Drugs to Build Bones May Weaken Them

Drugs to Build Bones May Weaken Them

Above link (click on it to read the original article) is NY Times News article on drugs that are used to treat osteoporosis may actually weaken them.

Osteoporosis is a serious health concern for American women. It is defined in women as bone mineral desnsity lower than 2.5 times the normal bone density. It is measured by DEXA. The main concern about osteoporosis is that it leads to increase risk of fracture. Hip fracture, especially, is traumatic to the patients, often requiring several months of rehab.

Osteoporosis is most common in post-menopausal women. It also is caused by the use of steroid medication. Osteoporosis can be prevented with lifestyle advice and sometimes medication, and in people with osteoporosis treatment may involve lifestyle advice, preventing falls and medication (calcium, vitamin D, bisphosphonates and several others).

There are a number of medications that are used to treat osteoporosis including fosamax. During my training at Dr. Andrew Weil's Program in Integrative Medicine, I was educated by my patients who researched about fosamax and was concerned about the possibility that fosamax actually may weaken the bone. The concern was a theoretical one at that time; it was thought that bone density increase was due to abnormal bone density growth that may not be as strong as normal bone. It seems that my patients may have been on to something.

Physicians at Weill Medical College of Cornell University are reporting that prolonged Fosamax—generically known as bisphosphonate alendronate—use may increase the risk of femur fractures, the large thigh bone that connects the leg to the hip. Continued evidence indicates that long-term alendronate use may overly suppress bone metabolism, which limits the repair of microdamage and increases fracture risk, Dr. Joseph M. Lane and colleagues report in the Journal of Orthopaedic Trauma. This report can be read by clicking following hyperlink http://www.newsinferno.com/archives/3443.

Meanwhile, earlier this year Canadian researchers issued a warning that bisphosphonates, sold under the names of Didrocal, Actonel, and Fosamax can lead to bone necrosis, a painful and disfiguring condition that results in bone death. The study found that such drugs almost tripled the risk of developing bone necrosis. The study was conducted by researchers at the University of British Columbia (UBC) and McGill University and is the largest study of its kind into the connection between bone necrosis and specific brands of bisphosphonates: Didrocal, Actonel, and Fosamax. Prior to that warning, the U.S. Food and Drug Administration (FDA) issued a warning about bisphosphonates and its link to a higher possibility of severe and sometimes incapacitating bone, joint, and muscle pain. “I think the study’s important just basically to let the public know if they do experience any severe, unusual pain they could tell their health professional,” said Dr. Mahyar Etminan, the principle investigator from the University of British Columbia. This report can be read by clicking following hyperlink http://www.newsinferno.com/archives/3443.

This puts many patients who are on Fosamax and related medicine at a catch 22. There are integrative approaches to slowing the bone loss using nutrition - calcium, magnesium, boron, and strontium. In addition, green tea extract, and ipraflavone can be useful. However, there is no documented study of strengthening the bone. From preventive point of view, the maximal protection comes from having had maximal bone density achieved in the teen years - which is affected by genetics, nutrition, and physical activity.

John Kim MD MPH
www.georgiaintegrative.com

Popular Fish, Tilapia, Contains Potentially Dangerous Fatty Acid Combination

Popular Fish, Tilapia, Contains Potentially Dangerous Fatty Acid Combination

Last week, I posted an article about Tilapia containing potentially dangerous omega 6 fatty acids resulting in increased inflammation. Above article from Science Daily detail the account of the risk.

"The researchers say the combination could be a potentially dangerous food source for some patients with heart disease, arthritis, asthma and other allergic and auto-immune diseases that are particularly vulnerable to an "exaggerated inflammatory response." Inflammation is known to cause damage to blood vessels, the heart, lung and joint tissues, skin, and the digestive tract." (from http://www.sciencedaily.com/releases/2008/07/080708092228.htm)

During my study with Dr. Andrew Weil, I found above statement to be absolutely a true statement. Inflammation has become a rampant epidemic resulting in causing so much health problems in the developed countries. This has been made worse by the use of the industrial farming practices combined with our business modeling focused on the lowest price doctrine.

As a result, we pay heavily on the treatment side as a society and as members of the society. The solution is not simple; it involves consumer consciousness which must educate the industry. Organic is a good start, but not good enough; we need to be mindful of nutritional contents of the food. Salmon not enough - you need to know that it is either Organic fed with high omega 3 fatty acids feed or from the nature without heavy metal toxins.

