Friday, February 26, 2010

Heart Smart: the latest from Bonnie

Foundational Cardiac Pharmacological Treatments, Statins and Aspirin, Should Have the Public Asking Their Doctors and Government Tough Questions.

In a jaw-dropping development, the FDA added the entire class of statin medications to its Watch List for the potential signal of serious risk/new safety information they call "Cognitve Effects."

A drug is added to the Watch List based on potential signs of serious risks or new safety information identified in the agency's Adverse Event Reporting System (AERS), derived from patient complaints and physician observations. The FDA states that the appearance of a drug on the AERS list does not mean that the agency has determined that the drug actually poses the listed risk. While the FDA evaluates whether there is a casual relationship between a listed drug and a possible risk, it is not suggesting that physicians stop prescribing these drugs, or that patients stop taking them.

That said, the fact that the FDA put statins on their Watch List after they, and the cardiology/Pharma community, have staked their reputations on them, is significant. A large portion of the country already takes statins, and millions more, even young children, would be on them, if possible. As I have documented on numerous occasions, statins come with a laundry list of side effects that keeps getting longer. In early February, the Lancet published a study showing that statins raised the risk of developing diabetes by nine percent. Since statins have been in use (about 20 years), there have been more than 1000 publications discussing their toxicity. That's more than four studies per month!

All this for a class of drugs that do not even improve HDL (good) cholesterol, which some cardiologists believe is more important to address than lowering LDL (bad) cholesterol.

I found these nuggets only because I track research journals and review what drugs end up on the FDA Watch List. It begs the question. Where is the media on this issue?

Note: if you continue with statin medication, please make sure that you supplement with a minimum of 100 mg. high quality Co-EnzymeQ10. In addition, if you are concerned about your statin use, ask your physician if you can try Niaspan (niacinamide), especially if you biggest cholesterol issue is low HDL.

For information on the effects of statins, please visit the website of Dr. Beatrice Golomb, one of the foremost researchers in the field.

I will say that the media has stepped up the pressure on aspirin. Last week, the Wall Street Journal published The Danger of Taking Aspirin Daily. While the contents in this article should not surprise my clients, as we have pounded this issue into submission over the last two decades, it will come as a shock to much of the public who have bought the aspirin theory hook, line, and sinker. For up-to-the-minute data, simply type the word aspirin in the top left of this blog to read what we have compiled on aspirin. In short, fish oil has gone head to head with aspirin in research and has been found to be just as efficacious, if not more, with virtually no side effects.

You may have read last week about a Senate report stating that drug maker GlaxoSmithKline knew of possible heart attack risks tied to Avandia, its diabetes medication, years before such evidence became public. The report also asks the U.S. Food and Drug Administration why it allowed a clinical trial of Avandia to continue even after the agency estimated that the drug caused 83,000 heart attacks between 1999 and 2007. A cardiologist's commentary in Forbes concerning the Avandia situation, as well as Big Pharma as a whole, offers a glimmer of hope that the medical community may finally be starting to get it.

Are There Alternatives?
On the opposite end of the safety spectrum, we have diet, exercise, and health professional-recommended dietary supplements. Besides the obvious heart health stalwarts such as diet, exercise, and stress reduction, safe nutrient alternatives should be discussed with your licensed health professional:

Vitamin D
According to a study in the journal Maturitas, middle aged and elderly people with high levels of vitamin D could reduce their chances of developing heart disease or diabetes by 43%. A team of researchers carried out a systematic literature review of studies examining vitamin D and cardiometabolic disorders, which include cardiovascular disease, type 2 diabetes mellitus and metabolic syndrome.

Researchers looked at 28 studies including 99,745 participants across a variety of ethnic groups including both men and women. The studies revealed a significant association between high levels of vitamin D and a decreased risk of developing cardiovascular disease (33% compared to low levels of vitamin D), type 2 diabetes (55% reduction) and metabolic syndrome (51% reduction). All studies included were published between 1990 and 2009.

In most cases, I refrain from citing meta-analyses, because there can be such bias and generalization of data. However the reductions in preventing these diseases are so overwhelming, the study is impossible to ignore.

Journal of the American College of Nutrition also reported the crucial role vitamin D plays with diabetes prevention for one simple reason: vitamin D cell function, or lack thereof due to deficiency, leads to glucose intolerance and inhibited insulin secretion inhibited.

With cases of diabetes set to double and spending on the disease to triple by 2034, according to Diabetes Care, would it not be in our best interest to test every Americans vitamin D levels at their annual physical? Not to mention that it is a dirt cheap, preventive health measure.

Note: the medical vitamin D range is 32-100. The optimum range is 40+ in winter months and 50+ in summer (or good sun months).

For the other nutrients on this list, we have consistently documented their benefits over the years (not a complete list, just the most researched).
  • Magnesium
  • Co-Enzyme Q10
  • EPA/DHA Omega-3 Fish Oil
  • Plant Sterols/Stanols
  • Vitamin E
  • Niacin (for raising HDL)
The Future of Diet and Heart Health As Seen Through the Eyes of a USDA Panel
The following comments are taken directly from the transcript at a meeting from an expert committee chosen to update the 2010 USDA Dietary Guidelines.

"Looking at the number of patients with heart disease over the next half century. We're currently at about 12.4 million Americans have heart disease, and by 2050 that number will be about 25 million.

The good news is that we're doing a great job in patients who develop heart disease, keeping them alive. Our case fatality rates have fallen by about 75 percent. That's the good news.

The bad news is that we really haven't affected incidence, and as I'll mention, is it the new cases are still appearing? And the consequences of this graph is tremendous levels of disability, health care cost, and it's all preventable.

So the epidemiologic background of all this is that while mortality continues to fall, the incidence of coronary heart disease does not appear to have declined since about 1990 so that the new cases are still filling the reservoir.

Serum cholesterol levels appear to have been stable since 1990. This is actually despite the widespread use of effective cholesterol lowering drugs, which is now certainly an industry in the multiple billions off dollars. So if everything remained the same, one might have expected to have a decline in serum cholesterol.

So this is really the challenge, is where we're going to go from here, particularly in the public health way, not in a pharmacologic way?"

Pretty compelling stuff. I cannot wait to see if they actually actually address this issue in the DGA update. Regardless, the "cat has been let out of the bag."

In summing up the rest of this testimony, here are the main points discussed:
  • Total fat and saturated fat consumption has gone unchanged since the mid-1990s. However, saturated fat replacement with carbohydrates, may have reduced LDL cholesterol, but negatively affected HDL and triglycerides.
  • Replacing as little as five percent of saturated fat with omega-3 fat reduced cardiovascular heart disease events and type 2 diabetes in middle age to older adults. The committee discussed using this model as opposed to replacing that five percent with carbohydrate.
It is apparent what is happening here. The tide is starting to turn on what have been considered rock-solid paradigms for reducing the risk of heart disease. Too bad it is coming twenty years late.

Probiotic prevents diarrheaa

The American Journal of Gastroenterology study was performed on 255 hospital patients, ages 50 to 70, receiving penicillin, cephalosporin or clindamycin. Within 36 hours of starting antibiotic therapy, patients began to take (each day, 2 hours after breakfast) either 2 probiotic capsules, 1 probiotic capsule and 1 placebo capsule, or 2 placebo capsules. All patients were hospitalized for at least 5 days and received antibiotics for at least 3 days (but not more than 14 days). They continued with their assigned treatment for 5 days after finishing the course of antibiotics. Each probiotic capsule contained 50 billion colony-forming units of L acidophilus and L. casei.

At 21 days after the end of their assigned treatments, the incidence of antibiotic-associated diarrhea was 44.1% in the placebo group, 28.2% in the 1-capsule group and 15.5% in the 2-capsule group. Rates of diarrhea due to C. difficile were 23.8%, 9.4%, and 1.2% with placebo, 1 capsule, and 2 capsules, respectively.

The authors estimate that treating five patients at the higher probiotic dose would prevent one case of C. difficile-associated diarrhea. Overall, the 2-capsule group had the lowest rate of gastrointestinal symptoms, followed by the 1-capsule group. The investigators observed a similar pattern for symptom duration. They attribute their high response rates to the high probiotic dosage: "The probiotic load of this quantity likely overwhelms the intestinal tract and repopulates the gut with nonpathogenic flora, as well as enhances immune response to inhibit or destroy pathogenic bacteria."

