Kids May 'Learn' to Tolerate Food Allergens

Doctors have long used allergy shots to desensitize children and adults to environmental allergens such as bee stings, pollen, mold and dust mites.

Now researchers are trying to apply that theory to food allergies, through processes called oral immunotherapy and sublingual immunotherapy.

They believe they can build up a child's tolerance for a food that prompts an allergic reaction by exposing the child to tiny amounts of that food.

"It is something that has been recently put into play," said Dr. Michael Pistiner, an allergist in Leominster, Mass., and a spokesman for the American Academy of Allergy, Asthma & Immunology. "More and more of these trials have been started. It does seem to be very promising. It's very exciting."

Trials involving eggs, peanuts and milk have produced positive results, said Dr. Scott H. Sicherer, an associate professor of pediatrics at the Jaffe Food Allergy Institute at the Mount Sinai School of Medicine and chairman of the allergy and immunology section for the American Academy of Pediatrics.

"The studies are promising in that some individuals are able to get to high doses of the food used in treatment," Sicherer said.

Sublingual immunotherapy works by placing an extract of the food allergen under the child's tongue. The membranes of the mouth absorb trace amounts of the allergen, absorbing just enough to desensitize the immune system without prompting an allergic reaction.

Oral immunotherapy takes it a step further by having children eat tiny amounts of the allergen. "The approach involves ingesting an extremely small and then gradually increasing amount of the food under medical supervision, with the hope of getting to an amount that is not causing reactions and is more substantial in dose," Sicherer said.

However, both Sicherer and Pistiner warn that these therapies are still in the experimental stage, and many questions remain.

"All of the experts working in this treatment currently believe it is too early to attempt widespread use and that much more needs to be done to see if this is a viable treatment," Sicherer said.

For one thing, there's still a risk of severe allergic reaction prompted by even the tiny amounts used in immunotherapy.

"People have significant reactions trying to do this, including anaphylaxis, and not all can move ahead with dosing," Sicherer said.

Researchers also are not sure how deeply ingrained the tolerance becomes in a child undergoing oral or sublingual immunotherapy.

"Is there ever a time you can stop taking it, or does it only work as long as you're taking your maintenance dose?" Pistiner asked. "Does it give you complete ability to eat that food, or does it only help prevent reactions when trace amounts of the foods are consumed?"

For example, if you're allergic to pine nuts, will immunotherapy allow you to eat pine nuts as you like, or will it only prevent you from having an allergic reaction when you eat a food processed on equipment that also processes pine nuts?

The doctors agree on one other point: This is absolutely not something a person should try at home.

The amounts of food given allergic children are measured out precisely, and delivered under the watchful eyes of doctors ready to step in and treat any side effects or allergic reactions at a moment's notice.

"This is an experimental therapy that should only be undertaken under the direction of a trained allergist," Pistiner said. "Doing this at home is absolutely not safe."

Bonnie - this is something we have been keeping our eye on for a while now and will continue to do so.

5 minute Alzheimer's test?

A five-minute test may indicate whether someone has Alzheimer's disease.

Researchers in the online medical journal BMJ report that the 10-task test detects 93 percent of Alzheimer's patients.

The test is self-administered and consists of simple tasks including short-term memory, associations, connecting dots and word recall.

The Test Your Memory quiz has to be checked out further, but researchers say it could be more accurate than the currently used Mini-Mental State Exam. A sample test is available.

Folate linked to lower colorectal cancer risk

Increased intakes of folate from the diet may reduce a woman’s risk of colorectal cancer by about 50 per cent, according to new findings from Korea. The highest intakes of folate, a B-vitamin found in green leafy vegetables, chick peas and lentils, were associated with a 66, and 70 per cent reduction in a woman’s risk of cancers of the colon and rectum, respectively, report researchers in the European Journal of Clinical Nutrition. However, men did not benefit from the vitamin.

The study adds to an ever-growing body of case-control and prospective cohort studies have reported that increased intakes of folate may reduce the risk of colorectal cancer by 40 to 60 per cent. Over 30 case-control and prospective cohort studies have reported colorectal cancer risk reduction associated to the vitamin. Similar risk reductions have also been reported for the lesion that precedes the cancer, the adenomatous polyp. However, some studies have linked folic acid intakes to an increased risk of the disease.

A review paper published in the April issue of Nutrition Reviews by Joel Mason from USDA Human Nutrition Research Center on Aging at Tufts University addressed the potential Janus effect of folate on colorectal health. “Under most circumstances, adequate intake of folate appears to assume the role of a protective agent against cancer, most notably colorectal cancer,” wrote Dr Mason. “However, in select circumstances in which an individual who harbours a pre-cancerous or cancerous tumour consumes too much folic acid, the additional amounts of folate may instead facilitate the promotion of cancer.” The complex links between folate and cancer have created a “global dilemma”, said Dr Mason.

The Korean researchers analyzed data obtained from 596 men and women with colorectal cancer, and compared this to data from 509 people free of the disease. All the participants were aged between 30 and 79.

A possible explanation for the contradictory results of studies with the vitamin and colorectal cancer may be the difference between the synthetic and natural forms of the vitamin. “The fact that folic acid, which is not a naturally occurring form of the vitamin, is used by food and pharmaceutical industries for fortification and supplementation is potentially of importance,” wrote Tufts University’s Mason in Nutrition Reviews. On passage through the intestinal wall, folic acid is converted to 5-methyltetrahydrofolate, the naturally circulating form of folate. However, some studies have suggested that oral doses of folic acid in high doses may overwhelm this conversion pathway, leading to measurable levels of folic acid in the blood. “There has been some concern that this oxidized, non-substituted form of folate might feasibly be detrimental because it is not a naturally occurring co-enzymatic form of the vitamin,” he added.

