Depression among the Elderly

This question from S.R. in Tuckahoe:  Thank you for the information about SAD, but my grandma seems to have SAD all of the time. Any thoughts?

Seasonal affective disorder, or SAD, is a mood disorder that predictably happens at about the same time every year.

Typically it begins in the late fall and continues through the winter and is related to the decreasing amount of sunlight and its effect on the production of various brain hormones, particularly serotonin. If someone is sad all of the time, then they don’t have SAD but could be sad for a myriad of other reasons.

Symptoms like:

• difficulty concentrating, remembering details and making decisions
• fatigue and decreased energy
• feelings of guilt, worthlessness and/or helplessness
• feelings of hopelessness and/or pessimism
• insomnia, early-morning wakefulness or excessive sleeping
• irritability, restlessness
• loss of interest in activities or hobbies once pleasurable, including sex
• overeating or appetite loss
• persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment
• persistent sad, anxious or "empty" feelings

are all classical signs of depression. If this sounds like your grandma, then it is important that she see a mental health professional because left untreated not only is her quality of life negatively impacted but she could become suicidal. Therefore, treating depression isn’t a do-it-yourself-at–home kind of thing but should be taken seriously.

As we age our production of hydrochloric acid in our stomach decreases, which makes it harder to digest and absorb some important nutrients. Furthermore, the accumulated effects of the “wear and tear” of life begin to take their toll, again increasing our need for many different nutrients.

In the recently published article  "The effect of low-dose omega 3 fatty acids on the treatment of mild to moderate depression in the elderly: a double-blind, randomized, placebo-controlled study," it was again demonstrated how important good nutrition is. They reported that just a small daily intake of fish oil containing only 300 mg each of EPA and DHA can have useful effects against depression in the elderly population.

Now that winter seems to be finally abating, go with your grandma for long and regular walks, the exercise and sun exposure will do you both good, make sure she is eating a broad and varied diet with a good daily multivitamin and include some fish oil in her supplements. In our office we use the Metagenics brand of fish oil because of its purity and mild taste.

Maintain Your Brain: Tips to Retain Concentration and Memory

This question from E.T. in Bridgehampton: Last week you wrote about depression and you mentioned trouble with concentration, my dad has trouble with his memory and concentration but I don’t think that he’s depressed. Any ideas?

Many of us in the “49 and holding” crowd joke about “senior moments.”

But when they start happening to you more often, they’re not funny at all. Instead, they’re frustrating, embarrassing and perhaps even worrisome especially to your kids who immediately have visions of nursing homes and diapers. Have you ever walked into a room — and forget what you went in to get? Run into someone you haven’t seen lately — and can’t recall their name? (I can never remember names.) Misplaced your glasses, your house keys or your car? It’s ironic. Just when you’ve got life almost figured out with all of this wisdom and experience under your belt, your brain is no longer “old reliable.” You never know when it’s going to trip you up, frustrate you, embarrass you, or make you wonder if you’re starting to lose your marbles.

So what’s a dad to do? Researchers at Harvard have been doing extensive studies in this area, lest they suffer the same fate as us mortals, and have dutifully been reporting their findings. Aside from stress and the myriad distractions of daily life, they have concluded that there are both structural and functional reasons for our brain faux pas.

Once we become an (AARP) card carrying member of the “49 and holding” crowd, structural changes become evident in our brain. Oxidative damage and the accumulation of toxins cause damage to the protective myelin sheath which makes our nerves short circuit a bit thus causing “data loss.”

Furthermore, as we age our levels of neurotransmitters and brain hormones, decrease causing a functional slowing of the transmission of information. The pharmaceutical industry has responded with drugs like Provigil, Aricept and Namenda to name but a few. These drugs try to close the gate after the chickens already flew the coop by manipulating neurotransmitter levels.

From a more pro-active perspective there are some natural supplements that have proven themselves to be helpful. Phosphatidylserine restores the brain's supply and output of acetylcholine, the neurotransmitter so important to memory, and so may turn back the clock in an aging brain. Alpha-glycerylphosphorylcholine, or Alpha-GPC is a cholinergic brain supplement that increases the synthesis and secretion of the neurotransmitter acetylcholine, which is the brain's messenger responsible for sending signals across the brain and to the muscles of the body. And Acetyl L-Carnitine (ALC) is basically a fat soluble amino acid that has the ability to cross the blood-brain barrier and get to the brain blood circulation, where it acts as a powerful antioxidant, which helps in prevention of the brain cells' deterioration. Its supplementation has been shown to be neuroprotective in instances of cerebral ischemia and may be useful in treating peripheral nerve injury. There are numerous supportive supplements ranging from blueberries to ginko and vinpocetine, to name but a couple.

Back to our friends at Harvard who put together 10 research-proven tips for a better memory:

1. Believe in yourself. Middle-aged and older learners do worse on memory tasks when exposed to negative stereotypes about aging and memory, and better if exposed to messages about memory preservation into old age.

