March 2006
A stalk a day could keep your pain away
I’ve gathered a lot of folk remedies from my patients over the years–things their great grandmothers whipped up in the kitchen that the whole family has sworn by ever since. This month we’re talking about pain, so I thought I’d share one of the simplest folk remedies I’ve heard of for it: celery. Supposedly it’s good for you in any form,whether you like it cooked in your homemade chicken noodle soup, cut fresh and topped with peanut butter, or liquified in a glass of vegetable juice. Now, like most folk remedies, there’s not a lot of research behind it, but celery’s pain-relieving effects are probably due to the fact that it’s a diuretic. Getting the exess fluid out of your system can help reduce inflammation and ease your pain. There’s certainly no harm in giving it a try. ACD
Do painkillers kill more than pain?
I still find that lots of people are unaware of the dangers of common over-the-counter painkillers like acetaminophen and ibuprofen. Folks think because you don’t need a prescription for them, they’re safe. Nothing could be further from the truth. The hard fact is, thousands of people die each year from the toxic side effects of these drugs.
I’m not saying they don’t have their place. Most of my patients who use them are trying to get rid of arthritis pain. And that’s no small potatoes. I know folks whose joints hurt so bad they can barely walk to the mailbox. Relieving that pain can give people their lives back. But before you pop your next Tylenol, you need to know the safe way to do it-and what you can do instead if your pain isn’t going away after a dose or two.
“Aging in a bottle” and other little-known risks of the most common painkiller
Let’s start with acetaminophen, the main ingredient in one of the most common pain relievers on the market-Tylenol.
It works okay for headaches and the pain associated with regular old wear-and-tear osteoarthritis. But take even a little too much, and you can destroy your liver. Acetaminophen can also damage your kidneys. Obviously, people who already have kidney disease are at greater risk, but anyone taking too much can run into trouble.
And here’s some more food for thought: Acetaminophen uses up an important free radical scavenger in the liver, N-acetylcycteine (NAC). Even if it doesn’t cause outright liver or kidney failure, it hampers the body’s ability to squelch free radicals, which accelerate aging and promote disease. Another reason not to use too much.
The problem is, it’s hard to say exactly how much is TOO much. Too much for some is okay for others. That’s because our liver detoxification systems vary from person to person. So the one-size-fits-all instructions on the label can actually be a prescription for disaster.
As a general rule, too much is over 4 grams-that’s 12 regular tablets. It sounds like a lot, but if you’ve got chronic arthritis and take three tablets every four hours, you’ve hit your max by dinnertime. Plus, if you’re sensitive to drugs or if you drink (even in moderation), even half that amount can catch up with you down the road, especially if you use it daily for months or years. And if you have any kind of liver disease, including a fatty liver, or if you take any other drugs that can damage the liver, you also need to be especially careful. In fact, if you’re taking any of the following drugs, I’d recommend staying away from acetaminophen altogether: Macrodantin and Macrobid (nitrofurantoin); amiodarone; cholesterol lowering statin drugs like Lipitor, Zocor, and Crestor; methotrexate; allopurinol; valproic acid; high-dose niacin (over 500 mg a day); antifungals like Diflucan (fluconazole); and even aspirin.
Using acetaminophen a few times week, a few times a month is usually safe. That’s the way these drugs are meant to be used. But if you find your pain isn’t going away entirely with this sort of occasional use, you’ll be much better off using the safer, more effective ways to manage it. More on that in a moment.
But first, let’s talk about the other major player in the over-the-counter painkilling arsenal.
Trading in one pain for another
You’ve probably heard of the class of drugs referred to as non-steroidal anti-inflammatories, or NSAIDs for short. These include common over-the-counter drugs such as Advil (ibuprofen) and Aleve (naproxen) and prescription drugs like Voltaren (diclofenac), Incodin (indomethacin), Relafen (nabumetone), and Mobic (meloxicam). As a group, NSAIDs have been associated with increased risk of stomach ulcers and bleeding and kidney failure. It’s estimated that over 10,000 people a year die of intestinal bleeding as a result of taking these drugs.
This class also includes the now infamous Cox-2 inhibitors. Two of these drugs, Vioxx and Bextra, were recalled when researchers discovered they increased risk of heart attack and stroke. They can also lessen the effects of blood pressure medications, which is why some experts predict that the increased risk of heart attack and stroke will end up being the case with all of these drugs. Besides, long-term use of Cox-2 inhibitors causes pathological changes in joint tissue that result in its destruction. So they may actually end up making arthritis worse years down the road.
