We're going to talk about the pain free diet program. A lot of you are probably thinking, what's he going to talk about. Is it the Mediterranean diet? Is it the diet that reduces insulin resistance? Is it a diet rich in boron or strontium or fish oil or what magical ingredient of the diet can help people cope with pain? Is it 5-HTP in the diet or tryptophan that can help the brain cope with pain? We know that serotonin has a lot to do with our perception of pain and mood, should we be eating turkey and milk to get a lot of tryptophan into the brain to cope with pain?
Well, this story actually is the duh story of the week because, well, it's in one of the latest editions of the journal, Obesity Research. And the headline here is: Weight Loss May Ease Arthritis. And to that I say, duh uhh. It's not just because weight bearing presses down on the joints. Sometimes you see people who are seriously overweight and you feel sorry because there's a lot of pressure on their knees and ankles and they seem to be trudging painfully along. And it also has to do with the physiology of excess fat cells in the body.
Excess fat cells in the body may do something to promote inflammation because -- I'm sure you'll agree -- not only gorillas walk on their knuckles, that is, mostly. Very few people walk on their knuckles. I guess some people look like they do.
Many people who are overweight experience arthritis all over their bodies, and you can't claim that the arthritis they have in their fingers is from the pressure of the weight. And yet pervasive arthritis, not just arthritis in the knees and ankles occur with weight bearing.
But this study shows that people ages 60 and older had just a 12 percent likelihood of pain if they're underweight. That's an incredible statistic because most people over the age of 60 are pretty achy. Wouldn't you agree? Show me a 60 year old who doesn't have pain, that's the exception rather than the rule. But among people who are underweight, only 12 percent in this survey reported chronic daily pain. But if they're very obese, 60 percent reported pain. It's kind of a duh story but it's pretty intuitive.
What kind of diet do you follow if you're suffering from arthritis? Any diet that gets you to your optimal weight will help at the very least.
I went to the gym this morning and did some strength training, bench pressing and dumbbell exercises, some lateral pull downs -- just that whole weight routine which I enjoy doing several times a week. And I've gotten away from simple reliance on aerobic exercise. I used to run like a maniac. That was the only time of exercise I did.
Now I've diversified my exercise portfolio to include strength training, which I think is extremely valuable especially as you get a little older, you tend to lose muscle mass and so strength training offsets that. The fact that I've gained muscle mass in the past few years and I feel really good. I'm no longer daunted by the prospect of if I need to load a chair into a station wagon, I'm able to do this and take it on.
But traditionally, we identify strength training with the population of young guys, teenage and twenty-something men go after exercising. And actually, I was at the gym with 27-year-old guy who's just in phenomenal shape -- everything I did he did 20, 30, 40, 50 pounds more.
But this is a study -- actually a couple of studies came out this week that look at the role of weight training populations in women and in the senior population. One study looked at people going to Curves, which is a place that's an exclusive enclave for women. And it's also kind of a nice place because it's a friendly environment, shall we say, for individuals who are not muscleheads. They're sort of amateur exercisers. Some are trying to deal with weight problems and it's a very congenial environment for getting your exercise done, nonthreatening.
Curves encourages thirty minute workouts three days a week -- that's a modest goal -- and also a low calorie diet, plentiful in protein and vegetables. And what they found was following ten weeks of dieting and exercising lose weight and raise their metabolic rate the study participants were able to eat as much as 2600 calories a day -- that's really a lot of calories -- and maintain their weight loss. These women also lost fat and increased the proportion of muscle to body weight. So even if you don't lose weight, when you increase your muscle to fat ratio, you look better. Your size improves even though the scale may not budge that much. They gain strength and they made medically significant improvements in blood pressure, resting heart rate and aerobic fitness even though they weren't doing aerobic exercise, they were doing strength training.
This other study looked at this done in Canada, a home based resistance program, strength training, middle-aged and elderly volunteers. They found that they not only got stronger muscles but also a stronger immune system. The men and women were aged 54 to 82. They followed a thirty-minute, three-day-a-week schedule but they did this at home. They didn't even have to go to a gym. They used stretchy tubes and resistance balls at home. The resistance balls at home, if you know how to use them, are good for safe workouts. And they did this for 11 months, thirty minutes, three days a week. That's the key; you don't even have to do it every day.
Blood tests showed their bodies produced higher levels of natural killer cells which help fight infection. They didn't lose weight but they improved their cholesterol. And so exercise should be encouraged not just for muscle heads and other nontraditional populations.
Weight loss may ease arthritis
Kevin Fontaine, Johns Hopkins School of Medicine
Weight training helps women, elderly, studies show
Study conducted with Curves health and weight loss program
I'd like to talk about the use of anti-depressants in children. Younger and younger children are being diagnosed as having depression. Maybe it's a statement about our culture or our times or it's related to the abysmal diets that kids are on. Not enough essential fatty acids or maybe it's some form of environmental pollution that's addling the brains of our younger citizens. But a lot of prescribing of antidepressants to younger and younger kids and this without adequate information, data from tests on the effects in kids because many of these drugs have actually been tested in men who are twenty, thirty years old. We don't even know how these drugs work in the female population.
There's a new study in the Lancet -- world's leading medical journal -- that claims that drug companies withheld information showing antidepressants were ineffective and, even worse, could be harmful to children. And they should have issued warnings on their products. This is a big deal in England where they have banned the use of all antidepressants in children except for Prozac.
There's a whole line of SSRI medications -- Selective Serotonin Reuptake Inhibitors -- that are currently in use in this country. But across the pond, their use has been suspended because of concerns over heightened risk of suicide. And what they're saying here is, they're accusing the drug companies of sandbagging this information.
One physician over there who is head of something called the National Collaborating Center for Mental Health says they have this data sitting in front of them showing that the drugs don't work and there are some risks that they will increase suicidality in children. Why didn't they just put a health warning saying don't use in children? Well, the problem is there was a discrepancy between published studies and studies that were performed but were held back, they were unpublished.
