Are Vitamins Dangerous?
Wow, is that a loaded question or what? The answer is “it depends”. Like most issues in medicine, there are positive (pro-vitamin) research studies and negative (anti-vitamin) studies, so the patient and their physician need to take both into consideration when embarking on a rational supplementation program. My patients know that I am a big believer in supplements when taken in the right dose and the right form and for the right reason. So for the record I freely admit my pro supplementation bias. Your doctor may feel completely differently.
Clearly, some supplements can be dangerous, especially when taken in the wrong dosage or the wrong form. Take vitamin A for example. Ingest too much vitamin A and you can become sick and even increase your risk of lung cancer, especially if you are a smoker. Vitamin A actively competes with the potent anti cancer effects of Vitamin D in the body. Too much vitamin A can therefore potentially negate any beneficial effect of vitamin D. This is particularly true if the user is vitamin D deficient.
Beta-carotine, however, is a precursor to vitamin A and is converted to vitamin A only on demand (as the body needs it), so it is a much safer way to make sure you have adequate vitamin A available without the risk of toxicity that can occur when taking preformed vitamin A. (Warning! Cod liver oil has large amounts of preformed vitamin A, and I tell my patients to avoid it entirely to avoid vitamin A toxicity.)
On the other hand, the health benefits of having a healthy vitamin D level are extensive and well documented. To learn some of these, spend time on the Vitamin D Council website.
The Iowa Women’s Health Study has been widely quoted in the media this week. The authors contend that women who had an average age of 61 at the beginning of the study and who took vitamin supplements had a higher mortality that those who did not. The increased risk was small, about 2.5 % but statistically significant. Women who took iron and copper had the highest increased risk.
Big news indeed, but I have to ask, why didn’t these same news agencies report the results from a study published in the July 2011 issue of the European Journal of Nutrition that looked at the effect of supplementation on all cause mortality and revealed a completely different result?
This European study prospectively followed about 24,000 healthy participants for 11 years and demonstrated that long-term users of vitamin supplements had a 48% reduced risk of death from cancer and a 42% lower all-cause mortality when compared to non vitamin users. The authors of the study also noted a “sick user” component. That is, once someone became ill, they were more likely to start taking vitamins. If an author does not correct for this effect, then results can become skewed. The Iowa Women’s Study noted that supplement use increased over the time of the study. In 1986 when the study began, about 65% of the women reported taking one supplement daily. By 2004 that number had increased to nearly 85%. Could this have been a “sick user” effect?
Life Extension wrote a rebuttal to the Iowa Women’s Health Study. For those of you who want to dig deeper into the potential problems with the Iowa Women’s Health study, I suggest you read it.
I have been telling all of my male patients and all of my post menopausal (or hysterectomy) female patients for years that you do not need to take iron in your supplements unless you are documented to be iron deficient. Perhaps the biggest take away for me from the Iowa Women’s Health study is a validation of that statement for those of you who are post menopausal. Guys, you weren’t included in the study but I stand by my statement.
It is important to discuss what supplements you are taking with your doctor. Some supplements can interfere with prescription medications by making them less effective. Others can enhance the side effects of certain medications with potentially disastrous outcomes. Be sure to know the dose and frequency of your supplements so your doctor can help you make the best informed decision.
Disclaimer: My blog posts on the Prime Care website are meant for informational purposes only and are not intended to be considered as medical advice or as a diagnostic tool. Seek prompt medical attention if you have health concerns.
Hypothyroidism
The Thyroid gland is in your neck and makes thyroid hormone which controls how the body uses and stores energy. Hypothyroidism is the term doctors use when a person does not make enough thyroid hormone.
Women, especially over 50, are more likely to have hypothyroidism than men are.
What are the symptoms of hypothyroidism? — Some people with hypothyroidism have no symptoms. But most people feel tired. That can make the condition hard to diagnose, because a lot of conditions can make you tired.
Other symptoms of hypothyroidism include: lack of energy, getting cold easily, developing coarse or thin hair, getting constipated (having too few bowel movements), unexpected weight gain and depression.