Bonnie - for this reason, when supplementing with folate (outside of a multivitamin/mineral), we always recommend Metagenics ActiFolate, which contains all three forms of folate (folic acid, 5-formyltetrahydrofolate, and L-5 methyl tetrahydrofolate) to assure optimal absorption.

Prostate Cancer Screening Has Yet To Prove Its Worth, Researchers Say

The recent release of two large randomized trials suggests that if there is a benefit of screening, it is, at best, small, says a new report in CA: A Cancer Journal for Clinicians. The review says because prostate cancer is virtually ubiquitous in men as they age, it is clear that a goal of "finding more cancers" is not acceptable.

Instead, public health principles demand that screening must reduce the risk of death from prostate cancer, reduce the suffering from prostate cancer, or reduce health care costs when compared with a non-screening scenario. The authors suggest prostate cancer screening has yet to reach one of these standards to date.

No major medical group, including the American Cancer Society, currently recommends routine prostate cancer screening for men at average risk.

The report says a computer modeling study using National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registries estimated that more than one in four cancers detected in whites (29 percent) and nearly half of cancers detected in blacks (44 percent) were overdiagnosed cancers. A similar model using data from Europe estimated a 50 percent overdiagnosis rate. The authors say patients who are diagnosed with clinically insignificant tumors are subject to unnecessary diagnostic tests and unneeded treatment and suffer psychosocial harms. They are also labeled "a cancer patient," which can have negative economic consequences. Also, say the authors, overdiagnosis significantly affects 5–year survival statistics, making them uninformative in demonstrating progress in cancer control.

In a separate but related editorial, Peter Boyle, Ph.D., D.Sc., of the International Prevention Research Institute, Lyon, France and report co-author Dr. Brawley say "the real impact and tragedy of prostate cancer screening is the doubling of the lifetime risk of a diagnosis of prostate cancer with little if any decrease in the risk of dying from this disease." They say in 1985, before PSA screening was available, an American man had an 8.7 percent lifetime risk of being diagnosed with prostate cancer and a 2.5 percent lifetime risk of dying from the disease. Twenty years later, in 2005, an American man had a 17 percent lifetime risk of being diagnosed with prostate cancer and a 3 percent risk of dying from the disease. They add that even in the best case scenario, applying the findings of a European trial that found PSA led to a 20 percent reduction in the risk of death, the average man who chooses screening decreases his risk of prostate cancer death from a lifetime risk of 3 percent to a lifetime risk of 2.4 percent. In exchange, he doubles the chances of becoming a prostate cancer patient, his risk of diagnosis rising from about nine percent to at least 17 percent.

They conclude that "men should discuss the now quantifiable risks and benefits of having a PSA test with their physician and then share in making an informed decision," and that "the weight of the decision should not be thrown into the patient's lap."

Acid-reducing Medicines May Lead To Dependency

Treatment with proton pump inhibitors (PPIs) for eight weeks induces acid-related symptoms like heartburn, acid regurgitation and dyspepsia once treatment is withdrawn in healthy individuals, according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute.

"The observation that more than 40 percent of healthy volunteers, who have never been bothered by heartburn, acid regurgitation or dyspepsia, develop such symptoms in the weeks after cessation of PPIs is remarkable and has potentially important clinical and economic implications," said Christina Reimer, MD, of Copenhagen University and lead author of the study. "This study indicates unrecognized aspects of PPI withdrawal and is a very strong indication of a clinically significant acid rebound phenomenon that needs to be investigated in proper patient populations."

The use of PPIs for acid-related symptoms and disorders is extensive and rapidly escalating. While the incidence of new patients being treated with PPIs remains stable, the prevalence of long-term treatment is rising, the reasons for which are not fully known. Studies have shown that up to 33 percent of patients who initiate PPI treatment continue to refill their prescriptions without an obvious indication for maintenance therapy. Rebound acid hypersecretion, defined as an increase in gastric acid secretion above pre-treatment levels following antisecretory therapy, is observed within two weeks after withdrawal of treatment and could theoretically lead to acid-related symptoms such as heartburn, acid regurgitation or dyspepsia that might result in resumption of therapy.

"We find it highly likely that the symptoms observed in this trial are caused by rebound acid hypersecretion and that this phenomenon is equally relevant in patients treated long term with PPIs. If rebound acid hypersecretion induces acid-related symptoms, this might lead to PPI dependency. Our results justify the speculation that PPI dependency could be one of the explanations for the rapidly and continuously increasing use of PPIs," Dr. Reimer added.

Bonnie - uh, this is not good. Among the cornucopia of adverse effects PPIs create, this could be the worst of them all.

Vitamin C repairs blood vessels, helps diabetics

Antioxidants such as vitamin C can repair damaged blood vessels, and could be a lifesaver for anyone suffering from type I diabetes.

The disease often damages blood vessels, and this can lead to heart disease, amputation, kidney disease and blindness.

In the first ever trial with humans, researchers discovered that high-dose vitamin C and other antioxidants could repair damaged blood vessels. The vitamin was injected into the patients.

The researchers, from the University of Warwick, are now going to test the therapy on people with type 2 diabetes, the ‘lifestyle’ disease.

Because they were working with very high doses given intravenously, the researchers doubt that standard over-the-counter vitamin C tablets would have the same beneficial effects.

