Bad Back Treatments.

by Timothy Carey, MD, MPH  

Back pain — it’s not so much a question of if you’ll get it, but when. Four out of five people experience annoying lower back pain at some time in life… and it’s natural to want to do something to fix it. But before you do, know this: The scientific evidence now shows that for lower back pain, waiting it out is just about as effective as more dramatic (and risky) treatments, such as surgery, narcotics and steroids.

 Back Attack

 Before we go further with this, though, we need to be clear on one point. Back pain that is of sudden onset due to a fall or blow to the back, or accompanied by other symptoms that could indicate a heart attack or other medical emergency requires an immediate trip to the ER. And if you experience back pain and you also have other medical issues (such as cancer or neurological problems), see your doctor to be sure it isn’t a sign that something else is going on.

A  study published in the medical journal Spine, reported that people with back pain were getting complicated treatments that don’t help and may in fact cause harm… while less than half get a prescription for the safe, effective and simple self-treatment proven to make things better — which is exercise. I called the study author, Timothy Carey, MD, professor of social medicine at University of North Carolina, Chapel Hill, and director of the Cecil G. Sheps Center for Health Services Research, to ask some questions. Dr. Carey told me that low back pain does not always require tests, such as CT scans or MRIs. Unless you have a history of cancer, osteoporosis, fever, weight loss (these are sometimes called red-flag symptoms) or current muscle weakness or urinary difficulty, it probably makes sense to wait one month before proceeding with such tests.

 Why Tests May Cause Harm

 A recent study from Stanford University showed that in regions of the US where there is lots of MRI technology available, there are far more back surgeries — and also that having an MRI early in the course of back pain not only doesn’t tend to lead to a better outcome, it may actually induce health-care providers to suggest unneeded surgery. Aggressive use of CT scans also can lead to overtreatment, Dr. Carey noted. “These imaging techniques provide wonderful pictures of the anatomy of the back, but the images are only loosely correlated with how the back functions,” he said.

 Dr. Carey’s advice: Before agreeing to undergo an imaging procedure, discuss with your doctor what next steps are being considered. As Dr. Carey points out, “if the results aren’t going to change treatment, then there’s not a good reason to get the test.”

 We all know the dangers of narcotic drugs, which are often overused for back pain, Dr. Carey told me. He authored a study (also reported in the journal Spine) that looked at 732 people with chronic low back pain that had lasted longer than three months. Sixty-one percent had been treated with narcotics. “These can have significant side effects and can be habit forming, and there’s very little evidence that they work well to improve patients’ functioning,” he added.

 What’s a Back Patient To Do?

 Meanwhile, only half the respondents in Dr. Carey’s study had been given a prescription for exercise even though there’s strong evidence that engaging in aerobic exercise several times a week helps alleviate back pain. He told me that exercise can be very effective if you take it seriously as a therapy and really do it. “Just as you take a medication at a specific dose, a specific number of times a day, for a specific number of days, exercise also needs to be structured,” he explained. If you aren’t particularly fit or haven’t been exercising, Dr. Carey advises walking briskly 10 minutes a day for the first week, then checking with your doctor before extending your workout to 20 and eventually to 30 minutes a day.

 Try this: Also good are range of motion exercises for the spine, such as slow rotations. Gradually (over 30 seconds or so) bend from one side through the front and then on to the other side — then reverse the movement. Do this for five to 10 minutes before aerobic exercise, said Dr. Carey. The stretching and strengthening that yoga offers can be helpful in relieving back pain, too. He said it’s best to “get out and get moving,” noting that prolonged bed rest is bad for the back and should be avoided. He acknowledged that people with back pain may find exercise increases their discomfort initially, but he urges sticking with it. “You’re not damaging your back, and after a week or two, the pain level will start to decline,” he said.

 If you do need a pain reliever, several are effective and safe when taken for a short time. These include acetaminophen (Tylenol)… over-the-counter NSAIDs such as ibuprofen (Advil)… and prescription muscle relaxants, such as cyclobenzaprine (Flexeril), especially if you’re having trouble sleeping. All muscle relaxants tend to be sedating, so be cautious if you’re going to drive, and never combine them with alcohol.

