Medical Articles by Dr. Ray

Jul

2003

Food And Mood

By Ray Schilling | Health, Mental Health, Nutrition

“Food affects your mood” is the heading of an article by Dr.Susan Biali (practising family physician with a degree in dietetics) in the June 24, 2003 edition of The Medical Post (page 24). According to her there is good evidence in the medical literature to indicate that a number of biologically active brain hormones depend on what we eat. There are 5 major items that she pointed out, which I summarized below in tabular form.

The medical literature points to the importance of these various food factors to allow us to have a balanced brain metabolism. When these ingredients are present our mood is more likely to be normal with more resilience to depression.

The literature centers around various population groups in comparison with the North American population. For instance, in an article of the Dec. 2000 issue of Psychiatric Clinics of North America a study was reported that found that Taiwanese and Chinese people consume a lot more omega-3 fatty acid rich foods such as fish than North Americans.

In the same study the rate of major depression was found to be 10-times more frequent in North Americans and the investigators felt that this was so because of the brain hormone stabilizing effect of the omega-3 fatty acids. Other researchers suggest that chronic stress might lead to a depletion of omega-3 fatty acids in the brain through an oxydation process, which eventually results in depression.

Food And Mood

Several nutritional factors appear to have caused deficiency states of essential brain nutrients, one being the junk foods like candy bars, French fries, hamburgers etc. leading to a dysbalance of the omega-6 fatty acid to omega-3 fatty acid ratio. Another factor is the increase of consumption of highly refined carbohydrates (sugar and starch), often also called high glycemic foods. This is known to lead to the metabolic syndrome, also called syndrome of insulin resistance. Finally many people still have too much fat in their diets with a high amount of hydrogenated vegetable oils (see link). It is also important to note that folate, Vit. B6 and Vit.B12 are required for prevention of hardening of the arteries by lowering homocysteine levels.

Brain food components that affect your mood
Food item:	Comments:
omega-3-fatty acids	Chinese and Taiwanese eat much more of these and have 10 times less depression than North Americans
DHA, a long-chain omega-3-fatty acid	our daily intake is 100mg less per day than 50 years ago due to our diet being based on commercial livestock; lack of DHA leads to depression
too much omega-6-arachidonic acid in “junk foods”	ratio of omega-6 to omega-3 arachidonic acid has increased from fast food consumption; this leads to depression
folate and Vit.B12	deficiency associated with depression
tryptophan	an essential amino acid that is needed to make serotonin, a brain hormone without which we experience depression

So what is “brain food” ? Dr. Biali pointed out in her article that it is always best to start with a low fat, well balanced food plan where junk foods are avoided and where vegetables and fruit provide the low to medium glycemic index carbohydrates. Fish should be eaten at least three times per week to provide the brain with the essential omega-3 fatty acids.

It is probably not recommendable to take tryptophan as a supplement: in 1989 several fatalities occurred from impurities in commercial tryptophan and many researchers are concerned about dysbalancing the network of brain hormones by giving an overdose of only one amino acid, but not giving enough of the others. It is much safer to simply eat enough protein (meat, soy protein, milk products) and the body can pick and choose what it needs in terms of amino acids including tryptophan. With folates one needs to be careful not to exceed 0.8 mg per day as with mega-doses of folate in the 15 mg range toxic symptoms of vivid dreams, disturbed sleep patterns and even occasional seizures developped. A good multivitamin supplement will not only provide the right folate dose, but also Vit. B12, which is also needed to prevent depression.

Last edited December 9, 2012

Jul

2003

High Blood Pressure On The Increase In The US

By Ray Schilling | Heart Disease, High Blood Pressure, Prevention, Stroke

High blood pressure on the rise

Dr. Hajjar, of the University of South Carolina in Columbia and Dr. Kotchen, of the Medical College of Wisconsin in Milwaukee have compared a large group of people in the US in the years 1999-2000 with prior studies in 1988-1991and 1991-1994 where peoples’ blood pressures were measured.

The latest study involved more than 5000 people, the prior studies more than 9000 people each. Almost 29% of the population has a blood pressure of 140/90 or higher in the latest study.

