Created on Tuesday, 08 November 2016 21:15
Why would a college-educated young man from a well-to-do family from the DC area hitch-hike from South Dakota to Northern Alaska and then wander off into the remote woods with a rifle, ammunition, and little else, determined to live off the land shooting wild game and foraging for wild plants?
A lot of people have wondered about that, but there are no clear answers. And, it ended tragically. He survived for a while on game like squirrels, porcupines, birds, ducks, and even a moose once, while he also ate wild berries and this native root called "wild potato" although it is unrelated to the potato that we know. It's actually a leguminous plant, and it's edible root has the texture of carrot.
But, it was still a low calorie diet because the meats were very lean and the plant foods were all very low in calories. From the start he started losing weight- and he was thin to begin with. After about two months, he had had enough, and he still had the bodily reserves to walk out, which he decided to do. However, the creek that he crossed getting there had swelled to a raging river from snow melt, and he could not cross it. It was too treacherous from the rapids and the rocks, plus the water was deep and only slightly above freezing. He never would have made it, and he knew it. So, he went back to the abandoned bus that he had turned into his camp, and he resumed doing what he was doing. I suppose that his hope at that point was that somebody would come along who could help him get out, but nobody showed up.
Then, there was a piece of bad luck. The wild potato he was eating turns very hard and fibrous in the late summer; it loses its succulence. So, he resorted to eating its seeds. But, what he didn't realize is that the seeds are NOT edible. The seeds are high in a toxic amino acid called canavanine.
I know about canavanine. Remember back in the 1980s that there was a big kick of eating alfalfa sprouts? People grew them at home; markets sold them; salad bars served them; they were everywhere. Well, alfalfa sprouts also contain canavanine but not as much as this other plant. And, it's one of those things where you have to eat a lot of it to be poisoned. A little cluster of alfalfa sprouts wasn't gong to kill anybody. But, he was eating large quantities of these toxic seeds. And reportedly, his thin, weakened, undernourished condition made it harder for his body to tolerate the canavanine. The effect that it had on him symptomatically was to make him very, very weak, to where he could hardly stand. And obviously, if you can't stand and walk, you can't hunt, and you can't forage. So, he just starved. Having arrived there in late April, it's believed that he probably died in the abandoned bus in mid-August. His corpse, which was found by hunters inside a sleeping bag within the bus, presumably about three weeks after he died, weighed 66 pounds.
Again, a lot of questions are circulating about what drove him to do this extremely extreme thing. But, a question that I have which I haven't seen asked before is this: he was a young man; 24 years old; at the height of his hormonal surge of young adulthood. So, why wasn't he more interested in other things. You know, chasing girls? He wasn't going to find them hiding behind trees in the Alaskan wilderness. Even before he went to Alaska, he didn't seem to have much interest that way. And apparently, somebody at college ribbed him about being gay, which he lambasted as nonsense, and I have no reason to doubt it. He wasn't interested in boys. He wasn't interested in girls. He wasn't interested in anybody. It wasn't that he was homosexual; it was that he was asexual. But why? What was wrong with him?
At various times in life, there are certain values and interests and urges and pursuits that you expect normal people to have. Why didn't he have them?
So, I have to assume that he had some pretty major psychiatric illness going on. And reflected in that, I believe, is the very slipshod, haphazard way he went about preparing for this venture, with woefully inadequate equipment, supplies, and knowledge.
It's notable that he had taken other solo road trips before this, but always remaining within civilization, but upon returning home from these road trips, he was also exceedingly thin. I mean to where his mother was aghast at the sight of him and started cooking 'round the clock to revitalize him. So, why did that happen? Money may have been a factor, but I doubt that accounts for it. His family was well-off, and he could have gone to them for money. I think that once he got away from a structured day in which meals happen according to schedule, according to the clock, that he would literally forget to eat. Hunger, alone, was not spurring him to eat enough food, and it happens. And, I think that may have been part of his mental illness too.
I have seen programs on television about guys who were surviving in the wild in extremely harsh places, like Northern Canada, but these were highly trained individuals. And since, there were tv cameras there and a crew recording it, the guy obviously wasn't really alone, although they made it look that way. I'm not saying that he cheated and took help, but he was protected in the event of an emergency. There was no chance that he was going to starve to death. He was like a tightwalker with a net. What Chris McCandless did was extremely reckless, almost to the point of being suicidal. And there's mental illness rearing its ugly head again.
Humans are obviously natural beings, but it doesn't mean that we can live in the wild, especially not in a place like that. Why do it in Northern Alaska? Why not go to a tropical rain forest? And even there, I am sure there are lots of things that can go wrong. Most people know that if you just release a domesticated dog into the wild, he is not going to survive; he is not a wild animal. He is domesticated. Well, we are domesticated too, and 10X more so.
