July 2009

Red Yeast Rice: A Natural Way to Lower Cholesterol

Red yeast rice, a product used in China, is made by fermenting a type of red yeast called “Monascus purpureus” over rice.It has been found to reduce cholesterol when used as a supplement.

A recent study [Ann Intern Med. 2009; 150(12):830-9, W147-9 (ISSN: 1539-3704)] examined 62 people with elevated LDL cholesterol and put them on a 12-week lifestyle program. Half of the participants took 600 mgs of red yeast rice daily and the other half took placebo. After 6 months the treatment group lowered their LDL cholesterol by 35 mg/dl compared to 15 mg/dl in the control group.The side-effect profile was the same in both groups.

Red yeast rice is basically a natural statin drug. If you decide to try it, it is important that you let your doctor know, because your liver enzymes and muscle enzyme should be checked at regular intervals when you start therapy. It is encouraging that those taking the red yeast rice did not have muscle pain as a side effect and that it was relatively safe to use. Therefore, it may be a good alternative for you if the statin drugs caused muscle pain and damage.

It is important to point out, however, that natural does not always mean it is safe. It is still a drug and it is important to look at it that way.I also think it is important to take it with at least 100 mgs of Coenzyme Q10 which has been found to protect muscle. As far as which brand to use, that is a tough one.There is no regulation over supplements. I advise my patients to look for brands that have “GMP” on the label. That is used when companies comply with good manufacturing practice, a standard that is set by the FDA.

Reflux Rebound

According to a new study in the journal Gastroenterology (Gastroenterology 2009 Jul; 137:80), the recurrence of symptoms can be a problem when you stop certain medications used for acid reflux or indigestion. This is known as symptom rebound. Prior studies have shown that when using the medications known as “proton pump inhibitors” (PPIs) to treat reflux, stopping these drugs can cause the acid-making cells in the stomach to go into high gear and make too much stomach acid, thus causing the original symptoms to reappear quickly. Examples of some of the PPIs include Nexium, Prilosec, and Prevacid.

In the above-mentioned study published this month, 120 volunteers who had no history of, or recent symptoms of, acid reflux, were divided into two groups, one group receiving  12 weeks of a placebo, and the other group receiving 8 weeks of a PPI followed by 4 weeks of a placebo. Neither the volunteers nor the researchers knew which group was on which regimen; this is known as a double-blind study. For the first 8 weeks, neither group had much in the way of symptoms. However, after going on a placebo after 8 weeks of treatment with a PPI, this group had significantly more symptoms of heartburn and reflux than did the group that had been on placebo the entire time, showing again that stopping PPIs leads initially to increased stomach acid production.

This is significant for a couple of reasons. One reason is that if you have been placed on a PPI to treat indigestion symptoms, you should expect to have an initial increase in symptoms right after you stop it. This is a temporary thing and should be treated with antacids.

The other reason this is important is that many of us buy over-the-counter (OTC) Prilosec or Prevacid and take it for only a short time or pop it when we think we need it. Then when we stop the medication, the symptoms return and may even seem worse. We then start the PPI again, stopping it when the symptoms are relieved, and on goes the vicious cycle. It is important to know that this does happen with PPIs and that it is temporary. Taking some antacids for a few days should relieve it.

Better yet – don’t take OTC meds, such as PPIs, willy-nilly!  Start with simple things to relieve your reflux symptoms: raise the head of your bed; take off those tight pantyhose; lose some weight; and use antacids first.

Celiac Disease: The New “IT” Disease of the 21st Century

You may be hearing or reading a lot about Celiac Disease recently. Several celebrities have it and have been talking about it, and it seems to be all over the news.The results of a recent Mayo Clinic study have found that celiac disease is four times more common today than it was in the 1950’s (see reference below).

Celiac disease is a hereditary condition that is caused by an intolerance of gluten.This is a wheat protein. If a celiac patient is exposed to gluten it causes inflammation and destruction of the lining of the small intestine. This leads to malnutrition.

Symptoms can include:

* abdominal bloating and pain
* chronic diarrhea
* vomiting
* constipation
* pale, foul-smelling, or fatty stool
* weight loss
* unexplained iron-deficiency anemia
* fatigue
* bone or joint pain
* arthritis
* bone loss or osteoporosis
* depression or anxiety
* tingling numbness in the hands and feet
* seizures
* missed menstrual periods
* infertility or recurrent miscarriage
* canker sores inside the mouth
* an itchy skin rash called dermatitis herpetiformis

Although these symptoms can be a part of other diseases of the gastrointestinal track, the diagnosis of celiac disease is relatively easy to make with a series of blood tests. The treatment sounds easy, but it can be tough to stick to. A celiac patient must avoid gluten. When they do, the small intestine can heal and the symptoms abate.The problem is that gluten is in a lot of foods. It can be found as filler in medications and is commonly used in lip balms.

If you have many of the above symptoms, it would be a good idea to get checked out. Treating celiac disease early can help to avoid a lot of problems and the fix is pretty simple (well, sort of!)

Reference:

“Increased Prevalence and Mortality in Undiagnosed Celiac Disease.”
Alberto Rubio-Tapia, Robert A. Kyle, Edward L. Kaplan, Dwight R. Johnson, William Page, Frederick Erdtmann, Tricia L. Brantner, W. Ray Kim, Tara K. Phelps, Brian D. Lahr, Alan R. Zinsmeister, L. Joseph Melton, Joseph A. Murray.

Has CPR Improved Survival After a Cardiac Arrest?

CPR outcomes have not changed for hospital patients.

