Category Archives: Health Conditions

March 27th, 2013

Disrupted Sleep Could Be Early Sign Of Alzheimer’s

Introduction

Poor sleep quality and use of sedative hypnotic drugs (sleeping pills) is associated with a significant risk for Alzheimer’s disease. Use of these drugs was associated with a whopping 230% increase over an eight-year period in a study in France while in a study in the U.K., the risk was even greater over a 22-year follow up – a dramatic 294% increase. Other studies have shown that poor sleep quality may be the result of AD and not necessarily the cause.

Background Data:

Although genetic factors play a significant role in determining susceptibility to Alzheimer’s disease (AD), like most chronic degenerative disease, lifestyle and environmental factors also play a significant role. The primary brain lesions of AD are the result of deposits of a substance known as beta-amyloid. Although the immune cells in the brain normally remove beta-amyloid and plaque, research is beginning to characterize a chronic and excessive inflammatory reaction to amyloid proteins in the brain in susceptible individuals that can promote AD. Some dietary factors showing promise in reducing beta-amyloid include the Mediterranean diet and the following natural products:

  • Curcumin
  • Resveratrol
  • Celery seed extract
  • Ginkgo biloba extract

New Data:

Researchers from the Washington University School of Medicine in St. Louis found that the inability to sleep through the night was associated with an increased risk the preclinical form of Alzheimer’s disease. The study included 145 people between ages 45 and 75 with normal brain function. All patients had their spinal fluid analyzed and researchers found that about one-third of them were very likely to have Alzheimer’s-linked beta-amyloid plaques in the brain (considered preclinical Alzheimer’s).

Those subjects who were the least efficient sleepers in the whole study were five times more likely to have preclinical Alzheimer’s. While researchers are exploring the formation of the beta-amyloid as being the cause of the poor sleep quality, a more likely explanation is that the poor sleep quality is actually the cause of the beta-amyloid formation.

During the deeper levels of sleep the repair mechanisms and antioxidant system of brain cells are heightened. The link between sleeping pill usage and the dramatic increased risk for AD may be the result of the fact that many of these drugs negatively impact the ability to achieve deeper levels of sleep.

Commentary:

One of the key underlying causes of poor sleep is faulty blood sugar control. Basically, most people with sleep maintenance issues are on the “blood sugar rollercoaster.” When blood sugar levels drop rapidly during the night it causes the release of cortisol and adrenaline leading to arousal and difficulty in getting back to sleep. Insulin resistance is the key factor in causing the blood sugar rollercoaster and is also a key risk factor for AD. In fact, AD is often popularly referred to as “diabetes of the brain” and even “type 3 diabetes.”

Obviously, taking a sleeping pill does not address the underlying cause of the poor sleep quality and looks like it makes the situation even worse. Instead the key focus should be on improving insulin sensitivity and stabilizing blood sugar levels.

Reference:

Ju YE, McLeland JS, Toedebusch CD,  et al. Sleep Quality and Preclinical Alzheimer Disease. JAMA Neurol. 2013 Mar 11:1-7.

December 5th, 2012

Is the Dark Ages of Type 2 Diabetes Care Lifting?

When medical historians look back on the last 70 years of medicine, they will refer to it as the Dark Ages of drug therapy. There are numerous examples: non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis, sedative hypnotic drugs for insomnia, and perhaps the most glaring example of all, the use of oral hypoglycemic drugs in the treatment of the major epidemic of our time – type 2 diabetes. The statistics on the growing epidemic of type 2 diabetes are staggering as it is now estimated that one-half of all Americans adults will develop the disease by 2020. What is even more alarming is the failure of the medical system to adopt natural treatments that focus on curbing this epidemic and instead utilize drug therapies that may cause more harm than benefit.
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Background Information

In 1970, the Dark Ages of type 2 diabetes was officially ushered in with the published results from UGDP (University Group Diabetes Project) study. In this study, the group receiving the drug tolbutamide showed a 250% increase in mortality due to heart disease compared with the group on diet therapy alone. The death of tolbutamide was met with something very interesting – the drug industry simply stopped comparing deaths due to cardiovascular outcomes for forty years and the FDA adopted a policy that new diabetes drugs only needed to show that they lower blood glucose levels.

In essence, the drug companies and the FDA did not feel the effect of these drugs on the critical outcome of actually extending a patient’s life was important. Eventually, the “see no evil” approach was exposed when the drug Avandia (rosiglitazone) was shown to increase the risk of a fatal heart attack by 64% and was attributed to causing nearly 100,000 heart attacks since it was launched. The problem with Avandia is just the tip of the iceberg.

Steven Nessen, M.D., and his colleagues of the Cleveland Clinic have played a major role in guarding against the unbridled focus on fasting glucose, hemoglobin A1c levels, and blood lipid levels with type 2 diabetes medication. It was Dr. Nessen’s group that blew the whistle on Avandia by reanalyzing documents filed by the drug’s maker to the FDA to look for the effect of the drug on heart attack risk. Their 2007 follow up analysis based on study-level data that became available after a court settlement required the drug maker to disclose all clinical trial results further uncovered the link.

By 2010, Avandia was removed from the European market and severely restricted in its use in the U.S. In 2012, GlaxoSmithKline, Avandia’s maker, paid a record $3 billion fine for civil and criminal penalties for concealing safety data for rosiglitazone.

New Data

The most popular drug treatment for type 2 diabetes is metformin (Glucophage) – classified as a biguanide, an older diabetes medication based upon compounds from the plant goat’s rue (Galega officinalis). Despite its popularity, there has never been a double-blind study to show that it does not cause the same issue with increased risk of cardiovascular death as tolbutamide or Avandia, but there is some circumstantial evidence that it is much safer.

