Medical Articles by Dr. Ray

Dec

2008

Climb Stairs And Stay Healthy

By Ray Schilling | Fitness, Health, Heart Disease, High Blood Pressure, Men's Health, Prevention, Women’s Diseases

Everybody knows that walking from the TV to the fridge does not qualify as exercise, and those few steps to the mailbox don’t do the trick either, when it comes to staying fit. But by the same token it is also a fallacy to believe that only the work-out in the gym will reap benefits and improve aerobic capacity. According to Dr. Philippe Meyer and colleagues at Geneva University Hospital in Switzerland, the mundane task of taking the stairs can show statistically significant changes in aerobic capacity, decrease in body weight, decrease in fat mass, waist circumference, decrease in diastolic blood pressure and increase in heart healthy HDL cholesterol. Dr. Meyer asked 77 healthy hospital workers including 20 physicians to exclusively use the stairs at the 12-storey hospital. During this 12 week quest for more fitness promotional signs encouraged stair climbing. All of those 77 participants were a sedentary group of individuals. Nevertheless they had to walk…the cafeteria was on the twelfth floor! At the baseline the participants walked up and down an average of 4.5 storeys per day, and at the end of the twelve weeks they were walking about 20.6 storeys per day.

Climb stairs and stay healthy

The tangible results showed that aerobic capacity and fat mass remained significantly improved, even though the participants walked less storeys after 12 weeks. It seems that initial change of habits-walking instead of taking the elevator- had made the difference in the transformation from couch potato to more active individual.

Stair climbing is an excellent exercise for healthy individuals in the general population. This high intensity exercise cannot be recommended to heart patients that are not entirely stable or to a patient who has angina. In these cases caution and a supervised exercise program is needed.

More information about fitness: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

The Medical Post, November 18, 2008, page 17

Last updated Nov. 6, 2014

Dec

2008

Home Monitoring Works For Patients On Blood Thinner

By Ray Schilling | Heart Disease, Prevention, Stroke

The standard treatment for patients with risks for blood clots is a prescription for the medication called warfarin. Patients who suffered a stroke or who have atrial fibrillation will receive this drug, as do individuals who have a mechanical heart valve. Following pulmonary emboli blood thinners are also required for a period of time. Even though warfarin is a medication that has been in use for several decades, there are important guidelines. Warfarin is a blood thinner, and it is imperative that the blood values of the patients are closely monitored. Too much warfarin could lead to disastrous bleeding, whereas too little medication can lead to blood clots. Both conditions can be life threatening. As a result, patients who are taking warfarin have to present for blood tests on a weekly basis at a lab. Managing proper coagulation may become less cumbersome in future, as a trial that was run at 28 Veteran Affairs medical centers has shown. Tests enrolled 3,644 patients who required warfarin, and they received training in using a home monitor, which took about 30 minutes. They used the home monitoring device for 2 to 3 weeks, after which they returned to their local center for assessment, how successfully they had monitored their INR level.

: Monitoring INR at home

The results were encouraging: 2,922 patients-80% of the original group showed that they could successfully handle home monitoring, either by themselves or with the help of a caregiver. They would phone in their test results on a weekly basis and would receive instructions by phone for dosage adjustment. The advantage for the patient is the fact, that they become more involved and empowered in their own care and show more engagement towards their health.

More information on:

1. Atrial fibrillation: http://nethealthbook.com/cardiovascular-disease/heart-disease/irregular-heart-beats/atrial-fibrillation/

2. Pulmonary emboli: http://nethealthbook.com/lung-disease/pulmonary-emboli/

The Home INR Study (THINRS , Presented at the Annual American Heart Association Meeting, New Orleans, Nov. 8 to 12, 2008

Last updated Nov. 6, 2014

Dec

2008

Fifty Percent of US Population Do Not Take Enough Calcium

By Ray Schilling | Heart Disease, High Blood Pressure, Nutrition, Osteoporosis, Women’s Diseases

Even though supermarket shelves are stocked to the hilt with a wide assortment of groceries, not all is well in the USA. At the annual meeting of the American College of Nutrition Theresa A. Nicklas, D.P.H. summed up the current situation in the following statement: “The American population is overweight but undernourished.” Results from a study of more than 25,000 people showed, that half the population does not get enough calcium, magnesium and potassium.

Many people consume more calories than they need, but nutrients like the ones mentioned before and which are essential for functions such as immunity, bone health and blood pressure are falling short of the recommended amounts. The only age group in which the recommendations for calcium intake were met was the age group up to 8 years. In adults the needs were not met, and more females than males were deficient in all of the three nutrients.