Those are all the most serious potential side effects of NSAIDs. There are other risks that are much more common, such as mild rashes, diarrhea, and indigestion. By far the most common complaint I hear from people taking NSAIDs is “Doc, it’s tearing up my stomach!”
The problem is this: A drug that confers a benefit in one tissue-such as joints-can cause harm in another tissue-such as the lining of your stomach or your kidneys. It’s kind of a crapshoot, because we don’t really know who is susceptible to these adverse effects. So to cover their bases, some doctors recommend acid-blocking drugs like Pepcid or Prilosec along with the pain medication to moderate the harmful effects of these drugs on the lining of the stomach. But the idea of using one drug to treat the adverse effects of another always makes me uneasy.
Frankly, I prefer that patients avoid drugs like Advil and Celebrex altogether. Ice, massage, and natural remedies can work just as well and are safer. Nonetheless, NSAIDs can definitely reduce pain in acute strains or sprains and arthritis flare-ups, and they’re usually easier to get your hands on. Just don’t use them for more than a few days for two weeks max. And don’t use them for exercise-induced muscle pain: They actually slow tissue recovery.
It is possible to use prescription and over-the-counter painkillers safely, but as you’ve read, sometimes the risks outweigh the benefits.
My favorite natural solution is fish oil. Next month, I’ll tell you how it helps, how to use it, and lots of other suggestions for relieving your pain without putting yourself at risk. ACD
Too much of a not-so-good thing:
Beware of acetaminophen in other painkillers
Acetaminophen is an ingredient in a lot more drugs than just Tylenol, and to avoid overdose you need to look out for these “stealth” sources too. The list includes prescription painkillers like Percocet, Vicodin, Darvocet, Fioricet, Roxicet, Lorcet, Lortab, Vicoprofen, Wygesic, and Zydone.
But it’s also in some unexpected products. In fact, if you start reading labels carefully, you’ll find that acetaminophen is actually in over 200 different over-the-counter and prescription medications, including many cold remedies.
Another thing to keep in mind is that some drugs can magnify the damage potential of acetaminophen. For example, anti-seizure medications like phenobarbital, phenytoin, and carbamezepine and the anti-tuberculosis drug isoniazid can make even normally safe doses of acetaminophen dangerous.
Be sure to let your doctor know how much acetaminophen you’re using before you begin any new prescription medications.
HOMETOWN HEALING
Kick the creepy crawlies to the curb
Doreen’s been coming to my office now for a few months. She has a slight case of asthma and she’s on a blood thinner and another medication to take care of her irregular heartbeat. But other than that, she’s the model of health. She’s in her 70s and takes great care of herself-even teaches yoga and tai chi. But last time she came in for a check- up, Doreen told me she was having a problem. She described it as “the creepy crawlies” and said it was getting worse-to the point where it was affecting her sleep.
Doreen was more concerned that there may be some dangerous underlying disease in connection with her problem rather than the problem itself being the problem, if you see what I mean. But anything that interferes with sleep is enough of a problem all on its own, in my book.
It turns out Doreen has restless legs syndrome. People who have it usually describe it the same way Doreen did: a creepy-crawly, itching, or pulling sensation in the legs that gets better with movement, usually walking. But it’s typically worse at night, so it disturbs normal sleep. And to make it even more maddening, restless legs syndrome (RLS) can go away for weeks or months at a time, then come back all of a sudden without warning.
It’s associated with kidney problems, pregnancy, and iron deficiency. And you don’t have to be anemic to be low enough on iron to experience RLS. If you have restless legs, you should have your serum ferritin checked: This is a measure of body iron stores-not just your hemoglobin and hematocrit, which is what doctors test for when they suspect anemia. If it’s below 30, supplement with iron for two months- I like Solgar’s Gentle Iron or a tonic from Germany called Floradix Herbs Plus Iron (although this one is pricier) -then check levels again in two months. Fixing the iron deficiency will often calm the restless legs. I also like to make sure my patients are getting enough magnesium-at least an extra 400 milligrams a day, preferably magnesium citrate or glycinate, which are absorbed better in the body than the oxide form.
Simple tonic soothes restless legs
The solution for Doreen, though, ended up being even simpler. She didn’t have kidney disease and her ferritin level was okay. And pregnancy obviously wasn’t a factor. Her case was idiopathic, which literally means “causes itself.” (This is a clever way doctors have of saying they don’t know what the true cause is.) But she found that drinking a simple 7-oz. bottle of tonic water every evening was all it took to settle her restless legs.
Quinine sulfate, an old malaria drug, is also a time-honored, unofficial “off-label” treatment for restless legs. And good old tonic water (I usually recommend you leave the gin or vodka out) has some quinine in it-enough to calm down some folks’ symptoms. So in keeping with her desire to try a safe (and in this case cheap) treatment before resorting to a big-gun drug with big-time side effects, Doreen gave it a shot. And it worked.