There are numerous cause of Hypothyroidism but Hashimoto’s Thyroiditis, an autoimmune disease, is the most common. This occurs when the body makes antibodies that attack the thyroid and keep it from producing enough hormone. Other causes include radiation therapy, thyroid surgery and certain medications.
If it is not treated, hypothyroidism can also weaken and slow your heart. This can make you feel out of breath or tired when you exercise. Untreated hypothyroidism can also increase your blood pressure and raise your cholesterol—both of which increase the risk of heart trouble.
Is there a test for hypothyroidism? — Yes. Your doctor can test you for hypothyroidism using a simple blood test.
How is hypothyroidism treated? — Treatment for hypothyroidism involves taking thyroid hormone pills every day. Approximately 6 weeks after you start taking the medicine your doctor will test you again to determine if you are on the correct dose. He or she may adjust your dose depending on the results. Most people with hypothyroidism need to be on thyroid pills for the rest of their life.
If you have any of the symptoms described above, call your doctor and make an appointment for an examination and testing.
Is Your Bread Slowly Poisoning You?
I am working on a blog post on IODINE , a trace element critical to overall health. Iodine is found in every cell in the body and is essential for the normal hormone receptor functioning for every hormone you have. Hormones make things happen in your body. They control your metabolism, your blood pressure, your blood sugar, when you wake up and when you go to sleep, how you respond to stress and your sexual functioning among other things.
Most Americans are not getting enough iodine in their diet. To make matters worse, we are exposed to a lot of bromides, often on a daily basis through occupational, environmental and food exposures. For you chemistry buffs, you will know that bromine and iodine have similar chemical properties and are classified as Halides, along with chlorine and fluorine. Since their chemical properties are similar, they compete for the same receptors in the body. Bromine displaces iodine from your body and is a major contributor to iodine deficiency.
Think of a hormone as a key and the hormone receptor as a lock; a grossly simplified analogy perhaps but a very important concept. When the key is in the lock, it can turn the lock and open the door. When a hormone binds to its receptor, stuff happens (i.e. the door opens, your blood pressure rises, you digest your food, you wake up, etc.). But what happens if you have the wrong lock or the lock has been tampered with? The key may fit in the lock, but can’t unlock to door to open it. This is exactly what happens when bromides get into your body. Bromides compete with Iodine and bind to the iodine sites, and important metabolic functions are disrupted (the lock does not work).
Bromides serve no natural function in the body and in fact have been classified as potential carcinogens. For example, bromides concentrate in breast tissue and have been implicated as a possible cause of breast cancer. Bromide is carcinogenic in rats and kidney toxic in both man and experimental animals when given orally.
Symptoms of bromide toxicity are varied and include rashes and acne, diarrhea or digestive problems, headache, fatigue, sluggishness, impaired memory and concentration, irritability, emotional instability, insomnia and depression among others.
Bromides are found in flame retardants, hydro-spa sanitizers, and even some medicines!
A major source of human bromide exposure comes from the breads we eat. Potassium bromate has been used as a food additive for over 80 years. When added to dough, it stiffens the bread and helps prevent falling of the dough. Because of health concerns, bromates have been banned in numerous countries, including England in 1990, Canada in 1994 and even China in 2005. In addition, in 1991, California declared bromate a carcinogen under the state’s Proposition 65. Baked goods sold in California have to bear a cancer warning if they contain more than a certain level of bromate.
Many commercial bakers, including Best Foods, Inc. (maker of Arnold, Entenmann’s, and Orowheat brand breads and rolls), Pepperidge Farm, and Pillsbury, have switched to bromate-free processes. Also, some supermarket chains, including Giant, Jewel, Ralph’s, and Von’s, do not use bromate. Some breads are now being labeled bromate free. If you see “enhanced flour” on the list of ingredients be suspicious that it contains potassium bromate.
Brominated vegetable oil (BVO) is found in many consumer citrus flavored soft drink products such as Mountain Dew, some Gatorade and some Powerade, Orange Fanta, Orange Crush, Sun Drop, Squirt and Fresca. BVO can be found in some bakery products and brands of pasta as well. The FDA requires that products containing brominated vegetable oil list it as an additive on the ingredient label, so check labels before you buy!
