High Dose B Vitamins and Alzheimer's Disease

There are no medications at this point that can slow the decline from cognitive impairment to Alzheimer's disease. A new study published in the Proceedings of the National Academy of Sciences offers some hope in supplementation with B vitamins. 156 elderly people with mild cognitive impairment, and high serum homocysteine levels, were given a combination of vitamin B12 (500 mcg), B6 (20 mg), and folic acid or a placebo over a two year period. The 80 subjects receiving the B vitamins showed significantly less brain degeneration than the placebo group. These B vitamins lower homocysteine levels in the blood. High homocysteine has been associated with a number of conditions, including neurodegenerative conditions. My recommendation would be to use folic acid in the form of 5-methyltetrahydrofolate, a better absorbed form of folic acid, especially in individuals with genetically impaired enzyme function. 

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Fish oil studies

The May 9, 2013 issue of the New England Journal of Medicine published a large Italian study that concluded that fish oil did not prevent cardiovascular disease or death from cardiovascular disease. The subjects in this study were given 1,000 mg of ethyl ester omega-3 fatty acids. The preferred form that the body recognizes as natural is the triglyceride form. So right here there are some issues. There also seemed to be more benefit from fish oil in women, although the researchers downplayed that effect. Previous studies have shown a benefit of omega-3 fatty acids, so while this study has been strong points, I wouldn't quit taking fish oil. I also think it is foolish to have just one intervention and hope to prevent heart disease. Quitting smoking, eating a healthy, plant-based diet with lean protein and healthy fats, and exercising at least 150 minutes per week are as important as taking fish oil. Eating fish is also healthy, but more than twice per week is not recommended because of mercury contamination found in fish. 

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Omega 3 Fatty Acids and Mortality

A study published in the April 2, 2013 Annals of Internal Medicine, showed a positive association between higher levels of serum omega-3 fatty acids and reduced risk of death, primarily from heart disease. While there are several weaknesses in the study, such as only measuring the serum omega-3 at the beginning of the study, there are some interesting points. The authors found that DHA was more important than EPA, two of the most talked about omega-3 fatty acids, in preventing cardiovascular death. The take home message here is to not just supplement with EPA (there is now even an EPA-only prescription drug), but to use a balanced formula. I like to include DHA, EPA, as well as GLA. Together they have a powerful anti-inflammatory effect. 

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Fruits, Vegetables, and Mortality

A Swedish study published in the American Journal of Clinical Nutrition August 2013 found that eating fruits and vegetables are associated with living longer for both men and women. Consuming fewer than 5 servings of fruits and/or vegetables per day is associated with shorter survival and higher mortality rates. Those who never consumed fruit lived 19 months less than those who ate at least one fruit per day. On the vegetable side, those who consumed 3 vegetables per day lived 32 months longer than those who never consumed vegetables. 

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High Intensity Exercise and Overweight Men

The International Journal of Obesity published a study in June 2013 that looked at the effect that various intensities of exercise have on appetite in overweight sedentary men. Continuous moderate intensity exercise did not suppress appetite. However both high intensity intermittent exercise and very high intensity intermittent exercise suppressed appetite, even up to 38 hours later. They found that the overweight men tolerated the high intensity intermittent exercise very well. While most doctors would recommend that you start an exercise program more moderately, this shows that for weight loss, it is necessary to build up to high intensity intermittent exercise, such as interval training. 

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Breast Cancer and Fish

The July edition of the British Medical Journal has a large meta-analysis looking at fish, fish oil consumption and the risk of breast cancer. All in all the examined data covering 20,905 cases of breast cancer and 883,585 participants. Their conclusion was that a higher consumption of omega-3 fatty acids (found in fish and fish oil) was associated with a lower risk of breast cancer. They found this to be true in both studies that looked at dietary consumption and in studies that looked at omega-3 blood levels. Because so much fish is contaminated, it is a good idea to limit one's fish intake to twice a week and then supplement with a high quality fish oil that mimics the natural form of fish oil (not the prescription fish oil). 

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Fruits, Vegetables, and Bladder Cancer in Women

The July 1, 2013 issue of the Journal of Nutrition has a study that found a higher intake of fruits and vegetables resulted in a lower incidence of bladder cancer in women. Fruits and vegetables contain many vitamins and phytonutrients that may prevent turning on certain genes that promote cancer, as well as decrease overall inflammation. This association was not found in men, although eating fruits and vegetables is healthy for them as well. 

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Surgery and Meniscal Tears

The standard treatment for meniscal tears, including horizontal degenerative tears of the medial meniscus, is arthroscopic surgery. Certainly if you see a surgeon, that's what they're trained to do. A study in 2009 found that surgery did not improve the outcome. Now a new study published online May 23 in The American Journal of Sports Medicine, confirmed that patients are no better off two years later with surgery or with physical therapy treatment. The physical therapy treatment was directed at strengthening the muscles around the knees and improving flexibility. The researchers said, "although traditionally medial meniscal tears have been treated by arthorscopic meiscectomy, there is no scientific eveidence to support its efficacy for degenerative changes, which include horizontal tears of  the medial meniscus."

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Can't Say Anything Nice About Processed Meat

The March 7, 2013 issue of BMC Medicine published a study that found an association between processed meat (bacon, sausage, ham) consumption and mortality. This was especially true for cardiovascular disease, but also for cancer. The authors concluded that eating processed meat once in a while is not a problem, but eating it everyday is definitely a problem. Processed meats seem to be more detrimental to one's health than even red meat.  Processed meats contain more additives that are part of the curing or smoking process. These could very well be the culprits in increasing the mortality rates. Studies like these, though, may be colored by the fact that many people who eat processed meats also don't exercise regularly, may smoke, and may have high stress lives. So these studies are food for thought, but one needs to look at the big picture. 

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Diabetes, Exercise, and Visceral Fat

An interesting study published online June 25 in the journal Radiology followed 12 diabetic patients with high triglyceride levels. They took initial blood work and abdominal magnetic resonance imaging (MRI) of all patients. The patients exercised 6 days a week burring approximately 500 calories per session. Aside from the regular exercise, the patients also went on a trekking expedition partway through the study. there were no changes to their diets. After 6 months the triglyceride levels had improved. More importantly, they had decreased visceral abdominal and paracardial fat volume, although epicardial fat did not change, nor did cardiac function. Visceral fat is see as quite inflammatory. Exercise alone reduced that, even without weight loss. Exercise reduces one's inflammatory burden. 

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Fish, Fish Oil, and Breast Cancer

A meta-analysis published online June 27 in the BMJ, found that a higher consumption of omega-3 fatty acids was associated with a 14% lower risk for breast cancer compared to those who ate the lowest amount of omega-3 fatty acids. This study was conducted in Asia, Europe, and the United States. They looked at both the amount of omega-3 fatty acids consumed, whether it be from fatty fish or from supplements, and blood levels of omega-3 fatty acids and found the association to hold true in both. Interestingly, in the American and European populations there was no risk reduction in breast cancer with higher fish consumption, whereas in Asian populations higher fish consumption was associated with a lower risk for breast cancer. They speculate that (1) in Asia more fish is eaten, and (2) American and European fish are more contaminated with pesticides. Westerners are often getting their omega-3 fatty acids from supplements, of which the high quality ones are screened for any kind of contamination. The protective effect was seen with about 100 mg of omega-3 fatty acids per day or two oily fish meals per week. They found consistency of consumption to be important. 

