Now, however, researchers behind a new review that takes a second look at the findings of the landmark study say that these results are flawed -- and that they do not support the benefits initially reported.

Not only did this second look turn up no evidence of the "striking decrease in coronary heart disease complications" reported by investigators behind JUPITER (Justification for the Use of Statins in Primary Prevention), but it has also called into question drug companies' involvement in such trials, according to an article in the June 28 issue of Archives of Internal Medicine.

Moreover, Dr. Michel de Lorgeril of Joseph Fourier University and the National Center of Scientific Research in Grenoble, France, and coauthors argue that major discrepancies exists between the significant reductions in nonfatal stroke and heart attacks reported in the JUPITER trial and what has been found in other research.

"The JUPITER data set appears biased," Lorgeril and coauthors wrote in conclusion.

Dr. Paul Ridker of Harvard Medical School and Brigham and Women's Hospital in Boston dismissed de Lorgeril's criticisms. Ridker reported the JUPITER results at the American Heart Association meeting in 2008.

In an email to MedPage Today, Ridker said that JUPITER data "overwhelmingly stand for themselves. Among a group of individuals with low levels of cholesterol, we clearly demonstrate that those with elevated levels of [the inflammation marker] hsCRP are in fact a high-risk population, and that using statin therapy in this group cuts event rates for [heart attack] and stroke in half."

Ridker also pointed out that the "FDA has extensively reviewed these data, found the trial to be well conducted, and recently provided a new indication for the use of statins in primary prevention on the basis of the JUPITER data."

AstraZeneca, maker of the popular statin Crestor (known generically as rosuvastatin), also defended the JUPITER results and the way in which the study was conducted.

Donna Huang, an AstraZeneca spokesperson, told MedPage Today in an email that the study "was undertaken with a fully independent steering committee, data and safety monitoring board, and academic study statistician."

She also said Ridker and his co-investigators controlled all data. "AstraZeneca played no role in conducting data analyses and had no access to unblinded trial data," she wrote.

De Lorgeril and coauthors point out that nine of 14 authors of the JUPITER article have financial relationships with AstraZeneca, which sponsored the trial. Ridker has a patent interest in the assay for C-reactive protein (CRP), an inflammation biomarker evaluated in all JUPITER trial participants.

"The sponsor's pervasive role is clearly described in the second paragraph of the 'Methods' section of the report: 'the sponsor collected the trial data and monitored the study sites,'" the authors wrote.

De Lorgeril and coauthors concluded that "the results of the JUPITER trial are clinically inconsistent and therefore should not change medical practice or clinical guidelines. The results of the JUPITER trial support concerns that commercially sponsored clinical trials are at risk of poor quality and bias."

Adding to the controversy, authors of another article in the same issue of Archives reported that a review of 11 large primary-prevention trials showed no effect of statin therapy on deaths in high-risk patients.

The JUPITER trial has stood alone in its finding of a significant benefit in patients with no evidence of coronary heart disease. The trial examined the effect of rosuvastatin in patients with normal or low cholesterol levels but elevated levels of CRP.

Investigators randomized 17,802 apparently healthy men and women to receive either the statin rosuvastatin or a placebo, and then they studied these groups to compare how many suffered heart attacks, strokes and other heart-related problems. The trial ended early when an interim analysis showed a 44 percent reduction in these events in the group taking the statins; with results this positive, the logic went, why continue the study?

But de Lorgeril and his coauthors cited the early termination as one of several methodologic problems with JUPITER. Although prespecified early stopping points are a well-accepted feature of clinical trials, the rules for stopping should be clearly described. That was not the case in the published description of the JUPITER protocol.

"Indeed, we still do not know which endpoint was used to define [the rules for stopping], or which level of benefits ... was required to justify early termination," de Lorgeril and coauthors wrote.

The authors also expressed concern that the trial ended early despite the fact that the data were not consistent with a large difference between the actual drug and the placebo.

On the basis of their review, de Lorgeril and coauthors concluded that "the time has come for a critical reappraisal of cholesterol-lowering and statin treatments for the prevention of CHD complications. The emphasis on pharmaceuticals for the prevention of CHD diverts individual and public health attention away from the proven efficacy of adopting a healthy lifestyle, including regular physical activity, not smoking, and a Mediterranean-style diet."

