Health Evaluation for John Doe

Up to 50% of all people with leg artery disease have diabetes; for them, controlling both conditions is crucial.  Diabetes increases your risk for leg artery disease fourfold, and accounts for nearly half of all amputations in the U.S.  that aren't related to accidents.

Diabetes makes hardening of the arteries much more dangerous (especially in the feet and toes) through several different mechanisms, and it's still not fully understood which ones matter most.  People with diabetes are prone to nerve damage in the legs and feet, which means they often may overlook minor injuries.  This, combined with poor circulation that slows wound healing, can cause small wounds to develop into more serious infections.  Diabetes also makes people more likely to develop blockages in smaller vessels far from the heart, and those blockages tend to be more widespread and harder to treat.

Research has shown that IBS frequently co-exists with CFS and fibromyalgia.  Depending on the study quoted, between 34% and 73% of CFS/FMS sufferers have Irritable Bowel Syndrome.

Forgetfulness is a symptom of hypothyroidism.

Thyroid diseases may produce brittle nails or splitting of the nail bed from the nail plate.

Hypothyroidism reduces the amount of nitric oxide in the lining of the blood vessels, causing them to stiffen, which in turn raises diastolic blood pressure.

Gastrointestinal manifestations of hypothyroidism include GERD as a result of delayed emptying of the stomach.

Patients suffering with Wilson's Syndrome, a form of hypothyroidism, occasionally experience intense and previously unfamiliar cravings for sweets.  The low body temperature patterns may affect the function of enzymes involved in glucose metabolism that could result in lower blood sugar levels which might contribute to sweet cravings.

Sub-clinical hypothyroidism, with raised thyroid stimulating hormone (TSH) levels but mild or absent overt symptoms, has been found to be more common among vegans than the general population.  Most vegans have low iodine intakes but a significant minority consume excessive amounts of iodine from seaweed, particularly kelp.  Both low and excessively high iodine intakes in vegans have been linked to elevated TSH levels.  The optimal range for TSH appears to be 1-2 mIU/l with values below 0.5 suggesting hyperthyroidism and values above 5 suggesting hypothyroidism.

A study of rheumatoid arthritis patients found evidence of thyroid dysfunction 3 times more often than in controls.  The excess thyroid dysfunction was due to either hypothyroidism or Hashimoto's thyroiditis.  [Annals of Rheumatic Diseases, 1993;52 pp.454-6]

Hypothyroidism can trigger loss of libido in both men and women.

In rare cases, diffuse hair loss may be the only symptom of hypothyroidism, but in many people with hypothyroidism the hair is not affected.  Once thyroid hormone is administered, regrowth of hair occurs in approximately 2 months.

Hypothyroidism can manifest as dry or scaly or yellowish skin.

Hypothyroidism can manifest as dry, flaky skin.

Hypothyroidism can present itself as obstructive sleep apnea and snoring.

If anemia is identified as a problem then the likelihood of Hypothyroidism is reduced.  Therefore, it is wise to rule out anemia first, because both can contribute to similar symptomology.  Of course, it is not impossible for both to occur simultaneously, but this is less likely.

Not only can poor attention to detail be a sign of stress, but so can its exact opposite, being a perfectionist.

Gas can be caused by stress and the nervous habit of frequent swallowing.

Many people say their tinnitus is worse when they are tired or stressed.

Teeth-grinding is often stress-related.

Small muscle twitching, usually called "tics", are often triggered by stress and anxiety.

Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal disease.  [Journal of Periodontology July 1999]

African-Americans have higher rates of diabetes, prostate cancer, hypertension and coronary heart disease than whites.

High blood sugar can cause two problems which affect vision, namely blurred vision and retinopathy – a disease of the back of the eye.  Blurred vision is one of the first signs of elevated blood sugar.  The shape and size of the lens in your eye changes when your blood sugar fluctuates.  This swelling of the lens can cause blurred vision.

If you notice blurred vision, you should have your blood sugar checked.  The acceptable range for fasting glucose is 80-110mg.  If your blood sugar is substantially higher or lower than the acceptable range, contact your doctor.  When your blood sugar is controlled, your vision will return to its previous state.

Blood pressure that is consistently at or above 140/90 is a sign of Type 2 Diabetes.

It was reported in 2010 that a Chinese study of 19,567 people found a correlation between increased napping and increased risk of developing type 2 diabetes.  Participants reporting frequent naps (4-6 days per week or daily) were 42% to 52% more likely to have diabetes.

