INTEGRATIVE HEALTH EDUCATION

A monthly review of 100 medical journals

Volume 13 ■ Number 1 ■ January 2012

EDITOR'S NOTE

A recent Twitter study reviewed the content of postings over a fixed period of time. It revealed that people are less happy than in years past. This is not surprising, but I choose to look at the doughnut, not the hole. There is much to be unhappy about these days of economic turmoil; yet, these travails are encouraging us to do an inventory of how we have been living as a society. Introspection and self analysis are very likely to cause some regrets and unhappiness. But, doing so may lead all of us to making the necessary changes to correct the factors that have lead to these dire conditions.

Forgiving ourselves and all of those who have contributed to our unhappiness is the only sane way to retain our health and be happy. As we start 2012, let us commit to living a more holistic and spiritual life. Our economic and political wellbeing depend on it (See my blog "Will the Mayans Get Us?") Hugo Rodier, MD

Whence allergies? Your gut!

This newsletter has been reporting on this simple concept for over a decade (good studies published in peer review journals.) Still, no journal has caught on as the journal Nature has. Its reports are so concise and clear that it is best to quote directly from commentators reviewing the last two studies on this field. The implications are enormous, which is why I chose these two articles to start the new year:

The title of the first article is "Microbiome: Gut reaction."[1]

The twists and turns of the human gut support an active and diverse microbial ecosystem. The tens of trillions of bacteria aren't just hitchhikers; they interact intimately with the immune system, and are so integral to our health that some scientists have deemed them the "forgotten organ". Today scientists are trying to unravel the relationship between changes in lifestyles in recent decades, changes in our microbiota, and the skyrocketing prevalence of allergies in the developed world. Establishing a link between these phenomena could lead to treatments for allergies and asthma.

It was the 'hygiene hypothesis' (see 'When allergies goes west', page S2) that first posited a causal link between Western lifestyles and allergy. Scientists found that zealous use of antibacterials, from cleaning products to antibiotics, had limited exposure to pathogens in early childhood. They suggested that the regulation of immune responses was compromised by this limited exposure. In the late 1990s, Agnes Wold, a bacteriologist at the University of Gothenburg in Sweden, brought gut microbes into the equation. Wold and her colleagues observed that typical gut bacteria colonize infants in Pakistan earlier than they colonize infants in Sweden. This delay, Wold suggested, could compromise immune tolerance - affecting the ability to cope with harmless antigens such as food and pollen.

 Huffnagle, a microbiologist at the University of Michigan in Ann Arbor, has built on this concept of the hygiene hypothesis. He proposes that the Western lifestyle can dramatically alter our gut microflora leading to allergies and other inflammatory diseases, an idea he calls the 'microflora hypothesis'.

The theory is supported by observational evidence. City dwellers, increasingly the predominant demographic, are exposed to a narrower range of microbes than people in rural areas - and they get more allergies. Children in rural Burkina Faso, where allergies are rare and the typical diet is high in fibre, have a different profile of microbes in their faeces than children living in Europe. The rapid increase in allergic diseases in the West has coincided with widespread use of antibiotics, especially broad-spectrum drugs. Antibiotics can profoundly alter the microbial composition of the gut, and studies show that children who are given antibiotics in their first year are more susceptible to allergies. "More and more of these smoking guns point to the role of the microbiota affecting immune development," says Brett Finlay, a microbiologist at the Michael Smith Laboratories, University of British Colombia in Vancouver.

Bugging the immune system: The immune cells in the gut are in constant contact with a diverse microbial milieu, and the human gut "has more immune cells than the rest of the body put together," says David Artis, a microbiologist at the University of Pennsylvania in Philadelphia. To an immune cell, beneficial or harmless bacteria (known as commensals) look much like harmful ones, but the beneficial bugs have developed methods of shaping the function of the immune system, so that their presence doesn't provoke an immune attack. "These bugs are flipping switches," says Sarkis Mazmanian, a microbiologist at the California Institute of Technology in Pasadena. If these beneficial microbes fail to colonize our guts early in life, or if they succumb to a course of antibiotics, then switches don't get flipped and the immune system can become hypersensitive, attacking harmless microbes and other substances such as pollen, pet dander or shellfish - or so the thinking goes.

Scientists are still trying to figure out which switches are flipped, how the commensal bacteria flip them, and what the consequences are. "I think there will probably be multiple pathways through which commensals can influence allergic disease," Artis says.

Several of these pathways appear to involve regulatory T cells: immune cells that suppress inflammation by keeping the immune system in check. "Our immune system is sort of like a loaded gun, and as soon as there's a microbe, it wants to fire," says Mazmanian. Mice lacking regulatory T cells develop allergies or autoimmune diseases, and research suggests that some microbes can increase their abundance or boost their activity. Kenya Honda, an immunologist at the University of Tokyo, has been investigating this link.

Honda's research focuses on bacteria in the Clostridium genus, many species of which live symbiotically in the intestines of mice and humans (although others, like C. dificile, are highly pathogenic). His team took mice that had been bred to be free of microbes, and inoculated them with a mixture of 46 different Clostridium strains. Sure enough, this was a catalyst for the production of regulatory T cells in the colon; inoculation with other types of bacteria had little or no such impact². The team then used the same 46 Clostridium strains to boost the microbiota of standard laboratory mice, which typically already have Clostridium bacteria at a low level, and subjected them to tests that would ordinarily provoke an allergic response. They found that the Clostridium-boosted mice exhibited much more muted allergic responses than a control group, suggesting that microflora rich in Clostridium can provide at least partial protection against allergies."Mice treated with antibiotics designed to eliminate Clostridium species had more food allergies than untreated mice."

Another mouse study, yet to be published, reinforces Honda's findings. A team led by Cathryn Nagler, an immunologist at the University of Chicago in Illinois, found that mice treated with antibiotics designed to eliminate Clostridium species had more food allergies than untreated mice. Nagler's team also found fewer regulatory T cells in the lining of the colons of these mice. "One of our challenges now is to see how those regulatory cells get out of the colon to mediate protection against allergic disease," Nagler says.

The title of the second article is "Peripheral education of the immune system by colonic commensal microbiota."[2]

Researchers at the University of Toronto have found an explanation for how the intestinal tract influences a key component of the immune system to prevent infection, offering a potential clue to the cause of autoimmune disorders like rheumatoid arthritis and multiple sclerosis.

"The findings shed light on the complex balance between beneficial and harmful bacteria in the gut," said Prof. Jennifer Gommerman, an Associate Professor in the Department of Immunology at U of T, whose findings were published online by the scientific journal, Nature. "There has been a long-standing mystery of how certain cells can differentiate between and attack harmful bacteria in the intestine without damaging beneficial bacteria and other necessary cells. Our research is working to solve it. The researchers found that some B cells-a type of white blood cell that produces antibodies-acquire functions that allow them to neutralize pathogens only while spending time in the gut. Moreover, this subset of B cells is critical to health.

