Saturday, January 31, 2009


From an e-mail I received this week:
I was wondering your thoughts on Moxxor. I pasted below an email I got from a friend who is helping promote it. Please let me know your thoughts.

Oh dear, another product about which I know nothing but upon which I am asked an opinion. The standard dilemma--do I write back and say "This is Dr. Paley's secretary. Thank you for your query but unfortunately the doctor is unable to answer individual e-mails." Or do I look it up and give it my best guess. Well that's what I did.

Moxxor is a supplement made of oil d'green-lipped mussels. The thought of eating bi-valves always brings to my mind "The Walrus and The Carpenter" poem from Alice in Wonderland; the first poem I ever memorized (one of three lifetime poems by rote for me) wherein a walrus and carpenter entice little oysters to scurry from their beds for a walk along the beach and ultimately eat them all(2).

Back to Moxxor, just letting you know I'm a little uncomfortable right up front with its origins. I am, however, very pro-omega-3-fatty acids, and Moxxor's green-lipped mussel variety is, per glowing Internet reports, a particularly fine one. GLM-omega-3's are purported to have potent anti-inflammatory properties. One fellow who actually met the guy who developed Moxxor (a toothy, widely grinning fisherman from New Zealand) took his first dose, worked out like mad at the gym that afternoon, then woke up the next day pain-free from his exercise session.

Now if you can wait long enough for the graphics to load (which I did not), tells you how you can become an independent distributor of the stuff. Right there that's enough to make me want to write back to this lady about what a silly scam it all is--just buy the 3 for 1 omega-3's at But I looked in on and learned a thing or two about the health benefits of GLM's.

UK Scientists did a meta-analysis of studies treating osteoarthritis with GLM(1). They concluded "The data... suggests that GLM may be superior to placebo for the treatment of mild to moderate OA. As a credible biological mechanism exists for this treatment, further rigorous investigations are required to assess efficacy and optimal dosage." The credible mechanism is provided by numerous studies that show that GLM's have unique poly-unsaturated fatty acids with significant anti-inflammatory activity.

Whoa, I'm down for that; I've got a finger, two thumbs, a knee, and a foot in serious need for significant anti-inflammatory activity. Maybe I could become a Moxxor dealer and get out of primary care. I'll let you know if I ever get past the graphics delay and my bi-valve aversion to actually order this stuff.
(1) Brien, S, et al. Systematic review of the nutritional supplement Perna Canaliculus (green-lipped mussel) in the treatment of osteoarthritis. QJM 2008 Mar;101(3):167-79.

(2) Here's the part that's put me off my Oysters Rockefeller:

*'But wait a bit,' the Oysters cried,
'Before we have our chat;
For some of us are out of breath,
And all of us are fat!'
'No hurry!' said the Carpenter.
They thanked him much for that.

'A loaf of bread,' the Walrus said,
'Is what we chiefly need:
Pepper and vinegar besides
Are very good indeed --
Now, if you're ready, Oysters dear,
We can begin to feed.'

'But not on us!' the Oysters cried,
Turning a little blue.
'After such kindness, that would be
A dismal thing to do!'
'The night is fine,' the Walrus said,
'Do you admire the view?'

'It was so kind of you to come!
And you are very nice!'
The Carpenter said nothing but
'Cut us another slice-
I wish you were not quite so deaf-
I've had to ask you twice!'

'It seems a shame,' the Walrus said,
'To play them such a trick.
After we've brought them out so far,
And made them trot so quick!'
The Carpenter said nothing but
'The butter's spread too thick!'

'I weep for you,'the Walrus said:
'I deeply sympathize.'
With sobs and tears he sorted out
Those of the largest size,
Holding his pocket-handkerchief
Before his streaming eyes.

'O Oysters,' said the Carpenter,
'You've had a pleasant run!
Shall we be trotting home again?'
But answer came there none --
And this was scarcely odd, because
They'd eaten every one.

