If all of the previous information on diabetes prevention and management hasn’t inspired you to take better care of yourself, then what you read here may scare you into it.
At a certain age, you begin to naturally have more to worry about when it comes to hearing, eyesight, and chronic pain. When you add in diabetes, the serious complications can lead to pain, amputation, and even death. But there is plenty that you can do to protect yourself, from simple solutions to big-picture ideas. It’s also important to make sure that the community around you is made aware of how to handle themselves should an emergency arise. This includes your doctor, any family or close friends, and certainly a caregiver if you have one.
The Diabetes Complication That Kills More People Than Most Cancers
A foot or leg amputation is one of the most dreaded complications of diabetes. In the United States, more than sixty-five thousand such amputations occur each year.
But the tragedy does not stop there. According to recent research, about half of all people who have a foot amputation die within five years of the surgery—a worse mortality rate than most cancers. That’s partly because people with diabetes who have amputations often have poorer glycemic control and more complications such as kidney disease. Amputation also can lead to increased pressure on the remaining limb and the possibility of new ulcers and infections.
Latest development: To combat the increasingly widespread problem of foot infections and amputations, new guidelines for the diagnosis and treatment of diabetic foot infections have been created by the Infectious Diseases Society of America (IDSA).
HOW FOOT INFECTIONS START
Diabetes can lead to foot infections in two main ways—peripheral neuropathy (nerve damage that can cause loss of sensation in the feet), and ischemia (inadequate blood flow).
To understand why these conditions can be so dangerous, think back to the last time you had a pebble inside your shoe. How long did it take before the irritation became unbearable? Individuals with peripheral neuropathy and ischemia usually don’t feel any pain in their feet. Without pain, the pebble will stay in the shoe and eventually cause a sore on the sole of the foot.
Similarly, people with diabetes will not feel the rub of an ill-fitting shoe or the pressure of standing on one foot too long, so they are at risk of developing pressure sores or blisters.
These small wounds can lead to big trouble. About 25 percent of people with diabetes will develop a foot ulcer—ranging from mild to severe—at some point in their lives. Any ulcer, blister, cut, or irritation has the potential to become infected. If the infection becomes too severe to treat effectively with antibiotics, amputation of a foot or leg may be the only way to prevent the infection from spreading throughout the body and save the person’s life.
A FAST-MOVING DANGER
Sores on the foot can progress rapidly. While some foot sores remain unchanged for months, it is possible for an irritation to lead to an open wound (ulcer), infection, and amputation in as little as a few days. That is why experts recommend that people with diabetes seek medical care promptly for any open sore on the feet or any new area of redness or irritation that could possibly lead to an open wound.
Important: Fully half of diabetic foot ulcers are infected and require immediate medical treatment and sometimes hospitalization.
Don’t try to diagnose yourself—diagnosis requires a trained medical expert. An ulcer that appears very small on the surface could have actually spread underneath the skin, so you very well could be seeing just a small portion of the infection.
WHAT YOUR DOCTOR WILL DO
The first step is to identify the bacteria causing the infection. To do this, physicians collect specimens from deep inside the wound. Once the bacteria have been identified, the proper antibiotics can be prescribed.
Physicians also need to know the magnitude of the infection—for example, whether there is bone infection, abscesses, or other internal problems. Therefore, all diabetes patients who have new foot infections should have X-rays. If more detailed imaging is needed, an MRI or a bone scan may be ordered.
The doctor will then classify the wound and infection as mild, moderate, or severe and create a treatment plan.
HOW TO GET THE BEST TREATMENT
Each person’s wound is unique, so there are no cookie-cutter treatment plans. However, most treatment plans should include the following:
•A diabetes foot-care team. For moderate or severe infections, a team of experts should coordinate treatment. This will be done for you—by the hospital or your primary care physician. The number of specialists on the team depends on the patient’s specific needs but may include experts in podiatry and vascular surgery. In rural or smaller communities, this may be done via online communication with experts from larger hospitals (telemedicine).
•Antibiotic treatment. Milder infections usually involve a single bacterium. Antibiotics will typically be needed for about one week. With more severe infections, multiple bacteria are likely involved, so you will require multiple antibiotics, and treatment will need to continue for a longer period—sometimes four weeks or more if bone is affected.
If the infection is severe or even moderate but complicated by, say, poor blood circulation, hospitalization may be required for a few days to a few weeks, depending on the course of the recovery.
•Wound care. Many patients who have foot infections receive antibiotic therapy only, which is often insufficient. Proper wound care is also necessary. In addition to frequent wound cleansing and dressing changes, this may include surgical removal of dead tissue (debridement) and the use of specially designed shoes or shoe inserts—provided by a podiatrist—to redistribute pressure off the wound (off-loading).
•Surgery. Surgery doesn’t always mean amputation. It is sometimes used not only to remove dead or damaged tissue or bone but also to improve blood flow to the foot.
If an infection fails to improve: The first question physicians know to ask is: “Is the patient complying with wound care instructions?” Too many patients lose a leg because they don’t take their antibiotics as prescribed or care for the injury as prescribed.
Never forget: Following your doctors’ specific orders could literally mean the difference between having one leg or two.
›James M. Horton, MD, chair of the Standards and Practice Guidelines Committee of the Infectious Diseases Society of America, www.idsociety.org. Dr. Horton is also chief of the department of infectious disease and attending faculty physician in the department of internal medicine, both at Carolinas Medical Center in Charlotte, North Carolina.
Foot Care Is Critical If You Have Diabetes
To protect yourself from foot injuries:
•Never walk barefoot, even around the house.
•Don’t wear sandals—the straps can irritate the side of the foot.
•Wear thick socks with soft leather shoes. Leather is a good choice because it breathes, molds to the feet, and does not retain moisture. Laced-up shoes with cushioned soles provide the most support.
In addition, pharmacies carry special diabetic socks that protect and cushion your feet without cutting off circulation at the ankle. These socks usually have no seams that could chafe. They also wick moisture away from feet, which reduces risk for infection and foot ulcers.
•See a podiatrist. This physician can advise you on the proper care of common foot problems, such as blisters, corns, and ingrown toenails. A podiatrist can also help you find appropriate footwear—even if you have foot deformities.
Ask your primary care physician or endocrinologist for a recommendation, or consult the American Podiatric Medical Association.
Also: Inspect your feet every day. Otherwise, you may miss a developing infection. Look for areas of redness, blisters, or open sores, particularly in the areas most prone to injury—the bottoms and bony inner and outer edges of the feet.
If you see any sign of a sore, seek prompt medical care. You should also see a doctor if you experience an infected or ingrown toenail, callus formation, bunions or other deformity, fissured (cracked) skin on your feet, or you notice any change in sensation.
›James M. Horton, MD, chair of the Standards and Practice Guidelines Committee of the Infectious Diseases Society of America, www.idsociety.org. Dr. Horton is also chief of the department of infectious disease and attending faculty physician in the department of internal medicine, both at Carolinas Medical Center in Charlotte, North Carolina.
If You Have Diabetes, a Joint Replacement, or Arthritis
When most people think of bone problems, broken bones and osteoporosis (reduced bone density and strength) come to mind. But our bones also can be the site of infections that can sometimes go unrecognized for months or even years.
This is especially the case if the only symptoms of bone infection (a condition known as osteomyelitis) are ones that are commonly mistaken for common health problems, such as ordinary back pain or fatigue.
ARE YOU AT RISK?
Older adults (age seventy and older), people with diabetes or arthritis, and anyone with a weakened immune system (due to chronic disease, such as cancer, for example) are among those at greatest risk for osteomyelitis.
Anyone who has an artificial joint (such as a total hip replacement or total knee replacement) or metal implants attached to a bone also is at increased risk for osteomyelitis and should discuss the use of antibiotics before any type of surgery, including routine dental and oral surgery. Bacteria in the mouth can enter the bloodstream and cause a bone infection.
TYPES OF BONE INFECTIONS
Before the advent of joint-replacement surgery, most bone infections were caused by injuries that expose the bone to bacteria in the environment (such as those caused by a car accident) or a broken bone or an infection elsewhere in the body, such as pneumonia or a urinary tract infection, that spreads to the bone through the bloodstream.
Now: About half the cases of osteomyelitis are complications of surgery in which large metal implants are used to stabilize or replace bones and joints (such as in the hip or knee).
Osteomyelitis is divided into three main categories, depending on the origin of the infection:
•Blood-borne osteomyelitis occurs when bacteria that originate elsewhere in the body migrate to and infect bone. People with osteoarthritis or rheumatoid arthritis are prone to blood-borne infections in their affected joints due to injury to cells in the lining of the joints that normally prevent bacteria from entering the bloodstream.
•Contiguous-focus osteomyelitis occurs when organisms—usually bacteria, but sometimes fungi—infect bone tissue. These cases usually occur in people with diabetes, who often develop pressure sores on the soles of their feet or buttocks due to poor circulation and impaired immunity.
•Post-traumatic osteomyelitis occurs after trauma or surgery to a bone and/or surrounding tissue opens the area to bacteria and other microbes. The use of prosthetic joints, surgical screws, pins, or plates also makes it easier for bacteria to enter and infect the bone.
Important: Any of the three types of bone infections described above can lead to chronic osteomyelitis, an initially low-grade infection that can persist for months or even years with few or no symptoms. Eventually, it gets severe enough to literally destroy bone. Left untreated, the affected bone may have to be amputated.
DIFFICULT TO DIAGNOSE
When osteomyelitis first develops (acute osteomyelitis), the symptoms—such as pain, swelling, and tenderness—are usually the same as those caused by other infections.
If the initial infection is subtle (low-grade) or doesn’t resolve completely with treatment, it can result in chronic osteomyelitis. In this case, you may have no symptoms or symptoms that are nonspecific. For example, someone who has had surgery might blame discomfort on delayed recovery, not realizing that what they have is a bone infection.
Surprising finding: When we studied the histories of more than two thousand osteomyelitis patients, we found that most of those with chronic infections had relatively little pain from the infection itself. About 28 percent of those who required surgery for infection had normal white blood cell counts—suggesting that, over time, the body adjusts to lingering infections.
If a doctor suspects that you may have osteomyelitis because of chronic pain, swelling, possibly fever, fatigue, or other symptoms, he/she will usually order special laboratory tests that detect the formation of antibodies. If the results indicate the presence of infection, he may then order an X-ray or magnetic resonance imaging (MRI) scan. These and other imaging tests can readily detect damaged bone tissue and reveal the presence of infection.
BEST TREATMENT OPTIONS
About 60 to 70 percent of people with acute osteomyelitis can be cured with antibiotics (or antifungal agents, if a fungal infection is present) if treatment begins early enough to prevent the infection from becoming chronic. In these cases, patients exhibit symptoms, test positive for infection, and readily respond to drug treatments. Most patients can be cured with a four- to six-week course of antibiotics. Fungal infections are more resistant to treatment—antifungal drugs may be needed for several months.
For chronic osteomyelitis, surgical debridement (the removal of damaged tissue and bone using such instruments as a scalpel or scissors) is usually necessary.
Reasons: Damaged bone can lose its blood supply and remain in the body as “dead bone”—without living cells or circulation. Such bone is invulnerable to the effects of antibiotics.
After debridement, the surgeon may insert a slow-release antibiotic depot, a small pouch that releases the antibiotic for up to a month. This approach can increase drug concentrations up to one hundred times more than oral antibiotic therapy.
Even with these treatments, in people with chronic osteomyelitis who are otherwise healthy, up to 6 percent may require a second or even a third operation to cure the infection. In people with diabetes or other disorders, the percentage may be as high as 25 percent.
To improve your chances of a full recovery from chronic osteomyelitis: Eat well, maintain healthy blood sugar levels, stay active after treatment (to promote blood circulation, prevent blood clots, and help maintain an appetite), and don’t use tobacco products.
