Sustainable Medicine

breast cancer screening and prevention

2011-11-27T17:25:00.000-08:00

A follower of my blog asked me about breast cancer sceening and prevention - one hears such contradictory advice from different quarters.
First of all, as I've perhaps said before, screening (= early detection) is not the same as prevention. But although we believe that as much as 80% of cancers are environmentally-caused (take lung cancer, for example) we don't know very much about SPECIFIC steps people can take to reduce their risk. Fat cells manufacture and excrete low-level estrogens into the blood stream, so obese people are at a somewhat higher risk for cancers of the female reproductive system. We know that a healthy diet, full of fresh fruits and vegetables, reduces the risk of almost all cancers, as well as heart disease. Taking hormone replacement therapy has been shown to increase the risk of uterine and possibly breast cancer, and bio-identical hormones have not been proven to be safer. A healthy mental and emotional life increases longevity and probably reduces risk for cancers. Vitamin supplementation does not reduce risk for breast cancer.
Conventional medicine plays lip service to prevention, but has put most of the emphasis on early detection.

Why? In large part, blame human nature. If you're a radiologist at a busy hospital, you might read 1000 or maybe more mammograms a year. A certain number will turn out positive. At the end of the day or year, you can point wiith some deserved satisfaction at, let's say, 15 women who will probably survive breast cancer because of the mammogram which you read. If you're a gastroenterologist doing 5 colonoscopies a day, at the end of a month you can point to several patients with an early cancer who may well be saved through the early detection which you performed. That is satisfying.

If you're a primary care doctor or a holistic doctor who has spent 30 years counselling thousands of patients to eat better, exercise, meditate, etc. you surely have saved hundreds of patients from developing cancer and heart disease. But can you definitively point to any single one? Patients often exclaim: doctor so-and-so saved my life, by putting in a stent just as I was having a heart attack; by removing a malignant lump, etc. But who says: that doctor saved my life by recommending and helping me to implement a healthier lifestyle 20 years ago? I'm not saying patients are not very grateful to a good primary care doctor, but it's usually impossible to pinpoint a specific disease that was prevented, especially in the case of cancer, whose origins are so often hidden.

So what about mammograms? A yearly mammogram from age 40 to age 74 will catch the highest proportion of early cancers. This course is warranted in those who have a strong genetic susceptibility or family history of breast cancer. The United States Preventive Services Task Force, which is made up of about 16 specialists in several disciplines who assess the data for and against major medical interventions, has determined that the rather few lives which might be saved through routine yearly mammograms from age 40 to age 50 may not be worth the enormous cost and risk involved in all those mammograms. Mammograms in this age range are often unreliable and often result in a great deal of fear, and in many cases, unnecessary surgical procedures to remove possible lesions which might well never progress to invasive cancer. Thus, the USPSTF does not recommend routine mammograms age 40-49. The USPSTF further states that between ages 50 and 74, a mammogram every 2 years might be sufficient to get the most benefit with the least risk and cost.

Of course, physicians' groups with a vested interest have come out strongly against these recommendations, but I believe the research done by the PSTF is solid. I haven't heard any reputable scientific sources state that the risk of radiation from cumulative mammograms, while certainly not negligible, is a major cause of subsequent breast cancers.

What about thermography? When I was in med school or residency, in the 1970s, there was a big controversy about the relative reliability of mammography, which was pretty new then, as compared with thermography, which was also being done in hospitals. As I remember, the evidence at the time pointed to the unreliability of thermography compared with mammograms, and hospitals abandoned thermography as an accepted, proven early detection method. I hadn't heard anything more about thermography until recently, when patients have begun asking me. Apparently thermography centers, not related to any hospital and, as far as I know, not being performed or read by doctors, have made a comeback. However, there is no new objective scientific evidence to prove that they are any more reliable than those which were done in the 1970s. So it sounds to me a bit like a money-making scheme, preying on people who understandably are hesitant to get mammograms, offering an apparent alternative. It's a little like homeopathic "immunizations," offered to people who are hesitant or refusing to give their children conventional immunizations. There may be plenty of reasons why people don't want to give their children all the conventional immunizations, but in my mind, homeopathic "immunizations" have nothing to do with homeopathy, and offer a false sense of security. There's not a shred of evidence that they prevent anything. Perhaps there is really some new research or improvement in the technology of thermography, but I seriously doubt it. I'm open to that idea, but I'd expect that somewhere I would have come across some reputable research in that direction, since radiologists are always looking for ways to improve the accuracy of mammograms, using ultrasound, for example, as well as MRI. If thermograms were really helpful, you can be pretty sure they would be used by radiology departments. If you google breast thermography, you will read some sites (all published by people who make their money performing thermograms or selling the equipment) which make claims that thermography is a valid alternative. For the sake of fairness, checkout the FDA letters also found under breast thermography, citing the lack of evidence and requiring the purveyors of thermographic equipment to stop making false claims. I'm sure many of you will have some skepticism about what the government says about health care, but don't run the danger of abandoning science altogether. Look for the money stream!

