March 1, 2004 I want to address the current presidential campaign from the standpoint of healthcare. We began by talking last week about Ralph Nader's political platform. I want to take a critical look -- -- I want to look at the concepts behind the healthcare rhetoric in the political campaign this year. Tonight we're going to take a look at Kerry. But don't worry; the Republicans will not be spared my scrutiny. We will keep an honest but critical eye on the candidates, all of them. But now it's time to turn our attention to John Kerry who will probably be anointed the democratic candidate after tomorrow's Super Tuesday primary that's coming up and it looks like an inevitability. His healthcare policies were summarized recently in the Christian Science Monitor, "The centerpiece of Kerry's plan is allowing every American access to the healthcare plan currently offered to federal employees and members of congress. They plan to expand coverage to families with incomes up to 300 percent of poverty, parents who earn up to 200 percent of poverty and single adults at or below the poverty level."
Here are some of the basic proposals: I'm reading here from a critical view of Kerry's platform by a medical observer by the name of Peter Barry Chowka. He writes on issues related to complementary and alternative medicine. Kerry wants universal electronic medical records. He says this will dramatically reduce waste and medical care and it will help with costs. But I see it as a big pain and something that is going to virtually drive out of the economic arena anything but large group practices of doctors or hospital-based medical practices. Individuals like me, physicians who are trying to be the lone wolves of medicine, will have a great deal of difficulty complying with government regulations if this goes through.
Another point in Kerry's proposal, and here we're quoting Kerry's own, his own platform - "assure federal government adopts modern computerized methods for healthcare transactions." Again, computerization, everything from requesting medical records, submitting a bill, setting an appointment, again, big expenses.
A new deal to provide healthcare coverage to every child -- that is good. John Kerry's plan will ensure that the government picks up the cost. Nearly 20 million kids enrolled in Medicaid in exchange for states covering kids in the children's health insurance program. The problem though, this is going to cost a lot.
John Kerry will provide at least 30 billion dollars in the fight against AIDS by 2008, Kerry is interested in increasing the amount we spend on AIDS. We now spend 4 billion. He wants to spend 30 billion on AIDS, but diabetes receives only 150 million dollars a year in government research funding. That's only about 4 percent of the AIDS budget. Why is that? It's because diabetes is not a politically correct disease. And no mention of it could be found in Kerry's healthcare proposal. AIDS, that's an important cause. All the movie stars, celebrities, beautiful people want to deal with and eradicate this terrible scourge. But diabetes is a much bigger problem. Diabetes kills over 200,000 people in this country. AIDS, far less. And there's a real tendency for people to die of diabetes related causes in this country -- no mention in the Kerry platform.
A review of the healthcare plans of all ten of the original leading democratic candidates for president -- that includes Dean, Sharpton, John Edwards, and Ohio republican Dennis Kucinich, --revealed that only one of them even mentioned alternative medicine. And who do you think that is of all the candidates? It's lowly Dennis Kucinich, the eccentric candidate. He's for legalizing pot and he's pro-alternative medicine. He's always been an advocate for alternative medicine. He has a section entitled, 'Complementary and Alternative Medicine' at his official campaign website. He says, under a Kucinich administration, complementary and alternative medicine will be included in an enhanced Medicare for all single-payer healthcare program but references to Kerry and complementary alternative medicine are just not abundant. It's gotten in the news a little bit because Mrs. Kerry or Heinz-Kerry -- she's the Heinz heiress -- she is kind of into alternative stuff, meditation, and yoga and stuff that the wealthy often embrace because it's a part of their avant garde lifestyle. So clearly, Kerry enjoys a personal perspective on complementary and alternative practices but he writes nothing about this in his platform.
So Peter Barry Chowka, in this column, writes that all the democratic candidates, including Kerry, support some form of mandatory national healthcare with no ability of a citizen to opt out. In other words, you've got to join this program. This is a real abrogation of freedom of choice. You can't be a refusenik. You're going to be in the same homogenized, essentially socialist, medical program under a democratic regime according to Chowka. And it's ironic, he says, that liberal newspapers like the New York Times have said this in opposition to the justice department's subpoena of hospital records in cases of partial birth abortions. They say, "Congress and the Attorney General" -- this is from the Times - "have no business second guessing sensitive medical decisions made by individuals and their doctors". But the health platform advanced by most democratic candidates will require universal electronic medical records for everyone in the country. So how about that as second-guessing of sensitive medical decisions? It's going to be controlled by the federal government.
They're also going to insist that you be part of a national healthcare plan since the per capita cost of conventional healthcare in this country is now $6,000 a year. The taxes required to enroll everyone will be considerable,. Nobody's talking about that. Chowka notes that alternative medicine has actually grown and thrived to this point within the current system, which has moderate constraints. But it's basically a free market climate that currently exists where people do have some choice. They can choose what kind of health plan they want to belong to or they can choose not to belong to a health plan. Unfortunately, that leaves some people just not covered at all. But as a result you can make the choice, usually, to pay dollars on the barrelhead and see a nutritionist, see an acupuncturist, see an alternative practitioner, and to some extent under the current system, if you get sick, you are not insulated from the consequences of your bad lifestyle choices.
If you want to opt for a higher standard of care, you want to save a few dollars, you can see a complementary physician or nutritionist, which is usually not covered under current healthcare plans. But, what they're saying here, this is in the words of Peter Barry Chowka, he says no democratic candidate except Kucinich, who has no chance of becoming president in any case, has proposed any role for alternative medicine in their monolithic plans for the American medical system. And I think that's a deficiency in the platform of the Democratic Party. Maybe they will begin to address these concerns as the campaign progresses. It's early on, but that's a view I share with Peter Barry Chowka.
