Many of you may know of melatonin as the hormone supplement to be used for sleep. Although that’s true, there is so much more that this hormone can do. Some researchers feel that even if you sleep well, melatonin is still worth taking for other reasons.

One thing to note is that Melatonin, like many other hormones, starts to decline in our 40’s. It is a hormone produced not just in the brain but in many other tissues throughout the body: the most abundant production being in the intestine. Researchers have also found that it is produced in the retina, the skin, the bone marrow, the thymus and in white blood cells which makes it an important regulator of the immune system.
Here are the many effects of Melatonin:

1. Protects against viral and bacterial infections-Studies have shown that melatonin reduces the ability of bacteria to reproduce, provides a non-conducive environment for bacteria to live, and decreases inflammation. It has also shown to be effective in treating viral infections, and in treating premature infants suffering from respiratory distress syndrome and septic shock. This is where melatonin can have a profound effect in strengthening our immune system.

2. Cardiovascular health- Studies in mice as well as humans have shown a reduction in blood pressure when taking melatonin. As we age, the risks of coronary disease, high blood pressure, heart failure and stroke increase and melatonin decreases. Melatonin can prevent and treat heart disease and high blood pressure due to its anti-inflammatory and anti-oxidant effects.

3. Alzheimer’s and neurodegenerative diseases- Melatonin is the major antioxidant in the brain and nervous system. Since oxidative stress is the primary destructive force on our brain cells, having enough melatonin is essential to preserving brain cells and function, especially over the age of 60. Melatonin acts directly on the DNA and mitochondria in our cells allowing them to behave more like our younger selves.
When our brain cells die (due to poor health, drugs, malabsorption, sedentary lifestyle and aging), we rely on brain stem cells to replace them. But these cells diminish as we get older and they are harder to replace. Melatonin can help this process of neurogenesis (brain stem cells replacing dead cells). It also stimulates hippocampal neurogenesis, which is important because the hippocampus is the region in the brain that regulates short-term memory and spatial orientation.

4. Menopause- Melatonin has been shown to help menopausal symptoms including mood and reducing depression. There seems to be a recovery of pituitary and thyroid functions in melatonin-treated women.

5. Ionizing radiation- X-rays, CT and PET scans are the main sources of ionizing radiation which with repeated and prolonged exposure increases the risk of cancer. Children are especially at risk. Melatonin in human studies has been able to cancel the potentially damaging effects of ionizing radiation. The doses used in research are 300 mg of melatonin which seems quite high but the effects were amazing. Lymphocytes (WBC’s) in blood samples were taken from men and women. After exposure of the equivalent of 1000 CT scans (I know…that’s alot!) all the samples had a degree of genetic damage due to the radiation. The cells that were taken an hour and two hours after the melatonin dosing had significantly less genetic damage. Something to think about if you need these procedures done.

6. Macular degeneration- Melatonin is produced in the retina, the part of the eye that is affected by macular degeneration. People with macular degeneration (MD) have lower levels of melatonin. Oxidative stress is the primary cause of this condition. Studies have shown that it can prevent and slow the progression for either dry or wet MD.

7. Cancer- There are several published studies on the use of melatonin and cancer. Researchers have reported that not only has melatonin been shown to have an anti-cancer effect but it also has an immune reaction against cancer. It protects healthy cells from the negative effects of chemotherapy and radiation. Some studies showed that adding melatonin to chemotherapy enhanced the treatment effect of the drug while at the same tome decreasing the side effects. Melatonin has been used in breast cancer studies since it has SERM (selective estrogen receptor modulator) and SEEM (selective estrogen enzyme modulator) properties. This means it has anti-estrogen and anti-aromatase actions. Melatonin also stimulates apoptosis (programmed cell death). Melatonin has shown cancer prevention and benefits in the treatment of prostate cancer whether cancer cells were sensitive to hormones or not. The anti-cancer properties of melatonin include colorectal, breast, prostate, pancreas, liver and brain cancer.

Choose a pure melatonin in a powder or use capsules free of additives. If side effects occur (ie. waking up with vivid dreams) try a different brand. Also, there is no negative feedback inhibition with melatonin. This means that there is no concern with taking melatonin that it can cause the body to stop making its own. You can take as much as you want and it will not interfere with your own production of melatonin.