Mind you, Doreen’s was a relatively mild case. You may need more help-or an entirely different approach. If it doesn’t work for you, start with the supplements I mentioned earlier. Opt for drugs as a last resort.
One of the most common drug treatments is low dose levodopa, the same drug used for Parkinson’s disease. A newer agent for the same thing, Requip, is being pretty heavily promoted right now and may work better for some people. The anti-seizure medication Gabapentin, also known as Neurontin, can work. So can Klonopin, a benzodiazapene tranquilizer from the same class as Valium, but it can be habit forming. If a medication is the only thing that solves the problem, I say fine. But follow Doreen’s lead and try the natural route first, and let me know how it works for you. ACD
How you-and your legs-can get some rest
1) Try drinking a small bottle of tonic water in the evening for a few days to see if it makes a difference.
2) If not, have your serum ferritin checked. If it’s below 30 ng/ml, invest in a good iron supplement (such as Solgar’s Gentle Iron or Floradix Herbs Plus Iron) and take it for two months.
3) Along with the iron, take 400 mg of magnesium citrate or
glycinate each day.
4) If the iron doesn’t work either, talk to your doctor about one of the drugs that might be able to help: Requip, Neurontin, or Klonopin.
10 Facts You Should Know About…Fats
The “forbidden food” that can help you lose weight and much more
The “fat is bad” warning is an oversimplification based on bad science. It’s steered many people into the death-trap of processed carbohydrates, which have helped fuel the obesity boom in this country. Unfortunately, the medical profession shares some of the blame. Back in the 90’s they actually thought the public was too dim to appreciate a good fats/bad fats message.
You need fat-for energy and for your body to function properly.
Plus, let’s be honest-fats taste good! They add satisfying texture and richness to foods. That’s why low-fat diets are such a drag…and why they don’t work. Study after study shows they fail over the long term (after a year). Your body just isn’t getting all the nourishment it needs to be satisfied, so you end up overdoing it on other, supposedly low-fat things. Unfortunately, that’s the trap a lot of people have fallen into. But just because Aunt Mabel swears her pie crust is low-fat doesn’t mean you can have seconds or thirds. In fact, you’re better off bypassing it altogether in favor of something that does have some fat in it. You’ll eat less and be satisfied longer.
But there are good fats and bad fats. Man-made fats found mainly in shortening and margarine are a health disaster in the making. Natural fats from plants, fish, and animals that haven’t been injected with hormones and antibiotics are healthy, when part of a balanced diet. And the best fats you can give your body are essential fatty acids, especially the omega-3 variety. There are tons of reasons why, but here are the top 10:
1. Calm inflammation
Inflammation is the result of a revved-up immune system. When you’re sick or injured, it’s a good thing. But if it continues over the long term, inflammation can actually promote serious problems like heart disease, diabetes, and cancer. Good fats-omega-3s in particular-balance the immune system and calm inflammation.
2. Lower blood pressure
Omega-3s relax blood vessels, which lets blood flow through more easily and reduces blood pressure in the process.
3. Prevent sudden cardiac death
Good fats stabilize the heart muscle by regulating inflow of calcium. This helps prevent fast and irregular rhythms that can result in sudden death.
4. Reduce triglycerides, improve cholesterol
Studies have shown that omega-3s can reduce triglycerides by 30-40 percent and increase HDL “good” cholesterol by 5 percent or more. They also increase LDL “bad” cholesterol particle size, changing them from their dangerous small and dense form to a less harmful large and fluffy shape. Don’t expect overnight miracles, though-it usually takes up to a year for significant improvement.
5. Balance mood
Two specific omega-3 fatty acids, DHA and EPA, are abundant in the brain and are a vital part of healthy mental function. Andrew Stoll, M.D., a Harvard psychiatrist, has had success in treating depression and bipolar disorder (“manic depression”) with 5-8 grams of EPA-rich fish oil a day. For more information on his treatment protocol, read his excellent book, The Omega 3 Connection.
6. Avoid dementia
A recent well-designed study suggested that, thanks to its high content of healthy fats, eating fish just once a week reduces risk of dementia by over 50 percent. What drug can match that?
7. Treat arthritis
Omega-3s are a helpful addition to most treatments for regular old wear-and-tear osteoarthritis. Think of them like WD-40 for your rusty joints.
8. Improve dry skin
Dry skin, eczema, and even psoriasis often improve when you increase your omega-3 fats. And even if you don’t have a skin disorder, omega-3s can still help enhance the beauty of healthy skin.