The studies that were published, of course, were the ones that showed that these drugs were a great boon or panacea for childhood depression. And then there were the unpublished studies that were withheld, sandbagged, undisclosed, that showed that the drugs didn't work so hot and maybe there was a higher risk. And this is prevalent in the medical literature. There is bias that is reflected by the sponsors of the study i.e. namely, in many cases the very pharmaceutical companies that market these drugs. And there's a big brouhaha, especially over there in England where they're saying we're giving too many drugs to kids with depression.
Sunlight is bad for you, it causes cancer, we're experiencing a rise in cases of melanoma and skin cancer and most dermatologists are dead set against people baking in the sun or certainly going to tanning salons to get a -- I guess this is an oxymoron -- healthy tan.
But there's a guy who is bucking the current, he's Dr. Michael Holick and he's embroiled in controversy up at boss ton university. He's a vitamin D researcher and he's coming out with a new book and this book is going to make a splash. We'll have him here on this program; we'll interview him on our weeknight edition of Health Talk. I've heard him speak and he's an outstanding speaker and he makes a great case for the fact that we may have overreacted in our fear, our overzealousness, to prevent skin cancer.
We've got a lot of people hiding from the sun, slathering on sun screen, draping themselves with clothes and it turns out that we may have spawned an epidemic of vitamin D deficiency. Now, vitamin D is associated with osteoporosis, we know that. There's a lot of osteoporosis around and we're realizing that as we test people, certainly I see this in my clinic; many people are vitamin D deficient.
We had a call during the previous hour, a guy whose wife takes vitamin D supplements and they even spent the winter in Florida and her vitamin D levels were actually pretty darn low even after basking in the sun. It's harder to make vitamin D in your skin and harder to absorb it when you get past a certain age. But now there's research and Dr. Holick has popularized it along with others that vitamin D has other roles besides preventing osteoporosis. It may help to prevent cancer, specifically cancer of the colon, prostate and breast. It also certainly plays a role in preventing psoriasis and other skin problems.
Multiple sclerosis and rheumatoid arthritis are also associated with low levels of vitamin D and both diseases respond to vitamin D supplementation. And there are even mood problems associated with low levels of vitamin D. Fibromyalgia, a common problem, achy body may be associated with low levels of vitamin D. We're actually seeing some of our low vitamin D patients respond beautifully to high-dose vitamin D supplementation and their pain abates.
These are the contentions of Dr. Holick and others and he's under the gun. They have forced him to resign from his position in the department of dermatology at Boston University because they said he's spreading heresy. They're also concerned that he may have commercial links to the tanning industry, they've donated $150,000 to his research and they think, well it's a conflict of interest, he has commercial ties and that's no good. But Holick's resignation is largely symbolic because he's going to remain director of Boston University Medical Center's vitamin D lab while continuing to teach with no drop in salary. He says he believes he's being punished for challenging one of the dogmas of dermatology. And some dermatologists agree that Holick's arguments shouldn't be dismissed so lightly.
So you're going to see a big brouhaha over sun recommendations. Previous recommendations to completely avoid the sun may actually spawn a whole host of other problems.
Boston University advocate of sunlight draws ire
Michael F. Holick
Here's another problem that afflicts men around 79 and sometimes younger. It's male ageing. And male ageing is reflected as decreased sexual function, depressed mood and fatigue. And some research done in Italy suggests that there's a nutrient that can team up with testosterone therapy. But it's even more potent than testosterone at addressing the symptoms of male menopause sometimes referred to as andropause. It's in a pretty good medical journal, it's in the April issue of Urology, which is the major medical journal of all the urologists of the world.
In Italy, 120 patients either got testosterone or a combination of testosterone and carnitine. The average age of the patients was 66. And what they discovered was that testosterone helped but testosterone plus carnitine performed even better. And carnitine had a more significant effect on various tests that measure sexual function.
I didn't even know this but there is something called the International Index of Erectile Function. Don't even ask me what that is. There's also a test called nocturnal penile tumescence and another test was administered which is the depression melancholia scale. There was a fatigue scale test administered. All these tests improved with testosterone and carnitine seemed to act as "hamburger helper" for testosterone in reversing the symptoms of male ageing.
So I'll keep this in mind as I administer anti-aging programs to my male patients who are suffering from symptoms of male menopause.
Carnitine improve symptoms of male aging
Urology. 2004;63:641-646
CALLER: I have bulges in my cervical spine and I lost the use of my right arm, I can't write or cut meat. And I'm told that surgery is a consideration here. I want your opinion.
DR. HOFFMAN: Here's my opinion on this and there was quite a nice article on back and neck problems in Newsweek Magazine this week where they actually summarized the research pretty accurately. A lot of the research shows that if you look at a lot of people's spines, you'll find all kinds of abnormalities. You're going to see bulging disks and cracked disks and supposed appearance of nerve compression. And some people with the appearance of these problems are fine and other people have really debilitating symptoms.
And surgery is at best a stop gap measure. It's almost never definitive in terms of permanently alleviating pain and disability. And I guess, sometimes it gets to an emergency; you can't move your arm, that's really serious. But I would undertake, for sure, a program of weight optimization and physical therapy. I would take high doses of magnesium to release muscle spasm. I find that sometimes patients who have muscle spasms benefit from intravenous magnesium, they need higher doses to help their muscles relax.
And there's also a stress component. You know the expression, I got pain in my neck. Well what's the pain in your neck, in your life? If you can figure that out, sometimes you can alleviate these problems. I donýt want to be simplistic because you say you can't move your arm but complex neurosurgery for pain syndromes -- it's a risky business. And sometimes results are not 100 percent.
The other thing I would recommend: I certainly would recommend a trial of acupuncture, because acupuncture can sometimes alleviate problems like this. There are other types of injection therapies. You sometimes hear them described on health shows. These therapies sometimes can help to alleviate chronic pain problems and problems of immobility. Certainly if you have a bulging disk that's compressing on a nerve and there's no way around it, this is the time for judicious action or surgery and you may actually have to have that procedure.
