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June 17, 2003 Research Update |
James Bogash, D.C. Mesa, AZ
info@lifecarechiro.com
www.lifecarechiro.com
Estrogen Plus Progestin & Dementia & Mild Cognitive Impairment
Depsite an attempt to promote HRT as protecting against dementia and Alzheimer's, this study shows increased risk. Heck...if this stuff didn't have billions of dollars behind it pushing for its use, I'm darn sure these compounds would have a skull and crossbones on them and kept in a high cabinet where the kids couldn't get to them.
JAMA -- Abstracts: Shumaker et al. 289 (20): 2651
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Effect of Estrogen Plus Progestin on Stroke in Postmenopausal Women
Ditto on the above with an increased risk of ischemic stroke. Hey, this isn't me making this stuff up just to make it look bad!!
JAMA -- Abstracts: Wassertheil-Smoller et al. 289 (20): 2673
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Incidence of Recurrent Venous Thromboembolism After Treatment w/ Vitamin K Antagonists in Relation to Time Since First Event
This one is kind of an important one for me because I've had numerous patients in my office who have been on blood thinners for years for an isolated event many, many years ago. Basically, there doctors where afraid to take them off of the blood thinners for fear of recurrence. I remember a recent patient that had a clot in the femoral artery probably 10 years prior and had been on thinners since, with getting his blood checked every two weeks and the works. Fine and dandy, right? No future risk of stroke, right? This patient has Parkinson's that was progressing. High dose vitamin E and ginko may protect against progression but these are no-nos with blood thinners (or so the "standard of care" would have us believe). This patient needed to have a serious heart-to-heart with his PCP and decide on his options. This study finds that after 9 months, risk from a one-time incident is negligent and blood thinners may no longer be needed.
Arch Intern Med -- Abstracts: van Dongen et al. 163 (11): 1285
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Rapid MRI vs Radiographs for Patients With Low Back Pain
This study found no additional benefit to ordering MRI over standard Xrays. Interestingly, this study found that patients who had MRIs were more likely to undergo surgery. Basically, this supports what I always tell patients--just because something shows up on an MRI (i.e. disc herniation) does not mean that it is causing your current symptoms. Nothing replaces a good exam. An MRI should NOT be used to make a diagnosis, but rather to confrim what you already know or clarify a diffiucult case presentation.
JAMA -- Abstracts: Jarvik et al. 289 (21): 2810
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C-section increases risk of hospital care in childhood for asthma, gastroenteritis
While these results may seem confusing at first, recall that a newborn's first exposure to beneficial bacteria is through the vaginal vault during delivery (provided that the mother has not undergone antibiotic therapy anytime in the past that may have destroyed or upset local flora in the vaginal vault). This exposure sets in motion a series of processes that help the developing child's immune system mature properly.
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Treatment of multiple sclerosis with the pregnancy hormone estriol
I'll take this opportunity to freshen up on female hormones. The human produces three estrogens; estradiol, estrione and estriol. Estriol is generally considered the friendly hormone, and many regimens of natural HRT rely heavily upon estriol. In this study we see estriol as possibly being protective against MS. This study tried to figure out why MS symptoms seem to be reduced or in remission while a woman is pregnant (a condition where estiol levels are high) and found that estriol may be a factor.
Entrez-PubMed
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Probiotic strains in IL 10 knockout mice and link with cytokine balance
Many theories have been proposed as to why probiotics favorably impact the immune system, and this mouse study shows that probiotics actually have the ability to favorably alter the cytokine balance away from a Th-1 dominated state, which would lower risk of autoimmune conditions such as MS, lupus and rheumatoid arthritis.
Gut -- Abstracts: McCarthy et al. 52 (7): 975
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Live probiotics protect intestinal epithelial cells from the effects of infection with enteroinvasive Escherichia coli
With all this good research backing up probiotic use, I think I'm going to run out and eat some dirt...or, maybe just make a fruit smoothie with probiotic cultures mixed in.
Gut -- Abstracts: Resta-Lenert and Barrett 52 (7): 988
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H. pylori Eradication Can Result in Significant Weight Gain
This presentation follows on the heels of a research study that shows increased ghrelin levels (a hormone that increases hunger) with H. pylori eradication, with the hypothesis that this may lead to increased weight gain. This article supports that hypothesis. And remember in ten years when the shift starts moving away from H. pylori eradication that you read it here first...
