Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Does botox works at both ends: check anal fissures

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You have heard about botox or botulinum toxin for skin wrinkles. Even botox parties are celebrated. Seems funny considering its use in anal fissure? By the way, botox or botulinum toxin has other uses too, like in achalasia, gastroparesis due to pyloric spasm etc.

Anal fissure

Anal fissure (different from hemorrhoids) can really be a pain the rear (no pun intended). Although acute anal fissures can be managed by conservative measures alone, the optimal medical treatment for chronic anal fissure is still lacking.

Is It Leaky Gut or Leaky Gut Syndrome?

Surgery is effective for treatment of chronic anal fissure but has significant morbidity.

Botox or botulinum toxin for anal fissures 

Recently, Brisinda and colleagues (Br J Surg 94:162-7) from Italy compared the efficacy of local nitroglycerin ointment versus botulinum toxin (botox).

Results

Botox group had superior healing rates at both 4 and 8 weeks. Adverse events were more likely to be due to nitroglycerin.

Bottomline

This finding of a comparison between two medical treatments must be interpreted in the context of data on comparison with placebo where nitroglycerin has only been marginally superior. In contrast, the efficacy of botox was similar to placebo.

Until long term studies can show superiority of botox over placebo, its use for routine treatment of chronic anal fissure may not be prudent.

Have you used botox for any reason? Do you or someone you know has chronic anal fissures? Please share the remedies that have or have not worked for you.

Here is info on botox or nitroglycerine for anal fissures.

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Is folic acid supplement good or bad ?

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Folic acid or folate supplementation is considered part of alternative medicine.Folate/folic acid is involved in numerous vital biochemical reactions in the body. Multiple studies have documented that folic acid supplementation during pregnancy reduces the risk of neural tube defects.

Folate/folic acid in cancer

Since folate deficiency may contribute to abnormal DNA synthesis, it has been widely believed that folic acid supplementation may help prevent certain cancers. Multiple previous studies including the Nurses Heart Study found beneficial effect of folic acid in colon but not breast cancer.

In contrast to the observational studies, results from a recent randomized controlled trial suggest that folic acid may actually be harmful and increase the risk of colon cancer. Cole and colleagues studied the role of folic acid supplementation in 1021 men and women with a recent history of colorectal adenomas. Repeat colonoscopy was done at 3 years and than 3 or 5 years later.

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The authors found that there was an increased risk of cancer/advanced colon lesions in the folic acid group. Interestingly, the investigators also found there was an increased risk of non-colonic cancers, primarily prostate cancer.

Interestingly, Lashner and  colleagues reported (1993) that higher folic acid levels increase risk for colon cancer in patients with ulcerative colitis. Subsequently, the same investigator based on his two other studies suggested that folic acid supplementation probably reduces risk of colon cancer in ulcerative colitis. Folic acid supplementation has been recommended in patients with ulcerative colitis.

Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health

In recent years, the wheat flour and other grains have been fortified with folic acid. Interestingly, there has been a concomitant increase in colon cancer during the same period.

Pregnant females and those desiring pregnancy should continue to get folic acid supplementation. Recent data indicates that folic acid supplements are safe in this population. However, the policy of adding folic acid to wheat flour and grains may need to be re-evaluated. At the same time, so as to temper our enthusiasm for denigrating folic acid supplementation altogether, we have another recent study that documents that folic acid supplements reduce risk of stroke by 18 percent.

Do you take vitamin, mineral or other nutritional supplements? What are your thoughts on the literature about folate or folic acid and cancer. Certainly, one size does not fit all! Overall literature does seem to favor benefit. 

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Beta carotene and brain function, Alzheimer’s disease

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 Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health

How oxidation hurts brain and antioxidants may help?

Antioxidants like beta carotene (pro-vitamin A) have potential to inhibit processes harmful to brain and cognitive function potentially delaying Alzheimer’s disease . Oxidative reactions contribute to brain aging resulting in a declining function and beta carotene considered to be nutritional supplement as part of alternative medicine may inhibit the harmful process.

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However thus far, beta carotene supplementation for enhancing health benefits has yielded mixed results at best. While enhancing immunity in children, the effect in cancer and heart disease has largely been disappointing. Such supplementation may also be deleterious in certain people.

Betacarotene supplements and cognitive decline

A  Physician Health Study Group from the Harvard Medical school studied the effect of betacarotene on cognitive function. It demonstrated that beta carotene supplementation over long term retards the aging related cognitive decline. A global score on a battery of five cognitive tests was used as an outcome measure in this placebo-controlled study.

The authors found that men taking 50 mg beta-carotene every other day for an average of 18 years had better cognitive function as compared to the placebo. Verbal memory was also superior in the group taking these supplements. These results suggest that nutrition supplementation with antioxidants of betacarotene type would delay the onset of Alzheimer’s disease.

Is It Leaky Gut or Leaky Gut Syndrome?

Although the study was conducted in men, it is likely although not certain that similar effects would be seen on cognition/brain in women also.

Given the conflicting data thus far, the jury is still out whether taking beta carotene supplements may be helpful for overall health. One verdict is probably clearer: best way to get this vitamin might be five servings of fruits and vegetables per day!

What do you think about the concept of taking nutritional supplements including antioxidants and betacarotene? Do you or someone close to you take them on a beta carotene or any other supplements on a regular basis? Please share your thoughts.

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Acetaminophen, arthritis drugs and constipation

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Constipation is a widely prevalent disorder. Similarly acetaminophen and other NSAIDs or arthitis drugs are also commonly used. Constipation is more likely to occur in women and the elderly. The causes of constipation are not fully understood. A variety of medications including many heart, high blood pressure drugs as well as anti-depressants may contribute to this problem.

Acetaminophen, NSAIDs and constipation 

Now comes a study from the Mayo Clinic showing that commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin and aspirin-like medications commonly used for arthritis increase the risk for constipation.

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Dr. Chang and colleagues found that subjects who chronically consume over 7 tablets of acetaminophen per week had 2.7 times increased risk for constipation. The risk due to aspirin and other NSAIDs was increased almost two times as compared to those who did not. 

Be advised that NSAIDs, both OTC and prescription strength have potential for side-effects and as this study demonstrates they also increase the potential for constipation.

Do you take acetaminophen, aspirin or other NSAIDs regularly. Do you suffer from constipation? Do you take any OTC or prescription remedy for constipation? Please share your thoughts.

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Does zinc supplement help in respiratory infection?

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Do you take any supplements like vitamin C, vitamin E, ginger when you have cold? I take vitamin C supplements and zinc when I have symptoms of cold/flu. In fact, I have mentioned it as one of my personal choices in my book,  Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health

Zinc and pneumonia, respiratory infections

Check out this report in American J Clinical Nutrition showing beneficial effects of zinc in pneumonia patients. Meydani and colleagues conducted this study at the Tufts University. It was funded by among others, the National Institute of Aging and the USDA.

This observational study was conducted at 33 Boston nursing homes. Elderly Subjects received essential vitamins and minerals, including zinc everyday.

The investigators then compared patients with normal versus low zinc levels. They found that patients with normal zinc levels had a much lower all-cause mortality rate.

Is It Leaky Gut or Leaky Gut Syndrome?

In addition, subjects with normal zinc levels had lower occurrence rate of pneumonia and the total number of new antibiotic prescriptions. Duration of pneumonia and days of antibiotic use was also lesser among normal zinc level subjects.

The  results of this study are consistent with overall medical literature supporting the protective role for zinc.

What remedy do you use when you or someone in your family develops cold/flu? Do you take vitamin C or zinc for this purpose? Please share your thoughts. 

 Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health

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