What’s New! – A Healthy Living Newsletter

January, 2003
My patients frequently ask my opinion about new health books on the market. And there's certainly no shortage of experts peddling their advice! While many of these books are excellent, others are written by people who don't have a clinical background in the subject. Simply put - they're inaccurate.

The people writing the books either don't regularly use the medicines they write about or they're presenting theories as if they are facts. Others can be valuable tools for improving the quality of your life.

If you find this newsletter useful, please forward it to a friend!

The New Integrative Approach to Fibromyalgia How to Combine the Best of Traditional and Alternative Therapies Milton Hammerly, M.D.

This title really bugged me. It sounded so pretentious. I figured it was just another M.D. with a cursory knowledge of natural medicine writing another confusing book of misinformation for the general public. Was I ever wrong! I've never met Dr. Hammerly, but I really like the guy. He has a patient-centered approach that consists of a blend of conventional and natural medicine. And he's candid - really candid. He chides his medical colleagues when they ignore the centuries of benefits of natural medicine because many of these modalities don't fit into the research model of double-blind-placebo-controlled. "A lack of research does not mean a lack of results."And he urges the natural medicine physicians to work better with the conventional physicians and stop fighting within their own professions. But what does he say about fibromyalgia?

Fibromyalgia is a medical condition characterized by both generalized muscle pain and specific "tender points" of pain. It also includes: muscle spasms, joint pains, skin and connective tissue tenderness, numbness, tingling in the hands or feet, difficulty sleeping, debilitating fatigue, anxiety, headaches, difficulty verbally identifying objects, digestive problems, sensitivity to weather and temperature changes, circulatory problems, upper respiratory problems, frequent of chronic infections, food allergies, depression and trouble concentrating or "brain fog". And - the conventional medical community labels it incurable.

Hammerly packs his book with excellent suggestions including keeping a daily diary of symptoms to track the changes and perhaps patterns in the pain, fatigue and other symptoms of fibromyalgia, avoiding or minimizing flares, preparing for an office visit, exercising within the limitations of the condition, and treating related problems such as increased sensitivity to chemicals.

One of the most unique aspects of this book is Hammerly's understanding of both the harm and benefit of conventional medicine and his honesty in writing it down. For example, he advises the patient with fibromyalgia-related headaches not to rush for the ibuprofen or aspirin because of the drugs' cumulative effects on the kidneys and liver as well as their ability to cause rebound headaches. After listening to scores of patients tell me that their conventional physicians denied any drugs side-effects, it was refreshing that Hammerly wrote "All conventional medications can have potentially negative side-effects". But that doesn't mean the natural medicine is without its own side-effects - especially if not monitored by an experienced natural medicine physician. But it's like comparing a tacking hammer to a sledge hammer, the potential damage differs considerably.

His diet recommendations are equally excellent. He is one of the few practitioners of either conventional or natural medicine that recommends decreasing meat in the diet to lessen the pain, a move supported by copious medical research.

Also included under diet is food allergies/sensitivities. Many people with fibromyalgia react to specific foods and need to figure out which foods these are and to avoid them. The main culprits are chocolate, citrus, coconut, coffee, corn, cow's milk, eggs, fish, mustard, peanuts, pork, shellfish, soybeans, tomatoes, tree nuts, wheat and yeast. Hammerly urges his readers to keep a diet diary to determine if certain foods affect their symptoms.

My very few criticisms relate to his understanding of homeopathy and botanical medicine. For example, he wrote that Siberian, Panax and American ginseng have similar effects. As an herbalist, I disagree with the general nature of this statement relating to this condition. Panax ginseng stimulates the adrenal gland and should be avoided or used in minute amounts and then only under a physician's care as it can exacerbate the condition. On the other hand, Siberian ginseng, or Eleuthrococcus would be extremely beneficial.

Similarly, his explanation of homeopathy is extremely rudimentary. I have treated people with homeopathic remedies and within one to three months either substantially decrease their pain level and go off or decrease conventional medications or go into long-term remission. Also, he lists 3 remedies and their potential benefit for the symptoms of fibromyalgia. One of them, Rhus tox. is derived from poison ivy. For people sensitive to poison ivy, if you repeat this remedy too much, they may develop a pseudo case of poison ivy complete with itching and swelling. There are similar cautions for the other two remedies.