Dannon must pay up for false claims

Dannon must pay consumers up to $45 million in damages for falsely advertising the health benefits of its yogurt, under the terms of a class action settlement reached in federal court in Cleveland. The targets of the class action were two Dannon yogurt products -- Activia and DanActive -- pitched in TV ads by actress Jamie Lee Curtis.

Under terms of the settlement agreement, Dannon must remove the words "clinically" and "scientifically proven" from labels and advertisements of Activia yogurt in reference to claims the product helps to regulate the digestive system. In their place, the words "clinical studies show," or something similar, must be substituted. Dannon also must note that Activia and DanActive yogurts are food, not treatments or cures for any medical disorder or disease. Also, Dannon must remove the word "immunity" from DanActive labels and ads, as well as include a qualifier to the claim the yogurt "helps strengthen your body's defenses" or "helps support the immune system." That is only true, the qualifier claims, "when eaten regularly as part of a balanced diet and healthy lifestyle," according to the order.

Bonnie - these probiotic yogurts are underwhelming, deceptive, and loaded with sweeteners and artificial ingredients. It is nice to see the FTC take action.

Thursday, February 25, 2010

Doc's Diasppointment in Big Pharma

Steve - a respected Cardiologist chimes in after the revelations about GSK's Avandia.

Did he not get the memo years ago?

Wednesday, February 24, 2010

Recipe Du Jour March

Nana’s Gluten-Free Kasha Casserole

Directions for Cooking Kasha and Rice Pasta Shells:

-1 cup Pacific Foods Chicken Broth
-2 T. organic butter or no transfat butter substitute
-1 cup filtered water for kasha; 1 quart water for shells
-¼ tsp. salt (or to taste)
-dash of white or black pepper (optional)
-1 cup Kasha (buckwheat groats)
-1/2 cup brown rice pasta shells

Heat broth, one cup water, fat, and seasonings to boiling. In a separate non-stick skillet or saucepan, lightly beat an egg with a fork. Add the kasha. Stir to coat kernels evenly. Cook the mixture over high heat for 2-3 minutes, stirring constantly until egg has dried. Reduce heat to low. Stir in the boiling liquid. Cover tightly; simmer for 8-12 minutes or until kasha kernels are tender and the liquid is absorbed. While the kasha is simmering, boil the one quart of water with salt. Add the pasta shells and cook al dente. Mix the shells with the kasha when both are fully cooked.

Directions for Vegetable Mixture:

-½ cup minced onions or shallots
-¼ cup diced celery
-½ cup diced or shredded carrots
-¼ cup diced red/yellow peppers, opt.
-1 T. extra virgin olive oil or grapeseed oil

Saute all vegetables in the oil and a little chicken broth, if needed. When soft, add to the kasha noodle mixture. This recipe may be served immediately or put into a greased casserole and microwaved to reheat.


Stress Hormone, Depression Trigger Obesity in Girls

Depression raises stress hormone levels in adolescent boys and girls but may lead to obesity only in girls. Early treatment of depression could help reduce stress and control obesity -- a major health issue. Cortisol, a hormone, regulates various metabolic functions in the body and is released as a reaction to stress.

Although it is not clear why high cortisol reactions translate into obesity only for girls, scientists believe it may be due to physiological and behavioral differences -- estrogen release and stress eating in girls -- in the way the two genders cope with anxiety. If depression were to be treated earlier, she noted, it could help reduce the level of cortisol, and thereby help reduce obesity. "We know stress is a critical factor in many mental and physical health problems," said researchers.

Data suggests that depression is associated with spikes in cortisol levels for boys and girls after the stress tests, but higher cortisol reactions to stress are associated with obesity only in girls. The team reported its findings in a recent issue of the Journal of Adolescent Health. "In these children, it was mainly the peak in cortisol that was related to obesity," researchers explained. "It was how they reacted to an immediate stress."

Bonnie - very important finding that every parent and teen should take note of. Especially in the teen years, paying attention to health and amount stress is often ignored.

Tuesday, February 23, 2010

The Danger of Taking Aspirin Daily

Nice to see the Wall Street Journal is coming around to our way of thinking! The Danger of Taking Daily Aspirin.

Fish Oil and/or vitamin E are much safer long-term choices.

FDA Studying 27 Drugs, Drug Classes for Potential Safety Issues

US Food and Drug Administration (FDA) Watch List based on potential signs of serious risks or new safety information identified in the agency's Adverse Event Reporting System (AERS). The FDA states that the appearance of a drug on the AERS list does not mean that the agency has determined that the drug actually poses the listed risk. While the FDA evaluates whether there is a casual relationship between a listed drug and a possible risk, it is not suggesting that physicians stop prescribing these drugs, or that patients stop taking them.

Please note that Statin medications appear twice on this list.

Potential Signals of Serious Risks/New Safety Information Identified by AERS, Second Quarter 2009

Product Name: Active Ingredient (Brand Name) or Product Class Potential Signal of a Serious Risk/New Safety Information Additional Information as of December 31, 2009
Aliskiren (Tekturna, Tekturna HCT) Angioedema requiring intubation FDA approved Valturna (an aliskiren-containing product) on September 16, 2009. Risk for angioedema was included in the Warnings and Precautions section of the labeling for Valturna.
The Warnings and Precautions section of the labeling for Tekturna was updated in November 2009 to include angioedema requiring intubation.
Antipsychotics Agranulocytosis FDA has requested class labeling to add agranulocytosis to the Precautions section of the labeling for all antipsychotics. Refer to the July 2009 Drug Safety Labeling Changes summary page, listing products with "labeling for the entire class of antipsychotic drugs," on the MedWatch Web site.
Bumetanide (Bumex) Serious skin reactions (Stevens-Johnson Syndrome, toxic epidermal necrosis) FDA is continuing to evaluate this issue to determine the need for any regulatory action.
Cisplatin (Platinol) Leukoencephalopathy Under FDA study
Deferasirox (Exjade) Deaths FDA issued an Early Communication about an Ongoing Safety Review on this issue in September 2009.
FDA Issues Early Communication Regarding Deferasirox Safety in MDS, Sept. 2009
New Boxed Warning for Deferasirox, Feb. 2010
Under FDA study
Gabapentin (Neurontin) Drug reaction with eosinophilia and systemic symptoms (DRESS) Under FDA study
Imatinib mesylate (Gleevec) Hearing disorders and hearing loss Under FDA study
Immunosuppressants (transplant) BK virus nephropathy An FDA alert was issued in July 2009 about labeling changes for immunosuppressant drugs for this event.
FDA Adds Infection Warnings to Immunosuppressant Labels
Natalizumab (Tysabri) Herpes virus infections FDA evaluated case reports in AERS and determined that the current labeling, which addresses herpes virus infections in the Warnings and Precautions and Adverse Reactions sections of the labeling, is adequate.
Natalizumab (Tysabri) Pericarditis Under FDA study
Oseltamivir phosphate (Tamiflu) Hypothermia Under FDA study
Riluzole (Rilutek) Interstitial lung disease The Warnings section of the labeling was updated November 2009 to include interstitial lung disease.
Simvastatin (Zocor) and Diltiazem (Cardizem) Myopathy due to drug interaction FDA is evaluating this issue to determine if simvastatin labeling, which includes myopathy, is adequate.
Ticlopidine Disseminated intravascular coagulopathy Under FDA study

Potential Signals of Serious Risks/New Safety Information Identified by AERS, Third Quarter 2009

Product Name: Active Ingredient (Brand Name) or Product Class Potential Signal of a Serious Risk/New Safety Information Additional Information as of December 31, 2009
Alvimopan (Entereg) Gastrointestinal perforation FDA is studying this issue to determine the need for regulatory action
Bendamustine (Treanda) Infusion site extravasation Under FDA study
Dexlansoprazole (Kapidex) Name confusion with Casodex The FDA/CDER medication error division works closely with the Institute for Safe Medication Practices (ISMP) on some issues. Both FDA and ISMP have been evaluating this issue. The ISMP discussion of the issue is available on the ISMP Web site.
Doripenem (Doribax) Seizure events, hepatic events, thrombocytopenia, serious skin reactions Under FDA study
Enoxaparin (Lovenox) Catheter thrombosis, splenic rupture Under FDA study
HMG-CoA reductase inhibitors (Statins) Cognitive effects Under FDA study
Lamotrigine (Lamictal) Central nervous system infection, aseptic meningitis Under FDA study
Neuromuscular blocking agents Anaphylactic reactions and potential for cross-reactivity Under FDA study
Ramipril (Altace) Angioedema (requiring intubation) Under FDA study
Sirolimus (Rapamune) Progressive multifocal leukoencephalopathy (PML) Under FDA study
Tumor necrosis factor (TNF)-alpha blockers Demyelinating neuropathy Under FDA study
Valsartan-containing products Angioedema (requiring intubation) Under FDA study
Zonisamide (Zonegran) Rhabdomyolysis, pancreatitis Under FDA study

