Medical Articles by Dr. Ray

Mar

2007

Check For Vitamin B12 Deficiency In Elderly

By Ray Schilling | Mental Health, Nutrition, Prevention

Elderly patients frequently are seen at the doctor’s office because they are “feeling poorly”. Concerned family members mention that there is lack of energy, and mental impairment may also be present. Immediately there may be the question, whether these are symptoms of Alzheimers disease. The other observation may be that the older person is not eating properly. Family physicians will order laboratory tests including vitamin B12 levels. If a deficiency is shown, patients will be advised to take a vitamin supplement, and they may receive injections of vitamin B12.
The unfortunate fact is that vitamin B 12 levels are notoriously unreliable in the diagnosis of deficiency. As early as 1988 a publication in the New England Journal of Medicine showed that neuropsychiatric disorder due to vitamin B12 deficiency can be present in a patient who had normal blood levels and no other findings. It does take some other avenues to detect the deficiency. The blood can be tested for the metabolite called MMA (methylmalonic acid) which is raised with vitamin 12 deficiency. A second test is the measurement of HTC (holotranscobalamin), which is the fraction of vitamin B12 bound to the plasma protein transcobalamin, which delivers the vitamin to the tissues of the body.
Dr. Cherie McCracken and colleagues from the department of psychiatry at Liverpool University, England studied 42 men and 42 women ages 69 to 93.They were tested for cognitive functions like orientation, language, attention and memory. In addition researchers took measurements of the MMA and HTC, the tests mentioned above. None of the test persons had dementia due to the selection criteria, but 31% were cognitively impaired. Mental scores indicating cognitive impairment were associated with increasing age and MMA, and the areas of language comprehension, language expression and ideation practice (translating an idea into an action) were affected.

Check For Vitamin B12 Deficiency In Elderly

The reason for the correlation of MMA with impairment of brain function can be explained by the fact that MMA is toxic to the oxidative function of mitochondria. The process is like a chain reaction: when mitochondria are poisoned, the nerve cells will lack energy for proper function.
Despite this sophisticated interplay of blood levels and cell function in the brain, the message that comes from the researchers is very simple. The MMA has to be ordered as a test in elderly persons, and the next important step is supplementation with vitamin B12 to prevent deterioration in mental functioning.

More information about:

1. Causes of dementia: http://nethealthbook.com/neurology-neurological-disease/alzheimers-dementia-and-delirium/dementia/

2. Pernicious anemia: http://nethealthbook.com/anemia/anemia-from-deficient-red-blood-cell-production/megaloblastic-macrocytic-anemia/

Reference: The Medical Post, January 16, 2007, page 27

Last edited November 2, 2014

Mar

2007

Olive Oil No Magic Elixir

By Ray Schilling | Health, Nutrition

Health trends come and go, and some myths need to be demystified, such as the notion that we need a lot of one beneficial food to achieve good health. The Mediterranean diet has become a buzz word in the public, and there is certainly nothing wrong with a diet that emphasizes the benefits of vegetables and fish with omega-3 fatty oil. These figure prominently in foods of the Mediterranean. Olive oil, which is one of the fat sources, has been also touted as a “miracle food”, and the benefits of the healthy fats to which it belongs have received a lot of attention.
Dr. James Kenney, who holds a PhD in nutrition at the at the Pritikin Longevity Centre, questions inflated health claims of olive oil. No matter, which way you look at it, olive oil remains a calorie-dense and nutrient-poor food. Pound for pound, like all refined oils, olive oil has more than 4000 calories, and 13% to 14% of the calories in olive oil come from saturated fat. The good news is that compared to lard (38% saturated fat) and butter (63% saturated fat) olive oil is the better choice. People who switch from butter to olive oil will see a reduction of cholesterol, reports Dr. Kenney. The reason is that they are eliminating a lot of saturated fat, trans fat and cholesterol that was in the butter. Olive oil itself does not lower cholesterol, as monounsaturated fatty acids do not raise or lower cholesterol. As a result it is not a good idea to freely pour olive oil into salads, over vegetables or to dip white bread into it, transforming it into an oil-dripping calorie bomb.

Olive Oil No Magic Elixir

Olive oil can be compared to rocked fuel: it is a high calorie food, and if you plan to go on a long distance bike excursion across the country, you’ll clearly need more fuel than if you are working at a sedentary job in an office. Olive oil should be used like salt. It is a condiment, and choosing extra virgin olive oil in a spray pump gives us a boost of flavor. The real beneficial food sources in the Mediterranean diet are fruit, vegetables, beans, small amounts of whole grain and omega-3 rich fish. Flavonoids and antioxidants in the fruit and vegetables are some of the main players, but lifestyle and genetics may also play a role.

