Antiaging is the latest wellness craze, with many supplements promising to turn back the clock and help people feel younger.  Very few antiaging supplements have received rigorous attention.

Dehydroepiandrosteone (DHEA) and testosterone are two hormones widely promoted as antiaging supplements which were investigated in a randomized double-blind study published last month in the New England Journal of Medicine.  The study randomized elderly men who had low levels of testosterone and sulfated DHEA into three groups.  One group received DHEA; one group received testosterone; and one group received placebo.  The study also randomized women with low levels of sulfated DHEA to a group that received DHEA, and a placebo group.  The patients were followed for two years.  Their physical performance, bone mineral density, percent body fat, glucose tolerance and quality of life were measured.

The study concluded

Neither DHEA nor low-dose testosterone replacement in elderly people has physiologically relevant beneficial effects on body composition, physical performance, insulin sensitivity, or quality of life.

I guess I’m “pro-aging”.  I figure the better I do my job, the older my patients get!

Tangential Miscellany:

My staff and I wish you a very happy Thanksgiving.  May we all enjoy time with loved ones, and may we remember to express gratitude for our abundant blessings.

Preventive medicine is a rapidly growing field.  Testing that detects diseases in early stages, treatments that prevent diseases before they occur, and behaviors that make diseases less likely all hold the promise to keep us healthy and let us live longer.  Unfortunately the field is also increasingly marred by tests and services that are recommended to patients without any scientific evidence that they work, or worse, despite much evidence that they are useless.

That’s why I’ve long been a disciple of the U.S. Preventive Services Task Force (USPSTF).  The USPSTF is an independent panel of experts in primary care and prevention that systematically reviews the scientific evidence and develops recommendations for all kinds of clinical preventive services.  They are the most objective and least biased national recommendations panel, because (unlike many professional organizations) they have no incentive to encourage or discourage the use of any service.  (That’s why I included them on my Web Resources page.)  So whenever a patient asked “Should I have an annual chest X ray?” or “What tests should I have to check for ovarian cancer?” I always relied on their recommendations.

So I was delighted when my patient, Mr. Timo Kissel (thanks!), pointed me to a new feature that makes the USPSTF recommendations much easier to use by both patients and doctors.  They have a new tool called the Electronic Preventive Service Selector (ePSS) which can be used on the web or downloaded to a PDA.  The user enters his/her age, gender, use of tobacco, whether she is pregnant, and whether she/he is sexually active, and the website displays the recommendations tailored specifically for that person.  Try it yourself.  Go to the “Search for Recommendations” screen and enter your information.  Find out what you should do to stay healthy, and what unnecessary testing you should avoid.  (Be sure to look at the definitions of what the A, B, C, D and I grades mean.)

Some of the recommendations may surprise you and are counter to the practice habits of many doctors.  For example, screening for prostate cancer with a PSA blood test or a rectal exam is still controversial, and there is insufficient evidence to recommend for or against such testing.  Also, doing any kind of tests (like stress tests or CT scans) to look for heart disease in patients with no risk factors or symptoms of heart disease is known to be ineffective.

If you have the time, search around through the recommendations.  I’ll be happy to answer any of your questions that come up.

Tangential Miscellany:

I’m donating platelets again tomorrow.  My new readers may have missed the last time I wrote about blood donation.  I may bug you occasionally about donating blood.  It’s important.

Irritable bowel syndrome (IBS) is a very common chronic condition.  The most common symptoms of IBS are crampy abdominal pain, painful diarrhea or constipation, and abdominal bloating.  The cause of IBS is unknown.  Many of my patients suffer from it.  The National Institute of Diabetes and Digestive and Kidney Diseases has an informative website about the symptoms, diagnosis and treatment of IBS.

Last month the Annals of Internal Medicine published an important article about this common problem by a research team led by Dr. Mark Pimentel, a gastroenterologist at Cedars-Sinai Medical Center.  The study randomized 87 patients with IBS into two groups.  One group received rifaximin (an oral antibiotic that is not absorbed by the gut into the rest of the body) for 10 days.  The other group received placebo.

The group receiving the antibiotic had less IBS symptoms, and the improvement lasted for 10 weeks, long after the last antibiotic pill was taken.  Rifaximin is fairly safe and side effects were rare and not severe.

Rifaximin is by no means a cure of IBS, but for those whose symptoms are very bothersome, this study may represent an important advance.

Tangential Miscellany:

The Cedars-Sinai Medical Staff Pulse interviewed me about my practice.

Six weeks ago I wrote about Zostavax, a vaccine that prevents shingles.  At that time I suggested waiting to see if the CDC was going to recommend it.  Last week the CDC Advisory Committee on Immunization Practices (ACIP) recommended that all adults over 60 who have had chicken pox receive the vaccine.  The press release about the ACIP’s recommendation is here.  The Medical Letter review of Zostavax reported that shingles causes a very strong immune response, and once an adult has shingles, it is very unlikely she will ever have it again.  So they do not think the vaccine is helpful in adults who have already had shingles.

Therefore I’m recommending Zostavax to all patients over 60 who have had chicken pox but not shingles.  It’s a single shot, and the duration of efficacy is still unknown, meaning it’s possible that the protection will wane after a few years.  We don’t keep the vaccine in stock.  We order each dose as patients request it, and Merck ships it to us within two days of our order.

If you’d like to be vaccinated, please call the office to find out the price and schedule an appointment.

Tangential Miscellany:

In response to my post about the importance of daily weighing to maintain weight loss, Matthew Lehrer informed me about a software program that he has found very helpful in losing weight.  CalorieKing is a program that helps you track your eating and exercise and makes recommendations to help you achieve success.  It also has a PDA version so you can enter your food when eating away from home.  I would love to hear about anyone else’s experiences with it.