"When we got rid of that B-cell function, the host was unable to clear a gut pathogen and there were other negative outcomes, so it appears to be very important for the cells to adopt this function in the gut," said Prof. Gommerman, whose lab conducted the research in mice. Textbook immunology-based mostly on research done in the spleen, lymph nodes or other sterile sites distant from gut microbes-has suggested that B cells develop a specific immune function and rigidly maintain that identity. Over the last few years, however, some labs have shown the microbe-rich environment of the gut can induce flexibility in immune cell identity.

Prof. Gommerman and her colleagues, including trainees from her lab Drs. Jörg Fritz, Olga Rojas and Doug McCarthy, found that as B cells differentiate into plasma cells in the gut, they adopt characteristics of innate immune cells-despite their traditional association with the adaptive immune system. Specifically, they begin to look and act like inflammatory cells called monocytes, while maintaining their ability to produce a key antibody called Immunoglobulin A.

"What intrigued us was that this theme-B cells behaving like monocytes-had been seen before in fish and in vitro. But now we have a living example in a mammalian system, where this kind of bipotentiality is realized," said Prof. Gommerman. This B-cell plasticity provides a potential explanation how cells dedicated to controlling pathogens can respond to a large burden of harmful bacteria without damaging beneficial bacteria and other cells essential for proper function of the intestine.

It also may explain how scientists had failed to appreciate the multi-functionality of some B cells. "There are classical markers immunologists use to identify B cells-receptors that are displayed on their surface-and most of them are absent from plasma cells," said Prof. Gommerman. "So in some cases, what people thought was a monocyte could have been a plasma cell because it had changed its surface identity, although monocytes play an important role in innate immunity as well.This transformational ability, the researchers also found, is dependent on bacteria called commensal microflora that digests food and provides nutrients. That relationship highlights the importance of the gut in fighting infection, and begs the question of whether plasma cells trained in the gut to secrete specific anti-microbial molecules can play a role in other infectious disease scenarios, such as food-borne listeria infection.

It also opens a line of investigation into whether a systemic relationship exists between those anti-microbial molecules and healthy cells in sites remote from the intestine. Understanding the nature of that relationship could improve understanding of inflammatory mechanisms in autoimmune disorders such as lupus, rheumatoid arthritis and multiple sclerosis, in which immune cells attack and eventually destroy healthy tissue.But the next step, said Prof. Gommerman, is to look at human samples for the same type of multi-potentiality they saw in rodent plasma cells that acquired their anti-microbial properties in the gut.

"We're really at the early stages of understanding what we call the microbiome in the gut," said Prof. Gommerman. "There is a role for plasma cells in many autoimmune diseases, and B cells can do a lot more than just make antibodies. We need to understand the full spectrum of their effects within the immune response."

Practical tip, if you have not heard it before: maximize microbiota health by eating lots of fiber (plant based foods,) and get rid of milk, processed sugars and fatty red meats. Limit the use of antibiotics, and acid blocking pills, and get a water filter.

INTEGRATIVE HEALTH EDUCATION

A monthly review of 100 medical journals

Volume 12 ■ Number 9 ■ September 2011

EDITOR'S NOTE

One of the worst habits Americans have, due to running around too much and getting to bed too late, is skipping breakfast. With time most people develop insulin resistance, which is why their chances of obesity go up by 400% while those who eat breakfast reduce their chances by 40%, even though they eat more calories. Think of breakfast as an investment: the article "Breakfast Consumption Affects Appetite, Energy Intake, and the Metabolic and Endocrine Responses to Foods Consumed Later in the Day in Male Habitual Breakfast Eaters"[1] tells us that by eating breakfast you will also be less hungry through the day, which will decrease your chances of being waylaid by a vending machine. Breakfast as the most important meal of the day; so, go for lots of veggies and lean meats. Grains will seem "dead" to you once you get in the habit.

Hugo Rodier, MD

Our battered soldiers

Our current involvement in "foreign entanglements" tells me we have apparently not learned from the past, our own history in Vietnam and the tragic experiences of other world powers in the same regions of the world (France, Russia, UK.) We all suffer for it, since the trillions spent and inexplicably lost in those wars are at the expense of social programs to care for the needy in our own country. But we still don't come close to the suffering experienced by our soldiers: death, mutilated bodies, economic pain and scarred psyches. Many of them are asked to serve repeatedly, in order to avoid a draft that would surely intensify the wrath and opposition all Americans share by now.

Some of our veterans take their own lives. Some choose to get no treatment from VA hospitals, fed up with a government they feel has abandoned them. A significant proportion of them never recover from Post Traumatic Stress Disorder, which, unfortunately afflicts foot soldiers the most, as opposed to better educated and more affluent officers. This is what the article "Preinjury Psychiatric Status, Injury Severity, and Postdeployment Posttraumatic Stress Disorder"[2] reviews. In other words, the less affluent have no other economic choices but to join the military. Some may already suffer from social/economic and political inequalities and perhaps discrimination due to race which may make them angry and resentful.[3]

Solutions? Avoid foreign entanglements and support our veterans to integrate back in our society. Improve GI bills to get vets into colleges to get an education. Many studies have shown that the more educated we are, the healthier and wealthier we tend to be. VAH psychologists, counselors, nurses and doctors are anxious to be of help; so, if you know a veteran in distress, encourage him/her to have patience with the system. It's the only thing we have since we have chosen "guns over butter."

Are you afraid of pancreatic cancer? (Or any cancer for that matter)

Most people picture a person they know when a disease is brought up. While Americans may think of Patrick Swayze ("Ghost")  when pancreatic cancer is discussed I think of my last patient diagnosed with it, Dave. Dave came in yellow as a pumpkin, a sure sign that a mass was obstructing liver flow of bilirubin, which got up to 25. Testing confirmed the diagnosis of pancreatic cancer. His life expectancy is 6 months. Dave is one of my favorite patients; his gentle personality and good nature brighten our day at the office when he comes in.

What could we have done to prevent his cancer? It is easy to recommend eating better, and avoid toxins; Dave tried, I am sure. But, sometimes genetics gets the best of us. Yet, by eating more veggies and eschewing processed foods, Dave has lost 30 lbs and his bilirubin is now 8. It is not too late for the rest of us to lower the risk of ANY cancer. The article "Body Mass Index and Obesity- and Diabetes-associated Genes and Risk for Pancreatic Cancer"[4] revisits the 1931 Nobel Prize-winning research of Dr. Warburg, who demonstrated that high sugar diets increase the risk of cancer. The pancreas is inflamed working overtime, which elevates the risk of cancer.

