Thursday, October 30, 2008

USDA Publishes Proposed Amendment for Organic Livestock Farmers

The United States Department of Agriculture (USDA) has published a proposed amendment to the federal organic regulations that sets new grazing requirements for organic livestock and bans confined feedlots from the industry.

The USDA’s proposed rule clarifies requirements for organic livestock producers, principally dairy farmers, requiring their animals to graze on pasture and consume a significant percentage of their feed intake during the growing season. The rule also proposes expanding the definition of livestock to include bees and aquatic animals.

According to the Organic Trade Association (OTA), this regulation will continue to reinforce for shoppers that organic dairy products and beef, for example, are from animals that are receiving proper feed, access to fresh air and sunshine, and well-managed living conditions.

"Organic production is about continuous improvement of farms and the environment, and this proposed regulation is the next step in improvements for organic dairy, beef, lamb and goat production in the United States,” said Christine Bushway, OTA's executive director.

The Cornucopia Institute, however, has brought to light some concerns about the new proposal from past chair and member of the National Organic Standards Board (NOSB), Jim Riddle.

“While I appreciate the fact that the USDA has issued proposed rules to clarify pasture requirements, based on NOSB recommendations, I am very concerned about the proposed language on dairy replacement animals,” said Riddle.

Added Riddle, “The proposed change, contrary to language recommended by the NOSB, would institutionalize the current two-track system, which allows certain operations to continually bring in conventional heifers, while other operations are required to use only replacement heifers that have been raised organically from the last third of gestation. There should be one standard for all organic dairy farms, once they have converted to organic production.”

USDA is accepting public comments on the proposed regulations until December 23.

FDA Amendment to Include Vitamin D in Osteoporosis Claims

Effective January 1, 2010, the Food and Drug Administration (FDA) amended its label regulation authorizing a health claim on the relationship between calcium and a reduced risk of osteoporosis to include vitamin D.

Manufacturers will be able, under these new rules, to recreate product labels to add health claims to their products that qualify or reformulate products (by fortifying with calcium or vitamin D) to qualify for the health claims.

The FDA solicited comments on the calcium and vitamin D proposed rule, with the comment period closing on March 21, 2007.

Wednesday, October 29, 2008

Take Nexium to reduce aspirin-related ulcers!

Regular low-dose aspirin, taken typically to ward off a heart attack, may increase the risk of developing stomach ulcers, but this can be counteracted by taking another pill -- esomeprazole, more familiarly known as Nexium.

That finding comes from a study reported in the American Journal of Gastroenterology. Esomeprazole is a proton pump inhibitor, meaning that it suppresses gastric acid.

Bonnie - what an ideal scenario (snicker, snicker)! Mask the symptoms of aspirin with another drug that suppresses stomach acid. Of course, it was never mentioned in the study that stopping the aspirin may be a better alternative. In addition, all proton pump inhibitors destroy B-12 over time and make individuals more prone to opportunistic pathogens such as H. Pylori, a known cause of ulcers.

Tuesday, October 28, 2008

Epigenetics, Development, and the Kidney

"How cells partition the genome into active and inactive genes and how that information is established and propagated during embryonic development are fundamental to maintaining the normal differentiated state. The molecular mechanisms of epigenetic action and cellular memory are increasingly amenable to study primarily as a result of the rapid progress in the area of chromatin biology. Methylation of DNA and modification of histones are critical epigenetic marks that establish active and silent chromatin domains. During development of the kidney, DNA-binding factors such as Pax2/8, which are essential for the intermediate mesoderm and the renal epithelial lineage, could provide the locus and tissue specificity for histone methylation and chromatin remodeling and thus establish a kidney-specific fate. The role of epigenetic modifications in development and disease is under intense investigation and has already affected our view of cancer and aging." J Am Soc Nephrol 19: 2060-2067, 2008

Steve - translation: the bridge between our lifestyle and genes is epigenetic. Negative expression of our genes can be controlled epigenetically if we make proper lifestyle choices. This begins prenatally, throughout pregnancy, into early childhood, and beyond. Lifestyle choices do not just affect you, but the next generation after you, and several after that. While it seems almost too much of a burden to bear, the research is making the picture clearer nevertheless.

Kidney Stones Cases Rise in U.S. Children

To the great surprise of parents, kidney stones, once considered a disorder of middle age, are now showing up in children as young as 5 or 6. While there are no reliable data on the number of cases, pediatric urologists and nephrologists across the country say they are seeing a steep rise in young patients. Some hospitals have opened pediatric kidney stone clinics.

The increase in the United States is attributed to a host of factors, Poor diet is the leading cause of kidney stones, which are crystallizations of several substances in the urine. Stones form when these substances become too concentrated. Forty to 65 percent of kidney stones are formed when oxalate, a byproduct of certain foods, binds to calcium in the urine. (Other common types include calcium phosphate stones and uric acid stones.) And the two biggest risk factors for this binding process are not drinking enough fluids and eating too much salt; both increase the amount of calcium and oxalate in the urine. Excess salt has to be excreted through the kidneys, but salt binds to calcium on its way out, creating a greater concentration of calcium in the urine and the kidneys.

Experts mentioned not just salty chips and French fries, but also processed foods like sandwich meats; canned soups; packaged meals; and even sports drinks like Gatorade, which are so popular among schoolchildren they are now sold in child-friendly juice boxes. Children also tend not to drink enough water.

A common misconception is that people with kidney stones should avoid calcium.

Bonnie - low levels of B-6 and magnesium prevent kidney stones. Highly processed foods contain very little, if any, of these key nutrients.

Prostate Cancer Prevention Study Shows No Benefit for Use of Selenium and Vitamin E

Initial, independent review of study data from 35,000 men 50 and older from the Selenium and Vitamin E Cancer Prevention Trial (SELECT), funded by the National Cancer Institute (NCI), shows that selenium and vitamin E supplements, taken either alone or together, did not prevent prostate cancer over a five year period.

Bonnie - I cannot acknowledge any result from this study because it was flawed from the beginning:
  1. 200 mcg. selenium is a very small dose when gauging therapeutic value. Regardless, it is intended to be a complementary trace mineral for prostate health because it cannot be taken in large amounts due to toxicity issues.

  2. The vitamin E used in the trial was 400IU dl-alpha tocopherol, which is a synthetic form of vitamin E. Anyone knowledgeable health professional understands that synthetic E is worthless. In addition, most positive vitamin E research has predominately used mixed tocopherols, which compromises alpha, beta, gamma, and delta tocopherols; not just alpha alone. It has long been known that all four tocopherols need to work in unison for optimum effectiveness.
Will we see or hear about these two humongous flaws in the study? Probably not.

Monday, October 27, 2008

Facts About Today's Food Supply

Consuming a balanced diet that meets the recommended servings of fruits, vegetables, whole grains, essential fatty acids and lean sources of protein still may not ensure ample nutrient intake due to changes in our food supply.

Changes in the average nutrient content of 43 fruits and vegetables between 1950 and 1999 resulted in the following:

• 6% decrease in protein
• 16% decrease in calcium
• 9% decrease in phosphorus
• 15% decrease in iron
• 38% decrease in riboflavin
• 20% decrease in ascorbic acid

Food quality changes like these are the result of multiple factors:

Storage time and maturity at harvest
Nutrients can be harmed during storage or transportation. Storing tomatoes for 5 days decrease ascorbic acid by almost 13%. Harvesting plants prior to proper maturity diminishes nutrient content potential, particularly for fiber, vitamin A, vitamin C and polyphenols.

Genetic selection
Modern fruits and vegetables are genetically selected, and in some cases modified, for shelf life, high yield or other growth characteristics rather than their ability to extract or synthesize nutrients from the environment.

Atmospheric CO2
An increased level of CO2 in the atmosphere, due to pollution, decreases the nitrogen, potassium, magnesium and protein content of plants.

Fertilization quality
Fertilization of the soil with isolated key nutrients such as nitrogen, phosphorus and potassium, as opposed to more comprehensive fertilizers, can alter the composition of plants and lead to nutrient losses. For example, plants raised on high-potassium soil have higher levels of potassium, but reduced levels of calcium and magnesium.

Growing region
Differences in climate and soil type can cause large variations in nutrient content. Calcium-rich soil will produce plants higher in protein, while potassium-rich soils produce plants higher in carbohydrates. Regional rainfall can create wide variations in vegetable mineral composition, particularly for calcium, magnesium and potassium.

Farming practices
Free-range animals produce meat with significantly higher levels of omega-3 fatty acids and conjugated linoleic acid. Dairy products made from grass-fed animals are also higher in vitamin A, E and beta-carotene. Unfortunately, most farm animals are restricted to feedlots and given regular hormone or antibiotic treatments, resulting in meat containing lower levels of these critical nutrients.