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Calcium Revisited

A study published online May 23 in the Journal of Clinical Endocrinology and Metabolism  examined data from 9033 community-dwelling men and women participating in the Canadian Multicenter Osteoporosis Study. They found that in women a total calcium intake of about 1,000 mg/day was associated with lower all-cause mortality. It didn't matter whether the calcium came from food or supplements. In men this association was not found. The study may have been underpowered and therefore not found an association with men. This study is in contrast to some recent studies that found calcium associated with higher mortality, although again, mainly in men. I feel that it is safe to recommend women, especially those at risk for osteoporosis, take calcium/magnesium supplements with vitamin D3 and K2. If they are consuming a varied diet containing calcium rich foods, then I generally recommend about 500-600 mg calcium in a mixed supplement. I vary the amount I recommend based on their diet and risk factors. 

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More Bad News About NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are advertised as the go-to medication for any kind of pain or inflammation. Inflammation is seen as unequivocally bad. In reality, the inflammatory response is a normal response to an injury or insult to any part of your body. It is the response that repairs the lining of your gut, among other tissues. The molecules that blocked by taking NSAIDs are important for the proper function of your heart. A meta-analysis published online in the May 30 edition of The Lancet found that all NSAIDs, with the exception of naprosyn, are bad for your heart. This includes ibuprofen and diclofenac and COX-2 inhibitors such as Celebrex. Naprosyn did not appear to have adverse effects on the heart, but is very hard on the gut. This study just drives home how alternatives to these medications need to be used. This can be the use of cold, heat, exercise, weight loss, or topical treatments. I like Curcumin and Boswellia preparations, as well as the homeopathic remedy, Traumeel. 

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Statins and Diabetes

Since 2012 the USFDA has mandated a labeling change to all statins except pravastatin, warning that statins can raise blood sugar and HbA1c levels (an indicator of long term elevated blood glucose levels). Recent research has either confirmed the risk, or found the increased risk insignificant. The study that found the risk significant found the atorvastatin, rosuvastatin, and simvastatin were associated with a 22%, an 18%, and a 10% increased risk of new-onset diabetes respectively. These were found at moderate and high doses in people starting at an average of age 73 and followed for 14 years. The bottom line is here that although statins may have some benefits, they are not without risk. Ironically, having diabetes puts one at a significant increased risk of a cardiovascular event--something one is trying to avoid by taking statins. 

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Both Aerobic and Resistance Training Optimal for Diabetics

People with type 2 diabetes benefit from both aerobic and resistance training. Doing both seems to be optimal. A re-examination of data from a HART-D trail published in JAMA  in 2010 showed that the beneficial effects of exercise can be traced to the increased level of fitness and the decreased waist circumference. Belly fat is inflammatory fat, and it is important to reduce this fat. Exercise is an excellent way to start. This study did not show that increased muscle mass is responsible for the beneficial effects of exercise, although it seems it should, as muscles become more sensitive to glucose with exercise. Either way, the bottom line is that it is very important for people with type 2 diabetes to exercise. This study showed beneficial effects at 140 minutes per week cumulative, or 110 minutes of aerobic and 30 minutes of resistance exercise. This study was published in May 2013 in Diabetes Care. 

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Don't forget Iodine

Before iodized salt, it was not unusual for people not living near an ocean to develop a goiter. This was due to a diet deficient in iodine. Pregnant women who don't get enough iodine can have a child with a lower IQ, a recent paper published in Lancet (May 22, 2013) points out. We know that extreme iodine deficiency with hypothyroidism can result in a child with cretinism. The Lancet article points out how many women are mildly iodine deficient now. In England salt is not iodized, and not all salt is iodized here. Milk can be a good source of iodine, but organic milk has less iodine. Why, I don't know. It is important for pregnant women to take prenatal vitamins, as they all include iodine. Also consuming seafood can be helpful, but only in limited quantities, as so much seafood is contaminated with mercury. 

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Korean Ginseng Berry Helps Erectile Dysfunction

A study published online found that an extract of standardized Korean ginseng berry, 350 mg extract per tablet, improved all domains of sexual function in men with erectile dysfunction. There were no changes in blood chemistry and no side effects in this study. Korean ginseng has few reported adverse effects, but those include headache, insomnia, gastric problems, and constipation. It is important to note that this study used Korean, not American or Siberian ginseng. It also used the berry. A quick scan online did not show a specific product that can be bought online that meets the criteria of this study. However, that doesn't mean that someone is going to start marketing this soon!


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Diets High in Fiber May Prevent Stroke

A study published in the March 28 issue of Stroke found that diets high in fiber reduce the risk of stroke by up to 7%. We already knew that fiber-rich diets reduce blood pressure and low-density cholesterol, both of which play a role in stroke. So it comes as no surprise that diets rich in fiber would also reduce the risk of stroke. The researchers analyzed 8 relevant cohort studies from the United States, Europe, Australia, and Japan published between 1990 and 2013, comprising over 200,000 individuals. The follow-up ranged from 8 to 19 years. They were unable to assess soluble vs. insoluble fiber. What is also difficult to assess is it the fiber alone that is making the difference? or is it that fiber comes with fruits and vegetables, sources rich in phytonutrients that improve the health of the blood vessels? I think that eating a diet very rich in whole and fresh fruits and vegetables will automatically be rich in fiber as well as in phytonutrients. Diets with processed foods are low in both fiber and phytonutrients. 

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Fitness Can Protect Against Some Cancers

Findings presented at the 2013 annual meeting of the American Society of Clinical Oncology by Dr. Lakoski showed that in men, the highest levels of cardiorespiratory fitness decreases the risk of developing lung cancer (by 68%) and colon cancer (by 38%) in men. No effect on prostate cancer was noted. The study was done on 17,049 men (mean age 50 years) who had been assessed once at the Cooper Institute in Dallas. They were then followed for 20-24 years. Even if men weren't obese, if they weren't fit, their risk of getting cancer, and then dying of it was higher than in the fittest men. 

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Walnuts and Diabetes

Previous research has shown an association between walnut consumption and lowering the risk for cardiovascular disease. A new study published in the April 2013 edition of the Journal of Nutrition found that consuming walnuts may also help protect women against diabetes. The researchers used data from the very large Nurses Health Study. The benefits from walnuts can be seen in those who ate walnuts two to three times a week. The risk in those of developing type 2 diabetes was 24% lower. 

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Bread and Berries

More recent studies are looking at the effects of various combinations of food, as that's how food is consumed in the real world. This Finnish study looked at combinations of berries with white wheat bread or rye bread. When berries were combined with either bread there was a significant improvement in the bread's glycemic profile, or it's ability to increase blood sugar and elicit a high insulin response. We don't want high blood sugar or a high insulin response. The effect was more pronounced with the white wheat bread, which raises blood sugar more than rye bread to begin with. This study shows that combining food that is not so good for you with food that is very good for you can ameliorate some of the bad aspects of the food that is not so good for you!

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Fiber and Stroke

The March 28, 2013 issue of Stroke has a meta-analysis of eight prospective cohort studies from around the world looking at fiber intake and risk for stroke. They found that for each additional 7 grams of daily dietary fiber consumed, the risk for hemorrhagic and ischemic stroke combined was reduced by 7%. This is a great reason to have a diet high in fiber. Is there a medication that could do this?

