Legalizing Marijuana, What Might the Future Hold?

With all the excitement and controversy swirling around the legalization of Marijuana, as a physician I have no choice but to consider what negative ramifications might be in store for our country. Here are just a few of the many issues we must all consider.

What could be the adverse health consequences of rampant and regular marijuana use? Over the past few years, studies have begun to demonstrate unfavorable psychiatric fallout from marijuana. Schizophrenia, and other disorders of psychosis, it seems can be expressed in predisposed individuals who utilize the drug. The incidence of schizophrenia is already one in a hundred. The toll this disease takes on not only the patient, but also the entire family, is enormous. A life-long disease with no cure in sight, schizophrenia leaves its victims unable to function adequately in society, often leading to homelessness and premature death. There is also of course an associated financial burden our society bears from the disease. Imagine then the consequence of even a minor uptick in the frequency of this disorder. Anyone who understands schizophrenia would agree that saying it would be horrific is a gross understatement.

Then there is heart disease. Just last week a study was published citing an association of marijuana with premature heart attacks. Right when doctors are making inroads into reducing heart disease, we may now be unleashing a new and previously unrecognized threat. Remember the days of the great cigarette ads, “LSMFT. Lucky Strike means fine tobacco.” In days of old, tobacco use was the norm; nearly everyone smoked. Socially, it was the thing to do. Then came the studies proving the relationship between tobacco and heart attacks, strokes, chronic obstructive lung disease, and of course death. Following the studies there were lawsuits. The tobacco industry paid dearly for being less than forthright about the potential downside of smoking. The attorneys did quite well, bringing in personal gains of a billion dollars. Tobacco’s victims however did not do so well.  Will marijuana become the tobacco of our future? Have we just begun yet another global experiment testing the effects of a substance on us, the American populace? If so, let’s at least prepare for the fallout.

To protect our society as best as we can, I propose the following. Wherever marijuana becomes legalized, set aside a large portion of tax revenue for future payment of medical expenses related to marijuana’s use. Also, be sure to allocate enough funds to cover the lawsuits that will surely follow our inevitable acceptance of marijuana’s health dangers. Perhaps not just the marijuana sellers will be held accountable. If a government earns revenue through taxation of marijuana, might not the government be liable through complicity? I would also recommend that all marijuana users be forced to sign a waiver of liability. Let the finest attorneys craft this document so it can be as solid as is legally possible. Then, when the lawsuits start flowing in, marijuana enthusiasts will have a much tougher time blaming others for their choice. They need to be fully informed of the potential risks of marijuana, and their understanding must be well documented. Let’s not repeat the tobacco experiment with all its attendant errors. If marijuana is to be the next widespread health hazard, let’s at least protect the nation’s financial interests. Clearly our country is not in a position to take on any more debt.

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Two Recent Supplement Studies Merit Mentioning – Vitamin D and Glucosamine Sulfate

Two recent trials addressing commonly used supplements are worth noting as they exemplify pertinent and prevalent issues facing physicians and patients every day. One deals with vitamin D, the other with Glucosamine Sulfate.

The vitamin D study, published out of the University of California San Diego in Anticancer Research, is entitled “Meta-analysis of Vitamin D Sufficiency for Improving Survival of Patients with Breast Cancer.” In the trial, patients with the highest vitamin D levels had the best outcomes. This group had an average 25, OH-Vitamin D level of 30 ng/ml. The initiated should instantly recognize that this number lies on the lowest edge of a normal range for vitamin D. Yet, the press reported the following, “High vitamin D levels may increase breast cancer survival.” So what might an uninformed reader assume? Take large quantities of vitamin D to shield you from breast cancer, of course. This clearly is not at all what the study concluded. A more appropriate title for the press might have been, “Very low vitamin D levels associated with worse breast cancer outcomes.” Our takeaway message is probably to avoid very low levels of D. But, we should in no way infer that very high D levels protect us from cancer (or anything else for that matter). Some trials even suggest that very high D levels might be dangerous. Once again the ideal reaction to this single piece of evidence is simply to speak with your doctor. Have your vitamin D tested. If your level is very low, supplementation is likely in order. If your level is normal, probably no further action need be taken. The key though is not to act alone. This type of discussion is another opportunity to engage your physician and help develop your own brand of personalized medicine.

