Resveratrol is a chemical found in the skin of red grapes, berries, plums and peanuts.  It is being widely promoted as the latest antiaging wonder drug.  Fortunately, to separate research from hype, this issue of The Medical Letter reviewed the current knowledge on Resveratrol.

Resveratrol has shown some interesting benefits in animal experiments.  In obese mice, it increased insulin sensitivity and longevity.  In non-obese mice it did not improve survival but increased other markers of good health.  In simple organisms, such as yeast, resveratrol increased lifespan by up to 70%.  (My guess is that this is fabulous news for yeast, but not as good if you’re a human with a yeast infection.)

Studies of resveratrol in humans are lacking, so little can be said with confidence about either benefits or side effects.  The authors of The Medical Letter conclude

Resveratrol appears to produce some of the same effects as calorie-restricted diets that have reduced the incidence of age-related diseases in animals. Whether it has any benefit in humans remains to be established.

So I remain squarely in the pro-aging camp, and hope we all stay healthy and safe enough to grow old.

Tangential miscellany:

I’m proud to announce that I have been elected Fellow of the American College of Physicians.  If you’re curious what that means, see the link explaining FACP below.

Learn more:

The Medical Letter review of Resveratrol (by subscription only)

My previous posts on antiaging:

Growth Hormone Doesn’t Help Healthy Older Adults
DHEA and Testosterone Don’t Help Elderly Patients

American College of Physicians website:  FACP – What do these letters after your doctor’s name mean?

I’ll post the last part of The Healthcare Meltdown later this week, but meanwhile a quick post that deserves your attention.

What’s worse than a product that has never been shown to have any benefit whatsoever?  A product that has never been shown to have any benefit whatsoever and has serious side-effects.

Last week the FDA warned that Zicam zinc-containing nasal cold-remedies have been implicated in over 130 cases of long lasting or permanent loss of smell.  (Here’s a fun new word for you.  Anosmia is the medical term for the absence of the sense of smell.)  The FDA makes the point that the sense of smell is important for smelling smoke, a gas leak or spoiled food.  This is true.  The sense of smell is also critical for smelling a rose by any other name, smelling napalm in the morning, and sorting out who dealt it.

So please throw out your Zicam.  Remember, no medicine or supplement has been shown to decrease the duration of the common cold.  Sometimes the truth stinks.

Learn more:

FDA alert:  Loss of Sense of Smell with Intranasal Cold Remedies Containing Zinc

My post about zinc for the common cold:  Zinc Unproven in Treating Common Cold

At any given time thousands of people feel unwell and are dissatisfied with the diagnoses offered them by their doctors.  They struggle to understand their illness and frequently form patient groups for mutual support.  Every few years a new diagnosis captures their attention and becomes the latest vogue illness, usually without any scientific evidence.  Even worse, unscrupulous doctors latch on to these fad diagnoses to promise cures to patients who are desperate for relief.  A few years ago the fringe diagnosis du jour was chronic Epstein-Barr virus infection.  Then it was systemic Candida infection.  Now it’s chronic Lyme disease.

This week’s New England Journal of Medicine has a very helpful review article on the phenomenon of chronic Lyme disease.  The important point is that while Lyme disease is a well described and understood entity, chronic Lyme disease is a diagnosis that has never been substantiated despite careful attempts to study it.  It is an entity that is either self-diagnosed by patients or offered by physicians whose practice is, um, let’s say not evidence-based.  The patients are offered long term antibiotics for their symptoms, despite the multiple trials showing that this treatment is no more effective than placebo, and has all the potentially serious side effects of antibiotic therapy.

The entire article is available free even if you don’t subscribe.  If you know someone who is being treated with long term antibiotics for chronic Lyme disease you owe it to them to send them a link to the article.

Tangential Miscellany:

Fall is here.  Get your flu shots.

I know I just wrote about the common cold two weeks ago, but I don’t make the news, I just report it.

This week the news is about zinc.  A study in the journal Clinical Infectious Diseases reviewed all the studies in the medical literature on the efficacy of zinc for the common cold.  The study attracted some coverage in the general press including this article in Fox News.  The review simply found that the majority of studies were too small or too poor in quality to draw a definitive conclusion.  So even though most of the lay press headlines are suggesting that zinc isn’t effective in colds, a more honest conclusion is that we don’t know yet.  In the authors’ own words:

This structured review suggests that the therapeutic effectiveness of zinc lozenges has yet to be established.

