Archive for the ‘Chronic Illness’ Category

Nasal Irrigation Can Cause Sinus Infection

November 17th, 2009

Nasal Irrigation, Nasal Cleansing, Nasal Irrigation, Neti Pot, Sinus Infection

For pure misery, a sinus infection does the trick nicely — making the head pound, the tissues of the nasal passages feel like they’ll burst from pressure, even making the ears and gums and roof of the mouth throb. Plus, they trigger coughs and cause fever. Now imagine having sinus infections regularly, every few months or so. Those who have "recurrent rhinosinusitis" desperately seek relief, and for many of those sufferers, nasal irrigation seems like a godsend. It’s cheap, it gives instant relief, and until now, it seemed completely safe.

Researchers from Georgetown University found that people who used nasal irrigation every day significantly up their risk of having recurrent sinus infections. Nasal irrigation entails using a saltwater solution and a device called a "Neti pot." (It can also be done using a cup instead of the neti pot, and with other solutions that break up mucous, such as Alkolol.) The sinus sufferer simply takes the solution up the nose and then lets it run out, along with impacted mucous. For most sufferers, the process unblocks mucous from the ears and nose enough so that the pain diminishes right away. It also may actually heal the infection, providing an alternative to taking antibiotics. Many people believe that regularly rinsing out the mucous keeps new infections from forming, and so they irrigate not only to treat active infections, but also to prevent future ones. But the Georgetown University researchers say too much of even this good thing may not be so good, after all.

The study followed 68 chronic sinusitis sufferers who used nasal irrigation twice a day for a year. The next year, the subjects stopped the daily nasal irrigation completely, and their incidence of sinus infections went down by 62 percent. Put another way, the year that the subjects rinsed twice, every day, they suffered an average of eight episodes of sinusitis a year. After they quit the irrigation, they only had three episodes a year. Plus, the study included a control group of 24 subjects who continued to rinse every day while the original group discontinued rinsing. Those who kept rinsing had a 50 percent higher incidence of new sinus infections.

How could clearing out mucous possibly increase risk of sinusitis? "Daily long-term use [of nasal irrigation] may result in an increased frequency of acute [sinusitis] by potentially depleting the nose of its immune blanket of mucus," researcher Talal M. Nsouli, MD, wrote in a paper presented at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) recently.

According to Dr. Nsouli, "By washing the nose, we are removing the bad mucus but, unfortunately, we are also removing the good mucus that contains the antimicrobial agents as well."

Apparently, mucous contains immunoglobulin A, immunoglobulin G, lactoferrin, and lysozyme, which act as antibacterial, antifungal, and antiviral agents. So there’s good mucous and "bad" mucous, just as there are good intestinal bacteria and not-so-good bacteria. When you take antibiotics and kill all the intestinal bacteria, you end up with gastrointestinal problems and a compromised immune system. That’s why it’s important to take probiotics if you find yourself in the unfortunate position of needing antibiotics — to replenish the good bacteria that gets stripped out. In the same way, when you flush out all mucous, you strip away the protective element and upset the natural balance of the body. Mucous is there for a reason. It’s only when it’s old and dried or carries more infected material than not that it needs to be flushed out.

"I don’t have anything against short-term nasal saline irrigation — even aggressive nasal saline irrigation for three, four days or one week is totally fine," Dr. Nsouli said. "But when we are doing it on a daily basis, we are modifying the immunological biochemistry of the nose."

Dr. Gaelen T. Marshall, who edits Annals of Allergy, Asthma and Immunology, agrees that short-term use is advisable. "It is still a good idea to get rid of mucus through a saline wash when a patient has a cold," Dr. Marshall says. "But as with anything else, you can overdo it.

Of course, all of these "medical" statements must be taken with a grain of salt (tada!) since all this attention on the dangers of nasal irrigation serves the pharmaceutical industry well. We don’t necessarily need to throw the neti pot out with the saline solution. And remember, many medical practitioners still consider the first-line treatment for sinus infection to be antibiotics. And antibiotics can lead to chronic sinusitis plus a lot more trouble. Given the choice between nasal flushing and antibiotic treatment, the neti pot surely seems the less dangerous — just don’t use it twice a day, every day, on a prophylactic basis, at least not until more research comes in.

PS: And here’s a nice trick if using the neti pot while you actually have a sinus infection or cold. In addition to the salt, you can add a couple of droppers  of a good Echinacea based tincture to aggressively "go after" the bad guys.

:hc

Stress Makes the Belly Ache

November 14th, 2009

Stress, PTSD. Post-traumatic Stress Disorder, 9/11, Stomach Ache, GERD, Acid Reflux, Gastrointestinal Issues

The expression "stop bellyaching" tells a lot about how stress affects the body. For many people, when problems attack, so does a stomach ache.  Certainly it’s no surprise that tension messes up the gut, but the degree to which it creates serious gastrointestinal issues might surprise you.

