Mitigating preventable chronic disease....in 6 weeks!

Nutrition Metabolism, February 2012

Cleveland Clinic ran a study with their Lifestyle 180 program. Participants had at least one of 8 chronic conditions (obesity, hypertension, hyperlipidemia, diabetes, non-alcoholic fatty liver disease, multiple sclerosis, early stage breast or prostate cancer.

An initial 48 hours of lessons curriculum was taught twice per week, in four-hour sessions each over the first six weeks, called an Immersion Phase. During this period, the first four-hour session of the week was divided into 60 minutes of participant physical activity and 90 minutes of participant cooking and nutrition as well as stress management classes, while during the second session of the week, 60 minutes period was devoted to participant exercise and practice of cooking/nutrition, stress management and biometric one-on-one sessions each. The follow-up phase included three components to help maintain behavioral changes. These included 1) on-site classes at weeks 10, 18 and 30 that followed the same four-hour structure as occurred during the Immersion phase on the second day of the week, 2) a weekly e-mail newsletter and 3) the buddy system. Buddies were assigned within each group during the initial six-week session and were asked to keep in daily contact.

Nutritional aspects of the program most closely align with the Mediterranean diet. The Lifestyle 180 program eliminates trans fats as well as added sugars and syrups, limits saturated fat and substitutes only 100% whole grains/grain products for processed grain foods. Besides complex carbohydrates, Lifestyle 180 nutritional approach promotes an increase in intake of plant foods to provide a spectrum of phytochemicals exerting diverse beneficial biological functions.

The nutritional component of Lifestyle 180 was team-taught, with a chef and a dietitian. First, the chef worked with participants in the teaching kitchen. In an adjoining dining room/classroom, while participants were eating a meal they helped prepare, the dietitian conducted a seminar and guided a discussion about the nutritional aspects of what they had cooked as well as a covered topic of the day. To motivate participants to change how and what they eat, they were engaged into meal preparation in the kitchen. Gaining confidence with the kitchen equipment and different types of foods as well as learning how to manage time during meal preparation were considered important elements of the efforts to increase the likelihood that participants will change their dietary habits.

As part of the nutrition education of participants, one class during the Immersion Phase involved a grocery store experience. In this environment, participants learned how to read nutrition and ingredient labels, what to avoid in packaged foods and how to "shop" a grocery store (i.e. what aisles to avoid, which to frequent).

An exercise instructor led the class in the Lifestyle 180 Fitness Center that included progressive cardiovascular and endurance training as well as resistance training. Patients were encouraged to wear pedometers that were provided at start of the Program, with a goal of 10,000 steps per day and to record their steps on a daily diary sheet.

This component was team-taught, with a restorative yoga therapist and a behavioral health specialist. To sustain healthy lifestyle modifications, behavioral interventions were implemented during the course of the program. Those included goal setting, keeping records of lifestyle practices, social support, cognitive restructuring and problem solving. Patients learned meditation and mindfulness practices and performed simple yoga poses initially sitting or standing and at later stages of the program lying down. Regular elicitation of the "relaxation response", the physiological opposite of the "fight or flight response", may reduce psychological distress and improve medical symptoms in patients with any of a wide array of medical conditions.

Preventable chronic diseases continue to drive health care costs substantially and importantly upward, in part due to a lack of sustainable treatment options. Specific medications, such as cholesterol-lowering and diabetes medications target mostly one chronic disease-associated abnormality of elevated LDL cholesterol or plasma glucose, respectively, rather than the cause of the abnormality.

While surgical interventions successfully treat obesity and a spectrum of associated metabolic changes, they poorly address the behavioral and lifestyle-related factors that led to the development of chronic conditions in the first place. In contrast, comprehensive lifestyle interventions may result in multiple physiological systems changes including behavior modifications that support long-term healthier lifestyle choices.

The researchers report findings that a tri-pronged lifestyle intervention consisting of diet, physical activity and stress management improves disease-associated markers of participants with multiple chronic conditions. All measured biometric and laboratory variables significantly improved after just 6 weeks of intervention. Beneficial changes in blood pressure and glucose were observed in many participants by the second week of the program, thus supporting previously reported observations of the quick onset of measurable benefits that follow a comprehensive lifestyle intervention.

At week 30, HDL cholesterol is significantly higher than at the baseline and the total cholesterol/HDL ratio improves further. Fasting triglyceride level is also significantly reduced at both points in time (week 6 and 30) compared with baseline, reflecting the observations that triglycerides improve after weight loss.

Lifestyle 180 intervention resulted in significantly healthier markers of glucose metabolism and inflammation. Insulin and CRP show large percentage decreases. It is therefore, not surprising that the percent of participants with metabolic syndrome was significantly lower after 6 months of lifestyle interventions (an estimate relative 32 percent lower, from 54% to 37%).

One caveat: less than 25% of participants paid out of their pocket for participation in the program.

Medication changes at 30 weeks

	Diabetes	Hyperlipidemia	Hypertension	Total
Stopped	33	39	79	151
Decreased	47	12	30	89
Avoided	3	18	3	24
Total	83	69	112	264
Started	12	14	36	62
Increased	9	3	6	18
Total	21	17	42	80

Participation in a comprehensive Lifestyle 180 program resulted in significant and rapid, as well as clinically and biologically relevant improvements in biometric and laboratory outcomes, including reduced need for medications, for adults with multiple chronic conditions.

Bonnie: none of what was accomplished here is difficult to do outside of a hospital setting. Many of us live under these healthy lifestyle parameters each week, including reading our weekly eNewsletters. It just reaffirms that when done properly, dramatic change in health can occur rapidly and definitively.

Kids get 16% of calories from added sugar

They are downing an average of 322 calories a day from added sugars, or about 16% of their daily calories. Boys consume 362 calories a day from them; girls, 282 calories. The data from the National Center for Health Statistics, released today, show 59% of added-sugar calories come from foods and 41% from beverages. But soft drinks are still the biggest single source of added sugars in children's diets. Added sugars include table sugar, brown sugar, high-fructose corn syrup, maple syrup, honey, molasses and other caloric sweeteners in prepared and processed foods and beverages, such as cakes, candy, cookies, muffins, soft drinks, jams, chocolates and ice cream.

