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.[1] 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

  1. 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

  1. 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.”

 

EXPENSIVE URINE

                     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

                  Curcumin                    Turmeric

                  Genistein                     Soy

                  I3C                              Cruciferous

                  Sulpharanes                 Cruciferous

                  Beta carotenes Veggies

                  Resveratrol                  Grapes

                  Isothiocyanates            Cruciferous

                  Luteolin                       Celery, green pepper, peppermint

                  Lycopene                     Tomatoes

                  Anthocyanins              Pomegranate, wolfberry, plankton, algae

                  Delphidin                    Pigmented fruits, berries

                        Lupeol, sylimarin        Mango, olive oil, herbs

                        Gingerol                      Ginger

                        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.

 

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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

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OMEGA OILS for the treatment of depression

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.

 

[1] Book Crossing the Quality Chasm, 2001, page 13

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