Understanding the Essential Folate

Folate is integral for producing and repairing healthy cells, as well as encouraging optimal detoxification. Thus, it is essential that folate is metabolized properly.

Folic acid, the form most commonly in supplements and fortified food, is a synthetic oxidized form not found naturally in food. It must be converted to tetrahydrofolate. Evidence shows that in a large majority of the human population (maybe 25%), this process may be slow and inefficient due to negative epigenetic expression, leaving us with extended exposure to unconverted folic acid. There is a belief that with this overload, a very small part of the population may be at higher risk for certain forms of cancer. Recent data has clarified this issue, which should allay any concern.

• Last week, Harvard researchers reported “no evidence for an increased risk of advanced or multiple cancerous adenomas” from folic acid, according to a double-blind, randomized trial.
  

• Eating plenty of folate may reduce the risk of colorectal cancer by 64% in women consuming more than 300 mcg. daily compared to those consuming less than 200 mcg. A review paper published by Joel Mason from USDA Human Nutrition Research Center on Aging at Tufts University, best addressed folate's effect on colorectal health. “Under most circumstances, adequate intake of folate appears to assume the role of a protective agent against cancer, most notably colorectal cancer,” wrote Dr Mason. A possible explanation for the contradictory results of studies with folic acid and colorectal cancer may be the difference between the synthetic and natural forms of the vitamin. “The fact that folic acid, which is not a naturally occurring form of the vitamin, is used by food and pharmaceutical industries for fortification and supplementation is potentially of importance.” On passage through the intestinal wall, folic acid is converted to 5-methyltetrahydrofolate, the naturally circulating form of folate.
  
  Some studies have suggested that oral doses of folic acid in high doses may overwhelm this conversion pathway, leading to measurable levels of folic acid in the blood. “There has been some concern that this oxidized, non-substituted form of folate might feasibly be detrimental because it is not a naturally occurring co-enzymatic form of the vitamin,” Mason added. Bonnie - the concern only comes from excessively high doses of folate, which according to the next study, is non-existent. As the new Harvard study reported, at normal levels this is not an issue.
  

• Intakes of folic acid from fortified foods and supplements do not lead to excessive intakes. “At current fortification levels, US adults who do not consume supplements or who consume an average of 400 micrograms folic acid/d from supplements are unlikely to exceed the upper limit in intake for folic acid,” wrote Robert Berry from the Centers for Disease Control and Prevention. Less than 3 per cent of the study population exceeded the tolerable upper level of 1,000 micrograms a day. Because of this study and other successes seen around the world, the United Kingdom Food Standard Agency just recommended that folic acid be added to bread on a mandatory basis. A total of 51 countries now have some degree of mandatory fortification of flour with folic acid.
  
  

What Would We Be Without Folic Acid Fortification and Supplementation?

• Drugs that interfere with the action of folic acid produce a six-fold increase in birth defects in pregnant women.
  

• The Scottish Spina Bifida Association said 15 babies had been born in Scotland with the condition since January 2009 - double the normal number. It said folic acid supplements, which research suggests can prevent many cases, were often taken too late. Scotland does not have a folic acid fortification program.
  
  
• Low maternal folate levels are linked to the development of attention-deficit/hyperactivity problems in children at age seven to nine years. Researchers state that maternal nutrition contributes to an individuals' development, with potential consequences for their behavior later in life. The long term effects of poor maternal nutrition may even branch out to the child's ability to interact with peers or form social bonds.
  

• Johns Hopkins researchers state that taking folic acid and iron supplements together during pregnancy may reduce infant mortality by 31 per cent.
  
  
• Low serum folate concentration is associated with an altered morphology of human bone in older adults.

• Folate may prevent premature birth and heart defects. Now pregnancy specialists are asking if it's time for the government to boost the amount being added to certain foods to help ensure mothers-to-be get enough.
  
  Texas researchers analyzed nearly 35,000 pregnancies and found that women who reported taking folic acid supplements for at least a year before becoming pregnant cut in half their risk of having a premature baby. Their risk of having very early preemies, the babies least likely to survive, dropped even more.
  
  Canadian researchers analyzed 1.3 million births in Quebec since 1990 to look for heart defects, the most common type of birth defect. They found the rate of serious heart defects has dropped 6 percent a year since Canada began its own food fortification in December 1998.
  
  The U.S. Preventive Services Task Force recommend that women take a daily supplement with 400 micrograms to 800 micrograms of folic acid daily. But because only about a third of non-pregnant women take precautionary folic acid supplements, fortifying foods made with enriched flour ensures everyone gets a modest amount.
  

• Increased intake of folate and folic acid may reduce the risk of hearing loss in men by 20 per cent. Researchers used the most recent figures from the Health Professionals Follow-up Study cohort from years 1986 to 2004, a group consisting of 51,529 male health professionals. The study identified 3,559 cases of men with hearing loss. When the nutritional data was analyzed, men over the age of 60 with high folate intake from foods and supplements had a 20 per cent decrease in risk of developing hearing loss.
  

• Supplements of folic acid may improve cardiovascular health and reduce the prevalence of peripheral arterial disease (PAD). Daily doses of 400 micrograms of folic acid led to significant improvements in blood pressure and improved blood flow after 16 weeks of supplementation. Furthermore, equal doses of 5-methyltetrahydrofolate (5-MTHF), the naturally circulating form of folate, produced the same results, leading the researchers to conclude that “5-MTHF may be a safe and effective alternative to folic acid in those who have a genetic predisposition to synthesizing folic acid.”
  
  

Dosage Recommendations

• Do not exceed 1 gram (1000 mcg.) of supplemental folate unless supervised by a licensed health professional.
  
  
• Make sure that along with folate, you supplement with an adequate amount of vitamin B-12 and vitamin B-6 .
  

• Because testing for a genetic predisposition to synthesizing folic acid is prohibitively expensive, insure yourself by supplementing with all three forms of folate (folic acid, 5-methyltetrahydrofolate, 5 formyl tetrahydrofolate; available in Metagenics ActiFolate).
  
  

References
Nutrition Reviews, April 2009
Proceedings on the National Academy of Sciences, August 2009
European Journal of Clinical Nutrition, August 2009
British Journal of Surgery, September 2009
BBC News, 2009
American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting, October 2009
British Journal of Clinical Pharmacology, October 2009
Journal of Child Psychology and Psychiatry, November 2009
American Journal of Epidemiology, November 2009
American Journal Clinical Nutrition, November 2009; December 2009

Recipe Du Jour November

Immune Boosting Broth

Bonnie - you've heard the old adage, chicken soup can cure colds. But this chicken broth really can boost your immune system with tons of quercetin-loaded allium veggies (onion, garlic, leek, shallot). The bones even provide a bioavailable source of calcium.

Note: use of free-range or organic chicken/turkey carcass and organic vegetables preferred

• 2 small or one large chicken/turkey carcass (leave some meat on the bones)
• 6-8 inner celery stalks, with leaves
• 4-8 cloves garlic, minced
• 2 large shallots, diced
• 1 medium yellow or white onion, diced
• 2 large leeks (use mostly white part), sliced or 1 c. chopped chives
• 12 c. filtered water
• 1 c. carrots, peeled and sliced optional
• 1 c. parsley leaves
• 1 T. olive, grapeseed, or avocado oil
• sea salt and white pepper, to taste

Directions: in a large soup pot, saute garlic, shallot, onion, and leek in oil until translucent. Add all other ingredients. Bring to a rolling boil. Turn down the heat to simmer. Cover and cook for two hours. Strain and cool.

Freeze in containers of multiple sizes. Use in soups, stews, mashed potatoes, casseroles, or any dish in which you want flavor and an immune boost!

Yield: 3 quarts

Do you have your own immune-boosting recipe? Please share in the comments box below.

