Monday, May 30, 2011

Migraine Headaches

Migraines are chronic headaches that can cause significant pain lasting from 4 hours to several days. About 30 million Americans suffer from migraines, with women being affected three times more often than men. Around 75% of sufferers have a family history of migraine. Symptoms can be so severe that all you want to do is to lie down in a dark, quiet place. The pain of migraine is believed to occur when brain cells trigger the trigeminal nerve to release chemicals which cause swelling of blood vessels on the surface of the brain, causing pain and inflammation. The typical migraine headache affects one half of the head and is pulsatile in nature. Typical symptoms may include photopbobia or phonophobia (increased sensitivity to light or sound), nausea and vomiting (also called "sick headaches"). Once the attack is full-blown, many people will often be sensitive to anything touching their head. One-fourth of people who suffer from migraine headaches will perceive an aura, a sign or warning that a migraine will soon occur. The diagnosis is usually based on medical and family history. CTs and MRIs may also be obtained to rule out more serious causes.

Types of headaches:
Migraines: see above
Tension headaches: Also called chronic daily headaches; tension headaches are the most common type of headaches. These muscle contraction headaches usually cause mild to moderate pain, especially at the base of the skull.
Mixed headache syndrome: This is a combination of migraine and tension headaches.
Cluster headaches: The least common and the most severe. The pain of a cluster headache is intense and may be described as having a burning or piercing quality that is either throbbing or constant. The pain is so severe that most cluster headache sufferers cannot sit still. The pain is usually located behind one eye or in the eye region. Cluster headaches can occur one to three times per day during a cluster period, which may last weeks to months.
Sinus headaches: Sinus headaches are often associated with a deep and constant pain in the cheekbones, forehead, or bridge of the nose and may be associated with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever or facial swelling.The pain usually intensifies with sudden head movement or straining.
Hormonal headaches: Also called menstrual migraines, are often associated with changing hormone levels that occur during menstruation, pregnancy, and menopause. Birth control pills may also trigger these headaches in some women.

Migraine triggers include: (this is only a partial list)
Stress: at work or home is well known to cause migraines.
Physical factors: intense physical exertion may provoke migraines.
Foods: some migraines appear to be triggered by certain foods (or food dyes) such as alcohol, cheeses, chocolate, aspartame, excess caffeine or mono sodium glutamate.
Sensory stimuli: bright lights, certain scents such as perfume or paint thinner and secondhand smoke can also trigger migraines.
Changes in sleep patterns: either missing sleep or getting too much.
Physical factors: Intense physical exertion (including sexual activity) may provoke migraines.
Hormonal changes: fluctuations in estrogen seem to trigger headaches in many women. They will often report headaches immediately before or during their periods, when they have a major drop in estrogen. Oral contraceptives and hormone replacement therapy may worsen migraines. However some women may be helped by continuous therapy.
Environmental changes: changes in weather can prompt a migraine.
Medications: certain medications may aggravate migraines.

Medical Treatment: (directed at preventing the headaches and treating the acute pain)

Preventive treatment:
Blood pressure medications: beta-blockers (atenolol, propranolol, timolol) and calcium channel blockers (verapamil)
Antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor) and desipramine (Norpramin)
Antiseizure medications: gabapentin (Neurontin), topiramate (Topamax) and valproic acid (Depakote)

Acute pain treatment:
Acetaminophen-isometheptene-dichloralphenazone (Midrin): Dichloralphenazone is a mild sedative and Isometheptene is a vasoconstrictor, causing constriction (narrowing) of blood vessels
Dihydroergotamine (D.H.E): available as an injection or nasal Spray (Migranal). It is an ergot alkaloid, which acts as a potent vasoconstrictor, narrowing blood vessels
Ergotamine tartrate/caffeine (Cafergot): both vasoconstrictors, which act to constrict blood vessels.
Triptans: sumatriptan (Imitrex, generic), rizatriptan (Maxalt), naratriptan (Amerge, Naramig), zolmitriptan (Zomig), eletriptan (Relpax), almotriptan (Axert). They causine blood vessel constriction and inhibit inflammation.

Nausea medications:
Metoclopramide (Reglan)
Prochlorperazine (Compazine)
Promethazine (Phenergan)

Non-prescription medications:
Ibuprofen: Advil, Motrin or generic (best value)
Excedrin Migraine: Tylenol, aspirin and caffeine (works well).
Caffeine: such as hot tea or coffee. Avoid heavy use as it may trigger migraines.

Nutritional supplements:
Coenzyme Q10 (CO Q10)
Riboflavin (Vitamin B2)
Feverfew (Tanacetum)

Common food triggers:
MSG (Mono sodium Glutamate)
Unsaturated oils
Nitrites and other preservatives.
Food dyes
Beer, red wine
Alcohol (in general) 
Oranges, strawberries
High glycemic foods.
Coffee, tea (especially heavy use)
Energy drinks

Friday, May 27, 2011


Premenstrual syndrome (PMS) is described as a collection of physical symptoms combined with emotional changes centered around a woman's menstrual cycle. This condition is estimated to affect up to 75% of women, especially during the childbearing years. The symptoms typically will appear during the premenstrual phase of a woman's cycle and decrease (or disappear) shortly before or during menstruation. Many different symptoms have been associated with PMS and they must be severe enough to interfere with the woman's everyday life. Most commonly, one or more emotional symptoms such as tension, irritability and/or saddness occur with the physical symptoms. PMS may also be related to social and psychological factors; approximately 60% of women with depression also have PMS. Premenstrual dysphoric disorder (PMDD) is considered a more severe form of PMS.

