|Issue #97 - October 2010|
Welcome to this issue of Naturopathic News, issue #97. It's my mission to help you find optimal solutions to health problems. This newsletter is one way to do that. The more educated you are about your health options the better able you will be to take control of your health. If you would like to stop receiving my newsletter please send me an email and let me know. If you have a friend or family member who you think would appreciate the information provided, send me their email address.
BREAST CANCER DEATH RATE AND MAMMOGRAMS
A new study suggests that mammograms have a very limited role to play in reducing the breast cancer death rate. Yearly mammograms were shown to reduce cancer mortality by 2%, a number small enough to be insignificant.
Beginning in their 40s or 50s, most women in this country get a mammogram every year, as recommended by health officials. But this study suggests that the decision about whether to have the screening test may now be a close call.
In the new study, mammograms, combined with modern treatment, reduced the death rate by 10 percent, but the study data indicated that the effect of mammograms alone could be as low as 2 percent or even zero. A 10 percent reduction would mean that if 1,000 50-year-old women were screened over a decade, 996 women rather than 995.6 would not die from the cancer. This is an effect so tiny it may have occurred by chance.
This study looked at what happened in Norway before and after 1996, when the country began rolling out mammograms for women ages 50 to 69 along with special breast cancer teams to treat all women with breast cancer. In the study, which is continuing, women were followed for a maximum of 8.9 years.
The new study is "very credible," said Dr. Barnett Kramer, associate director for disease prevention at the National Institutes of Health. "This is the first time researchers used real populations to compare the effects of treatment and mammography in the modern era of treatment," Dr. Kramer said.
In their study, the investigators analyzed data from all 40,075 Norwegian women who had received a diagnosis of breast cancer from 1986 to 2005, a time when treatment was changing markedly.
In that period, 4,791 women died. And, starting in 1996, Norway began offering mammograms to women ages 50 to 69 and assigning multidisciplinary treatment teams to all women with breast cancer. The question was, did the program of mammograms and treatment with coordinated medical teams lower the breast cancer death rate?
The investigators found that women 50 to 69 who had mammograms and were treated by the special teams had a 10 percent lower breast cancer death rate than similar women who had had neither. They also found, that the death rate fell by 8% in women over 70 who had the new treatment teams but had not been invited to have mammograms.
That means, Dr. H. Gilbert Welch of Dartmouth wrote in an additional analysis in an accompanying editorial, that mammography could have reduced the breast cancer death rate by as little as 2 percent, an amount so small that it is not really different from zero.
Two percent is an estimate, Dr. Welch said. But, he said, whatever the effect of mammograms is, "all the signals here are that it is much smaller than we believed."
And screening has a cost, Dr. Welch said. Screening 2,500 50-year-olds for a decade would identify 1,000 women with at least one suspicious mammogram resulting in follow-up tests. Five hundred would have biopsies. And 5 to 15 of those women would be treated for cancers that, if left alone, would have grown so slowly they would never have been noticed.
Dr. Kalager worries about the small chance of benefit in light of the larger chance of finding and treating a cancer that did not need to be treated. "Since I'm a breast cancer surgeon, I know what being treated is like," she says. The decision to be screened, she says, "is a matter of personal preference. Is it worth it to risk becoming a patient
without it being necessary?"
New England Journal of Medicine, September 23, 2010
DR. PAIS’S COMMENTS: I find it encouraging that even a breast cancer surgeon is questioning the rationale of unnecessary screenings. It will be interesting to see how much this information is communicated to women. Will you be told that your routine mammogram has a 2% chance (maybe zero) of being any benefit to you? Before you respond that mammograms aren’t harmful, so why is this a problem, take a look at Dr. John Gofman’s “Radiation and Human Health”. Then we can have a scientific discussion.
SURGICAL RECOVERY AND VITAMIN D
This study reports that almost 50% of orthopedic surgery patients are deficient in vitamin D, a condition that impairs bone healing, muscle function and surgery recovery.