Industrial waste and contamination
Chemical residues and industrial waste, including heavy metals, pollute the land, water and food supply. Most of us carry a significant body burden of pesticides and pesticide metabolites.

Conclusion
Unlike foods, supplements also have the benefit of providing consistent levels of vitamins and minerals. Beyond the food supply, there are myriad reasons for taking supplements which we have discussed incessantly: stress, nutrient-depleting meds, genetic variables, environment, chronic or acute disease, etc.

Going Loco for Local.

Locally grown food tastes better.
Food grown in your own community is usually picked within the past day or two. It’s crisp, sweet, and loaded with flavor. Produce flown or trucked is much older. Several studies have shown that the average distance food travels from farm to plate is 1,500 miles.

Local produce is better for you.
Fresh produce loses nutrients quickly. Locally grown food, purchased soon after harvest, retains its nutrients.

Local food preserves genetic diversity.
In the modern industrial agricultural system, varieties are chosen for their ability to ripen simultaneously and withstand harvesting equipment. Only a handful of varieties of fruits and vegetables meet those rigorous demands, so there is little genetic diversity in the plants grown. Local farms, in contrast, grow a huge number of varieties to provide a long season of harvest, an array of eye-catching colors, and the best flavors.

Local food is GMO-free.
Although biotechnology companies have been trying to commercialize genetically modified fruits and vegetables, they are currently licensing them only to large factory-style farms. Local farmers don’t have access to genetically modified seed, and most of them wouldn’t use it even if they could.

Local food supports local farm families.
With fewer than 1 million Americans now listing farming as their primary occupation, farmers are a vanishing breed. Local farmers who sell direct to consumers cut out the middle man and get full retail price for their crops.

Local food builds a stronger community.
When you buy direct from the farmer, you are re-establishing a time-honored connection between the eater and the grower.

Local food preserves open space.
As the value of direct-marketed fruits and vegetables increases, selling farmland for development becomes less likely. The rural landscape will survive only as long as farms are financially viable.

Local food helps to keep your taxes in check.
Farms contribute more in taxes than they require in services, whereas suburban development costs more than it generates in taxes.

Local food supports a clean environment and benefits wildlife.
A well-managed family farm is a place where the resources of fertile soil and clean water are valued. Good stewards of the land grow cover crops to prevent erosion and replace nutrients used by their crops. Cover crops also capture carbon emissions and help combat global warming.

Local food is about the future.
By supporting local farmers today, you can help ensure that there will be farms in your community tomorrow, so that future generations will have access to nourishing, flavorful, and abundant food.

5 Most Dangerous Food Additives.

If you see the following ingredients in your pantry or at the grocery store, throw out and avoid.
  1. Artificial Sweeteners - Aspartame harms nerve cells because when broken down in the body, it turns into formic acid and formaldehyde; sucralose, saccharin, acesulfame-K, neotame, and others are no better.

  2. Trans Fats - hydrogenated oils, shortening; added to baked goods and processed foods to increase shelf life; some labels say "zero trans fats" but legally may still contain 0.5 grams; creates a host of inflammatory-related diseases.

  3. Monosodium Glutamate (MSG) - flavor enhancer added to foods to enhance salty taste; causes neurologic, cardiac, and digestive issues; found in countless foods, including soups, ethnic foods, salad dressings, and many vegetarian items. Beware of hidden MSG under the names yeast extract, hydrolyzed vegetable protein (anything hydrolyzed), plant protein extract, sodium caseinate, calcium caseinate, textured vegetable protein, autolyzed yeast, torula yeast, malt extract; MSG also appears as natural flavorings and spices in some cases (you must trust the brand to be MSG-free).

  4. Nitrates/Nitrites - chemicals added to processed meats to make salty and appear red in color; carcinogenic and allergenic.

  5. Artificial Food Colors & Flavors - you may see the word F.D.&C. Yellow, red Dye 40, blue 1, etc.; linked to cancer, allergy, nausea; just one color additive can cause behavioral disorders in children; banned in Europe, but availble in foods, medications, and cosmetics in US.

Honorable Mention -

  1. High Fructose Corn Syrup - processed sweetener that is much cheaper than sugar; indicated in obesity and diabetes; worse than any other conventional sweetener, despite what The Corn Refiners Association's PR campaign leads you to believe.

  2. Acrylamide - chemical produced during high temperature cooking in foods such as french fries, cakes, and snack foods; considered "probable" in relation to several forms of estrogen-receptor positive cancers; chip companies Heinz, Frito-Lay, Lance, Proctor and Gamble, and Kettle Foods recently settled a lawsuit in California agreeing to lower levels of acrylamide in their foods; European Safety Authority has agressively reduced acrylamide levels in their food products.

FYI -
  • Many Florida oranges are dipped in artificial orange dye to make them more visually appealing.
  • There are many foods which are marketed as "healthy" or vegetarian/vegan foods that contain many of the aforementioned offending ingredients. Our Natural Foods Shopping List helps you avoid this, because we've screened the brands for you already.
  • Ahi Tuna, Sashimi Tuna, and Farmed Salmon are treated with artificial dye for color.

Osteoporosis drugs and irregular heartbeat

People who take bisphosphonates, drugs for prevention or treatment of osteoporosis may be at increased risk for atrial fibrillation, or irregular heartbeats, according to research presented today at a conference of the American College of Chest Physicians.

Atrial fibrillation can produce a variety of symptoms, including light-headedness, palpitations, chest pain, shortness of breath -- or no symptoms at all. The study involved more than 16,000 women ages 69 to 75, some of whom took bisphosphonates and some of whom took a placebo. Of those who took the real drugs, 2.5% to 3% experienced irregular heartbeats. For 1% to 2% of the women who took bisphosphonates, the episode was serious, resulting in hospitalization or death, according to the study. Overall, the women taking bisphosphonates were twice as likely to suffer a serious heartbeat irregularity.

It's not the first time the association has been made between the drugs and an irregular heartbeat. A study in the May 3, 2007, New England Journal of Medicine found that while the drugs reduced the risk of fractures, the researchers noted an increased incidence of atrial fibrillation in women getting a once-yearly infusion of bisphosphonates.

Bonnie - how many more studies are we going to have to read about until these class of drugs go away?

Friday, October 24, 2008

McDonald's tests steamer cooking

McDonald’s Corp. is in the early stages of testing a steamer that could cook shrimp, broccoli and oatmeal, indicating that such possible products “speak to a healthier and more expansive product focus going forward” for the world’s largest fast-food chain. Health-conscious menu offerings such as salads and snack wraps have played a critical role in the recent turnaround of Oak Brook-based McDonald’s. The steamer could also cook scrambled eggs in 10 seconds. McDonald’s also told analysts during a meeting Thursday about an energy-efficient fryer that uses 20% less energy and 40% less oil.

Steve - I'll believe when I see it. The wraps and salads (especially with dressings) are nothing to write home about. However, when McDonald's makes "improvements" to their menus, the competition often follows suit.


Large food companies add new nutritional label

Several of the largest U.S. food and beverage makers have agreed to implement a new nutritional labeling system on their packages aimed at helping consumers pick healthier food choices. The new Smart Choices symbol was developed by the companies, scientists, health organizations and others over the past two years that wanted to come up with one standard to identify healthier foods. The Smart Choices symbol will be placed on the front of packages of foods that meet certain criteria and will contain two simple pieces of information: calories per serving and the number of servings in a package. To qualify for the Smart Choices symbol, foods would need to meet certain benchmarks in limiting items like total fat, trans fat, sodium and added sugars, while also containing beneficial items like fiber, calcium and certain vitamins. Among companies that will use the symbol are Coca-Cola Co, General Mills Inc, Kellogg Co, ConAgra Foods Inc, Kraft Foods Inc, PepsiCo Inc and Unilever, as well as retailer Wal-Mart Stores Inc. The Smart Choices label will begin appearing on packages in the middle of 2009.

Steve - huh? Nutritional labeling system created by the companies that make the products? Isn't that convenient. I cannot wait to see what is considered a "Smart Choice."

