Integrative Medicine and Wellness

Vitamin K2, but Not Vitamin K1, is Helpful for Bone Density

2008-10-27T17:10:00.004-04:00

The importance of vitamin K in the prevention and treatment of osteopenia/osteoporosis has just been discounted in a WebMD review ("Vitamin K: No Help for Bone Density") of research published Oct. 14, 2008, in PLoS Medicine (Cheung A, et al.) In the study, Canadian researchers, not surprisingly, found that taking 5 mg per day of vitamin K1 does not protect postmenopausal women from age-related declines in bone density.

What is surprising is that the researchers, despite noting that vitamin K is a family of compounds, and that vitamin K2 is the form which is an approved treatment for osteoporosis in Japan, chose to use vitamin K1 in their clinical trial.

It is well known that vitamin K1 (phylloquinone) is involved in blood coagulation. It is also well documented that vitamin K2 (menaquinone) is the essential cofactor for the carboxylation (activation) of the (gamma-carboxyglutamic acid) Gla-containing proteins involved in calcium regulation.

Numerous peer-reviewed studies have shown that vitamin K2 - given either as the synthetic form MK-4 (a short-chain version called menatetrenone) at a dosage of 45 mg/day, or as the natural form, MK-7 (a long-chain menaquinone derived from natto) at a dosage of 45 mcg/day - is a highly effective activator of osteocalcin, the Gla-containing protein integral to calcium deposition in bone. This body of research conclusively demonstrates that vitamin K2 not only lessens fracture incidence and improves bone density but also, via the carboxylation of another Gla protein (matrix Gla protein), inhibits arterial calcification.

Finally, even though they did not use the right form of vitamin K, looking at the research more closely shows that in the treatment group fractures were down - only 9 women getting vitamin K1 vs. 20 getting placebo had fractures (which is why we want higher bone density!). In addition, surrogate markers of bone production were up and the trends were toward higher density at several points during the intervention.

Why Cheung et al. did not use the optimal form of vitamin K remains a mystery, as does the lack of critical analysis and incomplete conclusion provided by the review. Hopefully, the outcome of this misleading publication will not be an increased incidence of osteopenia/osteoporosis in women at risk of these conditions who are dissuaded from supplementing with vitamin K2.

References:

Cheung A, Tile L, Lee Y, et al. Vitamin K Supplementation in Postmenopausal Women with Osteopenia (ECKO Trial): A Randomized Controlled Trial, PLOS Medicine, Oct. 14, 2008; Vol 5: p. e196.

Pizzorno L, Pizzorno J. Vitamin K: Beyond Coagulation to uses in Bone, Vascular, and Anti-Cancer Metabolism. IMCJ, Apr/May 2008, Vol 7:No. 2, p.24-30.

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Strong Bones for Life - Naturally (Part 2)

2008-10-16T07:00:00.001-04:00

Your Bones, Your Choice

Of course, even old decrepit bone is better than no bone, the situation seen in osteoporosis, which results when osteoclasts' demolition work greatly outpaces osteoblasts' new construction. Fortunately, this unbalanced situation, which can develop if the body becomes chronically pro-inflammatory and/or lacks a good supply of all the materials needed to build new bone, can be prevented and treated without drugs.

Here's what you need to build strong bones for life, naturally.

Calcium
Daily calcium needs:

Women 19-50: 1,000 mg

Women 51+: 1,200 mg

Postmenopausal women not taking HRT: 1,500 (if on HRT, 1,200 mg daily; if you are taking HRT, it should be bio-identical bi-est and progesterone compounded specifically for you after you have had your hormone levels - all three estrogen fractions and progesterone - checked, not Premarin and Provera! If your physician is not aware of this, switch physicians.)

Remember, you get calcium from both food and supplements, so keep a food diary for a week or two to estimate your typical calcium intake and then take enough supplemental calcium to reach the above amounts.

If you regularly eat dairy products (from cows, sheep, or goats), soyfoods with added calcium, sesame seeds, and greens such as spinach, collard greens, Swiss chard, or broccoli, you are likely getting about 600 mg calcium from food each day.

Choosing a Calcium Supplement
You will see different forms of calcium in supplements. Choose either chelated calcium or hydroxyapatite (#3 or #4 below). Here's why:

Naturally-derived calcium: may appear on labels as bone meal, oyster shell, limestone, or dolomite (clay). Avoid these supplements since naturally derived calcium may contain significant amounts of lead.

Calcium carbonate: the most commonly used form and the least expensive, but not nearly as well absorbed as chelated calcium. If taking calcium carbonate, take with meals when your stomach will be secreting hydrochloric acid to digest the food as it will also help you break down and absorb calcium carbonate.

Chelated calcium: will appear on the label as calcium-citrate, calcium-malate, calcium-gluconate or calcium-aspartate. In these chelated forms, the calcium is bound to an organic acid (citrate, malate, gluconate) or amino acid (aspartate), which improves its absorption. Chelated forms of calcium are more expensive than calcium carbonate, but build more bone for the buck, so are worth it.

Hydroxyapatite: sometimes appears as MCHC (microcrystalline hydroxyapaptite). The most expensive form of calcium, hydroxyapatite, is a complex crystalline compound that contains calcium linked with phosphorus in a pre-formed building block of the bone mineral matrix. MCHC contains hyrdoxyapatite plus bone-derived growth factors and all the trace minerals that comprise healthy bone. If you are at high risk of osteoporosis or have osteopenia, you should be taking MCHC.

Vitamin D
Vitamin D is essential for calcium's absorption both from the intestines and into bone.

You want vitamin D3, the natural form. The fully activated form of the vitamin in the body is titled 1,25-dihydroxycholecalciferol as know as "calcitriol".

Some supplements (especially the less expensive ones) contain synthesized D2 (called ergocalciferol). Current research shows this is not as biologically effective as the natural D3. (Houghton L, Vieth R. The case against ergocalciferol (vitamin D2) as a vitamin supplement. Am J Clin Nutr. 2006 Oct;84(4):694-7).

Anyone living in northern latitudes (e.g., the Pacific Northwest or New England) is at high risk for vitamin D deficiency and should have her or his blood levels of 25(OH)D3 checked. 25(OH)D3 is the major circulating form of vitamin D in the blood and the best barometer of vitamin D status. Be sure this is the vitamin D test your doctor orders for you; many labs/doctors test D2.

Adequate blood levels of vitamin D to provide for bone health (as well as protecting against colon and breast cancer, multiple sclerosis, inflammatory bowel disease, depression - and a host of other ailments) begin at 75 nmol/L of 25OH-D3. Blood levels of vitamin D between 90 and 100 nmol/L are optimal.

The amount of vitamin D you need will depend on the results of your blood test. A daily intake for all adults of >/=1000 IU vitamin D is needed to bring vitamin D concentrations up to 75 nmol/L in at least 50% of the population. If you live in northern latitudes or live in the south but get little sun exposure or wear sunscreen, you can start taking 1,000 IU of D3 daily right away. However, you may need 2,000 or even 5,000 IU of D3 daily for 6-8 months to restore adequate levels of this critical nutrient.

We are currently involved in a corporate wellness program in Canada. We found that 82% of the employees have low levels of vitamin D in their blood.

Magnesium
If your blood test reveals that you are significantly vitamin D-deficient (we've seen vitamin D levels around 30 nmol in many patients and levels as low as 13 nmol in several), and your physician recommends you take more than 2,000 IU/day for an extended period of time, you will also need to supplement with magnesium citrate, 500 mg, twice daily.

Calcium and magnesium counterbalance one another in numerous cellular activities. If you are taking high levels of vitamin D, you will be absorbing significantly more calcium and will need to ensure your magnesium levels are sufficient to maintain this balance.

This is very important: symptoms of magnesium deficiency include migraines and tension headaches, muscle weakness, leg cramps, restless legs, elevated blood pressure, transient ischemic attacks, and heart arrhythmia.

Vitamin K
Vitamin K, specifically vitamin K2 or menaquinone, activates a group of proteins (the Gla-proteins), which are responsible for where calcium gets delivered in the body. Vitamin K2 ensures that the calcium you consume (and which will be getting into your circulation in higher amounts now that you are taking vitamin D) is deposited where you want it—in your bones, and not where you don't—in your blood vessels and other soft tissues.

When your vitamin K2 levels are adequate, two of the Gla-proteins that are activated are: (1) osteocalcin, the protein responsible for anchoring calcium within bone, and (2) matrix Gla-protein, which prevents calcium from depositing in the heart, arteries, breast and kidneys.

Both vitamin K1 (phylloquinone) and vitamin K2 (menaquinone) are available as supplements. Vitamin K1 is primarily involved in helping your blood clot normally, although our bodies are able to convert a small amount of K1 into K2.

For bone health, K2 (menaquinone), particularly natural menaquinone derived from natto, which may be labeled MK-7 (menaquinone-7) is the most potent form. You may also see K2 as menatretrenone; this is MK-4, a synthetic version that must be taken in much higher doses because its half-life in the body is quite a bit shorter.

If you are taking MK-7, a daily dose of 45 mcg is sufficient. If taking MK-4, take 5 mg daily.

Best food sources of vitamin K (K1) include kale, spinach, Swiss chard, broccoli, Brussels sprouts, parsley and romaine lettuce. Natto, from soy, is an excellent source of K2, but is not easily available in the U.S., nor would the taste appeal to most Americans.

Boron
Boron protects against calcium loss by helping to maximize the activity of both estrogen and vitamin D in bone.

The drop in estrogen levels that occurs during menopause triggers an increase in the production of a pro-inflammatory mediator called interleukin-6, which stimulates the production and activity of osteoclasts. Boron is needed for the conversion of estrogen to its most potent form, 17-beta-estradiol, which allows the body to make the most use of its remaining estrogen.

Boron is also involved in the reaction in the kidneys in which vitamin D is converted to its most active bone-building form, (1,25-(OH)2D3)—a compound that is even 10 times more potent than D3.

In one study of postmenopausal women, supplementation with 3 mg/day of boron reduced urinary calcium excretion by 44%!

Best food sources of boron are apples, pears and grapes. Leafy greens, legumes and nuts can also be good sources of this mineral; however, since the boron content of fruits and vegetables depends upon that provided by the soil in which they were grown, which can vary dramatically, boron supplementation with 3 mg/day is recommended.

Omega-3s
Inflammation-related activation of osteoclasts plays a key role in osteoporosis. Not only do the omega-3 fatty acids lessen the production of pro-inflammatory cytokines that activate osteoclasts acids, these fats also stimulate the activity of osteoblasts. In contrast, the pro-inflammatory omega-6 fats so abundant in the typical American diet stimulate osteoclasts. (Fernandes G, Lawrence R, Sun D. Protective role of n-3 lipids and soy protein in osteoporosis. Prostaglandins Leukot Essent Fatty Acids. 2003 Jun;68(6):361-72; Heaney RP, Carey R, Harkness L. Roles of vitamin D, n-3 polyunsaturated fatty acid, and soy isoflavones in bone health. J Am Diet Assoc. 2005 Nov;105(11):1700-2; Watkins BA, Li Y, Lippman HE, Feng S. Modulatory effect of omega-3 polyunsaturated fatty acids on osteoblast function and bone metabolism. Prostaglandins Leukot Essent Fatty Acids. 2003 Jun;68(6):387-98.)

Experts suggest the optimal ratio of omega 6:omega 3 fatty acids is 4:1 or even 2:1. The standard American diet delivers a ratio somewhere between 10 and 20:1.

In a recent study, subjects consumed each of three diets for a period of 6 weeks. The first, a typical American diet, delivered a 9.6:1 ratio of omega 6:omega 3 fats. The second and third diets provided ratios of 3.5:1 and 1.6:1 omega 6 to omega 3 fats, respectively. Walnuts, a rich source of both omega 6 and the omega 3 fats, were the primary sources of omega-3s in the second diet; a little more than one ounce (37 grams) of walnuts and ½ ounce (15 grams) of walnuts were included in each day's meals in the form of walnut granola, walnut butter, walnut pesto or plain walnuts as a snack. The third diet contained about 20 grams (2/3 ounce) per day of flaxseed oil, a highly concentrated source of the omega 3 fat, alpha linolenic acid.

Indicators of bone loss called N-telopeptides (NTx, which are produced when osteoclasts break down bone collagen, were measured and found to be significantly lowered by the diets containing a lower ratio of omega 6 to omega 3 fats. The second diet, in which the ratio of omega 6: omega 3 was 3.5:1 reduced NTx 11.5%, while the third diet dropped NTx levels by 15.3%.

The researchers also measured levels of a pro-inflammatory cytokine called TNF-a (tumor necrosis factor alpha), which increases osteoclast production and activity. As the ratio of omega 6: omega 3 dropped, levels of TNF-a also dropped substantially. (Griel AE, Kris-Etherton PM, Hilpert KF, et al. An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans. Nutr J. 2007 Jan 16;6:2.)

In other research, a few weekly servings of salmon (14 ounces per week), has been shown to raise omega 3 levels more effectively than taking a daily fish oil supplement while also lowering blood levels of a number of pro-inflammatory chemicals including TNF-a. Researchers think omega-3s may be better absorbed from fish because fish contains these fats in the form of triglycerides, while the omega-3s in almost all refined fish oils are in the ethyl ester form. Once absorbed, omega-3s are converted by the body from their triglyceride to ester forms as needed. (Elvevoll EO, Barstad H, Breimo ES, Brox J, Eilertsen KE, Lund T, Olsen JO, Osterud B. Enhanced incorporation of n-3 fatty acids from fish compared with fish oils. Lipids. 2006 Dec;41(12):1109-14.)

Your Bones, Your Choice
You only have one body. Doesn't supporting its inherent drive to maintain strong, healthy bones by supplying the natural compounds it uses in normal bone remodeling make better sense than giving it a drug that poisons your osteoclasts and puts you at risk for abnormal heart rhythms and jaw bone death? Your bones, your choice.

~Joseph Pizzorno, ND and Lara Pizzorno, MDiv, MA, LMT

Part 1: Bisphosphonate Drugs

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Strong Bones for Life - Naturally (Part 1)

2008-10-13T14:24:00.004-04:00

Bisphosphonate Drugs

It's true, as Sally Fields emphasizes in her TV ads for Boniva, that you have only one body; it's not true that Boniva and the other bisphosphonate drugs commonly prescribed to prevent osteoporosis offer the best way to take care of it!

Although prescribed to 30 million Americans each year, the bisphosphonates (e.g., Fosamax, Boniva, Actonel), have now been linked to serious potential complications.

A recent FDA alert warned physicians that all bisphosphonate drugs may cause "severe and sometimes incapacitating bone, joint, and/or muscle (musculoskeletal) pain...[that] may occur within days, months or years" after starting the medication, and in some patients, may not resolve even after discontinuing the drug.

Even more frightening are recent studies conclusively linking bisphosphonate use with jaw osteonecrosis or bone death. Osteonecrosis occurs when bone damaged as a result of poor blood flow or trauma is not removed and replaced with new bone. Initial symptoms include numbness, heaviness, swelling, pain and infection in the jaw, and progress to loosening of the teeth, decay and death of the jaw bone. Bisphosphonates accumulate in bones, particularly in the jawbone, and inhibit the bone's natural ability to repair everyday damage.

A Cochrane Review noted that age = or > 60 years, female sex and previous invasive dental treatment were the most common characteristics of patients taking bisphosphonates who developed osteonocrosis. (Pazianas M, Miller P, Blumentals WA, et al. A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clin Ther. 2007 Aug;29(8):1548-58.) Considering that the target population for bisphosphonate drug use is postmenopausal women, and many women now 60 or older have had some kind of invasive dental procedure in their lifetime, these risk traits for osteonecrosis with bisphosphonate use are far too common for comfort; so common that concerned dentists are highly reluctant to perform any type of dental surgery on women taking these drugs.

In one of the most recent studies, published in the Journal of Oral Maxillofacial Surgery in April 2008, researchers at the University of Southern California's School of Dentistry found a direct correlation between the development of microbial biofilms (bacterial colonies that cause chronic infections) in affected bone and the use of bisphosphonates. (Sedghizadeh PP, Kumar SK, Gorur A, et al. Identification of microbial biofilms in osteonecrosis of the jaws secondary to bisphosphonate therapy. J Oral Maxillofac Surg. 2008 Apr;66(4):767-75.)

Just how many people now have osteonecrosis of the jaw caused by bisphosphonates? Incidence of osteonecrosis among cancer patients, who are given an intravenous and more potent variety of these drugs (e.g., Zometa and Aredia), is estimated at between 1% and 10%. Among those with osteopenia/osteoporosis taking the lower-dose pill forms (Fosamax, Actonel, Boniva), no one knows for sure. Studies to provide firm answers are just beginning, but it has been established that invasive dental procedures, such as tooth extractions or root canals, greatly increase risk of osteonecrosis in women taking bisphosphonates. As for treatments, cutting away the dead bone just worsens the situation, so antibiotic rinses are used, but frequently fail to remedy the condition. And since bisphosphonates remain in bones for years, no one knows how long the risk of osteonecrosis remains, even if the drug is no longer being taken. (Kolata G. Drug for Bones is Newly Linked to Jaw Disease, New York Times, June 2, 2006)

Recent studies have also reported bisphosphonate use as a risk factor for atrial fibrillation (abnormal heart rhythm) in women. One study estimates that 3% of atrial fibrillation cases might have been due to bisphosphonate (specifically, alendronate) use. (Heckbert SR et al.) Physicians are warned that bisphosphonate use needs to be closely monitored in certain populations at high risk of serious adverse effects from atrial fibrillation (such as patients with heart failure, coronary artery disease, or diabetes). In other words, those at risk for serious side effects from bisphosphonates also include anyone with heart disease or diabetes, a significant percentage of the U.S. population. (Heckbert SR, LiG, Cummings SR, et al. Arch Intern Med. 2008 Apr 28;168(8):826-31; Cummings SR, Schwartz AV, Black DM. N Engl J Med. 2007 May 3;356(18):1895-6.)

Not surprisingly, hundreds of lawsuits have now been filed against the manufacturers of biophosphonate drugs, and a class action suit appears likely.