What happened to Chris McCandless was like the exaggeration of all the human ventures that just aren't well thought out. He was lacking in judgment, again, part of his mental illness. He wasn't completely lacking in judgment because when he reached the river and realized it was too treacherous to cross, he did turn back. But, he struggled with it. He almost tried to cross it. There was probably a 50/50 chance that he would have. He probably put his hand in the water and felt the sting of the icyness, and that jarred him into coherence. That put the brake on. But, he needed a lot more brakes on himself than he had. He killed himself. He killed himself the moment he disappeared into those woods.
If you'd like to read the book, it's called Into The Wild, and the author is Jon Krakauer. It's very well written.
Created on Sunday, 02 October 2016 21:27
This is way off-topic, but I'm putting it up anyway, for the same reason that Bill Clinton gave us: "because I can."
The JFK story is a lie, but we are bombarded with lies, including a lot of medical lies. And, one of those medical lies which they tell in order to support the booming kidney transplant industry is that it doesn't hurt to donate a kidney.
It damn well hurts you. It hurts you a lot. It is a crime against yourself to do it. And now, refreshingly, here is an article written by a medical student who at the age of 18 was conned into donating a kidney but now, he regrets it.
I'm putting the whole article up right here. But, Medicine has known all along that donating a kidney is extremely compromising. Consider that the most widely used measure of kidney function is the blood creatinine test. Normally it's at about 1mg/dl or less. And the lower the better. You donate a kidney, and it rises to nearly 2. Once it gets to 3, you're in early stage kidney failure. So, you're half-way there just from donating a kidney. And it makes sense. Normally, in life, your kidneys take turns working. Each as its own ureter draining into the bladder, but at any given time, 90% of the output is coming from just one kidney. Meanwhile, the other one is resting and repairing. But, obviously, if you donate a kidney, you're remaining kidney has to work 24/7/365 year after year after year until you die. It's like a hamster on a treadmill that never stops, and doing twice the work as before.
So, read this refreshingly honest article that somehow slipped past the censors. ANY SURGEON WHO CUTS A HEALTHY KIDNEY OUT OF SOMEONE SHOULD BE PROSECUTED FOR MEDICAL MALPRACTICE AND INFLICTING SEVERE BODILY HARM.
At 18 years old, he donated a kidney. Now, he regrets it.
When I was 18, my stepfather’s brother had been on dialysis for just over a year. He was thin, he exercised regularly and he seemingly was in perfect health, but inexplicably his kidneys began to fail him. Although I was just about to leave for college, I’d heard enough about the misery of dialysis to decide to get tested as a possible donor. In the back of my mind, I knew that the chances of our compatibility were incredibly low because we were not related by blood. Perhaps that made it easy for me to decide to get tested.
When we received the results, I was stunned to find out that he and I were a match. The transplant team gave me plenty of opportunities to back out of the donation, and it put me through countless evaluations, physical and psychological. Much of my family was steadfast against my becoming a donor. Looking back, who could blame them? Their son-grandson-nephew was going to undergo a major operation with no benefit to himself.
However, I continued to be confident in my choice. I relied on the one fact that would be repeated to me many times: “The rate of kidney failure in kidney donors is the same as the general population.” Why wouldn’t everyone donate a kidney, I wondered.
My mother was the only one to — reluctantly — support my decision. She accompanied me to San Francisco, where the surgery took place, and we settled in for the weeks that I would spend recovering. On the day of the surgery, anesthesia flowed into my arm and the world swiftly slipped away. Then, just as quickly, it seemed, I awoke, nauseated and confused. So much preparation for such a short nap. The anxiety I’d felt about the surgery was now gone — as was one of my kidneys.
[Your iPhone will soon help you sign up to be an organ donor]
Michael Poulson regrets giving that kidney away. (University Photo)
An uneventful recovery came and went. I returned to college and resumed a normal life. Likewise, my step-uncle did very well and is living a full and healthy life, as is my donated kidney.
Five years after the surgery, when I was 23 and getting ready to go to medical school, I began working in a research lab that was looking at kidney donors who had gone on to develop kidney failure. For that research, I talked to more than 100 such donors. In some cases, the remaining kidneys failed; in others, the organ became injured or developed cancer. The more I learned, the more nervous I became about the logic of my decision at age 18 to donate.
And then in 2014, a study looking at long-term risks for kidney donors found that they had a greater risk of developing end-stage renal disease. Another study that same year raised the possibility that they may face a heightened risk of dying of cardiovascular disease and all-cause mortality (although this point remains controversial).
Other studies and surveys, though, suggest that the risk, while greater, is still fairly small.
