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PHYSICIANS ARE AWARE OF METABOLIC SYNDROME BUT DO NOT FULLY UNDERSTAND – (01-26-08)
Metabolic syndrome, its preeminent clusters, incident coronary heart disease and all-cause mortality
Despite the vast amount of research, few give Metabolic Syndrome the respect it deserves. I personally believe that this is because while many physicians are aware of metabolic syndrome, by not reading current literature they may not fully understand the full breadth of this condition.
Let’s put it in terms of this study. When we talk about relative risk, it gives us an idea of how much something (in this case, having MetS) increases your risk of a disease. Now, if the rates of a particular disease are already pretty high in the general population (such as with heart disease), then the risk becomes more important.
In this study, those patients having all 5 components of MetS (high BP, low HDL, high triglycerides, increased blood glucose and increased waist-to-hip ratio) the relative risk was a whopping 6.24 time higher. There’s no beating around the bush here. This is a dangerous condition and needs to be treated as such.
Research Updates September 6, 2005
***Plasma Oxidized Low-Density Lipoprotein, a Strong Predictor for Acute Coronary Heart Disease Events in Apparently Healthy, Middle-Aged Men***
I frequently have patients come in with cholesterol that is just slightly elevated–maybe 210 or 220. There have been times that these patients have been doing everything else right and their cholesterol is just a little elevated. We need to remember that cholesterol does not do its damage until it gets damaged itself. This damage to LDL cholesterol creates a compound called an oxysterol and THIS is what does the damage. High intakes of fruits and veggies with lots of antioxidants can protect this cholesterol from becoming oxidized. We can see from this current study that these oxidized cholesterols really do increase risk greatly (up to 4x the risk).
http://circ.ahajournals.org/cgi/content/abstract/112/5/651
***Docosahexaenoic acid: A positive modulator of Akt signaling in neuronal survival***
While this may get a little too deep into biochemistry for most of us, the bottom line is that certain types of healthy fats are protective to our brain. This is yet another reason to believe that many of our neurodegenerative diseases such as Alzheimers and Parkinson’s are indeed diseases of lifestyle. Less intake of healthy fats over a lifetime leaves brain cells more suseptable to damage and cell death.
http://www.pnas.org/cgi/content/abstract/102/31/10858
***Prenatal Anxiety Predicts Differences in Cortisol in Pre-Adolescent Children***
The implications for this are staggerring. Consider a few scenarios: pregnant mother told antidepressants are okay in the 3rd trimester, a pregnant mother under abnormal levels of stress, or an insulin resistant mother with abnormally high levels of cortisol. All of these scenarios lead to differing levels of neurotransmitters in the bloodstream. The developing fetus is bathed in these hormones. So, take the antidepressants–the developing fetus becomes used to abnormally high effectiveness of serotonin. Baby gets born, no more drugs and their brain now detects a serotonin deficiency, even though their is no true physiological deficit. Run the same scenario for a stressed out mom with high cortisol levels. Not a good situation for the child, and this is one of the reasons I am a little pessimistic about our future generations’ risk of chronic diseases. I think we have yet to have scratched the surface of chronic diseases and shortened lifespans.
http://www.sciencedirect.com/science/article/pii/S000632230500377X
***Oxidative stress levels are raised in chronic fatigue syndrome and are associated with clinical symptoms***
There are probably many CFS patients out there that were convinced that their symptoms were “all in their head.” The common fault in this type of situation is thinking that, because a doctor ordered all the tests he or she were familiar with, the condition has no physical basis. What physicians should be thinking instead, would be what type of tests might explain some of the feelings that this patient is experiencing? The measurement of isoprostanes appears to be one of those tests..
http://www.sciencedirect.com/science/article/pii/S0891584905002121
***High Circulating Thyrotropin Levels in Obese Women Are Reduced after Body Weight Loss Induced by Caloric Restriction***
The fact that TSH levels increase with improper weight loss is nothing new–just thought I’d add it here as a reminder. Our physiology is incredible, and if you attempt weight loss by just cutting back calories, our bodies think starvation is at hand, and will reduce the metabolism in an effort to conserve energy. A weight loss program CANNOT focus on calorie restriction alone-you will end up worse than when you started.
http://jcem.endojournals.org/cgi/content/abstract/90/8/4659
***Cereal fiber and whole-grain intake are associated with reduced progression of coronary-artery atherosclerosis***
While this is not new news and is a quite consistent finding in the research, it does beg the question of how the high protein, “carbs are evil” crowd would respond…
http://www.sciencedirect.com/science/article/pii/S0002870304005071
***Dietary beta-cryptoxanthin and inflammatory polyarthritis***
So we all know that fruits and veggies contain compounds that are good for us. Most noteable are the carotenoids–those compounds that bring the brilliant colors to fruits and veggies (reds, yellows, purples, blues…). But one glass of OJ can fight off rheumatoid arthritis? By half? Sometimes we really forget just how powerful Mother Nature is, but studies like this really bring the concept back home.
http://www.ajcn.org/cgi/content/abstract/82/2/451
This study finds that the addition of soluble fiber added to the diet increased both the amount of calcium absorption and the amount of bone density at 1 yr. I’m sure there are a multitude of other dietary factors that will also increase calcium utilization. Put this into the picture of cultures that have very low intakes of calcium and yet very low incidence of osteoporosis. We have become so programmed by the dairy industry that calcium from dairy is the end all and be all for bone health, that we have forgotten that there are many other dietary factors that go into bone health. Osteoporosis is a disease of lifestyle, NOT calcium deficiency.
