Friday, December 23, 2016

Can Frankincense Treat Cancer?

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

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

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

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

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

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

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

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

Wednesday, December 21, 2016

Serum Vitamin D

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

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

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

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

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

Monday, December 19, 2016

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source: December 12, 2016 National Institutes of Health

Friday, December 16, 2016

U.S. Doctors Still Over-Prescribing Drugs

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

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

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

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

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

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

Wednesday, December 14, 2016

Wisdom Wednesday: The Thyroid Profile

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

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

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

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

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

Wednesday, December 7, 2016

Wisdom Wednesday: Lipid Panel Continued

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

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

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

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

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

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

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

Monday, December 5, 2016

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

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

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

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

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

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

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

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

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

Friday, December 2, 2016

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

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

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

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

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

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

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

Wednesday, November 30, 2016

Wisdom Wednesday: Lipid Panel

There are four basic markers in the lipid panel – total cholesterol, triglycerides, HDL and LDL. This week we focus on cholesterol only as there is so much misinformation about this blood test.


The laboratory range for the total cholesterol is 130-200 mg/dL while the functional range is 180-220 mg/dL. Cholesterol is a component of cell membranes, the myelin sheath and bile salts. It is the precursor for steroid hormones. Every cell in the body is able to produce cholesterol. The diet provides only 25% of the total cholesterol in the body as 75% is synthesized in the liver, intestines and skin.

The primary focus of general practice and cardiology has been on lowering total cholesterol as the key to preventing cardiovascular disease. Physicians often believe that the lower the cholesterol and LDL levels the better. However, there are several problems associated with reduced cholesterol.

Low cholesterol weakens cellular membranes and the quality of the myelin sheath that covers and protects the peripheral nervous system. It impairs memory and the ability to think. It results in poor steroid hormone production (e.g. cortisol, estrogen, testosterone, progesterone). It also impairs the immune system.

Levels below 180 mg/dL are associated with a 200% increase in cerebrovascular accidents, lung disease, depression, suicide and addictive behavior. A 300% increase in liver cancer is also noted.

Monday, November 28, 2016

Mercury Levels Dropping in North Atlantic Tuna

Mercury levels in one tuna species have decreased along with industrial emissions of the dangerous chemical element, a new study finds.

The results suggest that reductions in mercury emissions could quickly result in lower mercury levels in some species of ocean fish, according to researcher Nicholas Fisher and colleagues. Fisher is a professor at the School of Marine and Atmospheric Sciences at Stony Brook University in Stony Brook, N.Y.

Mercury, a neurotoxin, can harm the nervous system of humans. It accumulates in tuna and other types of fish, which has led to warnings against eating too much tuna, the researchers said in background notes.

Although increased coal burning in Asia has raised mercury emissions globally, levels have fallen in North America 2.8% a year between 1990 and 2007, the researchers said.

Over a similar period, mercury in north Atlantic waters dropped 4.3% annually. And mercury in the air above the North Atlantic Ocean declined 20% from 2001 to 2009, the researchers said. To assess the effects of those declines, the research team analyzed mercury levels in tissue samples from nearly 1,300 Atlantic Bluefin tuna caught between 2004 and 2012. During that time, mercury levels in the fish fell an average of 19%, the researchers said in a news release from the American Chemical Society. The findings were published recently in the journal Environmental Science & Technology.

Friday, November 25, 2016

Poor Sense of Smell May Signal Alzheimer’s Risk

A person’s sense of smell may help predict their risk for Alzheimer’s disease, a new study suggests.

The researchers included 183 older people, and 10 had possible or probable Alzheimer’s disease, the researchers said.

Study volunteers were tested on their ability to recognize, remember and distinguish between odors. These odors included menthol, clove, leather, strawberry, lilac, pineapple, smoke, soap, grape or lemon. The study participants were then asked to complete another test of odors. The second test included 10 new odors in addition to those from the original test. These tests were developed at Massachusetts General Hospital in Boston.

The participants also underwent genetic, imaging and memory tests. Those with a reduced sense of smell seemed to be at increased risk of Alzheimer’s, the researchers said.

“There is increasing evidence that the neurodegeneration behind Alzheimer’s disease starts at least 10 years before the onset of memory symptoms,” principal investigator Dr. Mark Albers, from the department of neurology at Massachusetts General, said in a hospital news release.

“The development of a digitally enabled, affordable, accessible and noninvasive means to identify healthy individuals who are at risk is a critical step to developing therapies that slow down or halt Alzheimer’s disease progression,” he added.

Wednesday, November 23, 2016

Wisdom Wednesday: The CBC (continued)

The white blood cells (WBCs) defend against infection and foreign substances through phagocytosis. They comprise about 1% of the healthy adult blood and have a life span of 13-20 days. Then they are destroyed by the lymphatic system. The number of WBCs in the blood are regulated by the endocrine system.

WBCs are also found in the lymphatic system. A majority of the cells are created in the bone marrow, then trained in the thymus. However, the spleen, liver and thymus can also produce WBCs if the bone marrow is unable to keep up with the demand.

An increase in WBCs is found in acute viral or bacterial infection, stress, intestinal parasites, a diet high in refined foods, or certain cancers.

A decrease can occur in chronic viral or bacterial infection, pancreatic insufficiency, bone marrow insufficiency, anemias due to folic acid, vitamin B6, or B12 deficiency, nutritional deficiencies, or chronic intestinal parasites.

Clinically, I use Andrographis Complex, colloidal silver, Neutrophil Plus, and Ultra Vir-x for infection fighting. Echinacea is best used as a preventative but it does provide a little support during acute infections. Think of Echinacea as “duct tape” for the immune system.

A chronic low WBC count responds really well to Ultra Vir-x and Neutrophil Plus, but variable doses of vitamin A and vitamin C can also raise a low WBC count over time.

The various types of WBCs are generally listed by the percentage of the total WBC count they represent. Neutrophils are the most common WBC, normally over 50%. They have a life span of 8 days and are usually the first responders to infections. They increase with acute infection, high stress, intestinal parasites, inflammation and Leaky Gut. They can decrease with chronic viral infection, food allergies, digestive insufficiency, bone marrow insufficiency, and anemia.

Lymphocytes are the second most common WBC. The functional range is 24-44%. They react to toxic by-products of protein metabolism and are able to recognize hundreds of millions of different molecules. The various types of lymphocytes provide a more specific immune response to offenders.

Monday, November 21, 2016

Healthy Living Can Overcome Genes Linked to Heart Disease

New research shows that people can minimize an inherited risk for heart attack by living right – exercising, eating healthy, staying slim and quitting smoking.

Even with a little effort in these areas, people can cut their high genetic risk of heart disease by more than half, said senior researcher Dr. Sekar Kathiresan, director of the Center for Human Genetic Research at Massachusetts General Hospital in Boston.

But the opposite also is true, Kathiresan warned. People born with a genetic advantage protecting them against heart disease can ruin their good luck through unhealthy lifestyle choices.

“For heart attack at least, DNA is not destiny,” Kathiresan said. “You have control over your risk for heart attack, even if you’ve been dealt a bad hand.”

Kathiresan presented his findings Sunday at the American Heart Association’s annual meeting, in New Orleans. The study was published simultaneously in the New England Journal of Medicine.

For their research, Kathiresan and his colleagues pooled data on more than 55,000 participants in four large-scale health studies.

The researchers analyzed each person’s genetic risk for heart disease using a panel of 50 gene variants. They also judged each person’s lifestyle based on four factors: smoking, body weight, diet and exercise.

The requirements to have a good lifestyle were not rigorous, Kathiresan said. “It’s safe to say we’re not being that aggressive in terms of the lifestyle score,” Kathiresan said. Even these minimal lifestyle changes mattered greatly for people at high genetic risk of heart disease.

Friday, November 18, 2016

U.S. Doctors Don’t All Follow Prediabetes Screening Guidelines

Only about half of U.S. family doctors follow guidelines on screening patients for prediabetes, a new study finds.

