Friday, July 31, 2009

environmental health in pediatric care

Pediatric medical and nursing education lack the environmental health content needed to properly prepare health care professionals to prevent, recognize, manage, and treat environmental exposure-related diseases. Few studies have evaluated the effectiveness of programs that incorporate pediatric environmental health (PEH) into curricula and practice.

This Environmental Health Perspectives study evaluated the effectiveness of the National Environmental Education Foundation's (NEEF) Children's Environmental Health Faculty Champions Initiative, which is designed to build environmental health capacity among pediatric health care professionals.

During the 12 months following the workshop, the faculty champions' average pretest score of 52% was significantly elevated to 65.5% on the first posttest and to 71.5% on the second posttest, showing an increase and retention of environmental health knowledge. Ninety percent of faculty champions reported that PEH had been integrated into the curricula at their institution.

The initiative was highly effective in achieving its goal of building environmental health capacity among health care professionals.

Steve - this is so important for health professionals. We have a special section in our wellness packet that addresses environmental exposure because it is crucial to the overall wellness picture.

Effect of Magnesium on Blood Pressure

The objective of this Annals of Pharmacotherapy study was to evaluate the long-term blood pressure-lowering ability of oral magnesium versus placebo in patients with implanted cardioverter defibrillators (ICDs).

In 50 patients who completed at least 12 weeks of follow-up, 86% of patients, regardless of randomization, had a baseline intracellular magnesium deficiency, but no patients had a serum magnesium deficiency. At 12 weeks, magnesium significantly reduced systolic blood pressure compared with placebo. In the 45 patients who continued in the study through the 24-week time period, the systolic blood pressure reduction was maintained.

Exercise Reduces Risk for Premature Death From Cancer in Men

A study from Finland has shown that men who exercised for at least 30 minutes a day at moderate to high intensity halved their risk of dying prematurely from cancer, mainly gastrointestinal and lung cancer.

The results were published online July 28, 2009 in the British Journal of Sports Medicine.

Physical inactivity over a person's lifespan might be a "key factor in the initiation of cancer development," the authors note.

Two Studies On Polycystic Ovarian Syndrome

Researchers have found evidence that chronic disease in either a mother or father can create unfavorable conditions in the womb that are associated with the development of polycystic ovarian syndrome (PCOS) in daughters.

In another study, researchers found that brothers of women with PCOS and insulin resistance are themselves at greater risk of developing insulin resistance or diabetes, suggesting that factors associated with the condition can be passed down to sons as well as daughters.

The two studies were presented to the 25th annual meeting of the European Society of Human Reproduction and Embryology.

One researcher states: “These findings suggest a new pathway for the development of PCOS. We think that factors associated with the pre-existence of cardiovascular dysfunction in the mother or the father, and which operate during pregnancy, may create adverse conditions for the fetus, which alter the metabolic profile of offspring, leading to insulin resistance and reproductive consequences, such as PCOS, for daughters. A family history of diabetes is, therefore, not essential to observe an insulin resistance-related disease in offspring.”

The study was the first to show that brothers of women who had PCOS and insulin resistance were themselves more likely to develop insulin resistance or even diabetes or dyslipidaemia (a disruption in the levels of lipids (or fats) in the blood).

Another researchers states: “These results mean that we should pay attention to the health not only of women with PCOS but also to their brothers as they seem to have an increased risk for the medical problems that make up the metabolic syndrome, such as insulin resistance, diabetes and cardiovascular disease. Our findings are also in accordance with the hypothesis that not only is PCOS is a heritable disease, but that factors associated with it, such as insulin resistance, can be passed down to the next generation of either sex."

Steve - another indicator of the wide ranging effect of epigenetic activity.

MSG Causes Weight Gain

A recent study out of the University of North Carolina at Chapel Hill cites what animal studies have hinted at for years: MSG (aka monosodium glutamate) could be a factor in weight gain.

The study focused on 750 Chinese men and women, ages 40-59, living in 3 rural villages in north and south China. Most of the study subjects prepared their meals at home without commercially processed foods and roughly 82 percent used MSG. Those participants who used the highest amounts of MSG had nearly 3 times the incidence of overweight as those who did not use MSG, even when physical activity, total caloric intake, and other possible explanations for body mass differences were accounted for. The positive correlation between MSG and higher weight confirmed what animal studies have been suggesting for years.

How prevalent is MSG in the U.S. diet? Americans consumed about 1 million pounds of MSG in 1950, and today that number has increased by a factor of 300!

The Food and Drug Administration (FDA) describes MSG as "naturally occurring," and has it on the GRAS ("generally regarded as safe") list. However, not only could MSG be causing us to gain weight, but some studies also reveal that as many as 25 to 30 percent of Americans have adverse reactions to it (e.g., palpitations and migraine headaches), and as many as 30 percent are extra sensitive to it if they consume more than 5 grams at one sitting.

Unfortunately, eliminating MSG from the diet is much easier said than done, since—given the fact that food processors often change recipes—there's no list of "safe" foods that never contain MSG. A good start is to avoid anything with MSG anywhere in the ingredient list, but there will still be many foods that have MSG hidden inside other ingredients. Likewise, even products labeled "no MSG added" can still contain these hidden sources.

Best bets for avoiding MSG

  • Buy organic produce whenever possible.

  • Make things from scratch, avoiding processed ingredients as much as possible.

  • Limit making stews or soups in a crock pot, since slow-cooking tends to cause small amounts of glutamic acid to be released from the protein sources (e.g., meat, chicken) in the recipe.

By Margaret Furtado, M.S., R.D. - Posted Mon, Jul 27, 2009

Thursday, July 30, 2009

Organic food no better than conventional?

A group of British researchers concluded that organic foods aren't nutritionally superior to their conventionally produced cousins after reviewing 50 years of published literature on the topic.

However, the review didn't address any contaminants or chemical residue connected with different agricultural production methods. One of the main benefits of organic food is the absence of chemical additives.

The study by researchers at the London School of Hygiene & Topical Medicine was published Wednesday in the American Journal of Clinical Nutrition.

Bonnie - as we have discussed so many times in the past, a review study is very subjective. This blog alone can cite several recent studies showing that organic food is better from a nutritional point of view. The fact that they did not consider the effect of pesticides leaves a major void.

The review comes with other strong limiting factors. Notably, a large number of studies were excluded because they did not specify an organic certifying body, there was no information on the cultivar or livestock breed, no statement of which nutrient or nutritionally relevant substance was reviewed, no information on statistical methods, or no information on laboratory methods.

The researchers also excluded studies in foreign languages that did not have English abstracts; the team could not locate 11 studies that may have contained relevant data; and two studies published after the cut off date were not taken into account.

Nutrigenomics explains omega-3’s immune health benefits

Omega-3-rich fish oil beneficially affects gene expression, says a new nutrigenomic study that published in the American Journal of Clinical Nutrition. The study is said to be the first to show that DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid) can affect gene expression to a more anti-atherogenic and anti-inflammatory status.

Study details Dr Afman and her co-workers from the Nutrition, Metabolism and Genomics Group at Wageningen University recruited 111 healthy Dutch elderly subjects and randomly assigned to consume 1.8 or 0.4 g of EPA plus DHA every day, or to consume 4.0 grams of high-oleic acid sunflower oil per day, for six months. Microarray analysis of gene expression in PBMCs revealed that that high EPA plus DHA supplement resulted in altered gene expression of 1040 genes, while the sunflower oil supplement altered gene expression of 298 genes. “Of these genes, 140 were overlapping between the groups, which resulted in 900 uniquely changed genes in the EPA plus DHA group,” said the researchers. Furthermore, the altered genes were involved in inflammatory- and atherogenic-related pathways, said the researchers. “These results are the first to show that intake of EPA plus DHA for 26 weeks can alter the gene expression profiles of PBMCs to a more anti-inflammatory and anti-atherogenic status,” concluded the researchers.

Wednesday, July 29, 2009

August Locavore Tidbit

What's in season in the Midwest and other colder climates: Beans, Beets, Bell Peppers, Blackberries, Blueberries, Broccoli, Cabbage, Cantaloupes, Carrots, Cherries, Cucumbers, Currants, Eggplant, Fennel, Garlic, Horseradish, Lettuce, Melons, Mushrooms, Nectarines, Okra, Onions, Peaches, Pears, Plums, Potatoes, Radicchio, Radishes, Raspberries, Rhubarb, Scallions, Summer Squash, Sweet Corn, Sweet Potatoes, Tomatoes, Turnips, Watermelons.