CALLER: I had a question about SAM-e -- what is it and is it an effective treatment for fibromyalgia?
DR. HOFFMAN: Very good question. SAMeis an amino acid. It's methionine that's slightly modified. It's a very interesting substance because it seems to work both on the brain and on joints and it has an additional benefit in terms of treating liver problems; it's very helpful for the liver. SAMe possibly works along the same lines that folic acid and B12, B6 work on homocysteine. It is related in some ways to the homocysteine story but SAMe can work as natural antidepressant. We know that fibromyalgia is often linked to depression. In a sense when we say it's all in your head, it doesn't mean that you're nuts, it just may mean that abnormal brain chemistry makes people more vulnerable to the effects of pain.
And then in fibromyalgia we have sleep problems and that may compound the neurotransmitter imbalance that may make people more susceptible to fibromyalgia. So there is some good data showing that SAMe is a useful alternative in fibromyalgia. Certain patients respond well.
And what you have to do with SAMe is you should take a fair amount for a while. With SAMe, the stuff is expensive and the dose required to get a good response in fibromyalgia is a little more than people might be willing to take long term. It comes as 200 or 400 milligram capsules or tablets. And before you dismiss it -- some people say, "Well, I took it." Well what does that mean? "Well, I took 200 milligrams once or twice a day for a week and it didn't help, so I'm not going to take it anymore."
Well, you might shortchange yourself that way because it may require 800 or 1,200 or even 1,600 milligrams after SAMe to get a really good result. And believe me, people who get a good result from SAMe are willing to spend the extra money to take it because it really can have phenomenal effects on mood and energy and on fibromyalgia.
But you have to conduct a little science fair project on yourself. You also need to take it away from food because if you take it with food, it will dilute some of its effectiveness. But give yourself a nice three to four week trial of 400, 800, as much as 1,200 -- 1,600 milligrams of SAMe. Take it in divided doses two or three times a day and see if it doesn't help your fibromyalgia condition. It's a very, very useful nutrient.
CALLER: Can you give me a safe and effective treatment for toenail fungus?
DR. HOFFMAN: It depends on how serious the toenail fungus is. Is it just a little bit on one toe or is it pervasive? Are all your toes really crumbly?
CALLER: It's all the toes. This is for my husband.
DR. HOFFMAN: A couple of comments on that. One is a personal observation. When I was a kid, I was prey to this. And now, as I sit here, I'm wearing sandals and I'm looking at my toes. All my toes look fine. There's not even a trace of toenail fungus.
And I think the difference is in terms of that turn around -- I never have taken antifungal medication, really strong antifungal medication that's recommended for treatment of this. I simply improved my diet, got rid of lots of the sugar that I was consuming.
My parents didn't even know any better. My mom thought she was offering me a nutritious treat when she presented me with a Hostess Twinkie or a Snowball. That was what they fed kids in the 1950s along with soft drinks and fruity drinks and things like that -- and of course, plentiful ice cream.
So now with the reduction and intake of refined carbohydrates and junk, that obviously is the proof.
Another reason you can get toenail fungus is when you have poor circulation to your feet. And I actually examined a couple -- patients came to me who were husband and wife. They were in their 60s. And sometimes when you look at relatively healthy people there's not a lot to remark on. But I remarked on how nice their toenails were. The reason is that they both exercise a lot, they follow a good diet and have great circulation to their feet. And sometimes poor circulation to the feet can give you funky toenails. It's kind of like the opposite of athlete's foot -- it's like non-athletes foot.
If you're sedentary and you eat a bad diet and you have circulatory problems, not enough blood circulating to the toes and the toes get bad. But given that you have this problem, or your husband has this problem and it's so severe, just diet and exercise are not going to make it go away.
There are topical things you can put on the toes. You can put concentrated oil of oregano or you can put tea tree oil on the toes but that's usually not enough for very advanced toe fungus. You have to take something internal and you usually have to take medication and it has to be done carefully because these medications are very strong, they can affect liver function. There are two now available, one is Sporanox the other is called Lamisil. Lamisil is now highly advertised in a very clever series of ads on TV where they show a little cartoon character fungus who burrows under your skin and into your nails to cause your nails to look ugly and your skin to crack. But once the antifungal medication kicks in, then lifestyle changes to preserve the good nail appearance are important: exercise, good diet, and avoidance of sugar and junk.
CALLER: My husband is 79 and he went to the doctor to get some blood tests and he found that his homocysteine is at 10.
DR. HOFFMAN: That's not a big problem, that's a very, very little problem. This is what's happened with homocysteine: Homocysteine is a risk factor for cardiovascular disease and stroke and blood clots. And when I first started becoming aware of homocysteine, I said, "Well, what's the normal or optimal level of homocysteine?" I asked my lab, and they said anything under 17 is fine. Then they changed it to 14, and then they changed it to 10. Now, there are some people who are even urging us to get our homocysteine down to 7 or 8 and that's where I'd like to get it.
But 10 is not bad. It probably could be brought down a couple of points with some additional folic acid, B12, B6. The other nutrients that seem to help are vitamin B2 or riboflavin and there's something called TMG -- trimethyl glycine, sometimes referred to as betaine -- which will help get it down. We use a poduct called Homocystrol +TMG
. The other issue is occasionally we'll see somebody where it's hard to get homocysteine down, they've got a hypothyroid condition. But I donýt think that's a big problem. That's a little problem, a kind of a non problem.
CALLER: Now the second one deals with thyroid, underactive, the doctor said.
DR. HOFFMAN: Well, bingo. That's what I just said. If your thyroid is underactive your homocysteine will go up. So pay some attention to the thyroid, give just a B complex or a multi that's rich in B vitamins and this problem will just depart. It will be all fixed up.
CALLER: About every three years, my son seems to get kidney stones. He just went into the hospital this morning and they used, I'm not sure what it's called, some kind of a laser process where they break it up?
