Welcome to Dr. Paz’s Newsletter #9

 

This newsletter will focus on timely topics that can have a direct impact on your health. If you are interested in sending a question, you can send it to drpaz@drpaz.com.  Please remember,  your questions should be of general medical interest and should not include any patient-specific information since this is not a HIPAA compliant email.

 

 

Supplement Recommendations and Full Disclosure

 

Beginning with this newsletter, I will start recommending specific brands of supplements. The supplements I recommend are only available through healthcare practitioners. I have decided to do this for several reasons. As you may know, the supplement industry is not regulated in the same fashion as the pharmaceutical industry. As a result, it is possible to purchase supplements that are very poorly made, contain contaminants and have little or none of the expected ingredients. By way of an example, here are a few recent headlines from Consumerlab.com, which independently purchases supplements and reviews them for quality:

31% of Protein Powders & Drinks Fail ConsumerLab.com Review

ConsumerLab.com finds quality problems in 7 of 24 omega-3 supplements

Majority of Nutrition Bars Fail ConsumerLab.com Testing

 

Because of this, I have chosen several manufacturers that I have personally vetted and I believe produce extremely reliable products. These are not always the cheapest available of a given type, but the old adage "you get what you pay for" certainly applies here. Clicking on links in the newsletter, or going to my website will get you to these products.

 

The cost to maintain a website, produce a newsletter and to maintain malpractice insurance have steadily risen. (Yes, I need malpractice insurance to write a medical newsletter.) By purchasing supplements through my website and newsletter, a small portion is returned to me so that I can continue with the work of keeping you informed on important medical issues. This does not increase your cost in any way. It does ensure that you will be purchasing a high-quality supplement to help accomplish your health goals.

 

Clinical Focus- Natural Treatments for Anxiety

 

The Covid Pandemic, inflation, the falling stock market, housing prices, political unrest—  it seems the world is full of more than enough issues to generate anxiety in all of us. For many of us, these worries turn into full-fledged anxiety disorders. Data from the National Co-morbidity Study Replication (NCS-R), suggests an estimated 19.1% of U.S. adults aged 18 and older had an anxiety disorder in the past year, with a higher prevalence in females(23.4%) than for males(14.3%). An estimated 31.1% of U.S. adults experience an anxiety disorder at some time in their lives.

    According to the Harvard Medical School 2007. National Comorbidity Survey (NCS), among adults with an anxiety disorder, an estimated 22.8% had serious impairment and 33.7% had moderate impairment, which interfered with their daily lives.

 

What is Anxiety? Anxiety is defined as “a feeling of worry, nervousness, or unease about something with an uncertain outcome.” Anxiety disorders are the most common mental illness in the United States.  While there are many different types of anxiety disorders, they all share a common symptom: fear or worry that is out of proportion to the actuality of the situation.

Anxiety disorders can be debilitating, making it difficult to function in day-to-day life. Fortunately, there are a number of natural treatments for anxiety that have been shown to be effective in reducing symptoms. Moreover, it is important to understand that anxiety is a normal emotion that everyone experiences at some point in their life.

 

 

 

Natural Treatment Options for Anxiety

 

EXERCISE.  Regular, aerobic exercise has long been shown to reduce symptoms of stress, anxiety and depression.  It also clearly improves sleep.  In order to use exercise for this purpose, it needs to be rather vigorous.  You will need an activity that makes you "huff and puff and break a sweat".  I would recommend approximately 150 minutes per week of this type of exercise to treat anxiety. Of course, check with your doctor before starting any new exercise program.

https://link.springer.com/article/10.1186/s12913-018-3313-5

 

TALK THERAPY.  It is important to recognize that no amount of medication or supplements will fix a bad relationship, hostile work environment or other painful life circumstances.  However, talk therapy with a therapist trained in this area can make a huge difference in recognizing the underlying problem and taking steps to correct it.  There is no shame in seeking the help of the therapist and many times this may be the treatment of choice. https://www.tandfonline.com/doi/abs/10.1080/10503307.2020.1729440

 

WEIGHTED BLANKETS.  A weighted blanket looks just like any other blanket. You probably wouldn’t notice any difference until you lift it and discover it’s much heavier than it should be. What gives weighted blankets their weight is their filling. Unlike standard blankets that might use feathers or polyester-type stuffing, weighted blankets are typically stuffed with glass beads or plastic pellets.