Compared to the 1988-1991study this is a significant increase of 3.7%. More than half of this was explained on the basis that the population’s weight (measured by body mass index calculation) had increased. The sub groups who had the largest increase in blood pressure were as follows:

1. diabetics with high blood pressure. In this high risk group only about 25% had a blood pressure readings of less than 130/85, which is the target value.

2. Mexican Americans had a significantly poorer awareness and control of their elevated blood pressures than the non-Hispanic whites and non-Hispanic blacks.

3. Women as a group were poorer in blood pressure controlling than men.

4. People above the age of 60 had a much higher rate of uncontrolled blood pressure as well.

The study concluded that by concentrating campaigns and efforts on these four target groups significant gains could be made in terms of control of blood pressure, reduction of strokes, heart attacks and kidney damage.

Here are some links regarding high blood pressure, prevention of strokes and heart attacks to various chapters of my nethealthbook.com:

High blood pressure link

Heart attack link

Stroke link

Last edited October 26, 2014

Jun

2003

Genetic Link Found For Bipolar Disorder

By Ray Schilling | Diabetes, Mental Health, Prevention, Women’s Diseases

A staff psychiatrist at the Dalhousie Medical School in Halifax (Novia Scotia, Canada) has gathered 1100 DNA samples and psychiatric histories from patients with bipolar disorder and family members who do not have this psychiatric disease. Dr. Martin Alda, The Medical Post reports on page 46 of the May 20, 2003 edition, and his medical team were able to identify 4 areas of interest on chromosomes 15, 7, 6 and 21 where molecular markers for bipolar disease were located.

Two additional tools, namely responders to lithium (common bipolar disease stabilizer) and certain ethnic group differences, are being utilized as well. Dr. Alda has already found that unstable genes can be stabilized in the presence of lithium. By studying the genes involved in the expression of bipolar disorder and defining what triggers a depressive response and what triggers a manic episode, the researchers hope to unravel the mysteries that still surround this intriguing disease. Dr. Alda is also studying the connection of diabetes and biploar disease. Patients with biploar disease are 3 times more prone to diabetes than the general population. As these patients (bipolar patients with diabetes) are poor responders to lithium, there is a suggestion that perhaps the newly defined genetic loci are blocked in some way by the hormone changes in diabetics. Further investigations in this direction are planned by the research group.

Genetic Link Found For Bipolar Disorder

Link to bipolar disorder: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/bipolar-disorder/

Link to diabetes:

http://www.nethealthbook.com/articles/hormonalproblems_diabetesmellitus.php

Last edited October 26, 2014

Jun

2003

Effect Of Smallpox Vaccination Lasts Much Longer

By Ray Schilling | Infectious Disease, Prevention, Skin Disorders

Introduction

A study found that the effect of smallpox vaccination lasts much longer than previously thought. In the age of bioterrorism Americans worry about what would happen in the case of an attack with smallpox. Due to concentrated efforts worldwide through the WHO for many years, smallpox could be declared eradicated in the US in 1949 and worldwide in 1972. American children since then did not receive a smallpox vaccination. However, 95% of Americans over the age of 35 have been vaccinated and according to a recent study have been shown to still have a very good immune response that likely would make them immune to a bioterrorism attack with smallpox virus.

Review article in the British Medical Journal

A review article in the British Medical Journal (BMJ 2003;326:1164) on May 31, 2003 reports about a study by Oregon researchers from the Departments of Molecular Microbiology and Immunology in Portland. Dr. Mark Slifka and Dr. Erika Hammarlund (Oregon Health Sciences University) collected blood samples from 306 previously smallpox vaccinated volunteers to check for antibody levels as well as T cell responses against smallpox antigens. The volunteers were of different ages and included people who were vaccinated against smallpox as recently as last year and as long as 75 years ago. All of them showed a very good response due to high antibody levels and their serum was able to neutralize the smallpox vaccinia virus in Petri dishes.

Good T cell responses after 35 years of smallpox vaccination

The T cell mediated cellular immune response showed some slowing down in the older age group. However, another study done by a North Carolina research group and also presented at a meeting from the American Society for Microbiology in Washington, DC. and published recently (New England Journal of Medicine 2002;347:689-90) found that T cell responses lasted a very long time. A group of people vaccinated 35 years earlier, so the North Carolina group reported, had perfect T cell responses to the smallpox vaccinia virus. The conclusion of these studies is that the effect of smallpox vaccination lasts much longer.