Hyperinsulinemia and insulin resistance are both factors that increase the risk of developing type 2 diabetes.  Hyperinsulinemia often predates diabetes by several years.

Lack of sexual desire can be a consequence of diabetes.

If you are diabetic, you are at higher risk of developing infections, including periodontal diseases.  These infections can in turn impair the body's ability to process and/or utilize insulin, creating a vicious circle in which your diabetes may be more difficult to control and your infection more severe than in a non-diabetic.  [Journal of Periodontology November 1999]

Research suggests that gastritis and ulcers are triggered by bacterial overgrowth, rather than by stomach acidity.  Long-term treatment of patients with potent acid blockers (proton pump inhibitors) which produce a more alkaline environment that is unfriendly to acid-tolerant bacteria such as Helicobacter pylori, may actually allow the overgrowth of other types of bacteria in the stomach, including Lactobacillus, Enterobacter, Staphylococcus and Propionibacterium which can result in inflammation, gastritis and ulceration.  [Gastroenterology, Jan 2002]

Some bacterial infections of the small bowel increase passive intestinal permeability.  IBS has been studied in patients with diarrhea, cramps and specific food intolerances.  Abnormal fecal flora has been a consistent finding, with a decrease in the ratio of anaerobes to aerobes, apparently due to a deficiency of anaerobic flora.  Previous exposure to antibiotics – metronidazole in particular – was associated with the development of this disorder.

A variety of bacterial pathogens can cause severe gastrointestinal symptoms such as bloody diarrhea, fever or abdominal pain.  In addition, many of these intestinal microbes can exacerbate or cause flare-ups of symptoms in patients who already have ulcerative colitis.

During the early 1980s, exaggerated immunologic responses to components of the normal fecal flora were proposed as possible mechanisms behind inflammatory bowel disease.  Little progress has been made in confirming or disproving this theory, although bacterial overgrowth of the jejunum has been found in 30% of patients hospitalized for Crohn's disease, in which it contributes to diarrhea and malabsorption.  The demonstration of increased intestinal permeability in patients with active Crohn's disease and in healthy first degree relatives suggests the existence of a preexisting abnormality, such as dysbiosis, that allows an exaggerated immune response to normal gut contents to occur.

Elimination diets can induce remission in Crohn's disease as effectively as prednisone.  The primary bacteriologic effect of elemental diets is to lower the concentration of Lactobacilli in the stool drastically without altering levels of other bacteria.

Immunologic responses to gut flora have been advanced by several authors as being important causative factors of inflammatory joint diseases.  It is well-known that reactive arthritis can be activated by intestinal infections with Yersinia, Salmonella and other enterobacteria.  In some cases bacterial antigens have been found in synovial cells and may enter the circulation because of the increased intestinal permeability associated with the intestinal infection.  Increased intestinal permeability and immune responses to bacterial debris may cause other types of inflammatory joint disease as well.

Researchers at Columbia University Medical School studied 55 men undergoing X-ray exams of their arteries and found that those with a lower testosterone level had higher degrees of heart disease (blockage of the coronary arteries).  This study also found that the protective HDL cholesterol levels were higher in men with higher testosterone levels.

Low testosterone is linked to hypertension, obesity, atherosclerosis and increased waist-to-hip ratio – all of these being heart attack risk factors.  Administration of testosterone to men has been reported to decrease the risk factors for heart attack.

Researchers at Columbia University Medical School found that serum testosterone levels were about 90ng/dl lower in patients who had suffered myocardial infarctions (MI) than in those who had not.  These results suggest that low testosterone levels predispose men to MI and are lower in men with severe coronary artery atherosclerotic disease than in controls.

Some 30% of men with spinal osteoporosis have long-standing testosterone deficiency, and one-third of men with testosterone deficiency have subnormal bone density that puts them at risk of fractures.

Without sufficient testosterone the penile muscles atrophy, with the result that insufficient blood is trapped for developing or maintaining an erection, which in turn leads to poor performance and the anxiety that follows.  One study found that low testosterone is a factor in 20% of men under 30 with erectile problems.

Many studies over the years have shown that testosterone is critical to sexual desire.  One of the most common symptoms of low male testosterone level is a loss of libido.

When we skip meals, we often also skip the drinks that go with the food.  If your hydration status is already marginal, a delayed meal may be enough to trigger dehydration symptoms.

Your daily water requirement is based on your ideal weight (not your actual weight), and your ideal weight is calculated from your height and gender.