DR. HOFFMAN: It's actually soundwaves -- it's called a lithotripsy. It's an ultra-focused sound beam that literally smashes the stones. And it actually makes a loud noise. And it's scary sometimes to have this done, just in terms of the sound. It's loud, like a pistol shot.
CALLER: That's what he said.
DR. HOFFMAN: It's a weird process. But what it does is it smashes and fragments the stones so they can be passed, usually under some kind of sedation because passing a stone hurts. But these tiny fragments are generally safer and more easily passed.
The first thing to do if you have kidney stones is to analyze the stone if you capture it. And another thing you can do is to analyze your urine. What we do in our practice with patients that have recurrent kidney stones is we do something called a "stone risk profile". And it analyzes the urine for many different characteristics: levels of calcium, levels of oxalic acid, magnesium, citric acid , and the total volume because if you're producing a low volume of urine, it's a dead giveaway that you're simply not drinking enough liquid. We analyze these factors and address the problem.
The most common type of kidney stone, the usual type of kidney stone, is something called a calcium oxalate stone. And those stones respond to, not so much a low calcium diet -- we used to think, don't give calcium to people with kidney stones -- but a reduction in the amount of oxalic acid. Certain foods are high in oxalic acid. Black tea is high in oxalic acid. Rhubarb is high in oxalic acid. Certain vegetables, in particular, meats, have virtually none. And also we give two major nutrients -- magnesium citrate, the citrate form of magnesium, is most protective against stones. And also vitamin B6. Vitamin B6 does something to help prevent stones from forming.
Usually we have very good results in stopping recurrence of stones.
The other thing -- sometimes there's a reason that people develop stones, a disease process. We actually find that some stone-formers have the condition of, hyperparathyroidism. Parathyroids are glands that sit on top of the thyroid. This is more common in women but it's worth checking for.
People with hyperparathyroidism actually tend to develop accelerated osteoporosis -- it pulls calcium out of the bones -- the calcium goes into the urine, it calcifies in the kidneys and then, ultimately, you pass stones. So people who have recurrent bouts of stones ought to get checked for this and potentially other disorders.
CALLER: When we came back from a winter in Florida, my wife who has osteoporosis took a blood test. One of the items on the blood test was the vitamin D and I asked that it be checked. It came out about 25
DR. HOFFMAN: That's really an interesting commentary on the effects of going to Florida in the winter because 25 is pretty darn low. That is not an optimal level of vitamin D. And from the sound of you -- you're a pretty savvy guy -- you probably have her on a supplement that contains some calcium and vitamin D, certainly if she has osteoporosis. And look what the result is; she's not even at an optimal level of vitamin D. She was in the sun, she was taking the supplement and it didn't do the trick?
CALLER: Right. She is over 70 and the endocrinologist didn't say a thing about it but I read an article by Dr. Holick on the D and osteoporosis and he said 40 to 50 would be a more acceptable number. Under 30 is inadequate for a person of that age with that disease.
DR. HOFFMAN: Dr. Holick is an advocate of sunlight and vitamin D and that's putting him in the crosshairs among dermatologists in this country who are saying, we're campaigning to make people stay out of the sun and he's saying get back in the sun.
But here's the thing: Because of malabsorption and because of ageing and because the skin is not as efficient in converting ultraviolet light into vitamin D in older people, there's a huge epidemic of vitamin D deficiency. People with darker skin have more trouble making vitamin D. Their skin is designed to spend more time in the sun and they burn less easily. But they also manufacture vitamin D less easily. So we're in big trouble because of -- now, especially when we say stay out of the sun, use lots of sun screen, and then couple that with the northern latitude.
And even Florida -- she wasn't actually producing enough vitamin D.
CALLER: She was taking 800 IU of vitamin D a day --
DR. HOFFMAN: -- Which is too little for many older individuals.
CALLER: So what we want to do is to follow some advice of a number of doctors and I think we're going up to 3,000 IU. And right now, the upper limit they say is 2,000. But that's going to be raised to 4,000 shortly I understand.
DR. HOFFMAN: Here's what I have to say on this: If you're going to go with higher doses of vitamin D, you should do so responsibly like you were doing, and get your vitamin D measured frequently. Because especially in some people, high doses of vitamin D can produce a rapid uptick in your calcium absorption and the results can be hazardous.
We were mentioning kidney stones earlier. You can get kidney stones from excessive vitamin D consumption. But the vast majority of people have inadequate vitamin D. I think vitamin D is trending upwards in terms of what we'll see as the ultimate recommendation. It's not uncommon for me to put patients on 2-, 3-, 4,000 international units of vitamin D a day. The old recommendation was 400 or 800, it's completely inadequate.
And for some patients I put them on 50,000 a week and that has to be prescribed. You have to go to a pharmacy to get those kinds of doses. And remarkably, I see some of those people, they take 50,000 a week for ten weeks in a row and they come back and the vitamin D has gone up but it has not gone up to the upper limits of normal. It's just sort of in the moderate or medium range. Did you have another part to your question?
CALLER: The other part was with strontium. I read a lot lately about using strontium for osteoporosis and I think we're ready to embark on that in addition to all of the other things we are using.
DR. HOFFMAN: Right. Strontium is the new strong player in the prevention and treatment of osteoporosis. This is in the wake of a big study in the New England Journal of Medicine showing that strontium is a mineral and it is a mineral that will be offered by prescription. But it's also something that is sold as a mineral because it's like chromium, selenium, vanadium. Strontium is in the same column in the periodic table as calcium and it acts in the bone matrix to strengthen bone. And it's generally very safe. It needs to be taken away from calcium.
So there are some supplements out there that are a mixture of everything, it has some magnesium, some boron, some calcium, some vitamin D and the strontium is mixed in there -- that's worthless because the calcium will interfere with the absorption of strontium. Strontium has to be taken at bedtime at a dose of approximately 600- 700 milligrams and it should be taken about three hours away from either calcium in a meal or calcium as a supplement. It needs to be taken specifically in that fashion to enhance bone but it's approximately as effective as Fosamax and Actonel. And I think it's a great natural alternative.