Calcium intake prevents osteoporosis

The situation could be corrected by consuming 3 to 4 equivalents in the dairy group. It should be added that not only dairy foods are rich in calcium. For individuals who do not consume dairy foods, soy products are rich in calcium, as are almonds, almond butter and nuts. Legumes (beans) as well as green vegetables (bok choi, collard greens, turnip greens) are calcium sources that should be incorporated in a nutrient rich diet.

More information about osteoporosis: http://nethealthbook.com/arthritis/osteoporosis/

Annual Meeting of the American College of Nutrition

Last updated Nov. 6, 2014

Dec

2008

Disease Of Peripheral Blood Vessels Occurs With Metabolic Changes

By Ray Schilling | Diabetes, Heart Disease, High Blood Pressure, Prevention, Weight loss

Metabolic syndrome has serious health consequences: diabetes, high blood pressure and heart disease are just a few conditions that are associated with it. It is also known that diabetic patients are prone to pressure sores and ulcers of their feet and if the leg became gangrenous, the patient would lose it due to the need to amputate. Peripheral artery disease or PAD has recently been studied by Dr. Aruna D. Pradhan, and the prospective study involved 27,000 women. At the beginning of the study the middle aged women were free of cardiovascular disease, but a quarter of them had the hallmarks of metabolic syndrome. Twenty five percent of those with the condition also were diabetic. During the 13 years of follow-up 114 women developed peripheral artery disease and those patients with metabolic syndrome were 62% more likely to develop the disease. The individuals with metabolic syndrome had other features: they were less likely to exercise, more likely to smoke and their weight was higher. But 7,000 women with metabolic syndrome had another important feature in their lab tests: they had markedly higher levels of biomarkers of systemic inflammation, which was manifested in higher levels of C-reactive protein.

: Metabolic syndrome causes peripheral artery disease

Once all the criteria are stacked up against each other, it becomes obvious that the presence of metabolic syndrome alone is not responsible for the most significant increase in peripheral artery disease. It is not the high cholesterol levels or the high triglyceride readings that are the villains in this condition. The driving force is systemic inflammation, as documented by the high C-reactive protein levels in blood tests.

More information about hardening of arteries: http://nethealthbook.com/cardiovascular-disease/heart-disease/atherosclerosis-the-missing-link-between-strokes-and-heart-attacks/

American Heart Association, New Orleans, Nov. 8 to 12, 2008

Last updated Nov. 6, 2014

Dec

2008

Treating Gastroesophageal Reflux Helps Asthmatic Kids

By Ray Schilling | Allergies, Asthma, Gastrointestinal Disease, Prevention

Asthma in children can be associated with allergies, but as Dr. Aaron K. Kobernick reported recently, other health conditions can also contribute to childhood asthma. He found that approximately two thirds of children with persistent asthma who had no allergic symptoms had another health condition, namely gastroesophageal reflux disease. The condition of acid reflux aggravates asthma. A prospective study examined children with moderate persistent asthma over a 2 year period. Initially the children underwent spirometry testing to assess their lung function. Another test involved monitoring of the acidity (ph values) in the esophagus of those children. The latter test demonstrated that the majority of the asthmatic kids also had GERD (gastroesophageal reflux disease).

: Acid reflux aggravates asthma

Those children who were free of acid reflux received asthma medication only, but the patients with acid reflux and asthma received medication to treat the reflux.
In some cases surgical intervention was necessary. It became apparent that the children whose reflux was treated either surgically or with medication had an improvement of asthma symptoms of 22 to 25 %, whereas asthma medication alone contributed only to an improvement of 11%. Dr. Kobernick concluded that the large airways can react to the exposure of stomach acid, which results in an aggravation of asthma symptoms. Treating the acid reflux condition will result in less asthma in young patients with GERD.

More information on:

1. Asthma: http://nethealthbook.com/lung-disease/asthma-introduction/

2. GERD: http://nethealthbook.com/digestive-system-and-gastrointestinal-disorders/acid-reflux-gerd-esophagitis-barretts-esophagus/

Annual Meeting of the American College of Allergy, Asthma, and Immunology, November 6 – 11, 2008, Seattle, Washington

Last updated Nov. 6, 2014

Nov

2008

Pills For Diabetes Not Always Useful

By Ray Schilling | Diabetes, Fitness, Heart Disease, Nutrition, Obesity, Prevention

Oral anti-diabetic drugs have been on the market for decades. They are often prescribed to patients with type 2 diabetes in an effort to control blood sugar levels. Type 1 diabetes patients, those who suffer from diabetes since childhood, generally require a different therapeutic approach. They receive insulin in the form of injections, or more recently by pump. The usefulness of the oral antidiabetic drugs has been researched by Elizabeth Sevin, PhD,MPH of John Hopkins Blomberg School of Public Health, Baltimore. Pooled data analysis found that patients who took one of the older medications, metformin, were at a reduced risk of death from cardiovascular illness. Metformin works by blocking the breakdown of glycogen (a storage form of sugar) in the liver, reduces absorption of sugar from the gut and increases insulin sensitivity thus controlling blood sugar more tightly. This protected the heart from cardiovascular illness. None of the other oral medications for type 2 diabetes was significantly linked to cardiovascular illness, but cardiovascular disease and mortality was higher in the patient group that took the drug rosiglitazone.

