Paging Dr. Frischer: Dulse

Fact is indeed stranger than fiction: picture a type of marine algae that tastes like bacon! It’s high in fiber, vitamins, minerals, antioxidants, and protein…and is fat free.

173877950

It’s called dulse (rhymes with pulse), and is available online (try Amazon) and at some Whole Foods markets. I bought this seaweed dried, in whole-leaf form, and fried it in a small amount of olive oil for about one minute on each side. The saltiness (it grows in salt water, after all), the nice crunch, the slight greasiness of the olive oil, and the flavor are definitely reminiscent of bacon.

My wife - let’s just say that she was highly skeptical – shared it with me, and even she enjoyed it! My office staff, typically more interested in chocolate than in marine vegetation, was enthusiastic as well. 

Dulse has been harvested and eaten, often in soups, in Northern Europe for hundreds of years or more. The earliest written accounts date back to the 15th century. Today, it is dried and sold for up to $90 a pound as a cooking ingredient or nutritional supplement, often in powder or flake form.

Bon Appétit suggests: To achieve that bacon-like effect, pan-fry some dried whole-leaf dulse with oil over medium-high heat until crisp, then slap it between two slices of bread with lettuce, tomato, and mayonnaise for a DLT. Eat raw or cooked dulse as a snack, or add it to sandwiches and salads.

At Oregon State University, researchers who were originally developing a super-food for abalone developed a new strain of dulse that grows very quickly and can be farmed. Chefs working with it have come up with a long list of recipes ranging from crackers and salad dressing to beer and ice cream.

What makes this seaweed exciting is that it isn’t difficult to produce, and the Oregon strain in particular could become an efficient and lucrative crop. Dulse has a shelf life of about ten days in the refrigerator, and can last a very long time in dried form. 

My conclusion is that dulse is tasty, nourishing, and has the potential to be a pretty flexible ingredient in recipes. If you are choosing nutritionally between bacon and seaweed…seaweed wins! 
 

Paging Dr. Frischer: Jet lag

Whether you’re a frequent flyer or have taken a one-time trip to a faraway location, you have likely experienced jet lag. Upon your arrival and/or return, perhaps you suffered headache, lethargy, fatigue, insomnia, irritability, mild depression, difficulty concentrating, loss of appetite, confusion, dizziness, or even diarrhea or constipation.

Jet lag is a very modern problem. The term came into use when the use of jet aircraft became common. Travel by propeller-driven aircraft, ship, or train was too slow to cause such a thing. When we rapidly change time zones, our body’s circadian rhythms are slow to adjust to the new schedule. 

Jet lag, also known as desynchronosis, or circadian dysrhythmia, can have a major affect on sleep and alertness. Distance alone is not a factor in jet lag – for example, a flight from Greenland to very distant Argentina would cover many miles, but fall within the same time zone. But when we travel east to west or west to east, our body still feels that it remained in the original time zone. Our natural patterns for eating, sleeping, hormone regulation, body temperature, and other functions no longer correspond to the new environment. 

The speed at which the body adjusts to the new schedule depends on the person, as well as on the direction of travel. Travelling east is usually more difficult than travelling west because the body clock must be advanced, which tends to be more difficult than delaying it. Most of us have a circadian rhythm that is longer than 24 hours, so lengthening a day is easier than shortening it. 

Some people may require several days or more to adjust to a new time zone, while others experience little trouble. What can we do to minimize jet lag? 
•    Plan for the new time zone by adjusting your sleep and wake habits for several days prior to the trip: get up and go to bed earlier prior to an eastbound trip, and later for a westbound trip. 
•    Try to select a flight that arrives in the early evening. If you must nap during that day, do so in the early afternoon, and for less than two hours.
•    Change your watch to reflect the new time zone as soon as you board the plane. Avoid alcohol and caffeine at least three to four hours before your new bedtime. 
•    Airplane cabins have low humidity levels. Avoiding dehydration by drinking extra water during the flight.
 
Upon arrival at your destination:
•    Make an effort to stay awake until the local bedtime.
•    Avoid heavy exercise close to the new bedtime.
•    Consider using earplugs and a sleep mask to help dampen noise and block out light, in order to stay asleep.
•    Time your meals with local mealtimes, and avoid heavy meals for the first few days.
•    Set two alarms, or request two wake-up calls, in case you miss the first one. 
•    Spend time in the daylight to help regulate your biologic clock. 

What about the use of sleep aids to combat jet lag? While pills don’t resolve the biological imbalance, they may help to manage in the short-term. Test out a new medication prior to the trip, so that you won’t be surprised by an unexpected negative reaction, or by the lack of a positive response. Many find that melatonin or Benadryl helps to get a better night’s sleep (and, of course, that caffeine helps to stay awake). 

Jet lag is generally temporary and usually does not require treatment. Symptoms should improve within a few days, but can last longer. If you travel frequently, you may wish to speak to your doctor about medication or other strategies. Bon Voyage!

Paging Dr. Frischer: Effects of alcohol

Having just returned from a wonderful wine tasting weekend in the beautiful Napa Valley, I can wax on about the beneficial effects of alcohol. 

Most of us enjoy a drink from time to time, and studies show positive health effects (under certain circumstances) from drinking in moderation.

However, excessive drinking over time, or even on a single occasion, can take a serious toll on our health. Every sip of beer, wine, or other alcoholic drink quickly enters the bloodstream and comes into contact with nearly every organ in the body.

When we consume more alcohol than our body can efficiently metabolize, the blood alcohol level rises. The affect it has on us depends on a number of factors, including weight, age, gender, body composition, general health, food consumption, and the presence of other drugs or medications. What actually happens to our organs when we drink?

Alcohol affects the *brain* in a number of ways, changing coordination, mood, memory and thinking. Speech can become slurred and more difficult. Changes in coordination interfere with balance and the ability to walk. Thought processes, impulse control, and ability to form memories change. Over the long term, drinking can actually shrink the brain’s frontal lobes, and severe alcoholism can lead to permanent brain damage and dementia. Damage to the nervous system may result in pain and numbness. Alcoholism can cause a thiamine (vitamin B1) deficiency, which can result in rapid eye movements, weakness, or paralysis of the eye muscles. Acute alcoholic withdrawal can cause seizures and delirium.

Drinking excessively over time, or even a one-time binge, may damage the *heart*. It can lead to cardiomyopathy, heart arrhythmias, stroke, and high blood pressure. (Of course, in moderate amounts, it can protect healthy adults from developing coronary heart disease.)

Alcohol can wreak havoc on the *digestive system*, from the mouth to the colon. Even a single incidence of heavy drinking can cause injury to the digestive tract. It can damage the salivary glands and irritate the mouth and tongue, leading to gum disease, tooth decay, and tooth loss. It can lead to ulcers in the esophagus, acid reflux, heartburn, stomach ulcers and inflammation of the stomach lining (gastritis). It can cause gassiness and diarrhea. It can also lead to internal bleeding from ulcers, hemorrhoids, or esophageal varices. It makes it harder for the digestive tract to absorb nutrients and vitamins and to control bacteria. As a result, alcoholics often suffer from malnutrition.

The *liver’s* job is to break down and detoxify harmful substances, including alcohol. Liver disease is life threatening because it allows toxic substances to remain in the body. Excessive drinking can cause fatty liver, fibrosis, and ultimately cirrhosis (scarring caused by chronic liver inflammation), which can destroy the liver. Another danger is alcoholic hepatitis, which can lead to jaundice. Women are at higher risk for alcoholic liver disease than men, because women’s bodies tend to absorb more alcohol and take longer to process it.

