High Schoolers' paltry fruit, veggie consumption

A diet high in fruits and vegetables is associated with a decreased risk for many chronic diseases and some cancers, and can aid in weight management. Current daily fruit and vegetable recommendations for adolescents who participate in 30 minutes of physical activity daily are 1.5 cups of fruit and 2.5 cups of vegetables for females and 2 cups of fruit and 3 cups of vegetables for males (1 cup is approximately equal to one medium apple, eight strawberries, 12 baby carrots, or one large tomato).

However, recently published data from the National Health and Nutrition Examination Survey 2003--2004 revealed that consumption was considerably below these levels. To assess fruit and vegetable consumption among high school students, CDC analyzed data from the 2010 National Youth Physical Activity and Nutrition Study (NYPANS). This report describes the results of that analysis, which indicated that, in 2010, the median number of times per day that high school students consumed fruits and vegetables was 1.2 for both. For vegetables, the median number of times per day was lower for non-Hispanic black students and Hispanic students than non-Hispanic white students.

Overall, 28.5% of high school students consumed fruit 1 time daily, and 33.2% of high school students consumed vegetables 1 time daily. The infrequent fruit and vegetable consumption by high school students highlights the need for effective strategies to increase consumption. Policy and environmental approaches to provide greater access to and availability of fruits and vegetables are among the strategies that schools and communities might choose to achieve this goal.

Morbidity and Mortality Weekly Report 11/25

Catching seasonal flu reduces future severity

Courtesy of Reuters Health

Immunity from previous cases of seasonal flu helped temper the severity of the pandemic flu that spread around the globe in 2009. Texas researchers monitored hundreds of adults through the 2009-2010 flu season and found that those who had seasonal flu in the past were less vulnerable to the pandemic H1N1 strain.

Researchers tracked 513 adults. Overall, 116 subjects were infected with H1N1 as determined by antibodies in their blood. Thirty-three percent of those who had no evidence of antibodies to the previous season's flu at baseline became infected with H1N1 - compared to 18% of those with antibodies to seasonal flu, according to the report in Clinical Infectious Diseases.

Low vitamin D linked to heart disease

Courtesy of Reuters Health

In people with low blood levels of vitamin D, boosting them with supplements more than halved a person's risk of dying from any cause compared to someone who remained deficient, in a large new study from American College of Cardiology.

Analyzing data on more than 10,000 patients, University of Kansas researchers found that 70 percent were deficient in vitamin D and they were at significantly higher risk for a variety of heart diseases.

D-deficiency also nearly doubled a person's likelihood of dying, whereas correcting the deficiency with supplements lowered their risk of death by 60 percent.

"We expected to see that there was a relationship between heart disease and vitamin D deficiency; we were surprised at how strong it was," Dr. James L. Vacek, a professor of cardiology at the University of Kansas Hospital and Medical Center, told Reuters Health.

"It was so much more profound than we expected."

Magnesium helps overcome fear and anxiety

Emotional, painful experiences contribute to future behavior that can be unduly influenced by fear or anxiety. Full-blown post traumatic stress disorder may develop, which is related to an overheated brain stem and limbic system. A new study in Journal of Neuroscience shows that elevating brain levels of magnesium can help undo the bad programming and help create new brain response patterns not influenced by fear or anxiety. The researchers found that elevated brain magnesium was able to induce the production of BDNF, your brains rejuvenation compound. This led to an increase in synaptic plasticity, enabling the learned fear response to actually change. Magnesium is a potent anti-inflammatory mineral which also helps make brain energy. The fact that it is able to assist in the rewiring of past memories is good news for any person with anxiety.

Please help petition the FDA

Easy way to petition the FDA's NDI Draft Guidance that may affect your access to dietary supplements

http://www.citizens.org/?p=2804

Canada recommends fewer mammograms

Canadian women will wait 3 years between breast-screening mammograms, according to a new set of breast cancer guidelines released by the Canadian Task Force on Preventive Health Care (CTFOPHC). They have also been told not to do breast self-exams, and their doctors have been told not to perform breast examinations in the office. The CTFOPHC reasons that regular screening for breast cancer with mammography, breast self-exam, and clinical examinations — all practices that have been widely recommended to reduce breast cancer mortality — causes women too much anxiety, results in too many false positives, and is too costly. The new recommendations were published in the November 22 issue of CMAJ.

Our Doc's Musings: Giving Thanks

In honor of Thanksgiving and giving thanks here is a list of but a few of the many, many actions and reactions that occur in our incredible body. May we all be thankful for this amazing gift that we each have been given.

There are 30 - 40 billion white blood cells circulating inside of; which are replaced every few days.

One drop of blood contains 5 million red blood cells, 7 thousand white blood cells and thousands of platelets.

3 million red blood cells are made per minute.

The heart weighs less than one pound yet beats around 40 million times per year.

The heart pumps 2.5 gallons per minute and 1,314,000 gallons per year.

The energy output of the heartbeat in a 24-hour period is enough to raise three fully loaded Greyhound buses off the ground.

The lungs use about 90 gallons of pure oxygen per day.

We take around 9 million breaths per year.

Our lungs pump about 2 gallons of air per minute while at rest and about 26
gallons of air per minute while exercising.

There are more than 600 muscles in your body. To press a barbell over your head takes 200 of them and 31 of them are in your face.

Nerves transmit their signals at 300 mph.

Stomach acid is so strong, that one drop of it on the skin will leave a painful blister, but the stomach is left unharmed.

The stomach produces 2.5 quarts of acid per day and over the course of 70
years will produce 60,000 quarts to help digest 40 tons of food.

Have a wonderful, healthy and well digested Thanksgiving!

Dr. Liselotte Schuster
847-509-9067

Normal weight persons eat more meals

Normal weight adults, including those who had lost a lot of weight and kept it off, ate more often than overweight people in a new study looking at factors that may help in preventing weight gain. Researchers following about 250 people for a year found that overweight individuals ate fewer snacks in addition to meals than people in the normal body weight range, but the overweight still took in more calories and they were less active over the course of the day.

"Weight loss maintainers" consumed the fewest calories, at about 1,800 a day, compared with the normal weight and overweight subjects, who took in 1,900 and more than 2,000 calories a day, respectively. Weight loss maintainers also were the most physically active of the three groups. The results, published in the Journal of the American Dietetic Association, suggest that weight loss maintainers intentionally do more to keep from regaining extra pounds.

Researchers speculate that snacking might help prevent weight gain by staving off intense hunger. For example, if you wait 10 hours after you've last eaten, you end up eating a lot more food. If you sit down and you're really hungry, you also tend to eat more calories.

Recurrent wheeze in children

Key findings of the December issue of Acta Paediatrica study found that more than half of 4,171 children with recurrent wheeze had episodic viral wheeze (57%) and 43% had multiple-trigger wheeze.

Fish consumption before nine months of age
Eating fish before the age of nine months almost halved the likelihood of suffering recurrent wheeze at 4.5 years. The authors have previously reported that fish is beneficial in both eczema in infancy and allergic rhinitis at pre-school age. Other research has suggested a protective effect on the development of asthma.

