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

Carlston, M.D.
Family Practice and Complementary Medicine

www.carlstonmd.com

July 10, 2009

Dear Patients,

I hope you are enjoying the beautiful summer. After being gone a lot, I am very happy to have the time to tend to some basics – yard work, house cleaning and gardening as well as spending time with friends and family. It is clear that daily habits, taking care of the business of our lives, are most of who we are. It seems that it is the little things, our most common and most mundane activities, which define and reflect our inner health. You can’t cope with stress very well if the only time you relax and take care of yourself is during vacations. Instead, the way we live our daily lives is the truest expression of our selves.

A couple of years ago, I enjoyed one of the best weeks of my life when I drove across the US with my son. At one point, exploring old family history, a new friend in rural Minnesota strongly urged me to go to their county fair, which was underway that evening. I went, compelled by the enthusiasm expressed by this typically stoic Minnesota/Swedish farmer. The fair was nothing special, just some really small rides, typical farm food, country music and a demolition derby (okay, I admit that was weirdly cool). Compared to the Minnesota State Fair or even the Sonoma County Fair, it was not much. However, the people were enjoying themselves much more than I had ever seen at any fair. I spent a couple of blissful hours that summer night just wandering around the fair, watching the people and enjoying their happy faces. It was a fantastic evening and taught me unexpected lessons about the joys of simplicity. Although one small part of me regretted missing out on the night that they held the big combine demolition derby with those house sized monsters going at it, the experience left me feeling quite comforted and complete.

Best,
Michael Carlston, MD
www.carlstonmd.com

GERD Drug Damage and/or Dependence?
Vitamin D Is Almost Becoming Boring
Swine Flu (aka H1N1) Vaccination

GERD Drug Damage and/or Dependence?

One of the medical fads of recent years has been gastroesophageal reflux – GERD for medical types, heartburn for real people. Believing that too much acid is the cause of the problem, treatments have bounced between various forms of acid-reducing agents for decades.   When I started working in the hospital as a nursing assistant in the early 1970’s, we gave everyone Maalox. Then, the acid-suppressing drug called cimetidine popped up so we gave that to every one. It worked fairly well, but caused breast swelling in men and could cause lethal failure of the bone marrow (that is where your body makes blood).   More recently we got the proton pump inhibiting drugs (Aciphex, Nexium, Prevacid, Prilosec, Protonix, Zegerid).

In a recent study conducted in Denmark, healthy people, without any history of GERD related symptoms, were given either a PPI drug or placebo for 8 weeks. For the four weeks after stopping the treatment they were tracked for any GERD symptoms. After stopping the pills, those who were on the drug, not placebo, were three times more likely to experience some acid-related symptom. I find it disturbing that the likelihood of these symptoms was just as high in the fourth week after stopping the drug. When did the subjects recover? Did these previously healthy subjects ever recover? Recent studies of the long- term effects of antibiotics on the normal bacteria living in subjects’ intestines found that they never recovered during the study interval, which was 6 months.

These drugs impair absorption of nutrients. Now we have learned that they cause the problems they are meant to treat. So, take a drug for a problem but then after you stop the drug the problem gets worse than it was before taking it? Hmmm, sounds like a good investment for stockholders but not for patients.

Vitamin D Is Almost Becoming Boring

Long-time readers of this newsletter have probably noticed that I have not been writing about the latest vitamin D research findings in every single newsletter recently. That is because there is so much evidence accumulating, that none of it seems particularly surprising.   Certainly more research is needed, particularly to fully establish firm causative links and optimal vitamin D blood levels. However, it is absolutely clear that, given the lack of risk from taking anything less than bizarrely high doses coupled with the high likelihood of benefit, we all should be working to raise our D levels.

I am happy to report that the NIH is supporting a massive clinical study of vitamin D and omega-3 fish oil as protection against heart disease, cancer and stroke. That five-year study will begin next year and include 20,000 subjects. Unfortunately the experimenters will only give each subject 2,000 iu of D3 a day which will not be enough to raise the blood levels of many subjects even to the dubiously low end of the currently recognized “normal” blood range. It would be much better to target a certain blood level and give each subject enough to achieve that level. Such a conservative dose, without targeting a specific blood level, will save the lab costs but will limit what we can learn from the study. As a scientist I am eager for the information we will gather but as a clinician, our current state of knowledge tells us enough that I think it would be unethical for me to wait five years for the study results before treating patients for this problem.

The important questions for me have to do with sorting out when it is really necessary to check blood levels (i.e. why not just take a lot?) and learning to more perfectly predict how much supplementation it will take to raise a specific individual’s D to a certain level. The answers to these questions will come as my years of clinical experience pile up.

Swine Flu (aka H1N1) Vaccination

The South American winter, with some dozens of deaths in Buenos Aires, as well as ongoing anxiety in the Northern hemisphere, are keeping the H1N1 (swine) flu in the media. The reasons to be concerned are, as I have discussed previously, H1N1 influenzas tend to be the most dangerous, the age of those most severely affected by this H1N1 follow that same pattern, infectious disease spreads extremely rapidly in this age of air travel and past serious pandemics have mutated from not so nasty to really nasty during the Southern hemisphere winter.   The reasons not to be concerned are that this H1N1 has not been so bad, a mutation making it more deadly would most likely make it less contagious, and we have learned a lot about immune stimulating factors (including vitamin D) in recent years that are likely to reduce vulnerability to the flu. At the present time the US government is strongly considering funding a vaccination program for US citizens.

I will tell you why I won’t be immunized.

The government last funded an influenza vaccine program in the 1970’s, when there was also fear of a re-emergence of the 1918 swine flu.   That epidemic never developed; however, nearly 700 Americans died from a neurologic disease (Guillain-Barré Syndrome - GBS see http://www.ninds.nih.gov/disorders/gbs/gbs.htm    and http://www.cdc.gov/FLU/about/qa/gbs.htm) as a consequence of the vaccine. Much more often, people with GBS do not die, but are left with persistent paralytic weakness. Since that time our ignorance about why some developed GBS and then what to do to prevent GBS persists. We have learned that it is apparently also linked to a meningitis vaccine.

I am not convinced that the likelihood of devastation from H1N1 is so high, for the reasons above. Personally I prefer other approaches, which I view as safer and often more effective. My grandfather died of GBS years before the swine flu, so I might also have a genetic vulnerability to this rare but severe adverse effect. I plan to continue to “do the right thing” as far as maintaining my health (diet, exercise, sleep, stress management, keeping my vitamin D up), and adding other immune support as the circumstances warrant.

One more comment I would like to make: H1N1 appeared among people living on the edge of a massive industrial pig farm in Mexico. This is yet another example of the bad consequences of tightly packing animals (including human ones) together in what can only become an unhealthy environment, inevitably leading to new and very nasty infectious diseases. Do your part for the health of us all by supporting your local family farmers!

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