Posted by: Christopher Maloney, Naturopathic Doctor | July 14, 2014

Barefoot Running And Reality Meet?

Thanks to books like Christopher McDougall’s Born to Run, barefoot running has become the extreme sport of the middle-aged set. Like free rock climbing, only on solid ground. All you need to do is not wear your running shoes.

Truthfully, I think barefoot running owes much of its appeal to its naughtiness. Running around without your shoes is exactly what mother told you not to do. So now we have these waif thin extreme runners recommending that you throw caution to the wind and go out into the world with –gasp- naked feet.

So you go out, and use proper bouncing technique. It’s more like prancing than running, really. Put in a couple of miles, and you might fool yourself into thinking you’ve gone caveman at last. Break out the spear and fur loincloth.

But then, it all comes crashing down. My personal downfall was not glass or any debris of civilization. It was a pile needle cluster, structured like a

caltrop

caltrop for the unwary running. One second I was booking down a path, the next I was hunched over wiping blood off my foot and thinking “mom was right.”

Mom was right. Barefoot running is the sort of sport that leaves the legions of duffers in the dust. Unless your feet have the texture and thickness of a shoe sole, take a tip from one more of the walking wounded and wear shoes.

Posted by: Christopher Maloney, Naturopathic Doctor | June 27, 2014

Does Your Doctor Get The Training To Treat Obesity?

The trend toward obesity is increasing. Family doctors are expected to be on the front lines, counseling patients on how to live healthier lives. But many of those doctors are not taking up the challenge. A recent Washington Post article states that only one in eight office visits have any discussion of diet or nutrition.

Why? Many doctors are themselves overweight or obese. They aren’t able to control their own weights, so it is difficult to counsel others to do better than they do themselves.

Were doctors trained in obesity? Only 25% believe that they have sufficient training to talk to patients about exercise or diet. In response, the number of hours devoted to teaching doctors about nutrition has declined in the last ten years.

So let’s recap. We have an epidemic and we have doctors. The doctors are under trained, don’t feel ready, and mostly avoid talking about the epidemic. The training they receive has declined rather than increasing.

Does anyone feel positive about this situation? What if we added to the mix that at this rate one in four Americans will be diabetic, and that a single diabetic costs the healthcare system on average more than a million dollars in his or her lifetime.

It isn’t that we spend so much on healthcare that is the most frustrating. It’s that no one seems to be able to do the math on where our healthcare billions would be best spent.

Some are bucking the trend. Tom Bartol here in Maine instituted a positive reinforcement system (office wide applause) for weight loss. He has been amazingly effective using a little ingenuity at no increased cost. Is it time to have professional nutrition inspectors the same way we have hand washing inspectors in the major hospitals? What you measure gets managed, and we aren’t currently managing our national weight.

If you want to start comparing how we’re doing compared to the rest of the world, have a look at the body weight scales at Wikipedia. Hint: we’re not competitive.

Posted by: Christopher Maloney, Naturopathic Doctor | June 26, 2014

Do You Have Lyme Disease? How Would You Know?

Lyme disease is endemic in Maine. That means anyone can get it any time they go outside or  their animals go outside and come back inside.

If you are fortunate enough to see a tick on you and develop a bull-eye rash, then it’s likely you’ll get at least a round of antibiotics. If you don’t be prepared for an interesting trip down the rabbit hole.

For the uninitiated, Lyme disease has divided conventional doctors. Some fall into the “antibiotics until they are well” camp (I’m sort of here, because I hate suffering) and the “there’s no such thing as chronic lyme” camp.

Now, you’d think the two camps would eventually resolve. But they aren’t. It’s gotten to a point that they have their own labs. In a recent study, the major lab for the antibiotics forever crowd got panned by the other side. “Serological tests came back positive in 91% of cases from the (pro-chronic lyme lab) versus 8% of cases from the (no-chronic lyme lab).” (study here)

So that’s the end of that lab, right? Nope. Because there’s a new form of Lyme coming along, Borrelia miyamotoi sensu lato. Yep. It’s a mouthful, and the regular testing and testing for the regular species is not going to give you an accurate diagnosis.  So it’s back to the drawing board for who’s right about how much Lyme is around and how long it should be treated.

Posted by: Christopher Maloney, Naturopathic Doctor | June 23, 2014

Should You Get Tested For Vitamin D? Panel Says No.