Not included in this analysis are sugars in fruit and 100% fruit juice.

Steve: add the fact that sugar is as addictive as drugs and that addicts need more to be satiated, we have a serious issue.

Researchers at the Oregon Research Institute in Eugene tested whether eating ice cream would lead the brain to require more and more of it before sending signals that it's an enjoyable treat. They surveyed 151 adolescents about their food cravings, and then scanned their brains while showing them images of a chocolate milkshake to determine how strong their cravings were. The researchers also measured brain activity when the subjects drank a tasteless liquid as a comparison. The teenagers were then fed actual milkshakes.

The participants who reported eating more ice cream over the previous two weeks enjoyed the shakes less -- at least according to the brain scans. The scans showed less activity in the area of the brain associated with reward."We believe that means the more an individual is consuming a high-fat, high-sugar and high-energy food, they develop a tolerance of it in a similar fashion that you see happening with drug addiction or alcohol addition," said the researchers.

Nations' health not improving

The nation's overall health is not improving, a recent national report finds. Worrisome increases in obesity, diabetes and the number of children living in poverty are offsetting modest improvements in overall health, according to "America's Health Rankings."

The report, which is published annually, found that for every person who quit smoking in 2011, someone else became obese. Moreover, the number of U.S. children living in poverty continued to climb in 2011, as did the number of Americans who lacked health insurance. "The health of America is in serious, serious trouble," Reed Tuckson, MD, executive vice president and chief of medical affairs at United Health Group, said at a Washington, D.C., news conference releasing the report in December. "This ordinarily would be a celebratory moment, but quite frankly, my heart is heavy. We are delivering a tsunami of preventable chronic illness into the hands of a delivery system that America cannot afford."

Overall, the report is a mixture of good and bad news. Tobacco use has declined 3.4 percent since 2010 and 25.4 percent since 2001. However, while 1.4 million Americans quit smoking last year, another 1.4 million Americans became obese. Overall, the prevalence of obesity has increased 137 percent, rising from 11.6 percent of the population in 1990 to 27.5 percent of the population in 2011. More than one in four American adults — or 65 million people — are considered obese today. If current trends continue, 43 percent of Americans will be obese by 2018.

In 2011, 8.7 percent of American adults, or more than 20 million people, had been told by a physician that they have diabetes. The number is almost double the 4.4 percent diabetes prevalence seen in 1996. If the diabetes trend continues, 10 percent of all health care dollars will be spent managing the complications of diabetes by 2020.

The rankings are published jointly by American Public Health Association, the United Health Foundation and Partnership for Prevention. The report assesses the nation's health based on 23 factors, including binge drinking, prenatal care, violent crime, occupational fatalities and obesity. This is the first time in the report's 22-year history that not a single state has a prevalence of obesity less than 20 percent.

For the fifth year in a row, the report ranked Vermont as the healthiest state, followed by New Hampshire, Connecticut, Hawaii and Massachusetts. Vermont's strengths include a high rate of high school graduation, a low violent crime rate, a low rate of infectious disease, a high usage of early prenatal care, high per capita public health funding, a low rate of uninsured residents and ready availability of primary care physicians. Vermont has low immunization coverage.

More omega-3 equals larger brain volume

Courtesy of the New York Times

Low blood levels of omega-3 fatty acids are associated with smaller brain volume and poorer performance on tests of mental acuity, even in people without apparent dementia, according to a new study in the journal Neurology. Scientists examined 1,575 dementia-free men and women whose average age was 67. The researchers analyzed the fatty acids of the subjects’ red blood cells, a more reliable measurement than a plasma blood test or an estimate based on diet. They used an M.R.I. scan to measure brain volume and white matter hyperintensities, a radiological finding indicative of vascular damage.

People in the lowest one-quarter for omega-3 levels had significantly lower total cerebral brain volume than those in the highest one-quarter, even after adjusting for age, body mass index, smoking and other factors. They also performed significantly worse on tests of visual memory, executive function and abstract memory than those in the highest one-quarter.

Citrus fruits reduce stroke risk

High intake of flavanones, a subclass of flavonoids found in the greatest concentrations in oranges and grapefruit, is associated with a 19% lower risk for ischemic stroke in women, a new analysis from journal Stroke has shown. Although oranges are the best source of flavanones, North Americans tend to drink the juices of these fruits, which do not provide adequate flavonone content.

The average intake of total flavonoids was 232 mg/d, the lowest intake was 96.8 mg/d, and the highest was 761.2 mg/d. Tea was the main contributor to total flavonoid intake, with apples and oranges also contributing significant amounts. Blueberries were the main source of anthocyanins, and oranges were the main contributors to flavanone and flavone intake.The study found that flavanone intake was inversely related to the risk for ischemic stroke.

Bonnie - as good as citrus can be, one has to be careful. Because of its acidity and allergy potential, many people do not tolerate citrus well. You also need to be careful regarding citrus and certain medications.

FDA Warns on Statins

The Food and Drug Administration raised safety concerns about the popular class of cholesterol-fighting drugs called statins, warning that patients taking the drugs may face a "small increased risk" of higher blood sugar levels and of being diagnosed with diabetes. The FDA is also adding language that memory loss may occur as well. Full story below.

http://online.wsj.com/article/SB10001424052970203833004577251392001194250.html

http://healthland.time.com/2012/02/29/fda-warns-statin-users-of-memory-loss-and-diabetes-risks/

Bonnie - if the FDA comes out with a warning on the most popular class of drugs on earth, take heed. Believe me, it took a 500 pound weight of data dropped on their heads to make this announcement.

According to a recent study in Therapeutic Advances in Drug Safety, this is how many patients it takes to treat with statins to save one life or prevent one cardiac event:

• All-cause mortality: 28
• Coronary heart disease mortality: 34
• Nonfatal myocardial infarction: 38
• Need for revasculariztion: 24
• Stroke: 58

With the mounting number of side effects, does this seem fair to the patients who will not benefit?

