Happy Meal has staying power (but for 137 days!)

Salon.com explores the secret to immortality of McDonald's food in this article. The chain's burgers can resist rot for years. Scientists explain why they have the shelf life of the undead.

And as long as we are on this topic, Bonnie still has in her office a 28 year-old Hostess cupcake that does not look much worse for wear!

Salt water therapuetic for sore throat

Courtesy of the NY Times

THE FACTS
Nothing but time can cure the common cold, but a simple cup of salt water might ease the misery this winter. A sore, itchy throat and respiratory congestion are some of the more common symptoms of a cold, and gargling with salt water seems to help for several reasons. A saline solution can draw excess fluid from inflamed tissues in the throat, making them hurt less, said Dr. Philip T. Hagen, editor in chief of the “Mayo Clinic Book of Home Remedies,” which is due out in October. Dr. Hagen pointed out that gargling also loosens thick mucus, which can remove irritants like allergens, bacteria and fungi from the throat.

In a randomized study published in the American Journal of Preventive Medicine in 2005, researchers recruited almost 400 healthy volunteers and followed them for 60 days during cold and flu season. Some of the subjects were told to gargle three times a day. At the end of the study period, the group that regularly gargled had a nearly 40 percent decrease in upper respiratory tract infections compared with the control group, and when they did get sick, “gargling tended to attenuate bronchial symptoms,” the researchers wrote. Other studies have also found gargling helpful against sore throats and congestion. According to the Mayo Clinic, for best results, dissolve half a teaspoon of salt in a full glass of warm water and gargle the solution for a few seconds before spitting it out. Adults who want a more palatable remedy against cough and sore throat can try mixing warm water with lemon and honey. No need to spit it out.

THE BOTTOM LINE Gargling with a saline solution can ease symptoms of a cold.

Shocker: kids don't drink enough water

Children in the United States are not drinking as much water as they should, and the deficiency can have far-reaching implications. For instance, impaired cognitive and mental performance are linked to inadequate hydration. According to the study published in the American Journal of Clinical Nutrition, only 15 to 60 percent of boys and 10 to 54 percent of girls, depending on age, drink the minimum amount of water recommended by the U.S. Institute of Medicine. Children obtain much of their water from sweetened beverages rather than plain water, the researchers found. And those who drink the most plain water consume fewer sweetened beverages and eat fewer high-calorie foods.

Researchers suggest giving children water instead of sweetened beverages during the day and between meals. If you need to make it more appealing, put sliced cucumbers, oranges, lemons or strawberries in ice water, the researchers suggested. And if your child is hooked on sodas, she advised transitioning to sparkling or flavored unsweetened waters.

Celiac can occur at any stage of life

Celiac disease is showing an increasing presence among the elderly, says a study in the Annals of Medicine. The study followed 3,511 volunteers who submitted blood samples in 1974 and 1989, and updates every two to three years until 2007. This study adds weight to the concept that celiac disease can emerge at any age, because researchers surveyed the same people over time. Researchers found that the incidence of celiac disease doubled every 15 years since 1974 and that the incidence increased as subjects aged, with some developing the disease in their 50s or 60s. If someone can be gluten-tolerant for 40 or 50 years before developing celiac disease, then environmental factors may outweigh genetic causes for the disease, says Alessio Fasano, director of the Center for Celiac Research, which led the study. Fasano says that other unknown environmental changes and changes in "the composition of bacteria in our guts" may be causing gluten autoimmunity to present itself later in life.

Bonnie - for those of you who are of the belief that one can just "grow out" of an intolerance to gluten, this study begs to differ. If wheat continues to be a daily staple of the human diet, we will continue to see more cases of gluten intolerance and celiac.

FIR Sauna season is here again

As the air begins to cool in many areas of the country, our Rejuvenating Room, featuring a Far Infrared Sauna, is just heating up.

According to Dr. Susan Lark, the reason why sunlight feels so good even when your skin is covered is the result of infrared radiation. Not only does it penetrate clothing, but skin, muscle, and even bone, delivering benefits directly to your cells. For those living in cold climates who rarely get adequate sun exposure, a dry Far Infrared Sauna can be a relaxing and therapeutic experience.

