Thursday, July 26, 2012

Dietary Modification Reduces Hot Flashes

Weight loss from healthy dietary modification may help to eliminate hot flashes in postmenopausal women, according to the results of a study in journal Menopause. The trial was designed to assess the effect of a healthy diet with reduced fat and increased fruit, vegetable, and fiber intake. Although weight loss was not a goal, the 48,835 participants assigned to the intervention group lost, on average, 4.5 pounds between baseline and year 1 when compared with the control group.

The dietary intervention versus control group was significantly related to a higher likelihood of symptom elimination among women with vasomotor symptoms. Moreover, women who lost more than 10 pounds or more than 10% of their body weight between baseline and 12 months were more likely to eliminate vasomotor symptoms than women who maintained their weight.

Tuesday, July 24, 2012

IOM to study vaccine schedules

The Institute of Medicine (IOM) is currently asking for public comment on how best to study the effect that vaccine schedules have on the health of our children. We commend the IOM for embarking on this brutally difficult challenge.

One admission we found in their commission paper was that while there may be studies that exist for individual vaccines and their side effects, there has NEVER been a study exploring the effects from vaccine schedules. Given the fact that the schedule seems to change every year, with an ever-increasing vaccination load, it is not a surprise that the IOM is asking for public comment on how best to proceed.

One thing we agree upon is that there is a desperately need for this.

Exercise adds almost 4 years to your lifespan

Weight-loss drug Qsymia: our take

Bonnie and Steve: Welcome to the next weight-loss strategy: combine an amphetamine with an anticonvulsant! Even more exciting is that “these prescription medications would be taken for the rest of a person’s life," according to the FDA. Don't you feel like going to your doctor's office to get a prescription for Qsymia?

After not approving a weight-loss drug for 13 years, the FDA approved two in consecutive weeks. At least each of the new drugs -- Belviq and Qsymia -- is being restricted. The FDA was so worried about Belviq, that it has asked for the Drug Enforcement Administration to control its use, like it does opiate painkillers. Qsymia won’t have these restrictions. But the FDA and drugmaker Vivus have worked out a plan to try to ensure that doctors don’t start running diet pill-mills. Vivus will track which doctors are prescribing the drug, and which ones undergo training.

Up to 10 percent weight loss sounds great, until you look closely. That weight loss occurred when used by selected volunteer patients in carefully designed, closely monitored clinical trials who made dramatic changes to their diet and exercised regularly as well. That will not happen in the real world.

The funny thing is that a version is already on the market. Any licensed doctor can prescribe phentermine together with certain versions of topiramate, the epilepsy drug.
Here is our take in February when it was formerly named Qnexa (changed the name to Qsymia because of bad press?):

Side effects covered in our blog piece February 2012:

A panel of medical experts voted to endorse the controversial obesity drug Qnexa, clearing the way for the Food and Drug Administration to approve a new prescription obesity medication for the first time since 1999. The FDA will issue a final ruling later this year, but the agency typically follows the recommendations of its advisory committees. In 2010, the same advisory committee decided that the drug's risks of heart problems and birth defects outweighed its benefits. Qnexa, a combination of the anticonvulsant drug topiramate and the appetite suppressant phentermine, led to an average loss of 10% of total body weight in the first year of use. However, the trials also found that that the drug caused a slight increase in heart rate, which can boost the odds of a heart attack or stroke. In addition, researchers detected an increased risk of birth defects - typically cleft lip - in women who became pregnant while taking the drug. According to the clinical trial data and previous studies, the risk of having a baby with a cleft lip is two to five times greater in women who took Qnexa.  In our opinion, we do not recommend touching this med until at least 3 or 4 years of post-market research on its side effects has been performed. Besides, does the economic cost and potential for adverse effects in exchange for a ten percent reduction of body weight seem like a good trade-off?

Study: these antioxidants lowered risk of pancreatic cancer

Increasing dietary intake of the antioxidant vitamins C, E, and selenium could help cut the risk of developing pancreatic cancer by up to two thirds, suggests research published in the journal Gut. If the association turns out to be causal, one in 12 of these cancers might be prevented.

