Happy Holidays to you all!

The health-related headlines recently have primarily been about the newly discovered risks from various anti-inflammatory arthritis medications.  I am sure this is not overly surprising to many of you because most of you share my skepticism about prescription medication.  Unfortunately, intense effects almost invariably means nasty adverse effects as well.  The conventional medical community and media, easily swayed by compelling marketing from the drug companies and wishful thinking, seldom ask enough questions.  As a consequence, Americans tend to overuse medication and often we discover problems with medication many years after its usage has become commonplace.

The office will be closed December 22 through January 2.  We will be visiting family in Minnesota and then Melanie has been so thrilled by my knee surgeries this year, she decided to have one herself.  A new permutation of the "jealous knee syndrome"?

The sun is returning so we can look forward to brighter days ahead.

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

Although prescription medications are generally prescribed with a single specific intent (pain reduction, antibacterial effect, etc.) nothing has only one effect on the human body.  Unfortunately we are know learning that some of the most widely used medications for arthritis and pain also markedly increase the risk of heart attack.  First it was Vioxx, then Celebrex and yesterday the government issued a warning that naprosyn might cause problems as well. 

Carrying this series through to its obvious conclusion, all drugs in these classes must now be suspect. Vioxx and Celebrex are COX - 2 inhibitors - Bextra, Vioxx, Celebrex, As you can tell from their "real" names (rofecoxib, celecoxib and valdecoxib) any medication ending in "coxib" is part of this class.  Naprosyn - this is a nonsteroidal anti-inflammatory drug (NSAID), what about others (ibuprofen, diclofenac etc).  You may recall that some studies have been coming out finding that ibuprofen and other NSAIDs, when taken with aspirin appear to interfere with aspirin's tendency to reduce heart attacks.  Could it be that rather than blocking the beneficial effect of aspirin they might actively increase risk on their own?  This seems increasingly likely.

The bottom line should not be for you to conclude that all medication is evil.  Instead, I recommend that you minimize your use of prescription medication, avoid newer medications so we can learn more about them (don't be a guinea pig!) and try to develop your own healthy skepticism about the wonders of modern pharmacology.

Several months ago some in the medical community created a media flurry with the pronouncement that we should all be taking a SUPERPILL.  This pill would include various cholesterol lowering anti-inflammatory anti-blood pressure medication which would then help us all live longer.  As there are still some in the medical community who are capable of independent thought, a Dutch researcher decided to calculate the effect of eating more almonds, garlic and other research-proven heart healthy foods.  Turns out that men aged 50 and older would add 6 years to their life expectancy and women of the same age, 5 years.

So, besides the almonds are garlic what do you have to eat? Every day one half glass of wine, 100 grams (3 ounces) of dark chocolate, 400 grams (3/4 lb) of fruits and veggies and fish four times a week.

Although the beneficial effects of this dietary approach are equivalent to the pharmacologic approach, the side effects are not.  The drugs have lots of adverse effects, some potentially fatal.  The side effects of the dietary approach include better tasting food and financial stress for McDonald's, Wendy's, Burger King....

Building the credentials of alternative treatments for arthritis (see VIOXX, CELEBREX etc above) is a US government funded story of acupuncture treatment. 

First, here is the background information. Osteoarthritis is very common.  The percentage of Americans with osteoarthitis is approximately equal to our age.  In other words, 40-50% of Americans have some form of arthritis in our 40s and by age 70, the rate approaches 80%. It can be very severe. Osteoarthritis disables more than 10% of Americans over age 60. Although we have positive studies of glucosamine sulfate, homeopathic remedies, fish oil, a variety of herbs and other supplements, it is great to have as wide a variety of choices as possible.

This study included nearly 600 subjects with mild to moderate osteoarthritis.  It was a placebo-controlled trial (always difficult in acupuncture, experimenters used sham needles).  The subjects improved gradually so that by 8 weeks, significant improvement was apparent and by 26 weeks those in the acupuncture group had a roughly 40% reduction in pain and a similar improvement in their ability to function in their daily lives.

Most people recognize anemia as a condition which makes a person tire easily.  Actually many more symptoms can be caused by anemia. Including susceptibility to infections, mood disorders, hives, numbness in the  extremities and many others. Also we know that many people will have problems even when their blood is not officially anemic.  For example, although your hemoglobin level will not drop into the anemic range until one test (ferritin) is under 12, lots of studies show that athletic performance often drops when the ferritin is under 30.

This leads many labs to report any value of 10 or more as "normal".  At 10, there is no stainable iron left in the bone marrow. The body's warehouse is empty, people feel poorly and their test is normal.  Unfortunately adding to this difficulty is the fact that the problem is very common.  Probably one quarter of my female patients aged 35 - 60 are iron deficient. Surveys show that as many as 50% of female collegiate and high school athletes on any one team are likely be iron deficient.  Excepting hematologists and sports medicine physicians, most doctors do not realize that the lab is misleading them when they report ferritin as normal.

Similarly, vitamin B12 deficiency is very common among elderly and vegan populations but laboratory measurement is even worse.  A simple B12 measurement often tells us that the patients B12 is normal when it is not. For example, one better screening test for B12 deficiency is methylmalonic acid (MMA).  The MMA goes up when the patient lacks adequate B12.  One study found 2/3 of their elderly patients with normal B12 were actually deficient in B12 when MMA was tested.