Effect Of Smallpox Vaccination Lasts Much Longer

Conclusion

There is no point of vaccinating more often than two times in a lifetime. Even one-time vaccinated people often have good immunity against smallpox. People born after 1972 and never vaccinated against smallpox should consider vaccination and discuss this with their doctors. There are, however, some known complications of the vaccine such as a myopericarditis (a heart condition). Next, generalized vaccinia can occur, a skin condition common in people with skin problems like acne or psoriasis. 1 in 10,000 immunizations will get viral encephalitis, which often leads to brain damage. There is presently a campaign to vaccinate 500,000 frontline healthcare workers in the US against smallpox. This is a government plan to prepare for a smallpox bioterrorism attack. Due to the possible complications so far only 35 000 healthcare workers have volunteered for vaccinations. Link to overview regarding history of smallpox from the CDC.

Jun

2003

Hormones After Menopause (HRT) Not For Everybody

By Ray Schilling | Hormones, Prevention, Women’s Diseases

Lately there have been several review articles published in the medical literature about hormone replacement therapy (HRT) after menopause for women. A number of longterm follow-up studies have shown that HRT with a combination of estrogen and progesterone hormones is associated with a higher risk of stroke, heart attacks, blood clots and pulmonary embolism. The WAVE trial has recently shown that estrogen replacement does not lead to protection from heart disease or strokes, however exercise and weight loss (from calorie restriction) does.

Two more recent studies add to the story: the one is a study showing that urinary incontinence (=bladder leakage) is much worse on estrogen replacement (HRT) than without it. The other study showed that estrogen replacement leads to dementia of the Alzheimers type.

Here are the details: Dr. Jodi Steinauer (University of California at San Francisco) reported about the findings during the American College of Obstetrics and Gynecology meeting at New Orleans. The study was designed to see whether estrogen/progestin hormone replacement would improve bladder function with aging. Episodes of urine loss when coughing, sneezing or running (urinary incontinence) were observed by the 1208 women from the HERS trial (Heart and Estrogen/Progestin Replacement Study) who were followed along for 4 years. The women were either given a hormone tablet (estrogen/progestin) or a “fake” pill with no hormones (placebo pill). To the surprise of the investigators the opposite of what was expected happened: The HRT group did much worse than the placebo group.

Hormones After Menopause (HRT) Not For Everybody

After one year urinary incontinence was up 2 to 3-fold in the HRT group and after 4 years this number was up 3 to 5-fold. Of the women who did not have stress incontinence in the beginning, only 38% of the placebo group developed it over 4 years, whereas in the HRT group 54% developed it. The authors concluded that HRT replacement therapy in menopause should be avoided (reported in The Medical Post, page 1 and 86, May 13, 2003).

Recently a new study (JAMA 2203;289:2651-62) showed that dementia was double the rate in older postmenopausal women on HRT than in the placebo group. 4532 postmenopausal women aged 65 years or older from the Women’s Health Initiative’s memory study (“WHIMS”) were followed by researchers for 4 years. The HRT therapy consisted of Prempro (Premarin and Provera). None of the women had dementia in the beginning of the study. After 4 years 21 of the placebo group had developed it (age related), the Prempro group developed 40 dementia cases. It is unclear why the HRT group had developed dementia, but the authors of the study theorize that perhaps a series of mini-strokes would be responsible for this.

In summary, it appears now with more evidence from the literature that HRT should only be given to postmenopausal women in a few selected patients under close medical supervision, but that the majority of women likely should not take it. Osteoporosis can be prevented by regular brisk walks, dietary changes with fat reduction and avoidance of refined sugar etc. as another powerful tool to achieve longevity. Keep in mind that these “hormone” replacement trials were regarding Premarine and Provera, both products of the drug industry. The body reads these hormone-like susbstances as estrogen-like substances and gets an overdose with the regular dosaging. Only bio-identical hormones in the right mix will be heart and brain protective and will work against osteoporosis. In short, the study described above was done with the wrong “hormones” and should have been done with bio-identical hormones. In menopause there are all kinds of reasons why a woman should use bioidentical hormones to return to her previous hormone balance, but it needs to be supervised by a knowledgeable physician with experience in this.

