Wednesday, June 23, 2010

Bonnie's Blog is on hiatus until July 8th.

What a perfect time to catch up on over 350 entries made so far in 2010!

Tuesday, June 22, 2010

US invests in disease prevention

The US Department of Health and Human Services (HHS) has earmarked $250m for investment in the prevention of chronic diseases. The second part of the Prevention and Public Health Fund, announced last week by US Department of Health and Human Services Secretary Kathleen Sebelius, is designed to promote public health and wellness by developing the nation’s health infrastructure.

According to HHS, chronic diseases such as these are responsible for 7 of 10 deaths each year among Americans, and account for 75 percent of the nation’s health spending. The $250m investment under this new fund is designed to tackle some of the underlying causes of chronic disease. It will be channeled into initiatives on a federal, state and community level to help prevent obesity and improve fitness. It will also be used to support the existing public health infrastructure, to develop research and tracking and to expand public health training initiatives.

Earlier last week, Secretary Sebelius announced the allocation of the first half of the Prevention and Public Health fund to increase the number of clinicians and strengthen the primary care workforce. “With these investments and others, the Affordable Care Act is continuing the Obama Administration’s historic work to promote wellness and reduce chronic disease. The new law also calls for a national strategy to improve the nation’s health, eliminates co-pays for key preventive services like cancer screenings, and provides new support for employer wellness programs,” said HHS.

Bonnie - while this is a start, the "devil is in the details." How the money will be allocated has yet to be revealed. In addition, there needs to be a lot more than $250 million invested in prevention of chronic disease. But as i said, this is a start, which I could not say previously.

Beneficial mouth bacteria helps infection: study

Bacteria in the mouth may offer probiotic potential against upper respiratory tract infections, according to a study in journal Applied and Environmental Microbiology. So far, the benefits of probiotics have been predominantly explored in the intestinal tract, however, other initial studies suggest probiotics may contribute to wellness in the stomach, vaginal tract, skin and mouth. Upper respiratory tract infections are the leading cause of visits to the pediatrician, especially in children between the ages of 5 and 12.

Bacteria newly isolated from the mouths of healthy volunteers were analyzed and two potential probiotic bacterial strains, Streptococcus salivarius RS1 and ST3, were identified. Following comparison with a recently developed oral probiotic prototype, S. salivarius strain K12, all three bound to human pharyngeal cells and antagonized S. pyogenes (the upper respiratory culprit) adhesion and growth. Additionally, all were sensitive to antibiotics routinely used for treating upper respiratory tract infections.

Steve - if we could use probiotics as treatment instead of antibiotics, that would be a much safer solution for the general population.

Ghrelin's (a.k.a gremlin) craving affect

The "hunger" hormone ghrelin, which acts in the brain to stimulate hunger and increase food intake, heightens the appeal of high-calorie foods over low-calorie foods, according to a study being presented at The Endocrine Society's 92nd Annual Meeting in San Diego.

The results also suggest that an increased release of ghrelin from the stomach into the blood may explain why a person who skips breakfast also finds high-calorie foods more appealing than low-calorie foods.

Bonnie - as we stated in a recent eNewsletter, testing leptin, the hormone which keeps ghrelin in balance, can assist with minimizing cravings brought upon by ghrelin if you are found to be deficient.

Monday, June 21, 2010

Coffee, tea shown to benefit heart

Drinking several cups of tea or coffee a day appears to protect against heart disease, according to a 13-year-long study from Journal of the American Heart Association. Those who drank more than six cups of tea a day cut their risk of heart disease by a third, the study of 40,000 people found. Consuming between two to four coffees a day lowered the risk of the disease by 20%.

Friday, June 18, 2010

Higher HDL associated with lower cancer risk

An inverse and significant association exists between levels of high-density lipoprotein (HDL) cholesterol and the risk of incident cancer. Researchers report in the Journal of the American College of Cardiology that even after adjustment for multiple variables, there was a 36% lower risk of cancer for every 10-mg/dL increase in HDL cholesterol.

People with high levels of HDL (the good cholesterol) are unlikely to die of heart disease, but this finding that subjects were also less likely to get cancer is significant.

Sugary foods linked to pancreatic cancer risk

Courtesy of Reuters Health

People with diets high in sweets and other foods that cause rapid blood-sugar spikes may have a higher risk of developing pancreatic cancer than those who eat less of those foods. In a study of nearly 1,000 Italian adults with and without pancreatic cancer, researchers found that those whose diets were high in so-called "glycemic index" showed a greater risk of the cancer than participants whose diets were relatively low-glycemic index. This suggests that sugary, processed carbohydrates -- rather than carbs like fiber-rich grains, fruits and vegetables -- may be particularly linked to pancreatic cancer, the researchers report in the Annals of Epidemiology.

Steve - according to the 2010 Dietary Guidelines Committee recommendations, glycemic index has no affect on disease. It shows just how up on the research the committee really is.

Thursday, June 17, 2010

Meditteranean diet strikes again

A study of twins shows that even with genes that put them at higher risk of cardiovascular disease, eating a Mediterranean-style diet can improve heart function, according to research reported in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association. Using data from the Emory Twins Heart Study, researchers found that men eating a Mediterranean-style diet had greater heart rate variability (HRV) than those eating a Western-type diet. Heart rate variability refers to variation in the time interval between heart beats during everyday life -- reduced HRV is a risk factor for coronary artery disease and sudden death.

Father's Day Prostate Plan

Men are more often delinquent in adhering to preventative practices than women. When it comes to prostate prevention, men should not procrastinate. Safe prostate health prevention recommendations (specifics must be discussed with your licensed health professional):

Majority of the Male Population (if well tolerated) -

Vitamin D
Levels should be taken every year to ascertain the optimal vitamin D3 dose for you. American Journal Lifestyle Medicine 12/2009

Polyphenols (green tea, red wine, black coffee): the FASEB Journal explains that antioxidants in red wine and green tea produce a combined effect to disrupt an important cell signaling pathway necessary for prostate cancer growth.

Cruciferous Vegetable Family
Broccoli, Cauliflower, Bok Choy, Cabbage, Brussels Sprouts, among others;
Food Chemistry 10/2008

EPA/DHA Omega 3
Clinical Cancer Research 4/2009, Journal Nutrigenetics and Nutrigenomics 10/2009

Journal Nutrition 9/2009, American Journal Clinical Nutrition 9/2009

Selenium and Vitamin E Combination
Journal of the National Cancer Institute 2/2009

If Family History of Prostate Problems, Chronic Inflammation, or Benign Prostatic Hyperplasia, add one or more of the following:

Saw Palmetto Complex

Saw palmetto berry extract in combination with other prostate nourishing nutrients such as pumpkin and pygeum seed is suggested.
Some clinical studies show that saw palmetto is comparable in efficacy to finasteride (Proscar) and saw palmetto might be better tolerated. Cochrane Database Review 2002 (3)

Ground Flaxseed or Fermented Soy
American Journal Clinical Nutrition showed an association between consumption of soy foods and 26% lower incidence of prostate cancer risk in men who consume them as opposed to those that do not. The risk was lower in men who consumed organic fermented soy foods as opposed to nonfermented.