›George Cierny, MD, and Doreen DiPasquale, MD, physician-partners at REOrthopaedics in San Diego. Dr. Cierny was an international lecturer in orthopedic surgery who published more than one hundred scientific papers and book chapters in the field of musculoskeletal pathology and infection. Dr. DiPasquale, an orthopedic surgeon, was residency program director at George Washington University in Washington, DC, and National Naval Medical Center in Bethesda, Maryland.
Natural Cures for Painful Neuropathy
Peripheral neuropathy may be one of the most common conditions you’ve never heard of—and it is indeed common. Estimates are that it affects as many as two-thirds of people with diabetes, 10 to 20 percent of people with cancer, and 8 percent of all people over age fifty-five. One reason may be that neuropathy is not an isolated medical condition. Rather, it results from other medical problems including vitamin deficiencies, autoimmune disorders, and heavy metal exposure, in addition to diabetes and cancer. Symptoms generally come on gradually over a period of weeks or even months, starting in the toes and sometimes the fingers. They include burning and tingling sensations, numbness, and occasional sharp, sudden pains similar to electrical shocks. Intensity of symptoms varies widely, from mild annoyance to numbness severe enough to impair function to debilitating pain.
MEDICAL TREATMENTS
Mainstream medical doctors often treat peripheral neuropathy with pharmaceutical drugs, but they all have serious side effects, including dizziness, sleepiness, dry mouth, blurred vision, weight gain, nausea, headache, and in serious cases, allergic reaction and confusion, among others.
Given the problems with pharmaceuticals, it’s good to be aware about natural approaches to the problem. The first step is to find the root cause and correct it as much as possible. For example, people with diabetes must control blood sugar levels to help slow further peripheral neuropathy development. People who suspect vitamin deficiencies should see a holistic physician for blood level tests and to help them establish a healthy diet and vitamin protocol. They must also avoid or greatly reduce alcohol consumption. Those having chemotherapy should alert the supervising doctor immediately if numbness or tingling starts in their feet or hands. The doctor may be able to alter the drugs somewhat to keep the neuropathy from escalating. However, when chemo-related peripheral neuropathy begins weeks or even months after completion of chemotherapy—as is often the case—the next step is to seek treatment to alleviate the discomfort and possibly help reduce or even heal it. This advice holds true for other causes of peripheral neuropathy as well, although you should check with your doctor to be sure it is appropriate for you.
NATURAL APPROACHES
The natural substance with the longest record for helping both diabetic peripheral neuropathy and chemotherapy-induced peripheral neuropathy is alpha-lipoic acid, a powerful antioxidant that scavenges many harmful free radicals. (Note: Alpha-lipoic acid can reduce blood sugar levels, so your doctor should monitor your medication and blood sugar for the duration.) It’s not a quick solution however—you should wait eight to twelve weeks before assessing results. The other natural substance I recommend is acetyl-L-carnitine, which has a regenerative effect on the nerves. Again, stay on acetyl-L-carnitine therapy for eight to twelve weeks to assess its efficacy. To further reduce nerve irritation, I often prescribe a vitamin B complex including B-12, as well as vitamins E and C, selenium, and Pycnogenol, a plant-derived substance that has antioxidant, anti-inflammatory, and other powerful properties. Injections or sublingual doses of vitamins B-12 and B-1, which you can get from your doctor, are also helpful.
ACUPUNCTURE
Acupuncture is an increasingly popular treatment for peripheral neuropathy, in particular that caused by chemotherapy. Yi Hung Chan, LAc, DPM, is a staff member at the Bendheim Integrative Medicine Center of the Memorial Sloan-Kettering Cancer Center in New York City. Dr. Chan treats many neuropathy patients, some of whom are still in chemo and others who develop peripheral neuropathy after chemo completion. To attain the greatest relief, he recommends starting acupuncture treatment at the first sign of symptoms—early intervention helps to avoid full-blown neuropathy and may reverse symptoms. In his clinical practice, Dr. Chan has found that about 80 percent of patients show substantial improvement after eight to twelve sessions of treatment.
Patients start acupuncture with one to two appointments per week. Those still in chemotherapy continue acupuncture sessions for about six weeks after completion of cancer treatment and taper off from there. When peripheral neuropathy begins after chemo, Dr. Chan recommends one to two sessions per week for six or so months with occasional follow-up sessions after that. Although Dr. Chan’s experience is mostly with chemo-related peripheral neuropathy, he notes that in a small study of seven individuals with diabetes, done at Harvard in 2007, acupuncture eased their neuropathy pain as well.
HEALTHY HABITS
All people with peripheral neuropathy should maintain a healthy lifestyle and keep their weight normal to lessen pressure on the feet. A regular practice of meditation, yoga, or any other calming technique helps provide relaxation when neuropathy flares. Other ways to increase comfort are to keep the feet warm, wear soft-leather shoes with good support, and sleep with light blankets to avoid pressure on sensitive feet. Though some people are unable to obtain full relief from peripheral neuropathy, there is fortunately much you can do to make it bearable.
›Mark A. Stengler, NMD, a naturopathic medical doctor and leading authority on the practice of alternative and integrated medicine. Dr. Stengler is author of the Health Revelations newsletter, The Natural Physician’s Healing Therapies, and Bottom Line’s Prescription for Natural Cures. He is also the founder and medical director of the Stengler Center for Integrative Medicine in Encinitas, California, and former adjunct associate clinical professor at the National College of Natural Medicine in Portland, Oregon. MarkStengler.com.
Vitamin B-12—Better Than a Drug for Diabetic Neuropathy
Twenty-five percent of people with diabetes develop diabetic neuropathy—glucose-caused damage to nerves throughout the body, particularly in the hands, arms, feet, and legs (peripheral neuropathy).
You experience tingling and prickling. Numbness. And pain—from annoying, to burning, to stabbing, to excruciating. Drugs hardly help.
“Many studies have been conducted on drugs for diabetic neuropathy, and no drug is really effective,” says Anne L. Peters, MD, professor of medicine and director of the University of Southern California Westside Center for Diabetes and author of Conquering Diabetes.
But a new study says a vitamin can help.
LESS PAIN AND BURNING
Researchers in Iran studied one hundred people with diabetic neuropathy, dividing them into two groups. One group received nortriptyline, an antidepressant medication that has been used to treat neuropathy. The other group received vitamin B-12, a nutrient known to nourish and protect nerves.
After several weeks of treatment, the B-12 group had:
•78 percent greater reduction in pain
•71 percent greater reduction in tingling and prickling
•65 percent greater reduction in burning
“Vitamin B-12 is more effective than nortriptyline for the treatment of painful diabetic neuropathy,” conclude the researchers in the International Journal of Food Science and Nutrition.
Latest development: A few months after the Iranian doctors conducted their study, research in the United States involving seventy-six people with diabetes showed that the widely prescribed diabetes drug metformin may cause vitamin B-12 deficiency—and that 77 percent of those with the deficiency also suffered from peripheral neuropathy!
Anyone already diagnosed with peripheral neuropathy who uses metformin should be tested for low blood levels of B-12, says Mariejane Braza, MD, of the University of Texas Health Science Center and the study leader. If B-12 levels are low, she recommends supplementing with the vitamin, to reduce the risk of nerve damage.
HEAL THE NERVES
“If you take metformin, definitely take at least 500 mcg a day of vitamin B-12, in either a multivitamin or B-complex supplement,” advises Jacob Teitelbaum, MD, author of Pain-Free 1-2-3! “It’s the single, most effective nutrient for helping prevent and reverse diabetic neuropathy.
“On a good day, the best that medications can do for neuropathy is mask the pain,” he continues. “But vitamin B-12 gradually heals the nerves.”
Best: If you already have neuropathy, Dr. Teitelbaum recommends finding a holistic physician and asking for fifteen intramuscular injections of 3,000 to 5,000 mcg of methylcobalamin, the best form of B-12 to treat peripheral neuropathy. “Receive those shots daily to weekly—at whatever speed is convenient to quickly optimize levels of B-12,” says Dr. Teitelbaum.
Resource: To find a holistic physician, Dr. Teitelbaum recommends visiting the website of the American Board of Integrative Holistic Medicine, www.abihm.org.
If you can’t find a holistic physician near you, he suggests taking a daily sublingual (dissolving under the tongue) dose of 5,000 mcg for four weeks. (Daily, because you only absorb a small portion of the sublingual vitamin B-12, compared with intramuscular injections.)
At the same time that you take B-12, also take a high-dose B-complex supplement (B-50). “The body is happiest when it gets all the B-vitamins together,” says Dr. Teitelbaum.
He points out that it can take three to twelve months for nerves to heal, but that the neuropathy should progressively improve during that time.
Also helpful: Other nutrients that Dr. Teitelbaum recommends to help ease peripheral neuropathy include:
•Alpha-lipoic acid (300 mg, twice a day)
•Acetyl-l-carnitine (500 mg, three times a day)
›Anne L. Peters, MD, professor of medicine and director of the University of Southern California Westside Center for Diabetes and author of Conquering Diabetes.
›Mariejane Braza, MD, researcher, University of Texas Health Science Center, and internist, Valley Baptist Medical Center, Harlingen, Texas.
›Jacob Teitelbaum, MD, author of Pain-Free 1-2-3! and From Fatigued to Fantastic!EndFatigue.com.
Help for Diabetic Foot Ulcers
Diabetic foot ulcers can be healed by acne medication.
Recent finding: In a study of twenty-two men with diabetes, more than 84 percent of ulcers treated with topical tretinoin, a popular acne medication, and antibacterial cadexomer iodine gel shrunk by at least half. In the group treated with a placebo solution and cadexomer iodine gel, 45.4 percent of ulcers shrunk by half.
Theory: Tretinoin stimulates blood vessel growth, which helps deliver oxygen to the wound site. Left untreated, diabetic ulcers may increase risk for amputation.
›Wynnis Tom, MD, assistant clinical professor of medicine, University of California, San Diego.
Better Foot Care with Charcot
Charcot foot (a condition in which bones in the foot weaken and break) is common in people with diabetes and/or peripheral neuropathy. They may have a loss of feeling in the feet due to nerve damage and are sometimes unaware that they have Charcot foot until it causes severe deformities.
If you have diabetes and/or peripheral neuropathy: See a podiatrist or orthopedic surgeon to be monitored for Charcot foot, which can be treated with surgery and/or specialized footwear. Warning signs include sudden swelling or pain of the foot and/or leg.
›Valerie L. Schade, DPM, FACFAS, podiatric surgeon, Tacoma, Washington.
Toenail Fungus Trouble…and a Unique Cure
When is the last time you took a good look at your toenails? If it has been a while, you may be in for an unpleasant surprise—in fungal form. Toenail fungus infection, also called onychomycosis, is a common condition that turns nails a yellow or brown color. In some cases, the nail thickens or splits and may fall off. Sufferers may experience pain around the nail and notice a foul smell. The infection is typically caused by any one of several types of fungi that feed on keratin, the protein surface of the nail. Occasionally, different yeasts and molds may cause the infection.
By age seventy, almost half of Americans have had at least one affected toe. While the infection can occur in fingernails, it most often affects toenails, because feet are confined to the dark, warm environment of shoes, where fungi can thrive. The nails of the big toe and little toe are particularly susceptible, because friction from the sides of shoes can cause trauma to the nail surface, making it easier for fungi to penetrate. Nail fungus is not the same as athlete’s foot—because athlete’s foot affects the skin rather than the nail itself—but the two conditions may coexist and can be caused by the same type of fungus.
I find that athletes and others who commonly use gym locker rooms and showers are more likely to develop toenail fungus due to the damp floors and shared environment. Women who wear toenail polish are at increased risk because moisture can get trapped beneath the polish. Tight-fitting shoes and hosiery that rub the toenails also contribute to the problem. People with diabetes and other circulation problems that prevent infection-fighting white blood cells from adequately reaching the toes are particularly susceptible to the fungus, as are people with compromised immune systems, such as those with cancer or HIV.
