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.

TIME article on precocious puberty

http://www.time.com/time/magazine/article/0,9171,2097388,00.html

Low B-12 again linked to cognitive decline

Guidelines suggest serum B12 measurement in patients with suspected dementia in order to screen for severe B12 deficiency as a potentially treatable cause of cognitive decline. There remains a concern that some individuals with more modestly low levels of B12 may also experience cognitive decline that may be made clinically worse by high levels of serum folate, a more common occurrence in the United States since the introduction of mandatory folic acid grain supplementation.

A recent study aimed to examine the relationship between cognitive decline, MRI changes, and levels of B12 and other biochemical markers of B12 deficiency, namely serum homocysteine and methylmalonic acid (MMA). In a study of 6158 persons, both homocysteine and MMA were significantly associated with poorer cognitive testing across multiple domains; B12 levels demonstrated no such association. Access Medicine, October 2011

Antioxidants Key to Avoiding the Flu?

Why do some people end up in bed feverish, hacking and sneezing for days from the flu — when others seem to never get sick? To answer that question, University of Michigan researchers did the first study of its kind: They infected 17 healthy people with the flu virus and discovered that everyone who is exposed to the flu actually is affected by it, but their bodies just have a different way of reacting to it. Half of the study participants got sick; the other half didn’t notice a thing. According to the journal PLoS Genetics, there is an active immune response which accounts for the resistance of certain people getting sick, and that response is just as active as the response we all know and hate, which is being sick with the sniffles, fever, coughing and sneezing. It’s just that the responses are different.

Although they understand that some people’s immune systems resist the virus, they still don’t know how or why that happens. There is a behind the scene active immune response even when you don’t get sick. What they found were differences in their biological metabolism and gene expression. These differences had to do with antioxidants.
Moreover, the researchers claim it is certainly possible that people who resisted the flu virus had very high levels of antioxidant precursors in their blood, and this may what protected them, but they cannot say that because they don’t know.

Too many babies getting reflux meds?

Bonnie - Hmm. Where have you heard this before?

In a commentary published in Journal of Pediatrics, Eric Hassell, MD, a pediatric gastroenterologist, warns that the use of acid-suppressing medications to babies under 1 year old has skyrocketed. One large study in the U.S. found a 16-fold increase in the number of prescriptions for a kid-friendly liquid form of acid-suppressing drugs between 1999 and 2004. Despite this recent spike in prescriptions, Hassall argues that the vast majority of infants don't have gastroesophageal reflux disease (GERD), which is what these drugs are meant to treat. He suggests that a baby's inconsolable crying and spitting up, which are separate symptoms, have become combined into a diagnosis of acid-reflux disease by some pediatricians.

But this spitting up likely isn't "acid reflux" because infants have frequent feedings that tend to buffer stomach acid. Most reflux is physiological. In most cases, it's not the spitting up that should be treated. The real issue is the unexplained crying. Some moms and dads put a lot of pressure on pediatricians to "do something" to help their hard-to-soothe infants. It's sometimes easier and quicker for a doctor to write a prescription instead of taking the time to explain what parents can try in place of drugs. He suspects that both parents and pediatricians are unaware of the extent to which acid-reducing drugs are being overprescribed or of their potential side effects if used long-term.

According to Esther Israel, MD, a pediatric gastroenterologist, "Gastroesophageal reflux is not a disease in infants. It's a normal physiological response that babies often outgrow." She says that before turning to medications, there are a lot of things that can be done from a behavioral perspective. These include soothing-type activities, such as rocking or patting the newborn in a quiet place. Dietary approaches such as switching from a milk protein-containing formula to a soy-based or hydrolyzed one may also make a difference. If a mother is breastfeeding, she can try eliminating milk products from her diet to see how her baby responds. If colic is a concern, infants usually outgrow it in their first three to four months of life.

Cow's Milk Usually to Blame
As the piece above alludes, there are times when infant formula needs to be changed. A study in the October issue of Gut Liver explains that in children who actually do have Gastroesophageal Reflux Disease, cow's milk allergy (CMA) is the major culprit. 81 children with actual GERD were enrolled in the study. All subjects received omeprazole for 4 weeks after the initial evaluation. Empirical elimination of cow's milk from the diet was started for the patients who did not respond to the omeprazole treatment.

Cow's milk was eliminated from the diets of the remaining 27 patients who did not respond to treatment. All signs and symptoms of GERD were resolved in this group after a 4 week elimination of cow's milk from the diet. A diagnosis of CMA was considered in one third of the pediatric cases with signs and symptoms of GERD. This finding shows that CMA can mimic or aggravate all signs and symptoms of severe GERD during infancy.

Study blows the doors off "statin fortress"

A recent study from Journal of Evaluation in Clinical Practice has just blown the doors off the "statin fortress".

According to the study, many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol is a frequently used variable in the risk estimates. Some studies indicate that the predictive properties of cholesterol might not be as straightforward as widely assumed. The researchers aim was to document the strength and validity of total cholesterol as a risk factor for mortality in a well-defined, general Norwegian population without known CVD at baseline.