Dr. Altman: dermotologist says acne linked to diet

Bonnie and Steve: We've said this for years. However, if you did not take our advice, maybe you'll listen to a dermatologist. This is Dr. Altman's column word for word at the blog entitled "Rash Decisions".

Should we talk to our acne patients about diet?

by Emily Altman, MD, Dermatology

For years I sat in exam rooms with parents and teens and told them there was no relationship between diet and acne to the great delight of the kids. Parents begged me to tell their kids that too much of potato chips, pizza, chocolate, soda or any junk food at all was what was causing the kids to break out. But from what I knew at that point, there was no scientific evidence of a link between diet and acne. Well, little did I know!

Acne vulgaris, the most common skin condition, is a highly prevalent, multifactorial disorder of the pilosebaceous unit. The epidemiology data from 2001 showed that approximately 45 million people in the United States have acne, with an estimated prevalence of 85% in those between ages 15 and 24 (1).Acne affects 60-70% of Americans at some time during their lives. Twenty percent have severe acne with permanent physical and possibly psychological scarring (2).

Acne forms as a result of obstruction and inflammation of hair follicles and their accompanying sebaceous glands (pilosebaceous units). There are multiple factors involved, including the biology of the sebaceous gland itself, sebum production, hyperkeratinization of the hair follicle, bacterial influences, the immune functions of the sebaceous gland, neuropeptides, cytokines and toll-like receptors, hormones and nutritional factors (3).

Although familial studies have demonstrated that hereditary factors are important in determining susceptibility to acne (4), twin studies have suggested that developing clinical acne is partially under environmental control (5).

Nutrition is one of those environmental factors that can and should be controlled in any acne treatment regimen. So what is the evidence for the role of nutrition in the pathogenesis of acne?

In one of the first papers to be published on the subject of the relationship of acne and diet, Cordain et al examined the prevalence of acne in two nonwesternized societies: The Kitavan Islanders of Papua New Guinea and the Ache hunter-gatherers of Paraguay (6). No cases of acne were found among the 1200 Kitavan (including 300 15-25 year olds) or 115 Ache (15 15-25 year olds) examined. The authors observed that both the Ache and Kitavan diets were composed of minimally processed plant and animal foods, virtually devoid of typical Western-diet high glycemic loads that may acutely or chronically elevate insulin levels. Neither society had any evidence of insulin resistance. Kitavans were also not found to be overweight or hypertensive. Previous studies have demonstrated that diet-induced hyperinsulinemia elicits an endocrine response that promotes unregulated tissue growth and enhanced androgen synthesis. Based on that the authors concluded that dietary interventions with low glycemic loads may have a therapeutic benefit in acne treatment.

Interestingly, in the Eskimo and Zulu populations, acne was absent when they were living and eating in traditional manner, but became a problem when these populations moved from their villages to the cities (7).

A 2006 prospective cohort study by Adebamowo et al. that examined 6094 girls aged 9-15 years showed that a greater consumption of milk was associated with a higher prevalence of acne (8). The results were not associated with the fat content of the milk. The authors postulated that the milk intake affected acne though the insulin-like growth factor-1 pathway and through the bioactive molecules milk contains, such as androgens, 5 alpha reduced steroids and other steroid hormones. The sebaceous gland has a full complement of enzymes that can produce testosterone from cholesterol or from its precursors found in milk. Similar results were shown when the Adebamowo team looked at dairy consumption and acne in teenage boys (9).

In 2007 Smith et al. compared the effect of an experimental low glycemic-load diet with a conventional high glycemic-load diet on clinical and endocrine aspects of acne vulgaris. In that study 43 male patients with acne completed a 12-week, parallel, dietary intervention study with investigator-masked dermatology assessments. Primary outcomes measures were changes in lesion counts, sex hormone binding globulin, free androgen index, insulin-like growth factor-I, and insulin-like growth factor binding proteins. The study found that at 12 weeks, total lesion counts had decreased more in the experimental group compared with the control group. The experimental diet also reduced weight, reduced the free androgen index, and increased insulin-like growth factor binding protein-1 (which reduced the bioavailability of IGF-1) when compared with a high glycemic-load diet. The study suggested that nutrition-related lifestyle factors play a role in acne pathogenesis (10).

The evidence for the role of insulin, insulin-like growth factor-1, hyperglycemic food and milk consumption in the pathogenesis of acne was summarized in a viewpoint paper by Melnik and Schmitz (11). Authors wrote, "A growing body of evidence underlies the role of insulin resistance with increased insulin/IGF-1 signalling in the pathogenesis of acne. IGF-1 is the key hormonal mediator regulating adreno-gonadal androgen synthesis, amplifying cutaneous androgen activity and stimulating proliferation of sebaceous follicle."The authors provided an overview of conditions associated with increased IGF-1 serum levels. Many of these conditions are frequently associated with acne.

• Large for gestational age newborns of mothers with milk consumption during pregnancy
• Large for gestational age newborns of mothers with diabetes during pregnancy
• Cow milk formula-fed newborn infants
• Recombinant IGF-1 therapy for dwarfism
• Precocious pubarche
• Puberty
• Adolescents or adults who were small for gestational age or had low birth weight
• PCOS
• Milk and milk protein consumption
• High glycemic foods
• Acromegaly
• Obesity
• States of hyperinsulinemia and insulin resistance
• IGF-1 gene variations like absence of IGF-1 CA 19/19 allele
  

In 2011 Veith and Silverberg looked conducted a meta-analysis of the data on the impact of diet on acne reported in the literature (12). Dietary factors included high glycemic load; milk and dairy; chocolate; salty, oily, and fatty foods. The impact of obesity on acne was also examined. The authors concluded that of all the factors looked at, there is strong evidence for an association between high glycemic load foods and acne. A similar association was found with milk. Dairy products contain approximately 60 other growth factors and micronutrients that can influence acne (3).With all this evidence, the conclusion seems very clear. In addition to prescribing medications, counseling about dietary modifications, such as elimination of dairy products and high glycemic foods must be part of treating acne patients in order for have optimal treatment outcomes.