More than one-third of American adults have prediabetes, and most don’t know it. Prediabetes means that that blood sugar levels are higher than normal but not high enough to be diabetes. Diagnosing and treating prediabetes can prevent patients from developing diabetes, a leading cause of death in the United States.

University of Florida researchers surveyed more than 1,200 family doctors in academic medical settings nationwide. They found that those doctors with a positive attitude toward prediabetes as a clinical condition were more likely to follow national screening guidelines and offer treatment for their patients. Prediabetes treatments include medicine, exercise and losing weight.

Other doctors were more likely to suggest their patients make general lifestyle changes that may reduce heart disease risk, but aren’t associated with lowering blood sugar levels. Doctors also cited patients’ ability to make lifestyle changes, stay motivated and economic resources as significant barriers to preventing diabetes.

The study was published Nov. 8 in the Journal of the American Board of Family Medicine.

“Some physicians think that a prediabetes diagnosis ‘overmedicalizes’ patients, and some believe it is best to focus on providing general advice on healthy lifestyle,” study author Arch Mainous III said in a university news release. Mainous is chairman of health services research, management and policy in the College of Public Health and Health Professions.

The American Diabetes Association recommends prediabetes screening for adults who are overweight or obese and after age 45. The U.S. Preventive Services Task Force recommends screening for people between 40 and 70 years of age who are overweight or obese.

Wednesday, November 16, 2016

Wisdom Wednesday: The Complete Blood Count (CBC)

This is the most common laboratory test performed – CBC with differential. It is divided into three segments – the red blood cells (RBCs), the white blood cells (WBCs), and the platelets. Today’s blog will concentrate on the RBCs.

The conventional RBC normal range is from 4.6-6.0 million/uL for men and 3.8-5.1 million/uL for women. The functional range for men is 4.2-4.9 and 4.0-4.5 for women. Red blood cells are the most common blood cell making up 25% of all the cells in the human body. They carry 98% of all oxygen to tissues.

Young RBCs are called reticulocytes. Although it takes two days to produce one RBC, your body produces 2.4 million per second.

RBCs have a life span of 120 days and are filtered by the spleen. They are very flexible, flowing easily through the small capillaries and can circulate the body in 20 seconds.

A decrease in the RBC count can be caused by anemia, chronic liver or kidney dysfunction, free radical damage or blood loss. The RBC count increases in dehydration, asthma or respiratory distress, vitamin C deficiency and Polycythemia.

Hemoglobin is the iron carrying portion of the RBC. Four molecules of oxygen can attach to each molecule of hemoglobin. The laboratory range for hemoglobin is 12-16 g/dL but I prefer 14-15 for males and 13.5-14.5 for females. The hemoglobin is decreased in iron deficient anemias, nutritional deficiency, intestinal parasites, internal bleeding, vitamin B6 or copper anemia. It is increased in dehydration, Polycythemia, adrenal dysfunction, asthma, spleen hypofunction and elevated testosterone.

The hematocrit (HCT) measures the percent of RBC’s in the blood. The laboratory range is 36-50% in males and 34-44% in females. I narrow that slightly for the functional range. The hematocrit is a key component of anemia and dehydration screening.

Monday, November 14, 2016

More Than Half of Americans Have Chronic Health Problems

“The health of individuals in the U.S.A. is increasingly being defined by complexity and multimorbidity, the co-occurrence of two or more chronic medical conditions” said study authors, Elizabeth Lee Reisinger Walker and Dr. Benjamin Druss.

They emphasized that people with multiple health issues need more access to care and better coordination among their health care providers.

The Emory University researchers examined public health records to find out what percentage of U.S. adults have chronic medical conditions, mental illness or substance abuse problems, and how many were also living in poverty.

Chronic medical conditions looked at in the study included asthma, cirrhosis, diabetes, heart disease, hepatitis, high blood pressure, HIV/AIDS, lung cancer pancreatitis and stroke, according to the report.

The study, published online recently in Psychology, Health & Medicine, found that nearly 40% had a least one chronic medical condition. In addition, about 18% had been diagnosed with a mental illness in the past year, and about 9% abused drugs or alcohol during that time.

Overall, about 15% were living in poverty, the investigators found. Among those with chronic conditions, many had less than a high school education, were unemployed, were receiving government aid and had no health insurance.

“Just over half of adults in the U.S. have one or more chronic conditions, mental disorder, or dependence on substances. These conditions commonly overlap with each other and with poverty, which contributes to poor health,” Walker said in a journal news release. “In order to promote overall health, it is important to consider all of a person’s health conditions along with poverty and other social factors.”

Friday, November 11, 2016

Water: Can It Be Too Much of a Good Thing?

Dehydration is a familiar foe for endurance athletes. But did you know that drinking too much water can be potentially fatal, particularly if not treated properly? And you don’t have to be an elite athlete like a marathoner to fall victim to what doctors call water intoxication.

Water intoxication occurs when a person has consumed so much water that the salt levels in the blood become diluted, said Dr. Aaron Baggish, co-medical director of the Boston Marathon.

“When sodium concentrations are low in the blood, it actually allows water to leak out of the blood into the other tissues, a condition known as hyponatremia, added Baggish, who’s also associate director of the Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center.

The brain appears to be the organ most affected by hyponatremia, and begins to swell as water leaks out of the blood and into brain cells, he said. Usually, the symptoms are mild, such as confusion, headache and nausea. But if left untreated, people might wind up suffering seizures, Baggish said. In the worst cases, the brain continues to swell uncontrollably, resulting in a potentially fatal condition called brain stem herniation, he said.

“The brain is soft tissue that’s contained in a fixed skull. When the brain swells, there’s one real way it can go as an exit path, and that’s down to the bottom of the skull where there’s a hole that connects the brain to the spinal cord,” Baggish said.

Death from water intoxication is very rare among athletes like marathon runners, said Dr. William Roberts, a former president of the American College of Sports Medicine.

“We’ve noted maybe a half dozen deaths out of probably 3 or 4 million finishers, so it’s not a very common cause of fatality,” said Roberts, who’s also a professor with the University of Minnesota’s Department of Family Medicine and Community Health. Marathon runners are more likely to die from a heart attack or heat stroke, he said.

Wednesday, November 9, 2016

Wisdom Wednesday: Functional Blood Chemistry

This time every year I encourage my patients to have broad based laboratory testing of their blood and urine. These tests are excellent predictors of general health and help me correlate and confirm my QA (Quintessential Applications) findings.

I do this through our holiday newsletter, reducing the lab fees for the months of December, January and February. For the next several weeks, I will be reviewing the routine tests I recommend on the Wisdom Wednesday blog.
Comprehensive Metabolic Profile (CMP) – this series of tests provides information about electrolytes, liver, kidneys, bone and mineral status. It contains 14 tests as compared to the Basic Metabolic Panel with has 7. Managed care will often only order the BMP to save money.

The tests are:
  • Glucose
  • Calcium
  • Albumin
  • Total Protein
  • Sodium
  • Potassium
  • CO2
  • BUN
  • Chloride
  • Creatinine
  • Alkaline Phosphatase
  • Bilirubin
  • Anion Gap (calculated measurement)

The patterns seen on the metabolic panel:
  • Dehydration
  • Digestive imbalances
  • Malabsorption
  • Protein assimilation
  • Hypochlorhydria
  • Dysbiosis
  • Insulin resistance
  • Diabetes
  • Liver/gall bladder
  • Inflammation
  • Cardiovascular
  • Renal insufficiency
  • Edema
  • Metabolic acidosis
  • Metabolic alkalosis
  • Male urinary issues
  • Adrenal dysfunction

Function ranges and laboratory ranges can vary widely from test to test. For example, the laboratory range for the fasting glucose is 65-99 mg/dL while the functional range is 80-100 mg/dL. That’s pretty close. However, the laboratory range for calcium is 8.5-10.8 mg/dL but the functional range is much narrower at 9.2-10 mg/dL. In most cases the narrowed functional range allows the practitioner to see patterns in general health before they indicate obvious disease.

