An Apple A Day

If you read about vitamin supplements you must be confused.  Actually, it would be hard not to be. Vitamins are, by definition, essential to health.  Studies of hundreds of millions of people confirm that truth. However, a rash of recent studies have linked taking vitamin supplements to higher rates of a variety of diseases, especially cancer.  What’s up?

The fundamental problem is bad research.  This bad research is the consequence of poor understanding, plus the difficulties inherent in designing and conduct nutritional studies that apply to the real world.  The best examples of the faults in these nutritional studies are probably those dealing with folic acid and vitamin E.  

Many studies show that dietary folic acid reduces the risk of many diseases, particularly cancer.  The prevention of congenital spinal malformations is the main reason our food supply has been fortified with folic acid for decades.  Surveys of the American population show that this approach works.  That is the simple part.  The confusing part is that some studies have shown an increased risk of cancer with folic acid supplementation, while others have shown that folic acid lowers the risk of the very same cancers.

As many of you have heard me explain following your own blood testing, nearly 20% of us have a genetic inability to convert folic acid to its metabolically active form.  Those individuals among us need to take a special form of folate.  If they take the common, most widely available kind of folic acid, not only does it not help, it seems to cause problems consistent with the unhappy research findings. After MERCK, which holds a patent on this form of folic acid, allowed others to use it, I had it added to my multiple vitamin.  Very few multiple vitamins contain this form of folic acid, as it is more expensive.  Two months ago I read an editorial in a major medical journal wherein a couple of prominent experts pointed out that negative studies on folic acid in diabetics had neglected to address this issue.  Their opinion, with which I am in complete agreement, was that these studies were fundamentally flawed and almost certainly drawing incorrect conclusions as a consequence.

Vitamin E has also taken a lot of heat due, to a similar lack of understanding.  Most of the vitamin E you can buy in supplements comes as alpha tocopherol.  Unless you are a chemist, your brain won’t want to swallow that word or distinguish it from beta, gamma, delta or any other tocopherols.  It is not even that simple, because even with all of those tocopherols, an additional class of compounds called tocotrienols are part of the Vitamin E family and seem to be important.  Food contains all of these compounds, and it appears that alpha tocopherol might be the least important of all.  As one vitamin E researcher wrote, “taking a mixture of vitamin E that resembles what is in our diet would be the most prudent supplement to take”.  I would amend that statement to read, “taking a mixture of vitamin E that resembles what would be in an ideal diet and considers your individual needs, would be the most prudent supplement to take”.

A recent survey concluded that very few Americans were low on any vitamins or minerals.  While that got significant media attention, the fact that hundreds of studies have shown the opposite, did not.  Many of those studies actually measured body levels.  That is especially important as estimates from dietary records are woefully misleading.  Dietary records are infamously different from the truth of what people really do eat.  On top of that, absorption varies tremendously from person to person and even time to time for the same person.

Thankfully, there is evidence that some who write about and study nutrition are thinking more clearly.  The “experts” are becoming more expert.  Also, those with a better understanding are getting at least some attention for their criticisms.

Positive evidence of the benefits of dietary supplementation continues to accumulate (of course).  Recent studies have shown that the brains of people of all ages, from young children to elderly adults, function better beginning just days after starting to take a multiple vitamin.  The same holds true of omega-3 supplements. In an example of the complexity of nutrient interaction, vitamin E lowers the rate of prostate cancer but only when taken along with selenium.

Bottom line-

Think critically -  If something is vital, many of us need it.

Don’t forget the food – A vitamin pill cannot entirely replace good food.  

Don’t go crazy -  Take moderate amounts of nutrients as a safety net.

Go crazy if YOU need to -  Some people, especially when ill, need much more.

Vitamins vary – Cheap forms of nutrients cost less, but they are usually a waste of money and can be harmful

Many medications are available only by prescription (unless you own a computer or travel to another country).  That is because of the risks that accompany their use. When drugs become available we tend to believe that availability is some sort of certification that they are safe, and weak compared to prescription meds. Not true.

Recent news that daily use of aspirin lowers the risk of a number of cancers (especially esophagus, colon, rectum and lung) is another example of apparently wonderful information that is not, if you know enough.  Seems great, doesn’t it?  Take a safe drug and prevent some very nasty diseases.  Shouldn’t I be taking it anyway, because it prevents heart attacks and strokes?

