Complementary Medicine and Supplement Research Update Newsletter 2010
See Newsletter 2008 back issues and Newsletter 2009 newer issues.
The name of the newsletter for 2011 has been changed to Natural Healing Secrets.

Emails from readers
Just wanted to so thank you. I know it is not so easy to try to influence peers. I enjoy your newsletters and your joint health supplement, Joint Power Rx, has really changed my life; simple chores were miserable and working out was so painful and now I'm really fit again and on my way to being even more so. So just sending some warm fuzzies your way.

I am a biochemist with many years experience in basic and applied biomedical research as well as teaching biochemistry to life sciences students. The other week I was researching something related to the pro and con on the use of nutritional supplements in disease prevention / cure and I stumbled upon your website. After touring it and seeing the wealth of information and the way it is presented I have to confess that I became "addicted" to this website. Also, I am impressed by your honesty with which you answered questions under the heading FAQ. Your site stands tall among many others that cater to those interested in natural medicine and better ways to improve ones health.

Thank you for maintaining such a terrific website -- it is rich with quality, non-biased information. I've logged it as a Favorite.

I have admired the balanced viewpoints expressed on your website about aging, health, and nutritional supplements and hormones.

Thank you for consolidating known herbals, and the hard science behind them. Your site is a unique starting ground for anyone interested in herbal medicine. You have sparked an intellectual curiosity in me, for which I am truly grateful.

Your products, in my opinion are one of, if not the best quality and most reasonably priced supplements on the market! I have dedicated thousands of hours of my personal time researching supplements since day one of the inception of the world wide web. Scams is abundant in cyberspace! One has to do their home work prior to purchasing any supplements, along with their protocol of prescribed medicationsand health history. You have my utmost trust! You are a man and a doctor of integrity, honesty and a genuine concern for all people!

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SUPPLEMENT RESEARCH UPDATE and complementary medicine reviews - by Ray Sahelian, M.D.
Vol. 7, Issue 12 -- December, 2010
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Learn Natural Healing Secrets each day by following me on Facebook at http://www.facebook.com/pages/Dr-Ray-Sahelian-MD/168736156487808. Visit the page and click LIKE. Sooner or later there will some information that may make a crucial influence in your health. You can post comments about your experiences with supplements and foods and also read what others have posted about their tips and experiences on natural ways to treat medical conditions. You may find excellent alternatives to prescription medications.

Ginger is an amazing herb. I try to eat some most days of the week. Sue, a reader of my Facebook page, recently posted: "I munch on crystalized ginger for nausea associated with migraines. I drink ginger tea, sprinkle it on many foods and other teas, and love the pickled ginger you can buy for sushi. Try dark chocolate covered ginger for a treat!" John says, "I can recommend a small chopped piece of the root in pumpkin soup, with a little coconut milk. Also its good in vegetable juices ... you only need a small piece." Whether eaten as the root, drank as tea, added to vegetable juices or soups, or taken as a capsule or tablet, ginger has numerous health benefits: It improves circulation and blood flow, thins the blood by having anti-platelet activity which could be of benefit in those with heart disease, reduces inflammation which could be of help in arthritis and many other conditions associated with inflammation, has cancer prevention benefits thus reducing the risk of this dreaded disease, and helps with nausea associated with pregnancy and chemotherapy. Some people even notice an aphrodisiac effect. I just came across a study of its possible role in eye health which I review below. See http://www.raysahelian.com/ginger.html for a full article.

Ginger for cataract prevention
Diabetic animals were given ginger in their diet. At the end of two months slit-lamp examination revealed that feeding of ginger not only delayed the onset but also the progression of cataract in rats. There are many other nutrients that could be of help in cataract prevention, see http://www.raysahelian.com/cataract.html for more info.

Ginger has anti-inflammatory activity
Compounds in this root inhibit cyclooxygenase (COX), an enzyme responsible for formation of substances called prostanoids, including prostaglandins, prostacyclin and thromboxane, some of which cause inflammation. There are various types of COX enzymes, named type 1, 2, and 3. Ginger has been found to inhibit type COX-2 which makes it beneficial in the treatment of various forms of arthritis.

Pomegranate juice for kidney health
Dialysis patients drank pomegranate juice at the start of each dialysis session three times a week for a year. There was a reduction in both inflammation and damage caused by free radicals. Patients with kidney disease who drank pomegranate juice had lower blood pressure and fewer heart problems. See http://www.raysahelian.com/pomegranate.html for details.

Cranberry for lower urinary tract symptoms in men

Researchers treated 42 men with an average age of 63 years who had lower urinary tract symptoms with benign prostatic hyperplasia. They took 1500 mg of dried powdered cranberry or placebo for 6 months. The cranberry treated group experienced improvement in rate of urine flow, average flow, and had lower total PSA levels. See http://www.raysahelian.com/cranberry.html for info.

Emails
I take several supplements a day but not to extreme, so I think. I subscribed to your newsletter for more information. But the reason I am writing: I regularly watch DiscoveryHealth channel on DTV. On "Dr G Medical Examiner (Orange CO FL), a healthy 52 yr old woman died in her sleep. A normal autopsy could find no reason. Dr G does not give up, she became very interested in finding 'closure' for the lady's husband. After 8 months of interviews and research Dr G concluded that the woman died from heart arrhythmia caused by high doses of DHEA. I do not take DHEA but have considered it and this program gave me an opportunity to do some Internet research. I just wanted you to know that death has occurred from excessive DHEA consumption.
   A few years ago I received an email from an elderly gentleman who reported his wife had been taking 50 mg of DHEA and 50 mg of pregnenolone for months and developed severe heart rhythm problems ending up in the emergency room. Unfortunately it proved to be fatal. So, it is possible that very high dosages could cause heart problems leading, in rare cases, to death. I did not get a chance to see the show so if anyone knows further details about the dosage the woman was taking, do email me.

Just stumbled upon your site yesterday and spent all day on it! It is full of no-nonsense, honest information. Thank you so much! I will definitely recommend it to friends.

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SUPPLEMENT RESEARCH UPDATE and complementary medicine reviews - by Ray Sahelian, M.D.
Vol. 7, Issue 11 -- November, 2010

A natural herb that increases libido in women? CNN interviewed Chris Kilham, a noted botanist, regarding the traditional use of maca, a radish-like plant that grows in the high Andes mountains in South America. The episode was taped in Peru. The topic was in regards to the use of this Peruvian plant as a sex booster for women. Although CNN says no human studies have been published in regards to the aphrodisiac properties of this herb, actually there have been some which I mention later. Throughout history many tribes have found roots, flowers, leaves, barks, plant and animal extracts that boost sexuality. Yet, for some reason, modern doctors and scientists seem reluctant to admit that such aphrodisiacs exist. Human sexuality is influenced by levels of certain brain chemicals and hormones. Some plants have substances that influence neurotransmitter and hormone levels. What's so difficult in accepting the fact that out of the countless plants on this planet that there are some that have a positive influence on sexuality? Why are some scientists so eager to deny the benefits of herbal remedies? It puzzles me.
   www.PhysicianFormulas.com now has a very popular package of seven bottles of different herbal aphrodisiacs and a free bestselling book called Natural Sex Boosters. This month you will get a free bottle of maca along with it. See below. You only take once capsule total a day, not all eight the same day. So, the first day you take a capsule, lets say, of tribulus terrestris, the second day you take a capsule of tongkat ali, the third day you take a capsule of Passion Rx, and so on for eight days. Then you take a break for a few days and resume. The order of which to take is not too important. If you notice an enhancement sooner than 8 days, you can take a break for a few days and resume again when the enhancement subsides.
   NEW FACEBOOK PAGES: If you would like to see the link to the CNN tape on maca, go to our new Advance Physician Formulas Facebook page where you will see regular updates regarding research on dietary supplements and the products sold on the website. Click LIKE and become a friend.
   Dr. Ray Sahelian, M.D. now also has a new Facebook page where he will mention the latest updates on natural healing. Visit his page and click LIKE.

Maca likely to become a popular aphrodisiac
Although CNN focused the episode on maca, I think there are more potent natural aphrodisiacs such as catuaba, muira puama, tribulus terrestris, mucuna pruriens, tongkat ali, horny goat weed and yohimbe, just to name a few. See http://www.raysahelian.com/libido.html
   A year ago an Italian team at Morgagni-Pierantoni Hospital, in Forlì, Italy, did a double-blind clinical trial on fifty men affected by mild impotence. They were randomised to treatment with maca extract, 2.4 grams, or placebo. After 12 weeks patients taking maca experienced a more significant increase in sexual satisfaction than those taking placebo.
   Two years ago researchers at the Department of Psychiatry, Massachusetts General Hospital, in Boston, tried to find out if maca was effective in those who were taking selective-serotonin reuptake inhibitors since SSRI meds induce sexual dysfunction in many patients. SSRIs included Prozac, Zoloft, Paxil, and other prescription antidepressants. They tried 1.5 g/day and 3 g/day in twenty depressed outpatients. Those taking 3 grams a day had a significant sexual improvement but subjects on 1.5 g/day did not notice as much.
   Comments: Maca is sold in varying dosages and extracts. We have had the best responses in those who have alternated its use with other herbal aphrodisiacs, such as in the Natural Sex Boosters package mentioned above. See also http://www.raysahelian.com/maca.html.

Emails

Hormone testing
Hello! I love your website and refer to it for great guidance with supplements. Recently I read your page on progesterone with great interest. What is your opinion on blood vs. saliva testing for progesterone levels? I ask because my saliva test showed high progesterone levels and my blood test showed low normal range. Which in your opinion is more accurate? I do not have any symptoms of high progesterone, quite the opposite. When taken off progesterone for 5 months I had severe insomnia, anxiety, depression, etc. just as I did prior to starting the hormone. I am perimenopausal.
   I think hormone level testing, either by blood or saliva, is overdone and often unnecessary. Plus, different labs can give different results and there is no guarantee that the laboratory where it is being done will give accurate results. There can be discrepancies between saliva and blood testing and often blood testing is more accurate but not always. Even if the results are consistent, different doctors will use the same results to recommend different dosages. I prefer to base hormone usage and dosage on symptom relief and to use the lowest amount and the least frequency that works for the patient rather than trying to seek an optimal blood or saliva test level.

