Wednesday, December 22, 2010

Blog #23 Men with Rashes Continues....

Returning to Alan’s skin of many irritations, I thought briefly about all the possible causes of rashes. In the almost 30 years I have been a nutrition detective, I have seen rashes caused by all manner of substances.

Here is a list of the ones I can remember:

• Food reactions to chicken, eggs, olive oil, nuts, fish, grains (especially wheat and sometimes rice), potatoes, seeds, most fruits, a few vegetables….any food can do it but vegetables and lamb react the least.

• Medicines especially anti-depressants, mood stabilizers, anti-seizure meds and antibiotics.

• Bad stuff added to foods including preservatives, additives, colors, pesticides and genetically modified organisms (GMOs) which is actually bacteria DNA spliced in to food.

• Contact rashes from creams, sun screen, soap, bubble bath, shampoo, dryer sheets, laundry detergent, pollen, swimming pool water, leaves, wool, animals (all sorts including a guinea pig).

• Molds (either outdoor varieties or from a sick house).

• Yeast problems.

• Touching water (true story). This was probably from the chlorine in tap water.

• Mites and other bug bite reactions.

• Essential fatty deficiency.

The list is long and basically includes almost anything you can think of but I had ten minutes to make a good guess. Most people can figure out topical contact irritants on their own unless it is something in the environment like pollen or mold. Once I saw a child with extensive eczema. The referring doctor and I tried all sorts of elimination diets and environmental changes but nothing helped. Finally, the family went to Italy for a month and the child’s skin completely cleared up. We then realized (through an additional process of elimination) that the problem was likely an environmental mold though we never knew exactly which one. Allergy testing also could not pinpoint it. Wouldn’t it be nice if your doctor recommended an extended European vacation for unresponsive eczema? Besides his wife had worked that angle pretty hard by eliminating the usual suspects without success. So, I ruled out topical culprits and circled in on the diet and family history.

If a food is causing such a complex ongoing rash it would have to be one that is commonly consumed. It cannot be mangos or pork chops because people do not eat enough of them through out the year to cause this much skin trouble. The number one frequently eaten food irritant responsible for bizarre, extensive rashes is gluten. I already knew his son was doing better off gluten. That made it very easy to ask the father to go on the same diet. For good measure, I added some supplemental fish oils to deal with the papules (or chicken skin) which are often a sign of essential fat deficiency. Those two steps are straight forward and will probably help. He readily agreed because he confessed after I suggested a gluten-free diet that eating too much bread gave him gas anyway.

You may be thinking, “oh come on!” After you go through all of this he admits that he thinks gluten bothers him. The answer was sooooo obvious all along. Why didn’t he figure out gluten was bothering him if his son could not tolerate it and he got gas when he ate it? Why most of us miss the obvious things about ourselves is one mystery I cannot figure out.

Tuesday, December 14, 2010

Blog #22 An Afternoon at a Different Conference

I decided I needed to understand hormones better, being menopausal and all. Getting good information on natural hormone replacement is much harder than you would think and as a result, I found myself on a plane to Las Vegas heading for the American Academy of Anti-Aging Medicine (A4M) conference.

Las Vegas, I discovered is not for anyone suffering from sensory processing disorder or a low tolerance to cigarette smoke. The hotels are designed so you have to walk through miles of underground casinos to get anywhere, including the registration desk or conference center. Casinos appear to be the only indoor facilities left in the country where cigarette smoking is not only allowed but possibly necessary so the calming effect of nicotine can help people deal with the stress of losing their nest eggs to computerized slot machines. “Gee, what are the chances of winning against a computer that sets the odds and makes up the rules?” I commented to my roommate, Victoria.

She informed me that I was missing the point and that it was all about the dopamine rush. Given the crowds, I would have to say she was right and I should probably learn more about dopamine since it is clearly popular. I made some mental adjustments to accommodate the environment and enjoy the conference.

For the next three days I immersed myself along with 4000 other physicians and practitioners in the latest research on maintaining/regaining vitality with aging. One speaker summed up the challenges of getting older with the Phillip Roth quote, “Aging isn’t a battle, it’s a massacre”. While it can certainly feel and look like that, there are many strategies people can use to manage the ravishes of time more effectively.