References:
Agency for Healthcare Research and Quality. Management
of acne. Summary, evidence report D technology assessment: number 17. AHRQ publication no. 01-E018, March 2001.http://archive.ahrq.gov/clinic/epcsums/acnesum.htm
Fulton J. Acne Vulgaris. eMedicine 2011 http://emedicine.medscape.com/article/1069804-overview#a0101
Kurokawa I et al. New developments in our understanding of acne pathogenesis and treatment. Experimental Dermatology 2009;18:821-832
Goulden V, McGeown CH, Cunliffe WJ. The familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals. Br J Dermatol. 1999;141:297-300.
Walton S, Wyat EH, Cunliffe WJ. Genetic control of sebum excretion and acne: a twin study. Br J Dermatol. 1989;121:144-145.
Cordain et al. Acne Vulgaris. A Disease of Western Civilization.Arch Dermatol. 2002;138:1584-1590
Ghodsi SZ et al. Prevalence, severity, and severity risk factors of acne in high school pupils: a community-based study. J Invest Dermatol. 2009 Sep;129(9):2136-41
Adebanowo CA et al. Milk consumption and acne in adolescent girls. Dermatol Online J. 2006 May 30;12(4):1.
Adebamowo CA. Milk consumption and acne in teenaged boys.J Am Acad Dermatol. 2008 May;58(5):787-93.
Smith RN et al. The effect of a high-protein, low glycemic-load diet versus a conventional, high-glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial. J Am Acad Dermatol. 2007;57(2):247-56
Melnik BC, Schmitz G. Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Experimental Dermatology2009;18:833-41.
Veith WB, Silverberg NB. The Association of Acne Vulgaris With Diet. Cutis 2011;88:84-91

How many Americans blow off breakfast?

A national survey conducted by StrategyOne sought to understand breakfast habits and the role breakfast plays in providing Americans with the sustained morning energy they need. Sixty-one percent of American adults believe breakfast to be the most important meal of the day, yet only 48 percent eat breakfast every morning.

• Breakfast skipping is more common in major Southern cities, with Dallas-Fort Worth (54 percent) and Houston (60 percent) residents forgoing breakfast most frequently.

• New Yorkers (69 percent) and Los Angelenos (66 percent) suffer most from morning energy drain, while residents of Washington, D.C. (44 percent) and Boston (46 percent) are least likely to be sluggish in the morning.

• Among those who eat breakfast daily, men seem to get more out of their breakfast, with 53 percent of men feeling more productive after breakfast versus 44 percent of women.

• Almost two in three Americans admit to having low levels of energy in the morning, with 57 percent looking to breakfast to help provide fuel for their morning.
  

Dr. Schuster's eBrief: 10 Steps to Prepare for Birth

I have been working with pregnant women since 1989 and here are 10 suggestions to help prepare mom and newborn for the best birth possible.

1. It has been shown that chiropractic care during pregnancy helps to decrease labor time, keeps women comfortable during pregnancy and keeps baby in the best position for birth. Therefore, I recommended getting adjusted monthly in the first and second trimester, every two weeks during the third trimester and then weekly during the last few weeks of pregnancy.
2. To prepare the body and mind to be strong and flexible for birth, take yoga, guided meditation and or other classes that are specifically geared towards pregnant women.
3. Consider taking birth classes that are outside of the hospital. These are often more comprehensive and offer more helpful tools for both the new mom and new dad.
4. Along with having one’s husband or partner at the birth consider adding a doula or a trusted friend. These people add an element of experience; support and advocacy that can help create a more fulfilling birth experience. Some doulas also come to the home a few days after the baby is born to check up on everything.
5. Pain has been associated with something wrong, with injury to the body. Labor is not injury; a woman’s body is designed to accommodate birth. What causes the “pain” of labor? The ligaments of the uterus and the surrounding muscles are stretching and the baby puts pressure on the cervix, low back and birth canal. Understanding this and then training the mind to describe these feeling of labor as strong sensations can help reduce the fear that is often associated with delivery. Consider taking Hypnobirthing classes and reading books that are written by Ina May Gaskin. These help prepare the mind and body to open up during birth and delivery.
6. Prepare the body for a smoother labor by doing 100 kegel exercises a day. These can be done sitting, standing, lying down, any time, anywhere. To help reduce the likelihood of tearing, massage the perineum and the labia with non-irritating vegetable oil and apply a warm washcloth there as well. This is great to do at nighttime before sleep. Putting a warm compress there during delivery also helps keep the area as pliable as possible. GLA, also known as Evening Primrose Oil can also be used to help soften the cervix.
7. Tone the uterus with red raspberry leaf tea. 1 cup daily during pregnancy and a few cups daily in the last month is recommended. Continue to drink it daily after birth to allow the uterus to get back to normal size in a shorter period of time.
8. If there is any back pain during labor or if there are premature contractions a few weeks before labor there are exercises to help with that. These can be found in the book “Hands of Love” written by Dr. Carol Phillips. These hands on postures can be done by one’s husband, doula or chiropractor. These are very effective in taking pressure off of the spine to help reduce pain, stop premature contractions and to help ease labor.
9. If one is carrying a breech baby then this warrants to get adjusted by one’s chiropractor with the “Webster In-Utero Constraint Technique”. This is a specific chiropractic adjustment that is highly effective in balancing the hips. This helps the baby to be in the best alignment for delivery and often takes between 2 to 6 adjustments for the baby to turn. Adding acupuncture to this technique also helps those who have breech presentations.
10. To help enhance dilation of the cervix during labor, a) stimulate the nipples, b) get intimate with one’s partner, c) walk around, d) massage the jaw, e) use aromatherapy such as the scents of lavender with neroli to create a sense of deep relaxation of the mind and allow the body to open up, g) apply acupressure to the web of the thumb and a few inches above the inner ankle, h) change postures during labor, because certain positions will open the hips up more than others, and sometimes just moving into a different position will get labor back on track, i) get onto ones knees and elbows, this is another way to change the hips and the baby to be in a better position for labor.