 You may have an uncomfortable week or two while recovering from benign low back pain but, with patience and conservative treatment, most such back pain improves, notes Dr. Carey. In a small number of cases, the pain doesn’t improve — and then it may be time for more doctor visits and tests.


Timothy Carey, MD, MPH, professor of social medicine, University of North Carolina, Chapel Hill, and director of The Cecil G. Sheps Center for Health Services Research, Chapel Hill

Health Traps in Gluten-Free Diet

  by Andrew L. Rubman, ND

 What’s The Real Problem?

 First and most obvious, it may be that you are unknowingly still eating gluten. Besides the obvious, that you’re getting gluten from places you don’t expect it (such as sauces and medications), Dr. Rubman outlined two other possibilities.

 Celiac disease or gluten intolerance isn’t your only digestive issue…

 It could be that you have other dietary sensitivities as well. One common problem is that many people who are gluten-intolerant also are sensitive to cow’s-milk protein, Dr. Rubman said. Symptoms of this intolerance include increased mucus production, postnasal drip, low-grade inflammation, trouble swallowing and a lump in the throat. Another possibility is that your digestive problems are of a different nature altogether. For instance, you may be suffering from irritable bowel syndrome (IBS) or colitis. Rubman’s solution: See your physician for proper evaluation and treatment. Generally speaking, a good doctor will first try to improve overall digestive function and elimination and then, if that’s not the answer, test for various intolerances and allergies.

 Or, the culprit may be an unhealthy diet.

 Gluten-free is not necessarily the same thing as healthy, Dr. Rubman said. If the mandate to avoid gluten in your diet leads you directly to the gluten-free aisle in your supermarket where you buy the same types of processed, packaged and frozen foods you were eating before, you’re likely solving one problem and creating another. According to Dr. Rubman, many gluten-free products are loaded with unhealthy ingredients, such as sugar and saturated fat, which makes them taste better so that you will eat more of them. You’re not eating gluten, but you still feel sluggish, bloated, fatigued and irritable. Also, Dr. Rubman notes, eating lots of carbohydrates (particularly simple ones) may further compromise an already sensitive gastrointestinal tract by encouraging the overgrowth of unhelpful bacteria and yeast, which in turn leads to acid reflux, stuffy nose and other ailments. Rubman’s solution: Even gluten-free products should be looked at carefully for their overall healthfulness. Sugar is still sugar… fried is still fried… salt is still salt… processed is still processed. The more you emphasize whole foods in your diet, the better you will feel — period. In place of wheat, barley and rye, experiment with nutrient-rich, tasty and naturally gluten-free alternatives, such as amaranth, buckwheat, millet and quinoa. Try eating this way and see — it’s quite likely that within weeks of making these changes, your digestive disturbances will abate and you’ll have more energy, focus and immune strength… all of which will leave you feeling great.


Andrew L. Rubman, ND, medical director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut.

The Unsavory Truth about Vegetable Oils

by Maggie Ward, MS, RD, LDL

 In a recent profile of Whole Foods cofounder and CEO John Mackey, he said that he had given up sugar, most processed foods and vegetable oils. Vegetable oils? Most people think these are healthy, but they’re not… here’s why. It used to be that heavy weights were used to squeeze the oil from plants (which is what’s really meant by the term “vegetable oil”), but now most manufacturers use heat and chemical solvents, in particular petroleum-derived hexane. Both methods end up removing potential health benefits, I learned from Maggie Ward, MS, RD, LDN, nutrition director of Dr. Mark Hyman’s UltraWellness Center in Lenox, Massachusetts. The principle demon is heat. At certain temperatures, heat oxidizes and neutralizes many of the plant’s nutrients. This makes the oil rancid (yes — even though you can’t tell, which I will explain in a minute) and as a result, the oil’s healthy antioxidants and essential fatty acids are replaced by destructive free radicals. Adding insult to injury, most vegetable oils are then refined after extraction — using yet more chemicals and high heat to bleach and deodorize them. This removes color to make the oil look more appealing and erases any rancid smell and taste. The result is oil that is bland enough to add moisture and texture without changing the taste of baked foods, for instance. And the supposed benefit is that cooks can use these oils for frying, because they can be taken to high temperatures without smoking. But the real result of all this processing means that we end up using nutritionally void oil to cook in a way that is inherently unhealthful. And yes, this includes oils such as soybean and canola oil that are marketed as “healthy” and “good for you.”