Professor of Orthopedic Surgery and chief of the Metabolic Bone Disease Service at New York's Hospital for Special Surgery Joseph Lane, MD and colleagues looked at the medical charts of 723 men and women scheduled for orthopedic surgery from January, 2007 to March, 2008. 43% of the patients had insufficient preoperative vitamin D levels, defined as 20 to 32 nanograms per milliliter (ng/ml), and 40% had deficient levels of less than 20 ng/ml. Younger individuals, men, and those with dark skin were likeliest to be low in vitamin D.
Dr Lane stated that healing of bony tissue takes place two to four weeks following bone surgery, and sufficient vitamin D is needed for this process. "In the perfect world, test levels, fix and then operate," Dr Lane stated. "If you are really aggressive right before surgery, you can correct deficient levels quickly, but you have to correct it, measure it, and then act on it."
60% of trauma service patients had insufficient levels and 52% were deficient. A high percentage of vitamin D insufficiency was also observed in Sports Medicine and Arthroplasty (hip and knee replacement) services. "We frequently see stress fractures in the Sports Medicine Service and if you want to heal, you have to fix the calcium and vitamin D," Dr. Lane noted. "With arthroplasty, there is a certain number of patients that when you put in the prosthesis, it breaks the bone adjacent to the prostheses, which can really debilitate patients.
"This study should serve as a wake-up call to orthopedists that vitamin D deficiency is widespread, not necessarily tied to age, sex or background and screening for it should be part of routine presurgical care for adults," Dr Lane stated. "Meanwhile, patients who are planning to undergo any orthopedic procedure can request a screening (specifically, a blood test called the 25 hydroxyvitamin D test) or ask to be placed on a medically supervised vitamin D supplement regimen prior to surgery."
"The take home message is that low vitamin D has an implication in terms of muscle and fracture healing, it occurs in about 50 percent of people coming in for orthopedic surgery, and it is eminently correctable," he concluded. "We recommend that people undergoing a procedure that involves the bone or the muscle should correct their vitamin D if they want to have an earlier, faster, better, result. What we are saying is 'wake up guys, smell the coffee; half of your patients have a problem, measure it, and if they are low, then fix it.'"
The Journal of Bone and Joint Surgery, October 6, 2010
DR. PAIS’S COMMENTS: Until recently, the recommended daily allowance was set too low so that most supplements were set at that low amount. And though sunlight exposure is the best source of Vitamin D people have stayed out of the sun due to concerns about skin cancer. Or they’ve used sunscreens that block Vitamin D creation from the sun.
The one important addition I would make is that if you take the optimum Vitamin D level to be 50-70 ng/ml, as most nutrition-trained practitioners do, an even higher percentage of surgery patients would be Vitamin D deficient.
OSTEOARTHRITIS AND GLUCOSAMINE SULFATE
In this double blind intervention trial, 250 adults with symptomatic osteoarthritis of the lumbar spine were worked with. For six months, 1500 mg/day of glucosamine sulfate (GS) or placebo was administered.
A survey was used to determine any changes in pain-related disability. Scores were obtained both at the end of the trial, and six months after the end of the trial. There was a greater than 45% reduction in pain-related disability reported in the group receiving GS, which matches well with the outcomes of previous successful GS trials. However, the placebo (no medication) group achieved a 48% reduction in pain-related disability, which caused the authors to conclude that GS was ineffective.
Effect of glucosamine on pain-related disability in patients with chronic low back pain and degenerative lumbar osteoarthritis. JAMA 2010;304:45-52.
DR. PAIS’S COMMENTS: It’s useful to look at this trial and think about the results. First, does it make sense that almost half the people that did not receive any medication had less pain disability? What could account for this unlikely result? Turns out, almost 21% of those assigned to placebo admitted to taking GS during the second 6-month period. In other words, they cheated. Since they were told at the beginning of the trial that they would get GS or placebo, they figured that taking some GS might help.
Also, positive effects of GS were probably partially masked by the use of a wide variety of additional treatments that were permitted throughout the trial including chiropractic, analgesics, massage, and physiotherapy. In other words, too many uncontrolled variables were allowed to impact the results.
Another aspect I consider in my practice is dose. For a relative few, 1500 mg/day of GS is sufficient to produce results. However, many more get better faster with higher amounts. I choose their dose based on body weight, duration of symptoms, and what part of the body we’re actually working with. I have to wonder, how many of the participants just didn’t get enough GS to make a difference?