Pomegranate Fruit/Pomegranate Juice Concentrate
No more than 4 oz. daily. Journal of Nutritional Biochemistry 1/2009

If You Have Localize Prostate Cancer, add one or more of the following if authorized by your oncologist:

Large doses of Vitamin B-6 (25-50 mg.)
American Journal Clinical Nutrition 8/2009

High levels of vitamin A (retinol)
Men with the highest concentrations of vitamin A had a slightly lower risk of prostate cancer overall, but had a 42 percent reduction in aggressive prostate cancer risk.
Cancer Epidemiology Biomarkers & Prevention 4/2009

General Notes

False Positives with PSA Screening
  • One in eight men screened for prostate cancer will test positive when they do not have the disease. A positive result can mean undergoing invasive tests such as biopsy as well as potentially unnecessary treatment. A European study of those screened with prostate specific antigen (PSA) who tested positive but were later found not to have cancer were twice as likely not to agree to screening in the future even though they were at risk of developing the disease later, the British Journal of Cancer reported. Study leader, Dr Tuomas Kilpelainen, said: "I don't think routine screening should be advised until more is known on the adverse effects and costs of screening."
  • Two decades after the explosion in cancer screening fueled by reimbursement for prostate specific antigen (PSA) testing, a new analysis suggests that it is time to rethink the push for early detection of these two cancers. There is no argument that more cancers are being detected and at a much earlier stage, but that increase has not resulted in a decrease in metastatic disease, according to Laura Esserman, MD, MBA, of the University of California, San Francisco, and colleagues, who made their case in a special communication published in the October 21, 2009 issue of the Journal of the American Medical Association.
  • Men who are diagnosed with prostate cancer will probably live a full and long life without needing surgery. Only those who have very aggressive cancers should consider a radical prostatectomy, say researchers from the Memorial Sloan-Kettering Cancer Center. Those diagnosed with the cancer can expect to live for at least a further 15 years, especially if the cancer is slow-growing, without needing to have any treatment, according to a Journal of Clinical Oncology study of 12,677 men.
Balancing Blood Sugar
Minimizing refined carbohydrates, eating balanced meals/snacks, and minimizing or eliminating added sugars is crucial for prostate prevention.

Wednesday, June 16, 2010

Vitamin D reduce flu, respiratory illness

Vitamin D may reduce the incidence and severity of viral respiratory tract infections, including influenza, according to a new study published in journal PloS ONE. Researchers followed 198 healthy adults during the fall and winter 2009 to 2010 to determine if the declining concentrations of vitamin D seen in the fall and winter in a temperate climate could be a factor in the seasonal increased prevalence of respiratory viral infections such as the flu. In the double blind study, participants had blood samples drawn monthly using a 25-hydroxyvitamin D test to measure vitamin D levels. Participants reported any evidence of an acute respiratory tract infection (nasal congestion, sore throat, and/or cough with or without fever, chills, fatigue and general malaise). Of the 18 participants who maintained vitamin D levels of 38 ng/ml or higher during the study period, only three developed viral infections. Of the 180 other participants, 81 developed viral infections. Those with the higher vitamin D levels also experienced a marked reduction in the number of days ill. The findings suggest supplementing with vitamin D to achieve a blood level 38 ng/ml or higher could result in a significant health benefit by reducing the incidence of viral infections of the respiratory tract.

Steve - CDC, are you paying attention?

Bonnie's Critique of 2010 Dietary Guidelines for Americans

Bonnie - 700 pages for this? Nothing in this report is groundbreaking for our clientele except that the committee acknowledged the presence of not just food allergy, but food intolerance as a major issue affecting Americans which needs to be recognized. Most of the recommendations support what is already known. Other recommendations are clearly meant to placate food industry groups. Here is what we found to be meaningful.

-Gradually reduce total sodium intake to 1500 mg/day.

-Dietary monounsaturated fatty acids (MUFA) are associated with improved blood lipids related to both CVD and T2D, when MUFA is a replacement for dietary saturated fats. Increased MUFA intake, rather than high carbohydrate intake, may be beneficial for persons with T2D. High MUFA intake, when replacing a high carbohydrate intake, results in improved biomarkers of glucose tolerance and diabetic control. Bonnie - monounsaturated fats come from sources such as olive oil.

-Saturated fat is positively associated with intermediate markers and end point health outcomes for two distinct metabolic pathways: 1) increased serum total and LDL cholesterol and increased risk of CVD and 2) increased markers of insulin resistance and increased risk of Type 2 Diabetes. The evidence shows that 5 percent energy decrease in SFA, replaced by MUFA or PUFA, decreases risk of CVD and T2D in healthy adults and improves insulin responsiveness in insulin resistant and T2D individuals. Bonnie - the committee went after saturated fats in a big way, while mostly ignoring grain carbohydrates.

-Consumption of one egg per day is not associated with risk of CHD or stroke in healthy adults, although consumption of more than seven eggs per week has been associated with increased risk.

-Consumption of two servings of seafood per week (4 oz per serving), which provide an average of 250 mg per day of long-chain n-3 fatty acids, is associated with reduced cardiac mortality from CHD or sudden death in persons with and without CVD.

-Increased maternal dietary intake of long chain n-3 PUFA (EPA/DHA), in particular docosahexaenoic acid (DHA) from at least 2 servings of seafood per week, during pregnancy and lactation is associated with increased DHA levels in breast milk and improved infant health outcomes, such as visual acuity and cognitive development.

-Unsalted peanuts and tree nuts, specifically walnuts, almonds, and pistachios, in the context of a nutritionally adequate diet and when total calorie intake is held constant, has a favorable impact on cardiovascular disease risk factors, particularly serum lipid levels.

-Avoid trans fatty acids from industrial sources in the American diet, leaving small amounts from trans fatty acids from natural (ruminant) sources. Bonnie - some dairy products and meats contain conjugated linoleic acid, a natural form of trans fat which is not harmful.

-When stearic acid is substituted for other saturated fats or trans fatty acids, plasma LDL cholesterol levels are decreased; when substituted for carbohydrates, LDL cholesterol levels are unchanged. Bonnie - stearic acid is often used as an excipient in dietary supplements.

-Added sugars, including sugar-sweetened beverages, are no more likely to cause weight gain than any other source of energy. Bonnie - this is hilarious. An obvious placation of the soft drink lobby.

-Individuals who use non-caloric sweeteners are more likely to gain weight or be heavier. This does not mean that non-caloric sweeteners cause weight gain rather that they are more likely to be consumed by overweight and obese individuals. Bonnie - the second comment is them covering for the first comment, which is the most provocative statement so far.

-Gut microflora play a role in health, although the research in this area is still developing. Foods high in prebiotics (wheat, onions, garlic) may be consumed, as well as food concentrated in probiotics (yogurt), within accepted dietary patterns.

-Total grains servings are typically over-consumed in the US, so recommendations to consume more grains are not supported by this review. Bonnie - while encouraged by not recommending an increase, there should have been a reduction, to be replaced by vegetables.

-The DRI committee concluded that evidence was insufficient to set a Tolerable Upper Intake Level (UL) for carbohydrates. However, a maximal intake level of 25 percent or less of total calories from added sugars was suggested by the panel. Bonnie - this report is full of double talk, as seen here. This statement contradicts the "no increase in carbs" from above. 25 percent of carbs from added sugars (empty calories)? How will that help the obesity epidemic?

-Strong evidence demonstrates that intake of milk and milk products provide no unique role in weight control. Bonnie - The Dairy Council is probably fuming over this statement.

-Glycemic index and/or glycemic load are not associated with body weight and do not lead to greater weight loss, better weight maintenance, or cancer. While a relationship between high glycemic index and type 2 diabetes exists, there is little association between glycemic load and type 2 diabetes. No conclusion can be drawn to assess the relationship between either glycemic index or load and cardiovascular disease. Bonnie - this is hogwash. There is a plethora of evidence supporting glycemic load/index. This is protection for Big Sugar and Big Grain

-For both adults and children: vegetables, fruits, whole grains, fluid milk and milk products, and oils are underconsumed.

-For both adults and children: vitamin D, calcium, potassium, and dietary fiber are underconsumed.

-Strong and consistent evidence demonstrates a large reduction in the incidence of neural tube defects (NTDs) in the US and Canada following mandatory folic acid fortification.

-Substantial numbers of adolescent girls and women of reproductive capacity have laboratory evidence of iron deficiency.

-A substantial proportion of individuals older than age 50 years may have reduced ability to absorb naturally occurring vitamin B12 but not the crystalline form.

