Archive for the ‘Reproductive’ Category

Top 5 Recommendations for your Family Doctor

Posted on: May 31st, 2011 by doctor No Comments

According to the National Physicians Alliance, the 5 steps your family doctor can take to most likely improve the quality of care you and your family receive are:

  1. DON”T do x-ray, MRI, or CT imaging for low back pain within the first 6 weeks unless red flags exist for other serious conditions that present with low back pain.  Low back pain in the 5th most common reason for a visit to the doctor.
  2. DON’T prescribe antibiotics for most cases of sinusitis unless severe, and symptoms of colored nasal discharge, facial pain, or dental pain last 7 or more days.  Most cases of sinusitis seen in clinics are due to viral infections that will resolve on their own.  Still, antibiotics are prescribed for 80% of these patients.
  3. DON’T order electrocardiogram (also known as EKG or ECG) for patients without cardiac problems or at high risk of cardiac problems.  Without symptoms or being at high-risk, EKG testing is likely to cause more problems than it is likely to help.
  4. DON’T perform Pap tests for patients younger than 21 years (most abnormal results resolve on their own) or women with a hysterectomy without a medical history of cancer of the reproductive organs.
  5. DON’T use bone mineral density testing to screen for osteoporosis in women younger than 65 year or men younger than 70 years unless there is another medical condition that increases the risk of osteoporosis.  Bone mineral density results have surprisingly little ability to identify a patient’s risk of fractures if the patient does not have a history of fragility fracture.
Being an educated patient and discussing your concerns with your doctor is the best way to ensure you get the best quality care possible.  By avoiding unnecessary procedures and treatments you are less likely to experience adverse effects and help to keep health care costs down for everyone.
Be well,
Richard Malik, ND

Podcast on Vaginitis

Posted on: April 5th, 2009 by doctor No Comments

Vaginal itching, irritation, pain, or discharge are common concerns for women. Many cases of vaginal irritation and inflammation are due to infection with fungal, bacterial or parasitic organisms. My most recent podcast explains these concerns, helps you know when you should see your gynecologist, and provides specific suggestions that are often curative and can be used at home. You can listen to it in iTunes or in your web browser. Enjoy.

Be well,

Easily subscribe to the Simply Well Podcast in iTunes.


RSS makes it easy to subscribe to the Simply Well Podcast – just add the feed address (feed:// to your browser or email program and get new episodes automatically.

Vitamin C & Pregnancy – Is there a Risk?

Posted on: January 27th, 2009 by doctor No Comments

A patient recently questioned me on the amount of vitamin C that was in her multi-vitamin (500mg per day).  She heard from her midwife that vitamin C supplementation should be kept down to just the recommended daily allowance (65-80mg per day depending upon age and if pregnant) because it can cause miscarriage or birth defects.

I never heard such a thing and decided to double check.  

First of all, 500mg of vitamin C per day can be obtained by drinking 1 glass of orange juice, eating 1/2 cup of sweet red peppers, and two tomatoes.  I don’t think anyone would call this combination toxic to a fetus.

Secondly, the recommended daily allowance for vitamin C is determined by the amount needed to prevent scurvy – far from an optimal health goal.

Thirdly, the tolerable upper intake limit as established by Food and Nutrition Board of the United States Institute of Medicine is 2,000mg per day for an adult.  This level is established to prevent loose stools – if you take more vitamin C than your digestive system can absorb it causes osmotic diarrhea (caused by the unabsorbed vitamin C drawing water out of the body and into the bowel).

Fourth, there is no clear evidence that vitamin C causes any adverse effects that are commonly attributed to it including: kidney stones, genetic mutations, birth defects, atherosclerosis, rebound scurvy, or oxidative stress.

I have seen many patients benefit from vitamin C supplementation of about 2,000mg to 3,000mg per day, for brief or extended periods of time.  While I don’t think that everyone needs to take that much every day, these doses are safe (as long as loose stools don’t occur) and therapeutically effective for a number of health concerns.

The Bottom Line:

Taking 500mg of vitamin C per day is a safe dosage for women even if they are pregnant or breast feeding.

Be Well,


Women of Child Bearing Age & Folic Acid

Posted on: January 12th, 2009 by doctor No Comments

From a recent Centers for Disease Control report, most women from the ages of 18-24 are not aware of the importance of folic acid supplementation and do not supplement with folic acid. According to the report “Because women from this age group account for nearly one third of all births in the United States, promotion of folic acid consumption should be targeted to this population.”

