Friday, January 30, 2015

Could Nutrients in Fish Shield Fetus from Mercury’s Harms?

Three decades of research in the Seychelles, the islands in the Indian Ocean, found no developmental problems in children born to women who consume ocean fish at a much higher rate than the average American woman, a recent study concluded.

“They eat a lot of fish, historically about 12 fish meals a week, and their mercury exposure from fish is about 10 times higher than that of average Americans,” said study co-author Edwin van Wijngaarden, an associate professor in the University of Rochester’s department of Public Health Sciences in Rochester, N.Y. “We have not found any association between these exposures to mercury and developmental outcomes.”

The omega 3 fatty acids found in fish oil may protect the brain from the potential toxic effects of mercury, the researchers suggested.

They found mercury-related developmental problems only in the children of women who had low omega 3 levels but high levels of omega 6 fatty acids, which are associated with meats and cooking oils, van Wijngaarden said.
“The fish oil is tripping up the mercury.” He said. “Somehow, they are interacting with each other. We found benefits of omega 3s on language development and communications skills.”

The new findings come amid a reassessment regarding the risks and rewards of eating fish during pregnancy.

High levels of mercury exposure can cause developmental problems in children, the researchers noted. Because all ocean fish contain trace amounts of mercury, health experts for decades have advised expecting mothers to limit their fish consumption.

Wednesday, January 28, 2015

Wisdom Wednesday: The Knee

In athletes, knee injuries are second in frequency only to ankle injuries. So most of us damage our knees during adolescence. Unfortunately, proper care and rehabilitation is not generally performed as we seem to heal pretty quickly and are soon running around again. Of course, this comes back to haunt us latter on in life.

Knee replacement surgery was the 14th most common inpatient procedure in 2009. More than 4.5 million Americans are currently living with at least one total knee replacement (TKR). Over 650,000 knee replacements occurred in 2010.

Osteoarthritis is to blame for 96% of TKR. The conventional understanding of osteoarthritis is that constant wear and tear of the joint from micro trauma, or serious trauma damages the bone and it slowly breaks down. More recently, a theory has evolved that proposes that the trauma actually damages the blood supply to the bone and that it is the loss of blood supply that creates the osteoarthritis. While this seems to be merely semantics, this new theory opens the door for nutritional therapies to prevent and restore damaged bones and joints.

Several studies have found that the less invasive arthroscopic knee surgery has no better outcome than sham surgery. The first study, published in 2002 involved 180 participants randomly assigned to either have the real operation or sham surgery. The sham surgery involved cutting the knee to “fake” the surgery so the patient was unaware that no real surgical procedure had been performed. This multi-center, double blind controlled trial showed arthroscopic surgery had no benefits over sham surgery. In 2008, a Canadian study showed physical therapy alone to be as effective as surgery for osteoarthritis of the knee. The latest study in 2013, found no additional benefit from arthroscopic surgery over physical therapy for meniscal tears.

Monday, January 26, 2015

Can Coffee Protect You From Melanoma?

Coffee drinkers are less likely to suffer from malignant melanoma, and their risk decreases somewhat with every cup they swallow, according to findings published January 20th in the Journal of the National Cancer Institute.

“We found that four or more cups of coffee per day was associated with about a 20% reduced risk of malignant melanoma,” said lead author Erikka Loftfield, a doctoral student at Yale University School of Public Health who is completing her dissertation work at the U.S. National Cancer Institute.

Previous research has shown that coffee drinking could protect against less deadly forms of skin cancer, apparently by mitigating the damage to skin cells caused by the sun’s ultraviolet rays, the researchers said in background notes.

They decided to see if this protection extended to melanoma, the leading cause of skin cancer death in the United States and the 5th most common cancer. In 2013, there were an estimated 77,000 new cases of melanoma and about 9,500 deaths from the cancer, according to the study.

They found that people who drank the most coffee every day enjoyed a lower risk of melanoma, compared with those who drank little or no coffee. There was also a trend toward more protection with higher intake. People who drank one to three cups a day had about a 10% decreased risk of melanoma compared with those who drank none at all, while those who drank four or more cups had a 20% decreased risk.

The study only uncovered an association between coffee consumption and melanoma risk; it didn’t prove a cause-and-effect relationship.