The meta-analysis reported in the same issue of the journal, led by Dr. Kausik Ray of the University of Cambridge in England, examined the findings of 11 randomized clinical trials involving a total of 65,229 patients to see if statins cut death rates among intermediate and high-risk people with no history of cardiovascular disease. In this study, too, the support for statin use was lacking.

In an editorial that accompanied the two articles, Dr. Lee Green of the University of Michigan in Ann Arbor said the de Lorgeril and Kay studies add fuel to a high-stakes debate.

"In the long term, although sincere advocates on both sides will try to convince us otherwise we really must admit that we do not know," Green wrote. "We need good research to find out, and, as de Lorgeril and colleagues point out, that search must be free of incentives to find any particular desired answer."

retrieved from http://abcnews.go.com/Health/HeartHealth/cholesterol-busting-statins-study-raises-concerns/story?id=11037926

Photo: Corbis SEE ALL 8 PHOTOS

Could fatty fast foods and sugary snacks be as addictive as a hit of heroin? Yes, say scientists at the Scripps Research Institute, who released a groundbreaking study this week confirming what binge eaters have long suspected — high-fat, high-calorie foods cause profound chemical changes in the brain. Here, a look at the study's findings — and what scientists say people can do to kick their junk addiction.

How was the study conducted?
Researchers divided rats into three groups. All three were given unlimited access to standard rat food. A second group was also given restricted access to "cafeteria-style" foods — cheesecake, fatty meat, sponge cake and chocolate snacks — for an hour every day. The third group was given "unlimited access" to these options.

What happened to the fat-fed rats?
The rats whose fat intake was restricted demonstrated no "averse effects," but the rats given free rein to binge on junk food quickly became obese. Over time, not even even physical pain could dissuade the fat rats from haunting the cheesecake buffet: "When researchers applied an electric shock to the rats' feet in the presence of food, the rats in the first two groups were frightened away. But the obese rats were not. "Their attention was solely focused on consuming food."

Why did the obese rats act so differently?
Researches say their brains' chemical makeup had changed. The fat rats' brains needed more food to trigger the release of Dopamine, the brain chemical that triggers pleasure and comfort.

How is this similar to drug addiction?
The same phenomenon leads drug abusers to up their dosage. The initial "high" overstimulates the production of dopamine. After this first rush of euphoria, however, drug users (and over-eaters, scientists theorize) develop a pleasure tolerance, and consume increasingly large amounts in hopes of achieving the same "high," even when they know it's excessive.

Did the fat-fed rats regain healthier eating habits after the study?
Not right away. "When we removed the junk food and tried to put them on a nutritious diet — what we called the 'salad bar option' — the rats simply refused to eat," said Dr. Paul Kenny, a neuroscientist who led the study. "They basically starved themselves for two weeks."

Aren't the scientists who published this study giving fat people a "get out of jail free" card?
No, say scientists. While this study gives the medical community valuable insight into the "genetic" basis for overeating (people with low dopamine receptors are more susceptible to all types of addiction), "environmental factors, and not just genes" are also involved. Like drug users, over-eaters can overcome their addictions, though the brain makes the job more difficult.

How could this study alter weight loss efforts in the future?
Current dieting methods — calorie counting, going "cold turkey" and simply "developing self-control" — might soon be antiquated. Instead, doctors may start exploring drug-addiction therapies (yes, including  "junk food rehab") to treat obesity. Some are even suggesting that scientists start searching for a "chemical cure" to food addiction, like a pill to blunt the pleasure of starchy carbohydrates or unrefined sugar.

retrieved from (http://theweek.com/article/index/201362/Junk_food_More_addictive_than_cocaine on 5-27-2010

The side effects of statins can be far worse than previously thought, a study suggests.

For the first time, the level of harm posed by the cholesterol-lowering drugs has been quantified by researchers.

They found some users are much more likely to suffer liver dysfunction, acute kidney failure, cataracts and muscle damage known as myopathy.

For some patients, the risk is eight times higher than among those not taking statins. Overall, the risk of myopathy - which may be irreversible - is six times higher for men on statins and three times higher for women.

Statins: The controversial cholesterol-lowering pills can cause muscle damage

The scientists from Nottingham University stressed the benefits of statins in stopping heart disease outweigh the risks for most patients.