They assessed the association of total serum cholesterol with total mortality, as well as mortality from CVD and ischaemic heart disease (IHD). The study population comprised 52,087 Norwegians, aged 20–74, who were followed-up on cause-specific mortality for 10 years (510 297 person-years in total).

Among women, higher cholesterol meant lower all-cause mortality as well as CVD mortality. Among men, the association of cholesterol with mortality from CVD and in total followed a ‘U-shaped’ pattern.

The study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If the findings are generalizable, clinical and public health recommendations regarding the ‘dangers’ of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol
(by current standards) may prove to be not only harmless but even beneficial.

The entire study can be found here.

Results from Adverse Event Reporting (AER) System

The Food & Drug Administration AER system ensures that dietary supplement and prescription drug manufacturers report significant adverse events related to their products. The figures from 2008 were recently published.

• 1,080 from supplements (over half the US population, 154 million, take supplements)
• 526,527 from prescription drugs. For every adverse event from supplements, there are 488 adverse events from prescription drugs.
  

Counterstudy: elderly do need multivitamins

A Journal of Nutrition, Health & Aging study aimed to evaluate the status of several vitamins and to investigate the effect of regular individual supplementation on their status in subjects aged between 70-90 years (49% supplementing regularly, 51% without supplementation). Plasma levels of vitamins A, D, E, K and C were determined. The functional parameters of vitamins B1, B2 and B6, i.e. the activities of the erythrocyte enzymes transketolase, glutathione reductase and glutamic oxaloacetic transaminase, were analyzed photometrically; plasma folate and vitamin B12 were determined by RIA.

The status of vitamins A, E and C was generally satisfactory. Eighty-eight percent and 42% of participants were deficient in vitamins D and K, respectively, as were 29% for B6; up to 10% of participants were deficient in vitamins B1, B2, B12 and folate. A considerable percentage of participants was, however, at risk for vitamin deficiencies (vitamins B1, B6, B12, folate: 20–30%, vitamin B2: 60%). Except for vitamins A and K, regular intake of supplements had a significant positive influence on vitamin levels.

These results indicate that use of supplements significantly improved the status of several vitamins in elderly people. Due to age-related problems concerning the intake and digestion of nutrients, a moderate, regular supplementation might be a useful option for older people who are otherwise unable to satisfy their micronutrient requirements.

Soft drinks linked to violence

Teenagers who drink large amounts of soft drinks are more likely to be aggressive and violent. Drinking more than five cans of soda a week was linked to significantly higher levels of violent assaults, scientists non-diet soft drinks they drank during the past week, with a higher consumption increasing the likelihood of them being violent. Just over 23 percent of those drinking one or no cans had carried a gun or knife, rising to just under 43 percent of those drinking 14 or more cans. Writing in the journal Injury Prevention, the researchers concluded that sugar or caffeine could lead to aggression.

Risks with fertility drugs?

Bonnie wanted to comment because it has been a major topic in news lately.

Bonnie - many of you who know me can attest to the fact that I have never liked fertility drugs. However, it is not my place to insist that my clients shun them. If you have ever worked with couples who cannot conceive, it is heartbreaking. I always insist that couples exhaust every other option before they resort to taking fertility drugs. I have had many cases where dietary and lifestyle changes is all that is needed. In cases where diet and lifestyle is not enough, I still work with clients to make sure they are nutritionally optimal to handle the effects of the drugs.

Will I be surprised if in the next decade we see an large uptick in female cancers from fertility drugs? Unfortunately, not. Can I blame these individuals for taking them? Unfortunately, not. What I can blame is the appalling environmental, diet, and lifestyle habits that has driven so many to resort to these drugs.

Why you should NOT stop taking vitamins

by Dr. Mark Hyman
http://www.huffingtonpost.com/dr-mark-hyman/vitamin-dangers_b_1018430.html

Dr. Christiane Northrup steps up for breast thermography

http://www.huffingtonpost.com/christiane-northrup/the-best-breast-test-the-_b_752503.html

When Doing Nothing Makes Sense.

How refreshing to see an M.D. step up and be honest with us.

http://well.blogs.nytimes.com/2011/10/20/when-doing-nothing-is-the-best-medicine/?ref=health

Does your doc laugh at alternative medicine?

A Health Service Research study says your doc could be pulling a fast one. The researchers set out to examine personal use of complementary and alternative medicine (CAM) among U.S. health care workers. The researchers examined a sample of 14,329 employed adults. They discovered that health care workers are more likely than the general population to use CAM. Among health care workers, health care providers are more likely to use CAM than other occupations.

