What can you tell me about the Chinese medicine called fo-ti, said to be an effective tonic? What else is it used for and what, if any, risks are involved in taking it? Is it something that you would recommend?

I discussed your question with Tieraona Low Dog, M.D., director of The Fellowship at the Arizona Center for Integrative Medicine and an authority on botanical medicine. She tells me that fo-ti can be consumed raw or after processing. A preparation made from the raw tuber generally is used as a laxative and is intended to be taken only in the short term, for about two or three days. (Unprocessed fo-ti is described as "white" because of its light color compared with the "red" processed form.) In the United States, processed fo-ti is sold mostly in formulas said to bolster mental clarity and longevity, but Dr. Low Dog says that very few human studies support its use for either of these purposes.

She cautions against taking fo-ti because more than 25 cases of hepatitis have been reported in people who have used it, including one case in a five-year-old. Beyond that, fo-ti could potentially interact with a number of prescription medications, including some for diabetes (causing blood sugar to drop too low) and stimulant laxatives. (Fo-ti is a stimulant laxative, so taking it along with another drug with that effect could lead to dehydration.) Other drugs that may interact adversely with fo-ti include digoxin, Elavil, Haldol, Inderal, theophylline, Prilosec, Prevacid and Valium. Since fo-ti hasn't been well studied, it shouldn't be used by women who are pregnant or breastfeeding. (It is known to enter breast milk and could cause diarrhea in infants.)

Given the fact that there isn't much scientific evidence to support its use and because of safety concerns, Dr. Low Dog suggests consulting a doctor of Oriental Medicine who has training in traditional Chinese herbal medicine rather than trying it on your own. I agree.

Andrew Weil, M.D.

I understand that some research has found that giving up meat, poultry and fish in favor of a vegetarian diet can help relieve depression. Is this true? If so, can you tell me what makes the difference? 

On this site, I've discussed scientific data linking low tissue levels of the two essential omega-3 fatty acids found in fish oil - EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) - to a host of mental/emotional disorders, including depression, violent behavior, suicide, and learning disabilities. Dietary supplementation providing these fats, usually in the form of fish oil, has proved to be an effective, natural, and nontoxic therapy for bipolar disorder, attention deficit hyperactivity disorder, postpartum depression, and seasonal affective disorder. It also helps prevent depression and improve overall emotional well-being.

In the latest study, published February 14, 2012 in Nutrition Journal, the investigators noted that high intakes of arachidonic acid (a long-chain omega-6 fatty acid found in fatty red meat, egg yolks and organ meat) can promote brain changes that disturb mood, and wanted to explore how changing the fatty acid profile in the diet might impact mood. They recruited 39 volunteers for a two week trial. The participants were divided into three groups. Those in the "omnivore" group continued to follow their usual diets and to eat meat, fish or poultry at least once a day; those in the second group were told to avoid meat and poultry and to have at least three to four servings of fish per week (they were also allowed to eat eggs); and those in the third group avoided all animal derived foods, except dairy, for the duration of the study.

At the end of the two weeks, the researchers tested all of the participants with standard questionnaires designed to measure stress and mood and found that those on the vegetarian diet showed a decline in stress and tension and reported better moods than those in the other two groups. The researchers suggested that these positive changes could have been due to a reduction in the intake of arachidonic acid as well as to the effects of antioxidants in fruits and vegetables that may have boosted mood via a reduction of oxidative stress. They also pointed out that meat from grain-fed animals provides five times the ratio of omega-6 to omega-3 fats found in meat from grass-fed animals and may raise the risk for inflammation-related diseases including depression.

This small study hints at effects of dietary fats on mood and, perhaps, the possible benefits of a vegetarian diet. The researchers noted that their findings warrant further investigation.

Andrew Weil, M.D.

Exactly what is “pink slime”? I’ve heard it is in the meat used for hamburgers in school lunches, but I’m not clear on what it really is and whether or not it is used in other hamburger meat.

The term "pink slime" is credited to Gerald Zirnstein, a former U.S. Department of Agriculture (USDA) scientist, who with his colleague Carl Custer turned whistle- blower to let consumers know what they are paying for. The two former USDA scientists claim - rightly, I think - that if this filler is mixed in with the ground beef sold to consumers in supermarkets, the labels should say so. And they argue that because the stuff is not nutritionally equivalent to the beef to which it is added, the practice of using it amounts to economic fraud.