Wednesday, October 22, 2008

Reports of serious drug reactions hit record

The number of serious problems and deaths linked to medications reported to the government set a record in the first three months of this year, a health industry watchdog group said Wednesday. The Food and Drug Administration received nearly 21,000 reports of serious drug reactions, including over 4,800 deaths, said an analysis of federal data by the nonprofit Institute for Safe Medication Practices, which scrutinized data going back to 2004, and yearly totals dating to the 1990s. Two drugs accounted for a disproportionately large share of the latest reports. One was heparin, the tainted blood thinner from China that caused an international safety scandal. The other was Chantix, a new kind of anti-smoking drug from Pfizer. Chantix, which had the most reports of any medication, works directly in a smoker's brain to ease withdrawal symptoms. It also blocks the pleasurable effects of nicotine if the patient tries to light up again. But earlier this year, the FDA warned that Chantix may be linked to psychiatric problems, including suicidal behavior and vivid dreams. The government banned it for pilots. Pfizer said Wednesday it stands by Chantix, and that the volume of reports might be linked to publicity about the drug's side effects. The FDA had no immediate response to the report. The watchdog group, known as ISMP, has served hospitals and pharmacists for years as a clearinghouse for information on drug safety and medication errors. It is now reaching out to consumers with regular reports on drug safety trends, drawn from FDA records. "We believe that one of the most important tools to promote is to monitor trends on a regular basis," said Thomas J. Moore, a senior scientist with the group. "Knowing which drugs are causing injuries and how many people are being hurt is the raw material we need to fashion sound measures to promote patient safety." The FDA defines serious drug reactions as ones that cause hospitalization, require medical intervention, or place a life in jeopardy. The agency's monitoring system relies on voluntary reports from doctors and is only believed to capture a fraction of overall problems. The total of 20,745 cases reported from Jan.-March was 38 percent higher than the average for the previous four calendar quarters, and the highest for any quarter, the report said. Fatalities accounted for 23 percent of the cases. The total number of deaths, 4,824, was an increase of nearly 3 percent from the last calendar quarter of 2007. Previous research from ISMP has shown that serious drug safety problems reported to the FDA increased markedly from 1998-2005. The FDA case reports provide a signal of possible problems with a drug, but a cause-and-effect connection can only be established through painstaking investigation. If the FDA were a police agency, the reports would indicate "probable cause," but not neccesarily "guilt beyond a reasonable doubt." The ISMP study found that heparin accounted for 779 reports of serious problems, including 102 deaths. The FDA, using data that covers a longer time period has reported 238 deaths possibly linked to heparin. Heparin "illustrates an example of a significant drug safety problem that was promptly and effectively resolved by the drug manufacturers and the FDA once the issue was detected and understood," the report said. Not so with Chantix, it concluded. The FDA should forcefully warn patients taking Chantix that they may have blackouts and other problems that could lead to accidents, the report said. The current warnings say that patients may be too impaired to drive or operate heavy machinery, but such language is standard for many medications. The report found 15 cases of Chantix patients who appeared to have been involved in traffic accidents, and 52 additional cases involving blackouts or loss of consciousness. The FDA received 1,001 reports of serious injuries possibly linked to Chantix, more than for the ten best-selling brand name drugs combined. Chantix "continued to provide a striking signal of safety issues that require investigation and action," the report said. The authors acknowledged Pfizer's concern that publicity may be driving up the number of reports, but nonetheless concluded that there are enough to warrant further action by the FDA. Pfizer said the total sum of its data on Chantix, including results from clinical trials, show that the drug's benefits clearly outweigh its risks. "We stand by the efficacy and safety profile of Chantix," the company said in a statement. "There are few things that provide greater health benefits than quitting smoking. Pfizer is committed to reducing the prevalence of smoking globablly. As part of that mission, we want to increase peoples' understanding of the dangers of smoking and the benefits of quitting."

IBD, Liver Disease Patients Show Vitamin D Deficits

People with inflammatory bowel disease or chronic liver disease may be at increased risk of developing vitamin D deficiencies. Two separate studies, presented recently at the American College of Gastroenterology annual meeting, suggest that patients with certain digestive diseases should have their vitamin D levels regularly monitored. In the first study of 504 people with inflammatory bowel disease, researchers at the Medical College of Wisconsin found almost half were vitamin D-deficient at some point, with 11 percent being severely deficient. In patients with Crohn's disease and ulcerative colitis, low levels of vitamin D were linked to increased disease activity. Based on responses to patient questionnaires, those with Crohn's also had a worse quality of life compared to those with the disease who had sufficient levels of vitamin D. In the other study, researchers from University of Tennessee in Memphis found more than 92 percent of 118 chronic liver patients studied had some level of vitamin D deficiency, with a third being severely deficient. The patients included those with hepatitis C and/or cirrhosis.

Bonnie - when you have severe digestive conditions such these, your ability to absorb nutrients suffers greatly. The results of these studies are not shocking. It confirms yet again why it is imperative to add supplemental nutrients, including vitamin D to the healthy as well as the sick.

Food allergies increasing in US kids

Food allergies in American children seem to be on the rise, now affecting about 3 million kids, according to the first federal study of the problem. About 1 in 26 children had food allergies last year, the Centers for Disease Control and Prevention reported Wednesday. That's up from 1 in 29 kids in 1997. The 18 percent increase is significant enough to be considered more than a statistical blip, said Amy Branum of the CDC, the study's lead author. Nobody knows for sure what's driving the increase. Children seem to be taking longer to outgrow milk and egg allergies than they did in decades past. Children with food allergies also were more likely to have asthma, eczema and respiratory problems than kids without food allergies, the CDC study found, confirming previous research. The study also found that the number of children hospitalized for food allergies was up. The number of hospital discharges jumped from about 2,600 a year in the late 1990s to more than 9,500 annually in recent years, the CDC results showed. Details from the federal study http://www.cdc.gov/nchs/data/databriefs/db10.htm.

Bonnie - of course this is no surprise to us. Food allergies, which cause strong, sometimes life-threatening reactions, have been on the rise for years. However, what is not mentioned in this report, and sooner or later will become a major issue, is food intolerance. Many more children, and adults for that matter, have food intolerances, which are toxic reactions to food that create more minor, yet chronic symptoms that can accumulate and cause a slew of health issues.

I love how these federal officials cannot explain the rise in food allergies. It is so simple. As our diet has become more Western, homogenized, and cash crop-laden, food allergies have increased. As long as our diet is dominated by dairy, wheat, soy, and corn, the number of Americans with food allergies and intolerances will continue to rise.

Tuesday, October 21, 2008

Safety a problem for new generation drugs

Nearly a fourth of widely used new-generation biological drugs for several common diseases produce serious side effects that lead to safety warnings soon after they go on the market. Included in the report were the arthritis drugs Humira and Remicade, cancer drugs Rituxan and Erbitux, and the heart failure drug Natrecor.

The new study is the first comprehensive examination of these newer medicines, a driving part of the biotech revolution. The drugs are known as biologicals because they're made from living material and they typically affect the body's disease-fighting immune system. Many relieve severe symptoms by suppressing that system. It's that same mechanism that can result in side effects often not seen with traditional chemical-based medicines, said Dr. Charles Bennett, a Northwestern University drug safety expert.

The study appears in Wednesday's Journal of the American Medical Association. It involved 136 biologics approved in the United States and 105 in the European Union between January 1995 and June 2007. A total of 41, or nearly 24 percent, got safety warnings issued through June 2008. The results are a concern, and they underscore the need for closer scrutiny of drugs after their approval, Researchers said the study also is reassuring because most problems showed up relatively soon after the drugs became available, which minimized the potential for widespread harm.

Bonnie - it is not reassuring that the problems show up relatively soon after approval. They should be showing up before approval!

This is why I have a "wait 1-2 years rule for new meds."

10 Things to Know About Assisted Living

Steve - to echo what we alluded to in Assisted Living Fails to Make the Grade, there was a piece in the New York Times which offers helpful tips for dealing with Assisted Living. Unfortunately, the one thing left out was proper diet and nutrients.

Dr. Cheryl Woodson is a seasoned geriatrician in Chicago Heights, Ill., who has found that she can no longer afford to accept new Medicare patients.

She is also a blunt and funny woman who liberally dispenses wisdom to her elderly patients and their adult children, and herself a daughter who cared for her own mother with Alzheimer’s disease for a decade. Here’s some of Dr. Woodson’s advice on navigating the caregiving maze, which I culled both from her book, “To Survive Caregiving,” and from observing her during a recent day-long visit to her office.

1. Assisted living, a popular solution for elderly people who cannot live independently, is a “myth,” Dr. Woodson said, “a place for people who don’t exist.” Families often believe these facilities will meet all of their loved ones’ needs, enabling caregivers to focus on jobs and family, only to find this isn’t the case. Before long, the elderly resident will require more than “meals you don’t have to cook, grass you don’t have to cut and socialization,” Dr. Woodson said. At that point the elderly resident is in trouble, since assisted living facilities are not permitted by law to provide medical care and consider it to be the family’s responsibility.

2. Squaring a family’s expectations with those legal limits would require a thorough, first-hand assessment of the elderly person’s physical and cognitive health before admission to an assisted living facility. That rarely happens. New residents are admitted based on a report from their current physicians, who may not be qualified to diagnose the early signs of dementia and impending immobility or may sugarcoat the situation in order to help a desperate family. “They just need a little help,” the usual rationale for accepting elderly prospects into assisted living, is ridiculous on its face, Dr. Woodson said. “If they just needed a little help, they’d still be in the community.”

