AtroGene/ Carolina Mobile MD March 2011 Newsletter

3.2011




The year 2011 has brought much change to Carolina Mobile MD. After a brief period of opening up a brick-and-mortar location in Conway, SC, it was determined not to be an effective use of resources, thus CMMD merged with AtroGene Telemedicine and closed the Myrtle Beach area location. AtroGene provides strictly TeleHealth Consultations much like Carolina Mobile, yet without the house call service. Dr. Saleeby will continue to head the group of healthcare providers and additional services have been added. Online Lab Testing (www.eStatLabs.com) and a new practice web site (www.AtroGene.com coming soon) are a few new features that make it easier for patients to obtain routine preventive healthcare and fast and affordable access for acute illness.




In the works is a project called RedBanyan (www.RedBanyan.org) which will offer FREE healthcare for basic preventive and minor acute illness via telemedicine/Skype to NC, SC and GA residents who have NO health insurance.




We also had our inaugural Slow Food USA (Conway/Myrtle Beach) convivium meeting Feb. 17th at the Horry Co. Public Library. The meeting was a grand success drawing in excess of 20 people. Mr. David White (Oakland Farms Free-Range Chickens) was our guest speaker and our crowd came from a diverse backgroud of people interested in Safe, Good and Fair foods. For more visit http://www.slowfoodusa.org/ or our listing on Local Harvest: http://www.localharvest.org/slow-food-conway-myrtle-beach-convivium-M41976 Our next meeting will be held in Myrtle Beach in April.




------------------------



The Amazing Vitamin K

 by JP Saleeby, MD



In very recent years, the medical and scientific communities have begun to focus their attention on the benefits of Vitamin K. While not as popular as its big brother, Vitamin D, Vitamin K will no doubt come to the attention of mainstream media as soon as its many benefits are realized by the public. In the last five years, primary care physicians and specialists are testing Vitamin D levels on almost every patient. As research has poured in on the many health benefits in multiple arenas, from bone health to immune function, Vitamin D therapy is now considered standard of care. Likewise, Vitamin K is slowly gaining momentum in the public eye and in doctor’s offices.



Of historical interest, Vitamin K was first discovered as a compound in the 1930's. It was reported in a German science journal as koagulationvitamin for its control over coagulation, hence the letter designation “K” for koagulation. Newsworthy in the mid-20th century, Vitamin K made headlines when the 1943 Nobel Prize in Medicine was shared by American Dr. Edward A. Doisy and German Dr. Henrik Dam for their work with this vitamin. As early as 1938, the first report of using Vitamin K to treat a life threatening case of hemorrhage due to liver disease was documented. Its use as a therapeutic saved the patient from certain death.


Vitamin K is a lipophilic vitamin (meaning it is fat soluble) and is required chiefly for blood coagulation and metabolism of bone and other tissues. There are two natural forms of this vitamin and several synthetic versions. Vitamin K1, also known as phytomenadione, and Vitamin K2, menaquinone, are the two natural forms. Vitamin K2 is produced chiefly by bacteria in our large intestines. Vitamin K1 is found in green leafy vegetables such as spinach, turnip greens, Swiss chard, and the brassica vegetables like cabbage, broccoli, Brussels sprouts, and kale. Fruits like kiwifruit and avocado, as well as soybean oil are other food sources of Vitamin K.


The chief utilization of Vitamin K in medicine as a "therapeutic" is in its role with the coagulation of blood. It plays a key role in factors II, VII, IX and X as well as in protein-C and protein-S. All of these blood factors and proteins are linked to the clotting cascade that prevents us from hemorrhaging in the event of a severe traumatic injury. Additionally, Vitamin K has a significant role in bone metabolism with a relation to osteocalcin. It acts as a bone building hormone in a way, much like Vitamin D. Osteocalcin is synthesized by Vitamin K and is the "matrix" in bone that holds the calcium molecules together. Without Vitamin K, hip bone fracture rates increase despite adequate Vitamin D and calcium intake. In the 1998 Nurse’s Health Study, oral administrations of 110 micrograms per day of Vitamin K proved to decrease hip fractures when compared to control subjects.



Vitamin K is important in vascular biology as well, especially in the realm of artery plaque formation (calcification). There are Vitamin K dependent proteins involved in atherosclerosis or hardening of the arteries. The process of calcium plaque formation is hindered with adequate Vitamin K levels in circulation. Warfarin (Coumadin ®) is a drug often used to treat folks with coronary artery disease (CAD) and to prevent blood from clotting in heart chambers and deep veins where severe compilations may arise. However, while treating certain medical conditions with these blood thinners, which inactivate Vitamin K, we create other problems. Chief among these problems are an increase in our risk for developing arterial plaques, the possibility of affecting our immune system, and the likely impediment of bone mineralization.



Vitamin K's effect on coronary arteries goes like this. With low levels of circulating Vitamin K in the serum, there is an impact on the function of a protein within the endothelial lining of the arteries called the Matrix Gla protein (MGP). The effect of low Vitamin K on this protein is that it allows for an increase deposition of calcium in arteries. Drugs that lower Vitamin K's effect in a sense raise the risk for coronary artery disease. Vitamin K facilitates our immune system with positive links to phagocytosis and chemotaxis (the process by which “microorganism attacking cells" in our body find and eliminate infectious organisms). Furthermore, Vitamin K appears to have a role in apoptosis, the process of natural and desirable cell death. Apoptosis is the process by which our bodies can eliminate damaged, old or mutated cells thus reducing many forms of cancers.



Because Vitamin K2 is produced by bacteria in the human alimentary tract, the overuse of broad-spectrum antibiotics can wipe out this good type of bacteria in our intestines and may cause a relative deficiency. Poor nutrition with inadequate consumption of greens and fruit is another way to attain deficiency. Both means of deficiency can lead to clotting dysfunction, immune disruption, bone loss, and coronary disease. With a look at the latest research, it appears that Vitamin K2 is longer acting, has better bioavailability, and provides better bone strength when compared to Vitamin K1 supplementation. A subset of Vitamin K2 known as menaquinone–7, or MK–7 shows promise in current research as even a more potent form of Vitamin K. In the future, we may learn the better Vitamin K supplement to take is in fact MK-7.


