Staying Healthy This Winter

November 20th, 2011

Between colds, flus and the winter blahs, winter can be a tough season.  Here are some  natural steps to ensure a healthy winter season for you and your family.

  • Get your rest - sleep is a nutrient that is important for health and happiness.
  • Use a humidifier - dry winter air contributes to the increased rate of respiratory tract infections.
  • Eat plenty of vegetables, including fruits (yes, fruits are vegetables).  Vegetable soups,  roasted vegetables, and bean dishes are very warming in winter months.  Fruits always make a healthy snack or dessert.
  • Make sure you are getting enough vitamin D - up to 2,500 IU daily for children 1 year or older and up to 4,000 IU daily for anyone 9 years or older.  This almost always requires supplementation since we get no vitamin D from sunlight in winter months and a glass of milk has only 100 IU.
  • Omega-3 essential fatty acids are so important for healthy immune function and mood - they also help prevent cracked lips and dry hands.  If you like fish, great sources that are low in mercury and other environmental toxins include sardines, Alaskan salmon, herring, cod, and mackerel.  If you don’t like fish, taking fish oil capsules will do the trick - just make sure your brand is tested for rancidity, heavy metals, and environmental toxins.
  • Stay active - getting outside when the sun is out can have a remarkable affect on our health in the winter months.
  • I know, I know it is not fair to bring up during the holidays, but sugary sweets slow down the function of white blood cells that devour bacteria and can have negative affects on mood.  Refined carbohydrates like sugar (white, brown, sugar cane crystals, dehydrated cane juice, etc.) corn syrup, honey, and maple syrup are all culprits.  For homemade sweets, stevia extract is a wonderful, healthy, natural sugar substitute.  Apple pie, anyone?

If cold or flu symptoms start, liquid extracts of echinacea root and elderberry taken by mouth help symptoms while reducing the duration of illness.  Goldenseal (warning - a very bitter herb) works great in a neti pot for reducing nasal congestion or by mouth for sore throats.

Be Well,

Richard Malik, ND

Top 5 Recommendations for your Family Doctor

May 31st, 2011

According to the National Physicians Alliance, the 5 steps your family doctor can take to most likely improve the quality of care you and your family receive are:

  1. DON”T do x-ray, MRI, or CT imaging for low back pain within the first 6 weeks unless red flags exist for other serious conditions that present with low back pain.  Low back pain in the 5th most common reason for a visit to the doctor.
  2. DON’T prescribe antibiotics for most cases of sinusitis unless severe, and symptoms of colored nasal discharge, facial pain, or dental pain last 7 or more days.  Most cases of sinusitis seen in clinics are due to viral infections that will resolve on their own.  Still, antibiotics are prescribed for 80% of these patients.
  3. DON’T order electrocardiogram (also known as EKG or ECG) for patients without cardiac problems or at high risk of cardiac problems.  Without symptoms or being at high-risk, EKG testing is likely to cause more problems than it is likely to help.
  4. DON’T perform Pap tests for patients younger than 21 years (most abnormal results resolve on their own) or women with a hysterectomy without a medical history of cancer of the reproductive organs.
  5. DON’T use bone mineral density testing to screen for osteoporosis in women younger than 65 year or men younger than 70 years unless there is another medical condition that increases the risk of osteoporosis.  Bone mineral density results have surprisingly little ability to identify a patient’s risk of fractures if the patient does not have a history of fragility fracture.
Being an educated patient and discussing your concerns with your doctor is the best way to ensure you get the best quality care possible.  By avoiding unnecessary procedures and treatments you are less likely to experience adverse effects and help to keep health care costs down for everyone.
Be well,
Richard Malik, ND

Does Vitamin D Improve Depression?

May 14th, 2011

A recent study published in the British Journal of Psychiatry finds that vitamin D supplementation does not improve symptoms of in women older than 70.  The researches identified women who had vitamin D deficiency and gave them 500,000 IU of vitamin D one time each year for three to five years.  Hmmm.  This is an unusual vitamin D dosing regimen.

In my experience, providing 5,000 IU vitamin per day, every day, for adult patients is a safe way of maintaining optimal vitamin D status - using less than 4,000 IU does not usually work.  In my clinic, this approach has been a part of a successful program for improving depression in patients with vitamin D insufficiency or deficiency.  This means taking almost 1,800,000 IU of vitamin D per year - much more than what was provided in this study.