In past issues we have reviewed the groundbreaking study that showed a 2/3 reduction in the risk of cancer by eating specific fruits and vegetables.[5] Can you imagine a pill that would do that? Would you take it? Probably best to stick with "real food:"

                        Micronutrient            Food

                  ECGC                        Green tea

                  Curcumin                    Turmeric

                  Genistein                     Soy

                  I3C                             Cruciferous

                  Sulpharanes                 Cruciferous

                  Beta carotenes             Veggies

                  Resveratrol                  Grapes

                  Isothiocyanates            Cruciferous

                  Luteolin                       Celery, green pepper, peppermint

                  Lycopene                    Tomatoes

                  Anthocyanins               Pomegranate, wolfberry, plankton, algae

                  Delphidin                     Pigmented fruits, berries

                        Lupeol, sylimarin         Mango, olive oil, herbs

                        Gingerol                      Ginger

                        Capsaicin                     Red pepper

                        Sulfur                          Onions garlic

Up with smoke?

Children exposed to secondhand smoke at home are at least twice as likely to develop a neurobehavioral disorder (ADD) as are kids in smoke-free homes, a new study finds. And roughly 6 percent of U.S. children - some 4.8 million - encounter smoke at home.  Researchers at the Tobacco Free Research Institute in Dublin, Ireland, and at the Harvard School of Public Health's Center for Global Tobacco Control in Boston mined this information collected as part of the National Survey of Children's Health. This health report card was conducted by the CDC's National Center for Health Statistics. [6]

Parental smoking during pregnancy probably aggravates the ADD once the child is born; but, it is also associated with early growth problems, and a higher risk of obesity in preschool children.[7]

It has already been well documented that kids exposed to tobacco have more respiratory problems (asthma) and more ear infections.

BTW, smoking in adults increases the risk and aggressiveness of prostate cancer.

Bulking up

You are probably "fed up" hearing about fiber and how good it is for your BMs. Sure, but, another reminder won't hurt, especially when fiber has been found to increase longevity and reduce the chances of getting sick. How does that work? Fiber is also known as "prebiotics" because it feeds friendly bacteria, which make up 60% of our immune system;[8] as such, fiber improves your ability to metabolize food, detoxify and it also reduces inflammation. This is why gut flora has been shown to be sub-optimal in patients with Multiple Sclerosis.[9]

"Dietary fiber is important in digestion, and its relationship with chronic disease has been a topic of great interest for many years. Fiber consists of undigestible plant carbohydrates in both soluble and insoluble forms.  Soluble fiber (eg, fruit pectin) dissolves in water to form a gel, whereas insoluble fiber (eg, cellulose from wheat bran) does not. Both increase stomach distension, which increases satiety, and slow nutrient absorption. Soluble, and to a lesser extent insoluble, fiber is fermented by intestinal bacteria to produce short-chain fatty acids, which affect hepatic insulin sensitivity and lipid synthesis. The main function of insoluble fiber is to increase fecal bulk. Because these changes are thought to protect against the development of chronic diseases, a fiber-rich diet similar to that of early man is probably healthier than current Western diets."[10]

Telegraphed articles

"Higher Serum Free Testosterone Concentration in Older Women Is Associated with Greater Bone Mineral Density, Lean Body Mass, and Total Fat Mass: The Cardiovascular Health Study."[11] Don't be shy: get your doc to add testosterone to your hormonal replacement regimen.

"Adiposity and Bone: The Influence of Subcutaneous versus Visceral Fat and Insulin Resistance."[12]  Diabetic tendencies in obese children increase risk of thinner bones.

"Front-of-Package Nutrition Labeling - An Abuse of Trust by the Food Industry?"[13] Big Food lies on food labeling; surprise, surprise.

"Using Ecological Momentary Assessment to Determine Media Use by Individuals With and Without Major Depressive Disorder."[14] Depression is associated with more popular music and less reading print media.

"Television Viewing and Risk of Type II Diabetes, Cardiovascular Disease, and All-Cause Mortality."[15] Couch potatoes also eat more garbage while vegetating.

"National School Lunch Program Participation and Sex Differences in Body Mass Index Trajectories of Children From Low-Income Families."[16]  What a dilemma.. Some kids starve when school is out; but those who eat school lunches are more obese.

"Serum leptin and adiponectin levels correlate with exercise-induced bronchoconstriction in children with asthma."[17] "Obesity hormones" also make asthma worse. This is why a good diet improves/resolves asthma in most cases. Think of Dr. Warburg.

INTEGRATIVE HEALTH EDUCATION

A monthly review of 100 medical journals

Volume 12 ■ Number 8 ■ August 2011

EDITOR'S NOTE

About half of the stents placed in people's coronaries are of questionable value and even inappropriate in some cases.[1] Fortunately, more doctors are emphasizing preventive lifestyle changes much earlier in the course of heart disease. If they need to resort to pharmaceuticals, up-to-date doctors prescribe the oldest, safest and cheapest medications they have:

"If patients were prescribed [thiazide] diuretics for hypertension rather than the more expensive medications, the nation would save $3.1 billion every decade in prescription drug costs alone-and hundreds of millions of dollars more by avoiding stroke treatment, coronary artery bypass surgery and other consequences of high blood pressure."[2]

The best would be to educate patients on nutrition to avoid using 80% of pharmaceutical drugs in the treatment of heart problems.[3] Health boils down to METABOLOMICS (see late July blog), or the management of energy and information in good food by healthy microbes in the gut.[4] The cutting edge science pointing in this direction is so strong that Big Food is trying to cash in on it; but, their muddled thinking in pursuit of profits, not our health, produces laughable results: they are now marketing macaroni and cheese with a whiff of veggies in them. "What will they think of next?"[5] Hugo Rodier, MD

HEART AND THE GUT                                                                                                                        

Bad organisms in the gut (due to poor diets, too many antibiotics, acid blocking drugs, etc.) modulate food metabolism, which triggers the inflammation that leads to heart disease.[6] This concept is yet another neglected mechanism by which bad diets lead to heart disease, or any disease for that matter. A recent study showed that even young people without "traditional" risk factors, such as smoking, high blood pressure, cholesterol, etc., but with gut problems have a higher risk of heart attacks.[7] A lack of fiber in processed diets is one of the root problems. Fiber (prebiotics) in whole food diets feed probiotics or friendly bacteria in the gut. Then, our friendly microbiota is able to metabolize the food we eat well, which leads to less disease and longer lives.[8] This includes less heart disease:

"Dietary fiber is important in digestion, and its relationship with chronic disease has been a topic of great interest for many years. Fiber consists of undigestible plant carbohydrates in both soluble and insoluble forms. Soluble fiber (eg, fruit pectin) dissolves in water to form a gel, whereas insoluble fiber (eg, cellulose from wheat bran) does not. Both increase stomach distension, which increases satiety, and slow nutrient absorption. Soluble, and to a lesser extent insoluble, fiber is fermented by intestinal bacteria to produce short-chain fatty acids, which affect hepatic insulin sensitivity and lipid synthesis. The main function of insoluble fiber is to increase fecal bulk. Because these changes are thought to protect against the development of chronic diseases, a fiber-rich diet similar to that of early man is probably healthier than current Western-type diets."[9]

Understanding this vital connection between our diets, how we metabolize food in the gut chronic diseases explains some puzzling connections between diseases previously perceived as unrelated to other diseases. The fact that skin diseases like "Psoriasis increases risk of Coronary Artery Disease by 6%"[10] would be extremely puzzling, unless we consider the "Prevalence of the Metabolic Syndrome in Psoriasis."[11] In other words, how we metabolize our food in the gut determines practically all diseases, including heart disease.

Another gut link to heart disease is how the gut handles the amino acid arginine, whose research won the Nobel Prize in Medicine in 1998. Pfyzer  used it to create Viagra, a drug initially developed as an anti-hypertensive drug. Its better know function was discovered serendipitously when male study subjects were coming in the next day with huge ..smiles on their faces... But I digress. It turns out that poor diets and poor gut function leads to poor absorption of arginine. The following quotation is for eggheads and doctors only:

"Endothelium-derived nitric oxide (NO) is vasoprotective, as it enhances endothelial cell survival and proliferation, inhibits the excessive proliferation of vascular smooth muscle cells, and suppresses the adhesion of platelets and inflammatory cells to the vessel wall. Substantial evidence from preclinical studies and human research indicates that impairment of the endothelial NO synthase (NOS) pathway accelerates vascular disease and increases the risk for major adverse cardiovascular events. Impairment of the NOS pathway is multifactorial, but it is increasingly apparent that circulating inhibitors of NOS play an important role. Asymmetrical dimethylarginine (ADMA) and monomethyl-L-arginine (MMA) are endogenous competitive inhibitors of NOS. Most human studies have focused on ADMA, as it is the more prevalent species in human plasma. Plasma ADMA is elevated in patients with cardiovascular disease or with risk factors, and it contributes to vascular resistance and stiffness. Notably, several large studies have shown that plasma ADMA is an independent biomarker for cardiovascular morbidity and total mortality. Accordingly, endogenous mechanisms that regulate ADMA are deserving of further scientific attention."[12]

This means that a lack of arginine triggers changes on blood vessel walls that lead to plaque formation and poor blood vessel tone. A marker for a lack of arginine is the molecule DMSA, much like homocysteine goes up when we lack B vitamins. Eggheads need to know this, because focusing on how much arginine we have on board is not the final arbiter, but DMSA is. This is why some doctors dismiss studies on the benefits of arginine, despite the literature. I am guessing hey do so because arginine is an "alternative" food supplement..until it is turned into a drug (Viagra,) of course.

Arginine is also an antioxidant; a lack of antioxidants is yet another mechanism that leads to all diseases, including heart disease. The June 24^th issue of the journal Cell has on its cover a picture of the remarkable disfiguring seen in oxidized proteins. So, a lack of antioxidants in our diet contributes to the dysfunction seen on proteins, especially those composing cell membranes. This leads to poor cell communication and management of energy and information (metabolism), the slippery slope of disease. A diet high in antioxidants (fruits and veggies) prevents this problem:

"Predictors of Omega-3 Index in Patients With Acute Myocardial Infarction." Eat more fish, olive oils, avocados, and nuts. J. Mayo Clin Proc. July 2011 86(7):626

"Trans-Fatty acids, insulin resistance/diabetes, and cardiovascular disease risk." Get off processed fats. Journal Metabolism Clinical and Experimental 2011;60:901

"N-3 Fatty Acids in Cardiovascular Disease," including strokes,[13] NEJM 2011;364:2439

 "Cruciferous vegetable consumption is associated with a reduced risk of total and cardiovascular disease mortality." Eat more broccoli, cauliflower, cabbage, etc.

 J Clin Nutr 2011;94:240

Stress, inactivity and environmental toxins also contribute to heart disease:

"Effects of 1 day of inactivity on insulin action in healthy men and women: interaction with energy intake." Just one day vegetating on the couch increases risk of heart disease.

Journal Metabolism Clinical and Experimental 2011;60:941

"Counting strenuous work, physical activity minimum would go from 64% up to 71%." If you are exhausted at the end of the day after hard labor, don't feel too bad if you can't go running.

JAMA 2011;305:2509

"Healthy Psychological Functioning and Incident Coronary Heart Disease." The less well we cope with stress, the higher our chances of having heart problems. See my last blog (July 2011)

J. Arch Gen Psy 2011;68:400

 "Tai Chi Exercise in Patients With Chronic Heart Failure." Any stress management technique will help our heart. J. Arch Int Med 2011;171:750

"Statin Dose and Risk of Incident Diabetes," Intensive Rx increases risk of diabetes, which increases the risk of heart disease. Yet another reason why Simvastatin 80 mg is being taken off the market, if the FDA quits dragging its feet: it does not work any better than the 40 mg tablet.

            JAMA 2011;305:2556 & 2011;306:143

"Even short term NSAIDs is risky after a heart attack." A few days on Ibuprofen also increase the risk of heart problems. See below for more on these problematic drugs.

J. Family Practice News, June 1^st 2011, 16

GETTING HEARTBURN, YET?

Sure, you don't want to be in pain, so, you follow the commercial's advice to take advil-like drugs. But, they can increase the risk of high blood pressure and heart attacks. Before that happens, you may get plenty of warning: stomach problems, particularly heartburn. So, you decide to follow another commercial advice and start taking acid blocking pills. Too bad they alter the delicate balance of the gut microbiota, leading to the problems discussed above. These drugs are 53% to 69% of the time over-prescribed.[14]

Refusing to believe this data, a young wife recently insisted that her husband stay on the purple pill and abandon my diet plan, designed at his request, to cure his heartburn and Barrett's esophagus. No doubt she bought into the fear-driven use of pharmaceuticals, ignoring yet another study that cancer of the esophagus is seen in only 0.13% of patients like her husband.[15]

INTEGRATIVE HEALTH EDUCATION

A monthly review of 100 medical journals

Volume 12 ■ Number 7 ■ July 2011

EDITOR'S NOTE

The politics and economics of health care are so dominant that our President had to abandon his plan to push the Single Payer option favored by most doctors and patients (I feel it would be best for each state to have its own version.[1]) Big Pharma and the Insurance Companies preferred a potpourri/mess of regulations that in the end mostly favors them and their bottom line, profits. In the meantime, 47 million Americans have no health care and we slip further and further down in the rankings of people's health in the world, despite our country spending double the amount the top 5 countries spend per citizen.

