Suppliers must do a better job with chickens

Courtesy of consumereports.com

You would think that after years of alarms about food safety—outbreaks of illness followed by renewed efforts at cleanup—a staple like chicken would be a lot safer to eat. But in our latest analysis of fresh, whole broilers bought at stores nationwide, two-thirds harbored salmonella and/or campylobacter, the leading bacterial causes of foodborne disease.

That's a modest improvement since January 2007, when we found that eight of 10 broilers harbored those pathogens. But the numbers are still far too high, especially for campylobacter. Though the government has been talking about regulating it for years, it has yet to do so. The message is clear: Consumers still can't let down their guard. They must cook chicken to at least 165º F and prevent raw chicken or its juices from touching any other food. Each year, salmonella and campylobacter from chicken and other food sources infect 3.4 million Americans, send 25,500 to hospitals, and kill about 500, according to estimates by the national Centers for Disease Control and Prevention. But the problem might be even more widespread: Many people who get sick don't seek medical care, and many of those who do aren't screened for foodborne infections.

What's more, the CDC reports that in about 20 percent of salmonella cases and 55 percent of campylobacter cases, the bugs have proved resistant to at least one antibiotic. For that reason, victims who are sick enough to need antibiotics might have to try two or more before finding one that helps.

Consumer Reports has been measuring contamination in store-bought chickens since 1998. For our latest analysis, we had an outside lab test 382 chickens bought last spring from more than 100 supermarkets, gourmet- and natural-food stores, and mass merchandisers in 22 states. We tested three top brands—Foster Farms, Perdue, and Tyson—as well as 30 nonorganic store brands, nine organic store brands, and nine organic name brands. Five of the organic brands were labeled "air-chilled" (a slaughterhouse process in which carcasses are refrigerated and may be misted, rather than dunked in cold chlorinated water). Among our findings:

• Campylobacter was in 62 percent of the chickens, salmonella was in 14 percent, and both bacteria were in 9 percent.
  
• Only 34 percent of the birds were clear of both pathogens. That's double the percentage of clean birds we found in our 2007 report but far less than the 51 percent in our 2003 report.
  
• Among the cleanest overall were air-chilled broilers. About 40 percent harbored one or both pathogens. Eight Bell & Evans organic broilers, which are air chilled, were free of both, but our sample was too small to determine that all Bell & Evans broilers would be.
  
• Store-brand organic chickens had no salmonella at all, showing that it's possible for chicken to arrive in stores without that bacterium riding along. But as our tests showed, banishing one bug doesn't mean banishing both: 57 percent of those birds harbored campylobacter.
  
• The cleanest name-brand chickens were Perdue's: 56 percent were free of both pathogens. This is the first time since we began testing chicken that one major brand has fared significantly better than others across the board.
  
• Most contaminated were Tyson and Foster Farms chickens. More than 80 percent tested positive for one or both pathogens.
• Among all brands and types of broilers tested, 68 percent of the salmonella and 60 percent of the campylobacter organisms we analyzed showed resistance to one or more antibiotics.

Bonnie - most of us did not stop eating chicken when the last report came out and most will not stop from this report. However, it is another reminder to be smart and proactive about eating any foodstuff, whether it is raw vegetables or animal flesh. At the end of the day, we are the last line of defense. If we do not cook our meat properly, wash our veggies thoroughly, or check to see that our restaurant food is cooked properly, we certainly cannot count on the USDA, food manufacturers, food distributors, grocery stores, and restaurants to make sure our food is safe.

Behavioral therapy successful in autistic children

The first rigorous study of behavior treatment in autistic children as young as 18 months found two years of therapy can vastly improve symptoms, often resulting in a milder diagnosis. The study was small — just 48 children evaluated at the University of Washington — but the results were so encouraging it has been expanded to several other sites.

The National Institute of Mental Health funded the study was published in Pediatrics. Children aged 18 months to 30 months were randomly assigned to receive behavior treatment focusing on social interaction and communication — which are both difficult for many autistic children. Children in the specialized group had four hours of therapist-led treatment five days a week, plus at least five hours weekly from parents.

After two years, IQ increased an average of almost 18 points in the specialized group, versus seven points in the others. Language skills also improved more in the specialized group. Almost 30 percent in the specialized group were re-diagnosed with a less severe form of autism after two years, versus 5 percent of the others. No children were considered "cured."

The treatment is expensive; participants didn't pay, but it can cost $50,000 a year. Some states require insurers to cover such costs, and Autism Speaks is working to expand those laws.

Bonnie - behavioral therapy is very important for treating autism. ADD/ADHD drug makers would kill for these kind of results.

Adverse Events Common With Low- to Medium-Dose Glucocorticoids

In patients receiving glucocorticoids for inflammatory diseases, adverse events are very common, even at low to medium doses, according to a report in the Annals of the Rheumatic Diseases. The overall adverse event rate averaged 150 per 100 patient-years. In studies that focused only on patients with inflammatory bowel disease, the adverse event rate was 555 per 100 patient-years.

Adverse events in RA patients consisted primarily of psychological and behavioral disturbances, followed by dermatological and cardiovascular effects. PMR was primarily associated with gastrointestinal, endocrine and metabolic, cardiovascular and infectious events. IBD patients most often reported gastrointestinal and neurological events. "The risk-benefit ratio of glucocorticoids is an important issue for future studies and could help to create new targets for drug development" such as selective glucocorticoid receptor agonists, the authors conclude.

Vitamin D level has major role in CVD prevention

Inadequate levels of vitamin D are associated with an increase in the risk of cardiovascular disease and death, as reported at the American Heart Association 2009 Scientific Sessions. Results from 27 000 people 50 years or older with no history of cardiovascular disease for just over a year, found that those with very low levels of vitamin D (<15>30 ng/mL). Those deficient in vitamin D were also twice as likely to develop heart failure as those with normal levels.

"We concluded that even a moderate deficiency of vitamin D was associated with developing coronary artery disease, heart failure, stroke, and death," said coauthor Dr Heidi May (Intermountain Medical Center).

Deficiency in vitamin D is generally agreed to be a blood level of <20>150 ng/mL indicating excessive vitamin D. Data suggest that many people are likely getting inadequate vitamin D, he said, with studies showing that black Americans have blood levels ranging from 6-18 ng/mL and that white Americans have levels ranging from 16-25 ng/mL. In general, a supplement of 100 IU of vitamin D per day will increase blood levels of vitamin D by 1 ng/mL, Rimm said. Those taking 1000 IU per day should have blood levels in the range of 25-32 ng/mL and those taking 4000 IU should have levels of 40-50 ng/mL.

During the right times of year, five to 10 minutes a day of sunlight is sufficient is to make enough vitamin D. I do hear the concerns about skin cancer and I think people should wear suntan lotion, but it's probably better to put it on 10 minutes after you've been in the sun." Researchers cautioned that "in northern climes, even if you go out in the sun in January, you're not going to make much vitamin D, so there you would need supplementation to get adequate levels." One of the best dietary sources of vitamin D is fish. People should remember that diet is an important source of vitamin D, too, he noted. "One of the best dietary sources of vitamin D is fish. We already suggest people eat a couple of servings a week, but having three or four servings a week of fish can get you a fair bit of vitamin D, and would represent an additional 300 to 500 IU of vitamin D. This still might not be sufficient so you might need a little bit of sunlight or to take a vitamin D supplement. It's really a combination of things, that's probably the best approach."

Both Rimm and Dobnig said it is nearly impossible for anyone to suffer adverse effects from too much vitamin D. Those who spend whole days in the sun, such as lifeguards, have vitamin D levels ranging from 45 to 65 ng/mL, said Rimm. "Vitamin D is safe. Hypercalcemia is not a problem, with the rare exception of granulomatous disease," said Dobnig. He added that because vitamin D is a fat-soluble vitamin, it can be given weekly, or even monthly.

Recipe du Jour December

Everyone's getting on the immune-boosting bandwagon. Shockingly, Kellogg's labeled their Cocoa Krispies as a great way to build immunity, despite the second ingredient being sugar and containing partially hyrdrogenated oil (trans fat). Under FDA pressure, Kellogg's has since removed this erroneous claim.

Like we did with our Immune-Boosting Broth in November, Salmon Stimpanata is another immune-boosting recipe sure to excite. It has been a staple of a local restaurant in Highwood, IL called Washington Gardens. Here's why it is a great immune-boosting dish:

• Salmon - loaded with vitamin D, omega-3 fats, protein, an zinc
• Orange Juice/Lemon - vitamin C
• Red Onion - quercetin and other flavanoids

Not only does the presentation look beautiful, but it is incredibly delicious. Even fish haters will love it because there is no fishy taste. For those of you wanting to make it at home:

Salmon Stimpanata

-2 lb. salmon filets, cut into 4 pieces
-1 c. fresh orange juice
-juice of one lemon
-1 medium to large red onion, thinly sliced

Marinate salmon filets in the next three ingredients for ½ hour or more. In a pan (so that the salmon is completely covered with liquid- add a little water if needed), bring the liquid to a boil. The, cover immediately and turn off the heat (leaving the pan on top of the burner). When the salmon is no longer translucent, it is ready to serve! Serve with lemon wedges and orange and kiwi slices. SERVES: 4

SIDE DISHES: serve with steamed broccoli and wild rice pilaf.