Research Highlights November

American Journal of Clinical Nutrition

• Cocoa polyphenols may modulate inflammatory mediators in patients at high risk of cardiovascular disease.
  
  
• In NHANES 20003-2004 study, vitamin C status improved, and the prevalence of vitamin C deficiency was significantly lower than NHANES 1988-1994. Increase in vitamin C supplementation in addition to adequate dietary intake are believed to be responsible.
  
  
• Iodine supplementation improved perceptual reasoning in mildly iodine-deficient children and suggests mild iodine deficiency could prevent children from attaining their full intellectual potential.
  
  
• Consumption of four egg yolks daily, and possibly two egg yolks (rich in lutein and zexanthin) for five weeks benefited macular health in older adults with low macular pigment optical density. HDL cholesterol increased and LDL cholesterol stayed the same in this population whom were mostly taking statin medication.
  
  
• Nutritional supplementation in girls is associated with substantial increases in their offspring's (more for sons) birth weight, height, head circumference, height-for-age score, and weight for age score.
  
  
• Glutathione enzyme deficient persons have an increased risk of vitamin C deficiency than persons with normal glutathione. Bonnie Translation: glutathione deficiency is an epigenetic methylation pathway breakdown, brought upon by environmental forces. The cells have to use up more vitamin C than usual to compensate. For these individuals, can you say Allergy Fighters? It contains vitamin C and reduced glutathione.

Journal of Nutrigenetics and Nutrigenomics

• Dietary intake of fish and -3 polyunsaturated fatty acids (-3 PUFAs) may decrease the risk of prostate cancer development and progression to advanced stage disease. This could reflect the anti-inflammatory effects of PUFAs, possibly through mediation of cyclooxygenase (COX), a key enzyme in fatty acid metabolism and inflammation. Despite promising experimental evidence, epidemiological studies have reported somewhat conflicting results regarding the effects of fish/PUFAs on prostate cancer development and progression. The literature suggests that fish, and particularly long-chain -3 PUFAs, may have a more pronounced protective effect on biologically aggressive tumors or on their progression, and less on early steps of carcinogenesis. Moreover, the impact of LC -3 PUFAs may be modified by variation of the COX-2 gene. Overall, results to date support the hypothesis that long-chain -3 PUFAs may impact prostate inflammation and carcinogenesis via the COX-2 enzymatic pathway.

Archives of Neurology

• The incidence and prevalence of dementia are expected to increase several-fold in the coming decades. Given that the current pharmaceutical treatment of dementia can only modestly improve symptoms, risk factor modification remains the cornerstone for dementia prevention. Some of the most promising strategies for the prevention of dementia include vascular risk factor control, cognitive activity, physical activity, social engagement, diet, and recognition of depression. In observational studies, vascular risk factors—including diabetes, hypertension, dyslipidemia, and obesity—are fairly consistently associated with increased risk of dementia. In addition, people with depression are at high risk for cognitive impairment. Population studies have reported that intake of antioxidants or polyunsaturated fatty acids may be associated with a reduced incidence of dementia, and it has been reported that people who are cognitively, socially, and physically active have a reduced risk of cognitive impairment. Most promising, interventions of cognitive and physical activity improve cognitive performance and slow cognitive decline.

New England Journal of Medicine

• Chronic mucocutaneous candidiasis may be manifested as a primary immunodeficiency characterized by persistent or recurrent infections of the mucosa or the skin with candida species. An autosomal recessive form of susceptibility to chronic mucocutaneous candidiasis is associated with genomic homozygous mutations in CARD9.

Food and Chemical Toxicology

• Flavonoids are known to have antioxidant activity that may limit DNA damage and help prevent degenerative diseases, including cancer. However, our knowledge of flavonoids’ role in DNA protection/repair mechanism(s) is limited. This study investigated the effects of quercetin on DNA oxidation and DNA repair in Caco-2 cells with or without oxidant (H2O2) challenge. Quercetin significantly reduced oxidative DNA damage, as measured by the number of single-strand breaks identified by single cell gel electrophoresis. Quercetin treatment also caused a measurable increase in the mRNA expression of human 8-oxoguanine DNA glycosylase (hOGG1). In addition, the highest level of quercetin tested maintained hOGG1 expression at basal levels or higher for up to 12 h after H2O2 treatment, while oxidant treatment alone resulted in significant reduction of hOGG1 at 8 h. Our study indicates that quercetin could protect DNA both by reducing oxidative DNA damage and by enhancing DNA repair through modulation of DNA repair enzyme expression.
  
  

Pilgrim Snacks

Eat snacks like the Pilgrims did for one month? This is exactly what my Granddaughter's second grade class is doing right now. Her teacher is asking that every student bring in a Pilgrim-like snack for one month. The lesson is to help the students appreciate the living conditions on the boat ride over to the Americas. The diet was very repetitive and the rations were small.
 
This got us to thinking. What did the Pilgrims really eat and can our clients learn from it? It also begs the question: would it be a good challenge for all of us to adhere to these foodstuffs during Thanksgiving month?

As you can see below, aside from the fact that the foodstuffs had no preservatives (except salt), they are in desperate need of a 21st century update!

• Biscuits (hard tack) - our alternative: Blue Diamond Nut Thins, Mary's Gone Crackers, or Flatbread
• Holland cheese - our alternative: imported Dutch Gouda
• Salted pork - our alternative: Shelton's or MSG-Free Turkey Stick Brand
• Dried beef - our alternative: Golden Valley Organic Beef Jerky or MSG-Free Brand
• Salted fish - our alternative: SnackMasters Salmon Jerky or MSG-Free Brand
• Oatmeal - long cooking variety
• Wheatmeal - our alternative: Cream of Wheat or Wasa crackers
• Beans/Peas - organic canned beans, hummus, Trader Joes dried peas
• Butter - organic
• Aqua-vitae (a strong liquor made from distilling beer or wine) - our alternative: for kids, Unsweetened Tea; for adults, Schnapp's or Chambord
• Beer (the primary drink for everyone, water was often considered unsafe) - our alternative: for kids, Filtered Flat or Naturally Sparkling Water; for adults, non-alcoholic rice beer

The glaring omission is fruits, vegetables, nuts, and seeds, which did not keep on long ship voyages or were too expensive. We would highly suggest making these part of your Pilgrim Snacks.

As long as you keep the snack balanced (always a healthy fat/protein with a carb) and the serving size small, enjoy Pilgrim Snacks!

Med Diet delays need for diabetes drugs

In this randomized controlled trial, 108 subjects with newly diagnosed type 2 diabetes were assigned to a Mediterranean-style diet (MED) while 107 were assigned to a low-fat diet based on American Heart Association guidelines.

The MED diet was rich in vegetables and whole grains, low in red meat, had a goal of no more than 50% of calories from complex carbohydrates, and no less than 30% of calories from fat (mainly olive oil). Both diets restricted energy intake to 1800 calories per day for men and 1500 for women, and each group received equal guidance on increasing physical activity. Subjects were followed for up to 4 years to assess the primary outcome of time to introduction of antihyperglycemic drug therapy. Per protocol, drug therapy was initiated when HbA1c exceeded 7% at 2 consecutive 3-month intervals. Secondary outcome measures included changes in weight, glycemic control, lipid levels, and blood pressure.

At the end of the trial, 44% of MED subjects required antihyperglycemic drugs compared with 70% of low-fat diet subjects.

Both groups lost weight, and though the MED group lost significantly more in the first year.

Other measures of glycemic control (changes in level of HbA1c, plasma glucose, serum insulin, HOMA insulin sensitivity, and adiponectin) all favored the MED participants. High-density lipoprotein (HDL) cholesterol increased and triglycerides decreased significantly more in the MED group.

