Archives For October 2013

images3854CDFSThe down side to herbal dietary supplements is that they could contain harmful toxins or poisons. Sad but true.

In a previous blog entitled Do Dietary Supplement Work, I explained how the FDA does not test for toxic substances or poisons in the dietary supplements and unfortunately people have died as a result.

In late 1989, an epidemic of mysterious symptoms later found out to be eosinophilia-myalgia syndrome (EMS) resulted in several thousand cases of the syndrome and 36 deaths. Physicians in New Mexico linked the epidemic to the ingestion of L-tryptophan (LT) which was eventually linked to a single manufacturer, Showa Denko K.K. of Japan.

Think this an isolated case?

From the California Poison Control:Acute hepatitis, inflammation of the liver, has been associated with the Chinese herbal product Jin Bu Huan, a combination of germander and ma-huang.
In another case, a combination of eight herbs (PC-SPEC) marketed to balance the immune system in patients with prostate cancer was found to contain potent estrogenic activity in vitro, in animals and in eight men with prostate cancer who developed breast tenderness, decreased libido, and deep venous thrombosis.
Other harmful effects have been described as a result of the herb interacting with prescription medication. St. John’s wort has been reported to lower drug levels of indinavir in HIV patients and it may affect the levels of other medicines metabolized by the cytochrome P-450 system.

And suprisingly these occurances are not just isolated to tablets and capsules. They also involve herbal teas. There are case reports of rapidly progressive interstitial nephritis (inflammation of the kidney) in young women who consumed a Chinese slimming tea that contained the nephrotoxic compound aristolochic acid. Aristolochia fangchi was used in place of Stephania tetrandra.10 The mistake was thought to be due to confusion between the Chinese names “Fang ji” (S.tetrandra) and “Guang fang ji” or “Fang chi” (A.fanchi). As a consequence, 80 cases have been identified and more than half of these patients have developed end-stage renal failure.12 Some of these patients have now developed cancer in the tube where urine exists the body.

Ayurvedic remedies (from India) and traditional Chinese medicines usually contain a complex mixture of various herbs, animal components and mineral substances. Heavy metals such as arsenic, cadmium, lead, mercury, and thallium have been found in appreciable quantities in some of these preparations. There are case reports of serious lead poisoning from herbal remedies imported from Asia and India.

You’re probably wondering where these toxins come from. Sometimes they are a result of failure to adhere to Good Manufacturing Practices. During growth, plants can be contaminated with microorganisms or their by-products, pesticide residues, or radioactive materials. Bales or cloth sacks used for shipment of medicinal plants may be exposed to bird or rodent excrement, and animal excrement often contains pathogenic bacteria. In addition, plant material can contain thefungi species, Aspergillus, which can produce the carcinogenic toxin, aflatoxin.

Other times they are a result of a deliberate addition of drugs to make the dietary supplements work better. Acute interstitial nephritis, reversible renal failure, loss of blood pressure control, and peptic ulceration have been reported with the multi-component Chinese herbal remedy “Tung shueh” used for arthritis. Chemical analysis of the product found that nonsteroidal anti-inflammatory and sedative drugs had been added to the herbal mixture. The toxicity caused by this product was most probably due to the addition of the synthetic drugs.

So how do you avoid becoming a casualty of herbal supplements? Well, you could avoid them all together, or if there is one that you really want to take you can look it up on the USP Dietary Supplement Verification Program website is or the Consumer Labs website Both these websites list products that have been tested and the results of those tests.

But if you feel like you have been harmed by an herbal product you should call the poison control and report the incident. You should also get checked by your doctor.

Be safe, be well. POWER TO THE PEOPLE!


imagesCA0PTSI0That vitamin is vitamin D. I know this because in a recent review of 32 trials with 74,789 patients vitamin D3 (but not Vit D2) significantly reduced the occurrence of death. (Cochrane Database Syst Rev 2011 Jul 6;(7):CD007470) In medical terminology the study reported “a significant decrease in all-cause mortality (relative risk [RR] 0.94, 95%CI 0.91-0.98), with an NNT of 161, assuming 10% mortality in controls (level 1 [likely reliable] evidence).”

In this analysis most of the participants were women older than 70 years old. The average treatment duration was 2 years and the reduction in death was mainly attributed to the fact that most patients had low levels of vitamin D.

So what does all this mean? It means that if you are old, debilitated, frail and have low levels of vitamin D you can increase your chances of survival if you restore your surrogate vitamin d blood levels (25ohd) to greater than 20 ng/ml with the use of vitamin D3, but not vitamin D2 or any other form of vitamin D.