Just a side note…I have used melatonin for teens with great success. I find it especially good for kids with sensory integration issues. So it’s not just for people older than fifty. By the time you are 20 years old, you have some deficiencies, but even those with alot of stress, inflammation, malabsorption, food sensitivities and repeated infections, melatonin may be a part of your healing program.

Reference:
Shallenberger, F. Melatonin isn’t just for sleeping-from cardiovascular disease and cancer to aging and macular degeneration the research will shock you. Townsend Letter. Feb/March 2019. pp.50-57.
Sanchez-Barcelo EJ, et al. Melatonin uses in oncology: breast cancer prevention and reduction of the side effects of chemotherapy and radiation. Expert Opin Investig Drugs. 2012 June, 21(6):819-31.

Spring is a common time for people to start moving more and thinking about doing a gentle detox. Here are some general recommendations and information about modified citrus pectins.

Food is one of the most important medicines we can use to re-energize and help detoxify. When we start eating more nutrient dense foods such as lean proteins, fruits, vegetables and legumes (high in fiber), it helps to balance blood glucose and insulin levels and removes those sugar cravings. Avoiding refined foods, sugars, cooked oils and trans-fats, alcohol, caffeine and preservatives reduces inflammation that make us feel sluggish and foggy headed. Keeping that healthy gut flora happy is a must so choose sauerkraut, kimchi, natto and green tea to help colonize good bacteria and aid in detoxification. Let’s not forget about water. Filtered or spring water is best. The general rule is to drink half your body weight in ounces. Also, when we feel better, it motivates us to exercise and to stick with our program.

Now let’s talk about binding those toxins so they can be eliminated in the body. Modified citrus pectin (MCP) from citrus peels is a unique dietary fiber that is metabolized by intestinal bacteria to short-chain fatty acids in the colon. MCP also removes toxic metals, environmental toxins, and even radioactive isotopes from the circulatory system and digestive tract. It is a safe gentle chelating agent and does not remove essential minerals due to its structure. When you combine it with alginates, you get a more powerful effect because the alginates from seaweed prevent the reabsorption of heavy metals.

MCP is also one of the most powerful immune enhancers according to a study by Dr. Isaac Eliaz. In healthy volunteers MCP showed a healthy increase in blood cytotoxic T-cells (which fight cancer) by 160%, and it activated natural killer cells (NK-cells) 10-fold which changes the activity of cancer.

Researchers have also shown that MCP binds to Galectin-3 (Gal-3) to reverse inflammation and fibrotic changes to the heart, kidney, liver, nervous system and other tissues. Gal-3 is recognized as a predictive biomarker and therapeutic target for heart disease. It is easily measured in the blood and is covered by most insurance companies. It can also be used to assess cancer risk and progression.
For those with no risk factors, 5 grams per day is recommended. This will help reduce toxic heavy metals, enhance the immune system, reduce inflammation and tissue damage. Also, as we age Gal-3 naturally goes up, so MCP will help with maintenance. If you have any chronic illness, cardiovascular disease, cancer, hepatitis or elevated Gal-3 (over 15), then 15 grams a day is recommended.
Start a healthy cleanse this spring. It’s worth the investment!

References:
Dr. Eliaz, I. 3-Step Spring Detox Diet. Amazingwellnessmag.com. March 1 2017
Komen, S. Modified citrus pectin. Komen.org. 2014.
Desaulniers, V. How can modified citrus pectin halt cancer cell growth? Thetruthaboutcancer.com. June 9, 2016.
Natural Medicines Comprehensive Database 2013. Published by Therapeutic Research Faculty, Stockton CA.
Isaac Eliaz, MD, MS, L.AC., www.modifiedcitruspectin.org

It is not uncommon for me to see aspirin on the medication list of many of my older patients. It is most common with my well-controlled hypertensive or hyperlipidemia clients whom have no history of clinically evident cardiovascular (CV) disease. So when I ask them why they are on aspirin, the common reply is, “I read that it prevents heart attack and stroke so I started it on my own”, or “My husbands cardiologist suggested I take it after I took him in for a check up”. Two new studies in 2018 might shed some light on the subject.