Weighted blankets come in various sizes, often weighing between 3 and 30 pounds or more. You can also find weighted blankets for anxiety in many styles to match your décor, from bedspreads to ones that resemble knitted works of art. 

A growing body of research supports using weighted blankets for anxiety. The consistent pressure of weighted blankets may replicate the benefits of deep pressure therapy and stimulate the parasympathetic nervous system. When your parasympathetic nervous system is active, feelings related to stress exposure begin to decline. Weighted blankets don’t require a prescription.

https://research.aota.org/ajot/article-abstract/74/2/7402205010p1/6662/Weighted-Blanket-Use-A-Systematic-Review

https://nwcommons.nwciowa.edu/celebrationofresearch/2019/researchprojects2019/28/

 

AYURVEDA.  This is an alternative medicine philosophy originating in INDIA over 5,000 years ago. Treatment combines natural products derived mainly from plants. Diet, exercise and lifestyle changes are also important components of Ayurveda.  For years I have prescribed a product called TRAN Q which has its origins in Ayurveda.  I have prescribed this with great success as a "natural XANAX".  It can be used on an as-needed basis to reduce stress and anxiety.  It can also aid in sleep.

It is a proprietary blend available through the Metagenics company. You can click HERE to order.

 

ASHWAGANDHA.  Withiania somnifera, known commonly as ASHWANGANDHA or winter cherry is an evergreen shrub in the nightshade family that grows in India, the Middle East, and parts of Africa. This is my first choice for long-term therapy. It has been used very successfully to stabilize stress hormones and reduce overall anxiety.  It is usually taken twice daily.  Typical doses range from 250-500 mg twice daily.  Finding high-quality ASHWANGANDHA can sometimes be a problem.

 Recommended Ashwagandha brands can be found in my Anxiety Protocol by clicking here.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8762185/

 

L-THEANINE.  This is an amino acid or building block of proteins found primarily in green and black tea and some mushrooms. L-Theanine can increase the brain hormones Serotonin, Dopamine and GABA which help regulate mood and sleep. It has very potent anti-anxiety properties when used regularly.  It is usually used twice daily or at bedtime to aid in sleep.  The typical dose is 100 mg twice daily. 

Recommended L-Theanine brands can be found in my Anxiety Protocol by clicking here.

 

https://link.springer.com/article/10.1007/s11130-019-00771-5?crsi=6624964158&cicada_org_src=healthwebmagazine.com&cicada_org_mdm=direct

 

DHEA. This  is one of the few true hormones that can be purchased over-the-counter.  It is normally made by the adrenal gland.  It is considered a sex hormone and can be converted into both ESTROGENS and TESTOSTERONE in the body.  Dosing and blood levels should be monitored by a physician.  Clinical evidence of its benefits for anxiety and depression is primarily in animal models and few human studies are available. I mention it here because I have used it successfully in clinical practice for years, especially in the elderly. It should be used with caution in anyone with a hormone sensitive cancer.

Recommended DHEA brands can be found in my Anxiety Protocol by clicking here.

 

https://www.sciencedirect.com/science/article/abs/pii/S009130570600311X

 

Cannabidiol(CBD). This is a major component in cannabis(Marijuana). It can be obtained as a singular component without any traces of THC, which is the hallucinogenic component of Cannabis. While delta-9-tetrahydrocannabinol (THC) can have a bad rap for being intoxicating and anxiety-inducing, cannabidiol (CBD) can actually be used to relieve anxiety. Research supports this benefit, with several studies reinforcing the positive effects CBD can have on various anxiety conditions.

The brand becomes quite important here since there is a lot of very poorly processed CBD on the market that may have very little effect.   For my preferred brand click here. Typical dosing for anxiety is one daily.

https://www.sciencedirect.com/science/article/abs/pii/S154431911930514X

https://link.springer.com/article/10.1007/s13311-015-0387-1?correlationId=4d9ea02c-da9a-44df-a279-bfae59b39531&error=cookies_not_supported&code=8f8987c3-1bf2-4f1d-9bc8-b38879f4402d

 

MAGNESIUM. This is a mineral that is responsible for over 300 reactions in the human body. It is a natural muscle relaxant and can aid greatly in anxiety and sleep. Foods high in Magnesium include: Pumpkin seeds, Chia seeds, Spinach, Almonds, Cashews, Black beans, Peanut butter and Brown rice. The form of magnesium can make a significant difference in its overall effects. Magnesium Threonate is generally preferred for anxiety because it better penetrates the blood/brain barrier delivering the mineral where it counts- your brain.

