Great Smokies Medical Center of Asheville

Archive for the ‘Miscellaneous Conditions and Treatments’ Category

Nutrients Slow Rate of Macular Degeneration

Monday, August 22nd, 2005

It seems that scientists are continually rediscovering that nutrition can affect health.

A recent clinical trial by the National Eye Institute reported in the journal Archives of Ophthalmology, October 2001 found that supplementation of vitamins and minerals slowed vision loss associated with intermediate and severe age-related macular degeneration (AMD) by 25%. The six-year long trial involved 3,600 participants aged 55-80 at high risk for AMD. One group was administered 500 mg of vitamin C, 400 IU of vitamin E, 15 mg of beta-carotene; 80 mg of zinc and 2 mg of copper daily. Other groups took only antioxidants, only zinc, or a placebo.

90% of AMD is called “dry” AMD and it occurs when the deterioration of light sensitive cells in the back of the eye results in vision loss. In the less common “wet” variety of AMD, blood and fluid seep into the tissues in the back of the eye between the retina and the blood vessels behind it. The resulting scarring affects the retinal nerve supply and results in loss of central vision. AMD is the leading cause of blindness in an aging population. An estimated 2 million Americans have AMD.

Additional studies also suggest that there are other nutrients that likely have even greater effectiveness in the treatment of AMD. These include selenium, lutein, zeaxanthin, DHA and EPA, and vitamin B12. Selenium is a powerful antioxidant. Lutein and zeaxanthin are naturally occurring yellow pigments called carotenoids that are abundant in the retina. They are abundant in egg yolks, kale, collards, and swiss chard, but can be taken as a dietary supplement. DHA and EPA are essential fatty acids that are rich in fatty fish such as salmon or mackerel and are critical for eye health. Vitamin B12 offers important nutritional support for the nerve supply to the eye. Use caution when choosing nutritional supplements. I have found that less expensive look-a-likes may be of questionable quality that appeal to a consumers who have no way of assessing their quality. Buyer beware.

Since it is difficult to obtain adequate nutrients in food grown on soil depleted by non-organic farming, I suggest the following for sensible dietary support for AMD: an abundance of fresh organic vegetables in the diet, blueberries and blackberries that are rich in beneficial proanthocyanadins, 3-4 meals of fatty fish per week, drinking about 3 quarts of water per day if not on medical restriction of fluids, in addition to eliminating sugar, margarine and other hydrogenated oils, and chemical additives from the diet.

Avoidance of direct sunlight in the eye by wearing sunglasses with ultraviolet protection may be of benefit, as are stopping smoking and tight control of diabetes. Regular dilated eye exams are recommended for those with loss of vision or for anyone over age 55.

Interestingly, a similar clinical trial on the impact of nutrients on cataracts, a clouding on the lens of the eye, found no benefits in nutrient supplementation. In my experience, the use of the antioxidants glutathione and superoxide dismutase are effective in reducing cataracts in some individuals when supplied by eye drops. This is likely because it is difficult to get nutrients to the cataract through nutrients taken by mouth as the lens has a poor blood supply, especially in an aging population.

Just Say No to NSAIDs

Monday, August 22nd, 2005

The easy availability of over-the-counter and prescription drugs classed as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) combined with the increase of chronic degenerative diseases in our nation make it a strong likelihood that any individual, especially as they age, will utilize NSAID therapy to treat pain and inflammation. NSAIDs include aspirin, plus numerous other over-the-counter and prescription drugs such as Ibuprofen, Feldene, Motrin, Advil, Indocin, Orudis, Aleve, Naprosyn, etc.

Well-known side effects of NSAIDs include gastrointestinal ulceration and liver toxicity. (Do not drink alcohol while on NSAIDs treatment.) The statistics are impressive.

  • More Canadians bleed to death from NSAID use than from gunshot wounds.
  • The annual use of aspirin in the US is estimated to exceed ten thousand tons.
  • Between an estimated 10,000-20,000 people die annually from NSAID use.

The average cost of an uncomplicated gastric ulcer hospitalization is $15,000. For active, concurrent ulcers the cost averages $86,000.In light of the fact that 70 million prescriptions for NSAIDs are written every year in the US, it is suggested that over $100 million are spent treating this one side effect of NSAID use annually.

This does not include the more insidious but equally significant and costly complications of NSAIDs such as those disrupting adequate absorption of nutrients which profoundly impacts health over time. NSAIDs enteropathy masquerades as inflammatory bowel disease, which leads to changes in the permeability of the intestines, thereby encouraging malabsorption, food allergy and bleeding.