How metformin works for type 2 diabetes

Due to the controversial reports about this drug, the researchers took a closer look at all the other oral anti-diabetic medications. None of them, not even the newest ones, proved to be superior, and the only one that showed a slight benefit was metformin. The author cautions that the association is too weak to be of significance, and a lot more long-term research would be needed to substantiate the benefits for cardiovascular protection.

More information on Diabetes: http://nethealthbook.com/hormones/diabetes/type-2-diabetes/

Comments on Nov. 18, 2012: I do not see any further benefit for more research on oral anti-diabetic agents. Rather this type of research would indicate that subcutaneous insulin treatment 3 or 4 times per day as originally suggested by Banting and Best is still the best treatment for diabetes coupled with an exercise program and a low fat, low glycemic carbohydrate diet.

Arch Intern Med. 2008;168:2070-2080

Last updated Nov. 6, 2014

Nov

2008

Low Testosterone And Heart Disease

By Ray Schilling | Heart Disease, Hormones, Men's Health

More men than women seem to be affected by cardiovascular illness, and the reasons have been manifold. At one time work stress was cited for the prevalence of heart disease in men. Other lifestyle factors, lack of exercise, being overweight, poor dietary choices and smoking have been found to play significant roles. The risk for cardiovascular disease increases with age, as does the likelihood for hypertension, elevated cholesterol levels and glucose intolerance.

Some attention has been paid to the fact that hormones can also play a role, and research has now shown that testosterone has some direct cardiovascular effects. Testosterone has been found to dilate blood vessels. The effect can be likened to the calcium channel blocker Nifedipine. It has also been substantiated that males with coronary artery disease and heart failure tend to have low levels of testosterone. If testosterone deficient men receive replacement therapy, vasodilatation (dilation of blood vessels) has been demonstrated in males who have received testosterone replacement for a few months. Male hormone replacement therapy has also been found to relieve the symptoms of angina in patients with heart failure. The question, how testosterone fits into the concept of disease prevention, comes up in this context. Researchers have found enough evidence that a low testosterone blood level has an independent association with accelerated atherosclerosis (hardening of arteries).

Testosterone in men prevents heart disease

Animal experiments have shown that the development of fatty streaks in blood vessels happens at a higher rate in castrated animals. The more encouraging finding is the fact that this condition is reversible by replacement of testosterone. Male hormone therapy has received a lot of bad press in the case of overtreatment with androgens to achieve muscle growth in body building. However, in this case there was no testosterone deficiency and athletes and their coaches were using doses that were too high. This type of administration entails grave health risks and has nothing to do with good medicine. In case of hormone deficiency replacement the normal body function of a younger male is restored with bioidentical testosterone, which can be a tool to better health for the aging male. Anti-aging physicians are very familiar with this treatment modality.

More on the heart vessel protecting effect of bio-identical hormones:

http://nethealthbook.com/cardiovascular-disease/heart-disease/atherosclerosis-the-missing-link-between-strokes-and-heart-attacks/

Journal of Men’s Health – Volume 5, Issue Suppl (September 2008)

Last updated Nov. 6, 2014

Nov

2008

Hormone Dependency of Prostate Cancer

By Ray Schilling | Cancer, Hormones, Prevention

In this month’s Lancet Oncology Manit Arya et al. have reviewed the research and clinical achievements of Harvard Medical School trained Charles Huggins. This Canadian-born American surgeon won the Nobel Prize in Physiology and Medicine in 1966 for his outstanding research on treatment of prostate cancer. Here are the key findings of a publication in 1941 by Huggins and Hodges: 1. Prostate cancer is a cancer that is hormone controlled 2. Prostate cancer that has spread to other organs can be inhibited in growth by removal of testosterone production (surgical removal of testicles or orchiectomy) or by treating with female hormones (estrogens). 3. Prostate cancer that has spread to other organs is made to grow faster, if testosterone is injected. The authors of this review pointed out that despite hundreds of further research papers these “original studies have withstood the test of time”.

