Stone Turtle HealthNaturopathic Medicine and Massage Therapy for the Whole Family

While listening to Dan Savage's podcast the other night, I heard a head and neck specialist discussing the throat cancer and how an overwhelming percentage (70%!!) of them are caused by HPV, instead of tobacco use (study link here). Although vaccinations are an issue that many people feel strongly about, the HPV vaccine (which is currently being recommended for both girls AND boys) specifically focuses on HPV-16 and HPV-18, the two types of HPV that cause throat cancer, anal cancer (in both sexes) as well as vaginal and cervical cancer (in women). I've included a few links here, from the Oral Cancer Foundation and the CDC. While no one wants to think about children having sex, the window between vaccination age (beginning at 11 years old) and sexual experimentation may be, unfortunately, not that long. 

http://www.oralcancerfoundation.org/hpv/index.htm

http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm

As young adults in our late teens and early twenties, we can be exposed to HPV through oral sex or transference from another partner who has it in their throat (from performing oral sex on their previous partner) and the oral cancer will not show up in us until our late 30's or early 40's. Given that oral sex is generally seen as a "less risky" sexual behavior when discussing HIV and pregnancy, these findings are quite concerning because they may lead people to go back to more risky, penetrative intercourse to avoid exposure to a cancer-causing virus. As always, condoms, condoms, condoms!

Sunscreen. Sun block. Suntan lotion. What exactly is SPF? How much is enough? What is the FDA doing about it?

Now that we've (finally) got some sunshine in Seattle, it's time for a talk about sunscreen. Sunscreen is formed of organic and inorganic particles that are designed to block and/or absorb ultraviolet (UV) light from ths sun. Physical sunscreens reflect light, Chemical sunscreens absorb light. Many products have both forms inside. Blocking sunlight also blocks vitamin D creation, an issue that many patients have concerns about.

The SPF number reflects how well a sunscreen protects against UVB light, the type of UV ray that causes squamous cell carcinoma and basal cell carcinoma. It does not measure protection against UVA rays which cause melanoma or infrared light which also affects sun damage levels. UVB causes the most common types of skin cancer, but UVA causes the most deadly. SPF is, unfortunately, very inaccurate because most people don't put on enough. Also, wiping it off, swimming, and sweating all minimize its effectiveness, regardless of whether it is labeled "sweatproof" or "waterproof". Plus, we're supposed to be reapplying it every 2 hours, right? An SPF of 15 means that, theoretically, you're protected for 15 times longer than you would be without sunscreen. This, of course, doesn't take into account the changes in sun exposure throughout the day as the sun changes position in the sky.

The FDA has passed new regulations recently which will go into effect next year. These will require sunscreens to show that they block UVA and UVB rays in order to be labeled "broad spectrum" and only products with an SPF of 15 or higher can claim to prevent sun damage, wrinkles, and skin cancer. Further, no sunscreen manufacturers can label products as having an SPF higher than 50 because there is not enough evidence to prove that going above an SPF of 50 increases the benefit. The term "sunblock" can no longer be used, nor can "sweat-proof" or "water-proof". Instead, a product can be labeled "water-resistant", but then must state for how long, 40 or 80 minutes.

As always, staying out of the sun, avoiding tanning beds, and covering up with hats and long-sleeved clothing are very important in order to prevent sun damage, wrinkles, and cancer. If you're concerned about your vitamin D levels, talk to your doctor about alternate sources or about safer ways to get vitamin D naturally.

For more info:

Understanding Sunscreen Products - FDA

FDA Cracks down on Sunscreen Claims, bans 'sunblock'

What IS Sunscreen?

