Kids get healthy public service announcement needs transparency

A public service announcement for child obesity paid for by the nonprofit organization Physicians Committee for Responsible Medicine should be more transparent. The PCRM is a vegan organization. Their "Nutrition for Kids: A Get Healthy Approach to Achieving Weight Goals" menu is entirely vegan. While a vegan diet may be tolerated by some, it is definitely not for everyone. Many clients have come to see me in very bad shape after being on vegan diets. Before havng your child follow a diet like the PCRM recommends, I highly recommend seeing a health professional to evaluate if it is a viable choice.

Bonnie

Fish in children's diet cuts eczema risk

Including fish in the diet of an infant before nine months of age may reduce the risk of developing eczema by 25 per cent. according to data from 4921 infants that apperas in the Archives of Disease in Childhood.

Parents of the infants of six-month old babies were quizzed about their child's diet and any evidence of allergic eczema. The parents were quizzed again when the children reached 12 months of age. At six months of age, 13 per cent of the children had developed eczema. At 12 months of age, the figure had risen to 20 per cent. Symptoms first appeared after an average of four months. Nature rather than nurture was found to exert the greatest affect, with children born into families with a history of the condition being twice as likely to be affected by the age of 12 months, said the researchers. However, nurture did appear to exert an effect when the researchers considered the introduction of fish into the diet before the age of nine months.

Bonnie - I bet this has allergists dumbfounded considering fish is considered a top allergen under the age of 2.

Pfizer plans to abandon heart drug development

Pfizer Inc will drop efforts to develop medicines for heart disease, obesity, and bone health to focus on more lucrative areas such as cancer and Alzheimer's disease.

The New York based company would be leaving an area that includes its flagship $12 billion per year cholesterol-lowering drug Lipitor. The move is part of an effort to restructure the company into business units responsible for their own profits and losses. The plan is expected to include job cuts and a reduction in spending on research and development.

Steve - hmm...have they finally realized there are few pharmacological miracle cures for chronic disease? After the recent failures and adverse effects concerning obesity drugs Alli and Acomplia, heart disease drug Vytorin, and the class Bisphosphonate bone drugs, Pfizer sees the writing on the wall. This is a huge opportunity for preventive medicine.

Vitamin D has natural pain killing capabilities.

Women who get the right amount of vitamin D are less likely to suffer from chronic widespread pain, according to a new study in the Annals of Rheumatic Diseases.

Previous studies have also found that many people suffering from chronic pain have low vitamin D levels and that supplementing may help relieve certain types of pain.

About 10% of the population suffers from chronic widespread pain, which is pain that occurs on both sides of the body, above and below the waist, and lasts for longer than three months. This is the type of pain that characterizes fibromyalgia syndrome, but it can also occur without fibromyalgia.

The new study aimed to determine the range of vitamin D levels at which people were more likely to experience chronic pain. Almost 7,000 people gave information about bodily pain and had their vitamin D levels measured.

The researchers found that vitamin D status was associated with chronic widespread pain in women but not in men. Chronic pain was least likely to occur in women with the highest vitamin D levels. Women with lower levels were more than 1.5 times as likely to have chronic pain as were women with the highest levels.

Vitamin D again linked to breast cancer protection

Increased intake of vitamin D from the diet and from sunlight may reduce the risk fo breast cancer by over 20 per cent. The potential protective effects of the vitamin were not limited by the hormone receptor status of the tumors, according to research published online in the American Journal of Epidemiology. “This study suggests that vitamin D is associated with a reduced risk of breast cancer regardless of estrogen-receptor (ER) positive and progesterone-receptor (PR)] status of the tumor,” wrote lead author Kristina Blackmore from Mount Sinai Hospital in Toronto.

Canadian researchers analyzed the vitamin D intakes of 759 women with breast cancer, and compared this to the vitamin D intakes of 1,135 healthy controls. Increased intakes of the vitamin were associated with a 24 per cent reduction in the risk of developing ER+ and PR+ tumors.

Whole Grain Does Not Always Mean Whole Wheat

When most people see the word whole grain, they always assume this means whole wheat products. This couldn’t be further from the truth. In fact, I never recommend whole wheat. Why?

1. It has the highest gluten content of any grain.
2. Wheat is one of the most common food allergens.
3. Whole wheat often retains mold or is sprayed with fungicide to kill the mold (it is stored for a long time due to our national surplus).
   
4. Too much whole wheat can block the absorption of key minerals.

So what grains do I recommend?

BARLEY

• chewy, mild taste
• protein-rich and contains a type of fiber called beta-glucan, which helps lower cholesterol
• barley is versatile; there are many wonderful ways to use barley besides the usual mushroom barley soup

BROWN RICE

• rice that is stripped of its inedible outer husk, but retains its vitamin-rich bran layer
• has a nutty flavor and a chewy texture
• it is versatile and gluten-free
• it is available parboiled or precooked now for 3 minute preparation

BUCKWHEAT

• has 90% the protein value of a serving of milk and 80% protein value of an egg and contains all eight amino acids
• the shell, when dried and split, reveals a small kernel called a groat
• when roasted, buckwheat groats are called kasha
• buckwheat is gluten-free
  

POLENTA

• made from ground yellow or white cornmeal
• traditionally a slow-cooked grain
• high starch content makes it smooth and creamy when cooked
• polenta is gluten-free
  

QUINOA

• has more protein per serving than any other grain
• considered “complete” because it contains all eight essential amino acids. It can easily be added to soups, salads, and baked goods
• quinoa is gluten-free
  

WILD RICE

• the wild aquatic grass called zinzania aquatica from which wild rice is derived has no relation to the rice plant
• it has a high nutritive value containing niacin, riboflavin, and thiamine
• the seeds of wild rice contain an antioxidant that some believe might help reduce their chances of getting cancer
• adds color and flavor to any recipe wild rice is gluten-free

DELICIOUS GRAIN RECIPES

CHICKEN AND BARLEY SALAD (main dish)
1 cup quick-cooking barley
2 cups broccoli florets
½ cup sweetened dried cranberries or cherries
4 oz. chicken, grilled and cut into strips
½ cup walnuts or pecans, chopped
1/8 tsp. sea salt, optional
½ cup raspberry vinaigrette dressing

Bring 3 cups water to boiling in a medium size saucepan. Stir in barley, reduce heat to medium-high and cook 6 minutes. Add broccoli and continue to cook for 3 minutes. Stir in cranberries, cook 1 minute, then drain. Transfer barley mixture to a serving bowl and stir in cooked chicken pieces, nuts, and salt. Pour vinaigrette over salad and gently stir to combine. Serve slightly warm or at room temperature. SERVES: 4

QUINOA STUFFED SQUASH (main dish)
3 small acorn squash, halved and seeded
¾ cup quinoa, rinsed
2 mild Italian sausages, casings removed
½ tsp. garlic powder
1 small sweet red pepper, seeded and diced
2 T. pure maple syrup

Heat oven to 400º. Place squash halves, cut-side down, on a 15x10x1-inch baking pan. Add 2 cups water, and transfer to oven. Bake at 400º for 35 minutes. Meanwhile, put quinoa in a bowl. Pour ¾ cup boiling water over quinoa; cover with plastic wrap. Let stand 30 minutes. Once quinoa is softened, heat a nonstick skillet over medium-high heat. Add sausage and chop into little pieces; cook 2 minutes. Stir in garlic powder and red pepper. Cook 3 minutes. Remove from heat. Stir in quinoa. Remove squash from oven; pour off water. Flip over squash; brush with maple syrup. Spoon filling in squash; return to oven. Bake 15 minutes longer. SERVES: 6

RUSSIAN KASHA (side dish)
1 box kasha (buckwheat) such as Wolff’s
½ chicken broth; ½ water (follow package instructions)
12 oz. package mini pasta shells (rice or durum wheat)
2 T. olive or grapeseed oil
1 cup baby carrots, diced
½ cup onion, diced
1 cup celery, diced
¼ cup fresh parsley leaves
sea salt to taste

Cook buckwheat in water and broth according to package directions. Add salt to taste. Cook pasta in salted water until al dente. Drain. Sauté carrots, onion, and celery in oil. Mix with cooked buckwheat and pasta. Stir in parsley. May be served immediately or refrigerated and reheated. SERVES: 8

Antidepressants may damage male fertility

Common antidepressant drugs may reduce some men's fertility by damaging the DNA in their sperm, according to scientists. A study of 35 healthy men given paroxetine -- sold as Paxil or Seroxat by GlaxoSmithKline found that, on average, the proportion of sperm cells with fragmented DNA rose from 13.8 percent before treatment to 30.3 percent after just four weeks. Similar levels of sperm DNA damage have been linked to problems with embryo viability in couples trying to have children. The research by Peter Schlegel and Cigdem Tanrikut of the Cornell Medical Center in New York was reported in New Scientist magazine and is due to be presented in November at a meeting of the American Society for Reproductive Medicine.

