Monday, January 31, 2011

Dietary Guidelines for Americans 2010: Our Take

A suspected, there is very little that has changed since the last incarnation. While the committee had alluded to major changes during their meetings, the report is more of the same. Here are a few of the highlights/lowlights from our perspective:
  • We got a kick out the top 25 sources of calories among Americans age 2 and older: grain-based desserts top the list for all three age ranges, with yeast breads and pizza to follow. The full list is available on page 12.
  • Suggested reducing sodium from 2,300mg to 1,500 mg daily. Not exactly a revelation.
  • While they said to keep trans fat consumption as low as possible, they did not recommend eliminating all synthetic trans fat, which is downright abominable!
  • "Nutrients of Concern": Potassium, Dietary Fiber, Calcium, Vitamin D; for specific groups: Iron, Folate, Vitamin B-12. Hmm, where is magnesium, omega-3, etc.?
  • They did allude to the effectiveness of the DASH and Mediterranean Diet for cardiovascular health.
  • They pooh-poohed glycemic load/glycemic index.
  • They had a small section on coping with food allergies and food intolerances. The DGA once again referred to food intolerances as legitimate. Why does the medical community not address them?
  • They stated that "sufficient evidence is not available to support a recommendation for or against the use of multivitamin.mineral supplements in the primary prevention of chronic disease for the healthy American population." You've got to be kidding right? The healthy American population that most commonly consumes calories from grain-based desserts, yeast breads, and pizza? For a committee that emphasized real foods and nutrients, it seems that to get to back to a healthy population, a multivitamin/mineral supplement can at least supplement nutrients for the majority who are eating horrifically. In addition, many studies have shown that nutrient-dense foods are not provide the proper amount of nutrients that they used to because of the nutrient-poor soils that exist.

USDA's Dietary Guidelines for Americans to be released this AM

We will break it down once the full report is available. While the DGA has been rendered insignificant over the last few decades because of special interest influence, we shall see if any significant changes have been made.

One early statement that appears in the Executive Summary: "A basic premise of the Dietary Guidelines is that nutrient needs should be met primarily through consuming foods. In certain cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise might be consumed in less than recommended amounts." This verbiage is the most credence the DGA has given to dietary supplements to date.

Thursday, January 27, 2011

Berries a preventative tool for HBP

Eating blueberries can guard against high blood pressure, according to new research published in the American Journal of Clinical Nutrition. The new findings show that bioactive compounds in blueberries called anthocyanins offer protection against hypertension. Compared with those who do not eat blueberries, those eating at least one serving a week reduce their risk of developing the condition by 10 per cent.

This is the first large study to investigate the effect of different flavonoids on hypertension. The research team studied 134,000 women and 47,000 men from the Nurses' Health Study and the Health Professionals Follow-up Study over a period of 14 years. None of the participants had hypertension at the start of the study. During the study, 35,000 participants developed hypertension.

Dietary information identified tea as the main contributor of flavonoids, with apples, orange juice, blueberries, red wine, and strawberries also providing important amounts. When the researchers looked at the relation between individual subclasses of flavonoids and hypertension, they found that participants consuming the highest amounts of anthocyanins (found mainly in blueberries and strawberries in this US-based population) were eight per cent less likely to be diagnosed with hypertension than those consuming the lowest amounts. The effect was even stronger in participants under 60.

The effect was stronger for blueberry rather than strawberry consumption. Compared to people who ate no blueberries, those eating at least one serving of blueberries per week were 10 per cent less likely to become hypertensive.

Gluten's Comorbid Influence

According to an exhaustive review that recently appeared in Expert Review of Gastroenterology and Hepatology, celiac disease is now one of the most common chronic diseases encountered in the Western world. Since it is so common, much comorbidity will occur either as associations or simply by chance, or as complications of the disorder.

Autoimmune diseases constitute clinically important associations, of which Type 1 diabetes mellitus and thyroid disorders are the most important. Several liver disorders are also associated. The most common malignant complication of celiac disease is an increased risk of lymphoma by approximately fivefold. The increase of fracture risk is modest. Although neurological and psychiatric conditions affect celiac patients, no disorder have been identified. Reproductive problems occur as well. It is important that these co-morbidities are recognized because if not, symptoms will be falsely attributed to deliberate or inadvertent ingestion of gluten, rather than prompt a search for a second diagnosis. Furthermore, in a patient with an established diagnosis that is considered falsely to account for the whole clinical picture, celiac disease is likely to remain undetected. Note: there were many diseases the researchers alluded to but we did list because the "research" was not substantive to warrant a true connection to celiac. It is the research yet to be done that we really want to see because in our opinion, it will blow public health educators away. What you read below is just the tip of the iceberg.

Detailed Breakdown:

Autoimmune Disorders

Type 1 Diabetes Mellitus
Type 1 diabetes mellitus is the most common and best-researched association. The diagnosis of celiac disease may precede that of diabetes, but in approximately 90% of patients, diabetes is diagnosed first. A gluten-free diet has been shown to be effective in reversing ill health due to celiac disease in these patients, and improvement in height, weight and a reduction in hypoglycemic episodes has been shown in some series, but not all. Even those who regard themselves as asymptomatic should be offered a gluten-free diet because it may have unexpected benefits, and if it does not, it is likely to be abandoned by the patients themselves. Whether or not to screen patients with diabetes for the presence of celiac disease remains controversial, but a case can be made for a screening program when the high frequency of the association is considered, that patients may have symptoms and a gluten-free diet can improve health. There is support for screening children and adolescents with Type 1 diabetes and in practice, screening is being increasingly undertaken.

From available evidence, one could argue that screening of those with Type 1 diabetes for celiac disease is worthwhile, and that a gluten-free diet should be offered to all those who are positive.

Thyroid Disease
Thyroid disease was three-times more likely to occur in adults who were newly diagnosed with celiac disease in comparison with healthy controls. Using a study done with the Swedish In-Patient Registry, celiac disease was found to be associated with hypothyroidism, thyroiditis, and hyperthyroidism. The highest risk estimates for thyroid disease were observed in children, which is in keeping with other studies that raised the issue of whether children with celiac disease should be screened for thyroid disease. Autoimmune thyroiditis may arise when children are on a gluten-free diet, which suggests that thyroid disturbance is independent of the presence of gluten. However, gluten withdrawal in adults, may normalize thyroid tests in those with subclinical hypothyroidism. It is important to be aware of these associations, because those with celiac disease may have symptoms such as weight loss, lethargy and diarrhea attributed to celiac disease in relapse because of lax adherence to a gluten-free diet, rather than to the presence of thyroid disease.

Liver Disease
A number of liver conditions have been reported to be associated with celiac disease. Recent population-based data observed a fourfold increased risk of having an autoimmune liver disease for primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis in people with celiac disease in comparison with general population controls. A result normalizing in 86% of those with an abnormal result at diagnosis of celiac disease following a year of treatment with a gluten-free diet suggests that investigations for liver disease should only be initiated in those celiacs with persistent hypertransaminasemia despite gluten-free diet or if otherwise indicated.

Other Autoimmune Diseases
Recent population-based data observed an 11-fold increased risk of Addison's disease developing in those with celiac disease. Conversely, those with established Addison's disease had a ninefold increased risk of developing celiac disease. A positive association between celiac disease and immune thrombocytopenic purpura has been found. The prevalence of celiac disease in patients with psoriasis was increased threefold in comparison with age- and sex-matched controls. Sjogren's syndrome, primary hyperparathyroidism, hypoparathyroidism, hypopituitarism and systemic lupus erythematosus have all been described in association with celiac disease, but the body of research is scant as of now.

Diagnosed celiac disease has been traditionally linked with greatly increased risks of lymphoma and other malignancies. As larger, population-based studies have appeared, more modest although still increased risks are suggested, with the risk of lymphoma increased at least fivefold with a 30% increased risk of any malignancy in people with celiac disease in comparison with the general population. These larger studies have also supported an increased risk of small intestinal adenocarcinoma, esophageal cancer and oropharyngeal cancer in diagnosed celiac disease.

Refractory Celiac Disease
Nonresponsive celiac disease (NRCD) has historically been described as a failure to respond to treatment with a gluten-free diet and can be described as primary NRCD (the celiac never responds to a gluten-free diet) or secondary NRCD (response is lost after initial improvement with recurrence of symptoms after 1 year). Depending on study design and study population selected, the prevalence of NRCD is approximately 15–30%. The majority of cases of NRCD are probably related to continued gluten exposure: inadvertent ingestion of small but immunologically significant amounts or nonadherence. Having confirmed the index diagnosis of celiac disease holds true and established adherence to a gluten-free diet, other causes of symptoms need excluding. This includes conditions associated with celiac disease that are amenable to treatment, such as microscopic colitis, pancreatic insufficiency, irritable bowel syndrome, small bowel bacterial overgrowth, thyroid dysfunction and lactose intolerance. Note: from what we see, these are often people who cannot handle cornstarch that is prevalent in so many gluten-free products.