2. Economize your brain use. Take advantage of calendars and planners, maps, shopping lists, file folders and address books to keep routine information accessible. Designate a place at home for your glasses, keys, and other items you use frequently.

3. Organize your thoughts. New information that’s broken into smaller chunks, such as the hyphenated sections of a phone or social security number, is easier to remember than a single long list.

4. Use all your senses. The more senses you use when you learn something, the more of your brain will be involved in retaining the memory.

5. Expand your brain. Widen the brain regions involved in learning by reading aloud, drawing a picture or writing down the information you want to learn (even if you never look back at your notes).

6. Repeat after me. When you want to remember something you have just heard or thought about, repeat it out loud. For example, if you’ve just been told someone’s name, use it when you speak with him or her: “So John, where did you meet Camille?”

7. Space it out. Instead of repeating something many times in a short period, as if you were cramming for an exam, re-study the essentials after increasingly longer periods of time — once an hour, then every few hours, then every day.

8. Make a mnemonic. Mnemonic devices are creative ways to remember lists. They can take the form of acronyms — such as the classic “Every good boy does fine,” to remember the musical notes E, G, B, D and F on the lines of the treble clef.

9. Challenge yourself. Engaging in activities that require you to concentrate and tax your memory will help you maintain skills as you age. Discuss books, do crossword puzzles, try new recipes, travel and undertake projects or hobbies that require skills you aren’t familiar or comfortable with.

10. Take a course. Memory-improvement courses are becoming more common. Choose one run by health professionals or experts in psychology or cognitive rehabilitation. Stay away from courses that center on computer or concentration games, which generally won’t help you with real-life memory problems. Select a course that focuses on practical ways to manage everyday challenges.

Embarrassing Digestive Problems

This question from F.K. in Sagaponack: My husband seems to be healthy but his digestive problems can be ... embarrassing, any ideas?

Digestive problems can occur for numerous reasons and many a book has been penned about them.

As usual, any problem that is new, severe, of rapid onset or accompanied by pain or blood in the stool should be checked out by your physician. Fortunately, most problems are of a functional nature.

As we age, three things commonly happen to our digestive tract. Things tend to slow down, so we need more roughage/fiber and water. Our stomach’s production of hydrochloric acid decreases as does our production of digestive enzymes. As a result we can develop symptoms of gas, bloating and indigestion as the good bacteria in our digestive tract are thrown out of balance by their changing environment.

To add fuel to the fire, as our production of hydrochloric acid and enzymes decreases, it makes us more susceptible to infections. Over time the accumulated assaults of innumerable tiny and sometimes not so tiny infections in the digestive tract can cause damage to what are referred to as the “tight junctions,” so that incompletely digested molecules are absorbed into our blood stream. This will then lead to the development of food allergies which will only make these symptoms worse.

Now, what is hubby to do? First, to address the slowing down issue — which allows food to putrefy and produce gas — eat more fiber, drink more fluids and exercise.

As we exercise — fast walking, bicycling or swimming being among the best — it not only helps our muscle tone, bone density and svelte appearance, but it also stimulates our gut to move more regularly, hopefully at least twice per day. To compensate for our decreased production of hydrochloric acid, the natural supplement Betaine HCL right before meals can be very helpful. Taking a supplement like Similase BV after meals can support our decreased production of digestive enzymes. To minimize the effects of inflammation and infection, making sure that we have plenty of good microbes in our digestive tract is of vital importance. Probiotics like Jarro-Dophilus or Pro-Flora can easily fit the bill here.

If the digestive problems remain then coming in for food allergy testing and addressing the undigested molecules that are leaking into the blood stream can often solve the problem, if not then more extensive testing is indicated. Until then, Glade air freshener can work wonders.

Why Am I Always Getting Sick and Never Healing Well?

This article by Dr. Jesse Stoff appeared on Southampton Patch on April 23, 2011

A. J. in Sagaponack asks: I seem to be always sick with something and not healing well. Any thoughts?

When my daughter, Summer, gets a small cut on her finger and asks for a Band-Aid, she does so with the full expectation that when the Band-Aid is removed a couple of days later, the cut will have been “magically” healed.  She is usually rewarded by her faith in her body’s healing capacity.

On a macroscopic level, healing appears to us as a miracle or as magic because of all the little elements that go into the repair of the damaged tissue. The removal of foreign material and destruction of harmful bacteria all happens in a microscopic world that is not directly accessible to our unaided eye.

My daughter’s unquestioning child’s faith in the healing powers and magic of her body are also an important ingredient when it comes to healing more severe or recurrent diseases. Left to its own devices, the body tends towards health. When someone doesn’t heal well or keeps getting sick there is reason that lies in one or more of the five areas that affect the integrity of our immune system. The first of these is nutrition. Nutrition supplies the basic biochemical building blocks that provide the infrastructure for our immune system to function properly. Just eating a broad diet doesn’t guarantee that you’ll get what your immune system needs because there are issues of the quality of the food and the efficiency of the digestive system to be reckoned with.