Manufacturers of Bisphosphonates

Fosamax - Merck & Company
Boniva - Roche and GlaxoSmithKline, popularized by Sally Field commercials
Actonel - Proctor & Gamble Pharmaceuticals, Sanofi Pharmaceuticals
Skelid - Sanofi Pharmaceuticals
Didronel - Proctor & Gamble Pharmaceuticals
Reclast and Zometa - Novartis Pharmaceuticals

How Bisphosphonates Work

Even if the bisphosphonates did not put you at risk for severe musculoskeletal pain, the loss of your jaw, or abnormal heart rhythms, these drugs would still not be your best choice for strong healthy bones. Why? Because all they do is suppress bone turnover and remodeling.

Our bones, unless inhibited by bisphosphonates, are constantly rebuilding themselves throughout our lives. Cells called osteoclasts break down old or damaged bone, signaling other cells called osteoblasts to replace it with strong new bone. Bisphosphonates kill osteoclasts. Bone density goes up on these drugs, but the bone they leave in place is worn out tissue your body would normally clear out and replace with strong new bone.

This is why bisphosphonates put people at risk for osteonecrosis (jaw bone death). Because these drugs suppress osteoclastic activity, damaged bone is left in place rather than resorbed, so the amount of damaged old tissue accumulates until it reaches a level when any trauma or insult will result in extremely poor healing, the exposure of necrotic bone to the oral environment, development of pain, and increased risk of microbial infection, which is precisely what is seen in bisphosphonate-associated cases of osteonecrosis of the jaw.

Next: Part 2 - Your Bones, Your Choice

~Joseph Pizzorno, ND and Lara Pizzorno, MDiv, MA, LMT

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Pharmaceutical-Flavored Water?

2008-03-12T15:00:00.001-04:00

Our water supply has a drug problem.

Will your next refreshing glass of water actually be a drug cocktail? A just-released 5-month AP investigation indicates this is more than likely. Albeit in miniscule amounts, drugs-- including antibiotics, anticonvulsants, mood stabilizers and sex hormones--were present in the drinking water supplies of 24 metropolitan areas, including southern California, northern New Jersey, Detroit, Washington D.C., Philadelphia, PA, and Louisville, KY.

Although you're unlikely to notice any immediate effects (to reach a therapeutic dose of any of the drugs detected, you'd need to swallow 120 Olympic size pools of water), long term chronic exposure to this pharmaceutical cocktail may not be safe.

"These are chemicals that are designed to have very specific effects at very low concentrations. That's what pharmaceuticals do," notes John Sumpter, Distinguished Professor of Ecotoxicology at Brunel University, London.

Sumpter, who pioneered the field now known as endocrine disruption, was one of the first to show that effluents from sewage treatment contain estrogenic hormones, including estradiol, the main component of the contraceptive pill. His work lead to the surprising (at the time) conclusion that human drugs were getting into rivers and causing intersexuality in fish.

Fish may be more sensitive than humans (after all they breathe water), but do we want to just wait to see if humans are affected?

"We know we are being exposed to other people's drugs through our drinking water, and that can't be good," says Dr. David Carpenter, a professor at the Environmental Health and Toxicology Division, School of Public Health at the University of Albany in New York.

And while prescription drugs are subjected to clinical trials to evaluate their safety in humans, it behooves us to realize that even those that are passed with a supposedly clean bill of health cheat, in real life terms, to get it.

Drugs are evaluated as single agents, typically over a period of months. In real life-and now in our water supply-drugs are not artificially constrained to one at a time, and the exposure is often not for a few months. In the case of our water, it's for a lifetime.

Pharmaceuticals not only frequently produce significant undesirable side effects when given one at a time-properly prescribed and administered drugs are the 4th leading cause of death in the U.S.-they also interact with other drugs, and the results of these interactions have not been evaluated.

How do the drugs get in our water?

The drugs we take are not completely metabolized into harmless compounds, but pass out of our bodies in urine and feces. And even the drugs we don't take end up in the water supply: more than half of us flush unused and expired meds down the toilet.

Plus, we're not the only ones using drugs. Cattle are given steroids to bulk up, and pets are being medicated for everything from arthritis, cancer, and heart disease to diabetes, allergies, dementia and that Western lifestyle affliction, obesity, to the tune of $5.2 billion over the past five years. The most recent data shows Americans increased their spending on animal meds nearly 10% in 2006. (Animal Health Institute: http://www.ahi.org/index.asp)

What's a consumer to do?

Lessen the load on the ecosystem:

Dispose of unused or unwanted medications at take-back sites or ask your doctor, nearby hospital or pharmacist to take back unused and expired drugs. Do NOT flush unused meds down the toilet or toss them in the trash. Check the www.earth911.org database or contact your local household and hazardous waste office to find out a drug-take-back program nearby.

Purchase drugs in small amounts; they'll cost you less and you won't end up with leftovers.

Work with a health care provider to develop health and wellness strategies you can commit to; you'll feel better, enjoy life more, and reduce your need for medications.

When medication is necessary, ask your doctor or pharmacist for one with the least environmental impact.

Check out the Teleosis Institute, an organization that is working to provide programs to get pharmaceutical (and personal care product) waste out of the environment in California. If you don't live in California, you'll still find lots of good information and resources there, and you might also tell your elected officials to have a look.

Lessen the load on your body:

In addition to lessening your need for drugs by taking steps to become healthier, you can improve the quality of the water you drink by:

Filtering your water. For information on the various types of filters, check the National Resources Defense Council website: (http://www.nrdc.org/water/drinking/gfilters.asp)

Putting your filtered water in a reusable glass or stainless steel pitcher or bottle. Plastic bottles contain compounds, such as bisphenol A (BPA) and polyethylene terephthalate (PET), that have been shown to migrate into the beverages they contain. BPA A has been shown to be both estrogenic and neurotoxic. PET plastics used for water bottles leach antimony, a regulated contaminant with both acute and chronic health dangers. ( Le HH, Carlson EM, Chua JP, Belcher SM. Bisphenol A is released from polycarbonate drinking bottles and mimics the neurotoxic actions of estrogen in developing cerebellar neurons. Toxicol Lett. 2008 Jan 30;176(2):149-56. Westerhoff P, Prapaipong P, Shock E, Hillaireau A. Antimony leaching from polyethylene terephthalate (PET) plastic used for bottled drinking water.

Water Res. 2008 Feb;42(3):551-6. Shotyk W, Krachler M.

Contamination of bottled waters with antimony leaching from polyethylene terephthalate (PET) increases upon storage. Environ Sci Technol. 2007 Mar 1;41(5):1560-3. PMID: 17396641.

These 3 websites had the best summaries of the effects of the various filters we could find. Only reverse osmosis specifies that drugs are removed, and these filters remove needed minerals-which we need.

Heart Spring

Pure Water Systems

Garden Club of America

TYPES OF FILTERS

Carbon filters remove many organic chemicals and chlorine and radon. Carbon filters should be of good quality and maintained properly. Because bacteria can grow on some filters, it is imperative that carbon filters be changed frequently.

Reverse osmosis units remove most toxic minerals and organic chemicals but generally do not remove radon or chlorine. They should be used with carbon filters. Reverse osmosis units are slow and should only be used for drinking water at a spigot. The purified water becomes aggressive and can corrode the pipes of the delivery system. These pipes and faucets should not be made of lead or lead components.

Distillation removes pollutants by boiling water and cooling the steam so it condenses back into water. Distillation is slow and expensive and distilled water is poorly buffered. Therefore, distilled water can be highly aggressive and should be stored in glass or other inert containers.

Water softeners remove calcium and magnesium from “hard” water and make it clean better. However, calcium and magnesium are considered human nutrients.

The healthiest water is free of pollutants but contains beneficial minerals like calcium and magnesium.

by Lara Pizzorno

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Technorati Tags: drugs, drinking water, contaminants, contamination, water

Are You Getting Enough Iodine?

2008-03-05T14:34:00.005-05:00

Iodine intake has been decreasing in the U.S. since the early 70s as a result of changes in Americans' food and dietary habits, and because, as recently published research shows, iodized salt may contain far less than the amount of iodine listed on the label.

Milk, and therefore dairy products, used to be a decent source of this important trace mineral, but their iodine content has greatly decreased due to changes in cattle feed and a phase out of iodine dairy sanitizers. The average iodine content of U.S. whole cow's milk has plummeted from 184 mcg/L) in 1978 to 19 mcg/L in 1989-90.

Sea vegetables, such as kelp, dulse, hijiki, and nori, remain an excellent source of iodine (a mere 1/4 cup supplies 415mcg), but are not frequent American fare, and unless certified organic, may contain heavy metals.

This leaves iodized salt as the major source of dietary iodine for the U.S. population. Unfortunately, relying on salt for our iodine may not be effective for a number of reasons.

Americans have been told to limit salt intake and are taking the advice to heart. Because excessive sodium intake can increase hypertension risks, many agencies now recommend reducing salt intake. A 1995 report found 58% of men and 68% of women reported never using salt, using "lite" salt, or rarely using ordinary table salt. More recently, the American Medical Association has suggested that the FDA remove salt from the "Generally Recognized as Safe" list. (Interagency Board for Nutrition Monitoring and Related Research. Third Report on Nutrition Monitoring in the United States. Executive Summary; 1995; Page ES-10; http://www.cdc.gov/nchs/data/misc/tronm.pdf.)

Even those of us not actively limiting our salt intake may not be getting much iodine along with our sodium.

A study published in the January 2008 issue of Environmental Science and Technology, Dasgupta P, Liu Y, et al. indicates iodized salt is not likely to contain the amount of iodine it's supposed to, and even if it did, virtually all of the salt actually used in prepared foods in the U.S. is not iodized.

According to product labels, all U.S. iodized salt contains 45 mcg of iodine per gram, but when the University of Texas researchers analyzed 88 samples of iodized table salt from 40 states, 53% of samples contained less. Iodine values in freshly opened, top-of-the can samples averaged 44.1 mcg/kg, but actual values ranged from as little as 12.7 to 129 mcg/kg. And the amount of iodine within each can was not homogenous but varied as much as 3.3 times among the 5 samples taken at different depths from the same container. Iodine was also found to decrease greatly during high humidity storage, although light or heat had little effect. (Dasgupta P, Liu Y, Dyke J. Iodine nutrition: iodine content of iodized salt in the United States. Environ. Sci. Technol., 42 (4), 1315-1323, 2008.)

In sum, if you're using iodized salt, you have no idea how much iodine it is actually providing, and the longer you've had that container of salt, the more likely it's iodine content has decreased.

In addition, in the U.S., the use of iodized salt is not mandatory either in restaurants or food processing. Americans are eating out a lot and even when eating at home, often rely on prepared processed foods. So, although the prepared food we're buying may be highly salted, with very few exceptions, the salt used by restaurants and fast-food outlets is non-iodized salt, and so is the salt used by food processors, who say they fear the possibility that iodized salt might change the flavor of their products.

This concern turns out to be unsupported by fact. In 2006, UNICEF invited delegates from the Republic of Moldova to Switzerland, where all salt for both human and animal consumption must be iodized, to convince them to use iodized salt in food production. Iodine deficiency is common in Moldova where, every year, approximately 27,000 newborn babies suffer from brain damage as a result—a tragedy that using iodized salt in processed foods can eliminate. Delegates visited food factories where they found that the addition of iodine to Swiss bread, baked goods, and world-renowned cheeses causes no change in the taste or consistency of these foods. (Summary here.)

Switzerland used to have high levels of iodine deficiency. In 1806, when Napoleon ordered the Prefect of the Swiss Canton of Valais to conduct a survey for military service recruitment, out of 70,000 inhabitants, 4,000 were diagnosed with cretinism. Later, researchers discovered that cretinism, along with goiter (swelling of the thyroid gland in the neck) and, more importantly, mental retardation, were direct effects of iodine deficiency.

Iodine is necessary for the body's production of thyroid hormones, which, in addition to regulating metabolic rate, direct brain development, so iodine is critical in the fetus (the brain is formed during the 1st trimester of pregnancy), infants and children (brain development continues through adolescence). Lack of sufficient iodine is the leading cause of preventable mental retardation in the world. Even a mild iodine deficit in pregnant women, infants, and children, can lower intelligence by 10-15 IQ points, lessening an individual's mental abilities throughout life.

Switzerland introduced iodized salt in 1922, and since 1960, has eliminated iodine deficiency through universal salt iodization--providing iodine through all salt for human (including table salt and salt used for industrial food production) and animal consumption. Both the visible signs, like cretinism and goiter, as well as the more important hidden effects of iodine deficiency on brain development and IQ, have completely disappeared in Switzerland.

A vastly different situation currently exists in the US. Public-health studies over the past 30 years indicate that iodine levels in the U.S. population, particularly in women of childbearing age, are too low. Urinary iodine (the standard means of evaluating iodine levels in the body) has plummeted by almost 50% in adults, and the frequency of moderate iodine deficiency (urinary iodine excretion of less the 50 mcg per liter) in pregnant women has jumped from 1% to 7%. To underscore how low this is, the WHO defines iodine deficiency as a urinary iodine excretion of anything less than 100 mcg per liter, and estimates that, world-wide, approximately 2 billion people, including 285 million school-age children, are iodine-deficient.

In a recent editorial in the New England Journal of Medicine entitled "Iodine Nutrition - More is Better," thyroidologist Robert Utiger of Harvard Medical School urges that the recommended daily intake of iodine be increased to 300 to 400 mcg, a dosage he feels can best be met through a universal salt iodization program similar to Switzerland's. (Utiger RD, N Engl J Med. 2006 Jun 29;354(26):2819-21, PMID: 16807421)

Utiger's suggested RDA is significantly higher than current U.S. recommendations (see Table: Recommended values of iodine intake in the U.S.), but he argues that the most recent data shows the small easily correctable risks of possible excess iodine consumption are far outweighed by the substantial irremediable risks of iodine deficiency, which is widespread. (Teng W, Shan Z, Teng X, et al. Effect of iodine intake on thyroid diseases in China. N Engl J Med 2006;354:2783-93.)

"The best way to address this issue is to at least assure that iodized salt contains the amount of iodine it should, ideally to raise the iodine content of salt, and get the food processors to use iodized salt," says Utiger.

What can you do now to ensure an adequate intake of iodine?

Check your multiple vitamin and mineral supplement to be certain it provides at least 150 mcg per day. If you are pregnant, trying to become pregnant or breast-feeding, your pre-natal supplements should deliver at least 290 mcg per day.
Use iodized salt when cooking at home and carry a small container in your purse or briefcase for use in restaurants.
Experiment with sea vegetables. Many can be found in the form of flakes or powder as well as strips or sheets.
Nori-used in sushi rolls is also available in seasoned snack-size strips, great for crumbling over soups or salads.
Kelp-light brown to dark green strips, can often be found in flake form.
Dulse-a reddish-brown seaweed that is soft and chewy in texture, can be found ground fine for use as a salt substitute.
Kombu-add a strip to beans while cooking; it will help prevent gas and add flavor.
Wakame-used to make Japanese miso soup.
Arame-a lacy sea vegetable with a sweeter, milder taste, adds salty flavor to soups or stews.
Hijiki-looks like strands of wiry, black pasta, a great addition, in small amounts (it's quite flavorful), to carrot salad. Soak hijiki and mix with shredded carrots, chopped pickled ginger, sesame seeds and oil, a little finely sliced scallion, and a dash of tamari.

One important caveat: Purchase only certified organic sea vegetables to ensure they are free of contamination. Sea vegetables have a high affinity for heavy metals, and if grown in polluted waters, can soak up not only healthful minerals, but also contaminants such as arsenic, lead, cadmium or mercury.

(van Netten C, Hoption Cann SA, Morley DR, van Netten JP. Elemental and radioactive analysis of commercially available seaweed. Sci Total Environ. 2000 Jun 8;255(1-3):169-75. PMID: 10898404)

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Technorati Tags: iodine, food, diet, health, thyroid

Eat Red for Valentine's Day

2008-02-11T15:19:00.000-05:00

Our first-ever National "Eat Red Week," (February 4-10) just ended, encouraging Americans to discover the heart-healthy power of red fruits and vegetables. Cherries (especially tart cherries), red grapes, tomatoes, red chili peppers-all these plant Valentines are loaded with phytonutrients our hearts, arteries and veins just love.

Tart cherries. Tart cherries get their deep red color from disease-fighting phenols called anthocyanins. Michigan State researchers found that tart cherries contain the highest concentrations of anthocyanins 1 and 2, which help block the cyclooxygenase enzymes (COX-1 and COX-2) that are also the target of common pain meds like aspirin, ibuprofen, and acetaminophen.⁽¹⁾

Tart cherries contain 30-40 milligrams of anthocyanins 1 and 2 in every 100 grams (3 ounces) of fruit. (Blueberries lack anthocyanins 1 and 2, but keep eating them; they're packed with lots of other good things!) Tart cherries outstrip sweet cherries in the anthocyanin/phenol department, delivering more than twice as many per 100 grams (92-47 milligrams in sweet cherries vs. 312 milligrams in tart ones).

Tart cherries also score way high on a lab test called the Oxygen Radical Absorbance Capacity (ORAC), which measures how many free radicals a food can neutralize. (Damage done to cells, tissues and organs by free radicals is a key factor not only in cardiovascular disease, but also in virtually every chronic, degenerative disease, not to mention, aging.)

A person needs to consume 3,000 to 5,000 ORAC units each day for blood levels to maintain a good antioxidant defense system, nutrition researchers estimate. Just slightly more than 3 ounces (100 grams) of tart cherry juice concentrate delivers 12,800 ORAC units. A single ounce supplies 3,622 ORAC units. A quarter cup of dried tart cherries weighs in at 3,060 on the ORAC scale, and a half cup of frozen tart cherries supplies, on average, 1,362 ORAC units. ⁽²⁾

Other research recently published in the American Journal of Clinical Nutrition revealed that tart cherries rank 14 in the top 50 foods for highest antioxidant content per serving size – surpassing well-known antioxidant stars like red wine, dark chocolate and orange juice.⁽³⁾

Red grapes."How do I love thee? Let me count a few of the ways I protect your heart..."

