Sunday, May 31, 2009

New Treatments forAlcohol Addiction

Go To Health – New Treatments for Alcohol Addiction
Doctors and nurses often use the following screening questions to find and help people with alcohol addiction:
*Have you ever felt you should cut down on your drinking?
*Have people annoyed you by criticizing your drinking?
*Have you ever felt bad or guilty about your drinking?
*Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
Answering yes to 2 or more of these questions indicates a strong possibility of problem drinking. Some reports say that 8% of the population has serious problems with alcohol, and most do not get treatment.

AA is a highly effective treatment for many people. It replaces drinking friends with the fellowship of AA members and sponsors who support sobriety and teach important coping skills. Many members consider that the 12 steps are a guide to a new way of life. Alcoholics who use drug treatments would do well to go to AA as well, for ongoing social support.

Antabuse is a drug that makes people seriously ill if they drink. As long as it is taken it is a deterrent, but it has a mixed record because it does not reduce the craving for alcohol, nor does it treat alcohol withdrawal symptoms. It is more widely used and more successful in Europe, with abstinence rates of 50%

Naltrexone, is used to decrease cravings for alcohol. Alcohol increases the release of brain opioids, compounds that promote a sense of pleasure. Naltrexone, an opioid antagonist, blocks brain receptors for these opioids, making it easier for drinkers to remain abstinent or stop quickly in the event of a slip. Naltrexone can reduce relapse and craving for alcohol in many but not all people. It is also used in treating opiate addiction (heroin, oxycontin, et al.) and smoking. This is important, as heroin use is rising. A monthly injection of Naltrexone has been found to work better than a daily pill, at a lower overall dose. It should not be used if a person has hepatitis or cirrhosis.

Baclofen is prescribed as a muscle relaxant, and has been found to reduce cravings for alcohol. Its structure is similar to a brain neurotransmitter known as GABA, which lowers excitability and relaxes muscle tone. It decreases craving for alcohol, is helpful in withdrawal, and can be used by people with cirrhosis. Baclofen use has been popularized by Olivier Ameisen, an academic cardiologist who wrote ‘The End of My Addiction’. He recounts his recovery from being a serious alcoholic with the use of Baclofen. Trials are also underway to treat cocaine addiction with this drug.

Campral is a new drug that seems to restore chemical balance in the brain after people stop drinking; It does not help with withdrawal symptoms, but may reduce sleep disturbances. It should not be used by depressed people, who may become a suicide risk.

Genetic differences may explain why these 3 drugs are helpful for some but not all. (Pregnant and breast-feeding women should not use them.) Considering the huge personal and social dangers of alcohol abuse, they are important new medications
Sadja Greenwood. MD

Monday, May 25, 2009

Green Tea

Go to Health – Green Tea

Archeological evidence suggests that people consumed tea leaves steeped in hot water as many as 500,000 years ago! Green tea tastes good, and is both energizing (caffeine) and calming (theanine). Recently scientists have been investigating the potential cancer preventive and therapeutic effects of green tea. The polyphenols in green tea, known as catechins, are considered to be the beneficial molecules The most active of these is known as EGCG (epigallocatechin gallate). Researchers at the Medical Sciences Center, University of Wisconsin-Madison have found that EGCG has several ways in which it may be active against cancer - altering the expression of genes involved in cell growth and division, growth of new blood vessels in the cancer (angiogenesis), cancer cell death (apoptosis) and metastasis. These laboratory studies have been augmented by population-based studies in groups of people who drink a lot of green tea – mostly in China and Japan. Such studies are suggestive, but not definitive.

*Bladder Cancer – women who drank black tea and powdered green tea were less likely to get bladder cancer, and men with bladder cancer who drank green tea had a better survival rate.

*Breast Cancer - In one study of 472 women with various stages of breast cancer, researchers found that women who consumed the most green tea experienced the least spread of cancer. Women with early stages of the disease who drank at least 5 cups of tea every day before being diagnosed with cancer were less likely to suffer recurrences of the disease after completion of treatment. However, women with late stages of breast cancer experienced little or no improvement from drinking green tea. . In one very large clinical study from Japan, researchers found that drinking green tea was not associated with a reduced risk of breast cancer.
*Ovarian Cancer - In a clinical study conducted on ovarian cancer patients in China, researchers found that women who drank at least one cup of green tea per day survived longer with the disease than those who didn’t drink green tea. In fact, those who drank the most tea lived the longest.