Drinking can cause pancreatitis, a serious inflammation and swelling of the blood vessels of the *pancreas,* which interferes with digestion and regulation of metabolism. A damaged pancreas can result in a lack of insulin, which then leads to hyperglycemia and diabetes.

The *reproductive system* is significantly impacted. For men, heavy drinking affects the testosterone level, leaves the penis limp and the libido reduced. As few as five drinks per week decreases the sperm count and affects their ability to swim. Almost three-quarters of men who drink excessively have at least one sexual health issue such as low desire, erectile dysfunction, or premature ejaculation. It can cause infertility by affecting the testicles. Excessive drinking can cause a woman to stop menstruating and become infertile. It also can increase her risk of miscarriage, premature delivery, and stillbirth. Fetal Alcohol Syndrome (and related disorders) can result in a baby with physical abnormalities, learning difficulties, and emotional problems.

Long-term alcohol use makes it harder for the body to produce new *bone*, and increases the risk of osteoporosis and bone fractures. It can lead to broken *blood vessels*, which turn the skin and eyes red, and cause puffiness in the face. Alcohol affects the ability to make *muscle*, leading to weakness, cramping, and even atrophy.

Alcohol weakens the *immune system*, making the body an easier target for infections like pneumonia and tuberculosis. It is associated with an increased risk of developing a number of cancers, including cancer of the mouth, esophagus, throat, liver, breast, and colon.

It is clear that there is an enormous difference between drinking moderately (never more than two drinks per day) and drinking excessively.If you are not able to limit your alcohol consumption, I urge you to get help and to not drink at all.

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

Paging Dr. Frischer: Diet Soda

Diet sodas have long come under scrutiny. Are they a healthy alternative to “regular” soda? Are they harmful?

A recent statement from Coca Cola isn’t surprising: “People have enjoyed drinking a Coca-Cola for more than 129 years. Like all soft drinks, it is perfectly safe to drink and can be enjoyed as part of a balanced diet and lifestyle.”

It’s common knowledge that until 1903, Coca Cola’s recipe included actual coca leaf. John Pemberton, a morphine-addicted pharmacist, formulated the original recipe. When coca leaf was removed from the formula, Coca Cola needed to create a new formula with addictive properties. History demonstrates just how successful they were!

It wasn’t until the late 1950’s that diet colas were introduced in the United States. By the 1980’s, they became mainstream and profitable. Originally, the target market was women who were watching their weight. Currently, the marketing strategy includes men and children as well, as a “healthier” alternative to regular sugar soda. One tagline states: “Regret Nothing: no sugar, no calories.”

The perceived benefit of drinking diet soda instead of regular soda is that we are consuming far fewer calories. Diet soda contains no high fructose corn syrup, sucrose, or other forms of processed sugar. The artificial sweetener in most diet soda is aspartame, which is indeed calorie-free. Some, especially those who don’t like to drink plain water, find diet sodas to be a good source of hydration.

While diet soda is a source of fluid, it offers no positive nutritional or health benefits. In fact, drinking diet soda on a daily basis is associated with a long list of increased risks: stroke, diabetes, osteoporosis and greater risk of bone fracture (due to high levels of phosphoric acid), hypertension, kidney disease, heart disease, metabolic syndrome, type-2 diabetes, nausea, dizziness, and migraine headaches. The most surprising correlation, however, shows that diet soda may actually contribute to weight *gain*!

Why? Research has focused on artificial sweeteners leading to overconsumption of other sweet foods. The theory is that diet sweeteners trick the body and disrupt its natural ability to regulate calorie intake.

Aspartame, the most commonly used sweetener in diet sodas, has been the subject of controversy since being approved by the Food and Drug Administration in 1974. It remains on the EPA watch list of most hazardous chemicals.

After reviewing the data, I am in agreement with the large body of scientists who feel that diet soda is not helpful, and likely is harmful to our health. While roughly 20% of us consume diet soda regularly, consumption has been on a steady decline, while the consumption of bottled water has been rising. Hydrating our bodies with water, milk or vegetable juices is far more healthful. If you enjoy fizz in your drinks, try carbonated water.

My recommendation is to avoid diet sodas entirely.

Paging Dr. Frischer: Shrinking

Many times every day, I walk down the hall of my office as my nurse is measuring a patient’s height. I often hear the same reaction: “I didn’t used to be that short!”

We do shrink as we age, usually starting around the age of 40. Overall, men will lose about two inches by age 80, and women three inches. This happens because the bones of our spine lose density, and the gel-like disks that separate each vertebra get worn down and thin. As a result, our spinal column actually becomes shorter. This spine deterioration, compounded by muscle loss, can also cause that hunched-over look (cervical kyphosis).

As a woman approaches menopause, rapidly decreasing levels of estrogen can cause loss of bone mass, and after menopause, bone loss actually outpaces the building of new bone. This loss of bone density and associated loss of height is caused by osteoporosis. Women over 70 who lose height rapidly have a greater chance of fracturing a hip as well.

Shrinking is not inevitable, and happens differently for everyone. Those who live in the city shrink less than those who live in the country.Educated people shrink less than those who are uneducated. It’s likely that these types of differences are connected to accompanying habits such as drinking, smoking and inactivity.

What can we do to slow this height loss?

■ Women over 50 should supplement their daily diet with 1,000 mg of calcium, as well as at least 600 units of vitamin D, as this helps the body to absorb the calcium. The best food sources of calcium are almonds, broccoli, kale, salmon, and soy products like tofu. Dietary sources of vitamin D include oily fish, egg yolks, and fortified milk.

■  Exercise is critical. What we do *after* the age of 40 appears to have the biggest impact. Those who have always exercised, or even those who start exercising just after turning 40, lose only about half as much height as those who never exercise, or stop working out during middle age. The best exercise is weight bearing, like running, jumping, or strength training. Whatever puts stress on your bones will signal the body to add new cells and strengthen the bones.

■ Quit smoking. Smoking works in several different ways to cause bone loss, including by lowering estrogen levels.

■ More than one alcoholic drink per day also works in several ways to cause bone loss, including by blocking the absorption of calcium in the stomach.

Osteoporosis, resulting in loss of height and sometimes bone fractures, used to be considered a normal part of aging. We now understand it to be preventable and treatable. Proven strategies include consuming adequate amounts of calcium and vitamin D, participating in weight-bearing exercise, avoiding tobacco, limiting alcohol, and using medication when appropriate.

Talk to your doctor about an appropriate strategy for you.

Paging Dr. Frischer: Full Moon

Many years ago during my medical residency training at UCLA, I spent time in the emergency room. You can imagine how interesting it could be to work a graveyard shift, and that seemed especially true if it happened to fall on a night with a full moon. Nurses warned me to be ready for anything on those nights. Even today, there are times when my receptionist will look at
me, raise her eyebrows, and suggest that there must be a full moon.

Could the phase of the moon alter our physical or mental state? Ancient Assyrian and Babylonian discuss this. Note that the word *lunatic* was derived from the Latin word *luna*, meaning moon.

The human body is made up of about 75% water. The moon (along with the sun) causes the tides. Could these gravitational tides affect our body? The effect of gravity diminishes with distance but never goes away; in theory everything is always tugging on everything else. Do note that the highest tides occur both on full and new moons - yet no one seems to connect
strange behaviors or events to new moons!

Over the years, researchers have searched for any statistical connection between the moon and human biology or behavior. Reliable studies comparing the lunar phases to births, deaths, heart attacks, suicides, violence, psychiatric hospital admissions, emergency room visits, epileptic seizures, surgical outcomes, menstruation, and sleep habits (to list just a few) have
simply found no significant correlation. Many studies that claimed to find connections turned out to have used flawed methods, or have not been able to be reproduced.