The disease has the worst prognosis of any cancer, with just 3% of people surviving beyond five years. Genes, smoking, and type 2 diabetes are all risk factors, but diet is also thought to have a role, and may explain why rates vary so much from country to country.

The researchers tracked the health of more than 23,500 40 to 74 year olds. Forty nine people (55% men) developed pancreatic cancer within 10 years of entering the study. This increased to 86 (44% men) by 2010. The nutrient intakes of those diagnosed with the disease within 10 years were compared with those of almost 4000 healthy people to see if there were any differences.

The analysis showed that a weekly intake of selenium in the top 25% of consumption roughly halved their risk of developing pancreatic cancer compared with those whose intake was in the bottom 25%. 

Those whose vitamins C, E, and selenium intake was in the top 25% of consumption were 67% less likely to develop pancreatic cancer than those who were in the bottom 25%.

Monday, July 23, 2012

New mammography study shows no benefit to overall death risk

Bonnie: This study got very little exposure last week.

New research evaluating the timeline of mammography introduction and its effect on death from breast cancer in Sweden indicates no benefit of screening mammography on overall survival. The results appeared July 17th in the Journal of the National Cancer Institute.

Researchers evaluated data from the Swedish Board of Health and Welfare from 1960 to 2009 in women who were 40 years and older. They found that from 1972 to 2009, breast cancer mortality rates decreased by just under 1% per year, declining from 68.4 to 42.8 per 100,000 population, which is similar to the rate in the prescreening period.

In counties in which screening was introduced from 1974 to 1978, mortality trends during the next 18 years were similar to prescreening levels; in counties in which screening was introduced from 1986 to 1987, mortality increased by approximately 12% after the introduction of screening. In contrast, in counties in which screening was introduced in 1987/88 and in 1989/90, mortality declined by approximately 5% and 8%, respectively, after the introduction.

The lead researcher said that the "results reinforce the growing body of data showing that randomized trials on mammography screening were biased and ended up with results that suggest that reductions in breast cancer mortality are associated with screening." He added that mammography screening increases the diagnosis of indolent cancers that are not life-threatening (overdiagnosis).

Two editorials questioned the methods used in this study.

Thursday, July 19, 2012

Chalk Up Two More for B12

A July study from the Journal of the American Geriatric Society examined whether deficient B12 status or low serum B12 levels are associated with worse sensory and motor peripheral nerve function in 2,287 older adults. B12-deficient status was found in 7.0% of participants, and an additional 10.1% had low serum B12 levels. Poor B12 (deficient B12 status and low serum B12) was associated with worse sensory and motor peripheral nerve function. Nerve function impairments may lead to physical function declines and disability in older adults, suggesting that prevention and treatment of low B12 levels may be important to evaluate.

Another study from the journal Gut showed that adding vitamin B12 to standard hepatitis C virus (HCV) treatment significantly boosts the body's ability to keep the virus at bay. Between 60% and 80% of those infected with the viral liver infection HCV will go on to develop chronic hepatitis, and roughly a third of them will progress to cirrhosis and terminal liver disease.

Ninety four patients with HCV infection received standard treatment or standard treatment plus vitamin B12. There was no difference between the two treatment approaches at 4 weeks, but there were significant differences in response at all the other time points, particularly 24 weeks after stopping treatment, which is the aim of HCV treatment and the closest it can be get to a cure. Overall, adding vitamin B12 to standard therapy strengthened the rate of sustained viral response by 34%, the findings showed.

Wednesday, July 18, 2012

FDA way late on BPA and only took a baby step

Bonnie: Isn't this nice? After the FDA let the industry take their sweet old time removing BPA, they are officially putting a lid on bisphenol A (BPA) in baby bottles and sippy cups. This move was not for the safety of the public. "FDA's action is based on industry's abandonment of these uses of BPA," Curtis Allen, an FDA spokesperson said. "The agency continues to support the safety of BPA for use in products that hold food."
The agency will still permit use of BPA in other food containers such as cans and water bottles, even as several manufacturers have voluntarily begun tagging their products as "BPA Free" in light of bad press.
The move was in response to an October 2011 petition from the American Chemistry Council, generally an advocate for the chemical industry. The ACC asked the FDA to phase out rules that allow BPA in food packaging because manufacturers had already abandoned it because of safety concerns.

