Hippocrates , the ancient Greek founder of medicine, along with his contemporaries, were cutting the bark off of willow trees to create a tincture that lowered fever, and alleviated pain. The active ingredient in these tinctures is called acetylsalicylic acid, more commonly called aspirin.

Chemists eventually discovered how to make aspirin in a lab and it became one of the best selling pharmaceuticals by the end of the 19^th century. Minor aches and pains, along with fever were treatable with mild medications for the first time. By the mid 1950’s and 60’s acetaminophen (Tylenol) and ibuprofen (Motrin and Advil) came on to the market. These drugs were more effective and less toxic than aspirin and the sales of aspirin began to decline.

During this time, scientists were discovering the biochemical mechanism of how aspirin worked. This research made it clear that aspirin prevented blood clots- just as heart disease, which is cause by clots forming in blood vessels, was becoming rampant in post-war United States.  Aspirin sales recovered and are now booming, not for the relief of pain and fever, but for the prevention of heart attack and stroke.

New research mentioned in the previous post seems to demonstrate that aspirin also prevents colon cancer. As a naturalist, I believe that most humans are healthy in their natural state and that the choices we make can lead to good or poor health, except in some rare instances. Using aspirin to prevent disease is tricky for a naturalist like me. It is preventative, but it is also a step taken after a health problem that could have been prevented has already occurred.

Aspirin is not harmless- it caused many deaths during the flu pandemic in the early 20^th century from overdose. Aspirin use is a leading cause of gastrointestinal and other forms of internal bleeding because it prevents clot formation. It can be toxic in fairly small doses and it has a wide array of effects. We just discovered that it can reduce the likelihood of colon cancer but there could be negative effects we still have yet to find.  But for people who already have risk factors for heart disease or stroke, or colon cancer, aspirin is certainly more natural than the alternatives. A chemical derived from willow bark appeals to my naturalist sensibilities more than removal of ¾ of a colon or sewing leg veins into the heart.

While I understand the need for the treatments to prevent and treat disease in people who have put themselves at risk, far too much emphasis has been put into these interventions and not enough on prevention. Modern medicine all too often approaches health as something that can be administered, when it is clear that health must be a discipline that we all practice, protect and cherish. I believe that nothing demonstrates this conflict more starkly than the inevitable rise of bariatric surgery. Check back soon for new research supporting this controversial set of procedures and why it makes me a bit uncomfortable.

Be Well ,

Dr. Bruce Feinberg

In the past week two high profiled medical research stories came to international attention.  Stories that are very unsettling to the many of us who are among the group of physicians who consider themselves naturalists.  The first of these studies published in Lancet revealed that a daily dose of low dose aspirin may not only prevent heart disease but also prevent cancer and decrease the risk of a cancer, if already present,  spreading through the blood (metastases).  The second story line published in the NEJM demonstrated that bariatric surgery (obesity surgery to reduce stomach size e.g., stapling), was more effective than medical therapy (pills, diet, and exercise) in controlling diabetes type II.  While many herald these results as medical breakthroughs, triumphs of modern science, man conquering disease, for others like myself they challenge core beliefs of how we should live and how we should manage our health.

I consider myself a naturalist which does not mean that I abhor science or its fruits of medicine, surgery, radiation, and technology.  The breakthroughs in understanding how the human body works and how it is under constant attack by our environment and the science breakthroughs to confront that onslaught is welcome.  Antibiotics dramatically increased life expectancy, vaccinations against the polio and small pox viruses prevented thousands from suffering and death, 85% of cancer in children is now curable.  However, as much as 70% of disease in younger and middle aged adults is self induced by smoking, sedentary lifestyle and obesity.  My belief structure is founded upon a philosophy that for the vast majority of us our natural state is one of health and it is our lifestyle choices that bring on many of the modern diseases that plague our society.  The extension of that philosophy is that if poor lifestyle choices can bring on these modern diseases then re-establishing healthy living can eradicate them.