A frequently quoted study was performed by an international group of scientists, who examined the sleep patterns of children and differences in their daily activities. The findings revealed that during full and new moons, the children in the study slept five fewer minutes. The change in sleep represented about a 1% decrease, with no noticeable change in daily
activity.

One statistically significantly study performed by the Colorado State University Veterinary Medicine Center involved almost 12,000 participants: dogs and cats. During a full moon, emergency room visits increased by 28% for dogs and increased by 23% for cats. How this single study would relate to human behavior is unclear.

Certainly there are creatures that shape their lives around the tides. The behavior of coastal wading birds and the breeding of the California Grunion (fish) are good examples of that.

So, why does this myth persist so stubbornly? Perhaps when I was a resident in that UCLA emergency room, knowing that it was a full moon, I interpreted traumas and crises as more extreme or bizarre. Perhaps when strange things happen during a full moon, we tend to make that connection, but when strange things happen over the rest of the month, we don’t automatically connect them to astronomic events. Perhaps, before electricity, the light of the full moon kept people up at night, causing sleep deprivation and associated psychological issues.

Whatever the reason, I think that we can comfortably discard this very old myth!

Paging Dr. Frischer: Flatulence

I had fun with my girls when they were young! We would make a game of using the scientific term for socially awkward bodily functions. Soon, all of their friends were doing it as well. Along those lines, let’s address…flatulence. 

Gas is always present in the GI tract - in the stomach and throughout the intestines. It builds as a normal part of the digestive process. On average, we pass gas 10 to 25 times per day, between one and three pints in total. It’s often released with a sound and/or odor. You may hear it referred to as flatulence, passing gas, farting, or breaking wind.

Flatulence is made up of five odorless gasses; nitrogen, hydrogen, carbon dioxide, methane, and oxygen. The familiar odor is from trace gasses and sulfur-containing compounds. The proportion of each of these gasses depends on the unique balance of gut bacteria. Gas can be quite uncomfortable. When the pain is on the left side, it can be confused with symptoms of heart disease. When it is to the right of the colon, it might be confused with gallstones, or appendicitis. 

A food may not be fully digested in the small intestine, often due to the lack of an enzyme. It then enters the large intestine, where bacteria break it down further and gas is produced. What are the most common foods that may lead to excessive gas?

High lactose foods, including milk, ice cream, and cheese. A deficiency of the digestive enzyme lactase is very common, and results in lactose intolerance. 

■ Beans, which contain the complex natural sugar raffinose – as do cabbage, asparagus, broccoli, and Brussels sprouts.

■Potatoes, corn, noodles, and wheat are high in starches that can produce gas. (Rice is also a starch, but does not cause gas.)

■Onions, artichokes, pears, and wheat contain fructose. It is also added as a sweetener to some soft drinks and fruit drinks.

■Stone fruits like apples, peaches, apricots, cherries and pears, and dried fruits such as prunes, raisins and figs contain the sugar sorbitol. Sorbitol is also added as a sweetener to sugar-free gum, candy, and other weight-loss products. 

■  Beans, peas, oat bran, and most fruits contain soluble fiber. Bacteria in the large intestine break down soluble fiber, and this produces gas. (Insoluble fiber, on the other hand, cannot be broken down by intestinal bacteria, and produces little gas.)

Some activities may lead to an increase in gas, like swallowing air by eating or drinking in a hurry, chewing gum, consuming various tobacco products, sucking on hard candy, drinking carbonated beverages, and hyperventilating. 

Some medical conditions can be responsible for excessive gas production. Malabsorption syndrome occurs when the body isn’t able to properly digest some foods. Small bowel intestinal bacterial overgrowth is a result of an increase in the number or types of bacteria. In fact, any condition that slows the speed of food passing through the colon will allow more opportunities for bacteria to create fermentation, and therefore, gas. 

What can be done about it?

Keep a food diary, and use trial and error to help identify those foods that may lead to excessive gas. Stop eating a suspicious food, and watch for any improvement. Increase water intake. Increasing your dietary fiber will help if constipation is the cause of the gas. I have seen the following gentle remedies suggested (and they won’t hurt): yogurt, ginger, raw honey, peppermint, cinnamon, pineapple, flaxseed, fennel, and juices made from kale, spinach, cucumber, and other greens. 

If making changes in the diet doesn’t help, try an over-the-counter product. Lactase supplements provide the enzyme to digest lactose. Beano contains an enzyme that digests the sugar in beans and many vegetables. Mylanta, Maalox, and Gas-X bind to gas bubbles in the stomach. Activated charcoal tablets may provide relief from gas in the intestines. Probiotics can help by correcting the balance of bacteria in the gut. 

Certain prescription medications may be effective; for example, Reglan can reduce gas by increasing bowel activity, and antibiotics would be used in the case of bacterial overgrowth syndrome or parasitic infections. 

The key is to figure out what will work best for you. If you need help, see your doctor. Don’t hesitate to get medical attention if gas is accompanied by pain, severe cramps, diarrhea, constipation, blood in the stool, fever, nausea, or vomiting. 

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

Paging Dr. Frischer: Candida

As a medical doctor, I am guided by a system of thought that is supported by research, common sense, or at least by experience. Patients come to me for advice, and I make sure that my answers instill confidence, build trust, and lead to positive results. 

However, I’m often asked about subjects where I find no support from my training, the medical literature, or personal experience. One such topic is Candida. 

What is clear and well researched is that Candida is a genus of yeast and is the most common cause of fungal infections. Many species are completely harmless and live in and on humans. Exposure to Candida is so common that tests that measure a response to Candida can be used to confirm that the immune system is working properly. Candida is a normal member of our gut flora, among trillions of microscopic yeasts and bacteria. 

Sometimes Candida becomes so numerous that it causes a yeast infection, especially on the surface of the skin in such warm moist places as beneath the breasts, armpits, the groin, nail beds, and, for those who are very overweight, in folds of skin of the lower abdomen. Another common site for fungal infections is the mouth, where the infection is called oral thrush. Candida is also responsible for the most common vaginal infection. These infections become more common with age, diabetes, diseases causing suppression of the immune system (such as AIDS, cancer or critical illness), use of oral steroids, and heavy use of antibiotics. 

It’s possible, but rare, for Candida to get into the bloodstream and spread throughout the body. This is known as candidemia, and can happen if someone has a very weakened immune system and a yeast infection that has gone untreated. Symptoms usually include high fever and chills. It is seen most often in people who have been in the hospital, and represents a leading cause of bloodstream infection and death among hospitalized patients. 

Despite the fact that Candida can cause serious problems, it is still normal and universally found among healthy people, and belongs in our bodies. Yet since around the 1980’s, there has been much discussion about the purported condition of chronic candidiasis. This has absolutely no support among mainstream medicine. The concept became a social phenomenon in 1986 with the publication of The Yeast Connection by Dr. William Crook. In his book, he proposed that systemic candidiasis, or Candida hypersensitivity, was responsible for a long list of common conditions and non-specific symptoms including fatigue, sexual dysfunction, asthma, and psoriasis. Dr. Crook conducted no research to support his claims. He managed to bypass research, peer review, and scientific consensus, going directly to public promotion! This concept was further bolstered by a 2009 Huffington Post blog by Kim Evans, who claimed that 90% of the population has a problem with Candida overgrowth. She speculated that Candida overgrowth could be the root cause of hundreds of different problems in the body.

Today, Candida hypersensitivity remains a popular condition among some alternative practitioners. The American Academy of Allergy, Asthma and Immunology states that it is speculative and unproven. They point out that some of the proposed treatments offered can be dangerous. 

I am committed to practicing medicine that is supported by science. So, my recommendation is to look elsewhere for an explanation of your symptoms. At this time, medical science believes that practically all of us have candida growing in our intestines…and that it is not harmful. 

