Tag Archive: use

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Integrative Medicine: Focus on eating nutritious food before using supplements

December 7th, 2011 / tags:, , , , , , / categories: Uncategorized /

Hold it before you pop that vitamin into your mouth! You may not be doing your health a favor by taking your favorite supplement.

We know that one-third of American adults take a multivitamin or mineral supplement regularly – and most of them believe they are improving their health by doing so. But a new study published this month in the Annals of Internal Medicine co-relates certain vitamins and minerals with increased mortality in older women.

The Iowa women’s health study was an ongoing study of over 38,000 women in Iowa followed since 1986. The women were an average age of 62, and were surveyed in 1986, 1997 and 2004 about their multivitamin and supplement use. Sixty-three percent were taking at least one supplement when the study began in 1986; however, by 2004 that number climbed to 85 percent. More than 25 percent of the women studied reported taking four or more supplements on a regular basis.

Mortality in this group of women was tracked from 1986 through 2008. The results of the study are somewhat surprising:

• Several commonly used dietary vitamin and mineral supplements may be associated with increased total mortality risk.

• Specifically the use of multivitamins, vitamin B6, folic acid, iron, magnesium, zinc and copper were associated with increased risk of total mortality when compared with corresponding non-use.

• The increased mortality association seems to be strongest with supplemental iron.

• In contrast to the findings of many earlier studies, calcium seemed to be associated with decreased risk – 9 percent less.

• Some supplements, including beta-carotene, vitamins A and C, and selenium, didn’t appear to affect death risk either way.

Is this data clinically significant?

Maybe, maybe not. The total number of increased deaths in this study was small, so this data may or may not be reproduced in subsequent studies. There were twice as many women in the study on hormone replacement therapy than the normal population, and hormone replacement therapy comes with its own risks. The population was mostly Caucasian, from a rural area, so this data may not apply to other demographics.

But it certainly tells us that we don’t know very much about the long-term effects of various multivitamins and supplements.

So, with all this confusing data, who should be on a multivitamin or mineral supplement? Those who are deficient in certain minerals, or those who have been advised by their doctor to do so.

What should the rest of us do? Vitamins and minerals are not a replacement for eating a variety of nutrient-rich foods. We all need to concentrate on eating fresh foods, fruits and vegetables, and focus on minimizing our intake of (low nutritional value) processed foods. Supplements should be just that – a supplement, and not a replacement, for a healthy diet.

And keep your doctor in the loop on all the vitamins and supplements you are taking, for the latest medical advice based on your personal health.

© Copyright The Sacramento Bee. All rights reserved.

Drs. Kay Judge and Maxine Barish-Wreden are medical directors of Sutter Downtown Integrative Medicine program. Have a question related to alternative medicine? Email adrenaline@sacbee.com.

Article source: http://www.sacbee.com/2011/10/16/3979195/focus-on-eating-nutritious-food.html#mi_rss=Fitness

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Integrative Medicine: Pot benefits, risks deserve study

December 7th, 2011 / tags:, , , , / categories: Uncategorized /

This month, the California Medical Association made news when it became the first state medical association to recommend the legalization and regulation of cannabis, better known as marijuana.

The CMA’s Council on Scientific and Clinical Affairs noted in its recommendations that there is an increasing body of evidence that marijuana may be useful in the treatment of a number of medical conditions, but research to determine both risks and benefits is hampered in the United States because marijuana still is classified as an illegal drug.

The CMA council believes that the legalization and regulation of marijuana will allow for broader research and objective data on the potential benefits and risks of marijuana. It also will help to regulate dispensaries of marijuana, regulate the physicians who prescribe marijuana, ensure that safe and consistent products are available to patients, reduce diversion and improper use of medical cannabis, and support the physicians who wish to appropriately prescribe medical marijuana to patients who are most likely to benefit from its use.

To give you some perspective on the current controversy around marijuana, here’s a little background.

Marijuana is classified under the Controlled Substances Act of 1970 as a Schedule 1 drug, meaning that it has a high potential for abuse and has no accepted medical benefit. However, marijuana, like other herbal remedies, has been used as a medicinal agent for thousands of years in many parts of the world. The Irish physician and pharmacologist Dr. William O’Shaughnessy, who had spent years studying its medical benefits in India, first introduced marijuana into Western medicine in 1841; it was used to relieve pain, muscle spasm and convulsions.

In the 1930s, marijuana came under fire in the United States as a harmful drug, and in spite of a lack of good data about its potential risk, it was removed from the U.S. Pharmacopeia in 1942.

In 1970, Congress initiated the Controlled Substances Act, which then awarded marijuana its Schedule 1 status, effectively shutting the door on further research. Shortly thereafter, Congress authorized the creation of the National Commission on Marijuana and Drug Abuse to study the risk of marijuana use. The commission’s report to Congress in 1972 was titled “Marijuana, A Signal of Misunderstanding.”

The physicians and other members of the commission concluded that there was “little proven danger of physical or psychological harm from the experimental or intermittent use of the natural preparations of cannabis,” and that “the actual and potential harm of use of the drug is not great enough to justify intrusion by the criminal law into private behavior.”

They also recommended the decriminalization of simple possession of marijuana. That recommendation was ignored by the Nixon administration, and marijuana remained classified as a Schedule 1 dangerous drug, unsuitable for any medical use (and this remains puzzling to many health care providers who work in the field of substance abuse, considering that alcohol and nicotine are both considered significantly more addictive and physically harmful than marijuana).

The controversy continued, and in 1996, 14 states including California legalized the use of marijuana for medical purposes.

