The Commonwealth Fund report on health care in industrialized nations came out June 17th 2014. It again ranks the USA dead last. All other nations spend an average of $3,406 per patient per year. The US spends $8,508; yet, we have much less to show for. Why is this? If you recall the Journal of the American Association has reported that our health care system only addresses 10% of the issues that impact our health. The other 90% is more or less covered-with mixed results- in newsletters such as this one. Essentially, the 90 % is about lifestyle, diet, environmental exposures, and relationships.
We cope with these poor outcomes with band aid solutions, such as the ACA, aka Obamacare. In my opinion, we are buying into a broken system. It is better than nothing, which is what doctors recently wrote in the New England J. of Medicine. They comment on the upcoming Medicaid requirement that patients pay copayments at the time of their visits:
“If this sort of flexibility encourages more states to expand Medicaid, most low-income adults will be better off for the effort — since some cost sharing is almost certainly preferable to being left without any coverage at all.”
In my opinion, big corporations, seeing their health premiums go up quarterly, and being quite adept at maximizing profits, have adopted THE best way to address health care issues: they teach their employees-and incentivize them with rewards-to eat better, manage stress and exercise more. Pepsi Cola, as much as I dislike their products, is one of the leading corporations saving millions in this manner.
ACA will demand that physicians comply with strict protocols based on pharmaceutical prescribing. This is a mistake: “Guidelines should inform but not dictate, guide but not enforce, and support but not restrict.” Then, a doctor like me would be free to first try a diet for six months before prescribing a statin drug to lower cholesterol, as the American Heart Association has famously recommended. Simple interventions like decreasing red meat intake and increasing fish consumption can improve our vascular systems; fewer strokes are seen with such a change.
In the future, prevention and diet are predicted to be the most effective ways to manage cardiovascular disease. Not a bad idea, considering that pharmaceuticals are often found to be ineffective after they have been out for a few years. The latest casualty is Ezetimibe prescribed to lower cholesterol.
Ulcers “bugging you?” How about obesity?
I will never forget two physicians chatting within ear range at a conference: “Do you remember when we used to think that ulcers were caused by stress?” Back then doctors were stunned to discover that the bacteria H. Pilory, present in the stomach of ninety percent of us, was responsible for the inflammation that characterizes an ulcer. This concept went on to win a Nobel Prize for the good doctor who, in frustration that he was not deemed credible, ate high amounts of H. Pilory and thus gave himself an ulcer.
As much as this bacteria IS indeed associated with ulcers, there are some bothersome problems with this hypothesis. Number one, why is it that only four percent of people get ulcers? Remember that ninety percent of us have it in the intestines. Number two. Why do we pick on ONE organism when the gut is teeming with a microbiome comprised of thousands of species? Would it not make more sense to think of an overall imbalance therein which predisposes H. Pilory to become a source of inflammation? Number three, by restoring the ability of the gut mucosa, the lining of the stomach, to “molt” as God intended, that is, every thirty six hours, we would decrease the chances of this bacteria invading the deeper layers of said lining, thus avoiding the ulcer. In other words, “It is not the bug but the terrain.”
But, the main problem with going after H. Pilory with antibiotics and not trying to optimize antioxidating and ant- inflammatory functions of the wall of the stomach, is an imbalance of the gut microbiome; in other words, the antibiotics used against it are disrupting that gut ecosystem, which, time and time again, is being shown to be critical to maintain health. Antibiotic therapy for H. Pilory has long been associated with esophageal cancer. Apparently the H. Pilory has a protective effect there. And now, another problem is being associated with the eradication of these ubiquitous bacteria:
“The decline in Helicobacter pylori infection in the Western world over the past few decades may be at least partly responsible for the increased prevalence of obesity.”
As noted ad nauseum in this newsletter, our gut flora, among many other functions, determines how we manage the food we eat. You and I could eat the same amount of calories, but, if I am colonized with bacteria that do not process food effectively, I may become obese despite ingesting the same amount of calories. So much for “calories in calories out.”
