PPIs increases C. Diff diarrhea

Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea. Studies included 133,054 individuals. Overall, there was a significant increase in the risk of CDAD in patients taking PPIs. C. difficile represents an escalating threat to public health, and CDAD cost the United States an estimated $3 billion in 2005, researchers stated at the annual meeting of the American College of Gastroenterology.

Steve - I would venture to say that GI docs don't tell you about this risk before they prescribe PPIs.

If you do get diarrhea of any kind a multitude of research data shows the benefits of probiotics. According to a new review by Cochrane Collaboration, probiotic bacteria given as therapies for diarrhea reduce the length of time sufferers are affected and lessen the chance of episodes continuing for more than four days.

Probiotics may help in a variety of different ways including eliminating the bacteria, viruses or parasites responsible, for example, by competing for the same nutrients. Giving probiotics in conjunction with rehydration fluids reduced the duration of diarrhea by around a day and reduced the risk of diarrhea lasting four or more days by 59%. No serious adverse effects were reported in the trials.

Problem with painkillers during pregancy

Taking mild painkilllers such as aspirin, acetaminophen and ibuprofen during pregnancy, especially during the second trimester, can cause a sharp increase in reproductive problems in male offspring. The team found that women who used two of the drugs simultaneously during the second trimester were as much as 16 times as likely to bear a son with undescended testicles, a condition known as cryptorchidism. Cryptorchidism is known to be a risk factor for poor semen quality and testicular germ cell cancer in later life. The researchers demonstrated in rats that the drugs block the production of testosterone, which is necessary for the formation of male sex organs.

Researchers questioned 834 pregnant women in Denmark and 1,463 in Finland about their medication use, then examined their sons at birth. The Danish women received only a written questionnaire, while the Finnish women received both a written questionnaire and a phone interview. The women were more likely to say they had taken the painkillers in the phone interview, apparently not considering them to really be "medications."

The team found that women who used more than one painkiller simultaneously had a seven-fold increase in risk of having a son with cryporchidism compared with women who took nothing. The second trimester appeared to be particularly sensitive. Any painkiller use during this period doubled the risk of cryptorchidism. Ibuprofen or aspirin quadrupled the risk, while acetaminophen doubled the risk. Using more than one painkiller simultaneously led to a 16-fold increase in risk. Overall, the researchers said, the incidence of cryptorchidism in Denmark during the study was 8.5%, compared with 1.8% in a similar study in 1959 to 1961. "Moreover, this finding is in accordance with the reported decline in reproductive health in the adult male population in the last five decades," they wrote in their report in the journal Human Reproduction.

As part of the same study, other researchers found that the analgesics disrupted the production of androgenic hormones in rats, leading to an insufficient supply of the male hormone testosterone during the crucial early period of gestation when the male organs were forming. The effects were comparable to that caused by similar doses of known endocrine disruptors such as phthalates, whch are used in the manufacture of plastics like PVCs.

Bonnie - this so disheartening to read. I have been so vehemently against aspirin prescribed during pregnancy, which is such common practice. In two other studies related to pregnancy from the Am J Clin Nutr:

• The composition and development of infant gut microbiota are influenced by BMI, weight, and weight gain of mothers during pregnancy.
  
• Researchers found no association between mild caffeine intake during pregnancy and risk of preterm delivery.
  

While Warning About Fat, Govt Pushes Cheese

Steve - is this not par for the course. Ugh.

While Warning About Fat, U.S. Pushes Cheese Sales

Supplemental Calcium: Never Take Alone and Don't Overdo It.

According to a new study in the October 27th issue of British Medical Journal (BMJ), calcium supplements taken by themselves can increase the risk for myocardial infarction.

It is well known that calcium plus vitamin D supplements taken together prevent bone loss and reduce the risk for fracture in postmenopausal women and are associated with a reduction in the rate of bone mineral density loss at the spine and hip. More importantly, calcium plus vitamin D supplements reduce the overall risk for fracture by 12%. However, calcium by itself has not shown to be nearly as beneficial.

The researchers examined randomized, double-blind, placebo-controlled trials through November 2007 of elemental calcium at dosages of at least 500 mg per day. Researchers did not consider studies that combined supplements of calcium with vitamin D.

The main outcomes of the study were the time to first myocardial infarction, the time to first stroke, and the composite endpoint of myocardial infarction, stroke, or sudden death. The study included data on a total of 20,072 patients. The mean age of participants in these trials was 72 years, and 83% of subjects were women. The mean dose of calcium was slightly more than 1000 mg/day, and both calcium carbonate and calcium citrate were represented in the clinical trials.

Among trials with patient-level analysis, there were 143 and 111 myocardial infarctions among participants receiving calcium supplements and placebo, respectively. Individuals with higher dietary calcium intake appeared to be at a particularly elevated risk for myocardial infarction when taking calcium supplements. Calcium supplementation also appeared to promote a higher risk for recurrent cardiovascular events. There was no significant difference between calcium supplementation and placebo in the risks for stroke, the composite cardiovascular endpoint, or death.

The authors do discuss the major issue with their study. They only analyzed calcium supplementation without vitamin D supplements. Given that calcium supplementation appears most effective in reducing the risk for fracture when combined with vitamin D, the results of this study should not apply directly to most women receiving supplements for bone health. This is particularly salient given that a recent study found that vitamin D supplements at doses of approximately 1000 IU per day were associated with a lower risk for cardiovascular disease (whereas combination therapy with calcium plus vitamin D had no significant effect on the risk for cardiovascular outcomes).