Toenail fungus doesn’t usually clear up on its own. In fact, it tends to get more severe over time, affecting a larger portion of the nail and spreading to adjacent toes and to the other foot. Therefore, I recommend starting treatment as early as possible.
CONVENTIONAL TREATMENTS
Medical doctors generally turn to topical and oral antifungal treatments. For mild cases that involve a small area of the nail, a medicated nail polish containing an antifungal agent, such as ciclopirox, is often prescribed. For toenail fungus that covers a large portion of a nail or affects several nails, the typical medical approach is to prescribe oral antifungal medications, such as itraconazole or terbinafine. These are quite powerful medications and may need to be taken for up to twelve weeks until the infection clears up. In 10 to 20 percent of cases, the fungus returns within several months.
The most worrisome side effect of oral antifungals is liver damage. To monitor the effect of these medications, liver enzyme tests should be performed before beginning treatment and every four to six weeks during treatment. An elevation in liver enzymes means that the drugs are irritating the liver and need to be discontinued. Several patients who were being treated by other doctors have come to see me after elevated liver enzymes forced them to stop this pharmaceutical treatment. As a last resort, the nail can be surgically removed, at which point the infection will clear up, and the nail will slowly grow back.
AN UNUSUAL CURE
The typical natural treatment for toenail fungus is to apply tea tree oil or oregano oil. Using a cotton swab, apply nightly to the affected area, continuing treatment for eight to twelve weeks. These oils work well to clear up mild toenail fungus, but they are often not strong enough for moderate to severe cases. There is an unusual yet effective therapy for severe toenail fungus developed by Mark Cooper, ND, an innovative naturopathic doctor. Years ago, Dr. Cooper treated an HIV-positive patient who commented on an article he had read stating that bleach killed HIV on surfaces (not in the body). Knowing that hospital bedsheets and floor surfaces are washed with bleach to kill all types of fungi, viruses, and bacteria, Dr. Cooper theorized that bleach might also kill toenail fungus and clear up persistent cases of infection.
Dr. Cooper, who practices at Alpine Naturopathic Clinic in Colorado Springs, has treated hundreds of his patients with this topical bleach treatment. My patients have responded very well to it too.
How it works: Mix one cup of household bleach with ten cups of warm water. Soak the toes of the affected foot for three minutes, then thoroughly rinse off the bleach solution with water and dry the feet completely. Do this twice weekly, with three days between treatments. Most cases resolve in two to three months. Severe cases may take longer.
Boosting the strength of the bleach-and-water mixture beyond the one-to-ten ratio will not increase the effectiveness of the treatment, and it could irritate the skin. Nor is it wise to increase the frequency or duration of treatments. Dr. Cooper told me about a seventy-four-year-old man who misunderstood the directions—instead of soaking his toes for three minutes, he tried to soak them for thirty minutes. The burning pain was so intense that he had to stop the soaking after twenty minutes. Obviously, this treatment needs to be used with caution and should not be used when there is an open wound near the infection site.
Interesting: Bleach is composed of sodium hypochlorite (NaOCl). Household bleach usually contains 3 to 6 percent NaOCl, while industrial-strength bleach contains 10 to 12 percent. Near the end of the nineteenth century, after Louis Pasteur discovered its powerful effectiveness against disease-causing bacteria, bleach became popular as a disinfectant. It is still used today for household cleaning, removing laundry stains, treating waste water, sterilizing medical equipment, and disinfecting hospital linens and surfaces.
FUNGUS-FIGHTING FOODS AND SUPPLEMENTS
Dr. Cooper explains that the topical bleach treatment is even more effective when combined with an antifungal diet. Avoid simple sugars (white breads, pastas, cookies, and soda) and alcohol—they suppress immune function and contribute to fungal growth. Eat raw or cooked onions, shallots, and leeks, plus garlic (as a food or an extract) as often as possible for their antifungal action.
I also have found that severe cases of toenail fungus, especially in people with diabetes, clear up more quickly when natural antifungal supplements are taken orally. The most potent is oregano oil. It contains plant compounds, such as carvacrol and thymol, that have strong antifungal properties. I recommend taking three doses daily for four to eight weeks. Each dose equals one 500-mg capsule or five to fifteen drops of the liquid form mixed with two to four ounces of water. Some people may experience heartburn from oregano oil, so if you are prone to heartburn, you may need to reduce the dosage. Oregano oil should not be ingested by people with active stomach ulcers (since it can irritate the stomach lining) or by pregnant or nursing women (as a general precaution). It should be given to children only under the guidance of a doctor.
How will you know when the fungal infection is gone? When the discolored nail returns to its normal hue or when the damaged nail grows out and a new nail grows in normally.
FUNGUS PREVENTION STRATEGIES
•Wash your feet every day using calendula soap. Made from the marigold plant, it is gentle yet antiseptic. Find it in health-food stores.
•Always dry feet thoroughly with a clean towel. Do not share towels with other people.
•Keep toenails clipped short to reduce the protein surface on which fungi feed.
•Avoid going barefoot in public places. Wear plastic sandals in community showers and locker rooms and at poolside.
•Choose socks made of breathable fabrics, such as cotton. Change socks immediately after exercising and whenever feet perspire.
•Be sure your shoes are not too tight. If shoes get damp, change them promptly.
›Mark A. Stengler, NMD, a naturopathic medical doctor and leading authority on the practice of alternative and integrated medicine. Dr. Stengler is author of the Health Revelations newsletter, The Natural Physician’s Healing Therapies, and Bottom Line’s Prescription for Natural Cures. He is also the founder and medical director of the Stengler Center for Integrative Medicine in Encinitas, California, and former adjunct associate clinical professor at the National College of Natural Medicine in Portland, Oregon. MarkStengler.com.
Free Yourself from Chronic Pain
Talk about piling on—many people who are chronically ill, for instance with diabetes or cancer or who have suffered a traumatic injury, ultimately end up with a condition called neuropathy, where their nervous systems turn against them, randomly sending out pain signals that can range from tingling that is merely uncomfortable to stabbing sensations so painful that they are debilitating. Opioids and antidepressants can help, but these drugs have side effects that can make them less-than-great choices. Acupuncture can be helpful too, but generally speaking, treatment is not all that effective.
So here’s information from a recent study that’s good news, even though the study was very small, did not include a control group, and the treatment worked for only about one-third of the patients who tried it. New research evaluated the use of a therapy called transcutaneous electrical nerve stimulation (TENS) in people with neuropathy as the result of a spinal cord injury. This form of treatment involves placing electrodes (attached to a battery pack) on the skin along both sides of the spine at the level of and just above the spinal cord injury to deliver electrical current. The same technique has been used to treat other forms of chronic pain and muscle spasms.
SHOCKING BUT EFFECTIVE
Twenty-four patients were given TENS units and taught to self-administer the treatment three times a day for thirty to forty minutes at a time. They did this for two weeks at high frequency and then for another two weeks at low frequency.
Results: About one-third of the patients reported pain was reduced at least somewhat—29 percent were helped by high-frequency stimulation and 38 percent by low-frequency stimulation. But what I thought was most notable about this study was that six patients—one-quarter of those who tried this therapy—asked if they could keep their TENS units so they could continue the treatments themselves at home. Clearly, they experienced some benefit.
To those who’ve never tried it, TENS may sound more like torture than treatment—after all, you’d think that stimulating nerves that have already gone haywire would simply cause more pain. According to Cecilia Norrbrink, RPT, PhD, from the department of clinical sciences at the Karolinska Institute in Stockholm, Sweden, where the study was done, TENS is not painful, and it does work well for some people. She says scientists believe that it works by using the body’s own pain-inhibiting systems.
Her very simplified explanation: High-frequency TENS activates large nerve fibers, which are the ones carrying nonpainful signals such as touch. Stimulating these nerve fibers releases transmitter signals in the spinal cord that can inhibit the pain signals coming from small nerve fibers. Low-frequency TENS, on the other hand, seems to activate neurons in the brain stem (where inhibitory pathways start) by releasing pain-blocking endorphins.
Another option: There’s a form of Japanese acupuncture that incorporates electrical stimulation through the needles, according to contributing medical editor Andrew L. Rubman, ND. It is called electroacupuncture, and it might be a good option to explore with your acupuncturist or naturopathic doctor.
CAN YOU DO THIS AT HOME?
Side effects from the treatment are minimal—some patients experience muscle spasms, and others find the electrodes irritating to their skin. But those are minor complaints compared with the pain relief the treatments sometimes deliver. If you’re interested in exploring TENS treatment for neuropathic pain, discuss it with your doctor—there’s a long list of medical cautions that are considered contraindications for its use. If you are among the lucky ones, this might provide welcome relief.
›Cecilia Norrbrink, RPT, PhD, department of clinical sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
Say What? A Surprising Link to Hearing Loss for Women
You might expect to lose your hearing a little bit as you age, but you may be shocked by a recent study that points to a risk factor that may make hearing loss even worse. Women with this specific condition need to listen up!
Needing to turn up the volume on the TV or radio yet again, straining to catch a dinner companion’s words in a crowded restaurant, having trouble identifying background noises—it’s normal to notice an increase in such experiences as we get older.
But: This recent study has highlighted an important and often overlooked risk factor that can make age-related hearing loss among women much worse than usual—diabetes that is not well controlled.
STUDY DETAILS
Researchers reviewed the medical charts of 990 women and men who, between 2000 and 2008, had had audiograms to test their ability to hear sounds at various frequencies; participants were also scored on speech recognition. Study participants were classified by age, sex, and whether they had diabetes (and, if so, how well controlled their blood glucose levels were).
Results: Among women ages sixty to seventy-five, those whose diabetes was well controlled were able to hear about equally as well as women who did not have diabetes, but those with poorly controlled diabetes had significantly worse hearing.
For men in this specific study, there was no significant difference in hearing ability between those with and without diabetes, no matter how well controlled the disease was, though this finding could have been influenced by the fact that men generally had worse hearing than women regardless of health status. But smaller studies have shown that diabetes can have an impact on hearing, no matter what your sex (see article that follows).
NOW HEAR THIS
Are you still not convinced this is a dangerous disease? Diabetes also increases the risk for heart disease, vision loss, kidney dysfunction, nerve problems, and other serious ailments, so this recent study gives women with diabetes yet one more important motivation for keeping blood glucose levels well under control with diet, exercise, and/or medication.
If you have not been diagnosed with diabetes: If your hearing seems to be worsening, ask your doctor to check for diabetes, particularly if you have other possible warning signs, such as frequent urination, unusual thirst, slow wound healing, blurred vision, and/or numbness in the hands and feet.
›Derek J. Handzo, DO, an otolaryngology resident, and Kathleen Yaremchuk, MD, chair of the department of otolaryngology–head and neck surgery at Henry Ford Hospital in Detroit. They are coauthors of a study on diabetes and hearing loss presented at a recent Triological Society Combined Sections Meeting.
Control Your Blood Sugar…Protect Your Hearing
If you’re like most people, you probably assume that hearing loss is an inevitable part of growing older and that you can’t do anything about it other than get a hearing aid. But that’s not always true.
Most of the nearly forty million Americans who don’t hear as well as they used to have sensorineural hearing loss (SNHL)—damage to delicate, hairlike nerve endings (hair cells) in the inner ear. These tiny hair cells translate sound vibrations into electrical impulses that are sent to the brain.
While SNHL does often result from aging or loud noise (repeated exposure or a single exposure to a very loud noise, such as an explosion), it also can be due to unexpected causes such as certain health problems or even prescription or over-the-counter (OTC) drugs.