3. Instead, without verifying the physician’s report or the family’s representations, these facilities may admit residents who already need help with simple tasks like dressing or eating, or will in the very near future, and then charge extra for these services. Some do this to fill empty beds; others give residency a shot as a kindness to desperate families, Dr. Woodson said. But when the resident declines, as all of them will unless they die suddenly, more and more a la carte services mean a bigger and bigger monthly bill, or more and more work for family members who expected the opposite.

4. Coordinating all the services that the assisted living facility doesn’t provide generally falls to one sibling, Dr. Woodson noted, who then becomes overwhelmed, sacrificing more than should be expected. The solution is hiring a geriatric care manager — “They should be called rent-a-daughters,” Dr. Woodson said — adding further to the expense, until the resident and family can no longer afford this kind of accommodation and are forced to consider a nursing home.

5. Most families balk at the prospect of transferring an aging parent to a nursing home because they like the aesthetics of assisted living — the carpeted floors, overstuffed chairs and crystal chandeliers. But without round-the-clock care, many residents are “as alone at night as if they were in their own homes,” Dr. Woodson said. Other families are unwilling to break a promise to Mom or Dad never to put them in a nursing home. The spirit of that promise — to give a parent the best possible care — is what matters, Dr. Woodson said, “and sometimes that means not doing it yourself.” An aging parent’s condition may eventually require three shifts of nurses and aides, not a family member trying to take care of everything 24/7.

6. The doctors who see residents at assisted living facilities are essentially freelancers, not employees, since their fees are paid by Medicare and they also may maintain private practices. So rather than hang around the facility expecting them to answer your questions on the fly, Dr. Woodson suggested calling and arranging to see them “by appointment, not by ambush.” This consultation will not be covered by Medicare unless it coincides with a medical procedure for the resident. Still, it is essential in order to stay on top of an elderly person’s medications, some of which may be unnecessary and even dangerous, and to make decisions about which medical care improves the quality of life and which is pointless and wasteful.

7. If a parent lives in an assisted living facility, families should closely monitor the monthly pharmacy bill, less for cost than for content. Is Xanax being prescribed for anxiety? There are numerous other remedies available without the potentially dangerous side effects. What about muscle relaxants for arthritic pain? They increase confusion in the elderly and add to the risk of falls; instead, ask for pain medication and/or a heating pad. If the assisted living facility offers to have prescriptions filled and delivered by a local pharmacy — a huge convenience for family members — be sure it’s a pharmacy that insists upon periodic blood work or other tests for drugs that are supposed to be closely monitored.

8. The goal of medical care for the elderly, in Dr. Woodson’s view and the view of every geriatrician I’ve ever interviewed, is to make day-to-day life more comfortable, not to cure illness or extend longevity. Examples? A joint replacement to relieve pain and improve mobility makes sense only if the patient has the cognitive ability to complete physical therapy. Otherwise, he or she will never walk again and would be better off avoiding surgery and simply being kept comfortable. Similarly, anyone who would refuse cancer treatment because of advanced age probably doesn’t need a mammogram, Pap smear or colonoscopy. “Why draw a map to someplace we know we’re not going?” Dr. Woodson asked.

9. Apply similar standards to immunizations and vaccinations. If someone is so ill or disabled that death would be welcome, refuse the vaccine for pneumonia, long known as “the old person’s friend.” But never say no to the shingles vaccine, which can prevent an excruciating rash. “Even if someone was only going to live five more minutes, that’s the one thing I’d suggest,” Dr. Woodson says. “It’s a quality-of-life issue.”

10. Do not assume that the presenting symptom of Alzheimer’s disease will be forgetting words, losing things or other obvious examples of short-term memory loss. Often the first thing a family member will notice is an empty checking account, Dr. Woodson said, because a normally cautious and frugal person has been tricked by a get-rich-quick scheme or other scam. And like missing money, look out for pills missing from those seven-day dispensers that help people with multiple medications keep track of what they’re taking and when. Family members may find the dispensers empty and worry about overdose, Dr. Woodson noted, but often the missing pills will turn up under couch cushions or scattered elsewhere around the house. Take this as a cue that it may be time for a cognitive assessment.

Magnet device aims to treat depression

The government has approved the first noninvasive brain stimulator to treat depression — a device that beams magnetic pulses through the skull. If it sounds like science-fiction, well, those woodpecker-like pulses trigger small electrical charges that spark brain cells to fire. Yet it doesn't cause the risks of surgically implanted electrodes or the treatment of last resort, shock therapy.

Called transcranial magnetic stimulation or TMS, this gentler approach isn't for everyone. The Food and Drug Administration approved Neuronetics Inc.'s NeuroStar therapy specifically for patients who had no relief from their first antidepressant, offering them a different option than trying pill after pill. "We're opening up a whole new area of medicine," says Dr. Mark George of the Medical University of South Carolina in Charleston, who helped pioneer use of TMS in depression. "There's a whole field now that's moving forward of noninvasive electrical stimulation of the brain." While there's a big need for innovative approaches — at least one in five depression patients is treatment-resistant — the question is just how much benefit TMS offers. The FDA cleared the prescription-only NeuroStar based on data that found patients did modestly better when treated with TMS than when they unknowingly received a sham treatment that mimicked the magnet.

For a more clear answer, the National Institutes of Health has an independent study under way now that tracks 260 patients and may have initial results as early as next year. Quantifying the benefit is key, considering the price tag. TMS is expected to cost $6,000 to $10,000, depending on how many treatments a patient needs, says Dr. Philip Janicak of Rush University Medical Center in Chicago, who helped lead the NeuroStar study. That's far more expensive than medication yet thousands of dollars cheaper than invasive depression devices.

Bonnie - like with any new treatment, I tell my clients to take a wait and see approach. In this case, I would wait for the NIH study results to come out as well as track its effectiveness at Rush Chicago. It does seem promising as well as safe.

Monday, October 20, 2008

Education protects against Alzheimer's impact

Mentally demanding jobs and more education appear to protect people from the memory loss associated with Alzheimer's disease, Italian researchers said on Monday. The findings bolster the previous research about Alzheimer's and other forms of brain impairment, said Valentina Garibotto of the San Raffaele University and Scientific Institute and the National Institute of Neuroscience in Milan, Italy. "The theory is that education and demanding jobs create a buffer against the effects of dementia on the brain, or a cognitive reserve," Garibotto said in a statement. "Their brains are able to compensate for the damage and allow them to maintain functioning in spite of damage." The study published in the journal Neurology involved 242 people with Alzheimer's, 72 men and women with mild memory problems and 144 volunteers with no memory problems.

Steve - yet another study lauding the benefits of preventative techniques for combating Alzheimer's.

Why aging is putting more people at risk for developing allergies

By Kelly Greene
Wall Street Journal

Not everybody outgrows a stuffy nose. Oren Cline, an 87-year-old retired accountant in Hickory, N.C., checks his computer every morning "to see what the pollen situation is for the next four days. When the pollen's bad, I don't go outdoors," he says. "My allergies have gotten worse as I've gotten older." The traditional view that allergies and asthma wane with age is falling to the wayside. Allergies affect 17% to 20% of the U.S. population, and that proportion doesn't decrease with age. In fact, symptoms in many cases worsen, or erupt for the first time in later life, says Karen Calhoun, chairman of the University of Missouri School of Medicine's otolaryngology department in Columbia, Mo. She is also president of the American Society of Geriatric Otolaryngology, a group formed two years ago, in part, to focus on the problem. "We have patients come in all the time and say, 'How can I have allergies? I'm 65 years old, and I've never had allergies before,' " Dr. Calhoun says. "They hit a threshold where they can't ignore the symptoms anymore."

At the other extreme, some older patients fail to get treatment, chalking up their symptoms to "aging," says James Pacala, a geriatrician and associate professor at the University of Minnesota Medical School in Minneapolis. "It won't even occur to them that allergies might be the problem," Dr. Pacala says. The reasons for an allergy flare-up in later life can include a move to a new part of the country, an accumulation of exposures in one location, changes in one's health, and genetics. "If you have one parent who's allergic, you have about a 40% chance of developing allergies; if you have two parents with allergies, there's a 60% chance," Dr. Calhoun says. Relocating to a mild climate -- where pollen is prevalent nearly year round -- is a common trigger. It can take a few years for the body to build up what are called reactive cells to an irritant, but once that happens, flare-ups can start.