Necessity of supplements
The latest issue of Prevention Magazine has apparently taken the position that vitamin supplementation (except for vitamin D, Omega 3s, B-12, and calcium) provides no real health benefits and may even be harmful. I would expect this from outdated medical sources, but was quite surprised to see this position taken by Prevention Magazine. They are claiming that their new position is supported by the latest cutting edge research. Can you shed light on this?
   I have not seen or read this issue but if what you say is true, it makes little sense to me. It's like saying only certain medications, such as a few antibiotics or heart medications are of benefit in treating certain medical conditions and the rest are not of any benefit. The whole issue is much more complicated. There are billions of people who live on this planet each with their unique biochemistry, physiology and metabolism, plus each has a diet from food sources from different regions that have different nutrient and mineral compositions. Add other factors such as climate, latitude, use of medications, medical diseases, psychiatric conditions, use of alcohol, tobacco, activity levels, sleep patterns, etc, and you can see that making blanket statements makes little sense. I cannot emphasize enough the metabolic uniqueness of each individual. There are hundreds of nutrient supplements and thousands of herbal supplements and they each have a role to play in health and disease.

Magnesium controversy
As a reader of your website and enjoying every page of it, I must say though, that you could recommend a better form of magnesium instead of oxide. Magnesium oxide has a lower rate of absorption and in higher doses will mess up the colon. I understand that it's the cheapest form but far the better. The recommendation should be with a form of citrate, glycinate or taurinate.
   I would appreciate if you can provide us with references to long term human studies, at least 5 years, that show taking one form of magnesium provides better health benefits than another form. This would be quite interesting to our readers. I am currently agnostic on the form of magnesium to use. Many people think that absorption, alone, determines the value of one form over another. But there are many factors that determine the benefits or risks of supplements besides absorption. Assuming one form is better absorbed, it is also possible that it could have more side effects or toxicity over long term use or interactions with other supplements or medications. Hence, if a study was done giving 400  mg of mag oxide and compared to 400 mg of, let's say, citrate, for several years on a daily basis, assuming the citrate is better absorbed, it is possible that we may find some unknown harm has occurred in someone who took the citrate versus the oxide. In the September issue of the newsletter I reviewed studies that showed that excess calcium intake through supplementation actually increases the risk for heart attacks and stroke. Isn't it possible that if some people had used a form of calcium that had was not absorbed as well that their rate of heart attacks would have been less? My point is that a whole range of factors have to be considered in determining the benefits of a supplement rather than one factor, such as absorption. Nutritional medicine is much more complicated than most people realize. See http://www.raysahelian.com/complementarymedicine.html for prior issues of the newsletter.

Vitamin D caution
Just wanted to briefly share my recent experience in order to encourage people to be more cautious. I have a history of irritable bowel syndrome and chronic fatigue syndrome. I started supplementing Vitamin D3 orally at 1000 IU per day and gradually increased to 5000 IU per day over a period of a year or so. I was and am, under the care of a qualified nutritionist, we tested my 25 OHD levels and serum calcium every 3 months. My serum 25OHD level hit the 'therapeutic zone' when I increased to 5000 IU, which most patients apparently comfortably tolerate. However, it unequivocally caused bowel inflammation in me and severe constipation - and it took weeks for the flare up to subside after stopping the supplementation. During the whole period I only experienced adverse effects from my 'experiment'. Sensitive individuals please take note.
   Thanks for sharing, readers of my newsletter know that I am cautious about high dose use of this vitamin while there are many doctors who are prescribing massive amounts.

Flaxseed oil and cancer
I read on a website regarding the possibility that consuming flaxseed oil may promote prostate cancer. There seem to be conflicting opinions on the matter. Would you please comment on this in a future newsletter.
   I have seen no such evidence. A search on medical research sites did not reveal such association. As a general rule I recommend the use of flax seed ingestion as opposed to using large amounts of the oil. See http://www.raysahelian.com/flaxseed.html

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SUPPLEMENT RESEARCH UPDATE and complementary medicine reviews - by Ray Sahelian, M.D.
Vol. 7, Issue 10 -- October, 2010
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An encouraging two year study long with a large number of people shows regular use of B vitamins reduces brain shrinkage in seniors with memory problems and may slow the progression towards dementia. I am glad to see that benefits occurred and it reinforces my belief that many aspects of mental decline as we age can be treated but its too bad that so few doctors are aware of the various brain supplements that could be useful. Years ago I wrote a book called Mind Boosters (also sold as Mind Boosting Secrets) where I reviewed all the potential vitamins, minerals, nutrients, fatty acids, hormones, and antioxidants that could improve mental function. You can find information about it at this page, http://www.raysahelian.com/memory.html and there are links to different chapters that you can read the latest information and research on each brain enhancer for free.

Benefit of B vitamins
Researchers from Oxford University report their two-year clinical trial was the largest to date regarding the treatment of mild cognitive impairment with B vitamins. The scientists conducted a study with 168 volunteers with mild cognitive impairment who were given either a vitamin pill containing high doses of folic acid, vitamin B6 and vitamin B12, or a placebo dummy pill. Brain scans were taken at the beginning and the end of the trial to monitor the rate of brain shrinkage. On average the brains of those taking the vitamins shrank at a rate of 0.76 percent a year, while those taking the dummy pill had an average brain shrinkage of 1.08 percent.
   Comments: Over the years there have been conflicting reports regarding the use of B vitamins in seniors as a way to reduce the progression of brain atrophy with age. Overall, though, the balance points to some benefits and I don't see any harm in taking a low to moderate dose of a B complex supplement a few times a week. An alternative is to take a capsule or two of MultiVit Rx which has all the B vitamins along with several other antioxidants and minerals. Another option is to take a capsule of Mind Power Rx a few times a week. The study used only three vitamins, folic acid, B6, and B12. It is possible that the other B vitamins could also be of benefit. The ideal dosage of these vitamins for long term use, such as several years or decades, is not known. Therefore, to be on the safe side, I would suggest taking an amount lower than what they used in the trial. See http://www.raysahelian.com/dementia.html for more information.

Bronchial asthma treatment with herbs
Investigators at the University of Beni Sueif in Egypt enrolled patients with bronchial asthma and subdivided them into two groups .Group 1 received oral capsule of a formula with boswellia, licorice, and turmeric 3 times daily for 4 weeks and group 2 received placebo. There was a significant decrease in the plasma levels of lnflammatory markers in those who received the herbal remedy compared with the placebo group. See http://www.raysahelian.com/asthma.html for more info.

Improved survival after cancer with vitamins
A Danish study evaluated the survival of patients with end-stage cancer who received supplements of coenzyme Q10 and a mixture of other antioxidants including vitamin C, selenium, folic acid and beta-carotene. During a period of 9 years, 40 patients who had end-stage cancer were included. Primary cancers were located in the breast, brain, lungs, kidneys, pancreas, esophagus, stomach, colon, prostate, ovaries and skin. Median predicted survival was 12 months, whereas median actual survival was 17 months, a greater than 40% longer survival than predicted. See http://www.raysahelian.com/cancer.html for additional nutraceuticals that could influence cancer prevention or treatment.

Emails
I am a 39 year old woman. I took a 25 mg of DHEA pill and 50 mg pregnenolone pill for 2 weeks. I could not sleep, and my heart raced so bad the last week of this that I was sent to the emergency room. The lab results showed nothing. I came home and started looking up my supplement side effects, and came to your site. I am glad I did. I now know what caused my heart to race.
   Comments: I am surprised that there are companies still selling high dosages of these supplements. I personally get heart rhythm disturbances from both DHEA and pregnenolone if I take more than 10 mg for a few days but I know some people who seem to tolerate them quite well. See http://www.raysahelian.com/pregnenolone.html

I started taking Eyesight Rx vision enhancer tablets about one month ago. When I went to the retina specialist yesterday, my right eye had improved by 2 lines and my left eye had improved by 1 line. This was wonderful news, as I had eye surgery on my right eye last December for a hole in the macula. Four months ago both eyes showed a slight loss in vision so I started taking your Eyesight Rx. I am hoping that in another six months, when I have another eye test, there will be even more improvement. Thanks for a good product. I take one tablet, on an empty stomach, first thing in the morning. I take it for a week and then stop for two days. I haven't had any side effects. My doctor didn't give me much hope for regaining good vision after the surgery to repair the macular hole, we were just happy that I didn't totally lose my vision.
   This eye formula is quite interesting. I take it off and on and there is no doubt that it enhances visual acuity. It is easier to see distant objects and to read. Color perception is enhanced, so is day and night vision. I usually only need a half tablet but some people need a higher amount. You can bite off as much as you like from the pill and use the rest the next day. It works best when crushed with the front teeth and allowed to melt for a few minutes under the tongue. See http://www.raysahelian.com/eyesight.html

I am a Registered Dietitian of many years who like you, is skeptical about increasing the vitamin D recommendations because of a paucity of long-term evidence. There are many more people on the D bandwagon and I am very concerned that a pseudo hormone which by definition has multiple targets sites in the body may have many more unintended consequences than we can see now. After years of caring for dialysis patients who were switched to high calcium dialysate baths and provided calcium carbonate / acetate tablets multiple times a day to act as phosphate binders, we saw that cardiac calcification increased to deadly effect. Vitamin D research is in its infancy and I applaud your discretion.

In regard to the study on calcium that you mention in your latest newsletter, if I am not mistaken, the individuals in the trial were given only calcium alone without also being given magnesium or vitamin D, nutrients that are vital for proper absorption of the calcium. If that is the case, obviously the poor results, with the increased heart attacks and strokes, could reasonably be attributed to that fact. I will much appreciate it you you will clear this up. Much appreciate your expertise and the caution and prudence that you employ in your recommendations of supplements.
   Until extensive clinical trials are done that test the influence of calcium / magnesium / vitamin D combination supplementation in varying dosages for several years or decades, we will not know whether the addition of magnesium and / or vitamin D lessens or increases the risk for heart attacks and stroke.

