A friend of mine (60-something) has nasal polyps. He's had them removed two times, but now they have recurred. I want to know of any preventive things to do. I hear not drinking wine helps. Are there any holistic measures he can take?

Bear

Polyps are a "red flag" indicating the presence of chronic inflammation. Chronic sinusitis (longstanding bacterial infection of the facial sinuses) is one possible explanation, as is allergy (for example, allergies to pollen, dust mites, mold spores, cat dander and so forth). Since chronic sinusitis and allergies are both very common, many folks with polyps actually have BOTH problems. If the underlying infection or allergy is not treated, polyps will often recur. In very young patients, the doctor also has to consider cystic fibrosis (CF) as a possible explanation, as many children and young adults who have CF get recurrent nasal polyps.

The treatment of polyps is a bit controversial. Many ear, nose and throat specialists (ENTs) treat polyps initially with a course of high-dose oral corticosteroids. (Corticosteroids are not the build-you-up anabolic steroids that some athletes and bodybuilders abuse. Corticosteroids are potent anti-inflammatory hormones.) Corticosteroids, if used chronically, are associated with a large number of serious side effects. These include cataracts, osteoporosis, ulcers, worsening of diabetes (in other words, a diabetic who was well-controlled on pills may need to start taking insulin), personality changes, insomnia, waterweight gain and much, much more. Although these side effects are more common with long-term use of corticosteroids, they may also occur with short courses.

By the way, don't confuse oral corticosteroids with nasal corticosteroid sprays. The latter are carefully formulated so that they primarily act locally, within the nose, and very little spray is absorbed by the rest of the body. They are a great deal safer than oral corticosteroids. They can be used to help prevent polyp recurrence, once the polyps have been surgically removed, but I have been very disappointed in their ability to "shrink" existing polyps.

So ... back to the controversy. Should your friend's doctor treat him with high-dose oral corticosteroids, or should he recommend surgery? Either way, your friend must accept some risk -- the risk of drug side effects on the one hand, or of surgery and general anesthesia on the other hand. Oral corticosteroids are not always effective, by the way, and the polyps usually recur after a while.

I tend to favor the surgical option, but this decision must be tailored to each individual. Also, with each patient, I try to identify the underlying cause of the polyps and treat it accordingly, so that the polyps will not recur. There are excellent therapeutic strategies available to address chronic sinusitis and allergy. Your friend can discuss this further with his ENT.