"I saw a lady yesterday who moved here from upstate New York, and her first complaint was allergies," says Jeff Williamson, head of geriatric medicine at Wake Forest University School of Medicine in Winston-Salem, N.C. Sometimes, cutting back on travel can create a problem, too. Mr. Cline, the retired accountant in North Carolina, used to find relief for his allergies in Arizona, where he would head during the spring. But now he lives in an assisted-living apartment closer to family and relies instead on air filters and homeopathic remedies for relief.

Surprisingly, living amid a lifetime of possessions -- favorite books and furniture, for example -- can aggravate allergies to mold and dust. Doctors refer to it as the "lifetime load" theory. "With aging and allergies, one thought is that the sheer duration and breadth [of] stuff you get exposed to over life have a cumulative effect that winds up eventually sensitizing the body's immune system -- and creating an allergy you didn't have before," Dr. Pacala says.

Physiological changes in the body can unmask symptoms, too. The amount of water in the body generally decreases with age, which in turn decreases the action of tiny hairs, called cilia, in the nose that help wash it out. There's less blood flow to the nose as you get older, too, due to a variety of vascular conditions. "All of that ends up drying your passageways, producing more inflammation, and making you stuffy," Dr. Pacala says. Cumulative damage to the nose, including polyps and bent cartilage, contributes as well.

Scientists also are starting to look at the impact of menopause and hormone-replacement therapy. There's not much research yet, but a few studies point to hormone-replacement therapy as a factor in wheezing and asthma, in which the inflammation moves to the lungs. Hormone-replacement therapy was associated with asthma-like symptoms among women, particularly in those with a low body-mass index, according to study results published in the journal Allergy in January. A study two years ago of more than 2,000 Scandinavian women found that hormone-replacement therapy was associated with an increased risk for asthma, wheezing and hay fever.

Diagnosing allergies among older patients can be tricky. One problem has been the standard skin-prick test. "As people get older, their skin changes and is less reactive" to such testing, Dr. Calhoun says. She used a different form of testing -- an intradermal, or skin-puncture, test that goes deeper -- and found the incidence of allergies "almost exactly the same" among 100 people over age 60 as it was among 200 people under age 45. "The older folks tended to be a little more allergic to mold, maybe because of longer exposure and older household goods," she says. Another problem: Doctors simply don't think to ask older patients about allergies or postnasal drip, which could be chaining people to their homes and their tissues. To be fair, that's because physicians typically are busy treating acute health problems among older patients, such as heart disease. But treating allergies may have a bigger impact on a patient's lifestyle. "Rhinitis is something that's frequently lower on a doctor's list than a patient's," Dr. Pacala says. "My father's 82, and he has developed this constantly runny nose, and it drives him crazy. You go out into the world, and you're constantly having to wipe your nose. It's a drag."

Doctors also find it difficult, at times, to sort out allergy symptoms from those indicative of other medical problems. "Breathing difficulties can indicate allergies, an infection, emphysema or pulmonary fibrosis, and all the heart problems that can cause breathing difficulties, like cardiac asthma or heart failure," Dr. Pacala says. "When a person comes to me with breathing complaints, I'm going to rule out the really bad things first, then go down the list. It can be very difficult to disentangle" allergies from asthma, he adds.

Medications, too, can trigger side effects that include nasal symptoms, breathing problems or a cough. Ace inhibitors -- commonly used to treat coronary disease, diabetes and high blood pressure -- can lead to a dry cough, Dr. Pacala says. And beta blockers, which "do really good things for the heart and blood pressure, tend to constrict the airways in the lungs," he adds.

So, what's the best way to deal with allergies in later life? First, actually deal with them. "It's easy enough to find out if you are or are not allergic," Dr. Calhoun says. "If you have symptoms, find out and do what you need to get better. There's no need to suffer." Of course, that's easy to say and hard to do. One popular tool is a "neti pot," which "looks like an Aladdin lamp," Dr. Calhoun says. How it works: You pour saline in one side of the nose, and it comes out the other side. (YouTube has a number of entertaining videos that show how it's done.). "It's very effective," Dr. Calhoun says. "Let's say you're allergic to a particular mold. This one you're allergic to sticks to the mucus inside of the nose. If you can mechanically wash it away, it's not there anymore making your body react." Another basic fix that can bring great relief: a humidifier, particularly in the winter. "I have patients who come in with problems every October or November when the heat comes on," says Dr. Pacala, who practices in Minnesota.

Trying over-the-counter medications may seem like the simplest fix, but they can cause a number of disconcerting -- and sometimes hazardous -- side effects. At Wake Forest, Dr. Williamson's patient, for example, was taking Tylenol PM to deal with her allergies at night. "The morning after, she was dizzy, and she's really thin, which puts her at high risk for falling," he says. Watch out for first-generation antihistamines, such as diphenhydramine, the active ingredient in Benadryl, which can worsen memory conditions and cause confusion among people with mild Alzheimer's disease, as well as cause drowsiness, Dr. Pacala says. Alfa-adrenergic medications, such as Sudafed and Afrin nasal spray, shrink blood vessels to reduce stuffiness, but can exacerbate heart problems. The two types of medicine are often combined in cold preparations. In a man with an enlarged prostate, the combination can relax the bladder and cause the sphincter to clamp shut. "The next thing you know, he's in the emergency room with acute urinary retention," Dr. Pacala says.

Fortunately, newer drugs with less dire side effects can help alleviate symptoms. Second-generation antihistamines, including Zyrtec, Allegra, Clarinex and Claritin, "don't cause confusion or drowsiness as often," Dr. Pacala says. Nasal steroid sprays reduce inflammation, though they may take a while to start working. And there are other medications that "work at different spots of the process [in which] the allergen" triggers inflammation or irritation. Scientists are experimenting with anti-inflammatory drugs as they look for common links among allergic reactions, coronary disease and other health problems in which inflammation plays a role. Inhalers may work also, Dr. Pacala says, with nasal inhalers typically targeting seasonal allergies and oral inhalers targeting wheezing. "I've gotten burned a couple of times where I'm treating somebody for the wrong thing, and then I stick them on an inhaler and they get better."

Bonnie - once again, another allergy piece that completely omits food as an allergy/intolerant agitator. Unfortunately, Ms. Greene interviewed only conventional allergy professionals instead of delving a bit deeper.

Obesity 'lifts inflammation risk'

Obesity and lack of fitness raise the risk of illness by impacting negatively on the body's internal chemistry. A US team found levels of white blood cells were highest in men who were unfit and overweight. White blood cells are key to fighting infection, but high levels can be a sign of inflammation, which is linked to coronary heart disease. The study appears in the British Journal of Sports Medicine.

Steve - this should come as no surprise to any of us.

Fatty acids clue to Alzheimer's

Controlling the level of a fatty acid in the brain could help treat Alzheimer's disease. Tests on mice showed that reducing excess levels of arachidonic acid lessened animals' memory problems and behavioral changes. Writing in Nature Neuroscience, the team said fatty acid levels could be controlled through diet.

Researchers looked at fatty acids in the brains of normal mice and compared them with those in mice genetically engineered to have an Alzheimer's-like condition. They identified raised levels of arachidonic acid in the brains of the Alzheimer's mice. Its release is controlled by the PLA2 enzyme. The scientists again used genetic engineering to lower PLA2 levels in the animals, and found that even a partial reduction halted memory deterioration and other impairments.

In short, too much arachidonic acid might over-stimulate brain cells, and lowering levels allowed them to function normally.

Steve - keep in mind that this is only a mouse study. We rarely ever post non-human subject studies. HOWEVER! This study is incredibly important because it connects Alzheimer's directly to diet and inflammation. Arachidonic Acid is saturated omega-6 fatty acid. How long have we said that omega-6 fatty acids cause inflammation while omega-3 fatty acids reduce inflammation? How long have
we said that in most of the human population, the omega-6 to omega-3 ratios are highly skewed to our detriment (20:1 instead of 2 or 3:1)?

Foods High in Arachidonic Acid:
  • Red Meat
  • Organ Meats
  • Dairy
  • Egg Yolks
Why are these foods so high in AA? Because conventional livestock are fed grains that cause them to produce large amounts of omega-6 (corn and soy). When livestock are fed a genetically compatible diet (i.e. grass-fed beef, flax fed chickens), the omega-6 to omega-3 ratios are ideally balanced.

Additionally, Linoleic Acids are UNsaturated omega-6 fatty acids. While they are not implicated in this study, they do exacerbate the huge disparity in omega-6 to omega-3 ratios. Examples are:

  • Safflower oil
  • Sunflower oil
  • Corn oil
  • Soybean oil
We do not need human studies to confirm the terrible effect high omega-6 to omega-3 ratios have on humans. Let's make this an integral part of Alzheimer's awareness.

Friday, October 17, 2008

Adverse Effects

By Judith Warner
New York Times

I never fully appreciated myself until I lost myself.