In the ARRIVE trial, some 12,000 non-diabetic patients were randomized to 100mg of daily aspirin or placebo. Enrolled men were 55 years or older with 2 or more CV risk factors. Women in the study were at least 60 years old and had 3 or more CV risk factors. After a 5 year follow up aspirin had no CV benefit in reducing CV-related death, heart attack, unstable angina, stroke or transient ischemic events anymore than placebo. Those in the aspirin group had a slightly higher risk for gastrointestinal bleeding.

In the ASCEND trial, 15,000 middle aged or older diabetic patients were randomized to 100mg of aspirin daily or placebo. During average follow up of about 7 years, aspirin prevented 1 vascular event but caused 1 serious hemorrhage for every 100 treated patients.

So what does this mean…

Maybe we shouldn’t use aspirin as the magic prophylactic bullet for primary prevention that we once thought. Among diabetic patients, the trade off between a small benefit and harm are razor thin. And balancing one adverse event (CV event) against another adverse event (gastrointestinal bleed) is not straightforward. We cannot predict which of those outcomes would apply to any given patient. The other consideration is that a large proportion of patients in both studies were taking statins and antihypertensive drugs, and only a small proportion were current smokers. So you could conclude that these studies examined the incremental benefit of aspirin, added to other standard preventative treatments.

I like to individualize my healthcare with patients since outcomes in studies give us associations and not cause-and-effect results. One additional way to determine if a patient would benefit from aspirin is by performing a random urine test known as Aspirin Works. This measures 11-Dehydrothromboxane B2 in the urine which is produced from the breakdown of thromboxane A2. It is released by activated platelets (that cause our blood to clot) and urine levels can be used to monitor the response to aspirin therapy. This test may determine that you don’t need aspirin, or if on aspirin that your dose needs to be changed.

Ask your doctor or practitioner to perform this simple urine test to see if a daily aspirin would specifically benefit you.

Reference: Brett, A. Aspirin for primary prevention of cardiovascular events; JWatch.org, Oct 1, 2018, Vol. 38, No. 19.
NEJM JW Cardiol Oct 2018 and N Engl J Med 2018 Aug 26; [e-pub]

All medications have risks, whether they be a supplement or prescription drug. One example would be non-steroidal anti-inflammatory (NSAID) drugs such as Advil, Naproxen, Celebrex, or Diclofenac. Many people use these drugs long-term for menstrual cramps, headaches, aches and pains, arthritis or injuries. Long-term use can increase the risk for acute kidney injury or chronic kidney disease progression. They also raise the risk for cardiovascular events such as myocardial infarction (heart attack) and stroke. So it’s been suggested to avoid use of these medications for those with hypertension, heart failure or chronic kidney disease. This is difficult, especially for the elderly who typically have these health conditions but also need pain relief for treatment of osteoarthritis.

In a recent U.K. study, Diclofenac was associated with excess risk for myocardial infarction as opposed to Naproxen. Also, Ketorolac, another NSAID, can adversely affect kidney function more than other NSAIDs. Factor in dehydration, nausea, activity limitations especially after surgery, and acute kidney injury and you can see that the use of these meds can be a real danger.

With the opioid crisis in the forefront, nonnarcotic alternatives for pain control are in high demand. If you need to use an NSAID, there are some like Diclofenac that pose a higher risk for cardiovascular events and GI bleeding compared with other NSAIDs or Tylenol. There is little justification to use Diclofenac before trying other traditional NSAIDs. Better yet, it’s worth trying herbs such as Ginger, Curcumin and Boswellia (AKBA). Combining Boswellia’s activity with Curcumin and Tumeric can offer even higher levels of pain relief. CBD is also an amazing pain reliever if monitored well.
I always advocate plenty of fluids, avoiding food allergens and other inflammatory triggers and getting healthy sleep as the foundation for reducing pain and optimal wellness.

References: Dubreuil M et al. Risk of myocardial infarction with use of selected non-steroidal anti-inflammatory drugs in patients with spondyloarthritis and osteoarthritis. Ann Rheum Dis 2018 Aug; 77: 1137.
Schwenk, T. NSAID use in patients with hypertension, heart failure, or chronic kidney disease. Journal Watch 2018 Nov; Vol. 38 No. 22 p. 180.
Myers, C. Plants for pain relief. Health and Happiness 2019 Feb; p 12.