However, the study will put the brakes on calls for statins to be given to the healthy for prevention, where there are no classic risk factors or symptoms.

Statins are prescribed for six million patients at risk of heart disease, including diabetics and angina sufferers.

Although drug information leaflets warn of side effects, there has been little analysis of the relative risks and benefits.

The latest study, in the British Medical Journal, used records of more than two million patients in England and Wales aged 30 to 84.

Of these patients, 225,922 were new users of various types of statins.

Their health was analysed from 2002 to 2008 to determine risk by gender, ethnicity and other medical conditions.

For example, the risk of myopathy for black male patients was eight times higher than for non- statin users.

It was also five times higher for women with type 1 diabetes and double for women with type 2 diabetes.

The results showed statin use was linked to lower risk of oesophageal cancer but increased risk of moderate or serious liver dysfunction, acute renal failure, moderate or serious myopathy and cataracts.

The study estimated the number of extra cases of a certain condition that could be expected for each 10,000 patients treated with statins.

For high-risk women, there would be 271 fewer cases of heart disease and eight fewer cases of oesophageal cancer but 74 more of liver dysfuncpatientstion, 23 more of kidney failure, 307 more of cataracts and 39 more of myopathy.

The figures for high-risk men were similar, except for myopathy, with an extra 110 cases.

In medium-risk women, there would be 228 fewer cases of heart disease and seven of oesophageal cancer.

However, there were 17 extra cases of renal failure, 252 of cataracts, 65 of liver dysfunction and 32 of myopathy.

Figures for medium-risk men were again similar except for a higher risk of myopathy.

The higher the dose of a statin, the more at risk a patient was from acute kidney failure and liver dysfunction.

Lead researcher Julia Hippisley-Cox, of Nottingham University, said one of the reasons for the study was the lack of hard evidence about the level of side effects.

She added that the results were being fed into a website - www. qintervention.org - where doctors and could assess an individual's risk of certain side effects.

She called for doctors to closely monitor those at higher risk through more frequent checks on liver, kidney, muscle and eye health.

June Davison, of the British Heart Foundation, said: 'For people with, or at high risk of heart disease, the benefits of statins far outweigh this risk.

'The good news is that the researchers found no significant link between the use of statins and risk of Parkinson's disease or many cancers.'

retrieved from http://www.dailymail.co.uk/health/article-1280040/Statins-The-effects-worse-feared.html#  on 5/21/2010

In research conducted at the University of Michigan, a compound known as sulforaphane, found in broccoli and broccoli sprouts, was demonstrated to target cancer stem cells in cell cultures and in mice. Cancer stem cells, which are not destroyed by chemotherapy, are believed to be involved in the ability of breast cancer to recur, grow and spread. "The existence of cancer stem cells (CSCs) in breast cancer has profound implications for cancer prevention," the authors note in their introductory remarks to their article, published in the May 1, 2010 issue of Clinical Cancer Research.

University of Michigan Comprehensive Cancer Center researcher Duxin Sun, PhD and colleagues injected varying concentrations of sulforaphane derived from broccoli extract into mice implanted with breast cancer tumors. The concentrations of sulforaphane tested were higher than those provided by normal consumption of broccoli or its sprouts.

Examination of the animals' tumors found a substantial reduction in cancer stem cells, while normal cells did not appear to be significantly affected.  Additionally, cancer cells derived from animals that received sulforaphane that were reimplanted into other mice failed to form tumors. Tests in cultured human breast cancer cells showed a similar reduction in cancer stem cells.

“Sulforaphane has been studied previously for its effects on cancer, but this study shows that its benefit is in inhibiting the breast cancer stem cells," stated Dr Sun, who is also an associate professor of pharmaceutical sciences at the University of Michigan College of Pharmacy. "This new insight suggests the potential of sulforaphane or broccoli extract to prevent or treat cancer by targeting the critical cancer stem cells.”

“This research suggests a potential new treatment that could be combined with other compounds to target breast cancer stem cells," commented coauthor and Distinguished Professor of Oncology Max S. Wicha, MD, who directs the U-M Comprehensive Cancer Center. "Developing treatments that effectively target the cancer stem cell population is essential for improving outcomes."

