August 2006 PDF

This issue

• 10 worst foods for your heart
• Managing migraines drug free
• Should you vaccinate?

* * * * * * * *

Butterbur vs. Allegra

I love it when scientists decide that a natural supplement is just as good as a manufactured drug.

Recently, a group of researchers got together to evaluate the differences between patients’ responses to Allegra-the popular allergy drug-and butterbur, a supplement with a pretty good bit of research behind it. And it turns out that butterbur is as good for attacking cases of the sniffles as Allegra.

The researchers examined 16 patients suffering from the sniffles. Some of the patients received 180 mg of Allegra, some received 50 mg of butterbur, and others received a placebo.

They found that there were no differences between the Allegra and the butterbur-at least not when it came to the patients’ responses to it. Both groups got significant and equal relief.

This is great news. And it’s one of those occasions when we can say almost for sure that a natural supplement is just as useful as a chemically enhanced, manufactured, expensive drug (that doesn’t always work, by the way).

Is your doctor (mis)treating your blues like major depression?

You  know, it makes me sick how so many doctors will look at a mildly depressed patient and then just automatically write a prescription for Paxil or Zoloft without even batting an eye.

But what he’s really giving you is a prescription to gain 20 pounds, not want to have sex with your spouse, and to possibly have frequent thoughts of suicide. Worse yet, most of those prescriptions are being handed to patients who don’t have actual clinical depression at all–just a bad case of what we used to call “the blues.”

Let me tell you the real solutions –and rest assured that they don’t involve any of the problems I just mentioned, or taking drugs at all, for that matter.

Know what you’re treating

In our quick-fix society, though, doctors and patients don’t always want to take time to figure out which natural alternatives are worth trying. And the result is that way too many people out there are taking drugs that they just don’t need.

You see, what most patients don’t realize-and what too many doctors refuse to take the time to consider-is that there’s a big difference between major depression (which might actually call for a drug) and mild to moderate depression (which might not).

Take my patient Mike, for instance.

When he first came to me a while back, he was so weighed down by sadness that he could barely gather the strength to push back the covers and get out of bed. Some days he didn’t even try.

He didn’t want to work. He didn’t want to do the things he used to love doing, like playing catch with his kids, riding his bike, or going out to dinner with friends. And even the tiniest mishap-something as small as a flat tire-sent him on a downward spiral, until he felt as if he was never going to be happy again.

When you feel that bad, you’ll do just about anything to make it stop. Mike needed an antidepressant. Extreme cases like Mike’s are usually caused by a pretty serious chemical imbalance, and that requires somewhat drastic measures.

But cases like Mike’s tend to be the exception rather than the rule. The truth is that a lot of people out there are taking antidepressants they probably don’t need. Many of them are dealing with minor or moderate depression (what I call “the blues”). And in those cases, drugs are rarely the answer. Often, these patients just need some lifestyle changes and maybe a good, mood-boosting supplement.

So before you ask your doctor to write you a prescription for one of the feel-good drugs you’ve seen on TV, the first step is to figure out if you’re seriously depressed or if you’re just struggling with a bout of the blues.

When to call in the pros

Above all, it’s important that you treat depression like you would any other condition. Don’t diagnose yourself, because there could be a bigger problem than you can see.

When they’re diagnosing major depression, psychiatrists usually look for five or more of the following symptoms:

• a consistently sad, anxious, or “empty” mood
• loss of interest or pleasure in normal activities, especially those that you used to enjoy
• significant weight loss without dieting
• insomnia (especially if you’re waking up a lot in the early morning) or excessive sleeping
• persistent physical symptoms, like headaches, chronic pain, constipation, or other digestive disorders, that don’t respond to treatment.
• restlessness or irritability
• daily fatigue
• low self-esteem or frequently feeling guilty, hopeless, or worthless
• poor concentration and indecision
• excessive thoughts of death
• a suicide attempt or plan

Of course, you could have just one, two, or three of these problems and still be depressed-but you’re probably not dealing with major depression. However, minor depression can become major depression if it’s not treated. So it’s important to catch it before it gets worse.

