Dec

01

Pumpkin Tales

Blog / Cancer / General Health / Nutrition / Prostate

With the recent fall holidays, I was inspired to do some research on pumpkin seeds and prostate health. PumpkinsPumpkin seeds are a common component in natural men’s health formulas, and I’ve heard somewhere along the way that men in Turkey consume a handful of pumpkin seeds a day often, and that they have a very low incidence of prostate disease. Now, I couldn’t find any data to back this up, and I don’t know if it’s true, but I did find some other interesting research on pumpkin seeds. (If you do know the source of this information, please visit my Contact page and let me know!)

In 2009, a Korean study was published in the journal Nutrition Research and Practice. Forty-seven men with enlarged prostates were enrolled in the study and were either given a placebo, pumpkin seed oil (320 mg/day), saw palmetto oil (320 mg/day), or a combination of pumpkin seed and saw palmetto oil (same dose). All 3 treatment groups showed improvement in urination by 3 months. Their symptoms were measured on a 35 point scale and on average went from 18-20 down to 4-9 after treatment for a year. No side effects were reported in the trial, although some patients did leave the study because their symptoms worsened.

A study published in the International Journal of Oncology in early 2011 investigated a supplement called ProstaCaid that contains 33 herbal and nutrient ingredients, including pumpkin seeds (2% of the total preparation). They studied this compound in the lab on prostate cancer cells and measured how it affected the cells’ gene expression and ability to grow. The supplement had a very strong effect, keeping the cells from growing and being able to invade other cells (which is how cancer spreads).

Although nothing I found strongly supports using pumpkin seeds to treat prostate disease, it’s no surprise that there isn’t a lot of research on this. Foods from nature are full of ingredients and compounds that have an array of effects on the body. Eating these foods has numerous effects that we can’t possibly ever study or fully understand. The take home message for me, here, is that this is a reminder of the power of real food. Eat real food, as it comes from nature. You can’t go wrong.

Posted by Adrienne Carmack, MD | 0 comments
Nov

07

Cranberry Cures

Bladder / Blog / General Health / Infection / Nutrition

erhaps the most widely usePd alternative therapy in urology is cranberries. Many patients are aware that they are beneficial for the urinary tract and will use them if they have any signs of problems.Cranberries

Cranberries are one of the most widely studied foods in medicine. Numerous studies and a large statistical review by the Cochrane Group, one of the leaders in evidence-based medicine, have shown them to be beneficial.

The main use for cranberries in urology is for preventing urinary tract infections in those who experience them more than 2 or 3 times a year. Cranberries are 90% water, but they also contain numerous chemicals that are thought to keep bacteria from growing in the urinary tract or sticking to the bladder wall. The current theory is that fructose and proanthocyanidins are mainly responsible for this, but it’s not really known or completely understood.

Both cranberry juice and tablets have been found to be effective. Cranberry products last in the system for about 6 hours or so, so using them multiple times a day is sometimes indicated. I generally recommend using them at night at a minimum, because that is when the bladder gets fullest and bacteria can thus grow the most to set in an infection.

Whether or not cranberries can be used to actually cure infections is controversial, and there isn’t much data to support this. These days, antibiotics work so well, and usually after only 3 doses, that there isn’t much of a search for alternatives.

If someone is having recurring urinary infections, it is important to be evaluated by a health care provider to ensure there is no other underlying issue causing the recurrence. In most cases, we find that there is not, that it’s simply factors within the patient’s body that are predisposing them to the infections. At that point, it is appropriate to start a preventive program. The standard of care is a daily low dose antibiotic, but numerous studies have compared low dose antibiotics to cranberry tablets and found them to have very similar results with much fewer side effects.

My general advice to patients who are experiencing recurring infections, along with other measures such as increasing fluid intake, is to begin using cranberry juice or tablets 3 times a day, with bedtime being the most important dose not to miss. If this is effective in preventing further infections, we continue it for at least 6 months to allow the urinary tract to completely heal, as it is much easier for a new infection to set in when the bladder is still irritated from the last infection. I’ve had some patients be able to stop preventive measures after 6 months, and others who got another infection right away and have needed to stay on the cranberry products long-term.