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SUPPLEMENT RESEARCH UPDATE and complementary medicine reviews - by Ray Sahelian, M.D.
Vol. 7, Issue 9 -- September, 2010
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A couple of weeks ago we got an email from someone who wanted to know why my recommendations on vitamin D were much more cautious than other websites he had come across. We emailed back saying that there are different opinions on various nutritional topics and it was up to each person to decide whose opinion to trust and follow. He emailed back saying he was not interested in opinions, he wanted facts. He, and many others, do not realize how difficult it is to do long term clinical trials and how few of them are available. Even when these are done, sometimes they show contradictory results. Some people assume that nutritional science has already advanced to the point that clear answers are available regarding how much to take of each supplement for optimal health and thus there should be one, unequivocal, standard answer. This is far from truth and reality. As a simple example, lets take the case of calcium supplementation. For several decades doctors have been recommending calcium supplementation for osteoporosis prevention to postmenopausal women at dosages ranging from 800 mg to 1500 mg assuming no risks were involved, only benefits. You would think that after decades of research regarding such supplementation science would have already figured out all there is to know about the ideal dosages, benefits and risks. However, some disturbing research was recently published. Apparently such supplementation increases the risk for heart attacks. I discuss this in more detail below. My point in mentioning this study is that you should be cautious in accepting any nutritional advice given by anyone if they make it seem that no uncertainty exists regarding their recommendations. Currently there seems to be an unquestioning belief among some doctors and scientists that we should all daily supplement with vitamin D in high dosages, such as 5,000 or 10,000 units. Will we find out years or decades later that supplementation in massive dosages has downsides that we are not currently aware of?

Calcium supplements and heart attack risk
Bone loss and fractures are a major health concern among older people. Ian Reid, professor of medicine at the University of Auckland in New Zealand reports that long term calcium supplementation may increase the risk for a heart attack, along with potentially increasing the risk of stroke and death. Ian Reid and colleagues did a meta-analysis encompassing several studies that tracked 12,000 elderly people over four years. Most were women, and the average age was 72. Half of them were given calcium supplements, at least 500 mg a day or more, and the other half dummy pills. There was a 30 percent increase in heart attacks in the people who were took calcium. The researchers write, "If you have 1,000 people taking calcium for five years, we expect to find 14 more heart attacks, 10 more strokes and 13 more deaths in the people given calcium than they would have had if they hadn't been treated with the mineral. That is 37 more adverse events and we expect 26 fractures being prevented. So calcium is associated with more bad things happening than with bad things prevented." It is possible that very high levels of blood calcium may damage blood vessels, contributing to hardening of arteries (atherosclerosis). When a calcium supplement is taken, the blood calcium level goes up over the following four to six hours to the top end of the normal range. This is avoided somewhat through food because the calcium from food is very slowly absorbed and so the blood calcium level changes very little. Higher blood calcium may lead to the formation of plaques in blood vessels, which can lead to heart attack, stroke and other cardiovascular diseases, BMJ, online July 29, 2010. John Baron, M.D. a professor of medicine at Dartmouth Medical School, in Lebanon, New Hampshire, was a co-author of the study.
   Comments: To prevent or reduce the risk for osteoporosis, engage in more exercise, reduce or eliminate smoking and keep a healthy weight. Calcium is found in some vegetables, fortified cereal, and dairy products such as milk and yogurt and there is no risk of increased heart attack from consuming it in the diet. My recommendations to patients who are prone to osteoporosis is to still take the calcium tablets, but reduce their dosage to about 200 to 600 mg a day rather than 800 to 1500 mg daily. Also, it may be a good idea to spread it out three times throughout the day at 100 to 200 mg each tablet rather than take them all at one time. This would reduce the high blood calcium level that would occur when a very large amount, such as 1000 mg or more, is taken at one time. The results of this study also makes one question the wisdom of taking massive amounts of vitamin D, such as 5000 or 10,000 units daily. Will we, years from now, discover that there is also a higher risk for cardiovascular disorders, or other health issues, from such supplementation? I don't know, but for the time being I am staying in the cautious range of 400 to 2000 units a day whereas some doctors are nonchalantly recommending much higher amounts. Many people take vitamin D along with calcium. Could the addition of high doses of vitamin D ease the entry of calcium into blood vessels and tissues and hence increase the risk the damage to arteries and other tissue or organs, or could it have a preventive effect? We don't yet have the full answers. See http://www.raysahelian.com/osteoporosis.html

Turmeric could be useful for cancer prevention
Geranylgeranoic acid is one of the most potent cancer-preventive retinoids and is found in several medicinal herbs such as turmeric, basil, rosehip, cinnamon and others. Oral intake of turmeric tablets to healthy volunteers led to increased concentrations suggesting an efficient bioavailability of geranylgeranoic acid in the turmeric tablets through oral administration. See http://www.raysahelian.com/turmeric.html for details.

Some obesity drugs are unsafe
Weight-loss drugs Xenical and Alli will carry new warnings about rare reports of liver injury. The FDA says Roche's prescription drug Xenical or Glaxo's over-the-counter pill Alli cause liver damage. Symptoms may include itching, yellow eyes or skin, dark urine, light-colored stools or loss of appetite. Some patients have died or have needed liver transplants. See http://www.raysahelian.com/weightloss.html for natural ways to reduce weight. There's nothing better than exercise and eating less, especially at night. Abbot Laboratories makes Meridia with the generic name sibutramine. Meridia use is now associated with a higher risk for heart disease.

Emails
I am a physician that is into supplementation. I enjoy your site and the balanced, scientifically-weighted information it provides. Like you, I feel that proper dosages and dosing frequency is very important, as I have experienced first-hand the negative aspects of from improper dosing schedules and/or lack of cycling. For quick referencing, have you thought about creating an area of your site listing the supplements you feel should not be used every day or others that are safe to take daily?
   Yes, I have written about this topic, please see http://www.physicianformulas.com/store/scripts/newsletterpage.asp

Thank you for posting helpful information on the net. I wanted to chime in with the other person mentioned on your vitiligo page who has seen repigmentation with a gluten free diet. Since I was diagnosed with Celiac Disease about 6 years ago, and been on a gluten free diet I have seen significant repigmentation over the entire 5 years, starting about 6 months into the gluten free diet. I had vitiligo for 25 years before this occurred. Repigmentation has occurred, so far, over about 2/3 of the affected spots. See http://www.raysahelian.com/vitiligo.html

I have recently purchased some libido supplements (Horny goat Weed, Maca, Tongkat ali, Tribulus and Catuaba). I read on a website that if you take these supplement’s any more than once a week then tolerance will kick in and stop them from working. On your labels it says take them a few times a week. Other internet sites say 5 days on 2 days off. Could you please shed just a little bit off light on this in your opinion? I just want to know I am taking these properly.
   There is not enough long term human research to know the benefits and risks of taking these sex enhancing herbs for prolonged periods, nor to know what the appropriate dosage is and how to combine them with each other, the ideal number of days to take a week, and how they interact with each other. Plus, each person reacts differently. Therefore, the most practical advice at this time is to take them the least amount of days and in the lowest dosage that provides the benefits that are sought. This would vary among individuals based on their sensitivity and tolerance, other supplements used, age, sex, use of medications, use of coffee or alcohol, overall health condition, genetics, etc. As you can see no simple answers can be given that would apply to everyone. One approach is to take one tongkat ali capsule the first day, a tribulus capsule the next day, the catuaba the third day, etc. and after five days to take a 2 or 3 day break and then resume. This is just a general guideline. See http://www.raysahelian.com/sexherbs.html

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SUPPLEMENT RESEARCH UPDATE and complementary medicine reviews - by Ray Sahelian, M.D.
Vol. 7, Issue 8 -- August, 2010
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Are you aware that there are effective natural alternatives to medications prescribed for depression? There are several that are popular, including 5-HTP, St. John's wort and SAM-e. Recently some studies have shown that fish oil supplements could also be helpful. I have tried all of the above and have found them to be of benefit, but in different ways. I am not depressed but still notice an effect in mood after a few days of supplementation. We are often asked how does one know which product to take first. It's difficult to predict which of these natural antidepressants will work in any one individual, but later I offer some suggestions.

Do fish oils help fight depression?
Over the years many studies have reported conflicting results. Some of the confusion is due to the fact that some studies have looked at omega-3 as a stand-alone therapy; others have tested it in combination with antidepressants, and different studies have used different fish oil formulations and dosages. In a study with 432 patients diagnosed with at least moderate depression, patients took either fish-oil capsules or a placebo every day for eight weeks. Among anxiety-free patients, symptoms improved significantly more with fish-oil than with the placebo. Taking anti-depressants, or not taking them, did not affect the results. On another topic, a new study shows that women who take fish oil pills appear to have a lower rate of breast cancer. See http://www.raysahelian.com/fishoils.html for details. I, personally, notice only a mild effect on mood from fish oil supplementation compared to the ones below which are more potent.

Use of 5-HTP, St. John's wort, or SAM-e as mood lifters
Some of the most common questions we are asked by email relate to which supplement to begin with as a treatment for mild or moderate depression. Although the only way to know for certain is by trial and error, some generalizations can be made. 5-HTP, a nutrient that converts into serotonin, is helpful in those whose depression is associated with anxiety, overeating, or difficulty sleeping. Dosages range from 50 mg to 200 mg daily, taken on an empty stomach. You can begin with a 50 mg pill 20 minutes to half an hour before dinner. A drawback to 5-HTP is that, similar to Prozac and other SSRI medications, it can reduce sex drive. St. John's wort herb is of benefit to many people with low mood and the effects often begin within a few days. A dose of 300 mg in the morning before breakfast is reasonable although some people may require a second pill midday. High dosages can lead to insomnia. SAM-e is very potent. Some people notice the mood lift within a day or two. However, this nutrient is not recommended to those who have a tendency for mania or those whose depression is associated with anxiety and insomnia. A starting dose is 200 mg taken before or with breakfast but the dose should be reduced to half as much once benefits are noticed. All the above can be taken with a few fish oil pills daily. See http://www.raysahelian.com/depression.html for further information. Some people find a combination of St. John's wort and 5-HTP, or SAM-e and 5-HTP to be helpful, but before combining make sure you learn how each one effects you by itself. Required dosages are likely to vary over time.