Antibiotic treatment in the first week of life
Being treated with broad-spectrum antibiotics in the first week was associated with double the risk of recurrent wheeze at 4.5 years. Just 3.6% of the children in the no wheeze group had received antibiotics, compared with 10.7% of those who had experienced three or more episodes.

Use of paracetamol (acetaminophen) during pregnancy
The prevalence of prenatal paracetamol exposure in the wheeze group using asthma medication was 12.4% and taking paracetamol during pregnancy increased the risk by 60%. The effect was particularly noticeable in the multiple-trigger wheeze group, where it more than doubled the risk.

Top 10 most dangerous toys

http://toysafety.org/worstToyList_index.shtml

Antibiotics for acne come with side effects

According to a study published yesterday in Archives of Dermatology, students receiving oral antibiotics for acne reported a three-fold increase in episodes of pharyngitis (chronic sore throat) compared to students not receiving oral antibiotics, but who had acne. Less than 1% of the total subjects tested for group A streptococcus, so any connection to strep A as the cause of pharyngitis has been ruled out.

Bonnie - while this is certainly a new side effect discovery, it is by all means not the only one. It is no secret any longer how devastating antibiotic use can be. It can permanently alter the gastrointestinal microbiota, set oneself up for serious damage in the future, not to mention the common GI complaints that accompany antibiotic use. What's worse is that little is known about the severity of long-term use in patients such as those with acne.

Delayed cord blood clamping for three minutes minimum

Waiting for at least three minutes before clamping the umbilical cord in healthy newborns improves their iron levels at four months, according to British Medical Journal. Delaying cord clamping is not linked to neonatal jaundice or other adverse health effects and should be standard care after uncomplicated pregnancies, adds the study.

Iron deficiency and iron deficiency anemia are major public health problems in young children around the world and are associated with poor neurodevelopment. Young children are at particular risk due to their high iron requirements during rapid growth.

Bonnie - many home birthing centers have promoted this for decades.

Whether phone or in person, obesity counseling effective

Weight-loss programs offering support via telephone and the Web work about as well as in-person counseling to help obese people lose weight, a study has found.

Two intervention programs were compared with a control group in the two-year study released today in the New England Journal of Medicine, in which 415 obese men and women participated. They were randomly placed in a weight-loss program that offered support remotely, via the Web, telephone and email; in a two-year program that included in-person support in addition to the remote support; or in a control group that encouraged independent weight loss.

After two years, the control had lost an average of about 1.8 pounds, but the remote group and the in-person group had similar average weight losses: 10.1 pounds and 11.2 pounds, respectively. At the two-year mark 18.8% of people in the control group had lost 5% of their starting body weight, compared with 38.2% of those in the remote group and 41.4% of those in the in-person group. Achieving and maintaining a 5% drop in body weight is considered an achievement among many health professionals, because it can lower the risk of some weight-related illnesses such as cardiovascular disease and type-2 diabetes.

Bonnie - I have done phone consults for years, and more recently, video consults. For those of you who live a distance away, don't feel that the only way to meet with me is to come in person.

Water's Dirty Little Secret

University of Illinois scientists report the first identification of a cellular mechanism linked to the toxicity of a major class of drinking water disinfection byproducts. This study, published in Environmental Science & Technology, suggests a possible connection to adverse health effects, including neurological diseases such as Alzheimer's.

"I'm not implying that drinking disinfected water will give you Alzheimer's," said Michael Plewa, lead scientist and professor of genetics in the U of I Department of Crop Sciences. "Certainly, the disinfection of drinking water was one of the most significant public health achievements of the 20th century. But the adverse effects of disinfection byproducts (DBPs) that are unintentionally formed during this process are causing concerns as researchers unveil their toxicity."

More than 600 DBPs have been discovered. Although researchers know some DBPs are toxic, little biological information is available on the majority of these water contaminants. The Environmental Protection Agency regulates only 11 of these DBPs, he said.

Plewa's laboratory investigated the biological mechanism, or the cellular target that leads to toxicity, in the second-most prevalent DBP class generated in disinfected water -- haloacetic acids (HAAs).

"The EPA has regulated HAAs for nearly 15 years. However, we did not know how they caused toxicity before this study," he said. "Now that we've uncovered the mechanism for HAAs, we can make sense of past data that can lead to new studies relating to adverse pregnancy outcomes, different types of cancer, and neurological dysfunction."

Plewa believes this will assist the EPA in establishing regulations based on science. Their research will also help the water treatment community develop new methods to prevent the generation of the most toxic DBPs.

"It's fairly simple," Plewa said. "To increase the health benefits of disinfected water, we must reduce the most toxic DBPs. If we understand their biological mechanisms, we can come up with more rational ways to disinfect drinking water without generating toxic DBPs."

In this study, researchers focused on three HAAs -- iodoacetic acid, bromoacetic acid and chloroacetic acid. After they rejected their first hypothesis that the HAAs directly damaged DNA, they looked at research in a different area -- neuroscience. Plewa's graduate student, Justin Pals, discovered an amazing connection, Plewa said.

In neurotoxicology, iodoacetic acid reduces the availability of nutrients or oxygen in neurons by inhibiting glyceraldehyde-3-phosphate dehydrogenase (GAPDH).

"Researchers are interested in understanding how to prevent damage after a stroke or other neurological damage," Plewa said. "Iodoacetic acid kills these cells. One of the targets they found was that iodoacetic acid inhibited GAPDH."

Plewa's lab conducted quantitative GAPDH enzyme kinetics and discovered that the data were highly correlated with a diversity of adverse health markers.

"All the pieces of the puzzle fell into place in an instant," Plewa said. "We had discovered our cellular target -- GAPDH. Never before had this type of research been done with this level of precision and associated with a large body of adverse biological impacts."

They discovered that the HAA disinfection byproducts were toxic because the cells cannot make ATP, and this causes oxidative stress.

"Cells treated with HAAs experience DNA damage," Plewa said. "So they start expressing DNA repair systems. HAAs are not directly damaging DNA, rather they are inhibiting GAPDH, which is involved in increasing the oxidative stress that we are observing."

A growing body of information has shown that GAPDH is associated with the onset of neurological diseases.

"If you carry a natural mutation for GAPDH and are exposed to high levels of these disinfection byproducts, you could be more susceptible to adverse health effects such as Alzheimer's," he said.

More research is needed to study iodinated disinfection byproducts because they are the most reactive in inhibiting GAPDH function and are currently not regulated by the EPA, Plewa said.

"We replaced the standard working model of direct DNA damage with a new working model based on a cellular target molecule," he said. "This discovery is a fundamental contribution to the field of drinking water science."

Bonnie - while I do not have hard data to back this up, I suppose that using reverse osmosis filtration would be the most logical option to removing as many toxic agents as possible.

Blood type may define stroke risk

People with AB and women with B were a little more likely to suffer one than people with O blood — the most common type, a study found. It fits with other work tying A, B and AB to more risk of blood clots in the legs and heart attacks. Blood type O also has been tied to an increased risk of bleeding, which implies less chance of clots, the cause of most strokes.

