Posted by & filed under Nutrition.

Coffee

In a very large study involving over 400,000 men and women over 13 years, those who drank more coffee were found to live longer. (NEJM May 17, 2012, pp.1891-1904)

Subjects were aged 50-71 at baseline. Compared with men who drank no coffee, the incidence of death was 6% less in men who drank one cup of coffee daily, 10% less in those who drank 2-3 cups daily, and 12% less in those who drank 4-5 cups daily.

In women, those who drank one cup of coffee daily had a 5% lower risk of death compared with those who drank no coffee. Risk reduction was 13% in women who drank 2-3 cups daily, and 16% in those who drank 4-5 cups daily.

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Posted by & filed under Cancer.

After years of upset, hormone cancellations and denials, now comes more evidence that estrogen replacement therapy does NOT cause breast cancer. Estrogen may even protect against breast cancer. If you find this surprising, read on.

Published in Lancet Oncology, March 7, 2012, the study was an extended, 12-year follow-up of 7,645 women, half of whom had been treated with estrogen for an average of 6 years, the other half with placebo. All of the women had received hysterectomy. Follow-up continued for 6 years after the termination of therapy.

The risk of invasive breast cancer was LOWER (0.27% per year) in women taking estrogen than in women taking placebo, meaning no hormone (0.35% per year). In women who did develop breast cancer, those taking estrogen were less likely to die from it (6 deaths, or 0.009% per year) than women who took placebo (16 deaths, or 0.024% per year). Death from any cause was also lower in the hormone-treated group.

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Posted by & filed under Gastrointestinal.

Heartburn ControlMillions of people suffer every day from the very uncomfortable symptom of heartburn. This is also known as GERD (gastroesophageal reflux disease). Heartburn is a very unpleasant burning sensation located in the anterior chest that radiates from the stomach to the throat.

Sometimes it appears as a sensation of pressure on the chest and can mimic symptoms of a heart attack. It is worse at night when the patient is lying down and it is aggravated by eating spicy food, tomato, chocolate, coffee, citrus fruits and juices. Symptoms improve with the use of antacids.

When untreated, it can progress to esophageal ulcers, strictures, hoarseness and respiratory problems. Dental erosions, laryngitis, nocturnal choking, sinusitis and cancer of the esophagus are additional complications.

An estimated 14-20% of all US adult have some degree of gastroesophageal reflux.

Americans spend in excess of $10 billion dollars a year on acid reducing medications which are considered the first line of therapy for GERD. Despite the use of these medications, the incidence of esophageal cancer has increased significantly in the past 20 years, with an estimated increase of 200-600%

The other problem related to the use of acid reducing medication is that suppression of acid decreases absorption of iron, calcium and vitamins.There is also a moderate increased risk for fractures in menopausal woman on these drugs. Read more »

Posted by & filed under Cancer.

It was found previously that low vitamin D levels increase the risk of developing breast cancer. Recently it has also been found that low vitamin D levels are associated with markers of more aggressive disease and of metastases. (Aggressive Breast Tumors Linked to Vitamin D Deficiency: April 29, 2011, at http://www.urmc.rochester.edu)

Women with vitamin D levels below 32 ng/ml had a higher percentage of hormone negative cancers, known to be more aggressive. They also had a higher Onco Dx score, a genetic test of cancer cells that predicts the likelihood of metastasis.

In other words, higher vitamin D levels not only lessen the chance of getting breast cancer, but will likely also improve survival in those who have breast cancer. Read more »

Posted by & filed under Gastrointestinal.

Gastroesophageal reflux is common. It occurs when stomach acid moves up into the esophagus and causes burning, erosions or ulcerations. If the acid moves higher, it may enter the larynx or even the lungs, causing cough, wheezing or shortness of breath. Many patients with nighttime cough suffer from reflux, and are treated with antacids and proton pump inhibitors.

It now appears people with nocturnal reflux should also be evaluated for sleep apnea. During sleep apnea, tissues in the back of the throat, including the tongue, fall backward and occlude the airway. The body struggles to get enough air, leading to a tightening of abdominal muscles, and forcing the stomach up against the diaphragm. This pushes stomach contents up through the gastroesophageal sphincter (valve) into the esophagus, thus causing reflux.

