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MARCH 2020 TABLEHOPPING
No one wants to really talk about it but the biggest healthcare issue in America today is dementia. Sure cancer is a terrible thing but many people are cured of cancer. Dementia, at least today, is relentlessly progressive and besides profoundly affecting the patient it has a massive effect on the caregivers as well. Just as everyone knows someone with cancer likewise everyone know someone with dementia. Unfortunately, the currently available treatments for dementia are very limited. The toll on caregivers is massive. Dr. Dale Breseden proposes a treatment plan that includes addressing your diet, your exercise,your sleep and your stress as well as removing toxins and some supplements. In his book the End of Alzheimer’s, he documents multiple cases of people that were dramatically improved in memory and whose brain scans actually show regrowth of brain. A 2 year study in Finland called the Finger study demonstrated a significant beneficial intervention effect on overall cognitive performance was seen in a group of people who receive dietary guidance for physical activity cognitive training and intensive monitoring and management of metabolic and vascular risk factors.
So dementia is not inevitable and you can have a significant impact on your risk of dementia and your degree of dementia based on your lifestyle. As you know from my prior writings many people consider dementia a type of diabetes, so called diabetes type 3. This is one more reason to go to your doctor and ask for a fasting insulin level and a measurement of insulin resistance. Ask your doctor for a fasting insulin test and a HOMA score which is a way of measuring insulin resistance.. Your doctor is likely to say that your sugars have been fine so there is no need to measure insulin but you must remind them that sugars will be normal for years as insulin rises and the only way to know this is to measure insulin and if they are going to measure your insulin you might as well do a thorough test by checking the sugar at the same time and learn about your insulin resistance. I believe, after 33 years in medicine, that Dr Breseden is right in that diet plays a crucial role in preventing dementia. Minimizing sugar in all of its forms and maximizing basic simple whole foods I think is your best defense against this mental scourge.
Do you remember where you your car keys? Did you forget where the car is in the parking lot? Do you ever go down into the basement and wonder what you went down looking for? Is at the beginning of dementia or is it just benign forgetfulness of being older? Do you cover up for your loved one in the doctor’s office when they started asking memory questions? Is your doctor or even testing your memory? If you’re in Medicare you are supposed to have a memory test at your annual wellness visit. This is happening?
Well, if you worry about memory loss you do not have to rely in your doctor. Everyone and anyone who has an interest in dementia, who worries about dementia, who has a loved one with memory loss now has access to testing and treatment regardless of the ability to pay. There is a company called Clarity Clinical Research which is located at 6700 Kirkville Rd., Suite 107 East Syracuse New York. The phone number is 315-706-5905. You do not need a referral from your doctor. You do not need a referral from your neurologist. All you need to do is call this number to have yourself tested or your loved one tested. They will establish a baseline and if it is appropriate, offer you the option of being enrolled in a clinical trial. Given that the currently available medicines for dementia do not have a real impact on the disease, having a trial available is possibly a game changer for you and your loved one. . I understand from my conversations with the experts at this facility that it does not matter whether you have a little memory loss or whether you have advanced dementia they will evaluate you and try and find a trial for you. Clinical trials are the way medicine advances. Clinical trials are not new to Central New York . Many people that get chemotherapy are involved in clinical trials.. The testing and treatment available at Clarity Clinical Research are simply not available anywhere else in the area. They have access to scans that are not available outside of research settings. Again, all testing and treatment including the scans etc are free. No charge whatsoever whether you have insurance or not. Furthermore you don’t need approval from your insurance company or medical provider to get tested and treated. So if you really worry about your memory or your loved ones memory you are a phone call away from the most thorough and aggressive testing available anywhere. Of course,I urge you to improve your lifestyle as the primary approach to prevent memory loss and that’s outlined in books like Dr Breseden or Dr Perlmutter’s book Grain Brain. Naturally , I suggest you do both…investigate the lifestyle changes and avail yourself of the most advanced testing and treatment available by calling Clarity Clinical Research. Call today before you forget about it !
National Healthcare Guideline
Here I go again, taking on another major important national healthcare guideline. … Both the United States Preventive Task Force and the American Academy of Family Practitioners recommend AGAINST using the PSA as a screening test. The American Cancer Society recommends that men only be offered PSA testing after a discussion of the risks and harms. Who is spending that much time with their doctor?
Directly from the American Society of Clinical Oncology comes the following information: “Prostate cancer is the most common cancer among men, except for skin cancer. This year, an estimated 174,650 men in the United States will be diagnosed with prostate cancer. Around 60% of cases are diagnosed in men over 65. The average age of diagnosis is 66 years. The disease rarely occurs before age 40. Most prostate cancers (90%) are found when the disease is in only the prostate and nearby organs. This is referred to as the local or regional stage.
The 5-year survival rate tells you what percent of men live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for most men with local or regional prostate cancer is nearly 100%. For men diagnosed with prostate cancer that has spread to other parts of the body, the 5-year survival rate is 30%. Prostate cancer is the second leading cause of cancer death in men in the United States. It is estimated that 31,620 deaths from this disease will occur this year.”
Interestingly enough, Prostate Specific Antigen (PSA) —which means a protein that is specific to prostate tissue— was first used by the police starting in 1966 when it was identified in semen and came to be used in cases of sexual assault. Then in 1979 it was discovered that this protein could be found in low amounts in the blood stream of men. PSA was first used in diagnosing prostate cancer in 1987 and was approved by the FDA for this purpose 7 years later.
