Author Archives: ewperttulamd

Erectile Dysfunction a Risk Factor for Dementia

June 10-16th is designated Men’s Health Week, and in addition June is Alzheimer’s and Brain Awareness Month. Today’s post will look at research regarding dementia and erectile dysfunction (ED).

ED is a common medical problem, particularly in aging males. The Massachusetts Male Aging Study showed about 40% of males are affected at age 40, while nearly 70% are affected by age 70. Data from the National Health and Nutrition Evaluation Survey (NHANES) showed that over 18% of males age 20 and older were afflicted with ED.

A research group based in Taiwan performed a retrospective cohort study on a population of  Asian men. There were two groups, the first group were men who had recently been diagnosed with ED. The second group, or control group, were matched samples, without ED. There were over 4,000 subjects in the ED group, and nearly 21,000 subjects in the control (non-ED) group. Other health issues such as anxiety, chronic kidney disease, coronary heart disease, depression, diabetes mellitus, hyperlipidemia, hypertension, hypothyroidism and stroke were tracked. The subjects were followed over a 7 year period.

After the 7 year follow-up period what the researchers found was astounding- the subjects with ED were 1.68 times more likely to develop dementia than the non-ED (control) group.

The researchers also discovered that the subjects with anxiety, chronic kidney disease, depression, diabetes mellitus, hypertension and stroke were 1.48 times more likely to develop dementia.

This study, published in 2015, was the first population based study to examine the risk of developing dementia among men with ED. While the study population was Asian men, there is reason to believe that the results would similarly apply to non-Asian populations.

There are several possible mechanisms for the association between ED and dementia. One possible factor is damage to the endothelial layer, which lines the blood vessels. Damage to this crucial layer is associated with coronary heart disease, diabetes, and hypertension. A pro-inflammatory state is seen to be a factor in endothelial damage.

This is an important research paper, and should been seen as a distant early warning of sorts. Given the inability of the currently available medicines to reverse dementia, a more preventative strategy should be considered. Men with ED, particularly at younger ages, should consider what health changes they can make to lower their future risk for dementia later in life.

“Lay hold of today’s task, and you will not need to depend so much upon tomorrow’s. While we are postponing, life speeds by.”–  Seneca

(Source- Medicine, Volume 94, Number 24, June 2015)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

Acupuncture for Sexual Dysfunction

June 10-16th is designated Men’s Health Week, and so our posts this week will address men’s health issues. Today’s post will examine the use of acupuncture for sexual dysfunction, in both men and women.

Anti-depressant medication use is common, and sexual dysfunction rates may be as high as 50-90% with some of these medications. The results of a study may offer hope to those who suffer sexual side effects from commonly prescribed anti-depressant medications.

This research was conducted in Toronto, Canada. 35 subjects enrolled in the study, both men and women. Participants were referred into the study after complaining of sexual side effects from anti-depressant medications. After enrolling in the study, each subject received twelve acupuncture visits, following a fixed acupuncture treatment protocol. Subjects completed a self assessment of sexual functioning, as well as an assessment of anxiety and depression, throughout the study. There a was also a follow up visit one month after the treatment protocol was completed.

Results of the study showed significant improvement in symptoms, particularly among males. Males were also more likely to have decreases in anxiety and depression while receiving acupuncture treatment.

Interestingly, the self reported symptom severity scores one month after completion of the acupuncture treatment were similar to those at completion of the acupuncture treatment, indicating that perhaps acupuncture treatment is able to produce some longer lasting improvements in sexual function.

As with most acupuncture studies, the number of reported adverse reactions to acupuncture treatment is very low. In general the vast majority of patient’s treated with acupuncture find it a well tolerated therapy. Given how frequent sexual side effects are with commonly prescribed anti-depressant medications, perhaps consider acupuncture as a way to help with this, in both men and women.

“Prevention is better than cure.” – Desiderius Erasmus

(Source- Journal of Alternative and Complementary Medicine, Volume 19, Number 11, 2013)

This blog is a review of published medical and health literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

Vitamin D and Erectile Dysfunction

June 10-16 is designated Men’s Health Week, and so several posts this week will address men’s health concerns. Today’s post will examine vitamin D and it’s potential association with erectile dysfunction (ED).

Data from the CDC indicate that approximately 25% of Americans are at risk for vitamin D inadequacy, while 8% are at risk for deficiency. Data from the National Health and Nutrition Examination Study (NHANES)  shows over 41% to be vitamin D deficient in their sample of nearly 4500 adults, with African-Americans and Hispanics generally having worse levels of vitamin D deficiency.