Beyond that, pink slime apparently isn't as safe as the USDA and the manufacturer would like us to think. In 2009 the New York Times reported that government and industry records it obtained showed that "in testing for the school lunch program, E. coli and Salmonella pathogens have been found dozens of times in (the manufacturer's) meat, challenging claims by the company and the USDA about the effectiveness of the treatment. Since 2005, E. coli has been found 3 times and salmonella 48 times, including back-to-back incidents in August (2009) in which two 27,000-pound batches were found to be contaminated. Fortunately, the meat was caught before reaching lunch-room trays."

The widespread use of this stuff most recently came to public attention when chef Jamie Oliver began campaigning against it. As a result, McDonald's, Burger King and Taco Bell have announced that they would remove "pink slime" from their products. However, the Agriculture Department still buys millions of tons of it for use in school lunches. (In March 2012 the USDA did announce that schools participating in the national school lunch program can opt to not receive meat containing pink slime.)

Pink slime is produced by only one company, Beef Products, Inc. (BPI), of Dakota Dunes, South Dakota, which successfully persuaded government officials that consumers don't need to be told on product labels that the ground beef they buy contains bits of the cow they probably wouldn't want to eat. In response to increased consumer awareness, BPI suspended operations at three of its plants, and one of the companies that uses the product and supplies ground beef to several major retailers and fast-food chains has filed for Chapter 11 bankruptcy. ;

If you use ground beef and want make sure what you buy contains no pink slime, choose organic versions. Meanwhile, Costco, Publix, Whole Foods, H-E-B, Tops, A&P, and Target announced that they never sold beef with added pink slime, and at this writing a number of large retail chains including Giant Food Stores, BJ's Wholesale Club and Kroger Co. are now pledging that they will not sell meat containing the questionable additive. ;

If you use ground beef and want make sure what you buy contains no pink slime, choose organic versions.

Andrew Weil, M.D.

I heard on the radio that eating spicy foods can help lower triglycerides. Is this true? If so, what kind of spices should I use, and I’m curious about how spices would do this. 

Some research has suggested that eating spicy foods can lower triglyceride levels by about one-third. This finding comes from a small study at Penn State that compared the effects of eating a 1,200 calorie, high-fat, high-carbohydrate meal of chicken curry, Italian herb bread, and a cinnamon biscuit spiced with a two-tablespoon blend of turmeric, garlic, oregano, paprika, rosemary, cinnamon, black pepper and cloves to the effects of eating the same meal without the spices. The study leader said that the spices used provided antioxidants equivalent to amounts found in five ounces of red wine or 1.4 ounces of dark chocolate. The study participants were healthy, overweight men between the ages of 30 and 65. They ate the spicy meal at one sitting and then, a week later dined on the same food without the added spices.

The researchers commented that they decided to examine the effects of these particular spices on triglyceride levels because lab tests have shown that they have potent antioxidant properties. The researchers measured the participants' triglyceride levels before each meal and every half-hour after eating for three-and-a-half hours. They reported that after the spicy meal, the men's triglycerides dropped by about one-third, compared to their levels when they ate the same menu minus the spices a week later. ; In addition to the drop in triglycerides seen, the researchers reported a 13 percent increase in antioxidant activity in the blood and a 20 percent decrease in insulin response. ;

What we don't know yet is whether eating spicy foods regularly will result in lower triglyceride levels in the long term. The research team now plans to study which spices in the blend were most beneficial and how much of them would be needed to reliably produce effects similar to those seen in this pilot study.

