INFOGRAPHIC: “MEDICAID PHARMACY BENEFITS IN U.S.”
Category Archives: Medicine
DR. C’S MEDICINE CABINET: “B-COMPLEX VITAMINS”
The Idea that lack of certain nutritional factors could cause disease predates the germ theory by hundreds of years. British sailors could be saved from the ravages of SCURVY by a little sour fruit, and were called LIMEYS. Just before the first World War, a “milk factor” was found to be contained in butterfat, and was called Vitamin A.
The factor in “rice polishings”, known for decades to prevent disease caused by a diet exclusively of white, or “polished”rice was called Vitamin B.
Thus the Lettering system of vitamin-naming began. It wasn’t known until just before the Second World War that “vitamin B” was in fact several different substances (B1. B2. etc.), and later yet until these factors were found to be small, non-protein molecules that were “cofactors” in important enzymatic reactions essential in the body.
The metabolic pathways of our Hunter-gatherer ancestors could depend on the DIVERSE FOOD sources of Paleolithic man to supply these vital substances. Therefore, the body did not need to synthesize them, saving energy, but paving the way for future problems.
As a group, B vitamins produce energy from nutrients, support immune function, regulate cell growth, maintain Myelin, and maintain RBCs, among other crucially important things.
Some substances used to be considered B Vitamins, were later found to be synthesized in our bodies: these include Choline, Carnitine, Lipoic acid and PABA.
The latter is essential to Bacteria, leading to the development of the Sulfa Drugs, which Block PABA synthesis. Another pair of substances are so widely present in foods as to be rarely deficient: B5, Pantothenic acid, and B7, Biotin.
Three important, essential B Vitamins, B6, Pyridoxine, B9, Folic acid, and B12, Cyanocobalamin are so intertwined in their effects, they are best considered a unit. For instance, if B9 is supplemented while B12 is deficient, severe neurological problems arise. B6,9 and 12 must be kept balanced.
That leaves B1,B2, and B3, Thiamine, Riboflavin, and Niacin. Thiamine and Niacin deficiencies used to be common, especially when white rice and white flour replaced the more common brown variety, and led to Beri-Beri and Pellagra respectively.
My own Medicine Cabinet used to have the enriched B-vitamins, called B50 and B100 at Trader Joes. To cut down on pills, I switched to a multivitamin rich in most B vitamins. With the additional 4 mg. of Folic acid, I now take 1000% of the MDR of B6, B9 and B12, which I explained in a previous post to be driven by my elevated Homocysteine.
The Medical establishment and much research demeans the “health food nuts” as doing little more than making their toilets healthier. Indeed, research on Vitamin E supplementation has shown to cause cancer, Vitamin D supplementation to be useless, and folic acid supplementation to be potentially bad. Vitamin C supplementation does nothing but increase the likelihood of Kidney stones, etc.
The experiments are performed, and MDRs calculated on GROUPS of people, however, and with the INDIVIDUAL VARIATION in metabolism, with AGING of the human body (research on nutrients rarely includes the Elderly), and the lousy fast foods of the modern diet, I will continue with my supplementation.
In 2 of the vitamins, D and folic acid, B9, I am on firm ground, having blood levels of 25 hydroxy Vitamin D, and Homocysteine respectively to give me a frame of reference.
The truth is that the medical profession is poorly educated in nutrition, has little incentive to improve their knowledge, and has scant spare time to take dietary histories even if they knew more.
Even in the 60s when I routinely had my Patients keep a “diet diary” so I knew what they were eating, most doctors did not think this worth the time.
Educate yourself on SLEEP, DIET and EXERCISE, resolve to practice what you learn, and leave the medical profession to do what they are best at, and paid for: give medicines and perform procedures and surgery.
–Dr. C.
VIDEOS: STARTING INSULIN EARLY FOR TYPE 2 DIABETES
JAMA NETWORK (AUG 5, 2020): 2020 American Diabetes Association (ADA) guidelines recommend that after a trial of metformin, doctors add additional drugs based on the presence of cardiovascular and kidney-related comorbidities, risk of weight gain and hypoglycemia, and cost. In this video, Irl B. Hirsch, MD, of the University of Washington in Seattle, explains the rationale for starting insulin next for patients with persistent HbA1c elevation above 9-9.5% despite lifestyle changes and metformin.
