The TV advertisements by lawyers always seem to be at the forefront of news about bad side effects of prescription drugs.  Like buzzards circling over a carcass, lawyers are following the news that the diabetes medicine Avandia was associated with increased risk of heart attacks.  The interesting thing is that drug companies sometimes market drugs which can cause harm to recover their research costs and make a profit.  They figure that by the time the customers and the Food and Drug Administration (FDA) find out about the side effects, they will have made a lot of money even if they have to pay some claims for injuries caused by their product.  Many of the late night commercials by lawyers are targeted at the following three drugs.

Avandia (Rosiglitazone) is used along with a diet and exercise program and sometimes with Avandryl and Avandamet to treat type-2 diabetes, also known as adult-onset diabetes.  Avandia is made by the pharmaceutical company SmithKline Beecham which found as early as 1999 that the medicine posed risks to the heart, but the information was never made public.  On May 21, 2007, the FDA issued a Safety Alert regarding Avandia.  A study concludes that patients taking Avanida face a 43% increased risk of heart attack, and a 64% increased risk of dying from heart related (cardiovascular) disease, such as congestive heart failure.

Reglan (metoclopramide) is used to relieve heartburn and speed the healing of ulcers and sores in the esophagus (tube that connects the mouth to the stomach) in people who have gastroesophageal reflux disease (GERD).  Reglan is also used to treat nausea and vomiting, and to facilitate gastric emptying in patients with gastroparesis. Another use for Reglan is as a treatment for migraine headaches.  On February 25, 2009, The FDA required the manufacturers of metoclopramide-containing drugs to add a “Black Box” notice warning about an increased risk of the development of Tardive Dyskinesia which is characterized by repetitive, involuntary, purposeless movements such as lip smacking, tongue protrusion, tremors, rapid eye blinking, and seizures.

Accutane (isotretinoin) is used to treat severe acne that has not been helped by other treatments, such as antibiotics.  Isotretinoin is in a class of medications called retinoids. Accutane has been linked to a variety of severe, life-threatening side effects including birth defects, depression, suicide, inflammatory bowel disease, Crohn’s disease, and ulcerative colitis.  On June 26, 2009 Roche Holding AG, the manufacturer of Accutane initiated a nationwide recall of the popular medication after stating that they have awarded over $33 million in lawsuits directly related to bowel disease claims.

Before taking any prescription drugs, we should always think very seriously about their side effects and whether we really need the medicines.  It seems that sometimes the cure is worse than the disease.

Retinyl Palmitate

According to the Centers for Disease Control and Prevention, 53,919 people in the United States were diagnosed with melanoma skin cancer in 2006, and in the same year 8,441 people died as a result of this disease.  The rates of skin cancer are increasing as the result of unprotected sun exposure and the use of tanning beds.

Melanoma

Sunscreens can prevent skin cancer as well as wrinkles and skin discolorations.  Sunscreens, also known as sunblock or sun creams, are lotions, sprays, gels or other topical products that absorb or reflect some of the sun’s ultraviolet (UV) radiation and help protect against sunburn.

In addition to the sun-blocking chemicals, sunscreens often have retinyl palmitate, a form of Vitamin A, which in theory should be good for the skin.  Vitamin A is an ester, primarily retinyl palmitate, which is converted to an alcohol (retinol) in the small intestine.  Vitamin A is needed by the retina of the eye for night vision and color vision.  Vitamin A deficiency is estimated to cause approximately 250,000 to 500,000 cases of blindness per year in children of developing countries.  Retinoic acid, the oxidation product of Vitamin A, acts as an important hormone-like growth factor for epithelial and other cells.

Retinyl palmitate, or vitamin A palmitate, is the ester of retinol (vitamin A) and palmitic acid.  Retinyl palmitate is a source of vitamin A added to low fat milk and other dairy products to replace the vitamin content lost through the removal of milk fat.  Retinyl palmitate is a constituent of many topically-applied skin care products, including most popular sunscreens. After its absorption into the skin, retinyl palmitate is converted to retinol, and ultimately to retinoic acid, the active form of vitamin A.