There is no known upper limit or toxic level of the natural Vitamin K1 & K2, however, scientists show toxicity with the synthetic forms and that they should be avoided as a source of supplementation. This fact was demonstrated in a recent ban on synthetic Vitamin K3 due to the occurrence of hemolytic anemia and cytotoxicity. This is yet another example of how natural compounds often trump synthetics in nutritional medicine. It appears Mother Nature can rarely be outperformed in the lab.


How to get the most Vitamin K out of your veggies? Well, cooking them in water will yield less concentration due to the hydrophobic properties of this vitamin. You will probably throw out much of the Vitamin K in your vegetables when you pour off the cooking water. Cooking them in oil (sautéing in olive oil, for example) will retain the bioavailability of this vitamin three-fold. Eating meat, eggs, and dairy is another source of providing Vitamin K2 in addition to that produced by E. coli in our gut. But it is with a healthy gut microflora that we acquire most of our Vitamin K2.


Deficiencies can occur with Inflammatory Bowel Syndrome (IBS), cystic fibrosis, alcoholism, liver disease, in bulimics, and those taking chronic anticoagulants, antibiotic therapy, and salicylates. Bleeding and bruising disorders are signs of deficiency; osteoporosis and coronary artery disease (CAD) are also associated, but realized over the course of many years. Unlike many other vitamins, Vitamin K is recycled in our bodies, thus reducing the threat of deficiency, provided both enzymes responsible for this process in our bodies are working well. Warfarin (Coumadin ®) blocks Vitamin K epoxide reductase (VKOR), one of the two enzymes responsible for Vitamin K recycling and maintaining healthy levels. Interesting to note, long term use of aspirin (ASA) and cephalosporins (an antibiotic class) can lead to K1 deficiencies by interference with enzyme function. Furthermore, the drugs cholestyramine, cholestipol, orlistat, and the fat substitute, olestra, have been noted to decrease Vitamin K absorption, in all probability leading to a drop in serum Vitamin K levels that can affect health.

 Because newborns are susceptible to clotting abnormalities, due to immature livers and sterile guts (inability to have E. coli produce Vitamin K2), they are usually born deficient in varying degrees. There is a 1.5% incidence of unexpected bleeding in newborns due to low levels of Vitamin K. Mothers on anticonvulsants, rifampin and isoniazid (both antibiotics) while pregnant tend to have offspring with sterile guts and an even higher incidence of Vitamin K deficiency. Therefore, the American Academy of Pediatrics recommends about 1.0 milligram of Vitamin K1 be administered to each newborn.


There is a connection in theory with Alzheimer’s disease. The APOE4 gene that has been implicated in Alzheimer's disease seems to be responsible for low Vitamin K levels in this subset of patients. It is surmised that supplementation with Vitamin K may reduce the occurrence of Alzheimer's disease, but more research is needed. There also appears to be a connection with some types of cancers. Interestingly, there are two Japanese studies showing females with liver disease with a high risk for liver cancer, having a 90% reduction in development of liver malignancy if they were supplemented with Vitamin K. In a 2008 published German study of male subjects, there was a drop in prostate cancer risk with Vitamin K supplementation.


Vitamin K must be rather important to our body as there are at least three ways in which it is maintained; by diet (eating greens), by production in our gut (bacterial), and by enzymatic recycling. Sometimes the importance of a particular substance can be found in the redundancies our body creates to conserve it, such is the case with Vitamin K.


Pearls on Vit. K:

 Ø Vitamin D dependent osteoblasts effect production of osteocalcin, a Vitamin K dependent protein, leading to good bone health, as long as both vitamins are in adequate and balanced supply.


Ø Growth arrest specific gene 6 protein (Gas6) a Vitamin K dependent protein is responsible for cellular growth regulation factor found in nerve tissue, heart, lung, kidney and cartilage.


Ø Good idea to supplement with between 10 - 120 mcg/d of Vitamin K2 (providing Coumadin users are monitored closely under physician supervision).


Ø Large Vitamin A doses have been noted to affect absorption of Vitamin K, while large doses of Vitamin E can affect and antagonize Vitamin K enzymatic activity. We see a rise in bleeding risk with large doses of Vitamin E intake. There is a balance between the fat soluble vitamins that needs to be adhered to. It is unwise to guess and gamble with what you take and supplement.




Yusuf (JP) Saleeby, MD is an integrative and nutritional medicine practitioner. He has been the chief formulator for a number of independent nutraceutical companies. He is a medical writer / blogger and offers telemedicine consultations to his patients. Currently medical director of the AtroGene group.




=======================================


Pearls of the Month:


DID YOU KNOW:



· 19.4% of South Carolinians are uninsured (no health insurance).


· In 2002, uninsured South Carolinians cost the system $1,936 per uninsured individual.


· 60% of the uninsured are hard working citizens of South Carolina.


· 74% of the uninsured list affordability as the reason they have not purchased health insurance.


· 50% of eligible individuals do not enroll in public programs because they do not want to receive government support or don't want the government to provide health coverage.


· 78% of businesses in South Carolina, excluding self-employed and government workers, have fewer than 10 employees. And 53% of small employers with 1 to 10 employees do not offer group-sponsored health insurance to their employees.


· South Carolina is one of the unhealthiest states, ranking 46th in the nation.

Source: www.covertheuninsuredsc.org/

· A 2010 Press Ganey Pulse Report (survey) demonstrated the national average emergency room wait time was 4-hours and 7-minutes long.


· There are 123-million emergency room visits in America each year. The vast majority are considered non-emergent.


· There are an estimated 312,000 Primary Care Physicians (PCP) today, but the current need requires about 13,000 more.