We'll take on the Republicans at a later date because there are some big problems in the current republican platform. Not so much from the standpoint of healthcare, but from the standpoint of the issues that are important to us who are concerned about the environment.
http://www.naturalhealthline.com/newsletter/15feb04/kerry.htm
Anger, Hostility Linked to Rhythm Disorder in Men
Here's an item that I think is very important, it also has to do with heart disease: Anger and hostility linked to a rhythm disorder in men. No, it doesn't mean -- it's not rhythm disorder where people can't dance or keep a tune -- this is in the medical journal, Circulation. And it has to do with a condition of atrial fibrillation. Individuals with anger and hostility were 30 percent more likely to develop atrial fibrillation than less hostile men, and anger had some bad effects on the heart as well. So stay cool, stay calm and keep your heart rhythm in control.
Circulation, March 2, 2204
Low Vitamin c may up asthma risk
. Notwithstanding all these people who are advising you to stop taking your vitamins -- your cardiologist says get off that vitamin E, it's interfering with your statin drug, the very same statin drug that can cause you to lose your memory or suffer liver function problems or suffer body aches. That doctor will say we don't want to get in the way of that important medication. But here's a big study that I bet most doctors won't pay much attention to. It's from the medical journal of Epidemiology, an important journal because epidemiology means we're studying the ways people get diseases as a population. According to the study, children with low levels of vitamin C may be more likely to develop asthma. And that's important because a lot of kids just eat junk. They eat no fruits and vegetables, those are major sources of vitamin C in the diet. They take no supplements, so vitamin C is extremely low. Vitamin C to some extent is the disease of poverty. Homes that aren't kept clean, by virtue of housing, substandard housing, industrial pollution, car pollution in the inner-city, lots of bus traffic and where families can't afford to buy good food or may be culturally disadvantaged and just don't know the value of good food. Vitamin C levels can be extremely low.
In this study they looked at more than 4,000 children and they found that there was a correlation between low levels of vitamin C and carotenoids. Carotenoids are what you find in fresh fruits and vegetables. They are the things that provide yellow and green and orange and red colors to fruits and vegetables. So this is an important correlation to suggest -- a very simple procedure for allergy-proofing kids is to provide them with adequate amounts of these important antioxidants.
American Journal of Epidemiology, February 15, 2003
Will vitamin E interfere with the activity of statin drugs?
There actually is a study -- a very limited study, but it's been given great credence by conventional medicine and the cardiology community -- which shows that people who take statins actually get a reversal or partial reversal of the benefits of the statins when they take, in particular, vitamin E. It's a small study, it's a short study. If I recall the study -- about 27 people over a period of just two years. If there were studies showing the ineffectiveness of a popular drug, those studies never would have been accepted by the conventional medical community . They would have said, "Look, it's too small a study. It's for too short a time." A lot of cardiologists have gleefully embraced that study to say, "Hey. You're wasting your time with the vitamin E and the antioxidants. They don't do any good anyway." But I say, it's not so much that the vitamin E or C potentially interfere with the statins, it's: why do you need the statins in the first place if you're using beneficial supplements that can prevent oxidation of LDL, that can reduce the risk of cardiovascular disease and cancer? We ought to think of the supplements as being of first priority and not so much what impact they have with the statins as an afterthought. So, I'm looking very carefully at this issue. I think that what we'll see is additional studies being done, longer studies.
One of the interesting things about that particular study is that after that very short study -- 27 people, two years -- they said, let's not even study vitamin E anymore. Let's put this to bed. It's vitamin E. It doesn't work. It's garbage. There were actually editorials to that effect in some medical journals to the effect of, "See, we told you so, it's junk. So let's not even risk patient's lives by using antioxidants." That's how biased the conventional medical community is against antioxidants, a proven principle in prevention in cardiovascular disease, in Alzheimer's.
So what are you going to do? You're going to avoid taking vitamin E and C so your statin works better and then you're going to get Alzheimer's and cancer because you didn't have enough antioxidants. Does that make sense? But that's kind of the way conventional medicine thinks unfortunately. They take one study based on a few individuals and they draw unreasonable conclusions
Can CoQ10 further impair a serious kidney condition?
On the contrary, CoQ10 works great in people with kidney conditions. One of the things that we see in patients with kidney conditions is that -- a real decrease in production of CoQ10. It's really very safe. CoQ10 is very helpful for people who have renal failure. Even patients who are on dialysis benefit from CoQ10. They feel much better when they take CoQ10. I'm not going to go into the particulars but CoQ10 is fine.
Is it possible to be involved with an exercise program if a person has two stents?
If you have cardiovascular disease that does not mean you should become a couch potato; in fact, au contraire. You should be exercising and you should be doing both aerobic exercise as well as some strength training. The stents open up the circulation to your heart. You should be careful in the early phases of exercise. You probably should begin with something called cardiac rehab. That's where you get supervision. Medical people are in attendance so if something should go wrong, you can get medical care. They can then establish your threshold for normal exercise then you don't always have to do it under supervision. Ultimately, you can begin to do it at home. You can translate it to activities of your own. People who have had heart attacks, people who have had stents, people who have had bypasses, it's essential that they begin some form of exercise. They shouldn't go nuts on it but they should begin some form of exercise to stay well.
What are Lipitor's effects on memory and other cognitive functions?
One of the rare but real side effects of Lipitor and other statin drugs is something called TGA, which stands for transient global amnesia which means for a short period of time, you can't remember anything. And this is a pretty devastating side effect. It does occur rarely, less than one tenth of one percent of the time in people who take these types of drugs. But when it occurs, it's a pretty disturbing side effect. And new reports, I think, are going to appear in 2004 suggesting that the incidence of this side effect is probably a little greater than we once thought. So there are side effects associated with statins. The main side effect being liver problems and also some people have severe muscle aches and pains, generalized fatigue, and there are others. It's well-known that this can be a side effect. Now the concern is -- so what if you don't have transient global amnesia? It is not obvious what happens if you're just a little tired, a little forgetful, you can't focus, you can't concentrate. Who's going to notice? If you're taking the statin, chances are you're over the age of 45, 50 or 60 and people say, well that's what happens when you get a little older, you can't remember as well. And how are you going to know whether it's your drug or whether it's the natural process of aging that's causing you to have difficulty remembering?
When do you think I can start resuming a normal exercise regimen after inguinal hernia repair?