For years the PSA was done at your annual physical and if it was elevated you were sent for a biopsy to see if you have cancer. If you did test positive you are offered a choice between watching, radiation, surgery or hormonal treatment. Not everyone with an elevated PSA will have a positive biopsy. PSA levels rise as you age and bike riding, rectal probing, prostate irritation or infection can also raise the PSA. We have established a cutoff of 4.0 as the upper limit of normal but some people age normalize the number so as you get older up to 6.0 is considered normal. I have personally had patients with a PSA of 3 who had cancer (their prior PSA was less than 1 so the level of 3 was quite a jump) and patients with a level of 30 who did not have cancer. (They had a biopsy and it was just due to a very enlarged prostate.) So, your doctor CAN do a PSA test at your annual physical but some doctors, blindly following the guidelines, have abandoned this practice. Why? Because some researchers believe that the PSA does more harm than good because:
- Some prostate cancers are slow growing and should be left alone.
- There will be many people who have an elevated PSA who have biopsies that come back normal and they have been put through psychological stress needlessly. There are dangers of biopsy as well including infection, etc.
- Some people will be overly aggressive about treating slow growing cancers and have operations or treatments that leave them with incontinence and sexual dysfunction.
None of these are, to me, important enough to stop checking PSA. As noted above, prostate cancer is the most common serious cancer men get. … About 1 in 6 men will be diagnosed with cancer and it’s still obviously a common cause of death. ANY test that can help diagnose cancer is worth considering. Once you have the diagnosis it’s up to the individual patient as to how aggressive to be. That’s a completely different problem than diagnosing the cancer in the first place. Once you know, you are in the driver’s seat and can get all the consultations and opinions you want. But until you know, and the PSA test is the first stage of discovery, you have no idea what fate awaits your prostate and you. The blood test is cheap, reproducible and reliable and still covered by most insurances. I know I would have a hard time explaining to some widow that her husband’s prostate cancer death could have been prevented or at least delayed by a simple readily available blood test that I did not do because some guidelines said it was no longer appropriate.
There have been 2 large scale studies looking at the benefits of PSA testing. Roughly 75,000 men were tested with PSA starting in 1993 and there was no benefit in overall mortality between the group who got tested with PSA and the group that did not, although there were 22% more cancers found in the PSA testing group.
A second, larger study, was done in Europe … the European Randomized Study of Screening for Prostate Cancer began in the early 1990s. A total of 162,000 men between the ages of 55 and 69 were recruited. Quoting directly from the Harvard Medical School article: “After about nine years of observation, 214 men in the PSA screening group had died from prostate cancer, while 326 men in the comparison group had died from the disease. That means screening reduced the risk of dying from prostate cancer by 20%.”
The PSA is a screening test just like colonoscopy and mammogram and when you look at these tests from a population-based standpoint none of these tests —I repeat none of these tests— have been shown to cut down more mortality at the population level. That said, every physician I know has seen people whose lives were saved by a colonoscopy a mammogram or a PSA test. The PSA test is far cheaper than a colonoscopy or mammogram and for a disease that is going to affect one in 6 men I think that ongoing screening is appropriate and I will continue to do it. Yes, it is true that many more men will die WITH prostate cancer than FROM prostate cancer but on my watch I want to find any cancer as early as possible. The PSA is a test that does just that. I urge you to have this discussion with your own personal physician.
Until next month … Get well … Stay well.
(ed. Readers can listen to Dr. Joe Barry’s radio show “Your Health Matters” airing Sunday afternoons at 12:00pm on WSYR 570)
January Table Hopping Article 2020
I am not going to start the year with an exhortation for exercise and changing your diet. Been there…done that. Rather, we start the new year together with an education regarding how to detoxify yourself from all of the foul chemicals you insist on slathering on yourself and ingesting. There is actually a national data bank that maintains fat tissue samples from patient’s all across the United States and based on an analysis of these fat tissue samples ( because that is where a lot of the poisons are stored… in your fat ) shows that 100% of Americans… that is every single sample that they tested , from all across America , tested positive for multiple contaminants/poisons.That is correct, 100% of the samples tested positive for stylene (a breakdown product of Styrofoam) 100% tested positive for xylene , 100% tested positive for ethyl phenol. Chloroform was found in 76% and benzene was found in 96% of samples.. That is not sick people, that is the average joe and jane, that is you and me. If the fish that lived for 4 or 5 years in the fairly clean waters here in Upstate NY have so many chemicals in them that the DEC warns you not to eat more than one a month, how likely is is that you, having lived much longer, would be free of contaminants? The answer is, based on the science available to us today, zero. We all have multiple toxins in us no matter what you want to think about how to clean your air and water are. The air in your house..yes, your house, is significantly more toxic than the air outside your house and most of you leave your house as little as possible. So it is fairly straightforward that we all have contaminants/pollutants in our fat stores. Thousands of chemicals are used in and found in all the processed foods we ingest daily as well as exposure to chemicals in your house, water etc. Don’t think because you are a vegetarian or eat organic that you are safe…most assuredly you are not.
Having all these strange chemicals in your body simply cannot be a good thing for you no matter how much you store them in your fat or otherwise. These chemicals; the heavy metals, the plastic derivatives etc affect the cell membranes, they affect energy transport, they increase cancer risk etc . All these risks are well documented in the scientific literature. Now what can we do about them?
Well, there are natural detoxification pathways in the body and detoxification is broken up into three phases. Phase one is where the chemicals are converted from fat soluble to water soluble thereby allowing them to be processed and transported easier for removal from the body. This involves oxidation, reduction, hydrolysis and epoxidation. This usually involves the cytochrome P450 system in your liver . This can be dangerous because you’re taking these compounds out of the fat and actually making them more available to the body and to possibly have more of a toxic effect so you have to move on to phase two. Phase two is where the compounds and molecules are made even more hydrophilic that is water-loving to again facilitate transport out of the body. This is done by glysine, glutamine and glutathione, acetylation sulfation and thiosulfation. Lastly , phase three is the process of transporting these chemicals to the sites of excretion primarily the bile tract and urine. Another way to look at it is to say that phase one is transformation phase two is conjugation and phase three is transportation.
