THAT’S THE WAY THE COOKIE CRUMBLES (14 page)

“I expect to see 150. I’ll be disappointed if I don’t.” That remarkable statement comes from Dr. Ronald Klatz, president and founder of the American Academy of Anti-Aging Medicine, an umbrella organization of physicians dedicated to using treatments that may slow the aging process. Klatz is optimistic about his life expectancy because he regularly injects himself with human growth hormone. Thousands of other North Americans are also puncturing their thighs, abdomens, or bottoms daily with syringes filled with this purported antiaging miracle. And they are opening their wallets wide to do so. Those who cannot afford the fifteen hundred dollars a month for the hormone injections are banking instead on dietary supplements, known as “secretagogues,” which allegedly stimulate the release of growth hormone in the body. But before these hopefuls start reserving cruise tickets to celebrate their hundredth wedding anniversaries (presuming they have enough money left after paying for all that growth hormone supplementation), I think they should take a closer look at this alleged shot of youth.

To be sure, human growth hormone (hgh) is a fascinating substance. If our pituitary gland doesn’t release it properly, then we simply do not grow. “Pituitary dwarfs” remain short in stature, but they are otherwise normal. Today, we can treat children affected by this condition with injections of growth hormone. Before the late 1970s, the only source of this hormone was the pituitary of human cadavers. Extraction was difficult, and, in a few cases, tragedy occurred when viruses from the donor contaminated the sample. This is no longer a danger, because today we produce the substance using E. coli bacteria that have been modified with the gene that codes for human growth hormone production. Thanks to this technique, the hormone has become widely available, and the situation has stimulated research on the use of growth hormone for conditions other than lack of growth. One of these conditions is aging.

We experience a decline in growth hormone production as we age, as can be demonstrated by measuring hormone levels in the blood. Actually, hgh is difficult to measure, so we generally monitor it through levels of insulin-like growth factor 1 (igf-1), which the liver cranks out in response to human growth hormone. igf-1 is the hormone that carries out the work attributed to growth hormone. We measure it in blood plasma as units (U) per liter. Young men show values in the range of 500 to 1,500 U, with only five percent falling below 350 U. Of healthy men over sixty, however, thirty percent have values below 350 U. On the one hand, we could argue that this is to be expected, because we have no need for growth hormone once we have stopped growing. On the other hand, adults who have pituitary disease commonly show growth hormone deficiency and exhibit symptoms such as increased body fat, reduced strength, and impaired psychological well-being. Doctors can reverse these symptoms in their patients by administering growth hormone, so the question of what happens if growth hormone is given to aging men who are healthy but exhibit low blood levels of igf-1 is certainly an appropriate one to consider.

Dr. Daniel Rudman of the Medical College of Wisconsin addressed this very question in a landmark study published in
The New England Journal of Medicine
in 1990, a study that triggered all the subsequent hype about hgh. Hype that was mostly unwarranted. First of all, the study was small. Only twelve healthy men between the ages of sixty-one and eighty were treated, and only for six months. Some of the results were certainly encouraging. Body fat decreased by fourteen percent, while lean body mass and skin thickness increased by nine percent and seven percent, respectively. We could interpret these as modest antiaging effects, but we have to remember that the researchers selected these subjects because they had low igf-1 levels to start with. Two-thirds of the elderly do not fit into this category.

Furthermore, the fact that both blood pressure and plasma glucose levels increased in the experimental group was somehow lost amid all the glowing reports. Neither do most people who read the original study know that it continued after the preliminary results were published. They did not hear that several of the men developed carpal tunnel syndrome, a painful hand condition, or that a couple of them experienced breast growth. They may not have heard that the authors of a 1996 study published in
The Annals of Internal Medicine
, while confirming Rudman’s results, found that in spite of the antiaging effects the subjects enjoyed no measurable improvements in muscle function, strength, or physical performance. They did, however, suffer an increase in joint pain and breast enlargement. Some researchers began to wonder whether growth hormone might also stimulate the growth of tumors in the body.