Does Healthful Oil Exist?

 Don’t throw up your hands in frustration — there are oils that are good for you, produced in ways that preserve their health-giving properties, says Ward. Here’s a list, along with what you need to know about them…

Olive oil. Olive oil is the leader of the pack when it comes to health, but it requires careful handling. Purchase only olive oil that is cold-pressed (it will say this on the label) and preferably extra-virgin, which will have the most nutrients. When cooking with olive oil, Ward cautions against using heat higher than medium, and if the oil does start to smoke, she says, it should be thrown out. Not only will the heat make it rancid, it will destroy nutrients and create carcinogens, Ward says. To cook healthfully with olive oil, preheat the pan for up to a minute and then add the food and oil at the same time rather than starting with the oil alone. This prevents overheating and provides a bonus — the food better absorbs the oil’s healthy essential fatty acids. For added flavor and health, sprinkle a bit of olive oil over the food when you have finished cooking. To store olive oil: Keep it in a dark glass bottle or any opaque container in your cabinet or on the counter — no need to refrigerate unless your kitchen is exceptionally warm.

Tropical oils. Coconut and, to a lesser degree, palm oil have had a health resurgence in recent years. As saturated fats, these used to be considered heart unhealthy, but this type of oil is now recognized by physicians and scientists as necessary and good for you (though not in excess). These oils will not oxidize, so you can cook with them at higher temperatures. Storage for coconut and palm oils: Since these oils are not temperature- or light-sensitive, it is fine to store them on the counter or in the pantry.

 Seed and nut oils. Some seed and nut oils have become popular as seasoning added to salads and other dishes after cooking. Sesame oil, for example, has plenty of antioxidants, and Ward says that unrefined sesame oil retains more of its nutrients because the seeds are easy to press. However, seed and nut oils turn rancid quickly (even when kept cool), so it is best to buy small quantities that you can use within a few weeks. Sniff the oil before using — toss it if it no longer smells fresh. Nut and seed oil storage: Refrigerate in dark bottles.

Source(s): Maggie Ward, MS, RD, LDL, nutrition director of Dr. Mark Hyman’s UltraWellness Center, Lenox, Massachusetts.

Relief from IBS Naturally


by Alexander C. Ford, MD and Andrew L. Rubman, ND

Sometimes old-fashioned remedies work best, and for the millions of people with one very hard-to-treat condition — irritable bowel syndrome (IBS) — an old remedy beats everything modern science has dreamed up. If you or someone you know has IBS, please read on.

As many as one in five Americans suffer from IBS, a miserable disorder that can bring an endless progression of constipation, diarrhea, gas, bloating and stomach cramps. Where expensive new IBS drugs have been disappointing, it turns out that a classic stomachache remedy, peppermint oil, can often get the job done more effectively.

In with the Old, Out with the New

At McMaster University in Ontario, Alexander C. Ford, MD, and his colleagues analyzed the results of many previously published studies on adults with IBS, including 12 comparing fiber with placebo, 22 comparing antispasmodics with placebo, and four comparing peppermint oil with placebo. Peppermint oil was surprisingly effective, bringing relief to 74% of patients. This compares very favorably with antispasmodics, which helped only 61%, and fiber, which was beneficial to just 48%.

Peppermint oil may be most helpful in soothing the abdominal pain and cramping that are common IBS symptoms and, over time, it may also help ease diarrhea or constipation. Scientists believe it works by blocking the movement of calcium into muscle cells in the gastrointestinal tract, thereby reducing muscle contractions, discomfort and bloating.

