Dr. Barry Dworkin » Alternative Medicine

Enzyme supplements may play role in good health

Dr. Barry Dworkin — Tue, 27 Jul 2004 22:34:37 +0000

Originally published in The Ottawa Citizen July 27, 2004
Original Title: Cozy up to Co-Q

An early study released recently by the Michigan Head Pain and Neurological Institute in Ann Arbor, Michigan, showed that co-enzyme Q10 (CoQ) may be another treatment approach for migraines.

Before delving deeper into this story, a little CoQ cell biology and metabolism review will help clarify the issue.

Within our cells reside mitochondria. These tiny organelles are the cell’s power plant, using glucose and fatty acids for fuel. They produce the power by using enzymes contained within them. The purpose of an enzyme is to convert one compound into another and pass it onto another enzyme to make further changes or send the product off to its final destination.

Each enzyme has its own repetitive purpose, similar to work on an assembly line. But even the enzymes need help to function in top form.

Enter the co-enzyme.

Co-enzymes support the function of the enzyme. Indeed, without them the enzyme system would likely malfunction or be unable to produce a quality product.

CoQ or ubiquinone (from the word ubiquitous, “found everywhere”) is an antioxidant and is produced in the liver, pancreas, heart and kidneys, usually in sufficient amounts for proper physiological function. Minute quantities of CoQ are found mainly in chicken and beef. Indeed, the only way to increase the body’s supply of CoQ is through consumption of dietary supplements.

There are claims that CoQ will be helpful in treating congestive heart failure, Parkinson’s disease, heart muscle damage (cardiomyopathy), hypertension, heart attack recovery, diabetes and, now, migraines.

What is the scientific evidence to support these claims?

The migraine study hypothesis stated that a possible cause for migraine headaches could be due to the cell’s inability to produce enough energy to function properly. CoQ was given to patients to see if it would relieve their headaches. At the American Academy of Neurology’s annual meeting in April, reports suggested 300 milligrams a day halved the migraine frequency compared to placebo.

“The bottom line is that there are safe alternatives with a firm scientific basis for preventing migraine for people who don’t want to take prescription drugs, that also can be used to complement prescription drugs,” said Dr. Richard B. Lipton, a neurology professor at Albert Einstein College of Medicine in the Bronx, New York.

People suffering from congestive heart failure (CHF) have lower levels of CoQ in their heart muscle. A one-year double-blind, placebo-controlled trial of 641 people with moderate to severe CHF divided the group into halves; one group received two milligrams per kilogram body weight of CoQ daily, the other half received placebo — but both groups remained on their conventional medical therapy. The CoQ group experienced a reduction in the severity of their symptoms and had fewer readmissions to hospital for CHF exacerbations.

Other studies produced similar results, but two recent and well-designed double-blind studies did not show any benefit. More clinical trials are needed before any definitive therapeutic recommendations are made.

Three double-blind placebo-controlled hypertension studies demonstrated a nine-per-cent reduction in blood pressure in one, and similar results for the others. These studies used small patient populations (range 59 to 83 people) using doses between 60 to 100 milligrams daily.

People with hypertension can have other illnesses. It can affect young and old. The next step would be to look at specific patient populations to provide a means of comparison.

How well does it work for treating heart attack patients? In a double-blind study, 145 patients were given placebo or 120 milligrams of CoQ daily for 28 days along with their conventional medical treatment. The results showed that the CoQ group suffered fewer recurrent heart attacks, chest pain (angina pectoris) and irregular heart rhythms (arrhythmias).

One eight-week and one 12-week double-blind placebo-controlled diabetes study showed a significant reduction in blood sugar levels in people taking 100 milligrams of CoQ twice daily compared to placebo. However another study failed to note any difference.

Although there were initial positive reports about the use of CoQ in Parkinson’s disease and cardiomyopathy, the results were not statistically significant. Further trials are forthcoming.

CoQ is generally safe when taken as directed. People taking warfarin (Coumadin) should not take CoQ because it may impair the blood thinning action of the medication. Its safety has not been evaluated for children and breast-feeding or pregnant women.

Cholesterol-lowering medications like the statins, beta-blockers, tricyclic anti-depressants and phenothiazines (antipsychotic) medications can reduce CoQ levels.

