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Monday, July 26, 2010

Dr. Saleeby to Talk

Thursday, July 22, 2010

High Dose Vitamin C Gains Acceptance in Western Medicine

It is 3:00 PM on a typical mid-summer day when the call comes in over the EMS radio. A 9-year old boy suffering thermal burns is in rout to our Emergency Department; ETA 10-minutes. A very characteristic summertime event, as the report continues that the child was dousing a still smoldering pile of burning yard-trash with gasoline. The resultant flash back scorched his face, neck and hands. For the purposes of this article we will call him Jimmy. Jimmy arrives with 1st and 2nd degree burns to over 15% of his body surface area. We rush to stabilize him, administering morphine IV for pain control and boluses of Ringer Lactate IV solution according to the Parkland formula for fluid resuscitation. The burn team members on the other end of the phone at the regional Burn Center in Augusta are accommodating as usual, as we get ready to air transport this little fellow to their center. Jimmy does exceptionally well at the center, a week later he is discharged and I receive a report from the burn surgeons. To my utter amazement it includes details of the use of high dose intravenous Vitamin C infusions the day off and the days that followed his arrival.

High Dose Vitamin C? In my 17 years of practicing traditional Western Medicine, I thought I would never see the day when a “vitamin” was a mainstay of care in a critically injured patient. Research has proven the utility of this vitamin in reducing capillary leakage and reducing fluid loss, enhancing healing and reduction in scar formation. While trained as an allopath my interests have in the past decade and a half been leaned towards the alternative. My approach in my private practice is integrative. By integrative I refer to my allopathic trained as a medical doctor (MD) but subscribing to selected, evidence based alternative or complementary diagnostics and therapeutics. Shying away from the temptations of polypharmacy and pill pushing for a more holistic and natural approach. With the advent in recent years of higher doses of Vitamin D3 replacement being prescribed by American physicians it was only a matter of time before other “nutritional” therapies caught on. I cheer on the embracing of these therapies.

Vitamin C, also known as ascorbic acid or ascorbate, is a carbohydrate compound closely related to and derived from the glucose molecule. Glucose is a simple sugar that is used by most living organisms as a fuel for cellular energy. Vitamin C remains one of the most important nutrients we as humans rely on for good health whether we know it or not.

Vitamin C was first identified by a Hungarian scientist named Albert Szent-Gyorgyi, MD, PhD in 1926, while conducting research on the chemical process that causes fruits and vegetables to turn brown. He succeeded in isolating a white crystalline substance from the adrenal gland of cows, which he referred to as Cx11. He later isolated these same crystals from the juice of potatoes and cabbages renaming it hexuronic acid. Finally, in 1932 after producing the first pure crystals of vitamin C, Dr. Gyorgyi bestowed the name ascorbic acid to the substance in recognition of its role in preventing scurvy. The Latin word, ascorbic means "without scurvy". Scurvy, a rather horrible disease, results in defective collagen synthesis leading to defective dentine formation, hemorrhaging into the gums, and loss of teeth. Hemorrhaging is a hallmark feature of scurvy and can occur in any organ not just the gums. Hair follicles are one of the common sites of cutaneous bleeding. Bony changes are usually observed in the very young. Scurvy was first described by the Egyptians as early as 1500 BC, and struck the crew of Magellan's around-the-world journey in 1519-22. A British report in c.1600 indicated that in the previous 20 years some 10,000 mariners had suffered the disease. Seafarers were often susceptible due to poor dietary intake of Vitamin C on their long voyages. In 1747 as the HMS Salisbury sailed from England to the Plymouth Colony, James Lind the ship's physician performed a simple experiment to determine the cause of this disease, it was one of the first controlled scientific studies using fresh citrus fruit in some sailors and having a control population that ate citrus-free meals. The ingestion of limes and oranges saved those sailors from scurvy. Consequently, British sailors during WWII were often referred to affectionately as “limeys” for their now notably historic consumption of this fruit while at sea.