· 65-million Americans live in areas without enough Primary Care Physician coverage.


· Wait times of about 2-months are routinely being reported for patients to see their physicians (PCPs).


Quote of the month:

“America has the best doctors, the best nurses, the best hospitals, the best medical technology, the best medical breakthrough medicines in the world. There is absolutely no reason we should not have in this country the best health care in the world.”                   – Dr. Bill Frist (US Senator Ret.)




# # #

Ten Questions you should ask your doctor.

There is a new advertising campaign on TV.  It pushes the patient/consumer to "Ask Questions" of his/her doctor.


It is a government sponsored TV ad and corresponding web site explores the questions.


http://www.ahrq.gov/questionsaretheanswer  is the link to the web site.  Have a look, it is helpful and informative.  An informed patient is a safe patient and ultimately fewer mistakes or untoward outcomes occur.


For those in need of answers and don't have a Primary Care Physician (PCP) don't despair, there are answers via telemedicine.  I recommend using the knowledgeable physicians at AtroGene Telemedicine group.  For first and second opinions on important matters concerning your health, this is an invaluable resource.  Affordable too.



Some of the questions you should ask your doctor:

1. What is the test for?
2. How many times have you done this procedure?
3. When will I get the results?
4. Why do I need this treatment?
5. Are there any alternatives?
6. What are the possible complications?
7. Which hospital is best for my needs?
8. How do you spell the name of that drug?
9. Are there any side effects?
10. Will this medicine interact with medicines that I'm already taking?

Jack LaLanne Dies at 96

http://www.jacklalanne.com/ (Jack at 71-years old)



Jack LaLanne died Sunday from complications of pneumonia at the age of 96.  He was fit as a fiddle to the end.  He exercised every day up until his death.  He was the American Guru of Fitness and Nutrition before it was in vogue.  In 1936 he opened up the first modern health club (gym) in America and today is the icon of exercise and good nutrition which he preached over TV and other media until this year.  In his 50's and 60's he would demonstrate incredible feats of strength and endurance.  On his 70th birthday, he celebrated by towing 70 rowboats with seventy people on board for a mile and a half across Long Beach Harbor, all while handcuffed and with his feet shackled. 

"With healthier citizens," he said, "we unburden society from sickness, and reduce the medical bills that are draining people's savings and causing so much grief."  He will be remembered for his contributions to all Americans and his warning that the only bad thing you can do to your body is not use it.

Amazing Vitamin K

The Amazing Vitamin K Story

by JP Saleeby, MD

In very recent years, the medical and scientific communities have begun to focus their attention on the benefits of Vitamin K.  While not as popular as its big brother, Vitamin D, Vitamin K will no doubt come to the attention of mainstream media as soon as its many benefits are realized by the public.   In the last five years, primary care physicians and specialists are testing Vitamin D levels on almost every patient.  As research has poured in on the many health benefits in multiple arenas, from bone health to immune function, Vitamin D therapy is now considered standard of care.  Likewise, Vitamin K is slowly gaining momentum in the public eye and in doctor’s offices. 

Of historical interest, Vitamin K was first discovered as a compound in the 1930's.  It was reported in a German science journal as koagulationvitamin for its control over coagulation, hence the letter designation “K” for koagulation.  Newsworthy in the mid-20^th century, Vitamin K made headlines when the 1943 Nobel Prize in Medicine was shared by American Dr. Edward A. Doisy and German Dr. Henrik Dam for their work with this vitamin.  As early as 1938, the first report of using Vitamin K to treat a life threatening case of hemorrhage due to liver disease was documented.  Its use as a therapeutic saved the patient from certain death.

Vitamin K is a lipophilic vitamin (meaning it is fat soluble) and is required chiefly for blood coagulation and metabolism of bone and other tissues.  There are two natural forms of this vitamin and several synthetic versions.  Vitamin K1, also known as phytomenadione, and Vitamin K2, menaquinone, are the two natural forms.  Vitamin K2 is produced chiefly by bacteria in our large intestines. Vitamin K1 is found in green leafy vegetables such as spinach, turnip greens, Swiss chard, and the brassica vegetables like cabbage, broccoli, Brussels sprouts, and kale.  Fruits like kiwifruit and avocado, as well as soybean oil are other food sources of Vitamin K.

The chief utilization of Vitamin K in medicine as a "therapeutic" is in its role with the coagulation of blood.  It plays a key role in factors II, VII, IX and X as well as in protein-C and protein-S.  All of these blood factors and proteins are linked to the clotting cascade that prevents us from hemorrhaging in the event of a severe traumatic injury.  Additionally, Vitamin K has a significant role in bone metabolism with a relation to osteocalcin.  It acts as a bone building hormone in a way, much like Vitamin D.    Osteocalcin is synthesized by Vitamin K and is the "matrix" in bone that holds the calcium molecules together.  Without Vitamin K, hip bone fracture rates increase despite adequate Vitamin D and calcium intake.  In the 1998 Nurse’s Health Study, oral administrations of 110 micrograms per day of Vitamin K proved to decrease hip fractures when compared to control subjects. 

Vitamin K is important in vascular biology as well, especially in the realm of artery plaque formation (calcification).  There are Vitamin K dependent proteins involved in atherosclerosis or hardening of the arteries.   The process of calcium plaque formation is hindered with adequate Vitamin K levels in circulation.  Warfarin (Coumadin ®) is a drug often used to treat folks with coronary artery disease (CAD) and to prevent blood from clotting in heart chambers and deep veins where severe compilations may arise.  However, while treating certain medical conditions with these blood thinners, which inactivate Vitamin K, we create other problems.  Chief among these problems are an increase in our risk for developing arterial plaques, the possibility of affecting our immune system, and the likely impediment of bone mineralization.