However, a possible link has been found between retinyl palmitate in sunscreens and skin cancer.  One study found that tumors and lesions developed up to 21% faster in lab animals coated with cream containing retinyl palmitate compared with cream that did not contain it.  This may be due to the formation of free radicals that are created when retinyl palmitate is exposed to ultraviolet light.[1]

Learn more about vitamins

[1] Qingsu Xia, et al., Photoirradiation of Retinyl Palmitate in Ethanol with Ultraviolet Light -
Formation of Photodecomposition Products, Reactive Oxygen Species, and Lipid Peroxides, Int. J. Environ. Res. Public Health 2006, 3(2), 185-190, PMID: 16823091
“Our results demonstrate that, similar to irradiation with UVA light, RP can act as a photosensitizer leading to free radical formation and induction of lipid peroxidation following irradiation with UVB light.”

To estimate the number of calories that you should eat, you also need to know your level of activity.  If you are very active, you will need more calories than if you are sedentary.  While it is relatively easy to estimate the number of calories in your food by weighing and measuring, it is a lot harder to estimate the number of calories burned by exercise.  People often overestimate their amount of activity and consequently they eat more calories than they burn, and gain weight over time.

The Calorie Restriction Calculator estimates the Basal Metabolic Rate, and then uses an activity factor to obtain the total number of calories needed per day.  Using the wrong activity factor alters the estimate of daily calories substantially.

A paper on metabolism used a definition of “vigorous exercise” as expenditure of 14.1 to 16.3 kcal/kg of ideal body weight per day.[1]  Using the rounded figure of 15 Calories per kilogram of body weight, then “vigorous exercise” for a person weighing 150 pounds (68 kilograms) corresponds to 1020 Calories per day.  If walking at 4 miles per hour burns about 300 Calories per hour, then you would need to walk 3 hours and 24 minutes to burn off 1020 Calories.

The activity factors for the Calorie Restriction Calculator are:

• 1.200 = sedentary (little or no exercise)
• 1.375 = lightly active (light exercise/sports 1-3 days/week, approx. 590 Cal/day)
• 1.550 = moderately active (moderate exercise/sports 3-5 days/week, approx. 870 Cal/day)
• 1.725 = very active (hard exercise/sports 6-7 days a week, approx. 1150 Cal/day)
• 1.900 = extra active (very hard exercise/sports and physical job, approx. 1580 Cal/day)

The activity factor lightly active corresponds to walking 2 hours per day, moderately active corresponds to walking 3 hours per day, very active corresponds to walking 4 hours per day, and extra active corresponds to walking 5 hours per day (20 miles).  More strenuous exercises, such as climbing stairs or running, burn more calories per hour.  Most people who exercise from 30 minutes to 45 minutes per day are in the “lightly active” category.  You can use the CR calculator to determine the number of calories for each level of exercise for your particular weight by subtracting the calories for a specific activity level from the calories for the sedentary option.

See the chart listing the calories for various activities

[1] Thissen JP, Ketelslegers JM, Underwood LE., Nutritional regulation of the insulin-like growth factors, Endocr Rev. 1994 Feb;15(1):80-101. Review. PMID: 8156941

Although a lifetime may seem long, it does not seem so when we examine it in terms of decades rather than years.  Only one person in 10,000 lives beyond their tenth decade.

First Decade (age 0 to 9) - Age of dependency.  Our mothers must feed us and clean us. We learn to walk and talk. We start our education.

Second Decade (age 10 to 19) - Discovery of sexuality. Raging hormones awake our awareness of the opposite sex.  We have to learn to channel our primal impulses within the rules of society.  Our ability to think logically starts to develop.

Third Decade (age 20 to 29) – Early adulthood. We feel independent. We try to find a comfortable niche within society with our first real job and our own partner and family.

Fourth Decade (age 30 to 39) – The prime of life. We have figured out how the world works.  We think that we know what we want. We raise our children, and we plan for our future.

Fifth Decade (age 40 to 49) – Middle age. Although we don’t feel old during this decade, the chances of living to twice this age are not very good.  We may have a mid-life crisis that forces us to evaluate our life and try to make it better, but it is not easy to change because we have to live within the constraints of our work, family structure, and social environment.

Sixth Decade (age 50 to 59) – Age of biological decline. We become aware of wrinkles, gray hair, arthritis pains, menopause, and decreased libido.  We listen more carefully to advertisements about Cialis and Viagra. We become eligible for membership in AARP.   We need reading glasses.