The fact that it took a petition from a pro-chemical organization to get the FDA to react at all simply boggles the mind!
"This is only a baby step in the fight to eradicate BPA," Sarah Janssen, senior public health scientist at Natural Resources Defense Council, said in a statement. "To truly protect the public, FDA needs to ban BPA from all food packaging. This half-hearted action, taken only after consumers shifted away from BPA in children's products, is inadequate. FDA continues to dodge the bigger questions of BPA's safety."

Our Microbes: great explanation and graphic

How New York City's trans fat ban worked

Tuesday, July 17, 2012

Comsetics and diabetes risk

Chemicals in beauty and personal care products may boost women's risk of diabetes, according to a study from Environmental Health Perspectives. Researchers found elevated concentrations of phthalates, hormone-disrupting chemicals commonly used in products such as soaps, nail polishes, hair sprays, perfumes and moisturizers, in the urine of their female subjects. Women with the highest levels of mono-benzyl phthalate and mono-isobutyl phthalate were nearly twice as likely to develop diabetes as those with the lowest levels of the two chemicals.

The researchers also cautioned that the women in the study "self-reported" their diabetes, a less than ideal method of conducting research. And while the study found a potential connection between phthalates and diabetes in women, it did not prove a cause-and-effect relationship.

The Case for Standing, Again.

American adults may boost their life expectancy by two years by sitting for fewer than three hours a day. While admitting this was a tough task, researchers say in a BMJ Open article that reducing television viewing to under two hours a day could similarly add 1.4 years.

US adults spend about 7.7 hours per day engaged in "sedentary behavior". Much of this occurs spent behind their desks at work. However, new strategies to reduce sitting time, such as standing more at work using a standing desk or treadmill desk, having walking meetings, going to see someone down the hall rather than emailing them, are beginning to take hold.

Steve: The study further bolsters this video I posted in May.

Hospital menus' abysmal sodium levels

Steve: After reading this study, one wonders if the hospitals really want you to leave!

An Archives of Internal Medicine study published July 16th demonstrated that hospital patient menus contain excessive levels of sodium: 86% of regular and 100% of diabetic standard-unselected menus exceeded the Upper Level (UL) of 2300 mg of sodium, and 100% of these menus exceeded the Allowed Intake (AI) of 1500 mg. Sodium levels in 2 sodium-restricted diets typically fell within prescribed levels; however, approximately half of all 2000-mg sodium-restricted menus exceeded that prescribed level when patients self-selected their food. This observation could have important clinical implications given the therapeutic necessity of sodium restriction in conditions such as decompensated heart failure. There are very few published data on the sodium content of hospital patient menus. 

The menus studied serve a large group of hospitalized individuals, many of whom are nutritionally vulnerable and/or have cardiovascular diagnoses for which sodium intake regulation is essential. Based on the growing reliance on prepared and processed foods in the hospital setting, the findings highlight the need for sodium-focused food procurement and menu-planning policies to lower sodium levels in hospital patient menus.

Iron supplements fight fatigue in women

Bonnie: note that any iron supplementation should only be prescribed under the auspices of a physician or licensed health professional.

Thursday, July 12, 2012

Not Exactly a Ringing Endorsement for Propecia

ConAgra Shows Its True Colors.

ConAgra is going back to high fructose corn syrup in their Hunt's brand ketchup. Why are they doing this when they removed HFCS from all of their ketchup products several years ago? According to them, consumer demand has waned. Yeah right.

