March Podcast — Brittle Bones and Bad Drugs

Did drugs cause this broken bone?The March edition of the Alternative Healthpod is now available. If you are not a subscriber, you can listen to it here, or as always subscribe to it by clicking on this feed. You can also subscribe via iTunes. Show Notes:

Two new studies published last week show that long-term use of oral drugs prescribed to prevent osteoporosis may be associated with unusual fractures of the thigh bone -- in other words, they are weakening the bone they are supposed to strengthen.

The research is not the first to link the drugs, known as bisphosphonates, with fractures. Other research has found that these drugs also increasing the risk bone death in the jaw.

Dr. Melvin Rosenwasser, a professor of orthopedic surgery at Columbia University College of Physicians and Surgeons in New York City, and co-author of the study, said that when bisphosponates are "used beyond a certain point...they may actually be bad."

A second study looked at bone biopsies taken from the thigh bones of 21 women, all past menopause, who had suffered fractures at the site. Nine had not taken the drugs, while 12 had, for an average of 8.5 years.

The women on the bisphosphonates, researchers found, had 90% "old" bone, meaning that new bone was not being created in the women taking the osteoporosis drugs.

Source: American Academy of Orthopedic Surgeons Annual Meeting, 2010.

If you are taking osteoporosis drugs, or are concerned about your risk of fracture, please contact me immediately at 860-567-5727, or email me at

It’s Not The Winter Blues, It’s Your Winter Diet!

That's the name of this year's first podcast, and it is up and available now. The feed for all my podcasts is here. And, as promised, here are the show notes:

Br J Community Nurs. 2009 Oct;14(10):422, 424-6. Dietary factors and depression in older people.

Williamson C. British Nutrition Foundation, London.

Depression is one of the most prevalent mental health conditions and can affect people of all ages, but it is becoming more common among the older population with increasing life expectancy. Observational studies have found poor micronutrient status (particularly folate and vitamin B12) to be associated with an increased risk of depression in older people. Supplementation with folic acid has been shown to enhance anti-depressant drug treatment and there is preliminary evidence that supplementation with certain micronutrients may help improve depressive symptoms in older patients. There has also been a lot of interest in the role of long-chain omega-3 fatty acids in depression.

Dietary pattern and depressive symptoms in middle age.

Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A. Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK.

 BACKGROUND: Studies of diet and depression have focused primarily on individual nutrients. AIMS: To examine the association between dietary patterns and depression using an overall diet approach. METHOD: Analyses were carried on data from 3486 participants (26.2% women, mean age 55.6 years) from the Whitehall II prospective cohort, in which two dietary patterns were identified: 'whole food' (heavily loaded by vegetables, fruits and fish) and 'processed food' (heavily loaded by sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products). CONCLUSIONS: In middle-aged participants, a processed food dietary pattern is a risk factor for CES-D depression 5 years later, whereas a whole food pattern is protective. 

If you are interested in more information about diet and depression, contact me by clicking here.

Thanks for listening, and as always, your feedback and comments are very much appreciated!

My Christmas Gifts

Probably the best thing about this holiday, in my mind, is that it gives us all the opportunity to be grateful. As a friend of mine recently pointed out, when you spend your time being grateful, you don't have a lot of room in your life for stuff like anger, or fear, or jealousy. It's hard to be grateful and angry simultaneously. Try it. See? Weird, it just can't happen. So I'm feeling really grateful today, as I sit and type this beside a wood stove cranking out the heat and eating a clementine. I'm grateful for the warmth of the stove. The children upstairs still sleeping. The deliciously healthful food made possible by a civilization which, for all of its many faults, gives me the capability to eat an orange in the middle of a cold New England winter. And I'm very grateful to the patient who brought me the fruit.

It is always somewhat surprising to me, when holiday season comes around, and patients bring such wonderful gifts to share with Teresa and me.  Diets be damned, they say, and bake with abandon, creating the most  delicious concoctions enticing me to keep my energy up with a quick midday sugar fix. Or two. Or three. (Hmm. I'm pretty sure I'll be doing the Center's New Decade - New Me weight loss program in lead-by-example format!). I am touched by these gifts, as I know that they signify my importance in their lives. And when I realize that, I am immediately humbled and awed by the trust which my patients place in me.