Cranberry products are just one component of a comprehensive approach to treating recurring urinary tract infections. But they are simple, affordable, and safe. Definitely worth trying!

Posted by Adrienne Carmack, MD | 0 comments
Aug

22

Dear Diary

Blog / General Health / Nutrition / Overactive Bladder

Awareness is key when one has a health issue they’d like to overcome. Dear DiaryFor urinary symptoms such as urinating too frequently or having accidents, a voiding diary (also sometimes called a bladder diary) is an excellent way to get this awareness. One of the most common reasons I see patients is for urinating too often and too much. I often ask them to record a voiding diary, where for 2 or more days, they actually measure how much they are urinating and write down the times as well. They also record fluid intake.

This gives us an excellent objective picture of what is really going on. Some patients are found to truly have severe overactive bladder, where they can only hold a very small amount of urine and have to void abnormally despite not drinking much liquids. However, in a vast majority of patients, I find that they are simply unaware of their bladder capacity and are drinking too much fluid for their bladder to handle and waiting too long to urinate. Many of these patients are cured when we look at their voiding diary and are able to tell them to drink 1/3 of what they are drinking, or 1/2, or to use the restroom on a more regular basis.

So many patients are drinking large amounts of fluid because they have been told it’s healthy, that it’s what they need. But, really, they are flooding their bladders. The fluid is not benefitting them and is simply passing right through, making them need to urinate all the time and have accidents.

This lack of awareness is common in many health conditions. People are doing what they were told to do by someone else, but not listening to their bodies. Recording a diary such as this can be immensely helpful in understanding what is really going on in one’s own body. Diaries are also useful for conditions like menstrual disorders, food sensitivities, and any situation that is responsive to environmental factors.

There is, no surprise, not much research on this. But I did come across a really interesting study in which 44 women with urinary incontinence were randomized to either undergo bladder health education by a urology nurse, which included information on using a voiding diary to determine how much fluid one should be drinking and how long one should be able to go without using the restroom, as well as pelvic floor exercises, or to no intervention. Sixteen percent of the patients who had no treatment improved, but 52.2% of those who underwent the 2 hours of education improved. They didn’t need medications, they didn’t need surgery… just knowledge and awareness.

To truly achieve health, one must really take ownership and responsibility for their environment and how their body responds. This is unique for every individual, and no one else can understand or modify this for someone else. Take charge, use resources like physicians or other health care providers when needed, but remember that you are the only one who truly has the power to get your body into its optimal state.

Posted by Adrienne Carmack, MD | 0 comments
Aug

15

Eat Where You Live

Blog / General Health / Nutrition

Today, I want to share about the benefits and ease of eating local. Most people in our society are used to going to the grocery store and many of them don’t eat any food that does not come from the store or a restaurant. People have forgotten that food comes from the earth, for free.farmers' market

Now, many people may choose not to spend time obtaining food for free from the earth, either by gardening or foraging, and that is fine, but it’s an important decision. If it is worth it for you to work at something else so that you can buy food, go ahead. I do it. However, I realize the power of my choices with what I buy. Eating organic at the grocery store is more expensive, but eating organic from home and local farms does not have to be. Great deals can be found by joining CSAs, meat share programs, and visiting local farmers’ markets.

This is not to say I never go to the grocery store. But, when I do, I think about what I am doing and whether that item is truly worth all of the energy expenditures that went into producing it, transporting it, stocking it, etc. Sometimes I feel it is, and sometimes I find myself looking for another way to meet whatever need or desire I purchased that item for. It’s a learning process for me, too, but it’s not difficult.

From the science standpoint, as with most topics on sustainable methods of achieving health, is not great. As I’ve said before, the scientific medical literature is a poor standard for measuring the quality of an intervention other than a pharmaceutical. But, there is still some promising data to be found. In this recent study from Spain, the juice conventionally versus organically raised mandarins was evaluated for various nutritional aspects. The organic juice had higher antioxidant activity, total carotenoid concentrations, mineral contents, vitamin C content, as well as a more intense and appealing color and taste. The literature does go both ways, though, with some studies claiming there is no difference. This, for me, is not enough to ignore what is right before my eyes. Food that grows naturally and easily is more beautiful, flavorful, and enjoyable to eat. Food grown locally has a far less impact on the environment that food grown in mass and shipped around the world.