The plaintiffs say their initial testing of the products found PCB levels ranging from 12 nanograms to 850 nanograms per recommended dose, CBS News reported.

The lawsuit by two citizen environmentalists and the Mateel Environmental Justice Foundation says the fish oil products violate California's Proposition 65, which requires manufacturers to warn consumers about all chemical exposures.

The eight supplement makers or distributors named in the lawsuit are: CVS Pharmacy, Rite Aid, General Nutrition Corp., Solgar, Twinlab, Now Health, Omega Protein, and Pharmavite, CBS News reported.

retrieved from (http://www.empowher.com/news/2010/03/04/popular-fish-oil-products-contain-pcbs-lawsuit)

Is it doctors practicing defensive medicine? Or are patients so accustomed to a culture of medical technology that they insist on extensive tests and treatments?

Full article can be seen at: http://www.breitbart.com/article.php?id=D9ED7U3G0&show_article=1

Sarah D.

This is a link to an excellent article pertaining to the health risks associated with High Fructose Corn Syrup and Agave nector. 

-Joint stiffness.

-Poor circulation.

-Cold or numbness of the hands or feet.
-Loss of the outside portion of the eyebrows.
-Poor memory.
-Constipation.
-Increase in weight even on a low calorie or low carbohydrate diet.
-Reduced initiative.
-Mental confusion.
-Ringing in the ears along with decreased blood pressure and/or slow pulse. (This can also be an adrenal problem.)
-Muscle cramps while at rest.
-Catching colds or other infections easily. Difficulty recovering from infections.
-Requiring excessive sleep (more than 8 hours).
-Chronic digestive problems. This is often low stomach acid.
-Edema, especially in the face.

TESTS: Tests provide about half of the needed information. Out of 100 patients with the above symptoms, about 10 will have genuine (primary) hypothyroidism. The rest will mostly be excessive adrenal (cortisol) output blocking conversion from T4 to active T3, or low pituitary or hypothalamus function leading to low thyroid function. Some cases are excess estrogen or low adrenal function.
-TSH. This is the primary test. The healthy range is about 2.0-4.0. With symptoms and a reading above 4.0, this is probably primary hypothyroidism. With symptoms and a score below 2.0, the problem is probably a weak anterior pituitary. If the TSH is between 2.0 and 4.0, look at the T4, T3, and cortisol. 
-T4 (thyroxin) should be in the middle or just above the middle of the normal range. 
-T3 or T3 uptake should be in the middle or just above the middle of the normal range. If there are symptoms, and the T4 is in the middle or upper part of its range, and the T3 is in the lower part of its range, the person is an under-converter.- Cortisol from a salivary adrenal stress test. Blood TSH, T4, and T3 may be fine. But if there are symptoms, cortisol may be high because of stress or excess carbohydrates in the diet. If the cortisol is high, the patient is almost certainly making reverse T3 instead of real T3. Reverse T3 is not a functional hormone but it looks like normal T3 on a blood test. This is often treated with T3 and T3 may relieve symptoms. But it may be better treated as a high cortisol issue. At least half of adrenal issues are excess cortisol output!
-Estrogen is best tested from a saliva sample. 
-Iodine. Paint a silver dollar size of drugstore tincture of iodine on your skin. If it soaks in quickly (the stain is gone in less than 24 hours), you need iodine unless you have an iodine allergy. 
-Basal temperature. The goal is 97.8-98.2 per day. 

1. Increase activity by changing daily activities or adding an exercise routine. I find that simple exercises like walking, biking, gym ball work, and swimming are the most effective. You can do most of these exercises around your home or neighborhood and are very cost effective.

2. Avoid the high calorie foods like pastries, candies and processed junk foods - stick to real and whole foods like fruits (20%) and vegetables (80%) for your carbohydrate intake.

3. Go ahead and adopt a low-carb diet, and don’t dive back into the cookies and cakes when you reach your health goals. If you want to maintain your health, you must maintain your diet.

4. Avoid white processed flour, high fructose corn syrup, and sugars. Load up on complex carbohydrates like high fiber, low starch green vegetables and fruits like berries, melons, and citrus.

5. Drink enough water. Thirst is often disguised as hunger that causes us to over-eat. Stay away from sugary beverages. You should drink half your body weight in ounces of water. If you weigh 150 lbs, drink 75 oz. of water per day. If you currently do not drink a lot of water gradually increase intake until you reach your desired goal.