Journal of Clinical Endocrinology & Metabolism, 2009

'Hidden' Lactose in Drugs Used for the Treatment of GI Conditions

Lactose is the most common form of excipient used in drug formulations and may be overlooked when advising these patients.

A wide range of medications prescribed for the treatment of gastrointestinal conditions contain lactose. We have quantified the lactose content in a selection of medications using HPLC. Lactose is present in amounts that may contribute towards symptoms. Lactose-free alternatives were also identified.

Lactose is present in a range of medications and may contribute towards symptoms. This may not be recognized by the prescribing doctor as excipients are not listed in the BNF, and the quantity of lactose is not listed on the label or in the accompanying manufacturer's leaflet.

Alimentary Pharmacology & Therapeutics, July 1 2009

Bonnie - finally they recognize this? Now they have to acknowledge cornstarch, artificial food dyes, talc, and more.

Dietary Supplements Boost Cancer Survival

Norwegian researchers have discovered that dietary supplements improve the rate of survival of women diagnosed with solid tumor cancers. Their study, which will be published in the September 2009 issue of the International Journal of Cancer, shows that women with solid tumors had better survival rates if they had used dietary supplements in the year before they were diagnosed.

The new study was conducted by researchers at the University of Tromso using data collected from participants in the Norwegian Women and Cancer study. Data on the type and frequency of supplementation was drawn from questionnaires completed by the women between 1996 and 1999. The study analyzed data on 4,242 women who were diagnosed with their first cancer between the time they completed the questionnaires and the year 2007. The types of cancer the researchers analyzed in the study were solid tumor cancers including lung, colorectal, and breast.

The dietary supplement most often used by the Norwegian women was cod liver oil, but also included minerals and multivitamins. The women who had taken cod liver oil on a daily basis during the year before they were diagnosed with a solid tumor cancer had a 23 percent lower risk of dying during the time period studied than women who never used supplements.

Further, victims of lung cancer significantly lowered their risk of death by the use of supplements—users of cod liver oil had an a 44 percent lower risk, and users of other supplements had a similar rate of 45 percent or 30 percent, depending on the type of supplementation and whether use was daily or occasional. The researchers made adjustments for each woman’s age, smoking habits, and stage of cancer.

Bonnie - while it is difficult to review research on subjects with cancer, these are encouraging results. Why do I have this feeling the mainstream media won't pick up on this one.

Antibiotics Take Toll On Beneficial Microbes In Gut

It’s common knowledge that a protective navy of bacteria normally floats in our intestinal tracts. Antibiotics at least temporarily disturb the normal balance. But it’s unclear which antibiotics are the most disruptive, and if the full array of “good bacteria” return promptly or remain altered for some time.

University of Michigan scientists have shown for the first time that two different types of antibiotics can cause moderate to wide-ranging changes in the ranks of these helpful guardians in the gut. In the case of one of the antibiotics, the armada of “good bacteria” did not recover its former diversity even many weeks after a course of antibiotics was over.

The findings could eventually lead to better choices of antibiotics to minimize side effects of diarrhea, especially in vulnerable patients. They could also aid in understanding and treating inflammatory bowel disease, which affects an estimated 500,000 to 1 million Americans, and Clostridium difficile, a growing and serious infection problem for hospitals.

Normally, a set of thousands of different kinds of microbes lives in the gut – a distinctive mix for each person, and thought to be passed on from mother to baby. The microbes, including many different bacteria, aid digestion and nutrition, appear to help maintain a healthy immune system, and keep order when harmful microbes invade.

“Biodiversity is a well-known concept in the health of the world’s continents and oceans. Diversity is probably important in the gut microsystem as well,” says Vincent B. Young, M.D., Ph.D., senior author of the study, which appears in the June issue of Infection and Immunity.

The study results suggest that unless medical research discovers how to protect or revitalize the gut microbial community, “we may be doing long-term damage to our close friends,” says Young, assistant professor in the departments of internal medicine and microbiology and immunology at the U-M Medical School.

Mice, which normally develop a diverse set of microbes after being born without one, then were given either cefoperazone, a broad-spectrum cephalosporin antibiotic, or a combination of three antibiotics (amoxicillin, bismuth and metronidazole). The scientists then observed what changes in the gut microbiota occurred immediately after the antibiotics were stopped or six weeks following the end of treatment.

“Both antibiotic treatments caused significant changes in the gut microbial community. However, in the mice given cefoperazone, there was no recovery of normal diversity. In other mice given the amoxicillin-containing combination, the microbiota largely recovered, but not completely,” says Young.

Funding for the study came from the National Institutes of Health.

Research Highlights - July

American Journal Clinical Nutrition

• While naturally-occurring nitrates in fruits and vegetables can be healthful, nitrates and nitrites used for processed meats are considered carcinogenic. However, new insights have shown by using vitamin C in processed meats can modulate the formation of carcinogenic compounds to reduce their negative effects.
  
  
• Zinc supplementation in children 6-8 years old may benefit child growth, particularly in areas where a deficiency of zinc is common.
  

Journal Nutrition

• Higher nut consumption has been associated with lower risk of coronary heart disease (CHD) events in several epidemiologic studies. The study examined the association between intake of nuts and incident cardiovascular disease (CVD) in a cohort of women with type 2 diabetes. For the primary analysis, there were 6309 women with type 2 diabetes who completed a validated FFQ every 2–4 y between 1980 and 2002 and were without CVD or cancer at study entry. Major CVD events included incident myocardial infarction (MI), revascularization, and stroke. After adjustment for conventional CVD risk factors, consumption of at least 5 servings/wk of nuts or peanut butter [serving size,28 g (1 ounce) for nuts and 16 g (1 tablespoon) for peanut butter] was significantly associated with a lower risk of CVD. Furthermore, when we evaluated plasma lipid and inflammatory biomarkers, we observed that increasing nut consumption was significantly associated with a more favorable plasma lipid profile, including lower LDL cholesterol, non-HDL cholesterol, total cholesterol, and apolipoprotein-B-100 concentrations. These data suggest that frequent nut and peanut butter consumption is associated with a significantly lower CVD risk in women with type 2 diabetes. cases.
  

