"Integrative Health Education " Newsletter

Dr. Hugo Rodier publishes a monthly newsletter on the latest integrative medicine news and information. Dr. Rodier researches of over 150 medical journals each month to provide his readers top scientific information for optimal health. The newsletter does not sell any products.

INTEGRATIVE HEALTH EDUCATION

A Monthly Review of 150 Medical Journals

Volume 9 � Number 4 � April-May 2008 

EDITOR’S NOTE 

 It’s been a while since I wrote about the problem with the ‘calories in = calories out” paradigm. In light of recent discoveries about how we process food in the intestines, I wish to revisit this issue. In my view, this worn out paradigm needs to be “flushed down the toilet,” literally, as you will see. Perhaps you remember the articles I have previously reported herein on how our intestinal flora modulates our metabolism, influences the amount of calories we extract from food and even sends signals to our brains to talk us into continually feeding them (the organisms dwelling in our gut) the processed foods rich in chocolate and refined sugars we got them addicted to. Naturally, they turn around and demand that we keep that kind of diet up: now them and us are addicted to bad foods.
            There is another reason why we need to abandon the “calories in = calories out” dogma: it never worked.
            The evidence to change these old paradigms has been around for a while, yet, some still profess that there is no such evidence. Soon, the weight of scientific inquiry will be too large to ignore, especially when the NIH awarded 122 grants to nutrition-related investigations, out of 236 grants in 2007 (http://nccam.nih.gov/research/extramural/awards/2007.)

Hugo Rodier, M.D.

Who governs whom?

            Do we control our intestinal flora, or do they control us? Let us astart considering the question by remembering that most of the genetic material within our body is theirs, not ours. Now, read the highlights from this great review article, “Gut Microbiota and Its Possible Relationship with Obesity” (J. Mayo Clinic Proceedings 2008;83:460.)

·        “Mice raised on regular food have 40% higher body fat and 47% more gonadal fat content than germ-free mice, even though they consumed less food than their germ-free counterparts. The distal gut microbiota from the [fat] mice was then transplanted into the germ-free mice, resulting in a 60% increase in body fat within 2 weeks without any increase in food consumption or obvious differences in energy expenditure.”

·        Microbiota promotes absorption of monosaccharides, fermentation of indigestible polysaccharides and short-chain fatty acids; also, regulation of genes that promote deposition of fat in lipocytes.

·        “Gut microbiota can affect both sides of the energy balance equation, influencing energy harvest from dietary substances and affecting genes that regulate how energy is expended and stored.”

·        “…More end products of fermentation (acetate, butyrate,) and fewer calories in the feces of the obese mice, leading them to speculate that the gut microbiota in these mice facilitate the extraction of additional calories from ingested food…[this] suggests that differences in caloric extraction of ingested food substances may be determined by the composition of the gut microbiota.”

·        Inflammation seen in metabolic syndrome likely related to intestinal microbiota and its effect on high fat diets. Chronic imbalances in microbiota (endotoxemia) have been associated with insulin resistance, diabetes and obesity. Endotoxemia raises levels of inflammatory markers like cytokines, interleukins and TNF.

·        Polymyxin B, an antibiotic active against gram negative organisms in the gut has been shown to reduce fatty liver and IR. Antibiotic Rx decreases the incidence and delayed the onset of diabetes in a diabetes-prone rat model. These rats had less bacteroides, which reduced inflammation of pancreas and cell membranes.

·        Healthy gut organisms (bacteroidetes) increase to 15% of total organisms, up from 3%, when people lose weight by treating the firmicutes, or bacteria associated with weight gain.

·        Methanogenic Archaea, or gut organisms that produce methane, also increase the extraction of calories frrm consumed polysaccharides.

·        Prebiotics (fiber) improve microbiota, thus reducing insulin resistance and metabolic problems by improving processing of food in intestines.

·        “Probiotics (friendly bacteria in capsules) resulted in distinct changes in the microbiome with associated metabolic alterations in a variety of tissues affecting energy, lipid, and amino acid metabolism.”

