Medical Articles by Dr. Ray

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

Jun

2008

Diabetes Onset Can be Delayed

By Ray Schilling | Diabetes, Fitness, Nutrition, Prevention

Diabetes delayed by diet and exercise

Prevention is the buzzword in healthcare, but often medicine has to embark on the curative avenues. With the onset of a health problem patients are often tempted to throw in the towel: it’s too late now anyways. There is nothing I can do. It’s up to medication, pills or shots to get a handle on my problem. Nothing could be further from the truth, as major clinical trials have shown, when it comes to intervention to prevent the onset of diabetes. There is a stage where lab tests show that a patient has impaired glucose tolerance. He or she is”pre-diabetic”. Without intervention the development of diabetes is more or less imminent. But this does not mean that “it is too late “. It is exactly at that point, where lifestyle intervention can make a difference. How long do these post-intervention studies remain effective? Professor Guangwei Li at the China-Japan Friendship Hospital in Beijing, China and Dr. Ping Zhang from Centers for Disease Control and Prevention followed up patients 20 years after enrolment. In 1986, 577 adults from 33 clinics in China were randomly assigned to a control group or one of three lifestyle intervention groups (diet, exercise or diet and exercise combined).

Diabetes Onset Can be Delayed

All of the patients had impaired glucose tolerance. There was an active intervention program until 1992, and in 2006 participants were assessed for the long-term effect of the interventions. The results showed that the combined lifestyle interventions reduced the incidence of diabetes by about half during the active intervention period of 6 years. Over the 20 year duration the reduction was 43 %. At the end of the 20 year period 80% of the intervention group had developed diabetes, whereas 93% of the control group that had not followed a lifestyle intervention program were diabetic. The researchers reported that lifestyle intervention programs for patients with impaired glucose tolerance can indeed make a difference. A six year intervention program can delay the onset of diabetes by 14 years.

More information about diabetes: http://nethealthbook.com/hormones/diabetes/

Reference: Lancet 2008;371:1783-1789; 1731-1733.

Last edited November 3, 2014

Jun

2008

Boost Babies’ Health with Mom’s Diet

By Ray Schilling | Allergies, Asthma, Health, Nutrition, obstetrics, Prevention, Vitamins and supplements

Prenatal supplements and good advice on proper nutrition during pregnancy have long been included in proper prenatal care. Importance has been placed on folic acid to prevent neural tube defects in the fetal development. Calcium is recommended, often in the form of dairy products, but it does not end there: just swallowing the supplement and adding some more milk may be helpful but not quite enough. Certain dietary habits have been found more beneficial, such as the eating habits in the Mediterranean countries. A research team from the University of Crete in Heraclion, Greece included women who were involved in antenatal care at all general practices in Menorca, Spain. The study took place in the time frame of 12 month starting in 1997. After six and a half years 460 children were also included in the analysis.

Dietary habits were studied and assessed by food questionnaires and the children were assessed for the development of allergies and asthma.

Boost Babies’ Health with Mom’s Diet

The children of mothers who consumed the most vegetables, fish and legumes were almost 80% less likely to have persistent wheeze and more than 40 % less likely to have allergies. The results are consistent with the fact that a high level of adherence to the Mediterranean diet during pregnancy is protective not only to the mother but also to the child.

More information about prenatal visits (where nutritional habits are checked as well): http://nethealthbook.com/womens-health-gynecology-and-obstetrics/pregnancy-labor-delivery-2/prenatal-visits/

Reference: The Medical Post, April 22, 2008, page 25

Last edited December 18, 2014

Jun

2008

You Are What You Sleep

By Ray Schilling | Obesity, Stress management

Lack of sleep can lead to childhood obesity

Stressful lifestyles often contribute to physical disorders and psychological difficulties, but little has been known about the fact that unbalanced sleep patterns also dysbalance a healthy body weight. Jean-Philippe Chaput of Laval University, Quebec City presented some facts at the 16 th European Congress on Obesity in Geneva, that emphasizes the importance of a balanced sleep pattern. There can be not only too little sleep but also too much sleep, as Dr. Chaput found out by studying 276 adults. Those who had a pattern of short duration sleep (5 to 6 hours) and those individuals who slept 9 to 10 hours were 35% and 25% more likely, respectively to show weight gains of 5 kg compared to the group that slept for 7 to 8 hours. The most likely reason is an alteration of certain hormones: short sleepers had high leptin levels and low ghrelin levels. In a previous study on children it also became obvious that to little sleep increases the risk of overweight and obesity in children. It was also possible to establish the type of weight gain.

You Are What You Sleep

Short sleep duration in kids lead to abdominal fat rather than to overall body fat deposits. Too little sleep in children seems to have more health consequences than previously thought, as it is the most important risk factor for overweight in this group. The most important risk factor was sleep duration that is too short, followed by parental obesity, watching TV and lack of physical activity.