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Mindful Meditation and Stress

The body responds in a variety of ways to chronic stress. One phase of adapting to chronic stress is marked by having higher levels of the hormone cortisol. Chronically high levels of cortisol have numerous unwanted effects: fat accumulation around the waist, depressed immune function, lower bone density, lack of libido, and many others. A study conducted by the Shamatha Project at the University of California, Davis measured mindfulness in participants using a questionnaire before and after a three month long meditation retreat. They also measured salivary cortisol before and after the retreat. Overall mindfulness scores improved after the three month retreat. Cortisol levels dropped in those who had high levels, but not in those with normal levels. You wouldn't want cortisol to drop below normal, as that is a problem as well. This study shows a nice correlation between mindfulness, mindfulness meditation, and the hypothalamic-pituitary-adrenal system, which is involved in cortisol production. Intuitively it's not surprising that after a 3 month meditation retreat that there would be some positive changes both psychologically and physiologically. 

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Olive Oil and the Brain

We've known for quite some time now that olive oil, an important component of the Mediterranean diet, has been associated with a lower risk of cardiovascular disease. Now a new study has found that olive oil may play a role in preventing Alzheimer's disease. A study published in the February 2013 edition of ACS Chemistry and Neuroscience found that extra-virgin olive oil may enhance the clearance on beta-amyloid, a protein found in excess in the brains of those with Alzheimer's disease, from the brain. These are early studies, but once again show the importance of diet in preventing chronic illness. 

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Ore Good News on Cocoa

A study published in the March 2013 edition of Molecular Nutrition and Food Research studied liver cells exposed to cocoa compounds. They found that the liver cell's insulin pathways and receptors improved when exposed to the cocoa compounds. It is a big jump to say that diabetics should have chocolate, since most chocolate also has a lot of sugar. However including cocoa itself in the diet is not a bad idea. I like to mix plain yogurt with unsweetened cocoa and cinnamon, along with some fresh fruit as a snack. You could also add in nuts with that if you'd like. 

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Type 2 Diabetes and Bedtime

An interesting study published May 1, 2013 online in Diabetes Care found that obese people with type 2 diabetes were better able to control their diabetes if they went to bed earlier and rose earlier, as well as if they ate a smaller dinner. These two factors were independent of each other. Going to bed later and getting up later creates a misalignment with the body's internal clock. Apparently this also affects the body's ability to control sugar levels. How would going to bed earlier and rising earlier compare to the current diabetes medications? How about adding in a healthful, low glycemic diet, and exercise? How would that whole program compare with medication?

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Aerobic Fitness in the Elderly

A study presented at the 2013 American Society of Hypertension 2013 Scientific Sessions in San Francisco found that men 70-93 years of age reduced their risk of all-cause mortality by 15% for those with moderate levels of aerobic fitness and by a whopping 37% for those with a high level of aerobic fitness. You can't find that in a pill! And look at those age groups. Fitness is not just for the young. Other studies are finding that being fit in midlife confers a benefit later in life of fewer heart attacks. There doesn't seem to be a big downside to exercising. 

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Breast Cancer and Exercise

Numerous studies have been done before showing an association between breast cancer and exercise, with exercising reducing the risk for recurrence or for getting breast cancer. A study published in Cancer Epidemiology, Biomarkers, and Prevention, looked at the changes in hormone breakdown molecules and how they are affected by exercise. Estrogen breaks down in the body into three main metabolites, 2-OHE1, 4-OHE1, and 16-OHE1. Studies have shown that a low 2-OHE1 to 16-OHE1 ratio (or higher levels of 16-OHE1) increase the risk for breast cancer. This study showed that exercise favorably alters this ratio toward a higher 2-OHE1/16-OHE1 ratio. This study was done on pre-menopausal women. 

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Chiropractic Manipulative Therapy for Acute Low Back Pain

The most prestigious spine journal, Spine, published a study concluding that adding chiropractic manipulative therapy to standard medical care offered a significant advantage for decreasing pain and improving physical function when compared with only standard care for men and women (active duty military) between 18 and 35 years of age with acute low back pain. This study only had two arms, both receiving standard medical care, but one also received chiropractic adjustments. I would have been really curious to see what a chiropractic only arm would have shown and wonder why they didn't have such an arm. 

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Vegetarians and Heart Disease

A study published in the March 2013 edition of the American Journal of Clinical Nutrition found that consuming a vegetarian diet was associated with lower risk of ischemic heart disease. The study was done in Great Britain and included 44,561 subjects. 

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Fit at 50 and Mental Health

Earlier I posted a blurb about a longitudinal study looking at lifelong exercise and cognitive  function. Another study was done looking at the 20,000 participants in the Cooper Center Longitudinal Study. The researchers found that those who were most fit at age 50 were 36% less likely to get Alzheimer's disease and those who were least fit. They also found that  higher midlife fitness was associated with lower risk of all-cause dementia later in life. This study was published in the February 5 edition of the Annals of Internal Medicine. 

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Coffee, Green Tea, and Stroke

A Japanese study published online March 14 in Stroke found that drinking coffee and green tea resulted in a lower incidence of stroke. While this is good news, one needs to pay attention to the details. Those drinking green tea drank 2-4 cups of green tea per day. Those in the highest coffee drinking group drank 2-3 cups of coffee per day. An earlier Swedish study found an increased risk of cardiovascular disease in those who drank more than 7 cups of coffee a day. Like with most things, coffee is probably not harmful, and probably helpful if you drink one to two cups per day. Much above that and it is probably more harmful than helpful. Green tea is probably more effective in higher doses than at low doses. And as with everything, having a underlying diet rich in fruits and vegetables, along with healthy fats and good sources of protein are essential for good vascular health. 

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Lifelong Exercise and Mental Function

A study published in the March 13 edition of Psychological Medicine, found that lifelong exercise improved cognitive function at age 50. This study has some interesting aspects. One is that it is longitudinal: data was collected through face-to-face interviews at the ages of 11, 16, 33, 42, 46 and 50, thus reducing the risk of recall bias. Those who exercised weekly as a child and continued to do so as an adult performed better on tests of memory, learning, attention and reasoning at the age of 50 than those who exercised two to three times per month or less. There was also an association between the more intense the exercise, the better the person performed on cognitive tests. The greatest benefit emerged from participating in lifelong intensive exercise. 

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Calcium, Vitamin D, and Hip Fracture

The Women's Health Initiative was the largest randomized, double-blind, placebo-controlled clinical trial using 1000 mg of elemental calcium given as calcium carbonate along with 400 IU of vitamin D3. When the results were first published in 2006 the headlines read that calcium and vitamin D do not prevent hip fracture. That is because not everyone took the supplements. A new analysis looked at only those women who took the supplements and combined the results with the WHI prospective observational study, the researchers found that there was actually a 38% lower risk of hip fracture in those women who took the supplement at least 80% of the time. That is significant risk reduction. Interestingly, the researchers found no increase in cardiovascular disease, a concern in some other studies. A recent study found that the increased risk may just be in men, not women. Regardless, it isn't time to throw away your calcium supplements. I generally have women taking around 600 mg of calcium citrate along with at least 300 mg of magnesium and 1,000 IU of vitamin D3 along with vitamin K2. 