Recommended Magnesium brands can be found in my Anxiety Protocol by clicking here.

 

https://www.mdpi.com/2072-6643/9/5/429?ref=iBS3b30HWbLi

https://eprints.whiterose.ac.uk/111407/

http://www.thehealthcloud.co.uk/look-magnesium-l-threonate-benefits/

 

Why not just take Xanax? XANAX and other antianxiety drugs do have a place in the treatment of acute anxiety when used for very short periods of time.  Typically uses would be after the death of a loved one or to treat fear of flying.  However, long-term use is frequently accompanied by a long list of side effects including fatigue, memory loss, depression, falls in the elderly and potential withdrawal syndrome if stopped suddenly.  There is evidence that long-term use of drugs like XANAX significantly increases the risk of dementia.

https://www.webmd.com/anxiety-panic/what-are-anxiolytics

https://www.hindawi.com/journals/bn/2016/3730940/ 

 

Medical News and Commentary

Getting the Flu vaccine and Covid booster together? Maybe you should re-think that. The flu season is upon us.  I am generally in favor of the flu vaccine, especially in patients who are at high risk.  The ideal time to receive this is October through November.  The CDC is also recommending the new-variant Covid booster shot.  They state that getting both together is safe.  However, a study recently published in the Journal of the American Medical Association(JAMA Network) suggests that there is a significant increase in side effects when both are given simultaneously.  Their conclusion:” simultaneous administration of COVID-19 mRNA booster and seasonal influenza vaccines was associated with significant increases in reports of systemic reactions during days 0 to 7 following vaccination”

My recommendation: If you are going to receive both vaccines, I would recommend 4-6 weeks between each injection.  This will help to minimize side effects.

 

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794318 

 

Under 65 and have Covid? Maybe Paxlovid is not for you. Pfizer’s COVID antiviral Paxlovid appears to have little or no benefit for younger adults, although it still reduces the risk of hospitalization or death in seniors, according to a new Israeli study. In a study of 109,000 patients researchers found that Paxlovid reduced hospitalizations among people 65 and older by roughly 75% when given shortly after infection. But people between the ages of 40 and 65 saw no measurable benefit, according to the analysis of medical records. If you contract Covid, you should first consult with your doctor regarding the best treatment. If you choose not to take Paxlovid, you might consider the Vitamin protocol I outlined in Newsletter #6

 

https://www.marketwatch.com/story/study-finds-pfizers-antiviral-has-little-or-zero-benefit-for-younger-adults-and-who-says-ba-5-omicron-subvariant-accounted-for-74-of-cases-in-latest-week-11661438030?siteid=yhoof2

 

Food “use by dates”- Follow your nose, not the date. We’ve all seen these labels on food: “best by,” “use by,” “best if used before,” “best if used by,” “guaranteed fresh until,” “freeze by” and even a “born on” label applied to some beer. While these labels are interpreted as expiration dates by the public, they are actually picked arbitrarily by the food manufacturer and are not regulated by the FDA. For example, a food producer may survey consumers in a focus group to pick a “use by” date that is six months after the product was produced because 60% of the focus group no longer liked the taste. Smaller manufacturers of a similar food might play copycat and put the same date on their product.

 According to Jill Roberts, Associate Professor of Global Health, University of South Florida, this confusion is likely responsible for around 20% of the food wasted in the home, costing an estimated $161 billion per year.

So, what should you do? In the absence of a uniform food dating system, consumers could rely on their eyes and noses, deciding to discard the fuzzy bread, green cheese or off-smelling bag of salad. However, I would encourage you to pay close attention to the dates for more perishable foods, like cold cuts, in which microbes grow easily.

 

https://www.yahoo.com/news/food-expiration-dates-dont-much-122641713.html

Tea Drinker? You may live longer. Scientists from the National Cancer Institute used a large database project that asked about the tea habits of nearly a half million adults in the United Kingdom, then followed them for up to 14 years. They adjusted for risk factors such as health, socioeconomics, smoking, alcohol intake, diet, age, race and gender.