It is best to take CoQ in its dry tablet or capsule form with meals because it is better absorbed with fats and oils.

Consult your physician before trying CoQ, especially if you have suffered a recent heart attack or have diabetes, heart disease, cancer or kidney failure.

For more information, check the website http://www.consumerlab.com, which provides independent analysis of many herbal products.

© Dr. Barry Dworkin 2004

A closer look at St. John’s Wort

Dr. Barry Dworkin — Wed, 12 May 2004 12:42:14 +0000

Originally published in the Ottawa Citizen, May 12, 2004
Original Title: All smiles: worts and all

Known as Fuga Demonum or Devil’s Scourge, its original use was to ward off evil spirits and prevent demonic possession. Sixth century Gaelic legend makes reference to St. Columba who carried a piece of the flowering plant in deference to St. John the Baptist around whose birthday the flower would bloom.

Hypericum perforatum or St. John’s wort (wort is the old English term for plant) is used by many to treat depression, anxiety, inflammatory disorders, viral infections and for wound healing.

Several chemical compounds within St. John’s wort do have medicinal properties: the hypericin family, the flavonoids, hyperforin (related to hop bitters), some amino acids and tannins. Indeed, any natural plant extract contains a plethora of biochemical and pharmacological ingredients that can and do interact with different body functions and biochemical processes.

Many double blind placebo-controlled studies indicate that St. John’s wort is effective for mild to moderate clinical depression. It seems to provide benefits similar to serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and low dose tricyclic antidepressants and was much better than placebo. Most of the studies used a specific plant extract called LI 160 rather than the whole herb.

St. John’s wort is ineffective for people suffering from severe forms of depression that usually require hospitalization. Prescription anti-depressant medications do far better than St. John’s wort under these circumstances.

Hypericin and hyperfolin were originally thought to be the main ingredients that combat depression. Studies seem to indicate that this may not be the case. These two compounds are useful quality control markers with respect to the manufactured product.

Indeed, it seems that when hypericin and hyperfolin are extracted for study, other unidentified chemical compounds come along for the ride. It is these compounds that may be responsible for the antidepressant effect.

There is no evidence to support St. John’s wort for the treatment of anxiety, human immunodeficiency virus (HIV), premenstrual disorder, chronic pain, insomnia and menopausal symptoms. With respect to HIV, the herb can interfere with the actions of certain medical therapies and make the condition worse.

As with any medication, drug interactions and side effects can occur. St. John’s wort does affect the liver’s capacity to metabolize certain drugs. There is a particular liver enzyme pathway called the cytochrome P450 system; one of the most important liver mechanisms to detoxify chemical agents and drugs.

The cytochrome P450 system can be induced (accelerated). This will cause the rapid breakdown of medications and reducing their therapeutic effect. If the cytochrome P450 system is shut down or slowed, the liver is unable to clear out the medication in a timely manner; standard medication dosing schedules can lead overdose and toxic side effects. St. John’s wort induces the P450 system.

St. John’s wort can reduce the efficacy of many medications; the list is too long for this column. Some of the more common drugs affected are the heart medication digoxin, the cholesterol-lowering agent simvastatin (Zocor) and anticoagulant or blood thinner warfarin (Coumadin).

It can interfere with the metabolism of birth control pill causing bleeding or spotting between periods, irregular menstrual bleeding and increase the risk of pregnancy. These side effects occur because the liver eliminates the pill’s hormones within at a faster rate. Indeed, it is recommended that an additional birth control method be used when taking St. John’s wort.

Concomitant use of St. John’s wort with SSRIs like paroxetine (Paxil) and sertraline (Zoloft) can result in excess levels of serotonin causing among other symptoms, agitation, hyperthermia, sweating and rapid heart rate. This “serotonergic syndrome” is a medical emergency.

It can also cause itchy red irritating rashes with skin sun exposure (photodermatitis). This reaction occurs with doses of two to four grams (2000 to 4000 milligrams) of St. John’s wort extract.

It is not recommended for use in pregnancy because it may stimulate contractions of the uterus. Its safety while breastfeeding has not been established.

People suffering from bipolar disorder should avoid using it because it can stimulate a hypomanic or manic episode.

An excellent independent testing organization called Consumer Labs (www.comsumerlabs.org) recently released a review of St. John’s wort products. Six of the ten brands tested for quality control failed.

