Food Combos That Fight Cancer

by Carole Jackson, Bottom Line Health

Talk about a dream team: There are two anti-inflammatory substances in broccoli that come together when we eat it to help us fight killer diseases such as cancer and heart disease. The trouble is, when we cook broccoli for too long, we unknowingly neutralize substance A — and substance B can’t work without its partner. One healthful solution would be to eat broccoli only raw — I don’t know about you, but that’s not a thrilling idea to me. Another solution would be to lightly steam broccoli for no more than two to four minutes to preserve its nutrients, but getting the timing just right while you’ve got three other things cooking isn’t always easy. So I was delighted to see that a new study has found that you can fix this problem a third way — by simply eating a certain other kind of vegetable along with your nicely cooked broccoli. While other studies have shown that overcooking broccoli disables its disease-fighting power, this is the first study that shows a way to get some — or even most — of that power back.

Interested in hearing more about this disease-fighting veggie duo, I called Elizabeth Jeffery, PhD, a professor of nutritional sciences in the College of Agricultural, Consumer and Environmental Sciences at University of Illinois in Urbana-Champaign and a coauthor of the study.


Dr. Jeffery called the disease-fighting compound that we want from broccoli “SF” — that’s short-hand for sulforaphane, which you’ve no doubt heard of for its anti-cancer and anti-heart disease benefits. But the SF isn’t just sitting around in the broccoli waiting for you to eat it — it has to be created when an enzyme called myrosinase (substance A) removes a sugar molecule from a larger molecule, glucosolinate (substance B), and frees up the SF. Chewing breaks up the broccoli cells so that substance A and substance B come into contact and produce SF. The glitch occurs when cooking broccoli, because the enzyme myrosinase is destroyed by heat — so no SF can be produced.

For this research, Dr. Jeffery studied four healthy men between the ages of 18 and 30. The men were each fed one of four different food combinations every six days for 24 days. One control meal was cereal and yogurt, another meal was cereal and yoghurt with ½ teaspoon of broccoli powder (which has no myrosinase), a third was cereal and yogurt with four teaspoons of fresh, raw broccoli sprouts (which do contain myrosinase) and the fourth meal was cereal and yogurt with a combination of the powder and the sprouts. To see just how much SF each meal produced, the mens’ blood and urine were tested just before they ate each meal and then again six, 12 and 24 hours afterward. To keep other factors from affecting the results, the men were given a list of foods that contain glucosolinates and were told to avoid these foods for three days before the study and during the study. The men were also told to avoid dietary supplements and to limit alcohol to no more than two drinks per day.

The results: Out of all four meals, the combination of broccoli sprouts and broccoli powder produced the highest levels of SF in the body, which suggests, said Dr. Jeffery, that eating a myrosinase-containing food along with your broccoli can bring back the broccoli’s disease-fighting properties — even if you cooked the myrosinase out of the broccoli.

That second food doesn’t have to be broccoli sprouts, but it should be something raw (since cooking the second veggie would destroy its myrosinase too), said Dr. Jeffery. So if you’re not a big fan of sprouts, you can choose among these other veggies for a similar effect, she said: radishes, mustard seeds and greens, arugula, watercress, wasabi root and leaves, cabbage and horseradish. Phew. I don’t know about you, but I’m so glad that I don’t have to give up cooking my broccoli.


Elizabeth H. Jeffery, PhD, professor of nutritional sciences, College of Agricultural, Consumer and Environmental Sciences University of Illinois at Urbana-Champaign.

Why Strokes Are Hitting Young People

by Carole Jackson, Bottom Line Health

When I think about stroke, the first thing that comes to mind is people in their 70s or 80s who have had cardiovascular problems for decades. So I was taken aback to hear that a new study found that, in the US, between 1995 and 2008 the number of hospitalizations for ischemic stroke — the kind caused by a blood clot — increased by 30% among people between the very young ages of 15 and 34 and by 37% among people between the ages of 35 and 44 — yes, we’re talking about 15- to 44-year-olds!

Why in the world would more people in the primes of their lives be having strokes? According to the study, which was done by the federal Centers for Disease Control and Prevention (CDC) and was published in the September 2011 issue of Annals of Neurology, the rise may be due to an increase in the risk factors for stroke among that age group, including hypertension (high blood pressure)… diabetes… and obesity. The researchers also said that the results could be due to improvements in the way hospitals track patients admitted for stroke and better imaging tests that enable greater accuracy in identifying stroke.

It would be nice if the increase was just due to better diagnosis… but it’s not. I called hypertension and stroke specialist George Bakris, MD, professor of medicine and director of the Hypertension Center at University of Chicago Medical Center, to give me a clearer picture of the situation because he had carefully examined the study and its results.


Of all the increased risk factors found among young people in the CDC study, hypertension was the most common. One in three stroke patients ages 15 to 34 had hypertension, and more than half ages 35 to 44 had it. Based on his clinical experience, Dr. Bakris wasn’t surprised by these findings, sad to say. He’s been practicing medicine for 24 years and he told me that before 1995, he had never seen an adolescent for hypertension. But over the past 16 years, he’s seen a growing number of them — in fact, today he is treating about two dozen teens for hypertension. He agreed that some of the study findings may have to do with better tracking and imaging, but he said that the vast majority of the results likely stem from the increased risk factors — especially obesity. As Dr. Bakris noted, the rate of being overweight or obese among American teens has quadrupled in the past 25 years, and, of course, obesity has become the most common cause of hypertension in this age group.

