Detailed summaries- June 12 and June 19, 2004

JUNE 12, 2004

DR. HOFFMAN: This news just came out this week. A new study released Thursday shows that many kids take too many headache pills. According to Reuters Health, nearly one quarter of children and teens with chronic headaches are overusing over-the-counter pain relievers.
The definition of overuse: Taking more than three doses per week for over six weeks.
Now you might say, "Well, so what? Kids have headaches, why not take medication to ameliorate the headaches?" Well, there are many reasons why kids shouldn't overuse these medications, according to Dr. David Rothner of the Cleveland Clinic. He says some pain relievers contain aspirin which puts kids under the age of 19 at risk for a serious complication called "Reye's Syndrome". It's a potentially fatal disorder.
So the concept: baby aspirin is really an oxymoron. Baby aspirin is baby-sized aspirin that should be used by adult heart patients for prevention.
Other risks of overuse of over-the-counter pain medicines include kidney failure and we're thinking of some, in particular, NBA athletes who may have used too many pain medications. Ordinary, non-steroidal anti-inflammatory drugs like Advil can actually damage the kidney and children's kidneys may be more vulnerable.
Additionally, liver problems can occur with acetaminophen, Tylenol-type drugs and non-steroidal anti-inflammatory drugs and aspirin. But now Tylenol can cause intestinal and stomach bleeding.
And finally, most importantly, overusing pain relievers may cause a once-occasional headache to blossom into a daily one. This is a familiar theme. It's called "analgesic rebound". The body gets used to pain relievers. No, this isn't addiction or getting high. But the body is getting used to these medications and when they wear off, the headache comes back and it requires additional medication to quell the headache. Add to this the fact that many combination, over-the-counter headache remedies contain caffeine -- Excedrin is an example. When you go off these things, you're going to have another headache, and you're going to have to take another pain killer.
Very telling in this study is that most of the headache sufferers were girls and students who got high grades in school. In other words, conscientious overachievers are more susceptible to headaches. They'll go on to get good grades. They'll go to good colleges and graduate schools. They'll get good jobs but they'll be incapacitated by health problems by the time they're middle aged because of serious pain problems and dependency on medication.
So the bottom line is, check out your kids if they're suffering from headaches. If you see they're using medication more than twice a week, then bingo, you've got a problem on your hands. According to Dr. David Rothner, you have to do something about it, consult a headaches specialist or -- we do a lot of work with kids of this kind. We work with their diets. We utilize certain supplements like magnesium to reduce the susceptibility to chronic, daily headaches and migraines. And the best approach is to avoid overdependence, long-term medication. The occasional headaches pill is okay but if it gets to be more than that, you've got a problem with your kid.

DR. HOFFMAN: Well, they call it the "Salad Bar Effect." Too many options can increase consumption, according to a study reported on by the Associated Press last month. And when I was young, they called it the "smorgasbord effect." Remember those all-you-can-eat spreads that you folks like to take the family to. The goal was, you starve yourself for the whole day and then you'd go to the smorgasbord. It was new, it was novel, it was before sushi and it was a great big pigout.
I remember once, I went camping with a bunch of guys. We subsisted on beans and trail mix, caught a couple of trout, but we had a meager diet, we had a lot of exercise. Then us five guys jumped into our Pontiac Bonneville -- it was probably a 1975 Pontiac Bonneville -- headed out of the mountains and we hit the first smorgasbord we could find. Well, we practically destroyed that place. They weren't happy that they were charging us each $4.95 for the amount of food that we were consuming.
Studies have been done on the Salad Bar Effect and they suggest that variety increases consumption. With monotonous meals people eat until they're full. When there's too much variety, there's a problem. Variety can increase calorie consumption an average of 25 percent.
One nutrition researcher Judith Stern, who is vice president of the American Obesity Association, says that nutritionists have been wrong. We've been telling people for years that variety is important, but it's that variety that really helps to make you fat. Scientifically speaking, it's called "sensory specific satiety." It's a mental process that makes food taste better at first, but progressively less interesting as a person continues to eat it.
If you switch to a new food, even if the person is full, it will be appealing. And that's why -- talk to a skinny person in their 50s or 60s, they've been eating a certain way all their lives. Generally, they have a pretty set way of eating. They eat certain foods at certain times on a pretty regular basis and that may be one of the secrets to their staying thin.
Food marketers know about this. As a result, Coca-Cola has diversified. They sell nearly 400 different drinks. Frito-Lay offers about 150 different chips and pretzels in the United States alone. Campbell's produces 170 soups. If you're going to the supermarket and you're saying, "I'm just bored of eating, I'm looking for a new flavor sensation," well, then you know you're probably eating too much.
If you need fireworks to light up your taste buds it may mean that you actually need to eat less. Consumers are surrounded by a staggering array of food when they walk into a market. A typical grocer has 35,000 products. That's up from 10,000 in 1983. During the 1930s -- think of the typical corner grocer in the 1930s -- it was around 800 items. Today, 35,000 different products.
And also this may explain the benefits of certain diets. If you go on the ultra low-carb diet, all you can eat is fat and protein. You get bored with it, right? Similarly, if all you can eat is brown rice and beans -- that's not too sexy -- you get bored with it. Even if you were to go on a doughnut diet, which is not a good idea, you'd get sick of it eventually.
So if you're overweight, think of the concept of sensory specific satiety. Variety may not be the spice of life, for you it may be source of obesity.