These recent medical research trends obviously challenge that naturalist philosophy.  Surgery proved more effective than diet and exercise in controlling diabetes, more interesting still, blood sugars often normalized within hours of surgery suggesting a heretofore unknown mechanism for blood sugar control as calorie restriction and weight loss was previously thought to be the mechanism.

Similarly, irrespective of lifestyle, low dose daily aspirin demonstrated benefit in both vascular disease and cancer reduction — and even more interestingly — prevented cancer spread.

How to incorporate these results into the physicians tool-box, how to identify those who are best served by these interventions and those who may be harmed as no intervention is risk free is critical to optimizing the expansion of the medical arsenal against the onslaught of disease as we age.  Naturalists like myself will continue to struggle with such findings and continue to expound upon the benefits of healthy lifestyle but we must not ignore the science that we also cherish.  In the coming weeks we will provide more insight into these research breakthroughs that may forever change the landscape the medical care.

Be Well,

Dr. Bruce Feinberg

Hepatitis C is spread predominately via blood- by IV drug use and to a lesser extent, blood transfusions. The virus was not discovered until many years after the discovery of Hepatitis A and B viruses and it was not screened from the blood banks until years after it’s discovery. Hepatitis C is curable most of the time, if it is caught early…which is a big “if.”

What makes hepatitis C scary is that patients who are infected can often have little or no symptoms until years or decades after exposure to the virus. While many people become infected in their wild days of youth, they do not succumb to the illness until they are middle aged. Infection with the hepatitis C virus is most prevalent in the baby-boomer generation, those born between 1945 and 1965.

Hopefully, as we recognize the burden of disease shifting towards other illnesses, clinical practice will shift with it. Screening for hepatitis C is not routine, as it is still unclear if there is benefit form it and patients are unlikely to admit to the main risk factor, prior IV drug use. If caught soon enough hepatitis C can be cured 70% of the time and new, experimental treatments could cure up to 90% of infections. This gives me hope that we can figure out a way to prevent the loss of many lives and even more years of suffering from the virus, but changes must be made first. Despite more than 15,000 deaths per year and an estimated 3 million people with current hepatitis C infection, relatively little funding and public awareness exists about this disease. Beyond the confusing naming of the illness discussed in the previous posts, the reason for the lack of support is obvious; Hepatitis C is a taboo disease, it’s usually gotten from IV drug use.  I have little interest in passing judgment on things people may have done in their past. I do, however, see a source of suffering that some research and some will power could eliminate.

Be Well,

Dr. Bruce Feinberg

Just as researchers were discovering that a virus could be causing a great number of cases of hepatitis, a question soon became apparent. Why did some patients have bad initial symptoms but never have liver failure while others had no initial symptoms but later developed irreversible liver failure? Scientists were scratching their heads.  It was soon appreciated that there were two liver specific viruses that cause viral hepatitis so the first was named the Hepatitis A virus and the second the Hepatitis B virus. Hepatitis A could be acquired through food like shellfish, cause a moderate initial illness but had a very low risk of later liver failure.  On the other hand, Hepatitis B was often transmitted person to person, especially through blood and sex, often causing no initial illness but occasionally resulting in liver failure ten to twenty years later.  Understanding the differences was critical and led to the testing of all donated blood by the Red Cross.

For a long time researchers believed there was just Hepatitis A and Hepatitis B viruses. As technology has improved researchers have discovered many more viruses that primarily cause liver inflammation.  Today we have discovered five distinct viruses with the rather uncreative names Hepatitis A thru E and there is growing evidence for a hepatitis F, which is confusing to say the least. The expanding number of hepatitis viruses and the growing realization of their impact is increasing awareness, but the naming creates a problem of understanding, which is why so often when people use “hepatitis” they are referring to viral hepatitis. But each of these viruses is a unique disease. And Hepatitis C may be the most dangerous of all.

Read next week’s blog as we uncover the scourge that is Hepatitis C.

Be Well,

Dr. Bruce Feinberg

PART I-THE STORY UNFOLDS

Sometime between 2006 and 2007 infection with the Hepatitis C virus began killing more people than HIV/AIDS. Because these estimates were derived from death certificates they almost certainly underestimate the true number of deaths, as hepatitis C often goes unrecognized.