Dr. Batmanghelidj, author of Your Bodies Many Cries for Water, believes that in the same way we have a "hunger pain" signal, we also have a "thirst pain" signal in the body, and that it is called dyspepsia (heartburn).

Renal insufficiency can occur from underperfusion due to dehydration.

Due to older people's precarious homeostatic mechanisms they are much more prone than younger people to dehydration and electrolyte imbalances.  This may induce a confusional state which may be mistaken for a dementing illness such as Alzheimer's.

Dr. Bantmanghelidj, MD in his book Your Body's Many Cries for Water reports many cases of angina attacks being reduced by drinking adequate water.

A loss of 4-5% of body weight of fluid decreases the capacity for hard muscular work by 20-30%.

Dehydration occurs in patients with severe diarrhea as seen in ulcerative colitis.

Dehydration may result from the increased urinary frequency brought on by caffeine.

Excess sweating or dehydration can deplete minerals in the body – minerals that are important for good muscle function, such as sodium, potassium, calcium, magnesium and phosphorus.

Intermittent blurred distance vision is a sign of mercury toxicity.

Kidney disease, including kidney failure, is a possible symptom of mercury toxicity.

Mercury poisoning may be causing chest pain or angina, especially in anyone under age 45.

Heavy metals such as mercury, cadmium, lead and thallium poison the glucose metabolizing catalysts, thus reducing the flow of energy throughout the body.  It is interesting to note that the symptoms of heavy metal poisoning are similar to symptoms associated with hypoglycemia i.e. hyperactivity, mood swings, manic depressive behavior, poor concentration and impulsive and unpredictable behavior.

This symptom may be one of many associated with mercury toxicity.

In vitro studies suggest that even low, environmentally relevant exposure levels of mercury, which are not toxic, still contribute to immune dysfunction by interfering with proper lymphocyte functioning.  [Scand J Immunol 50(3): pp.233-241]

People with mercury amalgam fillings who grind their teeth or chew gum can suffer additional mercury release.

Mercury toxicity can cause hair loss.

Exceptionally dry skin has been associated with mercury toxicity.

Unusual tics or twitching of facial muscles have been associated with mercury toxicity, as well as with muscle cramps in cases of high occupational exposure to mercury.

Short term memory loss is initially the most common complaint associated with mercury toxicity.

Most patients with ulcers complain of pain or discomfort that is located in the upper part of the stomach, often in the area immediately below or around the lower part of the breast bone.  This is called epigastric pain.  Symptoms may be associated with meals, or occur in-between meals, or sometimes even occur at night to the point where one can be woken up from sleep.  This pain may be relieved by meals also.

Bleeding from an ulcer may occur in the stomach or the duodenum, and sometimes is the only symptom.  Rapid bleeding causes bowel movements to become black or even bloody.

Patients with a bleeding ulcer may report a sense of passing out upon standing called orthostatic syncope.

Inflammation may be caused by aspirin and nonsteroidal anti-inflammatory medications (NSAIDs), but the bacterium H. pylori is generally responsible.

There is a relatively high prevalence of GERD amongst patients with duodenal or gastric ulcers.  Persistent dyspepsia/heartburn symptoms after eradication of H. pylori and ulcer resolution might suggest the treatment of GERD as a separate entity.  [Am J Gastroenterol 2000;95: pp.101-105]

In general the duodenum isn't as well protected with mucus as is the stomach and is more prone to ulcers.  A deficiency of pancreatic juices to neutralize the acid chyme from the stomach, or stress causing sympathetic inhibition of enzyme secretion can lead to duodenal ulcer formation.

Severe inflammation of the stomach lining (gastritis) can result in ulceration.

Preventative health measures are something that many people (and their doctors) often forget.  They become especially important as you grow older.

If you have a family history of high blood pressure, heart or kidney disease, diabetes or stroke, you should have your blood pressure tested annually.

If you wear corrective lenses or are over 50, eye exams should be performed every two years or so.

If you have a family history of high blood pressure, heart or kidney disease, diabetes or stroke, you should have your blood pressure tested annually.

If you don't know your cholesterol levels, or haven't had them checked within the past five years, you should consider this simple test.

Those with high blood pressure should have a yearly eye examination.

Persons with diabetes must take extra care to be sure to have thorough, periodic eye exams (at least yearly), especially if early signs of visual impairment are noticed.  Anyone experiencing a sudden loss of vision, decrease in vision or visual field, flashes of light, or floating spots should contact their eye doctor right away.