Bonnie - if you are a client and have followed my advice, you should feel at ease because you are not taking supplemental calcium by itself. You are most likely taking a supremely absorbed calcium source along with gut-friendly magnesium and vitamin D3. Well before we started blogging about it (11/15/05, 2/16/06, 1/16/08), I warned that taking supplemental calcium by itself, as well as taking too much, was a bad idea. So the results of this study should not come as a surprise. If you have been supplementing with calcium by itself (especially in the carbonate or citrate form), then you are running the risk of rogue calcification, which can show up in the form of calcium deposits in the arteries.

If you are unsure of how much calcium, magnesium, and vitamin D you should be taking, contact your licensed health professional to individualize the amounts for your needs.

Calcium is an extremely beneficial mineral, but the requires the assistance of other vitamins and minerals to be put to beneficial use.

Coffee may slow liver disease

Drinking coffee could help slow the progression of fibrosis in patients with fatty liver disease, according to new research presented at the American Association for the Study of Liver Diseases' annual meeting. And a separate study presented at the same meeting found that patients with chronic hepatitis C who drank the most coffee and had failed standard treatment fared much better with retreatment. While the beneficial mechanism is not yet understood, these studies add to the number of beneficial studies that already existed.

Lifestyle intervention helps weight loss

Apart from bariatric surgery and pharmacotherapy, few clinical trials have evaluated the treatment of severe obesity. The objective of this study was to determine the efficacy of a weight loss and physical activity intervention on the adverse health risks of severe obesity.

The three year trial included 130 severely obese adult participants without diabetes. A one-year intensive lifestyle intervention consisting of diet and physical activity was implemented. One group (initial physical activity) was randomized to diet and physical activity for the entire 12 months; the other group (delayed physical activity) had the identical dietary intervention but with physical activity delayed for 6 months.

101 subjects completed the 12-month follow-up assessments. Although both intervention groups lost a significant amount of weight at 6 months, the initial-activity group lost significantly more weight in the first 6 months compared with the delayed-activity group. Weight loss at 12 months, however, was similar in the 2 groups. Waist circumference, visceral abdominal fat, hepatic fat content, blood pressure, and insulin resistance were all reduced in both groups. The addition of physical activity promoted greater reductions in waist circumference and hepatic fat content.

As suspected, among patients with severe obesity, a lifestyle intervention involving diet combined with initial or delayed initiation of physical activity resulted in clinically significant weight loss and favorable changes in cardiometabolic risk factors. JAMA 10/27/2010

Metagenics receives two patents

Metagenics Inc. received two new patents for its research on the anti-inflammatory properties of reduced iso-alpha acids (RIAA) derived from hops. U.S. Patent No. 7,794,757, “Modulation of Inflammation by Hops Fractions and Derivatives," was awarded for a proprietary method to reduce inflammation associated with pain using a formulation of hops derivatives that selectively inhibits the pro-inflammatory activities of the COX-2 enzyme without affecting the housekeeping activities of COX-2 (protection of the gastrointestinal lining), thus providing effective anti-inflammatory support with high degrees of predicted safety. U.S. Patent No. 7,807,203, “Anti-inflammatory Pharmaceutical Compositions for Reducing Inflammation and the Treatment or Prevention of Gastric Toxicity" was awarded for the application of a proprietary formulation of hops in preventing or treating disorders of the stomach and/or intestines that can lead to ulcers.

The discoveries were made by researchers at Metagenics’ wholly-owned biotechnology subsidiary, MetaProteomics® LLC. Inflammation is recognized as underlying factor in a wide range of chronic health conditions, including osteoarthritis, ulcers, autoimmune disease, low bone mineral densit, and metabolic syndrome. Rho iso-alpha acids derived from hops, say the researchers, modulate enzymes called kinases. Kinases perform a variety of tasks, including chemically modifying other proteins, regulating cellular pathways (particularly those involved in the transmission of signals within the cell), and regulating substances that can negatively impact health, including eicosanoids, cytokines and free radicals.

“We believe that our research opens the door to a new class of therapeutic agents that address inflammatory-related conditions at the cellular level" said Jeffrey S. Bland, Ph.D., FACN, Metagenics chief science officer and president of MetaProteomics.

Steve - contact us if you want to know what products have these ingredients included in them.

Fish oil no help to those with Alzheimer's

Daily supplements of docosahexaenoic acid (DHA) were ‘not useful’ in reducing cognitive decline associated with mild-to-moderate Alzheimer’s disease, says a new study from the Journal of the American Medical Association (JAMA). Researchers report that DHA at a dose of 2 grams per day did not affect cognitive and functional abilities after 18 months of supplementation.

The concern with this study is that it focused on supplementing DHA in individuals who were currently coping with Alzheimer’s disease. It didn’t answer the question of whether DHA—taken over long periods of time and several years prior to disease onset—could have helped prevent these participants from developing the disease. Further, the study only tested DHA under the assumption that it could be used as a treatment, which is highly unlikely given how little we know about Alzheimer’s disease.

The results echo those presented at the Alzheimer's Association 2009 International Conference on Alzheimer's Disease (ICAD 2009) in Vienna, which suggested that DHA may improve both memory function and heart health in healthy older adults, but the omega-3 had no general impact on the cognitive health of people with mild to moderate Alzheimer's.

