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Month: October 2019

Too much of a good thing (aka – Doctors make the worst patients)

Too much of a good thing (aka – Doctors make the worst patients)

By:  Sasha Klemawesch, MD

 

Like many Americans, I go on and off “health kicks”.  You know, periods of time when you’re exercising, eating right and “doing everything you’re supposed to”.  On my most recent one, I decided I should start supplementing my diet with vitamins, calcium, iron, etc.  The problem is, they make those dang gummies so tasty!  For several weeks I was taking 2-3 times the recommended amount every day, and I couldn’t figure out why I had started to become uncomfortably constipated.  It wasn’t until I woke up one morning and my joints were aching that an old med school adage popped into my head, and I realized both my constipation and arthralgia (joint pain) were due to my overdoing it on the calcium gummies.  The saying is a mnemonic device for remembering the symptoms you get from hypercalcemia, and it goes “Stones, Bones, Groans, Psychiatric Overtones”.

“Stones” refers to kidney stones, since the excess calcium can precipitate in your kidneys and form crystalline stones.

“Bones” is because you can experience bone/joint/muscle pains when your calcium level is too high due to any etiology.  It also alludes to the fact that certain conditions which cause hypercalcemia do so by leeching it out of your bones, thereby weakening them.

“Moans & Groans” is probably the most commonly experienced phenomenon:  abdominal pain, nausea, constipation.  A pharmacist once told me that he shakes his head every time he sees a person’s med list with both Tums and stool softener on it, since Tums are just calcium carbonate, and most people who are popping them throughout the day are often also very backed up.

“Psychiatric Overtones” is just what the name implies:  you can get a variety of psychologic symptoms, the most common being a funky mood (depression accounts for more than a third of the mental ramifications) but you can also experience anxiety, cognitive dysfunction, or in severe cases, coma.

The good thing about calcium is that if your kidneys are in good working order, all you need to do is keep yourself extra hydrated, and it will flush itself out of your system in a few days.  In fact, that’s pretty much the same treatment we start in the emergency department, except we do it through bags of IV saline.

Another key point this episode brings to light is how important it is to make sure your primary care doctors know everything you are taking.  Just because something is over the counter, or maybe a kid form, that doesn’t make it benign (in my case I was taking children’s calcium gummy bears).  Too much of a good thing can in fact be bad, so if you are thinking of starting some supplementations, make sure to run it by your PCP to make sure it won’t interact with any of your medications or have any ill effects on your chronic conditions.

Triclosan and Antibiotic Resistance

Triclosan and Antibiotic Resistance

The New England Journal of Medicine recently published research regarding triclosan and its effect on bacteria.

Triclosan is a poly-chlorinated aromatic compound that targets fatty acid synthesis.  It is found in household items such as some toothpastes, deodorants, and shaving creams.  It is added to these products because of its antimicrobial properties.  Measurable levels of triclosan can be found in the urine of 10% of Americans.

Unfortunately, chronic low-level exposure to triclosan can lead to bacteria becoming resistant to medicinal antibiotics.  Two examples are multi drug resistant E. coli (a common cause of urinary infections) and multi drug resistant Staph (MRSA).

The FDA has banned the use of triclosan in soaps for this reason.  But unfortunately, this prohibition does not include other commonly used products.

Other than promoting antibiotic resistant bacteria, there is also an impact of triclosan on the normal human flora (the microbiome).  The long-term health consequences of changes in microbiome have yet to be studied.

Got Milk?

Got Milk?

By:  Sasha Klemawesch, MD

If you are a dairy lover who is also unfortunately lactose intolerant (and therefore, dependent on taking Lactaid capsules every time you want to eat some cheese or drink a milkshake), good news!  You may be able to scrap those pills!

Studies have shown that lactose intolerant patients who have regularly consumed dairy products (aided by Lactaid capsules), are often able to stop the pills after a few years.  Because they were partaking in dairy on a regular basis, the bacteria in their gut microbiome evolved to accommodate the milk, yogurt, etc.  Once the flora in your GI tract adjusts, the bacteria themselves can take over digesting the lactose, so even though the patient is still technically lactose intolerant, their microbiome has taken over the job that the Lactaid caps were doing and they’re now able to go out for ice cream without taking their medicine along with them.