Seventh Decade (age 60 to 69) – Retirement age. We become eligible for Medicare.  If we are lucky and have planned well, we can stop working and start traveling or doing community service.  If we have not saved enough to afford retiring, we have to continue working.  If our health is not good, we now take medicines for diabetes, high cholesterol, and high blood pressure.

Eight Decade (age 70 to 79) – Age of decreased mobility. The little pains of twenty years ago have increased so that now they impede what were normal activities.  Visits to doctors become more frequent.  We may need a cane, hernia surgery, or cataract surgery.  Our age spots are harder to cover.  Our circle of friends starts to shrink as they start to die.  Heart attacks, strokes, and cancer take their toll.

Ninth Decade (age 80 to 89) – Age of assisted living. Even if we can still take care of ourselves, we may need somebody to help us clean the house, go shopping for us, or prepare our food.  Health problems become more severe.  We may become incontinent and have to wear adult diapers.  Most people will not live beyond this decade.

Tenth Decade (age 90 to 99) – Pre-centenarian. Congratulations!  if you have made this far, it means that you have good genes, fewer or less severe health problems than the average person, and good family support.  If you are still active, you may live to be a centenarian. The life expectancy at age 90 is 3.8 years, and by age 99 the life expectancy drops to 2.1 years.  Every day may be a struggle for life.  There can be digestive problems, cardiovascular problems, mobility problems, or immune system problems on any given day.

Learn about Longevity Science

The Upward Bow pose (Urdhva Dhanurasana) and other yoga poses that require the head to be inverted may disturb the inner ear and cause vertigo and dizziness.  The inner ear has a vestibular system formed by three canals that are approximately at right angles to each other and which are responsible for the sense of balance and spatial orientation.  The inner ear has chambers filled with a viscous fluid and small particles (otoliths) containing calcium carbonate.  The movement of these particles over small hair cells in the inner ear sends signals to the brain that are interpreted as motion and acceleration.  Inversion of the head can cause some of the otoliths to shift position or slip into one of the semicircular canals and induce vertigo and instability, often accompanied by nausea.

The disorientation resulting from changes in position of the head is often diagnosed as Benign Paroxysmal Positional Vertigo (BPPV), and is treated by trying to reposition displaced otoliths back to their original position by turning the head in specific ways.  The Epley Maneuver, developed by Dr. John Epley in 1980, is often performed by a doctor or a physical therapist and requires holding the head at specific angles, and then turning the head 90 degrees to the other side for specific periods of time to allow the otoliths to settle.

Vertigo is very debilitating because it makes it impossible to perform ordinary activities.  The irony of developing vertigo through yoga is that yoga is supposed to help the body and the mind.  Many people practice the yoga positions that require inversions without any problems, but unfortunately, it is not possible to predict who will be affected adversely by inverted yoga poses.

The purpose of yoga, and all other exercises, is to improve the body.  You have to use discretion in establishing the limits of stress to which you will subject your body in any physical activity.  Going beyond your comfort zone may improve your confidence, but it also has the potential of causing temporary or permanent damage.

Learn how to have a safe workout

Diet Calculator

Did you eat too much for the holidays? If you are thinking about going on a diet, you need the right tools to measure your progress.  Some people give up when they have a small setback, but to be successful you have to keep your objective in mind.

The Diet Calculator tells you how much weight you need to lose to be within the normal range.  In addition, the calculator will estimate the percentage of body fat and the Body Mass Index (BMI).  By weighing yourself regularly and using the calculator, you can track your progress toward your goal.

The best strategy for losing weight is to reduce the amount of food that you eat and increase your activity level by exercising regularly.  In particular, cut out sweet drinks and desserts because they don’t provide nutrition, but they are high in calories.  Eat only two-thirds of your normal portions  to keep your normal eating schedule and reduce your daily calories by one third.  Within a week you will see your weight start to drop.

Learn what to eat to lose weight

Antonio Zamora – Age 67

A large percentage of people who are retired or close to retirement take medications for diabetes, high blood pressure, high cholesterol, digestive problems, and other chronic conditions that have developed over their lifetime.  If you listen to the drug commercials during the national evening news, this is normal, but it should not be.  Many of the diseases that we associate with old age are the result of bad diet, exposure to harmful chemicals, and lack of exercise.

Optimum Nutrition
Your diet should include enough protein and essential fatty acids to maintain a normal weight.  The large number of overweight people all around us distorts our notion of what is a normal weight.  Use this Body Mass Index (BMI) Calculator to determine whether your weight is in the normal range.