More about fats, the good, the bad and the ugly here: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/fat-good-bad-fatty-acids/

Reference: The Medical Post, February 2, 2007, page 17

Last edited November 2, 2014

Mar

2007

Pancreatitis Can Occur With Statin Use

By Ray Schilling | Gastrointestinal Disease, Heart Disease, Prevention

Drug safety is a concern in the administration of prescription medications and non- prescriptions and any new drug that hits the market has undergone a rigorous screening procedure before its release. Side effects still can occur, and all of the possible ones have to be listed. For physicians it always remains a matter of careful judgement, whether the benefits of a prescription outweigh the disadvantages of any side effects. It is also a concern for the patient to be fully informed. Despite all precautions there are still surprises: some drugs have been taken of the shelves, because the side effects showed up after some time and the risk for the patients were too much. There may be the sense of false security about a prescription drug that has been on the market for a long time that all is known about possible side effects, but researchers and physicians remain alert to the fact that there may be adverse drug reactions that have not been observed.Statins, which are used for lowering high cholesterol levels, have been researched in a review of case reports and observational studies led by Dr.Sonal Singh of Wake Forest University in Winston-Salem, N.C. The authors reported in the December issue of Drug Safety that there have been numerous case reports in which statins have been implicated in acute pancreatitis. It appears to be a genuine adverse reaction, but it remains rare. The researchers estimate that there would be one case of acute pancreatitis in 300,000 patients treated with statins for a year.

Pancreatitis Can Occur With Statin Use

The review suggested that pancreatitis can occur in high and low statin doses, but it is more likely to happen after many months of therapy. Due to the low incidence and mild severity in the majority of cases, statin therapy is still considered safe.
The first line of defense in the treatment of high cholesterol remains a proper diet and an active lifestyle. Statins are needed for patients with familial hypercholesterolemia and those where diet and lifestyle choices have not been successful enough.

More information about:

1. Statins: https://www.askdrray.com/statins-can-hurt-the-consumer/

2. Pancreatitis: http://nethealthbook.com/digestive-system-and-gastrointestinal-disorders/pancreatitis/acute-pancreatitis/

Reference: The Medical Post, February 2, 2007, page 2

Last edited November 2, 2014

Mar

2007

Depression Increases Stroke Risk

By Ray Schilling | Mental Health, Prevention, Stroke

Strokes have been observed mainly in the aging population, and various lifestyle factors play a role in the risks. It is generally well known that smoking is one of them. High blood pressure that is left untreated will have a stroke as a consequence. Even though in the past the development of a stroke was more commonly seen in older patients, it has become something to be reckoned with for patients that are middle aged.
While some risk factors are the same in all the age groups, researches scrutinized the age group under 65 for additional risk factors. The one that stands out is depression.
Margaret Kelly-Hayes Ed.D. and her colleagues evaluated data from the Framingham Heart Study, looking at 4,120 participants aged 29-100 years who were followed for 8 years. In the course of their research they checked for symptoms of depression by administering the Center for Epidemiological Studies Depression Scale (CES-D). If patients were taking medication for depression they were included in the study. In participants under 65 with depressive symptoms the stroke risk was found to be four times higher than in the population of the same age group without depressive symptoms.

The findings were commented on by Dr. Francisco Javier Carod-Artal, of the Sarah Hospital in Brasilia, Brazil. He found that a growing body of evidence suggests that biological mechanisms underlie a bidirectional link between depression and many neurological illnesses. Mood disorders can influence the development of disease.

Depressed patients 4 times more at risk of getting stroke

Pinpointing exactly why depressive symptoms are increasing the risk for strokes is a challenge. Dr. David Spiegel from Stanford (Cal.) University was interviewed and he believes that the problem is environmental as well as biologic. People who are depressed may smoke more, avoid social contact, may lack self care and neglect taking blood pressure medication.
In any event it is important to treat depression, and to take care of all the known steps in stroke prevention.