Friday, January 23, 2015

Only 23 Percent Protection from This Year’s Flu Vaccine

A new study finds the current vaccine reduces your risk of needing medical care because of flu by only 23%.

Most years, flu vaccine effectiveness ranges from 10 to 60% reported the U.S. Centers for Disease Control and Prevention (CDC).

Despite the reduced effectiveness of this season’s flu shot, “vaccination is still important,” said lead report author Brendan Flannery, an epidemiologist with the CDC. “But there are ways of treating and preventing flu that are especially important this season,” he added.

These include early treatment with antiviral drugs and preventing the spread of flu by washing hand and covering coughs, he said.

Twenty-three percent effectiveness means that there is some benefit – a little less flu in the vaccinated group. Flu is usually more common among unvaccinated Americans, Flannery said, “but this year there is a lot of influenza both in people who are vaccinated and in people who are unvaccinated.”

The findings are published in the January 16th issue of the Morbidity and Mortality Weekly Report.
In flu seasons when the vaccine is well matched to the circulating H3N2 strains, effectiveness has been between 50-60%, the CDC said. This year, however, about 70% of the H3N2 virus seen has been different from the H3N2 strains in the vaccine, which explains its reduced effectiveness, Flannery said.

This year’s shot is most effective – 26% - for children 6 months old through 17 years. Older people get less benefit – just 12% of those 18 to 49 years and 14% for those 50 and older, the CDC said.

Wednesday, January 21, 2015

Wisdom Wednesday: Red Yeast Rice

About once a month a patient will tell me their primary care physician recommended red yeast rice because their cholesterol is high. It was bad enough when I just had to counsel patients against the use of this dangerous supplement. Now I have to convince them that their doctor gave them bad advice.

Red yeast rice (RYR) is made from yeast (Monascuspurpureus) grown on rice. It is a dietary staple in some Asian countries. Processed red yeast rice supplements include red yeast rice extract (RYRE), which is any extract of red yeast rice, and Xuezhikang, an alcohol extract of red yeast rice.

RYR contains several compounds known as monacolins, which block the production of cholesterol. One of these, monacolin K, has the same structure as the drugs lovastatin and mevinolin. Studies suggest that RYR use may lead to a 10-33% reduction in low-density lipoprotein (LDL, or “bad”) cholesterol.

While that all sounds good, physicians should not be recommended this supplement, nor should anyone take it.

There are several problems with this supplement:

The first issue is dosage. There is no standardized amount of monacolins or lovastatin in these products. One tablet may contain as much as 20mg of lovastatin (twice the recommended starting dose to lower cholesterol) and the next tablet may contain little or none of the active compounds. If the supplement company standardizes the active compounds, like the manufacturer Pharmanex did with Cholestin, the FDA ruled that should be considered a drug not a dietary supplement. The U.S. District Court followed suit and ruled that Cholestin is an unapproved drug and it was removed from the U.S. market.

The second issue is potential toxicity and death from citrinic acid. Again, the levels of this toxic chemical vary from tablet to tablet and brand to brand.

Monday, January 19, 2015

Exercise, Diet May Be Key to Beating a Common Irregular Heartbeat

Atrial fibrillation (AF) is a potentially dangerous form of irregular heartbeat for older Americans.

However, a new study suggests health changes in eating and exercise habits can help ease the condition.

According to the Australian researchers, AF is the most common cause of irregular heartbeat, and it’s been linked to a heightened risk for dementia, stroke and death.

The new study included more than 149 people who had undergone a procedure called catheter ablation to treat the condition. In this procedure, the tissue surrounding the problem area in the heart is burned.

In addition, 61 of the patients also took part in an aggressive “risk factor management" program after they underwent catheter ablation. The program was designed to reduce lifestyle risk factors such as being overweight, having high blood pressure, high cholesterol or high blood sugar levels, sleep breathing problems (such as sleep apnea), and smoking and drinking.

After five years, patients who managed these lifestyle factors were five times more likely to be alive and to be free of heart rhythm problems such as AF than those who hadn’t gotten healthier – 87% versus 18%.

