Wednesday, December 30, 2015

Wisdom Wednesday: 2015 In Review

I posted just under 150 blogs this year. As I search the internet on various health issues, my blogs are beginning to show up. Imagine my surprise when I found my blog on Betafood had over 50,000 hits. So far it’s only the unusual topics that make it close to the top of any search list. After all, how many people have written about Betafood? The timely topics are still flying below the radar.

In reviewing the past year, my most common topic was the adverse effects of various drugs. More and more studies are being published about negative drug effects forcing physicians to reevaluate their drugs of choice. Reverse medical thinking, admitting that the drug or procedure that has been the standard of medical care for years is apparently not good medicine, is slow to gain momentum. Doctors are concerned that the general public will lose faith in medicine if they admit they were wrong. Faith is not the issue, it’s honesty and quality of care.

The second most common topic was nutritional supplementation. I often hear from physicians and patients alike that there is no credible research on nutritional supplements. Certainly, more research needs to be done, but there are tens of thousands of peer reviewed published studies available on PubMed on a host of nutritional supplements. About half of all new drugs developed by Big Pharm are still based on natural substances. However, you can not patent a natural substance. If you isolate and alter, creating something that is unique – then you can hoard that substance and have exclusive rights to its’ production and sales.

Third was dietary recommendations. I’ve written about Paleo, Mediterranean, Atkins, vegetarian and others. All have merit and all have limitations. The only diet that has been proven to extend life is reduced caloric intake. Here in the United States, we just eat too much – of everything. The rate of type II diabetes parallels our rate of obesity, with a ten-year time lag. Obesity rates hit 50% in 2000 and in 2010, just over 50% of the population was either diabetic or pre-diabetic. Of note, obesity rates have now leveled (not declined). If this trend continues the rate of diabetes in the U.S. should level off by 2025.

Number four was toxic changes to our environment. Pollution of the water, air, and soil continues to increase. Mercury contamination of deep water fish, like tuna, is increasing by 4% per year. Although sanitation standards in the U.S. are very high, I won’t drink the tap water, neither should you. There are over 800 BPs that are known estrogen disruptors that are still allowed to be used in the food industry. As much as we try as individuals to keep our bodies clean, the collective effort by the governments of the world are lagging way behind. I’ll keep up the effort, but I honestly think it’s too late. The planet will survive, but we won’t.

Coming in fifth was exercise. I wrote about running, swimming, cycling and evolving technology to monitor your efforts. I have become very attached to my Fit Bit, tracking all my exercise, including ADL (activities of daily living). The software does all the work and the feedback is extremely valuable. Personally, it has really helped me transition from intense exercise that was a factor in stimulating AF (atrial fibrillation) to a more moderate format that helps prevent AF.

The Bottom Line:
My first impression on review of my blogs for 2015 was that there was too much focus on the negative. However, I believe people must be aware of a problem, then create a solution. To that end, I hope that the information I provide helps you to work to improve your health and life.

Monday, December 28, 2015

Toxic Chemicals May Weaken Infants’ Response to TB Vaccine

This study focused on two common toxins: PCBs, an industrial chemical; and DDT, used in pesticides. These so-called “persistent” pollutants are not easily broken down and remain a health threat years after being banned.

PCBs were banned in the United States in 1979. DDT is banned in the United States, but is still used in some countries to control malaria-carrying mosquitoes, the study authors, from the University of Rochester in New York, said in a university news release.

The researchers analyzed blood samples and immune responses from 516 pairs of mothers and infants in an area of Slovakia heavily contaminated with environmental toxins. Each baby received the tuberculosis vaccine in their first four days of life, and their immune system (antibody) response to the vaccine was assessed six months later.

Harmful chemicals were detected in more than 99% of the blood samples. But the infants with the highest levels of PCBs and other chemicals had the lowest antibody response to the TB vaccine, the investigators found.

Those with the highest levels of PCBs had 37% fewer antibodies against TB than those with the lowest PCB levels. Exposure to DDT also was tied to reduced TB-antibody levels. And infants with exposure to both chemicals had the lowest levels of TB antibodies, the findings showed.

In addition, like many chemicals, PCBs and DDT cross the placenta and are passed from mother to child through breast-feeding, the authors said in the study published December 9 in the journal Environmental Health Perspectives.

Wednesday, December 23, 2015

Wisdom Wednesday: Natural Medicine Cabinet

The average American medicine cabinet contains aspirin, Aleve, Advil, Tylenol, band aids, and all the left over prescriptions for the past 15 years. But what natural supplements should you keep on hand to treat those acute illnesses and injuries?

  • Colloidal silver is the most important supplement in my home medicine cabinet. At the first sign of a cold or flu, begin gargling and swallowing a mouthful every couple of hours. Colloidal silver has activity against all variety of infections – viral, bacterial, molds, and even parasites. There have been a couple of studies showing it to be effective in treating MRSA. It can be applied topically for ear or skin infections. Often it will relieve a sore throat immediately. However, don’t let your guard down. If you fail to continue treatment, the impending infection may roar back with a vengeance.
  • A Netti Pot – can be purchased at any drug store. They look like a teapot. You fill the pot with distilled water and Kosher salt, stick the spout in one side of your nose and tilt your head to the side, allowing the water to flow through your sinus cavities and out the other nares. You then repeat the process on the opposite side. I will admit that irrigating the sinuses is a little painful, but it is like magic for relieving sinus congestion. I like to use a little colloidal silver (10:1 water to silver) in place of the salt. Never use tap water as it may contain nematodes that can burrow from the sinus cavities into the brain and be potentially fatal. (And you still wonder why I don’t drink tap water)
  • Betafood – an organic beet supplement. It contains betalain pigments that create the rich red color. Betalain has two actions on the gallbladder. Taken over time, it gradually thins the bile. However, if chewed, the taste stimulates dilation of the bile duct within seconds. So keep this one on the shelf for heartburn, GERD, and acid reflux.
  • Andrographis Complex – This is an herbal product containing Andrographis, Echinacea, and Holy Basil. It is a very potent infection fighting combination. Take one tablet every two hours at the first sign of a cold or flu, then reduce to three per day for a few days once you feel better.
  • Antronex – This is a natural antihistamine. It contains yakriton, a liver fat extract that facilitates liver detoxification. Antronex is very effective for swelling from bug bites, hives or any allergic reaction. Take one per hour until the inflammation subsides. In children or even toddlers, reduce the dosage to two tablets per day. I recommend grinding up the tablet and putting it in apple juice for the little ones. Antronex can also be used to reduce mucous congestion after you have recovered from a cold. Again, take one per hour until you feel a dry “cotton mouth” sensation, then reduce the dosage. Once you have taken Antronex, the chemical pathways through the liver apparently become facilitated and just one or two tablets will have the effect that may take hours on the first round.
  • Arnica – This is a homeopathic remedy. It is extremely effective for acute injuries. In tablet form, look for the 30X dilution of Arnica Montana. Take 3-4 pills before and after any surgery. Many plastic surgeons use Arnica routinely to reduce swelling, bruising, and healing time. Don’t touch the pills but rather pour them into the cap and then directly into your mouth. This preserves the energy of the homeopathic preparation. You can also buy an ointment for topical application but don’t use it on open wounds.
  • Omega 3 Fatty Acids – of course, I take these daily but loading up with 4-6 pearls per day can reduce prostaglandin inflammation in place of Aleve or Advil without the side effects. It is the most common supplement I use for acute low back pain.
  • Boswellia – This is an Ayurvedic plant that reduces leukotrienes and cytokines. It is extremely effective for asthma but is also good for any inflammatory condition, including hangovers. Take 2 tablets twice per day with fat. The fat increases absorption into the lymphatic system by 500%. Again, with children, reduce the dose to one per day.

The Bottom Line:
I could go on, but these are the basics that I keep at home. Anytime you can avoid taking a drug, you spare your liver from the additional detoxification. We now know that any time anyone takes a baby aspirin; they suffer a small GI bleed. Please consider alternative natural supplementation for everyday health issues.

Monday, December 21, 2015

Primary Care Docs the Leading Prescribers of Narcotic Painkillers

Americans continue to be plagued by an epidemic of prescription narcotic painkiller abuse, and a new study finds primary care physicians (PCP) are by far the biggest prescribers of the drugs.

Researchers led by Dr. Jonathan Chen, of Stanford University, looked at data from 2013 Medicare Part D prescription drug coverage claims.  They focused on prescriptions for narcotic painkillers containing hydrocodone (like Vicodin), oxycodone (Oxycontin and Percocet), codeine and others in this class, known as opioids.

