Friday, May 30, 2014

Scientists Identify ‘High-Priority’ Chemicals That May Cause Breast Cancer

An estimated 12.4% of women born in the US today will develop breast cancer at some point during their lives. Past research has indicated that exposure to some chemicals may increase the risk of breast cancer.
Monday, May 12, 2014 (Medical News Today)

Now, a new study has identified 17 “high-priority” chemicals women should avoid in order to reduce such risk and demonstrates how their presence can be detected.

Scientists from the Silent Spring Institute in Massachusetts say their findings, recently published in Environmental Health Perspectives – a journal from the National Institutes of Health (NIH) – significantly advance breast cancer prevention efforts.

“The study provides a road map for breast cancer prevention by identifying high-priority chemicals that women are most commonly exposed to and demonstrates how to measure exposure,” explains study author Ruthann Rudel, research director of the Silent Spring Institute.

According to the research team, only 5-10% of breast cancers are a result of high-risk inherited genes. Furthermore, they note that about 80% of women diagnosed with breast cancer are the first in their family to develop the disease. Such figures, the researchers say, are evidence that breast cancer is caused by additional factors.

The researchers first identified 216 chemical that have been associated with mammary tumors in rodents. Then they identified 102 of these chemicals as likely exposure to women. Finally, they cross correlated the rodent studies with human breast cancer studies. All studies measured breakdown products (metabolites) of each chemical or the chemical itself in the blood, urine or other samples.

The result was a consolidation of chemicals into 17 high-priority groups that may cause breast cancer in women. The number one source of breast cancer carcinogens in the environment was gasoline and chemicals created by combustion of gasoline, like benzene and butadiene. Such chemicals are present in vehicle fuel, lawn equipment, tobacco smoke and burned or charred food.

Solvents including methylene chloride and other halogenated organic solvents – often found in industrial degreasers, specialty cleaners and spot removers were also high on the list.

Other mammary carcinogens include chemicals found in flame retardants, stain-resistant textiles, hormone replacement therapy and drinking water disinfection byproducts.

This is the first study I have reviewed that compared the carcinogenic risks of petroleum products with those of HRT (hormone replacement therapy). I think this is a wake up call for all women.

Limiting your exposure to gasoline and exhaust fumes is important. Use electric power tools in place of gas power equipment. Avoid stain-resistant rugs, fabrics, and furniture. Drink distilled water from glass containers.

Most of these carcinogens are more toxic after phase 1 liver detoxification. They tend to bog down in phase 2 liver detoxification. This is also the pathway used to detoxify the various forms of estrogen. One of the estrogen metabolites is 16-hydroxyestrogen. Although it can result from phase 1 detox of natural estrogen, it is the major metabolite from many HRT products. It is a potent carcinogen, involved in estrogen dominant breast cancer. I suspect that many of these carcinogenic chemicals disrupt normal estrogen detox in the liver.

Be proactive about your environment. Limit exposure to these chemicals as much as possible. If you feel you may be at risk, check your homocysteine blood levels. A high test result indicates impaired sulfur amino acid metabolism necessary for phase 2 liver detox. You can also test the urine for estrogen metabolites – dehydroxyestrogen 2, 4 and 16. The ratio of these metabolites is a good risk assessment for estrogen dominant cancers.

Wednesday, May 28, 2014

Wisdom Wednesday: The Liver

New patients frequently want to do a liver detox. They know little or nothing about the process, but feel that’s a good place to start. Nothing could be further from the truth.

While we all can benefit from periodic liver detoxification, several other issues must be addressed prior to attempting to “cleanse” the liver. In the QA (Quintessential Applications) protocol, the liver is step 19 of 32, not step one. Most of my previous Wednesday Wisdom blogs have addressed the previous 18 steps. So after resolving any hidden adrenal issues (see last Wednesday’s blog), we evaluate the liver.

Everything that gets into the blood stream and needs to be removed must go through phase 1 liver detoxification. The process alters the chemistry of substances so they can be removed through the bowel or kidneys. Caffeine is removed through phase 1 detox. In the office, I use a caffeine challenge as a test for the phase 1 pathway.

The Cytochrome P-450 pathway is also a part of phase 1. Many prescription drugs begin to be removed from the body through the P-450 pathway. As mentioned in previous blogs, Silymarin (Milk Thistle), St. John’s Wort, and Black Cohosh all affect this pathway. The use of any of these herbs may be contraindicated with certain prescription drugs. For example, Coumadin, a common blood thinner, is rapidly removed from the body when the cytochrome P-450 pathway is enhanced by taking St. John’s Wort. In a similar fashion, the proteases used to treat HIV/aids are also removed so fast, that they have no effect of the virus they are designed to treat.

Phase 2 liver detoxification is reserved for those chemicals that can not be made water soluble in phase 1. Unfortunately, most chemicals that require phase 2 liver detox become more toxic after being processed through phase 1. When people undertake a liver detox program and feel ill, it is usually the result of ramping up phase 1 to the extent that phase 2 detox can not keep up and the toxic intermediate by-products of phase 1 build up in the blood stream.

One hundred years ago, the only chemicals that required phase 2 liver detox were the hormones we made and alcohol. However, virtually every man-made chemical, all the artificial favors and additives in our foods, and most drugs require phase 2 liver detoxification. All the hormone additives that have found their way into our drinking water and the 800 plus hormone disruptors in our environment also need this extra step to be removed from the body.

The processing of estrogen through the liver demonstrates the phases of detoxification nicely. Once estrogen has been used by the body it enters the liver. During phase 1 detox, a hydroxyl group (OH) is added creating dehydroxyestrogen. There are three forms, 2-hydroxy, 4-hydroxy, and 16-hydroxy depending on where the OH group is added. All three forms are more toxic than estrogen, but the 16 form is highly carcinogenic. To be eliminated, dehydroxyestrogen must go through phase 2 liver detox to be made water soluble, it is then eliminated through the bowel and kidneys.