Journal of the American Dietetic Association

• Studies suggest that IBS symptoms in one quarter of patients may be caused or exacerbated by one or more dietary components. Recent studies indicate that a diet restricted in fermentable, poorly absorbed carbohydrates, including fructose, fructans, sorbitol, and other sugar alcohols is beneficial. Despite a long history of enthusiastic use, fiber is marginally beneficial. Insoluble fiber may worsen symptoms. Some patients with IBS, especially those with constipation, will improve with increased intake of soluble fiber. In clinical practice, it is very difficult to establish that a patient's symptoms result from an adverse reaction to food. A double blind placebo-controlled food challenge is the most reliable method. A modified exclusion diet and stepwise reintroduction of foods or trials of eliminating classes of food may be useful.

American Journal Preventive Medicine

• Some effects of early-childhood moderate-to-vigorous physical activity (MVPA) on fatness appear to persist throughout childhood. Results indicate the potential importance of increasing MVPA in young children as a strategy to reduce later fat gains.

• Community-based health promotion is a widely advocated strategy in public health to favorably alter lifestyle. The aim of this study was to investigate the net effect of a cardiovascular disease–prevention program (Hartslag Limburg) on lifestyle factors after 5 years of intervention (1998–2003). The community intervention Hartslag Limburg succeeded in preventing age- and time-related unfavorable changes in energy intake, fat consumption, walking, and bicycling, particularly among women and those with low SES.

British Medical Journal

• Monitoring bone mineral density in postmenopausal women in the first three years after starting treatment with a potent bisphosphonate is unnecessary and may be misleading.Routine monitoring should be avoided in this early period after bisphosphonate treatment is commenced.

Food and Chemical Toxicology

• Curcumin might be a potential candidate agent against acetominophen-induced nephrotoxicity, but further studies are required to identify this issue before clinical application becomes possible.

• Cordyceps militaris is well known as a traditional medicinal mushroom and is a potentially interesting candidate for use in cancer treatment. The data from this study indicate that Cordyceps induces the apoptosis of A549 cells through a signaling cascade of death receptor-mediated extrinsic and mitochondria-mediated intrinsic caspase pathways. It also concludes that apoptotic events due to WECM were mediated with diminished telomerase activity through the inhibition of hTERT transcriptional activity.

Journal of Clinical Allergy and Immunology

• Epidemiologically, the increase in asthma prevalence from the 1960s to the 1990s fits well with decreased levels of sun exposure and consequently lower levels of vitamin D. Furthermore, low maternal levels of vitamin D are associated with increased risk of wheezing in offspring in early childhood. There have not been studies that directly examine the relationship between vitamin D levels in individuals and asthma severity. Brehm et al (Am J Respir Crit Care Med 2009;179:765-71) measured 25-hydroxy vitamin D levels in 612 asthmatic children aged 6 to 14 years living in San Jose, Costa Rica. Insufficient levels were found in 28% of the children. Increasing serum vitamin D levels were associated in multivariate analysis with lower serum IgE levels, smaller skin test responses to house dust mites, lower peripheral blood eosinophil counts, less bronchodilator responsiveness, and reduced likelihood of hospitalization for asthma in the previous year. Although causation cannot be established from a cross-sectional study, the data are consistent with insufficient levels of vitamin D leading to increased sensitization and more severe asthma. Among the more attractive explanations for this possible beneficial effect of vitamin D in asthma is the improved function of regulatory T cells and increased resistance to infection.

• The purpose of this study was to examine whether the efficacy of sublingual immunotherapy (SLIT) with standardized timothy extract was reduced by combination with other allergen extracts. A single-center, randomized, double-blind, placebo-controlled trial with SLIT was conducted. After an observational grass season, SLIT was administered for 10 months to 54 patients randomized to 1 of 3 treatment arms: placebo, timothy extract as monotherapy, or the same dose of timothy extract plus 9 additional pollen extracts. Symptom and medication scores were collected and titrated nasal challenges, titrated skin prick tests, specific IgE, IgG4 and cytokines release by timothy-stimulated lymphocyte proliferation were performed.Improvement in multiple relevant outcomes strongly suggests that SLIT with timothy extract alone was effective; however, the results for symptom and medication scores were not significant. The differences between multiple allergen SLIT and placebo only in skin sensitivity to timothy suggest a reduction in SLIT efficacy in this group.

New colon cancer screening guidelines

If you are over 50, doctors recommend that you get screened for colon cancer. But it’s up to you and your physician to decide which test is best for you.

The latest report by the U.S. Preventive Services Task Force —the nation’s leading independent panel of experts in prevention and primary care—concluded that the three top methods for colon cancer screening are equally effective, and it did not recommend one over the other. The tests are:

• Colonoscopy—every 10 years. This procedure explores the entire colon via a tiny camera mounted on several feet of tubing, allowing doctors to sample suspicious growths. The patient is sedated, and there’s a small risk of perforation.