In sheer number of prescriptions written, the largest prescribers were PCPs.  Family practice doctors issued 15.3 million prescriptions, while internal medicine physicians issued 12.8 million, the researchers found.

The study also found nurse practitioners wrote 4.1 million prescriptions for narcotic painkillers while physician assistants ordered up 3.1 million.

Based on claims-per-prescriber, pain specialists led the way, followed by those in pain management, anesthesiology and physical medicine and rehabilitation, the researchers said.

There’s been a 10—fold increase in the abuse of narcotic painkillers in the United States over the past two decades, Chen noted in a Stanford news release.  Some experts have  suggested that small groups of high-volume prescribers and so-called “pill mills” are the main reasons for the narcotic painkiller overdose epidemic in the United States.

However, Chen’s team now believes that “high-volume prescribers are not alone responsible for the high national volume of opioid prescriptions,” and “efforts to curtain national opioid overprescribing must address a broad swath of prescribers to be effective.”

Friday, December 18, 2015

The Tale of Two Studies

I was fortunate enough to run across these two studies released on the same day this week.  So please compare and contrast:

Tuesday, December 15, 2015 National Institutes of Health - Less than half of Americans strongly believe that the flu shot will help them avoid the illness, and one-third don’t believe it will protect them at all, a new study finds.

The fact that The Harris Poll turned up so many full shot doubters is troubling, one expert said, because immunization does offer protection.

“Vaccination can provide as much as 60-70% guarantee of protection against the flu,” said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City.  “Why shouldn’t everyone said as much protection as possible?”

However, the online survey of 2,225 adults, conducted in mid-October, found that 32% didn’t think flu vaccination would protect them, while only 43% “strongly believed” a flu shot offers help against the virus.

And nearly half of those surveyed - 42% - thought “people take the flu season too seriously.”

Tuesday, December 15, 2015 National Institutes of Health - More than half of U.S. hospitals  don’t require health care providers to get a seasonal flu shot, a new study finds.

Wednesday, December 16, 2015

X-rays May Miss Hip Arthritis

X-rays don’t detect hip arthritis in many patients, resulting in delayed diagnosis and treatment, researchers report.

The researchers looked at information from almost 4,500 Americans taking part in two arthritis studies. In one study, only 16% of the patients with hip pain had X-ray evidence of osteoarthritis in the hip and only 21% of those with X-ray evidence of arthritis had hip pain.

“The majority of older subjects with high suspicion for clinical hip osteoarthritis did not have radiographic hip osteoarthritis, suggesting that many older persons with hip osteoarthritis might be missed if diagnosticians relied on hip radiographs to determine if hip pain was due to osteoarthritis,” said study corresponding author Dr. Chan Kim.

Kim is an instructor of medicine at Boston University School of Medicine.

A missed or delayed diagnosis of hip arthritis can have serious consequences. Up to 10% of patients with hip arthritis don’t get enough exercise and are at increased risk for heart and lung disease, obesity, diabetes and falls, the researchers said.

“Given these findings, patients with suspected hip OA [osteoarthritis] should be treated regardless of X-ray confirmation,” Kim said in a university new release.

Monday, December 14, 2015

Endurance Athletes May Pay Physical Price

The endurance competition known as the Ultraman could lead to muscle damage associated with insulin resistance, a new study reveals.

Ultraman athletes may also experience higher levels of the stress hormone cortisol and a drop in their testosterone levels. These negative health effects are temporary but call into question the long-term health of people who train for and compete in these races on a regular basis, researchers from Florida State University caution.

The three-day Ultraman includes an initial 6.2-mile open swim and a 90-mile bike ride. On day two, athletes complete a 172-mile bike ride and on the final day they run a double marathon, or 52.4 miles.
During the Ultraman competition last year in Florida, researchers assessed the health of 18 athletes, including four women.

“We’d analyze the competitors on the spot,” Michael Ormsbee, assistant professor of exercise science and sports nutrition at Florida State, said in a university news release. “We looked at everything we could to get a full picture of their health.”

The athletes were weighed every morning before they competed. They also gave urine and blood samples so researchers could monitor their blood sugar levels and other changes in their body.

The study, recently published in the European Journal of Applied Physiology, found that, overall, the athletes lost body fat but they didn’t lose weight because they retained fluid.

Friday, December 11, 2015

The ‘Irrelevant’ Appendix

The appendix has been dubbed [as] a vestigial organ, thought to no longer perform a relevant purpose in the human body.

“Popular belief tells us the appendix is a liability,” Gabrielle Belz with Melbourne’s Walter and Eliza Hall Institute said in [the release] statement. “Its removal is one of the most common surgical procedures in Australia, with more than 70,000 operations each year. However, we may wish to rethink whether the appendix is irrelevant for our health.”

In the U.S. appendicitis will affect over 5% of the population, the National Institutes of Health stated.
Research by Belz and Eric Vivier with the Centre d’Immunologie de Marseille-Luminy in France found that the appendix might play a role in helping maintain one’s immune system with a good microbiome.

Their study, published in the journal Nature Immunology explained that a specific type of immune cell called innate lymphoid cells (ILCs), help “control the composition of the microbiota and gut immune responses.” These cells help protect against bacterial infections in people with weak immune systems, the researchers found.

And the appendix, Belz said, with protection from infection by ILCs might then “reseed ‘good’ bacteria within the microbiome – or community of bacteria – in the body.”

“A balanced microbiome is essential for recovery from bacterial threats to gut health, such as food poisoning,” she explained.

Wednesday, December 9, 2015

Wisdom Wednesday: Homocysteine

Homocysteine is an amino acid, one of the building blocks for protein. However, homocysteine is not found in the diet. Rather it is manufactured in the body from another amino acid methionine.

Methionine is one of nine essential amino acids that cannot be synthesized in the body and must be in the diet. Methionine is found in most proteins – red meat, turkey, chicken, fish, soy, many cheeses, and yogurt.

When homocysteine is created it is an intermediate metabolite. Vitamin B6 then converts it to cysteine or vitamin B12 and folic acid convert it back to methionine. However, deficiencies of these vitamins or other co-factors can allow homocysteine to accumulate in the blood stream.

In normal metabolism, when damage occurs to an artery wall, a little C-reactive protein (CRP) is created. This stimulates the homocysteine to combine with LDL (low density lipoprotein) and creates a patch over the damaged area of the artery. If, over time, the plaque begins to come loose, the body sends calcium into the plaque to secure it to the artery wall.

In abnormal metabolism (pathology), any of these factors that elevate can allow this repair process to run wild creating atherosclerosis and heart disease. Unfortunately, the first factor discovered in this process was LDL cholesterol. So it was labeled as “bad” and statin drugs were developed to lower the LDL and total cholesterol.

The statin drugs actually do work (a little bit) but they do so because they lower the CRP, not because they lower the LDL cholesterol. In fact, the data never supported the claim that high cholesterol is associated with coronary artery disease. Over half of patients suffering their first heart attack have normal or even low cholesterol.

Monday, December 7, 2015

Protein in Aspirin May Reduce Alzheimer’s Disease Risk

Researchers have found that a key protein in aspirin may help pulverize an enzyme linked to neurodegenerative conditions like Alzheimer’s, Parkinson’s and Huntington’s diseases – suggesting that taking the common drug may help reduce American’s disease risk. In their research, published this week in the journal PLOS One, study authors at Johns Hopkins University and Boyce Thompson Institute discovered that salicylic acid, a byproduct of aspirin, binds to the enzyme GAPDH (Glyceraldehyde 3-Phosphate Dehydrogenase), preventing it from moving into a cell’s nucleus where it would cause cell death.

During oxidative stress, GAPHD is affected than enters the nucleus of neurons, where it affects protein turnover and leads to cell death, causing neurodegenerative loss. The anti-Parkinson’s drug Deprenyl [inhibits] GAPDH entry into the nucleus.

“The new study establishes that GAPDH is a target for salicylate drugs related to aspirin, and hence may be relevant to the therapeutic actions of such drugs,” co-author Solomon Synder, professor of neuroscience at Johns Hopkins University in Baltimore, said in the release.

In the current study, scientists also observed that a natural derivative of salicylic acid from the Chinese medical herb licorice and a lab-synthesized derivative bind to GAPDH more effectively than salicylic acid.

My Take:
This study hit several news outlets on December 1st. On Facebook, many people were touting the benefits of taking aspirin. Unfortunately, the information from this study has been misconstrued.

Let’s start with some history – Bayer began making aspirin well over a 100 years ago, trying to mimic the apparent benefits of White Willow Bark. Salicylic acid (SA) is a major component of White Willow Bark, so Bayer took acetone (nail polish remover) and combined it with citric acid (from citrus fruits) to make acetyl salicylic acid.