The Bottom Line:
The CMP is an inexpensive broad based look at metabolism. The BUN and creatinine are excellent indicators of kidney function while the SGOT and SGPT reflect liver status. Although the fasting glucose does have value, I prefer the hemoglobin A1c as an indicator of long term glucose control.

Monday, November 7, 2016

Irregular heart Rhythm Patients May Not Always Need Blood Thinners

People with an abnormal heart rhythm called atrial fibrillation (A fib) typically take powerful blood thinners to prevent strokes. However, those who suffered only short bouts of A fib – estimated at 20 seconds or less – were at no more risk for stroke or other heart complications than people without atrial fibrillation, a new study shows.

“Some patients have atrial fibrillation 100% of the time, while others might have only a few seconds of atrial fibrillation once a year,” explained study author Dr. Steven Swiryn. He’s a clinical professor of cardiology at the Feinberg School of Medicine at Northwestern University in Chicago.

“Where atrial fibrillation only happens rarely and lasts a short time, it can be difficult to detect,” Swiryn said.

Implanted devices such as pacemakers and defibrillators monitor a patient’s heart rhythm constantly, and they can spot short episodes of atrial fibrillation, he said.

“We can then more accurately answer the question, ‘How much atrial fibrillation does the patient have to have in order to be at risk of stroke and benefit from anticoagulation?’ Swiryn said.

The answer seems to be that patients with only short episodes of atrial fibrillation aren’t at enough risk for a stroke to warrant blood thinners, he said. “This allows physicians to avoid prescribing anticoagulation unnecessarily, since the risk of bleeding may be more than the benefit of stroke prevention,” Swiryn said.

Atrial fibrillation is the most common abnormal heart rhythm condition, and affects about 2.7 million Americans.

Friday, November 4, 2016

Calcium Supplements Won’t Harm the Heart

Over the past decade, a number of studies have raised questions about whether calcium supplements might contribute to heart disease or stroke. Just this month, a study of U.S. adults found that supplement users were more likely than nonusers to have plaque buildup in their heart arteries. (Calcium is a component of artery-clogging “plaques.”)

But a new research review, commissioned by the National Osteoporosis Foundation (NOF), has come to a different conclusion. On balance, the review found, the evidence doesn’t support a connection between calcium supplements and heart disease or stoke.

As long as people don’t go overboard, calcium supplements should be considered “safe from a cardiovascular standpoint,” say the guidelines from the NOF and the American Society for Preventive Cardiology. Getting calcium from foods such as milk, yogurt and tofu is still preferred, the groups say.

The guidelines and evidence review were published online Oct. 24 in the Annals of Internal Medicine.

The researchers analyzed 31 studies. Four of them were clinical trials, where older adults (mostly women) were randomly assigned to take calcium, with or without vitamin D.

None of those trials showed that supplement users had higher risks of heart disease, stroke or death than participants given placebo pills, the review found.

The rest of the studies the Tufts team analyzed were observational: They looked at the relationship between people’s calcium intake, from diet or supplements, and their risk of heart disease or stroke. Again, the researchers found the studies showed no consistent connection between higher calcium intake and higher cardiovascular risks.

Wednesday, November 2, 2016

Wisdom Wednesday: DHEA

DHEA is a hormone that is naturally made by the human body. It can also be made in the laboratory from chemicals found in wild yam and soy. The human body cannot make DHEA from these chemicals so simply eating wild yam or soy will not increase DHEA levels. However, the human body can make progesterone from wild yam when ingested, but not from topical creams or gels.

Supplementation of DHEA appears to be effective in persons over the age of 40 for a wide variety of conditions. However, the standard dosage of 25-50mg per day, is excessive (in my opinion) as the human body typically produces about 25mg per day when healthy.

I prefer a dosage of 5-10mg per day. Anything higher than that and you are using HRT (hormone replacement therapy) rather than reestablishing normal adrenal function. My concerns on dosage come from a study showing that at a dose of 5-12.5mg of DHEA daily, the telomeres attached to the nucleus of the cells of the body actually lengthen. Telomere length has been strongly tied to health and longevity. Higher daily doses of DHEA actually shortened telomeres.

DHEA is made from cholesterol naturally via two enzymes and is highly localized to the adrenal glands. It is also made in smaller quantities in the testes, ovaries, and brain. Circulating levels of DHEA in the brain can be 6-8 times higher than in the blood stream.

Monday, October 31, 2016

For Overheated Viewers of Presidential Race

The bitter U.S. presidential race has led to heated arguments among many Americans. But there are ways to lower the tension and prevent spirited discussions about Donald Trump and Hillary Clinton from getting too hostile, psychologists say.

“De-escalate when arguments get too personal,” said Emanuel Maidenberg, a clinical professor of psychiatry and biobehavioral sciences at the University of California, Los Angeles.

“The purpose of many discussions around politics is to express and exchange points of view – not to win. Be the first to de-escalate,” he said in a university news release.

The American Psychological Association reported last week that more than half of U.S. adults felt very or somewhat stressed by the vitriolic campaigns. Those results stemmed from an August poll – conducted well before disturbing recent reports of hacked Clinton State Department emails and sexual misconduct accusations against Trump.

Even if you fervently support one candidate, it’s important to question others about their views, Maidenberg said.

“It can be difficult to show understanding when you strongly disagree with a friend’s view, especially if it upsets your sense of right and wrong. But asking questions about why they feel that way – rather than attacking – is worth the effort,” Maidenberg said.

You need to remember that political views are only a small part of what makes a person who they are. Also, limit your exposure to political coverage in the media. “There’s a difference between being informed and being overwhelmed,” Maidenberg said.

Also, take time to consider the implications before you share your political views on Facebook or Twitter, he suggested.

Friday, October 28, 2016

Monitoring, Not Treatment, May Be Better for Some Prostate Cancer Patients

More than 90% of men in Sweden who have very low-risk prostate cancer choose close monitoring rather than immediate treatment – and more American men should use that option, researchers say.

In a study of nearly 33,000 Swedish men with very low-risk (stage T1) prostate cancer diagnosed between 2009 and 2014, the number choosing what is called active surveillance increased from 57 to 91%.

“For men who are diagnosed with low-risk prostate cancer, it is important to know that active surveillance is an accepted way to manage the cancer,” said lead researcher Dr. Stacy Loeb. She’s an assistant professor in the departments of urology and population health at NYU Langone’s Perlmutter Cancer Center in New York City.

“There is no rush to get treatment – low-risk prostate cancer can be safely monitored,” she added. “Some men will eventually need treatment, but others will be able to preserve their quality of life for many years.”

In the United States, the majority of men with low-risk prostate cancer get treatment upfront, which can have side effects, such as urinary and erectile problems, Loeb said.

Active surveillance isn’t wait-and-see, she explained. It involves regular blood tests and regular biopsies to gauge the growth of the tumor. When the tumor grows to a point where treatment is needed, then it’s time for curative surgery or radiation.

The report was published online Oct. 20 in the journal JAMA Oncology.

A recent British trail showed that 10 years after diagnosis, the risk of dying from prostate cancer was the same whether men initially had surgery or radiation or opted for monitoring, Loeb added.

Wednesday, October 26, 2016

Wisdom Wednesday: ‘Entitled” People May Be Pursuing an Unhappy Path

“Entitlement is a broad construct, but basically it refers to a desire to get something for nothing,” explained study lead author Joshua Grubbs, assistant professor of psychology at Bowling Green State University in Ohio.

According to Grubbs, entitlement is a personality trait where a person has an exaggerated belief that he or she is vulnerable to disappointment. And when disappointment strikes, it can mean anger, blaming others, social strife, collapsed relationships and depression, Grubbs’ team said.

That’s because entitlement is “really an attitude of ‘deservingness’, without any consideration for earning those things you want,” said Grubbs, who conducted the review while a graduate student in psychology at Case Western Reserve University in Cleveland. “I often describe it as someone saying, ‘I exist, therefore I deserve whatever I want.’”

