Medical Articles by Dr. Ray

Aug

2008

Osteoporosis Drug Prevents Breast Cancer Recurrence

Standards in breast cancer treatment have been surgery, radiation therapy and chemotherapy. In hormone receptor positive cancer types Tamoxifen has been the drug of choice for many years to achieve suppression of the ovaries in premenopausal women. A new medication under the name of Anastrozole has also been introduced. In the meantime researchers have examined the success of the various approaches. No difference has been found between Anastrozole and Tamoxifen, but a new drug which has been used for osteoporosis patients shows that it can boost disease free survival for breast cancer patients. The medication called zoledronic acid taken in combination with either Tamoxifen or Anastrozole can increase disease free breast cancer survival by 36%. Zoledronic acid can inhibit tumor cell growth and stimulate the immune response, and the lead author of the study, Dr. Michael Gnant concludes that the combination treatment creates a tumor-hostile environment. The benefits are not only a reduction of bone metastases but others as well.

Osteoporosis Drug Prevents Breast Cancer Recurrence

The most concerning side effect is osteonecrosis of the jaw, but the researcher reported that in the trial not a single case has materialized. Other researchers, such as Dr. Martine Piccart-Gebhart , professor at the department of oncology at the University of Brussels caution that this is an important trial, but it should not be seen as a practice-changing trial. More work is needed to establish the best dosage and treatment schedule. More results from other trials investigating the combination treatment with zoledronic acid are expected this summer.

More information about breast cancer: http://nethealthbook.com/cancer-overview/breast-cancer/

National Review of Medicine, June 2008, page 18 and 19

Comment on Nov. 17, 2012: There is criticism regarding Zoledronic Acid because of osteonecrosis of the jaw and the fact that biophosphonates also have the metatasis suppressing effect. See this link.

Last edited November 4, 2014

Aug

2008

Iron Intake Lowers Blood Pressure Readings

By Ray Schilling | High Blood Pressure, Nutrition, Vitamins and supplements

Various possibilities exist to lower blood pressure. Reducing the intake of sodium is one effective way, exercising is also of importance. Detailed studies on various population groups have shown that the consumption of red meat has a direct relationship to blood pressure readings: a 102.6 gram in 24 hours increase in the consumption of red meat was related to an increase of 1.25 mmHg in blood pressure readings. The numbers may sound small and insignificant, but the fact remains that population groups, such as the Japanese, who traditionally consume little or no red meat have lower blood pressure readings.

Red meat is considered a valuable iron source, but the intake of iron containing foods (such as red meat) from animal sources is linked to higher blood pressure readings, based on the “International Collaborative Study on Macro-/Micronutrients and Blood Pressure” (=INTERMAP).

Iron Intake Lowers Blood Pressure Readings

Current INTERMAP results suggest that the intake of non-heme iron, which is from non-animal sources has a blood pressure lowering effect. Further investigations are needed to detail these findings and to find out more about the reasons of the blood pressure increasing, respectively decreasing effect of iron from animal sources and iron from plant sources.

More information about high blood pressure: http://nethealthbook.com/cardiovascular-disease/high-blood-pressure-hypertension/

Reference: BMJ 2008;337:

Last edited November 4, 2014

Aug

2008

Dietary Habits Help For Clear Skin

By Ray Schilling | Nutrition, Skin Disorders

Acne can be a bothersome skin condition that is not only a source of embarrassment to adolescents but it can plague adults as well. A lot of foods have been associated with the annoying “zits” from chocolates to French fries or junk food. More research has come up in recent years, and some new facts have emerged. Clement Adebamowo of the Harvard School of Public Health in Boston studied 4,000 teenage boys and found a significant association between the intake of skim milk and the development of acne. There are numerous explanations for the dairy-acne connection. According to US doctors Alan Logan and Valori Treloar there are at least 4 precursors of the “acne hormone” dehydroepiandrosterone in milk from pregnant cows. Even though milk has a low glycemic index research has substantiated that milk based foods increase levels of insulin. Insulin in turn seems to be one of the major players when it comes to skin fat production (sebum). This leads to the blockage of skin follicles and the development of blackheads and acne. Lacks of dietary oxidants are also putting fuel on the fire of acne. Acne sufferers demonstrate lower antioxidant blood levels and as a result there is no ammunition to fight the skin inflammation of acne. Other foods contributing to this problem are omega-6 rich oils (sunflower, safflower and soybean).

