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DR. STEMMLER’S MONTHLY TEACHING ROUNDS

JANUARY, 2001

CLINICAL STORY OF THE MONTH

(COPYRIGHT STEMMLER, 2001)

Martha Landers walked into her new job as a medical assistant packed with the enthusiasm of a 25 year old who is "finally out there." Her favorite procedure was to draw blood, and she built up quite a reputation in school; they called her " Leechy Landers," with all due respect.

Soon she became well liked by her coworkers and very appreciated by her patients. "Can Martha draw my blood today?" was the standard question in the clinic. But 6-7 months into her wonderful new job, Martha noticed a slight shaking in her right hand. She wondered if she was smoking too much or not getting enough sleep. The tremor continued and her mother became worried. She made an appointment to see a doctor. The doctor, who was even more worried, referred her to a neurologist, a movement disorder specialist, at the medical center. The diagnosis: essential tremor. The neurologist explained that there wasn’t really a good treatment for this condition, but researchers at the medical center were studying some new drugs. Would she be opposed to participating in one of these drug trials?

The drug was, of course, free, and all the testing was covered by a grant. Martha found it to be an attractive proposition – until she tried the drug. She became as "sick as a dog." Other drugs were tried, each with its own bag of side effects. Martha was getting desperate. Her boss suggested she take a leave of absence, since the tremor was now interfering with her working skills. She was running out of treatment options, and her tremor had gotten so bad that she was unable to hold a cup to her mouth without spilling it all over her.

Then her mother went on the Internet, like most of today’s desperate patients, and she came across our website. There she read an article that I had published in 1989, entitled "Benign Essential Tremor Resolved with Acupuncture." In that article I described a 38-year-old woman who had suffered from tremor in both hands, and even in her head. It dated back to the time when she was 2-3 years old, when her family used to call her "shaky bones." Multiple doctors and drug trials had not helped her in the least. Surprisingly, within three acupuncture treatments, her tremor resolved 100%. I should add that 11 years later, it had not returned either.

A year later, Martha and her mother drove 6 hours each way to come and see me, and stayed in Houston for 3-4 days at a time. On her first visit, I took a lengthy history. Her diet was nutritionally inadequate, she smoked, and was on birth control pills. Her tongue showed a very red tip and a thin white coating in the middle 1/3 section of the tongue. I told her "when your tongue normalizes, your tremor will stop." I put her on an herbal combination to resolve her "internal wind" and treated her with few needles in a very precise design.

She had immediate relief after her treatment, but she was still shaking the next morning. After her second visit, she was able to drink from a glass without spilling. Just for precaution, we started with plastic cups for her "drinking trial" (no side effects) at each visit. After 5 visits, she graduated to a hand-painted crystal glass; now we could trust her again. During her first weekend back home, she rode her horse for the first time in 1 year, now able to finally grip the reigns again.

Her fine motor activities also resumed – "she could pluck her eyebrows now!" By the 12th visit there was almost no tremor left, and by the 15th treatment, not even a month later, all her tremor was gone. She returned for 5 more visits, and was then discharged, now 100% symptom-free for 9 weeks.

On visit #17, shortly before being discharged, her tongue appearance was normal, and she drew a steady spiral on the same sheet where she had drawn a shaky spiral for her neurologist 6 months earlier.

5/19/2000                                  11/27/2000
(click for larger images)

It goes like the saying, "The proof is in the pudding…"

Martha’s life is back to normal. She can return to her clinic and to drawing blood – if she so desires – or she can choose anything else that she wishes to do in life!

 

WHAT’S NEW IN MEDICINE – EAST AND WEST

EAST

Green Tea May Prevent Cancer, Heart Disease.

"An antioxidant found in green tea (epigallocatechin gallate or EGCG) appears to have a protective effect against cancer, heart disease, and other life-threatening illnesses such as stroke and liver damage. EGCG offered a significant protection from DNA damage – 25 times more effective than equivalent concentrations of vitamin C."

(From: Modern Medicine, vol. 65, December 1997)

COMMENTS:

 In the area of prevention, what could be more pleasant or affordable than a cup of freshly brewed green tea? In China, the legend of the beginning of tea dates back to 2737 BC, when the Emperor Sh’eng Nung was relaxing outdoors near a cauldron of boiling water. A breeze carried a few leaves from one of the surrounding trees, known as Camellia Sinensis (Chinese Camellia trees), into the water. A pleasant aroma emerged from the cauldron, and the emperor tried a sip from a small cup. He was delighted. Yet, tea only became a popular drink during the Sung dynasty (960-1279 AD), while the first recorded mention of tea was in 59 BC.

Tea is called Cha in China, and it is represented by the characterà

Mainland China’s green tea is known to be of the highest quality. Most processing in smaller farms is still done by hand, where tea leaves are fired in a wok or dried in the sun, sorted by size and rolled into various shapes. There are at least 500 varieties of green teas, many of which never reach the export market. Some of the better known types in the US are: Gunpowder, Jasmine, Eshan Pekoe and Baozhong.

Green tea has multiple beneficial effects on the tea drinker. A German proverb reads: "Wait and drink tea," which means "wait and see," or think and reflect on an issue while sipping tea. Green tea, and especially Jinshua Jasmine tea, has been found to strengthen brain function, decrease fatigue and strengthen the heart and bladder, among a series of other functions. Green tea contains numerous antioxidants, such as: caffeine, catechins, flavonols, fluoride, selenium, vitamin C, vitamin E and zinc. It is now recommended to drink 3-4 cups of green tea a day, unless there are contraindications to doing so. Patients with heart disease, kidney disease, diabetes or other chronic conditions should first ask their doctor if their condition allows for the consumption of fluid containing sugar and caffeine, although the level of caffeine in tea is much lower than in coffee. A cup of green tea usually contains 20 mg of caffeine, a cup of black tea has 80-120 mg and a cup of coffee has 100-200 mg.

