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

Carlston, M.D.
Family Practice and Complementary Medicine

www.carlstonmd.com

July 15, 2007

Dear Patients

I am off to a medical meeting at the end of this week, and then vacationing next week so the office will be closed from Thursday July 19 until Monday, July 30. After I return the next newsletter should include an announcement about an interesting online health education project.

My new multiple vitamin has arrived. If you want to order, or for more information, write to us at [email protected], or call the office (707-545-1554).

Best
Michael Carlston, MD
www.carlstonmd.com

Rosacea and GreenTea Extract
Fasting and Rheumatoid Arthritis
Jellyfish First Aid

Rosacea and GreenTea Extract
A recent study of a topical cream containing green tea extract found it to be highly effective for the treatment of rosacea. The month long placebo controlled trial utilized a product manufactured by Syed Skin Care, Inc. applied twice a day. 20% of these 500 otherwise healthy, young adult patients (average age 30) responded to the placebo cream, while 74% responded to the active treatment.

There are a few reasons to view the study cautiously. It is a single study. The cream may not work in patients who are older or have an associated disease causing the rosacea. The product is fairly expensive ($125 for less than 2 ounces). Most importantly, the company that sells the product funded the study. In fairness, most studies are funded by a company with something to gain. http://www.syedbeauty.com/

Other studies have found that natural products (topical vitamin C and a flower extract for example) can be helpful. We need to learn which treatment works the best for which patient.

Fasting and Rheumatoid Arthritis
For a long time people have believed that diet has an impact on rheumatoid arthritis. This is hard to test in part because extreme dietary changes require highly dedicated patients/study participants. Consequently, we know very little on this matter. Given this relative lack of evidence, widespread medical doubt about the effectiveness of dietary interventions most likely betrays a basis against nutrition as therapy. At the same time many of us have seen positive effects of dietary change, at least in the short term. Evidence is accumulating that supports this belief.

The Journal of Alternative and Complementary Medicine reported on nearly 1,000 patients suffering from rheumatoid arthritis, osteoarthritis, fibromyalgia or migraine who underwent a 7 day therapeutic fast. For to days the patients ate a small (800 calories) amount of carbohydrates in the form of rice, potatoes or fruit. Then they could have only mineral water, herbal tea and veggie broth for a week (350 calories). During the fast they also had laxatives or enemas for cleansing. The four days after the fast they gradually resumed eating, favoring a vegetarian diet. Other groups (including over 1,000 additional patients) utilized different diet therapies, including a Mediterranean diet which met their caloric needs, and other elimination diets.

Over a third (37%) of the fasting patients reported that they were “much better”, while 24% of those treated with other dietary interventions reported similar improvement. Overall, 78% of those fasting reported improvement in their health.

The best designed studies specifically addressing rheumatoid arthritis and fasting indicate that a short fast on vegetable juice (a week or so), followed by a vegetarian diet, seems to lead to improvement in symptoms and laboratory disease markers. One study followed patients for a year, and continued to show a benefit at the close of the study.

Jellyfish First Aid
Jellyfish stings can add a unwanted hazard to a pleasant warm water vacation. A few simple precautions can be very helpful. First, stay away from them. Usually they aren’t so easy to spot until they are right in front of your facemask, and then swimming rapidly in reverse might only help you plow into the rest of the jelly swarm behind you. If you see dead fish in the water, they might be dead because of jellyfish. Be careful.

If you run into a jellyfish, remember that they are very simple creatures and their stingers fire automatically. The jellyfish can be in the ocean but those stinging cells clinging to your skin on the beach can inject you with venom if you push on them. Rinse them off with seawater. Fresh water can make the cells fire.

After you’ve gotten all of the jellyfish parts off your body, the next step is to deactivate the jellyfish toxin. Heat inactivates the toxin, so soaking in hot water or even leaning up against a hot car can be very helpful. Vinegar can also help.

Ear Tubes Don’t Help
Placing ear tubes (PE tubes) in small children was the most common surgery in the USA for many years. I was one of many claiming that antibiotics were needlessly overused for ear infections, and ear tubes were just as needlessly used when the antibiotics did not work. Research ignored since early in the 1980’s contradicted clinical practice. The one claim remaining to be disproved has now been dispatched.

Fearing developmental delays (reading, social skills and academic achievement) surgeons advocated PE tubes. Researchers had documented that no such delays occurred up to age 6. As some aspects of development are hard to measure until children get a bit older, researchers recently completed a study following children from under 3 up to age 11. There was no evidence of any benefit from the PE tubes.

In addition to the confirmation that children rarely if ever need this surgery, the identity of the lead author of this study pleases me. That author was the subject of a great deal of controversy, including hearings in the US Senate over the use of governmental research funds. He was the lead investigator in a study that, when submitted for publication, concluded that antibiotics were effective for otitis media. The lead statistician had his name removed from the article because he said this conclusion was untrue. The lead investigator had been receiving considerable financial support from the manufacturer of the antibiotic customarily used to treat children’s ear infections.

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July 15, 2007

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