Richard G. Petty, MD

T'ai Chi Ch'uan and Shingles

Shingles can be a particularly nasty problem, and treatment can be tough. It should be called herpes zoster, and it is caused by re-activation of varicella zoster virus (VZV) that causes chickenpox.

A new study  from the Norman Cousins Center for Psychoneuroimmunology at UCLA, has shown that t’ai chi therapy can stimulate the immune system of patients with shingles to levels comparable to those achieved using a vaccine against VZV.

It was a controlled trial in which the researchers randomized 112 healthy adults aged 59 to 86, who had a history of varicella infection, to Tai Chi Chih (TCC, a simplified, standardized form of tai chi) or health education (HE) for 25 weeks. After 16 weeks of intervention, subjects were vaccinated against VZV. The results of blood tests showed that TCC alone increased immunity against VZV by an amount comparable to that induced by varicella vaccine in the HE group.

It was interesting that the effects of the two were additive; TCC, together with varicella vaccine, produced a substantially higher level of immunity against VZV than vaccine alone, raising it to levels usually observed in adults 30 years younger.

The tai chi group also showed significant improvements in scores for physical functioning, bodily pain, vitality, and mental health.

Regular readers will recall another report from this research group, indicating that TCC reduced the activity of the sympathetic nervous system. The two studies both show that there is something special going on: the practice does not only calm the mind and body, it also regulates parts of the body that are normally beyond voluntary control.

There are clearly plenty of reasons for taking up t’ai chi, though now we shall have to see whether other forms of t’ai chi can achieve the same results.

Acupuncture for Itch

Acupuncture has been used for every conceivable type of problem, and I have often been surprised how well it can help some skin problems. I was particularly impressed by its effectiveness in treating shingles, but I have sometimes also found that it can be very helpful in treating chronic itching.

So I was interested to see a study from Bochum in Germany in which 32 healthy volunteers had histamine applied to both forearms. Histamine is the chemical that normally causes a red wheal and a flare after being bitten by a mosquito or other bug.

Then, five minutes later, they had electroacupuncture of either the right or left ear. There are specific points on the ear that are said to be good for treating itching. They then re-tested the volunteers four weeks later, but this time without the acupuncture.

Acupuncture was found to significantly reduce  - and in some cases completely prevent – the areas of itchy redness, but only on the same side that had the acupuncture. So if the right ear was treated, the itch and redness was less on the right side, but not of the left.

This is an impressive demonstration of something that we have seen in clinical practice, but until now have never proven.

Sunscreens Are a Last... Resort

We talked recently about the ongoing discussion about whether sunscreens are harmful, and perhaps even the “cause” of skin tumors. The theory doesn’t make much sense.

And now there is a new report from Switzerland published in the Lancet, suggesting that thick fabrics such as denim and wool offer the best protection against the sun's rays, while traditional thinner summer fabrics such as cotton and linen are much less effective. I can attest to that, having been burned through a cotton shirt on a cloudy day in Singapore.

The researchers reviewed 500 studies and recommended staying out of the sun, or wearing thick clothes and hats. They say that using sunscreen is the least effective option, and should really be seen as a last line of defense against the potentially harmful rays of the sun.

Obviously we need to be practical: living in the Southern United States, there is no way that we could work outside wearing our winter woollies.

There are some lightweight clothes that offer up to 50+ UPF (ultraviolet protection factor). Another good option is to wash clothes in a specialty detergent that boosts the UPF of your everyday clothes for up to 20 washes.

So sunscreens it will have to be.

Sadly many people do not use them properly.