Natural pills to increase female sex drive
Recently the drug flibanserin from Boehringer Ingelheim, nicknamed the "pink Viagra," designed to boost sex drive in women — the latest attempt by the drug industry to find a female equivalent to Viagra — failed in two studies. The drug was aimed at premenopausal women with lack of sexual desire, a market that drug companies have been targeting for more than a decade since the blockbuster success of Viagra in men. The search for so-called "female Viagra," has proved elusive though, with many drugs abandoned after showing poor results. Fortunately, there are several natural herbs and combinations that can improve a woman's desire. Some of these include muira puama, maca, mucuna pruriens, tribulus terrestris, tongkat ali and Passion Rx. The over the counter hormones DHEA and pregnenolone can be used for brief periods to increase libido. For more information, see www.raysahelian.com/female_libido.html

The misuse of cholesterol lowering drugs
There is no evidence that prescribing cholesterol-lowering drugs known as statins to patients at risk of heart disease reduces their chances of premature death. An analysis published last month questions research that led the FDA to allow the statin drug Crestor or Pfizer's Lipitor wider use for prevention of heart disease in those who do not already have it. The Food and Drug Administration increased Crestor's market to millions more people in February, 2010 partly because of a study reported in 2008 by Crestor's maker. As a result, more doctors put healthy people on statin drugs, often inappropriately. The earlier Crestor study funded by AstraZeneca was controversial: Crestor reduced the risk of certain heart problems in half for the middle-aged and older men and women in the study, who had normal levels of LDL, or "bad" cholesterol (below 130). Critics suggested the dramatic results might be exaggerated because the experiment was stopped after two years instead of the planned five. They questioned why the authors didn't report the rates of death from heart attack and stroke, which when teased out of the data turned out to be unaffected by Crestor. In a meta-analysis - a study which reviews all previous published scientific evidence on a specific area - Professor Kausik Ray from the University of Cambridge found little evidence that statins saved lives in the short term in groups without heart disease. Dr. Rita Redberg, a cardiologist at University of California San Francisco, and editor of Archives of Internal Medicine says, "Why take a medicine that hasn't been shown to make you feel better or live longer? Yet that's what millions of Americans are doing." People taking these drugs have higher risks of liver dysfunction, kidney failure, muscle weakness and cataracts. Archives of Internal Medicine, June 28, 2010. See http://www.raysahelian.com/heartdisease.html for natural ways to reduce the risk of heart disease.

Emails
I'm a man and 55 years old. Please suggest a blood-test that would help me determine which herbs and supplements to take. I came across a web site that says if I send them a blood sample they can analyze it and tell me what vitamins and minerals and other products I need to take.
    Medical research has not reached a level of sophistication where a comprehensive blood testing for levels of vitamins, minerals, nutrients and other substances in the body would lead to an accurate determination of which vitamins, minerals, amino acids, hormones, fatty acids, herbs or other dietary supplements one should take over the long term that will prove to increase longevity. There are many websites that claim through an extensive blood test they can accurately advise a specific multivitamin and multimineral regimen. Some of these sites may not actually do a comprehensive test but rather make up some numbers since it is too expensive to test for tons of nutrient, mineral and vitamin levels. The human body is much, much more complicated than many people realize. An important point that many people do not consider is that blood levels sometimes do not reflect the levels of a substance within tissues or cells. For instance, one can have a low level of DHEA hormone shown on a blood test but the levels could be high in hair or prostate tissue. Hence, by taking a DHEA pill, one could cause more harm than good, for instance hair loss or prostate gland growth. Other factors to consider: Changes in daily food intake make a significant impact on levels of nutrients at any one time in the bloodstream; There are variations throughout the day depending on what time the blood sample is taken; There are changes throughout the seasons; Different labs may provide results that can vary up to 20 to 30 percent or more from other labs; Changes in sleep and activity level could influence blood results; Use of medications and resulting interactions with supplements could have an influence; There could be racial differences in optimal levels. There are hundreds of potential vitamins, minerals, amino acids, fatty acids, hormones, etc that could be supplemented and how do we know the proper ratios? Could taking a few dozen and missing out on several other crucial ones throw things out of balance and make health matters worse? As you can see, with all of these uncertainties, I do not suggest you fall for the scams that some websites are promoting. For general overall diet and longevity advice, see http://www.raysahelian.com/diet.html and www.raysahelian.com/longevity.html

I purchased four test kits for Vitamin D3 from an online web site and I paid $220 for them. Testing twice a year would cost a family of four $440, which amounts to 1% of an annual income of $40,000 per year, which sounds affordable to me, especially when you consider that maintaining healthy blood levels of D3 could pay for the cost of the tests in saved medical bills.
    I am not sure how reliable the tests done by a testing center online are when they are so inexpensive compared to other tests done in a doctor's office. There are differences in results between different labs. One percent of a family's total income is still very high for just testing a level of one of countless hormones, amino acids, vitamins, minerals, nutrients, fatty acids, etc that are in the body. Omega-3 oils are crucial for optimal health. Why not spend another 1 percent of one's income on testing levels of epa and dha fatty acids? What about vitamin C and E levels; what about testing the numerous hormone levels? Where do you draw the line? Plus, there is no guarantee that those who test for vitamin D levels will live longer than those who just spend 10 to 20 minutes a day in the sun and take 400 to 1000 or 2000 units a day without testing for such levels. Testing for vitamin D levels should be reserved in situations where a doctor suspects the patient to have very low levels due to an unusual diet, hardly any sun exposure, or a chronic medical condition rather than the general healthy population.

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SUPPLEMENT RESEARCH UPDATE and complementary medicine reviews
Vol. 7, Issue 7 -- June, 2010
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Berries are becoming more and more popular as articles are published regarding their benefit in reducing the risk for cancer, heart disease, and potentially increasing longevity. All berries have benefits and the purple ones, such as acai, have been promoted heavily. I will review a couple of interesting new studies regarding their benefits.
    For many years I have written about my concerns about the overuse of stating drugs for cholesterol reduction. I have had angry emails from doctors who claim that my concerns about the safety of these drugs was unjustified. Recently another study points out that the risks associated with these drugs has been underestimated by the medical profession.
    Have you ever wanted to try free samples of certain products rather than buying a whole bottle? Physician Formulas website is now making available free samples of Eyesight, Mind Power Rx, and Passion Rx with Yohimbe. There are additional free products that you can take a look at by visiting the home page. Only one free bottle per order.

Acai berry diet makes fruit flies live longer
Investigators at the National Institute on Aging in Baltimore, MD provided acai berry pulp to fruit flies. The amount was 2 percent of their diet. Acai supplementation increased the lifespan of female flies fed a high fat diet compared to the non-supplemented control. They conclude, "Acai has the potential to antagonize the detrimental effect of fat in the diet and alleviate oxidative stress in aging."
    Comments: I am not sure if humans added acai or other berries to their diet they would live longer, but this is quite a promising finding and encourages me to either add more berries to my diet and / or take one or two acai or other berry extract capsules most days of the week. Thus far we have not had feedback of any side effects associated with such supplementation. For more details of this study, see http://www.raysahelian.com/acaiberry.html
   
Berries prevent cancer
A study at The Ohio State University, Columbus, Ohio, compared the ability of different berry types to prevent chemically-induced cancers in the rat esophagus. Rats were treated with a cancer causing agent for 5 weeks, then placed on diets containing 5% of either black or red raspberries, strawberries, blueberries, noni, acaí or wolfberry until the end of the study. All berry types were about equally effective in inhibiting tumor formation. See http://www.raysahelian.com/berries.html

AHCC and cancer chemotherapy side effect reduction
Active hexose correlated compound (AHCC) is an extract of a basidiomycete mushroom that is used as a supplement by some cancer patients undergoing chemotherapy; it is thought to enhance the therapeutic effects and reduce the side effects of some chemotherapy drugs. In the first study, AHCC given to rats was able to reduce arabinoside-induced hair loss, and 6-mercaptopurine- and methotrexate-induced liver injury. In the second study, use of AHCC reduced damage to the immune system, kidneys, and the liver when it was combined with chemotherapy drugs such as cisplatin. See http://www.raysahelian.com/ahcc.html
    Comments: If additional studies in humans confirm these findings, AHCC may become a useful supplement in some cancer patients undergoing chemotherapy with certain drugs.

Risks of cholesterol lowering drugs
In a study covering more than 2 million people in Britain, researchers from Nottingham University found that people using cholesterol-lowering statins have higher risks of liver dysfunction, kidney failure, muscle weakness and cataracts. For every 10,000 high risk women treated with statins, the positive impact would be around 271 fewer cases of heart disease and 8 fewer cases of esophageal cancer. On the other side, there would also be 307 extra patients with cataracts, 74 extra patients with liver dysfunction, 23 extra patients with acute renal failure and 39 with a muscle weakness condition called myopathy. Similar figures were found for men except rates of myopathy were higher. For details, see http://www.raysahelian.com/statins.html

Diet and breast cancer
Postmenopausal women who eat foods rich in estrogen-like plant chemicals called lignans have a decreased risk of developing breast cancer. In an analysis of more than 20 studies, it was found that postmenopausal women who reported the highest intakes of dietary lignans were 14 percent less likely to develop breast cancer than those with low intakes. See http://www.raysahelian.com/lignan.html for details.

Questions
What is your general recommendation concerning alcohol consumption (i.e. standard drinks per day or week for women and men)?
    It's difficult to know exactly how much alcohol and in what form is ideal since it varies among individuals, but one or two ounces of wine, or a few ounces of beer a day is more likely to be helpful than harmful. Timing makes a difference, too. If you drink right before bed and that helps you sleep better, the benefits are enhanced. But if you drink right before bed and it disturbs your sleep, then any benefits of the alcohol are reversed by the sleep disturbance. Bottom line, the benefits of such consumption and the amount varies among individuals, by the type of alcohol, ie, beer, wine, liquor, by the amount, and the time of day of consumption. See http://www.raysahelian.com/alcohol.html

I am in my twenties and I am pretty satisfied with my sexual activity but I was looking for ways to enhance my ability and pleasure. I was just wondering if it is unwise to take natural aphrodisiac products when young and if it would have major side effects as I grow older. Secondly, are you supposed to take it only on days you plan on engaging in sexual activity. What would you suggest to be the smartest way to approach taking these products and which ones?
    When used occasionally, these are safe products for young people who do not have medical issues or taking medications. Since the herbs take a few days to work best, one could take them a few days a month and then take a break. I don't foresee any major health issues for long term use when these aphrodisiacs are taken only a few days a month for years and decades. Some of the common aphrodisiac herbs and formulas include Passion Rx, avena sativa, catuaba, horny goat weed, muira puama, maca, mucuna pruriens, tongkat ali, tribulus terrestris, and yohimbe. See http://www.raysahelian.com/aphrodisiacs.html

Everywhere we read that people over 50 should take a low dose aspirin each day for heart attacks in men and stroke prevention in women. Some doctors recommend to take 2 baby aspirin daily. I know it can cause bleeding in GI tract but I like to use natural or alternative things when I can. Since aspirin is used to prevent the clots that cause strokes and heart attacks or at least thin them, would the following be good or what can you suggest? Garlic, nattokinase Coq10, grape seed extract, guggul, carnitine, just don't know who to ask - my MD is clueless.
    There are no easy answers since each person has a different blood clotting or thinning predisposition and each person has a different diet. As a general rule I prefer to limit baby aspirin use to once or twice a week and have a higher intake of several herbs and nutrients that thin the blood. See such a list at http://www.raysahelian.com/bloodclot.html

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SUPPLEMENT RESEARCH UPDATE and complementary medicine reviews - by Ray Sahelian, M.D.
Vol. 7, Issue 6 -- May, 2010
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Hardly a week goes by without a new study being published on the benefits of vitamin D. It is becoming clearer that many Americans are not getting enough sun exposure and additional amounts of the vitamin through supplementation could be helpful. There are many unanswered questions, though, that will take years or decades to be determined. What is the right daily dosage? Is blood testing necessary and how often? Should everyone be tested for blood levels or is the expense not worth it, particularly in these tough economic times? What are the long term benefits and risks of supplementation at various dosages?
    When the benefits of this vitamin are touted in the media, hardly anyone mentions the potential side effects or toxicity. Over the coming months and years I hope to provide you with a balanced opinion on the benefits of supplementation while reminding you that not all is known about the risks. My views on dosage recommendations and testing are updated regularly at http://www.raysahelian.com/vitamind.html. Make sure you read the section about risks and toxicity especially the concern about brain calcification. See below for my answers to recent questions on this topic.    