He said this outlook doesn’t necessarily hinge on wealth. “We observe it across cultures and economic status,” he added. But no matter its source, “entitlement has long been known to be associated with negative emotion and distress,” Grubbs said.

The review of the data uncovered a common three-step pattern of pressures and behavior that often plague entitled individuals.

  • There’s a burden of living with the constant threat of failed expectations.
  • Adversity tends to cause them to lean even more heavily on an inherent sense of superiority.
  • These behaviors just perpetuate the cycle of disappointment, unhappiness, frustration and social turmoil.

“Ambition, drive and high standards are not necessarily symptoms of entitlement at all,” he said. “You can want to be successful and have high standards for yourself while still being humble and grateful. Many of the world’s greatest, most-accomplished leaders have been truly humble people.”

Monday, October 24, 2016

Americans Are Changing Their Supplements of Choice

Traditional multivitamins are falling out of favor among Americans, while supplements such as vitamin D, fish oil and probiotics are gaining ground, a new study finds.

Researchers found that between 1999 and 2012, Americans’ overall use of supplements remained stable. Slightly more than half of adults said they took vitamins, minerals or some other type of dietary supplement. What’s changed are the products of choice.

Multivitamins and many individual vitamins and minerals are less popular, as are botanicals such as Echinacea, ginseng and garlic extracts, the investigators found.

On the other hand, more people are using vitamin D, omega-3 fatty acids and probiotics – “good” bacteria said to benefit the digestive system.

“I did expect to see that vitamin D use would go up, and that fish oil would go up,” said lead researcher Elizabeth Kantor, an epidemiologist at Memorial Sloan Kettering Cancer Center in New York City.

That’s because both have been the focus of a lot of research and media attention in recent years, Kantor pointed out.

Some studies, but not all, have suggested fish oil pills can curb the risk of heart attack and other cardiovascular trouble. And studies have hinted that vitamin D could be protective against a range of ills, from cancer to diabetes to multiple sclerosis – though clinical trials testing those ideas have yet to be finished.

The drop in multivitamin use was less expected, Kantor said. But it also makes sense, she added. During the study period, a number of studies questioned the value of multivitamins when it comes to preventing major health conditions.

Americans Are Changing Their Supplements of Choice

Traditional multivitamins are falling out of favor among Americans, while supplements such as vitamin D, fish oil and probiotics are gaining ground, a new study finds.

Researchers found that between 1999 and 2012, Americans’ overall use of supplements remained stable. Slightly more than half of adults said they took vitamins, minerals or some other type of dietary supplement. What’s changed are the products of choice.

Multivitamins and many individual vitamins and minerals are less popular, as are botanicals such as Echinacea, ginseng and garlic extracts, the investigators found.

On the other hand, more people are using vitamin D, omega-3 fatty acids and probiotics – “good” bacteria said to benefit the digestive system.

“I did expect to see that vitamin D use would go up, and that fish oil would go up,” said lead researcher Elizabeth Kantor, an epidemiologist at Memorial Sloan Kettering Cancer Center in New York City.

That’s because both have been the focus of a lot of research and media attention in recent years, Kantor pointed out.

Some studies, but not all, have suggested fish oil pills can curb the risk of heart attack and other cardiovascular trouble. And studies have hinted that vitamin D could be protective against a range of ills, from cancer to diabetes to multiple sclerosis – though clinical trials testing those ideas have yet to be finished.

Friday, October 21, 2016

The ‘Love Hormone’ May Quiet Tinnitus

People suffering from chronic ringing in the ears – called tinnitus – may find some relief by spraying the hormone oxytocin in their nose, a small initial study by Brazilian researchers suggests.

“Oxytocin has actions in the brain and the ear that may help in tinnitus treatment and provide immediate relief,” said lead researcher Dr. Andreia Azevedo. She is with the department of otolaryngology at the Universidale Federal de Sao Paulo. She speculated that it may regulate fluid in the inner ear, and a brain effect that may be related to the production of the neurotransmitter dopamine.

Although oxytocin appeared safe, its long-term effects aren’t known, Azevedo said. “We did not have any side effects, but further larger studies are necessary to establish the role of oxytocin in tinnitus treatment, she added.

As many as one in 10 Americans suffers from tinnitus. The disorder is characterized by hearing sounds when there are none. The sounds can be perceived as ringing, buzzing, crickets or hissing. For those who struggle with it daily, the noise is so bothersome that it interferes with thinking, emotions, hearing, sleep and concentration, according to a previously published study.

For the new study, the researchers randomly assigned 17 people with tinnitus, average age 63, to puffs of oxytocin or placebo (distilled water) in each nostril.

The study volunteers were asked to assess their symptoms 30 minutes after treatment, and then again, 24 hours later. Azevedo’s team found that patients who received oxytocin reported a significant reduction in tinnitus compared with those who received the placebo.

Wednesday, October 19, 2016

Wisdom Wednesday: Omega 3 Fatty Acids: DHA vs EPA

Chronic inflammation has been identified as a potential link between obesity and cardiovascular diseases. In people who are obese, fat cells release greater amounts of inflammatory and signaling molecules (adipokines) that induce insulin resistance, blood vessel dysfunction, and systemic inflammation, all of which increase the likelihood that an artery may become damaged. Once damaged, the artery will express proteins that attract white blood (immune) cells to the location to help with repair and recovery. These immune cells also begin secreting chemicals (cytokines) that signal more immune cells to come to their location.

Theoretically, the damage should resolve but that doesn’t happen because the chronic inflammation and dyslipidemia associated with obesity continually damages the arteries, never allowing them to fully repair. As the damage accelerates, LDL particles become trapped in the artery wall and become oxidized. Macrophages engulf the LDL particles creating “foam cells” and ultimately accumulate to form plague on the artery wall.

There is a growing body of literature suggesting that the omega-3 fatty acids EPA and DHA have the potential to reduce the inflammatory state associated with obesity. EPA and DHA serve as the precursor molecules from which anti-inflammatory compounds (resolvins, protectins and maresins) are synthesized. A recent meta-analysis of 68 randomized controlled trials showed that EPA and DHA supplementation significantly reduced several inflammatory molecules: tumor necrosis factor alpha, C-reactive protein and interleukin-6.

However, some studies used EPA and DHA in combination while others used only one of the fatty acids in isolation. A new double-blind, randomized placebo-controlled crossover study was recently published to try and differentiate the effects of these fatty acids. Men and women with abdominal obesity and low-grade inflammation consumed 2.7 grams of EPA, 2,7 grams of DHA, or three grams of corn oil for 10 weeks each. Inflammatory molecules, blood lipids, and body composition were assessed before and after each phase.

Compared to corn oil, DHA supplementation affected numerous inflammatory markers and blood lipids, including a significant reduction of CRP, whereas EPA was more limited in its effects.

Monday, October 17, 2016

Could Prescribed NSAID Painkillers Raise Heart Failure Risk?

Use of prescription-strength ibuprofen, naproxen and other commonly used pain relievers may be tied to a higher risk of heart failure, researchers report. These medications known as NSAIDs, may raise a person’s relative risk of heart failure by nearly 20%, according to the analysis of medical records.

The risk increases with the amount of NSAIDs a person is taking, said study author Andrea Arfe, a Ph.D. student at University of Milano-Bicocca, in Italy.

“Our findings – which focused only on prescription NSAIDs – might apply to over-the-counter NSAIDs as well,” Arfe said. “Although over-the-counter NSAIDs are typically used at lower doses and for shorter durations, they are sometimes available at the same doses as prescription NSAIDs and they may be inappropriately overused.

The findings were reported Sept. 28 in the BMJ.

According to the American Academy of Orthopaedic Surgeons (AAOS), NSAIDs decrease inflammation and pain by blocking an enzyme called cyclooxygenase. This enzyme comes in two forms, COX-1 and COX-2. COX-1 protects the stomach lining from digestive acids, while COX-2 is produced by injured or inflamed joints.