Skin Cancer, Sun, and Sunscreen

Last summer, the state of Washington amended our medical marijuana laws to include naturopathic physicians and nurse practitioners as providers who are legally permitted to write "authorizations" for medical marijuana use for patients suffering from a few very specific conditions. Since that time, I have worked with a number of patients who have had qualifying conditions and turned away even more folks who may have been suffering from pain but who just did not qualify or did not have the documentation to back up their claims of having qualifying conditions. Authorizations basically state that the doctor has advised the patient on the risks and benefits of medical marijuana and it is the doctor's opinion that the patient could benefit from using it. The law explicitly states that doctors cannot help patients obtain medical marijuana. Oddly, it's not illegal for the patient to possess medical marijuana, but it is illegal federally for anyone to buy or sell it. There are dispensaries, etc out there, but I can't tell my patients where to go. It's just a "Here you go, now you are allowed to treat yourself. Good luck finding some medication!" kind of thing.

One of my patients from last fall showed up in my waiting room last week. When I last saw her, my patient was recovering from brain surgery to remove a prolactinoma with associated pituitary apoplexy. In English, she had a prolactin-secreting tumor in her brain that had been causing bleeding in her pituitary gland, a tiny gland that sits behind the eyes and regulates most of the hormonal signals in the body. She was maybe 100 pounds, soaking wet, appeared very dizzy and disoriented, and was relying on her family to take care of her. She was only 28 and after I saw her, I went into my office and cried. I didn't think I had been able to do anything for her and she looked like she didn't have much longer to live. I wrote her an authorization, thinking that I would have written someone who was suffering like that as many authorizations as there are days in the week if I thought it would have done her any good.

Cut to 6 months later. She had been in to her oncologist's office to get fitted for a radiation crown, to begin irradiating the tumor that they couldn't remove surgically. A few weeks ago, in preparation, she had completed some imaging. When she got to the doctor's office, with a plan to see him every 3-6 months for the foreseeable future, she was told that he couldn't do anything for her. They had checked and re-checked, sent out for a second opinion and finally determined that there were no errors- there was simply no tumor visible in any of her scans. She was told by her oncologist that she no longer had to worry about radiation, about coming in every 3 months to poison her body in an attempt to gain a few more months. He said to come back in a year for a re-evaluation.

When she walked into my office last week, I hardly recognized her. There was no disorientation, no dizziness. She had put on enough weight and had such a healthy glow about her that she now looks like any other young woman walking down the street on a sunny afternoon. My patient told me that the only change she had made to her medication regimen had been to start creating and consuming capsules of hemp oil and hash oil mixed with powdered marijuana leaf. She told me of her oncology visits, that her doctors had told her they were going to launch studies searching for a link between tumor regression and medical marijuana. Most importantly, she told me that she is determined to enjoy life, to live each day in awe of the beauty that surrounds her, that she can find in little, everyday joys. We cried together a bit, and she promised me that she will be doing everything she can to get her story told, to bring more research money to help other cancer patients. Before she left, I was the one thanking her.

The good news is, she's not alone. Norml's blog entry talks about other research, dating all the way back to the 70's.

We're entering the time of year when many people get up and dressed in the dark, drive to work in the dark, and then drive home in the dark, after sitting all day in an office with fluorescent lighting. Many of us are exhausted all the time, regardless of our sleep habits. We need sun, really need it. Our bodies use sunlight to activate vitamin D, which is used in so many chemical reactions, from absorbing calcium in the digestive tract to supporting immune function and brain health. Without vitamin D, we find ourselves lethargic, depressed, with poor digestion, low back pain, and not functioning at our best mentally.

In the state of Washington, something like 80% of people are clinically vitamin D deficient, the highest rate in any of the 50 states, including Alaska. Washington also has the highest rates of MS, depression, and certain kinds of cancers. Not only that, but in many cases, people who test within the normal range (lab values between 30-100 are a typical normal range), may still not be getting enough vitamin D to adequately absorb all their dietary calcium. Values greater than 50 are necessary to properly absorb calcium, which is used in bone health (as we all know), brain function and also in muscle contraction and relaxation (skeletal, smooth, and cardiac). Without adequate absorption, our bodies begin to break down bone cells to release calcium, leading to osteopenia and, in some cases, osteoporosis. This bone damage begins in our 20s and women are particularly susceptible although it can happen to men, too. Weight-bearing exercise, such as walking or weight training, is also important to help maintain healthy bones, but without the calcium to lay down over the lattice of bone cells, bones become brittle and more prone to fracture.

