December 14, 2000 Research Update

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

Chromium Supplementation Lowers Glucose, Lipid Levels

Chromium has been recommended for years for sugar handling problems, and is nicknamed GTF, glucose tolerance factor. It is not a stretch to believe that it can lower cholesterol levels as well. Since insulin stimulates HMG-CoA reductase, the enzyme that makes endogenous cholesterol, and chromium can lower the need for insulin, it's a rational train of thought. This study dropped HbA1c levels with no side effects, and even very small changes in HbA1c result in major benefits of end organ damage.

(article) Dietary supplementation with chromium decreased glucose and lipid levels in type 2 diabetics enrolled in an active rehabilitation program, Dr. Haim Rabinovitz reported here in a poster presentation at a meeting of the Gerontological Society of America. In addition to receiving standard diabetes treatment, all subjects were given 200 mcg of chromium twice a day for 3 weeks. Participants were placed on a low-sugar diet of 1500 calories a day. Blood samples, dietary intake, and anthropometric data were collected before and after supplementation. The researchers found a significant decrease in the subjects' fasting blood glucose levels, from an average of 189 mg/dL to 150 mg/dL. Their hemoglobin A1c levels also improved, falling from an average of 8.15 to 7.58. Total cholesterol dropped from 225.26 mg/dL to 211.42 mg/dL. Triglyceride levels fell from 152 mg/dL to 136 mg/dL. Chromium appears to work by increasing the sensitivity of the patients' insulin receptors, so they are able to use the insulin more effectively, Dr. Rabinovitz explained. There have been no side effects from it, he added.

Calcium Citrate Shown to Have Superior Bioavailability

Calcium carbonate has been recommended by many doctors who are not informed on the latest research, with many patients taking Tums and other calcium carbonate sources. Carbonate forms require stomach acid to be absorbed, and many patients are hypochlorhydric (not enough stomach acid) and become more so with age. In addition, many calcium sources are coming under fire for containing heavy metals such as aluminum and lead. Calcium citrate and MCHC are probably the most optimal sources of calcium. And, don't forget that calcium is not all that is needed for bone health; we need numerous other minerals and vitamins, which are not typically found in most calcium supplements.

J Clin Pharmacol. 2000;40:1237-1244 The study, published in the November issue of the Journal of Clinical Pharmacology, used 3 measures to determine calcium bioavailability — serum calcium, urinary calcium, and serum parathyroid hormone (PTH). This randomized crossover study compared the single-dose bioavailability and effects on PTH of commercial calcium citrate 250 mg (Citracal, Mission Pharmacal) and calcium carbonate 500 mg (Os-Cal, SmithKline Beecham) supplements in postmenopausal women. Dr. Heller continued, "calcium citrate produced greater suppression of serum PTH by more than 50% over calcium carbonate. This provides physiological evidence that calcium citrate was better absorbed. We additionally found that calcium citrate may be particularly advantageous in those who absorb calcium poorly from calcium carbonate. Our data suggests that there is an important difference in bioavailability between calcium supplements in postmenopausal women. Careful long-term studies should be done to determine if there is an equal difference in protection against bone loss and fracture."

Ginkgo Remedies Fail WHO Standards

I have always maintained that buying herbs from anything less than a well known nutriceutical company is a mistake. The quality control is not there and varies widely. There are several companies in the country that sells only to physicians, and these companies, in general, adhere to GMP standards and can be relied upon for safety and reliability. On the positive side, ginko does have many good benefits anywhere increased blood flow is needed. I have even had numerous patients even respond nicely with ginko for treatment of impotence.

