February 19, 2001 Research Update

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

The obesity epidemic in young children

This finding is no big surprise. There are a few important things to consider here. First, despite all these findings, I don't see any major changes in society; nor do I expect it. When we look at childhood obesity, we need to look to the causes. Don't peer too deeply into genetics--we're doing it to ourselves via the environment. I know I'll catch an earful from this, but I blame the parents. The old "monkey see, monkey do" adage. How can a child be expected to lead a healthier lifestyle if their role models do not? We need to start with ourselves, begin teaching our kids healthier lifestyle by example, not by preaching. bmj.com Dietz 322 (7282): 313 http://bmj.com/cgi/content/full/322/7282/313

Activity and pain killers best for back pain

Apparently, this author has been living in a cave and has never heard of manipulative therapy. The activity I can unquestionably agree with, but the pain killers? Does anyone out there actually still believe that pain killers and anti-inflammatories address the cause of the pain in the first place? There has never been, and probably will never be, a study on chiropractic care for low back pain. Sure, there's been studies on manipulation on low back pain. But, (to me anyway...) chiropractic care involves soft tissue techniques, stretching, lifestyle modifications, addressing sleeping and working positions, postures and environment and yes, manipulation. It's the global package. That is why natural medicine fits so well into the chiropractic philosophy; therapy for almost any condition involves attacking the problem from multiple angles at once, safely and effectively. bmj.com Somani 322 (7282): 318b http://bmj.com/cgi/content/abridged/322/7282/318/b

Trial of two prescribing strategies for childhood acute otitis media

This study evaluates the "wait and see" attitude with childhood ear infections vs immediate antibiotic usage. This is really a neat article illuminating several points. First, it once again notes that antibiotics are NOT painkillers!! Antibiotics were not any more effective than placebo at reducing pain in the first 24 hours. After 24 hours they were more effective, but pain was also less severe after 24 hours anyway. 77% of the parents in the wait and see group were "very satisfied" and were less likely to believe in the effectiveness of antibiotics and in the need to see the doctor with future episodes. So, not only does using a "wait and see" approach produces similar results, but the parents seem to have a more realistic view in the effectiveness of medicine. bmj.com Abstracts: Little et al. 322 (7282): 336 http://bmj.com/cgi/content/abstract/322/7282/336

Celiac Disease Overlooked as Cause of Iron-Deficiency Anemia

Celiac disease (gluten insensitivity; an allergy to certain proteins in wheat, barley and rye) does occur at a surprisingly high percentage in our population (one in 100 to 300, depending upon whom you ask...), and anemia is only a small portion of the potential deleterious effects; Alzheimers, autoimmune diseases, dental caries and osteoporosis are but a few others on the list. Remember that food allergies, no matter the type, can upregulate the immune system and lead to excessive inflammation. One chaep, easy way to begin to cut down on some of your food allergies is to add betaine HCL (stomach acid) to your meals--the better we break down proteins to amino acids, the less likely those proteins are to invoke an allergic response.

Br J Haematol 2000;111:898-901 Especially in menstruating women, celiac disease appears to be underinvestigated as a potential cause of iron-deficiency anemia. Dr. D. J. Unsworth of Southmead Hospital in Bristol, UK, and colleagues identified 483 blood samples from prospective blood donors who met study criteria for anemia (hemoglobin <11 g/dL for women, <13.5 g/dL for men in order to recruit enough men). Of the donors, 28 women (26 premenopausal) and 4 men tested positive for IgA anti-endomysial antibodies and were asked to undergo further followup for celiac disease. Of the 25 subjects who underwent endoscopic small intestinal biopsy, 22 "had histological changes compatible with celiac disease," the researchers write. Twenty-one of these were women, and Dr. Unsworth's team notes that none of the women had been previously investigated for the possibility of celiac disease. The research team reports that their screening of anemic adults for celiac disease resulted in a detection rate of over 6%, compared with 0% detection of celiac disease using EDTA blood samples from 250 nonanemic blood donors. "Celiac disease serology is easy, cheap and reliable," the authors write. "We recommend that all cases of anemia of uncertain cause, including all women with anemia ascribed to menstrual blood loss or poor diet, be checked for celiac disease-associated autoantibodies."

Insulin Resistance in Muscle, Liver May Be Triggered by Fat Cell Defect

This is a rather complex article looking at the commonly held belief that fat cells do not have an influence on insulin resistance; rather, they are believed to suffer the effects of insulin resistance occurring in muscle and liver. This may not be so. This study used mice to initiate insulin resistance only in fat cells. Soon, changes in insulin sensitivity were also seen in the liver and muscle cells. In English, this means that the fat cells send out some (currently called "resistin") hormone that leads to insulin resistance in other cells. And remember that insulin resistance is a major contributor to diabetes. So much for calories in, calories out being the only thing you need to worry about for weight loss!!

Nature. 2001;409(6820) Fat cells that can't take up blood sugar normally appear to trigger the same problem in muscle and a related problem in liver, say researchers from Beth Israel Deaconess Medical Center in Boston, Massachusetts. Using a sophisticated genetic approach, the researchers wiped out the key protein in mouse fat cells that insulin tells to move glucose from the blood into the cells. Soon, muscle also ignored insulin's orders to take up glucose, and liver disregarded insulin's instructions to shut down the organ's glucose production. "This paper clearly shows that fat also is important for whole-body insulin action. We think fat releases a molecule that circulates to muscle and liver and impairs insulin signaling in those cells, " says senior author Barbara Kahn, MD, chief of the division of endocrinology and metabolism at Beth Israel Deaconess Medical Center. "For years, people have thought — and data have shown — that glucose uptake in muscle is very important for normal insulin action and to prevent diabetes. researchers thought the decreased glucose uptake into fat of obese and diabetic people was not important in causing insulin resistance," says Kahn, also a professor of medicine at Harvard Medical School. The new study reinforces a new appreciation of fat as an endocrine organ that influences other tissues. In January, for example, other researchers identified a hormone produced by fat cells, dubbed resistin, that prompts other tissues to resist insulin. Resistin is the latest in the list of active factors known to be secreted by fat that can affect insulin action. The list includes tumor necrosis factor-alpha, fatty acids and leptin, which works through the brain to regulate feeding and metabolism. Kahn's research group excludes all of these as likely culprits in the new paper.