What's the bottom line? If you have reason to believe that you're at higher risk than most women for breast cancer, you may want to opt for yearly screening starting age 40. If you feel your risk is average, or perhaps below average, it's probably fine to wait till 50 and possible opt for mammograms every other year after that. But in any case, try not to live your life in fear of cancer. Stop reading all the so-called "health" literature that bombards us every day. It will only make you crazy and, yes, will probably increase the chance that you will get cancer. Yes, Virginia, we all will die some day! Live life with enthusiasm and joy and try to avoid the trap of living in fear.

request for new topics readers wish to hear about

2011-11-17T17:52:00.000-08:00

Dear Readers,
It's time for you to let me know what you would like me to blog about. Possible topics could be controversies surrounding the diagnosis and treatment of lyme disease; the whole issue of colonoscopies and colorectal cancer screening; and autism. I know a lot of you read my blog through the kimberton clinic website. but you can't comment or become a follower through the website. For that you have to log onto sustainablemedicine.blogspot.com. Then you can make a comment following any of my blogs. I promise to read and respond if possible. Richard G. Fried, M.D.

Vitamin Supplements - Part Two

2011-10-12T17:35:00.000-07:00

How can this be? The vitamin hypothesis seemed so plausible. Some may be tempted to doubt the research, published as it is in journals tied, for example, to the AMA. But conventional medicine has nothing to gain financially or otherwise, from disproving the vitamin hypothesis. In fact, big pharmaceutical companies sell far more vitamin supplements than organic or natural companies. No, it is time to revisit our beliefs and suppositions, and realize that we were wrong.

Let me begin with an analogy. I have an organic vegetable garden. I do not add nitrogen, postassium, phosphorus, or any other minerals directly to my soil, even if they are derived from natural sources, as many of them are. I feed my garden organic compost and composted manures. They provide all the nourishment my vegetables need to flourish. Each plant can "choose" to absorb just what it needs from the soil. When you use isolated, soluable fertilizers, the plant is pretty much "forced" to take up what it's given. Plants have evolved through millions/billions of years to absorb their nutriments from soil. Often they have to deal with inadequate soil, and they do the best they can. But seldom in nature have they had to deal with an excess of soluable nutriments; this is a foreign situation for which they may have developed no evolutionary protective mechanisms.

I would argue that the same holds for animal and human nutrition. We would have to eat hundreds of oranges to get 10 grams of vitamin C. Resveratrol, a popular supplement, is presumed to be the "active" ingredient in red wine, which has been proven, if consumed in moderate amounts, to reduce heart disease. Current supplements contain as much resveratrol as is in 250 or more glasses of red wine. Even in my college days, I didn't get close to that! Common sense would argue that consumption of any nutrient in amounts far beyond what you could possibly get in nature, could be dangerous. The human organism is simply biologically "naive" to such doses, and it is always potentially dangerous to go against nature in that way.

Here is another example, perhaps far-fetched, to illustrate my point that quality cannot be replaced by quantity. Imagine a situation where, in an attempt to improve the quality of public school education, a large survey was made of successful teachers, which found that, on average, they smiled more often than less successful teachers. The next logical step would be to analyze exactly which facial muscles were being stimulated. From that research would come a program to improve education by holding mandatory training sessions during which less successful teachers were taught to contract certain facial muscles, let's say, every minute. Of course, the training sessions would not be capable of distinguishing a grimace from a smile, since they use the same muscles. In fact, the grimace contracts the facial muscles even more than the smile, so it would be logical to assume that it would work better.