·        The authors feel that “genetic tendencies are more important than diet, age, and lifestyles in determining the composition of the gut microbiota.” I am not sure I totally agree. But, their statement is understandable in light of their extraordinary findings. They are putting great emphasis on their research, which points to a radical departing from established dogma. If I knew how much they understand nutrition and probiotics, I could judge their statement more accurately. In my opinion, they may not have studied the field of nutrigenomics, or cutting edge research in food sciences. Take a look at the next article…

Genes are not all they are cracked up to be

After Mendel and the discovery of DNA we fell in love with the exciting world of genetics, with good reason. But, we may have gone too far, swinging too much to the other side, thus placing genes on an unreachable pedestal. Without intending to de-throne genetics, let’s consider this article, which attempts to restore balance. Simply put, genes have no function, nor influence on our body, until they are copied into functional messages or glycoproteins. This process, called “epigenetics,” is heavily influenced by the food we eat, our environment, and in my opinion, our heart, relationships, emotions and thoughts. Here are the highlights of the article “Epigenetics, a Window on Gene Dysregulation, Disease” (JAMA 2008;299:1249.)

• Environmental, nutritional signals can increase risk of disease, cancer.
• Epigenetic changes happen in gestation, neonatal, puberty and old age.
• “Mother’s nutrition during pregnancy can permanently change the epigenetic programming of her offspring.”
• “Maternal supplementation of yellow agouti mice with compounds like folic or genistein during pregnancy blocked the negative effects (DNA hypomethylation) of bisphenol A on th epigenome of the offspring.”
• “Epigenetics at the Epicenter of Modern Medicine” (JAMA 2008;299:1345.) This companion article highlights what the cover issue of the journal Discover reported on last November. Basically, a lack of B vitamins undermines the process of methylation of DNA and Liver detoxification, increasing our chances of developing certain cancers, like colon cancer.
• Finally, the Cover issue of the J. Science December 21^st, 2007 reported the

            “Breakthrough of the year: human genetic variation.”

Back to the intestines

            Every year, about 100,000 people die due to pharmaceutical issues. Most of them succumb to the side effects of anti inflammatory drugs for pain. Here is an article that sheds some light on this serious problem, “NSAID-induced intestinal damage: are luminal bacteria the therapeutic target?” (J. Gut 2008:57:145.)

·        Antibiotics like tetracycline, kanamycin, metronidazole, neomycin attenuate NSAIDs intestinal damage. Why? Could it be that they are working on the intestinal flora? Sulfasalazine, steroids immunosupressive compounds for Chron’s and Ulcerative Colitis may be doing the same thing.

·        Bacterial-host interaction increases cytokine expression, or a tendency to inflammation. Therefore, NSAIDs damage may be due to antibacterial action

·        Probiotics could prevent the problem!

·        “Antibiotics may be used cyclically to eliminate certain bacterial populations, followed by exogenous probiotics to fill the open ecologic niche, thereby improving the balance of enteric microbiota for long term efficacy. The availability of specific means to modulate innate immune system is likely to break the link between anti-inflammatory activity and intestinal toxicity of NSAIDs.”

·        Numerous other articles have been herein reported to document why carefully chosen antibiotics are therapeutic to alleviate many conditions that originate from an imbalance of intestinal flora. Visit the archives newsletters for more information.

Apigenin,” J. Skin & Allergy News, March 2008, page 32

• It’s a flavonoid found in herbs (endine, clove, chamomile,) apples, cherries, grapes, tea, wine, beans, broccoli, celery, leeks, onions, barley, parsley and tomatoes. It has these beneficial actions:
• Chemopreventive, J. Pharm Sci 1997;86L721
• Anti inflammatory, J. Skin Pharm Appl Skin Physiol 2001;14:373
• Antispasmodic, anxiolytic, J. Planta Med 1995;61:213

Still scared?