Aside from increasing detoxification through deep, dermal sweating, FIR can enhance photobiostimulation, a recharging of the mitochondria. FIR is special for its ability to penetrate tissues to a depth of more than nine inches without burning. Recent research has shown positive effects for myriad maladies, including Parkinson's symptoms relief, pain associated with Rheumatoid Arthritis, and immunodeficient individuals with bacterial and fungal infections.

Click here for details about our Rejuvenating Room and Far Infrared Sauna Therapy

Feds files complaint against POM Wonderful.

The Federal Trade Commission filed a complaint that challenges the company's statements that pomegranate can prevent and treat everything from heart disease to erectile dysfunction.

The agency called the claims -- found in advertisements in print publications and on the Internet -- "false and unsubstantiated" and based on flawed medical research.

In a story this March, the Chicago Tribune named POM Wonderful as one of several products on the market that made health claims in its advertising that are permissible only for FDA-approved drugs.

The FTC is asking a judge to issue an order that would require the company to stop making claims that pomegranate products can cure, prevent or treat any disease unless the claims are first approved by the U.S. Food and Drug Administration.

Among the advertising claims the FTC is challenging are that the product has "super health powers," that drinking an 8 ounce glass of POM Wonderful slows the rate of prostate cancer, that the juice can treat erectile dysfunction and that it has been proven reduce arterial plaque by 30 percent.

The administrative complaint does not mean the company has violated the law, the FTC said. A hearing has been scheduled for eight months from now before an administrative law judge.

Steve - this is a very complex issue. DSHEA is very specific about what you can and cannot say in directly promoting the benefits of your product. Just because POM has invested tens of millions of research into the health effects of their product does not mean they can promote that research legally. The supplement industry recently won a huge lawsuit against the FTC on this very issue. However, unless the DSHEA law is modified, these will only be individual victories.

Unfortunately, I think things are going to get worse, not better. The European Union has basically eradicated the individual's right to choose their own natural products/supplements to the point where they are basically classified as drugs. Many in Congress want to see this happen in the US.

In our opinion, the benefits of pomegranate are not up for debate. Independent research outside of the POM company has confirmed this. That said, there is a huge turf war for market share between the government, Big Pharma, and the natural products industry. Because POM appears to have brazenly gone against the rules of DSHEA in the eyes of the FTC, they are a ripe target.

Note that POM is also suing the FTC. To be continued...

Prestigious studies cite vitamins, diet for dementia prevention

According to a study citing the most important principles for prevention of dementia, researchers stated in International Journal of Clinical Practice: "There is some evidence that natural or high intake of vitamins B, C and E from food decreases dementia risk; however, there is insufficient evidence to recommend for or against supplementation with vitamins B, C and E for the prevention of dementia. Adherence to the 'Mediterranean diet' may affect not only risk for Alzheimer disease, but also subsequent disease course. Frequent consumption of fruits and vegetables, fish, and omega-3 rich oils may decrease the risk of dementia and Alzheimer's disease. Avoidance of tobacco can be recommended. There are potential advantages of moderate consumption of wine (specific doses cannot be stated, although effects on diseases other than dementia suggest beneficial associations with 1–2 glasses per day for men, and up to 1 glass for women).

Bonnie - the fact that they even mention vitamins B, C, and E is a small victory. You cannot fathom how conservative and anti-supplement many of the dementia and Alzheimer's researchers are. Of course they would be when so much of their funding comes from Big Pharma.

The Times crow's about quinoa

http://well.blogs.nytimes.com/2010/09/24/theres-something-about-quinoa/?ref=health

Nearly everyone fails to meet Dietary Guidelines, suggests study

Nearly the entire US population fails to eat a diet in line with the Dietary Guidelines for Americans, according to new research published in the Journal of Nutrition. The researchers, from the National Cancer Institute and the National Center for Nutrition Policy and Promotion, examined 2001-2004 NHANES (National Health and Nutrition Examination Survey) data including 16,338 individuals’ dietary habits. They found that more than 80 percent of those aged 71 and above, and more than 90 percent of all other age groups of both sexes, overconsumed discretionary calories – those that come from solid fats, added sugars and alcohol. A majority did not meet MyPyramid recommendations for every food group except total grains and meat and beans, the researchers found. “Nearly everyone” failed to meet recommendations for dark green vegetables, orange vegetables, legumes, and whole grains, which were the groups with the lowest adherence to recommendations.

“In conclusion, nearly the entire US population consumes a diet that is not on par with recommendations. These findings add another piece to the rather disturbing picture that is emerging of a nation’s diet in crisis,” the authors wrote.