Traditional NSAIDs – like aspirin or ibuprofen – block the action of both COX-1 and COX-2, which is why some people suffer from stomach upset after taking them, the AAOS said. Newer NSAIDs like celecoxib (Celebrex) target only COX-2, and are referred to as COX-2 inhibitors.

“These drugs have been around for a long time, and they have important pain relief and anti-inflammatory properties, but they also have cardiovascular side effects,” said Dr. Christopher O’Connor, editor-in-chief of the cardiology journal JACC: Heart Failure. They have been shown to hold onto sodium, and there’s some reduction in kidney function.

Friday, October 14, 2016

U.S. Life Expectancy Lags Behind Other Wealthy Nations

The health of U.S. citizens is specifically challenged by smoking, diabetes, high blood pressure, drug abuse and gun violence, said study co-author Dr. Mohsen Naghavi. He’s a professor with the Institute of Health Metrics and Evaluation at the University of Washington in Seattle.

The United States isn’t meeting the high expectations set by the country’s wealth and the amount it spends on health care, mainly because not all U.S. citizens benefit equally from their nation’s advantages, Naghavi said.

“This comes from inequality in access to health care, along with other social and economic factors,” he said.

Infant mortality in the United States was six deaths out of every 1,000 kids younger than 5, while the average for all high-income nations combined was about five deaths per 1,000.

U.S. men and women also had poorer life expectancy, compared with the rest of the developed world.
These findings are part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2015, a scientific analysis of more than 300 diseases and injuries in 195 countries and territories.

The numbers show that the United States needs to rethink its approach to health care, said Dr. Prabhjot Singh. He is director of Mount Sinai’s Arnhold Institute for Global Health in New York City.

“We are investing in the wrong stuff, and we are paying for it with our lives,” Singh said.
Researchers found that drug abuse and diabetes are causing a disproportionate amount of ill health and early death in the United States, compared with other countries.

Wednesday, October 12, 2016

Wisdom Wednesday: Supplements: Pharmaceutical vs Whole Food

Recently a patient inquired about a supplement that I recommended for her. Is it pharmaceutical or natural? Although the question was valid, I realized immediately that her understanding of the terms was skewed. So let’s clear up some misconceptions.

A supplement that has all natural ingredients can be pharmaceutical quality. In fact, all the herbal supplements I recommend are pharmaceutical quality and all natural. As I have mentioned in numerous blogs, I purchase my herbs from Australia and by law, they are manufactured to pharmaceutical standards.

So what does that really mean? Medi-Herb sources the raw herbs from various growers throughout the world. Pre-shipment samples are tested in the lab for identification, validation (species, plant part), and efficacy (actives, phytochemical profile). Then chromatography is used to separate the phytochemicals in an herbal extract in individual components. High performance thin layer chromatography (HPTLC), ultra-high performance liquid chromatography (UHPLC), and gas chromatography (GC) are all used prior to mass spectrometry (MS). If the sample passes all these quality tests than an order for bulk purchase is placed. Once the bulk shipment arrives, samples are taken and the tests are repeated. When all aspects of quality control of the raw material are confirmed then manufacture begins. If not, the herb is sent back.

After manufacture through proprietary cold percolation, samples are again tested using all the same processes noted above. When all extract meets all criteria, it is bottled for sale. This creates an extract of the full spectrum of compounds of the herb without causing damage or degradation.

The result – an all-natural, pharmaceutical quality herbal extract.

Monday, October 10, 2016

Are There Alternatives to Statins?

Statins are the go-to therapy for lowering “bad” LDL cholesterol, but other treatments also can effectively reduce risk of future heart problems, a new evidence review reports.

These alternative therapies – including a heart-healthy diet, other cholesterol-lowering medications, and even intestinal bypass surgery – seem to confer the same level of heart health protection as statins when cholesterol levels decrease.

Nonstatin therapies reduced the risk of heart problems by 25% for each 1 millimole per liter decrease in LDL cholesterol levels. That’s very similar to the 23% reduction per 1 millimole per liter decrease seen with statins like atorvastatin (Lipitor) and simvastatin (Zocor), the researchers said.

What’s more, the benefits of these therapies stack up if more than one proves effective at lowering a person’s cholesterol levels, said senior researcher Dr. Marc Sabatine, a cardiologist at Brigham and Women’s Hospital in Boston.

“The focus really should be not on a particular drug, but on reducing LDL cholesterol,” Sabatine said. “These data show there are multiple interventions that can do that.”

Statins, which work by reducing the liver’s production of cholesterol, were taken by more than one-quarter of U.S. adults aged 40 and over during 2011-2012, according to a national survey.

A heart-heathy diet reduces the amount of LDL cholesterol you eat while increasing dietary components like fiber has been shown to help clear cholesterol from the bloodstream.

Zetia (ezetimibe), is a drug that blocks absorption of cholesterol in the digestive tract.

Friday, October 7, 2016

How Older People Can Head Off Dangerous Drug Interactions

Potentially serious drug interactions are a daily threat to older people who take multiple medications and supplements, according to the U.S. Food and Drug Administration.

One drug can affect the effectiveness of other drugs and how your body uses them. For example, your kidney and liver may not work as well, which affects how drugs are broken down and leave your body, the FDA said.

“There is no question that physiology changes as we age. Many chronic medical conditions don’t even appear until our later years,” Dr. Sandra Kweder, an FDA medical officer, said in an agency news release. “It’s not that people are falling to pieces; some changes are just part of the normal aging process.”

The FDA says these safety tips will help prevent harmful drug interactions or side effects:
  • Follow your doctor’s directions
  • Keep a medication list
  • Learn about possible drug interactions and side effects
  • Routinely go over your medication list with your doctor

“As a society, we have become reliant on pharmaceuticals to help us attain a longer and higher-quality life. It’s a wonderful success of Western medicine,” Kweder said. “The goal should be for each of us to access that benefit but respect that medicines are serious business. To get the most out of them, you should take them with great care and according to directions.”

Wednesday, October 5, 2016

Wisdom Wednesday: Five Tips to Protect Yourself from the Seasonal Flu

Experts say an annual flu shot is the best way to avoid the aches, fever, congestion and fatigue that flu brings – and to protect those who are at high risk for flu-related complications.

“Every year, people die from influenza,” said Cindy Weston, an assistant professor of nursing at Texas A&M University. “After sizable outbreaks, people will respond with large amounts of vaccinations, but they should be getting vaccinated every year to protect those most vulnerable, mainly children and the elderly.”

The U.S. Centers for Disease Control and Prevention recommends an annual flu shot for everyone older than 6 months of age. This includes pregnant women.

“The flu strain mutates every year,” she explained. “The flu shot you get this year is different from the one you got last year because it is made specifically for the prominent strains of the virus.”

If vaccination rates are low, a potentially deadly flu outbreak could occur, Weston said. Millions of people get the flu every year, leading to hundreds of thousands of hospitalizations and thousands of deaths, according to the CDC.

“Flu season typically lasts from fall to spring,” Weston said. “The outbreak may peak at various times during those seasons, but people should be vaccinated before they return home for the holidays to prevent an outbreak.”

After you get the shot, it takes two weeks for your body to develop antibodies against the virus, Weston pointed out.

Monday, October 3, 2016

Smart City Planning Can Cut Deadly Diseases, Improve Air Quality

Cities that promote walking, bicycling and public transportation can expect a drop in chronic illnesses such as heart disease and diabetes, a new study suggests.

The findings stem from an international study led by the University of Melbourne in Australia and the University of California, San Diego (UCSD).

The goal: To see how city design – including street layout and access to shopping within walking distance – affects the environment and health in places like Boston; Copenhagen; Delhi, India, London and Sao Paulo, Brazil.

Team members reported their findings Friday during a meeting at the U.N. General Assembly. The findings were also reported in the latest issue of The Lancet.