With strontium now on the scene, it may make it unnecessary for many people to take these stronger medications.
CALLER: I have two questions based on a diagnosis of idiopathic pulmonary fibrosis.
DR. HOFFMAN: Okay, you have a lung disease that's kind of like emphysema, because you are short of breath, but it's actually the opposite of emphysema. In emphysema, the lungs expand and expand and they become sort of ineffectual. And in pulmonary fibrosis, the lungs contract down and you really feel a tightness as you inhale. Is that the way it is for you?
CALLER: Well, I didn't have any symptoms when it was diagnosed in 1997 but recently I had them and I have had a deep decline and, of course, I had more pronounced symptoms of fatigue and shortness of breath.
DR. HOFFMAN: Idiopathic is a medical word, fancy word that means we don't know why this occurs. Let me ask you a question: Did you ever take antidepressant medication?
CALLER: No.
DR. HOFFMAN: Okay because that's -- actually certain antidepressants of an older category, drugs like Elavil when given at high doses have actually been associated with this condition. And the other thing is, did you ever work in a factory or were you ever exposed on a chronic basis to bad air, polluted air or particulate matter?
CALLER: In my early years. First 17 years,I lived in Buffalo. There's a high incidence of lung disease there but I don't know if that would carry over to the period. Now I'm 82 so I don't know.
DR. HOFFMAN: Sometimes early events in life can actually shape the state of your lungs.
CALLER: My question is: They want to do a lung biopsy under anesthesia with the idea of treating me with steroids. Someone said that L-cysteine was good for that --
DR. HOFFMAN: Actually, L-cysteine is pretty good, but n-acetyl-cysteine or NAC, is better. Just ask for NAC. NAC is, actually in my experience, preferable for treatment of this condition. And the other thing that is potentially helpful is fish oil. fish oil has an anti-inflammatory effect on these types of problems.
The other thing that we would do, specifically for this condition, is give you an inhaler. And that's a little nebulizer device that you can use at home and you put a few drops of something called glutathione in the inhaler. And you would be a good candidate for using this as a way of reducing inflammation in the lungs.
Now there's a whole question as to -- do you want to get a lung biopsy to prove that you have this condition so that you can begin taking a medication that will ultimately slow the progression but could have some devastating health consequences for you? You're 82. You sound healthy and with it. And you have, potentially have a very good life expectancy. So the question is: Do you want to go under the knife, have a procedure which is not very risky but there is a slight risk of problems and complications and difficulties that might complicate your life?
And number two: Why can't they just put you on the prednisone? You should really ask that question because they often do that for conditions like asthma, other types of lung problems. So I'm not sure what the big deal is that you really need that biopsy. But maybe I'm missing something here. I think patients should ask these types of questions. Give me a good rationale. How will this test or treatment make a difference for me? Is it necessary? And there may be also some natural ways to deal with the problem.
I'm very familiar with the condition because actually my father had this condition and there is no specific cure for it. But I wish back then, many, many years ago when he had the condition, that I would have known as much as I now know about nutrition because we might have been able to help him more. But at that time, twenty years ago, the treatment was the same -- prednisone, just using steroids.
We need to make some progress and perhaps use an intelligent medicine approach using conventional medicine and nutrient support in dealing with this degenerative lung condition which is poorly understood.
CALLER: Along with Propax, can I also take calcium supplements containing zinc and vitamin D and also an eye supplement containing zinc and B vitamins? I do have osteoporosis and macular degeneration. In other words, are there any vitamins and minerals to be avoided when taking Propax?
DR. HOFFMAN: I think that's a very good question. propax is a combination of a multiple vitamin. It has vitamins and minerals. And here's the important aspect of Propax: It contains something called NT factors. NT factors work specifically on the cell membrane helping the cell membrane communicate more efficiently with other cells and also helping energy production within the cells because the membrane of the mitochondria is important for energy production.
Mitochondria is a little, tiny structure within the cell -- and the Propax people have done their homework. They've done research showing that Propax can help energy. Cancer patients who are experiencing post-chemo fatigue feel better. They've done research showing that fatigued patients and elderly patients enjoy improvements in energy production and how they feel subjectively. And I find it very helpful in my patients, and I take it myself. I think it is a good supplement.
This is a very good question because the one thing about Propax, is; it is designed so that you can take other supplements with it. So it's a good basic multiple. But if you wanted to specifically target osteoporosis, for example, or your eyes, it can be teamed well with other supplements that target those health issues. For example, Propax doesn't contain very much calcium. It's only got 360 milligrams of calcium in it. So if you want to combine it with a supplement that targets osteoporosis -- something like Osteosupport, which would give you 700 milligrams of calcium, 360 plus 700, you're going to get close to your daily requirement of about 1200 or perhaps up to 1500 of supplementary calcium.
Vitamin D is important for osteoporosis. There's not much vitamin D in Propax, just a minimal amount. So you're not going to go over the top and you have to be careful with vitamin D, too much can be toxic. In eye formulas, there's often a lot of zinc. Zinc is an important nutrient, you can't actually overdose on zinc. There's only 12.5 milligrams of zinc in Propax. So if you take a supplement that has 40 or 50 milligrams of zinc in the average eye formula, you're not going to go over the top. I don't think you're going to get in trouble with those particular combos.
Things that you can OD on: Vitamin D, vitamin A, too much zinc can be toxic, too much of anything can be toxic. But some of the thresholds for vitamins are a little low and you have to keep an eye on them. But I think you'll do fine with that combo.