We generally think of medical research as a good thing. Billions of dollars go into new approaches, new treatment, new methods of detection. But do they really change things? In many cases, the answer is no. How many untold billions have gone into AIDS research without anything even resembling a cure? Many cancers still have high mortality rates. This study reviews 50 years of technological advances in renal treatment, but finds no overall change in mortality rates. I’ve said it a thousand times before and I will continue to say it–prevention is infinitly better than a cure. Lets spend even a mere 10% of the large organizations’ budget (Amer Heart, Amer Cancer, Amer Diabetes) for prevention and we would see a huge return on investment in just a few short years. Does everyone know that Tylenol and ibuprofen damage the kidneys? Or that a large chunk of patients on dialysis got there because they took too much Tylenol? Probably not.
http://www.sciencedirect.com/science/article/pii/S0002934305002469
***Do drug samples influence resident prescribing behavior?***
Geez!! Does no one in the midst of this travesty see this as a problem? It’s almost laughable if it didn’t affect all of us so much. We’ve done study after study after study that confirms that YES–the drug companies’ advertising that both patients and doctors is effective at changing prescribing behavior. So do we stop it? No. We do another study to confirm the same thing. Is it just me, or is there a problem here. There’s no question that we recognize the problem in it’s illicit form–the drug pusher on the corner gives a small child their first taste of some drug and the child gets addicted. So where are the studies finding that drugs given to children on the playground influence future drug buying decisions on the playground? There are none–we take a strong proactive approach. So how does the behavior and relationship differ between prescribed and illicit drugs? Does it influence your decision to know that death by pharmaceutical is the leading cause of death in the US?
http://www.sciencedirect.com/science/article/pii/S000293430500197X
Research Updates October 20, 2005
***FDA Standards Good Enough for Government Work?***
Unfortunately, many people here in the US have an image of the FDA as a governmental agency that is constantly on the vigil to protect an unsuspecting public from the pharmaceutical companies. Not quite so romantic. This editorial does a nice job of outlining one of the major problems with the FDA approval process. It’s not that the FDA has lax standards, it’s just that their approval process does not have much application in the real world. Many times, in initial clinical trials of a pharmaceutical, the drug is compared to placebo in a patient that is at an extreme of a condition (the article illustrates this with Redux, which was tested in patients with severe obesity). But in the real world, the drug reps convince physicians to prescribe for much milder conditions, thus skewing the risk benefit ratio.
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***Association between SSRIs and upper gastrointestinal bleeding***
I must admit that this interaction never occurred to me, but it makes sense since platelets use serotonin for proper functioning. With the inhibition of the transporter that platelets use to pick up serotonin, this would affect platelet function. By themselves, the risk is not great, but add aspirin or NSAIDs into the mix, and the risk skyrockets.
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***Male rats show an indifference-avoidance response for increasing concentrations of the artificial sweetener sucralose***
Take it for what it’s worth. It’s a rat study. Humans sometimes display a surprising lack of common sense and self preservation inherent in other species…
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***Congenital heart defects and maternal biomarkers of oxidative stress***
Wow. Practically by the week we are finding more and more studies linking interuterine environment and risk of chronic diseases later in the newborn’s life. Given that oxidative stress is such a major concern with today’s poor lifestyle choices, does this mean that we will soon see increases in the numbers of congenital heart defects? The unfortunate answer is probably yes. Then, given the links with septal defects and migraine headaches and stroke, we will probably see an increase in the rates of these associated conditions as well. Quite a rosy picture for the future, huh?
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***Intake of omega-6 and omega-3 fatty acids and fish and risk of community-acquired pneumonia in US men***
Didn’t see any headlines in the paper on this one about skipping the flu vaccine and boosting your immune system through healthy lifestyle changes. Probably not as dramatic as “Thousands predicted to die as flu vaccine shortage ravages the nation.”
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***Dietary pattern, inflammation, and incidence of type 2 diabetes in women***
It’s nice to see Dr. Walter Willett’s name on this study, but the intro states that dietary patterns that lead to inflammation and diabetes are largely unknown. Unknown by whom? Maybe the obese family of 4 in the McDonald’s drive thru for the second time that day, but I think the rest of us can pretty much guess what dietary patterns lead to inflammation and diabetes. So what did they conclude? High sugar sweetened drinks, refined grains, diet drinks and processed meat but low in wine, coffee, cruciferous and yellow veggies leads to DM and inflammation. I never would’ve guessed.
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***Comparative effects of hydroxocobalamin and cyanocobalamin on plasma homocysteine concentrations in end-stage renal disease***
This issue of cyanocobalamin has come up once before a few years back, but it was enough to give me cause for concern. The study suggested that cyanocobalamin actually inhibited one of the enzymes it was supposed to be helping. This study did not look at this enzyme affect, but it did find a much stronger effect of raising cobablamin levels in the bloodstream with hydroxy vs cyano (40 fold increase vs 10 fold increase).
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***Apoptosis in human pancreatic cancer cells induced by eicosapentaenoic acid***
Pancreatic cancer is definitely low on the list of cancers you would want to get. There just aren’t 3 yr survival rates. A few years back, Dr. Gonzalez published a small clinical trial in panreatic cancer using various approaches such as vegetarian diet, digestive enzymes, detoxification and coffee enemas and got a few patients in this trial past 3 yrs. The results were enough for the NIH to give him a grant to further his research. You can bet the the positive results from his approach is not from one single approach; rather, it is the accumulation of many beneficial components in this lifestyle. In the study here, the researchers found that EPA, an essential fatty acid, induced the death of cancer cells in the lab. Not a bad start.
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***Coenzyme Q10***
American Family Physician has been doing these reviews on natural compounds for several issues now, and, overall, they are very well balanced. This article reviews CoQ10 and is good reading for anyone wanting additional info on this powerful antioxidant. Which, by the way, is lowered with statin drugs to lower cholesterol..
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***Anti-tumor necrosis factor-alpha therapies attenuate adaptive arteriogenesis in the rabbit***
Recall that TNF-alpha is a molecule that turns on inflammation in the body. More TNF-alpha means more inflammation. It works at a much earlier point in the generation of inflammation than other agents to control pain such as NSAIDs. The newest class of drugs for autoimmune conditons like rheumatoid arthritis, Crohns’ and psoriasis blocks the action of TNF-alpha. While it can be very helpful for many patients with this condtion (and expensive…) I have always had concerns with long term use of this class of meds. Here, in this rabbit study, we see that it inhibits the ability of the vessels in the heart to form new branches–a process that is essential for survival of the heart when major arteries get blocked. A complete lifestyle overhaul can work very well in patients with these autoimmune conditions, without the dangers of increased infections, cancer and now ischemic heart disease.
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Research Updates November 21, 2005
***Nearly half of patients with migraine with aura are found to have a heart defect, study finds***
This one has created quite a stir in the cardiologist community. Many have moved on this information and are doing septal defect repairs in greater numbers. Skeptics point out that risk of stroke from this condition (known as paradoxical embolism – an emboli forms in the deep veins of the leg, breaks free, goes to the right chamber of the heart just as a patient is bearing down – called valsalva manuever- to allow enough pressure for the emboli to pass through septal defect to left chamber on, then still only 20% of this blood goes on to the brain) is very low. We may be looking at this from the wrong angle. Studies have shown an increase in heart defects when a pregnant mom has increased oxidative stress. Maybe this is all just an inkling of the bigger picture that the migraine sufferer has been dealing with since he or she was in the womb. Either way, the migraine patient still needs to be viewed as a whole for full resolution of their headaches.