A recent study out of Stony Brook University Medical Center in New York evaluated 697 patients who had helped clean up after the events of 9/11. Four to five years after the cleanup, 41% had gastroesophageal reflux disease (GERD), compared with about 20% of the general population. GERD occurs when stomach acid or bile backs up into the esophagus, causing chronic heartburn and acid reflux. It’s an uncomfortable condition at best; debilitating at its worst, sometimes driving victims to surgery.

It’s noteworthy that even without an obvious triggering trauma, one out of every five adults in the general population has the disease. That’s a huge percentage, but not surprising given that obesity often links to GERD and so many people count among the obese. It’s also relevant that exposure to acute trauma such as that experienced by people cleaning up human remains at the World Trade Center site not only doubled the incidence of GERD, but also caused gastrointestinal symptoms that persisted for years (and that still persist, the research shows).

The researchers found that length of time at the cleanup site correlated with risk of GERD — the longer the exposure to the site, the greater the likelihood that the person developed gastrointestinal disease. No correlation was found to obesity among the cleanup workers. The researchers attribute this phenomenon to stress — not to environmental toxins.

Not surprisingly, many of the 9/11 cleanup workers suffer from continuing psychological problems, and the researchers found that such problems correlate to GERD. Five years after the cleanup, 21% of those with GERD had post-traumatic stress disorder (PTSD), 21.5% were clinically depressed, and nearly 30% had anxiety disorder. Two years later (seven years after the trauma), the numbers of those with both GERD and mental health problems actually went up. By 2008, almost 33 percent of the GERD sufferers reported depression. In fact, having several mental health disorders — for instance, both anxiety and depression — made the risk of GERD among the 9/11 workers almost inescapable. Among those with both depression and anxiety, 64 percent had GERD. Add PTSD into the mix, and that rate goes up to almost 70 percent.

It seems counterintuitive that as the years since 9/11 have passed and the traumatic events have become more distant, those originally exposed to the trauma have experienced an increase rather than a decrease in associated gastrointestinal and mental health symptoms. So much for the "time heals all wounds" theory. The explanation might be that untreated grief and trauma don’t disappear with time, but rather, simmer beneath the surface, creating a snowball effect. In any event, the researchers suggest that treating mental health issues may be key to resolving the gastrointestinal health issues.

As Dr. Douglas Brand, one of the researchers involved in analyzing the study data, says, "Eight years after 9/11 we are still realizing the aftereffects on those who responded and participated in the massive cleanup efforts. Shortly after this highly stressful and toxic exposure, the appearance of GERD characterized by high comorbidity [the addition of one or more disorders in addition to the GERD] with mental health disorders, but no relation to obesity or smoking, suggests that mental health disorders may play an important role in the persistence of GERD among these workers. Thus, treatment of the underlying mental health disorder may be necessary to resolve the physical manifestation of GERD."

Hopefully the experts will take to heart evidence that counseling needs to be given to those exposed to trauma at the time of the exposure — even if the victims of that exposure seem functional — rather than letting trauma reactions (and concomitant physical symptoms) develop over the ensuing years.

Meanwhile, a simultaneous study found another reason that high-stress environments induce bellyaches. Dr. Mark Riddle of the Naval Medical Research Center in Bethesda, Maryland, studied the impact of infectious gastroenteritis among military personnel on the subsequent development of long-term gastrointestinal diseases including irritable bowel syndrome. Infectious gastroenteritis includes such conditions as diarrhea and dysentery, commonly contracted by people traveling and living in stressful situations.

When we deploy overseas, one of the biggest risks is infectious gastrointestinal disorders," Dr. Riddle said. "By six months, troops will usually have one or more episodes of infectious gastroenteritis." Doctors typically prescribe antibiotics to wipe out the causative bacteria and end the acute episode, but this study found that once infected, the victim may suffer far-reaching and long-lasting consequences far beyond the run-of-the-mill dysentery bout. Those who had experienced even one incident of infectious gastroenteritis were at six times the risk for subsequent functional diarrhea, and at four times the risk for irritable bowel syndrome.

The researchers point to the continued stress that troops remain subject to as a triggering factor in developing gastrointestinal diseases once a vulnerability has been established through prior infection. Dr. Riddle also notes that the vulnerability may be related to changes in "gut microbiota or neural symptoms related to the gastrointestinal tract."
In other words, though the antibiotics may take care of the infection, something is messing up the gut bacteria. Reading between the lines, it looks like all fingers point to the antibiotics doing long-term damage, stress or no stress. (Once again, as I always point out, after exposure to antibiotics, you need to supplement with a good probiotic formula to rebuild populations of beneficial bacteria.)

Considering the vulnerability of the gastrointestinal system to stressors both environmental and psychological, we can only hope that the experts get smart and start distributing mental health care to those exposed to trauma, as well as supplements that replenish gut flora and education about how to protect and revitalize the bowels. And as for GERD/Acid Reflux, you might want to read up on exactly how it manifests in your intestinal tract and the various natural health approaches you can use to overcome it. I’ve covered this extensively, in my newsletter series on the intestinal tract, but if you just want to cut to the chase and jump right in, you can start with Your Stomach, Part 3.