6. Eat smaller portions. Make a loose fist with each of your hands and hold them together. That is about the size of your stomach. It doesn’t take much to feel full. Stop eating when you are full. If you have the need to eat everything on your plate, use a smaller plate.

7. Eat slowly and start with a healthy salad or appetizer. It takes about 20 minutes for your stomach to signal your brain that it has had enough. We can eat way too many carbs in those few minutes.

8. If you do eat a sweet or starchy carbohydrate food, eat it in the evening. If you eat sweet carbs early in the day, you will tend to crave the sweets throughout the remainder of the day.

9. Use the "carb counting" packet to determine which foods have the lowest carbohydrates per serving. The more you use this handout the more familiar you will become with which foods to choose when planning your meals.

 10. Plan your meals! If you know in advance what you are having for your next meal this helps to avoid making rash food choices. Planning saves time by knowing what your are going to eat so you do not sit around wondering what your going to have for your meal. This also saves time and money when shopping for groceries. You have a list of foods you need to purchase and this stops "graze shopping."  Thus saving money and time.

11. Your diet starts at the grocery store. Use your food lists to make a shopping list of foods you will be purchasing at the grocery store. This habit will save you time, money, and helps you gain control of your foods. If the bad foods are not in your house, you can not eat them.

12. At breakfast eat like a KING, at lunch like a PRINCE, and at supper like a PAUPER. Research has shown that people tend to eat less and healthier foods throughout the day if they start the day with a good breakfast.

Myth #3: Eating Fat Makes You Fat.

Carl Lavie, MD, FACC, who is the medical director of Cardiac Rehabilitation and Prevention at Ochsner Medical Center, and his associates reviewed data from tens of thousands of patients included in retrospective epidemiologic studies and large randomized controlled trials. According to Dr Lavie and colleagues, the most compelling evidence in favor of omega-3 fatty acids in cardiovascular disease comes from 4 trials of nearly 40,000 participants who received eicosapentaenoic acid (EPA) with or without docosahexaenoic acid (DHA) for primary prevention, following heart attack, and in heart failure. These long-chain omega-3 fatty acids penetrate the cell membrane to help regulate the electrical activity of the heart as well as improve vascular tone, stabilize plaque, and normalize blood pressure.

"This isn't just hype; we now have tremendous and compelling evidence from very large studies, some dating back 20 and 30 years, that demonstrate the protective benefits of omega-3 fish oil in multiple aspects of preventive cardiology,' Dr Lavie commented. "The strongest evidence of a cardioprotective effect of omega-3s appears in patients with established cardiovascular disease and following a heart attack with up to a 30 percent reduction in cardiovascular-related death."

A relatively recent controlled trial found a 9 percent reduction in deaths from heart failure among participants who received omega-3 fatty acids compared with those who did not. "If we translate this finding, it means that we only need to treat 56 patients for four years to prevent one death," Dr Lavie noted. "And we are talking about a very safe and relatively inexpensive therapy."

The authors recommend that healthy people consume 500 milligrams EPA plus DHA per day and people with heart disease or heart failure consume up to twice that amount, although many individuals regularly consume higher levels. "There are clear health and heart benefits associated with increasing one's intake of foods that are rich in omega-3s, including oily fish like salmon, sardines, trout, herring, and oysters" Dr. Lavie observed "Patients should talk with their doctors about whether a fish oil supplement is needed to get the right amount and, in turn, benefit from the associated cardiovascular protection."

source http://www.lef.org/newsletter/2009/0807_Review-Confirms-Omega-3-Benefits.htm?source=eNewsLetter2009Wk32-2&key=Article&l=0#article

Richard D. Semba and his associates analyzed data from participants in the Women's Health and Aging studies I and II, which were designed to evaluate the causes of physical disability among community dwelling older women. For their study, the researchers selected 714 women in their seventies who had their serum 25-hydroxyvitamin D levels measured upon enrollment.