Resveratrol, a flavonoid found in the skin of red and purple grapes (and therefore in red, but not white wine), improves blood flow by stimulating the production and/or release of nitric oxide (NO), a molecule made in the lining of blood vessels (the endothelium) that signals the surrounding muscle to relax, dilating the blood vessel and increasing blood flow.⁽⁴⁾

Resveratrol also inhibits angiotensin II, a hormone secreted in response to high blood pressure and heart failure. Angiotensin II can damage the heart because it tells cardiac fibroblasts, the family of heart muscle cells responsible for secreting collagen, to proliferate. The resulting production of excessive amounts of collagen causes the heart muscle to stiffen, reducing its ability to pump blood efficiently. ⁽⁵⁾

Pterostilbene, another antioxidant in grapes, activates PPAR-alpha. The PPARs are a family of receptors on our cells that mediate their absorption of compounds for use in energy production. PPAR-alpha is crucial for the metabolism of lipids, including cholesterol. ⁽⁶⁾

Tomatoes. A number of recent studies have found that women with the highest intake of lycopene-rich tomato-based foods have a significantly reduced risk of heart disease. In the most recent, a 4.8 year prospective case-control trial involving almost 40,000 middle-aged and elderly women in the Women's Health Study, as the women's blood levels of lycopene went up, risk for cardiovascular disease dropped-- lots.

The women were stratified into four groups, according to their dietary lycopene intake. After excluding those with angina, women whose plasma lycopene levels were in the three highest groups were found to have a 50% reduced risk of cardiovascular disease compared to those with the lowest blood levels of lycopene. ⁽⁷⁾

Red chili peppers. Firing up your tastebuds with chili peppers can help protect the cholesterol in your blood from oxidation - a first step in the process that leads to atherosclerosis. In a randomized, crossover study involving 27 healthy subjects (14 women, 13 men), eating freshly chopped chili greatly increased cholesterol's resistance to free radical injury.

Subjects were randomly divided into 2 groups. For 4 weeks, half the subjects ate a freshly chopped chili blend (30 grams/day, about 1 ounce), consisting of 55% cayenne, while the other half consumed a bland diet (no chili and other spices were kept to a minimum). After 4 weeks, the groups switched diet for another 4 weeks. Blood samples were taken at the beginning of the study and after each diet.

After the chili-diet, the amount of free radical damage to cholesterol was significantly lower in both men and women than after the bland diet. In addition, after eating the chili-spiced diet, women had a longer lag time before any damage to cholesterol was seen compared to the lag time seen after eating the bland diet. In men, the chili-diet also lowered resting heart rate and increased the amount of blood reaching the heart. ⁸

This year, send your heart a Valentine: eat red!

Related Topics:

Studies Cited:
⁽¹⁾ (Seeram NP, Momin RA, et al. Cyclooxygenase inhibitory and antioxidant cyanidin glycosides in cherries and berries. Phytomedicine. 2001 Sep;8(5):362-9.)
⁽²⁾ (Wu X, Beecher GR, Holden JM, Haytowitz DB, Gebhardt SE, Prior RL. Lipophilic and hydrophilic antioxidant capacities of common foods in the United States. Journal of Agriculture and Food Chemistry. 2004;52:4026-4037.)
⁽³⁾ ( Halvorsen BL, Carlsen MH, Phillips KM, Bohn SK, Holte K, Jacobs DR, Blomhoff R. Content of redox-active compounds in foods consumed in the United States. American Journal of Clinical Nutrition. 2006;84:95-135.)
⁽⁴⁾ (Lu KT, Chiou RY, Chen LG, Chen MH, Tseng WT, Hsieh HT, Yang YL. Neuroprotective effects of resveratrol on cerebral ischemia-induced neuron loss mediated by free radical scavenging and cerebral blood flow elevation. J Agric Food Chem. 2006 Apr 19;54(8):3126-31.)
⁽⁵⁾ (Olson ER, Naugle JE, Zhang X, Bomser JA, Meszaros JG. Inhibition of cardiac fibroblast proliferation and myofibroblast differentiation by resveratrol. Am J Physiol Heart Circ Physiol. 2005 Mar;288(3):H1131-8.)
⁽⁶⁾ (Rimando AM, Nagmani R, et al. Pterostilbene, a new agonist for the peroxisome proliferator-activated receptor alpha-isoform, lowers plasma lipoproteins and cholesterol in hypercholesterolemic hamsters. J Agric Food Chem. 2005 May 4;53(9):3403-7.)
⁽⁷⁾ (Sesso HD, Buring JE, et al. Plasma lycopene, other carotenoids, and retinol and the risk of cardiovascular disease in women. Am J Clin Nutr. 2004 Jan;79(1):47-53.)
⁽⁸⁾ (Ahuja KD, Ball MJ, Effects of daily ingestion of chilli on serum lipoprotein oxidation in adult men and women. Br J Nutr. 2006 Aug;96(2):239-42.)

Technorati Tags: food, red, valentinesday, chilipeppers, tomato, tartcherries, eatred

Natural Medicine is Based on Science, Too!

2007-12-06T13:27:00.000-05:00

Newsweek Gratuitously Targets CAM

I strongly agree with Jerry Adler in his editorial in this week's Newsweek Magazine that we should make health care decisions based on evidence. In fact, my whole career in the past 35 years has been to advance science-based natural medicine. Science does not belong to any one profession; it is a way of looking at the world to achieve reproducible results and maximize efficacy and safety. Unfortunately, Mr. Alder appears to have an anti-CAM rather than a pro-science agenda.

While he gleefully (and appropriately) gives examples of CAM (complementary and alternative medicine) therapy failures and unsubstantiated and outlandish claims, he ignores equally egregious examples of prescription drug failures, adverse drug reactions and intentional fraud found in conventional medicine. Why does he conveniently ignore the several articles the past year in the medical journals he so trusts that have documented numerous examples of research faked to make drug intervention trials look better and conscious efforts by pharmaceutical companies to avoid reporting adverse events?

Only a single example, the Vioxx tragedy, is estimated to have caused as many as 100,000 excess deaths. This single, properly prescribed and supposedly well-researched drug has, in my opinion, caused far more serious harm by several orders of magnitude than all CAM errors, contaminated or misadvertised products, and adverse events combined. As Mr. Alder so conveniently ignores, several state attorney generals have now sued Merck for intentional consumer fraud. And they are winning.

I don't want to appear to justify CAM failures by pointing out conventional medicine failures - neither is acceptable. As I tell my students and include in my many lectures; "We do research not to prove what we do works, but rather to get better." I am a "true believer" in the natural medicine approach to health. However, that does not mean that everything we believe is correct or that every therapy is safe and effective. The only way to know is to do objective research.

Happily, there are now hundreds of thousands of good quality studies published in peer reviewed journals evaluating CAM therapies. While most show efficacy and safety, some do not. Knowing the difference is how we get better. I could give so many examples. Let's look at just a few recent studies:

A study of 42 healthy volunteers found that green tea phytonutrients increase activity of the enzymes that detoxify carcinogens.
A placebo-controlled study of 297 children found that giving them drinks containing FDA-approved food colors resulted in hyperactive behavior.
A study of 29 postmenopausal women who had suffered from at least 14 hot flushes each week experienced a 50% reduction in symptoms after consuming 1.4 ounces of crushed flax seeds per day.
A study of 29,361 men found that those who ate more than a serving of either broccoli or cauliflower each week almost halved their risk of developing advanced-stage prostate cancer.
A study of 889 patients found that drinking cranberry juice significantly boosts eradication of Helicobacter pylori (the bacterium responsible for ulcers and many digestive complaints) in women receiving triple therapy with the antibiotics omeprazole, amoxicillin and clarithromycin (OAC).
A prospective study of 5,611 adults 60 years or older found that those who most closely followed a Mediterranean style diet decreased their overall mortality rate by 50% after 6 years.

The list is endless.

Mr. Adler's diatribe does a disservice to the over one hundred thousand CAM researchers and clinicians conscientiously studying this medicine and providing health care and the approximately half the population of the US who seek health care from state-licensed CAM professionals and use CAM products.

In this blog, we will continue our commitment to providing our understanding of the best research available. This means considering both negative and positive results.

References
Chow HH, Hakim IA, Vining DR, et al. Modulation of human glutathione s-transferases by polyphenon e intervention. Cancer Epidemiol Biomarkers Prev. 2007 Aug;16(8):1662-6.

McCann D, Barrett A, Cooper A, Crumpler D, Dalen L, Grimshaw K, Kitchin E, Lok K, Porteous L, Prince E, Sonuga-Barke E, Warner JO, Stevenson J. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet. 2007 Sep 5; [Epub ahead of print]

Pruthi S, Thompson SL, Novotny PJ, Barton DL, Kottschade LA, Tan AD, Sloan JA, Loprinzi CL. Pilot evaluation of flaxseed for the management of hot flashes. J Soc Integr Oncol. 2007 Summer;5(3):106-12

Kirsh VA, Peters U, Mayne ST, Subar AF, Chatterjee N, Johnson CC, Hayes RB; Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Prospective study of fruit and vegetable intake and risk of prostate cancer: J Natl Cancer Inst. 2007 Aug 1;99(15):1200-9. Epub 2007 Jul 24.

Masala G, Ceroti M, Pala V, et al. A dietary pattern rich in olive oil and raw vegetables is associated with lower mortality in Italian elderly subjects. Br J Nutr. 2007 Aug;98(2):406-15. Epub 2007 Apr 3.

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Technorati Tags: CAM, complementary and alternative medicine, integrative medicine, health and wellness

Functional Medicine Day: Autism Spectrum Disorder

2007-12-05T00:27:00.000-05:00

Welcome to the Functional Medicine day. Today we are welcoming functional medicine doctors and interested health care consumers to discuss this cutting-edge approach to medicine. I am posting this interesting case to get the conversation started. [Note to visitors: To learn more about functional medicine, you can download this PDF file: What is functional medicine?]

Autism is a growing concern, with increasing numbers of children being diagnosed, especially boys. Incidence of autism is now about 1/166, which represents about a tenfold increase in the past 2 decades, although the numbers vary according to researcher. The causes are not yet fully determined, but we do know that, as typical of most diseases, autism is multifactorial.

The main causes appear to be mitochondrial dysfunction, detoxification dysfunction and intestinal fungal overgrowth. This latter cause, according to autism expert Sid Baker, MD, occurs in about 1/3 of cases with aggressive antifungal therapy resulting in complete remission in many.¹ Nutrients reported to help autistic children include magnesium, vitamins B2 and A, and medium chain fatty acids. There have been reports that many autistic children have problems eliminating heavy metals, especially mercury.

Case Study

This child, now seven, was first brought to see me at age two. His mother reported that she had seen some symptoms at age 1 (repetitive behaviors), but they disappeared when they removed nuts from his diet. He was growing normally and apparently meeting milestones until age two when he started to get physically weak. This was first noticed when he became unable to climb the gym set at the park which he had climbed with no problems many times before.

Relevant family history is that his parents (mother 49, father 55) were supposedly infertile ( >12 known miscarriages). Unexpectedly, his mother maintained her pregnancy and successfully vaginally delivered him and his fraternal twin. His problems are not surprising considering the history of unsuccessful pregnancies and parents' age well beyond optimal. His fraternal brother is relatively normal, although he does suffer from migraine headaches and food allergies.

Screening blood tests (which showed elevated serum lactic acid) and evaluation of developmental landmarks by a pediatrician resulted in a presumptive diagnosis of autistic spectrum disorder. Conventional care offered little hope, so his parents sought help elsewhere. An elevated lactic acid can be an indication of mitochondrial deficit, so I initially put him on high levels of vitamin B2 and modest levels vitamin B1, Mg, creatine, acetyl-L-carnitine, NAC, glutathione, lipoic acid, and CoQ10 -- a combination of nutrients that would promote energy metabolism while bolstering mitochondrial antioxidant defenses. Later, after doing a urinary organic acids profile, we refined his supplement program and had his mother start giving him medium chain fatty acids (two grams per day). These fatty acids from coconut oil are more easily metabolized by the mitochondria for energy production. The results were remarkable: he became much stronger, and his autistic symptoms all resolved.

Although he is not cured, his metabolic function has been much improved; however, if he stops taking the supplements, he quickly starts to deteriorate. Activation of his mitochondria requires 100 mg/d of B2 (about 50 times the RDI).

His health is not perfect; he is still somewhat physically fragile, and I know we haven't found or fixed all his problems. But if you met and talked with him, you would only see a bright, engaging boy, a bit small for his age.

Interestingly, in reviewing this with his mother before posting his story on the blog, she now feels that his apparent developmental deficiencies were all due to muscle weakness rather than mental issues. Her comment:

Brent (not his name) was having problems learning to read, and he would ask me, "Mom is that an "i" or an "l", or is that an "h" or an "n", and I was very concerned thinking he was slipping mentally, as he should have known this without any problem at this stage. But I would notice at other times he could read words easily, especially if they were listed rather than in sentence form. I also noticed the longer he tried to read a book, the worse his word recognition or decoding became. I was talking with a counselor at his school, and she explained it is much harder for the eyes to track horizontally between each small word and that the eye muscles have to develop the coordination and strength. When she said muscle strength, I knew immediately Brent's problem was eye muscle weakness, not loss of mental function. I explained the problem to him; we changed how he reads, and he got his self confidence back and is now decoding and reading quite well. So, he obviously has muscle weakness throughout his body. The other very obvious place being his swallowing difficulties.

I can understand how a mother would not want her child to be diagnosed as autistic. And autism syndrome covers a wide range of dysfunction, ranging from mild to severe. She may be right that most, if not all, of Brent's developmental problems could be explained by muscle weakness secondary to mitochondrial dysfunction. As we progressively restored his mitochondrial function, his muscles began developing again, and his physical and mental deficiencies eventually resolved.

The problem with an autism spectrum disorder diagnosis is that there is no specific confirmatory lab test--it is more a diagnosis by exclusion. If we had not caught this early and normalized his mitochondrial function, it is highly likely it would have resulted in (further?) neurological damage and converted his presumptive diagnosis into full manifestation.

Regardless of the diagnosis, Brent clearly has a significant mitochondrial defect that resulted in serious problems, most all of which we were able to resolve with a sophisticated nutritional intervention.

Related Topics:

¹ Editor's Note: The successes reported by Dr. Baker as a result of alternative treatments have not yet been supported by scientific studies.

Technorati Tags: functional medicine, autism, autism spectrum disorder, integrative medicine, alternative medicine

Vitamin K - Keeping Calcium in Your Bones and Out of Your Blood Vessels

2007-11-29T11:32:00.000-05:00

You may have thought vitamin K was all about blood clotting - the necessary kind that prevents you from bleeding to death when you get cut or injured - but this nutrient plays other roles just as essential to your health. New research reveals that vitamin K controls calcium, keeping it in your bones and out of your blood vessels.

In nature, vitamin K is found in primarily in two forms - K1 (phylloquinone) and K2 (menaquinone).

K1 is the form in which vitamin K produces clotting factors. Produced by plants and algae, K1 is found in green leafy vegetables such as broccoli, kale and Swiss chard, and in plant oils, such as canola and soybean oil.

K2 is more potent and has the widest range of activity. Far more active than K1 in both bone formation and reduction of bone loss, K2 is also the form in which vitamin K has been found to protect against arterial calcification and the oxidation (free radical damage) of LDL cholesterol. (Schurgers LJ, Dissel PE, et al. Z Kardiol 2001; Jono S, Ikari Y, et al. Thromb Haemost 2004)

Produced by bacteria and also via the conversion of K1 to K2 by beneficial bacteria in the intestines of animals, including humans, K2 is better absorbed than K1 and remains active far longer; K1 is cleared by the liver within 8 hours, but measurable levels of K2 have been detected 72 hours after ingestion. (Schurgers LJ, Teunissen KJ Blood 2007)

Natto (fermented soybeans) is the richest dietary source of vitamin K2. Dairy products (milk, butter, cottage cheese, cheese) and egg yolk also provide small amounts.

How Does Vitamin K Work in the Body?

Vitamin K carboxylates Gla-proteins. Carboxylation activates these proteins, which have widespread effects throughout the body, including regulating blood clotting and calcium. Fifteen Gla-proteins have been identified, but researchers think up to 100 may yet be discovered. (Uotila L, Scand J Clin Lab Invest Suppl 1990)

K1 is the preferred form used in the liver to carboxylate clotting factors, while K2 is preferentially used in the rest of the body to carboxylate the other vitamin K-dependent Gla-proteins, including osteocalcin, which is essential for bone health, and matrix-Gla protein, which prevents calcification of soft tissue, i.e., blood vessels and organs.