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***Plasma IL-6 concentration is inversely related to insulin sensitivity, and acute-phase proteins associate with glucose and lipid metabolism in healthy subjects***
What a tangled web we weave…It is known that insulin resistance leads to inflammation (hyperinsulinemia leads to increased TNF-alpha which turns on inflammation), but this study and several others point to the fact that inflammation also increases insulin resistance. So it becomes a feed forward cycle. This is one of the reasons why I am against drug therapies like metformin because they do not address the overall levels of inflammation present in the body. Only by addressing lifestyle factors that contribute to inflammation (exercise, increased intake of omega 3 fatty acids, decreased intake of omega 6 fatty acids, heavy metal and chemical avoidance, increased fruits and veggies…) will we be able to control both the inflammation and the insulin resistance.
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***Relation between dietary omega-3 and omega-6 fatty acids and clinically diagnosed dry eye syndrome***
Can’t say I’ll use this info every day in practice, but thought I’d include it to show how far reaching the benefits of a diet high in healthy fats can go. Of course, give it some time, and I’m sure you’ll skin eye cream made with quacamole with a line stating that “clinical studies PROVE that quacamole can reduce wrinkles..
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***Pomegranate fruit juice for chemoprevention and chemotherapy of prostate cancer***
There are several multi level martketing groups out there promoting certain juices with high antioxidant properties. Mangosteen (Xango) and noni juice are two that come to mind. These are very expensive because you are paying for the MLM structure. However, I do believe these have strong benefits because of their antioxidant properties. I usually recommend pomegranate, which I believe delivers an equivalent amount of antioxidant power for a heck of alot cheaper.
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***Glycemic and insulinemic responses in women consuming extruded amaranth***
It’s always good to keep up to date on information on the grains that we replace wheat for. This study looks at amaranth and finds the glycemic index higher than that of white bread. The authors do note, however, that the amaranth was from processed snacks and this may have had a large effect on the glycemic index. You can bet the processing definately puts a negative factor to the grain.
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***Calorie Restriction Promotes Mitochondrial Biogenesis by Inducing the Expression of eNOS***
Despite reading the ads and articles you see everywhere, the ONLY approach that has been shown to improve lifespan in mammals is calorie restriction without nutrient restriction. Period. However, the pharmaceutical companies are looking for what physiological pathways are triggerred with caloric restriction so they can make a drug that does the same thing. We want to have our cake and eat it too (all chocked full of refined carbs and saturated fat…), but we definately, as a society, do not want to do what’s right. Heck, we can’t even do the high protein diets right; we have to load up our favorite foods with artificial sweeteners instead of avoiding them.
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***Nitrate and nitrosative chemistry within Barrett’s oesophagus during acid reflux***
I personally think we are severely mismanaging reflux disease. Despite lack of evidence for too much stomach acid production, we prescribe acid blockers. It’s not that these drugs are not effective for symptomatic improvement, it’s just that they don’t fix the problem, and open a Pandora’s box of problems when you shut down an essential process in human health. This article supports another little recommended approach for those with reflux–avoidance of nitrate containing foods. Basically, the dietary nitrates make it into the saliva which, when it meets the acidity in the esophagus, creates nitrous acid, which increases risk for esophageal cancer.
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***Influence of intestinal bacteria on induction of regulatory T cells: lessons from a transfer model of colitis***
Ok–follow this one closely because it’s important. Take white blood cells from a mouse that has never been exposed to any bacteria along with white blood cells from another mouse that was grown normally with exposure to bacteria. When the white blood cells from a sterile mouse are put into another mouse, that mouse develops intestinal inflammation (consistent w/ colitis, Crohn’s, ulcerative colitis) sooner than when white blood cells from the normally grown mice are given. Additionally, when these types of WBCs are given to mice with colitis, the sterile mouse WBCs had no effect, but the normal WBCs were able to calm the disease. So what does this mean? It means that the WBCs from normally grown mice have the ability to control or even stop the intestinal inflammation, but WBCs from the sterile mice do not have this control. This strongly supports the idea that destruction of normal bacterial flora in an infant with a developing immune system can have long reaching, damaging effects on their long term intestinal health.
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***Comparison of the effects of amitriptyline and flunarizine on weight gain and serum leptin, C peptide and insulin levels when used as migraine preventive treatment***
This definately goes into the “we’re mismanaging migraines” file folder. Since we are truly beginning to view migraines as a local manifestation of a systemic problem, drug therapy that worsens overall health is definately a step in the wrong direction. Migraine patients need to be addressed with full attention to lifestyle to manage their headaches as well as lowering their risk of certain chronic diseases that migraine patients are at risk for.
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***Prevention of Upper Respiratory Tract Infections by Gargling***
Wow. This one surprised me a little. Merely gargling with water several times per day drastically cut the risk of upper respiratory infections (about a 40% reduction), and even when an URTI did start, the severity was less. From gargling water. As a preventative method, how much do you think this would cost? Less than the cost of merely one antibiotic pill to treat the infection, I’m sure. Looking at the above study, what a great method to lower antibiotic use among everyone. Of course, little evidence suggests that antibiotics are useful for URTIs anyway…
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June 23, 2003 Research Update
James Bogash, D.C. Mesa, AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com
Supplementation with branched-chain amino acids in advanced cirrhosis.
It seems like I’ve been coming across more and more patients who have or know someone close to them that has a liver that is failing. Given the increased pharmaceutical drug and over the counter pain relievers (Tylenol is now one of the top or possibly even #1 cause of liver failure) this is not surprising. Here we see branched chain amino acids protecting the liver. Add to this regimen milk thistle and N-acetyle cysteine and you’ve got some powerful tools to help retain what functional liver these patients have left.
Gastroenterology Online - Click here for more information.
Glycyrrhizin, an active component of liquorice roots, and replication of SARS-associated coronavirus.
This study found that licorice was more effective than many other common prescription antivirals on the market. I’m trying to figure out why this wasn’t all over the news…
The Journal : Current Issue - Click here for more information.
SSRIs: suicide risk and withdrawal.
Wow. GlaxoSmithkline withheld info from the UK’s regulatory agency when it got approval for paroxetine (Paxil). The study basically showed no increased efficacy over placebo. My question is…this kind of behavior is rampant here in the US as well. How on Earth do these companies not get shut down by the regulatory agencies? Unfortunately, I think we can all guess at the answer.