The truth is, it is hard to get good numbers about what happens to donors. Hospitals are required to follow them for only two years post-donation, which does not catch such long-term complications as chronic kidney disease, cardiovascular issues or psychiatric issues. There is no national registry for kidney donors or other large-scale means of tracking long-term outcomes.
The result is that we know neither the denominator (the total number of kidney transplants that have occurred over the decades) nor the numerator (the number of donors who have gone into kidney failure). And what we do know is incomplete. Yet the need for donors remains great, as the number of Americans needing a kidney transplant has steadily increased — to more than 120,000 — while the number of transplants performed has remained relatively steady — at about 30,000 per year .
[The U.S. spends more money on this medical condition than any other]
Donors are lauded for their altruism and bravery for what is promoted as a benign procedure with low long-term risk. We are told about neither the reality of donation risks nor the scarcity of data that’s available.
As a medical student and soon-to-be physician, I’ve come to better understand the imperfections in the idea of informed consent. We work with the data we have, and patients aren’t always told that it may not be that solid. At the time of my surgery, I thought the system was designed to protect me as a donor. Yet, now, more than eight years later, I am angry that I was never fully informed of the lack of research or the unknown long-term health implications for me.
Mostly I’ve come to terms with the increased risks of being a kidney donor. But I’d be lying if I said I don’t get anxious about it. I feel vulnerable. Sometimes I can think of nothing but my remaining kidney. I’ll feel pressure on my ribs, and I think, “Is that my kidney acting up, or simply back tension?” Or I’ll wonder: “Should I be feeling this lump? Am I going into kidney failure?”
Being a kidney donor has become a part of my identity. Some people — particularly in medical school — have put me on a pedestal for my altruism and bravery. But often I find myself hiding the fact that I donated, which I’d like to think of as an act of modesty. The sad and difficult truth is this: Knowing what I know now, I regret donating in the first place.
Created on Wednesday, 28 September 2016 16:36
The term “side effects” is a euphemism for the adverse, toxic effects of medical drugs. And keep in mind that often the desired, sought-after effects are also toxic. For instance, acid-blockers work by poisoning the cells that produce stomach acid. Impairing the production of stomach acid is certainly a toxic effect in my book, since producing stomach acid is normal and healthy.
But, the biggest problem with the popular understanding of “side effects” is that if they don’t manifest visibly and palpably that they don’t exist. It’s often assumed that if a medical drug is well tolerated in the act of taking it, if it doesn’t cause you pain or discomfort, that it must be safe. That is a delusion. Let’s say, for instance, that a drug is poisoning the cells in your bone marrow which produce blood cells. So, those cells are under attack, and they start producing abnormal, defective blood cells, whether red, white, or platelets, or a combination. Are you going to feel anything? Probably not and for a long time. There are no pain receptors in your bone marrow. And if your blood contains abnormal cells, that is a high number of them, you won’t necessarily feel anything right away either. Eventually, say if you become anemic from the toxic effect of a medical drug, you’ll start experiencing symptoms, such as fatigue, shortness of breath, lack of stamina, paleness, etc. But, by then, by the time symptoms appear, the condition will be advanced. The early and intermediate stages of the drug-induced pathology will probably entail no symptoms at all.
It’s quite true that some people may tolerate a medical drug better than other people. And the converse is also true that some people may not tolerate a medical drug that most tolerate. Take, for instance, statin drugs. Statin drugs cause muscle breakdown which can lead to pain, which is very common. But, in some people, the muscle breakdown is so great that it overwhelms the kidneys with the breakdown products of muscle protein. And, the result is they go into kidney failure. Of course, not everybody goes into kidney failure from taking a statin, but, I think it’s fair to say that everybody heads in that direction from taking a statin. Statins increase the risk of kidney failure, diabetes, and cancer. And that’s in everybody. And that’s in exchange for what? A vanishingly small statistical reduction in heart disease risk? It’s so small that 100 people would have to take statins for 10 years in order for 1 of them to avoid 1 heart attack. The risk/reward ratio for those drugs is absolutely appalling.
Antibiotics are another class of drug that work by poisoning. The whole idea of them is to poison: bacteria. And you hope that that can be done without poisoning you- very much. But, at least with antibiotics, it’s usually a temporary thing. You take them for a week, maybe 10 days; maybe even 2 weeks. But, it’s not a life sentence. However, there are many drugs that are meant to be a life sentence. They put you on blood pressure drugs with the expectation that it is a life sentence. They put you on diabetes drugs with the same expectation. When they put you on drugs for arthritis, they don’t expect you to ever stop taking them. It’s meant to be permanent.
And even drugs that are supposed to be for temporary use often wind up being permanent or at least long-term. For instance, most sleeping pills say that you should only take them for 10 days. But, if people were only going to take them for 10 days, how could the drug company afford the expensive ads? They know very well that people go on Ambien or another sleep drug for years and years and years. That includes drugs that were only tested for 6 weeks, meaning that they tested the safety of the drug over just 6 weeks of use.