Poor phase 2 liver detox is a major factor in the cause of estrogen dominant breast cancer. Several studies have shown that the use of a cruciferous vegetable extract (supports phase 2 detox) makes the cancer drug Tamoxefin, 50 times more effective at preventing recurrence of breast cancer.

Virtually every patient that enters my office is suffering from impairment of phase 2 liver detoxification. New patients complete a Symptom Survey in my office consisting of 240 questions about various symptoms they may be experiencing. The survey is then computer analyzed, categorizing the symptoms by potential organ of origin. Ninety-nine percent of the time, the liver is the most common source of their symptoms.

Please do not attempt a liver detoxification program without consulting a qualified nutritionist. Do increase your cruciferous vegetable intake. Arugula, Brussels sprouts, broccoli, cabbage, and cauliflower are just a few of the vegetables high in sulfur which is vital for phase 2 liver detox. The use of herbs can be very effective in reducing liver inflammation, but must be used with strict nutritional supervision.

Friday, May 23, 2014

Health Benefits of Red Wine Antioxidant Questioned

Resveratrol is an antioxidant found in grapes, red wine, peanuts, chocolate and certain berries, and it has been credited with a large number of health benefits in various studies.
Thursday, May 13, 2014 (Medical News Today)

Now, however, a research team presents findings that question whether such benefits come from the compound.

The researchers, led by Dr. Richard D. Semba of Johns Hopkins University School of Medicine, publish their results in JAMA Internal Medicine.

For years, the Western world has marveled at the so-called French Paradox, which points to the low incidence of coronary heart disease in that population despite their high-cholesterol and high-saturated fat diet. This has been attributed to their regular intake of red wine, with its high levels of resveratrol and other polyphenols.
But this latest study, which assessed a large group of Italians – who consume a diet rich in resveratrol – found that they do not live longer and are just as likely to develop cardiovascular disease or cancer as individuals who consume smaller amounts of the compound.

“The story of resveratrol turns out to be another case where you get a lot of hype about health benefits that doesn’t stand the test of time,” says Dr. Semba. “The thinking was that certain foods are good for you because they contain resveratrol. We didn’t find that at all.”

The team used data on 783 men and women over the age of 65 who were part of the Aging in the Chianti Region Study from 1998 to 2009.

They measured chemical levels using mass spectrometry to analyze 24-hour urine samples looking for breakdown products of resveratrol.

Results showed that resveratrol concentration was not linked with inflammatory markers, cardiovascular disease, cancer or death.

Participants in the study were not taking resveratrol supplements, says the team, adding: “Although annual sales of resveratrol supplements have reached $30 million in the US alone, there is limited and conflicting human clinical data demonstrating any metabolic benefits of resveratrol.”

Though their study yielded negative results, Dr. Semba notes that other studies have shown that consuming red wine, dark chocolate and berries does have protective effects for the heart and reduces inflammation in certain people.

“It’s just that the benefits, if they are there, must come from other polyphenols or substances found in those foodstuffs,” he adds. “These are complex foods, and all we really know from our study is that the benefits are probably not due to resveratrol.”

The benefit is in the food – the wine, grapes and chocolate – not any one chemical substance. This is the kind of reductionist thinking that leads to the outrageous claims given to vitamin C in the 1970’s and more recently vitamin D.

We know that one glass of red wine, especially if consumed during a meal, actually enhances phase II liver detoxification. Unfortunately, the second glass (or any additional intake) dramatically impairs liver detoxification.

The French Paradox comes from the Framingham Study that is the basis for statin drug therapy. Researchers found that in the Gascony region of France, the local population eats goose liver and other high fat foods. They also live longer, healthier lives then the rest of the planet. Despite these findings, cardiologists developed this dogma about the need to lower everyone’s cholesterol with drugs. In fact, there were several areas in the world where no correlation between high fat intake and cardiovascular disease was found. Until recently, this data has largely been ignored by cardiologists and the American Heart Association.

Isolated nutrients have value to the nutritionist for treatment of specific health issues. Various forms of folic acid, vitamin B12 or iron are used to treat anemia. Vitamin B6 is used to support sulfur amino acid metabolism. However, resveratrol has no real benefit as an isolated nutrient. I commonly use grape seed extract, containing resveratrol for capillary fragility and phlebitis. But I have never recommended resveratrol as a stand alone supplement.

There is no substitute for a good diet. Supplements are just that, a supplement to a good diet. Stay away from isolated nutrients, unless recommended by a qualified nutritionist for a specific health issue. Instead choose food based supplements like grape seed extract or cruciferous vegetable extract that contain all the phytochemicals grouped together as they are found in real food.

Wednesday, May 21, 2014

Wisdom Wednesday: Hidden Adrenal Issues

For years, nutritionists, including me, have struggled to resolve adrenal issues. When they are found in the initial evaluation of the endocrine system (see last weeks’ Wednesday Wisdom), you must determine whether the adrenals are underactive (adrenal fatigue), overactive (adrenal stress), or both. Yes, the adrenals can be up and down, like a rollercoaster, on a daily or even hourly basis.

In general, direct glandular support, including the use of an adaptogen, is required to rebuild the adrenal glands. This often takes three or four months of nutritional therapy. I believe the constant overstimulation and stress of modern life makes it difficult for the adrenals to recover.

Once the general endocrine function of the adrenals is restored, an underlying or ‘hidden adrenal’ issue is often present. Undetected and untreated, endocrine function will quickly fail again.

Sometimes all that is required is continued support with an adaptogen. However, more often, hormone activity must be evaluated and treated, above and beyond glandular function. The adrenals may now be functioning normally, but cortisol levels can still be high and DHEA may also remain low.