Vitamin D3 is available without a prescription, but only your doctor can monitor vitamin D levels with a blood test. You might want to ask her about it even if you are young and healthy. Young people who restore their vitamin D levels report more energy and a happier mood. No wonder vitamin D levels naturally increase when we are exposed to sunshine. Sunshine = higher levels of vitamin D = happier mood.

Vitamin D exists in two major forms in the body: Vitamin D2(ergocalciferol) and Vitamin D3(cholecalciferol). Vitamin D2 is found in fortified foods and OTC supplements. Vitmin D3 is unique in that it can be synthesized in human skin when sunlight changes the chemical bonds of cholesterol into Vitamin D3. But fortunately there is a back-up source of Vitamin D3 and that is food from animal sources like dairy products, meat and eggs. These forms of vitamin D act similarly in the body and require activation by enzymes. The first step of activation occurs in the liver, and the final step occurs in the kidney. Both these organs have to be healthy to have enough vitamin D in your body.

These discoveries are so important that in 2010 the FDA (under the advice of The Institute of Medicine who did all the research for the FDA) increased the minimum recommended daily allowance of Vit D from 400 to 600 IU daily for people aged 51 to 70 years and from 600 to 800 IU daily for those over 70 years old, but not to exceed 4,000 IU daily. Vitamin D at really high doses can cause an imbalance of calcium in the body which can lead to damage of blood vessels and over time can lead to organ damage, particularly kidney damage. So a little big is good, but a lot is not better.

Some people’s bodies make enough vitamin D if they are in the sun for 10 to 15 minutes at least twice a week. People with darker skin or older people may not be able to get enough vit d this way and so it is recommended that they take supplements.

But what I find the most fascinating about vitamin D is that it is actually a pro-hormone or precursor to hormones such as cortisol, testosterone, estrogen, progesterone, DHEA and others. The basic multiple ring structure is the same because they all originate from cholesterol. And apparently some of them can interchange identities which is why body builders who take too much testosterone end up with high levels of estrogen and can develop breasts.

So it looks like vitamin D serves as a back-up hormone, but which hormones can it become? That will have to be another blog. Also in another blog…maybe the next one… I will tell you of a popular dietary supplement that works by the placebo effect according to the research. I will also tell you when I would recommend this supplement, because I would recommend it under the right circumstances. hehehe.


imagesV3JGU0UAAnswer: It depends on the supplements. Some do and some don’t, but one thing I know for sure. The FDA does not test them to make sure supplements are what they say they are. The FDA doesn’t even test to see if they contain harmful toxins or poisons. The supplements can be grass clippings or vegitable oil for all the FDA knows. Their only concern is that the supplements are labeled properly and according to the Dietary Supplement Health and Education Act (DSHEA 1994). The supplement label can make claims that a product can build or support health, or provide a good source of supplementation. The label cannot state that the supplement can prevent, treat, or cure any condition or disease.

But before you completely lose faith in dietary suppliments, know that there are some good, high quality produts out there. Some of those products voluntarily submit to rigourous testing to an agency called U.S. Pharmacopeia. It is a federally recognized nonprofit organization that tests supplements for their content and sanitary manufacturing conditions. Access to the USP Dietary Supplement Verification Program website is

Any product that passes the test bears a seal of approval that looks like this: usp seal

Beware of tricky advertisers that display a similar copy-cat seals on their labels.

Also, to retain the seal the USP annually tests the products off the shelves of random stores.

ConsumerLab is also another agency that test products but this time without the manufactorers permission. Its reports disclose information such as: which multivitamins failed testing and why; which multivitamins exceed tolerable upper limits for certain nutrients; which lowcost multivitamins provide the same nutrients as more expensive popular brands; headtohead comparisons of all multivitamins reviewed and rated; and concerns, cautions, and potential adverse effects of the products tested.

Access to reports requires membership for a cost of $33 for 1 year or $54 for 2 years; the website is

There is one thing that these labs do not test for, that is if the supplement produces a desired effect in the body. That task is left to the clinical trials and are posted in the medical journal.

And what do the various studies say about each individual supplement. Well, it depends on the product, the dose, and condition it is treating in the study. It all gets very complicated and new studies are coming out every day proving and disproving theories. It’s also tricky to read these clinical trials because researchers with hidden agendas can doctor up the results in their favor. It takes a skilled eye and an expert in the field to detect that.

