(Dr. Isadore Rosenfeld's 2nd visit to Power Surge)
Dearest: Returning to Power Surge tonight is Isadore Rosenfeld,
M.D. Dr. Rosenfeld is the author of 9 New York Times bestsellers, including
his newest,the first volume in an annual series,
"Dr. Isadore Rosenfeld's Breakthrough Health 2004: 167 Up-to-the
Minute Medical Discoveries, Treatments and Cures That Can Save Your Life,
From America's Most Trusted Doctor!" as well as a textbook for doctors. Affectionately called, "America's favorite
doctor" and "America's most trusted doctor," Dr. Rosenfeld is one of the
leading and most effective proponents of the medical enlightenment of
the America's public. Dr. Rosenfeld is Rossi Distinguished Professor of
Clinical Medicine at New York Presbyterian Hospital / Weill Cornell Medical
Center and an attending physician at New York Presbyterian Hospital. He
was president of the New York County Medical Society and was a member
of The Practicing Physicians Advisory Council for the Secretary of Health
and Human Services. In addition to maintaining a private practice in Manhattan,
Dr. Rosenfeld has served as a consultant to the National Institutes of
Health, was the first physician to be honored by the New York Heart Association
for Distinguished Contributions to Science and Medicine. He received the
United Nation's Citizen of the World Award in November 1999 and was awarded
the San Valentino D'Oro Gold Medal for Medicine. As the health editor
for Parade magazine, in which his columns are enjoyed by more then 80
million readers, he is also medical consultant for Fox TV, where he appears
every Sunday morning on his popular Sunday House Calls program. It is
a pleasure to welcome you back to Power Surge, Dr. Rosenfeld.
Dr. Isadore Rosenfeld: It's really good
to be here again. I enjoyed our last chat very much.
Dearest: It must be very gratifying being referred to as
"America's most trusted doctor." Yet, at the same time, I would imagine
it also holds a great deal of responsibility. I'm interested in your thoughts
about this affectionate term whenever your name is mentioned.
Dr. Isadore Rosenfeld: Naturally, I'm very flattered. I'm
not sure that it's justified but I'm not going to argue with it. To the
best of my recollection I have never made an evaluation which has represented
any commercial interest, so when I recommend a treatment, test or hospital.
It's done spontaneously with no personal motivation. That may be why I
earned the nickname.
Dearest: I realize there are many fabulous drugs, prescription
and OTC, that are helping to improve the quality of life for many who
years ago would have died from the same condition. However, I'm concerned
that we're becoming an over-medicated society. I can't walk into my doctor's
office without being handed some "sample" of something to try. I don't
want to take all these drugs. Why are Americans using so many drugs?
Dr. Isadore Rosenfeld: I believe that in every medication,
there is a little poison that in selecting a medication you have to balance
the benefit with the possible toxicity. The fact is that in the first
decade of the 1900's the average life expectancy was 47 years and it's
now in the 80's. That's due to medications as well as to testing and other
medical protocols. I thank God every day for the many drugs that can save
lives from cancer, strengthen sick hearts, correct chemical abnormalities,
and many other problems. Everyone who is prescribed medications should
understand what the circumstances and whether it can be treated another
way. If a doctor prescribes a medication and discusses the side effects
and the possible benefits, you should be able to make a good decision.
You do not need to take a medicine unless you are satisfied with the side
effects.
Dearest: You mention the liver, what about the impact of
someone, for example, taking five different drugs, all of which must pass
through the liver. What possible long-term effects can many of these medications
have on our livers?
Dr. Isadore Rosenfeld: Some of them are reversible when you
stop the medication. If you have a life-threatening infection, the drug
may effect the liver, but the medication is very important. A blood test
can determine possible liver toxicity. If there is a problem, the doctor
will monitor you with blood tests and watch for liver problems.
Dearest: Continuing along the same lines, there's been an
enormous amount of positive feedback about the statin drugs - cholesterol
lowering medications, such as Lipitor, Pravachol, Zocor as having tremendously
positive effects on our health, especially heart health. Could you elaborate
on exactly what makes this genre of drugs so miraculous?
