ABSTRACTS

LEBANON, NEW HAMPSHIRE. Researchers at the Dartmouth Medical School warn that the use of sunlamps and sun beds is a potent risk factor for skin cancer. Their study involved 603 patients with basal cell carcinoma (BCC), 293 patients with squamous cell carcinoma (SCC), and 540 control subjects. Each participant was interviewed by the researchers to determine their sun sensitivity, sun bathing habits, and the use of artificial tanning devices. The researchers conclude that any use of a sunlamp or sun bed increases the risk of BCC by a factor of 2.5 and that of SCC by a factor of 1.5. These elevated risks are independent of age, sex, sun sensitivity, and extent of natural sun exposure. The use of artificial tanning devices at a young age was particularly detrimental with the risk of BCC increasing by 20 per cent and that of SCC by 10 per cent for each decade younger the patient was at the first use of the tanning device. It is particularly disturbing that high school girls are the most frequent users of tanning beds with over 50 per cent reporting having used one at least four times in the past 12 months.
Karagas, Margaret R., et al. Use of tanning devices and risk of basal cell and squamous cell skin cancers. Journal of the National Cancer Institute, Vol. 94, February 6, 2002, pp. 224-26 (brief communication)

TORONTO, CANADA. Many digestive problems such as bloating, abdominal distention or pain, heartburn and belching are caused by a lack of stomach acid (hypochlorhydria). An adequate output of stomach acid is required in order to prevent fungal and bacterial overgrowth in the small intestine (candidiasis and Helicobacter pylori) and to facilitate the flow of bile and pancreatic enzymes.
Dr. Jonathan Prousky of the Canadian College of Naturopathic Medicine believes that many cases of hypochlorhydria can be traced to a relative lack of vitamin B3 (niacin, niacinamide). Some people, it appears, have a much higher than normal need for vitamin B3 especially when under stress. If this need is not met then digestive problems arise. Dr. Prousky cites the cases of two patients with abdominal bloating and other digestion-related problems whose condition improved very significantly after starting to supplement with 1-3 grams/day of niacin (in divided doses). One of the patients also suffered from gastroesophageal reflux (GERD); his symptoms completely disappeared after beginning niacin supplementation.
Dr. Prousky suggests that patients who suffer the symptoms of low stomach acid production can markedly improve their condition by supplementing with 200-500 mg of niacinamide with every meal. For more severe cases betaine hydrochloride and 500-1000 mg of niacin per meal may be required. This regimen may also help to eradicate a Helicobacter pylori infection. NOTE: High doses of niacin should only be taken under the supervision of a physician.
Prousky, Jonathan E. Is vitamin B3 dependency a causal factor in the development of hypochlorhydria and achlorhydria? Journal of Orthomolecular Medicine, Vol. 16, No. 4, 4th quarter 2001, pp. 225-37 [74 references]

SEATTLE, WASHINGTON. Several studies have found an increased risk of breast cancer among postmenopausal women on hormone replacement therapy (HRT). Researchers at the Fred Hutchinson Cancer Research Center now confirm this connection. Their study involved 705 postmenopausal women who had been diagnosed with primary invasive breast cancer and 692 age-matched controls. Recent long- term users of HRT, whether estrogen alone or estrogen plus progestin, were found to have a 60-80 per cent increased risk of breast cancer. The risk increase was particularly high for lobular breast cancer. Women who had been on HRT for 57 months or more had a three-fold increased risk for this type of cancer while women who were currently on combination therapy (estrogen plus progestin) had a four-fold increase in the risk of lobular breast cancer.
The researchers also noted that women who had had two or more screening mammograms prior to their diagnosis had twice the incidence of breast cancer than did women who had never had a mammogram. Even having just one screening mammogram increased breast cancer risk by almost 60 per cent. This compares to a 71 per cent increased risk among women who had first-degree relatives with breast cancer.
Chen, Chi-Ling, et al. Hormone replacement therapy in relation to breast cancer. Journal of the American Medical Association, Vol. 287, February 13, 2002, pp. 734-41