Click https://ja.ma/2DhR4DV for complete details.
DR. C’S PODCAST: WEEKLY MEDICAL NEWS (AUG 2)
DR. C REVIEWS MAJOR HEALTH AND TELEMEDICAL NEWS FOR THE WEEK ENDING AUGUST 2, 2020.
PODCAST: FEAR OF VACCINES, CONFUSION OVER ORIGINS OF CORONAVIRUS (sCIENCE)
Science Editor-in-Chief Holden Thorp joins host Sarah Crespi to discuss his editorial on preventing vaccine hesitancy during the coronavirus pandemic. Even before the current crisis, fear of vaccines had become a global problem, with the World Health Organization naming it as one of the top 10 worldwide health threats in 2019. Now, it seems increasingly possible that many people will refuse to get vaccinated. What can public health officials and researchers do to get ahead of this issue?
Also this week, Sarah talks with Science Senior Correspondent Jon Cohen about his story on Chinese scientist Shi Zhengli, the bat researcher at the center of the COVID-19 origins controversy—and why she thinks President Donald Trump owes her an apology.
Finally, Geert Van der Snickt, a professor in the conservation-restoration department at the University of Antwerp, talks with Sarah about his Science Advances paper on a new process for peering into the past of paintings. His team used a combination of techniques to look beneath an overpainting on the Ghent Altarpiece by Hubert and Jan Van Eyck—a pivotal piece that showed the potential of oil paints and even included an early example of painting from an aerial view.
THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #7: TENSION HEADACHES
Headache has been with us since Neolithic times, and has caused enough distress to induce our ancestors to scrape holes in their skulls, perhaps to let out the causative Evil Spirits, or maybe a subdural hematoma.
When I was a practicing Allergist, i was sent many headache patients by other Doctors.This was, presumably, because the referring physician thought that their patients had “sinus” headaches. In fact, free standing headache does not commonly come from the sinuses.
Most headaches thought due to ‘sinuses” are in fact “vascular “ headaches. The theory of vascular headaches is that the average diet contains many chemicals that are active on blood vessels. Tyramine, degraded proteins and caffeine are examples. These chemicals, working on the blood vessels, cause irritation and pain. It follows,then, that avoidance of these chemicals would relieve the vascular headaches.
“Vascular headache”, and it’s severe cousin, Migraine headache, is now included under PRIMARY HEADACHE, which also includes Tension headache, and a variety of less common diagnoses. But it is still useful for Treatment, which is why I use the term.
My treatment was a fresh, “health food” diet which avoided preserved foods such as salami, sausages, sauerkraut, leftovers, cheeses, red wine and a variety of other foods likely to have degraded amino acids and Tyramine.
The “mold-free diet” was the published diet closest to listing the suspected foods. The benefit reported from the diet encouraged me to continue recommending it. Vascular headaches are essentially a mild variety of migraine headaches. The foods avoided in the “mold-free diet” are still, after several decades of progress still recognized as migraine triggers.
I encountered only one patient with BRAIN TUMOR in my practice. She had severe, unremitting, gradually increasing headaches over a 4 week period. I called a Neurologist, the type of doctor that treats most severe headaches, who informed me he had NEVER seen a patient with a brain tumor who presented with a headache only, so uncommon it is.
Tension Headaches are milder, and usually can be handled at home. These headaches are usually accompanied by tenderness in the muscles of the back of the neck, or in the temple region, and are brought on by stress.
Hypertension, if extremely high, can cause headache, and can be dangerous, but I never saw a case. Nor did I attend a patient with temporal arteritis, which can also be an emergency.
There are some “red flags” that indicate urgent need for evaluation:
- New headache in older patient
- New change in headache pattern, or progressively worsening headache
- Signs and symptoms of illness ( fever, stiff neck, rash).
- Headache triggered by cough or exertion.
- Headache in pregnancy or postpartum period
- First, worst Headache.
- New headaches with AIDS, compromised immunity, or cancer.
- Headaches accompanied by mental changes, weakness, or abnormal Neurological signs.
Selective medications are available for some headaches.
Preventative and abortive medications sometimes are helpful for migraine. Antidepressants, tryptans, beta blockers, and corticosteroids are medications best prescribed by specialists.
