Archive for the ‘Menopause’ 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

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Does Vitamin D Improve Depression?

Posted on: May 14th, 2011 by doctor No Comments

A recent study published in the British Journal of Psychiatry finds that vitamin D supplementation does not improve symptoms of in women older than 70.  The researches identified women who had vitamin D deficiency and gave them 500,000 IU of vitamin D one time each year for three to five years.  Hmmm.  This is an unusual vitamin D dosing regimen.

In my experience, providing 5,000 IU vitamin per day, every day, for adult patients is a safe way of maintaining optimal vitamin D status – using less than 4,000 IU does not usually work.  In my clinic, this approach has been a part of a successful program for improving depression in patients with vitamin D insufficiency or deficiency.  This means taking almost 1,800,000 IU of vitamin D per year – much more than what was provided in this study.

According to the Institute of Medicine, 4,000 IU of vitamin D is the upper intake limit for universal safety in people older than 9 years old.  At this level of intake, the annual dosage of vitamin D is 1,460,000 IU – again, much more than the 500,000 IU used in this study.

Honestly, I don’t know if randomized control trials will end up showing that vitamin D supplementation prevents or treats depression.  However, providing one third of the usual annual dose to maintain vitamin D sufficiency is not a very good way to assess the effectiveness of vitamin D for depression.  Providing that dosage all at once makes even less sense.

This is an example of how the results of research and the headlines may not provide an accurate assessment of the question that is trying to be answered.

Be Well,

Richard Malik, ND

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Proton Pump Inhibitors and Fracture Risk

Posted on: May 14th, 2011 by doctor No Comments

A recent article in the New York Times reports on research that links long-term Proton Pump Inhibitors (PPIs) with a 30% increased risk of bone fractures.  According to the article, the long-term use of PPIs may decrease absorption of calcium in the intestines.

PPIs reduce the acidity in the stomach in order to reduce symptoms of heartburn.  While this is an effective approach for reducing the burning pain caused by the regurgitation of stomach acid into the esophagus, lowered acidity in the stomach decreases the absorption of some nutrients – including calcium – and increases the chances of getting several types of infection including infections of the digestive tract and lung.

Some forms of calcium do not require stomach acid in order to be absorbed.  These forms include calcium citrate and calcium citrate/malate.  When taking PPIs or other antacid medicines, it is a good idea to supplement calcium intake with these forms of calcium especially if you are at increased risk of osteoporosis or of fracture.

The only drawback of calcium citrate and calcium citrate/malate is that these forms of calcium are very bulky – capsules usually contain only 150mg of calcium.  This means that the usually recommended dosage is 5 to 10 capsules per day.

Ensuring healthy vitamin D status is also very important for calcium absorption.

For more information on addressing osteoporosis, read my previous blog post on osteoporosis.

Other nutrients whose absorption can be decreased by acid lowering medications include magnesium and vitamin B-12.

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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More Vitamin D News

Posted on: March 3rd, 2009 by doctor No Comments

Published on February 23rd, 2009 in the Archives of Internal Medicine, a very large study with 18,000 participants found that the people with lowest serum vitamin D levels (based on 25-OH Vitamin D testing as mentioned in the last post) were 36% more likely to get an upper respiratory tract infection than people with the highest (but safe) levels of serum vitamin D.

Another similar study from August of 2008 published in the same journal showed a 26% reduced risk of death (all-cause mortality) in people with the highest (but safe) vitamin D levels when compared to people with the lowest vitamin D levels.

Vitamin D deficiency is epidemic in northern latitudes, with 50% of some populations being clinically deficient.

Vitamin D acts like a hormone in the body – it regulates calcium metabolism (addressing osteoporosis), affects blood pressure (lowering effect), improves mood (likely by increasing levels of important neurotransmitters), and affects immune function (useful for colds, prevention of allergies in newborns, and possibly auto-immune disease).

Click HERE to get the best available vitamin D or go to my Holistic Pharmacy to find the best nutrients, herbs and supplements available.

Be Well,

Richard

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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 doctor@maliknd.com.

This post is a reprint of another blog posting.

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