Dietary Habits Help For Clear Skin

Strong allies to fight the inflammatory process of acne are foods that are rich in omega-3 fatty acids such as salmon, mackerel or sardines. The intake of fruit and vegetables is beneficial (acne sufferers generally eat fewer fruits and vegetables than those who have a clear skin.) A trial by Robyn Smith of RMIT University in Melbourne, Australia showed that acne patients who were instructed to consume a low glycemic diet high in protein had significantly less acne lesions that their counterparts. This dietary approach reduces androgen levels. Beside a dietary approach there is still the need for dermatological input. Using both avenues acne sufferers will reap the most benefits.

More information about acne vulgaris: http://nethealthbook.com/dermatology-skin-disease/acne-vulgaris/

The Medical Post, June 24, 2008, page 19

Last edited November 4, 2014

Aug

2008

Positives And Negatives Of Folate

By Ray Schilling | Nutrition, obstetrics, Vitamins and supplements

Ten years ago folate became the hero among the food additives. The decision was made to make it mandatory to enrich flour, pasta and other foods with folate with the goal to reduce the incidence of neural tube defects in newborns. Folate also was a valuable as a prenatal supplement. A study which involved seven provinces of Canada which was published in July 2007 in the New England Journal of Medicine showed that the supplementation has been a success in this respect, as neural tube defects had been reduced by 46 %. Folate also seems to have been of benefit in the reduction of strokes, as it has the propensity to lower blood homocysteine concentrations. In the meantime not all seems to be well, as there is a darker side to folate. Already decades ago studies warned that folic acid given to leukemia patients hastened the progression of the disease. In a publication of the American Medical Association results from a polyp prevention study were written up. The vitamin was associated with a higher rate of advanced adenomas (tumors of the colon). These findings cannot be easily ignored. On the one hand about 1,500 children are saved from a devastating birth defect; on the other hand the number of colon cancer cases increases by 15,000 per year. At this point there is no suggestion in Canada or in the US to abandon the food fortification with folate. In the U.K. the implementation of folate fortification has been delayed till more research is available.

Positives And Negatives Of Folate

As food supplementation with folate may be higher than necessary, it seems wise to exercise a measure of caution. Women with a family history of colonic polyps should be advised to take the minimum folic acid dose in their prenatal supplementation. As far as male patients are concerned doctors should excise caution before they advise patients that are over 40 about the perceived benefits of vitamin supplementation. Any of the perceived benefits ought to clearly outweigh the potential risky side effects, which is not only true for any medication but also for any vitamin supplement.

Reference: The Medical Post, July 8, 2008, page 1 and 23

Last edited December 4, 2012

Aug

2008

Lead Poisoning Down, But Watch For Mercury

By Ray Schilling | Health, Nutrition

The devastating results of lead poisoning in children have put consumers on alert. Lead in paint and in the glaze of ceramic products has gone unrecognized until the 1970’s. Since then stricter regulations have reduced or eliminated lead from paint products in North America. The additional move to unleaded gasoline has contributed to successful lead reduction. Consumers, however, should not let down their guard and be aware of the fact that there are still possibilities of lead exposure. Sources can be manifold. While most of lead exposure domes from old lead paint that was applied decades ago, especially in older homes, some exposure can come from imported toys, which just recently made headlines in the news. Some exposure can also come from medications and “nutritional products” imported from overseas. Imported cookware and other products have also been a significant source of lead contamination. The general awareness has paid off, as there is a significant reduction of lead levels since the ‘70’s. Public health warnings have been issued about mercury levels in fish, and this has led to concerns in consumer groups whether it is safe at all to consume fish. Blowing the warning whistle alone does not do a service to consumers. It is much more important to inform consumers to recognize, which of the fish species are averaging less than one tenth of Canada’s commercial mercury limit if 0.5 parts per million.