"There's increasing evidence that blood type might influence risk of chronic disease," said chief of preventive medicine at Harvard's Brigham and Women's Hospital. The study was presented at an American Heart Association conference. The study involved 90,000 men and women that have been studied for more than 20 years.

Men and women with AB had a 26 percent increased risk of stroke compared to those with type O. Women but not men with B blood had a 15 percent greater risk compared to those with O. What's the explanation? Blood type depends on proteins on the surface of red blood cells. A pattern of immune system responses forms early in life based on them. Certain blood types may make red cells more likely to clump together and stick to the lining of blood vessels, setting the stage for a blood clot.

High serum cholesterol: lower noncardiovascular deaths

Association Between Serum Cholesterol and Noncardiovascular Mortality in Older Age
Journal of the American Geriatric Society, November 2011

Objectives: To clarify the association between cholesterol and noncardiovascular mortality and to evaluate how this association varies across age groups.

Participants: Adults aged 55 to 99 (5,750)

Measurements: Participants were evaluated for total cholesterol and subfractions and followed for mortality for a median of 13.9 years. Total cholesterol and its subfractions were evaluated in relation to noncardiovascular mortality within age-groups (55–64, 65–74, 75–84, ≥85).

Results: Age- and sex-adjusted analyses showed that each 1-mmol/L increase in total cholesterol was associated with an approximately 12% lower risk of noncardiovascular mortality. Age group–specific analyses demonstrated that this association reached significance after the age of 65 and increased in magnitude across each subsequent decade. This was driven largely by non-high-density lipoprotein cholesterol and was partly attributable to cancer mortality. HDL-C was not significantly associated with noncardiovascular mortality.

Conclusion: Higher total cholesterol was associated with a lower risk of noncardiovascular mortality in older adults. This association varied across the late-life span and was stronger in older age groups.

If you read between the lines, this study seems to suggest that for cardiovascular risk, keeping HDL high is more important than total or LDL. For noncardiovascular risk, keeping total and LDL high seems to be more protective.

Details of Study

Although it has been reported that total cholesterol has a strong inverse association with noncardiovascular mortality, such that people with higher levels of total cholesterol have a lower risk of noncardiovascular mortality, other studies have found that the effect of total cholesterol on noncardiovascular mortality is neutral. Few studies have examined the subfractions of cholesterol in relation to noncardiovascular mortality. Clarifying the role of total cholesterol and its subfractions as a risk factor for noncardiovascular mortality is of great consequence to primary and secondary prevention efforts. This study also provided a unique opportunity to examine this association in a sample in which cholesterol was measured before statins were introduced into the general population.

Although there was no significant association for total cholesterol in those aged 55 to 64, each 1-mmol/L increase in total cholesterol in those aged 65 to 74 reduced the risk of noncardiovascular mortality 12%. As age increased, this risk decreased, the reduction being 14% in those aged 75 to 84 and 20% in those aged 85 and older.

Whereas the two earlier studies with neutral findings had included participants with CVD at baseline, the current study included only healthy older adults. This suggests that total cholesterol is potentially a better predictor of noncardiovascular mortality in people who are free from CVD. Additionally, in the current study, cholesterol was not shown to be strongly associated with cardiovascular mortality.

Several factors added to the validity of these findings. First, the study population was drawn from a large, established, prospective, population-based cohort study, providing enough power to test the hypotheses of interest. Second, the availability of a long follow-up period (median 13.9 years) provided sufficient case numbers and enough time to evaluate trends. Third, total and HDL-C were evaluated at the same time and in the same participants, which also enabled the evaluation of non-HDL-C and the relationship between total and HDL-C (ratio measure). This enhanced the ability to make comparisons across these markers of cholesterol and thus to identify trends and differences and their individual utility as clinical markers in older adults. Fourth, specialists in the field confirmed cause of death, increasing the certainty to which a classification of cause of death can be attributed. Finally, because the baseline for the current study predated the introduction of statins, concurrent or prior drug use did not influence the measures of cholesterol at baseline.

Bonnie - this study seems to suggest that for cardiovascular risk, keeping HDL high is more important than lowering total or LDL. For noncardiovascular risk, high total and LDL seems to be more protective. The plot thickens.

Why our brains are so easily addicted to sugar

If the brain goes hungry, Twinkies look a lot better, a study led by researchers at Yale University and the University of Southern California has found.

Brain imaging scans show that when glucose levels drop, an area of the brain known to regulate emotions and impulses loses the ability to dampen desire for high-calorie food, according to the study published online September 19 in The Journal of Clinical Investigation.

"Our prefrontal cortex is a sucker for glucose," said one of the senior authors of the research.

The Yale team manipulated glucose levels intravenously and monitored changes in blood sugar levels while subjects were shown pictures of high-calorie food, low-calorie food and non-food as they underwent MRI scans.

When glucose levels drop, an area of the brain called the hypothalamus senses the change. Other regions called the insula and striatum associated with reward are activated, inducing a desire to eat, the study found. When glucose is lowered, the prefrontal cortex seemed to lose its ability to put the brakes upon increasingly urgent signals to eat generated in the striatum. This weakened response was particularly striking in the obese when shown high-calorie foods.

The results suggest that obese individuals may have a limited ability to inhibit the impulsive drive to eat, especially when glucose levels drop below normal. The key seems to be eating healthy foods that maintain glucose levels. The brain needs its food.

Congress submarine our children again to pander to special interest

In an effort many 9-year-olds will cheer, Congress wants pizza and french fries to stay on school lunch lines and is fighting the Obama administration's efforts to take unhealthy foods out of schools.

The final version of a spending bill released late Monday would unravel school lunch standards the Agriculture Department proposed earlier this year. These include limiting the use of potatoes on the lunch line, putting new restrictions on sodium and boosting the use of whole grains. The legislation would block or delay all of those efforts.

The bill also would allow tomato paste on pizzas to be counted as a vegetable, as it is now. USDA had wanted to only count a half-cup of tomato paste or more as a vegetable, and a serving of pizza has less than that.

Nutritionists say the whole effort is reminiscent of the Reagan administration's much-ridiculed attempt 30 years ago to classify ketchup as a vegetable to cut costs. This time around, food companies that produce frozen pizzas for schools, the salt industry and potato growers requested the changes and lobbied Congress.

School meals that are subsidized by the federal government must include a certain amount of vegetables, and USDA's proposal could have pushed pizza-makers and potato growers out of the school lunch business.

Piling on to the companies' opposition, some members of Congress argue that the federal government shouldn't tell children what to eat. In a summary of the bill, Republicans on the House Appropriations Committee said the changes would "prevent overly burdensome and costly regulations and ...provide greater flexibility for local school districts to improve the nutritional quality of meals."

Bonnie - If the taxpayer is paying for these meals, they should be healthy! The government SHOULD dictate exactly what should be consumed as to not put more of a healthcare burden on taxpayers with higher rates of obesity, diabetes, and chronic disease. My God...the health of school-aged children has been deemed a national security issue by the armed forces generals.

