ABSTRACTS

BOSTON, MASSACHUSETTS. There is ample evidence that frequent fish consumption or supplementation with fish oils markedly reduces the risk of coronary heart disease, sudden cardiac death, and heart attacks in men. Up until now there has been little work done to see if the same holds true for women. Researchers at the Harvard Public School of Health have just released the results of a major study aimed at remedying this situation.
The study involved 84,688 female nurses who were enrolled in 1970. All participants completed food frequency questionnaires in 1980, 1984, 1986, 1990 and 1994. In the 16-year period between 1980 and 1996 a total of 1513 women either died from coronary heart disease (484) or suffered a non-fatal heart attack (1029). After adjusting for age, smoking and other known cardiovascular risk factors the researchers conclude that women who eat fish once a week have a 34 per cent lower incidence of death from heart disease and a 25 per cent lower incidence of non-fatal heart attacks. They also conclude that the protective effect of fish consumption is entirely due to the content of omega-3 fatty acids (fish oils) in the fish. They also note that both fish and fish oil consumption were associated with a decreased risk of dying from any cause. The researchers believe that fish oils reduce the incidence of heart disease through their antiarrhythmic effects and their reduction of platelet aggregability and triglyceride levels. They conclude that their findings lend further support to the benefits of twice weekly fish consumption.
Hu, Frank B., et al. Fish and omega-3 fatty acid intake and risk of coronary heart disease in women. Journal of the American Medical Association, Vol. 287, April 10, 2002, pp. 1815-21

FAIRFIELD, IOWA. Atherosclerosis involves a thickening of the inner wall (intima) of the arteries. It is thus possible to follow the progression/regression of atherosclerosis by a non-invasive, ultrasonic measurement of the intima-media thickness (IMT) of the carotid arteries. Researchers at Maharishi University and the St. Joseph Hospital in Chicago have just completed a study in which they evaluated the effect of various diet and lifestyle modifications on IMT. The study involved 43 men and women over the age of 65 years. Fifteen of the participants had two or more risk factors for coronary heart disease and were classified as a "high risk" group. The participants were randomly allocated to either receive just usual care from their normal health care providers (control group), to receive the best atherosclerosis prevention care offered by modern medicine (modern medicine group) or to participate in a preventive program based on Ayurvedic medicine (Maharishi Vedic Medicine [MVM] program). The MVM program included daily meditation, yoga, walking, herbal remedies and a diet high in fruit and vegetables.
All participants had their IMT measured at the beginning of the study and after having followed the program for a year. Followers of the MVM program were found to be four times more likely to have experienced a decrease in IMT than were those who had been assigned to the modern medicine or the control group. The difference was particularly noteworthy in the high-risk group. Here the IMT in the MVM group decreased by 0.32 mm on the average as compared to a decrease of 0.08 mm in the modern medicine group and a 0.02 mm increase in the control group. The researchers conclude that the MVM program resulted in regression of atherosclerosis in 80 per cent of all members of the MVM group and in 100 per cent of the members of the high risk MVM group. This is comparable to the results achieved with the program designed by Dr. Dean Ornish. They do emphasize though that their study was really only a pilot program and that larger scale trials are required to confirm their findings.
Fields, Jeremy Z., et al. Effect of a multimodality natural medicine program on carotid atherosclerosis in older subjects: a pilot trial of Maharishi Vedic Medicine. American Journal of Cardiology, Vol. 89, April 15, 2002, pp. 952-58