Besides obesity, there are other dangerous trends that Dr. Bakris sees in the lives of teens and young adults that he said contribute to high blood pressure and, therefore, stroke risk…

  • More caffeine. Young Americans are drinking a ton of soda and coffee and, now, so-called energy drinks with very high levels of caffeine, all of which can raise blood pressure.
  • Less sleep. It’s not unusual among teens and young adults to stay up much of the night and get just a few hours of sleep.
  • Stress. It is, of course, endemic in our culture, and young people are not immune to it — especially right now with the economy so poor. For example, Dr. Bakris said that some of his young patients can’t find jobs, while others are working the equivalent of three.


As we all know, one tricky thing about hypertension is that most people who have it exhibit no symptoms at all. Add to that the fact that young people aren’t exactly rigorous about getting regular medical checkups, and you have a recipe for a very bad outcome, including a stroke. In fact, Dr. Bakris mentioned that even when he finds high blood pressure in a young person, since the condition doesn’t generally interfere with day-to-day life, it isn’t unusual for the patient to refuse to take blood pressure medication or make the lifestyle changes that could cure it. The heart of the matter is: Youth doesn’t protect you from disease as much as you think it might!


George Bakris, MD, professor of medicine, director, Hypertension Center, The University of Chicago Medical Center.

Glucose on the Brain Helps Alzheimer’s Patients

by Carole Jackson, Bottom Line Health

Tell someone with Alzheimer’s disease about your day and he’s likely to forget what you said hours — if not minutes — later. This is the sad and frustrating state of affairs that is affecting many families now, since more than five million Americans have Alzheimer’s. Though there are some treatment options out there, there is no known cure and there are no effective ways to prevent it or delay its progression. So I was intrigued to read a new study that found promise in a simple intervention — a few squirts of insulin up the nose appeared to stop memory loss in its tracks.

I called the study’s lead researcher Suzanne Craft, PhD, a psychiatry professor at the University of Washington and director of the Memory Disorders Clinic at the VA Puget Sound Health Care System — both in Seattle — to learn more. The study was published in the September 12, 2011 issue of Archives of Neurology.


Dr. Craft and her colleagues studied 104 men and women ages 55 to 85 with mild-to-moderate-stage Alzheimer’s or amnestic mild cognitive impairment (often a precursor to the disease) and split them into three groups — one group was given a moderate dose of aerosolized intranasal insulin (20 IU)… another group was given a double dose of insulin (40 IU)… and the third group was given a placebo (a saline nasal spray). The doses were administered twice a day (after breakfast and dinner) using 90-second inhalations for four months. Participants used a special device that shoots the spray deep into the nose, delivering it directly to the nerves that lead to the brain. It may sound unpleasant, but Dr. Craft says that the treatment didn’t bother any patients.

Both before beginning treatment and after four months of the treatment, participants had a story read out loud to them that contained 44 bits of information. Twenty minutes after hearing the story, patients were given a recall test. On the second recall test, after four months of the treatment, those who had been given the moderate insulin dose of 20 IU performed 25% better than the placebo group, while the group that got the double dose of insulin didn’t show any increase in recall memory.

So how come sniffing a moderate amount of insulin seemed to help? The brains of people with Alzheimer’s either lack normal levels of insulin or are unable to metabolize the amounts of insulin that are present, said Dr. Craft. This is important because the brain needs glucose to function, and effective insulin metabolism is necessary for the brain to use glucose. (This is why past studies have shown an associative link between insulin-related health conditions, such as diabetes, and Alzheimer’s.) So Dr. Craft thought that administering the right amount of insulin directly to the brain — not too much, not too little and not to the entire body, which could be dangerous — might improve memory. And it looks like she and her colleagues are on to something.


This isn’t the first study to suggest that insulin might be a helpful therapy for Alzheimer’s patients — I first wrote about this in 2007 (see Daily Health News, May 17, 2007). And Dr. Craft told me that many other researchers are exploring this connection, too. Could this be the treatment for Alzheimer’s that everyone has been waiting for, something that could help stave off its worst effects while scientists continue to seek a cure? Maybe in a few years, but Dr. Craft said that long-term studies that confirm the results and ensure safety will have to be done first. She’s cautiously optimistic.


Suzanne Craft, PhD, director, Memory Disorders Clinic, Veterans Affairs Puget Sound Health Care System, professor of psychiatry and behavioral sciences, University of Washington, Seattle.

A Cup of Sunshine? Coffee Defends Against Depression

by Carole Jackson, Bottom Line Health

Here’s news that may bring smiles to the faces of coffee lovers. A large new study suggests that drinking caffeinated coffee is associated with a lower rate of depression. Since other studies have already noted links between coffee drinking and potential protection against type 2 diabetes, heart disease, Parkinson’s disease and several types of cancer, one might be tempted to say that there are sufficient “grounds” to say that coffee’s health benefits are plenty potent.