Or maybe you’re not depressed at all. A lot of these things are also symptoms of other conditions, like a sluggish thyroid or an iron deficiency.

A visit to your primary doctor can help rule these things out. But if those things check out OK, you should make an appointment with a psychiatrist. After all, you wouldn’t see a podiatrist about a headache or a chiropractor about digestive problems. A psychiatrist knows the most about what’s going on inside your head.

Brain chemicals out of balance

There are tons of theories out there about what causes depression. I tend to think of it as the effect of too much stress or trauma in a person who’s already predisposed to depression.

Highly stressful life events-like death, divorce, financial turmoil, or abuse-can also trigger episodes of depression. Over time, these episodes can keep happening until they become a habit. And the longer it goes untreated, the worse it gets.

To be honest, no one is completely sure what the specific physical causes are. We do know that it has something to do with the levels and function of three different neurotransmitters in the brain: dopamine, norepinephrine, and especially serotonin. When the levels of these neurotransmitters get too low, different messages-including happy thoughts-get lost and can’t bridge the gaps between brain cells, hampering our brain’s ability to communicate with itself.

This is where one of the most popular groups of antidepressants, called SSRIs, comes in.

While there are many different kinds of antidepressants, selective serotonin reuptake inhibitors (SSRIs) -which include drugs like Zoloft, Celexa, Paxil, and Lexapro-are the most popular ones out there. They boost your serotonin levels and can decrease anxiety in certain people. While they can be lifesavers in cases like Mike’s, these are also powerful drugs that can have some serious drawbacks.

Recent studies have shown that certain antidepressants–especially Paxil–can increase suicidal thinking among children and adults.

There’s no clear reason why this happens. But several studies have shown that patients taking SSRI antidepressants attempt suicide at a higher rate than patients not taking antidepressants. Of course, that doesn’t mean that everyone who takes antidepressants will try to kill himself. It’s a risk, though.

A depressed libido

Antidepressants, especially SSRIs, are notorious for messing up people’s libidos or sexual function. In my experience, almost everyone who takes an SSRI antidepressant winds up with this problem.

These drugs boost your serotonin without boosting a similar neurotransmitter called dopamine, which is directly associated with your sex drive and your ability to experience pleasure. As a result, SSRIs create an imbalance that dampens your libido.

Some doctors might prescribe an additional antidepressant like Wellbutrin or even an erectile dysfunction drug like Viagra to fix the problem. But treating one drug’s side effect with another drug always makes me uneasy. So let’s focus on some safer, natural remedies instead.

One proven herbal alternative for men is Ginkgo biloba, which helps get you going by increasing blood flow to your genitals. I recommend Nature’s Way Ginkgold, 60 to 120 mg twice a day.

Rhodiola is another proven herbal remedy that is effective for both men and women. This stuff is great for improving both your mood and your sex drive. Rhodiola balances out your hormones, and increases dopamine-one of the neurotransmitters in your brain-which is very important for sexual function and libido. It’s great for treating mild to moderate depression, and it’s also safe to use long-term, or alongside an antidepressant.

Start with 100 mg a day. Increase your dose by 100 mg every four to seven days, but don’t exceed 300 to 400 mg.

Side effects beyond the bedroom

Another problem with SSRIs is an increased risk of nosebleeds and gastrointestinal bleeding.

Also, certain drugs-especially Paxil and Effexor-can cause serious withdrawal symptoms, especially if you quit taking them too quickly. Those side effects can include serious headaches, anxiety, gastrointestinal problems, insomnia, sweating, muscle spasms, nightmares, and dry mouth.

Cheaper, safer ways to tackle depression

The truth is, a lot of patients could benefit just as much from nutritional therapy, which costs less than antidepressants, and has few-if any-side effects. And these treatments are still safe even if you’re already taking a drug.

