First comprehensive paper on statins' adverse effects released

A paper co-authored by Beatrice Golomb, MD, PhD, associate professor of medicine at the University of California, San Diego School of Medicine and director of UC San Diego's Statin Study group cites nearly 900 studies on the adverse effects of HMG-CoA reductase inhibitors (statins), a class of drugs widely used to treat high cholesterol. The result is a review paper, currently published in American Journal of Cardiovascular Drugs, that provides the most complete picture to date of reported side effects of statins, showing the state of evidence for each.

The paper also helps explain why certain individuals have an increased risk for such adverse effects. "Muscle problems are the best known of statin drugs' adverse side effects," said Golomb. "But cognitive problems and peripheral neuropathy, or pain or numbness in the extremities like fingers and toes, are also widely reported." A spectrum of other problems, ranging from blood glucose elevations to tendon problems, can also occur as side effects from statins. The paper cites clear evidence that higher statin doses or more powerful statins – those with a stronger ability to lower cholesterol – as well as certain genetic conditions, are linked to greater risk of developing side effects.

"Physician awareness of such side effects is reportedly low," Golomb said. "Being vigilant for adverse effects in their patients is necessary in order for doctors to provide informed treatment decisions and improved patient care." The paper also summarizes powerful evidence that statin-induced injury to the function of the body's energy-producing cells, called mitochondria, underlies many of the adverse effects that occur to patients taking statin drugs.

Mitochondria produce most of the oxygen free radicals in the body, harmful compounds that "antioxidants" seek to protect against. When mitochondrial function is impaired, the body produces less energy and more "free radicals" are produced. Coenzyme Q10 ("Q10") is a compound central to the process of making energy within mitochondria and quenching free radicals. However, statins lower Q10 levels because they work by blocking the pathway involved in cholesterol production – the same pathway by which Q10 is produced. Statins also reduce the blood cholesterol that transports Q10 and other fat-soluble antioxidants. "The loss of Q10 leads to loss of cell energy and increased free radicals which, in turn, can further damage mitochondrial DNA," said Golomb, who explained that loss of Q10 may lead to a greater likelihood of symptoms arising from statins in patients with existing mitochondrial damage – since these people especially rely on ample Q10 to help bypass this damage. Because statins may cause more mitochondrial problems over time – and as these energy powerhouses tend to weaken with age—new adverse effects can also develop the longer a patient takes statin drugs. "The risk of adverse effects goes up as age goes up, and this helps explain why," said Golomb. "This also helps explain why statins' benefits have not been found to exceed their risks in those over 70 or 75 years old, even those with heart disease."

High blood pressure and diabetes are linked to higher rates of mitochondrial problems, so these conditions are also clearly linked to a higher risk of statin complications, according to Golomb and co-author Marcella A. Evans, of UC San Diego and UC Irvine Schools of Medicine. The connection between statins' antioxidant properties and mitochondrial risk helps explain a complicated finding that statins can protect against the very same problems, in some people, to which they may predispose others – problems such as muscle and kidney function or heart arrhythmia.

This paper was funded in part by a Robert Wood Johnson Generalist Physician Faculty Scholar award to Dr Golomb.

Bonnie - what more does the cardiology community need to see on this issue? The least they can do is force the drug makers to put CoQ10 back into the drug as a combination. For those who have know us for a while, we slammed the statin drug manufacturers, who wanted to put CoQ10 in the original formula, but decided against it because it was "too expensive." How do we like that decision now?

Chemical in nonstick cookware linked to infertility

Chemicals found in everyday products such as food packaging, upholstery and carpets may be associated with infertility in women, according to researchers at the University of California-Los Angeles School of Public Health.

Doctors studied the chemicals, perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA), in 1,240 women from the Danish National Birth Cohort, which includes nearly 100,000 women and their children. The chemicals also have been found in non-stick cookware, pesticides, clothing and personal care products, as well as industrial surfactants and emulsifiers, according to the study released in Human Reproduction.

Two studies published in 2007 showed that babies exposed to the chemicals in the womb were more likely to be born smaller than other infants. Earlier tests on animals have linked the two chemicals to cancer and developmental problems. Studies show that the chemicals can remain in the environment and in the body for decades.

The new study is the first to link perfluorinated chemicals to infertility, authors says.

Authors say it's possible that the chemicals interfere with the hormones involved in reproduction. In the study, women with higher chemical exposure had more irregular periods.

Manufacturers say they're already using safer alternatives to these chemicals. 3M has stopped making PFOA and PFOS. DuPont's manufacturing processes now remove more than 97% of PFOA.

Bonnie - isn't that nice of 3M and DuPont. We have know that this has been problematic for a while. Only when pressured by consumer groups did these companies take action. Safer alternatives? I'd like to see the safety studies on the new chemicals.

Take Safety Into Your Own Hands

The Government Accountability Office (GAO) has concluded that the Food and Drug Administration as currently structured is inadequate. Surprised? Of course not. The GAO has labeled the FDA's oversight of food safety and medical products, as well as the EPA's control over toxic chemicals, as areas of high risk.

While the Obama Administration is haggling over how best to fix these departments, we have a few suggestions as to how you can, to the best of your ability, control what goes into your mouth and onto your body. Some of these sound simple and redundant, but now more than ever, we must be vigilant about adhering to them.


FOODSTUFFS

• Drink filtered water

• Eat Locally Grown - less chemicals, less times exchanging hands, less processing, you get the picture

• Certified Organic - while they are not immune to food safety issues, the risk is much lower and certified organic foodstuffs contain less chemicals.

• The least amount of ingredients in the product, the better. In most cases, this indicates that the foodstuff is real food.

• Reduce processed food intake - more ingredients and longer shelf life usually means ingredients that have come from numerous manufacturers all with different food safety practices.

• Purchase food well before the expiration date.

• Avoid consumption of raw fish, meat, poultry, or dairy.

• Use cooked leftovers within two days.

• Avoid consuming samples at grocery stores.

FOOD PREPARATION

• Whether at home or eating out, make sure your food is cooked through.

• Keep eating areas at home and at wok well sanitized.

• Add spices and other natural ingredients to your food to stave off bacteria (garlic, onion, basil, ginger, curry, clove, cinnamon, oregano, and sage have been studied for their antimicrobial activity); some of these spices may not be well tolerated by all (especially with salicylate sensitivity).

• Keep raw animal food separate from other foods and in sealed bag or container to avoid cross-contamination.

• Don't leave raw meat in the refrigerator longer than 2 days; freeze if not using quickly.

• Wash fruits and vegetables with cold water filtered before eating; cut away bruised or damaged areas

• Never leave food out for over one hour unless it is properly heated/cooled.

MEDICATIONS

• Do not take any medications that have not been in the marketplace for a minimum of two years

• Look at the expiration dates of your meds to see if they are still good. If expired, do not throw in the garbage. Give to proper waste disposal service so it does not go back into the environment/water supply.

• Before taking any medication, ask your doctor and pharmacist about any side effects and contraindications. Then, read the insert of the medication before taking the product. The same goes for any applicable medical device or surgical procedure.

DIETARY SUPPLEMENTS

• Take dietary supplements from a trusted source (we've got you covered on this one).
  
  
• Take probiotics daily to maintain optimal gut flora balance.
  

PERSONAL CARE

• Consistent hand washing with soap and very warm water.

• Avoid direct hand contact with eyes, ears, nose, and mouth.

• Keep the host healthy (this means you).

• Body should be balanced 60% alkaline/40% acid.

• Use safe household products and cosmetics.

Recent Food Safety Articles from NCI

http://www.nutritionalconcepts.com/Newsletters/082008.htm
http://www.nutritionalconcepts.com/Newsletters/05152008.htm
http://www.nutritionalconcepts.com/prodserv/safeproducts.htm

The 2009 U.S. Government Accountability Office Report can be found at http://www.gao.gov/docsearch/featured/highrisk.html

Obama influences USDA to retain fruit and vegetable program

Fruit and vegetable growers have won a small but symbolic victory as the Obama administration starts steering the Agriculture Department in a new direction.Facing political heat from California lawmakers, Agriculture Secretary Tom Vilsack has agreed to retain $3.18 million in a grant program that encourages fruit and vegetable consumption. The decision reverses a move made quietly in the dying days of the Bush administration. It also gives a little taste of how Washington works. The Bush administration had wanted to spend the $3.18 million implementing a country-of-origin labeling program. Vilsack decided, instead, to return the money to a specialty crop block grant program. Though the dollar amounts are modest, the former Iowa governor stressed he's sending a signal."It is clear, from what President Obama has indicated to me, that he wants this department to promote nutrition through the use of healthy fruits and vegetables," Vilsack said.