May these 10 steps help you or someone you know have the most wonderful birth experience for mom and baby!

In health and happiness,

Dr. Liselotte Schuster
(847)509-9067

drliloschuster@sbcglobal.net

www.liloschuster.com

Antibiotics proves to be no help for sinusitis, again.

Bonnie: while these studies seem to publish at a rapid pace, many people, including our own clients, simply do not listen. Aside from providing no help for sinusitis sufferers, antibiotics can do so much short and long-term damage. It is astonishing that doctors keep acquiescing to the patient in this regard because sinusitis is almost always viral or fungal, not bacterial.

A study in Journal of the American Medical Association found patients with acute rhinosinusitis had no differences in symptoms or quality of life three days after starting on amoxicillin compared with patients who received a placebo instead. "It provides further evidence for what we've really suspected for a long time -- that in the management of patients with acute sinusitis, antibiotics do not convey any additional benefit," said the lead researcher.

The study's authors also criticized physicians who prescribe azithromycin (Zithromax Z-Pak) for sinus infections."If anything, it's less effective," he said. "The prevalence of its prescribing represents sloppy practice."

Review: Probiotics for IBS

An Alimentary Pharmacology & Therapeutics review summarized and critically evaluated current knowledge of probiotics used to treat Irritable Bowel Syndrome (IBS). Of the 42 trials evaluated examining the efficacy of probiotics in IBS, 34 reported beneficial effects in at least one of the endpoints or symptoms examined. The review suggests the future holds much promise for the use of lactic acid bacteria (probiotics) in the treatment of irritable bowel syndrome. The selection of probiotic strains for use in clinical trials (predominately lactobacillus acidophilus and bifidobacterium) has largely been based on those with a historical profile free of harmful side effects, so it is not surprising that they exhibited an excellent safety record.

There is now a strong rationale behind their use, solid evidence for strain specific efficacy and emerging data identifying potential mechanism of action for agents that have an enviable safety profile compared with pharmacological agents.

Steve: you and I have known this for a while. However, it is always nice to see it published in a respected, peer-reviewed, medical journal polished off with a parting shot at pharmaceutical safety.

Splenda Essentials: don't be fooled

Bonnie: I can just picture Splenda's executives patting themselves on the back. Don't be fooled. The paltry amount of vitamins in their new product does not even scratch the surface in limiting the damage it can do.

http://www.anh-usa.org/toxic-chemical-being-sold-as-a-health-conscious-sweetener/

Op-Ed: breast cancer research alternatives

http://opinion.latimes.com/opinionla/2012/02/komen-alternatives-for-a-cure.html

Hospital food getting a makeover?

http://online.wsj.com/article/SB10001424052970204642604577213390021632180.html?mod=WSJ_hpp_MIDDLE_Video_Top

No single diabetes diet fits all

Bonnie - This is the quote of the week: For the first time, a spokesperson for the American Diabetes Association admitted that "there is no one diet that is consistently better at helping people manage diabetes." It based upon individual needs.

I'm glad they are finally coming into the 21st century!

Arsenic in brown rice syrup

Bonnie and Steve: An Environmental Health Perspectives study released ahead of print today found high levels of arsenic in brown rice syrup products, including two organic infant formulas. Similar to a study about arsenic found in apple juice, this definitely has the public uneasy.

The study did not released the brand names of the cereals, energy bars, athletic food products, and infant formulas. For our clients: the baby formula we recommend, Baby's Only, states their products do not have detectable arsenic levels: http://www.naturesone.com/pdf/N1_Response_Arsenic_and_Other_Toxins_in_US_Food_Supply.pdf

Hopefully, we can learn more about the brands in question. If you are worried about any products you consume with brown rice syrup, contact the manufacturer and ask them if their brown rice syrup comes form California. If it does, then it should be fine. This was one study was on brown rice syrup, not brown rice. That is a major distinction. Feel free to avoid any products you may consume with brown rice syrup until this is sorted out.

If you are concerned for yourself or your child, you can do a simple serum or hair analysis test to screen for arsenic.

Here's the abstract:

BACKGROUND: Rice can be a major source of inorganic arsenic (Asi) for many sub-populations. Rice products are also used as ingredients in prepared foods, some of which may not be obviously rice-based. Organic brown rice syrup (OBRS) is used as a sweetener in organic food products as an alternative to high fructose corn syrup. We hypothesized that OBRS introduces arsenic into these products.
OBJECTIVE: We determined the concentration and speciation of arsenic (As) in commercially available brown rice syrups, and in products containing OBRS including infant formula, cereal/energy bars, and high energy foods used by endurance athletes.
METHODS: We used ICP-MS and IC-ICP-MS to determine total As (Astotal) concentrations and As speciation in products purchased via the internet or in stores in the Hanover, NH area.
DISCUSSION: We found that OBRS can contain high concentrations of Asi and dimethylarsenate (DMA). An ‘organic’ infant milk formula containing OBRS as the primary ingredient had Astotalconcentrations up to six times the EPA safe drinking water limit. Cereal bars and high energy foods containing OBRS also had higher As concentrations than equivalent products that did not contain OBRS. Inorganic As was the main As species in the majority of food products tested in this study.
CONCLUSIONS: There are currently no US regulations applicable to As in food, but our findings suggest that the OBRS products we evaluated may introduce significant concentrations of Asi to an individual’s diet. Thus, we conclude that there is an urgent need for regulatory limits on As in food.

Is That "New Car Smell" Toxic

http://men.webmd.com/news/20120215/is-that-new-car-smell-toxic

Lipsticks have lead

While many of you have known this for a while, the cosmetics manufacturers have done nothing to remove lead in over 400 kinds of lipsticks tested by the FDA. Five lipsticks made by L’Oreal and Maybelline, two Cover Girl, two NARS lipsticks, and one made by Stargaze also landed in the top 10 most contaminated of the cosmetics.

