Biotin and Psoriasis Again

Last year I wrote about how I started taking biotin, a member of the B-vitamin group, to help my fingernails and found that it helped my hair and skin as well.  I had developed little painful, crusty spots on my elbows which I thought were psoriasis.  Not long after I started taking biotin the spots disappeared, leaving little scars.  

Now I’m sure it works, at least for me.  Recently I went on a trip and didn’t bring quite enough biotin with me.  I was only off it for 3-4 days but when I got back the painful, crusty spots were reappearing on my elbows.  I went right back to the biotin and the spots dried up.  I’m concerned about psoriasis not only because it is painful and unsightly but also because it seems to be linked with heart disease, which runs in my family.  So maybe by doing something good for my skin I’m also helping my heart.  I wish someone would research all this so we could understand it better.  Medical websites say that biotin deficiencies are rare; I suspect that this is because testing for biotin deficiencies is rarely done.

More Help for Sore Muscles: The Thumper

The Thumper Sport

I still like foam rollers for working the soreness out of large muscle groups like the back and the upper legs because the weight of your body helps you to work into those areas (see “Foam Rollers:  Help for Sore Muscles”).  But for smaller body parts, like the very top of the back and the biceps muscles, the rollers aren’t much help so I decided to try a percussion massager.  The first one I got was a HoMedics device for about $40.  It worked pretty well but started making an ominous noise after a couple of months so I took it back to Bed, Bath, and Beyond (thanks to their liberal returns policy).  That experience was enough to persuade me that these machines can really be useful so I decided to invest in a Thumper.

This massager is the descendant of the first deep muscle percussion massager, produced in 1974, which was based on research by Canadian chiropractor Lyman Johnson.  The Thumper is still made in Canada and the company now produces a whole line of massage-related products, including one for horses! I got the simplest one, the Sport Percussive Massager, which came with good instructions, including a DVD demonstrating its use.  The only drawback is that the Thumper is pricey; I paid about $140 on Amazon.  On days when I don’t use the foam roller I use the Thumper on my back, arms and legs, and even my hands and feet.  You hold it on each spot for less than a minute so the whole process doesn’t take long.  It definitely loosens up stiffness and helps me to relax in the evening.  It seems to be well made and has a two-year warranty, an indication that the company is serious about quality.  

Four years ago Mark Tarnopolsky a neurometabolic researcher at McMaster University injured a hamstring in a waterskiing accident.  He was so impressed with the effects of massage in improving his condition that he decided to explore the underlying mechanisms that cause it to work.  “They found that massage reduced the production of compounds called cytokines, which play a critical role in inflammation. Massage also stimulated mitochondria, the tiny powerhouses inside cells that convert glucose into the energy essential for cell function and repair.”  So massage both suppresses inflammation and promotes faster healing.  “Basically, you can haveyour cake and eat it too,” said Tarnopolsky.  Researchers found no basis for the claim that massage removes lactic acid from muscles.

When to Question Your Doctor: A Cautionary Tale

Most people are in awe of physicians.  Medical doctors are smart, well educated, and devote their working lives to helping others.  The least we can do, it would seem, is not to add unnecessary complication to their already-overstressed schedules by disagreeing with them.  The current New England Journal of Medicine has an important article, “SpeakingUp — When Doctors Navigate Medical Hierarchy,” by Ranjana Srivastava of the Monash Medical Center in Australia. 

It turns out that not only patients are intimidated by physicians; doctors are also intimidated by other doctors so that they do not always speak up when they sense that something is wrong.  Medical professionals are especially loath to interrogate those whom they perceive as outranking them in the medical profession’s pecking order.  Srivastava, an oncologist, was unwilling to express her sense of uneasiness about a patient to the surgeon about to operate on him.  Her account of the incident and its consequences is honest and moving.  
  
The message I took away from this article is this:  if something bothers you, speak up.  Be respectful, ask reasonable questions, but don’t keep silent.  To this I would add:  if the doctor becomes annoyed or brushes your reservations aside, get a second opinion.

Abdominal Migraines

My paternal grandmother would sometimes get abdominal pain severe enough to send her to the emergency room.  She had a number of exploratory surgeries that turned up nothing until finally, in her seventies or eighties, she said, “No more surgeries.”  My father used to get migraine headaches.  I don’t get those, but once in a great while (about every seven years) I get an abdominal migraine.  Usually at night after a big meal, maybe under stressful circumstances, I will get painful spasms below my navel (about 7 on a scale of 1 to 10), accompanied by sweating, vomiting, and diarrhea until my whole system is cleared out.  After that the pain continues; I can’t keep down any food or liquid; and of course I can’t sleep.