Friday, December 4, 2015

Probiotics May Not Shield ‘Preemies’ From Serious Illness

Probiotics don’t protect very preterm infants from serious complications, such as a bowel condition called necrotizing enterocolitis, sepsis or death, according to a new study.

The findings challenge previous research that suggested potential benefits from probiotics, the British researchers said. Probiotics are good bacteria found in certain foods and supplements.

The study included more than 1,300 very preterm infants. The babies were given either the probiotic Bifidobacterium breve or a placebo. This probiotic was used because it was the only one previously reported to show any benefit when the study began, the study authors explained.

Sepsis (a potentially life-threatening complication of an infection) occurred in 11% of the probiotic group and 12% of the placebo group. Necrotizing enterocolitis occurred in 9% of the probiotic group and 10% of the placebo group. Death before hospital discharge occurred in 8% of the probiotic group and 9% of the placebo group.

The results of the study were published November 25 in The Lancet.

A previous study found probiotic reduced the risk of necrotizing enterocolitis in very preterm infants. But, the infants in that study had low overall complication rates. In addition, different strains of probiotics were included in the review, the authors of the new study explained.

“These two large trials suggest that, while probiotics are generally safe in the short term, they are not universally effective, and that different strains and combinations should be investigated separately,” Kate Costeloe, from Barts and the London School of Medicine and Dentistry, Queen Mary University of London, and colleagues said in a journal news release.

Wednesday, December 2, 2015

Wisdom Wednesday: NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used OTC (over-the-counter) drugs in America. They differ in potency and duration of action. They also differ in their tendency to cause ulcers and bleeding based on their relative inhibition of COX-1 and COX-2.

Cyclooxygenase (COX) is an enzyme that is responsible for the formation of prostanoids. The three main groups of prostanoids – prostaglandins, prostacyclins, and thromboxanes – are each involved in the inflammatory response.

However, some of these chemical groups, especially the prostaglandins, produce anti-inflammatory compounds as well. The omega 3 fatty acids (like fish and flax seed oil) are used to make PG-3 (prostaglandin 3) which is anti-inflammatory and the omega 6 fatty acids (like evening primrose and black current seed oil) make the PG-1 series, also anti-inflammatory.

So while reducing inflammatory compounds that produce pain, NSAIDs also reduce the anti-inflammatory compounds that provide relief. These anti-inflammatory compounds also protect and maintain the lining of the GI tract, protect the liver, heart, and other tissues of the body.

Traditional NSAIDs are considered “nonselective” because they inhibit both COX-1 and Cox-2. It is the COX-1 inhibition that is associated with most of the side effects. Bleeding, ulcers, and perforation of the stomach or intestine can occur at any time without warning. Aspirin and Advil (ibuprofen) are the most common “nonselective” NSAIDs.

Celebrex (Aleve) was the first selective COX-2 inhibitor introduced in the late 1990s. Subsequent COX-2 inhibitors Vioxx and Bextra were removed from the market when it was discovered that COX-2 inhibitors are associated with an increased risk of heart attack. Two other COX-2 inhibitors Arcoxia and Prexige have so far been rejected by the FDA. Celebrex remains as the only COX-2 inhibitor available in the United States.

Monday, November 30, 2015

Hepatitis C Drugs – Too Expensive to Use?

About 46% of Medicaid patients in four northeastern states were denied treatment with new direct-acting antiviral (DAA) drugs, which have been shown to cure more than nine out of ten hepatitis C patients, researchers reported in a new study. These powerful medications include Sovalda (sofoshuvir) and Harvoni (ledinasvir).

By comparison, only 10% of privately insured patients and 5% of Medicare patients were denied treatment said study author Dr. Vincent Lo Re III, an assistant professor medicine and epidemiology in the division of infectious diseases at the Perelman School of medicine at the University of Pennsylvania in Philadelphia.

State Medicaid programs have place stringent pre-approval requirements on the drugs due to their high cost Lo Re explained. A 12-week round of treatment for just one patient can cost as much as $90,000.

However, such tight coverage policies might prove pennywise but pound-foolish. Early treatment of hepatitis C with the new drugs can save billions in health care costs according to another study, published November 23 in the journal JAMA Internal Medicine.

Hepatitis C can do terrible damage to the liver if left untreated, including scarring of the liver and liver cancer, according to the U.S. National Institutes of Health. Serious cases often require a liver transplant. “Medicaid likely will end up spending even more in the long run as hepatitis C patients grow sicker and require more drastic treatment, “said Tom Nealon, chief executive officer of the American Liver Foundation.

About 3.2 million Americans are estimated to have chronic hepatitis C infection, according to background information provided in the JAMA report.

Friday, November 27, 2015


Polypharmacy is the use of five or more prescription drugs. In the past eleven years, polypharmacy increased from 10% to 15% for those aged 40-64 years and from 24% to 39% for those over 65 years. Sometimes, the number of daily medications taken by a single patient can be bewilderingly high (e.g., more than 10). As I noted in a recent blog, this is becoming a real issue in my practice. Just imagine the complications for the anesthesiologist assessing the medications and potential interactions prior to surgical intervention.

This data is from a retrospective study from the National Health and Nutrition Examination Survey. It was published in an editorial piece written by Alex Macario, MD in the November 19th issue of JAMA (Journal of the American Medical Association) entitled “Are Americans Taking Too Many Medications?”

Here are a few more statistics for your review:
  • The percentage of adults reporting use of any prescription drugs increased from 51% in 1999-2000 to 59% in 2011-2012.
  • There was increased use of antihypertensives (from 20% to 27%), antihyperlipidemics (6.9% to 17%) primarily driven by statins; and antidepressants (from 6.8% to 13%).
  • Among those interviewed, 4.6% to antidiabetic agents in 1999-2000, which increased to 8.2% in 2011-2012.
  • Prescription proton-pump inhibitors (PPIs) increased from 3.9% to 7.8%.
  • The 10 most commonly used drugs in 2011-2012 were simvastatin (a statin for high cholesterol), lisinopril (hypertension), levothyroxine (hypothyroid), metoprolol (another antihypertensive), metaformin (diabetic med), hydrochlorothiazide (diuretic), omeprazole (PPI), amiodipine (another antihypertensive), atorvastatin (another statin), and albuterol (asthma).

The author asks the critical question – Is a primary care physician (PCP) managing the patient’s multiple medications to ensure that each is warranted and that the combination is optimal?

My Take:
Are Americans taking too many medications? Yes. Is a PCP managing the patient’s meds? No, they may be pretending to too so, but there is no way to manage polypharmacy. The interactions between the various meds are so numerous and varied that it can not be managed.

I am constantly amazed that a patient can actually walk into my office taking 10 or more medications. I know that I could not function under that drug load, but their bodies slowly adapt over time. They’re alive, but not really living.

The Bottom Line:
If you look at the top nine medications, they all treat diseases stemming from metabolic syndrome – a preventable condition. I have a T-shirt that I wear frequently and it reads:

I take Metformin for the diabetes caused by the Hydrochlorothiazide I take for high blood pressure which I got from the Ambien I take for insomnia caused by the Xanax I take for the anxiety that I got from the Wellbutrin I take for chronic fatigue which I got from the Lipitor I take because I have high cholesterol because a healthy diet and exercise with regular chiropractic care and superior nutritional supplements are just too much trouble!

Wednesday, November 25, 2015

Wisdom Wednesday: Ending Medical Reversal

This is the title of new book written by Vinayak E Presad, MD and Adam S. Cifu, MD. Medical reversal is the phenomenon of a new superior trial arising that contradicts current clinical practice or the result of many claims that specific treatments have a benefit turned out not to be true.

You’ve all heard the contradictory reports. Coffee is bad for you today, tomorrow it’s good for and by next week it will be bad again.

The medical community is most concerned that these conflicting studies undermine the pubic confidence in medicine and therefore the authority of the doctor. The book claims medical schools spend too much time on the basic sciences and not enough time on practical application.

I believe they need to reverse their concepts of medical reversal. The issue is losing sight of the basic functions and chemistry of the body as it strives to maintain homeostasis. For example, most vitamin B12 injections are cyanocobalamin. This is the inactive form of vitamin B12 found in food. It must be converted to one of the active forms by the cells that line the small intestine upon absorption from the gut. When you inject cyanocobalamin into a muscle, there is no conversion to the active form. The blood levels look great on the lab test, but the patient does not improve. This is biochemistry 101, very basic stuff, that is lost on the doctor that has forgotten much of what they learned early in medical school. They rely of the drug rep to tell them what to use.