Babies on probiotics have significantly lower allergies: study

Infants exposed to probiotics (lactobacillus strain) through dietary supplements from 35 weeks' gestation through 2 years of age had a significantly lower risk for eczema and rhinoconjunctivitis. The protective effect lasted until the children were at least 4 years of age, according to a study published in Clinical and Experimental Allergy.

425 infants were followed for 4 years after daily supplementation with probiotic or placebo. Mothers received supplements from 35 weeks' gestation until their child's birth, continuing to 6 months after birth if they were breast-feeding, and all infants received supplements from birth until age 2 years.

The cumulative prevalence of eczema by age 4 years was significantly reduced in the children taking the probiotics compared with children in the placebo group. The prevalence of rhinoconjunctivitis at age 4 years. In addition to significantly reducing the risk of eczema by 4 years of age, the use of the probiotic also provided some protection against wheeze and atopic sensitization.

Eat less, gain memory?

Older people who consumed more than 2,143 calories a day had more than double the risk of a type of memory loss compared to those who ate fewer than 1,500 calories a day, according to a study being released by the American Academy of Neurology. Mild cognitive impairment is the condition between normal forgetfulness due to aging and early Alzheimer's disease.

Researchers divided the participants into three equal groups. The first group consumed 600 to 1,526 calories daily; a second between 1,526 calories and 2,142 calories and a third, more than 2,143. The odds of having MCI more than doubled in the highest calorie group compared to the lowest calorie group.

Fantastic voyage through the gut

Processed food like ramen noodles and gummy bears are bad for you. Now, for the first time ever, you can see how for yourself. Artist and provacateur Stefani Bardin‘s newest project M2A™:The Fantastic Voyage offers a graphic look at how the gastrointestinal tract (GI) processes a meal of Top Ramen, Gummy Bears and Blue Gatorade versus a meal of hand made noodles, pomegranate/cherry juice gummy bears, and hibiscus gatorade.

Bardin worked in collaboration with gastroenterologist Dr. Braden Kuo of Harvard University and Massachusetts General Hospital to launch the first ever clinical study using the M2A™ Capsule (mouth-to-anus) to record video of the digestion process. They also used a SmartPill wireless gastroenterology device to capture rich time, pressure, and pH data of how the GI tract reacts as each kind of food is digested.

While the final results are not published yet- Bardin and Kuo are raising money to run more trials- the video is a disturbing look at how difficult it is for the body to break down food made for shelf-life. Which makes sense, given the ingredients used to preserve and give them their color are derived from petrochemicals and butane. Perhaps more disturbing, however, is that fact that “since artificial colorings and flavorings are considered the intellectual property of a company, manufacturers are not required to divulge this information since it could potentially do economic harm to their business if someone stole their trade secrets,” says Bardin.

The goal of this project? Bardin explains, “to present unseen and often veiled information about our food system in unexpected ways, so that the public with as much knowledge as possible in order to make informed choices about the food they eat.”

http://www.petrifiedunrest.net/M2A.html

Trans-fat blood levels plummet. Yeah!

Excerpts courtesy of the Washington Post

The amount of trans fat in the American bloodstream fell by more than half after the Food and Drug Administration required food manufacturers to label how much of the unhealthful ingredient is in their products. Blood levels of trans fat declined 58 percent from 2000 to 2008. The decline, unusually big and abrupt, strongly suggests government regulation was effective in altering a risk factor for heart disease for a broad swath of the population. Researchers at the Centers for Disease Control and Prevention discovered the decline by analyzing blood drawn as part of the National Health and Nutrition Examination Survey, which interviews and examines a sample of Americans at least once a decade.

Surgery no benefit for women with noncyclic chronic pelvic pain

According to the Agency for Healthcare Research and Quality, despite the frequent use of invasive surgical procedures to treat women with noncyclic chronic pelvic pain, little evidence supports a surgical approach. The new review from AHRQ’s Effective Health Care Program has found in general, a lack of high quality research available to evaluate the comparative effectiveness of both surgical and nonsurgical treatment options for noncyclic (not occurring during menstruation) chronic pelvic pain.

Preventive care: co-pay or no co-pay?

We found this explanation to be very helpful:

http://www.latimes.com/health/la-he-health-411-20120213,0,7604082.story

Should nutrition groups take corporate money?

http://www.chicagotribune.com/features/tribu/julieshealth/chi-should-nutrition-groups-take-corporate-money-20120210,0,1395956.story

Wake Up to Gluten Intolerance.

--portion from eNewsletter--
"A major problem for people with gluten sensitivity is that physicians using tests for celiac disease simply state that the client does not have celiac disease, leading uninformed patients to fend for themselves. Symptoms continue, but the yet unanswered question remains: 'Are people with gluten sensitivity at risk for the same long-term, serious systematic side effects of celiac disease?'"

Bonnie: The answer is a resounding yes. We hear this frustration from clients on a weekly basis.

"It is time to not only recognize, but to treat and further research gluten sensitivity, as unconfirmed environmental factors continue to spread this problem further into the general population."

Steve: These quotes appear in an amazing report from this month's Expert Review of Gastroenterology and Hepatology, thoroughly validating what we have known for years. Here are a few more highlights from the finest report on gluten intolerance (they call it sensitivity by the way) that we have read to date.
--end portion from eNewsletter--

"Nonceliac gluten sensitivity is a separate problem from celiac disease, which emerged prior to 2008. Until this time, the medical establisment only officially recognized gluten as being problematic in people with celiac disease. It is clear that many health-insurance companies lack both the name and reimbursement coding for gluten sensitivity."

Steve: This is a huge problem when clients are trying to get reimbursed.

"People with gluten sensitivity test negative for celiac disease and wheat allergy, but experience resolution of symptoms on a gluten-free diet."

Bonnie: Clinically evident on a weekly basis here.