We evaluate the ‘hidden adrenal’ by challenging the adrenal response to joint stress and histamine response. If either of these tests is positive, then ongoing adrenal support is vital.

West Point Military Academy runs a very stressful program. It is very difficult to get in and even harder to stay. The stressors are physical, emotional, and mental. Over the course of four years, 25% of cadets will have knee surgery. This is a direct result of multiple stress factors as the major support for the knee comes from muscles associated with the adrenal glands. When stressed for a long period of time, the ‘hidden adrenal’ can not support weight bearing stressors induced by running or other forms of exercise. The ‘hidden adrenal’ patient is often the one that is easily injured every time they try to return to vigorous exercise.

Vitamin C is the most basic support for adrenal function. I have a Barbados cherry tree in my front yard. It produces the Acerola cherry, the highest natural source of vitamin C on the planet. If you look at the ingredient list on any vitamin C supplement, you will often see it listed. My tree produces fruit from May through October each year. Everyday, during those months, my family and I compete with the local bird population for our daily dose of vitamin C.

Ascorbic acid is not really vitamin C, although medically the labels are used synonymously. Ascorbic acid is the anti-oxidant portion of the vitamin C complex. It acts like a wrapper surrounding and protecting the bioflavonoids, taurine, quercitin, and copper that make up the remainder of the vitamin C complex.

The mainstay of adrenal support are the adrenal adaptogens that I frequently mention – Ashwaganda (my personal favorite), Schisandra, Tribulus, Rehmannia, Korean ginseng, and Chaste Tree. You might add Maca to that list as it is thought to be an adaptogen.

Licorice is the tonic of choice. Tonics give an immediate lift but provide no long term support. Licorice should not be used with an overactive adrenal gland. It must also be used with caution in anyone having high blood pressure.

High cortisol levels from long term adrenal stress result in a loss of up to 50% of cortisol receptors in the cells of the body. Licorice works by temporarily making the remaining receptors more receptive to cortisol. This is what creates the ‘tonic effect’ of licorice. However, it also stimulates increased production of rennin in the kidneys which ultimately raises blood pressure to increase venous return to the heart from the lower extremities.

I seldom recommend DHEA supplementation. This is HRT (hormone replacement therapy) and can depress DHEA production by the adrenals, creating a need for more and more supplementation. Healthy adrenals produce about 25mg of DHEA per day, yet you can buy 50mg tablets of DHEA in any health food store. On the rare occasion I do use DHEA, I recommend 5 or 10mg per day for 1 week only. That creates a tonic effect without suppressing adrenal hormone production.

Try to reduce your stressors. Put that cell phone away when you can. Limit TV and video game time. Please don’t go to sleep with the TV on. Make time in your busy schedule to unwind. Take a vacation, read a book. If you suffer from adrenal stress or fatigue, consider nutritional evaluation. Give the adrenals time to respond, they are working too hard to begin with.

Monday, May 19, 2014

Toothpaste, Sunscreen Chemicals ‘Interfere With Sperm Function’

Endocrine disruptors (EDCs) are chemicals that interrupt the processes of natural hormones and have been previously implicated in affecting human reproduction.

Monday, May 12, 2014 (Medical News Today)

Now, these chemicals – which can be found in household and personal care products – have been shown to affect sperm function, potentially impacting fertilization.

A recent study published in the journal European Molecular Biology Organization reports that EDCs are present in everything from food and textiles to drugs and household products, including plastic bottles, toys and cosmetics.

With a new bioassay developed by the researchers from the Center of Advanced European Studies and Research in Germany and the University Department of Growth and Reproduction in Denmark, they were able to rapidly test hundreds to thousands of chemicals for potential interference with function of human sperm.

They explain that for their study, they tested about 100 chemicals and found significant results that suggest endocrine disruptors may lead to widespread fertility issues in the Western world in a way that has not been identified until now.

The team’s findings reveal that about one third of these chemical showed adverse reactions.
Some of these chemical include ultraviolet filters such as 4-methybenzylidene camphor (4-MBC), which is used in some sunscreens, and Tirclosan, an anti-bacterial agent used in toothpaste.

“For the first time,” says Prof. Niels E. Skakkebaek, leader of the Danish team, “we have shown a direct link between exposure to endocrine disrupting chemicals from industrial products and adverse effects on human sperm function.”

They looked specifically at how these chemicals affected the CatSper ion channel, which they explain is a calcium channel that controls sperm motility.

Applied at concentrations they measured in bodily fluids, the team says EDCs directly open the CatSper channel, increasing calcium levels in sperm and changing their swimming behavior. The investigators say this also triggers the release of digestive enzymes that help the sperm to break through the egg.

Additionally, EDCs make sperm less sensitive to progesterone and prostaglandins, which are two hormones released by cells around the egg.

The authors conclude their study by writing: “Here we provide a direct link between exposure to EDCs and potential adverse effects on fertilization in humans. About 800 omnipresent man-made chemicals are suspected to interfere with the endocrine system. To this day, the majority of these potential EDCs have not been evaluated for their action in humans.”

Sperm health is based on three factors – morphology (shape), mobility, and DNA fragmentation. I commented on increasing DNA fragmentation rates in my blog “Study Questions Safety Thresholds for Hormone Disrupting Chemicals” posted on April 25, 2014. Now we see evidence of adverse effects on mobility as well.

EDCs are everywhere. As I have noted previously, subjects have to fast in order to test EDC elimination rates from the body as our intake of these man-made chemicals is constant. Omnipresent is a term usually reserved for God, but it is an apt description of EDCs as well. They are in our drinking water, even the air we breathe. Unfortunately, government regulations do not require that these compounds be measured in our food, drink, or topical products.