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Diabetes and Weight Training

Up until now most research on diabetes and exercise has focused on aerobic exercise or a combination of aerobic exercise and resistance training. A new Australian study looked at progressive resistance exercise and people with type 2 diabetes and found that the benefits were comparable to adding a second drug to the diabetic regimen. Diabetics are often started on metformin. When that fails to control blood sugar adequately, then a second drug is added in. Progressive resistance training would have the same effect. It is believed that the reason is due to the increase in muscle mass. Muscle requires glucose for energy. The more muscle you have, the more the glucose is used. Exercise also makes muscle cells more sensitive to insulin, which allows the glucose into the cells. The resistance training must get progressively more aggressive. Light weight-training does not have the same effect. While a combination of serious weight training and aerobic exercise is ideal, this study does allow that resistance training alone can be beneficial. This is useful for those people who cannot do aerobic exercise due to physical limitations. 

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MRI Studies and Low Back Pain

The March 25, edition of JAMA Internal Medicine had and article looking at the appropriateness of ordering an MRI of the lumbar spine for lower back pain. They found that in nearly half the cases the MRI ordered was not appropriate. There is a poor correlation between lower back pain and findings on MRI. The worst record was from family practice doctors. My theory is that they are the least equipped to do a thorough clinical examination of the lumbar spine and have few options for treatment, as compared to chiropractors for example. My experience has also been that often these exams are requested by the patients in the belief that with the great amount of pain they are experiencing, something should show up on MRI. Far more often than not, what shows up does not explain the pain. It is up to the clinician to educate the patient on the necessity of such a test. 

On the other hand, the investigators found that the vast majority of MRIs ordered for headaches were deemed appropriate. That does not mean they found something, only that the clinical suspicions warranted further imaging. 

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Melatonin and Migraine

Medscape reports on a study presented at the American Academy of Neurology 65th Annual Meeting that found that 3 mg of fast-acting (not time-released) melatonin per day (taken between 10 and 11 pm) was more effective than placebo in treating migraines and was as effective as 25 mg of amitriptyline. Melatonin has fewer and less serious side effects, with lower rates of daytime sleepiness and no weight gain. Melatonin is a hormone produced by the pineal gland. In supplement form it is effective in attenuating jet lag and helping normalize sleep patterns. Subjects in the placebo and in the amitriptyline  groups gained weight, while those in the melatonin group lost weight. 

Other studies have found feverfew, butterbur, magnesium, and riboflavin to help reduce the frequency of migraines. 

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A Type of Vitamin E and Cancer

The March 19, 2013 issue of Science Signaling had a an animal study of prostate cancer that showed that gamma-tocopherol inhibited an enzyme necessary for cancer cells to survive. Vitamin E consists of various tocopherol. Most vitamin E supplements contain mainly alpha-tocopherol, which does not have this anti-cancer effect. In nature gamma and delta tocopherol are abundant, along with alpha. Tocopherols are found in nuts and seeds. If you want to take them in supplement form, then look for "mixed tocopherols" on the label. 

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A New Market for Acid-Blocking Drugs

There has been a drug company motivated push to medicalize normal physiologic responses. One of the largest markets for adults has been the stomach acid problem, or the disease called gastroesophageal reflux, or GERD. This used to be called heartburn. The main causes include a weakness of the esophageal sphincter, perhaps due to ingestion of alcohol, chocolate, or peppermint, obesity and pregnancy, and a motility problem. Acid is necessary for digestion of proteins, absorption of nutrients, and killing of food-borne pathogens. So rather than deal with the causes of reflux, we've opted to stop the acid. The downstream effects of this can be hip fracture (due to poor calcium absorption), vitamin B12 deficiency (fatigue, neuropathy, anemia), small intestine bacterial overgrowth, and many other conditions. What I find particularly hideous is that a proton-pump inhibitor has now been reformulated for infants who spit-up or have reflux. This drug is approved on a study of 127 children aged 1-11 years. 5% or more (they don't say how many more) of the children had side effects including cough, vomiting, diarrhea, and abdominal pain. Rather than give these infants and children a drug, wouldn't it be safer to do a dietary intervention and/or manipulative intervention? 

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The Magic of Gastric Bypass

By now it is well known that obese people who undergo gastric bypass surgery miraculously are cured of their type 2 diabetes. A small study published online March 25, 2013 in Diabetes Care, showed that the improvement or disappearance of type 2 diabetes is due to people eating a lot less after surgery. The surgery has the same effect as an ultra-low calorie diet would have. Perhaps there are other mechanisms at work as well. However, there are down sides to gastric bypass surgery, including nutritional deficiencies. All of these things need to be taken into consideration when contemplating having such a surgery. 

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Fish Oil and Heart Health

There has been a lot of misinformation or poor information recently about fish oil and heart disease. An observational longitudinal study involving 5, 201 adults older than 65 and published in the April 2, 2013 issue of the Annals of Internal Medicine showed that higher blood levels of omega-3 polyunsaturated fatty acids (PUFA), as are found in fish oil, were correlated with a 27% lower risk of all-cause mortality. Most of the benefit was due to reduced risk of cardiovascular death. The rate of arrhythmic death fell by nearly one half. Other studies have shown that omega-3 PUFA intake benefits heart rate, blood pressure, strength of the heart muscle, electrical stability of the heart, as well as the health of the blood vessels. Those with the highest levels could expect to live about 2.2 years longer than those with the lowest levels. The authors also recommend formulas that have both DHA and EPA, and not just EPA alone. Another study found that the form of omega-3 PUFA found in prescription fish oil is inferior to the over-the-counter version used by many nutriceutical companies, such as Nordic Naturals. 

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Walking, Chemotherapy, and Colorectal Cancer

A study published in the January issue of the Journal of Clinical Oncology studied a cohort of 2,293 colorectal cancer patients at baseline and then 16 years later. The researchers found that those people who engaged in about 150 minutes of exercise a week after diagnosis resulted in cutting the risk of dying from colorectal cancer in half. These are better than the odds from chemotherapy. This is not to say don't undergo chemotherapy, but is saying that you should at least walk 30 minutes a day whether or not you undergo chemotherapy. On the other hand, spending  6 or more hours per day of leisure time sitting compared to fewer than 3 hours per day was associated with a higher all-cause mortality.

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Leisure Time Physical Activity

PLoS one published an interesting study looking at leisure time physical activity. The editor's summary explains it best: 

These findings suggest that participation in leisure time physical activity, even below the recommended level, is associated with a reduced risk of mortality compared to participation in no leisure time physical activity. This result may help convince currently inactive people that a modest physical activity program may have health benefits, even if it does not result in weight loss. The findings also suggest that physical activity at recommended levels or higher may increase longevity further, and that a lack of leisure time physical activity may markedly reduce life expectancy when combined with obesity. Although the accuracy and generalizability of these findings may be limited by certain aspects of the study's design (for example, some study participants may have overestimated their leisure time physical activity), these findings reinforce the public health message that both a physically active lifestyle and a normal body weight are important for increasing longevity.