Read the truth about bio-identical hormone replacement under the “menopause” link below.

Here is a link to “menopause”: http://www.nethealthbook.com/articles/menopause.php

Last edited December 9, 2012

Jun

2003

Vitamin B-6, Vitamin B-12, Folic Acid To Control Hardening Of Arteries

By Ray Schilling | Heart Disease, Nutrition, Prevention, Vitamins and supplements

The May 2003 issue of the medical journal “Clinical Practice” contains an article by the dietician Andrea Miller (pages 46 to 49) about supplementation with these vitamins in relation to hardening of the arteries from too much of the amino acid homocysteine.

Homocysteine is an amino acid that contains sulfur, which is formed from the metabolism of methionine, an essential amino acid that we depend on in our food for maintaining a normal metabolism. There are complex metabolic pathways that involve several enzymes to function normally, which involve the three vitamins B-6, B-12 and folic acid (folate) to balance everything.

If one of these vitamins or any of the enzymes involved malfunction, a surplus of homocysteine results with an accelerated hardening of the arteries throughout the body. A certain percentage of the population does not have the full concentration of one or more of the metabolic enzymes in their system. If the food we eat is also relatively deficient in the above named vitamins, the body runs out of alternative metabolic options and produces dangerous levels of homocysteine. A normal blood level of homocysteine is between about 5 and 10 micro-mol per liter. This is not routinely measured by screening tests unless the doctor suspects a genetic trait in the family where family members tend to get heart attacks at an early age (mid 30’s to early 40’s). When the level of homocysteine is elevated to 12 micro-mols per liter, a supplement with folic acid of 1 mg per day would reduce this by 25% to safe levels of 9 micro-mols per liter. This results in a 15% decrease of the death rate from heart attacks.

Vitamin B-6, Vitamin B-12, Folic Acid To Control Hardening Of Arteries

Vitamin B-12 is found in animal products such as meat, poultry and dairy products. Vegetarians may not get enough Vit. B-12 and should supplement as should persons above the age of 50. A lack of B-12 vitamin leads to pernicious anemia.

Vitamin B-6 is found widely distributed in meat, fortified grains and poultry and usually is in our food supply to a satisfactory degree.

Folate (folic acid) is contained in orange fruits, beans, lentils and green vegetables. However, not everybody eats well banced meals and the food supply could be marginally deficient in folate.

Recommendation: The take home message is that a good multivitamin tablet containing about 400 to 600 micrograms (=0.4 to 0.6 mg) of folate (folic acid), 5 mg of vitamin B-6 and 20 micrograms of vitamin B-12 would be providing an adequate amount of these vitamins and reduce homocysteine levels in most people to safe levels. It is not recommended to take single vitamin supplements of these vitamins as this could lead to toxicity. Also, there is no point in taking higher doses of the vitamins as this also would lead to toxic reactions.

Link to information about balanced nutrition: http://www.nethealthbook.com/articles/nutrition.php

Last edited December 9, 2012

Jun

2003

Exercise Saves Lives In Women Over 65

By Ray Schilling | Cancer, Fitness, Health, Heart Disease, Prevention, Stroke, Women’s Diseases

A recent study released in the Journal of the American Medical Association (JAMA Vol. 289 No. 18, May 14, 2003) has found a profound effect of exercise on the survivial of elderly women. Dr. Gregg et al. have followed 9518 women aged 65 or older for a total of 12.5 years with a follow-up visit in between at about the 6 year point. They found that women who exercised (walking, aerobics etc.) and who were compared with a control group who was sedentary (no form of exercise), had the following improved survival rates.

These findings were independent of other factors up to an age of 75 years. In other words, age, smoking, weight and a number of pre-existing diseases did not influence these improved survival figures from the effect of exercise. However, when a woman had a significant chronic disease or was older than 75 years of age, the survival improval from exercise was not as strong as indicated in the table above. Also, the follow-up visits showed that those women who exercised continually, had the highest survival advantage.