Honey a sinusitis treatment?

Honey may help bring sweet relief to chronic sinusitis sufferers. Scientists say natural germ fighters in honey attack the bacteria that cause the discomforting disorder. "Honey has been used in traditional medicine as a natural anti-microbial dressing for infected wounds for hundreds of years," noted study co-author Dr. Joseph G. Marsan, from the University of Ottawa. The objectives of the study were to evaluate the activity of honey on so-called "biofilms," which are responsible for numerous chronic infections, Marsan explained. "Certain bacteria, mainly Staph aureus and Pseudomonas aeruginosa, have found a method of shielding themselves from the activity of anti-microbials by living in substances called biofilms, which cannot be penetrated by even the most powerful anti-microbials," he said. The report was to be presented Tuesday at the American Academy of Otolaryngology-Head and Neck Surgery Foundation's annual meeting in Chicago.

In the laboratory, Marsan's team applied honey to biofilms made up of the bacteria that cause sinusitis. They found that honey was more effective in killing these bacteria than antibiotics commonly used against them. "Our study has shown that certain honeys, namely the Manuka honey from New Zealand and the Sidr honey from Yemen, have a powerful killing action on these bacterial biofilms that is far superior to the most powerful anti-microbials used in medicine today," Marsan said.

The Canadian findings echo research published last year in the Archives of Pediatrics and Adolescent Medicine, by a team at Penn State College of Medicine. That group found that honey worked better than commercial cough medicines containing dextromethorphan (DM) in easing children's cough.

American kids most medicated

Courtesy of Julie Deardorff, Chicago Tribune

American children are approximately three times more likely to be prescribed antidepressants and stimulant medication than children in Europe, according to a study in the journal Child and Adolescent Psychiatry. One possible reason for the differences? Direct to consumer drug advertising which can increase awareness and the use of meds to treat emotional and behavioral problems in kids, according to lead author Julie Zito of the University of Maryland.

Researchers found the use of antidepressant and stimulant medications was three or more times greater in the U.S. than in the Netherlands and Germany. The use of anti-psychotic drugs in the U.S. was 1.5 to 2.2 times greater than the other countries.

Steve - I can't say I'm surprised. Kids are overdiagnosed and overmedicated in the US.

Panel hears thoughts on food marketing to kids

Combating the growing obesity problem among children will require stronger action at all levels from food makers to governments and schools, witnesses told U.S. lawmakers Tuesday at a hearing about how foods are marketed to kids. Dr. Julie Gerberding, the head of the CDC, said children can't make healthy food decisions for themselves and they and their parents are being influenced by advertising. She said researchers must understand the relationship between advertising and obesity, and that there should be standards and agreement on what healthy choices are."This is job one for our nation," Gerberding said. "This is our future. We owe it to our children and we've got to do a lot more than we have been doing to get this problem under control."

Steve - for those with children who watch Nickelodeon, Disney, and Cartoon Network, the junk marketed is beyond belief. And for them to tag it as "part of a complete breakfast" is ludicrous. Big Food will fight regulation tooth and nail because they know how important kids' marketing is to branding not just short-term, but long-term. The government will end up letting them "police themselves" which will amount to window dressing. The only recourse we have as parents is to stop buying the junk food. Stop giving in to your children when they clamor for junk. When sales go down, then Big Food will listen.

Drug Maker Pledges to Report Payments to Doctors

In the midst of a national debate over the influence of industry money on medical research and practice, the drug maker Eli Lilly says it will begin publicly reporting all of its payments to outside doctors for speaking and consulting services. The company’s chief executive, John C. Lechleiter, announced on Wednesday that starting next year it intends to post all its payments to doctors in an online database. The posting will “likely include” the name of the doctor or some other identifying information, along with the reason for the payment, the company said. Members of Congress have been pushing for a national registry of such payments.

Steve - I'll believe it when I see it.

Celiac Disease in Men Threatens Bone Health

Peter Green, the director of the Celiac Disease Center at Columbia University, published an article in the Scandinavian Journal of Gastroenterology, showing that celiac disease appears to progress faster in men, deprive men's bodies of more needed nutrients, and cause particularly acute damage to bones. In fact, says Alessio Fasano, the medical director at the University of Maryland's Center for Celiac Research, celiac disease is one of the leading causes of male osteoporosis, a condition that many men don't realize they can get. Experts estimate that only about 5 percent of Americans with the condition ever receive a diagnosis, and it typically takes doctors about 11 years to correctly identify a person who has celiac disease, since the problem is often misdiagnosed as irritable bowel syndrome or anemia. That's troubling because untreated celiac disease significantly increases the risk of severe medical problems, including gastrointestinal cancers and non-Hodgkin lymphoma, in addition to osteoporosis. And while osteoporosis is most common among postmenopausal women, the disease also poses a significant threat to more than 2 million men, according to the National Institutes of Health. Experts suggest that any man with osteoporosis should have himself screened for celiac disease—just as anyone, male or female, who has celiac disease should get screened for osteoporosis. For people who do have both diseases, research has shown that adopting a gluten-free diet halts the progression of osteoporosis and even improves bone density by 10 percent.

Chocolate Helps Heart Stay Healthy

A small square of dark chocolate daily protects the heart from inflammation and subsequent heart disease, a new study of Italians suggests. Milk chocolate does not do the job. Specifically, only 6.7 grams of chocolate per day (or 0.23 ounces) represents the ideal amount, according to results from the Moli-sani Project, one of the largest health studies ever conducted in Europe. For comparison, a standard-sized Hershey's kiss is about 4.5 grams (though they are not made of dark chocolate) and one Hershey's dark chocolate bar is about 41 grams (so a recommendation might be one of those weekly).

The researchers found a relationship between dark chocolate intake and levels of C-Reactive protein in the blood of 4,849 subjects in good health and free of risk factors (such as high cholesterol or blood pressure, and other parameters). People having moderate amounts of dark chocolate regularly had significantly lower levels of C-reactive protein. In other words, their inflammatory state is considerably reduced." The findings are detailed in the latest issue of the Journal Nutrition.

The milk in milk chocolate interferes with polyphenols, so the team kept that out of the study.

Bonnie - this is the same reason why you should not assume that you are getting the antioxidant effect from tea or coffee if you put milk or cream in it!

Overuse of antibiotics blamed in spread of drug-resistant strain of intestinal infection

Courtesy of the Daily Herald

Joan Corboy couldn't figure out what was making her so sick.

The 80-year-old Wilmette woman lost 55 pounds in five months, with chronic diarrhea so bad she "had to lay in bed hour after hour" because she felt so weak.

"I'm one tough cookie," she says. "But it was a dreadful experience."