Locally grown produce provides a fresh, less toxic product, supports your local economy, and reduces your carbon load.

Red Quinoa Pilaf - August Recipe

  • Great side dish
  • Gluten-frees
  • Serves 7
  • 10 minute prep
  • 30 minute cook time
2 tsp olive oil
1/2 c. chopped onion
2 tsp. minced ginger
2 garlic cloves, minced
1 cup Inca Red Quinoa
1 1/2 cups organic, reduced-sodium chicken broth
1 cup canned (garbanzo) chickpeas, rinsed and drained
1/3 cup raisins, plumped in hot water for 10 minutes, then drained
1 T. minced fresh mint (do not use if salicylate-sensitive)
2 T. lime juice
Salt and black pepper to taste

Directions: Heat the oil in a large skillet over medium heat. Add the onion, ginger, and garlic, and saute for 4 minutes. Add the quinoa, and saute 1 minute.

Add the broth and bring to a boil. Lower the heat, cover, and cook for 15 minutes. Fluff the quinoa with a fork, and add the chickpeas, raisins, mint, and lime juice. Season with sat and pepper. Cook for 1 minute.

Probiotics for cold and flu?

FDA rules on dental amalgams

The U.S. Food and Drug Administration said silver-colored dental fillings that contain mercury are safe for patients, reversing an earlier caution against their use in certain patients, including pregnant women and children.

"While elemental mercury has been associated with adverse health effects at high exposures, the levels released by dental amalgam fillings are not high enough to cause harm in patients," the FDA said, citing an agency review of roughly 200 scientific studies.

Still, in final regulations issued as part of an earlier legal settlement, it said the fillings were now considered "moderate risk" devices and will include details about the risks and benefits of the products. They will also carry warnings against their use in patients with mercury allergies or in poorly ventilated areas.

Steve - part of the problem is that there is the unknown of how heavy metals affect health at chronic low-level exposure over a lifetime. None of the data the FDA considered contains studies of this nature.

Monday, July 27, 2009

Colic In Babies May Be Caused By Gut Bacteria

Researchers at The University of Texas Health Science Center at Houston say one organism discovered during their study may unlock the key to what causes colic, inconsolable crying in an otherwise healthy baby.

“Right now, pediatric gastroenterologists can treat just about anything that comes through the door,” said J. Marc Rhoads, M.D., professor of pediatrics at The University of Texas Medical School at Houston, which is part of the UT Health Science Center at Houston. “With colic, there is no evidence-based treatment we can offer. Colic can be a dangerous situation for a baby. The parent’s frustration over the crying can lead to maternal frustration, post-partum depression and even thoughts of harming the baby.”

Published in the July 23 online edition of the Journal of Pediatrics, the study pointed to an organism called Klebsiella, a normally occurring bacterium that can be found in the mouth, skin and intestines. In the study of 36 babies, half of which had colic, researchers found the bacterium and gut inflammation in the intestines of the babies with colic.

“We believe that the bacterium may be sparking an inflammatory reaction, causing the gut inflammation,” said Rhoads, the lead investigator for the study. “Inflammation in the gut of colicky infants closely compared to levels in patients with inflammatory bowel disease. Colic could prove to be a precursor to other gastrointestinal conditions such as irritable bowel syndrome, celiac disease and allergic gastroenteropathies.”

Babies in the study were fed breast milk and/or formula. Previous research articles have not shown significant data supporting the theory that breastfeeding protects infants against colic. The babies in the study were recruited from UT Physicians’ pediatric clinics and Kelsey-Seybold clinics.

Right now, pediatricians prescribe special hypoallergenic infant formula to try and treat colic, but none of it has been proven in studies to be effective in treating the condition.

“During our study, we also found that the babies that didn’t have colic had more types of bacteria in their intestines. The presence of more bacteria may indicate that specific bacterial species (phylotypes) are beneficial to humans,” Rhoads said.

A larger study is needed to examine Klebsiella and the use of a probiotic, which is a dietary supplement made up of good bacteria, to control the gut inflammation.

Bonnie - treating babies with probiotics for colic? What a novel idea (I say with tongue in cheek).

Friday, July 24, 2009

Omega-3, -6 levels linked to bowel health

Increased intakes of omega-6 fatty acid linoleic acid may double the risk of ulcerative colitis, a type of inflammatory bowel disease. On the other hand, the highest intakes of omega-3 were associated with 77 per cent reduction in the risk of the disease, according to findings of the European Prospective Investigation into Cancer and Nutrition (EPIC) with 203,193 men and women published in Gut.

Researchers analyzed data from 203,193 people from UK, Sweden, Denmark, Germany and Italy aged between 30 and 74. Linoleic acid is found in foods such cooking oils (especially corn and sunflower oils), red meat (particularly beef and pork), and polyunsaturated margarines. During the course of four years, 126 cases of ulcerative colitis were documented. Dividing the participants into four groups depending on their linoleic acid intakes, Dr Hart calculated that highest average intake of linoleic acid was associated with 149 per cent increase in the risk of ulcerative colitis. Conversely, the highest average dietary intakes of DHA were associated with a 77 per cent reduction in ulcerative colitis risk.

Bonnie - yet another ideal example of how essential fatty acid imbalance perpetuates chronic inflammatory disorders.

Thursday, July 23, 2009

Are we what our mother's ate?

Mothers' health in the days and weeks prior to becoming pregnant may determine the health of offspring much later in life, according to results of studies reported at the annual meeting of the Society for the Study of Reproduction. These studies demonstrate that maternal nutrition, protein intake and level of fat in the diet may cause epigenetic changes in the developing fetus that can have long-term health consequences.

Too Much of a Sweet Thing? Maternal Diabetes and Embryo Development

The time between ovulation and conception may be a critical one for maternal and fetal health, according to Kelle Moley, M.D., Washington University School of Medicine. In mouse studies, she found that subtle differences in maternal metabolism had long-lasting effects. Indeed, when Dr. Moley transferred embryos from a diabetic mouse into a non-diabetic mouse shortly after egg implantation, she noted neural tube defects, heart defects, limb deformities and growth defects in offspring. These findings indicate that we may need to re-direct our ideas about maternal health to the time prior to pregnancy, she says.

Take Your Vitamins Before Becoming Pregnant

Are we encouraging pregnant women to take vitamins when it may be too late to impact the health of a growing fetus? According to Kevin Sinclair, Ph.D., University of Nottingham, maternal nutrition even at the time of conception can alter fetal development. In studies with sheep and rodents, he found that offspring of mothers with vitamin B12 and folic acid deficiencies were fatter, became insulin resistant and had higher blood pressure by the time they reached middle-age, demonstrating that early molecular changes may not manifest themselves for many years.

Low Protein Diet May Lead to "Jumpy" Offspring

Low protein levels in female mice during the first few moments of conception, when the egg is still dividing, caused abnormal growth, cardiovascular disease, high blood pressure and jumpy behavior in their offspring. According to Tom Fleming, Ph.D., University of Southampton, mice born to mothers with low protein grew bigger – extracting as much nutrients as they could to compensate for poor nutrition while in the womb.

Beyond Genetics: How Dormant Memories Can Impact Later-Life Events

According to epigenetic theory, changes in the genome can happen at any time through the impact of environmental factors on the expression of genes over time. One of the most critical periods is early life when epigenetic memories are created that may impact a person's susceptibility to disease later in life, says Shuk-mei Ho, Ph.D., University of Cincinnati Medical Center. According to her research, these "memories" may remain dormant until an environmental trigger brings them to the surface, modifying risk for disease.

Bonnie - as more scientists are discovering, proper prenatal planning is one of the most important things we can do for our children.

Wednesday, July 22, 2009

Two studies confirm importance of healthy lifestyle

Journal of American Medical Association, July 2009

Relation Between Modifiable Lifestyle Factors and Lifetime Risk of Heart Failure

The lifetime risk of heart failure at age 40 years is approximately 1 in 5 in the general population. However, little is known about the association between modifiable lifestyle factors and the remaining lifetime risk of heart failure.