Paging Dr. Frischer: TMAO

Now here is something useful: a new lab test to predict your risk of a heart attack. Thanks to the work at the Cleveland Heart Clinic, TMAO has been discovered. What is it? How does it help?

TMAO (trimethylamine N-oxide) is a compound produced by the liver after intestinal bacteria digest certain nutrients. It affects how cholesterol accumulates in tissues, particularly the artery wall. High levels of TMAO indicate an increased risk for developing atherosclerosis, which can lead to heart attack, stroke, and death.  

What are these gut bacteria, and why are they important? On the internal lining of our digestive tract are trillions of microorganisms. The bulk of these microorganisms are critically important bacteria. Each of us has a unique composition of these gut bacteria. Among their many jobs are to produce essential vitamins and to help us digest food. They also form a barrier between the contents of the intestines and the blood stream, continuously combating invasive and disease-causing bacteria.  

Our diet influences our gut microbe composition. Red meat, eggs, and high-fat dairy are high in phosphatidylcholine, choline, or L-carnitine, which provide the material needed for gut bacteria to start producing TMAO. In contrast, vegans and vegetarians produce very little TMAO. 

The reason to check TMAO levels is to determine whether your diet is working for you, and whether more aggressive preventive efforts may be needed. To lower your TMAO level and encourage a healthier makeup of gut bacteria:

■      Consume more green leafy vegetables and fiber.

■     Avoid foods rich in TMAO precursors such as whole milk, eggs, fatty yogurt, cream cheese, ice cream, butter, and red meat like beef, pork, ham, lamb and veal.

■      Consider taking probiotics regularly.

■     Avoid dietary supplements or energy drinks that contain phosphatidylcholine/choline or L-carnitine.

Be on the alert for more information regarding TMAO blood tests. At present, this lab test can be obtained only from the Cleveland Heart Clinic and in a few practices across the United States. It is not yet available at our local standard labs. 

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

Paging Dr. Frischer: Questions to ask your doctor

You just left your doctor’s office…and are now kicking yourself for forgetting to ask important questions! You’re not alone. 

I’m quite aware of this, and often find myself instructing my patients, “Here are some questions you should be asking me.” My goal is to teach my patients to think like a doctor, and to get the most out of a visit. 

Remember that I work for you, and it is up to both of us to help you make the best possible choices regarding your health care.

When you leave a doctor, you should have a good understanding of your overall health picture.

Ask any of these questions, as necessary:
■ What is wrong with me?
■ If my diagnosis is uncertain, what are the possibilities?
■ Why do I have this problem?
■ How do I get rid of it?
■ How can I prevent it from happening again?

Were you prescribed medicine? If you don’t know the answer to every question below, then be sure to speak with the doctor, staff, or pharmacist:
■ Is this medicine to be taken with or without food or other medications?
■ Is it to be taken at a particular time of day?
■ What are the side effects?
■ What is the likelihood that it will be effective? 
■ What might happen if I choose not to take it?

Did your doctor recommend a test?
■ What is the name of the test(s)?
■What specifically is the doctor looking for?
■ Does the test come with any risks?
■ What will happen if I choose not to take the test?
■ When will I receive test results, and from whom?
■ What is the next step?

 Did your doctor refer you to a specialist?
■ What kind of doctor is the specialist?
■ What will they do that is different from what your primary care doctor is doing?
■ When will I follow up with the specialist and with my primary care doctor?
 
Your doctor has been trained to look at the big picture, and to develop an overall roadmap of where your care is headed. You should have a good understanding of this as well. If you are facing cancer or another serious disease, your care can become quite complex. How will you analyze different courses of treatment? Should you see a specialist, or get a second opinion? When should you be scouring the Internet for information? How should you manage the well meaning, but often-untrained friends and family members who offer their “expert” opinions?
 

Remember that this is your life, and your care. If you are comfortable with the answers to your questions, than follow the recommended plan. Otherwise, you can choose to look elsewhere for healthcare. When facing serious health issues, you will need to establish a support system made up of your doctor, your family, and your community. Use them, according to their own particular strengths, to help you through a difficult time.

Always remember that your doctor is working for you. He or she wants to make a positive difference in the lives of their patients. Arrive at the appointment prepared. Help your doctor to help you get the very most out of the health care system, and to achieve your very best possible state of health. 

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

Paging Dr. Frischer: Ear Wax

Today’s challenge is to make earwax interesting. It’s an extremely common problem among my patients, and a little education won’t hurt. I do recognize that the subject is unappealing and not discussed in polite company, but we all have it; so here’s an earful.

History tells us that in medieval times, earwax was used by scribes to prepare pigments. The 1832 edition of American Frugal Housewife recommended earwax to prevent the pain resulting from a wound from a nail. It also suggested that earwax was a good remedy for cracked lips. Before waxed thread was commonly available, seamstresses would use their own earwax to stop the cut end of a thread from fraying. That sounds pretty ingenious to me.

Earwax is also known as cerumen. It is a sticky combination of sebum (sloughed off skin cells from inside the ear) and secretions from glands in the outer ear canal. There are basically two types – wet and dry. The type depends on your genetic makeup. Almost all of those with African or European ancestry have the wet type of earwax, and almost all East Asians, Pacific Islanders, and Native Americans have the dry type. Earwax color can range from bright orange to dark brown. Adults tend to have harder and darker earwax, while children typically have softer, lighter wax. 

Earwax is a good thing:

■ It protects us in a way similar to that of eyelashes and nose hair. Earwax shields us from bacteria, dirt, and other microorganisms that might get into the sensitive inner ear and cause irritation, inflammation, or infection. The waxy substance traps and essentially suffocates whatever might collect (and breed) in the ear canal, and has antimicrobial properties.

■ Similar to tears, earwax lubricates our ears. Without adequate amounts, our ears would feel dry and itchy.

■ It makes our ears self-cleaning. When we chew, we help keep earwax churning slowly from the eardrum to the ear opening, where it normally dries up, flakes off, or falls out.

Since our ears are self-cleaning, we should never stick anything in them…in theory. We’ve all heard this. Are cotton-tipped swaps used by most of us, including doctors? Absolutely. Be aware, however, that we may actually be pushing wax further into the ear, where it can block the ear canal. This affects hearing, and earwax is the most common cause of partial hearing loss.

As we age, earwax may become more of an issue. The skin of the ear canal becomes drier, making it more difficult for earwax to drain normally. Cilia, the tiny hairs in the ear, tend to increase with age and trap more earwax. Hearing aids, ear buds, and earplugs may block the drainage of earwax. Those who suffer recurrent ear infections or some skin conditions may tend to accumulate more earwax.

Symptoms of excessive earwax accumulation include frequent ear infections, tinnitus or ringing in the ears, pain or itching in the ear canal, partial loss of hearing, dizziness and vertigo, and the sensation of plugged ears.

So, what is the safest way to clean our ears? Let’s start with what NOT to do. Ear candling, also called ear coning or thermal-auricular therapy, is an alternative medicine practice purported to improve general health and well being, and to remove earwax. A hollow candle is used to soften and suction out wax. Ear candling may be dangerous and ineffective. Hot wax is simply not a good thing to have anywhere near the ear canal and eardrum.

If you have diabetes, a weakened immune system, a tube in the ear, or a perforated eardrum, do not attempt to remove earwax yourself. However, most healthy people can remove earwax by softening it with drops of baby oil, mineral oil, glycerin, hydrogen peroxide, or an easily found commercial product like Debrox. Once softened, the wax can be washed out by gently squirting water into the ear canal with a rubber-bulb syringe.

