INTEGRATIVE HEALTH EDUCATION – A monthly review of 50 medical journals
Volume 17 Number 9 September 2016
If you are old like me you see many changes, even in the most obdurate issues and people. Once of the changes I have seen is the understanding that Environmental factors impact our health. I became aware of the impact of pollution by reading reputable medical journals when I was in Medical School in the early 80’s. Back then, anyone who dared speak about pollution was labeled as a hippie. It was hard to be green back then.
Air pollution used to be one of those neglected environmental issues. Fortunately, everyone now embraces the need to breathe cleaner air. Change takes place when people are ready to accept it. Fighting to push the timeline usually results in an ulcer and/or a revolution. Sure, they will build you a statue after you die a premature death, but, chances are you won’t live to enjoy the notoriety. As I scale down my practice to serve those who truly appreciate my services I am reminded of the NIH’s statement that any innovation in medicine takes 17 years for doctors to accept. But, you will not have to wait 17 years for good studies to reach your neighborhood clinic if you read this newsletter on a regular basis.
Hugo Rodier, MD
Quantile Regression Analysis of the Distributional Effects of Air Pollution on Blood Pressure, Heart Rate Variability, Blood Lipids, and Biomarkers of Inflammation in Elderly American Men: The Normative Aging Study J. Environ Health Perspect; 2016DOI:10.1289/ehp.1510044
Residential Proximity to Major Roads, Exposure to Fine Particulate Matter, and Coronary Artery Calcium: The Framingham Heart Study
- Arterioscler Thromb Vasc Biol. 2016;36:1679
ANOTHER ISSUE READY FOR PRIME TIME: GUT FLORA IN GENERAL, THE BRAIN-GUT
CONNECTION IN PARTICULAR
Metabolism in mind: New insights into the ‘gut-brain axis’ spur commercial efforts to target it Journal of Nature Medicine 2016;22:697
DERMATOLOGISTS ARE SLOWLY REALIZING THAT SKIN PROBLEMS START IN AN IMBALANCE OF GUT FLORA (DYSBIOSIS) CAUSED BY BAD DIETS, EVEN SERIOUS PROBLEMS LIKE PSORIASIS…
Lifestyle intervention in psoriasis: a new avenue for treatment? Am J Clin Nutr 2016 104: 241
Long-term effects of weight reduction on the severity of psoriasis in a cohort derived from a randomized trial: a prospective observational follow-up study
Am J Clin Nutr 2016 104: 259
… AND, OF COURSE, ACNE AND ECZEMA
Synbiotics for Prevention and Treatment of Atopic DermatitisA Meta-analysis of Randomized Clinical Trials JAMA Pediatr. Published online January 25, 2016. oi:10.1001/jamapediatrics.2015.3943
Dialogue between skin microbiota and immunity Science 21 November 2014: Vol. 346 no. 6212 pp. 954-959
Antipruritic effects of the probiotic strain LKM512 in adults with atopic dermatitis Annals of Allergy, Asthma & Immunology, Pages 209–216.e7, August 2014
Acne vulgaris: a disease of western civilization
- Arch Derm 2002;138:1584
Diet Gains Legitimacy as Potential Factor in Acne J. Skin and Allergy news, May 2008, page 9. Report on Annual Hawaii Dermatology Seminar, Waikoloa
SPEAKING OF DERMATOLOGY…
USPSTF: United States Preventive Services Task Force: Not enough evidence to recommend total-body screenings for skin cancer
“The New York Times (7/26, St. Fleur, Subscription Publication) reports that yesterday, “the US Preventive Services Task Force [USPSTF] said…that there still isn’t enough evidence to recommend total-body screenings” for skin cancer “and declined to take a position on the practice.” The USPSTF “said that it could not determine – after reviewing thousands of research papers and studies from around the world – whether the benefits of screening outweighed the potential for harm if unnecessary or excessive procedures were performed.”
Modern Healthcare (7/26, Johnson, Subscription Publication) reports that “the guidelines uphold 2009 recommendations that found there was not enough evidence to assess the benefits or harms in conducting visual examinations to screen for skin cancer in patients at moderate risk.” However, “the report found there was little evidence to support the idea that routine screenings were harmful, such as an increase in the occurrence of misdiagnosis or overdiagnosis and overtreatment.”
