The Nutrition Facts of Life

July 5, 2011

• For PTs: HR = 2.0
  
  
• For MDs: HR = 1.6
  
  
• For DCs: HR = 1.0

Statistically, this means you are twice as likely to end up disabled if you got your care from a PT, rather than from a DC.

You’re also 60% more likely to be disabled if you choose an MD to manage your care, rather than a DC.

The authors concluded: “In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than with chiropractic services or no treatment.”


The Abstract:

OBJECTIVES:   To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain (LBP).

METHOD:   A total of 894 cases followed 1 year using workers' compensation claims data. Provider types were defined for the initial episode of disability and subsequent episode of health maintenance care.

RESULTS:   Controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95% confidence interval [CI] = 1.0 to 3.9) or physicians (HR = 1.6; 95% CI = 0.9 to 6.2) was higher than that of chiropractor (referent, HR = 1.0), which was similar to that of the patients non-treated after return to work (HR = 1.2; 95% CI = 0.4 to 3.8).

CONCLUSIONS:   In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than in chiropractic services or no treatment.

• For PTs: HR = 2.0
  
  
• For MDs: HR = 1.6
  
  
• For DCs: HR = 1.0

Statistically, this means you are twice as likely to end up disabled if you got your care from a PT, rather than from a DC.

You’re also 60% more likely to be disabled if you choose an MD to manage your care, rather than a DC.

The authors concluded: “In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than with chiropractic services or no treatment.”


The Abstract:

OBJECTIVES:   To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain (LBP).

METHOD:   A total of 894 cases followed 1 year using workers' compensation claims data. Provider types were defined for the initial episode of disability and subsequent episode of health maintenance care.

RESULTS:   Controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95% confidence interval [CI] = 1.0 to 3.9) or physicians (HR = 1.6; 95% CI = 0.9 to 6.2) was higher than that of chiropractor (referent, HR = 1.0), which was similar to that of the patients non-treated after return to work (HR = 1.2; 95% CI = 0.4 to 3.8).

CONCLUSIONS:   In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than in chiropractic services or no treatment.

Abstract

The objective of this population-based cohort study was to investigate the association between a lifetime history of neck injury from a motor vehicle collision and the development of troublesome neck pain. The current evidence suggests that individuals with a history of neck injury in a traffic collision are more likely to experience future neck pain. However, these results may suffer from residual confounding. Therefore, there is a need to test this association in a large population-based cohort with adequate control of known confounders. We formed a cohort of 919 randomly sampled Saskatchewan adults with no or mild neck pain in September 1995. At baseline, participants were asked if they ever injured their neck in a motor vehicle collision. Six and twelve months later, we asked about the presence of troublesome neck pain (grade II-IV) on the chronic pain grade questionnaire. Multivariable Cox regression was used to estimate the association between a lifetime history of neck injury in a motor vehicle collision and the onset of troublesome neck pain while controlling for known confounders. The follow-up rate was 73.5% (676/919) at 6 months and 63.1% (580/919) at 1 year. We found a positive association between a history of neck injury in a motor vehicle collision and the onset of troublesome neck pain after controlling for bodily pain and body mass index (adjusted HRR = 2.14; 95% CI 1.12-4.10).

Our analysis suggests that a history of neck injury in a motor vehicle collision is a risk factor for developing future troublesome neck pain. The consequences of a neck injury in a motor vehicle collision can have long lasting effects and predispose individuals to experience recurrent episodes of neck pain.

By BRIAN HAMACHER

Updated 8:18 AM EST, Mon, Feb 14, 2011

Energy drinks not only may make your kid hyper, but it turns out they might also make them seriously unhealthy.

A study issued Monday from the University of Miami School of Medicine says energy drinks could pose a risk for serious adverse health effects in some children, especially those with diabetes, seizures, cardiac abnormalities or mood and behavior disorders.