Psychotropic drugs boost fall risk in the elderly

Studies including nearly 80,000 people aged 60 and older confirms that certain types of widely prescribed drugs. Falls often have serious consequences for older people, such as injuries leading to disability and admission to a nursing home, or even death.

The Archives of Internal Medicine study analyzed the risk of falling associated with nine classes of drugs. Three classes turned out to significantly boost fall risk: sedatives and hypnotics, typically prescribed as sleeping aids; antidepressants; and benzodiazepines, which include tranquilizers like Xanax and Valium. The researchers also saw an increased risk in patients taking non-steroidal anti-inflammatory drugs -- like aspirin-- and drugs for treating psychosis, but they note that people may be taking these drugs to treat conditions that would in and of themselves increase their risk of falling. Prescription drug use among the elderly is on the rise. One recent Canadian study found 1 in 7 people over 80 had filled a prescription for an antidepressant. Older people who are taking any of the drugs associated with falls should talk about the medication with their physician and their pharmacist.

Preeclampsia linked to hypothyroidism

Women in whom preeclampsia develops during pregnancy are more likely than other women to have hypothyroidism in late pregnancy or subsequently, according to British Medical Journal (BMJ).

Bonnie - what can help prevent this: adequate lean protein consumption, magnesium, and iodine

Exploring a low-acid diet for bone health

Bonnie - Jane Brody, long-time health columnist for the New York Times, goes out on a limb with this piece (can you hear the tongue-in-cheek?).

While it is nice to see Jane get with the times by suggesting that dairy/milk is not all that it is cracked up to be for bone health, she still talks up whole wheat, which is one of the most acidic foods on earth.

Protein should be the only acid food consumed regularly and has shown to be bone healthy when consumed properly.

Wheat's effect in diabetics

It is common knowledge that type 1 diabetics are at increased risk for celiac disease. New research from the journal Diabetes also suggests that they also have an abnormal, exaggerated immune response to wheat proteins, separate from any genetic, gluten-related abnormality.

Bonnie - gluten intolerance combined with a wheat protein intolerance is the ultimate double whammy disaster!

WSJ - flu fighters in your food

Courtesy of Laura Landro, Wall Street Journal

While many people are still waiting for swine-flu vaccine to become available in their area, there is a lot they can do in their own kitchens to help fight off disease and build a strong immune system. Scientists in the growing field of nutritional immunology are unveiling new evidence of the complex role that nutrition plays in fighting off infectious diseases like influenza. A diet rich in nutrients such as vitamin A, found in colorful fruits and vegetables, and zinc, found in seafood, nuts and whole grains, can provide the critical fuel the body needs to fight off disease, heal injuries, and survive illness when it does strike, experts say.

Scientists are still studying all the complex ways in which nutrients interact with the immune system. There is still much that they don't know about minerals such as zinc, for instance, including how they are absorbed and all the roles they play in the body. But scientists do know that certain vitamins and minerals can improve the body's ability to fight off infection: Studies in healthy elderly adults, for example, have shown an improved immune response to vaccination and fewer infections after receiving extra doses of vitamin E.

To create immune cells to fight off a specific infection, the body has to rapidly draw nutrients from the bloodstream, says Anuraj Shankar, a researcher at the Harvard School of Public Health. "If you don't have an adequate intake of vitamins and minerals, you won't be able to produce the number of immune cells you need, and the immune cells you do produce may be compromised," Dr. Shankar says. That makes it impossible to mount an effective response to infection, he says.

The benefits of good nutrition may have been recognized first by Hippocrates, the ancient Greek physician who declared "let food be thy medicine, and medicine be thy food." An 18th century naval surgeon's discovery that citrus fruits could cure scurvy in sailors was later recognized as a vitamin C deficiency, and after the 1930s, when dairies began to fortify milk with vitamin D, the disease known as rickets was virtually eliminated in the U.S. Researchers warn that malnourished people may be a breeding ground for more dangerous infectious diseases.

Animal studies at the University of North Carolina show that in a host with poor nutrition, viruses mutate in the face of a weak immune response to become more powerful. And once those mutations occur, even well-nourished hosts are susceptible to the newly virulent virus. "A lot of people may think malnutrition on the other side of the world isn't their problem," says Melinda A. Beck, a researcher at the University of North Carolina, Chapel Hill. But malnutrition "is a driving force in emerging infectious diseases that are spreading around the world," she says. The human body doesn't have to be starving to suffer from malnutrition.

Studies show that obesity, in addition to its other health risks, may also make people more susceptible to infections like the flu. A diet heavy on processed and fast foods may be low in the vitamins and minerals important for health. And diets that are high in saturated fat appear to actually depress the body's immune response, increasing the risk of infections. Dr. Beck says studies of mice show that only 4% of lean animals infected with the flu virus die. That compares with a death rate of between 40% and 60% in obese mice infected with the virus. And after a small study showed that obese people vaccinated for the flu didn't mount a strong immune response, the University of North Carolina is expanding its trials to compare vaccination response rates in lean and obese people. When obese people fall ill, "their immune function may not be strong enough to mount an effective response," says Donald Hensrud, a Mayo Clinic specialist in preventive and internal medicine and editor-in-chief of "The Mayo Clinic Diet," a new book promoting weight loss through a healthy diet that allows unlimited quantities of fruits and vegetables.

Scientists have long known that some vitamins, minerals and other nutrients can play a key role in the immune system by acting as antioxidants. These protect and repair cells from oxidative stress, the damage caused by molecules known as free radicals. But nutrients work in ways beyond acting as antioxidants, says Dr. Beck. For example, vitamin A can enhance the immune system "by stimulating specific proteins necessary for immune function by activating specific genes," she says. So, if vitamin A is deficient, then the immune cells that require vitamin A to function properly won't work as efficiently. Animal studies show that a deficiency of vitamin B-6, which helps maintain the health of organs that make white blood cells, can decrease antibody production and suppress the immune response. And selenium in small amounts can help stimulate immune cells and may prevent the growth of some tumors.

A survey by the CDC in 2007 showed that the majority of adults consume less than the government's recommended five servings of fruits and vegetables daily. But quantity matters: A 2004 Harvard study of 110,000 men and women showed that people who averaged eight or more servings of fruit and vegetables daily were 30% less likely to have had a heart attack or stroke than those who had only 1.5 servings daily.

Nutrition experts say to boost immunity it is also important to avoid processed foods, and to minimize trans fats and unhealthy saturated fats from animal products and vegetable oils like palm and coconut. Instead, they say, people should eat foods rich in unsaturated fats such as olive oil. Contradictory AdviceSome advice for a healthy diet can seem contradictory. For example, heart-healthy diets typically include unsaturated fats such as omega-3 fatty acids, which are found in fish such as salmon and trout and in flaxseed and walnuts. For people who don't want those foods, nutritionists may recommend fish-oil supplements, which can be beneficial in suppressing chronic inflammation in the body, a condition that can lead to coronary artery disease and arthritis. But those same anti-inflammatory properties of fish oil can also suppress the immune responses necessary to combat an acute viral infection. Studies at the University of North Carolina have shown that mice fed with fish oil have an impaired resistance to infections, including the flu. "If I suppress the immune response and get a viral infection, I'm worse off," says Dr. Beck, who is studying the links between fish oil and resistance to influenza.

One nutrient hard to get in food is vitamin D. Even with the fortification of milk, orange juice and other food products, some experts have been sounding the alarm in recent years about wide deficiencies, especially in children. Tests are available for about $100 to determine vitamin D levels, but their accuracy is in question. And just how much vitamin D different people need is the subject of considerable debate. The federal government's current recommendations range from 200 international units daily for children to 600 IUs for adults, with a safe upper limit of 2,000 IUs daily. The American Academy of Pediatrics recommends 400 IUs for children, and vitamin D experts at Oregon State University and elsewhere recommend 2,000 IUs daily for all adults. The Institute of Medicine, a government advisory group, is expected next year to update the recommendations. Adrian Gombart, a researcher at Oregon State University's Linus Pauling Institute, says vitamin D, in addition to building strong bones and fighting off a variety of diseases, appears to activate proteins that help the body fight off infection. "Vitamin D won't prevent you from getting the flu, but it might allow you to mount an optimal immune response, suffer less of the effects, and resolve the infection more quickly," says Dr. Gombart, who is researching the nutrient's role in stimulating immune cells.

Bonnie - the study about fish oil possibly suppressing immune function against the flu is one mouse study and needs much more study. However, there is no doubting the immune supporting effects of Cod Liver Oil, which contains fish oil but also has the added benefit of vitamin A& D.