The exact cause of PMS is not known, but changes in hormone levels in the brain may play a role. PMS may be due to declining levels of estrogen and progesterone that occur prior to menstruation. The current thinking is that serotonin, a brain neurotransmitter, diminishes with lower levels of estrogen (premenstrual). Preliminary studies suggest that up to 40% of women with symptoms of PMS have a significant decline in their circulating serum levels of beta-endorphin. Beta endorphin is a naturally occurring opioid (codeine like) neurotransmitter which has an affinity for the same receptor as heroin. Some researchers have noted similarities in symptom presentation between PMS symptoms and opiate withdrawal symptoms

Risk factors:
Women between their late 20s and early 40s.
Women who have at least one child.
A history of postpartum depression.
A history of major depression.
Family history is a good predictor for the risk of PMS.
Hypoglycemia (low blood sugar) may be a precursor to PMS.

Symptoms of PMS: The definition of PMS requires the presence of emotional symptoms as the chief complaint with one or more associated physical symptoms.
 Mood swings.
 Crying spells.
 Increased stress.
 Bloating of the abdomen.
 Breast tenderness.
 Carbohydrate cravings.
 Swollen or tender breasts.
 Feeling tired, fatigued.
 Trouble sleeping, insomnia.
 Upset stomach, bloating, constipation, or diarrhea.
 Headache or backache.
 Joint or muscle pain.
 Decreased libido.
 Trouble with concentration or memory.

Medical therapies:
Over the counter (OTC):
 Nonsteroidal anti-inflammatory drugs (NSAIDs): such as ibuprofen may help.
 Evening primrose oil: has been used with some success. 
 Phenylalanine: has been shown to reduce PMS symptoms in some women.
 St. Johns wort: has been shown to help in a number of cases.
 Birth control pills: help to stabilize hormone levels.
 Antidepressants: selective serotonin-reuptake inhibitors (SSRIs) increase serotonin levels. Either
 intermittent therapy or continuous may be prescribed for more difficult cases.
 Anti-anxiety medications: such as Klonipin may be used for severe anxiety.
 Diuretics: such as spironolactone has been used to decrease water retention.
 Bromocriptine or danazol: are occasionally used for relieving breast pain.
 Clonidine: has been reported to successfully treat a number of  PMS symptoms such as stress or anxiety.

Natural Treatments:
A healthy lifestyle is the mainstay.
Limit  caffeine.
Limit alcohol.
Eat frequent, small meals.
Vitamin B6
Vitamin D
Vitamin E
A low-salt diet.
A low glycemic diet.
Get regular exercise.
Sleep regularly.

Other therapies:
Cognitive behavioral therapy may be an alternative to antidepressants.
Light therapy may decrease the need for antidepressant medications.

Thursday, May 26, 2011


Approximately 20 million adults suffer from depression in the US. The most common age of onset is between the early 20s and the early 30s. This statistic may also overlap with depression in young people. Depression in younger individuals more often relates to social situations; whereas, in adults the causes are often related to biological, environmental or medical causes. The diagnosis of depression is generally based on history, information obtained from relatives or friends and a professional mental status exam. Depression generally isn't an illness that you can treat on your own; the important thing is to recognize the symptoms and get help in the early stages. Many individuals will either fail to recognize the symptoms themselves, be in denial or simply refuse any treatment.

Signs of depression: (you will generally experience at least four of these symptoms)
Feelings of worthlessness or hopelessness.
Loss of interest in usual activities.
Difficulty concentrating or remembering.
Worsening of other chronic diseases (arthritis, chronic pain, fibromyalgia...).
Sadness, pessimism.
Insomnia or excessive sleep.
Weight gain or loss.
Fatigue, lethargy.
Anxiety or irritability.
Thoughts of suicide or death.
Headache, stomach ache or generalized pains.

Causes of depression:
Biological causes: such as changes in hormones (cortisol) and neurotransmitters in the brain, such as serotonin and norepinephrine
Environmental situations: such as stress or significant emotional circumstances (divorce, death of a loved one, conflict, bankruptcy, etc...)
A chronic illness or chronic pain
Certain medications (beta blockers, barbiturates, benzodiazepines...)
Sexual, mental or physical abuse
Drug and alcohol abuse
Poverty and isolation
Genetic factors may also play a role

Classification of depression:
Major depressive disorder: also called major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once pleasurable activities. Major depression is disabling and often prevents a person from functioning normally in society.
Dysthymic disorder: also called dysthymia, is characterized by long–term (two years or longer) but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well. These people may also experience one or more episodes of major depression during their lifetimes.
Psychotic depression: which occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations, and delusions.
Postpartum depression: is generally diagnosed if a new mom develops a depressive episode within a month or so after delivery. It is estimated that 15-20  percent of women experience postpartum depression after giving birth. Often supportive therapy and a little "me time" is all that is required.
Seasonal affective disorder (SAD): which is characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight (think Alaska or possibly the northwest). Light therapy may be helpful.
Bipolar disorder: also known as manic-depressive disorder, is a condition in which an individual will experience extreme swings from depression to mania.

Psychiatric therapy:
Cognitive behavioral therapy (CBT):  helps you identify the negative thoughts and behaviors; then replace them with healthy and positive ones. The idea is that your own thoughts determine how you feel and you can change the way you think to behave in a positive way.
Interpersonal therapy (IPT): focuses on improving past and present social roles and interpersonal interactions such as disputes, grief and loss or transitions such as retirement or divorce. IPT does not attempt to solve inner conflicts from past experiences.
Electroconvulsive therapy (ECT): uses electrical currents in the brain to affect levels of neurotransmitters in your brain.  It may give immediate relief of severe depression when other treatments are not working.