This isn’t the time or place for a deep dive into the chemical details but it’s simple chemistry. And like all chemical reactions detoxification is very dependent on having the right chemicals and enzymes , vitamins and minerals like zinc, selenium, copper, etc. If you have a deficiency in these chemicals you are not going to be able to clean these poisons out of your body. How are you going to maintain the proper nutrient balance and minerals and vitamins with your McDonalds and Pizza Hut addiction, your donut and pancake habit, your soda and juice dependence? If you want the best chemical reactions to occur in that vast electrochemical bath that is your body you must provide the best chemicals and reagents. These pathways are very well known and so are the chemicals that compose them including glycine, certain B vitamins, glutathione, vitamin C , methionine, and cysteine to name just a few. You can get them from food and / or supplements. It’s still a wild wild world in the supplement market. Since everyone has toxins in them why shouldn’t we all be working on some detoxification on a regular basis.
Now, I am not talking about coffee enemas or the more aggressive detoxification using chemicals like EDTA and captomere…thats way above your pay grade but I am talking about eating health foods like garlic, artichoke, black and green tea, coffee, milk thistle and the whole broccoli family. If you want to maintain the most important pathways of detoxification I have been recommending a daily dose of Vitamin C, R Lipoic acid and Glutathione but many people also recommend N Acetyl Cysteine and Acetyl L Carnitine as well. Of course I am not going to give you doses etc…you have to do your own research or ask your own health care provider what they know about the toxics ever present in your body and how to detoxify yourself. Of course an excellent primer on this subject is Dr Sherry Rogers book Detoxify or DIe ! Maybe it’s too late for Christmas but it still makes a great birthday present. Of course I didn’t invent the term but “the solution to pollution is dilution” so keep the water intake up. Another great detox program is any multi-day fast. I know multi day fasting and cold water immersion are supposed to be very very healthy and I have seen study after study that supports both practices but I find the sauna and skipping breakfast so much more palatable.
I will be talking about other unfamiliar topics in the columns to come. My research into the very basic molecular nature of cellular function has me investigating the effects of light , electriciy and vibration and will be bringing you some interesting insights that modern medicine is ignoring because there is no big pharma behind it. Until then , eat your brocoli.
Monitoring Your Sugar Intake
I was going to write this month about detoxing and I think it is a very important topic. However, I think there is something that is probably just as important and easier for you to discuss with your doctor. That is – measuring your sugar. Not just pricking your finger but checking your glucose level whenever you want … especially after meals so you can see for yourself immediately the effect of the food you have just eaten on your glucose level. I am talking about CGM (continuous glucose monitoring). If you think you have a good diet, if you think you are taking care of yourself, why not prove it to yourself and your health care provider by applying a monitor that can, for 2 weeks: check your blood sugar whenever you want; as often as you want; without having to prick your finger. I don’t think this is just for diabetics either although obviously this is very important for them to really understand the relationship between what they eat and their bodies response. This isn’t the same as checking your insulin level but it is very readily available and easy to understand. If you are diabetic or have metabolic syndrome or are overweight or just wonder about the interaction between the food you eat and your sugar it is finally easy to have this monitored. I am currently recommending this monitoring to every one of my diabetic patients. I also recommend the monitoring to anyone who is curious about their diet and its effects on their health. Do you really think that peanut butter and jelly sandwiches are healthy? Check your sugar afterwards and see for yourself. Do you really think that ice cream is an innocent treat? See for yourself. If you really think those sodas are not harmful check your sugars after a can and actually measure your own bodies response.
There is a continuous glucose monitor called the Freestyle Libre which is inexpensive and often covered by insurance. You apply the sensor to your upper arm and use a monitor to be able to measure your glucose level anytime. The tiny needle in the sensor really is not painful and its much better than pricking your finger. The sensor is pretty durable and can handle showering, etc.
Now we have been talking for some time about the so-called closed-loop system where diabetics could have their sugar monitored by this device and then have insulin administered to keep their sugar levels normal. I think this is going to be a disaster. People will eat whatever they want knowing that this system will handle their sugars but it will result in them getting much more insulin and, as you know, I believe that excess insulin leads to heart disease, dementia, generalized inflammation, arthritis, increasing cancer risk, etc. So I do not think treating your elevated sugar with insulin is the best option. Of course here I am talking about type II diabetics type. Type I diabetics are dependent on insulin. They are much less common and this is not the article for them although obviously monitoring their sugars are very very important for them and this sensor will apply to them as well.
I have just ordered the system for myself because I am curious as to what really happens when I have my pork fried rice for lunch and whether my late night pretzel snacking is raising my sugars or not. Also I am curious as to how low my sugar will go during the long periods when I do not eat. What effect will sauna use have on my sugars? What effect will strenuous exercise have on my levels? All of these questions I will soon have an answer to … once I get past my insurance company. For me this is just intellectual curiosity but for you, if you are diabetic or prediabetic, it may affect how you eat, what you eat, the dosing of your medications, etc. If you are overweight and you wonder whether your current diet is really the best for you you can measure your sugar levels. You can have instantaneous reliable and reproducible answers. This is not magic. This is nothing particularly new. This device has been around for months now and every primary care doctor should be familiar with it and be recommending it. I never understand why more patients do not ask me for this device. It’s your health … you should be and can be in the driver’s seat in terms of monitoring your health and this is one more device to assist you. Go – partner with your health care provider to improve your health one measurement at a time!
Until next month … Get well … Stay well.
P.S. Don’t forget about the Desantis Orchestra at the Palace theater on Sunday December 8th and the Solstice at the Cathedral December 5th, 6th, and 7th at St. Paul’s downtown. If you like seasonal live local music in great settings both of these shows are for you. -See you there!