The Washington Post (7/26, McGinley) reports that the statement, published in the Journal of the American Medical Association, “drew immediate pushback, with some physicians saying the outcome might encourage people to skip the awkward ritual of stripping down for an examination by their” physician “for melanoma and other skin cancers.”
In medical school I was told that supplementing vitamins was “expensive urine.” Nothing was said about the more expensive pharmaceutical urine; about 90% of the drugs we take are eliminated in the urine before they have an effect on our body… (Come to think of it, this is probably a good thing!) Each vitamin has been reviled before being accepted. The same is happening with vitamin D. BTW, it is a pro-hormone, not a vitamin.
Vitamin D status is associated with uteroplacental dysfunction indicated by pre-eclampsia and small-for-gestational-age birth in a large prospective pregnancy cohort in Ireland with low vitamin D status
Am J Clin Nutr 2016 104: 354
Vitamin D Receptor Activation Reduces Angiotensin-II–Induced Dissecting Abdominal Aortic Aneurysm in Apolipoprotein E–Knockout Mice
Arterioscler Thromb Vasc Biol. 2016;36:1587
Vitamin D Deficiency Accelerates Coronary Artery Disease Progression in Swine
Arterioscler Thromb Vasc Biol. 2016;36:1651
Serum 25-hydroxyvitamin D concentration is inversely associated with mucosal inflammation in patients with ulcerative colitis
Am J Clin Nutr 2016 104: 113
Calcium and 1,25-dihydroxyvitamin D3 modulate genes of immune and inflammatory pathways in the human colon: a human crossover trial
Am J Clin Nutr 2016 103: 1224
Vitamin D deficiency in Europe: pandemic?
Am J Clin Nutr 2016 103: 1033
WHENCE HEAR DISEASE?
A while back a Cardiologist called me telling me I should stop telling his patients that insulin resistance was driving their heart problems. First of all, patients have a right to see another doctor if they so choose. They don’t “belong” to any one doctor. Second, he was not keeping up with his own cutting edge literature. But, more and more cardiologists are beginning to accept the medical literature pointing to insulin resistance behind cholesterol problems that lead to arterial disease. It all begins with faulty lipid processing in Fatty Liver, a condition driven by insulin resistance.
Low Endogenous Secretory Receptor for Advanced Glycation End-Products Levels Are Associated With Inflammation and Carotid Atherosclerosis in Prediabetes JCEM 2016;101(4):1701-9
Impaired Insulin Suppression of VLDL-Triglyceride Kinetics in Nonalcoholic Fatty Liver Disease JCEM 2016;101(4), pp. 1637
Relationship of Insulin Resistance to Prevalence and Progression of Coronary Artery Calcification Beyond Metabolic Syndrome Components: Shiga Epidemiological Study of Subclinical Atherosclerosis J. Arterioscler Thromb Vasc Biol. 2016;36:1703
We saw the same reticence to accept Omega oils. Anyone who dared speak of their benefits was labeled a “snake oil” salesman. Omega Oils are now prescription drugs 10 times more expensive than the Omega Oils over the counter. Do you believe Big Pharma’s studies that their oils are better?
Studies show evidence of heart benefits from omega-3s
“TIME (7/18, Oaklander) examines the heart benefits of omega-3s in fish oil supplements, noting they are “the most popular natural product in America among U.S. adults,” eight percent of whom take them. Despite their popularity, the piece points out that experts’ research and conclusions about omega-3s’ purported heart benefits “have been surprisingly uneven.” However, a recent large study published in JAMA Internal Medicine led by researchers at Tufts University “added to the weight of evidence in favor of the fatty acids for heart health.” The study examined omega-3 levels in tissue and blood samples of 45,637 healthy people “to see if there was a connection to coronary heart disease.” While it did not find any link between heart attacks and omega-3s in general, it “did find that people who had diets rich in fish-derived omega-3s had a lower risk of fatal heart attacks.”
NUTRITION AND CANCER
Oncologists have begun to accept the fact that diets and environments play an important role in preventing and treating cancer, which is intimately connected to how cells handle ENERGY (Mitochondria.)
Mitochondria and Cancer Journal Molecular Cell Volume 61, Issue 5, p667–676, 3 March 2016
Apoptosis by dietary factors J. Carcinogenesis 2007;28:233. See quotations below
- “In spite of substantial progress in the development of anticancer therapies, the incidence of cancer is still increasing worldwide. Recently, chemoprevention by the use of naturally occurring dietary substances is considered as a practical approach to reduce the ever-increasing incidence of cancer.”