The cause of her illness turned out to be a virulent strain of a common intestinal bug that's quickly become one of the most widespread infections in hospitals and other health-care settings. The bacteria -- Clostridium difficile, or C. difficile -- has been around at least 30 years. But there's been a sharp increase since 2000 in cases tied to an unusually toxic, antibiotic-resistant strain -- NAP1. Experts blame the overuse of antibiotics for helping spread this latest super bug.

The federal Centers for Disease Control and Prevention estimates that C. diff sickens as many as 500,000 Americans a year and contributes to at least 15,000 deaths. "We're seeing more cases, and we're seeing more severe cases," says the CDC's Dr. Carolyn Gould.

Dr. Stuart Johnson, a Loyola University Medical Center infectious disease doctor, says he sees two cases of C. diff for every one of MRSA, a drug-resistant staph. Other hospitals say they haven't seen a big increase in serious cases, which typically occur in older people who've been on antibiotics.

"You have to acquire the bacteria, which is done through ingestion of spores or swallowing them," Gould says. "The second element is receiving antibiotics, which disrupt the normal, or 'good,' bacteria in the colon that would normally control the C. diff."

Hospitals and nursing homes are prime breeding grounds. There are two antibiotics that still work against C. diff, but re-infection rates are high.

Since the drug-resistant strain of the bacteria became widespread, many Chicago hospitals have taken steps to curb C. diff outbreaks. For instance, patients with a confirmed case of C. diff are put in private rooms, and hospital staffers have to wear gloves and gowns when treating these patients, says Dr. Gary Noskin, an infectious disease specialist at Northwestern Memorial Hospital.

"In terms of precautions the public can take, they can quit demanding antibiotics for everything," says Dr. John Segreti, head of infection control at Rush University Medical Center.

Bonnie - it is nice to see doctors are starting to get it. Dr. Gould even recognizes how antibiotics wipe out good bacteria that would otherwise control C. Difficile. This is why it is crucial to always take high dose probiotics, including acidophilus and saccharomyces boulardii during a round of antibiotics.

Research Showing Drug Failure Published Less Often

The first research to track every prescription drug approved by U.S. regulators over several years concluded that many studies finding the medicines ineffective were not published in medical journals. To win approval from the Food and Drug Administration, companies must submit at least two studies demonstrating a drug is safe and effective, even if other clinical trials find it is not. The researchers tracked all studies submitted to the FDA by drug companies seeking approval for new treatments from 1998 to 2000. By 2005, five years after the last FDA approvals of the drugs, most of the studies finding the drugs ineffective hadn't been published in journals. Other trials finding them effective were much more likely to be published. The analysis was published today in the Public Library of Science journal, PLoS Medicine.

Some critics have said drug companies selectively publish results that show a drug works and fail to publish those suggesting it doesn't. Concern that publication bias -- the tendency for positive studies to be more frequently published than negative ones -- may mislead consumers -- led Congress last year to mandate the creation of a registry of clinical trials. Under that legislation, drug companies must submit the results of all trials they conduct for posting on a government Web site that lists trials and results.

Steve - when transparency is demanded, the truth comes out.

Dietary supplements cause 600 'adverse events'

Side effects from the use of food supplements resulted in 604 "adverse-event" reports — a list that includes at least five deaths — through the first six months that such accounts have been required by law. The Office of Nutritional Products, Labeling and Dietary Supplements in the Food and Drug Administration's Center for Food Safety and Applied Nutrition acknowledged receiving 368 mandatory reports from supplement manufacturers and 236 reports from consumers or health care professionals. An adverse event can be anything from a concern that a supplement isn't working to a serious illness that follows consumption. FDA spokesman Michael Herndon said five deaths and 85 hospitalizations were reported through April 15. "Some of these deaths were likely due to underlying medical conditions," he says.

If the trend continues, there will be fewer than the 960 adverse-event reports the FDA had estimated it would receive each year. "These numbers don't alarm us," says Steve Mister, president and chief executive of the supplement trade group Council for Responsible Nutrition. "We thought they would be much less than the FDA estimate."

For perspective, the FDA took in 482,154 adverse-event reports for prescription drugs last year.

Bonnie - we applauded the AER bill when it was passed and it seems to be accomplishing its purpose. While the low numbers exhibit the overall safety of dietary supplements, it also proves the point that taking them should be overseen by a health professional. However, for people to put them in the same category as drugs is preposterous. And if "concern that a med is not working" was added to the adverse-events report for meds is listed, the 482,154 number would triple.

A public health paradigm for Alzheimer's prevention

One headline screams: "study reports rise in pre-dementia." While another laments: "another disappointing year for Alzheimer's drugs." According to Mayo Clinic researchers, while nearly one million older Americans slide from normal memory into mild impairment each year, we are no closer to a "cure" for cognitive impairment disorders. That is on top of the 500,000 Americans who develop full-blown Alzheimer's - a problem sure to grow as baby boomers age. About 5.2 million Americans now live with Alzheimer's. By 2050, that number could swell to 11 million to 16 million. If ways can be found to postpone Alzheimer's by as little as two years, nearly 2 million cases of the disease could be avoided.

It is unfortunate that the National Institutes of Health/Aging and leading nonprofit Alzheimer's research organizations allocate the majority of their budgets to pharmacological "miracle cures" instead of the long-term solution...prevention. If you go to the Alzheimer's Association National Chapter website and click on Clinical Trials Index page, you will see a laundry list of medication trials underway. As of 9/23/2008, guess how many trials are listed under prevention? One.

In this piece, we try to lay out what we think is the most effective non-pharmacologic Alzheimer's policy based upon what the current research shows. Besides doing our own research, some of this information was presented by the Greater Illinois Chapter of the Alzheimer's Association. In our view, they are much more focused on prevention and non-pharmacological treatments than the National Chapter.


INCORPORATING A NON-PHARMACOLOGIC PARADIGM

While most of the experts lament the lack of pharmacological treatments to prevent mental slides or reverse "pre-dementia," there are non-pharmacological treatments that exist with research that can help. However, none of these are getting the funding or attention they deserve. While millions of dollars in grants are given to researchers studying pharmacological cures, a study such as one spearheaded by the University of Illinois to identify strong scientific evidence for the efficacy of non-pharmacological therapies for early stage dementia, received $3000. Preventive intervention will save a lot of money in the future and can produce tangible results immediately. Not to mention the current pharmacological treatments in use do little and produce debilitating side effects.

Let's make something crystal clear: most people are told when brain neurons die, they cannot regenerate. THIS IS WRONG! Data as early as the 1980's have shown that environment can have a detrimental as well as positive effect on neurons. The U of I researchers discovered that enriched environments can create neuronal regeneration.

Here are therapies with definitive research that embody Enriched Environment:
(starred items have the strongest evidence)

• Structured Exercise**
  Exercise is cheap. Everybody can do it. Studies looking at exercise interventions showed overall improvements in numerous mental categories. Types of fitness included home-based aerobic/endurance activities, strength training, balance and flexibility training, Tai Chi, and Chi Gong. Researchers believe that they work so well because they cannot be done mindlessly and are great for balance. According to results presented at the 2008 Alzheimer's Association International Conference in Chicago, people in the early stages of Alzheimer's disease who are more physically fit had less shrinkage in areas of the brain that are important for memory.
  
  In Alzheimer's, the hippocampus is one of the first regions of the brain to sustain damage. Researchers found that people who had early-stage Alzheimer's disease and were physically fit had more brain volume in areas that are important to memory that people with the disease who were less fit.
  
  In a separate study, Australian researchers found people with dementia who took part in a 12-month home exercise program directed by their caregivers had fewer falls and better quality of life.
  

• Multiple Environmental Stimuli**
  Examples such as music, cognitive tasks, and opportunity to explore environment. Studies looking at cognitive training and enhancement programs incorporating the above showed continued improvement of MMSE (Mini-Mental State Exam) scores for up to two years following the intervention.

• Social Interactions/Support groups**
  Greater Illinois Chapter has myriad options to explore. Strength in numbers!
  

