Niacin Much Less Helpful in the Age of Statins

Niacin has been getting some bad press recently. A brief retrospective of Niacin’s rise to prominence will help us understand its recent fall from favor. Niacin is also known as vitamin B3 or nicotinic acid, a molecule that we need in tiny quantities in our food. As far back as the 1950s it was known that niacin in higher doses reduces blood levels of cholesterol. At that time our understanding of heart disease was in its infancy and there were few effective medications to treat or prevent card...
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Yoga Or Stretching Helps Chronic Back Pain

Everyone hates stress, and for good reason. Stress makes us miserable. Perhaps for that reason, stress is blamed for virtually every disease for which the cause is still unknown. Later, when we discover the true cause, we find that it is unrelated to stress. We thought stress causes stomach ulcers before discovering the bacterium that is the true culprit. We thought stress caused heart attacks before a study comparing high-stress to low-stress individuals showed that this wasn’t true. Stress cau...
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Difficult to Digest Carbohydrates Implicated in Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic condition marked by abdominal pain, bloating, and alternating constipation and diarrhea. There is no specific test for IBS and other more serious diseases like celiac disease and inflammatory bowel disease can cause similar symptoms. The good news is that when a doctor has ruled out these more serious diseases and diagnosed IBS the patient can be assured that her illness is chronic but not progressive or life-threatening. The bad news is that IBS sympt...
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Ivacaftor – a Breakthrough in Cystic Fibrosis Treatment

One of the implicit themes we were taught in medical school is that an understanding of the basic science of a disease informs and guides treatment of patients. The general philosophy that we absorbed was that an understanding of the molecular or cellular defects in a disease would explain the abnormal organ physiology which would explain the patient’s abnormal signs and symptoms. This understanding of the abnormality at a molecular or cellular level would also help discover medications that cor...
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Vitamin E Increases Risk of Prostate Cancer

Lots of my patients take vitamin supplements. I don’t recommend them. My patients don’t ask me about it, they just tell me. In the absence of a specific vitamin deficiency or medical condition, there is absolutely no evidence that any vitamin improves any health outcome. I’ve always assumed that vitamins are generally ineffective, but harmless. Some patients are very eager to feel like they’re doing everything they can to be healthy, and I usually decide not to say anything and instead save my...
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National Panel Advises Against Prostate Cancer Screening

Every year in the US over 200,000 men are newly diagnosed with prostate cancer, and every year 30,000 men die of the disease. With a problem this common that kills so many, you would think that aggressive testing of healthy men is certain to save lives. Whether screening for prostate cancer has any benefits has always been controversial. By the way, screening means testing for a disease in a patient without any signs or symptoms of the disease. It means testing healthy members ...
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A Revolution in Atrial Fibrillation Treatment

Atrial fibrillation is an irregular heart rhythm affecting about 3 million Americans. The most serious risk of atrial fibrillation is stroke, caused by a blood clot forming in the abnormally beating heart chambers and traveling to a blood vessel in the brain. For over 50 years the mainstay of atrial fibrillation treatment has been the anticoagulant warfarin (better known by the brand name Coumadin) which effectively decreases the risk of stroke by preventing blood clots. By the way, medicines t...
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