Antidepressant use skyrockets...again

Data from the National Health and Nutrition Examination Surveys, 2005–2008

• Eleven percent of Americans aged 12 years and over take antidepressant medication.
• Overall, females are 2½ times as likely to take antidepressant medication as males. Twenty-three percent of women aged 40–59 take antidepressants, more than in any other age-sex group.
• Non-Hispanic white persons are more likely to take antidepressants than are non-Hispanic black and Mexican-American persons.
• About one-third of persons with severe depressive symptoms take antidepressant medication.
• More than 60% of Americans taking antidepressant medication have taken it for 2 years or longer, with 14% having taken the medication for 10 years or more.
• Less than one-third of Americans taking one antidepressant medication and less than one-half of those taking multiple antidepressants have seen a mental health professional in the past year.

Antidepressants were the third most common prescription drug taken by Americans of all ages in 2005–2008 and the most frequently used by persons aged 18–44 years. From 1988–1994 through 2005–2008, the rate of antidepressant use in the United States among all ages increased nearly 400%.

This data brief discusses all antidepressants taken, regardless of the reason for use. While the majority of antidepressants are taken to treat depression, antidepressants also can be taken to treat anxiety disorders, for example.

Staggering Statistic? About one in 10 Americans aged 12 and over takes antidepressant medication.

Full report is at http://cdc.gov/nchs/data/databriefs/db76.htm

Diet Drinks or Water?

Obese patients enrolled in the six-month CHOICE trial at the University of North Carolina, Chapel Hill, were twice as likely to lose 5% of their body weight no matter if they'd been randomly assigned to a water group or a diet drink group, as opposed to a control group.

But in every other result, water drinkers outshines the diet beverage drinkers, according to data presented at the Obesity Society's annual meeting.

The two intervention groups were instructed to replace at least 200 kcal of caloric beverages every day with either water or diet drinks. At six months, they said, there was no difference in absolute weight between the two study groups -- but those who drank water had a significantly greater improvement in fasting glucose and a trend toward a lower diastolic blood pressure compared to the control group.

At three months into the trial, participants consuming diet drinks were more likely to be consuming more calories in general compared to the water drinkers.

After six months, the diet beverage drinkers were more likely to consume non-sugar carbohydrates compared to the water group.

Diet beverage drinkers were also more likely to eat desserts, sweeteners and breads at three months, compared to the water drinkers.

There have been several recent studies actually linking diet beverages to weight GAIN, so the weight-loss percentage in this study is questionable as it is.

Let there be no doubt, however: water far outshines diet beverages in every way.

It's Simple. Better Diet Equals Better Mental Health.

In a new and burgeoning area of research, two new studies show that diet quality can have a significant effect on mental health outcomes and may potentially have a role in preventing and treating such common illnesses as depression and anxiety.

In PLoS One, researchers found that better diet quality was associated with better mental health in adolescents cross-sectionally and over time. Importantly, these findings suggest it may be possible to prevent teenage depression by ensuring adolescent diets are sufficiently nutritious, and improving diet quality may help treat depressive symptoms in this population.

Three quarters of lifetime psychiatric disorders emerge in adolescence or early adulthood, and a recent survey showed more than 22% of adolescents aged 13 to 18 years had already experienced a clinically significant mental health problem.

A healthy diet was defined as one that included fruit and vegetables as "core food groups" and included both 2 or more servings of fruit per day and 4 or more servings of vegetables, as well as general avoidance of processed foods including chips, fried foods, chocolate, sweets, and ice cream. An unhealthy diet was high in snack and processed foods. The investigators found that higher healthy diet scores at baseline predicted higher (better) Pediatric Quality of Life Inventory scores at follow-up, whereas higher "unhealthy" baseline scores predicted poorer mental health. Adolescents who improved the quality of their diets also experienced improved mental health. In contrast, those whose dietary quality deteriorated experience a worsening of their mental health status. During the 2-year study period, adolescents who improved the quality of their diets also experienced improved mental health. In contrast, those whose dietary quality deteriorated experience a worsening of the

These findings come directly on the heels of another study by the same researchers in Psychosomatic Medicine, revealing a significant link between better-quality diets and improved mental health outcomes, and specifically depression and anxiety, in a cohort of adult men and women. Individuals with better quality diets were less likely to be depressed, whereas a higher intake of processed and unhealthy foods was associated with increased anxiety.

One organization that shuns corporate funding

Unlike the American Dietetic Association (soon to be Academy of Nutrition and Dietetics), the prestigious organization that grants Bonnie Minsky her C.N.S. (Certified Nutrition Specialist) certification accepts no corporate funding.

"Dear Members and Friends of the College,

Many members of the College have expressed that they wish the College to be a strong voice for unbiased nutrition science. On September 28, 2011, the Board of Directors adopted a policy that the College shall accept no corporate funding. The policy states: "The American College of Nutrition accepts no funding from for-profit corporations. This policy fosters our mission and our ability to advance unbiased science without compromise." We are proud to have taken this important step as a scientific body, and believe this will strengthen even further the voice of the College as an advocate for the crucial role of rigorous, unbiased nutrition science in improving human health."