Fortunately, solutions are available, even at top ranked medical schools in the USA, where Integrative Medicine departments are implementing simple lifestyle and environmental changes that strike at the root of disease.[2] Doctors and patients are beginning to realize that the pharmaceutical approach, while helpful in a crisis, is not the only, nor the best way to address chronic problems. The tsunami of expensive "me, too" drugs is increasingly seen for what it is, a cash cow for Big Pharma in a hypercompetitive market that does not serve patients well.

"The United States would do well to watch (England) carefully how the "burden of illness" and "wider societal benefits" come to affect pharmaceutical pricing, decision making, and sources of influence over the interpretation of societal value."[3]

Yet, President Obama has given away our country's power to negotiate lower prices on drugs the government buys in bulk for Medicare and Medicaid beneficiaries because "the business of America is business." This mentality has had its day and the results are plain for all to see. Surely there is room to compromise, whether we come from the left or the right. Ideally, our society could modify the infamous "bottom line" to include profits, social and environmental responsibility, like England seems to be contemplating.[4] Hugo Rodier, MD

Studies with minimal commentary, after exhausting your patience with ranting editorial

"Social rejection shares somatosensory representations with physical pain." It hurts physically to get dumped. J. Proceedings of the National Academy of Science 2011; Epub March 28, 2011

"Confronting reality: pitfalls of calorie posting." Not worth the trouble; do you see people losing weight? American J. Clinical Nutrition 2011 93: 4 679

"Front-of-Package Nutrition Labeling - An Abuse of Trust by the Food Industry?" Pretending to inform the public, the food industry ramps up marketing ploys. NEJM 2011;364:2373

"Exploring how calorie information and taxes on high-calorie foods influence lunch decisions." The twinkie tax works in decreasing consumption. Am J Clin Nutr 2011;93:689

"Subcutaneous adipose tissue in relation to subclinical atherosclerosis and cardiometabolic risk factors in midlife women." Beer-belly= higher risk of heart disease. Am J Clin Nutr 2011;93:719

"Energy, evolution, and human diseases." If you want to lose weight and have a good immune system, quit eating garbage! Am J Clin Nutr 2011;93:875S, 891S

"Short-term consumption of a high-fat diet impairs whole-body efficiency and cognitive function in sedentary men." You are not thinking clearly if you believe that an occasional fatty meal is harmless. FASEB J. 2011;25:1088

"Dietary Whey Protein Lowers the Risk for Metabolic Disease in Mice Fed a High-Fat Diet." No, you are not a mouse, but whey can also help you with weight/cardiac/diabetic issues, especially if you cannot give up high fat foods. J. Nutrition 2011;141:582

"DNA methylation in metabolic disorders." B vitamins modify genetic tendencies, thereby lowering the risk of obesity and diabetes. Am J Clin Nutr 2011;93:897S

"MTHFR 677C→T genotype is associated with folate and homocysteine concentrations in a large, population-based, double-blind trial of folic acid supplementation." Some people need a metabolized form of folic acid, MTHFR, to accrue benefits. Am J Clin Nutr 2011;93:1365

"Adjunctive L-Methylfolate May Help in treatment Resistant Depression." L-methylfolate ~ MTHFR (see above.) 19^th European Congress of Psychiatry, Vienna, 2011

"Low Plasma Vitamin B-6 Status Affects Metabolism through the Kynurenine Pathway in Cardiovascular Patients with Systemic Inflammation."  Significant reduction of inflammation in vasculature and joints with B6. J. Nutrition 2011;141:611

"Dietary B vitamin intake and incident premenstrual syndrome." Processed foods lack B vitamins, which drive PMS. Low B vitamins also seen with GI abnormalities, heavy metals, metformin and acid-blocking pills. Am J Clin Nutr 2011;93:1080

"The Association of Serum Phthalates and Parabens with Mammographic Breast Density." Plastics/endocrine disruptors over stimulate breast, thus increasing the risk of breast cancer. They also mess with menses. J. Cancer Epidemiol Biomarkers Prevention 2011;20:718

"Endocrine Disruptors and Polycystic Ovary Syndrome (PCOS): Elevated Serum Levels of Bisphenol A in Women with PCOS." Plastics disrupt ovarian function.
J Clin Endocrinol Metab 2011 96: E480

"Targeting Dimethylarginine Dimethylaminohydrolases in Pulmonary Arterial Hypertension: A New Approach to Improve Vascular Dysfunction?" The amino acid arginine works with B vitamins to improve tone/lining of ALL arteries. J. Circulation 2011;123:1156

"Low Levels of Asymmetric Dimethylarginine in Children with Diabetes Mellitus Type I Compared with Healthy Children." Arginine helps arterial health in diabetics and pre diabetics.  J. Pediatrics 2011;158:602

"Association between Oxidative Stress and Masked Hypertension in a Multi-Ethnic Population of Obese Children and Adolescents." Lack of antioxidants in diet (like arginine) makes blood vessels stiffer = high blood pressure. J. Pediatrics 2011;158:628

 "Serum α-Carotene Concentrations and Risk of Death Among US Adults: The Third National Health and Nutrition Examination Survey Follow-up Study." Live longer eating carrots.

J. Arch Intern Med. 2011;171:507

"A mitochondrial enzyme degrades carotenoids and protects against oxidative stress." Add broccoli, spinach and sardines (Alpha lipoic acid, COQ10) to your carrots.                                  FASEB J. 2011;25:948

"Low plasma coenzyme Q₁₀ levels and breast cancer risk in Chinese women." See above.