Young adults were most likely to fall short of recommendations for fruits, milk and oils, and those aged 31 to 50 were most likely to drink too much alcohol. Moreover, the researchers applied their findings to the US food supply, which they said has oversupplied solid fats, added sugars, and sodium, and undersupplied fruits, vegetables, whole grains, and milk over at least the past several decades.

“The stark contrasts observed between the diets of Americans as well as the US food supply and current dietary guidance underscore the need for individual- and environmental-level interventions to facilitate healthier dietary intake patterns,” the authors concluded. “Without such interventions, the diets of most U.S. adults and children will continue to be markedly divergent from recommendations, a worrisome state in the context of the obesity epidemic and alarming rates of other diet-related chronic diseases.”

Bonnie - while disheartening to read as a public health professional, it once again sheds light on the major issues with the American diet's core infrastructure. The key word to take from this study is individual. While we wait...and wait...for a titanic shift of public policy, what can be accomplished quickly is dietary education and training on an individualized level. The new health care reform legislation makes taking advantage of this more palatable because it is now covered by insurance one hundred percent in most scenarios.

Finally. I can guarantee that the majority of my clients not only meet, but exceed and improve what is required from the Dietary Guidelines for Americans for fruits, vegetables, and legumes. The other aspects of the guidelines I do not support anyway.

Supplements reduce heart attack risk: large study

In a large study to be published in the American Journal of Clinical Nutrition, researchers looked at the multivitamin/mineral use of 34,000 female subjects aged 49-83 to gauge risk of myocardial infarction (heart attack) over a ten year period.

Researchers looked at 31,671 women with no history of MI and 2262 women with a history of MI. The multivitamin/mineral intake was estimated to be close to the recommended daily allowances. Results were very encouraging:

• In the group with no history of CVD, women using multivitamins alone, as compared with no use of supplements, was associated with a 27% lower risk of MI.
• Women using multivitamins together with other supplements had a 30% lower risk of MI.
• The lower risk was stronger among women who used supplements for five years or more.
• While a much smaller sample size, in women with a history of CVD, there was no association between supplements and MI.

Steve - we need more large studies with long-term follow-ups like this one when looking at the preventive effects of dietary supplements.

Similac recall

Illinois-based Abbott Laboratories says it is recalling about 5 million containers of its top-selling Similac powdered infant formula due to possible contamination by beetles or larvae of the bugs. The product being recalled is sold in cans and plastic containers, and that only the powdered versions of the popular infant formula is involved in its “proactive” action. Similac sold in liquid form is not part of the recall.

The company said in a news release posted on the web site of the FDA that an internal quality review detected the “remote possibility of the presence of a small common beetle in the product produced” in one of its manufacturing facilities. Abbott says the FDA had determined that while the formula containing the beetles “poses no immediate health risk, there is a possibility that infants who consume formula containing the beetles or their larvae could experience symptoms of gastrointestinal discomfort and refusal to eat as a result of small insect parts irritating the GI tract.”

It says consumers desiring more information or to find out if they have the product in their possession should go the web site similac.com and type in the lot number. Or people may call 800-986-8850.

Doc's health habits affect credibility with patients

Physician's confidence in their ability to counsel patients on a healthy diet and exercise may be related to their own personal habits. Factors that predicted confidence in counseling included the doctor's own exercise time, being overweight, and if the doctor had adequate training in counseling patients. The study, to be published in Preventive Cardiology, shows doctors' own health habits matter when it comes to patient counseling.

Both attending and trainee physicians subjects in this study reported low levels of confidence in their ability to effectively counsel patients regarding healthy lifestyle habits. However, greater degrees of self-confidence for counseling were seen with increased levels of personal exercise. Attending physicians were more likely to exercise four or more days a week and more than 150 minutes a week than trainees. In the survey, 69 percent talked to patients about exercise compared to only 38 percent of trainees who gave exercise counseling.

Few trainees or attending physicians were confident in their ability to change patients' behavior even though it's well-known that weight loss can prevent or alleviate obesity-related diseases such as hypertension and diabetes. Factors that predicted confidence in counseling included the doctor's own exercise time, being overweight, and if the doctor had adequate training in counseling, the study showed. Adequate training was the strongest predictor for confidence in talking about healthy eating habits, the survey showed. With the prevalence of obesity among adults in the U.S. increasing, many physicians lack confidence in their ability to counsel patients regarding lifestyle.