The real causes of medical reversal are:
  • Flawed understanding of physiology and pathophysiology
  • Poor quality studies
  • Affected by publication bias and selective reporting
  • Made by dishonest investigators
  • Based on publication subject to the influence of Big Pharma or other conflicts of interest

You are familiar with a few of these – recommending aspirin to prevent heart attacks in patients that have never had a heart attack (primary prevention), the use of cardiac stints in stable heart patients, and the prescribing HRT (hormone replacement therapy) using known carcinogenic compounds.

Monday, November 23, 2015

Heart Stints Ineffective?

Angioplasty – the procedure used to open narrowed or blocked arteries – doesn’t seem to lengthen life for people with stable heart disease and chest pain, a new study finds.

After 15 years of follow-up, the study found that people who had angioplasty fared no better than those who had their heart disease treated with medication and lifestyle changes alone.

“Stenting is effective and improves survival when performed early in the course of a heart attack,” said lead researcher Dr. Steven Sedlis, an associate professor of medicine at NYU Medical School in New York City. “But the benefits of routine stenting for patients with stable heart disease have been uncertain and highly controversial.”

Co-author Dr. William Boden, a professor of medicine at Albany Medical College in Albany, N.Y., said, “We know that in heart attack patients, angioplasty can be lifesaving.” But in patients with stable heart disease – even those with chest pain – medication and lifestyle changes may be the best way to minimize the risk of heart attacks and heart-related death, he said.

About one million angioplasties are done each year in the United States, and about 500,000 are done in patients with stable heart disease, Boden said.

“Patients need to understand what they are getting an angioplasty for,” Boden said. “If they are being told that it’s going to reduce the risk of heart attack or it’s going to make them live longer, they’re getting the wrong message.”

Friday, November 20, 2015

AMA “Ban Prescription Drug Ads”

Direct-to-consumer advertising for prescription drugs and medical devices drives up health care costs and should be banned, the American Medical association said Tuesday.

Currently, ads for drugs to treat diabetes, depression, impotence and more deluge TV viewers. This drives demand for expensive treatments, the nation’s most influential doctor group said when it adopted the new policy.

“Today’s vote in support of an advertising ban reflects concerns among physicians about the negative impact of commercially driven promotions, and the role that marketing costs play in fueling escalating drug prices,” Dr. Patrice Harris, the association board chair-elect, said in an AMA news release.

“Direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate,” she added.

Hoping to make prescription drugs and medical devices more affordable, the new policy also calls for a physician task force to study the issue, a campaign to demand choice and competition in the drug industry, and greater transparency in prescription drug prices and costs.

The United States and New Zealand are the only countries that permit direct-to-consumer ads for prescription drugs, according to the AMA.

This type of advertising is big business. Ad spending by drug makers increased 30% from 2012 to 2014, reaching $4.5 billion, according to market research firm Kantar Media.

Meanwhile, prices of generic and brand-name prescription drugs have risen steadily in recent years, including a 4.7% increase in 2015.

The high cost of prescription drugs is the top health care priority for Americans, according to a Kaiser Family Foundation report released las month.

Wednesday, November 18, 2015

Wisdom Wednesday: 23ANDME

For the first time genetic testing is available directly to the consumer (you) at an FDA approved lab for $199. Just google “23ANDME” to reach the web site for genetic testing.

They will mail you a home kit. You return it with a saliva sample and they will analyze your DNA for genetic variants.

Variants are genetic snippets that are associated with a variety of health conditions. You actually have two snippets for every genetic trait – one from your mother and one from your father. As long as your parents are not too closely related, you chances of having defects in both gene snippets are relatively rare. For example, having a pair of defective snippets for the conversion of folic acid to its biologically active form (5-MTHF) only occurs in 8% of the population. However, we know very little about why your body chooses a particular snippet of DNA to reproduce a RNA copy. Each snippet is used about 50% of the time. It does appear that under stress, the body tends to use the defective snippet more frequently.

While having a pair of defective snippets for folic acid is rare, 25% of the population in the U.S. has one defective snippet for conversion. The same is true for vitamin B6 and vitamin B12. That means I see patients with one or more genetic defects every day.

Until recently, genetic testing was very expensive, upward of $500 dollars for one genetic snippet. Now advances in genotyping chips has allowed multiple panels of testing for a reasonable price.

The ACE gene codes for the Angiotensin-1 converting enzyme. This enzyme has a pivotal role in regulating blood pressure. A defective snippet can reduce exercise performance, cardiovascular fitness, glucose balance and salt sensitivity.

Monday, November 16, 2015

Junk Food Not to Blame for America’s Obesity Epidemic

Despite their bad reputation, junk food, fast food and soda aren’t the root cause of American’s obesity epidemic, Cornell University researchers contend.

While these sugary and salt-laden foods may not be good for your health, the scientists found no significant difference in how much of these foods either overweight or normal weight people consumed – The real problem, according to the researchers: too many Americans eat too much.

“These are foods that are clearly bad for you and if you eat too much of them they will make you fat, but it doesn’t appear to be the main driver that is making people overweight and obese,” said lead researcher David Just, co-director of the Cornell Center for Behavioral Economics, in Ithaca, N.Y.

“For 95% of the country, there is no relationship between how much fast food and junk food they’re eating and their weight,” Just said. “Because of the bad habits we have, with all our food, just eliminating junk food is not going to do anything.”

But that doesn’t mean it’s OK to eat junk food. “These foods aren’t good for you,” he said. “There is no good argument for soda in your diet.”

Just said a broader approach is needed to fight the obesity epidemic. “We are eating too much generally. We need to cut back on our total consumption. We need to be better about exercising,” he recommended.

For the study, Just and his colleague Brian Wansink, director of the Cornell Food and Brand Lab, used the 2007-2008 National Household and Nutrition Examination Survey to analyze a sample of about 5,000 adults in the United States.

Friday, November 13, 2015

Back Pain Patients Seek Pain Relief First, Mobility Second

When asked to choose between a treatment that would reduce back discomfort and one that would help them stand and walk, the vast majority of patients wanted to ease their pain, a new study found.

“There has long been a debate in the medical community over striking the right balance between pain relief and physical function,” said the study’s lead author, Dr. John Markman, director of the Translational Pain Research Program in the University of Rochester Department of Neurosurgery in Rochester, N.Y.

“While physicians have leaned toward the need to increase mobility, this study shows that patients have a clear preference for pain relief,” Markman said in a university news release.

The study’s authors focused on nearly 270 patients who had trouble standing and walking and suffered from chronic back pain associated with lumbar spinal stenosis. The participants were asked to choose between a therapy that reduced their pain and one that would enable them to stand and walk. Nearly 80% of the patients said they would rather have relief from their pain than greater mobility, the study published recently in Neurology found.

“Even the patients who could not stand long enough to pick up a letter from their mailbox or wash the dishes after dinner chose pain relief,” said Markman.

The authors pointed out patients are playing a greater role in setting new standards for pain relief, demanding new medications that are both safe and effective.

Wednesday, November 11, 2015

Wisdom Wednesday: Iatrogenic Disease

Iatrogenic – induced inadvertently by [the words or action of] a physician or by medical treatment or diagnostic procedures.

I have experienced many examples of iatrogenic disease over the course of 39 years of practice. In the early years of my chiropractic career, it was trying desperately to treat patients that had failed back surgery syndrome. I have also treated a number of patients that became ill from bowel resections and cholecystectomies. But those number pale compared to the escalating numbers of patients developing new diseases from their medications.

This week alone I have two patients that appear to have developed type II diabetes from taking statin drugs. In both cases they have been taking statin drugs for years. When the diabetes was detected, their PCP (primary care physician) just added metformin and glyburide to their growing list of prescription drugs. One patient was on five meds, the other on ten. Neither case responded to the diabetic medications and they ended up in my office.

In another case this past week, a patient’s insomnia was due to her thyroid medication and another patient’s memory loss was secondary to his heart medication. His memory loss mimicked intermittent, advanced dementia. It was the radical swing in memory issues that keyed me in to the medications as the cause. Of course, he is on ten additional medications daily, so some the effect is probably from drug interactions.

Monday, November 9, 2015

Low Fat Diets No Better

Low fat diets are often promoted as a superior way to lose weight, but they’re no more effective than other types of diets, a new review indicates.

“We found that low fat diets were not more effective than higher fat diets for long term weight loss,” said study leader Deirdre Tobias, an associate epidemiologist at Harvard Medical School and Brigham and Women’s Hospital in Boston.

The key to success seems to have more to do with adherence than a specific weight-loss plan, Tobias said. “Being able to stick to a diet in the long term will probably predict whether or not a diet is successful for weight loss,” she said.

The new analysis was published online Oct. 30 in The Lancet Diabetes & Endocrinology journal. The research was supported by the American Diabetes Association and the U.S. National Institutes of Health.

