Perlmutter Health Center

A Quarterly Health Update · Fall 1996 · Vol. 1 No. 4

David Perlmutter, MD, FACN

Quotes

"A doctor is a man who writes prescriptions till the patient either dies or is cured by nature." -- John Taylor

"One of the most obvious facts about grown-ups to a child is that they have forgotten what it is like to be a child." -- Randall Jarrell

"Nature can refuse to speak, but she cannot give a wrong answer." -- Charles Brenton Huggins

"Natural forces are the healers of disease." -- Hippocrates

"Psychiatrist: A man who asks you a lot of expensive questions your wife asks you for nothing." -- Sam Bardell

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Zinc and the Common Cold

The common cold is without question the most frequently referenced human health malady when it comes to vitamin treatments, folk remedies, and nutritional approaches. While studies have demonstrated that increased vitamin C consumption may reduce the risk of catching a cold, no study as yet has clearly proven a role for vitamin C in shortening the length of symptoms in this all too common malady.

Dr. Michael Macknin and colleagues at the Cleveland Clinic Foundation in Ohio have recently published their research demonstrating an actual shortening of duration of the common cold in patients receiving supplemental zinc. They evaluated 100 patients in a randomized, double blind, placebo controlled study. Within 24 hours of the onset of cold symptoms, participants received either lozenges containing 13.3 mg of zinc (gluconate) or a placebo, every two hours while awake until cold symptoms disappeared. The average time until patients were symptom free was 4.4 days in the group receiving zinc compared to 7.6 days in the placebo group.

When looking at particular symptoms, those which improved most rapidly in the treatment group included cough, nasal congestion, headache, and hoarseness, while little change was noted with respect to duration of fever, muscle aches, sneezing, or scratchy throat.

How supplemental zinc could be so effective in reducing the duration of cold symptoms is unclear. It is known, however, that zinc can prevent the replication of various viruses as well as inhibit the ability of certain viruses to anchor themselves to the lining cells of the lungs. Zinc also has various anti-inflammatory properties which may explain some of the symptomatic improvements noted in this study.

Another helpful addition to the anti-cold armamentarium includes echinacea. This powerful herb is widely available at health food stores and has been the subject of more than 350 scientific studies world wide. Echinacea has a profound effect on the immune system, increasing the number of disease fighting cells as well as their effectiveness. We generally recommend the use of the tincture, 1 full dropper in a small glass of water, 2-4 times a day for 1-2 weeks or until cold symptoms have abated. Zinc lozenges, like the ones described above are also commonly available at health food stores.

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Treatment of Acute Myocardial Infarction

Coronary angioplasty is an invasive medical procedure in which a small catheter is threaded into blocked coronary arteries in an attempt to re-establish blood flow. When the catheter arrives at a region of blockage, a small balloon is inflated, expanding in the arterial channel, and compressing the offending plaque build-up and other debris into the arterial wall.

We are now witnessing a significant increase in the utilization of this procedure in the treatment of acute myocardial infarction. Patients admitted to hospitals with coronary artery blockages are often rapidly transported to the X-ray department for emergency "life saving" coronary angioplasty. But a recent study appearing in The New England Journal of Medicine (October 24, 1996), challenges the wisdom of this approach. In their report, doctors from the University of Washington compared the mortality during hospitalization, long term mortality, as well as the use of monetary resources of patients admitted to hospitals with acute myocardial infarction in 19 Seattle hospitals treated with either coronary angioplasty or the use of a medication given intravenously designed to dissolve blood clots. The data of this large and comprehensive study indicate, "In a community setting, we observed no benefit in terms of either mortality or the use of resources with a strategy of primary angioplasty rather than thrombolytic therapy in a large cohort of patients with acute myocardial infarction." This is to say that patients having the much more aggressive (and profoundly more expensive) angioplasty technique did no better than patients who simply received intravenous medicine designed to break up blood clots (thrombolytic therapy).

We marvel at the new advances in medical technology, and with good reason. Recent advances in medical sciences have taken us to new frontiers which we would not have even dreamed about a decade ago. Nevertheless, it is important to realize that just because a technique is new and "state of the art" it may not be the most appropriate choice. Indeed, as this study now demonstrates, a high tech and very expensive technique may offer no advantages when compared to the time tested standard.

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Safety of Appetite-Suppressant Drugs Questioned

After years of fading into the background, "diet pills" are once again exploding in popularity. Diet centers and weight loss clinics seem to be moving away from an approach based upon nutritional and lifestyle changes in favor of a drug based approach emphasizing pharmaceutical agents like Fenfluramine (Pondimin, Redux).