Until we know more, I wouldn't count on spicy foods to keep your triglycerides in check. However, we do know that garlic, turmeric and ginger have antioxidant and anti-inflammatory properties, and I have long recommended including them in the diet. Rosemary has been shown to increase blood flow to the brain, improving concentration. It also contains numerous anti-inflammatory compounds, and has been used medicinally for centuries. ;
;
Serum triglycerides can soar after you load up on carbs, especially the high-glycemic-load kinds that quickly raise blood sugar. Reducing intake of these carbs, along with regular exercise, and weight management can help keep triglycerides under control. I would also suggest cutting back on alcohol, avoiding beer especially. (Even small amounts of it can elevate triglyceride levels.) In addition, increasing your intake of omega-3 fatty acids can substantially reduce triglyceride levels. Start by eating salmon, sardines, black cod, and herring on a regular basis. You should also consider taking a good fish oil supplement, at least two grams per day, which can help lower your triglycerides into the healthy range. Fasting triglycerides should be less 150 and, optimally, less than 100.

Andrew Weil, M.D.

I have read that taking evening primrose oil can increase production of estrogen and is therefore not safe for use by women who have had estrogen-receptor-positive breast cancer. Can you tell me whether this is true?

I discussed your question with Tieraona Low Dog, M.D., director of the Fellowship at the Arizona Center for Integrative Medicine and an authority on botanical medicine. She says she isn't aware of any "contraindications" (reasons to withhold treatment) of the use of evening primrose oil by women who have had breast cancer. Dr. Low Dog also notes that surveys have shown that some of these women use EPO to relieve hot flashes, particularly those caused by the anti-estrogen drug, tamoxifen. Although many users report that it helps, there is little formal, clinical evidence to show that it is effective for everyone.

I can find no evidence suggesting that evening primrose oil has estrogen-like effects or that it increases breast cancer risk or risk of recurrence. I did come across a report suggesting that GLA might actually augment the treatment of an aggressive type of breast cancer associated with the Her-2/neu gene. Research at Northwestern University found that GLA inhibits the action of this cancer gene and also improves the response of these breast cancer cells to Herceptin, the drug used to treat Her-2/neu-positive breast cancer. (However, I've seen no confirming follow-up studies.) ; ; ;

If you've had breast cancer and find that evening primrose oil relieves hot flashes or is otherwise helpful to you, there's no reason not to continue using it.

Andrew Weil, M.D.

What can you tell me about yerba maté tea? I’ve heard that it is good for bones and may protect against colon cancer. True?

Maté contains xanthines, a class of chemical compounds that includes caffeine as well as theophylline and theobromine, the stimulants in tea and chocolate. Some scientists contend the primary type of xanthine in maté is actually "mateine," a compound they say is chemically similar to caffeine but with slightly different effects. Some South American researchers claim that unlike caffeine, mateine induces sleep, and while it's a stimulant, doesn't trigger the jitteriness associated with caffeine. I don't agree with them.

Recent evidence does suggest that drinking maté preserves bone mineral density in postmenopausal women, a surprising finding since caffeine is believed to contribute to bone loss and an increased risk of fractures. A study from Argentina published in the January 2012 issue of the journal Bone compared 146 postmenopausal women, some of whom who drank one liter of yerba maté tea daily for five years and some of whom didn't. (The researchers excluded women whose health history put them at high risk for osteoporosis.) Results showed that the yerba maté drinkers had 9.7 percent higher bone density in their lumbar spine and 6.2 percent higher bone density in the area of the thigh just below the hip joint (this area is called the femoral neck) than the women who didn't drink the tea. In another study, women who drank Chinese tea also had higher bone density in these two sites compared to women nondrinkers of tea; the increases were 4.3 percent and 4.7 percent respectively.

As far as colon cancer is concerned, findings from the University of Illinois suggest that bioactive compounds found in one cup of maté tea can disrupt colon cancer cells, at least in the lab. Researchers exposed human colon cancer cells to caffeine derivatives from yerba maté. They found that the cancer cells self-destructed due to DNA damage from the caffeine derivatives, and that these same compounds also reduced important markers of inflammation. Even though these were only test tube studies, the investigators concluded that there is "ample evidence" to consider drinking yerba maté tea for these potential benefits, particularly if you're worried about your colon cancer risk. Their findings on the effects of maté tea on the development of colon cancer in rats are awaiting publication.

Andrew Weil, M.D.

A friend has recommended something called the Graston Technique to help with IT Band pain that I'm dealing with as a result of running. Do you think this is a useful treatment for soft tissue pain?