Viewpoint

Current American Diabetes Association guidelines recommend the initiation of metformin immediately upon diagnosis of type 2 diabetes along with lifestyle changes designed to induce weight loss. However, oral antihyperglycemics fail over time, creating the need for ever-intensifying drug regimens. Results of the current study demonstrate that a Mediterranean-style diet can delay the need for antihyperglycemic agents for at least 3 years for most newly diagnosed patients.

This is a truly remarkable finding. Because the current guidelines are focused on weight loss, they recommend either a low-carbohydrate or low-fat calorie-restricted diet. The present study finds clear superiority with a low-carbohydrate approach.

This study suggests that while weight loss may be an important goal for most diabetic patients, how that weight loss is achieved might make a difference in long-term maintenance of glycemic

Annals of Internal Medicine

Steve - we have been blessed with a cornucopia of wonderfully positive diet and lifestyle research recently. It is very encouraging to see.

Diet And Intestinal Bacteria Linked To Healthier Immune Systems

Insoluble dietary fiber not only keeps you regular, say Australian scientists, it also plays a vital role in the immune system, keeping certain diseases at bay.

The indigestible part of all plant-based foods pushes its way through most of the digestive tract unchanged, acting as a kind of internal broom. When it arrives in the colon, bacteria convert it to energy and compounds known as 'short chain fatty acids'. These are already known to alleviate the symptoms of colitis, an inflammatory gut condition.

Similarly, probiotics and prebiotics, food supplements that affect the balance of gut bacteria, reduce the symptoms of asthma and rheumatoid arthritis, also inflammatory diseases.

Published October 28 in Nature, breakthrough research by a Sydney-based team makes new sense of such known facts by describing a mechanism that links diet, gut bacteria and the immune system.

PhD student Kendle Maslowski and Professor Charles Mackay from the Garvan Institute of Medical Research, in collaboration with the Co-operative Research Centre for Asthma and Airways, have demonstrated that GPR43, a molecule expressed by immune cells and previously shown to bind short chain fatty acids, functions as an anti-inflammatory receptor.

"The notion that diet might have profound effects on immune responses or inflammatory diseases has never been taken that seriously" said Professor Mackay. "We believe that changes in diet, associated with western lifestyles, contribute to the increasing incidences of asthma, Type 1 diabetes and other autoimmune diseases. Now we have a new molecular mechanism that might explain how diet is affecting our immune systems."

"We're also now beginning to understand that from the moment you're born, it's incredibly important to be colonized by the right kinds of gut bacteria," added Kendle. "The kinds of foods you eat directly determine the levels of certain bacteria in your gut."

The conclusions drawn from the current research provide some of the most compelling reasons yet for eating considerably more unprocessed whole foods -- fruits, vegetables, grains, nuts and seeds.

Bonnie - music to my ears!

Statins have dramatic effect on the brain

A study in the October Journal of Lipid Research finds that statin drugs can have profoundly different effects on brain cells -both beneficial and detrimental.

These findings reinforce the idea that great care should be taken when deciding on the dosage and type of statin given to individuals, particularly the elderly.

John Albers and colleagues compared the effects of two commercially used statins, simvastatin and pravastatin, on two different types of brain cells, neurons and astrocytes (support cells that help repair damage). By directly applying the drugs to cells as opposed to administering them to animals, they could eliminate differences in the drugs' ability to cross the blood-brain barrier as a reason for any differing effects.

Albers and colleagues looked at the expression of genes related to neurodegeneration, and found that indeed, despite using biologically equivalent drug concentrations, differences were seen both between cells, and between drugs; for example, simvastatin reduced the expression of the cholesterol transporter ABCA1 by approximately 80% in astrocytes, while pravastatin lowered expression by only around 50%. Another interesting difference was that while both statins decreased expression of the Tau protein -associated with Alzheimer's disease -- in astrocytes, they increased Tau expression in neurons; pravastatin also increased the expression of another Alzheimer's hallmark, amyloid precursor protein (APP).

While increased levels of these two proteins may account for potential risks of disease, Albers and colleagues also note that large decreases in cholesterol proteins like ABCA1 should be considered. Brain cholesterol levels tend to be reduced in elderly people, and in such individuals the long-term effects of statin therapy could lead to transient or permanent cognitive impairment.

Bonnie - this should make anyone considering or currently taking statins think twice. As we have alluded numerous times, cognitive impairment is a possibility in those taking statins.

Does it still seem plausible to get most of the adult population on statin medication as Big Pharma is trying to do? Especially when there are other options for healthy lipids along with diet and lifestyle modification. We found this chart on hearthealthyonline.com

Medicine-------Lower Triglycerides------Raise HDL-------Lower LDL
Niacin-------------20-50 percent---------------15-35 percent----5-25 percent
Fish Oil Pills---25-30 percent----------------little effect--------little effect
Fibric Acids----7-30 percent-----------------1-20 percent-----5-25 percent
Statins------------7-30 percent-----------------5-15 percent-----8-55 percent

Fish Oil and Rheumatoid Arthritis

New research from Queen Mary, University of London and Harvard Medical School has revealed precisely why taking fish oils can help with conditions like rheumatoid arthritis.

In a paper published in Nature October 28, researchers describe how the body converts an ingredient found in fish oils into another chemical called Resolvin D2 and how this chemical reduces the inflammation that leads to a variety of diseases.

The research also suggests that Resolvin D2 could be the basis for a new treatment for diseases including sepsis, stroke and arthritis. Unlike other anti-inflammatory drugs, this chemical does not seem to suppress the immune system.

The researchers, who were funded by the Arthritis Research Campaign, the Welcome Trust and the National Institutes of Health, looked at a particular ingredient of fish oils called DHA. They were able to show how the body converts DHA* into Resolvin D2 and discover its exact chemical structure.

"This research is important because it explains at least one way in which fish oils can help in different types of arthritis. We can also work on this chemical and see if it can be used not only to treat or even prevent arthritis, but also as a possible treatment for a variety of other diseases associated with inflammation," stated researchers.

Curcumin found to kill cancer cells

A molecule found in a curry ingredient can kill esophageal cancer cells in the laboratory, suggesting it might be developed as an anti-cancer treatment, scientists said on Wednesday.

Researchers at the Cork Cancer Research Center in Ireland treated esophageal cancer cells with curcumin -- a chemical found in the spice turmeric, which gives curries a distinctive yellow color -- and found it started to kill cancer cells within 24 hours.

The cells also began to digest themselves, they said in a study published in the British Journal of Cancer.

Bonnie - this is not anything new. Curry is a wonderful spice to use for many of us. Unfortunately, many others do not tolerate it very well, especially those with salicylate issues.

In depth look into agave

Agave Syrup May Not Be So Simple
By Laura Johannes
Wall Street Journal

Agave is not just for tequila anymore. The sap from the Mexican plant is now increasingly being sold as a natural sweetener called agave nectar. Companies that sell it say it saves calories and raises blood sugar less than conventional sugar. Doctors are skeptical that it is healthier, and a major testing lab issued a warning that it is not safe for diabetics.

Agave (pronounced ah gav ee), sometimes mistaken for a cactus because of its spiky, sword-shaped leaves, is a flowering plant in the lily family. Its nectar is popping up in beverages, baked goods and on restaurant menus; it is also gaining popularity as an all-purpose sweetener, often next to honey in supermarket aisles.

Agave-nectar composition varies, but typically is primarily fructose. It has about the same amount of calories as sugar, or slightly more, but companies say its sweeter flavor allows you to cut the amount, saving calories.

Agave's other claim to healthfulness is that it has a low glycemic index, meaning it breaks down more slowly creating less of a sugar rush. At least two companies have marketed their products as a good alternative for diabetics. But the Glycemic Research Institute, a Washington, D.C., laboratory, issued a warning Friday that diabetics experienced "severe and dangerous side effects" during testing of an agave nectar. "The diabetics passed out on the floor and had to be taken to the hospital," says Ann de Wees Allen, chief of biomedical research at the lab. She declined to say how much of the product the diabetics consumed during the test, saying that would be disclosed after a complete analysis of the results.

