Archive for Gastroenterology
Why should gastroenterologists be interested in nutrition and obesity?
Umm…because it is the keystone upon which health and disease pivots? Because it holds the potential to stave off most diseases known to man? Because it can modify the progression and severity of many (if not all…) chronic diseases, many of them GI disorders? Because the GI tract is the first and largest area food we eat is exposed to? Why is this even a question?? This is a sad state of how behind medicine is when it comes to health.
Effect of L. plantarum on CVD risk factors in smokers
Wow…talk about cutting across organ systems!! This study shows many cardiovascular benefits (inflammatory markers, lipids, BP, fibrinogen and leptin) from probiotic use. A gastrointestinal intervention resulting in multi-factorial cardiovascular benefits. Go figure. Now if only gastroenterologists would recognize that probiotic therapy actually exists. And if only they would mention this benefit to cardiologists…And if only pigs could fly.
AJCN — Abstracts: Naruszewicz et al. 76 (6): 1249
Hypochlorhydria, Inflammation, Parietal and G-Cell Populations
This study has incredible implications. This is a mouse study, but if it holds true in humans (and if this concept ever makes it out of this journal…) it could blow a hole in one of the highest prescription classes in Western civilization.
This article suggests that the normal stomach up-regulates its ability to make MORE acid in response to inflammation caused by bacterial infection. On the other hand, stomachs with impaired gastric acid production (hypochlorhydria), are more susceptible to infection and further injury from bacteria. The hypochlorhydria can be genetic or from treatment with acid suppressive drugs. The bottom line–we need to seriously re-evaluate or use of acid suppressive therapy in patients with gastritis and ulcers and especially H. pylori infection.
Gastroenterology — Abstracts: ZAVROS et al. 122 (1): 119
Coating Doesn’t Reduce Risk of Upper GI Bleed From Low-Dose Aspirin
The whole “aspirin a day” for health is becoming more and more controversial. First, there is no evidence that aspirin prevents a FIRST heart attack; only a second. Next, it is rare that a patient has their clotting ability monitored on aspirin therapy to check if it is even needed, and so many patients may be thinning their blood to dangerous levels. This is evidence by an increase in strokes in patients taking long term, low dose aspirin.
Am J Gastroenterol 2000;95:2218-2224 Use of low-dose aspirin increases by threefold the risk of an upper gastrointestinal (GI) bleed requiring hospital admission, according to a population-based cohort study from Denmark. Enteric coating of the aspirin does not reduce this risk. The investigators report that the standardized incidence rate ratio — “calculated as the ratio of the observed to the expected number of upper GI bleeding” — was 3.1 for all users of low-dose aspirin. This ratio increased to 5.6 when low-dose aspirin was combined with nonsteroidal anti-inflammatory drugs (NSAIDs). When aspirin was combined with non-NSAID drugs, the ratio was 4.7. The risk was similar for 100-mg and 150-mg tablets, and for enteric-coated and noncoated tablets. The risk remained elevated, with a standardized incidence rate ratio of 1.8, during the year after treatment with aspirin was discontinued. If confirmed, these findings “will have important public health implications for the assessment of the overall public health benefits of low-dose aspirin,” Dr. Sorensen’s group concludes.
Peppermint oil reduces gastric spasm during upper endoscopy.
Peppermint has been used for centuries to calm GI spasms. For patients with irritable bowel syndrome, many have found relief with peppermint oil. Here we see it replacing a commonly used antispasmodic during GI spasms during endoscopy. Gastrointestinal Endoscopy Online
Insulin resistance and tissue repair: A “fato-logical” phenomenon.
Wow!! If you ever had some uncertainty about what insulin resistance is than this is a great overview. Gastroenterology Online -
Hyperinsulinemic Hypoglycemia with Nesidioblastosis after Gastric-Bypass Surgery
I know this is a long title, so let me paraphrase it in English…”Gastric bypass surgery results in an attempt by the pancreas to compensate by making more insulin to the point where the brain runs so low on fuel as to be potentially lethal and these patients needed another operation to pull out a portion of the pancreas containing diseased regions.” Wow.
Granted, this is only a case series presentation, but what a racket. You get paid cash to bypass the stomach (oh hell–what was Mother Nature thinking of anyway? Digestion is overrated.) and then you make money on the back end from insurance when the potentially fatal condition needs to be corrected. And I’ve got a hard time getting 5 visits for a low back sprain from an insurance company…
Use of Gastric Acid Suppressive Agents and the Risk of Community-Acquired Clostridium difficile associated disease.
Let’s first say that C. difficile is not something you want to suffer through. The authors of this paper seemed a little surprised to find an almost tripling of the risk of acquiring this infection in patient on acid suppressive drugs.