Latest development: Recent scientific research is revealing that there may be more opportunities to prevent or slow SNHL than once thought. The following are some of the surprising causes of SNHL and what you can do to prevent it.
VIAGRA AND OTHER DRUGS
There are hundreds of ototoxic drugs that can damage hearing. For example, in a study published in 2011 in Laryngoscope, researchers in the UK identified forty-seven cases in which men who took sildenafil or other drugs for erectile dysfunction experienced SNHL—and 67 percent of them developed it within twenty-four hours of starting the medication. Other ototoxic drugs include:
•Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen.
•Loop diuretics, such as furosemide used for high blood pressure, congestive heart failure, and kidney disease.
•Antidepressants, such as fluoxetine, clomipramine, and amitriptyline.
•Antianxiety medications, such as alprazolam.
•Certain antibiotics, including erythromycin, gentamicin, neomycin, and tetracycline.
•Chemotherapy drugs, such as cisplatin and carboplatin.
•Quinine-based antimalarial drugs.
Important: The hearing loss caused by these drugs may be temporary or permanent depending on factors such as dosage and the length of time the medication was taken.
Self-defense: If your doctor prescribes a new medication, ask whether it could cause hearing loss. You can also research drug side effects online at the Physicians’ Desk Reference website, www.pdrhealth.com.
If the medication can affect hearing, ask your doctor if there are alternatives that are suitable for your particular condition. If not, an audiologist should conduct hearing tests before you begin taking the medication to obtain a baseline. These tests should be repeated several times during the course of treatment with the drug.
For the greatest protection: Normally, an audiologist checks hearing in the 250- to 8,000-hertz (Hz) range, but to monitor drug-related hearing loss, it is best to examine the high-frequency range (between 9,000 and 20,000 Hz), where damage is likely to occur first.
If your hearing is affected, the prescribing physician should reconsider how best to treat the condition for which you were prescribed medication.
If you’re already taking a drug that you suspect may be causing hearing loss, see an ear, nose, and throat (ENT) specialist for advice. Also notify an ENT specialist if you develop a sense of fullness in one or both ears (which could signal hearing loss) or tinnitus (ringing, buzzing, or other unwanted sounds with or without hearing loss).
BLOOD SUGAR PROBLEMS AND HEARING LOSS
Most physicians realize that diabetes slowly destroys blood vessels throughout the body, increasing risk for heart disease, stroke, Alzheimer’s disease, chronic kidney disease, blindness, and even amputation of circulation-starved limbs. Now, hearing loss has been identified as an underrecognized complication of diabetes.
Recent research: In a study of forty-six people with type 2 diabetes and forty-seven with rheumatoid arthritis, those with diabetes had three times more cases of hearing loss than the study participants with arthritis.
Possible mechanism: Diabetes reduces circulation and causes nerve degeneration—two factors that can affect the viability of hair cells involved in hearing.
Another danger: Studies have linked obesity and high triglyceride levels—both of which often accompany diabetes—to SNHL.
To preserve your hearing: Take steps to prevent high blood sugar. Weight loss, regular exercise, and a diet that limits processed foods and emphasizes unprocessed foods (such as vegetables, fruits, whole grains, legumes, fish, lean meat, and poultry) are the best approaches to take.
RIDING IN A CONVERTIBLE AND LOUD NOISES
Most people know that loud noises such as jackhammers and explosions can damage hearing. But other causes are being discovered. For example, researchers at the St. Louis University School of Medicine tested noise levels while riding in a convertible at fifty-five miles per hour or faster with the top down and windows open. Levels were found to be above 85 decibels (dB)—the point at which hearing damage begins.
Self-defense: Avoid regularly exposing your ears to any sounds above 85 dB. To protect yourself:
•Use earplugs when you operate noisy equipment of any kind, such as a lawn mower, power saw, chain saw, snowmobile—or even your vacuum cleaner.
Also helpful: If you are in an environment where you can’t hear another person talking to you who is three feet away or closer, wear earplugs—or leave.
•Lower the volume of your iPod or other music player if you notice any signs of hearing damage, such as your ears feeling muffled or full or ringing in your ears.
ANTIOXIDANTS = BETTER HEARING
In many cases, you may be able to prevent hearing loss that could require a hearing aid by consuming an abundance of certain antioxidants.* For example:
•Coenzyme Q10 (CoQ10). In people with SNHL, those who took the powerful antioxidant CoQ10 daily experienced improved hearing, according to recent research by Italian scientists.
•Fish oil. Several studies link diets high in omega-3 fatty acids from fish to preventing or delaying age-related SNHL.
Important: I recommend using molecularly distilled fish oil (check the label)—it is less likely to contain toxins such as mercury than other fish oil products.
Also helpful: Diets rich in vitamin C, vitamin E, the B-vitamin riboflavin, magnesium, and the antioxidant lycopene were linked to better hearing, according to a recent study from researchers at Vanderbilt University in Nashville. Other nutrients that may help prevent hearing loss include resveratrol, lecithin, alpha-lipoic acid, acetyl-L-carnitine, and N-acetylcysteine.
Talk to an integrative physician for advice on the specific nutrients and dosages that would be best for you. To find an integrative physician, consult the Academy of Integrative Health and Medicine, www.aihm.org.
›Michael Seidman, MD, director of the Otolaryngology Research Laboratory and the division of otologic/neurotologic surgery and chair of the Center for Integrative Medicine at the Henry Ford Health System in Detroit. Dr. Seidman is coauthor, with Marie Moneysmith, of Save Your Hearing Now: The Revolutionary Program That Can Prevent and May Even Reverse Hearing Loss. His formulations for preventing and treating hearing loss are available at BodyLanguageVitamins.com.
Alzheimer’s: Is It “Type 3” Diabetes?
For years, scientists from around the world have investigated various causes of Alzheimer’s disease. Cardiovascular disease factors, such as hypertension, stroke and heart failure; other neurological diseases, such as Parkinson’s disease; accumulated toxins and heavy metals, such as aluminum, lead, and mercury; nutrient deficiencies, including vitamins B and E; infections, such as the herpes virus and the stomach bacterium H. pylori; and head injuries have each been considered at one time or another to be a possible contributor to the development of this mind-robbing disease.
However, as researchers continue to piece together the results of literally thousands of studies, one particular theory is now emerging as perhaps the most plausible and convincing of them all in explaining why some people—and not others—develop Alzheimer’s disease.
A PATTERN EMERGES
Five million Americans are now living with Alzheimer’s, and the number of cases is skyrocketing. Interestingly, so are the rates of obesity, diabetes, and metabolic syndrome (a constellation of risk factors including elevated blood sugar, high blood pressure, abnormal cholesterol levels, and abdominal fat).
What’s the potential link? Doctors have long suspected that diabetes increases risk for Alzheimer’s. The exact mechanism is not known, but many experts believe that people with diabetes are more likely to develop Alzheimer’s because their bodies don’t properly use blood sugar (glucose) and the blood sugar–regulating hormone insulin.
Now research shows increased dementia risk in people with high blood sugar—even if they do not have diabetes. A problem with insulin appears to be the cause. How does insulin dysfunction affect the brain? Neurons are starved of energy, and there’s an increase in brain cell death, DNA damage, inflammation, and the formation of plaques in the brain—a main characteristic of Alzheimer’s disease.
AN ALZHEIMER’S-FIGHTING REGIMEN
Even though experimental treatments with antidiabetes drugs that improve insulin function have been shown to reduce symptoms of early Alzheimer’s disease, it is my belief, as an integrative physician, that targeted nondrug therapies are preferable in preventing the brain degeneration that leads to Alzheimer’s and fuels its progression. These approaches won’t necessarily reverse Alzheimer’s, but they may help protect your brain if you are not currently fighting this disease or help slow the progression of early-stage Alzheimer’s.
My advice includes:
•Follow a low-glycemic (low-sugar) diet. This is essential for maintaining healthy glucose and insulin function as well as supporting brain and overall health. An effective way to maintain a low-sugar diet is to use the glycemic index (GI), a scale that ranks foods according to how quickly they raise blood sugar levels.
Here’s what happens: High-GI foods (such as white rice, white potatoes, and refined sugars) are rapidly digested and absorbed. As a result, these foods cause dangerous spikes in blood sugar levels.
Low-GI foods (such as green vegetables, fiber-rich foods including whole grains, and plant proteins including legumes, nuts, and seeds) are digested slowly, so they gradually raise blood sugar and insulin levels. This is critical for maintaining glucose and insulin function and controlling inflammation.
Helpful: www.glycemicindex.com gives glucose ratings of common foods and recipes.
•Consider trying brain-supporting nutrients and herbs.* These supplements, which help promote insulin function, can be used alone or taken together for better results (dosages may be lower if supplements are combined due to the ingredients’ synergistic effects).
›Alpha-lipoic acid is an antioxidant shown to support insulin sensitivity and protect neurons from inflammation-related damage.
Typical dosage: 500 to 1,000 mg per day.
›Chromium improves glucose regulation.
Typical dosage: 350 to 700 mcg per day.
›Alginates from seaweed help reduce glucose spikes and crashes.
Typical dosage: 250 to 1,000 mg before meals.
›L-Taurine, an amino acid, helps maintain healthy glucose and lipid (blood fat) levels.
Typical dosage: 1,000 to 2,000 mg per day.
KICK UP YOUR HEELS!
Regular exercise, such as walking, swimming, and tennis, is known to improve insulin function and support cognitive health by increasing circulation to the brain. Dancing, however, may be the ultimate brain-protective exercise. Why might dancing be better than other brain-body coordination exercises, such as tennis? Because dancing is mainly noncompetitive, there isn’t the added stress of contending with an opponent, which increases risk for temporary cognitive impairment.
Best: Aerobic dances with a social component, such as Latin, swing, or ballroom, performed at least three times weekly for ninety minutes each session. (Dancing for less time also provides some brain benefits.) If you don’t like dancing, brisk walking for thirty minutes a day, five days a week, is also shown to help protect the brain against dementia.
Free courses: In addition to getting regular physical activity, it’s helpful to learn challenging new material to exercise the brain. For free online lectures provided by professors at top universities such as Stanford and Johns Hopkins, go to openculture.com/freeonlinecourses. Subjects include art, history, geography, international relations, and biology, among many others.
›Isaac Eliaz, MD, LAc, an integrative physician and medical director of the Amitabha Medical Clinic & Healing Center in Sebastopol, California, an integrative health center specializing in chronic conditions. Dr. Eliaz is a licensed acupuncturist and homeopath and an expert in mind/body medicine. He has coauthored dozens of peer-reviewed scientific papers on natural healing. DrEliaz.org.
Blood Sugar Problems? Take Action Now to Protect Your Brain
Knowledge is power—so even though the news from a recent study on dementia is not exactly welcome, the information is indeed beneficial if it inspires people to take steps that can help keep their brains healthy. The findings are particularly important for people with diabetes, and also, surprisingly, for those with prediabetes, a condition that now affects half of Americans ages sixty-five and older.
In the study, 1,017 seniors did oral glucose tolerance tests (in which blood sugar is measured after fasting and again after consuming a sweet drink) to determine whether they had normal blood sugar levels, impaired glucose tolerance (a prediabetic condition), or diabetes. Participants were then followed for fifteen years to see who developed Alzheimer’s disease, vascular dementia (caused by blood vessel damage), or some other form of dementia.
Findings: Compared with participants who had normal blood sugar levels, those with prediabetes were 35 percent more likely to develop some type of dementia and 60 percent more likely to develop Alzheimer’s. People with diabetes fared even worse, having a 74 percent higher risk for dementia of any kind, an 82 percent higher risk for vascular dementia, and more than double the risk for Alzheimer’s.
The connection: Diabetes and prediabetes can damage blood vessels, causing inflammation and lack of blood flow to the brain, which in turn lead to brain cell death, and/or excess glucose carried through the blood vessels to the brain may allow accumulation of proteins that damage nerve cells.