Steve - for those with Alzheimer's, taking fish oil has myriad benefits. However, to use as a treatment to slow the decline is a bit of a stretch. Studying supplements like they do medications is the wrong approach. A study on fish oil's preventive benefits over a long period of time is what researchers should be focusing on.

One other aspect of the study that should be questioned is the subjects use of DHA derived from algae instead of fish.

Here is a study geared more to the effectiveness of fish oil: A study published in the November's Alzheimer's & Dementia: The Journal of the Alzheimer's Association suggests that taking docosahexaenoic acid (DHA) may improve memory and learning in older adults with mild cognitive impairments. A randomized, double-blind, placebo-controlled study to evaluate the effects of DHA -- the principle omega-3 fatty acid in the brain -- on improving cognitive functions in healthy older adults with age-related cognitive decline. The study found that DHA taken for six months improved memory and learning in healthy, older adults with mild memory complaints. While the MIDAS study focused on a population of healthy adults with age-associated memory impairment, a study recently published in the Journal of the American Medical Association (JAMA), conducted in a population that had previously been diagnosed with Alzheimer's disease, did not indicate DHA provided a statistically significant benefit to cognitive function. The lead author of the JAMA study also highlighted that their results may have been different had DHA been administered before the participants' disease progressed.

Babies anitibiotic use and risk of IBD

Babies treated with antibiotics for middle-ear and other infections may have increased odds of developing inflammatory bowel disease later in childhood, according a study in the American Journal of Gastroenterology. Among 36 children with either ulcerative colitis or Crohn's disease -- the two main forms of inflammatory bowel disease (IBD) -- 58 percent had been prescribed at least one course of antibiotics in the first year of life. In contrast, only 39 percent of 360 IBD-free children studied for comparison had taken antibiotics during their first year. The findings support the theory that factors affecting the early-life balance of "good" and "bad" bacteria in the intestines may contribute to IBD.

The researchers found that children with IBD were more likely to have been prescribed an antibiotic during the first year of life -- most commonly for middle-ear infections, but also for respiratory and other types of infection. Overall, antibiotic use in infancy was linked to a tripling of the risk of IBD relative to children who had no antibiotic prescriptions in their first year of life.

Pharma Execs to now face criminal charges

Courtesy of the Philadelphia Inquirer

Rats that infested a Philadelphia warehouse 40 years ago have found their way into the legal nightmares of the nation's drug companies. Frustrated that even billion-dollar fines seem to have little effect on pharmaceutical firms, the Food and Drug Administration has increasingly signaled its intent to use a legal doctrine spawned by those long-gone rodents to bring criminal charges against top executives, even those who might have been unaware of company misdeeds.

Earlier this month, Eric Blumberg, FDA litigation chief, told an industry audience that his agency was looking for cases to use what is known as the Park Doctrine as a tool to "change the corporate culture" of firms that have thus far shrugged off other penalties. In one area the FDA is targeting are companies that have illegally promoted products for unapproved uses, a practice know as off-label marketing. "I don't know when, where, or how many cases will be brought," Blumberg told a gathering of the Food and Drug Law Institute, "but if you are a corporate executive - or counsel advising such a client - I would not wait for the first case to decide now is the time to comply with the law. They won't get a mulligan on their conduct."

In an interview Thursday, Blumberg was pointed. "They need to take this seriously and find out what is going on in the marketing and sales divisions of their companies," he said of pharmaceutical executives. "In my view, one thing that will get executives' attention is a few cases in which we have convicted two-legged defendants." He singled out firms, including Pfizer Inc. and Eli Lilly & Co., that have paid multiple penalties in recent years. Eli Lilly, for instance, was hit with a $1.4 billion fine last year for illegally marketing Zyprexa, a antipsychotic drug. The same year, Pfizer was fined $2.3 billion for illegally marketing the pain reliever Bextra. Neither company's stock price suffered significantly, leading some to conclude that even massive fines are viewed by investors and executives as simply the cost of doing business. Neither firm responded to calls for comment.

"It is clear that fines are not working here," Blumberg said. "We need to put something else on the scale to make people think twice, three times, before they promote drugs for unapproved uses." That something is the threat of prison and industry debarment, which could result from a successful prosecution using the Park Doctrine. Under the Park Doctrine, a corporate officer is liable for illegal corporate actions the officer should have known about or was responsible for preventing. It stems from a case involving John Park, president of Acme Markets Inc. in 1970, when the company was cited for rodent infestations at a warehouse here. The FDA charged Park personally with violating sanitation laws after other rodent infestations were discovered despite a number of agency warnings. Park argued that as company president he was too far removed from warehouse supervision to be held responsible. The U.S. Supreme Court ultimately agreed with the FDA that Park, as president, was responsible for ensuring rodent-free warehouses. Park got off relatively easy: a $250 fine.

Prosecutors now hope to extract stiffer penalties under the doctrine, including up to a year in prison and $100,000 fines. Those are the possible punishments facing four executives of Synthes Inc., a West Chester firm that pleaded guilty early this month in connection with illegal clinical trials of a bone cement. Charged under the Park Doctrine by the U.S. Attorney's Office in Philadelphia, the executives have also pleaded guilty. The Park Doctrine can be "a very powerful tool," said Assistant U.S. Attorney John Pease, who supervises criminal prosecutions involving pharmaceutical-industry fraud cases in eastern Pennsylvania.