It really depends on the exercise. And the doctor is probably going to give you the go ahead to begin exercises as soon as you go back and see him because essentially, you have been closed up with some really wicked, strong Gortex mesh. That's what they usually do. In fact, the area is stronger than it was before you had the surgery because you just had biological tissue before. Now you have superfabric in there that keeps you from herniating again. So I would say it's not so much a factor of the danger of reherniating, which you have to have complete healing. It's a matter of pain, and pain is a different matter. Men are at much lower risk of reherniating than having some degree of residual pain after hernia surgery. It's very common to have some pain. It does not feel just quite right because that's a very sensitive area, as you may imagine. And so sometimes you'll feel like it's a little funny because there's actually foreign body in there. There's stitches, a Gortex mesh, or some type of material in there and you may feel some discomfort. But don't let it feel like you're going to burst forthwith a recurrence of your hernia. That is less likely after the hernia surgery. I think you get a clean bill of health to begin stuff, but work up gradually so you get good healing.
Have you heard of any studies indicating that Zocor can cause erectile dysfunction or loss of desire for sexual activity?
If you check the PDR, the Physician's Desk Reference, there is erectile dysfunction as one of the many but probable secondary side effects of Zocor. It's not a common side effect but is does occur more frequently in men who take statin drugs than in control groups. I've actually seen some men who complain about that. It's probably not so much a direct effect on circulation, more likely its from a pervasive sense of fatigue that some individuals get, associated with statin drugs. They don't feel well. And hence, it may have an impact on sexual function.
The problem is, a lot of stuff has happened over 12 years and you happen to have been on statin drugs. You could just as easily blame it on a Republican administration or Clinton before him, or the fact that we had a stock market recession, or any number of factors that have occurred in the last 12 years. Or perhaps the fact that you're 12 years older. Over the last 12 years, your DHEA and testosterone have declined as often happens as men age.
That's a more likely scenario for reduction in sexual functioning. There may be some anxiety or mood issues that can affect sexual performance, probably a more reasonable scenario than blaming the drug that you take. The fact that you take Zocor, that's an indication that you're not in the best of shape because if your cholesterol was perfect, you might not need to take Zocor. Other things that accompany high cholesterol include increased body fat, elevated blood sugar, high blood pressure and a pervasive sense of feeling crummy. And that's not sexy. So address your high cholesterol through diet, get to optimum weight, take natural supplements and do some exercise and maybe you'll end up feeling sexier. You'll get off the Zocor and that will help the war effort.
How would I know if I had a chemical imbalance?
The problem with the term "chemical imbalance" is while it may be true that some people have abnormal levels of the neurotransmitters that send messages around the brain, the notion of a chemical imbalance suggests that we can attain better lives through chemistry -- the expression, better living through chemistry. And if we only took drugs like Prozac, Zoloft and so on, that we would be better people. We would avoid shyness. We would avoid PMS. All of these things are being blamed on chemical imbalances. And while, indeed, there may be some real basis for it, I think we're taking it too far. It becomes too easy to prescribe medication for people who have all manner of mild-mood disorders. There are some people that are very depressed, dysfunctional, suicidal, and people really need pharmacological attention. But to take people with casual mood problems and tell them they must be on medication, you know, we're just extending the marketing of powerful drugs, just like we do with ADD. And now we have kids on antidepressant medications. And that's very questionable. So what we can do is measure levels of neurotransmitters. We can determine if there is a chemical imbalance. We can do urine tests, sometimes blood tests. This will give us a clue as to what neurotransmitters are deficient. If serotonin is low, we can give precursors like tryptophan, or 5-hydroxytryptophan. If dopamine is low, we can give tyrosine. We can use targeted therapy. We can use essential fatty acids like fish oil to help balance mood and energy. We can get people on better diets and exercise. And we can get people to good behavioral psychology to improve their cognitive view of the world.
March 2, 2004
Research Shows Estrogen Plus Progestin Cut Postmenopausal Women's Colon Cancer Risk
New England Journal of Medicine. March 4, 2004
Doctors Re-examine Hormone Replacement
Yale University to re-think the results of the Women's Health Initiative Study. The group to be led by Dr. Frederick Naftolin
March 3, 2004
McDonald's to Eliminate Super sizes by Year-End
Reuters: The Super size fries contain 610 calories; 29 grams of fat, 390 milligrams of sodium, 77 grams of carbohydrates
Low Carbs Cause Mood "Lows"
Judith Wurtman, director of the Program in Women's Health at the MIT Clinical Research Center.
http://www.nutraingredients-usa.com/news/printnews-NG.asp?id=50322
March 4, 2004
There's an article in the Times by Donald McNeil Jr. entitled, "The Addictive Effects of Steroids Raise Questions About User's Awareness". It has to do with reports that many athletes including San Francisco Giants slugger Barry Bonds and New York Yankees Jason Giambi and Gary Sheffield were part of a ring of individuals that were using, possibly distributing, steroids produced by an outfit called BALCO -- Bay Area Laboratory Cooperative -- where some of the principals are now under indictment. The article suggests that steroid use is potentially addictive. The article points out, that once people start taking steroids within the first three days they can feel invincible, on top of the world. Within two weeks, workouts change -- what used to take an hour and a half and make a person tired, now becomes a two hour workout with enough energy to go back and do the same thing. Once a person feels that good, he or she doesn't want to lose it. A lot of these guys are hooked on looking buff. They look in the mirror and don't want to give that up. So the question is, all of these guys, these baseball players are saying, "I didn't know I was using steroids, I mean I just got some stuff from this place and these were vitamin drinks, and so how was I supposed to know that there were steroids in there?" And that argument, according to this article, is somewhat disingenuous, at the very least. Pitcher Turk Wendell has charged that Barry Bonds was fully aware that he was using steroids. Barry Bonds shot back in a very hot tempered fashion, he says, "I'm not using any bleeping steroids" -- it was bleeped out in his interview on TV.
