Friday, July 29, 2016

FDA Bolsters Warnings about Class of Antibiotics

The U.S. Food and Drug Administration announced Tuesday that it’s strengthening label warning on a class of antibiotics called fluoroquinolones because the drugs can lead to disabling side effects, including long-term nerve damage and ruptured tendons.

The agency also cautioned that these bacteria-fighting drugs – including levofloxacin (Levaquin) and ciprofloxacin (Cipro) – shouldn’t be prescribed for sinusitis, chronic bronchitis or simple urinary tract infections unless no other treatment options exist.

“Fluoroquinolones have risks and benefits that should be considered very carefully,” Dr. Edward Cox said in an FEDA news release. He’s director of the Office of Antimicrobial Products at the FDA’s Center for Drug Evaluation and Research.

“It’s important that both health care providers and patients are aware of both the risks and benefits of fluoroquinolones and make an informed decision about their use,” Cox said.

A safety review revealed that potentially permanent side effects involving tendons, muscles, joints, nerves and the central nervous system can occur hours or weeks after exposure to fluoroquinolone pills or injections. Also, two or more serious side effects can occur together, the FDA said.

Because of this, the FDA recommends reserving these antibiotics for serious bacterial infections, such as anthrax, plague and bacterial pneumonia.

In these cases, “the benefits of fluoroquinolones outweigh the risks and it is appropriate for them to remain available as a therapeutic option,” the agency said.

Besides Cipro and Levaquin, other fluoroquinolones include moxifoxacin (Avelox), ofloxacin (Floxin) and gemifloxacin (Factive).

The FDA has reported concerns about fluoroquinolones since 2008. At that time, it added a boxed warning because of increased risk of tendinitis and tendon rupture.

Wednesday, July 27, 2016

Wisdom Wednesday: Thyroid and the Immune System

I have written frequently about the role of the thyroid in general metabolism, production of the hormones T3 and T4, and the thyroid autoimmune disease Hashimoto’s thyroiditis. The thyroid gland also serves an important role in your immune system.

There is increased interest in the role of autoimmune disease on the health of the thyroid. Some experts state that fully a third of all cases of hypothyroidism are due to the autoimmune disease Hashimoto’s thyroiditis. However, there is little or no interest the reverse scenario – the thyroid’s effect on the immune system.

We know that thyroid hormones have the ability to dampen the cytokine load. Cytokines are chemicals released from the immune system. When we are unable to control the cytokine load systemic inflammation ensues. Increased cytokines also can suppress TSH (thyroid stimulating hormone), can decrease conversion of inactive T4 to active T3, and make thyroid hormonal binding sites in the cells less responsive. So hypothyroidism and inflammation become a vicious cycle.

Iodine also plays an essential role in immune function. Dietary iodine is collected in the thyroid gland where it is used to form thyroid hormone. T3 is three molecules of iodine attached to cholesterol. T4 is four molecules of iodine attached to cholesterol. When iodine stores in the thyroid are adequate, iodine also acts as a disinfectant.

My analogy is a salt water pool. Rather than load the pool up with chlorine to keep the algae at bay, salt (NaCl) is added to the fresh water. When water flows through the pump a small cylinder sends an electric charge through less than one gallon of the water, changing the salt to chlorine. The water in the cylinder is super chlorinated, killing the algae, but the amount of chloride that ends up in the pool is minimal. Of course this system only works when the pump is running and requires adequate salt in the pool.

In much the same way, blood is constantly coursing through the thyroid. When iodine status is adequate, the iodine disinfects the blood much like the chlorine does in the pool. Obviously, the pump (heart) works 24/7, but iodine status is typically low in much of the population.

Monday, July 25, 2016

Most Americans Are Eating Better

More than half of Americans were eating healthier in 2012 than they were in 1999, a new study finds.
In fact, the percentage of adults with poor diets dropped from 56% to 46% during that period. By 2012, people at more whole grains, fruit, nuts, seeds and fish while cutting back on sugar-sweetened drinks, the researchers found.