• Flexible Sigmoidoscopy—every five years, supplemented with stool samples at certain intervals. The test checks only the last two feet of the intestine, and sedation is not required. The risk of perforation is slight.

• High-Sensitivity Fecal Blood Test—once a year. The patient prepares stool samples, which are analyzed for microscopic traces of blood. This method has a higher risk of “false positive” and “false negative” results.

For the first time, the USPSTF recommends against routine colon cancer screening for people over 75, finding the benefits small compared with the risks. It recommends that screening stop altogether after age 85. But screening is strongly encouraged for 50- to 75-year-olds. Currently, only about half of Americans get tested. Experts stress that early detection can make a big difference in your ability to survive colon cancer.

C-Reactive Protein Further Defined?

C-reactive protein, or CRP, a marker of inflammation in the body, is unquestionably associated with heart disease. Multiple studies have found that the more CRP in a person’s blood, the greater the likelihood of heart disease. But in a study that appears in Journal of the American Medical Association, researchers analyzing genetic data from more than 100,000 people conclude that their study “argues against” the notion that the protein causes heart disease. CRP is “a biomarker — a marker of disease process — and not a risk factor,” said Dr. James A. de Lemos, an associate professor of medicine at the University of Texas Southwestern Medical Center, who wrote an editorial accompanying the study. Dr. David Altshuler, a professor of genetics and medicine at Harvard Medical School, said the distinction was important.

The real issue is inflammation. CRP goes along with inflammation, and it is inflammation that is likely to be causing heart disease.

The new study, by Dr. Paul Elliott of Imperial College in London and 35 co-authors, made use of a recently developed technique that can get answers quickly about causality. Without it, the only method was what is seen as the gold standard in medicine — large controlled clinical trials in which people are randomly assigned to take a drug, or not, and followed for years. The new method, Mendelian randomization, “is changing the way we think about causality,” Dr. Lauer said. It is a type of study that only recently became feasible as researchers found genetic variants associated with proteins like CRP and developed tools to analyze data from what was, in this case, more than 100,000 people. Different people produce different amounts of CRP, and the amount a person produces is determined by tiny inherited changes in the CRP gene. So in a population, there are people who just happen to produce more CRP throughout their lives and others who just happen to produce less. If CRP causes heart disease, those who make more CRP would have more heart disease. That, however, is not what the study found. “There was no association” between CRP genes and heart disease rates, Dr. Elliott said. People with genes that increased CRP production throughout life had no more heart disease than those with genes resulting in less CRP. The association between CRP and heart disease must be reflecting something else. For example, if CRP levels go up when heart disease begins, because there is inflammation in the arteries, CRP levels would be higher in people with incipient heart disease.

But CRP itself would be playing no role in heart disease risk — it was just marker of inflammation in the arteries. An elevated CRP level indicates increased risk, even if the protein does not cause the risk.

Bonnie - I never consider CRP a direct risk factor. It simply indicates overall inflammation, which IS a major factor in heart disease and many other inflammatory diseases.

Roll out the next drug for weight-loss

Contrave, a new pill by Orexigen Therapeutics which combines naltrexone and bupropion (wellbutrin), will be coming soon to a pharmacy near you.

Bupropion is a norepinephrine-dopamine reuptake inhibitor that is used for the treatment of depression and smoking cessation, while naltrexone is an opioid antagonist that is approved for alcohol and opioid dependence.The combination of these two drugs is supposed to target hunger, fullness, and reward centers in the brain that control the balance of food intake and energy expenditure.

In one study after 56 weeks, results showed that patients in the medication treatment group lost 9.3% of their body weight, compared with a loss of 5.1% in the placebo patients. Both groups had to follow healthy dietary and lifestyle patterns.

The discontinuation rate due to adverse events was 26% in the medication treatment group, compared with 13% in the placebo group. The most frequent side effect was nausea (34% in the medication treatment group vs. 11% in the placebo group), headache (24% vs. 18%), and constipation (24% vs. 14%).

USDA buys what kids eat, despite food chart

Courtesy of the Des Moines Register

The government wants kids to eat more fruits and vegetables but doesn't seem to be putting its money where its advice is.

For every dollar that the U.S. Department of Agriculture spent buying commodities for school lunches last year, 55 cents went to beef, chicken and cheese vs. about 23 cents for fruits and vegetables.

Agriculture Secretary Tom Vilsack stumped a group of Iowa business leaders recently by asking them what was the single food item for schools that the USDA spent the most on. His answer: mozzarella cheese.

"Part of our challenge is to figure out how to make the kids' choice be the salad rather than the pizza slice," Vilsack said.

Critics have long linked the federal school lunch program to the nation's childhood obesity problem.

The Robert Wood Johnson Foundation produced a study last year of USDA food-buying practices that was illustrated with two pyramids. One was the traditional USDA food-guide pyramid, which recommends eating more fruits and vegetables than anything else. The other pyramid showed what USDA buys for schools. The pyramids were reversed.

The dairy industry, it should be no surprise, doesn't think the USDA is buying too much cheese.

"Kids need nutrition and mozzarella is a fairly cost-effective, high-nutrition food, and it's one that people, especially kids, like," said Chris Galen, a spokesman for the National Milk Producers Federation.

"If all you did was give kids salads you'd have a lot of wasted food, which is not what schools want, and you wind up with a lot of hungry kids."

No one is suggesting the USDA stop buying cheese or meat. But should the USDA stop providing so much meat and cheese to the schools and substitute produce?