Does humidity affect influenza virus outbreaks? Absolutely, study says

A new study reported Monday in the journal PLoS Biology indicates that the best correlation is with absolute humidity -- a measure of the actual amount of water vapor in the air, compared with relative humidity, which is a measure of how much is in the air compared to how much the air can hold. Absolute humidity is lowest in winter in most temperate regions of the world and much higher in the summer. A variety of laboratory studies have shown that flu viruses become less infective when there are higher quantities of water in the air. To validate these findings in humans, a team headed by atmospheric scientist Jeffrey Shaman of Oregon State University used 31 years of absolute humidity data for several states, then for the country as a whole, in mathematical models of influenza spread. In both cases, they found a much closer correlation with absolute humidity than with any other variable they studied. A dry period was not an absolute requirement for triggering a seasonal outbreak, but it was present in 55% to 60% of the outbreaks. "The virus response is almost immediate," Shaman said in a statement. "Transmission and survival rates increase about 10 days later. Observed mortality rates follow." The seasonality of flu may affect that of other infectious diseases, the researchers said, because the flu virus lowers immune response. Researchers don't know, however, how higher humidity reduces virus transmission.

Steve - do you think the CDC would pay billions of dollars to appliance manufacturers to mass produce whole-house humidifiers so that every American could have one in their homes/apartments/offices? Why not? There is just as much efficacious data on humidity's effect on inflluenza, if not more, than there is on vaccinations.

Antioxidants may help lower diabetes rates

The findings of the study, published in the journal Nutrition, Metabolism & Cardiovascular Diseases supports the view that dietary antioxidants are associated with improved glycemic biomarkers in healthy adults, as well as in diabetic patients. Researchers said recent studies suggested that oxidative stress is related to diabetes, possibly originating through increased free-radical production, with the theory proposed that pancreatic cells are particularly susceptible to reactive oxygen species, due to their low free-radical quenching enzymes. “Thus, by damaging mitochondria, oxidative stress could induce apoptosis of pancreatic beta cells, blunt insulin secretion and dysregulate glucose levels,” they continued.

The scientists also report that total dietary antioxidant capacity has been found to be inversely related to markers of inflammation, suggesting that inflammation and oxidative stress are interrelated. And they explained that the hypothesis that a diet high in antioxidants could be inversely related to the development of diabetes prompted their decision to evaluate the relationship between glycemic indices (glucose, insulin and insulin resistance) and dietary antioxidant intake, in apparently healthy adults as well as in adults with diabetes.

Data from participants consisting of 551 men and 467 women indicated that higher total dietary antioxidant intake was correlated with lower levels of glycemic indices in healthy individuals, as well as in pre-diabetic and diabetic ones.

Monday, February 22, 2010

High levels of V-D may reduce several diseases

Middle aged and elderly people with high levels of vitamin D could reduce their chances of developing heart disease or diabetes by 43% according to a study in the journal Maturitas. A team of researchers carried out a systematic literature review of studies examining vitamin D and cardiometabolic disorders. Cardiometabolic disorders include cardiovascular disease, type 2 diabetes mellitus and metabolic syndrome.

Researchers looked at 28 studies including 99,745 participants across a variety of ethnic groups including men and women. The studies revealed a significant association between high levels of vitamin D and a decreased risk of developing cardiovascular disease (33% compared to low levels of vitamin D), type 2 diabetes (55% reduction) and metabolic syndrome (51% reduction). All studies included were published between 1990 and 2009 with the majority published between 2004 and 2009. Half of the studies were conducted in the United States, eight were European, two studies were from Iran, three from Australasia and one from India.

Steve - this is a meta-analysis, which we rarely use because there can be such bias and generalization of the data. However the reductions in preventing these diseases are so overwhelming, it is impossible to ignore.

GSK, maker of Avandia, knew of cardiac risks

Courtesy of Associated Press

A Senate report said Saturday that drug maker GlaxoSmithKline knew of possible heart attack risks tied to Avandia, its diabetes medication, years before such evidence became public. Sen. Max Baucus, chairman of the Senate Finance Committee, and Chuck Grassley, the committee's ranking Republican, released the report, which follows a two-year inquiry, on Saturday. They are also asking the U.S. Food and Drug Administration why it allowed a clinical trial of Avandia to continue even after the agency estimated that the drug caused 83,000 heart attacks between 1999 and 2007.

In a letter to FDA Commissioner Margaret Hamburg that was also released Saturday, the senators said the committee's report was based on researchers' studies of Avandia, internal GlaxoSmithKline documents and FDA documents. They said committee investigators had interviewed GlaxoSmithKline and agency employees as well as what it called anonymous whistleblowers. Based on its knowledge of the heart attack risks, GlaxoSmithKline "had a duty to sufficiently warn patients and the FDA of its concerns in a timely manner," the report said. Instead, the company tried to downplay findings that the drug could increase cardiovascular risks while also working to downplay findings that a rival medication might reduce such risks, it said.

GlaxoSmithKline said in a statement the drug is safe. It said the committee report took data out of context from analyses of Avandia. In May 2007, the New England Journal of Medicine published an analysis of dozens of studies on nearly 28,000 people who had taken Avandia. The journal said there was a 43 percent higher risk of heart attack for those taking Avandia compared to people taking other diabetes drugs or no diabetes medication. The findings raised concerns because two-thirds of the people with Type 2 diabetes, the most common form, die of heart problems.

Later that year, the FDA ordered a warning to be included on Avandia's label warning that it might increase the risk of heart attacks. But the label also says data on the risks are inconclusive. "Contrary to the assertions in the report, and consistent with the FDA-approved labeling, the scientific evidence simply does not establish that Avandia increases cardiovascular ischemic risk or causes myocardial ischemic events," GlaxoSmithKline said. In their letter to Hamburg, the senators said the documents the committee reviewed included an analysis conducted by two safety officials at the agency.

The analysis compared Avandia to Pfizer Inc.'s Actos diabetes drug, and found that Avandia has an increased risk of heart attack and heart failure. The letter also quoted the researchers as saying that said the study itself was dangerous, as it meant patients continued to take the drug. FDA spokesman George Strait said the FDA is reviewing new data on Avandia and will present those findings to an advisory committee this summer. "Meanwhile, Commissioner Hamburg is reaching out to ensure that she has a complete understanding and awareness of all of the data and issues concerning this drug," Strait said.

Bonnie - this should not surprise anybody. We have seen the same shenanigans with drug after drug. As we have stated like a broken record, you should never try a new medication unless it has been on the market for at least two years.

Acupuncture May Relieve Menstrual Cramps

Acupuncture may help relieve menstrual cramps, which affect up to half of all young women, a systematic literature review has found. In their analysis of 27 studies involving nearly 3,000 women, researchers from the Oriental Hospital at Kyung Hee University Medical Center in South Korea found that acupuncture may be more effective than drugs or herbal medicines. "There is convincing evidence on the effectiveness of using acupuncture to treat pain as it stimulates the production of endorphins and serotonin in the central nervous system," researchers wrote in a statement. "Compared with pharmacological treatment or herbal medicine, acupuncture was associated with a significant reduction in pain," according to the study which appeared in BJOG.

Friday, February 19, 2010

Health, United States, 2009

Centers for Disease Control's Annual Report Highlights (or in some cases, lowlights)

  • Leading cause of death in ages 1-44: unintentional injury
  • Leading cause of death in ages 45-64: cancer
  • Leading cause of death in ages 65 and older: heart disease
  • Between 1990 and 2007, heart disease deaths declined 41% and cancer declined 18%.
Overweight, Obesity
  • In 1960, 44.2% of the population was overweight. In 2006, the rate was 66.9%.
  • In 1960, 13.3% of the population was obese. In 2006, the rate was 34.1%.
  • In 1960, 51.2% of the population was a healthy weight. In 2006, the rate was 31.4%.
  • Between 1976-1980 and 2005-1006, the obesity rate in preschool-age children doubled from 5% to 11%
  • In school-age children 6 to 11 years old, obesity doubled from 7% to 15%
  • In school-age children 12 to 19 years old, obesity tripled from 5% to 18%
  • Adults 20 to 74 years old, obesity doubled from 15% to 35%
Prescription Drugs
  • The percentage of the population with at least one prescription drug during the previous month increased from 39% in 1988–1994 to 47% in 2003–2006. During the same period, the percentage taking three or more prescription drugs increased from 12% to 21%. The increases were across the board for every age group.
  • The number of prescriptions for every class of medication (excluding antibiotics), in every age group, increased exponentially between 1995-1996 and 2004-2005.
Dietary Supplements
  • In 2003–2006, 54% of adults 20 years of age and over reported taking a dietary supplement in the past month. The use of dietary supplements is higher among women than men, and reported use increases with age.
Caloric Intake
  • Between 1971 and 2006, total caloric intake has steadily increased.
  • While carbohydrate intake has steadily risen over this period of time, protein and fat intake has declined.
Steve - many of these statistics mirror the public health issues currently facing the United States. The one on carbohydrate intake says it all. If the statisticians were to break down the type of carbs consumed, I'm sure that grains and refined sugars would be prominent.