Infection is the second area that affects the functioning of our immune system. Viruses that directly attack immune function like EBV, CMV and HIV will have long term consequences on our ability to protect ourselves from future infections. EBV and CMV are common. More than 96 percent of the population have been exposed to them at some point. Imbalances in the micro-organisms in our digestive tract will also have a profound affect on immune system.

As a consequence of our industrialization, toxins now abound throughout our environment. A casual perusal of http://toxnet.nlm.nih.gov will give you some small idea of how big and prevalent the problem is. That’s why it is important to limit your exposure to toxins wherever you can such as choosing to eat as much organic food as you can and drinking plenty of pure water, fluoride not included.

Trauma is the next agent of immunological suppression. The only form of trauma that can directly hurt our immune system is that which comes from the exposure to radiation. This not only brings to mind Chernobyl, Three Mile Island and Fukushima but also commercial flight. When you are cruising at 35,000 feet, you are above much of the atmosphere that protects us from ionizing radiation. Studies have shown that air flight personnel have a higher incidence of severe and chronic diseases because of this.

The fifth horseman of immunological apocalypse is stress. The term stress was coined by Dr. Hans Selye just more than 70 years ago. According to Selye, “dis-ease is an attack on any particular aspect of your body or mind that creates a distressed physiology.”  Stress is an individual’s non-specific response to any stimulus, conscious or unconscious, physical or physiological. It is such an integral component of our existence that Selye has stated that, “Complete freedom from stress is death.” There are two categories of stress: eustress (characterized by happiness and enjoyment) and distress (characterized by anguish, tension and worry).  During distress the adrenal glands secrete the steroid hormone cortisol to excess and without the normal cycling that usually occurs, which will then suppress immune function.

Based on your history and physical findings, lab tests can determine the best way to proceed both by answering the question of why your immune system isn’t protecting you as it should and what medical disorders you have now that should be directly addressed.

What To Do About Stubborn Acne

This article by Dr. Jesse Stoff appeared on Southampton Patch.

This question comes from P.L. in Hampton Bays: I have recently been getting more acne and it is very stubborn and resistant to the treatments that I’ve tried. Any ideas?

Most people know that those familiar yet annoying red and white pimples of acne are largely influenced by hormones.

Hormone levels and their balance influence the production of sebum, the oily skin lubricant. Fluctuating hormone levels cause the sebum to get thicker and clog skin pores, trapping otherwise harmless bacteria and allowing a small local infection to occur known as acne. Treatment can be a bit tricky. The use of long term antibiotics can throw the delicate balance of intestinal micro-organisms out of whack leading to chronic digestive problems and bigger health problems. Topical lotions and creams can dry out the skin causing cracking and allowing the bacteria to track in deeper and can just be uncomfortable to deal with.

Your action plan should include addressing the known nutritional deficiencies that can predispose to acne infections by lowering your immunological resistance. Amino chelated zinc — that is zinc that is attached to an amino acid like zinc gluconate or methionine —  vitamin C, vitamin A, probiotics, like acidophilus, and essential fatty acids are helpful in supporting immune function. Eating a diet that is higher in predominantly organic vegetables than animal proteins is helpful in reducing some hormonal stress. Lower fat diets seem to make it easier to get acne under control. Getting more and higher quality sleep — which means going to sleep by 10, not to watch TV — is also important as it will reduce stress levels that can further throw your hormones out of balance. Increasing your water intake, regular exercise and addressing possible underlying food allergies, like we do in the office, are all very helpful in stopping and reversing acne.

Skin inflammation is a common symptom of allergies and if you have recurrent acne it may be worth looking into. Topically a non-petroleum based cream, like lanolin, with tea tree oil and Calendula can be very helpful. Warm Epsom salt water compresses, or yellow clay are better for drawing out the infected material than jabbing a needle into it and possibly spreading the bacteria deeper.

Why Am I Tired All The Time Since My Pregnancy?

This article by Dr. Jesse Stoff appeared on Southampton Patch.

This week's question comes from M.M. in Tuckahoe: Since I recently gave birth to my son, I have been so very fatigued, but all of my blood tests look “good.” Any thoughts?

As with any health problem, in order to feel better you first have to know what’s wrong.

Looking for a quick fix rarely gives lasting results. In fact, taking stimulants will, in the long run, usually make the problem worse, so put the coffee down and let’s sort this out.

As with any problem, we start at the beginning with a differential diagnosis. Unfortunately, in the various textbooks of differential diagnosis, the list of illnesses that have fatigue as a major component of their presentation goes on for pages and pages of very small print. If the fatigue is really debilitating then that list has to be seriously looked at.

This is where experience and common sense come in handy as a way to eliminate most of the causes. For instance, since you recently gave birth to your son (congratulations, by the way) then it’s a safe bet that you don’t have prostate cancer. But, there is a variety of problems with your endocrine system (balance of hormones) that can cause severe fatigue and are related to pregnancy. Some of these include thyroid or adrenal imbalances and diabetes, just to get us started. The “usual” blood tests won’t pick up an early thyroiditis, for example, as special blood tests are needed and must be specifically ordered.