How can a trend so ominous and a disease so threatening remain so unrecognized by the vast majority of the population?  One big reason for this ignorance is confusion about what is meant when we say hepatitis. Hepatitis is a general term that essentially means inflammation of the liver. Many things can cause a liver to be inflamed: Drinking too much alcohol, taking too much Tylenol (and other medications), consuming too many calories, and eating too much fatty food, can all cause liver inflammation and even liver failure.  But increasingly viruses are being recognized as responsible for hepatitis. These viral illnesses are often called “Hepatitis” but there are many more causes for a constellation of symptoms referred to as hepatitis.

Initially the hepatitis patient, viral or otherwise may feel lousy, drained, and nauseated. They may have a loss of appetite and may have some vomiting or fever. Since the liver’s primary function is to detoxify the body, Substances normally cleared from the blood by the liver begin to accumulate, turning the skin and eyes yellow (jaundice) and making the skin itch. However, for many, especially those who have been infected with Hepatitis C, the initial inflammation of the liver- the early hepatitis- is completely a-symptomatic.

In this population, the liver continues to be inflamed. Silently, the hepatitis becomes chronic, and slowly the liver begins to fail. The accumulating toxins that the liver would have cleared alter the mind causing confusion and tremors; Blood flow through the liver becomes compromised causing the blood pressure to rise in the veins of the digestive tract, which can lead to dangerous bleeding and fluid accumulation in the abdomen and legs.  The chronically inflamed liver may even regress to liver cancer. Chronic hepatitis is a slow, debilitating and deadly illness that often presents too late to be effectively treated.

Read next week’s blog as we begin to uncover the mystery of viral hepatitis.

Be Well,

Dr. Bruce Feinberg

The ultimate goal of cancer research is to prevent the disease the way vaccination has eradicated polio and smallpox. In the absence of a definitive strategy, medical science’s best efforts have been applied to finding or screening for the disease early enough so that it is curable in virtually all of those in whom the disease is found. There have been unquestioned successes. The pap smear is the best example, as it permits the early detection and cure for cervical cancer. Recently there has been a trend looking at these screening tests to evaluate their benefit. Many guidelines no longer recommend getting a PSA test for prostate cancer and all guidelines have reduced emphasis on getting the test regularly.

The problems with these screens: while they did find more disease, there was little evidence that it changed the number of deaths. Although I appreciate the science and recognize the need to scrutinize the cost and value of all medical interventions, I remain steadfast in my support of early detection with the best-proven means available.  My logic is simple. Cancer evolves from a precancerous state to an aggressive life threatening cancer. Catch the disease when it is precancerous and you prevent the cancer.

With this trend of screening tests being put under scrutiny, it was only a matter of time until perhaps the most dreaded screening test of all, the colonoscopy, was looked at. This week, the results of a study examining the effect of colonoscopies 23 years in the making were released. It was performed at institutions around the world and it followed patients who had precancerous lesions removed on colonoscopy for an average of 15.8 years and compared it to the expected number of deaths from colon cancer based on epidemiological data. The results were impressive; there was a 52% reduction in deaths that were expected from colon cancer.  While an imperfect study, it is seen as very well done and very strong support for test that is started on your 50^th birthday.

With such a powerful tool to combat a dangerous disease, it is amazing how common colon cancer is to this day. Colon cancer is still the second most deadly cancer but far too few people are up to date on their colonoscopy. The huge effect of this study assumes that 100% of people get their colonoscopies done and this is not the case. While many screening tests have been scrutinized and shown to have limited use, it seems that colonoscopy is a good test that deserves doing. While uncomfortable and inconvenient, it certainly is better than colon cancer. Think about it – is a minor inconvenience once every decade worth another decade of life?

You be the judge.

Be Well,

Dr. Bruce Feinberg

Ever since the Industrial Revolution, there has been an increase in the incidence of heart attack. The reasons for this are multifaceted. An industrial economy allows people to be more sedentary, eat richer foods, and die less from other causes (such as infection). Nonetheless, many have thought that there must be other causes for this increase beyond the way it affects our lifestyle.