“This is a very important finding because it shows the huge gap between what happens when patients are able to manage the underlying risks of their health and those who rely solely on medical intervention,” lead author Dr. Rajeev Pathak, a cardiologist and electrophysiology fellow at the University of Adelaide in Australia, said in a university news release.

Friday, January 16, 2015

Random Mutations Responsible for About Two-Thirds of Cancer Risk

Although about one-third of cancers can be linked to environmental factors or inherited genes, new research suggests the remaining two-thirds may be caused by random mutations.

The new study was published January 1 in Science.

These mutations take place when stem cells divide, according to the study by researchers at Johns Hopkins Kimmel Cancer Center. Stem cells regenerate and replace cells that die off. If stem cells make random mistakes and mutate during this cell division, cancer can develop. The more of these mistakes that happen, the greater a person’s risk that cells will grow out of control and develop into cancer, the study authors explained in a Hopkins news release.

Although unhealthy lifestyle choices, such as smoking, are a contributing factor, the researchers concluded that the “bad luck” of random mutations plays a key role in the development of many form of cancer.

“All cancers are caused by a combination of bad luck, the environment and heredity, and we’ve created a model that may help quantify how much of these three factors contribute to cancer development,” said Dr. Bert Vogelstein, professor of oncology at the Johns Hopkins University School of Medicine.

Cristian Tomasetti is a biomathematician and assistant professor of oncology at the Johns Hopkins University School of Medicine and Bloomberg School of Public Health. “If two-thirds of cancer incidence across tissues is explained by random DNA mutations that occur when stem cells divide, then changing our lifestyle and habits will be a huge help in preventing certain cancers, but this may not be as effective for a variety of others,” Tomasetti suggested.

Wednesday, January 14, 2015

Wisdom Wednesday: The Shoulder

Shoulder pain is a very common clinical complaint, second only to low back pain in frequency. Research indicates that most of us tear our rotator cuff (the group of muscles that support the shoulder joint) sometime in our lives and most of us actually forget the injury.

I guess I’m not like most people because I vividly remember tearing both my right and left rotator cuff even though the first injury was 45 years ago.

The shoulder joint is very complex. It is a little like the hip joint but is designed with much greater range of motion but can’t tolerate constant weight bearing. There are no ligaments in the joint proper. Ligaments attach bone-to-bone. So the head of the humerus (upper arm) is suspended from the glenoid fossa (shoulder socket) by a series of tendons attached to the rotator cuff muscles.

Think of the humerus as the gondola on a hot air balloon. As long as all the cables (tendons and muscles) are even in strength and tension, the balloon sits level. However, shorten or break even one of those cables and the gondola will lurch to one side. When the humerus is riding unevenly in the socket, inflammation and subsequent degeneration occur.

To complicate matters, when the shoulder is lifted above level, the clavicle (collar bone) and scapula (wing bone) both elevate to change the shape of the joint allowing even greater range of motion.

The four rotator cuff muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. Each one acts to strengthen and facilitate motion in the shoulder but all have their unique evaluation and treatment issues.

Monday, January 12, 2015

Many Consumers Misled About Bogus Weight-Loss Supplements

Think a pill you saw advertised on the internet can miraculously help you shed unwanted pounds? You’re not alone.

A new Consumer Reports survey finds many Americans are misinformed about the quality and effectiveness of these supplements.

“The barrage of advertising leads us to think there’s a magic way to melt away 10 pounds – even when we have no evidence that supplements work,” Dr. Pieter Cohen, a physician at Harvard Medical School who studies supplements, said in a Consumer Reports news release.

“The labels on weight loss supplements look like those on over-the-counter medications, and the supplement facts are organized like nutrition facts labels,” he added. “There’s no way for consumers to tell the difference.”

So it’s not surprising that the new survey of nearly 3,000 Americans found that about 20% of respondents were misinformed, believing, erroneously, that the U.S. Food and Drug Administration guarantees the safety and effectiveness of weight-loss supplements.

More than a quarter of respondents to the survey said they had tried a weight-loss product in the past, and believed the product was safe and would help them lose more weight than other methods.

About 25% also believed the products have fewer side effects than over-the-counter or prescription medications. But the same survey suggests that’s just not true. About half of those polled who said they had tried a weight-loss supplement said they also developed at least one symptom such as rapid heart rate, jitteriness, constipation/diarrhea, or dry mouth.