Beta Carotene deficiency looms

"We mustn't protect ourselves against consuming too much beta-carotene, but rather against consuming too little." This was the conclusion drawn by leading experts in the fields of medical and nutritional science at the 2nd Hohenheim Nutrition Conference in Stuttgart, Germany. Georg Lietz, Ph.D., of Newcastle University reported the general population in the United Kingdom and other European countries is not obtaining sufficient beta-carotene through diet alone, and thus cannot benefit from the essential health promoting functions offered by the vitamin A precursor. Vitamin supplements and foodstuffs enriched with beta-carotene can be a good and safe way to insure adequate vitamin A intake. Concerning the repeated discussion of the safety of beta-carotene, professor Hans K. Biesalski of the University of Hohenheim, Germany, explained the only potential for danger existed in the case of extremely high doses of supplements consumed by heavy smokers, although even for this segment of the population a daily consumption of up to 10 mg would still be harmless.

Phthalates linked to ADHD

Phthalates are important components of many consumer products, including toys, cleaning materials, plastics, and personal care items. A new report by Korean scientists in Biological Psychiatry, adds to the potentially alarming findings about phthalates. They measured urine phthalate concentrations and evaluated symptoms of attention-deficit/hyperactivity disorder (ADHD) using teacher-reported symptoms and computerized tests that measured attention and impulsivity. They found a significant positive association between phthalate exposure and ADHD, meaning that the higher the concentration of phthalate metabolites in the urine, the worse the ADHD symptoms and/or test scores.

Steve - feminizing boys and now exacerbating ADHD symptoms? Our government regulators better take a long, hard look. I bet they will not like what they find.

FDA, Merck took too long to pull Vioxx

The risks of taking anti-inflammatory drug Vioxx could have been detected nearly four years before the drug was pulled from the market, according to analysis of nearly 30 clinical trials.The findings, published in the Archives of Internal Medicine on Monday, analyzed 30 Vioxx trials involving around 20,000 individuals and fund evidence of the drug's risks from as early as 2000.The Merck-made drug was pulled in 2004 after it was linked with serious cardiovascular problems, including heart attacks.Much of trial data used in the meta-study has only become available because of litigation against the firm.The study's authors, including Joseph Ross of the Mount Sinai School of Medicine in New York, said the results showed the need for the open publication of clinical trials."Physicians and the public deserve to be in a position to make informed choices about risk and benefits (of pharmaceutical products)," the authors said.Merck voluntarily withdrew Vioxx from sale in September 2004 after a company internal study in 2001 showed the drug doubled the risks of heart attack in patients who took it for 18 months or longer.The company has since faced a slew of lawsuits and was forced to pay billions of dollars in damages.

GSK pulls swine flu vaccine in Canada

Courtesy of AP

Pharmaceuticals company GlaxoSmithKline PLC said Tuesday it has advised medical staff in Canada to not use one batch of swine flu vaccines in case they trigger life-threatening allergies. Company spokeswoman Gwenan White said that they issued the advice after reports that one batch of the swine flu vaccine might have caused more allergic reactions than normal. "We have advised health care professionals not to use that batch while health authorities and GlaxoSmithKline investigate," she said. White said the batch at issue, which has been distributed across Canada, contains 172,000 doses of the vaccine. She declined to say how many doses had been administered before the advice to stop using them was given. White said U.K.-based GlaxoSmithKline wrote to Canadian health care professionals advising them to stop using the batch on Nov. 18. She says a total of 7.5 million doses of the vaccine have been distributed in Canada.

Dietary items found for healthy colon

Eating fruits and vegetables, and drinking tea and red wine may offer overweight men and normal weight women some protection from colon and rectal cancers. Plant-based foods contain flavonoids, compounds thought to interfere with cancer-causing processes, the study team notes in the International Journal of Cancer.

120,852 men and women, 55 to 69 years old, filled out dietary surveys as part of a large designed to assess ties between diet and cancer. Over about 13 years, 1,444 men and 1,041 women developed colon or rectal cancer. Compared with the least intake, the greatest intake of catechins -- common in berries, grapes, black chocolate, tea, red wine, and some beans -- seemed to be associated with lower colorectal cancer risk among both overweight men and normal weight women. The researchers observed a similar trend for flavonols -- found in onions, kale, apples, pears, tea, wine, and fruit juices -- in normal weight women.

FDA investigating Meridia

U.S. regulators are reviewing preliminary data suggesting patients taking Abbott Laboratories Inc.'s weight loss drug Meridia may have a higher risk of cardiovascular problems, the Food and Drug Administration said on Friday. The FDA said early findings from a recent study suggested patients taking Meridia, also known as sibutramine, may have a higher number of cardiovascular-related problems, including heart attacks, strokes, cardiac arrests and deaths, when compared to patients who took a placebo. Meridia is an appetite suppressant approved to treat obese adults. It can cause side effects ranging from headaches and constipation to higher blood pressure and a faster heart rate.

Funeral Industry Workers Exposed to Formaldehyde Face Higher Risk of Leukemia

Long durations of exposure to formaldehyde used for embalming in the funeral industry were associated with an increased risk of death from myeloid leukemia, according to the Journal of the National Cancer Institute. Previous studies have shown excess mortality from lymphohematopoietic malignancies and brain cancer in anatomists, pathologists, and funeral industry workers, all of whom may have worked with formaldehyde.

In a case-control study among funeral industry workers who had died between 1960 and 1986, researchers compared those who died from lymphohematopoietic malignancies and brain tumors with those who died from other causes. Lifetime work practices and exposures to formaldehyde were obtained by interviews with next of kin and coworkers. This study was the first epidemiological investigation, to the authors' knowledge, to relate cancer risk to duration of employment, work practices, and estimated formaldehyde exposure levels in the funeral industry. The number of years of embalming practice and related formaldehyde exposures were associated with statistically significantly increased mortality from myeloid leukaemia, with the greatest risk among those who practiced embalming for more than 20 years.

"Further studies of leukemia risk in relation to specific embalming practices and exposures, as well as similar specific exposure studies in other professional groups that are exposed to formaldehyde and that have an increased risk of leukaemia, should help to clarify our understanding of cancer risks related to formaldehyde."

Bonnie - now that they have shown negative effects in funeral workers and Katrina victims, can anyone tell us how constant exposure to formaldehyde through injected vaccinations can affect our health? Unfortunately not. There is no data.

Low marks for US on premature births

Courtesy of NY Times

More than half a million babies — one out of eight — are born prematurely each year in the United States, prompting the March of Dimes to give the nation a D on its premature births report card. The report card did not give an A to a single state. Vermont, which has a preterm birth rate of 9 percent, got a B, while 17 states got F’s, including Mississippi, with a preterm birth rate of 18.3 percent. The prematurity rate in Puerto Rico, at 19.4 percent, was the highest in the country.

Several states did receive stars for taking steps to reduce smoking among women of childbearing age or providing health insurance coverage for pregnant women, which may help reduce preterm birth rates, the report card noted. Multiple births and elective Caesarean sections also push up preterm birth rates. The March of Dimes has been encouraging pregnant women to refuse to be induced for delivery before 39 weeks unless there is a medical reason.

B-6 for morning sickness

Vitamin B-6 (Pyridoxine or the activated form of B-6, Pyridoxyl-5-Phosphate) is considered a first-line treatment for nausea and vomiting (morning sickness) in pregnancy by the American College of Obstetrics and Gynecology. Vitamin B6, 12.5 - 25 mg three or four times daily is safe and often effective for mild nausea.

Folic acid raises cancer risk?

Bonnie and Steve - A new study published in the November 18, 2009, issue of the Journal of the American Medical Association (JAMA) raised concerns that high folic acid supplementation may increase the risk of developing cancer.

The latest JAMA study was based on two randomized, double-blind, placebo-controlled clinical trials during which almost 7,000 patients with ischemic heart disease were given vitamin B12, vitamin B6, or placebo between 1998 and 2005. The trials took place in Norway, a country that does not fortify its products with folic acid. Basing the trials in Norway was significant because it allowed researchers to better gauge the impacts of folic acid supplementation. In the study, folic acid and B12 supplementation was associated with a 21% increased risk for cancer, a 38% increased risk for dying from the disease, and an 18% increase in deaths from all causes.

The majority of the participants were former smokers, and many of the cancer deaths in the study were related to lung cancer. The real headline of this study should be that smoking increases the risk of lung cancer—the study found that a total of 94 percent of the subjects who developed lung cancer were either current or former smokers.

Epidemiological studies have demonstrated no associations between intakes of folate or folic acid and lung cancer risk. It is also important to note that the general rate for cancer has gone down in the United States, where folic acid fortification has been mandatory since 1998. If high doses of folic acid have a paradoxical effect on lung cancer, then we likely would not have seen these drastic reductions in lung cancer incidence over the past two decades.

Reference our October post Understanding the Essential Folate for anyone who doubts the effectiveness of folic acid. As we have said so many times over the years, you cannot judge a nutrient by testing it on smokers and patients with heart disease.