Cooling inflammation

Agricultural Research Service (ARS)-funded scientists have reported new reasons for choosing "heart-healthy" oats at the grocery store. Nutritionist Mohsen Meydani, director of the Vascular Biology Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston, Mass., led the research on the oat compounds, called avenanthramides. Meydani previously has shown that phenolic antioxidants in oats obstruct the ability of blood cells to stick to artery walls.

Chronic inflammation inside the arterial wall is part of the process that eventually leads to a disorder known as atherosclerosis. Meydani and colleagues have reported findings that suggest the avenanthramides of oats decrease the expression of inflammatory molecules. The study showed that forms of avenanthramides possess potential anti-inflammatory properties through inhibiting factors that are linked with activating proinflammatory cytokines. Cytokines are small proteins released by cells while seeking to protect and repair tissue. Some trigger inflammation, for example, while responding to infection. Inhibiting inflammation through diet, drugs, or key nutrients is considered to be of great benefit in preventing atherosclerosis, according to the study in Free Radical Biology & Medicine.

The study provides additional indications of the potential health benefit of oat consumption in the prevention of coronary heart disease beyond its known effect through lowering blood cholesterol.

FDA adds warning to asthma meds

The Food and Drug Administration on Thursday called for putting new limits on powerful and long-lasting bronchial drugs that millions of Americans use to treat asthma -- a move designed to lower the risk of complications leading to hospitalization or even death.

Physicians were urged to switch asthma patients away from medicines containing both long-acting beta agonists, commonly called LABAs, and inhaled corticosteroids.

Instead, the FDA said, patients should use products containing only the corticosteroids or other asthma-relieving medication whenever possible.

In addition, patients who cannot control asthma symptoms any other way should use LABAs for the shortest possible time, but the drugs should never be used alone in treating asthma in adults or children, the agency said.

About 95% of LABA users receive the drug through a combination product, according to the agency.

The drugs affected by the FDA action include the LABA-only products Serevent and Foradil, along with Advair and Symbicort, which contain both LABAs and inhaled corticosteroids. All are dispensed in inhalers via prescription.

Manufacturers will be required to include new warnings on the drugs' labels, educate patients and physicians about risks associated with the use of LABAs and study whether using the long-acting compounds in tandem with other drugs makes them safer.

Statins slightly raise diabetes risk

New data from a large meta-analysis of major statin trials suggests the LDL-cholesterol–lowering drugs increase the risk of developing diabetes mellitus by 9%. Investigators stress, however, that clinical practice should remain unchanged in patients with moderate or high cardiovascular risk, given the low absolute risk of developing diabetes, particularly when when compared with the benefit of statins.

Dr Steven Nissen (Cleveland Clinic, OH), who was not involved in the meta-analysis, praised the researchers, calling their interpretation of the data "responsible." Most important, he agreed with their conclusions, stating that the benefits of statins exceed the risk of diabetes and that physicians should not alter clinical practice based on these findings. "In all of these trials, the population with diabetes or the population with new-onset diabetes had the same benefit in terms of reduction in morbidity and mortality as did people who received statins who were not insulin resistant or who had prediabetes," Nissen said. "Whatever this effect is, it doesn't lessen the favorable effect of statins on clinical outcomes. I don't think people should hesitate to give prediabetic patients statins because they might develop diabetes a few weeks or a few months later and deny them all the other benefits of these drugs."

The results of the study appear in the Lancet.

Bonnie - what are cardiologists going to say? Their reputations are on the line because they want half the world on statins! As we have seen with so many classes of medications, the side effects caused by statins continues to mount over time. It is also sad that even though research shows Niacinamide works effectively, with far fewer side effects, it is hardly ever prescribed first.

Low vitamin D in utero raises MS risk

Vitamin D exposure before birth may play an important role in the development of multiple sclerosis later in life, the Harvard Nurses' Mothers' Study suggests. The risk for multiple sclerosis is lower among women whose mothers had a high intake of either vitamin D during pregnancy.

Investigators studied more than 35,000 nurses whose biological mothers completed a questionnaire about their maternal milk intake, maternal dietary vitamin D intake, and predicted maternal serum 25-hydroxyvitamin D during pregnancy with their daughters' risk of developing multiple sclerosis. About 200 women were diagnosed with multiple sclerosis.

Investigators found that women born to mothers with a high vitamin D intake during pregnancy were less likely to have multiple sclerosis. The researchers report that the predicted vitamin D level in the pregnant mothers was inversely associated with the risk for multiple sclerosis in their daughters.

"It is important to realize that our results suggest, but certainly do not prove, an association. We agree with this critique, which can only be addressed by conducting an independent investigation, possibly using biomarkers of vitamin D status in pregnancy rather than self-reported diet. We are working on this." Still, researchers say, the findings will be of interest to women with multiple sclerosis and their physicians because of the higher-than-average risk for disease in their children.

Thursday, February 18, 2010

Later Introduction of Baby Foods Related to Lower Risk of Obesity Later in Life

One area of great interest is the possibility that being breastfed might predispose a person to being lean, and the longer the better. Extended breastfeeding, however, is usually associated with delayed introduction of complementary "baby" foods, and it is possible that this (gain rather than breastfeeding) might influence weight. To investigate this possibility, a team of Danish researchers led by Kim Fleischer Michaelsen investigated these factors in a group of individuals who were studied from birth until adulthood. Their findings, and an accompanying editorial by Michael Kramer, are published in the March 2010 issue of The American Journal of Clinical Nutrition.

Neither breastfeeding duration nor timing of complementary foods was related significantly to BMI in childhood, adolescence, or early adulthood. However, at 42 y of age the risk of being overweight decreased with increasing age at introduction of complementary foods. For instance, for each month introduction of vegetables was delayed, the risk of being overweight at 42 y of age was reduced by 10%. ASN Spokesperson Shelley McGuire, PhD, highlights that "As parents, we all want to know what we can do to help our children avoid obesity, so research like the study led by Dr. Fleishcher Michaelsen is extremely important- it provides evidence that breastfeeding per se may not have an effect on body weight; instead, it may be other feeding choices (like when baby foods are introduced) that are related to breastfeeding choices. Most likely, these factors work together to prevent or predispose a growing child to obesity later in life."

Bonnie - wow - this is an extremely long study!

Wednesday, February 17, 2010

Fat acts differently in those with PCOS

Fat tissue in women with polycystic ovary syndrome produces an inadequate amount of the hormone adiponectin, that regulates how fats and glucose are processed, promoting increased insulin resistance and inflammation, glucose intolerance, and greater risk of diabetes and heart disease, according to a study conducted at the Center for Androgen-Related Research and Discovery at Cedars-Sinai Medical Center.

Polycystic ovary syndrome, or PCOS, is the most common hormonal disorder of women of childbearing age, affecting approximately 10 percent of women. It is the most common cause of infertility, and an important risk factor for early diabetes in women.

"We're beginning to find that fat tissue behaves very differently in patients with PCOS than in other women," said Ricardo Azziz, M.D.,M.P.H., director of the Center for Androgen-Related Research and Discovery, and principal investigator on the study. "Identifying the unusual behavior of this fat-produced hormone is an important step to better understanding the causes underlying the disorder, and may be helpful in developing treatments that will protect patients against developing heart disease and insulin resistance."

Fat tissue is the body's largest hormone-producing organ, secreting a large number of hormones that affect appetite, bowel function, brain function, and fat and sugar metabolism. One of these hormones is adiponectin, which in sufficient quantities encourages the proper action of insulin on fats and sugars and reduces inflammation. Women with PCOS produce a smaller amount of adiponectin than women who do not have the disease, in response to other fat-produced hormones, according to the research to be published in the February issue of Journal of Clinical Endocrinology and Metabolism.