• Sleep Management**

• Diet/Nutrition**
  CHAP (Chicago Health and Aging Project) finds 50% less risk of developing Alzheimer's with high vitamin E in diet. One weekly serving off fish showed a 60% reduction of developing Alzheimer's. Higher trans fat intake creates 2-3 times the risk of mental decline, whereas monounsaturated fats create a 70-80% reduction. High copper levels increase rate of decline, which is why detecting zinc deficiency (depleted by copper), is important. Antioxidants from fruits and vegetables are a given to reduce oxidative distress.
  

• Falls Prevention
  Falls increase cognitive impairment so it is imperative to incorporate techniques to prevent them.
  

• Volunteer Programs
  Volunteering for schools, nonprofits, etc. create an enriched lifestyle and are highly recommended.
  

• Driving Evaluations
  At least every six months, driving evaluations, including an on-road test are suggested to track mental status.
  

• Education Programs**
  This category can encompass two avenues to explore:
  1) take college courses to broaden your education on myriad topics
  2) participate in programs for individuals/families facing dementia and Alzheimer's

• Technology-Based Interventions
  For example, learning email or computer programs. Technology-based programs also offered strong promise because they minimize the need for professional support services, may be utilized by caregivers, and may be widely disseminated.
  

These therapies do provide improved outcomes. Especially if they include participation by a family member or caregiver. Following the diagnosis of early stage dementia, Alzheimer's medications such as Aricept are almost always prescribed. Unfortunately, non-pharmacological therapies are rarely recommended. While still limited, these services are available all over the country and can be utilized for as little as $12.50/day. However, there is no list that exists that a physician can hand the patient to utilize these services. This needs to change.


NO DRUG CURE ON THE HORIZON

Drugs to reverse Alzheimer's disease have proven elusive. Recent clinical trials aimed at halting Alzheimer's have faltered and such treatment appears to be far off. As such, Alzheimer's disease research is at a crossroads, according to the Alzheimer’s Association 2008 International Conference. Though technology to detect the condition early is advancing rapidly, there is still no way to halt or reverse the devastating disease. The arrival of such a disease-modifying medication is now unlikely before 2010, perhaps later.

Five Alzheimer's disease medications are available. But all of these drugs treat the symptoms of the disease, such as memory problems and mental confusion. They do not cure, halt or even slow the disease process, and a review published earlier this year in the Annals of Internal Medicine concluded that the drugs produce few, if any, meaningful benefits.


WHAT THE FUTURE HOLDS

The Alzheimer's Breakthrough Act of 2007, which attempts to lay out an all-inclusive approach to treating Alzheimer's, is a step in the right direction. However, it is mired in the Congress' legislative morass and has not even reached a vote in the Senate, much less the House. Once the lobbyists get through with it, the focus will most likely be drug-heavy.

We need to coordinate a country-wide effort to create a database of non-pharmacological services and where they are available. It needs to be simple to access and easy to modify. Doctors, nurses, caregivers, family, friends, and patients need to all be on the same page. It would not be an expensive venture and could be done quickly. Let's allocate a small amount of the money going to drug research to accomplish it.


RELATED LINKS (within the last year)

High EPA concentration may decrease risk of dementia.

B-Vitamins decrease memory loss in elderly.

MSG slows brain cell growth.

EPA/DHA reduce inflammation in Alzheimer's patients.

Good cholesterol may protect memory.

Mercury teeth fillings may harm some.

Vitamin E lengthens lives of Alzheimer's patients.

No good drugs for dementia.

Tips to prevent memory loss.

Researchers deem Alzheimer's Type 3 Diabetes.

Alzheimer's may be result of Western Diet.

Long term beta carotene may slow mental decline.

Driven people may avoid Alzheimer's.

Are statins a problem for the brain?

Obesity dramatically increases risk of Alzheimer's.

Common drugs hasten decline in elderly.

Antipsychotics no longer recommended for Alzheimer's patients.

Walking and exercise prevents dementia.

Acupuncture beats drug to treat hot flashes: study

Acupuncture works as well as a drug commonly used to combat hot flashes and other menopausal symptoms that can accompany breast cancer treatment, and its benefits last longer, without bad side effects. Researchers tested acupuncture, which began in China more than 2,000 years ago and involves inserting needles into the body, against the Wyeth antidepressant Effexor, for hot flashes in breast cancer patients. Acupuncture was just as effective as Effexor, also called venlafaxine, in managing symptoms including hot flashes and night sweats. After 12 weeks of treatment, symptoms were reduced for 15 additional weeks for women who had undergone acupuncture, compared with two weeks for those who had taken Effexor. The findings were presented at an American Society for Therapeutic Radiology and Oncology meeting in Boston. There were no bad side effects with acupuncture, and women reported increased energy, overall sense of well-being and sexual desire, the researchers said. Those taking Effexor reported side effects including nausea, headache, difficulty sleeping, dizziness, increased blood pressure, fatigue and anxiety.

Steve - wow, this is great stuff! The data is piling up supporting the effectiveness of acupuncture.

Massage eases pain in cancer patients

Massage therapy eases pain in patients with advanced cancer, when friends and family members can be afraid to touch them and painkillers don't always work. Researchers from the University of Colorado in Denver tracked 380 patients who were feeling moderate to severe pain, treating them with either Swedish massage or simple touches.

Patients getting six episodes of 30-minute massages or touches experienced immediate improvement in pain and mood each time, although the benefit didn't last. Neither approach reduced the amount of pain medicine needed. More than 1.4 million people in the U.S. are diagnosed with cancer each year, and 565,000 die from it, according to the American Cancer Society. For pain control, some patients and health professionals are turning to massage, which may lead to relaxation, improve circulation, release endorphins and decrease inflammation and swelling.

The study, funded by the National Center for Complementary and Alternative Medicine and other cancer and charitable foundations, appeared in Annals of Internal Medicine. David Mejia, a 39-year-old engineer in Denver, said massage has helped him during his two-year fight against a blood cancer called multiple myeloma. He said he gets an emotional and psychological benefit from the experience in addition to pain relief, easing bouts of depression, irritability and anxiety.

Osteoporosis, osteopenia screening and prevention are best done when we're older

By Susan Brink
Los Angeles Times Staff Writer

September 22, 2008

JUST A few years back, it was heresy to suggest that, when it comes to protecting bones, early treatment may not be the answer.

Part of the rite of passage through menopause a decade ago became bone-density screening. Around age 50, many women would position their skeletons under the X-ray eye of new machines that could calibrate the alarming rate at which their bones were being eaten away. On top of that, they began to hear commercials featuring women, often much younger than they, praising a pill for saving them from nursing homes, physical deterioration and crumbling spines.

It was no longer sufficient to get enough calcium and vitamin D and do weight-bearing exercise. Suddenly, there were drugs available, Fosamax being the first in 1995 of a class called bisphosphonates, that could put that lost bone density back, help prevent painful, even deadly, fractures and reduce the number of women going through old age with crooked backs.

A combination of new technology and clever marketing was pushing fear of fractures from geriatric reality to midlife worry. Meanwhile, women were hit with a new word, osteopenia, which sounds like a fearsome disease. The pre-osteoporosis, non-disease condition, named by the World Health Organization in 1992, has a broad enough definition to include about half of all women over 50. "The average bone density for a 60-year-old Caucasian woman would put her in osteopenia," says Dennis Black, an epidemiologist at UC San Francisco who studies the effectiveness of osteoporosis treatments.

Confused about what the new label actually meant, young, healthy women suddenly seemed more worried about their bones than did their mothers and grandmothers -- who really had something to worry about. "Women don't understand what their risk is, one way or the other," says Dr. Ethel Siris, director of the Toni Stabile Osteoporosis Center of Columbia University Medical Center in New York.

Things have changed.

