Hot Flash

A 19 year old guy come in stating he is having a reaction to a pill.  He took it this morning and about 1 hour later and it got the point of flushing, palpitations, headache, anxiety and now shortness of breath. Previous history is inhaler use for cough after bronchitis treatment about 2 months ago. Only recreational drug was tobacco which he stopped last year cold turkey.  No history of this before and otherwise healthy.
As I was pulled out of another patient room, I enter and notice a red young skinny guy who seemed to be using his shoulders to breath with shaking anxiety.  His physical exam was otherwise normal so I ordered a shot of steroid, high dose benadryl and an IV fluid to make him start peeing.  I gave him reassurance and ask why would a young guy be taking Niacin (then I told him I was given a dose back in 1982 right before I went on stage for Mr Natural New Jersey.....it was supposed to increase "vascularity" to improve the way blood vessels protrude from the skin).  Seems like his mom has a cholesterol issue and the doc said because of my young guys elevated triglycerides he would be fine taking over anything over the counter.  "Redboy" went straight to GNC and bought regular niacin and here we are (should have read consumer labs reviews.)

Niaspan is the prescription form of it and docs prescribe the drug for lowering triglycerides and LDL levels. The theory was if you lover "Bad Cholesterol-LDL" the risk of a heart attack will decrease.  Current thinking is to forget the standard LDL and pay attention to the small, more dense lipids (which require a more expensive blood test called a fractionated lipid panel).  The family of medicines called Statins work to lower LDL but modestly change triglycerides and sometimes lower the good cholesterol (HDL). They have been broadly recommended to prevent high cholesterol in everyone according to studies (some of which are funded by drug manufacturers) The problem is medicines have side effects and I have had patients develop chronic muscle pain for up to 18 months after stopping the statin.  I guess to fight heart disease it's back to exercise, nutrition change and relaxation therapy.  (yes...the Beatles were right-see link)

Here is the reason why nutrition changes FIRST would be important unless there is an urgency in lowering blood levels.  (like an evolving heart attack).  One study (VA HIT) showed by lowering HDL using gemfibrozil the events of coronary heart disease decreased.  So now the buzz words are: raise HDL!!! Gemfibrozil essentially works by not being absorbed from the gut and pulling out cholesterol with your poop. Hey, fiber would do that too right?!?! (see my video on fiber)  Bottom line is sometimes in the midst of massive disease, we need medicines that can produce "massive" side effects. In the decades before disease strikes, over the counter supplements can sometimes cause side effects as well.   Thus it would be prudent to take care of things before you get to advanced disease naturally with lifestyle changes.  The only problem is most people don't feel symptoms at the beginning of bad health.  Eating mostly plants, meditating and taking time off to walk doesn't seem to be inviting to the population who "drives thru" to eat.  Deepak Chopra suggests always keeping life in balance.  Eating industrialized food, sitting all day, always relying on adrenaline (caffeine and sugar) for "energy" is not part of being balanced with the universe.  Fat zebra can't run from lion (unless lion is also fat) so bad zebra health results in not keeping up with the safety of the herd. You can sport your individual stripes but longevity comes when aligned with the universe.  

To V(itamin) or not To V(itamin)....that is the question.

People are coming in totally confused about whether they should take a vitamin supplement or not.  I dont blame them....even the medical community is clueless about nutrition.  It boils down to that,,,,nutrition. Average medical school student spends no time learning about food except cholesterol is bad because Dr Oz said so.  It used to be important in curriculum about 30 years ago but now so much else is squeezed into 4 year that some "non essential" stuff had to be dropped.  No problem....we will save the education for residency.  Oops, no one to teach it to residents except the attending physicians who were trained 20 years ago when nutrition was dropped.   No problem, make it mandatory CME (seminars required 1 time every 7-10 years) training to keep private practice docs updated.  Oops, most docs attend the lectures but stuff the literature under the pile of bills and charts when they get back to the real world.
When doc tells you to eat a balanced diet, you should ask the doc what s/he eats.   When the doc tells you to exercise, you should ask him/her what they do to keep fit.
Dr Klein and associates on the SELECT trial concluded vit E (in alpha tocopherol form) and selenium (in L-methionine selenium form) were associated with an increase in prostate cancer risk for men.  The doses studied were the measurements found in common over the counter vitamins (400IU and 200Mcg respectively).  So the conclusion of Dr Klein is dont take it if you have a history of prostate cancer and he went on to say in an interview....dont take the supplement at all.. The information is good but the they only studied the intake of one type of tocopherol.  Vitamin E in nature comes in 8 forms (my favorite natural sources are almonds, sunflower seeds, kiwi and mangoes).  If you take it there should be a balance of mixed tocopherols and tocotrienols.  The cheapest synthetic  to produce is listed as dl tocopherol - the most abundant form normally found in tissue and blood is d alpha tocopherol.  There is good evidence for Vit E aiding in Alzheimers and Parkinsons disease.  So end of the day, change your nutrition to include a mostly plant based whole food diet.  It you are just starting out a lifestyle change and want to include a supplement or two to provide building blocks to repair the long standing damage accumulated, ok to take a vitamin but you should read labels and empower yourself with the research (google scholar or pubmed) but also know how to interpret the data (www.drweil.com gives Andy's  translation for "layman" of up-to-the-minute research).  The idea will be eventually to get off everything once you have maximized on nutrition and lifestyle.   (in my DrRic 12 Weeks to Change I suggest adding different supplements every few weeks while also self empowering with reading and seeking reliable sources of information to develop your person plan for change)
By the way, as typical for statistical healing, one way to know which supplements you may benefit from (everyone lacks a different level of nutrition) is to get a blood test for every vitamin you are about to take and make sure you "really need it".  Medicare/Medicaid is the insurance of choice for the highest risk people in the US and it Does Not Cover vitamin blood tests.  So I can get substandard blood tests and 'tease out" an opinion from a CBC and CMP (the basic blood all docs order) and say "looks like your blood system is normal so continue current eating pattern".  Kinda like getting an xray of the chest on a tobacco user and saying "all normal-no cancer" so you can continue smoking!!! ......or.......telling an obese person "your annual cholesterol and glucose is normal " so dont change your weight!!!!  My head is spinning from all this dis-empowering research....I'm going hiking....but first I take my "prostate cancer inducer".

 ( ...note: the vit E is lower than the SELECT study but selenium is same  Nice knowing you!!)