“With the world’s population estimated to reach 10 billion people by 2050, and three quarters of this population living in cities, city planning must be part of a comprehensive solution to tackling adverse health outcomes,” report co-author Billie Giles-Corti said in a Lancet news release. Giles-Corti is lead investigator at the NHMRC Center for Research Excellence in Healthy Livable Communities at the University of Melbourne.

In the 19th century, she said, city planning helped curb outbreaks of infectious disease through improvement in sanitation, housing and efforts to separate housing and industrial areas.

“Today, there is a real opportunity for city planning to reduce non-communicable diseases and road trauma, and to promote health and well-being more broadly,” Giles-Corti added.

The researchers used computer models to study several factors that could affect a city’s quality of life. Among them: how far people must travel to shop; availability and safety of bike paths; parking costs; and access to public transportation.

Friday, September 30, 2016

Alternative Pain Relief

Popular drug-free methods of managing pain from such common conditions as headaches and arthritis appear to be effective, according to a new review.

Millions of Americans seek pain relief through such alternatives as acupuncture, tai chi and yoga. But there has been little information to help doctors make recommendations about these approaches.

“For many Americans who suffer from chronic pain, medications may not completely relieve pain and can produce unwanted side effects. As a result, many people may turn to nondrug approaches to help manage their pain,” study lead author Richard Nahin said in a U.S. government news release.

“Our goal for this study was to provide relevant, high-quality information for primary care providers and for patients who suffer from chronic pain,” Nahin added. He is lead epidemiologist at the U.S. National Center for Complementary and Integrative Health (NCCIH).

Researchers reviewed 105U.S.-based clinical trials from the past 50 years.

Several alternative approaches showed promise for providing safe and effective pain relief. They included acupuncture and yoga for back pain; acupuncture and tai chi for osteoarthritis of the knee; and relaxation techniques for severe headaches and migraine. Results of massage therapy for short-term relief of neck pain were also promising.

Evidence was weaker in some cases. The study found massage therapy, spinal manipulation and osteopathic manipulation might help relieve back pain while relaxation therapy and tai chi might help people with fibromyalgia.

Wednesday, September 28, 2016

Wisdom Wednesday: Hormone Receptors

Hormones are chemical messengers secreted into the blood or extracellular fluid by one cell that affect the functioning of other cells. Most hormones circulate in blood, coming into contact with essentially all cells. However, a given hormone usually affects only a limited number of cells, which are called target cells. A target cell responds to a hormone because it bears receptors for the hormone.

Hormone receptors are found either exposed on the surface of the cell or within the cell, depending on the type of hormone. In very basic terms, binding of a hormone to a receptor triggers a cascade of reactions within the cell that affects function.

A traditional part of the definition of hormones described them as being secreted into blood and affecting cells at distant sites. However, many of the hormones known to act in that manner have also been shown to affect neighboring cells or even have effects on the same cells that secreted the hormone. Nonetheless, it is useful to be able to describe how the signal is distributed for a particular hormonal pathway, and three actions are defined:
  • Endocrine – the hormone is distributed in blood and binds to distant target cells.
  • Paracrine – the hormone acts locally by diffusing from its source to target cells in the neighborhood.
  • Autocrine – the hormone acts on the same cell that produced it.

Two types of molecules bind to the hormone binding sites: Agonists are the hormones themselves. They bind the receptor and trigger all the post-receptor events that lead to a biologic effect. Antagonists are molecules that bind the receptor thereby blocking the agonist, preventing the intracellular signaling system.

Monday, September 26, 2016

Calcium Supplements Might Raise Older Women’s Dementia Risk

Taking calcium supplements with the hope of keeping osteoporosis at bay may raise an older women’s risk of dementia, a new study suggests.

And that seems particularly true if a woman has already sustained an event causing poor blood flow to the brain (cerebrovascular disease), such as from a stroke, the researchers said.

The study can’t prove cause-and effect. However, dementia risk was seven times higher in female stroke survivors who took calcium supplements, compared to women with a history of stroke who didn’t use the supplements, the findings showed.

Lead researcher Dr. Silke Kern stressed that the findings apply only to calcium supplements. Calcium from food appears to affect the brain differently than calcium from supplements, she explained. Food calcium appears to be safe or even protective said the neuropsychiatric researcher at the University of Gothenburg in Sweden.

Kern isn’t sure why calcium supplements might have this effect. Calcium plays a crucial role in cell death, she said, and high levels of calcium in the blood might prompt the early death of neurons. Excess calcium also might somehow affect the blood vessels within the brain.

But Dr. Neelum Aggarwal cautioned against blaming calcium supplements alone for any person’s dementia risk. “We need to consider that the combination of nutrients will be more predictive than one nutrient,” said the associate professor of neurological science and director of research for the Rush Heart Center for Women at Rush University Medical Center in Chicago. “For example, calcium, phosphorus and magnesium all are typically looked at for their effects on multiple organs, and cognitive [mental] functioning will be affected most likely by a combination of these nutrients. To say that only one nutrient increases the risk of dementia is premature, and more studies need to look at a combination of nutrients.”

Friday, September 23, 2016

45 Potential Toxins Found in Household Dust

In a new evidence study review, researchers have identified 45 potentially toxic chemicals in dust samples from homes in 14 states.

These chemicals come from a broad array of consumer products, including furniture, carpeting, drapes, electronics and toys, said lead author Ami Zota. She’s an assistant professor at George Washington University’s Milken Institute of School of Public Health in Washington, D.C.

“Indoor dust is a reservoir for consumer-product chemicals,” Zota said. “Many of the times when these chemicals are added to consumer products, they’re not chemically bound to the products. They can migrate out of the product and into the air or dust,” she explained.

“Some of these chemicals are associated with serious health outcomes,” she said, “particularly children’s health.”

The American Chemistry Council, which represents the chemicals industry, said the study “only tells part of the story.” “The mere presence of a chemical does not signify risk to human health,” the council said in a statement. “Assessing health risks depends not only on understanding which substances are present in something like dust but also on the actual amount, route, duration and timing of exposure to those substances. Most of this important information is missing in this study.”

Dr. Kenneth Spaeth is chief of occupational and environmental medicine for Northwell Health in Great Neck, N.Y. He said the presence of these potentially harmful chemicals in homes has been known for some time and is worthy of some concern.

Wednesday, September 21, 2016

Wisdom Wednesday: Progesterone for Men?

Progesterone occupies an important position in the pathway of hormonal synthesis in both men and women. While many of us think of progesterone as being a hormone strictly for women, men need progesterone too.

Most progesterone in women is produced in their ovaries, it is also produced in the adrenal glands of both sexes and in the testes in males. In fact, after menopause, progesterone production falls dramatically in women, while the male body makes more.

Not only is progesterone found in males, but men relay on the alleged “female hormone” to preserve their masculinity. In fact, progesterone is a precursor to testosterone – the male sex hormone. As men age and testosterone begins to decline, estrogen levels steadily rise. As estrogen levels increase, progesterone levels plummet. Therefore, boosting progesterone levels can be of great benefit for men.

Hormone levels are a real balancing act – it is the ratios of all the hormone with each other that makes the system work. Hormones are cell messengers that carry signals to different cells in the body. This communication can be impaired by a multitude of factors, including: nutritional inadequacies, stress, toxicity, organ toxicity/malfunction, and mineral deficiencies.

Dr. John R. Lee coined the term estrogen dominance. He described a condition where a woman (or in this case a man) has excess estrogen in relation to progesterone. Even if a man’s estrogen levels are low, it is still possible that he will experience symptoms of estrogen dominance – if the ratio to progesterone is high.

The main cause of estrogen dominance in men is exposure to xenoestrogens, hormone-mimicking chemicals found in consumer-based products, tap water and even in the air we breathe. Other causes of estrogen dominance in men include alcoholism, obesity, chronic stress and endocrine dysfunction.