Researchers from the Harvard School of Public Health in Boston examined the health data of nearly 51,000 women (average age 63) who were taking part in the Nurses’ Health Study, an ongoing examination of nurses and their health habits. At the start of the Harvard study, all of the participants were considered “depression free” (no diagnosis of depression from a doctor, no antidepressant use and no severe depressive symptoms per the Mental Health Questionnaire). Every two years, the women were asked to provide information on their caffeine intake as well as whether or not a physician had diagnosed them with depression or prescribed them an antidepressant. The study collected data for 10 years — making this one of the few studies to ever look at the long-term effects of caffeine. Among participants, 82% of the caffeine consumed came from coffee and 13% and 6% came from tea and soft drinks, respectively.

What the researchers discovered: The more caffeinated coffee women drank, the less likely they were to become depressed over the course of the study. For example, women who drank four cups a day were 20% less likely to become depressed than women who drank one or fewer cups a week, and those who drank two to three cups a day had a 15% lower risk. Women who drank decaffeinated coffee were no more or less likely to be depressed than women who drank no coffee at all, which leads the researchers to believe that caffeine itself might explain the link.

It’s important to note that a “cup” was defined as 150 milliliters, which is about five ounces — less than half the size of a 12-ounce “tall” at Starbucks. And the researchers aren’t sure if taking your coffee black, with sugar or with milk will make a difference, since those details weren’t studied. The findings were published in the September 26, 2011 issue of Archives of Internal Medicine.


To try to figure out the answer, I spoke with Michel Lucas, PhD, RD, one of the Harvard epidemiologists who conducted the research. He told me that previous studies have linked caffeine (found in coffee or anything) with the release of dopamine and serotonin, neurotransmitters in the brain that are associated with enhancing mood temporarily. But exactly why caffeine may deflect depression over the long term hasn’t yet been pinned down.

And, the coffee study may come as a surprise to many people who connect caffeine consumption with a spike in anxiety — which often goes hand-in-hand with depression. “A high level of caffeine can increase jitters and nervousness in some people, and could therefore potentially cancel out any mood-enhancing benefit that the caffeinated coffee may bring,” said Dr. Lucas. And since our reactions to caffeine vary greatly by individual, he added, it’s important to know your limits. “Some people drink three cups of caffeinated coffee in one day and find that they can’t sleep and have anxiety, while others can drink six cups a day with no such effect,” he said.

While this finding may be reassuring for people who drink coffee, Dr. Lucas said it doesn’t mean that if you don’t drink coffee, you should start. This study shows only an association between caffeinated coffee and a low risk for depression — more research needs to be done to see if there is a cause-and-effect relationship.

But if you like coffee and it makes you feel good — this is yet another reason to enjoy your morning cup(s) of Joe!


Michel Lucas, PhD, RD, an epidemiologist at the Harvard School of Public Health, Boston.

Hidden Health Danger of Gravel Roads

by Carole Jackson, Bottom Line Health

A long ride down a gravel road in the country might have you conjuring up visions of a remote campsite or a picturesque pond at its end, but if you live in Dunn County, North Dakota — or in certain parts of 11 other states — the gravel road is more likely to stir up the harmful mineral erionite. It’s an asbestos-like fiber that can cause mesothelioma, a type of cancer that affects the tissues that surround the lungs and abdominal organs. In fact, erionite is much more potent than asbestos in terms of causing mesothelioma. Talk about dangerous dust!

What’s even scarier is that while the government has imposed severe restrictions on how asbestos can be used in the US, it has not taken any similar action with erionite — at least not yet. Investigators at the University of Hawaii Cancer Center in Honolulu hope that their recent research on the dangers posed by this mineral will change all that.


Over the past few decades, geologists have discovered that natural erionite deposits exist in the rock of at least 12 western states — North Dakota, South Dakota, Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah and Wyoming. When this rock is made into gravel, carcinogenic fibers are released into the air — and these carcinogenic fibers continue to be released into the air whenever the gravel is disturbed, like when a car drives over a road (or a driveway!) that is made of erionite-containing gravel.

If you breathe in these fibers, they can become lodged in your lungs, where they can cause abnormal cell development. Decades later — usually 30 to 60 years after exposure — this may lead to mesothelioma. Unfortunately, our current medical therapies have little impact on this lethal type of cancer, which has an average survival rate from diagnosis of just four to 18 months.

It sure was disheartening to learn that something as simple as a stone could cause such a life-threatening disease. To find out more, I spoke with Michele Carbone, MD, PhD, lead author of the study that made these discoveries, and Haining Yang, PhD, a member of the research team led by Dr. Carbone.

To explore the potential health risks that are associated with inhaling erionite gravel, Dr. Carbone and his team — in partnership with scientists at the Environmental Protection Agency, the National Institute of Environmental Health Sciences and several universities — turned their focus on Dunn County, North Dakota, where more than 300 miles of roads have been surfaced with erionite-containing gravel over the past 30 years.