More information about:

1. Stroke prevention: http://nethealthbook.com/cardiovascular-disease/stroke-and-brain-aneurysm/stroke-prevention/

2. Depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

Reference: MD Consult News, January 29, 2007

Last edited November 2, 2014

Feb

2007

King Tut’s Death Demystified By CT Scan

By Ray Schilling | Orthopedics

CT scans are important diagnostic tools in medicine. They are generally performed in radiology departments or departments for diagnostic imaging in hospitals. They are extremely useful to get detailed information that surpasses the simple findings an x-ray can provide.
Recently CT scanning has been used as a tool by archeologists to examine a patient that has passed away 3,300 years ago. Tutankhamun, the Egyptian king, died very young. After an x-ray examination in 1968 which seemed to detect bone fragments in the boy king’s skull, it was speculated that he had been a victim of foul play. Dr. Ashraf Selim, a radiologist at Cairo University and leader of the CT examination of King Tut, did not find any evidence of this. During the discovery of the mummy by the Englishman Howard Carter in 1922 Carter and his cronies were quite rough, when they tried to remove the pharaoh’s golden mask, and as a result some bone fractured, which also matched a defect within the first cervical vertebra. This being an injury long time after death excluded foul play. What was obvious in the CT finding was a fracture to the femoral bone, which occurred before the death of the young king. While researchers cannot assess how this injury happened, the findings suggest that the injury was likely an open wound that became infected and led to the untimely death of the king (no antibiotics there at that time).

King Tut’s Death Demystified By CT Scan

It is rare that archeologists will draw on CT scans to uncover a mysterious death, but CT scans are not only tools for specialists like orthopedic surgeons or neurologists. They can be a helpful tool to assist in other areas of medicine such as forensic medicine to find valuable insights.

Reference: The Medical Post, January 16,2007, page 16

Last edited December 5, 2012

Feb

2007

Avoiding Back Pain By Relaxed Sitting

By Ray Schilling | Arthritis, Health, Pain, Prevention

This article is about “avoiding back pain by relaxed sitting”. Notably, parents and educators often reprimand children and students to “sit up straight”. The results however are not that favorable. Truly, a 90 degree angle in this position is causing problems. Specifically, it causes the largest movement of the spinal disc and a lot of strain. To put it another way, conventional wisdom has it that sitting up straight avoids back pain. It must be remembered, this has important implications for a large population group that has work situations with mostly sitting jobs. In addition, consequences of bad posture are also quite visible: lower back pain is the leading cause of disability in the U.S. and Canada and a major cause for missed work days.

Improper posture and back pain are related

Investigators have presented evidence, that a 135 degree body/thigh sitting position, leaning back, is the optimal position to avoid back pain. The author of the study, Dr.W. Bashir from the department of radiology and diagnostic imaging at the University of Alberta Hospital in Edmonton emphasizes, that the angle of posture has been under question for some time, and improper posture and back pain are related.

Positional MRI scans

Positional MRI scans have shed more evidence on the spine. There are special MRI machines that take images when the patient is not in a supine position, but in a position that allows the patient free motion during the test. Spinal angles can be measured and spinal disk movement can be observed in various positions and angles.
The 90 degree angle showed most spinal disk movement, creating stress for the spine. Another unfavorable position is a slouching posture.

Avoiding Back Pain By Relaxed Sitting

Scan results showed a reduction in spinal disk height, signifying more wear and tear of the lumbar spine. Spinal disk movement was least pronounced with the 135 degree angle. This more relaxed position poses less strain on spinal disks and the associated muscles and tendons. Employees sitting comfortably versus sitting up straight can make the job place friendlier to people’s backs.

More about back pain: http://nethealthbook.com/arthritis/lower-back-pain/

Reference: The Medical Post, January 16, 2007, page17

Last edited November 2, 2014

Feb

2007

Lycopene Benefits Backed By Science

By Ray Schilling | Cancer, Diabetes, Health, Heart Disease, Nutrition, Osteoporosis