Steve - while a drop in the bucket, this is hopefully the first of many victories for advancing nutrition with this administration!

Researchers explain cruciferous veggies effect on pancreatic cancer

Texan researchers have identified a pathway to explain how a compound in cruciferous vegetables like broccoli may protect against pancreatic cancer. The tissue of cruciferous vegetables, like broccoli, cauliflower, cabbage and Brussels sprouts, contain high levels of the active plant chemicals glucosinolates. These are metabolized by the body into isothiocyanates, which are known to be powerful anti-carcinogens.

The results, published online ahead of print in the Journal of the National Cancer Institute, study extends out understanding of the potential anti-cancer benefits of such vegetables.

Steve - mmm...learn to love those cruciferous veggies!

Nutritional Support May Improve Survival in Esophageal Cancer

Locally advanced esophageal cancer may have a better outcome if radiation therapy is augmented by nutritional support. Nutritional support was associated with significantly better survival compared with patients given IV fluids or those who did not get nutritional or fluid support, Jeffrey Haynes, M.D., of the University of Pennsylvania, reported at the Gastrointestinal Cancers Symposium.

Weight loss of five pounds or more predicted worse survival.

The findings should be interpreted cautiously because the study was retrospective and because nutritional supplements and IV fluids were given at physician discretion, he added.

Nutritional support during chemoradiation has been shown to improve outcomes in other types of cancer. Those observations provided the impetus for the retrospective review.

The analysis included 132 patients treated with curative-intent radiotherapy. In 77% of the cases, patients were given oral or enteral nutritional supplements during radiation therapy, and 38% received IV fluids. Median follow-up was 14.1 months, and median survival from the end of radiation therapy was 1.5 years. Compared with nutritional support alone, IV fluids with or without nutritional support doubled the hazard ratio for mortality. Patients who received neither nutritional support nor IV fluids also had a significantly higher mortality risk compared with the patients who received only nutritional support.

Omega-6 Fatty Acids Can Be Good for You

All that discussion about the omega-6 fatty acids found in vegetable oils, nuts and seeds possibly being bad for your heart is unfounded, a new science advisory from the American Heart Association claims.

"There has been a lot of talk in the nutrition world that omega-6 fatty acids might be bad," said William S. Harris, the nutritionist heading the committee that issued the report in the Jan. 26 online issue of Circulation. "We wanted to evaluate it, and if it is not true, we wanted to make sure the American public eats enough of them."

The debate arose because arachidonic acid, a component of omega-6 fatty acids, is a building block for some inflammation-related molecules, and there have been fears that it might increase the risk of heart disease.

Bonnie - the issue is not that omega-6's are bad when eaten in moderation. The issue is that the ratio of omega-6 consumed in the U.S. compared to omega-3 is completely out-of-whack (20:1). This disparity is a main reason why so many Americans are inflamed.

I never said to avoid omega-6 foods. You need to curtail consumption and increase omega-3 consumption to optimize your ratio (3:1).

Mercury in corn syrup?

By Michael Hawthorne
Chicago Tribune

Researchers have detected traces of mercury in samples of high-fructose corn syrup, a widely used sweetener that has replaced sugar in many processed foods. The study was published in the peer-reviewed journal Environmental Health.

The source of the metal appears to be caustic soda and hydrochloric acid, which manufacturers of corn syrup use to help convert corn kernels into the food additive.

A handful of plants across the nation still make the soda and acid by mixing a briny solution in electrified vats of mercury. Some of the toxic metal ends up in the final product, according to industry documents cited in the study.

Corn syrup manufacturers insisted their products are mercury-free. But the study said at least one maker of caustic soda that has used the mercury-based technology listed the corn syrup industry as a client.

The researchers cautioned that their study was limited. Only 20 samples were analyzed; mercury was detected in nine.

A former EPA scientist who reviewed the paper said more study is needed to establish the risk, if any, posed by contaminated corn syrup.

Reflux drugs may inhibit the breakdown of other drugs

Circulation, the journal published by the American Heart Association, suggest that the drug interaction between a class of acid reflux medicines called proton pump inhibitors and the blood thinner Plavix may result in serious adverse outcomes within one year of therapy initiation, and further research support investigations into the effects of cytochrome P450 2C19 genetic polymorphisms. The Food and Drug Administration on Monday said it has ordered the makers of clopidogrel -- also known as Plavix -- to conduct studies into the possible interaction. Until those studies have been assessed by the FDA, federal regulators are advising physicians to reconsider whether to start or continue patients on drug therapy that combines the two drugs.

Proton pump inhibitors, which suppress the production of stomach acid, include the prescription drugs Nexium, Prevacid, Aciphex and Protonix. Prilosec is a proton pump inhibitor largely sold over the counter, and FDA urged patients on Plavix who may take any of these drugs to discuss the combination with their physician.

FDA says it was prompted by published reports that clopidogrel is less effective in reducing cholesterol levels in some patients. Proton pump inhibitors appear to reduce the breakdown of some drugs by the liver. It may also increase the concentration of diazepam (Valium), phenytoin (Dilantin) and warfarin (Coumadin).

Bonnie - this is not a surprise. We knew that PPIs reduced/blocked the absorption of many vitamins and minerals.

ADHD drugs can cause hallucinations

Drugs for attention deficit hyperactivity disorder can cause children to have hallucinations even when taken as directed. U.S. Food and Drug Administration researchers analyzed data from 49 clinical studies conducted by makers of the drugs and found they can cause psychosis and mania in some patients, including some with no obvious risk factors. In some cases, children hallucinated that worms, bugs or snakes were crawling on them. "Patients and physicians should be aware of the possibility that psychiatric symptoms consistent with psychosis or mania" might arise in the course of treatment, Dr. Andrew Mosholder and colleagues wrote in the journal Pediatrics. FDA researchers urged doctors to discuss the potential side effects with parents and children to help ease their anxiety if such symptoms should occur.

The Crestor for C-Reactive Protein Study: Limited Benefits and Serious Risks

Jay S. Cohen MD
Medicationsense.com

If you read a newspaper or watched television news on December 10, 2008, you would have thought that Crestor, a cholesterol-lowering statin medication, was a wonder drug.

Of course, a few years ago you would have thought the same thing after the heavy news coverage for another powerful statin, Lipitor. Yet, my analyses at MedicationSense (2005, 2006) revealed that the Lipitor studies demonstrated limited benefits and worrisome adverse effects.

The new Crestor study, which involved more than 17,000 subjects, examined the drug's effectiveness in reducing elevated blood levels of C-reactive protein (CRP), a marker for cardiovascular inflammation.¹ It is currently believed that increased levels of inflammation are associated with a higher incidence of heart attacks and strokes (more on CRP below).

Crestor Study Results -- and What They Really Mean
The authors of the Crestor-CRP study reported that over the 1.9 years of the study, there was a 44% reduction in cardiac events (defined as heart attack, stroke, severe angina, or cardiac death) among the subjects taking Crestor versus those taking a placebo. A 44% reduction sounds very impressive, but it is misleading.

Here on the actual numbers from the study. Over 2 years, 1.36% of subjects in the placebo group experienced a cardiac event; 0.77% of subjects in the Crestor group experienced an event. The difference was 0.59%. That is, less than 1%, a tiny difference.

The difference was so tiny that it will require 120 individuals with elevated CRP to take Crestor every day for two years for just one person to obtain benefit.² Meanwhile, the other 119 individuals taking and paying for Crestor for two years will obtain no protection from a cardiovascular event.

Why would the results of the Crestor-CRP study be proclaimed so loudly nationwide despite being so tiny? The Crestor-CRP study was underwritten by AstraZeneca, the manufacturer of Crestor. We have seen previously that the marketing departments of drug companies are masters at obtaining maximum media coverage for their studies even if the results are unimpressive. Wide exposure means increased sales and big profits.