9. Balance your hormones
Healthy fats are great for women going through menopause. Their hormone-regulating effects can help cut down on hot flashes, night sweats, and many of the other nagging symptoms that make so many women miserable. Healthy fats also support thyroid health, which can give you a great energy boost.
10. Aid weight loss
That’s right-some fats can actually help you lose weight. Adequate intake of healthy fats reduces cravings and helps prevent overdoing the sweets. Plus, omega-3s actually help you burn more fat and calories during the day.
Finding the right fats
With all the benefits, it seems like s simple choice. But, unfortunately, over 99 percent of the population is seriously deficient in these essential fats thanks to modern food processing practices. But it’s really not all that difficult to get enough when you know where to look. Start in your local fish market or at the seafood counter of your grocery store.
Fatty fish like salmon, herring, and sardines are some of the best food sources of omega-3s. I recommend eating them up to three times a week. But keep the mercury warnings in mind. Some fish have higher levels than others, and you want to keep your intake of them to a minimum. Check out the current advisories before you stock up. The Monterey Aquarium Seafood Watch has the best list of safe and not-so-safe fish going. Their website is www.mbayaq.org.
If you don’t like fish (or if you’re pregnant), grass-fed organic beef, free-range chicken and eggs, and organic dairy products are other good sources of healthy fats, as are almonds, walnuts, pumpkin seeds, sunflower seeds, and flaxseeds.
Since most people are deficient in omega-3s, I usually recommend taking a fish oil supplement in addition to upping your intake of food sources. Aim for a minimum of 1 gram total DHA and EPA a day (you may need up to 3-5 grams total for heart, mood, or arthritis support). Take 500 mg in the morning and again before bed.
Of course, I know fish oil and omega-3s aren’t going to help much when it comes to topping your baked potato or corn on the cob. As I mentioned earlier, margarine isn’t the health food it’s made out to be. The truth is, you don’t have to give up butter. I tell my patients it’s fine in moderation. Or you can use olive oil, which is my top pick for cooking. ACD
Life-saving news about vitamin D
Find out the catch-and what you can do to avoid being “caught”
Seems like every time you hear about vitamins in the news, it’s some sort of warning about the supposed dangers associated with them. More often than not, these reports are only part of the story-the exaggerated, taken-out-of-context part the drug companies want you to hear. But every now and again, a vitamin makes headlines for all the right reasons. Lately, that’s been the case with vitamin D.
In December, a group of resear-chers came out with some pretty impressive findings on vitamin D and cancer. They reviewed results of 63 different studies and found conclusive evidence that getting enough vitamin D can cut the chances of getting breast, ovarian, and colon cancer in half.
But it’s not just about cancer. Getting enough vitamin D can mean the difference between spending your retirement walking hunched over in constant fear of falling and breaking a hip or working in the garden and being able to enjoy nine holes of golf without a cart. Vitamin D improves the absorption of calcium and phosphorous, which are essential for healthy bones. That’s why children with low levels of vitamin D develop rickets, which causes bowing of the legs. Adults can develop a similar condition-osteomalacia-where slight bone softening causes a gnawing pain often mistaken for fibromyalgia. And beyond bone health, correcting vitamin D deficiency can also help normalize blood pressure and protect against Type II diabetes.
Sounds great, but there’s a catch.
You probably aren’t getting enough. Recent research reveals up to 50 percent of us fall short on this potentially life-saving vitamin. But there are some easy ways to make sure you’re in the right half.
How to get enough no matter where you live
First things first: You should find out what your levels are. Have your doctor check your 25-hydroxy vitamin D. Levels below 20 nanograms per milliliter (ng/ml) are deficient, 20 to 30 borderline, and 30 to 50 healthy. The best month to test is November. If you’re deficient then, you’ll be severely deficient by the end of winter. That’s because the best source of vitamin D-the sun-isn’t as available then. In fact, unless you live in the deep South, it’s impossible to get enough vitamin D from sunlight from November through February.
This is where food sources come in handy. Cold-water deep-sea fish like sardines and salmon have the most vitamin D. Some other decent options are eggs (with the yolks), liver, and cheese. If you eat a lot of them, you may be able to get enough from food alone. But just to hedge your bets, you might want to consider taking a supplement too, at least during the winter. For deficiency or borderline levels, take a single 50,000 IU capsule (which you’ll need a prescription for) once a week for eight weeks. Then have your doctor recheck your levels. Once they’re normal, you can cut back to 1,000 to 2,000 IU per day. Or some people prefer to stick with the 50,000 IU capsules and cut back on the frequency to just once or twice a month. You should have your levels checked every two to four months until you figure out the dose that suits you best.