Hoodia no better than placebo (no surprise here)

A double-blind, placebo-controlled trial published in American Journal of Clinical Nutrition found that the weight management plant hoodia performed no better than pacebo in affecting energy intake or body weight. While the trial was just published, major supplement manufacturers, such as Unliver, have known this for several years, which is why they backed out of a $20 million deal with a major hoodia producer.

Bonnie - I never bought into the hoodia hype. The data, as well as waning consumer demand, is bearing this out.

Local Doc dishes on supplements

Courtesy of Dr. Patrick Massey, contributor to the Daily Herald

Do vitamins increase the risk of death? According to one recent medical study, the conclusion may be yes. However, does the data really support the conclusions or are the results being exaggerated? In my opinion, the conclusions of the study are a real stretch based on the structure of the study itself.

This study, published in the Archives of Internal Medicine, is not a double blind, placebo controlled, prospective study. It is part of a larger study and concluded that elderly women who took vitamins had a slightly increased risk of death compared with those who did not. In contrast, this study also suggested that calcium, as a supplement, was associated with a 3.8 percent reduced risk of death.

The data was part of the very large Iowa Women’s Health Study consisting of 41,836 postmenopausal women, ages 55 to 69 who filled out questionnaires in 1987, 1997 and 2004. The questionnaires covered many aspects of health including vitamin use. Although these studies are essential because they provide a large amount of data, correlation does not prove causation. This means that self-reported data is notoriously unreliable, and since there are no controls, the results are far from conclusive. These types of studies are usually the foundation for further, well-designed and controlled studies.

There are a number of factors that can affect the skew, the statistics and the conclusions. It may be possible that those women who have more illnesses and are at a greater risk of death simply use more. Medication use also is important. Even safe over-the-counter pain medications can increase the risk (small but real) of serious hospitalization and death. In addition, physical activity, diet and habits like smoking and alcohol abuse all can affect the outcome.

Among health care professionals, whether vitamins are helpful, harmful or a waste of money is very controversial. However there are, literally, thousands of well-designed, prospective studies worldwide demonstrating the benefits of vitamins for heart disease, diabetes, high blood pressure, pain, Alzheimer’s disease, etc. It is important that accurate information is available to the general public and health care community.

Fortunately, there are now a number of credible resources for accurate information about vitamin use. One of these sources is the Natural Health Research Institute (I hold an unpaid position on the scientific advisory board). The institute is described as “an independent, nonprofit organization that supports science-based research on natural health and wellness.” Its goal is to inform people about the benefits of good food, supplements (if needed) and healthy lifestyles.

The institute is having its sixth annual scientific symposium in Schaumburg on Friday, Oct. 28. The symposium is open to the public and the speakers are internationally recognized experts in the area of vitamins and health. The topic is “Measuring the efficacy, safety and cost savings of dietary supplements.” More information can be found on their website: naturalhealthresearch.org/nhri.

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

Healthy Halloween Tips

Do you cringe around Halloween time? Weeks of parties, school events, and trick-or-treating increase your child's (and sometimes your) candy/sweet consumption ten-fold over any other time of the year. Do you find your child's attention span off, emotional and physical highs and lows more pronounced? More immune-depressed than usual? All the excess sugar and chemicals help to create these symptoms.

Here are some ideas to make Halloween a bit healthier:

• Trick-or-treating: what to do with all the candy! If you are an enterprising parent or child, turn that candy into cash! We have used the following method for two generations of Minsky children. Tell your child that for every piece of candy, they will receive a nickel or dime (your choice). When you explain to them what it can add up to, and they can use the $ to spend as they wish, they usually jump at the chance. Don't forget to let them know that they can still eat a piece or two of their spoils (if interested).
  

• School Parties or Events: we always recommend kids eating healthy snacks instead of candy. Although, if your child is going to eat candy, try to accompany them with their own candy (free of artificial ingredients and hydrogenated fats) and always, ALWAYS accompany it with a healthy fat (like nuts/seeds) or lean protein (jerky, deli turkey, etc.). This will protect against blood sugar highs and lows.
  

• Handing Out Candy: do your visiting trick-or-treaters a favor. If you are going to pass out candy, try to offer the best of the worst (free of artificial sweetners, artificial flavors, artificial colors, hydrogenated or partially-hydrogenated fats). For instance, Whole Foods has on sale Yummy Earth Organic Gummy Bears and Lollipops, Wee Glee Gum, as well as, Endangered Species Dark Chocolate Squares.
  
  Or better yet, do not hand out candy at all. You can also hand out pretzels, seeds, trail mix, raisins, or other dried fruit.
  
  Non-food items like a pencil, eraser, stickers, trading cards, toothbrushes, or coins are great ideas.
  
  
• Eat a Meal or Big Snack Before Halloween Parties/Events: this way, your kids will be less apt to gorge on the junk because they are already satiated.
  
  
• What to Do With the Leftover Candy? Adults, do not consume it. It's bad for you too and does not set a good example. Do not give it away to neighbors or charity (why would you want others to consume junk). Throw it in the trash!
  

