Archive for the ‘Cancer’ Category

Benefits of Exercise

Posted on: December 1st, 2014 by Richard Malik No Comments

It is common wisdom that exercise is healthy. A few of the benefits of exercise include: reduced cardiovascular risk, reduced diabetes risk, prevention of several types of cancer, improved mood, and reduced risk of Alzheimer’s disease.

But, how much exercise at what intensity is most helpful? Simple, clear guidance on the benefits of exercise is difficult to find.

Fitness sport couple running jogging outside on trail

When assessing a patient’s cardiovascular risk, I like to use a global risk assessment calculator that factors in age, gender, cholesterol ratio, blood pressure, smoking status, and diabetes status. My favorite cardiovascular global risk assessment tool can determine the benefits of various treatments (including exercise, Mediterranean diet, or statin therapy) on cardiovascular risk. Unfortunately, in this calculator (which is better than any other I have seen) the effect of physical activity is absolute – “physical activity” reduces cardiovascular by about the same amount as statin therapy. But it can’t be this simplistic; physical activity once a week must be less effective than daily physical activity; running for an hour must have a different benefit than walking for an hour.

To help clarify the benefit of exercise on physical health, I asked my research assistant, Dakota, to summarize a recent systematic review on physical activity and mortality. He summarized the research like this:

  • People of all ages who are able to be physically active will have a reduced mortality rate of 14 to 26% by doing 150 to 300 min of moderate to vigorous physical activity a week, respectively.
  • Doing a certain amount of physical activity a week does not guarantee a longer life and does not reduce the negative affects of smoking or an unhealthy diet.
  • Studies show that the more vigorous the activity the more beneficial it is to the body.
  • Studies also show the more time spent doing physical activity per week the better as long as a healthy diet is maintained and nutrients are not depleted.
  • Physical activity is shown to reduce mortality substantially more in women than men.
  • As a strict relation of risk reduction per calories burned the results were greater than or equal to 10% risk reduction for 1500kcal/week in men and 650kcal/week in women.  Studies support the message that ‘some is good, more is better.’

So, to reduce mortality by about 26%, exercise for 300 minutes per week. Men should burn about 3,750 calories per week and women about 1,600 calories per week. My favorite way to assess calories burned is to use the Runmeter app on my iPhone – it can be used for walking, biking, hiking, or running. Just enter your weight into the app and it will calculate calories burned and help you keep track of your own benefits of exercise!

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Be well,

Richard Malik, ND

Naturopathic Medicine in Connecticut, Naturopathic Medicine in Vermont, Naturopathic Oncology in Vermont, Naturopathic Oncology in Connecticut

 

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Power Over Breast Cancer Risk

Posted on: November 16th, 2014 by Richard Malik No Comments

The National Comprehensive Cancer Network is an alliance of comprehensive cancer centers that establishes evidenced based guidelines for prevention, detection, risk reduction, and oncology treatment of all different types of malignancy. I was intrigued and happy to see a recent editorial in the Journal of the National Comprehensive Cancer Network that helps put into perspective the power of simple, daily lifestyle choices on the risk of getting breast cancer.

The editorial states:

  • “15% of overall breast cancer risk is attributable to weight gain in adulthood.”
  • “moderate physical activity is estimated to decrease breast cancer risk by 15% to 25%”
  • alcohol consumption increases the relative risk of breast cancer by about 50% “and this risk increases with increasing amounts.”
  • estrogen/progestin hormone replacement therapy has been shown to increase breast cancer risk by 25%

It also states that only 5% to 10% of all breast cancers are caused by inheritance.

Reducing risk of breast cancer can be straight-forward and manageable:

  • eat plenty of vegetables, fruits, and lean sources of protein.
  • exercise regularly – walking 60 to 90 minutes, using the stationary bicycle for 45 minutes, or jogging for 30 minutes a day is enough
  • maintain a healthy weight or use diet and exercise to achieve slow, but steady weight loss.
  • avoid alcohol.