Bonnie - as we reported in another study recently, at least public health officials are beginning to recognize this problem.

Reimbursement for Nutritional Counseling Services

We are a cash practice. The method in which our clients are reimbursed by insurance for our services is bringing a prescription with diagnosis code from their physicians. Now that most of the Affordable Care Act has gone into effect, coverage for preventive care is front and center. Here are the best suggestions for reimbursement:

Private Insurance 
Most health care providers should have no-cost preventive services included in their insurance plans. Ask your provider if they differentiate how much they will reimburse for preventive services in-network or out-of-network. Ask your provider to specify how they quantify in-network or out-of-network and how much they reimburse for out-of-network. Every provider has their own interpretation of this issue.

The following services we provide should be reimbursed 100 percent, with no co-pays, and no questions asked by your insurance provider, as long as you have a prescription from your physician that includes the correct diagnosis code(s) and the words "for medical nutrition therapy."

• Diet counseling for adults with higher risk for chronic disease
• Obesity counseling for all adults
• Folic acid supplements for women who may become pregnant
• Iron supplements for children ages 6 to 12 months at risk for anemia
• Obesity counseling for children

Each provider will have their own procedure and diagnosis codes that they will attribute to these services.

There are many more preventive services that we did not mention that will be covered partially or in full as long as you have a prescription from your physician that includes diagnosis code(s) and the words "for medical nutrition therapy." Services with an "A" or "B" rating from the US Preventive Services Task Force are included. Here is a link to the full list.

Medicare
For our services, you would go through the same process as above. Then, you would submit the claim yourself to Medicare for reimbursement. Medicare is currently only covering counseling services for diabetes.

Disclaimer
As you know with private insurance and Medicare, there are never any guarantees! These tips are just to give you the best chance for coverage.

Paleolithic diet gathering steam

by Jess Halliday
Freelance Journalist for Food Industry Issues

There’s something incongruous about the hi-tech modern food industry sniffing around the Paleolithic era for the next big consumer trend. But hold the side order of cynicism. There might just be some logic to good old-fashioned instinctive eating. Unilever has unveiled a new research program that aims to re-create the diet of the caveman and apply modern biological science to it in the hope of unlocking some long-forgotten dietary knowledge that was instinctive to our ancestors.

The idea of eating like a caveman is nothing new. Gastroenterologist Walter Voegtlin first published The Stone Age Diet book in 1975, and other researchers have picked up the trail. US-based independent research group Paleobiotics Lab, has also been flagging up the heavy load of prebiotic fiber inulin in our ancestors’ diets, and the benefits it can bring. Like many off-beat new trends, it has been a way of life for a handful of health fanatics for decades. But are we ready for it to enter the mainstream? Your average caveman couldn’t have had a more different diet to the way we eat today. Tonight’s dinner may be a ready meal with an ingredients list as long as your arm – when once it would have been an armful of berries picked from a shrub.

Unilever’s new inspiration is not completely out of left-field. First, the natural trend has been gathering pace. We have started to snub those complex ingredients list, preferring them to feature foods we actually recognize as foods. How more natural can you get than to eat like your ancestors, who would have had no idea what an E-number is, let alone how to skin it. Nostalgic eating, too, has been a big hit. Especially in the recession, we have sought simplicity and savings by digging out our grandmothers’ old-fangled recipes. And once we have had our fill of braised offal and apple pie, what about Granny’s Granny’s recipes… and all the Great-Grannies going back 1200 generations?

Unilever is looking at a time when filling your stomach was a full time occupation. If you got the nutritional balance wrong or plumped for the wrong berry, the consequences were – a horrible death. Instinct, then, was a pretty crucial life skill. The Paleolithic era was also the time when the human genome was set. And by gum, evolution just hasn’t been able to keep up with fast moving consumer trends since then. We’re pretty much the same human beings as our ancient ancestor – just with worse spear skills but considerably better at maneuvering a supermarket trolley. The ability to eat instinctively for our genes has been largely crowded out by a sensual confusion of branding, tastes and textures.

