Category Archives: alternative & complementary medicine

Dukan Diet Doc disciplined

Diets come and go, like fashion it seems..but the diet that grabbed the headlines last year was the Dukan Diet, said to be the reason the Duchess of Cambridge, Kate Middleton, managed to shed those pounds to squeeze into her wedding dress for that royal do of the year.

Kate Middleton - lost 4 pounds in 4 days with the Dukan Diet

It now transpires that the inventor of the diet, Dr Pierre Dukan,70, is to be hauled up by the French Ethics Council for breach of the medical ethics code.  In a book out in January, the star nutritionist proposes bumping up A-level equivalent pupils’ marks if they manage to maintain an acceptable Body Mass Index, a measure of body fat based on height and weight. The French College of Physicians has lodged a complaint against Dr Dukan because his remarks  could prove harmful for pupils already suffering from obesity or anorexia.

The good doctor’s intention is quite clear and should be lauded, what with the large proportion of obese children and the hazards it poses towards their health. he said: “There is nothing unhealthy about educating youngsters about nutrition.”

“My idea would change nothing for those who have no need to get thinner. But for those who do, it would only motivate them to lose weight.”

Dr Pierre Dukan, inventor of the celebrity diet

The Dukan Diet has been a rave favorite with celebrities worldwide – its followers include Jennifer Lopez and Victoria Beckham. But it has also drawn quite a bit of controversy. The British Dietetic Diet has branded it the ‘worst diet of 2011’, claiming that there was no scientific basis and that it was harmful to cut out food groups.

What the diet entails is nothing new essentially, it bears resemblance to the time-tested Atkins Diet which has been around for decades. It comprises of  a complicated four-stage approach based on eating lots of protein-rich meat and fish and cutting out carbohydrates : the “attack“, “cruise“, “consolidation” and “stabilisation” phases.

During “attack”, which lasts five to 10 days, participants are meant to eat nothing but lean meat, fish, eggs and low-fat dairy products – plus a tablespoon and a half of oatbran a day.

In “cruise” they are allowed some vegetables every other day, but no spuds. Their oatbran allowance goes up half a tablespoon. This can go on for months, until a dieter’s “true weight” has been achieved.

Those strong-willed enough to achieve that aim can then start eating some bread and fruit once more, a period known as “consolidation”.

Finally, participants reach “stabilisation”, when they can eat whatever type of food they like – apart from on Thursdays.(don’t ask me why, but you can eat anything you like on the other days, provided its on the list of the first two phases).

 

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The Reason Steve Jobs Died

For such a visionary man who had a profound influence on the IT landscape, Apple’s announcement of his demise was strangely devoid of the cause of death. Maybe because Steve Jobs was an intensely private person, but it is a known fact that he had been suffering from a type of pancreatic cancer since 2004.

 

There are two types of cancer of the pancreas : the commoner (95%) exocrine type aka adenocarcinoma and the rarer (5%) neuro-endocrine type aka Islet cell carcinoma. The latter  form was what afflicted Steve Jobs, according to several sources. Although rarer, this form of tumor is slow-growing and can produce various hormones (“functional tumors”), af act which was acknowledged by Steve Jobs in explaining his profound loss of weight.

A gaunt Steve Jobs, as the illness took hold

Patrick Swayze- another victim of pancreatic cancer

 

Nevertheless, cancer of the pancreas, apart from being difficult to diagnose in the early stages, is notorious for carrying a bad prognosis.. only 4% of people suffering from it can expect to live beyond 5 years. So how did Steve Jobs  manage to go on for 7 years?

Standard treatments for pancreatic cancer include the 3 common tumor-fighting strategies — surgery, chemotherapy, radiation and, most recently, targeted anticancer drugs.

Firstly, it was reported that he underwent pancreatectomy (an operation to remove the tumor) when it was first diagnosed in 2004. It is not known whether he underwent chemotherapy or radiation but, subsequently, in 2009, he had a liver transplant which probably meant that the cancer had spread to the liver. Although liver transplants are not the usual way of treating such spread of cancer, it is believed that it can be a form of cure for neuro-endocrine tumors such as the one Jobs had.

