Wednesday, April 29, 2015

Wisdom Wednesday: Supplement Quality Issues

Over the past few weeks the media has been reporting on vitamin supplement quality issues. Some studies indicate as much as 80% of OTC (over the counter) supplements do not contain the vitamins, minerals and herbs listed on the label.

To those of us in the field of nutrition, this is old news. It is very difficult to find good quality supplements in the United States. This is because the FDA (Food and Drug Administration) classifies supplements as food; therefore they are only subject to food quality standards.

Food quality standards address what should not be in food, not the ingredients themselves. It limits, but does not prohibit cockroach parts and rat feces. As a consumer, you are left to proper identify the food on your own. The concept is that most of know the difference between cauliflower and broccoli, even if we are color blind. However, that premise fails when faced with a tablet, powder, or any other processed supplement.

Europe has established very strict standards for supplements. Although these standards are voluntary, the European nutritional companies are quite diligent in meeting these standards.

Monday, April 27, 2015

Bone-Building Drug Strengthened Hips, Spines of Frail Women in Study

Frail, older women may only need a single dose of the osteoporosis drug Reclast to build bone strength, a new study suggests.

But greater bone density did not translate into fewer fractures among these high-risk women, who were living in nursing homes and assisted living facilities during the study, the researchers added.

“Two surprising findings emerged,” said study author Dr. Susan Greenspan, a professor of medicine at the University of Pittsburg.

The drug improved bone strength in the very old and frail as well as it did in younger and more robust seniors, but there was no association between increasing bone density and reducing fractures, she said.

“We first wanted to see if frail elders could even tolerate such treatment and whether it would improve bone density. However, we had expected to see a positive trend of fewer fractures. But if anything, there were more fractures in the treatment group,” Greenspan said, although “that could well be just a chance finding.”

The study was published online April 13 in the journal JAMA Internal Medicine.

Fracture in the elderly occur not only because the bones are weak, but also because people in this group are prone to falls writes Dr. Robert Lindsay, chief of the Osteoporosis Center at Helen Hayes Hospital in West Haverstraw, N.Y. in an accompanying editorial. “Both risks are high in this population. The study tells us that treating one side of the equation, bad bones, can only do so much when the risk of injury is high, because the patients studied were quite frail.”

Friday, April 24, 2015

Inhaled Measles Vaccine Falls Short of Injected Version in Study

A comparison of injected and inhaled measles vaccines in Indian infants found the injected version provoked a much stronger immune system response, researchers report.

International scientists split a group of 2,000 babies between the ages of 9 and 12 months into two equal groups, giving them a single dose of either injected or inhaled measles vaccine. While none of the children contracted measles, blood tests showed significantly more antibodies against the virus in children injected.

“This was a study of the delivery mechanism more than the vaccine, and I think it says that giving it by shot is better than the inhaled version,” said Dr. Kenneth Bromberg, director of the Vaccine Research Center at The Brooklyn Hospital Center in New York City.

“Whatever advantages there were to the inhaled vaccine are negated by the [children’s] immune response to the injected version,” added Bromberg, who wasn’t involved in the research.

The study is published in the April 16 issue of the New England Journal of Medicine.

Led by physicians at the World Health Organization, the new study tracked the babies receiving inhaled or injected measles vaccines for about three months post-immunization. Blood tests showed antibodies for measles in about 85% in the inhaled vaccine group, compared with nearly 95% of the injected group.

Wednesday, April 22, 2015

Wisdom Wednesday: Betafood

No, not the fish food. Betafood is a product manufactured by Standard Process. It is nothing more than organic beets.

Red beets contain betalain pigments, such as betanin and betacyanin. That is what gives the characteristic red color.

Taken daily, betanin will thin the bile that is released from the gallbladder to emulsify fats in the diet. When the food bolus leaves the stomach and enters the small intestine it is slightly acidic (unless you take a proton pump inhibitor like Nexium). The small intestine is slightly alkaline when empty. As the food drops into the small intestine, the pH drops and temporarily becomes acidic. This signals the gallbladder to contract and expel bile.

The bile runs along the common bile duct. As it passes the pancreatic duct it triggers the release of pancreatic enzymes that digest the fats, carbohydrates, and proteins. Together, all these digestive chemicals are then dumped into the small intestine.

As we age, the bile typically thickens, becoming sluggish and the flow decreases. This is a significant impairment to digestion. The amount of bile released from the gallbladder can also decrease (decreased ejection fraction). This often leads to a gallbladder attack and subsequent surgery to remove the gallbladder.