Well, given that we are constantly exposed to an enormous amount of bacteria in our daily lives, and given that stomach acid acts as a very strong barrier to these bacteria, suppression of this protection will of course open up yet another Pandora’s box of health problems with acid suppression. Ah heck. What was Mother Nature thinking anyway? We don’t need stomach acid for health.
Zinc for severe pneumonia in very young children: double-blind placebo-controlled trial.
To me, this is another no brainer. Zinc supplementation is very safe and very inexpensive. In this study it reduced the hospital stay by one day and the duration of pneumonia by one day. The cost of the zinc in this study was probably under $5 (exchange rate for hospital = $45) and saved many hundreds if not thousands of dollars in hospital charges. But once again, do not look for zinc supplementation in a hospital near you soon. The Journal : Back Issues - Click here for more information.
Gastrointestinal bleeding after the introduction of COX 2 inhibitors: ecological study.
This is a very interesting article. When the COX-2 selective inhibitors were first released, I was seeing many patients come in that were prescribed this class of drugs, most inappropriately (was only supposed to be used in patients at high risk of GI complications). However, the number has dropped off to almost zero. This once blockbuster class of drugs seems to be falling to research that is finally showing that it is not all that effective as a pain med, and it’s side effect profile is really nothing to brag about, either. And all this coupled with the fact that this is a very expensive class of drugs compared to other NSAIDs. This article notes that, with the 41% increase in NSAID use (due entirely to the increased use of COX-2 inhbitors), a 10% increase in hospitalization rates for upper GI bleeds was seen. Sell your Pharmacia stock. bmj.com Mamdani et al. 328 (7453): 1415 - Click here for more information.
Prevalence of Vitamin D Deficiency Among Healthy Adolescents.
The results of this study are a little surprising (24% of kids were deficient), but I can assume that our demonizing of sunlight is much to blame. There have been many studies lately pointing to deficiencies of Vit D in almost every age group. The thing to consider here is that every single cell of the body has a receptors for Vit D even though we may not yet know the full breadth of what this vitamin does. But I can guarantee, even with what little we know, that chronic, widespread deficiencies of Vit D will lead to increased rates of MS, osteoporosis and certain types of cancer. Arch Pediatric Adolesc Med — Abstracts: Gordon et al. 158 (6): 531 - Click here for more information.
A Randomized Controlled Trial to Change Antibiotic Prescribing Patterns in a Community.
Okay. Pediatric journals print studies that show that educating a provider to lower antibiotic use in ineffective. Does anyone else out there have any idea how to reign in the antibiotic overuse? This is not just a matter of creating antibiotic resistant bacteria. This deals with the larger problem of destroying off normal flora and thereby losing their protective and beneficial effects on our health. Arch Pediatric Adolesc Med — Abstracts: Doyne et al. 158 (6): 577 - Click here for more information.
Incidence of High-Strain Patterns in Human Coronary Arteries–Assessment With Three-Dimensional Intravascular Palpography and Correlation With Clinical Presentation.
I thought this was interesting. We are starting to get pretty ingenious with our cardiovascular imaging (and opening up cans of worms in regards to exactly how well we are really “treating” CVD). With this type of ultrasound imaging the physician can actually tell if the plaque is deformable or not. The deformable plaques are much more likely to rupture and lead to heart attacks. Interestingly, these plaques also correlated with CRP levels. Circulation — Abstracts: Schaar et al. 109 (22): 2716 - Click here for more information.
Proinflammatory effects of copper deficiency on neutrophils & lung endothelial cells.
I do not like to look at a “one deficiency-one outcome” situation because I think that almost every condition (with few exceptions) is multi factorial and a wholistic approach needs to come from multiple angles. However, sometimes research comes out that does remind us of the importance of individual nutrients. To me, this article would support the inclusion of both whole grains as well as a good quality multivitamin.
Proinflammatory effects of copper deficiency on neutrophils and lung endothelial cells – Immunol Cell Biol, Vol 82, Issue 3. Click here for more information.
Prevalence and Features of the Polycystic Ovary Syndrome.
This article suggests a prevalence as high as 8% of PCOS which puts it as the most common endocrine abnormality of reproductive aged women in the US. PCOS has been linked very strongly to insulin resistance. This link seems to come from elevated insulin affecting 15,20 lyase, the enzyme that converts testosterone to estrogen. So, elevated insulin slows conversion to estrogen, essentially rising levels of testesterone, which messes up the ovulation process. The problem is that PCOS has traditionally been treated with oral contraception, which is know to worsen insulin resistance. Another perfect example of how we can actually screw the body up worse if we try to override human physiology instead of balance it. JCEM — Abstracts: Azziz et al. 89 (6): 2745 - Click here for more information.