Unfortunately for humans, we do not possess the ability to manufacture their own Vitamin C. And by definition a vitamin is a substance necessary for survival that must be taken in from the outside (ingested exogenously). Plants and most animals possess an enzyme called gluconolactone oxidase (GLO) that allows them to readily convert glucose into Vitamin C. Humans have somehow lost the ability to do what virtually every other life form on earth can do with ease during our evolutionary development by losing the ability to make GLO and requiring ingestion of Vitamin C containing foods. In actually GLO is the 4th enzyme in the pathway to converting glucose to Vitamin C and the only one we humans are missing. Besides ourselves, three other species of mammals do not make this vitamin and they include the gorillas, guinea pigs and the fruit bats. Why these four mammalian species lost this ability is poorly understood.

The reasons why Vitamin C is important are many. It offers Antioxidant protection. Vitamin C protects us from the ravages of free radical damage that can destroy cell membranes, damage DNA and lead to the development of degenerative diseases, cancer and pre- mature aging. In addition to helping the body utilize folic acid, Vitamin C helps in the recycling process of other anti-oxidants such as Vitamin E, Coenzyme Q10, alpha Lipoic Acid and Glutathione. Antioxidants are the key to maintaining health and longevity. They are at the root of all degenerative diseases. Did you know that some animals utilize Vitamin C as a “stress hormone”? In goats for example their serum levels of Vitamin C jump exponentially when under physical stress. A goat will on an average day will produce between 5 and 15 grams of ascorbate. Interestingly, that same goat, if under stressed, will produce 5 - 10 times its baseline levels of ascorbic acid. Evolution has conditioned this animal to increase production in times of need. Some have referred to this vitamin in these animals as “the other stress hormone” after cortisol.

Vitamin C is crucial in collagen production. Vitamin C helps in the manufacture of collagen, the basic cellular "cement" that keeps muscles, tendons, bones, teeth, skin and arteries healthy and strong and aids in the repair of blood vessels and broken bones. The amino acids Lysine, Glycine, Proline when combined with Vitamin C make collagen. Zinc is an important mineral in this pathway as well. So without adequate dietary intake of Vitamin C and Zinc skin and tissue repair is hindered. Vitamin C and the mineral Zinc are the two co-factors crucial in the enzymatic production of collagen and hence the particular importance in the use of Vitamin C in full thickness burn victims of late.

News reports tout the importance of Vitamin C in cardiovascular health. Vitamin C benefits heart conditions of all kinds. It has been found to normalize blood pressure, reducing cholesterol and repairing arterial walls. In fact, there are researchers that believe cardiovascular disease is in reality the early stages of scurvy and can be prevented with a vitamin protocol centering on high doses of Vitamin C. This was the belief of two-time Nobel Prize laureate Linus Pauling. Dr. Pauling dedicated much of his life’s work to research on Vitamin C. His own personal daily intake was huge, and who am I to disagree with such a great mind. His theories continue today by other luminaries in medicine and science. Vitamin C does not allow Low Density Lipoprotein (the “bad” cholesterol) to oxidize. It is the oxidation of this "bad" cholesterol that produces plaques on our artery walls and results in coronary artery disease. Vitamin C's effects on the cardiovascular health may soon be revealed in ongoing studies to play a bigger role than some very powerful drugs the medical establishment is currently using as first line medication.

The immune system is not to be overlooked, for ascorbic acid plays a major role. Vitamin C aids white blood cells that attack and destroy everything from cancer cells, viruses, bacteria, to parasites of all kinds. It also controls the release of histamine, a sometimes undesirable side effect of our immune system at work. There are cancer treatment protocols using very high doses of IV Vitamin C. My experience has been with its use in the Myers’ Cocktail infusions.

Since we all lack the GLO enzyme we cannot provide ourselves with the antioxidant protection and other benefits that Vitamin C was designed to provide. We have no way of self-regulation. Antioxidant experts from researcher Linus Pauling to Cellular Health author Dr. Matthias Rath (who discovered the Lp(a) risk factor for heart disease) recommend a rather high oral dosage each day to fully support and aid the immune system and optimize health. Such high doses should first be discussed with a knowledgeable nutritionally minded physician. Doses that exceed oral intake tolerability can be administered intravenously on a set schedule depending on the body’s needs.

