January 22, 2001 Research Update

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

Complementary Medicine May Have Scant Effect in Asthma

Sometimes I'm not sure if we'll ever "get it." When it comes to using natural medicine to address a chronic disease, we are not looking for one magic bullet to solve everything. This is how the pharmaceutical companies think. Instead, the patient with asthma would eliminate intake of common allergens (milk, corn, wheat...), load up on probiotics, manipulation, exercise, make sure living space is clean and as dust free as possible, high dose Vit C to prevent release of histamine from mast cells, and several natural anti-inflammatories to boot. Of course this study does not show a benefit of individual complementary medicine!! How 'bout doing a study with all of these interventions compared to standard pharmaceutical intervention??

Ann Allergy Asthma Immunol 2000;85:438-449 There is little evidence that complementary or alternative medicine is useful in asthma treatment, according to a review of the subject. Drs. Donna Melissa Graham and Michael S. Blaiss of the University of Tennessee, Memphis, note that "complementary/alternative medicine is commonly used by patients with chronic conditions including asthma." Despite the lack of supporting evidence, they add, one third of the US population has tried such remedies. The researchers reviewed the literature covering a wide range of therapies, including traditional Chinese medicine, herbal medicine, aromatherapy, chiropractic manipulation and reflexology. The study was supported by an unrestricted grant from Astra Zeneca Pharmaceuticals. However, they came across few well-controlled studies that supported the efficacy of such approaches for asthma or atopic disorders. Among significant design flaws often encountered, were "insufficient numbers of patients, lack of proper controls, and inadequate blinding." In addition, "subject groups are often not well characterized in regard to asthma severity and use of conventional medications." The team found some indications for which "certain herbal therapies...could possibly be helpful in the treatment of allergic diseases." Nevertheless, they conclude that "available scientific evidence does not support a role for complementary/alternative medicine in the treatment of asthma."

Flavonol and Flavone Intake Linked With Nonfatal MI

Geez!! This was the exact title of the article. For those "title surfers" the first thought would not be a good one!! Flavones are INVERSELY linked with MI!! Anyway, this is, once again, not a tremendous surprise. Flavanoids are substances found in green tea, fruits and veggies.

Epidemiology 2001;12:62-67 Consumption of flavonols and flavones, which are found in tea, vegetables, fruits and wine, is inversely associated with nonfatal myocardial infarction in male smokers. Since the evidence on the relationship between heart disease and flavonols and flavones is mixed, Dr. Tero Hirvonen, of the National Public Health Institute, in Helsinki, Finland, and a multicenter team sought to clarify this relationship by evaluating 25,372 Finnish men enrolled in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. The trial was originally designed to see if supplementation with alpha-tocopherol and beta-carotene, either alone or in combination, reduced the risk of lung cancer in male smokers aged 50 to 69. At baseline, all participants completed a dietary questionnaire. After adjustment for age, supplementation group and cardiovascular risk factors, men in the highest quintile had a 23% lower risk of a nonfatal myocardial infarction compared with those in the lowest quintile. "The largest decrease in coronary risk in our data was observed between the lowest and the second-lowest quintiles of flavonol and flavone intake," the researchers point out. "This pattern may indicate that only very low intake of flavonols and flavones increases the risk of coronary heart disease or that low intake is a surrogate measure for lifestyle risk factors related to the risk of coronary heart disease," Dr. Hirvonen's group concludes. In contrast to the risk of nonfatal myocardial infarction, the adjusted risk for coronary death was not significantly associated with intake of flavones and flavonols, according to the report. The findings of this study conflict with the results of most other studies on the subject, which suggest that high intake of flavones and flavonols is associated with a reduced risk of coronary death, but not with a lower risk of nonfatal myocardial infarction. According to the researchers, the discrepancy may result from differences in the study populations. They note that the intake of antioxidants was lower in their Finnish study population than that in the populations of most other studies.

EPA Says US Children Face Environmental Health Threats

I don't mean to diminish the importance of maintaining a clean environment. It is unquestionable that we have toxins in our environment that negatively impact our health. The best way I can illustrate my concern is with a conversation I had with an asthmatic's mother recently. The mother had done everything she could think of; got rid of the cat, uses air filters, covers on the mattress and pillows, etc... But she never once considered attacking the problem from inside. By improving her daughter's health. The rates of asthma are increasing, and I'm afraid we are going to blame it all on the external environment, and not claim any personal responsibility for the internal environment.