Exercise Saves Lives In Women Over 65

The bottom line: increasing and maintaining a physical exercise program will likely lead to a longer life. At the same time the exercise program needs to be started early enough to be of benefit to those who are older than 75 years of age.

Disease and death rate reduction from exercise in women aged 65 and over
Reduction of:	Effect of risk reduction:
overall death rates	48%
cardiovascular disease	36%
cancer	51%

Some of the Associations that were contributing to this important study were: The National Center for Chronic Disease Prevention and Health Promotion (Atlanta, Ga), the Graduate School of Public Health, University of Pittsburgh (Pittsburgh, Pa), the Prevention Sciences Group, Departments of Medicine and Epidemiology and Biostatistics, University of California (San Francisco) and the University of Minnesota and Section of General Internal Medicine, Veterans Affairs Medical Center, Minneapolis.

Here is a fitness link: http://www.nethealthbook.com/articles/fitness.php

Last edited December 9, 2012

May

2003

Allergies, Asthma And Diabetes All Helped By Fish Oil

By Ray Schilling | Allergies, Arthritis, Diabetes, Heart Disease

Cod liver oil was what your grandmother told you to take. It turns out she was right as two studies from Manchester/England and Boston/US have shown. The common denominator are omega-3-fatty acids, which are found in fish oil, cod liver oil, mackerel, salmon and other fish, generally speaking all sea food that feasts on plankton.

1. A prospective study with a cohort of 1100 children from before their birth until their 5th birthday, which will be next year, is being conducted in Manchester/England.

A smaller pilot study with 37 children (4-year-olds from this cohort) was recently analyzed as reported in Denver by Dr. Clare Murray, a pediatric lung specialist from the University of Manchester. The investigators have done detailed diet analyses with the help of the parents. They found that children with severe asthma were taking in a lot less omega-3-fatty acids than a healthy control group. Further analysis showed that the asthmatic group took in a lot of the inflammation provoking omega-6-fatty acids, whereas the control group had a much better balance between these two unsaturated fatty acids. Apparently it is the ratio between omega-6 to omega-3 fatty acids that determines whether the prostaglandin metabolism is switched versus pro-inflammatory (ratio more than 3 to 1) or versus anti-inflammatory (ratio 3 to1 or less). This article can be found in the Medical Post, Vol39, No.17 (page 19), April 29, 2003.

2. Another study is mentioned on the same page of the Medical Post: Dr. Frank Hu from the Harvard School of Public Health is the lead author of a study published in Circulation: Journal of the American Heart Association. 5103 female nurses with established type 2 diabetes have been followed for about 18 years and their medical histories, life styles and eating habits were updated every two years.

Allergies, Asthma And Diabetes All Helped By Fish Oil

In the beginning of the study every patient was free of heart disease and cancer. The big surprise was that eating fish 5 times per week diminished the risk for developing heart disease by 65%. Even the women in the study who ate fish once or twice per week had 40% less heart disease than those who did not eat fish. In addition, fish eaters survived those who were not fish eaters much better (lower mortality). Controls of women without diabetes who ate fish five times per week had also a reduction of heart disease by 35% compared to non fish eating controls. Dr. Hu stated that it is the omega-3 fatty acids in fish that are the active ingredient. They are known to reduce irregular heart beats (arrhythmias) that can lead to sudden death. Omega-3 fatty acids also reduce blood fat levels (triglycerides), clot formation and improve blood vessel function. He also noted that both genders have the same benefit (no difference between male and female), just that the study was done on female nurses.

Comments: For your information the table below shows what foods contain omega-3 and omega-6 fatty acids.

Omega-3 and omega-6 fatty acids in our food
Type of unsaturated fatty acid:	Foods that contain this type of unsaturated fatty acid:
omega-3 fatty acid	flaxseed oil, walnuts, macadamia nuts, fishoil, canola oil, mackerel, salmon, sardines, tuna and most cold water fish
omega-6-fatty acid	corn oil, cotton seed oil, grape seed oil, safflower oil, soybean oil and sunflower oil

In the past 50 years the food industry has changed the ratio of omega-6 to omega-3 fatty acids in many common foods to the point that the ratios are now 12 to 1 and up to 25 to 1. It is cheaper to produce these foods in that manner as they often have a longer shelve life. Read food labels. Inform yourself about omega-3 fatty acids. Take 2 capsules of a high strength, molecularly distilled (to remove PCB’s, mercury and other heavy metals) fish oil once per day and include more fish in your meals. Avoid deep fried foods, as they contain omega-6 fatty acids.