The study, called "Health Effects of Energy Drinks on Children, Adolescents, and Young Adults," says the energy drinks "have no therapeutic benefit to children, and both the known and unknown properties of the ingredients, combined with reports of toxicity, may put some children at risk for adverse health events."

retrieved from: http://www.nbcmiami.com/news/local-beat/UM-Study-Says-Energy-Drinks-Pose-Serious-Risk-to-Kids-116150794.html?dr on 2/14/2011

According to study surveys, adolescents account for half of the energy drink market, and as many as 50 percent have reported consuming energy drinks.

The study says high levels of stimulants such as caffeine, taurine and guarana are in the energy drinks and that safe levels of consumption of these ingredients haven't been established for children.

It also says energy drink overdose can lead to seizures, stroke and even sudden death.

But some are saying the study's findings are hogwash, and that mainstream energy drinks like Red Bull contain as much and even only half as much caffeine as a cup of coffee.

“This literature review does nothing more than perpetuate misinformation about energy drinks, their ingredients and the regulatory process,” said Dr. Maureen Storey, senior vice president of science policy for the American Beverage Association, in an e-mail to the Miami Herald.

First Published: Feb 14, 2011 7:56 AM EST

The discovery turns standard medical practice on its head. Surgeons have been removing lymph nodes from under the arms of breast cancer patients for 100 years, believing it would prolong women’s lives by keeping the cancer from spreading or coming back.

Now, researchers report that for women who meet certain criteria — about 20 percent of patients, or 40,000 women a year in the United States — taking out cancerous nodes has no advantage. It does not change the treatment plan, improve survival or make the cancer less likely to recur. And it can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling.

Removing the cancerous lymph nodes proved unnecessary because the women in the study had chemotherapy and radiation, which probably wiped out any disease in the nodes, the researchers said. Those treatments are now standard for women with breast cancer in the lymph nodes, based on the realization that once the disease reaches the nodes, it has the potential to spread to vital organs and cannot be eliminated by surgery alone.

Experts say that the new findings, combined with similar ones from earlier studies, should change medical practice for many patients. Some centers have already acted on the new information. Memorial Sloan-Kettering Cancer Center in Manhattan changed its practice in September, because doctors knew the study results before they were published. But more widespread change may take time, experts say, because the belief in removing nodes is so deeply ingrained.

“This is such a radical change in thought that it’s been hard for many people to get their heads around it,” said Dr. Monica Morrow, chief of the breast service at Sloan-Kettering and an author of the study, which is being published Wednesday in The Journal of the American Medical Association. The National Cancer Institute paid for the study.

Doctors and patients alike find it easy to accept more cancer treatment on the basis of a study, Dr. Morrow said, but get scared when the data favor less treatment.

The new findings are part of a trend to move away from radical surgery for breast cancer. Rates of mastectomy, removal of the whole breast, began declining in the 1980s after studies found that for many patients, survival rates after lumpectomy and radiation were just as good as those after mastectomy.

The trend reflects an evolving understanding of breast cancer. In decades past, there was a belief that surgery could “get it all” — eradicate the cancer before it could spread to organs and bones. But research has found that breast cancer can begin to spread early, even when tumors are small, leaving microscopic traces of the disease after surgery.

The modern approach is to cut out obvious tumors — because lumps big enough to detect may be too dense for drugs and radiation to destroy — and to use radiation and chemotherapy to wipe out microscopic disease in other places.

But doctors have continued to think that even microscopic disease in the lymph nodes should be cut out to improve the odds of survival. And until recently, they counted cancerous lymph nodes to gauge the severity of the disease and choose chemotherapy. But now the number is not so often used to determine drug treatment, doctors say. What matters more is whether the disease has reached any nodes at all. If any are positive, the disease could become deadly. Chemotherapy is recommended, and the drugs are the same, no matter how many nodes are involved.

The new results do not apply to all patients, only to women whose disease and treatment meet the criteria in the study.

The tumors were early, at clinical stage T1 or T2, meaning less than two inches across. Biopsies of one or two armpit nodes had found cancer, but the nodes were not enlarged enough to be felt during an exam, and the cancer had not spread anywhere else. The women had lumpectomies, and most also had radiation to the entire breast, and chemotherapy or hormone-blocking drugs, or both.

The study, at 115 medical centers, included 891 patients. Their median age was in the mid-50s, and they were followed for a median of 6.3 years.

