August 13, 2001 Research Update

James Bogash, D.C. Mesa, AZ
info@lifecarechiro.com
www.lifecarechiro.com

Bone mineral density in women with essential hypertension

This is an interesting insight on the authors' part. Article looks at the relationship of calcium balance in the body (as measured by bone density) to high blood pressure and found that women with high blood pressure had lower bone density. Knowing that increasing evidence supports the role of hyperinsulinemia in "essentil" hypertension, it may be that the mechanism that is responsible for decreased bone density is also the altered insulin sensitivity. Medicine Direct http://www.medicinedirect.com/journal/journal/article?acronym=AJH&format=abstract&uid=PIIS0895706101013036

Cutaneous Disorders in Crohn's Disease Respond to Infliximab

This article supports things I've said for awhile now. Many chronic autoimmune conditions may actually come from the same basic metabolic defect, and that the ultimate manifestation of a certain disease is just a branch along the changes caused by the original defect. We are now seeing a drug (infliximab, a drug that blocks TNFalpha from doing it's job) that is having an effect of rheumatoid arthritis, Crohn's disease and now several autoimmune skin disorders as well. Before we get too excited here that the answer has been found, remember that TNFalpha is needed for healthy immune function and cancer prevention. I am sure that the long term use of these drugs will produce higher rates of certain types of cancer. Lowering levels of TNF naturally included weight loss, maintaining insulin sensitivity and leaning towards a plant based diet. Improvement of Pyoderma Gangrenosum and Psoriasis Associated With Crohn Disease With Anti-Tumor Necrosis Factor alpha Monocl http://archderm.ama-assn.org/issues/current/abs/dob10040.html

Coeliac disease in the father affects the newborn

Wow!! Forever the male has been viewed as rather unimportant in the health of the fetus, and yet several studies are starting to show that this is far from true. In this case, coeliac disease (allergy to gluten proteins most commonly found in wheat), whether treated or untreated has an effect on the birthweight. While I would find it hard to follow a pathway that would lead to a defect in the sperm resulting in this outcome, coeliac disease may be a factor that is transferred to the fetus and has a rapid phenotypic expression in the developing fetus. Gut -- Abstracts: Ludvigsson and Ludvigsson 49 (2): 169 http://gut.bmjjournals.com/cgi/content/abstract/49/2/169

Brain White-Matter Lesions in Celiac Disease

If this article does not give you an idea of how important it is to recognize the impact of food allergies on our overall health, I'm not sure what will. Reactions to food allergies can range from minor GI irritation to irreversible brain damage. Physicians need to begin to recognize the impact that the GI tract has on our overall health. The author suggests that this response is mediated through an upregulation of the immune system leading to focal damage in the brain. Consider this...many people crave the foods they're allergic to and so eat them very often. That leaves opportunities on almost a daily basis to wreak havoc on our immune systems... Pediatrics -- Abstracts: Kieslich et al. 108 (2): e21 http://www.pediatrics.org/cgi/content/abstract/108/2/e21

Evidence Assessment of Management of Acute Otitis Media

I'm not going to go into this in more detail, but I do want to once again stress that antibiotic resistance is really only a minor complication of antibiotic missuse. Consider the long term chronic effects that destroying the normal flora has on overall health. Alterations in the GI tract can lead to a host of quality of life-destroying illness, potentially including allergies, asthma, Crohn's disease, rheumatoid arthritis and most all autoimmune conditions. Consider that next time you're given an antibiotic for a condition that will clear up just as quickly without it. Pediatrics -- Abstracts: Takata et al. 108 (2): 239 http://www.pediatrics.org/cgi/content/abstract/108/2/239

Time-release analgesic drug causes fatal overdoses in United States

So there's another drug on the market killing people. That's not news. But read the tactics that the pharmaceutical company used to market to physicians. 7,000 around the country including paying for hotel and travel expenses for attendees to pain management seminars. This should be illegal but would interfere with freedom of speech. In a perfect world these tactics should be fruitless, allowing sound, unbiased research to guide clinical decision making... wjm -- 175 (2): 82 http://www.ewjm.com/cgi/content/full/175/2/82

Vitamin Use May Weaken Flu Shot's Efficacy in Elderly

It's amazing that this one hasn't been plastered all over the news. Once again, we need to take some things with a grain of salt. First, I am not a fan of the flu shot and would rather see a patient do other things to stimulate overall immune health against a wide variety of diseases, not just a shot in the dark at only a few. This study gave certain patients a limited nutrient multivitamin prior to flu vaccination and checked them one month later. This abstract does not identify how the response was checked. The author suggests that these results may be from a lack of trace minerals such as zinc in the vitamin. Here's my spin (and this is pure speculation..). The presence of additional factors (in this case the multi) helped to balance the immune response. Remember that the Th2 response is strengthened by vaccines and Th1 is strengthened by exposure to antigens. It is possible that the presence of certain nutrients at vaccination time averted a Th2 dominant state (which zinc has been shown to do), resulting in an overall more healthy patient.