In the study, adiponectin was lacking in PCOS patients whose weight was considered to be in a healthy range, as well as in those patients who were overweight.

Bonnie - the little data that is available for natural substances with properties that may assist in boosting adiponectin production includes: acacia, aloe, astragalus, curcumin, fish oil, ginkgo biloba, heartwood, hops, resveratrol, and Vitamin D3.

There are currently lab tests available to test for low Adiponectin levels.

Tuesday, February 16, 2010

GI medication gone wild

One of every 10 Americans was prescribed at least 1 gastrointestinal (GI) medication on an outpatient basis in 2007 compared with 1 of every 15 Americans in 1997, according to a recent report from the US Department of Health and Human Services. A 60% rise in the number of Americans who were prescribed GI agents accompanied a 170% increase in total expenditures on these medications, which was $18.9 billion in 2007 compared with $7 billion in 1997 (adjusted to 2007 dollars). The average price per GI drug purchase increased during this period from $90 to $120 for a 33% increase. The overall inflation rate for this 10-year stretch was 29%. These findings emerged from the Medical Expenditure Panel Survey, sponsored by the Agency for Healthcare Research and Quality and the National Center for Health Statistics. Expenditure and purchase estimates for prescription medications include refills as well as the original script.

Americans aged 65 years and older were the heaviest users of GI medications. In 2007, 26.6% of this age group were prescribed a GI medication. In contrast, just 8.9% of Americans aged 18 to 64 years had at least 1 such prescription. That rate among Americans aged 17 years and younger was 2.5%.

Bonnie - one in 10 is beyond shocking. Use is highest in the elderly population, which has the most to lose from taking them. I have expounded incessantly about the issues with GI medications, especially long-term use.

Acid level impacts inflammation

Steve - it is not like we need more affirmation that excess acidity causes inflammation, but this Canadian Medical Association Journal was well conceived.

In vitro data suggest that lower extracellular pH activates the immune system. We conducted a population-based study of the relation between serum acid–base status and inflammation.

We examined the serum anion gap and serum levels of bicarbonate and inflammatory biomarkers in 4525 healthy adults who participated in the National Health and Nutrition Examination Survey during 1999–2006. We excluded participants who had chronic disease, recent infection and an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m 2.

After adjustment for age, sex, ethnic background, body mass index, serum albumin level and other factors, we found that a higher anion gap and lower bicarbonate level were associated with a higher leukocyte count and higher C-reactive protein level. Compared with participants in the lowest quartile of anion gap, those in the highest quartile had a leukocyte count that was higher and a C-reactive protein level that was higher. A higher anion gap and lower bicarbonate level were also associated with a higher platelet count, a larger mean platelet volume and a higher ferritin level.

A higher serum anion gap and lower bicarbonate level were associated with higher levels of inflammatory biomarkers in a healthy sample of the general population.

Walking helps osteoarthritis

"Progressive walking" combined with glucosamine sulfate supplementation has been shown to improve the symptoms of osteoarthritis, according to journal Arthritis Research and Therapy. Researchers found that patients who walked at least two bouts of 1500 steps each on three days of the week reported significantly less arthritis pain, and significantly improved physical function. All patients received the dietary supplement for six weeks, after which they continued to take the supplement during a 12-week progressive walking program.

The program, called Stepping Out, includes a walking guide; a pedometer; weekly log sheets and a weekly planner, all intended to help patients adopt the exercise regime. Seventeen patients were randomly assigned to walk five days per week, while the remaining 19 were instructed to walk three days a week. The team found that both groups achieved significant improvement in their symptoms, however being encouraged to walk five days a week was not more effective than being encouraged to walk three days.

Probiotics during pregnancy may cut obesity in child

The development of high blood sugar levels during pregnancy, called gestational diabetes, is known to boost a woman’s risk of subsequently developing type-2 diabetes, as well as putting the offspring at increased risk of childhood obesity and diabetes as they get older. Finnish researchers are now reporting that probiotic supplements may reduce the frequency of gestational diabetes by 20 per cent, according to data published in the British Journal of Nutrition.

In addition to the benefits to mother, the study’s findings may also have benefits for the baby, with fewer births of larger babies. "Based on the present findings, perinatal dietary counseling combined with probiotics could provide a safe and cost-effective tool in addressing the obesity epidemic,” researchers added. Subjects were recruited during their first trimester of pregnancy and randomly assigned to a control group, or a group that received intensive dietary counseling provided by a nutritionist. The women in the dietary counseling group were further randomized to receive probiotic supplements containing lactobacillus acidophilus and bifidus or placebo. No adverse events were reported, and no effect on the duration of pregnancies were recorded.

“The results of the present study show that probiotic-supplemented perinatal dietary counseling could be a safe and cost-effective tool in addressing the metabolic epidemic,” wrote the researchers. “In view of the fact that birth size is a risk marker for later obesity, the present results are of significance for public health in demonstrating that this risk is modifiable,” they added.

Steve - music to our ears!

Monday, February 15, 2010

New USDA Rules Establish Strong Organic Standards for Pasture and Livestock

Locallly grown food up 20%

Locally produced foods was one of the hottest nationwide trends in foods, one of which is farm friendly or local foods. Farm-friendly or local foods are just as they sound, foods that are found closer to the farm, often on the farm, but also at farmers markets, local CSA’s (community supported agriculture), and in local family-owned grocery stores. The vast majority of these farms often use different terms to describe their production methods. Common terms are homestead, organic, natural, sustainably grown, free-range and grass-fed, air-cooled poultry, grown from heirloom seeds or produced with respect for the land, animals, and workers. Regardless of the terminology, much of the food is produced without pesticides, antibiotics or growth hormones.

Sales from food produced using these principals have grown 20 percent per year over the past decade and now reach nearly $11 billion nationwide. Research shows that nearly half of consumers purchased organic foods within the past six months with fruits and vegetables heading up the largest category, but with an increasing large proportion coming from the dairy case. Meat and poultry also appear to have the next most potential because consumers are growing increasingly concerned about BSE, E coli and the presence of growth hormones and antibiotics in their meat.

Magnesium may boost lung function in asthmatics

Daily supplements of magnesium may improve lung function in asthmatics, and improve their quality of life. Measures of lung capacity increased by about 6 per cent during six months of magnesium supplementation, and improvements were also observed in the bronchial response to methacholine, a chemical that produces constriction of the lungs, according to findings published in the Journal of Asthma.

Epidemiological studies have reported beneficial effects of magnesium on asthma occurrence and management, but less than half of adults in the US consume the recommended levels of the mineral, according to the National Health and Nutrition Examination Survey (NHANES) for 1999-2000.

The participants were randomly assigned to receive either the a daily dose of 340 milligrams of magnesium or placebo for 6.5 months. At the end of the study, a 6 per cent improvement in lung function, measured as the peak expiratory flow rate (PEFR), was observed in the magnesium group, and not in the placebo group. Furthermore, 20 per cent more methacholine was needed in the magnesium group to produce bronchoconstriction to the same degree as seen in the placebo group. Quality of life, a subjective measure obtained by questionnaire, only improved in the magnesium group, added the researchers.

Friday, February 12, 2010

Food's Toxic Effect Part II

Food's Toxic Effect Part I (2007)

Many of us are aware of food allergies. These are immediate, catastrophic inflammatory responses to foreign proteins in foods or substances that we ingest (commonly known as anaphylaxis). It is estimated that 12 million Americans suffer from true food allergies. Most of us know if we have a true food allergy.

However, many of us are unaware of what approximately 72 million Americans suffer from: food intolerance. If our practice is any indication, we think the number of Americans with food intolerance is much higher than estimated.

Food intolerances are most indicated in individuals with inflammatory bowel problems which can include eosinophilic esophagitis, Crohn's disease, ulcerative colitis, and irritable bowel syndrome. Additionally, those with rheumatoid arthritis, osteoarthritis, post-traumatic arthritis, fibromyalgia, and migraines often have food intolerances.

Simply, when an intolerant food is presented to the digestive system, it has a toxic effect at the cellular level. Gluten intolerance is a perfect example of how a substance, in this case, the glue that holds grain together, attacks the cells in our digestive tract and creates a host of adverse effects. As the toxicity becomes more pronounced (cells begin to die or under perform), this is when we contract chronic conditions such as the aforementioned.