A meta-analysis, or study of studies, released this week has confirmed what many cardiologists have feared.  Short-term exposure to some of the most common air pollutants (Carbon monoxide, nitrogen dioxide, sulfur dioxide and a group of common airborne particulate matter known as PM) increases the risk for heart attack. Studies have showed this over the long term but proving that there is an increased risk from short exposure suggests that the effect of pollution is real, and not an artifact from the other lifestyle factors of people who live in polluted areas.

Before you decide to pack everything up and leave the city because of this, the increase of this risk to you specifically is very small (less than one half of 1% increase in heart attack risk). This finding is significant, though because that slight increase over the entire population leads to many more heart attacks than would be present if we had cleaner air.

This is more evidence that the condition of our planet is ultimately linked to our personal health. Reducing our impact on Earth will provide us with a healthier environment to thrive in.

Be Well,

Dr. Bruce Feinberg

Source: http://jama.ama-assn.org/content/307/7/713.short

A listener and reader of the blog had sent me an email recently. So much of what I say on the air and here on the blog has to do with eating right. He wanted to know specifically what I meant by that. Here is my reply:

- Portion control: First and foremost it is essential to eat the appropriate amount of calories. Eating 5000 calories a day is unhealthy, regardless if it’s pizza or quinoa with kale. Moderation is key. 2000 calories is a good number for most people but bigger guys who are active may need more, small women may need less. It is better to eat small meals (or snacks) 4-5 times a day than 2 whopping meals. Spikes in blood sugar after huge meals lead to more generation of fat.

- Food is cooked not manufactured: Processed packaged foods are not good for you. Avoid them or have them in moderation. A good rule of thumb is shop mostly on the outside of the grocery store, not in the aisles. Fresh fruits and vegetables should be mostly what you eat. Frozen veggies are better than canned, but fresh is best.

-Learn to cook: Making food for yourself allows you to control what is in it. Appreciate the time it takes and be mindful of what you put in your body. Food from natural ingredients made for you, by you brings health to the mind and body.

- Brown carbs > white carbs: Eat whole grain when you can (everything comes in whole grain now so this isn’t hard). This goes for rice and potatoes too. Brown rice is better than white rice, sweet potatoes are better than normal ones. The more plant matter in your grain, the slower you will digest it and the less fat you make with it.

-Dairy and fish are great in moderation: Have a little bit of dairy and fish. Beware- frying fish removes all those good “fish oils” and replaces them with the cooking oil. Grill or bake those fillets. Red meats have lots of saturated fats. Poultry can be lean but watch out, chicken skin makes chicken just as bad as a steak.

-Salad is not always best: Why starve yourself when that dressing has more fat than a burger? A turkey sandwich on whole wheat bread is often a healthier choice than a cheese salad slathered in fatty blue cheese, ranch or Cesar dressing.

-Nuts and yogurt are your friend: These are great healthy sources of fats and proteins which are essential. They can also make great on-the-go snacks. Watch out for sugar added to or coating both nuts and yogurt. You could be getting lots of sugar with out knowing it.

-Sugar is in everything and is why Americans are obese: be wary of how much sugar is in something. Soda, sweet tea and juice cocktails such as fruit punch, lemonade and even minute maid orange juice is a dessert, not a drink. Avoid these, think of them like a slice of cake because they have as much sugar.

My favorite author about food is Michael Pollan and he has many books that have really shaped how I feel about food. Some of his books talk about personal diets where as others talk more about the philosophy and development of food in this country.

If you have any question about your health or things I say in the blog or on the air, please email me. I love hearing from listeners, and I will reply to your emails.

Be Well,

Dr. Bruce Feinberg

T’ai Chi Ch’uan is a Chinese martial art that has been practiced for nearly 200 years that translated into English means “Supreme Ultimate Fist.” It emphasizes the mental state and focus required to perform the series of movements precisely. The movements are designed to redirect blows, not stop them. It focuses on coordination and leverage, not force- both in body and in mind.