The product tested was a maple-flavored version of the Volcanic Nectar brand agave, sold by Global Goods Inc., of Highland, Utah. Company President Brian Oaks said the product, which has never been sold, had a significant amount of maple syrup in it, which likely caused the problems. Dr. Allen says the nectar had an extremely small amount of maple syrup in it and is almost identical to the company's flagship agave product.

Previous tests, in which diabetics consumed a small amount of Volcanic Nectar agave, had resulted in the lab awarding a "diabetic friendly" seal to the Volcanic Nectar product, which it has since rescinded. The lab has stopped testing agave on humans amid safety concerns. Also, Dr. Allen says the lab refused to test four other agave products after a chemical analysis it commissioned from another lab found they were mixed with high-fructose corn syrup, which was not disclosed on the label. She declined to name the brands. 'Free-for-All Food'

If you're hoping to use agave to lose weight, nutritionists warn it has as many, or more, calories as sugar. "I worry that people may get confused and start thinking it is a free-for-all food," says Gillian Arathuzik, a dietician at the Joslin Diabetes Center in Boston. Agave is 1.4 to 1.6 times as sweet as sugar, says Sabra Van Dolsen, president of Colibree Co., an Aspen, Colo., company that sells Nekutli brand agave nectar. Calories vary from brand to brand, but are typically more than sugar. Nekutli, for example, has 60 calories per tablespoon. A tablespoon of white sugar has 45 calories. Since agave is sweeter, you can use less, proponents say. Stephen Richards, chief executive of BetterBody Foods & Nutrition LLC of Salt Lake City and author of a self-published agave cookbook, says each cup of sugar can be replaced by one-half to two-thirds cup of agave.

But depending on how refined the product is, agave can have little or no flavor—or taste like honey or maple syrup, according to the companies and our subjective tests. Unscientific testing by a Wall Street Journal reporter found agave to be pleasant in tea, but it imparted a brownish tinge and odd taste to lemonade. When baking, oil can be reduced because agave is liquid, says Mr. Richards. Agave makes baked goods rise slightly faster, which can result in a "cakier" texture, he adds. In our test, blueberry bran muffins made with BetterBody's Xagave brand nectar were identical in flavor to a batch made with brown sugar, though the test muffins rose slightly more. The agave version was nine fewer calories a muffin, a 7% saving.

Bonnie - I would never recommend agave to hypoglycemic or diabetic individuals. For them, I put this into the same category as honey or pure maple syrup even though it is low glycemic.

Epigenetics and Autism

Researchers at Duke University Medical Center have uncovered a new genetic signature that correlates strongly with autism and which doesn't involve changes to the DNA sequence itself. Rather, the changes are in the way the genes are turned on and off. The finding may suggest new approaches to diagnosis and treatment of autism.

The researchers found higher-than-usual numbers of gene-regulating molecules called methyl groups in a region of the genome that regulates oxytocin receptor expression in people with autism.

"In both blood samples and brain tissue, the methylation status of specific nucleotides in the oxytocin receptor gene is significantly higher in someone with autism, about 70 percent, compared to the control population, where it is about 40 percent," said co-lead author Simon G. Gregory, Ph.D., assistant professor in the Duke Department of Medicine. The work appears in BMC Medicine journal online.

Oxytocin is a hormone secreted into the bloodstream from the brain, and also released within the brain, where it has a bearing on social interaction. Previous studies have shown that giving oxytocin can improve an autistic person's social engagement behavior and it is being explored as a potential treatment of the disorder. Higher methylation of the oxytocin receptor gene may make a person less sensitive to the hormone.

"These results provide a possible explanation of why social isolation forms part of the autism spectrum – because an autistic individual's ability to respond to oxytocin may be limited," Gregory said. " Oxytocin has been tied to levels of trust and ability to read social cues."

Although the methylation status of the OXTR gene is not a definitive diagnosis of autism by itself, a test for methylation might be used along with other clinical tests for diagnosing autism. Gregory said that methylation-modifying drugs also may be a new avenue for treatments.

Though not a change to the DNA sequence itself, methylation status can be inherited, by what is known as epigenetics - inherited changes in gene regulation.

"The epigenetic link to autism is extremely exciting as it provides another opportunity for us to explore the heritability of this disorder and argues the importance of exploring epigenetic markers in complex disease," said co-lead author Jessica J. Connelly, Ph.D., assistant professor in the Department of Medicine at the University of Virginia.

Steve - there is that buzzword again: epigenetics. If you recall what we have been saying for the last several years, environmental, dietary, and lifestyle choices all contribute to gene expression. If our choices are poor, such as exposing ourselves to poor diet and exposing ourselves and our unborn children to an excessive environmental toxic load, we overload methylation genes, thus negatively expressing genes we would rather keep latent. Soon enough, science will understand this connection and public health officials will have to take a long, hard look at the gigantic weight of toxicity that burdens the human population.

Confidence in supplements at all-time high.

Consumer confidence in dietary supplements reached a high point in 2009, with 84 percent of American adults indicating that they are confident in the safety, quality and effectiveness of dietary supplements compared to 81 percent last year, according to a new survey conducted by Ipsos-Public Affairs for the Council for Responsible Nutrition (CRN). In the last several years, confidence levels in dietary supplements have been on a gradual rise, with 80 percent of American adults indicating a favorable level of confidence in dietary supplements in 2007, and 79 percent of American adults responding similarly in 2006.

According to the results from the 2009 CRN Consumer Survey on Dietary Supplements, confidence in dietary supplements isn’t the only thing on the rise—the on-line survey also showed a slightly higher percentage of adults who label themselves as supplement users, with 65 percent classifying themselves as such. In 2008, 64 percent of American adults identified themselves as supplement users. These numbers are also consistent with previous years’ findings, as 68 percent and 66 percent of Americans identified themselves as supplement users in 2007 and 2006, respectively.

Consumers can also feel more confident given that in its first year of existence, the serious adverse event reporting system for dietary supplements demonstrated a strong safety profile when viewed within the context of similar reporting systems for other regulated industries.

Also up slightly this year is the percentage of consumers who regularly take a multivitamin; with 78 percent reporting they do so compared to 75 percent of supplement users who reported taking a multivitamin regularly in 2008.

1 in 5 kids vitamin D deficient

At least one in five U.S. children aged 1 to 11 don't get enough vitamin D and could be at risk for a variety of health problems including weak bones.

By a looser measure, almost 90 percent of black children that age and 80 percent of Hispanic kids could be vitamin D deficient — "astounding numbers" that should serve as a call to action, said Dr. Jonathan Mansbach, lead author of the new analysis and a researcher at Harvard Medical School and Children's Hospital in Boston.

The findings add to mounting evidence about vitamin D deficiency in children, teens and adults, a concern because of recent studies suggesting the vitamin might help prevent serious diseases, including infections, diabetes and even some cancers.

Exactly how much vitamin D children and adults should get, and defining when they are deficient, is under debate. Doctors use different definitions, and many are waiting for guidance expected in an Institute of Medicine report on vitamin D due next year. The institute is a government advisory group that sets dietary standards.

The new analysis, released by the journal Pediatrics, is the first assessment of varying vitamin D levels in children aged 1 through 11.

Previous studies in the journal this year found low levels were prevalent in U.S. teens, and also showed kids with low levels had higher blood pressure and cholesterol levels, and were more likely to be overweight.

The new analysis uses data from a 2001-06 government health survey of nearly 3,000 children. They had blood tests measuring vitamin D levels.

Bonnie - there are actually updated levels as we reported last week in our eNewsletter.

What Risks Are Associated With High-Dose Crestor?