CLEVELAND, OHIO. A team of researchers from the Cleveland Clinic and Thomas Jefferson University in Philadelphia reports that coenzyme Q10 is effective in preventing migraines. There is increasing evidence that migraine may be caused by some sort of mitochondrial impairment. Coenzyme Q10 has been used successfully in the treatment of mitrochondrial disorders so the researchers reasoned that it might be beneficial in the treatment of migraines. Their clinical trial involved 31 patients who, after a one-month baseline evaluation, were given 150 mg of coenzyme Q10 at breakfast for a three-month period. At the end of the period 61.3 per cent of the patients had a greater than 50 per cent reduction in the number of days they spent with migraine. The frequency of attacks declined from an average of 7.34/month before treatment to 2.95 at the end of the three-month treatment period. The average number of days spent with migraine decreased from 4.85 to 2.81 per month. No adverse treatment effects were observed in any of the patients.
The researchers conclude that coenzyme Q10 effectively prevents episodic migraine headaches (with or without aura). They call for randomized, placebo-controlled trials to confirm their findings and suggest that dosages above 150 mg/day may prove to be even more effective. They also point out that coenzyme Q10 has been found effective in the treatment of congestive heart failure and chronic muscular dystrophy and that no side effects have been observed at daily dosages as high as 3000 mg/day. The effect of oral supplementation takes about a month to be felt and may take as long as three months to reach its full potential. A daily intake of 100-150 mg will increase normal blood levels by a factor of two.
Rozen, T.D., et al. Open label trial of coenzyme Q10 as a migraine preventive. Cephalalgia, Vol. 22, 2002, pp. 137-41

MINNEAPOLIS, MINNESOTA. Elevated insulin levels have been implicated as a cause of high blood pressure (hypertension). It is known that certain soluble fibers, notably from oats, can significantly lower blood levels of insulin. A group of researchers at the University of Minnesota now reports that daily consumption of oat cereal markedly reduces blood pressure, cholesterol levels, and glucose levels in hypertensive individuals. Their 12-week, randomized, controlled, parallel-group trial involved 45 men and 43 women between the ages of 33 and 67 years who were assigned to either a low fiber control group or an oat cereal group. The control group consumed 146 grams per day of wheat cereal and Kellogg's Crispix while the oat group consumed 60 grams of Quaker Oatmeal and 77 grams of Quaker Oat Squares (providing 6 grams/day of soluble fiber). All patients continued with their antihypertensive or diuretic medications.
After four weeks on the protocol the oat group saw an average decline in systolic blood pressure of 7 mm Hg and a 4 mm Hg reduction in diastolic pressure. Seventy-three per cent of the participants in the oat group were able to stop their medication or reduce it by 50 per cent or more. Only 42 per cent of the patients in the low fiber group were able to do so. The oats group also experienced significant decreases in their levels of total cholesterol, low-density cholesterol, and blood glucose. The researchers conclude that daily oatmeal consumption can improve blood pressure control, reduce the need for hypertension medication, and significantly reduce overall cardiovascular disease risk.
Pins, Joel J., et al. Do whole-grain oat cereals reduce the need for antihypertensive medications and blood pressure control? Journal of Family Practice, Vol. 51, April 2002, pp. 353-59
Keenan, J.M., et al. Oat ingestion reduces systolic and diastolic blood pressure in patients with mild or borderline hypertension: a pilot trial. Journal of Family Practice, Vol. 51, April 2002, p. 369

SEATTLE, WASHINGTON. Air bags that expand instantaneously in front of the driver or front seat passenger in the event of a crash were first introduced in 1987. They were touted as a great improvement over seat belts and soon became obligatory, standard equipment in new vehicles. Early studies of their effectiveness in preventing fatalities gave disappointing results and some studies even found that they were detrimental. As a result the inflation pressure was lowered to reduce the risk of the bags actually harming people.
Researchers at the University of Washington have just released the results of a new study designed to determine the effectiveness of air bags. They evaluated over 51,000 vehicle crashes that occurred in the period 1990 to 2002 in the United States involving cars from model years 1987-2002. They found that drivers or passengers in cars with air bags had an 8 per cent lower risk of dying in the crash or within 30 days of the crash (12 per cent reduced risk for women, 6 per cent for men). The risk was the same independent of the inflation pressure of the bags and the bags only provided protection in frontal crashes. Somewhat surprisingly, the researchers also found that using a seat belt offered far more protection than did air bags. Drivers and passengers who were actually using their seat belt at the time of the crash had a 65 per cent lower risk of dying in the crash or within 30 days than did unbelted drivers. The conclusion from this study is clear. Always use your seat belt whether or not your car is equipped with air bags.
Cummings, Peter, et al. Association of driver air bags with driver fatality: a matched cohort study. British Medical Journal, Vol. 324, May 11, 2002, pp. 1119-22