Medications for depression:
Selective serotonin reuptake inhibitors (SSRIs). Many doctors start depression treatment by prescribing  SSRIs. They work by increasing the level of serotonin in your brain. These medications are safer and generally cause fewer side effects than other types of antidepressants. SSRIs include Prozac, Paxil, Zoloft, Celexa and Lexapro. Common side effects include decreased sexual desire and function, weight gain, insomnia, headaches or stomach problems.
Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications include Cymbalta, Effexor and Pristiq. Side effects are similar to those caused by SSRIs. These medications may also cause increased sweating and dizziness. People with liver disease shouldn't take Cymbalta.
Norepinephrine and dopamine reuptake inhibitors (NDRIs). Wellbutrin falls into this category. It is one of the few antidepressants that doesn't cause sexual side effects.
Atypical antidepressants. These medications are called atypical because they don't fit neatly into another antidepressant category. They include Desyrel and Remeron. Both of these antidepressants are sedating and are usually taken in the evening.
Tricyclic antidepressants. These antidepressants, such as Elavil, Sinequan and Tofranil, have been used for years and are generally as effective as newer medications. But because they tend to have more side effects, a tricyclic antidepressant generally isn't prescribed unless you've tried an SSRI first. Side effects may include dry mouth, blurred vision, constipation, urinary retention, a fast heartbeat and confusion. Older adults taking these medications are susceptible to memory problems, confusion or hallucinations.
Monoamine oxidase inhibitors (MAOIs). MAOIs — such as Parnate and Nardil are usually prescribed as a last resort, when other medications haven't worked. That's because MAOIs can have more serious side effects. Emsam is a newer MAOI that is prescribed as a patch. It may cause fewer side effects.
Other medications. Other medications to treat depression include stimulants, mood-stabilizing medications, anti-anxiety medications or anti psychotic medications such as Abilify, Geodon and Seroquel. In some cases, your doctor may recommend combining two or more antidepressants or other medications for better effect.

Natural therapies:
St. John's wort (Hypericum perforatum): is a wild yellow flower and has been used with moderate success to treat depression. Generally 2 to 4 grams of  St. John's wort is taken 2-3 x times a day.
SAMe (S-adenosylmethionine): appears to increase the amount of serotonin in the brain. The usual dosage ranges from 200 mg/day to 800 mg/day. Lower doses ranging from 50 to 200 mg/day to treat mild depression without triggering negative side effects including  diarrhea, stomach discomfort, anxiety, headache or insomnia. This supplement is also somewhat expensive.
Omega-3 fatty acids:  shown to help ease depression and also has a number of other health benefits.
The normal dosage is 1-2 grams daily.

Lifestyle changes:
Get some exercise.
Avoid alcohol and drugs.
Get adequate sleep.
Consider yoga or meditation.

Monday, May 23, 2011

Consider Circuit Training

Circuit training is a form of conditioning combining resistance and high-intensity aerobics. Circuit training is short bursts of resistance exercise, with or without weights, with  frequent repetitions, followed quickly by another exercise targeting a different muscle group. By switching muscle groups with a different circuit, no rest is needed between exercises and this gets the heart rate up. Circuit training combines 6-8 or more exercises that are completed one right after the other. Perform each exercise for a specified time, 2 or 3 minutes, then rest for about 30 seconds before moving on to the next exercise (for beginners, start with 30 seconds per exercise and increase the time as you improve). Start slowly if you have just begun to exercise. The best way to get started is to start at lower intensities meaning using lower weights with high repetitions and a little longer rest periods. Be sure to warm up and cool down when using circuit training.
Circuit training is easy to follow and will promote strength building as well as endurance. It will help to increase oxygen consumption for developing and maintaining cardio-respiratory fitness.

A simple beginner 20 minute workout (no weights required) from Motley Health:
1. Jog in one place for 3 minutes2. Jumping jacks, 25 reps. When landing, bend your knees slightly to reduce the impact on knee joints.
3. Hip Bridges, 10 reps. Lie on your back. With your arms straight and out by your side and palms facing upwards. With only your the heels of your feet touching the floor lift your hips up to form a straight line from the shoulders to the knee. Your legs should be almost vertical from the foot to the knee. Hold this position for 10 seconds. Squeeze your glutes (butt muscles) and then lower yourself. Muscle worked: lower back, hamstrings and glutes.
4. Crunches, 15 reps. Lie flat on your back with your knees bent. Place your hands behind your head with elbows pointing outwards. Support your neck with your hands. Keep your neck in a straight line with your spine. Flex your waist to raise the upper torso from the mat. Lower yourself until the back of your shoulders touches the mat. Muscles worked: abdominals.
5. Step ups, 1 minute. You will need a stepper for this. If you do not own a stepper then you can use the bottom step on a flight of stairs or a sturdy stool. Muscle worked: hamstrings, glutes, quads.
6. Reverse crunches, 15 reps. Lie on your back with your hands on your sides. Keep you knees bent. Bring your knees towards your head, till your hips come slightly off the floor. Hold this position for a second, and then lower your knees. Muscle worked: lower abs and obliques.
7. Mountain climbers, 1 minute. Get down on your hands and knees and raise your knees like a starting block sprinter. Run in that position, supporting your upper body with the palms of your hands. Keep your back straight. Muscles worked: triceps, deltoids, glutes, quads, hamstrings, calves.
8. Push–ups, 15 reps. The classic push, in the plank position with palms flat on the floor, point forward, about shoulder width apart. Muscles worked: triceps, deltoids, pectorals.
9. Squat thrusts, 1 minute. Stand straight. Now, drop to a crouch position. Immediately thrust your legs out straight behind on your toes, in push up position, now jump to pull legs back to the chest, in crouching position, then stand up straight. Muscles worked: arms, legs, chest, and lower back.

By doing this routine morning and evening, you will notice an improvement in endurance, sleep, weight and energy in just a few short weeks.