According to the Institute of Medicine, 4,000 IU of vitamin D is the upper intake limit for universal safety in people older than 9 years old.  At this level of intake, the annual dosage of vitamin D is 1,460,000 IU - again, much more than the 500,000 IU used in this study.

Honestly, I don’t know if randomized control trials will end up showing that vitamin D supplementation prevents or treats depression.  However, providing one third of the usual annual dose to maintain vitamin D sufficiency is not a very good way to assess the effectiveness of vitamin D for depression.  Providing that dosage all at once makes even less sense.

This is an example of how the results of research and the headlines may not provide an accurate assessment of the question that is trying to be answered.

Be Well,

Richard Malik, ND

Proton Pump Inhibitors and Fracture Risk

May 14th, 2011

A recent article in the New York Times reports on research that links long-term Proton Pump Inhibitors (PPIs) with a 30% increased risk of bone fractures.  According to the article, the long-term use of PPIs may decrease absorption of calcium in the intestines.

PPIs reduce the acidity in the stomach in order to reduce symptoms of heartburn.  While this is an effective approach for reducing the burning pain caused by the regurgitation of stomach acid into the esophagus, lowered acidity in the stomach decreases the absorption of some nutrients - including calcium - and increases the chances of getting several types of infection including infections of the digestive tract and lung.

Some forms of calcium do not require stomach acid in order to be absorbed.  These forms include calcium citrate and calcium citrate/malate.  When taking PPIs or other antacid medicines, it is a good idea to supplement calcium intake with these forms of calcium especially if you are at increased risk of osteoporosis or of fracture.

The only drawback of calcium citrate and calcium citrate/malate is that these forms of calcium are very bulky - capsules usually contain only 150mg of calcium.  This means that the usually recommended dosage is 5 to 10 capsules per day.

Ensuring healthy vitamin D status is also very important for calcium absorption.

For more information on addressing osteoporosis, read my previous blog post on osteoporosis.

Other nutrients whose absorption can be decreased by acid lowering medications include magnesium and vitamin B-12.

Be well,

Richard Malik, ND

Simple Steps for Staying Sharp, Stopping Senility

December 27th, 2010

Preventing cognitive decline as we age may require only simple measures, according to several recent research articles out of Oxford University, the University of Pittsburgh, and the National Institute of Aging.  Scientists have been looking into the association between preventive lifestyle measures and the size of our brains as we age.

As we age, our brains atrophy; they get smaller over time.  This is a normal process, just like graying hair or skin wrinkling.  However, according to MRI scans, people with senility tend to have more brain atrophy than similarly aged individuals with good cognitive function.  Alzheimer’s Disease produces even faster rates of brain atrophy.

Oxford University researchers recently published study findings indicating that in patients with mild cognitive decline older than 70 years old, daily supplementation for two years with folic acid (800mg), vitamin B-12 (500 micrograms), and vitamin B-6 (20mg) decreases the rate of brain atrophy compared to similar patients taking a placebo.

Research by scientists at the National Institute of Aging found that low folate levels may increase the likelihood of symptoms of depression - especially in women between the ages of 20 and 85 years old.

Folic acid, vitamin B-12 and vitamin B-6 status can be measured with a single simple blood test: homocysteine.  There is an inverse relationship between intake of these vitamins and homocysteine levels -  homocysteine goes down with supplementation of these nutrients.  Optimal homocysteine levels are less than 12 nm/L.

In another study, researchers from the University of Pittsburgh found that women and men in their 70’s who walk more than 9 miles per week have better cognitive function than their less active peers.  These patients were monitored for 9 years and their preservation of cognitive function was correlated with slower rates of brain atrophy.

The amounts of folic acid, vitamin B-12 and vitamin B-6 suggested above are non-toxic - adverse effects at these dosages does not commonly occur.  Physical activity, such as walking, not only improves cognitive function but also prevents cardiovascular disease, diabetes, osteoporosis, and enhances mood.  These natural approaches to mental health are affordable and powerful medicine you can use without a prescription.

Osteoporosis: A Deeper Look

October 6th, 2010

Osteoporosis and the increased risk of fractures affects a large portion of the population over the age of 50.  Osteoporosis is more common in women, but occurs in men, too.  The risk of breaking a bone increases as we get older because bones tend to become less dense as we age.  Calcium from the diet or from supplements is only one of many factors that play an important role in keeping bones strong and preventing fractures.

Current medical research tells us that 1,500 mg of dietary calcium is helpful in treating osteoporosis and preventing fractures.  However, some cultures have a calcium intake that is about one tenth that recommendation and have a lower risk of osteoporosis than we do.  How can that be?