So the long and the short of it is, you want to avoid bromides whenever you can. Bromine excretion can be measured in 24 hr urine collections by reference labs. High urinary excretion correlates with high tissue levels. To detoxify bromides I would suggest you enlist the help of a provider knowledgeable in alternative therapy to avoid and manage side effects that can occur during treatment.
If you think you may need detox from bromine exposure be sure to speak with your doctor about it. If you do not have a primary care provider and would like to see one of our providers, simply download the new patient form on our website and mark it “Bromine” and one of our staff will contact you to set up an appointment with someone comfortable diagnosing and managing this condition.
Disclaimer: My blog posts on the Prime Care website are meant for informational purposes only and are not intended to be considered as medical advice or as a diagnostic tool. Seek prompt medical attention if you have health concerns.
Magnesium
I often advise my patients to take magnesium. The potential health benefits are impressive and include reductions in blood pressure, improved blood sugar control, better bone mineral density and improved sleep. Over 300 enzyme reactions in the body need magnesium as a co factor. If you are not getting enough in your diet, you may be at risk of developing some significant health issues.
Magnesium is the fourth most common mineral in the human body. The vast majority of it is deposited in the bone. Only 1% is found in the blood stream at any one time, but the body works hard to maintain magnesium levels within a constant range. It will take magnesium from bone if there is not enough in your diet in order to maintain a normal level in the blood.
Magnesium rich foods include spinach, almonds, legumes, and whole wheat bread. Magnesium is also often found in “hard” water and mineral water. Bottled water, “softened” water and many municipal water supplies are magnesium deficient. The recommended daily allowance for males is 420 mg/day and 320 mg/day for women. It has been estimated that the daily magnesium deficiency in the typical American diet is close to 100 mg.
Magnesium improves blood sugar control. A study of 52 overweight, insulin resistant, non-diabetic individuals with normal magnesium blood levels were given 345 mg of magnesium a day. After 6 months, fasting blood sugar was reduced by 7%. A long term study of 85,000 women and 42,000 men revealed that those with the highest level of magnesium intake reduced their risk of diabetes by up to 34%. For every 100 mg increase in daily intake of magnesium, the risk of developing adult onset diabetes drops by 15%.
When taken at night, magnesium suppresses the release of cortisol from the adrenal glands. Elevated cortisol impairs sleep. Patients taking magnesium frequently report improved and more restful sleep.
Magnesium dilates bronchiole tubes, a property I exploited in the emergency department when I treated severe asthma attacks. After 2 months of magnesium therapy, chronic asthmatic children receiving 300 mg a day of had an average of 28% fewer days of severe asthma, and were able to reduce their prescription use of asthma inhalers by 40%.
Magnesium lowers blood pressure. It acts like a calcium channel blocker and may reduce systolic pressures by as much as 20 mmHg in magnesium deficient patients. Magnesium also stabilizes cell membranes. As such it reduces the chance of abnormal heart beats.
Magnesium can improve bone density. When deficient, calcium metabolism is altered and bones demineralize in an attempt to raise the blood level of magnesium.
Magnesium helps migraine patients. Research has shown that 50% of migraine sufferers are magnesium deficient. Interestingly 60% of migraine sufferers have a gene defect that impairs their magnesium metabolism. Magnesium also reduces panic attacks, and symptoms of depression.
Magnesium is available in several forms. I tell my patients to avoid most, as magnesium can cause diarrhea if it is not well absorbed. I prefer magnesium glycinate. I typically suggest 400 -800 mg at bedtime. Magnesium glycinate is inexpensive and available at most health food stores, or on-line from companies such as Life Extension.
Magnesium in very large doses can cause cramps and diarrhea. Muscle weakness and extremely low blood pressure are signs of magnesium toxicity. Magnesium can bind to antibiotics such as Cipro, Levaquin and Avelox and impair their absorption. There should be at least a 2 hour window between the dose of these antibiotics and magnesium supplementation. If you have any kidney disease you should not take magnesium supplements until you consult with your doctor.
Erectile Dysfunction and Heart Attack Risk
Impotent Men Are at High Risk for Heart Attacks
A review of 12 studies on men who are unable to sustain an
erection shows that impotence almost doubles a man’s chances of
suffering a heart attack, stroke, and premature death (Journal of
the American College of Cardiology, September, 2011).