So, there is no such thing as a “side effect.” There are only effects. And most drugs not only have toxic effects but work in their desired effect through poisoning something.
The fact is that there are very few drugs in Medicine that anyone with sense should want to take. Almost always, there are alternatives to taking medical drugs. And oftentimes, just living with your condition, whatever it is, is superior to treating it with medical drugs. I kid you not.
The time has come not only to reevaluate medical drugs, but to reevaluate our attitude towards medical drugs. They are, generally speaking, harmful and dangerous, and that is a fact.
Created on Thursday, 14 July 2016 17:01
People who blame pasta for weight gain have missed the message about the Mediterranean diet, according to Italian researchers. The team from the IRCCS Neuromed Institute in Italy crunched the numbers from earlier studies involving more than 20,000 Italians and discovered that pasta intake was associated both with lower obesity rates and healthier waist-to-hip ratios.
"We have seen that consumption of pasta, contrary to what many think, is not associated with an increase in body weight," researcher George Pounis says in a press release. The team's research was published this week in the Nature journal Nutrition & Diabetes.
The researchers say their findings show that people trying to lose weight are wrong to completely banish pasta from their diets, reports UPI, which notes that pasta sometimes gets the blame for weight gain when it's used as a "vehicle for overly salty, sugary, fatty sauces."
A nutrition professor at the University of Reading says that the results appear solid, with pasta intake in this case demonstrating adherence to the Mediterranean diet. "These results clearly show that it is wrong to demonize carbohydrates as the data clearly shows that consumption of a carbohydrate-rich food such as pasta does not have an adverse effect on body weight," he says.
Dr. Cinque: This doesn't surprise me in the least. And two other positive things about pasta are that it's usually is eaten with tomato sauce, which is healthy because of its high lycopene content, that is more available than in fresh tomatoes, and the simple fact that pasta mixes very well with vegetables, such as zucchini, spinach, peppers, etc., and eating more vegetables is absolutely good.
What I do is use half whole wheat and half regular pasta. That way, I get the benefit of some whole grain, yet, it still tastes like pasta, as we know it. Using all whole wheat makes for a much stronger and different taste that some may like and some may not. But, going 50/50 is something that everyone can do- painlessly.
I appreciate seeing articles like this that fight the demonization of carbohydrates. It's perfectly natural and normal to eat some carbohydrates. I don't say you have to eat pasta. Certainly, you can live without it. But, in that case, you should eat other carbohydrates. Avoiding them completely is ridiculous. But, I feel that way just as strongly about fats. Avoiding fats completely is ridiculous. It's perfectly natural and normal to eat some fats. And, would you believe that until a few years ago, it was taught that we can't taste fats, that our experience in eating them is all about "texture" and not taste? Fortunately, a few years ago it was discovered and announced that there are fat-detecting taste buds that are abundant and very sensitive.
Eschewing all carbohydrates or eschewing all fats is an extreme thing to do. Either one may result in some weight loss, and that's because in either case, you are throwing out a major class of food, and it is almost certain that you are going to reduce your caloric consumption. And frankly, it's a shock to your system. What I do is eat healthy carbs and healthy fats, and I round it out with a lot of fresh produce. And doing that, I stay thin. I weigh the same at 65 that I did at 35. I am not the least bit interested in eating a low-fat diet or a low-carb diet. My goal is to eat a healthy diet which includes both carbs and fat, with moderate caloric consumption, and a lot of vigorous exercise. Both carb-avoidance and fat-avoidance are extremely extreme. So, don't do either one.
Created on Sunday, 03 July 2016 16:17
Did you know that a tall Starbucks has about 7.6 times the caffeine of a can of Coke and 5.8 times that of a Diet Coke? That’s a flood of caffeine. A tall 12 ounce regular Starbucks coffee has 260 mgs. But, a Grande has 340! And a Venti has 420! Yikes!
A 12 ounce Coca Cola has 34 mgs of caffeine. A Diet Coke has a bit more: 45 mgs.
So you’d have to drink 8 Cokes or 6 Diet Cokes to equal the amount of caffeine that you get from one Starbucks coffee.
Coffee actually varies a lot in how much caffeine it contains. Typically, a 12 ounce cup of regular non-Starbucks coffee has 100 to 260 mgs caffeine. The average works out to 180 mgs caffeine.
A 12 ounce can of Red Bull (which is the larger one) contains 114 mgs of caffeine.
Decaf coffee is not completely devoid of caffeine. The average cup of decaf has 5 mgs. However, Starbucks decaf has 9 to 12 mgs of caffeine.