The researchers measured airborne concentrations of Dunn County erionite and evaluated its physical and chemical properties. Then they compared their results with earlier findings from Turkish villages, where erionite gravel is commonly used and 6% to 8% of all deaths in those villages have been attributed to mesothelioma. In their analysis of the data, Dr. Carbone and his colleagues found that…

  • On Dunn County roadsides, and even in nearby indoor areas and inside vehicles that were regularly driven on erionite gravel roads — including school buses — levels of erionite equaled or exceeded the levels that were found in the Turkish villages.
  • The physical and chemical properties of North Dakota and Turkish erionite were almost identical. Therefore, Dr. Carbone and his colleagues theorized that erionite from Turkey and North Dakota would have the same carcinogenic effects. When they injected mice with Dunn County erionite, they found that, sure enough, their theory was correct. Inflammation and abnormal cell growth — early signs of mesothelioma — occurred in the lungs of the mice.

These findings, which were published in the July 25, 2011 issue of Proceedings of the National Academy of Sciences, are alarming. To make matters worse, with the increasing development of rural areas in the US, erionite exposure is likely to rise, said Dr. Carbone.


Up until a few decades ago, it had been thought that no erionite existed in US rock — and, in any case, it wasn’t used on US roads or driveways, said Dr. Carbone. Since both the discovery and the use of erionite in the US are relatively new, the potential health consequences of erionite exposure in the US hadn’t been explored until this study — so these results may trigger more research on the topic. Since it usually takes decades for mesothelioma to develop, Dr. Yang said that we are now approaching the time when erionite-related mesothelioma may start to be detected. She said she wouldn’t be surprised if Dunn County (and other parts of the US exposed to erionite) saw a rise in mesothelioma in the years to come.


Right now, there is no easy way to know if the gravel road that you are walking or driving on contains erionite, since erionite gravel doesn’t look, smell or feel different than many other types of gravel. Fortunately, most gravel does not contain erionite.

Even if you do know for sure that you’re walking or driving on an erionite-gravel road, unfortunately scientists know of no good way that you can protect yourself. When I asked Dr. Carbone whether it might help to roll up the car windows and set a vehicle’s climate controls on “recirculate” — which is supposed to block all or most outside air from entering — he said that this might help lessen exposure, but it wouldn’t eliminate it, since no car’s recirculation system is 100% efficient. You could also try calling your county or state health department to see if erionite exposure rates are being measured and if erionite gravel is being replaced. Since research on this topic is new, not all governments may take action yet, but you can at least help raise awareness about the problem. Paved roads made of asphalt in affected areas may also contain some erionite gravel bits (they weren’t studied), but while traveling on those types of roads, you’re less likely to inhale as many harmful erionite fibers, so take asphalt roads if and when you can.

Also, if you experience any of the common symptoms of mesothelioma — trouble breathing… pain in the lower back or side of chest… trouble swallowing… swelling in face and arms… pain or swelling in the abdomen… or unexplained weight loss — call your doctor immediately, especially if you live in an affected area.


Michele Carbone, MD, PhD, professor of pathology, director, University of Hawaii Cancer Center, Honolulu.

Haining Yang, PhD, assistant professor of pathology, University of Hawaii Cancer Center, Honolulu.

Drug-Induced Sunburns

by Carole Jackson, Bottom Line Health

Even though summer is long gone, there’s still a chance that you can get burned by the sun — though ultraviolet rays are only part of the problem. Sometimes taking certain everyday medications and then, say, going to a football game or going skiing on a sunny winter day can actually produce raging sunburns and rashes — ones that can take much longer to go away than typical sunburns. I’m sure you’re asking yourself, How can this be?

We’re talking about something known as drug-induced photosensitivity. Some drugs — even the ones you swallow, not just topical meds that you put on your skin — make some people extra-sensitive to ultraviolet light. When you’re on one of these drugs and some of your skin is exposed to sun, the combination can inflame the skin and bring sunburn, hives, swelling, blisters and bumpy, red rashes that resemble eczema. And the more that you’re exposed to the sun, the worse the skin reaction can be.

Many of the drugs that can cause photosensitivity are common (more on them below), and since many people might mistakenly blame their skin problem on something else (like stress), it’s all but impossible to tell how many people are affected by this condition. So I called Alexandra Zhang, MD, a dermatologist at the Dermatology and Plastic Surgery Institute of the Cleveland Clinic in Independence, Ohio, who has conducted research on this topic.


Sometimes, Dr. Zhang explained, the skin reaction is photoallergic. This means that when you apply a topical drug, such as a cream, to your skin, and then the skin is exposed to UV light, the drug binds to proteins in the skin, causing the skin to produce defensive antibodies in response to the UV light. So an itchy, red rash resembling eczema can show up within minutes on the sun-exposed area — and then spread all over the body.

More commonly, Dr. Zhang continued, the skin reaction is phototoxic. This may happen with nontopical drugs (like pills that you swallow). If you take one and then are exposed to sunlight, the drug that’s in your bloodstream absorbs energy from UV light. The UV light causes the drug to change chemically and damage skin tissue. This type of reaction can cause a rash that mimics extreme sunburn anywhere on your body. And it doesn’t even take much sun exposure for this to happen — you can get it from merely sitting inside a car near one of the windows (and you most certainly can get it from artificial UV light, such as from a tanning bed).