There were two gifts this year which particularly moved me.

One of my patients, whom I know is no stranger to philanthropy, took her largesse to an entirely new level this year. In honor of me, she said, she gave the gift of a cataract operation (through Seva, a charity devoted to restoring sight and preventing blindness in the developing world)  so that another person might see again. When she told me, it brought tears to my eyes. To be the inspiration for such magnaminity is overwhelming. Thank you, Joan.

Another gift came in the form of an email from a grateful patient whose holiday was brightened by a new addition to the family -- whose presence, she said, was the result of the care which I provided.  I was deeply moved by her thanks as well, and reminded of the joy I experienced many years ago when my first child arrived.

So has it been a good Christmas? You bet! New eyes, new life, tasty treats and fruits and honey. My cup runneth over.

I hope your Christmas has been equally  joyful.

Friday Fun Facts

Fact #1 Remember, it's not all about calcium. A new study suggests that neutralizing an acid-producing diet may be an important key to reducing bone breakdown while aging. Fruits and vegetables are metabolized to bicarbonate and thus are alkali-producing. But the typical American diet is rich in protein and cereal grains that are metabolized to acid, and thus are acid-producing. With aging, such diets lead to a mild but slowly increasing metabolic acidosis which can then lead to bone loss.

Increasing fruit and vegetable intake can help reduce metabolic acidosis and thus decrease the rate of related bone breakdown.

Fact #2

“Honey, let me call you back on a land line. That annoying oxidative stress in my brain is acting up again.” Ginkgo Biloba has been shown to prevent oxidative stress in brain tissue caused by mobile phone use. Also, Ginkgo biloba prevented mobile phone induced cellular injury in brain tissue histopathologically.

Fact #3

If I was stuck on a deserted island and had to take only one vitamin with me, this would be the one. Women who have insufficient levels of vitamin D during their pregnancy may negatively impact a genetic variant in their offspring that increases the risk of multiple sclerosis.

Researchers found that proteins in the body activated by vitamin D bind to a DNA sequence next to the DRB1*1501 variant on chromosome 6. DRB1*1501 is a variant which increases the risk of MS to 1 in 300 in those who carry a single copy and 1 in 100 in those carrying 2 copies, in contrast to a risk of 1 in 1000 in the rest of the population. The team believes that a mother's vitamin D deficiency could alter the expression of DRB1*1501 in their children.

Fact #4

A guy walks past a mental hospital and hears a moaning voice " ... 13 ... 13 ... 13 ... ".

The man looks over to the hospital and sees a hole in the wall. He looks through the hole and gets poked in the eye. The moaning voice then groaned " ... 14 ... 14 ... 14 ... ". Researchers have discovered that a form of vitamin B1 could become a new and effective treatment for one of the world's leading causes of blindness.

Scientists believe that uveitis, an inflammation of the tissue located just below the outer surface of the eyeball, produces 10 to 15 percent of all cases of blindness in the United States, and causes even higher rates of blindness globally. The inflammation is normally treated with antibiotics or steroid eye drops.

"Benfotiamene strongly suppresses this eye-damaging condition and the biochemical markers we associate with it," said UTMB associate professor Kota V. Ramana, senior author of the study. "We're optimistic that this simple supplementation with vitamin B1 has great potential as a new therapy for this widespread eye disease."

Fact #5

What do you do when a pig has a heart attack? You call a hambulance!

People who have had heart attacks are likely to have been in traffic right before their symptoms started, according to new research.

“Driving or riding in heavy traffic poses an additional risk of eliciting a heart attack in persons already at elevated risk,” said Annette Peters, Ph.D., lead author of the study and head of the research unit at the Institute of Epidemiology, Helmholtz Zentrum Muchen, Germany. “In this study, underlying vulnerable coronary artery disease increased the risk of having a heart attack after driving in traffic.”

