Thursday, October 28, 2010

Bonnie's Bite: Menopause, MANopause Updates

Menopause Update
More than eight years have passed since the landmark Women’s Health Initiative study linked synthetic estrogen (Premarin) and progestin (Provera) to increased risk of heart disease and breast cancer. And, according to recent data, hormonal cancer rates have dropped precipitously as copious studies have confirmed the WHI finding. In turn,
with 6,000 women embarking on “the change of life” each day, according to the North American Menopause Society, those seeking symptom relief are still steering clear of prescription hormones in favor of bioidentical and topical hormones, dietary supplements and other natural alternatives. A journal Menopause study found that 80 percent of women now use complementary and alternative medicine to lessen symptoms.

It is imperative that you are vigilant in addressing menopause because new research has shown that during this time, a sudden drop in estrogen make women more prone to heart disease and stroke. Following is a primer to help navigate what is new with menopause.

Insomnia, Mood Swings, Tender Breasts and Irregular Periods
Chaste tree berry (Vitex)
Insomnia, mood swings, tender breasts and irregular periods are often the first signs of perimenopause (the three- to 10-year period leading up to the halt of menses), and the culprit is often a dip in the calming sex hormone progesterone. The herb chaste tree berry is among the most widely used phytoprogesterones—plant compounds that mimic progesterone in the body and may indirectly help boost progesterone production.

Progesterone Cream
Low-dose bioidentical progesterone creams are also available. (Although prescription varieties contain an average of 10 percent progesterone, over-the-counter versions, by law, must contain less than 30 percent.) Unlike the synthetic Provera, bioidentical progesterone (often derived from plant sterols in wild yams or soy) has a molecular structure identical to that of the progesterone our own bodies make. Work with an expert such as myself when taking any kind of hormone.

Hot Flashes
Black Cohosh
By far the most researched herb for menopause relief. A 2010 meta-analysis showed that in six out of nine recent trials, the botanical worked better than placebo. A 2006 study of 301 women found that those who took black cohosh for 16 weeks halved their hot-flash incidences; the placebo group improved by 20 percent. Another recent trial found that black cohosh extract was as effective as low-dose prescription estrogen for the treatment of menopause-induced hot flashes, anxiety and depression.

Scientists long assumed that black cohosh was a general phytoestrogen, acting on estrogen receptors throughout the body to quell symptoms. But recent research has called that theory into question, suggesting it may instead work on the central nervous system and have no estrogenic effect on the breast or endometrium. This makes it a safer option for women with a history of breast cancer who cannot take estrogen.

Soy
In topical form, soy phytoestrogens are effective at the right dose. Soy phyoestrogen supplements are not recommended, as the data has been mixed. Consuming fermented organic soy products are recommended in moderation for a positive hormone balancing boost.

Flax
I still support ground flaxseed for their hormone balancing lignans as well as a good soluble fiber source.

Libido
Maca Root
My top recommendation for boosting libido in men and women is the Peruvian maca root. It is a powerful sex enhancer, and it has absolutely zero toxicity. As an adaptogen (or stress modulator), maca root has long been used in Peru to help the body maintain healthy hormone levels in the face of stress or illness in men (sustaining testosterone and balancing cortisol) and women (maintaining beneficial estrogens well as balancing cortisol). In a few select cases, maca can adversely affect thyroid levels.

Other Sexual Dysfunction
Pueraria Mirifica
A common cause of sexual dysfunction in menopausal women is vaginal dryness, a result of dipping estrogen levels. One possible remedy is pueraria mirifica. Also known as Thai kudzu, it contains a compound called miroestrol, which has exhibited estrogen-like effects on vaginal tissue, similar to prescription estrogen but without the side effects.

Women Over 65
Synthetic hormone replacement therapy is not recommended because it has been linked to an increase incidence od dementia when started in women 65 years and older.

Bioidentical Hormones
I have not changed my position since my last post on bioidenticals. If you did not get a chance to read this when it was published, here it is.

As a certified menopause educator, feel free to schedule a change of life appointment so that I may individualize your peri, post, or menopausal needs through dietary and lifestyle modification.

P.S. If you have tried everything and are still having menopausal symptoms, we will be starting a dietary supplement trial shortly. Please email Steve at nutrocon@aol.com if you would like to be involved.

MANopause Update
HGH
My opinion on Human growth hormone (HGH), touted for its ability to keep men virile into old age, has not changed. I am vehemently opposed to it.
If taken by healthy adults it could cause a host of unhealthy side effects, including joint pain, soft tissue swelling, carpal tunnel syndrome, increased breast size in men, and a heightened risk of diabetes and pre-diabetes. Growth hormone should not be used for anti-aging purposes or virility. It can cost hundreds to thousands of dollars a month, there is no scientific evidence supporting it, and very real, potentially serious side effects may occur.

Testosterone Therapy
There are still too many unknowns. In the few studies that have been done, the reported side effects are numerous.

My one and only favorite for libido and testosterone enhancement at the moment is maca root. The other available supplemental options are too risky with regards to side effects.

Low testosterone is a clear and present issue as evidenced by an October Journal of Alzheimer's Disease study showing that serum levels of bioavailable testosterone (BT) can predict risk for Alzheimer's disease (AD) in older men. The need to find safer therapies to boost levels are an important public health issue.

In my opinion, the most effective way for men to improve their testosterone is to lower their estrogen levels. A saliva or blood test can confirm this. Eliminating dietary, environmental, and lifestyle factors that are contributing to an overabundance of estrogen is imperative. The earth is rife with xenoestrogenic chemicals in our water, food, medication, household, and place of work. Once pinpointed, they must be minimized or eliminated. One quick and easy way to assure that bad estrogens are being metabolized and excreted is to frequently consume brassica vegetables, such as broccoli, cauliflower, brussels sprouts, and bok choy. If you feel you need assistance in pinpointing the area where you may be creating an overabundant estrogenic effect, feel free to schedule an appointment.

Should Intestinal Healing Be Assessed in Treated Celiac Patients?

Response from Bret A. Lashner, MD
Professor of Medicine, Cleveland Clinic, Cleveland, Ohio


The mortality rate of patients with celiac disease is only slightly elevated compared with that of the general population. Most of the excess mortality in these patients, however, is from the increased risk for enteropathy-associated T-cell lymphoma. Because risk for lymphoma is believed to be directly related to untreated celiac disease, it would be reasonable to monitor patients with celiac disease for adherence to a gluten-free diet. Although no formal guidelines exist, ordering an annual celiac panel (tissue transglutaminase and endomysial antibodies) would be reasonable. Elevated titers of these antibodies could implicate the patient in being nonadherent to a gluten-free diet.

A recent study showed that serologic testing closely correlates with level of mucosal healing on biopsy. Because serologic testing is easier to obtain and less expensive than small-bowel biopsies, I think that serial serology measurements would be the best way to monitor patients with celiac disease. In a minority of patients, serologic measures will not improve on a gluten-free diet. These patients should be recounseled by a dietitian on the nuances of the gluten-free diet. In light of recent evidence that even foods believed to be naturally free of gluten (such as rice and millet) can be contaminated with gluten, people who believe they are following a gluten-free diet might have more gluten exposure than they realize. At this point, I do not believe that imaging studies or biopsies are necessary and are not likely to be cost-effective.

In patients whose celiac disease is truly refractory to a gluten-free diet, alternative diagnoses, such as collagenous sprue, amyloidosis, sarcoidosis, and other infiltrative diseases of the small bowel, should be ruled out with repeat biopsies and special stains, and then alternative therapies should be initiated.

If you practice emotional eating, your kids will too

Children's emotional eating is related to greater body mass index and a less-healthy diet, but little is known about the early development of this behavior. This study aimed to examine the relations between preschool children's emotional eating and parental feeding practices by using experimental manipulation of child mood and food intake in a laboratory setting.