In spite of these caveats, clinics started offering hgh injections. Anecdotal reports of wondrous effects flooded in, unconfirmed by any controlled studies. Then the market expanded to snare those who could not afford the expensive injections but who might be willing to swallow cheaper dietary supplements. These people also had to swallow some questionable science. Such as the notion that certain blends of amino acids significantly increase growth hormone production and trigger rejuvenating effects. Many of the supplement promoters referred to the Rudman study, which had nothing to do with their supplements and gave no support to their claims. It is also worth noting that Dr. Rudman (now deceased) did not back the claims of the hgh promoters, and he did not use the hormones himself, even though he was in the age category of the subjects who participated in his famous study.

Perhaps further research will justify the use of hgh to treat the elderly who are deficient, and possibly even those who have normal levels. But for now, anyone who is contemplating jumping on the hgh bandwagon should first read a study published in
Nature
, a top scientific journal. In it, researchers at the University of North Dakota record their discovery that mice with a growth hormone deficiency lived longer than normal mice; they also reported that small breeds of dogs and horses have increased life expectancies. Perhaps we should examine how humans with reduced levels of growth hormone fare in terms of longevity. I’m sure that Dr. Klatz would reject this approach. He says that if his daily injections of hgh fail to make him live to 150, then he will be “disappointed.” I’m betting he’s in for a disappointment. A major one.

“The reason that people die from arsenic is because they believe it to be poisonous.” At least, that’s what Mary Baker Eddy, the founder of Christian Science, claimed after she had been introduced to homeopathy, the popular practice that supposedly cures people with solutions that are so dilute they essentially contain nothing. Eddy surmised that since the adherents of homeopathy were cured with nothing, then disease must exist only in the imagination. One could achieve cures without physical intervention. She was not completely wrong about this: the mind is a powerful force. But she was certainly wrong about arsenic.

Just a few years before Eddy uttered her confused remarks about arsenic toxicity, the English government had introduced the Food and Drug Adulteration Act of 1860, prompted by a tragic case that demonstrated that arsenic poisoning was not all in the mind. It was in the liver, the kidneys, the blood, and the skin. At the time, druggists would mix calcium sulfate (plaster of Paris) into peppermint lozenges as a whitening agent. One day, as an assistant was preparing a batch of the candies, he accidentally reached for the wrong powder. Arsenic oxide, which was sold as a rat poison, ended up in the lozenges, sickening over two hundred people and killing as many as thirty. This, of course, was not the first time arsenic had killed people. Members of the Borgia family, notorious Spanish aristocrats of the late Renaissance, dispatched their enemies with arsenic, and Madam Toffana of Sicily built herself a career as a poisoner in the seventeenth century. Her method was quite inventive. She rubbed arsenic into the joints of freshly slaughtered swine, removed the synovial fluid, and used it to make her Aqua Toffana. While she sold this potion as a remedy for excessive redness of the cheeks, her customers could also, if they so desired, use it to remove a spouse from the conjugal bed. Permanently. As many as six hundred people may have met their end in this fashion before the authorities brought Toffana to justice and sentenced her to public strangulation.

Arsenic really can make the skin whiter. It does this by destroying red blood cells. Victorian ladies could not abide the thought of being mistaken for sunburned peasants, so they dosed themselves with “arsenic complexion wafers.” But aristocratic women were not the only ones who consumed arsenic — many other people did as well, firmly believing that it would improve their health. Stories about the healthy peasants of Styria, a region of Austria, had captivated their imaginations. Taking arsenic on the sly, the Styrians supposedly enjoyed protection against disease, an abundance of energy, beautiful complexions, and sleek hair. Why did they have to dose themselves in secret? Because the Church considered self-medication to be a sin. Illness was due to the action of demons, and such matters had to be dealt with by the Church alone.

Many scientists thought that the practice of eating arsenic was a myth, because nobody could survive the doses that the alleged arsenic eaters claimed to be consuming. But, in 1875, a physician presented a pair of arsenic eaters at a congress of German scientists and physicians. The two men, in full sight of the gathering, proceeded to eat about four hundred milligrams of arsenic oxide each. This was at least twice the dose established as lethal. The demonstration proved that a person could build up a tolerance to arsenic by consuming small, but increasing, amounts. Dorothy Sayers, the famed British mystery writer, was captivated by the story, and she based one of her most famous works,
Strong Poison
, on an ingenious case of arsenic poisoning. The murderer shares a poisoned meal with his victim, but he survives because he has gradually immunized himself with small doses of arsenic trioxide. Lord Peter Wimsey, Sayers’s detective, knows all about the nuances of arsenic and is therefore able to determine exactly how the crime was committed.