Your primary care doctor or an Ear Nose and Throat doctor (ENT) can remove earwax by washing, vacuuming or scraping out the wax. Don’t hesitate to see your doctor if your hearing has worsened, if you have ear pain, or experience blood coming from your ear canal. And, don’t forget to donate that excess earwax to your local seamstress.

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

Paging Dr. Frischer: Vitamin C

In 1747, a British Royal Navy surgeon conducted the first recorded controlled experiment. He proved that vitamin C prevented scurvy. Scurvy is now rare, but it was once common among sailors, pirates, and others who spent long periods of time onboard ships. When a voyage outlasted the fruit and vegetable supplies, the lack of vitamin C led to scurvy.

Vitamin C, also known as ascorbic acid, is water-soluble, which means that leftover amounts exit the body through the urine. Therefore, we need an ongoing supply in our diet for normal growth and development. Signs of vitamin C deficiency include fatigue, muscle weakness, joint and muscle aches, bleeding gums, leg rashes, and eventually scurvy.

Most experts recommend getting vitamin C from a diet that is high in fruits and vegetables, rather than from taking supplements. Good sources include citrus fruit (lemon, lime, orange, grapefruit), apple, melon, mango, berries, papaya, kiwi, watermelon, tomato, asparagus, broccoli, cabbage, cauliflower, dark leafy greens (kale, spinach), peppers (especially red), potato, and fortified food (bread, grain, cereal).

Why do people take vitamin C supplements? There is quite an unbelievable list of reasons. It has been used to prevent and treat the common cold. It is also used to treat gum disease, skin infections, HIV, stomach ulcers, tuberculosis, dysentery, bladder and prostate infections. It is also used to treat depression, Alzheimer and other dementias, stress, fatigue, ADD and ADHD, heart and arterial diseases, hypertension and high cholesterol, glaucoma, prevention of cataracts and gallstones, treatment of constipation, Lyme disease, heat stroke, hay fever, asthma, cystic fibrosis, infertility, diabetes, chronic fatigue, arthritis, cancer and osteoporosis. Finally, it has been touted to improve physical endurance, slow the process of aging, and help with the symptoms of withdrawal.

But what has Vitamin C actually been scientifically proven effective for? It’s truly amazing how much research has gone into this question. We can certainly agree that it does prevent scurvy. However, further studies of potential health benefits have provided conflicting results:

■ It does not appear to have any effect in the treatment of rheumatoid arthritis.

■ There is no clear evidence that vitamin C supplements help to prevent cardiovascular disease.

■ There is no evidence that supplements reduce the risk of myocardial infarction, stroke, or cardiovascular mortality. (One analysis found that it might reduce the risk of stroke.)

■ The use of high-dose IV vitamin C is not recommended as an anticancer agent.

■ Studies failed to find support for the prevention of breast cancer, but it might be associated with increased survival in those already diagnosed.

■ There is weak evidence that vitamin C might protect against lung cancer.

■ Taking vitamin C has no effect on the risk of prostate cancer.

■ There are mixed or weak results regarding a link between vitamin C supplements on the risk of colorectal cancer.

■ Studies examining the effects of vitamin C on the risk of Alzheimer’s disease have been conflicting. Maintaining a healthy dietary intake is probably more important than taking supplements.

■ No significant effects were found on preventing or slowing age-related cataracts.

■ Some research has shown that vitamin C may improve the absorption of dietary iron, and therefore help in treating anemia. Research is ongoing.

■ Vitamin C supplements appear to have no effect on overall mortality.

Finally, the effect of vitamin C on the common cold has been extensively researched. Surprisingly, it has not been shown effective in the prevention of the common cold (with one exception: when exercising vigorously in cold environments). Taking vitamin C supplements does not reduce the incidence or severity of the common cold in the general population, though it may reduce the cold’s duration.

Are there any risks associated with too much vitamin C? When obtained from food sources and supplements in the recommended dosages, vitamin C is regarded as safe. For most healthy individuals, the body can only hold and use about 250mg of vitamin C each day. At times of illness, during recovery from injury, or under conditions of increased oxidative stress (including smoking), the body can use greater amounts. Very high doses of vitamin C (greater than 2,000 mg/day) may contribute to kidney stones, as well as cause severe diarrhea, nausea, and gastritis.

The vast majority of uses for vitamin C are based on tradition and hearsay, or on marketing, rather than on hard scientific data. Many studies have been poorly conducted, and more and better research would be needed before I would recommend supplements for my patients.

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

Paging Dr. Frischer: Floaters

Have you observed floating squiggly lines, thread-like strands, or spots in your field of vision? What are they? Where do they come from? Are they serious?

Eye floaters are distracting, and at best are annoying. Most of us learn to ignore them. Let’s start with a little physiology: At the front of our eye, the cornea and lens focus rays of light onto the retina, in the back. As the light makes its way to the retina, it passes through the vitreous humor, a jellylike material that fills the back two-thirds of the eye. At birth and during childhood, the vitreous gel is clear and transparent.

As we age, this gel undergoes some liquefaction, resulting in small pockets of liquid lying within the firmer gel. In addition, collagen fibers in the gel become thickened and denser. Each of these strands casts a small shadow onto the surface of the retina, and these shadows look like floaters in the eye. As we look from side to side or up and down, these fibers, deposits, or boundaries between liquid pockets also shift in position, making the shadows move and appear to float or undulate.

Those at increased risk for floaters are older, nearsighted, diabetic, and/or have had cataract surgery. Serious causes of floaters include infections, inflammation, hemorrhage, retinal tears, and eye injury.

Occasionally, a section of the vitreous pulls fine fibers away from the retina all at once, rather than gradually, causing many new floaters to appear suddenly. This is called a vitreous detachment, which in most cases is not sight threatening, and requires no treatment.

Occasionally, eye floaters are due to white blood cells in the vitreous, a result of inflammation or infection. Anti-inflammatory drugs or antibiotics will reduce the number of white blood cells, and as a result, the number of floaters will decrease.

A detached retina is a serious emergency that causes a sudden increase in floaters. It occurs if part of the retina is lifted or pulled from its normal position at the back wall of the eye. A retinal detachment may also be accompanied by light flashes or peripheral vision loss. If left untreated, it can lead to permanent damage and even blindness, within just two or three days.
Generally, the treatment for floaters is watchful waiting. On rare occasion, floaters can be so dense and numerous that they significantly affect vision. A surgical procedure (vitrectomy) can remove floaters from the vitreous. The vitreous gel, which is mostly water, is removed along with floating debris. The vitreous is replaced with a salt solution. This operation carries significant risks, due to the possibility of retinal detachment, retinal tears, and cataract. Most eye surgeons will not perform this surgery.

Although certain herbs, vitamins, and iodine-containing products claim to decrease eye floaters, no oral or eye drop medications have been proven effective in clinical trials. Preventing trauma to the eyes and controlling diabetes are the best ways to help prevent floaters.

When should you see a doctor? A few floaters are not likely a serious problem. See an ophthalmologist if the number of floaters increases dramatically, is sudden in onset, if you experience flashes of light or any visual loss, develop floaters after eye surgery or trauma, or have pain.

The prognosis is good - well over 90% of people with floaters are not bothered by their presence, and no action is needed. 

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

Paging Dr. Frischer: Pink Eye

Just last week, a teacher visited my office with a pink and itchy eye. Pink eye, or conjunctivitis, was spreading through her elementary school classroom. This is one of the most common, contagious, and (thankfully) treatable eye conditions. There are roughly three million cases in the United States every year.

The “-itis” in conjunctivitis refers to inflammation, in this case of the conjunctiva, the thin, clear tissue that lines the inside of the eyelid. The inflammation makes the blood vessels of the eye more visible, giving the eye a pink appearance.