Twenty-five 3–5-y-old children and their mothers sat together and ate a standard meal to satiety. Mothers completed questionnaires regarding their feeding practices. Children were assigned to a control or negative mood condition, and their consumption of snack foods in the absence of hunger was measured.

Children whose mothers often used food to regulate emotions ate more cookies in the absence of hunger than did children whose mothers used this feeding practice infrequently, regardless of condition. Children whose mothers often used food for emotion regulation purposes ate more chocolate in the experimental condition than in the control condition. The pattern was reversed for children of mothers who did not tend to use food for emotion regulation. There were no significant effects of maternal use of restriction, pressure to eat, and use of foods as a reward on children's snack food consumption.

Children of mothers who use food for emotion regulation consume more sweet palatable foods in the absence of hunger than do children of mothers who use this feeding practice infrequently. Emotional overeating behavior may occur in the context of negative mood in children whose mothers use food for emotion regulation purposes.

American Journal Clinical Nutrition

BPA found in dental sealants

Widely used dental sealants and tooth repair resins contain substances that degrade into the controversial chemical BPA, but dentists can use the product safely in kids if they make sure to wipe or rinse away residue after treatment, a new study concludes. Pregnant women, however, might do better to wait until after delivery, researchers report journal Pediatrics.

In January, federal Food and Drug Administration officials called for more research on the chemical, explaining that the agency had “some concern about the potential effects of BPA on the brain, behavior and prostate glands of fetuses, infants and children.”

Canada has declared bisphenol A to be a toxic chemical, prompting calls for far-reaching curbs on the industrial chemical that is used in everything from the linings of aluminum cans to coatings on electronic till receipts. It is widely used to line food and beverage containers, and a recent government report said it was present in the bodies of 91% of Canadians.


A study was published last week in the journal Fertility and Sterility found that Chinese factory workers exposed to high levels of the plastics chemical BPA had low sperm counts, according to the first human study to tie it to poor semen quality. The findings echo studies in animals and follows previous research in the same men that linked BPA exposure with sexual problems.

Diet improves sleep apnea

The aim of the study was to assess the long-term efficacy of a lifestyle intervention based on a healthy diet and physical activity in a randomized, controlled, 2-y post intervention follow-up in obese adult patients. The intervention group completed a 1-y lifestyle modification regimen that included an early 12-wk weight-reduction program with a very-low-calorie diet. The control group received routine dietary counseling. During the second year, no dietary counseling was offered. Change in the apnea-hypopnea index (AHI) was the main objective outcome variable, and changes in symptoms were used as a subjective measurement.

The mean changes in diet and lifestyle with simultaneous weight reduction in the intervention group reflected sustained improvements in findings and symptoms of Obstructive Sleep Apnea (OSA). After 2 y, the reduction in the AHI was significantly greater in the intervention group (P = 0.049).

Favorable changes achieved by a 1-y lifestyle intervention aimed at weight reduction with a healthy diet and physical activity were sustained in overweight patients with mild OSA after the termination of supervised dietary counseling.

American Journal Clinical Nutrition

Favorite Fall Soup Recipes

Shari's Chicken and White Bean Herb Soup
8 tablespoons extra-virgin olive oil, divided
2 teaspoons chopped fresh sage
2 teaspoons chopped fresh thyme
1 teaspoon chopped fresh rosemary
1/4 teaspoon sea salt or NutraSalt
1 pound skinless boneless chicken breasts, cut into 1-inch pieces
1 small onion, chopped
2 medium carrots, halved lengthwise, cut crosswise into 1/4-inch pieces
1 large celery stalk, thinly sliced
1/2 cup tomato puree
4 cups low-salt organic chicken broth
2 15-ounce cans cannellini beans, drained
1/2 cup fresh Italian parsley leaves
1 bay leaf

Directions: Heat 4 tablespoons olive oil and next 4 ingredients in small skillet over medium heat until herbs are aromatic, about 11/2 minutes. Pour herb oil into bowl; cool. Heat 2 tablespoons oil in large pot over medium heat. Sauté chicken 5 minutes. Using slotted spoon, transfer chicken to bowl. Add 2 tablespoons oil to pot. Add onion, carrots, and celery; sauté until beginning to brown, about 15 minutes. Mix in last 5 ingredients. Bring to boil. Reduce heat; simmer 15 minutes. Add chicken; simmer until cooked through, about 5 minutes. Season with salt and pepper. Ladle soup into bowls. Gently swirl 1 teaspoon herb oil into center of each. SERVES: 6-8

Minestrone Soup
6 T. olive oil 2 small leeks, white and light green stalk, sliced thin
2 medium carrots cut in medium dice
2 medium tomatoes, skinned, seeded, and diced
2 celery ribs, thinly sliced
1 ½ c. cooked or 1 can, drained and rinsed cannellini beans or Great Northern beans
2 medium potatoes cut in medium dice
6 c. water or 3 c. water & 3 c. low-sodium V-8 juice
2 medium zucchini cut in medium dice
2 T. minced parsley
4 oz. thin fresh noodles (semolina or rice)
6 T. grated parmesan or sheep romano cheese
salt to taste

Directions: Heat oil in a 6 quart Dutch oven. Add leeks, carrots, and celery to pot and cook over medium heat for 15 minutes until softened. Add tomatoes to pot. Cook over medium heat for 5 minutes. Add beans, potatoes, and water to pot; simmer, covered for 30 minutes until potatoes are just tender. Add zucchini, parsley, and noodles. Simmer for 10-12 minutes until zucchini is tender but still firm. Remove soup from heat. Stir in cheese. Taste and season with salt. SERVES: 6-8

Pumpkin Soup
½ c. green onions, chopped
½ c. white onions, chopped
2 carrots, sliced
1 T. canola oil 1 (16 oz.) canned pumpkin
5 c. vegetable broth (Imagine Foods “No Chicken” or Pacific Foods vegetable broth)
2 T. fresh parsley
½ tsp. garlic powder
½ tsp. nutmeg
½ tsp. allspice dash of Tamari Lite (wheat-free soy sauce by San-J)
dash of sea salt (optional)

Directions: Sauté onions and carrots in oil in a 4-quart pot. Add remaining ingredients and bring to a boil. Reduce heat to simmer and cook for about ½ hour. Puree soup in a blender. This soup may also be served cold. SERVES: 8

Squash and Quinoa Soup
12 oz. skinless, boneless chicken breast halves, cut into 1-inch pieces
1/3 c. finely chopped shallot or onion
2 tsp. olive or canola oil
3 c. organic reduced-sodium organic chicken broth
½ c. filtered water
½ c. apricot nectar or pineapple juice (or ½ cup more water)
1 lb. butternut squash, peeled, halved, seeded and cut into 1-inch cubes
¾ c. raw quinoa, rinsed thoroughly and drained
2 small zucchini, halved lengthwise and cut into 1-inch pieces
sea salt and ground white pepper, optional
¼ tsp. cumin

Directions: In a large saucepan, cook chicken and shallot or onion in hot oil over medium heat for 2 to 3 minutes or until shallots are tender, stirring occasionally. Carefully add broth water, oil, squash, quinoa, and cumin. Bring to boiling; reduce heat. Simmer, covered, for 5 minutes. Add zucchini. Cover and cook 10 minutes more or until squash and quinoa are tender. Season, if desired with salt, pepper, and cumin. SERVES: 6

Wednesday, October 27, 2010

Hyland recalls teething tablets

Following an investigation of its manufacturing facility by the U.S. Food and Drug Administration (FDA), Standard Homeopathic Co. announced that it is voluntarily pulling its popular Hyland’s Teething Tablets from all retail shelves. Although Standard Homeopathic maintains that the products are safe, the 107-year-old company said it is initiating the recall “in an abundance of caution” after the FDA identified problems in the manufacture of its Teething Tablets.