Metabolic Bone Disease & Fracture Risk
There is a modest increase in the risk of fracture in celiac disease. Studies suggest there is a moderate reduction of BMD in untreated celiac disease, with weighted mean Z scores at the lumbar spine and hip. Studies have also suggested that a gluten-free diet improves BMD in people with symptomatic celiac disease.

Neurological Conditions

It might be expected that those with a chronic condition, especially if the diagnosis is delayed and the treatment is a restrictive diet that limits social interaction, would result in depression. There is no doubt that depression in celiac disease can be severe to the point where patients may attempt and succeed in suicide. A gluten-free diet improves depression and anxiety in some but not all cases. As well as a gluten-free diet, vitamin B supplementation is recommended to improve mood. Impaired availability of tryptophan may be important in depressive and behavioral disorders in celiac disease.

Migraine may occur in celiac disease and improve or be cured by a gluten-free diet.

Reproductive Problems
Previous studies have raised concern regarding reduced fertility and increased adverse pregnancy-related outcomes in women with celiac disease. Some authors have accepted that infertility is a complication of celiac disease. Reported associations between celiac disease and miscarriage have also added to the concern. Women with untreated celiac disease are at greater risk of delivering small babies than those without celiac disease.

Risk of Infection in Celiac Disease
People with celiac disease have a sevenfold increased risk of death from septicemia, and threefold increased risk of death from infection and pneumonia in comparison with general population controls.

Gastrointestinal Disorders
Irritable bowel syndrome is common, but only a small percentage of patients are referred to hospital for evaluation. Symptoms such as abdominal bloating, diarrhea and constipation are common to irritable bowel syndrome and celiac disease, so the two conditions are easily confused. A search for celiac disease in irritable bowel syndrome can be supported, because in a recent study of individuals with irritable bowel syndrome, the prevalence of celiac disease was increased fourfold. For those symptoms due to celiac disease, a gluten-free diet would be expected to be effective. However, a gluten-free diet may still be beneficial in those with symptoms owing to irritable bowel syndrome in the absence of celiac disease.

Celiac disease may occur in association with ulcerative colitis and Crohn's disease. Furthermore, these three disorders can be present in different members of the same family. The prevalence of ulcerative colitis and Crohn's disease was found significantly higher in celiac disease than in the general population. In 90% of instances, celiac disease is the first diagnosis to be made.

Other Various Disorders
Celiac disease was associated with an increased risk of subsequent pancreatitis.

Celiac disease and noncirrhotic intrahepatic hypertension may occur together, but the reasons are unknown.

Enamel defects and recurrent aphthous ulcers are observed in patients with celiac disease.

The prevalence of celiac disease is increased in some genetic disorders such as Down syndrome, Williams syndrome, and Turner syndrome.

In patients with cystic fibrosis, the prevalence of celiac disease is three-times greater than the general prevalence of celiac disease. Symptoms due to celiac disease will be alleviated by a gluten-free diet, so making this diagnosis is important and screening those with cystic fibrosis is recommended.

Although most, if not all, people with dermatitis herpetiformis have gluten-sensitive enteropathy.

Finally, an The American Journal of Gastroenterology study published this week states that periodic biopsy testing to monitor mucosal intestinal recovery is warranted in celiac patients on gluten-free diets. Poor compliance with the diet, severe villi atrophy, among other factors can impede intestinal mucosal recovery in a significant percentage of celiac patients. The study found that a lack of mucosal recovery increases the rate of all-cause mortality.

Wednesday, January 26, 2011

Poison Control Report: Supplements

The peer-reviewed scientific journal Clinical Toxicology published the annual report by the American Association of Poison Control Centers for 2009 (2010 is not available yet): there were no deaths from multiple vitamins or any single vitamin, no deaths from herbal medicine, no deaths from any amino acid or dietary mineral supplement and no documented deaths from homeopathic medicines. One death was attributed to an “Unknown dietary supplement or homeopathic agent”, but this cannot be verified as no supporting information is provided. The information is in Table 22B, journal pages 1138–1148. Trawl back through the prior Annual Reports published in the same journal and you will find a similar story year after year.

Conversely, in the US, adverse drug reactions are now the fourth leading cause of death, ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents and motor vehicle deaths.

US Government gets into drug biz

Big Pharma aren't coming out with new "breakthrough" drugs quickly enough, and now the U.S. government plans to spend taxpayer dollars conducting research on drugs which will be turned over to Big Pharma. Those drug companies, in turn, will sell them for a profit. How does that sit with you?

This is all happening because drug companies say they're scaling back their research funding to find new drugs. This terrifies the U.S. government, apparently, which doesn't recognize that scaling back drug company R&D is actually a good thing for America given how much economic damage and personal health damage is caused each year by Big Pharma's dangerous drugs.

The new government drug research center will operate under the National Institutes of Health (NIH) and be called the National Center for Advancing Translational Sciences, which could get at least $1 billion annually in funding.

Smell Another Big Pharma Bailout?

Many of Big Pharma's "blockbuster" drugs are outright failures from a human health perspective. Because so many of these drugs cause extremely dangerous and even deadly side effects, Big Pharma is becoming gun-shy in the wake of billions of dollars of lawsuits and the possibility of some executives going to prison.

Video Game influences children's eating habits

Video games have been labeled as one of the causes of childhood obesity, but a new study from the Baylor College of Medicine suggests that playing video games designed to encourage healthy eating habits may get children to eat more fruits and vegetables. The study looked at one group of children played two games designed to promote healthy eating and then answered questions about their experience. The study found that kids who played the special games ate about two-thirds of an additional serving of fruits and vegetables each day compared with those who didn’t.

Tuesday, January 25, 2011

150 years of diet and still no quick fixes

Steve - Lauren Neergaard of the Associated Press wrote a great piece about the history of trying to manage the public's eating behaviors.

The most telling part of the entire article reveals the core of what our tenet has been to clients since we started in 1985: "How real nutrition science was born. The government's first advice to balance proteins, carbohydrates and fat came in 1894."

Let us repeat that again, "How real nutrition science was born. The government's first advice to balance proteins, carbohydrates and fat came in 1894."

As they say, the more things change, the more they remain the same.

HCG Diet fraudulent and illegal: FDA

Steve - as reported back in July of 2010, we have never supported and have been very skeptical of this diet.

Courtesy of USA Today.

A popular type of weight-loss products, heavily promoted on the Internet, is fraudulent and illegal, Food and Drug Administration officials say. HCG weight-loss products that promise dramatic results and claim to be homeopathic are sold as drops, pellets and sprays on the Web, in drugstores and at General Nutrition Centers. They are supposed to be used in combination with a very low-calorie diet of 500 calories a day. Many of the labels indicate the products contain HCG, or human chorionic gonadotropin, a hormone made by the placenta during pregnancy. The hormone itself is approved as a prescription treatment for infertility and other conditions.

There is no evidence the oral over-the-counter products are effective for weight loss, says Elizabeth Miller, FDA's leader for the Internet and health fraud team. While they may not be dangerous, they're at least "economic fraud," she says. Because the products do not seem to be "a serious direct health hazard or a serious indirect health hazard," they have been a lower priority for FDA action than other products. Still, Miller says, "they could be subject to enforcement at any time." One of the issues is the homeopathic label. Homeopathy is an alternative medicine practice of using very small or diluted preparations of medicines or remedies to treat a condition. Miller says, "We are aware of HCG products that claim to be homeopathic, but it is not recognized in the Homeopathic Pharmacopoeia." Therefore, these products "are not recognized by the FDA as homeopathic drugs, so they are unapproved drugs and are illegal," she says.

Miller says HCG began being used for weight loss in the 1950s when a British physician had a theory that it could help people on a near-starvation diet not feel hungry. "Since then, a lot of research and clinical trials debunked that theory." Samuel Klein of Washington University School of Medicine in St. Louis agrees: "Data from most randomized controlled trials show that HCG is no better than placebo in achieving weight loss or reducing hunger."