And then, when I found myself again, I realized that I really was a prize.

This e-card-worthy sentiment washed over me on Wednesday, when I began to come out of a two-week immersion in what I can only describe as mild mental illness.

Otherwise put: I tried out a new migraine preventive medication, and lost a little bit of my mind.

I was trying out the new medication because my chronic headaches had become much worse again after a nine-month period in which, thanks to acupuncture, they’d gotten much better.

With acupuncture, I’d been able to lower my dosage of amitriptyline, an old tricyclic antidepressant now used to help manage migraines, by a third, and had, at the same time, reduced the frequency of my headaches by more than half.

I’d also, as a newly devoted patient of the Spectrum Center for Natural Medicine, turned into a greatly improved person.

I’d learned to lie, needles inserted, on a heated table, and look out a window for 20 solid minutes watching the clouds go by, totally at peace. I’d learned to relax to the sound of a gong.

I’d become a passionate devotee of Pema Chödrön, the Miss Porter’s School girl turned Buddhist nun, and had been lecturing friends on remaining “present” and “learning to stay.”

This new Zen-like quality actually led to a nasty fight down on a riverbank one warm day this past summer with my friend “D.”

I was standing in a shallow pool of pebbles trying to just Be, feeling the water around my feet and the wind on my cheeks, while she was feeling hot and complaining. Chief among her complaints: Dr. Phil had recently had the effrontery to invite someone on his show to talk about “The Power of Now.”

This had just made her sick.

“I have something to tell you,” I said.

Things did not go well from there.

(Full disclosure: while writing this, I had to email “D” for more information: “Remember when we had an argument down by the river about remaining present? Who was it you’d seen on Dr. Phil?”

“Eckhart Tolle,” she wrote back. “You would remember, if you had been … truly present.”)

I had even almost bought a crystal.

Then last month, my acupuncturist moved away. This was hard, and detrimentally affected my energy. My mother had a serious health scare, triggering one of those facing mortality moments that adversely affect everyone’s energy, too. Plus, I was given a do-or-die deadline on my three-years-overdue book on children’s mental health issues. And the economy collapsed.

Any one of these events could have been a migraine trigger. Together — combined, perhaps, with ragweed — they launched me right back to where I’d been one year ago, pre-acupuncture, in the darkest of the migrainous days, having headache after headache and popping pill after pill.

The only difference now was that my then-neurologist, too, had abandoned me. Sick of dealing with health insurance companies, he’d taken a job teaching and directing research at the National Institutes of Health. He hadn’t left me totally in the lurch. Before leaving, he’d given me the names of a number of good neurologists at a nearby teaching hospital.

“But you might not like their practice,” he said. He’d already gotten complaints. He ran an old-fashioned office; one doctor, one receptionist, one patient per appointment time. He usually ran late; he spent a lot of time talking during consultations.

If you asked him about drug side effects, he listed them for you. If you worried about them, he snapped at you.

“Maybe you’ll get them, maybe you won’t,” he said. “If you do, you’ll call me.”

He returned phone calls. He sometimes even answered his own phone.

“Will I have a heart attack and die if I take too many pills,” I once asked him about a certain medicine.

“You could take just one and have a heart attack and die, too,” he said.

This is why I trusted him.

The new neurologist’s office ran perfectly on time. All kinds of people were on hand to do all kinds of things with great efficiency and minimize the need for the doctor’s physical presence.

The new doctor wasn’t snappish. And he didn’t waste time on chitchat. I asked him for the drug I wanted, and he wrote a prescription. I asked about side effects. He said I shouldn’t have any.

I didn’t believe him.

I had already read the eight pages of tiny-type prescribing information on the new drug, which my old neurologist had thought I ought to try, too. Twenty-five percent of the patients who’d taken it in clinical trials had discontinued it due to adverse effects. In trials for migraine prophylaxis, 22 percent taking a therapeutic dosage had experienced “one or more cognitive-related adverse events” like difficulty with concentration, attention, memory and language.

But I didn’t say anything. I pride myself on not being one of those patients who walks into a doctor’s office with a ream of Internet printouts and cuts the doctor off at the knees.

And I wanted the drug to work. I really did. I particularly did because the new doctor told me that the one side effect I was likely to experience was weight loss (up to 25 pounds’ worth of weight loss), and the promise of weight loss (particularly the thrill of a health-threatening 25-pound weight loss!) sweetened the pot irresistibly.

The first week, on 25 milligrams, not much went wrong. I couldn’t concentrate, but then, I hadn’t been able to concentrate for the previous year, ever since I’d given up my eight-cups-of-coffee-a-day habit for the sake of fewer migraines. I was tired and a little bit irritable, but that wasn’t so unusual, either. I did have the strange experience of having a supermarket checkout clerk stop his work to ask me if I was O.K., when I raised my hands to my face to cool my cheeks, which were suddenly burning, and then to have my husband Max and the girls echo his words, as I made the same gesture nightly at dinner, but I assured them that I was indeed O.K.

Everything was O.K., except that, as 25 miligrams turned into 50, such questions, coming more frequently, began to feel more and more like an insult to my integrity, an assault upon my honesty; they were an insinuation that I was lying about nothing being wrong.

And then everything began to get a little funky. Everything tasted bad. Everything became too much of an effort: working, not working, talking, listening, being with people, being alone. I couldn’t concentrate. I couldn’t sit still. I couldn’t tie one thought, word or sentence to another.

“What is wrong with you?” my daughter Julia finally snapped on Monday when we went out to lunch and she beat me in three straight games of tick-tack-toe. Bored with winning, she attempted to ask me the questions on a parent questionnaire that had come home in anticipation of teacher conferences.

What are your goals for your child in math this year?

“I hope she will learn what she needs to learn,” I said.

What concerns do you have about your child’s progress in math?

“I hope that she will make progress.”

“MOM!” she shouted. “Those aren’t answers.”

“I’ll try harder,” I said.

What concerns do you have about your child’s work habits?

“I hope,” I said, thinking hard, “that if I need to be concerned about her work habits, someone will tell me to be and then I will have concerns.”

You can imagine how this story ends. After all, here I am, stringing one word after the other. I left a message for the new neurologist at 8:45 on Tuesday morning. I said that I was having serious cognitive and mood-altering side effects.

Unable to work, I sat at my desk, by the phone, and waited.

At 4:30, I emailed Max: “I am going over to the neurologist’s office to blow my brains out. Please be sure to collect the life insurance and file an adverse event report with the F.D.A.”

“Sounds like a plan,” he replied.

The doctor’s office — that is to say a nurse — returned my call at 5:15. I had decided on my own by then to taper off my dosage but was still feeling wretched and wasn’t inclined to let her off the phone easily.

Didn’t doctors usually react quickly — and with some concern — when patients reported adverse drug reactions? (According to Sidney Wolfe, the director of the health research group at the non-profit Public Citizen, adverse drug reactions kill about 100,000 people a year and land 1.5 million in the hospital.)

Well, she said, not in this case. “It wasn’t something that was particularly unpredictable.”

No, it really wasn’t.

It isn’t unpredictable that a patient will get little or no information on drug side effects from her doctor — or any kind of real responsiveness if she has a bad reaction. Studies 20 years ago showed doctors to be particularly unresponsive when it came to such concerns, and there’s been no sign of progress since then, Wolfe told me. “There’s pitifully low awareness,” he said.

It doesn’t much matter in the grand scheme of things if someone semi-loses her mind, then gets it back again. The case isn’t one for the record books; that was made clear to me by the nurse, who eventually promised — the next day, when my powers of speech had been fully restored, along with my ability to effectively harangue — that she would indeed relay my story to the doctor.

But it’s scary to lose yourself, however unimportantly. Scarier still to think of what happens to those who don’t manage to save themselves.

Steve - I recommend reading comments by readers with personal experiences are worth a read at this link.
http://warner.blogs.nytimes.com/2008/10/16/adverse-effects-2/?dpc

Chicken soup may lower blood pressure

Courtesy of USA Today

Chicken soup, which has been dubbed Grandma's penicillin for its purported cold-fighting abilities, may also help to lower high blood pressure.

Japanese researchers have found that collagen proteins found in chicken may actually lower blood pressure. These collagens appear to act like the blood pressure medications called ACE inhibitors.

One caveat, though: it's the chicken, not the rest of the stuff in the soup, that may be medicinal.

"As this study suggests, some collagen in chicken may lower blood pressure," said Dr. Byron Lee, a cardiologist at the University of California, San Francisco, School of Medicine. "But be careful. The salt we put on our chicken and in our chicken soup may offset or even reverse this potential benefit."

The report will be published in the Oct. 22 issue of the Journal of Agricultural and Food Chemistry.