Three of the products exceeded “the cadmium limit established for medicinal plants by the World Health Organization by 100 to 1000 per cent” and one of the three exceeded the State of California lead limit. Although the cadmium levels would not pose a serious health risk on their own, it is best to avoid this heavy metal because of the small safety margin. Cadmium is a carcinogen and kidney toxin.

The usual dose is 300 milligrams three times per day standardized to 0.3 per cent hypericin. Although effective for mild to moderate clinical depression, consult your pharmacist and doctor prior to using St. John’s wort.

Herbal Reality: Valerian

Dr. Barry Dworkin — Tue, 04 May 2004 12:53:49 +0000

Originally published in The Ottawa Citizen May 4, 2004
Original Title: Herbal Reality

Do herbal preparations really live up to their claims?

There are many anecdotal reports that they do make a difference and help people with a variety of ailments. Many websites purport to give information but, for the average consumer, it can be difficult to separate the facts from bias.

Some sites act as fronts for retailers; others have a political axe to grind.

The “natural” label so often cited for safety of herbal preparations is misleading. They contain many chemical compounds that can be therapeutic or toxic. As such, they require the same degree of evaluation as prescription medications.

In future columns I will present the latest evidence-based information on some of the more popular herbal preparations you may see every day in the stores. Indeed, with ongoing scientific inquiry, we will learn more about their safety and efficacy.

Take the herbal remedy valerian, for example.

People use valerian root, found in North America, Europe and Asia, to treat insomnia and anxiety. Valerian is widely available at pharmacies and health food stores, in capsules and pills.

Testing has focused on valerian as a single ingredient preparation and not in combination with other herbs.

Valarian’s chemical makeup includes compounds such as valpotriates and valeric acid that have direct sedative effects on the nervous system.

One double-blind placebo controlled study evaluated valerian extract’s ability to reduce sleep latency (the time it takes to fall asleep) and night awakenings and to improve sleep quality and dream recall. The extract did help people fall asleep faster and improved the quality of sleep, but had no effect on the other two measurements.

These results were best in people who described themselves as poor sleepers and smokers. Valerian had little to no effect on people who were already good sleepers.

Other small limited studies also showed improvement in sleep latency. However, most of the studies under review used different criteria to choose the study participants and varied the dosages. The small numbers make it difficult to come to a definitive conclusion about its ability to treat insomnia.

Doses between 300 to 600 milligrams per day did not produce any daytime sleepiness, although patients using 400 to 900 milligrams per day two hours before bedtime had the greatest benefit.

Valerian seems to be comparable to low-dose prescription sleeping pills such as the benzodiazepines lorazepam and oxazepam, among others. Continuous nightly use for several days to four weeks may be necessary before it provides significant relief. The potential advantage of valerian over benzodiazepines is the lack of addictive potential and lack of morning grogginess.

There is limited data regarding its ability to treat anxiety. Larger studies are needed before drawing any conclusions.

Valerian products produced from the species Valeriana officinalis are relatively safe, at recommended dosages, with minimal side effects and drug interactions. Side effects may include minor digestive system discomfort, dry mouth, vivid dreams and, very rarely, a mild stimulant effect.

Excessive dosing is associated with similar withdrawal effects as seen with benzodiazepine sleeping pills. Signs of toxicity may include trouble walking, hypothermia and increased muscle relaxation.

Valerian may augment the effects of barbiturates, anesthetics and other central nervous system depressants, and should not be used with alcohol. The safety of valerian has not been well evaluated for children or for women who are pregnant or nursing, and it is not recommended for use by such individuals or by women who may become pregnant.

Should you decide to use valerian, choose a product made from the root (or rhizomes) of Valeriana officinalis since most clinical research used this plant. Products made from other species can be rich in a compound, didrovaltrate, that is toxic to cells in laboratory tests.

The bottom line is that more rigorous studies are needed to flesh out which chemical component in valerian provides efficacy and its biochemical properties.

Herbal remedies can work, but they are not always safe

Dr. Barry Dworkin — Tue, 02 Sep 2003 12:34:59 +0000

Originally published in The Ottawa Citizen September 2, 2003
Original Title: Eau Naturelle

Herbal remedies are medical concern. A substantial minority of people use them. Indeed, many people do not tell their doctor about herbal medication use unless directly asked. This is not a recipe for good comprehensive health assessment. Some herbal preparations will adversely interact with prescription medications.