Studies have shown that most women will lose no more than 7% of their bone mass within the decade after menopause. Bisphosphonates have been shown to replace about 8% of bone within five years, so waiting will cost most women nothing. Counter to just about every other preventive healthcare message out there, when it comes to osteoporosis drugs, it's probably better to hold off. "Wait until the risk gets high enough," says Dr. Bruce Ettinger, adjunct clinical investigator at Kaiser Permanente, Northern California.

Even the drug marketers seem to be getting more realistic. "If you look at the TV ads, it's no longer the 45- or 50-year-old who's just finished her workout," says Ettinger. "It's a 65-year-old doing some stretching or gardening."

The current recommendation is that most healthy women get checked for bone loss with a bone-density test at age 65, not the minute they hit menopause, according to the U.S. Preventive Services Task Force. Those with risk factors, such as a family history of the disease, a fracture of their own, smoking, heavy alcohol use or a history of taking corticosteroids, should get a bone-density test around age 60, the 2002 recommendation said. And men should be tested at 70.

A drug's effect

This dramatic shift from early prevention to later prevention is an attempt to save healthy women from decades of pill popping to prevent a disease many may well never have. Like all drugs, these have side effects that can include upper gastrointestinal irritation, ulcers of the esophagus, upset stomach, bone pain and skin rash. But what has many people concerned is that the long-term effects are unknown. One sign of potential trouble is that dentists are seeing more jaw disease among women taking bisphosphonates.

Women, meanwhile, are still confused by the original messages. "Women in their 50s and 60s have grown up in a major transition time in terms of osteoporosis," says Ettinger. "They heard that when you hit 50, you lose bone and you won't get it back. Fosamax was promoting this whole thing, and most of the ob-gyns were on the bandwagon."

The drug arrived on the scene just as the baby-boom generation of women was about to reach a biological turning point, determined to head off the natural decline that comes with aging. Fosamax was the first bisphosphonate approved by the Food and Drug Administration for treatment and prevention of osteoporosis. And it promised to not only stall bone deterioration, but to actually replace bone that was already lost. Women looking no more than 45 years old began warning, through the television screen, "Don't wait for a fracture."

The message was aimed at viewers who probably didn't need the drug. In fact, in 1997 and 2001 letters to Merck & Co., maker of Fosamax, the FDA warned the company, which then changed its promotional language, that its ads were misleading and that its website overstated the benefits of the drug, while understating the risks. The criticism has been unfair, says Ronald Rogers, a Merck spokesman. In an e-mail message, he said, "Merck has consistently marketed Fosamax in accordance with its FDA approved label."

As the risks of drugs became better known, doctors and researchers came to more thoroughly assess the significance of osteopenia -- that new classification that is not a disease. Although women with the condition may be at higher risk than average, the label comes from the world of statistics. At an international conference on osteoporosis in 1992, experts agreed that "normal" bone mass was represented by the average 30-year-old woman, the age of peak bone mass. Below that level, regardless of her age and on a statistical sliding scale, a woman potentially entered a bone danger zone. Using that formula, a 70-year-old woman is measured against the healthy bone mass of a woman four decades her junior. The World Health Organization, at that same 1992 meeting, calculated what are called T-scores and determined that if a woman's score is negative 1 or higher, her bone mass is normal. The closer the negative number is to zero, the healthier the bone. If the T-score is negative 2.5 or lower, she has osteoporosis. And in between those two negative numbers, it's called osteopenia, an indication that bone mass is below the statistical norm, possibly putting the person at increased risk of a future fracture.

By that definition, about a third of women 50 to 64 have osteopenia, as do about two-thirds of those 65 and older, according to an analysis in the November/December 2007 journal Health Affairs.

Osteopenia, by definition for post-menopausal women, is just another word for normal.

Assessing risk

Despite the new knowledge of normal, the language from the National Osteoporosis Foundation is stark. The foundation estimates that 10 million Americans now have osteoporosis and says that half of all women, and 25% of men, over age 50 will have an osteoporosis-related fracture in their remaining lifetime.

But few women or men will suffer a fracture in their 50s or 60s, and even fewer will break a hip. "Lifetime risk depends on your point of view," says Black. "A 50% risk of fracture may be a wrist fracture, and those are relatively mild. Fracture of the hip, that may be about 16% or 17%, but that's not something for a 50-year-old woman to get alarmed about."

Nor should a 50-year-old man. Men get osteoporosis too, but generally at later ages. Four times as many women get the disease as men, and they become more vulnerable to bone loss after menopause, when their bodies lose much of their circulating estrogen, a hormone that slows bone loss.

Pinpointing personal risk is a numbers game that has, just this year, gotten a whole lot easier with some online tools that allow a physician, or a woman or man, to check out an individual's risk of a broken bone in the next decade. Two self-assessment tools are now available online.

Both use age, sex and half a dozen other health and lifestyle questions to figure the risk of a fracture in any one of four areas, and also the specific risk of a hip fracture, in the next 10 years. Siris cautions that women should probably discuss the test results with their physicians. "It looks simple, but some women might mislead themselves if they answer the questions incorrectly."

The first tool, called FRAX, is available at shef.ac.uk/FRAX/. Users have to convert their weight and height into metric measures, but it's become familiar enough among osteoporosis specialists to have taken on active-verb status. As Siris says, "At 65, get a bone-density test for sure. If she's not osteoporodic, but is osteopenic, FRAX her."

The other, newer tool -- at fore.org -- calculates in American pounds and inches.

Both risk calculators are more precise if people enter their actual bone-density test results. But they'll work without that number by calculating the risk as though the person had an average (for his or her age) bone density measurement.

The FRAX tool has been approved to be incorporated into the software of bone-density scanning machines, also called DEXA, for dual-energy X-ray absorptiometry. Eventually people getting the scans will get not just a puzzling negative number, but their own likely 10-year risk of an actual fracture.

Those results, says Ettinger, often make people think a whole lot differently about their own risk than hearing that they have a 50% lifetime risk of a broken bone. The risk for a hip fracture within the next 10 years, for example, for a healthy, white 50-year-old woman -- even with osteopenia -- is less than 1%.

Guidelines from the National Osteoporosis Foundation suggest that a 20% 10-year risk of any of four fractures -- wrist, spine, hip or upper arm -- or a 3% risk of a hip fracture is worth treating with drugs.

Hip fractures, the most serious of bone breaks, are a geriatric, not a midlife, epidemic. The average age of a person with a broken hip is 82, with 81% of hip-fracture patients 75 or older, and 43% of patients 85 or older, according to a study in the June 6, 2001, Journal of the American Medical Assn. It is then that the most frightening cycle brought on by osteoporosis is likely to begin: hip fracture, nursing home, loss of independence. About 24% of hip-fracture patients die in the year after their fracture.

Long before people get to that point, the drugs on the market, most of them bisphosphonates, can do some good. But the people for whom drug therapy can have the most benefit are often under-treated. A 2004 U.S. Surgeon General's report found that for 1999 to 2000, only 30% of eligible Medicare beneficiaries 65 and older had received a bone-density test.

And while bisphosphonates are No. 10 in U.S. sales in the top 20 drug categories, at $4.64 billion in 2007, according to market researcher IMS Health figures, it's not at all clear that those who need them most are taking them.

Treatment decisions

A lot of women don't understand what it means to have osteoporosis. A survey of 60,000 women over age 55, who were recruited through 700 primary-care physicians in the U.S., Canada, Europe and Australia, was reported Sept. 15 at the annual meeting of the American Society for Bone and Mineral Research. It found that more than 11,000 of them reported having a diagnosis of osteoporosis, putting them at known risk for a fracture. But 55% of the women with the diagnosis told researchers that they did not believe that they were at a higher risk of fracture than their undiagnosed peers.

"It seemed as though, regardless of how much risk they're at, they perceived themselves as at no higher risk than other women," says Siris, who presented the findings. "It's not surprising. Women have a lot of competing worries, and this is still a new area of public health interest," she says. "They worried that their back might get curved, but they didn't understand that that means vertebral fractures. Boy, are we not doing a good enough job of educating women."