In any case, with a transplant, the use of immuno-suppressive drugs became mandatory. These drugs work by preventing the body from rejecting the transplant (which came from a human donor) but carry severe side-effects, like suppressing the body’s own immunity. Sometimes, these drugs can themselves cause fatal effects.

Because of the poor outlook, many sufferers tend to try alternative treatment startegies. Some include the Gonzalez regimen (using enzymes and vitamin supplement), radiation-based hormone therapy and herbal therapy but it is unclear whether he had resorted to alternative therapy.

Despite the best available medical care, the fact that he finally succumbed to the illness goes to show that cancer of the pancreas remains notoriously difficult to treat and still carries with it a rather grim prognosis.

 

Where Have All The Slimming Pills Gone?

Looking for slimming pills? Don’t look too far, because virtually all the known slimming pills introduced over the last few decades have  all been banned or for restricted usage only. Whether its phentermine (Duromine, Adipex), ephedrine (Ephedra), rimonobant (Accomplia) or sibutramine (Reductil,Meridia) they’ve all fallen by the wayside due to their dangerous side-effects.

 

Impressive weight-loss ads often detract the consumer from the dangers of diet-pills

 

 

Duromine, one of the earliest slimming pills, is now indicated for short-term use only (I take it to mean less than 3 months) and can only be used in those who do not have a long list of medical conditions (see here). Since it is related to amphetamines (speed), it is very much a controlled substance and available only on doctors’ prescription.

Accomplia practically did not see the light of day, after it was banned within 2 years of use, after a significant percentage showed suicidal behaviour . I had written in an earlier posting here.

Latest to be banned in the US this month is sibutramine because of the high incidence of heart attacks and stroke. As I’ve said before, the Europeans seem to be more responsive and alert, having put this drug in cold storage since January this year.

However, the more worrying issue is that sibutramine has been found in several so-called herbal preparations. Examples include:

  • a Chinese herbal medicine, called “LiDa Dai Dai Hua Jiao Nang”, available on the Internet.
  • a Canadian product “The Slimming Coffee”.
  • In Malaysia, “Slimway Herbs” has been banned after earlier obtaining official approval.

 

Many Drinks and Herbal products contain sibutramine

 

 

So what drugs can be used safely?  Orlistat (sold as Xenical in prescription form and as Alli over the counter) is now the only prescription weight-loss drug approved for long-term use. The drawback of using this drug, as users will tell you, is that it “leaks” and stains trousers and clothing and wherever you sit down. The reason is that it works by preventing absorption of foods containing oil and fats, which then come out the other way (read “leaks out the other passage”!).

I guess the message is loud and clear – to lose weight, you have to fall back to good old diet and exercise!

The Many Faces of Viagra

Going through a very recent Drug Alert in my mail-box, I noted that the FDA in the US had issued a directive to a drug company to recall all its products designed to help erectile dysfunction aka ED aka sexual impotence.

ED - a major health issue with a major source of profits

This was because they all were purported to contain sulfoaildenafil . This substance was not declared on the label and is structurally similar to sildenafil, the chemical name for that famous blue pill, Viagra. In fact, both drugs carry a similar profile of side-effects – the major concern being it works in a similar fashion to drugs used in treating heart patients, and so can cause an over-reaction of these drugs which can lead to collapsing and even death in those heart patients.

Because the patent rights of Viagra are exclusive to Pfizer, many so-called performance-enhancing products and herbal remedies that profess to produce ‘stiff nights’ are believed to contain the alternative sulfoaildenafil as this product is non-patented and available from thousands of importers.

So its a great big market out there with countless such remedies. The marketing department of the drug company subject to the recall (here) must have worked overtime to come up with such names as:


Stiff Nights, Size Matters,Erex, Mojo, Hard Drive, Eyeful, Straight Up,  Monster Excyte, WOW,  Verect, Prolatis Libidinal, OMG, OMG45.