To examine the association between modifiable lifestyle factors and the lifetime risk of heart failure in a large cohort of men, the researchers used data from 20 900 men (mean age at baseline, 53.6 years) from the Physicians' Health Study I (1982-2008) who were apparently healthy at baseline. Six modifiable lifestyle factors were assessed: body weight, smoking, exercise, alcohol intake, consumption of breakfast cereals, and consumption of fruits and vegetables.

During a mean follow-up of 22.4 years, 1200 men developed heart failure. Overall, the lifetime risk of heart failure was 13.8% at age 40 years. Lifetime risk remained constant in men who survived free of heart failure through age 70 years and reached 10.6% at age 80 years. Lifetime risk of heart failure was higher in men with hypertension than in those without hypertension. Healthy lifestyle habits (normal body weight, not smoking, regular exercise, moderate alcohol intake, consumption of breakfast cereals, and consumption of fruits and vegetables) were individually and jointly associated with a lower lifetime risk of heart failure, with the highest risk in men adhering to none of the 6 lifestyle factors and the lowest risk in men adhering to 4 or more desirable factors.

Conclusion: adherence to healthy lifestyle factors is associated with a lower lifetime risk of heart failure.

Diet and Lifestyle Risk Factors Associated With Incident Hypertension in Women

Hypertension is an important preventable risk factor for death among women. While several modifiable risk factors have been identified, their combined risk and distribution in the population have not been assessed. These researchers aimed to estimate the hypothetical fraction of hypertension incidence associated with dietary and lifestyle factors in women.

A study of 83 882 adult women aged 27 to 44 years in the second Nurses' Health Study who did not have hypertension, cardiovascular disease, diabetes, or cancer in 1991, and who had normal reported blood pressure, with follow-up for incident hypertension for 14 years through 2005. Six modifiable lifestyle and dietary factors for hypertension were identified. The 6 low-risk factors for hypertension were a body mass index (BMI) of less than 25, a daily mean of 30 minutes of vigorous exercise, a high score on the Dietary Approaches to Stop Hypertension (DASH) diet based on responses to a food frequency questionnaire, modest alcohol intake up to 10 g/d, use of nonnarcotic analgesics less than once per week, and intake of 400 µg/d or more of supplemental folic acid.

A total of 12 319 incident cases of hypertension were reported. All 6 modifiable risk factors were independently associated with the risk of developing hypertension during follow-up after also adjusting for age, race, family history of hypertension, smoking status, and use of oral contraceptives.

For women who had all 6 low-risk factors, the hazard ratio for incident hypertension was 0.22% of the population.
5 low-risk factors, 0.8% of the population
4 low-risk factors, 1.6% of the population
3 low-risk factors, 3.1% of the population

Body mass index alone was the most powerful predictor of hypertension.

Conclusion: adherence to low-risk dietary and lifestyle factors was associated with a significantly lower incidence of self-reported hypertension. Adopting low-risk dietary and lifestyle factors has the potential to prevent a large proportion of new-onset hypertension occurring among young women.

Stress increases likelihood of getting sick.

In a new report in Perspectives on Psychological Science, researchers investigated how stress can wreak havoc on our bodies and provides some suggestions to further our understanding of this connection.

The field of psychoneuroimmunology (PNI) investigates how stress and negative emotions (such as depression and anxiety) affect our health. Over the past 30 years, researchers in this field have uncovered a number of ways that stress adversely affects our health, and specifically, how stress can damage our immune system. Numerous studies have shown that stressed individuals show weaker immune responses to vaccines, and as Kiecolt-Glaser observes, "The evidence that stress and distress impair vaccine responses has obvious public health relevance because infectious diseases can be so deadly." Stress and depression have been shown to increase the risk of getting infections and also result in delayed wound healing.

Inflammation is the body's way of removing harmful stimuli and also starts the process of healing, via release of a variety of chemicals known as proinflammatory cytokines (e.g., interleukin-6). However, too much inflammation can be damaging and has been implicated in the development of many age-related diseases. Negative emotions and psychological stressors increase the production of proinflammatory cytokines. A recent study revealed that men and women who serve as caregivers to spouses with dementia (and thus are under constant stress) have a four times larger annual rate of increase in serum interleukin-6 levels compared to individuals without caregiving responsibilities.

What's more, the changes in interleukin-6 levels among former caregivers did not differ from current caregivers, even following the death of the impaired spouse, indicating that chronic stress may cause the immune system to age quickly. Kiecolt-Glaser notes, "These stress-related changes in inflammation provide evidence of one mechanism through which stressors may accelerate risk of a host of age-related diseases."

Kiecolt-Glaser argues that our environment should be taken into account when studying the link between stress and our health. For instance, diet may modify interactions between psychological and immunological responses: Omega-3 fatty acids (found in fish and walnuts) can reduce production of some proinflammtory chemicals and increasing levels of omega-3 fatty acids may result in positive effects on mood and the immune system. Environmental toxins (such as pesticides and air pollutants) can have extremely negative effects on the immune system and these effects may be intensified in stressed individuals, increasing their risk for developing allergies, asthma, and viral infections.

Steve - yet again, we see the importance of gaining a foothold on what stresses us out and finding the solutions that work for us as individuals.

Stressed fat tissue? You betcha.

Ben-Gurion University of the Negev (BGU) researchers, in a collaboration with colleagues from the University of Leipzig, Germany, have identified a signaling pathway that is operational in intra-abdominal fat, the fat depot that is most strongly tied to obesity-related morbidity.

The paper was just published in the Endocrine Society's the Journal of Clinical Endocrinology and Metabolism.

"Fat tissue in obesity is dysfunctional, yet, the processes that cause fat tissue to malfunction are poorly understood -- specifically, it is unknown how fat cells 'translate' stresses in obesity into dysfunction," said Dr. Assaf Rudich, senior lecturer from the Department of Clinical Biochemistry at Ben-Gurion University.

Fat tissue is no longer considered simply a storage place for excess calories, but in fact is an active tissue that secretes multiple compounds, thereby communicating with other tissues, including the liver, muscles, pancreas and the brain. Normal communication is necessary for optimal metabolism and weight regulation. However, in obesity, fat (adipose) tissue becomes dysfunctional, and mis-communicates with the other tissues. This places fat tissue at a central junction in mechanisms leading to common diseases attributed to obesity, like type 2 diabetes and cardiovascular diseases.

Fat tissue dysfunction is believed to be caused by obesity-induced fat tissue stress: Cells over-grow as they store increasing amounts of fat. This excessive cell growth may cause decreased oxygen delivery into the tissue; individual cells may die (at least in mouse models), and fat tissue inflammation ensues. Also, excess nutrients (glucose, fatty acids) can also result in increased metabolic demands, and this in itself can cause cellular stress.

The BGU and Leipzig teams established a setup for collecting fat tissue samples from people undergoing abdominal surgery. The team identified a signaling pathway that is operational in intra-abdominal fat, the fat depot that is most strongly tied to obesity-related morbidity.

The degree of activation of a signaling pathway from these individuals was compared with those of leaner people, those with obesity predominantly characterized by accumulation of "peripheral" fat, and those with obesity with predominant accumulation of fat within the abdominal cavity.

They discovered that the signaling pathway was more active depending on the amount of fat accumulation in the abdomen, and that it correlated with multiple biochemical markers for increased cardio-metabolic risk. Moreover, the expression of one of the upstream signaling components, a protein called ASK1, predicts whole-body insulin resistance (an endocrine abnormality that is strongly tied to diabetes and cardiovascular disease), independent of other traditional risk factors.

Researchers also demonstrated that although non-fat cells within adipose tissue express most of this protein in lean persons, the adipocytes themselves increase its expression by more than four-fold in abdominally-obese persons.

Steve - over the years, we have periodically written about this issue. This is one reason why those with chronic inflammatory disorders often have trouble losing weight.

Monday, July 20, 2009

Multivitamins may lower heart disease death risk

Long-term regular consumption of a multivitamin may reduce the risk of dying from heart disease by 16 per cent, according to a new study from the American Journal of Epidemiology. Intakes of vitamin E over 215 milligrams per day over the course of ten years were also associated with a 28 per cent reduction in the risk of death from cardiovascular disease.

Researchers from Fred Hutchinson Cancer Research Center at the University of Washington analyzed the 10-year use of multivitamin, vitamins C and E supplements on 5-year total mortality, and death from cancer or cardiovascular disease (CVD). Data from 77,719 Washington State residents aged between 50 and 76 was obtained by a self-administered questionnaire.

