Dr. Thomas Cowan: Holistic Family Medicine

Question: I am starting to suffer from varicose veins. Is there any way this unsightly condition can be avoided?

Answer: The problem of varicose veins runs the gamut from a harmless cosmetic annoyance to an almost life-threatening situation. Varicose veins usually manifest as prominent, swollen, blue-to purplish-color veins in the lower legs. These veins are rarely painful and rarely constitute a genuine medical problem. But for the elderly, swollen veins can become engorged with blood, leading to infection and a situation we call phlebitis, which can then lead to cellulitis, an infection of the tissues around the veins. At times, these infections can become chronic, severely interfering with the patient’s quality of life.

Furthermore, this same process can take place in other parts of the body, wherever the venous blood flow becomes sluggish, and can lead to engorged, swollen veins. Examples of this include hemorrhoids, which could be referred to as varicose veins in the rectal area. Clearly, an understanding and solution to the problem of venous blood flow is needed in order to help these sufferers.

In the chapter on heart disease in my book The Fourfold Path to Healing, you know that I presented a view of the circulation at variance to the usual views expressed in conventional medicine and physiology. That is, rather than seeing the motive force for the movement or circulation of the blood in the heart, I point out that the true force that “pumps” the blood is the generation of osmotic pressure at the cellular level. This osmotic pressure is generated primarily through the creation of water from the metabolism of food. The food that is the most efficient at generating water are the fats for the simple reason that fats possess copious amounts of hydrogen that can combine with oxygen in the process of cellular metabolism.

Furthermore, the more saturated the fat, the more hydrogen it contains, and therefore the more water generated from its breakdown. The osmotic pressure generated in the veins through the creation of new water in the cells is the motive force for “pushing” the blood uphill in the veins. This continual osmotic pressure generated provides a continuous push up the hill towards the heart, and this prevents the blood from falling back down the hill, creating downward pressure on the veins. When the circulation is sluggish, varicose veins eventually develop, a situation in which this downward pressure pushes out and eventually breaks the walls of the veins.

Rudolf Steiner, when describing the mechanism of circulation of the blood, referred to the force that moves the blood as a kind of “primary streaming” akin to the force that causes the sap to move up the tree from the soil to the crown of the tree. This primary streaming is an integral part of any living being; Steiner called it the etheric or life force, the force that counteracts gravity and that is the essence of the difference between the living and non-living world.

Varicose veins therefore develop out of two co-existing situations. First, there is insufficient osmotic pressure generated in the cells, resulting in a weak upward flow. This is often caused by insufficient or poor quality fats in the diet, or the inability to metabolize these fats into water. Second, there can be a weak primary streaming force in the person, a situation that often gets worse as the person ages. In a sense, as we age our basic “vital” force gets weaker, the very force that “pushes” the blood up our veins and the sap up the trees. This can be the result of a myriad of causes, some of which must be addressed in a true therapy for varicose veins.

Two other issues must be addressed in a comprehensive therapy for varicose veins: the tendency to infections and a progressive weakening of the walls of the veins.

In order to increase the osmotic push in the veins, the first part of the therapy is to ensure adequate good quality saturated fats in the diet. This should include the whole nourishing traditional dietary approach, with particular attention on including liberal amounts of butter and coconut oil in the diet. Coconut oil not only provides saturated fats, but the lauric acid in coconut oil has the added benefit of an anti-microbial element.

In order to help with the digestion of fats, the diet should include lacto-fermented vegetables, particularly sauerkraut, and bone broth, which is a general digestive tonic.

The blood vessel walls are nourished by certain food factors, especially foods that contain tannins, and rutins, a family of compounds in the vitamin C co-factor group. These factors are found in many green vegetables, fruits and tannin-rich herbs. These can be included in the diet and used medicinally.

The best studied herb for varicose veins is horse chestnut, an herb that contains a rutin-like compound called aesculin, which is a specific nutrient that strengthens the blood vessel walls–the tannins in the horse chestnut “tan” the blood vessels, just like they tan a hide, which means they shrink and strengthen the walls. The preparation I like is Horse Chestnut comp from Mediherb, which is a mixture of Horse Chestnut and other tannin-rich herbs. The dose is 2 tablets twice per day for at least one year if significant symptoms are present.

Finally, the most rutin rich food source is probably buckwheat greens. The best supplement for this is the Standard Process product Cyruta Plus, given at the dose of 2 tablets three times per day.