More information about sleep apnea: http://nethealthbook.com/ear-nose-and-throat-diseases-otolaryngology-ent/nose-problems/sleep-apnea/

Reference: From the 16th European Congress on Obesity, May 2008

Last edited November 3, 2014

Jun

2008

New Modified Carrots and Food from Cloned Animals

By Ray Schilling | Nutrition

Researchers from Texas A&M AgriLife’s Vegetable and Fruit improvement Center and a research group from Baylor College of Medicine reported about their work earlier this year. They developed a new variety of super carrots that contain 41% more calcium than the regular garden varieties. In a study 15 men and 15 women ate regular carrots for a week. At the end of the week urine samples were taken to examine the amount of calcium absorbed. The test persons ate the modified carrots for a week, and more urine tests were taken. The result showed a higher intake of calcium from the modified carrots. The head of the study, Dr. Jay Morris, PhD made a statement that fruit and vegetables are beneficial for many reasons, but they have never been a good food source for calcium. He states that if the new technology is applied to a number of different fruit and vegetables, it could have a significant impact on preventing osteoporosis. This research may sound like a futuristic concept, but bioengineering and food from bioengineered animals may soon be a reality for consumers in the United States and in Europe. The FDA has reported that, for the most part, milk and meat from cloned animals is safe to eat. The European Food Safety Authority has also concluded at the same time that milk and meat from healthy cloned cattle and pigs are suitable for human consumption. At this point there was not enough information for the agency to come to a conclusion on the safety of food from other animal clones, such as sheep. The European agency noted that death and disease rates are higher in cloned as compared to conventionally reproduced animals, and it would be of essence that unhealthy clones will not enter the food supply.

New Modified Carrots and Food from Cloned Animals: BUY ORGANIC!

The European Group on Ethics in Science and New Technologies (EGE) advises against food production from cloned animals due to the current level of suffering and health problems in surrogate dams and animal clones. Cloning remains fraught with perinatal and postnatal disease of cloned animals. Abnormalities are also common in the form of malformations, increased weight, respiratory problems, enlarged fetal liver and kidney abnormalities. Ultimately the old adage is as valid as ever, even if it comes to the mundane task of shopping for dinner. It is called “buyer beware”!

More information about the safety of our food: https://www.askdrray.com/our-endangered-food/

Reference: The Medical Post, April 22, 2008, page 25

Addendum on Nov. 16, 2012: Buy 100% organic food. It is freightening to see how superficial the FDA testing methods have become with respect to cloned foods, genetically modified foods etc. Your only recourse is to buy 100% organic food!

Last edited November 3, 2014

Jun

2008

Puzzling New Neurological Syndrome Investigated

By Ray Schilling | Other neurological conditions, Pain

A new neurological syndrome has been described in early December 2007 and is presenting a challenge not only to the affected patients but also to the health professionals. The illness is characterized by pain, sensory symptoms, weakness and fatigue. Abnormal lab tests and MRI scan results were also present. The syndrome has affected at east two dozen workers who are working in pig slaughterhouses in three states of the U.S. Researchers have now a somewhat clearer picture of the mysterious illness, but Dr. Daniel Lachance, assistant professor of neurology at the Mayo Clinic in Rochester, Minnesota, describes the illness as one of the kind that has “defied explanation and a name”. At this point investigators have called it “progressive inflammatory neuropathy” (PIN), but the term is merely descriptive but not accurate enough. Dr. Lachance described the clinical picture based on findings on 18 patients from Minnesota who have been investigated in the most comprehensive manner.

The course of their illness was marked by pain, decreased sensation and tingling along with weakness and fatigue which far exceeded the findings of physical examinations. All of the affected individuals had abnormal MRI’s and abnormal results of the labs of their cerebrospinal fluid. Various tests of reflexes or quantitative sensory testing also showed abnormalities, and nerve conduction studies were abnormal in most of the patients. All of them had a new IgG auto-antibody biomarker. The findings point to an immune-mediated phenomenon which translates into a neurological illness. The workers affected all were exposed to aerosolized brain particles from slaughtered pigs.

All workers worked in the “warm room” where pigs were slaughtered and the brain extracted in a technique in which compressed air is shot into a dead pig’s foramen magnum. This blast of compressed air not only emulsifies the brain, but some of it becomes aerosolized and airborne. Symptoms seem to start within days or weeks of exposure, after which the course of the disease is chronic.

: Progressive inflammatory neuropathy caused by aerosolized brain particles from slaughtered pigs

Treatment has been symptomatic in those most severely affected with the medications of choice being methylprednisolone and/or intravenous treatment with immune globulin. Researchers have tested early on for human and porcine pathogens, but no infectious agent has been found. The precise mechanism by which the illness is occurring is not fully understood, but the syndrome does not seem to be food borne or transmissible from person to person.

Reference: The Medical Post, May 13, 2008, page 14, 15.