:hc

Living Near Green Good for Health

November 5th, 2009

Green Space, Green Areas, Parks, Health, Mental Health, Disease

At the turn of the last century, a popular cure for most major ailments was a stay in the country. The fresh air, it was believed, could strengthen a weak constitution and restore health. Now, new evidence shows that proximity to things green and alive in fact does exert a curative, or at least a protective health benefit.

Researchers from the EMGO Institute VU University Medical Centre in the Netherlands studied the medical records of 345,143 adults. Sorting the records by postal code, the researchers determined the percentage of green spaces such as parks or forests within two miles of each patient’s home. They then reviewed the records for prevalence of 24 different health conditions and found that those subjects living closest to green areas had a lower incidence of 15 of the 24 diseases on the list.

Apparently, the closer to the green, the more powerful the healing effect experienced. Head researcher Jolanda Maas, PhD, says, "The strongest associations we saw between green space and health occurred within a one kilometer [0.6 mile] radius of the home."  Also, the association was strongest for children, for low-income people, and for those who lived in slightly urban areas rather than in the inner city.

Of the conditions studied, mental health problems were the most affected by the presence of green. Those who lived close to parks or other natural areas had a 30 percent reduced risk of anxiety disorders requiring treatment and a 20 percent reduced risk of needing treatment for depression. It’s no secret that anxiety and depression can lead to a host of other health problems over time. In fact, both anxiety and depression negatively affect longevity, and so if green deprivation compromises mental heath, that surely has some spillover to physical health.

Among the physical ailments, respiratory conditions responded most dramatically to proximity to green. The data showed a sharp reduction of asthma rates, COPD, and upper respiratory infections among people who lived close to nature. An association also was found between green and lowered rates of cardiovascular disease, diabetes, cancer, and even back problems.

Earlier studies also underlined the palliative effect of green. Last year, researchers at the University of Glasgow found that the sizeable disparity in mortality rates between rich and poor families narrowed in residential areas closest to nature. In fact, the gap between rich and poor living in the greenest areas was half that in the most urban. In densely urban areas devoid of green, the mortality rate among poor people exceeded that of rich people by 1.93 times, but in the greenest areas, that gap shrunk to 1.43. When considering only death rates by cardiovascular complications, the figures become even more dramatic, with low-income people living in the least green areas having 2.19 times the incidence of death compared to their rich neighbors. But in the greenest places, the cardiovascular death gap between rich and poor ratcheted down to 1.54. Then again, we already knew that the closer people lived to heavily trafficked roads, the higher the incidence of cardiovascular disease.

But what causes the "green effect"? Researchers believe that those living nearest parks and outdoor recreational areas get more exercise, taking advantage of the opportunities such areas provide. This is particularly true of children. Parks also lead to social encounters, which improve mental health. And, people use parks and green areas simply to relax, so they can be major stress reducers. The researchers think that the reason the effect of green diminished in the heart of the city is because urban parks are considered unsafe so people use them less.

"The role of green space in the living environment for health should not be underestimated," the study authors wrote in the Journal of Epidemiology and Community Health. "Most of the diseases which were found to be related to the percentage of green space in the living environment are highly prevalent in society and in many countries, and they are the subject of large-scale prevention programs." The authors say that opening more green space might be an effective use of disease-prevention funds.

Interestingly, the authors did not mention several factors that might be key. First, where green dominates, the golden arches don’t. In other words, neighborhoods with plenty of natural areas probably don’t have fast food joints on every corner, and that means less access to junk food. Studies have shown that the closer people live to fast food restaurants, the more likely that they’ll have major health problems. Also, more green usually means fewer roads and buildings, which translates to fewer emissions from automobiles and places of business. Again, studies have repeatedly shown that the more pollution in the air, the greater the risk of numerous diseases and death. And finally, of course, plants actually remove pollutants from the air.

In fact, an analysis in Australia determined that if roofs in that country’s major cities were replaced with "green roofs" consisting of live plants, the carbon dioxide emissions could be reduced by half a million tons each year. While green roofs cost a bit more than regular roofs to construct, they increase roof life by two times and experts say costs can be recouped in a few years. Although not so common in the US, sales of green roofs in Europe are, so to speak, "through the roof," with 700 million Deutsch Mark in sales in 1997 in Germany alone. Of course, it might be far more satisfying to walk through a field filled with flowers or to bike through the woods than to climb up to your urban roof for a green fix, but at least the roof is close to home.

When you think about, real estate agents may have been onto something all these many years when they said, "The three most important things to consider when buying a home are: location, location, and location." But who knew they were talking about your health?

:hc

Economic Downturn Good for Health

October 27th, 2009

Recession, Depression, Longevity, Health, Mortality, Institute for Social Research

When the economy tanks, not everything goes into the toilet. Though it seems as counterintuitive as Magnetic Hill, where cars in neutral roll up the mountain, history shows that during economic recessions, longevity increases and health improves. In fact, according to a new study out of the Institute for Social Research at the University of Michigan, Ann Arbor, the Great Depression ushered in a considerable leap in life expectancy, but as soon as the economy looked sunny again, life expectancy took a nosedive.