Another characteristic of taking steroids is being prone to roid rages. Barry Bonds was hot tempered -- hot under the collar. And bouts of rage are characteristic in individuals who take steroids. The article goes on to describe cases where people gain as much as 50, 60 pounds of muscle weight, their bench pressing improves dramatically. That's the appeal, that's the allure of using steroids. But there's some down sides because testosterone breaks down into estrogens, men's voices may rise and their breasts get larger. That's not too appealing. Adolescents may stop growing because the growth plates in the bones close prematurely. There are a lot of adolescents using this -- that's probably the worse aspect of this. Who cares if these gorillas want to use steroids? They're professional athletes and if they want to mortgage their health and destroy their bodies, at least they're entertaining us. They can do what they want. But it sends a message to the youth of America that in order to compete, you have to have that competitive edge. And they begin taking these steroids, and some of them have not completed their normal growth. If a kid starts taking steroids before reaching normal height, that is definitely not good.
The flood of testosterone from outside the body tells your testicles to shut off their production of testosterone because it's not needed because you get so much testosterone from outside the body. Your own production can turn off the feedback and the testicles shrink. These athletes know that what they are taking is doing something because the effects of steroids are obvious. It's going to be interesting to see if testing gets more rigorous. We've already seen a trimmed-down version of Jason Giambi taking the field in spring training down in Florida. He says that he lost the weight by giving up fast food and cleaning up excess fat. Who knows?
Octogenarians Face Significant Functional Loss and Mortality After Cardiac Surgery
Am Heart J 2004;147:347-353,187-189
This story is important, it has to do with the risk of heart surgery if you're in your 80s. I had a case like this. I had a gentleman come to me and say that he has angina. He has chest pain and he is being urged to get an angiogram which will probably lead to heart surgery. He is making a conscious choice to manage his condition medically. He is taking all the medication he's been asked to take and he is undergoing chelation therapy to help him overcome this problem. He's aware that heart surgery could be beneficial for him but he is concerned about the risk. This gentleman is taking care of an ill wife and he can't afford to have down-time which might compromise his wife's survival. This is a guy with a clear head who's making a choice that he has chosen not to undertake drastic intervention. Some people might say this is irrational: we're in a modern age, the techniques are getting better and better and people well into their 80s and 90s can get heart surgery if it's necessary. Underline "if it's necessary". We've got lots of examples of fairly young, functional guys who underwent aggressive heart intervention and who are in the fast lane. They're doing fine. They're in the public eye. Guys like Dick Cheney, David Letterman, Larry King -- they've all had some form or another of drastic cardiac intervention. But these are guys who have had it done are in their 50s, 60s and they're not in their 80s.
So what happens when you operate on folks in their 80s? Well, this study just came out and I think it's going to turn the whole cardiology community on its head. From the American Heart Journal from this week, more than 50 percent of octogenarians who undergo cardiac surgery either die in the hospital or are discharged to a nursing care facility. The study shows that if you undergo heart surgery in your 80s, you have a nine-fold increase in your risk of hospital death and a three-and-a-half fold increase in the risk of the need to be discharged to a nursing care facility for intensive convalescence. This is not even looking at outcomes like reduced energy, vitality and complications like severe depression or changes in mental status which have been known to accompany cardiac surgery, particularly in older individuals where these problems are a little more likely to happen. It's a big decision and it argues for conservatism and each choice needs to be made individually. I'm not trying to scare older individuals off from heart surgery, because if you have a bad heart valve and you're going to die, then you need the surgery. These surgeries can be accomplished if you're 87 or 92 and sometimes you continue to lead a productive life. The risk benefit equation may tip in the favor of doing something. But that equation has to be examined very carefully because of the results of this study
Groups Urge No Antibiotics for Earaches
http://www.cdc.gov/drugresistance/healthcare
Several years ago, we interviewed the author of a book entitled, "No More Amoxicillin" . It was a book about ear infections. The mere idea that you could actually treat an ear infection without antibiotics was thought to be revolutionary. The author is Dr. Mary Ann Block. And this is something that we've been doing for a long time, treating a lot of kids for frequent ear infections by treating for allergies, by supporting their immune systems with beneficial supplements, by treating Candida -- a yeast problem that sometimes can arise from excessive dependence on antibiotics. And I am certain my listeners thought, "Well, you know, he's a little out there, that Hoffman guy. His guests are cutting-edge, they're visionary, they're a little idealistic. "
Fast forward and here's a headline from today's Associated Press -- this is, it's about six or seven years after the launch of that particular book "Groups Urge No Antibiotics for Earaches." All right, a couple of leading medical groups are expected to recommend, this spring, that doctors stop treating most ear infections in children with antibiotics, Federal health officials said this Tuesday. The move contradicts years of pediatric practice and the problem here -- it's not so much the doctors, there's a chance the doctors could get with this. Doctors could be re-educated, they can be given the rational arguments that most ear infections, about 80 percent, typically recover in two to seven days without antibiotics and that antibiotics just mess things up. They cause diarrhea and they may cause antibiotic resistance. We're doing individual kids a disservice. We're doing society a disservice by pumping antibiotics into the system. And after a while, when a serious infection comes along, the antibiotics don't work anymore.
But the title of the book, "No More Amoxicillin", would be considered ludicrous these days, with no offense to the rapper Ludacris. But these antibiotics don't work anymore. Amoxicillin resistance is so pervasive now that typically, doctors have to use much more powerful antibiotics to knock out infections. We go through antibiotics in usually two, three, four years before new, strong antibiotics become virtually useless.
So, what they're saying here is between five and six million children under age five suffer ear infections each year. And since that's the medicine prescribed in most of these cases, 10 million prescriptions each year may be written needlessly for ear infections in children of all ages. And what they're suggesting here is there are some cases -- yeah, really serious ear infections that persist, kids who have lowered immunity -- there's some cases where antibiotics may do some good but as a general rule, antibiotics should be used with restraint.