-For the general, healthy population, there is no evidence to support a recommendation for the use of multivitamin/mineral supplements in the primary prevention of chronic disease. Limited evidence suggests that supplements containing combinations of certain nutrients are beneficial in reversing chronic disease when used by special populations; in contrast, certain nutrient supplements appear to be harmful in other subgroups. Bonnie - obviously, we vehemently disagree with these statements. The head of the DGA committee is also the head of the American Dietetic Association, which came out earlier this year supporting a multivitamin/mineral. So where is the disconnect?

-Maternal weight gain during pregnancy outside the recommended ranges is associated with suboptimal maternal and child health. Women who gain weight excessively during pregnancy retain more weight after delivery, are more likely to undergo a cesarean section and to deliver large-for-gestational age newborns, and their offspring may be at increased risk of becoming obese later on in life.

-Moderate, consistent evidence shows that US consumers do not clean their refrigerators following available guidance, which impacts food safety. Bonnie - this is something that we should all do at least once or twice per year.

-Moderate, consistent evidence shows that health benefits derived from the consumption of a variety of cooked seafood in the US in amounts recommended by the Committee outweigh the risks associated with methyl mercury (MeHg) and persistent organic pollutants (POPs) exposure, even among women who may become or who are pregnant, nursing mothers, and children ages 12 and younger. Overall, consumers can safely eat at least 12 oz. of a variety of cooked seafood per week provided they pay attention to local seafood advisories and limit their intake of large, predatory fish. Women who may become or who are pregnant, nursing mothers, and children ages 12 and younger can safely consume a variety of cooked seafood in amounts recommended by this Committee while following Federal and local advisories.

-On average, Americans of all ages consume too few vegetables, fruits, high-fiber whole grains, low-fat milk and milk products, and seafood and they eat too much added sugars, solid fats, refined grains, and sodium. SoFAS (added sugars and solid fats) contribute approximately 35 percent of calories to the American diet. This is true for children, adolescents, adults, and older adults and for both males and females. Reducing the intake of SoFAS can lead to a badly needed reduction in energy intake and inclusion of more healthful foods into the total diet. Bonnie - the devil is in the details. The total reduction the committee suggests is only 3 percent (if maximum 25 percent from added sugars and 7 percent from saturated fats = 32 percent). How is that going to make a difference?

-Patterns of eating that have been shown to be healthful include the Dietary Approaches to Stop Hypertension (DASH)-style dietary patterns and certain Mediterranean-style dietary patterns.

-Improve the availability of affordable fresh produce through greater access to grocery stores, produce trucks, and farmers’ markets.

-Increase environmentally sustainable production of vegetables, fruits, and fiber-rich whole grains.

-Develop safe, effective, and sustainable practices to expand aquaculture and increase the availability of seafood to all segments of the population. Enhance access to publicly available, user-friendly benefit/risk information that helps consumers make informed seafood choices.

-Encourage restaurants and the food industry to offer health-promoting foods that are low in sodium; limited in added sugars, refined grains, and solid fats; and served in smaller portions.

-Selected behaviors that lead to a greater propensity to gain weight include too much TV watching, too little physical activity, eating out frequently (especially at Quick Service Restaurants [i.e. fast food restaurants]), snacking on energy-dense food and drinks, skipping breakfast, and consuming large portions. Self-monitoring, including knowing one’s own calorie requirement and the calorie content of foods, helps make individuals conscious of what, when, and how much they eat. Mindful, or conscious, eating is an important lifestyle habit that can help to prevent inappropriate weight gain, enhance weight loss in those who should lose weight, and assist others in maintaining a healthy weight.

-Individuals also should increase their consumption of dietary potassium because increased potassium intakes helps to attenuate the effects of sodium on blood pressure.

-An average daily intake of one to two alcoholic beverages is associated with the lowest all-cause mortality and a low risk of diabetes and coronary heart disease among middle-aged and older adults. Despite this overall benefit of moderate alcohol consumption, the DGAC recommends that if alcohol is consumed, it should be consumed in moderation, and only by adults. Moderate alcohol consumption is defined as average daily consumption of up to one drink per day for women and up to two drinks per day for men, with no more than three drinks in any single day for women and no more than four drinks in any single day for men. One drink is defined as 12 fl. oz. of regular beer, 5 fl. oz. of wine, or 1.5 fl. oz. of distilled spirits.

Written comments to the USDA will be accepted from June 15, 2010, to July 15, 2010.

Tuesday, June 15, 2010

Initial thoughts after reviewing the 2010 Dietary Guideline recommendations

Steve - They were published this morning and we will provide you detailed comments about its contents tomorrow.

The initial perception would be what you would expect...underwhelming. There are way too many special interests to appease. I can say that the testimony during the fact-finding process that had a chance to make meaningful change does not appear. The most important piece was to reduce grains servings by two and replacing with vegetables. After Big Grain sent a letter objecting, this recommendation is absent. And of course, milk is still the love child of the committee.

While there are some positive, yet rudimentary, conclusions, the most important aspects are more of the same.

Blood pressure drug raises cancer risk

Researchers said an analysis of available data on drugs in the class known as angiotensin-receptor blockers showed patients were 1.2 percent more likely to be diagnosed with a new cancer over four years than others who did not take the drugs. Most patients in the trials (86 percent) took Micardis, which has annual sales of more than $1.5 billion."The increased risk of new cancer occurrence is modest but significant," Dr. Ilke Sipahi and colleagues from Case Western Reserve University in Cleveland and colleagues wrote in the journal Lancet Oncology.

Dr. Steven Nissen, a cardiologist at the Cleveland Clinic, said in a commentary the findings were "disturbing and provocative, raising crucial drug safety questions for practitioners and the regulatory community." He said regulators need to look more closely at the risk of cancer with ARB use and that doctors should be more cautious about prescribing ARBs, and especially Micardis.

Bonnie - does anyone else notice the uptick in side effects of commonly prescribed medication? Is the FDA actually paying attention now? How asinine does it seem for Big Pharma to start paying the public to take these drugs?

There are proven ways to support optimal blood pressure without medication when working with a licensed health professional.

Vaccine contraindicated in certain infants

Rotavirus vaccine should not be administered to infants with severe combined immunodeficiency (SCID), according to the Centers for Disease Control and Prevention (CDC) and US Food and Drug Administration (FDA)-approved prescribing information and patient safety labeling. Both monovalent (RV1) and pentavalent (RV5) rotavirus vaccines are contraindicated in infants diagnosed with SCID and can cause vaccine-acquired infection. The CDC announced this new contraindication to rotavirus vaccine in the June 11 issue of Morbidity and Mortality Weekly Report.

The rotavirus vaccine is recommended by the Advisory Committee on Immunization Practices to be given to infants at ages 2 and 4 months for RV1 and ages 2, 4, and 6 months for RV5. This timeframe for rotavirus vaccination overlaps with the median age of 4 to 7 months when infants are usually diagnosed with SCID. Rotavirus vaccine is indicated for the prevention of rotavirus gastroenteritis in infants. The CDC advises parents to consult with an immunologist or infectious disease specialists before rotavirus vaccine is administered to infants with confirmed or suspected altered immunocompetence. Morb Mortal Wkly Rep. 2010;59:687-688.

Bonnie - this is yet another example of the lack of adequate safety studies being performed before a vaccine is released. Doing so could have helped the parents of infants with these disorders make more informed decisions.

Quercetin shines again: study

Asthma, cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) are serious and even life-threatening conditions. However, these health problems share something with a usually minor infection -- the common cold. The connection? Rhinovirus (RV), a single-stranded RNA virus from the picornaviridae family, causes the majority of colds and RV is also known to trigger exacerbations of CF, asthma and COPD.

But now University of Michigan at Ann Arbor scientists have found that a natural substance, the flavonoid quercetin, puts the brakes on the ability of Rhinovirus (RV) to replicate. It also fights inflammation. According to their research just presented at the American Thoracic Society (ATS) 2010 International Conference held in New Orleans, quercetin could be a treatment for rhinovirus-caused infections and could be particularly beneficial for people with serious underlying chronic lung diseases.