John Kim, MD MPH
Director
www.georgiaintegrative.com

Why integrative medicine is the way of the future

Why integrative medicine is the way of the future
Above is an article from an Austrian news discussing the application of integrative medicine for the treatment of cancer.

The 2008 Summer Wellness Brief is dedicated (click here to open Summer 2008 Cancer & Healing) on integrative oncology. When I worked with Dr. Andrew Weil at University Medical Center in Tucson, I was fortunate to witness a number of remissions that could not be attributed to medications alone.

There is a tendency in the medical field to give credit to the illness or to the disease and not to give enough credit to the individual's healing ability.

Integrative medicine explores the boundary of the healing ability of the person by providing a therapeutic healing partnership and by creating a synergy of healing techniques leveraged at helping the whole person, Mind, Body, and Spirit.

The therapeutic regimens that one can use using the mind, body, and spirit is almost limitless in its application. The goal is to empower our patients to feel comfortable about being an active participant in their healing.

This combination of empowerment, nutritional support, emotional support (we require our cancer patients to go to a support group and/or see a counsellor once a week), and conventional medicine and surgery can make a powerful impact. We saw two people achieve remission from Stage 4 cancer last year who followed above advise. We do not understand the exact mechanism of their healing at this point, but we are happy to see our patients enjoy a higher quality of life.

John Kim
Director
www.georgiaintegrative.com

Low-carb diet beats other diets in study

Low-carb diet beats other diets in study

Above link describes the outcome of a study demonstrating that Low-carb diets show superior results compared to other diets. The article states, perhaps tongue-in cheek, that Atkins diet may have a point. Atkins diet's weakness is that it underestimates the danger of cholesterol and the types of fat coming from meat sources in the form of omega 6 fatty acids which result in increasing overall inflammation in the body.

Inflammation is a common pathway where multiple illnesses come together. As a result of increasing inflammation, you put yourself at risk for increasing degenerative illnesses including Alzheimer's disease, osteoarthritis, as well as coronary artery diseases.

I prefer a nutrition plan based largely on vegetable, 1 - 2 servings of whole grain per day, and a high quality protein either from grass fed meat or safe fish (list is available from Monterey Bay Aquarium). My favorite is wild Alaskan salmon providing omega 3 fatty acids as well as excellent source of protein.

Extinguishing the Fear at the Roots of Anxiety

Extinguishing the Fear at the Roots of Anxiety

Above is the hyperlink to the New York Times article on anxiety. We live is a face paced world full of stress. The effect of stress can play havoc with both physical and mental health.

Perhaps the most well understood of effect of acute stress include production of cortisol, a stress hormone produced in our body, resulting in a number of problems including immune suppression, anxiety, blood sugar dysregulation, and weight gain. This understanding has helped to create a field of science referred as neuro-psycho-immunology.

Anxiety in Chinese medicine represents a Yang aspect of Shen (psych-emotional-spiritual) disturbance often leading to depletion of Shen energy resulting in symptoms of depression based on anxiety which is different from Yin aspec of Shen disturbance which results in depression based on fear, hopelessness, and helplessness.

There are many mind-body medicine combined with therapy that can result in significant transformative changes for mental health. An integrative approach focuses on understanding of the present mindfulness of the anxiety at a functional level. As to extinguishing the fear at the roots of anxiety, I am not sure any modality without transformative therapy work can be successful. Perhaps that is the reason, despite the explosion of mental illness medications, we still have an epidemic of mental illness negatively impacting quality of life...

Popular Tilapia Might Not Help Heart

Popular Tilapia Might Not Help Heart
Study finds farm-raised fish has high levels of unhealthy omega-6 fatty acids
Above is a new article link to US News and World Report stating that the fish Tilapia may be harmful to people. The farm-raised Tilapia has high levels of unhealth omega-6 fatty acids. This is not unique to farm-raised Tilapia. The potential health risks of farm-raised salmon is also discussed in below hyperlink:
http://research.cals.cornell.edu/entity?home=6&id=20834

In both cases, underlies the complexity issue of the food web. We are what we eat. So, we do our best to eat well. However, due to our current industrial production model of our food, we focus on costs rather than nutrition of the food.