In either case, Dr. Zhang noted, unlike a typical summer sunburn, drug-induced photosensitivity can crop up on body parts that haven’t been exposed to the sun, such as your back or your stomach — even when you were wearing a coat all day. (And that’s another reason that many patients don’t think Oh, the sun! when they have a photosensitivity reaction in the winter — they were mostly covered!) Even worse, drug-induced photosensitivity can continue to occur for weeks or months (sometimes even years) after you stop taking the medication that caused it!

A wide variety of drugs can set off a photosensitive reaction — and this list continues to grow. The list includes (but is not limited to)…

  • Antihistamines such as diphenhydramine (Benadryl), cetirizine (Zyrtec) and loratadine (Claritin).
  • Antibiotics such as ciprofloxacin (Cipro), levofloxacin (Levaquin), tetracyclines, azithromycin (Zithromax), sulfamethoxazole/trimethoprim (Bactrim) and doxycycline (Monodox).
  • Anticlotting drugs such as clopidogrel (Plavix).
  • High blood pressure medications such as nifedipine (Procardia) and captopril (Capoten).
  • Cholesterol-lowering drugs such as lovastatin (Mevacor) and simvastatin (Zocor).
  • Antidepressants such as amitriptyline (Elavil), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem) and paroxetine (Paxil).
  • Sedative/hypnotics such as alprazolam (Xanax) and zolpidem (Ambien).
  • NSAID pain relievers such as ibuprofen, sumatriptan (Imitrex) and celecoxib (Celebrex).
  • Oral contraceptives, since both progesterone and estrogen can cause photosensitivity.
  • Skin agents such as minoxidil (Rogaine) and (ironically!) PABA-containing sunscreens.

Why these rashes occur in some people but not others is unclear, said Dr. Zhang. The good news is that although these skin reactions can be annoying, very seldom are they dangerous. “The reactions are usually just a bad nuisance, to the point where you’re itchy all over and can’t function because you have to scratch,” she said. One exception: In individuals who are exposed to large amounts of sunlight after taking a large dose of psoralens — drugs that are used to treat certain skin problems, such as psoriasis — reactions can be severe or even fatal.


If you experience an unusual skin reaction and you think that a drug you started taking recently might be involved, visit your doctor, who may advise you to switch medications (if possible), so you can figure out if the drug is the culprit. If so, the rash should disappear within a few weeks or months after you stop taking the drug — although in rare cases it can last for years. In addition to switching drugs, you can also reduce the effects of the rash — and potentially even make it disappear — by applying a topical corticosteroid and by wearing sunscreen daily, even in the winter, said Dr. Zhang. But since some sunscreens (the PABA-containing ones mentioned above) will only make the problem worse, read the labels carefully. “Look for a broad-spectrum sunscreen that protects against both types of UV rays: UVA and UVB, because either can cause photosensitivity,” advised Dr. Zhang.


Alexandra Zhang, MD, a dermatologist at the Dermatology and Plastic Surgery Institute of the Cleveland Clinic, Independence Family Health Center, Independence, Ohio.

Breast Implants: Still Questions About Safety

by Carole Jackson, Bottom Line Health

The ongoing debate about the long-term safety of silicone breast implants — which were removed from the US market from 1992 to 2006 (except for breast reconstruction or to replace existing ones) — has reared up again. It was revealed this year that two long-term studies currently addressing the issue have, so far, analyzed only a fraction of the women that they were supposed to be following. The FDA, which regulates the silicone breast implants as medical devices, concluded this past August that they are safe when used as intended. But maybe the more accurate characterization would be: safe enough — as far as we know.


There are two brands of silicone gel-filled breast implants on the market in the US — one is made by a company called Allergan and the other is made by Mentor Corporation. Data on how well women with these implants fare over the long term (for 10 years or longer) is scarce. So when the FDA approved the devices for use in 2006, there was a condition: Each company was required to begin a 10-year study of safety data on 40,000 women who got their silicone gel-filled implants between 2006 and 2016. Since it’s now 2011 — and both companies are supposed to be halfway done with their research — the FDA held a two-day meeting in Washington, DC, to get an update on their progress… and it’s not so impressive.

Over the past five years, Allergan has collected survey data on only 60% of the women that it was supposed to be following, and Mentor Corporation’s patient response rate is even worse — a mere 21%. Therefore many fewer women are being studied than expected. One main problem is that women who are interested in participating in these studies are being asked to complete a massive, 27-page questionnaire each year following surgery.


Silicone implants are quite popular. In fact, in 2010, about 150,000 women got them in the US for cosmetic reasons. And based on what I know about human nature, I don’t think the woeful lack of safety data is going to hurt their popularity, especially since many women like their implants! So why would I be concerned? If you follow health news actively — and don’t just wait for companies to report on the safety of their own products — then you know that not everything is peachy in the world of breast implants. Lots of women have a great deal of trouble with them. I decided to bounce my concerns off someone who should certainly know — William Maisel, MD, deputy director for science and chief scientist with the FDA’s Center for Devices and Radiological Health in Silver Spring, Maryland.