These hundreds of hormone look-a-likes confuse the endocrine system. Please refer to the Wednesday Wisdom blogs starting on May 14th to learn just how challenging evaluation and treatment of the endocrine system can be.

EDCs must be processed through both phase one and phase two liver detoxification. Prior to the introduction of man-made chemicals into our environment, the only chemicals that required phase two liver detoxification were the hormones we made in our bodies and alcohol. Today there are literally tens of thousands of man-made chemicals that must pass through both phases of liver detoxification to be cleared from the body.

Unfortunately, EDCs, like real hormones are much more toxic after phase one detoxification. Until or unless the body can make them water soluble in phase two, they remain as potential carcinogens.

Read the labels on your food and personal use products. If you don’t recognize the ingredients, don’t use it. This is just another reason to avoid tap water and bottled water as well. Drink distilled water whenever possible. Let’s hope it doesn’t get to the point that we need bottled air.

Friday, May 16, 2014

Daily Aspirin To Prevent First Heart Attack Does Not Get FDA Backing

Does aspirin prevent heart attacks
Tuesday, May 6, 2014 (Medical News Today)

The FDA says while there is evidence that low-dose aspirin can prevent heart attacks, strokes and cardiovascular problems reoccurring (so-called secondary prevention), the case has yet to be made for using it to prevent a first event (primary prevention).

Aspirin works by interfering with the blood’s clotting action, so reducing the chance of clots developing and obstructing flow of oxygen and blood. Clots that obstruct a coronary artery can cause heart attacks, while blockages in the blood supply to the brain are a cause of stroke.

D. Robert Temple, FDA’s deputy director for clinical science, says for people who have not had a heart attack, stroke or cardiovascular problems, “the benefit has not been established but risks – such as dangerous bleeding into the brain or stomach – are still present.”

Neither does the data support the use of aspirin to prevent heart attack or stroke in people who have never had them but have a family history of them or are showing evidence of arterial disease, the report adds.
However, large trials looking at the use of aspirin in primary prevention of heart attack and stroke are ongoing, and the FDA will continue to monitor them and update consumers should the evidence change.

“The bottom line is,” say the FDA, “that in people who have had a heart attack, stroke or cardiovascular problems, daily aspirin therapy is worth considering.”

Aspirin was first marketed by the Bayer Company in 1897. It was developed to mimic the effects of White Willow Bark, an herb used to reduce inflammation. Salicylic acid was thought to be the active ingredient in White Willow Bark, so Bayer combined acetone (think nail polish remover) with citric acid to create aceto-salicylic acid – aspirin.

In wasn’t until 1994, when the chemical pathways for Aleve and Advil were discovered, that aspirin’s chemical pathway was also unraveled. It turns out, that the acetone is a Cox 2 inhibitor just like Aleve and Advil. The salicylic acid is not responsible for the anti-inflammatory effects in aspirin or White Willow Bark.

Subsequent research into White Willow Bark has failed to identify what chemical compounds account for its anti-inflammatory effects. Although it is often effective, I seldom use it as I want to know what chemical pathways I am affecting with treatment.

Aspirin, Aleve, and Advil cause over 16,000 deaths each year in the US. Most of the victims are over the age of 60 and less than a third has any warning signals. Most of them die from GI bleeds, but liver failure and heart attacks are the second and third most common form of death. By the way, the reference in this article to “bleeding in the brain” is called a bleeding stoke, so aspirin can cause strokes as well.

Daily aspirin does not really prevent heart attacks, strokes or pulmonary embolisms. It does however; reduce the risk of damage if such an event does occur. So there is some merit to its use.

Indiscriminate use of aspirin, Aleve, or Advil can be fatal. Please discuss the use of these drugs with your physician. Look for contraindications and drug interactions with any other prescription drugs. If you have not had a heart attack or stroke, even with a strong family history, aspirin is probably not for you.

Wednesday, May 14, 2014

Wisdom Wednesday: The Endocrine System

After evaluating general metabolism through the Krebs’s Citric Acid Cycle, it is time to look at hormone production in the body. I find evaluation and treatment of the endocrine system to be second only to dysbiosis in terms of challenges and rewards.

We start by testing the limbic system. That is the portion of the brain that gives you your sense of balance. It is also where the brain and endocrine system interact. An impairment of the limbic system generally indicates some endocrine dysfunction. The adrenals, pineal/pituitary gland, thyroid and reproductive system are all evaluated.

Frequently more than one endocrine organ is indicated as dysfunctional. Endocrine cross check is then performed. We find a weak muscle for each endocrine organ. (For example, a weak supraspinatous is commonly associated with the pineal/pituitary gland.) Then we cross check to see which organ appears to be the major involvement and treat it appropriately.

Chaste tree is often of great value in treating endocrine imbalances, especially if there is more than one organ involved. History usually includes poor sleeping habits, either onset insomnia or maintenance insomnia. Taken first thing in the morning, chaste tree stimulates production of melatonin by the pineal gland. Melatonin not only helps people have a better night’s sleep, it modulates all the other sex hormones. If your estrogen is a little high and your testosterone is a little low, or vice versa, chaste tree will often balance these levels as needed.

Adrenal imbalance, either as the major issue, or a minor involvement is almost universal. It is commonly said that all patients have adrenal imbalance, but only the women have an underactive thyroid. Although not always the case, there is some truth to that statement.

Adrenal adaptogens like Ashwaganda, Korean ginseng, Tribulus, Schisandra and Rehmannia are all great support for the adrenals. Licorice can also be used temporarily as a tonic. Although it provides great relief of symptoms, it does not help rebuild exhausted adrenal glands like the adaptogens do. Maca is also thought to be an adaptogen, but we don’t yet have enough research to confirm its’ ability to restore the adrenal glands.

Testing salivary cortisol (four samples over 24 hours) and DHEA can help confirm adrenal status.

