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

Carlston, M.D.
Family Practice and Complementary Medicine

www.carlstonmd.com

January 23, 2009

Dear Patients,

This newsletter has been stalled in electronic limbo for several weeks because of problems with my email program and the weeks it took to transfer your addresses, one by one, as I switched allegiance to a new program. If you mention something in this newsletter to a family member or friend who then complains that I forgot about sending it to them, please ask them to email me or go to the link on the website to sign up again. Similarly, if I added your email by mistake, please accept my apologies and write back so I can remove you.

Speaking of email, it is a fantastic means of communication, but with limitations. I would like to remind you that when you need to communicate with me about an urgent or complicated matter, you should call me in the office during my call back time slots (12-12:30 and 5-5:30 M, T, Th and F). With so many emails coming in, messages get buried, my response is often delayed and I cannot get enough information to provide you with adequate care. It is fine for you to email me, but please do so only when you can be very patient.

Best,
Michael Carlston, MD
www.carlstonmd.com

Vitamin D Testing Matters
Eating Patterns and Overweight
Thyroid Medicine and Coffee
Thyroid Matters
Link Firmly Established Between Hormone Use and Breast Cancer
New End-of-Life Care Document for Californians
Flu Vaccine Again

Vitamin D Testing Matters

As many of you know, I am particular about laboratory testing for many reasons. Perhaps the most important is lab error. I have urged many of you not to get your vitamin D levels checked at Quest Labs because their testing was faulty. An article in the New York Times discuses this matter. http://www.nytimes.com/2009/01/08/business/08labtest.html?_r=1&hp

Quest has finally acknowledged their mistakes, long after many of us complained about them, and has been offering to retest patients. If you went to Quest, for a D test you might want to contact them to take advantage of their mea culpa. However, even if the new test proves to be consistent, it still does not correlate with the test used in the research. So, if you DO use Quest, you must divide the 25 hydroxyvitamin D number they give by 1.3 to get the meaningful value.

If you have to pay for lab testing yourself, a new and relatively inexpensive option for testing your vitamin D has become available. Go to http://www.vitamindcouncil.org/health/deficiency/am-i-vitamin-d-deficient.shtml
to learn about it.

This is the best time of year to get your D tested, as it will probably soon be at it lowest level of the year, and taking too much D is very nearly impossible. While it would be ideal to check it more often, determining your low point is most vital. Get it tested sometime before April 1. If you recently went somewhere warm and sunny, delay your blood test a few weeks until you have gotten as pale as your neighbors.

Eating Patterns and Overweight

Eating until full and eating quickly were both associated with overweight in a study of over 3,000 Japanese adults. Those who ate quickly or until full were twice as likely to be overweight than other adults. Those who reported doing both, eating quickly and until full, were three times as likely to be overweight than others. 46% of men reported that they ate quickly and 51% said that they ate until feeling full. 36% of women said they ate quickly and 58% reported eating until they felt full.

These findings need to be confirmed with a more rigorously designed trial. However, these results are consistent with my own clinical (and personal experience). Our weight is determined by a very long list of factors. We should include HOW we eat, not just WHAT we eat, among the dietary factors to which we pay attention.

Thyroid Medicine and Coffee

Many years ago we discovered that calcium interferes with the absorption of thyroid medicine and have then warned patients not to take them around the same time. Surprisingly, it appears that we need to make the same warning about coffee. A recent study showed that drinking coffee within an hour of taking the most widely prescribed thyroid supplement (L or levo thyroxine) reduced absorptions by about one third.

Thyroid Matters

A small study of pregnant Canadian women found that nearly ¾ of them had significant iodine deficiencies. Iodine is essential to thyroid function. It is also essential to the developing fetus. Hypothyroidism in newborns is the most common serious birth abnormality, leading to mental retardation.

A couple of weeks ago another interesting thyroid study was released. This much larger study found that patients with apparently mild thyroid dysfunction had a higher death rate. They measured TSH (thyroid stimulating hormone) and found that people who were either in the low normal range or very slightly elevated range were both more likely to die than those in the most perfect part of the TSH range. TSH is made in the pituitary and its function is to tell the thyroid what to do. TSH increases when the thyroid is not producing enough thyroid hormone and TSH drops when the thyroid is hyperactive. I believe this finding will accelerate the adoption of a narrower “normal” range for the TSH.

Link Firmly Established Between Hormone Use and Breast Cancer

Building on data from several years ago, a very large study newly concluded that women taking menopausal hormones increased their breast cancer risk even if they only used the hormones for two years. Using the hormones for years doubled the breast cancer risk. Fortunately the risk drops quickly after discontinuing the hormones, equaling that of nonhormone users two years after stopping the hormones. The hormone combination these women used consisted of a Wyeth Pharmaceutical combination of estrogen and progestin called Prempro. Some argue that women are safe if they use other forms of these hormones or in different proportions. I have yet to see any convincing evidence that is the case.

New End-of-Life Care Document for Californians

As of January 1 California residents have a new way to declare and convey our wishes about what sort of medical care we want to have when we are seriously ill. The new document is intended for the use of seriously ill patients in emergency situations, as well as those expected to live less than a year. It is called Physician’s Orders for Life Sustaining Treatment (POLST). This law aligns California with a number of other states attempting to establish a standardized means that will insure that health care providers understand patient wishes and act accordingly. The forms are not available yet. For more information, including a comparison between POLST and Advance Directives, go to:
http://www.finalchoices.org/C4_textfiles/POLST_brochure_Final.pdf
AND
http://www.ohsu.edu/ethics/polst/

Flu Vaccine Again

Recently I’ve received a number of questions about the flu vaccine. This is an annual event in response to efforts to promote and expand use of the vaccine. If you wish you can read through my previous comments on the flu vaccine for the details, but the bottom line is that I am not a supporter of the vaccine for a number of reasons. That said, there are a small percentage of people for whom I would recommend it. People who are very ill with chronic debilitating disease are vaccine candidates, especially if their chronic disease is of a respiratory nature. However, those patients and any others who are concerned about serious illness developing as a consequence of influenza or other respiratory infection should first consider pneumococcal vaccination.

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