Not necessarily, according to the people who run the school lunchrooms. They say the USDA purchasing patterns don't reflect what schools are actually serving kids. Taking meat and cheese from the USDA makes school budgets stretch farther, said Erik Peterson, a spokesman for the School Nutrition Association, which represents school nutrition directors. The schools then buy other foods, such as fruits and vegetables, elsewhere.

For that reason, nutrition activist Margo Wootan doesn't believe it's that big of a deal that the USDA tilts its purchases toward meat and cheese and not to produce. Moreover, the USDA in recent years reduced the fat content of the meat and cheese it supplies to the schools, she says. She wants the USDA to provide more cooking advice so schools know how to prepare healthful versions of popular foods, such as pizzas and chicken nuggets. Whole-grain crusts are a start.

"They can't afford to take the risk of trying a whole new way of processing their most popular item," said Wootan, director of nutrition policy at the Center for Science in the Public Interest. "What if the kids don't like it and they're stuck with cases and cases of food that kids won't eat?"

Congress is due to update rules for the school lunch program this year, and lawmakers are likely to consider giving schools incentives to buy more fruits and vegetables. But there's unlikely to be much appetite for cutting back on the meat and cheese.

"What's caused the obesity epidemic is not the school lunches and school breakfasts, it's the junk kids get in the a la carte lines and the school stores and the vending machines," said Iowa Democrat Tom Harkin, the chairman of the Senate Agriculture Committee.

Bonnie - the major food lobbies that dominate the USDA could give a hoot. They want to pawn off their excess, low-grade meat, cheese, and milk on the school lunch program. They get paid wonderful subsidies for doing this. What are chances we see a major chunk of the subsidies go from the grain, meat, and dairy lobbies to fruit and veggie growers? Until I see some definitive action, which is non-existent, Vilsack is just another blower of hot-air and false promises.

How to Roll Your Own Sushi (California Rolls)

Ingredients
-2 cups medium-grain brown rice, cooked
-1 tsp. sea salt (for cooking rice)
-2 sheets nori
-6 to 8 oz. fresh crab
-1 avocado
-1 cucumber, peeled
-bamboo mat
-sharp kitchen knife
-sesame seeds, optional
-wasabi low sodium soy sauce or wheat-free tamari

Sushi Vinegar Ingredients
-1/3 cup rice vinegar
-2 T. sweetener, such as Sucanat (1 tsp. Stevia may be used as a sugar substitute)
-dash of sea salt

Directions: Over medium heat, warm vinegar on stove and mix in sweetener and sea salt (don’t boil because sugar can burn). Mixture is done when all the ingredients have dissolved. Add 1 T. vinegar mix to every one cup of cooked rice.

Vinegar Rice Prep

1. While the rice is cooking, prep the other ingredients. Cut up the crab, julienne the cucumber, and slice the avocado. Make sure to peel the cucumber. The skin does not go well with the sushi.
2. Prepare the vinegar mixture (this will eventually be mixed with the rice). You can either buy it in the store and heat it up in a pot or make your own (see recipe above).
   
3. Transfer the rice to a large mixing bowl.
4. While the rice is hot, fold vinegar into rice. This is called “cutting the rice”. Be sure to fold and not stir, as you do not want to break the kernels and have the rice turn mushy. Let cool to room temperature.
   

Sushi Roll Prep

1. On a bamboo mat, place a ½ sheet of nori smooth side down, rough side up. Using 3 to 4 ounces, spread rice lightly across the rough side, completely covering the seaweed. If desired, sprinkle the sesame seeds across the rice.
2. Flip the nori over so the smooth side of the seaweed is facing up. You can line the mat with plastic wrap if you prefer.
3. Place a few pieces of cucumber and avocado lengthwise and add crab. Make sure to squeeze out any liquid out of the crab, otherwise it will make the roll soggy and possibly fall apart.
4. Using the bamboo mat, begin to tightly roll the sushi. Start at the side closest to you and roll away from yourself. Also, make sure your hands are damp; if you touch the rice you don’t want it sticking to your hands.
5. Using a very sharp knife, cut roll into 8 pieces. Serve with wasabi and sodium-reduced soy sauce or tamari.

YIELD: 4 rolls
HANDS ON TIME: 45 minutes
TOTAL TIME: 1 hour

Lean Mass Better For Developing Bones In Young People

A child with leaner body mass, or muscle, builds bigger bones than a child who weighs the same but has a greater percentage of fat.

“There’s a little bit of controversy because weight itself has a positive influence on bone,” said researchers. “Heavier individuals tend to have more bone just to support their weight.”

The findings were presented at the annual meeting of the Pediatric Academic Societies.

“A larger child is going to have larger bones just because he’s heavier,” they said. “But if you have two kids at the same weight, the one whose weight is dominated by fat mass is more likely to have smaller bones than the one whose weight is dominated by lean mass. Smaller bones are weaker than larger bones.”

“Kids with higher lean mass, or muscle, tended to have greater rates of change, and kids with higher fat mass tended to have lower rates of change.”

This new knowledge is one factor that can help the medical community in forming guidelines about diet and exercise to deal with health issues such as childhood obesity and the subsequent influence on adult disorders such as osteoporosis.

Want to see how high carb foods affect your arteries?

Research from Tel Aviv University shows exactly how high carbohydrate foods increase the risk for heart problems.

Researchers visualized exactly what happens inside the body when the wrong foods for a healthy heart are eaten. They found that foods with a high glycemic index distended brachial arteries for several hours. It is a first in medical history. The results were published in the Journal of the American College of Cardiology.

Elasticity of arteries anywhere in the body can be a measure of heart health. But when aggravated over time, a sudden expansion of the artery wall can cause a number of negative health effects, including reduced elasticity, which can cause heart disease or sudden death.