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SUPPLEMENT RESEARCH UPDATE and complementary medicine reviews - by Ray Sahelian, M.D.
Vol. 7, Issue 5 -- May, 2010
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If you have been reading my newsletter for a while you have noticed that I am not a proponent of excessive testing, whether it be blood tests, scans, mammograms, etc. Rather than make the extra effort to eat healthier, exercise, and follow other healthy lifestyle habits, some people think that if they get tested enough and have blood results of their cholesterol levels, hormone levels, vitamin levels, lung scans, mammograms, bone density tests, PSA tests for prostate, etc., they will lead a longer life. Doctors, who are often petrified from being sued, go along with a patient's request, or encourage such testing thinking that somehow this will help the patient avoid an illness. Little by little we are finding out the pitfalls of unnecessary testing. In the last few months alone we have had reports that mammograms in women in their 40s may not always be a good idea, PSA tests for prostate cancer in men actually lead to more harm than good, and now a new report says that lung scans to detect lung cancer often find suspicious growths that turn out to not be cancer. The downside with false-positives is that they often lead to needless follow-up procedures, as well as stress and anxiety for patients and their families. That follow-up may include invasive tests, which carry risks. This whole issue of excessive testing resurfaced for me recently when someone emailed me an article on a health blog by a nutritionist who was advocating routine blood tests for vitamin D levels and we got an email from someone who was wondering what to do with a high level of pregnenolone hormone level found when their doctor ordered a blood hormone panel.

When to test and when not to
More and more I am coming across doctors and nutritionists who are recommending routing testing for vitamin D levels. At a cost of 50 to 200 dollars per vitamin D test, and repeated 3 or 4 times a year, it is unimaginable for me to spend a few hundred dollars of precious health care dollars on testing for one vitamin level. Don't people who advocate such testing recognize how much we, as a nation, already overspend on healthcare? Why not just pay a few dollars a year taking vitamin D pills instead of doing the testing. Do people test their levels of vitamin C, B vitamins, and vitamin E before they take a multivitamin? Do people test their levels of omega-3 fatty acids before taking fish oil pills? If the logic proposed by testing promoters is that we should know our test results before taking any supplement then why not spend thousands of dollars a year testing for every possible vitamin, mineral, hormone, neurotransmitter, fatty acids, lipids, inflammatory markers, amino acids, immune system function levels in the body? Even if we know the results at a specific point in time, there are few accepted guidelines regarding the dosage of supplementation based on such test results, and different doctor will recommend different supplementation dosages.
    Mind you, I am not against all testing. When done appropriately it can give a great deal of information about the patient and guide treatment in the proper direction. I just think that if a doctor spends more time doing a thorough history, review of symptoms, dietary history, sleep patterns, psychological stresses, and a thorough physical exam, he or she can often be much more selective in choosing the appropriate testing. The art of the full history and physical has been somewhat lost and replaced by the quick, easy and mindless referral to testing. In the case of vitamin D, if a doctor reviews the patient's pattern of sun exposure throughout the year and the types of foods a person eats, this alone will go a long way into determining the amount of the vitamin to suggest taking: from none to 2000, or perhaps in rare cases 3000, units a day.
    There is a website that I suggest you and your doctor refer to that evaluates the scientific basis of what screening tests are appropriate at different decades of life. I value the information, caution and thought that has gone into making the recommendations: See http://www.ahrq.gov/clinic/uspstf/uspstopics.htm. Not all the recommendations will eventually turn out to be right, but this site is a good start.

Nutritional supplements help mice stay healthy with age
When mice were supplemented with more than 2 dozen vitamins, minerals nutrients and herbal extracts, they did not experience a 50 per cent loss in daily movement like other non-supplemented animals. The benefits were associated with an improvement in the activity of mitochondria as well as by reducing levels of free radicals. David Rollo, from McMaster University, says, “This study obtained a truly remarkable extension of physical function in old mice, far greater than the respectable extension of longevity that we previous documented. This holds great promise for extending the quality of life of ‘health span’ of humans.” David Rollo says that it is unclear if the effects would be repeated in humans and years or decades of clinical trials would be required before any definitive conclusions could be made. The dietary product given to the mice included vitamins B1, B3 (niacin), B6, B12, C, D, E, folic acid, beta-carotene, CoQ10, rutin, bioflavonoids, ginko biloba, ginseng, green tea extract, ginger root extract, garlic, L-Glutathione, magnesium, selenium, potassium, manganese, chromium picolinate, acetyl L-carnitine, melatonin, alpha-lipoic acid, N-acetyl cysteine, acetylsalicylic acid, cod liver oil, and flax seed oil. See http://www.raysahelian.com/longevity.html

Better visual acuity in infants
In a study published in the April 2010 issue of the American Journal of Clinical Nutrition researchers wanted to determine the role of DHA supplementation on the visual acuity of formula-fed infants. DHA, along with EPA, are the two omega-3 fatty acids in fish oils. Healthy, term, formula-fed infants were randomly assigned to be fed an infant formula containing equivalent nutrient amounts, except for long-chain polyunsaturated fatty acids. Infants fed the control formula had significantly poorer visual acuity at 12 mo of age than did infants who received a DHA-supplemented formula. http://www.raysahelian.com/dha.html
    Comments: Years ago, when I was in the process of writing my book Mind Boosters, I experimented with taking fish oil softgels in different amounts. I noticed that when taking 5 or more in the morning, my vision would become sharper by afternoon. The retina of the eye requires DHA for optimal visual acuity. I then started experimenting with different herbs and nutrients to see if others had an influence on vision. Over the years I found several that had a positive role to play in eye health which led me to formulate Eyesight Rx, a dietary supplement that melts under the tongue for quick and efficient absorption. Most users find improvement within a few days: better day and night vision, and better reading and distance acuity. See http://www.raysahelian.com/eyesight.html

CoQ10 for fatigue reduction
Researches at Uppsala University in Sweden gave mice CoQ10 for 4 weeks. Mice were made to perform swimming exercise with loads attached to their tails, corresponding to approximately 5% of their body weights, and the total swimming time until exhaustion was measured. Mice given CoQ10 took much longer to get tired. The researchers say, "These results suggest that CoQ10 supplementation improves swimming endurance and has an antifatigue effect."
    Comments: I have noticed that CoQ10 gives me more energy when taking a dose ranging from 30 to 60 mg. Sometimes if I take 100 or 200 mg I feel more energetic for a while but somehow it seems to be counterproductive later or the next day. Try for yourself to see what dosage works best for you. This nutrient is often sold at 30, 50, 60, 100 mg, and some companies even sell 200 and 300 mg per pills. See http://www.raysahelian.com/coq10.html. Meat, fish, and nuts have a good CoQ10 content, while much lower levels are found in most dairy products, vegetables, fruits, and cereals. The average dietary intake is only 3 to 6 mg a day.

Emails
Q. I have a question and and I cannot find any info online about this, and the doctors have no info either. My husband is 55 years old, and recently had a physical with lab tests. Hormone testing was also done. Everything was in the normal range, except the pregnenolone, which was high. He is in good health, takes 25 mg of atenolol daily, an OTC multi vitamin, and 2 ounces of liquid aloe at bedtime. Non smoker, very light alcohol, exercises daily. Do you have any info on what could be causing the hormone to be over twice it's normal value?
    A. It is not easy for me to know without reviewing the whole medical history and doing a full physical exam. As I discussed earlier in this newsletter, in my opinion, there is no reason to do routine hormone testing unless there is a serious medical condition that makes a doctor suspect a hormonal deficiency or excess. Different labs are known to provide different results, particularly on hormone blood tests, such as pregnenolone, that are not routine. The level of a hormone varies throughout the day and over time. The problem with doing tests that are not required leads to results that often lead doctors to do more unnecessary testing and there is no evidence that doing extra tests leads to improved health and longevity. A physician has to evaluate the whole person and make a decision regarding treatment based on the whole picture rather than an isolated result of one blood chemistry, hormone level, or test result. When a blood result comes back that is not expected, and there is no immediate health problems that are of concern, often a good option is to retest it by a different lab a few weeks or months later.

Q. I wanted to let you know I got rid of toe rot on my big left toe that was fully fungus infected by using Epsom salt. I tried your recommended Epsom salt baths but the fungus came back when i stopped it. That is until I came up with a new idea. What if I could keep my big infected toe in Epsom salt instead of just a few hours a day how about months at at time? So I decided on a plan to purchase a pair of quality blue rubber gloves from Lowe's hardware store. Once home I used a pair of scissors to cut a single long digit off the glove. Then I filled it 25% of the way with Epsom salt and added 3 drops of water. Not at all uncomfortable, feels fine with, or without shoes and socks. Then I fitted the secured rubber finger digit over the infected toe. I started last September 2009. I would take the rubber finger off of my infected toe once a week and place a new load of Epsom salt in it. I stopped this in February 2010 and so far it appears to be gone with a new toe nail. I thought I'd share this blessed moment with you and hope it works for anyone else out there with this misery. And best of all not having to soak for hours each day.
    A. Thanks so much for sharing this. I want to mention that filing the nail every day is very helpful, too.