USDA backs rewarding schools serving healthy food

Schools that serve more fruits, vegetables and whole grains to pupils should see higher federal support rates than those serving less-healthier meals loaded with high fats and sugar, Agriculture Secretary Tom Vilsack said on Tuesday.

Child nutrition programs, which include school lunch and breakfast, are due for an overhaul but Congress is not expected to act before 2010. The government has targeted improving the nutritional quality and access to school meals amid rising child obesity rates. Vilscak did not suggest how large the bonus should be.

Schools get $2.88 in cash and Agriculture Department-provided food for each lunch meal served for free to poor children this school year. School meal programs provide an estimated 40 million meals daily and more than half the student's food intake during the school day. Students can receive free or subsidized meals if their family's income is low enough. Some $16.9 billion was allotted for child nutrition in the fiscal year that opened on October 1, up $1.9 million from fiscal 2008.

Senate Agriculture Committee Chairwoman Blanche Lincoln told Vilsack she was willing to pay more to serve healthier foods. "I'm certainly sympathetic to the concept of higher reimbursement rates. Common sense does tell us that as we improve that quality it also increases the cost," she said.

Steve - as sad is it is to say, this may be the one incentive that will work. However, nothing positive will happen unless the USDA greatly improves the quality of its own food that it provides as part of the school lunch program. However, if enough requests come from schools to spur demand, the USDA must react, and thus, will allocate more money to provide more fruits and vegetables as staple foodstuffs.

Two Important Weight Control Studies

According to one study in the Journal of the American Dietetic Association, most weight-control strategies emphasize energy-restricted diets and increased physical activity. Most are not effective over the long-term. Researchers found that a shift from a "weight-centered" approach to a more "health-centered" approach, or Health at Every Size (HAES), does not focus on weight-loss exclusively. Instead, it focuses on a healthy lifestyle with an emphasis on size acceptance and balanced eating. The subjects who followed the HAES model had lower feelings and perceptions of hunger with food intake when compared to the control (dieting) group.

Another study from Nutrition and Metabolism stated that exercise alone appeared to have minimal impact on measured outcomes in obese women. However, when combined with a diet rich in lean protein, greater improvements in waist circumference and body composition were seen. The protocol also stimulated improvements in markers of cardiovascular disease risk, energy expenditure, and psychosocial parameters.

Bonnie - let me get this straight. Instead of focusing on weight-loss fad diets, one should look to healthful, balanced lifestyle and dietary choices while embracing your body size, thus allowing the weight, however much you lose, to come off naturally? On top of that, combine exercise and a diet rich in lean protein encourages greater improvements in body composition as opposed to exercise alone?

Gosh, where have I heard this before?

Meditation lowers heart risk by 50 percent in study

Patients with coronary heart disease who practiced the stress-reducing Transcendental Meditation® technique had nearly 50 percent lower rates of heart attack, stroke, and death compared to nonmeditating controls, according to the results of a first-ever study presented during the annual meeting of the American Heart Association.

The nine-year, randomized control trial followed 201 African American men and women, average age 59 years, with narrowing of arteries in their hearts who were randomly assigned to either practice the stress-reducing Transcendental Meditation technique or to participate in a control group which received health education classes in traditional risk factors, including dietary modification and exercise.

All participants continued standard medications and other usual medical care.

The study found:

• A 47 percent reduction in the combination of death, heart attacks, and strokes in the participants
• Clinically significant (5 mm Hg average) reduction in blood pressure associated with decrease in clinical events
• Significant reductions in psychological stress in the high-stress subgroup

The trial was sponsored by a $3.8 million grant from the National Institutes of Health-National Heart, Lung, and Blood Institute, and was conducted at The Medical College of Wisconsin in Milwaukee in collaboration with the Institute for Natural Medicine and Prevention at Maharishi University of Management in Fairfield, Iowa.

According to Robert Schneider, M.D., FACC, lead author and director of the Center for Natural Medicine and Prevention, "Previous research on Transcendental Meditation has shown reductions in blood pressure, psychological stress, and other risk factors for heart disease, irrespective of ethnicity. But this is the first controlled clinical trial to show that long-term practice of this particular stress reduction program reduces the incidence of clinical cardiovascular events, that is heart attacks, strokes and mortality."

"This study is an example of the contribution of a lifestyle intervention -- stress management -- to the prevention of cardiovascular disease in high-risk patients," said Theodore Kotchen, M.D., co-author of the study, professor of medicine, and associate dean for clinical research at the Medical College.

Steve - as we have alluded to in the past, meditation can be a powerful stress reducer.

Probiotics intake beneficial against infections in kids

Lactobacillus Acidophilus can decrease the risk of upper respiratory tract infections including rhinitis, pharyngitis, sinusitis, otitis, and the common cold in children attending day care centers. The findings, which were published in the Journal of Clinical Nutrition, also found that the rate of absence from childcare centers due to infections was lower in children receiving the probiotic in comparison to those who were not.

The randomized, double-blind, placebo-controlled trial in 281 children attended day care centers in Zagreb, Croatia. The authors found that, compared to the placebo group, children in the probiotic group (probiotic powder put into milk) had a significantly reduced risk of upper respiratory tract, a reduced risk of respiratory tract infections lasting longer than three days, and a significantly lower number of days with respiratory symptoms. However, they noted that there was no risk reduction in regard to lower respiratory tract infections as a result of the consumption of the probiotic. And they found that children in the probiotic group had no significant reduction in the risk of gastrointestinal infections, vomiting episodes, and diarrheal episodes and no reduction in the number of days with gastrointestinal symptoms compared to the placebo cohort.

Bonnie - I would venture to say that these results were not as impressive as the Pediatrics study because the product was put in a milk. I would have liked to have seen them have some of the subjects take the probiotics alone.

Is Swine Flu more deadly than seasonal flu?

Question:

CDC estimates the number of deaths caused by the swine flu since April is 4,000. Six months into a regular flu season, there are already 18,000 deaths. If what the CDC says is true. Why such hysteria?

Answer:

Please comment below. We'd like to hear your answer.

P.S. Why has there not been a public outcry about deaths related bacteria transmitted by ticks so far this year? To date, two kinds of tick-related bacteria have killed 1,230 Americans.

Which age group is at greatest death risk from H1N1?

The answer may surprise you. According to a November 12th study from the Lancet, which focused on Mexico, where the outbreak originally began, the greatest mortality risk were in those:

Aged 70 and older: 10.3%
60 to 69 year-olds: 5.7%
50 to 59 year-olds: 4.5%
40 to 49 year-olds: 2.7%
30 to 39 year-olds: 2%
20 to 29 year-olds: 0.9%
10 to 19 year-olds: 0.2%
1 to 9 year-olds: 0.3%
1 year or younger: 1.6%

While the group most likely to be infected with H1N1 are those aged 10 to 39, this data certainly shows that young persons are not dying at a higher rate than older persons like some media reports lead you to believe.

Monsanto asks for approval of trans-fat free soy

Monsanto has submitted evidence to the FDA and USDA backing the safety of its Vistive III soybean traits, intended to provide heat stable, trans-fat free cooking oils. Food manufacturers have been under increasing pressure to eliminate trans fats from foods, after evidence mounted to show they raise levels of LDL (so-called ‘bad’) cholesterol, while lowering levels of HDL (‘good’) cholesterol, thereby clogging arteries and causing heart disease.

The latest soybean traits from Monsanto have also been billed by the company as a way to “significantly lower” levels of saturated fats. Monsanto already has low-linolenic soybean oils on the market under its Vistive brand – KFC and Kellogg’s have both used Vistive to slash trans fats from their products – but the company claims that its new generation traits confer “significantly extended fry life” and are more stable at high temperatures than either existing Vistive oils or conventional soybean oils.

Bonnie - pardon me if I am a bit skeptical of this new concoction. We hope to see the patent to see how it is chemically altered.

Plastic ingredient "feminizes" boys

Males exposed to high doses of phthalates in the womb went on to be less likely to play with boys' toys like cars or to join in rough and tumble games. This latest work adds to concerns about the safety of phthalates, found in vinyl flooring and PVC shower curtains. The findings are reported in the International Journal of Andrology.

Phthalates have the ability to disrupt hormones, and have been banned in toys in the EU (not in the US) for some years. However, they are still widely used in many different household items, including plastic furniture and packaging. There are many different types and some mimic the female hormone estrogen. This feminizing capacity of phthalates makes them true 'gender benders'

The same researchers have already shown that this can mean boys are born with genital abnormalities. Now they say certain phthalates also impact on the developing brain, by knocking out the action of the male hormone testosterone.

Bonnie - we have been reporting on this category of chemicals for a long time now. The fact that researchers earmarked the changes in the womb show once again the epigenetic effect from environment and lifestyle choices.