The hardest thing about an intensive conference, beyond the sitting, is information overload. Luckily, for me, I have a solid background and very specific questions I wanted answered which made the potential overwhelm manageable. There was so much generally interesting information that I compiled a list of the more fascinating little pearls.

So, here are:
The Top Ten Fascinating Facts and Observations Gleaned from the Anti-Aging Conference

1. Low testosterone is a common problem in aging men and reduces quality of life. The symptoms are low vitality (fatigue), passivity, low sex drive, weak erections, declining muscle tone and general grumpiness. It is also associated with increased mortality, cancer levels and heart disease. This condition is easy to diagnose and correct though it is generally considered to be vague and hard to treat.

2. Giving testosterone to men with low testosterone levels has never been proven to increase prostate cancer risk. The only time giving testosterone appears to feed prostate tumors is when a man’s testosterone level is extremely low (that is, at castration level which is very, very low).

Harvard urologist Abraham Morgentaler addressed this in great detail and prescribes testosterone even to men who have/had prostate cancer. In general, their PSA levels go down and their cancer growth is generally slower! He presented gobs of research. It took him 45 minutes to explain why there has been such general misunderstanding of the relationship between testosterone and cancer. For more info see his popular book: Testosterone for Life.

3. If you want to slow the aging and deterioration process, balance your hormones. Balanced hormones reduce the inflammation process and inflammation is associated with deterioration and most diseases.

4. Maintaining ideal weight is the best way to reduce inflammation, assuming you are doing this with a balanced diet. The short explanation is that gaining weight increases inflammation. Something about adiponectin inhibiting TNF-alpha (an inflammation marker that can now be measured in the blood) and dozens of other pathways that get thrown off as you put on the extra pounds. There were at least ten sessions on obesity and why it is bad for you. One presenter claimed Type 2 diabetes (usually from obesity) is now being called type 3 Alzheimer’s Disease.

5. Vitamin B-12 shots tied with correcting stomach issues can significantly reduce asthma attacks in adults and children. The theory is that most people with asthma have low stomach acid and absorption issues. When you think about it, the stomach and lungs and sinuses are all connected through a series of tubes. Something that affects one of them can bother the rest.

In children who are allergic or reactive to dairy products, a single exposure to milk can measurably reduce nutrient absorption capacity leading to low hydrochloric acid which causes vitamin B12 deficiency. Giving B-12 in a way that bypasses the stomach may help.

6. Synthetic progesterone (called progestins) does not have the diuretic and other beneficial properties of natural progesterone. Progestins also have more androgenic (testosterone) and pro-inflammation properties though they still appear to protect against uterine cancer. Increased inflammation leads to increased crankiness and headaches both of which are common side effects of the progestins.

7. Bioindentical hormones are well studied, especially in Europe. They are chemically and functionally completely different from the horse estrogen (Premarin) and synthetic estrogens given to most women seeking hormone replacement therapy. Studies have found the risk to breast cancer is significantly different depending on the estrogen being used. Estriol (found in bioidentical hormones) reduces breast cancer risk while high levels of estrones (found in synthetic estrogens) increase it.

8. Growth hormone treatment does not increase cancer risk. One study followed children treated for brain cancer who were later given growth hormone. The recurrence rate of cancer actually went down! This research was a pleasant surprise to hear and there was a lot of it. Once the presenter explained the biological link between growth hormone and immune function it made me wonder why so many people have been worried about growth hormone and cancer. (Probably because many of the early studies involved pouring growth hormone on a tumor in a dish and watching what happened.)

9. Hormone imbalances of all sorts contribute to the susceptibility to cancer. Higher cancer risk (in separate research presented over the course of the conference) was associated with low estriol, low testosterone, low oxytocin, low melatonin, low progesterone, low thyroid and low growth hormone. It does not take a rocket scientist to see the pattern there.

10. Information backed up with research is always sited as the thing practitioners most desire but nonetheless, the most popular speaker was Suzanne Somers. She was described as the most exciting event of the conference. She spoke about her personal experiences and quite the inspirational speaker. I developed a deeper appreciation for how much she has contributed to increasing awareness about alternative medicine. At 64, Somers is a walking testimonial to the wonders of bioidentical hormone replacement, alternative cancer treatment and plastic surgery though that last one was discreetly unmentioned.

