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I’ve been prescribed an antibiotic. Should I take a probiotic?

We are not one organism, we are many organisms. And when we disturb the relationship with our symbiotic partners, we can suffer unpleasant and sometimes life-threatening consequences. One of the most fascinating areas of medical research is the study of how our bodies interact with the the various organisms that we carry around, on us and in us. A focus is the gastrointestinal tract, particularly how the composition and function of those organisms contribute to what we think of as “normal” function, and how they can affect our risk for obesity and disease. My favorite analogy is from SBM’s own Mark Crislip who likened it to a “metaphorical rainforest” giving a vivid mental image of the of the number of species (thousands) in our guts, and the complexity of that ecology. If the gastrointestinal tract is a rainforest, then antibiotics are the metaphorical clear cutters, wiping out some of the normal bacteria, and creating the conditions where unwanted bacteria can grow.

Antibiotics are among the most useful (if not the most useful) classes of drugs in widespread use today. They’re also among the most widely prescribed, and both antibiotic overuse and their addition to animal feed present real dangers to their ongoing effectiveness. Their popularity stems in part from their effectiveness, but also from the perception that they are safe. And, in general, a course of most antibiotics is usually well tolerated. Among the side effects, diarrhea is common (with an incidence of 5% to 39%). It’s due in part to the antibiotic killing off  our normal “good” bacteria, which can significantly change the most prevalent species. In some cases, “bad” bacteria can surge as a result. Clostridium difficile infection is pretty much the worst gastrointestinal consequence of antibiotic therapy. It isn’t just a cause of antibiotic-induced diarrhea, “C. diff” infections are virulent and vicious, spreading easily, especially among hospitalized patients, causing widespread misery and even killing. (more…)

Posted in: Herbs & Supplements

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Melatonin for sleep disorders – Safe and effective?

It’s summertime, and the living is easy. Forget the solstice. For most of North America, this week is the real start of summer – July 1 in Canada, and July 4 in the USA. Vacation time means breaking out of that those usual routines of work and school. I’m amazed after a few weeks of vacation how much sleep my body will accept if given the opportunity, where it will climb from six to nine hours a night within a week. I try not to change my kids’ habits too much, and one area I’m fairly disciplined with is maintaining a predictable sleep/wake cycle, even when they’re on vacation. I’ve learned, mainly through trial and error, that I suffer the consequences when my own kids don’t get enough sleep, or when their sleep cycle is thrown off. It wasn’t always like this. I remember a period of what felt like years when I had to crawl out of my child’s bedroom on my hands and knees so as to not disturb a child who simply would not fall asleep. And when it finally, mercifully, occurred, it would be a brief respite before the cycle began again. The sleepless nights left us all cranky and exhausted. Admittedly I was fortunate, either due to my successful parenting (but more likely mean reversion) and my kids are pretty good sleepers now. I’m reminded of my good fortune when I speak with exhausted and frustrated parents who have children that cannot sleep and are worried about the causes and consequences of persistent insomnia. As a pharmacist I’m regularly asked about insomnia for both kids and adults as there are a number of over-the-counter products available, and many consumers are understandably apprehensive about seeking out prescription products. Tell someone there’s “natural supplement” for sleep and there’s usually a lot of interest. That’s what I’ve seen with melatonin, a hormone that is sold without a prescription in Canada, the United States, and other countries. It is widely perceived as safe and alternative health purveyors like naturopaths, and even some health professionals, may recommend it for treating sleeping problems in both adults and children. Beyond sleeping, some believe melatonin is a wonder drug with efficacy for diseases ranging from chronic fatigue to cancer to irritable bowel. (more…)

Posted in: Herbs & Supplements, Naturopathy, Science and Medicine

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Coenzyme Q10 for heart failure: The hype and the science

Could a product sold as a dietary supplement really be delivering the benefits that advocates have claimed for decades? That’s what you might be wondering about coenzyme Q10, following recent stories like:

What’s caused all the excitement about CoQ10 is the Q-SYMBIO trial, more properly called “The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure”, presented at the European Society of Cardiology conference last month. I’d normally wait for the full article to come out, and will review it if possible at that time, but the results are too interesting to ignore so I’ll dive into the study and the reaction – which is equally as interesting for advocates of science-based medicine. (more…)

Posted in: Clinical Trials, Herbs & Supplements

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“Sense and nonsense” about alternative medicine in USA Today