During pregnancy there are many changes that occur to your biochemistry. With the increased demands placed upon it, nutritional deficiencies are a real possibility. Since biochemistry underlies everything, if it gets out of balance your hormones can quickly follow suit and a so called post-partum depression may ensue, which often has fatigue as a prominent symptom.

Furthermore, many changes occur to your immune system during those blessed 40 weeks which can result in the onset of new allergies, re-activation of a dormant viral infection or the development of an autoimmune problem where, again, severe fatigue is a leading problem.

It’s not good medical practice to just do an Epstein-Barr VCA IgG antibody test, have it come back positive and say that you have “chronic fatigue syndrome” (CFS). To diagnose a chronic or reactivated EBV infection requires a six-antibody blood test panel; anything less is guess work. Also, according to the CDC, before you can diagnose CFS you must eliminate that looooong list of differential diagnoses, that I mentioned, and then methodically address the problems that show up. Taking short cuts won’t work.

In the mean time, attend to what you can: a good, balanced, predominantly organic food diet; going to sleep — not to bed to read or watch TV — by 10 p.m. is very important; mild, regular exercise, plenty of water and enlisting help from hubby are all very helpful steps that you can take today and are not to be underestimated. Beyond that, a thorough medical evaluation followed by well coordinated integrative care is your best bet for regaining your health.

Lyme Disease Symptoms May Continue After Treatment

This article by Dr. Jesse Stoff appeared on Southampton Patch.

Today’s question is from E.K. in Water Mill: Last summer I was bitten by a tick. Afterwards I had a red ringed rash around the bite site and felt sick. My doctor said that it was probably early Lyme disease and that I should take antibiotics, which I did. The rash went away but I still feel tired and achy and my blood tests are negative for Lyme disease. Any thoughts?

Lyme disease is caused by a spirochete called Borrelia burgdorferi, and is the most common tick-borne disease in the United States. The number of reported cases has more than doubled between 1992 and 2006, and almost 29,000 new confirmed cases were reported in 2008. Additional studies have shown that the actual number of cases of Lyme disease may exceed reported cases by a factor of 6 to 12 in endemic areas, such as where we live. There are several other infectious organisms that can be transmitted with the Borrelia spirochete and these co-infections can be as bad or worse as Lyme disease itself. The principle means of transmission of the disease is a tiny tick and at this point all of the different types of ticks are known to carry these infections. If you remove a tick from your skin you should save it and have it tested, through your local clinical laboratory, for Lyme disease.

Although common, in certain areas, some aspects of Lyme disease continue to be poorly understood and are a source of intense controversy among patients, physicians and researchers. When correctly diagnosed, the majority of patients, with acute Lyme disease, can be usually treated with a standard course of antibiotics such as Doxycycline. However, 10 percent to 20 percent of patients with acute Lyme disease, after completing the standard course of antibiotic therapy, still have symptoms. Some of these patients have an untreated co-infection, others still have an active Borrelia infection and a third group go on to develop chronic symptoms now identified as post-Lyme disease syndrome.

Post-Lyme syndrome seems to be a secondary auto-immune response to a cross reactive antigen to the Borrelia organism. These patients usually have abnormalities in their blood tests that range from an increase in inflammatory markers to evidence of anti-neuronal antibodies. These antibodies can attack the central nervous system and can account for a wide range of variable and changing symptoms. Treatment options also vary and may include; the use of anti-inflammatory supplements and/or drugs, antigen desensitization to raise the number and activity of TR1 suppressor cells all the way to the use of immuno-suppressive drugs in severe cases. Individual treatment varies depending upon the specific blood test results.

B Well

The B vitamins are a group or complex of water-soluble vitamins that play critical roles in cell metabolism by acting as co-factors for innumerable enzymatic reactions and thus helping with fatigue and the processing of many other nutrients.

B vitamins are primarily found in whole unprocessed foods (B it ever so humble, there’s no place like home… cooking). Processed carbohydrates such as sugar and white flour have a lower B vitamin content than their unprocessed counterparts. All B vitamins are particularly concentrated in meat, including turkey, tuna, liver and other meat products. Good sources for some of the B vitamins include whole grains, potatoes, bananas, lentils, chili peppers, tempeh, beans, and molasses.

B12 is critically important to help prevent macrocytic anemia and to reduce the risks of adult sudden death syndrome (dropping dead from a heart attack), peripheral neuropathy, memory loss and other cognitive deficits. Absolute deficiency is most likely to occur among elderly people, as absorption through the gut declines with age; but a relative deficiency is common in children with Autism and related spectrum disorders.

This is important to know because B12 is not available from plant products, making B12 deficiency a very real concern for vegans or children who are on a self-imposed limited diet. Sneaky manufacturers of plant-based foods will sometimes mislead you by reporting the “B12 content” in their food product. This will create confusion because the standard US Pharmacopeia (USP) method for measuring the B12 content does not measure the B12 directly. Instead, it measures a bacterial response to the food. The bio-chemical cousins of the B12 vitamin that are found in plant sources are great for bacteria, but cannot be used by the human body. So a good B-complex supplement by mouth is just what the doctor recommends.

