Q: What can women do about recurrent bladder infections?

A: There seems to be a gap in the significance placed on urinary tract infections between doctors who treat them and women who get them. Conventional medical doctors don't seem to spend much time thinking about UTIs, often prescribing an antibiotic automatically. But women who get them chronically suffer lots of discomfort. There are many botanical medicines that may help treat UTIs, among them Oregon grape (Mahonia aquifolium), bearberry (Arctostaphylos uva ursi) and goldenseal (Hydrastis canadensis). I have prescribed these to good effect many times. However, for a woman with recurrent UTIs, simply taking one of these herbs is unlikely to solve the long-term problem—just as giving a conventional antibiotic won't. These herbs are antimicrobials and, while useful and natural, I don't think they are a good long-term solution. An overreliance on antimicrobial treatments can result in resistant strains of bacteria developing. I much prefer using cranberry juice or tablets. Traditionally, cranberry juice was thought to cause urine acidification resulting in a bacteriostatic effect. However, recent research has demonstrated that a bacterial antiadhesion mechanism is responsible, which means the juice doesn't kill the bacteria, but inhibits the bacteria from adhering to the bladder wall.¹ Studies have shown cranberry juice and tablets both reduce UTI recurrence.2 They appear to be effective and safe and don't rely on antibiotic qualities.

Q: What is the best treatment for plantar warts?

A: Warts are caused by the human papillomavirus and are one of the most common skin diseases. They are a particularly vexing problem in children. A recent trial has thrown some cold water on the notion that having a pediatrician treat this rather benign condition is better then treating it at home with all-purpose duct tape. In this trial, children were randomized to receive either cryotherapy, a standard office practice whereby liquid nitrogen is applied to each wart for 10 seconds every two to three weeks for up to six treatments, or duct tape occlusion (applied directly to the wart) for a maximum of two months. The researchers concluded that duct tape was significantly more effective than cryotherapy for treating the common wart (85 percent compared with 60 percent complete resolution). They stated, "Tape occlusion therapy can now be offered as a nonthreatening, painless and inexpensive technique for the treatment of warts in children."3 A larger review of the literature suggests simple topical treatments containing salicylic acid have a good therapeutic effect also.4 However, many parents shy away from this because it can be painful. The researchers also state there is little evidence for the efficacy of cryotherapy, and there is also quite a placebo response—the average cure rate for warts with placebo preparations is 30 percent. Therefore, at-home techniques seem reasonable—I think duct-tape therapy is here to stay.

Q: Can vitamin D keep the elderly on their feet?

A: It is common knowledge that vitamin D can help prevent or at least delay the onset of osteoporosis. What is less clear is whether supplementation will help with another large problem among the elderly—losing their balance and falling. There are specific vitamin D receptors in muscle tissue, so some researchers hypothesized that vitamin D may actually help with balance and muscle coordination. In a recent double-blind, randomized, controlled trial, researchers studied 122 elderly women who had frequent falls and divided them into two groups: One group received 1,200 mg calcium plus 800 IU vitamin D (cholecalciferol) and the other group received just 1,200 mg calcium. During a three-month period, those taking vitamin D plus calcium reduced their risk of falling by 49 percent compared with those taking just calcium.5 In contrast, researchers conducting another recent study (a similar trial design) found a single large dose of vitamin D did not improve fall odds.6 This may suggest consistent supplementation with moderate doses is more effective. Because vitamin D is so important in osteoporosis prevention, the prudent thing seems to be to continue taking it, especially for those who are prone to falls.

Dan Lukaczer, N.D., is director of clinical research at the Functional Medicine Research Center, a division of Metagenics Inc., in Gig Harbor, Wash.

References

1. Howell AB. Cranberry proanthocyanidins and the maintenance of urinary tract health. Crit Rev Food Sci Nutr 2002;42(3 Suppl):273-8.

2. Stothers LA. Randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol 2002 Jun;9(3):1558-62.

3. Focht DR 3rd, et al. The efficacy of duct tape vs. cryotherapy in the treatment of verruca vulgaris (the common wart). Arch Pediatr Adolesc Med 2002;156:971-4.

4. Gibbs S, et al. Local treatments for cutaneous warts. Cochrane Database Syst Rev 2003;3.

5. Bischoff HA, et al. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 2003 Feb;18(2):343-51.

6. Latham NK, et al. A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). J Am Geriatr Soc 2003 Mar;51(3):291-9.

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