In a warning issued October 23, the FDA advised consumers not to use Hyland’s Teething Tablets and dispose of any of the product in their possession. Hyland’s Teething Tablets contain a small amount of belladonna, which can cause serious harm at larger doses. The FDA reported it had found inconsistent amounts of belladonna in the product during a laboratory analysis. The agency also said it had received reports of serious adverse events in children taking Hyland’s Teething Tablets “that are consistent with belladonna toxicity.” Hyland’s Teething Tablets is an over-the-counter homeopathic product intended to provide temporary relief of teething symptoms in infants and children.

In a statement, Standard Homeopathic said its own in-depth analysis, a comprehensive review of the company’s adverse event report log and more than 85 years of safe usage make it confident that Hyland’s Teething Tablets are safe for babies and kids. “We initiated this voluntary recall to ensure our consumers know that their families’ safety and health are our top priorities,” said Mark Phillips, PharmD, president and chief pharmacist of Standard Homeopathic Co. “We are committed to maintaining and deserving the trust they have placed in Hyland’s. We have worked for 107 years to build relationships with our consumers. We intend to preserve that tradition of trust.”

Tuesday, October 26, 2010

Exercise enhances bone health in children

Increasing the amount of physical activity that children get in school increases the health of their bones and might be one way of preventing hip and other fractures in adulthood, according to the American Society for Bone and Mineral Research 2010 Annual Meeting. Children who received 200 minutes per week of physical education at school showed significant increases in bone mass and improvement in bone structure, compared with children who received 60 minutes per week, and the increased intensity of exercise was not associated with more fractures.

Monday, October 25, 2010

B-12, Alzheimer's linked again

Both serum homocysteine (tHcy), an amino acid associated with vitamin B12, and holotranscobalamin (holoTC), the biologically active fraction of vitamin B12, may have a role in the development of Alzheimer's disease (AD). Among a group of elderly subjects followed up for 7 years, elevated baseline serum tHcy concentrations were independently associated with an increased risk of developing AD, whereas higher baseline holoTC values were independently related to a reduced risk for incident AD. The results were published in Neurology.

Friday, October 22, 2010

Acid Reflux Update

Bonnie -
Current Opinion in Gastroenterolgy's update on Gastroesophageal Reflux Disease (GERD) continues to push treating the symptoms with stronger meds and does not discuss getting to the root of the cause. At least they agree that GERD is not a one-size-fits all issue.
"The main focus for drug development in refractory GERD patients is more potent, early and consistent acid suppression. However, due to the diverse causes of PPI failure, one therapeutic strategy may not be the solution for all patients. It is likely that individually tailored therapy will be the best management approach."

Between 10 and 40% of patients with GERD who are not responding to proton pump inhibitors (PPIs) given once daily are very common. These therapy-resistant patients have become the new face of GERD in the last decade and presently pose a significant therapeutic challenge to gastroenterologists. In addition, gastroenterologists are beginning to find polyps in the stomach, in addition to the colon, which is very disturbing. They are attributing this to chronic PPI use.

One would think that research would focus more on lifestyle changes of the dietary nature. Their evaluation of this is laughable. Of course, there is no mention of the slew of negative data that has come out within the last year regarding the myriad of issues long-term PPI use causes.

Newest Findings
  • Commonly, doubling the PPI dose or switching to another PPI will be offered to patients who failed PPI once daily. Failure of such therapeutic strategies is commonly followed by transient lower esophageal sphincter relaxation reducers.
  • During a period of only 7 years (1997–2004), there was an increase by almost 50% in the usage of at least double-dose PPI in patients with GERD. Approximately 42.1% of all patients supplemented their prescription PPIs with other antireflux therapies, including over-the-counter antacids and H2-receptor antagonists. More than 85% of the patients still experienced GERD-related symptoms. Bonnie comment - this is a staggering statistic.
  • In the 2000 Gallup Study of Consumers' Use of Stomach Relief Products, 36% reported taking nonprescription medication in addition to a prescription medication for GERD. Of those, 56% stated that they used their prescription medication daily but still needed to supplement with nonprescription medication for breakthrough symptoms. Bonnie - the nonprescription is mostly taken without the physician's knowledge, creating a whole host of other potential issues.
  • Recently, weakly acidic and alkaline reflux has been implicated as a cause for refractory GERD-related symptoms. The mechanism by which weakly acidic reflux causes symptoms remains poorly understood. Bonnie - what is poorly understood? Your stomach needs an acidic environment to break down food and repel bacteria. When PPIs are consistently blocking acid production, what do they think is going to happen?
  • Inflammation of the esophageal lining is not limited to GERD: it can be found in up to 30% of asymptomatic patients, as well as in patients with esophageal candidiasis, food allergy, food intolerance, eosinophilic esophagitis, and esophageal cancer. Bonnie - food allergy, food intolerance, and candida: bingo!
  • Evaluation for proper compliance and optimal dosing time should be the first management step in assessing patients with heartburn not responding to PPI therapy. The physician should emphasize the need to take PPIs half an hour before a meal.
  • The benefit of lifestyle modifications in GERD patients who fail PPI treatment has yet to be elucidated. In a recent systematic review of reports on lifestyle modifications for GERD, the authors determined that only weight loss and elevation of head of the bed appear to be effective. There were insufficient data to support any of the other commonly prescribed lifestyle modifications. Nevertheless, in patients with PPI-refractory heartburn, it seems reasonable to recommend avoidance of specific lifestyle activities that appear to trigger GERD symptoms. Bonnie - reasonable? I'd say so. If you did exhaustive research on cutting out the dietary and environmental offenders, the results would render most of the drug trials irrelevant.
  • For GERD patients on PPI twice daily who still exhibit symptoms, histamine 2 receptor antagonist (H2RA) at bedtime significantly reduced the frequency and duration of symptoms. Although no studies document any clinical correlation, the addition of H2RA at bedtime has become common practice in GERD patients who fail PPI treatment. However, patients rapidly develop tolerance (within 1 week) to the antisecretory effects of H2RAs given at bedtime. Bonnie - another off-label use where their is no sufficient data and the drug loses efficacy rather shortly.
  • Whereas doubling the PPI dose might be considered the standard of care, there is no evidence to support any further escalation of the PPI dose for symptom control or healing of erosive esophagitis. For double-dose therapy, the PPI should be taken before breakfast and before dinner. Bonnie - in other words, they are flying blind.
  • A recent study has suggested that a minority of GERD patients may lose PPI efficacy after 2 years of continuous treatment with one or two PPIs per day. Bonnie - many of that "minority" will stay on it for much longer than two years with awful consequences.
Drugs of the Future
  • Transient Lower Esophageal Sphincter Relaxation Reducers
    The most promising of these agents appear to be the gamma-aminobutyric acid B (GABAB) receptor agonists and metabotropic glutamate receptor 5 (mGluR5) antagonists, which can achieve a high level of TLESR inhibition. As a potential add-on treatment for patients who failed PPI therapy, early results shows the drugs reduce the TLESR rate by 40–60%, reduces reflux episodes by 43%, increases lower esophageal sphincter basal pressure, and accelerates gastric emptying.
    Bonnie - however, because the drug crosses the blood–brain barrier, a variety of central nervous system-related side effects have been reported including somnolence, confusion, dizziness, lightheadedness, drowsiness, weakness, and trembling.
  • Visceral Pain Modulators
    To date, there are no studies that have specifically evaluated visceral pain modulators in refractory GERD patients. However, given the fact that most patients who fail PPI treatment, the use of pain modulators is highly attractive. Pain modulators such as tricyclic antidepressants, trazodone (a tetracyclic antidepressants), and selective serotonin reuptake inhibitors (SSRIs) have all been shown to improve esophageal pain in patients with noncardiac chest pain.
    Bonnie - antidepressant side effects are well known and will limit the usage of these modulators.
  • Botulinum Toxin Injection
    In one recent study, botulinum toxin was administered by pyloric injection to 11 patients who had refractory GERD associated with gastroparesis. There was marked improvement in GERD-related symptoms, which correlated with improvements in gastroparesis-related symptoms and in gastric-emptying as assessed by scintigraphy. The mean duration of response is approximately 5 months.
    Bonnie - Botox is the newest substance likely to be touted for every chronic health issue. Of course it will disperse everything in its path...it is one of the deadliest toxins on earth! But the question is, at what long-term price? nobody knows.
Antireflux Surgery
A recent surgical study reported that overall, 82% of patients reported that the preoperative reflux symptom completely resolved, and 94% were satisfied with the results of the surgery. In another study, at the end of 1 year follow-up after surgery, all patients reported complete heartburn relief and 86% reported resolution of the regurgitation symptom. Patients' satisfaction rate with surgery was 87%.
Bonnie - when in doubt, operate (I am being facetious).