Treating risk factors for heart attacks with lifestyle
changes and/or medication helps to prevent heart attacks and
improves impotence (Archives of Internal Medicine, September 12,
2011). More than 50 percent of North American men over 40 are
impotent (JAMA, May 26, 1999).
GET A MEDICAL WORK UP FOR IMPOTENCE: Check your male
hormone, testosterone, and all risk factors for heart attacks.
All conditions and behaviors that damage blood vessels can cause
impotence: *diabetes, *depression, *stomach ulcers,
*high cholesterol, *atherosclerosis, *high blood pressure, *nerve
damage, *cigarette smoking, *taking more than two alcoholic
drinks a day, and so forth.
DRUGS THAT CAN CAUSE IMPOTENCE: diuretics, blood pressure
medications, non steroidals (naproxin), ulcer medications
(cimetidine, omeprazole, metoclopramide, antidepressants
(lithium, SSRIs), recreational drugs (marijuana, cocaine,
heroin), and so forth.
LIFESTYLE CHANGES THAT PREVENT AND TREAT IMPOTENCE:
*Do not smoke or take more than 2 drinks a day
*Avoid red meat, sugared drinks and foods with added sugars
*Eat large amounts of fruits and vegetables
*Exercise (caution: men with impotence are at increased risk for
heart attacks during exercise)
*avoid overweight,
*get enough vitamin D (D3 blood level above 75 nmol/L).
MRSA (Methicillin Resistant Staphylococcus Aureus) infections
MRSA is an acronym for Methicillin Resistant Staphylococcus Aureus. Staph aureus is a common bacteria that frequently causes wound infections and abscesses. About 10% of the population at any one time will have staph aureus positive nasal swabs. Methicillin is a second generation antibiotic that is structurally similar to penicillin. It was developed to address the problem of penicillin resistance that began to emerge in hospitals in the 1950’s and 1960’s.
Initially limited to ICU and hospital settings, MRSA has become a problem in the general community. Sports teams, classrooms, jails, health clubs and nursing homes have all battled the problem of MRSA infections. The concern with MRSA arises because bacteria that are resistant to methicillin are frequently resistant to many other antibiotics. Such is the case for hospital acquired MRSA. “Super bugs” are being isolated that have no known effective antibiotic.
Fortunately, community acquired MRSA has so far been sensitive to several commonly used antibiotics. These antibiotics were used heavily in the past, but when bacteria became resistant doctors stopped prescribing them and the bacteria lost their resistance to them over the ensuing years. Locally we have been very successful using sulfa drugs, doxycycline, and clindamycin while treating MRSA infections.
MRSA infections frequently cause abscesses. These can occur anywhere on the body. MRSA abscesses are painful, grow rapidly and frequently require an incision to drain the infection. The fluid that drains from a MRSA infection is highly contagious and so every precaution should be made to prevent contact with this fluid. Bandages should be disposed of immediately after use and towels should be used only once before placing them in the laundry. Laundry should be washed in hot water with bleach. A weak bleach solution can also be used to sanitize hard surfaces. This is important because MRSA has been shown to survive for up to 3 months on hard surfaces such as plastic and metal .
If you think you might have a MRSA infection it is important that you be seen right away. At Prime Care we have the experience and the equipment to handle this serious health issue in a timely and comfortable manner. We can drain the abscess under local anesthesia and start antibiotics right away. In addition we will follow you up on a regular basis until we are certain you are well on your way to recovery.
You do not need an appointment. Simply present to any Prime Care location and we will be happy to serve you.
Disclaimer: My blog posts on the Prime Care website are meant for informational purposes only and are not intended to be considered as medical advice or as a diagnostic tool. Seek prompt medical attention if you have health concerns.
Hot Flashes
Hot Flashes are experienced by about 75% of women as they approach menopause. Hot flashes are characterized by a sense of warmth, generally in the upper chest, face and scalp region and are accompanied by perspiration and a flushed appearance. Many women also experience an increased heart rate, weakness and even dizziness. Hot flashes may start years before a woman experiences menopause and will continue for 5 yrs in about 80 % of the women who experience them. In about 10 % of women, hot flashes will last up to 10 yrs.