 The vitamin D test is a very simple, cost-effective blood test that can be performed at any time of day (you don't have to be fasting) and is covered as a standard laboratory test by almost every insurance plan. Supplementation with vitamin D is an essential tool for getting through the dark winters of the Northwest and should be done under a doctor's care. Most over-the-counter supplements are either in a poorly absorbable tablet or are in insufficient dosages to have any significant effect on vitamin D deficiency. It is a fat-soluble vitamin that should be taken with food to aid in its absorption. Adults, pregnant women, and children all have varying recommended dosages and should seek professional testing and advice from their family naturopath before beginning supplementation.

And the most important caveat: Don't use tanning beds to try to ramp up your D levels. They project both the vitamin D- enhancing UVB light as well as the skin cancer-inducing UVA. Stay out of the tanning beds!

An article in the Telegraph, a prominent UK newpaper, states that the rate of throat cancer in men over 50 has increased by over 67% since the mid-80s. Being overweight is a significant risk factor for adenocarcinoma, the type of throat cancer studied by Professor Janusz Jankowski, a Cancer Research UK funded clinician at the Barts & The London School of Medicine & Dentistry in England.

The full article on increased rates of throat cancer  goes on to state that, while it is the 9th most common cancer in the UK, it is the most difficult to detect and treat, with only an 8% survival rate after 5 years.

Since cancer seems to be a bogeyman for so many people (wherease diabetes, heart disease, and other sequelae of poor lifestyle choices and obesity seem to elicit a resigned shrug), maybe this article, and the study, will garner more widespread attention to the difficulties ahead for overweight and obese people and help to motivate changes in lifestyle, diet, and exercise.

Today, I was given a link (via a FB friend and colleague) to what was termed "a visual representation of the research done on supplements". It's very pretty and interactive (you can click on a tab to gauge the benefits of a supplement as related to a specific category of illness). The link is here: http://www.informationisbeautiful.net/2010/snakeoil-scientific-evidence-for-health-supplements/

It's an interesting site, not just because of the visual qualities, but because they use interesting parameters to affect the size of the "balloons", each depicting a different supplement. The higher up the page, the more "large, human, randomized, placebo-controlled trials" were found in searches of two top search engines, PubMed and Cochrane. The size of the balloon reflects the number of Google hits for a supplement. I'm not entirely sure of the relevance of this, myself, since anytime a supplement comes into fashion, the number of websites and Google searches will correspondingly shoot up.

I look forward to seeing this specific illustration grow and change as the authors find more studies to validate or invalidate health claims made by people on both sides of the supplement argument. I would posit that, while many herbs, vitamins, and minerals have not been included because they have not been the focus of these large studies, there is something to be said for an herb with a 3000-plus year tradition of being used for a certain condition. This is termed "empirical evidence" (as opposed to evidence found using the scientific theory of forming a hypothesis, eliminating variables and testing the hypothesis) by people supporting a specific issue and "anecdotal evidence" by those opposing it. As humans, we have a wonderful capacity for assigning value to an object through spin, or, as I like to call it, creative wordsmithing.

For my practice, I will continue to suggest treatments that I've seen work, have been educated to understand why they work (what effect they have on the body physiologically), and have seen research on that is compelling enough for me to feel comfortable prescribing to my patients. Many, many of the treatments I use fall outside of the scope of this link and it's graphical representation, but I feel that they have a good grasp on the need to protect consumers from false health claims and a strong commitment to recommending demonstrably useful supplements. It's a great start to educating the public.