Sunday, May 22, 2011


Psoriasis is a non-contagious chronic skin disorder that causes scaling and inflammation. It occurs when the immune system speeds up the growth cycle of skin cells. Psoriasis affects males and females equally and most commonly appears in the teens or early twenties. The prevalence is estimated to be around 2-3% in the US. Individuals will often experience flares and remissions throughout their lives. There are five types of psoriasis: plaque, guttate, inverse, pustular and erythrodermic. The most common type is plaque psoriasis and is commonly seen as thickened red and white scaly patches. They most frequently appear on the elbows, knees, lower back, and scalp. The diagnosis is usually based on the appearance of the skin. While there are no special blood tests, a skin biopsy or scraping may be helpful to confirm the diagnosis.

The actual cause is unknown, but believed to be triggered by a problem with the immune system. The theory is that your immune system’s T cells (white blood cells) mistakenly attack your skin, triggering inflammation and swelling, causing your skin cells to grow faster than normal. The cells then "pile" up on the surface of the skin, causing it to become thicker, forming patches or plaques. Psoriasis has a known genetic component. The disorder is chronic and recurring, varying in severity from minor localized plaques to extensive body coverage. Numerous factors have been suggested as aggravating psoriasis, including stress, illness, withdrawal from steroids or environmental factors. There are many treatments available; but because of its chronic recurrent nature, psoriasis is a challenge to treat.

Other areas of involvement include the fingernails and toenails (psoriatic nail dystrophy). Psoriasis can, in more severe cases, cause inflammation of the joints, which is known as psoriatic arthritis. Between 20 and 30 % of all people with psoriasis may have psoriatic arthritis. Psoriasis is linked to a 2 fold increased risk for (nonmelanoma) skin cancers, lymphoma and liver disease; this increased risk may be attributed to the number of different therapies.

Types of psoriasis:
Plaque: the most common form,  causes dry, raised, red skin lesions covered with white or silver scales. The patches may itch or be painful and can occur anywhere on your body.
Guttate: means drop, it is uncommon (less the 2%) and looks like small, salmon-pink drops on the skin. They are usually found of on the trunk, arms, legs and scalp.
Inverse: mainly affects the armpits, the groin, under the breasts and around the genitals (the skin folds). Inverse psoriasis causes smooth patches of red, inflamed skin.
Pustular: pus-filled blisters appearing just hours after your skin becomes red and inflammed.
Erythrodermic: least common type, it can cover your entire body with a red, peeling rash that can itch or burn intensely.

Symptoms of psoriasis:
Dry, cracked, scaly skin.
Skin plaques that may bleed.
Itching, sore, or burning skin
Pitted fingernails or toenails.
Toenails or fingernails that may loosen, thicken, or crumble.
Infected or inflamed blisters on the skin plaques.

Topical agents:
Moisturizers, mineral oil, and petroleum jelly: soothe affected skin and reduce the dryness.
Medicated creams and ointments: reduce inflammation and help clear the plaques
Steroids (seven classes, in order of potency): they are anti-inflammatory agents used to reduce the swelling and redness of lesions.
Retinoids (Retin-A, Tazorac):  help slow the growth and increase shedding of skin cells.
Activated vitamin D3 (calcipotriol), and its analogues can inhibit skin cell proliferation.
Coal tar: a soothing, old remedy, may be cancer promoting at strengths greater than 5%.   
Dithranol (anthralin): decreases skin cell growth.
Taclonex Scalp (steriod plus Vit. D): a new topical ointment for treating scalp psoriasis.

Sunlight: has long been used effectively for treatment.
Lamp: with wavelengths of 311–313 nm are most effective.
Psoralen and ultraviolet A phototherapy (PUVA): combines the oral or topical administration of psoralen with exposure to ultraviolet A light. PUVA may be associated with nausea, headache, fatigue, burning, and itching. Long-term treatment is associated with squamous cell carcinoma.

Excimer laser: emits a high-intensity beam of ultraviolet light (UVB), used with success to treat moderate to severe psoriasis.

Systemic (internal) treatment: Pregnancy must be avoided during these treatments.
Methotrexate: an immunosuppressant medication.
Cyclosporine: an immunosuppressant medication.
Retinoids (synthetic vitamin A): decreases the growth rate of skin cells.
Most people experience a recurrence of psoriasis after systemic treatment is discontinued.

Biologics (created by biological processes): are usually given by a self-injection
Alefacept (Amevive): blocks and kills T cells, controlling inflammation.
Adalimumab ( Humira):  prevents tumor necrosis factor (TNF) from causing inflammation (tumor necrosis factor promotes inflammation).
Ustekinumab (Stelara): inhibits the immune system by blocking interleukin (cytokines, which cause inflammation).

Alternative therapy:
Fish oil (omega-3s)
Vitamin A
Vitamin D
Vitamin E
Limit alcohol,
Stop smoking.
Control stress.
Ichthyotherapy: fish feed on the psoriatic skin providing a temporary relief of symptoms.

From the Mayo Clinic:

Image of plaque psoriasis 
Plaque psoriasis
Image of guttate psoriasis 
Guttate psoriasis
Image of scalp psoriasis 
Scalp psoriasis
Image of inverse psoriasis
Inverse psoriasis
Image of nail psoriasis
Nail psoriasis
Image of pustular psoriasis 
Pustular psoriasis
Image of erythrodermic psoriasis
Erythrodermic psoriasis

Tuesday, May 17, 2011

Telomere Testing; Do You Want It?

Would you have a test to show how fast you are aging, which also offers an estimate of how long you may live? This test is not science fiction and is expected to be available to the public this year. The blood test measures what are called telomeres, which are the tips of a person's chromosomes. Scientists believe they are one of the most important indicators of the speed at which a person is aging. Telomere length is a good representation of your biological age, not your chronological age.While we know that people who are born with shorter telomeres have a shorter lifespan, we don't know whether longer telomeres are going to give you a longer lifespan. There is a growing body of scientific evidence that a person's telomeres could also give insights into the risk of dying prematurely from a number of age-related disorders such as heart disease or a number of cancers.