Drug makers raising prices at fastest rate ever

Courtesy of NY Times

Even as drug makers promise to support Washington’s health care overhaul by shaving $8 billion a year off the nation’s drug costs after the legislation takes effect, the industry has been raising its prices at the fastest rate in years. In the last year, the industry has raised the wholesale prices of brand-name prescription drugs by about 9 percent, according to industry analysts. That will add more than $10 billion to the nation’s drug bill, which is on track to exceed $300 billion this year. By at least one analysis, it is the highest annual rate of inflation for drug prices since 1992.

The drug trend is distinctly at odds with the direction of the Consumer Price Index, which has fallen by 1.3 percent in the last year. Drug makers say they have valid business reasons for the price increases. Critics say the industry is trying to establish a higher price base before Congress passes legislation that tries to curb drug spending in coming years.

This year’s price increases would effectively cancel out the savings from at least the first year of the Senate Finance agreement. And some critics say the surge in drug prices could change the dynamics of the entire 10-year deal. “It makes it much easier for the drug companies to pony up the $80 billion because they’ll be making more money,” said Steven D. Findlay, senior health care analyst with the advocacy group Consumers Union.

Steve - this is what happens when you have "financialized medicine." Drug companies are tied to Wall Street and their stocks take a beating if they cannot continually increase prices. This is their only recourse because Big Pharma is inordinately bloated, yet refuses to find ways to be more efficient (aside from mergers and layoffs). So the only industries in the United States who are raising their prices in a recession are the drug makers and health insurance providers. How can we not consider this criminal when you are dealing with products that many people's lives depend on?

Niaspan licks Zetia, Vytoirn

As we reported back in August, a NEJM study confirmed that Niaspan (high-dose prescription B-Vitamin, Niacin) significantly outperformed Zetia and Vytorin in shrinking buildup in artery walls and raisin HDL, the good cholesterol. According to Preventive Chief of Cardiology Chief at Johns Hopkins University, "Zetia has been on the market for seven years and we still have not proven that it improves clinical outcomes. These new results will be very influential in getting more doctors to turn to Niaspan."

Bonnie - so typical. Approve the drug first and then see if it works. If it doesn't, it either goes away slowly or is pulled from the market when it causes adverse outcomes. Niaspsan has been effective for decades, but it is not a moneymaker for the drug companies.

Multivitamins reduce food allergy risk: study

Daily supplements of multivitamins do not have any effect on allergic disease in eight year old children, says a new study from Sweden. Writing in the American Journal of Clinical Nutrition, scientists from the world famous Karolinska Institute report that multivitamin supplements had no effect on the incidence of asthma, allergic rhinitis, eczema, or atopic sensitization in 2,423 eight-year olds. However, when the scientists limited their analysis to children who started supplementation before the age of four, a 39 per cent decrease in the risk of sensitization to food allergens. “Our results show no association between current use of multivitamins and risk of allergic disease but suggest that supplementation with multivitamins during the first years of life may reduce the risk of allergic disease at school age,” they concluded.

Options when antibiotics are ineffective

Faced with a growing prevalence of antibiotic-resistant bacteria, hospitals in the United Kingdom are adopting traditional medicinal techniques to fight infection, such as maggots and honey.

Methicillin-resistant staphylococcus aureus (MRSA) and other drug-resistant infections kill or hasten the death of 8,000 British patients per year, while MRSA now kills more people in the United States annually than AIDS.

At the Royal United Hospital in Bath, England, many wounds are now being disinfected with Manuka honey rather than pharmaceutical antibiotics.

"Honey has been used in healing for centuries, but now new products have overcome the problems associated with using conventional honey and bring it into a modern healthcare setting," said the hospital's Kate Purser.

Honey is one of the oldest forms of medicine known, and was employed both as food and antibiotic by the ancient Egyptians and, more recently, by German doctors during World War I. Its high sugar content means that the water in honey is almost chemically inert, making it unavailable for the growth of bacteria, fungi or viruses. A naturally occurring enzyme known as glucose oxidase also makes honey acidic enough to create a hostile environment for most bacteria.

The honey used by Royal United Hospital is not the same as the honey found on supermarket shelves, however. The honey is a variety known as Manuka honey, which is produced from the manuka plant, native to New Zealand. This honey is then irradiated to kill any trace bacterial spores.

According to Manuka honey products company Honeymark, the honey has proven effective at killing MRSA in scientific trials. While honey already contains a variety of chemicals that can be beneficial to the body -- such as the antioxidant pinocembrin, which only occurs in honey -- Honeymark claims that Manuka honey contains even more of these beneficial compounds, which are derived from the manuka flower.

"These medicinal compounds, in most cases, outperform many pharmaceuticals and traditional forms of medicine," the company said in a press release.

Honeymark claims that Manuka honey can be use both topically and internally to treat conditions caused by bacteria, viruses or fungi, including infected wounds, acne, eczema, stomach ulcers or other gastrointestinal conditions, ringworm and upper respiratory infections. No side effects have been reported, and in contrast to pharmaceutical antibiotics, bacteria appear unable to develop resistance to Manuka honey.

Manuka has a further benefit over pharmaceuticals, according to Honeymark.

"Antibiotics are indiscriminate killers. When taken orally, antibiotics kill all bacteria, both good and bad," the company said. "For reasons that are currently unknown, Manuka Honey does not effect good bacteria in the body and only destroys harmful, infectious bacteria. This is something that pharmaceuticals have not been able to accomplish."

Dorothy Yeo of Bath said that honey dressings led to drastic improvement in her ulcer. "I felt I wasn't getting anywhere and the pain made it hard to sleep," she said. "But now I'm able to sleep without tablets, and new skin is forming over my ulcer. I'm very pleased and I'd recommend it to anyone."

While honey can kill the bacteria that cause infection, sometimes other measures are required to remove the dead tissue left by infection or injury. At Royal United Hospital, one such technique is the application of sterilized greenbottle fly larvae, more commonly known as maggots.

Statin's long-term effects continue after stopping the drug

Cholesterol-lowering statin drugs may cause serious and long-term muscle damage that persists even after the drugs are halted, according to a new study published in the Canadian Medical Association Journal.

Researchers have known for some time that minor muscle aches and weakness, known as myalgia, occur in between 10 and 15 percent of patients taking statins, while more severe, persistent pain known as myopathy occurs in roughly 2 percent. In the current study, researchers performed muscle biopsies on 83 patients, 44 of whom were taking statins and also suffering from myopathy severe enough to interfere with exercise and daily activities. Twenty-nine of these patients were currently taking statins, while the other 15 had ceased using the drugs at least three weeks before.

Another 19 participants were taking statins but not suffering from myopathy, while the final 20 had never experienced myopathy and never taken statins.

Researchers found signs of muscle damage in 25 of the myopathy patients, including the majority of those who had already stopped taking statins.

"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," said senior author Annette Draeger.

The researchers also found that only one of the patients with muscle damage had elevated levels of the enzyme creatine phosphokinase (CPK), widely believed to be a marker of muscle distress.

"This paper is challenging the dogma that if the CPK level is low, it rules out the possibility of muscle damage," co-author Richard Karas said. "You can have microscopic muscle damage and the level of CPK can still be normal."

Reflux meds under fire

Consequences are emerging in patients who are prescribed proton pump inhibitors (PPIs) for reflux diseases. Physicians are warned to monitor these effects and prescribe these medications carefully, according to a new commentary published in the November 2009 issue of Otolaryngology -- Head and Neck Surgery.

There is a growing body of literature demonstrating that acid is not the only causal agent of tissue damage in reflux disease, and that PPIs are not effective at treating all cases of GERD and LPR.

In addition to the evidence that acid isn't the only contributing agent in reflux disease, the authors' search of recent research on PPIs pointed out that there are many unexpected consequences and side effects from this class of drugs. They can include: increased rates of hip fractures, possibly related to altered calcium absorption; altered vitamin B12 and iron absorption, related to alteration of the gastric pH; increased odds of acquiring nosocomial Clostridium difficile-associated diarrhea; and increased odds of contracting community-acquired pneumonia; and may predispose otherwise healthy individuals to clinically significant small intestinal bacterial overgrowth.

The authors further advise physicians treating reflux disease patients to weigh the risks of treatment versus the risks of not treating the disease, and to consider a goal of a more holistic approach that includes diet and lifestyle modification. These additional steps could prove beneficial in lowering healthcare costs associated with reflux diseases, and encourage patients to continue practicing behaviors that would improve their overall health.

Bonnie - music to my ears!

Silk products no longer from organic soybeans

Until early 2009, Silk brand soy milk was made using organic soybeans. But earlier this year, Dean Foods (owner of the Silk brand) quietly switched to conventional soybeans, which are often grown with pesticides. But they kept the same UPC barcodes on their products, and they kept the product label virtually the same, only replacing the word "organic" with "natural" in a way that was barely noticeable. They also kept the price the same, charging consumers "organic" prices for a product that was now suddenly made with conventionally-grown soybeans.