Wednesday, January 21, 2009

Pedometer-based walking intervention

I love these names--if I recommend pedometers, and I do, then I am conducting pedometer-based walking interventions. Visions of two wild-eyed pedometer experts swooping unannounced into your workplace, grabbing you one arm apiece, and carrying you out to the parking lot where they install a pedometer on your waistband and drag you screaming, half-walking/half-kicking around the parking lot until you hit 10,000 steps.

Anyway, scientists from the Dept. of Family Medicine conducted a meta-analysis of PBWI's which means that they not only searched six electronic databases for weight loss outcomes in nine different studies that compared the pedometered with the pedometerless to see who lost the most weight, but they also contacted real-life pedometer experts just in from field interventions to interpret the results. Their conclusion?

Pedometer-based walking programs result in a modest amount of weight loss. Longer programs lead to more weight loss than shorter programs.

I trust the experts were pleased.

Monday, January 19, 2009

Statins and infection control

I have any number of patients who take statin drugs(1) to lower their cholesterol levels in order to reduce their risk of unwanted cardiovascular outcomes such as stroke or heart attack. I would prefer, in an ideal world, that these patients control their risk factors with healthy habits in diet, exercise, and weight control, but, alas, this is not a perfect world but rather one in which many lack time, will-power, and resources to make these changes in a timely fashion.

In addition to their ability to reduce cholesterol production and increase LDL clearance by the liver, these drugs are known to reduce inflammation in the body. Inflammation is a good thing as a first responder to infection or injury, but inflammation gone amok is part of the pathological process that increases tissue destruction in Alzheimer's disease, athersclerosis (hardening of the arteries), cancer, arthritis, and severe infections.

Danish and American researchers theorized that the anti-inflammatory effects of statins could improve outcomes for patients admitted to the hospital for pneumonia; those persons protected from over-exuberant inflammation by statins might be more likely to walk out of the hospital rather than being rolled out through a basement door on a gurney. They examined the hospital records for nearly 30,000 patients over 7 years looking for pre-admission statin use as correlated with the risk of sepsis and death associated with serious pulmonary infections. Indeed, those patients currently on statins had a 31% better chance of being alive 90 days after their pneumonia diagnosis compared with those in a statin-less state.

Wondering why? Dr. Kasturi Haldar of the Center for Rare and Neglected Diseases (I kid you not) informs us in an editorial in the same Archives issue that it's all about G proteins. Statins block the isoprenylation (whatever that is) of small G proteins. This decreased prenylation business protects against Alzheimer's disease because the beta-amyloid guck that gums of the brainworks in the disease depends on the breakdown of amyloid precursor protein, a process which in turn counts on prenylated G proteins.

In infections, little G proteins increase the inflammatory response which can fill the patient's airway with fluids and white cells instead of the air upon which we depend. G proteins might also promote the bacteria's ability to enter cells and prosper therein. As in Alzheimer's, as statins decrease the prenyl pool upon which G protein function depends, the decreased inflammatory response may reduce the inflammatory response.

So if you are ever called upon to weigh the decision of statins or not in your future health care plan, consider this side benefit of the use of these drugs.
(1)Lipitor, Crestor, simvastatin, lovastatin, fluvastatin
(2) Thomsen, RW, et al. Preadmission Use of Statins and Outcomes After Hospitalization With Pneumonia. Arch Int Med Vol 168 (No.19), Oct. 27, 2008.

Monday, January 12, 2009

Skinceuticals C E Ferulic

So what's Arlen Specter doing on my blog? Well, he's got those pouchy things going on on either side of his mouth. And that's my newest obsession--my little pouchy things where acne scars are coalescing with wrinkles. I googled Arlen Specterish pouchoid look and found Well, actually not, I don't exactly remember what I googled but it was some combination of Vitamin C serum and aging skin. Topical vitamin C is known to stimulate collagen production, and collagen is the fibrous tissue that keeps your cheeks off your chin and your chin off your collar. And Dr. Benabio's excellent blog noted that this fern-derived antioxidant called ferulic, when combined with topical C, stablizes the latter and allows it to penetrate better into damaged skin. And he said someday soon, topical C plus ferulic would be available.