You know the expression, on Bunker Hill, the battle of Bunker Hill; "Don't shoot until you see the whites of their eyes"? Well, that's what doctors ought to do with germs. Use some restraint. Don't pull the trigger. Get the infection in the cross hairs, and don't pull the trigger until it seems that the infection is not responding to natural care, natural support. We can use things like vitamin C. We can use zinc. We can prevent ear infections with xylitol chewing gum and xylitol nose drops. We can deal with food allergies. Many kids are wheat allergic, milk allergic, getting rid of those things can make a big difference. But here's where the problem is going to be: The problem is that many parents are so freaked out when their kid is crying, tugging at their ear -- that's a typical sign that a kid, even a kid who can't talk, he's going to, like, bat his eardrum or bat his earlobe -- and that's the international sign that my ear hurts, right? Parents, you're aware of that. Parents are going to be so freaked out by this that they're going to demand that doctors don't just sit there, but do something. Prescribe something. Give me some strong bug juice to eradicate this ear infection or my poor child will suffer terrible consequences. And waiting in the wings is America's legal profession with the threat of malpractice and liability and it's going to make it hard for doctors to do the right thing. Under pressure from the risk of malpractice, from parents who are demanding, they may just relent and unnecessarily prescribe antibiotics in the 80 percent of cases, where according to the American Academy of Pediatrics and American Academy of Family Physicians, they say it no longer matters whether you use antibiotics. I feel vindicated by this story. But are we really going to see a return to science-based medicine in this country or are we going go with our current status of total reliance on drugs? Maybe old habits are going to die hard.
Does Androgel [testosterone replacement] wear off?
Androgel does wash off but most of the Androgel that you want to get into your body will enter your body fairly quickly. It's not something like a nicotine patch. You know, a nicotine patch, we want that to work for a long period of time. Put the patch on and there's a very slow time-release of the medication into your system. With the Androgel, you rub it into your wrist or you rub it into your elbow crease or somewhere else on your body and it penetrates your skin fairly quickly to enter -- it actually gets into the subcutaneous fat and also enters the bloodstream. Most of it is in the fat and is released in a depot fashion through the day. So you don't have to worry if you shower a few hours later or if you play racquet ball and you sweat, that's not going to make it go away.
The best way to find out what's happening is to periodically get your testosterone levels checked and ask your doctor also to check for what is called free testosterone.
You just have to follow the blood levels that the doctor gives you feedback on. Men tend to find they are trimmer , stronger and have better endurance. Some men find an improvement in their sex life.
A little bit of testosterone given under doctor's supervision can be a good thing.
What can be taken along with prednisone to protect the immune system? Prednisone is a steroid that tamps down inflammation and compromises the immune system.
Doctors frequently tell patients to take Caltrate for calcium and Aciphex to protect the stomach from bleeding ulcers.
When you're on prednisone, it's important to take calcium but also to take some additional vitamin D which will help aid in the absorption of calcium and the interesting thing about vitamin D -- and this is very recent information -- is that deficiencies in vitamin D can cool down autoimmune conditions. We know this is the case with rheumatoid arthritis. We know this is the case with multiple sclerosis. It's perhaps the case in other autoimmune diseases like Crohn's and ulcerative colitis. We see a lot of deficiencies of D in those conditions so we're using D as a way to modulate the immune system.
The other thing that will help put out the fire, so to speak, is to use fish oil. Fish oil is a wonderful, natural anti-inflammatory.
When you're taking prednisone, it's often hard to sleep. One of the reasons that occurs is because prednisone interferes with the body's production of melatonin. So often we use melatonin as a sleep aid. And there's some information that melatonin may help to offset autoimmune conditions. It's not as strong as evidence as with fish oil and vitamin D but at least it will help you sleep and you'll feel better.
And the other thing that happens when you take prednisone, especially for a long time, is your DHEA goes down, that's an adrenal hormone. DHEA is often at rock bottom when a patient is taking prednisone. DHEA actually helps the body counter autoimmune conditions. This is complicated and should be done under some supervision from a nutritionally-oriented physician.
The other thing I would suggest is to take a really good hard look at diet. The number one food that might be contributing to an autoimmune condition is gluten, the whole gluten family of grains. Foods that are common precipitants of autoimmune problems are dairy and corn. In certain arthritic conditions, it might be the night shades-tomato, potato, eggplant and the pepper family. A Paleolithic diet is a good way to go. Think of the way people ate twenty- or fifty-thousand years ago without dairy, grains, refined foods. This might be the best way to recovery.
How can you deal with calcium oxalate kidney stones?
About 85 percent of kidney stones are calcium oxalate. Sometimes you can have uric acid stones or other less typical types of stones that can be due to chronic infections. A special type of urine test called a Stone Risk Analysis can done. Levels of different minerals and substances in the urine are determined. The way the stones form is a little like, adding salt to a glass of water. Eventually the salt is going to crystallize, and precipitate out, it's not going to dissolve anymore. It is possible to reach a critical point in urine formation where the chemicals that are present in urine coalesce into stones and they precipitate out .This happens in the kidneys .It hurts terribly when the stones are passed.
Typically, it is found that people need more magnesium, they need more citric acid and that's why nutritionally oriented doctors give magnesium citrate which is a great preventive for stones .Magnesium is helpful for blood pressure, energy, and it also has a laxative effect.
B6 is often helpful for this type of stone, it's also important to drink more water and to avoid foods that are high in oxalate. Those foods include tea, and spinach, rhubarb is possibly one of the highest in oxalic acid.
Some people who have operations on their intestinal tract may have a higher susceptibility to stone formation because all the fat that passes through their intestinal tract may pull calcium out and leave the oxalate there. Then the oxalate gets stuck in the kidneys.
Some people think you have to watch out for calcium consumption. That's not usually the case with kidney stones. But the best thing to do is find out from your doctor what type of stones you have and then begin a regimen of diet and supplements to prevent stones from forming. It's very successful in our practice.
Soda Sales Banned in Philadelphia School
http://www.cnn.com/2004/EDUCATION/02/05/school.sodas.ap/
March 6, 2004
What are the blood tests APO A1, APO B, the ratio of APO A1 to B, and what do they mean?
These are tests that discriminate between helpful cholesterol particles -- and harmful cholesterol particles. And it's not a test too commonly done but some people believe, and I share this belief, that the test is more accurate even than our current cholesterol HDL and LDL system. But just as in "Fiddler on the Roof", in medicine -- tradition, tradition, tradition, when you get stuck on a certain mode of testing it's hard to get away from it.