(ed. Readers can listen to Dr. Joe Barry’s radio show “Your Health Matters” airing Sunday afternoons at 12:00pm on WSYR 570)
NOVEMBER 2019 TABLE HOPPING
HIGH BLOOD PRESSURE HOAX BY DR SHERRY ROGERS
Ok, so you have been diagnosed with hypertension, high blood pressure, the pressure ..it goes by several names but it’s deadly serious by any name. Hypertension is more common as you get older…at least here in America. It affects about half of all adults in the USA. Hypertension is a significant risk factor for strokes, heart attack, heart failure, and kidney failure and loss of vision. It’s serious and should be taken seriously. I just finished reading The High Blood Pressure Hoax by Dr Sherry Rogers so I can offer you a new perspective on this critical health topic.
People can rightly argue about taking statins for cholesterol. (statins are just not that effective and have significant side effects). People can go back and forth about how tightly we should be controlling your sugar (it’s the insulin level that’s important not your blood sugar) but no-body argues that hypertension should be treated. Dr Rogers thinks anything over 120/80 is hypertensive which is a pretty strict definition. I usually use 140/80 in most adults and 160/80 in frail elderly since HYPOTENSION this group is especially dangerous due to inc risk of falls and underperfusion of the brain leading to an INCREASED risk of dementia.
Don’t let your doctor diagnose you with hypertension on the basis of a few office blood pressure measurements. This is serious enough that you should get multiple readings either at the drugstore or, better yet, buy your own BP machine and take your own readings. Best of all is getting your doctor to check a 24 hr bp monitor. That’s considerably more accurate as a cardiovascular risk evaluator that the readings your doctor gets in the office. This was just evaluated in several months ago in the JAMA.
Ok, so we agree that you should get multiple blood pressure readings before getting labeled as hypertensive. So what about treatment? Well, first we have to talk about the cause of hypertension. Is your doctor telling you it’s just caused by aging? Then why is hypertension so very uncommon in the third world? Same reason that cancer and heart disease are low…their diets are healthy, ours are not . We are killing ourselves with our diet, plain and simple. . We health care providers repeated the mantra that came down from on high….high fat diet is bad and you should get most of your calories from carbohydrates. How embarrassing to admit that we had that completely wrong ?! So why would you put any trust in what I am going to recommend here? Because the things I am going to recommend are cheap, readily available , nontoxic, natural , gluten free, blood diamond free , gender indiscriminant, and hopefully you get my point. I am not endorsing any product or getting any benefit from these recommendations. As we say in the business I have nothing to disclose.
Your doctor will say that your getting older and your pipes are getting stiffer and you exercise less, and we all take in too much salt so it’s only natural that you get hypertension as you age. Well , how do you explain those that age but don’t get hypertension…My short answer is they lived healthier…less processed foods , less processed oils and much less carbs ! In the 1950’s only 5% of dietary intake was carbohydrate based. By the 1990’s 60% of the standard american diet were carbohydrates. Thats a ginormous shift. The government experts said saturated fats were bad and carbohydrates were not only harmless but better for you. That advice , so readily taken up by nutritionists and doctors alike, continues to be ruinous to America both as a country and one citizen at a time.
No ..as Dr Rogers points out in her book and as also attributed to Linus Pauling…all disease is a result of some deficiency or the presence of some toxin. Translation… hypertension is caused by the combination of wrong lifestyle and environment with the ratio changing from person to person but it’s mostly lifestyle people. Unless your diet is righteous you could have a nutritional deficiency that, once corrected,could resolve the high blood pressure which is just your bodies way of showing stress on the system. Why not try some simple supplements before taking some prescription medicine ? Well, taking a pill is easy for you and it’s easy for your doctor. But, think of it this way, you don’t have a beta blocker deficiency, you don’t have a calcium blocker deficiency, you do not have a diuretic deficiency. You weren’t born with these deficiencies and you didn’t develop these deficiencies. You could ,however , easily have a magnesium deficiency or a potassium deficiency or both and when you correct the deficiency the blood pressure may return to normal. Unfortunately the usual magnesium and potassium that your doctor does is not accurate in reflecting total body magnesium needs. Sodium you can measure from simple blood test because most of it is extracellular. Magnesium and potassium are primarily intracellular so you have to measure the RBC magnesium and potassium. The big local lab LACNY can do this test for you and your doctor and it’s usually covered by your insurance.
Of course you must eat less processed foods eliminate corn oil, high fructose corn syrup, soda and canola oil. These all inflame your system and raise your blood pressure. This is the way to improve your heart disease, your diabetes, your pressure, etc. Unless your blood pressure is sky high why not try different things for a month before resorting to BP meds. Blood pressure takes years and decades to exert its effects. Ample time to deal with the underlying problem rather than turn immediately to some pharmacologic There are other supplements to consider including L Arginine; an amino acid.