Jodi H. Walker, PharmD
Medscape Pharmacists

Rosuvastatin, a hydroxy-methylglutaryl coenzyme A reductase inhibitor, is approved in doses ranging from 5 mg to 40 mg daily. Rosuvastatin is a potent statin, about twice as potent as atorvastatin, 4 times as potent as simvastatin, and at least 8 times as potent as pravastatin and lovastatin. Dosing rosuvastatin at 80 mg exceeds the manufacturer's maximum daily dose and is not approved by the US Food and Drug Administration (FDA).

This dose has been evaluated in clinical trials, however. In fact, the manufacturer initially was developing an 80-mg dose. Although rosuvastatin 80 mg monotherapy resulted in the greatest reduction of low-density lipoprotein (LDL) cholesterol (65%) compared with other studied statins, it also was associated with increased risk for muscle toxicity (eg, myopathy, rhabdomyolysis) and renal toxicity (eg, proteinuria, hematuria, increased serum creatinine). According to preapproval documents, among patients receiving the 80-mg dose, the incidence rates of myopathy (1%) and rhabdomyolysis (0.4%) were higher than those reported in the original new drug application and labeling of approved statins.

Preapproval documents also noted a high frequency of elevated creatine kinase levels associated with rosuvastatin compared with other statins. The FDA ultimately denied approval of the 80-mg dose because of safety concerns and the limited additional benefit compared with the 40-mg dose.

Cases of rhabdomyolysis and renal failure have been reported since marketing of rosuvastatin, including a recent case of rhabdomyolysis associated with the 80-mg dose. Risk factors for rosuvastatin-induced myopathy and rhabdomyolysis include age 65 years or older, Asian ethnicity, hypothyroidism, renal impairment, and coadministration with cyclosporine, lopinavir/ritonavir (Kaletra®), fibrates, niacin, or gemfibrozil.

General risks for statin-induced rhabdomyolysis have been proposed and include hepatic dysfunction, hypertriglyceridemia, small body frame and frailty, metabolic muscle diseases, drugs affecting statin metabolism or elimination, postoperative status, and chronic alcohol use.

Due to risk for myopathy and rhabdomyolysis, the lowest effective rosuvastatin dose should be used. A lower initial dose of 5 mg is recommended for patients of Asian ethnicity, patients with severe renal impairment, and patients taking concomitant lopinavir/ritonavir. A reduced initial dose should be considered in patients receiving fibrates or niacin; coadministration with gemfibrozil should be avoided. The 40-mg dose is only recommended for patients who have not achieved their LDL goal with 20 mg.

Choosing to prescribe rosuvastatin 80 mg is influenced by several issues: patient risk factors for rhabdomyolysis, concomitant medications, comorbid conditions, and need for close monitoring. The benefits and risks inherent in such dosing depend on the individual patient. Patients who receive any dose of rosuvastatin should be monitored closely after any dosage adjustments. All patients on rosuvastatin should be counseled to seek immediate medical attention for signs and symptoms of rhabdomyolysis, including muscle pain, muscle weakness or cramps, and dark urine. If rhabdomyolysis is suspected, the statin should be discontinued immediately and supportive measures taken.

Living with gluten intolerance one year after diagnosis

No Pain, No Gain One Year After Diagnosis of Gluten Intolerance
By Erin Madison
Great Falls Tribune
http://www.greatfallstribune.com/article/20091021/LIFESTYLE/910210312/1024/rss04

Phytochemicals prevent oxidative stress

Eating more plant-based foods, rich in substances called phytochemicals, seems to prevent oxidative stress in the body, a process associated with obesity and the onset of disease, according to the Journal of Human Nutrition and Dietetics. To get enough of these protective phytochemicals, researchers suggest eating plant-based foods such as leafy greens, fruits, vegetables, nuts and legumes.

The researchers studied a group of 54 young adults, analyzing their dietary patterns over a three-day period, repeating the same measurement eight weeks later. The participants were broken into two groups: normal weight and overweight-obese. Although the adults in the two groups consumed about the same amount of calories, overweight-obese adults consumed fewer plant-based foods and subsequently fewer protective trace minerals and phytochemicals and more saturated fats. They also had higher levels of oxidative stress and inflammation than their normal-weight peers. These processes are related to the onset of obesity, heart disease, diabetes and joint disease.

Currently, there are no recommendations for how much of these plant compounds people should be getting each day. Using a phytochemical index could be a good way to come up with these recommendations.

Bonnie - most of my clients meet the phytochemical requirements, but for those who need a product rich in phytochemicals, we have Metagenics Phytoganix.

Analysis questions prostate and breast cancer screening methods

Courtesy of the New York Times

Two decades after the explosion in cancer screening fueled by reimbursement for mammography and prostate specific antigen (PSA) testing, a new analysis suggests that it is time to rethink the push for early detection of these two cancers. There is no argument that more cancers are being detected and at a much earlier stage, but that increase has not resulted in a decrease in metastatic disease, according to Laura Esserman, MD, MBA, of the University of California, San Francisco, and colleagues, who made their case in a special communication published in the October 21 issue of the Journal of the American Medical Association.

In broad strokes they painted a picture of increased detection and costly treatment of cancers that pose minimal risk, without making a dent in killer cancers. The researchers touched a nerve with the commentary and the American Cancer Society has already gone on record saying that it is reconsidering its position on the risks and benefits of breast and prostate cancer screening. Otis Brawley, MD, chief medical officer of the society, said that the benefits of screening have been exaggerated.

When prostate cancer mortality in the U.S. was compared with the rate in United Kingdom -- where PSA screening is not recommended -- there was no difference, although the incidence of prostate cancer was dramatically higher in the U.S. For breast cancer, seven randomized trials found a relative reduction in mortality ranging from 20% to 30%, but the "observed decrease in mortality is attributable to both screening and adjuvant therapy, with an estimated decrease of 7% to 23%, and 12% to 21%, respectively."

What is an effective screening technique is the detection of premalignant lesions, which is exactly what occurs with both colonoscopy and pap smears, two screening strategies that have significantly decreased invasive colorectal and cervical cancers.

Esserman argued that it is time to develop new screening strategies -- possibly new biomarkers -- that will be able to differentiate between "significant- and minimal-risk cancers." At the same time, she recommended new strategies to "reduce treatment for minimal-risk disease" and calls for the development of "clinical and patient tools to support informed decisions about prevention, screening, biopsy, and treatment and offer treatments tailored to tumor biology."

Bonnie - I anticipate that there are many health professionals and patients out there who are a bit peeved with this report.

10/22/09 Note: The American Cancer Society says it is not currently rethinking its stance on cancer screening, as was widely reported. "We are not redoing or rethinking our guidelines at this time, nor are we going to restate our guidelines to emphasize the inadequacies of screening," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society.

Non toxic method helps keep fruit, vegetables and flowers fresh

Did you know that millions of tons of fruits and vegetables in the United States end up in the trash can before being eaten, according to the U.S. Department of Agriculture?

A Georgia State University professor has developed an innovative new way to keep produce and flowers fresh for longer periods of time. Microbiologist George Pierce's method uses a naturally occurring microorganism -- no larger than the width of a human hair -- to induce enzymes that extend the ripening time of fruits and vegetables, and keeps the blooms of flowers fresh. The process does not involve genetic engineering or pathogens, but involves microorganisms known to be associated with plants, and are considered to be helpful and beneficial to them.

"These beneficial soil microorganisms serve essentially the same function as eating yogurt as a probiotic to have beneficial organisms living in the gastrointestinal system," Pierce said.

The process works by manipulating the organism's diet so that it will over express certain enzymes and activities that work in the ripening process and keeping the flower blooms fresh. Pierce analogizes this to using diet and exercise to improve the performance of an athlete.