Andrew Shao of the Council for Responsible Nutrition, an industry group, says HCG is "not considered a legal dietary ingredient and therefore cannot be sold as a dietary supplement. I am not aware of any scientific evidence that supports its use when taken orally." Because HCG is a peptide hormone, it would be broken down by the stomach and rendered ineffective, he says. He says the products are mostly sold over the Internet, so it's difficult to track sales. Kevin Wright, president of HCG Platinum, says his company made HCG products until about two months ago; it stopped because it found a formula that doesn't use the hormone. Some bottles of the HCG formula are still on store shelves, selling for about $70 an ounce. Many other companies are still selling HCG products, and there are weight-loss clinics that use the prescribed injectable hormone, he says. FDA's Miller also has concerns about injectable versions of HCG for weight loss. The drug is not approved for weight loss, she says. Dieters getting injections of the hormone from people who aren't licensed to do so run the risk of getting infections and can't be sure what product they're getting.

Friday, January 21, 2011

Why We Get Fat

by Bonnie Minsky

Fifty years ago, one of nine Americans would be considered obese; as of 2010, it was one of three with two of three considered overweight. Children are fatter, teens are fatter, and even babies are born fatter. Who or what do we hold accountable for this?

1. The USDA Food Pyramid and Dietary Guidelines are based on politics and food surpluses instead of hard science. Following a heavy dairy based diet (especially since dairy cows have been fed corn, antibiotics, and estrogenic hormones) and grain based diet (cornmeal and whole wheat are the biggest culprits), Americans have become the sickest and fattest than at any time in recorded history. Is it any wonder that Type II Diabetes has reached epidemic proportions?

2. During the last 30 years, health officials still promote the calories in/calories out theory. They tell us to exercise more and eat less. When it doesn't work, they assume we're lying. I disbanded this theory 30 years ago when I was called into do a program for poverty-stricken women who relied solely on food stamps. They were absolutely not getting enough calories, but with two exceptions, were obese. In my 25 years of nutrition counseling, I have found that 90% of my obese clients do not take in more calories than they try to expend.

3. Obese individuals are desperate to find a magic bullet. Drugs, weight-loss supplements, elixirs, dangerous detoxification programs, and surgeries have been hawked to the public from all angles. The money spent on these treatments have created so much frustration that many yo-yo dieters give up in frustration.

4. Thousands of books have been written regarding the secrets to weight loss. The weight loss diets fall into opposite ends of the spectrum from the the very low the very low the very high protein...and to the very high fat. Because most of these plans can work short-term due to reduction of calories and loss of water weight, pseudo-successful dieters spread the word like wildfire. When they stop working, the dieter jumps on the next dieting bandwagon...only to throw the body out of homeostasis once again.

How can we prevent obesity or lose weight and keep it off forever?

Eat Real Food.
Isn't it interesting that after 48 years of being in the weight loss business, that even Weight Watcher's is finally steering dieters into eating more natural, less processed foods. They admit that "calorie counting has become unhelpful". For instance, a 100 calorie apple is not handled by the body the same way as 100 calorie cookie is handled. So get rid of the artificial flavors/colors, MSG, hormones, antibiotic residues, trans fats, and fake preservatives. Eat less out of a box, jar, or can. Eat more from fresh fruits, fresh/frozen vegetables, lean unprocessed meats/poultry/fish, healthy oils, and raw/dry roasted nuts/seeds. Your body will feel satisfied and will be able to stop foraging for missing nutrients.

Balance Proteins, Carbohydrates, and Fats.
The International Obesity Conference (which our Circle of Health had already endorsed) wasn't wrong when they said about 50% carbs ( mostly from fruits and vegetables), about 30% protein, and about 20% healthy added fats would keep excess weight off, satisfy, and prevent future disease. This is the basic description of one of eight Mediterranean Diets that relies heavily on beans instead of bread and fish/poultry instead of fatty meats. This also describes the Japanese (especially the Okinawan) Diet that avoids most cow's milk products and grains, except rice. Organic fermented soy, healthy fat, loads of fruits/vegetables, and fish make this the healthiest diet in the world. I've never seen an individual combining the best of the Mediterranean and Okinawan diets all the time ever have a major weight or health problem!

Look at Your Individual Needs.
Good results on routine blood tests, having enough energy, feeling calm, sleeping well, feeling free of pain unless you've overexerted yourself, and having the ability to concentrate are good indicators of a body in homeostasis. If this is not your M.O., then work with a licensed health professional to determine if nutrient deficiencies, excess stress, overexertion, food allergy, and/or food intolerances could be culprits.

Eat to Live...Instead of Living to Eat.
Eat slowly, savor every delicious bite of your food, and thank nature and industry for providing you with easy access to a wide variety of foods from which to choose. But just like a child who can't buy everything he wants at the toy store, you shouldn't buy everything you want at the grocery store.

Take Baby Steps.
Losing weight and keeping it off is the surest way to building optimum health. If you even make one positive "forever" change each month, within a maximum of two years you will have changed the course of your life in a positive way. And once you feel how wonderful it is to be able to focus on the truly important things in your life, instead of on feeling lousy and constantly thinking about your weight, you will have achieved.

We have dedicated the entire month of January emphasizing sound, smart, safe tips for reducing or balancing weight in our subscription-based NCI Well Connect eNewsletter. Email for more information.

FDA Looks Into Post-Vaccine Seizures in Young Children

Courtesy of the Associated Press

Government officials are investigating an apparent increase in fever-related seizures in young children after they got a flu shot. The U.S. Food and Drug Administration on Thursday said there have been 36 confirmed reports of seizures this flu season in children ages 6 months through 2 years. The seizures occurred within one day after they were vaccinated with Fluzone, the only flu shot recommended in the United States for infants and very young children. Ten of the children were hospitalized, but all recovered.

The FDA said it is investigating to see if there is any connection between the vaccine and the seizures, or if something else caused the convulsions. The agency said recommendations for using the vaccine have not changed, nor has there been any change in flu vaccine guidance. In the U.S., vaccination is recommended for everyone except infants under 6 months. The vaccine's manufacturer, Sanofi Pasteur, issued a statement emphasizing that no clear link has been established between the flu shot and the seizures and that the cases may be coincidental.

Thursday's announcement comes at a time when the FDA has been working on disclosing more information about potential safety problems with drugs and devices after they've been approved. The government uses a national reporting system to monitor possible side effects following vaccination. Doctors, nurses, parents and vaccine manufacturers all can file reports. "It's meant to cast a wide net" to look for problems, but is only regarded as preliminary information that must be checked out, said Shelly Burgess, an FDA spokeswoman.

FDA officials said they've been paying special attention to seizure reports because of an unexplained higher rate of fevers and seizures in young children in Australia and New Zealand who got a specific flu vaccine earlier this year. In August, a U.S. vaccines advisory panel said doctors should avoid using that vaccine, made by CSL Biotherapies, in children ages 6 months through 8 years. It's possible the Australia cases sparked increased reports this fall, said Dr. Andrea Sutherland, an official in the FDA's Center for Biologics Evaluation and Research.

The fever-related seizures — called febrile seizures — are convulsions brought on by a fever in infants or small children. A child often loses consciousness and shakes. Most seizures last a minute or two, and often children quickly recover. Such seizures may occur with any common childhood illnesses that may cause fever, such as ear infections, colds, influenza and other viral infections.

Here is the FDA's Official Notice.

Thursday, January 20, 2011

Update on colds and sinusitis in children

Young children experience an average of six to eight colds per year. Of every 10 children with a cold, one develops sinusitis. Sinusitis occurs when the sinuses, which do not drain properly during a cold, become secondarily infected with bacteria. Instead of getting better, children with sinusitis often have worsening or persistent cold symptoms. In order to alleviate the symptoms of sinusitis, parents and physicians often resort to using decongestants, antihistamines and nasal irrigation. These treatments are available without requiring a prescription and are widely used. Previous studies have shown that the use of antihistamines and decongestants in children is associated with significant side effects.

After a comprehensive review of the literature, we failed to find any trials that evaluated the efficacy of these interventions (compared to no medication or placebo) in children with clinically diagnosed acute sinusitis. Accordingly, the use of antihistamines and decongestants in children with acute sinusitis cannot be recommended. Cochrane Database of Systematic Reviews 12/2010

Another reason to adhere to the "two year" rule

Federal health officials are warning doctors and patients that a recently-launched heart drug from Sanofi-Aventis SA has been linked to liver damage in a handful of patients. The Food and Drug Administration said Friday it has received several reports of liver damage with Multaq tablets, including two cases in which patients had to have their livers removed. Both patients were women and roughly 70 years old. They had been taking the drug for 4.5 months and 6 months, respectively. The FDA approved Multaq in July 2009 to treat atrial flutter and atrial fibrillation which are irregular heart rhythms that can reduce blood flow and lead to stroke. More than a half-million prescriptions for Multaq have been written since the drug was approved.