The study focused on the two decades between 1920 and 1940, a period of extreme economic volatility. During the years of the Depression, from 1929 to 1933, the gross domestic product dropped five percent while the population experienced a 6.2-year gain in life expectancy. The pattern held true for both genders and across ethnic groups. While life expectancy has consistency climbed since the 1920s (it was 57.1 years in 1929, and currently is 77 years), the gains were greatest and fastest during the years of the worst economic conditions. In the case of this study, life expectancy rose by 8.8 years during the entire 20-year span, with, as mentioned above, the majority of the increase — 6.2 years — occurring during the four years of the Depression. Of course, one needs to read life expectancy numbers with a skeptical eye since they don’t always mean what you think they mean.

Nevertheless, throughout the 20 years studied: whenever the economy improved, mortality rates went up. Whenever the economy suffered, mortality rates went down. Translated another way, according to Dr. Christopher Ruhm of the University of North Carolina, for every increase of one percent in unemployment, mortality rates drop by half a percent. And according to research director Dr. A. Tapia Granados, the same thing happened during the recession in the early 1980s and 1990s. Recessions abroad have seen the same pattern. On virtually every health parameter studied — heart disease, kidney disease, cancer, pulmonary disease, tuberculosis, infant mortality — recession ushered in improvements. The only exception was death by suicide, which did increase during the Great Depression.

"This is a pattern that is found again and again," Dr. Granados confirmed. "The basic finding … is that mortality rates tend to evolve in parallel to the economy. When the economy goes up, mortality tends to go up. When the economy goes down, mortality rates tend to go down, too."

The scientists have no definitive explanation for the unexpected phenomenon, but they do have some theories. First, they cite the fact that fewer people drive automobiles when the economy is bad. This means that fewer die in automobile accidents, which helps mortality statistics. It also means that air pollution from vehicular emissions decreases, reducing deaths triggered by particulate matter. Along a similar line of reasoning, when companies shut down, they add less pollution to the air, and so in times of low productivity air quality improves. Then again, wouldn’t the health benefits of better air quality be reflected several decades down the line after long term non-exposure?

An article in US News and World Report suggests that recession cuts into people’s cigarette and alcohol budget, and the less people drink and smoke, the healthier they stay. It’s a good theory, but there’s a credibility gap given the fact that recent data indicates that cigarette sales have gone up for the first time in years ever since the recession hit. Recent tax increases on cigarette sales may be impacting that trend, but overall, alcohol, tobacco, and chocolate are among the few items still selling well in spite (or possibly because of) the economy. And again, as with air quality, wouldn’t the mortality benefits show up several decades down the line? I mean, it’s not like you get cancer one month after smoking your first cigarette.

Dr. Granados postulates that the debilitating impact of working too hard explains higher mortality in boom times. "During expansions, firms are very busy, and they typically demand a lot of effort from employees, who are required to work a lot of overtime, and to work at a fast pace. Also, new workers may be hired who are inexperienced, so injuries are likely to be more common," he says. He suggests that the stress may drive people to smoke, drink, and eat unhealthy foods — but again, data shows that smoking and drinking rates stay relatively stable as the economy fluctuates. But he’s probably on target in suggesting that work demands may cause people to sleep less, and of course, there’s the general impact of stress on the body to consider — and that’s a huge factor. Then again, you might think that being out of work would be incredibly stressful, but as it turns out, it’s not that simple.

Along those lines, another study perhaps offers some clues. The University of Michigan research compared two groups of subjects, one surveyed between 1986 and 1989 and another between 1995 and 2005. The study found that those who "feared" losing their jobs suffered far more health-wise than those who had actually been laid off or fired. "In fact, chronic job insecurity was a stronger predictor of poor health than either smoking or hypertension in one of the groups we studied," the director of that study, Sarah Burgard, said.

The other viable theory that Dr. Granados puts forth is that economic distress causes people to band together. People have more time to spend socializing, and they tend to support each other more than when everyone has money. "This would improve the level of social cohesion and social support and could have a protective effect on health," he says.

One possibility that none of the experts put forth is that when people can’t afford medical treatment, they fare better simply by avoiding doctors. They aren’t subject to harmful pharmaceuticals, hospital disasters, and dangerous diagnostic and surgical procedures. While public health officials fret and sigh that people aren’t getting the care they need, in fact, doing nothing may oftentimes be healthier than going to the doctor. Given the 98,000 deaths annually from medical error in the US, less exposure to medical practitioners may have a bigger impact on declining mortality rate than those other factors named. The bottom line is that it is not a coincidence that time after time, when doctors go on strike, mortality rates drop dramatically in those cities or countries affected by the strikes.

I’m certainly not saying there’s no place for health care and that we should all just ride out whatever ailments assail us without any intervention. But if illness does come, a natural health regimen may be the safest first choice, reserving pharmaceuticals and surgeries for the most dire cases and for illnesses that won’t respond to less invasive approaches. Hopefully, this is a lesson the public can learn without having the economy completely bottom out.