April 27, 2004
Study finds seasons affect cholesterol
Archives of Internal Medicine. Dr.Ira Ockene, University of Massachusetts
Food warning labels on FDA's plate
By Raja Mishra. The Boston Globe. April 26, 2004
Statins do not increase breast cancer risk
Cancer 2004;100
Tale of two studies: cutting through confusion on virtual colonoscopies
By Tara Parker Pope. The Wall Street Journal. April 24, 2004
April 29, 2004
Coenzyme Q10 may ward off migraine attacks
Am Acad Neur. 56th Annual Meeting: Abstract S43.004. Presented April 28, 2004
Drug firms withheld negative data
The Lancet, April 24, 2004
Cautions attached to the bowel drug Zelnorm
FDA: Robert Justice
Drug for preemies linked to problems
Science News. April 17, 2004. Vol. 164. p. 254
May 4, 2004
Activity may raise ovarian risk in older women
Cancer, April 1, 2004
Jellyfish stings
Stanford University Medical School: Safe Sea-www.drugstore.com
Can only the rich afford to be thin
By Nanci Hellmich. USA Today. May 3, 2004
May 5, 2004
For these working dogs, mold is gold
By Max Barash. CNN.com. April 23, 2004
Selenium may protect against prostate cancer
Journal of the National Cancer Institute, May 5, 2004
N-Acetylcysteine Curbs Emphysema in Rats
Chest 2004;125:1500-1506
Now customers can lost pounds on a supermarket's special offer
http://www.scotsman.com/scitech.cfm?id=476462004
May 6, 2004
Dieters curbed carbs, loaded up on protein way back in the 1860's
The Wall Street Journal. May 4, 2004
The gas we pass:exercise really does help
American Journal of medicine, April 15, 2004
When your spouse makes you sick: research probes toll of marital stress
The Wall Street Journal. May 3, 2004
May 7, 2004
New study shows chromium picolinate and biotin combination significantly lowers coronary risk factors in people with Type 2 diabetes
www.diachrome.com
May 8, 2004
Monologue: The Sun Wars
Get ready for the sun wars. It's prom time and it's also summertime and, as usual, the American Academy of Dermatology is teaming with pharmacies and various public interest groups to get the word out that too much sun is bad for you. They're also leveling their sights this season at tanning salons because part of the essential accoutrement for prom night is a tan. And in a lot of places in this country it's just not warm enough, sunny enough, to bask out there and bronze. So it's kind of a hurry-up assist.
A lot of kids are baking in tanning salons. Are they mortgaging their futures; inheriting the risk of serious, dangerous, life-threatening skin cancers? Or, could they be enhancing their health?
Well, there's a counter campaign to the standard campaign. The standard campaign is the American Academy of Dermatology's annual Melanoma Monday; it's usually held in the spring. But there's a media alert. You're going to have to follow the money trail because the media alert comes from an outfit called Wolff System. Wolff System happens to be the major company that manufactures all of the indoor tanning machines in this country.
They're conducting a pretty active campaign and they're teaming up with an interesting guy, Dr. Michael Holick, who is director of the vitamin D research lab at Boston University Medical Center -- believed by many to be the nation's leading authority on vitamin D. This is a strange alliance with the indoor tanning industry -- to point out the benefits of sunshine and even artificial ultraviolet rays, because artificial ultraviolet, just like sunlight, triggers the production of vitamin D in the skin.
So this press release says -- this is the countervailing view against the standard view of dermatologists, that too much sun is bad for you. It says, "Ignoring the health benefits of naturally occurring vitamin D production in the skin, the American Academy of Dermatology is promoting its annual Melanoma Monday today..." -- this is from a couple of weeks ago -- "in effort to promote more office visits for its members." That's not too bad.
Dermatologists want to promote skin cancer awareness but it accrues to their bottom line. The academy is ignoring last week's published findings by the University of Michigan Health System that point to the benefits of vitamin D. They also level criticism to chain drugstores which are co-sponsoring events, basically to sell sunscreen and vitamins. They're selling antioxidant vitamins to people as part of their summer marketing program.
Antioxidants tend to protect the body from harmful rays but what they're saying here is that vitamin D is essential not just for the prevention of osteoporosis but also reduces the risk of colon cancer.
Vitamin D deficiency is associated with more than 100,000 additional cases of cancer and 30,000 annual cancer deaths -- it is now estimated. And so we're going to have some increased incidents of skin cancer perhaps even melanoma, although there's some controversy surrounding that.
But what they're saying is, "Okay everybody, get out of the sun. Let's outlaw bikinis. Everybody's going to slather SPF 40 sunscreen all over their bodies, hide under a tent or umbrella at the beach. And what's going to happen? Well the net result -- yeah, a few less people will die of skin cancer -- we'll have 100,000 additional cases of cancer and 30,000 annual cancer deaths because of vitamin D deficiency."
Is that a plausible scenario? Well, there's some scientific reason to believe that that may be the case. Colon cancer risk is far lower in equatorial regions where people get a lot more sun exposure. Prostate cancer too, linked to vitamin deficiency. Breast cancer perhaps also. Multiple sclerosis, there are 400,000 cases of MS in this country. It is estimated that we can perhaps reduce by half the number of MS cases with adequate vitamin D. And sun exposure may be preventive. Also, rheumatoid arthritis also may be associated with vitamin D.
A new study saying that insulin resistance -- hey, it's what all those diets are about, the Atkins, South beach and so on--all these diets are about insulin resistance, is worsened by vitamin D deficiency. So get ready for the sun wars. They're saying, tan responsibly. Even occasionally go to a tanning salon because it's going to make the vitamin D. Look, you have to balance these things because just like in life, in health, balance is the key.
There are a lot of things out there that purport to deal with sticky problems like infertility but they're just based on a wing and a prayer.
This particular nutritional supplement called Fertility Blend has actually been validated in a scientific study in the April issue of the Journal of Reproductive Medicine. That's about as good as it gets. A small study, but a statistically significant study.
What they did here was took 30 women, age 24 to 46, who have been unable to conceive -- lots and lots of couples come to see me with that predicament because people are delaying child birth. And then when they're finally ready, they're financially set, they feel they're in a good place, their biology fails them. And part of it is due to age. Part of it is due to our environment. Part of it's due to stress. The very stress of contemplating pregnancy and dealing with infertility workups, ironically, makes it more difficult to conceive.