The last one above (OMG45) ,by the way, is not, as you might imagine, make it last 45 min…its for those aged 45 and over! 🙂

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Medical Marijuana – the Momentum Multiplies

To the casual observer, it would seem surprising that marijuana would be legalised under the Obama administration. Law-enforcers will apparently not arrest users and sellers of marijuana (aka weed,grass,cannabis,hashish,ganja) – provided they conform to US state laws on its use for strictly  medical purposes.

A legalised marijuana dispensary in Oakland,Calif - authorities in LA are clamping down and closing 475, leaving only 70 in 2010

New Jersey became the latest  USA state to allow its medical use, adding to the 14 which had done so earlier. Unlike California,  where doctors are authorizing patients to take marijuana to relieve such minor ailments as anxiety, headache, premenstrual syndrome, and trouble sleeping,  New Jersey has tightened regulations to allow its medical use only for people who have less than a year to live, or those with specific symptoms resulting from certain chronic diseases like AIDS, cancer and Crohn’s.

Marijuana tincture - early 20th century pain relief

Marijuana has been used medicinally  as an intoxicant for thousands of years in Eastern culture. In Western medicine, several well-known pharmaceutical companies, including Eli Lilly , sold cannabis in powdered or tincture forms in the early 20th century as a painkiller, antispasmodic, sedative, and “exhilarant.” Since then, its use declined because more effective drugs for these purposes became available.

Now, researchers have shown its usefulness  in the treatment of neuropathic pain (intense pain due to nerve damage), improving nausea and poor appetite in patients on chemotherapy as well as releasing muscle spasms in patients with multiple sclerosis. While medical research has been slow, (researchers are finding it difficult to get the plant legally and to get permission to undertake such research), its medical use remains controversial in many areas other than the few indications above.

Wishful Thinking - Proponents of Legalising Marijuana Hope To See This Kind of Outlets!

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How Marijuana Became Legal..Medically

The news that the Obama administration will not seek to arrest marijuana users and suppliers as long as they conform to US state laws on its use for medical purposes must have raised quite a number of eyebrows(see here). In the first place, not many are aware that pot is legal, within restrictions, that is. Secondly, the new policy is a significant departure from the Bush administration, which had insisted it would continue to enforce federal anti-pot laws regardless of state codes.

marijuana dispensary

Patients wait for assistance at a marijuana dispensary,Oakland,Ca. There are more dispensaries in Los Angeles than Starbuck or McDonalds outlets!

Currently, 14 states in the US allow the use of marijuana for medical purposes: Alaska, California, Colorado, Hawaii, Maine, Maryland, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont and Washington. If Obama has his way, Federal anti-narcotic agents cannot prosecute outlets selling large amounts of marijuana as long as it is for medical use.

marijuana_Irvin Rosenfeld

Irvin Rosenfeld, who suffers from painful bone disease, gets his legal pot from the US government

In the US, 4 citizens actually obtain their marijuana from the federal government, with FDA approval. One of them takes it to relieve chronic pain and muscle spasms caused by a rare bone disease, invariably fatal, called multiple congenital cartilaginous exostosis.(see pic)

Typically, the medical use of marijuana is for patients with:

chronic pain (particularly nerve pain caused by diabetes, AIDS, and hepatitis);

– movement disorders and muscle spasticity (especially for multiple sclerosis patients);

-“drug sickness'”, as an anti-nausea and anti-vomiting agent (for those, say, undergoing chemotherapy);

-poor appetite, as an appetite stimulant for those with wasting diseases like AIDS and cancer.

Marijuana, whose botanical name is cannabis, has been used medicinally — and as an intoxicant, of course — for thousands of years in Eastern culture. In Western medicine, several well-known pharmaceutical companies, including Eli Lilly , sold cannabis in powdered or tincture forms in the early 20th century as a painkiller, antispasmodic, sedative, and “exhilarant.” Since then, its use declined because more effective drugs became available.

The question now is that, with medical marijuana being legalised, what constitutes medical use? The potential of abuse is apparent – just look at California, where doctors are authorizing patients to take marijuana to relieve such minor ailments as anxiety, headache, premenstrual syndrome, and trouble sleeping. There are about 700 medical marijuana dispensaries now operating in California openly distributing the drug :- narcotics trafficking done legally!

