Thursday, March 27, 2014

Dramatic Changes in Fibromyalgia Guidelines

Multispecialty panels of physicians in Canada, Israel, and Germany have simultaneously made changes in the diagnosis and treatment of fibromyalgia.  Previous focusing on specific tender points and pain medications has not been successful.  Instead they recommend a diagnosis based on a cluster of symptoms.  The 3 medications currently approved to treat FM (Lyrica, Cymbalta, and Savella) are only mildly successful and can cause significant side effects.  Instead, new emphasis is placed on alternative therapies such as exercise, tai chi, guided imagery, acupuncture, spa therapy, naltrexone and hyperbaric oxygen.  This is a big step in the right direction.


Tuesday, March 25, 2014

New Guidelines for Weight Loss

The Obesity Society has issued new guidelines for the management of overweight and obesity to help doctors and patients achieve successful weight loss.  Body Mass Index and waist circumference appear to be the best indicators for cardiovascular risk, diabetes and all-cause mortality.  No one diet was recommended, but reduced calories and patient preference were important factors.  The guidelines did not discuss food allergies, HCG, or herbal reduction of cravings.  But they did include the one drug that is approved for weight loss (Orlistat, which blocks the absorption of fat) and bariatric surgery.  Support groups and counseling for 6-12 months are helpful for many patients.

See Family Practice News, December 13, 2013, p. 13.


Thursday, March 20, 2014

Risk Calculator Changes Cholesterol Guidelines

The American College of Cardiology and the American Heart Association have radically changed the approach to cholesterol levels, which is good and not-so-good.  It is now recommended that everyone takes a questionnaire that estimates his or her 10-year and lifetime risk for having a heart attack or stroke.  Then the patient chooses the risk factors that he can modify to reduce the risk.  The good part is the recognition that there are many risk factors other than cholesterol for vascular disease.  The bad parts are that no one agrees on what should be on the risk factor list, and that this approach might greatly expand the number of people that are put on statin drugs with minimal benefit.

Google the Framingham Risk Analysis or go to the Chappell Heart Alzheimer’s Stroke Score (CHAS) score, which will soon appear on

Tuesday, March 18, 2014

Is Testosterone Treatment for Men Safe?

There has been a flood of advertising about treatment of men with “low T”.  There is little doubt that some men feel better if their blood testosterone is low and they are treated with the hormone.  However, there might be a slight increase in the risk for heart attacks in patients that have been treated with synthetic testosterone.  With the limited evidence we have at this time, it would be advisable to first try natural approaches, such as supplements to raise nitric oxide.  If testosterone is prescribed, bio-identical hormone replacement might be preferable.

See JAMA, Nov. 6; 310: 1805.


Tuesday, March 11, 2014

Comparing the Impact of a Mediterranean Diet to Chelation Therapy in Diabetic Patients

One of the most publicized studies in 2013 was a 5-year Spanish clinical trial that compared the Mediterranean diet with or without extra olive oil and nuts to a low fat diet in diabetics and those with high risk factors for diabetes.  There was a slight reduction in cardiac events, but they had to treat 70 patients for 5 years to prevent one event. The TACT study of chelation therapy showed that you only had to treat 7 patients to prevent one cardiac event over 5 years.  According to chief investigator, Dr. Lamas, the impact of chelation therapy appears to be greater than any other single intervention to treat diabetes.

See the NEJM Journal Watch, year in review for 2013, the factoral analysis for TACT is in press to be published in the American Heart Journal.

Thursday, March 6, 2014

Bacteria in the Digestive Tract Can Have a Huge Impact

The New England Journal of Medicine reports that we might be witnessing the birth of a revolution in our understanding of human health and disease.  Bacteria in our guts are being linked to cancer, autoimmunity, liver disease, asthma, autism, obesity, diabetes, heart disease, synthetizing important vitamins and amino acids, detoxification, and improving digestion.  Our bodies typically contain 13 trillion cells and 130 trillion bacterial cells, 20,000 genes and 5-8 million bacterial genes.  Alternative practitioners have been talking about the biofilm for years.  It is about time that physicians are finally paying attention.


See the New England Journal Watch, Year in Review for 2013.(subscription needed)

Tuesday, March 4, 2014

Migraines in Children

Migraine headaches occur in 10.5% of children ages 10-15 years of age and 7% of 7 year olds.  Environmental triggers can include lack of sleep, dehydration, stress at school including bullying, and hormone imbalance.  Many drugs are available.  Often overlooked are food allergies and yeast problems, which are readily treatable.  The Kaufman techniques of pain neutralization might be particularly helpful.

See Family Practice News 1 Feb 2014, p. 15.