Medical Marijuana Back in the News – This Time For Seizures

This past week or so America is reading about how parents are carting up their kids and moving to Colorado in order to receive “Medical Marijuana” for seizures. I just watched the video on USA today and honestly, the one child who reportedly is having hundreds of seizures a day looked to me like she was just blinking. I don’t know how someone is objectively measuring this child’s reported seizure activity- call me skeptical. Also the father who is constantly clenching his jaw and not looking at the camera seems a bit unconvincing and unconvinced himself.

My intention of bringing this topic up again is not to bash parents who are desperately seeking to make their children seizure free but rather to point out the irony of average citizens making brazen claims that marijuana has therapeutic efficacy for seizures.  The examples used in the video are certainly pretty mild conditions. Not all involuntary muscle contractions represent seizures either.  Did the editors of USA today bother to test what was in that bottle the parents claim contains special street marijuana?  For all we know it is a liquefied version of their therapeutic seizure medication.

In the US we have an agency called the FDA which is responsible for overseeing the approval of medications/drugs for indicated medical conditions.  How in the world did this country get to where we are legalizing medical marijuana before the professionals have debated the topic?  To this point the doctor community has never suggested in any substantive number that marijuana bought in the streets has any true medicinal value. Additionally how is it regular folks are out there informing the rest of us that there is a new indication for dope, namely childhood seizures?  What’s astounding is that the media is so stupid they would publicize such claims as if gospel, suggesting doctors and the pharmaceutical industry are so stupid they never figured this out before marijuana was legalized in a few states.  This really smells fishy. 

A couple of years back I took a very honest and thorough review of the history of marijuana as well as the evidence (or rather lack of) regarding medical reasons to use marijuana.  I will remind folks that this whole thing about using the herb of choice for everything from immune system health to seizures just flat lacks scientific evidence.  Given its often desirable side effects, of course America wants to consume marijuana. As far as I am concerned that that is a topic of public debate but please don’t drag your doctor into this. Also, if there really is an opportunity to find an indication then lets by all means scientifically pursue this. Does anyone doubt Johnson and Johnson, for instance,  wouldn’t jump on the opportunity to purify, test and seek FDA approval for selling whatever might be active in the concoction those parents are giving these anecdotal cases?  I don’t.

Florida’s own John Morgan of Morgan and Morgan wants to set the democratic platform up for the medical marijuana topic, I say go ahead and seek legalization, just not for medical reasons.

The Benefits of Omega-3 Fatty Acids

Omega -3 fatty acids are in the news a lot lately. This recent posting indicates brain atrophy with aging is linked to low measured omega-3 fatty acid levels in the body. Recently I was made aware of a small study showing that krill oil appears to have superior absorption for the omega-3 fatty acids based upon using the omega-3 index measurement.

In my practice I use various tests to assess nutritional status of my patients. For the past year in select patients I have customized a deep cardiovascular risk assessment lab profile from a company called Health Diagnostics Labs in Virginia. This reference lab panel includes measuring the omega-3 index which measures your body’s levels of essential fatty acids. The above mentioned article indicates that knowing and improving this in our bodies translates to a more preserved brain mass with aging. Whether this translates to improved memory is unknown at this time.

If readers are interested in having a nutritional assessment and to consider dietary and/or supplementation considerations to optimize their nutrition, I encourage you to make a service request with my office. Remember I have a registered dietitian on staff to assist in nutritional and weight loss counseling as well.

Maryland Experiments With Capping Hospital Spending

The Centers for Medicare and Medicaid recently offered a waiver to Maryland in order to try to pursue their hospital payment model as a possible scenario for the rest of the nation.  It is based upon their current model which has been in place since the 70’s. Reportedly in Maryland, hospital prices are the same regardless of insurance status. This makes sense and is how our office prices its services (click here to see Internal Medicine of Southwest Florida prices). The price is the same regardless of insurance status with the exception of Medicare. Medicare sets its prices and we don’t have any say in that program.   The problem I see with setting an entire state’s hospital prices is that health care is a cottage industry. Local patient populations, local overhead costs vary and so having a price for an entire state is not efficient nor necessarily going to be market-based, but the concept of a fair and similar price for the overall buyers is the proper way  to conduct business. It allows honest market disclosure and the same opportunity to access the system, as long as the buyer is agreeable to paying.

I view hospitals like the power grid, bridges, and roads- necessary infrastructure.  Hospitals are a horse and buggy industry due to the movement of better outpatient capabilities ,but they will never be completely obsolete. I think following more of a utility model of payment for hospitals makes sense.  In our present utility industry we have both regulated and private utility services. There is no region in this nation that doesn’t have reliable power. Even in the catacombs of my low population home state of North Dakota, every farm has power and heat. The utility model made that possible and it is still followed.  This is why considering a different paying model for their maintenance and services makes sense. Maryland apparently has been ahead of the curve by 4 decades with their concept. Fee for service is still the best way to pay for things in health care. The reason is it maximizes productivity. All other convoluted models, such as the recent Accountability Care Organization model, result in far too much regulatory modeling with low efficiency and low output delivery of services.