However, other than these minor complaints, I think this is a terrific book. If you or someone you know wants to purchase a single reference book for Fibromyalgia, then purchase this one. It's the best, by far, of any book I have read on the condition.

Out of the Darkened Room When a Patent is Depressed: Protecting the Children and Strengthening the Family William R. Beardslee, M.D.

Most of us think of depression as an individual's process. The person periodically descends into an impenetrable gloom and then, hopefully, recovers with medication or time. Challenging this perception of depression, Dr. Beardslee describes depression as a family illness. Labeling it an illness similar to diabetes or heart disease but with a far worse stigma, he compassionately describes its effect on all family members, especially the children, and proceeds to guide the reader on how to protect and strengthen the child. So why am I including a book on the effect of parental depression on children in a newsletter about natural medicine? I guess because depression is so rampant and whether you treat it, as a natural or conventional practitioner, it is still very important to be aware of and minimize its effect on children.

Parents with depression often question their ability to be successful parents. How can they raise healthy, emotionally-balanced children, when they have so little control over their own emotional health? Just as the person who has recently suffered a heart attack expects to take time to completely recover, Beardslee urges the depressed person to be patient with himself and to "see depression for what it is - a serious illness that need not destroy the capacity to be a good parent."

In Out of the Darkened Room , Dr. Beardslee discusses "resilience" in children and how to develop it. Resilient children share certain characteristics: good relationships with others, capacity to get tasks accomplished, and self-understanding. Resilient children can distance themselves from the depression of the parent and move on with their own lives. Children with little resilience get mired in guilt and tend to blame themselves for their parent's depression. They cling to the depressed parent with fears and insecurities of their own - an overwhelming burden to the parent already taxed by depression.

To break this cycle and get the children on a stronger emotional footing, Beardslee leads the family through a series of meetings in order to expose the depression and to develop coping skills. He explains that depression "almost always starts as a series of disjointed incidents in the life of the individual sufferer, experiences that cause the sufferer to feel alone." Breaking the silence of depression by talking about those incidents, he makes an opening for a real discussion that exposes the fears and lack of understanding on the part of both the children and the parents. To this end, he gives detailed advice on when, where and how to hold the meetings. He even includes passages on getting children reluctant to participate involved in the process. By naming the behavior as depression instead of "mommy is having a bad day: or "daddy is going to the hospital for a rest", Beardslee enables the child to have a better understanding of depression and therefore be less impacted by it

Out of the Darkened Room is a rare and insightful book that is emotionally draining to read. As you read it, you are struck by Beardslee's immense concern for the welfare of his patients. It's not sugar-coated or written as an authoritative text. Instead, Beardslee describes his process in helping his patients and their families with depression as well as giving the reader a graphic insight into their children's thought processes over many years. It's a tough book to read, but if you have a family member with depression; it's worth the effort.

Herb & Health Tip: Here is the second installment of the herbal cautions being sent around the Internet.

"St. John's Wort - Avoid mixing with any prescription medications. In particular, avoid taking St. John's Wort (SJW) and:
a. Antidepressants
b. B. Indinavir sulfate (Crixivan), a protease inhibitor used to treat HIV
c. Digoxin (Lanoxicaps, Lanoxin), a drug used to increase the force of contraction of heart muscle and to regulate heartbeats
d. Theophylline (Slo-bid, Theo-Dur) an asthma medication
e. Cyclosporin (Neoral, Sandimmune, SangCya), an immunosuppressant
f. Chemotherapy

SJW has been shown to affect your body's metabolism of all of these drugs. Many other drugs are likely to be affected too. Until more is know about SJW's ability to alter the metabolism of pharmaceutical medications, it is probably best not to combine such medications with SJW.
Also, the combination of SJW with some antidepressants, such as selective seratonin reuptake inhibitors, may cause an excess of seratonin (seratonin syndrome). Typical symptoms include headache, stomach upset and restlessness."

Let me tell you about Hypericum, also known as St. John's Wort. My reference is The Principles and Practice of Phytotherapy by Simon Mills and Kerry Bone.*

St. John's Wort's chief action is as an antiviral. It has demonstrated its effectiveness in vitro and in clinical practice against herpes simplex virus types 1 and 2, parainfluenza virus, vaccinia virus, and several other variations of enveloped viruses. ("Enveloped" simply describes the structure of the various viruses.) It also demonstrated potent activity in the test tubes and in humans against several retroviruses, including HIV. This anti-retrovirus activity increased with exposure to light. That means St. John's is a great herb to use for many, but not all viruses.