If you ask me, that's just another reason to cycle instead of drive.

The Portion is the Person

When I took my all-to-brief holiday in Scotland last year, I was impressed by the lack of overweight people in that country -- and likewise taken aback upon my return to the the Super-Sized U.S. Now there is some data that helps to explain why, as a nation, we have become so...ample. It seems that we've been happily goosing up the calories in what constitutes a serving.

For example...

Two slices of pizza in 1989 was worth about 500 calories. In 2009, those same two slices are worth 850 calories.

And I'm old enough to remember the original 8-ounce bottle of soda, which contained only 97 calories. Today's standard 20-ounce size bubbles up to a full 242 calories.

Just for good measure (so to speak), let's tack on a nice "personal" size bag of chips for another 300 calories...

junk food lunch

...and there's your lunch, at 1,400 calories. Just a little less than 1/2 of (what should be) your entire daily intake.

In my next post, I'll talk about how you can escape the super-size trap.

Friday Fun Facts

Holy cow! Is it that time already? Fact #1

Mastic is fantastic for H. pylori! A recent study evaluated the antibacterial activity of mastic gum, a resin obtained from the Pistacia lentiscus tree, against clinical isolates of Helicobacter pylori. The minimal bactericidal concentrations (MBCs) were obtained by a microdilution assay. Mastic gum killed 50% of the strains tested at a concentration of 125 microg/ml and 90% at a concentration of 500 microg/ml. The influence of sub-MBCs of mastic gum on the morphologies of H. pylori was evaluated by transmission electron microscopy. The lentiscus resin induced blebbing, morphological abnormalities and cellular fragmentation in H. pylori cells.

Fact #2

An ajoene -ajoene situation...a myriad of potential health benefits from garlic's most active compound. Garlic has been viewed for its health benefits for thousands of years, and recently science has begun to show why.

According to Dr. Eric Block, leading expert in garlic sulfur compounds, ajoene (pronounced ah-hoe-ene) and dithiins are the most active compounds formed from fresh garlic. Broad research speaks to the potential medical benefits of ajoenes. Since the discovery and identification of ajoene in 1984, there have been many studies that have demonstrated its activity on bacteria, lipids, fungus, cholesterol,viruses, inflammation, parasites, tumors, and blood clots and platelets.

Fact #3

Vitamins K1 and K2 are neck and neck. Japanese scientists, led by Jun Iwamoto from Keio University School of Medicine in Tokyo, reviewed seven randomized clinical trials for vitamin K1 and K2 in relation to bone health in post-menopausal women.

“Despite the lack of a significant change or the occurrence of only a modest increase in bone mineral density, high-dose vitamin K1 and vitamin K2 supplementation improved indices of bone strength in the femoral neck and reduced the incidence of clinical fractures,” wrote the researchers in Nutrition Research.

Fact #4

For immunity boosting...think zinc!

Zinc plays an important role in immune function. Researchers at Tufts University set out to determine whether serum zinc concentrations in nursing home elderly are associated with the incidence and duration of pneumonia, total and duration of antibiotic use, and both pneumonia-associated and all-cause mortality.Outcome measures included the incidence and number of days with pneumonia, number of new antibiotic prescriptions, days of antibiotic use, death due to pneumonia, and all-cause mortality.

Compared with subjects with low zinc concentrations, subjects with normal final serum zinc concentrations had a lower incidence of pneumonia, fewer (by almost 50%) new antibiotic prescriptions, a shorter duration of pneumonia, and fewer days of antibiotic use. Zinc supplementation to maintain normal serum zinc concentrations in the elderly may help reduce the incidence of pneumonia and associated morbidity.

Fact #5

Test, test, test --- calling you.

Insufficient and deficient levels of vitamin D may increase the risk of metabolic syndrome by 52 percent, according to a joint Anglo-Chinese study.

According to findings published in Diabetes Care, a study with 3,262 Chinese people aged between 50 and 70 showed that 94 percent were vitamin D deficient or insufficient, and 42 percent of these people also had metabolic syndrome. Vitamin D deficiency is becoming a major concern among the elderly.