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More Good News on Berries

A study published in the January 14, 2013 edition of Circulation based on data from the Nurses' Health Study 2 found that a diet rich in blueberries and strawberries, as well as a diet rich in anthocyanins both reduce the risk for myocardial infarction. Strawberries and blueberries are high in anthocyanins, as are eggplant and other purple vegetables and fruits. While the data comes from food frequency questionnaires, and is controlled for all sorts of factors, it is still difficult to quantify the effects. Most of the women consuming berries also took better care of themselves overall. A good diet consists of a variety of fruits and vegetables. One rule of thumb is to try and consume all the colors of the rainbow daily. Eating berries at breakfast already gives you blue and red!

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Potassium and Bone Health

A Swiss study published in the October 5, 2012 edition of The Journal of Clinical Endocrinology & Metabolism concluded that including potassium citrate supplementation in the diet can increase bone density in non-osteoporotic individuals. The reasoning behind this supplementation is the reduce the body's acidic environment that is created by a diet high in meat and grains. While the article doesn't say this, a diet high in fruits and vegetables is also high in potassium, which could be an alternative to supplementation. It is certainly something to keep in mind in addition to calcium (at lower doses than previously recommended), vitamin D3, and vitamin K2. 

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Vitamin D and Old People

Two studies published in the Journals of Gerontology Series A: Biological Sciences and Medical Sciences found a correlation between low levels of vitamin D and dementias and/or Alzheimer's in older women. Vitamin D can be gotten from sunshine, oily fish, and supplements. The women may have had low vitamin D from not getting outside due to lack of mobility. Lack of mobility has also been shown to increase the risk for dementia. It becomes a chicken and egg question. While it wouldn't hurt to supplement an older person's diet with vitamin D, and highly likely would be beneficial, I'm not entirely convinced it alone would improve dementia. It would have to be part of a comprehensive program including both mental and physical exercise, along with a good diet. 

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Antibiotics and Acute Sinusitis

A study published in Evidence Based Medicine in 2012 that reviewed 4 meta-analyses found that antibiotics provide only the barest minimum of benefit over a placebo in acute sinusitis. However, unlike the placebo, antibiotics had more adverse events, such as diarrhea, which was reported in 30-74% of patients. Like my previous report on coughing and antibiotics, it might be time to rethink automatically giving antibiotics to patients with sinus infections. 

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Vitamin B6 for Bone Health

A Chinese study published in Osteoporosis International on December 13, 2012 found that women with the highest intake of vitamin B6 had the lowest incidence of hip fracture. The highest intake was 0.78-1.76 mg/1,000 kcal/day, or not that much. This amount would be found in 2-3 bananas/day, or 3-4 servings of meat/day, or 10 servings of milk or dark green leafy vegetables, or in a supplement. What the article did not say, but is important to remember, is that for B6 or pyridoxine to function well, the body must have adequate magnesium. Most Americans are deficient in magnesium. 

I posted another Chinese study on my professional page on Facebook (www.facebook.com/drjessicaseaton) that thin older men with higher carotenoid (fruits and vegetables, especially orange and yellow) had a lower risk of hip fracture. 

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Eggs and Risk of Coronary Heart Disease and Stroke

The British Medical Journal published a meta-analysis about egg consumption and cardiovascular disease risk. This is an issue because people with cardiovascular disease used to be told to avoid eggs because of the high cholesterol in eggs. This study found that one egg a day did not increase the risk for coronary heart disease or for stroke in non-diabetics. However, there was in increased risk in diabetics, for which the mechanism was not known. 

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Major Depression and Methylfolate

A study published in the December 2012 issue of the American Journal of Psychiatry reported good outcomes when L-methylfolate was added to selective serotonin reuptake inhibitors (SSRIs) in patients with major depressive disorder (MDD). This was a randomized placebo controlled study of 75 adults with MDD who were resistant to SSRIs alone. In this study they were continued on SSRIs and given either a placebo or 15 mg/day of L-methylfolate. The L-methylfolate group did better than the placebo group. L-methylfolate is a biologically available form of folic acid, a necessary B vitamin involved in countless reactions in the body. It is particularly important in reactions involving methyl groups, such as in biotransformation or detoxification cycles. While this study needs to be replicated, it would also be interesting to see how this population would do with an excellent diet and L-methylfolate supplementation...maybe throw in some fish oil and vitamin D as well. 

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Exercise and Mental Health

Most often the recommended amount of exercise is 150 minutes a week, or 30 minutes 5 times a week. Research published in the September 7, 2012 issue of Preventive Medicine looked at how much exercise is ideal for good mental health. The study included self-reported data on physical activity and mental health symptoms from 7674 adults from the 2007 US Health Information National Trends Survey (HINTS). The researchers concluded that the optimal amount of physical activity for improved mental health may be from 2.5 (150 minutes) to 7.5 hours of activity per week. Less than that or more than that did not result in a better mental health profile. The researchers speculated that more exercise than that might be coming at the expense of other activities, such as spending time with family or social activities. I think there is a fair amount of wiggle room here. It surely depends on whether the individual has a time-consuming job or not, is single or not, and a host of other factors. This is a good starting point, however. 

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Fish Oil, Glucosamine Sulfate, Chondroitin Sulfate and Inflammation

A study published online in the November 8 issue of the American Journal of Epidemiology found that glucosamine sulfate, chondroitin sulfate, and fish oil all reduce hs-CRP, a marker of inflammation associated with cardiovascular disease, cancer, and rheumatoid diseases. The researchers examined data from the 9947 participants in the National Health and Nutrition Examination Survey (NHANES). While the effects were seen in both men and women, the effects were stronger in women. In women, glucosamine sulfate reduced hs-CRP by 27%, and chondroitin sulfate reduced it by 33%. Fish oil reduced it by about 16%. In earlier research these supplements have been associated with a reduced risk of chronic diseases associated with inflammation. 

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Fiber and Breast Cancer

The results from the European Prospective Investigation into Cancer and Nutrition showed that a higher intake of fiber, particularly from vegetables, was associated with a small reduction in risk of breast cancer, especially the estrogen negative and progesterone negative types. There are not a lot of things that prevent these types of breast cancers, so every little bit helps. 

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The Limits of MRI in Sciatica

MRI or magnetic resonance imaging is a wonderful tool. With no radiation we can peer into the body and visualize not only bone, but also soft tissue, such as muscles and nerves. A Dutch study published in the March 14 issue of the New England Journal of Medicine cautions doctors, and patients, not to read too much into a positive MRI. Whether surgery or conservative care was performed for disc herniations, there was little to no correlation between MRI findings and outcomes. In my own clinical practice, I've often seen patients with sciatica get an MRI only to find that it does not explain their pain. I've also had patients with pretty gnarly looking MR images who were not experiencing any back pain or sciatica at that moment. Back pain and sciatica are often the result of many factors, the underlying anatomy as seen on MRI being just one factor. An MRI does not or should not replace taking a good history and doing a good examination. 

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Omega-3 Beneficial for Brain and Metabolism

A Swedish study published in the December issue of Nutrition Journal looked at the effects of supplementing with three grams of omega-3 polyunsaturated fatty acid (PUFA) fish oil or a placebo for 5 weeks. 40 participants between the ages of 51 and 72 were enrolled in the study with half given fish oil and the other half placebo. The fish oil contained 3,000 mg of omega-3 fats, of which 1500 mg were EPA and 1050 mg were DHA. After 5 weeks the supplementation was stopped for 5 weeks. Then the groups were switched. Cognitive function, such as working memory, improved in the fish oil group but not the placebo group. The omega-3 group also had lower systolic blood pressure and lower plasma inflammatory markers. Other studies have shown that the natural glycerol form of omega-3 oils, such as found in Nordic Naturals and Designs of Health products, are superior because the body recognizes them, as compared to the prescription form, such as Luvaza. 