In an online notice, the FDA said it would add a new warning about the risk for liver damage to the label of Multaq. The agency said patients should contact their doctor if they experience signs of liver injury, including nausea, vomiting and fever. If doctors suspect a toxicity issue they should discontinue use of the drug and test the patient's liver enzymes.

Wednesday, January 19, 2011

Organic better than conventional milk nutritionally

A new study published in the Journal of Dairy Science suggests that organic supermarket milk may offer a better nutritional profile than conventional milk. Researchers at Newcastle University studied the composition of 22 different milk brands over different years and seasons to establish patterns in their nutritional content. They found that organic milk had higher concentrations of beneficial fatty acids including polyunsaturated fatty acids and conjugated linoleic acids (CLA). Specifically the researchers looked at 12 conventional milk brands and 10 organic brands. On average, omega-3 levels were 60 per cent higher in organic milk and CLA levels 30 per cent higher. Butler indicated that the differences are explained by the higher quantity of grass and conserved grass in the diet of organic cows.

Steve - this should not come as a surprise to anyone. Cow's were meant to eat grass, not corn, soy, and animal byproducts.

Effects of long-term cell phone use: the debate continues

The highest-quality research data available suggests that long-term exposure to microwaves from cellular phones may lead to an increased risk of brain tumors, reports a paper in the November/December issue of Journal of Computer Assisted Tomography. Although debate continues, independent studies with long-term follow-up strongly suggest an increased risk of brain tumors related to the use of cellular or cordless phones. "We conclude that the current standard of exposure to microwave during mobile phone use is not safe for long-term exposure and needs to be revised," conclude the study authors.

There is increasing public concern about the potential cancer risks from microwave emissions related to wireless phones -- not only cellular phones and base stations (transmission tower antennae), but also home cordless phones. Some studies have reported that long-term wireless phone users have increased rates of brain tumors, including malignant gliomas and benign acoustic neuromas. However, other studies have found no association. To gain insight into the controversy, researchers analyzed studies that included more patients who had used a cell phone for ten years or longer and were performed without financial support from the wireless industry. The findings suggested that the more hours of cellular phone use over time, the higher the risk of developing brain tumors. Risk also increased along with the level of power from the wireless device, years since first use, total exposure, and younger age when starting wireless phone use. Based on an analysis of pooled data from different studies, researchers write, "[L]ong-term cell phone usage can approximately double the risk of developing a glioma or acoustic neuroma in the more exposed brain hemisphere" -- that is, on the side where the user typically holds the phone to the ear. That conclusion is consistent even with data on the long-term cell phone users from the Interphone studies.

The researchers suggested some steps that cell phone users can take to reduce exposure. These include limiting the number and length of calls, restricting children's cell phone use, communicating by text instead of voice, and wearing an "air tube" headset (not a regular wired headset) rather than holding the phone to the ear. The researchers also urge adoption of newer phones and other technologies to reduce exposure, and call for government action to revise standards for microwave exposure.

Statins for Everyone? Not so fast.

According to British researchers, people without heart disease should think twice before taking cholesterol-lowering statins. While statins require a prescription in the US, they are sold over the counter in England, and one in three Brits over 40 are currently using them. In a report by the Cochrane Collaboration, researchers found the drugs did appear to slash deaths ever so slightly in patients at low risk of heart disease. But many of the reports they looked at -- all but one funded by drugmakers -- were flawed. In particular, while all the studies focused on benefits, only half provided information on the side effects of the drugs.

Pooling the results, they estimated that treating 1,000 people with statins for one year would lower the number of deaths from nine to eight. The researchers believe that trial funders, investigators and journal editors have failed to provide adequate information to doctors and their patients to assess the benefits and harms of statins in primary prevention.

5-a-Day may not cut it

Five servings a day has been the tenet for fruit and vegetable consumption for years, but new research from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart study confirms what we have been saying for a while now: eight servings may be needed to cut the risk of dying from heart disease. The diet and lifestyles of more than 300,000 people across eight countries in Europe found that people who ate at least eight portions of fruits and vegetables a day had a 22% lower risk of dying from heart disease than those who ate three portions a day. Each additional portion in fruits and vegetables was linked to a 4% lower risk of death.

The average intake of fruits and vegetables in the various countries was five servings a day. Spain, Greece, and Italy were the leaders in fruit and vegetable eating. Italian men enjoyed 7.5 portions a day, and Spanish women 6.7 portions. Healthy eating tailed off the further north the researchers looked in Europe. U.K. men managed 4.1 portions a day, and women 4.8 portions. Swedish men and women were the worst, with only 3.5 and 2.9 portions a day.

Bonnie - realistically, if everyone could get their 5-a-Day (which is highly unlikely in the US), we would all be better off. However, 8-a-Day is the now the benchmark which we should all aspire to.

Monday, January 17, 2011

Internet health information rarely sourced

The number of people looking for health information online has soared, but few will check where the information comes from, according to an international survey by researchers at the London School of Economics (LSE). The survey questioned more than 12,000 people in Australia, Brazil, Britain, China, France, Germany, India, Italy, Mexico, Russia, Spain and the United States and found that 81 percent of those with internet access use it to search for advice about health, medicines or medical conditions. It also found that 68 percent of those who have access have used the internet to look for information about specific medicines and nearly 4 in 10 use it to look for other patients' experiences of a condition. The majority of those surveyed do not check the source of where they get their information.

Steve - we have and will continue to bridge the gap for valuable, sourced information so you can make the most educated wellness choices possible.

OTC meds tax guidance

The Internal Revenue Service last week issued new guidance allowing the continued use of health flexible spending arrangement and health reimbursement arrangement debit cards for the purchase of prescribed over-the-counter medicines and drugs. The new guidance modifies previous guidance to permit taxpayers to continue using FSA and HRA debit cards to purchase over-the-counter medications for which the taxpayer has a prescription. Effective after Jan. 15, 2011, in accordance with the new guidance, this use of debit cards must comply with procedures reflecting those that pharmacies currently follow when selling prescription medications. The procedures include requirements that a prescription for the medication be presented to the pharmacy that dispenses the medication and that proper records be retained. In accordance with the Affordable Care Act, the cost of over-the-counter medicines or drugs can be reimbursed from a health FSA or HRA if a prescription has been obtained. The new guidance, IRS Notice 2011-5, as well as answers to frequently asked questions on, also contain further details on health FSA and HRA debit card purchases.

Three cheers for omega-3's

An American Journal Clinical Nutrition placebo-controlled, double-blind, study compared the effects of a nutritional dose of EPA+DHA (0.85 g/d) with those of a pharmaceutical dose (3.4 g/d) on serum triglycerides, inflammatory markers, and endothelial function in healthy subjects with moderately elevated triglycerides. The higher dose of EPA+DHA lowered triglycerides by 27% compared with placebo, whereas no effect of the lower dose was observed on lipids.

Loss of muscle mass with aging is a major public health concern. Omega-3 (n–3) fatty acids stimulate protein anabolism in animals and might therefore be useful for the treatment of sarcopenia. This American Journal of Clinical Nutrition study was to evaluate the effect of omega-3 fatty acid supplementation on the rate of muscle protein synthesis in older adults receiving either omega-3 fatty acids or corn oil for 8 wk.

Corn oil supplementation had no effect on the muscle protein synthesis rate and the extent of anabolic signaling element phosphorylation in muscle. Omega-3 fatty acid supplementation augmented the hyperaminoacidemia-hyperinsulinemia–induced increase in the rate of muscle protein synthesis, which was accompanied by greater increases in muscle phosphorylation. Hence, this is the first study to show omega-3 fatty acids stimulate muscle protein synthesis in older adults and may be useful for the prevention and treatment of sarcopenia.

Friday, January 14, 2011

Influenza strains increasing resistance

The CDC stated on their website last week that of the type A influenza flu strains they have subtyped this flu season, 52% do not match what is in this year's batch of flu vaccine. Does one look at this as the glass half full or empty?

In addition, two new studies raise public health concerns about increasing antiviral resistance among certain influenza viruses and their ability to spread. The findings were published in the January 1 issue of The Journal of Infectious Diseases. Influenza viruses are treated with two classes of drugs: M2 blockers (adamantanes) and neuraminidase inhibitors (NAIs), including oseltamivir and zanamivir.

While the spread of influenza strains with resistance to one class of drugs has been well documented in recent years, a new report from the Centers for Disease Control and Prevention (CDC), confirms that dual resistance can emerge in several ways and has been on the rise during the past three years. The study revealed that additional antiviral resistance could rapidly develop in a previously single-resistant strain as a result of mutation, drug response, or gene exchange with another virus. Dual resistant viruses increased in number from 0.06 percent (2007-2008) to 1.5 percent (2008-2009) to 28 percent (2009-2010). If circulation of viruses with dual resistance becomes more widespread among any of the predominant circulating influenza A viruses, treatment options will be extremely limited.