How to Make Your IBS Better

Look for “enteric coated” peppermint oil capsules at your health food store, since taking peppermint oil straight can produce reflux symptoms, suggests Daily Health News contributing medical editor Andrew L. Rubman, ND. Dr. Rubman often prescribes doses of 200 mg to 300 mg to be taken once, twice or three times daily — but not more often, as larger doses can be toxic. He says most patients find it helpful to take a dose just before eating a meal.

Several factors should be weighed in identifying the right treatment for an IBS patient, including whether symptoms are dominated by diarrhea or constipation or whether both occur about equally. If your doctor seems quick to recommend newer pharmaceuticals, consider seeing a specialist in natural medicine to discuss the older remedies and over-the-counter medicines. As Dr. Ford pointed out to me, even though peppermint oil helped the most people in his analysis, the other two treatments — fiber and antispasmodics (which lessen spasms in the GI tract) — were effective for many, and they are safe, inexpensive and readily available over the counter at most pharmacies. Also, Dr. Rubman pointed out that there are many other useful botanical extracts that are antispasmodic as well, including valerian, skullcap, viburnum, juniper berry, hyoscamus niger, gentian and gelsemium. “Their effects may vary from minor to profound, so it’s best to use these only under physician care,” he added.

Dr. Ford has also been exploring another “new old” remedy for IBS –probiotics — and results are promising. Bottom Line’s Daily Health News will keep you up to date.


 Alexander C. Ford, MD, gastroenterology division, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada.

 Andrew L. Rubman, ND, medical director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut.

The Right Place for Stroke Treatment

 by Ralph L. Sacco, MD

Hospitals advertise constantly these days and, by and large, the ads don’t say much that you need to pay attention to. But if you notice that a nearby hospital promotes itself as a “stroke center,” do take note — a new study from the University of Toronto reports that being treated at a stroke center vastly reduces your likelihood of suffering serious permanent disability from stroke.

 What’s a Stroke Center?

 Here in the US, a hospital that wants to be certified as a “primary stroke center” by The Joint Commission must meet very specific criteria, including team training for staff. With stroke, time is everything. At stroke centers, everyone — from the ambulance staff responding to 9-1-1 calls all the way through the doctors and nurses working in the emergency room — expedites diagnosis and treatment to be sure patients who would benefit from the clot-busting drug tissue plasminogen activator (tPA) get it in time to help.

In a call to Ralph L. Sacco, MD, MS, professor and chairman of neurology at Miller School of Medicine, University of Miami, and now the incoming president of the American Heart Association, he reiterated how important it is to know in advance how to deal with a stroke emergency. “For every minute we delay treatment and dispensing tPA, millions of brain cells die,” Dr. Sacco said. “The recommended window for successful treatment is four and one-half hours — but within that time and before the drug can be given, the symptoms of stroke have to be recognized, 9-1-1 called, the patient taken to a hospital, and a CT scan performed. That’s not a lot of time to work with.”

 How You Can Be Prepared

 “Learn which primary hospitals are certified for stroke treatment and which are not,” Dr. Sacco advised, noting that there are stroke centers in most urban areas. Look online, at, where you can click on your state to find a list of primary stroke centers accredited by The Joint Commission.

 Refresh your memory on the warning signs for stroke, from The American Stroke Association:

 Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.

  • Sudden confusion, trouble speaking or understanding.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, loss of balance or coordination.
  • Sudden, severe headache with no known cause.

Another quick way to test is to have the person smile. If one side of the face droops, stroke may be suspected.

 Finally, remember that it is always best to call 9-1-1 immediately if you suspect stroke in yourself or a companion. Research has shown that people who walk into an emergency room on their own may be treated with less urgency. A trained emergency team responding to a 9-1-1 call not only can get you to the right hospital, but also can start some treatment right away and help speed you through the admission process.


Ralph L. Sacco, MD, is chairman of neurology, Miller Professor of Neurology, Epidemiology, and Human Genetics at the Miller School of Medicine, University of Miami. Dr. Sacco will serve as president of the American Heart Association for the 2010-2011 term.