Many medical devices and drugs that are FDA-approved, as we all know, carry serious risks. In the case of breast implants, Dr. Maisel readily acknowledged that they can cause problems that include scarring, pain, infection, a hardening of the tissue around them, and even rupturing — which can cause silicone to leak into a woman’s body (that’s one of the reasons that they were removed from the market in 1992). Past research shows that the longer a woman has implants, the more likely she is to experience complications. In fact, one in five women who chooses to get implants for cosmetic reasons will likely need to have them removed within 10 years! But all of those risks are old news and not enough to make the FDA keep silicone implants off the market.

“Not every patient is the same, which is why we always encourage patients to talk to their doctors,” said Dr. Maisel. After all, there is evidence supporting patient happiness, too. In the FDA’s recent review of research, it found studies that showed that more than 90% of women with silicone implants are satisfied. Plus, body image improves in the majority of women who receive silicone implants, and this feeling lasts for at least two years post-implant. “Based on the total scientific data available right now, we believe that implants are safe and effective,” said Dr. Maisel.

Although there is a little bit of long-term data, the thorough research that we thought we were going to have in five years from Allergan and Mentor Corporation doesn’t seem likely to provide the big-picture information that doctors were hoping it would. So what’s a woman who is considering getting silicone implants supposed to do, since aspects of the implants’ long-term safety are still largely unknown (and may be for a while)? Simply put: It depends on how much of a risk-taker you are. Are there other implant options to consider getting? Besides silicone, the only other type of implant on the market is saline, but “saline implants have a similar risk profile,” said Dr. Maisel.

If you already have silicone implants, said Dr. Maisel, keep a close eye on them and schedule follow-up appointments with your doctor. The FDA recommends that you have periodic MRI scans (three years after your surgery and then every two years after that) to help detect “silent ruptures” that you may not be able to feel. So talk to your doctor about scheduling those tests — especially since Dr. Maisel said that many doctors don’t tell patients about this MRI recommendation. Maybe it’s because MRIs aren’t cheap: An MRI could set you back $2,000 or more — and insurance may or may not cover any of the cost. Also: Notify your doctor if you develop any unusual symptoms, like pain, asymmetry, lumps, hardness or swelling, because it could mean that your implants have become defective — and you may need to have them removed or replaced.

William Maisel, MD, deputy director for science and chief scientist, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland.


by Carole Jackson, Bottom Line Health

It’s not easy being a doctor. Often it’s like being a detective and needing to find the right clue that will solve “the case.” Doctors know that some of their decisions are life or death, but they don’t always know which ones. So it makes sense, theoretically, to err on the side of caution and order more tests and make more referrals rather than less… or does it? A new survey reports that even doctors think that some of those tests and referrals are unnecessary — and even potentially hazardous.

According to a survey of 627 randomly chosen doctors nationwide that was created and administered by MDs from Dartmouth Medical School in Hanover, New Hampshire, and the Veterans Affairs Medical Center (VAMC) in White River Junction, Vermont, one in four primary care physicians acknowledged practicing medicine too aggressively — meaning that he/she had ordered more tests or made more referrals than he thought were necessary. The findings were published in the September 26, 2011 issue of Archives of Internal Medicine.


I spoke with one of the lead researchers, Brenda Sirovich, MD, an associate professor of medicine at Dartmouth and an internist at the VMAC, who told me that this study demonstrated that there is often “a message in medicine that more is better” — but not necessarily because it leads to better patient care. In the survey, these were the most common reasons cited by doctors (in order) for their overzealous efforts…

1. Fear of a lawsuit. “Doctors perceive that it’s easy to be sued by a patient for not ordering a test or making a referral — so the more tests you run and referrals you make, the assumption is, the less likely you are to suffer litigation,” said Dr. Sirovich. And it’s a valid fear for physicians to have: Three out of four doctors in “low-risk” specialties (such as family medicine, pediatrics and psychiatry) will be sued for malpractice by age 65 — as will 99% of doctors in “high-risk” specialties (such as neurosurgery and thoracic-cardiovascular surgery), according to a study published in the August 18, 2011 issue of The New England Journal of Medicine.

2. Process drives their practice. Physicians are increasingly encouraged to complete “checklists” so that the performance of the physician, the practice and/or the hospital system can be monitored by an employer, an insurance company and/or a government agency. The checklists often contain tests (or diagnoses that need to be ruled out by the tests). The goal of having checklists is to standardize processes across physicians and practices in order to improve the quality of care, said Dr. Sirovich. But some doctors feel boxed in by these checklists, since their instincts and experience become less important than following the rules.

3. An assembly-line approach. Doctors have such a limited amount of time with each patient that, instead of asking more questions that could lead to a more accurate diagnosis or discussing all the multiple treatment options, Dr. Sirovich said, they usually conclude, “Let’s refer you to a specialist” or “Let’s run some tests.”