Vitamin K's effect on coronary arteries goes like this.  With low levels of circulating Vitamin K in the serum, there is an impact on the function of a protein within the endothelial lining of the arteries called the Matrix Gla protein (MGP).  The effect of low Vitamin K on this protein is that it allows for an increase deposition of calcium in arteries.  Drugs that lower Vitamin K's effect in a sense raise the risk for coronary artery disease.  Vitamin K facilitates our immune system with positive links to phagocytosis and chemotaxis (the process by which “microorganism attacking cells" in our body find and eliminate infectious organisms).  Furthermore, Vitamin K appears to have a role in apoptosis, the process of natural and desirable cell death.  Apoptosis is the process by which our bodies can eliminate damaged, old or mutated cells thus reducing many forms of cancers.

Because Vitamin K2 is produced by bacteria in the human alimentary tract, the overuse of broad-spectrum antibiotics can wipe out this good type of bacteria in our intestines and may cause a relative deficiency.  Poor nutrition with inadequate consumption of greens and fruit is another way to attain deficiency.  Both means of deficiency can lead to clotting dysfunction, immune disruption, bone loss, and coronary disease.  With a look at the latest research, it appears that Vitamin K2 is longer acting, has better bioavailability, and provides better bone strength when compared to Vitamin K1 supplementation.  A subset of Vitamin K2 known as menaquinone–7, or MK–7 shows promise in current research as even a more potent form of Vitamin K.  In the future, we may learn the better Vitamin K supplement to take is in fact MK-7.

There is no known upper limit or toxic level of the natural Vitamin K1 & K2, however, scientists show toxicity with the synthetic forms and that they should be avoided as a source of supplementation.  This fact was demonstrated in a recent ban on synthetic Vitamin K3 due to the occurrence of hemolytic anemia and cytotoxicity.  This is yet another example of how natural compounds often trump synthetics in nutritional medicine.  It appears Mother Nature can rarely be outperformed in the lab.

How to get the most Vitamin K out of your veggies?  Well, cooking them in water will yield less concentration due to the hydrophobic properties of this vitamin.  You will probably throw out much of the Vitamin K in your vegetables when you pour off the cooking water.  Cooking them in oil (sautéing in olive oil, for example) will retain the bioavailability of this vitamin three-fold.  Eating meat, eggs, and dairy is another source of providing Vitamin K2 in addition to that produced by E. coli in our gut.  But it is with a healthy gut microflora that we acquire most of our Vitamin K2.

Deficiencies can occur with Inflammatory Bowel Syndrome (IBS), cystic fibrosis, alcoholism, liver disease, in bulimics, and those taking chronic anticoagulants, antibiotic therapy, and salicylates.  Bleeding and bruising disorders are signs of deficiency; osteoporosis and coronary artery disease (CAD) are also associated, but realized over the course of many years.  Unlike many other vitamins, Vitamin K is recycled in our bodies, thus reducing the threat of deficiency, provided both enzymes responsible for this process in our bodies are working well.  Warfarin (Coumadin ®) blocks Vitamin K epoxide reductase (VKOR), one of the two enzymes responsible for Vitamin K recycling and maintaining healthy levels.  Interesting to note, long term use of aspirin (ASA) and cephalosporins (an antibiotic class) can lead to K1 deficiencies by interference with enzyme function.  Furthermore, the drugs cholestyramine, cholestipol, orlistat, and the fat substitute, olestra, have been noted to decrease Vitamin K absorption, in all probability leading to a drop in serum Vitamin K levels that can affect health. 

Because newborns are susceptible to clotting abnormalities, due to immature livers and sterile guts (inability to have E. coli produce Vitamin K2), they are usually born deficient in varying degrees.  There is a 1.5% incidence of unexpected bleeding in newborns due to low levels of Vitamin K.  Mothers on anticonvulsants, rifampin and isoniazid (both antibiotics) while pregnant tend to have offspring with sterile guts and an even higher incidence of Vitamin K deficiency.  Therefore, the American Academy of Pediatrics recommends about 1.0 milligram of Vitamin K1 be administered to each newborn. 

There is a connection in theory with Alzheimer’s disease.  The APOE4 gene that has been implicated in Alzheimer's disease seems to be responsible for low Vitamin K levels in this subset of patients.  It is surmised that supplementation with Vitamin K may reduce the occurrence of Alzheimer's disease, but more research is needed.  There also appears to be a connection with some types of cancers.  Interestingly, there are two Japanese studies showing females with liver disease with a high risk for liver cancer, having a 90% reduction in development of liver malignancy if they were supplemented with Vitamin K.  In a 2008 published German study of male subjects, there was a drop in prostate cancer risk with Vitamin K supplementation.

Vitamin K must be rather important to our body as there are at least three ways in which it is maintained; by diet (eating greens), by production in our gut (bacterial), and by enzymatic recycling.  Sometimes the importance of a particular substance can be found in the redundancies our body creates to conserve it, such is the case with Vitamin K.

Pearls from Dr. Saleeby:

• Vitamin D dependent osteoblasts effect production of osteocalcin, a Vitamin K dependent protein, leading to good bone health, as long as both vitamins are in adequate and balanced supply.
• Growth arrest specific gene 6 protein (Gas6) a Vitamin K dependent protein is responsible for cellular growth regulation factor found in nerve tissue, heart, lung, kidney and cartilage.
• Good idea to supplement with between 10 - 120 mcg/d of Vitamin K2 (providing Coumadin users are monitored closely under physician supervision).
• Large Vitamin A doses have been noted to affect absorption of Vitamin K, while large doses of Vitamin E can affect and antagonize Vitamin K enzymatic activity.  We see a rise in bleeding risk with large doses of Vitamin E intake.  There is a balance between the fat soluble vitamins that needs to be adhered to.  It is unwise to guess and gamble with what you take and supplement.

-----------------

JP Saleeby, MD is an integrative and nutritional medicine practitioner.  He has been the chief formulator for a number of independent nutraceutical companies.  He is a medical writer / blogger and offers telemedicine consultations to his patients.

(c) 2011

References:

Berkner, K. L. and Runge, K. W. (2004), “The physiology of vitamin K nutriture and vitamin K-dependent protein function in atherosclerosis”. Journal of Thrombosis and Haemostasis, 2: 2118–2132.