You're most likely to develop IT band pain if you run on only one side of the road. When you do this, the foot that is on the outside slope of the road is often lower than the other foot, a position that tilts the pelvis and stresses the IT band. Other possible causes are excessive pronation (the way your ankle rolls inward and your foot rolls outward when you land on it while running), a discrepancy in the length of your legs (one is slightly longer than the other), a lateral pelvic tilt (one side of the pelvis is lower than the other), bowed legs, and tight gluteal (buttocks) muscles or tight quadriceps (the big muscles on the front of the thigh).

The Graston Technique® is an unproven method of treating injuries by breaking down scar tissue that causes pain. Practitioners use six stainless steel instruments instead of their hands to find the scar tissue. In essence, the technique involves further damaging the affected soft tissue in the belief that this will promote healing. This method is an offshoot of "soft tissue mobilization," a physical therapy technique for which there is sparse supporting evidence.

The best research we have for demonstrating the efficacy of the Graston Technique comes from a study in mice that showed some benefits in terms of new tissue formation, but no effects on healing. A search of the medical literature for "Graston" yielded 13 articles, mostly case reports, which describe of the use of the technique on one or more patients. These are not studies - the authors are not comparing one treatment method against another to learn whether a new approach works better than an old one, or better than none at all. One of the articles described the design of a proposed trial of the Graston Technique; another was a pilot study comparing the Graston Technique to manual soft tissue mobilization in the treatment of carpal tunnel syndrome: it concluded that both methods worked.

If I were you, I would stay away from the Graston Technique. In my view, it lacks solid scientific support demonstrating its safety and effectiveness. The standard treatment for IT band pain is rest, ice, elevation and over-the-counter anti-inflammatory medication such as ibuprofen. If those methods don't help, you may want to try physical therapy and learn specific stretches to relieve pain in this area. The practitioner may assess your running form and recommend particular shoes that could help correct any imbalances. The best approach may be to enlist the help of a knowledgeable sports therapist to figure out what caused the problem in your case so you can avoid further episodes.

Andrew Weil, M.D.

What risks of deep vein blood clots are associated with airline travel? I once read that you’re at greater risk if you fly economy class and sit by a window, but recently I’ve heard that’s not true. 

The new guidelines, published in the February 2012 issue of the journal Chest, debunk the existence of an "economy class syndrome" - the increased danger of developing DVTs while flying coach - and state that the very small risk of contracting DVTs while flying that does exist is no greater in economy class than it is in business class or first class. However, the panel of experts who wrote the guidelines warned that on flights of six hours or more, passengers sitting in window seats are at greater risk of DVT than those seated elsewhere, because in that location you're more likely to remain immobile for long stretches of time than you would if you were on the aisle.

The panel found no evidence to support the idea that dehydration or drinking alcohol increases the risk of DVT. ;

The authors emphasized that while DVTs are rare in passengers subjected to taking long flights, those that do occur usually affect individuals who have one or more risk factors and have been on flights longer than eight to 10 hours. Risk factors include previous DVT or pulmonary embolism, certain types of cancer, recent surgery or trauma, immobility, advanced age, taking birth control pills or other forms of estrogen, pregnancy, and obesity.

If you're at risk of DVT, the guidelines recommend getting up often on long flights to walk around and stretch your calf muscles. Book an aisle seat whenever possible so you can get up easily to move about the plane. Another option for those at risk is the use of below-knee compression stocking. (However, the guidelines specify that these stockings should not be used by anyone who is not at increased risk.)

All told, the average risk for a DVT is about one per 1,000 persons per year. That risk doubles for long flights (or sitting for long hours on buses, trains or driving a car). Unless you know for sure you're at risk, I wouldn't worry too much about developing a DVT during air travel. But do get up occasionally and walk the aisles.

Andrew Weil, M.D.

I understand that all adults are supposed to get whooping cough shots. I’m sure I had one when I was a kid, so why would I need another one now? Do the shots wear off? And what’s the threat of whooping cough, anyway? 

This new recommendation is actually an update of one from 2005, when the CDC recommended that in addition to children over the age of 2 months, all adults up to the age of 65 be vaccinated with Tdap. Those over 65 weren't included at the time because no whooping cough vaccine was available for this age group. In 2011 a Tdap vaccine was approved for use in individuals age 65 and older.