Immunology Breakthrough Has Big Implications

In May, the Wall Street Journal published an article that describes a new breakthrough in the field of immunology. The breakthrough is that antibodies work inside of cells as well as outside of them.  This discovery has huge implications for antiviral treatments and gene therapy treatments.  Included below is the full text from the article.

It isn’t often that an entire field of medical science gets turned on its head. But it is becoming clear that immunology is undergoing a big rethink thanks to the discovery that antibodies, which combat viruses, work not just outside cells but inside them as well. The star of this new view is a protein molecule called TRIM21.

 

Dissident researchers have sparked a big rethink in the science of fighting infection. Yarek Waszul

Until recently, the conventional wisdom was that the body fights off infection in two separate ways. First is the adaptive immune system, which works outside the cell. It generates antibodies to intercept specific invaders, locking onto them like a tracking missile and preventing them from entering the cell. A second line of defense, the innate immune system, operates within the cell; it is like an expansive air-defense network, blasting away at all invaders.

Three years ago work by Leo James, William McEwan and their colleagues at the Laboratory of Molecular Biology in Cambridge revealed that this understanding was incomplete. They found that the neutralization of adenoviruses (common viruses causing colds and other infections) by antibodies was happening mainly inside the cell, not outside, and by an unexpected mechanism.

Their announcement—a challenge to the entire field of immunology—elicited a predictable immune reaction of its own from the establishment. Sure enough, leading journals rejected the Cambridge group’s paper, sometimes without even reviewing it, while key funding agencies turned down the group’s grant applications.

Gradually, though, the authors have won the argument. New papers from the group have pinned down what is going on. They describe a potent detection mechanism that links the antibodies outside a cell with its innate immunity, somewhat dissolving the distinction between the two.

Dr. James’s team has shown that if an adenovirus enters the cell with antibodies attached, those antibodies will attract TRIM21 molecules, which pull the virus into a disposal system and send danger signals to put the whole cell in a state of antiviral alert. This explains the hitherto baffling finding that just one or two antibody molecules can neutralize a virus 1,000 times their size.

The significance of the group’s finding is just sinking in. It gives medicine a whole new angle on infection, and it just might crack the hitherto almost insuperable problem of how to cure viral infections, rather than just prevent them by vaccination. Though treatments do exist for viruses such as HIV, they are neither as common nor as effective as antibiotics for bacterial infections. No effective remedy exists, for example, for the many kinds of common cold, whatever your grandmother says.

Perhaps the new knowledge that TRIM21 and other molecules like it are key antiviral defenders will lead to a true antiviral therapy, though if it was as easy as turning up the volume of TRIM21, then cells would surely be doing it. And it’s worth noting that some viruses (including HIV) use a tactic for getting into cells that allows them to evade TRIM21.

The discovery may aid vaccine design and begins to explain why gene therapy has often run into trouble. Such therapy uses adenoviruses to carry new genes into cells, but frequently this provokes a strong native-immune response. TRIM21 possibly plays a part in this. Finally, there is a chance that TRIM21 will help to explain autoimmune diseases, in which the body attacks itself. TRIM21 itself is a target of autoantibodies in autoimmune conditions such as lupus.

In short, we will be hearing more from this molecule.

 

Matt Ridley

May 24, 2013

Wall Street Journal

Negative News for Multivitamins: Are There Reasons to Question Conclusions from the Media?

My readers know that in my view, nutrition is everything when it comes to general health and wellness (well nearly everything).  Globally there is population evidence suggesting that people who eat a diet emphasizing vegetables and fruits (and thus high density micronutrient/antioxidant food sources) have lower incidences of virtually any disease you wish to look for.  We know that vitamins are essential to proper cellular function and energy metabolism- that’s why we call them essential vitamins. Without them, chemical cellular activities necessary for life cannot run.

We know also that eating protein throughout the day results in faster metabolism and lower central obesity.  Clearly nutrition and lifestyle are critical to health. So why do the media and a large part of the medical community want to toss out conversations and studies looking at the role of nutrition and supplements on our health?  I think it is because it is very hard to control for broad variables like multivitamins and food sources. Doctors are not well versed in nutrition- I recall being told dogmatically in medical school that “vitamins are a waste of money” with very little support of that dogmatic statement.  This thinking hasn’t really changed. It is easy to attack things you are ignorant of.

 Those that want to tout the benefits of supplements have plenty of water to carry as well. Scientists that have done vitamin studies do a poor job controlling for the supplements used.  Good study design is critical for decent science. The supplement industry fails to do good studies and this is convenient for the industry (and equally convenient for the doctors to stay dogmatic). I say it is high time some folks put their money where their mouths are.  Meanwhile we consumers have to do our best to eat optimally if we are interested in staying well.  The decision to supplement is personal. Based upon the current literature no one should anticipate their insurance carrier paying for vitamins.