Women may have been scared off by drug side effects, or the vast unknowns of long-term use. But options have increased. The original treatments were taken in daily doses, patients had to eat before taking them and they had to remain upright for 30 minutes or so after taking them. More than half of the women who were prescribed those drugs stopped taking them within a year.

Newer versions of the drugs now can be taken weekly or monthly. On the horizon are drugs administered by injection every three months, or even once a year in an IV drip, the latter aimed largely at nursing-home patients. And a presentation Sept. 16 at the annual meeting of the American Society for Bone and Mineral Research showed a new Amgen drug, denosumab, awaiting FDA approval, reduced the incidence of spine and hip fractures with no evidence, after a three-year trial, of the jaw-deteriorating side effect seen with bisphosphonates.

The trick now is not to scare every woman into worrying about a test that says she has less bone mass than a healthy 30-year-old -- while getting women who truly are at risk to get tested and do something about it.

Bonnie - Susan should be commended for "stepping out" the way she did in this piece. I cannot recall another reporter, much less research study, that has been as forthcoming about how overblown the osteoporosis issue really is. Bravo!

School-Based Efforts Boost Kids' Fruit, Vegetable Intake

Children will eat fruits and vegetables at school, if the school gives them a push, a new report says. Researchers at the University of Maryland found three equally successful approaches based on teacher training with a tested curriculum and events that sometimes included parents. The biggest difference maker, though, was repeated exposure -- through taste testing -- to fruits and vegetables.

"Fruits and vegetables are a key contributor to children's health," lead investigator Bonnie Braun, an associate professor in the university's Department of Family Science, said in news release issued by the school. "Unfortunately, national reports indicate that children's consumption of these foods normally decreases from kindergarten to fifth grade. Students from low-income families are particularly at risk of inadequate intake."

Braun's team, which focused on elementary schools where at least half the population was eligible for the free or reduced lunch program, found that if schools increase fruits and vegetables on their cafeteria lines, children must be willing to eat them. "Our hypothesis was that school-based interventions, focused on increasing children's preference for fruits and vegetables, would be associated with an increase in consumption both in school and at home," Braun said.

Prior to the interventions, not even one of 10 students (7 percent) was eating the recommended five fruits and vegetables a day. In fact, seven of 10 (70 percent) ate fewer than three servings of fruits and vegetables daily; of those, more than half (56 percent) ate fewer than two servings. After the interventions, 60 percent of the students increased their taste for fruits and vegetables, and half either maintained their higher-than-average intake or increased intake

Energy brews creating a negative health buzz

By Mike Hughlett, Chicago Tribune reporter

Take one of the hottest trends in the beverage world — energy drinks — combine it with alcohol, and what do you get?

A brew with a wallop of liquor that also delivers a wide-eyed caffeine punch, masking intoxication in the process, according to concerned attorneys general in 25 states, including Illinois.

With the growing popularity of such buzz-brews among younger drinkers, those officials Wednesday asked MillerCoors to drop plans to introduce Sparks Red, a new stimulant-laced malt beverage that has even more alcohol than its current energy-brew offerings.

MillerCoors, a joint venture of the nation's second- and third-largest breweries that is in the process of moving its headquarters to Chicago, said it has no plans to do so, which may lead to legal action against it.

The plea to MillerCoors is the latest move in a crusade against the nation's top beermakers over the hybrid beverages, which breweries have become enamored with as a partial cure for anemic sales of conventional beer.

In February, attorneys general from several states, including Illinois' Lisa Madigan, subpoenaed Miller and Anheuser-Busch, the nation's biggest beermaker, asking for information about energy-alcohol drinks.

Both companies have reportedly complied with the subpoenas, and, in June, Anheuser-Busch said it would remove caffeine and other stimulants from its Tilt and Bud Extra offerings.

Now, the pressure is being ratcheted up on MillerCoors, and not only by the attorneys general. Last month, the Center for Science in the Public Interest sued the company, claiming stimulants used in the Sparks offerings aren't approved for alcoholic beverages.

On Wednesday, 25 attorneys general sent a letter to Leo Kiely, MillerCoors chief executive, saying the introduction of Sparks Red, slated for Oct. 1, "mocks [Miller's] oft-stated goal of promoting safe and responsible enjoyment of its products."

The group could end up suing MillerCoors. "If they continue to proceed in this manner, it will be one of the options we'll look at," Madigan said.

The attorneys general claim drinks like Sparks particularly appeal to young people and underage drinkers. And they say young drinkers are vulnerable because of limited judgment and a penchant for riskier behavior.

Pete Marino, a spokesman for MillerCoors, said the company "goes to great lengths to ensure all of our products are marketed in a very responsible manner to legal drinking-age adults." And MillerCoors' Sparks beverages, "have all been approved for sale by the federal government."

With 8 percent alcohol, Sparks Red would pack more of a punch than Sparks' original version or Sparks Plus, which contain 6 percent and 7 percent alcohol, respectively. Most conventional beers have a 4 percent to 5 percent alcohol content.

Like most energy drinks, Sparks is also loaded with caffeine. The attorneys general say that adding caffeine to alcoholic beverages reduces drinkers' sense of intoxication. "They are getting drunker faster and are not feeling the effects of being drunk," Madigan said.

Research on the subject is limited. But in their letter to MillerCoors, the attorneys general cited a recent study that concluded college students who mix alcohol and energy drinks got drunk twice as often than those who consumed alcohol alone.

Bonnie - I applaud this action because energy drinks, with or without alcohol, are terrible dietary choices.

September Research Highlights

American Journal Clinical Nutrition:

• A high plasma EPA concentration may decrease the risk of dementia, whereas high ratios of n–6 to n–3 fatty acids and of AA to DHA may increase the risk of dementia, especially in depressed older persons (1214 nondemented participants in this study). The role of EPA in dementia warrants further research.
  
  
• Maternal fish intake during pregnancy and the duration of breastfeeding are independently associated with better early child development. Future research and consumption guidelines, incorporating nutritional benefits as well as contaminant risks, should consider the overall effect of prenatal fish consumption on child development.
  
  
• 1.2 g fish oil daily produced a rapid increase in erythrocyte DHA and total n–3 fatty acids in 62 firefighters. The consumption of either 2.4 or 3.6 g flax oil/d (in capsules) was sufficient to increase erythrocyte total phospholipid ALA, EPA, and docosapentaenoic acid fatty acid content.
  
  
• Grains showed no protective effect from subjects risk of colorectal cancer when evaluating 85,903 men and 105,108 women.
  

FDA drafts guidelines for genetically engineered animals

The U.S. Food and Drug Administration, part of the Department of Health and Human Services, today released for public comment draft guidance on the regulation of genetically engineered (GE) animals. The guidance document is intended to clarify the FDA's regulatory authority in this field, as well as the requirements and recommendations for producers of GE animals and products derived from GE animals.

The comment period for the draft guidance, titled "The Regulation of Genetically Engineered Animals Containing Heritable rDNA Constructs," runs for 60 days and closes Nov. 18, 2008. The 25-page document is available online at http://www.fda.gov/cvm/GEAnimals.htm.

Bonnie - from our initial assessment, there is no place in the directive for labeling when sold to market. This is crucial for the consumer. We will have more comments once we scrutinize the doc.

9/19/08
After reviewing the draft guidelines, I want to reiterate that these are non-binding recommendations. This describes the FDA's current thinking. Public comment will be accepted until November 18, 2008. Here is our assessment:

• GE animals are here to stay. It just depends on how they are delivered (properly labeled or hidden) to the marketplace.
• They would like a directive that covers GE animals being developed to enhance food quality, improve animal health, products for therapeutic use, enhance animals interaction with humans, develop animal models for human disease, and produce industrial/consumer products.
• There concerns with regard to safety are evident throughout the directive.
• One glaring issue that we anticipated has to do with labeling these products in the marketplace. The FDA does not feel that as long as they decide a certain GE animal product is safe, it would not have to be labeled GE. This is the same feeling they have about GE plants. This is not acceptable.
• Based upon the language in their directive, the FDA seems to be taking a much more thorough approach to assessing safety before approving these products. However, all of this can change once the lobbyists get hold of them before policy implementation.