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SUPPLEMENT RESEARCH UPDATE and complementary medicine reviews - by Ray Sahelian, M.D.
Vol. 7, Issue 4 -- April, 2010
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Ever since I began studying the benefits of herbs used for sexual enhancement I have wondered why this knowledge has not been more accessible to doctors and the public who currently think the only effective sex boosters are prescription drugs such as Viagra, Cialis, and Levitra. I wrote a book called Natural Sex Boosters a few years ago and began formulating Passion Rx in 2004, which has become a very popular product. Recently Dr. Mehmet Oz, who has a health show on TV called the Dr. Oz Show, had a segment on a natural aphrodisiac from Asia called Tongkat Ali. The very day the segment was aired, Tongkat Ali became one of the most searched keywords on Google. I discuss this herb in my book, website, and this natural sexual enhancer is also included in Passion Rx aphrodisiac herbal mix. Tongkat Ali is an effective aphrodisiac. It increases libido in men and women, increases sensation, pleasure, and blood flow, but it has side effects on high dosages. I prefer using this herb is a formula with other sex herbs and extracts, such as tribulus, mucuna, damiana, catuaba, muira puama, horny goat weed, maca, avena sativa, and others, in order to use a lower amount and get the benefits from the other herbs that work in different ways to improve overall sexuality. The result is Passion Rx, an effective formula for men and women which has much fewer side effects than many other products used for sexual enhancement. The version of Passion Rx with Yohimbe has a very high rate of reorder. The side effects from high dose Tongkat Ali include restlessness, irritability, increased body temperature, increased heart rate, and insomnia. That is why I prefer using lower amounts. With time more people will begin to recognize that effective natural aphrodisiacs do exist, despite the denial of many in the medical community. The advantage of the prescription drugs is that they cause genital engorgement in an hour or two whereas the herbs and the formulas take a few days for optimal enhancement. The advantage of the natural aphrodisiacs is that, in addition to improved blood flow to the region, they also improve sensation, desire, stamina, and overall pleasure, a more comprehensive approach. The herbs are also cheaper, do not require a prescription, and do not cause permanent visual damage as some of the drugs have the potential to do. See http://www.raysahelian.com/tongkat_ali.html and http://www.raysahelian.com/libido.html

Curcumin and liver health
Austrian scientists report that feeding curcumin to mice reduces the types of inflammation that can cause liver cell damage and scarring. They wanted to find out if curcumin could delay the damage caused by progressive inflammatory liver disease, including two conditions called primary sclerosing cholangitis and primary biliary cirrhosis. Both of these conditions cause the liver's plumbing system of bile ducts to become inflamed, scarred, and blocked. Mice given curcumin in their diet had significantly reduced bile duct blockage and reduced liver cell damage and scarring. See http://www.raysahelian.com/curcumin.html

Risk of Lipitor, a statin drug used for lowering cholesterol
A study was conducted in people taking placebo and in patients given daily Lipitor (atorvastatin) during a 2-month treatment period. Despite beneficial reductions in LDL cholesterol, atorvastatin treatment resulted in significant increases in fasting insulin and glycated hemoglobin levels consistent with insulin resistance. See http://www.raysahelian.com/atorvastatin.html
    Comments: In the last issue of the newsletter I mentioned that certain medications used to lower blood sugar levels, such as Avandia, were actually found to increase the risk for heart disease. Here we find that a drug used to lower cholesterol levels increases blood sugar levels potentially increasing the risk for diabetes.

Breast cancer screening update
A major debate blew up in the United States last November after the U.S. Preventive Services Task Force questioned the value of screening mammograms for women under 50. Now, scientists in Europe have added fuel to the fire. They say they had found no evidence that screening women for breast cancer has any effect on death rates. In a study published in the British Medical Journal, researchers from Denmark and Norway said reductions in breast cancer death rates in regions with screening were the same or actually smaller than in areas where no women were screened.
    Comments: In previous newsletters I explained my reasons for women in their 40s to consider the risks in getting routine mammograms and I advised them to wait till age 50. I am not yet ready to dismiss the usefulness of mammography in women over 50, but if two or three additional studies show similar results as the one above, then I may change my mind.

Diet influences risk for endometriosis
Women who eat lots of tuna, salmon and other foods rich in omega-3 fatty acids such as EPA and DHA are less likely to develop endometriosis than those whose diets are rich with trans fats. The study of more than 70,000 American nurses found that women who ate the most omega-3 fatty acids were 22 percent less likely to be diagnosed with endometriosis than women who ate the least. The major sources of trans fats in the study were fried foods from restaurants, margarine and crackers. See http://www.raysahelian.com/endometriosis.html

Do you really need that PSA test for prostate cancer?
Dr. Richard Ablin of the University of Arizona, who discovered the PSA test now says that routine PSA screening has become "a hugely expensive public health disaster." He says the screening procedure is too costly and ineffective. "I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster," wrote Richard Ablin in a commentary for The New York Times. He adds, "So why is it still used? Because drug companies continue peddling the tests and advocacy groups push 'prostate cancer awareness' by encouraging men to get screened. PSA testing does have a place, after treatment for prostate cancer and for men with a family history of prostate cancer. Testing should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit." See http://www.raysahelian.com/psa.html

Emails
I started taking DHEA in the interest of increasing the usefulness of my workouts, increase my libido (which was waning). I was 41 when I was taking it (I am 43 now). At the time I was frankly in the best shape of my life (running 6 miles/day or 50 min cardio + 90 pushups). In my opinion, the hormone addition did contribute to my workouts, and a further decrease in BMI. I felt great. My libido had increased (which I hadn't felt since my kids were born), partly due to the workout endorphins, but definitely increased with the DHEA. My arms were cut -- but then they began getting veiny, like a male body builder's. My breasts shrunk (which I attributed to weight loss, but this got extreme), and THEN my hair started falling out. Panic. I was taking 25 mg daily per info on the internet, and as recommended on the bottle. I stopped taking it when my hair started coming out (which was scary). Over time, things went back to "closer to normal."

I attended the Vitamin D seminar in Toronto, Ontario in November 2009 and Dr. Charles Gant MD, Ph.D. told us that 2000 IU of Vitamin D daily will prevent 75% of breast cancers. He also says it will be a long time before it gets into the mainstream because there will be too much loss of money by pharmaceutical companies and the oncologists. A doctor I know gives his diabetic patients 50,000 IU daily and takes that himself. My own orthomolecular physician tells me he has a hard time getting his MS patients up to a normal level of Vitamin D with 50,000 IU daily.
    I wonder whether these doctors can guarantee that prescribing these massive dosages of vitamin D for several decades will not lead to calcification of blood vessels throughout the body and heart and the small arteries that supply blood to the sinus node and atrial node that regulate heart rhythm and these high dosages will not cause calcification of blood vessels in the brain leading to early dementia. At this time 400 to 2000 units, perhaps up to 3000 units a day, seems reasonable based on one's sun exposure, diet, and medical condition. I am concerned using higher amounts and I mention them on the vitamin D page of my website.

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SUPPLEMENT RESEARCH UPDATE and complementary medicine reviews - by Ray Sahelian, M.D.
Vol. 7, Issue 3 -- March, 2010
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I am a medical doctor and really respect your balance and wisdom, which I find very professional. However I have a different opinion about your recent discussions about Vitamin D as multiple authorities have recommended increasing the RDA dramatically. We are dealing with a hormone here, not a vitamin, and this needs to be emphasized by enlightened authors. In sunny climates people produce thousands of units a day. An English study gave 10000 U daily IM for 120 days with no side effects. CM Heaney and a large group of respected researchers recommended to governments that 2400 U gave even elderly women with poor absorption a modest level, and 6000 U in those working in full sun gave no-one too much.
    Until I see studies that show giving people several thousands of units a day for 10 to 20 years or longer provides benefits that are superior to giving 600 to 2000 units a day, I will stay on the cautious side. Over the past few decades I have seen too many enthusiastic doctors prescribe high dosages of certain vitamins, herbs, supplements and hormones only to later realize that adverse effects occurred that were not initially easy to predict.

Lifeguards, certain farmers and sailors and others who work outside and who are out in the sun all day can make thousands of units of vitamin D a day. Doesn't this prove that this supplement is safe in 10,000 unit dosages?
    Firstly, the amount of vitamin D made by sun exposure is done gradually throughout the day as opposed to taking a 10,000 unit pill that raises blood levels excessively high right away and thus may theoretically cause calcification in vessels and tissues. Secondly, is there any evidence that people who are exposed to more than 5000 units a day are healthier and live longer than those who get 1000 to 2000 units a day? Is it possible that an overall daily intake of 1000 to 2000 units is just as beneficial as taking 10,000 units and probably with fewer side effects?

About your response to the last question. My understanding is that proper exposure to natural sunlight (proper meaning at a low-enough latitude, during the summer, at a time of day when the sun is high in the sky, without wearing too many clothes that block the sunlight, without wearing sunscreen, without cloud cover, without excess smog, and not being so old as to have a highly impaired vitamin-D-making response) can produce relatively high levels of Vitamin D (in the form of
D3) fairly quickly (less than 30 minutes of exposure). Also, that a reaction balance is fairly quickly achieved in human skin properly exposed to sunlight so that additional sunlight exposure results in very little additional Vitamin D3 production. Is this not true? The Vitamin D council website says, "Humans make at least
10,000 units of vitamin D within 30 minutes of full body exposure to the sun, what is called a minimal erythemal dose."
    When I referred to people being exposed all day I was thinking of people who wear some clothes and are in and out of the sun throughout the day. Perhaps full naked body exposure can lead to the production of 10000 iu in less than an hour, but most people don't get this daily whereas some people are taking a 10,000 iu pill daily and that may be a concern.
 