Bonnie - let's be crystal clear that these researchers are not referring to most commercial brands of chicken soup that contain a slew of sodium and chemicals. To take advantage of chicken soup, it needs to be either organic and low sodium if store-bought, or my first choice, homemade!

Pfizer to settle Celebrex and Bextra lawsuits

Pfizer Inc. has agreed in principle to pay $894 million to settle litigation related to its painkillers Celebrex and Bextra. The bulk of the settlement, $745 million, will resolve 90% of the known personal injury suits that allege the painkillers caused heart attacks and strokes, according to Pfizer, which will take a third-quarter pre-tax charge to earnings of $894 million, a statement provided by the company said.

Steve - now that Pfizer is settling to make all of this go away, it is another reminder for you to be extra cautious when your doctor wants to prescribe a new drug. As we have said for years, wait at least 1-2 years minimum until a drug is on the market before even thinking about taking it.

Soy reduces breast cancer risk by receptor status

Rather than protecting against all breast cancers, high levels of soy food consumption appears to specifically reduce the risk of estrogen receptor (ER)-positive tumors and human epidermal growth factor receptor 2 (HER2)-negative tumors, Japanese researchers report in the International Journal of Cancer.

Dr. Takeshi Suzuki, at Aichi Cancer Center Research Institute in Nagoya, and associates conducted a study of 678 women with breast cancer and 3,390 controls matched by age and menopausal status with no history of cancer.

The researchers "observed a significantly reduced risk" of breast cancer among the women who ate the most soy and were ER-positive, HER2-negative or both.

For women who ate the most soy compared with those who ate the least amount the odds of having ER-positive breast cancer were reduced by 26 percent and for women with HER2-negative breast cancer, the reduced risk was 22 percent.

Soy intake was not significantly associated with HER2-positive or ER-negative tumors, or with the presence or absence of the progesterone receptor (PR).

However, Suzuki's team found that "when the three receptors were jointly examined, a reduced risk was observed only for patients with ER-positive/PR-positive/HER2-negative tumors," with a 27-percent reduction seen only in the women who ate the most soy.

"These findings are biologically plausible, and suggest a potential benefit of soybean products in the prevention of breast cancer," the investigators conclude.

Bonnie - this is a significant study because it confirms several things that we know about soy.

1) Soy is not a cancer preventative for everyone. It would make sense that soy would reduce positive estrogen receptor breast cancer because phytoestrogens can have a positive effect on balancing good and bad estrogen.

2) Only fermented soy foods (tofu, tempeh, miso) are healthful. Most of the soy products in the Western Diet: soy protein isolate, soybean oil, etc. have no beneficial effect on health. This study was performed in Japan, where fermented soy products aare consumed exclusively.

Aspirin no heart protection for diabetics: study

Doctors should not routinely give aspirin to people with diabetes to help guard against a heart attack or stroke.

"Although aspirin is cheap and universally available, practitioners and authors of guidelines need to heed the evidence that aspirin should be prescribed only in patients with established symptomatic cardiovascular disease," William Hiatt of the University of Colorado wrote in the British Medical Journal.

The study led by Jill Belch and colleagues at the University of Dundee in Scotland included data on 1,276 men and women who had never had a heart attack or stroke but were at high risk because they had diabetes or peripheral arterial disease.

The researchers gave some people either aspirin or a placebo and others an antioxidant or placebo. They found that after eight years the number of heart attacks and strokes was about the same.

The researchers noted that aspirin remains effective for reducing risk among men and women who have already had a heart attack or stroke.

Bonnie - yet again, the one-size-fits-all drug mentality, in this case aspirin, proves to be misguided.

Bottled Water Quality Investigation: 10 Major Brands, 38 Pollutants

Published by Environmental Working Group; October 15, 2008

Authors: Olga Naidenko, PhD, Senior Scientist; Nneka Leiba, MPH, Researcher; Renee Sharp, MS, Senior Scientist; Jane Houlihan, MSCE, Vice President for Research

The bottled water industry promotes an image of purity, but comprehensive testing by the Environmental Working Group (EWG) reveals a surprising array of chemical contaminants in every bottled water brand analyzed, including toxic byproducts of chlorination in Walmart’s Sam’s Choice and Giant Supermarket's Acadia brands, at levels no different than routinely found in tap water. Several Sam's Choice samples purchased in California exceeded legal limits for bottled water contaminants in that state. Cancer-causing contaminants in bottled water purchased in 5 states (North Carolina, California, Virginia, Delaware and Maryland) and the District of Columbia substantially exceeded the voluntary standards established by the bottled water industry.

Unlike tap water, where consumers are provided with test results every year, the bottled water industry does not disclose the results of any contaminant testing that it conducts. Instead, the industry hides behind the claim that bottled water is held to the same safety standards as tap water. But with promotional campaigns saturated with images of mountain springs, and prices 1,900 times the price of tap water, consumers are clearly led to believe that they are buying a product that has been purified to a level beyond the water that comes out of the garden hose.

To the contrary, our tests strongly indicate that the purity of bottled water cannot be trusted. Given the industry's refusal to make available data to support their claims of superiority, consumer confidence in the purity of bottled water is simply not justified.

Figure 1. Pollutants in Walmart and Giant Bottled Water Exceed Industry and California Standards

The California legal limit of 10 parts per billion (ppb) for total trihalomethanes (TTHMs) in bottled water has been set by the California Health and Safety Code, Division 104, Part 5 (Sherman Food, Drug, and Cosmetic Law, CDPH 2008). The industry standard, Bottled Water Code of Practice, published by the International Bottled Water Association (IBWA 2008a), also sets a limit for TTHMs at 10 ppb. Two of the TTHM chemicals, bromodichloromethane and chloroform, are regulated in California under the Safe Drinking Water and Toxic Enforcement Act, also known as Proposition 65 (OEHHA 2008). For bromodichloromethane, a concentration above 2.5 ppb exceeds a cancer safety standard, as established by the state of California (OEHHA 2008). The standard is based on the Proposition 65 No Significant Risk Level for bromodichloromethane at 5 micrograms per day. For a water consumption rate of 2 L/day (Title 27, California Code of Regulations, Article 7, Section § 25721), this corresponds to a contaminant concentration in water of 2.5 ppb. The concentration values indicated by the bars correspond to findings from the specific brand purchased at the specific location. For the entire dataset, see section Walmart and Giant Water Exceeds Safety Limits [0]. Two independent samples of Sam's Choice water were purchased in Oakland, CA, with total trihalomethane levels at 21 and 23 ppb and levels of bromodichloromethane at 7.7 and 8.5 ppb. Two independent samples of Acadia water were purchased in Stafford, VA with total trihalomethane levels at 22 and 23 ppb.

Laboratory tests conducted for EWG at one of the country’s leading water quality laboratories found that 10 popular brands of bottled water, purchased from grocery stores and other retailers in 9 states and the District of Columbia, contained 38 chemical pollutants altogether, with an average of 8 contaminants in each brand. More than one-third of the chemicals found are not regulated in bottled water. In the Sam's Choice and Acadia brands levels of some chemicals exceeded legal limits in California as well as industry-sponsored voluntary safety standards. Four brands were also contaminated with bacteria.

Walmart and Giant Brands No Different than Tap Water

Two of 10 brands tested, Walmart's and Giant's store brands, bore the chemical signature of standard municipal water treatment — a cocktail of chlorine disinfection byproducts, and for Giant water, even fluoride. In other words, this bottled water was chemically indistinguishable from tap water. The only striking difference: the price tag.

In both brands levels of disinfection byproducts exceeded safety standards established by the state of California and the bottled water industry:

  • Walmart’s Sam’s Choice bottled water purchased at several locations in the San Francisco bay area was polluted with disinfection byproducts called trihalomethanes at levels that exceed the state’s legal limit for bottled water (CDPR 2008). These byproducts are linked to cancer and reproductive problems and form when disinfectants react with residual pollution in the water. Las Vegas tap water was the source for these bottles, according to Walmart representatives (EWG 2008).
  • Also in Walmart’s Sam’s Choice brand, lab tests found a cancer-causing chemical called bromodichloromethane at levels that exceed safety standards for cancer-causing chemicals under California’s Safe Drinking Water and Toxic Enforcement Act of 1986 (Proposition 65, OEHHA 2008). EWG is filing suit under this act to ensure that Walmart posts a warning on bottles as required by law: “WARNING: This product contains a chemical known to the State of California to cause cancer."
  • These same chemicals also polluted Giant's Acadia brand at levels in excess of California’s safety standards, but this brand is sold only in Mid-Atlantic states where California’s health-based limits do not apply. Nevertheless, disinfection byproducts in both Acadia and Sam’s Choice bottled water exceeded the industry trade association’s voluntary safety standards (IBWA 2008a), for samples purchased in Washington DC and 5 states (Delaware, Maryland, Virginia, North Carolina, and California). The bottled water industry boasts that its internal regulations are stricter than the FDA bottled water regulations(IBWA 2008b), but voluntary standards that companies are failing to meet are of little use in protecting public health.