Glucosamine sulfate is not a panacea. It has a very specific application based on what it does. Essentially, GS provides the nutritional building blocks for cartilage. If cartilage is part of your joint issue then GS should have an effect to reduce pain and inflammation. If not, then it won’t.
Several previous studies have reported GS to be effective in reducing symptoms of osteoarthritis of the knee and hip. I don’t think JAMA would have published this trial had the outcome favored GS over placebo. This is what is called a "negative publication bias. In other words, JAMA is there to promote drugs, not supplements.
PANCREATIC CANCER AND SODA CONSUMPTION
Information on consumption of soft drinks, juice, and other dietary items, as well as lifestyle and environmental exposures, was collected through in-person interviews from 60,524 people taking part in the Singapore Chinese Health Study.
Drinking two or more sodas a week almost doubled a person’s risk of developing pancreatic cancer. Following these people for 14 years 140 cases of pancreatic cancer (PC). Individuals who consumed 2 or more soft drinks a week experienced a significant increase in risk of pancreatic cancer compared with individuals who did not consume soft drinks. There was no association seen between drinking fruit juice and risk of PC.
Soft drink and juice consumption and risk of pancreatic cancer: the Singapore Chinese Health Study. Cancer Epidemiol Biomarkers Prev. 2010;19(2):447-455.
DR. PAIS’S COMMENTS: Pancreatic cancer does not respond well to treatment: 5-year survival is less than 5%. Therefore, prevention is the best approach. Cigarette smoking is the one accepted risk factor consistently associated with increased risk of pancreatic cancer. Type 2 diabetes also increases risk, which led to a theory that producing high levels of insulin might somehow lead to malignant transformation of pancreatic cells.
In most cancers, the cells that become cancerous have been somehow overworked, irritated, or in some way abused before becoming cancer cells. They have been pushed by something to grow faster, work harder, secrete more or in some manner live harder lives. Estrogen pushes both breast and uterine cells to become cancerous. Testosterone pushes prostate cells to become prostate cancer. This theory about pancreatic cancer suggests that high sugar intake pushes the pancreas.
Here are some pages that are of particular interest:
Store : There are 308 products from Emerson listed on this page. If yours isn’t one of them please let me know and I will add it so you can order online. This is particularly convenient after hours or on the weekend. Of course, you can always order by phone from Emerson at 800-654-4432.
Newsletter : Here you will find all 97 issues of my health newsletter, "Naturopathic News”.
Optimal Health Points : This is my blog that I update periodically. Check out my latest post, “No Deaths From Vitamins, Minerals, Amino Acids Or Herbs”.
Come join my fan page at www.facebook.com/NaturalDoc
Help me bring information, news, and stories about natural medicine to the Facebook community.
For those of you who don’t know, Facebook is a social networking website. Users can add friends and send them messages, and update their personal profiles to notify friends about themselves. Additionally, users can join networks organized by city, workplace, and school or college.
Facebook pages help you discover new artists, businesses, and communities as well as those you already love. On my fan page www.facebook.com/NaturalDoc I post discussions that you can join in with and relay breaking health news related to disease prevention, clinical nutrition, and ways to make you healthier.
I’m looking forward to exploring this community with you. See you there!
LET ME HELP YOU MAKE WISE SUPPLEMENT CHOICES
As is often the case, a recent new patient asked if I would review their choice and use of supplements and herbs. Why does this happen so often? For many, taking a vitamin or herb is their introduction to natural medicine. Their desire to be healthier drives them to take supplements and herbs. The death, pain, discomfort, and side effects experienced with over the counter and prescription drugs compels people to look elsewhere. It’s very different with supplements and herbs which, when used correctly, have an incredibly low risk of harm.
Some people take this to an extreme and take every supplement or herb that someone tells them is ‘good for them’. It might be a clerk, an internet ‘expert’ source, or a friend who is marketing the latest or greatest fad. Most of these individuals or companies have no professional training or experience in the medical use of the supplements or herbs that they’re selling. The people they’re selling to come into my office with 5,10, 15, or more supplements that they’re taking. Sometimes it’s been so long since they started taking them that they don’t remember why they’re doing it. When I ask, they can’t tell me what, if anything, a particular product is doing for them. Yet, they can be quite fearful of stopping any of these items, as if their health would careen off a precipice without them.