And how do you optimize gut flora? A diet high in fruits and vegetables, avoid antibiotics and acid-blocking drugs and take probiotics. Also exercise more. Even diabetics are found to improve sugar control by working on gut flora health.
Men issues: new PSA test and hydraulics
The test to screen for prostate cancer, the Prostate Specific Antigen (PSA) has become somewhat controversial since early detection and treatment does not seem to make a difference according to many studies. I say it is still a good idea to check it because I see men doing better with nutritional therapy. Now, a new way to order it may be more informative: the Prostate Health Index (PHI), which has recently been approved in the United States, Europe and Australia. It requires that you check a “proPSA,” then plug it into this formula:
([-2]proPSA/free PSA) × √PSA = <27 means that no biopsy of the prostate is needed.
The same factors that increase the risk of prostate cancer also cause Gout, Erectile Dysfunction (ED), and practically all diseases: poor diets, toxic environments and emotional/mental issues. This is a central tenant of Integrative Health. How else would you explain the recent association between Gout and ED? It is now advised that patients with Gout be screened for hydraulic problems.
Frequent readers of this newsletter know the common pathways to all diseases. The specific common denominator involved above isâ€¦Insulin Resistance. Google the Nobel Prize in Medicine 1931. It was given to Dr. Walburg for his work on hyperglycemia and cancer. The latter is significantly involved in Gout and arterial disease, including ED.
This is why, other than working on lifestyle issues, a single supplement has been shown to help with all three of the problems listed above: theamino acid arginine. It not only lowers insulin resistance but it helps improve arterial elasticity. It is best to take ~6 grams a day in conjunction with the amino acid citrulline. BTW, research on arginine won the Nobel Prize in medicine in 1998; Pfizer cashed in on that and created Viagra.
No pun (times two!) intended, but there is also a “sausage link” to poor circulation: processed meats are not good for your arteries or our heart. Also, reducing or replacing red meat with fish lowers the risk of circulatory problems, specifically, strokes.
“Increased Acetaminophen use Major Cause Autism, Attention Deficit with Hyperactivity, and Asthma.”
In my opinion this is because acetaminophen interferes with liver function. I am convinced that environmental toxicity, coupled with poor detoxification in liver and gut, are the cause of skyrocketing health problems like the ones herein highlighted.
“Paint, glue, degreaser fumes exposure increases memory and cognitive problems in retirement,”
“Estriol helps MS and estradiol helps Parkinsonism,”
“Obesity and headache.” Obesity also compromises detoxification function: see “Fatty Liver.”
 “Bridging the divide between health and health care,” JAMA 2013;309:1121
 “Pinching the poor? Medicaid cost‐sharing under the ACA,” New Engl J Med. 2014 Mar 27;370(13):1177‐80.
 “Managing manifest diseases, but not health risks, saved PepsiCo money over seven years,”
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 “The new cholesterol and blood pressure guidelines: perspective on the path forward,”
JAMA 2014 Apr 9;311(14):1403‐5.
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JAMA 2014 Mar 26;311(12):1195‐6.
 “Ezetimibe prescribing fails to keep up with evidence,” JAMA 2014 Apr 2;311(3):1279
 J. Gastroenterology Cover issue May 2014
 “Exercise linked to more diverse Microbiome,” J. Gut Epub June 9 2014
 Joint meeting of the International Society of Endocrinology and Endocrinology Society
June 23 2014 Abstract OR40-5
 European League Against Rheumatism (EULAR) Congress 2014: Abstract OP0135. Presented June 13, 2014.
 “Processed and unprocessed red meat and risk of heart failure,”
J. Circulation Heart Failure2014:DOI:10.1161/circheartfailure.113.000921
 “Diet higher in protein may be linked to lower risk of stroke,” June 11, 2014 American Academy of Neurology
 Journal of Restorative Medicine, Volume 2, Number 1, October 2013, pp. 14-29(16)
 J. Neurology Reviews June 2014 page 2
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 J. Headache 2014;54:219