Over a median of 72 months, 14 percent of the women died. Thirty-six percent of the deaths were attributed to from cardiovascular disease, 18 percent to respiratory disease, 15 percent to cancer, 27 percent to other causes and 4 percent to unknown causes. When participants were ranked according to serum vitamin D levels, deaths were found to have occurred in 8 percent of those who had vitamin D levels among the top 25 percent of subjects, compared to 19.2 percent of those in the lowest quarter. Women whose vitamin D levels were lowest at less than 15.3 nanograms per milliliter were likelier to be African-American, have a higher body mass index, and have lower levels of physical activity, cholesterol and triglycerides compared with those in the top quarter. While 35.6 percent of women whose vitamin D levels were highest at over 27.0 nanograms per milliliter used vitamin D supplements, just 16.3 percent of women in the lowest category reporting using them.

The study's findings confirm those of two analyses published last year in the Archives of Internal Medicine. The authors write that vitamin D is involved in numerous functions, including regulation of the renin-angiotensin axis, modulation of cellular proliferation and differentiation, and cytokine production. It also is involved in modulating immune function and maintaining vascular health. "The role that vitamin D plays in different tissues may account for the associations between vitamin D deficiency and cardiovascular disease, cancer, and mortality," they write. "Controlled clinical trials are needed to determine whether vitamin D supplementation will improve health outcomes such as cardiovascular disease and mortality in older adults who have insufficient levels of vitamin D."

source: http://www.lef.org/newsletter/2009/1006_Vitamin-D-Levels-Associated-with-Increased-Survival-6-Year-Period.htm?source=eNewsLetter2009Wk41-1&key=Article&l=0#article

This study, entitled “Dietary Influences on Cognitive Function with Aging,” is published in volume 1114 of the Annals of the New York Academy of Sciences: Healthy Aging and Longevity

ScienceDaily. Retrieved September 21, 2009, from http://www.sciencedaily.com /releases/2007/11/071106164725.htm

Purification Program Details

The 21-day purification program is so effective because it focuses on the whole person–making better food and beverage choices, taking whole food supplements, reducing stress, and increasing exercise. The purification program is more than just a diet. It encourages patients to adopt a healthier lifestyle, which, in turn, helps them look and feel better.

This streamlined, easy-to-follow program emphasizes whole, organic, and unprocessed foods; whole food supplements; and water. Vegetables and fruit are eaten from days 1-10, with select proteins added at day 11. Whole food supplements taken during the program include: SP Cleanse^®, SP Green Food^™, SP Complete^™, and Gastro-Fiber^® or Whole Food Fiber. Other supplements such as Whey Pro Complete, a protein powder with 15 grams of protein per serving, can also be added to the protocol to support purification.

To assist the patient during purification, we provide an all-in-one purification guide that describes the program and offers features such as an FAQ section; a tear-off shopping list; program-friendly shake and salad accent recipes; a daily intake journal; and an area for you to recommend additional supplements.

NEW YORK - Treatment with a cholesterol-lowering statin drug may very occasionally cause double vision, drooping eyelids or weakness of the muscles that control eye movement, investigators report.

Dr. F. W. Fraunfelder and Dr. Amanda B. Richards, from the Casey Eye Institute, Oregon Health & Science University, Portland, investigated adverse events of this type documented in three large databases and report their findings in the medical journal Ophthalmology.

The team identified a total of 256 case reports of eye-muscle disorders associated with statins — which include drugs such as Lipitor, Zocor, or Crestor, for example.

The average dose of the statins was within the range recommended for each medication. The average time from starting on the statin to the occurrence of the eye problem was 8 months.

Among the 256 case reports, 62 patients stopped taking the statin and the double-vision or eyelid-droop resolved, Fraunfelder told Reuters Health. "Sixteen case reports indicate that the statin was started again and the (problem) reoccurred," he said. "This is positive re-challenge data and very compelling evidence that a real adverse drug reaction occurred with statins."

The side effect is rare, however. It's known that statins can sometimes cause inflammation of skeletal muscles (myositis) in the body, and the current side effect "probably represents a localized myositis in the extraocular muscles," Fraunfelder noted.

“despite the development of increasingly potent statins ( cholesterol lowering drugs) capable of markedly lowering cholesterol levels, coronary (heart) disease remains the leading cause of death in Western societies. Even after prescribing the drug for nearly 20 years, with no apparent benefit, cholesterol continues to be the target for cardiovascular disease…. And statins the treatment of choice. New England Journal of Medicine , March 2, 2006

“Mortality from cardiovascular disease causes is expected to increase by 90 % by 2020, as compared with that of 1990. The prediction of increased cardiovascular disease should be well reported and disturbing. Rather, pharmaceutical companies continue the cholesterol hysteria and development of medial agents designed to either block the liver’s ability to produce cholesterol or block its absorption.” New England Journal of Medicine, April 19, 2007.”