For a variety of reasons, type 2 diabetes has become much more common and along with it your risk of developing kidney disease. However, recently a research team found that you can protect yourself with high doses of vitamin B1, thiamine. In their study, they gave participants 300 mg daily (100 mg, three times daily).

To determine how well the nutrient worked, they measured how much protein, microalbumin, the patients lost in their urine during the three-month study. Their results were fantastic! The thiamine reduced protein loss by 41%. What's more, 35% of the patients stopped losing protein altogether.

So here’s the beef, it takes more than spinach to be strong.

B well.

Let The Sunshine In

You may have read the recent news and heard the reports on vitamin D (Total 25-hydroxyvitamin D (D₂ + D₃)). The prestigious Institute of Medicine just upped their vitamin D recommendation from a mere 400 IU per day to a still-paltry 600 IU per day. WOW… not. And they didn't stop there. They claim most people get enough vitamin D each day. They say no one should take more than 4,000 IU each day.  

I've told my patients for decades that everyone needs to take at least 5,000 IU daily. Now this report says I'm wrong. So what should you believe?

Well, I take a scientific approach to things. So if you do a little research on Medline or Vitasearch, you will find literally hundreds of studies that show the health benefits of mid normal ranges of vitamin D. Amongst a myriad of other positive health effects, mid normal ranges of vitamin D build strong bones, support your eyes and heart, boost your immune system, and help relieve joint discomfort. The mid normal range part is important, if you haven’t had your Vitamin D level tested, then you should - just to know where you stand.

Normally, when clad in a bikini, or similar attire, your body produces 5,000-10,000 IU just from being outside for an hour on a sunny summer day. So why would taking that much in the cold, dark winter do you any harm? It doesn't. No doctor I know has seen any harmful effects from that amount. In fact, I routinely recommend my cancer patients take 10,000 IUs daily, or even 50,000 IU twice weekly or more, with no toxicity.

You see, there's a simple blood test to measure the level of vitamin D in your blood. Everyone — even the Institute of Medicine — agrees that levels below 20 nanograms per milliliter indicate a "serious deficiency."  Yet, in the same breath, they said that the too-low level of 20 ng/mL is enough for good health. That's just sheer lunacy. This group is so confused, it's sad. But it's also very dangerous. This report will end up harming a lot of people.

The truth is that there's an epidemic of vitamin D deficiency in this country. Nearly every SICK patient I test is low. I see levels less than 40 in almost every known osteoporosis patient. I see levels in this range with cancer patients as well. Without adequate levels of vitamin D, your body can’t mount a good defense.

Consider this: There's not enough sunlight in Riverhead during the winter months to make barely ANY vitamin D. How are these folks supposed to make up the shortfall? What's more, being outdoors is no assurance you're making enough vitamin D on your own. I was pleased that the news reports included "respected" dissenters from major medical centers across the country, including Harvard, UC San Diego, and Johns Hopkins. Some of these experts are calling for up to 4,000 IU daily, not too far from my 5,000 IU recommendation.

Dr. John Cannell, of the non-profit Vitamin D Council, is in the thick of all the emerging research. He believes that a level of 70ng/mL is optimal. I push my patients to that level.

So follow me and ignore the new warnings. I'm sticking with my daily 5,000 IU dose, especially in winter. I suggest that you do so as well and get your vitamin D blood level checked.

--Jesse Stoff, M.D.

Of Limes, Brits and Vitamin C

Here's a quiz. Can you tell me how the British got the notorious nickname of "Limey?" Most of us probably don't have a clue, but the story is actually quite fascinating. Many, many years ago when the Royal British Navy sent their sailors on long voyages, they found that their sailors developed poor nutrition. As a result they often developed a disease known as scurvy. Suffering from swelling and bleeding gums, hair and teeth loss, wounds that wouldn't heal, vision difficulties and fatigue and digestive problems, the sailors had a hard time surviving, let alone completing their missions. Fortunately, however, someone astutely observed that if the sailors ate more fresh fruit, the symptoms would not occur. Unfortunately, fruit did not travel well on the high seas.

The British began experimenting to find a fruit that would not spoil when stored in a barrel in the lower hold of the ship for long periods of time. The most beneficial fruit they discovered was, of course, limes! In fact, they found that limes were still good several months into the ocean voyage, allowing the sailors to ward off scurvy and better fight the pirates of the New World who were raiding their cargo ships and throwing their tea into Boston Harbor. Hence, the expression “limey” came to refer to a British sailor.

So, what do Brits, limes and vitamin C have in common? What the British didn't learn until many years later was that the "preventative" agent found in limes is actually vitamin C. Since the first vitamin was isolated 90 years ago, scientists have been studying the link between nutrition and a healthy body. Vitamin pioneers, for example, demonstrated that too little vitamin A brought on a long list of deficiency symp¬toms, including hard lumpy skin, hair loss, liver and muscle problems. And, as more vitamins were discovered, it became clear that other vitamin deficiencies affected the skin as well.