Pink eye is diagnosed with an eye exam, and your doctor may take a culture of the fluid in the eye if it is a severe case. There are three types of conjunctivitis:

Bacterial conjunctivitis results in a sticky, yellow or green eye discharge. Upon awakening, the eye may feel as if it is glued shut. Bacterial conjunctivitis is easily spread by direct contact by hands that have touched the eye. It’s caused by bacteria, including staphylococcus aureus, streptococcus pneumonia, or haemophilus. It tends to occur in one eye, and may accompany an ear infection.

Bacterial conjunctivitis typically needs treatment. Mild bacterial conjunctivitis may get better without antibiotics, but antibiotic eye drops or ointment can help shorten its course, reduce its spread to others, and lessen the risk of complications.

Viral conjunctivitis causes itching in the eye, a watery discharge, and sensitivity to light. It is highly contagious and can be spread by coughing and sneezing. It is usually caused by the adenovirus, and might accompany an upper respiratory tract infection, cold, or sore throat.
Most pink eye cases caused by viruses are mild and will resolve by themselves in a week or two without treatment or lab tests. Antiviral medication may be prescribed for serious cases, including infections caused by herpes simplex, varicella zoster (chicken pox and shingles), or rubeola (measles).

Allergic conjunctivitis symptoms include watery, itchy eyes, a runny nose, sneezing, and scratchy throat. It affects both eyes and it is not contagious. It is caused by allergies to pollen, dust mites, molds, animal dander, irritants including contact lenses and solutions, chlorine from a swimming pool, smog, or makeup. It often occurs seasonally, during high pollen counts of the spring, or mold in the fall.

Most cases of allergic conjunctivitis are mild and will resolve on their own. Symptoms can be treated with artificial tears for the dryness, and cold packs for the inflammation. Eye drops and oral medication for allergies may help. More importantly, reduce contact with the allergen (such as pollen, or animal dander).

See your doctor if your pink eye is accompanied by moderate or severe pain or by changes in vision (including sensitivity to light, or blurring), if the eye is intensely red, if the pink eye gets worse, or if it simply doesn’t go away.

How can we prevent conjunctivitis? As my teacher patient learned the hard way, viral and bacterial conjunctivitis are highly contagious and spread easily! Take these preventive steps:

■ Wash your hands often with soap and warm water or an alcohol-based hand sanitizer, especially if you have touched an infected person’s eyes, bedding, or clothing.

■ Avoid touching or rubbing your eyes.

■ If you have conjunctivitis, gently wash any discharge from the eye several times each day.

■ If one eye is infected, don’t use the same eye drop dispenser or bottle for the non-infected eye.

■ Don’t share makeup, makeup brushes, contact lenses or solutions, or eyeglasses with anyone who is infected. To avoid re-infecting yourself, throw away or sterilize any of these items you may have used while infected.
 

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

 

Paging Dr. Frischer: Cataracts

Has your vision has been gradually declining? Do your surroundings seem darker than usual? You could be suffering from cataracts. Worldwide, cataracts are the leading cause of vision loss.
 
A cataract is a clouding of the lens in the eye, and most are related to aging. They can occur in either one or both eyes, but do not spread from one eye to another. Cataracts affect more than 22 million Americans age 40 and older. By age 80, more than half of all Americans will have cataracts (or will have had cataract surgery), There are more cases of cataracts worldwide than there are of glaucoma, macular degeneration, and diabetic retinopathy combined.
 
To understand more, let’s review some anatomy. The lens of the eye focuses light, or an image, onto the retina. The retina is the light-sensitive tissue at the back of the eye. In a normal eye, light passes through the transparent lens to the retina. Once it reaches the retina, light is changed into nerve signals that are sent to the brain.
 
Why does a clear lens become cloudy? The lens is made of mostly water and protein. As we age, some of the protein may clump together and gradually cloud more and more of the lens. In addition, the lens may slowly color with age, with vision gradually acquiring a brownish shade.
 
How can you tell if you might have a cataract? Be aware of cloudy or blurry vision, faded colors, glare from headlights or lamps, halos around lights, sunlight that appears to be too bright, poor night vision, double vision or multiple images in one eye, and frequent changes in prescription for glasses or contact lenses. Your optometrist or ophthalmologist can make a diagnosis.
 
Treatment depends on the stage of the disease. In the early stages, new glasses, brighter light, anti-glare sunglasses, and magnifying lenses will help. When these measures are no longer effective, and the vision loss interferes with everyday activities, surgery can remove the cloudy lens and replace it with an artificial one. Cataract surgery is one of the most common operations, and is quite safe and effective. Because an artificial lens replaces the old cloudy lens, once the surgery has been done, the cataract cannot return.
 
Even though cataracts may start earlier, vision problems are often not noticed until age 60 and older. Researchers have not determined exactly why cataracts tend to form with age, but risk factors include:

■ Ultraviolet radiation (from sunlight and other sources)

■Diabetes

■Hypertension

■Obesity

■Smoking

■Long-term use of corticosteroid medications

■Statin medicines (used to reduce cholesterol)

■Previous eye injury, inflammation, or eye surgery

■Hormone replacement therapy

■Significant alcohol consumption

■Extreme nearsightedness

■Family history

 
You will notice that some of these potential risk factors can be prevented with lifestyle changes (including smoking!) and others are more problematic. A number of controversial studies suggest that certain nutrients and nutritional supplements may reduce the risk. Vitamin E and the carotenioids lutein and zeaxanthin may be effective. These can be found in sunflower seeds, almonds, spinach, kale, and other green leafy vegetables, as well as in supplements.

Researchers also believe that good overall nutrition can help reduce the risk of age-related cataracts. I would certainly recommend eating green leafy vegetables, fruit, and other foods with antioxidants, even with an unproven link to cataract prevention.
 
If you have observed that your vision is declining, becoming darker, or that you see halos at nighttime, the good news is that your problem may very well be able to be fixed with a simple surgery. I encourage you to see your doctor. 

Paging Dr. Frischer: Food and medication

What we eat and when we do it is significant for so very many reasons. Among the most important relates to our medications. You have likely heard warnings such as “Never drink grapefruit juice with cholesterol medication.”
 
Medication effectiveness is an especially important issue for older adults; while they make up roughly 13% of the population, they account for 34% of prescriptions and 30% of over-the-counter drugs taken in the United States. About two of every five people on Medicare report taking five or more prescription medications. Older patients often have more than one doctor prescribing for them, making it difficult to track all of the medications. Drugs might interact with each other, or with another disease process. To further complicate matters, as we age, physiological changes affect how a drug is absorbed, distributed, metabolized, and excreted.
 
On top of all of these factors, the way in which we consume our food and drink can significantly impact a medicine’s safety and effectiveness. Let’s take a look at some of the most common food/drug interactions.
 
Grapefruit is well known for interacting with a variety of different drugs, resulting in either a higher or lower concentration of the medication in the blood. This can lead to an increased risk of serious side effects. Grapefruit contains furanocoumarins, which can change the way that the body metabolizes a drug by inhibiting an enzyme. Grapefruit also contains bioflavonoids (as do Seville oranges, pummelos, rose hips and black currants). Bioflavonoids affect most calcium channel blockers (prescribed for high blood pressure), statins (cholesterol-lowering drugs), antihistamines, some antibiotics (including ciprofloxacin), thyroid medication, birth control pills, stomach acid drugs, and some cough suppressants. If you use any of these medicines, it is best to simply avoid grapefruit altogether.
 