Living in America, we are familiar with fear mongering as a tool to influence public opinion. Sadly, this is a technique as old as the hills and it does not spare medical practice. As previously reported in a commentary published in the JAMA, the “Myth of Osteoporosis” (book) is well entrenched. Here is another article fearlessly addressing this problem, “Drugs for pre-osteoporosis: prevention or disease mongering?” (British Medical Journal 2008:336:126.)

·        An already controversial condition, osteopenia, or thinning bones before they develop osteoporosis, has been expanded to increase the market for drugs.

·        The cut-off values for bone density “somewhat arbitrary” according to original WHO statement in 1994. Those values were intended for epidemiologic studies, not for clinical treatment.

·        “Treating those at risk of being at risk?... Impressive sounding reductions in relative risk can mask much smaller reductions in absolute risk.” A 75% reduction of relative risk by raloxifene translates into 0.9% reduction of absolute risk. The true incidence of fractures is less than 1% a year: this influences the results as above, when risk is overstated.

·        We need to treat 270 women for 3 years to prevent one vertebral fracture

·        Focus on vertebral fractures, not hip fractures. 2/3 of vertebral fractures are subclinical. Meaning we are not even aware they happen, until we notice that we are getting shorter.

·        The side effects of these drugs are played down: diarrhea, GERD, more vascular, neurologic and lab abnormalities. More venous thrombosis or clots are seen with raloxifene. Osteonecrosis, or rotting of the jaw has been reported.

·        Analysis of data done mostly by docs with ties to drug companies

·        “Shifting the focus in fracture prevention from osteoporosis to falls” (British Medical Journal 2008;337:124) is an article published along side this one. It reports that over 80% of fractures are seen with no osteoporosis at all…

“Bromelain,” J. Skin and Allergy News, February 2008, page 34

·        Proteolytic enzyme from the stem of the pineapple. It is absorbed by white cells which enhances enzymatic activity (J. Derm Therapy 2003;16:106.)

·        Activity: anti inflammatory, fibrinolytic, skin debridement; inhibits platelet aggregation, and growth of malignant cells (J. Ethnopharmacology 1988;22:191, J. Cell Mol Life Sci 2001;58:1234.) Anti inflammatory activity through modulation of arachidonic acid cascade (J. Ethnopharmacology 1988;222;191,) which reduces capillary permeability (J. Med Hypothesis 1980:6:99.) All this translates into a very practical application: bruise reduction after trauma of any kind.

·        Bromelain reduces edema, bruising, pain, and healing time after dental surgery. Recommended before and after surgery (J. Dental Med 1965;20:51, J. Skin Therapy Letters 2000;5:1.)

·        Less swelling after long bone fracture surgery, J. Acta Chir Orthop Traumatol Chech 2001;68:45.

·        Bromelain potentiates antibiotic action in Rx of bronchitis, sinusitis, pyelonephritis and wounds. It also helps Rx of angina, thrombophlebitis (J. Altern Med Rev 1998;3:302.)

·        It inhibits growth of tumors in animals (J. Planta Med 1990;56:249) because it has imunomodulatory activity (J. Cell Mo Life Sci 2001;58:1234.)

Drinking toilet water, like Fido

      We all get grossed out when we catch out doggie drinking out of the toilet. Well, we may not be able to “cast the first stone…” An AP study (Salt Lake Tribune, March 10-12^th, 2008) reported that many drugs we discard from our body after we have ingested them are found in our sewage, since most drugs are used or metabolized only 80%. The rest is flushed down the toilet. Antibiotics, antidepressants, anxiolitics, anticonvulsants and hormones are now found in the drinking water of 41 million Americans. Drugs like prozac and prematin and even xanax for anxiety. So, if all makes you anxious, drink more water…

      About 24 major metropolitan areas were involved in this study. Previously no tests have been available to look for the problem, which is still the case in many cities. The EPA doesn’t know what to make of the problem. Philadelphia had 56 types of drugs in its potable water, but studies like this are rarely made available to public. There are no national standards to look into this problem

      Most fish are now hermaphrodites. They swim in waters where 10+ pharmaceuticals have been detected. Every bluegill, black crappie and channel catfish had levels of antidepressants tested. A few parts per million of these drugs may or may not be a problem, but we don’t know for sure, or do we? Previously, you have read about endocrine problems triggered by toxins in the environment… You be the judge, for now.