The second trial evaluated what was described by the press as a “new form of Glucosamine” – Glucosamine Sulfate. First, please understand that Glucosamine Sulfate has been available for decades. Being more costly than its counterpart, Glucosamine HCL, it is typically found in only superior products. For me the interesting aspect of this trial (published in The Annals of Rheumatologic Disease) is that in a double blind placebo controlled fashion (the purported king of clinical trials) Glucosamine Sulfate was shown to statistically significantly decrease joint space narrowing over a two-year follow-up period. Older studies had similar findings, and consequently for the past ten years I’ve recommended a Glucosamine Sulfate-containing joint product that I formulated for VitalRemedyMD called JointFormula (catchy name I know). I’ve received nearly universal patient reports of improvement in joint discomfort. Anecdotally, results have been most dramatic in the hands and knees. Many of those who take JointFormula have written notes of gratitude, thanking us for helping them avoid knee replacement surgery. Yet, some trials other than the above-mentioned have “proved” the worthlessness of Glucosamine. How do we explain this to our grateful patients? Placebo effect is surely a possibility. It is also possible that what works in one person might fail in another. And, we must always acknowledge that clinical trials are not the final word. We see enough discordance of conclusions among the trials; so by this observation alone we should know that trials are hardly ever truly “conclusive.” The lesson from this study is that there will always be conflicting results among clinical trials. The ultimate decisions regarding patient care always reside between patient and doctor. Trial results help guide doctors; they should not shackle them. And, patients should not be made to feel foolish for their beliefs, nor should doctors be made to feel unscientific for theirs. Instead, doctors need to continue “practicing” medicine as best as they can, and patients must remain their own most potent advocates for health and wellness.

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Carpe Diem

Carpe Diem – Seize the Day! This powerful dictum always brings me back to Robin Williams’ moving portrayal of the beloved and inspiring professor in the film Dead Poet’s Society. It is a call to action, a renewal of the spirit and a return to optimism and determination, like the feeling of hopeful yearning we experience when we pledge those New Year’s resolutions. As the clock ticks away the final minutes of the old year, the excitement can be intoxicating. But so often we fail. After the rush of the New Year’s celebration fades and reality sets in, those ambitions can once again seem insurmountable. The truth is we very often unknowingly set ourselves up for failure.

Maybe this year we can keep a few rules in mind: Be realistic, keep it simple, and understand that self-motivation is essential when it comes to making real changes in your life. You have to be the one who is convinced you need to make a change. You have to really want it; your desire to make the change has to be greater than the desire to keep things the same. If you’ve ever spoken to someone who successfully stopped smoking or made any significant and lasting lifestyle change and asked them how they did it, the answer is always the same: “I wanted it and I just did it!”

Be realistic. Create short-term goals and make changes in small steps that are part of longer-term goals. If you need to lose twenty-five pounds, focus on losing five pounds. And instead of trying to lose five pounds in a week, focus on losing one pound a week. Acknowledge and reward your efforts and progress each step of the way, and never abandon your goals because of momentary failure or neediness. Remind yourself where you were last week or last month. If you are doing anything more than before, you have made progress. If you remain on the path you have chosen and your goals remain in view, your chance of attaining them becomes ever more likely.

Don’t get caught up in the false hope of quick fixes when it comes to making lifestyle changes. It is unfair and foolish to think that decades of unhealthful habits can be eradicated in a week or two.

Finally, don’t fall into the trap that fixing one thing you think has gone wrong is going to change your life. Getting to your ideal weight or driving a fancier car does not equal happiness. It’s not about trading places with someone else who seems to be better off than you are, or looking like the model on the cover of Vogue or GQ, and it’s not about turning back the hands of time. It’s about striving to be the best version of you at this moment and investing in your future. Health and happiness comes as a result of taking better care of you, inside and out, and requires addressing a multitude of factors every day of our lives. Don’t wait for all the stars to be in some perfect alignment; start now in the midst of everything. Today is the first day of the rest of your life.

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Learn to Read the Label: What to Look for When Choosing an Omega-3 Fish Oil Supplement

Omega-3 fish oil supplement labels can be very deceiving. This video explains how to choose the appropriate fish oil supplement.

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When Passions Collide – Omega-3s Are Essential So Why Would We Remove Them From Our Diets?