The Journal : Current Issue - Click here for more information.
Induction of interleukin-12 production in mouse macrophages by berberine deviates CD4+ T cells from a Th2 to a Th1 response.
Berberine is a compound that was made famous by goldenseal. In this study berberine was able to shift the cytokine balance from a Th2 to a Th1 mediated profile. In essence, this would help shift an asthma or allergy sufferer towards a more normal response. Interestingly, berberine is also well known to be an effective broad spectrum antibiotic, antihelminth and antiviral compound. Click here for more information.
Epidural corticosteroid injections for sciatica.
The epidural for low back pain is always one that hits close to home. In my own practice, I rarely see long term benefit from steroid injections. Flexion/distraction therapy is an extremely effective and safe treatment for sciatic pain. Also, I see a high number of patients that have been told they have sciatica but, clinically have no evidence of it. This may be another example of clinicians using advanced imaging like MRIs instead of using their exam findings and intuition.
Ann Rheum Dis — Abstracts: Valat et al. 62 (7): 639 - Click here for more information.
Metabolic disturbances in obesity versus sleep apnoea: the importance of visceral obesity and insulin resistance
I must admit this is a very interesting concept. Basically, this article opens up the idea that sleep apnea may actually be a manifestation of underlying insulin resistance and obesity. We have always known that abdominal obesity was a risk factor for sleep apnea, but the association with insulin resistance would really change the approach to treatment. I am always in support of a CPAP machine because sleep apnea can have some pretty serious long term consequences, but now we should add aggresive lifestyle changes for insulin resistance as well. Click here for more information.
Effect of vitamins and aspirin on markers of platelet activation, oxidative stress and homocysteine in people at high risk of dementia.
It was nice to see therapeutic levels of the vitamins used in this study. Many times the researchers will use levels just barely above the RDA and when the findings do not show a benefit, the results are plastered all over the news. Here we see 1 mg of B12 (something like 15,000 times the RDA) and 2 mg of folic acid (5X). The antioxidant levels are not as high as I would like but they still showed lowering of markers of oxidative stress. Click here for more information.
Effects of low-dose warfarin and aspirin versus no treatment on stroke in a medium-risk patient population with atrial fibrillation.
This article touches on what I consider a controversial topic. The chronic use of warfarin in a patient with atrial fibrillation produces a “small beneficial effect” on stroke and major vascular events. The question is, does a “small beneficial effect” justify the continued use of warfarin that would prohibit intake of foods (green, leafy veggies, ginko, ginseng, high dose Vit E, fish oils) that have a huge beneficial effects across the spectrum of multiple chronic diseases? This is a question that only a patient and their prescribing physician can answer, evaluating the risk for other chronic diseases vs ischemic stroke. Click here for more information.
Adolescent diet and risk of breast cancer.
While it should come as no surprise that the diets we eat in our teenage years will affect our risk of cancer down the line, at some point our national organizations (AHA, American Cancer Society, American Dietetic Association) need to wake up and smell the coffee. As a nation, we do a sickeningly poor job at prevention given the sheer volume of preventative measures. Now, at a time when the bar is raised further (i.e. educating our teens…) our national organizations maintain the status quo. Click here for more information.
Effect of supplemental phytonutrients on impairment of the flow-mediated brachialartery vasoactivity after a single high-fat meal.
UGHHH!! That’s just what we need–a research article that finds that a fruit-and-veggies-in-a-pill can help balance out the effects of a high fat meal!!! As Americans we are always looking for the easy way out and this will just support that attitude. NOTHING will ever replace a diet low in saturated fats and high in fruits and veggies. NOTHING!!
Cardiosource - Click here for more information.
May 29, 2003 Research Update
James Bogash, D.C. Mesa, AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com
Spinal manipulative therapy is an independent risk factor for vertebral artery dissection.
Had to comment on this one. With the risks that some researchers have stated, patients would be dropping dead left and right in my office alone. Other, more favorable researchers doing very large studies (this one had 171) have estimated that 1 chiro in 40 will experience a cerebral-vascular incident in THEIR LIFETIME OF PRACTICE. When we talk deaths, there are literally less than 100 on record over the past 50 years or so. Compare this to NSAIDs, a common therapy for neck pain. Conservatively, 16,000 deaths PER YEAR. And a quick search on PubMed did not produce ANY articles showing benefit of NSAIDs in neck pain. And yet these researchers have started a cascade of controversy that states that risks of spinal manipulation outweighs benefits. Talk about double standards!! Neurology — Abstracts: Smith et al. 60 (9): 1424 - Click here for more information.
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 endoscopy. Gastrointestinal Endoscopy Online - Click here for more information.
Risk of CVD–Related, All-Cause Death & Serum Enterolactone.
There is much evidence suggesting a protective effect of plant lignans (found in whole grains, flaxseed, soy…) on many diseases including CVD and breast and endometrial cancer. However, many of these studies are not raising a fundamental question. Lignans are converted by intestinal bacterial to enterolactone. What impact does the widespread destruction of normal flora with antibiotics have on this conversion rate? Arch Intern Med — Abstracts: Vanharanta et al. 163 (9): 1099 - Click here for more information.
Intermittent fasting effects on glucose metabolism, neuronal resistance to injury from calorie intake.
One of the only well founded true “anti-aging” approaches out there is calorie restriction w/o nutrient restriction. Well, unfortunately, this approach is just not fun. Well, we may have an easier alternative. Alternate day fasting in mice appears to produce the same favorable changes in insulin sensitivity, serum glucose and ability to protect neurons from injury. PNAS — Abstracts: Anson et al. 100 (10): 6216 - Click here for more information.
Seasonal Prevalence of Intestinal Parasites in US During 2000.
Most people are blissfully unaware of the high prevalence of parasites here in the US and believe infection with parasites is limited to those outside of the US. Welcome to reality. A study of 5,792 samples showed a prevalence as high as 43% in the summer of several types of parasites. Think that course of diarrhea last week was the flu???… Thanks to DSD newsletter for bringing this to my attention. American Journal of Tropical Medicine and Hygiene, June 2002 Abstracts - Click here for more information.
Inertia on folic acid has caused unnecessary deaths.