Are You Getting the Calcium You Eat?
The metabolism of calcium is complex.  On average, only about 30% of the calcium that you consume gets into your body.  So an average person that is consuming 1,500 mg of dietary or supplemental calcium is really only getting 500 mg that can be used to strengthen the bones.

Maximizing what your body does with the calcium that you eat is very important.  Vitamin D dramatically improves intestinal calcium absorption.  Did you know that vitamin D deficiency is epidemic in the northeast and is more likely as we age?  Correcting low vitamin D levels not only improves calcium absorption and bone health, but it often helps improve muscle aches and strength in the elderly.  A simple blood test can determine if you are vitamin D deficient - ask your doctor.  In lieu of doing a blood test, a daily intake of 1,000 IU of vitamin D3 is generally recognized as safe.

The absorbability of calcium also depends upon the type of calcium that you eat.  Calcium carbonate which is found in most calcium supplements and in antacids is cheap but poorly absorbed even under the best conditions.  Calcium that naturally occurs in spinach is very poorly absorbed.  The most absorbable form of calcium is calcium citrate-malate (with citric and malic acid) - it is up to 50% more absorbable than calcium carbonate.  Orange juice fortified with calcium citrate-malate is an excellent food-based source of calcium.

Through advertising, we are told how milk is good for healthy bones.  The calcium in milk is well absorbed, but not as well absorbed as the fortified calcium in orange juice or the calcium that is naturally found in kale.  Other vegetables with high levels of well absorbed calcium include: broccoli, kale, kohlrabi, mustard greens, rutabaga, turnip greens, and watercress.  Tofu set in calcium is also an excellent source.  Ten ounces of these foods are approximately equal to one eight ounce glass of milk in absorbable calcium content.

Are You Loosing the Calcium that You Eat?
Milk and other sources of animal protein like meats and other dairy products acidify the body.  When your body is more acidic you lose more calcium in your urine; the consumption of animal protein increases your calcium requirement.  High protein diets may contribute to osteoporosis and explain why some cultures have a very low incidence of osteoporosis while consuming very little calcium.

Other dietary and lifestyle factors encourage urinary calcium loss, including: smoking, excessive alcohol consumption, caffeine, and sugar.  Reducing your intake of these substances will help to improve your calcium status.

Besides Calcium & Vitamin D…
Bones are like muscles - the more you use them the stronger they get.  Weight bearing exercise like running and aerobics or weight training encourage strong bones - they are helpful for treating or preventing osteoporosis.  Even in people with severe osteoporosis, most fractures occur because of a fall.  Exercise reduces the risk of falling by improving coordination, strength, agility, and balance.

Vitamin K is found in abundance in the same vegetables that are good sources of calcium.  The enzymes in your bones that are responsible for taking calcium and putting it into your bone matrix depend on vitamin k; without it, they cannot do their job!  Several studies show aggressive daily dosages of vitamin K being effective for halting or reversing osteoporosis.  Vitamin K can prevent some forms of blood thinning medication from working - a very bad thing.  Aggressive vitamin K therapy should be done with the guidance of a knowledgeable physician.

Strontium - a mineral similar to calcium - is used in a prescription form in Europe to effectively reduce the risk of osteoporosis and to prevent losses in bone mineral density.  The prescription form is not available in the United States, but, based on the research I have done, there is no reason to expect the prescription form to work better or be safer than the forms available in supplements.  Strontium should still be used with the guidance of a knowledgeable physician.

Responsible & Effective Osteoporosis Prevention:
The development of osteoporosis occurs over decades and involves many factors.  The treatment and prevention of osteoporosis, from a natural perspective, are very similar:

  • Participate in physical activities that encourages strong bones;
  • Consume absorbable forms of calcium that do not encourage calcium loss;
  • Eat adequate, but not excessive amounts of animal proteins;
  • Make sure to get adequate daily vitamin D (about 1,000 IU);
  • Eat plenty of vegetables that are rich in vitamin K;
  • Don’t smoke
  • Consume small amounts or no alcohol, caffeine, and sugar.

Anyone can do their best to prevent fragile bones following the guidelines provided here.  However, osteoporosis and its precursor, osteopenia, are important medical conditions and should be addressed and monitored with the assistance of a doctor.