In a strange ruling, the U.S. Preventative Services Task Force now says not all Americans should be tested for low vitamin D levels. (NYT article here)

They agreed that most people are deficient. But they didn’t think the testing was very accurate, that different ethnic groups needed different levels, and that they weren’t sure supplementing with vitamin D did that much good.

Vitamin D deficiency isn’t harmless. “People with low vitamin D levels were more likely to die from cancer, heart disease and to suffer from other illnesses.” One study found people that used vitamin D had lower death rates across the board. But another one didn’t find that it made much difference.

Here in Maine, I’ve always thought testing for vitamin D was a bit foolish. Most Mainers are going to be short on vitamin D come March, and probably have too much of it come August. So unless you’re a snowbird, I think having a little in the winter months seems wise.

Posted by: Christopher Maloney, Naturopathic Doctor | June 5, 2014

Will Dr. Oz’s Hay Fever Diet Save You From Allergies?

 

When the Huffington Post gives Dr. Oz space to promote a new allergy relieving diet, I’m immediately interested.

So,  what are these amazing allergy relieving foods?

Here’s a summary of Dr.Oz’s hay fever preventing diet:

Breakfast omelet with asparagus and onions with rosmarinic acid (rosemary or sage) or oatmeal (avenanthramides)

Lunch kale salad (full of quercetin blocking histamine release) Or chicken salad with grapes and ginger

Snack carrots (carotenoids less hay fever) Or green tea (with ECGC blocking hay fever)

Dinner soup and grilled cheese (Aged cheeses high in dietary histamine.) Or fish and veggies (high intakes of vitamin e plus omega-3 may have a protective effect against hay fever)

So, how do we judge the effect of this diet? 

Normally I’d go through each of Dr. Oz’s claims and look at the evidence, but what immediately struck me is that while his additives may be histamine-blocking, his ingredients might be making things worse!

First off, eggs are one of the most common allergens. Allergic responses can occur immediately, after two hours, in twelve hours, or in twenty-four hours. If you are allergic to eggs a skin prick test is not definitive, you need a blood draw. (study here)

But what about the rest? Well, it turns out that they’re not allergy relieving. Dr. Oz manages to give us four of the top allergy causing foods in his one day diet. The top allergens include: milk, eggs, wheat, soybeans, beef, pork, and chicken.

So I have to pan this diet because it doesn’t meet the straight-face test for ingredients. Dr. Oz would have done better to recommend his condiments: rosemary, ginger, and grapes, be added to an elimination diet. That might help a little with allergies.

Those with children would be far better to do an elimination diet, that helps in 90% of cases. (study here)

Here’s a variation on the elimination diet I wrote up for my patients.

Those who would like to reduce their allergies might try sublingual therapy, which is generally nicer that getting the shots and better than antihistamines. (study here

Posted by: Christopher Maloney, Naturopathic Doctor | June 2, 2014

How Long Do Prescriptions Last?

First, a word of warning. If you get your prescriptions wet or store them on the windowsill, then all bets are off. The water or the sunlight will alter the prescriptions and make them much less effective.

Also, if you notice that your prescriptions have changed color or altered in consistency, I would bring them back to the pharmacist to make sure there isn’t something wrong with them. If, in the rare case they’ve changed color or shape coming from the pharmacy, take them back immediately! While multiple safeguards are in place, mistakes can happen.

So,Chances are pretty good that it is still fine. But how much longer than the expiration date is it “safe” to take a drug?

We don’t know. The manufacturers and the pharmacists are going to be very conservative with their estimates. They suffer if something isn’t effective, and they benefit when patients buy more drugs.

So no one is checking to see if consumer drugs are still safe after the expiration date. We do have information about government depots of drugs. Those drugs last well beyond the expiration date, “by an average of 57 months.” For those of you doing the math, that’s almost five years after the expiration date on the label. (Thanks to the Post-Gazette article covering this in depth).

But this information, the best available, hasn’t filtered down to even Consumer Reports. The medical head there gives a blanket recommendation to throw away all medication a year after expiration, and says that expired tetracycline can do kidney damage. (Con Rep here).

Ok, so if that is the case, let’s look for the medline citation on that effect. We come up with one report of kidney toxicity linked to tetracycline, from 1966! Yikes! (citation here). The studies since then indicate that tetracycline itself can be toxic to the kidneys, whether or not it is expired. (2002 study here) So there isn’t sufficient evidence to discard that prescription either.