Tangential Miscellany:

Our receptionist, Jennifer, will be leaving us to enroll in nursing school and pursue her dream of a career in nursing.  We wish her much success.  We are excited that our new receptionist, Jaymes, comes wonderfully recommended by physicians we know and respect.  He has many years of experience listening to, advocating for, and helping patients.  Please help us welcome him, and go easy on him the first couple of weeks!

This week another dietary supplement moves from the “not proven to have any benefits” column to the “potentially harmful” column.  A study in the Annals of Internal Medicine which was reported in this CNN article is the largest study yet to look at the effects of selenium on the development of diabetes.

This story actually starts over a decade ago with a study designed to test if selenium prevents cancer.  The authors randomized 1,312 patients of a dermatology clinic with a history of skin cancer to receive either a selenium supplement or placebo.  The patients were then followed to see if selenium led to a lower risk of developing new skin cancers.  It didn’t.  (The results were published in this 1996 paper in the Journal of the AMA.)

In this week’s study the data from the first study was re-analyzed looking at the development of diabetes.  Patients who had a diagnosis of diabetes at the start of the study were excluded, and numbers of patients in each group who developed diabetes during the initial trial were counted.  Surprisingly, the patients in the selenium group developed diabetes more frequently than the placebo group at a rate that suggested that for every 25 people who take selenium rather than placebo for 10 years one additional case of diabetes would result.

So selenium doesn’t prevent skin cancer and may actually increase the risk of developing diabetes.  Of course we already have lots of ways to increase the risk of diabetes.  My favorite one is cheesecake.

Thanks to Linda T. for pointing me to this story.

I have many patients who swear by alternative therapies that are unproven or, worse, proven not to work.  How should I counsel them?  On the one hand, each individual is unique and it’s possible that what applies to thousands of patients in a study shouldn’t be generalized to the specific patient sitting in my office right now.  On the other hand, we all (I included) have a staggering capacity for self-delusion, and it’s possible that my patient is just engaging in wishful thinking because he sincerely wants the therapy to help.

This week’s Annals of Internal Medicine published a study which offers a case in point.  The study was the most rigorous review of previous studies that tested chondrointin’s benefits for arthritis pain.  The study was also discussed in this editorial in Annals, and it was covered in this LA Times article.

The conclusion of the study was fairly definitive.

Large-scale, methodologically sound trials indicate that the symptomatic benefit of chondroitin is minimal or nonexistent.

Well, that’s that, right?  The only reason to take chondrointin over placebo is if the chondrointin is cheaper.  Nevertheless, many of my patients use chondrointin for arthritis pain and swear by it.  The editorial offers them, and me, some advice.

However, some patients are convinced that it helps, which could be because of a placebo response or even a therapeutic response resulting from enhanced absorption or limited metabolism of chondroitin. Because no frequent or severe adverse effects have been reported, chondroitin sulfate should not be considered dangerous. If patients say that they benefit from chondroitin, I see no harm in encouraging them to continue taking it as long as they perceive a benefit.

So like chicken soup, chondrointin might not help, but it probably won’t hurt.

Garlic is frequently touted as a natural treatment for high cholesterol, and many garlic extracts are sold with the suggestion that they improve cholesterol levels.  The current issue of the Archives of Internal Medicine has an article reporting the most definitive study yet looking at the effects of garlic on cholesterol.  Volunteers were randomized into four groups:  raw garlic, powdered garlic supplement, aged garlic extract supplement, or placebo.  None of the groups had a significant change in their cholesterol, though the raw garlic group reported much more bad breath and body odor.

The results are also reported in this Los Angeles Times article.  This statement from the study’s principal author summarized it well.

“It just doesn’t work,” said Christopher Gardner, a Stanford professor of medicine who led the study. “If garlic was going to work, in one form or another, then it would have worked in our study. The lack of effect was compelling and clear.”

Nevertheless, I still think it’s yummy.

Tangential Miscellany:

I wrote last summer about my involvement with the Society for Innovative Medical Practice Design (SIMPD), a national organization of physicians who work for their patients, not for insurance companies.  Because of my long-standing interest in medical ethics, I had the honor to serve with Dr. Robert Briskin and Dr. Garrison Bliss on the SIMPD ethics committee.  We were charged with the task of crafting a statement of ethical principles that would guide us and future physicians in our new practice models.  I’m very happy with the product of our work.  Our statement of ethical principles demonstrate that concierge physicians take ethics seriously, and that practices that align physician interest with patient interest can avoid many of the ethical pitfalls of traditional practices.  If you have an interest in medical or business ethics, I’d love to hear your feedback.

