Thanks again to all of you who have expressed your appreciation for this newsletter. It is great to know that you like it. The effort is worthwhile for me because I know that it helps you. Your feedback, just as when I see you in the office, is what helps me learn to do a better job taking care of all of my patients.

The long search for a new office space appears to be reaching a conclusion. Although the new owner wanted us out by June 1, it looks like we will be moving around July 15 to Wikiup Professional Park near the Luther Burbank Center. We are hoping to have an open house there so you can get comfortable with the new location. I will update you as the plans are finalized.

Best, Michael Carlston, M.D.
www.carlstonmd.com 
707-545-1554

Last newsletter I mentioned a study which found that dark red contacts can treat migraines for many patients. Several of you wrote back about how to get them. There is often a considerable delay between clinical research and application. Not in this case. While there is insufficient research to shout the truth from the rooftops, the study was decent and such a nontoxic alternative is absolutely worth a try. In case you or someone you know is interested, here is more information.

The contacts are nonprescription, soft lenses (8.6 with 14.0 diameter). The patient puts them on at the onset of a migraine and takes them off when the pain has diminished to a manageable level. They will last up to 2 years if cared for properly. To order them call (713) 704-0619. They charge $250 for the contact lenses.

Some time ago there was suspicion about a potential correlation between vaccinations and autism. The rapid rise in the incidence of autism and concurrently increasing number of immunizations given to children made this a reasonable theory. The use of a mercury preservative in those vaccines further increased the plausibility of such a link. Statistical analyses ultimately “proved” the lack of correlation.

Hmmm? Well, this could “prove” to be another lessons in the “lies, damned lies and statistics” category.

Recent research shows a notable deficiency of the chemical glutathione in autistic children. This raises some intriguing possibilities. Glutathione is a neuro-protective antioxidant. One thing it does is help the body eliminate heavy metals - like mercury for example.

Speculating on these links, one possibility might be that children with a genetically low glutathione level are vulnerable to mercury in immunizations and then vulnerable to autism. They may be victims of an unfortunate combination of circumstances. If that is true, then the rate of autism should drop as a result of the elimination of mercury from vaccines. That good news would be expected in the next 5 years, provided the governments proposed relaxation of environmental mercury standards does not add to the problem.

This discovery may not lead to these conclusions. The finding of glutathione deficiency may turn to be an error after studying more autistic children. It could be a result of the disease rather than a cause.

Another potential repercussion might be that glutathione could be helpful as a treatment. The association of metabolically similar enzymes with autism does suggest this is real and might lead to some effective treatment. Another recent study (Am J Clin Nutr. 2004 Dec;80(6):1611-7.) showed that supplementation with folinic acid, betaine, and methylcobalamin made the blood of autistic children return to normal levels. The point of course is having a clinical benefit and that has not been proven yet.

One ongoing theme of this newsletter is that sometimes you need to be careful about what you read. Gina Kolata of the New York Times for example regularly picks up on research findings of adverse effects of over hydration. While this is a real problem, the problem of over hydration and subsequently lowered blood electrolytes (salts) is much less common than dehydration.

Many of you remember my comments about this 2 years ago when US Track and Field warned athletes about entering competition already dehydrated and against drinking extreme amounts of water during long (over 4 hours) races. Ms. Kolata ignored the admonition about dehydration and trumped up the later recommendation, leading the UST&F authors of the statement to publicly apologize for the media misinterpretation of their work.

The latest flap comes from a study of 2002 Boston Marathon runners. Investigators learned that those who competed for a long time (again 4 hour plus range) and drank massive amounts of water (some had sports drinks) that they actually GAINED weight, lowered their blood electrolytes.

MANY studies show that dehydration of as little as 2% hampers athletic performance. Many studies find little or no hyponatremia among marathon participants. In addition, a study of Boston Marathon runners the following year, found that over one third of the runners had hypernatremia (abnormally elevated levels of the most important electrolyte - sodium). This study is more significant because they studied these individuals because the athletes collapsed during or after the race. In other words, when there is a problem, the problem is more likely to be related to under hydration than over hydration.

The bottom line once again is that, while this is a problem for a small group of people, it is obvious who they are and the opposite problem is much more common. The best guideline is the simple approach of looking at the color of your urine.

One of the casualties of our hurried lifestyle is family time. The great majority of couples I see with young children rarely spend any time together as a couple. Similarly, as the kids get busier and busier with after school soccer practices, gymnastics, music lessons, etc, etc even sitting down to eat dinner together becomes quaintly old fashioned. In my house, over a few years, we went from eating every meal together to never eating together except for special events. It turns out that spending meal times together is a marker for much healthier teenagers.

Researchers studied nearly 5,000 adolescents from a variety of ethnic, economic and social groups in the Minneapolis- St. Paul area. They found that teens in families that ate together two or fewer times a week consistently had poorer academic performance, more depression, suicide and drug and alcohol abuse.

Although we get along pretty well in our family, we decided to return to the family dinner pattern. What I like most about it is that it leads to casual non-crisis management family talk. Just like when I point out to couples that it is very difficult to be real happy with your partner when all of your conversation is about uncompleted tasks (dishes, house cleaning, car pool, dentist appointments…) when your children are becoming young adults it is not much fun when every interaction is a pain (you need to clean your room, I don’t think you should be friends with her, can you turn that music down….). If you aren’t doing it now, I strongly recommend taking this simple step to improve your family life.

Another study showing the benefit of St John’s Wort might even be boringly old news at this point. However researchers in Germany learned some interesting things recently. They watched 251 patients with moderate to severe major depression comparing SJW with a conventional SSRI anti-depressant (PAXIL). Turns out that the SJW patients did better than those on PAXIL with not only a greater improvement in the their but also significantly fewer adverse effects. The key findings here were that SJW worked in more severe depression and the dosage they used. They used 900 mg three times a day which is three times the most widely used dosage in the US and quite possibly why some of the studies have shown only modest benefit from SJW.