Researchers believe that telomere testing will become common and reasonably priced in the next few years; but question is whether there should be controls over its broader use. The results of the tests might also be used negatively, such as by companies offering life or medical insurance policies. In addition, their may be a concern that telomere testing may be used by unscrupulous organizations trying to sell unproven anti-aging remedies. 

One other note is about a substance called telomerase, which is an enzyme that adds DNA sequences to the telomeres on the ends of chromosomes (it lengthens the telomeres). This enzyme is believed to be the new "fountain of youth" and may also have a role in cancer therapy. The big question is whether or not a telomerase supplement (TA-65, very expensive) will actually work to extend lifespans or prevent disease. I do not know the answer and this type of therapy is still considered experimental. 


Monday, May 16, 2011

Testosterone and Heart Health

Approximately 30% of men age 60 and older are considered to have symptomatic low testosterone. Symptoms of low testosterone include: low energy and fatigue, poor memory and concentration, decreased sexual desire and function as well as poor sleep patterns. Physical signs may include decreased muscle mass, increased fat deposition (central adipose tissue) and weaker bones. Men, statistically, have more than twice the risk of dying from heart disease than women. It has been assumed for years that testosterone contributes to the overall risk of heart disease in men. However, having a low level of testosterone is considered an adverse risk factor for heart disease and increased mortality. Low levels of testosterone have been associated with insulin resistance (a precursor to diabetes and a risk factor for heart disease) and poor cholesterol levels. These factors though will lead to higher risks of cardiovascular disease.

A number of studies have consistently show these risk factors also coincide with increasing estrogen levels in men. The most recent large study comes from Dr Kevin Channer of the Royal Hallamshire Hospital in Sheffield, England, in which he studied almost 1000 men with heart disease. The mortality rates appeared to be twice that in men with a proven testosterone deficiency. Another European study (with 11,000-participants), called the EPIC Norfolk study, showed that the men with "normal" testosterone levels had 40% fewer deaths from heart attacks and cancer. An NIH-sponsored study (The Aging in the Chianti Area Study) showed a nearly 50% higher mortality rate (cardiovascular and cancer) in men with low testosterone. The link between low testosterone and heart disease appears to apply only to men.

Low levels of testosterone have been associated with insulin resistance (a precursor to diabetes) and poor cholesterol levels. These factors alone lead to much higher risks of cardiovascular disease. Prostate cancer patients who are on androgen (testosterone) deprivation therapy (ADT) are at an elevated risk for heart disease. Evidence shows that when one’s androgen levels are lowered, a metabolic syndrome ensues. Metabolic syndrome and heart disease can therefore potentially be prevented by maintaining optimum testosterone levels.

How testosterone may decrease heart disease risk:
Testosterone increases nitric oxide, an arterial dilator.
Improves insulin resistance. 
Decreases risk of metabolic syndrome.
Reduces inflammatory proteins.
Suppresses growth of smooth muscle cells in arteries (preventing plaque formation). 

Sunday, May 15, 2011

Calorie Counting and Weight Loss

Tracking calories is the key to successful weight loss. While nutrition is extremely important, calorie counting is more important than just restricting fats or carbohydrates for loosing weight. You should balance out your diet and know where your calories come from. A healthy diet is rich in fruits, vegetables, whole grains, seafood, lean meats, low fat dairy and nuts. Keep a diary in order to calculate your caloric intake. There are many free online and phone app calorie counter programs such as "". A diet no lower than 1200 calories per day with a consistent exercise program will help you lose up to 1 pound per week. One pound is equal to burning about 3500 calories. Eat five or six times daily with 75% of your calories consumed in the first 8-10 hours of awakening and do not skip breakfast. Don't forget to consume 8 glasses (64oz) of water per day.

Depending on your activity level, 40-50 % of your calories should come from carbs, 30-40 % from protein and 20 % from healthy, unsaturated fats. Limit foods with too much sugar and saturated fats. Keep portions small for high caloric foods that are sugary, fatty and otherwise unhealthy. Diet alone is not enough to promote significant weight loss. In the beginning, start slow with a regular exercise program, then increase your efforts. The heavier you are, the more calories you will burn. Most experts recommend 30 minutes or more of physical activity on most days in order to shed the weight. Try to walk 10,000 steps daily and take the stairs! To make the most of your exercise sessions, try short bursts of high intensity exercise, which burn more calories than consistent exercise like jogging on the treadmill. High-intensity interval workouts (circuit training) also leads to greater reductions in total body mass compared with steady-state exercise. Please remember to start slowly and increase your intensity gradually. 

Friday, May 13, 2011

Chronic Inflammation and Diet

Inflammation is the body’s natural defense against injury or disease. Chronic inflammation, on the other hand, is believed to be a major contributor to disease. When your body experiences a constant inflammatory response, you become more susceptible to aging and chronic disease. Instead of protecting our body, chronic inflammation slowly begins to destroy it, one cell at a time. This inflammation has been connected to many diseases including: obesity, diabetes, atherosclerosis, high blood pressure, Alzheimer’s, Parkinson’s and some cancers. A number of factors are believed to contribute to chronic inflammation, but the most common and probably most important is your diet. The modern diet offers us an upside-down ratio of fatty acids (too little omega 3s, too much omega 6), too much sugar and simple carbohydrates or high levels of wheat and common food allergens. High-carb, low-protein diets are pro-inflammatory. The biggest culprits are processed foods, sugary foods, unsaturated oils and trans (hydrogenated) fats. These types of foods are found everywhere in our society: snacks, fast foods, fried foods, pastries and so on. Refined sugar and other foods with high glycemic values increase insulin levels which over stimulate the immune system. Lastly, be aware of increasing food sensitivities such as gluten, eggs, dairy, soy and nuts.