Your doctor will tell you that hypertension is just you getting older and your artery stiffening up but really it’s endothelial dysfunction which is the inner lining of the blood vessels and we know that nitric oxide relaxes the muscles surrounding the endothelium, lowering the blood pressure. It also keeps platelets from sticking to the blood vessel forming plaques. It regulates many other enzymes. .Nitric oxide is made from L-Arginine which is a simple amino acid that you can supplement. Why not try that first before taking a pill.? In her book Dr. Rogers referenced several articles published in major medical journals that criticized the use of diuretics. Dr. Rogers claimed that people taking diuretics had WORSE cardiovascular outcomes.. Because it’s important I get this right I actually found those references and reviewed them and they were both published in major medical journals and do substantiate her claim that diuretic therapy, especially for diabetics, was associated with increased mortality not decreased. Unfortunately when you bring this up to your doctor he or she is going to say “That’s crazy, I don’t know anything about it “. That’s when you hand him copies of the article. Here are the references for those who are interested. Just type the following in the web browser PMID: 1823530 and And N Engl J Med 1994; 330:1852-1857
Besides L-Arginine another amino acid has been shown to cause vessel dilatation and promote diuresis and stop abnormal platelet aggregation is taurine , another simple amino acid. Why not give taurine a try before subjecting yourself to prescription medicines . Of course you have to get rid of the corn oil and canola oil and all the processed oils in order to stabilize your membranes and although this will take awhile it will slowly help you return your natural ratio of Omega-3 to omega-6 back to 1 to 1 instead of the 1 to 20 it is now in the developed world. This drastic change in the ratio from the norm cannot be a good thing for your health. I have not yet found a commercial salad dressing sold in Wegmans or Walmart that is free of these processed oils , except Braggs which I dont think tastes that great at least not compared to my wife’s home made dressing. Olive oil on the other hand is not a processed oil. How about trying some celery which has also been shown to lower blood pressure. There is no such thing as too much Brassica vegetables: cabbage, broccoli ,cauliflower, Brussels sprouts ,kale, collard greens, turnips, radishes, horseradish and watercress. They are natural and aggressive detoxifiers and the toxins you build up in your body certainly contribute to hypertension. Bottom line is that if you are interested there are multiple natural ways to try to treat your blood pressure before resorting to prescriptions. Dr Rogers lays all this out for you in her book which is readily available on the internet. There is a ton of referenced literature in all her books They are not too technical and I recommend them to all my patients who want to try natural products before resorting to big pharma. I used to think Dr Rogers was on the fringes of medicine but now I know she was at the forefront and I have learned much from her books and you can too ! Until next month …Get well, stay well.
JT BARRY MD
Checklist For The Last Chapter
It’s been a while since I’ve covered it but I have to deal with it practically every day so let’s make sure we get through it as painlessly as possible. What I am talking about is your dying … the last chapter of your life and what control you have over it. I have been known to say to people ”I like you. -I hope you drop dead.” People are taken aback until they actually think about it, then they get it. You can drop dead in your sleep after years of good or you can succumb to one of your many illnesses probably during some nursing home stay. You know what a great place they are. They must be great because they are full all the time. Yet everyone I know says ”You’ll never get ME in one of those places!” This column is for you to plan ahead so you actually have some say in what happens to you when you are no longer independent. Don’t leave it up to your kids, most don’t have what it takes to do the right thing and honor your wishes, it gives many of them a guilt trip making life or death decisions that were not thought out ahead of time. You know me – I think you should have it all planned out, the burial business, even what you want in your obit and the music you want played. But we are not talking about what happens after you die, we are talking about filling out a few forms that will guide your care at possible end of life situations.
Either you are going to go out easy or hard —that’s your call— either surrounded by friends and family in your own home or die in some sterile Intensive Care Unit being tortured by emotionally repressed staff that are treating your body, doing whatever they can to eke out a few more hours or days of your badly dwindled self. I don’t know about you but that’s an easy choice for me. So that means I am a DNR. -Do Not Resuscitate. No CPR for me. I am well read on the success statistics of CPR and except for defibrillator use, there is only a tiny chance of meaningful recovery.
So the first decision you have to make is who will be your health care proxy. You should list an alternate because people die, etc. This person should have a good idea of your end of life wishes. My wife is my proxy and she knows my wishes well. There are free forms on the internet so you have no excuse.
Then you decide on DNR for yourself or not. If you really want everything done, (which I translate to mean that you have no idea what’s in store for you), but if you do indeed want every possible means taken to keep you alive all you need is the Health Care Proxy.
If you want to be DNR which, to me, translates to mean dignified death then you have to get an out of hospital DNR form from your doctor. They have blank ones on file. This only works if people see the paper so keep it in that folder on the fridge next to your med list.
Now it’s New York State so you know there is some terrible paperwork yet to be faced. A completely unnecessarily complex form that tortures patients families and doctors alike. It’s called the MOLST form. This form addresses reasonable questions about your care but in a needlessly complicated way. The form proceeds to ask about full code versus DNR, then whether you just want respiratory support, then to ask about IV fluids, antibiotics, at what point to hospitalize you etc. -Good questions … bad form.
I know a lady who had two children who were both doctors. -The daughter came to her mother one day and said, “You know, mom, your son is your health care proxy. Did you know that if you were in a nursing home and had pneumonia he would withhold antibiotics and let you die?!” The mother responded ”That’s exactly why HE is my proxy and you are not. If I ever end up in a nursing home that means I’m in a bad way. Don’t keep me around.”
It’s hard to pull the plug … it’s hard to see your loved one slowly endure the dwindles. Each one of us has to decide for themselves the right thing to do but it sure helps the family a lot if your wishes are obvious and oft repeated. My guiding principles are to try and treat everyone at this time like they were my own father and also to go along with whatever they want to do for as long as we can (even if its not in their best health interests) because that’s what I would want done for me. I hope I drop dead … just not today.
Now let’s get serious. Your loved one is in the adult home or nursing home. They wouldn’t be there if they could avoid it. They wouldn’t be there if they were healthy. They are indeed writing the last chapter of their lives. Why are you still insisting on giving them so many pills. Of course they are depressed. -Do you really think a little white pill is going to make it all better? You are deluding yourself and subjecting your loved one to unnecessary meds. Dr. Richard Kennedy published in the Journal of the American Medical Association November 2018 that the most commonly used drugs Aricept and Namenda actually worsened dementia and cause patients to be worse off than without the medicine. I know people that have started their mother or father etc., on one of these pills and they did well and I’m not discounting that but the published literature in a very prestigious medical journal says not only do they not work but they make people worse. Also, I see many people in the nursing home setting still taking cholesterol drugs. Dying quickly of a heart attack or stroke would be a blessing in these patients. The evidence that statin drugs work well in this population is very very limited and I don’t think justifies their use. For that matter I wouldn’t treat blood pressure because I think the side effects of many of the blood pressure pills outweigh the possible benefits. No, may I suggest to you that when you are putting your loved ones in the nursing home it’s time to stop almost every single medicine and focus on what’s important … their comfort. If they want ice cream and whiskey for breakfast and dinner great. If they want to eat M & M ‘s instead of peas, what color do they prefer? Multiple studies have shown that when you stop the polypharmacy some patients actually improve off the medications!