A two-ounce 5-hour energy has 138 mgs of caffeine. That’s in the same ballpark as a cup of coffee, but remember, it’s just 2 ounces. Imagine if you drank 6 of them to equal the 12 ounces. You’d get 828 mgs of caffeine, which could actually be lethal.
Two tablets of Excedrin has the same amount of caffeine, essentially, as one 5-hour energy. So, if you take two tablets, the standard dose, it’s like drinking one 5-hour energy.
Coffee ice cream is pretty darn caffeinated. 8 ounces has 45 to 75 mgs of caffeine, so more than a can of soda.
Chocolate is relatively low in caffeine, but it does have some. Each Hershey’s kiss has 1 mg. Each Reese’s peanut butter cup has 4 mgs. Each Milky Way candy bar has 14 mgs of caffeine.
Tea has less caffeine than coffee but more than chocolate. Each 12 ounce cup of tea has 72 mgs of caffeine. You can get rid of most of the caffeine in tea by steeping it the first time, discarding that liquid, and then steeping it again with the used tea bag. Most of the caffeine comes out in the first steeping, so this is an easy, practical way to decaffeinate tea.
Each little No-Doz pill (the over-the-counter stimulant drug) has 200 mgs of caffeine, and the same is true for Vivarin.
I thank Dr. Linda Carney, MD of Buda TX for this information.
Created on Thursday, 09 June 2016 18:40
This is an article about Vitamin D deficiency and its role in heart disease by a leading cardiologist. Note the statistics on Vitamin D deficiency among Blacks and Hispanics, and that's because of their darker skin. She advises that one shouldn't take more than 4,000 IUs without a doctor's approval, but the Vitamin D Foundation, which is run by a doctor, recommends 5000 IUs daily for most people. However, this time of year (summer) if you get plenty of sun, as I do, you should cut back. What I do is take 5000 IUs of Vitamin D3 every day for most of the year, but in June, July, and August, I cut back to 5000 IUs every other day. Dr. Cinque
The author: Dr. Erin Michos, a preventive cardiologist and researcher at Johns Hopkins, has been studying the potential impact of vitamin D and cardiovascular health for over 10 years. Ironically, at her last annual checkup, Michos -- an avid outdoor runner -- was shocked to learn that she, too, was vitamin D deficient with a blood level of only 15 nanograms per milliliter. Should she take a vitamin D supplement for her heart health? In this piece, Michos and her internal medicine colleague Samuel Kim discuss the "sunshine" vitamin.
Vitamin D: Does it Even Matter?
Vitamin D is a hormone that helps control calcium levels in your body, which is ultimately important for your overall bone health. Vitamin D is produced in the skin from exposure to ultraviolet B rays in sunlight or taken in from food or dietary supplements. However, only limited food sources contain vitamin D, such as fatty fish, cod liver oil, eggs, milk, cereal and bread.
It's well-known that vitamin D is important for bone health. Very low levels of vitamin D can cause low levels of calcium in your blood, which can increase your risk of bone fractures, tingling and numbness sensation, and muscle weakness.
Recent research, including many of the studies that Michos conducted, has found that the sunshine vitamin may also be linked to other health conditions, like an increased risk of heart disease, stroke, diabetes, high blood pressure, abnormal cholesterol levels, erectile dysfunction and obesity.
Still, most of these observational studies do not prove a cause and effect because they don't involve intervention to correct low vitamin D levels. Having a low vitamin D level may simply be a risk marker indicating an individual is less healthy from other causes. Further research needs to be conducted to see if treating vitamin D deficiency through vitamin D supplementation can impact vascular disease outcomes. Fortunately, randomized clinical trials to answer this question are ongoing.
[See: The Best Foods for Lowering Your Blood Pressure.]
Who Becomes Vitamin D Deficient?
There are three major groups of people who develop vitamin D deficiency:
1. People who do not get enough vitamin D either through diet or sunlight exposure. Inadequate sunlight exposure is a problem for many people, especially darker-skinned individuals, those who use sunscreen for skin cancer protection and those who live in sun-limited areas in northern parts of the U.S.
2. Patients with kidney and liver diseases can have low vitamin D levels because they have decreased levels of important proteins that metabolize vitamin D.
3. Patients with bowel diseases, such as celiac disease, Crohn's disease and cystic fibrosis, or who have had any surgery that removes or reconnects the intestines or stomach cannot readily absorb vitamin D.
Who Should Get Tested?
In general, routine testing of vitamin D is currently not recommended except for people with kidney diseases, bowel diseases and a higher risk of osteoporosis, including previous bone fractures and low calcium levels.
When testing for vitamin D deficiency, physicians order the blood test for 25-hydroxyvitamin D concentration. This is the form of vitamin D that is the best measure of vitamin D stores in the body.