:hc

When Patients Ignore Symptoms

October 24th, 2009

Health Information, Medical Advice, Cardiovascular Disease, Heart Attacks, Ignored

One of the great advantages of HMOs, at least according to advocates, is that they typically offer patient education, a key preventative health measure. But recent evidence indicates that merely providing health information and medical advice doesn’t guarantee that patients will heed it.

A new study just published in the journal Circulation: Cardiovascular Quality and Outcomes, followed 3522 people with an average age of 67, who had a history of heart problems. Half of the subjects received intensive counseling about how to recognize heart attack symptoms and when to seek help. The study found that the patients who received the counseling were not one bit more likely to seek help at the appropriate time than patients who had received no such coaching. During the duration of the study, 565 of the subjects made use of emergency medical services due to cardiovascular symptoms.

The subjects who had received counseling waited 2.2 hours between experiencing symptoms and getting to the hospital, the un-counseled group waited 2.25 hours. Given the fact that patients need to receive treatment within 90 minutes of the onset of symptoms in order to prevent the worst outcomes, and given that the counseled group had been warned about the 90-minute window, the education clearly failed to make a dent. Also, the patients who hadn’t received counseling actually made better use of the emergency medical system, employing it 66.9 percent of the time, versus only 63.6 percent for the "educated" patients. Again, this points to the failure of the counseling, which focused on the urgency of getting to the hospital immediately and using the emergency medical system to expedite delivery of services.

In the case of cardiac problems, not heeding medical advice can mean big trouble — trouble, of course, best avoided by implementing natural health practices that prevent heart disease in the first place. But this blog entry isn’t about people following the advice of natural health practitioners; it’s about people following the advice of their doctors. And, as it turns out, advice issued after medical problems have developed often comes too late and patients don’t listen anyway, as other studies attest. It seems that the impulse to ignore what the doctor says may come with the human psyche. Patients consult doctors, but they don’t always like what they’re told and in the end, do what they please.

One study found, for example, that two-thirds of patients with gum disease ignore advice given by their dentist about how to brush their teeth. And if you think the results of such noncompliance would not equate to the dire consequences of failing to act in the case of cardiac warning signs, you would be wrong. Serious medical conditions associated with periodontal disease include, rheumatoid arthritis, diabetes, and heart disease. As it was, the dentists in the study advised patients to brush for two minutes twice a day. The patients used special toothbrushes that recorded brush time, and the vast majority fell short, though half believed that they had complied.

One of the lead researchers, Professor Peter Heasman of Newcastle University, said: "I think that many dentists and dental hygienists are fully aware that their patients do not always follow their professional advice. Nevertheless, we were surprised to find so many of our patients who were unable to follow instructions accurately, even in the short term."

Dr. Heasman’s comment allows that patients might not understand that non-compliance can really lead to loss of teeth [and death], rather than assuming deliberate non-compliance. But deliberate non-compliance seems to be the reason that college students ignore advice to wash hands regularly as a flu-busting measure, a recent study found. The schools involved in the study placed sanitizer gel dispensers at the entrances to public buildings, with signs urging students to make use of the gel, but only 17 percent of students did so. At New York University, students received flyers and emails urging them to wash hands and stay out of classes if they became ill, but again, most simply paid no attention.

NYU freshman Daniel Lee explains, "I think most people just toss the fliers out without giving them a second thought."

Perhaps of greater concern is the fact that young people also ignore advice about taking pharmaceuticals, according to a 2001 study by the Royal Pharmaceutical Society in Great Britain. The study followed 200 people aged 18-39, and found that only a small minority followed the instructions they were given with their prescription medicine. One-third ignored advice to avoid alcohol when on their pills, many drove when on medication that could make them drowsy, and 50 percent stopped taking their medications before completing the recommended course.

What’s going on here? Are people unable to pay attention long enough to grasp the advice? Are they simply cantankerous, rebellious, pig-headed? Or is ignoring medical advice sometimes actually called for?

In fact, while doctors fret and moan about patients who fail to complete the course of their medications, given the side effects of so many medications, stopping may be "just what the doctor [should have] ordered." For instance, the recommended course for antibiotics keeps shrinking. Whereas a 10-day course of treatment once was standard for upper respiratory infections, doctors in Europe now typically prescribe only five days. Recent research indicates that three days of treatment for non-acute pneumonia works as well as five days. So patients who use their own intuition and stop after a few days may simply be in advance of the medical establishment. When patients stop taking medications that make them feel awful, they may be making the wise choice — or they be helping to breed resistant strains of viruses and bacteria that threaten all of humanity. The problem is that they don’t necessarily know what alternatives are available to them (no thanks to the medical professionals), and doing nothing may be dangerous.

There’s also the fact that a very recent study found that the percentage of patients leaving the hospital against medical advice has increased 40 percent in recent years. Still, only 1.2 percent of all hospital patients self-discharge, and many of those leave for financial reasons; but patients who leave because they fear getting worse in the hospital are on to something real, given the fact that hospital-induced infections are legion, and medical errors account for 98,000 wrongful deaths a year in the US alone.  