By using the bowel tolerance test (or Ascorbic Acid Flush test) everyone can determine his or her own necessary level of Vitamin C and tolerability. This amount is different for each individual and may change depending on the health and stress of that person. If you are stressed by some sort of acute illness such as a cold, conducting the same test rapidly can be achieved by increasing the dose of Vitamin C. Under stress the bowels will tolerate greater doses of the vitamin. I routinely order and advise patients on optimal doses using the Ascorbic Acid flush test. Those patient with Iron metabolism problems such as Hemochromatosis or a blood disorder called Thalassemia need to exert caution for Vitamin C greatly increases iron absorption and this can be harmful in these individuals.

Conversely high doses of Vitamin C can hinder the absorption of Ginseng if taken together. High dose Vitamin C increases serum levels in the concomitant use of the drug Acetaminophen (Tylenol). High levels of Tylenol especially in an individual with liver disease can be harmful. There are reports that high dose Vitamin C inhibits effect of statin (HMG-CoA reductase) drugs such as Zocor, Mevacor and Lipitor. These lipid lowering drugs are used quite commonly in our society. High dose Vitamin C may also reduce the blood thinning effects of warfarin (Coumadin) and that is important for those people taking that medication to be aware.

Before embarking on high dose Vitamin C usage, it is important to determine your personal needs and the correct preparations, dosing schedule and adjunct supplements that need to be taken. Therefore consultation with a nutritionally minded physician is recommended and imperative. Oh, and in closing, Jimmy is doing just fine these days with the most minimal of scars following his accident.

-JP Saleeby, MD is an Emergency Room physician and Integrative Practitioner; he is a medical writer and blogger. Dr. Saleeby has recently relocated to the Myrtle Beach area to open a dedicated Natural Medical practice with other complementary medicine healers.

**To be published in an upcoming edition of Myrtle Beach Quarterly

Friday, July 9, 2010

Vitamin C reduces the risk of heart attack in patients with elevated CRP.

Vitamin C reduces the risk of heart attack in patients with elevated CRP.

Block G, Jensen CD, et al: Vitamin C treatment reduces elevated C-reactive
Free Radical Biol Med: 2009 Jan 1;46(1):70-7.
University of California, Berkeley, 94720, USA.

Abstract from the NIH:

Plasma C-reactive protein (CRP) is an inflammatory biomarker that predicts
cardiovascular disease. Lowering elevated CRP with statins has reduced the
incidence of cardiovascular disease.

We investigated whether vitamin C or E could reduce CRP. Healthy nonsmokers
(N=396) were randomized to three groups, 1000 mg/day vitamin C, 800 IU/day
vitamin E, or placebo, for 2 months. Median baseline CRP was low, 0.85 mg/L. No
treatment effect was seen when all participants were included. However, a
significant interaction was found, indicating that treatment effect depends on
baseline CRP concentration. Among participants with CRP indicative of elevated
cardiovascular risk (> or =1.0 mg/L), vitamin C reduced the median CRP by 25.3%
vs placebo (p=0.02) (median reduction in the vitamin C group, 0.25 mg/L, 16.7%).
These effects are similar to those of statins. The vitamin E effect was not
significant. In summary, treatment with vitamin C but not vitamin E
significantly reduced CRP among individuals with CRP > or =1.0 mg/L. Among the
obese, 75% had CRP > or =1.0 mg/L. Research is needed to determine whether
reducing this inflammatory biomarker with vitamin C could reduce diseases
associated with obesity. But research on clinical benefits of antioxidants
should limit participants to persons with elevations in the target biomarkers.

Sunday, July 4, 2010

Evidenced Based Medicine's Pitfall

Failure. The word failure is my son's new child-acceptable expletive, taking presidency over the word "snap" used extensively last year. My 10-year old son uses this word repeatedly throughout the day when things just don't come out as expected or there is a serious breakdown or injury on America's Funniest Home Video show. Anyway, I can't think of a more appropriate word than "failure" when it comes to a study published in the Cochrane Reviews on June 16, 2010.

Cabello JB, Burls A, Emparanza JI, Bayliss S, Quinn T. Oxygen therapy for acute myocardial infarction. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD007160. DOI: 10.1002/14651858.CD007160.pub2 is a trial which studied O2 therapy in AMI patients and had a unusual conclusion: There is no conclusive evidence from randomised controlled trials to support the routine use of inhaled oxygen in patients with acute AMI. A definitive randomised controlled trial is urgently required given the mismatch between trial evidence suggestive of possible harm from routine oxygen use and recommendations for its use in clinical practice guidelines.