Chilling Out With Chilies

There are several friends of mine who would not travel abroad or even eat without having chilies by their side, almost to the point of, well.. an addiction! Well, that might be the right word, as it is well-known that the active ingredient of chilies, capsaicin, has been shown to stimulate the production of endorphins, the feel-good chemical produced by your own body in response to strenuous exercise, excitement, pain and orgasm.

Chilli_SantaFe

Sign in an obviously Hispanic store in Santa Fe, New Mexico (courtesy of ZA Yusof)

This probably explains why people go bungee-jumping, jump off buildings in their parachutes and return for more. Endorphins mimic the ‘hard drugs’ like opiates in their ability to produce natural pain-relief and a sense of well-being, as well as being addictive – the difference being that endorphins are produced within our bodies. Well, this same effect is produced when consuming chilies, due to this production of endorphins.  So much so, while Mexico has gained the dubious reputation as a source of clandestine drugs, it has always been  known for  exporting the  legalised form-  chilies!

There are many healthy benefits in consuming chilies:

  • it prevents sinusistis and blocked noses
  • it has anti-inflammatory and pain-relieving properties, useful in arthritis and nerve diseases
  • capsaicin can fight cancer cells from the prostate
  • capsaicin, according to a Duke University study, can can also help to kill the ulcer-causing bacteria, H. pylori
  • chilies are high in antioxidant carotenes and flavonoids, and contain about twice the amount of vitamin C found in citrus fruits

Are there any unpleasant effects? Apart from watery eyes, a running-nose and stomach irritation, consuming chilies do cause an irritating cough, due to the capsaicin. See here for a possible cure to the cough.

For chili connoisseurs, many are aware of the Scoville Scale, measured as Scoville Heat Units (SHU) which determines how ‘hot’ different types of chilies are.Chilli Scale2For those friends of mine who claim to have conquered the bird-eye chili (phrik thai, chili padi), they would be amazed to know that it ranks under moderately hot only (see Thai peppers in above diagram). The real challenge is in trying the world’s hottest chili, Naga Jolokhia, which comes from India. Those who have tried it claim that it is too hot to be taken au naturel and recommend it be pickled in mustard oil and taking the oil, one drop at a time!

chilli_bhut_jolokhia

The Naga Jolokhia -the World's Hottest Chili

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Going For Surgery? Remember This..

My doctor colleagues were quite puzzled recently when a patient, after undergoing routine surgery, took a longer time than usual to wake up after GA was completed and stopped. The patient required an overnight stay in the ICU before finally waking up 24 hours later! It was subsequently discovered that the patient had been taking supplements, in this case, St John’s Wort.

evening-primrose-oil

This popular supplement,EPO, needs to be stopped 2 weeks prior to surgery (see text)

Before undergoing surgery, one important info which must be disclosed to your doctor is whether you are taking herbal supplements. This is often left out by patients when doctors enquire on what medications they are taking, as often many people do not equate medicines with supplements.

Many intensive care physicians including anaesthesiologists will tell you of their experience with patients who take a long time to wake up after surgery; develop fits upon recovery or bleed excessively after surgery; all due to the taking of herbals.

Incidents like the above used to mystify many doctors previously but evidence is now clear that several over-the- counter supplements can interfere with the various actions of medications used during surgery.

Take a look below at some common examples:

Herbal supplement Possible complications
Aloe vera May cause increased intestinal muscle movement to digest food (peristalsis), may decrease effectiveness of water pills (diuretics) given after surgery
Bromelain May cause bleeding or interact with antibiotics such as amoxicillin or tetracyclines
Danshen May cause bleeding
Dong quai May cause bleeding
Echinacea May interfere with immune functioning, may alter effectiveness of immunosuppressant drugs given after transplant surgery
Ephedra May cause abnormal heartbeat, may cause extreme high blood pressure and coma if combined with certain antidepressants and anesthesia
Feverfew May cause bleeding
Garlic May cause bleeding, may interfere with normal blood clotting
Ginger May cause bleeding
Ginkgo May cause bleeding
Ginseng May cause bleeding, may cause rapid heartbeat, may cause high blood pressure
Goldenseal May cause or worsen swelling and high blood pressure
Kava May enhance sedative effects of anesthesia
Licorice (not including licorice candy) May increase blood pressure
Omega-3 fatty acids May cause bleeding if taken in doses greater than 3 grams a day
Senna May cause electrolyte imbalance
St. John’s wort May increase or decrease the effects of some drugs used during and after surgery
Valerian May prolong the effects of anesthesia
The above list is not exhaustive. As more cases are encountered, the list gets longer!
Evening Primrose Oil (EPO) is now implicated in the cause of fits or seizures following general anaesthesia.
Some points to note if you are undergoing planned surgery:
  1. Remember that the list of medications that you need to reveal to your doctor includes all supplements, whether as pills or as a drink.
  2. Some of these herbals may have to be stopped more than 2 weeks prior to planned surgery.
  3. In emergency surgery, remember to reveal to your doctor and next-of-kin what you are taking so that some preventive measures may be undertaken beforehand by the doctors.
  4. Some people believe if something is natural, it is safe. That is not necessarily true. If in doubt, show your care-giver the original container of the supplement.


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A Rich Man’s Disease Becomes Middle-Class

I was quite bemused recently to see a regular patient hobble in to the clinic in slip-ons,  a typical scene with which most doctors would be able to diagnose immediately an  attack of acute gout. Bemused because a few weeks earlier he had joked about gout being a ‘rich man’s disease’ and he was sure, given the recession and his financial state, that there was no way he was going to get an attack.

Gout, more accurately acute gouty arthritis, has always been referred to as ‘ the rich man’s disease’ because of its association with rich foods and alcohol once available to aristocrats (like King Henry VIII and Sir Isaac Newton). The scenario today has changed as it extends its hold on the older, sedentary and overweight middle-class workers.  Acute gouty arthritis is caused by  excess uric acid ( a by-product of ingested proteins) being deposited to joints, especially the large toe, causing an excruciatingly painful situation which often wakes one up in the middle of the night.

Gout_James_Gillray

English caricaturist, James Gillray(1757-1815), himself a gout sufferer, aptly illustrated the misery and pain of Gout

Gout_Apple-Cider-Vinegar

Pain relief requires strong  medications like non-steriodal antiinflammatory analgesics(NSAIDs) or colchicine and once the pain subsides, to take medications on a long-term basis to help prevent forming uric acid (like allopurinol) or to help throw away uric acid via the urine (like probenecid). As these have side-effects, many switch to alternative remedies, like apple cider vinegar, celery and other anti-oxidants.

Just to keep you updated, there has been no new medications for treating gout for the past 40 years(!)….until quite recently, when Uloric was introduced in the market. Touted to be safer than existing medications (which cannot be given to people with kidney disease and also carry death-threatening allergic reactions), the US FDA recently approved its general use.

Stuff which you need to reduce to avoid gout include:

Alcohol.

Dairy foods (can be problematic for many with gout.)

Fluoridated and chlorinated (tap) water.

Fried Foods .

Junk foods and baked items have saturated and trans fats.

Meats with high protein levels like Steak, Turkey, Duck, Goose, Pheasant, Herring, Anchovies, and Sardines.

Mushrooms and Mushroom Gravy.

Organ Meats like Kidney and Heart (read pate).

Peas and some beans.

Pizza (white flour, cheese and meat for a triple whammy).

Roasted Nuts.

Sugary foods, esp high-fructose corn syrups.

Tangerines and other citrus fruits.

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When Medicines Were Simple & Effective..

medicines1

Bayer's heroin: Between 1890 and 1910 heroin was sold as a non-addictive substitute for morphine. It was also used to treat children with strong cough.

medicines2

Mariani wine (1875) was the most famous Coca wine of it's time. Pope Leo XIII used to carry one bottle with him

medicines3

For Inhaling IF You Have Asthma

medicines4

Cocaine tablets(1900) - All stage actors, singers, teachers, and preachers had to have them for a maximum performance

Ahh…thanks to medical research, we have better alternatives nowadays. But are all of today’s products free from side-effects?

(Thanks to Ron in Vancouver for the material)

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