After the initial node biopsy, the women were assigned at random to have 10 or more additional nodes removed, or to leave the nodes alone. In 27 percent of the women who had additional nodes removed, those nodes were cancerous. But over time, the two groups had no difference in survival: more than 90 percent survived at least five years. Recurrence rates in the armpit were also similar, less than 1 percent. If breast cancer is going to recur under the arm, it tends to do so early, so the follow-up period was long enough, the researchers said.

One potential weakness in the study is that there was not complete follow-up information on 166 women, about equal numbers from each group. The researchers said that did not affect the results. A statistician who was not part of the study said the missing information should have been discussed further, but probably did not have an important impact.

It is not known whether the findings also apply to women who do not have radiation and chemotherapy, or to those who have only part of the breast irradiated. Nor is it known whether the findings could be applied to other types of cancer.

The results mean that women like those in the study will still have to have at least one lymph node removed, to look for cancer and decide whether they will need more treatment. But taking out just one or a few nodes should be enough.

Dr. Armando E. Giuliano, the lead author of the study and the chief of surgical oncology at the John Wayne Cancer Institute at St. John’s Health Center in Santa Monica, Calif., said: “It shouldn’t come as a big surprise, but it will. It’s hard for us as surgeons and medical oncologists and radiation oncologists to accept that you don’t have to remove the nodes in the armpit.”

Dr. Grant W. Carlson, a professor of surgery at the Winship Cancer Institute at Emory University, and the author of an editorial accompanying the study, said that by routinely taking out many nodes, “I have a feeling we’ve been doing a lot of harm.”

Indeed, women in the study who had the nodes taken out were far more likely (70 percent versus 25 percent) to have complications like infections, abnormal sensations and fluid collecting in the armpit. They were also more likely to have lymphedema.

But Dr. Carlson said that some of his colleagues, even after hearing the new study results, still thought the nodes should be removed.

“The dogma is strong,” he said. “It’s a little frustrating.”

Eventually, he said, genetic testing of breast tumors might be enough to determine the need for treatment, and eliminate the need for many node biopsies.

Two other breast surgeons not involved with the study said they would take it seriously.

Dr. Elisa R. Port, the chief of breast surgery at Mount Sinai Medical Center in Manhattan, said: “It’s a big deal in the world of breast cancer. It’s definitely practice-changing.”

Dr. Alison Estabrook, the chief of the comprehensive breast center at St. Luke’s-Roosevelt hospital in New York said surgeons had long been awaiting the results.

“In the past, surgeons thought our role was to get out all the cancer,” Dr. Estabrook said. “Now he’s saying we don’t really have to do that.”

But both Dr. Estabrook and Dr. Port said they would still have to make judgment calls during surgery and remove lymph nodes that looked or felt suspicious.

The new research grew out of efforts in the 1990s to minimize lymph node surgery in the armpit, called axillary dissection. Surgeons developed a technique called sentinel node biopsy, in which they injected a dye into the breast and then removed just one or a few nodes that the dye reached first, on the theory that if the tumor was spreading, cancer cells would show up in those nodes. If there was no cancer, no more nodes were taken. But if there were cancer cells, the surgeon would cut out more nodes.

Although the technique spared many women, many others with positive nodes still had extensive cutting in the armpit, and suffered from side effects.

“Women really dread the axillary dissection,” Dr. Giuliano said. “They fear lymphedema. There’s numbness, shoulder pain, and some have limitation of motion. There are a fair number of serious complications. Women know it.”

After armpit surgery, 20 percent to 30 percent of women develop lymphedema, Dr. Port said, and radiation may increase the rate to 40 percent to 50 percent. Physical therapy can help, but there is no cure.

The complications — and the fact that there was no proof that removing the nodes prolonged survival — inspired Dr. Giuliano to compare women with and without axillary dissection. Some doctors objected. They were so sure cancerous nodes had to come out that they said the study was unethical and would endanger women.