      As always, rather than get scared about environmental problems, resolve to eat a very good diet, so that you reduce the levels of these toxins, not only by avoiding them, (water filters don’t help this problem,) but by revving up your detoxification pathways.

Telegraphed articles

“Neurologic and psychiatric manifestations of gluten sensitivity,”

            J. Pediatric 2008:152:244

“Metal chelation and inhibition of bacterial growth in tissue abscesses,”

            J. Science 2008:319:962

Soy protein isolate reduces biomarkers of prostate cancer

            J. Nutrition and Cancer 2008:60:7

Citrus flavonoids inhibit oral cancers

            J. Nutrition and Cancer 2008:60:69

Mushroom ganoderma lucidum has apoptotic effect on premalignant urothelial cells

            J. Nutrition and Cancer 2008:60:109

Mango extract and lupeol has apoptotic effect on mouse prostate cancer

            J. Nutrition and Cancer 2008:60:120

Broccoli extract (sulpharane) may help reduce UV skin damage

            JAMA 2007;298:2731

No negative effects on prostate safety were detected with testosterone treatment in men

            JAMA 2008;299:39

“Exercise May Boost Aging Immune System,”

JAMA 2008;299:160

Tonsillectomies are not beneficial in mild-moderate abcesses

            J. Archives Otolaryngology-Head & Neck Surgery 2007;133:1083

Low vitamin E associated with decline in physical function in the elderly

            JAMA 2008;299:308  

                   INTEGRATIVE HEALTH EDUCATION

             A monthly review of 150 medical journals

                                      Volume 9 ‘ Number 1 ‘ January 2008                                   

                                                        EDITOR’S NOTE 

                        Listerine, the mouthwash most of us gargle before we go to bed at night, or at least before we go on a date, or both, was originally designed to serve as a scrubbing agent for surgeries. As often happens, the bean counters in charge of maximizing profits looked for a way to expand their market. Soon, they convinced the public that the chances of landing a better looking partner was one swig of Listerine away. Today, their product is practically a necessity in our households.

                        The same thing is happening with many other products that originally were intended to treat serious medical conditions. For example, the “purple pill” for heartburn came out in the 80’s for the treatment of serious bleeding ulcers, and antidepressants were originally prescribed for people at the verge of suicide. Today, both of these drugs have slowly “expended their markets,” so that today they are commonly found in just about every household’s medicine cabinet. We may argue that we need these drugs to lead better lives. True, but take a minute to consider these issue’s articles.

Hugo Rodier, M.D.

Medical Nemesis

About 30 years ago, a gadfly by the name of Ivan Illich wrote the book “Medical Nemesis,” where he argued that some docs were creating diseases out of normal human conditions that up to then were accepted as part of life. His radical opinion was shocking to most people back then. But, today, he seems more in line with the regular guy in the street: “Is there a new epidemic of medical problems or is it that medicine is better able to identify and treat already existing problems? Or does it mean that a whole range of life’s problems have now received medical diagnoses... despite dubious evidence of their medical nature?” (“The Medicalization of Society: on the transformation of human conditions into treatable disorders,” Book review in JAMA 2007;298:2070.)

 I am of the opinion that the second proposition is more likely: “What better way than to convince otherwise healthy people that they are now ill and need something to treat their malady, something that is conveniently for sale?” (JAMA 2007;298:2070.)

             Other examples of medicalized conditions highlighted in this book: osteoporosis, ADHD, bipolar disorder, fibromyalgia and dyslexia.

Overtreated

             “Utilization of costly medical and surgical services is highly, often dramatically, variable from place to place, and the degree of utilization has no relationship to favorable outcomes. It follows that much of what is afforded to the patient is unnecessary. Furthermore, the driving force is the cash flow that is necessary to feed what has become a voracious, greedy monster” (“Overtreated: why too much medicine is making us sicker and poorer,” book review in JAMA 2007;298:2070.)