Here are the rules for using sunscreen:

• Use plenty: incorrectly applied SPF 30 is about the same as SPF 15-20
• Apply it before being exposed to the sun: most sunscreens work by reacting chemically with the skin, so they don't start absorbing damaging rays immediately and should be applied generously at least 20 minutes before going outside to reach maximum protection
• Reapply after swimming or sweating
• Try and avoid being outside between 11AM and 3PM
• Reduce you exposure to an absolute minimum if you have a personal of family history of skin cancer
• Make sure that you do not have any illnesses that may make you photosensitive
• Be extra careful if you are on any medications that can increase your sensitivity to the sun

   
If you are in any doubt about any lesions on your skin, have them checked by an expert.

It can be fun in the sun and nobody wants to be a killjoy.

But my own mother had a melanoma in her forties, almost certainly at a site that had burned repeatedly when she was a teenager. And for people who say that these cancers are caused by sunscreens, I'd like them to explain how a young man lost an eye after developing an ocular melanoma. I have it on good authority that he had never applied sunscreen to his eyeball.

There is little doubt that some people are more sensitive to the sun's rays than others, and if you have a family history, your may have the high risk genes.

Enjoy the sun, it can do you a lot of psychological as well as some physical good.

Just please be careful out there.


"May the sun bring you new energies by day. May the moon softly restore you by night. May the rain wash away any worries you may have. May gentle breezes refresh your soul and all the days of your life. May you walk gently through the world and know its beauty.”
--Unknown Author

Probiotics: Caveat Emptor Part 2

After I posted about the new data on the apparent importance of intestinal microorganisms and weight management, I received some very helpful comments and emails.

If you look at the "comments" section of the post, you will see this:

"www.Probiotic-Lab.com is manufacturing and distributing Bacteroidetes as a natural bacteria supplement for weight loss."
Posted by an "R.Russell"

Now I have previously reported on a conference in London at which a number of experts expressed concern about some probiotics available in the United Kingdom. So on your behalf, I not only posted the following response, but also emailed the company. First, because there is nothing on their website about marketing probiotics for weight loss and second because it is important to have these questions answered whether they are marketing probiotics for weight loss or for skin care.

This is what I wrote on the blog and also in my email to the company:

On behalf of my many readers may I ask www.Probiotic-Lab.com two questions?
1. In my posting I referred to a short piece that I wrote about a conference in London, at which some of the speakers warned that some products on the market did not contain the active ingredients claimed on the label. How do you guarantee the activity of your preparations?

2. Though I am very familiar with the use of probiotics - I first used them in, I think, 1982 - I am intrigued that you are already distributing Bacteroidetes as a natural bacteria supplement for weight loss. What evidence do you have that they are effective? I could not find anything on your website or from a search of the literature. If you have some data to share I would love to analyze it, and if it's of good quality I will go ahead and write about it, both here and in my articles.

Kind regards,

RP

I wanted to give them time to respond because of the holidays.

But as of today - seventeen days later - there has still been no response to my communications.

I also checked the scientific references on the front page of Probiotic Lab's website. The first does not have anything to do with weight or skin infections, but actually refers to a study of ear infections. The second reference is problematic: it refers to the "American Medical Journal." But sadly I am not familiar with a journal of that name. I have looked at a range of American Medical Journals in case the journal name or date is wrong. But again I can find nothing.

I shall be delighted if someone can help.

I also looked to see if there is any published peer-reviewed literature on the use of probiotics and either weight management or skin disease, and again I have not been able to find anything.

So you can draw your own conclusions.

Should any data come to light I shall report it. Or if the company responds, I shall post what they say.

Stress and the Skin

You have probably noticed how stress can have an impact on some people’s skin. Increasing stress can initiate or worsen skin disorders such as psoriasis and atopic dermatitis. There has also been a lot of discussion about whether stress can also exacerbate acne and cause cold sores to erupt.

A new study published in the December issue of the American Journal of Physiology-Regulatory, Integrative and Comparative Physiology sheds important light on this association.

It is well known that one of the physical effects of stress is to increase levels of a range of steroid hormones called glucocorticoids. The best known glucocorticoid is cortisol or hydrocortisone. So the question was whether the missing link between stress and skin problems might be one or other of the glucocorticoids.