“Some prominent institutions wouldn’t even take part in it,” Dr. Giuliano said, though he declined to name them. “They’re very supportive now. We don’t want to hurt their feelings. They’ve seen the light.”

retrieved from: http://www.nytimes.com/2011/02/09/health/research/09breast.html?_r=1&pagewanted=print on 2/11/2011

By Jeremy Laurance, Health Editor

Friday, 4 February 2011

The world is facing a "population emergency" as soaring rates of obesity threaten a pandemic of cardiovascular disease, scientists have warned.

Scientists blame obesity, alcohol and the growing tendency to delay motherhood for record levels of the disease.

Up to 47,700 women are being diagnosed every year, equal to 130 a day. That is double the number 30 years ago.

Testing time: Almost 50,000 women are being diagnosed with breast cancer every year

Experts describe the figures as a ‘wake-up call’ and say thousands could avoid the disease if they drank less, maintained a healthy weight and took more exercise.

The rise has also been blamed on the fact that increasing numbers are delaying motherhood and consequently having fewer children. The figures show that there are now 124 cases per 100,000 women, twice as many as any other type of cancer.

Scientists believe some forms of breast cancer are triggered by the sex hormone estrogen, which is linked to obesity, alcohol consumption, having fewer children and not breastfeeding.

They also blame hormone replacement therapy taken by millions every year to combat the symptoms of the menopause.

Figures from Cancer Research UK show that 47,700 women were diagnosed in 2008, compared to 42,400 in 1999 and just 24,120 in 1978.

Women are most at risk once they reach the menopause and 22,900 new cases – almost half – occur among those aged 50 to 69.

Doctors believe many tumors are caused by unhealthy lifestyles and are urging women to change their eating and drinking habits, particularly during the menopause.

Probable causes: Experts blame lifestyle choices such as alcohol and obesity, along with a growing wish to put off motherhood, for the spike in cancer rates

Research has found that obesity increases the risk of breast cancer after the menopause by up to 30 per cent. The overweight are also more likely to develop tumors.

Fat cells produce estrogen and levels of this cancer-triggering hormone can be twice as high in obese women as those of a healthy weight.

Alcohol is also thought to raise the levels of estrogen. Previous studies have shown that drinking even only one glass of wine a day can raise the risk of breast cancer by a fifth.

Enlarge  

Women may also be increasing their risk by having fewer children, or none at all, because the levels of estrogen decline during pregnancy. Those who delay motherhood and consequently have fewer babies will be exposed to estrogen for a higher proportion of their lives.

The risk is elevated further because breast-feeding has been shown to protect against the tumors as it lowers the level of estrogen and other hormones.

Dr Kat Arney, from Cancer Research UK, said: ‘There are several lifestyle factors such as alcohol, weight and activity which increase the risk.

‘It is also linked to a woman’s reproductive history. If a woman starts having children earlier in life she is less at risk. A woman who does not start having children until her thirties will only have one, maybe two.’

She added that the popularity of HRT was also a factor and urged women to take it for as limited a time as possible.

Dr Rachel Greig, of Breakthrough Breast Cancer, said: ‘These figures are a wake-up call and should not be ignored.

‘More women are developing breast cancer and, although survival is improving thanks to breakthroughs in breast awareness, screening and treatment, we clearly have much further to go.

‘A two-pronged attack is needed – commitment to research into the causes of breast cancer, supported by women arming themselves with knowledge of the risks that may contribute to the disease.

‘Some risk factors, such as getting older, cannot be changed but the good news is that others can. By drinking less, maintaining a healthy weight and getting physically active, women can reduce their risk of developing breast cancer.’

A major study in 2009 said that more than 40 per cent of breast cancers could be prevented if women made simple lifestyle changes.

The report by the World Cancer Research Fund advised women to take least 30 minutes of exercise a day and limit alcohol to one unit a day – a single small glass of wine.

"Women on combined hormone therapy with estrogen plus progestin were twice as likely to die from breast cancer compared to women receiving placebo," says medical oncologist and study author Dr. Rowan Chlebowski.