DR. HOFFMAN: Many of you have heard about chelation therapy. Chelation is a therapy that originally was used to treat industrial workers who accumulated very high levels of toxic lead or cadmium. It's use was then expanded to circulatory diseases. And many doctors like myself have seen the benefits in our patients who have circulatory problems, people who have angina, people who want to make sure that they don't get a recurrence of heart disease after bypass or angioplasty.
People are experiencing circulatory problems to their brains. They're getting TIAs or they're subject to brownouts in focus and concentration due to blood vessel narrowing. This whole category of patients benefits from chelation.
Also, people may have something called "claudication" .It's the narrowing of arteries in their legs. There is a big ongoing study of chelation therapy -- we've talked about that on our weeknight edition of Health Talk -- it's a program for people who have had heart attacks they can enroll with the TACT study. That's the study that's undertaken by the National Institutes of Health, $35 million of government money going into the study to demonstrate, once and for all, whether chelation therapy really is beneficial for heart patients.
By the way, if you want information on that, the number is (888)644-6226 to find out where you can participate for free as a subject for investigation of chelation therapy.
A big study this week that seems to validate the benefits of chelation therapy, at least in theory. What they're saying here is that a lot of Americans are walking around with modest levels of lead and cadmium. It's in the environment. We used to put lead in gasoline. Cadmium is a common pollutant that's found in cigarette smoke. What they're saying here is that lead and cadmium are harmful even at much lower levels than those set by certain safety standards. They increase the risk of peripheral arterial disease, according to a study that was just published in a journal called Circulation. That's the journal of the American Heart Association.
Scientists "need to think more carefully about this association and do more experiments with cadmium and lead at lower doses to determine what exposures to these metals might be doing in terms of the risk of cardiovascular disease." The older the subjects, the more they smoked, the higher their levels of both lead and cadmium and these folks had demonstrable changes in circulation to their extremities.
The author suggests that cadmium and lead can damage the lining of the blood vessels and reduce their flexibility. Chelation therapy, grabbing onto cadmium and lead, may pull these harmful heavy metals out of the blood vessel wall out of the tissue where they play havoc, promote free radicals and set the stage for arteriosclerosis and blockage.
DR. HOFFMAN: A big story last month was that the prestigious Institute of Medicine, a government sponsored research body, finally weighed in with its opinion on vaccine safety particularly as it regards the link between vaccines and autism, and released a statement. "The scientific evidence supports no association with autism for either mercury-containing vaccines or the MMR vaccines." This has produced a firestorm of protest in the autism community because there's lots of parents who are irate. They're convinced that their kids were harmed by these vaccines.
The clamor has reached the halls of Congress where representatives like Indiana's Dan Burton have decried the Institute of Medicine's statement that vaccines are fine. And the big problem here is that the Institute of Medicine report is said to be the final report on vaccine safety. They're saying no need to allocate anymore funds to additional research because vaccines are safe. End of story, period.
But now comes disturbing evidence in a report published online this week in advance of a publication later this month in a journal called Molecular Psychiatry that thimerosal, which is the mercury-based preservative found in childhood vaccines, can increase the risk of autism-like damage in mice. They're saying here that -- and this is,-- bear with me on the scientific terminology -- they're saying the same immune response from genes in mice that predict mercury-related immunotoxicity also predict neurodevelopmental damage that have features reminiscent of autism.
And they're saying that the mice exhibited changes, after all, they're mice. Mice are different than people. But the mice might foretell potential hazards to children from mercury-containing vaccines. Most mercury has been removed from most vaccines but if you try to get a flu vaccine, it's almost impossible to get a flu vaccine without added mercury. And now they're encouraging children at very young ages to get flu vaccines, especially in the wake of last year's flu scare which turned out to be exaggerated.
A lot of kids got vaccines containing thimerosal, which is a potentially toxic form of mercury, and they're saying, no problem.
Latest study still raises the question about this -- and I just say, why in heck do they keep doing this? Well, they say the mercury is a good preservative. It's cheaper that way. We can't afford the cost of individual-dose vaccines without preservative but I'm saying, it's our kids. Aren't our kids precious enough to safeguard from even the potential hazard of what is a known neurotoxin?
We tell moms who are pregnant not to eat certain fish that are laden with mercury but we say, hey, vaccines with mercury, no problem. That's double speak.

DR. HOFFMAN: Call it the medical equivalent of the popular TV show American Idol or harkenening back to the Gong Show with Chuck Barris. It's kind of an audition for the skill set of the nation's 16,000 medical graduates in the class of 2005. Starting Monday, they'll be tested on the skill that doctors are often criticized for lacking, their bedside manner. This according to an article in this week's Wall Street Journal. This is part of the new skills assessment that is going to be required of every single medical graduate.
Now there are already tests in place but they are pen and paper tests. This clinical skills assessment test is more like an audition with judges. It will use actors playing patients with symptoms of common illnesses and there will be scenarios that will change the bedside skills of aspiring doctors. They'll be graded on their ability to communicate with patients, gather information, perform physical exams and diagnose illnesses.
Five hundred or so actors have been hired for the five test centers that are regional in different parts of the country and there will be judges. Examiners will observe doctor and the actor who will play a patient but I can envision a scenario like this: An examiner, a Simon-like examiner might be saying, "Oh, stop, stop. That was absolutely awful. Did you actually go to medical school or did you study meat cutting? You have absolutely no talent. Have you considered law school?"
Well, maybe it won't be that bad but students can flunk these exams and a lot of students are irate. They're not pleased with another layer of testing and the expense that comes along with it because it's going to cost big bucks to take these tests. The new tests will cost an additional $975 plus an additional cost of $300 to $500 to travel to a regional test center.
There are centers in Chicago, Houston, Philadelphia and Los Angeles and already this is going to add to the burgeoning debt that many medical students accumulate. I can vouch for that because it took me about fifteen years to pay off my medical education. Current cost is $140,000 for medical education and one student who was interviewed said, "For us to have to pay an additional $1,000 for someone to tell us, 'yes, you can communicate with patients' is unsettling but they're going to do it." And that suggests that the public will have an additional layer of assurance that the doctors of the future will have the ability not just to pass tests but to talk to, interview and interact with actual patients.
It's spawning a new cottage industry for unemployed actors. Ramonita Corsino is a 67-year-old resident of Feasterville Pennsylvania. She's going to play a patient at the Philadelphia Center along with her actor patient son, Victor. This is going to provide -- it's kind of like a WPA for actors .Maybe they can't make it on soap operas but maybe they can play patients and feign symptoms that medical students are going to have to diagnose.