Some people look at me when we have these discussions like I am trying to finish off their relatives. On the contrary, I am devoted to doing everything I can to improve the quality of their life. Unfortunately patients and doctors alike put way too much faith in the pills which is not justified by the published medical literature but the urge to do something is very strong. It’s taken me over 30 years as a physician to realize that sometimes, often really, less is more.
Until next month … get well … stay well.
(ed. Readers can listen to Dr. Joe Barry’s radio show “Your Health Matters” airing Sunday afternoons at 12:00pm on WSYR 570)
To Bleed Or Not To Bleed
It’s no wonder that you’re confused and your health suffers accordingly. You keep getting conflicting advice from health professionals. Being one of them, a health care provider, it’s a little embarrassing. Coffee bad … coffee good. Milk bad … dairy great. Eggs bad … eggs redeemed like the Christ child. Your government and professional guidelines recommended that you get 60% of your calories from carbohydrates. My people believe that insulin controls the burning of fat in you body and we tell you to limit dramatically your carbs to keep your insulin low. Who do you believe? How do you decide?
Sometimes the advice or guidelines change based on improvements in science and, of course, that is appropriate. But, too often the guidelines are either not based on the highest levels of science or the industries involved had some less-than-appropriate involvement in guiding the guidelines. There is plenty of literature on this. So I try to rely on the evidence, the science and not the guidelines. A case in point is the aspirin controversy.
On one hand we have the United States Preventive Services Task Force that currently recommends that adults 50 to 59 years of age start taking a daily low-dose aspirin if they have a 10% or greater 10-year cardiovascular risk, do not have bleeding risks and are willing to do so for 10 years. In patients older than 59 the risks outweigh the benefits and there’s insufficient evidence to assess the benefits of people younger than 50. This recommendation, which was issued in 2016, was based on 11 randomized control trials between 1988 and 2014.
On the other hand, we have the U.S. Food and Drug Administration in 2014 that cited that there is insufficient evidence for using low-dose aspirin therapy for primary prevention of heart attack or stroke and three recent studies support this position. In the “aspirin to reduce the risk of initial vascular events” or the ARRIVE trial, 12,000 European and U.S. adults 55 years of age or older without diabetes were given a hundred milligrams of aspirin daily for 5 years. They were at moderate risk of cardiovascular disease … meaning heart attack or stroke. No difference occurred between composite outcomes of cardiovascular death, myocardial infarction, unstable angina, stroke, or TIA. However, 1% of the aspirin group had bleeding versus only 0.5% of the placebo group.
Another trial, the Study of Cardiovascular Events and Diabetes Trial, enrolled 15,000 adults 40 years of age or older in the United Kingdom. After a follow-up of 7.4 years the aspirin group had a lower percentage of people having a serious vascular event than the placebo group but this benefit was offset by an increased risk of major bleeding. The numbers needed to treat would be 91 and 112 respectively from which they concluded that aspirin had no net benefit.
Finally, the Aspirin And Reducing Events In The Elderly Trial, examined the effects of 5 years of daily low-dose aspirin on community-dwelling adults 70 years or older in the U.S. and Australia. There were no differences in the primary endpoint of disability free survival, dementia, cardiovascular deaths, or hospitalization. However, the aspirin group had a higher rate of major hemorrhage and higher all-cause mortality.
So there are three recent good sized trials that question the use of aspirin in primary prevention. If you have already had a heart attack or stroke that’s a different story … stay on your aspirin. But the rest of you —schooled to take your aspirin and your multivitamin every day like trained seals, believing, somehow, that this would protect you despite your many and manifold dietary indiscretions— may want to think twice about the daily aspirin ritual. Your doctor should be having this conversation with you on a regular basis. -What are your risks and how can you best modify them? Lifestyle changes have always trumped medications but how much time does your doctor spend talking about this and making a plan to improve your health. For that matter, has your doctor assessed your 10 year Cardiovascular risk using the American Heart Association / American College of Cardiology risk calculator? How else are you deciding whether or not to take aspirin or take a statin? Personally, I think the calculator grossly overestimates your risks and therefore favors statin use in most people —and practically everyone over the age of 70 regardless of other risk factors— but at least it’s a place to start your cholesterol and aspirin conversation. Did I emphasize that dietary and exercise changes are far more effective than any medication in changing your risks of dying from the most common causes of death? It’s easy to recommend some medication, it’s harder, takes longer, and is more involved, to talk to patients about changing their behavior but that’s where the real benefits are. Stop depending on your doctor to manage your illness and enlist them in your efforts to improve your wellness. Your office visits should be a review of your diet and exercise, a conversation about improving your lifestyle, serial evaluations of your efforts long before you and your doctor turn to pills.
Getting back to the question of aspirin … When I am asked about aspirin I suggest people take it religiously … one tablet of any dose once a week on Sunday.
Until next month … get well and stay well.
Sugar Substitute Skulduggery
There is an additive that was recently approved by the FDA that you should know about. Its industrial name is E951. The plan is to include it in over 6,000 products. It will be consumed by millions of people daily. It will likely be added to soft drinks, chewing gum, candy, desserts, yogurt as well as pharmaceuticals, in particular, syrups and antibiotics for children.
