September 25, 2009 | 1:59 pm

Reservations Regarding Resveratrol

Posted by Albert Fuchs, M.D.

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Resveratrol is a chemical found in the skin of red grapes, berries, plums and peanuts.  It is being widely promoted as the latest antiaging wonder drug.  Fortunately, to separate research from hype, this issue of The Medical Letter reviewed the current knowledge on Resveratrol.

Resveratrol has shown some interesting benefits in animal experiments.  In obese mice, it increased insulin sensitivity and longevity.  In non-obese mice it did not improve survival but increased other markers of good health.  In simple organisms, such as yeast, resveratrol increased lifespan by up to 70%.  (My guess is that this is fabulous news for yeast, but not as good if you’re a human with a yeast infection.)

Studies of resveratrol in humans are lacking, so little can be said with confidence about either benefits or side effects.  The authors of The Medical Letter conclude

Resveratrol appears to produce some of the same effects as calorie-restricted diets that have reduced the incidence of age-related diseases in animals. Whether it has any benefit in humans remains to be established.

So I remain squarely in the pro-aging camp, and hope we all stay healthy and safe enough to grow old.

Tangential miscellany:

I’m proud to announce that I have been elected Fellow of the American College of Physicians.  If you’re curious what that means, see the link explaining FACP below.

Learn more:

The Medical Letter review of Resveratrol (by subscription only)

My previous posts on antiaging:

Growth Hormone Doesn’t Help Healthy Older Adults

DHEA and Testosterone Don’t Help Elderly Patients

American College of Physicians website:  FACP - What do these letters after your doctor’s name mean?

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

September 18, 2009 | 6:37 pm

A New Blood Thinner May Outperform Coumadin

Posted by Albert Fuchs, M.D.

Atrial fibrillation is a very common abnormal heart rhythm affecting 3 million Americans.  The most dangerous complication of atrial fibrillation is stoke, which can happen when a blood clot forms in the fibrillating heart chambers and travels to the brain.

Blood thinners have been the mainstay of treatment for atrial fibrillation.  They reduce the risk of stroke by preventing blood clots.  Warfarin (marketed under the brand name Coumadin) is the most effective available oral blood thinner, but taking it is fraught with difficulty.  The appropriate dose varies widely between individuals because of genetic differences, and even in the same individual the correct dose varies from one time to another.  The only way to dose warfarin correctly is to check blood tests periodically and adjust the dose based on the results.  Too much warfarin and the risk of dangerous bleeding increases; too little and the risk of stroke from atrial fibrillation is undiminished.  This need for frequent lab monitoring and the many interactions that warfarin has with foods and with other medications make it one of the least convenient and potentially most dangerous medicines in common use.  But for atrial fibrillation warfarin is the best we have.

An important study in this week’s New England Journal of Medicine compares a new blood thinner, dabigatran, with warfarin.  Over 18,000 patients with atrial fibrillation were randomized to either warfarin or to two different doses of dabigatran.  The lower dose of dabigatran was as effective at preventing strokes as warfarin, but was safer, causing fewer incidents of major bleeding.  The higher dose of dabigatran was as safe as warfarin (i.e. equal numbers of major bleeding) but prevented more strokes.

That by itself would be encouraging enough, but the major advantage for many patients will be that dabigatran does not require laboratory monitoring and has much fewer interactions with other medications.  It is taken twice a day at a fixed dose, making it dramatically simpler than taking warfarin.

Dabigatran should be available in the US in 2010.

Learn more:

Wall Street Journal article:  New Blood Thinner Matches Warfarin

New England Journal of Medicine article:  Dabigatran versus Warfarin in Patients with Atrial Fibrillation

New England Journal of Medicine editorial:  Can We Rely on RE-LY?

Tangential miscellany:

To my Jewish readers I extend wishes for a sweet and healthy year.  To my readers who, like me, are astronomy geeks: happy fall equinox!

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

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September 11, 2009 | 5:41 pm

The Facts on Red Yeast Rice

Posted by Albert Fuchs, M.D.

Many of my patients ask me whether they should take red yeast rice to lower their cholesterol.  This week’s issue of The Medical Letter has a very handy review of red yeast rice which I summarize below.

Red yeast rice is a food that is produced by fermenting rice with a specific species of yeast.  It has been used in Chinese cooking and medicine for centuries.  It contains many molecules that are similar to statins, the family of medicines including Liptor, Zocor and Crestor.  In fact one of its ingredients is lovastatin, the medication in Mevacor, the first statin approved in the US.

Statins have been repeatedly proven to prevent strokes and heart attacks, but statins also sometimes cause muscle or liver inflammation, a side effect also present in red yeast rice.

Because it is sold as a food supplement, not as a medication, the quantity of active ingredients in red yeast rice formulations is not standardized and varies widely.

The article concludes that red yeast rice has many of the benefits and side effects of statins but unlike statins, its ingredients are not standardized.  The bottom line is that “generic lovastatin would be safer and cost less”.

Learn more:

The Medical Letter review of Red Yeast Rice (by subscription only)

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

0 Comments — Leave your comment

September 4, 2009 | 1:09 pm

National Cholesterol Education Month

Posted by Albert Fuchs, M.D.

The CDC says that September is National Cholesterol Education Month, and who am I to argue?  So here is a dollop of education about cholesterol.

• High cholesterol is a major risk factor for strokes and heart attacks.  Other risk factors include
  • smoking,
  • age,
  • high blood pressure,
  • diabetes and
  • having a first-degree relative who had a heart attack in middle age or younger.
• High cholesterol doesn’t feel like anything.  The only way to know if your cholesterol is high is to have it checked.
• High cholesterol can be safely and effectively lowered with dietary changes, exercise and medications.
• Lowering high cholesterol with a family of cholesterol medicines called statins has been proven to prevent strokes and heart attacks.

So if you haven’t had your cholesterol checked in years, or if you know your cholesterol is high and you’ve been desperately ignoring it, get back to your doctor and get her advice.

Learn more:

The CDC webpage for National Cholesterol Education Month

Tangential miscellany:

My last post, Rational Rationing, generated lots of email responses and led to very stimulating discussions.

This month The Atlantic published a terrific article on the problems of our current healthcare system written by media and technology executive David Goldhill.  (Thanks to Timo K. for pointing me to it.)  It’s a very well researched and very personal analysis of what’s wrong and how to fix it.  I urge you to read it.  How American Health Care Killed My Father

Have a happy and safe Labor Day.

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

0 Comments — Leave your comment