But it also presents prosecutors with a number of hurdles, he said. The crimes under scrutiny have a five-year statute of limitations, for instance. Often, prosecutors are not even alerted to them for several years, he said. "And with multinational pharmaceutical companies with billions in revenue, you find responsibility is very diffuse," Pease said. "The real challenge is finding a person who was in a position to know about and prevent the conduct that occurred." Scott Gottlieb, a former FDA commissioner who is now a partner with Arcoda Capital in New York, said another challenge would be assuring that an off-label case would hold up in court, particularly if it involved executives several layers above the departments that committed the illegal acts. "There are clearly cases where the management is so far removed from the activity, they have no direct knowledge of the issue," he said. "To hold them criminally liable is a significant policy step that needs to be done with great care." He agreed, however, that bringing criminal charges against executives "would be a significant deterrent."

James Prutow, a consultant to pharmaceutical companies on regulatory matters, said just the talk of charges had caught the attention of his clients. "Executives are really stepping back and asking, 'OK, how can we ensure that we are doing, both, the right thing as a company and also as individuals so we are not on the FDA's radar screen?' " Prutow, a partner with the management-consulting firm PRTM, said he expected that the FDA would bring a high-profile off-label case under the Park Doctrine sometime in the next six months. "When that happens, it really is going to wake people up," he said.

Bonnie - finally!

Bonnie's Bite: Menopause, MANopause Updates

Menopause Update
More than eight years have passed since the landmark Women’s Health Initiative study linked synthetic estrogen (Premarin) and progestin (Provera) to increased risk of heart disease and breast cancer. And, according to recent data, hormonal cancer rates have dropped precipitously as copious studies have confirmed the WHI finding. In turn, with 6,000 women embarking on “the change of life” each day, according to the North American Menopause Society, those seeking symptom relief are still steering clear of prescription hormones in favor of bioidentical and topical hormones, dietary supplements and other natural alternatives. A journal Menopause study found that 80 percent of women now use complementary and alternative medicine to lessen symptoms.

It is imperative that you are vigilant in addressing menopause because new research has shown that during this time, a sudden drop in estrogen make women more prone to heart disease and stroke. Following is a primer to help navigate what is new with menopause.

Insomnia, Mood Swings, Tender Breasts and Irregular Periods
Chaste tree berry (Vitex)
Insomnia, mood swings, tender breasts and irregular periods are often the first signs of perimenopause (the three- to 10-year period leading up to the halt of menses), and the culprit is often a dip in the calming sex hormone progesterone. The herb chaste tree berry is among the most widely used phytoprogesterones—plant compounds that mimic progesterone in the body and may indirectly help boost progesterone production.

Progesterone Cream
Low-dose bioidentical progesterone creams are also available. (Although prescription varieties contain an average of 10 percent progesterone, over-the-counter versions, by law, must contain less than 30 percent.) Unlike the synthetic Provera, bioidentical progesterone (often derived from plant sterols in wild yams or soy) has a molecular structure identical to that of the progesterone our own bodies make. Work with an expert such as myself when taking any kind of hormone.

Hot Flashes
Black Cohosh
By far the most researched herb for menopause relief. A 2010 meta-analysis showed that in six out of nine recent trials, the botanical worked better than placebo. A 2006 study of 301 women found that those who took black cohosh for 16 weeks halved their hot-flash incidences; the placebo group improved by 20 percent. Another recent trial found that black cohosh extract was as effective as low-dose prescription estrogen for the treatment of menopause-induced hot flashes, anxiety and depression.

Scientists long assumed that black cohosh was a general phytoestrogen, acting on estrogen receptors throughout the body to quell symptoms. But recent research has called that theory into question, suggesting it may instead work on the central nervous system and have no estrogenic effect on the breast or endometrium. This makes it a safer option for women with a history of breast cancer who cannot take estrogen.

Soy
In topical form, soy phytoestrogens are effective at the right dose. Soy phyoestrogen supplements are not recommended, as the data has been mixed. Consuming fermented organic soy products are recommended in moderation for a positive hormone balancing boost.

Flax
I still support ground flaxseed for their hormone balancing lignans as well as a good soluble fiber source.

Libido
Maca Root
My top recommendation for boosting libido in men and women is the Peruvian maca root. It is a powerful sex enhancer, and it has absolutely zero toxicity. As an adaptogen (or stress modulator), maca root has long been used in Peru to help the body maintain healthy hormone levels in the face of stress or illness in men (sustaining testosterone and balancing cortisol) and women (maintaining beneficial estrogens well as balancing cortisol). In a few select cases, maca can adversely affect thyroid levels.

Other Sexual Dysfunction
Pueraria Mirifica
A common cause of sexual dysfunction in menopausal women is vaginal dryness, a result of dipping estrogen levels. One possible remedy is pueraria mirifica. Also known as Thai kudzu, it contains a compound called miroestrol, which has exhibited estrogen-like effects on vaginal tissue, similar to prescription estrogen but without the side effects.

Women Over 65
Synthetic hormone replacement therapy is not recommended because it has been linked to an increase incidence od dementia when started in women 65 years and older.

Bioidentical Hormones
I have not changed my position since my last post on bioidenticals. If you did not get a chance to read this when it was published, here it is.