J. Cancer Epidemiol Biomarkers Prev. Published Online First April 5, 2011; doi:10.1158/1055-9965.EPI-10-1261   

"Rapid Suppression of Growth Hormone Concentration by Overeating: Potential Mediation by Hyperinsulinemia." Poor tissue renewal and growth with processed foods that increase risk of pre Diabetes/hypoglycemia. J. Clinical Endocrinology Metabolism 2011;96:824

"Exposure to Room Light before Bedtime Suppresses Melatonin Onset and Shortens Melatonin Duration in Humans." Don't watch TV before falling asleep. Read with indirect light in the evening. J Clin Endocrinol Metab 2011;96:E463

"Blood Pressure and the Risk of Developing Diabetes in African Americans and Whites: ARIC, CARDIA, and the Framingham Heart Study." If you have high blood pressure, you have a higher risk of developing diabetes. Think of "starched" blood vessels. J. Diabetes Care 2011;34:873

"α-Lipoic acid can improve endothelial dysfunction in subjects with impaired fasting glucose." Broccoli antioxidant protects arterial lining in pre diabetics. Journal Metabolism Clinical and Experimental 2011;60:480

"Association of serum lycopene and brachial-ankle pulse wave velocity with metabolic syndrome." So do tomatoes (see above.) J. Metabolism Clinical and Experimental 2011;60:537

"Hemoglobin A_1c as a Diagnostic Tool for Diabetes Screening and New-Onset Diabetes Prediction: A 6-year community-based prospective study." A1c >5.9 = diabetes. A1c >5.6 = pre diabetes. J. Diabetes Care 2011;34:944

"The Relationship Between β-Cell Function and Glycated Hemoglobin: Results from the Veterans Administration Genetic Epidemiology Study." Another good diabetic screening is the Glucose Tolerance Test. Ask our doc to order insulin levels, too. J. Diabetes Care 2011;34:1006

"Almond consumption improved glycemic control and lipid profiles in patients with type 2 diabetes mellitus." If you chew them 40 times before swallowing they decrease appetite, too. Journal Metabolism Clinical and Experimental 2011;60:474

"Microbiota regulates immune defense against respiratory tract influenza A virus infection." Keep gut flora healthy (fiber, lots of fruits and veggies; limit antibiotics, acid-blocking pills, etc) and you will have a better chance against colds and the flu. PNAS 2011;108:5354

"Facebook and depression in teens." Either Facebook makes teens depressed or they are so depressed they log on Facebook. J. Pediatrics, Epub March 28^th 2011

"Rotenone and Paraquat Linked to Parkinson's Disease: Human Exposure Study Supports Years of Animal Studies." Pesticides are neurotoxic; they are derivatives of nerve gas used in WWI and WWII. J. Environmental Health Perspectives 2011;119:a259 & JAMA 2011;305:1188

"Widely Used Pesticides with Previously Unknown Endocrine Activity Revealed as in Vitro Antiandrogens." Dimethomorph, fludioxonil, fenhexamid, imazalil, ortho-phenylphenol, and pirimiphos-methyl also mess with your hormones. J. Environ Health Perspect 2011;119:794

"Green tea polyphenol EGCG blunts androgen receptor function in prostate cancer." If you cannot afford to eat organic at least drink green tea. FASEB J. 2011;25:1198

"A Prospective Study of the Effect of Gastrointestinal Reflux Disease Treatment on Children with Otitis Media," Processed foods directly and indirectly cause ear infections. J. Archives of Otoralyngology-Head and Neck Surgery 2011;137:35

"Soy Food Consumption and Breast Cancer Prognosis." How many times must I write that soy LOWERS the risk of breast cancer? J. Cancer Epidemiol Biomarkers Prev. Published Online First February 25, 2011; doi:10.1158/1055-9965.EPI-10-1041

"Progesterone Prevents Sleep Disturbances and Modulates Growth hormone, Thyroid Stimulating Hormone, and Melatonin Secretion in Postmenopausal Women." Progesterone is not just a sex hormone. Don't take estrogen alone without progesterone, even when you had a hysterectomy. J Clin Endocrinol Metab 2011 96: E614

"Regulation of Tight Junction Permeability by Intestinal Bacteria and Dietary Components." Probiotics improve "leaky gut." J. Nutrition 2011;141:769

INTEGRATIVE HEALTH EDUCATION

A monthly review of 100 medical journals

Volume 12 ■ Number 6 ■ June 2011

EDITOR'S NOTE

More on FOOD ADDICTION from last month's issue: the conclusion of a study that looked at food addiction scores (DSM-IV-TR) and the Yale Food Addiction Scale scores and their correlation to the findings of a Functional MRI of the brain. There was greater activation in the anterior cingulated cortex, medial orbitofrontal cortex, and amygdala in response to anticipated receipt of chocolate milk share:

"If certain foods are addictive, this may partially explain the difficulty people experience in achieving sustainable weight loss. I f food cues take on enhanced motivational properties in a manner analogous to drug cues, efforts to change the current food environment may be critical to successful weight loss and prevention efforts. Ubiquitous food advertisement and the availability of inexpensive palatable foods may make it extremely difficult to adhere to healthier food choices because the omnipresent food cues trigger the reward system. Finally, if palatable food consumption is accompanied by dis inhibition, the current emphasis on personal responsibility as the anecdote to increasing obesity rates may have minimal effectiveness."[1]

Hugo Rodier, MD.

Coffee update

I drink a cup a day; more than that and I get reflux and gastritis, because I have a family history of not optimally replenishing the lining cells of my stomach, which need to be "recycled" every 36 hours. If one does not do this effectively, one may also end up with gastritis and heartburn. Of course, most doctors still blame the stomach acid, not remembering that it needs to be there for proper digestion and to keep bad organisms from colonizing our gut.

These issues are not addressed in the new article about coffee lowering the risk of prostate cancer; neither is the negative effect of coffee on blood pressure and heart rhythm. While coffee is correctly shown to lower the risk of prostate cancer (and breast cancer as well) by 33%, the study's 6 cups a day give me pause;[2] we may be robbing Peter to pay Paul.

This salutary effect of coffee is also reported with decaffeinated coffee, which points to its antioxidant content as the source of its anti cancer function. Sadly, decaffeination uses many chemicals, unless you find the coffees that use a more organic decaffeination process. Unfortunately, we may be at the mercy of marketing claims that may not be true. I would not give up on "the real coffee," just yet: caffeine helps potentiate the detoxification function of antioxidants in the liver, it also helps bowel movements, thereby increasing detoxification and elimination of the very xenoestrogens (endocrine disruptors) associated with prostate cancer.

Too much fruit?

I get asked this question at least once a week. There may be some "yeast fanatics" out there advising people to avoid fruit. While this may be true in a few isolated cases, it is not true in most people, even in most diabetics. Sure, your blood sugar goes up when you eat fruit, but, by enriching our cell membranes, we become more "insulin sensitive" in the long run. Diets that have 13 servings of fruits and veggies combined are best. Think of exercising; your heart rate does go up, only to return to a lower average resting heart rate when you exercise routinely.

The journal Neuron, March 3^rd 2005 shows fruit raining on the cell membrane on its cover issue, illustrating the need of the right sugars to constitute our cell membranes optimally, so that they may function best, and as noted above, be more receptive to the action of insulin. Remember that this vital hormone takes glucose from the blood stream into our cells to fuel the latter.  Another cover issue, the Journal Science, March 23^rd 2001, is about "Glycobiology," the science that deals with how important the right sugars are for us. Natural sugars not only optimize cell membrane function, but the function of most proteins through the process of "glycosylation," or adding sugar to a protein. Insulin itself is a "glycoprotein."