*Prostate Cancer - Laboratory studies have found that green tea extracts prevent the growth of prostate cancer cells in test tubes. In a large clinical study conducted in Southeast China researchers found that the risk of prostate cancer declined with increasing frequency, duration and quantity of green tea consumption. However, both green and black tea extracts also stimulated genes that cause cells to be less sensitive to chemotherapy drugs. Given this potential interaction, people should not drink black and green tea (as well as extracts of these teas) while receiving chemotherapy.

Pancreatic Cancer - In one large-scale clinical study researchers compared green tea drinkers with non-drinkers and found that those who drank the most tea were significantly less likely to develop pancreatic cancer.. However, it is not clear from this population-based study whether green tea is solely responsible for reducing pancreatic cancer risk.

*Colorectal, Esophageal, Lung, Stomach Cancer -– conflicting results, including possible increased risk. Extremely hot drinks are can damage the esophagus.

Green tea extracts are also being studied for possible help with inflammatory bowel disease, diabetes, alcoholic liver disease, arthritis, weight loss, dental caries, genital warts, and even prevention of cold and flu symptoms. Stay tuned for more studies.

Green tea contains 20-30 mg of caffeine per cup, compared to 100 mg in a cup of coffee; you can also make decaf green tea.. Pills containing green tea extracts are available, some without caffeine.
Sadja Greenwood, MD - back issues on my blog –

Saturday, May 23, 2009

Emergency Contraceotion - the Morning-After Pill

Go to Health – the morning-after pill , aka emergency contraception, Plan B

Jessica broke up with her boyfriend, and went off the birth control pill. Three months later they got back together, had a celebratory drink, and had sex without a condom.

Maria and her husband were both in school and working to support their children. When they had sex, the condom broke.

Liza went to a great party, with dancing, liquor, drugs and cute guys. She felt woozy after a drink, and had to lie down in a bedroom. She woke up to find she was being raped.

Fortunately, all these women knew about the morning-after-pill, otherwise known as Plan B , which can prevent pregnancy 89% of the time if taken within 72 hours after unprotected sex. The first pill is taken as soon as possible, and the second 12 hours later. The sooner it is taken, the more effective it is. Side effects can include nausea, abdominal pain, fatigue or headache, but in general are not severe.

Plan B contains a high dose of levonorgestrel, a progesterone-type hormone that is used in many birth control pills. It prevents pregnancy primarily by stopping ovulation (the maturation and release of eggs from the ovaries) or by preventing fertilization of the egg if ovulation has already occurred. Plan B also alters the lining of the uterus, making it less receptive to a fertilized egg.

If a woman is already pregnant, Plan B will not cause an abortion. Also, Plan B should not be used as a regular birth control method, because other methods such as the birth control pill, IUD or condoms are usually much more effective. Plan B is used in emergencies, which is why it is known as emergency contraception.

Plan B is available locally, at the West Marin Pharmacy, Safeway, or Longs. Call first to make sure it is in stock. If you are 17 or older, it is available without a prescription; younger women need a prescription from a doctor. It may be less expensive from a family planning clinic like Planned Parenthood. Men 18 and older can also buy Plan B. Women who rely on condoms, or are forgetful about the birth control pill should have Plan B immediately available in reserve, so they can use it as soon as possible after unprotected sex.

The Copper-T is an intrauterine device (IUD) that some women use for regular birth control, but you can also have it inserted up to five days after sex to prevent pregnancy. It reduces your risk of getting pregnant by more than 99%. Another advantage to the Copper-T IUD is that you can keep it in place to prevent pregnancy for up to ten years. IUDs are a good form of contraception if neither partner has a sexually transmitted disease such as gonorrhea or Chlamydia.