The outcome? Well, heart disease and cancer aren’t pleasant ways to end your days. What we have instead of instinct is an armory of technologies that can be turned back to basics. Archeologists, anthropologists, evolutionary geneticists, food scientists, botanists… that’s the team of intrepid investigators Unilever has put together for its foray into diets past. We can’t turn back eating habits 12000 years and we probably wouldn’t want to. I would rather my local supermarket ran a special on mammoth chops any day than have to go out and hunt them myself. But we can certainly use today’s techniques to mine knowledge from the past, and use it to make better food in the future. Working together these scientists might, just might, unearth the long-lost secret of optimal nutritional need. If it comes with a cute picture of a caveman on the package, I’d buy it.

Don't count on evolution to eradicate diabetes

Gene variants associated with an increased risk for type-1 diabetes and rheumatoid arthritis may confer previously unknown benefits to their human carriers, say researchers at the Stanford. As a result, the human race may have been evolving in the recent past to be more susceptible, rather than less, to some complex diseases.

According to the lead researcher, "Everything we've been taught about evolution would indicate that we should be evolving away from developing type 1 diabetes. But instead, we've been evolving toward it. Why would we have a genetic variant that predisposes us to a deadly condition?" The researchers speculate that at least some of the risky changes may protect carriers against certain viruses and bacteria -- a trade-off that may have made evolutionary sense in the not-too-distant past when infectious diseases were devastating and largely untreatable.

According to the study, published in Science One, the idea that disease-causing genes can be beneficial is not new. The most clear-cut case involves a gene variant that, when present in two copies, causes sickle cell anemia, which can result in severe pain, organ damage and death. Although it seems that natural selection would work to eliminate the disorder, the variant remains prevalent in some areas of Africa because people with just a single copy are less susceptible to malaria. Evolutionarily the trade-off is worth it: Far more people are protected from malaria than ever develop sickle cell anemia even in today's environment. Unlike sickle cell anemia, which is caused by a mutation in just one gene, many complex diseases are associated with several variants -- specific locations in the DNA where the nucleotide "letters" vary between individuals. These locations are known as SNPs, for single nucleotide polymorphisms. Some of these SNPs are associated with an increased disease risk, while others protect against developing the disease.

When calculating an individual's overall genetic risk, it's necessary to consider the net effect of all of his or her variants. Researchers picked seven well-known conditions to study: type-1 and type-2 diabetes, rheumatoid arthritis, hypertension, Crohn's disease, coronary artery disease and bipolar disorder. Previous genome wide association studies have identified several hundred SNPs associated with each disorder. The Stanford researchers found that of the top SNPs associated with type-1 diabetes, 80 have been recently increasing in prevalence, meaning that they underwent positive selection. Of these, a surprising 58 are associated with an increased risk of the disorder, while 22 appear protective. Similarly, SNPs associated with an increased risk for rheumatoid arthritis were found to be positively selected. In contrast to type-1 diabetes and rheumatoid arthritis, we're evolving away from a tendency to develop Crohn's disease. Results for the other three disorders -- type-2 diabetes, coronary artery disease and bipolar disorder -- showed that protective and risky SNPs were positively selected in about equal proportions.

Regardless of the reason, some evolutionary tenets still apply. Healthier people are, presumably, more likely to reproduce and pass those same genes -- be they protective or risky -- to their offspring. When conditions changed because of differences in diet, exposures or location as populations move around the globe, carriers of the risky SNPs began to develop the conditions we struggle with today.

"Even though we've been finding more and more genetic contributions to disease risk," said researchers, "that's not really an appealing answer. There have got to be some other reasons why we have these conditions."

Bonnie - the reason is simple. Since agriculture was created, and humans began consuming grains approximately 10,000 years ago, we have been negatively expressing our genetic SNPs. Epigenetics, which deems how our genes are expressed, are driven by our lifestyle choices. Grain consumption is diametrically opposed to our genetic makeup. We are trying to genetically overcome millions of years of evolution based upon a paleolithic diet.

A new study in Journal Nature reveals that our use of stone tools to consume meat dates roughly one million years earlier than previously believed with Lucy's species, Australopithecus Afarensis. With this new discovery, we have a million more years of evolution to overcome in being able to tolerate grains.

These geneticists and paleontologists should get together with epigeneticists to produce a compelling argument for governments and the World Health Organization to curtail grain consumption worldwide. In its place, agriculture can grow more epigenetically harmonizing crops called vegetables and fruit!