I commend this author on her heroism in stating that some 350,000 deaths due to cardiovascular disease could have been prevented in the past decade if physicians would’ve started recommending and industry fortifying with folic acid. Of course, this number would need to be extraplated back an additional 3 decades because first hints that folic acid could prevent neural tube defects begin in the late 50′s. The morale?? While waiting on the sidelines to recommend a potentially beneficial vitamin like folic acid, which, incidently, has never been linked to one single death at 400 mcg, millions were dying. How many nutrients are in the same situation now that folic acid was in 40+ yrs ago? bmj.com Ellis 326 (7398): 1054-c - Click here for more information.
Mitochondrial dysfunction in elderly: possible role in insulin resistance.
This is an interesting concept and would lead to some additional intervention for lower insulin resistance in an elderly population. Mitochondrial support with supplements such as coenzyme Q10, carnitine and malic acid may be warranted in this situation. This would, of course, be on top of lifestyle changes, resistance training, chromium and essential fatty acids to affect the insulin resistance. Entrez-PubMed - Click here for more information.
Adverse renal effects of anti-inflammatory agents: evaluation of selective and nonselective cyclooxygenase inhibitors.
With the sharp increase in COX-2 use such as Celebrex and Vioxx (most of this use being inappropriate for its indications), we really need to evaluate the selective COX-2 inhibitors against other known damages from NSAIDs. Here we see that the COX-2 inhibitors are just as dangerous to the kidneys as traditional NSAIDs. And much more expensive. Hey–just use the cheaper NSAIDs and save the extra money for that kidney transplant!! Click here for more information.
Evaluation of cyclooxygenase 2 inhibitor use in patients admitted to a large teaching hospital.
For those of you that thought I was just babbling about the overuse of COX-2 inhibitors…Click here for more information
Up regulation of TNF-alpha, interferon gamma in ankylosing spondylitis during treatment with etanercept.
This article really raises some concern with me (beyond my previous level of concern over this class of drugs). Recall that TNF-alpha is a cytokine that controls many other aspects of the immune system and is generally thought of as an up-regulator of the immune system. However, we do know that this class of molecule is also important in fighting cancer cells. Elevated TNF-alpha levels are associated with autoimmune diseases such as rheumatoid arthritis, ankylosing spondylitis and Crohns and a new class of drugs “binds up” these TNF-alpha molecules floating around in an attempt to lower clinical aspects of these conditions. However, in this article we see that etanercept (a TNF-alpha blocker) surely does binds up TNF-alpha, but the T-cells of the body respond by producing even more. While this may be okay while on the therapy, what happens with the patient terminates medication usage? Will this “super” elevated TNF-alpha level result in even worse degree of disease than prior to medication usage? We just don’t know yet. Ann Rheum Dis — Abstracts: Zou et al. 62 (6): 561 - Click here for more information.
May 9, 2002
James Bogash,D.C.Mesa,AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com
Polyphenols inhibit pancreatic cancer growth.
I realize that, to some of you, this seems like old news (and it is…). For those of you new to Updates, fruits and veggies contain literally thousands of substances we have not even identified yet that protect us from just about every disease on the planet…Article Abstract - Click here for more information.
Hep A Infections in the US, Implications for Childhood Immunization.
This is one that really irritates me. Hepatitis A infections in children are frequently so minor they are not even noticed. Adult cases are where problems can occur. However, we vaccinate the children as an attempt to cut into the cycle of the transmission of the virus. Because children are accessible and we can mandate stuff like vaccinations. Remember the next time your child or someone you know gets a hep A vaccine–your child is being used. Pediatrics — Abstracts: Armstrong and Bell 109 (5): 839 - Click here for more information.
Zinc for the Treatment of Acute Diarrhea in Young Children.
I’m not sure of the mechanism by which zinc would work directly, but indirectly zinc is essential for healthy immune function. To this mix of zinc I would also include probiotics in the several billions CFUs per day. Pediatrics — Abstracts: Strand et al. 109 (5): 898 - Click here for more information.
Drug companies maintain “astounding” profits.
Is anyone surprised about this title? Is anyone surprised that the healthcare system is so overburdened from pharmaceutical payments? The things that still amazes me is that direct to consumer advertising is effective. It absolutely, positively should not be. Prescriptions given to a patient should be influenced by nothing except medical necessity for the patient. So much for a perfect world…bmj.com Gottlieb 324 (7345): 1054b - Click here for more information.
Dietary nitrate, mutagenic concentrations of NO at the GE junction.
Now this is a convoluted pathway…we eat processed meats high in nitrates. This gets absorbed in the GI tract and makes it back to the saliva where bacteria in the mouth convert the nitrate to nitrite. The nitrite is swallowed and turned to nitric oxide by gastric juice. This elevated nitric oxide is believed to be a contributing factor to cancer risk in the upper stomach and lower esophagus. Talk about a physiology/biochemistry lesson!! Just remember this next time you are about to take a bite of processed meat…Gastroenterology Online - Click here for more information.
The Role of Thyroid Hormone in Blood Pressure Homeostasis.
I must admit that the evaluation of hypertension and factors associated with it do not generally include evaluating thyroid function. This article suggests that thyroid function can indeed be a factor in high blood pressure and should be added to the list of therapeutic avenues for anyone with hypertension. Add to this lowering insulin resistance, exercise, consuming healthy fats and lots of fruits and veggies and you are well on your way to lowering blood pressure naturally. JCEM — Abstracts: Fommei and Iervasi 87 (5): 1996 - Click here for more information.
Menstrual Cycle Irregularity and Risk for Future CVD.
While this is not a big surprise if you understand physiology, the irony comes in with common medical management of menstrual problems. To my knowledge, I have come across two major treatment approaches: birth control pill and hysterectomy. While the first may seem a little more benign, consider this…the BCP is known to increase insulin resistance and thereby increase risk of CVD. Still sound like a good approach? Instead, try supporting hepatic detox of estrogens, fixing constipation (which encourages resorption of conjugated estrogens that were on their way “out”), avoid xenoestrogen exposure and using progesterone cream. In contrast to the BCP, this approach would actually lower risk of CVD. JCEM — Abstracts: Solomon et al. 87 (5): 2013 - Click here for more information.
Morning Light Therapy for Treatment of Antepartum Depression.
Now we must be very careful instituting therapy such as this. While we know that many antidepressants are approved by the FDA for use in nursing mothers, this light therapy thing should be avoided until proper studies are done identifying the risks. All kidding aside this small study showed a tremendous benefit for a condition that can be problematic to treat, especially if the mother is nursing. With a therapy like being exposed to light in the morning, why wouldn’t anyone try this as a first line of attack? Couple that with exercise and proper diet and I’m sure response will skyrocket. American Journal of Psychiatry — Abstracts: Oren et al. 159 (4): 666 - Click here for more information.