This is pure, unadulterated, outrageous cronyism. At least this person from the USDA has some perspective:

USDA spokeswoman Courtney Rowe said that the department will continue its efforts to make lunches healthier.

"While it's unfortunate that some members of Congress continue to put special interests ahead of the health of America's children, USDA remains committed to practical, science-based standards for school meals," she said in a statement.

Gluten-Free Thanksgiving Stuffing Ideas

http://well.blogs.nytimes.com/2011/11/12/gluten-free-thanksgiving-stuffings/?ref=health

BMJ confirms media's cozy relationship to Big Pharma

The relationship between doctors and drug company marketers is finally falling under increased scrutiny, but a new group is stepping in to take drug company money -- journalists and media organizations looking for easy funding. The Australian, a newspaper in Australia run by the Murdoch empire, has accepted an undisclosed amount of sponsorship money from the drug industry for a series of articles on health policy. The idea was first proposed at a meeting between advertising agents. Many are saying that such financial closeness between journalists and the companies they report on raises concerns. According to an article in the British Medical Journal: “... [W]hat we’re witnessing is a slow and subtle attempt to buy influence and goodwill within the media, which in general have become increasingly rigorous in their coverage of the unhealthy aspects of pharmaceutical marketing ... Spreading around cash, free travel, and sponsorship has an effect -- if it didn’t, the industry wouldn’t do it.”

Steve - we have been commenting on this issue for a while now. When journals like BMJ starts to comment, it is already endemic to the industry.

Xylitol for ear infections.

The Cochrane Collaboration November 2011
"Acute otitis media (AOM) is the most common bacterial infection among young children in the United States with limitations and concerns over its treatment with antibiotics and surgery. Therefore, effective preventative measures are attractive. A potential preventative measure is xylitol, a natural sugar substitute that reduces the risk for dental decay. Xylitol can reduce the adherence of Streptococcus pneumoniae (S. pneumoniae) and Haemophilus influenzae (H. influenzae) to nasopharyngeal cells in vitro.

In the four main studies evaluated, there was a reduced risk of occurrence of AOM in the xylitol groups compared to the control groups. Xylitol chewing gum was superior to xylitol syrup in preventing AOM among healthy children. There is fair evidence that the prophylactic administration of xylitol among healthy children attending day care centers reduces the occurrence of AOM by 25%.

Xylitol sugar supplement is effective for preventing middle ear infection in children up to 12 years of age. Antibiotic treatment of AOM is costly and raises concerns regarding the development of antibiotic-resistant strains of bacteria. Surgery is invasive and costly and because of these factors, effective measures for preventing AOM are sought. An alternative treatment is xylitol or birch sugar. Xylitol has been used for decades as a natural non-sugar sweetener principally in chewing gums, confectionery, toothpaste and medicines, and can reduce the risk of tooth decay. No significant adverse effects were identified in our research."

Steve - pretty strong stuff. Make sure you pass this along to your pediatricians. Please note that for those who are corn intolerant, only use birch-bark derived xylitol gum. Most xylitol is corn-derived. In addition, because xylitol can have a laxative effect, only use in moderation. Otherwise, giving your kids great tasting chewing gum that reduces dental caries and ear infections seems like a win-win, eh?

Choline's Effect on Cognition.

Choline is the precursor to the neurotransmitter acetylcholine. Loss of cholinergic neurons is associated with impaired cognitive function, particularly memory loss and Alzheimer disease (AD). A study in last week's American Journal of Clinical Nutrition investigated 1391 dementia-subjects with the mean-age of 60. Participants underwent neuropsychological evaluation and brain MRI at exam before and after the study. Higher concurrent choline intake was related to better cognitive performance.

Steve - aside from dietary-derived choline, recent data on supplemental Citicoline (a precursor to choline), looks very promising.

For GI experts, evidence mounting for probiotics

Mounting evidence is building a strong case for the use of probiotics, or "good" bacteria, to alleviate common gastrointestinal (GI) symptoms, such as diarrhea, bloating, and inflammation, according to several studies highlighted at the American College of Gastroenterology 2011 Annual Scientific Meeting.

Researchers found that in studies covering 3000 patients, probiotic prophylaxis significantly reduced the odds of developing antibiotic-associated diarrhea and Clostridium difficile–associated diarrhea by about 60%. In another trial in which more than 3000 patients received a single or a combination of antibiotics for various indications, the preventive effect of probiotic use was significant, regardless of the species used and regardless of the antibiotic administered.

In the largest study to date on probiotics in a nonpatient population, researchers evaluated the efficacy of Bifidobacterium, a probiotic that has relieved symptoms in patients with irritable bowel syndrome, to see how well it relieved abdominal discomfort and bloating in nonpatients. The double-blind randomized placebo controlled study was conducted on more than 300 nonpatients who had experienced abdominal discomfort and bloating more than twice weekly, on average, for at least 3 months. They had not seen a physician or received prescribed mediation for their symptoms in the previous 12 months. "By giving a specific probiotic orally, we could actually reduce the levels of these proinflammatory cytokines and actually enhance the production of an anti-inflammatory cytokine, which is the exact replication of what we identified in animal models and more basic models," said the researchers. Plasma levels of the anti-inflammatory cytokine interleukin (IL)-10 rose significantly in healthy volunteers and patients with psoriasis, but not in those who took the placebo for 8 weeks. Plasma levels of 2 proinflammatory cytokines — tumor necrosis factor-alpha and IL-6 — dropped in all patients who received Bifidobacterium. C-reactive protein levels were also significantly lower in patients with psoriasis, ulcerative colitis, and chronic fatigue after treatment with the bacterium than after treatment with placebo.

"It's ironic that we would worry about taking an organism when we've got billions of organisms in the GI tract" and the amount is relatively small, researchers observed. Instead of worrying about drug toxicity in that population, "we're worried about something that has vanishingly low side effects. It can't be zero, but it is very, very low." "If we paid more attention to prescribing antibiotics, we wouldn't have a lot of these problems," added researchers.

Bonnie - this is big-time stuff coming from a conservative organization like the ACG.

Low acid diet for Reflux: where have we heard this before?

http://well.blogs.nytimes.com/2011/11/07/tired-of-feeling-the-burn-low-acid-diet-may-help/?ref=health

Why I never became a registered dietitian

http://www.anh-usa.org/new-campaign-to-make-big-changes-at-ada/

EPA/DHA Canola Oil?

Cargill and BASF Plant Science announced they will co-develop a new dietary source of EPA/DHA. The source, a canola oil, will make it easier for food processors to provide consumers with optimal intakes of EPA- and DHA-rich omega-3 polyunsaturated fatty acids. The new generation of EPA/DHA canola oil will be produced through a genetically modified crop. The modification process will allow Cargill and BASF Plant Science to put genes into the canola to produce the DHA.

Steve - the same thing is begin produced through a GMO soy. There a few huge issues here:

1. Plant-based EPA/DHA comes from ALA. The body must then convert ALA into EPA and DHA. At least one quarter of the human population cannot convert ALA to EPA/DHA. Fish oil does not have this problem.
   