BOSTON, MASSACHUSETTS. Dr. Ted Kaptchuk of the Harvard Medical School provides an excellent overview of the current status of acupuncture in the United States. The first use of acupuncture took place in China during the Stone Age. The technique has been slowly accepted by the western medical establishment and is now practiced by over 3,000 medical doctors and almost 11,000 non-physician acupuncturists in the USA alone. Strictly controlled clinical trials have provided overwhelming evidence that acupuncture is effective in preventing postoperative vomiting, nausea and dental pain. Some studies have shown effectiveness in the treatment of other types of pain, but the evidence is less convincing. Dr. Kaptchuk ingeniously compares a diagnosis in Traditional Chinese Medicine to an "internal weather report". Such terms as "excessive dampness", "heat", "warm", "dry", etc. are used to describe a patient's unique "climate". This climate can be adjusted by inserting fine needles in one or more of the 2000 known acupuncture points. That the insertion of acupuncture needles can have a profound effect was recently demonstrated in a functional magnetic resonance imaging study. Inserting a needle at a certain point of the foot (traditionally related to vision) activated an occipital lobe (brain) region which was exactly the same region activated by stimulation of the eye using direct light. Dr. Kaptchuk concludes that acupuncture has discernible treatment effects despite the fact that western medicine, so far, has been unable to explain its mode of action. [113 references]
Kaptchuk, Ted J. Acupuncture: theory, efficacy, and practice. Annals of Internal Medicine, Vol. 136, March 5, 2002, pp. 374-83

STOCKTON-ON-TEES, UNITED KINGDOM. Impaired glucose tolerance (IGT) is a rapidly growing health problem in the western world. Studies in the UK have shown that around 17 per cent of people between the ages of 35 and 65 years have IGT. The diagnosis of IGT, also known as insulin resistance, is made if fasting glucose levels are between 110 mg/dL (6.1 mmol/L) and 126 mg/dL (7.0 mmol/L). It is estimated that over half of all people with IGT develop type 2 diabetes within 10 years of diagnosis. People with IGT also have double the risk of developing cardiovascular disease than do people with normal fasting glucose levels. Dietary and lifestyle changes are very effective in reducing the risk of IGT progressing to diabetes with some studies having found a 58 per cent reduction in risk of progression. No pharmaceutical drugs have been found effective in halting the progression from IGT to diabetes.
A group of researchers from the University of Durham has just completed a survey of 34 general practitioners to determine what they know about IGT and how they treat it. All participants knew what IGT was, but few were aware that it progresses to type 2 diabetes and markedly increases the risk of cardiovascular disease. More than half the group had no idea how many of their patients had IGT and, of those who hazarded a guess, most thought the prevalence was less than 1 per cent (actual prevalence is 17 per cent). The doctors had no specific plan for dealing with the condition and few were aware that dietary and lifestyle modifications are highly effective in halting IGT in its tracks. Several would prescribe metformin (Glucophage) even though there is no evidence that it would be of any benefit. The Durham researchers conclude that, "Awareness of impaired glucose tolerance needs to be raised, and guidelines for management are needed".
Wylie, Graeme, et al. Impaired glucose tolerance: qualitative and quantitative study of general practitioners' knowledge and perceptions. British Medical Journal, Vol. 324, May 18, 2002, pp. 1190-95

NEWPORT NEWS, VIRGINIA. There is ample evidence that lack of sun exposure increases the risk of many types of cancer. The mortality rates for breast cancer, prostate cancer, colon cancer, ovarian cancer, and non-Hodgkin lymphoma are twice as high in the northeastern part of the US as in the southwest. Dr. William Grant, PhD, an independent American researcher, now reports additional evidence indicating the eight more cancers are associated with lack of exposure to UV-B radiation (sunshine!). Dr. Grant found a clear inverse correlation between UV-B exposure and mortality from bladder, kidney, lung, pancreatic, stomach, rectal, esophageal cancers and cancer of the corpus uteri. He estimates that over 21,000 white Americans, 1400 African Americans, and 500 people from Asian and other minorities die prematurely every year from cancer because they don't get enough sunshine.
Dr. Grant and most other researchers in the field believe that the lack of sun exposure leads to a vitamin D deficiency, which is known to be implicated in the progression of many cancers. Vitamin D is formed in the skin when it is exposed to sunlight. Vitamin D formation is totally inhibited by sunscreens and most clothing. Dr. Grant points out that winter time UV-B levels in Boston are insufficient to promote vitamin D synthesis in the skin. He advocates prudent sun exposure when it is available and vitamin D supplementation when it is not. Editor's Note: If lack of sun exposure is a problem in northern USA then it is obviously even more of a problem in Canada. Researchers at the University of Toronto recently concluded that Canadians need to supplement with 4000 IU/day of vitamin D when they are not exposed to sunshine.
Grant, William B. An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation. Cancer, Vol. 94, March 15, 2002, pp. 1867-75