Tizanidine Helpful in Chronic Daily Headache.
I’m sorry, but articles looking for new medications for headaches always irritates me. First of all, most patients have multiple types of headaches (and while “migraine” seems to be the wastebasket diagnosis most are given, I find most are not migraine at all…) so they will need multiple therapeutic angles. I can say with a high degree of confidence that almost every headache patient can achieve full relief within a few weeks if they are willing to following recommendations. We don’t need more drugs for a problem we already have a good answer to. Click here for more information.
AAN Annual Meeting: Abstract #S25.004. April 2002.
Apr 25 — Chronic daily headaches (CDH) of migraine, migrainous, or tension type responded to tizanidine (Zanaflex) in a double-blind, placebo-controlled trial reported at the American Academy of Neurology annual meeting in Denver, Colorado.”Tizanidine is an alpha2-adrenergic agonist that inhibits the release of norepinephrine at both spinal and supraspinal levels (locus ceruleus), with antinociceptive effects that are independent of the endogenous opioid system,” write Alvin E. Lake III, and colleagues from Ann Arbor, Michigan.Of 200 patients completing a 4-week, single-blind placebo baseline, 134 met criteria for CDH and were randomized to tizanidine or placebo; 92 completed at least 8 weeks of treatment, and 85 completed the 12-week study.Reduction in headache measures in patients receiving tizanidine were all significant compared with placebo, including headache index, severe and total headache days, peak and average intensity, and headache duration. Outcome was similar in patients with migraine, migrainous, or tension-type headache. Adverse events reported by patients receiving tizandine were generally mild to moderate, and included somnolence in 47%, dizziness in 24%, dry mouth in 23%, and asthenia in 19%. Adverse events led to treatment discontinuation in 13 patients, and 2 patients had elevated liver function test levels that returned to normal without intervention.”Tizanidine showed superior efficacy over placebo for chronic daily headache (migraine, migrainous, and chronic tension-type headache),” the authors write.
EU Scientists Confirm Hormone-Treated Beef Risks.
Okay…so Europe won’t take most of our beef because the growth hormones in them pose a potential risk to human health. But here in the United States this same hormone treated beef is perfectly safe. Looking at the fact that we have girls developing breasts at single digit ages possibly due to the “safe” hormones in meat, I would lean just a little more towards Europes’ stance…Click here for more information.
Apr 23 – New checks by European scientists have confirmed fears that using growth hormones on cattle could affect human health, the European Commission said on Tuesday. The findings reinforce opinions issued in 1999 and 2000 on hormone-treated beef, which the EU used to support its ban on them. This resulted in a trade row with the United States where they are used extensively. The European Union’s scientific committee, which reviewed 17 case studies, “confirmed that the use of hormones to stimulate the growth of cattle raises a potential risk for consumers’ health,” the Commission said. The committee “has found no reason to change its earlier opinions issued in 1999 and 2000,” it added in a statement. In 1999, the World Trade Organisation (WTO) ruled that the EU’s decade-old embargo was illegal and authorised Washington to impose $117 million of sanctions on EU goods in retaliation. In response to the ruling, the Commission promised regularly to evaluate scientific data on hormone use. Talks between Brussels and Washington on beef are ongoing. The EU has offered compensation in the form of increased duty-free access for US meat free of hormones. Under current arrangements, US and Canadian producers can export 11,500 tonnes a year duty-free to the 15-nation EU. “We would prefer a switch from sanctions to compensation. There are ongoing technical talks and we shall see what they deliver,” Commission spokesman Anthony Gooch told journalists. The EU executive decided in February to end extra testing of US hormone-free beef for residues due to growing confidence that the meat exported as such contained no banned substances.
June 24, 2002
James Bogash,D.C.Mesa,AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com
Effects of fruit and vegetables on antioxidant concentrations, BP.
This is another of those “how much did we spend on this study???” study. Is there anyone out there that thinks that increased consumption of fruits and veggies won’t positively impact markers of health? Do we really need to spend money just to quantify what common sense already tells us? The Journal : Back Issues - Click here for more information.
Breastfeeding and lowering the risk of childhood obesity.
With the rates of diabetes and obesity skyrocketing, it is always good to see studies outlining protective behaviors. Unfortunately, whether or not an infant was formula fed cannot be changed in the child’s later years. The US government is considering spending millions on educating children on exercise and healthy eating but are missing the obvious (as surprising as that may be for government…). How about a multi-million dollar advertising campaign towards the benefits of breastfeeding? The Journal : Back Issues - Click here for more information.
Activation of the mucosal immune system in irritable bowel syndrome.
It has been difficult to find structural abnormalities in IBS and it is nice to see some research along these lines. IBS is primarily a functional disorder and I’m sure that the localized inflammation found in this study is a result of the altered function. Imbalance in pathogenic flora, improper digestion leading to putrefactive by products and yeast overgrowth have all shown to play a factor in IBS. Each of these by themselves could lead to a localized inflammatory response. Gastroenterology Online - Click here for more information.
Oral Contraceptives and Glucose, Insulin, and Diabetes.
Articles like this are good to see, but the citations appearing in other medical journals does make me scratch my head in wonder. This study did show lower fasting glucose levels and lowered risk of diabetes (after ten years of use). However, insulin levels were elevated. Medscape’s review implied that insulin levels were lowered!! And then you wonder why our health system is so screwed up. My interpretation?? Elevated insulin from pharmacological interventions can never be a good thing. It is entirely possible that oral contraceptives has some type of insulin secretagogue property yielding higher insulin and lower glucose and lowered risk of diabetes in the short term. I feel confident that if this study were to be followed up in another decade the results would not be so “drug friendly.” Dia Care — Abstracts: Kim et al. 25 (6): 1027 - Click here for more information.
Lawyers poised to sue US junk food manufacturers.
Doesn’t that just take the cake?? Oops…might not have cake after the attorneys get through all this mess. So much for personal responsibility!! If we sue the junk food manufacturers might as well go after anyone who uses enriched wheat flour (and how about the government for forcing “enriching??”). While I can say this is absolutely ridiculous, I’m sure they can find a jury somewhere that will award some money. bmj.com Charatan 324 (7351): 1414 - Click here for more information.
Nutritional genomics.