In short, it often makes sense to heed advice intended to prevent problems in the first place. If you ignore heart-attack symptoms, you can end up dead within a few hours. If you fail to brush your teeth thoroughly, you can end up toothless, diabetic, or dead from a heart attack. If you drink while on prescription meds, you’re asking for trouble. But sometimes it makes sense to ignore advice that would hurl you into the pill-popping, hospital frequenting medical mainstream, as long as you know what alternatives might work more safely and effectively.

:hc

Showerheads Spread Disease: Health Blog

September 22nd, 2009

Showerheads, Bacteria

The bacteria police are at it again, having already discovered that handbags, money, and recyclable shopping bags teem with bacteria. Now they have a new and surprising item to add to the gross-out list. Ironically, it’s an item you most likely think of as antibacterial. After unscrewing 50 showerheads across the country and examining the contents, researchers from the University of Colorado discovered that a full third of them harbored dangerous bacteria that could cause lung infections and breathing problems. It turns out that showerheads are a perfect environment for the formation and growth of biofilm — i.e, warm, moist, and protected.

So much for getting disinfected in the tub. The researchers found 15 different types of bacteria hiding in the fixtures, including a particularly high concentration of Mycobacterium avium, a relative of the tuberculosis microbe. This species of bacteria thrives in city water supplies that chlorinate, because it’s resistant to chlorine and so can proliferate wildly when competitive bacteria get wiped out. It causes a nasty, antibiotic-resistant infection that can linger for years, with symptoms ranging from persistent cough to fatigue and breathessness. Doctors have been seeing steadily increasing numbers of people with infections caused by Microbacterium avium, particularly women who have compromised immune systems. They postulate that the spike in these lung infections has everything to do with showers — with the fact that showers have become more popular than baths, and also because of the chlorinated water issue in municipal systems. In fact, four of the shower heads tested came from rural homes supplied by private wells, and no Microbacterium avium were found in those.

Just how bad is the problem? To give some perspective, put this in your shower-cap: when in New York, the researchers tested the air in city subways and found that breathing subway air is healthier than breathing shower vapors, at least from a microbial point of view. The showerheads the team tested had 100 times more Mycobacterium avium than tap water from the faucet. The dark, moist environment provided by the showerhead creates a perfect breeding place for bacteria, and so they thrive there. This means that when you first turn on the shower, beware. That first blast most likely contains the highest concentrations of bacteria, fresh from the nozzle.

“If you are getting a face full of water when you first turn your shower on, that means you are probably getting a particularly high load of Mycobacterium avium, which may not be too healthy,” one of the researchers, Norman Pace, said.

Apparently, the bacteria suspend themselves in droplets of water and when you inhale, you take those bacteria deep into your lungs, where they can wreak havoc if you’re immune system isn’t buff. “The water droplets formed when a shower is turned on are very, very small and can go deep into your lungs and carry bacteria deep into your lungs, which is how you get disease,” said study director Leah Feazel. “A bath, on the other hand, doesn’t usually have the aerator on it to create these tiny particles and is therefore safer.”

Does this mean that you should either walk around grimy rather than chance a shower or draw a bath if you want to get clean?

Not necessarily. First, the scientists say that metal showerheads are far less bacteria-friendly than plastic ones, so you can switch to metal to minimize problems. In fact, you should replace showerheads a few times a year, they say. Cleaning out the old fixture probably won’t do it; the researchers found that bleach did not kill the microbes (remember, avium is resistant to cholorine). “We tested bleaching shower heads and we actually found that we had more of the mycobacteria after bleaching than we did before,” said Ms. Feazel. She suggests letting the water run for 30 seconds or so before immersing yourself — although this, admittedly, isn’t an environmentally friendly solution. You do have the option of using a whole house filtration system. And there are even some dedicated shower filters that incorporate silver to actively kill bacteria.

Then again, the researchers claim that if you have a strong immune system, you can probably ignore all of the above. “This really shouldn’t concern average, healthy people. The main concern is for people who are immune-compromised,” the researchers say, athough they admit that even healthy people can succumb. On the other hand, the more you force your immune system to fight the effects of your morning shower, the less immune function is available to fight everything else you face, from swine flu to cancer.

In any event, the shower-head is just one of many dangers lurking in the bathtub. I recently wrote about PVC in vinyl shower curtains, which can cause serious damage to the liver as well as to the nervous, reproductive, and respiratory systems. Then, if your water is chlorinated, there are the carcinogenic properties of chlorine to fret about.

It’s enough to make you want to return to the middle ages when people bathed once a year and carried flowers to the altar to cover the smell.

:hc

Optimism Adds Years: Health Blog

September 10th, 2009

Optimism, Longevity

When Norman Vincent Peale wrote the Power of Positive Thinking, he didn’t focus on longevity as one of the benefits of happy thoughts. The many imitators who have followed him, including the authors of The Secret, also don’t hype long life as a chief benefit of thinking positive. On the other hand, I actually devoted a whole chapter, “The Thought that Kills,” to the subject in Lessons from the Miracle Doctors. And in fact, several major studies over the years have backed me up and discovered that optimistic thinking does result in longer life. 