I am computer woman, see me google. Off to vitamin C AND ferulic arriving at Skinceuticals C E Ferulic Sample Size . What the heck, thinks I, it was on sale in December, so for $25, why not?

Fast forward to three weeks later, a patient told me today my skin looked great. "Good color," she said, "You look healthy!" Need I say more?

September, 2009 update: Still using CE Ferulic. A little goes a long way--one tiny sample body supplies nightly face application for over a month. Skin looking so good that my 20-something year old daughter noticed it and took one of my bottles for herself! Get your own CE Ferulic my dear!

Sunday, January 11, 2009

Fat or not, the fit live longest!

I mentioned in my previous post that exercise promotes immunity, just one more reason to dance as if your life depends on it. Exercise scientists set out to study the association between cardiorespiratory fitness, extra weight, and the predisposition to keel over dead in older adults. They enrolled 2600+ adults aged 60 or older in the Aerobics Center Longitudinal Study, poked, prodded, measured, and then watched their subjects' survival stats over 22 years. Here's what they found:

In conclusion, in this prospective study of adults 60 years or older, low fitness predicted higher risk of all-cause mortality after adjustment for potential confounding factors, including adiposity. Fit individuals had greater longevity than unfit individuals, regardless of their body composition or fat distribution...It may be possible to reduce all-cause death rates among older adults, including those who are obese, by promoting regular physical activity, such as brisk walking for 30 minutes or more on most days of the week which will keep most individuals out of the low-fitness category(1).

So here's what I hear: "I'm so discouraged. I've been working out for a month now and I haven't lost any weight." A couple of points: 1) Working out at the rate of 20 minutes on a treadmill 3 days per week is insufficient to promote fitness or weight loss, though theoretically it's better than nothing at all, and 2) If you are on the road to fitness with sufficient cardiovascular workouts, you are promoting good long-term health--and survival--whether or not you lose weight. All-cause mortality is just that, death from any cause whether it be heart attack, stroke, cancer, or sepsis from an overwhelming infection with some nasty, multi-drug resistant bacteria.

What's on your New Year's resolution agenda?
(1) Sui, X, et al. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA 2007 Dec 5;298(21):2507-16.

Friday, January 09, 2009

ESBL E. coli

My 60 year old patient needed help from two of us to walk from the waiting room into the exam room. Once there and lying down, her blood pressure was 78/40 and her pulse was 120. I was unable to check her 'postural' blood pressure (comparing values sitting to standing looking for a significant drop indicative of dehydration) as she kept losing her balance and her consciousness in the standing position. Long story short--once admitted to the hospital, her diagnosis was sepsis (invasion of bacteria into the bloodstream) from an overwhelming urinary tract infection caused by ESBL E. coli.

I'll admit, I hadn't heard of this bad boy before Ms. B. nearly died from her infection. Just looking at the culture & sensitivity report, however, was enough to make my heart sink. Cultures of her blood grew an E. coli species resistant to all but 2 antibiotics tested, and those two were 1) only availble by IV, and 2) did not even exist back when I was in training.
Beta-lactam antibiotics are named for a beta-lactam ring in their structure. They include penicillin whose discovery revolutionized the treatment of infectious disease, and cephalexin, the miracle drug discovered after many bacteria developed resistance to penicillins. Extended-spectrum beta-lactamase-producing E. coli (or ESBL E. coli) produce an enzyme (beta-lactamase) that destroys the beta-lactam chemical ring, rendering it useless against the little buggers.