Happy Halloween! Bonnie and Steve

BMJ: dark chocolate is real deal for the heart

A BMJ study aimed to evaluate the association of chocolate consumption with the risk of developing cardiometabolic disorders. The primary outcome was cardiometabolic disorders, including cardiovascular disease (coronary heart disease and stroke), diabetes, and metabolic syndrome. The study assessed the risk of developing cardiometabolic disorders by comparing the highest and lowest level of chocolate consumption.

There was a beneficial association between higher levels of chocolate consumption and the risk of cardiometabolic disorders. The highest levels of chocolate consumption were associated with a 37% reduction in cardiovascular disease and a 29% reduction in stroke compared with the lowest levels.

Medicare patients: the clock is ticking on your free wellness visit

Preventative medicine was a guiding principle behind the new federal health reform law, but one provision aimed at that -- free annual "wellness visits" for seniors -- remains a largely unused benefit, federal data show. As of last month, only 1.2 million of the 31 million eligible Medicare beneficiaries nationally had gone in for wellness visits since the benefit went into effect in January. Health care providers say they believe few Medicare patients even know about the program. One reason may be that doctors and clinics aren't telling them. Physicians are largely divided on the merits of the consultations. While some see them as potentially life-saving, others consider the new government mandate a billing headache .In some cases, patients keen to get the checkups are getting stuck with large out-of-pocket bills after demanding physical examinations, which are not included with the benefit. Wellness visits are annual talks with physicians to go over medical history and discuss ways of staying healthy. Medicare pays health providers roughly for the visits, and the patients pay nothing. But the time needed to do the assessments makes it a money loser for some doctor's offices. Wellness visits include a basic check of patients' weight and blood pressure, updates of family medical histories, an assessment of cognitive abilities and a discussion of healthy living practices.

Steve - many of our clients have used their "Wellness Visit" to meet with Bonnie this year. They get a prescription from their physician with "Wellness Visit" written on it. We give the client a receipt with "wellness visit" printed. Then the client submits the claim to Medicare for reimbursement.

Folic acid lowers risk of language delay

Starting folic acid supplementation around the time of conception may decrease the likelihood of severe language delay when the child is 3 years old. Children born to women who began taking the supplements from four weeks before conception to eight weeks after conception were 45% less likely to have severe language delay at 3 years, according to a study in the Oct. 12 issue of the Journal of the American Medical Association.

Vitamin E and prostate cancer risk

The same day as the Archives of Internal Medicine study came out, a JAMA study, which had been previously discredited for its design, found that vitamin E may increase prostate cancer risk. We said back in 2004 when they last reported on this study that it was poorly designed and used only synthetic alpha tocopherol, not natural, mixed tocopherol vitamin E. The lead researchers even alludes to this. Any nutritional expert worth their salt knows that therapeutic supplemental vitamin E needs to be dispensed as mixed tocopherols. Most of the studies showing the benefits of vitamin E have used mixed tocopherols.

Many natural cereals are anything but

Make sure to look on page 30 which shows "natural cereals" made with GMOs, page 34 for cereals with pesticides.

http://cornucopia.org/cereal-scorecard/docs/Cornucopia_Cereal_Report.pdf

Sugary cereals as low as they can go

General Mills says it has taken out as much sugar as it can in its sugary cereals. Now it is the consumer to decide whether to opt for healthier fare or not.

http://online.wsj.com/article/SB10001424053111904563904576589182476489512.html?mod=WSJ_article_MoreIn_Health

Supplements increase mortality in older women?

A study just published in Archives of Internal Medicine called, "Dietary Supplements and Mortality Rate in Older Women: The Iowa Women's Health Study," states:

"Researchers assessed the use of vitamin and mineral supplements in relation to total mortality in 38 772 older women in the Iowa Women's Health Study; mean age was 61.6 years at baseline in 1986. Supplement use was self-reported in 1986, 1997, and 2004 questionnaires. Of the 15 594 deaths (only 40% of the sample size because they were unable to obtain the death records of many of the subjects) identified through the State Health Registry of Iowa, the a multivariable adjusted proportional hazards regression model, the use of multivitamins absolute risk, vitamin B6, folic acid, iron, magnesium, zinc, and copper were associated with increased risk of total mortality when compared with corresponding nonuse (the risk being the strongest with supplement iron).

Bonnie & Steve - not surprisingly, the media failed to mention how the supplements positively affected the subjects. We thought we would mention it. Here is a direct quote from the study:

"Compared with nonusers, supplement users had a LOWER prevalence of diabetes mellitus, high blood pressure, and smoking status; a lower BMI and waist to hip ratio; and were less likely to live on a farm. Supplement users had higher educational level, were more physically active, and were more likely to use estrogen replacement therapy. Also, supplement users were more likely to have lower intake of energy, total fat, and monounsaturated fatty acids, saturated fatty acids, and to have higher intakes of protein, carbohydrates, polyunsaturated fatty acids, alcohol, whole grain products, fruits, and vegetables."

So why was there no mention about supplemental benefit for many of these lifestyle factors? The lead researcher of the study has published negative, questionable research on supplements before, only to be proven wrong years later (i.e. beta carotene and vitamin A).

