A Message from Molly Greacen, Licensed Acupuncturist and Herbalist, Dipl Ac, CH www.womanmedicine.com
Treating Urinary Tract Infections Naturally Research show that common tests and procedures can do more harm than good.
August, 2011
.Greetings!
Here is a great article on treating urinary tract infections. It might be good to save for the next time you or a friend has to deal with this potentially stubborn problem. I routinely treat UTIs with Chinese herbs, acupuncture, diet and cranberry supplements. You CAN get off the merry-go-round of recurrent infections and antibiotics!
Also I want to pass along an interesting article from Newsweek, which discusses new research showing that we all probably would benefit from less medical testing and procedures; they can sometimes do more harm than good!
There is a coupon at the bottom of this newsletter for 1/2 off your next visit, for folks who have not been in for the past 6 months, as well as new patients.
I would love to hear back from you with your comments.
Warmly, Molly Greacen
Simple Tips for Overcoming Urinary Tract Infections Safely and Naturally
Up to 60 percent of women will experience a urinary tract infection (UTI) at some point in their lives. UTIs are one of the most common reasons why women visit their healthcare professionals and women are 10 times more likely to get a UTI than men. With an estimated 150 million cases in the world each year, the resulting healthcare cost is around $6 billion, not to mention the lost time from work and other normal activities.
Women are 10 times more likely to suffer from urinary tract infections than men.
UTIs can result in a range of symptoms from mild pain and discomfort to more serious cases that involve your kidneys and renal system and require hospitalization.
Sexual activity is one of the most common risk factors in acquiring a UTI and is part of the reason why so many women will experience a recurrence of the infection -- 30-40 percent of women will get another UTI within six months of the first infection. Over time, the conventional treatment, which is almost always antibiotics, stops working as well, requiring stronger or new antibiotics that can cause potentially harmful side effects and make your body more resistant to antibiotics when you really need them.
Signs and symptoms of a UTI include:
Burning or pain when urinating
More frequent than normal urination or a sudden, urgent need to urinate
Lower abdomen pain or cramping
Blood or pus in your urine or a strong smell to your urine
Painful sexual intercourse
Fever, chills, nausea or vomiting
What Causes UTIs?
UTIs are caused by bacteria entering the urethra, the tube that carries urine out of your body. Your body produces lots of natural agents inside the bladder, which keep urine sterile, but if bacteria enters the urethra, the bladder or urinary tract can get infected. The bacteria can come from a number of sources, but in most cases a UTI is caused by bacteria in fecal matter that travels to the area around the urethra. This bacteria, most commonly E. coli (Escherichia coli), is the infecting agent in 70-75% of UTI cases.
However, there are other risk factors that make you more likely to develop a UTI as well. These include:
New or multiple sex partners or frequent or intense sexual intercourse
Diabetes
Pregnancy
Irritation from harsh skin cleansers or contraceptives like diaphragms or spermicides
Taking birth control pills
Having a history of UTIs, especially if you had more than one in six months
Conventional UTI Treatment
If you suspect you have a UTI, your health care provider will feel your abdomen and the area around your kidneys and will also do a urine test to check for infection. The typical medical treatment for a UTI is a 1-10 day round of antibiotics. However, patients with frequent urinary tract infections may also be placed on a low-grade dose of antibiotics that they take every day as a way to prevent new UTIs from occurring.
The most common antibiotic used for UTIs is trimethoprim-sulfamethoxazole (TMP-SMX, brand names Bactrim, Septra). But, unfortunately, new antibiotic-resistant strains of E. coli have begun appearing that don't respond to treatment with TMP-SMX. So health care professionals have begun to try other antibiotics in the penicillin, cephalosporins, or fluoroquinolone families. It is feared that the bacteria may become resistant to these antibiotics as well.
Problems with Conventional Treatment
The first problem with conventional antibiotic treatment of UTIs is that antibiotics often have unpleasant and potentially dangerous side effects. These can include:
Stomach upset, abdominal pain, nausea, vomiting or diarrhea
Vaginal itching or discharge
Allergic reactions
Headache or dizziness
Photosensitivity (making it easy to get sunburned)
Convulsions
The second problem with antibiotic treatment of UTIs is that bacteria can become resistant to them, making it harder and harder to treat the next infection. According to the Centers for Disease Control and Prevention (CDC), antibiotic resistance is a major public health problem because almost every type of bacteria can become resistant to antibiotics with overexposure to the antibiotic. In fact, the CDC says that it is frequent and inappropriate use of antibiotics that causes bacteria to become drug-resistant. Then when a UTI or other infection occurs, the antibiotic won't work as well -- or at all. Once this happens, treating the infection becomes more difficult, requiring stronger antibiotics, which may have harsher side effects, and leaving you vulnerable to the more serious repercussions of an uncontrolled infection.