If you must consume grains, one way to try to lower your risk from developing diabetes is to have a high level of magnesium, according to a study in the Journal of the American College of Nutrition.

For more on how epigenetics is key to evolution, here is a compelling article.

Inflammation affects intelligence and mortality

Inflammation is associated with lower intelligence and premature death, according to research published in Brain, Behavior and Immunity. In one of the largest, longest studies ever performed, data collected over several decades on inflammation and intelligence were measured at 18-20 years of age in nearly 50,000 young men, and deaths over the following 35 years were recorded.

Men with low-grade inflammation performed more poorly on standardized intelligence tests, even after excluding those with signs of current illness. Inflammation also predicted an increased risk of premature death, according to researchers. While researchers know inflammation is associated with infection, cardiovascular disease, and brain function impairment, this is the first time that similar associations have been shown in healthy young people. This suggests that even low levels of inflammation can have detrimental consequences for health and brain function. This is why we include C-Reactive Protein (CRP) in our initial blood panel for new clients, which can indicate cardiac and whole body inflammation.

One interesting finding was the role environmental factors played during childhood. Children of farmers had higher levels of inflammation than those whose fathers were non-manual workers, potentially because they were exposed to more pesticides.

Moreover, In European Heart Journal, experts admit the emerging status of biomarkers of inflammation is crucial to lead to advances in clinical care, but they must do better.

Clinicians must improve the number needed to treat and strive for further refinements in risk prediction to individualize interventions.

Clinicians must aim to assure that individuals targeted for medication do not lessen their adherence to a healthy lifestyle, believing that they enjoy pharmacological protection from unhealthy behaviors. Clinicians need to understand more about the mechanisms and clinical significance of unwanted actions of statins, including dysglycemia.

Most importantly, clinicians need to devise measures to optimize lifestyle change at both a medical and societal level. For individual patients, implementation of sustained lifestyle change, while very challenging in practice, is paramount for success.

The expects go on to say recognition that inflammation contributes to cardiovascular risk independent of LDL levels raises the possibility that other anti-inflammatory treatments might reduce cardiovascular events. But of those that are currently available, anti-inflammatory strategies have drawbacks in this regard.

Non-steroidal anti-inflammatory agents (NSAIDS) effectively combat inflammation, but if anything, seem to augment atherosclerotic complications. Moreover, NSAIDS tend to cause slight elevations in blood pressure that over time can adversely affect cardiovascular outcomes. Glucocorticoids also exert strong anti-inflammatory effects, yet may accelerate atherosclerosis rather than abate its consequences. This class of agents causes many metabolic perturbations that may mitigate their anti-inflammatory actions. For example, glucocorticoids cause dyslipidemia, hypertension, and insulin insensitivity, each an important risk factor for atherosclerotic events. Pharmacological inhibitors of certain other effectors of inflammatory pathways, such as the matrix metalloproteinases, have also exhibited undesired actions that render them unsuitable for prevention of atherosclerotic events. The continued search for selective anti-inflammatory agents remains a high priority for future research in this arena.

Unfortunately, the researchers never mention the myriad natural substances for lowering localized or whole body inflammation. Thankfully, we have vast experience in naturally reducing inflammation based upon individual needs. When vigilantly adhered to, clients get results.

Docs still know little about nutrition

Teaching Doctors About Nutrition and Diet
By Pauline W. Chen, M.D.
Excerpts from New York Times

Within days of being accepted into medical school, I started getting asked for medical advice. Even my closest friends, who should have known better, got in on the action. “Should I take vitamins?” “What do you think of this diet?” “Is yogurt good for me or not?” Each and every time someone posed such a query, I became immediately cognizant of one thing: the big blank space in my brain. After all, even with medical school acceptance in hand, I was no more a doctor than they were. But I also soon realized that many of their questions had nothing to do with medications or operations, or even diseases. With all the newspaper and television reports about newly discovered carcinogens and the latest diets and miracle nutrients, what my friends and acquaintances really wanted to know was just what they should or should not eat.

Years later, as a newly minted doctor on the wards seeing real patients, I found myself in the same position. I was still getting a lot of questions about food and diet. And I was still hesitating when answering. I wasn’t sure I knew that much more after medical school than I did before. One day I mentioned this uncomfortable situation to another young doctor. “Just consult the dietitians if you have a problem,” she said after listening to my confession. “They’ll take care of it.” She paused for a moment, looked suspiciously around the nursing station, then leaned over and whispered, “I know we’re supposed to know about nutrition and diet, but none of us really does.” She was right. And nearly 20 years later, she may still be.