The media blitz that preceded two publications in the Annals of Internal Medicine (December 17th 2013 volume 159 Number 12) highlights how the medical community at large enjoys pooh-poohing supplementation of vitamins for diseases.  In fact, the editorial provided in the same journal was titled: Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements.  Below I provide an analysis of the two trials from a doctor’s perspective.

Tasty Guilt Free Dessert

Lemon Peel Ricotta Crème Recipe – South Beach Diet

This healthy dessert recipe comes from Dr. Agatston’s famous book, The South Beach Diet.  His diet has been scientifically validated to help with metabolic syndrome, diabetes and pre-diabetes.  His diet is also cholesterol/lipid friendly and I highly recommend it as a diet appropriate for most folks.

You can go with even lower fat ricotta cheese to achieve less calories and less saturated fat. Also you can use other flavorings to provide more variety to this “pudding” type dessert.  I have found you can make them ahead of time and keep them in a ramekin (custard dish) so they are easily available for an after dinner snack. Flavorings to consider: chocolate, almond extract, lime peel, banana, berries.  If you use real fruit you won’t need to add the artificial sweetener.  Having a pre-made handy dessert in the fridge will keep you from being tempted to eat something less healthy.  Storing them in the refrigerator also allows the flavoring to “stew” a bit and enhance the flavor experience (cover them though to prevent staleness).

Fast and easy to make, this is sort of a pudding made with ricotta cheese, grated lemon peel, vanilla, and sugar substitute. Good for a snack or dessert for those following the South Beach Diet.

Prep Time: 5 minutes

Cook Time: 15 minutes

Total Time: 20 minutes

Ingredients:

• 1/2 c part-skim ricotta cheese
• 1/4 tsp grated lemon peel
• 1/4 tsp vanilla extract
• 1 pkg sugar substitute

Preparation:

Mix together the ricotta cheese, lemon peel, vanilla extract, and sugar substitute. Serve chilled.

Yield: 1 serving

Per Serving: 178 cal, 14 g pro, 7 g carb, 10 g fat, 6 g sat. fat, 38 mg chol, 0 g fiber, 155 mg sodium

Recipe from: The South Beach Diet : The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss by Arthur S. Agatston M.D. (Ballantine Books)

Copyright 2003 by Arthur S. Agatston M.D.

Weight Loss Recently Shown to Improve Symptoms and the Frequency of Atrial Fibrillation.

This recent article which was well executed, shows that in obese subjects with atrial fibrillation (a common problem which is associated with significant risk for stroke),  weight loss results in less burden of symptoms and severity of symptoms. There were a few important points born out in this study from Australia.

The premise of the study was that it is firstly observed that obesity is a risk factor for atrial fibrillation. Obesity is defined as a body mass index of 30 or higher. BMI is readily calculated from a person’s weight and height. The question asked was whether weight reduction can reduce the burden of atrial fibrillation. Both groups in the study were counseled on weight loss and had routine medical care as well as medical optimization equally.

Point one. The intervention group used meal replacements to achieve rapid and initial weight loss. Meal replacement for weight management works. I have been aware of this on a personal and as a provider basis for years. Those of us with weight issues need to think of Purina For People. I recommend Pharmanex’s TR 90 program and formulated nutrition/protein supplementation from Pure Encapsulations and Pharmanex’s line of morning shakes as a strategy for weight loss and weight control.

Point two: It worked superiorly. At the beginning the groups had BMI’s averaging above 32. At the end of 15 months the intervention group’s average BMI was 27.2 while the control group had a BMI of 32.5 (better than in the beginning of the trial but barely). At the beginning of the trial the average weight in the intervention group was 217.8 lbs and at 15 months they were at 176 lbs.

Point three: All risk factors improved statistically. HDL cholesterol improved (the good stuff), inflammation, and blood pressure improved.

Point four: The heart remodeled (left atrial enlargement improved, and left ventricular septal thickness improved) favorably with the larger amount of weight loss. This translated to less atrial fibrillation.

Point five: Intervention involved intense supervision and health system support. Wouldn’t it just make more sense to not get so overweight to begin with?

Point six: There was less blood pressure medication use in the intervention group but not for the control group.

Point seven: There were a lot of newly diagnosed sleep apnea patients and treatment in both groups. This did not go down at the end of the treatment study but rather went up 4-5 fold in both groups (with 2 less cases in the intervention group). If you have or had obesity and atrial fibrillation, perhaps you should be screened for sleep apnea.

For those readers who are patients as well, remember that I have been offering a special and tailored approach to health and wellness for years. Nutrition and dietitian services combined with my lipidology certification offers me a unique skill set to help folks minimize risk for cardiovascular disease. Invest in yourself and your health so that you can receive dividends of benefits with lower insurance risk, lower overall healthcare expenditures and personal health and satisfaction.