Original research from Italy shows a higher prevalence of vitamin D deficiency in a group of men with vascular ED, compared to men without vascular ED. 143 men were enrolled from a hormone clinic in Milan, Italy. The participants were divided into vascular ED, non-vascular ED, and borderline ED groups, based on penile doppler results. These groups were then compared based on various lab tests, including Vitamin D, lipids, and testosterone levels, among others.

The results showed a higher prevalence of vitamin D deficiency in the men with vascular ED, compared to men with non-vascular ED. Vitamin D levels were also lower in the men with more severe ED.

It is believed that normal vitamin D levels are important to healthy functioning of the endothelium, which lines the blood vessels. The results of this study indicate that low vitamin D levels are a potentially modifiable risk factor for ED of a vascular cause. If you are developing ED, you may want to get your vitamin D level checked.

“You take the healthiest diet in the world, if you gave those people vitamins, they would be twice as healthy. So vitamins are valuable”–  Robert Atkins MD

(Source- Journal of Sexual Medicine 2014;11)

This blog is a review of published and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone.

 

Acupuncture May Offer Hope for Alzheimer’s

June is Alzheimer’s and Brain Awareness Month. Today’s post will review a study of using acupuncture for mild to moderate Alzheimer’s disease (AD).

Alzheimer’s Disease is the most common form of dementia, and is a degenerative brain disease. It is estimated that nearly 6 million Americans have AD. According to the CDC it is the 5th most common cause of death among adults age 65 and older. Early symptoms of Alzheimer’s Disease include mild memory loss, and may progress to changes in mood and behavior, and difficulty with performing familiar tasks. The annual costs of AD are estimated to be $200 billion. Age is the most important risk factor for AD. Unfortunately, at this time there are no effective medical treatments to stop or reverse AD.

A research group in China performed a randomized trial, comparing the efficacy and safety of acupuncture to the medication donepezil (brand name Aricept) in a group of subjects diagnosed with mild to moderate AD. Subjects were aged 50 to 85 years. 43 individuals were assigned to the acupuncture group, while 44 were assigned to the donezepil group.

The study itself last 28 weeks- a 4 week baseline period, a 12 week treatment period, and a 12 week follow-up period. The acupuncture group received three treatments each week, lasting about 30 minutes each. The treatments were provided by 9 experienced acupuncturists, who individualized treatments to each respective subject.

There were two primary outcome measures, the ADAS-cog and the CIBIC-Plus. The ADAS-cog consists of 11 tasks to measure the symptoms of AD. The CIBIC-Plus on the other hand is a comprehensive global assessment of change in behavior, cognition and function, and requires separate interviews with the caregivers as well as the patients.

The results of the study demonstrated that acupuncture improved the participants score on the ADAS-cog and CIBIC-Plus, indicating improvement in cognitive function and global clinical status.

It is interesting that the study design used a known pharmaceutical treatment (donepezil) as the comparator group to acupuncture, rather than using sham (fake) acupuncture. There is evidence from many studies that sham acupuncture is not a true placebo, and often studies that use sham acupuncture show an elevated placebo response. It is also important to note that no one withdrew from the study due to an adverse side effect from acupuncture, which again points to the safety of this treatment.

A diagnosis of Alzheimer’s Dementia can be devastating to a patient, and in some ways even more so to the patient’s caregivers, which are often family members. Given the results of this study perhaps acupuncture should be given some consideration as a additional treatment for this overwhelming disease.

“I know for certain that we never lose the people we love, even to death. They continue to participate in every act, thought and decision we make. Their love leaves an indelible imprint in our memories. We find comfort in knowing our lives have been enriched by sharing their love.”– Leo Buscaglia

(Source- BMC Complementary and Alternative Medicine (2017) 17:556)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Not Even One

May 31st is World No Tobacco Day, and today’s post will examine a study on the effects of cigarette smoking and risks of coronary heart disease and stroke.

Most folks are well aware of the adverse risks of smoking to health. The first Surgeon General’s Advisory Committee on Smoking and Health report was released in January of 1964. The committee had reviewed more than 7,000 articles related to smoking and disease, available in the medical literature at that time. The committee concluded that cigarette smoking was a cause of lung and laryngeal cancer in men, and a likely cause of lung cancer in women.

The percentage of American’s who smoke has dropped from roughly 42% of the population in 1964, to about 14% today. While these statistics are encouraging, tobacco use still accounts for about half a million deaths in the U.S. each year, and about five million death worldwide.

While most people agree on the health risks of cigarettes, what would be the risk of just one cigarette a day? Certainly the risk couldn’t be too high?

A research group from the UK set out to answer this same question. They performed a meta-analysis and systematic review of published studies from 1946 to 2015, eventually including 141 cohort studies. The researchers looked specifically at the risks of smoking on coronary heart disease and stroke.