The most common thyroid problem is a lack of iodine in the diet. This is especially true for people raised in the mid-west. Michigan is considered the goiter capital of the US as the soil iw so iodine deficient. A simple “iodine patch test” performed by applying a bit of mercurochrome to the skin on the under side of the forearm is an accurate test for iodine deficiency. The patch should last a minimum of eight hours. The sooner it disappears, the greater the iodine deficiency.

Thyroid blood tests can be very helpful, but can also miss some thyroid problems. The TSH (thyroid stimulating hormone) is actually a pituitary hormone telling the thyroid what to do. Although the medical norms are 0.4 to 4.4 uIL/ml, the healthy range is actually between 1 and 2. Anything above 2 is an indicator of subclinical hypothyroidism.

Even if the T3 and T4 (active and stable forms of thyroid hormone, respectively) are well within the medical norms, a large portion of the T3 may be “reverse T3” rendering it non-functional.

In Hashimoto’s Thyroiditis, the immune system is attacking the thyroid (and possibly other tissue sites as well). The tests for this disease are the TPO (thyroid peroxidase) and thyroid auto-antibodies. These tests are seldom run and can be transient as well, running high, then returning to normal, only to run high again. It is estimated that at least one third of the diagnosed cases of hypothyroidism in this country are actually Hashimoto’s Thyroiditis undiagnosed. I think the real number is closer to one half.

Modulating the immune system is the key to treating Hashimoto’s Thyroiditis. Currently, conventional medicine just supplements thyroid hormone to keep the TSH within medical norms.

My favorite herb for reproductive imbalances is the adaptogen Tribulus. It binds to any open hormonal sites in the brain. Those sites are open only when that particular hormone is low. Tribulus stimulates the brain to request more hormone production of the deficient hormone(s). So it is self regulating.

Hormone imbalances are quite common. If you suffer from poor sleep and/or poor sex drive, have your hormone levels evaluated. Consider nutritional therapy in lieu of hormone replacement therapy (HRT).

Monday, May 12, 2014

Mixing Supplements with Medications

One in three adults in the US are taking both prescription medications and dietary supplements, creating a risk for dangerous interactions, according to a new study.
April 30, 2014 (Reuters)

Multivitamins with added ingredients like herbs and fish oil were the most common form of supplement mixed with medications, researchers found. “Multivitamins are commonly assumed to be safe, but our analysis suggests multivitamins, which may include multivitamin ‘plus’ combination products, can also contain botanical and herbal ingredients that have the potential to interact with prescription medications.” Harris Lieberman told Reuters Health. Lieberman, the study’s senior author, a researcher with the Military Nutrition Division of the US Army Research Institute of Environmental Medicine (USARIEM) in Natick, Massachusetts.

For their study, Lieberman and his colleagues, used information taken from the 2005-2008 National Health and Nutrition Examination Survey (NHANES), which represents the entire national population. The researchers focused on 10,480 adults (4,934 women who were not pregnant and 5,016 men) who answered survey questions about their dietary supplement and prescription medication use, as well as whether they had any of the following conditions: asthma, arthritis, congestive heart failure, coronary heart disease, angina, heart attack, stoke, high blood pressure, high cholesterol, emphysema, chronic bronchitis, cancer, weak bones or problems with the liver, thyroid or kidneys.

The researchers found that 47% of participants diagnosed with any of those medical conditions used both supplements and prescription medications. That compared to about 17% of adults who didn’t have those conditions, but were taking prescription medications for other reason, such as birth control pills or antidepressants. Overall, 34% of the participants – representing some 72 million people in the US – were taking some kind of dietary supplement along with a prescription medication. Cardiovascular medications were most likely to be used along with dietary supplements, followed by central nervous system agents, hormones, metabolism-related drugs, psychotherapeutic agents and antibiotics or antivirals.

Multivitamins containing other ingredients were more common that standard multivitamins. The ingredients most often added to the enhanced multivitamins included fish oil, botanicals, herbs, probiotics, fiber, enzymes, antacids and glucosamine and chondrotin.

Supplement use was most common among people with diagnosed osteoporosis, followed by those with thyroid, cancer, arthritis, cardiovascular, kidney, diabetes, respiratory and liver conditions.

The authors call the finding “concerning” because some herbal supplements are known to alter the way the liver metabolizes drugs, and can increase or weaken the potency of a medication. “Patients, especially those taking medications or given new prescriptions, should always inform their doctors about what dietary supplements they are taking, and doctors can help patients by asking about their supplements,” Lieberman said.

Drug – herb interactions are common, so common that I have a 700 page textbook on herbal safety. I am constantly looking for potential interactions in my patient population. The herbs are really quite safe, when taken properly; it’s the way in which they react to many drugs that is at issue.

Honestly, drug – drug interaction is a much bigger issue. For example, lovastatin, commonly prescribed to lower cholesterol (currently taken by 49% of the population over the age of 60) has 214 known drug interactions, representing 632 band and generic drugs on the market.

The average American takes four prescription medications with little or no knowledge about how these drugs interact. It is estimated that a third of all cases of senile dementia in our country are from overprescribed medications.

The multivitamin is not really an issue. Recent studies have found they have little if any value in human health. The “plus” combinations in many multiple supplements contain so little content that they are neither helpful nor harmful. As noted in an earlier blog, herbal quality in the US in non-existent. Contamination is a bigger issue in the “proprietary blend” of herbs noted on the label.

Silymarin (milk thistle), St. John’s Wort and Black Cohosh will either increase or decrease drug clearing time through the cytochrome P450 liver pathway. This is a common metabolic pathway for many prescription drugs. However there are alternatives when medications prevent safe use of these herbs.

Ginkgo is a potent blood thinner and should not be used with other blood thinners, like Coumadin. The blood thinning effects of fish oil are generally overstated.