NSAIDs act by blocking the effects of a natural substance produced by the body called Prostaglandin 2 (PGE2) which promotes inflammation in the body. Unfortunately, this blocking action is not very discriminating, as NSAIDs also block the effects of Prostaglandins 1 and 3 (PGE1 and PGE3) which are powerful anti-inflammatory substances produced by the body. This lack of selectivity of drug action is responsible for the effects of long term chronic use of NSAIDs: increased pain and inflammation. Chronic NSAID use results in increased pain and inflammation because their use blocks the body’s ability to treat inflammation with its own internal pharmacy.

Many biochemists rate the importance of prostaglandin synthesis as the single most important factor determining occurrence of degenerative illnesses including but not limited to: arthritis, diabetes, asthma, gastrointestinal ulceration, cancer, schizophrenia, learning disabilities, and virtually any medical condition ending in the suffix “-itis” which is Latin for inflammation.

Understanding this action of NSAIDs allows one to opt instead for therapies which promote the production of the body’s own anti-inflammatory PGE1 and PGE3 as a strategy to block inflammation instead of inhibiting our natural anti-inflammatory pharmacy. Knowing how prostaglandins are formed leads to potential solutions . . . read on.

Prostaglandins are produced as a direct result of eating Essential Fatty Acids (EFAs). EFAs are called essential because they cannot be manufactured by the body as are all other fats are including cholesterol, triglycerides, monounsaturated fats, etc. We must depend on external food sources for essential oils.

There are two types of EFAs: Omega 3 and Omega 6. The synthesis of our natural anti-inflammatory PGE1 results from the intake of Omega 6 oils, and is most easily promoted by eating Evening Primrose Oil (EPO). The synthesis of our natural anti-inflammatory PGE3 results from the intake of Omega 3 oils. Flax seed oil and fish oils (EPA and DHA) are rich in Omega 3 fats and therefore promote PGE3 formation.

The recommended ratio between Omega 6 and 3 oils for health maintenance is roughly 4-8:1, respectively. Other ratios are used therapeutically for shorter periods of time and/or for specific clinical situations or documented need based on EFA analysis-a blood test which measures levels of greater than forty individual fatty acids.

Food sources of these delicate, beneficial EFAs include raw, unroasted seeds (sunflower, sesame, flax, poppy, and pumpkin seeds) and unroasted nuts (walnuts, almonds, pistachios, brazil nuts, cashews, pecans, macadamias, filberts,) and their oils, in addition to fish and their oils. EFAs occur in other cold pressed oils such as corn, safflower and soy to some extent.

Unfortunately, modern oil extraction methods destroy these heat-sensitive oils. Due to their tendency to become rancid quickly, they are virtually stripped out of foods in our supermarkets in deference to long-lived but harmful fats including trans fatty acids and hydrogenated oils which have very long shelf lives: margarine, shortening and most commercial vegetable oils.

GSMC has carefully selected from the highest quality oils available on the market and have chosen Omega, Flora, or Efamol brands. We also use Cardiovascular Research, Allergy Research Group and Thorne Research brands for other selected oils. Freeze these oils until opened, then refrigerate after opened. If you take oils in gel caps, taste the contents of the caps weekly to be certain they are not rancid. Ingesting high quality oils is so critical that this is one instance where we ask you to use the specific products we recommend or their exact duplicates from another source. Taking poor quality, rancid or damaged oils will in fact promote inflammation.

Elevated levels of the pro-inflammatory PGE2 can be identified through EFA analysis, a blood test available at GSMC. Elevated PGE2 levels can be lowered in three ways. First, by correcting deficiencies of the nutrients Vitamin B3 and B6, zinc and magnesium which, when present in adequate amounts, limit the production of PGE2. Second, by limiting intake of eggs, beef, pork and shrimp as they are high is arachidonic acid which converts into PGE2. And third, by eating sesame oil or sesame seeds which can be effective in decreasing PGE2.

The optimal functioning of our cells depends on the ability of our cells to create energy. Using a car engine as an analogy, the presence of the spark of energy that occurs in an engine is critical to an engine’s performance and depends on the spark plug, the proper gap, delivery of the fuel from the carburetor, properly functioning valves, and timing. If any part of the energy production is not working right, your engine will miss and may stall or die. Similarly, each cell’s ability to make energy depends on optimal supply and timing of vitamins, minerals, fats, protein, carbohydrates, enzymes, neurotransmitters, and ultimately, the vital “spark” of energy produced from all of the above. Disruption of this “spark” of energy leads to the chronic illnesses of our modern world-heart disease, arthritis, hypertension, diabetes, etc.