APO A is a favorable APO lipoprotein and the higher your A, the better it is and the lower the B, the better it is. B is bad, that's easy to remember.
With LDL, the so called "bad stuff".
You can actually have your LDL subfractionated to see if the LDL is predominantly good particles, which are the large, fluffy LDL particles, the small particles are dense, and they're heavier. It's kind of like the difference between large, fluffy cumulus clouds and dense, damaging hail stones in terms of the effect on coronary arteries. So you can actually get more information on these subfractionations.
We're doing these now to help differentiate between people who are at risk and also as a measure of progress.
And APO B particles are associated with the metabolic syndrome or Syndrome X. And often in the presence of APO B we'll see other signs. We'll see people who are a little fat around the midsection; they may have borderline diabetes. These are people who are more prone to cardiovascular disease.
First we looked at overall cholesterol and that was simplistic because we know now that some people with cholesterols under 200, in fact, one third of people with cholesterols under 200, get heart attacks.
So we need more and better discriminators of whether they have good cholesterol or bad cholesterol. So we broke it out into the good HDL and the bad LDL. But just like with Chinese boxes, they keep opening and opening and opening, the LDL and the HDL themselves can be subfractionated. They can be broken into good LDL and bad LDL. And similarly with HDL, the good stuff, you can sometimes get a falsely reassuring picture when your HDL is high but you don't have enough of the good HDL. See http://www.berkeleyheartlab.com/
You know, with better diet, and taking certain supplements like fish oil , niacin, these problems will turn around and you can get a better report card when you repeat the test.
What is C-reactive protein and do you get the levels down?
C-reactive protein is an inflammatory marker. These are other markers that are important in cardiovascular disease risk. We're going beyond cholesterol to decide whether people are at risk. We measure Highly Sensitive C-Reactive Protein. C-reactive protein is particularly important for women. It seems to be a more prominent risk factor than for men, though it's important for men too. C-reactive protein can be lowered by a diet like the salad and salmon diet. A Mediterranean diet will lower C-reactive protein. The less sugar and pasta and refined starch you have, the better your C-reactive protein -- we've seen that turn around in our office
Fish oil may be helpful; aspirin may be helpful statin drugs may be helpful as a last resort in getting C-reactive protein down. Exercise is helpful in getting C-Reactive down. Sometimes the cause of elevated C-reactive protein is a hidden infection in the body or it might be an undiagnosed case of osteoarthritis or an inflammation elsewhere in the body. So under those conditions, treating the underlying problem helps to get the C-reactive protein lowered. If there's infection, if there's gum disease, periodontal disease is a major cause of elevations in CRP, we have to address that cause.
What can be done when fish oil supplements cause nausea?.
You can get some of the benefits of fish oil supplements by taking flax oil. Flax oil is a building block for EPA. It gets converted in the body to EPA. Fish oil contains EPA. Flax oil is not efficiently converted into EPA. So taking flax oil for some people does not result in any of the health benefits of EPA. These benefits are anti-inflammatory effects, blood pressure lowering effects, cholesterol-improving heart-healthy effects and therefore, what I've endeavored to do is find products that are less fishy. Through some of the newer manufacturing techniques they've managed to get rid of the nauseating parts of the fish oil, the smelly fish proteins that at times accompany fish oil capsules. The cheaper ones do smell of fish. The newer ones are almost neutral in smell and they are highly distilled. The product that I'm using now is a product called Orthomega made by OrthoMolecular. It's a clean product most patients don't have trouble with it.
Another thing you can do is if you experience nausea with fish oil, is to make sure you take a little bit of food, take your capsule, and then eat some more food. Make a food sandwich for your vitamins, especially the fat soluble vitamins and then they won't hang out in your stomach and cause irritation or cause regurgitation. That's the strategy you use if supplements bother your stomach or cause you reflux.
How can a person maintain their weight with a slow [hypo] thyroid?
This is tough because it's called a thermodynamic equation and it gets complicated because it's based on your sex and it's based on your age and it's based on your height and weight and your activity level. But it's also based on your metabolism. And since your metabolism has slowed down because of your thyroid problem until that gets fixed and it can be difficult to adjust doses properly to adjust doses properly to get people up to maximum metabolism.
It's a complicated equation. There are people who put out guidelines that people should eat such and such percent carbs and such percent of fat and you know the nutritional guidelines for protein and I think those guidelines are for the birds, I think you really have to individualize.
Generally, I've found that people with hypothyroidism or slow metabolism of any kind, do better on low-sugar, low-carb diets -- that moderate amounts of fat are beneficial. You can do 20, 30-grams of fat easily -- and fat is nine calories per gram, so you do the math. But the fat should be of the right kind. We generally suggest that people do not overindulge in saturated fat, that they get mono-unsaturated and polyunsaturated fats. The mono comes from oils like olive oil and the polyunsaturated fat should come mostly from fish, oily fish provides that, and of course, nuts.
So I've got to say that there is no single path towards optimal metabolism for hypothyroid patients. First you've got to get that thyroid tuned up. Do take a look at the Salad and Salmon Diet ; the guidelines there call for moderate intake of fat. There are really two types of people in the world, there's types of people who like to count calories and count percentage of protein and grams of carbohydrates and fat, and for other people, myself included, that is utterly boring and demoralizing. It's taking an activity which should be spontaneous and enjoyable and applying a mathematical template to it. Just eating, weighing your food looking it up on tables and you have to exercise restraint. But what I prefer to do is tell people here are the kinds of foods that are generally good to eat; here's the types of foods that you can use as a special indulgence but in moderation; here are the foods that you just shouldn't even mess with, they're not worth it, they're off limits. And then you can eat up a storm of the right foods, moderate your intake of stuff that's problematic and just ditch the food that's junk. I think that works better for me and for the majority of my patients.
What is the best way to treat macular degeneration when glaucoma is also present?