Researchers from the Veterans Affairs Medical Center, San Francisco and the University of California at San Francisco and Yonsei University Wonju College of Medicine, Wonju, Korea decided to study this possible connection.

You may have heard that the skin is the largest organ in the body and provides the critical barrier between the environment and the internal organs. Its most important function is providing a permeability barrier that prevents us from drying out. When we are healthy we are approximately 65-70 percent water. We are able to survive and function in dry environments because the skin forms a permeability barrier that prevents the loss of water.

The physical location of the permeability barrier is in the outermost layer of the epidermis that is known as the stratum corneum. The stratum corneum is composed of dead cells surrounded by lipid membranes. The stratum corneum layer continuously sloughs off, and therefore has to be constantly regenerated. The epidermal cells in the lower epidermis are continuously proliferating to provide new cells, which then differentiate, move toward the surface and ultimately die, to form a new the stratum corneum. This process is going on in your skin right now, though it can be disrupted by damage such as sunburn. If the process becomes overactive, it can lead to the development of thick, hardened skin.

It was already known that psychological stress disturbs this elegantly balanced system by decreasing the proliferation of epidermal cells and inhibiting their differentiation. As a result the function of the permeability barrier is impaired.

To test the hypothesis that glucocorticoids would have adverse effects on skin function, they stressed some hairless mice by putting them in small cages in constant light and forcing them to listen to the radio for 48 hours.

Before being stressed one group of mice was treated with mifepristone, which you may know by its two other names, RU-486, or the “morning after” pill, which blocks the action of glucocorticoids. A second group was given a drug called antalarmin, which blocks glucocorticoid production. A third group was stressed but received neither drug and a fourth group remained unstressed in ordinary cages and without the continuous light and sound to which the other groups were exposed.

The mice that received mifepristone or antalarmin showed significantly better skin function compared to the stressed mice that did not receive either treatment.

The experiment demonstrated the important role that glucocorticoids play in inducing the skin abnormalities brought on by psychological stress. Although we hope that the study will lead to a way to treat people who suffer from these skin conditions, there is still a long way to go. It’s always difficult to extrapolate from mice to people. Second, there may be serious side effects of modulating glucocorticoid activity. Glucocorticoids are essential hormones that play many important roles. Blocking their action could have negative outcomes. This is one of the reasons why we are skeptical about advertisements that claim that some herbal concoction can “cure” cortisol-related obesity. If something could really modify the activity of cortisol or other glucocorticoids in the body, it would likely have many most undesirable effects.

The research team is now looking at the effect of psychological stress on the skin's production of antimicrobial peptides, which play a role in defense against infection. It has long been thought that psychological stress might also reduce the ability of the skin to protect from infections.

I never like to leave a report involving animal experiments without also saying a heartfelt thank you to the animals that participated in the experiments.

This research is interesting and may have a number of spin offs. But I have another rather obvious question: since we already know that there is a link between stress and some skin problems, why not focus on stress management techniques, rather than trying to find new medicines to help counteract the biochemical effects of stress?

Arsenic and Water Safety

Here is a new study that may turn out to be one of the most important of the year.

Tens of millions on people around the world, most particularly in Bangladesh, are forced to drink water containing dangerously high amounts of arsenic. The very same stuff that has been used by countless poisoners.

The classic symptoms of arsenic poisoning are:

• Headache
• Abdominal pains
• Vomiting
• Difficulty breathing
• Light headedness
• Delirium
• Neuropathy
• Stroke
• Skin lesions: usually thickening of the skin of the palms and soles with wart-like excresences
• Reduced production of red and white blood cells
• Increased risk of cancers of the lung, skin, bladder, liver, kidney and prostate
• Death

The exact pattern of symptoms depends on the acuity of the exposure, the amount of arsenic to which a person is exposed and the individual's own makeup.