Stimulants used in children with ADHD raises cardiac risk

Exposure to methylphenidate and amphetamine salts (used in ADHD drugs) shows a similar risk for cardiac emergency department (ED) visits for children and adolescents with attention-deficit/hyperactivity disorder (ADHD), according to results of a large retrospective cohort study reported in the July issue of Pediatrics.

"Although the evidence base for the cardiac effects of central nervous system stimulants that are used for the treatment of...ADHD is still unsatisfactory, concerns have resulted in a Food and Drug Administration (FDA) mandate for medication guides to alert patients to potential cardiovascular risks and adverse psychiatric symptoms," write Almut Gertrud Winterstein, PhD, from the Department of Pharmaceutical Outcomes and Policy at the College of Pharmacy, and the Department of Epidemiology and Biostatistics at the College of Public Health and Health Professions, University of Florida, Gainesville, and colleagues.

They write that clinical trial data have shown evidence of cardiac adverse effects, including increases in heart rate and blood pressure and case reports of cardiac sudden death, in children exposed to stimulants. In addition, the authors published a recent cohort study of more than 50,000 children with ADHD that showed a 20% increased risk for cardiac ED visits for all stimulants combined.

The investigators used claims data from the Florida Medicaid fee-for-service program, which represented 2,131,953 children and adolescents. They analyzed data from 30,576 patients newly diagnosed with ADHD who were between the ages of 3 and 20 years, enrolled between July 1994 and June 2004, and newly prescribed methylphenidate (n = 18,238) or amphetamine salts (mixed amphetamine salts or dexamphetamine, n = 17,175).

Overall, the authors conclude, "Additional population-based studies that address manifestation of serious heart disease, especially after long-term use, dosage comparisons, and interactions with preexisting cardiac risk factors are needed to inform psychiatric treatment decisions."

Bonnie - and there are calls from the public to make these medications over-the-counter to improve performance of daily tasks?

Reflux med use in infants with GERD symptoms

This opinion appeared on Medscape.

Proton pump inhibitors (PPIs) are not US Food and Drug Administration-approved for use in infants, but their use has increased dramatically since 2000. The authors point out that to date, the studies evaluating treatment effects of PPIs for gastroesophageal reflux disease (GERD) suffered from methodological issues such as low patient numbers, nonrandomized, nonplacebo-controlled, etc. This study sought to remedy many of the methodological issues of the previous studies.

This Journal Pediatrics multicenter study, conducted in the United States and Poland, enrolled infants during 2006 and 2007. The 162 subjects were randomized 1:1 to intervention drug or identical placebo, and all subjects had been diagnosed with GERD by at least clinical evaluation. Not all subjects received diagnostic testing such as impedance probes or pH probes or endoscopy.

Eligible infants were subjected to 7 to14 days of nonpharmacological intervention (limiting tobacco smoke exposure, changes to feeding strategies and positioning strategies) before randomizing to drug or placebo. All subjects had sufficiently abnormal scores on parental questionnaires (validated) that assessed infant GERD and symptoms associated with GERD. All infants included in the study also had to exhibit daily crying within the hour after feeding for at least 25% of feeding episodes in the 4 days prior to randomization; these data were from a daily diary completed by the parents.

The intervention drug was lansoprazole, given at doses of 0.2 to 0.3 mg/kg/day for infants younger than 11 weeks old and 1.0 to 1.5 mg/kg/day for infants 11 weeks or older. Subjects were to continue their assigned treatment for at least 1 week. They could then go on open-label (not blinded) lansoprazole if the site investigator deemed the treatment ineffective. Either way, data collection on symptoms continued for up to 4 weeks.

The primary outcome variable was the number and frequency of crying episodes during the first hour after feeds, obtained from daily symptom diaries completed by the parents. Identical data obtained from the 7 days before treatment served as the baseline for each subject. The authors were able to calculate responder rate at 4 weeks after randomization. Subjects were labeled "responders" at week 4 if they experienced at least a 50% reduction in percentage of feedings associated with crying or a 50% decrease in overall crying duration in the first hour after feeds.

The subjects were 50% men, 80% white. Approximately 25% of the sample were born prematurely. In regard to primary outcome, both groups had a 54% response rate to treatment (intervention or placebo). In a similar manner, the rate of discontinuing assigned therapy due to perceived non-response was 35% in lansoprazole group and 36% in placebo (nonsignificant). Reduction in crying, reduction in regurgitating, and reductions in feed refusal and back arching were virtually identical between the 2 groups. For example, the percentage of feeding episodes associated with crying and arching of back after feeds decreased about 20% in both groups.

The parents' global assessment of whether the subject improved was 56% in treatment group and 51% in the placebo group. The investigators identified higher rates of lower respiratory tract infections (5% vs 1%) in those on the treatment drug, but the difference was not significant. The authors conclude that their study did not identify a difference reduction of symptoms attributed to GERD between lansoprazole and placebo.


This study excels by more than tripling the number of subjects involved in any previous randomized, placebo-controlled, blinded trial, but the fact that the subjects did not have objective evidence of GERD (via pH or impedance probe, for example) will remain an opening for criticism by skeptics. However, I think it is worth taking several issues into account. First, many children are treated with medications, including PPIs, for GERD without test documentation of GERD. In that regard, this investigative approach in this study more closely mirrors daily clinical practice. Given that, the study shows at a minimum that placing infants on PPIs based on only history and physical examination findings is no better than placebo. Also, it is worth noting that the previous studies, with their methodological limitations, did not demonstrate an improvement with PPI use. This consistency of findings between different studies is for me the most convincing aspect of the series of studies. The authors are correct to note that one can't extend these findings to children with documented erosions or older children, but the data do support a more stringent standard for which infants should receive PPIs.

Bonnie - how sad. If you read this carefully, you'll see that this is a microcosm of what is wrong with our health care system. As I have said for a while now, it is downright criminal to use PPIs in infants, especially long-term. This is so frustrating to me because I have seen the damage done by these drugs in adult clients. I cannot imagine the host of long-term effects they will create in infants.

Flavanoids role in Alzheimer's becoming clearer

A group of chemicals found in many fruits and vegetables, as well as tea, cocoa and red wine, could protect the brain from Alzheimer’s disease.

Speaking at the British Pharmacological Society’s Summer Meeting in Edinburgh, Dr Robert Williams will argue that, while much more research needs to be done, there is mounting evidence that certain flavanoids – chemicals found in plants and food derived from plants – might provide therapeutic benefit for Alzheimer’s sufferers.

However, a new concept is emerging that suggests flavonoids do not act simply as antioxidants but exert their biological effects through other mechanisms. A small number of recent studies carried out in models of Alzheimer’s disease have found that oral administration of green tea flavanoids or grape flavanoids reduces brain pathology and, in some cases, improves cognition. Dr Williams and colleagues have focused their own cellular studies on a flavanoid called epicatechin, which is abundant in a number of foodstuffs, including cocoa.

“We have found that epicatechin protects brain cells from damage but through a mechanism unrelated to its antioxidant activity and shown in laboratory tests that it can also reduce some aspects of Alzheimer’s disease pathology.

“The challenge now is to identify the single flavonoid or combination of flavonoids that exert the most positive effects and to define the mechanisms of action and optimal quantity required before embarking on clinical trials to treat their effectiveness in dementia.”

Power of fish in older persons undeniable

Recently, there has been growing interest in whether dietary factors, particularly oily fish and meat, might influence the onset and/or severity of dementia. To examine this, a group of international researchers studied older people in 7 middle- to low-income countries and published the results of their study in the August 2009 issue of the American Journal of Clinical Nutrition.

Data from 14,960 participants (≥65 y of age) living in China, India, Cuba, the Dominican Republic, Venezuela, Mexico, and Peru were analyzed. In each of the study countries, except India, there was an inverse association between fish consumption and dementia prevalence. These data extend to low- and middle-income countries previous conclusions from industrialized countries that increased fish consumption is associated with lower dementia prevalence in later life.

The authors propose that this relation is not due to poor overall nutritional status in those with dementia, because meat consumption tended to be higher in this group. The relation between meat consumption and dementia remains unclear.

Friday, July 17, 2009

Celexa ineffective in children wwith autism

Although no medications are currently approved by the US Food and Drug Administration for core symptoms of autism spectrum disorders (ASDs), selective serotonin reuptake inhibitors are widely prescribed for children with these conditions. The goal of this National Institutes of Health-sponsored, randomized, controlled trial was to evaluate the efficacy and safety of Celexa (citalopram hydrobromide) therapy for repetitive behavior in children with ASDs.