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 7, Issue 2 -- February, 2010
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I just came back from a natural medicine conference and had a chance to talk to many of the attending doctors. Many of these doctors were new to natural medicine and came because so many of their patients had asked them about supplements that they felt they had to learn more about this topic. I was glad to see that more traditional physicians are now taking into consideration the potential of natural healing. The pace of change is slow but but growing. Some of the lectures at the conference involved the role of vitamin D in the prevention of cancer, the natural treatment of depression and anxiety with dietary supplements, and the role of diet and food selection in the prevention and treatment of metabolic disorders. There has been a lot of new research lately and I am looking forward to reviewing these findings with you in the coming year.
   At the conference I just attended some of the doctors I talked to were quite enthusiastic about checking routine vitamin D levels in their patients and were prescribing large doses of the vitamin. I had a chance to ask ten different doctors what dosage of the vitamin they would give to their patients based on a hypothetical blood level. Later I discuss their responses and my opinion on vitamin D testing and whether it should or should not be a routine test for everyone.
   My review of the necessity of mammogram testing in the 40 to 50 year old age range in the last issue was well received with no single negative comments, only positive ones.

St. John's wort and hot flashes
Researchers from Iran note that among a group of women they randomly assigned to take either St. John's wort or a placebo for eight weeks, those taking the herb had a greater reduction in daily hot flashes. Among women taking the herb, the average number of hot flashes was lowered  from roughly four per day to two per day after several weeks of use. The herb also reduced the duration and severity of the women's hot flashes. The study included 100 women who were 50 years old, on average, and had been experiencing moderate to severe hot flashes at least once per day. See http://www.raysahelian.com/stjohn.html

Red yeast rice as an alternative to statin drugs
Doctors at Chestnut Hill Hospital in Philadelphia randomly assigned 43 patients with high cholesterol to take either red yeast rice capsules or pravastatin (Pravachol, one of the cholesterol lowering statin drugs such as Lipitor and Zocor) every day for 12 weeks. The supplement group took four 600 milligram capsules twice per day, while the pravastatin group took 40 mg a day. By the end of the study, 1 of 21 patients on red yeast rice had stopped the treatment due to muscle pain, as had 2 of 22 patients on pravastatin. LDL cholesterol levels fell by an average of 30 percent among supplement users, and by 27 percent among pravastatin users. See http://www.raysahelian.com/redyeastrice.html

Magnesium is of benefit in heart disease, at least in men
A review conducted at Brigham Young University, Provo, Utah looked at six clinical trials regarding the benefit of magnesium supplements in patients with coronary heart disease. Magnesium dosages ranged from 130 to 800 milligrams per day. A higher magnesium intake was associated with reduced risk of heart disease in male subjects but there was no decrease in the development of CHD in women who also had a high magnesium intake. The researchers suggested that “There is a possible association between a modestly lower risk of CHD in men and increased magnesium intake; therefore, it is reasonable to encourage diets high in magnesium as a potential means to lower the risk of CHD.” See http://www.raysahelian.com/magnesium.html
    I don't know why this study did not find magnesium was of benefit to women with heart disease, I still think it is worthwhile for women who have heart disease to take 100 to 200 mg a day of this mineral since it is quite safe.

Milk thistle benefits liver health during chemotherapy
Oncologists at Columbia University Medical Center in New York randomly assigned 50 children with acute lymphoblastic leukemia to take either milk thistle capsules or placebo capsules for four weeks while undergoing their "maintenance" round of chemotherapy. At the start of the study, all of the children had signs of liver inflammation from their previous round of treatment. After one month, children taking milk thistle had lower levels of two liver enzymes that show liver damage than those in the placebo group. Children on milk thistle were also somewhat less likely to need their chemotherapy dose lowered at any point. See http://www.raysahelian.com/milkthistle.html

Emails
Q. I agree with your cautious position on Vitamin D, especially in high dosages. Having worked with antiopiates in treating autoimmune diseases while working on my PhD at the University of Arizona, I am sure that the opiate modulating effects of sun exposure play a significant factor in the observed clinical benefits attributed to Vitamin D. In fact, I would personally bet that Vitamin D is likely a good biomarker for opiate modulation through ultraviolet exposure, and thus simply taking Vitamin D may only be emulating one measurable biological indicator associated with this exposure. I don't deny that Vitamin D has beneficial effects on health, but not to the extent that is currently attributed to this vitamin. Since natural production of Vitamin D is largely associated with ultraviolet light exposure, rather than dietary intake, one needs to consider the generation of endogenous opioids associated with this same light exposure which have very profound immunological and psychological effects. Many chronic tanning booth users show classical opiate withdrawal symptoms when given an opiate antagonist such as naltrexone, clearly demonstrating that opioids role in maintaining health should not be a factor to be dismissed so readily. Nyles Bauer, Clinical Immunology.
   A. This is an interesting point to keep in mind.

Q. I appreciated your input on the new breast cancer guidelines. I am a registered nurse and now feel I have substantiation for the suspicions I had that we were being asked to have mammograms too often. For myself, at age 58, I have now made the decision to do it every 2 years. In addition, I would love to hear more in the future about bowel cancer, screening such as colonoscopy, what age to begin, how often to have screening, and get some accurate info on that. Since bowel cancer is high on the list of killers, would like to see more info on bowel health, what we know about polyps, if they are preventable, how long til they turn cancerous, etc. Thanks for all you do -- keep it up.
   A. My latest guidelines on mammography testing are at the mammography page.

Q. I am writing to thank you for your wonderful Eyesight Rx formula. I am convinced it has played a vital part in healing and preserving my vision. In October 2008 I was blind in my left eye due to iritis. I was terrified that there might be permanent damage or scarring due to inflammation within the eye. Even the ophthalmologist caring for me was worried about this. I began looking into what the human eye really needs to function at its best and trying to find supplements and other aids to heal it. This year when I took my vision exam at the DMV, I am happy to tell you that the letters in front of both eyes were clear and easy to read. My left eye was even stronger than the right! Part of the credit for this goes to you and your exceptional formula. I have been taking it faithfully and will continue to do so indefinitely. You have my respect and gratitude because you have contributed so much toward the restoration of my eyesight. May all you do for others be returned to you many times over in the coming year. A very happy and healthy holiday season to you and your wonderful staff and a 2010 full of blessings.
    A. Fish oils at several capsules a day can help with vision. Once the benefits of Eyesight Rx are noted, some people do better taking it every other day and at a lower dosage of a quarter or a third of a tablet.

Q. My doctor prescribed vitamin d 50000 iu to be taken once a week. I took my first dose on a Friday, felt great over the weekend but by Monday I felt dizzy, exhausted, toxic, had a headache, my head felt constricted. I felt so tired I could not stay awake.
   A. I prefer to use this vitamin daily in lower dosages than the massive amounts once a week.

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SUPPLEMENT RESEARCH UPDATE - by Ray Sahelian, M.D.
Vol. 7, Issue 1 -- January, 2010
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Even though the focus of my newsletters is generally on supplements, we have had so many emails from women and men who want clarification on the issue of breast cancer testing that I am devoting this newsletter issue to the benefits and risks of mammograms. I will return to supplement research in future issues. I want you to be aware that advice, some of it misleading, is being given to you regarding the necessity and frequency of mammography testing by those who have a financial interest in this area. After you read this issue, send it to, or discuss it with, your friends and doctors. They need to know the crucial information I am about to reveal.
    The medical establishment and the news media have oversimplified and oversold the benefits of mammograms. The more mammograms are done, the more money is made by the medical establishment and certain corporations and societies. In November 2009 the United States Preventive Services Task Force (USPSTF) an independent and highly respected agency made up of doctors and researchers with no ties to corporations revised guidelines for mammograms for women between the ages of 40 to 50 who have no family history of breast cancer. Previously the guidelines were to have mammograms every year or every other year. But after reviewing all the latest studies, this agency found that more harm than good was being done in this age group by such screening and suggested women talk with their doctors about the benefits and risks rather than undergoing routine testing. Most women were shocked to hear this new recommendation partly because the USPSTF did not explain themselves well. Women thought, "How can it be that getting a mammogram can hurt me? Aren't mammograms supposed to find a cancer that can be cured early?" The medical establishment, including the American Cancer Society, lashed back at the USPSTF and advised women aged 40 to 50 to continue getting mammograms. Were profits an influence regarding this backlash? I highly suspect this to be the case. Companies which manufacture mammography equipment or benefit from an increased use of medications and medical care, place political pressure, and are donors to organizations, such as the American Cancer Society, that are against any change in the recommendations. Women from ages 40 to 50 have been sold the idea that mammograms save lives but there is no proof that they do so in this age group and women have not been adequately told of the risks involved, including a higher risk for cancer from radiation. In this issue I will tell you all the potential risks so you that you can make an informed decision. Of the nearly 200,000 women who will get breast cancer next year, half will be over the age of 61. About 25,000 women will be under the age of 40. Only 1 in 2500 women develop breast cancer by age 30. Younger women have the least to gain, and the most to lose, from screening.

Risks of mammography that the news media and your doctors may not be aware of, or may not admit. The following pertains to women younger than age 50.

Higher breast cancer risk due to radiation exposure
Routine mammograms in young women increase the risk for future breast cancer due to direct radiation exposure to breast tissue. For young women who have a high risk of breast cancer because of genetic mutations, the radiation from yearly mammograms may make the risk even higher. It is quite possible that women who may never have developed breast cancer in their lifetime may get this disease in their 50s, 60s, or later, from having routine yearly mammograms in their 30s or 40s. We are exposing millions of young women to such radiation without fully understanding the future impact.
    The annual mammograms give a dose of radiation that has accumulative effect on the body. In addition to exposing the body every year to radiation, many women must have additional screening when they receive a false-positive result, adding to further radiation exposure. Nobody knows exactly how much the risk for cancer is increased due to having regular mammograms in young women, but it is quite possible that the medical establishment and the American Cancer Society are not emphasizing this risk, or are not aware of it, as much as they should. The premenopausal breast is very sensitive to radiation, each rad of exposure increasing breast cancer risk by 1 percent, resulting in a cumulative 10 percent increased risk over ten years of premenopausal screening, usually from ages 40 to 50. Risks are even greater for "baseline" screening at younger ages, for which there is little or no evidence of any future relevance. See this EXCELLENT article written by a respected university affiliated medical doctor that reviews the risk of radiation from mammography and exposes the profit motive of certain corporations and organizations, and forward this article to anyone who you think would benefit, including your doctor, http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4194

False negatives
Some breast cancers do not show up on mammograms, or "hide" in dense breast tissue. A normal (or negative) study is not a guarantee that a woman is cancer-free. The false-negative rate is estimated to be 15 to 20%, higher in younger women and those with dense breasts. A normal mammogram can give a false reassurance that everything is okay with the breast tissue. Mammograms often miss very aggressive cancers that develop between screenings, while finding slow-growing tumors that may not pose a threat.