There is some controversy though about what is considered a normal amount of vitamin D in a blood test. The Institute of Medicine says that blood levels of 25-hydroxyvitamin D greater than 20 nanograms per milliliter should be adequate. However, many experts, including the Endocrine Society, advocate for levels greater than 30 nanograms per milliliter.
Because of the widespread use of sunscreen and more time spent indoors, particularly for occupational work, vitamin D deficiency is actually quite common. In the U.S. alone, the National Health and Nutrition Examination Survey found that over 40 percent of the American population was deficient in vitamin D (levels less than 20 nanograms per milliliter), with the highest rates seen in African-Americans (82 percent) and Hispanics (69 percent).
[See: Pharmacist Recommended Vitamins and Supplements.]
How Do You Treat Vitamin D Deficiency?
Vitamin D can be obtained from diet, but food sources generally have small quantities. In the absence of adequate sunlight exposure, it can be difficult to get enough vitamin D from diet alone. As a reference, 1 cup of milk (8 ounces) is roughly equal to about 100 International Units of vitamin D. For individuals with fair skin, 15 to 30 minutes of midday sun exposure during the summer months can give you close to 5,000 IU a day -- the equivalent of drinking 50 glasses of milk! Dark-skinned individuals and the elderly may produce less vitamin D in response to sunlight.
Prolonged peak sunlight exposure is not recommended for patients with a higher risk of skin cancer, especially individuals who are fair-skinned. Vitamin D from tanning beds is also not recommended given the high risk of skin cancer development.
In addition to diet and sunlight, you can get vitamin D from supplements. Vitamin D supplements come in either D2 (ergocalciferol) or D3 (cholecalciferol) forms. We generally recommend D3, since this is the form that is naturally produced in the body by sunlight, but either supplementation is reasonable. Most supplements at lower doses can be purchased over the counter without a prescription.
It is not completely clear what the ideal vitamin D intake goals should be for each individual. The U.S. Preventive Services Task Force recommends that all adults should intake at least 600 to 800 IU daily. The National Osteoporosis Foundation recommends somewhere between 800 to 1,000 IU daily for adults over age 50.
For patients with vitamin D deficiency, the guidelines recommend an initial treatment with a 50,000 IU vitamin D booster pill -- which normally requires a doctor's prescription -- once a week for eight weeks, then transitioning to a once-a-day supplementation between 1,500 and 2,000 IU. Patients on seizure medications, steroids, antifungals and HIV antiviral medications are often recommended to take two to three times more vitamin D because these medications can increase vitamin D metabolism. Personalized vitamin D treatments can be discussed with your doctor.
[See: The 12 Best Diets for Your Heart.]
What Are the Side Effects of Vitamin D Supplements?
In general, the side effects from vitamin D supplements are uncommon and relatively benign. However, high doses could lead to high calcium or phosphorous levels, increased thirst, a metallic taste in the mouth, tiredness, constipation and kidney stones. Although vitamin D toxicity is rare, it's not recommended to take more than 4,000 IU a day, unless a doctor is also monitoring your blood levels.
So What Does All This Mean for Me?
Vitamin D deficiency is common in the U.S., especially because many of us stay indoors and do not eat vitamin D-rich foods. There are reasonably good data to support the use of vitamin D supplementation by patients with a higher risk of osteoporosis. However, the benefit of supplementation in the normal aging population remains unclear.
Although there are more data to suggest that vitamin D deficiency may increase the risk of heart diseases, high blood pressure and obesity, it is not unclear at this time if and how vitamin D treatment will improve the development or progression of these diseases. More research is needed. Also, vitamin D treatment may only benefit those with deficiency, not individuals who already have adequate levels from sunlight and diet.
Back to our case about the author: Despite her physical activity levels, perhaps it isn't so surprising that Michos ended up vitamin D deficient. She eats a largely vegetarian/vegan diet, does most of her outdoor physical activity in the early morning, avidly uses sunscreen in the summer and lives in the northern part of the U.S. -- all known risk factors for deficiency.
In the end, Michos decided take a vitamin D supplement for her bone health, particularly because of her family history of osteoporosis. But at this time, despite her own research, she cannot recommend vitamin D for the sole purpose of preventing heart and related vascular diseases. As mentioned, there are several large randomized clinical trials ongoing now to test whether vitamin D treatment can reduce the risk of heart disease, cancer, diabetes and death. Hopefully, the results of these trials will inform future recommendations to patients.
Dr. Erin Michos is a cardiologist and associate professor of medicine at the Johns Hopkins University School of Medicine with a joint appointment in epidemiology at the Johns Hopkins Bloomberg School of Public Health. She is the associate director of preventive cardiology for the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. Her research interests focus on general preventive cardiology, cardiovascular health in women, vitamin D and management of lipid disorders.