Approximately 100 years after the Brits' "lime discovery," doctors actually isolated the active component in limes, and vitamin C has only continued to draw medical interest since that time. Perhaps one of vitamin C's most famous advocates was the two-time Nobel prize winner, Linus Pauling, who devoted the last decades of his life to researching this vitamin and finding new ways of applying it for treatment of many different disorders, including the common cold, various forms of gum disease, cancer and heart disease.!

Today we know that vitamin C is a very powerful antioxidant. But it is also a water soluble vitamin, which means that your body does not store it in any appreciable amount. If vitamin C is not available, the body does without it the best it can. If the vitamin C is available, however, it is used for a long list of biochemical reactions including many that are implicated in wound healing and in the normal functioning of our immune system. It is a very critical co-factor for the normal structure and function of our bodies.

Perhaps better than any other, this vitamin absorbs free radicals from our blood. Free radicals are biologically active compounds that destroy tissue structure, thus accelerating the aging process. In addition, increased levels of free radicals in our blood are associated with an increased risk of cancer, arteriosclerotic heart disease and cataract development. Recent studies have shown that if someone takes 1,000 mg of vitamin C twice a day, it can cut their risk of heart disease significantly. And taking antioxidant vitamins and supplements, including vitamin C, has been shown to decrease the incidence, development and progression of cataracts.

An interesting kitchen experiment can help you visualize the antioxidant effect of vitamin C. Take an apple and cut it in half. Than dissolve a vitamin C pill in some water and coat one half of the apple with it. Leave the other half alone. After putting the two halves next to each other on the kitchen counter and leaving them for a few minutes, you will notice a difference. The half that does not have the vitamin C coating will begin to oxidize and turn brown. As the hours pass it will become soft and "mushy" and will begin to shrivel like a prune. The vitamin C coated half will still look as good as it was when it was part of the intact apple.

Interestingly enough, most animals can synthesize vitamin C. But, owing to a quirk of evolution, man has lost this capacity and has become dependent upon taking it in, either through foods or by way of supplementation. So, what's the moral of the story? Should we all follow the example of British sailors of old and begin consuming limes in order to gain the benefits of vitamin C?

Well, that's one way of doing it. But fortunately, due to advances in modern medicine, we now know that vitamin C can be found in a variety of sources. For instance, it is found plentifully in nature and on our vitamin store shelves. Common sources include; rose hips, lemongrass, corn, hibiscus, Sago Palm, and tapioca, for example. Although these sources of the vitamin are equally beneficial in respect to potency, it is important, to take into consideration any known allergies you may have. For example, if you have an allergy to rose, then you don't want to take vitamin C that is extracted from rose hips. Although vitamin C is also synthesized these days, the synthetic version may be associated with an increased risk of kidney stones. It is therefore better to take vitamin C that has been extracted from natural sources. It is also best to take it in combination with other bioflavonoids such as rutin and hesperdin. Because vitamin C is very acidic, it can, in minor ways, temporarily alter the pH in the digestive tract and create some irritation. For most people, taking six or eight grams of vitamin C can cause diarrhea and sometimes stomach cramping and mucous in the stool. This is not a toxic effect nor is this a dangerous side effect, it is merely a biochemical effect of the concentrated vitamin. Newer preparations of vitamin C, such as Bio En’R-G’y C, are designed as a high dose supplement and prepared so as not to cause stomach upset.

Other than limes, there are many foods that contain appreciable sources of vitamin C. Perhaps the most notorious is orange juice. However, it is important to note that because of how quickly it reacts with oxygen and free radicals, vitamin C has a very short life. For example, if you were to make some fresh squeezed orange juice and leave it on the counter for even a half hour, as much as 75 percent of the vitamin C that was originally in there would be destroyed because of its reaction with oxygen. Other nutritious and delicious sources of the vitamin include broccoli, Brussels sprouts, cantaloupe, grapefruit, mustard greens, pineapple, spinach, strawberries and turnip greens. Although, cabbage contains a fairly large amount of vitamin C, much of it is often lost because it tends to be overcooked.

So, that's the tale of Brits, limes and vitamin C. And, no, we don't have to become a "limey" to reap this vitamin's gains. But it is interesting to think about the connection… just think of the health benefits we may have missed if the British never gatecrashed our tea party.

Resisting Arrest: Antibiotic Resistant Bacteria are Gaining Ground

Germs! They're all around us, they can spread quickly and they can be deadly and, with the increase in air travel, they easily cross borders. But what is most alarming is that new strains of bacteria are resistant to some of the most powerful drugs available. This is causing great concern among the medical community.

This emergence of drug-resistant bacteria has the potential to become a much more serious global threat. Because of the increasing population density and indiscretions in the area of public sanitation (i.e. garbage strikes, refuse on the street, people mindlessly secreting and excreting on our sidewalks, etc.), we are seeing a resurgence of many infectious diseases.