Did the Styrians really improve their health by taking arsenic? In a word, no. While small amounts of arsenic can promote growth — indeed, arsenic compounds are additives in pig and poultry feed — the amounts that the Austrian peasants ingested were dangerous. Arsenic interferes with the absorption of iodine, and it can cause a condition known as goiter, an enlargement of the thyroid gland. Many Styrians were afflicted with this condition. Even worse, cretinism, a condition characterized by stunted growth and mental retardation caused by a deficiency of thyroid hormone, afflicted many of their children.

The Styrians had easy access to arsenic because they were miners and metal smelters. Arsenic is present in many metallic ores, and when these are smelted, arsenic is converted to arsenic oxide. This substance is volatile; it emerges as a white smoke, which can be condensed on cool surfaces. Indeed, the development of the German mining industry made large amounts of cheap arsenic oxide available. You may think that this would have led to mass poisonings, but it may actually have initiated quite the opposite effect. The plague, which had devastated Europe up to the seventeenth century, came to a relatively sudden halt. This horrific disease was carried by fleas, which lived on rats. And there were rats everywhere. There was no simple way to get rid of them — at least, not until cheap arsenic oxide came along. Rapidly becoming the rat catcher’s primary weapon, the poison put a huge dent in the rat population. It is interesting that one of the first industrial pollutants may have played a role in improving public health. And arsenic may still have a role to play in health improvement. Researchers at Memorial Sloan-Kettering Cancer Center in New York City report that in a trial, eleven out of twelve patients with acute promyelocytic leukemia experienced complete remission after treatment with small daily doses of arsenic trioxide.

While arsenic may have limited benefits, it is far more likely to kill than to cure. We now recognize it as a carcinogen, capable of causing skin cancer, lung cancer, and bladder cancer. This is a major worry in some areas of the world, such as Bangladesh, where the water in two to four million wells has dangerous levels of arsenic. The water consumed by up to forty million people contains a concentration of arsenic hundreds of times greater than that considered safe — about ten micrograms per liter. Ironically, authorities initiated the well boring because so many people were dying from gastrointestinal diseases brought on by drinking pond and river water contaminated by sewage.

We began to recognize the extent of the problem in 1995, and we now know that for over a decade the villagers have been drinking water containing unacceptably high levels of arsenic. Among these people, skin blemishes, lung disease, skin cancer, and liver failure are on the rise. In a few more years, we may be able to attribute one in ten deaths in this part of the world to arsenic poisoning. The arsenic occurs naturally in the soil and leaches into the well water. There is certainly no evidence that these unfortunate people are developing any sort of immunity to arsenic, but they didn’t start with small doses.

Still, Dorothy Sayers’s story does present us with some interesting chemistry. While Sayers wrote fiction, we all know that the truth can sometimes be stranger. Pope Clement VII was supposedly murdered in 1534 with arsenic. The killer blended arsenic oxide with the wax used to make a candle the pope would carry in a procession, and the fumes ultimately poisoned the pontiff. The perpetrator of this assassination was even cleverer than you may guess. Burning wax is a source of the hydrogen needed to change arsenic oxide to a gaseous form of arsenic, known as arsine. Arsine can kill more effectively through inhalation than arsenic can through ingestion. Arsenic is “strong poison” indeed.

I’m not exactly a disinterested bystander when it comes to the dental amalgam controversy. My mouth is filled with “silver.” So, in 1990, I was riveted to the TV when
60 Minutes
, the usually excellent news program, introduced a story with the sensational headline “Is there poison in your mouth?” It’s a valid question and one that deserves scientific scrutiny.

So, is there poison in my mouth? There sure is. Dental fillings are about fifty percent mercury, a nasty metal that has the ability to wreak havoc with the nervous system. In 1953, in Minimata, Japan, thousands of people ate fish that had been tainted with mercury due to a local chemical company’s reckless methods for disposing of the metal. The severity of their reactions was determined by the amount of fish they consumed: those who ate little were unaffected; those who ate a lot became totally disabled or died. In other words, mercury is only a poison at large doses. The Minimata victims stand as a tragic reminder to us all of what mercury can do.

