Perlmutter Health Center

A Quarterly Health Update • Winter 1998 • Vol. 3 No. 1

David Perlmutter, MD, FACN

Quotes

"Those who think they have not time for bodily exercise will sooner or later have to find time for illness." Edward Stanley

"I suppose one has a greater sense of intellectual degradation after an interview with a doctor than from any human experience." Alice James

"Doctors should never talk to patients about anything but medicine. When doctors talk politics, economics or sports, they reveal themselves to be ordinary mortals, idiots like the rest of us." Andy Rooney

"There's another advantage of being poor --- a doctor will cure you faster." Frank McKinney Hubbard

"After two days in the hospital, I took a turn for the nurse." W.C. Fields

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Hyperbaric Oxygen Therapy for Brain Injury

Until quite recently, precious few therapeutic modalities were available to hasten the recovery of damaged neurons in head injured individuals. Medical science has explored a wide variety of avenues to achieve this goal including nutritional support, medications designed to act as "metabolic enhancers," and creative forms of physical and cognitive rehabilitative techniques. Unfortunately, even under the best of circumstances, significant recovery is often limited.

Now, a new and exciting technique which involves increasing the oxygenation of brain tissue, has now been demonstrated to have profound potential in improving brain function in these patients. Hyperbaric oxygen therapy is actually a fairly simple technique in which patients are exposed to pure oxygen under increased atmospheric pressure for a specified length of time. In fact, hyperbaric oxygen therapy is not new on the medical scene - it has been used for decades as a means of enhancing tissue oxygenation to improve would healing, salvage limbs which would otherwise have been amputated due to poor blood supply, and in a variety of other conditions characterized by poor blood flow and oxygenation.

In a recent article appearing in the Southern Medical Journal, Dr. Richard Neubauer, a pioneer in the use of hyperbaric oxygen therapy for brain disorders, demonstrated profound improvements of brain metabolic activity in brain injured patients. (See Book Review in this issue.) His research utilized a specific form of brain imaging, SPECT, to detect changes of brain metabolic activity following hyperbaric oxygen therapy treatment. Specifically, Dr. Neubauer believes that the target of hyperbaric oxygen therapy are those neurons that although compromised in their function, still retain viability. Dr. Neubauer calls these damaged nerve cells "idling neurons," implying that their metabolic machinery can be enhanced. As he states, "Brain injuries, regardless of their cause, share common pathophysiologic pathways that result in the destruction of neurons, and, to a varying extent, formation of idling neurons." Further, he stated that various forms of brain injury have " … a common pathophysiology and may include a penumbra of recoverable tissue. We propose that hyperbaric oxygen therapy be used routinely as an early diagnostic tool and as an adjunct to physical rehabilitation for patients with brain injuries. We also believe that research in this area would be promising."

In various other countries including South Korea, Japan, China, Russia, Italy, Germany, and Great Britain, hyperbaric oxygen therapy is routinely used as an adjunctive treatment for various forms of brain injury. Its therapeutic usefulness is likely a result of a variety of factors. First, hyperbaric oxygen leads to stabilization of cell membranes within the brain providing an improved environment for metabolic activity. Second, the increased oxygen levels provided by hyperbarics activates specific white blood cells which function to clear debris left by the damaging event. Third, the level of brain free radicals is reduced. These are damaging chemicals which result as a consequence of normal brain metabolism. Fourth, and perhaps most importantly, hyperbaric oxygen therapy dramatically increases the growth of new blood vessels to the damaged brain areas.

It is unclear why hyperbaric oxygen therapy, so widely used throughout the rest of the world, has not yet gained a significant foothold in the American armamentarium of therapeutic techniques for brain injury. Perhaps it is because oxygen itself cannot be patented and therefore cannot be promoted by a specific pharmaceutical company. Nevertheless, now that well respected scientific journals are publishing articles demonstrating the profound effectiveness of this technique, we will likely see greater availability of hyperbaric oxygen therapy in the United States in years to come.

To obtain more information about hyperbaric oxygen therapy on the world wide web, visit perlhealth.com. or call (239) 434-9OXY (434-9699).

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Multiple Sclerosis Patients Turn to Alternative Therapies

At a recent conference sponsored by the National Multiple Sclerosis Society, researchers reported the results of a survey of 240 multiple sclerosis (MS) patients. Surprisingly, over half of the respondents reported choosing some form of alternative therapy, typically in conjunction with more mainstream approaches. The most commonly used alternative therapies included acupuncture, supplemental calcium, chiropractic therapy, homeopathy, marijuana, massage therapy, meditation, visualization, vitamin B complex, vitamin C, vitamin E, and yoga.