In order, for us to eat well, we need to feed the farm-raised animals a balanced nutrious meal so that they can provide that nutrition for us. These examples also extend to chickens who can provide eggs and meat.

I recommend that people look for organic meat. In Atlanta, we are fortunate to have Dekalb Farmer's Market providing us with cost-effective organic food.

The 11 Best Foods You Aren’t Eating

The 11 Best Foods You Aren’t Eating

Above is a news article from the New York Times on 11 Best Foods to eat.
I am impressed with the emphasis on nutrition these days. In Georgia Integrative Medicine, we view problems at many levels. The first level is the understanding of the physical dimension or structure. The second level is the understanding of biochemical dimension. The next levels involve energetics and psycho-emotional-spiritual axis referred in Chinese medicine known as Shen.

The nutrition aspect impacts first on biochemistry but also effects structural, energetical, and psyco-emotional-spiritual axis. The old adage we are what we eat has a lot of truth in it.

What we eat provides for the ingredients for biochemistry. Sardine for example provides omega-3 fatty acids and bioavailable calcium (provides skins and bones were not removed). Omega 3 fatty acids results in lowering of inflammatory molecules in the body.

In Georgia Integrative Medicine, Chef Nola Daniel CNC provides both nutritional consultations and healthy cooking 101 classes to help our patients to eat for wellness.

Costly Cancer Drug Offers Hope, but Also a Dilemma

Costly Cancer Drug Offers Hope, but Also a Dilemma

Above is a link from the New York Times on Avastin, a costly cancer drug.

The critics of integrative medicine have long been raising the lack of evidence as a reason for their skeptism. However, it comes to light that the lack of evidence of effectiveness is not limited to complementary and alternative medicine modalities.

Avastin which can cost up to $ 9000 per month. About 100,000 people take Avastin in the U.S. currently. The total amount spent for Avastin last year is estimated to top 2.3 Billion dollars.

According to the NY Times, "But there is another side to Avastin. Studies show the drug prolongs life by only a few months, if that. And some newer studies suggest the drug might be less effective against cancer than the Food and Drug Administration had understood when the agency approved its uses." This is to say that there may not be a clear benefit of Avastin for effectiveness. In treatment of an illness, there are other considerations other than effectiveness. These are also referred as "Quality of Life."

Given the on going financial crisis in health care due to unaffordability, this is an example where the critics of integrative medicines need to focus on evidence and conventional medicine. Dr. Andrew Weil advocates that there needs to be a logical way for us to evaluate the evidence. The more potential harm an agent can cause, the more rigorous evidence should be. In contrast to medications, many integrative therapeutics are less invasive and focus on improving quality of life.

I spent two years at San Diego State University for Masters in Public Health where I was educated in how to evaluate the evidence presented in a study. A result of my degree was the development of ability to discern if a treatment was effective reviewing all evidence in the scientific literature. This helped me to author more than 20 articles reviewing effectiveness of integrative medicine modalities using the scientific method.

In Georgia Integrative Medicine, we do our best to practice an evidence based medicine and we are mindful of the cost-effectivenss as well as cost-quality of life issues. Our evidence is our patients who get well and make the world a better place to be.

The University of Arizona Program in Integrative Medicine Earns 'Center of Excellence' Designation

The University of Arizona Program in Integrative Medicine Earns 'Center of Excellence' Designation

Above article shares the news that Integrative Medicine status has been elevated to Center of Excellence at University of Arizona where the movement began.

Dr. Andrew Weil created Program in Integrative Medicine and began to train physicians in the art of integrative medicine where you are integrating the best of modern science and ancient wisdom.

I had the priviledge being able to benefit from two fellowships. Currently, there are many types of fellowships including research fellowship, residency combined with fellowship, medical student elective, and undergraduate elective.

As a result of the training, I was able to contribute to the field as a consultant, author, and as a clinician. We are fortunate to have an academic venue where physicians can obtain bonafide training in an area currently lacks ready supply of well trained physicians.

Doctor moves beyond ‘fixing the broken piece’

Above is a story of a physician who completed the Associate Fellowship with Dr. Andrew Weil.

For me, I had a unique experience of being able to complete two fellowships with Dr. Andrew Weil at University of Arizona's Program in Integrative Medicine. The first fellowship, the residential fellowship, is no longer available. The residential fellowship consisted of two years of hands-on training with Dr. Andrew Weil and other master teachers in his group. These teachers included nationally renown figures providing education for the next generation of physicians committed to empowering patients through a healing partnership exploring all options conventional and alternative in a mindful manner.