In a very detailed comprehensive analysis of medical records 250,000 veterans receiving care in Veterans Health Administration hospitals throughout the United States, metformin was shown to be safer than glyburide and glipizide – two popular drugs in the same class as tolbutamide. For every 1,000 patients being treated with metformin there were two fewer heart attacks than those taking the other drugs. These results are encouraging given the tremendous popularity of metformin and further calls into question the use of sulfonylurea drugs like glyburide and glipizide. But, the key question has yet to be answered – “Does metformin reduce death rates for heart disease in type 2 diabetes compared to diet therapy?”

Reference

Roumie CL, Hung AM, Greevy RA, et al. Comparative effectiveness of sulfonylurea and metformin monotherapy on cardiovascular events in type 2 diabetes mellitus: a cohort study. Ann Intern Med. 2012 Nov 6;157(9):601-10.

See also

Nissen SE. Cardiovascular effects of diabetes drugs: Emerging from the Dark Ages. Ann Intern Med. 6 November 2012;157(9):671-672

August 1st, 2012

September is Prostate Cancer Awareness Month

Prostate cancer (PC) is the most diagnosed form of cancer in American men. Each year there are roughly 200,000 men that are diagnosed with PC and over 30,000 will die from it. In many respects, PC is the mirror of breast cancer in women. It is a hormone-sensitive cancer that will affect at least one out of every six men now living in the United States.
Most PCs are slow growing; however, there are cases of aggressive PCs. The cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly the bones and lymph nodes. Next to lung cancer, in men PC is the second leading cause of death due to cancer.
The big push conventional medical circles will make this month is encouraging men over the age of 50 years to see a physician for two tests:
• A digital rectal exam–the doctor inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall to check for hard or lumpy areas.
• A blood test for prostate-specific antigen (PSA)- which will usually be elevated in men with PC. A normal PSA ranges from 0 to 4 nanograms per milliliter (ng/ml). A PSA level of 4 to 10 ng/ml is considered slightly elevated; levels between 10 and 20 ng/ml are considered moderately elevated; and anything above that is considered highly elevated. The higher the PSA level, the more likely it is that cancer is present. However, approximately 35% of men with diagnosed PC will have a “normal” PSA of less than 4. The level of prostate-specific antigen (PSA) in the blood tends to rise with PC, but minor elevations may be due to less serious conditions like prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate).
However, recently there has been a bit of controversy regarding the fact that screening for prostate cancer has led to harming many more men compared to the number that have died from prostate cancer. Many doctors will state that the rationale for early detection of prostate cancer is that it leads to more effective treatment. Unfortunately, the data on PSA screening for PC does not support this notion. Several reviews on the impact of PSA screening show no statistically significant difference in death due to PC between men randomized to screening and those who were not screened. In fact, the Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force believe that PSA screening produces more harm than good based upon very extensive analyses.
Harmful effects of screening included high rates of false-positive results for the PSA test resulting in over-diagnosis and the adverse events associated not only with biopsies (such as infection, bleeding and pain), but also in the treatment of PC with chemotherapy and radiation. It is believed that in most cases, the PC would not have seriously affected many lives if it had simply been left alone. Most PCs are extremely slow growing meaning that men can live with PC, rather than die from it. In fact, autopsy studies report that more than 30% of all men over the age 50 have evidence of PC, but only 3% will die from it.
My feeling is that the problem with early screening is not the screening; it is what happens after the screening that is the issue. In the case of PSA screening, the approach should be “watchful waiting” versus immediate biopsy unless accompanied by significant recent increase in PSA levels, family history, or in African-Americans. And, if the biopsy is positive, even then a conservative approach should be taken with the majority of men. Now, that does not mean that I advocate idleness with “watchful waiting.” In fact, I recommend just the opposite; focus aggressively on the preventive measures against PC detailed here: http://doctormurray.com/health-conditions/prostate-cancer-prevention/

July 17th, 2012

Blueberries

On May 8, 1999 the United States Department of Agriculture July proclaimed July as National Blueberry Month. It is fitting that July is the month of celebration given the importance of blueberries in American history and the fact that the United States produces over 90% of all of the blueberries in the world.

Blueberries are among the most important foods for good health. The diverse and wondrous health benefits of blueberries are primarily due to their high content of specialized pigments known as anthocyanins. These special flavonoids are responsible for the deep blue or purple color of blueberries.

Currently, the most popular medical use of blueberries is their use in improving vision and protecting against age-related macular degeneration. Additional research also points out that blueberries may be protective against the development of cataracts and glaucoma, and quite therapeutic in the treatment of varicose veins, hemorrhoids, and peptic ulcers.

Another very practical application of the antioxidant activity of blueberries is in the protection against Alzheimer’s disease and age related cognitive decline. In animal studies researchers have found that blueberries help protect the brain from oxidative stress and may reduce the effects of age-related conditions such as Alzheimer’s disease. Specifically, when older rats were given the human equivalent of 1 cup of blueberries a day they demonstrated significant improvements in both learning capacity and motor skills, making them mentally equivalent to much younger rats. When the rats’ brains were examined, the brain cells of the rats given blueberries were found to communicate more effectively than those of the other older rats that were not given blueberries.

While blueberries are an excellent food, a blueberry concentrate with all the anthocyanin-power of fresh picked blueberries is a convenient way to gain all of the health benefits. Two 500 mg capsules of a 36:1 blueberry concentrate is equivalent to ¼ cup of fresh blueberries. For general health, take two capsules daily.