BMI Calculator

Learn about Optimum Nutrition

Exercise
You should engage in 30 minutes of vigorous exercise at least three to four times per week.  Exercise improves your coordination and your muscle strength.  Exercise also keeps you lungs and circulatory system in good working condition.  But be careful.  Avoid getting injured from strenuous or high-impact exercises.

Keep Active Socially and Mentally
As you age, you will need to maintain a good social network.  Many people who live to a ripe old age become depressed when they feel isolated as their friends and relatives start dying.  You can keep engaged by volunteering to teach young people, or by participating in social organizations that make you feel useful.

Try to stay healthy
The two most common causes of death are heart disease and cancer.  If you can avoid these two dangers, you have a good chance of living a long life.  Many cardiovascular diseases can be avoided by maintaining a normal weight and exercising regularly.  The risk of cancer can be reduced by avoiding substances that damage your cellular DNA and cause tumors, such as the chemicals in tobacco.

Learn how to reduce cancer risks through diet and lifestyle changes

Homeopathy is a form of alternative medicine that treats patients with drug or herbal preparations that are so diluted that the final solution may not contain detectable amounts of the drugs or herbs.  In fact, homeopathic remedies may be so diluted that they are just water.  Clearly, any benefit obtained from such medicines would likely be due to the placebo effect, which is the belief by the patient that he or she will get better.  This belief sometimes has a therapeutic effect.  Homeopathic remedies may be just water, but they can cause harm by preventing a sick person from seeking competent medical advice and being cured by verified conventional treatments.

Homeopathic remedies are a big business.  The market for homeopathic medicines is estimated to be 300 million euros in France, 200 million euros in Germany, over 26 billion Rupees in India, and $200 million Dollars in the United States.

Homeopathic products do not need to be tested for safety or effectiveness, but they must be labeled with a list of ingredients and the conditions for which they are used.  A 1938 law allows drugs listed in the Homeopathic Pharmacopoeia of the United States to be sold without the validation that governs standard medications.  In essence, homeopathic products are manufactured and distributed without FDA approval.

Some homeopathic products may actually contain harmful substances.  In June 16, 2009, the Food and Drug Administration (FDA) warned consumers to stop using and discard three zinc-containing Zicam intranasal products because the products may cause a permanent loss of sense of smell.[1]  The manufacturer of Zicam, Matrixx Initiatives, agreed to pay $12 million dollars in 2006 to settle 340 law suits by consumers who claimed that Zicam had ruined or destroyed their sense of smell.  FDA Inspectors are also investigating other homeopathic products that have caused allergic reactions from impurities introduced during manufacturing.

Just because a product is popular or heavily marketed, it does not mean that it is safe and effective.  Claims for herbal medicines are a big gray area.  There are many herbal medicines whose ingredients have been proven effective.  The antibacterial properties of garlic and the pain relief from chewing leaves of willow, which contain aspirin, have been known for thousands of years.  However, the claims made for many herbal medicines are not likely to be confirmed through research by pharmaceutical companies because there are no profits to be made from natural products that cannot be patented.  A successful economic model for new drugs requires identifying the active compounds in a natural product and then creating synthetic analogues that can be patented.

[1] FDA Warnings on Three Zicam Intranasal Zinc Products [link]

According to the National Center for Health Statistics, 106.7 million Americans age 20 and older have total blood cholesterol levels of 200 milligrams per deciliter (mg/dL) and higher. That is 35% of the population of the United States! The epidemic of high cholesterol is mainly due to the fats used in packaged and commercial foods. Cholesterol can be lowered by avoiding hydrogenated fats and eating polyunsaturated fats found in fish, walnuts, and sunflower seeds. Unfortunately, essential fatty acids turn rancid rapidly, and manufacturers avoid them to prevent packaged foods from spoiling while they sit in supermarket shelves.

The worst fats for your health are hydrogenated fats because they increase Low Density Lipoprotein (LDL), the “bad” cholesterol, and they decrease the High Density Lipoprotein (HDL), the “good” cholesterol. Saturated fats like those found in coconut oil and palm kernel oil increase cholesterol levels powerfully, but these are the fats that are used by manufacturers because they do not get stale.