- “By making modifications in the diet, more than 2/3 of human cancers could be prevented…. Dietary chemopreventive compounds offer great potential in the fight against cancer by inhibiting the carcinogenesis process through the regulation of cell defensive and cell death machineries.”
- “Apoptosis, a form of programmed cell death, plays a fundamental role in the maintenance of tissues and organ systems by providing a controlled cell deletion to balanced cell proliferation. The last decade has witnessed an exponential increase in the number of studies investigating how different components of the diet interact at the molecular and cellular level to determine the fate of a cell. It is now apparent that many dietary chemopreventive agents with promise for human consumption can also preferentially inhibit the growth of tumor cells by targeting one or more signaling intermediates leading to induction of apoptosis.”
- “The two major pathways that initiate apoptosis are extrinsic (death receptor-mediated,) and intrinsic (mitochondrial mediated.) Mitogenic and stress responsive pathways are involved in the regulation of apoptotic signaling. Noteworthy is the crosstalk between some of these pathways.”
- Nutrients found to work in apoptosis:
ECGC IN Green tea
Beta carotenes Veggies
Luteolin Celery, green pepper, peppermint
Anthocyanins Pomegranate, wolfberry, plankton, algae
Delphidin Pigmented fruits, berries
Lupeol, sylimarin Mango, olive oil, herbs
Capsaicin Red pepper
Sulfur Onions garlic
NUTRITION AND DEPRESSION
Don’t get depressed when you see good studies ignored on the role of our diet on our moods. Truth always prevails, one funeral at a time. See August blog on Mental illness.
- Jacka FN, Cherbuin N, Anstey KJ, Sachdev P, Butterworth P. Western diet is associated with a smaller hippocampus: a longitudinal investigation. BMC Med. 2015;13:215.
- Sarris J, Logan AC, Akbaraly TN, et al; International Society for Nutritional Psychiatry Research. Nutritional medicine as mainstream in psychiatry. Lancet Psychiatry. 2015;2:271-274.
- Gangwisch JE, Hale L, Garcia L, et al. High glycemic index as a risk factor for depression: analyses from the Women’s Health Initiative. Am J Clin Nutr. 2015;102:454-463.
- Mastroiacovo D, Kwik-Uribe C, Grassi D, et al. Cocoa flavanol consumption improves cognitive function, blood pressure control, and metabolic profile in elderly subjects: the Cocoa, Cognition, and Aging (CoCoA) Study—a randomized controlled trial. Am J Clin Nutr. 2015;101:538-548.
- Agarwal U, Mishra S, Xu J, Levin S, Gonzales J, Barnard ND. A multicenter randomized controlled trial of a nutrition intervention program in a multiethnic adult population in the corporate setting reduces depression and anxiety and improves quality of life: the GEICO study. Am J Health Promot. 2015;29:245-254.
- Akkasheh G, Kashani-Poor Z, Tajabadi-Ebrahimi M, et al. Clinical and metabolic response to probiotic administration in patients with major depressive disorder: a randomized, double-blind, placebo-controlled trial. Nutrition. 2015 Sept 28. [Epub ahead
OMEGA OILS for the treatment of depression
- Sarris J, Murphy J, Mischoulon D, et al. Adjunctive nutraceuticals for depression: a systematic review and meta-analyses. Am J Psychiatry. 2016;173:575-587.
- Appleton KM, Sallis HM, Perry R, Ness AR, Churchill R. Omega-3 fatty acids for depression in adults. Cochrane Database Syst Rev. 2015;11:CD004692.
- Mocking RJ, Harmsen I, Assies J, Koeter MW, Ruhé HG, Schene AH. Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder. Transl Psychiatry. 2016;6:e756.
- Superko HR, Superko SM, Nasir K, Agatston A, Garrett BC. Omega-3 fatty acid blood levels: clinical significance and controversy. Circulation. 2013;128:2154-2161.
- Amminger GP, Schäfer MR, Papageorgiou K, et al. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry. 2010;67:146-154.
- Amminger GP, Schäfer MR, Schlögelhofer M, Klier CM, McGorry PD. Longer-term outcome in the prevention of psychotic disorders by the Vienna omega-3 study. Nat Commun. 2015;6:7934.
 Book Crossing the Quality Chasm, 2001, page 13