A Quarterly Health Update • Summer 1997 • Vol. 2 No. 3

David Perlmutter, MD, FACN

Quotes
Steroids and Allergy - New Concerns
Health and Hyperbarics
Biotics - Pro and Anti
Book Review

Quotes

"A man is as old as his arteries" -- Tom Syndenham

"Middle-age has been said to be the time of a man's life when, if he has two choices for an evening, he takes the one that gets him home earlier." -- Alvan Barach

"A man ought to have a doctor's prescription to be allowed to use a golf cart." -- Paul Dudley White

"People are the only animals to eat themselves to death" -- The American Medical Association

"Vegetarians have vacked, shifty eyes and laugh in a cold, calculating manner. They pinch little children, steal stamps, drink water, favor beards." -- J.B. Morton

Steroids and Allergy - New Concerns

Summer is here allowing us to spend more time outdoors enjoying the sun's warmth as we pursue our favorite recreational activities. All of nature seems to flourish in the summer months, including a vast variety of flowering plants and trees which may fill the air with clouds of pollen. High levels of airborne pollen can significantly disrupt the lives of allergy sufferers. Perhaps the most common complaint of allergy sufferers is nasal congestion and irritation. The typical approach of conventional medical practitioners to treat these symptoms is to prescribe a nasal spray containing a steroid medication. Commonly prescribe steroid nasal sprays include Nasalide®, Decadron®, Beconase®, and Vancenase®.

Because these drugs are so liberally dispensed and utilized, it's important to recognize that while using a nasal spray may seem harmless enough, there may be significant dangers with their prolonged use.

First, remember that they are steroids. That means that their usage may be associated with a variety of problems, including inhibition of wound healing, recurrent episodes of nose bleeding, headache, sore throat, vomiting, overgrowth of yeast in the nose, worsening of diabetes, immune system suppression, worsening of osteoporosis, and several eye disorders.

Coughing, wheezing, and shortness of breath are also symptoms endured by the allergy sufferer, which unfortunately are also typically treated by steroid medications, usually delivered by the use of an inhaler. Several commonly used products of this type include Azmacort®, AeroBid®, Decadron®, Vanceril®, and Beclovent®.

Unfortunately, most patients are not aware of the significant dangers of using these medications. Yet, the evidence continues to mount that there may be important consequences about which patient should certainly be made aware.

In the March 5, 1997 issue of the Joumal of the American Medical Association, Dr. Edeltraut Garbe and co-workers described the results of their study to evaluate the risk of glaucoma in patients using inhaled steroid medications. In light of the widespread and long-term usage of these medications, their results are nothing short of alarming. They found that ongoing usage of high doses of inhaled steroids for three months or more increased the risk of glaucoma by an astounding 44%.

In addition to this increased risk for glaucoma, the likelihood of cataract formation is also profoundly enhanced in patients using inhaled steroid medications. In a large, wellconducted study appearing in the July 3, 1997 issue of the New England Journal of Medicine, Australian researchers reported a 300% increase in incidence of cataracts in users of inhaled steroids.

These studies were published in the two most widely read and highly respected medical journals in America. Yet, despite the fact that a large segment health care practitioners have seen and are likely aware of this information, the use of inhaled and nasal steroids will likely continue to represent one of the primary choices for treating nasal and pulmonary allergy conditions.

Nutritionally minded health care practitioners have long known that a group of substances called bioflavonoids can play a very important role in alleviating allergy-related symptoms. Bioflavonoids are chemicals found in fruits and vegetables responsible for much of their color and taste. Research aimed at understanding the biological activity of bioflavonoids dates back to the original work of Dr. Szent-Gyorgi published in 1936. The general public is now becoming much more aware of bioflavonoids since one group, the anthocyanidins, is thought to be responsible for some of the health benefits of red wine.

But it is the anti-allergic activity of the bioflavonoids that has really aimed the spotlight on this nutritional component as of late. Since the early 1980's, a large number of publications have demonstrated the actual biochemical pathways by which the flavonoids are able to inhibit a variety of allergic and hypersensitivity reactions.

Quercetin, one of the most widely studied bioflavonoid, profoundly inhibits the release of the chemical histamine from cells. Histamine plays an important role in the allergic response (hence the widespread use of antihistamines) and it works. In our experience, quercetin, along with vitamin C, has provided many of our allergy patients remarkable improvements in a variety of symptoms. Quercetin is typically found, combined with other bioflavonoids and vitamin C, in various natural allergy relief preparations found in health food stores. A typical adult dosage of quercetin is 400 mg twice a day with vitamin C 5001000 mg twice a day as well and, while steroids markedly increase the risk for cataracts, quercetin may have just have the opposite effect. Researchers who publish their work in Biochemical Pharmacology in 1976 demonstrated that quercetin actually proved effective in preventing and treating cataracts induced by diabetes.