CALLER: My daughter bought some coconut oil and I always thought that was something to avoid. But she tells me it has all these health benefits and I looked it up on the internet and I can't find anything negative about it. It's in a solid form at room temperature which I always thought was something else you avoid.
DR. HOFFMAN: It kind of looks like Brill Cream, right?
CALLER: Yeah, it looks like Crisco.
DR. HOFFMAN: Let me tell you about coconut oil because coconut oil is an interesting oil. Coconut oil is a vegetable oil that's a saturated fat and of course, saturated fats have a bad name. But there are advantages to coconut oil.
First of all, it looks like Crisco but the way you get Crisco is you take liquid oils and you alter their chemical structure until they're solid at a room temperature. That's artificial. Coconut oil is natural. Not everything that is natural is good for you but coconut oil has some beneficial properties. It contains a certain amount of something called "lauric acid" which is a fatty acid that has antiviral capabilities. It seems to break down the protective coating around certain viruses. So it's thought to be helpful for people who are struggling with immune problems or fighting off viral diseases.
Also, it is extremely stable when you heat it. So if you're frying, you may want to consider coconut oil to fry in as opposed to something like olive oil. Olive oil is supposed to be healthy -- and it is -- but it's better as a salad dressing than as a cooking oil because it's very easy to damage olive oil. You destroy the benefits by heating it.
Coconut oil is very stable and there are some studies that even suggest that it may be beneficial for people with autoimmune disorders. I'm not so sure that has been well substantiated. But I think coconut oil deserves a place in healthy cuisine.
One of my favorite ways of using coconut oil is: I get coconut milk -- but the kind that has coconut oil in it, the heavy kind -- and I make rice with it. I get some Basmati rice and I cook it up with ginger. I put some cardamom in there, some Asian-type spices, and then I throw in a little bit of coconut milk, the kind that you make Pina Coladas with -- the kind that actually has some fat in it -- and that's coconut oil. It makes a very tasty rice and it also has some health benefits and is a good recipe for summer.

CALLER: My wife suffers or was diagnosed with dementia last year and to compound it, she's also bipolar. It's really rough. Is there anything we can do to help her?
DR. HOFFMAN: There absolutely is and I think this is an important conversation to have in the wake of the death of President Regan who really has focused our attention on the problem of Alzheimer's and dementia.
A couple of important points about dementia, from a nutritional standpoint. It's vital to recognize that diabetics have about three times the risk of developing dementia. So clearly, controlling blood sugar and reducing insulin resistance -- really, insulin resistance we talk about as a risk factor for, obviously, diabetes, hypertension and heart disease-- but it's also a risk factor for Alzheimer's disease. And to the extent you can control insulin resistance -- and I'm not saying necessarily you have to go on the Atkins diet -- but restricting your intake of refined carbohydrates, increasing exercise and taking nutrients would help control insulin resistance. It is going to make a difference, number one.
Number two, controlling inflammation. Inflammation is a big issue and they're exploiting the use of nonsteroidal, anti-inflammatory drugs and aspirin. But I think there are better natural anti-inflammatories, things like curcumin and resveratrol . The antioxidants work well here. We know that free radicals contribute to the inflammatory process. And by tamping down free radicals, mopping them up with things like vitamin E and C and nutrients that penetrate the blood brain barrier like alpha lipoic acid , we can slow that process down.
We also like to use B12 in prevention or treatment of dementia. But vitamin B12 sometimes needs to be injected because some people don't absorb it that well by mouth.
And a way to kill two birds with one stone, with bipolar disease and dementia, is to feed your wife fish oil containing EPA and DHA.
There are some really good studies on how it can modulate the severity of bipolar disease -- this disease, formerly referred to manic depression but it's more PC to refer to it as bipolar disease -- but it also can slow the inflammation that promotes Alzheimer's and dementia. And in addition, if we keep in mind what the brain is made of -- the brain is made of fat and phospholipids -- by using phospholipid replacement therapy, one of the popular brands of nutrients that incorporates this idea is Propax with NT factor.
NT factor actually helps to replenish the cell membranes throughout the body but also in the brain. The brain and the nervous system has a very, very high percentage -- nearly 100 percent -- of phospholipids. So if you're deficient in phospholipids, nervous system problems can arise, fatigue, mental brown-outs, mood stuff.
You also want to control the blood sugar in a bipolar patient just because it affects mood, it can set off mood problems. Going too long without eating or having a sugary meal and afterwards you have reactive hypoglycemic, can absolutely set up the problem.
Other nutrients: coenzyme Q10 is important. You may want to use phosphotidyl serine . There's evidence that the use of vinpocetine can be helpful for brain circulation as well as gingko biloba . There are a variety of things that we can use here. The problem with some of these patients is that without real concerted attention from caregivers, these people aren't going to take things on their own.
So our cases that are most successful are where there's a really good support system, a very dedicated family or spouse or perhaps a care team that helps to prepare specific foods, that helps to prepare supplements, encourage patients to take supplements because it's difficult. Even swallowing problems sometimes ensue when you develop dementia and sometimes we can prepare these supplements in forms that are more easily assimilated in liquid forms or in syrups that have flavors that camouflage the ingredients.
Some of our compounding pharmacies like Hopewell Pharmacy specialize in custom formulas that deliver vitamins without the unpleasant taste, with pleasant natural flavorings.

