Given the state of medicine today, one would think that the gallbladder is near-vestigial and can be taken out on a whim with nary a price to pay. 

First, we need to understand some of the basic functions of the gallbladder.  The absolute most important job of the gallbladder is to store the bile that is constantly produced in the liver and release bile in response to the hormone CCK in response to a fatty meal.  The bile released then helps to emulsify and absorb the fat and fat soluble nutrients of our meal.

So what happens after a cholecystectomy (gall bladder removal)?  There are several negative consequences.

1. Most common is diarrhea.  This is because there is now unabsorbed fat in the intestinal tract (no bile to help with the absorption) which contributes to the osmotic diarrhea commonly seen.  Luckily, supplements containing bile acids can very successfully relieve the diarrhea.
2. Fat soluble nutrient absorption problems.  This includes the fat soluble vitamins A, D, E and K, but also fat soluble phytonutrients like lycopene (the red pigment in tomatoes that are known to protect the prostate and heart) and a long list of others.  Supplementation with certain vitamins is essential.
3. Increased risk of colorectal cancer.  The reasoning is not quite worked out, but it likely has to do with the constant slow release of bile acids from the liver that are no longer stored.  Because they aren’t stored and released to bind up with fats as needed, they are free to float down into the intestinal tract and create problems among cells that are not designed to handle the acids. Eating certain foods regularly may help bind up the bile acids and lower the risk of harm.

These little tidbits are rarely shared with patients prior to their surgical removals (which, by the way, is actually required–it’s called informed consent and is grounds for malpractice).  All too often, even severe gallbladder attacks are NOT grounds for gallbladder removal, despite popular opinion.  Recent studies suggest less than a third of patients with severe symptoms will continue to have problems.  This means that more mild symptoms should not even initiate the conversation.

Of course, the real answer is not damaging our gallbladder in the first place.  And this, while trying to avoid sounding like a broken record, is almost always a result of being prediabetic.  I’ve always told patients that gallbladder problems can occur decades before someone actually becomes diabetic.  So, of course, fixing the gallbladder has everything to do with pulling back from a pro-diabetic lifestyle.

This particular article gives us some insight into just how early this process starts.  Researchers found that obese preadolescents actually began to have problems with gallbladder motility long before they became an adult. 

I do not need to stress to anyone just the life altering importance of raising our children with good lifestyle habits and maintaining an ideal body composition.  If your child is NOT in this category, you need to understand fully that the damage to their delicate bodies has already begun.

The has been much controversy over the years in regards to the actual effectiveness of anti-depressant medications (mainly the SSRIs like Prosac) compared to placebo.  Anytime you have a drug that shows very little effectiveness compared to a placebo it has a tendency to highlight the dangerous side effects.  The list of side effects associated with anti depressants is a little too long, in my opinion, given their questionable effectiveness over placebo.  Consider these:

1. Anti depressants weaken bone health in the elderly population.
2. Anti depressants accelerate bone loss at the hip.
3. SSRIs have been associated with upper gastrointestinal bleeding.
4. SSRIs greatly increase the risk of becoming diabetic.
5. Anti depressants increase the overall risk of dying (not a good thing…).

As if this list wasn’t long enough, this particular study allows us to add vascular damage to this already-too-long list.  Researchers found that those who were on anti depressants had smaller diameter arteries (the authors note that the arteries were, on average, about 40 microns smaller in diameter–or the equivalent of about 4 yrs worth of normal progression with aging).

So what is someone to do?  No one can argue that exercise is THE most powerful weapon against depression.  However, getting a severely depressed patient off the couch may be near impossible.  In these cases, there are some natural approaches that can be instituted to get the brain in a better state, maybe allowing the patient some motivation to get out and exercise.

1. Coffee has been shown to lower the risk of depression.
2. A mere multivitamin given to elderly patients has been shown to improve depressive symptoms.
3. St John’s wort has held up in multple studies for mild to moderate depression.
4. Melatonin is being investigated as a potential treatment for severe depression.

And the list surely gets longer as we look harder, but by now you should get the idea…

The clear answer to this question is….Maybe.

Regular readers of the Rantings know how little of a fan I am of the entire statin class of drugs.  Clearly, this class of drugs, for primary prevention of deaths related to heart attacks, is just a hair above worthless.  If they didn’t have a long list of potentially fatal side effects and cost the healthcare system 10′s of billions of dollars per year AND they’re weren’t more effective alternatives available (Dr. Dean Ornish proved that lifestyle could reverse plaquing in the coronary arteries in the 70′s), then their paltry effectiveness wouldn’t be a big deal.