4. Tests sometimes make doctors money. The doctors in the survey acknowledged that money, not quality of care, is occasionally a factor, too. Only 3% admitted that financial considerations influenced how they practiced, but 40% said that they thought that other primary care physicians would order fewer tests if those tests didn’t provide any extra income.


We all want thorough doctors who weigh all possible causes for the symptoms that brought us to their offices, so what’s wrong with a few extra tests? After all, if your doctor isn’t 100% sure of a diagnosis, don’t you want him to be certain? Sure, there are potential benefits to having extra procedures — but it’s important to realize that there are also potential risks.

For example, one problem is that an unnecessary test could lead to a false-positive, meaning that you’re initially diagnosed with — and even treated for — a condition that turns out to be nothing. The test that led to the false-positive result might have exposed you to risk, such as radiation (not to mention unnecessary anxiety) — and it might also lead to a cascade of more unnecessary tests. On top of all that, the tests are likely to cost you — and certainly the health-care system — more money.


So what should a well-informed patient do to combat this potentially dangerous reality? Don’t automatically accept a test. It’s okay to question your doctors, making sure that they cover the following points…

  • • Why do I need this test? You doctor should offer a clear explanation of why you need it, matching your symptoms with the test.
  • • Would you have this test if you were in my situation? This may lead your doctor to stop and think more carefully about the recommendation.
  • • Are there other options? Ask your doctor to enumerate them and explain why he or she is recommending this particular option for you.
  • • Is waiting an option? Does your doctor think there will be harm in waiting some period and then reconsidering the test?
  • • What are the potential risks and benefits of the test? Know all the pros and cons before you agree to anything.

Most importantly, all of us need to have a two-way dialogue with our doctors. In their time-pressured haste, many doctors don’t take the time to ask a number of questions about their patients’ lifestyles that might uncover critical information that could lead to a more accurate diagnosis, test or treatment. If your doctor asks you only about symptoms and then goes straight to testing — without asking about what you eat, how active you are, where you have traveled, etc. — then you may want to consider changing doctors. Doctors need to be treating you, the patient — not just the stats in your patient chart.


Brenda Sirovich, MD, associate professor of medicine at Dartmouth Medical School, Hanover, New Hampshire, and an internist at the Veterans Administration Medical Center in White River Junction, Vermont.

Do Away With Dry Mouth

by Carole Jackson, Bottom Line Health

Dry mouth — it’s a discomfort that we all experience from time to time, usually when we’re under stress. It’s easy to relieve with a drink of water, and it typically disappears as soon as you get through the big presentation, the family squabble or whatever it was that set your nerves on edge — unless you’re among the 30 million or so Americans suffering from chronic dry mouth (the medical term is xerostomia). These unlucky folks have little to no saliva in their mouths on a regular basis, so they are always parched, their tongues may feel hot and swollen and they often have really bad breath. The good news is that there is a new over-the-counter (OTC) product for those who suffer that provides better relief — and also lasts longer — compared with its competitors.

But first, let’s talk about why getting rid of chronic dry mouth fast is important. Having a parched mouth can also, either directly or indirectly, lead to a host of health problems, some of which are serious. You likely never thought about it, but your body normally produces about 0.75 to 1.5 liters of saliva each day. Saliva is loaded with minerals that cleanse the teeth and gums. So chronic dry mouth raises your risk for periodontal disease, which seems logical — but periodontal disease, in turn, may elevate your risk for heart disease, a health concern on a whole different level. We also need saliva in order to fully taste our food, so chronic dry mouth can affect how much we enjoy meals, and we need saliva to swallow and break down our food properly, so chronic dry mouth can cause digestive problems. Plus, it’s easier to talk when your mouth and throat are well-lubricated.


It’s decidedly not normal for your mouth to constantly feel like a desert, but there are numerous reasons why it might happen. For instance, poor lifestyle choices (specifically, smoking and excessive drinking of alcohol) can dry out your mouth, as can diseases, including diabetes. It’s rare, but chronic dry mouth can also be a symptom of an autoimmune disorder called Sjögren’s syndrome (see Daily Health News, October 24, 2011 for more information on Sjögren’s). But the most common cause of chronic dry mouth, by far, is medication. Dry mouth is listed as a side effect of more than 1,800 different prescription drugs (and also of many OTC medications). About one-third of patients who are taking three or more prescription drugs are likely to suffer from dry mouth. So if you suffer from dry mouth and take medication, check with your doctor to see if switching to a different drug or making a lifestyle change might reduce — or eliminate — your symptoms.


No matter the cause of your dry mouth, there is a relatively new OTC, natural dry-mouth remedy that is blowing away the competition. A New York University College of Dentistry study published last year in The Journal of the American Dental Association (JADA) found that using OraMoist, a self-dissolving, muco-adhesive patch that’s slightly smaller than the size of a dime and sticks onto any oral mucosal surface (such as the roof of your mouth or the inside of your cheek), leads to a significant increase in salivary flow among dry-mouth sufferers after just two weeks of daily use. Another study, from the Hebrew University of Jerusalem in Israel, backs up these findings — and also found OraMoist to be twice as effective as a leading dry mouth mouthwash.