In order to help strengthen the vital force, perhaps the best therapy is regular vigorous movement of the lower limbs. This can be a regular walking program, yoga, spatial dynamics exercises, rebounding or any activity that tones and activates the muscles in the legs. This should be done on a daily basis to see optimal benefits.

This intervention should prevent further development of varicose veins and, if followed faithfully, even help them regress.

If signs of redness and infection are present, the legs should be elevated most of the day, hot compresses with a solution of Epsom salts should be applied 1-2 hours per day, and Echinacea, 2 tablets three times per day should be added to the therapy. In many cases, antibiotics can be avoided through these interventions.

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Fall 2006.

• Uncategorized
• Comments(0)

Question: Summer is here and my fair-skinned three-year-old has come home with a horrible sunburn after his first day at the beach. Is there anything I can do to relieve the burning and itching that is keeping him awake at night? And how do I prevent this from happening on our next outing to the beach?

Answer: If you consult any of the books on child care, they will tell you that the most important treatment for sunburn is prevention. Of course this advice does you no good if your child is already sunburned.

A very good topical treatment for sunburn is an ointment or gel called Combudoron by Weleda (www.weleda.com). It contains a number of ingredients that can help heal sunburn. Chief among them is Urtica urens, or small stinging nettle. Like other nettles, Urtica urens causes a burning sensation when it comes in contact with the skin. In this preparation, it acts like a homeopathic remedy to take away the burn.

Other ingredients in this soothing ointment include Echinacea and Calendula for wound healing and antiseptic action; Hypericum for its anti-viral properties; Aloe vera to accelerate wound healing in burns; Equisetum for wound healing; and Lavender and Pine essential oils.

In cases of open blisters and sores, the best treatment is fresh squeezed aloe juice. You’ll need to purchase an aloe plant at a nursery. Split a leaf lengthwise and squeeze out plenty of the juice onto the blisters. They should then be covered, not only to protect the wounds, but also because the flow of air over a wound can exacerbate the pain. Cover the wounds with saran wrap and then lightly with gauze.

By mouth, the patient can take homeopathic Cantharis and Arnica. Cantharis is derived from the green blister beetle, also known as Spanish fly, which has a burning bite. Arnica, as is well known, helps with achiness and soreness.

There are also dietary remedies that can help. Cod liver oil can help calm the nerves and hasten the healing process. Likewise, a natural vitamin C, such as Amla-C from Radiant Life (888-593-8333) will support healing and calm itchiness; taken at night a natural vitamin C will make it easier to sleep.

MSG exacerbates pain so care should be taken to avoid all processed food, most of which contains MSG. This may be a tall order in the summer when children are spending time on the beach and other areas where fast food is so readily available.

Sugar and sweet foods should be minimized, as these cause either low or high blood sugar, both of which make it difficult to heal and worsen feeling of pain. One theory holds that sugar consumption exacerbates the tendency to sunburn rather than tan.

As for avoiding a recurrence of sunburn, it is important to limit time in the sun, so that a tan can be developed gradually. The best thing is to cover the torso with a lightweight, light colored tee-shirt while at the beach and in the bright sunlight.

I do not recommend sunscreens as these have been implicated as contributing to skin cancer, but zinc oxide can be applied to the most vulnerable spots, such as the nose and shoulders.

With these precautions you should be able to avoid a repeat of the unpleasant effects of sunburn.

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Summer 2006.

• Uncategorized
• Comments(0)

Question: About six months ago I had a small growth on my cheek biopsied at the University of Iowa’s School of Dermatology. It came back as basal cell carcinoma. I already had one basal cell carcinoma excised from the top of my head. My face is starting to heal from the biopsy. I was advised to have the margins removed but have been hesitant because of the scarring. Is there anything I can do besides surgery to my beautiful face?

Answer: The history of skin cancer and its treatment is a very interesting exploration into the history of medicine in general and the treatment of cancer in particular. But first a little primer on skin cancer.

There are many different types of skin cancer, all of which get their names from the appearance of the various cells under the microscope. Practically speaking, there are two broad categories of skin cancer—melanoma and non-melanoma. This is the most practical way to think about skin cancer because melanomas have the possibility of spreading and killing the person, while generally speaking all of the other types of skin cancers do not spread except locally. By locally I mean a non-melanoma growth may “eat” away a large area around the original site, but it will never go to the lungs, liver, brain, etc. This is unlike melanoma, which can spread even in the early stages of the illness. In fact, I have known patients with very small original growths whose melanoma had already spread (metastasized) by the time of the diagnosis.