What Are Probiotics?
In one study of women with nearly constant UTIs, after taking oral probiotics for several days a number of the women had all of their symptoms disappear.
The term probiotic comes from the Greek words meaning "for life," just as antibiotic means "against life." Whereas antibiotics are meant to kill bacteria, probiotics are meant to help other healthy microbes grow. They are live, beneficial bacteria that help keep a healthy balance of microorganisms in your bowel, vagina, and body in general. Keeping the right balance of healthy, bacteria-fighting microorganisms can help reduce the occurrence of infection.
Probiotics occur naturally in fermented foods like yogurt but are also available in supplement form. In some countries, probiotics are considered a normal part of daily nutrition and digestive health.
In the United States, interest in probiotic foods and supplements is on the rise. Some health care professionals have begun recommending probiotics for digestive issues such as irritable bowel syndrome. Research also indicates that probiotics may help prevent and treat UTIs.
Probiotics for UTIs
In the healthy vagina and urogenital area, there are more than 50 different microorganisms. Depending on your age and your exposure to different factors, the composition of these microorganisms changes. When you take antibiotics or use products like spermicide, the balance can be disturbed. The same can happen when E. coli or other bacteria are introduced.
In premenopausal women, a healthy vaginal environment is dominated by a type of microorganism called lactobacilli. When a UTI occurs, tests show that the lactobacilli are greatly depleted. However, probiotics may help keep the population of lactobacilli healthy and strong, which can help prevent bacteria from gaining hold and turning into a UTI.
In one study, lactobacilli probiotics were administered by vaginal suppository to women who had a history of recurrent UTIs. Results showed that 27% of the placebo group had another UTI within 10 weeks, whereas only 15% of the women taking the probiotic had another UTI in the same time period.
In another study, women who douched with a probiotic solution had a significant increase in the time between infections. A second phase of the study showed that the use of probiotic vaginal suppositories reduced the recurrence of UTIs by 79% over a year. Success has also been seen when taking probiotics following treatment with antibiotics. The antibiotics kill both good and bad bacteria, which means they also kill the lactobacilli. Probiotics help restore the lactobacilli before bacteria can re-infect the urinary tract.
Although vaginal application of lactobacilli seems to have the most impact on preventing or reducing UTIs, oral ingestion of probiotics can help as well. A daily dose of probiotics can travel through the gut, exit the rectum and support the lactobacilli in the vagina.
In a study of women who suffered from nearly constant UTIs, after taking oral probiotics for several days a number of the women had all of their symptoms disappear. The researchers estimate that between 50-90% of women would have healthier levels of vaginal lactobacilli within 1-2 weeks of taking daily probiotics.
Probiotics for General Health
Probiotics have also shown promise in treating certain digestive disorders. The most promising treatments have been seen for infants and children who have infectious diarrhea. With probiotic treatment, studies show a reduction rate of up to 60% as compared to a placebo. Several studies show that probiotics can also help prevent recurrences of ulcerative colitis and Crohn's disease. A healthy digestive tract also promotes a healthier immune system in general.
Some preliminary research shows that probiotics may also:
Help prevent the development of allergies in children
Help patients deal with negative antibiotic side effects
Decrease the risk of certain cancers
Help prevent cavity-producing bacteria in your mouth
You may want to ask your health care practitioner about Probiotic Synergy™, one such high-quality product that may help alleviate symptoms associated with diarrhea, constipation, dysbiosis, bacterial infections, and yeast overgrowth.
With probiotics, it's all about survival. Probiotic organisms must survive three critical barriers to be of benefit -- the manufacturing process, time on the shelf, and most importantly, transit through the acidic environment of your stomach. Probiotic Synergy™ is formulated to handle all of the above, presented in moisture-resistant BIO-tract Probiospheres® that enhance stability and the ultimate delivery of probiotic organisms to your intestinal tract.