11-29-2014 Sunrise

Be well,

Richard Malik, ND

Naturopathic Oncology in Connecticut and Vermont

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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

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Natural Therapies for Breast Cancer

Posted on: January 3rd, 2010 by doctor No Comments

When considering natural therapies for breast cancer, it is important to understand what medical or research-based evidence exists that shows which natural therapies are effective and for what circumstances.  While there are many claims made on packages and the internet about herbal formulas, special diets, or new-fangled technologies, the evidence for natural therapies that work to cure breast cancer on their own is paltry, at best.
However, natural medicine truly shines in supporting oncology patients so they have the best results through surgery, radiation, and chemotherapy.  The options to reduce adverse effects, improve outcomes, and help cancer patients feel well are diverse.  When used in this way, the goal of natural medicine is to support conventional treatment approaches without interfering its effectiveness and to address concerns as they arise; natural treatments are tailored for each individual set of circumstances.  Here are some examples of my favorite approaches.
Glutamine is an amino acid (protein building block) that high doses helps to improve recovery from surgery and helps prevent nausea, ulcerative lesions in the mouth and digestive tract, and neurological toxicity from some chemotherapy drugs.
Ginger is an excellent and safe way for chemotherapy patients to prevent nausea.  Using capsules, liquid herbal extracts or even lollipops made by a compounding pharmacist are options that support easy compliance for the patient.
Doxirubicin is a common chemotherapy drug that is used to treat breast cancer.  However, one of the most serious adverse effects of doxirubicin is toxicity to the heart.  Coenzyme Q10 and L-carnitine are nutritional supplements that have been shown in medical research to reduce doxirubicin related heart damage without interfering with the drugs ability to kill breast cancer cells.
Another common concern for oncology patients is maintaining their immune function and white blood cell status.  Some approaches that are promising in this area include maitake mushroom extracts, ginseng (a popular Asian herb), ashwaganda (an herb from India), and vitamin E supplementation.
It is clear that natural therapies have a supportive role in cancer treatment.  But, if not used wisely, natural medicine can have negative effects.  For example, studies show that the herb curcumin (turmeric) can decrease the cell-killing effects of some chemotherapy drugs like cyclophosphamide and doxirubicin (both are used in breast cancer treatment).  Other dietary supplements that may reduce chemotherapy effectiveness include coenzyme Q10, glutathione, and cysteine.  The most effective and safest way of using natural therapies is to consult with your oncologist and work with a qualified professional.

Be Well,
Richard

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Breast Cancer – Reducing Your Risk

Posted on: January 3rd, 2010 by doctor No Comments

In a previous article, I discussed the recent changes to mammography recommendations.  This week I’ll share what women can do to reduce their risk of breast cancer.

First of all, it is important to acknowledge that cancer statistics are very complicated; the most recent research study may have results that contradict the one before.  This explains why it is easy to get confused by the divergent information about cancer in the news media.  I will try to provide some clarity.

Put simply, being at a healthy weight significantly reduces the risk of dying from breast cancer.  Numerous medical studies indicate that maintaining a health weight (BMI between 20 and 25) is the most important lifestyle factor in affecting breast cancer survival.

The healthiest way of achieving optimal weight is to eat plenty of vegetables and fruits and to exercise regularly.  A 2007 study published in the Journal of Clinical Oncology indicates that breast cancer patients who eat these healthy foods and exercise reduce their risk of dying from their cancer by up to 50%.

While having a glass of wine every day seems to prevent cardiovascular disease and decreases the rate of death from all causes, this amount of alcohol seems to increase breast cancer risk.  If you are concerned about breast cancer because of your personal or family medical history, avoid alcohol.  If cardiovascular disease seems more important, a few glasses of wine can be an enjoyable and healthy choice.

Hormone therapy with estrogen and/or progesterone for menopause increases the risk of women getting breast cancer.  While the increased risk may be small, it is real: a 24% increase in risk.  Natural treatments for menopausal symptoms work well.  Some of the best therapies I recommend include herbs like black cohosh, chaste tree, and St. John’s Wort.  Preliminary research indicates that black cohosh can even be helpful as an add-on treatment for breast cancer.

One of vitamin D’s roles in the body is helping to make sure that cells grow to be healthy and mature.  Because dangerous cancer cells are immature, vitamin D status may be important in all forms of cancer, including breast.  The best way to know your vitamin D level is to get a test from your doctor called 25-OH Vitamin D.  Insufficiency is defined as less than 30ng/mL and optimal levels are about 45ng/mL.  If testing is not available to you, taking 2,000 IU of supplemental vitamin D3 each day is a safe approach.

Be well,
Richard Malik, ND

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Mammograms – When is the Right Time?