A recent study has found that the chance of survival after cardiac arrest and CPR in the hospital is about 18%. This rate of survival hasn’t changed over the last decade. One would think that being in a hospital should improve the chance of surviving but it has not. Men, older patients and those from a nursing home had an even lower chance of survival. African Americans had a lower survival rate when compared to Caucasians.

Outpatient rates of survival after CPR have improved substantially; it is time for the hospitals to catch up. These rates beg the bigger question, however. Shouldn’t we be focusing on preventing the underlying diseases that result in cardiac arrest? It is time to push for changes in lifestyle that include diet and exercise. Preventive exams are all essential to catch and treat problems before they result in serious disease.

Don’t Take All Those Vitamin Supplements!

Remember back a few years when you used to walk out of the medical office with recommendations to take a whole handful of vitamins? I remember emphasizing to my patients how important  it was to at least take daily doses of Vitamin C and Vitamin E for their antioxidant effects and to prevent heart disease.

Then the studies came out showing that these two vitamins did nothing to prevent heart disease, and along with this came recommendations that taking these vitamins as supplements was not necessary.

Now it appears that taking those two vitamins regularly may have some unexpected negative effects.

A recent study in the May issue of the National Academy of Science Proceedings USA (Proc Natl Acad Sci U S A 2009 May 26; 106:8665) showed that Vitamins C and E actually may block some of the beneficial effects of exercise. That’s right – you can be exercising regularly and not getting the good physiological effects of it if you are taking these vitamins.

This study should do away with what many people think: that though vitamins may not help the body, they certainly can’t hurt. Now we know that they can.

So, back to our usual mantra: discuss with your primary care clinician what supplements you really need to be taking; eat nutritiously; exercise regularly; and stop taking unnecessary vitamins!

Hormone Therapy May Help to Prevent Colon Cancer

We’ve all heard that hormone replacement therapy (HRT) with Premarin and Provera has been found to increase the risk of breast cancer, and increase the risk of heart attack and stroke. However, there may be some good news about HRT. In a study that has been ongoing since 1986, doctors at the Mayo Clinic have found that HRT reduced the risk of colon cancer by 28%. Another study done at City of Hope Hospital found that HRT reduced the risk of colon cancer by 27%. We also know that HRT reduces the risk of fracture due to osteoporosis by as much as 38%.

When considering hormone therapy,most important for you to know are your risks for common adult diseases and conditions. If you are a person who is at more risk for colon cancer or for osteoporosis than for heart disease, stroke, or breast cancer, then you might want to discuss taking HRT with your doctor. Also remember that those studies showing that HRT increases the risk of heart disease, stroke, and breast cancer were done using Premarin and Provera only. There are other, potentially safer, options for HRT using more natural compounds of the hormones.

The North American Menopause Society just this month updated its position statement on the use of HRT in postmenopausal women which is in keeping with the above. They say that recent data support the initiation of HRT around the time of menopause to treat menopause-related symptoms; to treat or reduce the risk of certain disorders, such as osteoporosis or fracture in certain women; or both. They also say that the benefits of HRT right at the time of menopause outweigh the risks; but that the benefits of HRT decrease (and the risks increase) with aging and with the length of time since menopause began.

Bottom line: Consider the use of HRT right at the time of menopause for certain indications, but do not stay on them indefinitely (or greater than 5 years); also, the further in time you are away from the start of your menopause, the more risk there is in starting HRT.

Speak Up – It Could Save Your Life

When it comes to your doctor’s office and your test results, it’s time to rethink the old adage, “No News is Good News.”   

A recent study published in the June 22 issue of the Archives of Internal Medicine revealed distressing findings concerning this commonly used saying. The authors of this study reviewed 5.434 randomly selected charts of patients between the ages of 50 and 69 in twenty-three primary care offices. Out of 1,889 abnormal test results, they found 135 apparent failures in informing the patient of the abnormality, or in documenting in the medical record that the patient was informed. That’s 1 out of every 14 abnormal tests, or 1 out of 14 patients who was not told of abnormal test results!

Interestingly, in this study,those offices that had electronic medical records did no better than those with paper charts. This makes sense because the problem is usually due to the lack of a system to inform patients of abnormal lab results, not the type of medical records used. In fact, the offices that had the highest failure rates used a combination of electronic medical records and paper charts, rather than solely one type or the other.

Yes, this is just one study. And we always tell you that before you can draw conclusions about results in medical studies, the findings need to be repeated in many well-designed studies. However, those words of wisdom don’t give us much comfort in this particular instance because if you are the one patient that doesn’t receive notification of your abnormal lab results in a timely manner, it could literally be bad for your health. Disastrous, in fact.

So what’s the message you should take home from this study? If you haven’t heard from your doctor’s office – either via a phone call or a written report – within several weeks of taking medical tests, CALL (or email if that is the mode of communication your doctor prefers). These medical tests include bloodwork, Pap smears and mammograms, among others. And if the medical test results will determine your treatment, such as urine or throat culture, don’t wait several weeks, CALL two-three days after having the test done.

Yes, doctors and other primary care clinicians are overwhelmingly busy these days, as are their office staffs. And though many offices do have a system in place in notify patients of  lab results, others – as seen in this study – do not.  And yes, they may get snappy with you, or even repeat the saying that you would’ve been called if there was a problem. But pay no mind that. JUST GET YOUR RESULTS.

Don’t be shy – speak up. It could save your life.

Have a Happy and SAFE Holiday/Summer Weekend!

For some tips on enjoying this summer weekend safely, please reread our June blogs.

For our readers in the U.S., have a wonderful July 4th weekend; for our readers in other countries, enjoy this midsummer weekend!

J&R

 

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