2. This GMO canola oil will also be DHA-heavy. In order for EPA/DHA to work its magic, there must be an ideal balance of EPA/DHA (more EPA than DHA). Too much DHA, and not enough EPA, can have a detrimental effect depending on the individual need.
   
   

GI specialists acknowledge food intolerances

Bonnie - for many of you who have been diagnosed with food intolerances through our practice or another, this information should not come as a surprise. While it focuses on one aspect of food intolerance philosophy (eliminating and reintroducing certain carbohydrates), it further legitimizes the fact that food intolerance is a real and present danger for a large pat of the population. Enjoy!

Courtesy of Melinda Beck of the Wall Street Journal

As many as 20% of adults at some point suffer from a painful digestive disorder that is difficult to diagnose and has no cure. Treatment is hit or miss, and many sufferers never seek help because they find the symptoms hard to discuss. Irritable bowel syndrome (IBS) has long baffled gastro-intestinal experts. Some think it is caused by imbalances in gut bacteria; others point to psychological stress. Now, a small but growing contingent of specialists is focusing on food intolerances as a possible culprit—and a new dietary approach, called the low-Fodmaps diet, is gaining attention around the world.

The theory is that many people with IBS have trouble absorbing certain carbohydrates in their small intestines. Large molecules of those foods travel to the colon, where they are attacked by bacteria and ferment, creating the telltale IBS symptoms of gas, bloating, constipation or diarrhea. A long list of foods—including dairy products, some fruits and vegetables, wheat, rye, corn syrup and artificial sweeteners—can potentially create such problems in susceptible people.

Collectively, they're known as Fodmaps, an acronym that for stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. Physicians have long known that some of these foods can cause stomach upset individually. About 15% of American lack an enzyme needed to digest lactose, a sugar found in milk products. There's now growing awareness that foods with a high concentration of fructose can be difficult to absorb. Breath tests that measure gas produced in the intestine can diagnose both of those issues, although they are more common in Australia than in the U.S. Three other categories of sugars have also been found to cause absorption and fermentation problems in some people—including fructans that are found in wheat and rye, galactans that are found in legumes, and polyols, found in some fruits and in artificial sweeteners such as sorbitol and mannitol.

In fact, some experts say it's possible that people who do not have celiac disease but still have trouble digesting wheat products may actually be sensitive to the fructans in wheat rather than the gluten, which is protein component. The low-Fodmaps diet recommends eliminating all of those foods for a period of six to eight weeks, and then gradually adding back one group after another to identify which cause the most trouble. Eventually, many IBS sufferers find they can tolerate many foods on the list as long as they keep the total amount of Fodmaps under a certain level.

"It's not like having celiac disease, where people can't ever eat gluten," says Sue Shepherd, a dietician in Victoria, Australia, who developed the diet in 2001 mainly for patients with lactose or fructose intolerance, but found it worked well with IBS sufferers as well. Small studies in Australia and the U.K. have shown that the diet reduces symptoms in about 75% of IBS sufferers—higher than other diet or medication approaches. In one study, published in the Journal of Human Nutrition and Dietetics last month, researchers at Kings College in London compared 43 IBS patients on the low-Fodmap diet with 39 given standard diet advice such as limiting caffeine and carbonated beverages. More than 80% of those in the low-Fodmap group reported less bloating and less abdominal pain compared with about half in the control group.

Although the low-Fodmaps diet is still relatively unknown in the U.S., a presentation on it drew a rapt audience at the American College of Gastroenterology conference in Washington last week. Word is also spreading among IBS patient groups. "Many people who have tried it say they can't believe how much it's changed their lives," says Jeffrey D. Roberts, who founded an online support community at IBSgroup.org that has 45,000 members. "I was in a lot of pain and I didn't know what caused it," says Sarah Wade, 28, a paramedic in Melbourne who was diagnosed with IBS as a teenager. She was referred to Dr. Shepherd after a breath test—common in Australia but less known in the U.S.—indicated that she was fructose intolerant. Learning what she can and can't eat on the diet has alleviated her symptoms for the first time in years, she says. "Apples, pears and onions, I avoid at all costs. Artificial sweeteners, too. But the pain is gone, and I'm eating healthier than I've ever eaten before."

Rocky Parthenopoulos, 57 and also from Melbourne, struggled for decades with severe symptoms and, like many IBS sufferers, was told it was all in his mind. "I tried various laxatives, diets, exercise, vitamins supplements and alternative medicines, all to no avail," he says. "I had barium enema, colonoscopies, endoscopies, food-allergy tests, but was told l was healthy and normal." After losing his job in the tech industry, he found a clinic that worked with Dr. Shepherd and tested positive for both lactose and fructose intolerance. He found that at first, the low-Fodmaps diet was difficult to follow, since many foods on the list are common ingredients in processed foods. "There are many temptations to cheat," he says. But once he learned it, he says, his symptoms have gone from "an 8 or 9 out of 10 to 1 or 2. "It's turned my life around," he says.

The low-Fodmaps diet has "changed our practice enormously," says Peter Gibson, a professor of gastroenterology at Monash University in Victoria who noticed how well IBS patients fared on Ms. Shepherd's diet and encouraged her to pursue a doctorate testing it in clinical trials. One of the biggest pluses, he finds, "is that it puts people in control of what they need to avoid to manage their symptoms. It's not the doctor saying, 'You can't have this or that.' " The Fodmaps approach is gaining fans among U.S. gastroenterologists as well, even though many have been skeptical of diets in the past. William Chey, director of the Gastrointestinal Physiology Laboratory at the University of Michigan Health System, first tried the diet with IBS patients three years ago. "This Fodmap approach doesn't make everybody better, but it makes a lot of people significantly better," says Dr. Chey, who is also co-editor-in-chief of the American Journal of Gastroenterology. He is now helping to design large-scale clinical trials of the diet for the U.S.

For now, he and other experts say that because so many foods have Fodmap components and that reintroducing them can be tricky, IBS sufferers shouldn't try the diet on their own. But a growing number of dieticians are being trained in it—IBSgroup.org has started a registry—and academic medical centers are starting to offer it, too. GI doctors can also rule out more serious causes of symptoms, such as celiac disease, inflammatory bowel disease or colon cancer. "We've been missing the boat in not recognizing the role of foods in functional GI disorders," Dr. Chey says. "We'll see much more attention to this in the next few years."

Cancer tests not perfect

Excerpts from an article by Lauren Neergard, Associated Press

"We can find cancer early. We can reduce the burden of the disease. But along the way, we're learning our tests are not as perfect as we'd like," says the American Cancer Society's Dr. Len Lichtenfeld, a longtime screening proponent. "We're learning that we're now finding cancer that would in fact never cause harm."

Now cancer specialists are struggling to find a new balance: to quit over-promising the power of early detection and to help people understand that the tests themselves have risks — while not scaring away those who really need it.

Serious questions surround certain cancers — like which men, if any, should get a PSA blood test to check for prostate cancer, and whether women should start mammograms in their 40s or wait until they're 50. Also in question is whether doctors will be able to head off another looming controversy: Just which smokers and ex-smokers should get a pricey CT scan that can detect lung cancer but also is prone to false alarms?