For people who are left without conventional medical options, the best thing to do is take a portfolio of antioxidants for the eye. These would include zinc, vitamin E, vitamin C and mixed carotinoids, specifically the carotinoid called lutein . And lutein is present in egg yolks; it's also present in green leafy vegetables, spinach and the like. Nutritional supplements containing lutein can be valuable in slowing macular degeneration. In fact, there was a study we talked about in the program a few weeks ago that analyzed the economic impact -- just in terms of saving money for the overburdened Medicare system in this country -- and they found that there was some enormous savings and millions and millions of dollars in avoidance of Medicare costs if people simply took a balanced antioxidant that could slow the progression of macular degeneration, which is a really serious problem in this country. It's the major cause of blindness in individuals over the age of 60. So take a balanced antioxidant program with lutein.
What should be done about triglycerides, that run over a hundred.
If triglycerides run slightly over a hundred, it's not a big deal. We'd ideally like to see them around 80 but if they go into the hundreds, to me it's a sign of bad diet, lack of exercise, some sort of metabolic slow-down. These elevated triglycerides are associated with risk of heart attack and stroke particularly in women. Women are more prone to problems with high triglycerides -- of course, men can have that. And the way to deal with that is diet. Diet will really cut your triglycerides down. Again, I keep sounding the same theme, salad and salmon diet, limitation of flour products, sugars, juices and fruits; this will actually keep your triglycerides down. They are circulating fats but they respond to limitation of carbohydrates. Exercise helps but if a patient has a lot of medical conditions that prevent him from having adequate levels of aerobic exercise he'll have to compensate with the diet. Fish oil is helpful for controlling triglycerides and so is niacin. Niacin is helpful but you have to have niacin administered under a doctor's supervision. It's pretty effective for lowering triglycerides but can cause some health issues so you need to be monitored when you're on prescription levels of niacin.
What should be done about a PSA test of.9?
I don't think a PSA can get better than a .9. So why could this score leave someone with with worry and apprehension?
PSA is not a perfect test. Elevated PSAs sometimes lead to unnecessary biopsies in men who have no cancer and low levels of PSA are not completely predictive of freedom from cancer risk. But a PSA of .9 is very good. There is a slightly higher incidence of prostate cancer in the descendants of men with prostate cancer but that actually is more inherited from the female side. So if your uncle [mother's brother] had prostate cancer, it's worse than if your father had prostate cancer. There is some hereditary risk associated with having a father with prostate cancer. It's not at the order of magnitude that the breast cancer effect is seen. In other words, if your mother had breast cancer, you're probably in the order of a couple more digits more likely to get breast cancer -- perhaps 20 or 30 percent. It varies from study to study.
How would you suggest treating ADHD naturally?
Cod liver oil contains EPA and DHA which are important nutrients for the brain. I've written a book on this called, Natural Therapies for ADD. And that book is actually available via my website. Some stores are selling it as well; you can get it at BarnsandNoble.com, Amazon.com.
We work with a lot of kids who have these types of problems. Sometimes they have food intolerances, they do better with the elimination of certain foods, foods can access triggers for behavioral changes. They need to keep their blood sugar stable. Caffeine and food additives are a problem. Witness the effects of preservative removal in certain of the diets that are used for kids with ADD, such as the Feingold diet. It's useful to use more magnesium with these kids. Magnesium often has a calming and focusing effect. So there are a variety of things that can be used. I think that combined with good behavioral intervention can make a difference.
What would be the best way to treat psoriasis with natural therapies?
A couple of considerations with psoriasis: Again foods matter and sometimes people have food sensitivities that trigger this. I found that foods that most often contribute to psoriasis are tomatoes, citrus, wheat, corn, milk, those are probably the most common triggers -- yeast in some cases. Certainly, sugar can make the condition worse. The main nutrients that help are fish oil , vitamin A and D. So cod liver oil contains all three and can be useful. A lot of people in the winter are vitamin D deficient. Testing him for vitamin D levels would be important and replacing his vitamin D very aggressively could get his vitamin D levels up to a point where it regulates the overproliferation of psoriatic cells. There's actually a topical medication made from vitamin D called Dovonex and that proves the vitamin D, psoriasis connection.
March 13, 2004
What do you think is the safety and effectiveness of the supplement TMG?
TMG is a nutrient and is sometimes referred to as betaine, and that's a really good nutrient for lowering homocysteine. Homocysteine ideally should be six or seven but if yours is 9.9, you're at very little additional risk. Things that help homocysteine obviously are folic acid, B12, B6 and sometimes you can get a doctor to prescribe high doses of folic acid -- I often do so for my patients at a level much higher than you can get in a health food store. Doctors can prescribe those additional levels. It's just that supplement manufacturers are limited in their ability to put high dose, megadose folic acid into supplements.
. TMG or betaine plays a role in homocysteine metabolism. So it can be one of the things that can help correct an elevated homocysteine. In many supplements that are used for homocysteine you'll see B12, folic acid, B6 and TMG. TMG can make a difference.
TMG is also really helpful for fatty liver. Fatty liver will sometimes be picked up as a slight elevation in your liver function test. Your doctor will do tests for hepatitis and other diseases and say, well, "You don't have any of those." Astute physicians will say it's diet related -- clean up your act and you'll see those liver function tests normalize.
Betaine is extremely helpful for mobilizing the fat that is stuck in the liver cells. And so I think it's a very useful nutrient and it's also great for people with hepatitis because we know that hepatitis -- I'm talking about infectious hepatitis -- we know that that actually can be worsened by the effects of poor diet and fat accumulation in the liver. Betaine really is part of a liver support program. TMG really can make a difference.
Is L-Carnitine safe for teens who want to body-build ?
Yes, it's absolutely safe but I can't really say that L-Carnitine is going to marvelously accelerate muscle development and help burn fat.
We sometimes use carnitine with some of our sicker patients, especially patients who have been through diseases or have taken really strong drugs which might slow their metabolism down. We find that L-Carnitine helps to jump start a sluggish metabolism. So sometimes a sick patient will really blossom with carnitine administration and some of our overweight patients find that -- especially if they're sluggish and tired -- that carnitine is very helpful. But for the usual 17-year-old who is in magnificent health, carnitine isn't going to make that much difference.