Our recommendation is to make a public comment by requesting well constructed, 10-15 year, peer-reviewed, independently funded safety studies before being allowed to market. If this cannot happen, then every GE animal product should be labeled at the retail level.

Study 'Validates' CT Scans for Colon Cancer Screening

Virtual colonoscopy -- colon cancer screening using CT scans -- finds 90% of large, precancerous polyps. The finding comes from 15 academic and community medical centers that performed both virtual colonoscopy (CT colonography) and traditional colonoscopy on 2,600 patients aged 50 and older. The study "validates" new guidelines endorsing virtual colonoscopy as a colon cancer screening option, says study leader C. Daniel Johnson, MD, professor of radiology at the Mayo Clinic in Scottsdale, Ariz.

The study showed that virtual colonoscopy was able to detect 90% of polyps 10 millimeters or more in diameter. That's the same accuracy reported for colonoscopy itself in other studies. Colonoscopy is, however, able to detect much smaller polyps. A downside of virtual colonoscopy is that it requires the same bowel prep (cleansing of the bowels) as a real colonoscopy. The study appears in the Sept. 18 issue of The New England Journal of Medicine.

Bonnie - can we please put the issue to rest now? Insurance companies, if you are listening, please start covering virtuals! Doctors, if you are listening, please start offering this as an alternative to the traditional screening. Personally, I would always choose to go for the less invasive procedure, and in this case, it is a no-brainer.

FYI - a second study that appeared in NEJM, which involved 1,256 patients who had tested negative for growths, found that five years later, none of the patients had developed colon cancer. The study concluded that for patients with low-risk factors, a ten-year interval between screenings is sufficient, as opposed to the current recommendation for every 5.

Health moves 'halve early deaths'

Women could halve their risk of premature death by adopting a healthier lifestyle, research suggests. By avoiding cigarettes, exercising regularly, eating healthily and keeping weight in check, 55% of early deaths from chronic diseases could be avoided. Following all four lifestyle tips could cut 44% of cancer deaths and 72% of cardiovascular deaths, the study of nearly 80,000 nurses suggests. The work is published on the British Medical Journal website. In the 24-year study, 28% of the 8,882 deaths could be attributed to smoking and 55% to the combination of smoking, being overweight, not doing enough exercise and a poor diet.

Report author Dr Rob van Dam Drinking too much alcohol also contributed, but women with "light-to-moderate" alcohol consumption of up to one drink a day were less likely to die from cardiovascular diseases.

A spokeswoman from the British Nutrition Foundation said: "This study reaffirms the importance of prevention. "It is worth making lifestyle changes now, so that our later years are spent free from diseases such as cancer and heart disease." Professor Peter Weissberg, medical director at the BHF, said: "I hope the findings will encourage people to get active for their health."

Steve - ah...music to my ears!

Sorting Through the Claims of the Boastful Egg

Steve - an informative piece we found courtesy of the NY Times

It used to be, an egg was an egg.

Now they can be cage free and free range, vegetarian and omega-3 fortified, organic, “certified humane” or “American humane certified.” The incredible, edible egg is becoming unintelligible.

Some claims on egg cartons are regulated by the federal government, some by the states and some not at all. Some affect consumers’ health, some touch upon ethics and some are meaningless.

All purport to describe how the hens were raised, or what they were fed, or what extra benefits their eggs might provide.

So, what do these terms mean?

First, the basics: egg grades — given by the United States Department of Agriculture or other agencies — depend mainly on the firmness of the whites. AA eggs hold their shape in the pan a bit better than Grade A eggs. (Grade B eggs, for processed foods, are rarely sold in stores.) Egg sizes, like large or jumbo, are based on the weight of a dozen eggs. Then things get confusing.

The easiest way to ensure truth in labeling is to look for cartons bearing the National Organic Program emblem (a circular seal with “U.S.D.A.” over what looks like a field), any of the animal-welfare-related labels described below, or the U.S.D.A. shield (which looks like an interstate highway sign and which indicates the eggs’ grade). The organic and animal welfare programs require that producers be audited by third-party certifiers. The U.S.D.A. shield, which can be found on about 35 percent of eggs in the market, means that the agriculture department is auditing the eggs’ producers at least once a year to verify that their claims are true.

Definitions for some other common terms on egg cartons are below. Keep in mind that the agriculture department’s rules apply only to eggs with the department’s shield. For eggs that are not a part of its grading program, either state rules apply or the use of the phrase is unregulated.

How Birds Are Raised

CAGE FREE The agriculture department says this means that the chickens were kept out of cages and had continuous access to food and water, but did not necessarily have access to the outdoors.

FREE RANGE The agriculture department says that in addition to meeting the cage-free standards, free-range birds must have continuous access to the outdoors, unless there’s a health risk present. There are no standards, though, for what that outdoor area must be like. (A concrete lot could do.)

PASTURE-RAISED There is no regulation of this term, which implies hens got at least part of their food from foraging on greens and bugs, which adherents say can improve flavor. Some studies have found that pasture-raised eggs have more nutrients like omega-3 fatty acids, vitamin A, vitamin E and beta carotene, and less saturated fat and cholesterol.

ANIMAL CARE LABELS Four main terms indicate the level of care hens received.

For eggs from chickens that live in the sort of utopia conveyed by the images on most egg cartons, look for “animal welfare approved.” Available in limited markets, it is a new label by the Animal Welfare Institute that is given only to independent family farmers. Flocks can have no more than 500 birds, and chickens over 4 weeks old must be able to spend all their time outside on pesticide-free pasture with a variety of vegetation. They must have access to dust baths and cannot have their beaks trimmed (a practice on crowded egg farms) or be fed animal byproducts.

“Certified humane raised and handled” hens and “American humane certified” hens are kept cage free, though not necessarily outdoors.

“Certified humane raised and handled” is administered by Humane Farm Animal Care, the only animal welfare program audited each year for reliability by the Department of Agriculture. It is endorsed by many animal welfare organizations. It has requirements for, among other things, ventilation, density and the number of perches and nesting boxes that must be provided. It requires that each hen have at least 1.5 square feet of space (324 square inches).

The “American humane certified” label was created by the American Humane Society. Its standards, similar to those of “certified humane raised and handled,” prohibit forced molting (reducing feed to increase egg production) and require that hens have at least 1.25 square feet of space (225 square inches).

“United Egg Producers Certified,” formerly “Animal care certified,” is presented by the United Egg Producers, America’s leading trade association for egg farmers, which has standards for caged and cage-free layers. The group adopted the new name under pressure from the Federal Trade Commission and the Better Business Bureau, which agreed with complaints they had received that “Animal care certified” misled consumers by implying more humane treatment than the hens were getting. Even with the new title, many animal welfare advocates say those standards are too low. The standards permit hens to have as little as 67 square inches of space, less than a letter-size sheet of paper, which is 93.5 square inches.

What Birds Are Fed

ORGANIC Any product with the “U.S.D.A. organic” emblem must meet the standards of the agriculture department’s National Organic Program. Among the program’s requirements: birds must be kept cage free with outdoor access (though the time and the type of access are not defined), they cannot be given antibiotics (even if ill) and their food must be free from animal byproducts and made from crops grown without chemical pesticides, fertilizers, irradiation, genetic engineering or sewage sludge. If organic eggs do not have the program’s emblem, they may be part of an independent or state-run program, and it may take some research to determine the program’s standards.