The result? Higher tea intake — two or more cups daily — was linked to a 9% to 13% lower risk of death from any cause vs. non-tea drinkers. Tea temperature, or adding milk or sugar, didn’t change the results. These results were for black tea. Green tea may prove to be even more beneficial.

https://www.acpjournals.org/doi/10.7326/M22-0041

Like Potato Chips? They may shorten your life. Ultra-processed foods, like potato chips, shorten your life. Ultra-processed foods are foods that have undergone an extensive transformation of the original food and often contain only extractions of the food. A 2019 commentary in the journal Public Health Nutrition defined ultra-processed foods as “industrial formulations of processed food substances (oils, fats, sugars, starch, protein isolates) that contain little or no whole food and typically include flavorings, colorings, emulsifiers, and other cosmetic additives.” Examples may include processed reconstituted meat products, potato chips, candy, store-bought cookies, soft drinks, refined grain pretzels, commercial bread, sweetened breakfast cereals, and baking mixes.

Recent studies from the British Medical Journal suggest the  consumption of large amounts of ultra-processed foods resulted in a 29% greater risk of colorectal cancer, primarily in men.  Another study linked ultra-processed foods to higher death rates especially from cardiovascular disease. Additionally, ultra-processed foods have been linked to dementia. A study with more than 70,000 adults 55 and older found each 10 percent increase in ultra-processed food consumption was associated with a 25 percent higher risk of dementia and a 14 percent higher risk of Alzheimer’s disease. 

 

https://www.bmj.com/content/378/bmj-2021-068921

https://www.bmj.com/content/378/bmj-2022-070688

https://n.neurology.org/content/99/10/e1056

A daily multivitamin or chocolate for your brain?  The multivitamin wins. A recent study presented at the 14th Clinical Trials on Alzheimer's Disease Conference yielded some surprising results.  It compared 2200 participants age 65 and older for 3 years.  The purpose of the trial was to see if cocoa-containing products could improve cognition.  This was compared with a daily multivitamin.  Results showed that the daily multivitamin had significant benefits in overall memory and cognition, but the cocoa was not beneficial.  This was especially true in individuals with cardiovascular disease.

Dr Paz comments: I suspect the results were primarily due to the B vitamin content of the multivitamin.B vitamins, especially the methylated forms are essential for proper brain functioning. When picking a daily multivitamin, I would suggest you pick a moderate potency vitamin with methylated B's such as Metagenics PhytoMulti

 

https://www.mdedge.com/familymedicine/article/257885/alzheimers-cognition/vitamins-or-cocoa-which-preserves-cognition?ecd=WNL_FAM_220918_mdedge

Does your doctor measure your BMI? It may not be very useful. While we all know that obesity can increase our risk of cancer, heart disease, diabetes and shortened life expectancy, what is the best way to measure it?  Doctors have long used BMI (Body Mass Index)–a comparison of your height to your weight to determine obesity.  A normal BMI is between 20 and 25.  If your BMI is 30 or greater you are considered to be obese. You can find a simple  BMI calculator here.

However, this calculation has its limitations.  For instance based on this standard, virtually every linebacker and the National Football League would be considered obese.  Clearly they are not, given their total amount of muscle mass.  Additionally where you carry your extra weight can make a significant difference in risk.  New evidence shows that alternative measures other than body mass index such as a waist-to-hip ratio work better for predicting the risk of person with overweight or obesity faces from their extra weight. You can find instructions on measuring a waist-to hip and a calculator here

 

https://www.mdedge.com/familymedicine/article/258105/obesity/waist-hip-ratio-beats-bmi-predicting-obesitys-mortality-risk?channel=39313?ecd=WNL_FAM_220922_mdedge

 

 

IT’S JUST MY OPINION. The opinions in my newsletter are based on my interpretation of the literature and my personal experience from tens of thousands of medical visits over the last 37 years. 

  

TALK TO YOUR DOCTOR. The information I share in this newsletter is meant for general medical information purposes and is not specific to your medical care. Before you initiate any therapy you should discuss it with your doctor.  If your doctor is not open to discussing nutritional therapies, maybe it is time to find a new doctor….. 

Check out my website