Back to basic biology. Plants, animals and humans are biologically extremely complex. Context is turning out to be just as important in nutrition as measurable nutriments. When you eat whole, organic foods, the body can "choose" to absorb just the nutriments which it needs, in the context of the whole food. A concentrated supplement, even if derived from natural sources, cannot replicate that million-year-old process.

Vitamin supplements used to be given to prevent deficiencies. This is still valid. The irony is that those people who would probably need the supplements, that is, poor people eating fast food and junk food, are not taking them, while those who are knowlegeable about nutrition and are shopping in health food stores, not only don't need them, but may be being harmed by them, not to speak of the enormous cost. So donate your supplements to the poor, and use the money you save to buy organic, free range, grass fed meats, wild Alaskan salmon, organic, local grains, fruits and vegetables. Frequent your local farmers' market, or join a CSA. As Michael Pollan, the noted nutritional writer says in his most recent book, In Defense of Food, "eat food, not too much, mostly plants." Avoid anything which makes a health claim, since these are always processed, packaged foods. Grow your own food. Even towns and cities are often creating community gardens. Very often, fresh, unprocessed foods from the supermarket are actually healthier than processed organic foods.

Remember what I said in the beginning. There is a place for vitamin and mineral supplementation. Some people cannot absorb vitamin B12, or are iron deficient, for a varienty of reasons. Some people are low on Vitamin D, although sensible sunlight might improve that situation. Niacin, when consumed in pharmaceutical, not nutritional, doses, can lower LDL cholesterol and raise HDL, although it has not been proven to actually save lives. But once again, here it is being used as a drug, not a nutritional supplement. But the idea of well-nourished people taking supplements to improve health, must be seriously questioned.

Vitamin Supplements - A Failed Strategy

2011-10-12T16:40:00.000-07:00

Those who have read previous blogs or who are patients of mine probably know, often to their surprise, that I am not an advocate of vitamin supplementation in general. Of course, there are specific indications for specific vitamins, such as B12, and D, to treat specific deficiency states. But the vast majority of Americans who take vitamin and mineral supplements do so in the expectation that they may keep them healthier, support the immune system, delay ageing, and perhaps contribute to the prevention of chronic conditions such as cancer and heart disease, and it is this idea which I believe may be reaching the end of the line.

The rationale behind supplementation with multivitamins, iron, antioxidants, etc. rests with epidemiologic data which shows that traditional diets rich in antioxidants and certain vitamins and minerals, appear to confer long-term health benefits. An example would be the so-called Mediterranean diet. It is plausible, especially given the typical reductionistic thought of today, to hypothesize that we can isolate the most active element or elements that are beneficial in these diets, and give them as a supplement. This way, we measure/quantify how much we are getting, and at the same time, can continue eating as we have always. Our "scientific" culture understandably seeks to quantify everything. It is but a small step to assume that once we have isolated the beneficial ingredients of a healthful diet, we can increase the quantity far beyond what can be consumed through food, under the assumption that if some is good, more is necessarily better, or, at the very least, harmless, except to the pocketbook. Once the exclusive realm of what used to be called "health-food nuts," this idea gradually permeated our culture, and was eventually embraced by the medical establishment. Anti-oxidant mixtures in high concentration were promoted enthusiastically by conventional doctors to prevent lung cancer in smokers, heart disease, prostate cancer, and macular degeneration, to name just a few, while high doses of vitamin C became a mainstream practice to prevent the common cold. Of course, an enormous, multi-billion dollar industry has sprung up to serve and promote these practices.

Virtually all of these interventions have been proven either useless or actually harmful. First to fall was the use of beta-carotene in smokers.Then numerous studies, well-designed and without bias, demonstrated no benefit to vitamin C in the common cold. Meanwhile, literally scores, if not hundreds of studies, showed that vitamin E supplementation was either useless, or actually increased the incidence of heart disease. Two very recent studies provide what I think may be the final blow. A large study, involving 39,000 women averaging 62 years of age over many years, showed that multivitamins, B6, folic acid, magnesium, zinc and copper supplements were associated with an increased risk of death, with iron being the worst.This was published in the prestigious Archives of Internal Medicine, October 10, 2011. Finally, this week's Journal of the American Medical Association features a good-quality study which concludes that selenium and vitamin E supplements were either useless, or actually increased the risk of prostate cancer.