In conducting their analysis, Tobias and her colleagues looked at 53 published studies involving more than 68,000 adults. Those on low-fat diets did lose weight. But, those on low-carbohydrate diets were slightly more than 2 pounds lighter than those on low-fat diets after a follow-up of at least one year. The average weight loss across all groups was 6 pounds, the researchers said.

“The conclusion from this, and similar studies, is that weight loss is not a results of limiting one calorie nutrient over another, and that achieving weight loss is likely a matter of calorie control, in a manner that works for the individual,” said Connie Diekman, director of university nutrition at Washington University in St. Louis.

Friday, November 6, 2015

Heartburn Drugs Tied to Kidney Disease

Proton pump inhibitors (PPIs) seem to be linked with an increased risk of chronic kidney disease, two new studies suggest.

Prilosec, Nexium and Prevacid belong to this class of drugs, which treat heartburn and acid reflux by lowering the amount of acid produced by the stomach.

While the current studies have shown as association between these drugs and the development of chronic kidney disease, they did not prove cause-and-effect relationship.

Still, the lead author of one of the studies believes, “It is very reasonable to assume that PPIs themselves can cause chronic kidney disease,” said Dr. Pradeep Arora, a nephrologist and associate professor at the SUNY Buffalo School of Medicine and Biomedical Science in Buffalo, N.Y.

“Patients should only use PPIs for [U.S. FDA] approved indications, and not to treat simple heartburn or [indigestion],” he cautioned.

Chronic kidney disease is increasing in the United States, with more than 20 million Americans now suffering with it, according to the American Society of Nephrology. This occurs when a person’s kidneys become damaged and can’t filer blood as they should. Diabetes and high blood pressure are two common risk factors for kidney disease, the society said.

Arora’s study involved more than 24,000 patient who developed chronic kidney disease between 2001 and 2008.

One out of the four of the kidney patients had been previously treated using a PPI. People taking a PPI also had nearly twice the risk of dying prematurely, the researchers found.

In the second study, researchers were led by Dr. Benjamin Lazarus from Royal Brisbane and Women’s Hospital in Australia, and Johns Hopkins University in Baltimore. They followed more than 10,000 adults with normal kidney function form 1996 to 2011.

Wednesday, November 4, 2015

Wisdom Wednesday: Intracoastal Waterway Century

On October 25, 2015, my wife, Margie and I participated in the Spacecoast Freewheelers metric century bike ride. The ride began in the historic little village of Cocoa, wound north and east along the Indian River. The first rest stop was the American Police Hall of Fame Museum. After passing through the Kennedy Space Center, the course then turned south along the east side of the Indian River and Intracoastal Waterway. At southern most point, the route crosses the Indian River again, turning north back to Cocoa.

The weather was mixed with cloud cover to keep the heat down but the wind shifted as the ride progressed so we faced a head wind for the first 55 miles. Once we made the final turn to go north, the wind decided to stay southeast and give us a little push.

Neither of us had any experience in drafting as our annual trek from Miami to Key West strictly prohibits riding any closer than one bike length between riders. Triathlons also will disqualify riders for drafting.

However, after Margie and I each spent close to 40 miles without drafting, we were exhausted. Finally, a couple of retired firemen from Jacksonville offered to lead us in as they had been drafting us since the first rest stop.

Apparently, people who draft and never lead are called “leeches” and we had between 10 and 20 at all times. They ride in the draft that you create, saving up to a third of the energy the lead rider is expending.

Monday, November 2, 2015

Worse Psoriasis, Less Healthy Arteries

The skin disorder psoriasis appears linked with artery inflammation, raising the odds for heart disease, a new study says.

“As the amount of psoriasis increases, the amount of blood vessel inflammation increases,” said senior investigator Dr. Nehas Mehta, a clinical investigator with the U.S. National Heart, Lung, and Blood Institute.

His team also found that even mild psoriasis may indicate an increased risk for heart attack and stroke.
Just one psoriasis skin patch, or plaque, “might be biologically active, causing low-grade inflammation and starting a cascade, speeding up their blood vessel disease,” Mehta said.

“People really should know that psoriasis is not just a cosmetic disease,” he added.

Psoriasis is a chronic disease that affects about 3% of U.S. adults. It occurs when skin cells grow too quickly, causing thick, white or red patches of skin.

Blood vessel, or vascular inflammation is most likely the direct result of psoriasis, not treatment, Mehta said. Treating psoriasis may lower the risk for heart attack and stroke, he said. Mehta advises people with psoriasis to lower their risk of heart disease by controlling traditional risk factors.

“Avoid smoking, try to maintain a healthy lifestyle, including moderate exercise and a balanced diet,” he said. “You should also have your blood pressure, cholesterol and blood sugar checked. Try to do that, because psoriasis itself might be a risk factor.”

Friday, October 30, 2015

During Menopause, ‘Good’ Cholesterol May Lose Protective Effect on Heart

HDL cholesterol is commonly called the “good” cholesterol, but new research suggests that it could be harmful to women going through menopause.

The new study finds that rather than helping to inhibit the formation of dangerous plaque in the arteries, HDL cholesterol may increase its buildup during menopause. This process is known as hardening of the arteries, or atherosclerosis, and can lead to heart trouble.

“This was surprising,” said lead researcher Samar El Khoudary, an assistant professor of epidemiology at the University of Pittsburgh.

“We know that the good cholesterol is supposed to protect women,” she said. And, before menopause, good cholesterol does help protect against heart disease, El Khoudary said.

But during menopause, HDL cholesterol seems to add to the plaque buildup. She explained. “This was independent of other factors such as body weight and levels of bad cholesterol,” El Khoudary said.

It’s not clear why good cholesterol may turn bad, she said. “There are many biological changes that happen to women during the menopausal transition,” she said.

Among these changes is the addition of fat to the abdomen and around the heart. “This could put women in a state of chronic inflammation that could change the good cholesterol,” El Khoudary suggested.

Wednesday, October 28, 2015

Wisdom Wednesday: Treatment Before the Diagnosis?

This is an abbreviated case history to illustrate some of the unique features of the QA (Quintessential Applications) protocol.

A 34 four-year-old female came to my office with a chief complaint of severe pain under her left jaw. She had been to her primary care physician who thought it was a salivary gland but found no evidence of infection.

On palpation I could elicit pain but not from the salivary gland but actually from a small area just adjacent to a salivary gland. The area did not feel inflamed or abnormal in any sense, except she reacted to the pain.

Chiropractors are very good at palpation. It’s skill that is honed in school by palpating a hair through pages of Gray’s Anatomy. With practice, you can feel the distortion through about 80 pages of text. Now add 38 years of practice, palpating spines all day long.

So I was just as confused as her PCP. I could not identify the tissue from palpation.

Using the QA protocol, I looked for an injury reflex. However, Autogenic Facilitation was intact (any weak muscle strengthened when the nerve supply to that muscle was stimulated) eliminating an injury.

TL (therapy localization) to the jaw was active – if she placed her hand on the location of pain, any weak muscle became strong. Now I had a tool to evaluate her symptoms.

Next I checked to see what inflammatory pathway might be active. She was negative for prostaglandins but positive for both leukotrienes and cytokines. These pathways stimulate the immune system and when both are active can be autoimmune in nature. Typically, such cases will not respond favorably to ginger or boswellia, requiring a supplement that modulates the immune system.

Monday, October 26, 2015

For a Better Calorie Burn, Adjust Your Speed While Walking

New research, from Ohio State University, found that changing your pace could burn up to 20% more calories than maintaining a steady stride.

“Most of the existing literature has been on constant-speed walking. This study is a big missing piece,” study co-author Manoj Srinivasan, a professor of mechanical and aerospace engineering, said in a university news release.

“Measuring the metabolic cost of changing speeds is very important, because people don’t live their lives on treadmills and do not walk at constant speeds. We found that changing speeds can increase the [caloric] cost of walking substantially,” Srinivasan explained.

People may also be underestimating the number of calories they burn while walking in daily life or playing sports, the study authors said. The researchers estimated that starting and stopping may account for up to 8% of the energy used during normal daily walking. This caloric cost is often not included in calorie-burning estimations, Srinivasan’s group said.

Study lead author Nidhi Seethapathi, added that “walking at any speed costs some energy, but when you’re changing the speed, you’re pressing the gas pedal, so to speak. Changing the kinetic energy of the person requires more work from the legs and that process certainly burns more energy.” Seethapathi is a doctoral fellow in mechanical engineering at the university.