You should review all the "drug to drug" and "drug to herb" interactions of any prescription medications you take. Throw that multiple vitamin away, it’s worthless anyway. Please do not take herbs without consulting a qualified nutritionist. They are potent and can be harmful it not taken properly.

I believe people who take supplements with medications are just looking for help. The drugs don’t restore their quality of life and they just hope that supplements will be of some benefit.

Friday, May 9, 2014

Why Dangerous Supplements Linger on Store Shelves

The first cases of liver problems linked to a popular weight loss supplement called OxyElite Pro began in Hawaii last May.
April 30, 2014 (New York Times)

But is wasn’t until four months later that the Food and Drug Administration, the agency responsible for getting dangerous products off the market, learned of the outbreak, and the product was finally recalled in November.

Flaws in the way that dietary supplements are monitored and reported are causing potentially life-threatening delays in how long dangerous products linger on store shelves, said Dr. Pieter Cohen, an assistant profession at Harvard Medical School who has studied supplement safety problems. They are also, he said, setting the stage for similar episodes to occur again.

Writing in a recent editorial in The New England Journal of Medicine, Dr. Cohen said that one of the more significant problems in such instances is that many cases of harm are reported to doctors and poison control centers but are either delayed in reaching the FDA or do not make it to the agency at all.

Many doctors who suspect a supplement has injured a patient neglect to submit a timely report to MedWatch, the online portal that the FDA maintains to help identify clusters of injury linked to harmful products, Dr. Cohen said.

Dr. Cohen said that many doctors simply do not find the FDA or MedWatch very helpful in dealing with patients who have ingested a tainted product. So instead they turn to poison control centers, which offer medial advice in cases where a patient ingested something toxic. Indeed, in a report last year, the Government Accountability Office noted that from 2008 to 2010, more than 1,000 adverse events related to dietary supplements were reported to poison control centers – but not to the FDA.

“Because data are not routinely shared between the centers and the agency,” Dr. Cohen wrote, “the FDA did not have access to these reports.”

Critics of the $32 billion a year supplement industry argue that the FDA is hampered by a federal law that, they say, was written largely to protect the industry, the 1994 Dietary Supplement Health and Education Act.

The law, which gives companies much leeway in how they manufacture and advertise supplements, allows them to put products on the market without FDA approval. As a result, the agency has little power to stop tainted products from landing on store shelves in the first place, even though research suggests that adulteration and mislabeling are widespread.

Supplement regulation in the US is based on food quality. That is, the government regulates how “clean” the supplement is. It limits the contaminants like rat feces and cockroach parts, but pays no attention to the ingredients.

According to Consumer Labs, an independent laboratory funded by members like me, 80% of the Echinacea sold in the US either contains no Echinacea or contains ingredients from the wrong parts of the plant or wrong species.

Echinacea is the best selling herb in the US. Supplement companies are not generally interested in more regulation. If it says Echinacea, it flies off the shelf, so why mess with a market model that works so well?

I purchased my herbs from Australia, where by law, herbal quality is pharmaceutical grade. The supplement companies are required to test the raw product and every step of processing to ascertain that each tablet contains the same amount of the target and marker compounds known to be of therapeutic value. It is the same high standard we hold the drug companies to here in the US.

Echinacea is native to North America. So the Echinacea I use is grown here, shipped to Australia for processing, and then shipped back to the US for sales and distribution. Yes, it drives up the cost, but it is the only way I can guarantee I am using a viable, safe product.

The European countries have guidelines that a similar to those in Australia. However, the supplement companies voluntarily developed these guidelines without government regulation.

Red yeast rice is an example of a dangerous supplement available at any health food store. It is used to reduce cholesterol. It contains lovastatin, the same drug used in the manufacture of statin drugs. However, the lovastatin content in red yeast rice varies from tablet to tablet, and brand to brand. Some tablets contain none while others have been found to contain more than 20mg, twice the normal prescription strength used for initial treatment of high cholesterol.

In addition, red yeast rice often contains a toxin that can be fatal. Only a few supplement companies endeavor to remove the toxins from red yeast rice. Despite these serious risks, health food stores continue to sell this product. A least twice a month, I have a new patient who’s MD has recommended red yeast rice in lieu of statin drug therapy.

Be very careful buying over the counter supplements. Consult a qualified nutritionist rather than a clerk at the local health food or drug store. Avoid products that contain a “proprietary blend”. That generally means, they put a bunch of stuff in it, but didn’t bother to measure how much of each ingredient. That may be a sign of a good chef, but not a good supplement.

Wednesday, May 7, 2014

Wisdom Wednesday: Krebs’s Citric Acid Cycle (CAC)

The most common chief complaint heard in a physician’s office is fatigue. It is much more prevalent that pain, the second most common complaint. Why do so many of us lack energy? There are many possible answers, but often fatigue is caused by poor energy production in the body.

There are four macronutrients, the foods we use to generate energy. They are protein, fat, carbohydrate (sugar) and alcohol. Yes, alcohol is now officially listed as a separate food group. Regardless of which food group you ingest, it is converted to glucose if it is to be burned as fuel to create energy. That chemical process that creates all the energy in every cell of the body is called the Krebs’s Citric Acid Cycle (CAC).

Fat can be stored for later use or converted to glucose. Protein is used initially for growth and repair of tissue. However, any excess protein is either converted to fat and stored or converted to glucose. Protein is not stored in the body. Alcohol is really a carbohydrate but is also converted to glucose just like fat and protein.

Glucose is a six carbon ring. Initially, it is broken in half to create two molecules of pyruvic acid. This yields three molecules of adenosine triphosphate (ATP), the energy molecule used by every cell in the body. However, it requires two molecules of ATP to facilitate the process, so the net is only one molecule of ATP. This process is called glycolysis or anaerobic metabolism, because it does not require oxygen to run the chemistry.