Regular eye tests are recommended if you are over 40 years old.  The test for glaucoma must be performed by a trained person, either an ophthalmologist or a trained ophthalmic optician.  The test for glaucoma may not be a part of the standard eye test given and should be requested.

Those diagnosed with glaucoma will need to attend regular follow-up appointments during which any perceived loss of vision must be reported.  Those who have had an episode of acute glaucoma should be aware of the early symptoms and consult a doctor immediately should they re-occur.

Several malignancies can lead to night sweats.

May, 2012: According to research to be published in the American Journal of Respiratory and Critical Care Medicine, those affected by severe sleep disordered breathing (SDB) are 4.8 times more likely to develop cancer than those who are not.  Those with moderate SDB are at double the risk, and those with only slight SDB have a 10% increased risk of developing cancer.

The researchers from the University of Wisconsin-Madison looked at cancer rates in more than 1,500 people, in a study of sleep problems that has spanned 22 years.

Several studies have demonstrated reduced mortality from various cancers among regular aspirin users.  A 2012 study showed a large reduction in death from esophageal, stomach and colon cancers among daily aspirin users, and a 12% reduction for other types of cancer.  [JNCI J Natl Cancer Inst (2012) 104 (16): pp1208-1217]

Severe acute or prolonged abdominal pain is a possible symptom of many serious conditions.  You are advised to seek medical attention as soon as possible, unless you already know the cause of the pain.

Blood, as seen in the stool, can originate anywhere along the intestinal tract.  A black stool (called melena) usually means that the blood is coming from the upper part of the tract.  At least 4 Tablespoons (60ml) of blood must have been lost in order to make the stool black.  Maroon-colored stools suggest that the blood is coming from the middle portion of the intestinal tract, and bright red from the large bowel or rectum.  If stools change color suddenly, it can be evidence of internal bleeding which requires immediate medical attention.

The ingestion of black licorice, Pepto-Bismol, or blueberries can all cause black stools or false melena.  Stools should be tested for the presence of hidden blood.

High blood pressure commonly results from kidney problems, and often damages the small blood vessels in the kidneys.  When this happens, the blood vessels cannot filter toxins from the blood as easily.

Renal insufficiency due to underperfusion from a failing heart is more widespread than commonly thought.

Liver Cirrhosis can lead to kidney dysfunction and failure.

A kidney stone that is obstructing will cause damage to the kidneys in the long run if left untreated and may even lead to end stage kidney failure.  Anyone with a past history of kidney stones should have regular screening performed as the recurrence rate is high.

Excessively dry, persistently itchy skin is a possible symptom of kidney disease.

In general, you should see a specialist if you are over 40 and have the following symptoms:

• A change in normal bowel habits towards looser and/or more frequent stools that has lasted for over 6 weeks
• Any bleeding from the rectum.

In general, you should see a specialist if you are over 40 and have the following symptoms:

• A change in normal bowel habits towards looser and/or more frequent stools that has lasted for over 6 weeks
• Any bleeding from the rectum.

A putrefaction dysbiosis is accompanied by an increase in fecal concentrations of various bacterial enzymes which metabolize bile acids to tumor promoters.

Inflammatory bowel disease increases the risk of colon cancer.

Inflammatory bowel disease increases the risk of colon cancer.

Risk of developing breast and colon cancers is significantly increased in those who spend a lot of time sitting, according to research presented in November of 2011 at the American Institute for Cancer Research.

Aspirin has been found to reduce the risk of colorectal cancer by up to 60%, with researchers finding that 600mg of aspirin per day for 25 months substantially reduces cancer incidence after 5 years in carriers of hereditary colorectal cancer.

Congestive heart failure leads to reduced blood supply to the kidneys, which leads in turn reduced kidney function, and in turn excess fluid retention (edema).  The lungs may become congested with fluid (pulmonary edema) and thus the ability to exercise is decreased.

Edema of the ankles is a common manifestation of failure of the right ventricle related to both venous congestion and salt and water retention.  Those experiencing constant or worsening swelling of the feet or legs should see a doctor for a heart evaluation.

Edema fluid that collects in tissues during the day due to heart failure can result in increased night time urination.

Congestive heart failure occurs in about 7% of symptomatic patients with hemochromatosis.  If untreated, patients may develop an acute onset of severe congestive heart failure with rapid progression to death.

The immune system may trigger mild inflammation in the liver as a result of ulcerative colitis.  This problem is usually mild and goes away when the colitis is treated.