Gosh…what can I add to this article? This topic has the potential to be the future of medicine if we would drop the dogma and take the money out of pharmaceutical drugs. There are currently urine tests to analyze certain genetic variations that alter a patient’s need for certain nutrients. While clinically available now, I would guess that I’ll be long retired before this actually makes it into standard practice. It will take half that long for the researchers to spend the money to determine that nutrition really does play a role is disease prevention/management and half again for the clinicians to read their own medical journals. bmj.com Elliott and Ong 324 (7351): 1438 - Click here for more information.
Physical Activity and Inflammation in Middle-aged and Older US Adults.
This study finds that exercise lowers overall levels of CRP, a marker of chronic inflammation. This is really not an unexpected result;moderate exercise is a key component to a natural approach to any disease process since most diseases have an inflammatory component.
Relationship Between Physical Activity and Inflammation Among Apparently Healthy Middle-aged and Older US Adults. Click here for more information.
Study Questions Cost-Effectiveness of COX-2 Drugs.
This is one of those articles that raises some eyebrows. The fabulous new selective COX-2 inhibitors are being severely overused. The overview of this study goes into the specifics, but I do know one thing for sure–you can bet the pharmaceutical reps and direct to consumer advertising had something to do with it. Makes me wonder if some nutriceutical company came up with millions of dollars to advertising saw palmetto for prostate health to women, how effective would it be? Money talks and buyer beware!! Click here for information.
New evidence suggests that health plan sponsors may want to break doctors’ habit of prescribing COX-2 drugs for arthritis, acute pain and other conditions without first having tried less expensive treatments. The study, released today at the Express Scripts Outcomes Conference, questions the overall cost-effectiveness of COX-2 inhibitors, such as Pharmacia’s Celebrex (celecoxib) and Bextra (valdecoxib) and Merck & Co.’s Vioxx (rofecoxib). The analysis reinforces lingering doubts about the benefit of COX-2 drugs compared with traditional nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen. The debate centers on whether COX-2 drugs provide an added safety benefit for patients at risk of stomach problems, such as ulcers and bleeding, that can occur when using traditional NSAIDs. Researchers in the June 1st issue of the British Medical Journal conclude that an earlier study of Celebrex leaves the false impression that the COX-2 drug has fewer gastrointestinal side effects than NSAIDs (see Reuters Health report, May 30). Express Scripts’ study focuses on the cost-effectiveness aspect. Annual spending for COX-2 drugs spiked 38% in 2000, the study found. The increase reflected a huge influx of new patients taking the drugs, said Fred Teitelbaum, the company’s vice president for research and planning. Spending grew another 15% in 2001. When the St. Louis-based pharmacy benefits management company probed deeper into utilization patterns, it discovered that 74% of new users had no evidence of being at risk for gastrointestinal adverse events. Furthermore, 29% of new users had a diagnosis of lower back pain, a condition not yet listed as an approved indication for COX-2s, it said. No clinical studies have shown COX-2 drugs to be any better than NSAIDs for lower back pain, according to Emily Cox, Ph.D., manager for outcomes research at Express Scripts. Also, short-term use of COX-2s was greater than expected, suggesting that these agents are not being reserved for patients requiring long-term treatment for which gastrointestinal side effects may be an issue. Cox said the study underscores a “significant opportunity” for health plan sponsors to encourage a more cost-effective approach. Express Scripts advocates an approach called step therapy, whereby physicians are encouraged to start new patients without risk of gastrointestinal side effects on a generic NSAID before progressing, if necessary, to a COX-2 drug. Express Scripts estimates that step therapy alone can trim health plan sponsors’ total spending within the NSAIDs class by 12%, said Brenda Motheral, the company’s senior director of outcomes research. So far, only a small percentage of Express Scripts clients have implemented a step therapy program, which typically blocks payment for a COX-2 claim without a clinical reason justifying the choice, explained Raulo S. Frear, vice president of clinical services. By presenting this new data, the company hopes to stimulate greater interest in “appropriate cost-effectiveness,” he said.
May 5, 2003 Research Update
James Bogash, D.C. Mesa, AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com
Tryptophan concentrations and ratios below normal in obese subjects.
As a background, tryptophan crosses the blood-brain barrier and gets converted to serotonin. Serotonin is a neurotransmitter used for many purposes included onset of sleep and satiety. In order for tryptophan to cross the BBB effectively, there cannot be much competition from other amino acids. In this study, the researchers found that plasma tryptophan concentrations are low. The significance of this finding is uncertain at this point, but the addition of 5-HTP supplementation may be a good route to take for obesity.
AJCN — Abstracts: Breum et al. 77 (5): 1112 - Click here for more information.
Fatty acid composition and measures of immune cell function.
With so much worry out today about the SARS virus and the flu and West Nile Virus we are looking for emergency cures when we seem to forget that a healthy lifestyle is still one of our most powerful tools in the battle against foreign invaders. In this study, the researchers found markers of effectiveness of immune cells were reduced with saturated and with high omega-6 to omega-3 ratios.
AJCN — Abstracts: Kew et al. 77 (5): 1278 - Click here for more information.
Nutrition proficiency positively correlated w/ perceived quality of nutrition training of family physicians.
Learning how to use nutrition and nutritional supplements effectively is something that really does require constant education. The nutritional background I had after leaving chiropractic school was merely a springboard for what I’ve learned since graduating. If physicians are not even getting the basics to start with, it does not give these physicians the tools they need to work effectively with natural medicine. This is one of the strongest reasons why supplements should not become prescription items–the only physicians who would be able to prescribe them would be the ones with the least training in their use.
AJCN — Abstracts: Mihalynuk et al. 77 (5): 1330 - Click here for more information.
Arterial Stiffness Increases With Deteriorating Glucose Tolerance Status.
More and more evidence is mounting for the contribution that insulin resistance plays in vascular dynamics, both directly and indirectly. Insulin resistance slows the breakdown of ADMA levels, thus blocking nitric oxide’s vasodilatory effects. Hyperinsulinemia lowers contractility of blood vessels. Insulin resistance increases homocysteine levels which then affects formation of plaque on the arterial walls. The list goes on, and one thing is clear–ANY patient with any degree of high blood pressure needs to address the issue of insulin resistance.
Circulation — Abstracts: Henry et al. 107 (16): 2089 - Click here for more information.
Baclofen on 24 hour pH metry and symptoms in GERD.
Okay, so it is interesting that a muscle relaxer such as baclofen has a beneficial effect on reflux disease. However, what I find particularly disconcerting is that this class of drugs raised the pH of the stomach (essentially lowered acid production). Given that many patients (with and many without GI complaints) do not make enough stomach acid, the fact that a drug unrelated (at least until this study..) to acid production would interfere with this essential physiologic action opens up a wide Pandora’s box of downstream mayhem.