CALLER: I'm suffering from shingles for the past week. I'm in my 70s, I'm taking Valtrex twice a day for it.
DR. HOFFMAN: Antiviral medication, that's fine.
CALLER: But the doctor said there is no medication to put outside of it to ease -- you know, when clothing touches it, it really hurts. And I was wondering if there was anything in alternative medicine that I can take, vitamins or topical --
DR. HOFFMAN: We have a pretty successful program for people who have the initial phases of shingles that involves a series of shots. The shots include vitamin B1, B12 and something called adenosine. It's actually used in cardiology for heart rhythm problems but it also has an effect as a natural antiviral. And part of its effect -- maybe outside of its effect to suppress viruses, because this combo of nutrients really seems to turn around pain early on before shingles becomes a really serious problem called "post-herpetic neuralgia."
Post-herpetic neuralgia can last years. It can be associated with serious depression, sometimes even suicidal thoughts because of the profound daily pain associated with the slightest touch or even a breeze.
So we want to get into the problem before post-herpetic neuralgia develops. Then you'll have to use pain medications and it's not easy to suppress. For patients, also in the initial phase of it, sometimes we will give them -- since it is a virus -- we'll give them intravenous vitamin C. Intravenous vitamin C is a great natural antiviral. I've seen patients with incapacitating pain turn around very quickly. And we encourage patients to take medications that are antiviral like Famvir and Valtrex but we also combine that with natural approaches.
Another thing that's worth thinking about is when the lesions heal, when you don't have blisters or open sores, you can use extract of cayenne pepper, it's called "capsaicin" and there's a lot of over-the-counter products invoking this. And initially, when you put it on it may burn a little bit but the burn actually takes the sting and the pain out of post-herpetic neuralgia. It can be used also for arthritis. It can be used for diabetic neuropathy but capsaicin is really designed for the pain of post-herpetic neuralgia once the sores heal.
So as long as you don't have any open sores, you can get yourself some capsaicin. Apply it three or four times a day, use a glove so you don't burn your hands. Be really careful that you don't rub your eyes afterwards because it's a really burny substance. But capsaicin pulls something called "Substance P" out of the affected area. Substance P is a neurotransmitter responsible for pain. Get rid of Substance P and your pain will abate.

CALLER: I hear you talk about your salmon and salad diet, would it be possible that I could get a copy of that and perhaps you could tell me what it's good for?
DR. HOFFMAN: Absolutely. The best way to do that is go to DRHOFFMAN.COM. At the website there's a section on the diet, the Salad and Salmon Diet . There's all kind of support and information, including recipes and links that are helpful in terms of sourcing the food.
What are you attempting the diet for, what kind of condition?
CALLER: I have rheumatoid arthritis.
DR. HOFFMAN: It's perfect for that. There is a lot of controversy about whether diet makes any difference in rheumatoid arthritis and for a long time the Arthritis Association inveighed against nutrition quackery.
All these people are saying you have to be on this diet, that diet, or the other diet for arthritis, that's nuts. Don't even listen to those people because they're quacks. But recently in a major medical journal, they had a study on the Mediterranean diet, a diet that is closely akin to the Salad and Salmon Diet. It's rich in fruits and vegetables, reduces sugar, reduces artificial colors and flavorings. There's a de-emphasis on saturated fat, an emphasis on mono-unsaturated and polyunsaturated fat and that diet produced significant improvements in patients suffering from rheumatoid arthritis.
Yeah, so the Salad and Salmon Diet definitely beneficial.

CALLER: Two years ago I had a nephrectomy, I had my left kidney removed.
DR. HOFFMAN: For what reason?
CALLER: Large tumorous cancer, self-contained fortunately.
DR. HOFFMAN: And this is one of the good stories in cancer is if you have an encapsulated tumor in one kidney and it's discovered early enough, you will do fine. The problem is when it gets out of the kidney and into the rest of the body, that's a very different story. So congratulations to you, you lost a kidney but you have a new lease on life.
CALLER: I talked about this for two years since the surgery and I can't seem to find one that can help me with diet so I found an Ayurvedic doctor. She wants to start in two weeks a fast, fruits, vegetables, the like; I'm sure you're familiar with it. And I asked her if it was taxing on the existing kidney and she said, no. And of course, I'm paranoid with the existing kidney. And I also found blood in the urine and no doctor says that it's a problem and that's an issue for me too.
DR. HOFFMAN: Okay, the reason for the fast, what are you trying to accomplish?
CALLER: Detox, detoxification. My business is signage. I'm in the sign business. And for years prior to this -- I'll tell you this, I'm guilty to tell you this but there would be a time where I was heating over kerosene heat or working with lead paint and smoking a half a pack of cigarettes every day. I don't do that anymore so we're working on a huge detox.
DR. HOFFMAN: All right, so there's something to be said for dietary restriction, fasting, cleansing, detoxification and Ayurvedic medicine is based on a centuries old, in fact millennia-old tradition, and if applied correctly this can help to detoxify your tissue, not just the lead and the chemicals that you were exposed to but also some of the residues of the bad diet that you may have been on for years until recently.
A lot of people who have one kidney are perhaps more concerned than they have to be about the effects of fasting or the effects of certain medications, it's as if having two kidneys, you feel like you have one in reserve. Now with one kidney you really have to safeguard it. But we generally find that people with one kidney, one kidney pretty much takes over the detoxifying capabilities of two kidneys. It's as if the body has built in some redundancy so that the loss of a kidney, the one kidney pretty much takes over.
The suggestion is obviously to avoid excess medications. The medications in particular that are associated with kidney problems are nonsteroidal anti-inflammatory drugs at high doses, maybe taking an occasional Advil, no big deal, and you also should be careful with ultra-high protein diets. And I'm all for carbohydrate restriction. Restricting of refined high glycemic index carbs is important. But other than that, I think it's really hard to do harm to that remaining kidney. I think you'll do fine, I would reassure you on that account.