Folic acid is a vitamin that reduces the risk of a serious birth defects of the brain and the spine called neural tube defects. The recommended consumption of folic acid is 400 micrograms per day for women of child-bearing age. The Recommended Daily Allowance (RDA) increases in pregnancy and breast feeding.

Some foods rich in folic acid include enriched breakfast cereal, orange juice, spinach, asparagus, lentils, and garbanzo beans.

Besides for the prevention of neural tube defects, folic acid is also used to lower cardiovascular risk (when deficient, prevention of cancer of the gastrointestinal tract, and gingivitis. Adequate levels of folic acid may also protect against breast cancer and help with depression.

For more information on nutrients that are commonly deficient in American diets, listen to my podcast called Response to Reader’s Digest Article on Supplements through iTunes or your Web Browser.

Hypothyroidism: Many Symptoms, One Disease

Posted on: January 1st, 2009 by doctor No Comments

If you have been experiencing persistent fatigue or sadness, it may be more complicated than simply shifting your attitude or pulling yourself up by your bootstraps.  Fatigue and depression (and many other problems) may be signs of a physical medical condition: hypothyroidism – a decrease in the function of the thyroid gland that results in lower levels of thyroid hormone throughout the body.  It may even be possible to have low thyroid function while blood test interpretations say that all is normal.

Thyroid hormone is produced by the thyroid gland; a subtle butterfly shaped gland found in the neck below the Adam’s apple and on either side of the trachea.  Thyroid hormone is important to many parts of the body.  It sends a message to cells in the body to increase activity, function, and energy consumption.  The more thyroid hormone that is present, the faster body systems and organs will run.  It is possible to have too much (hyperthyroidism) or too little thyroid hormone (hypothyroidism).

Effects of Low Thyroid Function:

The symptoms of low thyroid function are diverse and vary considerably from person to person.  The manifestations of hypothyroidism can be vague or subtle, slowly getting worse over months or years.  Patients with hypothyroidism often experience some of the following symptoms: fatigue, depression, poor memory, unclear thinking, low body temperature, cold hands and feet, sensitivity to cold, dry skin, constipation, frequent infections, weight gain, premenstrual syndrome, or hoarseness.

Having hypothyroidism is also associated with several medical conditions; low thyroid function can cause or contribute to infertility, menstrual irregularities, elevated cholesterol levels, atherosclerosis, heart disease, anemia, and carpel tunnel syndrome.

Diagnosis and Treatment:

Thyroid function is first assessed by checking a hormone that tells the thyroid gland to make more hormone, thyroid stimulating hormone or TSH.  Elevated TSH levels are a sign of low thyroid function while low TSH levels are indicative of hyperthyroidism.

The predominant medical view is that in the absence of elevated TSH, hypothyroidism cannot be diagnosed.  However, the possibility of hypothyroidism that is not detected by current lab tests and current standards does exist.  The standards for normal thyroid function have changed over the years and some endocrinologists believe that current standards miss many patients suffering from low thyroid function.  

The easiest treatment for hypothyroidism is supplementation with synthetic or animal derived thyroid hormone.  Improvement in symptoms usually takes as little as a few days or as long as six months.  However, excessive thyroid hormone replacement can cause high levels of thyroid in the body – hyperthyroidism – and result in anxiety, insomnia, palpitations, chest tightness, diarrhea, and osteoporosis.  So, thyroid hormone should be used carefully and with medical supervision – appropriate diagnosis and monitoring are important.

Addressing the Cause:

Iodine used to be a common cause of hypothyroidism.  Today, in our society iodine deficiency is rare.  Conversely, very high doses of iodine can cause hypothyroidism in as short as a few weeks and long term high daily intake seems to increase the risk of hypothyroidism over the years.

In today’s medical practice, hypothyroidism is most commonly caused by one of two issues: 1) an auto-immune attack on the thyroid gland; or 2) the thyroid gland puttering out – not functioning as well as is should or used to.  In either case, supplementation with thyroid hormone is helpful.

While the medical literature states that the causes of both types of hypothyroidism are unknown, there are numerous drugs and chemicals that are definitively known to cause auto-immunity or to hamper thyroid function.  Some of these substances include: food coloring; mercury; numerous solvents; and even some prescription drugs.  Some chemicals contribute to low thyroid hormone levels by increasing the liver’s breakdown of thyroid hormone.