Like the uncomfortable medical warnings on packets of cigarettes, this new research could lead to a whole new way to show patients the effects of a poor diet on our body.

The researchers looked at four healthy groups. One group ate a cornflake mush mixed with milk, a second a pure sugar mixture, the third bran flakes, while the last group was given a placebo (water). Over four weeks, "brachial reactive testing" was performed on each group. The test uses a cuff on the arm, like those used to measure blood pressure, which can visualize arterial function in real time.

The results were dramatic. Before any of the patients ate, arterial function was essentially the same. After eating, except for the placebo group, all had reduced functioning.

Enormous peaks indicating arterial stress were found in the high glycemic index groups: the cornflakes and sugar group. During the consumption of foods high in sugar, there appears to be a temporary and sudden dysfunction in the endothelial walls of the arteries.

Bonnie - compelling stuff! I think this will be a great tool for physicians and cardiologists to use if they truly want their patients to practice prevention.

Drug-resistant ear infections

Emerging Infectious Diseases
6/19/2009

Streptococcus pneumoniae 19A is a new "superbug" that is resistant to all Food and Drug Administration-approved antimicrobial drugs for treatment of acute otitis media (ear infection) in children.

In a new study, Serotype 19A accounted for 40% of the isolates and has emerged as the major serotype causing ear infections in children. Eight (50%) of the 16 isolates of 19A were highly penicillin resistant, and 8 others were also multidrug resistant.

Bonnie - I have been screaming to the mountaintops about the overuse of antibiotics for ear infections because of this very issue.

Cardiologist Gets 10 Years for Performing Unnecessary Interventions

An interventional cardiologist who implanted stents in patients who did not need them has been sentenced to 10 years in federal prison for healthcare fraud. Dr Mehmood Patel, formerly of Our Lady of Lourdes Hospital and Lafayette General Hospital in Louisiana, was convicted on 51 counts of billing private and government health insurers for unnecessary medical procedures and received the maximum sentence

Testimony during the trial also revealed that Patel falsified patient symptoms in medical records, including chest pain when patients never complained of such pain, and falsified findings on medical tests. From 1999 to 2003, Patel billed Medicare and private insurance companies more than $3 million, according to the Advocate, a Baton Rouge, LA newspaper. During this time, he was the top cardiology biller in the state and personally pocketed more than $500 000.

Steve - would it be in bad taste to suggest that you always should get a second and third opinion?

Recent advances (or lack thereof) in Celiac Disease

Current Opinion in Gastroenterology
Matthew J. Armstrong; Gerry G. Robins; Peter D. Howdle
6/25/2009

Large multicenter studies have provided further evidence of the role of environmental and nonhuman leukocyte antigen genetic factors in celiac disease. Siblings of celiac patients carry a high risk, but those found to have negative celiac serology are very unlikely to develop the disease. Advances in the efficacy of serological antibody testing potentiate the possibility of future accurate screening programs in the community. Adherence to a gluten-free diet remains paramount as the recognition of celiac related complications increases.

Despite the encouraging progress that has taken place in our genetic and immunological knowledge of celiac disease, early introduction of a gluten-free diet remains the cornerstone of treatment. Alternatives, however, aimed at altering the toxicity of cereal proteins are now looking more promising.

How to feed your baby right, even before birth

Bonnie - I thought I would lend my expertise to this piece. Some of Ms. Ward's info is correct, and some is not.

Eating healthfully for two without gaining too much weight is a common problem for pregnant women. The Institute of Medicine has released new weight-gain guidelines for pregnancy. USA TODAY talked to Elizabeth Ward, a registered dietitian in Boston and the mother of three girls. Ward is the author of a new book, the American Dietetic Association's Expect the Best: Your Guide to Healthy Eating Before, During and After Pregnancy. She's also a nutrition blogger on dietchallenge.usatoday.com.

Q: Why is it important for women to maintain a healthy weight before, during and after pregnancy?

A: Being at a healthy weight increases a woman's chances of getting pregnant. If a woman has a lot of excess body fat at the time of conception, there is an increased risk of neural tube defects, such as spina bifida, even when she is consuming the recommended amount of folic acid, a B vitamin associated with a lower risk of these defects.

Starting a pregnancy at a healthy weight gives the child a better chance of developing normally. It also lowers the risk of several complications for mom during those nine months, including high blood pressure, gestational diabetes and delivering a baby that's too large and may require Cesarean delivery.

Gaining the suggested number of pounds during pregnancy helps to minimize complications for mother and child, and it helps women achieve a healthy weight after pregnancy. Studies show that women should try to take off the excess pregnancy pounds, in a safe manner, within one year of delivery. After that, they're likely to keep those pounds on.

Q: How many extra calories do women need each day when they're pregnant?

A: During the first trimester, a pregnant woman does not require any extra calories. This seems odd, given that the baby is growing by leaps and bounds. However, he or she is still far too small to require extra energy from the mother. Calorie needs increase during the second trimester. At that time, a woman should add about 350 calories to her pre-pregnancy diet and about 450 calories a day more during the third trimester. Women who begin pregnancy overweight may need fewer calories and those who are underweight may need more.

Q: What are the calcium and iron requirements for expectant mothers?

A: Calcium needs do not increase with pregnancy. That's because a woman's body becomes super efficient at absorbing calcium. However, many women begin pregnancy with a calcium shortage and need to increase their calcium consumption to make the 1,000 milligram-a-day quota. That's the amount found in about three 8-ounce glasses of milk. Fortified 100% orange juice contains as much calcium as milk, too. Other calcium-rich foods include yogurt, cheese and tofu processed with calcium sulfate. Women shouldn't rely on multivitamins or prenatal dietary supplements for calcium — they do not contain nearly enough. But if a woman can't achieve her calcium requirement with food, she should consider calcium supplements.