“Many Americans are starting to pay attention to healthier diets. This is encouraging, and farmers, food manufacturers, retailers and restaurants should take notice,” said lead researcher Dr. Dariush Mozaffarian. He is dean of the Tufts Friedman School of Nutrition Science and Policy in Boston.

Despite these gains, the number of Americans eating an “ideal” diet increased only slightly, from 0.7 to about 1.5%, the investigators found. An ideal diet includes fruits, vegetables, fish, whole grains and less meat, salt and saturated fat.

Moreover, disparities persisted in the quality of diet based on race or ethnicity, education and income. Among whites, those with a poor diet decreased from 54% to 43%. But little change was seen among blacks, Mexican-Americans and Hispanics, the findings showed.

Not only did these disparities persist, but based on income, they may have widened slightly, Mozaffarian said.

In addition, Americans weren’t eating more total fruit and vegetables, and they were still consuming too much processed meat, saturated fat and salt, he said.

A poor diet leads to poor health, particularly obesity, diabetes, heart disease and some cancers. Each year, more than 650,000 Americans die from conditions related to diet, the researchers said.

Improving American’s diet goes beyond what people can do themselves, Mozaffarian said. “Government, industry and advocacy efforts are needed to improve many aspects of our food system, in particular to further promote minimally processed, healthier foods and reduce refined grains, starches and sugary drinks,” he said.

Friday, July 22, 2016

Just a Little of Statins’ Effect Enough to Help Heart

Giving high doses of statins to patients with heart disease doesn’t lower the risk of future heart trouble any more than moderate doses of the cholesterol-lowing drugs do, a new study finds.

Having heart disease raises the risk of heart attack and stroke, as blood vessels become clogged and cut the normal flow of blood and oxygen to the heart. These patients are typically prescribed statins on a long-term basis, to lower levels of vessel-clogging LDL (“bad”) cholesterol. But experts remain conflicted about exactly how low LDL cholesterol levels should go.

“Our study demonstrates that physicians treating patients with heart disease and elevated levels of cholesterol with statins have to ensure that patients meet a target of less than 100 mg/dL to prevent further [heart] events,” said study author Dr. Morton Lelbowitz. He is a senior physician with the Clalit Research Institute in Tel Aviv, Israel.

According to the U.S. Food and Drug Administration (FDA), millions of Americans currently take statins, including well-known brands such as Crestor (rosuvastatin), Lipitor (atorvastatin), and Zocor (simvastatin), among others. But the FDA also stresses that the heart benefits of lowering cholesterol levels with statins is “indisputable.” What is in dispute is what the ideal target cholesterol level should be.

For example, while the American Heart Association does not advocate for any specific LDL target level, the European Society of Cardiology recommends that LDL be brought down to a relatively “low” level of 69 mg/dL or less.

To examine the issue, investigators tracked more than 31,600 patients, ranging in age from 30 to 84, all of whom had been diagnosed with heart disease between 2009 and the end of 2013. All had been taking statins for at least one year.

Nearly 30% were found to have “low” LDL levels, meaning a reading of 70mg/dL or less. More than half had a “moderate” LDL level of between 70.1 and 100mg/dL, while nearly 20% had “high” levels exceeding 100 and as high as 130.

Patients were followed for an average of 1.6 years, and during that time more than 9,000 either died or faced a serious cardiac event, including heart attack, stroke, chest pain (angina), heart bypass surgery or surgery to unblock arteries (angioplasty).

Wednesday, July 20, 2016

Wisdom Wednesday: Nasal Irrigation

A recent study published in JAMA (Journal of the American Medical Association) indicates that nasal irrigation may be effective for the treatment of chronic sinusitis and sinus infection. The study involved just over 900 subjects, half of which used a Netti Pot daily for 30 days. Self-evaluation at three and six months revealed that 8% of those who used the Netti Pot reported long term resolution of symptoms verses those that used steam inhalation or other methods.

