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

Carlston, M.D.
Family Practice and Complementary Medicine

www.carlstonmd.com

March 6, 2009

Dear Patients,

Considering the intensity of worldwide economic fears and the sense of overhanging doom, every day I feel a bit surprised that the sun comes up and the world goes on. Certainly times are tight for all, and very bad for some, but it is still possible to laugh with friends, enjoy good music and the other pleasures of life. There has also been cheering news on some health matters, as you will read below.

I started a Facebook page for the office. Although it is as yet underdeveloped, you can go to Michael Carlston, MD on Facebook to check it out: http://www.facebook.com/pages/Santa-Rosa-CA/Michael-Carlston-MD/52162522178?ref=ts
It may be possible to dialog more about general questions you might have on that page, and others will also be able to benefit from the discussion.

On that Facebook page I posted information about a talk I am giving soon, entitled “Nutrition for Endurance Training and Competition”. The Fleet Feet running store in Santa Rosa is hosting the event. You can read an article I wrote, essentially outlining the talk, at http://fleetfeetsantarosa.com/carlston_article/

Best,
Michael Carlston, MD
www.carlstonmd.com

We Are Getting The Lead Out
Eating to Improve Control of Diabetes
Allergic Desensitization Does Not Have to Be a Pain

We Are Getting The Lead Out

Lead is a nasty environmental toxin. It has caused major health problems for humans since the Romans inadvertently poisoned themselves with it. We banned it from paint and from gasoline after we glimpsed the harm it was causing in modern America.   That was great because we then learned that lead was harmful at even lower levels than we had realized. Despite that awareness and those efforts to reduce lead in the environment, blood levels of our children continued to rise. I am delighted to report that a recent study found that from 1988 to 2004 (the most recent data available) the rate of US children with lead levels above 10 mcg/dl dropped from 9% to 1.4%. While lead can cause problems at levels even below 10 mcg/dl, this is a big step towards better health for our children.

Eating to Improve Control of Diabetes

Adult-onset diabetes is increasingly common as our society becomes fatter. While we continue to sort out how we got to this point, it is most important to sort out what to do about it. A new review of research applying a simple dietary approach indicates that the approach is effective.

Foods raise your blood sugar. Different foods raise your blood sugar to varying degrees. While there are times you want your blood sugar to jump up quickly, that rapid rise generally leads to an equally rapid crash. This crash is called reactive hypoglycemia. A long standing pattern of quickly rising and falling blood sugar appears to lead to insensitivity to blood sugar levels and insulin resistance, ie, Type 2 diabetes. Insulin dependent (ie, Type 1 diabetics) are vulnerable to swings of blood sugar from food, as their need for insulin will also vary just as much. A severely elevated blood sugar can cause serious problems, especially in the long term, but Type 1 diabetics can die from low blood sugar when they take too much insulin relative to their dietary needs.

An Australian researcher (Jennie Brand-Miller) started compiling information about blood-sugar raising (ie, glycemic) effects of specific foods. The glycemic index is the measure of this tendency (see also http://www.glycemicindex.com/aboutGI.htm). Pure “sugar” (glucose) was assigned a rating of 100, and so nearly everything else is considerably less than 100. The lower the number, the less that food tends to make your blood sugar blast through the ceiling.

It is a bit more complicated, though. The amount of food obviously has an impact, so the “glycemic load” factors the glycemic index of the food, along with how much of it you probably eat. Also, almost everyone eats more than one food at a time, and combining foods changes the glycemic index unpredictably.

Reviewers at the Cochrane Database reviewed studies of Type 1 and Type 2 diabetics placed on diets focused on low glycemic index and/or glycemic load foods. They found that patients on these diets did much better with markedly fewer episodes of uncontrolled blood sugar (both high and low), and experienced improvement in the standard measure of long-term blood sugar control (HgBA1C).

Allergic Desensitization Does Not Have to Be a Pain

Allergy shots are a pain. You have to go to the doctor all the time.   They hurt. They can cause very serious reactions. They don’t always work. Wouldn’t it be nice if you could just swallow some drops at home on your own, safely and effectively? Yep, and if the FDA gets with it, you will be able to.

Sublingual (ie, under the tongue) immunotherapy (SLIT) has been the usual method of allergic desensitization throughout Western Europe for many years. American medical journals are starting to publish more research on SLIT.

For example, in January, Annals of Allergy and Immunology published an Italian study of asthma patients treated with SLIT compared to inhaled steroids. All patients were allergic to grass pollen, and so that was the pollen used in the SLIT treatment. I will give you the details, but the short version is that SLIT blew away the conventional American treatment. They studied patients for 5 years. Both groups used significantly less bronchodilator (asthma rescue) medication, but the SLIT patients used less. Unlike the inhaled steroid group, patients in the SLIT group had improvement in their nasal symptoms and a reduction in their nasal steroid use. The hallmark of asthma, bronchial hyperreactivity, was better – but only in the SLIT group and not in the inhaled steroid group.

The FDA still has not approved SLIT allergens for use in the US.   European manufacturers have not responded to my inquiries as recently as a few months ago. I’ve been hoping to use SLIT now for over 20 years. Maybe the waiting, for both you and me, is finally coming to an end.

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