For information about how to check your Vitamin D levels, click here.

Friday Fun Facts

Welcome to a Brand Spankin' New Feature of DocAltMed. Every Friday, I will be publishing the Friday Fun Facts, which summarizes research in the field of alternative medicine.

I'm doing this to remind you that you *don't* need drugs to be healthy. All you need is the desire to be healthy and a doctor who knows how to help you.

I know this isn't nearly as much fun as David Letterman's top 10, but he's pretty much jumped the shark anyway. Without further ado...

Fact #1

This root may get to the root of the problem.

Curcumin, the major polyphenol found in turmeric, appears to reduce weight gain and suppress the growth of fat tissue in mice and cell models.

"Weight gain is the result of the growth and expansion of fat tissue, which cannot happen unless new blood vessels form, a process known as angiogenesis." said senior author Mohsen Meydani, DVM, PhD, director of the Vascular Biology Laboratory at the USDA HNRCA. "Based on our data, curcumin appears to suppress angiogenic activity in the fat tissue of mice fed high fat diets."

Fact #2

Magnesium is magnificent for high blood pressure.

Supplemental magnesium may reduce blood pressure in people with high blood pressure, but with seemingly normal magnesium levels, says a new study. On the other hand, the supplements had no effect on the blood pressure measurements of normo-tensive individuals, according to findings. “These findings suggest that magnesium supplementation may help prevent the progression of hypertension in normo-magnesemic non-diabetic overweight people with higher BP, although mechanisms of counter-regulation preventing further BP increase remain to be elucidated,” wrote the researchers.

Fact #3

This may make pork chops out of the swine flu.

There is compelling epidemiological evidence that indicates that because of vitamin D's seasonal and population effects on innate immunity, vitamin D deficiency may explain influenza's seasonality.

In 1992, Hope-Simpson predicted that, "understanding the mechanism (of the seasonal stimulus) may be of critical value in designing prophylaxis against the disease." Twenty-five years later, Aloia and Li-Ng found 2,000 IU of vitamin D per day abolished the seasonality of influenza and dramatically reduced its self-reported incidence.

Fact #4

Again, exercise to the rescue.

A home-based diet and exercise program reduced the rate of functional decline among older, overweight long-term survivors of colorectal, breast and prostate cancer, according to a new study.

"In conclusion, this study provides data on a long overlooked, yet important faction in older long-term cancer survivors. Long-term survivors of colorectal, breast, and prostate cancer participating in a diet and exercise intervention reduced the rate of self-reported physical function decline in comparison with a group receiving no intervention," the researchers write.

You Can’t Make This Stuff Up

Following on the heels of my previous entry regarding the absolute lack of credentials that MDs have in the field of nutrition, I discovered today that there is actually a movement afoot in the medical community to define an interest in healthy eating as a disease. I kid you not.

Their new "disease" is called orthorexia. Of course, they are defining an interest in healthy eating as an "obsession," but eating a raw foods diet, an Ornish diet, a vegetarian diet, a paleolithic diet, or essentially anything but an SAD (Standard American Diet), is considered prima facie evidence of an "obsession" with healthy eating.

Of course, if any of these doctors actually followed the nutritional research, they would know that the SAD diet is incredibly unhealthy. It is undeniably the root cause of both obesity and adult-onset diabetes, as well as the primary cause of heart disease.

In comparison, the diets which are claimed to be symptoms of orthorexia are actually quite useful for clearing up a variety of health problems, many of which were caused by the combination of a SAD diet and prescription drugs in the first place.

Of course, that brings us to the recommended cure for this "disease." It is drugs, of course! Specifically, antidepressants, because, by all means, a focus on improving one's health through diet is a sign of depression, right? Actually, quite the opposite. But that's a topic for another day.

What is also interesting is the background of some of the medical "authorities" promoting this imaginary illness.

Let me first point you in the direction of Steven Bratman, MD. No, I'm not going to post his URL here, because just reading that site makes me a little ill, but you can find it easily enough with the help of Mr. Google.