The study, reported by Monica Pignotti, MSW, CSW, was reported at a conference on "Multiple Sclerosis and Quality of Life." As reported in the September, 1997 issue of Neurology Reviews, "Realistic rationales were generally cited for the use of alternative treatment approaches. In most cases, patients tried the alternatives to ‘maximize overall health and to manage some of the stress’ involved in living with MS," said Ms. Pignotti, who is a research consultant with the National Multiple Sclerosis Society. The two most frequently cited specific reasons for choosing alternative therapies were symptom relief and stress relief. However, 11% of respondents did believe that alternative approaches might have a potential to reverse or slow the progression of disease. As Ms. Pignotti stated, "While some practitioners of complementary therapies hold out unsubstantiated promises and claims of a cure for MS, this study found that the majority of respondents used such treatments with relatively realistic expectations to enhance their overall health and sense of emotional well-being, rather than as a hope for cure.. Multiple sclerosis is a disease with no known cure and an unpredictable course. Alternative treatments are of greater interest to people with MS because of the hope they offer for improved quality of life."

Leading medical journals have published articles attesting to the usefulness of specific dietary measures in multiple sclerosis for the past several decades. Yet there still seems to be a profound reluctance on the part of the mainstream to embrace this information despite its scientific substantiation. Fortunately, as this survey describes, a majority of MS patients are looking beyond the prescriptions of the mainstream and availing themselves of many potentially useful therapies. As Ms. Pignotti concluded, "Today’s alternative therapy might well be tomorrow’s conventional approach."

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Garlic Fights Fatigue

One of the most common complaints voiced by patients visiting physicians is simply that their "get up and go, got up and went." Perhaps as a consequence of our very stressful society coupled with the declining quality of our food sources, fatigue now seems to be an almost ubiquitous complaint of patients seen in a general medical practice setting.

These days, a wide variety of nutritional supplements are being promoted to help alleviate fatigue. Unfortunately, the claims made by the producers of many of these products are often not supported by any meaningful scientific research. Clearly, when specific claims are made about a nutritional supplement, it is important that these claims be substantiated.

In an article entitled "Anti-Fatigue Effect of Aged Garlic Extract in Athletic Club Students," researchers at Japan’s prestigious Nihon University School of Medicine evaluated the effectiveness of aged garlic extract (Kyolic Garlic) in reducing fatigue in a group of 20 healthy students tested during intense physical training. The study evaluated both subjective and objective parameters. Subjective symptoms included drowsiness, weariness, difficulty in concentration, and several "body conditions" including headache, shortness of breath, and muscle pain. Objective measurements included evaluation of pulse, weight, blood pressure, muscle strength, reflex function, and several laboratory studies.

The results of this study were compelling. Virtually across the board subjective complaints were markedly reduced toward the end of the trial in the group receiving Kyolic Garlic, with the most significant results noted in the evaluations of drowsiness and weariness. Further, objective measurements also demonstrated a significant difference when comparing the group receiving the Garlic Extract versus that which did not. In the group taking Kyolic, reflexes seemed to improve during the course of the study as did laboratory studies measuring liver function.

This study confirms the usefulness of Kyolic Garlic in reducing several parameters of fatigue. As the study reports, "Results of the independently designed subjective symptoms test showed that complaints such as weary body and weak legs decreased with administration of aged garlic extract and disappeared by the end of the study. The results of the objective fatigue test showed improvement of physical functions."

Kyolic Garlic is a very important nutritional supplement not only because of its well substantiated role in reducing fatigue, but also because of its effectiveness in reducing cholesterol, improving glucose tolerance, and its ability to improve liver function and prevent liver cell damage. For more information on Kyolic Garlic, contact Wakunaga of America at (800) 421-2998.

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Coronary Artery Bypass - Neurological Consequesnces

The coronary artery bypass operation, designed to increase blood flow through compromised coronary arteries, has entrenched itself as one of the most commonly performed surgical procedures in North America. Indeed, roughly 450,000 Americans undergo this procedure annually despite the fact that often times the procedure is simply unnecessary. A recent report in the Journal of the American Medical Association revealed that close to half of the coronary artery bypass operations performed in the United States are done for "inappropriate reasons." A study by Harvard Medical School’s department of Public Health recently revealed that 84% of patients who obtained a second opinion after being scheduled to undergo a heart bypass procedure were told that they did not need it. During that study’s two year follow-up there were no deaths in the group of patients who canceled their surgeries based upon the second opinion.