The danger of unnecessary tests and procedures

2011-09-12T17:45:00.000-07:00

I've been saying for a long time that unnecessary tests and procedures are not only bankrupting our medical system, but dangerous for patients. In case you still think this is radical, non-mainstream thinking, check ouot Newsweek, August 22 &29, 2011, page 30. you can't get much more mainstream than Newsweek. the article says exactly what I've been saying (and doing) for years.

Readership

2011-09-11T17:06:00.000-07:00

Dear Readers: I'm sorry that there was such a gap in posting part 3 of Rise and Decline of Holistic Medicine. Now that the summer is over, I will be posting more blogs. Please let me know what you would like to hear more about. It's important that people make comments and sign into my blog, so that I know that people are reading it, although I'm sure most of you are reading my blog through my website. Thanks. Richard G. Fried

The Rise and Decline of Holistic Medicine, part 3

2011-09-11T16:59:00.000-07:00

As I've stated in previous blogs, I feel that Alternative/Complementary Medicine, at least as practiced by physicians, is in danger of losing its identity and turning into what I call "niche medicine." The holistic aspect, treatment of the whole person, using natural means and encorporating mental, spiritual and physical long-term health, has largely been replaced by scientifically questionable diagnoses, the denial of emotional aspects of illness, (how ironic!) and often the use of powerful drugs such as injectable and implantable sex hormones, high-dose oral and IV antibiotics, frequently at higher doses and for longer times than conventional doctors use. Some doctors seem to "specialize" in diagnosing and treating almost everyone for Lyme disease, others for chronic yeast or leaky gut syndrome, and others for doubtful nutritional deficiencies. The danger for the patient is that instead of listening carefully to the individuality of the patient and using all the diagnostic skills we were taught, a doctor may have a "pet" diagnosis, and tend to lump almost everyone into the same category. This is what I mean by "niche medicine."

How has this come about? Practicing true holistic medicine is very hard, and extremely time consuming. It requires hard work and great sensitivity. I was taught that it is impossible to be a good holistic doctor unless you are a good conventional doctor. It's much easier to rely on a variety of tests, which anyway give the impression of being more "scientific" and are likely to impress the patient.

The other reason is that true holistic medicine is not lucrative. When I started out in practice, one of the few things that all holistic doctors I knew had in common, was that we all made much less money than our conventional counterparts. Eventually, many holistic doctors found out that ordering tests and dispensing supplements, injections, IV infusions, etc. can be very lucrative. This is obviously true in conventional medicine, which is why health care costs in America are almost twice that of other developed countries, with poorer results. Unfortunately, the same tendency has corrupted what was once holistic medicine.

THE RISE AND DECLINE OF HOLISTIC MEDICINE, PART 2

2011-06-10T17:32:00.000-07:00

THE RISE AND DECLINE OF HOLISTIC MEDICINE, PART 2

William Crook published his blockbuster book The Yeast Connection in 197-. His central thesis (here very much simplified) was that modern diets, rich in refined sugars, together with the widespread and often inappropriate intake of antibiotics, had created a digestive environment which favored the overgrowth of intestinal yeast, causing a wide variety of symptoms. Hitherto, intestinal yeast overgrowth had only been recognized in the medical world in patients with serious immune deficiencies.

Crook’s contention, namely that intestinal yeast overgrowth is very common, and furthermore that it is responsible for a wide variety of constitutional symptoms, including fatigue, lethargy, weight gain, and depression, has never been adopted by the wider medical community. More important, there has been little scientific literature to support the “yeast hypothesis.” Nevertheless, it was quickly adopted as valid by a great number of alternative health care practitioners. And the idea, even if unproven, was plausible and had a holistic ring: poor diet and overuse of antibiotics had damaged our internal environment and was causing otherwise unexplained symptoms. Also, the initial remedy was simple and harmless: patients should avoid yeast, any sugars, and limit intake of antibiotics to what was absolutely necessary.

However, practitioners soon found that diet alone did not eliminate the symptoms they were ascribing to yeast overgrowth, so they began experimenting with increasingly large doses of nystatin, a comparatively harmless antifungal antibiotic. After a while, finding that nystatin did not heal many (or most) of these patients, they began using other, stronger antifungal drugs.