Self-defense: More research is needed, but for now, maintaining good blood sugar control seems like a sensible way to reduce dementia risk. Ask your doctor about getting screened for prediabetes and diabetes, particularly if you are over age forty-five, are overweight, have high blood pressure, have a family history of diabetes, and/or have a history of diabetes during pregnancy.
If you have prediabetes: According to the American Diabetes Association, you can reduce your odds of developing diabetes by more than half by doing moderate exercise (such as brisk walking) for thirty minutes five days per week and losing 7 percent of your body weight (about fourteen pounds if you currently weigh 200 or about ten pounds if you weigh 150).
If you have diabetes: Be conscientious about controlling blood sugar through diet, exercise, and/or medication, and talk to your doctor about seeing a neurologist if you notice signs of cognitive problems, such as memory loss.
›Yutaka Kiyohara, MD, a professor in the department of environmental medicine in the Graduate School of Medical Sciences at Kyushu University in Fukuoka, Japan, and coauthor of a study on diabetes and dementia risk published in Neurology.
A Cup of Decaf May Prevent Memory Loss
When you need a boost, chances are you reach for a cup of caffeinated coffee.
And if you find that it’s helping you to remember things more vividly and think more clearly while you’re working on an important task, you probably chalk that up to the caffeine.
Well, the caffeine might help in the short term. But recent research conducted at Mount Sinai School of Medicine in New York City shows that coffee itself also may provide a long-term memory benefit—even when it’s decaf!
In fact, the study showed that drinking a certain amount of decaf over the long term might reduce the odds of developing the neurological impairment that’s associated with the early stages of Alzheimer’s disease.
This is certainly promising news for those of us who are overly sensitive to caffeine but love the taste of coffee. And it’s even more promising for people with type 2 diabetes, because they’re often told by doctors to avoid caffeine to keep their blood sugar under control, and they’re also at higher risk for Alzheimer’s disease.
COFFEE’S SECRET WEAPON
To learn more, we contacted Giulio M. Pasinetti, MD, PhD, professor of neurology and psychiatry at Mount Sinai School of Medicine and the lead researcher in the study. Before the study, Dr. Pasinetti and his team had become interested in how chlorogenic acids—types of antioxidants found in coffee, as well as in grapes, cocoa, and other foods—affect the brain. They were interested in seeing whether the positive health effects of chlorogenic acids could come from coffee without caffeine. And they wanted to analyze how decaf could affect people with type 2 diabetes, since, as mentioned earlier, people with that condition are usually advised by doctors to avoid caffeine.
Researchers used mice in the study, because they could completely control what they ate. They gave the mice a high-fat diet that triggered the onset of type 2 diabetes. At the same time, they fed half of the mice a daily extract of decaffeinated coffee made from unroasted coffee beans.
WHAT THE DECAF DID
What they found? The decaf-drinking mice’s brains used 25 percent more oxygen—meaning that these mice were less likely to experience neurological impairment. Researchers suspect that the chlorogenic acids in decaf are the reason for this result.
WILL IT TRANSLATE TO HUMANS?
Of course, just because decaf helps mouse brains doesn’t necessarily mean that it helps human brains, but Dr. Pasinetti is hopeful, because a great deal of previous medical research using mice has, in fact, been followed by similar results in humans. (That’s a big reason mice are so often used in research.)
How much might humans consume to get a similar benefit? Dr. Pasinetti recommends asking your doctor about taking a daily supplement that contains 400 mg extract of decaf green (aka “unroasted”) coffee. (Dr. Pasinetti used an extract called Svetol, which can be found at www.swansonvitamins.com. A month’s supply costs ten dollars.) Or drink the equivalent (two cups of decaf per day), but Dr. Pasinetti says that roasting coffee beans sucks out some of the beneficial chlorogenic acids, so the benefit would not be as much as from the extract.
Another question is whether the results would be the same with regular (caffeinated) coffee. “Since we suspect that the benefits come from the chlorogenic acids in the coffee itself—and not the caffeine—caffeinated coffee is likely to prevent neurological impairment too,” says Dr. Pasinetti. “Other foods rich in chlorogenic acids, such as grapes and cocoa, are also likely to have similar benefits, but more research needs to examine that.”
›Giulio M. Pasinetti, MD, PhD, professor of neurology and psychiatry, Mount Sinai School of Medicine, New York City, and lead researcher of a study reported in Nutritional Neuroscience.
Statins Can Help Diabetes Complications
In addition to lowering risk for heart attack and stroke, statins lowered risk for diabetes complications, according to a recent finding. People with diabetes taking statins were 34 percent less likely to be diagnosed with diabetes-related nerve damage (neuropathy), 40 percent less likely to develop diabetes-related damage to the retina, and 12 percent less likely to develop gangrene than diabetics not taking statins.
›Børge G. Nordestgaard, MD, DMSc, chief physician at Copenhagen University Hospital, Herlev, Denmark, and leader of a study of sixty thousand people, published in The Lancet Diabetes & Endocrinology.
Remedies for Edema: Swollen Feet, Swollen Ankles, Swollen Hands, and the Rest of You
If you are someone who puffs up with water retention in the warm weather, the prospect of cooler days might be a relief (although damp, heavy weather can make you swell up too). Or you may be someone whose calves, ankles, and feet are often a little “cushiony” with water retention despite the weather. They may be so cushiony that they dimple when you press into them. That kind of swelling can be painful too—and it can be a sign of a serious health problem, even a medical emergency. But for most people who deal with limb swelling—men and women alike—it is simply a recurring nuisance that a doctor may or may not be able to diagnose. Here are some surefire remedies to soothe the swelling and also advice for when limb swelling might be life-threatening.
WHY WE SWELL
Swelling caused by fluid buildup is called edema (pronounced ih-DEE-mah). When it affects only your arms, legs, hands, and feet, it is called peripheral edema. We retain water because blood vessels in our arms, legs, hands, and feet expand or dilate. This dilation can be caused by hot or humid weather or a number of other causes. The dilation makes it easier for fluid to leak out of blood vessels into surrounding tissue, causing the tissue to swell. Sitting or standing in one position for a long time without moving makes the swelling worse because gravity just pulls all that fluid down to pool in your hands, legs, and feet.
RELIEF FOR SWOLLEN LIMBS
Besides weather-related effects on blood vessels, the reason why some people swell can’t always be figured out, but common disease-related causes of swelling are kidney and cardiovascular disease. Whether a doctor can or cannot pinpoint the cause of peripheral edema, he or she too often prescribes a diuretic and suggests that you cut back on salt.
Although cutting back on salt may be great advice, taking a diuretic may not be unless the swelling is related to high blood pressure or high blood pressure medication. But there are safe, natural ways to relieve swelling, including the following:
•Leg elevation. Keep your legs elevated while sitting for prolonged periods. Yes, put a comfy, compact ottoman under your desk, or put your legs up and rest your feet on that extra chair. Also, prop your feet up on a few pillows while lying on the sofa or in bed. Don’t just bear with swelling, because if it happens often, it can cause your skin and tissue to stretch and change. It can also lead to more serious and lasting edema.
•Walking breaks. If you really can’t plop your feet up on a chair in a place where you regularly spend time—such as in an office or another noncasual setting—then make a point of getting up from the chair and taking five-minute walking breaks every hour or so. This increases circulation and gets your lymphatic system to pump out excess fluid.
•Compression stockings. If you need to stand for a long time during the day, wear support hose or compression knee-highs or stockings. These help blood circulation between your feet and your heart, with one benefit being more spring in your step. In fact, athletes often use compression stockings to enhance their performance.
Compression stockings come in many styles and colors, price ranges (from about ten to one hundred dollars), sizes, and pressures. So when buying compression stockings online, you will need to find sellers that provide guidance on sizing and compression needs. One source is Bright Life Direct, which carries all the major brands and has easy-to-follow guidance and FAQs to figure out what size and kind of compression stocking is right for you—and right for your budget.
•Massage your hands. Swollen hands? To enhance circulation and lymphatic drainage, apply lotion to your hands and massage one hand and then the other, starting with the fingertips and moving down the hand to the wrist. Also exercise the hands by holding them at chest level and clenching and unclenching them. To do this effectively, gently make a fist and then open your fist and spread your fingers. Massage and exercise your hands several times a day when edema is acting up.
WHEN EDEMA IS DANGEROUS
There are other factors that can cause edema, and they can be life-threatening. Besides cardiovascular and kidney disease, other causes, which were spelled out by the American Academy of Family Physicians in a recent article by and for doctors, include liver disease, sleep apnea, allergies, use of certain medications (such as nonsteroidal anti-inflammatory drugs, antihypertensives, corticosteroids, antidepressants, diabetes medications, hormone replacement therapy), and chemotherapy. Edema also can be caused by surgical removal or malfunction of the lymph nodes, which, as part of the lymphatic system, filter fluid and cleanse the body of bacteria, viruses, and other debris.
What’s the danger of unchecked edema? Besides the fact that you might have a serious underlying condition needing treatment, all that swelling and stretching of the skin can cause a flaky, eczema-like appearance and even skin ulcers. Ulcers, in turn, can lead to serious skin infections, such as cellulitis, where the infection bores through the skin and into underlying tissue. And you probably also know that chronic swollen legs and feet can put you at risk for blood clots that can lodge in a leg or travel up to the lungs, heart, brain, or another part of your body. This is called thromboembolism (or stroke when it hits your brain)—and, just like a stroke, it can kill you.
If you are having symptoms such as shortness of breath, rapid heartbeat, or pain and heat in a limb, be sure to get to a doctor or even an emergency room right away. You could be experiencing thromboembolism. The symptoms may be accompanied by chest pain, fever, or intense anxiety (a feeling of doom). Once treated for a thromboembolic attack, you may be put on a medication to prevent blood clots and be instructed to wear compression stockings.
For all these reasons, if you have chronic edema—even if you can get relief from the self-treatments described above—it’s a good idea to get it checked out by a doctor. In addition to the suggestions listed above, additional steps a doctor might take if you have severe chronic edema include:
•Checking for clots. Even if you are not having a thromboembolic emergency, your doctor may order an ultrasound of the swollen limb to see whether clots have formed. If so, he or she will likely put you on a blood-thinning drug to prevent a thromboembolic event.
•Prescribing pneumatic compression. If swelling is severe and related to surgical removal or malfunction of lymph nodes, you might be instructed in the use of a pneumatic compression device, an inflatable garment resembling a boot, sock, or sleeve that does the work of a compression stocking but with greater intensity.
•Recommending physiotherapy. You also may be referred to a physiotherapist for massage and movement therapy and specialized compression techniques that involve use of bandage wrappings.
So do not endure swollen limbs simply because it’s something that you’ve put up with for years. Keeping the swelling in check and getting a handle on the underlying cause, when possible, can save you from major health woes down the line.
›Study titled “Edema: Diagnosis and Management,” published in American Family Physician.
A Cancer and Diabetes Risk Your Doctor May Not Know About
If you don’t have any of the well-known risk factors for cancer, including smoking, a family history of cancer, or long-term exposure to a carcinogen such as asbestos, you may think that your risk for the disease is average or even less than average.
What you may not realize: Although most of the cancer predispositions (genetic, lifestyle, and environmental factors that increase risk for the disease) are commonly known, there are several medical conditions that also can increase your risk, such as diabetes.
Unfortunately, many primary care physicians do not link diabetes to cancer. As a result, they fail to prescribe the tests and treatments that could keep cancer at bay or reduce the condition’s cancer-causing potential.
The high blood sugar levels that occur with type 2 diabetes predispose you to heart attack, stroke, nerve pain, blindness, kidney failure, a need for amputation—and cancer.