In a very simple sense, climacteric plants -- such as apples, bananas, peaches and tomatoes -- respond to climactic change, and when they do, they produce increased levels of signal compounds like ethylene. For fruit such as peaches, ethylene causes the peach to ripen, increases aroma chemicals, but unfortunately, makes the peach very fragile.

The catalyst in this process can be distributed through various formulations and configurations. These include being incorporated into shipping boxes, packing materials or used to treat the air of shipping containers. It could be used either with individual fruits or vegetables or for larger, bulk quantities.

This new process could have a big impact on preventing waste, improving the consumption of healthy fruits and vegetables, allowing companies to ship produce longer distances.

The method also will allow for the storage of fruits, vegetables and flowers at room temperatures rather than refrigeration, thus helping to save energy, Pierce said.

The U.S. patents related to this invention are owned by the Georgia State University Research Foundation, Inc.

Steve - what a great idea. Unfortunately, for this to be accepted nationwide, a huge company would have to license the patent.

Mental inextricably linked to the physical

The true burden of mental ill health is unrecognized since many "physical" problems are really "mind" problems. Most lung cancers are caused by addiction to smoking, and some obesity by a brain-driven compulsion to eat, says UK psychiatrist Dr Peter Jones. And to tackle such problems experts need to go back to delving the mind. He and other leading mental health experts are calling for more research.

Mental illness in its "classic" sense, including depression and schizophrenia, affects one in four people in the United Kingdom each year but receives just 5% of total health research spending. Yet the economic, social and human cost of mental illness totals far more.

And many "physical" health problems involve a strong mental component. Professor Peter Jones, head of psychiatry at the University of Cambridge, said: "Mental health and illness are seen as separate from physical health and disorders but it's becoming increasingly clear that is wrong. We need to zip together physical and mental health. It is absurd to think that biological processes would stop at the neck."

People with severe mental illnesses are nearly three times more likely to develop diabetes and other cardiovascular disease risk factors and, on average, die 25-30 years younger.

Bonnie - we have discussed the Gut/Brian Connection repeatedly over the years. There is an absolute connection between the mental and the physical. However, it is not just a one-way street. You can definitely heal the mental by addressing the physical. This is what most mental experts miss.

Why is alternative medicine absent in health care debate?

A new survey indicates 12 percent of parents with children under the age of 18 have spoken to their child's doctor about complementary and integrative approaches to medicine, yet nearly 90 percent say they want to know more.

Parents should be aware that integrative alternative medicine can be helpful from the onset of the disease and can save time and money and improve a child's quality of life, said Timothy Culbert, MD, medical director of Pediatric Integrative Medicine Clinical Programs at Children's Hospitals and Clinics of Minnesota, which conducted the nationwide survey.

“This is true for all kinds of conditions including acute illnesses like cancer or chronic problems like migraines or behavioral issues.” he said.

The survey assessed parents' attitudes about various approaches to treating a child's illnesses. Integrative medicine combines the best conventional medical therapies like drugs, chemotherapy and surgery with complementary therapies like massage, acupuncture and proper nutrition.

Natural treatments, including non-drug, less invasive therapies like acupuncture, massage and relaxation, are being found to be effective in the management of a variety of children's health concerns. They're designed to help kids more effectively control pain, maintain mental health and improve quality of life.

According to the study:

• 68 percent of parents say integrative medicine is an effective treatment approach.
• Parents are concerned about the overuse of prescription medications; 85 percent feel it's important to minimize a child's dependence on drugs, especially for behavioral issues like attention deficit hyperactivity disorder (ADHD) or anxiety.
• More than three-fourths of parents agree combining conventional and complementary/alternative approaches to medicine is innovative and that hospitals should offer medical experts on both conventional and complementary/alternative therapies.
• Almost two-thirds of parents who have children with serious health issues haven't considered an integrative approach because they are unfamiliar with the subject.
• Of the parents who have used integrative medicine as part of their child's treatment, 95 percent have reported a positive experience.

"Parents need to consult and work with their child's physician to determine what integrative medicine options are available that may be helpful," said Culbert. "There are so many different kinds of complementary therapies, it's important to learn about options to find an approach that will work best for each patient. I see first-hand every day the difference it can make in a child's life."

Children's boasts the largest, longest-running pediatric clinical integrative medicine program in North America. The program offers a holistic approach to care and helps children and their families manage the everyday struggles of illnesses in a more comprehensive way. Currently more than half of patients at Children's use some sort of outpatient complementary or alternative medicine to help manage their conditions.

Bonnie - the problem here is that many physicians cannot have a conversation about integrative health options because they have never been educated about them. This is why there is little mention of alternative health options in the health care debate aside from a few senators and house reps who have had major successes through integrative therapies.

CRP predicts heart attack, death, but not stroke

People with high levels of a protein called C-reactive protein (CRP), a marker for inflammation in the blood, may be at higher risk for heart attack and death but not stroke, according to a study published in Neurology.

The study involved 2,240 people from the Northern Manhattan Study who were 40 years old or older and stroke-free. Of the group, 63 percent were Hispanic, 20 percent non-Hispanic black and 15 percent non-Hispanic white residents.

All participants had their blood tested for CRP levels and were evaluated for stroke and heart attack risk factors. They were followed for an average of eight years. In that time, there were 198 strokes, 156 heart-related events and 586 deaths.

The researchers found that people with CRP levels greater than three milligrams per liter were 70 percent more likely to suffer a heart attack and 55 percent more likely to die early compared to people who had levels of one milligram per liter or less of the protein in their blood. The protein was not associated with an increased risk of stroke once other risk factors were taken into account.

CRP protein levels are associated with such medical and lifestyle risk factors as diabetes, smoking, alcohol consumption and physical activity. "It appears that by living a healthy lifestyle, one may be able to lower these protein levels, thus lowering the risk of cardiac events and possibly early death," said one researcher.

New school lunch program recommendations

School meals must meet standards established in 1995. At the request of the United States Department of Agriculture (USDA), the Institute of Medicine convened a committee to provide recommenda­tions to revise standards and requirements so that school meals are more healthful. In its 2009 report School Meals: Building Blocks for Healthy Children, the committee recommends that the USDA adopt standards for menu planning, including:

• Increasing the amount and variety of fruits, vegetables, and whole grains
• Setting a minimum and maximum level of calories
• Focusing more on reducing saturated fat and sodium
  

In 2007, these national programs provided lunch to more than 30.5 mil­lion children and breakfast to 10.1 million children. If the IOM’s recommended changes are implemented, they will result in school meals that not only appeal to students but also better meet students’ nutritional needs.

Steve - we will have a comment when we review the full report.

Reduce fracture risk with fermented soy

Postmenopausal women (but not men) may lessen their chances of fracturing a hip 21 to 36 percent by adding moderate amounts of fermented soy-based foods to their diet, according to a report in the American Journal of Epidemiology.

Researchers surmise that the bone-protective effects of soy isoflavones may play a critical role in the bone health of postmenopausal women.

Bonnie - the key in this study is that the soy foods were fermented (tofu, tempeh, miso, natto).

Breast cancer risk reduced with Med Diet

Adherence to a Mediterranean diet along with avoidance of Western-type foods may contribute to a reduction in postmenopausal breast cancer risk, according to findings published in this month’s American Journal of Epidemiology.

Research was initiated in 1990 and involved 65,374 women living in France who were born between 1925 and 1950. 2,381 developed postmenopausal invasive breast cancer during a median follow-up period of 9.7 years. The findings indicate that a Mediterranean diet comprised of mostly fruits, vegetables, fish and olive/sunflower oil, was associated with a reduced risk of breast cancer only if energy intake remains within recommendations and if ‘unhealthy’ foods are not consumed in large quantities. The risk associated with the 'alcohol/Western' eating pattern was higher in the case of tumours that were estrogen receptor-positive/progesterone receptor-negative, added the researchers.