The irony should be obvious: both the vitamin hypothesis and the yeast hypothesis began with “holistic” concepts, plausible if not proven, and the remedies suggested were inexpensive, harmless and often involved only a healthier diet. But gradually, the doses got bigger and bigger, and practitioners were soon using pharmacological doses of supplements and antifungal antibiotics. And to diagnose and test for the effectiveness of these treatments, expensive tests (often not covered by insurance) were used: analyses of blood, hair, urine and stool for micronutritional imbalances, and complex stool analyses in the case of suspected yeast overgrowth.

Not coincidentally, alternative medicine started to become lucrative. A colleague once described (with too much pride and precious little shame) how she had finally made alternative medicine work for her: A new hour-long consult (for which she charged the now-quaint fee of $250), typically ended with a send-away, comprehensive stool analysis, which cost her $150 but for which she charged the patient $300. The result came back in a couple of weeks with a four-color graphic printout of the results, and a computer-generated analysis, along with a list of suggested nutritional supplements to correct whatever imbalances had been found. The return consult was only $125, and, for the convenience of the patient, the physician kept the recommended supplements in stock and could sell them to him or her (with an appropriate mark-up). Physicians often claim to be bad at math, but this is pretty easy.

With the popularity of the yeast hypothesis came an important new tool in the armamentarium of the alternative practitioner: new diagnoses. Older holistic doctors had generally accepted the conventional diagnoses, and offered more natural, “holistic” therapeutic solutions. Now, in short order, came a host of new, “alternative” diagnoses: chronic mercury poisoning from dental fillings, “leaky gut syndrome,” widespread intestinal parasites, “stealth virus” infection, thyroid deficiencies unrecognized even by endocrinologists, adrenal exhaustion, and, most recently, chronic, undiagnosed Lyme disease.

Even more amazing is the remarkable similarity of symptoms in all these newly discovered diseases: inability to lose weight, fatigue, insomnia, loss of libido, headache, foul intestinal gas, depression, mental fuzziness, and joint aches, to name a few, all remarkably more common among woman than men.

A number of new diagnostic tests has sprung up to help the practitioner make his or her diagnosis: in addition to the standard analyses of blood and urine, new tests of saliva, stool, and hair are examined. Laboratories have been established which also do conventional blood tests, but cater to the CAM community by issuing non-standard criteria for determining what is normal or abnormal. What is missing is some kind of objective consensus for determining the significance of, say, copper in a hair sample. Does it reliably reflect blood or tissue levels, or perhaps say more about your shampoo, or how often you shower?

These new diagnoses may not be entirely without merit. But, in my experience, they are made with a power of conviction which seems to compensate for weak scientific evidence

The rise and decline of Holistic Medicine

2011-05-24T18:34:00.000-07:00

THE RISE AND DECLINE OF HOLISTIC MEDICINE, PART 1

Holistic medicine has been hijacked by a new breed of practitioners, armed with scientific-appearing statistics, utilizing high-tech diagnostic tests, charging very high fees (often not covered by insurance) and, ironically, often dispensing antibiotics and other drugs more freely than conventional doctors. How has this interesting and disturbing phenomenon come about? Let me begin with some personal observations, and follow with an informal history of alternative approaches to medicine over the past few decades.

When I began my family medical practice in the suburban Philadelphia region, alternative medicine (as it was known then) was almost unheard of. There were a few elderly doctors still practicing homeopathy, many of whom were graduates of Hahnemann Medical College when there were still vestiges of homeopathy being taught there. I attended a conference sponsored by the Pennsylvania Homeopathic Society during my first year in medical school in 1972. The average age of the participants (other than a handful of curious medical students such as myself, who were lured by the prospect of a free lunch) must have been over 75. Nationally, there was a handful of physicians practicing Anthroposophic medicine (probably less than ten). There were osteopaths who encorporated spinal manipulation into their medical practice. And there was a small number of family doctors (many of them osteopaths too) who tried to encorporate nutritional counseling, lifestyle counseling, and supportive psychotherapy into their practices.