This trend causes great reason for concern. In a study recently published in The New England Journal of Medicine, (August 29, 1996), it was revealed that the use of drugs to reduce the appetite (mainly derivatives of Fenfluramine) was associated with a profound increase of an often fatal lung disorder called pulmonary hypertension. The authors of this study found that when patients took these medications for more than 3 months, their risk of pulmonary hypertension increased 23-fold. As the authors reported, "The use of anorexic drugs was associated with the development of primary pulmonary hypertension. Active surveillance for this disease should be considered, particularly since the use of anorexic drugs is expected to increase in the near future."

The mentality of late 20th century western medicine seems to be one which attempts to identify a "magic bullet" for each of our particular ailments. Thus, to cure a physical ailment caused by dietary indiscretion and excess, doctors are now writing prescriptions for medications which are potentially lethal. True, it can be argued that while this group of medications is associated with significant risk, the various health complications of obesity may be more life threatening. There may very well be some validity to this argument when considering individuals who are significantly obese. But in reality, what we are now seeing is a very liberal use of these pharmaceutical agents for patients with only mild obesity in whom simple lifestyle and dietary changes are clearly the more appropriate choices.

Addressing this issue, an editorial comment was published in the same issue of The New England Journal of Medicine entitled, Pharmacotherapy for Obesity - Do the Benefits Outweigh the Risks? The authors stated, "Obesity is an escalating problem in the United States, and the condition is notoriously difficult to treat. Because the associated health hazards are considerable, medications are needed that produce and maintain weight loss safely and effectively." Further, they state, "Although physicians and patients need to be informed, the possible risk of pulmonary hypertension associated with dexfenfluramine is small and appears to be outweighed by benefits when the drug is used appropriately." What is troubling about this editorial is that despite the very high risk of a potentially lethal complication of fenfluramine use described in a well conducted research study appearing in the same issue of their journal, these editorial writers nevertheless seem to trivialize the risk in favor of using the drugs to assist weight loss.

But now the story becomes even more disturbing. According to an article appearing in the August 28, 1996 Wall Street Journal entitled, How Should Medical News Be Distributed?, the authors of the editorial that was so favorable with respect to the use of fenfluramine based weight loss products have received substantial payments from companies that stand to profit from sales of Redux. As Dr. Alan Gaby recently questioned in Nutrition and Healing (October, 1996), "Why, for example, did The New England Journal of Medicine (NEJM) choose these two authors to rebut an article that threatened to damage the estimated $3 billion dollar market for Redux? How could NEJM not have known about the conflict of interest when the Wall Street Journal learned about it before NEJM went to press?"

We have long known that pharmaceutical manufacturers play a pivotal role in determining what is and is not published in our most well respected medical journals. This influence, in addition to their advertising, directly affects how medicine is practiced and consequently has a bearing on your health.

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Garlic and Dementia

As our population ages and we watch the ever increasing incidence of dementing illnesses, it is important to watch the field of nutritional medicine for developments which may provide us with techniques to preserve brain function.

Doctors at the University of Tokyo have recently completed and published research evaluating the usefulness of aged garlic extract (AGE) on impairments of learning and memory performances in a breed of mice having a genetic flaw causing them to rapidly develop senility. This animal model is frequently used to evaluate various nutritional and pharmacological approaches to dementing illnesses.

The results of this study were profound. Brain function deterioration was markedly reduced in that group of mice receiving AGE. The authors speculate that several mechanisms may have been involved with preserving brain function in the group receiving garlic. First, it is known that AGE has high antioxidant activity. Antioxidant activity is known to have an anti-aging effect. Second, AGE is known to exert an effect on the immune system which may also play a role in reducing the rate of brain aging.

Other nutritional supplements which are effective in preserving brain function include Gingko biloba, lecithin, L-Acetyl Carnitine, grape seed extract, and, as described in this report, aged garlic extract (Kyolic garlic).

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Vitamins and Macular Degeneration

In a recent report by the National Society To Prevent Blindness, age related macular degeneration was described as being the number one cause of blindness in older adults. Unfortunately, our advanced medical armamentarium has little to offer for patients with macular degeneration. As the Yellow Emperor stated in the 4th Century B.C., "Prevention is the ultimate principle of wisdom." But can macular degeneration actually be prevented? A report published in the December, 1995 issue of The Archives of Opthamology entitled, Serum Antioxidants and Age-Related Macular Degeneration in a Population -Based Case-Control Study revealed a direct relationship between a certain group of antioxidant vegetable derived vitamins and macular degeneration. This study was designed to evaluate the relationships between levels of vitamins E and the carotenoids in patients with macular degeneration and those without.