That is why I rarely read the clinical trials directly. I usually read the commentaries from the experts in the field. Those commentaries are written as review articles and meta-analysis studies.

Sometimes the overall final opinions as to whether the supplement works or not can be found in the clinical guidelines set forth by a large group of experts who have come together and reviewed all the clinical trials and data. Sometimes these guidelines are old and need to be updated as new information becomes available, but usually they are reliable.

There will be more blogs about which supplements are endorsed by expert doctors and which supplements are so powerful they are used in the hospital setting. Also in a future blog, I will discuss what to do if you encounter a fraudulent dietary supplement or one that produces a adverse effect and evidence that the placebo effect is alive and well.

Skin Whitening

October 10, 2013 — Leave a comment

imagesCA0QXOSJSkin whitening, skin lightening and skin bleaching

Skin that is a consistent color is definitely more harmonious, but is lighter always better? Anyone using a skin whitener over a long period of time runs the risk of pigmentation increasing to the joints of the fingers, toes, buttocks and ears. The skin of the face can become thinned and the area around the eyes can have increased pigmentation causing a “bleach panda effect.”

One of the most common skin lighteners is Hydroquinone. It comes in 2 percent (available in cosmetics) to 4 percent (or more) concentrations (available r by prescription), alone or in combination with tretinoin 0.05 percent to 0.1 percent. Hydroquinone also known as Eldoquin, Epiquin Micro, Lustra, Melanex requires a prescription.

How much do they cost? Starting costs for hydroquinone alone is prescription strength 4 percent (28.4 g): $44.00, nonprescription strength 2 percent (28.35 g): $28.90
Hydroquinone does not bleach the skin but lightens it, and can only disrupt the synthesis and production of melanin hyperpigmentation. It has been banned in some countries (e.g. France) because of fears of a cancer risk.
How well does it work? Hydroquinone – 2 percent to 4 percent. The highest concentration is most effective, but may be associated with more severe irritant contact dermatitis, hypopigmentation of surrounding skin, and, rarely, a bluish-black discoloration .

Because of hydroquinone’s action on the skin, it can be irritant, particularly in higher concentrations of 4 percent or greater and predictably when combined with tretinoin. Some medications have been created that combine 4 percent hydroquinone with tretinoin and a form of cortisone. The cortisone is included as an anti-inflammatory. The negative side effect of repeated application of cortisone is countered by the positive effect of the tretinoin so that it does not cause thinning of skin and damage to collagen.

In addition to being an anti-wrinkle cream, tretinoin also lightens the skin. But research has shown that the use of Tretinoin (also known as all-trans retinoic acid) can only be somewhat effective in treating skin discolorations.

Azelaic acid: requires a prescription. is naturally occurring component of grains, such as wheat, rye, and barley. Azelaic acid is used to treat acne, but it is also effective for skin discolorations.

How well does it work? In randomized trials, azelaic acid 20 percent cream or 15 percent gel was found to be more effective than hydroquinone 2 percent and equally effective as hydroquinone 4 percent. Common adverse effects of azelaic acid include erythema, burning, scaling, and pruritus.
Cream (Azelex External) 20 percent (30 g): $274.56, Gel (Finacea External), 15 percent (50 g): $232.18.

Some alternative lighteners are natural sources of hydroquinone. They are safer but more expensive. They include Mitracarpus scaber extract, Uva ursi (bearberry) extract, Morus bombycis (mulberry), Morus alba (white mulberry), and Broussonetia papyrifera (paper mulberry). All of these contain arbutin (technically known anhydroquinone-beta-D-glucoside). Pure forms of arbutin are considered more potent for affecting skin lightening (alpha-arbutin, beta-arbutin, and deoxy-arbutin). Beta-Arbutin is also known by its more common name of Bearberry extract. Arbutin is derived from the leaves of bearberry, cranberry, mulberry or blueberry shrubs, and also is present in most types of pears.

Kojic acid also naturally occurring and does not require a prescription. It is a by-product in the fermentation process of malting rice for use in the manufacturing of sake, the Japanese rice wine. Many cosmetic companies use kojic dipalmitate as an alternative to kojic acid because it is more stable in formulations. In addition to local irritation, kojic acid may cause allergic contact dermatitis.