At 6 US academic centers, 149 children aged 5 to 17 years old with ASDs were randomly assigned to receive oral citalopram or placebo for 12 weeks.

Neither the CGI improvement subscale nor the secondary endpoint showed any significant difference between groups. Positive response occurred in 32.9% of the citalopram group and in 34.2% of the placebo group. Adverse events were significantly more common with citalopram than with placebo; notably, increased energy level, impulsiveness, decreased concentration, hyperactivity, stereotypy, diarrhea, insomnia, and dry skin or pruritus.

Based on these findings, there is no support for citalopram treatment of repetitive behavior in children and adolescents with ASDs. Given the high positive response rate in the placebo group, other medications often used off-label for children with ASDs should also be tested in randomized, placebo-controlled trials to evaluate their risk-benefit ratio.

Arch Gen Psychiatry. 2009;66:583-590

Thursday, July 16, 2009

Nutrients may clear plaque found In Alzheimer's Disease

Scientists have found that vitamin D3, together with a chemical found in turmeric spice called curcumin, may help stimulate the immune system to clear the brain of amyloid beta, which forms the plaques considered the hallmark of Alzheimer's disease.

The early research findings, which appear in the July issue of the Journal of Alzheimer's Disease, may lead to new approaches in preventing and treating Alzheimer's by utilizing the property of vitamin D3 — a form of vitamin D — both alone and together with natural or synthetic curcumin to boost the immune system in protecting the brain against amyloid beta.

Using blood samples from nine Alzheimer's patients, one patient with mild cognitive impairment and three healthy control subjects, scientists isolated monocyte cells, which transform into macrophages that act as the immune system's clean-up crew, traveling through the brain and body and gobbling up waste products, including amyloid beta. Researchers incubated the macrophages with amyloid beta, vitamin D3 and natural or synthetic curcumin.

The team discovered that curcuminoids enhanced the surface binding of amyloid beta to macrophages and that vitamin D strongly stimulated the uptake and absorption of amyloid beta in macrophages in a majority of patients.

Wednesday, July 15, 2009

Quinine may create Tryptophan deficiency

Unlike yeast, humans cannot make their own tryptophan and thus require dietary tryptophan, which is prevalent in meat. If quinine severely reduces tryptophan uptake, then it follows that people with preexisting tryptophan deficiencies would be especially at risk to this drug. The authors also note that tryptophan is important as a precursor for the brain chemical serotonin, so the enhanced tryptophan deficiency induced by quinine could explain why many of quinine's side effects are localized to the head region. They also note that side-effects could be averted simply by taking dietary tryptophan supplements in conjunction with quinine treatments. Journal of Biological Chemistry, 2009; 284 (27)

Bonnie - for anyone taking quinine who does not eat animal protein, a 5-HTP supplement is crucial and may be needed even for meat eaters.

Heat stroke guidelines for high school students

New guidelines released by the National Athletic Trainers’ Association for how high-school athletes should get acclimated to the heat in the first few weeks of pre-season practice provide these highlights:
  • The first five days of practice should be limited to one practice per day, of not more than three hours.
  • Athletes should not wear full pads or run full-contact drills until the sixth day of practice.
  • On double-practice days, neither practice should be more than three hours long, athletes should not practice for more than five hours total, and the two practices should be separated by a cool-down period of at least three hours.
  • During the first two weeks of practice, double-practice days should be followed either by rest days or by single-practice days.

Tuesday, July 14, 2009

Do you use Roundup weedkiller?

You may think twice after reviewing this piece that appears in Scientific American.

Administration Seeks to Restrict Antibiotics in Livestock

The Obama administration announced that it would seek to ban many routine uses of antibiotics in farm animals in hopes of reducing the spread of dangerous bacteria in humans. Dr. Joshua Sharfstein, principal deputy commissioner of food and drugs, said feeding antibiotics to healthy chickens, pigs and cattle — done to encourage rapid growth — should cease. And Dr. Sharfstein said farmers should no longer be able to use antibiotics in animals without the supervision of a veterinarian. Both practices lead to the development of bacteria that are immune to many treatments, he said.

The hearing was held to discuss a measure proposed by Representative Louise M. Slaughter, Democrat of New York and chairwoman of the Rules Committee. It would ban seven classes of antibiotics important to human health from being used in animals, and would restrict other antibiotics to therapeutic and some preventive uses. The legislation is supported by the American Medical Association, among other groups, but opposed by farm organizations like the National Pork Producers Council. The farm lobby’s opposition makes its passage unlikely, but advocates are hoping to include the measure in the legislation to revamp the health care system.

The Union of Concerned Scientists has estimated that as much as 70 percent of antibiotics used in the United States is given to healthy chickens, pigs and cattle to encourage their growth or to prevent illnesses.

Steve - the fact that this testimony came from Sharfstein is huge. Eradicating the use of antibotics for the sake of accelerated growth must end. This practice has cause too much damage already.

Monday, July 13, 2009

Glycemic load of diet tied to breast cancer risk

The amount of carbohydrates a woman eats, as well as the overall "glycemic load" of her diet, impact her chances of developing breast cancer.

The concept of glycemic load is based on the fact that different carbohydrates have different effects on blood sugar. White bread and potatoes, for example, have a high glycemic index, which means they tend to cause a rapid surge in blood sugar. Other carbs, such as high-fiber cereals or beans, create a more gradual change and are considered to have a low glycemic index.

Dr. Susanna C. Larsson of Karolinska Institute in Stockholm, Sweden and colleagues analyzed data on 61,433 women who completed "food frequency" questionnaires in the late 1980s.

Over the course of about 17 years, 2952 women developed breast cancer and, according to the investigators, glycemic load "was significantly positively associated with risk of overall breast cancer." Women with higher glycemic load diets were more apt to develop breast cancer.

In addition, carbohydrate intake, glycemic index and glycemic load were all positively associated with risk of a certain type of breast tumor - namely, estrogen receptor (ER)-positive/progesterone receptor (PR)-negative breast cancer.

Women with the highest "glycemic index diet" had a 44% increased risk of developing ER+/PR- breast cancer compared to women with the lowest glycemic index diet.

Women in the highest category of "glycemic load" had an 81% increased risk of ER+/PR- tumors, and those with the highest carbohydrate intake had a 34% increased risk, compared to those in the lowest groups.

The investigators speculate that high-glycemic load diets may boost breast cancer risk by increasing concentrations of insulin and sex hormones in the body, which may contribute to the development and spread of breast cancer cells.

International Journal of Cancer, July 2009.

Steve - this is pretty compelling stuff. Given the length of the study and the forward thinking of these researchers to investigate, glycemic index/load, there should be no doubt of its impact on overall health.

Thursday, July 09, 2009

Fish oil during pregnancy may slash infant allergy

The occurrence of eczema and food allergies was 16 and 13 per cent lower, respectively, in infants of mothers receiving fish oil supplements during pregnancy and the early months of breast-feeding, compared to placebo, according to findings published in the journal Acta Paediatrica.

“This randomized placebo-controlled double-blind study shows that omega-3 supplementation during pregnancy and lactation may reduce the risk of developing allergic sensitization to egg, IgE-associated eczema and food allergy during the first year of life,” wrote the authors, led by Catrin Furuhjelm from Linkoping University.

Immunoglobulin E (IgE) is the predominant antibody associated with an allergic response.

Furuhjelm and her co-workers recruited 145 pregnant women with allergies, or with partners or other children with allergies. Starting at the 25th week of their pregnancy, and continuing for between three and four months of breastfeeding, the women were randomly assigned to receive either daily fish oil supplements providing 1.6 g of EPA and 1.1 g of DHA, or placebo.

Using a range of tests, including clinical examination, skin prick tests, and blood tests for IgE, the researchers observed a 2 per cent prevalence of food allergy in the omega-3 group, compared to 15 per cent in the placebo group.

Furthermore, the incidence of IgE-associated eczema was only 8 per cent in the omega-3 group, compared to 24 per cent in the placebo group.

Bonnie - very exciting stuff.