Consider this, she says: The average woman has a 3 percent lifetime risk of dying of breast cancer, a low risk for a disease that women find so scary. Increasingly powerful mammograms are detecting more low-risk tumors, the kind that probably wouldn't have threatened a woman's life in the first place. PSA tests for prostate cancer are a much tougher call. Last month, a government panel recommended an end to routine PSA screenings, a step further than other major medical groups that urge men to weigh the pros and cons and decide for themselves. But the U.S. Preventive Services Task Force found limited, if any, evidence that screening average men improves survival. That's largely because so many men are diagnosed with slow-growing tumors that never would have killed them; still, they have treatments that can cause incontinence, impotence or even lead to death.

"We have cells in our body that are abnormal all the time, and our bodies deal with it," Lichtenfeld says. "Our technology takes us further and further down the early-detection path, and we need to sort through all this."

Bonnie - whoa, this is certainly a departure from past ACS rhetoric. NCI Well Connect subscribers can read more about this issue at our Well Connect blog.

School-age children need more protein

The current Dietary Reference Intake (DRI) recommendations for protein requirements in children are based on a factorial estimate and have not been directly determined. The objective of an American Journal of Clinical Nutrition study was to determine the protein requirement in healthy, school-age children by measuring the oxidation of phenylalanine in response to graded intakes of protein. To our knowledge, this study was the first to directly estimate protein requirements in children by using stable isotopes and indicated that current protein recommendations are severely underestimated.

Suprising statistics regarding fast food

A new national study of eating out and income shows that fast-food dining becomes more common as earnings increase from low to middle incomes, weakening the popular notion that fast food should be blamed for higher rates of obesity among the poor.

"There is a correlation between obesity and lower income, but it cannot be solely attributed to restaurant choice," said J. Paul Leigh, professor of public health sciences at UC Davis and senior author of the study, which is published online in Population Health Management. "Fast-food dining is most popular among the middle class, who are less likely to be obese."

They found that eating at full-service restaurants, which involve a range of food choices and sit-down service, followed an expected pattern: as income rose, visits increased. In contrast, eating at fast-food restaurants, characterized by minimal table service and food preparation time, followed a different pattern. Fast-food restaurant visits rose along with annual household income up to $60,000. As income increased beyond that level, fast-food visits decreased.

Additional correlations revealed in the study included:

• Men were more likely than women to go to both fast-food and full-service restaurants.
• People with more education were more likely to go to full-service restaurants.
• People who worked more hours were more likely to go to both fast-food and full-service restaurants.
• Smokers were more likely to go to fast-food rather than full-service restaurants.

The research was funded in part by the National Institute of Occupational Safety and Health.

Families choose organic

Seventy eight percent – more U.S. families than ever before – say they are choosing organic foods, according to a study published today by the Organic Trade Association (OTA). “In a time when the severity of the economy means making tough choices, it is extremely encouraging to see consumers vote with their values by including quality organic products in their shopping carts,” said Christine Bushway, OTA’s Executive Director and CEO. The finding is one of many contained in OTA’s newly released 2011 U.S. Families’ Organic Attitudes and Beliefs Study. “It’s clear that with more than three-quarters of U.S. families choosing organic, this has moved way beyond a niche market,” Bushway added. According to the study, four in ten families indicate they are buying more organic products than they were a year ago.

Big Food Preys on Your Addictions

http://www.bloomberg.com/news/2011-11-02/fatty-foods-addictive-as-cocaine-in-growing-body-of-science.html

2010 Dietary Guidelines - The Best Recipe for Heath?

by Walter Willett, MD and David Ludwig, MD
October 27, 2011 New England Journal of Medicine

http://www.nejm.org/action/clickThrough?id=2600&url=%2Fdoi%2Ffull%2F10.1056%2FNEJMp1107075&loc=%2F

Obese children need high-dose vitamin D3

Vitamin D deficiency is common in Americans, and especially in overweight and obese adolescents, according to the National Institutes of Health. University of Missouri researchers have found that providing obese adolescents with a high daily dose of vitamin D3 is safe and effective in improving their vitamin D status. A daily dose of 4,000 IUs of vitamin D3, the maximum intake level set by the Institute of Medicine (IOM), was both safe and effective at improving vitamin D status in obese adolescents. Obese adolescents are only about half as efficient at using vitamin D as their lean counterparts.

Fruit, veggies lower risk of pancreatic cancer: study

Comparing highest to lowest intake, researchers in the December issue of Cancer Causes and Control observed a significant reduction in pancreatic cancer risk for citrus, melon, and berries, other fruits, dark green vegetables, deep yellow vegetables, tomato, other vegetables, dry bean and pea, insoluble fiber, soluble fiber, whole grains. There was an increased association with non-whole grains. Results were similar after adjusting for diabetes or total sugar intake. The researchers conclude that the evidence exists showing that lower consumption of fruits, vegetables, whole grains, and fiber is associated with having pancreatic cancer. This may have a role in developing prevention strategies.

Medical nutrition crucial for Type 1 and 2 Diabetes

An article in Journal of the American Dietetic Association reviews the evidence and nutrition practice recommendations from the nutrition practice guidelines for type 1 and type 2 diabetes in adults. Major nutrition therapy factors reviewed are carbohydrate (intake, sucrose, non-nutritive sweeteners, glycemic index, and fiber), protein intake, cardiovascular disease, and weight management. Contributing factors to nutrition therapy reviewed are physical activity and glucose monitoring. Based on individualized nutrition therapy client/patient goals and lifestyle changes the client/patient is willing and able to make, dietitians can select appropriate interventions based on key recommendations that include consistency in day-to-day carbohydrate intake, adjusting insulin doses to match carbohydrate intake, substitution of sucrose-containing foods, usual protein intake, cardioprotective nutrition interventions, weight management strategies, regular physical activity, and use of self-monitored blood glucose data. The evidence is strong that medical nutrition therapy provided by dietitians is an effective and essential therapy in the management of diabetes.

Reporter explains media bias towards supplements

by Todd Runestad
Editor and Chief of Functional Ingredients

If it bleeds it leads, says the old adage about the journalism business. So when an April 15 study in the American Journal of Epidemiology found that among 180,000 people there was no association between multivitamin use and death from any means, what did the media have to say?

Crickets chirping.

And when a 2009 study of 77,719 people also found no increase in death and, in fact, a decrease in cardiovascular disease risk with multivitamin use as well as vitamins C and E, what did the media say?

That’s right: crickets chirping.

And when a 2007 story showed antioxidant vitamins C, E and A led to 13 percent fewer strokes and cardio deaths, plus 22 percent fewer heart attacks, and 27 percent fewer strokes, what did the mainstream media say?

CNN headlined with this: “Antioxidants not all they’re cracked up to be?”

Say what?

So it’s hardly surprising that when an Oct 10 epidemiological study—these are observational ones, where researchers give respondents questionnaires to fill out, making them inherently flawed but interesting nonetheless—found multivitamins led to higher death rates, the conclusion was:

“Is this the end of popping vitamins?”