These doctors generally tended to see fewer patients per day, emphasize more natural approaches to healing such as vitamin supplements and herbs, sometimes working with alternative practitioners such as massage therapists, and generally trying to treat the whole person (hence holistic) including body soul and spirit, in promoting health and treating disease. In general, they tended to emphasize low-tech, hands-on approaches rather than expensive, invasive tests, and usually tried to work out of the principles of prevention and healing, rather than just treating symptoms with drugs. Perhaps the most unifying characteristic of holistic doctors at that time was that they made less money than their more conventional colleagues.

Imagine, for a moment, the climate for such doctors at that time. A friend and colleague was brought in front of his local medical society because his name appeared on a poster announcing a conference promoting the benefits of massage therapy. I myself was questioned for possible disciplinary action at Pottstown Hospital in the early 1980’s, accused of squatting with a patient while she was in labor (an accepted technique of easing labor pains even then) and also of putting woolen hats on the heads of my newborn patients. Not infrequently would I receive disapproving calls from other physicians if my patients confessed to taking homeopathic medicines.

Driven largely by patient dissatisfaction with what was seen as an increasingly sterile, drug-dominated impersonal and uncaring medical establishment, the alternative/holistic health-care “movement” took off in the 1980’s and 1990’s, with burgeoning sales of nutritional supplements, organic foods, and rapidly gaining popularity and acceptance of modalities such as yoga, massage therapy, “energy work”, and meditation.

Not unexpectedly, the medical community began to respond. Some conventional doctors began (albeit begrudgingly) to tolerate and even accept their patients taking supplements, and getting massage or yoga lessons to help reduce stress, high blood pressure, etc. Medical journals started to advise doctors to discuss with patients any supplements or alternative treatments they might be taking in a non-judgmental manner, and eventually there came articles in journals with titles such as “How to enhance your practice (and income) by incorporating complementary approaches, such as Echinacea for colds, Saw Palmetto for prostatism, or Black Cohosh for menopausal symptoms.”

Spurred no doubt by increasing demand, more doctors began to turn to alternative approaches. Nutritional medicine became very prominent. Doctors began prescribing (and often dispensing) various combinations of high-dose vitamins and nutritional supplements (now called neutraceuticals) for enhanced well-being, immune boosting, as well as alternatives to drugs for treating various diseases. An office for alternative and complementary medicine was opened at the National Institutes of Health (NIH) and medical schools began to establish departments of complementary medicine.

Yet at the same time that complementary medicine (as it was now coming to be called) was achieving some degree of acceptance in society as well as the medical profession, the seeds for its corruption were being sewn. Let me give some examples.

Adelle Davis, who had a Master’s Degree in biochemistry as well as training in dietetics and nutrition, published her landmark book Let’s Eat Right to Keep Fit in 1954. She is widely credited with being the first to popularize the relation between nutrition and health in our affluent society. She was heavily and repeatedly attacked by mainstream authorities, who pointed out (correctly) that hundreds of her assertions were either unsubstantiated or actually contraindicated by the references which she gave.

Nevertheless she was one of the first to emphasize the importance of nutrition, not only to prevent extreme deficiency states such as scurvy or beriberi, but as a basis for optimal health. And her primary thesis, namely that the use of chemicals in the production, transportation and processing of foods robbed them of their nutritional value, helped birth the organic food movement.

This debate is of course not finished. Scientists continue to debate the extent to which modern commercial foodstuffs have lost nutritional value. But I would maintain that her idea was a holistic and a very important one, and was a major impetus to the organic food movement, now of course a huge industry and the most rapidly growing segment of the agricultural and good industry today.

Would that Adelle Davis had stayed with the concept of getting optimal nutrition from fresh, organic, home-cooked food! Instead, her books tended more and more to emphasize supplementation as the way to get optimal nutrition. She also correlated optimal nutrition with optimal health, and was quoted, for example, as saying that she never saw anyone get cancer who drank a quart of milk daily. From there, it was only a short step to claiming that nutritional supplements could not only prevent, but also treat a whole host of diseases.

So the nutritional revolution, which might have reoriented our thinking towards quality in nutrition, quickly turned into a competition for quantity. Recommended doses of supplements went out the roof, with mega, ortho and maxi doses being marketed and promoted, not only by the manufacturers, but by an increasing number of physicians and nutritionists. These supplements, even when extracted and concentrated from natural sources, no longer bear any quantitative relationship to anything you could get from eating real food. In other words, they work in the body more like chemicals or drugs than food. And while it is presumed, usually correctly, that these substances are harmless, this is by no means always so. For example, beta carotene, promoted as a cancer preventive, has been shown to increase the risk for certain cancers, and vitamin E, long promoted as an antioxidant to prevent heart disease, has now been shown in repeated trials, to actually increase the risk of certain heart diseases.