Here are the top 10 Health Breakthroughs of 2018:

10. Synthesized Antibiotics- There is a real concern regarding drug-resistant bacteria strains such as MRSA. Researchers in Britains University of Lincoln discovered a synthesized form of the antibiotic texiobactin that has already been used to treat infections in mice. The next step could be commercial drug use for humans to battle the growing epidemic of drug resistance.
9. Senescence Drugs- Some drugs are now being tested to kill old cells called “senolytics”. This will help extend our quality of life, not just our years.
8. Semiconductor technology- This can read the bodies vital signs on the skin. A thin plastic material laid over the skin can check heart rate, blood sugars and other readings that can be displayed on your Smart phone or sent directly to your medical professional.
7. CRISPR genome- Targeting the RNA of diseased cells has become more accurate and safe. Salk Institute scientists tested their technology against dementia which effectively restored healthy levels of proteins to the neurons affected by the disease.
6. Cancer vaccine. Human trials have been underway to treat patients with lymphoma which could present an all new treatment for the eradication of cancer.
5. Brain implants- A pacemaker for the human brain, or deep-brain stimulator, creates electrical impulses that could boost the memory of sufferers of epilepsy, Parkinson’s, and Alzheimer’s disease.
4. Ingestible Sensors: Track your gut health. This ingestible sensor developed by Australia’s RMIT University can measure the gases in your intestine that could help to diagnose gastrointestinal issues way before patients are symptomatic.
3. Cloning Monkeys- It’s been over 20 years since researchers cloned Dolly the sheep. Now China has cloned 2 monkeys which is the first time this technique has been used in primates. DNA was taken from fetal cells into eggs that had had their DNA removed, stimulated the eggs to develop embryos, and implanted them in female surrogates. Two female identical-twin long-tailed macaques’s were born. This could revolutionize research on disease.
2. Treating Muscular Dystrophy- Scientists corrected a gene mutation behind a form of muscular dystrophy in dogs. Duchenne muscular dystrophy is caused by a gene mutation that prevents the body from producing dystrophin, a protein required for strong muscle fibers. By using gene-editing technology we hope the same can be done in humans very soon.
1. Helping Paraplegics Walk- Having worked in the Neuro ICU treating para and quadriplegics, this is such a huge discovery! Researchers implanted tiny electrodes between patients’ vertebrae of paraplegics below the injury and delivered a weak electrical current to help amplify signals to the brain. After months of intensive physical therapy, one patient Jered Chinnock, could walk the length of a football field with assistance. “It feels,” he said, “like science fiction.”

Wishing all of you a Healthy and Joyful 2019!

References: The Week, December21/December 28, 2018. Pages 28-29.
Interesting Engineering.com. The 16 Most Remarkable Healthcare Innovations, April 7, 2018.

We are finding that “Age” is the most common risk factor for many diseases. So the older we get, the more likely we are to get heart disease, neurological conditions, diabetes and cancers. That puts us in a tough position. Of course we want to live a long life, but we want to do what we can to stay healthy and ideally avoid illness and disease.

So the question is, is aging a condition in itself that can be reset? Currently the oldest person on record is a French woman who died in 1997 at the age of 122! It is predicted that by 2040, Spain will have the longest-lived citizens reaching the average age of 86 years.

Scientists have used animal studies to better understand the cellular and molecular processes that cause the deteriorations of aging. There are 4 broad groups according to Tamara Tchkonia and Dr. James L. Kirkland of the Mayo Clinic. These groups include chronic inflammation, cell dysfunction, changes in stem cells that make them fail to regenerate disease, and cellular senescence, the accumulation in tissue of aging cells that accompanies disease.

Researchers have found that old cells secrete proteins, lipids and other substances that increase inflammation and cause destruction of tissues. Apparently, healthy young people have few of these aging cells, but after age 60, they begin to accumulate and their increasing quantity correlates with the disabilities of old age.

Could there be a remedy that removes these old cells while leaving young cells? Well, we’re getting closer.
In one study with mice, old cells were sensitive to a combination of 2 drugs; dasatinib, a cancer drug, and quercetin, a plant flavonoid. They improved cardiac function and exercise capacity in old mice delaying the symptoms of osteoporosis and prolonged healthy old age. I mean isn’t that what we all want?! Healthy quality years as we age.