In 1999, the California Legislature approved funding for cannabis research, leading to the formation of the University of California Center for Medicinal Cannabis Research, based at UC San Diego.

The beginning results of that research were published last year and were promising: Cannabis was found to significantly reduce neuropathic pain as well as muscle spasm and muscle spasticity, particularly in patients with multiple sclerosis.

One of the studies showed that marijuana significantly reduced HIV-related pain in more than more than 50 percent of patients. In other research endeavors, cannabis also has been shown to reduce pain and neuropathy in cancer patients and in patients with neurologic diseases. It also helps to reduce nausea and vomiting from chemotherapy, and it may help reduce the loss of appetite that can accompany cancer and HIV disease. Cannabis may also help augment the pain-relieving properties of narcotic drugs.

Even more intriguing, some data also suggest that cannabis may play a role in cancer risk reduction.

Rodent studies have shown that THC, one of the active ingredients in marijuana, not only reduces the risk of cancer in animals but also increases survival.

In a study of more than 64,000 Kaiser patients who were followed for about nine years, men who smoked marijuana had the lowest rates of lung cancer, even lower than the nonsmokers. A large case-control study done in Los Angeles also suggested a reduced risk of all cancers studied except for oral cancer in users of marijuana. There is biological plausibility for this: studies show that THC and other phytochemicals in marijuana inhibit the growth and spread of cancer cells in cell cultures and in rodents.

The public opinion on the legalization of marijuana has been heated and divided for many years; perhaps it’s time for more objective data on the potential risks and benefits of marijuana so that we can make informed decisions about its use.

The changes advocated by the California Medical Association can help pave the way for this.

© Copyright The Sacramento Bee. All rights reserved.

Drs. Kay Judge and Maxine Barish-Wreden are medical directors of Sutter Downtown Integrative Medicine program. Have a question related to alternative medicine? Email adrenaline@sacbee.com.

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Article source: http://www.sacbee.com/2011/10/30/4012504/integrative-medicine-pot-benefits.html#mi_rss=Fitness

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Inside Medicine: Assuming a pill will keep same look can be an Rx for trouble

December 7th, 2011 / tags:, , , , / categories: Uncategorized /

Fact: People often forget to take their pills.

And sometimes forgetting a pill can have serious consequences that land you in a hospital – perhaps in intensive care.

While a declining memory is a common cause of failure to take pills, there are others, such as the way a pill looks. Take, for example, an older woman who is easily confused yet manages to live by herself with brittle heart failure. For many years she has started each morning taking a round, white water pill. But this month, when she ran out of pills, the pharmacy gave her a bottle with a yellow flat pill (which contained the identical medication in the identical dose).

She noticed the absence of the round, white pill and thought the pharmacists mistakenly gave her the pills, so she didn’t take the flat yellow ones – believing they were the wrong medicine. She could have asked her doctor why she was given a new yellow pill, but she didn’t want to bother him.

After four days, she developed severe difficulty breathing and was taken by ambulance to the emergency department. She told the doctor: “I take four pills – a round white one, two capsules, and a long red pill.”

The doctor shrugged his shoulders. Gone are the days when doctors knew what each drug looked like or could look up the appearance in the Physician’s Desk Reference (PDR). Today, most drugs are made by many different drug companies and each company’s pill looks a bit different.

So if a person takes four pills each day, at the end of the month, when the prescriptions need to be refilled, the patient could end up with four different-looking pills.

When I prescribe a drug, I have no idea which company the pharmacy will use to fill the prescription, thus I have no idea what the pill will look like. Drugs with the same generic names are required to contain identical chemicals (called bioequivalence), but they are not required to appear the same. In fact, a generic drug is not allowed to use the brand name drug’s logo or other design features.

Jeremy Greene, writing in the journal Lancet, reminds us that we recognize many common products in our lives by their unique design features – the iPod, a bottle of Heinz ketchup or Grey Poupon mustard. Pills are no different and in both cases these design features cannot be copied.

In the past, the look of a pill played a much more important role in allowing people to be sure they were taking the same pill. Well into the 1960s, a pharmacist could not tell a person the name of the drug they were taking and the name was not listed on the pill bottle. The fear was that if people knew the names of their medicines they would self-medicate, swap drugs with friends and grow suspicious if doctors prescribed them placebos. So the person depended on the look of the pill to identify it.

Today, patients are far more involved in their health care and all information is fully disclosed both by the doctor and on the pill bottle.

We have made some great advances improving access to affordable drugs. Many drugs now are provided over the counter. All drugs need to be carefully labeled, and 80 percent of prescribed drugs are filled with generics. This saves Americans billions of dollars each year in lower drug costs.

The downside is that we have a system where a person can no longer use the drug’s appearance to identify their medicine. And most generic drugs have names that are nearly impossible to pronounce, let alone remember. Perhaps it is time to standardize the look of identical drugs. This could prevent errors made by doctors or pharmacists who mistakenly provide the wrong drug.

Despite great advances, we still have a long way to go in providing information to patients about their drugs. Names and the look are important, but so is information about the drugs’ effectiveness. Just as we are told the estimated highway mileage for our new car, each person should be told the likely benefit they can expect from taking a medicine – and the expected chance of harm. What is the chance it will prevent that heart attack, cure that infection, or treat the cardiac abnormality? Rather than list a zillion side effects, tell us what the chance is that we will experience one of those. Only with this sort of information can people make informed decisions about whether they want to buy, and take, their medications.

© Copyright The Sacramento Bee. All rights reserved.

Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Reach him at drwilkes@sacbee.com.

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Article source: http://www.sacbee.com/2011/11/05/4029249/assuming-a-pill-will-keep-same.html#mi_rss=Fitness

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