No one knows what causes hot flashes, but they are correlated with declining estrogen levels. Many hot flashes occur at night, when estrogen levels are lowest. Women who smoke, are overweight, or are African American are at increased risk of developing hot flashes.
Not all hot flashes are due to menopause. Narcotic withdrawal, hyperthyroidism and panic attacks can all produce very similar symptoms.
There are several potential treatments for menopausal hot flashes. Black Cohosh is an herb that has been used extensively in Europe. Most doctors recommend you do not use it for more than 6 months at a time. Soy contains plant estrogens (phytoestrogens) and as such may offer some relief of hot flashes. Evening primrose oil, flax, and vitamin E have all been used with limited success.
Hormone replacement therapy (HRT) can be prescribed for women who have debilitating of lifestyle limiting hot flashes. Interestingly, progesterone alone will improve hot flashes in 83% of women. This is because some of the progesterone is converted by the body into estradiol, the most potent naturally occurring human estrogen. Premenopausal women needing hormones are generally treated with progesterone alone. Post menopausal women, or post hysterectomy patients can be placed on bio identical estrogen in the form of a topical creme or a patch.
If you are experiencing severe hot flashes, we encourage you to speak with your doctor. If you do not have one, simply fill out the online new patient application and label it “HRT” and our staff will contact you and set up an appointment with one of our medical providers experienced with bio identical hormone replacement therapy.
Disclaimer: My blog posts on the Prime Care website are meant for informational purposes only and are not intended to be considered as medical advice or as a diagnostic tool. Seek prompt medical attention if you have health concerns.
Homemade Ice Pack
1) Take equal parts rubbing alcohol and water (usually 2 cups each) and place in a zip lock style gallon sized plastic freezer bag.
2) Place this bag inside another similarly sized freezer bag to protect against leakage.
3) Put bag in freezer for several hours
4) Remove bag from freezer and place wash cloth or hand towel on area to be iced down
5) Ice pack will remain flexible and cold for extended periods of time and can be reused over and over.
Be careful to not over cool the skin. This could cause freezing of the skin and result in painful blisters.
What you eat is more important
What You Eat Is More Important than How Much You Eat
July 24, 2011
A study From Harvard School of Public Health shows that telling overweight people to “eat less and exercise more” rarely helps them lose weight (New England Journal of Medicine, June 23, 2011). That encourages them to eat any foods they want and, as they age, they continue to gain weight which is associated with increased risk for heart disease, diabetes, strokes, breast cancer, colon cancer, and premature death.
120,877 healthy, non-obese women and men were followed for 20 years. The study shows which foods and lifestyle factors should be avoided to prevent an average weight gain of almost 17 pounds in 20 years. If you eat the wrong foods, you can gain weight even if you exercise. Small changes in eating and exercising can prevent this weight gain. Those who were overweight at the start of the study gained the most weight over the study time.
Study surprises: Weight gain is not associated with eating yogurt, nuts, or peanut butter. Yogurt appears to contain bacteria that cause the body to produce hormones that make you less hungry. Nuts contain primarily monounsaturated fats that are not associated with increased risk for weight gain.
Foods that caused the most weight gain:
� French fries (2 lbs per four-year period)
� potato chips (1.69 lbs)
� potatoes (1.28 lbs)
� other forms of potatoes (0.57 lb)
� sugar-sweetened beverages (1 lb)
� red meats (0.95 lb)
� processed meats (0.93 lb)
� refined grains (0.39 lb)
� sweets and desserts (0.41 lb)
� other fried foods (0.32 lb)
� fruit juice (0.31 lb)
� butter (0.3 lb)
Foods that caused weight loss:
� vegetables (-0.22 lb per four-year period)
� whole grains (-0.37 lb)
� fruits (-0.49 lb)
� nuts (-0.57 lb)
� yogurt (-0.82 lb).
Lifestyle factors: In addition to diet, the study shows that you should exercise daily, sleep 6 to 8 hours a day, restrict television watching, avoid smoking and do not take more than one drink a day.