Neil C Binkley, Diane C Krueger, Tisha N Kawahara, Jean A Engelke, Richard J Chappell and John W Suttie. (2002) "A high phylloquinone intake is required to achieve maximal osteocalcin {gamma}-carboxylation". American Journal of Clinical Nutrition 76 (5).

Higdon (2008). "Vitamin K". Linus Pauling Institute, Oregon State University. http://lpi.oregonstate.edu/infocenter/vitamins/vitaminK/. Retrieved 01-10-2011.

Warner, E.D.; Brinkhous, K. M.; Smith, H. P. (1938). Proceedings of the Society of Experimental Biology and Medicine 37: 628.

Stafford, D.W. (2005), “The vitamin K cycle.”. Journal of Thrombosis and Haemostasis, 3: 1873–1878.

Saxena S.P.; Israels, E.D.; Israels L.G. (2001). "Novel vitamin K-dependent pathways regulating cell survival.". Apoptosis 6 (1-2): 57–68.

Nimptsch K, Rohrmann S, Linseisen J (2008). "Dietary intake of vitamin K and risk of prostate cancer in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition. (EPIC-Heidelberg)". Am. J. Clin. Nutr. 87 (4): 985–92.

Brown, S.E., "Key vitamins for bone health — vitamins K1 and K2". www.womentowomen.com. http://www.womentowomen.com/bonehealth/keynutrients-vitamink.aspx. Retrieved Jan., 10 2011.

Nimptsch K, Rohrmann S, Linseisen J (2008). "Dietary intake of vitamin K and risk of prostate cancer in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition. (EPIC-Heidelberg)". Am. J. Clin. Nutr. 87 (4): 985–92.

Allison (2001). "The possible role of vitamin K deficiency in the pathogenesis of Alzheimer's disease and in augmenting brain damage associated with cardiovascular disease.". Medical hypotheses  57 (2): 151–5.

Habu, D., (2004) "Role of Vitamin K₂ in the Development of Hepatocellular Carcinoma in Women With Viral Cirrhosis of the Liver.". JAMA, 292 (3): 358-361.

Bellido-Martin, L. (2008) "Vitamin K-dependent actions of Gas6.". Vitam. Horm. 78:185-209.

Hendler S.S., Rorvik D.R., eds. (2001) “PDR for Nutritional Supplements.”. Montvale: Medical Economics Company.

Shakeology Lecture by Dr. Saleeby

https://docs.google.com/present/edit?id=0Af1JpAZlkE5rZGQ0a3pyOHdfMTg0ZnQ4amJrY3g&hl=en

Click on this for a PowerPoint Lecture on Shakeology (given 3/2009)

New Online Laboratory launch

AtroGene is soon to launch an online Direct Access Testing (DAT) web site for lab testing.  Keep your eye out for www.eStatLabs.com as it will be up and running in a month.

Osteoporosis Lecture by Dr. Saleeby

Happy New Year - Important new info from Dr. Saleeby

HAPPY NEW YEAR!

My main practice web site has changed... have a look at the new pages of http://www.carolinamobilemd.com/  The practice name and location has changed.  New space is shared in a finer, more upscale property downtown Conway.  The name AtroGene will represent the practice as it moves more into the 21st Century reliance on the Internet & Tele-medicine.  Will also be offering best-in-the-industry Online Labs at great cost savings to the consumer.  Access to my active patients to the full line of Xymogen nutraceuticals will be offered to my patients, via the web (http://www.xymogen.com/) email me for more information.

Today I want to feature a very well written article by Dr. Klein on the relationship between Diabetes and select supplements to deminish the coronary artery disease properties.

JP Saleeby, MD
-------------------------


Diabetes and Atherosclerotic Vascular Disease- Nutraceutical Intervention Update


David S. Klein, MD, FACA, FACPM

Alpha Lipoic Acid: The incidence of type 2 diabetes mellitus (DM) in the U.S.
is already high, and the rate is climbing rapidly. Medical complications seen in
DM patients include coronary heart disease, peripheral vascular disease,
nephropathy, neuropathy and retinopathy. While control of blood sugar levels is
of paramount importance, attention to the sequelae may reduce morbidity and help
reduce healthcare costs.

Pivotal in the development of diabetic complications is dysfunction of vascular
endothelia. Inflammation of the inner lining of the blood vessels results in
platelet aggregation and deposition of cholesterol resulting in atherosclerotic
plaque development. The formation of atherosclerotic plaque is results directly
from endothelial inflammation, often monitored by serum CRP levels.


Recently, it was observed that intravenous alpha lipoic acid (ALA), was found to
be beneficial in patients with DM who suffer from endothelial dysfunction.(1)
Forearm blood flow was measured before and after 21 days of either IV treatment
of 600mg ALA or placebo. Intravenous ALA treatment improves endothelium-dependent
vasodilatation. The investigators also observed that LDL-cholesterol was
reduced in the ALA treatment group.

It was postulated that ALA might improve endothelial function through inhibition
of NF-kappa B and metalloproteinase-9 and upregulation of intracellular adhesion
molecule-1 (ICAM-1).

Alpha Lipoic Acid may also be useful in the treatment of obesity, which is
itself a risk factor for the development of DM. At this time, 34 percent of
adults aged 20 and older are obese; 34 percent are ‘overweight.’
In a recent study, ALA was studied for weight loss in ‘pre-obese’ and obese
adults. Findings of a recent study observing 1,127 men and women between the
ages of 18 and 60 years, observations after measuring the BMI of all
participants, 53 percent were found to be obese and 43 percent were pre-obese.
Study participants were given ALA for 4 months at a dosage of 800mg per day.