Sometimes, between blogging, a demanding day (and night) job doing surgery and science, and everything else, I embarrass myself. Sure, sometimes I embarrass myself by saying something that, in retrospect, I wish I hadn’t. More often, I embarrass myself by letting things slide that I shouldn’t. For instance, when friends send me a prepublication copy of their books, I should damned well read them, don’t you think? So it was that Paul Offit sent me a copy of his latest book, which just hit the bookstores and online outlets this week, Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine, and I haven’t finished it. Oh, I’ve read a good chunk of it, but it’s not a huge book (around 335 pages); so I should have finished it by now, particularly since it’s quite good. My failure to properly read and plug the book aside, I’m glad to see that the book’s getting attention in a large media outlet, namely USA Today, in an article by Liz Szabo Book raises alarms about alternative medicine. There’s also a companion piece How to guard against a quack. I figure that the least I can do is to plug Dr. Offit’s book and the USA Today story in which he is featured, just as Harriet plugged his recent speaking appearance.

It’s also nice that Steve Novella and I were both interviewed. Now, excuse me while I get back to doing what I really should have had finished a month or two ago: Reading Dr. Offit’s excellent book.

Posted in: Book & movie reviews, Cancer, Health Fraud, Herbs & Supplements

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Tag Away

Skin tags

Skin tags

Skin tags (acrochordon) are benign growths, often raised on a pedicle with a tiny stem. 46% of the population has one or more of them.  They are usually ignored, but some people think they are ugly and want to get rid of them, and sometimes the lesions rub on clothing and become irritated. Never fear! Tag Away is here!

I saw it advertised on TV.  They said it is “not available in stores.” But they only meant their special TV offer is not available in stores. You can buy Tag Away on Amazon.com, at Walgreens, at Walmart, and elsewhere. Tag Away is an all-natural product that promises to remove unsightly skin tags painlessly. It comes in a 15 cc bottle and is applied with a cotton swab 3 times daily for 3-8 weeks. One website claims:

One of the secrets of this product’s amazing success rate is Thuka [sic] Occidentalis, which is world-renowned for its ability to eradicate even the largest, most unsightly skin tags.

That’s not true. It doesn’t have an amazing success rate, it’s not world-renowned, and there’s no evidence that it can actually remove skin tags of any size. (more…)

Posted in: Herbs & Supplements, Homeopathy

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CAM Docket: Kardashian Diet Products Klass Action

Kim, Khloe and Kourtney Kardashian permit the use of their names and images of their curvaceous bodies to promote “QuickTrim” diet products, a line of dietary supplements making overblown claims typical of the weight loss supplement industry. Their personal testimonies and formidable publicity machine (Kim alone has over 13 million followers on Twitter), “has reportedly generated $45 million in revenue since they struck the deal with New Jersey-based Windmill Health Products in 2009,” according to the N.Y. Post. Naturally, the sisters are paid for their efforts, although how that amount is calculated or how much they receive apparently is not a matter of public record.

SBM post Kardashian Klass Action photo
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Posted in: Health Fraud, Herbs & Supplements, Legal, Nutrition, Politics and Regulation

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Knee Osteoarthritis: Thumbs Down for Acupuncture and Glucosamine

Osteoarthritis is the “wear and tear” kind of arthritis that many of us develop as we get older.  Cartilage becomes less resilient with age, collagen can degenerate, and inflammation and new bone outgrowths (osteophytes) can occur.  This leads to pain, crepitus (Rice Krispie type crackling noises with movement), swelling and fluid accumulation in the joints (effusion), and can severely limit activity for some patients.

Since knee osteoarthritis is such a ubiquitous annoyance, home remedies and CAM offerings abound.  Previously we have covered a number of CAM options on this blog, including glucosamine, acupuncture, and several others. The American Academy of Orthopaedic Surgeons (AAOS) has just issued a 1200 page report evaluating the evidence for various treatments for knee osteoarthritis short of total knee replacement surgery. A 13 page summary is available online. They have done the heavy lifting for us, reviewing all the available scientific studies for evidence of effectiveness. Here’s what the science says: (I’ve highlighted the ones where the evidence is strong.)  (more…)

Posted in: Acupuncture, Herbs & Supplements, Surgical Procedures

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DMAA: Efficacious but is it Safe?

by Igor I. Bussel & Andrey A. Pavlov Jr.

Jann Bellamy has recently authored an excellent piece on the limitations of the FDA and how the DSHEA actually protects the profits of supplement manufacturers rather than the health and well-being of consumers. Bellamy used the very poignant and currently “controversial” example of DMAA (methylhexanamine or 1,3-dimethylamylamine) to illustrate her point regarding the loopholes and lack of enforcement power of the FDA. The authors of this piece had been considering writing about DMAA and felt this would be an excellent time to further expound on Bellamy’s work. The goal of this article will be twofold: 1) to discuss the known history and pharmacology of DMAA, especially in regards to the basic methodology for evaluating novel substances or novel uses of substances in the context of lacking RCT level evidence (i.e. the concept of science vs. evidence based medicine) and 2) how the DMAA story clearly and unequivocally demonstrates how the DSHEA allows for unscrupulous profiteers to game the system with little, if any, consequence and nothing but profit until the cost in lives forces the issue.