Most experts agree 5,000 to 10,000 IU a day are safe, so my recommendations are well within the safe range. But you do want to be careful not to take more than that. Excess vitamin D causes your body to absorb too much calcium. In the right amounts, calcium is a good thing, but too much can result in kidney stones, kidney failure, and calcification of the arteries leading to heart disease.
The rest of the year-March through October-try to get as much vitamin D as you can from the sun. I recommend getting 10-20 minutes of direct sun on the face and arms two or three times a week. Make sure it’s direct sun, though-that means no sunscreen. Even an SPF 8 sunscreen blocks 90 percent of the sun’s vitamin D effect. That doesn’t mean you shouldn’t use it at all. You’ll just want to wait it out for that 10-20 minutes before you put any on. Then make sure you reapply it every two hours. ACD
Sunlight lowers skin cancer risk?
People usually associate melanoma, a potentially fatal skin cancer, with excessive sun exposure. But a recent study from Australia suggests that too little sun is associated with increased risk of melanoma. What’s going on here? Well, if you’re not getting enough sun, you’re also not getting enough vitamin D, and as the recent research revealed, that ups your cancer risk.
But there’s still a case here for the dangers of too much sun. Remember the Golidlocks rule of thumb: Too little sun or too much sun gets most of us in trouble. A small amount, as recommended above, is just right for most. A sunburn is nature’s way of telling you you’ve overdone it.
Best bets for better vitamin D levels
1) Have your doctor check your 25-hydroxy vitamin D level. You want it over 30 ng/ml.
2) March through October, spend about 10-20 minutes outside without sunscreen two or three times a week. (If you live in the deep South, you can do this all year and skip the next steps.)
3) The rest of the year, take 50,000 IU of vitamin D once or twice a month or 1,000 to 2,000 IU per day. Some of you may need to do this year round.
4) Eat plenty of salmon, sardines, eggs, and other food sources of vitamin D all year long.
Your Questions Answered
The worry-free approach to preventing ovarian cancer
Q. I am a healthy woman in my early 40s with three healthy children. I’m not aware of any family history of cancer of any sort. I don’t smoke or eat the wrong foods. I’m not overweight. I go for a walk with a friend for an hour five days a week. I’ve been getting annual mammograms and pelvic exams and PAP smears, which have all been normal. I feel well. However, a close friend under similar circumstances was just diagnosed with advanced ovarian cancer and I’m scared out of my wits. What should I do?
–D.M., Charlotte, N.C.
A.This is a tough call. First, the good news: It’s highly unlikely you have ovarian cancer or will ever get it. Now the bad news: In spite of advances in treatment, the mortality rate has not changed much in the last 50 years. That’s because ovarian cancer isn’t usually discovered until it has spread to other organs.
But screening in people without risk factors and symptoms is pretty much needle-in-the-haystack medicine. In a recent large study of over 30,000 women, researchers had to go through approximately 1,500 ultrasounds and blood tests before they found even one case of cancer.
I know this all sounds like bad news, but there are a lot of things you can do to protect yourself. In fact, you’ve already done one of the most protective things-three times. Pregnancy appears to protect against ovarian cancer because it elevates levels of progesterone, which has a lasting effect in the body. Birth control pill use does the same thing. Here are some other steps you can take:
1) Make sure you’re getting enough vitamin A-2,000 to 3,000 IU per day. Vitamin A comes in two forms-retinol and beta carotene, which turns into vitamin A in the body. Avoid any supplements with the retinol form, unless supervised by a nutritionist. It can accumulate in the body and damage the liver, bones, and eyes. But you probably don’t need supplements at all. The recommended 2,000-3,000 IU a day is easily obtained from foods that contain beta carotene, such as carrots, apricots, spinach, and peas.
2) Up your vitamin D intake. See the article “Life-saving news about vitamin D” on page 6 for the best ways to do that.
3) Keep your body’s inflammation under control with natural anti-inflammatories. I prefer to see people take omega-3s in the form of fish oil, which has known cancer-protective effects. Curcumin and ginger are also good options.
4) The B vitamin folate is also protective. I usually recommend 400-800 micrograms a day, which is the usual amount found in multivitamins.
Try not to chase after cancer. If you’re healthy and don’t have a lot of risk factors, the stress involved in worrying about cancer could do more harm than good. On the other hand, you shouldn’t have to walk around with unanswered questions in your head-a proper sit-down with a doctor you can trust should be your next step.
The text contained herein does not constitute medical advice. America’s Country Doctor advises that you consult your own physician before acting on any recommendations contained within this publication.
Posted in Newsletter.