When you are at rest, most of your metabolism is anaerobic in nature. You break the glucose in half and create a little energy. However, as you begin to exercise, your heart rate increases, providing more oxygen to the tissues. Now your body takes those two molecules of pyruvic acid and strips all the hydrogen molecules off. It attaches them to B vitamins (and a few other chemicals) then sends the B vitamins into electron transport.

Electron transport (catalyzed by Co Q 10) then nets 27 molecules of ATP. This is termed aerobic metabolism because it requires the presence of oxygen. If you do the math, aerobic metabolism is 27 times as efficient as anaerobic metabolism.

This chemistry is most efficient when your heart rate is in your aerobic zone, approximately 70 to 80% of your Vmax (maximum heart rate). Your Vmax is 220 minus your age. So my Vmax is 158 and my aerobic zone is 110 to 130bpm.

The best part is that regular aerobic exercise facilitates more CAC/aerobic metabolism even when you are resting. That is, you actually burn more calories and create more energy when you are sleeping if you exercise on a daily basis.

After evaluating the nervous system, inflammation, and the immune system, I challenge the citric acid cycle to look for metabolic errors. A deficiency of one of the B vitamins is most common, but a lack of magnesium, manganese, lipoic acid, iron, Co Q 10, copper, or phosphorus can impair CAC function, resulting in low energy.

These patients find exercise very difficult or impossible and not effective for weight loss. Often subclinical hypothyroidism is an issue. Once corrected, exercise becomes an efficient mechanism for stimulating CAC. Energy levels rise and excess weight begins to drop.

Calculate your own Vmax and aerobic zone. Invest in a heart rate monitor, about $75 from a sporting good store, and use it to stay in your zone during exercise. Orange Theory gyms use this protocol for all their workouts. Have a thyroid stimulating hormone (TSH) blood test. The medical range is quite wide, about 0.4 to 4.4, depending on the lab. However, you want to be in the range of 1-2 to reflect healthy thyroid function. If you find exercise is difficult at best, or ineffective for weight loss and energy production, consider having your Krebs’s Citric Acid Cycle checked.

Monday, May 5, 2014

1 in 13 US Schoolkids Takes Psych Meds

More than 7% of American schoolchildren are taking at least one medication for emotional or behavioral difficulties, a new government report shows.
Thursday, April 24, 2014 NIH National Institutes of Health

“We can’t advise parents on what they should do, but I think it’s positive that over half of parents reported that medications helped ‘a lot’, said report author LaJeana Howie, a statistical research scientist at the US National Center for Health Studies.

Howie and her colleagues were not able to identify the specific disorders or medications the children received. However, she said that 81% of the children had been diagnosed with attention-deficit/hyperactivity disorder (ADHD) at some point in their lives.

Data for the study came from the National Health Interview Survey, which continually collects information about health and health care in the United States. All of the information on children is obtained through parental (or other guardian) responses. None of the information comes from medical records.

Overall, the researchers found that 7.5% of US children between the ages of 6 and 17 were taking medication for an emotional or behavioral problem. Significantly more boys than girls were given medication – 9.7% of boys compared with 5.2% of girls.

White children were the most likely to be on psychiatric medications (9.2%), followed by black children (7.4%) and Hispanic children (4.5%).

The study found that significantly more children on Medicaid or the Children’s Health Insurance Program were on medication (9.9%), versus 6.7% with private insurance and just 2.7% of children without insurance.

Additionally, more families living below 100% of the federal poverty level had children taking medications than those above the federal poverty level.

“There maybe parenting challenges, such as more single-parent households, medications may be more available than access to behavioral treatments, there may be more logistical issues with nonpharmaceutical interventions, like getting time off from work,” said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Steven and Alexandra Cohen Children’s Medical Center of New York. “It’s encouraging that the children who are identified as taking prescription medications are benefiting from those medications,” Adesman said. However, he added, “There are nonpharmaceutical treatments for virtually all psychiatric diagnoses in children. For households where a child has significant emotional or behavioral difficulties, counseling, behavior management and some forms of psychotherapy can be helpful as well.”

I suspect that the definition of helps “a lot” means the child is easier for the parent or teacher to manage. That is their behavior is subdued by the medication(s) so they appear more socially acceptable.

It has been my clinical experience that these psychiatric medications stifle creativity and dull the intellect. However, the use of amphetamines for ADHD goes well beyond that to create liver inflammation, adrenal stress, hypothyroidism, and bone loss.

In my opinion, most children exhibit behavior that we call “ADHD”. This is especially true of young boys. The symptoms of hyperactivity, short attention span, and physical outbursts are from lack of consistent, engaging physical activity and overstimulation from their high tech lifestyle.

One hundred years ago, as a child, you would have worked on the farm for several hours prior to walking to school. That excess energy was spent before you had to sit in a classroom and try to pay attention.

Even when I was young, we had recess three times a day. When I got home, if my chores were done, I went outside to play. Play was always physical – running, bike riding, and swimming. In the winter, it was snowball fights, ice skating, and sledding.

Today, it’s video games, texting, television, and no recess. The body is at rest, but the mind is over stimulated. Numerous studies show a strong correlation between video games, hyperactivity and even seizures.

The average American takes 4 prescription medications daily. Apparently, we now start them real young. All medications have side effects. I agree with Dr. Adesman, there are alternative therapies that avoid the use of drugs and can actually identify an issue if one exists.

Parents drug their children because it is easier that way. Easier for them, not the children. They do it because it is made available and recommended, especially if it is covered by insurance. We have no idea what the long term ramifications of drugging our youth will be. But it can not be good.

Friday, May 2, 2014

Can Coffee Treat Liver Disease?