There is no comparison between a fresh tomato in your garden, or even from a local farm, to what you can get at the grocery store. And the satisfaction that comes from eating a meal made with all local ingredients, where you can identify precisely where each item came from, is tremendous.

Finally, I want to share this quote. It came in my monthly newsletter that comes with my family’s bimonthly delivery of locally raised, grass-fed beef, pork, and chicken raised by people whom I have met personally, on farms I have been to. People who care about nutrition and the environment.

So how do you make it happen at your house? Simply decide that it’s a priority in your life. We are creatures blessed with free will aren’t we? So just do it. If time is often too short during the work week, have a cooking marathon on the weekend and put your meals away for the coming week. The rewards are great.”

-Jolie Vue Farms, June 2011 newsletter (http://jolievuefarms.com/)

Posted by Adrienne Carmack, MD | 0 comments
Aug

08

Gluten Sensitivity and the Urinary Tract

Bladder / Blog / General Health / Nutrition

Today’s post is a little focused but also very broad. Gluten intolerance or gluten sensitivity in the form of celiac disease are being recognized more and more. What’s important to recognize is that all of the body’s systems work together, not in isolation.Wheat Flower

Gastrointestinal, or digestive, disorders have a tremendous impact on the urinary system. Part of this comes from the physical, anatomic relationship between our bladders and colons. If the colons are full of stool in someone who is constipated, the bladder has much less room to expand and becomes sensitive to filling. Patients will often have urgency to urinate, frequency of urination, or the inability to urinate. Infections are also more common. Patients who have diarrhea, with inflammation of the intestines, will also often have inflammation of the bladder as well.

There are also functional, physiologic effects. When the GI system is disturbed in this way, so is the urinary tract. They are both part of our elimination systems, so what is being processed through one is being processed through the other. Thus far, I am only able to find one study in the literature on celiac disease and urinary topics. In this study, the researchers looked at rates of kidney stone formation in patients with and without celiac disease and found it to be higher in those with celiac. The reason for this was found to be higher levels of oxalate in the urine. Oxalate is metabolized in the intestines and, if it is not metabolized properly, is absorbed and then requires excretion in the urinary tract. Finally, the researchers found that a gluten-free diet reduced the risk of stone disease and lowered oxalate levels in the urine.

Also, many patients with autoimmune diseases experience irritation of mucosal surfaces. In urology, this often manifests as dysuria, or burning with urination. I have had patients who had dysuria but no evidence of infection who were found to have autoimmune disorders, including celiac disease.

My point in sharing this is that it is wise to consider your diet and digestive health when suffering from any condition in any organ system. Determining whether or not gluten affects your health is really rather simple. Simply plan your meals for 2 weeks to not include any gluten. Lists of gluten-containing foods and gluten-free recipes are abundant on the Internet. There are books written on it. Exploring your diet and its effect on your health is easy and can make a world of difference. What have you got to lose?

Posted by Adrienne Carmack, MD | 0 comments
Jul

30

It’s Not All In Your Genes

Blog / Cancer / General Health / Nutrition / Prostate

Many people assume that they will develop the same illnesses that “run” in their families. DNA doesn’t change, right?Double Helix

Well, there’s a lot more to the story than this. DNA is a message, and it gets translated via a variety of molecular processes, into proteins. Most of the DNA is not actively being translated. And, the great news is, what is being translated can be changed–for the better–by lifestyle changes.

Dean Ornish, MD, is a physician and researcher at the University of California-San Francisco. He has done amazing research on reversing heart disease and prostate cancer with lifestyle changes. These studies are a bit difficult to do because of ethical limitations, but men with a certain type of prostate cancer are often offered watchful waiting. For these men, who are found to have small amounts of very low grade prostate cancer, it is unknown whether the cancer will ultimately cause any problems, and so some of them elect to delay treatment unless the disease progresses. These men typically undergo repeated prostate biopsies and other monitoring to see if the disease progresses.