Here comes the buzz kill.  Other studies, larger and more carefully designed, have not found this effect.  Also, studies have found that taking aspirin does not prevent a first heart attack or stroke, as we had thought it would.  It might be a good idea for that purpose in some middle-aged individuals, and probably is for those who have already had a heart attack or stroke. Finally, recent data shows that daily aspirin doubles the risk of macular degeneration, already one of the most common causes of age-related blindness.

Aspirin used to be routinely given to infants with fever.  Then we learned that this could lead to (potentially fatal) Reyes Syndrome.  I have never liked using it in this circumstance, because fever is generated by the body in its effort to make itself an unpleasant place for bacteria and viruses to live.  Squashing the fever squashes the immune response and, as research shows, prolongs illness.

Ibuprofen, (aka ADVIL, MOTRIN, MUPRIN, RUFEN) seems like a good choice to so many.  Inflammation is “bad”, so anti-inflammatory is then good.

Ibuprofen is the leading cause of impaired kidney function in the US.  Years ago a kidney specialist told me she would not see a new patient for kidney trouble until the patient had been off ibuprofen entirely for at least a month, because dropping the kidney-imparing ibuprofen fixed 75% of the patients sent to her.

Ibuprofen markedly increases the risk of the most serious problem commonly seen in marathon runners.  Their kidneys slow down from the exertion.  Taking ibuprofen makes it worse. Their sodium drops and they can die.  Not good.

Many athletes take ibuprofen before engaging in their sport.  Ironically, ibuprofen increases damage to muscles and soft tissue because “inflammation” is one aspect of the healing process.  At the medical meeting of physicians working with endurance athletes before the Marine Corps Marathon last fall, I was delighted to find myself in the company of others who shared my dislike for ibuprofen.  We discussed its harms at length, as well as the muscle damaging effects of statin drugs.  I loved it.

Is Tylenol, the “safer choice”.  Not really.  Starting from the very beginning of my medical training I spent a great deal of time working as an Emergency Room Physician.  One of my first ER shifts I took care of a teenaged girl who was upset and, crying out for help, took an overdose of Tylenol, believing it was safer than aspirin.  By the time she arrived in the ER, she had changed her mind and was feeling fine. She did not realize that, although , in the coming days her life was at risk due to the delayed, liver toxicity of acetaminophen/tylenol.

Following the recognition of the link between aspirin and Reye’s Syndrome, everyone switched to Tylenol.  Now many think that the rise in childhood asthma, which began at the same time, is not a coincidence.

Remember, there is no “free lunch” biologically or otherwise.  The best medication is no medication.  Taking care of yourself, minding the essential health habits, will do far more to help you live well and happily than any medication.  There is a place for drugs but they are only pharmacological band aids.

Dear Patients

I am sorry that this email has to be so long. My sadness that it is necessary is, of course, far greater. Also, please do review this material carefully, as I am unable to respond to the very large volume of emails and phone calls that we have been receiving. Reviewing my previous email/blog posting might also be helpful. If you have further questions regarding your own health, please call the office and schedule an appointment.

I understand the instinctive fear so many of you are experiencing. The trauma suffered by the Japanese is nearly unimaginable. If you have the means, I hope you have made some donation to the American Red Cross or some other humanitarian organization on behalf of the Japanese.

Despite this nightmare, at our distance the radiation released is very unlikely to pose any significant health risks. The Chernobyl disaster (25 years ago next month) is the standard against which all are compared. For perspective, Chernobyl effects extended about 1,000 miles, and the great majority of ill effects were limited to a few hundred miles. Santa Rosa is approximately 4,600 miles from these plants. As the winds are driving the air across northeast towards Alaska and then down into Canada first, we are effectively even further away. Chernobyl was the worst nuclear reactor disaster of all time because of the combination of a large explosion (much larger than anything in Japan so far), as well as the volume and nature of radioactive material released.

I gained much of my earliest experience as a physician explaining health issues to other doctors, the media and the public thirty years ago, when I started speaking on “The Medical Consequences of Nuclear Waste Storage”. The point of my effort was to act on my concerns about the long term safety and security threats created by nuclear power. The range of responses taught me a lot about how people respond to controversial information that they did not want to hear. One caller on a radio show was upset because I was “scaring old people”. Another suggested that I crawl back into my “cave on Fantasy Island”. The Chief of Staff at a hospital where I lectured proposed launching nuclear waste on rockets to the sun, somehow ignoring the fact that rocket failures happen regularly and scattering plutonium over thousands of miles was a really, really bad idea. The funniest might have been the front page newspaper story which began quoting “Dr. Michael Carlston, age 26″, immediately proving my naivete and inevitable ignorance.