Vitamin D
1. Vitamin D intake without supplementation (from sunlight and food) is equivalent to 3300 IU/day, providing an average plasma level of 33.4 +/- 26.4 ng/ml in non-hispanic whites.1
2. A 25(OH)D plasma level of 52 ng/ml is associated with a 50% reduction of breast cancer risk.2
3. A 25(OH)D level of 40-60 ng/ml is associated with a 50% reduction in colon cancer, multiple sclerosis and type 1 diabetes risk.3
4. Supplemental intake of 4000 – 8000 IU/day typically provides a plasma 25(OH)D level of 40-60 ng/ml1 at a patient price of $6 per month for 5000 IU/day.
“We found that daily intakes of vitamin D by adults in the range of 4000-8000 IU are needed to maintain blood levels of vitamin D metabolites in the range needed to reduce by about half the risk of several diseases – breast cancer, colon cancer, multiple sclerosis, and type 1 diabetes,” said Cedric Garland, DrPH, professor of family and preventive medicine at UC San Diego Moores Cancer Center. “I was not surprised to find that the intakes required to maintain vitamin D status for disease prevention were so high – much higher than the minimal intake of 400 IU/day vitamin D that was needed to defeat rickets in the 20th century.”
“I was not surprised by this” said Robert P. Heaney, MD, of Creighton University, a distinguished biomedical scientist who has studied vitamin D need for several decades. “This result was what our dose-response studies predicted, but it took a study such as this, of people leading their everyday lives, to confirm it.”
The study reports on a survey of several thousand volunteers who were taking vitamin D supplements in the dosage range from 1000 to 10,000 IU/day. Blood studies were conducted to determine the level of 25-hydroxyvitamin D – the form in which almost all vitamin D circulates in the blood.
“Most scientists who are actively working with vitamin D now believe that 40 to 60 ng/ml is the appropriate target concentration of 25-vitamin D in the blood for preventing the major vitamin D-deficiency related diseases, and have joined in a letter on this topic,” said Garland. “Unfortunately, according a recent National Health and Nutrition Examination Survey, only 10 percent of the US population has levels in this range, mainly people who work outdoors.” In a prior study, the research team found that having a serum vitamin D level of 52 nanograms per milliliter was associated with a 50 percent reduction in breast cancer risk.2
While 4000 – 8000 IU/day is a higher than traditional intake, they are largely in a range deemed safe for daily use in a December 2010 report from the National Academy of Sciences Institute of Medicine.5
Interest in larger doses was spurred in December 2010, when a National Academy of Sciences Institute of Medicine committee identified 4000 IU/day of vitamin D as safe for everyday use by adults and children nine years and older, with intakes in the range of 1000-3000 IU/day for infants and children through age eight years old. While the IOM committee states that 4000 IU/day is a safe dosage, the recommended minimum daily intake is only 600 IU/day. The daily value was established as the minimum requirement to avoid a bone disease due to deficiency of that nutrient. Over time, RDAs have been misinterpreted as a target value for health, rather than the absolute minimum to avoid death or disease directly due to deficiency.
“Now that the results of this study are in, it will become common for almost every adult to take 4000 IU/day,” Garland predicted. “This is comfortably under the 10,000 IU/day that the IOM Committee Report considers as the lower limit of risk, and the benefits are substantial.” He added that people who may have contraindications should discuss their vitamin D needs with their family doctor.
“Now is the time for virtually everyone to take more vitamin D3 to help prevent some major types of cancer, several other serious illnesses, and fractures,” said Heaney. Cheaper vitamin D2 in fortified foods such as milk, is about 10% as effective (based on uptake and retention studies measured as area under the curve) as vitamin D3 or vitamin D produced naturally in the body from exposure to sunshine.
“There is no substantial downside to a serum level of 52 nanograms per milliliter of Vitamin D,” Dr. Gorham noted. “Such levels are common in sunny climates. There is no known adverse effect of serum levels below 160 nanograms per milliliter.” The researchers recommend that at least 1,000 IU per day vitamin D3 be consumed until further studies are conducted.
A vitamin D3 level should be a part of every routine physical exam.