Dr. Isadore Rosenfeld: We know that heart disease and stroke,
which remain the biggest killer of men and women, one of the biggest risks
is high cholesterol, elevated LDL (bad cholesterol), low HDL (good cholesterol).
These statin drugs, as they are called, lower or normalize these cholesterol
levels. It has been shown that these statin drugs have a tremendous effect
on overall health. They lower the risk of vascular disease, Alzheimer's,
a beneficial effect on some cancers, slow down disease of the aorta. Even
older people who have normal cholesterol and take statin drugs for any
length of time have a lengthened life. There is more and more information
that statins have other benefits such as anti-inflammation. That's the
reason that the NSAIDs (Non- steroidal anti- inflammatory drugs) such
as Motrin, can help prevent cancers of the bowel and other diseases. In
my experience only 2-3% of people who take statins develop liver problems.
In that case, I have the patient return in 2 months to have their blood
lipids measured as well as liver function. If their numbers are only slightly
abnormal, I may can continue and it will normalize. If the numbers are
high, we would stop. We have to balance the potential good with potential
harm. The liver problems are detectable and reversible. Whenever I give
a new drug, I monitor it carefully.
Dearest: Is it true that there's a greater benefit for those
using both statins and beta blockers? Also, what potential side effects
can one have from using statins?
Dr. Isadore Rosenfeld: The beta blockers are used for different
purposes than the statins. To lower cholesterol, a doctor would not use
both. The beta blockers would be used for heart problems. A doctor would
only use both if there were problems with both cholesterol and the heart.
Sometimes niacin or niacinamide is used with the statins. There are some
preparations with both the niacin and the statin.
Delta: I'd like to know what you think about Echinacea.
Dr. Isadore Rosenfeld: Echinacea is one of the most widely
sold herbal preparations sold in this country. It is used mainly for viral
upper respiratory problems like the cold. Some use it to prevent colds.
Others use it to make the cold less severe. There has been some information
that there is an increase in white blood cells. In my new book, I have
a section on echinacea, and it mentions a study that it doesn't help children.
It should be used with caution in people with autoimmune disorders. It
is not as popular now as it has been in the past. One of the problems
is that the FDA does not oversee its manufacture and there is no supervision
that drugs have. In a recent study, they found that the contents of bottles
of echinacea showed that there was none in the bottle. If you're going
to use it, be sure that it is made by a reputable company like TwinLab
or Solgar, not from overseas. There is a problem with things sold over
the internet. If you're going to take it, I don't think there's any problem
with taking it, but be sure that there's something in what you're taking.
It's more common for herbal preparations to be "blank" than things under
the FDA supervision.
GardenGal: In this case, with a family history of heart disease, what
is the single most effective thing a woman at the age of 50, who doesn't
smoke, drink, or have high blood pressure, cholesterol controlled with
exercise and Lipitor do to avoid a heart attack? Heart attacks ran in
the family with mother and father.
Dr. Isadore Rosenfeld: Standard risk factors
are the ones you don't seem to have, except for family history. Watch
your weight, avoid diabetes. The fact that you don't drink is not a plus
for this. A glass of wine at night reduces the risk, but don't start now.
Get tested with a C-reactive protein test. The C-reactive protein is a
marker in the arteries. You should also be tested for homocystine. Other
than that, you are doing everything you can. I don't usually recommend
aspirin for women with no risk factors but you have a bad family history
and are on Lipitor, so you might benefit from the aspirin. But I don't
recommend it generally, if there is no risk.
TiddyTi: Are beta blockers used to treat high BP?
Dr. Isadore Rosenfeld: Beta blockers are used for many functions.
They control cardiac arrhythmia, reduce nerves in speakers before they
speak, heart failure, palpitations. They are often used to prevent migraines.
They have many, many uses.
Nanna: Dr. could Remifemin cause liver damage as it has black cohosh
in it?
Dr. Isadore Rosenfeld: I've never seen that happen. If it
does, it's very rare.