One media outlet took a critical stance. ABCNEWS.com boldly offered a dissenting opinion. In "Doctor Urges Caution in Interpreting New Findings on Cholesterol Drug," Dr. Nortin Hadler wrote, "The benefit shown in this study is tiny, and if [the Crestor-CRP study] were repeated, there might be no benefit at all. I never leap to act on the basis of such small effects."³

Serious Side Effects Downplayed
In Crestor-CRP, the drug displayed many of the common adverse effects of other statin medications (Lipitor, Zocor, Pravachol, Mevacor, Lescol). Typical side effects include abdominal pain, muscle pain, serious muscle breakdown (rhabdomyolysis), renal disorders, and liver disorders. More subjects in the Crestor group experienced these side effects than subjects in the placebo group.

A far more serious adverse effect occurred with Crestor: 270 cases of newly diagnosed diabetes were reported among Crestor users, and 216 cases were reported among placebo users. The 54 more cases of diabetes in the Crestor group was a significant and worrisome finding. Diabetes is one of the most destructive, life-shortening disorders of our time. It also is a leading cause of heart attacks and strokes. Imagine, taking Crestor to prevent a heart attack and getting diabetes instead.

When the FDA decides whether to approve a new drug, it makes it decision based on whether the drug will produce significantly more benefit than risk. If Crestor were being evaluated today for approval by the FDA, I believe Crestor would not be approved because its use in the Crestor-CRP study was associated with many new cases of diabetes.

Should I Be Tested for Elevated CRP?
Half of all cardiac deaths occur in people with normal cholesterol levels, so other factors cleary are involved in the development of cardiovascular disease. New studies suggest that an elevated level of CRP may be as important an indicator of cardiac risk as cholesterol levels.^4.5

"Forward-thinking cardiologists suspect that internal inflammation is the root cause of many diseases including those of the heart and blood vessels," states cardiologist Stephen Sinatra. "Studies have shown that people with elevated CRP run two times the risk of dying from a cardiovascular-related problem compared with those who have high cholesterol levels. Combine a cholesterol burden with a markedly elevated CRP and your risk of heart attack and stroke increases by a factor of nine."⁶

Despite this, experts still disagree on whether the entire population should be tested for elevated CRP. I believe that anyone who has cardiovascular disease or is at risk for it should be tested for elevated CRP. Furthermore, I also encourage anyone interested in prevention to have a CRP test.

A CRP level below 1 is low-risk; 1-3 moderate-risk; above 3 high-risk.

Should My Elevated CRP Be Treated?
If your CRP level is elevated, it should not be ignored. Yet this does not mean that your doctor should immediately prescribe you a statin. As Dr. James Ehrlich, a pioneer in cardiovascular disease screening, said, an elevated CRP "is a call for more information, not an invitation to take an automation-like approach to prescribing life-long statins."⁷

An elevated CRP indicates a higher than normal level of inflammation in the body. Many medical conditions can produce inflammation. Your doctor should examine you for signs of infection: teeth, sinuses, bladder, ovaries or prostate. A recent cold or bout of the flu can also elevate CRP. Inflammatory disorders such as rheumatoid arthritis may cause an elevated CRP.

If no other causes of infection are found, the elevated CRP likely reflects cardiovascular inflammation. Should it be treated? Experts differ on this, but in general I recommend treatment.

Is Crestor the Only Treatment for Elevated CRP?
No. There are many choices, pharmaceutical and natural. This section will discuss statin therapy.

We have known for a decade that the effects of all statins are similar. This means that all statins can reduce elevated CRP.

In the Crestor-CRP study, 20 mg of Crestor was used. This is a powerful dose, and because Crestor is only available as a brand-need drug, it is expensive. At a nationwide discount pharmacy, 100 pills of 20-mg Crestor costs $340. The cost over one year is approximately $1360. Over 20 years, the cost of Crestor 20 mg per day is approximately $27,000.⁸ An equally powerful dose, 80 mg, of Zocor is available as a generic (simvastatin), and it costs about 90% less.

Just because the Crestor-CRP study used a powerful dose of Crestor does not mean that only a powerful dose will reduce elevated CRP. Some experts believe that it is not necessary to use the same strong statin doses that doctors frequently prescribe to reduce cholesterol levels. Elevated levels of CRP may not require such strong treatment. According to Dr. Uve Ravnskov, "It may be wiser to search for the lowest effective dose instead of the dose with maximal effect on LDL-cholesterol."⁹

If you are prone to getting side effects with medications, or if you simply want to reduce your risk of side effects, ask your doctor about starting with the lowest dose of simvastatin. If this does not adequately reduce your elevated CRP level, ask your doctor to increase the dose gradually until you arrive at the amount that works. With Zocor (simvastatin), the lowest dose is 10 mg.

Natural Approaches
Integrative doctors recommend a variety of natural approaches to reduce elevated CRP. Because smoking increases CRP, the first step for any smoker is to stop smoking. Being overweight increases CRP, so weight loss is also important. Healthy eating and exercise can also reduce CRP levels.

Women taking hormone replacement therapy should be aware that the therapy can increase CRP levels.¹⁰ Check with your doctor.

There are several natural supplements that have anti-inflammatory qualities. Alternative doctors often include one, such as curcumin or ginger, in their combination treatment for elevated CRP. Some alternative doctors include aspirin because of its proven anti-inflammatory effect.

Vitamin C might also be included in the treatment of elevated CRP. A study in the Journal of the American College of Nutrition demonstrated that 515 mg/day of vitamin C reduced CRP 24%.¹¹ In comparison, in the Crestor-CRP study, Crestor reduced CRP levels by an average up 37%. Vitamin C plus other therapies mentioned in this section might rival or exceed this result.

Vitamin E, with its natural anti-inflammatory effects, might also help reduce elevated CRP.

Omega-3 fatty acids (fish oils) have proven anti-inflammatory effects. Studies have shown that daily intake of omega-3 fatty acids reduce the risk of cardiac death and also reduce the pain of rheumatoid arthritis.^12,13 Fish oils should be a standard part of the treatment of elevated CRP. Because fish oils and aspirin taken together can increase the body's tendency for bleeding, check with your doctor before taking these therapies together.

A natural supplement with properties similar to prescription statins is red yeast rice. This fermentation product contains small amounts of several statin-like compounds. It works like a mild statin and, like prescription statins, reduces vascular inflammation and elevated CRP. Red yeast rice can also reduce cholesterol levels. Like prescription statins, red yeast rice can cause adverse effects, but the risk is low and, if side effects occur, they are usually milder than with prescription statins.

Jay S. Cohen M.D. is a nationally recognized expert on medications and side effects. He is an adjunct associate professor of preventive medicine. Dr. Cohen provides consultations to people across America who are interested in statin drugs or natural alternatives for reducing elevated CRP or cholesterol, or who are interested in cardiovascular health and methods of prevention.

References

1. Ridker PM, Danielson E, Fonseca FAH, et al (for the JUPITER Study Group). Rosuvastatin to prevent vascular events in men and women with elevated C?reactive protein. The New England Journal of Medicine, Nov. 20, 2008;359(21):2195?2207.

2. Hlatky MA. Expanding the Orbit of Primary Prevention ?? Moving beyond JUPITER. New England Journal of Medicine, Nov. 20, 2008;359 (21):2280?82.

3. Hadler NM. Crestor, by Jove... or Not. Doctor urges caution in interpreting new findings on cholesterol drug. ABC News, Nov. 10, 2008:http://abcnews.go.com.

4. Ridker, PM, Rifai, N, Rose, L, et al. R. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. New England Journal of Medicine 2002;347:1557-1565.

5. Albert, MA, Glynn, RJ, Ridker, PM. Plasma concentration of C-reactive protein and the calculated. Framingham Coronary Heart Disease Risk Score. Circulation 2003;108(2):161?5.

6. Sinatra, S. Statins: grossly overprescribed for cholesterol and underprescribed for internal inflammation. The Sinatra Health Report, Sept. 2002;8:1.