Many consumers continue to think that the term "natural" is basically the same as "organic," when in fact they are almost opposites. The term "natural" is entirely unregulated, and almost anything can be claimed to be "natural" even when it's sprayed with pesticides or treated with other chemicals.

Bonnie - unfortunately, these type of deceptive practices are more apt to occur when run by huge food conglomerates like Dean Foods. What audacity to think that nobody would notice. I stopped recommending Silk a long time ago because is has too much sugar.

Expert says H1N1 possibly less deadly than seasonal flu

The H1N1 (swine flu) pandemic appears to be leveling off and so far is no more deadly than seasonal flu and perhaps less so, according to Dr. James Wilde, director of the pediatric emergency department at the Medical College of Georgia. "It's too early to tell, but it may be that we've reached the peak of this pandemic and we're on our way down right now," said Wilde, who is board-certified in emergency pediatric medicine and infectious disease. He cautioned that physicians and the general public should not drop their guard yet.

As for the vaccine delays and disorder this fall, Wilde said blame likely lies with the federal government and manufacturers. Wilde said the federal government's insistence on giving thiomersal-free vaccines to certain risk groups over the years has created suspicion and misinformation on a preservative that is safe and needed for getting mass quantities of vaccines to the public. Meanwhile, he thinks manufacturers have failed to deliver vaccines, as previously promised, because of worries about losing money. "My own suspicion is the vaccine manufacturers don't want to be left with 200 million doses of vaccine," Wilde said, noting that manufacturers have had to absorb the cost of leftover vaccine in the past when viruses fizzled out.

Courtesy of The Post and Courier

Analyzing genes no predictor for disease

Genetic analysis is essentially useless in predicting a person's risk of cancer, heart attack or other common diseases, according to a set of commentaries published in the New England Journal of Medicine.

The decoding of the human genome in 2003 led to a flood of research into the contributions that genetic variation might make to the risk of various chronic diseases that tend to develop late in life, such as diabetes, heart disease or cancer. Since then, a number of for-profit companies have begun offering genetic screenings and disease risk assessments.

"With only a few exceptions, what the genomics companies are doing right now is recreational genomics," said David B. Goldstein of Duke University, author of one of the commentaries. "The information has little or in many cases no clinical relevance."

While genomewide analysis has successfully identified some differences between the genetic codes of healthy and diseased patients, these differences provide little information about disease risk. Researchers expected to find a small number of common genetic variations that were responsible for each disease. Instead, common gene variants appear to contribute to disease risk only very marginally.

Based on the failure of more than 100 genomewide studies -- carried out on thousands of patients in a number of different countries -- to deliver useful results, Goldstein suggests that the approach should be abandoned as a waste of resources. Genomewide analysis is only effective at uncovering common variations with large effects, Goldstein says. Discovering rare variants with smaller effects is "beyond the grasp of the genomewide association studies."

Steve - I love how they dismiss genetic analysis as ineffective but not offer an alternative. What they should have added in their opinion is the fact that Epigenetics, how lifestyle choices affect our genes, is where the all the research is at. As we predicted, this is where the future of gene control lies.

Fight the flu with vitamin D supplements

by Patrick Massey, MD
Daily Herald

One of the most frequent concerns of my patients is what to do about the flu, both seasonal and H1N1. Although the vaccines may be effective in preventing or lessening flu infections, medical science is showing that nature has provided us with some significant firepower of our own. H1N1 aside, the most active time for the flu is in the late fall, winter and early spring. Researchers have wondered what happens to the flu for the rest of the year. The answer may be related to sun exposure and vitamin D - less in the winter and more in the summer.

Vitamin D is not a vitamin but a hormone. Starting in the skin, the body is able to manufacture it from the combination of cholesterol and sunshine. Research is demonstrating that vitamin D is needed for good immune function. During the winter, sunshine fades, vitamin D levels fall and the flu really kicks in. During the summer, with lots of sun, vitamin D levels increase and the flu seems to disappear. Is there a connection?

The answer seems to be yes. A 2007 study, published in the medical journal Epidemiology and Infection, established that people who did not take vitamin D had 10 times greater risk of flu during the winter than in the summer. Interestingly, the incidence of winter flu was not different from summer flu for those who took vitamin D year round. In addition, those who did not take vitamin D had a nine times greater risk of winter flu than those who took vitamin D. It seems that vitamin D may be a good way to prevent winter flu. How can vitamin D reduce the incidence of flu?

The answer may be that vitamin D activates immune system-based proteins that kill the flu virus. These are called antimicrobial peptides, or AMD. These proteins kill a wide range of pathogens including bacteria, some viruses, fungi and even some types of cancer cells. In the winter, low vitamin D levels may result in meager AMD production - and an increased risk of contracting the flu. In contrast, the summer sun results in more robust vitamin D levels, encourages AMD production and may prevent the flu.

From my clinical perspective, though it's not definitive proof, patients with high vitamin D levels seem to have fewer infections than those with lower vitamin D levels. The optimal level of vitamin D has not been determined. However, current adult recommendations from the Institute of Medicine (400-800 IU per day) are probably too low for most people living in northern Illinois. In the winter, the sun is not intense enough for the body to generate any vitamin D and many people need at least 5,000 to 6,000 IU of vitamin D per day. Usual dietary sources are inadequate and supplementation is the only reasonable option. Vitamin D is generally safe and toxicity is vanishingly rare. It is important to check blood levels because it is the only way to know if you are taking enough vitamin D.

• Patrick B. Massey, M.D., Ph.D is medical director for complementary and alternative medicine for the Alexian Brothers Hospital Network.

Bonnie - it is nice to see a doctor suggesting vitamin D supplementation. However, I would never recommend the dosages he alludes to without testing vitamin D levels first.

Complementary and Alternative Medicine Therapies for Cold and Flu Season: What Is the Science?

Bonnie - this review appeared in Medscape, the most comprehensive physician website for releasing and reviewing clinical data. This should give you some ammunition when somebody tells you there is no proof that natural cold and flu remedies are effective and safe.

This was a very long commentary, so we could not provide every word. You can read the entire piece at http://www.medscape.com/viewarticle/711485_2. We highlighted specific points of interest in bold for quick perusing.

Medscape Family Medicine
Kathi J. Kemper, MD, MPH
November 2, 2009

Commentary

Influenza-like illnesses (ILI) and upper respiratory tract infections (URTI) typically peak in prevalence in the late fall through early spring. Home remedies and natural products have long been used to prevent and treat common viral illnesses. How should clinicians advise patients about the effectiveness and safety of these remedies when used to enhance immune function to prevent or treat virally mediated ILI or URTI?

Home Remedies

Home remedies range from diet (chicken soup or garlic) and dressing (warm head and feet) to poultices and vaporizers. Culturally, some families avoid cold foods (including dairy) and encourage spicy foods (such as garlic and ginger). Hot tea with honey and lemon is another popular remedy during winter months. Some mothers rub salves containing menthol, thyme, or eucalyptus on the sick family member's chest, and others make mustard poultices or enforce wearing hats, scarves, or warm socks. Hot steam or cool mist vaporizers are commonly used to increase household humidity and soothe dry respiratory passages; neti pots (small vessels with long narrow spouts) and saline rinses are used to wash viruses, allergens, and mucus out of the nose. Whether home remedies are effective prophylactic or therapeutic agents, or just make patients feel better to use them, these practices are generally safe and support cultural identity and self-efficacy, and their use can be tolerated by healthcare providers.

Sleep and Fluids

"Drink plenty of fluids" is well-worn advice that may have a basis in its common sense consequences. Dehydration can dry the respiratory mucosal surfaces; however, there is little evidence that drowning in extra fluids improves resistance to viral infections. On the other hand, the frequent trips to the restroom necessitated by larger than usual intake of fluids may promote additional hand washing, thereby reducing the spread of infections.

"Get plenty of sleep" is another adage voiced by grandmothers as well as clinicians, with the intent of supporting immune function. Sleep deprivation is associated with disruptions of immune function. In laboratory studies, depriving healthy adults of sleep induces a significant increase in both pro-inflammatory and anti-inflammatory markers (ie, E-selectin, intracellular adhesion molecule-1, interleukin [IL]-1beta, and IL-1 receptor antagonist) and a significant decrease in C-reactive protein and IL-6. Sleep deprivation can also impair the immune response to influenza vaccine. In a study of adult volunteers, influenza immunizations were administered to one group after 4 nights of partial sleep deprivation (sleep restricted to 4 hours per night) and to a second group after 4 full nights (7.5-8.5 hours per night) of sleep. Ten days after vaccination, mean antibody titers in the sleep-deprived volunteers were less than half of those in the volunteers who had normal sleep durations. Because individuals with poorer responses to vaccines also experience higher rates of illness, these findings support the concept that adequate amounts of sleep are important for optimal immunity during respiratory illness seasons. There are no data to suggest that excessive sleep (more than 10-12 hours per night for adolescents and adults) further improves immune function, but it appears prudent to avoid sleep deficits.

