diagnosed with heart failure. Around 1% of the general population also carry these mutations, but until now it wasn’t known if these are ‘silent’ gene changes or changes that can adversely affect the heart,” said co-author Dr. Antonio de Marvao in a news release from imperial College London. He is a clinical lecturer at the college’s MRC Clinical Sciences Centre in England.

Study co-senior author Dr. Stuart Cook is a professor of cardiovascular medicine at SingHealth Duke-NUS Academic Medical Center in Singapore. He said, “We now know that the heart of a healthy individual with titin gene mutation lives in a compensated state and that the main heart pumping chamber is slightly bigger.

He said the next step is to identify the specific genetic or environmental triggers, such as alcohol or viral infection, that increase the risk of heart failure in people with titin mutations.