ADELAIDE, AUSTRALIA. The optimum diet for type 2 diabetes patients has long been a subject of considerable controversy. Some researchers advocate a diet high in complex carbohydrates while others contend that a diet high in protein is superior.
Researchers at the Commonwealth Scientific and Industrial Research Organization have just released the results of a study, which shows that a high protein diet is superior to a high carbohydrate diet. The study involved 54 obese men and women with type 2 diabetes who were fed either a high protein (HP) or a low protein (LP) diet for eight weeks. The HP diet provided 30 per cent of energy from protein, 40 per cent from carbohydrates, and the remainder from fat. The LP diet provided 15 per cent of energy from protein and 60 per cent from carbohydrates. The fat portion consisted of 8 per cent saturated fatty acids, 12 per cent monounsaturated fatty acids, and 5 per cent polyunsaturated fatty acids. The diet was energy restricted (1600 kcal/day) for the first eight weeks and balanced for the following four weeks.
At the end of the trial, participants had lost an average of 5.2 kg (11 lbs). Women on the HP diet lost significantly more fat (5.3 versus 2.8 kg) than did women on the LP diet and the fat loss was particularly pronounced in the abdominal area. Both men and women experienced a 5.7 per cent (average) reduction in LDL ("bad") cholesterol on the HP diet as compared to only a 2.7 per cent reduction on the LP diet. Total cholesterol levels also declined significantly more in the HP group than in the LP group. Both groups also saw a significant drop in fasting and 2-hour insulin concentrations. The researchers conclude that the high protein diet is a valid choice for patients with type 2 diabetes and may actually reduce their risk of cardiovascular disease by 10 per cent.
Parker, Barbara, et al. Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Diabetes Care, Vol. 25, March 2002, pp. 425-30

LOS ANGELES, CALIFORNIA. The incidence of asthma among children in developed countries is increasing rapidly. The causes of this epidemic are not entirely clear, but the exposure to allergens and the increased emphasis on protection from early-life infections ("hygiene hypothesis") are thought to play a role. Researchers at the University of Southern California School of Medicine now report that frequent participation in team sports in areas of heavy ozone pollution is closely linked with an increased evidence of childhood asthma.
Their study involved 3535 asthma-free children from 12 southern California communities. Monitoring stations were set up in each community and the air concentration of ozone, nitrogen dioxide, and particulate matter were measured daily during the five-year study period. After five years, 265 of the children had developed asthma. The researchers found that children who lived in communities heavily polluted with ozone were 3.3 times more likely to develop asthma if they regularly participated in three or more team sports than if they played no sports or lived in communities with low ozone levels. They conclude that the development of asthma is linked to heavy exercise combined with exposure to high levels of ozone. Nitrogen dioxide levels and the level of particulate matter were not related to asthma incidence.
McConnell, Rob, et al. Asthma in exercising children exposed to ozone: a cohort study. The Lancet, Vol. 359, February 2, 2002, pp. 386-91

NEWCASTLE, UNITED KINGDOM. Acute otitis media is an inflammation of the middle ear often involving the exudation of pus from a pierced or broken eardrum. It is widely believed that otitis media is caused by a viral or bacterial infection. Researchers at the University of Newcastle now provide convincing evidence that otitis media with effusion (glue ear) may actually be caused, or at least exacerbated, by acid reflux from the stomach. They point out that reflux of gastric juice to the middle ear is quite possible in resting (supine) children because of the angle and immaturity of the eustachian tube in infants and children. The gastric juice would cause inflammation in the middle ear and provide an ideal breeding ground for bacteria.
To test their hypothesis the Newcastle researchers analyzed pus from 54 children aged 2 to 8 years who were suffering from otitis media. They found that 83 per cent of them had high concentrations of pepsin (a major component of gastric juice) in the pus. The average concentration was about 1000 times higher than the concentration found in blood serum. The researchers conclude that the pepsin came from reflux of gastric juice and suggest that glue ear could be prevented by antireflux treatment.
Tasker, Andrea, et al. Reflux of gastric juice and glue ear in children. The Lancet, Vol. 359, February 9, 2002, p. 493 (research letter)