We are obliged to issue another official statement on cod liver oil after the November bulletin of the Vitamin D Council, which contains "an unprecedented warning about the ingestion of cod liver oil and resultant vitamin A toxicity."

The warning accompanies a report on a review article co-authored by Dr. John Cannell, head of the Vitamin D Council, and fifteen other researchers, entitled "Cod Liver Oil, Vitamin A Toxicity, Frequent Respiratory Infections, and the Vitamin D Deficiency Epidemic" in the November issue of Annals of Otology, Rhinology and Laryngology.

NO PROOF THAT VITAMIN A IS TOXIC

Most of this paper is a review of studies showing the benefits of vitamin D in protecting against various illnesses, including respiratory infection. THIS PAPER DOES NOT PRESENT ANY INFORMATION WHATSOEVER INDICATING THAT COD LIVER OIL IS TOXIC, and, in fact, admits that vitamin A can significantly reduce the incidence of acute lower respiratory tract infections in Third World children.

A portion of the review article is an attempt to explain why a 2004 study providing 600 to 700 IU of vitamin D and 3,500 IU of vitamin A in the form of cod liver oil and a multivitamin failed to meaningfully reduce upper respiratory tract infections when studies from the 1930s found that cod liver oil could reduce the incidence of these infections by 30 to 50 percent. The authors of the recent commentary suggested that the older studies were more effective because cod liver oil in the 1930s contained much more vitamin D. They suggested that modern cod liver oil is low in vitamin D because the deodorization process removes the vitamin while manufacturers fortify the oil with only a fraction of the original amount. As an example, they cited cod liver oil made by Nordic Naturals, advertised as containing only "naturally occurring vitamins A and D," which has only 3 to 60 IU of vitamin D per tablespoon but between 150 and 12,000 times as much vitamin A.

This conclusion is essentially the same as the conclusion reached by the Weston A. Price Foundation and the research of Chris Masterjohn; we have continually pointed out that vitamins A and D work together and that without vitamin D, vitamin A can be ineffective or even toxic. We do not recommend Nordic Naturals regular cod liver oil or any brand of cod liver oil that is low in vitamin D. But it is completely inappropriate to conclude from this 2004 study that cod liver oil is toxic because of its vitamin A content. Similar reviews could be put together showing the benefits of vitamin A and cod liver oil in numerous studies, including the studies from the 1930s. Obviously the solution is to use the type of cod liver oil that people took in the 1930s, which did not have most of the vitamin D removed by modern processing techniques.

Our recommendations for cod liver oil brands can be found at westonaprice.org/basicnutrition/cod-liver-oil-menu.html

VITAMIN A DOES NOT ANTAGONIZE VITAMIN D

The Vitamin D Council report claims that the vitamin A in cod liver oil is excessive and antagonizes vitamin D by inhibiting the binding of its active form to DNA and thus preventing its ability to regulate the expression of vitamin D-responsive genes.

Vitamins A and D are both precursors to active hormones that regulate the expression of genes. The body possesses certain enzymes that convert each of these in a two-step process to their active forms: vitamin A is converted to retinal and then to active retinoic acid while vitamin D is converted to calcidiol and then to active calcitriol. While directly consuming either retinoic acid or calcitriol would be unnatural, consuming vitamins A and D, together, as in cod liver oil, is perfectly natural. The enzymes involved in these conversions are responsible for producing incredibly powerful hormones and are therefore highly regulated.

In order for vitamin D to activate the expression of its target genes, it must bind to the vitamin D receptor (VDR) and then combine with the retinoid X receptor (RXR), which is activated by a particular form of vitamin A called 9-cis retinoic acid. RESEARCHERS FROM SPAIN RECENTLY SHOWED THAT VITAMIN D CAN ONLY EFFECTIVELY ACTIVATE TARGET GENES WHEN ITS PARTNER RECEPTOR IS ACTIVATED BY VITAMIN A.