Findings show there may be benefits to drinking coffee.
April 14, 2014 (Medscape)

More that 2.25 billion cups of coffee are consumed each day throughout the world. Although coffee consumption varies from country to country, most Americans drink coffee daily. Despite early concerns about the damaging effects of coffee on health, contemporary studies suggest that coffee is beneficial for many medical disorders, including Parkinson disease, diabetes, symptomatic gallbladder disease, stroke, and chronic liver disease.

Coffee contains caffeine that is also found in tea and other plants. The quantity of caffeine present in each cup varies, but in general, approximately 85mg of caffeine is absorbed in the stomach and small bowel. It is metabolized through the liver by cytochrome P450. The half-life of caffeine is 4-6 hours.

Current studies suggest that caffeine binds to adenosine receptors and reduces the development of hepatic fibrosis from liver injury by limiting stellate cell activation and the secretion of connective-tissue growth factors and collagen.

Coffee appears to have a significant effect on all-cause mortality. The National Institutes of Health- American Association of Retired Persons Diet and Health Study involving 229, 119 men and 173,141 women demonstrated an inverse relationship between coffee consumption and mortality. In other words, coffee drinkers had a reduction in mortality compared with non-coffee drinkers.

Alcohol consumption and cigarette smoking can increase gamma-glutamyl transferase (GGT) levels. Coffee appears to reduce circulating levels of GGT. Green tea had no effect of GGT levels.

Alcoholic liver disease develops with excessive alcohol intake; women are at greater risk for alcoholic hepatitis at lesser quantities of alcohol-containing beverages than are men. Fatty liver is common in patients with excessive alcohol intake and cirrhosis develops in 10%-20% of those with chronic alcoholism.

Alcoholics who also drank coffee had a significant reduction in the risk for alcoholic cirrhosis. For alcoholics who also had hepatitis B or hepatitis C, the risk of developing advanced liver disease was also reduced if they also consumed coffee on a daily basis.

For patients with chronic HCV (viral hepatitis), coffee drinkers and those consuming caffeine-containing beverages are more likely to maintain normal aminotransferase (SGPT) levels or to reduce SGPT levels than are those with lower caffeine intake. No chronic HCV-infected patient drinking decaffeinated coffee had improvement of SGPT levels.

Primary liver cancer is the third leading cause of death in the world; more than 600,000 new cases develop annually, with a survival rate of 3%-5%. Hepatocellular carcinoma (HCC) risk factors include cirrhosis, HBV and HCV, alcohol, and cigarette smoking. Coffee consumption appears to reduce the risk for HCC in those at elevated risk.

Daily consumption of coffee appears to have a preventative effect on developing fibrosis in some liver diseases, especially alcoholic liver disease and NASH (non-alcoholic sterato-hepatitis). However, coffee consumption had no apparent effect of the development of NASH. In addition, some reduction in fibrosis was noted in all liver disease with daily consumption of coffee.

Although many treatments are available for chronic liver disease, alcoholics and patients with NASH who are unable to control their associated causal factors might benefit from drinking 2 or more cups or regular coffee daily.

This article contained a lot of research data that I eliminated. There were also forty references for sited material. If you would like to read the full article, please visit

Regardless of its potential health benefits or issues, coffee is here to stay. As a coffee drinker, it is nice to find support for one of “my vices”. I have long advocated the use of organic coffee rather than decaf. I limit myself to one cup in the morning. To be honest, I don’t feel any “lift” from drinking it or any fatigue if I skip it. I do really enjoy the ritual of brewing a cup for my wife and myself, then sipping it as we share a couple of minutes each morning before going off to work.

The nerve synapes in your brain produce norepinepherine, a neurotransmitter, which normally stimulates other nerves and then is chemically dismantled. This whole chemical process takes place repeatedly in less than a second. Caffeine actually prevents the norepinepherine from being dismantled so the neurotransmitter continues to stimulate. I tell my patients that caffeine is not like pressing the gas pedal on a car, it more like not letting you use the brakes.

Much like other herbs (yes, I consider coffee an herb) the best use is based on scientific research. When there is little research (approximately 80 of the 1500 herbs used medicinally have had significant research), I depend on traditional use. If something has been used for thousands of years, it probably has merit. Coffee certainly fits in this category.

Liver dysfunction is almost universal in my practice. If I have a patient complete a symptom survey, liver shows up as the most common cause of symptoms virtually 100% of the time. I believe it is the hundreds of thousands of man-made chemicals in our environment that damages our livers.

The SGPT and GGT are enzymes that elevate in the blood stream when the liver is inflamed and liver cell death escalates. These enzymes are measured on the complete metabolic profile (CMP) that I routinely run in the office. Frequently these enzymes are elevated. NASH, hepatitis C, alcohol and drug abuse are common issues.

Often prescription drugs are the culprit. Statin drugs commonly elevate liver enzymes so these blood tests are run every six weeks on patients taking statins to reduce cholesterol. For patients who can not or will not discontinue these medications, coffee may reverse some of the negative effects of medication.

I believe the influence of caffeine on the cytochrome P450 pathway in phase 1 liver detoxification is responsible for much of the benefit associated with drinking coffee. Many drugs are processed through this important pathway. Coffee, like silymarin (milk thistle) and St. John’s Wort, support this pathway and have hepatorestorative (liver healing) effects.

If you are a coffee drinker, then rejoice, the benefits seem to outweigh any negative issues. I highly recommend you drink organic coffee to avoid all those chemical additives. The additives in decaffeinated coffee are even worse, so just avoid it. If you have a liver issue, talk to your physician about drinking coffee. It may be of significant benefit for you. If you take any prescription medications, please review any possible conflict between coffee and the metabolism of your meds. You can visit and review your medications. Check to see if the drug is metabolized through the cytochrome P450 pathway. If so, you might have an issue.