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Effects of Different Types of Activity

An interesting research article published on PLoS ONE found that minimal intensity physical activity, such as standing and walking, for longer duration improves insulin action and plasma lipids more than shorter periods of moderate to vigorous exercise, such as cycling, in sedentary subjects when energy expenditure is comparable. What does this mean? If a sedentary person spends their day standing and walking, they will burn more calories, usually about 500 more, than when just sitting. Now, instead of walking and standing, that person does one hour of moderate to vigorous physical exercise burning about 500 calories, and then sits the remaining of the day. So either way the person is burning about 500 more calories over just sitting. The study found that walking and standing during the day resulted in better insulin sensitivity (a good thing) and a better lipid profile (such as cholesterol values) than if all of the calories are burned in a one hour session. These results lead to a reduced risk for diabetes and metabolic syndrome.

The best of both worlds would be one hour of moderate to vigorous physical exercise to improved cardiovascular fitness followed by spending the bulk of the day standing or walking, such as with a standing desk. 

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Physical Activity and Cognitive Health

A study published in the November 2012 issue of Stroke: Journal of the American Heart Association found that physical activity can protect against vascular dementia and cognitive impairment in non-disabled individuals ages 65-84 with some loss of brain white matter. For the purposes of this study, physical activity was considered moderate activity for 30 minutes 3 times a week. The people in this study were evaluated over a three year period of time. There is no downside to exercising as we age. 

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Gazpacho May Help to Lower Blood Pressure

A Spanish study published in Nutrition, Metabolism & Cardiovascular Diseases looked at the effect of gazpacho consumption on cardiovascular risk factors in nearly 4,000 people. They found that regularly consuming gazpacho soup lowered the risk for high blood pressure, or hypertension. This held true for both systolic and diastolic blood pressure.  Previous studies found a correlation between higher consumption of the individual ingredients: tomato, cucumber, garlic, and olive oil, and a reduced risk for hypertension.  Gazpacho lowered blood pressure in spite of its higher salt content.

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Diet and Heart Events

A study published last fall in Circulation looked at the diet of people with heart disease and/or diabetes who were already taking medications for their conditions. 31,546 men and women with an average age of 66.5 were given food frequency questionnaires and  followed for 56 months. Those whose diets were on the healthy end of the spectrum had a lower risk of recurrent cardiovascular events, such as cardiovascular death, congestive heart failure, or stroke. This study was significant because it showed that even if you're on medication, you can still benefit from a healthy diet. 

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Coughs Takes Longer To Clear Up Than You Think

We all expect our coughs to clear up in about a week after we've had a cold. Researchers reporting in the Annals of Family Medicine in January reviewed cough studies and said they found that coughs take about 3 weeks to clear up. At about 2 weeks post-cold many people visit their family practice doctor to get antibiotics. This only fuels antibiotic resistance and will not clear up a viral cough. Of course it is quite something else if after three weeks you still have fever and a cough that is not improving. You could have pneumonia. The researchers found that about 50% of patients diagnosed with an acute cough in 2006 were prescribed antibiotics, although most respiratory infections are viral. Bronchitis is generally a viral infection. 

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Processed Meat and Cancer Deaths

The March 7 online edition of BMC Medicine published one of the largest studies to look at processed meat consumption and mortality. The news was not good for those who enjoy bacon, sausage, and ham. There was a positive association between processed meat consumption and an increased risk of death from both cardiovascular causes and cancer. Over a 12 year period of time the risk of death was twice as high for those with high consumption compared to those with low consumption. The risk for cancer death was 43% higher and the risk for cardiovascular death was 70% higher in people eating more than 160 g/day of processed meats than in those eating 10.0-19.9 g/day. These data come from the European Prospective Investigation into Cancer and Nutrition (EPIC) study invovling 10 countries and almost half a million men and women. 

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Flaxseed and Blood Pressure

A study presented at the American Heart Association 2012 Scientific Session showed that over a 6 month period of time, people with hypertension and peripheral artery disease were able to lower their blood pressure significantly with 30 grams of flaxseed daily. The researchers were unable to determine which component of flaxseed was responsible for the  drop, since there are several candidates: alpha-linolenic acid, enterolignans, and fiber. Systolic pressure declined by 10-15mmHg and diastolic by 7 mmHg. 

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Diet and Heart Attacks

A study published in the December 2012 issue of Circulation found that eating a healthy diet results in fewer deaths from cardiovascular disease and strokes. This study used food frequency questionnaires to evaluate the diets of 31,546 patients, who had a mean age 66.5. The patients were taking drugs to treat their heart disease or diabetes already. Those who ate healthier and followed a more Mediterranean-type diet, high in fruits, nuts, olive oil, and vegetables, low in meat and saturated fats, had significant risk reductions for cardiovascular death, congestive heart failure, and stroke. 

Another study of similar design was just published in the New England Journal of Medicine and written about in the New York Times

:http://www.nytimes.com/2013/02/26/health/mediterranean-diet-can-cut-heart-disease-study-finds.html?smid=fb-share&_r=0

More and more we're seeing studies that are looking at the whole nutritional picture and not just singling out a single nutrient for study. This makes more sense for a lot of different reasons. 

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MRI and Sciatica

Magnetic Resonance Imaging (MRI) is a terrific way to see inside the body. It gives us a snapshot in time. The downside is that what we're seeing may not be the cause of the patient's problems. Early studies showed that about 40% of the population with no back pain or sciatica had herniated discs on MRI. Now a new study published in the March 14 issue of the New England Journal of Medicine found that MRI findings in patients with sciatica were not correlated with clinical outcomes whether or not they had surgery. After a successful round of conservative or surgical care, successful being the patient no longer has pain, did not necessarily mean that a herniated disc was no longer visible. The authors concluded that doctors and patients should not rely too much on MRI for their decision making. 

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Alzheimer's plaques and Vitamin D and DHA

A small pilot study conducted at UCLA and published in Journal of Alzheimer's Disease found that both vitamin D3 and the omega-3 fatty acid DHA may play an important role in eliminating amyloid plaques in the brain, a hallmark of Alzheimer's disease. Blood was drawn from patients with Alzheimer's disease and then allowed to incubate overnight in a solution containing either an active form of vitamin D3 or an active form of DHA. Both solutions increased the ability of macrophages, immune cells, to gobble up amyloid beta, and both solutions decreased cell death induced by amyloid beta. Each solution used a different pathway to achieve the same result. 

Vitamin D3, the "sunshine vitamin," and DHA, found primarily in fish oils, are important for health in general, so including it in one's daily supplementation is probably a good idea whether or not long-term human studies show a benefit in preventing Alzheimer's disease. Stick to the recommended doses. 

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Hypermobility or "Double Jointed"

In my clinical practice I often see people who are extremely flexible. As children they would have been known as "double-jointed." In my experience they tend to have a lot more muscle, tendon, ligament, and joint issues. Now findings published in Arthritis and Rheumatism, a journal of the American College of Rheumatology, indicate that children with hypermobile joints are twice as likely to develop pain at these joints. The children were evaluated at ages 14 and 18. It would be interesting to follow them well into adulthood and then old age and see if they end up with more osteoarthritis. 