7. West A. JUPITER: separating the solid clinical matter from the hot gas. Holistic Primary Care, Winter 2008;9(4):1-2.

8. Crestor costs. Costco pharmacy, Dec. 20, 2008:www.costco.com.

9. Ravnskov, U. Is atherosclerosis caused by high cholesterol? QJM (Quarterly Journal of Medicine) 2002;95:397-403.

10. Walsh, BW, Paul, S, Wild RA, et al. The Effects of Hormone Replacement Therapy and Raloxifene on C?Reactive Protein and Homocysteine in Healthy Postmenopausal Women: A Randomized, Controlled Trial. Journal of Clinical Endocrinology and Metabolism 2004;85:214?218.

11. Block, G, Jensen, C, Dietrich, M, et al. Plasma C-reactive protein concentrations in active and passive smokers: influence of antioxidant supplementation. Journal of the American College of Nutrition 2004;23:141-147.

12. Simopoulos, AP. Essential Fatty Acids in Health and Chronic Disease. American Journal of Clinical Nutrition 1999;70(suppl):560S-569S.

13. Simopoulos, AP. The Mediterranean diets: What is so special about the diet of Greece? Journal of Nutrition 2001;131:3065S-3073S.

Low vitamin D linked to higher risk of dementia

A new large-scale senior population study has found that a lack of vitamin D in the elderly could be linked to cognitive impairment. The study, conducted on almost 2,000 adults over the age of 65, is the first of its scale to identify this relationship, and prompted researchers to suggest vitamin D supplementation as a possible means of reducing the risk of dementia. The findings from the researchers at the Peninsula Medical School, the University of Cambridge and the University of Michigan revealed that compared to those with optimum levels of vitamin D, those with the lowest levels were more than twice as likely to be cognitively impaired.

The elderly, in particular, are at risk of deficiency as the skin’s capacity to absorb vitamin D from the sun decreases with age. According to the researchers of the new study, which will appear in the forthcoming issue of the Journal of Geriatric Psychology and Neurology, 1,766 participants (708 men and 1,058 women) participated in the Health Survey for England in 2000. Their levels of cognitive function were assessed using the Abbreviated Mental Test (AMT), a common neurocognitive screening instrument. Fasting blood samples were also taken, and levels of serum 25(OH)D were measured.

Their findings revealed that people with normal cognitive function had higher levels of serum 25(OH)D than those who were cognitively impaired. Those with the lowest serum 25(OH)D concentrations were four times more likely to be cognitively impaired.

Bonnie - testing 25(OH)D levels at any age is crucial. The elderly are at particular risk for low levels because of lack of sun exposure and reduced ability to absorb critical nutrients.

Woman celebrates 104th birthday - attributes longevity to Cod Liver Oil

The Press
Richard Catton

An ex-pub landlady who attributes her longevity to cod liver oil has celebrated her 104th birthday.

Alice Leaf is a former landlady of the Phoenix Pub, in George Street, York. She was born in Heworth on January 21, 1905, and lived with her family in Bromley Street, off Leeman Road.

She started work at Terry’s on her 14th birthday in 1919 and remembers her father returning from serving in the trenches during the First World War.

Mrs Leaf married her policeman husband, Stanley, in 1928 and the couple went to live in Wakefield for his work. They also lived in Whitby before returning to York.

Her son, Raymond, said: “You would not think she was her age. She is laughing and joking and when she was 100 the mayor came to visit and went to the wrong person as my mother didn’t look old enough.”

Full Article:
http://www.thepress.co.uk/news/4068717.Alice_Leaf_celebrates_her_104th_birthday/

Green tea plus exercise speeds the loss of tummy fat

Several studies have hinted that green tea provides a boost to exercise-induced weight loss. Another study, published in the February issue of the Journal of Nutrition, supports that link and shows that tummy fat may be the first to go. The study evaluated 132 obese adults. All consumed a diet that was consistent in daily calories and participated in 180 minutes a week of moderate-intensity exercise. They also drank a daily beverage containing 39 milligrams of caffeine, but one group consumed green tea with 625 milligrams of catechins, an antioxidant that is the main component of green tea. After 12 weeks, the participants drinking the green tea had greater loss, 4.4 pounds compared with just over 2 pounds in the control group. The green-tea group also had larger declines in total abdominal fat, subcutaneous abdominal fat and triglycerides. H

The study was conducted by researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University as well as research centers in Florida and Japan. Another study on green tea, also featured in this issue of the Journal of Nutrition, shows that drinking plentiful amounts of the beverage over many years may have a subtle influence in decreasing the risk of breast cancer. The study examined almost 7,000 women, ages 20 to 74, in China. The women were evaluated for breast cancer incidence and consumption of green tea. Compared with nondrinkers, women who drank green tea had a slightly decreased risk of breast cancer. The benefit was strongest for women who drank the most green tea over longer periods of time.

Website for Peanut Butter Product Recalls

http://www.accessdata.fda.gov/scripts/peanutbutterrecall/index.cfm

My Family Health Portrait

The Surgeon General created an ingenious web tool where you can enter a family health history tree that can be viewed by family and health professionals. What a great reminder for us to stay on a healthy lifestyle path!

https://familyhistory.hhs.gov/fhh-web/home.action

Study doubts heart disease genetic testing value

(Reuters) – A study tracking a large group of women for a decade casts doubt on the value of testing for a certain genetic trait linked to heart disease to predict one's chances of illness. Knowing a woman had the abnormality on chromosome 9 did not improve cardiovascular illness prediction compared to typical risk factors such as high blood pressure, smoking, cholesterol levels, diabetes, family history of heart attack and C-reactive protein as an indicator of arterial inflammation. This common genetic trait has been shown to raise the risk for heart attack, stroke and other cardiovascular conditions, and commercial tests for it are available to consumers. The study appeared in the Annals of Internal Medicine.

Steve - we blogged this because it is yet another example that genetic predisposition to disease is a multifaceted task that has too many variables that have yet to be discovered. While continued science will most likely decipher the genetic combinations that cause human diseases, we should be focusing our short-term efforts on silencing the expression of their epigenetic triggers, which begins with diet, lifestyle, and environment.

Economic factors, contamination fears and Locavores feed home-growing boom

Excerpt By Beth Botts
Chicago Tribune

"I can't wait until spring," says author Bill Alexander. "I miss lettuce. I haven't had any decent lettuce for months."

He's not the only one waiting eagerly for the growing season to begin. All signs are that 2009 will be a banner year for vegetable growing, following a spurt last summer.

"We've seen almost double demand," says Tracy Lee, director of horticulture at the seed company W. Atlee Burpee Co. in Warminster, Pa. (burpee.com). "It's amazing."

When the Garden Writers Association in Manassas, Va., surveyed gardeners in spring 2007, they rated vegetables in second place (after lawns) among types of growing they intended to do, after it had wallowed in fourth or fifth place after perennials for years. Polling hasn't started yet this year, says executive director Robert LaGasse, but he expects the trend to continue.

Why the growth in enthusiasm for growing food? The economy surely has a role. An increase in seed sales is "typical when we see an economic downturn," according to Stephanie Turner, director of seed product at Park Seed Co., another venerable catalog house in Greenwood, S.C. (parkseed.com). "People are trying to stay home and beautify what they have and grow their own food."

But there are other factors at work: When tomatoes were pulled from store shelves last summer for fear of salmonella, it was only the latest of a succession of scares that revealed how long the supply chain is for supermarket produce—and how vulnerable to contamination. Sales of organically grown produce have been on the rise for years, and it's natural to go from buying expensive organic heirloom tomatoes at the farmer's market to wondering if you could grow them yourself cheaper.

If you grow your own food, you don't need to wonder what pesticide was sprayed on it or what was in the soil where it was planted or whether the people who picked it washed their hands. You control all that.

There also is a growing awareness that trucking fruits and vegetables long distances from farm to distribution center to supermarket to home uses a lot of gas and emits a lot of greenhouse gases.

The "Locavore" movement—which contends it is most environmentally responsible to eat food grown close to home—leads to a logical conclusion: There's no place more local than your own backyard. "Your produce is fresher and it hasn't traveled a long distance so you haven't contributed to the carbon footprint," Turner says.