The results were very interesting. The researchers found that patients with the lowest levels of lycopene, a carotenoid, were twice as likely to have macular degeneration. Lycopene is a powerful antioxidant found in a variety of vegetables. Tomatoes and tomato based products are rich sources of lycopene. In addition, lycopene is now found as an additive to various health food supplements. Lycopene has also been characterized as an important reason why tomato consumption is associated with reduced risk of prostate cancer.

An important point to remember is that generally one antioxidant given alone is not an effective approach since the antioxidants work in concert. Therefore, a good antioxidant program should certainly include a variety of carotenoids as derived from eating a well balanced meal rich in colorful vegetables as well as supplementation with selenium, vitamin E, vitamin C, and alpha lipoic acid.

It is certainly useful to have this information so that you can design a program for yourself to maximize health and prevent illness. But the information most useful to you would be an answer to the question, "How much of a particular vitamin or nutrient is right for me?" Indeed, when medical writers talk about a typical adult dosage of a certain vitamin, it is a generalization. Vitamin and nutrient needs vary profoundly depending on a variety of factors including:

Fortunately, a new comprehensive laboratory analysis is now available to determine levels of a variety of vitamins and in addition measure the effectiveness of the body's antioxidants. SpectraCell Laboratories provides the Essential Metabolics Analysis, evaluating vitamin and nutrient levels, as well as the Spectrox evaluation of antioxidant function. These evaluations take the guess work out of deciding upon nutritional supplements as they provide not only a clear understanding of the levels of important vitamins and nutrients but also the degree of antioxidant activity, so important in reducing age related degenerative diseases like macular degeneration.

These simple blood tests can be performed by any physician, and the results are invaluable. For more information about these evaluations, call SpectraCell at (800) 227-5227.

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Melatonin and Cancer

Melatonin, having long demonstrated its usefulness in the treatment of various sleep disorders as well as jet lag, may have some significant anti cancer activity as well. In the well respected journal Cancer, researchers from Italy described the usefulness of melatonin in the treatment of patients with brain tumors. These patients had tumors in the brain which had originated in other parts of the body. The study included 50 patients who were randomized, which is to say some received steroid medications and others received melatonin 20 mg per day at 8:00 pm.

At one year, 37% of the group receiving melatonin was still alive compared to only 12% of the group not receiving melatonin.

The authors state, "The mechanisms responsible for the efficacy of melatonin in patients with brain metastasis must be better defined." Nevertheless they speculate that melatonin may inhibit the production of certain chemicals made in the brain which would otherwise allow certain tumors to grow. The authors also describe the "anti tumor" effect of melatonin as has been noted in studies of inhibition of breast cancer cells in the laboratory when treated with this hormone.

We wait with anticipation the results of various ongoing studies evaluating the usefulness of melatonin for other malignancies and serious medical problems.

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Book Review

The Antibiotic Paradox - How Miracle Drugs Are Destroying the Miracle by Stuart B. Levy, M.D.
Plenum Publishing Corporation Publication, New York, New York, ISBN 0-306-44331-7.

Although at times somewhat technical, The Antibiotic Paradox is a sobering account of where we are at the end of the 20th century with respect to our "war" on microbes. While antibiotics have been described as the most important therapeutic discovery in the history of medicine, the misuse and overuse of these drugs has allowed bacteria to become resistant or insensitive to even the most sophisticated antibiotics now produced by the pharmaceutical industry.

This is a very real and troubling situation. In The Antibiotic Paradox, Dr. Levy reveals that in many countries antibiotics are sold over the counter without prescription, and in addition are liberally added to the feed of cattle to accelerate their growth. These factors enhance resistance of organisms painting a bleak picture for our future.

Dr. Levy is a world renowned authority on antibiotic use and resistance. He has been profiled in Time, Newsweek, The New York Times, The Washington Post, The New England Journal of Medicine, and USA Today, and has appeared on Good Morning America, Nova, and all major television networks. He is currently Professor of Medicine and of Molecular Biology/Microbiology at Tufts University of Medicine and a staff physician at the New England Medical Center.

In his book, Dr. Levy states, "Today doctors can no longer expect that their first choice of antibiotic for women's urinary tract infections or children's ear infections will work. Similarly, cancer therapy is rendered useless if patients are unable to fight infections that are sometimes resistant to eight to ten different drugs. In developing countries, people are now dying of previously treatable diseases that are no longer responsive to traditional antibiotics. These problems are just a harbinger of what will come if we do not act now."

I strongly recommend reading The Antibiotic Paradox. It is a fascinating but troublesome history of where we have been, and a sobering prediction for the future.

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Perlmutter Health Center - Commons Medical Center
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