Lead Poisoning Down, But Watch For Mercury

Dr. Copes, director of environmental health at the B.C. Centre for Disease Control explained at a recent meeting that salmon, rainbow trout and tilapia fall into this group of fish that can be enjoyed more frequently, whereas other species, such as halibut, tuna and sablefish have levels of mercury that are five to ten times higher. They are still under the commercial limit, but it means that the consumer could enjoy 10 meals of salmon as opposed to one meal of halibut, tuna or sable fish. The recommendation is not total avoidance, but less frequent consumption.

Reference: The Medical Post, July 22, 2008, page 17

Comment on Nov. 17, 2012: The oceans are continuing to deteriorate with regard to mercury content. It is no longer safe to eat halibut, tuna or sable fish. Salmon, rainbow trout and tilapia should be limited to perhaps once per week. Avoid salmon that has migrated past Japan because of radioactive contamination of the coast region there (due to the earth quake in March 2011, the devastating tsunami and subsequent radiation crisis from the nuclear plant).

More information about toxins in the environment: https://www.askdrray.com/protecting-yourself-from-environmental-toxins/

Last edited November 4, 2014

Jul

2008

Genetic Difference Influences Sweet Tooth

By Ray Schilling | Diabetes, Nutrition, Obesity, Weight loss

Environmental factors and ethnic customs can influence us to have certain likes and dislikes of foods, but researcher Ahmed El-Sohemy has found in his studies that there is also a biological and genetic basis for some of our food preferences. Researchers from the University of Toronto have discovered a genetic difference in people who consume extra sugar in their diet. The specific genetic constellation which the researchers have called GLUT2 does not only work in the pancreas, but it also is responsible for turning on satiety signals in the brain. It seems to have an impaired ability to notice high blood sugar levels that ultimately send “stop eating” signals to the brain. The habit to eat more sweets has been researched in persons with diabetes, but Dr. El-Sohemy does not believe that diabetes is directly connected with gene GLUT2. On the other hand he does not suggest that the presence of the gene should be an excuse to overindulge in sugar high foods. He states that food habits in humans are often connected to the availability of foods: if there is a birthday party and birthday cake, the people with a liking of sweets will be the first to get a slice of cake. On the other hand, if there are no sweets available, they will not make an extra trip to the store just for a piece of cake. The most logical approach is to minimize the availability of foods that are high in sugar, which is especially important for individuals who have GLUT2, the ”sweet tooth gene”, so they are not tempted to overindulge.

Genetic Difference Influences Sweet Tooth

Much was learnt from two separate studies that involved 100 older adults on the one hand who were overweight or obese and 587 healthy younger adults who were mostly lean. Foods and beverages that were consumed were carefully recorded. In both investigations blood was drawn for DNA analysis and the presence or absence of the variation of the GLUT2 gene was compared to the food intake data. The older obese group with the variant gene consumed 112 grams of sugar per day versus 86 Grams per day for the non-variant gene group (normal control). The younger population carrying the variant gene consumed 131 Grams of sugar per day, while the non-variant control of young people consumed 115 Grams of sugar per day. This illustrates how genetic influences have an effect on our eating habits and also that younger people ought to be careful that they do not overuse sugar containing foods.

It also points to the solution of controlling your weight, if you belong to the higher risk group with the GLUT2 gene: you must exercise more to burn up the extra calories you tend to eat. A brisk walk on a treadmill will consume about 300 or 350 Cal in 30 minutes depending on the slope and the miles per hour setting.