In Seattle, a strain of the common E. coli bacteria was found at a fast-food restaurant. It killed three children and left scores of others hospitalized. In New York City, an outbreak of an unusual type of strep bacteria that is capable of almost dissolving flesh has appeared. Part of the problem is sanitation, but part of the problem is personal awareness and hygiene. For example, when I used to work as a school physician, it was amazing to me how often children who were obviously ill, were still being sent to school by their parents. Kids with obvious fever, strep throat, rashes, and more were showing up and spreading germs among their classmates.

All of these factors contribute to the possibility of outbreaks. However , one of the major problems is that antibiotics have been used with fairly little discretion over the last couple of decades. Years ago, while working as an emergency room physician, if a child had a sore throat, swollen glands, a low-grade fever, aches and chills, and I did not offer a prescription for antibiotics, the parents would threaten to complain to the hospital authorities. Even though antibiotics are totally ineffective in treating the viral diseases that show these symptoms, people still expected them to be dispensed just in case.

Antibiotics have long been inappropriately prescribed for patients with common colds and other minor non-bacterial infections. The problem with that is twofold. On the one hand the antibiotics work as an evolutionary force, selecting for resistant bacteria and on the other hand many antibiotics are actually immunosuppressive. So what we wind up with are superbugs facing off against a population of people with weakened defenses, the results aren’t pretty!

Another problem occurs when patients prematurely stop taking their medication because the symptoms of their illness have disappeared. The disappearance of symptoms does not necessarily mean that the infection is cleared up. Therefore, stopping medication allows microbes not initially killed by the drugs to survive and develop resistance to the drugs.

This use, misuse and overuse of drugs have lead to the development of resistant strains of many common bacteria that used to be easily controlled. Bacteria are continually adapting and finding ways of resisting antibiotics. As a result, they can cause life-threatening diseases and show little, if any, response to even our most recent generation of antibacterial drugs. According to the Centers for Disease Control, 19,000 hospital patients die annually from antibiotic resistant infections, while another 58,000 die from complications caused by these infections. We see organisms causing life-threatening rashes, while tuberculosis and many other bacteria that used to be controlled are now running rampant through our schools, streets and places of business. Antibiotic-resistant bacteria are also causing an increase in the number of cases of diarrheal illnesses, sexually transmitted diseases and respiratory infections. This trend is a very dangerous one. Unfortunately, now that the ball is in motion, there is no easy way to stop it using the same technology that caused the problem. We develop more and more powerful antibiotics which ultimately lead to more complex and more resistant strains of these organisms, and more esoteric manifestations of their diseases.

While virtually no sector of society is blameless, the biggest consumer of these antibiotics; by far, is the livestock industry. Most commercially raised animals are routinely fed antibiotics to fight infections. Some livestock, like chickens, are also given "sub-therapeutic doses" of antibiotics as a growth stimulant. Sadly, this means that many of these drugs wind up in our foods while they are still in an active form. Milk, for example, is allowed to contain eighty different antibiotics while still being labeled as fit for human consumption. These low doses of antibiotics allow for the breeding of resistant strains of bacteria in animals and humans.

How can we get out of this cycle? One possible way is through the use of immuno modulators and natural medicines that strengthen a person's immune defenses. This helps to both battle the bacteria successfully once it has attempted to establish an infection as well as to prevent these bugs from getting into our system to begin with.

In our cities, with their major congestion, people with compromised immune systems often carry many of these organisms with them and often spread them to other people. So, we must include a rise in public awareness and consciousness as part of any plan of action. We can do what the Japanese do and wear a mask when we have a cold or flu. This prevents the spread of germs to friends or loved ones. You should also avoid taking antibiotics for minor illnesses and infections, minimize your consumption of food that is high in antibiotics (red meat, chicken, dairy) and look for organically raised foods. It is also good to try to do things that naturally raise the functioning of your own immune system by reducing stress and adding immune system building nutrients to your diet (i.e. vitamin c, zinc, beta-carotene, garlic) will also help. Last but not least you must be aware of your environment. At home, you should keep meat cold until cooking it, and then cook it well. Watch expiration dates on food containers and discard any canned goods if the can starts to bulge. Finally, when you are acutely ill - stay at home!!!!

What’s Happening to Our Food ?

“You are what you eat.”

We've had this drilled into our brains since we were tots. But today, even if you eat the well balanced diet you are supposed to, you may not be getting the all-important nutrients you think you are.

This problem is not new, but actually has its roots back in the 1950s. When scientific discoveries made synthetic fertilizers a reality, the farming industry was revolutionized. The tabloids of the day proclaimed an end to world hunger, since commercial farmers could now get extra crop out of the same square acreage of land every year. On the face, you might be inclined to agree with the press, but, if we look closer, your opinion might be very different.

Synthetic fertilizers were, and still are, high in phosphorous and nitrogen, and are designed to stimulate plant growth. This they do. But, these chemicals also cause the plants to become bloated by taking on a lot of extra water. So, the fruits and vegetables these plants bear are also bloated and contain a much higher relative content of water to nutrients than they ever contained before the use of these chemicals.