The work I did speaking on this topic was on behalf of Physicians for Social Responsibility. I founded a chapter in Minneapolis-St Paul and was the first local chair. This organization has advocated in opposition to nuclear power and weapons since 1961. Today some PSR experts held a very useful press conference, with information beyond what I have found elsewhere. You can access it at:
http://www.hastingsgroupmedia.com/031611radiationhealthexposure.mp3

Sadly, the impacts of the tragic situation in Japan are widening. In addition to the severe challenges they face with rescues, medical care and basic survival needs for at least one half million displaced people, the collapse of infrastructure has made it impossible for authorities to gain control over all of their damaged reactors. After expanding the quarantine area and warning of radiation releases endangering the local population, the company withdrew operators from the reactors for their safety, unfortunately ending the vital efforts to prevent worse damage than has already occurred. In addition, after encountering clouds of radiation, US ships and airplanes moved further off the Japanese coast, with some relocating to the other side of the island, away from the prevailing winds. This is all extremely bad for the Japanese people, and possibly the Chinese, if the winds shift. As there is plutonium on the site and the half life of plutonium is ridiculously long (24,000 years) the present crisis is not only a short-term issue. Some of you might recall the line in the old song that went “plutonium is forever”.

One type of radiation being released into the environment at the Japanese site at a rate equivalent to 400 chest Xrays/hour. That kind of radiation is deadly to people on and near the site, but can have absolutely no effect on us. Particulate forms of radiation (including radioactive iodine, strontium and cesium) are the forms that are carried on the wind. A tiny particle of radioactive material, inhaled, swallowed or entering your body through broken skin, would hardly budge a geiger counter, but would increase your risk of cancer markedly, especially if it were an element that remained radioactive for a long time.

Radiation impacts are always the most severe on young children, infants and babies developing in their mother’s womb. In contrast, the consensus is that the proven thyroid-protective effects of potassium iodide are outweighed by its adverse effects on adults over age 40, except when exposed to doses those nearby the reactors might experience. Age, type of radiation, amount of radiation and your health conditions are all factors to consider.

My recommendations:

DO THE THINGS YOU SHOULD ALWAYS DO TO BE HEALTHY
There is nothing specific you can do to prevent all possible adverse effects of radiation, except to avoid exposure. General measures may seem wimpy but they are actually the most important, as they are the best overall protective measures you can take. If you are deficient in iodine, you are prone to absorbing any iodine including the radioactive version

Fluids
Exercise
Eat well (especially leafy greens, sea vegetables and fish)
Avoid the things that make you sick
One special point here is that radioactive iodine loses its radioactivity over weeks. Consequently, plants and animals in areas inundated by fallout will incorporate radioactive iodine and then expose people eating them (including milk products). BTW, radioactive iodine levels are 10 times higher in goat and sheep milk products than in cows milk.

Strontium accumulates in the same manner and is radioactive for decades not weeks.
Sleep
Supplements – calcium blocks many radioactive minerals including the radioactive form of strontium with its half life of 29 yrs.

Specific supplementation
At this time, I am not personally taking or planning to take potassium iodide. I may take some ginseng and certainly will, as always, take calcium, my MVM and do my best to follow excellent health habits.

Herbs – Siberian ginseng has been shown to reduce damage caused by radiation.

VITANOX Is a combination of green tea, turmeric, rosemary leaf and grape seed I use for various conditions including radiation exposures. As a compromise, you can also (and with greater enjoyment) consume somewhat more nominal doses of some of these in your diet

Potassium iodide
To remind you of what I have written previously-
Potassium iodide is only useful for protecting the thyroid gland. It also disturbs the thyroid, and so should not be used carelessly. The last time I saw a patient whose thyroid function was impaired, seemingly by taking a slightly increased amount of iodine (600 mcg vs the 100,000 mcg in most anti-radiation pills), was yesterday. Adverse effects from high doses of iodine DO occur. The high dose, protective approach is effective when started at the beginning of exposure. There has not been any radiation spread to the US, and it is likely that there will not be at a level likely to cause any health effects.

The young are the most vulnerable, with the developing fetus and newborns the most extremely vulnerable, AND most vulnerable to ill effects of potassium iodide.