An excellent website for emergency contraception is

There is a medication that causes abortion in early pregnancy, known as Mifeprex (mifepristone, RU486), which will be described in another of these columns.
Sadja Greenwood, MD


Go to Health: ‘Plumpynut’

Severely malnourished children in Africa are being saved by a fortified peanut butter known as ‘Plumpynut’. It was developed by Andre Briend, a French pediatric nutritionist with WHO who saw the need for a food that was cheap to produce, ready to eat, and did not need clean water to prepare. It contains peanut paste, vegetable oil, powdered milk, sugar, vitamins and minerals, combined in a foil pouch that equals 500 calories. Peanuts contain monounsaturated fats, which are easy to digest; ‘Plumpynut’ is rich in zinc and protein, good for the immune system and muscle development. According to Doctors Without Borders, there is virtually no peanut allergy among the children they treat.

Mothers who are themselves malnourished can’t produce enough breast milk for their children, can’t afford to buy milk, and lack clean water, electricity and refrigeration.

Doctors Without Borders have been giving out packets of ‘Plumpynut’ in Niger, Malawi, Darfur, and other African countries since 2005 to children who are dramatically underweight and able to be treated as outpatients. Children love the taste and all but the weakest can feed it to themselves. In most cases, their weight gain and return to health is rapid . Please watch the remarkable results of using ‘Plumpynut’ on 60 Minutes with Anderson Cooper

Doctors Without Borders
estimate there are 20 million malnourished children around the world, and only about 3% are getting foods like ‘Plumpynut’ .

You can support Doctors without Borders by calling

Sadja Greenwood MD


Go to Health: Methamphetamine

Federal surveys indicate that about 1% of the population over age 12 uses meth in a given year. A rising number of users are smoking meth rather than snorting it or taking it orally. Smoking is said to create a faster, jolting high, quicker addiction and more ill effects. A recent study by the RAND Corporation, published on the Meth Project website, computes the annual costs of meth use in the US at $23.4 billion per year. These costs include health care, drug treatment, rehab, foster care for endangered children, the criminal justice system, injuries and deaths from exploding meth labs and cleanup of the toxic waste these labs produce.

There’s a good website on the use and dangers of methamphetamine: The Meth Project is a large-scale prevention program aimed at reducing first-time meth use among young people through public service messaging, public policy, and community outreach. Their messages are aimed at youth, and their motto is ‘not even once’. They have been active and successful in several rural states, including Montana, Idaho, Arizona, Wyoming and Illinois. Their method is to educate the public against trying meth with TV ads, radio, billboards and murals painted by youth. If you are concerned about the dangers of meth for our youth, check it out.

Taking even small amounts of methamphetamine can result in increased wakefulness, increased physical activity, decreased appetite, increased respiration, rapid heart rate, irregular heartbeat, increased blood pressure, and high body temperature. Long-term use leads to extreme weight loss, severe dental problems, facial scarring, anxiety, confusion, insomnia, mood disturbances, and violent behavior. Users can experience paranoia, visual and auditory hallucinations, and delusions (for example, the sensation of insects creeping under the skin).

Dopamine is a brain chemical with effects on many body systems having to do with activation and pleasure. First time meth users can experience extreme pleasure from an outpouring of dopamine in the brain. After a number of hours, there is an unpleasant crash, leading to a desire for more meth. Repeated use leads to serious addiction; it changes brain chemistry in a way that can take years to reverse. Treatment of meth addiction is a huge problem; there are as yet no effective drugs that decrease the cravings.

Three suggestions:. Parents should know that a dangerous drug mixing meth and ecstacy called Thiz is popular among youth, and has been seen in our local towns. Read the books by David and Nic Sheff on meth addiction - Beautiful Boy and Tweak. Get your dopamine high from working out, coffee, playing music – or whatever drug-free way of being turns you on.

Sadja Greenwood, MD


Go to Health! – Probiotics

Probiotics are living microscopic organisms that scientific research has shown to benefit health. Most often they are bacteria, similar or identical to the bacteria already in our intestines. The most common probiotic bacteria are Lactobacillus or Bifidobacteria, but there are many other bacterial strains that are useful for various illnesses.

We humans have more than 400 bacterial species in our guts; bacteriali numbers exceed by 10 fold the number of tissue cells in our bodies. About 70 % of the body’s immune system is found in the digestive tract, in lymphoid tissue that stores immune cells such as T and B lymphocytes, and defends against disease causing bacteria and viruses.

Research is ongoing to elucidate the effects of probiotic bacteria on the immune system. Some current uses of probiotics are for the following ailments:

*Infectious diarrhea caused by bacteria (salmonella, campylobacter, some strains of e coli) and viruses (especially rotavirus in children)

*antibiotic related diarrhea – there is evidence that taking probiotics when you start on an antibiotic may halp prevent diarrhea.