CALLER: I self-diagnosed myself as having a heel spur.
DR. HOFFMAN: It's cheaper that way isn't it?
CALLER: It's cheaper that way and I want to avoid steroid shots and surgery so I'm looking for some help.
DR. HOFFMAN: So let's presume that indeed you have heel spurs, but we can't really presume that. But you probably do if you have heel pain but it might be worthwhile even if you don't want the steroid shots to stop by a podiatrist or an orthopedist who specializes in foot problems and get a diagnosis.
And then here are some things that I generally suggest. You can get steroid shots and they do work but the problem is the condition, it will break the cycle of inflammation to some extent but the condition may come back and excessive steroid shots can cause localized loss of bone and can weaken some of the attachments where the tendons attach to the bone and potentially lead to more serious injuries.
But a shot or two is sometimes judicious and can actually break the cycle of pain. But short of that, one of the new techniques that is exciting and controversial -- because some studies say it works, others studies say it's not worthwhile -- is something called lithotripsy. Lithotripsy is used for kidney stones but it's also been applied to the problem of heel spurs and sometimes with good results. And you sound like a pretty resourceful young guy, you can probably look that up on the internet and that's one of the therapies that can make a difference.
The other things that I find beneficial are a couple of different nutrients. Glucosamine sulfate can make a difference, also fish oil can make a difference. So these things don't work instantaneously but over three to six months you can see a reduction in the seriousness of heel spurs. Also avoid heavy impact like jogging on hard surfaces, this is an endemic problem in athletes but using judicious methods physical therapy can help to gently stretch the tendons so the pain is alleviated.
This can make a difference but hey, if the problem persists, do see a doctor, get at least a diagnosis so we know what we're dealing with.

CALLER: I have a question regarding my son. I'll give you a quick heads up, he's on dialysis, he's 24 and he's experiencing tremors. It has been diagnosed as restless leg and more recently he's had just had some seizures which he's never before. We're trying to look at anything that we could do to help him.
DR. HOFFMAN: Dialysis is complicated, there is a real potential -- first of all, when you are under dialysis it means that you've got some pretty serious kidney problems that prompted kidney failure. So right there, there are some concerns.
He's probably on multiple medications so right there, it's not your average patient with restless leg syndrome. Sometimes it's hard to tease all these influences apart. But let's look at just the nutritional influences on restless leg. Deficiencies of iron is the main theme in restless leg syndrome.
Now you have to be careful for a dialysis patient with iron because without the ability to naturally eliminate, things build up. But it is possible that your son is iron deficient, it just needs to be tested. If he is iron deficient then iron supplementation can be undertaken, but not without testing. You can't just willy-nilly dish any kind of nutrient to someone who is on dialysis because you have to be careful, things accumulate.
Well a couple of things that can make a difference and generally are low in dialysis, are carnitine and CoQ10 . They're good bets because they're often extremely depleted in dialysis patients and many patients feel better. Restless legs and muscle tremors -- these are neurological and musculoskeletal things that really are influenced by levels of CoQ10 and carnitine.
You can make a plausible story that deficiencies of these key nutrients could make a difference. Check magnesium levels but magnesium is something that you have to be very careful with in dialysis because it's usually in excess. Low levels of magnesium in ordinary people cause muscle spasm. Right after dialysis he might be depleted in magnesium because dialysis pulls a lot of useful things out as well as toxic elements in the blood.
So it's worth studying this problem. I hope that your son improves soon and that he's in line for a transplant.

JUNE 19, 2004

DR. HOFFMAN: Vitamin D we think of as the bone vitamin and yes, indeed, it's important for osteoporosis. Interestingly, vitamin D even if it isn't necessary to strengthen your bones also tends to reduce the risk of falls if you're older. Go figure, it seems to work on the brain enhancing balance and coordination and so it may fight bone fractures two ways by strengthening bones and your risk of falling down.
Lots of new information has emerged about vitamin D in the recent months. This year, there were two big articles in the beginning of the year. One suggested that adequate levels of vitamin D could help to prevent multiple sclerosis. It could also help to prevent rheumatoid arthritis.
There have been some articles over the past couple years concerning cancer prevention and vitamin D. We think that that applies to prostate cancer and colon cancer and perhaps breast cancer. And then there's information about vitamin D and cardiovascular risk. Vitamin D seems to reduce insulin resistance. People who are overweight are often low in vitamin D. Vitamin D may help to regulate blood pressure and blood sugar, reducing the risks of type one and type two diabetes, it just keeps going on and on.
And now, here comes news that our kids may be in trouble when it comes to vitamin D. This is from this month's edition of the Archives of Pediatrics and Adolescent Medicine and it underscores something that we've been talking about for a long time on this program -- yeah, we told you so as usual, we were here first with this story.
The study finds many kids deficient in vitamin D and, yes, that's where it starts, it starts it childhood. Because the diseases that our country will confront in the 21st century have a lot to do with the circumstances under which we're raising kids in the beginning of this new century. Vitamin D may be a common but unrecognized problem among U.S. adolescents, new study findings suggest.
Researchers found that among 11 to 18 year olds living in Boston -- that is a high latitude city, maybe that's not the case in Miami but it could easily be the case in Minneapolis, Chicago, Seattle and all across the temperate part of the United States where winters are long and kids don't get exposed to sunlight.
Among 11 to 18 year olds living in Boston, nearly one quarter were deficient in vitamin D. That may influence their bone strength, it also may influence a variety of debilitating diseases. The reason for this, well, kids are increasingly staying out of the sun, we're protecting them from the sun. There's a campaign to reduce the incidence of skin cancer and that's good. But also, kids are increasingly filling up on soft drinks at the expense of milk and they spend more time indoors in front of the TV or computer than outdoors.
The problem is especially likely to occur in darker skin children, children of African American or Hispanic background because, for some of them, there's less of a premium of baking in the sun. Their skin is dark anyway and there's less of a tendency to bake vitamin D in your skin, if your skin is dark. Dark skin is nature's answer to SPF, it protects the skin from the rays of the sun but it also reduces the ability of the skin to make vitamin D.
The findings are published in the Archives of Pediatrics and Adolescent Medicine. They found that 24 percent of the kids were vitamin D deficient and nearly five percent were severely deficient. 36 percent of African American adolescents had vitamin D deficiency. They're saying here, a high rate of deficiency among healthy adults in this study suggest screening as something we need to look at and that's something I do in virtually every patient who comes to see me. Vitamin D, ultra important in your health, easy to check for, easy to fix with supplements or additional exposure to sunlight.