>> Omega-3 fatty acids. Two important omega-3 fatty acids-DHA and EPA-play an especially vital role in brain-cell communication. I even recommend them to patients who are already taking antidepressants.

Try taking between 1 and 5 g of EPA daily, along with 500 mg to 3 g of DHA.

>> Folate. Research has shown that about 1/3 of depressed patients have low folate levels. This doesn’t surprise me. Folate plays a big role in the processing and balancing of your brain’s neurotransmitters.

In one placebo-controlled study, researchers added 400 to 500 mcg of folate to participants’ usual doses of fluoxetine (Prozac). The folate boosted the women from a 50-percent success rate with the drug to 90 percent. Although it did not work in men, the dose may have been too low. I make sure that all of my patients on antidepressants also take at least 800 mg of folate.

>> SAMe. This is an essential molecule in the body that has been used to successfully treat both mild and severe depression, alone and in combination with drugs. Mild cases usually require about 200 to 800 mg per day, but more severe cases may need up to 2,800 mg per day.

Side effects are occasional and mild-nausea, loose bowels, agitation and anxiety, headaches, and palpitations. This stuff can be expensive, but COSTCO has a product that’s reliable and cheap-$39.99, which is less than a dollar per dose. Go to www.costco.com. ACD

Do away with depression

A big part of perking up depends less on what you swallow and more on the things you actually do.

1. Talk it out. For some people, psychotherapy works just as well as medication. And for people already taking drugs, the results could be even better because you’re getting twice the treatment.

What’s amazing is that when doctors have taken brain X-rays of depressed patients, the pictures of people on antidepressants vs. those in therapy show very similar results.

2. Get moving. This is a real no-brainer, whether you’re on an antidepressant or not. Like I’ve said many times before, exercising and yoga can definitely improve your mood. Exercise balances our hormones, improves our sleep, and stimulates mood-elevating brain chemicals called endorphins.

In fact, studies have shown that exercise can work as well as any medication for mild to moderate depression. Try aerobics, strength training, or yoga.

3. Cut down on the sugar and caffeine. For some people, sugary or caffeine-rich foods can cause send their blood sugar on a roller coaster, causing an emotional imbalance. Because of this, cutting down on sugary foods like cakes, cookies, candy, coffee, and soft drinks can relieve depression for certain individuals.

The 10 Worst Foods for your Heart

Before the food industry got its greedy mitts on our food supply-before there was a “food industry” at all-people managed to do OK on a diet that didn’t come in a box, bag, or can. The fact is, when it comes to food, we’d all be better off if we avoided anything in a package and ate only what we could buy from local farmers, or what we raised or grew ourselves.

As far as I’m concerned, fast food restaurants are palaces of obesity and disease. And those prepackaged chips, candies, and cookies that line store shelves are just as bad. With their disease-causing trans fats, empty calories, and high caffeine levels, these foods destroy the hearts of people who eat them.

This list could be 100 items long, but I’ve limited it to 10. So here are the worst of the worst, 10 foods that, in my view, are just as bad for your heart as cigarettes are for your lungs.

Donuts

These are nothing more than a killer snack with a hole in the middle.

These things are packed with  sugar, trans fats from hydrogenated oils, and high fructose corn syrup, or HFCS. (HFCS is a concentrated sweetener that causes all sorts of destruction in the human body.) And your body has no idea what to do with any of these “new-to-nature” substances. They increase your cholesterol and promote inflammation, increasing your risk of heart disease (not to mention diabetes, cancer, and dementia).

In fact, experts have estimated that if trans fats were removed from our foods we’d reduce so much disease that it would save 20,000 lives a year.

Canned soup

Turns out this so-called comfort food isn’t so comforting after all. A lot of these companies like to brag about how “healthy” their soups are, but in truth, one serving usually contains too few nutrients to even make a difference.

What you are getting, though, is more saturated fat, along with even unhealthier omega-6 and trans fats. And these trans fats promote disease-causing inflammation in the body, including in your heart.