(article) Some products that contain the herbal remedy Ginkgo biloba do not meet World Health Organization specifications, raising concerns that the products are ineffective or increase the risk of allergic reactions. Ginkgo biloba is marketed as a way to treat dizziness, headache, and memory and concentration problems. A test of 14 samples of over-the-counter products showed that in 11 cases, the products did not contain all active ingredients associated with Ginkgo biloba leaf extract as specified in standards set by the WHO, according to Kenneth So of the Hong Kong Consumer Council. The active ingredients of the Ginkgo biloba leaf are found in low levels in raw ginkgo leaf, and, according to So, the efficacy of the final product depends on all the active ingredients being present in the specified proportions. Testing showed that one product did deliver the recommended levels of active ingredients, but 13 other samples had levels of ingredients that were too low or too high. The level of a possible allergen, ginkgolic acid, was also tested. In 13 of the products, the amount of the compound was 16 to 733 times higher than the WHO's recommendation. Only one sample met the limit for ginkgolic acid, and this product failed in terms of the amount of its active ingredient. There is no definitive evidence linking Ginkgo biloba with a handful of cases of side effects, according to the council. "Nonetheless, potentially, ginkgolic acid could cause side effects and manufacturers should reduce the content of ginkgolic acid in preparations to below a specified content."

H. Pylori May Protect Against Diarrheal Disease in Children

I still remain on the fence about H. pylori. The is too much evidence both pro and con for the presence of this organism. A few questions need to be answered before we indiscriminantly eradicate H. pylori in every patient. Is H. pylori normal flora? How does transmission/infection take place? What percentage of healthy persons have H. pylori and no conditions associated w/ it? Current standard of care is to eradicate whenever found. It may be that in 20 or 30 years we will find that H. pylori protects against some GI cancers and may even act as a sentry for infection from other organisms. We just don't have enough data yet.

J Infect Dis 2000;182:1446-1449 An inverse relationship has been observed between Helicobacter pylori colonization and diarrheal disease in children. According to the results of a population-based study published in the November issue of the Journal of Infectious Diseases, these findings suggest that H. pylori may protect against gastrointestinal infection. The results of previous studies have suggested that H. pylori infection protects against colonization by other bacteria by inducing the production of immunoglobulin A and secreting its own antibacterial peptides, Dr. Dietrich Rothenbacher, from the University of Ulm, Germany, and colleagues explain. Dr. Rothenbacher's group points out that "although certain H. pylori strains are associated with increased risk of illnesses...in adult Western populations, it may well be that the benefits of colonization in most carriers outweigh the costs, since only a small proportion of H. pylori carriers develop clinically related diseases during any time during their life." The investigators believe the findings, if confirmed, "could substantially change management and prevention strategies, especially for children in the developing world, where both diarrheal illnesses and H. pylori are highly prevalent."

Type of Intestinal Bacteria May Affect Humoral Immunity in Infants

The therapeutic benefits of probiotics both for treating human disease as well as modulating human defenses countinues to mount. Establishing and maintaining healthy intestinal flora, I believe, is one of the most important events that occurs in a newborn and infant. The GI tract is the area where most of our interaction with our environment occurs, and our bodies need to be able to decide what to keep and what to discard. High use of antibiotics is instrumental in destroying this normal flora, and may very well be an underlying cause of the increase in chronic diseases common today.

Arch Dis Child Fetal Neonatal Ed 2000;83:F186-F192 The maturation of humoral immunity in infants may depend on what types of bacteria colonize in their intestines as well as on the timing of this colonization. Intestinal colonization with B. fragilis was a greater predictor of elevated levels of IgA-secreting and IgM-secreting cells than was intestinal colonization with other bacteria or diet, Dr. Gronlund and colleagues report. The highest number of IgA-secreting cells at 2 months and IgM-secreting cells at 6 months occurred in infants who had B. fragilis colonization at 1 to 2 months. "To our knowledge, this is the first report of an association between Bacteroides sp and maturation of humoral immunity in humans, and it provides a fresh view of the role of these predominant bacteria of the human gut," the authors write. "Our observations add an interesting facet to the discussion on the possible protective role of microbial contacts in the prevention of allergic diseases," the authors write. They note that infants born via cesarean delivery were more likely to experience a delay in intestinal colonization with B. fragilis. According to Dr. Gronlund's team, "It may therefore be no coincidence that the incidence of allergic diseases is increasing in parallel with the rate of sterile cesarean sections."