Zinc — Boosts Libido, Preserves Sight, Defeats Colds

 by Mark A. Stengler, NMD

Do you know zilch about zinc? Let’s rectify that, as this essential trace element is vital to your health and well-being. According to some reports, as many as 12% of Americans may have a zinc deficiency, a figure that may rise to as much as 45% in people over age 60. Among the important functions of zinc in our bodies — it boosts the immune response… protects cell membranes from harmful oxidants and structural damage… repairs DNA… and supports nearly 100 different enzymes that regulate the chemistry of cells and organisms.

Regular Daily Health News contributor Mark Stengler, NMD, told me that zinc is also helpful in stabilizing blood glucose… contributes to neurological function… and helps the formation of testosterone, thereby potentially boosting sexual function. (So the reputation of oysters as an aphrodisiac has a scientific basis — they have more zinc than any other food.) And, of particular interest to the older population, says Dr. Stengler, is that zinc helps prevent or reduce the damage of age-related macular degeneration, a leading cause of blindness in adults over age 60.

Why Do We Lack Zinc?

Our ability to absorb zinc may decline with age. On top of that, many older folks take medications known to deplete zinc, in particular thiazide diuretics and ACE inhibitors (used to control blood pressure) and acid-suppressing medications. Additionally, having a digestive disorder that prevents proper nutrient absorption — such as irritable bowel syndrome (IBS) or Crohn’s disease — can contribute to deficiency. And since animal products are a primary source of zinc, eating a vegetarian diet can also mean that you don’t get enough.

With so many people at risk, you’d think there would be good tests to measure zinc levels, but alas, the only ones available are not sensitive enough to be useful — so it is important to be aware of deficiency symptoms. Severe deficiency causes severe problems (such as rashes, chronic diarrhea and night blindness), but that’s rare in developed countries. Lower level deficiency is far more common, but its symptoms can be troublesome, too — including depression, a loss of appetite and libido, and frequent colds and other infections.

Zinc and Colds

When you get a cold or respiratory infection, supplementing with zinc can help relieve your sore throat and shorten your suffering, a benefit that has been demonstrated in many studies. This has made zinc-based cold fighters, including the Zicam Cold Remedy line, quite popular. There was considerable concern last year when the FDA issued a warning about use of Zicam products delivered nasally (its gels and sprays). These are no longer being sold, and according to Dr. Stengler, Zicam lozenges are safe (a daily dose — six lozenges — has 80 mg of elemental zinc). Dr. Stengler likes even better lozenges that contain 15 mg to 25 mg of elemental zinc, and in particular the brands Bluebonnet and LifeExtension. At the first sign of a cold, have one every two hours away from meals, since zinc supplementation may also interfere with the absorption of iron and calcium, and competes with copper for uptake from the gut. Note: Zinc may hinder absorption of antibiotics, so if you’re on them, be sure to use it at least two hours before or after the time you take the drug.

For Health in General

The zinc Recommended Daily Allowance is 11 mg a day for men and 8 mg for women. You can obtain this much from food (see below), but if you have signs of deficiency or are not eating a zinc-rich diet, Dr. Stengler says 15 mg per day is generally a good supplemental dose. The upper limit for a zinc supplement is 40 mg — too much zinc has been associated with prostate cancer. Pregnant and nursing women should not take zinc unless instructed to do so by a doctor.

Zinc-rich foods include…

  • Beef
  • Crab
  • Turkey
  • Oysters
  • Liver
  • Dairy including milk, yogurt and cheddar cheese
  • Cashews, almonds, peanuts
  • Crimini mushrooms
  • Spinach
  • Pumpkin seeds

For most people at most times, he says, eating a varied, healthful diet and taking a daily multivitamin with zinc should be sufficient to prevent deficiency.


Mark A. Stengler, NMD, a naturopathic medical doctor and leading authority on the practice of alternative and integrated medicine. He is editor of Bottom Line’s Natural Healing newsletter, author of The Natural Physician’s Healing Therapies (Bottom Line Books), director of the La Jolla Whole Health Clinic in La Jolla, California, and adjunct clinical professor at the National College of Natural Medicine in Portland, Oregon. To learn more about his work, visit and