While the subjects that reported good improvement was small, it was statistically significant and the study went on to suggest that the use of a Netti Pot should be considered in the treatment of chronic sinus conditions.

Clinically, I find the Netti Pot to be an excellent tool for home therapy. The traditional pot looks just like a plastic tea pot. You fill the pot as directed (more on that later), stick the spout in the end of one side of the nose then tilt the pot and your head to the same side allowing the water to enter the nose. The water flows through the sinus cavities and out the opposite side.

I’d like to say the sensation is pleasant, but I would be lying. It feels just like you might imagine – water up the nose. The Netti Pot kit comes with kosher salt that you add to distilled water.

Distilled water is vital. Tap water can contain nematodes that can breed in your sinus cavities then burrow into your brain causing death. When you drink tap water, the nematodes hopefully are killed by the hydrochloric acid in the stomach (unless you take a proton pump inhibitor, like Prilosec or Nexium). I keep warning you not to drink tap water but you should absolutely never use tap water in a Netti Pot.

I prefer to use colloidal silver in place of the kosher salt. It actually is much more painful than the salt, creating a burning sensation as it courses through your sinuses. However, the pain and watering eyes pass in about a minute.

Colloidal silver has antibacterial, antiviral and even antifungal activity. So regardless of what kind of infection you have, the colloidal silver will be effective. Three peer reviewed published studies have shown colloidal silver to be effective against MRSA. When I have used the Netti Pot with colloidal silver, I typically feel an improvement immediately. Even with a chronic sinus infection 4-5 days of treatment is usually sufficient to resolve the infection.

Monday, July 18, 2016

Dietary Mineral Could Be One Key to Blood Pressure Control

Sufficient dietary levels of the mineral nutrient magnesium might be a boon to good blood pressure new research suggests.

“Magnesium dilates arteries, and in doing so lowers the blood pressure,” explained Dr. Suzanne Steinbaum, a cardiologist who reviewed the new findings. “Foods high in magnesium include whole grains, beans, nuts and green leafy vegetables,” she added.

The new study was led by Dr. Yiqing Song, associate professor of epidemiology at Indiana University’s School of Public Health. According to the researchers, past studies that focused on the role of magnesium in regulating blood pressure have been relatively small, and produced mixed and controversial results.

To help sort the data out, Song’s group pooled the data from 34 clinical trials on magnesium supplements, which together involved more than 2,000 people.

The daily dosage of magnesium supplements used ranged from 240 mg to 960 mg. Most trials had participants meet or exceed the U.S. Recommended Dietary Allowance for daily magnesium intake.

Sifting through the collected data, Song’s team detected a small but significant link between magnesium intake and healthy reductions in blood pressure.

Song and his colleagues believe that the benefits of magnesium in regulating blood pressure may only apply to people with a magnesium deficiency or insufficiency.

Still, the finding “underscores the importance of consuming a healthy diet that provides the recommended amount of magnesium as a strategy for helping to control blood pressure,” American Heart Association Spokeswoman Penny Kris-Etherton said in an AHA news release.

“This amount of magnesium [368 mg/day] can be obtained from a healthy diet that is consistent with AHA dietary recommendations,” said Kris-Etherton, who is a professor of nutrition at the University of Pennsylvania.

Friday, July 15, 2016

Hundreds of U.S. Clinics See Unapproved Stem Cell ‘Therapies’

In an online search, researchers found at least 570 clinics offering unapproved stem cell “therapies.” Most often, the clinics market stem cell procedures for orthopedic conditions, such as arthritis and injured ligaments and tendons. This does have science behind it, but is still experimental, medical experts said.

In other cases, with little or no supporting evidence, clinics hawked stem cell “facelifts” and therapies for serious conditions such as chronic lung disease, Parkinson’s disease and multiple sclerosis.