In our estimation, roughly 40% of our clientele have food intolerances. In most cases, if the food triggers are not discovered in the first few appointments, we run a Food Intolerance (Cytotoxic) blood test that covers 209 foods, spices, and preservatives. We have used the same lab, Biotrition in Rolling Meadows, for many years because their results are accurate and consistent.

In February 2007, to our delight, one of the few studies ever done on food intolerance was published. It was a resounding success and mirrored almost to the letter how we treat food intolerance.

Analysis of the Journal of the American College of Nutrition study

Subjects in this study had all failed to reduce their Irritable Bowel Sydrome symptoms using the standard therapies such as anti-cholinergics, anti-spasmodics, anti-diarrheals, and serotonergic agents.

The researchers hypothesized that identifying and removing trigger foods that create inflammation (IgG) in the gut, in addition to balancing the gut microfloral environment, would reduce the IBS symptoms. Their "hypothesis" paid off.

After using food intolerance blood testing almost identical to the testing that Nutritional Concepts' uses, the subjects were asked to the eliminate the foods that were discovered to be the strongest agitators. The most frequent positive reactions found in the subjects were (dairy does not appear because all subjects had removed dairy from their diets prior to participating in this study):

4 or more molds - 70%
Baker's yeast - 85%
Onion mix - 65%
Pork - 60%
Peanut - 60%
Corn - 55%
Wheat - 50%
Soybean - 50%
Carrot - 45%
Cheddar Cheese - 40%
Egg White - 40%

After testing each subject's microflora via comprehensive stool analysis, it was discovered that 100% of the subjects exhibited deficiencies of beneficial flora. They were put on high dose, broad-spectrum probiotic supplements.

The subjects were retested at six months and one year.
  • Diarrhea, a dominant symptom in the subject cohort, was drastically reduced after food elimination and probiotic supplementation. Daily stool frequency was also reduced from 4.29 to 3.43.
  • Pain frequency (1 - no pain to 5 - severe pain) resulted in significant improvement from 3.65 to 2.71.
  • Subjects also reported significant improvements in interference with activity, body image, health worry, social reaction, sexual function, and relationships.
  • Researchers also found significant colonization of beneficial microflora after supplementation.
  • The authors of this study note that the medical community's reticence concerning IgG testing should be challenged and re-evaluated as a result of these findings.
Bonnie - I am so proud of the University of Kansas researchers who had the guts to perform this study. The study's design is very similar to how we have treated clients with IBS and other digestive ailments when food intolerance is suspected. Of course, the results of the study are also very similar to what we see with clients who follow our suggestions. The authors did note that food elimination diets are extremely time consuming for the patient and practitioner. This is probably why many patients and practitioners do not engage the paradigm. It is not sexy, but very effective. As the authors said, patients and practitioners with high degrees of motivation to improve get results.

Food's Toxic Effect Part II (2010)

Another Journal of the American College of Nutrition study, published in June 2009, showed that juvenile patients with severe Crohn's disease went into remission without medication within two months when put on a food exclusion plan with dietary supplements. This should leave little doubt that removing intolerant foods and infusing with tolerated foods and nutrients not only helps, but heals.

Analysis of the Study

Most moderate-severe juvenile Crohn's disease patients are in a constant catabolic state resulting in poor weight and growth failure. Anti-inflammatory, immunomodulatory, and monoclonal antibody drugs, as well as growth hormone, frequently fail to achieve sustained remission or reverse growth failure.

Objective: The object was to test whether an exclusion diet with nutraceutical therapy could induce sustained clinical remission and weight gain.

Methods: Subjects with moderate-severe Crohn's disease were treated with adequate caloric and protein intake. Dairy products, all corn and whole grains
, and any foods containing carrageenan were eliminated. Dietary supplements including a multivitamin/mineral, probiotic, and two proprietary natural antiinflammatory complexes, were administered twice weekly.

Results: Within 2 months of starting the diet and nutrients, all subjects went into remission, with discontinuation of all pharmacological drugs. Half of the patients have remained in sustained remission for 4 to 8 years. Other patients symptoms reoccurred when they became less compliant. 75% of subjects had excellent growth response.

Conclusion: The exclusion of food intolerants commonly associated with moderate-severe Crohn's disease engendered prolonged remission and restoration of normal weight juvenile subjects. The findings, according to the Columbia University researchers, justify larger controlled trials to evaluate the long-term benefit of compliance of this protocol in both juvenile and adult Crohn's disease patients.

Bonnie - in a way, Nutritional Concepts is a large controlled trial that has been going on for more than twenty years. The results have been very successful for detecting and removing intolerant foods not just for Crohn's disease, but myriad disorders that go beyond just the digestive system. Do not hesitate to contact our office for more information about how we go about addressing food intolerance.

Aspartame rebranded as AminoSweet

Leading aspartame producer Ajinomoto is launching a new initiative that will brand the sweetener aspartame as AminoSweet. Ajinomoto believes that the time is right to remind the industry that aspartame tastes just like sugar, and that it’s made from amino acids – the building blocks of protein that are abundant in our diet.The name AminoSweet is appealing and memorable. It reflects that AminoSweet comes from the same amino acids that are abundant in the food we eat every day.

Bonnie - surprised? The reason is simple. Aspartame has such a horrible reputation that they must distance themselves from the name. Ajinomoto is banking on the fact that consumers are so clueless that we can be duped into thinking this is a new product.

Ajinomoto better be very careful about how they market AminoSweet. If they try link it to anything natural, consumers and the Federal Trade Commission will be all over them. Let me be perfectly clear. While aspartame may be derived from amino acids, there is nothing natural about it. Aspartame is pure chemicals that cause debilitating side effects. Please read my eNewsletter comments about it.

Please pass this along to anybody you wish to educate about this "wolf is sheep's clothing." For more info about the history of aspartame, please watch the fascinating, sobering documentary Sweet Misery.

Thursday, February 11, 2010

Study says junk food commercials = obesity

The association between television viewing and childhood obesity is directly related to children's exposure to commercials that advertise unhealthy foods, according to a new UCLA School of Public Health study published in the American Journal of Public Health. The study is the first to break down the types of television children watch to better determine whether different kinds of content may exert different effects on obesity.

The researchers gathered data from primary caregivers of 3,563 children, ranging from infants to 12-year-olds, in 1997. Through time-use diaries, study respondents reported their children's activities, including television viewing, throughout the course of an entire weekday and an entire weekend day. Caregivers were also asked to report the format -- television programs, DVDs or videos -- and the names of the programs watched. This data was used to classify television viewing into either educational or entertainment programming and to determine whether or not it contained advertising or product placement.

Among all children, commercial viewing was significantly associated with higher BMI, although the effect was stronger for children younger than 7 than for those older than 7. Non-commercial viewing, including watching DVDs or educational television programming, had no significant association with obesity.

According to the authors, the findings strongly suggest that steering children away from commercial television may be effective in reducing childhood obesity, given that food is the most commonly advertised product on children's television and the fact that almost 90 percent of children begin watching television regularly before the age of 2. By the time they are 5 years old, children have seen an average of more than 4,000 television commercials for food annually. During Saturday morning cartoons, children see an average of one food ad every five minutes. The vast majority of these ads -- up to 95 percent -- are for foods with poor nutritional value, the researchers say. "Commercial television pushes children to eat a large quantity of those foods they should consume least: sugary cereals, snacks, fast food and soda pop," the researchers said. "Educational television has come a long way since today's parents were children, and there are now many fantastic shows on commercial-free television and, of course, wonderful content available on DVD."

Steve - there's also a wonderful tool called DVR/TIVO where you can skip the commercials.

A healthy new market for Crestor

by Julie Deardorff
Chicago Tribune

The U.S. Food and Drug Administration recently approved the drug rosuvastatin (Crestor) for people who have not been diagnosed with heart disease, leaving some preventive cardiologists shaking their heads. Crestor costs $1,500 a year. It comes with side effects, including muscle pain, gastrointestinal disorders, a "confused state" and an increased risk of diabetes. And the FDA's expanded use of Crestor will encourage dependence on pharmaceutical drugs, critics say.

"Is this the best way to spend money to promote good health?" wondered Northwestern cardiologist Steve Devries, an associate professor of cardiology at the Feinberg School of Medicine. Instead, "our strongest push should be to encourage healthy lifestyle changes," Devries said.