False positives
It is estimated that a woman who has yearly mammograms between ages 40 and 49 has about a 30 to 40 percent chance of having a false-positive mammogram at some point in that decade and about a 10 percent chance of having a breast biopsy within the 10-year period. It is estimated that 80% of all breast biopsies result in benign (no cancer present) findings.
    The radiologist may notice something unusual, and due to the fear of being sued, will suggest a biopsy even though it may not be necessary. Doctors are so afraid of missing a potential tumor that they will send their patients with minor abnormalities for additional testing even though technically they may not be needed thus significantly increasing the rate of false positives and further x-rays, blood tests, other diagnostic procedures, and biopsies.
    Screening mammography, like all cancer screening tests, has potential drawbacks, including adverse effects on survival, comfort, function and psychological well-being emanating from all procedures that result from screening. Since the average risk of dying from cancer during the 40s is relatively low, 1,900 women in that age group would need to be screened for a decade, and suffer all kinds of emotional, financial, and other hardships, to PERHAPS increase life expectancy of one life.

Mammograms may find a small cancer that may not cause death in the long run
According to an analysis by The Cochrane Collaboration, an international not-for-profit organization providing up-to-date information about the effects of health care, one in 2,000 women aged 40 to 50 will have her life prolonged by 10 years of screening, however, another 10 healthy women will undergo unnecessary breast cancer treatment that are not life threatening. Screening mammography does not reduce death overall, but causes significant harm by inflicting cancer scare and unnecessary surgical interventions. It is possible that many slow growing tumors are found during these mammograms that may never have come to clinical attention during a woman's lifetime had she not been screened. Yet, by catching these early tumors, unnecessary surgery, chemo and radiation are done which reduce quality of life. Tens of thousands of women may be getting mastectomies and chemo and radiation that didn't need it, who never would've gotten sick. Furthermore, spontaneous regression of invasive breast cancer has been reported.
    Even without mammography detection, many of these small cancers would eventually grow large enough for a woman to notice herself while taking a shower or putting on a bra, and appropriate treatment can be done at that time without any change in overall outcome. Breast cancer treatment has improved over the past decade so that most of later diagnosed cancer are fully treated and cured.

Physical pain, scarring
Pain occurs from breast compression during mammography, and from biopsies. Some women have pain after a biopsy that can last weeks or months. Permanent scarring can occur from biopsies particularly if the site gets infected.

Risk of hematoma and infection from biopsy
There is a small risk for infection from the surgical procedure resulting in the need for antibiotics and the potential harm from such medications. There is a risk of bleeding and forming a hematoma, a collection of blood at the biopsy site. Doing a biopsy of tissue located deep within the breast carries a slight risk that the needle will pass through the chest wall, allowing air around the lung that could collapse a lung -- this is a rare occurrence.

Mental pain and anxiety
Increased anxiety occurs  from unnecessary testing due to many false positives, and simply the anxiety naturally occurring between scheduling the screening procedure and receiving the results. This can lead some women to lose sleep, develop an anxiety disorder, or even get hooked on anti-anxiety medications. Women who undergo treatment for inconsequential disease found by screening have suffered serious psychological and physical harms from screening, which may include adverse effects from surgery, radiation, or chemotherapy such as delirium, functional decline, or even death. Some women with positive mammograms, even after getting a negative biopsy, have heightened anxiety for a period of time leading to poorer health and quality of life. The anxiety and depression can negatively impact work performance, interactions with spouse, family members and friends, and the care of children.
    Something else to consider: By focusing on mammography testing in one's 40s, and subsequent false positives and further testing and biopsies, many women shift their thinking about their breasts from that of sensitive, erotic and sensual tissue to that of tissue that can cause a horrible disease such as cancer.

Increased risk from compression?
Mammography entails tight and often painful compression of the breast, particularly in premenopausal women. Some have claimed that this may lead to distant and lethal spread of malignant cells by rupturing small blood vessels in or around small, as yet undetected breast cancers. There is a great deal of controversy regarding this claim and I am currently not sure how valid it is.

Danger of early removal of cancer?
Women who get screened find small tumors sooner. This leads to earlier surgery. Some of these tumors might not really be dangerous. Some claim that removing them might be dangerous since excision of the primary tumor may remove a negative growth factor that discourages metastases from growing, I am not sure whether this claim is accurate or not.

Financial burden
Due to the economic downturn, more women have no access to health insurance and the cost of the mammograms, doctor visits, and subsequent biopsies can cost 10,000 dollars or more during a 10 year period. The cost of a breast biopsy can range from approximately $1000 to approximately $5000 depending several factors, including the type of biopsy performed, the equipment used during the biopsy, and whether image guidance or other additional equipment is necessary to perform the biopsy,. Even if you have insurance through the company you work for, the cost of such testing and the higher rate of insurance premiums may result in your salary being less or perhaps not getting a raise. Health care costs are having a significant impact on businesses in this country. Eventually, one way or the other, everybody pays for higher health care costs, except the companies making money from such testing.
   The U.S. spent an average of $7,681 per person on health care in 2008, for a total of $2.3 trillion -- even though spending actually slowed dramatically that year because of the recession.

Appropriate use of limited health care funds
There are limited funds for health care in this and every country on the planet and we have to use these funds in a way that give us the most benefit with the least harm. Could the billions saved by avoiding these unnecessary mammograms be used for other purposes that yield a higher benefit? What about a campaign to educate people on how to eat healthier and exercise more thus reducing the risk of cancer and heart disease? What about using these savings to provide dental care or vision care for millions of children whose parents can't afford such expenses?

Miscellaneous additional costs, concerns and hassles
There are various other minor problems and hassles with testing. Filling out insurance forms, the cost of co-pays, scheduling hassles, time off from work or home that could be spent in more enjoyable and relaxing activities, the hassle of waiting at the testing centers or the doctors office, driving back and forth to the appointments and the gas expense, the risk for a car accident while driving to and fro from the appointments, etc.

Making money from mammography
Certain corporations and organizations are profiting from such testing and may not have the best intention of women in mind. I highly suggest you read this article written by Adriane Fugh-Berman, M.D., an associate professor in the department of physiology and biophysics at Georgetown University Medical Center. I suggest you send this link to everyone who you think would benefit from this honest expose. See http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4194

Bottom line
The medical establishment told women for decades that hormone replacement therapy offered benefits without adequately mentioning the risks of increased cancer, heart disease, and blood clots. Is it possible that again the same thing is happening with mammography testing, that the potential downside is not being adequately explained? Now that you have reviewed the potential harm from such screening, you can make up your mind if you wish to have mammograms in your forties. Ultimately you have to make the decision, it's your body.
    My suggestions: Starting at age 50, get about 10 mammograms in a lifetime, one every two years. This way you get the most benefit and the least harm from the tests. A woman can reduce her chances of getting breast cancer through good nutrition and making the right lifestyle choices, see http://www.raysahelian.com/breastcancer.html. Perhaps the money saved from unnecessary testing can be devoted to buying healthier foods, signing up to a gym, doing yoga, calisthenics, travel and leisure, or other quality of life improving activities.  I highly recommend this site regarding the wise recommendations of the USPSTF. See http://www.ahrq.gov/CLINIC/uspstfix.htm

In 2009 The American College of Radiology and The Society of Breast Imaging sent out a press release supporting routine mammograms starting at age 40. Are these recommendations based on science or profit?The American Cancer Society has donors such as Hologic, which makes breast imaging products, and Johnson and Johnson, which makes an image-guided breast biopsy product.The American College of Radiology has donors that include GE Healthcare, Siemens, Phillips, Hologic, and many others that make mammography machines or related products.The Society of Breast Imaging is an organization managed by the American College of Radiology. I do not trust the opinion of the these organizations. I trust the recommendations of the USPSTF.

Another article I suggest you read: http://kattlovecancerblog.blogspot.com/2009/11/new-mammography-guidelines-got-it-right.html

Emails received after the last issue
Dr. Sahelian, I have been following your writings for several years and I am so happy to have found a source I trust and respect. I am now 51 years old. At age 40 my doctor suggested I begin with annual mammograms. The first two years were fine, the results were negative. But at age 42 the result came back with a suspicious area in my right breast. I had additional testing done with ultrasound and such and it was suggested I have a biopsy. Scheduling for the testing and waiting for the results were quite difficult and I started having trouble sleeping. My doctor gave me a prescription for Xanax which helped a lot. Fortunately the biopsy came back negative. However, since I don't have insurance, I am a computer graphic expert working from home, it cost me several thousand dollars. I continued with mammograms and at age 45 now the left breast showed something suspicious. This time my nerves couldn't handle it and I resumed on the Xanax. I started getting hooked on the drug. It made me lethargic and made me lose interest in sex. My doctor suggested I have a repeat mammogram in 6 months. During this time my stress and anxiety became quite severe, I started having arguments and fights with my husband and children. To make a long story short, my husband left me, I wasn't sexually intimate with him anymore, the Xanax had taken my sexual urges away. The follow up mammogram was normal and I did not need a biopsy. However, 3 years later I had another suspicious mammogram which again necessitated a biopsy, fortunately it turned out to be normal. At this time I am 51 years old and have not had a cancer diagnosis but this whole testing has been bad for my health. I wish I had never done these tests. They have cost me close to 15,000 dollars over the past decade... I could instead have taken several vacations to Hawaii. It has also effected my marriage and work, and made me think of my breasts as harbingers of potential tumors rather than sensual organs. I hope these new recommendations will make fewer women go through the awful stress and anxiety I endured. I am, unfortunately, still hooked on Xanax, particularly when the time comes to schedule a cancer screening test. At other times passion flower or kava help me relax and avoid the medication.

I felt your comments regarding Rep Debbie Wasserman Schultz in your last newsletter were unnecessary and irrelevant. What was the point of that?
    I disagree. A politician who is not a medical doctor and has not reviewed the latest medical research as thoroughly as the USPSTF has no business going on TV and telling the American public to disregard the highly respected reccomendations of this independent agency. I am not aware of any other politicians in the past who has told the American public to disregard the recommendations made by this agency. I googled her name and American Cancer Society and found a picture of her with the president of this organization. The American Cancer Society receives funding from corporations that make breast cancer imaging equipment. Is this congresswoman influenced by these corporations? I don't know but the whole thing is quite suspicious. See http://topics.treehugger.com/photo/0e5n9db1Az0pt?q=American+Cancer+Society