If these pricey stem cell treatments are unproven and unapproved by federal regulators, how can these clinics exist?

“I ask myself that question all the time,” said Leigh Turner, a bioethicist who worked on the study.

Turner, an associate professor at the University of Minnesota’s Center for Bioethics, said attention used to focus on “stem cell tourism” – where people travel to countries such as China, India and Mexico to get unproven treatments.

“I think there’s a misperception that everything here [in the U.S.] is regulated,” Turner said. “But these clinics are operating here, and on a relatively large scale.”

Stem cells are primitive cells with the potential to mature into various types of body tissue. Medical researchers have been studying the possibility of using stem cells to repair damaged tissue in a range of chronic ills – with limited success so far.

But the general public has heard about the “promise” of stem cells for years, and it can be easy to be taken in by clinics’ marketing tactics, Turner said.

The businesses are usually not engaging in interstate commerce, which helps them “fly under the radar,” said Arthur Caplan, a bioethicist who was not involved in the study. Plus, there’s a regulatory gray area when it comes to so-called “autologous” stem cell therapy – which refers to treatments that use a person’s own stem cells.

Wednesday, July 13, 2016

Wisdom Wednesday: Long Distance Nutrition

My nutritional protocols are based on the QA (Quintessential Applications) format. This requires extensive muscle testing of the patient using a variety of neurological challenges. It does not lend itself to long distance nutritional consultation via telephone or Skype.

However, my practice has attracted more and more patients that live out-of-state or out of the country.

I developed a format where the initial evaluation takes place in my office. We formulate a nutritional protocol and then extrapolate the various potential routes the body may take along the path to healing. Follow up consultation is by telephone, E-mail or Skype.

My clinical experience with QA allows me to anticipate common pitfalls and shifts in nutritional support. For example, Chaste Tree is often the first herb I use in support of the endocrine system, especially if the patient suffers from poor sleep. However, Chaste Tree is seldom the total solution for hormonal imbalance.

Chaste Tree is much like the orchestra conductor. The conductor doesn’t play any of the instruments, but coordinates the music to create harmony. Just listen to the chaos when the musicians are warming up versus the majesty elicited by the conductor. Chaste Tree modulates the endocrine system. It can increase or decrease hormonal production ever so slightly, blending the chemistry to create balance. However, if one or more hormones is significantly out of balance, Chaste Tree will shift the endocrine system toward normal but cannot create full harmony. So often I use Chaste Tree for three weeks, note the improvement in sleep, then use another herb or herbal combination to bring the endocrine system into balance. It’s really a one-two punch.

Monday, July 11, 2016

Aging May Blunt Some of Exercise’s Benefits

Researchers compared men aged 18 to 30 with men 55 and older who used exercise bikes for 30 minutes. During that time, blood samples were collected six different times, to assess cell function and antioxidant response.

Antioxidants are believed to protect healthy cells from damage caused by unstable molecules called “free radicals,” according to the U.S. National Institutes of Health.

“Through this study, we were able to determine that an individual’s antioxidant response to exercise becomes suppressed with age,” researcher Tinna Taustadottir, an associate professor of biology at Northern Arizona University, said in a university release.

“Exercise is effective and critical for people of all ages, but this study shows that older adults do not achieve the same beneficial cellular responses as younger adults from a single bout of moderate exercise,” she said.

“By better understanding the molecular signals promoting beneficial effects of exercise, definitive recommendations could be made for improving the body’s reaction to oxidative stress, which could lower the risk for many chronic diseases,” the researchers said.

Oxidative stress involves the overproduction of oxygen byproducts that are toxic to cells.

Still, health experts advise seniors to make exercise a key part of their lives. According to the U.S. National Institutes of Health, studies have shown that exercise “provides many health benefits and that older adults can gain a lot by staying physically active”.