DR. HOFFMAN: This is the result of a survey conducted by Merck, a major pharmaceutical company. A new survey by Merck shows doctors don't provide older adults with adequate information on diet and exercise. The new survey shows that older adults may not be receiving the information on diet and exercise they need from their doctors to promote healthy aging.
Merck found that half of adults 65 and older who were questioned say that they would eat healthier if their doctors told them how. For adults 75 and older, the figure jumped to 57 percent. African Americans most strongly agreed with 67 percent saying that they would eat healthier if told by their doctors.
I think maybe there's some unconscious racism at work here because doctors may tend to see African American patients, stereotype them as poor, less resourceful, less interested in improving their lifestyle. It's actually the contrary. They're more zealous than non-African Americans about obtaining this kind of information. 42 percent of those surveyed say that they would exercise more if a doctor simply told them what to do.
Again, African American respondents lead the pack. The figure increased to 60 percent and yet they're not getting the advice they need. This just reassures me that what I'm doing in my practice is the right thing because we focus on diet and exercise and try to be a role model as well in terms of things that I do so that I can talk to my patients about these crucial issues.
Patients want to talk about this stuff, all too often doctors draw a blank.

DR. HOFFMAN: Many of you are familiar with the yeast connection, candida, based on books by individuals like Dr. William Crook who began writing about this in the 1980s. Many radio hosts on programs like this talk about candida. We get lots of calls about the yeast connection. But for many conventional physicians, this is a murky area, an area of controversy and it is thought to be a little fringy, not too factual, an area that has been exaggerated or made up.
But I want you to pay close attention to this next feature because it's based on research by doctors at the University of Michigan Medical School just presented at the American Society for Microbiology. Now, this is not a very holistic or complementary conference. This is a bunch of researchers who look at the effects of microbes on the body. And they're suggesting here that the yeast connection is more than just an old wives tale or a trendy panacea from the world of complementary medicine.
The article talks about the relationship between allergies and growth of yeast in the intestinal tract. And it starts out: "Allergies making your life miserable? Tired of popping antihistamines like candy? Can't go anywhere without your inhaler? The real problem may not be your stuffed up head, it could be the microbes in your gut."
This is according to scientists from the University of Michigan Medical School presenting the American Society of Microbiology. They say, a guy who is one of the lead researchers here is Dr. Gary Huffnagle. He's an associate professor of internal medicine and microbiology and immunology. He says we all have a unique microbial fingerprint. It's a specific mix of bacteria and fungi living in our stomach and intestines. And I'll point out to you that there are more of these in each and every one of your intestines than there are stars in the sky. You've got an entire world in there.
And Huffnagle continues, "antibiotics knock out bacteria in the gut allowing fungi to take over temporarily until the bacteria grow back after the antibiotics are stopped". We spoke to a listener on last night's weeknight edition of Health Talk who described a situation with her grandmother. Her grandmother went into the hospital for hip replacement, was given antibiotics and ended up having her colon removed because of the devastating effects of the antibiotics on the colon when probiotics weren't given to protect the colon from overgrowth by harmful bacteria.
So the article continues, żour research indicates that altering intestinal microflora -- that's another word for bacteria -- and fungus this way can lead to changes in the entire immune symptoms elsewhere in the body. What are those symptoms? Well, they could be inflammatory skin conditions, like psoriasis and eczema. They could be things like sinus congestion, asthma.They could be brain fog, they could be body aches and muscle aches and arthritic symptoms.
Huffnagle believes his research findings could help explain why cases of chronic inflammatory diseases like asthma and allergies have been increasing rapidly over the last 40 years, a time period that just so happens to correspond with widespread introduction of antibiotics.
And he goes on with a scientific explanation here that suggests that there is cross-talk, there's kind of a communication system between the bacteria that are normally present in your intestinal tract and your immune system. And when your normal flora get knocked out and harmful bacteria and yeast take over that communication, that cross-talk changes, ultimately changing your entire immune response.
They demonstrate this with a simple experiment. They gave a five-day course of oral antibiotics to normal lab mice and then they introduced some yeast, candida albicans, into the intestines of the mice who had been treated with antibiotics. And what they found was that after stopping the antibiotics upon exposure of the mice to a common mold allergen called "aspergillus", the mice had much stronger long responses to the aspergillus compared with mice that didn't receive antibiotics. And the inflammatory response grew stronger with every new exposure to the allergen.
After antibiotics change the mix of microbes in the GI tract, the mice developed an allergic response in the lungs when exposed to common mold spores. It's not like there was yeast in their lungs, the lungs being the place of strong immune response were more sensitized to things that ordinarily the lungs would say, "no problem". But after exposure to antibiotics and yeast, the lungs became sensitized. Mice that didn't receive the antibiotics were able to fight off the mold spores and had less of a serious reaction.
So this should lend credence, should spur additional research into the yeast connection which, I have to say, completely revolutionized the way I practice medicine. I first heard about this -- I was just entering the field of medicine in the early 1980s and I said, this is amazing. This is going to turn everything around because it calls into question a lot of the things that we do. We fluorinate and chlorinate our water, which changes our intestinal flora. We give babies and kids antibiotics like M&M's. We don't breastfeed our kids, thus setting up abnormal immunity in the gastrointestinal tract. And we consume enormous amounts of sugar and refined carbohydrates, feeding yeast.
And then once we turn into teenagers we start boozing it up, drinking lots of alcohol which promotes the growth of yeast. And then we take immune suppressant medications like steroids and other powerful medications which even further encourages the proliferation of yeast in our gastrointestinal tract sending our immune systems into a tailspin.
This is a revolutionary paradigm and if your physician dismisses it with a raising of an eyebrow or casual flick of his hand, stick to your guns because it's a very important way of regaining wellness if you have a variety of allergic and immune complaints.