At times, there may be an automatic dismissive response on the part of physicians should patients bring up the topic of herbal treatment options. This reaction comes in part from the outrageous claims (without supportive evidence) for some of these remedies. Some herbals list a multitude of unrelated diseases. Claims for Echinacea, for example, include using it to treat acne, strep throat, gonorrhea and even typhoid fever.

There is a saying, “Extraordinary claims require extraordinary evidence”. Physicians face the overwhelming task of trying to explain why the herbal/drug does not work for a particular condition(s) in five minutes or less. It is the responsibility of the claimant to prove the veracity of the health benefits, not the physician.

The popularity of herbal preparations rests in part on the notion that “natural is safe”. In fact, nature produces some of the most potent toxins and poisons known like botulinum toxin, lysergic acid (a component of LSD), cyanide, snake venom, belladonna and alcohol among others. Marijuana, peyote, mushrooms and moulds all produce substances that alter our body’s normal physiologic processes. All herbal products contain biochemical compounds as all organic living matter does.

Physicians need factual and credible scientific information to address their patients’ questions and concerns. Research continues to present interesting applications for some herbal regimens. For this reason, all herbal preparations should face the same safety assessment playing field, as do all prescription and over-the-counter medications because they are indeed drugs. Where they come from is irrelevant.

If we accept that herbal preparations possess the ability to alter our physiology then we must determine if it has beneficial therapeutic effects. Let us look at some of the latest research for some of the more popular herbal/plant medications; Echinacea, St. John’s wort, garlic, Gingko Biloba and Saw Palmetto. Do they stand up to scrutiny?

Echinacea, derived from the Asteraceae or Compositae family of plants, is purported to fight the common cold, urinary tract infections, vaginal yeast infections and genital herpes among 15 other uses.

Native Americans first used it to treat respiratory infections, snakebites and other ills. It use in the 1800s was a blood purifier and dizziness treatment. In the early 1900s, it was used to treat cold and flu and as an anti-infection agent.

Echinacea preparations may decrease the duration and severity of colds and flu but does not prevent them. Because of the multitude of Echinacea plant sources each with different chemical compositions, it is unclear which preparation is most efficacious. It fails to treat urinary tract infections, genital herpes and vaginal yeast infections.

Saw Palmetto is used to treat the symptoms of an enlarging prostate gland or Benign Prostatic Hypertrophy (BPH). Many clinical studies lasting up to 48 weeks show significant improvement in many symptoms. Patients report a reduced number of daytime and nighttime bathroom visits, easier start to urinary flow, less dribbling after urination and less painful urination.

Its effectiveness seems to be on par with the prescription drug Proscar. However, it does not reduce prostate size or PSA levels. Other BPH medications such as Flomax and Hytrin seem to be superior to Saw Palmetto for relieving symptoms.

The active ingredient of St. John’s wort, hypericin, is possibly as effective for the treatment of mild to moderate depression as the selective serotonin reuptake inhibitors (SSRIs) like Zoloft and Prozac. It is not indicated for severe depression. There is insufficient evidence to support other claims as a treatment Hepatitis C and diabetic nerve pain.

Of the 30 health claims for Gingko Biloba, several studies indicate it seems to be possibly effective for the treatment of dementia from Alzheimer’s or stroke, acute altitude sickness in mountain climbers, vertigo and distance walking leg pain in people with blocked arteries of the lower limbs.

Studies lasting three months to a year show that Gingko leaf extract can stabilize or improve some measures of cognitive and social functioning in patients with different types of dementia. In effect, the research indicates this improvement amounts to a six- month delay in disease progression. There are no head-to-head studies comparing Gingko to conventional medications for the treatment of dementia.

Garlic’s main use is in the prevention of cardiovascular disease. Most of the evidence shows it does reduce total cholesterol levels by four to 12 per cent but is ineffective raising the HDL or good cholesterol levels. Statin medications (lipitor and others) decrease levels by 17 to 32 percent and do raise HDL levels. Garlic can also interfere with blood thinner medications increasing bleeding risk. Patients who need a significant reduction of their cholesterol levels should not use garlic.