Research has increasingly pointed to a link between the nutritional status of Americans and the chronic diseases that plague them. Between the growing list of diet-related diseases and a burgeoning obesity epidemic, the most important public health measure for any of us to take may well be watching what we eat. But few doctors are prepared to effectively spearhead or even help in those efforts. In the mid-1980s, the National Academy of Sciences published a landmark report highlighting the lack of adequate nutrition education in medical schools; the writers recommended a minimum of 25 hours of nutrition instruction. Now, in a study published this month, it appears that even two and a half decades later a vast majority of medical schools still fail to meet the minimum recommended 25 hours of instruction.

Researchers from the University of North Carolina at Chapel Hill asked nutrition educators from more than 100 medical schools to describe the nutrition instruction offered to their students. While the researchers learned that almost all schools require exposure to nutrition, only about a quarter offered the recommended 25 hours of instruction, a decrease from six years earlier, when almost 40 percent of schools met the minimum recommendations. In addition, four schools offered nutrition optionally, and one school offered nothing at all. And while a majority of medical schools tended to intersperse lectures on nutrition in standard, required courses, like biochemistry or physiology, only a quarter of the schools managed to have a single course dedicated to the topic. “Nutrition is really a core component of modern medical practice,” said Kelly M. Adams, the lead author and a registered dietitian who is a research associate in the department of nutrition at the university. “There may be some pathologists or other kinds of doctors who don’t encounter these issues later, but many will, and they aren’t getting enough instruction while in medical school.”

Eventually, practicing physicians may even be able to earn continuing medical education credits, a requirement of many hospitals, state licensing boards and specialty boards. “It’s extremely difficult to get people to change their diets and their habits around food,” Ms. Adams said. “Anything that improves a doctor’s confidence and skill set will go a long way in helping patients. You can’t just keep writing out script after script after script of new medications when diet is just as important as drugs or any other treatment a patient may be using."

Bonnie - I applaud Dr. Chen's honesty in writing this piece. Most doctors would not admit to this, especially in a public forum. This is an issue I have harped on for decades and little has changed. While increasing the amount of nutritional education for doctors is priority number one, the second issue is to teach them the right kind of nutrition. If educators are just re-hashing the food pyramid and dietary guidelines, then it is a complete waste.

Omega-3 from GM yeast “comparable to GRAS fish oil”: DuPont study

The safety of an EPA-rich oil from genetically modified yeast is “comparable to that of GRAS fish oil”, says a new study from DuPont. Results of a 90-day rat study with eicosapentaenoic acid (EPA)-rich oil produced from GM Yarrowia lipolytica yeast produced no adverse effects at doses up to 976 mg EPA per kilogram of body weight per day, according to findings published in Regulatory Toxicology and Pharmacology.

The safety profile of EPA oil was comparable to that of GRAS fish oil. These results support the use of EPA oil produced from yeast as a safe source for use in dietary supplements.

Fears about dwindling fish stocks, however, coupled with the putative risk of pollutants from oily fish, have pushed some in academia and industry to investigate the extraction of omega-3 from alternative sources. DHA extracted from non-GM microalgae is already on the market by Martek, as is plant-source alpha-linolenic acid (ALA), a shorter chain omega-3 that is less bioavailable for humans. However, this has not stopped a widening of the search for alternatives.

One such approach has been to utilize genetic engineering of plants to produce SDA (stearidonic acid), EPA and DHA, with biotech giants Monsanto, DuPont, and BASF reporting progress. Indeed, Monsanto teamed up with Solae in 2007 to commercialize the former’s soybean variety developed specially to be rich in SDA. The oil is being commercialized by Solae under the brand name Soymega, and GRAS status (generally recognized as safe) was attained in 2009. On the other hand, BASF Plant Science, in collaboration with Rothamsted Research and the University of York in the UK, has inserted genes from micro-organisms such as Thallasiosira pseudonana into rapeseed to produce EPA-containing vegetable oil. DuPont moves forward The new study shows the progress of DuPont in this field, as it moves to establish the safety of its EPA-rich oil from yeast.