In 1989 that happened and I went to the emergency room.  That time I was lucky because the doctor there knew what this was.  He checked a few things, had an x-ray taken, and sent me home with pain medication.  He didn’t tell me the name of the condition; I found that out later for myself.  I stayed in bed the next day and after that I was fine.  Seven years later it happened again and I called my regular doctor.  I said, “I know what this is.  Please give me something for the pain and I’ll be OK in a day or two.”  My doctor was skeptical and wanted to be extra cautious.  She had me check into the hospital and lined up a surgeon.  The hospital ran various tests, found nothing, and let me go after a couple of days.  The next time, just as the pain was starting, I took a generic Pepcid AC (famotidine) and the pain stopped in its tracks: apparently this is the right thing to do.

Many doctors believe that only children get abdominal migraines but this seems to be wrong.  I get them, my grandmother probably did too, and I know at least one other adult who does.  In adults an abdominal migraine is probably mistaken for a stomach virus or food poisoning.  For people who get them often it probably makes sense to carry the pills around, just in case.

I get various kinds of muscle spasms too.  The best fix for these is to wet a washcloth with the hottest water you can stand and press it against the knotted up area.  Sometimes this has to be done a couple of times but after that the muscle will relax.  I’ve read that muscle spasms can be caused by deficiencies in any of various minerals.  I take potassium, magnesium, and calcium and the blood tests for these indicate that I’m where I should be.  Evidently this is just part of my genetic inheritance.

The Latest on Stilbestrol

In today’s paper I read about the Melnick sisters, whose suit against Eli Lilly and Company went to trial this week.  The sisters charge that a Lilly product, diethylstilbestrol (DES), which was given to their mother during four of her pregnancies, caused their breast cancers.  DES was given to pregnant women in the 1940’s and 50’s to prevent miscarriage.  It was later taken off the market when it was found to cause a rare type of vaginal cancer in the daughters of women who had taken the medication.  It was also found not to prevent miscarriage.

The circumstantial aspects of the Melnick case are compelling.  Four of the daughters developed breast cancer in their forties after their mother took DES during those pregnancies.  A fifth daughter, who did not receive in utero exposure to the drug, has not had cancer.  On the other hand, the pregnancies took place during the 1950’s; medical records no longer exist; and Lilly was not the only company that produced stilbestrol.  In addition, the prescribing doctor failed to follow Lilly’s recommendations, which called for using the drug after three or more consecutive miscarriages.  The Melnicks’ mother evidently did not have successive miscarriages.  

In “Stilbestrol and Me” I discussed my own experience with DES.  My mother’s doctor prescribed the drug after my would-have-been older brother was born a “blue baby” and died soon after, not really a miscarriage at all but a heart problem in the child.  DES is a good illustration of “The Twenty Year Rule.”  An apparently successful new technology appears; the medical profession gets excited and applies it to many patients.  Twenty years later (from the ‘50s to the ‘70s in the case of DES) unpleasant or dangerous side effects become evident and the medical profession backs off en masse.  You would think these experiences would lead all of us to be more cautious before trying out the latest thing on our irreplaceable bodies.

Update 1/10/2013:  Eli LIlly settled its case with the Melnick sisters for an undisclosed amount.  Lilly stated that, while it did not believe that its medication had caused the Melnicks' illnesses, the settlement was in its best interest.

“Dear CDC: BMI ≠ Body Fat”

Happy New Year!  Another year, another study apparently proving that being a little overweight is fine and may even reduce your risk of dying, as compared with being thinner.  This one, from the Centers for Disease Control and Prevention, re-analyzes data from 97 studies involving nearly three million people from various countries.  The study, which is being published in the Journal of the American Medical Association, has been widely publicized.  I counted two articles in the New York Times and one in the Wall Street Journal plus coverage on radio, TV, and the Internet.

This is the most recent illustration of “the obesity paradox,” the fact that, although excess weight is a factor in cardiovascular disease, obese patients with heart disease tend to live longer than those with no excess weight.  I would argue that the root of this “paradox” is in the definition of obesity.  When you used a flawed measuring device, you get incorrect results and BMI, which used as the index of fitness in all these studies, is seriously flawed, as I explained in my post, “What’s Wrong With BMI.”  

BMI is a ratio of weight to height:  multiply your weight in pounds by 4.88, then divide it by your height in inches, squared.  Anyone with a BMI over 25 is considered overweight; anyone over 30 is classified as obese.  This means that people who are fatter than average (unhealthy) are lumped together with people who are more muscular than average (very healthy).  Under this system, a person the same height and weight as Tony Horton would be treated as equally fit even if he had never exercised a day in his life!  Measuring the percentage of body fat for each individual would provide a more accurate picture of the situation.  Lots of people know that there are problems with BMI.  Melinda Beck’s article in the WSJ alludes to this.  A number of her readers know it too, as indicated by some of the comments on the article.  So why did the CDC use it in this case? The answer is that it is easier and cheaper to use existing data and the existing data all use BMI.