Monobenzone and mequinol are depigmenting agents. They do not require a prescription unless they are combined with treninoin or hydroquinone.
Depigmenting agents can permanently destroy the melanocytes that produce skin color. It’s a chemical form of vitiligo, the condition that Micheal Jackson claimed to have had.
These agents work best where there are specific zones of abnormally high pigmentation such as moles and birthmarks. Conversely, in cases of vitiligo, unaffected skin may be lightened to match the affected skin and therefore achieve a more uniform appearance.

Other options are Cinnamomum subavenium is a Chinese herb, Niacinamide, licorice extract (specifically glabridin), pomegranate extract, ellagic acid, vitamin E, and ferulic acid.

Beware of skin-whitening products that use any form of mercury which can be harmful.


databaseThese are my secret websites that I go to when I need to find out the “scoop” on a nutritional supplement. Now that you know this you, too, can become an expert….if the information doesn’t bore you to death first. hahah. I find this stuff fascinating and so it doesn’t even seem like work for me to read through it.

Federal Trade Commission
Consumer Information: Dietary Supplements
Food and Drug Administration
Dietary Supplements
Dietary Supplements Guidance Documents
and Regulatory Information
Using Dietary Supplements
Dietary Supplements: What You Need to
Consumer Updates
Orange Book
Tips for Dietary Supplement Users: Making
Information Decisions and Evaluating Information
National Institutes of Health
National Center for Complementary and
Alternative Medicine
National Institute on Aging
Office of Dietary Supplements


Antiwrinkle Creams

October 8, 2013 — Leave a comment

images2Did you know there is a drug in the form of a cream that actually makes your skin thicker, smoother, plumper and radiant? Tretinoin/Retin A, is a cream that is proven to do that. It is also known as trans retinoic acid, retinA, avita, renova, and requires a doctor’s prescription.

It stimulates the skin by causing irritation. It’s like a mini-chemical peel every day.
It must be used in conjunction with a good moisturizer and sunscreen to reduce further irritation. Also, if you use a lower strength and apply it every other day or three times a week, your skin will adjust to it and you’ll be able to increase the strength over time. It may take up to six months to see the full effects.

It should not be used when pregnant because retinoids cause birth defects in animals. However, there is no direct evidence that topical retinoids cause birth defects in humans.

How much does it cost? Generic form 0.025 percent (20 g): $42.65, 0.05 percent (20 g): $50.22, 0.1 percent (20 g): $58. The price is more for the various name brands.

Similar to tretinoin/RetinA is Tazaroten 0.05 percent

or 0.1 percent cream. It is also known as Avage External and Tazorac External, may be used as an alternative to tretinoin. It also requires a prescription. Treatment is initialted with 0.05 percent cream or gel applied twice per week at night. The concentration or frequency of application is gradually increased over several days as tolerated up to 0.1 percent cream applied once daily.

How well does it work? According to one small study, Tazaroten 0.05 percent is equivalent to 0.1 percent of retin a.
How much does it cost? 0.05 percent (30 g): $279.16 and 0.1 percent (30 g): $296.56

Retinol and retinyl palmitate are a milder form of tretinoin/retinA and Tazaroten. They can be purchased over the counter without a prescription and costs start at $15.00 for an ounce and go up from there.

How well does it work? Nonprescription 1 percent retinol was as effective as .02 percent tretinoin in improving photoagining a small randomazided study. Similar to tretinoin/Retin a and tazaroten they increase collagen production to minimize lines and wrinkles, and speed cell turnover to even out discoloration caused by UV damage. Because it’s a milder agent, it’s a good starting cream until you build up a tolerance and switch to a higher strength of tretinoin/retin a or tazaroten.

Also available without a prescription are several anti-aging creams sold in the cosmetic department. They can contain antioxidants, vitamins, or plant extracts that can be used alone or with prescription strength anti-wrinkle creams. However, there are very few studies telling us which ones work the best. Small studies conducted by the company that is trying to sell you their product are the most unrealizable sources of information. When researching these products look for studies that use a lot of people. It’s even more reliable if is double blind and random controlled. That means the people conducting the study and the participants do not know which product is the placebo and which is the active product. Another sign of a reliable study is one whose results are reproducible by other researchers. Those are the kind of studies done on retin-a and other reputable products.

Beware of buying expensive cosmecueticals. Sometimes the less expensive ones work just as well.