Prolonged increased levels of insulin are highly associated with chronic inflammation and glycosylation (addition of sugars to protein or lipid molecules). Glycosylation will increase the risk of many diseases including diabetes, heart disease and a number of cancers through the cytokine process. When inflammation occurs, cytokines (cell-signaling proteins) are released into the blood as part of the healing response. Cytokines, though, can be destructive to our bodies resulting in inflammation, damaging blood vessels, nerve cells, cartilage and other tissues thus leading to further inflammation.

Common symptoms associated with chronic inflammation:
Aches and pains
Frequent infections
Irritable bowel
Elevated blood pressure
Elevated glucose levels
Skin outbreaks, eczema
Joint swelling
Joint stiffness
Weight gain/obesity

Other possible causes of chronic inflammation:
Excessive caffeine
Illegal drugs
Chronic stress
Environmental toxins

An anti-inflammatory diet:
Lean meats
Unsaturated fats
Plenty of water

Anti-inflammatory supplements:
Essential fatty acids (EFA’s, Omega 3s)
Folic acid
Vitamins A, B, C, D, E
Green tea
Bioflavonoids (flavonoids)
Glucosamine (for joints)

Monday, May 9, 2011

Artificial Sweeteners and Stevia

Although artificial sweeteners are considered generally safe, many people and some experts remain wary. In the United States, artificial sweeteners fall under the Generally Recognized as Safe (GRAS) list which means "there is consensus among qualified experts that the substance is safe under the conditions of its intended use." Artificial sweeteners are so sweet that you need only a small amount,  just a fraction of a calorie, to get the sweetness of sugar. And since the body doesn’t generally absorb artificial sweeteners, it also doesn’t absorb the few calories they contain. It is important to note that there's currently no scientific evidence that proves any of the approved artificial sweeteners cause  health problems. Neotame and Splenda are considered the "safest" of the artificial sweeteners. All things considered, artificial sweeteners are probably ok if used sensibly.

Stevia is a natural and calorie-free herb in the sunflower family (not an artificial product), native to some regions in North America and South America. It is 300 times the sweeter than sugar. Stevia has a neglible effect on blood glucose levels and may even improve glucose tolerance. Therefore, Stevia is popular as a natural sweetener for diabetics and carbohydrate-controlled diets (ie, HCG). Stevia is currently banned as a food additive in Canada, Europe and the United States, where the Food and Drug Administration believes the herb has not been thoroughly tested. Strangely enough though,  it may be sold in the United States as a dietary supplement. It’s also easy to grow stevia for personal use in Zone 8, of the US (ie, Southern US).

Artificial Sweeteners:
Acesulfame K (Sunett, Sweet One): was approved for use by the FDA as an artificial sweetener in l988. According to the FDA, its safety is backed by more than 90 studies. The main concern for acesulfame K is that it may over-stimulate insulin secretion in a dose dependent fashion thereby possibly causing a reactive hypoglycemia (low blood sugar). Acesulfame K is 200 times sweeter than sugar.
Aspartame (Nutra-Sweet, Equal):  is being used increasingly in sugar-free formulations. Headache is the most common side effect; around 10% of people with migraine headaches reported an increase incidence triggered by aspartame. Another issue is that individuals with mood disorders (ie, depression) were particularly sensitive to aspartame and recommended that they avoided them. The American Medical Association and the FDA have both concluded that aspartame is safe for general use. However, people with a disorder called phenylketonuria (PKU) cannot metabolize an amino acid found in aspartame, allowing it to accumulate in the body to dangerous levels. Aspartame is 200 times sweeter than sugar.
Neotame: is made by the same company that produces NutraSweet (aspartame). It is derived from aspartame; but with one chemical change which enables the body to metabolize neotame differently. than aspartame, so products containing neotame are not required to carry the PKU warning. Neotame is 8,000 times sweeter than sugar.
Saccharin (Sweet ’N Low): was almost banned in 1977 because of studies in rats linking it to bladder cancer. Since then, the National Cancer Institute and the FDA have concluded that its use is not a major risk for bladder cancer in humans. Another concern for saccharin is the possibility of allergic reactions; it belongs to a class of compounds known as sulfonamides (sulfa), which can cause headaches, breathing difficulties, rashes or diarrhea. Saccharin is 500 times sweeter than sugar.
Sucralose (Splenda): is marketed as being “made from sugar and is a chlorinated sucrose (sugar) derivative. They convert sugar to the non-caloric sucralose by adding a chlorine molecule. Splenda can be substituted for sugar, spoon-for-spoon, in baking and cooking. There is also a new product called Splenda Blend that is half sugar, half Splenda. Sucralose is 600 times sweeter than sugar.

Neotame and Splenda are the only two artificial sweeteners ranked as "safe" by the consumer advocacy group "Center for Science in the Public Interest." 

Sunday, May 8, 2011

Improving Chronic Fatigue

The term chronic fatigue is generally used to mean excessive tiredness, exhaustion, lack of energy or lethargy. This discussion concerns prolonged fatigue unresponsive to simple things such as a good nights sleep. I routinely get a number of complaints concerning fatigue, and generally I tell my patients that the cause may be due to a number of factors where finding a simple cure may be difficult. The treatment of chronic fatigue often involves several therapies including significant lifestyle changes.

Chronic fatigue syndrome (CFS) merits special attention due to the severity and duration of  symptoms. The cause is generally unclear but could have several etiologies including infections (Eptein-Barr, Ross River and coxiella viruses), autoimmune disorders, nutritional deficiencies, or possibly allergies. The diagnosis is made by having four or more physical symptoms, along with fatigue, for at least six months without another identifiable medical cause. The symptoms of CFS are different in that patients will often have a wider variety of symptoms including muscle and joint pain, nausea or bowel issues, throat or ear aches, chest tightness or shortness of breath, headaches, dizziness, memory and concentration problems, extreme prolonged exhaustion and more psychological issues (depression, anxiety, panic attacks...). The treatment is similar to general fatigue with an emphasis on treating the physical or psychological symptoms such as depression and anxiety, chronic pain, gastrointestinal issues or possibly allergies.