I checked, and the same Wall Street Journal chimed in not a whit about the other studies mentioned above.

Okay, actually they did. On one. You can guess the one, can’t you? This is what they said:

“High doses of antioxidants may hurt more than help.”

Really now.

There are inherent flaws, as I said, about epidemiological studies. In this case, Jacob Teitelbaum, MD, noted, "The people taking multivitamins at the beginning of the study were statistically doing a lot better—there was less high blood pressure, less diabetes [than the non-supplement users]. The researchers totally ignored that."

So the story could have easily been spun in a different direction. But what media outlet wants to report on the life-affirming properties of vitamins when it’s much edgier to intone, “The case for dietary supplements is collapsing”?

Whoa! Occupy Salt Lake City!

But there's more to the story. According to the Nutritional Magnesium Association, the study actually showed that vitamin B complex was associated with a 7 percent reduction in deaths, vitamin C a 4 percent reduction, vitamin D an 8 percent reduction, and a 3 percent reduction for selenium, zinc and magnesium.

"This study showed a benefit from taking B-complex, C, D, and E vitamins, and calcium and magnesium. Therefore, if those wanting better health would take appropriate doses of supplements regularly, they would likely continue to achieve better health and longer life," said Robert G. Smith, Research Associate Professor, University of Pennsylvania, Department of Neuroscience, and member of the Institute for Neurological Sciences

It was encouraging to read the Natural Products Association get their response right (and a lot less milquetoasty than other industry trade groups, I might add) which called the WSJ story “disappointing” and “troubling” to use a single observational study—and in the face of others pointing to the contrary—to assert that the case for dietary supplements is collapsing.

The Natural Products Association also made the point, “Research is the cornerstone of our industry, and it seems that every week there is a new report about the importance of vitamins to the health of millions of Americans. Stories like the one in the Wall Street Journal might scare some Americans away from taking dietary supplements to improve their health, and that is just plain irresponsible.”

To which I have to quote Diane Wright Hoffpauer, the R&D Director at De Wafelbakkers—the best-tasting frozen waffles on the planet, in the opinion of my kids—who said, “I think the long term movement in Baby Boomers (approximately 75 million) and Echo Boomers (approximately 80 million) is toward less drugs and more supplementation plus more self-directed health care. As the health care crisis continues, this trend should increase even with studies such as these making the headlines.”

It’s true. Today’s “disease-management system”—let us not continue calling America’s mainstream physician-pharmaceutical-device-patient scheme such niceties as a “health care system”—is a disaster. The results of processed, depleted, microwaved modern foods—diabetic, obese, ADHD, autistic kids—are for all to see.

And we all know it. Which is why more Americans continue to take more supplements. They know something is not right at the supermarket.

As natural wag David Kern once wrote, “And still, there are those who insist that we throw away our nutritional supplements because they are 'worthless,' or even harmful. Antioxidants don't work, vitamins are useless, pharmaceuticals are healthy and down the rabbit hole we go. The health system is a broken shame and the American people are smarter than you think. That is the reason we continue to spend billions of dollars a year on supplements, why major cities are outlawing trans-fats in restaurants, and why Big Food is scrambling to reformulate with healthier ingredients. We are finally demanding it.”

Couldn’t have said it better myself.

Kosher offerings at Whole Foods

Whole Foods is taking the opportunity to reach out to its Jewish consumers by reminding them that it has a number of kosher-certified items for Hannukah, which begins Dec. 20.

The retailer is touting its availability of whole organic turkeys, pumpkin puree and roasted chestnuts to latkes, matzo meal and Hanukkah gelt (chocolate coins).

Specifically, Whole Foods is offering:

• Potato pancake, whole wheat matzo meal, latkes, natural cake, stuffing and soup mixes from Streit's, a family-owned purveyor of kosher food since 1925;

• Organic soups and dishes from Fig Food;

• Gefen Chestnuts, roasted and peeled;

• Yehuda lightly salted and toasted onion gluten-free matzo crackers;

• An assortment of Simply Organic gluten-free and vegetarian baking mixes;

• Elyon Kosher marshmallows;

• Responsibly-sourced, Whole Trade Hanukkah gelt from Divine Chocolate;

• Organic concord grape juice and gefilte fish from Kedem, a family business for eight generations;

• Exclusive So Delicious chocolate mint milk made from creamy coconut milk; and

• Hanukkah candles.

Select Whole Foods stores also will offer antibiotic-free kosher poultry options from Kosher Valley including fresh and frozen whole young turkeys and chickens, ground turkey and value pack options, which are all certified by the Orthodox Union and the K'hal Adath Jeshurun.

"Our customers can always count on us for the highest quality holiday products," said Errol Schweizer, senior global grocery coordinator for Whole Foods. "Whether they're looking for traditional holiday staples or the best organic and gourmet offerings, Whole Foods Market is a great kosher destination."

While Whole Foods may have an impressive selection of kosher products compared with other grocers, it faces stiff competition in largely Jewish areas where entirely kosher supermarkets provide the assortment of products not available at typical food retailers.

Fast Food Revolutionary

Chipotle is one of the few"fast food" restaurants we endorse. Here is how they do it.

http://online.wsj.com/article/SB10001424052970204644504576653503294898570.html?grcc=88888Z0&mod=WSJ_hpp_sections_lifestyle

Medication & Supplement Alert

Anesthesia
There are new concerns about an increased risk for learning problems in very young children exposed to general anesthesia during surgical procedures,,, according to a study published in the November issue of Pediatrics. The FDA requested and funded the study. About 37% of children who had had multiple surgeries requiring general anesthesia before age 2 had learning disabilities, compared to 24% of children who had just one surgery and 21% of children who had no surgeries.

Antibiotics
According to a recent editorial in Nature, entitled "Stop the killing of beneficial bacteria", experts hint that sometimes, our friendly flora never fully recover from antibiotic use. These long-term changes to the beneficial bacteria within people’s bodies may even increase our susceptibility to infections and disease. Overuse of antibiotics could be fueling the dramatic increase in conditions such as obesity, type 1 diabetes, inflammatory bowel disease, allergies and asthma, which have more than doubled in many populations.

Not surprisingly, an American Journal of Gastroenterology study found that people who are prescribed a large number of antibiotics tend to have a higher risk of inflammatory bowel disease (IBD), Researchers found 12 percent of people diagnosed with ulcerative colitis and crohn's diisease had been prescribed three or more antibiotics two years before compared to seven percent without the disease.

Antipsychotics
The antipsychotic drug asenapine maleate (Saphris) can cause life-threatening allergic reactions, even at the first dose, the FDA said. Label information for the drug will be updated to include a section about the risk, according to an FDA drug safety communication. Agency staff, searching the FDA's adverse event reporting system, discovered 52 reports of type I hypersensitivity reactions following asenapine dosing. These reactions can range from rashes and wheezing to full-blown anaphylaxis.