Selenium is essential for healthy immune functioning.  A large-scale study has shown that selenium supplementation reduces the incidence of viral hepatitis in selenium-deficient populations, presumably by enhancing immune function.  [Yu S-Y, Li W-G, Zhu Y-J, et al.  Chemoprevention trial of human hepatitis with selenium supplementation in China.  Biol Trace Element Res 1989;20: pp.15-20]

People who live in a chronically stressed-out condition are more likely to take up smoking, frequently overeat, and be far less likely to exercise.  All of these stress-related behaviors have a direct effect on the development of coronary artery disease.

It is also known that the surge in adrenaline caused by severe emotional stress causes the blood to clot more readily (a major factor in heart attacks) and that the stress of performing difficult arithmetic problems can constrict the coronary arteries in such a way that blood flow to the heart muscle is reduced.  Stress increases homocysteine levels, a known risk factor for coronary artery disease.

Cardiovascular risk factors that most highly predicted carotid artery wall thickness scores were holding anger in, being self-aware and having hostile attitudes.

Stress stimulates colonic spasm in people with IBS.  Stress reduction (relaxation) training or counseling and support help relieve IBS symptoms in some people.

Decrease your stress level.

Stress should be decreased by using stress management techniques such as progressive relaxation or guided imagery.

Based on their clinical experience and on very preliminary research, several doctors have suggested that a number of dietary factors may promote the overgrowth of Candida.  Dried fruits, which are high in sugar, have been blamed for contributing to promotion of Candida overgrowth.  Sugars avoidance is a standard recommendation on any anti-candidal diet.

A diet high in fruits appears protective against heart disease.  The total number of deaths from cardiovascular disease was found to be significantly lower among men with high fruit consumption in one study.  A large study of male healthcare professionals found that those men eating mostly a "prudent" diet (high in fruits, vegetables, legumes, whole grains, fish, and poultry) had a 30% lower risk of heart attacks compared to men who ate the fewest foods in the "prudent" category.  A parallel study of female healthcare professionals showed a 15% reduction in cardiovascular risk when they ate a diet high in fruits and vegetables compared to the effect of a low fruit and vegetable diet.

Fruit and vegetable consumption (a minimum of five portions daily) was associated with modest reductions of systolic and diastolic blood pressures in a controlled study of 690 healthy people ages 25-64.  [Lancet May 28, 2002]

A diet high in fiber helps prevent coronary heart disease.  Eating fruits high in the soluble fiber pectin has also been linked with reduced cholesterol levels, which protects against atherosclerosis.

Consumption of fruits is widely accepted as lowering the risk of most common cancers except prostate cancer.  Many doctors recommend that people wishing to reduce their risk of cancer eat several pieces of fruit and several portions of vegetables every day.  Optimal intakes remain unknown.

Eating carbohydrate-containing foods, including some fruits, temporarily raises blood sugar and insulin levels.  On the other hand, a diet rich in the soluble fiber found in fruit may lower the risk of type 2 diabetes, despite the high carbohydrate content of most fruit.

High-fiber supplements, such as pectin from fruit, have been found to improve glucose tolerance in some studies.  A review of the research revealed that the extent to which moderate amounts of fiber help people with diabetes in the long term is still unknown, and the lack of many long-term studies has led some researchers to question the importance of fiber in improving diabetes.  Nonetheless, most doctors advise people with diabetes to eat a diet high in fiber.  Focus should be placed on fruits, vegetables, seeds, oats and whole-grain products.

The fiber of choice for prevention of colorectal cancer seems to be psyllium, pectin or guar gum.  The amount of pectin in approximately two servings of fruit rich in pectin such as pears, apples, grapefruit, and oranges is 15gm.  Psyllium or guar gum are obtained by supplement.  The RDA of total fiber is 20-30gm.  In Scotland, where the average fiber intake is 2-3gm per day, there is a very high incidence of colon cancer.

For years, dietary fiber has been promoted by nutrition researchers and practitioners for colon cancer prevention.  However, in two recent studies high-fiber diets did not decrease risks of colon cancer.  The two studies are significant contributions to the literature, but they can not and do not close the discussion.  If anything, they underscore the real need for further research and analysis.

Both studies, for example, involved only short-term (four-year) adjustments to the diet.  One of them involved the use of wheat bran.  Colon cancer is a disease that can take decades to develop.  Convincing epidemiological evidence suggests that a healthy diet has its greatest preventive effect as a lifelong commitment, not a stopgap measure.  While wheat bran does not appear to provide any protective benefit, a high fruit and vegetable diet may still provide benefit in preventing colorectal cancer.