Some drugs are now being tested to kill old cells called “senolytics”. For example a drug called Metformin which has been used for 60 years to treat diabetes has been shown to be effective against several age-related diseases. Maybe we can prevent a host of age-related diseases- cardiovascular, cancer, dementia- that can help us not only live longer but with fewer disabilities related to aging.

Of course healthy eating, exercise, inner and outer connection through friends, family, community, religion or spiritual practices are the foundation of health. But maybe certain medicines can optimize and prolong good health. There are trials underway in humans looking at drugs and nutrients that will tackle all of the difficult causes of aging to help extend our health span so we can live healthier in our older years.

NYT – How Long Can People Live?

Many of us have experienced that annoying buzzing sound known as tinnitus. It’s thought of as more of a symptom than as a diagnosis. It affects more than a million people worldwide and has been chronicled as far back as the first century AD. Only 20% of people with tinnitus seek treatment. That is most likely due to the fact that most tinnitus comes and goes and is tolerated to a degree in which we can function. Although in the United States, almost one third of patients who request treatment report symptoms that are debilitating.

Tinnitus is variable with the quality and loudness of the buzz, hiss or ringing that is often described. Prevalence increases with age, smoking, male gender and ethnicity, with the non-Latino white population statistically at greater risk. Some conditions such as diabetes and other autoimmune diseases are risk factors for tinnitus. A history of loud sound, which can be recreational (those crazy late night concerts!), occupational or environmental also can predispose a person to tinnitus.

The majority of tinnitus cases are considered Primary which is defined as having no identifiable cause. On the other hand, Secondary tinnitus has an identifiable cause which can include a long list of conditions such as certain medications (NSAIDS, chemotherapy, antibiotics), inner and outer ear disturbances, neurological and vascular causes, infections and nutrient deficiencies. Persistent tinnitus (lasting more than 6 months) can impact ones quality of life and can lead to depression, anxiety, insomnia and neurocognitive decline. It can really be devastating!

The cause of tinnitus is alittle more complicated than we once thought. It is not simply a cochlear (inner ear) phenomenon. It has to do with the damaged stereocilia (inner ear organelles of hair cells) located in the cochlea that exhibit an increase in a spontaneous firing rate in response to lost frequencies which are relayed to higher structures in the brain. It appears to be a maladaptive neural plasticity as it results in increased spontaneous firing rates and synchrony among neurons in central auditory structures, according to research by Shore and colleagues (Shore, SE, Roberts LE, Langgguth B. Maladaptive plasticity in tinnitus- triggers, mechanisms and treatment. Nat Rev Neurol. 2016;12(3):150-160.

So, what to do?
First, lab testing should be done to rule out causes of tinnitus. Imaging is usually unnecessary unless one questions a tumor or vascular cause. When no underlying pathology is identified for tinnitus, then a patient should be sent for a full audiology evaluation. Management involves treatment of perceived loudness and treatment of comorbid symptoms such as depression, anxiety, sleep disturbance, etc.
The leading recommendation made by The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) is cognitive behavioral therapy (CBT). The sound cannot be eliminated but the patient’s response to the sound can be modified. Tinnitus Retraining therapy (TRT) is another form of habituation therapy that has been successful. Unlike CBT, which is the idea that behaviors are modifiable thoughts that can be changed by teaching coping mechanisms such as relaxation, TRT aims to eliminate the perception of sound. A patient wears a device similar to hearing aids using broadband noise that closes the gap between silence and the perception of tinnitus. This device is worn for 6 hours a day for 12 months.

Other alternative non-medical therapies include Chinese herbal medications such as Ginko biloba, vitamins, zinc, manganese, and melatonin. Cannabinoids, which is a plant that contains hundreds of chemicals that each act differently on the brain may have an inhibitory effect on neurotransmitter release. Other modalities such as yoga, meditation, physical therapy and mindfulness have helped patients feel more relaxed but they had no effect on the severity of tinnitus.

Of course prevention cannot be underestimated. Occupational noise and recreational use of music devices put people at heightened risk for hearing loss and tinnitus. If you are suffering from tinnitus, see a practitioner for evaluation to help your symptoms.

Reference: Gillian Ross, W, Danielsen, R. What’s the Buzz? Treatment Strategies in Chronic Subjective Tinnitus. Clinician Reviews. September/October 2018/Vol 28,NO 10. p. 34-41.