Lately a lot of attention has been directed to the health benefits of vegetables and fruit. Vitamin C has long been an accepted household term, and nobody questions the benefits. Newer buzz words are the terms “bioflavonoids” and “antioxidants”. Some products are aggressively marketed extolling the above named beneficial substances, but often the consumer is left mildly bewildered by exaggerated claims. Often the sale prices of these miracle foods are as lofty as the bold statements that go along with them.
For any shopper it is important to know that some of the most beneficial foods are not high priced items, but very common staples. Take tomatoes, for instance. They are a significant source for the substance lycopene, which lately has received a lot of attention. Lycopene and its dietary sources as well as its benefits have been researched world wide, and the results are now in. It is responsible for the red color in fruit or vegetables, such as tomatoes, and its isomeric form 5-cis-lycopene is the most stable form having the highest antioxidant properties. Common dietary sources are tomatoes, watermelons, pink guava, pink grapefruit, papaya, apricot and other fruit. In the Western diet tomato-based foods account for about 85% of dietary sources of Lycopene. Studies have shown that lycopene is more efficiently absorbed from processed tomato products compared to raw tomatoes. Once it is absorbed it is distributed throughout the body. The highest levels showed up in the testes, the adrenal glands, prostate, breast and liver.
Research going back to 1995 showed an inverse relationship between the consumption of tomatoes and the risk of prostate cancer. A follow up publication in 1999 showed that the same inverse relation of lycopene intake and cancer also included breast, cervical, ovarian, liver and other organ sites. Further studies have followed these initial publications, and the great majority of them suggest that an increased intake of lycopene showed an association with a significant reduction in the risk of many cancers.
Coronary heart disease and lycopene benefits were also examined. The strongest population based evidence comes from a multi center case control study in Europe (EURAMIC). 662 Cases and 717 controls were recruited from 10 different European countries, and there was a significant relationship between levels of lycopene in fatty tissue and the risk of myocardial infarction. Lower lycopene levels were associated with a higher risk of heart attacks.Lycopene was also shown to decrease levels of oxidized LDL (LDL or low density lipoprotein is known as the “bad” cholesterol). Another small study showed that lycopene was reducing total cholesterol levels and as a result was lowering the risk of coronary heart disease (CHD).
The list of benefits does not end here: the dietary oxidant reduces oxidative stress and levels of bone turnover markers, meaning that it may contribute to the bone health, especially reducing the risk of osteoporosis in postmenopausal women.

Lycopene Benefits Backed By Science

For people with mild hypertension (high blood pressure), consumption of lycopene resulted in significant reductions of systolic and diastolic blood pressures.
Infertility in males was significantly helped by lycopene intake. In a study infertile man received 8 mg lycopene per day in capsule form. Laboratory tests confirmed an increased sperm density along with functional sperm concentration and mobility. This treatment protocol with lycopene supplementation resulted in a success rate of 36% pregnancies in their partners.
Pregnant women with pre-eclampsia who were treated with lycopene supplement significantly improved, which was shown by decreased diastolic blood pressure, the reduction of pre-eclampsia and a decrease of intrauterine growth retardation, resulting in a healthier mother and baby.
Future research is pending surrounding lycopene in metabolic and inflammatory diseases and in its role of possibly preventing neurodegenerative diseases such as Alzheimer’s disease. Other inflammatory conditions such as arthritis and emphysema will likely also be shown to benefit from lycopene. Preliminary data has already indicated this.
The Food and Drug Administration (FDA) of USA has recently approved lycopene as a safe “natural coloring agent” and a Generally Recognized as a Safe (GRAS) component. The Department of Nutritional Sciences , Faculty of Medicine, University of Toronto, c/o Dr. A.V. Rao et al. who completed this meta analysis of the recent literature have recommended that we all consume a regular daily lycopene dose in our food and supplements as part of our diet for good health.

More info about lycopene and prostate cancer: http://nethealthbook.com/news/lycopene-reduces-prostate-cancer-risk/

Reference: The Whitehall-Robins Report, December 2006, Volume 15, No.4

Last edited November 2, 2014

Feb

2007

Mechanical Heart As Transplant Alternative

By Ray Schilling | Heart Disease

The device called HeartMate II (see image) is comparable in size and weight to a D-size battery, and it is the latest development to assist the left side of the heart. Older models were pulsating in nature, whereas the HeartMate II produces a continuous flow of blood. As a result of this, recipients of the device no longer have a discernible pulse, nor can their blood pressures be taken with the cuff around the arm. The leg muscles can naturally produce a surrogate pulse, and in the three years of human testing there have not been any problems related to the lack of pulse. It has been implanted at selected American test sites, and recently a 65 year old male patient has become the first Canadian to be implanted with the device at McGill University Health Center. Dr. Renzo Cecere, the heart surgeon involved, is very enthusiastic with the outcome. The patient made an exemplary recovery and stated that he feels more alive than he has in years, which is impressive, as in the past he could hardly take a step. He suffered of end stage left ventricular failure, and at this point only patients with this condition can enroll in the HeartMate II clinical trials.
Dr.Cecere foresees the device being appropriate for many Canadians. The longevity of the “mechanical heart” (it is good for 10 years) will make it a true alternative to a heart transplant. Some patients cannot receive a transplant because of age or medical conditions. Patients with a history of cancer would be the ones who could not be treated successfully with a heart transplant. The anti-rejection drugs that have to be taken on an ongoing basis produce immunosuppression, and this can revive a cancer in remission.