TRIANGLE PARK, NORTH CAROLINA. Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is a neurodegenerative disease that results in muscle wasting and weakness. It is usually fatal within 2 to 5 years of onset. Fortunately, ALS is relatively rare (1-2 cases per 100,000 people); it affects more men than women and is inherited in about 5-10 per cent of cases. Oxidative stress, cigarette smoking, exposure to heavy metals, pesticides, solvents and electromagnetic fields have all been implicated as possible causative factors.
Researchers at the National Institute of Environmental Health Sciences now report convincing evidence that occupational exposure to lead is a potent risk factor for ALS. Their study involved 109 ALS patients and 256 healthy controls. All participants were interviewed to determine their lifetime lead exposure and had blood samples drawn for determination of lead levels. Lead levels were also measured in bones (knee cap and shin bone) using x-ray fluorescence. The researchers found that ALS patients were 1.9 times more likely to have had occupational exposure to lead than were the controls. Most frequently cited occupations were soldering, battery manufacture or reclamation, painting or paint removal, and working with firearms. Residential or recreational exposure to lead was not associated with an increased risk of ALS. Lead levels in the blood, patella (knee cap), and tibia (shin bone) of ALS patients were found to be substantially higher than in the controls.
The researchers conclude that occupational lead exposure could substantially increase the risk of ALS. They speculate that lead may act through its known propensity to cause oxidative stress and mitochondrial dysfunction. Editor's Note: An obvious conclusion to draw from this work is that people who have had occupational exposure to lead should have their lead level checked and if it is high have chelation therapy to reduce it. Ensuring an adequate intake of antioxidants to prevent oxidative stress and coenzyme Q10 supplementation to prevent mitochondrial dysfunction may also be advisable.
Kamel, Freya, et al. Lead exposure and amyotrophic lateral sclerosis. Epidemiology, Vol. 13, May 2002, pp. 311-19

SACRAMENTO, CALIFORNIA. Vitamin B12 deficiency is associated with the development of megaloblastic anemia, mental dysfunction, and dementia resembling Alzheimer's disease. Vitamin B12 (cobalamin) is a very important cofactor in several biochemical reactions including the conversion of homocysteine to methionine and the synthesis of SAMe (S-adenosylmethionine). These reactions are believed to be crucial in maintaining neurological health.
Researchers at the University of Milan now report that a vitamin B12 deficiency is associated with higher levels of the inflammatory cytokine, tumour necrosis factor-alpha (TNF-alpha) and reduced levels of epidermal growth factor (EGF). It is believed that high levels of TNF-alpha speed up the progression of Alzheimer's disease thus explaining the association between low vitamin B12 levels and Alzheimer's. The researchers point out that the increase in TNF-alpha and the decrease in EGF can both be reversed by vitamin B12 supplementation. TNF-alpha is also implicated in the progression of HIV to AIDS and vitamin B12 has been found to slow this progression. Editor's Note: Vitamin B12 deficiency is widespread among older people. Taking a 1 mg sublingual B12 tablet daily could prevent a lot of future health problems.
Miller, Joshua W. Vitamin B12 deficiency, tumor necrosis factor-alpha and epidermal growth factor: a novel function of vitamin B12? Nutrition Reviews, Vol. 60, May 2002, pp. 142-51