More Natural Help for UTIs
In addition to taking probiotics, there are other natural ways you can help prevent the recurrence of UTIs. Certain lifestyle changes can help, such as:
Drinking plenty of fluids like water and herbal teas and avoiding caffeinated and high- sugar beverages
Drinking unsweetened cranberry and blueberry juice
Urinating before and after sexual intercourse
Avoiding sex while you are under treatment for a UTI
Eating antioxidant-rich and high-fiber foods while avoiding refined foods that contain trans fats and sugar
Ask your health care practitioner about taking daily multivitamins and supplements such as vitamin C, omega-3 fats and L-glutamine. UT Synergy is another promising option, which features UTIrose™, a patented extract of the hibiscus species designed specifically for urinary tract infections that is high in certain organic acids and polyphenols, especially flavonoids and proanthocyanidins. These compounds give UTIrose™ anti-microbial (especially against E. coli and C. albicans) and bacterial anti-adhesive properties. In an in-vivo study, patients receiving 200mg daily of UTIrose™ experienced a 57% reduction in urinary tract infections after 3 months and a 77% reduction in urinary tract infections after six months of use.
Be sure that you tell your health care provider what supplements you are taking. Also consider making an appointment with your health care provider to discuss whether probiotics or another natural option might be the right course for you in treating and preventing UTIs.
Dr. Stephen Smith, Professor emeritus of family medicine at Brown University School of Medicine, tells his physician not to order a PSA blood test for prostate cancer or an annual electrocardiogram to screen for heart irregularities, since neither test has been shown to save lives. Rather, both tests frequently find innocuous quirks that can lead to a dangerous odyssey of tests and procedures. Dr. Rita Redberg, professor of medicine at the University of California, San Francisco, and editor of the prestigious Archives of Internal Medicine, has no intention of having a screening mammogram even though her 50th birthday has come and gone. That's the age at which women are advised to get one. But, says Redberg, they detect too many false positives (suspicious spots that turn out, upon biopsy, to be nothing) and tumors that might regress on their own, and there is little if any evidence that they save lives.
These physicians are not anti-medicine. They are not trying to save money on their copayments or deductibles. And they are not trying to rein in the nation's soaring health-care costs, which at $2.7 trillion account for fully one sixth of every dollar spent in the U.S. They are applying to their personal lives a message they have become increasingly vocal about in their roles as biomedical researchers and doctors: more health care often means worse health. "There are many areas of medicine where not testing, not imaging, and not treating actually result in better health outcomes," Redberg says. In other words, "less is more." Archives, which is owned by the American Medical Association, has been publishing study after study about tests and treatments that do more harm than good.
That less health care can lead to better health and, conversely, that more health care can harm health, runs counter to most patients' conviction that screenings and treatments are inherently beneficial. That belief is fueled by the flood of new technologies and drugs that have reached the market in the past two or three decades, promising to prevent disease and extend life. Most of us wouldn't think twice if our doctor offered a test that has the power to expose a lurking tumor, or a clogged artery, or a heart arrhythmia. Better to know-and get treated-than to take any risks, the reasoning goes.
In fact, for many otherwise healthy people, tests often lead to more tests, which can lead to interventions based on a possible problem that may have gone away on its own or ultimately proved harmless. Patients can easily be fooled when a screening test detects, or an intervention treats, an abnormality, and their health improves, says cardiologist Michael Lauer of the National Heart, Lung, and Blood Institute. In fact, says Lauer, that abnormality may not have been the cause of the problem or a threat to future health: "All you've done is misclassify someone with no disease as having disease."
From PSA tests for prostate cancer (which more than 20 million U.S. men undergo every year) to surgery for chronic back pain to simple antiobiotics for sinus infection, a remarkable number and variety of tests and treatments are now proving either harmful or only as helpful as a placebo.
This realization comes at a time when Medicare has emerged as a fat target in the debate over taming the deficit, with politicians proposing to slash costs by raising the age of eligibility or even eliminating the program. Experts estimate that the U.S. spends hundreds of billions of dollars every year on medical procedures that provide no benefit or a substantial risk of harm, suggesting that Medicare could save both money and lives if it stopped paying for some common treatments. "There's a reason we spend almost twice as much per capita on health care [as other developed countries] with no gain in health or longevity," argues Dr. Steven Nissen, the noted cardiologist at the Cleveland Clinic. "We spend money like a drunken sailor on shore leave."
Many medical advances, of course, have saved lives and eased suffering for millions of people. Screening tests like mammograms can lead to early treatment of breast cancer, especially for women with hereditary risk or a strong family history of the disease. For cancer patients who report back pain, MRIs can prove invaluable for spotting tumors that have metastasized to the bones, allowing doctors to intervene before it's too late. The years between 1980 and 2004 saw a 50 percent decline in the death rate from coronary heart disease thanks to better treatments and drugs that reduce cholesterol and blood pressure. At least 7,300 lives are saved every year thanks to colonoscopies.