Natural Health Products

A growing number of randomized controlled trials have evaluated the effectiveness of natural health products. What is the scientific evidence for the effectiveness and safety of vitamin and mineral supplements, herbal products, or probiotics and homeopathic remedies in preventing or treating ILI and URTI?

Vitamins and Minerals

Vitamin C. Vitamin C (ascorbic acid) is the vitamin most often associated with warding off viral respiratory infections. A Cochrane systematic review of 30 randomized trials involving more than 11,000 adults concluded that prophylactic vitamin C supplementation (200 mg or more daily) is not effective in reducing the incidence of URTI in most adults (odds ratio 0.96; CI 0.92-1.0). On the other hand, a subgroup analysis of 642 very healthy adults engaged in highly physically stressful activities (marathon runners, skiers, and soldiers on subarctic exercises) showed a 50% decrease in the risk of developing a cold among those who took vitamin C supplements.[5] In the 30 studies that examined the impact of prophylactic vitamin C supplementation on the duration of URTI symptoms, vitamin C conferred a consistent benefit on reduction of cold duration (8% in adults and 14% in children). Of the 7 studies that assessed the impact of therapeutic vitamin C supplementation (taking vitamin C after symptoms had begun), there was no overall benefit on the severity or duration of URTI symptoms.

Vitamin C has mild in vitro antiviral activity against influenza virus,[6,7] and vitamin C deficiency impairs effective immune response to influenza viral infections in male mice.[8] However, clinical studies supporting the use of supplemental vitamin C to prevent or treat seasonal or atypical influenza are lacking. Side effects of vitamin C (in daily doses exceeding 3 to 6 g) include diarrhea and upset stomach; otherwise, the side effect profile of vitamin C is similar to that of placebo. Vitamin C appears to be most useful as a prophylactic agent to reduce the duration of URTI symptoms in children and in healthy adults undergoing physical stress. It does not appear to be useful once symptoms have started, and there is insufficient evidence to recommend its use for prophylaxis or treatment of ILI.

Vitamin D. Despite widespread fortification of food with vitamin D and the use of multivitamins, suboptimal vitamin D levels are increasingly reported in adults and pediatric populations in North America, particularly among those who are overweight and those with darker skin pigmentation. For example, according to the National Health and Nutrition Examination Survey (NHANES), the prevalence of optimal vitamin D levels (30 ng/mL or higher) in non-Hispanic blacks fell from 12% in 1988-1994 to 3% in 2001-2004. In addition to its well known effects on bone health, vitamin D is an important immune regulator, stimulating innate immunity and moderating inflammation.

A secondary analysis of NHANES data from 1988-1994 showed an inverse relationship between vitamin D levels and incidence of URTI. These results have been supported by other studies that show an increased risk for severe acute lower respiratory illness in people with low vitamin D levels. Historically, the association between rickets and risk for severe respiratory infection is well known, and vitamin D deficiency is associated with an increased risk for influenza.

Controlled trials of vitamin D supplementation, however, have had mixed results. In a randomized controlled trial of healthy adults with normal vitamin D levels, supplementation with 2000 IU of vitamin D daily had no significant impact on URTI incidence, duration, or severity. In a controlled trial of vitamin D supplementation to decrease bone loss in black women, a secondary finding was a significant reduction in the incidence of URTI and ILI respiratory illnesses among the women receiving vitamin D supplementation, particularly during the winter months. In controlled trials, serious side effects from vitamin D supplements have been rare.

Given the historical and epidemiologic data, randomized controlled trials of vitamin D supplementation to prevent and treat URTI and influenza are urgently needed, and while results of such studies are pending, it is prudent to avoid vitamin D insufficiency.

Zinc. The essential mineral, zinc, plays an important role in immune function. Zinc is a structural component of many enzymes and serves as an intracellular signal between immune cells. The activity of virtually all immune cells is modulated by zinc, and zinc deficiency leads to dysfunction of both humoral and cell-mediated immunity and increases susceptibility to infection.

Zinc deficiency is associated with an increased incidence and severity of pneumonia. In developing countries, zinc supplementation has been shown to decrease the incidence of childhood pneumonia. A meta-analysis of studies reported that zinc supplementation reduced the incidence of acute lower respiratory tract infections in children by approximately 15%. The effectiveness of zinc supplements in preventing or treating influenza-like illnesses requires additional research in better nourished populations.

Studies of the effectiveness of zinc supplements in preventing or treating URTIs have had mixed results. In a 2009 study of healthy Air Force cadets, zinc supplementation (15 mg daily for 7 months) was not associated with a decrease in the incidence of upper respiratory illnesses. Open-label studies of a zinc gluconate glycine lozenge suggested a 25% reduction in the duration of cold symptoms in children who received the lozenge. In a meta-analysis of 8 randomized, placebo-controlled trials of zinc supplementation in the treatment of recent-onset colds, 4 trials showed significant improvements, and the other 4 trials showed no improvement.

The benefits of zinc supplementation were most apparent among those who began taking zinc shortly after symptoms began, and who used products that did not contain citric or tartaric acid. A larger analysis of 14 controlled trials of zinc supplementation that were published from 1996 to 2006 suggested that zinc was not more effective than placebo as a remedy for colds. A more recent randomized controlled trial in Turkish children who started zinc supplementation shortly after cold symptoms developed showed a significant decrease in symptom severity but not in symptom duration. In another recent trial, adults were randomly assigned to zinc lozenges (13.3 mg of zinc acetate every 2-3 hours while awake) or placebo. The zinc group showed significant improvements in symptom severity and duration without significant adverse effects.

Zinc gluconate glycine lozenges are generally safe and well tolerated, but they can cause a metallic taste, nausea, and upset stomach. Because of the risk of choking, lozenges should not be given to young children. Nasal swabs and nasal sprays that contain zinc have led to anosmia (loss of sense of smell); these products should be avoided until further studies demonstrate safety.

Homeopathic zinc products are extremely dilute preparations that are generally very safe; they are not the same as non-homeopathic (allopathic) zinc lozenges or nasal swabs. There are no published clinical trials evaluating the effectiveness of homeopathic zinc as a remedy for URTI or ILI.

Overall, in spite of inconsistent evidence, it seems prudent to avoid zinc deficiency, although zinc supplementation in healthy, well nourished populations does not appear to reduce the risk for upper respiratory infections. Data on the effectiveness of lozenges in reducing the duration and severity of established URTIs have been mixed. Although lozenges appear to be safe, zinc nasal gels and swabs have side effects. Homeopathic zinc preparations are also safe, but clinical trial evidence of a benefit in preventing or treating URTI or ILI is lacking.

Herbal Products

In traditional practice, herbs are used to treat symptoms or for short term systemic support (up to 8 weeks) during cold and flu season. Herbs such as echinacea are generally not taken for longer than 6-8 weeks. Ginseng may be used for longer periods by elderly or debilitated patients. Other natural products, such as garlic, elderberry juice or jam, and honey, are considered foods and may be taken daily for long periods of time as part of a normal diet.

Andrographis. Andrographis paniculata is a bitter herb used in ayurvedic medicine (traditional medicine from India). Although not as well known in the United States as other herbs, andrographis has support from several clinical trials as a therapy for URTI. A review of 7 trials involving nearly 900 patients, including children, suggests that andrographis is significantly more effective than placebo in treating cold symptoms if started promptly (within 36-48 hours) after their onset. Russian studies have favorably compared andrographis to amantadine as a treatment for influenza infection. Andrographis supplements are generally well tolerated, but anaphylaxis has occurred. Additional studies are needed to determine its effectiveness in preventing URTIs and preventing or treating ILI in diverse populations in North America.

Echinacea. Research generally supports the use of high quality Echinacea purpurea products by adults to prevent or treat URTI. A 2007 meta-analysis of 14 controlled trials in adults concluded that E purpurea taken prophylactically decreased the odds of the common cold developing by 58% and decreased the duration of a cold by 1.4 days (both statistically significant). A 2006 Cochrane review evaluated studies of echinacea as a therapy for URTIs. Although most of the 16 studies that evaluated echinacea using aerial plant parts found that echinacea was more effective than placebo as a treatment for URTIs, it was suggested that additional rigorous trials are needed. A large controlled trial in pediatric patients found that echinacea may help prevent pediatric colds when taken during cold and flu season; however, echinacea does not seem to reduce the duration or severity of symptoms when used to treat colds in children. In vitro, echinacea inhibits the production of pro-inflammatory cytokines induced by the influenza virus and shows direct antiviral activity. Additional research to explore the clinical significance of this observation in preventing or treating ILI is needed. In most studies, echinacea has been well tolerated, but allergies and skin rashes are possible. There is substantial variability in echinacea products sold in the United States. Most of the studies that showed positive results used Echinacea Madaus, which uses aerial portions of the E purpurea species.