Because these types of cancer act so differently, they also need different treatments–the melanoma type more directed at stopping the metastasis, the non-melanoma types aimed at stopping the localized growth. Another general point is that non-melanoma skin cancers have been more conclusively associated with trauma to the skin, usually in the form of sunburns, while melanomas may not have any relationship at all to sun exposure, although this is controversial in the dermatology world.

For the treatment of non-melanoma skin cancers, like the basal cell cancer you have, it turns out there is a safe and effective alternative treatment out there which has been around for at least 200 years, perhaps even longer. The only problem is that the treatment is not for “the faint of heart.” The treatment is called escharotic therapy and is best described in a recently published book by Ingrid Naiman called Cancer Salves. With escharotic therapy, you put a caustic agent (usually sanguinaria root, but other caustics have been used throughout the centuries) in the form of a paste onto the skin cancer, then you cover the area. A few days later, the skin growth will be gone but there will be an open wound in its place. Properly done, with the proper herbs, all of the cancer cells will have been eliminated by the paste and then an eschar, or big thick scab, will form. This scab then takes from three weeks to a year to heal and fall off, depending on how big the scab is. When all is complete, there should be healthy new skin in the area, skin that is totally cancer-free. You can find a full description of these procedures in Naiman’s book, and can actually obtain the particular herbs on her website,www.cancersalves.com.

I have followed this procedure in my patients four or five times, and in each instance the area eventually healed without any trace of the original cancer nor, as of yet, with any recurrence of the growth—after many years in some cases. The comment about “faint of heart” I include because many people don’t enjoy having a large black scab on their face for months. Also, some but not all patients complain of a kind of painful, pulling sensation as the scab heals and a kind of burning sensation in the initial few days of treatment. Neither is extreme, and in all cases the patients say they would do the treatment again, but these cautions are worth noting.

For people with multiple or recurring growths in which it would be difficult to do multiple escharotic treatments, I would use the Iscador treatment discussed on my website www.fourfoldhealing.com and in my book the Fourfold Path to Healing. In fact, I have often had the situation where I was treating a patient for another form of cancer with Iscador and incidentally their non-melanoma skin cancers either got better or didn’t recur in the usual pattern.

I would also include the Mediherb Burdock comp at 2 tablets twice a day to this regimen, as the Essiac formula on which it is patterned has been very helpful for a variety of different types of skin cancer. This could be because its main herb, burdock root, has a particular affinity for the skin. Of course, in addition to these medicines and local treatments, a nourishing traditional diet and cod liver oil should be used as well.

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Winter 2005/Spring 2006.

• Uncategorized
• Comments(0)

Question: I have just been diagnosed with pre-leukemia, bordering on full-blown leukemia. Can you point me to any alternative therapy?

Answer: Leukemia is, generally speaking, an illness of the immune system, or perhaps more accurately said, a cancer of the immune system, so I thought this would be a good opportunity to introduce a therapy that I have recently become interested in. The therapy is called low-dose naltrexone (LDN), and more information, including copies of published studies, articles, interviews and even audio tapes of lectures by doctors who have used the therapy, can be found at the website www.lowdosenaltrexone.org.

LDN therapy is not only a promising therapy for many debilitating illnesses, including leukemia, but it offers insight into how our immune systems function.

Naltrexone was originally developed and introduced in the late 60s or early 70s. It is a drug that was created as an opiate receptor antagonist, meaning the drug blocks the opiate receptors in our bodies. A related drug, naloxone, was used as a very effective antidote for acute heroin or morphine overdose, often reversing the symptoms of overdose with these drugs in literally minutes. I can remember many times in my days of working in the emergency room that a patient with opiate toxicity was given naloxone and revived within minutes. Naltrexone, however, persists in the body for a longer period of time than does naloxone, and it was tried in patients for long-term use as a detox protocol for heroin addiction in the days before methadone. However, used in a once-per-day dose of 50 mg, it was unsuccessful in the treatment of heroin addiction. It was so effective in blocking the opiate receptors—which are the same as our endogenous endorphin receptors—that the patients felt chronically miserable and refused to take the drug. This outcome led to the discovery and elucidation of the role of endorphins in animal physiology. Endorphins are chemicals made in our bodies (in our adrenal and pituitary glands) which specifically make us feel good. They are exact copies of the exogenous (from the outside) opiates such as codeine, morphine, Vicodin, heroin, etc.

