Posted by: Christopher Maloney, Naturopathic Doctor | August 29, 2014

Who Is Responsible For Your Healthcare?

In an age where medical doctors tend to migrate around and patients don’t have the luxury of a lifelong relationship, it’s time for patients to get a sense of their own health. Taking simple tests and bringing those tests in to your doctor, is the subject of this inspiring talk by Talitha Williams.

I wish all my patients took the time and effort she did, and managing her own patient data led to less surgery for her and likely to weight loss for her husband.

Here’s the TED talk:

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

Do I Treat Lyme Disease? A Short Lyme Politics Primer.

I just got a simple question in my email: do I treat Lyme Disease? I wish there was a simple answer.


Lyme is one of those political diseases. You know, like Gulf War Syndrome, Multiple Chemical Sensitivity, etc. It shouldn’t be, because we have a clear cause and some decent treatments. But it has become more and more polarized rather than reaching medical consensus.

The process of treating Lyme has fallen into two camps: ILADS vs. the CDC.
At this point, they even have their own labs, with the CDC labs
requiring five genetic markers and IGENX requiring one for a positive test.

I have desperately waited for there to be a middle ground, but the two
groups (M.D.s on both sides) have become more entrenched in their
views rather than less.

On the ILADS side, (which includes most N.D.s), statistically 92% of
patients are diagnosed with Lyme by the lab. The CDC diagnoses around 6%. (see another blog post on this lab result) So as a practitioner, I’m left with patients who either clearly have Lyme or absolutely do not, depending on the lab. Very rarely, I’ve had patients who are clearly positive with the CDC markers, so I have both camps’ blessing to treat.

Now, treatment becomes an issue because ILADS tends to think that
antibiotics are necessary for the rest of your life (I’m paraphrasing,
but that’s the gist). They also throw in anti-parasitics, anti-fungals, the works. According to the CDC, a short course of Doxycycline will do the trick. If someone has continued symptoms according to the CDC, they have a mental illness that gets called Chronic Lyme Syndrome.

The problem I have with treating all the complexities of Lyme is that
I have colleagues who only treat Lyme, and they don’t have many cures.
People get better, but they tend to get better doing the same things I
would use for chronic fatigue, low thyroid, chronic stress, etc. In
other words, once you start treating the whole person, the Lyme
symptoms get better.

So I do treat Lyme, but not in a way that would make either the ILADS
or the CDC groups happy. If a patient has not started on Doxycycline
(I always start at 100mg and build up, because it can make people very
sick from the medication). I would start on that immediately. If she’s
miraculously better within four to five days, then Lyme (or
Bartonella, or the other cofactors, they all respond to Doxy) is her
primary problem. If she’s not better, then she’s looking at a fairly
long road, and should consider how much time and energy she wants to
dedicate to chasing Lyme before looking at whether it is Lyme (which
is hard to do, depending on who you believe).

So do I treat Lyme? Yes, I suppose I do. I just wish it was clearer how and when I should treat it.

Posted by: Christopher Maloney, Naturopathic Doctor | August 6, 2014

Is Ebola Caused by Vitamin C Deficiency? Could It Be Blocked By Green Tea?

I got an email asking about whether Ebola is caused by a lack of vitamin C. While enticing, the explanation that the Ebola virus simply drains all the vitamin C out of an individual seems simplistic. The analogy to scurvy, which involves the breakdown of connective tissue over months, doesn’t hold well. But I went looking.

If you look at the cases and treatment of Ebola, blood transfusions from previous patients who have antibodies to the virus beats the heck out of vitamin C transfusions. One infected nurse was treated with “oral rehydration solution, vitamin C, intravenous calcium, and papaverine. On 6 June, the nurse was transfused with 400 cm3 of blood. Two days later, her appetite improved, and the myalgia had disappeared.” If it was caused by Vitamin C depletion, we should have seen improvement following treatment with Vitamin C. The blood of other patients, presumably also depleted of Vitamin C, would have done nothing. Instead, it was their antibodies that saved her. If there are cases that were saved with vitamin C, I couldn’t find them.

Now, since I was looking at simple, household treatments for Ebola, I found this interesting study: “HSPA5 is an essential host factor for Ebola virus infection…using the HSPA5 inhibitor (-)- epigallocatechin gallate (EGCG) … impaired viral replication and protected animals in a lethal infection model.” (study here).

If your brain works like mine does, you’d think: “that compound looks familiar, where have I seen that before?”

Green tea. EGCG makes up almost half of the catechins in green tea. So if they’re right, and HSPA5 is necessary for the Ebola infection to take hold in a host, then drinking green tea might be protective?

What exactly would be the downside to providing healthcare workers with green tea? Or drinking green tea on the plane when traveling?

I wouldn’t go so far as to jump to any conclusions, but if they’re offering green tea in the cockpit service, I might indulge.

