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.