WHAT? FAILURE? This is so counter intuitive, I mean in my 17-year EM career O2 therapy is the mainstay and initial therapeutic used for our "chest pain" complaint patients and for years and hundreds of examples, I was witness to its ameliorating effects. Now some online journal is telling me otherwise? What gives? Well the authors are quick to point out that a large trial(s) needs to be performed to further evaluate this report. In this small study (n=387) 14 patients died and three times the number of fatalities occurred in those receiving oxygen therapy. There are probably a number of confounding factors that resulted in the outcome as it is. Here is one shining example of recent reports of how "evidence based medicine" (EBM) practice is flawed. Caveat Emptor! Anyone who buys into the 100% undeniable and infallibility of EBM needs to beware.


Thursday, July 1, 2010

Health Benefits of Sesame Seed Oil

Sesame Seed Oil

By JP Saleeby, MD

The cultivation of sesame (Sesamum indicum) seed and the oil derived go back hundreds of years. Sesame seed oil was one of the first oils ever pressed from seeds and it has been traced back to the Assyrians prior to 600 BC. The Assyrians as well as the Hindus that followed used the oil as a food source, a medicinal salve and as an oil to burn in their votive lamps. The oil itself has many uses, in antiquity as well in present day. It is used in industry as a solvent in injectable drugs and IV solutions. It is used in cosmetics and as a natural insecticide against weevil attacks of some grains. Lower grades of the oil are used in paints, lubricants and soaps. Higher grades of sesame oil are used as a culinary oil for cooking and seasoning. And of course sesame seed oil is used in alternative medicine applications, especially in Ayurvedic medicine.

Sesame oil is a good source of vitamin E as well as vitamin B6. Copper and magnesium are also present as is iron, zinc and calcium. Unlike most other oils, sesame (and olive oil) is temperature stable and does not smoke when used to cook in high heat. Additionally, it keeps well at room temperature for months to years without going rancid, as a polyunsaturated (omega-6 fatty acid high content) oil, much like olive oil (but olive is a monounsaturated oil predominantly omega-9). The stability of sesame oil is in part due to its content of sesamol, sesamiline (a glycoside) and sesamine (a complex cyclic ester) which are naturally occurring antioxidant and preservatives.

There is an old Ayurvedic medical practice called oil pulling in which oil is swished in the mouth for 10 minutes or more and said to pull toxins out of your system. Sesame oil is one of only two oils recommended for this therapy. It is also used as a mouthwash to kill harmful oral bacteria and frequently used by massage therapist as a preferred oil in therapeutic massage for its healing properties.

The topical and oral administration of sesame oil is said to treat many disorders such as poor circulation, GI problems, fatigue, inflammation, pain and as an antimicrobial. Due to the presence of lignans it has phytoestrogen properties as well that are helpful in premenopausal women. In modern studies it has shown anti-bacterial effects and in two rather recent studies has anti cancer effects. Maybe that is the reason it has been referred to as the Queen of Oils. Rather inexpensive and full of uses, daily oral ingestion and topical use can enhance wellbeing. I prefer mine in Oriental cuisine and as a base in home made humus (Tahini is a sesame paste heavy with oil and a main ingredient in this tasty dip). But don't go away thinking that you get enough on a sesame seed bun at McDonalds.

© 2010


Selective growth inhibition of human malignant melanoma cell line by Sesame Oil in Vitro: Malignant melanoma cells would not replicate in sesame oil: Prostaglandins, Leukatrines and Essential Fatty Acids; vol 46: 145, (1992)

Oleic acid found to reduce serum cholesterol levels: Effects of increasing dietary palmitoleic acid compared with palmitic and oleic acids on plasma lipids of hypercholesterolemic men: Journal of Lipid Research; vol 35: 656 (1994)

Sesame Oil significantly more effective in relief of dry nasal membranes than isotonic sodium chloride: Archives of Otolaryngology; vol 127: 1353, (Nov. 2001)

The effect of sesame oil mouth-rinse on the number of oral bacteria colony types; Maharishi Int’l University of Management, Fairfield Iowa, 1992

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Charleston; Myrtle Beach, SC; Raleigh-Durham, NC; Orlando, FL, GA, NC, SC, VA, FL, United States