As a federal agency under the Department of Health and Human Services, the CDC is looked upon as a leader in the fields of science and health.  When it continues to use and endorse BMI as a measure of good physical condition, it sets an example that others follow, which does a disservice to all of us.  In my doctor’s office my weight is measured on a BMI scale.  I ask my doctor why there is no body fat scale and she says that BMI is the current standard.  As long as this continues, there will be no data on body fat for anyone to study unless they do original studies themselves.  Fortunately, some of this research is being done.  A Mayo clinic study found that people of normal weight can be at greater risk of heart disease if the levels of body fat are high.

The timing of this new study and the ensuing publicity could hardly be more damaging.  Scientists at the CDC are surely aware that fat people who lose weight through appropriate diet and exercise (not illness) will lower their blood pressure, reduce their blood sugar, and improve their cholesterol readings, all of which will contribute to better health.  At the beginning of a new year many people are pre-disposed to turn over a new leaf.  Instead of encouraging people to cultivate better habits, the CDC puts its imprimatur on the perverse message that it’s OK to be fat.

Preventing Heart Disease: What We Thought We Knew Is Wrong

The word is out.  I first learned about it in a “Sound Medicine” interview last July with science writer Sharon Begley, a follow-up to an article she had written in April. In it she discussed research showing that giving statins to healthy people to lower their cholesterol does not help to prevent a first heart attack.  It turns out that cholesterol numbers are not a good predictor of heart attack risk and that lowering your cholesterol is unlikely to improve your odds.  (See my post, “Statins – Whoops!”)

More recently, Drs. Stephen Sinatra and Jonny Bowden were on “Dr. Oz” discussing the new approach and promoting their new book, The Great Cholesterol Myth:  Why Lowering Cholesterol Won’t Prevent Heart Disease and the Statin-Free Plan That Will.  Here is a synopsis by Dr. Joseph Raffaele:

“Dr. Sinatra explains that cholesterol is a vital substance, necessary for the proper functioning of our bodies. To name just a few: it keeps our cells flexible, is essential for hormone production, and is turned into vitamin D in the skin.  He believes it has been vilified as the cause of heart disease because of a longstanding misinterpretation of the studies often cited to support its role.  He rightly states that about half the people who have high cholesterol never get a heart attack and half who do have a heart attack have normal cholesterol.  The message is clear:  total cholesterol, the number we’ve all been obsessing about for the past few decades, is meaningless.  It’s not the cause of heart disease.”

If cholesterol numbers don’t matter, what does? Cholesterol is still in the picture but the issue is the particle size of your LDL cholesterol.  Small LDL particles are more likely to get into arterial walls and cause inflammation.  Inflammation is now thought to be a contributing factor in many illnesses, not just heart disease.  Obesity, insulin resistance, and a diet high in sugar and processed carbohydrates are factors that contribute to this condition.  Sinatra and Bowden recommend an anti-inflammatory diet with plenty of fruits and vegetables.  They note that only one group of patients has been shown to be helped by statins: middle-aged men who have already had one heart attack. 

“New Thinking on Heart Disease Prevention,” a blog post by Dr. Ryan Sweeney, provides a clear and concise summary of the new approach.  In addition to particle size and inflammation, Dr. Sweeney names oxidative stress as a factor contributing to heart disease.  The summary at the end includes the names of the tests that are needed to monitor the three factors:  CRP-hs, Homocysteine, Oxidized HDL and LDL, and LDL subtractions (for particle size).

In his blog post about the Dr. Oz show mentioned above, Dr. Joseph Raffaele takes all three doctors to task for not mentioning the benefits of hormone therapy in reducing the risk of heart disease for women who take it.  

“What if I told you there is natural therapy that reduces your risk of having a cardiovascular event by 41% and your chance of dying of any cause by 27%, while also being free of any of the side effects commonly seen with statins?   Would you take it?  In addition to heart disease prevention, this therapy’s common “side effects” include a reduction in hot flashes, vaginal dryness, depression, brain fog, insomnia, and vaginal dryness.  Serious “side effects” include a 23% reduction in breast cancer (yes, reduction) and improved bone density. If you are a menopausal woman between 50 and 60 years old, you can expect all these benefits from estrogen replacement.”

So here’s the situation:  millions of patients are currently taking statins with no benefit to their health and some potential hazards.  Statins can cause muscle weakness and memory loss,  as well as other physical and cognitive problems.  For a more extensive list of possible side effects take a look at “How Statins Really Work Explains Why They Don’t Really Work” by MIT scientist Stephanie Seneff.  All of us are paying for this useless and possibly harmful treatment through our insurance premiums and our taxes.  We will also be paying to treat whatever damage is done to patients who take statins.  At the same time, the use of hormone therapy, which has repeatedly been shown to reduce the risk of heart disease and to be safe for most women, is being discouraged by Medicare and insurance companies.  I have been on hormone therapy for thirty-three years, half my life, and I consider myself amazingly lucky.