Exercise and Respiratory Tract Viral Infections

Moderate-intensity exercise reduces inflammation and improves the immune response to respiratory viral infections. Acute and chronic moderate exercise induces a level of stress hormones that downregulates excessive inflammation within the respiratory tract and aids in activating innate antiviral immunity.

Prolonged intense exercise may do this as well but may shift the balance too much, actually allowing the virus to gain a better foothold and cause greater pathology. Further research is necessary to examine cellular and molecular mechanisms through which exercise modulates immune function.

Based on the available evidence, moderate-intensity exercise training should be used as an adjunct to other preventive measures against respiratory tract viral infection.

Exercise and Sport Sciences Reviews

Steve - those who train for marathons, but have no intention of making it their profession, should take a look at this study.

Docs "in-the-know" prescribe fish oil

Numerous speakers at the Heart Failure Society of America 2009 Scientific Meeting commented on the shortage of new heart-failure agents to show a solid clinical benefit when given on top of the standard medications. A group of Northwestern University researchers decided to make their case for a substance already available, but much overlooked: fish oil.

"Omega-3 supplementation is very good, but we don't talk about it. The bulk of evidence suggests that this intervention is relatively simple, well accepted by the patient, with no side effects, and has an effect on cardiovascular mortality and heart failure."

"There are very few drugs that you can put on top of the standard medications and reduce cardiovascular death by ten percent."

Steve - the fact that it is overlooked is not surprising given the fact that Big Pharma cannot make any money off of fish oil. On the heels of this commentary, a British Journal of Nutrition study of over 57,000 Danish subjects over eight years may reduce unstable angina and chest pains by 27% in men who consume as little as .4 mg daily.

Has your pediatrician discussed vitamin D deficiency with you?

According to an October report in Pediatric Pharmacotherapy, new recommendations for addressing vitamin D deficiency in children is crucial for pediatricians to discuss with parents.

Not only do 25(OH)D levels need to be maintained within a normal reference range, but daily supplementation is required.

• 400IU vitamin D3 is required immediately after birth for all breastfed infants and for formula-fed infants that do not consume at least 1 liter of vitamin D-fortified milk each day.
  
• Premature infants, dark-skinned infants, and children who live in higher latitudes (cold weather climates), should supplement with 800IU daily.
  
  
• Children who have low 25(OH)D levels (out of reference range) need to supplement with the following:
  
  Less than one month old = 1000IU
  1-12 months old = 1,000IU to 5,000IU
  More than 12 months old = more than 5,000IU

Bonnie - please get the word out!

Study: popular antidepressant = suicidal thoughts in men

Nortriptyline (under the brand names Sensoval, Aventyl, Pamelor, Norpress, Allegron and Nortrilen) has been found to cause a ten-fold increase in suicidal thoughts in men when compared to its competitor escitalopram (under the brand names Lexapro and Cipralex). These findings are published in the open access journal BMC Medicine.

The research was carried out by Dr. Nader Perroud from the Institute of Psychiatry, Kings College London, who headed up GENDEP, an international team. Dr Perroud said "Suicidal thoughts and behaviors during antidepressant treatment have prompted warnings by regulatory bodies". He continued "the aim of our study was to investigate the emergence and worsening of suicidal thoughts during treatment with two different types of antidepressant."

The study was carried out on 811 individuals with moderate to severe unipolar depression. While an overall trend in reduction of suicidal thoughts was observed, men who took nortriptyline were found to have a 9.8-fold increase in emerging suicidal thoughts and a 2.4-fold increase in worsening suicidal thoughts compared to those who took escitalopram.

Perroud concludes, "Our findings that treatment-emerging and worsening suicidal thoughts may also be associated with psychomotor activation triggered by antidepressants needs to be investigated in future studies. The study also refutes the idea that newer antidepressants such as the SSRIs are worse than older medications in terms of increasing suicidal thoughts."

Antibiotic Resistance: An Ecological Perspective on an Old Problem

Steve - I think this is pragmatic way of looking at antibiotic resistance. The one thing they fail to mention, however, that optimizing the host will always be the best option for prevention.

Antibiotic resistance is never going to go away. No matter how many drugs we throw at it, no matter how much money and resources are sacrificed to wage a war on resistance, it will always prevail. Humans are forced to coexist with the fact of antibiotic resistance. Public health officials, clinicians, and scientists must find effective ways to cope with antibiotic resistant bacteria harmful to humans and animals and to control the development of new types of resistance.

The American Academy of Microbiology convened a colloquium October 12-14, 2008, to discuss antibiotic resistance and the factors that influence the development and spread of resistance. Participants, whose areas of expertise included medicine, microbiology, and public health, made specifi c recommendations for needed research, policy development, a surveillance network, and treatment guidelines. Antibiotic resistance issues specific to the developing world were discussed and recommendations for improvements were made.

Each antibiotic is injurious only to a certain segment of the microbial world, so for a given antibacterial there are some species of bacteria that are susceptible and others not. Bacterial species insusceptible to a particular drug are “naturally resistant.” Species that were once sensitive but eventually became resistant to it are said to have “acquired resistance.” It is important to note that “acquired resistance” affects a subset of strains in the entire species; that is why the prevalence of “acquired resistance” in a species is different according to location.

Antibiotic resistance, the acquired ability of a pathogen to withstand an antibiotic that kills off its sensitive counterparts, originally arises from random mutations in existing genes or from intact genes that already serve a similar purpose. Exposure to antibiotics and other antimicrobial products, whether in the human body, in animals, or the environment, applies selective pressure that encourages resistance to emerge favoring both “naturally resistant” strains and strains which have “acquired resistance.” Horizontal gene transfer, in which genetic information is passed between microbes, allows resistance determinants to spread within harmless environmental or commensal microorganisms and pathogens, thus creating a reservoir of resistance. Resistance is also spread by the replication of microbes that carry resistance genes, a process that produces genetically identical (or clonal) progeny.

Rapid diagnostic methods and surveillance are some of the most valuable tools in preventing the spread of resistance. Access to more rapid diagnostic tests that could determine the causative agent and antibiotic susceptibility of infections would inform better decision making with respect to antibiotic use, help slow the selection of resistant strains in clinical settings, and enable better disease surveillance. A rigorous surveillance network to track the evolution and spread of resistance is also needed and would probably result in significant savings in healthcare.

Controlling antibiotic resistant bacteria and subsequent infections more efficiently necessitates the prudent and responsible use of antibiotics. It is mandatory to prevent the needless use of antibiotics (e.g., viral infections; unnecessary prolonged treatment) and to improve the rapid prescription of appropriate antibiotics to a patient. Delayed or inadequate prescriptions reduce the efficacy of treatment and favor the spread of the infection. Prudent use also applies to veterinary medicine. For example, antibiotics used as “growth promoters” have been banned in Europe and are subject to review in some other countries.

There are proven techniques for limiting the spread of resistance, including hand hygiene, but more rapid screening techniques are needed in order to effectively track and prevent spread in clinical settings. The spread of antibiotic resistance on farms and in veterinary hospitals may also be significant and should not be neglected.

The important messages about antibiotic resistance are not getting across from scientists and infectious diseases specialists to prescribers, stakeholders, including the public, healthcare providers, and public officials. Innovative and effective communication initiatives are needed, as are carefully tailored messages for each of the stakeholder groups.

Download the full report.

Low income Americans now have more access to fruits and vegetables

Millions of women and children are eating more fruits, vegetables and whole grains in a public health campaign that all states had to join by his month. In the largest overhaul since it began in 1974, the federal Women, Infants and Children (WIC) nutrition program has begun giving vouchers for a wider variety of food to its 9.3 million low-income participants — mothers, infants and children up to 5 years old.