Below is a list of the most common active ingredients found in nonprescription face creams.
Niacinamide, b3 which rdduced transepidermal water loss, lightens the sking and increases collagen production.
Vit C, protects for uva induced oxidateive damge, increases collagen formation, lightens the skin
Coenzyme q10: protects from uva induced damage and collagen damage.
Vit E. reduces uv induced redness
Alpha lipoic acied. Has anti-inflammatory properties and acts as an exfoliant.
Alpha and beta hydroxy acids. Increases exfoliation, improves hydrastion
Green tea extracts. Reduces redness and has antioxidant properties.
Soy isoflavanes –genistein and daidzein. Antioxidant, phytoestrogen, lightens the skin.
Grape seeds –antioxidant and anti-inflammatory to promote wound healing.
Coffee berry –antioxidant properties
Ginkogo bilobal –stimatates collagen formation
Ginsent –antioxidant and anti-inflammatory.
Hyaluronic Acid such as sodium hyaluronate or hyaluronan improves hydration

Exfoliants work by loosen the bonds between the dead cells in skin’s uppermost layer so they can be shed, improving texture and adding radiance. They also speed cell turnover. Products that improve hydration draw water to the skin to moisturize and temporarily plump. Antioxidants work by fighting free radicals (skin-destructive molecules produced by UV rays, pollution, allergens, and other irritants) to help prevent lines and wrinkles. Any product that increases collagen formation is making the lower layers of skin thicker and plumper. Anti- inflamitory products reduce redness, swelling, and tenderness.


Cosmetic Drugs

October 7, 2013 — Leave a comment

imagesCA1QS1VZMost primary care doctors usually don’t concern themselves with cosmetic drugs, so if you want one, you need to do your homework and bring up the subject. The best place to get information is the website MedlinePlus. It’s a government service of the U.S. National Library of Medicine National Institutes of Health and has no distracting or misleading advertisements. After reading about the drug you are interested in, I suggest Googling the prescribing guidelines and printing it for your doctor. This is also known as the package insert that comes with the product and is specifically written by the manufacturer for medical professionals.

Also, you have to be prepared to pay cash for the drug because insurance programs usually do not pay for cosmetic drugs.

If you go to a dermatologist or a specialist in the field of cosmetic medicine it’s unlikely that you will need to mention specific drug names, but if you plan on asking your primary care doctor for the prescription you might want to bring up the subject in a tactful manner. I would start out by telling the doctor all the things you have done to improve your health. Then I would say that since you are doing so well, you were wondering if you would be a candidate for the specific drug that you want. I would give the doctor the printed information and let him or her digest the situation.

If the doctor says no, you might want to ask the reason why and then work to remove that obstacle. You might even ask what you can do to remove that barrier.

Working with your primary doctor instead of a specialist in the field could save you a lot of money.

Cosmetic areas of improvement:
• thicker, longer, eyelashes
• reduced unwanted facial hair
• anti-wrinkle creams
• skin lighteners
• hair growth stimulants
For thicker, fuller and darker eyelashes use latisse also known as bimatoprost solution 0.03 percentpercent. It requires a prescription

It is applied to the lash line like eyeliner with an applicator that comes with the solution.
Eye irritation can be a side effect as well as brown pigment color change to the center of the eye called the iris. The frequency is less than a 3 percent and many people are willing to take that chance because it works so well.

How well does it work?
• 25 percent increase in lash length (vs. 2 percent for vehicle)
• 106 percent increase in lash thickness/fullness (vs. 12 percent for vehicle)
• 18 percent increase in lash darkness (vs. 3 percent for vehicle)
How much does it cost? For a 3ml bottle and applicators for a month, itwill cost about $124.79

To slow the growth of facial hair there is eflornithine 13.9 percent cream, also known as Vaniqua. It requires a prescription.

Originally a cancer drug, it was discovered to dramatically slow hair growth. A small amount is to be applied to the chin or upper lip area twice a day at least eight hours apart.
How much does it cost? 45 grams = $150.00
How well does it work? Eflornithine cream reaches its full effect in about four weeks, sometimes longer. Hair growth is slowed, but not completely obliterated. You will probably have to continue your current method of hair removal (e.g., shaving, plucking, cutting) to a lesser extent.

There are also pills available to slow unwanted facial hair, but you have to be tested for a hormone imbalance. These therapies include glucocorticoids, oral contraceptives (OCs), spironolactone, flutamide, finasteride, and insulin sensitizers (metformin and rosiglitazone).

Drugs that cause faicial hair in women are testosterone, danazol, anabolic steroids, glucocorticoids, cyclosporine, minoxidil, and phenytoin, and DHEA. Therefore stopping the use of one of the drugs could eliminate the unwanted hair.

See Anti-wrinkle creams blog
See Hair restoration and hair loss drugs.