These folks have been unable to conceive after trying for 6 to 36 months. Fifteen women took Fertility Blend. The ingredients in fertility blend include L arginine, green tea, chasteberry, and a variety of vitamins and minerals -- B12, folic acid, B6, E, zinc, selenium, E, iron -- and it worked. Of the 15 women taking the supplements for five months, five of fifteen became pregnant. Remember, these were women who had been unsuccessful for 6 to 36 months before. Some of them were up to 46 years of age. None of the 15 women taking placebo got pregnant. That's significant. Five out of fifteen -- one third versus zero.
And while it's important to point out that the company that makes this supplement partially underwrote the study -- you always have to look for that. Is there a conflict of interest? Did they jig the results? Let's assume the study was performed correctly and honestly. Published in the journal of Reproductive Medicine, you may say, "Where do we get more information about this." There's actually a website, a pretty nice website by the company that puts this out. It's www.babyhopes.com. And they'll tell you about the study. They'll tell you about the ingredients.
And interestingly, there's also a companion product for men because men are sometimes the problem. Men do not have active motile sperm that can basically swim up river and impregnate the egg. And so men need nutritional support too.
We've been doing this a long time. One of the ingredients that we like is L-carnitine for men who have sperm quality problems. But in this proprietary supplement called Fertility Blend for men, they incorporate L-carnitine but also several other nutrients and green tea. Green tea just keeps coming up all over as just being helpful. And you can read all about it at babyhopes.com.
Nutritional supplement may improve female fertility
J Reprod Med. 2004;49:289-294. http://www.babyhopes.com/fertilityblendwomen.html
Here's a story for all you people on the soy patrol.
We have a large constituency of listeners who are worried about soy. They're discerning listeners because the general line on soy is that it is heart disease protective and even cancer protective. It may protect against prostate cancer, may protect against breast cancer but there's some new thinking on soy that suggests that maybe there's a downside to excess consumption of soy, at least for some people.
There's one study that suggests that tofu could slightly increase the potential for dementia. There are concerns that if you have breast cancer that consuming lots of soy products might have an estrogenic effect, that soy might promote thyroid disease, or that in kids who are allergic to dairy, for example, who were given soy formula -- too much soy may interfere with childhood sexual development because of the phytoestrogens in soy. All this is theoretical and speculative. I still eat small amounts of soy myself. I enjoy something called edamame, which is cooked soybeans, with my Japanese food.
But here's a very interesting study from Wake Forest University Medical Center. The story is about potential for men to behave badly with soy. This is in the current issue of the scientific journal, Hormones and Behavior. The experiment was done in monkeys but we can easily transpose this to humans because we're so closely related to our fellow primates. It suggests in this study that while soy may be beneficial for women in a variety of ways, research in monkeys suggests that it could have an adverse effect on the behavior of men.
Men behaving badly with soy. They did a study over 15 months with adult male monkeys and one group of monkeys got a large influx of isoflavones. These are the concentrated extracts of soy. In the monkeys fed the higher amounts of isoflavones, frequencies of intense aggressive and dismissive behavior were elevated. These monkeys behaved badly. In addition, they were lonely.
The proportion of time spent by these monkeys in physical contact with other monkeys was reduced by 68 percent. Time spent in proximity to other monkeys was reduced 50 percent and time spent alone was increased 30 percent. So if your hubby, or your son is acting surly, sticking to himself, shunning physical contact and proximity with others, perhaps the problem is excess levels soy burgers or soy shakes.
It's an interesting study -- this isn't going to resolve the issue but hey, for those of you who are out there on the soy patrol, additional ammo for your concerns.
In male monkeys, too much soy has adverse effects
Wake Forest University: krchrdsn@wfubmc.edu
Well, it's the ultimate cure for sweet cravings. What is it? Well, if you're a rat, according to a recent article in Experimental Biology, the answer is exercise.
Rats were caged with two water bottles, one containing a sugar solution and the other one just plain distilled water. The rats were then run on treadmills for thirty-minute increments for a two-hour workout period with no food. And surprisingly, after all that exercise -- this is kind of counter-intuitive because you think, well if you burn off a lot of calories, you're going to want some sweets. Well, no. The taste for sweetness was lowered after exercise. The rats preferred plain distilled water to a sugary beverage after working out.
Why is it that exercise helps? Well, exercise reduces elevated levels of insulin. Insulin causes blood sugar levels to plummet and when you produce less insulin, you don't get as much low blood sugar. And you get off the blood sugar rollercoaster and end up craving less sugar and carbohydrates.
Cure for sweet cravings
Experimental Biology 2004 Conference Washington D.C. April 20, 2004
A low-fat diet may not be best for the heart, according to a story in the Journal of the American College of Nutrition this month.
When they do those cholesterol ads on TV, you often hear this phrase and tone: When diet and exercise are not enough use -- whatever they're pitching -- Zocor, Crestor, Lipitor.
But why should diet and exercise not be enough if you're following the correct diet? Well, the problem may be that the diet espoused by the American Heart Association, a low-fat diet may not be enough inherently -- this according to the Journal of American College of Nutrition.
They're saying that adequate fat intake -- you got me right -- adequate fat intake can help ward off heart disease by raising HDL cholesterol. They found in this study that people on a 50 percent fat diet -- this doesn't necessarily mean fat from hydrogenated sources or all saturated fats, but fats from mixed sources including mono-unsaturated fats and fat from omega three fatty acids in fish -- 50 percent of calories from fat boosted participants' HDL levels, thus protecting them from cardiovascular disease. The individuals on a low-fat diet, a 19 percent low-fat diet, had significantly lower HDL cholesterols. Their HDL was 54 as compared to 63 in these individuals following a high-fat diet, suggesting that may be one of the reasons why the high protein carbohydrate restricted diets are working well for people these days.