Over the past few years, whooping cough has become an increasing problem in the United States. In 2010, more than 21,000 cases were reported, one of the highest numbers in more than 50 years. And while whooping cough has always been regarded as a childhood disease, you're at risk unless you've had the vaccine within the past 10 years. The CDC reports that less than nine percent of adults in the U.S. have been revaccinated.

Whooping cough is caused by a bacterium, Bordetella pertussis, which is highly contagious and is passed from person to person by direct contact with droplets from the coughing or sneezing of an infected person. The most contagious period is early in the disease when the only symptoms appear to be those of a common cold: runny nose, sneezing, conjunctivitis (pink eye), an occasional cough, and a mild fever. After a week or two, the "cold" enters another stage with symptoms that characterize whooping cough: violent fits of coughing and a gasp for breath in between coughs that sounds like a "whoop." The coughing is so severe and deep that it often triggers vomiting and can result in broken ribs, seizures and dehydration. Attacks typically occur at night and can leave you exhausted from lack of sleep. In between coughing fits, you seem perfectly okay.

Unfortunately, whooping cough isn't easy to treat. If it is diagnosed during the first week, the antibiotic erythromycin may lessen the severity and duration of the infection. After that, there's no good treatment - you just have to let the disease run its course, which typically lasts six to eight weeks. Cough medicines usually don't help much. Over time, the coughing lessens in frequency and intensity but can linger for months. Household contacts should be immunized and also treated with erythromycin.

The most frequent complication (and the most frequent cause of death) of whooping cough is secondary bacterial pneumonia, which can occur in up to 30-40 percent of patients.

The most likely explanation for the return of whooping cough in recent years is that significant numbers of people stopped immunizing their kids out of concerns over the safety of pertussis vaccine. Today's newer vaccine is safer than the old one, and there is no reason not to use it. The risks of pertussis are much greater than those of the vaccine. This disease is no joke: in 2010 more than 9,100 people in California caught whooping cough and 10 infants died. The CDC reported that the outbreak was the highest recorded in the state since 1947.

Andrew Weil, M.D.

I've been diagnosed with a tumor on my neck. My friend suggested treatments with a Rife machine. How effective are these treatments and what are the dangers? I'm scared that treatments might cause the tumor to metastasize as the cells break down and wash through my system. 

The Rife machine was introduced in the early 1930s by Royal Raymond Rife, an inventor who maintained that all cancer is caused by bacteria and claimed that his machine could detect the microbes by the color of the auras they emitted. (Except for H. pylori, associated with stomach cancer, no other bacterial cause of cancer is known.)

Rife's invention got some medical attention in the 1930s, but its efficacy remained unproved. It probably would have disappeared by now if it hadn't been for a 1987 book called The Cancer Cure that Worked!: Fifty Years of Suppression. ; The book's authors claim that in 1934 Rife demonstrated his machine's ability to cure cancer but that "all reports describing the cure were censored by the head of the AMA from the major medical journals."

A 1994 review by the American Cancer Society of the Rife machine noted that once the cancer-causing microbes were identified by the Rife machine, it would purportedly generate radio frequencies of exactly the same vibratory rates as the bacteria and, according to Rife, "shatter" them. The truth is that radio waves cannot destroy bacteria. ;

Despite the fact that it has long been medically discredited, the Rife machine is still around, doing more harm than good. In 2007, the Seattle Times reported the case of a Washington state couple who were indicted for medical fraud. They operated a treatment center in their home using a Rife machine among other bogus devices. The man posed as a physician, and his wife scheduled appointments and, according to the news account, also warned patients not to talk about the treatment they received because it was "unapproved and clandestine." One of their patients, a 32-year-old man who had been diagnosed with testicular cancer, refused the immediate surgery his physician had urged and instead underwent a year"s worth of treatment with the Rife machine at the cost of several thousand dollars. He died in 2004 leaving a wife and three young children.

Rife machines don't work. When dealing with cancer, first determine what conventional therapies have to offer. Then try to find an oncologist who is open to an integrative approach; see Integrative Oncology edited by Donald I.Abrams, M.D. and me (Oxford University Press, 2009).

Andrew Weil, M.D.