Created on Wednesday, 08 June 2016 00:39
Increase the risk of Alzheimer’s by 50%? Kidney disease by up to 50%? Unfortunately, that’s exactly what the science suggests.
For years, I have warned about the dangers taking acid-blocking drugs—conventional medicine’s completely wrongheaded approach to stomach pain and acid reflux.
What causes acid reflux? It isn't acid. The acid is supposed to be there. Producing it is the stomach's normal function. What causes escape of the acid from the stomach into the esophagus and throat is pressure: pressure chronically exerted against the valve between the stomach and esophagus.
Ironically, too little stomach acid may be a factor in causing acid reflux. That's because the stomach is programmed to get to a certain ph, and if it doesn't get there, it keeps producing more weak gastric juice, and the extra volume increases the pressure in the stomach. And the high pressure exerted against the valve over time causes reflux.
Despite the evidence for this, conventional medicine gives us proton pump inhibitors (PPIs) to treat stomach pain and acid reflux, which work by eliminating acid production—thus making the problem even worse.
Unfortunately, the bad news doesn’t stop there. Recent studies have revealed a frightening spectrum of side effects caused by acid blockers:
- A large study published in JAMA Neurology found PPIs to be linked with dementia and Alzheimer’s disease. The study found that regular use of PPIs increased the risk for dementia by as much as 52% compared with nonusers.
- Two new studies have linked acid blockers with chronic kidney disease. The increase in risk is cited as 20–50%.
- Another study found that PPIs may raise the risk of heart attack by 15–20%. Other studies have shown that PPIs damage the lining of blood vessels and thus promote cardiovascular events.
The link with pneumonia and other infectious diseases was established years ago. This may be because acid is a barrier to infectious organisms getting inside your body.
Because stomach acid helps digest protein (and think of all the things your body does with protein) too little stomach acid can compromise protein digestion and nutrition overall. And, it can lead to nutrient deficiencies, since it is harder for the body to extract minerals and vitamins from food without stomach acid. An example is calcium, and reduced calcium absorption is a likely reason why PPI-takers are more susceptible to osteoporosis and bone fractures.
Stomach acid also protects your body from infection because the acid acts as a sterilizer. It's your stomach acid that protects you from bad germs in your food and water. Do you want to lose that protection? At what peril?
It can also be hard to stop taking PPIs once started. When patients stop taking them, fermentation can cause pain. It may also be hard to re-establish the ability to produce acid.
Given these dangers, why do doctors continue to suggest these drugs to their patients? As always, it is instructive to follow the money. Blockbuster drugs in this class such as Prevacid, Prilosec, and Nexium bring in billions of dollars each year and are some of the most widely prescribed drugs in the US. Nexium alone brings in about $6 billion a year. With so much money at stake, drug companies presumably do not want people to learn the truth, and drug companies hold a lot of sway with doctors.
The good news is that the problem can be managed without using these dangerous drugs. Mastic gum, deglycerated licorice (DGL) and orange peel extract are three natural remedies that are safe and effective. And, they can be combined, if necessary. It's a heck of a lot safer and better than taking acid-blockers.
Of course, lifestyle factors are paramount. If you need to lose weight, lose it. That will often help a lot. If you consume coffee and alcohol, stop both because they both make acid reflux worse. If you smoke, you obviously have to stop; you're killing yourself.
And another major and common factor is just plain over-eating. If you overfill the stomach, it's going to increase the pressure within the stomach and the pressure exerted against the esophageal valve. You just can't eat until you are full, as in stuffed. If you do that habitually, you probably will wind up with acid reflux. We just have to learn to stop eating before we feel stuffed.
Restoring stomach acid with hydrochloric acid supplements is another useful option, but I recommend talking to a doctor first before doing that, preferably one who is well-versed in complementary methods.
Acid-blockers are a big multi-billion dollar a year business, but I say it's all wrong. I would NEVER take them. I'm holding on to my stomach acid. That's because I need it. Likewise, you need yours.
Created on Thursday, 05 May 2016 15:22
Medical error is the third leading cause of death in the United States, after heart disease and cancer, according to findings published this month in the British Medical Journal.
As such, medical errors should be a top priority for research and resources, say authors Martin Makary, MD, MPH, professor of surgery, and research fellow Michael Daniel, from Johns Hopkins University School of Medicine in Baltimore, Maryland.
But accurate, transparent information about errors is not captured on death certificates, which are the documents the Centers for Disease Control and Prevention (CDC) uses for ranking causes of death and setting health priorities. Death certificates depend on International Classification of Diseases (ICD) codes for cause of death, so causes such as human and system errors are not recorded on them.
And it's not just the US. According to the World Health Organization, 117 countries code their mortality statistics using the ICD system as the primary health status indicator.
The authors call for better reporting to help capture the scale of the problem and create strategies for reducing it.