Omega-3 Supplements as Antidepressant

While omega-3 supplements are only nominally better than placebo as a treatment for major depression, they provide significant benefit in depressed patients without comorbid anxiety. In addition, the supplements are well tolerated, according to results of the Omega-3D trial reported here at the 9th World Congress of Biological Psychiatry (WCBP).

"We believe our findings are important because depressed patients without comorbid anxiety disorder account for about half of all depressed patients," Francois Lesperance, MD, professor of psychiatry at the University of Montreal, in Quebec.

"And, in fact, the level of improvement we saw in this subgroup is on a par with what has typically been reported with pharmacologic treatments. Many depressed patients prefer to avoid drug treatment because of the stigma associated with such therapy, not to mention potential treatment-related side effects, and thus it's nice to be able to offer patients an alternative treatment that is similarly effective but without the risks," he added.

Dr. Lesperance presented results in 432 patients with an episode of major depression who had been randomized to 8 weeks of treatment with 1050 mg per day of eicosapentenoic acid — an omega-3 fatty acid found in fish oil — or matched placebo masked with fish odor.

Also, most epidemiological studies have found low levels of omega-3 and high levels of omega-6/omega-3 ratios in depressed individuals compared with controls.

"Current depression treatments have severe limitations," Dr. Lesperance observed. "First, they are not sufficiently effective, with only about 30% experiencing a full remission after 8 weeks of treatment," he said.

"Also, 20% of patients stop treatment within the first 2 months because of problems with tolerability."

"For patients without comorbid anxiety disorder, the only downside I can think of with omega-3 supplements it that they are not reimbursed, and their cost is not insignificant," Dr. Lesperance said.

Bonnie - let's hope that all psychiatrists read this study as well as the researchers comments!

Wednesday, July 08, 2009

The Misbehaving Gut

Using the analogy of a misbehaving child, your gut will misbehave when you give in to its every whim. If you shower your gut with riches (i.e. rich food), it may eventually become spoiled.

You need to know what buttons to push to keep your gut in line. You have to pay attention to your gut so you know what it likes and what it does not.

Similar to a parent/child relationship, your gut takes it cues from the host, and will exhibit symptoms accordingly. Perpetually ignoring a problem with band-aid therapies will stunt the gut's ability to be independent.

Enough of the analogies. Now the data:

Intestinal Permeability

The intestinal wall is the most important barrier against the external environment. It is modulated by the immune system. When the wall begins to crumble, it allows external stressors to invade our bodies unopposed. Our immune system then goes into overdrive, which creates inflammation, compromises our ability to properly absorb nutrients, and causes us to the feel the adverse symptoms that lead to numerous gastrointestinal disorders.

A review in the July issue of American Academy of Allergy and Immunology names intestinal barrier dysfunction as the major factor contributing to predisposition for inflammatory diseases, including food allergy, inflammatory bowel disease, and celiac. AAAI lists several factors that contribute to weakening of the intestinal wall:
  • Chronic alcohol consumption (moderate to copious consumption);
  • Nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen, which brings a high incidence of gastrointestinal side effects, including intestinal permeability, ulcers, perforation, hemorrhage, hypermotility, and IBD;
  • Presence of pathogens such as E. coli and clostridium difficile, along with a lack of healthy microflora (i.e. probiotics);
  • Psychological and physical stress;
  • Incompatible diet.
Once the intestinal wall has been breached, it becomes the primary causative factor predisposing to these disease developments, according to AAAI:
  • Food Intolerance and Allergy
    The level of intestinal barrier dysfunction correlates with the severity of symptoms. Mismanaging symptoms leads to gastrointestinal diseases such as Crohn's and Eosinophilic Esophigitis,
  • Inflammatory Bowel Disease
    In patients with IBD, it occurs in 10-25% of their healthy first generation relatives.
  • Celiac Disease
    • Gliadin crosses the intestinal barrier and activates the immune system. Not surprisingly, healthy first degree relatives of celiac suffers also have increased risk of permeability.
    • A Mayo Clinic study that appears in Gastroenterology states that undiagnosed celiac disease in the U.S. is increasing in prevalence (1 in 100, up from 1 in 133 ten years ago) and is linked to a nearly fourfold increased mortality.
    • A study in British Medical Journal says that a minority of patients with recurrent mouth sores have celiac disease. In this five percent of celiac disease patients, recurrent mouth sores may be the sole manifestation of the disease. All patients showed significant improvement in sores after 2 to 6 months on a gluten-free diet.
    • Every cell lining the small intestine bristles with thousands of tightly packed microvilli that project into the gut lumen, forming a brush border that absorbs nutrients and protects the body from intestinal bacteria. In the June issue of the Journal of Cell Biology, researchers now find that microvilli emit gut enzymes to get a head start on breaking down food and could also be an important defense mechanism against intestinal pathogens. This is a very important discovery because when the intestinal wall is compromised, villi are destroyed This is why it is so critical to diagnose a gluten issue so that proper nutrient absorption persists.
  • Type 1 Diabetes
    Destruction of insulin-producing pancreatic cells.
  • Irritable Bowel Syndrome
    Psychological and/or physical stress and diet are the main causes. According to a study in the July issue of the Journal of the American Dietetic Association, IBS symptoms in one quarter of patients may be caused or exacerbated by one or more dietary components. The study targets certain sugars and insoluble fiber as a few of the foods that may worsen symptoms. A modified exclusion diet and stepwise reintroduction of foods or trials of eliminating classes of food is useful.
  • Ulcerative Colitis
    Due mainly to psychological and/or physical stress.
Healing Intestinal Permeability.

Discover what the is creating the problem and remove it completely.

Present your gut with compatible macro and micronutrients.

In most cases, when removing gut irritants, health microflora (probiotics) is absent. Infusing your gastrointestinal tract with probiotics is essential for healing.

When the gut is presented with the proper tools, it heals itself. While it can be a long road, we have clients who find relief almost instantaneously.

An allergist can diagnose any IgE (true) allergy through R.A.S.T. blood test or scratch/intradermal tests. Many allergists do not test for IgG food intolerances. We use a very reliable lab (Biotrition) that tests blood for over 200 foods and spices. An elimination diet with challenges is also an option, especially for gluten intolerance, in which a challenge is the gold standard. A proficient gastroenterologist should diagnose most gut disorders including Celiac disease, IBD, IBS, Ulcerative Colitis. A licensed dietitian nutritionist like myself can help you with dietary and lifestyle implementation.

Natural Alternatives
In some cases, medication may be required short-term to calm the gut to allow healing. Probiotics, Zinc Carnosine (Zinlori), and Digestive Enzymes are three common natural therapies to accelerate healing. In addition, a host of vitamins, minerals, and herbs are extremely effective. However, these substances need to be individualized by a licensed health professional.

GERD and Reflux

Rare Form of Reflux
While exhibiting the same symptoms as the more popular acid reflux, bile reflux is a backup of digestive fluid (bile). Bile is an alkaline fluid released from the gallbladder that aids the small intestine in the digestion of fats. For those who get no or only partial relief from acid reflux medication, your doctor should rule out bile reflux. If not treated, it can create bleeding ulcers, Barrett's esophagus, and esophageal cancer. Bile reflux can occur after gallbladder or gastric bypass surgery, from scar tissue or peptic ulcer blocking its normal path, and of course, poor dietary choices.

Acid Reducing Meds May Lead to Dependency
Treatment with proton pump inhibitors (PPIs) for eight weeks induces acid-related symptoms like heartburn, acid regurgitation and dyspepsia once treatment is withdrawn in healthy individuals, according to a new study in Gastroenterology.

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

The use of PPIs for acid-related symptoms and disorders is extensive and rapidly escalating. While the incidence of new patients being treated with PPIs remains stable, the prevalence of long-term treatment is rising, the reasons for which are not fully known. Studies have shown that up to 33 percent of patients who initiate PPI treatment continue to refill their prescriptions without an obvious indication for maintenance therapy.

Rebound acid hypersecretion, defined as an increase in gastric acid secretion above pre-treatment levels following antisecretory therapy, is observed within two weeks after withdrawal of treatment and could theoretically lead to acid-related symptoms such as heartburn, acid regurgitation or dyspepsia that might result in resumption of therapy.

When you continually block the production of stomach acid, your body becomes more efficient in producing it. So when you stop the PPI, you will overproduce acid for a period of time. This is why people who want to stop PPIs must SLOWLY wean off them.

