Probiotics for Acne? Yep Bacteria may be the cure

Acne vulgaris

I recently had a great idea when thinking about probiotics.  They are used to recolonize the gut with good bacteria after a course of antibiotics killed them off. Well why can’t the same be done for the skin in acne patient? We all have bacteria all over our skin and antibiotics have been the mainstay of acne treatment for years but is only minimally effective. Maybe the problem with acne patients isn’t that they have bad bacteria, but instead maybe they lack good bacteria. So after a course of antibiotics maybe we need to be spreading good bacteria on their skin.

Well like most great ideas someone already beat me to it. Dr. Huiying Le at UCLA medical center examined the bacteria on acne patients’ skin and compared it to those with clear skin. They looked specifically at a bacteria called Propionibacterium Acnes which has been linked to acne for years. They found that acne patients had two strains that clear skin patients did not have that they dubbed RT4 and RT5. And, more importantly, they found a strain that clear skin patients had that acne patients did not have called RT6. And RT6 was found to have genes that ward off bacterial viruses and potentially may prevent colonization with bad strains.

So in yet another area we are finding that the answer may not be killing our microscopic friends but instead making sure we are carrying the right ones.

We have ignored these possible treatment options by using beneficial microbes for far too long but I am glad to see the increased interest in this field. If you want another very interesting example of our symbiotic relationship with microscopic organisms read about the possible link between hookworm and allergies.

Nearsightedness- Go Back Outside and Play

Reading glasses

So I just had Lasik on my eyes so I have been thinking about my nearsightedness a lot lately. My vision prior to surgery was horrible (in the 20/200 range, or 7.5 diopters in my right eye and 5.5 in my left). I couldn’t even see the big E on the chart. And as I have talked to people it is clear I am far from alone. Countless people who I know have equally bad if not worse vision. This started me thinking, how could I or any of them ever have survived in the caveman and cavewoman days? (and I would like to point out that spell checker accepted caveman as OK but does not recognize cavewoman. A bit sexist I would say. Cavewoman power!). There is no way with my old vision I could have hunted or even foraged effectively. My spears would never have hit their targets and I would likely have been picking up rocks and rabbit droppings thinking they were berries. So clearly this must be increasing due to environmental reasons. And indeed studies show that rates of myopia (near sightedness) are on the rise.

The reason for this seems obvious to me. In the last thousand years and much more so in the last 100 years we have started spending more and more time indoors. We are now at a point where by far the majority of our life is spent indoors. It is great being in climate control and out of the elements but our eyes rarely have to fix on anything more than 30 feet away. And they can’t look much further than that because there is likely a wall in the way. I have learned through my research into the human body how amazingly adaptive it is. So it seems like our brain and our eyes have adjusted to live at 30 feet or less. Adapt to looking at things up close at the expense of looking at things far away which rarely happens. And this would explain why in most people vision is normal at birth and early childhood and it is not until elementary school or later that glasses are needed.

Indeed a study was done in 2008 in the journal Opthamology by faculty at the University of Sydney, Australia that showed that higher levels of time spent outside by children decreased the risk for nearsightedness. And it did not seem that exercise seemed to make a difference, just time outside.

This I think leads to a much-needed study. We have to quantify how much time needs to be spent outside to hopefully eliminate the risk for nearsightedness. We already have so many reasons to turn off the TV and gets kids outside, but it might be even more convincing to have a recommendation for X number of hours outside to keep vision strong and avoid the need for glasses. No surgery, no drugs, just playing outside.

Turmeric- Nature’s Ibuprofen, But WAY Better

Turmeric Root

Turmeric Root

Turmeric (a plant often used as a spice that can be found in any grocery store) is likely the most common herbal supplement I recommend to my patients. Non steroidal anti inflammatory drugs (such as ibuprofen, advil, motrin, aleve, aspirin) are some of the most commonly used drugs, both by physicians and over the counter. However, their serious side effects are well known and feared by physicians. They are one of the leading causes of stomach and intestinal ulcers and can cause kidney failure. They are usually safe is short courses but for people with chronic pain it becomes a real problem.

Turmeric however has been used in traditional Indian (Ayurvedic) and Chinese medicine for hundreds (possibly thousands) of years for its pain relieving and anti-inflammatory qualities. A study was done in 2011 in the journal Inflammation that looked at the anti-inflammatory capability of turmeric vs ginger vs indomethacin (a strong non-steroidal anti- inflammatory drug) in treating arthritis in rats. Turmeric actually did BETTER than both of them. And by quite a bit. Its anti-inflammatory capability was 10% better.