Alternative Medicine
The value of acupuncture has been evaluated in GERD patients who failed PPI once daily. When compared to doubling the PPI dose, adding acupuncture was significantly better in controlling regurgitation as well as daytime and night-time heartburn. This is the first study to suggest that alternative approaches for treating visceral pain may have a role in GERD patients with PPI-refractory heartburn.
Bonnie - finally, we get to something safe!

Psychological Treatment
Patients with poor correlation of symptoms and acid reflux events display a higher level of anxiety and hysteria than those who have a close correlation between symptoms and acid-reflux. Anxiety and depression have been shown to increase GERD-related symptoms report in population-based studies. A recent study provided the first evidence that response to PPI treatment may be dependent on the level of psychological distress. Thus, it has been proposed that patients who do not respond to PPIs are more likely to have a psychological comorbidity than those who respond.


Bonnie - after reading this, please at least explore dietary and lifestyle modification. You can see the viscous cycle that sets up for you if you do not.

Magnesium, Sudden Cardiac Death Risk

Bonnie and Steve - In January 2007, we made an impassioned plea for our readers to spread the word about the connection between magnesium and thirty-something's dropping dead from sudden cardiac death (article here). We were rebuked for the strong wording of the piece. Almost four years later, a study in this month's American Heart Journal supports our call to action. While the subject group was a bit older (45-64), this should be a wake up call, especially for those who are very active physically, to supplement with magnesium. Along with vitamin D, magnesium is the most deficient nutrient in Americans. Simply put, for maintaining good magnesium levels, diet is not going to cut it.

American Heart Journal Study Summary
Researchers hypothesized that serum magnesium (Mg) is associated with increased risk of sudden cardiac death (SCD).
The Atherosclerosis Risk in Communities Study assessed risk factors and levels of serum Mg in a cohort of 14,232 45- to 64-year-old subjects in 1987–1989. After an average of 12 years of follow-up, we observed 264 cases of SCD.

Individuals in the highest quartile of serum Mg were at significantly lower risk of SCD in all models. This association persisted after adjustment for potential confounding variables, with an almost 40% reduced risk of SCD in quartile 4 versus 1 of serum Mg observed in the fully adjusted model.

The study suggests that low levels of serum Mg may be an important predictor of SCD. Further research into the effectiveness of Mg supplementation for those considered to be at high risk for SCD is warranted.

Details

Sudden cardiac death (SCD) is a major public health problem comprising more than half of all cardiovascular disease (CVD) deaths in the United States.

Magnesium (Mg), a micronutrient and common cation in the human body, is a natural calcium (Ca) antagonist and modulates vasomotor tone, blood pressure, and peripheral blood flow. Although virtually all Mg is stored in cells, low levels of serum Mg are usually predictive of low levels of total body Mg as well. Previous epidemiologic studies have reported that serum and dietary Mg is associated inversely with CVD risk factors such as hypertension, type 2 diabetes mellitus, and the metabolic syndrome, in addition to CHD. Additional evidence from ecologic, clinical, and autopsy studies has shown higher Mg to be potentially protective against SCD; but no prospective studies have reported the association of Mg levels with incidence of SCD in the general population. In addition to its role in the regulation of blood pressure and maintenance of vascular smooth muscle tone, Mg deficiencies are known to cause ventricular arrhythmias, the most common precursors to SCD. Serum Mg levels are modified by intake of dietary Mg, Ca, and potassium (K), in addition to alcohol intake and physical exercise.

The main finding from this analysis was a significantly reduced risk of SCD in the highest quartile compared with the lowest quartile of serum Mg in a prospective cohort with >173,000 person-years of follow-up. This association persisted after adjustment for the major predictors of SCD and potential confounders (or mediators) of the Mg-SCD relationship, including hypertension, diabetes, serum K, heart rate–adjusted QT interval, and use of diuretics. The association was monotonic, with a declining risk of SCD with each quartile of higher serum Mg. This association did not differ by race, sex, prevalent CHD, use of diuretics, serum K level, or heart rate–adjusted QT interval. Despite these strong findings for serum Mg, we observed no association between dietary Mg and risk of SCD. This is not surprising given previous reports from this cohort showing no association of dietary Mg with either incident hypertension or CHD, despite associations of these outcomes with serum Mg.

Individuals who maintained serum Mg levels higher than the median value at 2 visits 3 years apart had the lowest risk of SCD. Nevertheless, a limitation of our study was an inability to assess levels of serum Mg just before an event. It could be that a sudden drop in Mg is important. However, measurement just before SCD is not possible in a prospective study. Serial measurements of serum Mg over many years would improve our ability to understand the impact of short-term transient changes in serum Mg on the risk of SCD.

Big Pharma a huge influence on prescriptions

Doctors tend to prescribe drugs that pharmaceutical companies promote to them and patients end up paying more but not always getting the most suitable medicines, researchers reported in PLOS Medicine.

The report found that doctors who accepted briefings or other information from drug companies were more likely to prescribe those products. None of the studies found that doctors prescribed a drug less often because of promotional or informational materials.

This week, the investigative journalism group ProPublica, along with several news organizations, reported that seven big drug companies had paid more than 17,000 U.S. doctors many thousands of dollars to talk to other doctors about the companies' products.

Steve - this should not come as a surprise to any readers of this blog.

Thursday, October 21, 2010

DBS effective therapy for Parkinson's: study

Deep brain stimulation (DBS) has proven to be a lifeline for some patients suffering from Parkinson's disease, those whose symptoms cannot be adequately controlled with medications. A neurosurgeon uses magnetic resonance imaging or computed tomography to identify the exact target within the brain where abnormal electrical nerve signals generate the disease's tremors and other symptoms, and a neurostimulator is then surgically implanted to deliver electrical stimulation to that area to block the signals.

More than 50 DBS experts -- including world-renowned neurologists, clinicians and surgeons -- pooled their experience with the procedure and reached a consensus, presented in the Archives of Neurology. Among their findings:
  • The best candidates for DBS are those who can't tolerate the side effects of medications, who don't suffer from significant active cognitive or psychiatric problems, and who do suffer from tremors and/or motor fluctuations.
  • DBS surgery is best performed by an experienced team and neurosurgeon with expertise in stereotactic neurosurgery -- microsurgery deep within the brain that is based on a three-dimensional coordinate system using advanced neuroimaging.
  • DBS, when used in the two most commonly treated areas of the brain -- the subthalamic nuclei and the globus pallidus pars interna -- is effective in addressing the motor symptoms of Parkinson's, but treatment in the subthalamic nuclei may cause increased depression and other symptoms in some patients.
  • Surgical removal of the area of the brain causing Parkinson's disease is still an effective alternative and should be considered in patients.
  • Surgical complication rates vary widely, with infection being the most commonly reported complication of DBS.

Wednesday, October 20, 2010

Fish oil benefits during pregnancy questioneds

According to a recent JAMA study, fish-oil supplements don't appear to help pregnant women prevent post-partum depression or boost the baby's brain development as previously believed. Several previous studies have shown that eating fish during pregnancy helped in the baby's brain development and in reducing the risk of post-partum depression.