Last week the Cleveland HeartLab held its fourth annual Clinical Symposium. Excellent speakers addressed the group of some four hundred physicians and nurse practitioners from across the country. One in particular spoke with passion and unswerving conviction about his brand of a “no heart disease” diet. Dr. Caldwell Esselstyn vociferously and vehemently admonished the audience not to include any oils in their diets. “No oils” he repeatedly shouted pounding his fists in the air. No one can deny he walks his talk; he is extraordinarily svelte, clearly carrying no superfluous fat on his own body. My talk was about the essential role omega-3 and omega-6 fatty acids play in health and disease. And I too have my convictions and passions. And so we collided.

I steadfastly adhere to a worldview incorporating moderation, scientifically rigorous reflection on every aspect of human beings (from our evolutionary roots to the most reductionist biologic understanding), and acknowledgement that we do not and likely will never know everything. My position does not make room for Dr. Esselstyn’s view. His is simply too extreme. It also fails to consider the fact that human beings cannot adequately produce some vital fats such as EPA and DHA; those afforded us by our friends, the fish. EPA and DHA are indisputably essential contributors to the entire gamut of health considerations. From skin to eyes to brains and hearts, our organs need these fats to thrive. In fact, every cell in the human body requires DHA for optimal function. And even more compelling is the fact that we cannot adequately manufacture this fat. We need to eat it. So why eschew it? That is the problem with his thesis. Even if his handful of subjects adhering to this diet fails to develop cardiovascular events, it does not prove that the lack of fat plays any role. There are just too many other variables left unconsidered. Additionally, what diseases might be borne of such an unnaturally restricted diet? Too many questions remain for us to make a global experiment of Dr. Esselystyn’s hypothesis. We’ve done this before with dietary advice and hormone replacement recommendations and sadly we’ve been wrong every time.

In sum, I genuinely applaud Dr. Esselstyn for his dedication to extinguishing heart disease. His passion is real and his motivation pure. Still, that does not mean I must agree with him.

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Chicken with Roasted Garlic and Balsamic Vinegar

4 boneless chicken breastsOLYMPUS DIGITAL CAMERA
1 jar whole mushrooms
2 Tbsp flour
salt and pepper, to taste
2 Tbsp olive oil
6 cloves garlic, peeled
4 Tbsp balsamic vinegar
1 cup chicken broth
1 bay leaf
1/4 tsp dried thyme
1 Tbsp butter

Season flour with salt and pepper and dredge chicken breasts in flour mix.  Heat olive oil in heavy skillet and brown chicken on one side, approx. 4 minutes.  Add whole garlic cloves.  Turn chicken pieces and scatter the mushrooms all over.  Continue cooking, shaking skillet.  Cook approx. 4 minutes and add the balsamic vinegar and broth.  Add bay leaf and thyme.  Cover closely and cook over medium low heat, about 10 minutes.  Turn pieces occasionally as they cook.  Transfer pieces to warm serving platter and cover with foil.  Let the sauce with the mushrooms cook uncovered, over medium high heat about 5-7 minutes.  Swirl in butter.  Remove and discard bay leaf.  Pour sauce over chicken and serve.

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Our Bodies are Truly Temples

woman doing yoga outdoors
Last week my son started Veterinary Medicine School. As with Medical School, the quintessential class for indoctrination in the Medical Arts is Gross Anatomy. He is dissecting a dog; I dissected a human being. Remarkably, they are quite similar. In order to help him and contemporaneously restore my own misplaced memories I took the opportunity to dust off my thirty-year-old Clemente Atlas of the human body. What I discovered was both astonishing and unanticipated. First the bad news – I had forgotten much more than I had remembered. Second and far more interesting and uplifting was my reinforcement that countless marvels abide within us all. Each of us is a universe of infinite possibilities. To say we are complex, intricate, amazing, unparalleled falls so short of the mark that it is nearly not worth saying. Our complexity is ineffable. Over the past decade my focus in cardiovascular prevention has been on our bodies’ microscopic goings-on; biochemistry, cell biology, molecular biology, and organic chemistry have been my playgrounds. Each time I’ve learned something new I’ve recognized how little I (we) know. With all we appreciate, we have merely scratched the surface of the elaborate, multifarious activities engaging each of our trillions of cells at every moment of life. And that’s the microscopic. I had neglected the macroscopic: our bones, muscles, nerves, organs, and network of vascular tributaries. Looking at the visible is no less remarkable than the invisible. Do this now. Lift your arm to scratch your head. In performing this singular simple act you have activated countless neural, muscular, vascular, and skeletal systems. And that doesn’t include all the cell-cell communications requiring the activation of genes and creation of proteins as well as the intentional movement of made-to-order bio-chemicals as well as armies of cells. All this just to scratch your head! Try to imagine how spectacularly intricate are our bodies’ activities when there’s a crisis, say a pneumonia or deep wound to your leg. The coordinated responses of layers of participants in maintaining our health and physical prosperity become fully activated. These reactions are so far beyond our wildest imagination that I predict no supercomputer will ever crack the code.