Of course, without adequate HCl to lower the pH of the food bolus, there is no trigger for the gallbladder and subsequently no trigger for the pancreatic enzymes either. This is why proton pump inhibitors create malabsorption syndromes like vitamin B12 deficient anemia and osteoporosis.

Clinically, I recommend Betafood daily in my practice. The lowest ejection fraction I have documented is 3% and we raised it to 80% in 3 months by having the patient take one tablet of Betafood with each meal.

Monday, April 20, 2015

Ritual, Not Science, Keeps the Annual Physical Alive

Ninety-two percent of Americans say it is important to get an annual head-to-toe physical exam, according to a Kaiser Family Foundation poll and 62% of those polled said they went to the doctor every year for their exam.

But the evidence is not on their side. “I would argue that we should move forward with the elimination of the annual physical,” say Dr. Ateev Mehrotra, a primary care physician and a professor of health policy at Harvard Medical School.

Mehrotra says patients should really only go to the doctor if something is wrong, or if it’s time to have an important preventive test like a colonoscopy. He realizes popular opinion is against this view. “When I, as a doctor, say I do not advocate for the annual physical, I feel like I’m attacking moms and apple pie,” Mehrotra says. “It seems so intuitive and straight forward, and [it’s] something that’s been part of medicine for such a long time.”

But he says randomized trails going back to the 1980s just don’t support it.

The Society for General Internal Medicine even put annual physicals on a list of things doctors should avoid for healthy adults. One problem, Mehrotra says, is the cost. Each visit usually costs insurers just $150, but that adds up fast.

“We estimate that it’s about $10 billion a year, which is more than how much we spend as a society on breast cancer care,” Mehrotra say. “It’s all a lot of money.”

Friday, April 17, 2015

Fit at 50? Cardiac Arrest During Exercise Unlikely

Physically active middle-aged men and women have little chance of suffering cardiac arrest while playing sports, a new study suggests.

Researchers reviewed more than 1,200 cases of sudden cardiac arrest among adults aged 35 to 65. They found only 5% of attacks occurred during sports activity such as jogging or bicycling.

And the outcome for those patients was positive, the researchers said.

“When you take a closer look at those who have a sports-related cardiac arrest, they were more likely to survive than those whose cardiac arrest was not sports-related,” said lead researchers Dr. Sumeet Chugh, associate director of genomic cardiology at Cedars-Sinai Heart Institute in Los Angeles.

“Overall, the news is good. The risk of dying suddenly if you participate in sports is quite low,” Chugh said.
However, if you have a known heart problem, any heart symptoms or are a “total couch potato”, you might want to see your doctor before starting any significant sports activity, he added.

For the report, published April 6 in the journal Circulation, Chugh’s team reviewed almost 1,250 cases of sudden cardiac arrest among middle-aged adults from the Oregon Sudden Unexpected Death Study. Patient’s average age was 51.

Of the 5% of cases suffered during exercise, more than one-quarter took place while jogging. Basketball and cycling accounted for fewer than one in five sports-related cardiac arrests, the study found.

Wednesday, April 15, 2015

Wisdom Wednesday: Genetic Nutrition and Fitness Assessment

Genetic testing for a variety of metabolic issues has been available for quite some time. However, until recently the cost was prohibitive. Over the course of the past two years competition and technical advancements have driven the price of testing down to a very practical level.

Today you can test 28 different genetic snippets for $250. These genetic variations relate to cardiovascular fitness, glucose balance, salt sensitivity, triglyceride clearance, cholesterol metabolism, collagen formation and bone structure, aerobic capacity, detoxification, inflammatory response, vascular flow, B vitamin metabolism, and antioxidant function.

For example, the gene MTHFR codes for methylenetetrahydrofolate reductase which converts folic acid (folate) in food to 5-MTHF, the biologically active form of folic acid in the body. Eight percent of the population has inherited altered snippets (SNP’s) from both parents and are unable to convert folic acid in the small intestine. These patients will be anemic unless supplementation with 5-MTHF is added to the diet.

Monday, April 13, 2015

Could Fish Oil Interfere With Cancer Care?

Fish oil supplements, and even certain fish, may hinder the effectiveness of cancer-fighting chemotherapy, a new study suggests.

Dutch researchers found herring, mackerel and three other fish oils increased blood levels of the fatty acid called 16.4(n3) in cancer patients. Experiments in mice have suggested this fatty acid makes cancer cells resistant to chemotherapy, the researchers said. But, it’s not certain that what was found to happen in mice would happen with human cancer patients.