This latest study does suggest that some subgroups of women might benefit from fish-oil supplements. For instance, those with a history of clinical depression—and thus are at higher risk of post-partum depression—who took 800 milligrams of fish oil daily lowered their risk of getting depressed after the birth by about 4% compared with those who didn't take fish oil.

Women in the fish-oil group had lower rates of pre-term births, particularly births earlier than 34 weeks of gestation.

Bonnie - let's not forget that according to the National Institutes of health, fish oil lowers triglyceride fat levels and are likely helpful in preventing heart disease, decreased blood pressure, improve thinking in kids with attention deficit-hyperactivity disorder, help with weight loss and reduce the risk of endometrial cancer.

A large body of scientific evidence has established a strong relationship between the DHA status of mothers and infants, and a variety of important pregnancy-related outcomes, including infant development. Unfortunately in this trial, we have no idea of the DHA status of the mothers at the beginning of pregnancy or when they were evaluated for depression. Further, we have no idea of the DHA status of the infants at 18 months when they were evaluated for neurocognitive outcomes. Without measurements of DHA status, it is difficult to draw conclusions from the study and certainly should not provide definitive advice to consumers.

In addition, supplementation occurred from mid-term to delivery—we know that maternal DHA status returns to below pre-pregnancy levels within a few weeks from delivery. A mother in the treatment group who started the trial with low DHA status would have returned to pre-pregnancy status by the time she was evaluated for depression at six weeks and six months post delivery. We may have seen different results if these women took fish oil consistently leading up to, during and after pregnancy (which I recommend), or if we were able to stratify the results based on DHA status.

There is no questioning the importance for pregnant and lactating women to consume the recommended amounts of DHA throughout pregnancy via eating two servings of fatty fish, such as sardines or anchovies, per week, or taking fish oil supplements (containing 200 to 300 mg/d of DHA, according to the Institute of Medicine).

While the benefits of DHA for a healthy pregnancy are well-established, there obviously needs to be more research to determine the effect of DHA on incidence of post-partum depression or neurocognitive development of infants.

Tuesday, October 19, 2010

Folic acid does not improve heart outcomes

Supplements containing the B vitamin folic acid don't reduce the risk for cardiovascular disease, death or cancer, according to a new large-scale analysis of studies on the issue. Because it lowers blood levels of the protein homocysteine, which is linked with heart and blood vessel disease and other ills, some scientists hoped that the powerful vitamin might lower the risk of heart disease, stroke or cancer. The current meta-analysis suggests that even taken at high doses, folic acid supplements don't have that effect. according to the Archives of Internal Medicine.

Researchers collected data on 37,485 people who took part in eight trials comparing the value of folic acid supplements against placebo. These trials represented all the large randomized studies available that were designed to lower plasma homocysteine levels for the prevention of cardiovascular disease. Over five years, there were 9,326 major coronary events, including strokes and new heart procedures. In addition, 3,010 patients developed cancer and 5,125 people died, according to the report. Even though those taking folic acid saw a 25% reduction in homocysteine levels, they were just as likely to have a heart attack or stroke as those receiving a placebo. There was also no significant difference between the groups in the likelihood of developing cancer or dying. The researchers acknowledged that some benefit in taking folic acid might emerge after five years — the length of the study period.

The researchers found no harmful effects from taking folic acid in multivitamin supplements or in folate-fortified foods.

Steve - first of all, I don't know of any clients using folic acid solely to prevent heart disease, stroke, or cancer. Besides women in their fertile years, individuals with a folic acid deficiency, or the elderly, most take folic acid as a complementary nutrient as part of a multivitamin or B-Complex.

As we have mentioned time and time again, meta analyses, such as this one, always need to be looked at with skepticism.

Another major flaw of this study is that taking folic acid alone for therapeutic value, without B-12, and B-6, is not advised because it can create a deficiency. Studies we posted this year in elderly subjects taking folic acid, B-6, and B-12 together showed reductions in brain shrinkage, depression, and hearing loss.

Finally, reducing homocysteine, which the aforementioned study confirmed, has shown to be beneficial for dementia prevention, especially for those with levels that are out of range.

Friday, October 15, 2010

Why bowel pain radiates

Bonnie - chronic bowel pain that is not treated often radiates to other organs, creating or further exacerbating pain in those areas as well. The following study sheds light on why this may occur. The findings are particularly relevant for those suffering from chronic pelvic pain.

When it comes to chronic pain, there are two things to remember:

  1. Chances are that pain starts in the gut, so rule out gastrointestinal disorders, intolerances, and allergies first.
  2. A friendly bowel is a friendly body.
Conditions that cause chronic pelvic pain -- such as irritable bowel syndrome and overactive bladder -- often occur together. Nerves in the painful organ may ''leak'' information to nerves in an adjacent organ, and as a result the brain isn't sure which organ the pain message originates from, according to University of Pennsylvania researchers presenting evidence at the annual meeting of the American Urogynecologic Society.

For patients, the findings may be reassuring, as they are sometimes told after examinations and testing that nothing is wrong functionally in the adjacent organ in which they feel pain.

Patients with chronic pelvic pain often have symptoms from multiple organs, such as bladder and bowel. Patients diagnosed with irritable bowel syndrome or IBS, for instance, often also have symptoms of bladder urgency, or overactive bladder, in which they get a sudden urge to urinate and may ''leak."

Researchers looked at an animal model to find out what happens to surrounding organs when the colon becomes inflamed and painful. They induced colonic inflammation with a chemical and then tested bladder function. They saw a lot of bladder spasms in the animals with colonic inflammation. Those with the inflamed colons had five times the number of bladder contractions as the control animals.

Researchers believe that nerves from the inflamed organ, in this case the colon, may be communicating with nerves from other organs. When the messages reach the brain, it doesn't know which organ is inflamed. Because of the 'cross talk between nerves, which scientists call cross-sensitization, it may send the pain message to both organs.

P.S. While this study focused mostly on chronic pelvic pain, I can assure you that gastrointestinal pain can lead to chronic pain in just about every other area of the body if left untreated.

New study shows how important CoQ10 really is

Steve - an October Journal of American College of Cardiology study was commissioned by the FDA to evaluate the importance of CoQ10 in clinical outcomes of 1,191 older subjects with heart failure taking rosuvastatin (Crestor) compared to placebo.

I'd say the importance of CoQ10 is evident after seeing these results.
  • Patients in the lowest coenzyme Q10 concentration had more atrial fibrillation/flutter and had overall lower heart function compared with those with the highest concentration.
  • After introducing medication, overall, coenzyme Q10 declined at 3 months with rosuvastatin but did not change in the placebo group (39% net difference).
  • In patients treated with placebo, the risk of the pre-defined primary outcome of cardiovascular death, myocardial infarction, or stroke was numerically highest in patients in the lowest coenzyme Q10 tertile, intermediate in the middle tertile, and lowest in patients in the highest coenzyme Q10 tertile. The same relationship was seen between coenzyme Q10 tertile and mortality and hospitalizations.
  • There was an excess of 11 deaths in the rosuvastatin group compared with placebo group.

  • Looking at nonfatal events, there were 18 more patients hospitalized at least once for any reason in the rosuvastatin group compared with placebo group.

  • There were 9 more nonfatal myocardial infarctions in the rosuvastatin group in the lowest coenzyme Q10 tertile.

Warning issued for chelation supplements

FDA issued warning letters to eight companies noting certain products they are selling for chelation are unapproved drugs and devices, marketed in violation of federal law. The agency also released a consumer advisory, updating its Consumer Update website with details about the warning letters and urging consumers to avoid non-prescription products for chelation. In its warning letters, FDA noted the various products claim to treat a range of diseases—including serious conditions such as autism, Alzheimer’s disease and cardiovascular diseases—by removing toxic metals from the body. However, there are no approved over-the-counter chelation products; the use of such products can pose serious safety issues including dehydration and kidney failure.

