January 5, 2004 Research Update

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

Hyperhomocysteinemia as independent risk factor for silent brain infarction

I recently had a patient who had asked her primary care doctor to run a homocysteine level based on some stuff she had been reading in layman's journals and her family history. Her doctor refused. I have routinely been running homocysteine and CRP levels on patients for quite awhile now. To say that elevated homocysteine (whether by itself or indirectly as a marker for altered folate/B12 status) has an impact on our health would be an incredible understatement. I am going to make a pretty strong statement here...any clinician who refuses to run a homocysteine level when a patient not only has a family history but REQUESTS the test should no longer be practicing. Being a physician and having patient's health in your hands requires certain committments--one of those would be to crack a medical journal at least once a month.

Neurology -- Abstracts: Kim et al. 61 (11): 1595

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Insulin resistance and tissue repair: A “fato-logical” phenomenon

Wow!! If you ever had some uncertainty about what insulin resistance is than this is a great overview.

Gastroenterology Online

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C-Reactive Protein and the Risk of Developing Hypertension

Someone needs to write an article entitled "chronic inflammation is a risk factor for and plays a role in every chronic disease known to man," then we could be done with all these little articles that related markers of inflammation to chronic disease states. It sure would save a bunch of money too... Come to think of it, throwing insulin resistance in the title would double our money saved on future research as well.

JAMA -- Abstracts: Sesso et al. 290 (22): 2945

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Water-Induced Thermogenesis

Well...having the body warm cold water that we drink increases metabolic rate and burns calories. Pretty neat and yet another reason to drink lots of water during the day. What surprises me, however, is that I haven't seen any infomercials later at night selling a special weight loss water program...the water could come all wrapped in dry ice...

JCEM -- Abstracts: Boschmann et al. 88 (12): 6015

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Relationship between cholesterol and survival in chronic heart failure

Well, now doesn't this just throw a wrench in the works? Lower cholesterol actually raised mortality rates in patients with chronic heart failure. Research like this really does make us think about our "blinders on" view of medical care today. Especially in light of the recent push to expand the use of statins to include just about everyone with a pulse.

Cardiosource

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Superoxide-mediated activation of uncoupling protein 2 causes pancreatic beta cell dysfunction

In English, this article links the progression of Type 2 diabetes to oxidative stress (superoxide is a free radical that causes damage to cellular membranes as well as DNA). Increased intake of fruits and veggies and antioxidants should be part of every regimine to lower risk and/or progression of type 3 DM.

JCI -- Abstracts: Krauss et al. 112 (12): 1831

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Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials

The last issue of the year of the BMJ is all parody, but this one really has a little too much irony in it. How many times have we come across studies where the end result was one that was incredibly obvious (i.e. fast food in children leads to obesity...) and yet lots of money was spent to perform the study? By the way, anyone out there interested in being in the placebo wing of this study?

bmj.com Abstracts: Smith and Pell 327 (7429): 1459

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Influenza-Associated Deaths Reported Among Children Aged <18 Years --- United States, 2003--04 Influenza Season

With all the hype going around I thought I should include this one. 42 reported deaths. 40% had underlying chronic medical conditions and the main cause of death the the flu is a secondary bacterial infection. The media has really made it sound like the planet will be wiped out within 3 months. I'm still waiting for the global devastation predicted from the flesh eating bacteria a decade or so ago. Bottom line--unfortunately, a few die from the flu every year. These numbers can't even be compared to the numbers who die from only one class of drugs (NSAIDs) in ONE DAY!!! And yet the media is hardly tripping over themselves to report that medication related deaths have been ranked close to the 3rd or 4th leading cause of death in the US. Keep your immune systems healthy and don't even consider the vaccination. Ironically (and I don't easily subscribed to conspiracy theories...), the Flumist vaccine majorly flopped this year, selling only a small percentage of what the manufacturer expected. However, with the hype of the flu and the "shortage" of the vaccine I have been hearing commercials for Flumist. This wouldn't be the first time a pharmaceutical company created a market for itself (aka Celebrex...).

Update: Influenza-Associated Deaths Reported Among Children Aged <18 Years --- United States, 2003--04 Influenza Season

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Misperceptions About Beta-Blockers and Diuretics

This is another one of those times that I have to throw up my hands in utter disbelief and confusion. It is now well accepted and proven that the older, cheaper meds for blood pressure are just as effective and safe as the new fancy-dancy expensive ones. And yet, clinicians are not getting the message. The same is happening with antibiotic overuse. There is such a disconnect between research and clinical practice as to be incredulous. I cannot believe that clinicians (and yes, I am generalizing here...) are so oblivious to what is in the medical literature. The only answer is that they never crack a medical journal and all their "continuing ed" comes from the drug companies. I know this reasoning is the only one that makes sense but I just find it hard to swallow--I believe most clinicians have only the based interests for their patients at heart.

Misperceptions About beta-Blockers and Diuretics. A National Survey of Primary Care Physicians - J Gen Intern Med, Vol 18, Is..

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Preventing colitis through alteration of the intestinal biota

This is a pretty nice overview of probiotics and their potential benefit to the GI tract. What does surprise me, however, is that with the whole issue of antibiotic overuse, all the concern is geared towards selection of antibiotic resistant bacteria (which, by the way, is a major contributing factor to the deaths of the children noted above with the flu). No concern is ever voiced about the destruction of normal, protective flora. Personally, I think this is the much, much more important concern affecting a much larger number of patients, especially children. How many infants are giving antibiotics for ear infections in their first 6 months without any thought to replacing the normal flora that were wiped out and are essential for proper development of that infant's immune system?

Gastroenterology Online

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