Vitamin K aids bone health in a number of ways:

After it's carboxylated by vitamin K2, osteocalcin can latch on to calcium and bind it to hydroxyapatite crystals forming the bone matrix. (Think of carboxylation as adding a trailer hitch to calcium, allowing it to be towed into and attached to bone.) (Bügel S, Proc Nutr Soc 2003)

Vitamin K2 also teams up with vitamin D3 to increase the production of Gla-proteins, including osteocalcin in osteoblasts (the cells that build bone), while also inhibiting the production of osteoclasts (the cells that break down bone). (Plaza S, Lamson D. Alt Med Rev 2005, Masterjohn C. Med Hypotheses 2007; Yamaguchi M, Sugimoto E, et al. Mol Cell Biochem 2001; Yamaguchi M, Uchiyama S, et al. Mol Cell Biochem 2003)

K2 works synergistically with bisphosphonate drugs, such as Fosamax, which lessen bone loss by poisoning osteoclasts (the cells that break down old bone). In a study of postmenopausal women with osteoporosis, fractures were experienced by 2 out of 25 women taking a bisphosphonate, 6 of 24 women taking calcium lactate, and only 1 of 26 women taking vitamin K and a bisphosphonate. (Iwamoto J, Takeda T, et al. Yonsei Med J 2003)

Research has linked osteoporotic fracture with vitamin K insufficiency for more than 20 years. A study published in 1984 found that patients who suffered fractures caused by osteoporosis had vitamin K levels 70% lower than age-matched controls. This association has been repeatedly confirmed with one recent trial involving almost 900 men and women finding those with the lowest blood levels of vitamin K had a 65% greater risk of hip fracture compared to those with the highest levels of the nutrient. (Hart JP, Lancet 1984; Bitensky L, Hart JP et al, J Bone Surg Br 1988; Hodges SJ, Pilkington MJ, et al. Bone 1991; Booth SL, Tucker KL, et al. AJCN 2000 )

Supplementation with vitamin K2 has been shown to be an effective treatment against osteoporosis. A review study of randomized controlled human trials of at least 6 months duration that assessed the use of vitamin K1 or K2 to lower fracture risk identified 13 trials. In all but one, vitamin K reduced bone loss with K2 being most effective, reducing risk of vertebral fracture by 60%, hip fracture by 77%, and all non-vertebral fractures by 81%. (Cockayne S, Adamson J, et al. Arch Intern Med 2006)

Vitamin K Combats Cardiovascular Disease

When levels of vitamin K are insufficient, high levels of uncarboxylated (inactive) osteocalcin float around in the bloodstream. Not only is calcium not delivered to the bones, which become porous, but it's deposited in the arteries, which become calcified. (Bitensky L, Hart JP, et al. J Bone Joint Surg Br 1988; Schurgers LJ, Dissel PE, et al, Z Cardiol 2001; Demer LL, Tintut Y, et al. Curr Opin Nephrol Hypertens 2002; Berkner KL, Rune KW, J Thromb Haemost 2004; Braam LA, Hoeks, AP, et al. Thromb Haemost 2004; Adams J, Pepping J. Am J Health Syst Pharm 2005; Purwosunu Y, Muharran, et al. J Obstet Gynaecol Res 2006; Cranenburg EC, Schurgers LJ, et al. Thromb Haemost 2007)

Cardiovascular disease is not just about cholesterol, which, if oxidized, can cause atherosclerosis, the formation of plaques on the innermost wall of the arteries. Just as lethal is arteriosclerosis, hardening of the arteries due to calcium deposits in their muscular midsection. Arteriosclerosis is the major culprit behind those surprising sudden deaths that occur in young men whose cholesterol levels are just fine.

Sudden death from heart attack is much more highly correlated with calcification of the aorta than cholesterol. In Framingham study research, aortic calcification was associated with double the risk of death from cardiovascular disease in men and women younger than 65, even after other risk factors (e.g., cholesterol) were taken into account. In men younger than 35, calcification of the aorta increased risk of sudden coronary death 7-fold. (Witteman JC, Kannel WB et al. Am J Cardiol 1990; Pohle K, Ropers D, et al. Heart 2003; Iribarren C, Sidney S et al. JAMA 2000)

In other research involving more than 100,000 men and women in California, aortic calcification increased risk of coronary heart disease 127% in men and 122% in women. Among women, it also increased risk of stroke 146%. (Iribarren C, Sidney S. JAMA 2000)

Fortunately, one of the vitamin K2-dependent proteins, matrix Gla-protein (MGP) is the strongest inhibitor of tissue calcification presently known. MGP is produced by small muscle cells in the vasculature where - once carboxylated by vitamin K2 - it binds to and inhibits a protein called bone morphological protein-2 (BMP-2). BMP-2 causes calcium deposition in blood vessels. (Kaneki M, Takayuki H, et al., Nutrition 2006; Demer LL, Tintut Y et al, Curr Opin Nephrol Hypertens 2002)

K2 also helps promote blood vessel elasticity by safeguarding elastin, the core protein in the muscle fibers primarily responsible for the elasticity of the arterial wall. Existing elastin is damaged and new production is inhibited by calcium deposition. (Seyama Y, Wachi H. J Athero Thromb)

In the Rotterdam study, a major European clinical trial following 4,807 subjects aged at least 55 over a 7-10 year period, researchers found that K2, but not K1, significantly reduced risk of cardiovascular disease by 57%, death from all causes by 26%, and severe aortic calcification by 52%. K1 had no beneficial effects. (Geleijnse JM, Vermeer C, et al. J Nutr 2004)

Special K Benefits for Postmenopausal Women: Combating the Calcification Paradox

As women enter menopause, they simultaneously lose calcium from bone and increase its deposition in arteries - a negative double whammy called the "calcification paradox," which greatly increases risk of both osteoporosis and cardiovascular disease. (Adams J, Pepping J, Am J Health Syst Pharm 2005) The drop in estrogen causes both problems, but vitamin K can help rectify them.

A 3-year study of 325 postmenopausal women receiving either K2 or placebo found that supplementation with K2 can prevent bone loss associated with estrogen decline. In the women given K2, bone mineral content increased, and hip and bone strength remained unchanged, whereas in the placebo group, bone mineral content and bone strength decreased significantly. (Booth SL, Broe KE, J Clin Endocrinol Metab; Knapen MH, Schurgers LJ, Osteoporos Int. 2007)

Plus, the vitamin K-dependent matrix-Gla protein that inhibits vascular calcification helps maintain the elasticity of postmenopausal women's blood vessels. In a 3-year study of 181 postmenopausal women, one-third were given a supplement containing vitamin D, one-third got a supplement providing both vitamin K1 and D, and one-third were given a placebo. In both the vitamin D and the placebo group, the elasticity of the common carotid artery decreased, while in those given K along with D, elasticity was maintained. (Braam LA, Hoeks AP, Thromb Haemost 2004)

Should You Supplement with Vitamin K?

While it is unlikely that your vitamin K levels are insufficient to meet clotting needs, levels of vitamin K necessary for clotting are much lower than those needed for bone and arterial protection. Studies of healthy adults have found high levels of uncarboxylated osteocalcin and matrix Gla-protein (MGP) in all subjects tested. (Cranenburg EC, Schurgers LJ et al. Thromb Haemost 2007)

Deficiency is more likely in people with digestive problems such as celiac disease, irritable bowel disease, or who have had intestinal bypass surgery, since vitamin K is a fat-soluble nutrient, and these conditions increase the likelihood of fat malabsorption.

Our vitamin K needs also increase with age. Older individuals (over age 70) require higher levels of vitamin K. (Tsugawa N, Shiraki M, et al. Am J Clin Nutr 2006)

Bile acid sequestrants (e.g., Cholestyramine, Colestipol), a class of drugs used to lower cholesterol levels, also bind and carry out fat-soluble vitamins, including vitamin K.

Anticoagulant medications, such as Coumadin, decrease clotting by interfering with vitamin K and may actually cause arterial calcification by preventing vitamin K from activating matrix Gla-protein. (Uotila L, Scand J Clin Lab Invest Suppl 1990; Schurgers LJ, Aebert H, et al. Blood 2004) Two recent studies involving more than 100 subjects have shown that patients treated with oral anticoagulants have double the calcification of patients not on these vitamin K-blocking drugs. (Schurgers LJ, Aebert H, Blood 2004; Koos R, Mahnken AH, Am J Cardiol 2005).

People taking these medications should discuss their vitamin K needs with their physician and NOT experiment with vitamin K foods or supplements on their own.

Want to Check Your Vitamin K Status?

A normal prothrombin time (the test for clotting activity that has been the standard used to check vitamin K sufficiency) is not sufficient indication that enough vitamin K is present to maintain vascular matrix-Gla protein activity or bone osteocalcin activity. Request an osteocalcin test; it measures how much uncarboxylated osteocalcin is present in the blood. High levels of uncarboxylated osteocalin indicate insufficient vitamin K is present to promote optimal bone health. Similarly, high levels of undercarboxylated matrix-Gla protein (MGP) indicate that insufficient vitamin K is present to protect against vascular calcification. (Berkner KL, Rune KW, J Thromb Haemost 2004; Cranenburg EC, Schurgers LJ et al. Thromb Haemost 2007; Bugel S. Proc Nutr Soc 2003)

~Lara Pizzorno, MDiv, MA, LMT

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Technorati Tags: vitamin K, calcium, bone health, clotting, integrative medicine

Genetically Modified Foods: Just Say No!

2007-11-20T13:51:00.000-05:00

Just Say "No" to GMO
This is perhaps the most controversial article we have written so are far for this blog. While we only cite one data source, Smith's Genetic Roulette, we spot checked several research articles and did a PubMed search that appears to confirm the seriousness of this issue.

Are GMO foods the next best hope for feeding our planet or should we follow the example set by consumers in the European Union, whose outcry reached such proportions that, in April 1999, virtually all major manufacturers publicly committed to stop using GM ingredients in their European brands?

The Case for GMOs

According to the GMO industry, there are many good reasons to use GMOs:

Reduced need for herbicides
Reduced need of pesticides
Reduced greenhouse emissions as GMOs require less tillage or plowing, thus less use of fossil fuels
Ability to manipulate foods to increase desirable components such as nutrients
Increased production of food for starving third world countries.

These are certainly worthwhile goals, and humans have been successfully modifying the genetics of their food supply for centuries.

The supporters assert that over a trillion GMO meals have been eaten, thus proving their safety. The problem, of course, is that the new technology is far different from the hybridization and selection methods used in the past.

The big question: "Are GMOs safe?"

The EU Consumer-Led Revolt
The EU consumer-led revolt against GMOs was triggered in February 1999 when media coverage exploded after top GMO safety researcher, Dr. Arpad Pusztai was called to speak before Parliament and went public with some very alarming research results.

Dr. Pusztai, a highly respected leader in the field with 35 years employment at the Rowett Institute in Scotland, had been given a UK government grant to design the long-term testing protocols that were supposed to be part of the European GM food safety assessment process. When Pusztai fed rats GM potatoes genetically engineered to produce a supposedly safe insecticide called the GNA lectin, all the animals showed potentially pre-cancerous cell growths, smaller brains, livers and testicles, partially atrophied livers, and damaged to the immune system--with most changes appearing after just 10 days.

Since other rats fed normal potatoes spiked with GNA lectin--even 700 times more GNA lectin than was present in the GM potatoes--did not develop these problems, Pusztai's results indicated that the problem lay with genetic engineering process itself. And that meant that all GM foods created from the same process, including those already on the market, might produce unintended ill effects.

According to Pusztai, when he expressed his concerns, he was fired and threatened with a lawsuit if he discussed his research. His 20-member research team was disbanded; the testing protocols were dropped, and a campaign was begun by pro-GM forces to discredit the study. Then an invitation to testify before Parliament allowed Pusztai to tell his story, and all hell broke loose. By April 1999, the protests of informed consumers had convinced manufacturers that GMOs would not sell in the EU, and all agreed to keep GMOs out of their European products, in spite of official approvals by a pro-GM European Commission.

Americans Ill-Informed about GMOs
In the U.S., the Pusztai story got virtually no press, and the U.S. mainstream media has failed to discuss other data suggesting GM foods may pose enormous health risks, including:

A preliminary study from the Russian National Academy of Sciences finding that more than half the offspring of mother rats fed GM soy died within three weeks (compared to 9% from mothers fed natural soy).
The estimated 10,000 sheep that died in India within 5-7 days of grazing on GM cotton plants engineered to produce their own Bt-toxin pesticide.
The only human GM feeding study ever published, which shows that the foreign genes inserted into GM food crops can transfer into the DNA of our gut bacteria. This study gives new meaning to the adage, "You are what you eat." Long after those GM corn chips you munched are history, your intestinal flora may still be churning out the "Bt" pesticide GM corn plants have been engineered to produce.

U.S. consumers mistakenly believe that, unless the FDA had approved each and every GM food through rigorous, well designed, long-term studies, GM food ingredients would not be allowed in our food supply and certainly could not be omnipresent in prepared foods in the form of corn, soy, cottonseed and canola derivatives.

Reality is that the FDA has absolutely no GMO safety testing requirements, and GM ingredients are ubiquitous in prepared foods. Unless a processed food contains only organic ingredients, it is highly likely to contain GM ingredients. The "research" that supports GMO safety is voluntarily provided by companies on their own GM crops and has been described by critics as "meticulously designed to avoid finding problems".

But 44,000 FDA internal documents later made public as a result of a lawsuit revealed problems. The overwhelming consensus among the FDA's scientists was that GM foods were substantively different, so different that their consumption might result in unpredictable and hard-to-detect allergens, toxins, new diseases and nutritional problems. Agency scientists urged superiors to require long-term studies, but were not only ignored, their statements about possible negative effects of GMOs were progressively deleted from FDA policy statement drafts. Evidence of this FDA activity was presented at a Washington, D.C., press conference in 1999, another story major media didn't publicize.

The result: The same companies that carefully avoid including GM ingredients in their European products are feeding GMOs to ill-informed consumers in the U.S. Americans know so little about GMOs that, although virtually all of us have now, albeit unwittingly, consumed GM foods (the vast majority of processed foods contain derivatives from the four major GM crops: soy, corn, cottonseed and canola), only about 1 in 4 realize it.

What's the Problem with GMOs?
The way they are created disrupts the plant's DNA in unintended, potentially harmful ways.

In genetic engineering, a single gene is removed from one organism and forcibly inserted into another. First, scientists identify the gene they want and analyze its sequence. (If the source gene is to be taken from bacteria, some of its sequence has to be rearranged because bacteria produce certain amino acids using a code different from the one used by plants).

After figuring out a working gene sequence, engineers add a promoter sequence at one end of the gene to turn it on (the most popular one in GM crops being CaMV 35S, which forces the gene to constantly churn out the protein), and a terminator sequence at the other end (which tells the DNA to stop). Lastly, scientists add a marker gene, usually one that confers antibiotic resistance, so they can later douse the plant cells with antibiotics, killing off normal cells and revealing those that have been genetically modified. This combination of gene sequences - called a "gene cassette" - is then multiplied into millions and inserted into target plant cells via one of two primary methods, both of which trigger a wound response the cell.

One method employs a bacterium (Agrobacterium tumefaciens), which normally infects a plant by inserting a portion of its own DNA into the plant's DNA and then causing the plant to produce tumors. Genetic engineers remove the tumor-creating section of this bacterium's DNA and replace it with the desired gene cassette, so the bacterium "infects" the plants with the foreign genes instead.

The second method uses a gene gun. Scientists coat millions of particles of tungsten or gold with gene cassettes and blast them into millions of plant cells, only a few of which incorporate the foreign gene cassette.

In either of the two delivery forms, the next step is the application of the antibiotic to which the gene cassette confers resistance. Most of the plant cells die, but a few - the ones in which the transgene has inserted - survive. These are developed into plants that researchers can duplicate by making clones through tissue culture or harvesting the seeds.

Each plant grown from a gene insertion is unique because where the transgene ends up integrating itself into the host DNA is uncontrolled and cannot be reproduced. For this reason, the possible consequences to the plant's DNA are different with each insertion, so all plants developed from a specific insertion are collectively referred to as an "event."

In sum, genetic engineering artificially combines genes from different species and forcibly inserts them into unknown and random locations on the host genome. The procedure, which disrupts the precise orchestration of thousands of genes that has evolved over millennia in the normal plant's genome, is highly mutagenic. (We now know that genes, like nutrients, do not work singly, but as part of highly integrated networks.) Plus it introduces bacterial genes for drug resistance along with strong promoters to express the foreign proteins at high levels in all parts of the plant.

In his book, Genetic Roulette, Jeffrey M. Smith, provides a detailed discussion of the documented health risks of GMOs, including evidence of reactions seen in animals and humans. Following are just a few of the indications he provides that GMOs are significantly changed by the process and may produce undesirable effects:

Evaluation of gene insertion sites have shown relocations of up to 40,000 DNA base pairs, mixing together of foreign and host DNA, large scale deletions of more than a dozen genes and multiple random insertions of foreign DNA fragments.
During insertion, the foreign gene may become truncated, rearranged or interspersed with extraneous pieces of DNA. The proteins produced by the distorted foreign gene may be misfolded or have added molecules, so they may operate differently and be harmful in unpredictable ways.
One study using a micro-array gene chip found that 5% of the host's genes changed their levels of expression after a single gene was inserted.
The promoter used in nearly all GM crops permanently turns on the foreign gene at high output. Scientists had thought the promoter would only turn on the foreign gene, but, in fact, it can accidentally turn on other natural plant genes--permanently--genes that may overproduce an allergen, toxin, carcinogen or anti-nutrient, or regulators that block other genes.
When certain viruses infect an organism, they splice themselves into the host's DNA. If the GM promoter is inserted in the vicinity of a dormant virus, it might switch it on, resulting in virus activation.
In GMO Roundup Ready soybeans, the "stop signal" placed at the end of the gene cassette is dysfunctional, so longer than intended RNA proteins are produced, which are further rearranged into four non-intended variants, any one of which might be harmful.
DNA changes in GM plants can alter the amounts of the chemicals the plant naturally produces, increasing its output of toxins or decreasing the amount of protective phytonutrients produced. For example, GM soybeans produce less cancer-fighting isoflavones.
GM proteins in soybeans, corn and papaya are similar to known allergens and may cause allergies.
Transgenes survive digestion and can transfer to gut bacteria or move into the blood and organs, including passing through the placenta into the fetus and through the blood-brain barrier. The only human feeding trial ever published confirmed that genetic material from Roundup Ready soybeans transferred into the gut bacteria in three of seven human volunteers. Once in the human gut bacteria, the transferred portion of the transgene produced herbicide-resistant protein. If the antibiotic-resistant genes that have been inserted into most GM foods on the market were to transfer to pathogenic bacteria in the gut, antibiotic-resistant diseases could develop. If the transgene for the Bt pesticide were to transfer to our gut bacteria, we could become living pesticide factories.