Warning letters were issued to the following companies: Artery Health Institute LLC, Cardio Renew Inc., Dr. Rhonda Henry, Evenbetternow LLC, Hormonal Health LLC, Longevity Plus, Maxam Nutraceutics/Maxam Laboratories and World Health Products LLC.

Two nutrients may reduce sun damage

A study published in The British Journal of Dermatology assessed the effects of a dietary supplement combining a lactobacillus probiotic strain and carotenoids (beta carotene and lycopene) on early UV-induced skin damage. Taking the supplement for 10-weeks was confirmed by dermatologists and subjects were under real conditions of use. Reduced early UV-induced skin damage caused by simulated or natural sun exposure in a large panel of subjects suggests that supplement could have a beneficial influence on the long-term effects of UV exposure and more specifically on skin photoageing.

Wednesday, October 13, 2010

Poison pill for bone drugs?

Government health officials warned doctors and patients Wednesday about an increased risk of thigh fractures with a widely used group of bone-strengthening drugs. The Food and Drug Administration said patients taking bisphosphonate drugs such as Fosamax and Boniva appear more likely to suffer a rare type of fracture of the femur. The fractures occurred just below the hip joint and make up less than 1 percent of all femur fractures.

In more than half the cases reported to the FDA, patients experienced pain or aching of the groin before the fracture. The FDA said it is updating the drugs' labels about the potential risk. The fractures were publicized in a report last month from the American Society of Bone and Mineral Research, which suggests several explanations for the fractures. One is that the slowdown in cell turnover seen with bisphosphonates could lead to weaker bones in some cases. The FDA said the fractures "may be related to the use of bisphosphonates for longer than five years." In reviewing reports of fractures, FDA officials said they found patients who had been taking the drugs up to 15 years. There are no guidelines for how long patients should take the drugs.

Are we done with diet drugs?

Bonnie - not a chance. They will keep coming because for Big Pharma, finding a drug solution to weight is the holy grail.

Abbott Laboratories has withdrawn the obesity drug sibutramine (Meridia) from the market in light of clinical trial data pointing to an increased risk for stroke and myocardial infarction, the US Food and Drug Administration (FDA) announced today. The study, called the Sibutramine Cardiovascular Outcomes Trial (SCOUT), demonstrated a 16% increase in the risk for serious cardiovascular events such as nonfatal heart attack, nonfatal stroke, the need for resuscitation after the heart stopped, and death in a cohort of patients given sibutramine compared with another given a placebo. The FDA is advising physicians to stop prescribing sibutramine and for patients to stop taking it and talk to their healthcare provider about alternative weight-loss regimens.

Other prescription drugs for short-term weight loss include phentermine and diethylpropion. Orlistat is available in both an over-the-counter form (Alli; GlaxoSmithKline) and prescription form (Xenical; Hoffman-La Roche) at a higher dose. Last May, the FDA revised the label for both versions of orlistat to warn about rare cases of severe liver injury associated with the drug.

In a related action, the FDA warned consumers today not to use a weight-loss product called Slimming Beauty Bitter Orange Slimming Capsules, sold over the Internet, because they contain sibutramine. The drug is not listed on the product label. The drug is likely still present in many households, via weight-loss nutritional supplements containing undeclared prescription-strength ingredients and other contaminants. While the FDA has warned about weight-loss supplements containing prescription medicines such as sibutramine, many are still available via the internet, mostly from overseas suppliers.

Bonnie - I have been a vociferous detractor of most ingredients added to weight-loss supplements. Even the ingredients considered "natural" can have major side effects. There are only a few options that I recommend, but must be administered on an individualized basis.

More reasons to choose rGBH-free milk

Steve - an organization backed by Monsanto sued the state of Ohio claiming that farmers and milk producers should not be allowed to put rBGH-free on milk packaging. While a lower court had ruled in favor of the Monsanto-backed organization, recently, a higher court ruled in favor of the farmers and milk producers. Their reasoning is what we have suspected all along, but is nice to see it in the public record. The main three points they agree with are:
  1. A compositional difference does exist between milk from untreated cows and conventional milk ("conventional milk," refers to milk from cows treated with rbST). The use of rbST in milk production has been shown to elevate the levels of insulin-like growth factor 1 (IGF-1), a naturally-occurring hormone that in high levels is linked to several types of cancers, among other things.

  2. Certain studies indicate that rbST use induces an unnatural period of milk production during a cow's "negative energy phase." According to these studies, milk produced during this stage is considered to be low quality due to its increased fat content and its decreased level of proteins.

  3. Milk from treated cows contains higher somatic cell counts (pus), which makes the milk turn sour more quickly and is another indicator of poor milk quality.
Yum!

Organic egg scorecard

From the Cornucopia Institute

“Systemic” abuses in organic egg production
http://www.cornucopia.org/2010/09/scrambled-eggs-report-spotlights-systemic-abuses-in-organic-egg-production/

The only large scale producer that got a very good rating was Organic Valley. We have always preferred their brand because they are a co-op of many family-owned egg farmers.

http://www.cornucopia.org/organic-egg-scorecard/

Monday, October 11, 2010

Why is food intolerance summarily ignored?

The insufficiency and misguided direction of our health care system is well documented. The failure to address major public health issues with preventive measures has deeply affected our well being, physically and financially. One glaring omission from the mouths of public health decision makers is food intolerance. The question is, why?

The 2010 Report of the Dietary Guidelines Advisory Committee is a perfect example. They dedicated almost nine pages to discussing food allergies, yet only the following for food intolerance:

"Before addressing some essential and often complex food allergy-related questions, it is important to facilitate a basic understanding of food allergies. Fundamentally, there are two types of food sensitivities or adverse reactions associated with exposures to food allergens. Those types involve the consumption of the triggering component(s) or inhalation of the causative agent(s). Sensitive individuals may present overt food allergy symptoms, or present symptoms associated with food intolerance.

According to the National Institute of Allergy and Infectious Diseases, the human body’s adverse response to food can be caused by several by two fundamental mechanisms. Those mechanisms either involve the immune system or numerous systems outside of the immune system, typically the digestive system. The latter is often referred to as food intolerance. A classic example of food intolerance is lactose. Other possible food intolerances perceived by consumers and may be clinically identified include strawberries, mushrooms, chocolate and raspberries. Yet, many individuals can present food allergy symptoms with these same foods."

This is a pretty significant statement, given the fact that most of the nation consumes lactose products on a daily basis and sixty percent of adults are believed to be intolerant. Lactose and gluten (which is affecting more Americans each year), while major reactors, only are two of hundreds of intolerant foods, which include some of the most common things we eat daily. Many experts believe up to 72 million Americans have food intolerances, most of which go undiagnosed.

Great Britain recently incorporated food intolerance testing into the health screening vernacular. Yet, even as the National Institute of Allergy and Infectious Diseases admits that food intolerance exists, most allergists and physicians in the United States do not acknowledge it. Research funding has suffered because of it. Despite the dearth of research, the data that exists is convincing.

Here are the three reasons why we believe food intolerance is ignored:
  1. Difficult to Diagnose.
    Unless anaphylactic reactions occur, patients are often diagnosed with food allergies when they may really be food intolerances. Allergists do not have a protocol to discern between the two. According to Marc Riedl, MD, MS, section head of clinical immunology and allergy at UCLA, patients with non-specific symptoms, such as a rash or digestive troubles, and positive skin-prick or blood tests actually have less than a 50 percent chance of having a food allergy. In order to make a proper diagnosis, they pointed out, physicians need to evaluate the data within the context of a patient's history and have a great understanding of symptoms consistent with true food allergy. "I frequently see patients in my clinical practice who have food intolerance, but have previously had inadequate or inappropriate evaluation and been told they have a food allergy. This causes a great deal of unnecessary anxiety and concern for the patient."
    Our response: as Dr. Riedl alluded to, it is not that difficult to diagnose if using the proper screening methodology and an expert in food intolerance can analyze the results.
  2. Allergists Are Averse to Change.
    Our response: maybe so, but look at how many more patients they could add to their practices.
  3. Denial.
    There are so many foods that our digestive system may deem toxic that to individualize one's food intolerances is a daunting task.
    Our response: if insurance would cover intolerance screenings as much as they do lipid panels, this would not be an issue. Insurance could also reimburse allergists the same amount for educational consultations as they do allergy shots.
Until public health experts get their act together to acknowledge food intolerance, all we can do is continue to shed light upon the issue by screening our clients who we suspect have food intolerances, see them heal, and have them share their results with everyone they know.