The latest study to confirm this link comes from The University of Pittsburgh, where researchers culled data from the Women’s Health Initiative study of more than 100,000 women over age 50 followed since 1994. The researchers found that optimistic subjects were 14 percent more likely to still be alive eight years into the study, and nine percent less likely to develop heart disease. Also, confirming the old sorcery idea that if you send out hostility it may come back to strangle you, the study found that women who hold hostile thoughts toward others or who are mistrustful do seem to suffer a boomerang effect, with hostility upping the risk of dying by 16 percent within the eight-year window. (What can I say? I love each and every one of you reading this.)

The researchers ascertained just how optimistic the subjects were by asking them to respond to a series of standardized statements such as, “If something can go wrong for me, it will,” “In unclear times, I usually expect the best,” “I’ve often had to take orders from someone who didn’t know as much as I did,” and, “It’s safest to trust nobody.” Apparently, even after controlling for other health issues and lifestyle factors (none of the women had cancer or heart disease at the outset), the optimists outlived the pessimists. Study director, Dr. Hillary Tindle of the University of Pittsburgh comments, “Taking into account income, education, health behaviors like controlling blood pressure and whether or not you are physically active, whether or not you drink or smoke, we still see optimists with a decreased risk of death compared to pessimists.”

As a side note, race plays a role in the happy-thoughts factor, with black women particularly vulnerable to death by misery. The pessimistic black women in the study had a whopping 33% greater risk of dying compared to their optimistic cohorts. Researchers don’t know why this discrepancy occurs. Also, earlier studies found that gender counts, with optimism playing an even greater role in longevity for men than for women.

One study that confirmed the gender factor also found a far stronger correlation between optimism and longevity than the current research. According to that study, which was led by Dr. Erik Giltay of the Psychiatric Center GGC in Delft, the Netherlands in 2004, optimists have a 55-percent reduced risk of death from all causes. The subjects included about 1000 men and women aged 65-85 who completed a 30-item “optimism” test. The most optimistic subjects not only lived longer than the least optimistic over a 15-year period; they also had a 23 percent reduced chance of death by cardiovascular event.

The authors of that study wrote in The Archives of General Psychiatry, “We found that the trait of optimism was an important long-term determinant of all causes [of death] and cardiovascular mortality in elderly subjects independent of socio-demographic characteristics and cardiovascular risk factors. A predisposition toward optimism seemed to provide a survival benefit in elderly subjects with relatively short life expectancies otherwise.”

Why does optimism seem to up the lifespan? The researchers essentially shrug their shoulders, although Dr. Tindle does put forth two theories. First, upbeat people tend to have more friends and larger social networks, which means that they probably get more support during crises. Also, they handle stress better, which means they not only stay happier, but their bodies manage the physiological impact of stress better. Then again, as I point out in Miracle Doctors, there are numerous studies that identify the direct connection between what you think and your immune system. Happy thoughts jack up your immune system. Unhappy thoughts shut it down. That alone would have a major impact on life expectancy.

So what can you do if you’re not naturally ebullient but you would like to live longer (despite your belief that it will be a long, miserable haul)? Find ways to handle your stress. One previous study of monks and nuns in Hamburg, Germany found that the monastic life leads to longevity, which the researchers attribute to the routine and lack of stress encountered by the cloistered subjects. Short of entering the monastery, though, maybe Stuart Smalley (Al Franken) was onto something. No matter what went wrong in his life, he was always able to affirm, “I’m good enough. I’m smart enough. And doggone it, people like me.”

:hc

Antidepressants Up, Therapy Down: Health Blog

August 13th, 2009

Antidepressants, Depression

Here’s some depressing news: Antidepressant use in the US has nearly doubled since 1996, according to a study out of Columbia University and the University of Pennsylvania. The study found that over 10 percent of the US population aged six and up now takes an antidepressant. Of those on antidepressants, only 20 percent get additional help from psychotherapy of any sort. These figures represent a breathtaking change from 1996, when (a still hefty) 5.84 percent of the population took antidepressants but of those, 31 percent saw a therapist. In the years leading up to 1996, we see an even more dramatic spike, with antidepressant use almost tripling in the six previous years between 1988 and 1994.

While it’s amazing to think that at this point 27 million Americans — one out of every 10 men, women, and children — depend on pharmaceutical drugs to get through the day, it’s even more incredible to consider that the vast majority don’t get any additional help to address the underlying issues causing the depression. They don’t get support handling difficult emotions, they don’t learn how to handle grief, when to leave destructive situations or how to improve them and so on — benefits that psychotherapy conveys. And so, the painful situation or chemical or nutritional imbalance triggering depression remains intact, ensuring continued dependence on drugs in order to cope. It’s the psychological equivalent of taking blood pressure medication without addressing the dietary issues that cause hypertension in the first place.