Yes we can pound our chests and pretend we are gods when we clone sheep. The truth is, to god, we are no god.

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Caution! Always View Clinical Trials with a Healthy Dose of Skepticism

We are barraged by data. In medicine this comes in the form of clinical trials and reviews. In everyday life data from news outlets strike us at every turn. We also have the internet and TV talk shows. Everyone seems to have an opinion about everything. So how do we separate the wheat from the chaff? When it comes to science, this is what I advise.

First, understand that science is not static; it is a process. It is also not black and white; it comes in countless shades of grey. Published studies are attempts to find biologic connections. They are single links in the chain of understanding. They do not stand alone; they always must be viewed in the context of all other clinical trials as well as our understanding of the complexity of human biology. Never though do we gain a hotline to god. Never are we able to say, “this is truth and all else fiction” after the publication of a clinical trial. So if you hear or see someone go to a place of certainty on the basis of a single trial, be very, very skeptical. Even if that individual is a so-called expert. The experts are not gods.

Second, there are levels of importance among the trials; some therefore are “better” than others. Rarely do you hear even the experts on TV speak about this. They typically speak only about the “abstract”, a brief summation at the beginning of every study. This is an area too complex for most clinicians to fully grasp. How then can we expect the lay population to comprehend this nuance?

Third, and probably most important of all, every trial comes with flaws. Sometimes these imperfections entirely devalue the trial’s results; other times they simply raise cause for concern. Regardless, to do a trial justice, one must read it with a fine tooth comb. In fact, when I really need to understand a particular study I spend four or five hours reading and critiquing it. Imagine that; four or five hours for a single trial. How then can I treat patients, teach, write, and still have time to read the many thousands of trials published annually. I can’t.

In sum, be cautious. Do not jump to conclusions when a study is published. Do not panic. Do not stop your medications or supplements until you’ve had the opportunity to discuss the findings thoroughly with your doctor. Always be circumspect and vigilant when learning about a clinical trial. Always maintain a very healthy skepticism. I guess in the final analysis the truth is that you can’t always believe what you read or hear. Competing interests often get in the way of truth. And the truth with clinical trials is that they are not at all about “the truth”. They are simply small cogs in the wheels of discovery.

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Taking on Tobacco

quit smokingMy daughter just wrote a paper on Nicotine for her Psychology class. Fascinating! Even as a cardiologist I never understood the intricacies and power of Nicotine addiction. Nicotine is a drug that influences innumerable neurotransmitters throughout our body and brain. It causes antithetical responses of relaxation/euphoria and alertness/readiness. Nicotine (and therefore cigarettes) is extraordinarily addictive. In fact, a single cigarette causes changes in our bodies that signal the beginning of dependence. And, nicotine/cigarettes clearly promote illnesses such as heart disease and cancer. Four hundred thousand Americans die annually as a direct result of their smoking. Perhaps worse, forty thousand of us die from second hand smoke. Forty thousand innocent children, spouses, siblings, and co-workers are killed each year because they are unwittingly barraged by cigarette smoke. And every day three thousand teenagers join the masses of tobacco-loving Americans. How can this be? How can we stand idly by while so many die from a single preventable cause? Sadly I cannot answer these questions. Surely it has something to do with money and power, and there is likely an element of civil liberties as well.

In light of the toll tobacco takes on so many, I’m particularly perplexed by the recent emphasis on gun control. Yes, guns are often the vehicles that cause untimely death. Murder, suicide, accidental injuries are all consequences of mishandled guns. But what baffles me most is that in a perfect world guns could be harmless. They do not by nature kill. It is their misuse that leads to misfortune. Tobacco on the other hand cannot be separated from death and disease. You can’t use tobacco as a sport (as you can a gun) and get away with it. Even a single cigarette can kill a person if smoked under the wrong circumstances (in the setting of a vulnerable artery feeding the heart or brain for example). So why not turn our attention to something even more devastating than guns? At a time of economic hardship and sweeping medical reform I feel it would be far better to focus our attention on preventing “preventable” disease and death. So I beseech the powers that be in our Capitol to take on tobacco. It is a fight worth fighting.

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