Reference: Medical Post Vol 44, No. 16, June 16, 2008: page 19 (based on May issue of Physiological Genomics)

Last edited December 4, 2012

Jul

2008

Have A Cup Of Coffee And Decrease Your Death Risk

By Ray Schilling | Health, Heart Disease, Nutrition

Coffee can be good for you, and this is one of the items, which even tastes good! There are some exceptions as discussed in previous articles: more than 2 cups per day can increase the risk for miscarriages in pregnant women. People who are anxious or nervous can find that coffee will aggravate anxiety. Patients with rheumatoid arthritis should also not indulge in the flavorful brew.

Aside from these exceptions researchers have found that coffee consumption can be beneficial. A recent study using the data from 41,736 male and 86,214 female subjects has evaluated data over a follow- up time of 18 years in the male group and 24 years in the female group. The risk of all-cause mortality decreased significantly with increasing coffee consumption in the male as well as in the female group.

Men had a relative risk reduction of 20% as compared to their counterparts with the lowest level of coffee consumption. Women with intermediate to high consumption had a relative risk reduction of 10% to 30 % as compared to the group that drank less than 1 cup of coffee per day.

Have A Cup Of Coffee And Decrease Your Death Risk

The limit of the study in this case was the self-reported nature of coffee consumption, but the researchers feel that the modest benefit of reduction of all-cause and CVD death warrants further investigation.

Reference: June 17, 2008 Annals of Internal Medicine

Last edited December 4, 2012

Jul

2008

Buprenorphine Prevents Relapses For Heroin Addicts

By Ray Schilling | Prevention, Substance abuse

It is a great challenge for persons who are suffering of drug addiction to quit. There is the difficult period of detoxification. Even though there is a lot of support, there will be intense withdrawal symptoms, and every drug free day is a hard won victory. It is a major milestone on the road to recovery to be discharged from a detox program, but the task to remain drug free and abstinent is anything but easy. For this reason it is of utmost importance that support to prevent a relapse is available in the form of counseling, support groups and a maintenance program which involves medication is accessible to the patient.

A standard treatment drug has been naltrexone which helped the recovering addict to remain abstinent. It has been largely used in patients who were recovering from heroin addiction. Dr. Richard Schottenfield from Yale University School of Medicine, New Haven, Ct. and colleagues led a randomized trial to compare the efficacy of the standard drug regimen of naltrexone with the medication Buprenorphine in patients who were in the process of receiving detoxification and drug counseling. A group of patients received placebo (sugar pills that contain no medication.) From the 126 detoxified heroin dependent patients 43 received the standard treatment of naltrexone, 44 received Buprenorphine and 39 took placebo pills.

Buprenorphine Prevents Relapses For Heroin Addicts

The researchers found that patients who received Buprenorphine lasted nearly twice as long till they experienced a relapse than those who were on naltrexone and more than twice as long as compared to those who took placebo pills.HIV risk reduction behaviors were significantly reduced in all three groups. Maintenance treatment with Buprenorphine is a significant public health approach to reduce problems that are connected with heroin dependence and can make a difference to the recovering heroin addict on the path of abstinence from the drug.

More information about opium and heroin addiction: http://nethealthbook.com/drug-addiction/opium-heroin/

Reference: Lancet (2008) vol.371, pages 2192-2200 and 2150-2151

Last edited November 4, 2014

Jul

2008

Chronic Kidney Disease Kills

By Ray Schilling | Diabetes, Heart Disease, High Blood Pressure

Chronic kidney disease (CKD) has been on the rise for several years and is responsible for premature deaths all over the world. Many different kidney diseases (glomerulonephritis, pyelonephritis, diabetic nephropathy, hypertensive nephropathy etc.) will lead to end stage kidney disease, called chronic kidney disease, and this in turn would require dialysis treatment or a kidney transplant. Often these patients will die prematurely.

Dr. Chi-Pang Wen and collegues from the National Health Research Institutes, Taiwan, have followed a total of 462,293 people with all stages of CKD since 1994. At the end of 2006 there were 14,436 deaths in this population. The two best screening tests to predict deterioration of kidney disease were the flow rate of fluid through the kidneys (medically termed “glomerular filtration rate”) and protein tests of urine. The glomerular filtration rate should stay constant and above a certain cut-off point, and protein should not leak into urine. When the medical researchers started to analyze the results of this study, they found that CKD was affecting about 12% of the general population (the figures are very similar to the US). The patients with CKD had an 83% higher general mortality and had a 100% higher mortality from cardiovascular diseases.