Fructose Reduces Circulating Insulin and Leptin, Attenuates Postprandial Suppression of Ghrelin, and Increases Triglycerides in Women.
This has been a tough one to explain. Research has shown that fructose (as in high fructose corn syrup) has little effect on insulin levels. This would, at first glance, make it seem a-ok from a dietary standpoint. But most functional medicine practioners have recommended avoiding it for a long time now. This article starts to shed some light on the harms of this dietary factor. Basically, fructose does not effect insulin, but it does affect leptin and ghrelin in a negative way. Lower leptin levels were seen (remember that leptin speeds up metabolism and suppresses hunger) and higher ghrelin levels (ghrelin will stimulate appretite) in the participants fed high fructose diets. This could definately lead to weight issues. JCEM — Abstracts: Teff et al. 89 (6): 2963 - Click here for more information.
Range of Neurologic Disorders in Patients With Celiac Disease.
Celiac disease (allergy the the gluten portion of certain grains such as wheat) is one of those conditions that exemplifies the problem with mainstream medicine. While specialities are common, this is not how the body works. Here we have a gastroenterological problem wreaking havoc on the neurological system. I still recall a patient I had several years back. He was diagnosed with dermatatitis herpatiformis 10 yrs prior to coming into my office. This condition is strongly associated with celiac disease. Did his doctor recommend a gluten free lifestyle? No. Gave him dapsone (used for leprosy) and told my patient that a gluten free diet was too difficult. My patient willingly went on a gluten free program with only the mere mention that this would be best for him. I think he always knew this was best but was never told this. How much damage was done to his neurological system in the 10 years before he went on a gluten free diet? Incidently, ADD/ADHD was one of the conditions noted in this article as being related to CD. Pediatrics — Abstracts: Zelnik et al. 113 (6): 1672 - Click here for more information.
Low Maternal Dietary Intakes of Iron, Magnesium, and Niacin Are Associated with Spina Bifida in the Offspring.
This is one of the reasons I tell patients that the pharmaceutical prenatals are general some of the poorest quality and most expensive vitamins I’ve ever seen. Some of them are so blatantly poor as to only contain folic acid, iron and calcium. Most are nothing more than a basic support. Few contain biotin, magnesium and niacin. I don’t think there are ANY that contain all three. They are based on a pharmaceutical model–not a model of healthy pregnancy. They should all be tossed in the garbage where they belong (care to know how I really feel?). Nutrition.org — Abstracts: Groenen et al. 134 (6): 1516 - Click here for more information.
Xylooligosaccharides and Fructooligosaccharides Affect the Intestinal Microbiota and Precancerous Colonic Lesion Development in Rats.
I can’t wait for my next game of Scrabble. Is the board even long enough for “xylooligosaccharides?” Anyway, fructooligosaccharides (FOS) are pretty well known for their ability to beneficially affect the intestinal flora and the health of the cells of the colon. This study in rats further supports this, but also finds that xylooligosaccharides were more effective than FOS. Both are naturally found in fruits and veggies. Nutrition.org — Abstracts: Hsu et al. 134 (6): 1523 - Click here for more information.
Impaired Fracture Healing in the Absence of TNF-alpha Signaling: The Role of TNF-alpha in Endochondral Cartilage Resorption.
It is quite common for drugs to be developed and marketed that affect certain biochemical pathways before we fully understand these pathways. This is evidenced by the withdrawl of many medications after they are approved by the FDA. Of particular concern for me is the new drugs that block TNF-alpha being used for rheumatoid arthritis, Crohn’s and psoriasis. While I understand that many patients with these conditions are suffering with their symptoms, I know that many of these patients have not exhausted (or, in many cases, even attempted) natural approaches. TNF-alpha is now known to be an integral component of bone healing and formation, fighting off cancer and fighting off infections. Blocking this messenger may yield more long term problems than it solves.
Impaired Fracture Healing in the Absence of TNF- Signaling: The Role of TNF- in Endochondral Cartilage Resorption. Click here for more information.
Reduced Osteocyte Density with Osteoporotic Vertebral Fracture.
The idea that the denser the bones, the stronger the bones, is an idea that is far too simplistic. We now know that it is not just the density, but the quality of the bone that also plays a role in fracture risk. This study finds that there are less active bone cells (osteocytes) in patients who have suffered vertebral fractures. The authors suggests that less osteocytes would make the bone less response to microtrauma and changes in stress on the bone.
Reduced Iliac Cancellous Osteocyte Density in Patients With Osteoporotic Vertebral Fracture. Click here for more information.
Dietary glycine prevents chemical-induced experimental colitis.