If you are over 40, and living in N California, I do not recommend taking it at this time based upon my understanding of the worst possible outcomes arising from the Japanese nuclear crisis. Although I have had potassium iodide on hand at my home for many years, I do not anticipate taking any of it with this incident. The exposure simply does not warrant doing so. I may take Siberian Ginseng and VITANOX as well as my usual calcium.

Again, I feel most strongly that the right approach as far as iodine is to take the RDA of iodine (100-150 mcg for people of all ages). There is evidence that the thyroid damage (including cancer) caused by Chernobyl, was compounded by chronic iodine deficiency. If you have not been taking a supplement with such a level of iodine, avoiding iodized salt, not consuming sea food, and have no thyroid disease, taking a bit more for a couple of weeks would be wise and not harmful. How much is that? For adults a maximum of 1-2,000 mcg (ie 1-2 mg), scaled down for children by age (200 mcg in the youngest). You really should start taking a MVM with an appropriate level of iodine for many long-term health reasons.

Decisions about whom to dose and when are related to level of radiation exposure. When there is a major exposure as the Japanese face, the decision is very clear. Unfortunately, radiation dosage units are very confusing because they mean different things. One measurement you have probably never heard of (Gray units) are the best guideline for thyroid protection, as it indicates how much radiation the thyroid has absorbed. An expert was quoted on the LA Times online site today stating that iodide is recommended at a 50 rad exposure. We do not use rads any more but actually the equivalence should be 5 rads for children or 500 rads for adults. Quite confusing. To simply things

Detectable radioactive iodine (5 cGy) – treat children only
Up to 1 month of age: 16 mg
1 month to 3 yrs of age: 32 mg
3 – 18 yrs: 65 mg (if 150 lbs+ take full adult dose 130 mg)

Higher levels (10 cGy)
Adults to age 40: 130 mg

Levels 100 times higher (500 cGy)
Adults over age 40: 130 mg

I would extremely cautious about continuing these doses more than a week.

At higher exposure levels the preventive iodine dose for children does not increase.

PREGNANT women and newborn babies are very vulnerable to radioactive iodine AND high doses of preventive iodine. These individuals should take one dose with the guidance of a physician (never more than two), and shelter away from exposures (ie, stay indoors). The reason for this is the high risk of killing off the newborns thyroid with high doses of iodine, leading to congenital hypothyroidism (also known as cretinism).

Remember that people who have thyroid disease or an allergy to iodine should not take high doses of iodine.

Instructions on how to make iodide palatable to children
http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm072254.htm

http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm072248.htm

General INFO on potassium iodide
http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm072265.htm

Best
Michael Carlston, M.D.
www.carlstonmd.com

We are bathed in all kinds of invisible energies. From cosmic rays to radio waves, we have no choice in the matter. Well, we do have some choice, but not much.

In the 1960′s my father was a computer whiz. He deliberately flunked out of college so that he could leave and join the Navy. There he learned much of what there was to know about electronics. Despite his higher educational choice, he was very smart and soon became the guy who’d fly off to the Pentagon to fix the computers they used for war games and firing nuclear missiles from ships. In part due to his influence, I grew up passionately immersed in the sciences, including computers. While I was notorious for my endless questions, the possibility of unintentional harm, questioning the reassuring understanding of the experts, had yet to enter my consciousness.

My first awareness of the sea of electromagnetic radiation we swim in came from a sixth grade take-your-child-to-work day. I do not remember much about that day, excepting one particular room. Some of the most sensitive work they did at this company was performed inside a room that had to be insulated from electromagnetic radiation. The room was unlike any other I have been in or seen at any time in my life. The room was made of copper and surrounded by wire coils constructed to block EMR. The strangest part of the experience was that inside this metallic echoing room it seemed surprisingly and strikingly peaceful and “quiet”. I was just 10 years old and blindly in love with science and technology. It was startling, unexpected and, as I became more questioning over the years, disturbingly laden with potential concerns.

EMR is another of the ways in which we have profoundly changed our environment in recent decades. It is not terribly surprising then, that we are more than a bit ignorant as to the impacts of the changes. For years research evidence has bounced back and forth on the ill effects of cell phones on our brains. Most of that concern has been whether cell phones increase the risk of cancer.

The results of medical research are usually considered dubious if the outcome is unexpected, particularly if those results challenge fundamental scientific “understanding”. There are MANY ironies in this. First, the reason we follow scientific methods is precisely to overcome our biases. Why then do we disbelieve our own results? Second, third, fourth and fifth (ad infinitum), scientific discoveries proving that we were previously totally wrong are common. That is how science advances. That is why we do science.