Extensive cold and flu panel now available

Comprehensive xTAG Respiratory Viral Panel can screen more efficiently for a dozen cold and flu viruses. A doctor/nurse takes a sample containing viruses from a patient's nasal cavity, throat, sinuses or bronchi. Nucleic acid is extracted from viruses found in the sample. Most respiratory viruses are based on unstable RNA and are converted to complimentary DNA (cDNA) for testing due to DNA's better stability.

MRSA rising in kids' ear, nose, throat infections

Researchers say they found an "alarming" increase in children's ear, nose and throat infections nationwide caused by dangerous drug-resistant staph germs. Other studies have shown rising numbers of skin infections in adults and children caused by these germs, nicknamed MRSA, but this is the first nationwide report on how common they are in deeper tissue infections in the head and neck. These include certain ear and sinus infections, and abcesses that can form in the tonsils and throat.

The study found a total of 21,009 pediatric head and neck infections caused by staph germs from 2001 through 2006. The percentage caused by hard-to-treat MRSA bacteria more than doubled during that time from almost 12 percent to 28 percent. The study appears in January's Archives of Otolaryngology.

MRSA infections were once limited mostly to hospitals, nursing homes and other health-care settings but other studies have shown they are increasingly picked up in the community, in otherwise healthy people. This can happen through direct skin-to-skin contact or contact with surfaces contaminated with germs from cuts and other open wounds. But staph germs also normally live or "colonize" on the skin and in other tissues including inside the nose and throat, without causing symptoms. Symptoms that it could be MRSA include ear infections that drain pus, or swollen neck lymph nodes caused by pus draining from a throat or nose abcess. Unlike cold and flu bugs, MRSA germs aren't airborne and don't spread through sneezing. MRSA does not respond to penicillin-based antibiotics and doctors are concerned that it is becoming resistant to others. The study authors said a worrisome 46 percent of MRSA infections studied were resistant to the antibiotic clindamycin, one of the non-penicillin drugs doctors often rely on to treat community-acquired MRSA.

Bonnie - we have been reporting on MRSA for a while now. We only have ourselves to blame for the rise in these cases. The chronic misuse of antibiotics have contributed greatly to the resistant MRSA strains. While there is very little data available, we recommend consulting your health professional about lauric acid (Monolaurin) and GSE (grapefruit seed extract) as natural preventatives. MayoClinic.com has good information about understanding MRSA.

Albertsons to tag products with nutrition information

Grocers are rolling out storewide nutritional information programs, under pressure from health groups to attack the nation's obesity problem. For instance, Supervalu, the nation's No. 3 grocer, which also owns Bristol Farms, Jewel-Osco and other chains, debuted shelf tags that indicate which foods are high in fiber or low in saturated fat. Their program was developed in collaboration with Joslin Clinic, a group affiliated with the Harvard Medical School. The program will place tags of various colors next to the bar code and product price, communicating that a product meets U.S. Food and Drug Administration criteria with nutrient content.

Smaller chains like Hannaford Bros. Co., based in Scarborough, Maine, launched a three-star system of good, better and best called Guiding Stars in September 2006.

Supervalu's approach "sounds helpful and good," said Michael Jacobson, director of the Center for Science in the Public Interest. But it doesn't go far enough, he argued. For example, it's useful to know which ice cream, cookies or other junk food is the best for you, and Supervalu won't be rating those types of foods for its nutrition tags.

The other issue is that there is no continuity among the nutrition groups that are hired by grocers. Jacobson is an advocate of one national system for the supermarket industry that has been tested to make sure it best encourages consumers to choose the most healthful foods.

Bonnie - this just sets the consumer up for more confusion. If the nutrition experts hired to create the labeling systems are all following the USDA guidelines, the effort will be meaningless. In addition, not putting labels on junk food is a joke. The grocers want it both ways: they don't want to be the "food police," yet they want to placate the government officials and public health experts that are calling for more effort in addressing the obesity epidemic.

At least Hannaford created good, better, and best labels, which leaves the consuumer to ponder the purchase items without these ratings.

"You are what you eat" is outdated

Chronically overweight people reprogram controls over their DNA and pass on fatness and disease not only to their children, but to future generations.

Melbourne scientists have proved for the first time that damage done by unhealthy eating is "remembered" in genetic controls - epigenetics - and turns off good genes needed to prevent diabetes, heart disease and other complications.

Lead researcher Assoc Prof Assam El-Osta, from the Baker IDI Heart and Diabetes Institute team, said, "It is this idea that you are what you eat, and perhaps that is a reflection of what your parents ate, and perhaps what your grandparents ate," he said.

The scientists proved that a single sugar hit, such as eating a chocolate bar, damaged the controls regulating the genes for two weeks.

But Prof El-Osta warned that regular poor eating meant the damage would last for months or years, and the real problems caused by an unhealthy diet were deferred until later life.

A poor diet could lead to very serious changes that are remembered for many months, or even years.

"You don't see the damage caused that day, that week or that month, but later on in life you see these complications like heart disease or problems with the eyes and your kidneys," Prof El-Osta said.

"This is not all doom and gloom . . . we think there is good epigenetic memory as well for individuals who have a good diet, not only for themselves but potentially for future generations. "If you have had five years of bad control, where good genes are switched off and bad genes switched on, changing that for a couple of months to a good diet may not have a tremendous impact.

"But going back to a good diet would have some effect 10 years later."

The findings were reported in the Journal of Experimental Medicine.

Steve - YES! YES! YES! This is the stuff public health professionals get excited about. Like we have said for the last several years, epigenetics does not just affect us, but one or two generations in the future. The mantra of "You Are What You Eat" is now a bit outdated. It now should be, "You and Your Future Generations Are What You Eat!"

Public Health Warning: Peanut Butter Products

Health officials urged consumers to avoid eating cookies, cakes, ice cream and other foods that contain peanut butter until they can learn more about an outbreak of salmonella contamination.

South Korean experts find way to remove lead from blood

South Korean scientists may have found a way to remove dangerous heavy metals such as lead from blood by using specially designed magnetic receptors. The receptors bind strongly to lead ions and can be easily removed, along with their lead cargo, using magnets, they wrote in an article in Angewandte Chemie International Edition, a leading chemistry journal.

"Detoxification could theoretically work like hemodialysis: the blood is diverted out of the body and into a special chamber containing the biocompatible magnetic particles," they wrote in a statement. "By using magnetic fields, the charged magnetic particles could be fished out. The purified blood is then reintroduced to the patient." Lead is a dangerous heavy metal and is especially toxic to children. Safe and effective detoxification processes are especially important.

The South Korean team, lead by Jong Hwa Jung at the Gyeongsang National University's department of chemistry, managed to remove 96 percent of lead ions from blood samples using these magnetic particles.

Bonnie - we would assume that this would be effective for other heavy metals as well.

Country-of-origin rules take effect March 16

Final U.S. regulations requiring meat and fresh produce to be labeled with country of origin will take effect March 16, the Department of Agriculture said.

The labeling rule, also known as COOL, is a longtime goal of U.S. farmers and ranchers convinced that identifying imported food may encourage manufacturers to use more U.S. products. Meat companies have opposed it and helped delay the requirements for years, saying they will result in additional expenses for labor, labels and changes to facilities needed to separate foreign and domestic products.

Coffee may reduce risk of dementia

Drinking coffee in middle age can decrease the risk of dementia later in life, a new study in the Journal of Alzheimer's Disease suggests. Those who drink coffee in midlife have a lower risk for late-onset dementia and Alzheimer's disease compared to those who drink little or no coffee. Researchers found the lowest risk among moderate coffee drinkers, or those who drank three to five cups a day. Their dementia or Alzheimer's risk was lowered by 65 per cent.

The study included data from patients who had participated in health surveys throughout the 1970s and 1980s. The average follow-up rate was 21 years. The researchers decided to study the association between coffee consumption in midlife and the development of late-onset dementia or Alzheimer's "because the long-term impact of caffeine on the central nervous system was still unknown" and because the processes that lead to these conditions may start decades before symptoms appear.

Bonnie - a significant study because the focus was long-term effects. In this case, coffee was found to be preventative. However, coffee loaded with sugar and milk/cream, as seen in other studies, lowers the protective effect greatly.