Friday, July 8, 2016

Has Butter Gotten a Bad Rap?

Spread the news: Butter may not be the unhealthy food many Americans believe it to be, new research suggests. However, that doesn’t mean that butter provides any real health benefit, the researchers were quick to add.

“Overall, our results suggest that butter should neither be demonized nor considered ‘back’ as a route to good health,” study senior author Dr. Dariush Mozaffarian, dean of the Tufts University School of Nutrition Science and Policy in Boston, said in a university news release.

His team’s review of the data on butter and health found no significant rise in risk of death or heart disease for people who favored the spread.

On nutritionist said her views on butter remain unchanged, however.

“Despite the findings of this study, I am not about to make a huge shift in the recommendations I make about consumption,” said Dana White. She is a dietitian and professor of sports medicine at Quinnipiac University in Hamden, Conn.

“Butter remains a very high-calorie and high-fat food with little nutrient density to offer, and therefore still needs to be consumed in strict moderation,” White said.

The new study was funded by the U.S. National Heart, Lung, and Blood Institute. Mozaffarian’s team reviewed data from nine studies that included more than 636,000 people living in 15 countries.

Average butter consumption for individuals in the study ranged from about one-third of a serving to just over three servings per day. One serving equals about one tablespoon of butter, the team said.

The findings showed that eating butter was only weakly associated with increased risk of premature death and not associated at all with heart disease. There was a slight association with protection against diabetes, the study found.

Wednesday, July 6, 2016

Wisdom Wednesday: Doctors Swamped by ‘E-Medicine’ Demands

Doctors say they’re drowning in electronic paperwork, feeling burned out and dissatisfied with their jobs thanks to countless hours spent filing our computerized medical forms, researchers report.

Electronic health records are a cornerstone in the effort to modernize medicine. But, new systems designed to chart a patient’s progress and instruct their future care have proven to be very time-consuming, the study found.

“While some aspects of electronic records can improve efficiency, computerized physician order entry is a major source of inefficiency and clerical burden for physicians,” explained lead author Dr. Tait Shanafelt, a Mayo Clinic hematologist and oncologist. “Tasks that used to be accomplished with a verbal or written order in less than 30 seconds can now take more than five minutes.”

As a result, physicians using these electronic records reported higher rates of burnout and increased frustration with the amount of computerized paperwork they must do, Shanafelt and his colleagues found.

“Physician burnout has been linked to decreased quality of care and medical errors, as well as an increase in the likelihood physicians will cut back their work hours or leave the profession,” he said.

Friday, July 1, 2016

Folic Acid for Moms-to-Be Not as Effective as Thought?

Fortifying cereals, grains, and flour with folic acid has not protected against the risk of certain birth defects as much as experts thought it would, a large, new study suggests.

At issue are neural tube defects, which include anencephaly, a fatal condition where the baby’s brain does not develop and a paralyzing spinal cord deformity known as spina bifida.

In the late 1990s, health experts found that low folic acid blood levels were linked to both birth defects. So, the U.S. Food and Drug Administration mandated that cereal and grain products be fortified with the B vitamin.

To measure just how effective that effort has been, investigators from Stanford University School of Medicine analyzed 1.3 million births across eight central California countries over two decades.

Between 1989 and 2010, there was an average of about 88 cases of neural tube defects for every 100,000 births.

But digging deeper, investigators found that the risk had already started to decline before the 1997 fortification mandate. There was a risk drop of nearly 9 cases per 100,000 births every year between 1969 and 1996 alone, the researchers said.

And that downward trend actually slowed after fortification, dipping be 1.7 cases for every 100,000 births annually between 1999 and 2010, the study authors said.

Study co-author Gary Shaw, associate chair of clinical research at Stanford’s department of pediatrics, said a number of unexamined factors might have played a role in the trend, including a notable rise in maternal obesity.

“And we now have to wonder if folic acid is the whole answer,” he said.