The unique advantage of the residential fellowship was that it provided me with an opportunity to work closely with Dr. Weil in person. These times included time spent in his clinic at University Medical Center learning medicine as well as times we hiked, gathered herbs, and cooked together as a group. It gave me a valuable insights.

During the fellowship, I was awarded with Osher Fellowship. Osher is a philantropist who created the University of California San Francisco's Osher Center for Integrative Medicine. One of the other opportunities which presented to myself was the Associate Fellowship described in the article. Compared to the residential fellowship, it was not as much hands on. However, it provided a valuable asset in the form of community. Also it expanded the number of graduates of the University of Arizona allowing them to provide the training to more people (about 50 per year rather than 4 per year of the residential fellowship). It also provides a self-sustaining way for the program to offer the valuable program to physicians.

I feel very fortunate to have had the training and I also feel extremely grateful that I am now in a community supporting this type of medicine.

4 Ways a Food Diary Can Help You Lose Weight

4 Ways a Food Diary Can Help You Lose Weight

Above is a news article posted by U.S. News & World Report

Obesity is quickly becoming an epidemic in the U.S.  There are no shortfall of the number and the variety of diets that are available in the U.S.  From Atkins Diet, Zone Diet, to South Beach Diet, there is no evidence that a single system of diet can result in the lasting weight loss.

The above news article advocates for the use of pen and paper to record your diet.  It is simple, low tech, and it works.  In Georgia Integrative Medicine, we use 7 day food log (click here to download the form for your use) to help patients to develop self-awareness about their own nutrition and physical activity.

As a part of my medical training, I completed University of California San Diego Preventive Medicine Residency (2 years of specialty training) and Master's of Public Health with Health Promotion.  This period of my training allowed me to learn about how to prevent illnesses and how to promote wellness through helping people make the change.  Much emphasis was made on Health Psychology and how to empower people.

Nutrition diary promotes mindfulness and introduces people to observe their habit of eating.  Understanding the unconscious habits of eating can be the first steps to develop healthful habits of eating.

In designing Georgia Integrative Medicine, we put a great deal of effort around being able to eat healthy manner.  After all, if we could not lead by example, it would be even more difficult for our patients to eat healthy.  We decided to build 2 less exam rooms and instead, we build a full Kitchen and dining room. We also have Chef Nola Daniel, CNC providing team members with nutritious wheat-free, dairy-free, organic meal freshly prepared every day.  We are proud to share that we are the ONLY integrative medicine facility to provide team members with nutritious meal.  

By having a kitchen, we can offer regular spelt bread making workshops and healthy cooking 101 workshops.  I invite you to consider joining us for the workshops.

Doctors in for a dose of alternative medicine

Doctors in for a dose of alternative medicine

Above is the link of an Australian news article summarizing recent trends in Integrative Medicine.  

Dr. Andrew Weil has provided leadership in the academic medical settings resulting in more than 20% of the U.S. Medical Schools belonging to a consortium in integrative medicine.  In addition, he has trained hundreds of physicians through the Program in Integrative Medicine.  

I feel fortunate to have completed two programs with Dr. Andrew Weil as an Osher Fellow.  The first program was a residential fellowship program where I saw patients with Dr. Weil at the University of Arizona's Medical Center.   This option is no longer available due to the expense of running a residential program.  In addition, to the residential fellowship program, I also completed Associate Fellowship (now referred as Fellowship) using internet distance learning model.

The article also updates evidence based approach to integrative medicine.  Not surprisingly, acupuncture has strong base of evidence.  I have written several review articles evaluating the effectiveness of acupuncture for treating numerous conditions including weight loss, back pain, asthma, knee osteoarthritis, and depression.  

In Georgia Integrative Medicine, we provide integrated assessments including:

• Western Medicine
• Chinese Medicine
• Classic Homeopathy
• Energy Medicine
• Medical Intuition
• Nutrition 

Since there is no studies looking at an integrated approach, it is not possible to comment on the effectiveness.  However, if the separate components work, then it is likely that a well-orchestrated variety of healing modalities will likely to help. 

There is a growing consensus that the tools of science is too limited to study complex phenomenon.  I think this is true.  

John Kim, MD MPH FAAMA