New research: For every 1 percent increase in HbA1C—a measurement of blood sugar levels over the previous three months—there is an 18 percent increase in the risk for cancer, according to a study published in Current Diabetes Reports.
Other current studies have linked type 2 diabetes to a 94 percent increased risk for pancreatic cancer, a 38 percent increased risk for colon cancer, a 15 to 20 percent higher risk for postmenopausal breast cancer, and a 20 percent higher risk for blood cancers such as non-Hodgkin’s lymphoma and leukemia.
What to do: If you have type 2 diabetes, make sure your primary care physician orders regular screening tests for cancer, such as colonoscopy and mammogram.
Screening for pancreatic cancer is not widely available, but some of the larger cancer centers (such as the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Florida, and the Mayo Clinic in Rochester, Minnesota) offer it to high-risk individuals.
This typically includes people with longstanding diabetes (more than twenty years) and/or a family history of pancreatic cancer. The test involves an ultrasound of both the stomach and small intestine, where telltale signs of pancreatic cancer can be detected.
Also work with your doctor to minimize the cancer-promoting effects of diabetes. For example, control blood sugar levels through a diet that emphasizes slow-digesting foods that don’t create spikes in blood sugar levels, such as vegetables and beans. Also, try to get regular exercise—for example, thirty minutes of walking five or six days a week. Studies have shown that regular exercise helps to control blood sugar. And consider medical interventions, such as use of the diabetes drug metformin.
›Lynne Eldridge, MD, medical manager of the Lung Cancer site for About.com and a former clinical preceptor at the University of Minnesota Medical School in Minneapolis. Dr. Eldridge practiced family medicine for fifteen years and now devotes herself full time to researching and speaking on cancer prevention. She is author of Avoiding Cancer One Day at a Time.
Diabetics: The Body Part That’s Aging Faster Than the Rest of You
People with type 2 diabetes have a lot of balls to keep in the air, medically speaking.
They need to, of course, keep their blood sugar in check, get regular eye screenings, and monitor their feet, which often can suffer from nerve damage.
Now new research may add another item to that already-long checklist.
It suggests that people with type 2 diabetes should start getting colonoscopies earlier and, perhaps, get them more frequently. Here’s why.
TYPE 2 DIABETICS HAVE “OLDER” COLONS
Researchers from Washington University in St. Louis reviewed colonoscopy records of male and female patients over a six-year span, comparing the incidence of precancerous polyps in three groups—those ages forty to forty-nine with type 2 diabetes, those ages forty to forty-nine without type 2 diabetes, and those ages fifty to fifty-nine without type 2 diabetes.
Their first finding was expected, since age increases the risk for precancerous polyps. Nondiabetics in their fifties had a much higher rate of precancerous polyps (32 percent) than nondiabetics in their forties (14 percent).
But their second finding was alarming. Diabetics in their forties had nearly the same rate of precancerous polyps (30 percent) as nondiabetics in their fifties (again, 32 percent). And this was after individual cancer risk factors—such as sex, race, obesity, smoking, high cholesterol, and alcohol use—were taken into account.
“It’s almost as if the colons of diabetics are ten years older,” study author Hongha Vu-James, MD, formerly clinical gastroenterology fellow at the university, says. It’s believed that the culprit is a high level of insulin in type 2 diabetics, since insulin is thought to promote cell growth in the colon, she says.
SHOULD SCREENING GUIDELINES CHANGE?
Current guidelines from the American Cancer Society (ACS) suggest that colorectal cancer screenings should begin at age fifty for people at average risk for colon cancer. ACS advises those at high risk (anyone with inflammatory bowel disease, a personal history of colorectal cancer, or a family history of colorectal cancer) to get screened even earlier (the age varies by risk factor). In addition, the site for the American College of Gastroenterology says, “Recent evidence suggests that African Americans should begin screening earlier at the age of forty-five.”
What about people with type 2 diabetes? The American Diabetes Association, while acknowledging that type 2 diabetes is linked with a higher risk for colorectal and other cancers, urges diabetics to reduce lifestyle-related cancer risk factors but doesn’t deviate from the “begin screening at age fifty” recommendation for those at average risk.
Dr. Vu-James, however, is hoping that her research—and future studies that replicate it—will change that. Her study suggests that people with type 2 diabetes should consider getting their first colorectal cancer screening earlier than age fifty.
In her view, doctors should be open to discussing the idea of earlier colorectal cancer screenings with diabetic patients based on their overall risk factors, and it might help to bring a copy of this article with you if you want to broach the idea with your physician. Unfortunately, if you have type 2 diabetes and you want to get a colorectal cancer screening before the age of fifty but you’re considered to be at average risk, according to the current guidelines, it’s unlikely that insurance will cover it, says Dr. Vu-James, and a colonoscopy can cost around $1,200 or more. If more research confirms Dr. Vu-James’s findings and screening guidelines change, colonoscopies are more likely to be covered in the future.
If you have type 2 diabetes and are over the age of fifty and you’ve already started getting colorectal cancer screenings, Dr. Vu-James says that there is no data yet on whether or not more frequent screenings are necessary, but if you’re concerned, talk to your doctor.
Also: This increased risk for colorectal cancer does not apply to people of any age with type 1 diabetes, says Dr. Vu-James, because type 1 is caused by a lack of insulin.
›Hongha Vu-James, MD, formerly clinical gastroenterology fellow, Washington University, St. Louis, and lead author of a study presented at a Digestive Disease Week conference in San Diego.
Diabetic Women at Risk for Colorectal Cancer
There seems to be no end to the health risks associated with diabetes, a truly insidious disease that can lead to other serious health problems. Having diabetes increases risk for cardiovascular disease, kidney failure, hypertension, stroke, and damage to the nerves and eyes. Recent research has also linked diabetes to a greater risk of certain cancers, including colorectal (colon or rectum) cancer. And now a study from Washington University in St. Louis concludes that diabetic women are at greater risk for developing colorectal adenomas—polyps that can turn into cancer. This is especially true for diabetic women who are also obese, defined in this study as having a body mass index of over 30.
The study compared the colonoscopy records of one hundred women with type 2 diabetes with those of five hundred nondiabetic women to evaluate the rate of adenomas in these women.
The results: Diabetic women had a significantly higher rate of adenomas compared with those who did not have the disease—37 percent versus 24 percent. Furthermore, women with type 2 diabetes were also more apt to have advanced adenomas—14 percent versus 6 percent. Apparently, at greatest risk of all are women who are obese and have diabetes. In fact, when compared with nonobese, nondiabetic women, these women faced nearly twice as high a risk of having any kind of adenoma and more than two times greater risk for having advanced adenoma.
We spoke with the study’s lead author, Jill E. Elwing, MD, about these results. She explains that insulin is in itself a growth factor and that might be what is behind the link between diabetes and colorectal adenoma—the growth factor could produce a pro-cancerous effect. The immediate takeaway from this study, she says, is that medical professionals and this group of vulnerable women should have greater awareness and pay more attention to regular screening. Women of any age who have type 2 diabetes should discuss a colorectal screening schedule with their doctors. And because being over age fifty is also considered a risk factor for colorectal cancer, diabetic women over that age should be particularly careful to follow their doctor’s advice about regular screenings, she says.
›Jill E. Elwing, MD, is in private practice in St. Louis, Missouri.
A Walk Does Wonders for Chronic Kidney Disease
If you have chronic kidney disease (CKD), there is a simple way that you might save yourself from needing dialysis or a kidney transplant. CKD, a condition in which the kidneys struggle to filter waste from the blood, is a silent health threat that you can be completely unaware of until serious damage is done. One in three adults with diabetes and one in five with high blood pressure has CKD, and like so many illnesses, incidence increases after age fifty. If left unchecked, end-stage renal disease—kidney failure—occurs. That’s when you’ll need to be hooked up to a dialysis machine to filter your blood or will require a kidney transplant to stay alive.
Although there is no cure once CKD sets in, it can often be kept from advancing, and now doctors have confirmed that a certain simple exercise can not only help you avoid dialysis or transplantation but also add years to your life. And that exercise is walking!
A PROVEN BENEFIT
We all know that exercise improves cardiovascular fitness, and researchers had already confirmed that it improves fitness in people with CKD. But could walking actually help with the disease itself—and in a significant way? That question had never been tested by research, so a group of Taiwanese researchers decided to find out.
The study started out with 6,363 patients whose average age was seventy. All had moderate to severe CKD, and 53 percent had CKD severe enough to need dialysis or a kidney transplant. The researchers recorded and monitored exercise activity and a range of other health and medical measurements in the group and identified 1,341 people who walked as their favorite form of exercise. These patients were compared with patients who did not walk nor exercise in any other way.
The results: Walkers were 33 percent less likely to die of kidney disease and 21 percent less likely to need dialysis or a kidney transplant than nonwalkers/nonexercisers. And the more a person walked, the more likely he or she was not on dialysis or in need of a kidney transplant and still alive when the study ended. So, for example, someone who walked once or twice a week for an average thirty minutes to an hour had a 17 percent lower risk of death and a 19 percent lower risk of needing dialysis or a kidney transplant compared with someone who didn’t walk or exercise. And someone who walked for an average thirty minutes to an hour seven or more times a week had a 59 percent lower risk of death and a 44 percent lower risk of needing dialysis or a kidney transplant.
Now, when researchers see this kind of dramatic result, they should always explore whether there was some reason other than the activity that was studied (in this case, walking) that could explain things. These are called confounding factors—for example, could it be that walkers walked because they were healthier, as opposed to being healthier because they walked? But no confounding factors were found. The average age, average body size, and degree of kidney disease was the same in the two groups, as was the prevalence of diabetes-associated coronary artery disease, cigarette smoking, and use of medications for CKD.
The bottom line for people with CKD—walk! Walk everywhere! Walk often! Even a thirty-minute walk once or twice a week can help. The more you walk, the greater the benefit.
ARE YOU AT RISK?
If you have diabetes or high blood pressure, your doctor should give you a simple blood test to see whether CKD is developing. Otherwise, here are telltale signs to keep an eye out for—these may signal that you should be evaluated for CKD:
•Unexplained fatigue
•Trouble concentrating
•Poor appetite
•Trouble sleeping
•Nighttime muscle cramps
•Swollen feet and ankles
•Eye puffiness, especially in the morning
•Dry, itchy skin
•Frequent urination, especially at night
Be sure to tell your doctor what medications you’re on when you are examined for CKD. Because the kidneys also filter medications out of your body, meds can build up to toxic levels in your system if the kidneys aren’t doing their job. If you have CKD, your doctor may take you off some medications and lower the dose of others.
While there’s no cure for CKD once it sets in, it need not advance to severe and deadly stages that require dialysis or a kidney transplant. Besides exercising and keeping the underlying cause (whether it be diabetes, high blood pressure, or something else) in check, mild CKD is managed by diet. To do it right:
•Make walking a priority.
•Work with your doctor to manage the underlying cause, and work with a dietitian to manage your nutrition requirements. A dietitian will plan a regimen that controls the amount of protein, salt, potassium, and phosphorus you consume, all of which can build up to toxic levels in people with CKD. A dietitian will also balance your CKD diet needs with those related to glucose control or whatever condition may be associated with your CKD.
›Che-Yi Chou, MD, PhD, Kidney Institute, division of nephrology, department of internal medicine, both at China Medical University Hospital, Taiwan. Dr. Chou’s study appeared in the Clinical Journal of the American Society of Nephrology.
Dangers of a “Slow Stomach”
When you eat a meal, you probably don’t think about the amount of time it takes your body to digest the food. But for many people, this is the key to uncovering a host of digestive ills—and even some seemingly unrelated concerns such as chronic fatigue.
WHEN FOOD MOVES TOO SLOWLY
In healthy adults, digestion time varies, but it generally takes about four hours for a meal to leave the stomach before passing on to the small intestine and colon.