Adelle Davis died of cancer in 1974, at the age of 70. Her death produced a paroxysm of doubt among her adherents, which would have been funny if it hadn’t contained unmistakable signs of fanaticism: her adherents felt her death was a kind of betrayal of everything she had stood for. Good nutrition and supplements, I suppose, were a guarantee of longevity.

Vitamin D - continued

2011-05-17T17:44:00.000-07:00

With all this uncertainty, what should you do? Here are my current recommendations:

     1. If you are generally healthy, active, and get a reasonable amount of ordinary sun exposure, it is probably not necessary to have your vitamin D levels checked, or to take a supplement.
     2. If you are a post-menoopausal female, or at any specific risk for osteoporosis (on long-term steroids, have an eating disorder such as anorexia nervosa, or are unable to do daily weight-bearing exercises due to illness or injury) you should probably take 1000 to 1200 mg of supplemental calcium, plus 1000 to 2000 units of vitamin D3 daily. Alternatively, get your level tested and treat accordingly.
      3. Except under unusual circumstances, do not take more than 4000 units of vitamin D daily for a prolonged period of time.
      4. Everyone should regularly exercise outdoors, and, while taking reasonable precautions against sunburn, moderate sun exposure and some tanning is probably good for you. Severe burning, such as when you stay indoors all year long and then go to the tropics for a couple of weeks, is dangerous and should be avoided. It is somewhat controversial whether moderate daily sun exposure leads to an increase in melanoma, which is the dangerous form of skin cancer. Basal and squamous cell carcinomas, by far the most common skin cancers, are basically benign and not to be feared. They almost never cause serious harm and can usually be treated, if they arise, with freezing or simple in-office dermatological procedures.
      5. Above all, remember that sunlight and vitamin D are not the same thing, any more than an orange equals vitamin C. Human beings have lived and thrived in sunlight as long as we have been on this planet, and sunlight confers many health benefits beyond just vitamin C. Sunlight is a powerful anti-depressant, for one thing. Here's a useful analogy: all of the hoopla surrounding the health benefits from anti-oxidants arose from epidemiological evidence that diets such as the Mediterranean diet, which are rich in natural antioxidants, are very healthy and are preventive against heart disease and cancer. Scientists, always eager to find the "active ingredient," isolated certain substances, particularly beta-carotene, vitamin E, selenium, vitamin C, and others in this diet and promoted these as supplements. Literally billiions of dollars of antioxidant supplements have been bought by the gullible american public. Instead of changing our eating habits, which is inconvenient, why not just take a supplement? Now, years later, convincing evidence is pouring in that antioxidants, when taken as a supplement, confer no health benefits and are likely to be harmful. It turns out that context and balance, always present in nature, are critical. I have no doubt that in future years, scientists will unravel hitherto unknown harms from taking vitamin D as an isolated substance. It's just good science and basic common sense. So, unless you have some of the specific health problems outlined above, get outside, exercise, and eat foods naturally rich in vitamin D.

Vitamin D - what do we know and waht should we do?

2011-05-16T18:55:00.000-07:00

There has been a great deal of professional and lay literature in the past year touting the "epidemic" of vitamin D deficiency. Everything from increased cancer and heart disease risk to osteoporosis has recently been linked to inadequate vitamin D intake, and many physicians have aggressively taken up the cause, and are enthusiastically recommending near-universal vitamin D supplementation. In this blog I will try to summarize what is known, what is conjectured, and finally, in a separate blog, what people should do.

Most people know that vitamin D is required for the body to take up calcium and certain other minerals into the bone matrix. Frank vitamin D deficiency leads to rickets, a condition we hardly ever see any more, at least in the USA. Vitamin D is not really a vitamin; it is a hormone which, on exposure to the sun's rays, is transformed into the biologically active substance we call vitamin D3.

One major health-concern today, especially in the ageing population, is osteoporosis. Recent studies have suggested that supplemental doses of calcium, which have been recommended for many years, especially to post-menopausal women, may increase risk for heart disease, unless they are accompanied with supplemental vitamin D.