And ironically turmeric not only does NOT cause stomach ulcers but actually has been shown to suppress H pylori (a bacteria well know to cause stomach ulcer) and even decrease the risk for stomach and colon cancer in animal studies.

The anti-inflammatory compound that seems to be doing the work in Turmeric is called curcumin. Unlike many herbal supplements LOTS of data already exists on the effects of turmeric, how, and where it acts in the body. Given that it has been used for centuries by traditional Ayurvedic and Chinese medicine doctors a safety record has already been well established. In fact the longest known living population on earth in Okinawa, Japan eats tons of Turmeric traditionally and drink tea made from it. Okinawa has an average life expectancy of 81.2 years as compared to 76.8 in the United States. Also Okinawa has the lowest rates of heart disease, cancer, and stroke.

So we have plant that is cheap, can treat arthritis or any other inflammatory condition, and its main “side effects” would actually be a decreased risk for cancer, heart attack and stroke and increased life expectancy. Oh yeah, and some studies show it may decrease the risk for Alzheimer’s dementia as well.

Despite this impressive record very few physicians know any of this. This needs to be studied and sanctioned as an acceptable treatment now.

Vitamin A for Dementia

English: Histopathogic image of senile plaques...

Histopathogic image of senile plaques in a patient with Alzheimer

A relatively new study lays bare the absolute absurdity of the current medical system. A chemotherapy drug called bexarotene which was usually used to treat cutaneous T cell lymphoma was found in rats to cause amazing gains in mental function of rats with dementia type brain changes. The findings were reported in one the most prestigious  science journals Science in 2012. Bexarotene works by acting on Vitamin A receptors (specifically retinoid X receptors). Do you know what else acts on vitamin A receptors? VITAMIN A!

And sure enough if you look back at the medical research studies on Vitamin A and dementia have shown beneficial effects including slowing or stopping dementia and even helping resolve the characteristic plaques seen in the brain. These studies have been predominantly done by Dr. Ono at the University of Kanazawa in Japan and they go back as far as 2004.

That is NINE years ago this link was already known. And has any randomized trial of Alzheimer’s patients been tried treating them with Vitamin A vs placebo? Of course not. But this is the second chemotherapy drug to be tried. So instead of using Vitamin A that costs 10 dollars a month to activate the vitamin A receptor we are going to use a chemotherapy drug that costs 1300 dollars a month.

It is not known if vitamin A would have this same effect as bexarotene, but it stands to reason that if a drug that activates vitamin A receptors has this effect, then vitamin A may as well. And some preliminary studies have fortunately been done and indeed show that it may very well be the case that vitamin A does help treat dementia. Its been nine years since those studies were done. Can we please stop looking at toxic chemotherapy drugs and instead look at vitamin A itself? Not to mention looking into the possibility of antiviral drugs.

Vitamin D and Hepatitis C

Hepatitis virions, of an unknown strain of the...

Hepatitis virions, of an unknown strain of the organism (Photo credit: Microbe World)

You will see a recurring theme of using vitamin D more. I will write why it is logical vitamin D would be so such a useful and yet frequently deficient vitamin in another post.

But yet another use that does not get the attention it should is Vitamin D in Hepatitis C infection. Hepatitis C is a virus that can cause a chronic infection the person is unable to clear. This can lead to cirrhosis and liver cancer. There are treatments but they have very serious side effects, make the patient feel horrible, and have a fairly high failure rate. However, vitamin D might be able to change that.

A 2011 study in Hepatology showed that Vitamin D caused liver cancer cells to produce interferon (a chemical produced by the body that stimulates the immune system). It just so happens that interferon is one of the main drugs we use to treat Hepatitis C. In 2011  a study by Bitetto et al. showed that severe deficiency in vitamin D led to only 10% of patients responding to interferon therapy and being effectively treated for their hepatitis C. In only mildly deficient patients this rate improved to 30% and improved further to 50% in those with normal Vitamin D levels. A 2012 article in Hepatology actually directly showed that Hepatitic C levels decreased in a dose dependent fashion when exposed to Vitamin D. However it is interesting that a recent article in the Annals of Hepatology specifically looking at Spanish patients found no change in Hepatitis C viral levels in the blood after vitamin D supplementation. Some other studies have shown no difference in response to treatment in baseline low vs normal vitamin D level patients.