What is a consumer to do? Start by getting smaller prescriptions for anything you get PRN (take as needed). Don’t keep the medications around unless you need them. But then keep them dry and safe, and discard them the same way you would a spice or something else that can keep, but may lose potency over time. Use the expiration date as an indicator, but not necessarily the last word on when things should go.

 

Posted by: Christopher Maloney, Naturopathic Doctor | May 27, 2014

Can Young Blood Reverse Aging? Did the vampires have it right all along?

A couple of weeks back I read about age reversal. A mouse study showed that aging mice reversed aging when given young mouse blood.

While the author, Alan Caron, sees this as a heralding moment in the future of humankind, there are darker implications.

Are we going to start up blood banks of the young for the old? Should we start putting ages on donated blood? (Because younger mice aged when given older mouse blood). Are we even going to see human blood on the health food menu or stocked on the fitness store shelves anytime soon?

Truly, I will be as thrilled as the next person to reverse aging. I just thought it will come as a pill, not as a horror movie drink.

To be fair, the researchers immediately isolated out a specific part of the blood that reversed aging. The protein, protein growth differentiation factor 11 (GDF11), is the part that reverses aging. And that factor is only specific to the rejuvenation of skeletal muscle, not the whole system. (study here).

But isn’t this a ground-breaking, earth-shattering announcement? Let me rewind the clock to 1978, when we had a study that says: “A single administration of….–a non-toxic, non-specific stimulant of the host defense system–partly compensates the age-determined suppression of the humoral, immune response.” (study here) The miraculous supplement? Coenzyme Q10, both popular and expensive today, but not age-reversing.

If you type in a search for mouse and age reversal, there have been more than a hundred mouse studies that show age reversal for a variety of organs, but translating that reversal to humans is harder than it sounds.

Let’s look a little more closely at our miracle protein of the day, GDF 11.

It is a “regulator of cell growth and differentiation in both embryonic and adult tissues.” (here) It shares that title with a lot of other proteins, but tends to dominate. It also tends to suppress, or block brain cell movement. So while it may be great for the skeletal muscle, you might be losing brain cells every time you take it.

Here’s the medicalese: researchers have shown “GDF11 to be a master regulator of neural stem cell transcription that can suppress cell proliferation and migration by regulating the expression of numerous genes involved in both these processes, and by suppressing transcriptional responses to factors that normally promote proliferation and/or migration.” (here)

So no, I don’t think going vampire is going to be a cure for the near future. I’m also not that excited about GDF11 when you see it on the supplement shelves. I’d steer clear of this one until we get some more information on long-term brain effects.

Posted by: Christopher Maloney, Naturopathic Doctor | May 24, 2014

Should Cancer Patients Avoid All Sugar?

In the realm of studies that I haven’t quite got my mind around, Colleen Huber’s study on cancer and sugar is right up there.

Here’s the situation. Dr. Huber works with cancer patients. They do conventional and alternative therapies. She recommends that they don’t eat too much sugar, or really any sugared foods at all. Some of the patients follow her recommendations, and some don’t. She doesn’t force the issue, but she was curious whether that particular restriction made any difference.

When she looked at the literature, no one has done this sort of study. In all the vast research on cancer, the idea that cancer might be affected by what you eat while trying to treat cancer is missing.

So Dr. Huber followed up on whether eating sweets made any difference in cancer remission for 317 patients. 48% of those avoiding sugar had remissions, compared to 31% in those who ate sugar. It’s a significant difference, enough to make a billion dollars for a cancer drug. But it’s maybe not enough to convince a chocoholic that they should abstain from sugar.

Patients who leave a practice may not be following a range of other recommendations besides avoiding sweets. So Dr. Huber looked at the patients who stayed with her right through to the end of their treatment or death, whichever came first. For those patients who stayed with her and did everything else she recommended, but still ate sugar, the remission rate was 36%. But in the group that did everything she asked, including stopping sweets, the remission rate rose to 83%.  Only 17% of those who stopped eating sugar died while under Dr. Huber’s care, while 64% of those patients who were doing everything for their health, except stopping sugar, died.

That’s what I can’t get my head around. If this is the largest study of its kind, then we are literally ignoring the biggest cause, not of cancer, but of the progression of cancer.