The research team tested quercetin on cells infected with RV. The results suggested that quercetin actually inhibited the ability of the virus to replicate. The flavonoid also appeared to reduce the RV-triggered immune system response that can cause cytokines (proteins that are secreted by specific cells of the immune system) to induce excess inflammation. "Therefore, quercetin may be beneficial in the treatment of viral infections, particularly in patients with underlying chronic lung disease," the researchers stated.

DDS-1 strain improves dermatitis

Steve - the supplement used in this study, UAS Labs DDS Plus, is one of the main probiotic supplements we recommends.

A study has found that supplementation with probiotics for two months had significant benefits for children with atopic dermatitis. Conducted using a mixture of probiotics from UAS Laboratories, the study involved 90 preschool children with moderate to severe atopic dermatitis (AD). AD, also known as Eczema, is one of the first signs of allergy during the early days of life and is said to be due to delayed development of the immune system.

Presented last week at the New York Academy of Sciences symposium Probiotics: From Bench to Market, the current study was designed to determine the impact of a mixture of L. acidophilus DDS-1 and B. lactis UABLA-12. The double blind placebo controlled study involved two groups of children aged one to three. One group received doses of the probiotics twice a day, while the second group received a placebo. After four weeks, the decrease in the group taking probiotics was almost 34 per cent after eight weeks, while the placebo group demonstrated a decrease of 19 per cent. Secondary outcomes included corresponding lymphocyte subset changes in peripheral blood.

Monday, June 14, 2010

Pill popping payola.

Steve - Big Pharma has a great deal for you. When you're not taking your medicine or forgo it all together, they'll pay you to be more compliant.

This New York Times article exposes a strategy we knew Big Pharma was looking into several years ago. The idea, which is being embraced by doctors, pharmacy companies, insurers and researchers, is that paying modest financial incentives up front can save much larger costs of hospitalization.

For instance, in a Philadelphia program people prescribed warfarin, an anti-blood-clot medication, can win $10 or $100 each day they take the drug — a kind of lottery using a computerized pillbox to record if they took the medicine and whether they won that day.

Aetna has begun paying doctors bonuses for prescribing medication likely to prevent problems: beta blockers to prevent heart attacks, statins for diabetes sufferers. Currently, 93,000 doctors are in Aetna’s “pay for performance” program; bonuses average three percent to five percent of a practice’s base income.

CVS Caremark began by discounting copayments for employees of some corporations in its drug plans, to encourage prescription filling, and is studying “the ‘I’ll pay you $10 a month to be adherent’ approach, the lottery approach,” and other incentives, said Dr. Troy Brennan, the chief medical officer.

Even the new federal health care overhaul includes incentives, expanding a program paying pharmacists extra for helping some Medicare patients learn to take pills correctly.

There are so many aspects of this strategy that are wrong that I don't know where to begin. They sure picked a perfect time to introduce this: when people are hurting financially.

Do not let any of the stakeholders fool you into believing that this is anything but a guaranteed path to achieving a Niagra Falls-sized financial windfall. Not taking into account existing patients on meds, how many millions more will be brought into the fold with the lure of financial incentives?

How sad for these patients who will accrue small sums of money, but fail to realize that it will be regurgitated back to the stakeholders in the form of higher taxes, higher insurance premiums, and higher drug prices.

The only explanation for this action is desperation on every front, including the patients that participate.

The funny thing is, as much or more money could be saved by preventing the hundreds of thousands of hospitalizations that occur every year because of the side effects of medication.

Do you feel the same way? We'd like to hear from you.

FDA rebukes Pfizer's handling of blockbuster drugs' serious adverse events

The FDA has sent a 12-page letter to Pfizer, rebuking the company for not swiftly reporting serious potential adverse effects of several approved drugs, including its blockbuster statin, atorvastatin (Lipitor). According to the May 26, 2010 letter, delays in reporting adverse events date back six years and have been growing more common: between March 2006 and December 2008, roughly 4% of more than 80, 500 reported complaints were sent late to the FDA; between December 2008 and June 2009, 9% of reports were sent late. The FDA stipulates that companies pass on information about adverse drug reactions to the agency within 15 days. Director of the FDA's New York office, Ronald Pace, sent the letter to Pfizer CEO Jeffrey Kindler, complaining that the company had not adequately documented or investigated reports of problems in patients taking some of its best-selling drugs, among them sildenafil (Viagra) and pregabalin (Lyrica), as well as Lipitor.

Pace cited "serious and unexpected adverse events . . . that were not submitted until they were identified during [a July–August 2009] inspection" of Pfizer headquarters. The agency also accused the company of misclassifying and/or downgrading reports of adverse events to "nonserious" without providing reasonable justification for doing so.

Steve - the delays and downgrading of serious adverse events should not surprise anyone.
What should surprise us is the FDA's very public rebuke.

The cult of celebrity doctors

Bonnie - Marni Jameson of the Los Angeles Times wrote this great piece on America's obsession with following the advice of celebrity doctors and gurus.

On occasion, clients question my advice when it differs from what television personalities such as Dr. Oz or Dr. Weil say.

In this excerpt, Marni explains exactly what I usually say to clients.

"One size does not fit all.

Seeking celebrity advice is not a health habit most doctors would recommend.

"If people have seen these doctors on television, they don't really care about their credentials; they assume they wouldn't be on TV unless they'd been screened and given the network stamp of approval," says Dr. Tom Linden, a psychiatrist and former broadcast journalist who is now a professor of medical and science journalism at the University of North Carolina, Chapel Hill.

"We project onto these celebrities traits, wisdom and other abilities that they may or may not have," Linden says.

Yet the reliance on media-savvy medical gurus is understandable, in a way.

The cost of going to the doctor, the limited time patients get for visits and the increasingly restricted access to specialists have combined to push people away from their doctor's office and toward the Internet and its panel of celebrity experts, said David Halle, professor of sociology at UCLA.

"The risk is that these celebrity doctors deliver one-size-fits-all medicine."

Linden says today's celebrity doctors can be divided into two broad categories: medical journalists and medical showmen.

"The journalists operate under journalistic principles," he says. "The others operate outside the sphere of journalism and are in the world of informational entertainment."

Celebrity doctors have a purpose in bringing awareness to public health issues. However, to follow their advice to the letter is like joining lemmings to the sea. You are not one size fits all!

Friday, June 11, 2010

Canada Knocks Out Flu, U.S. Public Kept In The Dark

Another reason for your kids to take Cod Liver Oil

Courtesy of Medscape Medical News

Levels of childhood sun exposure and the presence or absence of cod liver oil supplements predict age at onset of multiple sclerosis (MS), a new study suggests. "There's been demonstrated to be a north–south gradient in multiple sclerosis incidence, and migrating later on in life, even after a diagnosis of MS, from a colder to a warmer climate, has been associated with an improvement in disease course," Walter Royal, III, MD, associate director for research at the Veterans Affairs MS Center of Excellence, East, Baltimore, MD, who presented the work here at the Consortium of Multiple Sclerosis Centers 24th Annual Conference and the Third Joint Meeting of Americas Committee for Treatment and Research in Multiple Sclerosis.

Vitamin D is known to affect immune system functions that appear to benefit MS and other autoimmune diseases. The new research further demonstrates that "early experience can have a lasting effect," Dr. Royal added. Previous studies have shown that childhood sun exposure and cod liver oil supplements are associated with reduced risk of developing MS. In this report, the researchers examined a national cohort of veterans to determine whether these environmental factors affected the timing of symptom onset.

Participants were recruited from the nationally representative Veterans Health Administration Multiple Sclerosis Surveillance Registry, which includes age at MS symptom onset, disease subtype, home address location history, sun exposure, and intake of high vitamin D–content foods. All information was available by 5-year increments. For each participant, the researchers estimated past sun exposures for fall/winter and spring/summer seasons. They used latitude, altitude, and ultraviolet radiation count of the reported home residences to estimate solar radiation exposure. Multiple regression analysis was then used to link these variables to age at MS onset. The study included 948 patients with relapsing MS. For those living in low– to medium–solar radiation areas, the researchers found a significant association between earlier age at onset of symptoms and sun exposure in the fall/winter season between the ages of 6 and 15 years. Intake of cod liver oil during childhood produced a 3-year delay in onset. Vitamin D levels are frequently low in patients with MS, and physicians often prescribe supplements. The results of this study imply that such the strategy should be successful in changing the course of the disease, and that children of patients with MS should receive vitamin D supplements, according to Dr. Royal.