Experts noted that research on whether fish oil hurts or helps cancer patients has produced mixed results.
“Dietary supplements are not necessarily benign,” said Dwight Kloth, director of pharmacy at Fox Chase Cancer Center in Philadelphia, who had no role in the new study. “There are numerous cases in the literature where nutritional supplements and herbal drugs have had deleterious interactions with chemotherapy.”

Many patients begin taking supplements after they receive a cancer diagnosis, but concern is growing that supplements might interfere with anti-cancer treatments, according to background information with the study.

“Our research shows that when you affect the membrane of cancer cells by altering the fats in the outer covering of the cell, you can make the membrane stiffer or more fluid,” explained Christine Mets, director of the Laboratory of Medicinal Biochemistry at the Feinstein Institute for Medical Research in Manhasset, N.Y.

“These fats can make it more difficult for chemotherapy to enter the cell or make the cell better at pushing the chemotherapy out of the cell,” added Metz, who wasn’t involved in the study.

The study authors and other experts said the new report, published April 2 in the journal JAMA Oncology, doesn’t prove that fish oil blunts chemotherapy’s effects in humans.

“Taken together, our findings are in line with a growing awareness of the biological activity of various fatty acids and their receptors and raise concern about the simultaneous use of chemotherapy and fish oil,” the researchers wrote.

“Until further data become available, we advise patients to temporarily avoid fish oil from the day before chemotherapy until the day thereafter,” the researchers added.

Friday, April 10, 2015

Migraine, Carpal Tunnel May Be Linked

Carpal tunnel syndrome appears to increase risk for migraine headaches, and migraines may make it more likely that you’ll also have carpal tunnel syndrome, new research suggests.

The study is the first to find a link between carpal tunnel syndrome and migraine, but the connection is unclear, said Dr. Huay-Zong Law and colleagues of University of Texas Southwestern Medical Center at Dallas. The two conditions may share some “common systemic or neurologic risk factor,” they wrote.

The researchers analyzed data from nearly 26,000 Americans who took part in a health survey. About 16% said they’d suffered a migraine within the past three months, and nearly 4% had carpal tunnel syndrome within the past year.

Symptoms of carpal tunnel syndrome include hand numbness and weakness, caused by pressure on the median nerve in the wrist, the researchers noted. Migraines are recurring attacks that often involve throbbing headache, sensitivity to light and sound, nausea and vomiting.

Thirty-four percent of people with carpal tunnel syndrome had migraines, compared with 16% of those without the nerve disorder. After adjusting for other factors, the researchers concluded that the risk of migraine was 2.6 times higher in people with carpal tunnel syndrome.

Similarly, more than twice as many people with migraines had carpal tunnel syndrome – 8% versus 3% of those without migraines. After adjusting for other factors, the risk of carpal tunnel syndrome was 2.7 times higher among migraine sufferers, according to the authors of the study published March 23 in the journal Plastic and Reconstructive Surgery.
The findings may help “inform” the debate over the use of nerve decompression surgery to treat migraine, the researchers said.

Wednesday, April 8, 2015

Wisdom Wednesday: Studies of Questionable Value

This is just a sample of the studies I found on Pub Med over the course of the past two months. Pub Med posts research papers daily from around the world. It is the source for peer reviewed medical research. These are all studies that were funded within the scientific community. I limited myself to just a brief comment on each study. Please read and enjoy:

  • “Most HIV Infections Come From Undiagnosed or Untested People” – One would hope that only a small percentage of cases are from people transmitting this horrible disease intentionally.
  • “2 of 3 Smokers will Die Early If They Don’t Quit” - How long has the general public been aware of this simple fact?
  • “Risk of Violent Crime Rises with Depression, Study Finds” – I thought only happy people committed crimes.
  • “CDC Says Influenza Vaccine Only 18% Effective This Year” – That was in February, the most recent study dropped it to 13%, but medical authorities are still urging everyone to get their flu shot.
  • “Poor Response to Statins May Mean Clogged Arteries – About 1 in 5 patients taking cholesterol lowering drugs doesn’t benefit, research finds” – When is the American Cardiology Association going to admit that the research never supported high cholesterol as the cause of coronary artery disease?
  • “Rear End Takes a Front Seat in Plastic Surgery Offices – Butt implants also drove up the overall number of cosmetic procedures” – This has become the emphasis for health care in the U.S. It’s not how healthy you are, but how good you look.
  • “Decrease in Air Pollution Tied to Healthier Lungs in Children – Long term LA area study find kid’s lungs develop better with less smog” – As with most of the studies, this one really proves the obvious.
  • “Physical Labor, Hypertension and Multiple Meds May Reduce male Fertility” – Male fertility is an excellent measure of general male health, again pretty obvious.
  • “Smokers Fare Worse After Heart Procedures, Study Finds” – Let me get this straight, 2 of 3 smokers will die early and they fare worse after heart procedures. Who would have guessed?
  • “Kids Bad Diets May Mean Worse Health as Adults” – A poor diet during the developmental years can really affect your health as an adult?
  • “Breast-Fed Babies May Be Smarter, Richer Adults” – While my daughter who is currently breast feeding would love this study, some scientific group(s) actually funded it.
  • “Doctors’ Racial Biases May Not Influence Patient Care, Study Suggests” – But the study didn’t look at real-life cases.
  • “Smog Plus Pollen may Mean More Sneezing – Higher levels of airborne ozone, nitrogen dioxide, might boost potency of birch tree allergen” – This is the companion to the LA smog study.
  • “Just How Big is a Normal Penis? – Results size up thousands to arrive at averages. This is my favorite. Who paid for this study? The worse part is that it was a review of 17 previous published studies.

The Bottom Line:
The gold standard for studies is the double blind, placebo controlled, crossover study. Unfortunately, most studies that conform to these standards can only prove what we already know. These 14 studies cost millions of dollars and represent the direction health care research has been going for years. In contrast, clinical studies in nutrition are almost always criticized for not having the controls of the gold standard. In reality, if you can control all the variables have you learned anything?

Monday, April 6, 2015

Study Casts Doubt on Acetaminophen for Low Back Pain, Arthritis

Acetaminophen – best know as Tylenol in the United States – does not appear to help ease lower back pain and offers little relief for the most common form of arthritis, according to a new report.

The review of data from 13 studies could challenge existing recommendations on pain relief, experts say.

“These results support the reconsideration of recommendations to use [acetaminophen] for patients’ with these conditions," concluded a team led by Gustavo Machado of The George Institute for Global Health at the University of Sydney in Australia.

The researchers analyzed 10 studies that examined the use of acetaminophen to treat osteoarthritis of the hip or knee, and three studies that assessed the use of the painkiller for lower back pain.

Osteoarthritis – the most common form of arthritis – and back pain are among the leading causes of disability worldwide, the researchers said. Current clinical guidelines recommend acetaminophen as the first-line drug treatment for both conditions.

However, doubts about the effectiveness of the drug in treating the conditions, and concerns about the safety of the recommended full dose (up to 4,000 milligrams a day), have made those guidelines controversial, Machado’s team said.
Looking at the pooled data, the investigators found that for people with lower back pain, acetaminophen was ineffective in either reducing patient disability or enhancing quality of life.

Friday, April 3, 2015

Drinking Water Helps Prevent Kidney Stones

Drinking plenty of water will lower your risk of kidney stones, researchers report.

“This analysis shows that drinking water is an effective way to cut one’s risk for developing kidney stones in half,” Kerry Willis, chief scientific officer at the National Kidney Foundation, said in a foundation news release.

“Kidney stones cause significant discomfort and cost, along with a potential to contribute to the development of kidney disease, so confirmation of reducing risk through improved hydration is an important finding,” Willis added.

The current research looked at nine previous studies that included nearly 274,000 people. More than 550 people had a history of kidney stones.

The review found that people who produced 2 to 2.5 liters of urine were 50% less likely to form kidney stones than those who produced less urine. That amount of urine production is associated with drinking about eight to ten 8-ounce glassed of water a day, according to the researchers.

The study was presented Thursday at a National Kidney Foundation meeting in Dallas.

Wednesday, April 1, 2015

Wisdom Wednesday: Weight Lifting Routines

I recommend four different workouts done on alternate days. Start with just three routines for the first six weeks. Once you have improved your general strength, add the shoulder routine as the forth workout. Starting the shoulder routine too soon creates a real risk of shoulder injury.

Using free weight you will have much faster results than the machines. However, the risk of injury with free weights is also much greater. Again, I recommend using the machines for the first six weeks, and then gradually phase in some free weights.

In general, start with a weight (or setting) that you can lift a minimum of 8 repetitions (reps). Gradually increase the reps as you are able. When you can do 2 sets of 12 reps, increase to the next weight level. Again, you must be able to do at least 8 reps at the new weight.