In truth, there was nothing alternative about the research presented at this conference with the possible exception of the “aesthetic” courses. There was a whole tract, which I did not attend involving a bunch of frightening looking laser machines and Star Trek inspired apparatus for filing, zapping, exfoliating and otherwise revitalizing the skin and muscles. I did get a sample of the $250 a jar resveratrol rejuvenation cream. While I admit the claims are hard to swallow, wouldn’t it be nice if looking younger was as easy as putting on some really expensive cream?

Monday, December 6, 2010

Blog #21 Men with Rashes

If statistics are to be believed, men as a group, prefer to avoid doctors and perhaps more generally all of us in medically related fields. This has certainly also been my experience. A few times a year a man (or if the truth be told, a woman) will come in to see me just so I can look over what he is eating and taking to be sure he is up to date and doing the best for himself. I often catch myself looking at these people adoringly thinking this is so wonderful. They are taking care of themselves and being proactive. How rare. How inspirational. Prevention is so much more fun then disaster relief.

Sadly, most of us do not operate this way, especially those of the male persuasion. There was a book about this written a number of years ago by a physician’s wife. She relayed the story of how she had to force her husband, who was a cardiologist to go to the hospital because it was clear to her that he was having a heart attack. “I am fine,” he argued. But she was correct.

According to my husband, a self appointed expert on all guy things, being male and all, this attitude is completely understandable. “Men do not like to be seen as weak,” he explained as if it was patently obvious. “They will put up with a lot to keep up the appearance of strength.”

“How do they feel about dead?” I asked innocently at which point he suddenly developed an acute hearing problem.

Over the years I have noticed that most men come to see me for one of three reasons. First, and most popular, they are dragged kicking and screaming by a concerned loved one. Second, they have big complicated situations that have gotten so out of hand even they realize they have to do something. And my personal favorite, they come in with someone else and three minutes before the end of the session they want to know if they ask a “quick” question, really it is just a little thing they assure me. Is there anything they can do about the diarrhea they have had for the last ten years or this rash that covers their whole body and has confounded a gaggle of dermatologists?

You think I am exaggerating but this last situation happened recently. Alan came in with his wife who was the designated patient. I thought I was being clever and a full ten minutes before the end of the session, I anticipated there might be an issue and inquired if I could ask the gentleman a question. “Sure,” Alan replied.

“What are you doing about that rash?” I asked.

“Which one?” his wife cut in. “Lift up your shirt and show her, honey,” she cajoled apparently very happy that I had opened the subject.

I am not a dermatologist, but could see at least three different types of rashes. “If this was not so clearly irritating to you, “ I commented, “this would be fascinating. Look there is a ring worm,” I said pointing to a perfectly round red circle with a clear center. And there were hundreds, possibly thousands of little papules. “I wonder what they are from?” I mumbled thinking out loud. “These rough spots look like essential fatty acid deficiency,” I remarked pointing to several sand paper areas. “Though I bet that was diagnosed as keratosis pilaris.”

Keratosis pilaris (“chicken skin”) was indeed one of many diagnoses he had received over the years. Apparently, the numerous dermatologists and specialists he had consulted through the years were no longer fascinated and had given up on trying to unravel the situation, as had he.

Luckily, I am not a doctor and this allows me the freedom to take chances and say things that otherwise I would have to keep to myself to maintain decorum. “You must be miserable,” I blurted out. Alan responded with a shrug. “We have to do something about this,” I continued as if he had not been trying to fix the situation for years.

I assumed he had been tested for allergies. Alan confirmed he had and nothing significant had been found. I next asked if he ever found anything that had made it better or worse. His skin was obviously sensitive and his wife was careful with soaps and detergents she bought. Unfortunately, while some products used topically could make him worse, nothing he avoided in particular made him better. He had tried great numbers of ointments and salves through the years but nothing corrected the problem. Presently, he used moisturizers when he remembered or was particularly dry.

Since there were no clues in his dermatology history, I started asking about other symptoms (that might be related) and reviewed his children's medical histories. The original person I saw in his family was his son and he turned out to hold the answer to the mystery. To be continued……