My advice to people with hypermobile joints is to emphasize strength and core training to give the body more stability. 

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Flavonoids and Prostate Cancer

 An abstract presented in October at the 11th Annual American Association for Cancer Research International Conference on Frontiers in Cancer Prevention Research found that higher flavonoid consumption was associated with less aggressive prostate cancer. Flavonoids are found in fruits, vegetables, and beverages such as tea, coffee, wine, and fruit drinks. The men in this study got a lot of their flavonoids from orange and grapefruit juice. Dean Ornish has published work on diet, lifestyle, and prostate cancer as well. He was able to reverse prostate cancer using diet and lifestyle. 

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Legumes and Type 2 Diabetes

Research published online October 22, 2012 in the Archives of Internal Medicine found that people with type 2 diabetes who were eating a low glycemic index diet, benefited further by increasing their intake of legumes. A group eating more legumes was compared to a group eating more wheat fiber. The legume group lowered their hemoglobin A1c and systolic blood pressure more than the wheat fiber group. Type 2 diabetics benefit from dietary changes and exercise. 

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Healthy Mind and Healthy Bones

A study published in October through the American Society for Bone and Mineral Research found that people with a strong psychological sense of well-being had higher bone mineral density, particularly in the femoral neck. What is interesting, is that the researchers controlled for physical activity, age, gender, race, education, financial advantage, body weight, and smoking, yet still this association held up. Our sense of well-being affects the hormonal milieu in our body, which in turn can affect every system, apparently including the skeletal system. This is one more way the mind and body are not separate. 

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Optimism and Higher Levels of Antioxidants

A study published in the January 2013 issue of Psychosomatic Medicine found that optimistic people have higher levels of antioxidants in their blood. Carotenoids, a class of antioxidants, were anywhere from 3-13% higher, depending on age group, in optimistic people. Optimistic people tended to eat better and take better care of themselves overall. However, that alone did not explain all of the difference. Also, those with higher socioeconomic status tended to score high on optimism. What was interesting about this study is that rather than studying depressed people as is usually done, the researchers decided to study optimistic people and see how they are different. This was a cross-sectional study, so one can really only detect an association and not causation. 

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Rheumatoid Arthritis and Sunshine

The February 4, 2013 edition of the Annals of Rheumatic Disease has a study examining the effect of sunshine on the risk of getting the autoimmune disease rheumatoid arthritis RA). The researchers used data from the Nurses Health Study (NHS) and Nurses Health Study II (NHSII). Exposure to sunshine without sunscreen did result in a lower risk of getting RA. I found it interesting that the researchers were able to tease out that part of the reason was the increased levels of vitamin D, which has significant immune system effects. But that is not the whole story. They said part of the reason could be the sunshine or UVB exposure itself. Obviously people with very light skin don't have the option of exposure to sunshine without significantly increasing their risk for skin cancer. Small amounts of sun exposure, though, probably is protective for others. Of course, one can also take vitamin D as a supplement (take the D3 form). 

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Fitness in Midlife Lowers Dementia Risk

A study published in the February 5 issue of the Annals of Internal Medicine and using data from the Cooper Clinic Longitudinal Study at the Cooper INstitute (Dallas, TX), included 19,458 individuals who underwent standardized fitness testing in midlife (49.8 years), and in contrast to other studies using self-reported data, and who were then followed for an average of 25 years. Dementia was assessed from Medicare claims data. Participants with the highest level of fitness at midlife had a 36% reduction in risk of developing dementia from any cause during follow-up compared to those in the lowest fitness category. The authors commented that changes in the brain can occur up to 20 years prior to the onset of dementia, so the long follow-up in this study is important. They also pointed out that even if you're over 49, it is never too late to start a fitness program and decrease your odds of dementia. 

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Fish Oil and Strength Training in Older Women

We know that fish oil is good for your heart, blood vessels, preventing depression, neurological conditions, and for lowering triglycerides among other things. Now we can add to this list: improving strength gains in older women. A Brazilian study published in the February 2012 issue of the American Journal of Clinical Nutrition examined the effects of fish oil on 45 women around the age of 64 (+/- 1.4 years). The women were all started on a strength training program. Two groups of women were given fish oil (2000 mg/day) and the third was not. All started with about equal strength. However, after 90 days the fish oil supplemented group had significantly bigger gains in strength. 

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Coenzyme Q10 and Statins

Statins prevent the body from synthesizing cholesterol by blocking the HMG-CoA reductase enzyme—an enzyme also responsible for the synthesis of coenzyme Q10, also known as ubiquinone. Why do we care about this? CoQ10 is an essential component of our energy metabolism. Low levels of CoQ10 can lead to serious fatigue, poor heart function, and poor muscle metabolism. This is why everyone taking a statin needs to be on 100-200 mg of CoQ10 as well. A pilot study published in the December 5, 2012 issue of the Canadian Journal of physiology and Pharmacology found that giving patients who had statin-associated myopathy (muscle pain, stiffness, weakness) coenzyme Q10 decreased muscle pain, muscle cramps, and tiredness. 

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Losing Fitness over a Decade Doubles Risk of Death

A Finnish study presented in November 2012 at the American Heart Association 2012 Scientific Sessions showed that Finnish men who lost more than 15% of their cardiorespiratory fitness over a 10-year period fast a near doubling of their risk of acute myocardial infarction (heart attack) over the next decade and over twice the risk of dying of any cause. The men who were studies were between 42 and 60. During that period it would be quite easy to reduce fitness by 15% and one has to make a concerted effort to remain as fit. If you don't work at it, it will disappear far more quickly than in young people. 

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Diet and Colon Cancer

A study published online November 7, 2012 in the Journal of the National Cancer Institute found that in people with stage 3 colon cancer and whose BMI was over 25 a high glycemic load diet diet with high carbohydrate intake results in a significantly higher rate of recurrence of the cancer. High glycemic load meals cause larger spike in insulin levels, which have been associated with cancer. 

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Snack Food for Children

A study published online December 17, 2012 in Pediatrics found that children consumed fewer calories when served a healthy snack. A group of children were randomly assigned to one of four different groups while watching TV for 45 minutes: vegetables only, cheese only, potato chips only, or a combination snack of vegetables and cheese. The children were asked to evaluate their satiety (how full they were) before, during and after television viewing. Children who were offered vegetables consumed the fewest calories and those offered potato chips the most. The cheese and the combination group consumed about the same amount of calories: fewer than the potato chip group but more than the vegetable group. If you don't want your children to eat potato chips, don't keep them around!

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Fitness and Statins

The November 2012 issue of The Lancet had the results of a large study conducted over 10 years at the Veterans Affairs Medical Center in Washinton, D.C. The authors found that physical fitness boosted survival in patients on statins by up to 70%. The most fit participants with hyperlipidemia (high cholesterol) had a reduction in all-cause mortality of 60-70% compared to the least fit. Not only do those people taking statins who exercise benefit, but even those choosing not to take statins still had a 50% reduction in all-cause mortality if they exercised vigorously and regularly. Cholesterol is not the main player in cardiovascular disease. It only seems that way because there are pills available that can lower it. Ultimately you want to improve the health of your arteries and heart, not achieve some lab value. Exercise will help you maintain or achieve healthy arteries regardless of your cholesterol status. 