Monday, September 19, 2016

Sugar Companies Shifted Focus to Fat as Heart Harm

Analysis of 50-year old documents suggests the sugar industry manipulated research to play down the harmful effects of sugar on the heart, a new study says.

The sugar industry paid Harvard University nutrition scientists to build a case against saturated fat and cholesterol as primary causes of heart disease while downplaying the negative health effects of sugary foods and beverages, according to researchers at the University of California, San Francisco (UCSF).

As a result, consumers may have been misled for decades into thinking only saturated fat harmed the heart, and not sweets, the researchers said. During that time, obesity and associated ills like diabetes reached alarming levels in the United States.

“There are all kinds of ways that you can subtly manipulate the outcome of a study, which industry is very well practiced at,” said the study’s senior author, Stanton Glantz, a professor of medicine at UCSF.

“As the saying goes, he who pays the piper calls the tune,” Glantz said in a university news release.
The Sugar Association said it still supports industry-funded research, but admitted it should have been more open about its past involvement.

For its report, the UCSF team searched public archives for internal corporate documents from the sugar industry.

According to their analysis, the sugar industry was aware by the 1950s that if people cut fat out of their diets, their sugar intake would jump about 30%.

Around this time, studies began to warn of a link between sugar and risk factors for heart disease, like high cholesterol and triglycerides, the researchers said.

Friday, September 16, 2016

Smoking Thickens Heart Wall Leading to Heart Failure

Researchers assessed the hearts of 4,580 U.S. adults using echocardiography – ultrasound of the heart. The participants’ average age was nearly 76. None had any obvious signs of heart disease.

Even after accounting for factors such as age, race, body fat, blood pressure, diabetes and alcohol consumption, current smokers had thicker heart walls and reduced pumping function than nonsmokers and former smokers, the study showed.

The study was published Sept. 13 in the journal Circulation: Cardiovascular Imaging.
It’s long been known that smoking is linked with heart failure, even in people without heart disease. But, heath experts didn’t know how smoking increased the risk of heart failure.

“These data suggest that smoking can independently lead to thickening of the heart and worsening of heart function, which may lead to a higher risk for heart failure, even in people who don’t have heart attacks,” said study author Dr. Wilson Nadruz Jr. He is a research fellow at Brigham and Women’s Hospital in Boston.

My Take:
We are all well aware of the negative effects of smoking. I’d like you to focus on thickening of the heart artery walls as a measure of risk for heart failure and CVD (cardiovascular disease).

Thickening of the intima of the artery wall is a result of inflammation. At the same time plague adheres to the inside of the artery wall, again as a response to inflammation. The fact that this plaque is made of LDL cholesterol led to the myth that LDL cholesterol is “bad cholesterol” and should be lowered at all costs.

As a result, Americans have eaten “reduced fat” foods and taken statin drugs for a generation in error. This week we learned that decades ago sugar companies paid scientists to build a case against saturated fat and cholesterol as primary causes of heart disease. While we reduced our fat intake, we increased our sugar intake by an average of 30% and heart disease skyrocketed.

Wednesday, September 14, 2016

Wisdom Wednesday: Hormones and Cardiovascular Disease

Last weekend I attended a seminar on the relationship between hormones and cardiovascular disease. It was taught by Dr. Jack Monaco. He was an Ob/Gyn for 25 years, then switched to functional medicine. Of note, he became interested in holistic health because of his own health issues and while searching for (and finding) a medical alternative that worked, he found a new career.

Functional medicine as practiced by Dr. Monaco is much closer to mainstream medicine than my practice. I would not choose to practice using his model, but he has collected a wealth of information that I can adapt to my practice.

His treatment is based on the fact that hormone decline with age. Some, like growth hormone decline in our 20’s. Others, like testosterone and estrogen begin to drop typically in our 40’s. He believes that supplementing with bio-identical hormones improves the quality of life and actually reduces the incidence of CVD (cardiovascular disease) and morbidity.

He makes a compelling argument in that all the studies that relate increased CVD and cancer from HRT involved equine and synthetic hormones, not bio-identical hormones. However, I remain skeptical and continue to believe that it is much better to support the body to produce endogenous hormones. Exogenous hormones will always suppress natural hormone production.

If the patient has no capacity to produce their own hormones then bio-identical hormone therapy makes more sense. Even in my practice, patients often choose HRT before giving more natural alternatives a real chance. More typically, it’s the patient that has been taking bio-identical hormones that wants to get off them and still enjoy the benefits that seeks my advice.

As I say to all my female patients going through menopause, “it’s unfair of me to criticize you for wanting the relief provided by HRT.” “Despite the fact that I disagree philosophically, I support your right to choose your own therapy.”

Monday, September 12, 2016

Heart Birth Defects Dropped after Folic Acid was Added to Food

In a new study, researchers reviewed data from nearly 6 million births in Canada. The births occurred between 1990 and 2011. Folic acid food fortification became mandatory for all types of flour, enriched pasta and cornmeal in 1998 in Canada.

During the study period, there was an 11% decline in rates of congenital heart defects overall. But decreases weren’t seen in all types of heart defects present at birth.

The biggest declines – between 15 and 27% - were in structural defects of the heart, such as holes in the wall of the heart or a narrowing of the major artery (the aorta) that carries blood to the body form the heart, the investigators found.

But, there was no reduction in heart defects at birth caused by an abnormality in the number of an infant’s chromosomes, the finding showed.

An estimated 650,000 to 1.3 million children and adults in the United States have congenital heart disease, the researchers said. A hole in the wall of the one of the heart’s ventricles is the most common type of defect in children. These defects account for nearly 620,000 of the cases, the researchers added.

Folic acid deficiency during pregnancy can cause a number of complications, these include anemia and neural tube defects (such as spina bifida, an abnormality of the spine and spinal cord), the researchers explained.

Women who are likely to get pregnant should start taking folic acid supplements before conceiving because they may not get enough folic acid from their diet alone, said study senior author Dr. K.S. Joseph. He’s a professor of obstetrics and gynecology at the University of British Columbia in Vancouver.

Friday, September 9, 2016

Thyroid Levels in High-Normal Range May Be Linked to Cardiac Arrest

People with higher levels of thyroid hormone in their bloodstream may be at greater risk of sudden cardiac death, even if those levels aren’t abnormally high, a new study suggests.

“Our study shows that the risk of sudden cardiac death increases with higher thyroid hormone levels, even in the normal range,” said lead researcher Dr. Layal Chaker, a research fellow in endocrinology and epidemiology at Erasmus University Medical Center Rotterdam in the Netherlands.

Sudden cardiac death occurs when a person’s heart stops due to a malfunction in the electrical system that derives the heartbeat.

Researchers found that people with thyroid hormone levels at the high end of the normal range were 2.5 times more likely to die from sudden cardiac death, compared with people at the lower end of the range.

In addition, the 10-year risk of sudden cardiac death was four times greater among people with high levels of thyroid hormone, according to the report.

This potential connection between high-normal thyroid hormone levels and sudden cardiac death is “really new, in that we really never made this association in the past,” said Dr. Vincent Bufalino, an American Heart Association spokesman and cardiologist in Naperville, Ill.

“We do know that thyroid hormone in excess sort of speeds up the heart,” Bufalino said. “Your metabolism is faster, higher. Your engine is running hot, so to speak,” he said.

But negative effects on heart health have mainly been associated with “toxic” levels of thyroid hormone that are far above normal levels, he said.

Wednesday, September 7, 2016

Wisdom Wednesday: The Magic Velvet Bean

Mucuna pruriens (Velvet Bean) seeds are well established as an herbal remedy for the management of male infertility, nervous disorder, and also as an aphrodisiac. The ancient Indian medical system, Ayurveda, traditionally used M. pruriens to treat Parkinson’s disease. Velvet bean has been shown to have neuroprotective effects, which may be related to its antioxidant activity. In vitro studies demonstrate its ability to scavenge free radicals and reactive oxygen species (ROS).