We now have clear evidence that cell phone radiation does in fact alter brain metabolism. A study of 47 individuals was published in the Journal of the American Medical Association a week ago showing a 7% increase in the metabolism of glucose (the brain’s energy source) in the parts of the brain closest to the cell phone antenna.

The study did not show that this caused cancer or was harmful in any way. Actually there is evidence that electromagnetic radiation to the brain can cure otherwise incurable depression, so this cell phone jazz could be positive. I think the odds are against that. Certainly now, the evidence of a measurable biological affect should help us stifle our biases pooh poohing this issue. It should also make you think a bit about your own EMR radiation exposures from cell phones, etc.

I suggest reading the book, DISCONNECT, by Devra Davis as food for thought. She is a serious researcher formerly at Johns Hopkins and the National Cancer Institutes. Another of her books, THE SECRET HISTORY OF THE WAR ON CANCER, despite it sensationalist title, is an excellent source of information on environmental causes of cancer. DISCONNECT is not as good, but still worth your time.

The technological advances of humanity have dramatically changed our lives. They continue to do so in both good and bad ways. The leading cause of death today, cardiovascular disease, is so prevalent because we eat too much of the wrong food and we are not as physically active as human bodies are accustomed to being. Recent research adds to a growing, although still minority, consensus that the second-leading cause of death, cancer, is also essentially a man-made disease.

Cancer clusters are unexpectedly high rates of cancers in certain locales. The movie, ERIN BROCKOVICH, tells the story of the human cost, investigation and legal maneuverings around one such cancer cluster. For three decades, US Marines and their families stationed at Camp Lejeune in North Carolina were exposed to extremely high levels of a wide range of chemical toxins in their water (benzene, perchloroethylene, trihalomethanes and strontium-90). There is an ongoing investigation into the cancer cluster which has appeared among the people who have lived in the area. http://www.charlotteobserver.com/2010/10/29/1794488/calendar-exposes-cases-of-breast.html

To gain attention to the problem and in keeping with October’s breast cancer awareness theme, 14 of the 64 local men diagnosed with breast cancer posed for a 2011 calendar. You might be surprised, because breast cancer is so rarely seen in males that many people do not realize that it ever happens. It does. But such a rare event does not become common without something very unusual causing it. This is the largest known cluster of male breast cancers. The chemical contamination of that area is almost certainly to blame.

Since the Industrial Revolution, cancer has become our second leading killer, behind cardiovascular disease. For some time, the absence of cancer in ancient human remains was attributed to the fact that people usually died younger. That point of view required overlooking the substantial number of cases of cancer we see today among even young children. For many years now, we have accepted that our environmental exposures, especially to cigarette smoke, are a major cause of cancer. Conservative estimates now attribute 75% of cancers to environmental factors.

The War On Cancer is an acknowledged failure. Billions of research dollars have lead to only paltry advances in cancer treatment and survivorship. The problem is that we have yet to accept that we are the cause.

Over the years, an unintended and often unforeseen consequence of our technology is death for the majority of us. I think that the reason our “War On Cancer” has failed is that those directing and funding the fight have had the tactics wrong. This very considerable effort has been misdirected.

We must continue to develop treatments, but the key point is that cancer is a seemingly inevitable consequence of environmental toxin exposures. The only major impact we have had on reducing cancer death rates has been through prevention programs, such as those targeting cigarette smoking. Although that fight took decades and clandestine drama (e.g., the film THE INSIDER) tobacco is a relatively easy target.

One of the reasons research priorities have been so wrong is that tackling the complexities of a disease caused by many thousands of chemicals dispersed throughout the environment, with unknown specific effects and interactions, is extremely difficult. Adding to that, the opposition of many special interests makes it even tougher. Then we must admit that our individual special interests, living a life in many ways founded upon the comforts of these same products, would erode the sort of dramatic changes that might be required to win the “War on Cancer”.

Sadly, even if you grasp the importance of avoiding chemical exposures in your food, air and water, both inside and outside of your home, this is not something you as an individual can control. Similarly, as a physician, I can only advise you about what to avoid and suggest better choices. Exposures from arsenic and atrazine in our water, hormone-mimicking chemicals in babies’ pacifiers, and unnecessary medical radiation can be managed with determination and knowledge. But when the contamination of our and water is odorless and tasteless, receipts are laden with BPA, and organic greens come tainted with rocket fuel, you simply can not avoid all toxic exposures.