Michael Carlston, M.D. - Family Practice & Complementary Medicine

Carlston, M.D.
Family Practice and Complementary Medicine

www.carlstonmd.com

May 30, 2008

Dear Patients,

In this newsletter I wanted to share a few of my most recent blogs for Veria. In one week the office will close down for two and a half weeks while we are gone on vacation. I am looking forward to spending that time with my family and hope you make time to do the same.

Best
Michael Carlston
www.carlstonmd.com

The EPA and High Powered Greens
More Vaccine Questions – Thimerosal, Neurologic Damage and HPV
Athletic Performance Enhancement - Supplements and Society

The EPA and High Powered Greens
Many years ago a study of organic greens sold in the San Francisco Bay Area found that nearly all of the samples were contaminated by perchlorate. Although the greens were farmed organically, the water in that part of California had been apparently been contaminated with perchlorate in the rocket fuel leaking from tanks at Edwards Air Force base. Perchlorates have since been identified in water samples from nearly 400 sites in 35 states including the Colorado River which is the source of drinking water for nearly 10% of the US population. One study earlier this year found perchlorates in nearly ¾ of various foods tested. Among their ill affects, perchlorates impair thyroid function making pregnant women and their babies particularly vulnerable.

Although the EPA has acknowledged that perchlorate contamination is a wide-spread and real problem, it has been blocking moves to regulate perchlorate levels in drinking water. The EPA rationale for their inaction is that regulating won’t do any good. Ironically, one of the EPA’s own advisory committees (Children’s Health Protection) has been pushing for stricter standards and enforcement. When the EPA proposed a stand of 24.5 parts per billion (ppb), the chair of the EPA’s Children’s Health Protection Advisory Committee wrote that this standard "is not supported by the underlying science and can result in exposures that pose neurodevelopmental risks in early life," advocating a level that was much lower. California (6 ppb) and Massachusetts (2ppb) have established their own standards. As in other cases, the EPA may attempt to force the states to loosen standards bringing them into compliance with national standards. That is, if they decide to establish and enforce any.

More Vaccine Questions – Thimerosal, Neurologic Damage and HPV
Vaccines have long been such an emotional issue that entertaining a rational discussion was impossible. Even admitting to having questions was an indication of either insanity or stupidity. That is changing.

A newly released study of over 275,000 medical records of vaccinated children conducted by George Washington University reached a disturbing conclusion. Researchers uncovered a consistent relationship between the level of thimerosal (the mercury preservative in older vaccines) and the likelihood of autism, autism spectrum disorders, tics, emotional problems and attention deficit disorder. The linkage between the amount of exposure and risk is a strong indication that this is a believable conclusion.

Thankfully thimerosal exposure has been markedly reduced but this does not reassure those of us accustomed to trite dismissals of the questions we ask about medication safety. I have been in medicine long enough to observe again and again as some procedure or medication moves from total acceptance or standard of care to a past “mistake” that had serious consequences for large numbers of patients.

This brings me to the second matter.

When the new vaccination for Human Papiloma Virus (HPV) became available, almost immediately legislators moved to make the vaccine mandatory. As HPV sometimes leads to cervical cancer, the thought was that by mandating the vaccine, it would be eradicated in boys and girls thus preventing spread of HPV and future cases of cervical cancer.

Again one of the world’s foremost experts on HPV has taken a public stand cautioning against over reaction. Dr. Diane Harper, Director of Dartmouth University’s Gynecologic Cancer Prevention Research Group and the principle investigator on the HPV trials conducted by both Merck and GlaxoSmithKline says that the vaccine has not been out long enough to identify potential side-effects, should not be mandated and we should not undertake “a big public experiment”.

I wrote “again” because the physician who first recognized that HPV was sometimes linked to cervical cancer, went on record a decade ago admonishing physicians not to go overboard trying to eliminate all HPV as most HPV does not cause cervical cancer.

Athletic Performance Enhancement - Supplements and Society
Athletics and sporting competitions are a major focus of human activity. Here in the US, springtime is flooded with sports. People are becoming more active and the professional sporting calendar is awash with events. Baseball and professional soccer seasons are starting. Hockey and basketball are both in the midst of their season-ending playoffs. The NFL holds their draft so that no one forgets about their sport. Worldwide, the story is the same. The professional leagues in Europe are reaching their climax. The quadrennial international European soccer championships and the Summer Olympics are fast approaching. In the coming weeks and months, inevitably, a significant portion of our sporting attention will be drawn to the latest accusations of “doping” or other illegal performance enhancement. I will now make my contribution to the dialog.

There are many reasons for us to frown at athletic heroes who set a bad example and risk serious self-harm by breaking the rules of competition to get the edge over their opponents. However, I think this warrants more careful consideration.

The point of any competition is to perform at one’s utmost capacity. In athletics, whether the individual is striving to walk a single mile for the first time without stopping or pushing to break a world’s record in the nigh jump, the common feature is the effort and dedication to do one’s best.

Hopefully no one will argue that training, diet and attitude are all vital preparatory components to that achievement. The argument comes in when an athlete violates some standard of fairness in his/her preparation. Standards are often very poorly defined in part because they can be difficult to define, are innately laden with subjective valuations and even entirely lacking when intense effort leads to new and creative ideas that no one had thought of and so have not generated a consensus of moral opinion. There are some who believe that anything the athlete does to him or herself should be allowed and honored as a reflection of their dedication. Athletes in the ancient Olympic games grasped whatever advantage they could find including wrestlers greasing their bodies to make it difficult for their opponents to grasp them. Today it is blood doping, gene doping, hormone injections and undoubtedly other techniques still secret to the world.

The emotions surrounding athletic competition and doping make it difficult to fairly evaluate the use of supplements in athletic performance. For example, in many sports athletes can be disqualified for marijuana or cocaine use although the evidence shows that these substances both hamper athletic performance. One of the few supplements with good evidence of athletic performance enhancement is not only legal; it is dispensed on every street corner in Manhattan in the form of a warm drink called “coffee” by the natives.

A recent study of 10 volunteers at the University of California, San Francisco, found that an herbal supplement made the subjects feel that the exercise was easier over 80% of the time. This mix of herbs (citrus aurantium, green tea and guarana) and caffeine did not change heart rate, temperature or physiologic signs of fatigue (oxygen consumption, lactate or insulin). It raised the blood pressure slightly as well as the blood sugar. As many of us have been concerned about the ill effects of high doses of caffeine and the ephedra-like effects of citrus aurantium, this study is somewhat reassuring that those might not be such a concern, at least in these doses in a population of healthy men and women.

Where is your comfort level with performance-enhancement? I share the communal disdain felt towards “cheaters” but where is that line? In my opinion, it is not at all obvious.

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