12/06/01	NEWSLETTER	carlstonmd.com
Hello Patients		HOME
Given the summertime weather I wanted to pass along some thoughts about sun exposure.      I remember working with a dermatologist during my residency training in the early 1980's. He, like many of his patients was quite vain. In view of the high level of attention to looking good in his office, his recognition that a "nice tan" was really just early cancer and not desireable made a clear impression on me. The dark side of the wonderful life-giving rays of the sun is their damaging (oxidizing) effects on the skin and eyes. Best, Michael Carlston
In This Issue:		INDEX
Commentary:  Dr. Carlston's Comments On Sun Exposure Article:  CDC Campaign To Curb Over-prescribing Of Antibiotics Commentary:  Dr. Carlston's Commentary On Antioxidants
Sun Exposure		TOP
Your Skin.      The Sun's radiation causes sunburns from a single days overexposure. Long term exposure cause much greater problems. The lesser problem is that it makes the skin look leathery and old. The biggest problem is skin cancer. Many skin cancers are not serious - they can be frozen or cut off, which isn't fun but they won't kill you. Unfortunately another kind of skin cancer, melanoma, can kill you and we are in the midst of an epidemic of melanoma due to increasing ultraviolet exposure with outdoor time, air pollution and deterioration of the protective ozone layer. Children are especially vulnerable. One sunburn DOUBLES the risk of skin cancer for that child. What Can You Do? Stay out of the sun - most effective (but impractical) option Cover up with UV blocking clothing Use sunscreen - unfortunately many of the chemicals in suncreens are themselves damaging. For example many people are sensitive to PABA. Zinc oxide is probably the best sunblock. You know it as the white stuff on lifeguards noses. There is now a new formulation of zinc - micronized zinc oxide, which is clear and not so greasy. Apply antioxidants to the skin after sun exposure. There are now some very good products containing vitamin C especially for this purpose. Taking high doses of Vitamin E and C also prevents skin damage from the sun. Your Eyes.      Don't forget about your eyes! The two chief causes of blindness as we age are cataract and macular degeneration. Both of these are highly influenced by oxidative factors - dietarily and sun light. Wearing sunglasses helps prevent both of these but they MUST be UV blocking sunglasses. If not they could actually increase your risk of macular degeneration by opening up your pupils allowing the UV light to pass through damaging the retina.      You can enjoy the nice weather and be healthy. Best, Michael Carlston
Top Medical News		TOP
Hello Patients, Another really interesting news bit to pass along - sorry if I've been bending your ears too hard in the last 2 weeks. I really appreciate my patients' wise reticence about antibiotics. This effort from the CDC confirms that we have been ahead of the curve. Best, Michael Carlston, M.D. CDC To Launch State Campaigns To Curb Overprescribing Of Antibiotics By Steve Mitchell      WESTPORT, Jun 05 (Reuters Health) - The US Centers for Disease Control and Prevention will disburse ,000 to seven unnamed US states in July for campaigns aimed at curbing the overprescribing of antibiotics.      Five other states, including Alaska, Colorado and Wisconsin, have previously received funding for similar campaigns, Dr. Richard Besser of the CDC told Reuters Health. And there are "many more projects going on around the country," he added.      According to the CDC, some 50 million courses of antibiotics that are prescribed by physicians each year may be unnecessary and may lead to antibiotic resistance.      The campaigns will target physicians and consumers and "will promote appropriate use of antibiotics," Dr. Besser said. Data from the five states that previously received funding indicate that "programs that target both physicians and consumers are more effective in reducing overprescribing," he commented.      In part, the campaigns will be aimed at educating the public that antibiotics do not work on viral illnesses. Dr. Besser said that another purpose is "letting physicians know that antibiotics do not make the patient feel better [if they have a viral illness] and can actually make them feel worse."      Dr. Besser said that studies show that patients are less likely to accept antibiotics if they are aware of the risks of creating resistance. "We need to help out clinicians" in the area of communication "because it does take longer not to prescribe antibiotics," he noted.      The campaigns will present physicians with "principles and guidelines for prescribing antibiotics for respiratory infections." For instance, there is good evidence that "acute bronchitis is primarily a viral illness that doesn't respond to antibiotics," Dr. Besser said.      Another growing problem that may be increasing bacterial resistance is the use of antibacterial soaps and other products that contain antibacterial agents. The CDC "doesn't support the use of those products," Dr. Besser noted. "There is no evidence that any of those products prevent illness," and they may "promote bacterial resistance," he added. "Basic soap and water works fine."      In conjunction with the Emerging Infectious Diseases conference slated to begin on July 16, the CDC will hold a meeting on July 15 in Atlanta to present "information on how to change the behavior of overprescribing antibiotics," Dr. Besser said. Westport Newsroom 203 319 2700
Antioxidants		TOP
Dear Patients, Antioxidants have gotten quite a bit of negative media attention recently. The evidence is that this negative attention is undeserved.      For example many years ago 2 studies found that smokers who took large doses of synthetic betacarotene had an increased incidence of lung cancer. Those two studies have been recirculating recently. HOWEVER when the blood level of betacarotene before the study was considered, those patients with the highest levels of beta carotene had the LOWEST levels of lung cancer.      This is an example of how we can learn from or become confused by research. As many studies have shown similar decreased risks with other cancers etc we should ask why the inconsistency. That is how we learn.      In this case it appears either that synthetic beta carotene has adverse effects or it is the combination of beta carotene with other carotenes (alpha, beta, gamma etc) which is helpful. That is why I recommend a healthy diet and "natural mixed carotenoids".      Similarly the Institute of American Medicine recommended that people increase their intake of vitamin C to 200 mg a day but that over 500 probably doesn't help much. They are conservative and other research supports higher doses. This, coupled with an unpublished study, has then turned into a "500 mg dose is dangerous" media chorus. As a reviewer for the Journal of the American Medical Association and other medical journals I continually see studies which never get published or only in poor journals because the studies are so flawed. I don't change my opinions on the basis of anything less than a well done clinical trial (or of course clinical experience).      As human food consumption patterns have changed dramatically since we began domesticating animals and developing farming practices our intake of various vitamins, minerals and other dietary components has changed just as dramatically. For example, the fat in wild animals is predominantly monunsaturated (i.e. "healthier") fat. Similarly researchers have followed chimpanzees through the jungle to learn about the composition of their diet. As they are metabolically quite similar to humans they were extremely interested to learn that this 12 pound animals were getting well over 600 mg of vitamin C daily from the leaves and fruit they ate.      Anyway this is all just a reminder to take all you read with a grain of salt (Don't be nervous, salt is actually good for you) Best, Michael Carlston, M.D.
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