Oily fish and dementia risk: a world study

Increased intake of fish may reduce the risk of dementia by about 20 per cent, according to a new study from 14,960 people in seven countries that appears in a future issue of American Journal of Clinical Nutrition. The study indicated that the more fish consumed, the more beneficial the effects.

Transcontinental support Albanese and his co-workers examined the links between dementia and fish and meat intake in low- and middle-income countries, including China, India, Cuba, the Dominican Republic, Venezuela, Mexico, and Peru. “To our knowledge, this is the largest population-based study on this topic to date from either developing or developed country samples,” they said. Almost 15,000 people aged 65 or over were surveyed. After adjusting for various confounders and pooling the data from all the sites, the researchers report that they observed a dose-dependent inverse association between dementia and fish consumption. On the other hand, meat consumption was found to increase dementia risk.

Tuesday, July 07, 2009

Making sense of the FDA's acetaminophen recommendations

Last week, a Food and Drug Administration joint advisory committee made several recommendations about the painkiller acetominophen. The panel proposed:
  • Lowering the maximum daily dose to 2,600 milligrams from 4,000 mg.
  • Limiting the amount in a single over-the-counter pill to 325 mg, from 500 mg currently.
  • Banning sales of prescription pain relievers that combine opioids with acetaminophen, including Percocet and Vicodin, among the most widely prescribed drugs in the U.S.
  • “Extra strength” doses - equal to two 500-milligram pills - be switched to prescription only.
  • The largest dose available over the counter be limited to two 325-milligram pills.
  • Infants’ and children’s doses be standardized to prevent errors.
  • Propoxyphene, also sold as Darvon and in an acetaminophen combination called Darvocet, has been linked to accidental overdoses and suicides. The prescription medication will now come with a pamphlet describing the risk.

What prompted the FDA to make this recommendation?

According to the FDA, prescription acetaminophen combination drugs were prescribed 200 million times last year. Tylenol's maker says nearly 50 million U.S. adults and children take acetaminophen in any given week. Cases of acute liver failure and deaths related to acetaminophen have been increasing. An FDA memo reports an estimated 110,000 emergency room visits a year are related to acetaminophen, and several hundreds cases of acute liver failure are also reported. Of all acute liver failure cases, about half were accidental. This is not a problem that is limited to drug addicts. Also, acetaminophen is the No. 1 reason people need liver transplants for acute liver failure.

Why are acetaminophen injuries on the rise?

Drug strength has increased, and labeling is not clear. It’s easy to take more than the recommended daily dose without realizing it. People are unaware that acetaminophen is in many medications. The margin between a safe dose and a potentially lethal one is small.

It’s safe as instructed—but if you’re taking Percocet for your lower back pain, and Tylenol for your headache, and cough syrup three times a day and then you can’t sleep so you take an over-the-counter sleep aid, you are taking a lot more than you are aware of. Some people don’t even consider Tylenol a drug, so they don’t tell their doctors.

Even the most conscientious patients may not be aware of how much acetaminophen is in their prescription pain reliever because it is often labeled as APAP—an acronym for its chemical name, N-acetyl-para-aminophenol. The FDA in 2004 asked state pharmacy boards, which oversee labeling for prescription drugs, to require acetaminophen to be listed by name on the bottle, but so far, none have complied.

What products contain acetaminophen?

The prescription medications Vicodin and Percocet as well as 300 over-the counter medications NyQuil, Excedrin and Tylenol cold and flu. Many drugs that say "cold and flu" probably have acetaminophen for muscle pain and fever reduction.

What is the recommended until the official action is released?

  • Don't combine drugs that contain acetaminophen and inform your doctor if you have liver problems or drink alcohol daily.
  • You should tell your doctor or pharmacist about all the medicines you are taking. Read ingredient labels and follow directions exactly. Don't use more than the maximum dose in any given 24-hour period or go beyond the maximum days unless you have spoken to your doctor about it.
  • The first symptoms of acute liver failure caused by an overdose seem like the flu and don’t set in for several days, by which time it may be too late to save your liver and consequently your life.

As a precaution, should consumers switch to other types of over-the-counter pain relief?

Over all the risk of acetaminophen to any individual is low. Alternative over-the-counter products like aspirin and ibuprofen have side effects of their own. Far more people are harmed by regular use of aspirin and ibuprofen, which belong to a class of medicines called nonsteroidal anti-inflammatory drugs, or Nsaids. By most estimates, more than 100,000 Americans are hospitalized each year with complications associated with Nsaids. And 15,000 to 20,000 die from ulcers, kidney failure, hypertension, and internal bleeding linked to their use.

Nearly everybody on the panel recognizes that from a public-health perspective, Nsaids are much more concerning than acetaminophen. From what my clients say, taking Aleve (Naproxen) occasionally tends to be the most well-tolerated of all the OTC pain medication.

Non Pharmacological Options?

Any changes you wish to make to your painkilling medication regimen must be discussed with your physician first.

  • Limbrel (by prescription only) - high dose flavanoid complex derived exclusively from the plant sources skullcap and acacia; several clients have spoken highly of its efficacy.
  • Metagenics Kaprex - similar to Limbrel but a prescription is not necessary.
  • Cod Liver Oil - its vitamin D and omega-3 content have anti inflammatory properties.
  • Pain Relief Diet Action Plan - if food is causing the pain, our action plan will get to the bottom of the culprits.

Intestinal Cells Active In Pursuit Of Nutrition

Every cell lining the small intestine bristles with thousands of tightly packed microvilli that project into the gut lumen, forming a brush border that absorbs nutrients and protects the body from intestinal bacteria.

In the June 29, 2009 issue of the Journal of Cell Biology, researchers now find that microvilli extend their functional reach even further using a molecular motor to send vesicles packed with gut enzymes out into the lumen to get a head start on breaking down their substrates and could also be an important defense mechanism against intestinal pathogens.

Bonnie - this is a very important discovery because villi are destroyed in those with gluten intolerance, celiac disease, and other gut disorders. This is why it is so critical to diagnose a gluten issue so that proper nutrient absorption may continue.

Nitrates May Be Environmental Trigger For Alzheimer’s, Diabetes And Parkinson's Disease

Researchers have found a substantial link between increased levels of nitrates in our environment and food with increased deaths from diseases, including Alzheimer's, diabetes mellitus and Parkinson's. The study was published in the Journal of Alzheimer's Disease.

Researchers studied the trends in mortality rates due to diseases that are associated with aging, such as diabetes, Alzheimer's, Parkinson's, diabetes and cerebrovascular disease, as well as HIV. They found strong parallels between age adjusted increases in death rate from Alzheimer's, Parkinson's, and diabetes and the progressive increases in human exposure to nitrates, nitrites and nitrosamines through processed and preserved foods as well as fertilizers. Other diseases including HIV-AIDS, cerebrovascular disease, and leukemia did not exhibit those trends.

Susan De la Monte, a professor of pathology and lab medicine at The Warren Alpert Medical School of Brown University, says, "We have become a 'nitrosamine generation.' In essence, we have moved to a diet that is rich in amines and nitrates, which lead to increased nitrosamine production. We receive increased exposure through the abundant use of nitrate-containing fertilizers for agriculture." She continues, "Not only do we consume them in processed foods, but they get into our food supply by leeching from the soil and contaminating water supplies used for crop irrigation, food processing and drinking."

Nitrites and nitrates belong to a class of chemical compounds that have been found to be harmful to humans and animals. More than 90 percent of these compounds that have been tested have been determined to be carcinogenic in various organs. They are found in many food products, including fried bacon, cured meats and cheese products as well as beer and water. Exposure also occurs through manufacturing and processing of rubber and latex products, as well as fertilizers, pesticides and cosmetics.

Nitrosamines are formed by a chemical reaction between nitrites or other proteins. Sodium nitrite is deliberately added to meat and fish to prevent toxin production; it is also used to preserve, color and flavor meats. Ground beef, cured meats and bacon in particular contain abundant amounts of amines due to their high protein content. Because of the significant levels of added nitrates and nitrites, nitrosamines are nearly always detectable in these foods. Nitrosamines are also easily generated under strong acid conditions, such as in the stomach, or at high temperatures associated with frying or flame broiling. Reducing sodium nitrite content reduces nitrosamine formation in foods.