Steve - while we support the search for alternatives to fish-derived EPA/DHA, aside from microalgae (which only produces DHA), we are not supportive of any of these potential discoveries until they show efficacy and safety. Some of the players involved in this search do not have the finest track record. We know that they are only interested in creating a product which they can patent for themselves.

For something as crucial as EPA/DHA, I would like to see the WHO form cooperative of sorts, where these companies can share their research so they can collectively come up with a product that is safe, viable, environmentally-friendly, and widely attainable. They can then equally share in the profits. Ah...wishful thinking.

Glucosamine/Chondroitin useless for arthritis?

The popular supplements glucosamine and chondroitin don't do much to relieve the pain associated with hip or knee osteoarthritis (OA), according to a new analysis of 10 studies. This is not the first time that research has cast doubt on the effectiveness of these two supplements. The heavily anticipated, government-funded Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) also showed that overall they did not improve knee OA pain. A follow-up arm of this study showed that they did not do any better than placebo in slowing loss of cartilage that occurs in osteoarthritis of the knee. A smaller subset of GAIT participants with moderate-to-severe OA pain, however, did get some relief with the combined supplements. Because this group was small, researchers said the findings were preliminary and needed to be confirmed in further studies. The new analysis of 10 studies, comprising 3,803 people, reinforces the negative findings of the GAIT trial.Glucosamine, chondroitin, or their combination are no better than placebo (dummy pill) when it comes to joint pain and joint space narrowing, the new study shows. But the supplements are safe, the study researchers write. The findings appear online in BMJ.

"We see no harm in having patients continue these preparations as long as they perceive a benefit and cover the cost of treatment themselves," write the researchers, who were led by Peter Jüni of University of Bern in Switzerland. Second Opinion "The jury is in, and we have given these supplements a fair try," says David Pisetsky, MD, chief of rheumatology at Duke University Medical Center in Durham, N.C. "I don’t think there is a strong impetus for more study." Pisetsky does have a number of patients who take, and will likely continue to take, these supplements. "If you want to take them and perceive a benefit, that's fine, but tell your doctor," he says.

According to supporters, the safety of these supplements has never been doubted. You have to ask yourself, would you take a supplement containing glucosamine and chondroitin, have about two-thirds of a chance of getting significant relief, with some evidence that you can slow your disease progression, or just numb your symptoms with acetaminophen or anti-inflammatory drugs and risk ulcers, allergies, kidney or liver damage, hypertension, heart attacks and possibly death. The risk/benefit for glucosamine and chondroitin far outweighs that of the FDA-approved drugs for osteoarthritis.

Marc C. Hochberg, MD, MPH, professor of medicine and head of the division of rheumatology and clinical immunology at the University of Maryland School of Medicine in Baltimore, points out that the statistical techniques used in the new study were really not designed to be applied to groups, which may cast some doubt on the way the findings are being interpreted. "These supplements did have a very small effect," he says. "This effect was very similar or identical to what is seen with acetaminophen, which is the first line treatment of OA according to the American College of Rheumatology and other professional organizations." His advice? "If patients want to use glucosamine, then they should discuss this with their physician who may recommend a particular brand and manufacturer."

Bonnie - we have commented on this issue numerous times. Our clients only see benefits for minimizing the degradation of cartilage over time, not for treating pain unless the OA is mild. It does not do anything for moderate to severe OA pain.

Another study shows probiotics stop diarrhea

Compared to conventional rehydration therapy, probiotic administration shortened bouts of diarrhea in children, according to a randomized double-blind controlled clinical study published in a recent issue of BMC Infectious Diseases. The trial involved children aged one to 23 months who were hospitalized for acute rotovirus diarrhea. The children were randomly assigned to receive one of three treatments: oral rehydration solution plus placebo; oral rehydration plus Saccharomyces boulardii; or oral rehydration plus a probiotic combination (Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum and S. boulardii). Researchers measured the duration of diarrhea, fever, vomiting and hospitalization.

Median duration of diarrhea (58 hours) was shorter in children who received single-species product than in controls. Children on the single-species probiotic also has a shorter duration of fever compared to controls and of vomiting. The researchers concluded both products decreased the duration of diarrhea compared to oral rehydration solution alone. While the single species product reduced fever, the multiple species product cut vomiting subsequent to the initiation of treatment. They noted the “quantity of probiotic bacteria needed for optimum treatment of gastroenteritis remains to be determined, particularly when multiple species are included in the product.”