Bonnie - expectant mothers do need extra calcium (200-400 mg.). Otherwise, the mother may become deficient post partum. If deficient in vitamin D, the woman's body does not become super efficient in absorbing calcium. Of course, milk is the poorest source of calcium for absorption. Our Wellness Essentials for Pregnancy Prenatal provides 1/3 of what I recommend.

Many women enter pregnancy with low iron stores. Pregnancy boosts iron needs because your body produces more iron-rich red blood cells to support a growing baby. That depletes the supply of stored iron in a woman's body, so she must eat an iron-rich diet to keep up with pregnancy demands. Even with a balanced diet that includes such iron-rich foods as fortified grains, beef, poultry, pork and seafood, it's difficult for most women to achieve the 27 milligrams of iron they need every day during pregnancy.

Bonnie - I recommend 27-40 mg. in a prenatal or separately. If iron deficient during pregnancy, we add more.

That's why it's a good idea to take a multivitamin with 100% of the daily value for iron and other essential minerals and vitamins to fill in any nutrient gaps.

You are a good candidate for a prescription or over-the-counter prenatal multivitamin if:

• Your diet was poor at the outset of pregnancy, or is at any time during your pregnancy.

• Your diet had been inadequate for months or years before conception.

• You are carrying more than one child.

Bonnie - the prescription prenatals I have seen are far from complete.

Q: What are some beverages that pregnant women should avoid consuming and why?

A: Pregnant women should completely avoid alcohol. Alcohol can cause irreversible harm to a developing child. It deprives a baby of oxygen and nutrients that are required for the development of every organ, most notably the brain. Heavy drinking during pregnancy increases the risk of mental retardation, learning disabilities, birth defects and emotional and behavioral problems. There is no known safe amount of alcohol during pregnancy, and studies show even modest consumption of alcohol during pregnancy can cause problems in children.

According to the March of Dimes, pregnant women should limit caffeine to 200 milligrams a day, about the amount found in 10 ounces of brewed coffee. Caffeine has been linked to a higher risk of miscarriage in some studies but not all.

Q: Why is exercise important during pregnancy?

A: Exercise helps to foster weight control, keep blood pressure in check, reduce stress that may lead to overeating and improve circulation and strength. It may also help women sleep better. I exercised during my pregnancies because it made me feel good, and strong.

Most women with uncomplicated pregnancies can work out throughout their pregnancies, and they can start a program (most likely walking) while pregnant even if they have not worked out in the recent past. Always ask your doctor about exercise.

Bonnie - no pounding activities.

Some foods from Meditteranean Diet more effective than others

It’s been clear for a while now that adhering to a Mediterranean diet can lower the risk of death.

But the diet has many components, and it hasn’t been clear which elements of the diet are responsible for this benefit. An analysis published this week in the British Medical Journal aimed to find out.

Researchers based at Harvard and the University of Athens looked at data collected from more than 20,000 Greek men and women who were followed for an average of more than eight years as part of a study of nutrition and health.

They assessed participants’ adherence to nine components of the Mediterranean diet. They found that overall, people who adhered more closely to the diet were less likely to die during the study. They also parsed the data to see which elements of the diet were most strongly associated with this benefit. Here, in descending order of importance, are the keys:

• A moderate amount of alcohol (usually wine)
• A small amount of meat
• Lots of vegetables
• Lots of fruits and nuts
• A high ratio of monounsaturated to saturated fats
• Lots of legumes

Off-label morning sickness drug deemed safe for fetuses

Metoclopramide, a drug approved in the U.S. for nausea, vomiting and heartburn poses no significant risks for the fetus according to a large cohort study published in the June 11 issue of the prestigious New England Journal of Medicine. According to the pediatrician and clinical pharmacologist, principal investigator Dr. Rafael Gorodischer, prof. emeritus at Ben-Gurion University of the Negev, "Metoclopramide is the drug of choice in Europe and Israel for "morning sickness-like" symptoms of nausea and vomiting, which are common in pregnant women. In the U.S. however, it is only used in the most severe cases, as it is an "off-label" use for nausea and vomiting during pregnancy.

The findings of this very large cohort study examining infants born to mothers who were exposed to metoclopramide during the first trimester provide significant reassurance for the safety of the fetus when the drug is given to women to relieve nausea and vomiting during pregnancy." Between 50 percent to 80 percent of pregnant women experience nausea and vomiting during the first trimester and beyond, which can be severe.

In the study, 3,458 (or 4.2 percent) were exposed to metoclopramide during the first trimester of pregnancy of the 81,703 infants born to mothers during the study period. The rate of major congenital malformations identified in the group that was exposed to metoclopramide during the first trimester was 5.3 percent% (182 of 3458 infants), as compared with a rate of 4.9 percent (3834 of 78,245 infants). As a result, exposure to metoclopramide among this group was not associated with significantly increased risks of major congenital malformations. The results were unchanged when therapeutic abortions of exposed fetuses were included in the analysis. In addition, infants exposed in utero had no increased risk of perinatal mortality, low birth weight or premature birth. Data of this study support the labeling of metoclopramide for nausea and vomiting during pregnancy.

Bonnie - this is what they said about Thalidomide until babies were born without limbs. I would not want any pregnant woman to be a guinea pig for an off-label drug.