Oh, and to give this otherwise flavorless stuff some taste, they have to load it up with salt-a whopping 890 mg per serving in most cases. That swallows up at least half of your recommended daily salt intake, wreaking havoc on your blood pressure and putting you more at risk for heart disease and stroke.

The good news is that making your own soup is so easy that resorting to the canned stuff just doesn’t make much sense anyway. And homemade soup can be a nutritional powerhouse when you make it with fresh vegetables. Plus, there’s nothing tastier than some old-fashioned, homemade soup.

Soft drinks

Soft drinks are full of HFCS-laden calories. These drinks go directly to your liver and increase the production of fats called triglycerides, disrupting your metabolism. They also increase your insulin resistance, putting you at a greater risk for heart disease and diabetes.

And don’t think you can get off easy with a diet soda. We’re still not sure what the artificial sweeteners they contain (like aspartame and sucralose) will do to your body. So unless you’re willing to turn your body into a lifelong chemical experiment, skip soft drinks, diet or otherwise.

You should also know that regularly drinking too much caffeine will stiffen up your arteries, promoting high blood pressure, which is a major risk factor for stroke and heart disease.

Instead, try your favorite real fruit juice (not the fruit punches or cocktails lining most supermarket shelves), mixed 50-50 with some seltzer water. In a couple of weeks, your taste buds will rebel against the excess sweetness of soft drinks.

Fast-food hamburgers

Here’s an interesting fact: There are specially trained scientists in New Jersey who come up with amazing chemicals that mimic our favorite flavors (like beef), and then stick ‘em into all sorts of fast foods. Why? Because these foods have no flavor unless it’s chemically induced.

These burgers have actually been shown to temporarily lessen the diameter of your arteries (what doctors call vasospasm), constricting blood flow. This can eventually kill you if it gets worse.

But what more can you expect from a fat-filled hamburger made from a cow that’s been force-fed corn, penned up in a filthy lot, and pumped full of antibiotics and hormones?

If you’re craving a hamburger, cook your own on the grill, using grass-fed meat and a whole-wheat bun.

Low-fat frozen yogurt

This is a fake health food full of empty calories. It has none of the live, natural, healthy bacteria that you find in regular yogurt. It’s also loaded with high-fructose corn syrup, which messes up your cholesterol by increasing your triglycerides and promoting dangerous, artery-clogging plaque.

Like most low-fat foods, this stuff causes a spike in blood sugar and insulin levels, which increases your risk of diabetes, among other undesirable effects. You’re better off having a small dish of real ice cream every once in a while, rather than snacking regularly on this plastic junk.

Chicken nuggets

I’ll admit that there is a little bit of chicken somewhere in that nugget. You just can’t find it for all  the salt, preservatives, artificial coloring, corn sweetener, and trans fats (which are great if you want to keep your nuggets around in your pantry until Christmas, but they have no place in your diet). The salt alone is enough to damage your heart. The rest just adds insult to injury.

Why not try some healthy, range- fed chicken coated in real, whole-wheat breadcrumbs and baked in the oven?

Fast-food french fries

Back in the day, fries were made with lard or beef tallow (fat). Not exactly a health food-and a bad idea in excess-but a darn sight better than all the trans fats the modern versions of these crispy critters deliver into your system–including to your heart–with every bite.

Fast-food fries have actually been shown to increase your risk of diabetes. They’ll also lead you down the fast track to obesity.

Instead of placing that drive-thru order, try cutting potatoes into thin strips and baking them in a thin layer of organic seed-oil, with just a smattering of salt. It may not have quite the same crispy, deep-fried taste, but your heart will thank you for it.

Vegetable oil

This stuff has been touted by ignorant healthcare experts and dietitians as “healthy” polyunsaturated fat that’ll help lower your cholesterol.

But most vegetable oil is seriously over-processed. As a result, any protective nutrients that would reduce the chance of cholesterol oxidation in your body have been heated and stripped away during the manufacturing process. All that’s left is a bunch of disease-promoting free radicals that cause inflammation.