Infect Dis Clin Pract 2001:10:81-85 Older individuals who take multivitamins may not gain full benefit from influenza vaccination, a team of military doctors has found. "Physicians and patients should be cautious with multivitamin use," says principal investigator Dr. Peter T. Ender, of the Wright-Patterson Air Force Base Medical Center near Dayton, Ohio. "Depending on the combination, they may have harmful rather than beneficial effects." Among 79 adults age 65 and older, those who took a daily multivitamin for 100 days before flu vaccination showed a poorer immune response 1 month after vaccination compared with those who took placebo. The findings are published in Infectious Diseases in Clinical Practice. One possible reason for the poor response in multivitamin users, Dr. Ender said, is that the supplement used in this study included vitamins A, B, C, D, E, as well as thiamine, riboflavin, niacin, folate and pantothenic acid, but no trace elements such as zinc. Other recent studies have suggested that multivitamins containing those trace elements do have beneficial effects on the body's immune response. Dr. Ender concluded, "I would caution people [from] thinking that 'A vitamin can do no harm, so why not take them?' "

Role of Coenzyme Q10 in Chronic Heart Failure, Angina, and HTN

It's nice to see CoQ10 getting some recognition in the pharmacology journals, however, in the conclusion to this article, the author suggests that, while CoQ10 does show some promising results, it is not recommended for use at this time as monotherapy. Huh?? No self respecting physician who understands natural medicine would ever recommend just one thing for cardiovascular disease. It's a program, not an isolated therapeutic agent. I feel it may be a long while yet before we see natural therapeutics used in trials as they are used in clinical practice.

Pharmacotherapy 21(7):797-806, 2001 Coenzyme Q10 (CoQ10) has a pathophysiologic role in many disease states. The purpose of this review is to provide recommendations regarding the safety, efficacy, and dosing of CoQ10 in the management of chronic heart failure (CHF), angina, and hypertension. Coenzyme Q10 administered orally has favorable actions in the described cardiovascular conditions and appears to be safe and well tolerated in the adult population. Issues concerning optimum target dosages, potential interactions, monitoring parameters, and the role of CoQ10 as a monotherapeutic agent need to be investigated further. Favorable effects of CoQ10 on ejection fraction, exercise tolerance, cardiac output, and stroke volume are demonstrated in the literature; thus, the use of CoQ10 as adjuvant therapy in patients with CHF may be supported. Conclusions: Coenzyme Q10 therapy in angina and hypertension cannot be substantiated until additional clinical trials demonstrate consistent beneficial effects. However, CoQ10 may be recommended as adjuvant therapy in selected patients with CHF. At this time, CoQ10 should not be recommended as monotherapy or first-line therapy in any disease state.

NICE Says COX-2 Inhibitors Should Be Reserved for High-Risk Patients

Gosh, I'll but Pharmacia and Merck weren't terribly happy about this announcement!! Overall, despite much, much hype, the evidence supporting greatly safety with the new selective COX-2 inhibitors for pain is just not that strong. Remember that most NSAIDs inhibit both cyclooxygenase 1 and 2 and that COX-1 has a protective effect on many tissues in the body and that COX-2 is needed for certain pain producing pathways. Block COX-1 and you block the body's ability to protect itself and create injury. However, we still do not fully understand the picture of what COX-2 does. Block it and we are not yet sure what the long term consequences may be. The arrogance of man over nature never ceases to amaze me. Remember that nature already makes some selective COX-2 inhibitors with centuries of safety.

(article) Britain's National Institute for Clinical Excellence (NICE) said on Thursday that Merck and Pharmacia's blockbuster cyclooxygenase 2 inhibitors, Vioxx (rofecoxib) and Celebrex (celecoxib), should not be used routinely. In guidance to the National Health Service, NICE said that selective inhibitors of COX-2 should be used instead of standard nonsteroid anti-inflammatory drugs (NSAIDs) only by people with rheumatoid arthritis or osteoarthritis who are at high risk of developing serious gastrointestinal adverse events. NICE defined high-risk patients to include those over 65 years, those already using medications known to increase the likelihood of upper gastrointestinal adverse events, those with serious co-morbidity, and those requiring prolonged use of maximum recommended doses of standard NSAIDs. NICE also announced that its appeals' committee has rejected all appeals by Pharmacia and Merck. Both companies had complained that the Institute's guidance was perverse in the light of the evidence submitted. The guidance says that all NSAIDs, including the COX-2 selective agents, can cause gastrointestinal adverse events, including life-threatening perforations, ulcers or bleeds. "The risk of NSAID-induced complications is particularly increased in patients with a previous clinical history of gastroduodenal ulcer, gastrointestinal bleeding or gastroduodenal perforation. The use of even a COX-2 selective agent should therefore be considered especially carefully in this situation." The guidance adds that concerns have been raised over the cardiovascular effects of COX-2 drugs. One study comparing Vioxx and naproxen detected an increase in the rate of myocardial infarction in the Vioxx group. Further research is needed to resolve this issue but in the meantime the potential increased risk should be taken into account when prescribing COX-2 agents for patients with cardiovascular disease, according to the guidance.