This is not just a hypothesis, as studies done by the US Department of Agriculture back this up. The USDA has analyzed various foods to determine the amount of vitamins, minerals, proteins, insecticides, etc. that are present. What the studies have shown is that over the past 40 years, there has been a slow but progressive decline in the amounts of these critical nutrients present in our produce.

In addition to these fertilizer induced problems, the fact that the nutrients the plants take out of the soil are not being put back also helps speed the decline along. And, since each acre of land is producing more and more crops then it was capable of before, the nutrient depletion rate is increasing at a ever faster pace.

What, aside from the new fertilizers, has changed? Well, back before the turn of the century, Mom and Pop farm operations would grow their vegetables and feed the leftovers to their livestock. These animals would eat and digest the produce, and the fertilizer that they then produced would be put back onto the fields in order to recycle the nutrients so that next year's crop would have sufficient nourishment. Not only did they re-fertilize the land, but the farmers would keep it fallow during the winter. This allowed it to absorb the rain water and the minerals that would get washed down from the mountains. This would add to the soil replenishment and assure a bumper crop for the next growing season. Today, this simply is not the case. Now, we have fruits and vegetables that are raised in record time, to record weights, and with but a small fraction of the nutrition that they contained even just ten years ago. To add insult to injury, this produce is usually harvested before they are completely ripe. Various techniques are then used to accelerate the ripening process once the produce is picked and shipped to various markets for sale to you and me. In addition, many vegetables are treated with, chemicals to add color and kill fungi that would otherwise grow on their skins: Various waxes are also often applied to produce in order to keep them from dehydrating and shriveling up. Other produce, such as bananas, is literally gassed to induce ripening just before delivery.

When a fruit or vegetable is picked before it is fully ripened, the enzyme structure within it will not have reached its peak level of development or activity. So, not only are the fruits and vegetables depleted of the nutrients that we need to support our biochemistry, but furthermore they lack the critical enzymes that are necessary to support and stimulate our immune system. It is this decrease in enzyme levels, coupled with the decreased nutrient value and the effects of treatments designed to increase store shelf life, that has contributed to the rather poor state of nutrition that we find in virtually all Americans today.

What does all this actually mean to you and me? Unless you are eating a diet that consists primarily of organically grown produce and livestock, it means that the levels of nutrients that are critical for the normal operation of your cells will be sorely lacking.

There are many standard blood tests that can actually document the level of various nutrient deficiencies that you may be suffering from. What the big problem with these deficiencies, is that they contribute to the development, manifestation and spread of various chronic diseases, like cancer. While they may not directly cause the ailments, these nutrients are needed to stimulate and support our immune system, and a lack of them can certainly adversely affect the body's ability to contain, fight and control disease.

The American Cancer Society has officially acknowledged that there is some connection between what we eat and the diseases that we may develop. This is a big step, but it is just that — A step toward recognizing the value of clinical nutrition as a medical science that can be used to help decrease the incidence and severity of many diseases that commonly afflict Americans today.

What can we do to help ourselves? It used to be that just avoiding fast food and junk food might have been enough. Today this no longer cuts the mustard. And, since most fruits and vegetables are so low in nutrients due to the factors discussed earlier, nor does just having a glass of freshly squeezed orange juice in the morning, nor eating a salad with your dinner every night.

To help support your body, one of the things you should do is eat as much organic produce as possible. But, even this alone is not enough. Our water is polluted and it is impossible to walk down the street today and not breathe in tens-of-millions of free radical-causing chemicals that damage tissue and cell structure. What you must do, in addition to careful eating, is make the taking of vitamin and mineral supplements a regular part of your daily routine.

A simple blood test, called a lipid peroxide level test, can give you an idea of how much of a load your body is under in terms of fighting these toxic agents. If your level is elevated, you should be sure to add antioxidants to your diet. By eating organically grown food, and taking vitamin A, C, and E, and minerals like zinc and selenium, you will at least, begin to get proper nutrition. This is the best way to begin stabilizing your health and protecting your future.

Our First Post!

Allergies affect people in a systematic manner. Typically a substance, referred to as an “allergen,” is introduced to a person through skin contact, through the air or through ingestion.

Once exposed to an allergen, the body produces special proteins called Immunoglobulins. Immunoglobulin E (IgE) is a common trigger for allergies and responds in the presence of something a person is sensitive to, or something the body perceives as threatening. IgE attaches to cells in the body called “Mast” cells. These cells reside throughout the body, including in the skin, in the digestive tract, and in our respiratory tract. When we are exposed to an allergen the IgE binds to the Mast cells causing the release of histamine, which then causes symptoms such as itching, hives, headaches, gastrointestinal upset or respiratory tract discomfort.

With time, a person who is consistently exposed to allergens may become overly sensitive to these allergies. The body responds by producing increasing amounts of IgE resulting in a worsening of symptoms, to the point where asthma or other severe conditions may be triggered. Immunotherapy can desensitize you to the effects of the IgE antibodies and relieve the allergic symptoms. We offer the latest techniques of blended Immunotherapy to our patients.