What happens: When food enters the stomach, signals from hormones and nerve cells trigger stomach acid, digestive enzymes, and wavelike peristaltic contractions of the muscles in the stomach wall. Together, they break down the meal into a soupy mixture called chyme, which peristalsis then pushes into the small intestine.
This process is known as gastric motility. And when gastric motility is impeded—when stomach emptying slows to a crawl, even though nothing is blocking the stomach outlet—it’s called gastroparesis.
Surprising fact: An estimated one out of every fifty-five Americans suffers from gastroparesis—but the condition is diagnosed in only one out of every ninety people who have it.
When gastroparesis goes undetected: The symptoms of gastroparesis are often obvious—for example, nausea, vomiting, feeling full right after starting to eat a meal, bloating, and abdominal pain. But the condition can cause other health problems such as unwanted weight loss and even malnutrition. It also can interfere with the absorption of medications and wear you down physically (one study found that 93 percent of people with gastroparesis were fatigued).
GETTING THE RIGHT DIAGNOSIS
If you’re experiencing the symptoms of gastroparesis, see your primary care physician. He/she may refer you to a gastroenterologist. It’s likely the specialist will order the “gold standard” for diagnosing gastroparesis, a test called gastric emptying scintigraphy.
Next step: At the test, you’ll eat a meal that contains radioactive isotopes. (Radio-labeled Egg Beaters with jam, toast, and water are typical.) A scan is taken at one, two, and four hours after the meal with a scintigraph or gamma camera. A one-hour scan after drinking liquid is also recommended. If images from any of the scans show that your stomach isn’t emptying normally, you are diagnosed with gastroparesis.
Another approach: When I perform an endoscopy on a patient with gastroparesis-like symptoms (a thin, flexible tube with a light and camera on the end is inserted down the esophagus and into the stomach), if I see a significant amount of retained fluids or food despite an overnight fast, I make the diagnosis then and there, saving time and money.
FINDING THE CAUSE
Experts haven’t discovered the exact mechanisms underlying gastroparesis. In fact, an estimated 40 percent of cases are idiopathic—the cause is unknown. Gastroparesis is a complication for about 30 percent of people with type 1 or type 2 diabetes.
What happens: Diabetes can damage the vagus nerve, which runs from the cranium to the abdomen and plays a key role in digestion.
Medication also can cause gastroparesis.
Examples: Narcotic pain relievers, such as oxycodone, and anticholinergics, a class of drugs that includes certain antihistamines and overactive bladder medications.
Small intestine bacterial overgrowth, in which abnormally large numbers of bacteria grow in the small intestine, also can lead to gastroparesis.
GETTING THE BEST MEDICAL CARE
I have found that an integrative approach that combines conventional and alternative medicine is the best way to control gastroparesis.
Conventional treatment typically includes medications that either speed stomach emptying or help control the symptoms of gastroparesis such as nausea and vomiting. For example:
•Metoclopramide. This is currently the only FDA-approved medication for gastroparesis. Metoclopramide works by blocking receptors of the neurotransmitter dopamine, which accelerates gastric motility.
Problem: The FDA has approved metoclopramide for no more than twelve weeks of use because long-term intake can cause tardive dyskinesia—involuntary, repetitive body movements, such as grimacing. Because of this risk, I rarely prescribe metoclopramide for my patients.
Another medication option: The drug domperidone has the same dopamine-suppressing action in the digestive tract as metoclopramide, but it does not cross the blood-brain barrier and therefore is much less likely to cause tardive dyskinesia. Risks include breast tenderness and worsening of the heart condition long QT syndrome.
However, according to clinical guidelines for the management of gastroparesis published in the American Journal of Gastroenterology, domperidone “is generally as effective” as metoclopramide with “lower risk of adverse effects.”
Domperidone is readily available in most countries, where it is a standard treatment for heartburn, but not in the United States. However, your doctor can obtain it under the FDA’s Investigational New Drug program.
•Antinausea drugs. Prochlorperazine and ondansetron are commonly prescribed for gastroparesis.
•Botox. Injections of botulinum toxin into the pylorus (the opening from the stomach into the small intestine) can help some patients for four to six months, after which the injection must be repeated.
New approaches: Physicians at Johns Hopkins are now using a new and effective procedure called through-the-scope transpyloric stent placement. With this procedure, an endoscope is used to place a stent (tube) that helps transfer stomach contents into the small intestine.
Another new approach, pioneered by John Clarke, MD, of Johns Hopkins, involves placing a stent across the pylorus to drain the stomach.
ALTERNATIVE THERAPIES
Certain alternative therapies may also help with stomach motility and/or with nausea and vomiting:*
•Peppermint oil. This can help gastroparesis, but it also can worsen heartburn in people with gastroesophageal reflux disease (GERD). If you have gastroparesis but not GERD, an enteric-coated softgel of peppermint oil may help you.
Recommended dose: 90 mg daily.
•Iberogast. Studies have shown that this pharmaceutical-grade, multiherbal tincture can help with gastroparesis.
Recommended dose: twenty drops, two to three times a day, before meals. (Iberogast does contain alcohol.)
•Ginger. Gingerroot may help with nausea and improve gastric motility.
Recommended dose: 1,200 mg daily.
•Acupuncture. This treatment can help control the symptoms of gastroparesis. Acupuncture has been shown to be effective for nausea and vomiting and abdominal pain and bloating.
DIET/LIFESTYLE TIPS
Many dietary and lifestyle habits can improve stomach motility:
•Eat smaller, more frequent meals. Eat smaller amounts of food every two, three, or four hours.
•Reduce dietary fiber and fat. Both slow stomach emptying.
•Chew food thoroughly.
•Chew sugarless gum. Do so for about one hour after eating to stimulate peristalsis.
•Take a leisurely five- or ten-minute (or longer) walk after every meal.
›Gerard Mullin, MD, an associate professor of medicine at the Johns Hopkins University School of Medicine and director of the Celiac Disease Clinic, Integrative GI Nutrition Services and the Capsule Endoscopy Program at Johns Hopkins Hospital, all in Baltimore. He is author of The Inside Tract, editor of Integrative Gastroenterology and several other textbooks, and the author or coauthor of more than fifty scientific papers.
How to Prevent Glaucoma Vision Loss Before It’s Too Late
Imagine that, as you read on your computer screen, the many pixels on the screen begin to stop working, a few at a time, not right in the center, but in clusters all around the screen. It happens slowly, eventually wiping out all but a tiny central spot, which eventually drops out too. The screen is blank then.
That’s a pretty close analogy of what happens when glaucoma runs its course. You’ll start losing your peripheral vision first, one eye at a time, and you likely won’t even realize that it’s happening until much of the damage has been done. The damage is irreversible, but the process can be stopped with early detection and treatment.
ARE YOU AT RISK?
Glaucoma is the second-leading cause of blindness in the world after cataracts, and it mostly affects people as they age past sixty. The disease is characterized by dying ganglion nerve cells in the retina, the light-sensitive tissue at the back of the eye that catches the images we see. Once these cells die, they are never replaced, which makes early detection of glaucoma critical.
Among the many different types of glaucoma, the most common is open-angle glaucoma, caused by clogging of the eyes’ drainage canals in people who have a wide angle between the iris and cornea. Besides older age, risk factors include genetic predisposition, nearsightedness, higher eye pressure, high and low blood pressure, diabetes, and hypothyroidism.
DETECTION
The lack of symptoms is a major reason why glaucoma is often not detected early. And the idea that glaucoma always has something to do with high eye pressure is a prime reason why diagnosis is often missed by eye specialists during regular eye exams. Although high eye pressure is a hallmark of a condition called angle-closure glaucoma, it is not necessarily present in the more common open-angle glaucoma.
Annual eye exams are recommended for people who are over age sixty and anyone with a first-degree relative (parent, sibling, or child) who has or had glaucoma. People younger than sixty should consider getting eye exams, including glaucoma screening, every two years.
To ensure that your exams are thorough enough to detect glaucoma, make sure that, besides having eye pressure measured, you receive a side vision test, which examines peripheral vision, or a visual field test, which examines both peripheral and central vision. The optic nerve head or optic disc (a part of the eye where ganglion cells enter the optic nerve) should also be examined by the eye specialist to evaluate the health of those ganglion cells.
TREATMENT
If glaucoma is detected, treatment can prevent further damage by restoring eye-fluid drainage and/or relieving eye pressure. This is accomplished by use of daily eye drops or a combination of eye drops and oral medication. Many different types of eye drops—some known as prostaglandin analogs, some alpha agonists, and some carbonic anhydrase inhibitors—are prescribed, depending on glaucoma symptoms that need to be managed. Laser eye surgery or traditional types of eye surgery that relieve pressure and correct blocked drainage ducts are options for people who don’t get adequate relief from eye drops or who experience allergy or severe side effects from medications, but these people may still need to continue using some form of medication after surgery until eye pressure and drainage correct themselves.
Side effects of eye drops can include change in color of the iris and eyelid skin, stinging and burning of the eye, blurred vision, and related problems. But most people who become lax about eye drop use don’t do so because of side effects. They do so because they forget to use them, sabotaging their fight against glaucoma symptoms.
In a study in which we electronically monitored people who were using eye drops for glaucoma management, we discovered that, under the best of circumstances, patients were taking their eye drops only 70 percent of the time. Of course, eye drops can’t help relieve glaucoma unless they are consistently used.
Helpful: Set up a reminder system. For example, set your cell phone alarm to alert you when to use the drops.
As for alternative treatments for prevention of open-angle glaucoma beyond early detection and management, scientific evidence shows no association between glaucoma and a person’s personal habits, such as diet, use of vitamins and supplements, alcohol consumption, and caffeine intake. Altering these behaviors, unfortunately, will not decrease your chances of getting glaucoma or prevent it from getting worse. However, aerobic exercise (twenty minutes four times a week) can increase blood flow and reduce eye pressure, which can keep glaucoma from worsening.
WHERE TO GET TREATMENT
Optometrists can diagnose glaucoma and treat it with eye drops. Ophthalmologists can diagnose it and treat it with a wider range of therapies—eye drops as well as laser treatments and eye surgery. But whichever type of specialist you consult, make sure that he is up-to-date on how best to detect glaucoma during an eye exam. To find optometrists and ophthalmologists in your area who have specialized training in glaucoma diagnosis and treatment and have been given a seal of approval by glaucoma experts, visit the Glaucoma Research Foundation website.
›Harry A. Quigley, MD, A. Edward Maumenee Professor of Ophthalmology and director, Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University, Baltimore. Dr. Quigley’s book is Glaucoma: What Every Patient Should Know: A Guide from Dr. Harry Quigley.
Pycnogenol Helps Diabetic Retinopathy
Pycnogenol (pronounced pic-NOJ-en-all), an extract from the bark of the French maritime pine, is known to improve circulation, reduce swelling, and ease asthma. Now Italian researchers have found another use for it—it helps patients with diabetes who are in the early stages of diabetic retinopathy, a complication of diabetes in which the retina becomes damaged, resulting in vision impairment, including blurred vision, seeing dark spots, impaired night vision, reduced color perception, and even blindness.
All people with diabetes are at risk for diabetic retinopathy, and it’s estimated that as many as 80 percent of people with diabetes for ten years or more will have this complication.
Participants in the Italian study had been diagnosed with diabetes (the researchers did not specify whether the patients had type 1 or 2 diabetes) for four years, and their diabetes was well controlled by diet and oral medication. Study participants had early-stage retinopathy and moderately impaired vision. After two months of treatment, the patients given Pycnogenol had less retinal swelling as measured by ultrasound testing. Most important, their vision was significantly improved. This was especially noticeable because the vision of those in the control group did not improve.