(article) Fewer US children now live in counties with heavily polluted air, but children face other growing environmental health problems such as asthma, the US Environmental Protection Agency said on Monday. Outgoing EPA Administrator Carol Browner used the report to highlight concerns of the Clinton administration, which has fewer than 2 weeks left in office. "The Clinton-Gore administration has made the protection of children's health one of its highest environmental priorities," Browner said in a statement. "We especially are concerned about such issues as exposure to lead and pesticides and rising incidence of childhood asthma." The report showed there has been some progress in curbing environmental health threats to children. For example, data showed a decline from 28% in 1990 to 23% in 1998 in the percentage of American US living in counties where one or more of a half-dozen key air pollutants exceed national air quality standards. Those pollutants include carbon monoxide, sulfur dioxide and lead. The EPA also noted a decrease in the percentage of homes with both a tobacco smoker and a child under age 7. That fell from 29% in 1994 to 19% in 1999, the study said. Another improvement occurred in the availability of safe drinking water for children. The percentage of children living in areas that logged violations of drinking water standards fell from 19% in 1993 to 8% in 1998. But other trends are worrisome, according to the EPA, which found that environmental health problems are consistently higher among low-income families. Poor black children have a higher rate of asthma than children in other racial groups and income groups. Also, the prevalence of asthma among all children in the US increased from 5.8% in 1990 to 7.5% in 1995, the agency said. The EPA said that its report could not offer any quick fixes to the health issues, and instead it outlined how the federal government needs to develop better measurements and data to address children's environmental health issues. The EPA separately announced that it will require companies to make public more information about their lead emissions into the air, water and land. The new rules will require companies that annually use more than 100 pounds of lead and lead compounds to provide information to the EPA under the agency's consumer right-to-know program. Previously, reporting rules applied to users of more than 10,000 pounds annually.

Vit C Use and Bone Mineral Density in Postmenopausal Women

I am a very big fan of the use of Vit C for bone health because Vit C is essential for laying down ground substance, the framework upon which bone and cartilage is built. Interestingly, the average intake was 745 mg; much, much higher than the RDA.

J Bone Miner Res 2001 Jan;16(1):135-40 vitamin C is known to stimulate procollagen, enhance collagen synthesis, and stimulate alkaline phosphatase activity, a marker for osteoblast formation. Studies of dietary vitamin C intake and the relation with bone mineral density (BMD) have been conflicting, probably because of the well-known limitations of dietary nutrient assessment questionnaires. The purpose of this study was to evaluate the independent relation of daily vitamin C supplement use with BMD in a population-based sample of postmenopausal women. Subjects were 994 women from a community-based cohort of whom 277 women were regular vitamin C supplement users. vitamin C supplement use was validated. Daily vitamin C supplement intake ranged from 100 to 5,000 mg; the mean daily dose was 745 mg. Average duration of use was 12.4 years; 85% had taken vitamin C supplements for more than 3 years. BMD levels were measured at the ultradistal and midshaft radii, hip, and lumbar spine. After adjusting for age, body mass index (BMI), and total calcium intake, vitamin C users had BMD levels approximately 3% higher at the midshaft radius, femoral neck, and total hip (p < 0.05). In a fully adjusted model, significant differences remained at the femoral neck (p < 0.02) and marginal significance was observed at the total hip (p < 0.06). Women taking both estrogen and vitamin C had significantly higher BMD levels at all sites. Among current estrogen users, those also taking vitamin C had higher BMD levels at all sites, with marginal significance achieved at the ultradistal radius (p < 0.07), femoral neck (p < 0.07), and total hip (p < 0.09). Women who took vitamin C plus calcium and estrogen had the highest BMD at the femoral neck (p = 0.001), total hip (p = 0.05), ultradistal radius (p = 0.02), and lumbar spine. vitamin C supplement use appears to have a beneficial effect on levels of BMD, especially among postmenopausal women using concurrent estrogen therapy and calcium supplements.

Electrodermal testing as effective as skin prick for diagnosing allergies?

This is sort of funny to me. I consider skin prick tests just short of worthless (and painful!!). Skin prick tests check for classical IgE mediated allergies. Doesn't even come anywhere near checking for IgG4 mediated allergies (the delayed onset type). Electrodermal testing looks more towards sensitivities, and focuses less on IgE allergies. It is based on acupuncture principles, and yet there were no acupuncturists cited as contributing authors. Strange... Although I do not utilize this technique, it is one of those that I do have some degree of faith in. bmj.com Abstracts: Lewith et al. 322 (7279): 131 http://bmj.com/cgi/content/abstract/322/7279/131?lookupType=volpage&vol=322& fp=131&view=short

Prescription drug shortages plague US

This is supposed to be a bad thing, a "plague?" In many cases I would consider this a blessing. A ridiculous example given involves oxytocin, a drug used to induce labor. Brigham and Women's Hospital in Boston uses this in "almost every one of its 10,000 annual deliveries." (What ever happened to nature???) The truly ironic quote by Dr David Acker, the hospital's chief of obstetrics, was that, when doctors had to cut back on their use of the drug, "Fortunately no patient suffered." Okay, okay. So WHY do we use it at all?? No patient suffered because they did not have a drug to try to best nature? Forward this one to any midwives you know and they'll pass out laughing.... bmj.com Charatan 322 (7279): 130a http://bmj.com/cgi/content/full/322/7279/130/a

Hepatitis associated with Kava, a herbal remedy for anxiety

Two points here. First of all, everything in moderation. High levels of any herb can be dangerous. Second, we're talking about ONE case study here. Crack open a PDR and look for documented cases of liver damage among many of the common antianxiety drugs on the market. bmj.com Escher et al. 322 (7279): 139 http://bmj.com/cgi/content/full/322/7279/139

Are Patients' Office Visits with Physicians Getting Shorter?

I thought this was a very interesting article examining a very important question. The answer? No, they are longer by one to two minutes over the past decade. So why the appearance of shorter office visits? I don't know the answer, but I feel that if we could find out why patients feel this way then we would be somewhat closer to fixing our health care problems. Special Article -- NEJM 2001; 344: 198-204 http://www.nejm.org/content/2001/0344/0003/0198.asp