            And why is our health care system so prone to over-treatment? Don’t shoot the messenger: just read the next article:

“Medical Professionalism in a Commercialized Health Care Market,” JAMA     2007;298:2668. Before you read the highlights of this article, which I transcribed word for word so that my own opinion does not bleed through, you may want to know that this article was written by a Harvard M.D., who works on the Social Medicine department of that august University:

• “Professionals have an ideology that assigns a higher priority to doing useful and needed work than to economic rewards, an ideology that focuses more on the quality and social benefits of work than its profitability… Although this ideology is the most important part of medical professionalism, it is what is now most at risk… [by] the growing commercialization of the US health care system.”
• “The current focus on money-making and the seductions of financial rewards have changed the climate of US medical practice at the expense of professional altruism and the moral commitment to patients.”
• Technology appeals to new graduates who are burdened by debt from school. They tend to go into specialties “to behave simply as skilled technicians, focused exclusively on their patients’ narrow medical problems and unmindful of their professional obligations to the whole person they are serving.”
• Big Pharma “now uses its enormous financial resources to help shape postgraduate and CME of physicians in ways that serve its marketing purposes… that sells the drugs physicians prescribe and other tools physicians use… [doctors] are abdicating their ethical commitment to serve as the independent fiduciary for their patients.”
• Health care is just another industry now, which, by continuing on its present path is heading toward bankruptcy. Docs should work toward making health care a social service, like it is in the rest of the industrialized world.

             Them are fighting words… Still, I would not want to indict all docs. Rather, I would look into why this is happening. After all, docs need to take care of their finances so that they may keep their clinics open in order to serve patients. In my opinion, economic incentives created by our health care system are victimizing all of us, including doctors. The solution? Enforce the laws already in our books to police abuse at all levels of our economy. We must stop “corporate welfare,” which is also rampant in our health care system.

Where is the beef?

                        Another corporate problem is the way industry is mucking up our food supply in order to maximize profits, regardless of the health effects on consumers. About

70% of antibiotics made are given to farm animals, in order to avoid infections in the crowded conditions the poor creatures are raised. This practice is also welcome in the industry because animals so treated seem to get bigger and fatter. But, this practice, which is banned in the European Union, may well be responsible for mutating organisms that may be escaping the farms and creating drug resistant strains of bugs, like MRSA, the staph infection that is now becoming a major headache in our country. Some also blame this practice for the disappearance of about 20-80% of bees in 24 states. The practice of overusing pesticides and even injecting the pesticides into the DNA of our crops (GMO products) is also blamed for the decimation of our bees (“Our decrepit food factories,” NYT Magazine, December 16^th, 2007.)

                        As you know, if bees bite the dust, we will suffer, too, since they are vital for our crops to grow through pollination.

                        What can we do? In my opinion, we need to support local industry and farmers who grow their animals and crops as organically as possible.

Watching you eat the beef

                        In the Netherlands, Big Food has started to monitor customers’ reactions to the food they eat in restaurants, in order to maximize their sales by adjusting their advertisement and servings to the preferences thus observed in consumers. In the so-called “restaurants of the future,” your chair will measure your reactions to everything you put in your mouth, how fast you chew and who knows what else. The data will be used to alter the lights, sounds and even scents in the restaurant, in order to respond to the feedback that will cause you to consume the most food. These restaurants will even have “face readers,” to analyze your reaction to the food being served (New York Times, November 26^th, 2007.) Will they see my “avian salute?”

                        Now, there will always be marketing. But, how does it feel to know that your so-called “choices” may really be nothing but subtle manipulation to get you to consume more? In my opinion, being in touch with whom we are, and becoming “agents” for ourselves minimizes the chances that we are driven by agendas outside of ourselves. I wish for you to be so inner-driven.

Our boys: not driven enough?

                        A somewhat controversial book just came out: “Boys Adrift: the Five Factors Driving the Growing Epidemic of Unmotivated Boys and Underachieving Young Men” (JAMA 2007;298:2684.) The author’s opinions are interesting: you may not agree with them, but, there is not much argument that each new generation seems a bit less dynamic to each older generation, a fact that even Plato and Socrates noted.