In November I wrote about an important study in the Annals of Internal Medicine that demonstrated the effectiveness of an antibiotic for the symptoms of irritable bowel syndrome (IBS).  Dr. Mark Pimentel, the author of the study, is the director of the Cedars-Sinai Medical Center Gastrointestinal Motility Program.  Last year he published a book outlining his theories about the cause and treatment of IBS:  A New IBS Solution.  After reading my post about the Annals article, he kindly asked me to review his book.

The cause of IBS remains mysterious.  Dr. Pimentel makes the astute point that when the cause of a disease is unknown, it is very frequently initially presumed to be psychological.  A generation ago, stomach ulcers were thought to be due to emotional stress.  (They are not.  They are almost always due to a specific bacterium or to anti-inflammatory pain medicine.)  Heart attacks were thought to be more common in patients with the “type A” personality.  (They are not.)  The assumption that IBS has primarily psychological causes has stigmatized IBS patients, and has misdirected researchers away from potentially useful diagnostic tests and treatments.

Dr. Pimentel’s central theme is that bacterial overgrowth is a major cause of IBS.  Bacterial overgrowth is a condition that occurs when bacteria that normally live in the colon (large intestine) move into and colonize the small intestine which is normally free of bacteria.  Small intestine bacterial overgrowth can be diagnosed by testing for specific gasses in exhaled breath, and can be treated with antibiotics.  In language aimed for the general public, Dr. Pimentel summarizes the evidence supporting this theory, and details the protocol used at Cedars-Sinai to manage IBS.  The book is also peppered with patient testimonials which help put a human face on a medical problem that is frequently very miserable.

The ideas in A New IBS Solution are an important breakthrough in a very common disease for which treatments up until now have been only marginally effective.  I will certainly recommend the book to all of my patients with IBS.

I’ve written before about the popular antiaging trend in healthcare.  Another medication that has been widely touted as an antiaging remedy is growth hormone (GH).  It has been shown to be beneficial in certain diseases (especially GH deficiency) but has also been recommended by some to healthy older people to increase muscle mass, improve bone density, and “reverse aging”.

A systematic review of randomized studies of GH in healthy older adults in today’s issue of the Annals of Internal Medicine examines this issue.  The results have been widely reported in the general press, including this L.A. Times article, and this article in Forbes.

The study found no significant benefit from GH, but several serious side effects, including soft tissue fluid retention, carpal tunnel syndrome, joint pain, and, in men, breast tissue enlargement.

The authors of the study conclude:

“Use of GH as an antiaging therapy is widespread and has been advocated in the lay press and in scientific literature. Our analysis shows that this practice is not supported by a robust evidence base, offers little clinical benefit to the healthy elderly, and is associated with high rates of adverse events.”

This week there are three brief items of Tangential Miscellany:

There will not be a medical news post next week.  The posts will resume the week of January 29.

The Pedometer Project starts on February 1.  Folks are still signing up.  Send me an email if you’d like to join.

Finally, a year ago this week I posted my first weekly medical news post.  I’m very grateful for all the helpful feedback and encouragement about the posts that many of you have given me.  I’ll try to continue to keep you informed, motivated, and healthy in the next year.

I know I wrote about menopause only three weeks ago (and received some joking complaints from a few male patients about covering irrelevant topics) but I don’t write the medical literature; I just report it.

A great study was published this week in the Annals of Internal Medicine, and the summary for patients is free without a subscription. It’s brief and informative. The study enrolled menopausal women who were having at least two episodes of hot flashes per day and randomized them to five treatment groups, each of which received one of the following treatments: black cohosh (an herb frequently marketed for the treatment of menopausal symptoms), a multibotanical herbal product, a multibotanical herbal product and counseling to increase dietary soy intake, estrogen hormone therapy, or a placebo pill. The group receiving estrogen had fewer hot flashes and night sweats; the other four groups all had similar symptom frequency. Black cohosh, herbs, and soy did no better than placebo.

(By the way, a brewing controversy that I have not seen addressed is that the New England Journal of Medicine calls them “hot flushes”, while the Annals calls them “hot flashes”.)

An editorial in the same issue of Annals ends with some words of encouragement.

“The good news from [this study] has to do with the natural history of vasomotor symptoms. Women in the placebo group experienced an approximately 30% reduction in the severity and frequency of vasomotor symptoms during the 12-month follow-up period. … Therefore, if a woman is not severely bothered by her vasomotor symptoms, it is important to reassure her that she has a good chance of having fewer symptoms within 6 to 12 months. Indeed, she may not need treatment at all.”

So female patients should take heart – your symptoms will likely be mild and temporary. And male patients should be patient until I write about prostate problems, or football.

Tangential Miscellany:

I wish all of my patients and readers who are celebrating a very merry Christmas!