MAASTRICHT, THE NETHERLANDS. People who are constantly exposed to stress tend to experience a decline in their ability to learn and memorize things (cognitive performance). It is believed that this effect is caused by the fact that chronic stress reduces brain serotonin levels. Serotonin is formed from tryptophan supplied by the diet. Tryptophan competes with other large amino acids for entry to the brain so a diet high in protein may actually lead to lower tryptophan concentrations. Researchers at Maastricht University now report that consuming a meal containing alpha-lactalbumin, a whey protein with a high tryptophan content, increases the ratio of tryptophan to other large amino acids in the blood stream and improves cognitive performance in stress-vulnerable people.
Their double-blind, placebo-controlled, crossover study included 23 students who were highly vulnerable to stress and 29 who were not. The participants consumed a diet (breakfast, snack and brunch) containing either whey protein or sodium caseinate (control). One and a half hours after brunch they had a blood sample taken and were then seated in front of a computer and exposed to a cognitive performance test. Blood analysis showed that the ratio of tryptophan to other large amino acids was 43 per cent greater after the whey diet than after the control diet. It was also clear that stress-vulnerable participants on the whey diet performed much better on the cognitive tests than did those on the control diet. No difference in performance was noted for the low stress vulnerability group. Editor's Note: Increased serotonin levels reduce depression so a morning shake of whey protein powder and fresh berries may help brighten up your day.
Markus, C. Rob, et al. Whey protein rich in alpha-lactalbumin increases the ratio of plasma tryptophan to the sum of the other large neutral amino acids and improves cognitive performance in stress-vulnerable subjects. American Journal of Clinical Nutrition, Vol. 75, June 2002, pp. 1051-56

SHREVEPORT, LOUISIANA. It is common practice to perform a biopsy of the prostate on men whose PSA (prostate specific antigen) level exceeds 4.0 ng/mL. The results of the biopsy, which is expensive, uncomfortable and anxiety-provoking, are negative in most cases (65 to 85 per cent negative) indicating that no cancer is present. Urologists at the Louisiana State University point out that acute prostatitis (inflammation of the prostate gland) and benign prostatic hypertrophy (enlarged prostate) can also give high PSA readings. They now report on a just completed trial designed to determine if men with chronic prostatitis also have high readings and if so, how often these abnormal readings actually are an indication of prostate cancer.
Their trial involved 95 men who had been diagnosed with chronic prostatitis and who had an elevated PSA level (average of 8.48 ng/mL), but no abnormalities in digital rectal examination. The men were all assigned to a four-week course of antibiotics (fluoroquinolones or doxycycline) and anti-inflammatories (ibuprofen or celecoxib). At the end of the four weeks 44 of the men (46.3 per cent) had a PSA level of less than 4 ng/mL (mean of 2.48 ng/mL) and were deemed to be free of prostate cancer. The remaining 51 men underwent double sextant transrectal ultrasound guided biopsy. Thirteen patients (25.5 per cent) were found to have prostate cancer, 37 (72.5 per cent) had chronic inflammation, and one patient had an enlarged prostate. The researchers conclude that treatment of chronic prostatitis in men with high PSA levels can substantially reduce the need for biopsies. It is of interest to note that the PSA levels in the men eventually diagnosed with prostate cancer only declined from an average of 8.32 to 7.92 ng/mL after four weeks of antibiotic therapy. Editor's Note: The moral of this story is that one should always ensure that one does not have acute or chronic prostatitis before submitting to a prostate biopsy.
Bozeman, Caleb B., et al. Treatment of chronic prostatitis lowers serum prostate specific antigen, Journal of Urology, Vol. 167, April 2002, pp. 1723-26

NEWSBRIEFS

Achilles tendon disorders linked to antibiotics
Dutch researchers warn that the use of fluoroquinolones (Ciprofloxacin, Cipro) can lead to Achilles tendonitis or Achilles tendon rupture. The overall risk is fairly small (3 cases per 1000 patients), however, patients over 60 years of age who take fluoroquinolones do have a 3.2 times higher risk of developing an Achilles tendon disorder. The risk is doubled again if the patients take corticosteroids (prednisone) at the same time.
British Medical Journal, Vol. 324, June 1, 2002, pp. 1306-07

Is it the nuts or the oil?
Several studies have shown that regular nut consumption is associated with a reduced risk for heart disease and an improved cholesterol profile. Most nuts are high in monounsaturated fat (oleic acid), but it is not known whether it is the oil as such or some other component in the nuts that confers the benefits. Researchers at the University of California now report that whole almonds and almond oil have the same beneficial effect on triglyceride and cholesterol levels. Replacing half of normal fat intake with almonds or almond oil reduced triglyceride levels by 14 per cent, total cholesterol by 4 per cent, LDL cholesterol by 6 per cent, and increased HDL cholesterol by 6 per cent in a trial involving 22 men and women with normal cholesterol levels. The researchers conclude that the cardiovascular benefits of almonds are due to the oil itself or to some component in the oil.
Journal of Nutrition, Vol. 132, April 2002, pp. 703-07