History

DMAA was originally developed by Eli-Lilly in 1948 and then later trademarked as Forthane to be used as a nasal decongestant (there are varying accounts but it seems that Eli Lilly patented the molecule in the early 1940’s and then trademarked and marketed it as Forthane in 1971 for allergic rhinitis and then voluntarily withdrew it in 1983). The mechanism of action was vasoconstriction – the blood vessels in the nose would constrict so that less blood flow would lead to less nasal discharge. This is a mechanism used by common OTC nasal sprays like oxymetazoline (Afrin) and is indeed quite effective. However, Forthane was later withdrawn from the market because of significant side effects including headaches, tremors, and increased blood pressure. These effects likely occur because DMAA is structurally similar to amphetamine and as a result, the compound is not only a vasoconstricting agent but is also a central nervous system (CNS) stimulant. 

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Posted in: Herbs & Supplements, Legal, Science and Medicine

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Naturopathic organ repositioning coming soon to Pennsylvania?

Pennsylvania legislators need to know only one thing about House Bill 612 (licensure of naturopathic “doctors”) to vote against it: As a means of “naturopathic musculoskeletal therapy” the bill would allow naturopaths to “reposition body tissues and organs.”

This is impossible. You cannot “reposition” tissues and organs of the human body by external manipulation.

Why does this tell us everything we need to know about these naturopathic doctors and why they shouldn’t be licensed in Pennsylvania? For one thing, this is no mistake a bill draftsman made in understanding what naturopathic practice includes. House Bill 612 was obviously drafted by naturopaths. That means naturopathic doctors actually believe they can “reposition” your body’s tissues and organs. And that speaks to their poor education and training. They don’t even understand basic anatomy.

For another, it tells us naturopathic doctors reject evidence-based medicine as a standard of practice. There is no evidence that this “repositioning” of organs and tissues is beneficial for any condition or disease, even if they could do it in the first place, which they can’t.

And for yet another, this certainly calls into question their understanding of the disease process and their diagnostic skills. One has to wonder exactly what health problems they think these purportedly out-of-place organs are causing. And how do they go about determining which organs are out of place and where they should go? Or when they have been successfully returned to their proper position? Again, this should raise alarming questions in the legislators’ minds about their education and training. (more…)

Posted in: Herbs & Supplements, Homeopathy, Legal, Naturopathy, Politics and Regulation, Vaccines

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Coconut Oil

In a former life, when I was an Air Force doctor, one of my duties was to give “Healthy Heart” briefings with a script furnished by Air Force experts. It covered the scientific consensus of the time (the early 80s) about diet. It recommended a low fat diet, restricted cholesterol and saturated fat, and demonized tropical oils like palm oil and coconut oil. (Trans fats weren’t yet on the agenda.)

Times have changed. Today we are more lenient about cholesterol in the diet, less concerned about total fat and saturated fat, and more concerned about trans fats. While many major health organizations still discourage its use, coconut oil has not only been rehabilitated in the public mind, but all kinds of health benefits are being claimed for it.

The fats in coconut oil
Coconut oil is high in saturated fats; it contains more saturated fatty acids than any other non-hydrogenated oil. It is stable and has a long shelf life. It is used in movie theaters to pop popcorn and in South Asian cuisine for dishes like curries. A hydrogenated version of coconut oil is an ingredient in non-dairy creamers. Much of the research done on coconut oil studied hydrogenated or partially hydrogenated forms. According to an article in the New York Times:

Partial hydrogenation creates dreaded trans fats. It also destroys many of the good essential fatty acids, antioxidants and other positive components present in virgin coconut oil. And while it’s true that most of the fats in virgin coconut oil are saturated, opinions are changing on whether saturated fats are the arterial villains they were made out to be. “I think we in the nutrition field are beginning to say that saturated fats are not so bad, and the evidence that said they were is not so strong,” Dr. Brenna said.

Coconut oil contains lauric acid, which raises both HDL and LDL cholesterol levels. This may improve the cholesterol profile, although there are concerns that it may promote atherosclerosis by other means. Virgin coconut oil contains medium-chain triglycerides, which are not as risky as some other saturated fats.
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Posted in: Herbs & Supplements, Nutrition

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