Fruits also have a lot of fiber that mitigates the absorption of fructose from the GI tract, whereas sugar in processed foods lack fiber, which leads to a faster absorption of sugar from the GI tract; concomitantly, the resulting dramatic rise in blood sugar potentiates the addicting nature of artificial sugars. Also, fructose is metabolized differently in the liver, a function optimized by the high antioxidant content of fruits, particularly berries and kiwis.

Last but not least, is the fact that we have a genetic "sweet tooth,: which has kept us happy and living longer. BUT, we need to satisfy this sweet tooth with the right sugars, those given to us by Mother Nature, not Kellog or Mc Donald's. This is the main tenant of Glycobiology. Think of sex as an example: if you do not satisfy those normal needs in a respectful and socially acceptable way (fruit), you will be vulnerable to "temptations" (processed foods.)"

Preventing urine infections

If you have been reading this newsletter for a while, you will say "of course" when you read that probiotics prevent urine infections.[3] Probiotics, as you know, ARE the immune system. So, treat them well by eating whole foods high in fiber and low in trans-fats and refined sugars. The latter are redolent with antibiotics and many other chemicals that compromise friendly bacteria in the gut. Try to avoid frequent antibiotic therapy, which is not good for probiotics. Next time you have a UTI, see if you may get by with cranberry, uva ursi (herb) and vitamin C, 2 grams every other hour to acidify the urine. Urinating after intercourse is also helpful.

More than meets the eye

Selenium helps eye problems when people have an overly active thyroid gland.[4] Why is that?

"The decrease survival of patients with age-related eye disorders suggests that these conditions may reflect systemic rather than only local processes. The improved survival in people taking Zinc [suggests this]"[5]

Sure, take zinc, too, but the main point is that any dysfunction at the cellular level is likely to be at play IN ALL CELLS. That the eye may be affected first is because of genetic tendencies tha may lead to dysfunction therein being noticed first. Besides, the eyes are "windows" to look "inward," too. In other words, a lack of antioxidants like zinc and selenium predispose the eye (and all other cells) to disease, which then leads to decreased longevity. By the way, a lack of selenium has been associated with aneurisms of arteries, leading to fatal bleeding. If you have a family history, for sure you need to supplement selenium. Selenium is generally lacking in depleted soils, since most of it is found in plant foods. To get the 200 mcg needed, eat 4 Brazil nuts a day.

Are you being treated unnecessarily for hypertension?

Chances are that 40% of people are;[6] hope you are not one of them. A lot of patients' blood pressure surge when they go to the doctor. We call this "white coat" hypertension. Since I don't wear a white coat, people must be reacting to how mean some people think I am because I try to take their candy away..

To avoid unnecessary drugs, insist on bringing in blood pressure readings from home (if you own a cuff) or from a pharmacy. If the average BP reading is under 140/90, you probably don't need medication, although that number signals a developing problem. It would be best to get readings below 130/85. As we saw with the eye story above, spikes of blood pressure, even "white coat" driven, may mean that the cells lining our arteries are beginning to show inflammation/oxidation/toxicity, which drives the spasms of the arterial muscles that elevate blood pressure. In other words, look at any elevation of blood pressure as a sign that ALL your cells are in distress. Treatment with an anti hypertensive drug does not address these underlying concerns; it merely lowers the number, which mechanically may decrease hypertension problems on end organs (brain, heart, kidneys.) But, to work on the real problem (see above,) we need to change our diets and eat more foods with antioxidants (Google DASH diet.) BTW, lay off salt, and consider going easy on ibuprofen-like drugs and even Tylenol.[7] They raise blood pressure.

You may also optimize blood vessel integrity with the amino acid Arginine 3-6 grams, curcumin, vitamins K&D, and omega oils. The same approach may ease Atrial Fibrillation (quivering of the upper chambers of the heart) which is more than 50% preventable by addressing hypertension and obesity.[8] Yoga helps with this, too.[9]

The heart of the matter: the beer-belly

One of the main tenants of metabolic medicine posits that the BMI, counting calories and weighing yourself are micromanaging, ineffective, impractical ways to cope with the Battle of the Bulge. A more practical way is to lok down at your waistline. "Central Obesity and Survival in Subjects With Coronary Artery Disease: A Systematic Review of the Literature and Collaborative Analysis With Individual Subject Data"[10] goes as far as to say that your beer belly is one of the main factors that determine rate of survival in people with coronary problems.

"Excess Visceral Adipose Tissue/Ectopic Fat: The Missing Link in the Obesity Paradox?"[11] puts it all together: it is insulin resistance or pre diabetes that drives both the beer belly AND heart disease, a fact clearly illustrated by the lipid or cholesterol pattern where the triglycerides are elevated and the HDL or good cholesterol is depressed. Said pattern reflects the effect of insulin resistance on the liver's ability to handle cholesterol. Patients with coronary issues who have an elevated ratio of Triglycerides/HDL are more likely to have heart attacks in 10 years.[12]

This is why treating high cholesterol with drugs is more successful when antioxidants are added to the regimen; they improve liver function, particularly in those whose liver is said to be "fatty," a sure sign of insulin resistance.[13]

A more gentle way to treat inflammation

The evidence that anti inflammatory drugs, as helpful as they are to relieve suffering, come at a stiff price (side effects and 100,000 deaths/year) continues to mount; now we learn that these drugs increase the risk of diverticulitis.[14] Consider safer supplements like SAMe, MSM sulfur, glucosamine and Chondroitin instead.[15]

INTEGRATIVE HEALTH EDUCATION

A monthly review of 100 medical journals

Volume 12 ■ Number  4 ■ April 2011

EDITOR'S NOTE

Once in a while I run across the writings of courageous and cutting edge doctors who dare question our chaotic Health Scare system. Dr. Palfrey revisits the old myth of Vulcan, the God of Technology, raping Minerva, Mother Earth quite well, as the movie AVATAR also does. But, let me get out of the way for you to read his wise advice:

I've grown worried that the practice of medicine has tipped out of balance.Recent advances in scientific knowledge and technology have resulted in the development of a vast array of new tests, new pharmacologic agents, and new diagnostic and therapeutic procedures. These are so accessible to us in the United States that few of us can resist using them at every opportunity. By being impatient, by mistrusting our hard-earned clinical skills and knowledge, and by giving in to the pressures and opportunities to test too much and treat too aggressively, we are bankrupting our health care system. Ironically, by practicing this way, we are perpetuating serious economic and racial disparities and have built a health care system that rates in the bottom tier among all developed countries in many categories of children's health outcomes.