                        I had a hard time with the #1 reason he listed: Feminization of our education. The author argues that schools now de-emphasize competition and advocate a culture of “no winners.” While this is an understandable argument, I am not sure that this is a factor that would cause boys to lose their drive to reach for higher ground. The other factors made more sense to me: video games, prescription psychotropic meds (Ritalin may cause apathy,) endocrine disrupting chemicals and lack of heroic role models.

                        Whether our boys are really facing this epidemic or not is debatable. But, what is certain is that they will not do well in today’s world if we don’t help them get an affordable higher education. I feel we need to make post high school education as attainable as possible. The less education they get, the poorer and sicker they will be.

Health and education

             Here are the main points from the article “Future Health Consequences of the Current Decline in US Household Income,” JAMA 2007;298:1931

• People with incomes below $50,000 have shorter lifespan. They are more likely to receive poor health care.
• Education, race, environment also play a role
• Poverty has gone up from 11.7% to 12.6% since 2000. Those with incomes of $8,000 below poverty level increased by 45%. Except for the rich, personal income has decreased. Income inequality is widening. A booming economy is only benefiting the rich. The ratio between CEOs’ incomes and that of their employees has gone from 26 in 1965 to 245 in 2002.
• These trends will likely result in worse health in all Americans but the rich. There will be more uninsured people.
• The answer: education in an information society
• 40% more heart disease in those without a High School diploma

“Caffeic acid,” J. Skin & Allergy News, November 2007, page 26

                        It is found in grains, fruits, olives, spinach, grapes, cabbage, wine, asparagus and coffee. The main nutrients therein are phenylpropanoids and ferulic acid, which belong to the family of polyphenosl, like ellagic acid, tannic acid. Caffeic acid has anti cancer and antioxidant effects (J. Nut Cancer 1998;32:81.) It protects against peroxidation of phospholipidic membranes (J. Biochem Biophys Res Comm 1998;253:222) and reduces human skin UVB-induced erythema (Int J. Pharm 2000;199:39.) Caffeic acid is the most effective of polyphenolic acids as tumor-promotion inhibitor (J. Nut Cancer 1998;32:81.) The caffeic acid from bee propolis has anti cancer effects, too (J. Carcinogenesis 1996;17:761.)

“Garlic,” J. Skin & Allergy News, December 2007, page 21

                         Garlic seems to do just about everything, including keeping vampires away. If you don’t like it because it may ruin your social life, get the others around you to eat it, too! Garlic may prevent cardiovascular disease, arthritis, cancer, cataracts; inhibit platelet aggregation and thrombus formation; mitigate cerebral aging; rejuvenate skin and enhance circulation and energy levels (J. Ageing Res Rev 2003;2:39.) It also has:

·        Detox effects, antifungal, antibacterial, J. Tradit Chin Med 2003;23:198

·        Inhibits proliferation of most human cancers, J. Leuk Res 2004;28:667

·        Diallyl disulfide in garlic lowers the risk of colon, lung, and skin cancers, J. Food & Chem Tox 2004;42:1543, Am J. Contact Derm 1999;10:37, J. Skin Pharm Appl Skin Physiol 2001;14:373, J. Nut 2001;131:1027s

·        Diallyl Sulfide in garlic modulates xenobiotic metabolism and exert antitoxic, antineoplastic, bactericidal and hypolipidemic activity, J. Cancer Letters 1998;131:209

·        Ajoene in garlic inhibits proliferation of human leukemia cells, J. Leuk Res 2004;28:667 and also has antifungal effect. It has been used for the treatment of athlete’s foot (Rx of tinea pedis,) J. Mycoses 1996;39:393

·        Allergic reactions and contact dermatitis may be seen.

                        Despite all this evidence, you will still run into docs who will try to tell you that there is no evidence that garlic works at all. By now you have an idea why this is the case ($$$$.)