There were several factors in the supplement group that needed to be addressed: taking synthetic estrogen, not eating enough monounstaurated fat, eating too much polyunsaturated (inflammatory) fat, and eating too many carbs. All of these factors contribute to heart disease and cancer. It is fascinating to note that when researchers excluded supplement users who had CVD and diabetes, the supplements did not show any adverse affect on mortality. So, in essence, the supplement users were better off than the nonusers based upon the aforementioned lifestyle factors.

What does this say? That researchers can extrapolate data however they see fit, especially from a questionnaire-based study. For example, we can extrapolate from this study that if you looked solely at supplement users who were most likely to take synthetic estrogen, most likely to eat inflammatory fats and carbs, and who ate the least amount of monounsaturated fats, we guarantee that mortality risk would skyrocket. Even more egregious is that the researchers did not remove subjects who used synthetic estrogen, which has been linked to a greatly increased risk of CVD and cancer. This should be enough to discredit the study outright.

One other issue: we do not know what brands of supplements these subjects were on. If many of them were on brands such as Centrum, who knows. We do not consider those healthful supplements.

The media did get what it needed, however. Any time they can jump on a study discrediting supplements, they are all over it.

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Statement by Duffy MacKay, N.D., vice president, scientific and regulatory affairs, Council for Responsible Nutrition: “Dietary supplements are used by more than 150 million Americans in combination with other healthy lifestyle habits such as trying to eat a healthy diet and exercising regularly. Research consistently shows that dietary supplement users are higher educated, have higher income levels, and are more likely to engage in other healthy practices than non-supplement users. This study did not discount those facts, and expressly noted that supplement users were more likely to be physically active, more likely to have a lower BMI and waist-to-hip ratio, and have a lower prevalence of smoking, high blood pressure, and diabetes mellitus. The authors note in their article that ‘…dietary supplements are commonly taken to prevent chronic disease…’ The statement would be more accurate with the addition of one word: dietary supplements are commonly taken to help prevent chronic disease. In other words, dietary supplements should not be expected, in and of themselves, and without the synergy of other healthy habits, to prevent chronic disease. This study, however, attempts to tease out one piece of the healthy equation for good health—dietary supplements. CRN maintains that nutrients may be robbed of their beneficial effects when viewed as if they were pharmaceutical agents, with scientists looking to isolate those effects, good or bad. It’s important to keep in mind that this is an associative—not a cause and effect—study. Further, the authors themselves have noted additional limitations. In fact, when the authors did their initial [minimum adjusted] analysis, it appears they actually found benefit for many of the supplements, not just calcium; yet instead of stopping there, they went on to “further adjust” the data, possibly until they found statistics worthy of this publication’s acceptance. The study may make for interesting scientific water cooler discussion, but certainly does not warrant sweeping, overstated concerns for elderly women. Further, the authors show their own bias with this statement: ‘We recommend that they [dietary supplements] be used with strong medically-based cause, such as symptomatic nutrient deficiency…’ which basically means these researchers would rather wait till we all get scurvy before acknowledging any need for supplemental nutrients. Our advice to consumers: your best chance for living a long and healthy life is to engage in healthy lifestyle practices, and many in the scientific community maintain that rational, reasonable use of vitamins and other supplements is part of that equation. Talk to your doctor, or other healthcare practitioner, if you have concerns—but read between the lines of individual studies and don’t make your decisions—either for or against supplements—based solely on hype.”

Statement by Steve Mister, president and CEO, Council for Responsible Nutrition: “Consumers continue to look for the best way to live long and healthy lives, and as much as we would like for science to easily give us answers, the fact is that science is not black and white. But even more concerning is the recent drive to combine political agendas with what should be pure science. The supplement industry regularly gets accused of this practice—in some cases rightly so—yet medical journals seem to be given a pass, as if somehow they held no bias whatsoever. Let’s look at some of the facts in this publication. First, within the article itself are a number of opinions including this one: ‘Also, cumulative effects of widespread use, together with food fortification, have raised concern regarding exceeding upper recommended levels…’ It’s quite popular these days to talk about overnutrification, but in fact research consistently shows that most people are falling short in several key nutrients such as potassium, calcium, vitamin D, and fiber while certain subpopulations fall short in folate, vitamin B12, and iron. Second, the authors advise that dietary supplements only be used ‘with strong medically-based cause, such as symptomatic nutrient deficiency…’ Given the high dosages of iron reportedly being used by the women in the study— iron is the supplement for which there was the strongest negative association—it is highly likely the participants were taking the high dosage of iron reported in the study under a physician’s care for an iron deficiency which may itself have resulted in a shortened lifespan. But the piece purports to warn against over-the-counter use of vitamins. Next, the publication invited a commentary from a scientist whose opinion on supplements and their potential role in good health is already well-known, and whose own work has been the subject of controversy in scientific circles. In the spirit of true scientific discourse, wouldn’t it have been more appropriate to invite a commentary from a researcher who might have looked at the data in its entirety, with sufficient lead time, and provided a different perspective? The commentary states: ‘…Therefore, we believe that politicians and regulatory authorities should wake up to their responsibility to allow only safe products on the market.’ Critics of dietary supplements will continue to advocate that vitamins and minerals should be regulated like drugs, but even they should realize that although drugs undergo rigorous RCT testing, many safety issues for drugs still do exist. Furthermore if nutrients were regulated like drugs, the cost and availability of supplements would make it difficult for average consumers to make these products part of their healthy lifestyle. The editors add their own ‘editorial note,’ using this study as an opportunity to bemoan the fact that ‘A better investment in health would be eating more fruits and vegetables, among other activities.’ This recommendation comes despite the fact that we don’t see a lot of RCTs for fruits or vegetables either. Even without RCTs, we agree that people should be eating more fruits and vegetables; however, in a practical world, consumers are not doing that, and dietary supplements are an option—not a substitute—for getting some (not all) of the health benefits from fruits and vegetables. It’s time scientific journals acknowledge they have some biases, just like industry.”