When their analysis was completed, the results were astounding. For men, the relative risk of smoking a pack a day (20 cigarettes) on coronary heart disease was 2.04, while smoking only one cigarette a day still carried a 1.48 relative risk. So men who smoked only one cigarette a day still had 46% of the excess risk of those who smoked a full pack per day. The data for stroke was not much better, the relative risk for smoking 20 cigarettes daily was 1.64, while smoking only one cigarette a day still carried a 1.25 relative risk, which was 41% of the excess relative risk of those who smoked a pack a day.

The data for women is equally as grim. The relative risk for coronary heart disease in women who smoke a pack per day is 2.84, while one cigarette per day still has a relative risk of 1.57. So even just one cigarette has 31% of the excess risk of a full pack per day.

The data for women smokers relative to stroke are equally poor. For women who smoke a pack per day, the relative risk for stroke is 2.16, while one cigarette per day still yields a 1.31 relative risk. This means that the one cigarette per day female smoker still carries 34% of the excess risk of a full pack per day smoker, for stroke.

The 141 cohort studies included literally millions of subjects, a broad cross-section of the US population, and would seem applicable to the US population in general. It is crystal clear from these results that even one cigarette per day carries substantial risks, in this case increased risk of coronary heart disease and stroke, in both men and women.

“There is no safe dose of a carcinogen.”–  Rachel Carson

(Source- BMJ 2018:360:j3984)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

 

Acupuncture for Hypertension

May is National High Blood Pressure Education Month. Today’s post will review research on the use of acupuncture to lower blood pressure.

Hypertension is a significant health issue. Statistics from the CDC indicate that one third of American adults have hypertension, and another third fall into the pre-hypertension range. The costs of hypertension are estimated to be $50 billion annually.

A research group from China examined the possible benefits of acupuncture on hypertension. A meta-analysis was performed encompassing 23 different random controlled studies, with nearly 1800 subjects included in their analysis. Countries such as China, Germany, South Korea and the U.S. were included. Most participants had either mild, or mild to moderate hypertension.

After reviewing the data from this collection of 23 random controlled trials the study authors concluded that acupuncture when added to the existing anti-hypertensive medicine had a significant beneficial effect on lowering both systolic and diastolic blood pressure, when compared to sham (fake) acupuncture plus medicine. Acupuncture therefore showed a beneficial effect when used as an add-on treatment to standard pharmaceutical anti-hypertensive therapy.

Acupuncture has been shown to be a safe treatment, with infrequent side effects. This meta-analysis shows promise for adding on acupuncture treatments to existing anti-hypertension medications to yield additional blood pressure relief.

“First, modify the patient’s diet and lifestyle and only then, if these do not effect a cure, treat with medicinals and acupuncture.”-  Sun Simiao

(Source- PLOS ONE, July 24, 2015)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone.

 

Lose Weight and Eat More Fiber to Lower Blood Pressure

May is designated as National High Blood Pressure Education Month, and so today’s post focuses on blood pressure, and how it may be improved via two different lifestyle and dietary modifications.

According to statistics from the CDC, about 75 million Americans have hypertension, which is about one in three adults. Only about have of those with hypertension have it under control. The costs associated with high blood pressure are estimated at $50 billion each year. African-Americans are particularly at risk for hypertension, with about 46% afflicted.

First of all a meta-analysis from researchers in the Netherlands looked at 25 different random controlled trials including over 4800 subjects, examining the effect of weight loss on blood pressure. After pooling the data from these 25 studies, it was determined that a 5 kg weight loss (= 11 pounds) yielded an average 4.4 mm Hg drop in systolic blood pressure, and a 3.6 mm Hg drop in diastolic blood pressure. Weight loss was achieved by physical exercise, calorie restriction, or a combination of both. Larger blood pressure decreases were noted in those subjects who were already taking medicine for high blood pressure.

In addition to weight loss having a beneficial effect on blood pressure, it appears dietary fiber also has benefit. Researchers from Tulane University pooled data from 25 different studies, to examine the effects of dietary fiber on blood pressure. Nearly 1500 subjects were evaluated, with trials from the U.S., Canada, Europe, Australia and India included. The overall effect of dietary fiber on blood pressure was a 1.15 mm Hg drop in systolic blood pressure, and a 1.65 mm Hg drop in diastolic blood pressure. The drops in blood pressure were more significant in those patients with hypertension, with trials greater than or equal to eight weeks in duration, and in trials with fiber intake of 7.2-18.9 gm/day.

Therefore weight reduction and increased dietary fiber intake may be effective ways to help lower blood pressure, particularly in those who are currently diagnosed and being treated for hypertension. While certainly not a replacement for traditional hypertension therapy, losing weight and increasing fiber intake seem like simple lifestyle changes that could yield important benefits.