Elderberry. European black elderberry (Sambucus nigra) juice, is widely used to treat URTI and ILI. In vitro, elderberry binds to and prevents infection with influenza H1N1 virus. Studies from Israel and Norway suggest that black elderberry extract (1-4 tablespoons daily for 3-5 days for adults) can inhibit the growth of influenza viruses in vitro and shorten the duration of influenza symptoms while enhancing antibody levels against the virus. However, additional studies are needed to confirm these effects in more diverse North American populations (including children) before elderberry becomes a routine recommendation for preventing or treating ILI. No studies have demonstrated effectiveness of elderberry extracts in preventing or treating URTI. Elderberry is generally well tolerated, although allergic reactions are possible.

Garlic. Garlic (Allium sativum) is a commonly used food and folk remedy for preventing and treating the common cold. One high-quality trial of the effect of garlic supplementation on the common cold found that a daily garlic supplement (180 mg allicin content for 12 weeks) significantly reduced the incidence of the common cold. Randomized clinical trials have not addressed the effectiveness of garlic in treating URTIs or in the prevention or treatment of influenza. Garlic is generally safe, but its unpleasant effects on breath, belching, and body odor are well known.

Ginseng. Randomized clinical trials suggest that prophylactic standardized North American ginseng (Panax quinquefolium) supplements taken daily for 4 months can significantly reduce the incidence (by approximately 25%) and duration (by approximately 6 days) of URTIs in adults. In traditional herbal medicine, this herb is given to elderly or debilitated patients, not to healthy adults or children. Randomized controlled trials have not evaluated its benefits as a treatment once symptoms have begun. Additional research is needed to assess the effectiveness of ginseng in preventing and treating URTIs in pediatric patients. A randomized controlled trial from Italy evaluated the benefits of a standardized product of a different ginseng species (Panax ginseng) as an adjunct to influenza immunization. Taking 100 mg of P ginseng daily for 4 weeks before and 8 weeks after influenza immunization was associated with significantly higher antibody levels and natural killer cell activity compared with taking placebo. More research is needed to assess the safety and effectiveness of ginseng when used as a single agent to prevent or treat ILI in adult and pediatric patients. Ginseng may cause hypertension and agitation in large doses but otherwise is generally safe.

Honey. Honey is a home remedy commonly used to treat the symptoms of respiratory infections, particularly scratchy throats and coughs. A randomized controlled trial of 105 children with colds supports the use of buckwheat honey to quiet coughs that interfere with sleep. Honey has not undergone formal study to evaluate its prophylactic effects on the incidence of URTIs or in the prevention or treatment of ILI. Because of the risk for botulism, honey should not be given to children younger than 1 year old.

Pelargonium. African geranium (Pelargonium sidoides) is a native plant of South Africa used by Zulu and Basuto people. Two systematic reviews of 3 adult trials and 3 pediatric trials (most of which used the plant extract EPs 7630) concluded that pelargonium may be effective in alleviating symptoms of the common cold and bronchitis in adults. The benefits of pelargonium in treating cold symptoms were confirmed in a randomized controlled trial published in 2007. Additional research is needed to determine its effectiveness in preventing URTIs and in preventing or treating ILI in diverse populations. The product is well tolerated; side effects of the most common preparation include allergic reactions and upset stomach.

Probiotics

Probiotics encompass a large heterogenous group of bacteria that are normal inhabitants of the human gastrointestinal tract. These live microorganisms have undergone intensive study as treatments for gastrointestinal problems such as diarrhea, constipation, and IBS and as therapy for atopic conditions.

Recently, research has focused on the potential role of probiotics in preventing respiratory illnesses in adults and children. For example, in a controlled study in 10 healthy adults, taking 1 daily capsule of Bacillus coagulens, for 30 days significantly increased T-cell production of tumor-necrosis factor-alpha in response to exposure to adenovirus and influenza A (H3N2 Texas strain).

More than a dozen studies on the effectiveness of probiotics in preventing URTIs have been conducted, with mixed results. Most studies have shown some decrease in the severity and number of illness days in participants randomly assigned to treatment groups. Recent randomized, placebo-controlled, double-blind studies conducted over 3 winter seasons in healthy adult volunteers in Italy evaluated several synbiotic preparations. These preparations contained 3 to 5 strains of Lactobacillus plantarum, L rhamnosus, and Bifidobacterium lactis; lactoferrin; and prebiotics such as short-chain fructooligosaccharides (FOS) or galactooligosaccharides (GOS). The overall incidence, duration, and severity of URTI and ILI were significantly decreased in participants treated with synbiotics vs those in the placebo group. A study in Germany that evaluated the prophylactic effect of probiotics in healthy adults who took probiotics containing the strains L gasseri PA 16/8, B longum SP 07/3, and B bifidum MF 20/5 (5 x 107 colony forming units per tablet) daily for at least 3 months documented a significant reduction in days with cold symptoms and in the severity of symptoms and fever. On the other hand, 2 studies using other strains to prevent respiratory tract infections (one study of young men undergoing French commando training and another in marathon runners) did not show any benefit of probiotics. In addition to studying different populations, these studies may have had divergent results because probiotics have strain-specific effects on immune function.

Furthermore, various probiotics can have different effects on resistance to and recovery from viral infections when taken in combination with prebiotics such as FOS or GOS. In a randomized, double-blind, placebo-controlled study of children who were 3-5 years of age, participants who received either L acidophilus NCFM or L acidophilus NCFM in combination with B animalis subspecies lactis Bi-07 (vs placebo) WE RECOMMEND THESE TWO STRAINS twice daily for 6 months showed significant reductions in the incidence and duration of fever, cough, and rhinorrhea. Antibiotic use was also reduced by more than 65% and absences from daycare were reduced by approximately 30% compared with children receiving placebo.

Similarly, a randomized, double-blind placebo-controlled trial involving more than 500 children attending daycare in Finland showed that daily milk intake supplemented with Lactobacillus GG significantly reduced absences related to respiratory infections and reduced the severity of infections. In a crossover study of children with cystic fibrosis who are prone to serious respiratory infections, probiotic supplementation was associated with significantly fewer episodes of pulmonary exacerbations requiring hospitalization compared with supplementation with oral rehydration solution. In a study of formula-fed infants whose diets were supplemented with L rhamnosus GG and B lactis Bb-12 or placebo from ages 2 months through 12 months, there was a significant reduction in the incidence of acute otitis media, recurrent respiratory infections, and antibiotic use among those receiving the probiotics. In a similar study conducted with more than 200 infants attending Israeli child care centers, infants who received L reuteri had significantly fewer days with fever and fewer clinic visits, child care absences, and antibiotic prescriptions compared with those who received B lactis (Bb-12) or placebo, but there was no difference in the number of days with URTI. In a Swedish study, more than 900 pregnant women were randomly assigned to receive either placebo or probiotics (L rhamnosus GG and LC705, B breve Bb99 and Propionibacterium freudenreichii subspecies shermanii) for 4 weeks before expected delivery. Their infants continued to receive the same products with GOS for 6 months after birth. During 2 years of follow-up, the infants exposed to probiotics had significantly fewer URTI illnesses compared with the placebo-treated infants. Probiotics in food or supplements are generally safe and well tolerated in adults, children, pregnant women, and even premature infants. Sepsis-like illnesses have been described in case reports when probiotics were administered intravenously to severely immune-compromised patients.

Homeopathic Remedies

Homeopathy (or homeopathic medicine) was developed in Germany more than 200 years ago. A central homeopathic principle is that of similars, or "like cures like," meaning that a disease can be cured by a substance that produces symptoms similar to those of the disease or condition. Homeopathic remedies are extremely dilute preparations of the active substance (usually a natural ingredient) that are believed to have healing properties. Controversy exists among homeopaths about whether any homeopathic remedies are useful to prevent URTI or ILI in otherwise healthy adults. Typically, treatment depends on a broad constellation of emotional and mental characteristics as well as physical symptoms, so a remedy would not be selected purely to treat the flu or a cold per se. However, a number of homeopathic remedies are marketed as cold and flu products. Oscillococcinum is among the most popular products for ILI. A 2006 Cochrane review Oscillococcinum, including 3 prevention trials and 4 treatment trials, concluded that this remedy was not effective in preventing ILI; on the other hand, average treatment with Oscillococcinum (compared with placebo) was associated with a 0.28 day reduction in duration of ILI symptoms and marginally increased the chances that a patient would consider the treatment effective. Homeopathic remedies are very safe, and although their usefulness for ILI is only marginal, these remedies can be tolerated.

Conclusion

Upper respiratory tract illnesses and influenza-like illnesses are common, as is the use of home remedies and natural products to prevent and treat them. The strongest data for prevention of URTI in both adult and pediatric patients are from studies on probiotics. Although studies of black elderberry and andrographis are promising, no research has evaluated the optimal roles of these products with atypical H1N1 influenza infections. Aside from common sense precautions (avoiding honey for children less than 1 year old to reduce the risk for botulism; avoid giving bacterial products to severely immunocompromised patients), natural products are generally very safe, and their use can be tolerated.