Another useful natural remedy in the treatment of nasal and respiratory allergy symptoms is stinging nettles. Traditionally, nettles was administered as a tea made from the leaves of this perennial plant. Now it is available in tablet form at most health food stores. One tablet twice a day is a typical adult dosage, although some people still prefer to use the tea. Interestingly, the root of the stinging nettle plant is now being used in Germany for the treatment of prostate cancer and in Russia, scientists are exploring the use of the leaves in the treatment of cholecystitis (inflammation of the gallbladder).

Finally, we can't overlook the pivotal role that the essentially fatty acids play, not only in regulating general immune function, but also in reducing the overactivity of the immune response, which characterizes allergic reactions. Allergy sufferers should pay particular attention to supplementing their diets with essential fatty acids from both the Omega 3 and Omega 6 groups. This is easily accomplished by taking one tablespoon of fresh coldpressed flax seed oil each day or, two capsules of EPA (fish oil), along with two capsules of either Borage oil or evening primrose oil.

One of the ancient tenants of medicine is, "above all, do no harm."That means that first and foremost health care practitioners should seek out treatments that are not only effective but also unlikely to cause serious consequences. Unfortunately, because the pharmaceutical industry is so successful in influencing how medicine is practiced in this country, doctors have essentially been conditioned to reach for powerful and frequently dangerous medications for the treatment of common problems when often a less promoted natural approach may accomplish the same goal but without the risks.

Health and Hyperbarics

An exciting new technology is now available in various centers across the nation having application in a wide variety of medical conditions. This technology, hyperbaric oxygen therapy, involves treating patients with 100% oxygen delivered under higher than normal pressure. Normally, the air we breath is only 21% oxygen. This oxygen is carried almost exclusively by the red blood cell for distribution to the various tissues of the body. However, when breathing 100% oxygen at slightly increased pressure, oxygen is dissolved in virtually all of the body fluids including plasma, cerebrospinal fluid, and urine. This allows oxygen to permeate tissues where it would otherwise have difficulty reaching, such as the toes of the diabetic with poor circulation, wounds and burns healing slowly because of poor blood supply, and even areas of the brain deprived of oxygen as a consequence of a stroke.

Patients undergoing hyperbaric oxygen treatment rest comfortably in a clear acrylic chamber where they may sleep or watch television. Treatments typically last 90-120 minutes during which patients are exposed to pure oxygen under slightly increased pressure.

A large body of medical research testifies as to the effectiveness of hyperbaric oxygen in the treatment of a wide variety of medical problems. Some of the direct physiologic effect of hyperbaric oxygen include increasing the oxygen levels in the tissue, increased growth of blood vessels, increased formation of coliagen, enhanced immune cell activity, antimicrobial effect, enhancement of bone formation, inhibition of toxin formation, and inactivation of toxins which may be present. It is because of these physiologic activities of hyperbaric oxygen that it has become widely used in such fields as plastic surgery in the preparation and preservation of skin grafts as well as in the treatment of burns and infections of the soft tissue. In addition, hyperbaric therapy facilitates in reconstructive surgery and enhances wound healing. It has demonstrated significant usefulness in various neurological problems, including multiple sclerosis, stroke (both acute and chronic deficits), neuropathy, and closed head injury.

Dr. Richard Neubauer, a pioneer in the use of hyperbaric oxygen therapy in neurological disorders, has published extensive research on the usefulness of this technique in a variety of brain problems. In an article entitled "Hyperbaric Oxygen for Treatment of Closed Head Injury," published in the Southern Medical Joumal, Dr. Neubauer described how hyperbarics was able to restore function in "idling neurons" in patients suffering from stroke, closed head injury, and hypoxic encephalopathy (brain injury from lack of oxygen) as demonstrated by a sophisticated brain scan (SPECT) following treatment. SPECT scans showed residual increased brain function long after the hyperbaric treatments were completed. His work, and the work of others in the field, provides scientific support for this exciting new technology.

In light of the results being achieved across the country with hyperbaric oxygen therapy, we will soon be offering this technology to our patients. The Perlmutter Hyperbaric Center is scheduled to begin treating patients September 30, 1997. We will feature four state-of-the-art monoplace hyperbaric oxygen chambers manned by highly trained technicians under physician supervision.

For more information about hyperbaric oxygen therapy, please call (239) 649-7400.

Biotics - Pro and Anti

Everyone is familiar with antibiotics. In the strict sense, the term antibiotics refers to a substance which is "against life". But we generally use the term to refer to a class of pharmaceutical agents designed to destroy disease causing bacteria.

Without question, antibiotics are being grossly overused in modern society. They are prescribed for individuals suffering from colds (for which they are essentially useless), overused in children with ear infections (which typically improve without treatment), and are provided to cattle to increase their growth. In fact, it has been estimated that approximately 75% of the antibiotics produced in this country end up on the farm where they increase the yield of beef, pork, and poultry.