The new research - published this week in the journal Science - is from Rice University's Centre for Biological and Environmental Nanotechnology in Texas, and it may give us a quick and cheap way of getting most of the arsenic out of drinking water. The investigators used minute particles of iron oxide - very similar to common rust - to bind large amounts of arsenic. The iron oxide particles are really tiny: just 12 nanometres (billionths of a metre) across, about 5,000 times smaller than the width of a human hair. When mixed into contaminated water, the tiny crystals became coated with the poison and began behaving like iron filings. The iron oxide/arsenic combination can then be removed from water using a simple hand-held magnet.

One of the investigators, Professor Doug Natelson had this to say, "The idea of using magnetic particles to filter and clean water is not particularly new. The trick here is that these particles are very, very small, which means they're essentially all surface. So the arsenic sticks to the surface of the particles, and what we've found is that when the nanoparticles are in the right range of sizes, you can pull them out of solution with a relatively small magnetic field gradient that you could get from, say, a permanent magnet."

As an additional refinement, the scientists needed to develop a technology that would be usable in one of the poorest parts of the world. In one experiment flakes of rust were made into nanoparticles by heating them in coconut or olive oil at 350C. They could then be used in water purification.

This is excellent news, and if confirmed, it could save hundreds of thousands if not millions of livees, and unspeakably awful chronic ill health.

Retinoic Acid and Suicide

Retinoic acid is an organic compound derived from Vitamin A, that is involved in the development of the brain and in normal visual function. It is because of the involvement in the formation of the brain that medicine containing retinoic acid like compounds must not be given to women who could become pregnant.

In recent years it has become clear that it is also involved in the function of the mature nervous system, and there have been suggestions that it may have a role in illnesses life Alzheimer's disease and schizophrenia.

One of the big breakthroughs in skin care was the introduction, in 1982, of a form of retinoic acid - isoretinoin - for the treatment of severe acne. It is marketed as Accutane in the USA and Roaccutane in the United Kingdom. Since its introduction there have been claims that it has caused depression and suicide in some patients taking it. The package insert specifically mentions this possible association. The trouble has been trying to sort out whether people taking it for acne became depressed because of the acne, whether it was the drug, or whether it was a chance association. 13 million patients have taken it world-wide, so sadly some depression might occur by chance.

That it was the drug causing the problem was supported by reports of people developing depression within days of starting the medicine. But it's always difficult to go from association to causality. After all, it has not been possible to prove that smoking causes lung cancer, though nobody doubts it, becuase the association between the two is so strong.

The Medicines and Healthcare products Regulatory Agency had received 1,588 reports of suspected adverse events experienced by people taking the drug up to this month. This included 25 people who died from suicide.

Now a paper in the journal Neuropsychopharmacology has added substantial support the the notion that the medicine may cause depression. The researchers gave a form of retinoic acid to adolescent mice. They found that while there was no change in the physical abilities of the mice, the rodents spent significantly more time immobile in a range of laboratory assessments designed to test their response to stress.

This was interpreted as a sign that the animals were exhibiting signs of depression.

It's difficult to extrapolate from mice to humans, and this certainly does not nail down the problem. It also does not mean that people should stop their treatment: this medicine works. But it emphasizes the importance of doing what the package insert says: watching young people with acne who are on treatment for any signs of depression.

Aging, Skin and Cancer

There’s a very interesting paper in this month’s issue of the journal Developmental Cell, based on research conducted at the Oregon Health & Science University in Portland, Baylor College of Medicine in Houston and Leiden in the Netherlands.

The investigators have found a pathway through which a gene's over-expression causes stem cells in the skin to switch from creating hair follicles to creating sebaceous glands. This discovery may not only provide us with new ways of treating hair loss and oily skin, but it may help us to prevent and treat some cancers.