Carnitine is naturally supplied by animal protein. So you take a little animal protein in your diet, unless you have some real metabolic blockages, you're going to get it. Not that I'm against carnitine, but just that it may be inappropriate.
I thought you were going to say creatine. Are you sure he's not taking that for muscle growth? Because that's a more popular body builder's supplement -- a couple of letters are different but it's called creatine.
Creatine is also something that's already in the body. But what you do when you take creatine, you're really maximizing the amount of creatine you store in your muscle. That may help build explosive strength, although studies are controversial on that. It does bulk up the muscles -- but it's kind of artificial -- and kids like that. They want to look awesome. I can share their aspiration to bench press more pounds and have better endurance because it's fun to work out; it's fun to see your ability to lift more weight.
I was excited the other day when I surpassed my own bench press threshold by going up to 185 pounds. For a lot of professional weightlifters out there, that doesn't mean much, but surpassing your own body weight in bench pressing -- if you're sort of a rag-tag amateur like me -- is exciting.
Please discuss the difference between osteopenia and osteoporosis and the treatment for both.
A score of 2.5 is considered by some to not be osteoporosis. Some people use the number 2.6 as osteoporosis. At 2.6, you don't have major far-gone bone thinning.
If you're 60 and having that type of result suggested to you, you ought to be proactive and make sure that by the time you're 85 or 90, it's not two or three times worse. So you want to get in there and adopt some sort of strategy. The suggestion is that you take a bioavailable form of calcium. My favorite is calcium citrate with some calcium hydroxyapatite. Now calcium hydroxyapatite, isn't something that can be taken alone because (A, it's too expensive -- and B), you'd have to take eight or ten pills a day to get your calcium quotient.
I think in terms of oral calcium, all you would need to take is about 800mg or 1000mg a day. A lot of people are going to start screaming and say the requirement is for 1500 milligrams of calcium a day. Well, if you have any kind of calcium in your diet, it's very likely that you'll achieve 400, 600 or 800 milligrams of calcium a day. You can use dairy -- if you're not allergic to dairy, that's fine. For some people, dairy causes them gastrointestinal problems; it causes them respiratory allergies -- it's not good for them.
Soy can be helpful for dealing with osteoporosis. Ipriflavone is a relatively new bone building supplement. You also need to take additional magnesium, silica, boron, lysine and the essential fatty acids . Weight bearing exercise is key.
And the mind is important because if you are subject to stress, continually day in and day out; if you're worried and apprehensive that you might get a bone fracture and your doctor sends you into a complete state of depression with dire predictions about where you're going to be -- that's also not good for your bones.
I hope I don't sound cavalier about the risk of osteoporosis but people should live their lives and remove the veil of fear and anxiety that could ultimately be a serious health draining agent. I would just follow those instructions and I think you will be fine.
And Fosamax, I don't have a big problem with that and I think it will assist you in gaining some bone density. You can take that for a few years and see how that works.
I'm considering taking a dietary supplement for benign prostate enlargement.
My advice to a man in your predicament is to take a saw palmetto product. Take a standardized product -- 320 milligrams a day of the standardized saw palmetto extract. It's got a mixture of natural chemicals. We're not even sure which chemical does the job, but these natural substances may work synergistically to help the prostate.
It is a symptom reliever and it may slow down the progression toward prostate enlargement.
I have a question about my red blood corpuscles -- my hemoglobin and my iron count is low normal.
There's sort of a drill for this. If you have a low iron count accompanied by anemia, generally there are series of tests that your doctors will want to you undergo, particularly at the age of 60. Their concern is -- are you bleeding from the gastrointestinal tract? And sometimes you don't have to say, "Well I have blood in my stool", to be bleeding slowly and to have what is called occult or hidden blood. That can be checked for with tests such as the guaiac test which is to see if there is blood in the stool.
Okay. So now the concern is why is this happening? And I would say this: We can blame a lot of things on stress. And stress may compromise your ability to digest fully. But I've seen more and more patients who just can't get their iron up. And I ask them: are you vegetarian? Are you eating just brown rice and sea weed? And often they are not vegetarian and are eating considerable amounts of iron in foods like meat, fish, chicken, and eggs. And you can get some iron from vegetables but it's a less efficient delivery source. And they still remain iron deficient.
The problem is they have gluten intolerance. Unbeknownst to them they have mal-absorption that is due to the intake of food that flattens their intestinal villi. The villi are like little finger-like projections in the intestine that increase the surface area of the intestine to the size of a football field. We all have that within us; the absorptive surface that's equivalent to the size of an entire football field. But when these little finger-like projections flatten out, absorption is inefficient -- you can't take in enough iron -- and sometimes we will discover that the patient has gluten sensitivity.
So that's one angle I would check. We would also look to replete your iron with gentle sources of iron and dietary sources. I think dietary sources are best. Because iron is straightforward, it's either you get it or you don't.
I got my blood test results from my doctor and I have high iron.
A count of 59, with a range of normal from 15 to 50, is a little bit high but it's probably not a serious problem. You need to get a test called the ferritin test. The ferritin test is a good test to screen for a condition that could be consequential for you which is the condition of hemochromotosis.
Hemochromatosis is an iron overload condition. It can be dangerous because it can actually damage the liver. It can increase your risk of heart disease. It's believed it may even increase the risk of cancer and too much iron has also been implicated in parts of the brain where Parkinson's Disease occurs.
So too much iron -- we were talking about the effects of too little iron. If you have too little iron, you may be fatigued. You may actually have reductions in your thinking ability. In kids, too little iron reduces IQ in school performance. But too much iron can be very serious too. It's kind of like Goldilocks and the Three Bears. It's either too hot or too cold or the porridge is just right. In this case, the iron levels need to be right there, smack dab in the middle. Fifty-nine, I'm not too worried. Get a ferritin test, if the ferritin is over 200 or so, the most practical approach dealing with excess ferritin is to limit your intake of iron containing foods and give blood. Give blood and you will actually purge your blood of excess iron and you will do a good deed in the process.
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