Sound scary? The limited amount of research and case reports regarding what actually happens when animals and people consume GM foods is not reassuring. Here are just a few highlights from Smith's coverage of GMO's effects:

Rats fed Monsanto's Mon 863 Bt corn for 90 days showed significant changes in their blood cells, livers and kidneys.
Rats were fed the GM FlavrSavr tomato for 28 days. Seven of 20 rats developed stomach lesions (bleeding stomachs); another 7 of 40 died within two weeks.
About 25% of the sheep in herds grazing continuously on Bt cotton plants in India after the cotton harvest died within a week, according to reports from 4 villages. Post mortem studies suggested a toxic reaction.
Twelve dairy cows died on a farm in Hesse Germany, after being fed a diet with significant amounts of the GM corn variety, Bt 176. Other cows in the herd developed a mysterious illness and had to be killed. Syngenta, the producers of Bt 176, compensated the farmer for part of his losses, but despite the farmer's demands and public protests, no detailed autopsy reports were made available.
More than 20 farmers in North America have reported that pigs fed GM corn had low conception rates, false pregnancies or gave birth to bags of water. Both male and female pigs became sterile.
In mice fed GM soy, production of alpha-amylase, an enzyme responsible for digesting starch, dropped by as much as 77%.
In male mice fed Roundup Ready soybeans, the structure and gene expression pattern of testicular cells changed significantly.
Female rats were fed Roundup Ready soy starting before conception and continuing through weaning. 55.6% of the offspring died within three weeks compared to 9% of non-GM soy controls. In another study, after a lab began feeding rats a commercial diet containing GM soy, offspring mortality reached 55.3%. When offspring from the GM-fed rats were mated together, they were unable to conceive.
In 2003, approximately 100 people living next to a Bt cornfield in the Philippines developed skin, respiratory, intestinal reactions and other symptoms while the corn was shedding pollen. Blood tests of 39 people showed an antibody response to Bt-toxin. Symptoms reappeared in 2004 in at least four other villages that planted the same GM corn variety.
GM soy was imported into the UK shortly before 1999. Within a year, soy allergies in the UK had risen from 10% to 15% of the sampled population. Antibody tests show that some individuals react differently to GM and normal soy varieties. GM soy has higher levels of a known allergen.
One brand of the supplement L-tryptophan created a deadly epidemic in the U.S. in the 1980s. The company responsible had genetically engineered bacteria to produce the supplement more economically. The resulting product contained many contaminants, five or six of which were suspected as the cause of the disease. Not only the GM L-tryptophan supplement, but all L-tryptophan was removed, and still remains off the market.

Bottom Line
A PubMed search on "GMO" and "Safety" yielded 41 articles. Restricting the search to human studies dropped that to 20 articles. Restricting further to clinical trials yielded only one study, and it was of ability to track the presence of GMOs in the food supply!

Here is a list of the titles of the first 20 articles returned by this PubMed search:

Reappraisal of biosafety risks posed by PERVs in xenotransplantation.
Session VII: Risk management and monitoring.
The politics and science behind GMO acceptance.
Model for tuning GMO detection in seed and grain.
Approaches in the risk assessment of genetically modified foods by the Hellenic Food Safety Authority.
Biological safety concepts of genetically modified live bacterial vaccines.
Molecular farming on the rise--GMO regulators still walking a tightrope.
New measures of insecticidal efficacy and safety obtained with the 39K promoter of a recombinant baculovirus.
Need for an "integrated safety assessment" of GMOs, linking food safety and environmental considerations.
European GMO labeling thresholds impractical and unscientific.
[Application of near-infrared diffuse reflectance spectroscopy to the detection and identification of transgenic corn]
Role of the "National Reference Centre for Genetically Modified Organisms (GMO) detection" in the official control of food and feed.
GMO: human health risk assessment.
Regulations governing veterinary medicinal products containing genetically modified organisms in the European community.
Assessment of novel foods in animal nutrition.
The human side of GMO biosafety research.
GMO biosafety research in China.
Allergy assessment of foods or ingredients derived from biotechnology, gene-modified organisms, or novel foods.
Public health issues related with the consumption of food obtained from genetically modified organisms.[Genetically modified plants and food safety. State of the art and discussion in the European Union]

The rest of the article titles were similar. Notice something missing? No actual human research published! These are all opinion articles and recommendations on how to determine safety. But virtually no actual research. Now, we realize that such studies may have been published in food technology journals that are not in Medline. However, the medical research world is where we live and where we trust the results of the peer-review process.

The answer to our question, "Are GMOs safe?" is very clear: we don't know.

The surprising lack of studies published in the scientific medical literature is, to us, a huge red flag. If these are so safe, where are the actual human studies? The assertion that a trillion meals have been eaten is not compelling. If there is no actual system in place for monitoring the impacts of these foods and virtually everyone in the US is eating them every day then how is their safety to be assessed?

How to Go Non-GMO
If the risks documented in Genetic Roulette raise enough questions about GMOs' potential for harm that you wish to avoid consuming GMOs until more research has been done - research not controlled by the biotech companies - here are a few tips.

If you are traveling to Europe, no worries. GMOs are banned in EU foods. In the United States and Canada, however, GM foods are not only legal, but are unlabeled, so avoiding them can be challenging.

Eat Organic: Organic foods are not allowed to contain GM ingredients. Even the small percentage of non-organic ingredients allowed in foods labeled organic is not allowed to contain GMOs.

Prepared or Processed Foods:

Most generic vegetable oils and margarines used in restaurants and in processed foods in North America are made from soy, corn, canola, or cottonseed—the four major genetically engineered crops. Avoid these oils, unless they are organic or labeled non-GMO. Choose any other oil, e.g., olive, sunflower, or safflower.
Check the list of ingredients for GM enzymes, additives, sweeteners, soy and/or corn derivatives. Genetically modified bacteria and fungi are used in the production of enzymes, vitamins, food additives, flavorings and processing agents in thousands of foods on the grocery shelves as well as health supplements.
Flavorings such as vanillin and hydrolyzed vegetable protein, which is derived from corn and soy, can also come from GM sources. Xanthan gum is another product that may be derived from a GM process.
Aspartame, the diet sweetener, is a product of genetic engineering.
Honey can be produced from GM crops. For example, some Canadian honey comes from bees collecting nectar from canola. This has shut down exports of Canadian honey to Europe.
Most packaged foods contain soy and/or corn derivatives, e.g., soy or corn oil, soy flour, soy protein, soy lecithin, textured vegetable protein, corn meal, corn syrup, dextrose, maltodextrin, fructose, citric acid, lactic acid. Non-GMO alternatives can be found not only in health food stores, but in supermarkets. Mayonnaise, for example, which is traditionally made with soy oil, can be found in both non-GM soy and safflower varieties.

Vitamin Supplements: Among vitamins, vitamin C (ascorbic acid) is often made from corn; vitamin E is usually made from soy. Vitamins A, B2, B6, and B12 may be derived from GMOs as well. In addition, vitamin D and vitamin K may have "carriers" derived from GM corn sources, such as starch, glucose, and maltodextrin. In addition to finding these vitamins in supplements, they are sometimes used to fortify foods. Organic foods, even if fortified with vitamins, are not allowed to use ingredients derived from GMOs.

Eating Out:

Ask what oil is used for cooking. If the answer is "vegetable oil," margarine, soy, cottonseed, canola or corn oils, ask if olive or some other oil can be used instead or for something cooked without oil. Check to make sure the olive oil is pure and not a blend of canola and olive.
Avoid menu items with dairy, unless organic, and items made with non-organic meat. Very few restaurants buy organic milk or milk certified to be from cows that are not treated with genetically modified rbGH, and both non-organic meat and dairy products usually come from animals that have eaten GM feed. Also, a common enzyme, chymosin (called rennet), used in the production of hard cheeses, was formerly derived from the stomach linings of calves. In 1990, a GM cbymosin was introduced and is now found in more than 70% of non-organic U.S. cheeses.
Ask what foods are freshly prepared. Avoid menu items made with packaged sauces or processed foods since most contain GM derivatives (e.g., corn and soy derivatives).
Avoid desserts made with aspartame.

For an extensive list of foods by brand and category, indicating if they have GM ingredients, see http://www.truefoodnow.org/shoppersguide/guide_printable.html

References:
www.responsibletechnology.org
Smith, JM. Genetic Roulette, Yes! Books, Fairfield, Iowa, 2007.

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Technorati Tags: GMO, health, wellness, bacteria resistance, food, organic, diet

Single Antioxidants Don't Prevent Heart Disease

2007-11-01T08:22:00.000-04:00

Photo Credit: Marcelo Alves

A new research article published in the prestigious Archives of Internal Medicine provides further evidence that supplementing with mega-doses of antioxidant vitamins does not prevent heart disease.

In this new research study, more than 8,000 women took vitamin C, vitamin E, beta-carotene, a combination of the above, or placebo. All of the women in the study had either existing cardiovascular disease or multiple risk factors for this condition. They took the vitamins on average for nearly 10 years.

At the conclusion of the study, little difference was seen in the incidence of heart attacks and strokes, or death from any cause in women who were taking the vitamin supplements compared to placebo. A modest reduction in stroke incidence was noted in women taking both vitamin C and E, but the researchers concluded that this was likely to be random chance due to the lack of protective effect seen with similar combinations.

Now that we have dozens of studies with hundreds of thousands of participants, I think doctors can pretty safely conclude that prescribing high doses of single antioxidant vitamins does not provide significant protection against heart disease. This is a finding that may disappoint some consumers, but I think one that in retrospect should not be terribly surprising.

Researchers have been interested in the use of antioxidants in the prevention of heart disease since the observation that free radical damage is an event that helps to trigger the process of artery blockage. Since antioxidants help prevent free radical damage, their supplementation is a logical approach to protection of the arteries and prevention of this blockage. A major complication with antioxidant supplementation, however, involves the interactive nature of antioxidants. Antioxidants work as a team in the body to quench these free radicals. Studies have generally found that single antioxidant interventions do not provide full protection against free radicals, and in some instances, have suggested that mega-doses of single nutrients can actually increase free radical production.

Another significant issue is that the forms of antioxidants used in the studies are not those found in the typical healthy diet. For example, the alpha tocopherol form of vitamin E (even assuming they are using the natural rather than synthetic form) is gamma tocopherol, the form found in the human diet and highest concentration in the blood. In fact, high dosages of alpha tocopherol actually decrease gamma tocopherol. This is important since the gamma form is far more protective of the heart than alpha. In addition, beta carotene is only one of several hundred carotenoids found in the diet. High dosages of beta carotene actually decrease the abortion of other carotenoids from the diet.

There are ongoing clinical research trials using more comprehensive antioxidant formulas that have the potential to provide a better vitamin approach in cardiovascular disease. Unfortunately, they still do not seem to be addressing the issue of appropriate form.

Photo Credit: Ali Karimian

Until the results from more comprehensive antioxidant studies with appropriate dosage forms are in, cardiovascular disease prevention should primarily focus on good diet and lifestyle habits. If you want to take antioxidant supplements, use modest dosages and forms which are closest to those found in nature. For example, use mixed tocopherols which have more gamma than alpha tocopherol and mixed carotenoids rather than just beta carotene.

Here are a few of the things I tend to stress with my patients:

Aerobic exercise 5+ days per week
Smoking cessation
Diets rich in fresh fruits and vegetables daily
Cold water fish twice weekly
Weight control
Stress reduction
Low saturated and trans fats (often by eliminating fried foods and processed foods containing hydrogenated oils)

~Matt Brignall, ND

References:

Cook NR, Albert CM, Gaziano JM, et al. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women: results from the Women's Antioxidant Cardiovascular Study. Arch Intern Med. 2007;167:1610-8.
Lonn E, Bosch J, Yusuf S, et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. 2005 Mar 16;293(11):1338-47.
Omenn GS, Goodman GE, Thornquist MD, et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med. 1996;334:1150-5.
Waters DD, Alderman EL, Hsia J, et al. Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary atherosclerosis in postmenopausal women: a randomized controlled trial. JAMA. 2002;288:2432-40.

Related Topics:

Technorati Tags: antioxidents, vitamins, heart health, health and wellness

Ah, Roughage

2007-10-16T13:32:00.000-04:00

You really can't say enough great things about fiber. What can fiber do for you? Lower cholesterol; control body weight; improve blood sugar; prevent constipation, diarrhea, hemorrhoids, diverticulosis, gallstones, irritable bowel syndrome, syndrome X, and colon and rectal cancer; and improve immunity and liver detoxification.

What we call fiber, plants call structure. Fiber is comprised of carbohydrate and lignin that are resistant to human digestion. The recommended daily intake of fiber is 25 grams for women and 38 grams for men. The average American eats a meager 10-15 grams of fiber a day. In contrast, hunter-gatherer populations elsewhere in the world who eat and live now as they did thousands of years ago, eat as much as 100 grams of fiber a day. There are estimates that if Americans ate 13 grams extra of fiber per day (about 25 grams total), it would decrease their risk of colorectal cancer by about one third!

Location, Location, Location

It comes as no great surprise that fiber naturally occurs in large amounts in healthy foods. Animals do not produce fiber, so we can only get it by eating plant foods. Fiber is abundant in fruits, veggies, whole grains and beans. So when you choose high fiber foods, you are also choosing nutrient dense, low-calorie foods that improve your health beyond just the effects of the fiber.

Mind the Gap
If you are going to consciously increase your fiber intake, do it slowly and drink lots of water! Your intestines need some time to adapt to the changes in stool bulk and speed so you don't get constipated or diarrhea. Soluble fiber will bind up a lot of water, therefore you need to drink a lot of water to prevent becoming constipated dehydrated.

The Details
Although the definition of fiber is not entirely agreed upon, it is often defined as: a combination of cellulose, hemicelluloses, and lignins (not technically carbohydrates) that are resistant to digestion. Cellulose and hemicellulose are plant polysaccharides (complex carbohydrates) that make up the plant cell wall. This is where the vast majority of fiber is found.

The major types of fiber are found in the following foods:

Cellulose - bran, beans, peas, root vegetables, cabbage family of vegetables, outer layer of seeds, and apples
Hemicellulose - bran and whole grains
Lignin - root vegetables, whole wheat, fruits with edible seeds (such as strawberries)
Gums - oatmeal, barley, and beans.
Pectins - apples, strawberries, and citrus fruits

You'll notice in the list above, which is not exhaustive, that multiple types of fiber are found in the same foods, e.g. apples are good sources of both pectin and cellulose. This is because plants are mixtures of different types of fiber, and the amounts of each type can even vary based on the part of the plant and its age.

Different types of fibers are further categorized by their physical qualities to differentiate between their effects on the body: soluble, insoluble, fermentable or viscous. Again, the major types of fiber have various combinations of these physical qualities, sometimes contradictory. However, sometimes one type is dominant and the food is known for that property, such as prunes and stool softening.

The major types of fiber primarily have the following qualities:

Cellulose - insoluble and non-fermentable
Hemicellulose - some are soluble and viscous, some are insoluble
Lignin - insoluble and non-fermentable
Gum - soluble, fermentable and viscous
Pectin - soluble, fermentable and viscous

Generally, soluble and viscous fibers slow down the foods transit through the digestive system, while at the same time physically blocking the absorption of some nutrients, including glucose and fats. They also increase the sensation of fullness. They also physically trap enzymes responsible for the digestion. Insoluble fibers bulk the stool and speed up the foods transit through the digestive system. Sped up transit also decreases absorption of some nutrients simply because they lack the time to come into contact with the appropriate part of the intestines.

Below, the types of fiber are organized by their health-promoting properties:

Lower Cholesterol: Soluble and Viscous Fiber
- Soluble and viscous fiber bind to the cholesterol you have eaten, therefore reducing its absorption in the intestines.
- Viscous fibers bind to bile acids, which are made by the liver from cholesterol and are necessary for fat digestion. The bound cholesterol is excreted in the feces. As a result, the liver must use additional body stores of cholesterol to manufacture new bile acids.

Stable Blood Sugar Levels: Viscous Fiber
- Viscous fiber slows the rate at which food leaves the stomach, which delays the absorption of sugars after a meal. This effect also creates a feeling of fullness, which helps to prevent overeating and weight gain.
- The improved insulin sensitivity caused by viscous fiber is useful in the prevention and treatment of type 2 diabetes.

Protect the Intestines: Fermentable and Non-fermentable Fibers
- Fermentable fiber provides food for the "friendly" bacteria that live in the intestines (see my previous posting on friendly intestinal bacteria). A strong population of friendly bacteria out-competes pathogenic bacteria for residence in the intestines. This also improves detoxification since these good bacteria bind toxins present in the intestines until they are excreted. Fibers also bind to cancer-causing toxins which prevents them from coming into contact with the intestinal cells.
- The fermentation of fiber produces a short-chain fatty acid called butyric acid. This is the main fuel for the cells of the large intestine, therefore the presence of butyric acid helps keep the colon healthy and intact.

Regularity: Insoluble and Non-fermentable Fibers
- Insoluble and non-fermentable fibers increases the bulk of the feces.
- They decrease the transit time of feces through the intestines.
- Having regular bowel movements is associated with a decreased risk for colon cancer and hemorrhoids.

Nutrient Absorption
Unfortunately, most fibers decrease somewhat the absorption of nutrients we want to get from our food, in addition to the nutrients we want to avoid like fat, cholesterol, and sugar.
- There is a watery viscous layer on top of our intestinal cells which nutrients must pass through to be absorbed. Eating lots of viscous fiber is believed to increase the thickness of this layer.
- Soluble and viscous fibers physically block the absorption of some nutrients by binding to them. They also physically trap enzymes responsible for digestion.
- Insoluble fibers speed up food's transit through the digestive system, which decreases absorption of some nutrients simply because they lack the time to come into contact with the appropriate part of the intestines.
- Gums likely decrease the undulating muscle movement of the intestines, which is how nutrients are brought to the intestinal cells in order to be absorbed. The nutrients may miss their optimal absorption locations.
- Excessive intake of non-fermentable fiber, typically in supplemental form, may lead to mineral deficiencies.

Fermentable Fibers
Some fibers increase absorption of desired nutrients. Fermentable fibers produce short-chain fatty acids which acidify the intestinal environment, thereby improving calcium binding and absorption.

Bottom line, since fiber rich foods are richer in needed nutrients, their decreased absorption is not a problem and more than compensated by fibers inhibition on undesirable substances like excess fat and intestinal toxins.

Conclusion - the Magic Bullet
Rarely in nutrition would we call something a "magic bullet." However, healthy digestion and appropriate passage of food through the intestines is critical to good nutrition. The importance of fiber to the prevention and treatment of the major conditions affecting Americans today (heart disease, diabetes, and cancer), and its integral role in most digestive diseases and symptoms, make it is easy to see why we nutritionists idolize fiber. So do your health a favor and eat a variety of fibers by eating whole plant foods.