Rising Obesity May Not Be Related to Less Physical Activity

This study suggests that participants in this study, have an increase in obesity rates despite vigorous physical activity. As usual, this should be no surprise. Obesity, like so many other chronic diseases, is a multifactorial problem. It needs a global approach for prevention as well as treatment. Exercise is a key management tool for a healthier life, but does not negate the bad effects of other unhealthy lifestyle choices. Diet plays a major factor in the determination of insulin resistance, leptin resistance and weight management.

Prev Med 2001;32:57-65 There is a trend toward increasing overweight in the US military that is similar to the pattern among the general population. US military personnel were chosen for study in order to investigate better the association between physical activity and overweight, "given that most US adults are employed in sedentary occupations and engage in very little leisure-time physical activity," note Dr. Robert M. Bray and Dr. Christine H. Lindquist, from research Triangle Institute in North Carolina. Drs. Bray and Lindquist sought to "explore changes in the prevalence of overweight from 1995 to 1998 and the relationship between trends in physical activity and overweight during this period." To that end, they studied data on more than 33,000 service members. The investigators defined overweight as body mass index of at least 25 and classified subjects as physically active if they reported at least 3 days per week of vigorous activity. According to their report, there was a significant increase in overweight over the 3-year study period for both men and women. Fifty percent of subjects were classified as overweight in 1995, compared with 54% in 1998. The researchers report that around 67% of the subjects engaged in regular, vigorous activity. "The results of this study suggest that the rise in overweight among the military is not explained by a decrease in physical activity," Dr. Bray and Dr. Lindquist conclude, indicating that "other factors, such as dietary intake, may be influential."

Early Onset of Puberty in Girls Still a Mystery

A mystery to whom? Add estrogen-mimicking hormones to the environment (called xenoestrogens), give all sorts of growth-stimulating hormones to cows so they can mass produce milk, increasing rates of obesity (fat cells are a source of estrogen), destroy the GI's normal flora (certain unfriendly flora unconjugate estrogen in the gut, essentially thumbing their bacterial noses at the liver's attempt to get rid of the estrogen via the bile) and store everything possibly edible in plastic or vinyl (believed to act as a xenoestrogen) and the "mystery" is solved.

(article) Scientists have known for several years that girls and boys are reaching puberty earlier than in the past, but they still do not know why this is happening, or what the consequences might be, experts said at a forum here Monday sponsored by the Environmental Media Services. A study of 17,000 girls, reported in the journal Pediatrics in 1997, found that the average starting age of puberty among white girls had dipped a year from previous studies, to 9.7 years. African-American girls were found to reach puberty even earlier, at an average age of about 8, according to Dr. Marcia E. Herman-Giddens, the principal investigator and a professor at the University of North Carolina, Chapel Hill. Data on when puberty starts has been skimpy over the years — especially for African Americans. Still, Dr. Herman-Giddens said at the forum, "I am confident that this trend is a real trend," adding that adolescence seems to be starting earlier and lasting longer in children worldwide. She is currently analyzing data on US boys. "What we're seeing is a symptom of a very serious public health problem," said Dr. Herman-Giddens, noting that the long-term physical and mental health effects of early puberty are not understood. Among the potential causes she mentioned are obesity or overweight, genetics, low birthweight, poor diet, lack of activity, and, surprisingly, an absentee father or a nonrelative male in the house. Scientists have also been exploring whether so-called endocrine disrupters — a group of chemicals thought to interfere with hormonal function — might be spurring or delaying puberty, Dr. Herman-Giddens noted. Dr. John Peterson Myers, director of the W. Alton Jones Foundation and author of a book on chemical contamination and fetal development, said that some of these chemicals have retarded sexual development in rat fetuses. Among the most controversial of these chemicals are phthalate esters, which are found in toys, vinyl flooring, detergents, and cosmetics and lotions. The science is not certain, but there is a plausible link, contends Dr. Myers. On Wednesday the Cosmetic, Toiletry and Fragrance Association released a statement noting that phthalates are widely used and have been favorably reviewed by the US Food and Drug Administration, the US Environmental Protection Agency, "and other scientific bodies in Europe, North America and Japan." Dr. Diana Zuckerman, executive director of the National Center for Policy research for Women and Families, said that she worries about the psychological impact of early puberty on young girls. She explained that studies have shown that girls who develop at a young age begin dating earlier, have sex sooner, are subject to more psychological stress and behavior problems, and are more likely to drink and smoke. "No matter what they look like, they are still little girls," she said. Dr. Zuckerman added that early puberty places stress on parents, who have to explain sexuality when their child is young.

Drug Combo Shortens Delivery W/ No Apparent Risk to Mother Or Child

The arrogance of science nevers ceases to amaze me. When it comes to evidence based medicine, obstetrics and gynecology in the US is about as sad as it gets. Birth position for widest pelvic outlet, need of episiotomy, high rates of C-sections--all fly in the face of research. But the induction of labor is such a common practice that "normal" lengths of labor are almost impossible to predict. I understand that, at times, the fetus' life is at stake. Talk to a midwife and they would very strongly disagree with the 20-30% induction rate in this article. But...don't forget