The second study examined an outbreak of oseltamivir resistant (OR) pandemic H1N1 infection in a small group of hematological patients. The study is the first to confirm person-to-person transmission of the dually resistant strain. The 2009 pandemic H1N1 virus was inherently resistant to adamantine, but was susceptible to and treated with oseltamivir. However, by October 2009, emergence of OR H1N1 had been documented in rare patients on oseltamivir therapy. Eight of the 11 pandemic H1N1 virus infections were resistant to oseltamivir. Immunocompromised patients were more susceptible to the emergence of OR H1N1 virus on treatment and also transmitted the virus to others, despite often having no influenza symptoms or having completed antiviral therapy.

The researchers in both studies agreed that creative, preventive, and therapeutic choices will be required as unpredictable and antiviral-resistant influenza viruses continue to appear.

Bonnie and Steve - this is scary stuff folks. In one year, an H1N1 strain can increase its resistance to a drug over twenty-fold? The same reason a virus can mutate so rapidly is why the WHO and CDC have such trouble choosing what flu strains to add to each year's batch of flu vaccine. They are always playing catch-up.

Let's face facts; viruses rule the earth and we are just walking, talking viral and micrrobial vats. As hosts, we must strive to create the healthiest and most harmonious environments for these organisms. We host millions of viruses and bacteria.
The microscopic marauders you read about in the press like e. Coli, staph, and clostridium difficile? They all live inside us. 99.99% of the time they act harmoniously. However, there is that .01% of the time where they cause illness. In these instances, outside influences are almost always to blame.

Researchers are now discovering that "nuking the entire area," be it with antibiotics or other strong gut-eviscerating medication, is not always the best idea. Besides the obvious issue, antibiotic resistance, it can take up to four years to recover normal gut ecology after one round of antibiotics (especially if you do not accompany the antibiotics with probiotics).

So how do we make peace with our beloved viruses and bacteria?
  • Basic hygiene - not overkill, but to keep them from overpopulating from the outside (entering via mouth, fingers, ears, eyes, nose).
  • Eating a wide variety of foods, especially locally grown produce that contains billions of local microbes.
  • Doing everything possible to maintain a healthy host (optimal mind and body).
  • Probiotics are microrgansims, but beneficial in the sense that they help balance out marauding bacteria.
  • Natural antiviral/antimicrobial substances that have harmoniously kept in check viral and bacterial overzealousness for millenia (lauric acid esters from coconut; grapefruit seed extract for example).
  • Natural substances (vitamins, minerals, plant extract, spices) that have worked to harmoniously boost the host's immune system in times of viral or microbial proliferation.
  • If these paradigms are not sufficient and the host is continually attacked by its own as well as outside microscopy, then allopathic methods should most definitely be considered.

Trans fat deception: back in the news

An article published in the January/February 2011 issue of the American Journal of Health Promotion reveals that misleading labeling practices can result in medically significant intake of harmful trans fat, despite what you read on Food and Drug Administration (FDA) approved labels.

Consumers' inability to identify high-risk foods may cause individuals to exceed the daily recommended value of 1.11 grams of trans fat from processed foods and lead to adverse long-term health side effects. Current law requires that fat content of greater than five grams be listed in one gram increments, less than five grams be listed in .5 gram increments, and lower than .5 grams as containing zero grams of fat. Meaning, if a product has .49 grams of trans fat, the label can list the trans fat content as zero, thus masking a significant amount of trans fat that can exceed recommended limits and potentially lead to various adverse health effects. Because the daily recommended amount of trans fat from processed foods is only 1.11 grams, one would only need to consume a few deceptively labeled trans fat foods to exceed the healthy recommended intake.

Research shows that increasing daily trans fat consumption from .9% to 2.1%, or from two grams to 4.67 grams, will increase one's risk of cardiovascular disease by 30%. Researchers recommends the FDA revise its labeling protocol in order to prevent misleading the public about the amount of trans fat they are consuming.

Steve - we have reported on this issue since they changed the labeling requirements for trans fat. Here is an easy way to discern if trans fat is an issue: if you see the word "partially hydrogenated" in the ingredients, do not consume it.

Wednesday, January 12, 2011

Painkillers associated with heart risk

The drugs include traditional non-steroidal anti-inflammatory drugs (NSAIDS) as well as new generation anti-inflammatory drugs, known as COX-2 inhibitors. Researchers published in British Medical Journal a comprehensive analysis of all randomized controlled trials comparing any NSAID with other NSAIDs or placebo. They included 31 trials and 116,429 patients taking seven different drugs (naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib) or placebo to provide a more reliable estimate of the cardiovascular risks of these drugs than previous studies. Overall, the number of harmful outcomes that could be compared for placebo versus treatment was low. In 29 trials there was a total of 554 heart attacks; in 26 trials there were 377 strokes, and in 28 trials there were 676 deaths. However, the researchers did find that, relative to placebo, the drugs carried important risks.

For instance, compared with placebo, rofecoxib and lumiracoxib were associated with twice the risk of heart attack, while ibuprofen was associated with more than three times the risk of stroke. Etoricoxib and diclofenac were associated with the highest (around four times) risk of cardiovascular death. Naproxen appeared least harmful in terms of cardiovascular safety among the seven analysed preparations.

The researchers concluded that although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Cardiovascular risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug. An accompanying editorial says these cardiovascular risks are worrying because many patients have both cardiovascular disease and musculoskeletal disease, and suggests that it is time for an evaluation of a broader range of alternatives.

Vitamin deficiencies seen in metabolic syndrome, asthma

Metabolic Syndrome
A study conducted by researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging showed that the metabolic syndrome, a condition that increases a person's risk of developing cardiovascular disease and type 2 diabetes, was prevalent in a low-income urban community in Ecuador and that a poor diet low in micronutrients appeared to contribute.

The authors examined the relationship between the metabolic syndrome and micronutrients such as folate, zinc and vitamins C, B12 and E, and determined that 40 % of the population had the metabolic syndrome. The researchers observed a pattern of high carbohydrate, high sodium diets lacking in healthy fats and good sources of protein. Blood analyses indicated a significant number of participants weren't consuming enough of a range of micronutrients. Significant relationships were found between the metabolic syndrome and deficiencies of two of micronutrients, vitamins C and E. Higher blood levels of vitamin E may protect against the metabolic syndrome. Low blood levels of vitamin C were seen in 82% of the participants.

With high-calorie foods lacking essential nutrients serving as pillars of the diet, it is possible to be both overweight and malnourished. The results were published in the journal Public Health Nutrition.

Bonnie - while this population group has limited availability to the necessary macro and micronutrients to avoid nutrient deficiency, many in the United States simply choose to eat this way, thus creating an unnecessary burden on our health care system.

Deficiencies of certain nutrients in parents may be associated with the development of allergic disorders or asthma in kids, according to a new report published in the Journal of Allergy and Clinical Immunology. Researchers found zinc, vitamins A, D, and E, as well as fruits and vegetables, seemed to have a protective role. Pregnant women who ate a lot of vitamins D and E were 30% to 40% less likely to have a child who wheezed. Also, sticking to a Mediterranean diet during pregnancy was also tied to a drop of nearly 80% in babies' risk of wheezing. While the researchers are unsure as to the reason why, they postulate that diet has some impact on asthma risk, perhaps by affecting development of the lungs or immune system, reducing inflammation, or curbing the generation of free radicals.

Tuesday, January 11, 2011

Stroke survivors should not take statins: study

Courtesy of Reuters

People who have had a type of stroke caused by bleeding in the brain should avoid taking cholesterol-lowering drugs known as statins. Although statins are commonly used to prevent heart attacks and strokes, they said the drugs could increase the risks of a second stroke in these patients, outweighing any other heart benefits from the drugs.

"Our analysis indicates that in settings of high recurrent intracerebral hemorrhage risk, avoiding statin therapy may be preferred," Dr. Brandon Westover of Massachusetts General Hospital and Harvard Medical School and colleagues wrote in the Archives of Neurology. That was especially true of people who had strokes in one of the brain's four lobes - frontal, parietal, temporal, or occipital - which recur more frequently than such strokes that occur deep in the brain. Westover said people who have had this type of stroke have a 22 percent risk of a second stroke when they take statins, compared with a 14 percent risk in people who are not taking a statin.