For detailed data on food intolerance, go to Food's Toxic Effects Parts One and Two

For Future Consideration:
B-Cell activating factor (BAFF) is an exciting possibility as a mediating mechanism in testing via serum and gut lavage fluid for food intolerance. In a Alimentary Pharmacology and Therapeutics study, subjects with self-reported food intolerances had much higher BAFF levels than in subjects who did not report food intolerances. We will be tracking this testing methodology for future consideration.

Thursday, October 07, 2010

Europe okays xylitol claims to prevent tooth decay

The European Food Safety Authority (EFSA) has approved a health claim for xylitol sugar-free chewing gum that it reduces the risk of tooth decay. The application was submitted by leading gum manufacturer, Wrigley, under Article 14 of the health claims process. This approval follows an earlier endorsement by EFSA in 2008 for a claim submitted by the Dutch and Finnish group Leaf Holland that xylitol-sweetened chewing gum was beneficial to dental health.

The de- and remineralisation equilibrium of teeth is mainly driven by saliva and the main contributors are flow rate and concentrations of calcium, phosphate, and bicarbonate. At rest, low amounts of saliva are secreted, but stimulation by chewing may increase saliva flow more than 10-fold. When flow rate increases, saliva concentration of calcium, phosphate and bicarbonate also increases, and such increases favour remineralisation of tooth crystals.

Scientists said that, in order to obtain the claimed effect, 2 to 3 grams of sugar-free chewing gum should be chewed for 20 minutes at least three times per day after meals. "This quantity and pattern of use of chewing gum can easily be included within a balanced diet," they added. However, the Panel notes that there is a risk of osmotic diarrhoea at excessive intakes of polyols such as xylitol, sorbitol and mannitol. Furthermore, it cautions that the use of chewing gum should be avoided in children less than three years of age owing to a high choking hazard with the product in this age group.

Steve - most xylitol is corn-derived, so if you are intolerant to corn, make sure you consume xylitol products that come from birch bark, like the Xylichew brand gum.

Wednesday, October 06, 2010

PPI after MI linked to increased risk for adverse CV outcomes

Proton pump inhibitors (PPIs) are associated with an increased risk for adverse cardiovascular outcomes independent of clopidogrel use in patients who have had a myocardial infarction (MI), according to a new study published in the the Annals of Internal Medicine. In the study, the event rates were highest among patients who received a PPI (26.3%).

Bonnie - In addition to the following, I have heard several clients tell me that their gastroenterologists are beginning to find polyps in the stomach lining of their patients due to long-term PPI use.


Promoting Prevention through the Affordable Care Act

New England Journal of Medicine Editorial
by Howard K. Koh, M.D., M.P.H., and Kathleen G. Sebelius, M.P.A.

Too many people in our country are not reaching their full potential for health because of preventable conditions. Moreover, Americans receive only about half of the preventive services that are recommended — a finding that highlights the national need for improved health promotion. The 2010 Affordable Care Act responds to this need with a vibrant emphasis on disease prevention. Many of the 10 major titles in the law, especially Title IV, Prevention of Chronic Diseases and Improving Public Health, advance a prevention theme through a wide array of new initiatives and funding. As a result, we believe that the Act will reinvigorate public health on behalf of individuals, worksites, communities, and the nation at large — and will usher in a revitalized era for prevention at every level of society.

First, the Act provides individuals with improved access to clinical preventive services. A major strategy is to remove cost as a barrier to these services, potentially opening new avenues toward health. For example, new private health plans and insurance policies (for plans or policy years beginning on or after September 23, 2010) are required to cover a range of recommended preventive services with no cost sharing by the beneficiary. These services include those rated as “A” (strongly recommended) or “B” (recommended) by the U.S. Preventive Services Task Force (USPSTF), vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP), and preventive care and screening included both in existing health guidelines for children and adolescents and in future guidelines to be developed for women through the U.S. Health Resources and Services Administration (HRSA). Examples of covered services include screening for breast cancer, cervical cancer, and colorectal cancer; screening for human immunodeficiency virus (HIV) for persons at high risk; alcohol-misuse counseling; depression screening (when systems are in place to ensure accurate diagnosis, effective treatment, and follow-up); and immunizations. The prevention theme also affects individuals covered by public insurance programs. A number of policy changes will be phased in over time. For example, starting January 1, 2011, Medicare will cover, without cost sharing, an annual wellness visit that includes a health risk assessment and a customized prevention plan. Full coverage of many USPSTF-recommended services will also be available under Medicare with no cost sharing. Similarly, in 2013 and beyond, state Medicaid programs that eliminate cost sharing for preventive services recommended by the USPSTF or ACIP may be eligible for enhanced federal matching funds for providing those services.

Second, the law promotes wellness in the workplace, providing new health promotion opportunities for employers and employees. For example, the Act authorizes funds for grants for small businesses to provide comprehensive workplace wellness programs. The law also requires the secretary of health and human services to assess existing federal health and wellness initiatives and directs the Centers for Disease Control and Prevention (CDC) to survey worksite health policies and programs nationally.

Third, the Act strengthens the vital role of communities in promoting prevention. New initiative opportunities are designed to strengthen partnerships between local or state governments and community groups. For example, new Community Transformation Grants promise to improve nutrition, increase physical activity, promote smoking cessation and social and emotional wellness, and prioritize strategies to reduce health care disparities. Also, in further recognition that immunization is a foundation for public health, the Act authorizes states to use their funds to purchase vaccines for adults at federally negotiated prices. Grants for states will also support demonstration projects to improve vaccination rates.

Fourth, the Act elevates prevention as a national priority, providing unprecedented opportunities for promoting health through all policies. For example, a newly established National Prevention, Health Promotion, and Public Health Council, involving more than a dozen federal agencies, will develop a prevention and health promotion strategy for the country. The council will build on the foundation of preceding prevention initiatives, such as Healthy People (which has set the country’s health promotion and disease prevention agenda for the past 30 years), as well as efforts of expert groups such as the USPSTF, the Community Preventive Services Task Force, and the ACIP. A new Prevention and Public Health Fund, with an annual appropriation that begins at $500 million in fiscal year 2010 and increases to $2 billion in fiscal year 2015 and beyond, will invest in a range of prevention and wellness programs administered by the Department of Health and Human Services. Initial funds have already been invested in strengthening public health infrastructure, prevention research, surveillance, integration of primary care into community-based behavioral health programs, HIV prevention, obesity prevention, and tobacco control. Reinvigorated planning will also involve a national strategy to improve the quality of health care, improved data collection on health disparities, and authorization of a host of other new programs. Most newly authorized programs await appropriations and future funding as available through the annual budget process (exceptions are noted in the table).

The Act authorizes heavy investment in bolstering a primary care workforce that can promote prevention. For example, the law appropriates up to $1.5 billion for the National Health Service Corps between fiscal years 2011 and 2015 to place health care professionals in underserved areas, complementing other new investments for community health centers administered through HRSA. To guide future placements of health care professionals, a new National Health Care Workforce Commission will analyze needs.