As a certified menopause educator, feel free to schedule a change of life appointment so that I may individualize your peri, post, or menopausal needs through dietary and lifestyle modification.

P.S. If you have tried everything and are still having menopausal symptoms, we will be starting a dietary supplement trial shortly. Please email Steve at nutrocon@aol.com if you would like to be involved.

MANopause Update
HGH
My opinion on Human growth hormone (HGH), touted for its ability to keep men virile into old age, has not changed. I am vehemently opposed to it. If taken by healthy adults it could cause a host of unhealthy side effects, including joint pain, soft tissue swelling, carpal tunnel syndrome, increased breast size in men, and a heightened risk of diabetes and pre-diabetes. Growth hormone should not be used for anti-aging purposes or virility. It can cost hundreds to thousands of dollars a month, there is no scientific evidence supporting it, and very real, potentially serious side effects may occur.

Testosterone Therapy
There are still too many unknowns. In the few studies that have been done, the reported side effects are numerous.

My one and only favorite for libido and testosterone enhancement at the moment is maca root. The other available supplemental options are too risky with regards to side effects.

Low testosterone is a clear and present issue as evidenced by an October Journal of Alzheimer's Disease study showing that serum levels of bioavailable testosterone (BT) can predict risk for Alzheimer's disease (AD) in older men. The need to find safer therapies to boost levels are an important public health issue.

In my opinion, the most effective way for men to improve their testosterone is to lower their estrogen levels. A saliva or blood test can confirm this. Eliminating dietary, environmental, and lifestyle factors that are contributing to an overabundance of estrogen is imperative. The earth is rife with xenoestrogenic chemicals in our water, food, medication, household, and place of work. Once pinpointed, they must be minimized or eliminated. One quick and easy way to assure that bad estrogens are being metabolized and excreted is to frequently consume brassica vegetables, such as broccoli, cauliflower, brussels sprouts, and bok choy. If you feel you need assistance in pinpointing the area where you may be creating an overabundant estrogenic effect, feel free to schedule an appointment.

Should Intestinal Healing Be Assessed in Treated Celiac Patients?

Response from Bret A. Lashner, MD
Professor of Medicine, Cleveland Clinic, Cleveland, Ohio

The mortality rate of patients with celiac disease is only slightly elevated compared with that of the general population. Most of the excess mortality in these patients, however, is from the increased risk for enteropathy-associated T-cell lymphoma. Because risk for lymphoma is believed to be directly related to untreated celiac disease, it would be reasonable to monitor patients with celiac disease for adherence to a gluten-free diet. Although no formal guidelines exist, ordering an annual celiac panel (tissue transglutaminase and endomysial antibodies) would be reasonable. Elevated titers of these antibodies could implicate the patient in being nonadherent to a gluten-free diet.

A recent study showed that serologic testing closely correlates with level of mucosal healing on biopsy. Because serologic testing is easier to obtain and less expensive than small-bowel biopsies, I think that serial serology measurements would be the best way to monitor patients with celiac disease. In a minority of patients, serologic measures will not improve on a gluten-free diet. These patients should be recounseled by a dietitian on the nuances of the gluten-free diet. In light of recent evidence that even foods believed to be naturally free of gluten (such as rice and millet) can be contaminated with gluten, people who believe they are following a gluten-free diet might have more gluten exposure than they realize. At this point, I do not believe that imaging studies or biopsies are necessary and are not likely to be cost-effective.

In patients whose celiac disease is truly refractory to a gluten-free diet, alternative diagnoses, such as collagenous sprue, amyloidosis, sarcoidosis, and other infiltrative diseases of the small bowel, should be ruled out with repeat biopsies and special stains, and then alternative therapies should be initiated.

If you practice emotional eating, your kids will too

Children's emotional eating is related to greater body mass index and a less-healthy diet, but little is known about the early development of this behavior. This study aimed to examine the relations between preschool children's emotional eating and parental feeding practices by using experimental manipulation of child mood and food intake in a laboratory setting.

Twenty-five 3–5-y-old children and their mothers sat together and ate a standard meal to satiety. Mothers completed questionnaires regarding their feeding practices. Children were assigned to a control or negative mood condition, and their consumption of snack foods in the absence of hunger was measured.

Children whose mothers often used food to regulate emotions ate more cookies in the absence of hunger than did children whose mothers used this feeding practice infrequently, regardless of condition. Children whose mothers often used food for emotion regulation purposes ate more chocolate in the experimental condition than in the control condition. The pattern was reversed for children of mothers who did not tend to use food for emotion regulation. There were no significant effects of maternal use of restriction, pressure to eat, and use of foods as a reward on children's snack food consumption.

Children of mothers who use food for emotion regulation consume more sweet palatable foods in the absence of hunger than do children of mothers who use this feeding practice infrequently. Emotional overeating behavior may occur in the context of negative mood in children whose mothers use food for emotion regulation purposes.

American Journal Clinical Nutrition

BPA found in dental sealants

Widely used dental sealants and tooth repair resins contain substances that degrade into the controversial chemical BPA, but dentists can use the product safely in kids if they make sure to wipe or rinse away residue after treatment, a new study concludes. Pregnant women, however, might do better to wait until after delivery, researchers report journal Pediatrics.

In January, federal Food and Drug Administration officials called for more research on the chemical, explaining that the agency had “some concern about the potential effects of BPA on the brain, behavior and prostate glands of fetuses, infants and children.”