Fewer cases of AMD found

Fewer adults in the U.S. are developing age-related macular degeneration (AMD), possibly because of healthier lifestyles, researchers report in this month's Archives of Ophthalmology. AMD is an eye disease that gradually makes it difficult to see fine details, such as numbers on a watch or letters on a street sign. It is a leading cause of vision loss among people aged 60 and older, according to the National Eye Institute. Researchers reviewed data from the 2005-2008 National Health and Nutrition Examination Survey (NHANES) to determine the overall number of Americans with AMD. 6.5% of middle-aged and older adults in the U.S. had signs of the eye disease in 2005-2008. The findings are a stark contrast to an earlier NHANES analysis from 1998 to1994, which estimated that AMD developed in 9.4% of Americans. Study authors say lower rates of smoking, improved blood pressure management, and an increase in healthier diets and exercise programs may have contributed to the decline in AMD among older adults.

Bonnie - could it also be that more Americans are taking a multivitamin/mineral, providing the extra ACES plus zinc, selenium, and even lutein needed to reduce risk?

Pilot study using lipoic acid and fish oil combo to slow cognitive decline expands

Oregon Health & Science University researchers are expanding a study that found a combination of dietary supplements slows the cognitive and functional decline associated with Alzheimer’s disease. The results may help enable people with mild to moderate Alzheimer’s to live independently.

The new clinical trial will involve 100 participants in Portland, Bend, Medford and Klamath Falls who will receive either a combination of lipoic acid and fish oil or a placebo. An earlier pilot study demonstrated that the combination of these dietary supplements slows the mental decline of Alzheimer’s patients.

In addition, the OHSU research team will examine the effects of fish oil and lipoic acid on other factors – including diabetes, high blood pressure and cardiovascular disease – which are associated with an increased risk of Alzheimer’s. “There is some evidence that lipoic acid improves insulin metabolism – or insulin resistance – in diabetics,” said Lynne Shinto, N.D., M.P.H., assistant professor of neurology in the OHSU School of Medicine and lead investigator on the project.

The study is the first to consider the possible effects of insulin resistance on the progression of Alzheimer’s disease. Insulin is key to the body’s ability to extract a sugar called glucose, the body’s main source of energy, from food. That’s potentially important to treating Alzheimer’s because the human brain uses large amounts of glucose.

The new clinical trial also will examine whether the fish oil and lipoic acid combination reduces inflammation, which can lead to brain atrophy.

The National Institutes of Health and the National Institute on Aging funded the study.

Improve insulin sensitivity with magnesium supplements

According to a double-blond, placebo-controlled study from Diabetes, Obesity, and Metabolism, magnesium supplements may improve sensitivity to insulin and help reduce the risk of diabetes in overweight people. Daily supplements of magnesium (365 mg. daily) for six months improved two out of three measures of insulin sensitivity, compared with placebo, while blood sugar levels, measured as fasting levels of glucose in the blood, improved by about 7 percent.

“The results of the current study provide significant evidence that magnesium supplementation ameliorates insulin resistance in obese, insulin resistant subjects,” report researchers. “The efficacy of magnesium supplementation – even in subjects with normal serum magnesium concentrations – addresses the question of a prophylactic administration for people at risk for metabolic syndrome,” they added.

In addition to the significantly improved insulin markers following magnesium supplementation, there was also a trend for an improvement in blood pressure in the mineral supplemented group.

Steve - the evidence keeps piling up!

Monday, January 10, 2011

Local Doc: more medications not the answer

Daily Herald
by Dr. Patrick Massey

Last week, I read an interesting article about health care. The author believed the problems with health care, including rising costs and the increased incidence of many illnesses are because we have become complacent. Although most Americans do not like the idea of having illness, they feel helpless because they do not know what to do other than taking more and more medications. The author believed that we need a new American revolution. I agree.

Every year, we throw billions of dollars into the medical system and people are less healthy now than one or two generations ago. Medical providers have come to believe that every diagnosis must be treated with a medication and that medications are the only real solution to illness.

Over the past 30 years, hundreds of new medications are used earlier in the illness process and yet, Americans are increasingly less healthy. Most of us are overweight, have too much stress, too little sleep, eat all the wrong foods and do not exercise enough. We do not need more medications, but a new understanding, a new approach.

Medications save lives, but rarely cure. Rather than address the root causes of our illnesses, the answer from the medical community is more medications, surgery and other therapies. High cholesterol is not fixed with statin drugs. High blood pressure does not go away with diuretics. Cardiac bypass does not cure coronary heart disease. These are all band-aids that require continuous use of the medical system.

We, independent and self-reliant Americans, have quietly become conditioned to believe that our health is incontrovertibly bound to the medical system. Who is responsible for this state of affairs? Well, to a great extent, the current health system is responsible. It has become a supporter and enabler for the idea of living with illness rather than trying to achieve optimal health.

Truth be told, medical professionals including physicians, are taught almost nothing about health. They learn about pathology, anatomy, physiology and pharmacology. How to stay healthy is an afterthought. However, it is us who are our greatest impediments to health.

We have come to accept our illnesses as the result of poor genes, bad luck and growing old. It simply is not true. We need a grass-roots, old-fashioned American Revolution for health. This means that each of us takes complete responsibility for our own health and make those lifestyle changes that will allow us to become healthy.

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

Friday, January 07, 2011

Zinc supplementation in young children

Zinc is an essential element for growth and development of children. Its deficiency is associated with increased risk of infection, particularly diarrhea and pneumonia. Zinc supplementation in children has been reported to prevent pneumonia; however, its effect remains unclear. The aim of this study was to evaluate the role of zinc supplementation in the prevention of pneumonia in children of two to 59 months of age. Analysis showed that zinc supplementation was significantly associated with reducing the incidence and prevalence of pneumonia. Evidence provided so far from randomized controlled trials is sufficient to recommend zinc intake in deficient populations through supplementation, dietary improvements, or fortification, for enhancing child survival. Cochrane Database of Systematic Reviews 12/2010

Study shows prevention works for healthy cholesterol

Health campaigns targeted at teens could help reduce their risk of heart problems as adults. A study published in Archives of Pediatrics and Adolescent Medicine found that those with high cholesterol at 15 could normalize it by their mid-30s. Participants had levels of cholesterol and other blood fats measured in 1985 when they were aged 9, 12 or 15. They were measured again between 2004 and 2006, an average of 20 years later. Of those participants who had high-risk cholesterol levels in their youth, those who stopped smoking or lost weight became low-risk in adulthood, while those who increased their body weight or who started smoking were more likely to maintain those high-risk levels 20 years Researchers say this research gives a very clear example of why we need to invest more in adolescent health and make it a higher priority. "It is clear that young people's lifestyle choices have a long term impact on their health and it is cost effective and sensible to work with them to encourage healthy habits.We should all be eating five portions of fruit and veg a day. And, most importantly, the message is don't smoke."

Tainted Medication, Supplements, and Water Oh My!

2010 brought us sobering reminders of how careful we must be with what we ingest. In the following piece, we explore the recent issues with medication, supplements, the water supply, and what you can do to be proactive in protecting yourself.

How many recalls were there of some of the most commonly ingested OTC and prescription medication? More than in recent memory and way too many. If you have concerns:
  • Take only medication that is essential. We recommend this for many other reasons than just reducing your exposure to potential risk of tainted product.
  • Research the manufacturer's safety record before taking a medication. If the company has a checkered past, ask about a similar medication by another manufacturer with a better safety record.
  • Two year rule - we never recommend taking a medication that has just come to market. We always suggest waiting two years for the safety record to shake out.
January's British Medical Journal stated that US drug companies paid $15 billion dollars in fines for criminal and civil violations over the past five years. According to the report, illegal marketing activities and injuries from drugs pulled from the market have risen over the past five years, leading to major penalties. Public Citizen, an independent US watchdog organization, has called the drug industry “the biggest defrauder of the federal government.”

Dietary Supplements
Most dietary supplements are extremely safe and there have been very few issues in the industry's eighty year existence. However, with a booming business sector such as this, there are more unseemly players who want a piece of the pie (i.e, the recent Fruta Planta Diet fiasco). That said, quality control problems are not just limited to the periphery. Hyland, a reputable homeopathic manufacturing company, recently recalled their baby teething tablets and will not be available until this summer because of a quality issue.