Recently, researchers and physicians have begun to measure vitamin D levels in patients, and have often found inadequate levels. This has led to all kinds of conflicting recommendations for what constitutes deficiency, and what constitutes optimal vitamin D levels. One problem is that experts differ regarding what actually constitutes deficiency: some say serum levels less than 15 ng/mL, others 20, others (most commonly ) say below 30, and others advocate levels of 50 or above. Darker-skinned individuals need more sun exposure to be able to make adequate amounts of vitamin D from sunlight.

We certainly live in what I call a heliophobic society. Whereas people spent a great deal of time out of doors in the past, regardless of the season, many people nowadays hardly go outside. Children prefer to watch TV or play video games rather than playing outside, and many parents, fearful of stranger abduction and other kinds of dangers (imagined or real), actually discourage children from playing outside, except in the context of organized sports. Few adults work outside for a living any more, and many people who do exercise do so at the gym, or use a machine or tapes. The medical profession has created such a fear of skin cancer that those children and adults who do venture outside are usually slathered with high-factor sun screens. Even those who enjoy outside exercise often confine it to the warmer months of the year. Legitimate concerns about atmospheric ozone depletion have added to these fears.

In an interesting article recently published in the American Journal of Epidemiology (2010, 172 (1): 1-3 ) entitled "Anticancer Vitamins du Jour -- the ABCED's So Far," author Tim Byers traces the history over the past 30 years of vitamins which have been promoted as having a cancer protective effect. First it was Vitamin A and its precursor, Beta-carotene; then various B vitamins were heavily promoted to prevent cancer. Many of us will remember the great hoopla surrounding the huge supplemental doses of vitamin C touted famously by Nobel laureate Linus Pauling as being the key to longevity, especially in the 1980's. And more recently, in the last decade of the 20th century (temporarily falling out of alphabetical order) vitamin E was heavily promoted and touted for its antioxidant properties, preventing cancer and heart disease.

Unfortunately, all of these claims have been conclusively disproven. In fact, large supplemental doses of all these vitamins have proven either to be useless, or, especially in the case of vitamins A and E, to be harmful to human health.

With this sobering reality in mind, Dr. Byers cautions us to be wary of claims made on behalf of vitamin D supplementation. For example, African-Americans, who on average have lower blood vitamin D levels than whites, have a lower incidence of osteoporosis. That could, of course, be explained by as yet undiscovered compensatory mechanisms which may have evolved in people with darker skins. More troubling are reports that higher levels of serum vitamin D, at or above 40 ng/mL, are associated with increased all-cause mortality, fractures, pancreatic cancer, and prostate cancer. (JAMA, February 2, 2011 - Vol 305, No. 5, pp. 453-4).

So health -conscious individuals and their doctors are being presented with very conflicting information, and understandably are wondering what to do. And I must admit, I am too. In the follow-up to this blog, I will try to present my recommendations.

An introduction to sustainable medicine

2011-01-17T16:46:00.000-08:00

Sustainable Medicine embodies three fundamental principles:
       1. An approach to medicine which has as its goal, the long-term health and sustainability of the patient.
       2. A sustained, collaborative doctor-patient relationship. The current concept of a "medical home" embodies some aspects of this relationship.
       3. The medical practice must seriously consider economic considerations, both for the patient as well as society. Unnecessary tests, x-rays and procedures not only are bankrupting our society, but lead to bad medicine and threaten the long-term health of the individual and society.

Sustainable Medicine embodies many aspects of Complementary/Alternative Medicine. But CAM practitioners can be as guilty as conventional doctors when it comes to cost-consciousness and unnecessary testing. Scientific objectivity and critical self-analysis are woefully lacking in the CAM community, just as economic self-interest and the rabid influence of Big Pharma seriously taint the conventional medical world. Ironically, some of the very same elements which have corrupted conventional medicine can be found in the community of CAM practitioners.
In the coming weeks and months, I will post articles about the current Vitamin D controversy, the controversy regarding the MMR vaccine, autism and the work of Dr. Wakefield, issues regarding vitamin and nutritional supplements, and other current topics relevant to the practice of sustainable medicine. For now, please check out my website, kimbertonclinic.com, for more information and essays.