DR. HOFFMAN: Lots of us get our oil checked in our cars when we go to the gas station but maybe you didn't realize how important it is to get your oil checked for your health in general when you go to the doctor's office.
Recently, we have emphasized a linkage between cardiovascular risk and something called your omega ratio. Your omega ratio is the ratio of omega-3 fats that are present in your cells. It turns out that this ratio is more important than your cholesterol, your HDL, your LDL, your homocystine, your LP(a), your C-Reactive protein, all kinds of alphabet soup. All these factors are looked at intensively when we're trying to decide whether people are at risk for heart attack or stroke.
It turns out that the amount of omega-3 fatty acids in your cells is of paramount importance. And now, a new decision has been reached by the Food and Drug Administration to permit nutrient content claims for foods rich in specific omega-3 fatty acids for reduced risk of some cancers. The American Institute for Cancer Research applauded the decision by the Food and Drug Administration to permit nutrient content claims for foods rich in specific omega-3 fatty acids.
Cancer experts said that even though many Americans have cut back on fat, the relative amount of two specific kinds of fat in the typical diet remains out of whack and unhealthy. What they're talking about is the omega-3, omega-6 ratio.
Omega-6 fatty acids are plentiful in the American diet. They're found in vegetable oils such as corn, safflower, sunflower and soybean oil. They're often used in processed snacks, baked products and commercial salad dressings. We get plenty of those, too much.
But there's not enough omega-3 fats, found mostly in fatty fish like salmon, sardines, trout and herring also in canola oil, flax seed, green-leafy vegetables and walnuts. And the ratio of the 6 to 3 is an important determinant in your cancer risk. It's been shown to provide prognostication in terms of risk of breast cancer, prostate cancer and colon cancer as well as heart disease and other inflammatory conditions such as arthritis.
So make sure you get your oil checked, it could mean freedom from a variety of diseases.

DR. HOFFMAN: Now lots of you take tests and evaluations. You've had your IQ tested. You probably have had various academic tests like LSATs, MCATs, SATs. All kinds of evaluations have been performed on you and you kind of know where you stand.
But according to a new meeting of the American Endocrine Society -- they just held their annual meeting this week -- women may want to get an LQ. They may want to check their libido quotient, assess their potential for normal desire, arousal and sexual responsiveness with a simple blood test that is routinely offered in doctors offices.
Now, some of you smart and astute listeners may be saying, yeah, it's testosterone. Testosterone is the thing that makes the world go 'round but -- well, it does for men. But according to this new research, it doesn't play that much of a role for women. The test that tends to reveal most about the potential for sexual dysfunction in women is actually a test called DHEA sulfate. It's a test that we've been running routinely for the past fifteen years or so on both men and women to assess their levels of this important youth hormone.
It turns out that there was a strong relationship between low scores of DHEA-S and desire, arousal and responsiveness in women under 45. And it suggests -- although they're not ready to make the suggestion because they're a very conservative organization -- but it suggests, and in my experience it has been the case, there's really very little that acts as a female equivalent to Viagra and Cialis and Levitra -- those drugs don't really work for women because the sexual response is not a matter of hydraulics or blood flow it's a matter of desire. And sexual response occurs more in the brain than in the genitals.
It's true that the brain is the major sex organ of, especially the female and low levels of DHEA may predict a low level of interest in response. These levels have to be measured No, don't go down to the health food store where DHEA is legal over the counter and take a whole bunch of DHEA in hopes that it's going to restore your flagging sexual desire.
But do check with a physician who is familiar with measuring, replacing and monitoring levels of DHEA if this is an issue for you because it's one of the few known ways of turning things around in that department for women.
This happens to be in the same week that a study came out suggesting that testosterone is beneficial for women's sex drives but only in the case of women who have had a total hysterectomy where their ovaries have been taken out. We've known that for a while that hormone replacement for women who have had hysterectomy should include testosterone because it cannot only support sex drive and libido but it also improves mood, drive, energy, focus, concentration, muscle tone and is especially important if you have had a hysterectomy with the ovaries being removed.
So, think DHEA in terms of the women's equivalent of the popular male disorder, erectile dysfunction.

As much as I hate to admit it, the news just keeps on rolling in about the benefits of statin drugs. This week's edition of the Lancet has to do with the world's most popular statin drug, Lipitor. There are some studies that suggest that statin drugs may even reduce the risk of certain cancers.
Here's yet another disease, it's rheumatoid arthritis. According to a study in great Britain, researchers found that taking Lipitor reduced the risk of rheumatoid arthritis. In fact, these patients already had rheumatoid arthritis and Lipitor lead to significant improvement in disease activity and the reason is because it's an anti-inflammator. What they're suggesting is that it fights C-Reactive protein and other pro-inflammatory factors in your system and that may be why it also has the benefits in terms of cancer and multiple sclerosis.
And other conditions may stand to benefit from statin therapy that is if you don't get side effects, which unfortunately, are all too common.

DR. HOFFMAN: Something to consider this summer is that with warmer weather consumption of carbonated drinks is going to go up, especially sweetened sodas and a new feature of the market are those sweetened iced teas that are so popular.
This is not news but I think there are some surprising conclusions here. These beverages can eat away at your enamel, the protective shell around teeth, and there are some surprises here because I always thought that colas were the worst.
But it turns out that non-colas and canned iced tea were especially harmful. They contain flavor additives such as malic, tartaric and other organic acids that are more aggressive at eroding tooth enamel.
The suggestion is that if you use these beverages soda drinkers should rinse their mouth out with water after drinking and or use tooth paste and stop sipping at work. A person who consumes three to four 32-ounce beverages per day while working at a computer terminal recently developed rampant dental decay.
CALLER: I'm 43 years old, I have an 18 month old and a 6 year old. I'm starting to experience symptoms of perimenopause, I'm having problems sleeping, I get up at three o'clock in the morning and can't go back to sleep. I have night sweats, and mood swings. I can't take any kind of hormone replacement therapy because my mom has had cancer, breast cancer, twice.
DR. HOFFMAN: black cohosh is helpful. There's an herb called chasteberry or vitex that can be helpful. You may also want to use a simple strategy of keeping your blood sugar stable because there's a strong interrelationship between hot flashes and hypoglycemia. Eating a diet like the Salad and Salmon Diet to stabilize your blood sugar would be helpful.
Also, we've been doing some good work with patients using neurotransmitter support. They now prescribe Prozac and SSRI medication for women going through menopause. We feel that supporting levels of serotonin in the brain with things like B6 and 5-HTP we can help women make it through menopause with minimal trouble.

