MARCH 28, 2019 ALCOHOL

Is there a benefit to alcohol consumption or is there a health risk? The Global Burden of Disease Study examined this question from data from 1990 to 2016. The results were published and there were some revealing numbers. Among ages 15- 49, alcohol was the number one cause of disability adjusted life years and the leading cause of death, accounting for 10% of deaths at this age group. I found this surprising. What is more shocking is that among all age groups, 2.8 million deaths worldwide were linked to alcohol use.

Where you live does make a difference. In 2016 more than 2 billion people consumed alcohol and 63 % were male. Iran and Palestine have the lowest death rates from alcohol whereas Russia and Central Africa Republic have the highest death rates.

Other diseases associated with alcohol use were cardiovascular, specific cancers and TB.

I do believe it is the practitioners duty or rather responsibility to stop promoting drinking for health benefits. I do NOT think abstinence from alcohol is unrealistic. I think more physicians need to discuss alcohol with their patients. I also feel physicians should have more knowledge about 12 step support groups as Alcoholic Anonymous (AA), Al a Non, and ACOA ( Adult Children of Alcoholics )

Until tomorrow…

MARCH 27, 2019 VITAMIN D

Vitamin D is a fat soluble vitamin that is either consumed through dietary resources or synthesized when the skin is exposed to sunlight ( UV light) The benefits of vitamin D are well documented. I think Vitamin D is the vitamin of the decade of 2000-2010 and beyond Some even consider it a pandemic. Because a patient is not getting it from dietary nor sunlight ( as they wear sunscreen protection) you will need to supplement your Vitamin D

I supplement vitamin D for my patients by recommending Vitamin D liquid. Since vitamin D can be measured in the blood, patients should always let their practitioner know the exact dosage he/she is taking. You can always get Vitamin D from a food source like mushrooms. I would suggest dairy but so many are sensitive to dairy

It is also important to be educated on the label claims for vitamins, as well as possible toxicities.

Until tomorrow…

MARCH 26, 2019 RESISTANCE TO ANTIBIOTICS

There are many infections that are resistant to antibiotics This is also true of the Helicobacter pylori infection. H pylori has been implicated in the cause of peptic ulcers, gastric ( stomach ) cancer and even heart disease. Helicobacter pylori (HP) is increasingly drug resistant. There are failure rates of 5-10% even after two different antimicrobial antibiotics. Failure due to resistance to clarithromycin may be as high as 30 % and some are resistant to levofloxacin. There are even studies that we should eradicate all of the HPO as there may be a protection for the gut microbiome.

In high socioeconomic groups the rate of HP is thankfully decreasing There are other barriers which is the type of testing and timing of the testing. Test for active infection should include stool antigen and or breath testing. Both of these are sensitive and specific , 95 % for each respectively. Both of these tests MUST be performed more than four weeks after the use of either a bismuth product, and or an antibiotic. All of the PPI drugs must be stopped for more than 2 weeks.

To help resistance the patients should strictly adhere to regimen 1 feel that most patients cannot complete the protocol. I have used berberine containing herbs to treat HP effectively.

The other treatment modality is Mastica ( also called Mastic gum) which is the resin from a tree that grows on an island belonging to Greece. This is very effective in eradicating HP. I also use and employ gastrointestinal teas as Slippery Elm, Marsh mallow, and Meadowsweet

Until tomorrow…

MARCH 25, 2019 PROSTATECTOMY VS WATCHFUL WAITING

This is a very personal topic regarding prostate cancer. There are many treatment options after a man receives a diagnosis of prostate cancer. The decision does rest upon the patient but treatment options bvary from urologist to urologist. In the Internal Medicine ALERT released by Relias Media it was discussed that the incidence of death in the prostatectomy patients versus those men who did watchful waiting. These are two options that may be discussed with a patient with prostate cancer.

The cumulative incidence of death was 71.9 % for the radical prostatectomy group and 83.8 % for the watchful waiting group There has always been debate of what benefit does surgery offer versus the new watchful waiting . The new term in 2019 is active monitoring which is now preferred to immediate surgery

The conclusion is that men with advanced prostate cancer who have radical prostatectomy offers both survival and disease free survival benefits.

A lot to consider

Until tomorrow…

MARVCH 23-24, 2019 STRENGTH TRAINING BEST FOR HEART

We have been told that dynamic exercise as walking, treadmill and cycling is the best form of exercise for the heart. This may not be true.

A recent study published in November 2018 revealed that static exercise, as strength training might be superior to dynamic exercise for conferring protection against cardiovascular disease. The data was extrapolated rom 2005/2006 National Health survey ( NHANES) The study found that for adults greater than 45 years - 28 % engaged in static compared to 21 % in dynamic. Both groups had cardiovascular protection but better in the static group and in the younger age groups

The conclusion is that static appeared to better than dynamic for cardio-protection. This results were presented at American College of Cardiology conference on November 16, 2018

Until tomorrow…

MARCH 22, 2019 WHY WE NEED SLEEP

There have been many studies on the benefits of sleep. You must get quality sleep every night Many use conventional medications to sleep as Ambien, Trazadone, Lunesta, and Clonazepam. I usually want people to sleep without the conventional medications as some are addictive and have side effects. I utilize magnesium, theanine, CBD oil and many nervine herbs as Passion flower, Skull cap, California Poppy, Valerian and even Chamomille.

Quality sleep is known to facilitate the consolidation of memory as well as enhancing cognitive function. Over time it has been estimayted that quality sleep may protect against the development of dementia .

It has bene studied that restorative sleep , both stage 3 ( slow wave deep) and REM sleep have shown to reduce the deposition of amyloid ( beta ) in the brain and also facilitate (AB) ) clearance. It also enhances the glymphatic system of the brain enhancing drainage in metabolic toxins

These studies are encouraging. More needs to be done

Until tomorrow…

MARCH 21, 2019 SLEEP APNEA AND SLOW HEART BEATS

An evaluation for sleep apnea needs to be done for patients with slow heart rhythms as sinus node dysfunction, bradycardia, and sinus pauses. I also feel these patients should be screened for Lyme disease . It has been shown that treatment of sleep apnea offer cardiovascular benefits beyond reduction in nocturnal slow heart rates ( bradycardia)

It is important to make a correlation with appropriate testing of the amount of bradycardia in the face of sleep apnea. We do know that permanent pacemakers are recommended regardless of symptoms for patients with acquired second degree AV block Mobitz Type II, high grade block or third degree block.

Permanent pacemakers are not recommended for patients with AV block that are due to reversible causes as Lyme carditis.

Any patient with a history of snoring and day time tiredness should be evaluated for sleep apnea. There is also a major correlation between sleep apnea and coronary artery disease

Until tomorrow…

MARCH 20, 2019 ANTIBIOTICS AND KIDNEY STONES

Antibiotics do serve a purpose. Sometimes these antibiotics can be miraculous cures, but there are side effects. The main side effect is a disruption in the gut microbiome. Now there is also evidence that patients with kidney stones ( nephrolithiasis) have an altered gut microbiome compared to those without kidney stones. This is important information

The question is how this could happen ? The proposed mechanism is that changes in the gut microflora ( due to antibiotics) alter macronutrient leading to increased calcium formation. This increased calcium formation will lead to kidney stones.

Another hypothesis is that antibiotics select for multi resistant pathogens that promote kidney stone formation. It has been shown that 70 % of bacteria cultured from stones are multi resistant pathogens.

This has to be researched and studied more

Until tomorrow…