That means focusing on diet and exercise, which the FDA says you should do while taking Crestor, anyway. The FDA approval means Crestor can now be marketed to men over age 50 and women over age 60 who have at least one traditional cardiovascular risk factor (smoking, high blood pressure, family history) and high levels of C-reactive protein (CRP), a biomarker for inflammation. Elevated CRP is associated with the buildup of cholesterol and other fatty material in the coronary arteries. Cholesterol medication is designed to lower so-called "bad" cholesterol. And it can play a vital role in certain situations, said Devries.

But high levels of CRP "can be treated with weight loss, exercise, smoking cessation, reduced intake of sugar-boosting carbohydrates and reduced intake of unhealthy fats," said Devries. Moreover, a Mediterranean diet has been shown to reduce the risk of cardiac problems by more than 70 percent, he said. "Public health efforts should be focused on developing innovative programs to encourage health lifestyles-changes that have a far broader potential for improving health -- and at a lower cost -- than any FDA approval can achieve," said Devries.

Bonnie - it is nice to see Dr. Devries step out and comment on this issue. I have known Dr. Devries for a long time and I appreciate his candor. Obviously, I am in total agreement.

As I said a long time ago, the powers-that-be want as many people to be on a statins as possible.

Wednesday, February 10, 2010

DHA supplements may improve chemotherapy outcome

According to researchers in a new study published in the British Journal of Cancer, “our data show for the first time that a dietary intervention targeted on DHA is a feasible approach that has potential to substantially increase survival in metastatic breast cancer patients treated with chemotherapy.” The new study, if supported by additional research, suggests that the omega-3 DHA may help improve survival by sensitizing tumors to chemotherapy.

As part of their anthracycline-based chemotherapy (FEC) regimen, 25 women were given additional DHA (1.8 grams per day) for between 2 and 96 months. After an average of 31 months, researchers found that the overall survival of women was 22 months, and reached 34 months in women with the highest DHA levels in their blood. “Although the median time to progression (6 months) and overall survival (22 months) in our study were within the frame of published data, it should be stressed that our patient population had a particularly poor prognosis, as 68 per cent had liver metastases in addition to other sites of metastases,” stated the researchers. “The median overall survival of patients having liver metastases was reported to be 14 months.”

Breast cancer drug does not work with some antidepressants

Tamoxifen -- a breast cancer medicine used by millions of women -- won't work when taken with some common antidepressants, a new study says. Tumors were more than twice as likely to return after two years in women taking antidepressants like Prozac, Zoloft and Paxil, compared with those taking the anti-cancer drug alone, the study showed. The research by Medco Health Solutions was presented Tuesday at a meeting of the American Society of Clinical Oncology in Orlando. Doctors began treating hot flashes with antidepressants, an unapproved use, after a study linked the former standard remedy, hormone replacement therapy, to an increased risk of breast cancer and heart attacks. Hot flashes are also a side effect of tamoxifen. Other types of antidepressants, such as Effexor, may be safer for women on tamoxifen, said Powel Brown, a cancer prevention expert at Baylor College of Medicine.

Tuesday, February 09, 2010

Med diet may lower thinking and memory problems

A Mediterranean diet may help people avoid the small areas of brain damage that can lead to problems with thinking and memory, according to a study that will be presented at the American Academy of Neurology’s 62nd Annual Meeting. The study found that people who ate a Mediterranean-like diet were less likely to have brain infarcts, or small areas of dead tissue linked to thinking problems.

For the study, researchers assessed the diets of 712 people in New York and divided them into three groups based on how closely they were following the Mediterranean diet. Then they conducted MRI brain scans of the people an average of six years later. A total of 238 people had at least one area of brain damage. Those who were most closely following a Mediterranean-like diet were 36 percent less likely to have areas of brain damage than those who were least following the diet. Those moderately following the diet were 21 percent less likely to have brain damage than the lowest group. “The relationship between this type of brain damage and the Mediterranean diet was comparable with that of high blood pressure,” said study author Nikolaos Scarmeas, MD, MSc, of Columbia University Medical Center in New York and a member of the American Academy of Neurology. “In this study, not eating a Mediterranean-like diet had about the same effect on the brain as having high blood pressure.”

Previous research by Scarmeas and his colleagues showed that a Mediterranean-like diet may be associated with a lower risk of Alzheimer’s disease and may lengthen survival in people with Alzheimer’s disease. The study was supported by the National Institutes of Health.

First Lady Michelle Obama Launches "Let's Move" Obesity Campaign

Courtesy USA Today

Today, the self-described "mom in chief" is launching Let's Move, a campaign to help other parents deal with a national health crisis she describes in epic terms. The goal: to eliminate childhood obesity in a generation.

"It's an ambitious goal, but we don't have time to wait," the first lady said in an interview with USA TODAY in her spacious office in the East Wing of the White House. "We've got to stop citing statistics and wringing our hands and feeling guilty, and get going on this issue." She says she intends to "sound the alarm" about the epidemic: About 32% of children and adolescents today — 25 million kids — are obese or overweight, according to the Centers for Disease Control and Prevention. Those extra pounds put kids at a greater risk of developing a host of debilitating and costly diseases, including type 2 diabetes, high blood pressure and high cholesterol.

A 2005 study found that kids today may lead shorter lives by two to five years than their parents because of obesity. Meanwhile, the costs "take your breath away," Obama says. Obesity costs the country a staggering $147 billion a year in weight-related medical bills, according to government data. Obama says she will use all the power of her White House pulpit to promote a multifaceted campaign that will include more healthful food in schools, more accurate food labeling, better grocery stores in communities that don't have them, public service announcements and efforts to get children to be more active. Some of her plans, such as tax incentives for businesses, will need congressional approval.

Let's Move ( aims to do for healthy eating and exercise what the government's anti-smoking campaign did in the 1960s: change how people think about their health. "The first lady having a huge microphone and a spotlight is really helpful," Health and Human Services Secretary Kathleen Sebelius says. "It's a big health crisis. We need to involve not only the kids but the families."

Ideas grew from a garden Obama, 46, is announcing the campaign a little more than a year after she and her daughters, Malia, 11, and Sasha, 8, moved into the White House on the day Barack Obama was sworn in as president. Obama said then that she would spend much of her first year in Washington making sure her kids adjusted to their new school and to life being shadowed by the Secret Service. But the seeds of the obesity campaign were planted months ago — in an organic White House garden she set up with the help of local elementary schoolchildren. And her passion for working on the problem grew. "The garden was an important first step — just sort of exploring the ideas around nutrition and children," Obama says. "I was curious to find out whether kids connected with this issue if we talked about it in terms of fun and gardening." And they did. "Kids from urban environments, from households (like) mine, who were raised on fried foods and good, tasty stuff, were fully engaged in the process of planting these vegetables and watching them grow and harvesting them and cleaning them and cooking them and eating them, and writing about how vegetables were their friends," she says. "So we thought we could be on to something here if we make this conversation a national conversation."

She is taking that conversation to schools around the country, mayors' organizations and the nation's governors. And her campaign has commitments from the nation's pediatricians, children's TV networks and websites such as Nickelodeon and sports teams such as the New York Yankees. Each will do whatever it can do best, she says, to spread the message that it matters what children eat and how much they move. Yankees centerfielder Curtis Granderson, who will be with Obama at today's announcement, says he wants to encourage kids to do what he did as a child: Put aside the video games and get outside and play. "We didn't realize the importance of it at the time," he says. "But we would be outside for hours at a time having fun."

Obama says her busy schedule in the next couple of years will reflect her commitment to the cause. Last week, she started by filming the campaign's first public service announcement, a direct message to parents. "I know from my own experience," Obama says. "I would move heaven and earth to give my kids all the chance in the world for them to be at the top of their game in every way, shape and form. Let's Move operates under the principle that every family wants the same thing for their kid. So we're going to figure out how to make it easier for them to get it."

That casual, down-to-earth approach as the mother of two girls has earned her higher approval ratings in the polls than her husband's since he took office. In an interview about the childhood obesity campaign, she wears gray slacks and a lavender sweater, the kind of everyday outfit that works for her whether she's hula-hooping with schoolchildren on the South Lawn or visiting federal agencies to thank employees for their hard work. The issues she's addressing are serious, but she says she will keep it conversational. "The tone, hopefully, that I approach this, is one that is inclusive, and not judgmental — and helpful."

Political observers say it's the right kind of campaign for a first lady who wants to make a difference but wants to be careful not to delve too far into policy the way Hillary Rodham Clinton did with health care when her husband held the presidency. "Childhood obesity is a no-downside issue," says Boston University journalism professor Elizabeth Mehren, who has written extensively about political spouses. "It's something that mothers can connect to, so it fits in with her 'first mom' agenda." At the same time, "it's a back-door connector to that very pressing issue for her husband: health care."