Dr. Tim Byers, M.D., M.P.H.  from the University of Colorado School of Medicine stated in the same issue of NEJM that "...observational studies around the world continue to find that the risk of colorectal cancer is lower among populations with high intakes of fruits and vegetables and that the risk changes on adoption of a different diet, but we still do not understand why." [NEJM, January 22, 1999, NEJM 342: pp.1149-55, pp.1156-62, 2000.]

Whole fruit and fruit and vegetable juice, both high in potassium, are recommended by some doctors for congestive heart failure (CHF).  This dietary change should, however, be discussed with a healthcare provider because several drugs given to people with CHF can actually cause retention of potassium, making dietary potassium, even from fruit, dangerous.  Bananas are a rich source of potassium and need to be avoided in persons taking potassium-sparing diuretics.

Studies suggest that eating just one serving of dark leafy greens or broccoli each day can cut your risk of hip fracture in half.  A diet low in green leafy vegetables can be low in vitamin K.  Vegetarians have on average greater bone mass than meat eaters.

Fruit contains several things that are of benefit, including a sugar (fructose) that does not cause wild glucose swings, trace minerals, and fiber which slows glucose absorption.

Bulking up the diet with legumes such as beans and peas can lower the risk of heart disease, study findings suggest.  Men and women who ate legumes at least four times a week were found to have a 22% lower risk of coronary heart disease over 19 years than those who consumed legumes once weekly, researchers report in the November 26th issue of the Archives of Internal Medicine.  The study was based on interviews and medical exams of more than 9,600 Americans who did not have heart disease when the study began.  [Archives of Internal Medicine 2001;161: pp.2573-8].

Legumes contain low levels of sodium and high levels of potassium, calcium and magnesium – a combination that is associated with a reduced risk of heart disease.  Folate, a mineral also found in abundance in legumes, is thought to reduce blood levels of homocysteine, a compound that can boost heart disease risk.

Increased dietary copper through legume consumption may protect against heart disease.  [Archives of Internal Medicine 162, 15: pp.1780-1, August 12, 2002]

A study of 9,600 Americans found that those who ate plenty of legumes had lower blood pressure and were less likely to be diagnosed with high blood pressure.  [Archives of Internal Medicine 2001;161: pp.2573-8].

A study of 9,600 Americans found that those who ate plenty of legumes were less likely to be diagnosed with diabetes.  Legumes are rich in soluble fiber, which has been shown to help improve insulin resistance, the study authors note.  [Archives of Internal Medicine 2001;161: pp.2573-8].

Treatment is highly effective.  The form of vitamin B12 known as hydroxocobalamin is given by injection into a muscle twice during the first week and then weekly until the anemia and all other symptoms of deficiency have been fully corrected.  It may be necessary to stay on a maintenance dosage of vitamin B12 every three months for life to stop the problem coming back.

Vitamins B12, A, D, E and K along with calcium and a lactose-free diet are often recommended by clinicians treating IBS.

Vitamin B12 (with or without folic acid) has been reported in studies from the 1950s to help some people with hepatitis.[1] [2] Vitamin B12 injections are likely to be more beneficial than oral administration, though 1,000mcg taken orally each day can also be supplemented.

[1] Campbell RE, Pruitt FW.  Vitamin B12 in the treatment of viral hepatitis.  Am J Med Sci 1952;224: pp.252-62
[2] Campbell RE, Pruitt FW.  The effect of vitamin B12 and folic acid in the treatment of viral hepatitis.  Am J Med Sci 1955;229: pp.8-15

Low levels of vitamin B12 have been linked to an increased risk Alzheimer's disease.  [Neurology, May 2000] It remains unclear as to whether B12 supplementation will reduce the risk.

H. pylori infection may result in Vitamin B12 deficiency.

B12 supplementation is highly recommended for those on a vegan diet.

If you have kidney problems, taking magnesium supplements may make you accumulate the mineral too quickly, which could be toxic.

Magnesium has a mild effect on lowering blood pressure and so is used to treat and prevent hypertension and its effects.  In a double-blind, placebo-controlled trial, it was demonstrated that oral magnesium resulted in a significant dose-dependent reduction of systolic and diastolic blood pressure.  A mean reduction of 6mm Hg in diastolic pressure in patients with hypertension results in approximately 10% lower risk of coronary artery disease, and a 40% reduction in risk of strokes.