Wednesday, October 21, 2015

Wisdom Wednesday: “All Natural” Alternatives for Erectile Dysfunction

I wrote this blog prior to the incident with Lamar Odem and the use of herbal sexual enhancement products. This blog is more timely than I had imagined and his case should serve as a warning for all men.

The FDA (U.S. Food and Drug Administration) issued their consumer health information for October, 2015. It was a warning about products marketed as “dietary supplement” or “foods” that promise to enhance your sexual performance or increase sexual stimulation. The concern is that hidden drug ingredients or other undisclosed ingredients can endanger your health.

This year the FDA lab tests have found that nearly 300 of these products contain undisclosed drug ingredients. These often include the same active ingredients found in prescription drugs like Viagra, Cialis, and Levitra. Sometimes they contain combinations of undisclosed drugs in excessively high doses.

For example, one of these tainted products included 31 times the prescription dose of tadalafil (the active ingredient in Cialis), in combination with dapoxetine, an antidepressant that is not approved by the FDA.
“Some of these products have as many as six different ingredients contained in FDA-approved prescription drugs. We don’t know what danger this poses because these combinations have never been studied before they are sold to unsuspecting consumers,” says Gary Coody, R.Ph., FDA’s national health fraud coordinator.

Monday, October 19, 2015

Forget Three Square Meals – Americans Eat All Day Long

New research found that most folks were eating for 15 or more hours while awake, and the lion’s share of calories were eaten well after 6 PM.

“Most participants thought they don’t eat or drink that regularly outside their breakfast-lunch-dinner routine,” said study co-author Satchidananda Panda, an associate professor in the Regulatory Biology Laboratory at the Salk Institute for Biological Studies in La Jolla, Calif. Most people also assumed that they had been confining their eating routine to a 10-12 hour window, he added.

The study’s results are in the Sept. 24 issue of Cell Metabolism.

The findings stem from a new effort to track real-world eating behavior by means of a newly designed mobile app.

For three weeks, 150 healthy men and women continuously snapped photos of all the food, drinks and nutritional supplements they consumed. In turn, the app tracked all caloric intake, along with the exact time and place food was consumed, the researchers said. After 21 days, investigators determined that food intake was generally both erratic and continuous.

In essence, the study authors found that whenever they were awake, people ate. More than half of the participants spread their food intake over a roughly 15-hour period each day. Fasting tended to occur only during sleep, the study found.

Less than a quarter of daily caloric intake happened before noon. By contrast, more than a third of food was consumed after 6 p.m.

Lona Sandon, an assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center at Dallas, said the study findings are “not much of a surprise.”

“Basically this new study helps confirm what we already suspect,” she said. “Eating sporadically and at all hours is just not good for our health."

Friday, October 16, 2015

Coffee May Not Risk Irregular Heartbeat

New research suggests that drinking coffee doesn’t seem to up the odds of a common type of irregular heartbeat called atrial fibrillation.

The study included 75,000 people who reported their coffee consumption in 1997. Their average coffee consumption was three cups a day. The researchers followed the participants’ health for the next 12 years. The researchers also reviewed findings from four previous studies that followed nearly 250,000 people for up to 12 years. All studies were done in Sweden or the United States.

The investigators found no link between drinking coffee and atrial fibrillation in any of the studies. That was true even among those with the highest levels of coffee consumption. The findings were published September 22 in the journal BMC Medicine.

“This is the largest prospective study to date on the association between coffee consumption and risk of atrial fibrillation. We find no evidence that high consumption of coffee increases the risk of atrial fibrillation,” study author Susanna Larsson said in a journal news release.

Larsson is an associate professor of epidemiology at the Karolinska Institute in Sweden.

Wednesday, October 14, 2015

Wisdom Wednesday: Food Sequencing

The concept of food sequencing has been around for about 50 years. The original theory was if you ate your foods one at a time rather than a bite of this and a bite of that, the food would layer in the stomach. Because various foods break down at much different rates (animal protein is very slow, fruits are fast), eating in sequence could markedly improve digestion.

Food sequencing is not to be confused with food combining, although that’s easily done. Food combining takes various foods and groups them together based on how quickly they break down. For example, protein can be eaten with vegetables, but not with starches. Starches can be eaten with vegetables and fruits must be eaten alone.

Dr. Harvey Diamond and his wife, Marilyn, published a New York Times #1 best seller in 1987 on this topic entitled “Fit For Life”. They made the process very easy by recommending all fruit be consumed in the morning, then switch to protein and vegetables or vegetables and starch for lunch and dinner.

For most of my patients, food combining is not necessary. However, for those with persistent digestive issues, food combining often provides a marked reduction in digestive symptoms like gas, bloating, constipation, and diarrhea.

So let’s get back to food sequencing. Recently, a patient of mine who is diabetic began a food sequencing program to reduce her blood glucose levels. Within two weeks, her fasting blood glucose dropped 35 points with no change in the foods she eats, just modifying the sequence.

Monday, October 12, 2015

DNA Damage May Play a Role in Gulf War Syndrome

Unexplained chronic fatigue, muscle pain and problems with thinking are experienced by a quarter of Gulf War veterans, and new research suggests exposure to DNA-damaging chemicals may cause this condition, known as Gulf War Syndrome.

Previous studies have suggested that the symptoms stem from a malfunction of mitochondria, the site in cells where molecules that power the body are made. The mitochondria have their own DNA, separate from the cell’s.
Researchers analyzed blood samples to measure the amount of mitochondrial DNA and degree of damage to this DNA among veterans with Gulf War Illness (GWI)

The vets not only had more mitochondrial DNA, but also more mitochondrial DNA damage than otherwise healthy adults, the researchers found.

Study author Yang Chen, a doctoral researcher at Rutgers Biomedical and Health Sciences in New Jersey, presented the findings at a recent meeting of the American Psychological Association in Tampa, Fla.

“Future studies are necessary to confirm these findings and determine their association with mitochondrial function. Work in this area may guide new diagnostic testing and treatments for veterans suffering from GWI,” the study’s authors wrote.

Friday, October 9, 2015

Potatoes, Tomatoes Make Up Bulk of Americans’ Veggie Intake

The U.S. Department of Agriculture, finds that potatoes now make up 30% of the vegetables grown and processed for Americans each year, while tomatoes make up 22%.

“Variety is so important in a healthy diet across the board,” said registered dietitian Dana Angelo White. “While focusing on only a small number of fruits and vegetables is better than nothing, it still makes it difficult to meet your needs for essential nutrients.”

A diet highly focused on potatoes, especially, can be harmful said White, who is assistant clinical professor of athletic training at Quinnipiac University in Hamden, Conn. “If the majority of potato consumption comes from processed sources like French fries and potato chips, they may be doing more harm than good,” she said.

The new data, from the USDA’s Economic Research Service, seems to bear that out. White potatoes accounted for about 115 pounds of the 384 pounds per person of vegetables and legumes eaten by the average American in 2013. However, two-thirds of those potatoes were used for French fries, potato chips and other processed or frozen potato products.

The same trends were seen for tomatoes. Of the 66 pounds of tomatoes consumed by the average American, only 20 pounds were for fresh tomatoes. The other 46 pounds were processed in a number of ways, including canned tomatoes, tomato sauces (such as ketchup), or as ingredients in processed stews, soups and other items.

Another nutrition expert suggested that consumers vary the “color” in their diet.

Wednesday, October 7, 2015

Wisdom Wednesday: A Simple Case of Sciatica?

A forty-nine year old male presented at my office with complaints of chronic low back pain with radiation down the right leg into the foot. He states that the back pain began almost a year ago. He was treated 2-3 times a week by a chiropractor but noted no benefit after a month and discontinued care.

Seven weeks ago, after sneezing, the pain shot down the right leg. The leg pain has been constant ever since, but varies in intensity. His orthopedic surgeon diagnosed a herniated disc and prescribed muscle relaxants and anti-inflammatory medication that failed to provide any relief.

An MRI performed two days prior to his initial visit in my office shows desiccation of the L4/L5 and L5/S1 discs with apparent prolapse at L5/S1 impinging the thecal sac.

Based on the history and MRI, I had several questions (please review my blog “The Patient History” posted September 16, 2015):
  • Why didn’t he respond to a month of fairly intensive chiropractic care?
  •  His pain radiates along the course of the femoral nerve, not the sciatic nerve. Why was he diagnosed with sciatica?
  • If sneezing caused the prolapse at L5/S1, why isn’t the sciatic nerve affected and why are both discs desiccated? That takes at least a year, maybe as much as five years to show on imaging studies.
  • The femoral nerve does exit from L4/L5 but that disc looks much healthier than the L5/S1 disc that supplies the sciatic nerve. Is this really a disc problem?