BOSTON, MASSACHUSETTS. A high blood level of the sulfur-containing amino acid homocysteine is a potent risk factor for both stroke and cardiovascular disease. It has been estimated that exceeding normal levels (5-15 micromol/L) by as little as 5 micromol/L increases the risk of coronary artery disease by 60 per cent in men and 80 per cent in women.
Researchers at the Boston University School of Medicine now provide convincing evidence that high homocysteine levels are an equally potent risk factor for Alzheimer's disease. Their study involved 1092 men and women with an average age of 76 years who were deemed to be free of dementia when examined (as part of the Framingham Study) between 1986 and 1990. After an average eight years of follow-up 111 of the study participants had developed dementia of which 83 were given a diagnosis of Alzheimer's disease. The researchers found that people with a blood plasma homocysteine level above 14 micromol/L had nearly twice the risk of developing Alzheimer's disease as did people with lower levels. They also determined that a 5 micromol/L increase in homocysteine level corresponds to a 40 per cent increased risk of Alzheimer's disease.
Dr. Joseph Loscalzo, MD, in commenting on the findings, suggests that it may be possible to substantially reduce one's risk of Alzheimer's disease by supplementing with folic acid, vitamin B6 and vitamin B12. Such supplementation has, in numerous clinical trials, been found highly effective in lowering homocysteine levels.
Seshadri, Sudha, et al. Plasma homocysteine as a risk factor for dementia and Alzheimer's disease. New England Journal of Medicine, Vol. 346, February 14, 2002, pp. 476-83 [56 references]
Loscalzo, Joseph. Homocysteine and dementias. New England Journal of Medicine, Vol. 346, February 14, 2002, pp. 466-68 (perspective)

BETHESDA, MARYLAND. Researchers at the National Institutes of Health have confirmed that men who have undergone vasectomy are no more likely to develop atherosclerosis or cardiovascular disease than are men who have not had this surgery. Their study involved 3957 white men 45 to 64 years of age who were free of coronary heart disease when examined between 1987 and 1989. About 20 per cent of the men (1050) had undergone a vasectomy at an average age of 37 years. The men were followed for a nine-year period during which time 518 cases of cardiovascular disease (heart attack, stroke or coronary heart disease) were diagnosed. The researchers found no evidence that men who had undergone vasectomy had a greater risk of cardiovascular disease than did men who had not. This held true even in cases where the vasectomy had been performed 20 years earlier. The researchers also found no evidence of a greater incidence of inflammation, blood coagulation problems, peripheral arterial disease, i.e. intermittent claudication, or atherosclerosis or hardened arteries among men who had had a vasectomy.
Coady, Sean A., et al. Vasectomy, inflammation, atherosclerosis and long-term follow-up for cardiovascular diseases: no associations in the Atherosclerosis Risk in Communities study. Journal of Urology, Vol. 167, January 2002, pp. 204-07

SAN DIEGO, CALIFORNIA. It is often assumed that insomnia and difficulties in sleeping are bad for your health. Researchers at the University of California now challenge this belief. Their study involved more than 1.1 million men and women between the ages of 30 and 102 years. The participants were asked about their sleeping habits and frequency of insomnia at the beginning of the study period. Six years later 9.4 per cent of the men and 5.1 per cent of the women had died. The most common causes of death were cardiovascular disease and stroke, which accounted for 43 per cent of all deaths among women and 49 per cent among men. Cancer accounted for 36 per cent of deaths among women and 29 per cent among men. The researchers found that people who slept an average of 7 hours every night had the best survival rate. People who slept more than 8.5 hours or less than 4 hours per night had a 15 per cent increase in overall mortality as compared to those who slept 7 hours every night. People who regularly slept 10 hours or more had a 30-40 per cent higher mortality than did 7-hour night people.
There was no excess mortality among people with insomnia, but those who regularly used sleeping pills had a 10-25 per cent higher mortality than non-users. The researchers offer no rational explanation for their findings, but conclude that people who sleep between 7 and 7.5 hours a night tend to live longer.
Kripke, Daniel F., et al. Mortality associated with sleep duration and insomnia. Archives of General Psychiatry, Vol. 59, February 2002, pp. 131-36 [48 references]
Buysse, Daniel J. Can sleep be bad for you? Can insomnia be good? Archives of General Psychiatry, Vol. 59, February 2002, pp. 137-38 (commentary)