Strive to address the following known factors which can disrupt the formation of that critical spark of energy :

  • the ingestion of harmful fats (especially trans fatty acids),
  • chronic infections (including dental) and infestations (parasites, etc), · nutritional deficiencies characteristic of modern Western diets,
  • heavy metal toxicity,
  • chronic alcohol ingestion and tobacco use, drug exposure (especially NSAIDs, steroids, and antibiotics)
  • chemical exposures including pesticides and solvents,
  • insufficient digestion,
  • malnutrition (notably sugar excess), and
  • chronic stress.

Reduction of inflammatory symptoms via nutritional intervention may take weeks to months as one replenishes EFA deficiencies.

In summary, NSAID use presents serious risks and inhibits the production of beneficial anti-inflammatory prostaglandins whose presence is critical to health. Identification and removal of the true causes of inflammation is the optimal therapy. EFA and adequate nutrient intake are two well tolerated and safe ways to naturally favor one’s internal anti-inflammatory pharmacy, as is the avoidance of less healthful altered fats such as hydrogenated oils (margarine and shortening) and commercially processed oils which interfere with the production of the spark of life itself.

Chronic Sinusitis

Monday, August 22nd, 2005

By John L. Wilson, Jr., M.D.

Sinuses are hollow cavities in facial bones that are connected to nasal passages by narrow tubes that allow drainage. Sinuses help moisten, filter and warm the air we breathe. Symptoms of sinusitis (inflammation of the sinuses) may include a feeling of pressure, congestion and pain in the face particularly when bending over, headaches often just above or below the eyes, bad breath, fatigue, fever, toothache in upper jaw, post nasal drip, cough, and colored thick nasal secretion. Sinusitis becomes chronic when it lasts longer than 12 weeks. Antibiotics are prescribed in 84% of physician visits for sinusitis. In addition, decongestants, antihistamines, pain relievers, expectorants, and surgery are commonly prescribed to help patients obtain relief of their symptoms in the 46 million physician-visits annually for sinusitis.

Sinuses are lined by mucous membranes that can be sensitive to environmental exposures, including chemicals, fumes, smoke, pollens, animal danders, dust, dust mites, molds, and changes in atmospheric pressure, humidity, and temperature. Once irritated, the lining produces mucous in an effort to separate the irritant from the mucous membrane. The tissues become inflamed and swell, resulting in blocking the drainage of mucous from the sinuses and the stage is set for infection to develop. Serial Dilution Endpoint Titration, a method of allergy skin testing, can identify such allergic triggers, and sublingual (under the tongue) allergy serum is used in place of allergy shots to desensitize to those allergens. Neural therapy, a German form of acupuncture, as well as traditional Chinese acupuncture can be used to reduce the swelling and congestion of sinus membranes. Irrigating the nose and sinuses with a weak saline solution can be soothing and helpful in easing reactions to environmental triggers such as mold and dust. Allow the saline solution to flow passively-never use forceful irrigation. Adding a weak anti-microbial silver solution or antifungal drug such as nystatin to the irrigating saline solution can be helpful.

A recent study by Mayo Clinic found that 93% of sinus infections are caused by fungal infections, which makes sense as fungus or mold prefers a moist, dark, unventilated environment. Treating a fungal infection with antibiotics, which kill bacteria, can actually make a fungal infection worse. Instead, addressing the sinusitis with a decrease in dietary sugar intake, environmental control of molds, and antifungal herbs or drugs may likely be more successful.

Both indoor and outdoor air pollution can contribute to sinusitis. So much is known and apparent in the media about outdoor air pollution, that the fact that indoor air is often more polluted than outdoor air is forgotten. Wherever chemical exposures come from, one’s exposure can often be determined by identifying one’s work or home exposures. Although avoidance is the preferred treatment to the problem of poor air quality, HEPA air filtration and masks can be very helpful when avoidance is not possible. Air filtration is especially important and effective in the bedroom where most people spend roughly a third of their lives.

Imbalances in the microbes living in the intestine (overgrowth of yeast or harmful bacteria, or lack of beneficial healthy bacteria) can also contribute to sinusitis by stressing the immune system. A stool test, Comprehensive Digestive Stool Analysis, identifies such imbalances. The use of antifungal herbs and drugs can be used when combined with dietary sugar reduction and other steps to improve the quality of the diet. Boosting the immune system with nutritional supplements such as Vitamin C, transfer factor, thymus, or herbs such as Echinacea, Goldenseal, or Astragalus can also be helpful.

One of the hidden causes of chronic sinus congestion is food allergy. Many people will develop sinus symptoms as a result of an allergic reaction to foods-especially dairy products, wheat, corn (including corn starch, corn sugars, etc), or yeast. Adverse reactions to foods are often “masked” so the sinusitis sufferer is clueless to what may be keeping them sick. Click on Elimination/Challenge Diagnostic Diet for a simple at-home method for testing food allergies.

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