Gut — Abstracts: Ciccaglione and Marzio 52 (4): 464 - Click here for more information.
Prospective Study of Sugar and Risk of Type 2 Diabetes in Women.
Don’t you just love articles that throw a wrench in the works of what we commonly believe? Personally, I find that I really have to think more precisely in defending beliefs I have obtained in my research when articles such as this arise. Basically, these researchers found no association between sugar intake and Type 2 diabetes. Looking at the full text, no real taboos jumpted out at me (funding by major companies, poor approximation of sugar intake by dietary questionaires, small sample size…); however, I do have a few comments. First, this study looked only at 6 years. My feelings are that diabetes develops over decades of poor dietary choices–initially the body can adapt and keep up w/ poor lifestyle choices but ultimately fails with time. Second, this study relied on the ability of study participants to recall generally what that had eaten in the past. This leads to all sorts of potential errors and does not have the power to differentiate whole grains from refined carbs. Maybe the whole grains were protective enough to override the detrimental effects of refined carbs in a group this size. We just can’t tell from this study. My recommendation–continue to avoid processed sugars like the plague.
Dia Care — Abstracts: Janket et al. 26 (4): 1008 - Click here for more information.
WHO’s diet report prompts food industry backlash.
Not really much to comment on on this one, but I feel everyone should know about the backroom politics that go into the making of policy. This is one of the reasons I do not strongly support the American Cancer Society, American Diabetic Association and the American Heart Association. Their recommendations are to weak willed because of the industry influence (many of which are on the boards of these groups!!!)
The Journal : Current Issue - Click here for more information.
Increased intestinal permeability as a cause of fluctuating postprandial blood glucose levels in Type 1 diabetic patients.
This article really reminds us of (or should wake others up to…) the importance of the GI tract to every other system and every other disease. Increased intestinal permeability will allow larger molecules to enter into the body and increase the antigenic load that the immune system and liver have to deal with. Restoring permeability can be done with careful attention to diet, avoidance of common allergens, probiotics and soluble fiber intake. I’m sure the info in this article will also pertain to Type 2 diabetics as well.
Click here for more information.
Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain.
Being that manual therapy is the bread and butter of my practice, I had to add this one into the Update…
bmj.com Abstracts: Bos et al. 326 (7395): 911 - Click here for more information.
April 23, 2003 Research Update
James Bogash, D.C. Mesa, AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com
Lutein and Zeaxanthin Raise Macular Pigment Density and Serum Concentrations of these Carotenoids.
It is surprising how many elderly patients I see in my office that are affected by AMD. Many of them would do just about anything to get their eyesight back. I do not believe that AMD can be reversed, but I do strongly believe that carotenoids such as these, as well as zinc and the bioflavanoids found in bilberry can prevent or slow the progression. Another incredibly simple preventative measure is to constantly wear sunglasses–even when the sun is tucked behind the clouds.
nutrition.org — Abstracts: Bone et al. 133 (4): 992 - Click here for more information.
Watermelon Increases Concentrations of Lycopene, beta-Carotene.
What more could we ask for? Personally I could eat watermelon 24 hours a day. Recall that lycopene has strong evidence supporting its use for prevention and treatment of prostate cancer and is also present in tomato and grapefruit.
nutrition.org — Abstracts: Edwards et al. 133 (4): 1043 - Click here for more information.
Macadamia Nuts Lowers Plasma Total and LDL Cholesterol Levels.
Sadly, I had another patient recently that I obtained old bloodwork on (6 months prior). This women was on Lipotor, despite the fact that her cholesterol was under 200, HDL was sky high at 80-something and triglycerides were just under 300. This does not strike me as a patient that needs meds–she needs lifestyle changes to affect Syndrome X (abdominal obesity was also present). Worsening the picture was that her liver enzymes were elevated and her PCP made no changes. Worse, the “lifestyle changes” he gave here were no breads and low fat. What an incredible disservice this patient was given. She was surprised when I told her to increase nut consumption (as well as other beneficial changes for insulin sensitivity) because her PCP told her to avoid them…
nutrition.org — Abstracts: Garg et al. 133 (4): 1060 - Click here for more information.
Differential effects of oral vs transdermal ERT on CRP in postmenopausal.
Hate to rely all my sad stories, but I had a woman in this week; 60 years old, multiple open heart surgeries, stent placement in both renal artieries and 3 strokes. You would think her cardiologists (a long stream of them) would at some point have discussed insulin management, homocysteine and CRP with her. Appearantly not. She is also currently on oral ERT which, as we see in this study raises CRP levels.
Cardiosource - Click here for more information.
Induction of tumors in mice by genomic hypomethylation.
If you wish to fully understand the folic acid cycle and its contribution to the methylation process and how this drastically impacts our current health and disease prevention and how this pathway is subject to multiple genetic variations then don’t ask me. I don’t remember all that biochemistry either. Just know that folic acid and SAM-e are essential players in the ability of our bodies to protect DNA through a process called methylation. I have actually added high dose folic acid supplementation to my recommended basic vitamin list.
Entrez-PubMed - Click here for more information.
Valerian.
If I can get patients to get past the smell of this herb, most of them find it very effective at helping them sleep. Once again, American Family Physician gives a nice, unbiased review.
Valerian – April 15, 2003 – American Family Physician - Click here for more information.
Uric Acid and Survival in Chronic Heart Failure.
I don’t always include articles about new lab values for prognostication of disease until be know how to modify the risk factor, but here we see that, in patient with chronic heart failure, low uric acid levels had a 100% accuracy in predicting that these patients will NOT need transplantation. Can’t beat 100%!
Circulation — Abstracts: Anker et al. 107 (15): 1991 - Click here for more information.
Magnesium Improves Insulin Sensitivity, Metabolic Control in Diabetes.
If I’m reading this right (and someone please correct me if I am!!) it looks like these patients got 2.5 grams of magnesium per day in this study. This is an incredible dose–which is good because too often we see clinical trials with supplements that use non-therapeutic levels and then say that it was of no benefit. Keep in mind that 2.5 grams would need to be administered carefully to avoid diarrhea (past a point where no more magnesium is absorbed, it stays in the colon and attracts water…).
Dia Care — Abstracts: Rodríguez-Morán and Guerrero-Romero 26 (4): 1147 - Click here for more information.
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