Canada has declared bisphenol A to be a toxic chemical, prompting calls for far-reaching curbs on the industrial chemical that is used in everything from the linings of aluminum cans to coatings on electronic till receipts. It is widely used to line food and beverage containers, and a recent government report said it was present in the bodies of 91% of Canadians.

A study was published last week in the journal Fertility and Sterility found that Chinese factory workers exposed to high levels of the plastics chemical BPA had low sperm counts, according to the first human study to tie it to poor semen quality. The findings echo studies in animals and follows previous research in the same men that linked BPA exposure with sexual problems.

Diet improves sleep apnea

The aim of the study was to assess the long-term efficacy of a lifestyle intervention based on a healthy diet and physical activity in a randomized, controlled, 2-y post intervention follow-up in obese adult patients. The intervention group completed a 1-y lifestyle modification regimen that included an early 12-wk weight-reduction program with a very-low-calorie diet. The control group received routine dietary counseling. During the second year, no dietary counseling was offered. Change in the apnea-hypopnea index (AHI) was the main objective outcome variable, and changes in symptoms were used as a subjective measurement.

The mean changes in diet and lifestyle with simultaneous weight reduction in the intervention group reflected sustained improvements in findings and symptoms of Obstructive Sleep Apnea (OSA). After 2 y, the reduction in the AHI was significantly greater in the intervention group (P = 0.049).

Favorable changes achieved by a 1-y lifestyle intervention aimed at weight reduction with a healthy diet and physical activity were sustained in overweight patients with mild OSA after the termination of supervised dietary counseling.

American Journal Clinical Nutrition

Favorite Fall Soup Recipes

Shari's Chicken and White Bean Herb Soup
8 tablespoons extra-virgin olive oil, divided
2 teaspoons chopped fresh sage
2 teaspoons chopped fresh thyme
1 teaspoon chopped fresh rosemary
1/4 teaspoon sea salt or NutraSalt
1 pound skinless boneless chicken breasts, cut into 1-inch pieces
1 small onion, chopped
2 medium carrots, halved lengthwise, cut crosswise into 1/4-inch pieces
1 large celery stalk, thinly sliced
1/2 cup tomato puree
4 cups low-salt organic chicken broth
2 15-ounce cans cannellini beans, drained
1/2 cup fresh Italian parsley leaves
1 bay leaf

Directions: Heat 4 tablespoons olive oil and next 4 ingredients in small skillet over medium heat until herbs are aromatic, about 11/2 minutes. Pour herb oil into bowl; cool. Heat 2 tablespoons oil in large pot over medium heat. Sauté chicken 5 minutes. Using slotted spoon, transfer chicken to bowl. Add 2 tablespoons oil to pot. Add onion, carrots, and celery; sauté until beginning to brown, about 15 minutes. Mix in last 5 ingredients. Bring to boil. Reduce heat; simmer 15 minutes. Add chicken; simmer until cooked through, about 5 minutes. Season with salt and pepper. Ladle soup into bowls. Gently swirl 1 teaspoon herb oil into center of each. SERVES: 6-8

Minestrone Soup
6 T. olive oil 2 small leeks, white and light green stalk, sliced thin
2 medium carrots cut in medium dice
2 medium tomatoes, skinned, seeded, and diced
2 celery ribs, thinly sliced
1 ½ c. cooked or 1 can, drained and rinsed cannellini beans or Great Northern beans
2 medium potatoes cut in medium dice
6 c. water or 3 c. water & 3 c. low-sodium V-8 juice
2 medium zucchini cut in medium dice
2 T. minced parsley
4 oz. thin fresh noodles (semolina or rice)
6 T. grated parmesan or sheep romano cheese
salt to taste

Directions: Heat oil in a 6 quart Dutch oven. Add leeks, carrots, and celery to pot and cook over medium heat for 15 minutes until softened. Add tomatoes to pot. Cook over medium heat for 5 minutes. Add beans, potatoes, and water to pot; simmer, covered for 30 minutes until potatoes are just tender. Add zucchini, parsley, and noodles. Simmer for 10-12 minutes until zucchini is tender but still firm. Remove soup from heat. Stir in cheese. Taste and season with salt. SERVES: 6-8

Pumpkin Soup
½ c. green onions, chopped
½ c. white onions, chopped
2 carrots, sliced
1 T. canola oil 1 (16 oz.) canned pumpkin
5 c. vegetable broth (Imagine Foods “No Chicken” or Pacific Foods vegetable broth)
2 T. fresh parsley
½ tsp. garlic powder
½ tsp. nutmeg
½ tsp. allspice dash of Tamari Lite (wheat-free soy sauce by San-J)
dash of sea salt (optional)

Directions: Sauté onions and carrots in oil in a 4-quart pot. Add remaining ingredients and bring to a boil. Reduce heat to simmer and cook for about ½ hour. Puree soup in a blender. This soup may also be served cold. SERVES: 8

Squash and Quinoa Soup
12 oz. skinless, boneless chicken breast halves, cut into 1-inch pieces
1/3 c. finely chopped shallot or onion
2 tsp. olive or canola oil
3 c. organic reduced-sodium organic chicken broth
½ c. filtered water
½ c. apricot nectar or pineapple juice (or ½ cup more water)
1 lb. butternut squash, peeled, halved, seeded and cut into 1-inch cubes
¾ c. raw quinoa, rinsed thoroughly and drained
2 small zucchini, halved lengthwise and cut into 1-inch pieces
sea salt and ground white pepper, optional
¼ tsp. cumin