I first became interested in this additive because it has known adverse effects on the biome and you know how seriously I have been researching the importance of the bugs in your gut. Unfortunately E951 directly kills many of the bugs in your gut and adversely affects the ratio of Bacteroides and Firmicutes. You want more Bacteroides and less Firmicutes and E951 does just the opposite and that’s not good for you and your health. This is well-documented in the scientific literature.
When this additive was approved in Europe, there were immediate reports to their version of the FDA, which included: migraines, change in vision, nausea and vomiting, trouble sleeping, change in heart rate, abdominal pain, joint pain, depression, memory loss, seizures and brain tumors. That’s right brain tumors. Adverse reactions to E951 accounted for more than 75% of that agencies complaints involving a food additive!
E951 is made up of two main ingredients combined with a methyl ester. This methyl ester breaks down to methanol in the body. Methanol is grain alcohol. That’s the stuff that makes you go blind if you drink too much of it. This methanol, in turn, is converted to formaldehyde in the body. That’s right … formaldehyde. According to the American Cancer Society various agencies including National Toxicology Project, The International Agency for Research on Cancer, The EPA and The National Cancer Institute all list formaldehyde as a known or likely carcinogen. Furthermore one of the main ingredients is well-known to be neurotoxic. So, there are plenty of reported side effects: breakdown products that are known to cause cancer, ingredients known to be neurotoxic, adverse effects on the gut biome, etc. Who needs this product in the USA?
The pharmaceutical company reported 60 studies to evaluate the safety of E951. All 60 studies found no problem with the drug whatsoever. However, 93 independent studies were done and a problem was found 80% of the time. The drug company tried for years to get E951 approved. The science was so sloppy that the FDA took the rare step of asking the US attorney in Chicago to investigate the pharmaceutical company for its potentially illegal actions. The long list of very shoddy and very suspicious activity of the drug company can be found on the arizonaadvancedmedicine.com website.
Senator Edward Kennedy at the April 8, 1976 hearings before the Senate Subcommittee on Labor and Public Welfare stated: “The extensive nature of the almost unbelievable range of abuses discovered by the FDA on several major products is profoundly disturbing.”
So how does a drug whose research contained an unbelievable range of abuses get approval? Well, the FDA unanimously rejected the application for approval of E951 but when the President was elected, he appointed a new FDA commissioner who overruled the objections of his scientists. The head of the drug company went to work for the president on his transition team. How’s that for political skulduggery? Furthermore, this same commissioner went to work for the same drug company at the end of his tenure at the FDA.
So a drug, E951, with very poor scientific background, with reported toxicity, with known carcinogens as a by product of its breakdown in the body is unleashed on an unsuspecting and trusting public and will be incorporated into thousands of products used by almost every American.
Now for the reveal … E951 was actually approved in 1981! The President was Ronald Reagan. The head of the drug company was Donald Rumsfeld and the drug company was G.D.Searle. The FDA commissioner was Arthur H. Hayes who joined Searle’s public relations agency (Burson-Marsteller) as a senior medical advisor immediately after leaving the FDA (in 1983). You know E951 by its commercial name: Aspartame or Nutrasweet. Now you know the rest of the story.
If you really check out the details of the science you will never touch diet soda or a product containing Nutrasweet / Aspartame again. It does break down to methanol which turns into formaldehyde. It does trash your microbiome. It has indeed been the most reported food additive to the FDA. Research does suggest it causes brain damage and brain tumors. AVOID IT IN ALL ITS FORMS. Soda is the low hanging fruit of improving your health. Whether it’s the truly awful high fructose corn syrup found in regular soda or Nutrasweet in diet soda … you don’t need either one. Both are clearly bad for you and have nothing nutritionally redeeming about them. Just say no to soda and diet soda.
Until next month … get well … stay well.
(ed. Readers can listen to Dr. Joe Barry’s radio show “Your Health Matters” airing Sunday afternoons at 12:00pm on WSYR 570)
The Cardio ION Nutritional Test
Finally something new and exciting to talk about. Well it’s not actually new but its new to New York State. There is a company in Georgia that has been in business for over 20 years doing nutritional analysis and finally they have gotten clearance to do business in New York and that’s big news because this analysis could be fundamental to figuring out what’s wrong with you.
I do a lot of blood work … its one of the most important ways to access what’s wrong with you. We doctors check your thyroid, your Vitamin D, your liver and kidney function, your cholesterol etc. … but we have never before had the option to check your health at the cellular level. Never before could we check your amino acid levels, your toxins like aluminum, cadmium, mercury, lead, your omega 3’s, omega 6’s, oxidative stress, cell membrane components etc. all in one test.
Think of it this way. Your cells, the cells that make up your body —wherein all the chemical processes that keep you alive take place— are swimming in a pool of nutrients and chemicals. The question is … are your cells swimming in Skaneateles lake or are they swimming in Onondaga lake? Now for the first time we can actually measure these chemicals.
Your doctor knows about essential amino acids. Your doctor certainly knows about vitamins. Your doctor knows about chemical processes like the Krebs cycle. We all studied these pathways and processes. What we have not done is actually measure these nutrients in your body. We can now. We know the chemical components of these pathways. We know the composition of the cell walls and the mitochondria … but we have never before been able to see if your components are the right ones and the right amount. We can now. We can compare your own unique “recipe” with the gold standard “recipe” and the great thing is that we can adjust your recipe with changes of diet and use of selected supplements tailored to your specific deficiencies to approach the gold standard and when your recipe approaches the gold standard your health improves.
It’s really like a chemistry class. There are millions of chemical reactions taking place in your body continuously. Every chemist knows it is critical to have the right amount of the right ingredients to get a good product. Just ask Mr. White in Breaking Bad. Finally your doctor can order a test that tells us if you have the right amount of the right substrates for building health in your body.
How many people with chronic fatigue, malaise, or other chronic illness have been to doctor after doctor and found nothing actionable. “It’s your genes” or “it’s depression” or “its all in your head” are common rationale for not finding the cause of your illness. What if the real cause for your illness is some deficiency? Why not measure the measurable things and find out?