Surgeons could save lives, $20B by using checklist

Eight hospitals reduced the number of deaths from surgery by more than 40% by using a checklist that helps doctors and nurses avoid errors, according to a report released online today in the New England Journal of Medicine. If all hospitals used the same checklist, they could save tens of thousands of lives and $20 billion in medical costs each year,

The 19-point checklist has nothing to do with high technology. Instead, it focuses on basic safety measures, such as ensuring that patients get antibiotics to prevent infection and requiring that all members of the team introduce themselves. "An operation involves hundreds of steps with lots of team members," Gawande says. "We're good at making sure we do most of these things most of the time, but we're not good at doing all of them all of the time."

The study shows that an operation's success depends far more on teamwork and clear communication than the brilliance of individual doctors, says co-author Alex Haynes, also of Harvard. And that's good news, he says, because it means hospitals everywhere can improve. Researchers modeled the checklist, which takes only two minutes to go through, after ones used by the aviation industry, which has dramatically reduced the number of crashes in recent years.

Courtesy of USA Today

Steve - how easy would it be to follow a checklist? The only reason I can come up with for not following the check list is arrogance. A recent study also showed that a nurse checklist for ICU patients saw a dramatic drop in infection-related complications. This is elementary stuff "my dear Watson."

Nanotech in your vitamins

The ability of the Food and Drug Administration (FDA) to regulate the safety of dietary supplements using nanomaterials is severely limited by lack of information, lack of resources and the agency's lack of statutory authority in certain critical areas, according to a new expert report released by the Project on Emerging Nanotechnologies (PEN). The report, A Hard Pill To Swallow: Barriers to Effective FDA Regulation of Nanotechnology-Based Dietary Supplements, details the main problems at FDA in regulating nano-enabled dietary supplements and offers a host of recommendations for improving oversight of such products.

Current law requires supplement manufacturers to disclose limited information about their products, and what information is available is a result of dietary supplement manufacturers touting the use of nanotechnology when marketing their products, according to the report. "While it is not possible to precisely determine the prevalence of dietary supplements using engineered nanoparticles, it is likely that the public's exposure to these products will grow significantly in the next several years," says Lisa Barclay, also a co-author of the report.

Steve - this is another reason why you use a resource such as Nutritional Concepts to do the work for you. We screen any product we carry for nanoparticles. At this point in time, we do not endorse any products with nanomaterials because their is no data ensuring that they are safe.

USDA unable to weed out unapproved modified foods

The U.S. food supply is at risk of being invaded by unapproved imports of genetically modified crops and livestock. The report, released by the U.S. Agriculture Department's Office of Inspector General, said the USDA does not have an import control policy to regulate imported GMO animals. Its policy for GMO crops could become outdated as other nations boost production of their own GMO crops, the report added.

The Office of Inspector General recommended the department develop an overall control policy for all GMO imports and implement a strategy to monitor GMO crop and livestock development in foreign nations.

The audit found that the USDA needs to develop screening measures to weed out undeclared GMO crops and livestock. The department currently has no measures in place to identify a shipment of unapproved GMO imports unknown to the U.S. regulatory system, the report said.

The report noted that China has pledged $500 million toward biotechnology by 2010 and has developed a new form of GMO rice.

Although the implications associated with Americans consuming unapproved GMO food are unknown, the health and environmental concerns that it poses could threaten commerce.

Steve - we discussed this inevitability when we attended a public comment event held by the USDA. It is coming to fruition as predicted because the USDA and FDA are underfunded, undermanned, and corrupt (as they themselves have stated).

Eating starts with these 50 Superfoods

For those of you not familiar with the term Superfood, they are foods with special therapeutic value beyond calories and basic nutrients. We recommend many of the following to our clients for healing and prevention.

If tolerated, try to add one each week to your diet that you've never had before.

1. Almonds
   
2. Apples
3. Asparagus
   
4. Avocado
5. Banana
6. Blackberries
   
7. Blueberries (wild)
8. Bok choy
9. Brazil nut
10. Broccoli/Broccoli Sprouts
11. Brown Rice
12. Cauliflower
13. Cherries (tart)
14. Chocolate (70% cocoa or higher)
15. Cod Liver Oil
16. Coffee (unsweetened)
17. Collard Greens
18. Black Beans
19. Brussels sprouts
20. Edamame (boiled soybeans)
    
21. Eggs (organic, DHA infused)
    
22. Flaxseed (pulverized)
23. Garlic
    
24. Grapes
25. Grapeseed Oil
    
26. Kiwi
27. Mushrooms (Shiitake)
    
28. Mustard Greens
    
29. Oats (steel-cut only)
30. Olives/Olive Oil
31. Onions
    
32. Pomegranate
    
33. Prunes
34. Pumpkin (canned organic)
35. Quinoa
    
36. Salmon (wild caught)
37. Sardines
    
38. Scallops
39. Soy Milk (organic unsweetened)
    
40. Sunflower Seeds/Seed Butter
41. Sweet Potato
42. Tea (unsweetened)
43. Tofu/Tempeh
    
44. Tomato sauce
45. Turkey Breast (nitrate-free)
    
46. Walnuts
47. Watercress
    
48. Watermelon
49. White Potato (baked)
50. Yogurt (Greek)

Is there another food that should have made the top 50?
Leave in the comment box and we'll let you know if it belongs.

Study: DHA supplements may help premature baby girls

Australian doctors tested the fatty acid, DHA, in premature babies to see if it reduces the rate of mental retardation, which is more common in babies born very early, according to a study in today's Journal of the American Medical Association.

Doctors focused on 657 babies born before 33 weeks — about seven weeks before the end of the average 40-week pregnancy. Doctors randomly assigned half of newborns to a high-DHA diet and half to a standard one. For the high-DHA diet, breastfeeding mothers took six 500-milligram tuna fish oil capsules and, if needed, babies received infant formula in which DHA made up 1% of the total fatty acids. Mothers of babies on the standard diet got placebo pills, and their babies got regular formula.

Babies underwent standard development tests at 18 months.

Doctors found no difference in mental retardation rates overall or in boys, the study shows.

But premature girls given the high-DHA diet scored about 5 points higher on a 100-point test, which translates to a 55% reduction in the proportion of girls with a "mild mental delay" and an 80% reduction in the proportion of girls with "significant" mental delay, says author Maria Makrides of Women's and Children' Hospital in Adelaide, Australia. She notes that premature girls generally have lower risks of complications than boys.

There were no harmful side effects of taking DHA, which mothers naturally pass on to their babies in the womb. Babies born early miss out on the benefits of DHA, which may help develop their brains during the critical last weeks of pregnancy, Makrides says. She notes that the preemie girls given extra DHA had test scores nearly as high as those of full-term babies.

Based on those findings, her hospital is preparing to offer a DHA-rich diet to its preemies, Makrides says.

Stricken children thrive with intravenous doses of fish oil

By Carolyn Y. Johnson,
Boston Globe

With a toddler's aplomb, Ellie Brogan gives a tour of her body's plumbing. The pouch tucked into her diaper is "my ostomy." A hole in her stomach that hooks to a feeding tube is "my button." "My central line" feeds nutrients to a vein near her heart.

But after show and tell, Ellie scampers around the house like any other child, her blond curls bouncing.

You'd never know that when she was just a day old, doctors warned Abby and Gib Brogan that their daughter, born with just a tiny fraction of her small intestine and missing some of her colon, would probably need a liver transplant or die by her first birthday.

Now, 2 1/2 years later, Ellie is one of more than 100 children with rare "short bowel syndrome" who have received a therapy pioneered at Children's Hospital Boston. It uses an old-fashioned substance - fish oil - to keep their livers healthy, and doctors and Ellie's parents say it helped save her life.

Babies like Ellie, who lack the ability to digest food or absorb nutrients, need to be fed intravenously. But the IV nutrition also damages their livers.

Dr. Rusty Jennings, a pediatric surgeon and one of Ellie's doctors, described the double-edged sword physicians faced when treating such patients: "You can't not give it [the IV nutrition] to them or they'll die of malnutrition. You do give it to them, and they die of liver disease."

Then came an unusual leap of medicine from the lab into the clinic.