Skin cells turn over very quickly: just think how fast a graze gets covered over. Epidermal stem cells give rise to the outer layer of the skin that serves as a barrier for the body, as well as generating the follicles that produce hairs and sebaceous glands. These glands produce oils to lubricate the skin. In aged skin, a protein called Smad7 is overproduced, which triggers hair loss and sebaceous gland growth.

This is the first study definitively to link Smad7 over-expression and the pathological changes that occur in aged skin.

Here’s the twist: Smad7 shuts down signaling of another group of genes called Wnt. It binds to a Wnt signaling protein known as Beta-catenin and degrades it with an enzyme called Smurf2. (I don’t known why they decided to call it’s call it Smurf: it looks like ponderous chemical humor to me!) Wnt signaling is critical for organ development, but if Wnt signaling is too active, it also causes cancer.

Enhanced Beta-catenin signaling contributes to many types of cancer, including colon, lung and brain. Perhaps inducing over-expression of Smad7 or delivery of Smad7 directly to tumor cells would provide a therapeutic approach because of the boost in Beta-catenin degradation.

And finally, impaired Beta-catenin signaling contributes to neurodegeneration, such as that found in Alzheimer's and Parkinson’s diseases, retinal degeneration, some bone density defects and aging. For these diseases, blocking Smad7-mediated Beta-catenin degradation may offer a therapeutic approach.

Blueberries

One of the principles of integrated medicine is that anything that’s good for you should have more than one benefit. So omega-3 fatty acids may help with cardiovascular health, mood, memory, attention deficit disorder, as well as the health of skin and bones.

Another one is the blueberry. I’ve been sufficiently impressed by the data on the health benefits of blueberries to have been a regular grower and consumer for years. They contain a number of potentially healthful compounds including polyphenols and anthocyanins, which can help modulate and balance the free radical systems of the body. Remember what I said recently about the value of keeping some free radicals in the body? The last thing that we want to do is to be rid of all of them!

There is reasonably good evidence that regularly eating blueberries can support cardiovascular health and there have been suggestions that they may reduce the risk and aggression of cancers of the prostate and colon.

There is also some evidence in animals that some of the components of blueberries may reduce inflammation and the effects of strokes – interruptions to the blood flow in the brain.

As a consumer, I’ve been carefully watching the growing evidence indicating that blueberries – or some of their constituents may have effects on animal cognition, brain aging and the normal neuroprotective mechanisms in the hippocampal region of the brain.

We do not yet have proof that these same effects occur in humans, and there are always three questions when we look at nutritional data:

1. Can we extrapolate from the animal to humans? Mice are not men
2. Are the amounts of blueberries or blueberry extracts even close to what humans could consume without spending all day eating, or getting a terribly upset intestine? There have been countless reports of the benefits of supplements that had to be taken in the most enormous doses to do any good. I’ve mentioned before the problem of L-arginine, which is sold as a “Natural Viagra.” Except that you need to take around nine grams for it to do much good, and most supplements contain less than a tenth of that. Regular readers will also remember my report concerning an article on coffee and sex. It was said that coffee would raise a woman’s libido. And indeed it does, if she drinks at least ten large cups of coffee at once. And coffee is a marvelous diuretic.
3. When extracts are used, are we sure that we are getting the correct ingredient of the fruit? Many beneficial fruits contain just the right combination of nutrients to help us, so each can be taken in a small dosage or concentration. As with so much in integrated medicine, combinations are key. Take out one extract of a fruit, and you may lose the clinical effect that you wanted.

All that being said, the evidence is becoming progressively more interesting, and there is enough suggestive evidence for me to keep packing away the blueberries.

And just to show that I leave no stone unturned when checking the literature on your behalf, I rejoiced to learn that supplementing the diet of Arctic char with various supplements - including blueberries – improved the quality of his, ahem, semen. I do not know how this information will help any of us yet. Neither do I really know why a fish would want to eat blueberries or any of the other supplements that they were tried on. Though I'm sure that people have often asked similar off the wall questions about some of my research....