This move shows a real commitment to improving the health of the nation, does it not? Here is our opinion of what we think happened.
  1. ConAgra is a major corn grower, which is the main ingredient in high fructose corn syrup.
  2. ConAgra was part of an FDA petition by the Corn Refiner's Association to change the name of high fructose corn syrup to corn sugar. The Sugar Association vehemently opposed the petition.
  3. The FDA did not accept the Corn Refiner's Association petition and ruled that they must keep the name HFCS.
  4. With all of Hunt's ketchups containing table sugar, and ConAgra being angry at the Sugar Association for their role in denying them a way to dupe consumers, ConAgra decided to hit them where it hurts: add a line of HFCS-sweetened ketchup to compete with the existing table sugar-sweetened ketchup. Does anyone believe they will be priced equally?
  5. In addition, ConAgra can now showing solidarity to their beloved HFCS ingredient. All done under the ruse that "consumer demand waned".
Of course, the loser in all of this is the uninformed consumer. 

What's your take?

Wednesday, July 11, 2012

Study shows no such thing as a hypoallergenic dog

The allergy-friendly dog may be little more than wishful thinking, a new study of Labradoodles and other allegedly hypoallergenic breeds suggests.

In fact, scientists found that "hypoallergenic" canines had more of the allergy-causing protein Can f 1 in their fur than did dogs without the label. And the air in their owners' homes contained no less of it.

"The term 'hypoallergenic' is a misnomer that is not evidence based," they conclude in their report, published in the Journal of Allergy and Clinical Immunology.

Doris Vredegoor at Utrecht University in The Netherlands and her colleagues recruited nearly 200 dogs of four supposedly hypoallergenic breeds. They compared those with a group of 160 standard dogs.

Based on hair and coat samples, the researchers found higher levels of the Can f 1 allergen in the hypoallergenic group, with Poodles and Labradoodles leading the pack.

While floor dust from the homes of Labradoodle owners contained the lowest level of allergen, it's possible that allergic pet owners are more diligent with the vacuum cleaner, the Dutch team speculates. And the researchers found no differences in allergen levels in the air.

They didn't measure allergies in the pet owners, but they say the allergen levels they found in homes with "hypoallergenic" dogs were high enough to trigger allergic reactions and asthma.

The Questions of Fluoridegate

Cause of infant colic? PPIs won't help.

Helicobacter pylori infection was strongly associated with infantile colic in a study in Archives of Pediatrics and Adolescent Medicine. Astonishingly, this is the first study to investigate the role of H pylori in infantile colic. The cause of infantile colic remains unknown, despite being relatively common. Its prevalence ranges from 5% to 40%, depending on estimates.

Other potential causes of distress, including central nervous system abnormalities, broken bones or other trauma, infections, foreign bodies in the eye, and gastrointestinal problems other than colic, were ruled out in the study subjects.

Of the colicky infants, 81.8% tested positive for H pylori, and 18.2% tested negative. Among the infants without colic, only 23.3% tested positive for H pylori, and 76.7% tested negative.

Bonnie: Now that H pylori has finally been implicated as a possible factor for infantile colic, there must be a change in the blase nature of prescribing PPIs (reflux meds) to infants. PPIs do NOTHING for H pylori. In fact, because it neutralizes stomach acid, it makes H pylori worse. 

The standard medical therapy to eradicate H pylori is antibiotics. This can be devastating to infants, so the authors of this study allude to research showing that probiotics are helpful to treat H pylori. If your infant tests positive for H pylori, do everything possible to eradicate it first without antibiotics. Use antibiotics as the last resort. Before taking them, have your doctor culture the H pylori against several antibiotics to make sure one is effective. Many strains of H pylori are now antibiotic-resistant.

Staggering result in diabetes study

According to research reported at the 72nd Scientific Sessions annual meeting of the American Diabetes Association, patients who reduced their hemoglobin A1c levels by nearly one percentage point -- from a mean of 7.8% to 7% -- had a significant 45% decreased risk of cardiovascular death. The absolute risk of a death from a cardiovascular cause was 9.9 events per 1,000 person-years in patients with decreasing HbA1c and 17.8 per 1,000 in those with stable or increasing HbA1c.

The research team said that they undertook the study because of the ongoing debate about the relationship between glycemic control and adverse cardiovascular outcomes.

Besides the decrease in total mortality, the researchers found that better glycemic control was significantly associated with risk reductions in fatal and nonfatal coronary heart events of 39% and in fatal/nonfatal cardiovascular disease events of 37%.