Pesticide Exposure and Non-Hodgkin's Lymphoma in Children

I firmly believe that genetic factors in cancer and many other human diseases play a much smaller role than environmental factors. Many of the infant and childhood cancers have been related back to chemical exposure while in the womb, or in early childhood. We need to re-evaluate the chemicals we are exposing ourselves to every day without thinking twice about it.

Cancer 2000;89:2315-2321 A significantly increased risk of non-Hodgkin's lymphoma is associated with in utero and early childhood exposure to pesticides, according to a report in the December 1st issue of Cancer. While the risk is well known for adults, according to the authors, this is the first study that provides evidence of risk among children. Dr. Buckley's group found a significant association between non-Hodgkin's lymphoma and the use of pesticides in the home for most days (odds ratio 7.3). They also found an association between non-Hodgkin's lymphoma and pesticide exposure caused by professional exterminators (odds ratio 3.0) and from postnatal exposure (odds ratio 2.4). Although Dr. Buckley and colleagues have demonstrated an association between pesticide exposure and non-Hodgkin's lymphoma in children, they were unable to pinpoint any particular chemical agent.

Nonsteroidal Anti-Inflammatory Drugs and Hypertension

It seems that we can now add elevation of BP to the list of side effects of NSAIDs use. This list also contains gastric erosions/ulcers, disruption of intestinal permeability, kidney damage and liver damage. I could accept the harm vs benefit logic for NSAIDs if there were not tens if not hundreds of natural options to curb inflammation without these side effects. Remember...NSAIDs do not fix whatever caused the underlying inflammation.

J Clin Hypertens 2(5):319-323, 2000 Nonsteroidal anti-inflammatory drugs are among the most widely prescribed medications. Their effect on blood pressure has been monitored, and many small studies have determined a potential relationship between their use and elevation of blood pressure. These drugs may affect blood pressure by inhibiting prostaglandin synthesis, which may affect arteriolar smooth muscle tone and natriuresis. Since many patients with conditions such as osteoarthritis require treatment and also have hypertension, even modest elevations in blood pressure or inhibition of antihypertensive medication efficacy resulting from non steroidal anti-inflammatory drugs can be of significant clinical and public health importance. This review finds that certain drugs (e.g., indomethicin, piroxicam, and naproxen) may cause clinically relevant elevations in blood pressure in hypertensive patients. Aspirin and sulindac do not appear to elevate blood pressure significantly, even in hypertensive patients. Ibuprofen and other nonsteroidal anti-inflammatory drugs appear to have an intermediate blood pressure effect. Cyclo-oxygenase-2 inhibitors such as refecoxib and celecoxib have been shown to cause mild elevations in blood pressure, but further studies are needed to evaluate the full magnitude and population distribution of this effect.

FDA OKs Limited Heart Disease Claim for B vitamins

No known side effects at reasonable levels. Cheap. Helps with liver detoxification. Helps with nervous function. On and on. Any physician who plans on waiting for the FDA to determine the necessity and safety of B vitamins in lowering rates of heart disease via homocysteine would do well to remember that it took near to four DECADES to make the recommendation for folic acid and neural tube defects.

(article) The US Food and Drug Administration (FDA) said late on Tuesday that foods and dietary supplements containing vitamins B6, B12 and folic acid will be permitted to carry a claim that the vitamins may reduce the risk of heart disease. However, the claim must note that the scientific evidence is not conclusive, the agency said. The FDA said that an acceptable claim would run along the lines of: "Studies in the general population have generally found that these vitamins lower homocysteine, an amino acid found in the blood. It is not known whether elevated levels of homocysteine may cause vascular disease or whether high homocysteine levels are caused by other factors." Earlier this month, the FDA said that it would allow a limited claim for the association between omega-3 fatty acids and heart disease. The agency said scientific evidence that these compounds could reduce the risk of coronary heart disease (CHD) was not conclusive. vitamin B6 (pyridoxine) is found in fortified foods such as cereals and grains. vitamin B12 (cobalamin) is found in meat, fish and poultry, as well as fortified milk and breakfast cereals. Folate, or folic acid, is found in many fruits and vegetables and in fortified foods.