Dr. Ornish enrolled some of these men in a study of comprehensive lifestyle changes to see if this had an effect over simply making no changes and watching the cancer. In this study (available here), 93 men were randomly assigned to either make the lifestyle changes or make no changes. The men in the lifestyle changes group were prescribed a vegan diet supplemented with soy, fish oil, vitamin E, selenium, and vitamin C; walking for 30 minutes 6 days a week; stress management techniques; and participation in a support group once a week. Three men withdrew from the study because they felt this was too difficult.

Six men in the group who did not make changes had progression of their cancer during the first year of the study and went on to have surgery, hormone therapy, or radiation for their cancer. No patients in the group who made changes required this.

PSA, a marker of prostate cancer, actually *decreased* in the men who made changes and increased in the men who did not. Prostate cancer cells in the lab that were exposed to serum from these patients were not able to grow well in those who made changes, but there was very little effect on their growth in those who did not change.

A 2-year follow-up study has now been published, and, within 24 months, 27% of the patient who did not change went on to have treatment of their prostate cancer compared to only 5% of those who made lifestyle changes. Some of the men who did not have changes had marked rises in their PSA, but none who made the changes did.

Now, I think these results are pretty spectacular in and of themselves. But the researchers went on to study gene expression in these men after 3 months on the lifestyle change program (article available here).

They compared RNA samples from men before and after these changes were made. RNA is a messenger that helps translate DNA. Of the genes they measured, 48 were translated more, and 453 were translated less. This is a huge change! These genes were involved in numerous pathways that control cell growth, which is key in cancer.

This research is provocative. Changing your diet and lifestyle can change your body. Cancer may be able to be prevented or even reversed. What would it take for you to create such an environment for your body?

Posted by Adrienne Carmack, MD | 0 comments
Jul

21

Do Some Squats

Bladder / General Health / Pelvic Floor

One often overlooked factor in urology is toilets. Yep. The way we use the bathroom, both #1 and #2, is pretty important. This is because the pelvic floor muscles have a very complex interaction and using them incorrectly leads to their dysfunction. This in turn can lead to a variety of problems emptying the bladder properly.

Humans naturally squat to use the restroom–women for both urinating and defecating, and men for defecating. The porcelain throne, Western style toilet, creates an anatomic position that does not properly relax the pelvic floor muscles and requires straining to empty. This straining can cause big problems in the function of these muscles.Squatting Man

I suspected this was a factor in many of the voiding disorders I saw in my practice and was quite pleased when I came across the web site of Jonathan Isbit, who manufactures a device called Nature’s Platform. This allows one to climb into a squat over a Western style toilet. His site also has great information about potential benefits of squatting, with anatomic and scientific data to back it up. He also tells how to DIY your own squatting toilets without buying his invention. He shares information about the benefits of squatting for urinary tract function, pregnancy and childbirth, and many bowel disorders, including constipation, appendicitis, and diverticulitis.

This is really something very simple to try. If you’re physically able, you can simply climb onto the toilet seat and assume the squatting position (feet should be flat). If not, check out Jonathan’s site for information on other ways to squat. Trying this is virtually risk-free, simple, and definitely has the potential to help. What have you got to lose?

Posted by Adrienne Carmack, MD | 0 comments
Jul

08

Welcome to Holistic Urology

Bladder / Blog / General Health

Why holistic urology? Consider a bladder infection. Most people think that it is a simple problem. Bacteria get into the urine, they grow to create an infection, you take some antibiotics, and you are cured. The reality is bacteria get into the urine very frequently, and this usually does not cause an infection. A weak immune system, disturbed bowel function, disruption of normal flora in the body (meaning that healthy bacteria are no longer present), and lifestyle factors such as holding the urine are all major contributors. Simply treating the infection without addressing the underlying causes often leads to recurrence of the infection in the bladder or manifestation as other health problems later.

I created this site to share what I have learned and continue to learn about the variety of simple, effective, inexpensive, and sustainable ways that health can be achieved, particularly as it relates to the urinary tract. I am a classically-trained board-certified urologist in private practice in Texas. I do use medical and surgical treatments when I feel they are the best for the patient, but I have found that in many cases, they are incomplete, suboptimal, or not necessary.

A holistic approach can do amazing things. I hope to empower you to take charge of your own health, and learn some of the many things you can do to take full advantage of every illness as a sign from your body that changes need to be made.

Thanks for tuning in!

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Posted by Adrienne Carmack, MD | 0 comments
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