Questions about fillings, therefore, should address the amount of mercury involved and how much of it is released into the body. Unfortunately, the questions raised in the public domain rarely do this. The
60 Minutes
episode, for example, caught the audience’s attention with the account of a lady who supposedly contracted multiple sclerosis, had her amalgam fillings removed, and went dancing the next night. Nobody challenged this. Nobody mentioned that removing fillings actually releases more mercury into the system — the patient inhales mercury vapors generated by drilling.

The show’s producers presented anecdotal evidence to suggest that dental amalgam can bring on depression, irritability, listlessness, and arthritis. They displayed pictures of happy individuals who claimed that by removing their fillings they had turned their lives around. But the
60 Minutes
people had not followed up on their subjects. No one had bothered to find out whether the lady had kept dancing or whether the other improvements had persisted. At least not until
Dateline
, another news show, tackled the issue in a much more scientific fashion.
Dateline
’s producers focused on the activities of a dentist named Dr. Hal Huggins, the guru of the antiamalgam movement. Huggins claims that mercury can cause ailments ranging from prostate problems to leukemia and heart disease, and he recommends a variety of dietary supplements to rid the body of the evil toxin, an approach that has no chemical merit. “May you never know what we’re preventing” is one advertising slogan.

The
Dateline
episode featured a video provided by Huggins about an ms victim who came for treatment in a wheelchair and went home with a walker. This time, the reporter did follow up, finding that as soon as the lady got home, her condition reverted; her health has deteriorated progressively since. Authors of a recent German study examined forty patients who were convinced that they had health problems due to their amalgam fillings. They compared these people with forty others who had similar fillings but no problems. The researchers observed no differences in the mercury concentrations in the saliva, blood, and urine of their subjects, but they did note differences in their psychological profiles. Many of the “victims” had obsessive attitudes towards their bodies, and they had read extensively about the dangers of amalgam.

I do not mean to say that mercury in fillings cannot cause legitimate problems. In some cases, it can. There is the classic case of the woman whose doctor diagnosed her with trigeminal neuralgia, a neurological condition that causes sporadic, intense facial pain. As it turned out, she’d had a tooth filled that was very close to a gold crown. Dissimilar metals can form an electric cell and generate current when a medium capable of conducting electricity connects them. Acidic foods can turn saliva into such a medium. Whenever the unfortunate woman ate these foods, she would suffer a jolt of pain. When her dentist replaced the amalgam with porcelain, the problem vanished. Anyone who has ever chomped on a piece of aluminum foil knows what I’m talking about.

Then, just as some people are highly sensitive to peanuts or monosodium glutamate, others react to trace amounts of mercury — amounts that do not disturb the vast majority of the public. Some sufferers of myasthenia gravis, for example — a neurological disease associated with tiredness, slurred speech, and blurred vision — have shown clinical improvement after having their amalgam fillings removed. Perhaps they have a genetic susceptibility. Unfortunately, for every such case, there are numerous others for whom the removal of fillings has no effect at all — of course, these cases don’t make the news. We don’t hear about the lady with Lou Gehrig’s disease who spent ten thousand dollars to have her fillings extracted, only to see dental pain added to her list of problems, and we hear nothing about the ms victims who did not go dancing the day after their fillings were removed.

The New Jersey Dental School has developed an artificial mouth with artificial saliva, and it’s the most accurate tool we have to measure how much mercury fillings release. Measurements show that a person must have 135 fillings to reach toxic levels; other components of amalgam combine with mercury and greatly reduce its potential to evaporate. Researchers have also carried out many studies on mercury in the urine. These studies show that the lowest levels at which we can observe mercury-related health problems is one hundred micrograms of urinary mercury per gram of urinary creatine (a common measure). Extensive amalgam in the mouth results in about four micrograms per gram of creatine in the urine. Add to this the fact that dentists have higher blood levels of mercury, live on average three years longer, and experience the same disease patterns as the rest of the population. So, I’m leaving my fillings just where they are, but I’m taking good care of my teeth to ensure that I won’t need any more.