Directions: In a large saucepan, cook chicken and shallot or onion in hot oil over medium heat for 2 to 3 minutes or until shallots are tender, stirring occasionally. Carefully add broth water, oil, squash, quinoa, and cumin. Bring to boiling; reduce heat. Simmer, covered, for 5 minutes. Add zucchini. Cover and cook 10 minutes more or until squash and quinoa are tender. Season, if desired with salt, pepper, and cumin. SERVES: 6

Hyland recalls teething tablets

Following an investigation of its manufacturing facility by the U.S. Food and Drug Administration (FDA), Standard Homeopathic Co. announced that it is voluntarily pulling its popular Hyland’s Teething Tablets from all retail shelves. Although Standard Homeopathic maintains that the products are safe, the 107-year-old company said it is initiating the recall “in an abundance of caution” after the FDA identified problems in the manufacture of its Teething Tablets.

In a warning issued October 23, the FDA advised consumers not to use Hyland’s Teething Tablets and dispose of any of the product in their possession. Hyland’s Teething Tablets contain a small amount of belladonna, which can cause serious harm at larger doses. The FDA reported it had found inconsistent amounts of belladonna in the product during a laboratory analysis. The agency also said it had received reports of serious adverse events in children taking Hyland’s Teething Tablets “that are consistent with belladonna toxicity.” Hyland’s Teething Tablets is an over-the-counter homeopathic product intended to provide temporary relief of teething symptoms in infants and children.

In a statement, Standard Homeopathic said its own in-depth analysis, a comprehensive review of the company’s adverse event report log and more than 85 years of safe usage make it confident that Hyland’s Teething Tablets are safe for babies and kids. “We initiated this voluntary recall to ensure our consumers know that their families’ safety and health are our top priorities,” said Mark Phillips, PharmD, president and chief pharmacist of Standard Homeopathic Co. “We are committed to maintaining and deserving the trust they have placed in Hyland’s. We have worked for 107 years to build relationships with our consumers. We intend to preserve that tradition of trust.”

Exercise enhances bone health in children

Increasing the amount of physical activity that children get in school increases the health of their bones and might be one way of preventing hip and other fractures in adulthood, according to the American Society for Bone and Mineral Research 2010 Annual Meeting. Children who received 200 minutes per week of physical education at school showed significant increases in bone mass and improvement in bone structure, compared with children who received 60 minutes per week, and the increased intensity of exercise was not associated with more fractures.

B-12, Alzheimer's linked again

Both serum homocysteine (tHcy), an amino acid associated with vitamin B12, and holotranscobalamin (holoTC), the biologically active fraction of vitamin B12, may have a role in the development of Alzheimer's disease (AD). Among a group of elderly subjects followed up for 7 years, elevated baseline serum tHcy concentrations were independently associated with an increased risk of developing AD, whereas higher baseline holoTC values were independently related to a reduced risk for incident AD. The results were published in Neurology.

Acid Reflux Update

Bonnie -
Current Opinion in Gastroenterolgy's update on Gastroesophageal Reflux Disease (GERD) continues to push treating the symptoms with stronger meds and does not discuss getting to the root of the cause. At least they agree that GERD is not a one-size-fits all issue. "The main focus for drug development in refractory GERD patients is more potent, early and consistent acid suppression. However, due to the diverse causes of PPI failure, one therapeutic strategy may not be the solution for all patients. It is likely that individually tailored therapy will be the best management approach."

Between 10 and 40% of patients with GERD who are not responding to proton pump inhibitors (PPIs) given once daily are very common. These therapy-resistant patients have become the new face of GERD in the last decade and presently pose a significant therapeutic challenge to gastroenterologists. In addition, gastroenterologists are beginning to find polyps in the stomach, in addition to the colon, which is very disturbing. They are attributing this to chronic PPI use.

One would think that research would focus more on lifestyle changes of the dietary nature. Their evaluation of this is laughable. Of course, there is no mention of the slew of negative data that has come out within the last year regarding the myriad of issues long-term PPI use causes.

Newest Findings

• Commonly, doubling the PPI dose or switching to another PPI will be offered to patients who failed PPI once daily. Failure of such therapeutic strategies is commonly followed by transient lower esophageal sphincter relaxation reducers.
  

• During a period of only 7 years (1997–2004), there was an increase by almost 50% in the usage of at least double-dose PPI in patients with GERD. Approximately 42.1% of all patients supplemented their prescription PPIs with other antireflux therapies, including over-the-counter antacids and H2-receptor antagonists. More than 85% of the patients still experienced GERD-related symptoms. Bonnie comment - this is a staggering statistic.
  

• In the 2000 Gallup Study of Consumers' Use of Stomach Relief Products, 36% reported taking nonprescription medication in addition to a prescription medication for GERD. Of those, 56% stated that they used their prescription medication daily but still needed to supplement with nonprescription medication for breakthrough symptoms. Bonnie - the nonprescription is mostly taken without the physician's knowledge, creating a whole host of other potential issues.
  

• Recently, weakly acidic and alkaline reflux has been implicated as a cause for refractory GERD-related symptoms. The mechanism by which weakly acidic reflux causes symptoms remains poorly understood. Bonnie - what is poorly understood? Your stomach needs an acidic environment to break down food and repel bacteria. When PPIs are consistently blocking acid production, what do they think is going to happen?
  