The participants experienced After supplementation, investigators found that
participants experienced an 8-9 percent reduction in body weight, a reduction in
BMI by 2-4 points, and a reduction in waist size by 2.5-4 inches.(3)


Resveratrol: Resveratrol is a naturally occurring polyphenol found in the
skin of red grapes and is found in red wine. Thought to offer a range of
beneficial medical effects, Resveratrol is being studied for anti-cancer effects
and for cardiovascular benefits.


Recently, Resveratrol was studied (2) in patients given Resveratrol 40 mg, or
placebo, for six weeks. In the Resveratrol group, there was a significant
reduction in the generation of reactive oxygen species, binding of NF-κB (a
major regulatory component of pro-inflammatory cytokine production), and
expression of JNK-1 and Iκκβ (pro-inflammatory molecules). Study participants in
the Resveratrol group had decreased levels of CRP, TNF-alpha and IL-6 (two major
pro-inflammatory cytokines that are regulated by NF-κB.

According to the authors: “The extract induced a significant reduction in
reactive oxygen species generation, the expression of p47(phox), intranuclear
nuclear factor-kappaB binding, and the expression of jun-N-terminal kinase-1,
inhibitor of kappaB-kinase-beta, phosphotyrosine phosphatase-1B, and suppressor
of cytokine signaling-3 in mononuclear cells when compared with the baseline and
the placebo. PCE intake also suppressed plasma concentrations of TNF-alpha,
IL-6, and C-reactive protein.”

Whey Protein: In a recent study, (4) the effects of supplemental dietary whey
protein was observed in relation to body composition, lipids, insulin and
glucose in comparison to casein and glucose (control) supplementation. In this
12 week study, subjects were randomized to receive whey protein, casein or
glucose supplementation. Seventy men and women, mean ages of 48.4 (SEM 0.86)
years and a mean BMI of 31.3 (SEM 0.8) kg/m2 completed the study. Subjects
supplemented with whey protein had no significant change in body composition or
serum glucose at 12 weeks compared with the control or casein group. Fasting
glucose levels were significantly lowered in the whey group, as compared with
the control group at 6 weeks, and there was a significant decrease in total
cholesterol and LDL cholesterol at week 12 in the whey group as compared with
the casein receiving cadre. Fasting insulin levels were also significantly
decreased in the whey group compared with the control group. Demonstrating that
supplementation with whey proteins improves fasting lipids and insulin levels in
overweight and obese individuals.


Recommendation: Increasing scientific data support the use of Alpha Lipoic Acid
and Resveratrol in the treatment of patients with type II Diabetes. Available
at reasonable cost, these two nutraceuticals are useful in the treatment of a
variety of other conditions, as well, and afford the practitioner an additional
modality to offer patients.
These two nutraceuticals are widely available, but should be used in conjunction
with appropriate diet modification.

References:
1. Heinisch BB, Francesconi M, Mittermayer F, et al: Alpha-lipoic acid improves
vascular endothelial function in patients with type 2 diabetes: a
placebo-controlled randomized trial. Eur J Clin Invest 2010 Feb:40(2):148-54.
2. Ghanim H, Sia CL, Abuayseh S, et al: An antiinflammatory and reactive oxygen
species suppressive effects of an extract of Polygonum cuspidatum containing
Resveratrol. J Clin Endocrinol Metab 2010 Sept;95(9):E1-8. .
3. Carbonelli MG, Di Renzo L, Bigioni M, et al: Alpha-lipoic acid
supplementation: a tool for obesity therapy? Curr Pharm Des. 2010;16(7):840-4.
Pals S, Ellis V & Dhaliwal S: Effects of whey protein isolate on body
composition, lipids, insulin and glucose in overweight and obese individuals. Br
J Nutr. 2010 Sept; 104(5):716-23.


David S. Klein, MD has practiced pain medicine for the past 27 years and is the author of over 50 published articles and textbook chapters.  His writings have appeared in this blog previously.

Lecture on Osteoporosis

Dr. Saleeby to give Free Lecture at Pure Compounding Pharmacy on Osteoporosis.  For more information please call the pharmacy and secure a seat for this lecture. 

Date:  Jan. 6th, 2011 (First Thursday of the Month Free Lecture Series)
Time:  6:15 PM

Location:
Pure Compounding Pharmacy
3072 Dick Pond Road
Myrtle Beach, SC 29588
(843) 293-7979

Stem Cell Transplant Cures HIV In 'Berlin Patient'

The Huffington Post   |  Carly Schwartz First Posted: 12-14-10 01:04 PM   |   Updated: 12-16-10 12:25 

On the heels of World AIDS Day comes a stunning medical breakthrough: Doctors believe an HIV-positive man who underwent a stem cell transplant has been cured as a result of the procedure.
Timothy Ray Brown, also known as the "Berlin Patient," received the transplant in 2007 as part of a lengthy treatment course for leukemia. His doctors recently published a report in the journal Blood affirming that the results of extensive testing "strongly suggest that cure of HIV infection has been achieved."
Brown's case paves a path for constructing a permanent cure for HIV through genetically-engineered stem cells.
Last week, Time named another AIDS-related discovery to its list of the Top 10 Medical Breakthroughs of 2010. Recent studies show that healthy individuals who take antiretrovirals, medicine commonly prescribed for treating HIV, can reduce their risk of contracting the disease by up to 73 percent.
While these developments by no means prove a cure for the virus has been found, they can certainly provide hope for the more than 33 million people living with HIV worldwide. Alongside such findings, global efforts to combat the epidemic have accelerated as of late, with new initiatives emerging in the Philippines and South Africa this week.

Wiki-Medicine

Sep 26 2008  Wiki-Medicine. Scary.


Please convince me that I shouldn’t be bothered by this. The other day I was at the hospital paying a visit to a friend. As usual this trip to the hospital - like every other - involved a significant amount of waiting and doing nothing. I killed the time by doing some people watching, specifically doctor watching.