Opt for organic seed oils (like corn, sunflower, or safflower) that are cold-processed. You should be able to find these oils in natural food stores. They’re also popping up more often in your local supermarket’s natural foods section.

Margarine

This is yet another food that has been bragged about as healthy but is actually anything but good for you.

Margarine is loaded with disease-causing trans fats, several grams per teaspoon in most brands. What’s worse: 15 years ago scientist told us how bad this stuff was, but the so-called healthcare industry experts ignorantly and irresponsibly keep touting the healthiness of this useless, fake butter.

Just go ahead and enjoy a little bit of real butter on your bread. Remem-ber, you do need some saturated fat-you’re actually supposed to get 10 percent of your daily calories from it.

Starbucks strawberries and cream frappucino with whipped cream

Like to live on the edge? Have a cup of this with a donut for breakfast.

There’s over 100 calories just in the whipped cream alone. And the smallest size they offer still has 410 calories-almost a quarter of your recommended daily calorie intake. Have one every day, and you’ll soon transform your body into a gummed-up, overweight, inflamed mess.

Instead of these high-calorie, concoctions, just have a cappuccino, sweetened with a little regular sugar as a now-and-then treat. ACD

Don’t let migraines keep you in the dark

Frank is one of the friendliest people I know and also one of my best patients. He always has a kind word, always wears a smile, and always has a great attitude. But, ever since his 30s, Frank would get one humdinger of a migraine headache three or four times a month.

First he’d feel tired and a bit queasy. Then, once the headache hit, he’d have to retire to a dark, quiet room and sleep it off. But he hated living like a hermit on the days when the migraine came. One day, he just couldn’t take it anymore and came in to see me.

About 18 million Americans like Frank suffer with migraine headaches. About 25 percent of them-”migraineurs” as they’re called-experience a visual aura, which is a warning symptom preceding the migraine, accompanied by flashing lights and even partial vision loss. I suppose Frank was lucky that he didn’t have that problem. But unfortunately he wasn’t lucky enough to be one of the people whose migraines can be wiped out with regular old aspirin, ibuprofen, or Excedrin Migraine.

His headaches were throbbing and often came with severe nausea. For Frank, even the triptan drugs-which include Imitrex, Relpax, Amerge, and Maxalt-only knocked his headaches down by 70 to 80 percent. He was able to go about his daily business, but that’s still no way to live.

Like many of my patients, Frank wasn’t crazy about taking the drugs anyway. So even though the triptans were working somewhat, we decided to go the natural route.

All-natural trio cuts migraine pain in half

Six years ago, Dr. Alexander Mauskop, director of the New York Headache Center, devised a preventative remedy called MigreLief (www.migrelief.com), which contains feverfew, magnesium, and riboflavin (vitamin B2). All three have been shown to help lessen the frequency and severity of migraines.

Frank tried it, and, sure enough, within a couple of months his mig-raines decreased to just one or two per month. And the ones he got were about 50 percent less severe–much better results than drugs.

Then something great happened. Frank started exercising. He was already in fairly good shape for a guy his age and didn’t need to lose any weight. But his cholesterol level was on the high side, so he decided to get moving. He wasn’t even thinking about the exercise’s potential effects on his migraines, but fast-forward to one year later and Frank’s migraines are completely gone.

In my view, exercise should be the foundation of any migraine prevention program. It reduces stress, decreases depression and anxiety, and alleviates sleep problems–all of which can trigger migraines.

In fact, Frank had so much success with his exercise program that he doesn’t even have to take the MigreLief anymore, which I think is great. After all, I’m just as happy to see a patient stop using a supplement as I am when they can quit taking a drug. MigreLief served its purpose-it gave him a safe start on the road to a migraine-free life.

Keep in mind though that, as with any migraine preventive, you really need to allow three months for any remedy to work, just like Frank did.