The FDA has implemented several new steps to weed out the bad apples and ramp up testing with full implementation of the cGMP and AER guidelines. But you cannot fully rely on the FDA as evidenced by their consistent failures to keep medication safe.
  • If it looks, sounds, and is marketed as "too good to be true," be wary. Other terms such as, "money back guarantees," "heal all ills," etc. should have you looking elsewhere. Most of you have seen these ads on the Internet, radio, or television.
  • Consult a health professional with an expertise in dietary supplements. Unfortunately, most doctors are not experts (and part of the time you have to get beyond the argument with your doc of whether to take supplements at all). Pharmacists or offices like ours with decades of experience can be very helpful not just from a the standpoint of suggesting reputable, safe products, but evaluate potential contraindications with medication.
  • Doctors, pharmacists, and nutritionists who dispense supplements at their offices usually means that not only have they vetted the products, but they and their staffs take the products themselves. In our case, we have over 25 years of safety experience to draw from. When considering a product, we look upon it with patience, skepticism, and an exhaustive vetting process to make sure we feel it is safe, because not only do we have our clients best interests at heart, but ourselves as well. Most of us have taken these same products for decades.
  • If you do not choose to have your supplements evaluated by a health professional or pharmacist:
    • Do not buy products directly from the internet. Unless you are familiar with the company and brands they dispense, there is a possibility the supplements could be counterfeit or tainted.
    • Go to a reputable health food store. Certifications by nonprofit nutraceutical associations such as NSF can be helpful because it provide another level of safety screening. While the staff at health food stores are not licensed professionals, many of them have been in the business for a while and should have general knowledge.
    • Do not rely on someone telling you to buy a supplement because it has worked wonders for them. As with anything else, dietary supplements need to be individualized. "One man's supplement can be another man's poison."
    • Do your due diligence. See how revealing the label is. Call the manufacturer and ask them where they get their raw materials. Ask them if they are compliant with cGMP guidelines. Ask them their safety record. Then, go with your instincts. If you are confident with the company's transparency, then it is probably fine.
Most of you probably read about cancer-causing Chromium-6 found to be widespread in 89 percent of US cities tap water supplies, according to sampled laboratory tests commissioned by Environmental Working Group (EWG).

In 25 cities tested, hexavalent chromium, the carcinogenic “Erin Brockovich chemical,” was found at concentrations above the safe maximum recently proposed by California regulators. The National Toxicology Program has concluded that hexavalent chromium in drinking water shows “clear evidence of carcinogenic activity” in laboratory animals, increasing the risk of gastrointestinal tumors. In September 2010, a draft toxicological review by the U.S. Environmental Protection Agency (EPA) similarly found that hexavalent chromium in tap water is “likely to be carcinogenic to humans.” In 2009, California officials proposed setting a “public health goal” for hexavalent chromium in drinking water of 0.06 parts per billion (ppb) to reduce cancer risk. This was the first step toward establishing a statewide enforceable limit. Despite mounting evidence of its toxic effects, the EPA has not set a legal limit for hexavalent chromium in tap water nationally and does not require water utilities to test for it.

While we wait for the EPA to address this issue, if you live in an area where the numbers are high (you can look at your city here), certain water filtration methods will remove hexavalent chromium. Although basic water filters such as those made by Brita and PUR do not remove hexavalent chromium, most reverse-osmosis systems designed for home use can take the chemical out of water. Distilled water would also do the trick, but we usually dissuade our clients from drinking distilled water as it depletes your body of essential minerals. Bottled water is not necessarily an alternative because it is often drawn from municipal water systems and unless filtered by reverse osmosis, can still contain hexavalent chromium or other contaminants.

Thursday, January 06, 2011

Vitamins improve outcomes for breast cancer patients: study

A December Cancer Epidemiology, Biomarkers & Prevention study finds no evidence that the use of vitamins during first 6 months after a diagnosis of breast cancer adversely affected outcomes. In fact, vitamin use appeared to have a beneficial effect among patients with breast cancer who underwent chemotherapy. Vitamin use — and the use of vitamins C and E in particular — appeared to be associated with reduced risk for mortality and recurrence. Patients who used antioxidants (vitamin E, vitamin C, multivitamins) had an 18% reduction in their mortality risk, and the risk for recurrence was decreased by 22%. This association was observed whether vitamin use was concurrent or nonconcurrent with chemotherapy. However, this benefit was only seen in patients who did not receive radiotherapy.

Wednesday, January 05, 2011

The more things change, the more things stay the same

The news that FDA Deputy Commissioner Joshua Sharfstein is resigning is yet another example, in our opinion, of how reforms to the food, drug, and dietary supplements in the country are insufferably impeded by lobbyists and special interest.

Mr. Sharfstein has been the most proactive of any FDA official in recent memory in protecting the consumer (which is his job by the way) instead of special interests. He will not likely share his reasoning for resigning for decades (like Dr. Michael Kessler did in his book) because he wants to make a living. One can postulate that the change in the political climate made Mr. Sharfstein a pariah and he did not want to spend the next two years fighting Congress.

In his short 21 month tenure, he took on the Big Pharma, the dietary supplement industry (to root out tainted supplement manufacturers), and Big Food, with safety of the consumer being the main goal. We have followed the FDA very closely since 1985 and have never seen such positive action as we did under Sharfsetin (and to a lesser degree FDA Commissioner Margaret Hamburg).

It is possible that with the passage of the Food Safety Modernization Act, Mr. Sharfstein felt that he accomplished his main goal. In our opinion, with new House reps already looking into why certain drugs were pulled off the market and why drug approvals are at their lowest levels in years, Sharfstein probably saw the writing on the wall.

It is our hope that Commissioner Hamburg will assure that the progress Mr. Sharfstein made was not made in vain and that his successor will be of a similar ilk. How confident are we that this will occur? If we take past history into account, not very.

Tuesday, January 04, 2011

Celiac Update From Local GI Doc

Bonnie - Dr. Semrad definitely understands the nuances of the celiac issue. While I agree with her that self-diagnosing a gluten issue is a big mistake, I believe there are other reasons to avoid wheat other than just gluten.

Courtesy of Medill Reports Chicago

Gut problems - you’re not alone
by Tavaner K. Bushman

Studying the digestive system may not have the glamor or glory of other fields of medicine, but with an increasing number of Americans with digestive problems, it is essential. Dr. Carol Semrad, a gastroenterologist and associate professor of medicine at the University of Chicago, finished her medical degree at Columbia University in 1982, a time when fewer women were in medicine. She specializes in celiac disease, an autoimmune and digestive disease triggered by eating gluten, a protein found in wheat, barley and rye. She also has a background in clinical nutrition.

How did you become interested gastroenterology?

In medical school I liked internal medicine. I thought it was mentally the most challenging and comprehensive study of disease. If you knew the pathophysiology of how disease presents, anything else like surgery, was more mechanical. I was more interested in primary-disease processes.

I was very interested in the public health issues of food contamination and infectious diseases. Gastroenterology and the small bowel, where nutrition occurs and much of what goes on with digestion and absorption.

And celiac disease?

Celiac disease, although it was known in Europe, England and Ireland, in the U.S. it was viewed as a rare disease. When I trained in gastroenterology in the '80s, we would become excited if we saw a case of it once in a year. It wasn’t studied much.

Fast forward into the ‘90s when we developed antibody tests that were specific to identifying the disease and began to screen the American population and saw that there was a very high prevalence for the disease.

As relative to my colleagues in gastroenterology, I had been working in the area of small bowel disease, and it was the perfect opportunity for me to step in and take on celiac disease because I knew it well, but hadn’t seen it often.

Has the recent press coverage on celiac had an adverse affect with people self-diagnosing?

Yes, it has. I don’t blame anyone for wanting to know what is wrong with them, but there is a lot of good information and bad information on the Internet. Once individuals say, ‘Oh, I have this. I will just stop eating wheat,’ they lose the opportunity to make a secure diagnosis.

Then they get partially better or later realize that living gluten-free is a lot of work, more expensive and socially a lot more difficult than they thought and they want to know if they really have the disease. It’s hard to go backward and diagnose celiac once someone has been gluten-free. Triggering the disease is not always as easy as we thought it would be.

Is celiac considered a digestive disease?

Yes. I know it is always written about as an autoimmune disease, but I am very careful about using the word ‘autoimmune’ because we know that it is triggered by the gluten molecule. It is not that the self is attacking itself randomly. We know that there is the outside trigger and if you take it away, for 90 percent of people their bowel calms down. If you take the gluten away the lining regrows, which is a beautiful thing because there are very few diseases where you take something away and people get better.

It is true that if untreated, we don’t really know how the other autoimmune attacks occur. In other words, why is the thyroid attacked resulting in thyroiditis or Type 1 diabetes? We don’t know the exact connection that leads to autoimmune self damage.

In regards to celiac disease, what is your research currently focusing on?