Lifestyle factors associated with chronic fatigue:
Alcohol use or abuse
Excessive caffeine use
Drug use
Extreme physical activity
Sedentary lifestyle
Chronic insomnia
Medications (including antihistamines, prescription pain medications, heart and
blood pressure medications, antidepressants...)
Poor nutrition

Medical conditions associated with fatigue:
Hormonal imbalances
Chronic allergies
Dietary allergies
Adrenal fatigue (decreased cortisol levels)
Cancer ( such as leukemia or lymphoma)
Chronic fatigue syndrome
Chronic kidney disease
COPD, emphysema
Heart disease
Thyroid disease
Restless legs syndrome
Sleep apnea
Chronic pain
Liver failure

Psychological causes of fatigue:
Chronic stress (personal and professional)

Helpful tips to improve fatigue:
Eat a healthy low glycemic diet full of fruits and veggies.
(keeps glucose levels steady)
Evaluate any possible contributing medical conditions.
(including depression, chronic pain, sleep disorders...)
Evaluate all medications.
Get adequate, consistent sleep.
Exercise regularly.
Weight loss if needed.
Learn to relax.
Maintain a reasonable work schedule.
Try to change a stressful situation (work, home, financial...)
Take a multivitamin.
Avoid or decrease alcohol.
Avoid drug use.
Stop or decrease smoking.
Limit caffeine.

Medical therapies:
Hormone replacement
Stimulants (ie, Provigil)
Anti-anxiety meds (Klonipin, Ativan...), may worsen symptoms though.
Antidepressants (Prozac, Zoloft, Celexa, Wellbutrin, Cymbalta, Pristiq...)
Antivirals if blood work indicates an infection (Acyclovir, Valtrex...)
Medications for insomnia (Ambien, Lunesta...)
Restless leg medication in needed (Mirapex)

Natural therapies:
Phosphatidyl Serine (PS)
Coenzyme Q10 (CO Q10)
DHEA (if levels are deficient)
Omega 3 fish oil (DHA, EPA Krill)
Niacin (Vitamin B3)

Wednesday, May 4, 2011

Managing Anxiety

Anxiety seems to be everywhere in our society and affects about 20 million Americans. Many people may have an anxiety disorder and not recognize it as such. On the other hand, we as practitioners prescribe a whole lot of anti-anxiety medications in the US. Anxiety, at some level, is considered to be a normal reaction to stress. Whether the stress is professional, personal or situational, anxiety actually helps us to better deal with those situations. But when anxiety becomes excessive and irrational involving everyday situations, it may become disabling. The intensity and reasoning behind anxiety determines whether it is considered a normal or abnormal reaction.

Their are five types of anxiety disorders:
Generalized Anxiety Disorder-excessive unrealistic worry and tension
Obsessive-Compulsive Disorder (OCD)-those with constant thought
or fears causing repetitive routines
Panic Disorder-feelings of terror that will strike suddenly and repeatedly
without warning
Post Traumatic Stress Disorder (PTSD)-follows a traumatic event and causes
recurrent fears
Social Anxiety Disorder-extreme self-consciousness in every day situations

The physical effects of anxiety:
Shortness of breath
Heart palpitations
Head aches
Stomach aches
Body aches
Wet palms

Lifestyle changes to improve anxiety:
Decrease or avoid caffeine.
Decrease or avoid tobacco.
Decrease or avoid alcohol.
Exercise regularly.
Consider meditation.
Skip the news (often too negative).
Talk to someone you trust.
Improve sleep patterns.
Eat a low glycemic diet.
Consume 5+ servings of fruits and veggies daily.
Avoid fried (hydrogenated) foods.
Consider getting a (easy to manage) pet.
Try to limit or control stress.

Medications for anxiety:
Antidepressants: such as selective serotonin reuptake inhibitors (SSRIs) and includes Prozac, Zoloft, Paxil, Lexapro, and Celexa), tricyclic antidepressants (TCAs) such as Elavil, Tofranil and Pamelor, and the atypical antidepressant buspirone (BuSpar).
Beta blockers: such as propranolol (Inderal) and atenolol (Tenormin) are helpful in controlling the physical symptoms.
Anxiolytics: (benzodiazepines) such as Valium, Klonopin, Xanax or Ativin (generally for short term use due to dependence).
Hormone Replacement Therapy: may reduce the symptoms of anxiety if menopausal. 

Traditional therapies for anxiety:
There are a number of ways to treat anxiety disorders depending on the severity. Often a combined approach is necessary to treat the disorder with long term success.
Psychotherapy: addresses the emotional response to the stressors in our lives. It is a process in which mental health professionals help people by talking through strategies for understanding and dealing with their disorder.
Cognitive behavioral therapy (CBT): the person learns to recognize and change thought patterns and behaviors that lead to troublesome feelings. CBT can be very successful when begun early and combined with short term medical therapy when necessary.
Neuronal gap therapy: a newly discovered treatment centering on decreasing the excitement level in the brain by closing the communication between brain cells (neurons). This is still experimental, but holds great promise.

Natural remedies for anxiety:
Omega 3s: studies have shown low levels are associated with higher levels of anxiety and depression. Omega 3s are known to protect cell membrane health in the brain. This protection is believed to allow the brain to function better by preventing the "leakage" of neurotransmitters into the blood stream.
Kava Kava: is known to calm and sooth without any negative effects on thinking. Kava has been used for thousands of years for anxiety and is not considered addictive. Safety concerns have been raised with heavy use due to the risk of weight loss, rashes or liver and kidney damage. Use with caution.
St John's Wort: works similiarly to the SSRIs and. is commonly used to treat depression. The combination of St John's Wort with melatonin has been shown to improve anxiety.
Passionflower: has mild benzodiazapine effects and is helpful in reducing symptoms such as restlessness and nervousness. The results, though, are variable.
Valerian root: is believed to increase the amount of gamma aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain causing calming or sedation. The results are also variable.
Inositol: helps cell membranes to function properly and may also improve GABA function leading to a calming effect.