Be Well,


Back to School, Back to Wellness

August 24th, 2010

It is a great time of year to improve the health of your family.  While preparing for the coming school year, it can take only a few moments to identify simple steps that will substantially improve your family’s wellness and make your life simpler.

Sleep is important - I consider it an essential nutrient.  Some medical studies show that decreased sleep can increase your chances of getting a cold.  Healthy amounts of sleep also improve mood and support weight loss.  Keeping regular bed times and avoiding stimulating activities (i.e. movies, wild play, caffeine, and sugar) before bed can go a long way to getting your family to bed at a reasonable hour and waking refreshed.

Vitamin D is important for both neurological and immune function.  Vitamin D is produced in the skin when exposed to direct sunlight - something that does not occur in cooler months of the year.  2,000 IU of vitamin D per day is safe for adults and children older than 12 months.

Healthy food is the cornerstone of good health.  Most people know that vegetables, fruits and whole grains are health foods, but many don’t realize the many negative effects of refined carbohydrates.  Beyond encouraging obesity, refined sugars cause emotional agitation and reduce immune function; some studies show that sugar, honey, and maple syrup reduce the ability of white blood cells to destroy bacteria by as much as 50%!  Simply reducing - it is not necessary to eliminate - intake of refined carbohydrates can have many positive health effects for your family.

Imagine what your family’s school year could be like with less illness and irritability.  Imagine how this can improve your stress level and support the time and energy required for raising a family and having fulfilling relationships.  Sometimes, great changes can result from the simplest of interventions.

Be Well,


Simple Solutions for Seasonal Allergies

August 24th, 2010

As many as 25% of Americans experience a runny nose, itchy eyes, or asthma due to seasonal allergies.  There are some simple mainstream and alternative approaches that can alleviate symptoms in allergy sufferers.

An allergy is a type of response that occurs when the immune system is reacting to things in the environment that are not in and of themselves a threat.  For example, the danger in a person with a severe allergy to peanuts does not come from the peanut itself, but instead solely from the immune system’s extreme response.  Similarly, pollens, dander, dust mites, and other common allergens do not actually cause the symptoms of seasonal allergies, but trigger immune reactions that cause common symptoms.

The mainstream medical approach to seasonal allergies includes anti-histamines and other drugs that block the immune system’s ability to release natural chemicals that cause allergic symptoms.  These work for many, but not all allergy sufferers.  Another mainstream medical approach is immunotherapy - injections of small amounts of allergens that are designed to decrease your body’s sensitivity to identified allergens.

Another approach that helps many allergy sufferers reduce their symptoms and need for medication is identification and avoidance of non-seasonal allergens that a person’s immune system is reacting to.  This approach reduces a person’s total allergy burden and frequently reduces seasonal allergy symptoms.

Common non-seasonal allergens include dust mites and dander.  Simple steps that can have dramatic effects include: have pets sleep in another room, use dust mite covers on bedding, frequently vacuum with an effective HEPA vacuum, and use indoor HEPA air-purifiers.

Another common non-seasonal allergen is mold.  While HEPA vacuums and air filters can be helpful, the most effective approach is addressing the cause; identify damp places in the home and remedy them with a dehumidifier and, when necessary, minor renovations.

Another common non-seasonal allergen is mold.  While HEPA vacuums and air filters can be helpful, the most effective approach is addressing the cause; identify damp places in the home and remedy them with a dehumidifier and, when necessary, minor renovations.

Lastly, many chronic seasonal allergy sufferers see marked improvement when they identify foods they regularly consume that contribute to their reactions.  Offending foods can be identified through strict dietary avoidance (usually for several weeks) with controlled reintroduction to monitor changes in symptoms.  The hard part is knowing which foods to avoid.  Some specialty lab tests can be very helpful in this process, but many people end up reacting to one or more of the following foods: dairy, eggs, gluten containing grains, soy, or yeasts.

Lastly, many chronic seasonal allergy sufferers see marked improvement when they identify foods they regularly consume that contribute to their reactions.  Offending foods can be identified through strict dietary avoidance (usually for several weeks) with controlled reintroduction to monitor changes in symptoms.  The hard part is knowing which foods to avoid.  Some specialty lab tests can be very helpful in this process, but many people end up reacting to one or more of the following foods: dairy, eggs, gluten containing grains, soy, or yeasts.