BOSTON, MASSACHUSETTS. CT (CAT) scanning often involves the prior injection of a contrast agent (drug) in order to get sharper "pictures". It is known that contrast agents can cause acute renal failure, particularly in patients who already have impaired kidney function (renal insufficiency). Cardiac catheterization (angiocardiography), a diagnostic procedure where a catheter is threaded through a major vein into the heart, also makes use of contrast agents in order to obtain an enhanced image of the heart. This procedure uses larger amounts of contrast agents than does CT scanning and therefore involves a substantially greater risk of acute or permanent kidney damage.
Researchers at Tufts University School of Medicine now report that kidney damage (nephropathy) after cardiac catheterization can largely be avoided if patients are given n-acetylcysteine (NAC) prior to and after the procedure. NAC, a precursor of the antioxidant glutathione, is available in health food stores. The double-blind, placebo-controlled clinical trial involved 54 patients with stable chronic renal insufficiency who were scheduled for cardiac catheterization. The patients were randomized to receive four doses of either 600 mg NAC diluted in 30 mg of ginger ale or 3 ml of saline solution diluted in ginger ale (placebo). One dose was given before and three after catheterization. Acute kidney damage (nephropathy), defined as a 25 per cent or greater increase in creatinine was observed in 8 per cent of the patients who had been given NAC and in 45 per cent of patients who had been given a placebo. The researchers conclude that NAC should routinely be given to patients with chronic renal insufficiency prior to cardiac catheterization in order to prevent further kidney damage during the procedure.
Diaz-Sandoval, Larry J., et al. Acetylcysteine to prevent angiography-related renal tissue injury (The APART Trial), American Journal of Cardiology, Vol. 89, February 1, 2002, pp. 356-58

BUENOS AIRES, ARGENTINA. It is a widely held popular belief that the weather can affect the level of pain felt by patients with rheumatic diseases such as rheumatoid arthritis, osteoarthritis and fibromyalgia. It is also well known that some patients find relief by moving to a warm, dry climate. Medical science, however, has not accepted the idea that there could be a connection between rheumatic pain and weather conditions. This maybe about to change.
A group of Argentine medical researchers have just completed a fascinating study designed to investigate the connection. Their study was carried out in the city of Cordoba, which has a mild Mediterranean-type climate where differences between indoor and outdoor conditions are small. A total of 151 patients took part. Eighty-two had rheumatoid arthritis, 52 had osteoarthritis, and 17 had fibromyalgia; the trial also included 32 controls free of rheumatic disease. All study participants kept a daily log concerning their pain, when it was worst, what joints were affected, etc. from January 1 to December 31, 1998. They were not told what purpose the daily log served. Meanwhile the researchers received four weather readings a day of temperature, barometric pressure, and relative humidity in the area inhabited by the study group. A detailed statistical analysis of the collected data revealed some highly significant correlations (p< 0.001). Pain severity in rheumatoid arthritis patients was found to increase with lower temperature, higher atmospheric pressure, and higher humidity – so a cold, rainy day is definitely not a good one for these patients. Osteoarthritis patients felt more pain when the temperature was low and the humidity high while fibromyalgia patients fared worse if the temperature was low and the barometric pressure high. There was no correlation between weather conditions and pain in the controls. The researchers also found no correlation between climate variables and pain, except for humidity when measured five days before and five days after the days of painful episodes. They conclude from this that it is not overall climate, but rather climate changes that affect patients with rheumatic disorders.
Strusberg, Ingrid, et al. Influence of weather conditions on rheumatic pain. Journal of Rheumatology, Vol. 29, February 2002, pp. 335-58

SHEFFIELD, UNITED KINGDOM. It is estimated that as many as 15 per cent of all people in Western societies suffer from irritable bowel syndrome (IBS). IBS is characterized by abdominal pain, altered bowel movements (constipation or diarrhea) and abdominal bloating, fullness or swelling. Researchers at the University of Sheffield Medical School have found that the prevalence of celiac disease (a condition in which the small intestine fails to digest and absorb food) is seven times higher among IBS patients than among controls. Their study involved 300 patients newly diagnosed with IBS and 300 healthy controls. They found that about 75 per cent of the patients had been correctly diagnosed as having IBS; the remainder had either celiac disease (6 per cent) or some other organic abnormality such as diverticulosis (13 per cent). The researchers recommend that IBS patients be routinely checked for the presence of celiac disease.
Sanders, David S, et al. Association of adult celiac disease with irritable bowel syndrome: a case-control study in patients fulfilling ROME II criteria referred to secondary care. The Lancet, Vol. 358, November 3, 2001, pp. 1504-08