In the ABSENCE OF VITAMIN A, molecules called "corepressors" bind to the VDR/RXR complex and PREVENT vitamin D from functioning.

The molecular biology of 9-cis retinoic acid, however, is extremely complex, and this has led to some confusion. The RXR and its activator 9-cis retinoic acid partner up not only with the vitamin D receptor, but also with the receptors for steroid hormones, thyroid hormone, and most other nuclear receptors. In fact, if enough 9-cis retinoic acid is present, RXRs will even partner up with themselves. Ordinarily, this versatile form of vitamin A is gradually derived in small amounts from the larger pool of all-trans retinoic acid as needed. When scientists add large amounts of 9-cis retinoic acid to isolated cells, then, it may cause effects that smaller amounts naturally produced in the cell would not cause.

Researchers have shown, for example, that 9-cis retinoic acid interferes with the ability of vitamin D to stimulate the production of osteocalcin, a vitamin K-dependent protein involved in organizing the mineralized matrix of bone. This may have been because the excessive amount of 9-cis retinoic acid caused RXRs to pair up with themselves and thereby made these receptors unavailable to vitamin D. When scientists incubate cells with activated vitamin D and all-trans retinoic acid, ordinarily the source of 9-cis retinoic acid in the cell, the two hormones stimulate the production of osteocalcin with remarkable synergy.

More information on the interactions between vitamins A and D can be found in these articles:

http://www.westonaprice.org/basicnutrition/vitamin-k2.html

http://westonaprice.org/basicnutrition/vitamina-osteo.html

http://westonaprice.org/basicnutrition/vitamin-d-safety.html

http://www.ncbi.nlm.nih.gov/pubmed/16936639?

http://mcb.asm.org/cgi/content/full/28/11/3817?

More information on the conversion of carotenoids to vitamin A can be found in these articles: http://www.westonaprice.org/basicnutrition/vitaminasaga.html (see the section "Vitamin A Vagary"). http://westonaprice.org/basicnutrition/vitamina-osteo.html#carotenesnotad

http://www.ncbi.nlm.nih.gov/pubmed/16487202?

Unlike previous editions, the latest ACOEM occupational medicine guidelines actually recommend spinal manipulation.

By Tina Beychok, Associate Editor

Pain is the most prevalent health condition among U.S. workers and the most expensive in terms of lost productivity. Recent studies suggest more than six in 10 adults over the age of 30 experience chronic pain. Furthermore, health care expenditures for back and neck pain have risen to more than $80 billion a year in the U.S. – a dramatic increase over the past eight years, without evidence of improved health. In addition to the costs of lost productivity, an estimated $64 billion per year is lost due to workers continuing to work, even though pain reduces their job performance. This phenomenon is called "presenteeism."

Unfortunately, workers' comp can be a quagmire of contradictory and insufficient rules and regulations as to what treatments are and aren't covered. The American College of Occupational and Environmental Medicine (ACOEM) has been in the process of revising its Occupational Medicine Practice Guidelines, which have not always taken a positive view of chiropractic manipulation. In fact, the second edition of the guidelines, released in 2005, was heavily criticized by some in the chiropractic community.¹

The evidence-based guidelines include more than 200 recommendations for chronic pain, developed by a multidisciplinary panel and reviewed by leading medical and health organizations. The recommendations focus on treatments for several chronic pain conditions including complex regional pain syndrome (CRPS), neuropathic pain, trigger points/myofascial pain, chronic persistent pain, fibromyalgia and chronic low back pain. The recommendations are based on more than 1,500 references, including 546 randomized, controlled trials. Guidelines of interest to the chiropractic profession include the following:

Strength of Evidence – Moderately Recommended

Editor-in-Chief Kurt T. Hegmann, MD, MPH, stated, “These guidelines were developed using ACOEM's published methodology, which incorporates the highest scientific standards for reviewing evidence-based literature, ensuring the most rigorous, reproducible, and transparent occupational health guidelines available. Literally thousands of hours of review of the available scientific literature went into this process, yielding what we consider state-of-the-art medical guidelines.”

Occupational Medicine Practice Guidelines: Evaluation and Management of Common Health Problems and Functional Recovery in Workers, 2^nd Edition, 2008 revision. www.acoem.org/practiceguidelines.aspx.