Cancer cells are rapidly dividing cells, they require an enormous amount of energy. They need so much energy that one of the hallmarks of cancer is sudden unexplained weight loss as the cancer consumes body tissues to fuel its own growth. Add into that mix either no rapid calories or thousands of calories of readily absorbed sugar over a given month, and it seems obvious that sugar might play a role in the growth of cancer. But if Dr. Huber’s study is correct, sugar intake is a primary factor, if not the greatest factor, in cancer progression.

As I said, I’m having trouble coming to terms with the idea. I’d love to see a large scale trial, perhaps an experimental trial from within the cancer groups that don’t have ready treatments. Because if this is right, then we’re missing the boat on the best treatment for cancer.

Here’s the original study.

 

 

Posted by: Christopher Maloney, Naturopathic Doctor | May 16, 2014

What is MERS?

When you hear about a terrible killing disease that passes from person to person, it is reasonable to wonder what it is. I’m not someone who just believes the standard line that MERS isn’t that infectious. But I’m not sure it’s that deadly either.

Time’s take on MERS.

According to the official report, you need to have direct contact with an infected person, such as caring for them. But neither U.S. traveler was likely to be a caregiver of someone in the middle east. One of them was in Florida, and the other in Indiana. They were on plane flights with hundreds of other people before they disembarked. In order to avoid a panic, the CDC is not publicly telling everyone on their flight patterns to be checked. Here’s the CDC preliminary report from this month (here).

Researchers, “found a small but real risk of spread from those infected during flight. The risk ranged from one new infection in a five-hour flight in first class, to 15 infections from a “superspreader” (a highly contagious carrier) travelling 13 hours in economy. Those infected would probably show no signs when disembarking, says Brian Coburn, a postdoctoral fellow at the Centre for Biomedical Modeling at the University of California Los Angeles. ‘These newly infected individuals may be difficult to identify and could cause new outbreaks.’”(quote from CMAJ article by Carolyn Brown)

In Jordan, the deaths of two patients sent them looking for MERS-CoV and they then found it in seven other people, including six hospital workers. Without deaths, the testing would not have been done. That hospital found a 10% infection rate and a 22% fatality rate (here).

The official Lancet report lists 261 confirmed cases and 93 deaths, with the source and origin of the MERS cornavirus remaining unknown (here).

While Time mentions MERS and SARS in the same breath, the experts say this isn’t the same level of infection risk. The virus is widespread in camels, and doesn’t attack humans in the same way.

But the virus started spreading rapidly in April, and most of those transmissions were human-to-human. So a camel epidemic may have mutated to possible human-to-human one. The cornavirus  is very good at mutating rapidly to adapt to its hosts.

Unlike what you would think, people who spend a lot of time around camels aren’t getting infected. In testing, 74% of the camels tested positive for the virus.

So is this a new virus? “It may well be that MERS occurred much earlier than 2012 in humans, but was not recognized,” says Dr. Fontanet and his research team. (CMAJ article)

Anyone who has forgotten the avian flu should have a look at the extraordinary death rate associated with that particular virus. Yet we have yet to see the expected pandemic from that virus sweep the globe. Here is my tongue-in-cheek run up on that particular pandemic. Pardon the website, it’s not my forte.

Posted by: Christopher Maloney, Naturopathic Doctor | May 16, 2014

Your Hormonal Gut: Can Bile Trigger Weight Loss and Cholesterol Lowering?

If you’ve followed me at all, you know I’m all about hormones and weight loss. Going simply with calories in/calories out oversimplifies to the point of being just wrong.

We have a new study examining the effects of bile on bacteria growth. In mice, Drs. Gahan and Joyce found that a bacterial protein modifies the bile salts in the gut. The effect? “specifically increasing levels of this protein reduces serum cholesterol levels and weight gain.”

The next step is to work on human trials, but clearly the effects of the bacteria in our gut are highly under-appreciated. Gone are the days when a broad-spectrum antibiotic should be given without at least a course of yogurt or sauerkraut afterward. But instead we see the growth of MRSA, as careless practitioners prescribe one without the other, leaving a vacuum in the lower intestines likely to be filled by the latest hospital bacteria du jour.

Interestingly, we will see what the shift to easy gall bladder surgeries does to the interaction between bacteria and bile salts. Less bile, less effect, and more weight gain? Only time will tell.

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