In America, we might just enjoy a cup of tea or perhaps we drink it if we read that "it’s good for us." In China and in much of the Orient, however, drinking tea varies from a simple daily beverage (second in consumption only to water) to a sophisticated celebration. How the tea is prepared, where it is served, and from what container it is drunk, are all very important factors.

The finest pottery comes from Yixing, in the Jiansu province, 100 miles West of Shanghai. Such teapots have been used since before the 16th century. They are made of clay, which is beaten for several days in order to make it strong and tight. Often the firing of such pots may take more than 3 days at very high temperatures. The tea is then served into tiny teacups, which are often refilled during a gathering. Yixing teapots are fine art pieces, and there are growing numbers of collectors in the US who gather these century-old treasures from US Chinatowns and from abroad.

And, of course, you can always have a freshly brewed cup of green tea in the tearoom at our office. As of January 2001, we will offer a whole line of green teas, so that you can sample them all at your office visits. You may then find your favorite variety to include in your daily beverage consumption. Ganbei! (Cheers!)

(Some facts excerpted from: "Therapie mit Chinesischen Naturarzneimitteln", by Dietmar Kummer; from: "The Book of Green Tea", by Diana Rosen; and from: "Food in Antiquity: A Survey of the Diet of Early Peoples", by Patricia Brothwell [Contributor] and Don Brothwell.)

 

WEST

Low Fat/High Carb May be on its Way Out.

"A low fat diet may have a negative impact on lipid profiles in 30-50% of people with normal cholesterol."

(From: Family Practice News, August 1, 2000)

"Government and private-sector recommendations on diet have generally focused on lowering dietary fats and increasing carbohydrates to replace them…. But research suggests that this view is far too simple. Not all fats are bad. Many (such as those in nuts, seeds, and fish) are heart-healthy. And polyunsaturated and monounsaturated fats can lower bad cholesterol [LDL.].…[And] not all carbohydrates are created equal. In particular, they differ in their glycemic load."

(From: Harvard Women’s Health Watch, December 2000)

COMMENTS:

For the last year, I have guided many of you who were previously on low fat diets for high cholesterol, weight problems and "just-in-case", to switch to a higher protein, lower carbohydrate diet. The above articles are some of the first "official" articles in the medical literature announcing a shift from the "low fat food pyramid" to a "low glycemic index pyramid." On this latter diet, one would mainly eat protein (from meat, dairy and nuts), fruits, and non-starchy vegetables cooked in healthful oils. In smaller amounts, unrefined grains (whole grain bread) and only at the top of the pyramid, refined grains and sweets.

Many patients have asked me, "Doctor, is this Atkins?" And I will respond, "No. Atkins is one extreme of a high protein, lower carbohydrate diet. My recommendation is to increase the protein with lean meat, fish or fowl, eat fruits like berries, kiwi, apples, citrus, plums, apricots and peaches, and non-starchy vegetables, 1-2 slices of whole grain bread a day, no potatoes, no pasta, no rice, and only a small amount of sweets, preferably combined with a serving of protein to lower the glycemic index of the treat. This is essentially a Mediterranean diet. Many of the patients who have followed such a diet have seen very satisfactory results in their lipid profiles as well as on the scale. They report feeling better overall and noticing a significant increase in their endurance.

What has happened with the advent of the low fat diets is that where fats have been vacated, carbohydrates have taken their place. Many of these carbohydrates have a fairly high carbohydrate index or glycemic load. Such foods raise blood sugar levels rather quickly, increasing the risk of diabetes. They also increase one’s appetite. The extra calories are stored as fat, and even more fat is stored as a result of high insulin levels in response to the carbohydrate load. And to make things worse, the size of lipid particles, as in LDL measurements, tends to go from large and fluffy (a pattern A profile) to small and dense (a pattern B profile) in fat-restricted diets. Small particles, or B profile patterns, are associated with a higher risk for heart disease.

At our practice, we have been offering our "A la Carb" nutrition program, where I look at each patient individually, their food diary and preferences, lifestyles, lipid profiles and the state-of-the-art cardiovascular risk evaluation. Program participants are weighed and measured, their protein requirements are assessed, and a personalized food plan is crafted for them. State-of-the-art advance lipid testing gives each person a better estimate of their cardiovascular risk. Such testing includes fractionated HDLs and LDLs, triglycerides (or large VLDLs), C-Reactive protein, homocystein levels and lipoprotein a. More extensive cardiological studies may be justified if there is a strong family history, suspicious symptoms, and/or if results of the preliminary testing indicate possible underlying disease or unusually high risk. The results, so far, have exceeded all our expectations! If you are interested in making some life changes, and especially in improving your nutritional status and cardiovascular risk category, call us for an appointment or for more information. You may want to start by requesting our reading list. In the meantime, begin looking at the labels of all those low fat food items you so conveniently dropped in your shopping cart. You will be amazed at the amount of carbohydrates you may have been (unknowingly) consuming, and you may begin to understand why your weight may have gone up and why your cholesterol does not come down as expected. There are solutions to most of these problems, many of them quite simple and safe. So, do not despair and take charge of your life!

Christina Stemmler, M.D.


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