Aspirin
While many welcome the recent data showing aspirin's protective effect against bowel cancer in those with a family history, we must remind everyone that aspirin is not "one-size-fits-all". Case in point: frequent use of aspirin is associated with early aging macula disorder (AMD), as well as wet late AMD, especially in those who take aspirin daily, according to a new study in Ophthalmology.

Additionally, the risk of gastrointestinal (GI) bleeding needs to be considered when determining the potential preventive benefits associated with low-dose aspirin for cardiovascular disease and cancer. According to a new study in Clinical Gastroenterology and Hepatology, the use of low-dose aspirin increases the risk for GI bleeding, with the risk being increased further with accompanying use of cardiovascular disease-preventing therapies, such as clopidogrel and anticoagulants.

Diabetes Drugs
Two newer drugs used to treat Type 2 diabetes could be linked to a significantly increased risk of developing pancreatitis and pancreatic cancer, and one could also be linked to an increased risk of thyroid cancer. According to U.S. Food and Drug Administration's database for adverse events reported between 2004 and 2009 among patients using the drugs sitagliptin and exenatide, there was a six-fold increase in the odds ratio for reported cases of pancreatitis, compared with four other diabetes therapies they used as controls. Patients who took the two drugs were also more likely to have developed pancreatic cancer than those who were treated with the other therapies. The study is published in the journal Gastroenterology.

General Medication Use
Common medications may account for 10% of all lower urinary tract symptoms (LUTS) in men, but doctors may neglect to take the effects of these medications into account,according to a studies in Archives of Internal Medicine and British Journal of Urology International. Antihistamines, bronchodilators, sympathomimetics, anticholinergics, diuretics, and antidepressants were all indicated.

NSAIDs
Use of acetaminophen and nonaspirin nonsteroidal anti-inflammatory drugs was associated with a significantly increased risk for developing renal cell carcinoma, according to data presented at the 10th AACR International Conference on Frontiers in Cancer Prevention Research. The Harvard Medical School and Brigham and Women's Hospital in Boston demonstrated that any use of acetaminophen was associated with a 33 percent increased risk for RCC, and use of other NSAIDs was linked with a 26 percent increased risk. No significantly increased risk for RCC was found with the use of aspirin.

PPIs
Proton pump inhibitors may actually be aggravating damage in the small intestine caused by the nonsteroidal anti-inflammatory drugs, also known as NSAIDs. In a study published in the medical journal Gastroenterology, the extent of the hard-to-detect damage caused to the small intestine has only recently been discovered through use of small video cameras swallowed like pills. Suppressing acid secretion is effective for protecting the stomach from damage caused by NSAIDs, but these drugs appear to be shifting the damage from the stomach to the small intestine, where the ulcers may be more dangerous and more difficult to treat.

Reclast
Zoledronic acid (Reclast, Novartis Pharmaceuticals), an injectable bisphosphonate used to prevent and treat osteoporosis, is now contraindicated for patients with creatinine clearance below 35 mL/min or evidence of acute renal impairment, according to a label change announced recently by the US Food and Drug Administration (FDA). The revision, which also includes an updated warning on kidney impairment, comes in the wake of continued cases of fatal acute renal failure associated with the drug.

Statins
A Journal of Neurochemistry study recently explained why some experience neurological dysfunction when on statin medication: "cholesterol is highly enriched in the brain, and plays a key role in synapse formation and function. The brain does not derive cholesterol from the circulation; instead, the majority of cholesterol is made in glia and secreted in form of lipoproteins. Neurons can synthesize cholesterol, but the extent of neuronal cholesterol biosynthesis in the adult brain is unknown. Cholesterol biosynthesis inhibitors of the statin family are widely used to lower circulating cholesterol and cardiovascular risk. Lipophilic statins can cross the blood brain barrier and inhibit brain cholesterol biosynthesis with possible consequences for synaptic cholesterol homeostasis. We have investigated the effects of lovastatin on synapse maturation and synaptic vesicle release. Treatment of primary hippocampal neurons with low levels of lovastatin for one week reduced synapse density and impaired synaptic vesicle release. Neither lipoproteins nor geranylgeraniol fully counteracted the lovastatin-induced decrease of synaptic vesicle exocytosis, even when cholesterol depletion was prevented. In contrast, restoration of neuronal cholesterol synthesis with mevalonate prevented defects in vesicle exocytosis without fully normalizing neuronal cholesterol content. These results raise the possibility that chronic exposure of neurons to lipophilic statins may affect synaptic transmission, and indicate that hippocampal neurons need a certain level of endogenous cholesterol biosynthesis."

Steroids
People taking oral steroids are twice as likely as the general population to have severe vitamin D deficiency, according to a study in Journal of Clinical Endocrinology and Metabolism. Physicians should more diligently monitor vitamin D levels in patients being treated with oral steroids.

Thyroid OTC Supplements
People who use over-the-counter "thyroid support'' supplements should only do so through a licensed health professional. These supplements contain varying amounts of thyroid hormones and without supervision, can adversely effect thyroid levels, according to the American Thyroid Association.

TNF-Alpha Inhibitors
The boxed warning on the labels of all tumor necrosis factor alpha (TNF-alpha) inhibitors will be updated to warn about the risk for serious and sometimes fatal infection from 2 bacterial pathogens, Legionella and Listeria, the US Food and Drug Administration (FDA) announced recently. TNF-alpha blockers are used to treat rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, plaque psoriasis, and juvenile idiopathic arthritis, as well as Crohn's disease and ulcerative colitis. Because they suppress the immune system, these drugs come with a known risk for serious, life-threatening, opportunistic infections, which is a risk previously highlighted in the boxed warning on their labels.

Vitamin D
Inaccurate labeling and composition of dietary supplements led two patients to take massive overdoses of vitamin D -- and in neither case was it easy to identify the source of the patient's vitamin D Intoxication, according to the Journal of Clinical Endocrinology & Metabolism. After repeated questioning, the patient said they'd been taking multiple dietary supplements for two months, which had been prescribed for them by physicians. Ultraviolet spectrophotometry and high-performance liquid chromatography revealed that one supplement contained 186,400 IU of vitamin D3, instead of the 1600 IU that was the stated dose on the label. On top of that, the instructions mistakenly recommended 10 capsules a day, instead of one. In other words, the patients took more than 1.8 million IU of vitamin D3 daily for two months, more than a thousand times what the manufacturer had led the patient to believe he was ingesting. While they complained of malaise and their calcium levels were tremendously high, both patients were back to normal health quickly after stopping the supplements and no long-term effects occurred. Bonnie - this is why you must know or trust someone who knows supplement manufacturers!

Yaz
There are new safety concerns about the popular birth-control pill Yaz. Government scientists say the Bayer drug and other newer birth-control pills that contain the synthetic hormone drospirenone appear to increase the risk of dangerous blood clots. A new study released by the Food and Drug Administration reviewed the medical history of more than 800,000 American women taking different forms of birth control between 2001 and 2007. On average, women taking Yaz had a 75 percent greater chance of experiencing a blood clot than women taking older birth-control drugs. Yaz contains estrogen along with drospirenone, a next-generation synthetic hormone known to increase potassium levels in the blood.