The preponderance of the evidence points towards a benefit but there is some that shows no benefit. Given that we have a plausible explanation as to why vitamin D would help suppress Hepatitis C and given the increasing evidence that it works I see no reason why a large randomized trial has not yet been done. Most studies so far have been small. There is really no excuse for this as Hepatitis C is a VERY common disease and a large study could be put together quickly.

Some evidence is showing the same possible benefit from Vitamin B12 as well. These are harmless substances that could potentially change people’s lives and save the healthcare system immense amounts of money if it makes treatment successful and prevents cirrhosis or liver cancer. We need to move forward with this soon.

Horse Chestnust Seed Extract for Venous Insufficency

The fruit of the Horse chestnut tree. They are...

Venous insufficiency is a very common problem. It occurs when one way valves in the veins are not working properly due to damage therefore blood pools in the legs and fluid leaks out into the tissue of the lower leg. Most commonly it is associated with varicose veins but this is the most benign symptom. In severe cases (which I have seen MANY) the legs are chronically severely swollen causing pain and open wounds that simply will not heal. The only accepted treatments are compression stockings or frequent visits to have the legs wrapped. Usually these interventions are not very effective.

One time when I was researching treatments on UpToDate (a payed website many physicians use to get good reliable medical information) I found mention of an herbal supplement for venous insufficiency. This surprised me as UpToDate is a very western, main stream type of website that does not mention herbs or vitamins as treatments in any other instance that I know of. In this case it was Horse Chestnut Seed extract. So I went to the research and sure enough, studies by Dr Bisler, Pittler, Siebert and Leach all seperately showed that horse chestnut seed extract was effective for venous insufficency. Each of these physicians demonstrated it independently from each other. And it also surprised me (although by now I guess it shouldn’t have) that the data went back as far as 1996. I had never heard of this treatment for this very debilitating and costly disease and neither had any of my colleagues I spoke to, yet the data was almost 20 years old. And like many other natural treatments, it had few if any side effects and is quite cheap.

It is no silver bullet but it does offer significant improvement. Again, this has to be studied and that could be done easily and cheaply. Merely randomize a large number of venous insufficiency patients (my hospital alone could furnish a few hundred) to placebo or horse chestnut seed extract and there you go. We will finally know if it works and if so start using it. I for one already find the evidence compelling enough and use it for all my venous insufficiency patients.

Ulcerative Colitis, Crohn’s and Fiber

Working in the hospital I see a lot of cases of flares or inflammatory bowel disease (which includes both ulcerative colitis and crohn’s disease). Often the patients are seen by a gastroenterologist and placed on a low residue diet to “rest the colon.” During a flare there is profuse diarrhea and sometimes bleeding and the low fiber diet or even holding off on any food makes clear sense to me. However, I was surprised to hear that some of these patients were being told to continue this diet all the time. Even at major university centers with famous inflammatory bowel disease specialists they were being told to rest their colon with low residue diets (the term for a low fiber diet). Knowing that fiber is good for intestinal health this sounded counter intuitive to me so I went to see if there was literature backing this up. I was surprised at what I found.

A 1999 Journal of Gastroenterology study of 105 patients randomized them to plantago ovata seeds (a good fiber source) vs mesalamine (the most widely used ulcerative colitis medication). The patients in the fiber group did just as well as far as staying in remission as the mesalamine group at 1 year follow-up. So clearly fiber does not do harm and may be as effective as current medications. In 2003 in Japan another study was done using germinated barley as a fiber source and again showed significant benefit to giving fiber to ulcerative colitis patients.

So how about Crohn’s disease? Well in 1985 a study by Dr. Levenstein et al showed that a regular unrestricted diet was no worse than a low residue diet. In 1979 Dr. Heaton et al. did a study where they instructed Crohn’s patients to eat more fiber and unrefined carbohydrates and compared them to patients who received no dietary instruction. The high fiber diet patients did MUCH better than those not given instruction.

So from what research we have it looks like the low residue diet recommendation may actually be detrimental. The data that is out there is old and sparse but what we have points in the direction of a huge benefit of fiber for ulcerative colitis and crohn’s patients. Given the immense importance of diet in these diseases (which predominantly affect the gastrointestinal tract) there is no excuse as to why we don’t already know through extensive research what diet is best for these patients. This should have been done decades ago, but it is never too late. We need to do a study looking at high fiber vs low fiber vs uninstructed/unrestricted as soon as possible.