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Fat but Still Fit?

A study published online November 6 in PLoS Medicine pooled data from 6 prospective cohort studies and included 654,827 participants aged 21 to 90 years. Regardless of body mass index (BMI) those who exercised 75 minutes per week were likely to live 1.8 years longer. The more time spent brisk walking, running, swimming, cycling, or sweating in an aerobics class, they boost their life expectancy by 3.4 to 4.5 years. Interestingly, for sedentary people BMI made a larger difference with those at the higher end having the shortest lives. Within all BMI groups, exercising 150-299 minutes per week added 3.4 years to life expectancy, and 300-449 minutes per week added 4.2 years to life expectancy. On the other hand low levels of physical activity and a high BMI gave one the life expectancy of a smoker. Bottom line: exercise increases your  chances of living longer regardless of your body weight. Don't wait to lose weight before you exercise. Start now!

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NSAIDs and Intestinal Injury in Athletes

A study publsiehd in Medicine and Science in Sports and Exericse showed that ingesting ibuprofen before or during exercise has serious consequences for the intestines. During exercise there is less blood supply to the intestines. This makes sense, since you want the blood to be shunted to your muscles, your heart, and you lungs during exercise. Consuming ibuprofen during this period causes more damage to the gut than otherwise. The injury resulted in gut barrier dysfunction. In other words, when damaged, the intestines allow too much into the bloodstream that should really be kept out. This can have cause all sorts of sensitivity reactions from mild to severe. NSAIDs have also been known to cause ulceration, bleeding, perforation, and the formation of diaphragm-like strictures. Athletes are advised not to take ibuprofen before performing exercise. 

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Whole Grains and Prediabtes

A Swedish study published in the December 12 edition of the American Journal of Clinical Nutrition found that people who ate more than 59 grams of whole grains per day were 27% less likely to become prediabetic compared with people who at 30 grams less. 1/2 cup of brown rice is about 100 grams and is considered a whole grain, not a refined grain. this association was stronger in men than women. An interesting side note was that people with a genetic predisposition to diabetes did not have a reduced risk with whole grains. Many diets recommended for avoiding diabetes are very low in carbohydrates in general. What a study like this suggests to me, is that a low carbohydrate diet (with the carbs being consumed having a low glycemic index) is probably most suited to those with a genetic predisposition to diabetes. For others who are overweight and trying to avoid diabetes, a low glycemic load diet with at least 60 grams of whole grains per day, is probably the wiser choice. 

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An Apple a Day Can Lower Bad Cholesterol

Low density lipoprotein cholesterol (LDL) in and of itself is not bad, although it is often referred to as the "bad" cholesterol. It becomes "bad" if is oxidized or glycated or otherwise compromised and thus smaller and denser. If you have a lot of LDL but it is not oxidized, then you have less cardiovascular risk than someone with not as much LDL but much of it is oxidized. LDL can become oxidized through a poor diet, a diet rich in meats, pollutants, stress, and many other ways. Most physicians just check for LDL but not oxidized LDL or for particle size (small and dense being bad). New research shows that an apple a day can lower levels of oxidized LDL even more so than a supplement containing polyphenols. This study was funded by the apple industry, so we don't know how other fruits and vegetables would fare. It certainly wouldn't hurt to include organic apples in your diet on a regular basis when they're in season. 

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Diet is Important Even If You're on Medication

A large study with over 30,000 participants already suffering from cardiovascular disease and published in the journal Circulation showed that a good diet can improve outcomes. This large study was conducted in 12 different countries on people who were appropriately medicated for their condition. The researchers found that those who adhered more closely to a Mediterranean diet: high intake of fruits and vegetables, whole grains, nuts, and fish, low amounts of meat and eggs, reduced the relative risk of cardiovascular death by 35%, myocardial infarction by 14%, stroke by 19%, and congestive heart failure (CHF) by 28% compared to those eating the poorest diet. 

The bottom line is that it never hurts to eat right, even if you're on medication. The medication does not allow you to eat poorly. Some people think they can have a meal rich in butter and red meat because they're on statins anyway. This is not the case.

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Multivitamins and Cancer in Men

The October issue of the Journal of the American Medical Association had the results of a very large prospective randomized placebo-controlled study on the effects of multi-vitamins on men. The study was part of the the Physician's Health Study II, that included 14,641 male US physicians who were 50 years or older when the study began. The multi-vitamin that was used was Centrum Silver. At least they were all using the same multi-vitamin and were not relying on people simple stating in a questionnaire that they use a multi-vitamin. Centrum Silver is not the cadillac of multi-vitamins, so it would be interesting to see a comparison with a better multi-vitamin. But we know that's expensive and not likely to happen! The upshot of this aspect of the study was that those taking the multi-vitamin were less likely to get cancer. After 11 years there was an 8% reduction in total cancer. Prostate cancer was not affected at all, so if that is pulled out, there was a 12% reduction in cancer overall. Since this study was done on physicians who should know how to eat a good diet, the effect could be even stronger on groups of people who don't eat as well. 

Previous studies have shown mixed results with multi-vitamins. It is always important to know how the study was conducted to know if the results are at all meaningful. 

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Exercise and Parkinson's Disease

A prospective study with 67 Parkinson's Disease patients was published in the Archives of Neurology November 5, 2012. The patients, who all had gait and balance issues, were assigned to one of three supervised exercise groups 3 times per week for 3 months: (1) Higher-intensity treadmill for 30 minutes at 70-80% heart rate reserve, (2) Lower-intensity treadmill exercise (50 minutes at 40-50% heart rate reserve), and (3) Lower extremity stretching and strengthening (leg press, leg extension, leg curl). After 3 months they were evaluated by seeing how fat they could walk in 6 minutes compared to before the exercise intervention. Surprisingly, the group that did the best was group (2), the low intensity, 50 minute group. The researchers speculate that the longer duration probably had a beneficial effect. All three groups, however, did improve in the 6 minute walk, just not as dramatically. Only the stretch/resistance group improved in muscle strength. This study adds to a body of research showing that exercise is beneficial for people with Parkinson's Disease. 

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Psoriasis and Autoimmune Diseases

The November 2012 edition of the Journal of the American Academy of Dermatology found that people with psoriasis are 50% more likely to have another autoimmune disease, such as rheumatoid arthritis, multiple sclerosis, Hashimoto disease, Graves disease, systemic lupus erythematosis, Sjogren syndrome, Crohn's disease, and others. The current study also included two research letters. One stated that a chart review of 76 patients with psoriasis revealed 42% of them had a first degree relative with an autoimmune disease. The other research letter concluded that "the association among psoriasis and [celiac disease], and [inflammatory bowel disease] appears to be well described." Functional Medicine lends itself to treating autoimmune diseases by looking for triggers and mediators of these diseases that may have a genetic predisposition. Triggers can be food sensitivities, such as a gluten or a dairy intolerance, but is not limited to those. Other issues could be an impaired biotransformation system (colloquially known as "detox" system). 
I would recommend that anyone with an autoimmune disease look for a Functional Medicine doctor, as well as check out this website: http://www.terrywahls.com

Please visit my website at www.drjessicaseaton.com