When magnesium levels are low, more calcium flows into the vascular muscle cells, which contracts them – leading to tighter vessels and higher blood pressure.  Adequate magnesium levels prevent this.

Magnesium is helpful in preventing blood vessel calcification (and thereby atherosclerosis).  A daily dose of 50mg of vitamin B6 and 200-300mg of magnesium is often given.

You can reverse bone loss and regain bone mass with calcium, magnesium, vitamin D, and vitamin K.  Minimum doses should be in the following ranges: calcium (1200mg), magnesium (400-800mg) vitamin D (400 IU – consider supplementing in the winter months in females), and vitamin K (80mcg).  Calcium comes in many forms, so use those which are more absorbable such as hydroxyapatite, citrate, gluconate, and others.  Some special preparations have been shown to increase bone density without the use of any other nutrients.

Magnesium insufficiency-induced coronary artery spasm, more common in men than women, is now recognized as an important cause of myocardial infarction and may be of significance in angina pectoris.

300 young healthy male military recruits undergoing two months of basic training were studied.  The trainees were repeatedly exposed to high levels of impulse noises, with ringing of the ears as a consequence.  Each recruit received daily either 167mg of magnesium aspartate or a placebo.  Permanent hearing loss was significantly more frequent and more severe in the placebo group than in the magnesium group.  [Am J Otolaryngol 1994;15: pp.26-32]

By increasing calcium solubility (especially in the urine) and reducing calcium absorption, magnesium can help prevent kidney stones, especially those composed of calcium oxalate.  Research has shown this effect in a high percentage of people who form kidney stones regularly.  It is thought that calcium oxalate stones are most likely to form in people who are magnesium deficient, so it may just be correcting that deficiency.

Thiazide diuretics, such as Esidrix or Zaroxolyn, can be used to lower blood pressure.

Potassium-sparing diuretics such as Aldactone or Dyrenium help the body to retain potassium and are often used in congestive heart failure patients, often along with the other two types of diuretics.  They do not significantly lower blood pressure.

Loop diuretics such as Lasix or Bumex are often used to counter congestive heart failure symptoms and are especially useful in emergencies.  They do not, however, significantly lower blood pressure.  Thiazide diuretics, such as Esidrix or Zaroxolyn, can be used to treat edema in heart failure.

Some diuretics are useful against osteoporosis: Thiazides lower urinary calcium excretion, resulting in a positive calcium balance and increased bone mineral density and a reduction in fracture rates due to osteoporosis.  For reasons not fully understood, thiazides also stimulate bone mineral formation, which helps to slow the course of osteoporosis.

Thiazides lower urinary calcium excretion, which helps prevent calcium-based kidney stone formation.

One study found that aged garlic extract at 7.2gm per day reduced total and LDL cholesterol, as well as systolic and diastolic blood pressure.

Reduces platelet aggregation.

A mechanism by which atherosclerotic plaque accumulates on the walls of arteries is the oxidation of LDL cholesterol.  Garlic has been shown in repeated studies to protect against LDL cholesterol oxidation and oxidation in the linings of the arteries themselves.  Garlic, ginger and onions all have a beneficial effect on platelet aggregation which reduces the tendency to form clots too easily, thus preventing the blockage of narrowed arteries.

Garlic chelates heavy metals such as cadmium, gold, lead and mercury, and acts as a detoxifier.

When taken in high doses, garlic increases fibrinolytic activity.  This increased fibrinolytic activity inhibits platelet aggregation which contributes to the formation of blood clots.

Liberal consumption of garlic, ginger, cinnamon and other aromatic herbs can have significant antifungal activity.

Fats are the most difficult component of the diet to digest, remaining in the stomach longer and thus causing the need for more stomach acid in order to digest them.  Fatty foods cause more indigestion than proteins or starches.

There has been much recent research on the relationship between cancer and dietary fat – possibly more than on any other component of the diet.  A connection between high fat consumption and breast and colon cancer (two of the most deadly forms of the disease) has appeared in many studies.  Experts recommend that you consume no more than 20-25% of calories from fat.  That's about half of the fat that most Americans eat.  You should also choose modest amounts of appropriate vegetable oils.

It may be possible to reduce the risk by avoiding a high fat diet through, for example, cutting down on dairy foods and red meat.

A study involving zinc supplementation in inflammatory bowel disease illustrated the importance of taking adequate supplementation, but not too much.  In this study, excess amounts of zinc caused tissue injury and impaired wound healing [Cario et al.  2000].  However, relative zinc deficiencies, especially in the elderly, are common in the United States [Andrews et al.  1999].