Low testosterone causes prostate cancer

Estrogen treatment has caused cardiovascular and thromboembolic complications, which resulted in cessation of this treatment modality. Newer studies attempted to improve prostate cancer survival with synthetic luteinising-hormone-releasing-hormone (LHRH) agonists and various antiandrogens, but nothing compares to the survival success of a simple orchiectomy. The authors concluded that Huggins and Hodges have provided an “epic work”, which will stand out from the myriad of publications in science for “years to come”.

Manit Arya, Dr, FRCS, Iqbal S Shergill, FRCS, Philippe Grange, MD, Mark Emberton, FRCS , The Lancet Oncology – Volume 9, Issue 11 (November 2008)

Comment on Nov. 18, 2012: Unfortunately this type of research has confused the treatment of prostate cancer for decades. I have explained this in detail under this link: http://www.nethealthbook.com/articles/cancer_prostatecancer.php#introduction It turns out that the precise opposite is true: The aging male who is most prone to develop prostate cancer needs testosterone replacement, as prostate enlargement and prostate cancer is due to a LACK of testosterone, which causes estrogen dominance. This hormone scenario takes place in the aging male, if not corrected! This type of patient would need an understanding urologist as explained under the link above. Unfortunately many physicians, including famous ones are slow to adapt to new knowledge from their peers (in this case Harvard trained Dr. Abraham Morgentaler, an urologist who is cited under the above mentioned link).

Last updated December 3, 2012

Nov

2008

Early Childhood Weight Gain Leads To Weight Problems in Teens

By Ray Schilling | Health, Nutrition, Obesity, Prevention

A Finnish Study enrolled 541 children in a prevention trial at the age of 7 months. The same children were seen again at the age of 13 years. Every year the height and weight were measured. By the time the children were 13 years old, 16% were classified as overweight, based on body mass index determinations. For girls, there was an abnormally high weight gain (2.8 to 7.5 kg annually) from the 3rd to 4th year until the 12th year of age while normal weight kids gained only 2.1 to 4.8 kg annually. Boys showed no difference in weight gain pattern until the age of 5 years or older. Now the boys who developed an overweight pattern showed an increase from 3.5 to 7.9 kg annually while normal weight boys gained only from 2.6 to 5.5 kg annually. With respect to the body mass index the upper limit of a normal was exceeded for girls at the age of 5 years and for boys at the age of 8 years. Another important finding of the study was that the parents of the overweight adolescents were also overweight while the parents of normal weight adolescents were also within the range of a normal body mass index.

Early Childhood Weight Gain Leads To Weight Problems in Teens

Overweight child turns into overweight teen

Two major risks of developing overweight and later obesity were found: overweight parents and abnormally high weight gain in early childhood (ages 2 to 4). The investigators concluded that treatment for developing overweight problems in childhood needs to be addressed at this age, not later when it is much more difficult to treat.

More information about health for children: http://nethealthbook.com/news/health-children/

Lack of B vitamins in children predicts obesity: http://nethealthbook.com/news/lack-b-vitamins-children-predicts-obesity/

Pediatrics. 2008;122:e876-e883

Last updated November 6. 2014

Nov

2008

A Study About Parents’ Concerns Regarding Childhood Vaccinations

By Ray Schilling | Infectious Disease, Lung Disease, Prevention

In the October issue of the medical journal Pediatrics researchers published a study where 3,924 parents had been interviewed in a National Immunization Survey. 28% of the parents either delayed the vaccination because of concerns or refused vaccination of their child altogether. A multivariate analysis was performed that shed more light on this. There was a probability of about 2.35-fold (compared to parents who had no concerns) that one of the following factors was responsible for this: parents who would delay a vaccination had on average 2 or more children (4.3-fold more likely to delay than parents with one child) and unmarried mothers also were more likely to delay (probability 2.14-fold). Parents had a probability of 2.68-fold to refuse a vaccination when the child was 25 to 35 months old when compared to those with a child younger than this. The varicella vaccine, which is a live attenuated vaccine, was mostly the reason given when parents were unsure as to whether to give permission for vaccination or when they refused to give consent.

In contrast, reasons for delays of vaccination were that the child was ill and the vaccination was given at a later date when the child had recovered. The reason that parents decided not to delay or not to decline vaccination was that they discussed their concerns with the health care provider and they felt now informed and assured that vaccination was the right thing to do. The authors felt that the study emphasized how important it is to inform the parents of the science behind vaccinations.

A Study About Parents’ Concerns Regarding Childhood Vaccinations

Comments: The study did not review the fears of mercury poisoning with the preservative thimerosal, which is still contained in the vaccines of many countries and has been shown to be particularly devastating in autistic children and children with learning disabilities.

Pediatrics. 2008;122:718-725

Last updated December 18, 2014

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