Cohen said, “Of all dietary supplements, the ones for weight loss seem to cause the most harm – sometimes liver failure and even death.”

The survey showed that more than one-third of those taking weight-loss supplements were also taking a prescription medication for another condition. Many people taking weight-loss supplements don’t inform their doctor, and that could raise the risk for drug-drug interactions and potentially serious complications.

“These products can interact with prescription medications, but consumers often feel that supplements are different from prescription drugs, and doctors don’t ask about them,” said Cohen.

Friday, January 9, 2015

U.S. Bicyclist Deaths on the Rise

The number of bicyclist fatalities in the United States is increasing particularly among adults in major cities, a recent study shows.

After decreasing from 1975 to 2010, the number of bicyclists killed annually increased by 16% from 2010 to 2012. More than 700 bicyclists died on U.S. Roads in 2012, according to the Governors Highway Safety Association.
The study also reported that the percentage of these deaths that occur in densely populated urban areas has risen from 50% in 1975 to 69% in 2012.

“We’ve seen a gradual tread over time where more adults are bicycling in cities, so we need cites to develop ways for cyclists and motorists to share the road,” said report author Allan Williams, former chief scientist at the Insurance Institute for Highway Safety.

But the report also pointed out that many of the deaths were potentially preventable. Two-thirds of the deaths occurred in people who weren’t wearing a helmet, the researchers found. And, in 2012, almost 30% of the deaths were in people who had a blood alcohol content level above the legal driving limit of 0.08%.

One of the biggest shifts in cycling deaths was the average age of the victims. Eighty-four percent of bicycle deaths were adults in 2012. That compares to just 21% in 1975, according to the study. Overall, adult males accounted for 74% of the bicyclists killed in 2012.

The new research also found that states with high populations and multiple cities accounted for the majority of bicycle fatalities. Between 2010 and 2012, California, Florida, New York and Texas had nearly half of the country’s total bicyclist fatalities.

Wednesday, January 7, 2015

Wisdom Wednesday: TMJ Syndrome

Temporomandibular joint (TMJ) syndrome is typically characterized as pain in the jaw joint. Conventional medicine considers the syndrome a biomechanical issue caused by trauma. Often grinding or clenching the teeth is blamed.

There are a variety of treatments – night guards, filing of the teeth, orthodontics, and even surgical intervention. Over 40 symptoms are associated with TMJ syndrome including headaches, radiating pain in the neck and shoulder, and tinnitus (ringing in the ears).

Applied Kinesiology (AK) evaluates the TMJ as a cranial fault – a subtle misalignment between the mandible (lower jaw bone) and the cranial bones that make up the socket that articulates with the mandible. Muscle testing pinpoints the mechanical flaw, then cranial manipulation is performed in rhythm with breathing to restore normal movement of the cranial bones involved. This is very similar to Cranial Sacral Therapy, an osteopathic technique now practiced by very well trained massage therapists.

Balancing the strength of the supporting muscles of mastication (chewing muscles) is also important. If a muscle imbalance remains, the TMJ syndrome will quickly return.

Over the course of 38 years of practice, I have treated a number of TMJ syndrome cases successfully. However, many of the cases would recur within a matter of weeks or months. Even collaboration with dentists specializing in TMJ syndrome often met with limited or temporary success.

Implementing Quintessential Applications (QA) in my practice radically changed the way in which I evaluate and treat TMJ syndrome. QA creates a flow chart for step-by-step evaluation using AK procedures. Please review any of the Wisdom Wednesday blogs written during the first quarter of 2014 on the steps in QA.

Monday, January 5, 2015

Weight Training Key to Battling Belly Fat as You Age

Researchers from the Harvard School of Public Health found that combining aerobic activities with weight, or resistance training is key to preserving muscle and avoiding weight gain, particularly age-related belly fat.

“Because aging is associated with sarcopenia, the loss of skeletal muscle mass, relying on body weight alone is insufficient for the study of healthy aging,” study author Rania Mekary, a researcher at Harvard’s department of nutrition, said in a university news release.