Here are some links explaining this more:

Link about balanced nutrition.

More details about fat and fatty acids.

Last edited October 26, 2014

May

2003

Early SARS Treatment In Hong Kong Reduces Death Rate Dramatically

By Ray Schilling | Infectious Disease, Lung Disease

Dr. Loletta Kit-Ying So from the Pamela Youde Nethersole Eastern Hospital in Hongkong reported on May 10, 2003 in the medical journal The Lancet (Lancet 2003;361:1615-1617) about their experience with early SARS treatment. Key to the success of this group is early recognition and early treatment of SARS. They found that high doses of corticosteroids to control the inflammatory reaction of the airways coupled with the antiviral antibiotic ribavirin has meant a breakthrough in the treatment of SARS. They have treated 50 patients with the new combination protocol.

Medication protocol:

Initially the patient is started on the fluoroquinolone antibiotic levofloxacine 500 mg once per day. This has an immunomodulating effect and keeps the virus at bay. Methylprednisolone at 1 mg per kg of body weight given three times per day is the corticosteroid used for 5 days, the gradually tapered to nothing over 16 days. The virus itself is treated with the antiviral drug ribavirin 400mg three times daily intravenously for three days or until the patient becomes stable, followed by tablets (1200mg twice per day) by mouth.

Outcome:

The good news with this protocol is that 70% of patients have left the hospital and are recovered; 27% are treated and are stable; three patients are mechanically ventilated (on a respirator), but stable. One patient who was an elderly diabetic patient has died of a heart attack.

Early SARS Treatment In Hong Kong Reduces Death Rate Dramatically

There are no major side-effects of the treatment protocol. Some modifications are made with patients who have tuberculosis and with patients who are pregnant.

Here is an overview of SARS with links to the CDC.

Last edited October 26, 2014

May

2003

Blood Clot Dissolving Therapy Saves Lives

By Ray Schilling | Heart Disease, Prevention, Stroke

Clot dissolving therapy (fibrinolytic therapy) has saved many lives when it is applied fast enough with patients who have a heart attack. In younger patients up to age of 65 to 70 years this method was applied without questioning by the treating physicians.

Several studies have shown that elderly patients have more complications such as strokes, where there can be a brain hemorrhage causing another disaster, namely a stroke from a hemorrhage as a side-effect of the clot dissolving medicine. It’s a case of too much of a good thing overthinning the blood. A new study from Sweden, which was published in the Archives of Internal Medicine on April 29, 2003 (Arch Intern Med 2003;163:965-971) showed that elderly patients with a heart attack can also benefit from this clot dissolving therapy. The main investigators, Drs. Ulf Stenestrand and Lars Wallentin, have followed 6,891 patients who have sustained their heart attacks between 1995 and 1999. They were at least 75 years of age and older, but not older than 85 years. Of these patients 3,897 received fibrinolytic therapy and 2,994 did not. Combined survival statistics and statistics of whether or not the patients suffered a stroke as a result of the clot dissolving therapy were recorded over the next year.

There was a drop of 13% of deaths and of strokes in the treatment group when compared to the controls. There were some other ways that the investigators analyzed the data statistically, but the treatment group was always better off.

Blood Clot Dissolving Therapy Saves Lives

The investigators concluded that there is no reason to withhold this clot dissolving treatment from elderly patients as the practice had been up to then. Until randomized studies with more details can be done, they stated, one should treat elderly patients who have acute heart attacks until the age of 85 with clot dissolving treatments.

Here are some links that may be of interest:

This link explains what a heart attack is.

Last edited December 9, 2012

Introduction

Review article in the British Medical Journal

Good T cell responses after 35 years of smallpox vaccination

Conclusion

A Survivor’s Guide to Successful Aging

Prostate Cancer Unmasked

Healing Gone Wrong – Healing Done Right

Medical Question Answered

Social Media Links

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