The chart above shows the effects of individual dietary fatty acids on Total Serum Cholesterol, LDL cholesterol, and HDL cholesterol when 1% of the energy from carbohydrates in the diet is replaced by 1% of energy of the specific fatty acids. The chart shows cholesterol increases from lauric acid (C12:0), myristic acid (C14:0), and palmitic acid (C16:0) which are found in coconut oil, palm oil, and butter. Elaidic acid (trans-C18:1), which is present in hydrogenated fats, is the worst because it increases LDL and decreases HDL. The saturated fatty acid stearic acid (C18:0), the monounsaturated oleic acid (C18:1), and the polyunsaturated linoleic acid (C18:2) decrease LDL and increase HDL to various degrees.[1] Here are some steps to lower cholesterol:

• Avoid all hydrogenated fats (they are very common in commercial fried foods and baked goods)
• Reduce sources of saturated fats (butter, coconut oil, palm oil, fat from meats, chicken skin)
• Increase consumption of polyunsaturated fats (fish oil, walnut oil, flax seed oil, grape seed oil)
• Add soluble fiber to your diet (oatmeal, legumes)

Unfortunately, many of the oils available commercially are highly processed. The best thing is not to eat them. Meet your essential fatty acid requirements by eating foods that have the oils, e.g., fish, walnuts, sunflower seeds, etc. Olive oil does not lower cholesterol; it is basically neutral. The reason why olive oil receives a lot of positive promotion is because it is used in the Mediterranean diet, and the Mediterranean diet is associated with lower incidence of cardiovascular diseases, although this is not necessarily because of the oil.

The hardest part in normalizing your cholesterol will be avoiding the vast number of commercial foods that have hydrogenated fats and saturated fats. They include shortening, margarine, butter flavor popcorn, hash browns, french fries, biscuits, baked apple pies, chocolate chip cookies, taco shells, and the list goes on and on. Pay close attention to the food labels.

Learn how to lower your cholesterol

[1] Martijti B Katan, Peter L Zock, and Ronald P Mensink, Effects of fats and fatty acids on blood lipids in humans: an overview, Am J Cli. Nutr., 1994;60(suppl):1017S-1022S.

 
Mechanism of apoptosis and a toe with gout

When body fluids, such as urine, become very acid, solids dissolved in the fluids crystallize within the body and can cause gout and create tophi in the cooler parts of the body. The pain of uric acid deposits from gout can be excruciating.  The conventional treatment for gout consists of avoiding alcohol, foods high in purines, and some medications like niacin.  Many of the prescription medicines used to treat gout have undesirable side effects.

As if the suffering from gout were not bad enough, a study published in 2009 linked the occurrence of gout to increased incidence of cancer and concluded that “hyperuricemia may be an early manifestation of the carcinogenic process”.[1]  The study found that gout patients had increased incidence of all types of cancer, including cancers of the oral cavity, pharynx, colon, liver and biliary tract, pancreas, lung, skin (melanoma and nonmelanoma), endometrium and kidney, as well as of malignant melanoma.

Sodium bicarbonate (baking soda) is frequently used as a home remedy for gout. Sodium bicarbonate works by alkalizing body fluids to increase the solubility of uric acid and permit its elimination through the urine.  It is possible that this alternative medicine treatment for gout could also reduce the risk of cancer.

In 2007, researchers identified cellular signaling pathways that become active under alkaline conditions by removing amide functional groups from key cellular proteins (Bcl-xL) thus promoting the death of cancerous cells through apoptosis.[2]  German biochemist Otto Warburg initially proposed in 1966 that abnormal energy metabolism caused cancer. He showed that tumors have an acidic extracellular environment, and suggested that a switch from oxidative respiration to glycolysis, which produces lactic acid, starts the cell transformation toward cancer. Warburg’s work stimulated interest in the possibility that there was some kind of link between pH and cancer.  The latest findings raise hope that inducing alkalinization may prove an effective strategy to treat a range of cancers.

Wouldn’t it be wonderful if cancer could be prevented simply by regularly drinking some baking soda dissolved in water to keep body fluids from becoming too acidic?

[1] Boffetta P, Nordenvall C, Nyrén O, Ye W., A prospective study of gout and cancer.
Eur J Cancer Prev. 2009 Apr;18(2):127-32, PMID: 19337060

[2] Gross L (2007) Manipulating Cellular pH Suggests Novel Anticancer Therapy. PLoS Biol 5(1): e10