~Raven Bonnar-Pizzorno, MS (Nutr), RD candidate

References:

American Dietetic Association. Health implications of dietary fiber - - Position of the ADA. Journal of the American Dietetic Association 1997; 97:1157-1159.
Burton-Freeman B. Dietary fiber and energy regulation. J Nutr 2000 Feb;130(2S Suppl):272S-5S. PMID:15360.
Davy BM and Melby CL. The effect of fiber-rich carbohydrates on features of Syndrome X. J Am Diet Assoc 2003 Jan;103(1):86-96 2003.
Fernandez ML. Soluble fiber and nondigestible carbohydrate effects on plasma lipids and cardiovascular risk. Curr Opin Lipidol 2001 Feb;12(1):35-40 2001.
Groff JL, Gropper SS. Advanced Nutrition and Human Metabolism. Wadsworth Thomson Learning, New York, 2000.
Institute of Medicine. Dietary Reference Intakes: Proposed Definition of Dietary Fiber. National Academy Press, Washington DC, 2001.
Mahan K, Escott-Stump S. Krause's Food, Nutrition, and Diet Therapy. Saunders; Philadelphia, 2004.
McIntosh M, Miller C. A diet containing food rich in soluble and insoluble fiber improves glycemic control and reduces hyperlipidemia among patients with type 2 diabetes mellitus. Nutr Rev 2001 Feb;59(2):52-5 2001.
Pereira MA, Pins JJ. Dietary fiber and cardiovascular disease: experimental and epidemiologic advances. Curr Atheroscler Rep 2000 Nov;2(6):494-502. PMID:15350.
Swanson KS, Fahey GC. New developments in the area of dietary fiber. Nutrition in Complementary Care Newsletter 2001; 4(1):5,12.

Better Sex, Mediterranean-Style

2007-09-04T13:15:00.000-04:00

Can't get no satisfaction? Forget the oysters. Toss the Viagra. Eat a Mediterranean diet.

Around 30 million men in the USA and 100 million men worldwide have erectile dysfunction (ED).

Female sexual problems, such as low sexual desire or inability to achieve orgasm, are just as or even more prevalent, with some research estimating 3 out of 4 women have concerns about their sexual function. (Bachmann G. J Sex Med. 2006 Jul)

Research investigating sexuality among 3,005 older Americans (57 to 85) and 27,500 men and women in Brazil aged (40-80) found that, in both populations, about half of both men and women reported at least one bothersome sexual problem. (Lindau ST, Schumm LP, et al. N Engl J Med 2007 Aug; Moreira ED Jr, Brock G, et al. Int J Clin Pract. 2005 Jan)

Dooming half of us to sexual frustration for the majority of our (potentially) sexually active lives doesn't seem fair, nor does it appear to be a good way to ensure the perpetuation of the species. So, what's going on here?

Turns out that way more often than not, a diagnosis of sexual dysfunction - male or female - is associated with metabolic syndrome, defined as the clustering of several of the following key symptoms: insulin resistance, a fat belly (central obesity), high cholesterol, and high blood pressure. Research indicates the metabolic syndrome affects between 10 and 25% of adults worldwide. (Esposito K, Ciotola M, et al. Int J Impot Res 2005 May-Jun; Ahmed MH, Diabetes Res Clin Pract 2007 Mar)

Several studies have found an association between metabolic syndrome and diabetes and cardiovascular disease. Now, strong evidence links the risk of ED in men and sexual problems in women with the metabolic syndrome.

Men with the metabolic syndrome are more than twice as likely to have ED (26.7% versus 13%) and higher blood levels of C-reactive protein (a marker of inflammation that greatly increases risk of cardiovascular disease), compared to controls. (Esposito K, Giugliano F, Martedì E, Diabetes Care 2005 May)

As C-reactive protein levels increase, so does likelihood of ED along with the number of symptoms indicating the metabolic syndrome, including endothelial dysfunction (lack of elastic responsiveness in blood vessels that promotes high blood pressure). In fact, researchers now believe common vascular pathways (involving nitric oxide activity) underlie both ED and endothelial dysfunction. (Ahmed MH, Diabetes Res Clin Pract 2007 Mar)

In rating their sex life, premenopausal women with the metabolic syndrome have a 33% lower overall score, half the satisfaction, and almost 3 times the amount of C-reactive protein in their bloodstream, compared to controls. (Esposito K, Ciotola M, et al. Int J Impot Res. 2005 May-Jun).

After switching to a Mediterranean diet - high on the fruits, vegetables, whole grains, legumes, nuts (especially walnuts) and olive oil, and very low on the red meat, refined grains, and processed foods - both men and women score way higher on standardized indices of sexual function.

In men, the test is called the International Index of Erectile Function. The lowest score is 5, the highest 25. A score of 22 or more translates to a 2% or less chance of having ED. A score of 21 or less indicates a 93% chance of having ED. After 2 years on a Mediterranean-style diet, 13 out of 35 men with metabolic syndrome reported an IIEF score of 22 or higher. In the control group, 28 out of 30 men (who had remained on their former diet) had a score of 21 or less. (Esposito K, Ciotola M, Giugliano F. Int J Impot Res. 2006 Jul-Aug; Bandolier Journal, Diagnostic tool for erectile function. August 2001; 90-6; http://www.jr2.ox.ac.uk/bandolier/band90/b90-6.html)

Other research has shown that even one-third of obese men with ED can regain their sexual activity after 2 years of adopting a Mediterranean-style diet and getting regular exercise. (Giugliano D, Giugliano F, Public Health Nutr 2006 Dec)

In women, the comparable questionnaire is the Female Sexual Function Index (FSFI), and eating Mediterranean-style had comparable beneficial effects on sexual vitality in a study of 59 women with metabolic syndrome and diagnosed female sexual dysfunction. (www.fsfiquestionnaire.com; Esposito K, Ciotola M, et al. Int J Impot Res. 2007 Aug)

In the 31 women eating a Mediterranean-style diet, after 2 years, FSFI scores improved from an average of 19.7+/-3.1 to a mean post-treatment value of 26.1+/-4.1. (The maximum score on the FSFI is 36.) No improvements were seen in the 28 women in the control group. C-reactive protein (CRP) levels were also significantly reduced in the Mediterranean-diet group. And everything improved (desire, arousal, lubrication, orgasm, satisfaction, pain), not just one single sexual domain.

The better sex solution? Enjoy a Mediterranean-style diet. Women and men in the Mediterranean-style diet groups consumed more fruits, vegetables, legumes, nuts, whole grains and olive oil, compared with men and women on the control diet.

Inspired to try a sexier way of eating? Check out The World's Healthiest Foods for everything you need to know to make a Mediterranean-style diet easy on your time and wallet as well as your taste buds.

References

Ahmed MH. Metabolic syndrome and endothelial dysfunction and associated high proportions of erectile dysfunction in men: innocent bystanders or accessories to the crime? Diabetes Res Clin Pract. 2007 Mar;75(3):370-1. Epub 2006 Aug 21. PMID: 16920218

Bachmann G. Female sexuality and sexual dysfunction: are we stuck on the learning curve? J Sex Med. 2006 Jul;3(4):639-45. PMID: 16839320

Esposito K, Ciotola M, Giugliano F, et al. Mediterranean diet improves sexual function in women with the metabolic syndrome. Int J Impot Res. 2007 Aug 2; [Epub ahead of print] PMID: 17673936

Esposito K, Ciotola M, Marfella R, et al. The metabolic syndrome: a cause of sexual dysfunction in women. Int J Impot Res. 2005 May-Jun;17(3):224-6. PMID: 15716979

Esposito K, Giugliano F, Martedì E. High proportions of erectile dysfunction in men with the metabolic syndrome. Diabetes Care 2005 May;28(5):1201-3. PMID: 15855589

Esposito K, Ciotola M, Giugliano F, et al. Mediterranean diet improves erectile function in subjects with the metabolic syndrome. Int J Impot Res. 2006 Jul-Aug;18(4):405-10. Epub 2006 Jan 5. PMID: 16395320

Giugliano D, Giugliano F, Esposito K. Sexual dysfunction and the Mediterranean diet. Public Health Nutr. 2006 Dec;9(8A):1118-20. PMID: 17378950

Lindau ST, Schumm LP, Laumann EO, et al. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007 Aug 23;357(8):762-74. PMID: 17715410

Moreira ED Jr, Brock G, Glasser DB, et al. Help-seeking behaviour for sexual problems: the global study of sexual attitudes and behaviors. Int J Clin Pract. 2005 Jan;59(1):6-16. PMID: 15707457

(written by Lara Pizzorno, MA, MDiv, LMT, reviewed and edited by Dr. Joe Pizzorno, ND)

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Hydrogenated Oils and Trans Fats

2007-08-20T09:41:00.000-04:00

How can food products containing partially hydrogenated oils be trans fat free?

For years, nutrition experts have been recommending that people avoid foods with partially hydrogenated oils on the label because they contain dangerous trans fats. Now, products are appearing that contain hydrogenated oils, but are labeled "trans fat free." Confused?

I was at a child's birthday party this weekend, and the conversation turned, as it often does when I'm around, to nutrition and health. An old friend of mine asked me how it was that health food store-brand margarine could both contain hydrogenated oils and also claim to be trans fat free.

There are at least two ways that I'm aware of. But to understand them, we'd better take a detour into food chemistry. Unsaturated fats usually make up the bulk of vegetable oils. These fats are unsaturated because they have less hydrogen per gram than saturated fats. Unsaturated fats are cheap, but they are also liquid and less stable (spoil more quickly) than saturated fats, making a big problem for food manufacturers.

Manufacturers have made vegetable oils more solid and more stable by adding in extra hydrogen in an industrial process called hydrogenation. They traditionally haven't added in enough hydrogen to fully saturate the fat, leading to the description "partially" hydrogenated oils. Partially hydrogenated oils are popular in processed foods because they are cheap, stable, widely available, and add a nice mouth-feel.

In this process, a small percentage of the unsaturated fats become something called trans fats, fats that are thought to have particularly destructive effects on the human body even in small amounts. For example, trans fats are thought to increase bad LDL cholesterol, decrease good HDL cholesterol, and have been correlated with increased risk of heart attack. For these reasons, and ensuing regulatory pressure, the food industry is moving away from adding hydrogenated oils into food.

So, how does a product that contains hydrogenated fats call itself trans fat free? One way is by shrinking serving size. The FDA allows products containing up to half a gram of trans fats per serving to be labeled as trans fat free. When adverse effects of intake can be seen at levels as low as two grams per day or less, those almost half-gram servings could end up being more significant than you would guess. By defining servings on the small end, fatty foods like margarines can look low calorie and trans fat free, when they are, in fact, neither.

Alternately, companies can fully saturate the vegetable oil with hydrogen, creating an all saturated fat product. Since this product is very solid, it needs to be artificially thinned down by whipping with water before using. Although fully hydrogenated oils do not contain trans fat, they are by no means a health food. Saturated fats, whether naturally occurring or produced industrially, have the same adverse effects on cholesterol as trans fats, and are potentially worse for blood sugar control.

When possible, try to use liquid fats like organic canola, safflower, or sunflower oil in cooking instead of solids. For spreads and other mildly heated items, extra virgin olive oil is often a good choice. For those recipes that require more solid fats, use the non-hydrogenated margarines sold in health food stores, or just plain old organic butter.

Matt Brignall, ND

References:

de Roos NM, Bots ML, Katan MB. Replacement of dietary saturated fatty acids by trans fatty acids lowers serum HDL cholesterol and impairs endothelial function in healthy men and women. Arterioscler Thromb Vasc Biol. 2001 Jul;21(7):1233-7.

Lichtenstein AH, Erkkila AT, Lamarche B, et al. Influence of hydrogenated fat and butter on CVD risk factors: remnant-like particles, glucose and insulin, blood pressure and C-reactive protein. Atherosclerosis. 2003 Nov;171(1):97-107.

Odegaard AO, Pereira MA. Trans fatty acids, insulin resistance, and type 2 diabetes. Nutr Rev. 2006 Aug;64(8):364-72.

Thomsen C, Rasmussen O, Lousen T, et al. Differential effects of saturated and monounsaturated fatty acids on postprandial lipemia and incretin responses in healthy subjects. Am J Clin Nutr. 1999 Jun;69(6):1135-43

Zaloga GP, Harvey KA, Stillwell W, Siddiqui R. Trans fatty acids and coronary heart disease. Nutr Clin Pract. 2006 Oct;21(5):505-12.

When Does Organic Not Mean Organic?

2007-08-13T15:20:00.000-04:00

Photo Credit: John/FrenchDuck

Answer: When it refers to fish.

For most foods bought in the United States, "organic" is short-hand for foods that meet the standards for USDA organic certification. For fruits, vegetables, and other plant foods, there are well-crafted standards around soil, pest management, and post-harvest handling and processing required for certification. For animal foods, requirements include the same well-crafted standards involving organically grown feeds, animal husbandry practices, and stringent production and handling specifications. Organic standards also require inspection by state or private agencies working under USDA rules and regulations.

Even though the National Organics Program - started over 15 years ago in 1990 - has done a good job laying out standards for certification, it has continually wrestled with one issue that remains both its strength and its Achilles heel. That issue is sustainability.

Sustainable Is Not the Same as Organic

The word "sustainable" is most familiar to us in the world of energy, where it means energy that can be replenished in a relatively short time and without destroying the environment. Wind-power and solar power are two examples of sustainable energy. Sustainable can also be used in the realm of agriculture, where it means farming that respects ecological cycles, natural patterns in climate and unique aspects of geography.

Even though sustainable agriculture has always lain at the heart of the National Organics Program (NOP) as the guiding spirit that gave birth to the program itself, it's never lain at the center of evolving NOP policy. Especially in the area of animal foods, the NOP has continually wrestled with the role of sustainability. For example, there have never been comprehensive requirements for certified organic beef and dairy cattle to have ongoing access to open pasture and grazing, and the idea of requiring 30% of all food to come from the open pasture for at least 120 days is an idea that's currently being debated within organics-related organizations across the country. The natural patterns that would normally be followed by cattle have never been comprehensively written into the NOP policy on organic beef or milk. This absence of sustainability in the production of organic animal foods does not undermine the indisputable health value of these organically-produced foods, but it does reflect an ongoing challenge in the evolution of organic regulations.

Fish Pose Unique Challenges in Terms of Sustainability

The NOP has never known exactly what to do about fish. Up until now, the NOP has allowed producers of fish to market their fish as organic as long as a third party conducts the certification. Because no one has been allowed to use the green USDA organic logo, most producers have figured organic certification wasn't worthwhile. Still, it's possible to buy certified organic fish right now in the U.S., and two U.S. aquaculture operations produce organic seafood for sale as organic in the marketplace.

But a current controversy is brewing over regulation of seafood as organic, and it's a controversy that brings to light the great challenges of sustainability. First, is it really alright to raise fish inside a fish farm? Isn't that practice tantamount to denying them "open pasture?" Can a fish farm replicate natural patterns and respect ecological cycles, without resorting to chemical treatments of the water or the fish? Won't the isolated fish habitat - however ecological in and of itself - still end up disrupting the wider configuration of lakes and rivers and oceans that surround it?

The Current Marketplace Reality

At present, this sustainability controversy - and the lack of well-defined fish standards by the NOP - has an unpredictable array of fish products in the marketplace currently being sold as organic. There are fish farms with high standards producing high-quality organic farmed fish. There are fish farms producing extremely low-quality farmed fish and hinting at higher-quality. There are wild-caught fish being sold as high-quality but obtained from significantly polluted waters. There are also wild-caught fish from relatively clean water being properly sold as high quality. Clearly, these are murky waters - so murky, in fact, that in 2005 the state of California banned all organic claims on fish until more reliable guidelines can be established. But what about in the meantime?

Here's a summary of our marketplace approach:

In general, it's worth paying extra for foods that display the organic logo.

With fish, you're not going to find the organic logo.

Until clearer guidelines are established and the logo can be displayed, paying for foods that make organic claims may not be worth extra cost. The reliability of these claims is just too much in doubt.

At present, your best bet is to find a grocery or fish seller who can document fish quality, spend time talking with that person, and ask about the issues raised in this article. If you get satisfactory answers, stick with that seller, even if you have to pay a premium price. We would not be hesitant to buy certified organic fish from certain vendors who are extremely careful and fully public about their practices and quality control. Included here would be fish from several organic fish farms, as well as certain wild-caught fish.

If you can't find a high-quality seller, move fish lower down in your meal plan, to 1-2 times a week at most, and focus on the quality of the other 95% of your meal plan.

Staying On Top of Fish Quality

Because the EPA and USDA guidelines on fish safety can be so variable and confusing, pocket fish lists have become a popular and easy way to stay on top of current recommendations. The most popular and most frequently updated fish list we've seen comes from the Monterey Bay Aquarium.

Buck Levin, PhD, RD and Matt Brignall, ND

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Fresh, Frozen or Canned?

2007-08-09T22:30:00.000-04:00

Photo Credit: Ali Karimian

What's healthiest? Fresh, frozen or canned foods?

In general, organic, local, fresh is best, followed by frozen, then canned. This is not an absolute rule; frozen produce can be a better choice if it was frozen shortly after picking compared to fresh produce that traveled 3,000 miles to your grocery store - and then sat in your fridge for several days before you ate it.

Canned fruits and veggies typically have added sugar or salt, and sometimes preservatives and colors, too. Draining or rinsing off this salty water does decrease the amount of salt you consume, but you also lose the water-soluble vitamins and minerals (vitamin C, B vitamins, potassium), which have leeched into the salty water. Using this water as a soup base is one way to retain some of those nutrients in your diet.

Vitamin stability is affected by heat light, air, and pH. What happens to the food before you get it (agricultural practices, maturity, storage, handling, fermentation, drying, freezing, canning, and blanching), and after you get it (home food processing, storage, purchasing practices, cooking practices, food preparation, and reheating), all affect the amount of nutrients the food delivers to you by up to 20-fold!

In general, vitamins E, C, B1, folate, and retinol are the most delicate and likely to be lost through cooking, processing or simply the passage of time. Minerals and macronutrients (protein, carbohydrate, fats) are typically the most stable and most likely to survive.
If you are serious about retaining the most nutrients, here are the details:

The Produce Department

Fruits that stay ripe, like grapes, have pretty stable vitamin content. Fruits that spoil quickly, like raspberries, lose about half their vitamin C in a week. Many vegetables lose delicate nutrients (vitamins E, C, B1, folate, and retinol) rapidly as soon as they are picked.