While cardiac surgeons are quick to point out that angina may be completely alleviated in approximately 80% of patients undergoing bypass procedures, the fact that mortality rates as high as 8% are still being reported in some major centers is often downplayed. But perhaps an even more troubling and equally downplayed statistic is the fact that about 25% of patients who undergo the coronary artery bypass procedure will suffer some form of significant neurologic or cognitive complication, with some of these deficits representing permanent abnormalities.

Extensive research by Dr. Ola A. Selnes of the Johns Hopkins University in Baltimore published in the highly respected journal Lancet and presented at the 122nd Annual Meeting of the American Neurological Association has confirmed what has long been suspected regarding neurological consequences of the bypass procedure. As Dr. Selnes has stated, "Both neurologic and cognitive complications continue to be reported after coronary artery bypass despite ongoing refinements in surgical techniques and anesthesiology." Cognitive deficits are estimated to affect at least 25% of patients after coronary artery bypass surgery. Most deficits are assumed to be transient and relatively minor. The reality, however, is that few long-term studies document this assumption.

In this report, Dr. Selnes evaluated various parameters of cognitive function prior to surgery and re-evaluated patients one month, one year, and five years after surgery. Assessments included tests of language skills, both verbal and visual memory, psycho-motor skills, and tests of attention.

The results were clearly troubling. As Dr. Selnes stated, "A higher proportion of patients were doing significantly worse five years after coronary artery bypass surgery than we anticipated." The most striking abnormalities were found in tests of visual memory with clearly 23% of patients demonstrating a significant decline in this area. These studies also demonstrated prominent decline in tests of verbal memory and language skills.

During the coronary artery bypass procedure, patients are placed on a cardio-pulmonary bypass machine, allowing oxygenation of the blood while the heart is stopped. Dr. Selnes speculates that micro emboli, or small blood clots, formed while patients are on the bypass pump, may produce microscopic brain lesions that subsequently lead to long term degeneration of brain cells. Further, localized areas of poor blood supply to the brain have long been recognized as consequences of bypass surgery. But the actual mechanisms by which bypass surgery causes subsequent cognitive decline have yet to be fully elucidated. When these mechanisms are better defined, modifications of present surgical technique may allow a reduction in the incidence of these sometimes devastating consequences.

In our efforts to pursue the most advanced, high-tech techniques available for alleviation of our common medical problems, it is important to recognize one of the most fundamental doctrines of medicine - above all, do no harm.

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Anger and Stroke Risk

Clinicians have long suspected that a relationship existed between individuals who expressed anger and stroke risk. Indeed, medical literature has long described the so-called "stroke-prone personality." A mechanism underlying this relationship would certainly not be too difficult to conceive of since the statistical link between anger outbursts and hypertension as well as heart disease have been well described.

Recently, at the American Heart Association’s 70th Scientific Session, Dr. Susan Everson, a researcher at the University of Michigan’s School of Public Health stated, "Men who reported a high level of outward expression of anger - men who tended to have angry outbursts, had about twice the risk of stroke compared to men who controlled their tempers." In trying to unravel the mechanisms underpinning the relationship, Dr. Everson found that those individuals at higher risk for stroke tended to have more frequent experiences of anger with above average levels of job-related stress. Her studies also demonstrated that in anticipation of an exercise challenge, these stroke prone individuals had a more significant elevation of blood pressure.

But these results should not be taken to indicate that suppressing anger outbursts is necessarily good for health. As Dr. Everson stated, "People need to recognize what triggers their anger, and try to remove themselves from those situations.. Clinicians often encourage people to count to ten, or try relaxation techniques such as deep breathing."

These recommendations are important. While common knowledge recognizes important risk factors for strokes such as elevated cholesterol, cigarette smoking, obesity, family history, and coronary artery disease, an "explosive personality" should be added to the list. A variety of stress alleviation techniques can be employed including aerobic exercise, tai chi, deep breathing, meditation exercises, and even psychological counseling which may be beneficial in helping to

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Acupuncture Gains Mainstream Endorsement

After years of skepticism on the part of mainstream medicine, acupuncture now seems to be receiving the endorsement it has long deserved. A recent report by the National Institutes of Health endorsed acupuncture as an effective treatment for a wide variety of medical maladies including chronic pain, nausea, addiction, stroke rehabilitation, menstrual cramps, tennis elbow, headache, carpal tunnel syndrome, low back pain, asthma, and other medical problems. While mainstream medicine has been reluctant to embrace acupuncture’s effectiveness, it has certainly demonstrated its appeal to more than one million Americans who spend more than $500 million dollars each year for acupuncture treatments.