Monday, May 2, 2011

Erectile Dysfunction

Erectile dysfunction (ED) is the inability to develop a penile erection the during sexual activity. An erection results from blood entering and staying in the bottom and the sides of the penis (the corpus spongiosum and the corpora cavernosa) so that the penis enlarges, hardens, and assumes an erect position. Psychological impotence is erectile dysfunction due to thoughts or feelings rather than a physical cause. According to the National Institutes of Health, approximately 5% of 40-year-old men and 20% of 65-year-old men experience ED on a long-term basis. Impotence is frequently associated with poor physical health, poor diet and obesity.The most common medical causes of ED are cardiovascular (heart) disease, diabetes, neurological issues, hormonal inefficiencies (low testosterone) and medication side effects.

An erection can be acquired in two different ways. The first one is a direct reflex, achieved by manual stimulation of the penile nerves and the lower parts of the spinal cord. Stimulation of penile shaft leads to the secretion of nitric oxide (a blood vessel dilator) which causes the relaxation of smooth muscles of corpora cavernosa leading to an erection. The second is the psychological erection, which is achieved by mentally stimulating the limbic system (the inner cortex) of the brain. In both conditions, an intact neurological system is required and adequate levels of testosterone and pituitary hormones are necessary for an erection. 

Causes of ED:
Heart Disease
Low Testosterone
Spinal cord injuries
Brain injuries
Medications: anti-depressants (SSRIs are most common), anti-anxiety , anti-seizure, antihistamines, high blood pressure meds, muscle relaxants and cancer medications
Neurological disorders:  Parkinson's disease, Alzheimer's disease, Multiple Sclerosis, and strokes.
Peyronie's disease: scar tissue surrounds the corpora cavernosa, causing pain, abnormal curvature,  loss of girth and length.
Psychological causes: performance anxiety, stress, mental disorders (depression, schizophrenia, substance abuse, panic disorder, generalized anxiety disorder, personality disorders).
Surgery of the colon, prostate, bladder, or rectum.
Pelvic Radiation
Kidney failure
Smoking: promotes vascular disease (decreased blood flow).

Diagnosis of ED:
Blood tests: including testosterone levels, sex hormone binding globulin (SHBG), cholesterol, blood sugar, liver and kidney function and thyroid function.
Prostate examination: looking for an enlarged prostate.
Duplex ultrasound: used to measure blood flow to the penis.
Penile nerve function (bulbocavernosus reflex test): physical exam used to evaluated suspected nerve damage.
Nocturnal penile tumescence (NPT): a monitor measures nocturnal erectile events, the duration of events and penile tumescence (hardening) over night.

General reccomendations for ED:
Control medical issues: diabetes, hypertension, ... .
Quit smoking.
Exercise on a regular basis.
Decrease or abstain from alcohol.
Get enough sleep.
Limit stress .
Loose weight.

Medications for ED:
Phosphodiesterase-5 (PDE5) blockers: sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). These meds enhance the effects of nitric oxide which relaxes the muscles in the penis and increases blood flow. Contraindications include the use of nitrates or alpha-blockers for heart disease.
Alprostadil injectable (Caverject): uses a fine needle to inject alprostadil into the base or side of the penis producing an erection in five to 20 minutes that lasts about an hour. This medication is also available as a penile suppository.
Yohimbine: the prescription strength is rarely used due to side effects including rapid heart rate, high blood pressure, anxiety and insomnia. It is readily available as an herbal supplement with less side effects.
Testosterone replacement: works well in documented cases of low testosterone.

Other treatments:
Penis pumps: vacuum device placed over the penis, and then a pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis. Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm.
Penile implants: involves surgically placing either inflatable or semi rigid rods into the sides of the penis. The inflatable devices allow you to control when and how long you have an erection. The rods keep the penis always firm but malleable (bendable).

Here is a list of herbal remedies, from the Mayo Clinic, used in the treatment of ED:

Herbal remedy or supplementDoes it work?Dangers and possible side effects
DHEADehydroepiandrosterone (DHEA) is a building block for sex hormones. It may help some men if they have low testosterone (hypogonadism).DHEA can interfere with your natural balance of sex hormones. It can cause acne and may lower "good" high-density lipoprotein (HDL) cholesterol.
Epimedium (horny goat weed)This traditional Chinese medicine may help erectile dysfunction.There's little evidence about the safety or side effects of epimedium. It may cause blood thinning and lower blood pressure.
Folic acid and vitamin EIn some men taking sildenafil (Viagra), these vitamins seemed to help with erectile dysfunction. But more studies are needed to determine whether there's a clear benefit.Except in high doses, there's little risk of side effects from these vitamins.
GinkgoGinkgo may help erectile dysfunction by increasing blood flow to the penis. It may also help ease sexual side effects caused by antidepressants.Ginkgo may increase your risk of bleeding. This could be dangerous if you're going to have surgery or you take a blood-thinning medication.
GinsengAsian (Panax) ginseng has been used for centuries in traditional Chinese medicine for a number of conditions. A few studies show that ginseng may help with erectile dysfunction.This herb is generally considered safe. However, it may lower blood sugar levels, so use caution when taking ginseng if you have diabetes. In rare cases, ginseng has been linked to mania when taken with certain antidepressants.
YohimbeYohimbe is derived from the bark of the African yohimbe tree. A prescription form (yohimbineThe prescription form of this herb has been linked to a number of side effects, including increased blood pressure, fast or irregular heartbeat and anxiety.
ZincZinc may improve erectile function in men who have a zinc deficiency.Don't take zinc in high doses. Too much zinc can harm your immune system and cause other health problems.