There are two issues with this testing which is called Cardio-Ion test and its offered by Genova Diagnostics in California. The first issue is that it’s not a cheap test. -But neither is an MRI or a Cat Scan. The cost varies depending on your insurance and deductible etc. With no insurance the cost is around $500 dollars. As of 3/19/2019 there were only 5 doctors ordering this test in New York. As I said it’s been around for over 20 years but only available in NYS since 2018. As one of the five current doctors ordering the test in New York I am still trying to get a firm price for my patients but you don’t have to come to me or one of the other doctors. Your own doctor can sign up to order the test. There is no charge to open an account or onerous paperwork to do so it’s not that hard for your health care provider to get set up to do this test.
The second issue is that the test is so specific, so detailed, that it will take your doctor some real effort to learn how to interpret it. The 11 page report measures the standard items like total cholesterol triglycerides etc. but also measures ferritin fibrinogen, C-reactive protein, insulin, testosterone, magnesium, homocysteine coenzyme Q10, 2 different measures of your vitamin E, limiting amino acids, branched-chain amino acids, essential amino acids, neurotransmitters and precursors, urea cycle and ammonia detoxification, aluminum, arsenic, cadmium, lead, mercury, zinc, copper, selenium, lipid peroxidase, DNA oxidative stress markers, polyunsaturated omega-3, omega-6, monounsaturated fats, saturated fats, and nutrient markers. It also measures cell-regulation markers, toxicants and detoxification and compounds related to bacterial or yeast/fungal origin. How’s that for a list!!?! So your doctor understands all these components but has never had to review them in this way so be patient with them. I was introduced to this test by Dr. Sheri Rogers and I actually pay her to help me interpret the results. Once I have done enough tests I will be qualified on my own but I have been impressed with how much information you can extract from this test. Dr. Rogers —like Dr. Gundry— believes that food, the right food, is critical to your health and they both believe that supplements are necessary to achieve the right “recipe” -(in part because we live in such a processed, inorganic world). These two experts from vastly different experiences and very different geographical locations both believe that only through lab tests can we really know the correctness of your “recipe” so to speak.
Do your own research. It’s your health and wellness after all. I think this testing will become standard practice as more and more doctors become familiar with it. The more exact science we can bring to bear on your health the better.
Until next month … get well and stay well.
The Problem With Pot
Everybody and their brother is talking about the benefits of marijuana. According to cbdatwork.com recreational marijuana will be legalized in 2019 in New York State. Canada to the North of us and Massachusetts to the East have both fully legalized marijuana so it appears just a matter of time before its legal and available in New York State. Here’s an interesting bit of trivia … What was the first country in the world to legalize marijuana? The answer is a country in South America called Uruguay.
Let’s start with the very popular CBD oil. CBD oil is a legal derivative of the hemp plant that has some of the benefits of marijuana without the high. You can get CBD oil from well established outlets like Charlotte’s Web in Colorado … they even have dosing for your pets. Or you can get CBD oil from the local gas station and many places in between. The people selling CBD oil claim that it can help or cure many ailments … from insomnia, chronic pain, dyspepsia, arthritis, and chronic fatigue to name a few. I think CBD oil can help some people some of the time so I am all for trying it instead of more toxic drugs that your doctor or healthcare provider might prescribe. Benefits may be exaggerated but the likelihood of serious adverse reaction is low so the risk benefit ratio favors giving it a try.
Now medical marijuana has been legal for over a year now in New York State and it looks like recreational marijuana is on the horizon. I believe that marijuana is much safer than cigarette smoking and I believe marijuana is far safer than alcohol but that doesn’t mean is completely safe. All of the above, cigarettes, marijuana and alcohol and much more should be restricted from children. Most adults won’t be seriously harmed by pot. They might have issues with lack of motivation and concentration but there doesn’t appear to be a significant risk of lung disease, cancer, etc. with recreational use. Marijuana is touted as a treatment for chronic pain and insomnia, and the supposition is that people taking marijuana can and will take less sleeping pills and narcotics. Unfortunately, the literature and my personal experience as a Medical Marijuana Prescriber have not found that to be the case. Hey, even if it doesn’t cut down other med use, if it improves the quality of your life it’s a reasonable option to try. It’s no panacea but it’s also not opening up Pandora’s box.
However, one type of patient should probably avoid marijuana —medical or otherwise— those with a pre-existing mental illness … like depression, paranoia and schizophrenia. Research done by Alex Berenson has looked into the use of marijuana by people that are mentally ill. As you may be aware the THC content of marijuana has jumped from the historical norm of 2-3 % to over 20% from the modern cultivars. This increased potency can take a toll on patients with underlying serious mental illnesses. A January 2018 paper in the American Journal of Psychiatry found that people using cannabis in 2001 were almost 3 times as likely to use opioids 3 years later even after adjusting for other potential risks. Furthermore, studies have shown that people with schizophrenia are more likely to be violent under the influence of marijuana. Quoting Alex Berenson directly “Teenagers who smoke marijuana regularly are about three times as likely to develop schizophrenia, the most devastating psychotic disorder.” And, after an exhaustive review, the National Academy of Medicine found in 2017 that “cannabis use is likely to increase the risk of developing schizophrenia and other psychoses; the higher the use, the greater the risk.” There’s a lot more info about the connection between pot and mental illness elaborated in Berenson’s new book Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence.
Now I am not into fear mongering but I am also not into the overhyping that accompanies any new drug or treatment. I guess that makes me a goldilocks guy … the middle road seems safest to me. Again, I don’t think marijuana is a cure all but it’s also not the work of the antichrist. -Caution should be used in patients with psychiatric issues.
Until next month … get well and stay well.