* childhood allergy - In a recent trial, Lactobacillus rhamnosus was given to pregnant women for four weeks prior to delivery, and then to newborns at high risk of allergy for six months. As a result that there was a significant reduction in early skin allergies.
•bladder infections in women – certain strains of e coli in the bowel are responsible for about 85% of bladder infections. Studies have shown that daily oral capsules of certain lactobacillus strains have lowered the risk of repeated bladder infections, when used with weekly insertions of capsules in the vagina.=

*Yeast and bacterial vaginal infections - (not sexually transmitted diseases such as gonorrhea or Chlamydia) there is evidence that oral and vaginal lactobacillus can reduce the recurrence of these common problems

*recurrence of superficial bladder cancer – Japanese researchers have shown that oral capsules of certain probiotics, and the use of probiotics instilled in the bladder along with chemotherapy agents, have prevented recurrence without side effects, or prolonged the time of cancer recurrence.

*Research is ongoing in the use of probiotics for irritable bowel syndrome and ulcerative colitis.

You can easily get the benefits of probiotics by eating yogurt or other cultured milk products. Read the label to make sure that they contain ‘living cultures’. Adults who want a more concentrated form of probiotics can take them in capsules.. Choose a brand from a reputable supplement company; make sure that the capsule contains lactobacillus acidophilus, and bifidobacteria and that each capsule contains at least 3billion bacteria. Capsules should have been refrigerated, and should be refrigerated after you buy them. Since, the beneficial bacteria are only retained for days or weeks, continued use is required. Children can take probiotics; for this, confer with your child’s doctor.

Certain foods, called prebiotics, have carbohydrates that promote the growth of probiotic bacteria in the gut: bananas, berries, asparagus, garlic, whole wheat, oatmeal, barley, flaxseed, tomatoes, Jerusalem artichoke, onions and chicory, many greens ( dandelion greens, spinach, collard greens, chard, kale, mustard greens), and legumes (lentils, and beans). These are great foods that we all should be eating!
Submitted by Sadja Greenwood MD –

Vitamin B12

Go to Health – Vitamin B12

Vitamin B12 plays a key role in the normal functioning of the brain and nervous system, and in the formation of our red blood cells. It is involved in the metabolism of every cell of the body, especially affecting the synthesis of DNA (our genetic material).

Vitamin B12 is bound to the protein in food from animals (fish, meat, poultry, eggs and dairy); mollusks like clams and oysters are especially high. B12 is not present in plant proteins. Fortified breakfast cereals are an important source of vitamin B12 for vegetarians. Hydrochloric acid in our stomach releases vitamin B12 from proteins during digestion. Once released, vitamin B12 combines with a protein called intrinsic factor (IF). This complex can then be absorbed by the intestinal tract.

Young people eating a variety of animal foods are rarely deficient in Vitamin B12, unless they have an underlying disorder of the stomach or small intestine (such as untreated celiac disease , or surgical removal of these organs). Vegans – who eat no animal protein - should take supplemental B12; pregnant and lactating women should of course be careful to eat well and take supplemental vitamins as prescribed.

Older adults can develop a condition known as atrophic gastritis with inflammation of the stomach, bacterial overgrowth, and a deficiency of the protein known as intrinsic factor. Without intrinsic factor, vitamin B12 cannot be absorbed. This condition can lead to an illness known as Pernicious Anemia, which is treated with Vitamin B12 and other B vitamins. Patients have anemia, fatigue, numbness and tingling in the hands and feet , difficulty in maintaining balance, depression, confusion, dementia, and soreness of the mouth or tongue. Any one with these symptoms should seek medical care, as they will need careful assessment and treatment.

Scientists are now seeing that low levels of B12 can cause problems even if Pernicious Anemia is not present. New studies are showing the benefits of high normal levels of this vitamin.