Acupuncture is one of the oldest medical therapies still in use today. Historical accounts describe acupuncture being practiced in China as long ago as 1200 BC. Over the ensuing centuries, important modifications and refinements of the basic acupuncture technique were made, enhancing its effectiveness. Today, acupuncture continues to evolve utilizing modern innovations in technique including electrical stimulation of the acupuncture needles, laser acupuncture, and actual injection of various therapeutic medications into the acupuncture points.

In response to the growing demand for acupuncture in the United States, there are now about 4,000 American physicians using acupuncture as well as about 12,000 non-physician acupuncturists practicing in this country. Typically, acupuncture is considered a non-conventional form of medical therapy and therefore is not covered by many insurance plans. Hopefully, with the new endorsement from the National Institutes of Health, insurance coverage for this very useful and safe medical therapy will broaden. To obtain the full NIH consensus statement on acupuncture, contact the National Institutes of Health at (888) NIH-CONSENSUS, or visit the NIH Consensus Development Program website at http://www.consensus.nih.gov.

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Hormone Repalcement Therapy and Stroke

Hardly a day goes by that we do not hear some new therapeutic claim supporting the contention that virtually all post menopausal women should take some form of hormone replacement therapy (HRT). While the statistics clearly indicate a beneficial response in women using hormone replacement therapy with respect to osteoporosis, the claims of the effectiveness of HRT in reducing the risk of Alzheimer's disease or cardiovascular disease are less well substantiated.

Unfortunately, many clinicians continue to feel that menopause is some form of pathological event requiring medical intervention in the form of hormone replacement therapy and try to support the intervention with these often times not well substantiated therapeutic claims. Frequently the downsides of HRT, including the possibility of increased risks of certain forms of cancer, are understated.

In the past several years, the possibility that HRT may reduce stroke risk has become a topic of debate in the medical community. But in the study appearing in the November 1, 1997 issue of The Lancet, Danish researchers found that the risk of stroke in women using HRT was essentially identical to those who had not. In fact, transient ischemic attacks, or "mini strokes" were actually more frequent in women using HRT. At the conclusion of their report, the researchers speculated that their published results would lead to a re-evaluation of the effectiveness of hormone replacement therapy in general, and more specifically on its purported "beneficial effects" on the cardiovascular system.

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Book Review

Hyperbaric Oxygen Therapy by Richard A Neubauer, M.D. and Morton Walker, D.P.M.
ISBN #0-89529-759-0, Avery Publishing Group, Garden City Park, NY 11040

Hyperbaric oxygen therapy is a technique for delivering pure oxygen to the body under pressure. The therapeutic utility of this technique is now recognized world wide for an incredibly wide variety of medical problems including stroke, head trauma, hypoxic brain injury, poorly healing wounds, infections, multiple sclerosis, bone disorders, burns, circulatory problems, AIDS, and complications of radiation treatment and skin surgery. (See hyperbaric oxygen therapy for brain injuries - this issue).

Hyperbaric Oxygen Therapy is the first general book available to the medical consumer providing information about this remarkable procedure which has not yet become a routine part of conventional medical treatment in the United States, despite the fact that hyperbarics has long been utilized as a mainstay approach to a variety of medical problems in virtually every other developed country in the world. As the authors state, "Even with over 30,000 scientific studies on hyperbaric oxygen therapy published in medical journals, diving medicine journals, and clinical journals of other health care disciplines, there has been strong resistance from those representing the western medical establishment. It must fall, then, to the medical consumer to become well educated about hyperbaric oxygen therapy’s merits, and to demand access to this treatment. That is what will need to happen before hyperbaric oxygen therapy is widely used, and that is why we have written this book - for your edification and action."

Hyperbaric Oxygen Therapy is well written and tends to avoid using technical medical jargon that may alienate the general reader. Dr. Richard Neubauer is a world leader in the field, having spent more than a quarter century carefully documenting the clinical outcomes using hyperbaric oxygen therapy in a wide variety of medical situations.

There is no question that hyperbaric oxygen therapy will emerge as one of the most promising medical techniques of the next century - and this book explains why.

Hyperbaric Oxygen Therapy by Richard A. Neubauer, M.D. and Morton Walker, D.P.M. may be ordered by calling (239) 434-9OXY (434-9699).

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