The dilemma, say a growing number of physicians and expert medical panels, is that some of this same health care that helps certain patients can, when offered to everyone else, be useless or even detrimental.
Some of the most disturbing examples involve cardiology. At least five large, randomized controlled studies have analyzed treatments for stable heart patients who have nothing worse than mild chest pain. The studies compared invasive procedures including angioplasty, in which a surgeon mechanically widens a blocked blood vessel by crushing the fatty deposits called plaques; stenting, or propping open a vessel with wire mesh; and bypass surgery, grafting a new blood vessel onto a blocked one. Every study found that the surgical procedures didn't improve survival rates or quality of life more than noninvasive treatments including drugs (beta blockers, cholesterol-lowering statins, and aspirin), exercise, and a healthy diet. They were, however, far more expensive: stenting costs Medicare more than $1.6 billion a year.
If that finding makes you scratch your head-how can propping open a narrowed blood vessel not be wonderfully effective?-you're not alone. Many cardiologists had the same reaction when these studies were published. It turns out that the big blockages that show up on CT scans and other imaging, and that were long assumed to cause heart attacks, usually don't-but treating them can. That's because when you disrupt these blockages through surgery, you "spray a whole lot of debris down into the tiny blood vessels, which can trigger a heart attack or stroke," says Nortin Hadler, a professor of medicine at the University of North Carolina, whose book on overtreatment in the elderly, Rethinking Aging, will be published next month. Many of the 500,000 elective angioplasties (at least $50,000 each) performed every year are done on patients who could benefit more from drugs, exercise, and healthy eating.
New technology has sometimes made the problem more acute. Where once arterial blockages were detected by chest X-ray, now doctors can use cardiac CT angiography, which shows the heart and coronary arteries in dramatic 3-D. When it was introduced a decade ago to screen for cardiovascular disease, it seemed almost miraculous: a 2005 cover of Time trumpeted that it could "stop a heart attack before it happens." Difficult as it is to believe, however, there can be such a thing as too much information, especially from new imaging technology. "Our imaging and diagnostic tests are so good, we can see things we couldn't see before," says Lauer of the National Heart, Lung, and Blood Institute. "But our ability to understand what we're seeing and to know if we should intervene hasn't kept up."
In a recent study, John McEvoy, a heart specialist at Johns Hopkins Medical Institutions, and colleagues found that 1,000 low-risk patients who had CT angiography had no fewer heart attacks or deaths over the next 18 months than 1,000 patients who did not undergo the screening. But they did have more drugs, tests, and invasive procedures such as stenting, all of which carry a risk of side effects, surgical complications, and even death. The CT itself has a potential side effect: by exposing patients to high levels of radiation, it raises the risk of cancer. "Low-risk patients without symptoms don't benefit from CT angiography," says McEvoy, though high-risk patients with heart disease might.
The Cleveland Clinic's Nissen has seen firsthand what happens when doctors, armed with too much information, perform what turn out to be unnecessary procedures. In 2009 a 52-year-old woman with chest pain underwent a cardiac CT at a community hospital. Neither her LDL (bad) cholesterol nor her C-reactive protein (another risk factor for heart disease) were elevated. But since the CT showed several coronary plaques, her physicians performed coronary angiography. Complications ensued, and the woman wound up undergoing more procedures, one of which tore an artery. She eventually went to the Cleveland Clinic for a heart transplant-not because she had heart disease when it all started, says Nissen, but because of the cascading interventions triggered by the CT.
Nissen regularly counsels asymptomatic, low-risk patients against having cardiac CT, echocardiograms, and even treadmill stress tests; studies show they produce many false positives, leading to risky interventions. Even a clean scan can lead to worse health, if it makes people believe they can eat whatever they want and stop exercising. "I've had colleagues gain weight after a negative heart scan," apparently figuring they were home free, says UCSF's Redberg.