CALLER: I have a very inflammatory type of arthritis, namely psoriatic arthritis, and I found that of all the anti-inflammatories, that I do best on ibuprofen. However, my question is -- also I take aspirin for the heart benefits for the thinning of the blood.
Now, a recent report came out that ibuprofen interferes with the --
DR. HOFFMAN: -- heart benefits of aspirin.
CALLER: Right, right. Now my question is: If I space it, let's say by five or six hours, would that be all right?
DR. HOFFMAN: I'm not sure because both of them are anti-inflammatory. Both of them actually have some blood thinning effects. But for some reason, ibuprofen has not been found to be a prophylaxis against heart attack -- that's a preventive drug.
And in fact, there's recently been some concern about one anti-inflammatory in particular, it's the anti-inflammatory Vioxx as being something that may actually somewhat increase the risk of cardiovascular problems. And that's a big problem for the makers of Vioxx, they thought it was going to trump aspirin and all the other nonsteroidal anti-inflammatory drugs. And now, it turns out to be not that heart healthy.
So other things you can do, you can use other cardiovascular preventives. Why not use a little garlic extract Kyolic, use fish oil . Use some additional vitamin E . These things are circulatory enhancers. You may consider taking a little bit of EGCG which has wonderful anti-inflammatory effects, it can kill two birds with one stone -- help your arthritis as well as protect your heart.
I think these approaches are worthwhile.

CALLER: My mother had a blood screening and her lymphocytes were low, out of range at 9.
DR. HOFFMAN: How old is she?
CALLER: 85.
DR. HOFFMAN: And that's real common around that age. People's immune systems do get a little weak. We usually consider 1200 lymphocytes to be the optimal number, 900 is not too bad.
There are actually millions of these disease fighting white blood cells in your system and they fight viruses and they fight cancer. They are a type of lymphocytes called "natural killer cells" and their name is pretty apt because what they do is hunt down and destroy pathogens that are trying to invade the body. You can build up your lymphocyte count with immune stimulating things like selenium, vitamin E , zinc . Many older people are deficient in these things and they don't absorb that well.
Also, you may want to consider something like -- we use a product called Immpower which contains AHCC. AHCC is a nutritional supplement popular in Japan that supports your body's natural defense mechanisms. Clinical trials show that AHCC may play a significant role in increasing levels of various immune cells including natural killer cells.
And so these are some ways that we support people who have lowered immunity. And clearly, immunity is a big issue at 85 when people become more vulnerable to infections.

CALLER: I'm 85 years old and my homocysteine for the last two years has been around 12, 13.
DR. HOFFMAN: That's not terrible.
CALLER: Well, I'm taking up to 3mg. folic acid, B12, B6, TMG.
DR. HOFFMAN: You're doing all the right things. Let me just say that homocysteine is a risk factor for cardiovascular disease, perhaps stroke, blood clots and generally we like to get it under 10 but I would settle for 13 especially if we are doing everything we can.
I do have some patients who it's very hard to get it to single digits even though we use high doses of folic acid, B12, B6 and trimethyglycine as you're using. We use a product called Homocystrol +TMG
One problem that sometimes gets in the way of optimizing homocysteine is undiagnosed hypothyroidism. Low thyroid will sometimes keep your homocysteine on the high side. But I don't think you're going to come to great harm with a homocysteine of 13 and particularly, I'm encouraged by the fact that you're 85 and you remain quite healthy.
So whatever downside that homocysteine had, it hasn't resulted in premature cardiovascular disease, stroke or blood clots for you, and that's good news. CALLER: My mother suffers from grand mal seizures and I am calling you for nutritional information.
DR. HOFFMAN: I don't know what to tell you because grand mal seizures are a bad thing and there are many different things that can cause them. They can be caused by head injuries, brain tumors, aftermath of brain surgery. They can be due to funny brain circuitry which causes sort of a brain arrhythmia -- just like the heart may have an arrhythmia. I'm going to say some things in general to you.
Keeping blood sugar stable is one of the most important principles of management -- nutritional management of patients with seizures. We want to clearly put her on a diet where hyperglycemia is not an issue. Also, taurine and manganese may play a role in stabilizing brain waves?. We like to use essential fatty acids like fish oil .
But the suggestion is that by normalizing the level of essential fatty acids in the brain, we may actually get some anti-seizure activity. There's even a proposition that people who have uncontrollable seizures are sometimes put on an ultra-orthodox Atkins-type diet where they virtually consume no carbohydrates. It's called the ketogenic diet. That would have warmed the cockles of Bob Atkins heart because that's what he believed in as a principle of weight loss.
But here, where you have virtually no carbs, the body goes into starvation mode, the brain no longer requires glucose and switches its metabolism to ketones. And steady levels of ketones seem to reduce the ups and downs that the brain is subject to when blood sugar is the preferred fuel. And sometimes that helps. But in an older person who may be nutritionally compromised, I would say that would be kind of a radical approach. They sometimes do it in kids with serious seizure problems but it's not to be lightly undertaken because it's a very, very demanding dietary regimen.

CALLER: I have a chronic yeast infection.
DR. HOFFMAN: How old are you?
CALLER: 58.
DR. HOFFMAN: It's important to note whether you're premenopausal or postmenopausal because it means different things in the different age groups. You're sure, first of all, that this is a yeast infection -- your gynecologist is saying this is candida or yeast infection?
CALLER: Yes.
DR. HOFFMAN: Well, I would be concerned about two things. I would say either something is wrong with your immunity or something is wrong with your blood sugar because women past menopause, unless they're taking hormones, should be less prone to yeast infections. So which is it with you, have you had your blood sugar tested?
CALLER: No, I have not.
DR. HOFFMAN: If you were my patient I wo