As of now, antidepressants are the most commonly prescribed drugs in the US, at 118 million prescriptions a year. According to Dr. Kelley Posner of Columbia University Medical School and the New York Psychiatric Institute, 25 percent of all adults have at least one major depressive episode at some point in their lives. The World Health Organization (WHO) predicts that by 2020, depression will be the second leading cause of the global health burden. If they’re right, that means that there’s still room for more prescriptions. In fact, Dr. Posner thinks that lots of people who need the prescriptions don’t get them. “Fifty percent of African-Americans who have depression don’t seek treatment for it,” she said. “Not enough people are getting the treatment they need.”

More drugs! More drugs! Everyone needs more drugs.

Others, however, have a more skeptical view. For instance, Dr. Ronald Dworkin, author of the book Artificial Unhappiness, says, “Doctors are now medicating unhappiness. Too many people take drugs when they really need to be making changes in their lives.” His colleague, Dr. Robert Goodman, a New York internist, agrees. He says that it’s not medical need that’s driving the surge in antidepressant medications, but marketing to both doctors and consumers. “You put those two together and you get a lot of prescriptions for antidepressants,” he said. “It’s hard to believe that number of people are depressed, or that antidepressants are the answer.”

Party pooper! Just when I was convinced that everyone should be on antidepressants.

Then again, studies show that cases of clinical depression have been multiplying by enormous increments, doubling right along with antidepressant medications in the past decade. But are more people actually depressed than in the past, or is some other factor at play, driving up the numbers? Says Dr. Eric Caine, chair of the Department of Psychiatry at the University of Rochester, “People are not so embarrassed [as before]; they are more open to seeking help for depression.” Perhaps that explains it, and also explains the rising number of antidepressant prescriptions.

Or perhaps it works in reverse: the rising number of prescriptions means that doctors need to slap the “depressed” label on ever more patients in order to justify dispensing the meds. And in fact, there seems to be a pattern here. As the old saying goes, “To a hammer, everything looks like a nail.” And so we see ever more members of the medical community saying, “More drugs; more drugs!” Thankfully, though, there are a handful of dissenting voices that say, “Maybe not.”

If people and their doctors believe that antidepressants are the answer, they might do well to look at the facts. According to an article in the New England Journal of Medicine last year, the press on antidepressants hasn’t presented an accurate picture. Of the 74 antidepressant studies submitted to the FDA between 1987 and 2004, only 38 were “positive.” The remaining studies found that antidepressants, in fact, did nothing to relieve depression. Zip. Nada. Ultimately, even the positive studies tended to find that the drugs worked only for the most severely depressed patients.

As I’ve written before, the potential payoff from taking antidepressants certainly seems negligible for most (not all, but most) people, especially considering the risks. Those potential risks range from increased depression and suicide to weight gain, nausea, congenital defects, chest pain, insomnia, stroke, and so on. Thirty percent of those on antidepressants experience sexual dysfunction, and a recent report found the drugs blunt the ability to experience and express love.

Certainly, there are effective and safe alternatives. First, as Dr. Caine points out, “In mild to moderate depression, psychotherapy is as good as or better than medications.” As I reported last year magnets have been found more effective than medication for many depressed patients. I’ve also reported on numerous supplements and herbal approaches that can help. And of course, dietary and lifestyle changes can make an enormous difference in mental outlook — just getting off sugar and starting to exercise can work wonders.

That said, there’s little chance that antidepressant prescriptions will decline anytime soon: quite the reverse. At this point, current sales net $11 billion worldwide, with sales in the US comprising 71 percent of that figure. Think about that for a moment. If taken literally, that means that 71 percent of all the depressed people in the entire world live in the US. And don’t get me started on the “fact” that 80% of all children with ADD and ADHD seem to live here too. Certainly the pharmaceutical industry won’t let such juicy profits slide, and their task is eased by the fact that neither the masses nor the medical establishment want to accept that, by and large, the pills are just expensive placebos. There’s just too much appeal (and too much money) in the magic bullet solution.

:hc

Reusable Shopping Bags Under Attack: Health Blog

July 23rd, 2009

Reusable Shopping Bags

Just when you think you’re doing something right for the world, along comes the reality slam that exposes the hidden flaw in your righteous endeavor. Remember last year when the dark side of energy-efficient compact florescent light bulbs was exposed, revealing that the bulbs leak mercury when broken, or when you learned that reusable diapers may not be more environmentally friendly than disposables? Now, it turns out that the virtuous recyclable shopping bags that so many of us proudly use might be sewage dumps for bacteria. Or at least, so says the plastics industry.

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More Bad News about Statins: Health Blog

July 16th, 2009

Statins, Muscle Weakness, Muscle Pain, Lipitor, Crestor

The latest brick in the tomb of statins — those cholesterol-regulating meds — comes from a new study confirming that the drugs cause structural damage to muscles. Even worse, the study, published in the Canadian Medical Association Journal, found that muscle damage can continue to progress even after patients stop taking the drugs. As study author Dr. Annette Draeger of the University of Bern, Switzerland, puts it, "Although in clinical practice, the majority of patients with muscle symptoms improve rapidly after cessation of therapy, our findings support that a subgroup of patients appears to be more susceptible to statin-associated myotoxicity, suffering persistent structural injury."

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