Further research will help identify the therapeutically active ingredient(s) of these plants. Consult with your doctor and pharmacist about drug interactions and drug safety concerns before starting any herbal medication especially if you are taking prescription medication.

Links: ConsumerLabs (http://www.consumerlab.com/)
Health Central (http://www.healthcentral.com/centers/OneCenter.cfm?Center=Herbal_Remedies).

A Historical Perspective of Homeopathy

Dr. Barry Dworkin — Tue, 11 Sep 2001 12:38:11 +0000

Originally published in The Ottawa Citizen September 11, 2001

Homeopathy is regarded by some as an alternative or adjunct to the betterment of their health. Most are unaware of its history. I want to mention two numbers before we proceed. The reason will be apparent later. The total number of atoms in the universe is estimated to be about one googol (1 followed by 100 zeros). In chemistry, a mole represents the molecular weight of a substance expressed in grams. The number of molecules in a mole of any substance is 6.022 x 10²³ (Avogadro’s number).

In 1796, Samuel Hahnemann, a German physician, created homeopathic theory in response to his dissatisfaction with conventional medicine. Conventional medicine suffered from a dirth of evidence that its treatments were efficacious. They were often more dangerous to the patient than the actual disease.

He presented three hypotheses as the cornerstone of Homeopathy. The first was based upon the “law of similars”: Similia similibus curentur, like cures like. He hypothesized that if a substance caused a specific side effect or symptom in a healthy person then this same substance would cure a similar symptom in a sick person.

The second dealt with the power of diluted substances. If the substance were diluted to fantastically small amounts to minimize side effects, it would not reduce its effectiveness to heal. Hahnemann did not believe in the existence of atoms. He thought he could continue dividing matter endlessly. According to Hahnemann, the water/alcohol solution used in the dilution process remembered the substance that was once there. Vigourous shaking of the solution (succussion) evenly distributed the substance maximizing its healing energy.

The third principle stated in his book “Organon” was “The sole true and fundamental cause that produces all the countless form of disease is “psora”. Psora is also known as itch. This principle is rarely followed by followers of Hahnemann.

Homeopathy states that it uses “natural” substances to set it apart from conventional medicine. Some of these substances include Belladonna (deadly nightshade), hemlock Conium), cadmium, salt, mountain daisy (Arnica), sulfur, poison nut (Nux vomica), raw bovine testicles, crushed honey bees (Apis mellifica), venom of the Bushmaster snake (Lachesis), arsenic (Arsenicum album), rattlesnake venom (Crotalus horridus), Ipecac (Ipecacuahna), dog milk (Lac canidum), poison ivy (Rhus toxicodendron) and others.

How did Hahnemann determine what each substance did? He and his students tested the remedies upon themselves. They would eat various foods, plants, minerals and carefully observe the symptoms. The problem was they all knew what they were ingesting. One could be somewhat apprehensive knowing that they were swallowing snake venom or other noxious substance and feel somewhat queasy thereafter. Today we try not to allow both the researcher and the test subject from knowing the substance being used in order to avoid potential bias in reporting.

Homeopathic remedies are usually in pill form containing lactose. The labels on homeopathic preparations indicate a dilution factor, for example, C30 or D60. The “C” represents a dilution factor of 1:100, “D”, 1:10. The number that follows indicates the number of times it is succussed and diluted again. C30 indicates the 1:100 dilution is repeated 30 times. This is a dilution factor of one part per 1060 (1 followed by 60 zeros). One would be hard pressed to find one atom of the substance left at C30 since Avogadro’s number is exceeded. You would have to ingest billions of pills just to get one molecule of the medication. Some dilutions are C100 to 200 exceeding one part per googol. There are not enough atoms in the universe to leave just one in the solution.

Some toxic substances can remain so if insufficiently diluted. For example a dose of D6 cadmium exceeds safe limits. However when diluted to D10 or greater, there is little left to cause harm.

Homeopathy is concerned with the symptoms of disease. It is not designed to take into account the mechanism of disease. Let’s assume that the claims made by homeopathy are true. It states that a vital healing force (the essence of the substance) is retained within the solution regardless of how dilute. Three questions must be asked:

Why does the water/alcohol mixture remember the healing powers of an active substance but forget the side effects
What happens to the memory of the substance when the last drop of liquid evaporates from the lactose tablet?
Does the water remember other substances as well? Thousands of substances must have mixed with the water during its history. Do not these substances interfere with one another? Would not it be difficult to isolate a single effect?