In experiments in mice, Dr. Mark Puder, a Children's Hospital surgeon, and colleagues found that using a nutritional supplement made with fish oil instead of the standard one, made from soybean oil, did not cause liver damage.

In 2004, a desperately ill baby on IV nutrition in Jennings's care faced liver failure, and he approached Puder.

With approval from the US Food and Drug Administration, the hospital's institutional review board, and the parents, Puder changed the IV nutrition, swapping a fish oil formula for the standard fat supplement.

"At about a month, he started getting better," Jennings said. "It was just freaking amazing - I couldn't believe it."

From that single case came a shift in treatment. So far, 112 children at Children's Hospital - Ellie Brogan among them - have been given the fish oil, called Omegaven. The treatment is now available at 70 hospitals around the world. Parents call it a miracle.

Although the data have not yet been published, Puder said that more than 90 percent of the Children's Hospital patients are alive. He noted that the hospital often sees children who arrive from elsewhere in very bad shape and may be beyond the help of Omegaven because the therapy wasn't started sooner.

"Now we see, the sooner we start, the better we do," Puder said. It is not known whether the patients will now live close to a normal lifespan.

The Brogans are committed to telling their story and giving other parents hope through a blog that chronicles their journey.

Their lives have changed. Abby has switched fields and jobs. They moved from Connecticut to be closer to Boston. The couple, trained as marine biologists, say they have new respect for the oily fish used to make Omegaven - menhaden (also known as the common pogy). They have watched their little girl, whose eyes and skin were once yellowed by liver failure, develop more healthy coloring.

At the beginning of December, as she has improved, Ellie was taken off IV nutrition and the fish oil. She is eating food on her own, and her doctors hope her bowel will continue to adapt and allow her to live a more normal life.

"We think if it hadn't been for this," Gib Brogan said, "she might be post-transplant or she might not be with us."

Bonnie - this is truly amazing stuff. I commend the doctors for thinking out of the box.

Doctors going alternative

More mainstream physicians suggesting meditation, massage and acupuncture
By Julie Deardorff
Chicago Tribune

For years, Dr. Ali Keshavarzian ignored "alternative" therapies because his Western-trained brain wanted more evidence that they actually worked.

But Keshavarzian also knew conventional medicine often needed some assistance. And when he learned his patients were seeking out natural products, acupuncture, meditation and massage, he took a deep breath and dived in.

Ten years later, Keshavarzian straddles both worlds, using Western treatments along with a variety of alternative approaches, a combination known as complementary and alternative medicine, or CAM. "CAM is looking at a patient as a human being, rather than a disease," said Keshavarzian, a gastroenterologist at Rush University Medical Center. "Instead of treating 'ulcerative colitis,' I treat 'Mr. Jones.' "

The future success of the holistic CAM movement in the U.S. hinges on the very people who once viewed alternative medicine with cold skepticism: mainstream, conventionally trained doctors. Though many, such as Keshavarzian, still believe medical treatments should be backed by rigorous scientific data, they will not rule out adding into the treatment mix mind-body therapies that have been used for centuries in other cultures. Keshavarzian, for example, might suggest relaxation techniques when he thinks stress is a factor, acupuncture for pain or probiotics for acute diarrhea.

"The public has been on board for some time," said physician Andrew Weil, founder of the University of Arizona's School of Integrative Medicine, which has trained more than 350 physician fellows. "The professionals are harder to win over."

Five chronic conditions—mood disorders, diabetes, heart disease, asthma and high blood pressure—account for more than half of all U.S. health expenditures, according to the Institute of Medicine, part of the National Academy of Sciences, which advises the federal government on health issues. But these are the disorders that conventional medicine struggles to treat, according to the institute.

"Studies show that $2.5 trillion is being spent in a system that is not improving the overall health of our citizens," according to the institute. "Incidents of chronic disease are on a sharp rise and by 2023 will cost our nation $4.3 trillion."

Proponents say CAM, which is also called "integrative medicine," is a cost-effective solution.

Integrative treatments fall into four main categories: natural products (vitamins and supplements), energy medicine (acupuncture), manipulative practices (chiropractic work) and mind-body medicine (meditation or deep breathing).

For instance, if a patient needs bypass surgery, an integrative doctor would recommend it. But afterward, he or she might suggest fish oil, exercise or nutritional changes to aid healing.

Laura Restaino of Wheaton tried an integrative physician, Charles Dumont, a Loyola University pediatric gastroenterologist, after prescription drugs, creams, steroids and lotions prescribed by conventional doctors failed to treat her daughter Alex's severe eczema. After receiving hand acupuncture (using pellets in place of needles) from Dumont, the condition cleared up almost instantly, Restaino said.

Alex, now 12, sees Dumont every six to eight weeks for maintenance acupuncture. "He's kind, he listens and he doesn't rush," her mom said.

Though primarily driven by patient demand, the integrative medicine movement recently has received a boost from the conservative medical establishment, including the American Academy of Pediatrics, which has a CAM task force.

An increasing number of prestigious medical schools are teaching integrative practices. Since 1999, the Consortium of Academic Health Centers for Integrative Medicine, a group that includes Duke University, Harvard and Northwestern, has grown from 8 to 43 members. With more traditional medical schools focusing on health care that addresses the mental, emotional and physical aspects of healing, the use of CAM by the nation's future physicians is expected to grow.

Meanwhile, it's getting easier for practicing physicians to find CAM training. In early December, the University of Chicago and the Mayo Clinic co-sponsored the ninth annual two-day CAM conference for medical professionals. And the 2009 Integrate Chicago Conference on Jan. 17 at Loyola is being organized by, and for, medical students interested in integrative medicine.

Nearly 40 percent of adults used integrative therapies last year, according to a new government report, most often to treat chronic back, neck and joint pain, arthritis, anxiety, high cholesterol and head or chest colds.

And 12 percent of U.S. children have used an alternative therapy.

"Early in my career I felt like we [doctors] were missing the boat because we weren't addressing underlying problems," said integrative physician Steve Devries, a preventive cardiologist at Northwestern Memorial Hospital. "We'd often tell patients after angioplasty that they 'had the heart of a teenager again.' But it was completely untrue. We'd bought them time to correct the underlying problem, but if we didn't fix that then we'd see them again and again."

Now Devries focuses on prevention; his aftercare includes addressing factors that influence heart disease, including stress and nutrition. He'll find a therapy that fits a person—meditation, yoga, biofeedback or talk therapy—as part of an overall treatment plan. "The modality is not as important as the awareness of a mind-body connection," he said.

One of the challenges of integrative medicine, however, is that it requires more of a doctor's time. Critics say it also has a relatively small evidence base, but that, too, is changing. Though research funding pales in comparison to pharmaceutical drug trials, the National Institutes of Health's National Center for Complementary and Alternative Medicine has been increasing its pace of granting funds for CAM research. It has funded more than 2,200 research studies since 1999.

"The difference is that 50 years ago Western medicine began to examine its practice more vigorously; the other methods have begun to do it more recently," said Keshavarzian. "You can't dismiss CAM; it's the result of 1,000 years of experience. But we can vigorously study it."

Bonnie - it is nice to see Dr. Devries interviewed for this piece. I have referred clients to him for years.

38% of Adults Use Alternative Medicine

More than one-third of adults and nearly 12 percent of children in the United States use alternatives to traditional medicine, according to a large federal survey that documents how entrenched alternative therapies have become.

The 2007 survey of more than 32,000 Americans, which for the first time included children, found that use of yoga, "probiotics," fish oil and other "complementary and alternative" therapies held steady among adults since the last national survey five years earlier, and that such treatments have become part of health care for many youngsters.

"It's clear that millions of Americans every year are turning to complementary and alternative medicine," said Richard L. Nahin of the National Institutes of Health's National Center for Complementary and Alternative Medicine, which released the survey. "The use of complementary and alternative medicine seems to have stabilized in the United States."

The most commonly used are dietary supplements and herbal products, followed by deep-breathing exercises, meditation, chiropractic therapy, massage and yoga. "I think it's fair to say we can conclude that this is part of the steady state of medical care in the United States," said David Eisenberg, director of the Harvard Medical School's division for research and education in complementary and integrative medical therapies. "I think the news is complementary and alternative medicine use by the U.S. public is here to stay.