Posted on: January 3rd, 2010 by doctor No Comments

For women, breast cancer is the second most common cause of cancer and according to the Centers for Disease Control 41,000 women die each year from the disease.
Breast cancer has affected many women in every community in America.  Some women have themselves been diagnosed; but even when a relative or friend gets the news, it still can be a very personal experience for everyone involved: spouses, partners, children, parents, and friends.
Even for the health care community, breast cancer can be a very sensitive topic.  A recent article in the Journal of the American Medical Association encourages doctors and health care authorities to rethink cancer screening guidelines and the U.S. Preventive Services Task Force has actually changed mammography screening recommendations.  You may have heard about these changes on television news or in the New York Times.  The outcry from the media, legislators, and doctors has been substantial.
It certainly is a good time to take a careful and reasonable look at breast cancer issues.  This week, I will outline the screening recommendation changes and their reasons.  In following weeks, I will discuss approaches to breast cancer screening, prevention and treatment that make sense from a mainstream medical and naturopathic perspective.
With the changes in recommendations, no one is disputing whether mammography works for detecting early stage breast cancer; it does.  The concern is that all of the suspicious lumps found by mammogram result in many unnecessary biopsies and unnecessary worry  – at some point the cost outweighs the benefit.  According the best statistical evidence, for women 40-49 years old it takes screening almost 2,000 women to identify one cancer that would be helped by treatment.  For women 50-59 years old the number falls dramatically to about 1,300 women screened to identify one cancer helped by treatment.  For women 60-74 years old, the numbers get even lower.
The bottom line is that there are potential benefits and costs to any health care choice.  With the guidance of your physician, you get to choose the approach that makes sense to you; – every woman has different risk factors and concerns.
Next week, I will discuss prevention and other screening options.
Be well,
Richard Malik, ND

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Acai: Scam and Deception

Posted on: May 17th, 2009 by doctor No Comments

I am receiving so many junk mails about the AMAZING effects of Acai products.  In general, I am very skeptical when anything is advertised as a cure-all.  Acai certainly is marketed as an effective therapy for a vast number of health concerns.

Based upon my exposure to research from Acai manufacturers, the primary value of Acai is its high anti-oxidant activity.  ORAC (Oxygen Radical Absorbance Capacity) is one measure of antioxidant activity.

Promotional materials for Acai claim that the ORAC value of Acai is several times higher than other anti-oxidant rich foods.  As with all statistics and marketing, the devil is in the details.

According to one freeze-dried Acai supplement manufacturer, the ORAC value of 100 grams (about 3.3 ounces) of freeze-dried Acai is 5,500 ORAC or about twice that of 100 grams of blueberries.  That is very good.

However, this manufacturers supplement contains 1,000mg (one gram) of freeze-dried Acai per 2 capsules.  This provides an ORAC value of 55!  The ORAC value of one cup of blueberries is between 9,000 and 13,000 or equivalent to 260 servings of Acai freeze-dried supplement.

One $40 (discounted from $50!) of Acai supplement provides sixty 1,000mg servings of Acai.  In other words, $40 provides you with the anti-oxidants activity of 1/4 to 1/3 cup of blueberries.  

Bottom Line:

Anti-oxidants are very important and promote health, however you would get many times more anti-oxidant effect at a small fraction of the cost from eating some blueberries each day.

Be well,

Richard Malik, ND

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The 5 Best Foods

Posted on: May 17th, 2009 by doctor No Comments

A patient recently shared with me that she saw a nutritionist talk and he listed the what he thought were the five healthiest foods.  I can’t remember the whole list, but they included avocados, almonds, and eggs.  

I wouldn’t put these foods in my top 5 list because many people are sensitive to eggs and some are sensitive to tree nuts.  

Avocados are a vegetarian source of complete protein, high in fiber, and energy rich due to high amount of fat.  They contain a high amount of linoleic acid which your body primarily uses to make inflammatory fatty acids like arachidonic acid but also uses to make a generally anti-inflammatory fatty acid called Gamma Linolenic Acid (GLA).

Avocados are an excellent food and, for taste, one of my favorites.  But I wouldn’t call it one of the 5 healthiest foods.

So, even though I don’t like to list the 5 best foods (I think it is best and most fun to eat a large variety of healthy foods), I thought it would be a fun exercise to list my top 5.  Let’s see how it goes…