*Brain Power A recent study from Oxford University in England found that adults over age 60 who had higher vitamin B12 levels were 6 times less likely to experience brain shrinkage than those with lower levels on testing 5 years later. Testing involved brain scans and memory tests. None of the people in this study had what would be called vitamin B12 deficiency. The lead author in this study wrote:
‘Many factors that affect brain health are thought to be out of our control, but this study suggests that simply adjusting our diets to consume more vitamin B12 through eating meat, fish, fortified cereals or milk may be something we can easily adjust to prevent brain shrinkage and so perhaps save our memory.’ The study did not look at whether taking vitamin B12 supplements would have the same effect on memory.

*Link to Depression: A study from the National Institute of Aging found women with low B12 levels were more than twice as likely to develop depression as women with normal B12 levels. This finding did not apply to men in a similar study from Spain.

*Bone strength: several studies show an association between B12 levels and bone strength. B12 seems to help osteoblasts , bone-building cells.

*Age-related Macular Degeneration: this is the leading cause of blindness in the elderly. A Harvard study showed women taking high doses of vitamins B6, B12 and folic acid were found to have significantly more protection from this eye disease than women on placebos. Epidemiologist and study author William G. Christen of Harvard Medical School said that if these findings are successfully replicated in future studies, "the combination of these vitamins might become the first prevention method of early stages of age-related macular degeneration other than avoiding cigarette smoking” He felt that the same results would also be true for men.

Hearing Loss: A study from the University of Georgia showed that hearing loss was associated with low concentrations of serum vitamin B-12 and red cell folate (folic acid – another B vitamin). Animal studies have also shown this correlation..

Based on these recent findings, many doctors are advising people reaching middle age, as well as vegetarians and vegans, to supplement with vitamin B12. A test is available to determine blood levels of the vitamin; levels considered normal have gone up in recent years. Levels below 200 pg per milliliter were considered low in past years, but now optimal levels may range from 500 to 1000 pg/ml. If you have this test, your doctor or nurse-practitioner will advise you about your results.

In cases of deficiency, vitamin B12 can be given by injection. However, people can also take oral B12 tablets that are dissolved under the tongue, so that the vitamin goes straight into the blood stream. Fortunately Vitamin B12 is a safe supplement, and it is becoming more popular among people aware of the aging process. Stay in touch with your body’s needs as the years go by.
Sadja Greenwood, MD –back issues on my blog

Vitamin D

Go to Health! – Vitamin D

Vitamin D, formed on the skin with sun exposure, is a fat soluble vitamin essential for maintaining many body systems, including (but not limited to) calcium metabolism and bone strength. All the cells in our bodies have receptors for Vitamin D, so we know it has many effects.t

*Osteoporotic fractures - Women who take calcium and vitamin D supplements have been shown to have a lower risk of fractures, in the hip and other areas.

*Muscle strength -Vitamin D is also helpful in promoting muscle strength and decreasing muscle pain. Recent studies show a possible help of D in decreasing falls in the elderly.

*Heart disease - Low level of D is associated with an increased risk of heart disease, and high blood pressure.

*Cancer - results of some, but not all, human studies suggest that D may protect against certain cancers, including colorectal cancer. D regulates proteins responsible for cell division. Some epidemiologic studies show that women with breast cancer have lower vitamin D levels than matched controls.

* Autoimmune disease Adequate vitamin D levels may decrease the risk of autoimmune diseases such as type 1 diabetes, multiple sclerosis and rheumatoid arthritis.

* Memory loss with aging Recent research shows that older adults with low Vitamin D levels may be at higher risk for cognitive impairment,

*Respiratory infections people of all ages with low levels are more at risk for colds and other respiratory infections, including tuberculosis.

*Seasonal affective disorder (winter blues) and depression Studies are beginning on the use of Vitamin D for SAD, which may be more effective than light therapy.

As Vitamin D plays such an important role in human health, it is a good idea to have your health care provider order a test for a blood level of 25 hydroxy vitamin D. A level above 30 ng/ml is desirable, and 50 ng/ml is considered optimum. To achieve this level without high sun exposure, which can carry risks of skin cancer and skin aging, most adults in our area need to supplement with 1000 IU daily. Some doctors are advising more than this. We form very little Vitamin D on our skin between October and March at this latitude. People with darker skin absorb Vitamin D from the sun more slowly, and may need higher levels of supplementation.

Submitted by Sadja Greenwood, MD, as part of a new series- stay tuned for probiotics, B12, fish oil, the cost of methamphetamine, a new drug to treat addiction, and more.