MILANO, ITALY. Blood clots in the legs (deep-vein thrombosis) are a major cause of pulmonary embolism – a condition in which a blood clot lodges in the pulmonary artery. Pulmonary embolism is a very serious disorder that kills about 200,000 American every year. One of the main causes of vein thrombosis is immobilization, that is, lying or sitting still for extended periods of time. The condition is often found in hospitalized patients and, to an increasing degree, in long-distance air travel passengers particularly those crammed into economy class; hence the term "economy class syndrome".
Several studies have shown that deep-vein thrombosis (DVT) is associated with a high blood level of homocysteine, a sulfur-containing amino acid also implicated in the development of atherosclerosis. Researchers at the University of Milano now confirm this connection with a new study that also clearly shows the potential protective effect of vitamin B6 (pyridoxine). The researchers compared blood levels of homocysteine, folic acid, vitamin B6, and vitamin B12 in 397 patients with previous DVT and 585 matched healthy controls. After adjusting for confounding variables they determined that the incidence of DVT was twice as high among the participants with high homocysteine levels as among those with lower levels. There was no association between DVT incidence and blood levels of folic acid and vitamin B12. The association between low levels of vitamin B6 and an increased risk of DVT was, however, quite strong. The participants with low vitamin B6 levels (less than 33.2 nanomol/L of pyridoxal-5'-phosphate[PLP]) had twice the risk of developing DVT than did people with PLP levels above 46.5 nanomol/L. The researchers point out that vitamin B6 supplementation has been found to inhibit platelet aggregation and prolong bleeding time as well as protecting against heart attacks and atherosclerosis. Further studies are underway to determine if vitamin B6 supplementation can help prevent DVT.
Cattaneo, M., et al. Low plasma levels of vitamin B6 are independently associated with a heightened risk of deep-vein thrombosis. Circulation, Vol. 104, November 13, 2001, pp. 2442-46

NEWSBRIEFS

Antidepressant has serious side effects
Health Canada has warned Canadian physicians about the dangers of bupropion (Wellbutrin), a popular antidepressant that is also prescribed as an aid in quitting smoking (Zyban). Bupropion has been found to be involved in numerous adverse reactions including seizures, suicides, and liver failure. Health Canada warns that bupropion should not be prescribed to patients with seizure disorders, anorexia nervosa, bulimia or liver failure. They also caution that it may interact with numerous other medications to produce serious and sometimes fatal reactions.
Canadian Medical Association Journal, Vol. 166, January 8, 2002, p. 68

Organic produce really is healthier
British scientists have discovered evidence supporting the idea that organic produce is healthier than conventional produce and may help prevent heart attacks, cancer, and strokes. The scientists checked 11 brands of organic vegetable soups and 24 brands of non- organic soups and found that the organic brands, on average, contained nine times more salicylic acid than did the conventional brands. Salicylic acid is responsible for the anti-inflammatory properties of aspirin and helps prevent colon cancer and atherosclerosis. The British Food Standards Agency is reviewing the new evidence and may have to change their official position that organic produce is no better than the conventional variety.
New Scientist, March 16, 2002, p. 10

Safety of cell phone questioned – again!
Cell phones are considered safe because they don't emit enough microwave radiation to actually heat up the tissue in and around the ear. Very little work has been done to check if microwave radiation below that required for heating has any physiological effects. British scientists now report that exposing nematode worms to microwave radiation similar to that emitted from cell phones makes them gain weight and increases their fertility. These findings demonstrate, for the first time, that cell phone radiation can indeed have an effect on biological tissue. A larger research project is now underway to investigate the ramifications of the findings.
New Scientist, February 9, 2002, p. 4

Divorce can be bad for your health
Researchers at the University of Pittsburgh School of Medicine report that divorce and work-related stress are potent killers of men with an above average risk of coronary heart disease. Their study involved over 10,000 men who took part in the seven-year Multiple Factor Intervention Trial. The researchers found that married men who had divorced during the trial had a 37 per cent greater risk of dying during a nine-year follow-up period than did men who were still married. Stress at work also increased mortality with men who reported three or more different stressors having a 26 per cent excess mortality.
Archives of Internal Medicine, Vol. 162, February 11, 2002, pp. 309-15

Older people need folic acid
High blood levels of homocysteine are associated with an increased risk of cardiovascular disease, particularly among the elderly. Folic acid will lower homocysteine levels, but how much is needed? Scottish researchers conclude that a total intake of 926 micrograms/day is required to remove the homocysteine-related risk from 95 per cent of people between the ages of 65 and 75 years. It would be very difficult to obtain this amount from the diet so supplementation or fortification is required. NOTE: Folic acid supplements should always be taken in conjunction with vitamin B12 and preferably vitamin B6 as well.
Quarterly Journal of Medicine, Vol. 95, January 2002, pp. 27-35

BOOK REVIEW

The Food Connection
The Right Food at the Right Time
Sam Graci
Macmillan Canada, Toronto
372 pages 2001

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