However, given the concerns today about sun exposure, many children are encouraged to spend less time in the sun, or to wear skin protection when they do. MS also has a relatively low family incidence, so identifying at-risk children is difficult, according to James Simsarian, MD, director of the Multiple Sclerosis Program at the Neurology Center of Fairfax, Virginia, who attended the session here. "We've always talked about environmental factors at play [in developing MS], and [vitamin D exposure] could be one of them," Dr. Simsarian told Medscape Neurology.

Bonnie - Dr. Simsarian, the association is not "could be," it is definitely! First, sun exposure should not be shunned. Moderate exposure (15 minutes daily without sunscreen) poses no threat and provides solid vitamin D. Second, when sun is not accessible, vitamin D supplements, including Cod Liver Oil (which is the best absorbed source), is essential.

Does Diet Really Affect Acne?

According to Skin Therapy Letter, published by dermatologists, observational studies, including 2 large controlled prospective trials, reported that cow's milk intake increased acne prevalence and severity. Prospective studies, including randomized controlled trials, demonstrated a positive association between a high-glycemic-load diet, hormonal mediators, and acne risk. Based on these findings, there exists convincing data supporting the role of dairy products and high-glycemic-index foods in influencing hormonal and inflammatory factors, which can increase acne prevalence and severity.

The study's conclusion states: "Population-based and migration studies have suggested a correlation between diet and acne. Large, well-controlled, observational studies have demonstrated that diets high in dairy products are associated with an increase in the risk for and severity of acne. Researchers have found significant associations between all varieties of cow's milk and acne. The relationship between milk and acne severity may be explained by the presence in dairy of normal reproductive steroid hormones or the enhanced production of polypeptide hormones such as IGF-1, which can increase androgen exposure, and thus, acne risk. Recent findings also describe an association between a high-glycemic-index diet and longer acne duration. In addition, randomized clinical trials have demonstrated that a low-glycemic-load diet can influence hormonal levels and improve insulin sensitivity and acne. No study has established a positive association between acne and chocolate, saturated fat, or salt intake."

Steve - given the fact that an American Journal of Gastroenterology study recently linked the acne drug Accutane to a greatly increased risk of certain serious inflammatory diseases (the newest of a laundry list of adverse effects), moderating diet is a no-brainer.

Thursday, June 10, 2010

Australia stops flu vaccine for children under five

Australia's Chief Medical Officer, Professor Jim Bishop AO, MD, MMed, MBBS, FRACP, FRCPA announced that after considering the results to date of a comprehensive study into the safety of seasonal flu vaccine for young children, he has advised, as a precaution, the suspension of season flu vaccination for healthy children under the age of five years.

Professor Bishop said:

Since the first reports of a higher than usual occurrence of fever with convulsions in young children following seasonal flu vaccination in WA in April, investigations nationally have confirmed that a small number of children aged under five across the country have experienced fever with convulsions in the 24 hours after vaccination with the 2010 seasonal influenza vaccine. These reactions have been associated mainly with Fluvax, manufactured by CSL.

The investigation, carried out by the Therapeutic Goods Administration (TGA), in association with the Australian Technical Advisory Group on Immunisation (ATAGI) and the National Centre for Immunisation Research and Surveillance has no compelling biological, epidemiological or clinical factors which might explain the observed rates of fever with convulsions among very young children. Vaccine laboratory testing by the TGA, as well as an audit of the CSL manufacturing plant have not revealed any abnormalities, Prof. Bishop explained. He added that this investigation is ongoing.

While the expected febrile convulsions rate should be 1 per 1,000 at the most, epidemiological analyses point to a rate of febrile convulsions in children aged under five years following 2010 seasonal influenza vaccination of about 9 per 1000 children vaccinated.

Professor Bishop said:

While I am recommending that healthy children aged under five years not be vaccinated with seasonal flu vaccine this year, where a child aged under five has medical risk factors that would cause serious health effects for the child if they got the flu, parents should discuss with their doctor whether, on clinical evaluation of the risks and benefits, a seasonal flu vaccination would be the best option.

Doctors should note that, while a higher rate of febrile convulsions has been identified using Fluvax, insufficient doses of this season's Influvac and Vaxigrip vaccines have been used in children in this age group to accurately determine the rates for these vaccines. In addition, as the cause of the increase in febrile convulsions is not yet known, caution should be exercised.

In addition, the alternative for both healthy children and those with risk factors is the swine flu vaccine, Panvax, which has been shown to be safe and effective in young children and is freely available.

Influenza itself often causes fever in young children which can lead to convulsions and flu vaccine can also produce these side effects but there is a clear signal that the rate of fever with convulsions is higher with this year's vaccine across all jurisdictions.

The investigation found that, while there are some cases of fever with convulsions associated with the swine flu vaccine, these were in line with the expected rate of side effects for a flu vaccine based on the swine flu vaccine clinical trials and experience with seasonal flu vaccines in previous years, both in Australia and internationally.

The TGA will continue to work with overseas Regulators and the US CDC in Atlanta to ascertain the scientific reason for this phenomenon.

Source: Department of Health and Ageing, Australia

Wednesday, June 09, 2010

Outdoor eating food safety tips

by Alana Sugar

Keep hot foods hot
Hot foods need to stay between 140° and 160°F until ready to eat — harmful bacteria can rapidly grow when the temperature falls below this range. When food is cooked to temperatures of 165° to 212°F, most harmful bacteria is killed.

Keep cold foods cold
Cold food should be kept at 40°F or colder. Harmful bacteria can multiply quickly when temperatures climb above 40°F. Cold temperatures keep most harmful bacteria from growing and multiplying.

Follow the 2-Hour Rule
The very maximum amount of time any prepared food should be left at room temperature is two hours, and that includes preparation, serving and eating time. Watch the clock and pack up food before time is up! Be sure to throw away any foods left out longer than two hours, and if you are enjoying your meal in the sunny outdoors and the temperature is above 90°F, throw food out after one hour.

Stay cool with coolers
A well insulated cooler packed with ice or reusable cold paks is a fine alternative to a refrigerator. Make sure the foods you pack in the cooler, whether purchased or made at home, have been kept below 40°F. Open the cooler as infrequently as possible to retain cold air. Although it may look nice to set all of the food out on the picnic table, it is safer to leave cold foods in the cooler until right before eating.

Dishing it out
Keep hot foods at 140°F or warmer by using chafing dishes, slow cookers, and warming trays. Keep cold foods at 40°F or colder by nesting dishes in bowls of ice. You may also use small serving trays and replace them often. Make sure there are plenty of serving utensils to help your guests serve themselves without mixing foods from different dishes. Be sure to provide a serving spoon and plates for dips and salsas. Placing chips and dips at opposite ends of the buffet table may also help discourage “double-dipping.”

And don’t forget
Keep hands washed thoroughly, and keep cutting boards and all utensils clean with hot soapy water after each use.

All meats, including fish should be thawed and marinated in the refrigerator – never at room temperature! Remember to cook all meat, poultry, and seafood thoroughly from start to finish. Partially cooked meat is prime real estate for bad bacteria.

When taking food off the grill, always use a clean plate. Never put cooked food on a plate that previously held raw meat.

B-vitamins may reduce depression in elderly

Increased intakes of vitamins B6 and B12 may reduce the risk of seniors developing depressive symptoms, says a new study with 3,500 Chicagoans. For every 10 milligram increase in the intake of vitamin B6 and for every 10 microgram increase in vitamin B12 the risk of developing symptoms of depression were decreased by 2 per cent per year, according to American Journal of Clinical Nutrition. The study adds to previous reports linking B vitamin intakes and a lower risk of depression.