Most doctors are intensely risk-averse. We don't tolerate uncertainty. Not wanting anything bad to happen, we reflexively overtest and overtreat in order to protect our patients - and ourselves. We feel judged by everyone - ourselves, our colleagues, our patients, the health care system, and the lawyers. The meaning of "first do no harm" has changed for us. We feel that "doing everything" is the best practice and the way to prevent harm, and we believe that it will shelter us from blame. We order tests and treatments because they are available to us, well before their importance has been established, their safety has been determined, and their cost-benefit ratio has been calculated.

The evaluation of a child with fever and cough is a good example. There are many possible causes, and we have a huge battery of available tests that might give us potentially relevant information. But why should we no longer trust our physical exam, our knowledge of the possible causes and their usual courses, and our clinical judgment? How much will we gain by seeing an x-ray, now, and how likely is it that the result will necessitate a change in our management? How dangerous would it be if we chose to perform certain tests later or not at all? Might our residents not learn more by thinking, waiting, and watching? Who is actually benefiting when we order a test - the patient, the laboratory, the drug company, the health plan administrators, or their investors? And who is losing health care as we spend these dollars? We need to ask these questions of ourselves and our residents at every step of the clinical process.

I believe that we must rediscover the value of clinical judgment and relearn the importance of the personal, intellectual, scientific, and administrative thought that is central to the best practice of medicine. We need comparative-effectiveness research, as well as cost-benefit and long-term-benefit analyses, to inform us how to integrate traditional clinical skills with the use of new tests and therapies. Our time and attention have been diverted to the task of sorting out data instead of sorting out what is important to our patients, their families, and the community at large. This new style of test-avid, cover-all-possibilities practice is bankrupting our health care system and depriving many families of access to health care and a medical home.

We as clinicians must change our practice patterns, but first the medical community, through standard-of-practice guidelines, must give us permission (or better yet, encourage us) to practice in a less costly way, so we don't feel we are expected and incentivized to order expensive tests or treatments. Similarly, clinician-teachers must develop the confidence (or be given the imperative) to teach students, residents, and fellows how to practice in the most knowledge-based, least invasive, most frugal fashion possible and to seek input from physicians with more clinical experience when they feel the urge to order a test or initiate a treatment.

Education of the public is also critically important. We need to admit to our fellow citizens that the United States, despite its wealth, technology, and research expertise, is 21st in the world in terms of many indicators of health, and we must convince them that population-wide changes designed to improve health outcomes would be in everyone's best interest. We need to teach our patients that more medicine is not better medicine, that it is poor health care for doctors to order too many tests or too many interventions, and that costly efforts do not equal better health care. As we address their personal needs, we need to explain to our patients that we have to use new medical technology with care and wisdom. Indiscriminate health care spending is not fiscally sustainable at a national level and actually hampers the achievement of many universal health benefits.

Every participant in our health care system must focus on ways to optimize health while decreasing cost, at every step of the process. We need to change the financial incentives currently embedded in health care reimbursement systems that reward the use of tests, procedures, consultations, and high-cost therapies. And finally, the legal system needs to be more restrained about pursuing lawsuits when a difficult diagnosis is missed or a treatment fails, to diminish the pressure on health care providers to practice expensive, defensive medicine at every turn.

These are major changes, but today we are far from providing good care for all our citizens and far from achieving health care equal to that in many other countries. We need to incorporate more realistic clinical, scientific, and financial information into practice in order to bring our health care practices, and our health care system, back into balance.[1]

The good doctor's advice is backed by research that many of the nifty tests we have relied on, like CAT scans, are not as harmless as we have been told by the industry.[2] As he suggests, we need to educate our doctors and the public about these issues; it all boils down to education. Unfortunately, medical education is in the hands of the very industry that pushes for a fancy pharmaceutical-technological approach:

The extent of industry support of continuing medical education (CME) has prompted concern that the medical profession has lost control over its own continuing education.  In response, some academic medical centers, such as Memorial Sloan-Kettering Cancer Center, have stopped accepting support for CME from pharmaceutical and medical device companies; others, such as the University of Michigan, are planning to do so. Although the role of industry-sponsored CME remains controversial, there are proposals to either ban direct or indirect commercial support of CME or to otherwise reform the funding system. At present, a national ban on industry support is unlikely. The Accreditation Council for Continuing Medical Education (ACCME) has considered and rejected ending commercial support.[3]

So, what can we do? Spread the word; slowly, we, the people, will change the system. Be patient and see these problems as an opportunity for growth and change. We have the "True Grit"[4] necessary to overcome the greed and materialism that infects all areas of our society.

Hugo Rodier, MD

The Man in the Mirror

We need to work on the spiritual issues that plague our society, including our national addiction to refined foods, especially sugar. If we were to do this, we would immediately cut our health care expenses by 80%.[5] Of course, most dietitians will disagree that the problem is an addiction. The article "The Emerging Link Between Alcoholism Risk and Obesity in the United States"[6] leaves little doubt that we need to address obesity the same way we do alcoholism, smoking and any other addiction fueled by physiologic and emotional issues.To ignore this cutting edge research, in view of the tsunami of health problems obesity brings, is not wise:

We are in trouble. Effective strategies for preventing and treating obesity require a commitment to addressing its causes and consequences at multiple levels-from basic research through community and policy interventions.[7]

Pediatric update

The ones most affected by the bad foods we eat are our children (see blog "Reversing my Vote on Trixx.") Here are the most recent articles I have read that apply to our beleaguered children:

"Caffeine Consumption in Young Children" triggers insomnia.[8] Cola drinks included, especially while watching TV and playing video games.

Bad foods trigger reflux that may lead to ear infections in kids.[9] Instead of treating the reflux with the purple pill, may be an elimination diet could reveal the offending food. (milk for sure.)

An elimination diet can help kids with ADD.[10] The main problem is processed food full of preservatives, pesticides, trans fats and refines sugars.

Vitamin A helps boost the immune system in intestinal infections.[11] Eating more fruits and veggies can prevent and treat most infections.

Low vitamin D levels increase allergies, asthma and pre diabetes.[12] Kids should be taking from 800-2,000 IU, but it is best to keep their blood levels around 75.

Acupuncture better than eye patching for "lazy eye."[13] Avoiding surgery would be cheaper

Passive smoking raises kids' blood pressure.[14] And we thought that the only problem with this was allergies, ear infections and asthma.

Low normal thyroid function increases the risk of heart problems in teens.[15] Give them iodine.

Benzene products increase the risk of neural tube defects in newborns.[16] Take folic acid.

INTEGRATIVE HEALTH EDUCATION

A monthly review of 100 medical journals

Volume 12 ■ Number 23 ■ March 2011

EDITOR'S NOTE

                   INTEGRATIVE HEALTH EDUCATION

             A monthly review of 100 medical journals

                                        Volume 12 ‘ Number 2 ‘ February 2011                         

EDITOR'S NOTE