VEGETARIAN-FED For eggs that bear a U.S.D.A. grade shield, “vegetarian-fed” means the eggs came from hens raised on all-vegetarian feed. Hens are not naturally vegetarian, though; they enjoy eating grubs, bugs and worms. While there’s not a substantial nutritional difference between these eggs and conventional eggs, vegetarian eggs appeal to consumers who are turned off by some of the animal byproducts that can be included in conventional chicken feed, like feather meal, chicken litter, pork and cattle byproducts and “spent hen meal” (ground up dead hens).

NO HORMONES The Food and Drug Administration has not approved any hormone products for egg production, so this term is meaningless.

NO ANTIBIOTICS The Food and Drug Administration, which is responsible for food safety and oversees antibiotic use in poultry, does not allow routine use of antibiotics but does not define or regulate the term “no antibiotics.” The only way this claim is verified is if the eggs are U.S.D.A. graded (which means that hens did not receive therapeutic antibiotics but may still have been treated with antibiotics, if ill) or if the eggs are a part of the National Organic Program (which bans antibiotics entirely after chicks are 3 days old, even if ill). NATURAL, NATURALLY RAISED It means whatever the producers want it to mean because eggs in the shell are not a processed food.

FERTILE The term is unregulated but implies that the eggs came from hens that were likely to have been fertilized because they were uncaged and raised near a rooster. Some consumers like the idea of these more natural living conditions; others adhere to unproven beliefs that fertile eggs are more nutritious. Fertile eggs are stored at temperatures too cold for chicks to develop.

What’s in the Eggs

OMEGA-3 Eggs claiming to have extra omega-3 fatty acids, which are believed to improve heart health and mental acuity, come from hens whose diets include good sources of omega-3s, like flaxseed or algae. Producers in the U.S.D.A. grading program are audited to make sure the layers’ diets have been fortified and that omega-enriched eggs do not get swapped out for cheaper ones. The F.D.A. can audit producers’ claims about omega-3s but typically does so only if there has been a complaint. Unless the eggs claim to contain higher levels of docosahexaenoic acid (DHA) omega-3s, a form that is thought to be more important for cardiovascular health, the omega-3s are probably primarily in the alpha-linolenic acid (ALA) form.

PASTEURIZED This term is regulated by the F.D.A. and refers to eggs heated to temperatures just below the coagulation point to destroy pathogens. These eggs are recommended for recipes that call for raw eggs or for people susceptible to illness who prefer runny eggs.

HRT Use Raises Risk of GERD

Women who take hormones to relieve symptoms of menopause have a higher risk of developing symptoms of gastroesophageal reflux disease (GERD).

Also, women who use selective estrogen receptor modulators (SERMs), used to treat breast cancer and osteoporosis, also have a higher risk of developing reflux, according to a study in the Sept. 8 issue of the Archives of Internal Medicine.

In addition, women on oral contraceptives sometimes experience a relaxation of the lower esophageal sphincter, which allows stomach acids to rise up into the esophagus.

The authors of this study reviewed information on 51,637 postmenopausal women enrolled in the Nurses' Health Study. Participants had provided information on both postmenopausal hormone use as well as symptoms of GERD every two years from 1976 through 2002.

Women who had used hormones had a 46 percent higher risk of having symptoms of GERD, compared with women who had never used postmenopausal hormones. Women currently using estrogen only had a 66 percent raised risk while those currently using combined estrogen and progesterone had a 41 percent increased risk.

The chances of developing GERD symptoms were higher with higher doses of hormones and longer duration of use.

Current SERM users had a 39 percent increased risk, while women taking over-the-counter preparations had an increased risk of 37 percent.

Acid Reflux & Your Children

Acid reflux isn’t just for adults. More than half of all newborns experience the condition within the first three months of life.

“If you look at the research available, 60-70 percent of infants will have significant reflux episodes,” said Dr. Steven Schwarz, a professor of pediatrics at SUNY Downstate Medical Center and attending pediatrician at Long Island College Hospital.

Acid reflux is caused by a back-up of the contents of the stomach, including gastric acid, into the esophagus. But with infants, the contents of the stomach often reflux past the esophagus and out the mouth, resulting in regurgitation and vomiting or spitting up.

Acid reflux in infants usually occurs right after feeding, but until the muscle between the esophagus and the stomach matures, it can occur anytime a baby coughs, cries or strains.

Generally, if spitting up is the only symptom, doctors recommend some simple feeding and lifestyle modifications, Schwarz said.

Some suggestions include:

— Decreasing feeding volumes if the baby is formula fed;

— Decreasing feeding times if the baby is breast fed;

— Thickening formula or, on occasion, switching to a hypoallergenic formula;

— Smaller, more frequent meals.

In most cases, infant acid reflux will clear up on its own by 8-10 months of age, but in some rare cases, babies can develop breathing problems and/or acid-induced injury to the esophagus, called esophagitis.

So it’s important for parents to know the signs and symptoms that could indicate a bigger problem, including:

— Failure to gain weight;

— Irritability during feeding;

— Refusal to feed;

— Presence of blood in spit up;

— Breathing problems.

“Pharmacologic therapy should be reserved for those infants who demonstrate signs or symptoms of a complicated problem,” said Schwarz. “There’s nothing parents can do to prevent it, and basically for the vast majority of infants with reflux — which is most infants — as long as the baby is thriving and happy, there is no reason for concern.”

Much like their adult counterparts, children can also employ simple diet and lifestyle modifications to control their reflux-related symptoms.

“There are certain foods which we know are worse for patients with reflux,” Schwarz said. “Avoiding tomatoes, citrus products, caffeine, chocolate, and peppermint, can help, but lifestyle modifications should always be done under the care of a physician.”

Bonnie - unfortunately, many physicians do not adhere to Dr. Schwarz's plan. There has been an epidemic of overprescribing reflux meds to infants and young children for years. I wrote Reversing Reflux in Your Child Action Plan several years ago to address this issue. The unfortunate thing is that most parents have no idea the harm they can do to their child by allowing them to be on reflux meds if not truly necessary.

Migraine May Be Linked to Celiac Disease Risk in Children

There is some evidence that pediatric patients with migraines are at increased risk of celiac disease, Turkish researchers report in the September issue of Cephalalgia.

Dr. Fusan Alehan and colleagues at Baskent University Faculty of Medicine, Ankara, and colleagues note that although migraine has been reported to be associated with classic gluten enteropathy, it has not been studied extensively in asymptomatic celiac disease.

As they point out, most patients with celiac disease are asymptomatic or present with extraintestinal manifestations.

"Our finding of a higher prevalence of tTGA antibodies in migraine patients suggests that an association between migraine and celiac disease might exist in the pediatric age group," the investigators conclude, "and that further studies should be performed."

Bonnie - not surprising. I find that migraines are a common symptom of gluten intolerance or celiac in my clients.

Health facilities flush estimated 250M pounds of drugs a year

U.S. hospitals and long-term care facilities annually flush millions of pounds of unused pharmaceuticals down the drain, pumping contaminants into America's drinking water, according to an ongoing Associated Press investigation.

These discarded medications are expired, spoiled, over-prescribed or unneeded. Some are simply unused because patients refuse to take them, can't tolerate them or die with nearly full 90-day supplies of multiple prescriptions on their nightstands.

Few of the country's 5,700 hospitals and 45,000 long-term care homes keep data on the pharmaceutical waste they generate. Based on a small sample, though, the AP was able to project an annual national estimate of at least 250 million pounds of pharmaceuticals and contaminated packaging, with no way to separate out the drug volume.

One thing is clear: The massive amount of pharmaceuticals being flushed by the health services industry is aggravating an emerging problem documented by a series of AP investigative stories — the commonplace presence of minute concentrations of pharmaceuticals in the nation's drinking water supplies, affecting at least 46 million Americans.

Steve - the health services industry must be proactive in considering these medications as "medical waste." Our water treatment facilities need to update their ability to filter medication derivatives as well.