Researchers obtained data from 3,500 over 65 year-olds in Chicago. The volunteers were living in a normal community and were bi-racial with 59 per cent being African American. Over an average of 7.2 years of follow-up, the researchers noted that increased intakes of vitamins B6 and B12 were associated with a “decreased likelihood of incident depression”. The intakes of the vitamins came from both food and supplements.

Personal genetic test results were mixed up

A leading personal genomics company, 23andMe, says some of its customers received the wrong test results recently because samples were incorrectly processed. Up to 96 customers were affected by the mix-up. According to the blog Genetic Future, which reported on the mix-up Monday, some customers were upset about the test results before learning that they were given the wrong information. One woman suspected her baby might have been switched in the hospital at birth. The company, based in Mountain View, Calif., has since notified all of the customers affected and posted an announcement on its website that is accessible to customers who have accounts with the company.

Bonnie - just another reason why these genetic tests are "not ready for prime time."

P.S. The probe has widened to 5 companies that make these tests.

Tuesday, June 08, 2010

Big Grain does not want cut in recommended grains

Courtesy of Rosie Mestel
Los Angeles Times

During the lengthy deliberations for the 2010 Dietary Guidelines for Americans, one possibility discussed by the advisory group was to substitute some of the grains we eat with starchy vegetables like potatoes. The reasoning? First, we eat way too many spuds and they're currently counted as vegetables. (Loading up on fries is not what nutrition experts have in mind when they tell us to ramp up on produce.) Second, as the Nutrient Adequacy Subcommittee of the dietary guidelines advisory committee noted, the "macronutrient profile" of starchy vegetables is more similar to grains than, say, broccoli or kale, i.e., they have a lot of starch in them.

Such a shift would entail recommending fewer servings of grains so that we wouldn't ramp up our calorie intake. (There's a concern, you may have heard, that Americans are getting more calories than they need already.) To ensure that such a substitution could be done without robbing Americans of the nutrients they need for optimal health -- an interesting exercise, given how far we are from anything approaching such virtue -- the scientists ran models and found that the nutrition consequences were minimal.

The North American Millers' Association, American Bakers Assn,, American Institute of Baking, Grain Foods Foundation, Grains for Health Foundation, Independent Bakers Association, National Assn. of Wheat Growers, National Pasta Association, USA Rice Federation and Wheat Foods Council feel this is wrongheaded and wrote to the committee to state as much. Here's the trade groups' recent letter and here is the Dietary Guidelines Web page where you can access all the discussions of the advisory committee as they plod through each point -- fish, selenium, fiber, added sugar, more -- and, back in April, the potato-placement issue.

Among starchy vegetables, 80% of what we eat is spuds. And the fuller breakdown is:

Boiled potatoes: 26.5%
Baked potatoes: 13.2%
French fries: 18.2%
Potato chips: 19.1%
Hash browns: 6.5 %
Yellow corn: 8.3%
Hominy, grits, white corn: 1.7%
Green peas : 4.1%
Lima beans : 0.6%
Cow peas, black-eyed peas pigeon peas etc.: 0.5%

P.S. Some scientists have long argued that potatoes have no place in the vegetables group and that Americans eat way too many of them. One long-time spud foe is nutrition scientist Walter Willett of Harvard University.

Steve - it should come as no surprise that Big Grain is fighting tooth and nail to keep the amount of grain servings as is. They are at risk of losing two grain servings daily to be replaced with two vegetables servings. This would be a titanic shift in the DGA recommendations. Big Milk does the same, as does Big Beef, Pork, etc. While desperately necessary, I do not have very much confidence that the DGA Committee will make the adjustment.

Monday, June 07, 2010

Calcium supplements: too much of a good thing?

Negative health effects linked to taking too much supplemental calcium are on the rise, according to a commentary appearing in Journal of the American Society Nephrology (JASN). The incidence of the so-called milk-alkali or calcium-alkali syndrome is growing in large part because of widespread use of over-the-counter calcium and vitamin D supplements. Stanley Goldfarb, MD and Ami Patel, MD (University of Pennsylvania School of Medicine) recommend changing the name of the milk-alkali syndrome to the calcium-alkali syndrome because the condition is now associated with a large intake of calcium, not milk.

According to the authors, the obvious preventive strategy against the calcium-alkali syndrome is to limit the intake of calcium to no more than 1.2 to 1.5 grams per day. "Calcium supplements taken in the recommended amounts are not only safe but are quite beneficial. Taken to excess is the problem," said Dr. Goldfarb. "Even at the recommended dose, careful monitoring of any medication is wise and yearly determinations of blood calcium levels for those patients taking calcium supplements or vitamin D is a wise approach," he added.

Bonnie - finally, somebody other than me steps up to tell everyone that too much calcium is not a good thing! Excess calcium can build up in soft tissue anywhere in the body (calcification) as well as create mineral deficiencies. If you are not sure how much calcium you are taking and suspect it may be too much, please ask your licensed health professional.

Meditation Reduces the Emotional Impact of Pain

People who meditate regularly find pain less unpleasant because their brains anticipate the pain less. "Meditation is becoming increasingly popular as a way to treat chronic illness such as the pain caused by arthritis," said Dr Christopher Brown, who conducted the research. The study, to be published in the journal Pain, found that particular areas of the brain were less active as meditators anticipated pain, as induced by a laser device. Those with longer meditation experience (up to 35 years) showed the least anticipation of the laser pain.

Meditation trains the brain to be more present-focused and therefore to spend less time anticipating future negative events. This may be why meditation is effective at reducing the recurrence of depression, which makes chronic pain considerably worse.

Children who eat healthier have better bone mass, fat composition

Young children who eat dark green and deep yellow vegetables and limit fried food intake may have healthier fat and bone mass accrual over time than those who do not. "To our knowledge, no studies have examined, as we have, the association of diet composition with both fat and bone mass simultaneously in younger children," the authors note in their paper, published in the American Journal of Clinical Nutrition. The researchers sought to identify dietary patterns related to fat and bone mass in children aged 3.8 to 7.8 years.

A diet high in dark green and deep yellow vegetables was related to low fat mass and high bone mass, a high intake of processed meat was related to high bone mass, and a high intake of fried foods was related to high fat mass.

Steve - this should not come as a surprise to anyone.

Friday, June 04, 2010

Gluten intolerance rising

By Nancy Stohs
Star Tribune (Minneapolis)

Is it our imagination, or are gluten intolerance, and dietary disorders in general, increasingly in the news? Does this mean they're on the rise?The answers are yes and yes, according to experts."It is indeed well documented that all autoimmune (and allergic) disorders are on the rise worldwide, but limited to developed areas," said Stefano Guandalini, founder and medical director of the University of Chicago Celiac Disease Center, in an e-mail interview. "In general, it is safe to say the rates about double every 20 years or so."

There are various theories as to why, but the most prevalent is the "hygiene theory" - in other words, as a society we're just too clean. As a result, the immune system, largely controlled by the gut, receives inadequate stimulation, Guandalini said. With autoimmune disorders, which include gluten intolerance and type 1 diabetes (but not allergies), the body attacks itself rather than the invasive substance, causing permanent damage if allowed to continue.

Unfortunately, with all the attention given gluten intolerance - a plethora of new cookbooks, gluten-free items on restaurant menus, new gluten-free food products - some people are adopting a gluten-free diet on their own. This is always a bad idea, said both Guandalini and Carol M. Shilson, executive director of the center and a celiac disease sufferer herself. "There's no scientific evidence that it's better for you if you don't have celiac disease," Shilson said. The problem is, even in healthy people, gluten - a protein found in wheat, rye and barley (and possibly oats) - is not an easy substance for the body to digest. If you eliminate it from your diet for any amount of time, "it's very hard to go back to a regular diet."

Bonnie - this is a very profound statement. Does this suggest that humans should never adopt a high gluten diet? I certainly agree. We don't see the same digestibility issue with other carbs such as fruits, veggies, and rice.