The researchers looked at more than 16,000 postmenopausal women who were part of a large government study called the Women's Health Initiative. The women took either Prempro, a drug made by Pfizer that combines both estrogen and progestin, or a placebo or sugar pill. In 2002 the study was stopped early after five and a half years of treatment because of concerns about heart health, breast cancer and other health problems. This latest research looks at 11 years of follow-up on the health of these women and the authors found that those who had used the therapy were not only more likely to develop but to die from breast cancer.

For decades women have been prescribed HRT – medications containing female hormones to replace the ones the body no longer produces after menopause. These drugs can be very effective at alleviating the hot flashes, night sweats and other discomforts of menopause.  They have also been shown to help with bone health and may decrease the risk of colon cancer. But HRT, long heralded as being protective for heart health, has not lived up to its billing and women are now warned about the possible increase risk for heart attack and stroke. Last year a study found that combined HRT also increased a woman's risk of dying from lung cancer.

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Dr. Peter Bach, pulmonologist from Memorial Sloan-Kettering Cancer Center in New York, who was not involved in the most recent study, wrote an editorial published in the journal editorial.  It reads in part: "It took a lot of work for these investigators to unwind what ended up being a lot of incorrect assumptions about the safety of hormone replacement therapy particularly with combined agents like Prempro."

Pfizer, maker of Prempro, released a statement in response to the study: "As a science-based company, we take this analysis seriously. It is important to view the data in the full context of both the symptoms of menopause as well as the extensive body of information – developed over more than 60 years – on the known benefits and risks of hormone therapy."

The use of combined HRT declined sharply in the United States after the HRT part of  the Women's Health Initiative study was stopped in 2002. Researchers have subsequently seen a decline in the rate of new breast cancer cases. 15 to 20 percent of postmenopausal women now take HRT, down from 35 to 40 percent prior to the study.

Medical experts recommend that if women choose HRT, they take the lowest dose for the shortest duration. Check with your doctor about what is right for you and for information about other therapies that may help alleviate unpleasant menopausal symptoms.

The results of the estrogen only arm of the Women's Health Initiative trial will be released later this year. Estrogen only therapy is the preferred HRT treatment for women who, because of a hysterectomy, no longer have a uterus.

retrieved from http://pagingdrgupta.blogs.cnn.com/2010/10/19/study-hrt-increases-breast-cancer-death-risk/?iref=obinsite on 11/17/2010

Just over one-third of American adults are obese. Though alarmingly high, this rate has remained relatively steady over the past decade, leading some public health experts to suggest that the obesity epidemic has peaked.

Now, researchers at Harvard University are predicting that the worst is yet to come. If current trends continue, they say, the obesity rate in the U.S. won't level off until it reaches at least 42 percent, circa 2050.

"The recent slowdown in the increase in obesity prevalence is a natural part of the obesity epidemic reaching a saturation," says the lead author of the study, Alison Hill, a doctoral candidate in Harvard's department of biophysics. But, she adds, obesity rates "will still continue to increase, although at a slower rate, if no interventions are introduced."

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This bleak forecast, which appears in a study published this week in the journal PLoS Computational Biology, is based on the social networks research of one of Hill's co-authors, Dr. Nicholas Christakis, M.D., a professor of medical sociology at Harvard Medical School, in Boston.

In a 2007 study published in the New England Journal of Medicine, Christakis and a colleague suggested that obesity can spread through social networks, much like the flu. In the new study, the researchers took this theory a step further and used the "infectious disease" model of obesity to predict future trends.

Obesity rates have a tendency to snowball, they found, because a person's likelihood of becoming obese increases with each additional obese family member, friend, or acquaintance he or she has. What's more, obese people appear to have a stronger influence on their friends and family now than they did in 1971, when the earliest data used in the study was collected.

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"Over the past 40 years, there has been a steady increase in the rate of infection, and it is now the highest it has been," Hill says. "What's changing over time is how much each obese friend influences you."

Unfortunately that influence doesn't work the other way around. Only weight gain—not weight loss—is "contagious," according to the study.

Hill and her colleagues predicted the national obesity rate by applying their social networks model to 40 years of obesity data from the Framingham Heart Study, which has followed several generations of people in a single Massachusetts town. (Obesity rates in that study have roughly mirrored national trends: 14 percent of the study participants were obese in 1971, but by 2000 that number had reached 30 percent.)