Mechanical Heart As Transplant Alternative

So far the biggest known risk factors are bleeding, as patients have to take small amounts of blood thinners. Another risk is infection.
At this point the cost for the HeartMate II amounts to about $100, 000, and it does not have the Health Canada approval for general use yet.

More information about congestive heart failure: http://nethealthbook.com/cardiovascular-disease/heart-disease/congestive-heart-failure/

Reference: National Review of Medicine, January 15, 2007, page 36-37

Comment Nov. 15, 2012: The device was approved by the FDA in April of 2008.

Last edited November 2, 2014

Feb

2007

Nutritional Research Possibly Biased

By Ray Schilling | Nutrition

Influential articles about nutritional research are widely publicized. What is not so well known to consumers is the fact that a number of the research is funded by industry, which introduces test bias into the results, which can have far reaching implications. These results influence dietary recommendations, the department of public health, or regulations by the Food and Drug administration. The articles are widely publicized and also influence consumers’ choices.
Dr. Daniel Ludwig, author and director of the Optimal Weight For Life program at the Children’s’ Hospital in Boston, which is a Harvard medical institution, looked at 206 interventional and observational studies as well as scientific reviews. All of them were related to milk, soft drinks and juices. All the material was published between 1999 and 2003. The category was chosen, because these drinks are widely consumed by children and adolescents. There has been a considerable amount of controversy about the health risks and health benefit of these drinks. The soft drink industry is large and highly profitable, and the authors concluded that in this environment scientific bias could likely occur.
Of the 206 studies only 111 submitted the source of financial sponsorship. One third of them had mixed sponsorships, half of them were not sponsored by the industry and one in five was industry sponsored. Results showed, that industry sponsored research was 4 to 8 times more likely to be in favor of the companies’ products than those where the studies had independent financial funding.

Nutritional Research Possibly Biased

During the study period the researchers who declared the source of funding or a conflict of interest rose from 50 to 80 %.
Dr. Ludwig and his team suggested that there is the potential to public health harm, unless there is increased government funding available for nutritional research through a peer review process such as that at the National Institute of Health.

More information about sugar substitutes: https://www.askdrray.com/yes-there-are-healthy-sugar-substitutes/

Reference: BMJ 2007; 334:62, 13 January

Last edited November 2, 2014

Jan

2007

Ballroom Dancing Improves Heart Health

By Ray Schilling | Fitness, Health, Heart Disease, Prevention

It has been pointed out that there is not such a notion “It’s too late now to think of an exercise program”.
Researchers led by Dr. Romualdo Belardinelli, director of cardiac rehabilitation from the Lancisi heart Institute in Ancona, Italy took a close look at 110 patients with stable chronic heart failure. The average age of the patients was 59 years and 89 of them were men. The group was assigned different physical activities. Forty-four patients used an exercise bike or exercise treadmill three times a week for 8 weeks. Forty- four other patients chose to participate in 21-minutes of ballroom dancing consisting of waltzes (alternating slow and fast) three times per week. A third group of 22 patients had no exercise. Heart rates during exercise training and dancing were similar at 110 respectively 113 beats per minute. Cardiopulmonary fitness improved at a similar rate in both groups. Oxygen consumption increased by 16 % in the exercise group and by 18% in the dance group. In other words, exercise fitness had significantly improved in these two groups.

Quality of life as measured by the Minnesota Living With Heart Failure Questionnaire improved significantly more in the ballroom dance group, particularly in the emotional domain.

Ballroom Dancing Improves Heart Health

The findings are not just of significance to patients with heart failure. It is the observation that ballroom dancing seems to be a more effective way to get people into an exercise program who otherwise would not be interested in this. For some people it is simply more enjoyable to dance and enjoy social interaction as an additional benefit than running on a treadmill.

More information is available about:

1. Fitness: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

2. Health for adults: http://nethealthbook.com/health-adults/

3. Health for seniors: http://nethealthbook.com/health-seniors/

Reference: The Medical Post Dec. 19, 2006, page 17

Last edited November 2, 2014

Improper posture and back pain are related

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