Treatment for sleep apnea may also eliminate reflux. If you know of someone who is awakened by nighttime coughing, and doesn’t get a good night’s sleep, suggest evaluation for sleep apnea. The diagnosis will be missed unless specifically looked for.

Allan Sosin

Posted by & filed under Muscle/Joint Pain.

Twenty-seven million Americans have degenerative arthritis, called osteoarthritis. The rate of knee replacement surgery has dramatically risen, by a factor of ten in the last thirty years. Over 100,000 knee replacement procedures are performed every year. However, evaluation of knee x-rays has not confirmed an increase in radiologic abnormalities to coincide with the increase in surgical procedures. (Annals of Internal Medicine, Dec 6, 2011, pp. 725-731) Read more »

Posted by & filed under Cardiovascular.

An invasive cardiologist in Maryland recently had his license revoked by the state medical board for 2 years, for implanting unnecessary cardiac stents in his patients. He was the head of cardiology at his hospital. One day he had implanted 30 stents. Review of his cases revealed that he had overestimated the degree of blockage, and between 2007 and 2009 had inserted 585 unnecessary stents, at a cost of $3.8 million paid by Medicare.

Six hundred thousand angioplasties are performed in the US every year. Cardiac stents are of value in patients with new heart attacks, where they may reduce the extent of damage, and in patients with disabling angina, whose chest pain prevents them from performing daily activities or exercising. In patients with stable, non-limiting chest pain, heart catheterizations and stents offer no benefit, either in preventing heart attacks or prolonging life, over optimal medical therapy. Read more »

Posted by & filed under Muscle/Joint Pain.

A physician well-known to this corner had a sudden onset of severe low back pain going down both legs. He had been engaged in a vigorous physical program for years, and was in excellent condition. There was no known injury. MRI showed a large disk herniation between the second and third lumbar vertebrae.

The pain persisted over four months, with some relief from chiropractic, but he was still in pain.

Then he went to see a myofascial practitioner. Extremely tender trigger points were identified on both sides, in the buttocks, thighs and even lower legs, which, when pressed, exactly mimicked the lower back pain. These trigger points were pressed deeply and massaged. Specific exercises were directed to apply pressure to these points at home, using a rubber ball and foam roller, after range of motion and heat. Changes were recommended in sitting and sleeping positions.

The pain started to improve immediately, and after six sessions was about 70% resolved, only showing up at the end of the day.

Another individual developed severe rectal pain the day following prostate surgery. He was unable to sit, had to position himself on his side, and walking was impaired. Over the next year he saw numerous urologic and orthopedic specialists, pain specialists, had x-rays and MRIs, multiple injections, physical therapy, even an injection into a nerve plexus deep in the rectum, all without relief.

He went to a myofascial therapist. Severe trigger points were identified in his buttocks and treated. After only the second treatment his pain had improved and he could sit down again. Read more »

Posted by & filed under General.

An editorial in JAMA, Jan 4, 2012, deplores the persistent promotion of outmoded medical practices, in the guise of being valid.  (Reversals of Established Medical Practices, pp37-38)

Modern medicine presents itself as being “evidence-based,” meaning that its tests and therapies are proven by research to be valid.  Unfortunately for patients, that is patently not the case.  Many standards of care have never been tested in trials, or worse, have been tested and shown to be wanting in efficacy.  In a recent evaluation of 35 trials of established medical practices, 46% reported results consistent with the current practice, but an additional 46% offered results contradicting current practice, and another 8% were inconclusive.  In other words, more than half of the practices were lacking or had dubious validity.

Among the invalid therapies are vertebroplasty for spinal fractures, demonstrated in two studies to lack effectiveness, but nevertheless now utilized as much or more than before the studies were published.  Another invalidated procedure is the use of coronary artery stents in the treatment of stable angina.  Stents provide no advantage in survival, although they do reduce exertional chest pain, but so do medications, and with much less risk.

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Posted by & filed under Attention/Cognitive, Food.

Of 260 normal older adults, those who ate baked or broiled fish weekly, but not fried fish, had greater gray matter volume in areas of the brain responsible for cognition and memory.  After 15 years, 47% of those who didn’t have fish at least once a week developed Alzheimer disease or other cognitive impairment, compared to 28% of those who ate fish regularly. (JAMA, Jan 4, 2012)