According to the researchers, the absolute risk of a first fatal or nonfatal event caused by coronary disease was 10.3 per 1,000 person-years for those who had better glycemic control versus 17.9 per 1,000 for those without better control.

Eeg-Olofsson noted that these patients were receiving routine care for type 2 diabetes which shows that targeting HbA1c to 7% (the treatment target) can help mitigate the higher risk of cardiovascular events generally seen in diabetics.

Steve: This should quiet those who have doubted the efficacy of testing for HgbA1C.

Two obscure conditions brought on by B-vitamin deficiencies

A report in the July issue of Neurology reported a case of cerebral folate deficiency, a rare metabolic autoimmune syndrome, in an adult. A 58-year-old woman with progressive memory loss and myoclonus presented for medical attention. Results of cerebral spinal fluid analysis showed low levels of tetrahydrobiopterin and 5-methyltetrahydrofolate. The patient's serum folate level was normal. Serum contained folate receptor 1 blocking and binding antibodies (patient was not absorbing folate at the cellular level). The patient was treated successfully with folinic acid supplementation, and after 6 months of treatment, clinical symptoms had resolved. To the researchers knowledge, they reported the first case of adult-onset cerebral folate deficiency. Furthermore, this condition could represent a treatable form of early-onset dementia.

A second report in Neurology describes a case of vitamin B12 deficiency. A middle-aged man with neuropathy, myelopathy, impaired cognition, and extrapyramidal signs had neurologic and hematologic signs of vitamin B12 deficiency, with elevated methylmalonic acid and homocysteine levels. Brain magnetic resonance imaging showed signal abnormality in the globi pallidi, as can be seen in inherited methylmalonic acidemia. The clinical and radiographic findings reversed with vitamin B12 administration. Vitamin B12 deficiency can present with extrapyramidal symptoms and reversible bilateral globus pallidus abnormalities.

Bonnie: Both of these studies are important because they present unusual cases of B-vitamin deficiency. I see many cases where clients present with normal serum B-12 and folate levels, but still have symptoms of deficiency. While your blood may be circulating normal levels of B-vitamins, it does not mean that you are absorbing them at the cellular level. Epigenetic and genetic predisposition are both indicated. Providing the right sources of B-vitamins through supplementation can remedy the issue, as the aforementioned studies have shown. 

Size of meal now compared to 1950.

CDC The New (Ab)normal

Thursday, July 05, 2012

Reduce pancreatitis risk with these

In a study that appears in the journal Gut, subjects who ate more than four servings of vegetables daily were 44 percent less likely to develop acute pancreatitis than those who ate less than one serving of vegetables a day. The pancreas, which is located behind the stomach, releases digestive enzymes to break down food. Acute pancreatitis is a potentially life-threatening disease that occurs when those enzymes begin to eat the pancreas itself.

Researchers examined 80,000 adults for 11 years. On average, those surveyed ate almost two servings of fruit a day and about 2.5 servings of vegetables. Overweight people and those who consumed more than one alcoholic drink per day appeared to get the most positive benefit from eating a lot of vegetables.

Public health message still falling on deaf ears

A special July/August issue of the Journal of Public Health Management and Practice, dedicated to public health financing, suggests that a rebalancing of the US healthcare investment in clinical care and public health initiatives is needed to improve the health of the population and reduce overall costs.

"If we fail to strengthen our public health system now, we can look forward to falling further behind other developed nations and it will become more and more difficult to restore our health and competitiveness," according to Steven M. Teutsch, MD, MPH, of the Los Angeles County Department of Public Health and colleagues.

The lack of attention to public health and prevention has serious consequences not only for the nation's health but also the economy. A healthy workforce is essential to "sustain economic growth and continued gains in labor force participation and longevity," Teutsch and colleagues believe. Coverage for medical treatment is essential -- but the dollars invested in clinical care far exceed its contributions to the nation's health. Medical care accounts for only 10 to 20 percent of the factors that shape health, but accounts for about 97 percent of all health spending, according to Teutsch and coauthors.