There are a couple important things to remember:

  • if you have a serious anaphylactic allergy, always avoid that allergen, and
  • if experimenting with dietary avoidance, make sure the diet still has adequate options, calories, and nutrients - especially for children - because eating should always be fun and healthy.
Be Well,

Natural Therapies for Breast Cancer

January 3rd, 2010
When considering natural therapies for breast cancer, it is important to understand what medical or research-based evidence exists that shows which natural therapies are effective and for what circumstances.  While there are many claims made on packages and the internet about herbal formulas, special diets, or new-fangled technologies, the evidence for natural therapies that work to cure breast cancer on their own is paltry, at best.
However, natural medicine truly shines in supporting oncology patients so they have the best results through surgery, radiation, and chemotherapy.  The options to reduce adverse effects, improve outcomes, and help cancer patients feel well are diverse.  When used in this way, the goal of natural medicine is to support conventional treatment approaches without interfering its effectiveness and to address concerns as they arise; natural treatments are tailored for each individual set of circumstances.  Here are some examples of my favorite approaches.
Glutamine is an amino acid (protein building block) that high doses helps to improve recovery from surgery and helps prevent nausea, ulcerative lesions in the mouth and digestive tract, and neurological toxicity from some chemotherapy drugs.
Ginger is an excellent and safe way for chemotherapy patients to prevent nausea.  Using capsules, liquid herbal extracts or even lollipops made by a compounding pharmacist are options that support easy compliance for the patient.
Doxirubicin is a common chemotherapy drug that is used to treat breast cancer.  However, one of the most serious adverse effects of doxirubicin is toxicity to the heart.  Coenzyme Q10 and L-carnitine are nutritional supplements that have been shown in medical research to reduce doxirubicin related heart damage without interfering with the drugs ability to kill breast cancer cells.
Another common concern for oncology patients is maintaining their immune function and white blood cell status.  Some approaches that are promising in this area include maitake mushroom extracts, ginseng (a popular Asian herb), ashwaganda (an herb from India), and vitamin E supplementation.
It is clear that natural therapies have a supportive role in cancer treatment.  But, if not used wisely, natural medicine can have negative effects.  For example, studies show that the herb curcumin (turmeric) can decrease the cell-killing effects of some chemotherapy drugs like cyclophosphamide and doxirubicin (both are used in breast cancer treatment).  Other dietary supplements that may reduce chemotherapy effectiveness include coenzyme Q10, glutathione, and cysteine.  The most effective and safest way of using natural therapies is to consult with your oncologist and work with a qualified professional.

Be Well,

Breast Cancer - Reducing Your Risk

January 3rd, 2010

In a previous article, I discussed the recent changes to mammography recommendations.  This week I’ll share what women can do to reduce their risk of breast cancer.

First of all, it is important to acknowledge that cancer statistics are very complicated; the most recent research study may have results that contradict the one before.  This explains why it is easy to get confused by the divergent information about cancer in the news media.  I will try to provide some clarity.

Put simply, being at a healthy weight significantly reduces the risk of dying from breast cancer.  Numerous medical studies indicate that maintaining a health weight (BMI between 20 and 25) is the most important lifestyle factor in affecting breast cancer survival.

The healthiest way of achieving optimal weight is to eat plenty of vegetables and fruits and to exercise regularly.  A 2007 study published in the Journal of Clinical Oncology indicates that breast cancer patients who eat these healthy foods and exercise reduce their risk of dying from their cancer by up to 50%.

While having a glass of wine every day seems to prevent cardiovascular disease and decreases the rate of death from all causes, this amount of alcohol seems to increase breast cancer risk.  If you are concerned about breast cancer because of your personal or family medical history, avoid alcohol.  If cardiovascular disease seems more important, a few glasses of wine can be an enjoyable and healthy choice.

Hormone therapy with estrogen and/or progesterone for menopause increases the risk of women getting breast cancer.  While the increased risk may be small, it is real: a 24% increase in risk.  Natural treatments for menopausal symptoms work well.  Some of the best therapies I recommend include herbs like black cohosh, chaste tree, and St. John’s Wort.  Preliminary research indicates that black cohosh can even be helpful as an add-on treatment for breast cancer.

One of vitamin D’s roles in the body is helping to make sure that cells grow to be healthy and mature.  Because dangerous cancer cells are immature, vitamin D status may be important in all forms of cancer, including breast.  The best way to know your vitamin D level is to get a test from your doctor called 25-OH Vitamin D.  Insufficiency is defined as less than 30ng/mL and optimal levels are about 45ng/mL.  If testing is not available to you, taking 2,000 IU of supplemental vitamin D3 each day is a safe approach.

Be well,
Richard Malik, ND