Bratman is a self-proclaimed "quackbuster," which means he ignores all research which disagrees with his preconceived opinions. He has also written a book, "Health Food Junkies," which -- surprise -- is all about this mythical disease of orthorexia.

Of course, Bratman has the qualifications to address nutritional disorders and therapeutics because, according to his biography,  he opened a now-defunct health clinic, where he "worked closely with a wide variety of alternative practitioners, and received training in acupuncture, herbal medicine, nutrition, massage, osteopathic manipulation, and body-oriented psychotherapy."

Ok. So this guy's qualifications are...he watched someone else do nutritional counseling? Holy cow, asking Bratman for nutritional advice would be like asking someone to pilot an airplane because they've watched a few take off.

He's also written a lot of books, mostly for the pharmaceutical industry, and serves as a "consultant" in alternative medicine, whatever that may be. Pretty good for a guy who, according to his own data, possesses no certifications, license, or formal education in the field of alternative medicine.

In fact, I would be willing to bet I have had more formal education in pharmacology -- drugs, that is -- than Bratman has had in clinical nutrition.

Unfortunately, people do listen to unqualified individuals such as Bratman, and thus incredibly inane ideas such as orthorexia get wheels.

All of this wrongheaded manipulation over proper eating reminds me of a case I had a number of years ago. A mother came to me concerned because she thought her teenage daughters should be on a diet. Of course, I agreed to evaluate the girls and see if there would be some way in which I could help.

A few days later,  the patients came in. I conducted a history and physical exam, and low and behold, the girls were healthy. While perhaps a bit on the high side of normal in terms of their body fat, they were still within the normal range. They were physically active, with no complaints. Their diet, while not the best in the world, actually included some fruits and vegetables, which I considered an astounding success for two late-20th-century adolescents.

In short, there was really nothing much to do.

I consulted with the parent, and said that the girls looked fine, and I thought any special diet was unnecessary.

Mom began arguing with me. "Isn't there some diet you could give them?" she asked.

I told her to bring the girls back in a few days, during which time I would do a more thorough analysis of their food journals and see if there were some pertinent recommendations that I could make.

When they came back,  they entered the office with an air of excitement and anticipation. And it slowly began to dawn on me what was happening.

I was the instrument of a rite of passage: A Girl's First Diet. Like menarche or a training bra, the Diet was a step on the pathway to womanhood, because, of course, dieting is something all women must do.

I brought the girls and their mother in, and sat them all down. I explained to them that I had reviewed their diets carefully, as well as their physical exam findings, and that the best thing that they could do for their diet would be to include more fish and have more vegetables, particularly cruciferous vegetables. They should also make sure they should drink plenty of water.

Their faces fell with disappointment.

"Don't you have a meal plan for us?" One asked.

"I don't really like fish," said the other.

"What about foods they shouldn't have?" said the mother.

I explained to the disappointed multitude that, in fact, their diets were already pretty good, except for the absence of omega 3 fatty acids, which would be satisfied by the inclusion of fish. I added that I saw no reason to restrict their foods or create an unnecessary diet plan to follow, given their overall good health.

Their disbelief was palpable. I had ignored all of the sacraments of this ritual, developed at the Church of Weight Watchers and practiced at the altar of Jenny Craig. There was no arcane list of proscribed foods. No complex eating plan. No admonishments against those foods which medical doctors consider bad for you, like butter, or whole milk, or red meat.

We went back and forth for a while; it really took a good 15 minutes to get through to them that I really didn't want them to restrict their eating, but rather they should just emphasize certain foods. After they eventually realized I was not about to capitulate to their desire for their First Real Diet, two confused girls and a rather angry mother left.

I don't know whether or not the girls eventually got their diet or not, but the encounter did get me thinking about how twisted the messages about healthy eating and good nutrition get in this society. Somehow, medicine and marketing have turned a wholesome diet full of a range of nutrients, with an emphasis on foods that do not contain pesticides, hormones, chemical additives and preservatives, into an illness.

Orthorexia? If it were really a disease instead of a chimera, I would wish that more of my patients suffered from it.