Avoidance of these harmful substances and enhancing the body’s ability to get rid of them can be helpful.  Selenium (200 mcg daily); zinc (15 mg daily); iron (18 mg daily in absence of high iron levels); and the amino acid cysteine help the body make thyroid hormone and convert it to its most active form.  Cysteine is also important anti-oxidant that helps the body handle toxic chemicals and heavy metals.

Other supportive natural therapies include the far eastern Indian herbs ashwaganda and bacopa which support thyroid function and the action of thyroid hormone throughout the body.  Some patients benefit from supplementation with food grade thyroid gland products that supplement thyroid hormone levels.

While hypothyroidism can sneak up on people, accurate diagnosis and treatment often helps to relieve the symptoms and provides dramatic improvement quality of life.

Are bio-identical hormones safe?

Posted on: December 30th, 2008 by doctor No Comments

Many natural healthcare providers work with natural or bio-identical hormones claiming they are safer than common prescription hormones.  Prescription estrogen (also called conjugated estrogens) is obtained from the urine of mares.  Bio-identical estrogens are molecularly the same as human estrogen but are synthesized in laboratories from soy or wild yams.

Progestins are drugs that act like progesterone in the body.  These drugs are patented molecules that do not occur in nature.  They are not progesterone, but they do stimulate progesterone receptors in the body.

Many women experience dramatic improvements in their menopausal symptoms when taking either conjugated or bio-identical hormones.  But, are they safe?

Recent medical studies indicate that conjugated estrogens increase the risk of blood clots and other cardiovascular events like heart attacks and strokes.  They also show that conjugated estrogens (only) when combined with progestins increase the risks of some types of cancer.

The scientific research seems to indicate that bio-identical hormones do not cause the cardiovascular risks that are associated with conjugated estrogens or at the very least do so at a much lower rate.  Here are a couple of studies that show this (12).

What about cancer?  Based upon our best research, conjugated estrogens don’t increase the risk of cancer.  I am not aware of any data or scientific studies that allows us to make the same judgement about bio-identical estrogen.

Here are the important points:

1) conjugated estrogens increase the risk of heart disease, blood clots and strokes

2) bio-identical estrogen does not seem to increase the risk of heart disease, blood clots or strokes.  But, more research needs to be done in this regard.

3) conjugated estrogens do not seem to increase the risk of cancer

4) conjugated estrogens when taken with progestins increase the risk of some types of cancer

5) we do not know the effects of taking bio-identical estrogen alone on cancer risk

6) we do not know the effects of taking bio-identical estrogen in combination with bio-identical progesterone on cancer risk

As a patient, it is important that you know what risks you are taking when choosing whether or not to take hormones for menopausal symptoms.  It is also important to know what questions remain unanswered.  You have the right to make decisions that make sense to you.

If you are aware of any medical research showing the effects of bio-identical estrogens on cancer risk, please forward them to me at

This post is a reprint of another blog posting.

Vitamin D & Babies – A Mother’s Question

Posted on: December 29th, 2008 by doctor No Comments

A patient with a newborn recently asked if her child needed vitamin D supplementation.  Her infant’s pediatrician suggested it, but she is reluctant.TheAmerican Academy of Pediatrics recommends that infants receive 200 IU per day of vitamin D supplementation if breast-feeding because vitamin D in breast milk is typically low.   

Breast milk commonly contains only 25 IU of vitamin D per liter.  A liter is equal to about 4 cups – most mom’s know that there is no way they can produce 8 liters (32 cups) of breast milk each day for their newborn to provide the recommended 200 IU per day of vitamin D!  

With these facts in mind, infant supplementation with vitamin D makes sense.  But is that the end of the story?

According to research cited by the Canadian Pediatric Society, when mothers are supplemented with 4,000 IU per day, infants get plenty of vitamin D from breast milk.

To me, it seems to make sense that mothers are replete with vitamin D prior to supplementing breast-feeding infants with vitamin D.  This way vitamin D deficiency is prevented in both mothers and their infants.

How much is 4,000 IU of vitamin D?  It is more than the upper intake limit set by the Institute of Medicine that sets RDA standards.  4,000 IU of vitamin D is less several times less than the amount of vitamin D that your skin makes when exposed to summer sun for a few minutes.

If there is a concern about vitamin D toxicity, ask your doctor to test your levels.  The test is easy and very accurate.

Richard Malik is a naturopathic doctor with a practice in Lakeville, CT.  To find out more about his practice or read more of his articles on health and wellness,

This post is a reprint from another blog posting.

Go to top