DDW 2003: Abstract W1064. Presented May 21, 2003
May 27, 2003 (Orlando) — Eradication of Helicobacter pylori in patients with epigastric pain resulted in a significant increase in weight, and this was in a population that was somewhat overweight to begin with, British researchers reported here last week at Digestive Disease Week 2003. Lead investigator Athene Lane, MD, from Frenchay Hospital and the University of Bristol in the U.K., reported on findings of 10,537 individuals involved in the Bristol Helicobacter Project, a community-based, randomized, controlled study designed to evaluate the effects of H. pylori eradication. Of the total number of individuals involved, 1,634 subjects tested positive for H. pylori on 13C-urea breath testing. These individuals were then randomized to receive either ranitidine bismuth citrate 400 mg twice daily plus clarithromycin 500 mg twice daily for two weeks or placebo. Height and weight were measured at baseline and then at a six-month follow-up visit. All subjects also answered a questionnaire about dyspepsia symptoms before and after treatment. Average body mass was 77.2 kg at baseline and 75.9 kg at the six-month mark, with subjects on active treatment gaining an average of 0.6 kg more than subjects randomized to placebo, Dr. Lane reported. In total, 19% of patients receiving active treatment gained 3 kg or more compared with 13% of patients receiving placebo. Dr. Lane told Medscape that subjects who reported the greatest symptom relief after eradication therapy were those most likely to gain weight. "Weight gain was presumably the result of symptom relief," she said."General practitioners may want to warn their patients about what they eat [after treatment for H. pylori infection]," Dr. Lane continued. "They may want to caution them...because this was a significant amount of weight gain in many patients."
Probiotics Significantly Reduce Symptoms of IBS, Ulcerative Colitis
It's nice to see that probiotics are finally making it into the limelight. Sadly, this is about a decade behind the research and probably another decade before it makes it into clinical practice. Currently, most docs that have some inkling that certain bacteria may benefit the GI tract tell their patients to eat yogurt--which is usually laden with sugar or aspartame and has relative minute levels of probiotics compared to supplemental usage.
DDW 2003: Abstract M1582, presented May 19, 20003; Abstract W1523, presented May 21, 2003
May 21, 2003 (Orlando) — Probiotic therapy, primarily in the form of Lactobacillus acidophilus and Bifidobacteria infantis, significantly improves symptoms and quality of life in patients with irritable bowel syndrome (IBS) and other bowel disorders, researchers reported in a number of presentations here at Digestive Disease Week 2003.In a study designed to assess the efficacy of probiotics alone or in combination with antibiotics in patients with IBS, Stephen M. Faber, MD, from Albemarle Gastroenterology Associates, PC, in Elizabeth City, North Carolina, evaluated treatment in 44 patients with IBS. Twenty patients received probiotics alone and 24 received ciprofloxacin 500 mg twice daily for one week and two probiotic formulations, Lactobacillus (NCFM) 10 billion/g and Bifidobacteia infantis (Bifdo), 10 billion/g for four weeks. Patients completed the IBS-Quality of Life (IBS-QOL) questionnaire and the Symptom Frequency Index (SFI) before and after treatment. For the study group as a whole, IBS-QOL scores averaged 66.2 before treatment and 84.6 after treatment. SFI scores before treatment averaged 38, decreasing to 18 after treatment. In patients who received both probiotics and antibiotics, IBS-QOL scores averaged 67.6 before and 87.8 after treatment. SFI scores averaged 35 at baseline, decreasing to 18 after treatment.In the probiotic-only group, baseline IBS-QOL scores were 69.3, increasing to 86.4 after treatment. SFI scores were 39 at baseline and 17 after treatment.Differences in IBS-QOL and SFI scores between probiotic plus antibiotic treatment and probiotic-only treatment were statistically insignificant, Dr. Faber reported.A retrospective look at IBS patients treated with probiotics indicates that there is a deficiency of Lactobacillus in the gut flora in patients with IBS, Dr. Faber noted, "but we're not ready to call IBS an infectious disease."Probiotic therapy also improved symptoms of ulcerative colitis (UC) in a separate study presented by Richard N. Fedorak, MD, professor of medicine and director of the division of gastroenterology at the University of Alberta in Edmonton, Canada. In a safety and efficacy study of the probiotic formulation VSL3 (VSL Pharmaceuticals, Inc., Ft. Lauderdale, FL), which contains eight lactic acid bacterial species, Dr. Fedorak and colleagues evaluated 30 patients with active mild-to-moderate UC with recent flares. Patients continued with previous treatment that included mesalamine, corticosteroids, and/or azathiaprine, as long as the treatment regimen was stable prior to the study. Patients took two VSL3 sachets twice a day for six weeks. Ulcerative Colitis Clinical Scores were measured and sigmoidoscopy performed at baseline and after the six-week treatment period. Dr. Fedorak reported that remission occurred in 63% (19 patients) and there was a clinical response in an additional 23% (seven patients). There was no response in 13% (four patients). Worsening of symptoms occurred in one patient.Dr. Fedorak said that probiotic therapy was not associated with any adverse clinical or biochemical events. "I haven't heard of getting into trouble with probiotics," Dr. Faber told Medscape. "These are organisms that are supposed to be in the gut. The body knows how to control them, so it doesn't seem that you can overtreat."While probiotics have been recognized as beneficial components of food, Dr. Fedorak pointed out that "we don't use it as a food product anymore but as a treatment."Infantile diarrhea can be shortened by about a day from the usual three- to four-day course. That is very important in infants. Probiotics are effective with rotavirus symptoms, with antibiotic-induced diarrhea, in pseudomembranous colitis, and perhaps in radiation-induced diarrhea," he said.But Dr. Fedorak cautioned that "we don't know how they work. They appear to strengthen the mucosal barrier of the bowel and improve immune function. And we don't know which probiotics to use or in what combination."