A neurologist in New York City, Dr. Bernard Bihari, who at the time was treating heroin addicts with naltrexone, began to notice that many of these addicts who also had AIDS had very low levels of endogenous endorphins. He reasoned that perhaps this was what led them to use opiates in the first place. It was then discovered through literally hundreds of research papers that these opiate receptors are found all over the body, in particular on the cells produced by our immune system.

Cells such as lymphocytes, natural killer cells, and so on, are full of endorphin receptors, and in fact seem to be controlled by these same endorphins. It seemed reasonable to conclude that the immune dysfunction that is characteristic of such illnesses as AIDS, cancer, auto-immune diseases (lupus, MS, Crohn’s disease, etc.), chronic fatigue syndrome and possibly many other immunologically-mediated diseases shared low levels of endorphins as a unifying theme behind their immune dysfunction. In fact, one can see the body’s wisdom in connecting the chemicals which produce feelings of well-being to the core functioning of our immune system regulation. Feeling low and out of sorts, then, is not merely a psychological problem, but raises alarms as to your overall health. Something needs to change, so that you can feel better.

Through much experimentation, Dr. Bihari was able to show that the same naltrexone that blocks the endorphin receptors at a high dose at a much lower dose given at night blocks the receptors for only an hour or so. The body responds to this temporary block by dramatically increasing its synthesis of endorphins so the end result is often endorphin levels increased by four or five times, a restoration of immune function, and in many cases the remission of the underlying illness of the patient. Dr. Bihari was able to show this in numerous cases over many years, but it wasn’t until this year that this effect could be said to be proven.

In January, 2007 a study was published in the American Journal of Gastroenterology showing that over 67 percent of patients with Crohn’s disease had a full remission from no other therapy than LDN. Similarly, a case study was recently published of a patient with pancreatic cancer which had metastasized to his liver, who was alive and well over four years later with no tumors detectable by X-ray. The only therapies used in his case were LDN and supplementation with alpha lipoic acid. On the LDN website you will find numerous cases of cancer patients, patients with auto-immune diseases, etc., who have had similar positive results from LDN. It is worth noting that in over 20 years of use, this medicine has shown no toxicity and no side effects except mild insomnia in the first week or so of use. It is cheap, easy to procure, and indeed its only trouble seems to be that it is non-patentable, which means there is very little money to be made from its sale.

I became interested in the LDN story for several reasons. The first was a patient of mine with a prostate cancer recurrence who has had wonderful success using LDN as his main therapy. Next was this study just referred to, which was published by the most prestigious gastroenterology journal in the English-speaking world. And finally, I have been encouraged by research pointing to other modalities that have been shown to increase endogenous endorphin levels. The first of these is exercise, the second is acupuncture (which is probably why acupuncture often makes people feel good), the third is chocolate (whose high levels of phenylalanine prevent the degradation of the endorphins), and the last is Iscador, a medicine I have long used with success in my cancer patients. I can practically guarantee that good fats would be added to this list if anyone took the trouble to do the study. I say this because nothing makes people feel as good as a nutritious meal including the adequate provision of healthy fats. My guess is regular sexual activity could also be added to this list of endorphin-increasing “agents.” LDN, however, clearly is the most potent endorphin stimulant that we know of, and used in conjunction with the other endorphin-friendly interventions holds much promise for those suffering from the often devastating effects of immune dysfunction.

Naltrexone is a prescription medication licensed for use in 50 mg capsules for the short-term treatment of opiate overdose. There are a variety of compounding pharmacies that are currently making it available in 4.5 mg doses, which is the dose Dr. Bihari has found most effective for raising endorphin levels. The usual dose is 4.5 mg right before bed. I would be happy to discuss with any interested readers whether LDN would be right for them and, if so, to provide them with the required prescription. For those interested in more information on how to start LDN, please call my office at 415-334-1010 and schedule an appointment.

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Summer 2007.

• Uncategorized
• Comments(0)

Question: We always hear about the dangers of high blood pressure but my problem is low blood pressure, which makes me dizzy and tired. Is there anything that can be done for low blood pressure?

Answer: Over the years many of my patients have asked me about the significance of low blood pressure. This is a very interesting and surprisingly complex question, which merits some background information.