Back to the issue at hand.  Will this class of drugs protect my arteries?

I guess it just depends.  On what, you ask?  It’s not really a question anyone can answer right now.  What we can say, from this particular study, is that half show some very mild improvement in blood vessel diameter (3.2%) while the other half show larger losses (-5.3%) in the diameter of the blood vessels.

So it’s basically a crap shoot until researchers can spends hundreds of millions of research dollars to figure out who gets better and who gets worse, keeping in mind that “better” translates into a negligible improvement in overall mortality rates.  Sheeeeezzz…

Called me biased, but wouldn’t the right lifestyle changes to pull back from diabetes and improve your entire lipid blood panel be a safer, cheaper and better idea??

IV magnesium (2 grams-a pretty hefty dose) was shown to be just as effective as Reglen (normally used to speed up gastric emptying) for treatment of migraine in the ER.  So, most would look at this and ask why anyone would use magnesium if it is just as effective.  Hmmm… magnesium is much, much cheaper.

No known side effects (diarrhea if given orally, however).  Makers of magnesium IVs are not getting sued for damaging the nervous system.  Need any more reasons to use magnesium instead?

Read entire article here

This study really demonstrates how behind the research most clinicians are.  Just checking cholesterol really does not give us a good picture of where the patient is as far as their risk for heart disease.

This study evaluated subclasses of LDL (small, intermediate, large), VLDL (very low density lipoprotein) and HDL.  Worsening insulin resistance did not affect LDL levels.  However, strong changes were seen in the subclasses–decrease in the large LDL offset increases in the other sizes of LDL.

So, if one just looks at straight LDL, you just missed the fact that the real picture is one of worsening risk (larger LDL and larger HDL particles are generally considered protective).  Subfractioning of the cholesterol molecules is looking more and more like a good idea…

Read entire article here

Okay.  A couple problems here.  This study reviewed several statin drugs to determine which one lowered lipids better in patients with metabolic syndrome.  You know metabolic syndrome the condition where high INSULIN levels increase lipids.

So here’s my analogy:  Your house is on fire and the smoke detector is going off.  We take a baseball bat, hammer and the wrong end of a screwdriver and beat on the smoke detector to see which one breaks the detector into the smallest pieces.  Forget the fire–that’s not important.

And, just to be consistent with this study for my analogy, Astra Zeneca, the manufacturer of the hammer (which was found to be the most effective), paid for the study.  Suspicious?  And does anyone wonder why they didn’t check corresponding insulin levels?

Read entire article here

Tocotrienols are Vit E’s more powerful cousin and usually kept in the closet.  However, they are present in some of the higher quality vitamins as well as a wide variety of foods like rice bran and certain oils like palm.

We have known that they have some powerful antioxidant properties for awhile, but this review suggest additional benefits of lowering cholesterol and, as a wonderful bonus considering the increase in neurodegenerative disorders, reducing glutamate-induce neurotoxicity.

This would suggest that those people with seizures or at increased risk of Alzheimer’s or Parkinson’s should put this one on the protective list.

Read entire article here

Holy moly!!  Patients with normal/low cholesterol and elevated CRP had an ELEVEN TIMES risk of dying with coronary artery disease.  And there are still clinicians out there refusing to check CRP levels in patients with a family history of heart disease.

There is absolutely no excuse for this and these doctors should be pushed out of medicine.  And remember that fish oils, exercise and managing insulin resistance can bring down CRP levels quite well.

Read entire article here

Recall that our bodies (yes–women AND men) breakdown estrogen to get it out of the system.  This process can follow several pathways.  The “2″ pathway is generally considered protective.  The “16″ pathway is generally considered damaging to the genes, and the “4″ pathway is akin to lighting a stick of C4 and lying it directly on your good ‘ole double helix.

Luckily, the body has a mechanism to instantly get rid of the “4″ estrogen metabolite (which is subseptable to genetic variation along the COMT pathway), and the ratio between 2 and 16 is amenable to diet.  We know that compounds like cruciferous veggies contain indole-3-carbinol which gets converted to di-indolylemethane with the help of stomach acid.  This DIM goes on to make sure estrogen heads towards the 2, more friendly pathway.

This study confirms that lifestyle is an important determinant of this ratio.

Read entire article here