My view: If you have type 1 or 2 diabetes, undergo a comprehensive eye exam at least once a year. If retinopathy is detected, it would be wise to supplement with Pycnogenol (150 mg daily). Because retinopathy among diabetes patients is so prevalent, I recommend this amount to all my patients with diabetes to protect their vision. Pycnogenol has a blood-thinning effect, so people who take blood-thinning medication, such as warfarin, should use it only while being monitored by a doctor.
›Mark A. Stengler, NMD, a naturopathic medical doctor and leading authority on the practice of alternative and integrated medicine. Dr. Stengler is author of the Health Revelations newsletter, The Natural Physician’s Healing Therapies, and Bottom Line’s Prescription for Natural Cures. He is also the founder and medical director of the Stengler Center for Integrative Medicine in Encinitas, California, and former adjunct associate clinical professor at the National College of Natural Medicine in Portland, Oregon. MarkStengler.com.
How to See Better in the Dark
Aging often brings a reduction in the ability to see well in low light.
Reasons: Night vision has two elements. First, the pupils must dilate to let in as much light as possible. Normally, this happens within seconds of entering a darkened environment, but as we age, the muscles that control pupil dilation weaken, slowing down and/or limiting dilation. Second, chemical changes must occur in the light-sensitive photoreceptors (called rods and cones) of the retina at the back of the eyeball. Some of these changes take several minutes, and some take longer, so normally, full night vision is not achieved for about twenty minutes. Even brief exposure to bright light (such as oncoming headlights) reverses these chemical changes, so the processes must start over. With age, these chemical changes occur more slowly, and some of our photoreceptors may be lost.
While we cannot restore the eyes’ full youthful function, we can take steps to preserve and even improve our ability to see in low light. Here’s how:
•First, see your eye doctor to investigate possible underlying medical problems. Various eye disorders can cause or contribute to reduced night vision, including cataracts (clouding of the eye’s lens), retinitis pigmentosa (a disease that damages the retina’s rods and cones), and macular degeneration (in which objects in the center of the field of vision cannot be seen). Night vision also can be compromised by liver cirrhosis or the digestive disorder celiac disease, which can lead to deficiencies of eye-protecting nutrients, or diabetes, which can damage eye nerves and blood vessels. Diagnosing any underlying disorder is vital, because the sooner it is treated, the better the outcome is likely to be.
•Adopt an eye-healthy diet. Eat foods rich in the vision-supporting nutrients below, and ask your doctor whether supplementation is right for you. Especially important:
›Lutein, a yellow pigment and antioxidant found in corn, dark green leafy vegetables, egg yolks, kiwi fruit, oranges, and yellow squash.
Typical supplement dosage: 6 mg daily.
›Vitamin A, found in carrots, Chinese cabbage, dark green leafy vegetables, pumpkin, sweet potatoes, and winter squash.
Typical supplement dosage: 10,000 international units (IU) daily.
›Zeaxanthin, a yellow pigment and antioxidant found in corn, egg yolks, kiwi fruit, orange peppers, and oranges.
Typical supplement dosage: 300 mcg daily.
›Zinc, found in beans, beef, crab, duck, lamb, oat bran, oysters, ricotta cheese, turkey, and yogurt.
Typical supplement dosage: 20 mg daily.
•Update prescription lenses. Many people just keep wearing the same old glasses even though vision tends to change over time, Dr. Grossman says, so new glasses with the correct prescription often can improve night vision.
•Keep eyeglasses and contacts clean. Smudges bend rays of light and distort what you see.
•Wear sunglasses outdoors on sunny days, especially between noon and three p.m. This is particularly important for people with light-colored eyes, which are more vulnerable to the sun’s damaging ultraviolet rays. Excessive sun exposure is a leading cause of eye disorders (such as cataracts) that can impair eyesight, including night vision. Amber or gray lenses are best for sunglasses, Dr. Grossman says, because they absorb light frequencies most evenly.
•Do not use yellow-tinted lenses at night. These often are marketed as “night driving” glasses, implying that they sharpen contrast and reduce glare in low light. However, Dr. Grossman cautions that any tint only further impairs night vision.
Safest: If you wear prescription glasses, stick to untinted, clear lenses—but do ask your optometrist about adding an antireflective or antiglare coating.
•Exercise your night vision. This won’t speed up the eyes’ process of adjusting to the dark, but it may encourage a mental focus that helps the brain and eyes work better together, thus improving your ability to perceive objects in a darkened environment.
What to do: For twenty minutes four times per week, go into a familiar room at night and turn off the lights. As your eyes are adjusting, look directly toward a specific object that you know is there. Focus on it, trying to make out its shape and details and to distinguish it from surrounding shadows. With practice, your visual perception should improve. For an additional challenge, do the exercise outdoors at night, while looking at unfamiliar objects in a dark room, or while using peripheral vision rather than looking directly at an object.
•When driving at night, avoid looking directly at oncoming headlights. Shifting your gaze slightly to the right of center minimizes the eye changes that would temporarily impair your night vision, yet still allows you to see traffic.
Also: Use the night setting on rearview mirrors to reduce reflected glare.
•Clean car windows and lights. When was the last time you used glass cleaner on the inside of your windshield or on rear and side windows or on headlights and taillights? For the clearest possible view and minimal distortion from smudges, keep all windows and lights squeaky clean.
›Marc Grossman, OD, LAc, holistic developmental/behavioral optometrist, licensed acupuncturist and medical director, Natural Eye Care, New Paltz, New York. He is coauthor of Greater Vision and Natural Eye Care. NaturalEyeCare.com.
Beware of Eye Floaters—They Can Be a Telltale Sign of a Vision-Robbing Eye Condition
If you have ever noticed a few tiny dots, blobs, squiggly lines, or cobweb-like images drifting across your field of vision, you are not alone. These visual disturbances, called floaters, are common, and most people simply dismiss them as a normal part of growing older. But that’s not always the case.
When it could be serious: In about 15 percent of cases, floaters are a symptom of a harmful condition known as a retinal tear, which can, in turn, lead to a vision-robbing retinal detachment in a matter of hours to days.
HOW DOES IT HAPPEN?
The retina, which is an extremely thin, delicate membrane that lines the inside of the back of the eye, converts light into signals that your brain recognizes as images. However, with age, a jelly-like material called the vitreous that fills much of the eyeball commonly shrinks a bit and separates from the retina. If the shrinkage or some other injury exerts enough force, the retina can actually tear.
You might notice a sudden shower of new floaters or flashes of light that look like shooting stars or lightning bolts. What you’re seeing when this occurs are actually shadows that are being cast on the retina by the tiny clumps of collagen fibers that comprise the floaters. The flashes of light are caused by the tugging of the vitreous on the retina, which stimulates the photoreceptors that sense light.
Why floaters and/or flashes are a red flag: The retina lacks nerves that signal pain, so these visual disturbances are the only way you will be alerted to a tear. Left untreated, fluid can leak through the retinal tear, and the retina can detach like wallpaper peeling off a wall. A retinal detachment is an emergency—if it’s not treated promptly, it can lead to a complete loss of vision in the affected eye.
ARE YOU AT RISK?
Changes in the eye that increase risk for a retinal tear or detachment begin primarily in your fifties and sixties and continue to increase as you grow older.
In addition to age, you can also be at increased risk for a retinal tear or detachment due to the following:
•Nearsightedness. People of any age with nearsightedness greater than six diopters (requiring eyeglasses or contact lenses with a vision correction of more than minus six) are five to six times more likely to develop a retinal tear or detachment. That’s because nearsighted eyeballs are larger than normal. Therefore, the retina is spread thinner, making it more prone to tearing.
Important: If you’re nearsighted, don’t assume that corrective eyewear or LASIK surgery decreases your risk for a retinal tear or detachment. Neither does.
•Cataract surgery. This surgery alters the vitreous jelly, increasing the risk that the vitreous will pull away from the retina, possibly giving way to a retinal detachment.
Cataract surgery has been known to double one’s detachment risk, but a new Australian study suggests that improvements in technology, such as phacoemulsification, which uses an ultrasonic device to break up and remove the cloudy lens, have cut the risk from one in one hundred to one in four hundred.
•Diabetes. Because it impairs circulation to the retina over time, diabetes leads to a higher risk for a severe type of retinal detachment that is not associated with floaters and flashes and can be initially asymptomatic.
Individuals who have diabetes should be sure to have annual eye exams with dilation of the pupils to check for this and other ocular complications of diabetes. The Optomap test provides a wide view of the retina, but you also need pupil dilation for a thorough screening.
THE DANGER OF A RETINAL TEAR
Anyone who experiences a sudden burst of floaters or flashes, especially if they are large or appear in any way different from how they have in the past, should contact an ophthalmologist right away for advice.
If an eye exam confirms a retinal tear, it can be treated in an eye doctor’s office, using either lasers or freezing equipment to “spot-weld” the area surrounding the tear. (Anesthetic eye drops are used to numb the eye, but the procedure can still be uncomfortable.)
The resulting scar tissue will seal off the tear so the fluid doesn’t leak behind the retina and pull it away. The good news is that both laser photocoagulation and freezing are more than 90 percent effective in preventing detachment. There is a small risk for tiny blind spots.
WHAT IF A DETACHMENT OCCURS?
If you suffer a retinal tear but don’t get treatment within a day or two, the fluid can seep through the tear, detaching the retina.
Red flag for detachment: A gradual shading in your vision, like a curtain being drawn on the sides or top or bottom of your eye, means that a retinal detachment may have occurred. If your central vision rapidly changes, this may also signal a retinal detachment or even a stroke.
Retinal detachment is an emergency! When your doctor examines you, he/she will be able to see whether the center of your retina is detached. When the center is involved, vision often cannot be fully restored.
If you have suffered a retinal detachment, your doctor will help you decide among the following treatments:
•Vitrectomy. This one- to three-hour surgery is performed in a hospital operating room, usually with sedation anesthesia plus localized numbing of the eye. The vitreous is removed, tears are treated with lasers or freezing, and a bubble (typically gas) is injected to replace the missing gel and hold the retina in place until the spot-welding treatment can take effect. (The bubble will gradually disappear.)
Important: It is necessary to keep your head in the same position for seven to fourteen days in order to “keep the bubble on the trouble,” as doctors say. Therefore, you will need a week or two of bed rest at home. You may have to keep your head facedown or on one side.
•Scleral buckle. With this procedure, a clear band of silicone is placed around the outside of the eyeball, where it acts like a belt, holding the retina against the wall of the eyeball.
Also performed in a hospital operating room, scleral buckle involves freezing the retina or treating it with a laser to create localized inflammation that forms a seal, securing the retina and keeping fluid out.
Scleral buckle takes from one to two hours and is sometimes combined with vitrectomy to improve the outcome. It is frequently used for younger patients and those who have not had cataract surgery.
•Pneumatic retinopexy. Depending on where the retinal detachment is located, a twenty-minute, in-office procedure called a pneumatic retinopexy is an option for patients with smaller tears. With this procedure, a gas bubble is injected, and retinal tears are frozen or treated with a laser.
This is followed by up to two weeks of bed rest. Your head may need to be held in a certain position, such as upright at an angle, depending on the location of your tear.
With pneumatic retinopexy, the reattachment success rate is lower than that of scleral buckle or vitrectomy (70 percent versus 90 percent), but it is less invasive, and no hospital visit is required. In addition, pneumatic retinopexy costs less than a hospital-based procedure, which could range from $5,000 to $10,000.
Even with a successful procedure, 40 percent of patients who suffer retinal detachments see 20/50 or worse afterward even when using glasses. The remainder have better vision.
›Adam Wenick, MD, PhD, assistant professor of ophthalmology in the Retina Division at the Wilmer Eye Institute at the Johns Hopkins School of Medicine in Baltimore. He is board-certified by the American Board of Ophthalmology, with special expertise in retinal tears and detachment as well as other diseases of the retina.
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