Green leafy vegetables such as kale, collards, spinach, turnip greens, Brussels sprouts, broccoli, asparagus, and endive are high in vitamin K, which diminishes the effectiveness of Coumadin (warfarin), a commonly used blood thinner. Coumadin treats and prevents blood clots, and prevents strokes in patients with atrial fibrillation. Other foods that can affect Coumadin levels include cooked onions and soy. The trick is actually not to avoid greens, but rather to eat a consistent amount, so that Coumadin levels in the blood remains steady.
 
I am a fan of black licorice. In sufficient quantities, glycyrrhiza, contained in licorice root, can lead to low potassium, salt and water retention, edema, and high blood pressure. Glycyrrhiza can decrease the effectiveness of blood pressure medicines and the blood thinner Coumadin. By the way, did you know that most licorice root production is used for tobacco products?
 
Dairy products can decrease the effectiveness of some antibiotics, including tetracycline, ciprofloxacin, and azithromycin. The calcium and magnesium in dairy can bind to the antibiotics and prevent their absorption. (However, note that certain antibiotics, like metronidazole (Flagyl) should be taken with milk or water in order to prevent stomach upset.) Dairy can also decrease iron absorption.
 
Salt substitutes typically replace sodium with potassium. This can decrease the effectiveness of Lanoxin (digoxin), used to treat congestive heart failure; and ACE inhibitors, used to treat high blood pressure. Those with decreased kidney function already have a hard time eliminating potassium, and should avoid salt substitutes.
 
When is it important to have a full or an empty stomach? NSAID’s like Motrin, Advil, and Aleve should be taken with food because they can be irritating to the stomach lining. Tylenol is best taken on an empty stomach because food may slow its absorption. Antihistamines like Claritin, Zyrtec, and Allegra are also best taken on an empty stomach – they will be more effective. Certain antibiotics (including azithromycin and tetracycline) have poor absorption when taken with food.
 
Alcohol can be dangerous when combined with anti-anxiety medication like Xanax, Ativan, and Klonopin; antidepressants; or sleep medication, because it may add to the sedating effects of these drugs. Alcoholic can also increase or prolong the effects of insulin and oral diabetic medications, leading to low blood sugar. Alcohol and Tylenol are a bad combination; two or more drinks per day can increase liver toxicity.
 
Understanding of drug/drug, food/drug, and herb/drug interactions is rapidly growing. Further, genetic factors affecting pharmacokinetics and pharmacodynamics are being studied, which is expected to lead to improved drug safety and to enable individualized drug therapy. It’s extremely complex! I urge you to pay close attention to recommendations from your physician and your pharmacist.

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

Paging Dr. Frischer: Apple cider vinegar


There is likely a bottle of apple cider vinegar in your pantry right now. It’s a tasty ingredient for salad dressings, marinades, and homemade pickles.
 
Does it also bestow health benefits? Apple cider vinegar has a long history in health care. Hippocrates (who, even though he lived 2,500 years ago, is known as the father of modern medicine) wrote of it as a treatment for various types of infections. It has been credited with curing ailments ranging from warts to the flu. My personal experience with apple cider vinegar dates back to my grandmother. If we were sick, she mixed it with water and honey, and boiled it on the stove. We inhaled it through our nose, and I can certainly report that it cleared up my sinuses. Thank you, Grandma.
 
For thousands of years, vinegar has been used for weight loss. A 2005 study of only 12 people found that those who ate a piece of bread along with small amounts of white vinegar felt fuller and more satisfied than those who ate just the bread. In a Japanese study, 175 obese but healthy people of varying age and body mass index (BMI) consumed either vinegar or water daily for 12 weeks. Their diets were similar, and they kept food journals. Those who had vinegar lost slightly more weight…and gained it back after the study was over. The theory was that vinegar curbs appetite, or extends the feeling of being full.
 
Another touted use for small amounts of apple cider vinegar in the diet is to help lower blood sugar. The belief is that vinegar blocks some of the digestion of starch, and therefore prevents it from raising the blood sugar. Several small studies have found that vinegar may indeed help to lower glucose levels, including a 2007 study with a mere 11 participants who suffered from type 2 diabetes. Regular intake of about two tablespoons resulted in a 4-6% decrease in blood sugar.
 
Apple cider vinegar also has been credited with antimicrobial qualities, and is traditionally used as a cleansing agent, with its high acidity inhibiting the growth of certain types of bacteria. I could not find studies to support this.
 
A 2006 study showed evidence that vinegar could lower cholesterol…in rats. There have been no studies to date using people.
 
Another study using rats found that vinegar could lower elevated blood pressure, and a large observational study found that people who regularly consumed oil and vinegar dressing on salads had lower rates of heart disease. However, it’s not clear that the vinegar was the reason.
 
A few laboratory studies have investigated whether vinegar can kill cancer cells or slow their growth. However, observational studies have been confusing. One found that consuming vinegar was associated with a decreased risk of esophageal cancer, while another associated it with an increased risk of bladder cancer.
 
When diluted with water, it has been used as a skin toner. Bathing in diluted apple cider vinegar, or using a cloth soaked in diluted vinegar, is said to reduce the effects of sunburn. A reported treatment for warts is to soak the wart in diluted vinegar. Note: always be careful to avoid getting vinegar near the eyes.
 
Apple cider vinegar does have its downsides. The most obvious disadvantage is its taste – it’s not appealing to drink or to add to food in large quantities. It is highly acidic. While in moderate amounts the acetic acid in apple cider vinegar may act as a useful antiseptic, too much can actually cause damage. Undiluted, it can wear away tooth enamel, or burn gums and tissues in the esophagus. Those who are particularly sensitive might even experience burns on the skin. Over-consumption of apple cider vinegar could lead to a reduction in potassium, a critical electrolyte that affects hydration and the nervous system. Long-term use of apple cider vinegar can lead to loss of bone density.
 
My bottom line? I can personally vouch for my grandmother’s claim that it clears the sinuses. However, the many, many other claims simply have not undergone enough serious scientific evaluation to convince me to recommend it. However, keeping in mind the caveats listed above, the downside risks are minimal – feel free to use it as you see fit! 

Paging Dr. Frischer: Zika virus

The Obama administration intends to spend some $600 million, originally earmarked to fight Ebola, to combat the spread of the Zika virus. And, that looks to be just the beginning; Congress may authorize $1.8 billion more.

Just three months ago, the World Health Organization (WHO) declared the Zika virus infection an international public health emergency. It has been seen in at least 55 countries and territories between 2007 and March of this year. Just what do we know about Zika?

The scariest news about the Zika virus is that a pregnant woman can transmit it to her developing child. It has been shown to be the direct cause of microcephaly (the development of an abnormally small head), and is linked to a range of other serious developmental problems, including issues with hearing and vision. Less frequently, in adults, the virus is linked to Guillain-Barré, a severe autoimmune reaction.

Because 75%-80% of those infected with Zika show no symptoms, it is difficult to know how many cases actually exist, and extremely challenging to control its spread. In one out of four or five cases, however, those infected develop a flat pinkish rash, bloodshot eyes, fever, and joint pain.

The virus is most often spread by mosquitoes, but by sexual contact as well. It was first isolated in 1947 in a rhesus monkey and is named after the Zika Forest in Uganda. Until 2007, there were only 14 human cases of Zika documented. This current outbreak began in 2015 in Brazil. It is possible that the virus was brought to Brazil during the 2014 World Cup, by an infected traveler who had been exposed in French Polynesia. That person may have then been bitten by a mosquito, which subsequently infected others. A baby was born in Hawaii with microcephaly due to Zika, but the mother likely contracted the virus when she was in Brazil. The first case of Zika contracted on the United States mainland was through sexual transmission, when a person exposed outside of the United States had sexual contact with a partner in Texas.