Best college campus food right in our backyard

If only every college could offer this!

http://www.suntimes.com/lifestyles/food/7836038-423/good-meal-plan-wheaton-college-chef-takes-campus-food-to-next-level.html

PSA is "removed from the menu"

Excerpt Courtesy of Associated Press

A government panel is saying PSA blood tests do more harm than good and healthy men should no longer receive the tests as part of routine cancer screening. The recommendation by the U.S. Preventive Services Task Force, goes against the assumption that finding cancer early is always a good thing. Not so, said Dr. Virginia Moyer of the Baylor College of Medicine, who heads the task force."We have put a huge amount of time, effort and energy into PSA screening and that time, effort and energy, that passion, should be going into finding a better test instead of using a test that doesn't work," Moyer told The Associated Press late Thursday. The task force analyzed all the previous research on this subject, including five major studies, to evaluate whether routine screening reduces deaths from prostate cancer. The conclusion: There's little if any mortality benefit. But there is harm from routine screening: impotence, incontinence, infections, even death that can come from the biopsies, surgery and radiation, Moyer said. Moyer said 30 percent of men who are treated for PSA-discovered prostate cancer suffer significant side effects, sometimes death, from the resulting treatment. About a third of men ages 40 to 60 have brewing prostate cancer but "the huge majority of them will never know it in their lifetime if they are not screened," she added.

Better diet equals less birth defects

A study in the October issue of Archives of Pediatric and Adolescent Medicine examined whether better maternal diet quality was associated with reduced risk for selected birth defects. Increasing diet quality was associated with reduced risks for the birth defects studied. The strongest association was between anencephaly and cleft lip with or without cleft palate. The results suggest that dietary approaches could lead to further reduction in risks of major birth defects and complement existing efforts to fortify foods and encourage periconceptional multivitamin use.

Editor note: The critical period for maternal folate intake seems to be the first few weeks of fetal development. Ensuring adequate folate intake during this period is a vexing problem because the fact of pregnancy may not be known even to the mother at this early stage. The confluence of the problem of getting women of childbearing age to eat an adequate amount of folate with the observation that adequate folate helps prevent neural tube defects (NTDs) led to the addition of folic acid to grain foods in the US food supply starting in 1998. This strategy has been effective in getting folate to young potential mothers and also in reducing NTDs.

Bonnie - this is why it should be essential that young women in child-bearing years take a multivitamin with at minimum 400 mcg. of folate. As the researchers above allude to, food fortification helps, but is not enough.

GMO canola growing wild throughout North Dakota

Large, persistent populations of genetically engineered canola 1 have been found outside of cultivation in North Dakota. A study published by journal PLoS ONE reports that genetically engineered canola endowed with herbicide resistance have been found growing outside of established cultivation regions along roadsides across North Dakota. These "escaped" plants were found state-wide and accounted for 45% of the total roadside plants sampled. Furthermore, populations were found to persist from year to year and reach thousands of individuals. The authors also found that the escaped plants could hybridize with each other to create novel combinations of transgenic traits. The authors argue that their result, more than 10 years after the initial release of genetically engineered canola, "raises questions of whether adequate oversight and monitoring protocols are in place in the U.S. to track the environmental impact of biotech products."

Bonnie - as expected, all of the fears that detractors of GMOs had from the beginning are coming to fruition.

Why wheat makes you fat

Don't take it from us folks. Preventive Cardiologist Dr. William Davis said it as well. In fact, we could not have said it better ourselves. A client forwarded the following to us.

Interview with Dr. Davis

Dr. Davis' most recent piece on wheat.

Registered dietitians at odds over Big Food's influence at the ADA

http://www.grist.org/food/2011-09-26-pay-to-play-with-the-ada

Without Supplements, Most Americans Do Not Get Enough Vitamins and Minerals

Noted Conflict of Interest: this study was supported by the Fortification Committee of the North American Branch of the International Life Sciences Institute, a nonprofit organization backed by numerous food companies, including those that manufacture micronutrients.