Leslieananda: In June 2002 I had a total hysterectomy, two large tumors,
low malignancy ovarian cancer. All the classic meno symptoms but I also
developed rheumatoid arthritis and vision problems. NOW I have kidney
pain, extreme sugar sensitivity. My doctor is stumped. Seeking an endocrinologist.
Help?
Dr. Isadore Rosenfeld: I prefer not to answer a complicated
case like that. That is too complicated to answer in a chatroom. See what
the endocrinologist says. Marlo: Hi, Dr. Rosenfeld. I have been suffering
from panic attacks ever since my parents died two years ago. Also menopause
brought them on, too. Last night my heart was beating so hard I couldn't
catch my breath. I got so scared I panicked even more. What is the difference
between the symptoms of anxiety and a heart attack? They are so similar.
I also have PVCs. My pressure is normal and echo normal. My doctor wants
to put me on inderol.
Dr. Isadore Rosenfeld: First, I'm surprised
that the echo is normal, but you have the symptoms are similar to the
PVCs (premature ventricular contractions). If these are recurring problems,
you should have a heart workup with an electrocardiogram (EKG) and a stress
test. If the cardiovascular tests are normal, they are panic attacks.
Before dismissing the possibilities, get the heart tests.
Dearest: Please share with us about the over the counter
drug that may help prevent breast cancer. Thank you.
Dr. Isadore Rosenfeld: It has been shown that one of the
NSAIDs, such as Advil, every day over a period of years, has been shown
in one study to reduce the risk of breast cancer as much as 40% probably
because of the anti- inflammatory properties.
Nature: Thank you for talking my question. It's about menopause. The doctor
just put me on the CombiPatch. I get regular checkups and regular blood
work and I have no other issues. I'm in the last stages of the menopause.
I'm going to be on the patch for less than 4 years the doctor told me.
She said I'd be ok. I want to know can I lose the weight I've gained?
I have had blood tests for TSH and I'm fine. I do exercise 3 time a day.
I'm on the low dose 50/140 and I'm a small person 5 foot 4 inches and
weigh 118 now. I've always weighted 110. I've got 3 children, too.
Dr. Isadore Rosenfeld: My only comment
about menopause, generally speaking, is that menopausal women who have
disabling symptoms should not hesitate to take low dose hormones. I think
it's important for women to maintain the quality of life and stop the
hormones after 3-4 years. Women have been so scared of breast cancer and
other things that they don't take care of their quality of life. I prefer
the natural hormones. I'm an old fashioned doctor - watch what you eat
and exercise. NO weight reduction pills.
Barbie: Hello, Dr. Rosenfeld. I read your column every week and try to
catch you on TV. I've been diagnosed with ductal ectasia of the breast
and told to take evening primrose oil gelcaps to ease the pain. How much
should I take?
Dr. Isadore Rosenfeld: I have no experience with oil of evening
primrose. My only experience is for preventing migraines. For ductal ectasia,
this would have to be monitored by your doctor. The only indication for
which I use evening primrose is for the prevention of migraines. I don't
know of any other documented use.
SansSusie: Dr. Rosenfeld, I enjoy your appearance on Fox News on Sunday
mornings. However, I was shocked to hear you say that you do not recommend
taking antioxidants to prevent coronary disease (in fact you recommend
that women DO NOT take antioxidants.) In addition to guarding against
coronary disease, Vitamin E has been shown to boost immune function generally.
And new evidence suggests that Vitamin E inhibits the growth of cancer
cells. How can you in good conscience advise women NOT to take antioxidants?
Dr. Isadore Rosenfeld: I can only go by the research data.
The research data show that Vitamin E has no effect on coronary disease.
The combination of Vitamin E and C may reduce the risk of Alzheimer's
in very high doses. If you are taking a statin drug to lower cholesterol,
taking the antioxidants will not help. In large doses Vitamin E can elevate
blood pressure. We are so focused on vitamins. They should be obtained
in the diet, not from supplements. Beta- carotene is a major part of fruits
and vegetables and is a preventative for cancer. In a Finnish study, they
found that the beta carotene may predispose cancer in those for high risk.