Broad Range of Pollutants Found in 10 Brands

Altogether, the analyses conducted by the University of Iowa Hygienic Laboratory of these 10 brands of bottled water revealed a wide range of pollutants, including not only disinfection byproducts, but also common urban wastewater pollutants like caffeine and pharmaceuticals (Tylenol); heavy metals and minerals including arsenic and radioactive isotopes; fertilizer residue (nitrate and ammonia); and a broad range of other, tentatively identified industrial chemicals used as solvents, plasticizers, viscosity decreasing agents, and propellants.

The identity of most brands in this study are anonymous. This is typical scientific practice for market-basket style testing programs. We consider these results to represent a snapshot of the market during the window of time in which we purchased samples. While our study findings show that consumers can't trust that bottled water is pure or cleaner than tap water, it was not designed to indicate pollutant profiles typical over time for particular brands. Walmart and Giant bottled water brands are named in this study because our first tests and numerous followup tests confirmed that these brands contained contaminants at levels that exceeded state standards or voluntary industry guidelines.

The study also included assays for breast cancer cell proliferation, conducted at the University of Missouri. One bottled water brand spurred a 78% increase in the growth of the breast cancer cells compared to the control sample, with 1,200 initial breast cancer cells multiplying to 32,000 in 4 days, versus only 18,000 for the control sample, indicating that chemical contaminants in the bottled water sample stimulated accelerated division of cancer cells. When estrogen-blocking chemicals were added, the effect was inhibited, showing that the cancer-spurring chemicals mimic estrogen, a hormone linked to breast cancer. Though this result is considered a modest effect relative to the potency of some other industrial chemicals in spurring breast cancer cell growth, the sheer volume of bottled water people consume elevates the health significance of the finding. While the specific chemical(s) responsible for this cancer cell proliferation were not identified in this pilot study, ingestion of endocrine-disrupting and cancer-promoting chemicals from plastics is considered to be a potentially important health concern (Le 2008).

With Bottled Water, You Don't Know What You're Getting

Americans drink twice as much bottled water today as they did ten years ago, for an annual total of over nine billion gallons with producer revenues nearing twelve billions (BMC 2007; IBWA 2008c). Purity should be included in a price that, at a typical cost of $3.79 per gallon, is 1,900 times the cost of public tap water.1 But EWG’s tests indicate that in some cases the industry may be delivering a beverage little cleaner than tap water, sold at a premium price. The health consequences of exposures to these complex mixtures of contaminants like those found in bottled water have never been studied.

Unlike public water utilities, bottled water companies are not required to notify their customers of the occurrence of contaminants in the water, or, in most states, to tell their customers where the water comes from, how and if it is purified, and if it is merely bottled tap water. Information provided on the U.S. EPA website clearly describes the lack of quality assurance for bottled water: "Bottled water is not necessarily safer than your tap water" (EPA 2007b). The Agency further adds following consumer information:

Some bottled water is treated more than tap water, while some is treated less or not treated at all. Bottled water costs much more than tap water on a per gallon basis... Consumers who choose to purchase bottled water should carefully read its label to understand what they are buying, whether it is a better taste, or a certain method of treatment (EPA 2007b).

In conjunction with this testing program, EWG conducted a survey of 228 brands of bottled water, compiling information from websites, labels and other marketing materials. We found that fewer than half describe the water source (i.e., municipal or natural) or provide any information on whether or how the water is treated. In the absence of complete disclosure on the label, consumers are left in the dark, making it difficult for shoppers to know if they are getting what they expect for the price.

Figure 2. Walmart and Giant Are Bottling Tap Water

The municipal water sources of the Walmart’s Sam’s Choice and Giant’s Acadia bottled waters were identified either by calling the company representatives (Walmart) or from the label (Giant). Data on the levels of disinfection byproducts (total trihalomethanes or TTHMs) in these municipal water sources were obtained from Blairsville (GA) Water Department, Las Vegas Valley Water District, and Washington Suburban Sanitary Commission. These data were from tap water tests carried out in 2007, which the water utilities disclosed to their customers in the annual reports. For every utility the range of values from lowest to the highest represents the concentrations of TTHMs that were found in the tap water over the course of the year.

This study did not focus on the environmental impacts of bottled water, but they are striking and have been well publicized. Of the 36 billion bottles sold in 2006, only a fifth were recycled (Doss 2008). The rest ended up in landfills, incinerators, and as trash on land and in streams, rivers, and oceans. Water bottle production in the U.S. uses 1.5 million barrels of oil per every year, according to a U.S. Conference of Mayors’ resolution passed in 2007, enough energy to power 250,000 homes or fuel 100,000 cars for a year (US Mayors 2007). As oil prices are continuing to skyrocket, the direct and indirect costs of making and shipping and landfilling the water bottles continue to rise as well (Gashler 2008, Hauter 2008).

Extracting water for bottling places a strain on rivers, streams, and community drinking water supplies as well. When the water is not bottled from a municipal supply, companies instead draw it from groundwater supplies, rivers, springs or streams. This "water mining," as it is called, can remove substantial amounts of water that otherwise would have contributed to community water supplies or to the natural flow of streams and rivers (Boldt-Van Rooy 2003, Hyndman 2007, ECONorthwest, 2007).

Recommendations

Currently there is a double standard where tap water suppliers provide information to consumers on contaminants, filtration techniques, and source water; bottled water companies do not. This double standard must be eliminated immediately; Bottled water should conform to the same right-to-know standards as tap water.

To bring bottled water up to the standards of tap water we recommend:

  • Full disclosure of all test results for all contaminants. This must be done in a way that is readily available to the public.
  • Disclosure of all treatment techniques used to purify the water, and:
  • Clear and specific disclosure of the name and location of the source water.

To ensure that public health and the environment are protected, we recommend:

  • Federal, state, and local policymakers must strengthen protections for rivers, streams, and groundwater that serve as America’s drinking water sources. Even though it is not necessarily any healthier, some Americans turn to bottled water in part because they distrust the quality of their tap water. And sometimes this is for good reason. Some drinking water (tap and bottled) is grossly polluted at its source – in rivers, streams, and underground aquifers fouled by decades of wastes that generations of political and business leaders have dismissed, ignored, and left for others to solve. A 2005 EWG study found nearly 300 contaminants in drinking water all across the country. Source water protection programs must be improved, implemented, and enforced nationwide (EWG 2005b). The environmental impacts associated with bottled water production and distribution aggravate the nation's water quality problems rather than contributing to their solution.
  • Consumers should drink filtered tap water instead of bottled water. Americans pay an average of two-tenths of a cent per gallon to drink water from the tap. A carbon filter at the tap or in a pitcher costs a manageable $0.31 per gallon (12 times lower than the typical cost of bottled water), and removes many of the contaminants found in public tap water supplies.2 A whole-house carbon filter strips out chemicals not only from drinking water, but also from water used in the shower, clothes washer and dishwasher where they can volatilize into the air for families to breathe in. For an average four-person household, the cost for this system is about $0.25 per person per day.3 A single gallon of bottled water costs 15 times this amount.

EWG's study has revealed that bottled water can contain complex mixtures of industrial chemicals never tested for safety, and may be no cleaner than tap water. Given some bottled water company's failure to adhere to the industry's own purity standards, Americans cannot take the quality of bottled water for granted. Indeed, test results like those presented in this study may give many Americans reason enough to reconsider their habit of purchasing bottled water and turn back to the tap.

Footnotes.
1 A recent survey documented bottled water prices ranging from $0.89 to $8.26 per gallon (Food and Water Watch 2007). Retail prices vary widely depending on whether people are buying bottled water in bulk or individual bottles. Given this wide range in prices, EWG assumed a flat $1.00 per liter price per liter (or $3.79 per gallon), which is what most consumers would pay for a typical liter bottle of water bought from a convenience store. In comparison, EPA estimates that tap water costs consumers about $0.002 per gallon, on average, nationwide (EPA 2004).
2 EWG compared the prices and capacities of 7 faucet-mounted and pitcher filters. The prices ranged from $19.99 to $39.99 with treatment capacities ranging from 40 gallons to 100 gallons. With this information, we estimate an average cost of these types of systems as $0.31 per gallon.
3 EWG compared 5 different whole house carbon filter units and documented prices in the range between $64.99 to $795 per unit, with life spans between 3 and 36 months. Thus, the annual cost is in the range of $260 - $595 with an average of $375. This leads to an estimated cost of $1.00/day that translates into $0.25 daily cost per person for an average four-person household.