The Frozen Food Aisle

Commercial food is usually blanched before it is frozen. In this process, plant foods are cooked with hot water or steam for a short period of time. This decreases the water-soluble nutrients by 10-50%. Thawing further destroys vitamin C levels, so it's best to cook frozen vegetables while they are still frozen. Leafy green vegetables lose more nutrients than other vegetables because of their large surface area. As the months pass, the produce in your freezer will continue to lose its nutrients, so you should finish it off within 6 months. Although frozen foods have lost some of their flavor, freezing is generally a good way to preserve the nutrients and texture of many foods.

The Canned Food Aisle

Foods that are going to be canned are cooked at high temperatures and usually for a longer period of time when compared to commercial freezing. The temperature and duration of cooking are crucial factors; fewer nutrients are lost when cooking at high heat for a short period of time than at low heat for a long period of time. Vitamin B2 is more sensitive to light than to heat, but this can be tightly controlled in industrial processing. Vitamins A, E and beta-carotene are susceptible to destruction by air, but this can also be controlled during industrial processing.

During canning, green peas lose about 80% of their thiamin, 73% of their vitamin C, and 35% of their folate. The amount of time canned foods spend on the shelf also affects their nutritional value. For example, the vitamin C content can decrease another 20% over the course of a year.

Unlike vitamins, minerals are not destroyed by light, heat, pH, or oxidizing agents. Minerals are removed during physical processing or may leach into water. Cooked vegetables that have been frozen for 6 months do not have iron or zinc losses.

Salmon, which is typically cooked before being put in the can and then cooked again during canning, loses some of its carotenoids during pre-canning cooking, and another 15-35% during the actual canning. Some companies place the raw, fresh fish in the can, then seal and cook only once to minimize nutrient loss. These companies tend to offer wild-caught, environmentally friendly fish but may not be stocked in your grocery store. Fortunately, you can find them on the internet.

Interestingly, the calcium content of some fish increases as a result of the canning process. Fish that are canned with their bones, like sardines, have about 10-20 times more calcium than their fresh form. During canning, the calcium-rich bones soften, so they can be easily eaten. Fish that are not canned with their bones, like tuna, lose about half their calcium due to canning. However, these fish, whose bones are not normally eaten, are not a good source of calcium anyway.

Check Out

Although there are large variations among foods and among individual nutrients within foods, it is safe to say that the more a food is processed, the more nutrients are destroyed. Your best nutritional bet is organic, local, fresh produce, followed by frozen, then canned.

Raven Bonnar-Pizzorno, MS (Nutrition)

References:

Bender. Changes in micronutrients due to industrial processing. Bibl Nutr. Dieta. 1985(34) 44-55.
Mueller HR. The effect of industrial handling on micronutrients. J. Nutr. Sci. Vitaminol. 1990;36 Suppl 1:S47-55.
Nursal B, Yucecan S. Vitamin C losses in some frozen vegetables due to various cooking methods. Nahrung. 2000;44(6):451-3.
Prochaska LJ, Nguyen XT, Donat N, Piekutowski WV. Effects of food processing on the thermodynamic and nutritive value of foods: literature and database survey. Med. Hypotheses. 2000 Feb;54(2):254-62.
Reddy, MB. The impact of food processing on the nutritional quality of vitamins and minerals. Adv. Exp Med Biol. 1999. 459 99-106.
USDA National Nutrient Database for Standard Reference, Release 19 (2006)

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Cow's Milk Counteracts Tea's Cardioprotective Effects

2007-08-02T09:15:00.000-04:00

Photo Credit: Naama

Adding cow's milk to tea counteracts tea's beneficial blood-vessel relaxing effects, shows a study published in the European Heart Journal (Lorenz M, Jochmann N, et al., January 2007).

FULL STORY:

Sixteen healthy women volunteers drank 16 ounces of either freshly brewed black tea, black tea with 10% skimmed cow's milk, or boiled water as a control. After the women had consumed their assigned liquid, researchers used ultrasound to measure how well their brachial artery (the primary artery supplying blood to the arm) relaxed and expanded after a blood pressure cuff that had been inflated for 5 minutes on participants' forearms was deflated - a challenge test called "flow-mediated dilation."

Flow-mediated dilation gives a functional "video clip," showing how well blood vessels are able to respond to a sudden increase in blood flow, and is often used to help determine an individual's risk for heart disease.

Black tea significantly improved flow-mediated dilation compared with water, but adding milk completely blunted tea's beneficial effects.

To confirm these findings, similar experiments were performed in laboratory studies using isolated rat blood vessels and endothelial (blood vessel lining) cells. Once again, while tea increased the activity of the enzyme in endothelial cells that promotes relaxation (endothelial nitric oxide synthase) and promoted blood vessel dilation, these beneficial effects were completely inhibited when cow's milk was added to the tea.

Why does cow's milk short-circuit tea's cardio-protective effects? Casein proteins found in cow's milk bind to the helpful catechins in tea, preventing them from doing their protective work.

Practical Tip: To reap tea's protective effects against cardiovascular disease, enjoy your tea au naturel or, if you love "milk tea," try substituting a little soy milk or rice milk for cow's milk.

Reference:

Lorenz M, Jochmann N, von Krosigk A, Martus P, Baumann G, Stangl K, Stangl V. Addition of milk prevents vascular protective effects of tea. Eur Heart J. 2007 Jan;28(2):219-23. Epub 2007 Jan 9.

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Move Over Cholesterol

2007-07-30T16:00:00.000-04:00

Can you imagine any substance getting a worse rap than cholesterol? After all, how many people do you know who (1) have never purchased a product that was labeled "low cholesterol" or "cholesterol free," or (2) have never seen an advertisement for Lipitor (atorvastatin), the $12.9 billion dollar, best-selling, cholesterol-lowering statin drug of 2006, or (3) have never had their cholesterol measured, either in a doctor's office or a shopping mall?

Well, it's time to start imagining a new substance moving onto health's center stage.

FULL STORY:

That substance is homocysteine - a relatively unknown amino acid that was the subject of 500 research studies in 2006 and nearly 2,500 studies over the past 5 years. Similar to elevated cholesterol, elevated homocysteine is now considered an independent risk factor for atherosclerosis (clogging of the arteries). It's also been linked to increased risk of stroke, diabetes-related kidney problems, and age-related cognitive problems.

What's unique about homocysteine is its place in our metabolism. When properly metabolized, homocysteine can help us detoxify environmental pollutants and other unwanted substances in our body. It can also bolster our antioxidant system and help prevent damage to our tissue from free radicals. But when it isn't properly metabolized and it builds up inside our bloodstream (a condition called hyperhomocysteinemia), homocysteine can cause a multitude of problems.

What researchers now understand is that homocysteine latches on to cells throughout our body (including cells along our blood vessel walls) and disrupts their activity. With nerve cells, the result is over-stimulation and eventual damage to the nervous system. With the endothelial cells lining our blood vessels, the result is a weakened cardiovascular structure and eventual heart disease.

Fortunately, we've got practical ways to lower our risk of hyperhomocysteinemia. We can start out by having our blood level of homocysteine measured, to see if it's too high. Second, we can often lower it (as well as prevent it from becoming too elevated) by increasing our dietary intake of vitamins B6, B12, and folate. Green leafy vegetables are a great start for the B6 and folate. Non-plant foods are better for B12. Shrimp, scallops, snapper, and salmon are some of our favorites.

References:

Homocysteine-lowering trials for prevention of cardiovascular events: a review of the design and power of the large randomized trials. Am Heart J. 2006 Feb; 151(2):282-7.
Carlsson, C. M. Homocysteine lowering with folic acid and vitamin B supplements: effects on cardiovascular disease in older adults. Drugs Aging. 2006; 23(6):491-502.
Castro, R.; Rivera, I.; Blom, H. J.; Jakobs, C., and Tavares de Almeida, I. Homocysteine metabolism, hyperhomocysteinaemia and vascular disease: an overview. J Inherit Metab Dis. 2006 Feb; 29(1):3-20.
Ceperkovic, Z. [The role of increased levels of homocysteine in the development of cardiovascular diseases]. Med Pregl. 2006 Mar-2006 Apr 30; 59(3-4):143-7.
Guthikonda, S. and Haynes, W. G. Homocysteine: role and implications in atherosclerosis. Curr Atheroscler Rep. 2006 Mar; 8(2):100-6.
Hankey, G. J. Is plasma homocysteine a modifiable risk factor for stroke? Nat Clin Pract Neurol. 2006 Jan; 2(1):26-33.
Jacobs, P.; Wood, L., and Bick, R. Homocysteine in vascular disease: an emerging clinical perspective. Cardiovasc J S Afr. 2006 May-2006 Jun 30; 17(3):135-9.

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Research Interpretation in Natural Medicine

2007-07-26T09:30:00.000-04:00

One of the consistent controversies in the complementary and alternative medicine (CAM) community is how to interpret the vast quantity of research that comes out on a weekly basis. Market forces both supportive of and against CAM interventions often help to distort findings in the public eye.

Perhaps the biggest difficulty in interpretation of CAM research is that studies of unconventional approaches are almost uniformly of lower quality than studies in modern surgery or pharmacology. This lower quality is generally more a function of resource limitations than any intent, and is reflected in smaller numbers of subjects, problems with randomization or blinding of studies, or difficult to measure outcomes.

Still, lower quality research is still science, and is important in advancing our knowledge, as long as our interpretations are valid. Here are the different levels of research study, and some idea of the level of evidence they represent:

Double-blind, placebo-controlled trial: Usually the highest standard of research study. Here, researchers can demonstrate cause and effect most clearly. Even though this method can yield flawed results, this level of research is often sufficient to make a conclusion about a new treatment.

Unblinded clinical trial: Here, subjects in the study get a treatment, but they may not be compared to a similar group not receiving treatment, and are aware of the treatment they are getting. While this type of study is not definitive, it can help to identify potentially useful treatments worthy of further study.

Epidemiology or survey study: These are studies that survey a large group of people and attempt to find correlations between disease and health habits. These studies do not demonstrate cause and effect, but when they yield consistent results, can still sway medical opinion. Much of what doctors know about diet and exercise comes from this type of research.

Anecdote or case report: These describe the outcome of a single patient after a specific intervention. While patients and consumers often find this level of evidence compelling, I do not. Published case reports go through a peer-review process, which makes them more credible than other anecdotes. Interesting and important treatments often are first reported as a single case, but further research is virtually always necessary to confirm results.

Preclinical research: Animal and test-tube studies help to show the mechanisms by which treatments may work. They should not be the basis for general health recommendations, but when results are consistent with higher level studies, they can help to fill in knowledge gaps.

Meta-analysis: As their name suggests, this type of study gather together multiple research studies, sometimes of different levels of evidence. A meta-analysis is only as good as the studies analyzed, but can often highlight bias inherent in individual research studies.

Complicated and subtle interventions like diet and lifestyle changes are simultaneously thought to be some of the most important predictors of human health outcomes, and among the most difficult treatments to effectively study. For this reason, diet and lifestyle recommendations are often made based on the results of survey research, supported by consistent animal and test-tube findings. If you have been puzzled by how frequently healthy diet recommendations seem to change, this lower level of evidence may help to explain the inconsistency.

There are several questions I tend to ask about new treatments before I consider bringing them into my clinical practice. Here are a few:

Has the safety of the intervention been properly demonstrated in human beings (not just animals)?

What level of research is there to demonstrate efficacy?

Are the conclusions of the researchers plausible? Do they overreach?

Is this new treatment option equivalent to or better than other available treatments?

Matt Brignall, ND

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Diabetes Decreases Life Expectancy - Protect Yourself

2007-07-06T07:15:00.000-04:00

Having diabetes decreases life expectancy in persons over age 50 by an average of 7.5 years for men, and 8.2 years for women, compared to persons without the condition, reveals research using data from the Framingham Heart Study, which recruited 5,209 men and women starting in 1948 and has examined them twice yearly for more than 46 years.

Published in the June 11, 2007 issue of the Archives of Internal Medicine (Franco OH, Steyerberg EW, et al.) the data also shows that men with diabetes have 2.4 times the risk of developing cardiovascular disease and 1.7 times the risk of dying from it, compared to men without diabetes. For women with diabetes, the risk of developing cardiovascular disease is 2.5 times and risk of dying from it 2.2 times that of their diabetes-free peers.

Add to these frightening statistics the fact that a global diabetes epidemic is underway with an estimated 217 million people with diabetes worldwide (a number that is expected to increase to 300 million by 2025), plus the fact that a fundamental cause of diabetes is the unhealthy "Western" diet, and it becomes obvious that optimal nutrition is essential for diabetes prevention and healthy aging.

Follow a Mediterranean-style Diet

A review study in the March 2007 issue of the Journal of Nutritional Biochemistry (Schroder H) strongly suggests that a Mediterranean-style diet including lots of vegetables, fresh fruits, unrefined grains, beans, cold water fish, nuts, seeds, and olive oil as the main source of fat, offers significant protection against both type 2 diabetes and obesity.

Not only do numerous population studies consistently show a protective effect of a Mediterranean diet against diabetes, but a number of physiological mechanisms that explain why have now been identified. In brief, the Mediterranean diet is rich in:

Appetite-satisfying fiber, which slows the rate at which foods are digested and glucose is delivered into the bloodstream. When fiber is present in a meal, the small intestine secretes peptides, such as cholecystokinin, that signal fullness to the brain. Legumes and nuts, two fiber-rich staples in the Mediterranean diet, have been shown to greatly increase cholechystokinin secretion.

Healthy fats from olive oil, cold water fish, nuts and seeds. Some evidence suggests that oleic acid, the predominant fatty acid in olive oil, is associated with lower insulin resistance. Olive oil has also been shown to increase the rate at which fat is oxidized (burned) after meals in women with abdominal obesity. The omega-3-fatty acids supplied by cold water fish, walnuts and flaxseed render cell membranes more flexible and receptive to insulin signaling.

Protective antioxidants and phytonutrients. In addition to vitamin antioxidants such as beta-carotene, E and C, the characteristic foods of the Mediterranean diet provide a wide variety of phytonutrients with potent, synergistic antioxidant activity. Free radical damage (oxidative stress) plays a crucial role in the development of insulin resistance and beta cell dysfunction. (Beta cells are responsible for the production of insulin.) Even short-term administration of virgin olive oil has been found to decrease several markers of oxidative stress.

Magnesium, liberally supplied by vegetables, whole grains, legumes and nuts, is an essential co-factor in enzymes required for cellular energy production. Studies have linked insufficient magnesium with increased incidence of type 2 diabetes.

Moderate red-wine consumption. In the Mediterranean, a glass of red wine often accompanies lunch or dinner. In human population studies, moderate alcohol consumption has been shown to enhance insulin sensitivity and increase levels of adiponectin, a signaling molecule that stimulates cells' burning of both fatty acids and glucose (sugar).

And because, a Mediterranean diet is filled with nutrient-dense foods, which supply fewer calories overall, this delicious way of eating automatically promotes a healthy weight, again lessening your risk of type 2 diabetes.

Bottomline: Change to a healthy Mediterranean-type diet and dramatically lower your risk of becoming part of the diabetes epidemic.

Lara Pizzorno, MA, LMT

Franco OH, Steyerberg EW, Hu FB, Mackenbach J, Nusselder W. Associations of diabetes mellitus with total life expectancy and life expectancy with and without cardiovascular disease. Arch Intern Med. 2007 Jun 11;167(11):1145-51. PMID: 17563022
Schroder H. Protective mechanisms of the Mediterranean diet in obesity and type 2 diabetes. J Nutr Biochem. 2007 Mar;18(3):149-60. Epub 2006 Sep 11. PMID: 16963247

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Obesity: Nature vs. Nurture?

2007-06-27T18:37:00.000-04:00

Photo Credit: Yukari

What makes us fat, our parents or our lifestyle? The scientific research indicates that in most cases, genetics determines the range of our weight (which can be quite large), and food and exercise determine where we actually fall with in that range. Don't let the genetics argument make you feel hopeless about losing weight; just let it keep your expectations realistic. The role of genetics does not diminish the importance of nutrition and exercise. While you cannot change the range of options available within your genes, you can get them to express your healthiest and leanest options by changing your diet and physical activity.

The obesity crisis in America is a good indication that most people are living at the high end of their genetic weight range, and therefore nutrition and exercise are the answer. Regardless of what your genetic weight range is, healthy eating and exercise benefit your entire health and longevity. Obese people who lose just 5-10% of their initial weight significantly decrease their risk of associated diseases.

The extensive research on the Pima Indians provides a great example of the interplay between genetics and lifestyle factors. Pima Indians are genetically pre-disposed to type 2 diabetes, a disease that is produced largely by the same factors that cause obesity and obesity itself. The Pima Indians who live in the U.S. have the highest rate of type 2 diabetes of any population in the world (77% of people 55 and older) and correspondingly high obesity rates. Pima Indians living in Mexico have much lower rates of type 2 diabetes (9% of people 55 and older) and obesity. These two groups are genetically similar, but their diets and levels of physical activity are very different. As a result, the obesity rate among the American Pima men is 10 times that of the Mexican Pima men! In fact, the Mexican Pima Indian's rates of obesity and type 2 diabetes parallel that of other Mexicans living similar lifestyles even though they have a genetic susceptibility to type 2 diabetes. Why? Because Mexican Pima Indians eat comparable amounts of calories and fiber as other Mexicans living similar lifestyles and have comparable levels of physical activity. American Pimas have diets and activity levels similar to other Americans.

If you are overweight, it is important to continue to try to lose weight. Being overweight increases your risk of developing diseases like diabetes, heart disease, and arthritis, just to name a few. But beware fad diets that claim "Lose 10 lbs in a week!" The safe rate of weight loss is 1-2 pounds per week. At this rate, about 70% of each pound you lose is fat. If you are losing weight faster than this, you are burning less fat and more muscle. To lose one pound per week, you need to eat 500 fewer calories per day (or burn it with additional exercise). Examples of five hundred calories of food are a large serving of fast food French fries, or two small chocolate doughnuts.