Here are the 10 most common CAM treatments among adults, according to NCAAM.

1. Natural products: 17.7%
   (most common: EPA/DHA fish oil)
2. Deep-breathing exercises: 12.7%
3. Meditation: 9.4%
4. Chiropractic or osteopathic manipulation: 8.6%
5. Massage: 8.3%
6. Yoga: 6.1%
7. Diet-based therapies: 3.6%
8. Progressive relaxation: 2.9%
9. Guided imagery: 2.2%
10. Homeopathic treatment: 1.8%

Courtesy of the Washington Post

75% of heart attack patients had LDL readings at low-risk levels

A major new study has found that more than 75 percent of people hospitalized for heart attacks had cholesterol levels that would indicate they weren't at high risk.

Almost half of these patients had "bad" cholesterol, or LDL, levels below 100 mg/dL, which is considered optimal under current guidelines from the National Cholesterol Education Program.

The new research -- based on data from nearly 137,000 patients at more than 500 hospitals -- suggests that current LDL guidelines aren't low enough to identify people likely to have a heart attack, said Dr. Gregg C. Fonarow, lead author of the study published in the American Heart journal.

"Falsely, patients and doctors thought they were being well-protected" if LDL levels fell within the recommended range, Fonarow said.

Dr. Sidney Smith Jr., who's on a panel of experts that's revising government guidelines on heart disease and obesity, said the study makes a good case for lowering LDL recommendations. "It certainly gives us an idea on where we need to focus our efforts," Smith said.

Steve - wow are these doctors in denial. How low are they going to go? Until the entire country is on a statin?

They should be changing the guidelines to focus on cardiac inflammation. We have known for years that LDL cholesterol is only one piece of the puzzle. Quelling inflammation is much more important. Diet, nutrients, and other CAM therapies can handle this issue. In tougher cases, red yeast rice or statins may be warranted.

A study published in November 2008 called JUPITER, which involved 18,000 patients, showed that people with low cholesterol but who test positive for artery inflammation are still at high risk for heart attacks, strokes and deaths. The test for inflammation betrays the presence of a telltale protein called C-reactive protein, or CRP.

Treating people with high CRP levels dramatically reduced the number of lives lost to heart disease and the number of costly and painful procedures needed to restore heart patients to health.

FDA lets drugmakers advise doctors on unapproved uses

U.S. health officials finalized guidelines that make it easier for pharmaceutical companies to tell doctors about unapproved uses of medicines, a practice opposed by critics of industry marketing.

The Food and Drug Administration (FDA) guidelines explain when manufacturers such as Pfizer Inc and Merck & Co may distribute copies of medical journal articles that describe unapproved uses. The action could help companies expand the markets for medicines and medical devices.

The move, announced a week before Republican President George W. Bush leaves office, puts in place a policy that drew objections from congressional Democrats and drug-industry critics when it was proposed last year. Opponents say it will allow promotion of uses without adequate testing.

"In the final hours of this administration, political appointees at FDA have given drug companies a long-coveted parting gift," said Rep. Henry Waxman, chairman of the House of Representatives Energy and Commerce Committee.

"This fundamentally undermines the requirement that companies prove to FDA that each new use is safe and effective. I hope this policy will be carefully re-examined by the new administration," added Waxman, a California Democrat.

By law, manufacturers are prohibited from marketing their medicines for uses not approved by the FDA. But doctors can prescribe drugs for any use they see fit, a practice known as "off-label" use.

Distribution of medical literature suggesting a drug may have merit for an unapproved use is a marketing area that has been in dispute for years.

The FDA in its guidelines said "public health can be served when health-care professionals receive truthful and non-misleading scientific and medical information on unapproved uses."

Industry critics say distribution of the journal articles promotes untested uses of drugs and may be dangerous. It also may deter manufacturers from doing more tests of the new uses and subjecting them to FDA scrutiny for possible approval.

About one of five prescriptions in the United States was written to treat a condition for which the drug was not approved, according to a 2006 study published in the Archives of Internal Medicine. The researchers said most off-label use occurs without scientific support.

The guidelines also apply to medical device makers.

Steve - what a parting gift, Mr. Bush. Thanks a lot. So I guess now, any drug prescribed for health problems or symptoms NOT identified by the manufacturer should be avoided. Otherwise, you'll be a guiniea pig and Big Pharma will drive our health costs even hiigher.

Bug Crazy: Assessing Benefits of Probiotics - Our Comments

Access to article here.

While we commend The Wall Street Journal for warning consumers about the quality and research behind some of the probiotic strains in the marketplace, they also missed the boat on several issues:

• The products they referenced were predominately yogurt/dairy foods. This is fine. However, they failed to mention that many of these products are naturally/artificially sweetened and contain binders/fillers that may contraindicate with the effectiveness of the probiotic cultures.

• The article quotes a researcher who says that only 15 strains have human research behind them. This is incorrect. While the article references two strains that we commonly recommend, Bifidobacterium lactis (in Metagenics Ultra Flora) and Saccharomyces boulardii (Biocodex Florastor and Metagenics Proboulardi), it does not mention Lactobacillus Acidophilus NCFM (Metagenics Ultra Flora) and DDS-1 (UAS Labs), which
  have copious amount of research behind them.

Doctors give side effects center stage to keep lid on antibiotics

Kim Painter
USA Today

Would you beg your doctor for drugs that:
• Have a 5% to 25% chance of causing diarrhea?
• Land at least one in every 1,000 users in the emergency room?
• Help only about one in 4,000 patients avoid a serious complication?
• Do nothing to relieve your symptoms?

If you've answered no, congratulations: You've decided to stop demanding antibiotics for colds, flu and similar illnesses. And you've demonstrated what some doctors suspect: The best way to break patients of their dangerous, expensive addiction to unneeded antibiotics is to focus on the personal risks and benefits — which are becoming clearer, thanks to recent research.

The message, in a nutshell: "There's a very small chance this antibiotic will help you, but a much bigger risk that it will hurt you," says Jeffrey Linder, an assistant professor at Harvard Medical School and Boston's Brigham and Women's Hospital.Health educators have struggled to convince the public that antibiotics are useless for colds, influenza, most sore throats and the vast majority of bronchitis cases. That's because those illnesses are caused by viruses. Antibiotics kill only bacteria.

They've also told people that every time they take unneeded antibiotics, they encourage the growth of bacterial strains that resist antibiotics and can spread through households and communities, creating hard-to-control "superbugs." Result: "We're not getting anywhere," Linder says. Half of antibiotic prescriptions still go to people with viral illnesses.

Many doctors believe antibiotics satisfy these patients, prevent some complications and do little or no harm, he says. But recent studies that quantify risks and benefits might give these doctors pause — and the ammunition they need to resist patients' pleas. In one study, researchers from the Centers for Disease Control and Prevention found that one in every 1,000 patients who got antibiotics during a doctor's visit landed in an emergency room with an allergic reaction or other problem caused by the antibiotic. That's more than many experts expected and translates into 142,505 emergency room visits a year, says CDC researcher Daniel Budnitz. That number doesn't include people who just called their doctor to report a rash or suffered silently with antibiotic-induced diarrhea (which happens in up to 25% of cases, depending on the drug).

Meanwhile, British researchers found that doctors would have to give antibiotics to 4,000 cold sufferers to prevent one case of bacterial pneumonia, a report in the British Medical Journal says. Budnitz says the CDC is updating its antibiotic education campaign to put more emphasis on personal risks. Antibiotics are wonder drugs for certain conditions, but they "are not harmless," he says. So it makes no sense to use them when there are "uncertain, if any, benefits." But William Hueston, chair of the department of family medicine at the Medical University of South Carolina, isn't sure patients want or need to hear more antibiotic statistics. "Patients just want to feel better," he says. Doctors who help patients ease symptoms with pain relievers, inhaled drugs that work against cough, and other measures can avoid the antibiotic argument altogether, he says.

Bonnie - how many more years do we have to scream from the top of the mountain about this? Half of all prescriptions are going towards viral illnesses, still! It is unconscionable that doctors and patients continue to risk injury to themselves and the public at-large by demanding unnecessary prescriptions.