Since tobacco dependence and obesity represent substantial health threats, the Act addresses these specific challenges in a number of ways. For example, the directives for the new health plans established after September 23, 2010, also include coverage, with no cost sharing, of tobacco-use counseling and evidence-based tobacco-cessation interventions, as well as obesity screening and counseling for adults and children.

Starting this year, pregnant women on Medicaid will receive coverage, without cost sharing, for evidence-based tobacco-dependence treatments; in 2014, states will be forbidden from excluding from Medicaid drug coverage any pharmaceutical agents for smoking cessation, including over-the-counter medications, that have been approved by the Food and Drug Administration.

To promote healthy weight for populations, the Act appropriates funds for fiscal years 2010 through 2014 for demonstration projects to develop model programs for reducing childhood obesity. And on the policy front, menu-labeling provisions require the disclosure of specified nutrient information for food sold in certain chain restaurants and vending machines. Collectively, these complementary actions in the clinic and the community will benefit individuals as well as populations.

In short, to prevent disease and promote health and wellness, the Act breaks new ground. We believe the law reaffirms the principle that “the health of the individual is almost inseparable from the health of the larger community. And the health of each community and territory determines the overall health status of the Nation. Moving prevention toward the mainstream of health may well be one of the most lasting legacies of this landmark legislation.

Dr. Koh is Assistant Secretary for Health, and Ms. Sebelius is the Secretary for Health and Human Services, Department of Health and Human Services, Washington, DC.

Tuesday, October 05, 2010

Supps improve nutritional status of cancer patients

EPA and DHA from fish oil have immune-modulating effects and may improve nutritional status in cancer. This study investigated the effects of an oral nutritional supplement containing (n-3) fatty acids on nutritional status and inflammatory markers in patients with non-small cell lung cancer undergoing multimodality treatment. In a double-blind experiment, 40 patients with stage III NSCLC were randomly assigned to receive 2 cans/d of a protein- and energy-dense oral nutritional supplement containing (n-3) fatty acids (2.0 g EPA + 0.9 g DHA/d) or an isocaloric control supplement.

The intervention group had a better weight maintenance than the control group after 2 and 4 wk, a better
fat free mass maintenance after 3 and 5 wk, a reduced resting energy expenditure after 3 wk, and a trend for a greater mid-upper arm circumference and lower interleukin-6 production after 5 wk. After 4 wk, the intervention group had a higher energy and protein intake than the C group. In conclusion, a protein- and energy-dense oral nutritional supplement containing (n-3) fatty acids beneficially affects nutritional status during multimodality treatment in patients with NSCLC.

Journal Nutrition October 2010

Does the military believe in supplements?

US Army soldiers engage in strenuous activities and must maintain fitness and body weight to retain their jobs. Anecdotal reports suggest that the use of dietary supplements (DSs) by soldiers may reflect their unique occupational requirements and the complexity of their job and family responsibilities. A survey of 990 randomly selected soldiers was performed at 11 army bases globally.

Overall, 53% of soldiers reported the use of DSs 1 time/wk; 23% of soldiers used sports beverages, 6% of soldiers used sports bars or gels, and 3% of soldiers reported the use of meal-replacement beverages. Most commonly used DSs were multivitamins or multiminerals (37.5%), protein and amino acids (18.7%), individual vitamins and minerals (17.9%), combination products (9.1%), and herbal supplements (8.3%).

Soldiers, like civilians, use large amounts of DSs, often in combination. American Journal of Clinical Nutrition, October


Steve - recently, the U.S. Army has approved a study on the use of EPA and DHA omega 3s to improve the mood and mental health of soldiers in Iraq. The study will follow 250 soldiers for three months, who will receive either a placebo or fish oil concentrate pills. Patients will be evaluated using a number of psychological measures, as well as red blood cell concentrations of EPA and DHA.

Probiotic pacifier to prevent infant respiratory illness.

Probiotic supplements may reduce the incidence of respiratory illness for infants during their first eight months of life, says a new study. Researchers report that only 65 percent of infants who received daily doses of Bifidobacterium animalis subsp. lactis BB-12 experienced respiratory illnesses, compared with 94 percent of infants in the control group. The study, published in the British Journal of Nutrition, is said to be the first to administer the probiotics using a pacifier – with the results supporting this as an interesting delivery system for infants. A soft and broad new slow-release pacifier has been developed to contain a pouch in which the food supplement tablet can be inserted. The delivery method was tested before the study began: the BB-12–xylitol tablet and the control xylitol tablet dissolved from the pouch of the pacifier both slowly and completely during 7 to 15 minutes of sucking.

Best infant remedy for infection?

Exclusive breast-feeding for 6 months, as recommended by the World Health Organization, may protect infants against common infections, according to a study in the Archives of Disease in Childhood. "Breastfed infants are considered to be less prone to a variety of infections, including acute otitis media, and gastrointestinal and lower respiratory tract infections," writes the lead researcher. The goal of the study was to determine the impact of breast-feeding on the frequency and severity of infections in a well-defined population of infants with adequate vaccination coverage and healthcare standards. The investigators recorded type of feeding and all infectious episodes, including acute otitis media (AOM), acute respiratory infection (ARI), gastroenteritis, urinary tract infection, conjunctivitis, and thrush, in a representative sample of 926 infants who were followed up at ages 1, 3, 6, 9, and 12 months.

Compared with partially breast-fed or non−breast-fed infants, those who were exclusively breast-fed for 6 months had fewer infectious episodes: 58% less for ARI; 37% less for AOM; 14% for thrush. Prolonged exclusive breast-feeding was associated with fewer infectious episodes through age 1 year, as well as with fewer hospitalizations for infection. Partial breastfeeding did not seem to provide this protective effect.

Friday, October 01, 2010

Magnesium shines for diabetes prevention: study

According to a study in Diabetes Care, getting enough magnesium in your diet could help prevent diabetes. People who consumed the most magnesium in foods and from vitamin supplements were about half as likely to develop diabetes over the next 20 years as people who took in the least magnesium, according to researchers at the University of North Carolina at Chapel Hill. It's plausible that magnesium could influence diabetes risk because the mineral is needed for the proper functioning of several enzymes that help the body process glucose.

The researchers looked at magnesium intake and diabetes risk in 4,497 men and women 18 to 30 years old, none of whom were diabetic at the study's outset. During a 20-year follow-up period, 330 of the subjects developed diabetes. People with the highest magnesium intake, who averaged about 200 milligrams of magnesium for every 1,000 calories they consumed, were 47 percent less likely to have developed diabetes during follow up than those with the lowest intakes, who consumed about 100 milligrams of magnesium per 1,000 calories.

Researchers also found that as magnesium intake rose, levels of several markers of inflammation decreased, as did resistance to the effects of the key blood-sugar-regulating hormone insulin. Higher blood levels of magnesium also were linked to a lower degree of insulin resistance.

"Increasing magnesium intake may be important for improving insulin sensitivity, reducing systemic inflammation, and decreasing diabetes risk," researchers write.

Bonnie - I could not have drawn it up better myself. Finally, someone took a large, healthy group of young men and women who had no disease and tracked them over a twenty year period. While I am not surprised by the results of the study, it is pleasing to see that these researchers had the foresight to design the type of study that would allow them to really see what a mineral such as magnesium could do. Seeing the results of this study, and the plethora of others we have posted over the years, you can see why magnesium has always been my number one recommendation as a supplemental nutrient. One drawback health professionals consistently have about magnesium is it's pension for creating loose bowels. However, many of them are unaware of magnesium glycinate, a source that is supremely absorbed and does not create a loose bowel effect.

I wonder if our public health brain trust will take notice of this study. Although reported by Reuters, it was not even a blip on the media's radar. Think about the billions we could save in health care costs, the undo suffering that could be averted by millions of Americans, and the greater economic productivity that could be gleaned from this simple, cheap mineral. If public health officials would be as vigilant about heeding the call for optimal magnesium and vitamin D levels as they are for the flu shot, our society would be much better off.
Go magnesium!