One doctor in particular did something that caught my attention.
Leaving a patient in their room the sat down at the computer and started typing away. However as I looked closer I noticed that this dcotor was looking something up [pause for dramatic effect] on Wikipedia. Now for those of you who don’t know, Wikipedia is an on-line encyclopedia of just about anything, from the truly important to the totally random. What makes Wikipedia unique is that the content is user-created. That is, any dude sitting in his mom’s basement can jump on and help write the definition regardless of whether or not they have an idea of what they’re talking about. And while these same people can help ensure the accuracy of the content it is nonetheless the equivalent of selling dictionaries with an eraser and pen attached.

Now, please understand. I like Wikipedia. I use Wikipedia. But I don’t wholeheartedly trust Wikipedia. And I don’t think I want my doctor coming to a diagnoses with the help of Wikipedia. Aren’t there large, dusty books that they are supposed to be pulling off shelves or top-secret doctor only web-sites that they are supposed to be accessing when they leave the examination room? Is a 100K education supposed to hinge on what one can “google?”
Granted, I’m making an assumption that this doctor was doing something associated with a patient when she surfed to, read through, and wrote down several things in her chart from the site. But it sure looked like it.
I just don’t what the day that a doctor looks up my illness to be the very same day that some over-zealous pharmacy rep listed their experimental drug (that just so happens to lower your sperm count and make your hair fall out) as the “proven” cure all. But hey, maybe I’m making a big deal out of nothing. I tend to do that. Besides my doctor is awesome.
6 Responses to “Wiki-Medicine. Scary.”

1.Chrissy Says:
September 27th, 2008 at 2:16 pm

Geez…someone needs to tell that Doc about WebMD! That I trust!



2.Carrie LaMay Burgan Says:


September 28th, 2008 at 1:10 pm

I admit to using Wikipedia to identify muscle groups when I’m studying anatomy, but I’m but a lowly massage therapy student. General Wiki research is fine, but I would be scared, too. Is the doc to cheap to subscribe to the online reference DBs for docs? They exist in spades. Or yeah, use WebMD? Sadly, Google, Dictionary.com and Wikipedia are the top three free web “research” vehicles out there. When I was pursuing my Master’s in Library Science, we were inundated with information about students using these (non-reliable) sources as all primary sources in their undergrad-to-DOCTORATE papers. *slaps forehead* Heaven forbid someone actually pick up a dusty “Journal of the American Medical Association” (”JAMA”) and look something up.


3.Jen Says:
October 8th, 2008 at 9:19 am

Wow, that is really scarey. I am constantly telling people the truth about that website. Hopefully whoever wrote the page she looked at was another doctor.



4.Sarah Says:
January 8th, 2009 at 9:57 pm

Wikipedia is said to be more accurate in a lot more subjects than the Encyclopedia Brittanica.
I find that much more terrifying than any point you made.
5.dr who dolls Says: (spam content)

6.JP Saleeby, MD Says:
December 18th, 2010 at 7:33 pm

Well in this era of evidenced based medicine, it is really much different subscribing to an opinion, fact or fiction on wikipedia versus our established peer-reviewed journals? How confusing is it when in JAMA one month’s article in support of a new treatment is to be summarily rejected by another article the following month in NEJM?

###

http://www.poporthodoxy.com/2008/09/26/wiki-medicine-scary/#comment-597

Lower-income families in high-deductible plans more likely to forgo care

Dec 10, 2010 Medical Economics

Lower-income families in high-deductible health plans are more likely to delay or forgo care due to cost than higher-income families who have similar coverage, according to researchers from the Robert Wood Johnson Foundation Clinical Scholars program, Philadelphia Veterans Affairs Medical Center, and the University of Pennsylvania, Philadelphia.

Families who enrolled in these plans initially had higher incomes, but lower-income families are now equally likely to be enrolled in high-deductible plans. Overall, lower-income families were more likely to report that they had delayed or foregone care because of the cost, including care for an adult, care for a child, and operations or procedures.

In addition, lower-income families said they did not find their health plans difficult to understand, nor did they believe their families were not well protected from out-of-pocket healthcare costs. Regardless of income, most participants reported that they would talk with their clinicians about delaying or making different plans in 3 hypothetical situations: a $100 blood test during a check-up, a $1,000 colonoscopy, and a $2,000 magnetic resonance imaging scan for back pain.

The findings suggest that physicians play a central role in helping patients with decision-making in high-deductible health plans.

Antibiotic Stewardship

Antibiotic Stewardship 

by JP Saleeby, MD

http://cme.medscape.com/viewarticle/731689 John G. Bartlett, MD

To open up, I want to make it perfectly clear the intentions of this article by stating a few facts.  These are facts back up by loads of peer-reviewed publications.  These facts are likewise rational and logical.

• Fact:  Antibiotics save lives.
• Fact:  Antibiotics reduce morbidity and mortality in severe and life threatening infections.
• Fact:  Antibiotics have in the past 20-years been over-prescribed.
• Fact:  Antibiotics are necessary in the practice of good medicine and new guidelines need to be followed in light of present day resistance.

It is both intuitive and evidence based that appropriate use of antibiotics in modern medicine have saved thousands of lives.  Prior to the discovery of the antibiotics (antimicrobials) infection was a leading cause of death in humans.  Today, many life threatening illnesses such as pneumonia, sepsis, flesh-eating bacterial infections (necrotizing fasciitis), or meningitis are so dangerous, that delay in antibiotic therapy can cost a life.

For those pseudo-healthcare practitioners that are blinded by sheer bias and hatred toward contemporary western medicine (and suffer brain squeeze because their craniums are so far up their rectums), spouting the foolish notions that "you don't need antibiotics" or "antibiotics are never good for you", be warned.  Those reading this article that are experiencing a grave illness due to a microbe should be aware that those advocating the cockamamie notion that all things antibiotic are evil, should run as fast and far away from those practitioners.  Furthermore, they can and should be held culpable for the death of a patient should they intentionally delay people from getting life saving antibiotic therapy.  Intuitive practitioners, some chiropractors and those who favor wave eagle feathers and crystals over folks in an attempt to cure a complex septic patient should put their unsubstantiated opinions and bias' aside and refer their patients to a medical doctor for definitive care.  No need to stain you hands with blood over an idiotic notion unfounded by any empirical evidence.  Enough ranting about unfounded prejudice against antibiotics amongst healers.