"It is suggested that the debate on whether or not gluten sensitivity even exists is interfering with the very real need of it being recognized, treated and researched. It is time to recognize the numerous clinical cases of gluten sensitivities in adults and the need to formally confirm this through research. In addition, a renewed recognition needs to occur of the already medically established fact that a second bimodal wave of celiac disease can occur in adults, and not just in infants and children under 3 years of age with the classic symptoms of stunted growth, emaciation, anemia, pot-belly, diarrhea and foul smelling, pale stools. The failure to recognize that celiac disease can also occur later in life, results in a time to diagnosis that is often up to a decade. Is the same scenario occurring for patients with gluten sensitivity?"

Bonnie: This is not something you can usually grow out of. And it can happen when you are older because the damaging effects add up over time.

"What is Causing the Gluten Sensitivity Problem? Human Genetics, Plant Genetic Modification, Wheat Breeding, Improving Gluten Strength, Gluten as a Food Additive, Contaminated Gluten, Hormonal influences, Intestinal Infections, and Allergic Disease."

Steve: A very good list, with human genetics being the biggest, of course.

"The curious suggestion that such a gluten-free diet is 'dangerous' is not justified considering the serious side effects associated with celiac disease. Any 'problems' are easily addressed by referring patients to a dietitian, who will customize the diet and possibly recommend specific dietary supplements such as fiber and calcium.

Bonnie: The key is to replace the gluten-related calories optimally for your individual needs.

Benefits from an elimination diet may also be maximized by minimizing food allergens, utilizing digestive enzymes and providing omega-3 fatty acids or other dietary supplements. Additional dietary modifications may include foods that decrease inflammation, probiotics influencing gut microflora concentrations and limiting carbohydrates."

Bonnie: What a novel idea?

"Recognition of Gluten Sensitivity: The first step is to agree that gluten sensitivity is emerging as a serious problem. Creating criteria for the condition is the next step, followed by research to determine its prevalence, and adding gluten sensitivity to the medical insurance list of coded conditions."

"Treatment of Gluten Sensitivity: The current problem of ruling out celiac disease and not recommending a gluten-free diet for gluten-sensitive individuals needs to be corrected. Perhaps patients who are sure that certain foods trigger their symptoms, but are not sure of the causative factor(s), may be best served by providing them a test elimination diet. Patients need to be made aware of these side-effects of gluten so that they understand that this is not just a 'diet' in which gastrointestinal problems are the only consequence of consuming gluten. Currently, this is not the case in medical practice. In the best interest of these patients, referrals to dietitians are recommended. Gluten is not only found in wheat products, but in many hidden locations in the diet that are not easily communicated in a short office visit."

"Five Year View: Until gluten sensitivity is acknowledged, we cannot move together toward solving this problem. The gluten-sensitivity problem will continue in its current amoeba-like state, where no questions are being asked, let alone answered. It was the purpose of this paper to finally ask some of those questions, and ask more people to join in on the arduous task of answering them. In the meantime, gluten sensitivity will continue to spread silently through the unaware population, which includes many clinicians and researchers."

Bonnie and Steve: Could not have said it better ourselves.

Optimal vitamin D = strength and balance in elderly

According to a study in Journal of American Geriatric Society, supplemental vitamin D with daily doses of 800 to 1,000 IU consistently demonstrated beneficial effects on strength and balance. An effect on gait was not demonstrated, although further evaluation is recommended.

Tai Chi helps with Parkinson's symptoms

Tai Chi may help some of the worst physical problems of Parkinson's disease, as well as reduce the chances of a fall.

For the study, subjects with mild-to-moderate Parkinson's disease were assigned to one of three groups: The first took tai chi classes, the second exercised with weights, and the third was assigned to a program of seated stretching. All the groups met for 60-minute sessions twice each week. After six months, people who had been taking tai chi were able to lean farther forward or backward without stumbling or falling compared to those who had been doing resistance training or stretching. They were also better able to smoothly direct their movements. And they were able to take longer strides than people in the other two groups. Like resistance training, tai chi helped people walk more swiftly, get up from a chair more quickly, and increased leg strength.

Perhaps the most impressive benefit of tai chi, however, was that people in the tai chi group reported half the number of falls compared to those who were taking resistance training and two-thirds fewer falls than people who were doing light stretching exercises. The research is published in the New England Journal of Medicine.

My Potato Project: The Importance of Organic

Dr. Schuster found this gem.

I cannot believe that there are actually 146 dislikes!

http://www.youtube.com/watch?v=exBEFCiWyW0

Diet quality and mortality

A new study from Journal Nutrition shows that diet quality indices assessing compliance with dietary guidelines may be a simple, economical predictor of mortality. Researchers studied 972 participants aged 65 years and older in 1994/1995 and who were followed-up for mortality status until 2008.

Three measures of diet quality were used: the Healthy Diet Score (HDS), the Recommended Food Score (RFS), and the Mediterranean Diet Score (MDS). Data for all-cause mortality adjusted for age, sex, energy intake, social class, region, smoking, physical activity, and BMI.

The Mediterranean Diet Score was significantly associated with lower mortality. The Recommended Food Score was also associated with reduced mortality, albeit on a lesser scale. There were no significant associations for the Healthy Diet Score.

This was the first study to show that simple measures of diet quality using food-based indicators can be useful predictors of longevity.

Mediterranean Diet and Parkinson's disease

A Mediterranean-style diet rich in fruit, vegetables and fish can almost halve the risk of Parkinson's disease, according to new research in the European Journal of Neurology. Although it's not clear why certain foods might have a protective effect, some research suggests Parkinson's disease may be more likely to occur when cells undergo oxidative stress. Fruit, vegetables, fish and pulses all contain high levels of antioxidants, which can help to block this process.

Researchers assessed the eating habits of 249 newly-diagnosed Parkinson's patients and compared them with 368 healthy volunteers. They split them into three groups. 'Healthy' diets were dominated by fresh fruit, vegetables, fish, pulses, mushrooms and seaweed, 'Western' diets, featuring higher levels of red and processed meat and foods high in animal fats and - 'Light Meals' - roughly half way between the two.