  1. Cruciferous Vegetables – I know, this is a group of vegetables, not a single food, but they provide excellent nutrition, support detoxifcation, and even appear to reduce the risk of some cancers.  If I had to pick one cruciferous vegetable as my favorite, the winner would be… kale.  Other cruciferous vegetables include many types of greens, broccoli, cabbage, bok choy, and cauliflower.
  2. Seasonal fruits are rich in health promoting fiber and essential nutrients.  Fruit that is in season is richest in nutrients AND tastiest.
  3. Fish rich in omega-3 fatty acids, but low in mercury like sardines and wild Alaskan salmon
  4. Water – clean and pure water is important for tissue function, digestion, delivery of nutrients, and detoxification (urine and sweat)
  5. Medicinal spices – spices are herbs that are more tasty than medicinal herbs, but have excellent effects on health.  Healthful spices include garlic (anti-cancer and anti-microbial), cilantro (supports detoxification), ginger (improves circulation, aids digestion, and anti-inflammatory), turmeric (anti-inflammatory and anti-cancer), Rosemary (mildly anti-inflammatory), Thyme (supports lung function and weakly anti-microbial)
Well, I didn’t do a very good job of recommending 5 foods – looks like I listed about 30.  Oh well.
Be well,
Richard Malik, ND
RSS makes it easy to subscribe to the Simply Well blog – just add the feed address (feed://maliknd.com/simply_well/?feed=rss2) to your RSS reader (your email program) and get updates automatically.

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Organic or Not Organic – That is the Question

Posted on: April 7th, 2009 by doctor No Comments

Many people think that “organic food” is synonymous with “health food.”  This is not true.  Organic candy bars are almost as bad for your health as normal candy bars.  Eating a lot of organic sugar still helps people gain weight and obesity is a cause of most of our health concerns, including heart disease, cancer, and diabetes.  Basically, organic junk food is still junk food.

But, what is the difference between organic and inorganic produce.  Some people can’t afford to shop for organic produce.  For them, it is still important to buy healthy conventionally grown food because it is the next best thing.  Others can afford to buy some of their family’s groceries from the organic sections of their grocery store.

Here is some information to help you make the best decision.

EWG Shopper's Guide

EWG Shopper

First of all, let me be clear that organic produce is healthier than conventionally grown produce.  Research does show that organic produce tends to be more nutrient rich and tastier than conventionally grown produce.  Organic produce also tends to have lower amounts of residual toxic pesticides and herbicides.  From an ecological perspective, organic foods also tend to be grown with agricultural methods that are healthier for the ecosystem.  There are plenty of reasons to buy organic if you can afford it.

The Environmental Working Group has recently updated their list of the most and least heavily pesticided produce.  They calculated the amount of pesticides people would be exposed to when normally consuming these foods (oranges and bananas are peeled while apples and pears are washed and eaten with the skin).

If your budget is tight, only buy the organic produce that helps you avoid the greatest amounts of pesticides and herbicides.   This information will help you maximize the healthy effects of every dollar of your grocery budget.

Be Well,

Richard

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Getting the Right Blood Tests for Inflammation and Cardiovascular Risk

Posted on: April 6th, 2009 by doctor No Comments

I have seen several patients recently that simply had the wrong tests ordered by their MDs when assessing inflammation or cardiovascular risk. To prevent these testing errors, I encourage patients to better understand these tests and make sure their doctors are ordering the right ones.

A common test for inflammation is the Eosinophil Sedimentation Rate (ESR).  It measures the tendency of red blood cells to clump together – rouleaux or stacking formation.  This test is still offered by laboratories only because doctors not familiar with newer and superior tests still request it.  ESR tests can provide inaccurate results (false positives or false negatives) for many different reasons.

C-Reactive Protein (C-RP) directly measures a liver enzyme that is an acute phase reactant.  This enzymes rises quickly when inflammation is present and falls quickly when inflammation resolves.  Therefore, it is an excellent marker of inflammation; better than the ESR which is more likely to be falsely positive or stay elevated after inflammation has resolved.  It is the best blood test to help determine if a patient’s symptoms are due to trauma, injury, infection, auto-immune reactions, or cancer.

High Sensitivity C-Reactive Protein has many acronyms (HS-CRP, CRPHS, or Cardio C-RP).  It is a test that provides an assessment of an individual’s cardiovascular risk that is independent of other measures like total cholesterol, HDL cholesterol, or homocysteine.  HS-CRP measures a person’s baseline levels of inflammation and has been found to be an independent risk factor for cardiovascular disease because the formation of arterial plaques and clots that cause myocardial infarction and ischemic strokes are encouraged by chronic states of low-grade inflammation.  While high sensitivity C-RP is a good measure of risk of heart attack or stroke, it is not a test to assess inflammation from trauma, injury, infection, or auto-immune disease.  Frequently, this test is selected for patients when the normal C-RP is the right test.  I think this happens because clinicians are assuming that the “high sensitivity” test must be better than the normal test.

Be well,

Richard

RSS makes it easy to subscribe to the Simply Well blog – just add the feed address (feed://maliknd.com/simply_well/?feed=rss2) to your RSS reader (your email program) and get updates automatically.

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