There are approximately 150 species of annual and perennial wild legumes. One of them, Velvet bean is found throughout the tropical and sub-tropical regions of the world. However, the plant originated in southern China and eastern India. It actually is a good source of protein, comparable to soy, rice and lima beans.

Velvet bean contains a high concentration (4-7%) of L-dopamine. This amino acid can be converted in L-dopa by the human body. Velvet bean is the commercial food source for the drug L-dopa used in western medicine to treat Parkinson’s disease.

In my practice I commonly use herbs based on Ayurvedic medicine. Clinically, I use velvet bean in the treatment of Parkinson’s disease and often in cases of intention tremor that have not (yet) been diagnosed as Parkinson’s disease. Chemically, L-dopa cannot cross the blood-brain barrier, but L-dopamine can. So the trick is to supplement L-dopamine, let it cross the blood-brain barrier, then be converted into L-dopa. The conversion of L-dopamine to L-dopa is facilitated by vitamin B6. So we eliminate all supplementation of vitamin B6 and even limit some dietary sources.

Monday, September 5, 2016

Early Prostate Cancer Diagnoses Continue to Fall in U.S.

Diagnoses of early prostate cancer continue to decline in the United States, following the U.S. Preventive Services Task Force recommendation against routine screening for the disease, researchers report.

The screening involves a blood test that identifies levels of PSA (prostatic specific antigen), a protein produced by the prostate gland. That test can determine when cancer exists, but it often wrongly identifies nonexistent cancer.

The “false positive” results can cause anxiety and lead to unnecessary follow-up tests. Because of this, the task force issued a draft recommendation against routine screening in 2011 and a final guideline in 2012.

Since then, diagnoses of early prostate cancer in American men aged 50 and older dropped by 19% between 2011 and 2012 and by another 6% the following year, said lead researcher Dr. Ahmedin Jemal. He is vice president of the American Cancer Society’s surveillance and health services research program.

But while men may have been spare unnecessary anguish, less frequent screening may have a downside. Some experts worry more men will develop potentially fatal prostate cancer as a result.

There is a balance in the task force recommendation, said Dr. Anthony D’Amico, chief of genitourinary radiation oncology at Brigham and Women’s Hospital and the Dana Farber Cancer institute, in Boston.

Friday, September 2, 2016

Fatty Fish May Curb Eye Risks for Diabetes

Two servings of fish a week may be enough to lower the heightened risk for blindness that those with diabetes face, a new Spanish study suggests.

Diabetic retinopathy is a serious complication of type 2 diabetes resulting from a drop-off in blood supply to the patient’s retina. According to lead researcher Aleix Sala-Vila, it is the most frequent cause of diabetes-related blindness.

“We wanted to [see] whether regular consumption of seafood-fatty fish in particular- in the absence of any advice to increase seafood consumption or fish oil supplementation decreased the risk of diabetic retinopathy,” explained Sala-Vila, a researcher at the Centro de investigacion Biomedica en Red in Barcelona.

Sala-Vila’s team focused on patients whose overall diet was already composed of mostly low-fat or plant-based roods. That said, the team found that those who consumed at least two servings of fatty fish weekly had a lower risk for diabetic retinopathy than those whose diet included less fish.

Study participants were drawn from an earlier trial that had divided Spanish residents with type 2 diabetes into three different groups, each assigned to a different diet.

The first followed a low-fat diet. The second followed a Mediterranean (plant-based/red meat-free) diet, supplemented with extra virgin olive oil. And the third also followed a Mediterranean diet, supplemented by 30 grams a day of omega-3 rich walnuts, hazelnuts, and almonds.

The study found it was those in the second group who saw their vision risks fall.
Working with the same pool of participants, Sala-Vila’s team then asked about 3,600 diabetic men and women between the ages of 55 and 80 to report how often they consumed eight types of seafood before embarking on their assigned diets.

Wednesday, August 31, 2016

Wisdom Wednesday: Barefoot Running

Barefoot running or “natural running” is growing in popularity in the modern world. However, it is the way we all ran until the Romans starting building roads and it is still the way many people run in third world countries.

When you run wearing a modern shoe, the heel tends to strike the ground first. Although this is thought to be a more efficient way to run, it transmits tremendous shock to the body. Therefore, modern running shoes have cushions soles that are thickened in heel to absorb this shock. The soles are also quite stiff, resisting movement.

When you run barefoot the natural tendency is to land on your mid-foot or even on the outside of the mid-foot. This minimizes the forces transmitted to the body. People that run in this fashion can adapt to even hard surfaces like roads and sidewalks and are able to run without discomfort.

As I have aged, I have gradually shifted my running from the road to grassy fields and the beach. It helps that I live about a half a mile due west of the Atlantic Ocean. I have not, nor do I intend to learn to run barefoot on the pavement, but I really prefer to run barefoot on the beach.

I schedule my beach runs to coincide with low tide. The beach is much closer to level and more hard packed along the water’s edge at low tide. When I was training for my one and only marathon, I found that the angle of the beach inflamed by ITB (iliotibial band) if I exceeded 5 miles. The angle at high tide will stress the ITB in just a couple of miles.

Monday, August 29, 2016

Acetaminophen During Pregnancy May Up Risk of ADHD in Kids

Pregnant women who take acetaminophen – best known as Tylenol – might raise the risk that their child will develop behavioral problems such as attention-deficit/hyperactivity disorder (ADHD), a new study suggests.

Acetaminophen is generally considered safe in pregnancy – so safe, in fact, that at least two-thirds of women turn to it while expecting, according to the American Academy of Family Physicians.

But when pregnant women in Britain used the pain reliever, it appeared to increase the risk of behavior problems cropping up in their children by the time they turned 7, said lead researcher Evie Stergiakouli, a lecturer in genetic epidemiology at the University of Bristol.

Still, the study couldn’t prove cause-and-effect, and Stergiakouli believes that women should still take the drug if needed.

In the study, taking acetaminophen between 18 and 32 weeks in pregnancy was associated with a 42% increased risk of behavior problems in children and a 31% increased risk of hyperactivity, the researchers found.

No similar association cropped up in mothers who used acetaminophen after delivery, nor did it occur if the father used the over-the-counter drug, the findings showed.

“Only acetaminophen used during pregnancy has the potential to cause behavioral problems in the offspring,” Stergiakouli said.

These findings jibe with two other large-scale studies that have suggested acetaminophen may have an adverse effect on a baby’s brain during pregnancy, said Dr. Andrew Adesman. He is chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center in New Hyde Park, N.Y.

Friday, August 26, 2016

Tougher U.S. Air Standards Would Be Lifesavers

Curbing two types of air pollution could save thousands of lives in the United States every year, a new study contends.

Research by the American Thoracic Society (ATS) says that reduced airborne levels of ozone and fine particles would also prevent many serious illnesses and significantly reduce missed days of school and work. The ATS recommendations are lower than current U.S. Environmental Protection Agency standards.

Specifically, the ATS said 9,320 lives could be saved each year with an eight-hour ozone standard of 0.060 parts per million, rather than the EPA’s 0.070 standard. So would a fine particle annual standard of 11 mcg/cubic meter, rather than the EPA’s 12 mcg standard.

Stricter standards would reduce serious health events such as heart attacks, hospital admissions and emergency room visits by 21,400 a year, the ATS said. The reduced pollution would also cut 19.3 million days that severe breathing problems leave Americans unable to go to work, school or be physically active each year, the group said.

The study was published online in the August issue of the journal Annals of the American Thoracic Society.

“While there is information available about counties in the United States that exceed EPA air pollution standards, there has not been a similar source of information about how that air pollution actually affects the health of people living in those areas,” study lead author Kevin Cromar said in a society news release.

The pollution levels recommended by the ATS are based on national and international animal and human studies, the group said.

According to the ATS, the 10 urban areas that would benefit most from lower levels of these air pollutants are: Los Angeles, Riverside, CA, New York City, Phoenix, Pittsburgh, Fresno, CA, Bakersfield, CA, Houston, Cleveland, and Cincinnati.