The infection is potentially so devastating that the Centers for Disease Control and Prevention has issued travel notices, with huge consequences for tourism. As of April 18th, countries with active Zika transmission in the Americas that pregnant women are urged to avoid are: Aruba, Barbados, Belize, Bolivia, Bonaire, Brazil, Colombia, Puerto Rico, Costa Rica, Cuba, Curacao, Dominica, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Saint Lucia, Saint Martin, Saint Vincent and the Grenadines, Sint Maarten, Suriname, Trinidad and Tobago, U.S. Virgin Islands, and Venezuela. The World Health Organization warns that the virus is likely to spread throughout most of the Americas by the end of this year.

In addition, travel notices have been issued for a number of the Pacific Islands, as well as Cape Verde in Africa. Refer to the State Department or CDC website for more details.

Note that the upcoming summer Olympics are to be held, of all places, in Brazil. A number of athletes face a tough decision over whether to attend. Several countries have advised their own citizens to delay pregnancy for now, until more is known about the virus.

How is the diagnosis made? The general symptoms of Zika can appear similar to other viral infections, so the first question asked is whether there was a reasonable chance of exposure to Zika. If so, there are both blood and urine tests that can detect the virus.

There is no specific treatment for the Zika infection. There is no vaccination to prevent it, or medicine to treat it. Like the virus that causes the common cold, recommendations are to treat the symptoms, get lots of rest, and to drink plenty of fluids.

The virus is not considered dangerous to anyone other than pregnant women. It is not clear yet at what stage of pregnancy the fetus is the most vulnerable to infection. At this time, the best advice is if you are pregnant or planning to become pregnant, take extra precautions to avoid mosquitos, avoid sexual contact with a partner who could possibly have been exposed to the virus, and do not travel to the countries listed above. If you are pregnant and suspect that you may have Zika, consult your doctor as soon as possible.

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

Paging Dr. Frischer: Color Blindness

What you and I see may differ - are you aware that we don’t all share the same visual perception of color? Between eight and ten percent of men (but very few women) have some degree of color blindness. I suspect that we all know someone with this condition. Recently, a patient explained to me that he couldn’t see the difference between a green and a red traffic light. He immediately reassured me that from an early age he learned a simple trick: the red light is always on top!

How do we see colors? Think of the eye as a camera. In front is a lens that focuses images onto the retina, located at the back of the eye. The retina contains photoreceptors, which are shaped like rods or cones. They contain pigments that change when light strikes them. Just as a painter can mix a small number of colors together to make up every color and shade, when rods and cones work together, the eye can see millions of colors.

Color blindness is a condition where colors cannot be clearly distinguished. The name is misleading, because those with color blindness are certainly not blind. It can range from mild to severe. This problem can be life changing, and may make it harder to read and to learn. However, children and adults are usually able to adapt.

Most problems with color vision are inherited and present at birth. This type of color blindness doesn’t change with time, and occurs when cone cell types are missing or don’t work properly. There are different types of color blindness. Red/green color blindness is the most common. A much more rare form is blue-yellow color blindness (which is actually the inability to distinguish between blue and green; and yellow and violet!). Some young children have blue/green confusion, but this actually improves with age. The most rare type of color blindness is the total inability to distinguish colors, or monochromacy. It affects only about 1 in 33,000 people in the United States. Those with this condition see the world in shades of gray, have poor clearness of vision, and are extremely sensitive to light.

Occasionally, color blindness is not inherited, but acquired:

•Chronic illnesses that may limit color perception include Alzheimer's disease, diabetes, glaucoma, leukemia, liver disease, alcoholism, macular degeneration, multiple sclerosis, Parkinson's disease, and sickle cell anemia.

•Accidents or strokes can damage the retina or affect particular areas of the brain or eye.

•Some medications can affect color vision. These include antibiotics, barbiturates, anti-tuberculosis drugs, high blood pressure medications, and some psychiatric medications.

•Certain industrial or environmental chemicals, including carbon monoxide, carbon disulfide, fertilizers, styrene, and some chemicals containing lead, can affect color vision.

How is color blindness diagnosed? There are several tests. The most common is a series of circles filled with dots of different sizes and colors. A person with normal color vision sees a shape that, due to its color, clearly stands out.

There is no cure for inherited color blindness, and it cannot be prevented. If the cause is an acquired disease, accident, medication, or chemical, treating the cause may help, and some do improve over time. More often, however, the damage is permanent.

Most people compensate well, relying on shades and position cues that most of us don’t notice. There are lenses and visual aids that may help. If color vision may be a problem for you, “see” your primary care doctor, optometrist or ophthalmologist. 

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100,
Downey, CA 90240.

Paging Dr. Frischer - Coconut Oil

Once a nutritional public enemy, coconut oil has risen to the ranks of a major health fad. Why has this happened? How can an oil high in saturated fats become a nutrition darling? Is coconut oil actually good for us?

The benefits of coconut oil seem to be touted everywhere. Dr. Oz believes that coconut oil has “superpowers” with near miraculous qualities. On the web are numerous claims that it is heart-healthy; leads to the loss of excess body fat; helps to dissolve kidney stones; enhances immunity; helps to resist viruses, bacteria, yeast, fungi, and candida; boosts thyroid function, improves blood sugar control; increases energy and endurance; improves digestion and vitamin absorption; lowers cholesterol; is anti-aging; helps with Alzheimer’s dementia; is good for skin and hair; and is safe without side effects.

In the 1980’s, low-fat diets were big. In particular, this meant restricting saturated fats like coconut oil and palm oil. Since that time, the focus has shifted to limiting carbohydrates and trans fats, and less on saturated fats. Where does coconut oil fit in?

Coconut oil differs from other oils in several ways. 92% of its fat is saturated, making coconut oil far more saturated than most other oils and fats. Olive and soybean oil are about 15% saturated, beef about 50%, and butter has about 63% saturated fat. The closest competition to coconut oil is palm kernel oil, which has 82% saturated fat. It is, in fact, all those saturated bonds that make coconut oil solid at room temperature, and keeps it from going rancid for a long time. That makes it great to use in candy, chocolate, yogurt, movie theater popcorn, and other coatings that don’t melt until they hit the warmth of the mouth. Vegans find it great to use as a butter substitute.

Coconut oil is also unusual because it contains a high percentage of medium-chain triglycerides. Many other oils consist entirely of long-chain triglycerides. Soybean oil, for example, is 100% long chain. Why is this relevant? Our bodies metabolize medium chains differently than long chains. Medium chains go from the intestines to the liver, where they are burned off as fuel, and possibly raise the metabolic rate. This makes them less available to be circulated throughout the body and deposited in fat tissues.

Coconut oil contains lauric acid. Lauric acid does raise both HDL and LDL (the good and bad cholesterols), but claims also include that it may offer a number of health benefits, including antibacterial, antifungal and antiviral properties, acne benefits, and weight loss properties (due to speeding up the metabolism). More research is definitely needed to back these up.

Coconut water, the liquid inside of the coconut, is also growing in popularity. As a long distance runner, I often see it promoted as a natural sports drink, containing electrolytes. In emergencies, coconut water has reportedly been used when medical saline was unavailable. Evidently, during World War II, coconut water was used as an intravenous rehydration fluid for British and Japanese patients. This technique also may have been used since then for short-term emergency situations when nothing else was available.

Coconut oil, with its saturated fats, is not as bad as it was considered in the 1980’s. However, it is clear that polyunsaturated oils lower LDL cholesterol while coconut oil raises it, making it difficult to recommend that it replace olive, canola, or other liquid oils. As for the rest of the intriguing and tempting claims, stay tuned for more solid scientific evidence. If you enjoy it, by all means include it as part of a reasonable and balanced diet. 

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.