ESBL E. coli has been a problem in Europe for awhile. Its 'extended spectrum' resistance (eats not just one but most beta-lactam antibiotics) is theorized to have developed due to the overuse of antibiotics in animals--particularly chickens--raised for food. More often found in health care institutions such as hospitals, ESBL E. coli is clearly now out in the community where my patient came into contact with it.

Ms. B. survived, barely. When she came in earlier this week with symptoms of weakness and urinary burning and frequency, we both thought...and feared...the same thing. The culture came back yesterday--ESBL E. coli. She cried and I shuddered, feeling like I was glimpsing our future in Ms. B.'s today.

Ms. B. did nothing wrong, nor do we know just what to do right to avoid such a super-infection. I'd suggest hand-washing, scrupulous handling of raw meat especially chicken, vitamin D, and hot, sweaty exercise as known, immune-enhancing strategies.

Saturday, January 03, 2009

Red yeast rice revisited

I sweat along with one of my fifty-something year old patients at weekly Jazzercise sessions. As a result, I know her elevated cholesterol levels have nothing to do with a lack of exercise. We have tried several statin strategies to lower her numbers. Alas, even using CoQ10 supplements, low alternate day dosing of Crestor, and statins less likely to enter muscle cells, all still result in unacceptable side effects for her. She has chosen to motor on without meds.

She recently told me that she was using red yeast rice supplements as a 'natural' way to lower her cholesterol. I asked her how she was feeling, did she have any muscle pain with the supplement? As a matter of fact, she replied, she did notice that. She was surprised to learn that insofar as taking a supplement made by the fermentation of rice with fungus was natural, a process through which Lovastatin is made, she was going natural. So she was actually taking low-dose Lovastatin in an unregulated sort of way, complete with a risk of toxic contamination by the metabolic byproducts of fungus feasting on rice!

If you are interested in supplements, and I certainly am, I recommend you invest $30 or so in an annual membership to, where you can read reliable information on the science behind those OTC pills we take and the results of their testing various brands for content and contamination.

Thursday, January 01, 2009

Conditioner for limp, pathetic hair

No news to regular readers that my hair is a source of some angst to me. Progesterone cream helps to keep it on my head, but nothing was giving it that shine and manageability I sought. Conditioners, mousse, volumizer, sprays, gels...all gave me the dog-caught-in-a-rainstorm look. My neighbor/friend/hair consultant just sadly shakes her glowing bouncy locks as she trims my hair in about five minutes, says no product exists to improve this mane.

So, far be it for me to be a beauty consultant, but this tip is too good not to share. I was flipping through Health Magazine, checking "The best anti-aging secrets: Looking younger isn't all about serums, needles, and lasers. Here's 17 all natural moves." This is the same article that gave us the all natural move of chugging our coffee ASAP so as not to stain our aging yellowing teeth.

This was the #1 tip from Lisa Hedley, the founder and creative director of the Mayflower Inn & Spa:

Open Sesame (Oil): First thing every morning I massage organic sesame oil from the health food store all over my body. Working it in wakes me up and really gets my blood circulating. Plus the oil hydrates my skin, giving it a healthy glow. Then I jump in the shower--the oil naturally cleans away dead skin cells.

I thought that would be the sort of thing my daughter would enjoy--all that blood circulating and glowing in the morning. She said let's get real here, I'm not going to do that before I go to work. So I'm left with this bottle of sesame oil, and I'm sure as heck not going to smear it all over me pre-shower and risk falling in the tub and cracking my skull open. But...wait, I think, what if I massage it into my scalp, toss some coffee quickly past my pearly whites, then wash my hair? Couldn't hurt, maybe could leave a healthy hair glow?

Who'd'a thunk it? My hair is fabulous (in a relative sense)--soft, shiny, no frizz, no flyaway, no static. I'm sure it will be hard to keep my husband from running his fingers through it when and if he finally notices. Six bucks for 13 oz. of the organic stuff from King Soopers. I highly recommend it.