The official definition of normal blood pressure is around 120/80. Yet years ago, when I was in medical school, we were taught that the norm was dependent on one’s age, so that the systolic (top number) was normal if it was 100 plus the patient’s age over 90 or below. In fact, even though this way of looking at blood pressure is no longer considered valid, there has been no major study that I know of that shows a better prognosis in any measurement when the blood pressure is lowered with drugs to the level of 120/80 in elderly people.

Low blood pressure, on the other hand, has never been defined or been associated with an increase in any disease category. In fact, doctors today suggest that the lower one’s blood pressure the longer the life span and that those whose blood pressure doesn’t increase with age have some of the lowest overall all-cause mortality rates.

However, over the years I have had many patients who present with a picture of weakness that more times than not includes a significantly low blood pressure. By low blood pressure, I mean people whose blood pressure is less than 90/60. The typical person with blood pressure this low also complains of overall lowered vitality, sometimes allergies, almost always cold hands and feet and usually lowered libido. In serious cases low blood pressure can cause light-headedness, dizziness, weakness and fainting. All of these symptoms suggest a general overall lowering of one’s vitality. The low blood pressure is not the cause of this syndrome, nor is it by itself a sign of poor health, but in conjunction with these other symptoms suggests a state of low vitality.

So the question is what do we mean by low vitality and how does this correlate with these symptoms?

The regulation of blood pressure is a mysterious process which involves at least three mechanisms working in complex relation to each other.

1. Receptors—called baroreceptors—which reside in various organs and detect changes in arterial pressure. These receptors adjust the pressure by altering the force and speed of the heart’s contractions, as well as the resistance in the arteries.
2. The renin-angiotensin system (RAS), involves hormones secreted by the kidneys. When blood pressure drops, the kidneys compensate by activating a vasoconstrictor called angiotensin II. When the kidneys do not produce enough of this hormone, blood pressure will also be low.
3. Aldosterone is a steroid hormone produced by the adrenal cortex, which stimulates sodium retention and potassium excretion by the kidneys. When aldosterone is increased, the body retains fluid retention and blood pressure is raised. Alternately, low aldosterone production will result in low blood pressure.

As I have discussed in many other articles the adrenal hormonal output is directly involved in many symptoms of low blood pressure, not only is low aldosterone production associated with low blood pressure, but low cortisol (an adrenal hormone) is connected with allergies and fatigue; low sex hormone production (produced in part by the adrenal glands) is also related to adrenal hormone output and low libido. In other words, the lowered vitality that one often sees related to low pressure is a direct symptom of low adrenal and kidney hormone production. This is the issue that needs to be addressed, not specifi- cally a strategy to raise the blood pressure.

The way I address this specific variation on low adrenal function is to suggest a nourishing traditional diet along with adaptogenic herbs and supplements. The diet should contain an abundance of healthy fats, organ meats, raw animal foods and lacto-fermented foods. These provide the vitamins, minerals and enzymes, that is the raw materials, that the body can use for hormone production. Specifically, the adrenal gland uses good fats including cholesterol to produce hormones. Vitamins A, B₆ and C are cofactors in the production of these hormones and are abundant in the nourishing traditional diet. Vitamin A is available from cod liver oil; vitamin B₆from raw animal foods; and vitamin C is plentiful in lacto-fermented foods such as sauerkraut.

These patients also need to have a high mineral diet, especially in the form of daily soup broth and liberal amounts of Celtic or Himalayan salt. Sometimes if warmth is the main issue, extra fats and oils are needed, in particular one teaspoon of high-vitamin butter oil in addition to one teaspoon of cod liver oil.

It is imperative that the patient completely remove all trans fats from the diet. These interfere with adrenal hormone production and may also inhibit the function of the baroreceptors.

The adaptogenic herb I have found most useful in this situation is one of the forms of ginseng, such as Eleutherococcus or Korean ginseng. I like to use the high potency forms from Mediherb like eletherococcus tablets at a dose of one tablet, 2-4 times per day, or Rhodiola/ginseng (Rhodiola is another strong adaptogenic herb) at the same dose. I also add the standard process protomorphogen of the adrenal gland called Drenatrophin at a dose of one tablet, three times per day. With these simple interventions these symptoms can be lessened, the blood pressure raised to normal and the patients often feel much better.

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Summer 2008.

• Uncategorized
• Comments(0)