Others also applaud her choice, saying it goes beyond previous campaigns such as Nancy Reagan's anti-drug effort and Laura Bush's literacy push. "First ladies have taken on issues in the past, but this is different because childhood obesity is such a pressing public health concern," says Margo Wootan, director of nutrition policy for the Center for Science in the Public Interest, a consumer advocacy group. "Interest in nutrition is at an all-time high, and there is a lot of concern about the health and financial effects of obesity. "All the stars are aligned for her to make an impact."

Boston pediatric endocrinologist David Ludwig, one of the researchers who showed obesity may shorten kids' lives, says: "We can't just decry childhood obesity while continuing to condone junk food advertising aimed at young children and underfunding school lunch and physical education programs. What the first lady can do is help give momentum to that effort in a way few other people can."

The campaign will begin the way many government efforts do: with the appointment of a federal task force that will give government agencies 90 days to figure out what they plan to do to help. Obama's office already has lined up commitments from mayors, business leaders, grocery store owners, school lunch suppliers, non-profit groups, retailers and foundations. Other elements of the plan, several of which will need approval in Congress because they require new funding or offer tax breaks, include:

•The American Academy of Pediatrics will encourage its 60,000 members to check the body mass index (BMI), a number that takes into account height and weight, of all children at every checkup, and to give every child a kid-friendly prescription with suggestions for healthy, active living at those visits, says Judith Palfrey, president of the academy. The group had been working on the idea, and the campaign "was the magic moment to roll it out with the blessing of the first lady," she says.

•$400 million in tax credits and other incentives to get grocery stores to move into "food desert communities" where people don't have access to major grocery stores and have to rely on corner markets, convenience stores and hybrid gas stations that may charge more and have fewer healthful choices. It will also get fresh foods into smaller stores.

•A new foundation made up of existing foundations and groups to monitor the campaign.

•$25 million for schools to renovate their kitchens to replace deep fryers with equipment needed to store more produce and serve more nutritious food.

•$10 billion over 10 years for the Child Nutrition Reauthorization Act. Some of the money would be used to provide free and reduced-priced school meals for a million more children a year and to help schools serve more nutritious foods. Agriculture Secretary Tom Vilsack says he's encouraging schools to "focus on community gardens and school gardens, which can provide additional supplies."

Healthful eating at school is important: About 31 million kids eat lunch at school every day, and 11 million eat breakfast. Overall, kids consume about 30% to 50% of their calories in school. Reports from the Institute of Medicine, which advises Congress on health and science, recommend booting junk foods out of schools and making dramatic changes in school meals. Many companies are on board with improving school food, Obama says, by reducing the amount of salt, fat and sugar in school lunches and increasing the amount of whole grains and fresh produce. There are also changes to be made in the snacks provided to students. "There is no reason why we can't have water, healthy juice drinks in vending machines, granola bars, trail mix, whole-grain sandwiches," she says.

Just as important as better food, Obama says, is physical activity. The government recommends that children get 60 minutes or more of physical activity daily. Education Secretary Arne Duncan says improving food and physical activity at schools is "the right investment" of resources.

Despite her lofty goals, Obama says, she wants to reassure fellow parents that they don't have to make huge changes or break the bank to have an influence on their kids' weight and health. The Obama family has a chef now, of course, and the first lady no longer has to worry about whether she has time to cook healthful meals. But before she got to the White House, she says, she made a set of small changes to her girls' diets that made a difference. She started cooking once or twice a week more often than she had been. Instead of giving them juice boxes at meals and in their lunches, she gave them low-fat milk or water. And she eliminated after-dinner desserts on weekdays. "The kids didn't even notice," she says. "You take stuff out, they complain about it for, like, two seconds, and then it's like, 'OK, I'll drink the water.' "

She also says she doesn't want parents to beat themselves up if they slip up from time to time or get a little relaxed about the food they serve or the time their kids spend in front of a screen. "We don't have to be 100% perfect," she says. "My kids eat dessert. My kids watch TV. ... I love burgers and fries, and I don't want to live a life where I can never have them again. And if we told families and children that that was the answer, we'd never get there. "The beauty is we don't need to be 100% of the way there. If we get 20% of the way there, we will change the health status of our kids for a generation."

First Lady USA Today Interview

Bonnie - obviously, I am a big fan of the First Lady's initiative and I wish her the best in her endeavor. Like always, I will do my best to spread the word. My one worry, however, is that she will rely too much on pediatricians who are not well versed in promoting nutrition and have said as much. She should also include nutritionists and dietitians in the initiative. Research has also shown that pediatricians would like to discuss nutrition more during patient visits, however, they are not often reimbursed through insurance. This is something that must change.

Friday, February 05, 2010

Caffeine supports sports performance

Athletes can bolster their performance through the judicious use of caffeine, provided they use it responsibly and are mindful of possible side effects, according to the International Society of Sports Nutrition (ISSN). The organization released a 43-page position statement in the Journal of the International Society of Sports Nutrition detailing the performance-enhancing effects of caffeine and certain common misconceptions. Seven major points:
  1. Caffeine is effective for enhancing sport performance in trained athletes when consumed in low-to-moderate dosages (~3-6 mg/kg). Higher dosages do not result in additional performance benefits.
  2. Caffeine exerts a greater ergogenic effect when consumed in an anhydrous state as compared to coffee.
  3. Caffeine has been shown to enhance vigilance during bouts of extended exhaustive exercise, as well as periods of sustained sleep deprivation.
  4. Caffeine is ergogenic for sustained maximal endurance exercise and has been shown to be highly effective for time-trial performance.
  5. Caffeine supplementation is beneficial for high-intensity exercise.
  6. The literature is equivocal on caffeine’s benefit in strength-power performance.
  7. The scientific literature does not support caffeine induced dieresis during exercise or any harmful change in fluid balance that would negatively affect performance.
ISSN’s statement supported the use of caffeine not only for endurance activity but also in intermittent sports activities, and does exert a thermogenic effect on resting metabolic rate (RMR) at a dose as low as 100 mg. However, users are cautioned about using caffeine for enhancing performance if they are facing issues such as hormone imbalance, insomnia or chronic stress conditions.

Hidden danger of an aspirin a day

By Neena Abraham, M.D. (commentary appears in the NY Times)

If your physician has suggested you take aspirin to reduce your risk of heart disease, it is important to remember that even small doses of daily aspirin — including “baby aspirin,” at a dose of 81 milligrams daily — can increase your risk of ulcers and bleeding.

It is important to remember that all Nsaids, including over the counter aspirin, have the potential to damage the tissue of the gastrointestinal tract. Damage can occur anywhere, from mouth to anus. Over-the-counter doses of aspirin, or buffered or enteric coated aspirin preparations, do not eliminate the risk of developing an Nsaid-related ulcer. Your risk for bleeding is still two- to four-fold greater than if you were not taking the aspirin product at all. This risk increases in magnitude as the dose of the aspirin increases.

Some studies have suggested that one-third of aspirin-induced ulcers are related to over-the-counter aspirin use. The excess ulcer bleeding risk associated with aspirin use is estimated at 5 extra cases per 1,000 patients per year. However, it is important to remember that your risk of aspirin-induced ulcer will further increase if you have high-risk features such as: being older than 60, having a history of gastric or duodenal ulcer, having active Helicobacter pylori infection (the bacterium linked to ulcers), taking aspirin at the same time as you take full strength Nsaids (such as ibuprofen, Motrin and naproxen), anticoagulants (such as warfarin) or antiplatelet agents (such as clopidogrel or ticlopidine); or taking aspirin if you are a chronic steroid user.

Aspirin is not a nutritional supplement — it is a medication with real risks and side-effects, so it should not be taken without explicit cardiovascular risk assessment by your physician. If you and your doctor determine that the benefit of taking aspirin to prevent heart disease exceeds the risk of gastrointestinal bleeding, ensure you are only taking the minimum dose of aspirin required for cardiovascular risk reduction (in the United States, that is a dose of 81 milligrams a day). If you have high-risk features for aspirin and Nsaid-induced ulcers, as discussed above, discuss with your physician the appropriateness of taking a stomach protecting medication, such as a proton-pump inhibitor. It may also be important to be tested and treated for H. pylori infection to minimize your risk of ulcer formation.

Bonnie - once again, not exactly news for my clientele. And this doc is sugar-coating the dangers in the piece.