We know gluten triggers the disease, but we don’t know what the most important steps of the inflammatory process are. There is a subset of people who don’t get 100 percent better when they take gluten away or they have a lot of trouble staying away from gluten. We believe we need other modalities to treat as an adjunct to the gluten-free diet.

We are also doing a survey to look at screening rates in first-degree relatives of [celiac patients] to try to determine factors or barriers that stop first-degree family members from being screened. This will be important in terms of diagnosing the disease and getting to as many people as we can.

What are some of the biggest misconceptions about celiac disease?

The biggest misconception that came out of our survey is that individuals without digestive symptoms think they don’t have the disease. They think, ‘If I don’t have a bellyache or some sort of digestive problem, I don’t have celiac disease.’ That is just not true.

The second is the genetic testing for celiac disease. There are two genes - we call them risk-associated alleles - which means that if you have of of those two gene types, you have the genetic capacity to have the disease. It doesn’t mean you are going to get the disease, it doesn’t mean you have the disease. It’s just a thumbprint of one of the genetic components that have to be there to order for you to get the disease.

It seems that more and more people are suffering from digestive ailments. Why is this?

I don’t know. In our clinics we see patient after patient complaining of sometimes just a bellyache or gas, bloating or discomfort. It is described in many different ways. Some times it’s celiac disease, some times it’s not.

I can’t tell if there is more complaint about digestion because people are more willing to acknowledge it, where before people would be quieter about their illnesses.

People are creatures of habit, and with technological advances there are no boundaries to people’s work and less stable eating habits. I think there is a big connection there between that kind of stress and the gut.

For people without celiac disease, is gluten really so bad?

We do have some evidence that humans don’t digest the gluten protein as well as rice and corn protein. We lack the enzymes to totally break the gluten protein into the basic two or three amino acids that are in general not toxic and can’t ever trigger the immune system. [Gluten] may be more of an irritating [protein in the] grain that we ever knew.

Of all the proteins in wheat, gluten is what makes foods chewy and elastic. Over the years, people have cultivated for that property, so there is more and more gluten in each grain of wheat than there was 2000 years ago. No one was ever exposed to the concentration of gluten that they are now.

We don’t know why the prevalence of celiac disease is going up. It is going up in all countries. We know something is going on, we just don’t know what.

Sunday, January 02, 2011

Caffeine in children

Caffeine consumption in children is often blamed for sleep problems and bedwetting. Information on childhood caffeine consumption is limited, and many parents may not know the amount or effects of their child's caffeine consumption. In a study published in Pediatrics, researchers found that 75% of children surveyed consumed caffeine on a daily basis, and the more caffeine the children consumed, the less they slept.

Researchers surveyed the parents of over 200 children 5 to 12 years old during routine clinical visits. Some children as young as 5 years old were consuming the equivalent of a can of soda a day. The researchers also noticed that the older children between the ages of 8 and 12 years consumed an average of 109 mg a day, the equivalent of almost 3 12-ounce cans of soda.

Researchers found, however, that caffeine was not linked to bedwetting in these children.

The study authors stress the importance of parental awareness regarding their child's caffeine consumption. "Parents should be aware of the potentially negative influence of caffeine on a child's sleep quality and daily functioning," the researchers assert.

Brag About Mag

Dietary magnesium intake has been favorably associated with reduced risk of metabolic outcomes in observational studies. However, few randomized trials have introduced a systems-biology approach to explore molecular mechanisms of pleiotropic metabolic actions of magnesium supplementation.

Researchers published an American Journal of Clinical Nutrition study that examined the effects of oral magnesium supplementation on metabolic biomarkers and global genomic and proteomic profiling in overweight individuals. Subjects were randomly assigned to receive magnesium (500 mg) or a placebo for 4 wk with a 1-mo washout period.

Researchers observed that magnesium treatment significantly decreased fasting C-peptide concentrations and appeared to decrease fasting insulin concentrations. Gene expression profiling revealed up-regulation of 24 genes and down-regulation of 36 genes including genes related to metabolic and inflammatory pathways. Urine proteomic profiling showed significant differences in the expression amounts of several peptides and proteins after treatment.

In conclusion, magnesium supplementation for 4 weeks in overweight individuals led to distinct changes in gene expression and proteomic profiling consistent with favorable effects on several metabolic pathways.

Weight and Death Risk

According to a recent study in the New England Journal of Medicine, pooled data encompassing 1.46 million white adults, 19 to 84 years of age (median, 58 years), were used to examine the association between body mass index (BMI) and all-cause mortality. Age, smoking, alcohol consumption, physical activity, education, and marital status were all accounted for. Among healthy participants who never smoked, a J-shaped relationship between BMI and all-cause mortality was found. With a BMI of 22.5-24.9 as the reference category, hazard ratios among women were 1.47 for a BMI of 15.0-18, 1.14 for a BMI of 18.5-19.9, 1.00 for a BMI of 20.0-22.4, 1.13 for a BMI of 25.0-29.9, 1.44 for a BMI of 30.0-34.9, 1.88 for a BMI of 35.0-39.9, and 2.51 for a BMI of 40.0-49.9.

The authors conclude that in white adults, overweight and obesity (and possibly underweight) are associated with increased all-cause mortality. All-cause mortality is generally lowest with a BMI of 20.0-24.9.

Bonnie - while I have never used BMI to assess an individual's risk, it can be a useful tool when assessing one general assessment, such as death risk, in a large population pool.

Pfizer's deception revealed in WikiLeaks

Courtesy of Reuters

U.S. drugmaker Pfizer hired investigators to find evidence of corruption against Nigeria's attorney general to convince him to drop legal action against the company over a drug trial involving children, the Guardian newspaper reported, citing U.S. diplomatic cables made public by WikiLeaks.

Nigeria's Kano state sued the world's largest drugmaker in May 2007 for $2 billion over testing of the meningitis drug Trovan. State authorities said the tests killed 11 children and left dozens disabled. Pfizer and Kano's state government signed a $75 million settlement on July 30. In a statement, Pfizer said it "negotiated the settlement with the federal government of Nigeria in good faith and its conduct in reaching that agreement was proper." "Any notion that the company hired investigators in connection to the former Attorney General is simply preposterous," the company said. The Guardian reported on its website on Thursday that a memo leaked by WikiLeaks referenced a meeting between Pfizer's country manager, Enrico Liggeri, and U.S. officials suggesting the drug company did not want to pay to settle two cases brought by Nigeria's federal government. "According to Liggeri, Pfizer had hired investigators to uncover corruption links to federal Attorney General Michael Aondoakaa to expose him and put pressure on him to drop the federal cases," according to an April 2009 cable from Economic Counselor Robert Tansey of the U.S. Embassy in Abuja, cited in the Guardian report. "He said Pfizer's investigators were passing this information to local media."

Aondoakaa was removed from the post of justice minister in February this year by Nigerian President Goodluck Jonathan. "A series of damaging articles detailing Aondoakaa's 'alleged' corruption ties were published in February and March," the cable said. "Liggeri contended that Pfizer had much more damaging information on Aondoakaa and that Aondoakaa's cronies were pressuring him to drop the suit for fear of further negative articles," it said. In 1998, the U.S. Food and Drug Administration approved Trovan for use by adults only. After reports of liver failure, its use in the United States was restricted to adult emergency care. The European Union banned its use in 1999.

Women's health goals unmet

The United States has failed to reach almost every goal set for women's health, according to a new report by the National Women's Law Center and Oregon Health Sciences University (OHSU). The report — based largely on federal objectives drawn from the U.S. Department of Health and Human Services' Healthy People 2010 agenda — is the fifth in a 10-year look at the status of women's health in this country.

In this latest analysis, a satisfactory rating was only handed out on three of 26 measures of good health for women. The three goals that have been met throughout the country are the number of women receiving mammograms, the number of women getting screened for colorectal cancer and the number of women going for annual dental visits.

Since 2000, there has been some progress in reducing deaths from heart disease, stroke and breast and lung cancer. And, fewer women are smoking, the report found. However, more women are obese and more suffer from high blood pressure and diabetes. Also, fewer women are getting Pap tests for cervical cancer, and the incidence of Chlamydia and binge drinking are on the increase.

No state was given a overall satisfactory grade for women's health and only two states, Vermont and Massachusetts, got the next highest grade of "satisfactory minus." Thirty-seven states received an unsatisfactory grade, and 12 were given an F.

In addition to health goals, the report looked at 68 federal health policies. Medicaid coverage for breast and cervical cancer treatment and participation in the Food Stamp Nutrition and Education Program were the only of these goals that were met.

"Making the Grade on Women's Health: A National and State-by-State Report Card," makes it critical that prevention and wellness programs continued to be funded under health care reform, the researchers said.