Cancer and Heart Disease Get the Attention
"Top-ranked causes of death as reported by the CDC inform our country's research funding and public health priorities," Dr Makary said in an university press release. "Right now, cancer and heart disease get a ton of attention, but since medical errors don't appear on the list, the problem doesn't get the funding and attention it deserves."
He adds: "Incidence rates for deaths directly attributable to medical care gone awry haven't been recognized in any standardized method for collecting national statistics. The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used."
The researchers examined four studies that analyzed medical death rate data from 2000 to 2008. Then, using hospital admission rates from 2013, they extrapolated that, based on 35,416,020 hospitalizations, 251,454 deaths stemmed from a medical error.
That number of deaths translates to 9.5% of all deaths each year in the US — and puts medical error above the previous third-leading cause, respiratory disease.
In 2013, 611,105 people died of heart disease, 584,881 died of cancer, and 149,205 died of chronic respiratory disease, according to the CDC.
The new estimates are considerably higher than those in the 1999 Institute of Medicine report "To Err Is Human." However, the authors note that the data used for that report "is limited and outdated."
Strategies for Change
The authors suggest several changes, including making errors more visible so their effects can be understood. Often, discussions about prevention occur in limited and confidential forums, such as a department's morbidity and mortality conference.
Another is changing death certificates to include not just the cause of death, but an extra field asking whether a preventable complication stemming from the patient's care contributed to the death.
The authors also suggest that hospitals carry out a rapid and efficient independent investigation into deaths to determine whether error played a role. A root cause analysis approach would help while offering the protection of anonymity, they say.
Standardized data collection and reporting are also needed to build an accurate national picture of the problem.
Jim Rickert, MD, an orthopedist in Bedford, Indiana, and president of the Society for Patient Centered Orthopedics, told Medscape Medical News he was not surprised the errors came in at number 3 and that even those calculations don't tell the whole story.
"That doesn't even include doctors' offices and ambulatory care centers," he notes. "That's only inpatient hospitalization resulting in errors."
"I think most people underestimate the risk of error when they seek medical care," he said.
He agrees that adding a field to death certificates to indicate medical error is likely the way to get medical errors the attention they deserve.
"It's public pressure that brings about change. Hospitals have no incentive to publicize errors; neither do doctors or any other provider," he said.
However, such a major step as adding error information to death certificates is unlikely if not accompanied by tort reform, he said.
Still, this study helps emphasize the prevalence of errors, he said.
Human error is inevitable, the authors acknowledge, but "we can better measure the problem to design safer systems mitigating its frequency, visibility, and consequences."
They add that most errors aren't caused by bad doctors but by systemic failures and should 'not be addressed with punishment or legal action.
Dr. Cinque: So, what do they mean by "systemic" errors as opposed to doctor error? Do they mean that the doctor followed the standard protocol but the protocol was wrong? That's what it sounds like to me.
First, note that this has been reported before that medical errors are killing people on a grand scale. I mean: it has been known for decades. And they said then that steps were going to be taken, etc. etc. to reduce the medical carnage, but obviously, it hasn't worked. Second, medical deaths are still being grossly underreported. Take heart disease, for instance, the leading killer. If a person dies from the adverse effects of medications for heart disease, such as calcium channel blockers which are dangerous because they can trigger heart attacks, it's likely to be called a death from heart disease rather than heart disease treatment.
I'll admit that my perspective is very bleak. I think that most of medical treatment is killative. Leastways, most of it is harmful. Most of it amounts to suppressive, symptomatic, pharmaceutical tinkering which adds a new abnormality to the ones you've already got- complicating your condition, even if in some ways it seems better or looks better. They are not making you healthier; they are just making your disease manifest differently as you continue going downhill.
A good example are diuretics which are very widely prescribed but rarely do anybody any good. You're better off living with whatever fluid retention you have than trying to get rid of it forcibly that way. Better yet, take some constructive actions with diet, salt restriction, weight loss, exercise, supplements, and perhaps fasting to see if you can get it to resolve naturally and spontaneously through actual biological improvement rather than forcing measures. What's so terrible about that? Remember, patience is a virtue. You start doing the right things, and then you give it time. There is no need to resort to anything reckless and drastic.
This whole thing is complicated by the fact that there are areas in Medicine in which they do do valuable and beneficial things, such as surgery for cataracts, giving Metformin to Type II diabetics, antibiotics when necessary, and hormone replacement when indicated, especially when they are bio-identical. And I have no doubt that great work is being done with stem cells, and more is to come. But, none of that changes the fact that most of modern medical treatment is just disruptive pharmaceutical tinkering, which is hurting people and sometimes killing them. As a percentage, there isn't that much good in Medicine, and most of it should be avoided.
Does that seem radical? Well, I'm sorry, but it's true.