While so much attention is paid to the use (and misuse) of antibiotics, we are just beginning to learn about the profoundly important therapeutic benefit of probiotics (for life). While antibiotics destroy bacteria, the term probiotics describes a group of nutritional supplements designed to enhance the growth of certain bacteria, specifically within the colon. But why would we want to increase the growth of these bacteria? To answer this question, it is important to understand that the human colon contains at least 400 different species of bacteria whose total number far exceeds the number of cells in the entire human body. Many of these bacteria are harmful, and, given the opportunity, could rapidly cause severe disease. Fortunately, however, the growth of these potentially harmful bacteria is kept in check by several species of healthful bacteria, which perform a variety of important functions. Aside from preventing overgrowth of harmful bacteria, the healthful bacteria enhance immune function, assist in digestion, and help to maintain a healthful mucosal lining of the colon. Various factors can reduce the level of healthful gut organisms and thus increase the possibility of illness. On the top of the list areantibiotics. Modern wide-spectrum antibiotics are extremely powerful and can really take their toll on the important healthful-gut bacterial leading to overgrowth not only of more dangerous bacteria but also various yeast organisms which normally reside in the gut. Other factors affecting healthful gut bacteria include dietary change, aging, radiation therapy, chemotherapy, and even stress.

Fortunately, we are now able to obtain nutritional supplements designed to rejuvenate and enhance the level of important friendly gut bacteria. When buying a probiotic supplement, several important considerations need to be made. First, look for a product in which the bacteria are derived from human strains as opposed to those derived from animals. Next, the preparation should be designed to allow the bacteria to safely pass through the stomach acid and remain viable within the intestine. Third, make sure to pick a product that has a proven track record with respect to providing adequate amounts of living bacteria. The product literature should confirm that at least 100 million to 1 billion live bacteria can be provided by a typical dosage.

While many probiotic products appear on the health food store shelves, the product we recommend is Kyo-DophilusO manufactured by the Wakunaga Company, makers of Kyolic garlic. Kyo-Dophilus is a unique formulation of the three most important healthful bacteria: L. Acidophilus,B. Bifidum and B- Longum. Each capsule provides 1.5 billion living bacteria, formulated to withstand stomach acid in a sugar and dairy-free preparation. Another important and certainly convenient feature of Kyo-Dophilus is that it does not require refrigeration to maintain the viability of the bacteria.

Probiotics have become a cornerstone in our treatment protocols for a variety of medical conditions caused by dysbiosis (inappropriate balance of gut organisms). We use KyoDophilus in the treatment of inflammatory bowel disease, multiple sclerosis, chronic fatigue illnesses, fibromyalgia, and autoimmune diseases.

To learn more about the use of Kyo-Dophilus, contact Wakunaga of America, 23501 Madero Mission Viejo, CA 92691, telephone 800-421-2998.

Book Review

The Gift of Fear - Survival Signs that Protect Us from Violence By Gavin de Becker
ISBN 0-316-23502-4

The Gift of Fear represents somewhat of a departure from the style of book typically reviewed in The Perlmutter Letter. Nevertheless, the information it provides can be lifesaving and, therefore, has a proper place in a health-related forum.

In The Gift of Fear, De Becker presents a series of events described to him by clients in which their lives were threatened or they faced violence at the hand of another individual. His purpose in presenting these histories is to provide the reader the ability to recognize and act upon the warning signals provided by intuition which would otherwise have been overlooked. Further, he dispels the myth that most violent acts are unpredictable, random, and carried out by strangers.

Granted, this book was written primarily for women for as they author states "Men of all ages and in all parts of the world are more violent than women. For this reason, the language in this book is mostly gender-specific to men.When it comes to violence, women can proudly relinquish recognition in the language, because here at least, politically correct would be statistically incorrect." Nevertheless, this book provides an important message for all of us.

De Becker is a fascinating individual. In The Gift of Fear, he describes the extreme violence he experienced and observed as a child, and how he chose to let that affect him. He has served as a presidential advisor, advisor to the FBI and CIA, and has instructed law enforcement agencies around the world.

Certainly, a healthful diet, nutritional supplements, and appropriate exercise are important to maintaining good health and preventing illness. Unfortunately, in our society violent acts, which can have a profound impact on our health are all too common. The lessons learned in The Gift of Fear provide necessary tools for modern society.

"Knowing the patient is as important as knowing the illness."

Copyright © 2005-2008 Perlmutter Health Center All Rights Reserved.
Perlmutter Health Center - Commons Medical Center
800 Goodlette Road North - Suite 270 - Naples, FL 34102
Tel: (239) 649-7400 - Fax: (239) 649-6370