This study involved 29,133 male, current smokers, aged 50-69. Half the
group was given 20 milligrams of beta carotene a day. The other half received
a placebo. Those who received the real thing showed a rise in the rate
of lung cancer occurrence. I think for high risk people Vitamin C or E
may be helpful, but you have to look at each case individually.
Dearest: SansSusie, regarding your remarks about anti-oxidants,
Dr. Rosenfeld has a paragraph in his new book - When to say no to antioxidants. You'll
get your answers there. Joni: I have been on "natural" hormones from a
compounding pharmacy - Triest / progesterone / DHEA cream twice daily.
Do they have the same negative effects as synthetic HRT? It has really
helped with hot flashes, mood swings etc. and I hate to stop using it.
Have there been any trials on natural hormones with different/safer results?
I'm confused about whether to keep taking them with all the scary results
in the news! Been on them for 4 years now (58 years old)
Dr. Isadore Rosenfeld: I don't think that
you should stop using it if you have breast and cardiovascular tests regularly.
Anita: I am struggling with anxiety in menopause. I have been given Lorazapam
for the past two years and this worries me. What are the long term effects
of this drug?
Dr. Isadore Rosenfeld: I think that it's a pretty safe drug.
You can become dependant, if you continue for a long time, but they're
pretty safe. Use the lowest effective dosage. It is better to take that
than suffer with debilitating anxiety.
Dearest: I'm a fish eater. I use omega 3 essential fatty
acids (fish oils). You discuss the mercury content in fish. Should we
be concerned?
Dr. Isadore Rosenfeld: I think that certain fish have more
mercury than others. Pregnant women, nursing mothers, women of child-bearing
age should limit their fish intake to 12 ounces a week, no more than 6
ounces of tuna because of the mercury intake.
MsDeak: How do you feel about using Red Rice Yeast for lowering High
Cholesterol. Also, I've had low blood pressure of 80/56 for about 5 months
after I blacked out. I had a CT scan done and EKG done and all was okay.
I have been taking Magnesium supplements for 5 years. Should I be concerned
with a consistent low blood pressure?
Dr. Isadore Rosenfeld: I think Red Rice Yeast helps. Are
you following a low salt diet?
Dearest: Are you using medication?
MsDeak: No, I'm not on medication and I watch my salt intake.
Dr. Isadore Rosenfeld: You may have too little salt, then.
Some people don't get enough salt and have a low blood pressure. If you
continue to pass out, have a tilt table test.
Dearest: What is the blood test that can indicate vulnerability
to heart attacks and stroke even when all other predictors are normal
-- and is this test available to the average patient?
Dr. Isadore Rosenfeld: There are 2 widely used tests, homocystine
and C-reactive protein. They're both described in detail in my new book
"Dr. Isadore Rosenfeld's Breakthrough Health 2004". Elitha:
It seems like everyone is on antidepressants is there an epidemic of depressed
people?
Dr. Isadore Rosenfeld: I don't think it's
an epidemic. But I think that the availability of medications makes people
more likely to ask for one. There is more stress after 9/11, post disaster
stress syndrome, more terror alerts, flying problems, there is much more
stress in the world. I think it's a sign of the times. April: Dear Dr.
Rosenfeld, I went through an early menopause at age 43. I have gained
60 pounds! I have never been this obese. Could you please help me? I am
not on HRT. Thank You. I am 50 years old now.
Dr. Isadore Rosenfeld: I think you need to have an endocrinological
workup for thyroid and other hormones. See a nutritionist and get on an
exercise program. Get your sugar checked. You are vulnerable for diabetes,
but the main thing is thyroid.
Dearest: Dr. Rosenfeld, thank you for joining us tonight
in Power Surge. Your new book, "Dr. Isadore Rosenfeld's Breakthrough Health 2004: 167 Up-to-the
Minute Medical Discoveries, Treatments and Cures That Can Save Your Life,
From America's Most Trusted Doctor!" is a must- read for everyone
who wants to take control of his/her health. Everyone joins me in thanking
you for a most informative and stimulating evening.
Dr. Isadore Rosenfeld: Thank you. It was good to be back.