That makes going gluten free a bad idea even for people with symptoms who suspect they are gluten-intolerant. "Because it is a lifelong genetic disease that can be passed on, it's important to get a proper diagnosis," Shilson said. "And you have to be eating a regular diet (with gluten) or all the diagnostic tests will be rendered invalid. "Healthy people who eliminate gluten also are exposing themselves to "risks of some micronutrient deficiency or of excessive intake of carbohydrates," said Guandalini.

Bonnie - this is why it is important to work with a licensed nutrition professional.

Some further facts:
  • Prevalence of gluten intolerance for average, healthy people is 1 in 133; for people with first-degree relatives (parent, child, sibling) who are celiac, 1 in 22; and for those with second-degree relatives (aunt, uncle, cousin) who are celiac, 1 in 39. -Estimated prevalence for African-, Hispanic- and Asian-Americans is 1 in 236.

  • Celiac disease affects at least 3 million Americans.

  • Once diagnosed, gluten intolerance is for life, and the only treatment is elimination of gluten from the diet.

  • A significant number of people with celiac disease - 60 percent of children and 41 percent of adults, according to one study - do not exhibit any symptoms, which include but are not limited to diarrhea or constipation.

  • The average length of time it takes for a person with symptoms to be diagnosed with celiac disease in the United States is four years.

  • Gluten intolerance is not the same thing as wheat allergy or gluten sensitivity, neither of which is an autoimmune disorder. There is currently no diagnostic test for gluten sensitivity, though researchers, including those at the Celiac Disease Center in Chicago, are working to develop one. Bonnie - this is why the two month avoidance with a one week challenge is now recommended.

  • Celiac disease and type 1 diabetes often run together. There is about an 8 percent to 10 percent overlap, said Shilson. Some research suggests that untreated celiac disease might even cause type 1 diabetes, she said.

  • Upon diagnosis, people with gluten intolerance are often intolerant of milk. With healing of the intestinal surface, the lactose intolerance often goes away. Bonnie - this is not true. If you are lactose intolerant, the lactase enzyme, intended to digest lactose, does not return! If milk products can be digested again, it is the protein (casein), not the lactose.

Vitamin E reduces cardiovascular disease

A Pharmacogenomics study looked at individuals with both diabetes mellitus (DM) and the Haptoglobin (Hp) 2-2 genotype, who are are at an increased risk of cardiovascular disease. As the antioxidant function of the Hp 2-2 protein is impaired, researchers sought to test the pharmacogenomic hypothesis that antioxidant vitamin E supplementation would provide cardiovascular protection to Hp 2-2 DM individuals.

Analysis of the two trials demonstrated a significant overall reduction in the composite end point in Hp 2-2 DM individuals with vitamin E. Lifelong administration of vitamin E to Hp 2-2 DM individuals in the population would increase their life expectancy by 3 years. A pharmacogenomic strategy of screening DM individuals for the Hp genotype and treating those with Hp 2-2 with vitamin E appears to be highly clinically effective.

Steve - nice to see vitamin E getting some love!

WHO swine flu experts 'linked' with drug companies

Courtesy of BBC News

Key scientists behind World Health Organization advice on stockpiling of pandemic flu drugs had financial ties with companies which stood to profit, an investigation has found. The British Medical Journal says the scientists had openly declared these interests in other publications yet WHO made no mention of the links. It comes as a report from the Council of Europe criticized the lack of transparency around the handling of the swine flu pandemic. A spokesman for WHO said the drug industry did not influence its decisions on swine flu.

Guidelines recommending governments stockpile antiviral drugs were issued by WHO in 2004. The advice prompted many countries around the world into buying up large stocks of Tamiflu, made by Roche, and Relenza manufactured by GlaxoSmithKline. A year after the swine flu pandemic was declared, stocks are left unused in warehouses and governments are attempting to unpick contracts.

The BMJ, in a joint investigation with The Bureau of Investigative Journalism, found that three scientists involved in putting together the 2004 guidance had previously been paid by Roche or GSK for lecturing and consultancy work as well as being involved in research for the companies. Although the scientists involved had freely declared the links in other places and said WHO asked for conflicts of interest forms prior to expert meetings, the ties were not publically declared by WHO. It is not clear whether these conflicts were notified privately by WHO to governments around the world, the BMJ said, and a request to see conflict of interest declarations was turned down.

In addition, membership of the "emergency committee" which advised WHO's director general Margaret Chan on declaring an influenza pandemic has been kept secret. It means the names of the 16 committee members are known only to people within WHO, and as such their possible conflicts of interest with drug companies are unknown. On its website, WHO says: "Potential conflicts of interest are inherent in any relationship between a normative and health development agency, like WHO, and a profit-driven industry. "Similar considerations apply when experts advising the Organization have professional links with pharmaceutical companies. "Numerous safeguards are in place to manage possible conflicts of interest or their perception."

Bonnie - why does this not surprise me?

Thursday, June 03, 2010

Carbs Trump Fats

Editorial by Frank B. Hu
Department of Nutrition, Harvard University
American Journal Clinical Nutrition, June 2010

Steve - we italicized the most important comments if you do not wish to read the entire editorial.

For several decades, the diet-heart paradigm that high intake of saturated fat and cholesterol increases the risk of atherosclerosis and ischemic heart disease (IHD) has been the driving force behind national and international dietary recommendations for prevention of IHD. This model, which promotes diets that are typically low in fat (particularly saturated fat) and high in complex carbohydrates, has led to substantial decline in the percentage of energy intake from total and saturated fats in the United States. At the same time, it has spurred a compensatory increase in consumption of refined carbohydrates and added sugars—a dietary shift that may be contributing to the current twin epidemics of obesity and diabetes.

The changed landscape in obesity and dietary patterns suggests a need to reassess the dominant diet-heart paradigm and related dietary recommendations, ie, the strategy of replacing total and saturated fats with carbohydrates. A recent pooled analysis of 11 American and European cohort studies (n = 344,696 persons) found no association between decreased risk of IHD and replacement of saturated fat with carbohydrates; indeed, the approach was associated with a slightly increased risk. Similarly, a meta-analysis of 21 cohort studies (n = 347,747 subjects) found no significant association between intake of saturated fat compared with carbohydrates and risk of IHD, stroke, and total cardiovascular events. Conversely, observational studies as well as randomized clinical trials show that substitution of polyunsaturated for saturated fat has a beneficial effect on IHD.

Until recently, the role of carbohydrates in cardiovascular disease risk has received scant attention. Depending on chemical structure, carbohydrates are traditionally classified as simple or complex (polysaccharide). The latter are considered to be a healthy alternative to dietary fats. However, many complex carbohydrates (eg, baked potatoes and white bread) produce even higher glycemic responses than do simple sugars. Thus, the term complex carbohydrates is not useful in characterizing the quality of carbohydrates. More useful indicators of carbohydrate quality include the amount and type of fiber, the extent of processing, and glycemic index (GI) and glycemic load (GL). Numerous epidemiologic studies have found that higher intake of refined carbohydrates (reflected by increased dietary GL) is associated with greater risk of type 2 diabetes and IHD, whereas higher consumption of whole grains protects against these conditions.

In this issue of the Journal, Jakobsen compared the association between saturated fats and carbohydrates with IHD risk among 53,644 men and women in a Danish cohort of the Diet, Cancer, and Health Study. During 12 y of follow-up, 1943 incident cases of myocardial infarction (MI) were diagnosed. Multivariate analyses showed that saturated fat intake was not associated with risk of MI compared with carbohydrate consumption—a finding consistent with the results from a recent pooled analysis and a meta-analysis. However, replacement of saturated fat with high-GI-value carbohydrates significantly increased the risk of MI, whereas replacement with low-GI-value carbohydrates showed a nonsignificant inverse association with IHD risk.

This study is notable for its large size, long duration of follow-up, and detailed assessment of dietary and lifestyle factors. It is the first epidemiologic study to specifically examine the effects of replacing saturated fats with either high- or low-quality carbohydrates, and it provides direct evidence that substituting high-GI-value carbohydrates for saturated fat actually increases IHD risk.