Last edited December 4, 2012

May

2008

When Kids Are Migraine Sufferers

By Ray Schilling | Other neurological conditions, Pain

It is often assumed that migraine headaches are reserved for people with a family history of migraines and that those who are afflicted by those disabling headaches are usually adults. When a child has the symptoms of migraine headaches it is usually a source of grave concern to the parents. Dr. Lewis reported about his findings at a meeting which was sponsored by Rady Children’s Hospital. He has seen many young persons who suffer of headaches and pointed out that the greatest fear of the patient and the parents, is the thought of a developing brain tumor. If a patient has been having headaches for half a year or two years and has had an entirely normal neurological exam, Dr. Lewis can reassure the patient that there is no brain tumor. Breaking the vicious cycle of fear by reassurance often lifts a load of the patient’s back and things may settle down. About 11% of children in the age group of 5 to 15 years have migraine type headaches. The incidence has a peak at 12 years in boys and at 14 years in girls. Migraines have different criteria than headaches: there are at least 5 lifetime attacks that have a least two of the following symptoms: severe aches on both sides of the head, the front or on one side only, throbbing aches, moderate to severe pain that gets worse with activity. At least one symptom of the following has to be present: either light sensitivity, sensitivity to noise, nausea and vomiting. Dr. Lewis reports that proper sleep habits can make a difference. Too little, too much or inconsistent sleep is closely associated with the frequency of migraines. He cited the example of a sixteen year old who started having migraines after school ended at the end of June. She stayed up late and slept till noon. Once she returned to a regular sleep cycle she did a lot better. Eating patterns can play a role too. One of the common stories is the student skipping lunch and developing a headache about an hour later. Other migraine triggers can be sensitivities to certain foods, altitude changes, weather, motion sickness on a trip, excitement, dehydration and learning problems. Dr. Lewis reported that many of the very young patients age 4 to 5 with migraines may have attention-deficit hyperactivity disorder. If the performance problems are addressed headaches will resolve in 80 to 90% of the time. Headaches can also be linked to emotional aspects, peer problems at school, family problems or depression.

When Kids Are Migraine Sufferers

There is no drug that is officially approved for migraines in children. The medication that has been studied most closely is ibuprofen. A controlled trial of 7.5 mg/kg showed a response of 76 %. Acetaminophen with a dose of 15 mg/kg was studied in patients aged 4 to 16 years. The response was 54%. Neither of those two medications showed any adverse side effect. Sumatriptan nasal spray was well tolerated, showed a 1 hour response of 58%, had no side effects, but a bitter aftertaste. It was also pointed out that in a study oral sumatriptan and placebo scored the same. It is obviously most important to get to the root of the problem and eliminate the triggering factors after which medication can be used. The general consensus is to treat the attacks rapidly and consistently, get the patient back to his or her daily functioning, minimize backup medications and make sure that there are minimal or no adverse side effects.

More information about:

1. Attention-deficit hyperactivity disorder: http://nethealthbook.com/mental-illness-mental-disorders/developmental-disorders/attention-deficithyperactivity-disorder/

2. Migraine headaches: http://nethealthbook.com/neurology-neurological-disease/common-causes-headaches/migraine-headache/

Reference: Presentation at Annual Advances in the Practice of Pediatrics: San Diego 2008; Feb. 22-24, Hilton La Jolla

Last edited November 3, 2014

May

2008

Glucose and Colorectal Cancer Are No Sweet Deal

By Ray Schilling | Cancer, Diabetes, Heart Disease, Nutrition, Obesity

It has been noted in various publications that insulin resistance carries a host of health risks: aside from type 2 diabetes, there is cardiovascular disease. Also high insulin levels are associated with growth hormone like substances in the body. These substances are contributing to the development of some cancers.

There is other extensive medical literature stating that glucose (=sugar) and refined carbohydrate (cookies, cakes, French fries, doughnuts, bread, rice, potatoes) intake lead to chronic inflammation in blood vessels throughout the body, but also to a weakening of the immune system. This explains why such varied diseases as high blood pressure, hardening of arteries with resulting strokes and heart attacks, diabetes, asthma and cancer are caused by the same chronic inflammation that in turn is brought on by our eating habits of a refined diet consumed by most industrialized nations. This blog deals only with cancer of the colon and cancer of the rectum as a result of chronic inflammation.

Researchers from Minnesota and Maryland examined 375 individuals with recurrent polyps (=adenomas) and the identical number without recurrent adenomas. They followed the course of the patients for 4 years. In their study they looked at fasting serum. Patients who were found to have the highest levels of both insulin and glucose in their serum were at an approximately 50% higher risk of colorectal cancer recurrence. The strongest risk factors were elevated glucose levels.

Glucose and Colorectal Cancer Are No Sweet Deal

The individuals with the highest glucose levels also tended to be slightly older, have a higher waist to hip ratio and a higher body mass index. These results do point out the necessity of keeping a close tab on glycemic control in person with a history of colorectal polyps. It also is evident that consuming foods with a low to medium glycemic index will help to reduce the risk for colonic cancers.

More information about:

1. Colon cancer: http://nethealthbook.com/cancer-overview/colon-cancer/

2. Sugar causes cancer: https://www.askdrray.com/sugar-as-a-cause-of-cancer/

Reference: The Medical Post, April 1, 2008, page 21

Last edited November 3, 2014

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