The tendency to use pain killers, especially narcotics, must be tempered. Frequent use can create additional problems, like ADDICTION. The CAUSE of the headache must be found, if possible, and specifically treated.
Of course, I did find patients with true SINUS HEADACHE, but the headache was accompanied by fever, tenderness over the sinuses, yellow nasal discharge, and other evidence of SINUSITIS, and went away when the infection was treated.
If you have a lot of headaches, and no “red flags” or “risk factors”, you might try a “mold free diet” for a few weeks. Your Nutrition and health would certainly not suffer. And you might have fewer headaches!
Please read the following article for a more complete discussion of this common and annoying problem.
–Dr. C..
CORONAVIRUS: “HOW WE CAN REACH HERD IMMUNITY”
Scientists are working at breakneck speed to develop an effective vaccine for the coronavirus. Their ultimate goal: to immunize enough of the world’s population to reach herd immunity. WSJ explains.
Illustration: Jacob Reynolds
HEALTH: “MECHANICAL VENTILATION AND ACUTE RESPIRATORY DISTRESS SYNDROME” (INFOGRAPHIC)
HEALTH VIDEOS: “HOW CORONAVIRUSES WORK”
It’s one of the tiniest machines on the planet — about a hundred times smaller than the average cell. It’s so small that no scientist can spot it through a typical light microscope. Only with an electron microscope can we see its spiky surface. It’s not alive, and it’s not what most of us would think of as “dead.” This teensy machine seems to survive in a kind of purgatory state, yet it has traveled across continents and oceans from host to host, and brought hundreds of nations to a standstill. Despite its diminutive size, the novel coronavirus, dubbed SARS-CoV-2, has seemingly taken the world by surprise with its virulence.
LIGHTHEADEDNESS: ITS SYMPTOMS & CONDITIONS
Dizziness, Fainting, Falls, Orthostatic Hypotension, Heart rate and rhythm, Cardiac output and Perfusion, The Autonomic Nervous system,
Falls and Injury are all very interconnected. They all tend to accumulate as we age, but the young are not immune to these conditions. In all of these discussions,
I make the ASUMPTION that you have these conditions in an undramatic, infrequent, moderate way, and are not burdened by Risk factors such as diabetes and hypertension. Stroke is always a worry lingering in the background, and will be discussed at the end of the series.
I will begin with DIZZINESS AND FAINTING. The amazing thing is that we are able to walk upright all day without falling. We can surprisingly lie on our backs, suddenly get up and run away seamlessly, or at least we were able to do these things, most of the time. Our bodies almost magically supply our brains and balance mechanisms with the right amount of blood and nourishment ALMOST all of the time.
Everybody gets dizzy if they spin around enough, and even young people can faint if they stand long enough in one place. Dizziness and fainting is usually considered normal if there is a good explanation. It is when they are too sudden, too severe, last too long, or happen too frequently that we seek medical Help.
Dizziness can mean “lightheadedness” without the room spinning. This is often more concerning than Vertigo, since it more often is due to a lessening of blood flow to the brain. When we get up suddenly from a sitting or lying position, the blood may pool in our abdomen and legs, with consequent insufficient pumping of blood to the brain.
This happens at 1G to civilians, but it takes about 5Gs for young jet pilots to need their “blackout” suits. Instead of blackout suits, we can use support-hose, or even a constricting pants-suit which includes our lower abdomen.
I have also been using a buzzer-timer which reminds me to walk every 10 minutes, to keep me from staying in my comfortable lazy-boy too long. I try to walk rapidly and breathe deeply, and believe this helps keep my body “toned up” and responsive for when I stand up rapidly.
The other way to adapt would be to “baby” my body, and stand up more slowly. There are always the opposite ways to respond: go easy, or push the body and expect it to adapt. If you are worried, your Family Doctor can help you and suggest a path forward .
Perhaps you are overmedicated, need medication, or some tests would help clarify the situation. Vertigo is where the room seems to be spinning. You might be able to tell whether it is spinning clockwise or counterclockwise.
The most common cause is BPPV, or benign periodic positional vertigo, and you can wait it out. Look it up on the internet for parameters. Persistent Vertigo can also be due to inner ear (labyrinth) problems. which an ENT Doctor can address.
For more details, I have included a couple of good articles. A discussion of Falls is next in this series.
–Dr. C.
Reference #2
Doctors Without Waiting Rooms 