Journal Nutrition, October 2011
Foods, Fortificants, and Supplements: Where Do Americans Get Their Nutrients?
"Limited data are available on the source of usual nutrient intakes in the United States. This analysis aimed to assess contributions of micronutrients to usual intakes derived from all sources (naturally occurring, fortified and enriched, and dietary supplements) and to compare usual intakes to the Dietary Reference Intake for U.S. residents aged ≥2 y according to NHANES 2003–2006 (n = 16,110). We used the National Cancer Institute method to assess usual intakes of 19 micronutrients by source. Only a small percentage of the population had total usual intakes (from dietary intakes and supplements) below the estimated average requirement (EAR) for the following: vitamin B-6 (8%), folate (8%), zinc (8%), thiamin, riboflavin, niacin, vitamin B-12, phosphorus, iron, copper, and selenium (<6% for all). However, more of the population had total usual intakes below the EAR for vitamins A, C, D, and E (34, 25, 70, and 60%, respectively), calcium (38%), and magnesium (45%). Only 3 and 35% had total usual intakes of potassium and vitamin K, respectively, greater than the adequate intake. Enrichment and/or fortification largely contributed to intakes of vitamins A, C, and D, thiamin, iron, and folate. Dietary supplements further reduced the percentage of the population consuming less than the EAR for all nutrients. The percentage of the population with total intakes greater than the tolerable upper intake level (UL) was very low for most nutrients, whereas 10.3 and 8.4% of the population had intakes greater than the UL for niacin and zinc, respectively. Without enrichment and/or fortification and supplementation, many Americans did not achieve the recommended micronutrient intake levels set forth in the Dietary Reference Intake."

Good thing we're not zebrafish!

Although many artificial sweeteners (AS) have safety issues, the AS have been widely used in industry. To determine the physiologic effect of AS in the presence of hyperlipidemia, zebrafish were fed aspartame (Equal) or saccharin with a high-cholesterol diet (HCD). After 12 days, 30% of zebrafish, which consumed aspartame and HCD, died with exhibiting swimming defects. The aspartame group had 65% survivability, while the control and saccharin groups had 100% survivability. Under HCD, the saccharin-fed groups had the highest increase in the serum cholesterol level (599 mg/dL). Aspartame-fed group showed a remarkable increase in serum glucose (up to 125 mg/dL), which was 58% greater than the increase in the HCD alone group. The saccharin and HCD groups had the highest cholesteryl ester transfer protein (CETP) activity (52% CE-transfer), while the HCD alone group had 42% CE-transfer. Histologic analysis revealed that the aspartame and HCD groups showed more infiltration of inflammatory cells in the brain and liver sections.

Conclusively, under presence of hyperlipidemia, aspartame-fed zebrafish exhibited acute swimming defects with an increase in brain inflammation. Saccharin-fed zebrafish had an increased atherogenic serum lipid profile with elevation of CETP activity.

Food and Chemical Toxicology, November 2011

2 tips for those with muscle soreness after exercise.

• 30 minutes to 1 hour before exercise, drink or supplement with:
  Tart Cherry Gel or 8 oz. 100% Tart Cherry Concentrate
  OR
  Cranberry Extract or 8 oz. 100% Cranberry Concentrate
  These help reduce the amount of lactic acid that builds up in the muscle tissue.
  

• After exercise and stretching, apply arnica gel topically.
  

3 tips for our Chicago Marathoners

-Check for anemia (especially women; endurance activities use huge amounts of iron)
-Hydrate properly (not too much or too little)
-Take magnesium. It is the most vital nutrient because it protects the heart. You should take at least 350 mg. for training and the race itself.

Good luck!

Cost analysis: dinner at home versus McDonald's

Wonderful graphic of how a family of four can eat a healthier dinner at home compared to McDonald's for more than HALF the cost.

http://www.nytimes.com/imagepages/2011/09/24/opinion/sunday/20110925_BITTMAN_MARSHgph.htm

Food Matters Movie

http://www.foodmatters.tv/screeningeventcinema

Bonnie - most of this movie is "right on", except the part about plant food proteins being more bioavailable than animal proteins. There is no research to prove this assumption. In fact, humans are omnivores (with the ability to digest both plant and animal foods). Genetically some individuals, especially blood type O's, have powerful enzymes and a large amount of bile to break down animal proteins efficiently, but cannot break down plant proteins. Spirulina is both plant and animal, so efficiently absorbed, but you would have to drink s gallon of spirulina liquid to get the protein availability of 4 ounces of chicken breast!

This movie promotes a primarily raw foods vegan diet. Yes, raw food is beneficial. If you can't get at least half of your diet from raw foods, you can compensate by taking digestive enzymes. My sickest clients are vegans because they can't possibly get enough protein to repair cell damage. But I think the movie has tremendous value in that it helps the public think about what they're putting into their bodies and that real food is the best medicine!