Health.com: Obesity rates stabilize but remain high

Dr. Scott Kahan, M.D., the co-director of the George Washington University Weight Management Center, in Washington, D.C., says that the new study is "worthwhile" but should be taken with a grain of salt.

The data the researchers used to make their projections were collected before the obesity epidemic became a major public health concern, Kahan notes, and anti-obesity interventions have since been ramped up.

"We're in a different place," he says. "We never addressed obesity until five years ago. … We're addressing policies and schools and social norms [now]."

retrieved from http://pagingdrgupta.blogs.cnn.com/2010/11/04/study-u-s-obesity-rate-will-hit-42-percent/ on 11/17/2010

By Fiona Macrae
Cancer is a man-made disease, fuelled by the excesses of modern life, study of ancient remains from fossils to mummies has concluded.

A review of Egyptian mummies, fossil records dating back to dinosaurs and classical literature found tumours to be extremely rare until recent times, when factors from pollution to poor diet made life more toxic.

They discovered that the disease rate has risen dramatically since the Industrial Revolution, in particular childhood cancer – proving that the rise is not simply due to people living longer.

They believe that a better understanding of the origins of cancer could lead to new treatments for the disease which claims more than 150,000 lives a year in the UK alone.

Michael Zimmerman, a visiting professor at Manchester University, said: 'In an ancient society lacking surgical intervention, evidence of cancer should remain in all cases.

'The virtual absence of malignancies in mummies must be interpreted as indicating their rarity in antiquity, indicating that cancer-causing factors are limited to societies affected by modern industrialisation.'

To trace cancer's roots, Professor Zimmerman and colleague Rosalie David analysed possible references to the disease in classical literature and scrutinised signs in the fossil record and in mummified bodies.

Despite slivers of tissue from hundreds of Egyptian mummies being rehydrated and placed under the microscope, only one case of cancer has been confirmed.

This is despite experiments showing that tumours should be even better preserved by mummification than healthy tissues.

Dismissing the argument that the ancient Egyptians didn't live long enough to develop cancer, the researchers pointed out that other age-related disease such as hardening of the arteries and brittle bones died occur.

Fossil evidence of cancer is also sparse, with scientific literature providing a few dozen, mostly disputed, examples in animal fossil, the journal Nature Reviews Cancer reports.

Even the study of thousands of Neanderthal bones has provided only one example of a possible cancer.

Evidence of cancer in ancient Egyptian texts is also 'tenuous' with cancer-like problems more likely to have been caused by leprosy or even varicose veins.

The ancient Greeks were probably the first to define cancer as a specific disease and to distinguish between benign and malignant tumours.

But Manchester professors said it was unclear if this signalled a real rise in the disease, or just a greater medical knowledge.

The 17th century provides the first descriptions of operations for breast and other cancers.

And the first reports in scientific literature of distinctive tumours only occurred in the past 200 years or so, including scrotal cancer in chimney sweeps in 1775 and nasal cancer in snuff users in 1761.

Professor David, who presented the findings to Professor Mike Richards, the UK's cancer tsar and other oncologists at a conference earlier this year, said: 'In industrialised societies, cancer is second only to cardiovascular disease as a cause of death. But in ancient times, it was extremely rare.

'There is nothing in the natural environment that can cause cancer. So it has to be a man-made disease, down to pollution and changes to our diet and lifestyle.

'The important thing about our study is that it gives a historical perspective to this disease. We can make very clear statements on the cancer rates in societies because we have a full overview. We have looked at millennia, not one hundred years, and have masses of data.

'Yet again extensive ancient Egyptian data, along with other data from across the millennia, has given modern society a clear message – cancer is man-made and something that we can and should address.

Dr Rachel Thompson, of World Cancer Research Fund, said: 'This research makes for very interesting reading.

'About one in three people in the UK will get cancer so it is fairly commonplace in the modern world.

Scientists now say a healthy diet, regular physical activity and maintaining a healthy weight can prevent about a third of the most common cancers so perhaps our ancestors’ lifestyle reduced their risk from cancer.'

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.