Glycine is one of those amino acids that has been used for a long time for GI complaints. Here we see further support for this idea. Also included in a regimine including glycine would be soluble fiber and probiotics.
Gastroenterology Online. Click here for more information.
Once again, American Family Physician does a nice review of a natural agent. I have used ginko in my office with good results for dementia, hearing loss and impotence. However, I usually consider ginko in anyone younger than 50 years of age ineffective enough to not be worth the money..
Gingko Bilboa – September 1, 2003 – American Family Physician. Click here for more information.
Gene–Diet Interactions in Brain Aging and Neurodegenerative Disorders.
Once again, it is becoming more clear that another chronic degerative condition (in this case Alzheimer’s and Parkinson’s) are diseases of lifestyle. Elevated levels of homocysteine is being found to a major play in onset of these disorders. Of course this would mean that folic acid, B6 and B12 supplementation are essential for lowering your risk of these conditions.
Ann Intern Med — Abstracts: Mattson 139 (5): 441. Click here for more information.
The Relative Safety of Ephedra Compared with Other Herbal Products.
This is a letter to the Editor by Dr. Julian Whitaker on the safety of ephedra. This herb has gotten a bad rap lately, but most adverse effects we have seen have been from overuse. People drop dead daily from LABEL use of Tylenol and ibuprofen but there’s no big congressional push to outlaw those two. Remember that natural medicine is held to a much higher standard and, more often than not, can withstand the additional scrutiny.
Ann Intern Med — Whitaker 139 (5): 385 -a. Click here for more information.
Elevated Homocysteine with Higher Risk of Recurrent Coronary Events and Mortality in Acute Myocardial Infarction.
There’s that nasty homocysteine word again. Funny, for as often as it pops up in the medical literature, clinicians rarely pay heed to ordering homocysteine. This is especially disappointing because we know that supplementation with folic acid, B6 and B12 can lower levels of homocysteine.
Arch Intern Med — Abstracts: Matetzky et al. 163 (16): 1933. Click here for more information.
High Pressure Induces Superoxide Production in Isolated Arteries.
Wow! This article suggests that increased blood pressure alone is enough to start a cascade of damage in the cells lining the arteries. Increased superoxide without ample antioxidants to quench this free radical will result in further damage to the cell. This damage can begin the infiltration of white blood cells that begin plaque formation. This lends more support to the idea of antioxidant supplementation such as Vit C, E and CoQ10 to lower risk of CVD.
Circulation — Abstracts: Ungvari et al. 108 (10): 1253. Click here for more information.
Osteopathic Manipulation as Adjuvant Therapy in Children with Recurrent Acute Otitis Media.
While I love to see articles such as this (the findings not really a big surprise to any chiropractor), it is unfortunate that any press this article receives will not extend to chiropractic. Heck–why should it? Just because DCs perform 90% of manipulations and DOs have manipulation as an elective?? Oh well. Remember to add probiotic supplementation and avoidance of dairy to manipulation and just about every ear infection should become history.
Arch Pediatr Adolesc Med — Abstracts: Mills et al. 157 (9): 861. Click here for more information.
Lifestyle changes play a major role in reducing cardiovascular disease.
One of the researchers at this conference believes that, in the Nurse’s Health Study, 82% of CHD deaths could have been prevented with lifestyle changes. 82%. Think on that number. Essentially, here in the US CVD could drop off of the map of major causes of death. Knowing what we now know, there is absolutely NO excuse why CVD is still the major killer it is. None.
Vienna, Austria – Long-term studies on the effect of lifestyle changes on cardiovascular disease risk and mortality show that those who adopt a combination of several healthy habits achieve the greatest cardioprotective effect. Patients who stop smoking, follow a healthy diet, exercise daily, and drink a glass of wine or beer now and then are less likely to develop cardiovascular disease or die from it was the take-home message of a clinical seminar on the effect of lifestyle changes on cardiovascular health here at the European Society of Cardiology Congress 2003. Combination is the key “We cannot identify particular items that can be isolated, like a pill; rather, lifestyle changes have a synergetic effect,” said Dr Susana Sans Menendez (Barcelona, Spain), who was chairing the session. In this respect, the latest data from the Nurses’ Health Study, a long-term evaluation of over 120 000 nurses from 11 US states started in 1976, showed a combined impact of the following lifestyle components on primary prevention: moderate or vigorous exercise at least 30 minutes daily, a diet low in trans-fatty acids but high in omega-3 fatty acids and folate, regular intake of alcohol, a low BMI, and smoking cessation. “A total of 82% of CHD deaths in the general population would have been prevented with adherence to this healthy lifestyle,” said Dr Karin Michels (Harvard Medical School, Boston, MA), who presented the latest results of their study at the meeting.