On examination, he had great difficulty arising from a chair (Minor’s Sign – imagine an old coal miner arising from a rocking chair) and exhibited marked antalgic posture (he leaned forward and to the left about 45 degrees) favoring the right leg to walk. Both these findings are secondary to protective muscle spasm.

Monday, October 5, 2015

Lowering Beta-Blocker Dose May Boost Survival After Heart Attack

People treated with low-dose beta blockers after a heart attack may fare better than those given the standard dose of this commonly prescribed medication, a new study shows.

Heart attack patients given just one-fourth of the dosage used in clinical trails lived just as long as patients on a higher dose, according to researchers at Northwestern University in Chicago. And in some cases, those on a low dose lived even longer, with 20-25% increase in survival.

“We set out on a mission to show if you treat patients with the doses that were used in the clinical trials, they will do better. We expected to see patients treated with the lower doses to have worse survival,” lead investigator Dr. Jeffrey Goldberger said in a university news release. “We were shocked to discover that they survived just as well, and possible even better.”

Goldberger is a professor of medicine at Northwestern’s Feinberg School of Medicine and a cardiologist at Northwestern Memorial Hospital. He also directs the cardiac arrhythmia program at Feinberg’s Center for Cardiovascular Innovation.

“We now need to figure out how to dose it in individual patients. That’s something no one has considered in the decades that we have been using this medication,” Goldberger said. “This huge gap in knowledge has been completely unexplored. Since this is the medicine we use in every single heart attack patient, we ought to figure out how to use it properly,” he said in the news release.

Roughly 90% of people treated for a heart attack are given a beta blocker, the study authors noted. This class of medication, which includes metoprolol (Toprol XL) and acebutolol (Sectral), is used to improve survival and prevent further heart attacks.

Friday, October 2, 2015

More Americans Getting Knees Replaced, And at Younger Ages

The National Hospital Discharge Survey, shows that between 2000 and 2010, more than 5.2 million total knee replacements were performed in the United States. By 2010, the operation had become the leading inpatient surgery performed on adults aged 45 and over.

The rate at which middle-aged and older Americans got their knees replaced almost doubled over the years covered by the study, for men and women, the researchers found.

People aren’t putting off the procedure for as long, either. In 2000, the average knee replacement patient was about 69 years old, but by 2010 that age had dropped to just over 66, the finding showed.

“In the past, the tread amongst orthopedic surgeons was to delay performing a joint replacement on a patient until a person was so hindered by their joint pain that they were nearly incapacitated in their activities of daily living (ADL),” said Dr. Neil Roth, an orthopedic surgeon at Lenox Hill Hospital in New York City.

However, “that philosophy has evolved,” he said, so that nowadays surgeons “perform joint replacements sooner, to prevent physical deterioration and deconditioning, and to try to maintain activity levels.”

Why is the operation becoming more popular for both genders? According to Roth, aging boomers are demanding more mobility as they age. Joint replacements are getting better, too, he added.

“Technologically, the longevity of knee and hip implants has also improved, lasting sometimes up to 15 years or longer,” Roth said. “While that still may necessitate revision surgery for those patients in the younger age groups, 45 to 64, it may not require two revision surgeries.”

Wednesday, September 30, 2015

Wisdom Wednesday: Best Selling, Most Prescribed Branded Drugs

Through June of this year, the cholesterol-lowing drug rosuvastatin (Crestor, AstraZeneca) was the most prescribed branded drug in the United States, and the arthritis drug adalimumab (Humira, Abbott Laboratories) was the best-selling branded drug, according to the latest data from the research firm IMS Health.

Rosuvastatin had about 21 million prescriptions, followed by asthma medication fluticasone propionate/salmeterol (Advair Diskus, GlaxoSmithKline), at about 13.6 million prescriptions; the proton pump inhibitor esomeprazole (Nexium, AstraZeneca), at about 13.2 million prescriptions, the insulin glargine injection Lantus Solostar (sanofiaventis), at about 11.2 million, and the attention-deficit drug lisdexamfetamine dimesylate (Vyvanse, Shire), at about 10.6 million.

Rounding out the top 10 most prescribed drugs for the period (in order) were the antiepileptic drug pregabalin (Lyrica, Pfizer), the chronic obstructive pulmonary disease medication tiotropium bromide (Spiriva Handihaler, Boehringer ingelheim Pharmaceuticals), the diabetes drug sitagliptin (Januvia, Merck), the asthma/chronic obstructive pulmonary disease drug budesonide/formoteral (Symbicort, AstraZeneca), and the antipsychotic medication aripiprazole (Abilify, Otsuka Pharmaceutical).

The top seller, arthritis drug adalimumab (Humira, Abbott Laboratories), had sales of about $8.6 billion, followed by the antipsychotic Abilify, at $7.2 billion; the arthritis drug etanercept (Enbrel, Amgen), at roughly $6.1 billion; the cholesterol drug Crestor, at just under $6.1 billion; and the insulin glargine ingection Lantus Solostar (sanofi-aventis), at around $5 billion.

Monday, September 28, 2015

Antibacterial Soaps Fail to Beat Plain Soap

Lab tests conducted by a team of Korean researchers revealed that when bacteria are exposed to the standard over-the-counter antibacterial ingredient known as triclosan for hours at a time, the antiseptic formulation is a more potent killer than plain soap.

The problem: People wash their hands for a matter of seconds, not hours. And in real-world tests, the research team found no evidence to suggest that normal hand-washing with antibacterial soap does any more to clean the hands than plain soap.

“[The] antiseptic effect of triclosan depends on its exposure concentration and time,” explained study co-author Min Suk Rhee, a professor in the department of biotechnology and the department of food bioscience and technology at the College of Life Sciences and Biotechnology at Korea University in Seoul.

But most people who wash their hands with antibacterial soap do so for less than 30 seconds, Rhee noted, using formulations containing less than 0.3% triclosan – the maximum allowed by law. And that combination, he said, is “not adequate for having an antibacterial effect.”

Rhee and his colleagues outline their findings in the September 16 issue of the Journal of Antimicrobial Chemotherapy.

Triclosan is the antibacterial component of liquid soap. In bar formulation, it’s triclocarban, according the U.S. Food and Drug Administration. These ingredients have been somewhat controversial. Some contend there is no scientific evidence to back up claims that these products are more effective than regular soap. Others have argued that these ingredients aren’t safe.

Friday, September 25, 2015

Half of U.S. Adults Have Diabetes or High Risk of Getting It

Up to 14% of adults had diagnosed or undiagnosed type 2 diabetes in 2011-2012, and about 38% had diagnosed or undiagnosed prediabetes, the researchers reported. Prediabetes is defined as having elevated blood sugar levels that aren’t high enough to be called full-blown diabetes, the researchers explained.

“Prediabetes puts people at risk of diabetes in the future,” said lead researcher Catherine Cowie. She is program director of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases’ division of diabetes, endocrinology and metabolic diseases.

About one-third of those Americans with type 2 diabetes don’t know they have it, and most of those with prediabetes are unaware of their condition, the study authors said. For these adults, the findings should be a wake-up call to get treatment and make lifestyle changes that include losing weight and being more active, Cowie said.

Although data from recent years suggests that the increase in the prevalence of diabetes may be leveling off, it’s still too high, Cowie added.

“Diabetes can be treated, but only if it is diagnosed,” she explained. “The medical community needs to be aware that there is a high rate of undiagnosed diabetes in the population."

Type 2 diabetes is caused by obesity, poor eating habits and lack of exercise. The new report was published September 8 in the Journal of the American Medical Association.

Wednesday, September 23, 2015

Wisdom Wednesday: Toxicity in Everyday Life

The liver is our major organ of detoxification. Eighty percent of the blood entering the liver comes directly from the digestive tract. So it’s not any surprise that that is where most of our toxins enter the body. Toxins can enter any orifice and through the skin, but the mouth is, by far the most common avenue.

Liver detoxification is divided into two phases. Everything that enters the liver goes through Phase I liver detox. Phase II liver detox is reserved for spent hormones (the ones made in our body) and alcohol only. At least that was the case until we started manufacturing chemicals in the 20th century.

Today a vast majority of manmade chemicals must go through both phases of liver detox to be rendered harmless and expelled from the body. This massive list includes most medications, the pesticides and hormones sprayed on our food, antibiotics in our drinking water and 800 plus bisphenols that are known estrogen disruptors.

This landslide of artificial chemicals overwhelms Phase II liver detox in each and every one of us. Its negative effects grow exponentially with each new generation. When my new patients complete a Symptom Survey, the liver invariably shows up as the organ responsible for the largest percentage of symptoms, regardless of their history.

Recently one of my patients asked me to write a blog about a specific form of air pollution. I suggested that a blog on how to minimize the effects of our toxic environment might be more aligned with the purpose of my blog.