While total annual U.S. health spending is approximately $2.5 trillion, or about $8,100 per person, only $250 is related to public health. And while the U.S. spends twice as much per year as any other industrialized country, Andrew S. Rein, MS, and Lydia L. Ogden, PhD, MPP, of the Centers for Disease Control and Prevention state that that its health system ranks 37th in the world -- just behind Costa Rica.

Bonnie: I have a master's degree in public health. I heard the same message when I was in school in the late 1980's. It is impossible to improve our nation's health because we are not a preventive health care society. If we can alter the "treating the symptoms" model we are stuck in, our place in the world as a healthy nation will improve.

Tuesday, July 03, 2012

Tribune piece on dietary supplement manufacturing: the process is working

The June 30th article in the Chicago Tribune about the manufacturing troubles with dietary supplements is an indication that the process of weeding out the bad players is working. Most of the negative stories the writer referenced were about companies that had no business manufacturing supplements in the first place (Kirkman Labs, while we have never recommended them, would be the exception). They were not in the business for improving the well-being of its customers. They were looking to make money on the cheapest product available.

The piece reinforces what we have been shouting to the mountaintops. You cannot just pick up something off the shelf and take it. If you choose not to utilize the kind of experience and individualized expertise we can provide, always do your due diligence.

The funny thing is that the most reputable, successful, and long-standing supplement manufacturers were cGMP compliant well before the FDA made it a requirement. The FDA is correct in assuming that there should be no excuses for these violations.

Monday, July 02, 2012

Nothing but the best for our clients!

SweetLeaf Stevia® Sweetener beat out the competition to win two World Stevia Organization 2012 Best Stevia Product/Extract of the Year awards (in Paris). The non-profit WSO’s tasting committee and jury members awarded World’s Best Tasting Stevia Awards to SweetLeaf Natural Stevia Sweetener in the Extract category and SweetLeaf® Liquid Stevia Sweet Drops™ Chocolate in the Consumer Product Made with Stevia category.

Products were judged on sensory analysis, such as the general taste, aroma, appearance, flavor and mouth feel, in addition to clear ingredient listings, packaging, ease of preparation and directions for use. SweetLeaf was also the 2010-2011 Global Stevia Products Award winner.

Recall: 3 Standard Process Supplements

While we do not dispense or recommend Standard Process, we know that many of you do take them separately or know friends and family who do. There is a recall on three of their products for potential salmonella contamination. Here is the link:

Drug maker settles criminal charges for 3 billion

Bonnie and Steve: In the largest settlement ever made between and a drug company and a government, GlaxoSmithKline (GSK) pled guilty to three misdemeanor criminal charges related to its unlawful marketing of two antidepressants — Paxil and Wellbutrin — and failure to provide the US Food and Drug Administration with data about safety problems with the diabetes pill Avandia. GSK will pay $3 billion dollars for damages.

The criminal information says the company promoted Paxil as safe and effective for treatment of depression in kids and teens, despite FDA not having approved that use and plenty of evidence to the contrary. In 2003, FDA warned against the use of Paxil in teens because of a heightened risk of suicide.

Despite a lack of FDA approval, Wellbutrin was touted as good for treating conditions ranging from ADHD to obesity at a time when the drug had only been cleared to treat major depression. They also talked up the drug as a remedy for the side effects of other antidepressants, including sexual dysfunction. The feel-good spiel even had its own unofficial tagline, according to the government:
"GSK sales representatives sometimes referred to Wellbutrin as 'the happy, horny, skinny pill' " when touting its unapproved uses.

Other parts of the agreement settlement cover civil matters, ranging from overcharging Medicaid for drugs to paying kickbacks to doctors.

The lengthy indictment can be found at this link.

We could not believe how many new clients came to us, especially during a span from 1994-2003, who were taking Wellbutrin for off-label uses.

While this may sound like a huge amount for a settlement, GSK surely made much more from the drugs' sales. This settlement is more of a body blow than a knockout punch. Let it be a grim reminder of the depth and depravity some companies will exercise to make a buck. What's worse is their actions not only affected adults, but children.