Vaccination may lead to shingles epidemic
Australia, Canada and several European countries are considering routine vaccination of children against chickenpox. Most children in the USA already receive the vaccine. Researchers at the Public Health Laboratory Service in London, England caution that such a move could lead to a large increase in shingles (herpes zoster). Adults who had chickenpox in childhood apparently are more likely to get shingles if they are not occasionally exposed to children who have had the virus. If most children are vaccinated then the adults will no longer receive an occasional "booster shot" and will be more likely to develop shingles. The researchers calculate that vaccinating children in a population of about 300 million would result in an additional 21 million cases of shingles and 5000 people over 60 years of age would die from the disease. However, the vaccination program might also save the lives of an estimated 5000 children. One solution may be to extend the vaccination to cover older people as well – or forget the whole idea.
New Scientist, May 4, 2002, p. 7

Conflicts of interest flourish in medical industry
"Just how tainted has medicine become?" asks the headline in a recent editorial in the respected medical journal The Lancet. "Heavily, and damagingly so", is the answer according to the journal. The article cites as particularly damaging the practice of having medical doctors who receive funding from a pharmaceutical company play a leading role in the development of clinical practice guidelines for the use of the company's product. According to a recent survey over half of the authors of these guidelines had financial links to the company whose products they were reviewing. The Lancet also describes as "especially corrosive" the case of Genentech who donated $11 million to the American Heart Association while the Association was reviewing one of its products and later recommended it in its guidelines for stroke management. Sales of prescription drugs in the USA reached $155 billion in 2001, almost double what it was in 1997. Part of this phenomenal growth is no doubt due to the success of direct-to-consumer advertising campaigns, but paying doctors, even if indirectly, to push a company's product in the clinical guidelines used by all doctors is probably not hurting sales either.
The Lancet, Vol. 359, April 6, 2002, p. 1167

CRP predicts diabetes
There is growing evidence that a chronic inflammation is linked to type 2 diabetes. Scottish researchers now report that high blood levels of C-reactive protein (CRP), a marker of inflammation, can predict the risk of developing diabetes. A study of 5245 middle-aged men found that men who developed diabetes during a five-year follow-up period had an average (mean natural logarithm) blood CRP level of 1.05 mg/L while those who did not become diabetic had an average level of only 0.53 mg/L. Men with a CRP level of greater than 4.18 mg/L had a three times elevated risk when compared to men at normal levels. The predictive value of a high CRP also applies to women and was found to be independent of other diabetes risk factors.
Diabetes, Vol. 51, May 2002, pp. 1596-600

Frozen orange juice stays fresher
Researchers at Arizona State University have compared the vitamin C content of reconstituted frozen orange juice with that of ready-to-drink orange juice purchased four to five weeks prior to the expiration date. The frozen orange juice, when reconstituted, contained 86 mg of active (reduced) vitamin C per cup declining to 29-46 mg per cup after four weeks storage at 4 degrees C. The ready-to-drink juice contained 27-65 mg/cup when opened and 0-25 mg/cup at expiration four weeks later. The researchers conclude that ready-to-drink orange juice should be purchased three to four weeks before expiration and consumed within one week of opening.
Journal of the American Dietary Association, Vol. 102, April 2002, pp. 525-29

Sauna beneficial for heart failure patients
Japanese researchers report that sauna therapy is beneficial for heart failure patients. Their study involved 20 patients with chronic heart failure. The patients were treated in a dry sauna (60 degrees C for 15 minutes) followed by a 30-minute bed rest (covered with a blanket) every day for two weeks. A control group of 10 patients rested in bed for 45 minutes at 24 degrees C. At the end of two weeks clinical symptoms were improved in 17 of the 20 patients treated with the sauna. No improvements were noted in the control group. The researchers conclude that repeated sauna therapy improves vascular endothelial function and heart function.
Journal of the American College of Cardiology, Vol. 39, March 6, 2002, pp. 754-59