Triggers and treatment

No one’s entirely sure what causes migraines, though we know that they can be genetic. Experts also think that migraine headaches have something to do with a widening and narrowing of blood vessels in the brain, which triggers inflammation and pain.

When you get more than two migraines per month, the first thing your doctor should do is identify what triggers them so that you can avoid whatever that is. Frank’s main trigger was alcohol. Triggers can also include aged cheeses, chocolate, or other dairy products, citrus foods, and eggs. MSG, aspartame, and the nitrites in hot dogs, bacon, and other processed meats are also common culprits. And, of course, there’s stress. Migraineurs often suffer from depression and other mood disorders.

Preventing migraines can also mean taking drugs. They include beta-blockers like propranalol, tricyclic antidepressants like amitriptyline, and anti-seizure medications like Topamax. These drugs work by moderating nervous system activity in the brains of migraine sufferers. But they also come with side effects like fatigue, depression, low libido, weight gain, dry mouth, and constipation. When they work without side effects, these drugs can be a blessing. Those cases are rare though, and patients on these drugs need careful watching.

But, all of these things aside, there’s something you need that no supplement or drug can provide-a positive attitude and determination.

Frank was determined to get better. He’d had enough, and decided to do whatever he could to stop his pain. And sure enough, he did.

For more information about fighting migraines, I highly recommend Dr. Alexander Mauskop’s book What Your Doctor May Not Tell You About Migraines.

One more thing to keep in mind: Your headache might not be a migraine at all. A lot of people think they’re dealing with a migraine when it’s really a tension headache or possibly something more serious. Ask your doctor about your symptoms to figure out the problem. ACD

Your Questions Answered

Flu vaccines:  Who needs them, when, and why?

Q: I’m confused about the flu vaccine. I’ve heard all sorts of rumors about how it doesn’t work and can actually cause the flu. I’m 58 years old, about 20 pounds overweight, but otherwise healthy. Should I get the vaccine? What else can I do to protect myself against the flu?

–Tina L. , Cullman, AL

A: There are a lot of things that even doctors don’t know about the flu vaccine. We don’t really know how many lives it saves. We don’t really know how many flu cases it actually prevents. And we don’t really know how many people it harms.

But every year like clockwork, doctors, the media, and the government issue strong reminders about the importance of getting your flu shots. And, every year, scientists reformulate the vaccine to fight off the most common flu strains-including the latest mutations. But to be honest, this vaccine, like most medicines, works better for some people than others.

It appears to help reduce illness and death in people with lung disease. And it may prevent death in elderly people who get pneumonia. On the other hand, only about 40 to 50 percent of elderly patients who get the vaccine develop the antibody response in their immune systems that is necessary to ward off the flu. That leaves the other 50 to 60 percent still at risk.

As for those rumors that the flu vaccine can actually cause the flu, that’s true. I often see patients– most of them elderly–who seem to get a mild to moderate case of the flu after receiving the vaccine.

Additionally, the vaccine contains mercury. And this brings up another unknown: We still don’t know what effects this may have years from now.

What we do know is that about 200,000 people get the flu every year and about 36,000 of those people die from it. Personally, I suspect that the vaccine does save some lives. But meanwhile it makes many more people at least mildly ill, maybe even causing a very small number of deaths. But this is virtually impossible to prove.

The vaccine is usually recommended for people over 65 and anyone with a chronic degenerative disease like heart disease or diabetes. But a healthy person like you is probably better off just taking better care of yourself with proper nutrition, taking a multi-vitamin, avoiding sugar and stress-both of which can both hurt your immune system-and using common-sense measures like regular hand washing and avoiding sick people. If everyone would follow these rules it would probably save many more lives than a vaccine ever could.

You might also want to try taking Echinacea or olive leaf extract every day during the winter as an added immune booster. I’ve had good results with it and so have my patients. Nature’s Way has high-quality versions of both herbs. (Just follow the dosage instructions printed on the labels.)

Because Echinacea stimulates the immune system, you might want to take a break from it every sixth week and give your immune system a rest before starting back up.

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.