Secondarily, St. John's Wort has antidepressant activity through many mechanisms. It inhibits uptake of noradrenaline, seratonin and dopamine in humans. It is a weak MAO inhibitor. "Results from comparative trials suggest that Hypericum (St. John's) may work as well as standard antidepressants." St. John's Wort can be used for mild to moderate depression and is inappropriate for severe depression.

Thirdly, St. John's Wort has demonstrated anticancer activity (human stomach and colon cell lines) without any toxic effects on normal cells.

Additionally, St. John's extract has shown to be effective against a number of bacteria (Gram negative and gram-positive) including Staphylococcus aureus, E. coli and Pseudomonas aeruginosa.

St. John's Wort has low toxicity. Prolonged use may result in a state of sensitivity to sunlight. The concern about liver toxicity refers to a study of HIV-positive patients who had mild reversible liver enzyme elevations that returned to baseline after discontinuation of St.John's Wort. After reviewing 3250 patients using St. John's, 2.4% experienced either minor stomach upset or an allergic reaction such as itchiness. This is 10X less than the side effects normally protracted with orthodox antidepressants.

So what does this mean? St. John's Wort has demonstrated anti-viral, anti-bacterial, anticancer and anti-depressant activity with a potential of 2.4% of those taking it getting some sort of minor side effect that reverses with discontinuation.

Should it be used with anti-depressants? Probably not. It's better to try a good quality St. John's for 4-6 weeks and then to move onto the conventional drugs.

Should it be used with Indinavir? I worked at an HIV clinic for two years. We used St. John's with great results right alongside conventional anti-virals with no adverse interaction. The major side-effects of Indinavir are headaches, nausea, vomiting, diarrhea, dizziness and insomnia. Again, after consulting with your physician, you may consider trying a good quality St. John's Wort with regular monitoring.

What about Digoxin and St. John's? This is probably referring to a small (162) study of in which St. John's demonstrated its ability to promote stable heart function while decreasing depression. So, yes, it's an herb trying to stabilize the organism and may tonify the heart. This is a beneficial side effect.

Why is Theophylline, primarily an asthmatic drug, listed? Probably for the same reason as digoxin. Theophylline can cause life-threatening ventricular arrythmias. (And frankly, don't use St. John's when using Theophylline because if the ventricular arrythmias occur, St. John's will be blamed.)

Should St. John's be used with immune suppressants such as Cyclosporin? Absolutely not. The overwhelming majority of medicinal herbs should be avoided with immune suppressants. Herbs strengthen the human organism. They would work directly against drugs designed to weaken the human organism.

What about using St. John's with chemotherapy? In my practice, I tend to avoid most herbs during the actual process of chemotherapy. I use them before hand to build up the body and afterward to repair the damage to the normal cells.

Periodically, the pharmaceutical industry feels threatened by a natural product and goes after it in a very deliberate way. About 10 years ago, it was L-Tryptophan. L-Tryptophan was an inexpensive amino acid that was extremely effective in increasing seratonin levels and was virtually without side effects. A Japanese company produced a single bad batch after failing to complete the chemical process and several deaths occurred. The FDA was able to trace the bad batch back to the Japanese company, but still decided to ban the supplement.
Two years ago, the media flooded the public with warnings that St. John's Wort would cause birth control pills to fail resulting in a host of unwanted pregnancies. When the pregnancies didn't occur, the pharmaceuticals tried a different angle. If it were patentable and the pharmaceutical companies could make money off of it, this Internet email warning about herbs would not have occurred. Consider Viagra. It has caused over 60 deaths and continues to be on the market.

*The specific section on St. John's Wort that I am referencing is supported by 120 medical citations from various international medical and scientific sources such as The Lancet, Antiviral Research, Pharmocychiatry, The First National Conference on Human Retroviruses and Related Infections (1993), AIDS Treatment News and about 80 European medical journals (whose titles I was unable to translate). (The U.S. government has only recently established funding for researching unpatentable natural medicine while the European, Chinese, Japanese and Australian governments have provided this for years.)

To all the local readers, our office is located at 11825 SW Greenburg Rd., Ste A2, Tigard, Or. 97223.