Chronic Kidney Disease Kills

After a 13 year observation period with a median follow-up of 7.5 years 10.3% of the deaths in the entire population were due to CKD. In the low socioeconomic status group this figure was 17.5%. About 40% of the deaths from CKD occurred before the age of 60. Those in the study who had been taking Chinese medicines had a 20% increased risk to develop CKD.

In most countries around the world regular yearly screening of glomerular filtration rates and testing for protein leakage into urine is not done on a large scale. But this is the only way to prevent early kidney disease from developing into chronic kidney disease. Once early kidney disease has been identified, preventative measures like salt restriction, treating diabetes and treating unrecognized high blood pressure etc. can be implemented. In many cases this will prevent the need for dialysis, kidney transplants and death from chronic kidney disease.

More information about pyelonephritis, one of the possible causes of kidney failure: http://nethealthbook.com/infectious-disease/urinary-tract-infection/pyelonephritis/

Reference: Lancet ( 2008), vol. 371, page 2173 to 2182 (June 28, 2008)

Last edited November 4, 2014

Jul

2008

High-protein, Low-refined carb diet useful in controlling diabetes

By Ray Schilling | Diabetes, Nutrition, Obesity, Weight loss

Diabetes type 2 is often associated with obesity (body mass index higher than 30.0 kg per meter squared). At the 16th European Congress on Obesity in Geneva Dr. Neil Mann presented a study of 99 patients. Half were put on a high protein diet, the other half on a high carbohydrate low glycemic index diet and followed for one year with periodic blood tests and examinations by their family doctors. The study population’s age ranged from 30 to 75 years and their body mass index varied from 27 to 40. The hemoglobin A1C level that is a measure of severity of the diabetic condition ranged from 6.5% to 10%.

The high-protein diet was structured so that 30% of calories came from protein, 40% came from carbohydrates and 30% came from fat. With the high-carbohydrate low glycemic index diet 15% of the calories came from protein, 55% from low glycemic index carbs and 30% from fat. In both groups the total calorie intake per day was restricted to 1500 calories and the carbohydrates were given as low glycemic index carbohydrates (less processed). In both groups the diabetes was better controlled with hemoglobin A1C, triglyceride levels and cholesterol levels normalizing. Both groups also showed an equal amount of weight loss that stayed down as long the patients adhered to the diet. However, the high-protein group was able to reduce diabetes pills (metformin) and insulin achieving the same results as the high-carbohydrate low glycemic index group that could not reduce their medications. The conventional approach is to use a low-fat, high-carbohydrate diet along with medication. However, this diet tends to lead to higher triglyceride levels, higher blood sugar levels and a reduction in the good cholesterol (HDL).

High-protein, Low-refined carb diet useful in controlling diabetes

Dr. Mann who is a professor and head of the department of nutrition and food science at RMIT University, Melbourne, explained the people get confused when they hear the term high-protein diet as they think of the Atkins diet where the protein component was much higher. The diet that was investigated here is a more natural diet consisting of slightly higher protein and less processed carbohydrates. By containing more fat than in the conventional diabetic diet the patient is not getting hungry and finds it easy to stick to the diet, which leads to weight loss and improvement of the metabolism. Many patients can normalize their blood values and often even get off their diabetic medication (under careful supervision by their treating physician). The physician will address the three components of diabetic control (energy balance, glycemic control, and vascular complications) by recommending to the patient this high-protein/low-carb diet. This likely will replace the conventional approach of using a low-fat, high-carbohydrate diet.

More information about a Mediterranean type diet in firefighter’s, which is very similar to this study: http://nethealthbook.com/news/mediterranean-diet-benefits-us-workers/

Reference: 16th European Congress on Obesity, Geneva June 23, 2008

Last edited November 4, 2014

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