While there is no question about the helpfulness of antibiotics, it is also true that since their inception they have been abuse and over prescribed.  Now we realize the ills of haphazard and unbridled use as we see resistant organisms appear more often and on the rise.

According to Dr. J. G Bartlett in a Medscape CME published in November of 2010 entitled "Addressing the Rising Tide of Antimicrobial Resistance" he spells out the rise of the top six microbes that are defying our current regiment of antibiotic therapy.  They are Enterobacter, Staph. aureus, Klebsiella, Acinetobacter, Pseudomonas aeruginosa and Enterococcus.  In the US methicillin-resistant Staphylococcus aureus (MRSA) is on the rise with some 94,360 cases a year and 18,650 deaths annually reported by Kelevens et. al., in JAMA in 2007.  Those are some fierce numbers for a bacterium that only 10 years ago was only seen in hospital ICUs and nursing homes.  Now greater than 60% of cultures of abscesses in my local region culture positive for MRSA.  The whole penicillin class of drugs (Amoxil, Keflex, etc.) is useless against MRSA.  Clostridium difficile infections are another example with diagnosed cases on the rise and antibiotic resistance mounting as well.  Death by C. difficile infection has taken an exponentially rise since 1999.

Furthering the crisis of antimicrobial resistance and of great concern is that in the last ten-years the development of new antibiotics and antibiotic classes has all but dried up.  A 2004 report by the Infectious Disease Society of America (IDSA) stated that there is“antibiotic discovery stagnation” were we are witnessing bad bugs with no new drugs to fight them.  An example of how slow we are to develop new antimicrobials is seen in a study published in 2009 in the Clinical Infectious Disease journal by Dr. H.W. Boucher reporting that between 1983 and 1887 sixteen new antibiotics were developed.  From 1993 - 97 ten antibiotics were developed and this dropped to only five from 2003 - 07 and from 2008 projected until 2012 only one new antibiotic coming to market.  From the 1930's through the 1970's there were eleven new classes of antimicrobials developed by pharmaceutical companies, with only four classes in the 1950, and during the 2000's only two new classes were developed.  The 1980s and 1990's saw a dry spell, with no new antibiotic-class development. These are scary numbers considering the rapid rise in microbial resistant organisms just in the past decade.

http://cme.medscape.com/viewarticle/731689 John G. Bartlett, MD

So while antibiotic use is necessary and critical in the very ill, judicious use is necessary to save our "big guns" for those really bad infections.  Most pharangitis infections are viral and despite this fact many GPs would prescribe antibiotics just to appease an anxious patient, and not treat the real root cause.  This practice has to stop.  No one will argue about utilizing a broad spectrum aggressive antibiotic regiment in a septic patient, but we need to look at the evidence of stopping drugs when cultures are negative and using effective shorter courses.  Evidence is mounting that a three day course of antibiotics for community acquired pneumonia (CAP) is as effective as a seven- or ten-day course.  On the other side of the continuum, those that don't advocate the use of antibiotics at all will harm the really sick.  We must reach a happy medium.

JP Saleeby, MD is an emergency room physician who practices integrative medicine in solo practice.  His weltanschauung is practical, pragmatic and not at all crunch or granola.  For more information visit www.saleeby.net

© 2010

Dr. Saleeby's new practice Ribbon Cutting

Dr. Saleeby and Sharon are pictured with Dr. Melody Iles and Conway Chamber of Commerce members for the official Ribbon Cutting and Open House for the new practice located at 927 Fourth Ave., Conway, SC.  The practice SCWellness (aka Carolina Wellness & Medical Associates) is an integrative and holistic center offering traditional western medical and well as complementary and alternative medical treatments.  Dr. Iles is a naturopath with a masters in western herbology.  Dr. Saleeby has background in emergency medicine, occupational medicine and subscribes to a holistic approach.  A focus on prevention, wellness and balanced hormones he is now accepting new patients.

SC Wellness Open House and Ribbon Cutting Nov 17th 2010

http://southcarolinawellness.blogspot.com/2010/11/sc-wellness-open-house-and-ribbon.html

CDC's Recommendations for Flu Vaccine

What’s New for the 2010-2011 Influenza Vaccine

FDA Patient Safety News: Show #104, November 2010

With the influenza season upon us, the CDC is recommending that everyone aged 6 months and older get vaccinated to protect themselves and others. During the last influenza season, people needed one vaccine to protect against seasonal influenza, and another one for the 2009 H1N1 influenza. But this season's vaccine contains the 2009 H1N1 strain, along with two other strains that are predicted to cause influenza, so there is no need to get two different vaccines. As in earlier years, both inactivated and live attenuated vaccines are available.


There is now a vaccine that is specifically indicated for people 65 and older, called Fluzone High-Dose. People in this age group have the highest risk for seasonal influenza complications because people's immune systems weaken as they grow older. The new vaccine contains a higher dose of influenza virus hemagglutinin, which is intended to induce a stronger immune response and better protect the elderly against seasonal influenza.

People who are hypersensitive to egg proteins or who have had life-threatening reactions after previous influenza vaccinations should not receive the vaccine.


Additional Information:

FDA Center for Biologics Evaluation and Research. Influenza Virus Vaccine for the 2010-2011 Season. Updated September 17, 2010.

http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm094045.htm


FDA Press Release: FDA Approves A High Dose Seasonal Influenza Vaccine Specifically Intended for People Ages 65 and Older. December 23, 2009.

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2009/ucm195483.htm

CDC MMWR. Prevention and Control of Influenza with Vaccines

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr59e0729a1.htm



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FDA Patient Safety News is available at www.fda.gov/psn

Brain Support

You know it's time to see Dr. Saleeby for some Brain Support when you start doing things like this.