In a double-blind study on 18 patients, those taking zinc sulfate supplements had a gastric ulcer healing rate three times that of patients treated with a placebo.  [The healing of gastric ulcers by zinc sulfate.  Med J Aust 2(21): pp.793-6, 1975]

Maintain adequate zinc status: Reduced levels of zinc are being linked to Alzheimer's disease.  In one study, 38 elements were evaluated by neutron activation and mass spectrometry in the post-mortem brain tissue of eleven Alzheimer's patients and six controls.  An increase was found in aluminum, silicon and calcium; a significant decrease was found in zinc and selenium.  The lower level of zinc in all areas of the tissue studied correlates with reports indicating low serum levels of zinc in other dementia studies.  [Reduction of Zinc and Selenium in Brain Alzheimer's Disease: Corigan, et al., Trace Elements in Medicine, 91;8(1): pp.1-5]

Zinc supplementation has a clearly documented usefulness in shrinking an enlarged prostate.  Research has shown that zinc and essential fatty acids are important to help prevent prostate problems that affect men as they grow older.  Many studies confirm that a lack of these two nutrients in the diet could be associated with prostate enlargement.

Zinc has been found to inhibit the activity of 5-alpha reductase, the enzyme that irreversibly converts testosterone to dihydrotestosterone, a form which binds more avidly to the prostrate and stimulates greater growth.  It also decreases prolactin secretion by the pituitary gland, thus decreasing its binding to the prostate, both of which prevent prostatic enlargement.

Zinc supports tissue regeneration and can be especially useful if levels are deficient.

Tissue damaged by celiac disease has demonstrated an enhanced recovery rate with adequate zinc intake.

Vegetarians may need as much as 50% more zinc than non-vegetarians because of the lower absorption of zinc from plant foods, so it is very important for vegetarians to include good sources of zinc in their diet.

Many doctors and researchers agree that the regular consumption of tasty, mostly modern, commercially processed foods is the primary cause of adult-onset diabetes.  Consuming anything sweet, regardless of its calorific content, may be sending a signal from the mouth to the brain that more insulin is needed.

Keep your weight down, and keep simple sugars and refined carbohydrates to a minimum.  Researchers have found that diabetes mellitus (for which these are risk factors) nearly doubles the risk of developing both vascular dementia and Alzheimer's disease.

Refined carbohydrates are more readily absorbed than unrefined, and should be avoided in those with any glucose intolerance.

Processed food often has salt added as a flavor enhancer to encourage product sales.  Significantly reducing processed food consumption is always a good idea.  The general rule is that any food in a package has had salt added.  Look at the labels on the food that you eat.  If the sodium content per 100gm is greater than 0.2gm, the food is high in salt.

Recycles vitamins E and C when they've been used.  Dosage: 50mg bid.

Alpha lipoic acid is given in a dose of 300mg at least twice per day for hepatitis B or C.  Alpha lipoic acid (ALA), silymarin, and selenium have been used in combination with success in reducing symptoms and elevated liver enzyme levels (though the viral load was not substantially reduced).

Numerous additional studies have indicated that ALA is useful for the treatment of diabetes mellitus.  It stimulates increased glucose utilization in muscle cells and significantly reduces human insulin resistance.

600mg of alpha lipoic acid tid was found to improve polyneuropathy symptoms in patients with type II diabetes.  A maintenance dose as low as 100mg tid may be sufficient to provide benefits.  [Diabet Med 1999;16; pp.1040-1043]

Sources of sulfur such as alpha lipoic acid, MSM and garlic are helpful for protection against heavy metals in general and specifically useful in mercury toxicity.  Alpha lipoic acid should not be used alone, as it only mobilizes mercury with a weak bond.  Without additional chelators present, such as DMPS or DMSA, the mercury may just redistribute elsewhere in the body instead of being removed.

Alpha-lipoic acid has been used very successfully as a therapeutic agent in a number of conditions relating to liver disease, including alcohol-induced damage, mushroom poisoning, metal intoxification and carbon tetrachloride poisoning.

Reduces homocysteine levels (major cause of heart disease), thereby decreasing risk of heart disease.  A study found that people with a dietary intake of at least 300mcg per day of folic acid reduced their risk of stroke and heart disease by 20% and 13% respectively, compared with those who consumed less than 136mcg of folic acid per day.  [Stroke 2002;33: pp.1183-9]