Supplement Sources

Supplement Sources

By:  Sasha Klemawesch, MD

If the previous article freaked you out about taking supplements, here is a list of common things people often take in pill form and corresponding foods which they could instead be eating to reap the same (or better) benefits.  Every registered dietitian I’ve ever encountered says the same thing; “save your money”!  You don’t need oodles of vitamins and mineral tablets if you are eating a healthy balanced diet.  And the majority of the ingredients you are buying would be better absorbed from their natural food form anyways.

POTASSIUM –    Dried apricots, potatoes (esp. with the skin still on), dark greens like spinach and swiss                                      chard, lentils, prunes, tomato juice or puree, raisins, beans, and of course, bananas

CALCIUM             Milk, yogurt, cheese, sardines, dark greens like spinach and kale, figs, rhubarb, almonds                                  and many products which have been fortified such as cereal, OJ, soymilk, waffles, etc.

VITAMIN K          Kale, mustard & collard greens, swiss chard, natto, broccoli, brussel sprouts, and beef                                      liver

VITAMIN D          Salmon (in particular wild salmon as opposed to farmed), herring sardines, cod liver oil,

Oysters, egg yolks (esp. ones from free range chickens) as with Calcium many things like                                  milk & OJ are fortified with extra D as well

VITAMIN C         Guava, red & green peppers (esp. the sweet reds), tomato juice, oranges & OJ,                                                     strawberries, papaya, broccoli and potatoes

IRON                     Your body can absorb much more iron from animal sources like lean beef, oysters,                                            chicken and turkey, than from plants.  But, beans, lentils, tofu, potatoes, cashews, and                                      dark greens also have a good amount of iron, and many cereals and grains are fortified                                    with it as well

NIACIN (B3)        Liver, chicken breast, tuna, turkey, salmon (again, the wild type), anchovies, brown rice,                                  whole wheat, sunflower seeds, mangoes and nectarines

THIAMINE (B1)  Most breads, cereals and baby formulas are fortified in the US.  Foods naturally high in                                     B1 include pork, trout, black beans and acorn squash

FOLATE (B6)       Since 1998 the FDA began to require enriched breads, cereals, flour, etc. to contain a                                         substantial amount of folic acid, so very few Americans are deficient in it.  Natural                                             sources include beef liver, spinach, black eyed peas, asparagus and brussel sprouts.

VITAMIN B12     Clams, beef liver, rainbow trout, salmon and fortified breakfast cereals

PHOSPHORUS   Chicken, turkey, pork, organ meats, carp, pollack, low & non-fat dairy products and                                          sunflower and pumpkin seeds

OMEGA 3’s         Mackerel, salmon, herring, oysters, cod liver oil, caviar, sardines, flax & chia seeds and                                    walnuts

Dear Dr. K;

Dear Dr. K;

I read about a vaccine given to cats to make them less allergenic.  Is that true?

Not only is it true, but it works.  Swiss scientists coupled cat feline protein number one (the cause of most human cat allergy) to a cucumber mosaic virus and vaccinated cats.  The vaccine was safe for the cats and led to a marked reduction in their feline protein number one.

This research could provide a revolutionary new approach to humans with cat allergy:  making their cats “hypoallergenic”. The Swiss scientists also posited that the cats will also benefit because of improved relationship/fellowship with their owner.

Q – Tips: COPD

Q – Tips: COPD

Patients with COPD can have an exacerbation of their breathing problem for a variety of reasons.  Sometimes it is due to infection, but not always.  The New England Journal of Medicine just published research that indicated a very simple test that can determine if the exacerbation is due to infection (and therefore should be treated with antibiotics) is to measure a C-reactive protein (CRP).  If it is elevated, it indicates infection.

Q – Tips: Vancomycin

Q – Tips: Vancomycin

Vancomycin is a strong antibiotic that has found a great utility in treating serious drug resistant infections.  Generally it is a safe choice, but in a small percentage of patients it can cause a severe systemic allergy.

New research has discovered that a gene called HLA-A 32:01 is the factor predisposing to this allergic response.