Why do I think my approach is any different? Partly, it’s because of my background. I’ve literally been working with nutritional supplements since 1974. That’s 35 years assessing the quality and effectiveness of supplements. Starting in 1980 I started working with Western and Chinese herbs. The quality of herbs used and how they’re combined together has the greatest effect on the efficacy of the final product. Because I’ve grown, identified, harvested, and produced medicinal herbal products I recognize a good formula when I see one.
Licensed naturopaths like me receive the most extensive academic and clinical training in the use of nutritional supplements and herbal medicines of any professional in the United States. Nothing can substitute for such hands on experience, especially when you see, and are responsible for, the results of your treatments. Very different from the clerk in the store, or coworker who’s part of a MLM scheme.
What I’m offering to is easy access to this experience and training. Both for you and your family. If you have questions about the supplements or herbs you are taking, or are thinking about taking, now is the time to ask. Send me an email with the brand and name of the product you’re taking. Let me know that you want to bring the bottles in at your next visit, so I can see what you’re taking. Start a discussion on my Facebook fan page. Either way I’ll give you honest feedback about what I think is good, or what isn’t. We’ll fine tune what you’re taking to maximize effect and eliminate waste.
Let me hear from you and we’ll get started.
GET YOUR VITAMIN D TEST WITH ZRT LABORATORY
It just happened again the other day. A patient sent me a copy of the Vitamin D test she just had done. With frustrating results. The wrong test was done. After all these years, and all the information available, MDs and laboratories still order the wrong test. What a waste of money and time.
For a long time I looked for a home Vitamin D test. One that would be simple, easy, and accurate to do on your own. I finally found one. ZRT Laboratory in Beaverton OR. ZRT emphasizes research and technological innovation.
Until now, venipuncture blood serum has been the standard medium for testing Vitamin D. ZRT has developed and refined Vitamin D testing in blood spots. A few drops of blood from a quick and nearly painless nick of the finger, placed on a filter paper to dry are all that is needed. The total 25 (OH) Vitamin D is then determined by liquid chromatography/tandem mass spectrometry (LC-MS/MS). This method has been shown to be as accurate as the assay standard.
Ordering A Vitamin D Test
ZRT allows anyone to order a Vitamin D test kit for $95 plus shipping and have it sent to their home. ZRT will let me prepay for kits and send them to my office for $55 each. I am charging $65 per kit for patients to cover my overhead and analysis of results.
If you are interested in getting a Vitamin D test done through my office please prepay so I can order you a kit. Then you can either pick it up at my office or have it shipped to your home. Once you’ve taken the sample and sent it back to ZRT it’s only a matter of time before your results are sent back to me. I can even look at them online before the mail arrives.
If your doctor has refused to order a Vitamin D test or worse, ordered the wrong one, this is the fastest, least expensive, most accurate way to do it ourselves. Once we know what your Vitamin D levels are, the next step is making sure that you achieve optimum levels for prevention of disease and maintenance of health.
I am often asked what supplements I recommend. Many of you have been surprised to discover that I favor food over pills; lifestyle changes over fads. I have been working with nutrition for over 30 years, herbs for over 20 years. Where and when appropriate I recommend them to my patients. I strive to act from knowledge, experience, and research.
Emerson Ecologics (800-654-4432) carries almost all of the nutritional supplements and botanical extracts that I think are useful. Their customer service is excellent and their delivery is reliable (often only 2-3 days to this region). It’s a great way to get physician quality products at reasonable prices.
To offset the cost of shipping, reference my name when you establish your account and receive a 10% discount on every order. If you have any questions about these items feel free to email me.
That’s it for this issue of Naturopathic News. If you’ve thought a bit extra or learned something new, then I achieved my goal. As usual, if you have questions or concerns brought up by these subjects, let me know.
Gregory Pais, ND, DHANP
580 E. 3rd. St.
Williamsport PA 17701