Radiologists and other physicians who diagnose or treat back pain have their own version of the CT: it's called magnetic resonance imaging, or MRI. Just as cardiac CT makes sense in principle, so does getting a high-resolution image of the spine if someone is suffering lower back pain with no clear cause. An MRI typically costs about $3,000 and is designed to spot everything from bulging discs to hairline fractures. Find any of those things, the logic goes, and you can treat the problem surgically. But there's a fundamental flaw: clinical trials have shown that back surgery, including vertebroplasty (putting special cement on a tiny spinal fracture) and spinal fusion, is no more effective at alleviating ordinary pain than plain-old rest and mild exercise. But like any surgery, it carries risks. Last year the American College of Physicians warned that "routine imaging [for low back pain] is not associated with clinically meaningful benefits but can lead to harms." That's because the "abnormalities" seen in an MRI often have nothing to do with the back pain (people without pain have them, too), but seeing something on a scan makes a physician feel compelled to get rid of it. "There is a longstanding fallacy among physicians that if you find something different from what you perceive to be 'normal,' then it must be the cause of the patient's problem," says UNC's Hadler.
Dr. James Goodwin, a geriatrician at the University of Texas Medical Branch, cites an extreme example of this fallacy in the case of a frail 84-year-old woman who was told by her gastroenterologist that it was time for another colonoscopy, just a few years after her last one showed no problems. She died when the procedure perforated her colon. Though this outcome is rare, the recommendation that led to the woman's death is all too common, says Goodwin, even though expert groups advise against screening colonscopies for anyone over 75 or who has had a normal result within the past 10 years. He says he was dumbfounded when his elderly patients kept receiving "reminders" from their gastroenterologists telling them it was time for another colonoscopy-seven or five or even two years after their last normal one.
Both curious and concerned, Goodwin launched a study of Medicare patients. Fully 46 percent had a screening colonoscopy fewer than seven years after a negative one. Making matters worse, many of them were over 80.
Medical practice also suffers from a kind of mission creep: if a treatment works in severe disease, some doctors assume it will work in milder disease. But that is not necessarily so. Antidepressants, for instance, have been shown in randomized trials to help with severe depression but not with moderate or mild depression, yet are widely prescribed for those conditions. Drugs called proton pump inhibitors (PPIs) are effective against gastric reflux and rare esophageal diseases as well as some ulcers, but at least half, and possibly 70 percent, of the 113 million U.S. prescriptions for PPIs each year are for conditions they don't help, such as run-of-the-mill stomachaches. PPIs can cause bone fractures, severe and hard-to-treat bacterial infections, and pneumonia. Millions of people are being put at risk unnecessarily, which is one reason treating adverse drug reactions costs the U.S. $200 billion a year.
Statins, common cholesterol-reducing drugs, may also not benefit some people who are taking them. Statins are proved to help people with both heart disease and high cholesterol, but not those with just high cholesterol. The drugs are nevertheless widely prescribed to patients who fit the latter description, despite adverse effects, such as severe muscle disease in up to 20 percent of patients. Similarly, cardiac resynchronization therapy, a special pacemaker that causes the right and left ventricles to beat in sync, can save the life of a patient with congestive heart failure whose ventricles are at least 150 milliseconds out of sync. Yet patients with a mistiming of 120-150 milliseconds are receiving the devices.
Low-tech tests should sometimes be avoided, too. In an Archives paper published this month, a panel of physicians, led by Brown's Smith, announced its first list of tests and treatments that should be dropped altogether for certain patients and ailments: antibiotics for sinus infections, imaging for low back pain, osteoporosis screening for women under 65, and electrocardiograms and other cardiac screening in low-risk patients. Even blood panels for healthy adults made the list. Today's comprehensive blood tests measure 15 or so enzymes, proteins, lipids, and the like. Yet by chance alone, if you test for 20 things, something will fall outside the bounds of "normal," often due to simple lab error.
Many doctors don't seem to be getting the message about useless and harmful health care. Medicare pays them more than $100 million a year for screening colonoscopies; some 40 percent are for people in whom they will almost certainly harm more than help. Arthroscopic knee surgery for osteoarthritis is performed about 650,000 times a year; studies show that it, too, is no more effective than placebo treatment, yet taxpayers and private insurers pay for it. And although several large studies, including the Occluded Artery Trial in 2006, have shown that inserting a stent to prop open a blocked artery more than 24 hours after a heart attack does not improve survival rates or reduce the risk of another coronary compared with drugs alone, the practice continues at a rate of 100,000 such procedures a year, estimate researchers led by Dr. Judith Hochman, a cardiologist at New York University. "We're killing more people than we're saving with these procedures," says UT's Goodwin. "It's as simple as that."
Molly offers a free 15 minute consultation by phone or in person. Feel free to contact her at: Molly Greacen, Lic Ac ,Dipl Ac, CH 3625 Conifer Court, Boulder, CO 80304 303-546-0987 mollygreacen@ womanmedicine .com