Until now, WIC vouchers bought only milk, cheese, juice and eggs."It's a huge change," says undersecretary Kevin Concannon of the U.S. Department of Agriculture, which runs the program. He says the improved mix of foods will lower health-care costs, partly by reducing obesity. Nearly half of U.S. newborns are in WIC, available to families with incomes up to $33,874 for a household of three — 185% of the federal poverty level. The change won't increase monthly benefits, which average $43 per person, but will provide a new cash-value voucher for produce that is worth $6 for each child and $10 for a breast-feeding mother. Other vouchers will allow the purchase of whole-grain foods and will reduce the amount of dairy products. Most states began issuing the new vouchers on Oct. 1.

A handful did so earlier."People are very excited," says Susan Greathouse of Oregon's WIC program, which began issuing produce vouchers in August. She says mothers have used more than 80% of those distributed. Delaware, which began in January, also reports 80% use. In New York, which began the federal vouchers in January after issuing state-funded ones, 85% are being used.Another benefit: Neighborhood stores are stocking produce because customers can buy it.

The change didn't come without controversy. Dairy and juice groups expressed concern because their products would be allowed in smaller quantities to offset the cost of adding produce and grains. Mothers are thrilled to be able to buy produce, but "some of the changes are not that popular," says Laurie True of the California WIC Association, a non-profit group representing local WIC agencies.

Bonnie - we reported on this change a while ago. Boy, is this a welcome change! Hopefully, those taking advantage of the changes can set an example for those in their community that do not qualify for WIC. This was sorely, sorely needed and I commend the government for their actions.

I am shocked and incredibly encouraged that they lowered the amount of dairy and juice vouchers. Maybe they are starting to understand that they are not as healthful as once believed.

This is an instance where I can say my tax dollars are being well spent.

Folate-blocking drugs produce birth defects

Drugs that interfere with the action of folic acid can produce a sharp increase in certain birth defects if taken during the first trimester of pregnancy, Israeli researchers reported today in the British Journal of Clinical Pharmacology. It is well-known that high levels of folate in pregnant women increase the chances of a healthy baby, and most medical authorities suggest that folate supplements be taken during pregnancy to minimize risks.

The new study is the largest ever to look at the issue, the authors said. A team from Ben-Gurion University of the Negev studied 84,832 babies born at the Soroka Medical Center in Beer-Sheva. The drugs increased the risk of spina bifida and malformations of the brain more than sixfold. The results are conservative, the researchers noted, because they were unable to include data about spontaneous abortions. Among the drugs that cause problems are dihydrofolate reductase inhibitors, such as trimethoprim (Proloprim, Triprim and Monoprim), sulfasalazine (Azulfadine and Salazopyrin) and methotrexate that prevent folate from being converted into active metabolites. Other drugs that are known to lower serum and tissue concentrations of folate include the antiepileptic drugs -- such as carbamazepine (Tegretol, Carbatrol and others), phenytoin (Phenytek and Dilantin), lamotrigine (Lamictal), primidone, valproic acid (Depakote) and phenobarbital (Luminal) -- and cholestyramine (Questran and Cholybar).

Thomas H. Maugh II, LA Times

Green tea for cancer prevention

Drinking green tea may lower your risk of developing certain blood cancers, but it will take about 5 cups a day. After gathering information on the diets and green tea drinking habits of a large group of Japanese adults aged 40 to 79 years old, Naganuma and colleagues followed the group for development of blood and "lymph system" cancers.

The 19,749 men and 22,012 women who participated in the study had no previous history of cancer, the authors note in the American Journal of Epidemiology.

During 9 years of follow up, 157 blood, bone marrow, and lymph system cancers developed in the study group. The overall risk for blood cancers was 42 percent lower among study participants who drank 5 or more, versus 1 or fewer, cups of green tea daily.

Drinking 5 or more cups of green tea daily was also associated with 48 percent lower risk for lymph system cancers.

These associations held up in analyses that allowed for age, gender, education, smoking status and history, alcohol use, and fish and soybean consumption.

The researchers also observed reduced risk for blood-related cancers among obese study participants, who are considered to have higher risk of these cancers.

Got water?

People who get much of their daily liquids from plain water rather than other beverages may have healthier diets overall.

Using data from a national health survey of more than 12,000 Americans, researchers found that people who drank more "plain water" tended to eat more fiber, less sugar and fewer calorie-dense foods.

The reverse was true of people who got much of their fluids from other beverages, according to a report of the study in the American Journal of Clinical Nutrition.

Bonnie - this should not come as a surprise to anyone. I would bet they would find the same stats if subjects also drank unsweetened tea and coffee, or stevia sweetened beverages. Notice that artificially sweetened beverages and milk did not encourage healthier diets.

Probiotics help reduce fiber’s anti-nutrient actions

Formulating bread with Bifidobacterium strains may reduce levels of a compound in high-fiber bread thought to be behind fiber’s impairment of mineral absorption. While the consumption of whole-grain bread or fiber-enriched bread is increasing on the back of consumer understanding of the benefits of a high-fiber diet, wholegrain foods are also reported to impair mineral absorption. The impairment is thought to be related to the phytate and phytic acid content of these products.

According to new findings published in the Journal of Agricultural and Food Chemistry, phytase enzymes produces by strains of bifidobacteria, could reduce phytate and phytic acid levels in bread. "Bifidobacterium strains or the enzyme preparations would be the best approach to reduce the content of phytic acid in fibre-rich products for human consumption.” Results showed that, compared to high-fibre bread baked traditionally, fermentation of the bread with the Bifidobacterium strains led to significantly lower phytic acid levels. Not all phytates were removed however, and residual amounts of myo-inositol triphosphates (InsP3) were recorded. This is important, say the researchers, since InsP3 may positively affect human health.

Steve - another very encouraging reason to take probiotics, especially bifidus.

Parents part of the problem, solution for obesity

"Parents might be contributing to the overweight epidemic," said Dr. Elsie Taveras, an assistant professor of pediatrics at Harvard Pilgrim Health Care and Harvard Medical School, who has researched the issue.

They do so unwittingly, of course, Taveras said. And the point is not to make parents feel guilty about contributing to their children's weight problems, she said, but to get the word out because the trend is headed in the wrong direction.

Today in the United States, infants up to 6 months old are 59 percent more likely to be overweight than were babies 20 years ago, according to a study published in Obesity.

"What we found was, those children who gained more weight and gained it more quickly in the first six months of life had a higher risk of obesity when they were 3 years old," Taveras said. Her study was reported in Pediatrics.

The way parents feed their infants might play a role in this weight gain, another study found.

Mothers who fed their babies formula eight times a day, on average, rather than seven and "who were less sensitive in reading their baby's satiety cues," Worobey said, had babies who gained more weight between ages 6 and 12 months. The findings were reported in the Journal of Nutrition Education and Behavior.

One solution, he said, is for parents to pay closer attention to their baby's cues, asking their pediatrician for help if they aren't certain how to read those cues.

"Pulling the head away from the bottle is the infant's way to signal, 'Hey, I don't want to do this anymore,'" Worobey said. But the cue is often not noticed.

One way to remedy that, he suggests, is for parents to avoid feeding their infants while watching television. "You may be paying more attention to the TV," he said. "It's better to make it one-on-one time."

There could be cultural myths at work, too, he said, with some cultures still believing that a chubby baby is a healthy baby.

Taveras urged parents to check in often about weight with their infant's pediatrician. With about four "well-baby" visits in the first six months, parents should remember to ask each time about their child's weight. "They should discuss with their clinician how their child is growing," she said.

But the parental link to youngsters' weight might start well before birth, perhaps even before pregnancy.

Reporting in the Maternal and Child Health Journal, researchers found that women who start pregnancy at a normal weight but gain more than 25 to 35 pounds increase their child's risk for being overweight at age 3.

Bonnie - these are all very valid points that need to be addressed when educating potential parents, parents-to-be, and new parents.