Measuring waist circumference is a better indicator of healthy body composition among older adults,” Mekary explained. “Engaging in resistance training or, ideally, combining it with aerobic exercise could help older adults lessen abdominal fat while increasing or preserving muscle mass.”

The long-term study was conducted between 1996 and 2008. It included more than 10,000 healthy men aged 40 or older whole body mass indexes (BMI) varied widely. BMI measures body fat by looking at weight and height.
The researchers analyzed the men’s physical activity, weight and waist circumference to determine which exercises had the most significant effect on the men’s waistlines, or the amount of belly fat they had.

The men who did 20 minutes of weight training daily had a smaller increase in belly fat than the men who spent the same amount of time engaging in moderate to vigorous aerobic activities, such as stair climbing and yard work, the study, published online December 22nd in the journal Obesity, found.

Meanwhile, the men who became more sedentary over the course of the 12-Year study had a larger increase in body fat.

“This study underscores the importance of weight training in reducing abdominal obesity, especially among the elderly,” study senior author Frank Hu, a professor of nutrition and epidemiology, said in the Harvard news release. “To maintain a healthy weight and waistline, it is critical to incorporate weight training with aerobic exercise.”

Friday, January 2, 2015

‘Tis the Season for Seasonal Affective Disorder

Seasonal affective disorder (SAD) is a type of depression that occurs in some people due to decreased amounts of daylight during the winter.

SAD is triggered by disrupting the body’s internal clock, causing a drop in levels of a mood-affecting chemical called serotonin, or by altering levels of melatonin, which plays a role in sleep patterns and mood, researchers say.

“The most important take-home message is that people who experience seasonal affective disorder should not suffer in silence. SAD – like other types of depression – is treatable, and people who experience symptoms should seek help,” Dr. Jeffrey Borenstein, president for the Brain & Behavior Research Foundation, said in a foundation news release.

Symptoms of SAD may include: feeling depressed most of the day, nearly every day; feeling hopeless or worthless; low energy levels; loss of interest in activities you once enjoyed; sleep problems; appetite or weight changes; feeling sluggish or agitated; difficulty concentrating; and frequent thoughts of death or suicide, Borenstein said.

Treatments for SAD include light therapy, counseling and medications. Keeping your home or workplace as sunny and bright as you can may help. It also helps to spend more time outdoors, and to get regular exercise Borenstein said.

My Take:
I suffered from SAD my first semester at the University of Michigan. Ann Arbor, Michigan sits in a little valley and is generally covered by dark grey clouds for months on end during the winter. I literally did not see the sun for two months. After living in sunny South Florida, I knew what was wrong with me although the disorder had not yet been identified. I transferred to the University of South Florida and solved my depression.
I agree with most of Dr. Borenstein’s recommendations, just not the medication. Medications are considered efficacious if they work at least 50% of the time. Antidepressants work, at best one-third of the time. Medication is not a viable therapy for SAD.

I recommend chaste tree if sleep disorder is one of the symptoms. Please review my blog on chaste tree posted Wednesday, August 20, 2014. Chaste tree increases the body’s own production of melatonin, regulating sleep cycles and hormone levels.

Vitamin D can also be very helpful. The hormone (yes, it’s a hormone, not a vitamin) is manufactured in the skin when exposed to sunlight. Even in South Florida, vitamin D deficiency is common as we hide from the sun and use sunscreen daily. Please review my blog “Taking Vitamin D May Be Losing Its Shine” posted on Thursday, December 14. 2013. That was one of my earliest blogs. I recommend all my patients have their vitamin D levels checked once a year.

Personally, I play tennis in the early morning virtually every weekend. I do not apply any sunscreen and I’m out there for close to two hours. Despite my fair Irish skin, the early morning sun does not create any sunburn. I also run the beach just after sunrise once or twice a week wearing only a pair of shorts. (I love the feel of running barefoot at the water’s edge) Theoretically, just 15 minutes of nude sunbathing per day produces enough vitamin D for the body. If you get caught following that recommendation, don’t blame my blog.

The Bottom Line:
SAD is a real and significant issue. However, it is easily treated with simple supplementation and lifestyle changes. Have your vitamin D level checked and see where you stand.

Source: National Institutes of Health –Monday, December 29, 2014