Each person must decide for themselves what is best for their health. It has been my goal to present the history and background of homeopathy to you for expressly this reason.

No related posts.

The Misuse of Placebos

Dr. Barry Dworkin — Tue, 28 Aug 2001 12:51:07 +0000

Originally published in The Ottawa Citizen August 28, 2001

Attending a conference entitled The Scientific Review of Alternative Medicine, a number of physicians noted that the placebo effect was a very powerful force and motivator with respect to the success of alternative medicine practices such as therapeutic touch, chiropractic, herbal remedies and the like. It was further implied that physicians underutilize the placebo effect in our medical practices. In fact, some vociferously contested that we should use the placebo effect as do Alternative Medicine Practitioners (AltMedists) regardless of the therapies’ efficacy so long as it will help our patients.

For a group of scientifically literate people, I was surprised by this attitude. On the surface this argument sounds reasonable. What are the implications of implementing these treatments into our practice? I have reservations regarding the use of the placebo effect in this manner to bolster claims that a particular therapy is valid.

If we accept every claim at face value and give others the benefit of the doubt, despite the good intentions inherent in the action, we condone a slippery slope towards anarchic feel-good approaches to scientific problems. In that light, several people mentioned that some practices have existed for centuries and therefore had to be considered on an equal footing with scientific medicine. The length of time something is practiced does not justify that it is valid. For example witch hunts, slavery, blood-letting and cupping were commonly practiced and accepted in their time.

I think it is more reasonable to say to our patients that we do not have all the answers at this time but we will work hard to figure things out. We should not substantiate beliefs in extraordinary claims or miracle cures without the requisite proof. Extraordinary claims require extraordinary proof.

Scientific medicine is consistently challenged and responds by rethinking the way things work. It tests new hypotheses and discards old accepted notions when the evidence demands it. Scientific Medicine grows and develops with time.

Alternative Medicine is stagnant. It resists challenges because it is based on dogma or on the ideas of a few who were/are convinced they were/are right using unsubstantiated or unproven claims. Yet alternative medicine ridicules us for being dogmatic and unyielding because we dare ask questions and evidence of proof! We tend to fall into the trap of relativism, giving equal consideration to claims no matter how outrageous.

I do not want to be duped or fooled by anyone. If I am to provide consistent reliable information to my patients, my skepticism respects their integrity. My ability to separate out the proven from the unproven gives me the opportunity to evaluate potential benefit or harm to my patients. No one wants to be placed in a position of having provided or recommended a therapy to a patient that can be harmful. I disagree with the idea that boosting or augmenting the placebo effect is not harmful to our patients. One of the most important tenets of the doctor-patient relationship is the contract for trust. We do not lie to our patients. If we do not disclose to our patients what we are doing and why a therapy may or may not work (based on the evidence at hand) we nullify their right to self-determination and we show great disrespect. If we talk about therapeutic benefits placebo or otherwise, I do not know anything more disruptive to this effect then this destruction of trust

As physicians and scientists we need not apologize to others under the guise of relativism for insisting that therapeutic practices or modalities require concise thorough scientifically based evidence before subjecting them to a priori practices. It is a standard that insures the best possible measure of safety for our patients. In this manner, we can provide evidence-based information to our patients. It is then up to the patient to make up their minds and select the best possible alternatives and therapies for themselves.

If we state that there is not enough data to suggest, for example, therapeutic touch is of unlikely benefit to patients, by what standard and measurement does one use to prove validity? A common standard must exist to effectively compare therapeutic modalities. If some other method of measurement is needed, then propose it. However it must conform to known physical laws unless there are some new ones that have yet to be elucidated. It must be consistent and provide reliable data every time it is used and not devised as a superset of laws for each branch of alternative medicine.

AltMedists invariably use pseudoscientific jargon to “prove” their therapies work. They accuse critics of being stodgy Western thinking conservatives. Ad hominem attacks are irrelevant when trying to prove or disprove a point. Does not their use of jargon illustrate the language of science is indeed important when making claims?