The OraMoist patch moistens the mouth while simultaneously stimulating saliva production with a blend of natural ingredients, including citric acid, lemon flavor, calcium carbonate and xylitol. These ingredients are time-released, so the effects of one patch last up to four hours. Other OTC products on the market for dry mouth (including mouthwashes, sprays and gels) must be used every 20 minutes to get the same effect. Patch users have reported greater relief the longer they used the patch, so it also appears to have a cumulative benefit. A pack of 16 OraMoist patches, enough for five days if you use three a day, costs about $13.


I checked in with one of our regular expert medical sources, Mark Breiner, DDS, a holistic dentist in Trumbull, Connecticut, and author of the new book Whole-Body Dentistry: A Complete Guide to Understanding the Impact of Dentistry on Total Health, to get his opinion on the OraMoist patch for people with dry mouth. Dr. Breiner’s message was simple but important: Although the patch can bring welcome relief, it should be considered a temporary solution. So be sure to also talk to your doctor to see whether you can get rid of dry mouth altogether.

“Dry mouth is often a sign that something in your body is out of balance,” Dr. Breiner said. For example, a disease, lifestyle habit or drug could be the root cause. “Isn’t it better to deal with that than to just ‘cover up’ the problem?” he asked. You know the answer — and it could have a major impact on your odds of living a long and healthy life!


Mark Breiner, DDS, a holistic dentist in Trumbull, Connecticut, and author of the new book Whole-Body Dentistry: A Complete Guide to Understanding the Impact of Dentistry on Total Health (Quantum Health).

Flaxseed May Protect Against Radiation

by Carole Jackson, Bottom Line Health

It’s too bad that our risk for radiation poisoning didn’t end along with the Cold War. Today, we have nuclear terrorist attacks and power plant leaks to worry about. And if you aren’t concerned about those, there’s always the possibility of needing radiation therapy for cancer. So it was on multiple levels that I was intrigued recently by a new study showing that a common food may protect us against radiation — and that food is flaxseed.

The study, done on mice at the Perelman School of Medicine at The University of Pennsylvania in Philadelphia, revealed that a fairly small daily serving of flaxseed (the human equivalent of four tablespoons) is protective against radiation. To find out more, I called researchers Keith Cengel, MD, PhD, assistant professor of radiation oncology at the university, and Melpo Christofidou-Solomidou, PhD, research associate and professor of medicine at the university. Their findings were published in the June 24, 2011 issue of BMC Cancer.


The researchers told me that groups of mice were fed two very similar but not identical diets — the sole difference was that some mice ate no flaxseed and others ate 10% flaxseed. The mice were exposed to a large dose of radiation. Certain groups were given these diets three weeks before the radiation exposure, while others were fed these diets immediately after or two, four or six weeks after the radiation exposure.

Four months after the mice received radiation, the researchers examined their survival rates. They found that 70% to 88% of the mice who ate the flaxseed diet (either before or after radiation exposure) were alive, versus just 40% of the mice who didn’t eat any flaxseed. Not only did the mice who ate the flaxseed live longer, but they also had fewer side effects from the radiation — they lost less weight, had less indication of inflammation and had fewer lung problems, such as fibrosis.


The researchers think that it’s reasonable to theorize that this protective effect of flaxseed might benefit radiation-treated cancer patients and possibly even victims of a nuclear power plant leak or a “dirty bomb.” Even astronauts — who are exposed to radiation during space flight — and frequent fliers might benefit from flaxseed, they told me. It might also be useful for the “worried well” — those who fear that they’ve been exposed to radiation but show no symptoms or those who fear that they might be exposed in the future.

How does flaxseed work to stem radiation damage? The mice in the study received a single radiation dose that is equivalent to getting about 135,000 chest X-rays (the same amount that a cancer patient might get over an entire course of radiation treatment lasting perhaps many months). The researchers aren’t completely certain of the mechanism of protection, but they think that the flaxseed may have somehow prevented the DNA damage that typically occurs among normal, noncancerous cells immediately after radiation exposure. If this holds true among humans, then it might mean that eating flaxseed would help the radiation destroy malignant cancer cells without harming so many normal cells — that’s an important benefit, since damage to normal cells is one of the major drawbacks of radiation therapy.

But it’s important to realize that the results of the mice studies are preliminary, and Drs. Cengel and Christofidou-Solomidou hope that they can be replicated (without the unneeded radiation, of course) in studies of humans. If flaxseed pans out to be a good source of radiation protection among humans, imagine how cheap and easy it would be to hand out small packets of flaxseed to cancer patients or even to everyday healthy citizens if there is concern about a potential nuclear event or a radiation accident, such as the one that happened this past spring in Japan. The daily dose of flaxseed might be just a few tablespoons — for such a huge return.


Keith Cengel, MD, PhD, researcher, assistant professor of radiation oncology, Perelman School of Medicine, The University of Pennsylvania, Philadelphia.

Melpo Christofidou-Solomidou, PhD, professor of medicine, research associate, Perelman School of Medicine, The University of Pennsylvania, Philadelphia