• Inflammation of the esophageal lining is not limited to GERD: it can be found in up to 30% of asymptomatic patients, as well as in patients with esophageal candidiasis, food allergy, food intolerance, eosinophilic esophagitis, and esophageal cancer. Bonnie - food allergy, food intolerance, and candida: bingo!
  

• Evaluation for proper compliance and optimal dosing time should be the first management step in assessing patients with heartburn not responding to PPI therapy. The physician should emphasize the need to take PPIs half an hour before a meal.
  

• The benefit of lifestyle modifications in GERD patients who fail PPI treatment has yet to be elucidated. In a recent systematic review of reports on lifestyle modifications for GERD, the authors determined that only weight loss and elevation of head of the bed appear to be effective. There were insufficient data to support any of the other commonly prescribed lifestyle modifications. Nevertheless, in patients with PPI-refractory heartburn, it seems reasonable to recommend avoidance of specific lifestyle activities that appear to trigger GERD symptoms. Bonnie - reasonable? I'd say so. If you did exhaustive research on cutting out the dietary and environmental offenders, the results would render most of the drug trials irrelevant.
  

• For GERD patients on PPI twice daily who still exhibit symptoms, histamine 2 receptor antagonist (H2RA) at bedtime significantly reduced the frequency and duration of symptoms. Although no studies document any clinical correlation, the addition of H2RA at bedtime has become common practice in GERD patients who fail PPI treatment. However, patients rapidly develop tolerance (within 1 week) to the antisecretory effects of H2RAs given at bedtime. Bonnie - another off-label use where their is no sufficient data and the drug loses efficacy rather shortly.
  

• Whereas doubling the PPI dose might be considered the standard of care, there is no evidence to support any further escalation of the PPI dose for symptom control or healing of erosive esophagitis. For double-dose therapy, the PPI should be taken before breakfast and before dinner. Bonnie - in other words, they are flying blind.
  

• A recent study has suggested that a minority of GERD patients may lose PPI efficacy after 2 years of continuous treatment with one or two PPIs per day. Bonnie - many of that "minority" will stay on it for much longer than two years with awful consequences.
  

Drugs of the Future

• Transient Lower Esophageal Sphincter Relaxation Reducers
  The most promising of these agents appear to be the gamma-aminobutyric acid B (GABAB) receptor agonists and metabotropic glutamate receptor 5 (mGluR5) antagonists, which can achieve a high level of TLESR inhibition. As a potential add-on treatment for patients who failed PPI therapy, early results shows the drugs reduce the TLESR rate by 40–60%, reduces reflux episodes by 43%, increases lower esophageal sphincter basal pressure, and accelerates gastric emptying. Bonnie - however, because the drug crosses the blood–brain barrier, a variety of central nervous system-related side effects have been reported including somnolence, confusion, dizziness, lightheadedness, drowsiness, weakness, and trembling.
  

• Visceral Pain Modulators
  To date, there are no studies that have specifically evaluated visceral pain modulators in refractory GERD patients. However, given the fact that most patients who fail PPI treatment, the use of pain modulators is highly attractive. Pain modulators such as tricyclic antidepressants, trazodone (a tetracyclic antidepressants), and selective serotonin reuptake inhibitors (SSRIs) have all been shown to improve esophageal pain in patients with noncardiac chest pain. Bonnie - antidepressant side effects are well known and will limit the usage of these modulators.
  

• Botulinum Toxin Injection
  In one recent study, botulinum toxin was administered by pyloric injection to 11 patients who had refractory GERD associated with gastroparesis. There was marked improvement in GERD-related symptoms, which correlated with improvements in gastroparesis-related symptoms and in gastric-emptying as assessed by scintigraphy. The mean duration of response is approximately 5 months. Bonnie - Botox is the newest substance likely to be touted for every chronic health issue. Of course it will disperse everything in its path...it is one of the deadliest toxins on earth! But the question is, at what long-term price? nobody knows.
  

Antireflux Surgery
A recent surgical study reported that overall, 82% of patients reported that the preoperative reflux symptom completely resolved, and 94% were satisfied with the results of the surgery. In another study, at the end of 1 year follow-up after surgery, all patients reported complete heartburn relief and 86% reported resolution of the regurgitation symptom. Patients' satisfaction rate with surgery was 87%. Bonnie - when in doubt, operate (I am being facetious).

Alternative Medicine
The value of acupuncture has been evaluated in GERD patients who failed PPI once daily. When compared to doubling the PPI dose, adding acupuncture was significantly better in controlling regurgitation as well as daytime and night-time heartburn. This is the first study to suggest that alternative approaches for treating visceral pain may have a role in GERD patients with PPI-refractory heartburn. Bonnie - finally, we get to something safe!

Psychological Treatment
Patients with poor correlation of symptoms and acid reflux events display a higher level of anxiety and hysteria than those who have a close correlation between symptoms and acid-reflux. Anxiety and depression have been shown to increase GERD-related symptoms report in population-based studies. A recent study provided the first evidence that response to PPI treatment may be dependent on the level of psychological distress. Thus, it has been proposed that patients who do not respond to PPIs are more likely to have a psychological comorbidity than those who respond.

Bonnie - after reading this, please at least explore dietary and lifestyle modification. You can see the viscous cycle that sets up for you if you do not.