Don't give up. Weight loss is hard, and most people who successfully lose a significant amount of weight and keep if off for a long time were not successful the first time. They tried many times before they found a healthy diet and lifestyle that enabled them to lose the weight and keep it off.

Raven Bonnar-Pizzorno, MS (Nutr)

Foster G, Nonas C, eds. Managing Obesity: A Clinical Guide. Chicago: American Dietetics Association, 2004.
Laquatra I. Nutrition for Weight Management. In: Mahan L, Escott-Stump S, eds. Krause's Food, Nutrition, and Diet Therapy. 11th edn. Philadelphia: Saunders, 2004.
The National Weight Control Registry Brown Medical School/The Miriam Hospital Weight Control & Diabetes Research Center 196 Richmond Street, Providence, RI 02903
Schulz LO, Bennett PH, Ravussin E, et al. Effects of traditional and western environments on prevalence of type 2 diabetes in Pima Indians in Mexico and the U.S. Diabetes Care. 2006 Aug;29(8):1866-71.

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Chocolate: Cardiovascular Superstar?

2007-06-12T12:45:00.000-04:00

Photo Credit: Lisa Morgan

As if we needed more reasons to indulge, a number of recent studies are confirming what our hearts have always known: chocolate can be very good for you!

Based on his studies of the island-dwelling Kuna - who drink up to 40 cups per week of flavanol-rich cocoa and have a 10% lower risk of stroke, heart failure, cancer and diabetes than people who live on mainland Panama - Dr. Norman Hollenberg of Harvard Medical School and Brigham and Women's Hospital, believes epicatechin, a flavanol found in cocoa (and tea and wine), is so protective, it should be classified as a vitamin.

Hollenburg's research, published in the March 2007 issue of the International Journal of Medical Sciences, revealed that compared to the cocoa-loving Kuna islanders, among those living on the Panama mainland, relative risk of death from heart disease was 1,280% higher and death from cancer was 630% higher.

The link between cocoa flavanols and cardiovascular health is likely due in part to their improving blood flow by increasing production of nitric oxide, a molecule secreted by the lining of our blood vessels (the endothelium) to signal surrounding muscle to relax.

In research published in the Journal of Cardiovascular Pharmacology, ((Heiss C, Finis D, et al., February 2007), eleven healthy male smokers, with smoking-related losses in endothelial function resulting in impaired blood flow, drank three cups each day of a flavanol-rich cocoa drink (306 mg flavanol/cup). Within two days, the men showed measurable improvement in blood vessel function. After seven days, impairment of blood flow in these smokers was almost reversed. However, the improvement disappeared within one week of discontinuing the cocoa treatment, prompting researchers to recommend daily consumption of flavanol-rich cocoa.

Cocoa also appears to protect LDL cholesterol from oxidation (only after LDL has been oxidized or damaged by free radicals does it promote atherosclerosis) and increase levels of cardioprotective HDL cholesterol.

Japanese researchers divided 25 subjects with normal and mildly elevated cholesterol into two groups, one of which was given a drink containing 12g of sugar each day while the other group received a mixture of 26g cocoa powder and 12g of sugar each day for 12 weeks. (The cocoa drink contained 377 mg epicatechin, 135 mg catechin, 158 mg procyanidin B2, and 96.1 mg procyanidin C1 per 100g.) Blood samples were collected at the start and end of the trial, and levels of HDL and LDL, as well as LDL's ability to resist oxidation were measured. Compounds in the urine that indicate oxidative stress (free radical damage) were also measured.

After 12 weeks, changes in LDL's susceptibility to oxidation, expressed as lag time (the amount of time after exposure to free radicals before LDL is damaged), were noted. In the sugar only group, LDL became more susceptible to oxidation - a 19.8% reduction in lag time was recorded compared to baseline. In the cocoa group, LDL was protected by a 9.4% prolongation in lag time.

In addition, levels of protective HDL cholesterol increased 23.4% in the cocoa group compared to a 5.1% increase in the sugar-only group.

Cocoa drinkers also experienced an eight-fold increase in catechin excretion, a ten-fold increase in epicatechin excretion, and a significant 24% reduction in the urinary oxidative stress marker, dityrosine. Those drinking cocoa did not experience weight gain or increases in blood pressure or heart rate, and no adverse events were reported.

Confirming blood-pressure lowering effects seen in the Zutphen Elderly Study (Buijsse B, Feskens EJ, et al., Archives of Internal Medicine, 2006) in which older men with the highest cocoa intake had an average 3.7 mm Hg lower systolic and 2.1 mm Hg lower diastolic blood pressure compared to men drinking the least cocoa, a meta-analysis of 5 studies, also published in the Archives of Internal Medicine (Taubert D, Roesen R, et al., April 2007), indicates that cocoa lowers blood pressure as much as beta-blockers or ACE-inhibitors.

Researchers from the University Hospital of Cologne pooled data from 5 randomized controlled trials involving a total of 173 participants on the blood pressure-lowering effects of cocoa, and another 5 involving 343 subjects and looking at green and black tea.

In the cocoa studies, 87 were assigned to consume cocoa, and 86 served as controls. One third (34%) of the participants had high blood pressure. After an average follow-up of two weeks, both systolic and diastolic blood pressure dropped in the cocoa-consuming groups. Compared to controls, the cocoa drinkers experienced an average decrease of 4.7 mm Hg in systolic blood pressure and a drop of 2.8 mm Hg in diastolic blood pressure.

Hypertension is defined as having a systolic and diastolic BP greater than 140 and 90 mm Hg. "At the population level, a reduction of 4 to 5 mm Hg in systolic blood pressure [the top number, when the heart contracts] and 2 to 3 mm Hg in diastolic blood pressure [the bottom number, when the heart relaxes] would be expected to substantially reduce the risk of stroke (by about 20%), coronary heart disease (by 10%), and all-cause mortality (by 8%)," said the study's authors.

No such benefits were reported for the 343 individuals in the 5 tea studies (171 drinking tea, and 172 controls), an outcome researchers think is due to the difference in the polyphenols found tea and cocoa. While both are rich in polyphenols, black and green tea contain more flavan-3-ols, while cocoa contains more procyanids.

Practical Tips: Enjoy catechin-rich cocoa to your heart's content. Polyphenol-rich foods, including cocoa, green tea and red wine, are good for you. Remember, however, that unlike that consumed by the Kuna islanders, cocoa in our culture is typically delivered with lots of cardio-compromising sugar and fat. For a sophisticated cocoa true to your heart, try mixing unsweetened organic cocoa powder with low-fat milk, a dash of vanilla or cinnamon, and a spoonful of honey.

One other tip: The more bitter your cocoa, the more likely it is to contain a healthy serving of flavanols. Flavanols, including catechins, are sometimes removed from commercial cocoas because they tend to have a somewhat bitter taste.

Lara Pizzorno

Bayard V, Chamorro F, Motta J, Hollenberg NK. Does flavanol intake influence mortality from nitric oxide-dependent processes? Ischemic heart disease, stroke, diabetes mellitus, and cancer in Panama. Int J Med Sci. 2007 Mar;4:53-58. PMID: 17299579

Heiss C, Finis D, Kleinbongard R, Hoffmann A, Rassaf T, Kelm M, Sies H. Sustained increase in flow-mediated dilation after daily intake of high-flavanol cocoa drink over 1 week. J Cardio Pharm. 2007 Feb;49(2):74-80. PMID: 17299579

Baba S, Osakabe N, Kato Y, Natsume M, Yasuda A, Kido T, Fukuda K, Muto Y, Kondo K. Continuous intake of polyphenolic compounds containing cocoa powder reduces LDL oxidative susceptibility and has beneficial effects on plasma HDL-cholesterol concentrations in humans. Am J Clin Nutr. 2007 Mar;85(3):709-17. PMID: 17344491

Taubert D, Roesen R, Schomig E. Effect of cocoa and tea intake on blood pressure: a meta-analysis. Arch Intern Med. 2007 Apr 9;167(7):626-34. PMID: 17420419

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Good Bugs vs. Bad Bugs

2007-05-31T11:00:00.000-04:00

Did you know that your digestive tract is filled with bacteria? There are actually ten times more bacteria cells in your digestive tract than there are cells in your entire body: one hundred trillion bacteria compared to your ten trillion cells!

Because there are so many bacteria, and the good ones play such an important role in your health that they are called probiotics (pro = for, biotics = life), they are sometimes thought of as an extra helpful organ in your body.

Our digestive system is supposed to be filled mostly with good bacteria like Acidophilus species and Bifidobacter. When our gut is filled with good bacteria, they out-compete any bad bacteria that enter our bodies on food and drink, and prevent the bad guys from taking up residence.

The tables can quickly turn when we are exposed to too much bad bacteria at once (think potato salad that has sat out for hours at a long picnic) or when an antibiotic treatment kills not only the bad bugs, but most of the body's healthy bacteria, too. The bad bacteria then have an opportunity to colonize the walls of the intestines, injure them, and cause problems, like severe diarrhea.

Not only do good bacteria crowd out the bad guys, good bacteria support our health in a number of other ways:

Good bacteria digest fiber. Fiber is carbohydrate from plants that humans cannot digest, but bacteria can. Plant fiber not only provides good bacteria with food, but the byproducts of their digestion then serve as food for our intestinal cells. This is an unusual way for cells to be fed. Cells normally receive their nourishment from blood after food has been digested into nutrients and absorbed into the blood stream. In this case, the nutrients released from the fiber by good bacteria are not absorbed into the bloodstream, but feed the cells of the intestines directly.
Good bacteria produce some B vitamins and vitamin K for the body's use. B vitamins are essential for both energy production and nervous system function. Vitamin K is necessary for blood clotting and functions as an antioxidant.
Good bacteria even help produce enzymes that digest drugs and hormones. Probiotic bacteria produce enzymes that not only detoxify potentially harmful compounds themselves, but communicate with our liver, telling it to increase its production of needed detoxification enzymes.

If you're not convinced yet that it is natural and healthy to have bacteria living in your gut, here are some fascinating facts:

When babies are born, their intestines are sterile, meaning that they are free of bacteria. Within 6 hours of birth, a baby will have over a billion organisms living in his or her gut.
Breast milk contains not only good bacteria, but also a substance called bifido growth factor, which helps the probiotic bifido species of bacteria grow in the baby's intestines.
The profile of different species in a baby's gut is affected by whether s/he was born vaginally or by caesarian, in a hospital or at home, fed breast milk or formula, and if the mother is exposed to antibiotics or antimicrobial herbs.
By age 2, the baby's digestive tract will reach the adult level of colonization: 100 trillion bacteria.

Fermented foods, such as yogurt, kefir, tempeh, and sauerkraut, are good sources of these health-promoting bacteria.

Collins MD, Gibson GR. Probiotics, prebiotics and synbiotics: approaches for modulating the microbial ecology of the gut. Am J Clin Nutr 1999;69:1052S-7S
Holzapfel WH, Haberer P, Snel J, et al. Overview of gut flora and probiotics. Int J Food Microbiol 1998;41:85-101
Murray M, Pizzorno J. Probiotics. In: Pizzorno J, Murray M, eds. Textbook of Natural Medicine. 3rd edn. Edinburgh: Churchill Livingstone, 2005.
Hanaway P. Balance of flora, galt, and mucosal integrity. Altern Ther Health Med. 2006;12:52-60
Sult T. Digestive, Absorptive and Microbiological Imbalances. In: Jones D. ed-in-chief, Textbook of Functional Medicine. Gig Harbor, WA: Institute for Functional Medicine, 2005.

Why Weight Loss Diets Don't Work

2007-05-24T10:45:00.000-04:00

The equation should be simple: eat less + exercise more = lose weight. Yet, researchers generally find that weight loss diets only cause people to lose about half the weight that would be predicted by this simple model.

Researchers have known for more than 50 years that the amount of weight loss seen with reduced-calorie diets tends to be much less than would be predicted. Even worse, weight loss seems to start off at a rapid clip, then weight plateaus or even drifts back upward by the end of the first six months.

An article published in the American Journal of Clinical Nutrition attempted to figure out why this phenomenon occurs. They looked at three potential explanations:

that people eating low calorie diets absorb food more efficiently, getting more nutrition from less food;
that people eating low calorie diets slow their metabolism down to match their dietary intake; or
that people demonstrate reduced ability to follow low calorie diets for long periods of time.

The reviewers were able to present compelling evidence that food absorption and changes in metabolism were not enough to explain the difference between expected and measured weight loss in clinical research. Because of this, they concluded that people tend to drift away from low calorie dietary strategies, compromising their effectiveness.

This is no big surprise to doctors or nutritionists. We just discussed in a recent blog another in a series of research trials where weight loss was compromised by poor compliance with dietary recommendations.

A more interesting question is why people do a poor job of following diets over time. This is a much harder question to answer, but I would like to suggest a few possibilities:

Counting calories is hard. Diets that have successfully controlled diabetes, blood pressure, and cholesterol have focused more on patterns of food intake (kinds of foods eaten and general quantity) than absolute amounts.
Diets based on numeric goals don't necessarily eliminate the worst food choices. I find the most effective weight loss strategies are the ones that eliminate most of the extra calories from nutrient-starved processed foods, especially refined sugars and fatty, salty snacks.
Low calorie diets often leave people hungry. Hungry people snack, and this compromises their diet. Foods high in fiber tend to prolong the feeling of fullness (or satiety) after meals. High dietary fiber is almost always a key focus of my weight loss diet instructions.
Weight loss diets need to be flexible. As a doctor, I find weight loss diets to be a process of trial and error, and sometimes compromises are needed in some areas to make the overall diet one that my patient is willing to follow. A diet one person finds acceptable may not work for another person. Researchers use uniform strategies in their studies and I believe this is why they almost always see poor compliance impair results.

Whole foods is the bottom line. I believe no weight loss diet will ultimately be successful unless it prioritizes whole foods. Not only do whole foods help control weight, but virtually every epidemiological study shows that whole foods diets reduce the risk of most diseases.

References:

Heymsfield SB, Harp JB, Reitman ML, et al. Why do obese patients not lose more weight when treated with low-calorie diets? A mechanistic perspective. Am J Clin Nutr. 2007;85:346-54
Gardner CD, Kiazand A, Alhassan S,, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA. 2007;297(9):969-77.
Dansinger ML, Gleason JA, Griffith JL, et al. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293(1):43-53

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Is the Atkins Diet Really Superior to Other Weight Loss Diets?

2007-05-23T09:40:00.000-04:00

A new clinical trial published in the Journal of the American Medical Association showed that women following the Atkins diet lost more weight over a one-year period than women following other dietary plans. Expect supporters of the Atkins-style low-carbohydrate diets to cite this research as proof that their diet is superior to older low-fat weight loss diets that remain the standard of care in most medical settings.

In this new study, participants followed one of four diets for the entire year. The diets were as follows:

Atkins Diet: a low-carbohydrate, high-protein strategy
Ornish Diet: a very-low-fat, vegetarian diet
Zone Diet: a diet that attempts to balance protein, carbohydrates, and fats at every meal
LEARN Diet: a diet that follows a more traditional low-fat, high-fiber strategy

In addition to losing more weight than the people assigned to the other diet strategies (about 10 pounds, compared with about 5 in other groups), the Atkins diet participants had favorable changes in their cholesterol levels and no changes in blood sugar control or blood pressure. Critics have long been concerned about the possibility of the Atkins Diet leading to dangerous changes in each of these three important areas.

Color me unconvinced. I don't believe that this study teaches us anything about the relative efficacy of any diets. This is because the average participant in this study didn't even come close to following the recommended dietary strategy. The people assigned to the Ornish Diet, for instance, on average ate three times as much fat as this diet allows. Similarly, people following the Zone diet were supposed to get 30% of their calories from protein, but only managed to get 20% by the end of the study. It would have been very useful to see a little more information about what the food sources of the calories were (e.g., did the carbohydrates come from sweets or fruits and vegetables) to know more about why people failed to meet prescribed diet interventions.

The Atkins Diet participants were the closest to actually following the recommended diet, perhaps explaining the better outcome in this group. A similarly designed trial published in JAMA two years ago showed no real difference among any of these diets in weight loss efficacy.

My concern with the Atkins dietary strategy is that people following this diet over a period of years may develop health problems related to the high total fat and saturated fat content of the diet. Previously published research indicates that diets high in saturated fat can lead to insulin resistance (an important step toward diabetes), high blood pressure, and high cholesterol. While in the short term, the weight loss from the Atkins Diet may mask this effect, over a period of years, this effect would seem likely.

A much more important and obvious point than relative diet efficacy, at least to me, is the evidence that people do not easily adopt new diet strategies. Even though each person in this diet was given eight weeks of intensive dietary counseling, the diets people reported at the end of a year looked very little like the diets they were supposed to be eating.

It is my belief that the best way to build a weight loss diet is to start with understanding of the person's current diet. Then, work together with that person to identify and intervene with the most problematic aspects of that diet and finds ways to move to a more whole foods diet. This approach is far more effective than starting with a one-size-fits-all strategy, meets the individual's specific needs, and sets a diet up for success rather than failure.

References:

Gardner CD, Kiazand A, Alhassan S, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA. 2007;297(9):969-77.
Dansinger ML, Gleason JA, Griffith JL, et al. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293(1):43-53.
Rasmussen O, Lauszus FF, Christiansen C, et al. Differential effects of saturated and monounsaturated fat on blood glucose and insulin responses in subjects with non-insulin-dependent diabetes mellitus. Am J Clin Nutr. 1996;63(2):249-53.
Thomsen C, Rasmussen O, Lousen T, et al. Differential effects of saturated and monounsaturated fatty acids on postprandial lipemia and incretin responses in healthy subjects. Am J Clin Nutr. 1999;69(6):1135-43
Rasmussen BM, Vessby B, Uusitupa M, et al. Effects of dietary saturated, monounsaturated, and n-3 fatty acids on blood pressure in healthy subjects. Am J Clin Nutr. 2006;83(2):221-6

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Technorati Tags: diet, weight loss, Atkins, Ornish, Zone, LEARN, low carb, health and wellness