Low-fat may not be best for heart:study
Journal of the American College of Nutrition, April 2004
A new study suggests that more American children and adolescents are showing up with borderline blood pressure.
What's going on here? Here's a new report from the Archives of Pediatrics and Adolescent Medicine this month. Teens who habitually drink lots of caffeine, where do they get it? Are they drinking Starbucks? No. They're mostly getting it from soft drinks. They tend to have higher blood pressure than other teens. Check this statistic: An estimated 68 percent of boys and 62 percent of girls 12-17 drink at least one soft drink per day. African American teens are the group that consumed the most caffeine, that's about 4 cans of soda per day had higher blood pressure than other adolescents. So that's part of the problem.
Blood pressure higher in caffeine-drinking teens
Archives of Pediatric and Adolescent Medicine, May 2004
b>A warning about fluoride in this week's edition of the journal of the American College of Nutrition. Too much fluoride may harm baby's teeth.
We've been using fluoride for precisely that reason, to protect the teeth. And in fact, evidence suggests that dental cavities have plummeted. Whether it's the result of fluoridation of water systems or due to other hygiene measures is unclear. But a lot of people are opponents of fluoridation because they're saying we get enough fluoride, we get too much fluoride and excess fluoride can cause problems.
Well here's one of them. In particular, infants who drank the most water-based beverages, particularly infant formulas made with water which is fluoridated -- most municipal water supplies are fluoridated -- they were more likely to develop a condition called dental fluorosis when they were older.
Dental fluorosis makes your teeth look mottled or funky and this is the result of excess fluoride. During the 1970s, formula manufacturers reduced the amount of fluoride in their products but some formulas must be mixed with water which contains fluoride.
Very young infants are unlikely to benefit of the caries prevention of fluoride, according to a researcher, and they may be at risk for dental fluorosis.
There's an additional risk from using certain soy or liquid concentrate formulas or when kids begin early to drink beverages or eat foods that are contaminated with fluoride because the manufacturing process involves municipal water. Foley said that we ought to be careful about adding this potentially toxic chemical to our water supply. We're conducting a big experiment with the health of our children.
Too much fluoride may harm babies' teeth
Journal of the American College of Nutrition, April 2004
CALLER: I have been diagnosed with a partial blockage of the carotid artery. The carotid artery being the big artery that goes to the brain. Anyway, my main symptom for several weeks has been increased dizziness just walking around normally, not doing anything very energetic. This isn't painful and I'm not assuming any dire disease, but it is getting to be seriously inconvenient.
DR. HOFFMAN: Usually, they quantitate this. They tell you not just that you have a little blockage, they tell you a percentage of what is called "stenosis" or narrowing of the arteries. Do you have that statistic in mind?
CALLER: Unfortunately, at the moment I am uninsured and heading for Medicare in two months. And this doctor suggested that I, immediately upon getting Medicare or some other way to do it, get a carotid Doppler.
DR. HOFFMAN: I think this is a tough one to call because you're very symptomatic. On the other hand, there is a chance that the symptoms you experience are due to something completely different than the degree of blockage you have in your carotid artery. We can't really depend on that.
If you had the full freight of insurance -- I think we should treat everyone as if they had the full means to pay and not withhold therapy. But under these circumstances, you really do need a checkout. You need to get to see if there's some sort of problem that's causing you to have an emergency need for surgery to your carotid artery. I don't think that that is the case.
What I would probably do is, I would go to an ENT, an ear nose and throat doctor. That should not be terribly expensive. That doctor might be able to help you differentiate between the kinds of problems that occur with carotid artery blockage versus ordinary dizziness problems that many people are prey to. When you get insurance, you need to get a Doppler test and perhaps something called an MRA, which is a magnetic resonance angiogram, which is a noninvasive test. There's no dye shot in there but the test will actually, precisely tell you how narrowed your artery is.
I wouldn't necessarily go into an alarm mode yet because the degree of blockage that this doctor ascertained you had is -- well, there's some blockage but we don't know if it's necessarily linked to the symptoms you had.
But do see a doctor. Go to a clinic or perhaps there's a place you can be seen, inexpensively. Find an ear nose and throat doctor and find out what this is about and if there is blockage verified, call us back because we'll talk about strategies, some of your possible options for dealing with that.
CALLER: I heard you say something about nicotine being good for some people and I'd like to ask questions as they regard my husband.
DR. HOFFMAN: All right. I just think some people are born to smoke and the reason is they may have some critical deficiency in the production of certain neurotransmitters in the brain, namely dopamine. There are some people in our society that are dopamine junkies. The sort of Evil Knievel types, folks that like to jump out of planes and they like to climb up sheer mountain pinnacles with just their bare hands. I like skiing but I don't like to go rocketing off the sides of mountains and causing avalanches and things like that.
There are just some people who dig that kind of stuff and they may actually be treating their own genetic dopamine deficiency. They're sort of dopamine freaks and these people do well with nicotine. The only problem is the nicotine delivery system that's mostly available is one that kills you. It's called the cigarette. And in the future, they may be able to develop medications. We use nutritional supplements in some of these people to relieve the cravings that may result from low levels of dopamine.
CALLER: Something like Nicorette?
DR. HOFFMAN: I don't have a big problem with Nicorette. I think, actually, the big mistake that some people make is when they undertake the smoking cessation, is they take the nicotine replacement for too short a time. And they say, fine. They stop smoking. But then, the same urges come back and they don't have anything to allay them with.
CALLER: Well, my husband stopped smoking many years ago. But over the years, he keeps saying he thinks he needs nicotine. He read somewhere where he needs nicotine. Since having heard you, he has bought some -- two milligram size -- and he takes four a day. And I was just wondering if that was something you would recommend?
DR. HOFFMAN: I think that's fine. More research needs to be done on the long-term effects of nicotine alone. There may be some beneficial effects. There may be some deleterious effects. But it's far preferable to smoking. So let him take a couple of pieces of nicotine gum. And aside from the expense, it's probably not a big deal.
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