The results showed those in the 'Healthy diet' group who ate the highest amounts of plant foods and fish were nearly half as likely to get Parkinson's disease as those who ate the least. Neither of the other two diets had any protective effect.

Another reason to limit bread consumption

Courtesy of USA Today

Bread and rolls are the No. 1 source of salt in the American diet, accounting for more than twice as much sodium as salty junk food like potato chips. That surprising finding comes in a government report released Tuesday that includes a list of the top 10 sources of sodium. Salty snacks actually came in at the bottom of the list compiled by the Centers for Disease Control and Prevention.

"Potato chips, pretzels, and popcorn — which we think of as the saltiest foods in our diet — are only No. 10," said CDC Director Dr. Thomas Frieden. Breads and rolls aren't really saltier than many of the other foods, but people tend to eat a lot of them, said Mary Cogswell, a CDC senior scientist who co-authored the report.

CDC officials were amazed that just 10 foods are responsible for 44 percent of the sodium consumed. "It's possible to eat a whole bunch of sodium without it seeming salty," noted John Hayes, an assistant professor of food science at Penn State, who was not involved in the report.

After breads, next on the list were cold cuts and cured meats; pizza; fresh and processed poultry; soups; fast-food hamburgers; sandwiches; cheese; spaghetti and other pasta dishes; meatloaf and other meat dishes; snacks like potato chips and pretzels.

The perils of high heels

In case anyone missed this last week...

http://www.dailymail.co.uk/femail/article-2092317/How-wearing-high-heels-regularly-ruin-way-walk--off.html?ITO=1490

ADA fighting for domination in several states

http://www.anh-usa.org/american-dietetic-association-speeds-up-its-race-for-monopoly/

Show this to docs who laugh at you when you mention "gluten intolerance"

http://online.wsj.com/article/SB10001424052970204136404577206891526292590.html

Area with small businesses healthier

Counties and parishes with a greater concentration of small, locally-owned businesses have healthier populations -- with lower rates of mortality, obesity and diabetes -- than do those that rely on large companies with "absentee" owners, according to a national study of 3,060 counties and parishes in the Cambridge Journal of Regions, Economy and Society.

Some sociologists argue that small businesses -- unlike chain retail "big box" stores and large manufacturing plants -- have a greater investment in the community and thus have more at stake when it comes to the well-being of employees, customers and other local citizens. The researchers, who analyzed national population, health, business and housing data, found that the greater the proportion of small businesses, the healthier the population.

"The old way of thinking was that you wanted to work for a big company because of pension plans, health insurance, dental insurance," said the co-author. "But many of them have moved overseas to cheaper labor markets. So what we see are larger retailers, usually next to interstates, that pay low wages and may not even offer full-time jobs with benefits, but instead hire people to work 30 hours a week. There's a high turnover."

Larger companies showed a large drop in wages -- 33 percent in real dollars -- and access to health insurance between 1988 and 2003, previous research has shown. Amid restructuring and globalization, some large businesses are giving employees furloughs from full-time jobs, then rehiring them as short-time contract workers with no benefits. While locally owned businesses are not adding greater compensation or benefits, the pay gap is shrinking.

Said one researcher: "When someone creates a 'mom and pop' business, it's a huge step to bring that first employee on board. If it's a relative or neighbor, they'll bend over backward to hire and retain them. They're going to bring on board somebody they trust, and they'll pull every hair and every tooth in their head before they lay off someone who's their neighbor."

Small businesses are more likely to support bond issues for health infrastructures, recruit physicians, push for local anti-smoking legislation, promote community health programs and activities and support local farmers' markets.

Food Intolerance: the Silent Assassin

Book offers 10 checklists for hospital patients

http://yourlife.usatoday.com/health/story/2012-02-01/Book-offers-10-checklists-for-hospital-patients/52920616/1

Home births up 30 percent

http://yourlife.usatoday.com/parenting-family/pregnancy/story/2012-01-26/CDC-Home-births-rise-nearly-30-percent-in-US/52805556/1

Adrenaline athletes sponsoring...water?

The parallels between adrenaline sports such as snowboarding, freestyle skiing, surfing, skateboarding, and dirt biking seem like an energy drink marketer’s dream. Not only does sponsorship of such activities target teenage viewers, but also the shrapnel of exposure extends into more mainstream realms—products like Red Bull, Monster and Rockstar are now mainstays at little league baseball, high school soccer matches, and varsity football games. Very little emphasis is placed on the actual product itself.

Despite energy drinks’ popularity with the younger set, they are wholly vilified by in-the-know parents and pediatricians due to their high sugar and caffeine content. It is both surprising and encouraging that professional snowboarders Austin Smith and Bryan Fox started the Drink Water campaign, first with an insignia on the bottom of their boards (a prime spot for visibility in the half-pipe) and now with T-shirts, sweatshirts and stickers emblazoned with a clearly identifiable faucet logo and sold through their website,wedrinkwater.com.

According to Smith and Fox: “If you love snowboarding or some other healthy activity that defines many decisions in your life, you are likely a choice target-consumer for companies that sell ‘energy drinks.’ Maybe you, like us, started to feel uncomfortable about how effective these companies have become at encouraging young people to consume their product: beverages of caffeine, sodium, sugar, high fructose corn syrup, and even some mystery chemicals about which little is known … We're out to spread the Drink Water word. We don’t sell water, we just drink it.”

Smith and Fox rely on energy drink companies to support both adrenaline sports and themselves, yet they so vehemently disagree with the energy drink sponsorship message (which is essentially that consuming energy drinks will make you a better extreme sport athlete) that they actively encourage their fans and peers to simply drink water. In reality, extreme sports do not require energy drinks. Rather, the opposite is true. In order to perform at such elite levels, athletes want to avoid the crash (or ‘bonk’ in snowboarder speak) that occurs after drinking a high-sugar beverage.

Corporate sponsorship is a vital aspect of extreme sports. However, there has to be a responsibility factor. As we have seen with marketing junk food, children are sponges to advertising. Once they absorb a message, often times you have a customer for life.