Posted by: Christopher Maloney, Naturopathic Doctor | August 3, 2014

Does Manopause Exist? Do You Need Testosterone?

Manopause is the cover of Time this week, but the disease seems to be a little problematic. First, you can’t trust test results (see below), so any analysis of testosterone is in the eye of the clinician. Since prescription of testosterone is being done without FDA approval, there’s clearly a lack of studies on long term outcomes.

While clinicians can point to short term positive effects of testosterone in aging men, studies of younger men with similar symptoms do not show a direct relationship between testosterone and those symptoms.

A study on the effects of testosterone on patients with heart disease shows that those taking testosterone were more likely to have more heart problems. According to a more conservative study, “only 2% of 40- to 80-year-old men have (low testosterone). In particular obesity, but also impaired general health, are more common causes of low (testosterone) than chronological age.”

For those of us who lived through the estrogen wars, the sudden interest in testosterone is a fearsome reminder that some doctors do not care about history. If we go back twenty years, every woman could benefit from estrogen. Menopause was the disease, and we had the cure. Estrogen was good for everything, and no woman had to age. My eighty-year-old grandmother started to have her period again, all for the sake of her bones getting stronger.

Then came the Women’s Health Initiative Study, which showed that: “Estrogen plus progestin and estrogen alone decreased risk for fractures but increased risk for stroke, thromboembolic events, gallbladder disease, and urinary incontinence.”

Suddenly every prescribing doctor came to the defense of estrogen. I remember arguing with one ob/gyn who said she was looking forward to going on estrogen despite that silly study. It was flawed. Since then, we’ve seen a drop in breast cancer in direct correspondence to our drop in estrogen prescriptions. But now it’s men, and their perpetual need for testosterone, that has us running for our prescription pads.

Here’s the reality. Testosterone alone doesn’t seem to be that effective. Having seen patient after patient on testosterone, I haven’t heard from them that it changed their lives. These are younger men with low desire and with depression, prescribed testosterone because their levels were low. But it doesn’t seem to change the depression, and they experience no increase in desire.

No FDA approval, no long term studies, and I haven’t seen a beneficial effect. This is one illness that I’m not going to be too sorry to see go the way of estrogen replacement for eighty-year-olds.

Testing for Testosterone

Diagnosing low testosterone by blood is not conclusive. According to a review of the literature, “it is important to confirm low testosterone concentrations in men with an initial testosterone level in the mildly hypogonadal range, because 30% of such men may have a normal testosterone level on repeat measurement; also, 15% of healthy young men may have a testosterone level below the normal range in a 24-h period.” If someone wants to get more technical “Equilibrium dialysis and sulfate precipitation are the gold standard for free testosterone and bioavailable testosterone measurement.” But those aren’t available for routine use. Saliva testing for testosterone “cannot be recommended for general use at this time, since the methodology has not been standardized.” (complete review here)

 

Posted by: Christopher Maloney, Naturopathic Doctor | July 28, 2014

Should We Treat All Cancers? Prostate Cancer And the Case For No.

 

When a U.S. patient learns he has prostate cancer, of course he wants treatment. We treat all cancers, we treat them aggressively, and we either “beat them” or lose the battle trying.

But a different model of cancer is slowly emerging. A model where just because you can see the cancer doesn’t mean it’s going to do anything, and doesn’t mean you should do anything to it besides watch and wait. According to CNN: “It has been estimated that over diagnosis occurs in half of all patients with prostate cancer, perhaps 30% to 40% of those with thyroid cancer, 10% to 30% of breast cancer patients and even some with screen detected lung cancer.”

We are perhaps victims of our own technology. Cancers without symptoms or likely growth show up on ever more sensitive screening scans. These are overwhelmingly over treated.

But so what? Better to treat than not, right? Not really. Many of the treatments have serious side effects, including death. When faced with an aggressive cancer, it is well worth looking at these treatments. But when a tiny spot on the prostate results in surgery-induced incontinence and impotence, then we’ve crossed the line.

Is profit a motive?  To some extent. According to Dr. Otis Brawley, the chief medical officer of the American Cancer Society, “In the case of hormonal prostate cancer therapies, …their use consistently increased throughout the 1990s. Usage went down dramatically in 2003, when Medicare took much of the profit out of administering the treatment by reducing physician reimbursement for the drugs.”

But even after the profit was taking away, the same therapies continue to be overused. Patients are unwilling to accept the notion that just because they have cells that are cancerous does not mean they should immediately use the most drastic means necessary to remove them. And many doctors are unwilling or unable to communicate the new paradigm where having a cancer doesn’t mean you need to treat it.

Perhaps it’s time to end the “war on cancer” and come up with a new framework. But “living well with cancer” isn’t likely to get as many people out marching in support of more treatment options.

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

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