“One way to get high blood pressure is to go mountain climbing over molehills.”–  Earl Wilson

(Source- Journal of Hypertension, 2005, Vol 23 No. 3.  Hypertension, November 2003)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Physical Activity Lowers Women’s Heart RIsks

This week is National Women’s Health Week, and in recognition of this important week today’s post will look at a study in older women, examining the effect of physical activity on coronary heart disease.

A research group performed a prospective cohort study from subjects participating in the Women’s Health Initiative. Nearly 6000 women with an average age of 78 1/2 were enrolled, and were followed for up to five years. These were women without a history of heart attack or stroke.

The activity level of the women was measured by the use of a accelerometer that was worn on the right hip. This device is designed to capture measures of subject activity and mobility. Researchers found that light physical activity was associated with a dose-responsive reduced risk of cardiovascular disease and coronary heart disease in this cohort of older women. The results were considered to be statistically significant.

The group with the highest quartile of light physical activity was associated with a 42% reduced risk of heart attack or coronary death, compared to the group with the lowest quartile of light physical activity. Similarly, there was a 22% reduced risk of cardiovascular events in the highest quartile of light physical activity, compared to the lowest quartile of light physical activity group.

This was a well-designed study among a group of older women, a group that is often neglected in medical research. This was also a diverse population, including substantial numbers of black (33.5%) and Hispanic (17.6%) women. It is impressive that encouraging more activity, even of the “light” variety, yielded some very substantial results.

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.”– Hippocrates

(Source- JAMA Network Open, 2019, 2(3))

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Mediterranean Diet Good for Women’s Heart Health

May 12-18 is celebrated as National Women’s Health Week, and in recognition of this important week today’s post will examine research studying the effects of a Mediterranean-style diet on cardiovascular risk factors in women.

For those who are unfamiliar with the Mediterranean Diet, it is loosely based on the traditional cooking styles of those countries that border the Mediterranean Sea. Some of the important tenants of the diet include eating lots of vegetables and whole grains, using olive oil as a substitute for butter and margarine, eating more fish and less red meat, and choosing nuts as a healthy snack.

In a recently published paper, researchers affiliated with Harvard Medical School examined the effects of a Mediterranean-style diet upon cardiovascular risk factors in a group of women participants. This particular study involved nearly 26,000 women. To assess the women’s dietary habits, a food-frequency questionnaire which included 131 items was administered at enrollment in the study. The researchers then calculated what they termed the “Med Score” for each participant. The Med Score ranged in scale from 0 to 9, with a higher score indicating better adherence to the Mediterranean Diet. The subjects were then placed into three different categories (Low, Medium, High) based on their Med Score. Multiple lab markers were taken as well, including LDL, HDL, CRP, fibrinogen, and lipoprotein (a).

This group of women was then followed for about 12 years. They were monitored for cardiovascular events such as heart attack and stroke. The researchers discovered that the subjects in both the Medium Med Score group and the High Med Score group had significant cardiovascular risk reduction, compared to the Low Med Score group. The risk reduction was 28% in the High Med Score group, and 23% reduction in the Medium Med Score group, compared to the Low Med Score Group.

This is a very well done study, which adds to previous research on the benefits of the Mediterranean Diet. This is a large group of women, who were considered healthy at baseline, which is important to note. Here we have a relatively simple dietary modification that had a profound positive impact on women’s cardiovascular health. The Mediterranean Diet seems to be a low-risk diet, that is worthy of consideration by women, and men as well.

“No disease that can be treated by diet should be treated with any other means.”– Moses Maimonides

(Source- JAMA Network Open, 2018:1(8))

This bog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

Massage Therapy Helps Children with Asthma

Today is World Asthma Day, and today’s post will examine the use of massage to help asthma symptoms in children.

According to data from the CDC, asthma is the most common chronic disease among American children, afflicting over 6 million children. Asthma is the third leading cause of hospital admissions among children 15 and younger. It is also a leading cause of school absenteeism.

In China, a number of traditional therapies such as acupuncture are used to help with asthma. Another traditional therapy is massage. A group of researchers in Shanghai China performed a review and meta-analysis of the published research on asthma and massage therapy. They included 14 studies totaling 1300 subjects in their analysis.

The researchers concluded that massage therapy significantly improved the efficacy of asthma treatments in children, and also showed improved in pulmonary function measures.

Similar to the post yesterday regarding adding acupuncture to a conventional asthma regimen, consideration of what appears to be a safe and potentially effective treatment in massage seems reasonable in those already being treated for asthma.

“Anyone wishing to study medicine must master the art of massage”– Hippocrates

(Source- Evidence-Based Complementary and Alternative Medicine, Volume 2017)

This blog is a review of published medical and scientific literature, and should only be used for informational purposed. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.