Nitrosamines basically become highly reactive at the cellular level, which then alters gene expression and causes DNA damage. The researchers note that the role of nitrosamines has been well-studied, and their role as a carcinogen has been fully documented. The investigators propose that the cellular alterations that occur as a result of nitrosamine exposure are fundamentally similar to those that occur with aging, as well as Alzheimer's, Parkinson's and Type 2 diabetes mellitus.

The study was funded through grants from the National Institutes of Health. Two subsequent papers have been accepted for publication in the near future that demonstrate experimentally that low levels of nitrosamine exposure cause neurodegeneration, NASH and diabetes.

Steve - this is a timely study because there needs to be a distinction between nitrates/nitrites from processed meat and naturally-occurring forms in fruits and vegetables. A recent study appeared in the July issue of American Journal of Clinical Nutrition (see July 1 in our blog) exhibiting for the first time the benefits of nitrates/nitrites that occur naturally in fruits and vegetables. But those researchers were quick to point out there should be a major distinction between these and the chemical form that comes from processed foods. Meat products with added nitrates/nitrites for processing, preserving, and curing only apply; not steak, pork tenderloin, or ground beef for example.

Muscle Damage Present In Some Patients Taking Statins

Structural muscle damage may be present in patients who have statin-associated muscle complaints, found a new study in CMAJ (Canadian Medical Association Journal).

Many patients on statins develop muscle weakness and pain. In some cases, muscle biopsies show underlying structural injury, even in patients without elevated levels of circulating creatine phosphokinase.

The study, by researchers from the University of Bern, Switzerland and the Tufts-New England Medical Center in Boston, Massachusetts, looked at muscle biopsies from 83 patients, 20 of whom had never taken statins. They found significant muscle injury in patients who had taken statins, including several who had discontinued medication before the biopsy.

"Although in clinical practice, the majority of patients with muscle symptoms improve rapidly after cessation of therapy, our findings support that a subgroup of patients appears to be more susceptible to statin-associated myotoxicity, suffering persistent structural injury," write Dr. Annette Draeger from the University of Bern and coauthors.

They note there is a need to evaluate alternative treatment strategies for patients with significant muscle symptoms.

Bonnie - do think these subjects would be a bit peeved if they knew that first drug company to patent a statin opted not to include CoQ10 in the formula because it was too expensive? It very well could have averted the muscle damage.

Drug Firms See Poorer Nations as Sales Cure

by Avery Johnson
Excerpts from The WSJ

A strategic shift in the $770 billion pharmaceutical industry is now targeting the working poor in the developing world.

For the first time in a half-century, sales of prescription drugs are forecast to decline this year in the U.S., historically the industry's biggest and most profitable market. The Obama administration and Congress's attempt to pass legislation overhauling the health-care system, including provisions that could lower the cost of medicine, could put drug makers' U.S. businesses under further pressure.

As a result, developing countries like Venezuela have begun to look more attractive to the industry. Sales of prescription drugs in emerging markets reached $152.7 billion in 2008, up from $67.2 billion in 2003, according to IMS Health, which tracks the industry. IMS forecasts sales will climb to $265 billion by 2013.

With a handful of other drug makers, including the U.K.'s GlaxoSmithKline PLC, Switzerland's Novartis AG and France's Sanofi-Aventis SA, Pfizer is making a big push into the developing world. In addition to Venezuela, the company is expanding in China, India, Brazil, Russia and Turkey. Pfizer brought in $1.4 billion in sales from emerging markets in the first quarter of this year. That's a fraction of its $10.8 billion in overall sales in the same quarter, but a slice Pfizer says it's determined to expand.

Until recently, drug companies doing business in emerging economies have catered mostly to the wealthy and middle class. Now, Pfizer is turning to what it calls, in internal marketing discussions, the "bottom of the pyramid." Its program in Venezuela is an exercise in how to reduce prices enough to attract poorer customers while still turning a profit.

"There's an economy in the barrios," says Rafael Mendoza, the man Pfizer has put in charge of the strategy in Venezuela.

Pfizer is benefiting from a belief in Venezuela and in much of the developing world that branded medicines are worth paying a premium for because they're safer and more effective than generics. Pfizer's prices in Venezuela tend to be about 30% under U.S. prices, but are still 40% to 50% more than generics, which are widely available here since patents aren't usually enforced. In some cases, the spread is even wider. In a few Petare pharmacies, for example, Pfizer's cholesterol-lowering drug Lipitor costs between $100 and $125 a month for a standard dose, compared with less than $50 for a generic.

That can add up in a place where the monthly minimum wage is roughly $450. Some public-health officials question whether Pfizer is promoting what they say is an unfounded perception that generic drugs aren't trustworthy. "The quality of a product has nothing to do with the brand name," says Hans Hogerzeil, the World Health Organization's director of essential medicines and pharmaceutical policies.

Mr. Rodriguez's main approach in persuading Petare's doctors to prescribe Pfizer drugs is to emphasize the brand's quality over generics. He tells doctors that Norvasc, Pfizer's hypertension medicine, for example, stays in patients' blood for 56 hours, making it more reliable for older patients who might forget to take their medicines. Generic drugs, says Mr. Rodriguez, can't guarantee the same longevity.

He says patients in Petare will follow orders even if it means spending more. "If their doctor tells them -- their doctor from birth, the doctor they have had all their life -- 'Look, this is what is going to cure you, this is what will guarantee your health,' that's what the patient buys."

Pfizer also woos doctors by giving them computers and Internet access for use at their offices. In the U.S., the practice of drug maker "giveaways," even of items as small as pens and coffee cups with logos, has drawn fire for influencing doctors' prescribing, and the industry has voluntarily done away with most freebies.

In Venezuela and much of the developing world where doctors don't earn as much, the practice is more common, and it sometimes can benefit patients. At one of the clinics Mr. Rodriguez visited recently, for example, Carlos Serrano beamed about the computer and free Internet access Pfizer has given him. Dr. Serrano, who has practiced medicine in Petare for 30 years, uses the computer and a Pfizer "telemedicine" Web page to help diagnose patients online by communicating in real time with doctors in downtown Caracas.

Pfizer says the computers start out as loans and become permanent gifts once the doctors have shown that they are using them for medical purposes and have signed a waiver stating they understand they're not intended to influence their prescribing.

Dr. Serrano says he's increased by 40% the number of Pfizer drugs he prescribes since Mr. Rodriguez started calling on him in late 2007. The aid doesn't sway him, he adds. "There are some illnesses that have to be treated with a good product, no matter what the cost," Dr. Serrano says.

In the coming weeks, Pfizer plans to refurbish the crumbling exterior of Dr. Serrano's office and paint it with the logo of its program in Petare, called "Healthier Community," which combines "Pfizer blue" and Chávez red.

Mr. Rodriguez visits between eight and 10 of Petare's roughly 560 doctors a day. One group he says he's had less success with are Cuban doctors who staff the several dozen government-run clinics -- part of an oil-for-medicines swap between oil-rich Venezuela and the Castro regime. The clinics give away free drugs.

Mr. Rodriguez says he courted them for a year by passing them Pfizer-branded prescription pads, free samples and educational materials through the gates outside their buildings. At first skeptical, some doctors finally agreed to talk to him, says Mr. Rodriguez. He says he's now able to call on 17 of Petare's roughly 40 Cuban-staffed clinics.

Steve - kudos to WSJ for exposing this. They are using the same model with the developing world as they used in the U.S. Does this make your stomach turn as much as mine?

Xylitol again exhibits tooth health benefits

Children consuming eight grams per day of xylitol had 1.3 few decayed teeth, compared to children consuming only 2.7 grams per day of the sweetener, report researchers in the Archives of Pediatrics & Adolescent Medicine.

“This study is the first (to our knowledge) to demonstrate that xylitol topical oral syrup (8 g/d) divided into 2 or 3 doses given during primary tooth eruption in children aged 15 to 25 months reduces tooth decay,” wrote the researchers, led by Peter Milgrom.

“Furthermore, up to 70 per cent of decayed teeth could be prevented by xylitol in this setting.”

The new study was sponsored by Health Resources and Services Administration Maternal and Child Health Bureau and by a grant from the National Institute of Dental and Craniofacial Research.

Bonnie - while it is encouraging to see more data on the benefits on xylitol, this is a large daily amount. One common side effect of xylitol is loose stool, especially if the xylitol is ingested instead of in chewing gum. For those with a corn intolerance, xylitol is a poor choice because its source is corn (except in rare cases, like the Xylichew gum we recommend).