Unfortunately, most carbohydrates in Western diets are highly processed, including bread, rolls, pizza, white rice, and most ready-to-eat cold cereals and sugar. Prior studies show that these types of carbohydrates are particularly harmful for overweight and obese individuals, suggesting that adverse effects of carbohydrates are aggravated by underlying insulin resistance. The obesity epidemic and growing intake of refined carbohydrates have created a "perfect storm" for the development of cardiometabolic disorders. For this reason, reduction of refined carbohydrate intake should be a top public health priority. Several dietary strategies can be used to achieve this goal. These include replacing carbohydrates (especially refined grains and sugar) with unsaturated fats and/or healthy sources of protein and exchanging whole grains for refined ones. A combination of these approaches can increase flexibility in macronutrient composition and thus long-term adherence. In addition, limiting sugar-sweetened beverage consumption, a major source of dietary GL and excess calories, has been associated with lower risk of obesity, type 2 diabetes, and IHD.

Clearly, diets high in either saturated fats or refined carbohydrates are not suitable for IHD prevention. However, refined carbohydrates are likely to cause even greater metabolic damage than saturated fat in a predominantly sedentary and overweight population. Although intake of saturated fat should remain at a relatively low amount and partially hydrogenated fats should be eliminated, a singular focus on reduction of total and saturated fat can be counterproductive because dietary fat is typically replaced by refined carbohydrate, as has been seen over the past several decades. In this era of widespread obesity and insulin resistance, the time has come to shift the focus of the diet-heart paradigm away from restricted fat intake and toward reduced consumption of refined carbohydrates.

Steve - for a list high and low glycemic index/load carbohydrates, refer to our Blood Sugar Balance Action Plan.

Wednesday, June 02, 2010

No dietary supplements deaths according to Poison Control

Steve: there were no deaths caused by a dietary supplement in 2008, according to the most recent information collected by the U.S. National Poison Data System. The data appeared in the 174-page annual report of the American Association of Poison Control Centers, published in the journal Clinical Toxicology. The same cannot be said about pharmaceuticals.

Tuesday, June 01, 2010

Zinc's cardiac benefits

Chronic inflammation and oxidative stress are common risk factors for atherosclerosis. Zinc is an essential micronutrient that can function as an antiinflammatory and antioxidative agent, and as such, it may have atheroprotective properties.

An American College of Clinical Nutrition study hypothesized that zinc down-regulates the production of atherosclerosis-related cytokines/molecules in humans.

A randomized, double-blinded, placebo trial of zinc supplementation was performed in elderly subjects. One group was given an oral dose of 45 mg zinc/d as a gluconate for 6 mo. The other group was given a placebo. After 6 mo of supplementation, the intake of zinc, compared with intake of placebo, increased the concentrations of plasma zinc and decreased the concentrations of plasma high-sensitivity C-reactive protein, interleukin (IL)-6, macrophage chemoattractant protein 1, vascular cell adhesion molecule 1, secretory phospholipase A2, and malondialdehyde and hydroxyalkenals in elderly subjects.

These findings suggest that zinc may have a protective effect in atherosclerosis because of its antiinflammatory and antioxidant functions.

Magnesium, inflammation, and obesity in chronic disease

According to a study performed by the US Department of Agriculture, Agricultural Research Service and published in Nutrition Reviews, about 60% of adults in the United States do not consume the estimated average requirement for magnesium, but widespread pathological conditions attributed to magnesium deficiency have not been reported.

Nevertheless, low magnesium status has been associated with numerous pathological conditions characterized as having a chronic inflammatory stress component. In humans, deficient magnesium intakes are mostly marginal to moderate (approximately 50% to <100% of the recommended dietary allowance). Animal experiments indicate that signs of marginal-to-moderate magnesium deficiency can be compensated or exacerbated by other factors influencing inflammatory and oxidative stress; recent studies suggest a similar happening in humans. This suggestion may have significance in obesity, which is characterized as having a chronic low-grade inflammation component and an increased incidence of a low magnesium status.

Marginal-to-moderate magnesium deficiency through exacerbating chronic inflammatory stress may be contributing significantly to the occurrence of chronic diseases such as atherosclerosis, hypertension, osteoporosis, diabetes mellitus, and cancer.

Bonnie - they're just noticing this now?

42 drug companies received FDA warnings since 2009

Courtesy of USA Today

At least 43 drug factories supplying medication to thousands of U.S. consumers have received government warnings in recent months for failing to correct shoddy manufacturing practices that may have exposed patients to health risks. Violations serious enough to prompt warning letters from the U.S. Food and Drug Administration include plants using equipment and ingredients contaminated with bacteria or insects, failing to do proper testing to ensure drug strength and purity, and ignoring consumer complaints that products were making them sick. The 43 warning letters, issued since January 2009, reflect only some of the most serious manufacturing violations the FDA finds during facility inspections.

Among violations identified in FDA warning letters:

• Two of the three companies that supply propofol, an injectable drug used during surgeries, had safety recalls. In July, Teva Pharmaceuticals recalled propofol made in California after 41 patients developed post-operative fever and other symptoms the company said may indicate exposure to bacterial toxins. In November and March, a North Carolina plant run by Hospira recalled propofol because of contamination with steel particles.

• An Illinois plant run by Balchem that makes calcium carbonate, an ingredient in antacids and a menopause medication, sent out products made with water the plant knew was contaminated with coliform bacteria.

• A Massachusetts plant run by Braintree Laboratories failed to properly investigate 21 consumer complaints of bug parts or spiders in five of its medicine products, according to the May warning letter.

• Several species of bacteria were found on equipment at a Puerto Rico plant that makes drugs and cosmetics for Procter & Gamble, according to an April 2009 warning letter. The letter also cited the company for failing to investigate 198 complaints in the previous year alleging health problems associated with a Vicks Sinex product made there. In November, the company separately recalled Vicks Sinex nasal spray made in Germany because of bacterial contamination.

Grass-fed milk healthier

Courtesy of Reuters

Earlier experiments have shown that cows on a diet of fresh grass produce milk with five times as much of an unsaturated fat called conjugated linoleic acid (CLA) than do cows fed processed grains. Studies in animals have suggested that CLAs can protect the heart, and help in weight loss. Harvard School of Public Health researchers found, in a study of 4,000 people, that people with the highest concentrations of CLAs -- the top fifth among all participants -- had a 36 percent lower risk of heart attack compared to those with the lowest concentrations. Those findings held true even once the researchers took into account heart disease risk factors such as high blood pressure and smoking.

The new findings suggest that CLA offers heart-healthy benefits that could more than offset the harms of saturated fat in milk. "Because pasture grazing leads to higher CLA in milk, and it is the natural feed for cattle, it seems like more emphasis should be given to this type of feeding," stated researchers. Dairy products in the U.S. come almost exclusively from feedlots. And cow's milk is the primary source of CLA. (Beef contains a small amount.)

Antidepressants raise miscarriage risk

Courtesy of UPI

Canadian researchers say the risk of miscarriages is 68 percent higher in women who took antidepressants during pregnancy. Researchers from the University of Montreal said they recommend doctors discuss with their patients the risks and benefits of antidepressant therapy during pregnancy. The study, published in the Canadian Medical Association Journal, involved 5,124 women who were part of a large population-based group of pregnant women who had clinically verified miscarriages and a large sample of women from the same registry who did not have a miscarriage. Of those who miscarried, 284, or 5.5 percent, had taken antidepressants during pregnancy. Antidepressants known as selective serotonin reuptake inhibitors -- especially paroxetine and also venlafaxine -- were associated with increased risk of miscarriage as were higher daily doses of either antidepressant. A combination of different antidepressants doubled the risk of miscarriages. "These results, which suggest an overall class effect of selective serotonin reuptake inhibitors, are highly robust given the large number of users studied," Dr. Anick Berard, the study's senior author, said in a statement.