Parkinson’s disease is a neurological disorder where movement, coordination and balance become progressively impaired. There is also an increased chance of depression, not only from the neurological changes, but the reduction in mobility and impending death from the disease. There is no cure for Parkinson’s so much of the therapies for the disease focus on maintaining mobility, reducing symptoms, and keeping patients as functional and happy as possible.

In a study released this week, researchers discovered that patients with Parkinson’s disease had reduced balance impairment, fewer falls (a potentially devastating event for an elderly person) and improved functional capacity when they practiced Tai Chi compared to resistance training and stretching.

This is powerful evidence that exercise that incorporates mindfulness has benefits over more typical regimens. The advantages of exercise go beyond the mere improved strength and flexibility. The coordination and awareness fostered by Tai Chi clearly have benefits for overall function by strengthening the relationship between body and mind.

Be well,

Dr. Bruce Feinberg

Unconventional medicine is hard to define. What is common to these therapies is that they do not conform with the beliefs or standards of the conventional mainstream medical establishment or accepted standard of care. These standards can also be culturally dependent, which may create further confusion, i.e., traditional Chinese medicine is considered unconventional in the United States, whereas it is a standard practice in China. Also, with unconventional therapies, their proof of effectiveness is most often conveyed through personal anecdote rather than stringent, evidence-based criteria reached through multiphase clinical research.

Doctors often have a hard time recommending them for treatment because they lack the experimental evidence for effectiveness and safety. That being said, there are a great deal of complimentary treatments that integrate well with typical practice. Meditation, relaxation, imaging, prayer, massage, and dietary supplements are just a few of the interventions in the broad class of complementary therapies. These approaches to healing are not in conflict with conventional Western medicine; rather, in most cases, they can be effectively integrated into standard medical practice. Many of these treatments likely help, and at worst, do no harm.

On the flip side, alternative therapies are not intended to be integrated into conventional therapy; rather, they are offered as a complete therapy intended to be used instead of the standard of care. Unproven by evidence-based criteria, pharmacologic treatments comprise the bulk of alternative therapies. These therapies are particularly susceptible to quackery, and false and excessive claims and high-profit motives are common.

I understand why these unconventional treatments seem appealing. Mainstream medicine has become an increasingly technological and impersonal field with long wait times, burdensome costs and hurried doctors that has morphed healing away from the warmth and confidence most want form their caretaker. Using these alternative therapies frees healing from the sterile scientific nature of medicine, with complex, unpronounceable medication regimens, side effects, diseases with poor outcomes all explained with jargon and statistics. Unconventional therapies can be much more friendly and seem more holistic and in tuned with man people’s ideal of the healing process. Unfortunately, they are not as effective most of the time.

I often have had patients receive unconventional treatments. I think that they can be beneficial but there are a few guidelines that I suggest my patients follow. First, avoid any practitioner of any unconventional (or for that matter, mainstream) method who is evasive. People who practice healing techniques that they believe in will want to share them with your other doctors, not hide them. Second, avoid treatments that are touted to work only if you stop your traditional treatments. Third, avoid practitioners who have exclusive access to the cure but will not tell anyone what it is. Practitioners who truly believe in what they are doing want to share their successes. Fourth, beware of the motivations of the people making recommendations. It is unusual for natural healing techniques to be very expensive. If an exclusive treatment is being suggested and is very expensive, examine the motivations of the prescriber. Be aware that most unconventional therapies are not covered by insurance, given the absence of supporting data from well-designed clinical trials. Finally, pick an unconventional therapy that you feel good enough about to discuss with your physician. Your participation in restoring or maintaining your health is absolutely essential. The success of many alternative treatments depends in great part on your belief in the potential of the therapy to improve your health. If you truly believe in the therapy, be willing to discuss it not only with your family and friends, but also with your physician.

Do you have an unconventional treatment that you swear by? Have you ever been fooled by unconventional therapies that didn’t work? Have questions about an alternative therapy? Let me know in the comments section.

Be Well,

Dr. Bruce Feinberg