Monday, September 21, 2015

Exercise May Be Good Medicine for Irregular Heartbeat

Exercise appears to help control an irregular heartbeat known as atrial fibrillation in obese people, a new study shows.

Australian researchers found that “cardiorespiratory fitness” reduced the risk that this potentially dangerous heartbeat will return by as much as 84% - even more than losing weight. Cardiorespiratory fitness refers to the ability of the heart and lungs to supply oxygen to the body during sustained physical activity.

“This study adds to a growing body of evidence that aggressive risk factor management with increased physical activity should be an integral component of management of atrial fibrillation,” said lead researcher Dr.

Prashanthan Sanders, director of the Center for Heart Rhythm Disorders at the University of Adelaide in Australia.

Atrial fibrillation, the most common abnormal heart rhythm, affects about 2.7 million Americans, according to the American Heart Association. Obesity and inactivity are risk factors for atrial fibrillation, which can lead to stroke, the researchers pointed out.

The report was published online August 24 in the Journal of the American College of Cardiology.
For the study, Sanders and colleagues assigned 308 patients with atrial fibrillation to one of three groups based on their level of fitness: low, adequate, or high fitness. All had a body mass index (BMI) of 27 or more, meaning they were overweight or obese.

The groups were followed for about four years to see how their level of fitness affected the recurrence of the abnormal heartbeat. Patients were also offered a doctor-led weight loss and exercise program.

Friday, September 18, 2015

Acupuncture Might Help Ease High Blood Pressure

Researchers found that blood pressure levels declined slightly in a small group of patients treated 30 minutes a week with “electroacupuncture” - where needles carry low-level electrical stimulation - at specific points of the body.

“Potentially, blood pressure can be kept low with a monthly follow-up treatment,” said study co-author Dr. John Longhurst, a cardiologist at the University of California, Irvine.

A estimated 70 million U.S. adults - one in 3 - have high blood pressure, according to the U.S. Centers for Disease Control and Prevention. It’s believed that only half have their condition under control. High blood pressure can lead to stroke and heart disease.

Blood pressure can often be lowered by becoming more fit, taking medications or both. But these approaches don’t work for everyone, and the medication can cause side effects, especially among the elderly.

Acupuncture, an ancient Chinese therapy, is increasingly viewed as a possible alternative, the researchers said in background notes with the study. Practitioners insert thin needles into key points on the body in an attempt to rebalance the flow of energy.

High blood pressure was defined as 140-180 mm Hg over 90-99 mm Hg. None of the participants was taking blood pressure medication.

Wednesday, September 16, 2015

Wisdom Wednesday: The Patient History

I was taught that “history is 75% of the diagnosis.” I often repeat that phrase adding “without a history I might as well be practicing as a veterinarian.” No offense to vets, but without some dialog, just where do you begin?

Patients often are not very detailed in the their history. I frequently get “back” listed as the chief complaint and only history on my entrance case history form. If the patient is feeling a little more expressive, he will write “low back.” These patients are not engaged in their health. I believe they learned this behavior from health care providers that also were not engaged.

A study by Beckman and Frankel showed that 75% of the time physicians interrupted their patients within 18 seconds of them beginning to express their complaints. Less than 2% of the time did the patient ever return to complete their concerns.

Most patients have more than one complaint on entry with an average of three concerns per visit. Furthermore, some experts note than contrary to common opinion, most patients do not express their primary complaint first. It is up to the physician to listen carefully and arrange the various complaints by priority.

The engaged patient will provide a detailed history. We e-mail our entrance forms to new patients well ahead of their appointment so they can fill them out completely. If the history is complex (I love a complex health history), they will attach several pages to the form. Too often these are patients that have never been provided an opportunity to relate their history and they are desperate for help.

Monday, September 14, 2015

Probiotics Don’t Keep Bad Bugs at Bay

Probiotics don’t protect the intestines of critically ill patients against antibiotic resistant bacteria, a new study indicates.

“With fewer therapies available to treat multidrug-resistant organisms, innovative methods to prevent or eliminate gastrointestinal colonization [by bacteria] are necessary,” said lead author Dr. Jennie Kwon, a clinical researcher in infectious disease at Washington University School of Medicine in St. Louis.

Colonization is the first step before a full-blown infection can develop, the study authors explained.

The current research included 70 patients in intensive care units who received either standard care or probiotics twice a day for up to two weeks.

Probiotics are live microorganisms - popularly called “good” bacteria. Probiotics are believed to boost a person’s resistance to harmful germs, the researchers said.

Antibiotic-resistant bacteria colonized the intestines of 10% of patients who received probiotics and 15% of those who got standard care. However, this difference was not statistically significant, the researchers noted.

The study was published August 27 in the journal Infection Control & Hospital Epidemiology.

Friday, September 11, 2015


Electronic (e)-cigarettes are about 95% less harmful to health than tobacco cigarettes, and they might be useful in helping people kick the smoking habit, according to a report commissioned by Public Health England (PHE)

The authors of the report also found that regular users of e-cigarettes are almost exclusively adults who are already smokers. In fact, the rate of youths and adults who smoke cigarettes has continued to decline in England, and there is no current evidence that e-cigarettes are “renormalizing smoking or increasing smoking uptake,” they write.

At first glance, the PHE report appears to be at odds with research that has drawn different conclusions on various issues related to e-cigarettes.

Given the growing popularity and increasing use of e-cigarettes, questions remain about their effects on teens and young adults. In fact, a study published at the same time as the PHE report arrived at a different conclusion about the gateway issue (JAMA. 2015;314:700-707).

In an editorial accompanying the JAMA study (2015;314.673-674), Nancy A. Rigotti, MD, from the Massachusetts General Hospital and Harvard Medical School in Boston, explains that the study provides “the strongest evidence to date that e-cigarettes might pose a health hazard by encouraging adolescents to start smoking conventional tobacco products.”

But Dr. McNeill takes issues with the conclusions reached in the JAMA study.

“One of the issues we raise in our report is that of measurement,” she told Medscape Medical News. “It is not the same to equate ‘ever use’ with use, as ever use can mean that someone had just tried an e-cigarette once.”

In the JAMA study, that was the measure of e-cigarette use and smoking. “Adolescence is a time of experimentation, so what we are really concerned with is any regular use of e-cigarettes and uptake of smoking,” Dr. McNeill explained.

Dr. Hajeck said he agrees that the JAMA study does not show that vaping leads to smoking. “It just shows that people who are attracted to e-cigarettes are the same people who are attracted to smoking,” he pointed out. “People who drink white wine are more likely to try red wine that people who do not drink alcohol.”

Wednesday, September 9, 2015

Wisdom Wednesday: How Reliable Are Medical Studies? Half of Findings Couldn’t Be Replicated

Independent researchers couldn’t reproduce the findings of more than half of 100 experiments previously published in three prominent psychology journals, a new review reports.

This review should fuel skepticism over scientific claims, particularly if those claims are based on shaky statistics, said one of the new study’s authors, Brian Nosek, a professor of psychology at the University of Virginia. Nosek is also executive director of the Center of Open Science, the non-profit group that coordinated the project.

Only 47% of the follow-up studies were able to reproduce the same effects of the original studies, the review found. The strength of findings found during original studies also appeared to diminish when successfully replicated, Nosek said.

The new review also calls into question the statistics used in the original studies. About 97% of the original studies showed a statistically significant result, but only 36% of the replication studies did the same.

“Reproducibility is a central feature of science,” Nosek said. “A scientific claim doesn’t become believable because of the status or authority of the person that generated it. Credibility of the claim depends in part on the repeatability of its supporting evidence.”

Monday, September 7, 2015

Steriod Injections Probably Won’t Help Your Low Back Pain

Steroid injections for low back pain may provide some relief for certain patients, but any benefits are temporary, a new study finds.

Low back pain related to herniated disk and, to a lesser degree, spinal stenosis (narrowing of the spinal canal), is often treated with epidural steroid injections, the researchers said. But after reviewing 38 previously published studies, the researchers found no strong evidence to support their use for these conditions.

“These injections may not be as effective as perceived, and decisions should be based on an informed discussion of risks, benefits, and potential options, including surgery, medications and non pharmacological options like exercise therapy,” said lead researcher Dr. Roger Chou, a professor of medicine at the Oregon Health & Science University.

Chou said lower back pain usually improves over time without treatment, but some patients may want relief sooner.

“Patients may have a perception that these injections reduce the need for surgery or result in long-term benefits,” Chou said. “It’s important for them to understand that benefits appear to he short-lived and to weigh these short-term benefits against potential complications of the injections, such as infection and nerve injury.”