March 5, 2001 Research Update

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

Successful Withdrawal of Thyroid Hormone in Nursing Home Patients

The authors of this article went to four nursing homes and identified patients on thyroid hormone therapy; many were believed to be put on the therapy inappropriately or had only needed it temporarily. Many had been on the hormones since they were younger. Half of the patients that met the criteria for the study were successfully weaned from the hormones. This article raises many interesting issues. First, I believe we handle thyroid disorders very poorly. There are so many patients out there who are put onto thyroid hormone replacement for one main reason only -- abnormal lab findings. If those labs are normal, you're normal. If they're abnormal you're put on thyroid hormone. Yet, many, many times on the hormones, the patient's bloodwork comes back to normal but their symptoms are still present!! Two possibilities: subclinical hypothyroidism (us docs need to stop using labs and use our brains-LOOK at the patient for a change--not the bloodwork!!) and lack of effect of thyroid hormone. Glandulars typically work cheaper and more effectively than synthetic hormones.

J Am Board Fam Pract 13(6):403-407, 2000 Studies of community-dwelling patients have indicated that substantial numbers of patients might have had thyroid hormone therapy prescribed inappropriately and that thyroid hormone therapy in some can be discontinued without adverse effects or evidence of clinical hypothyroidism. We wanted to find out whether thyroid hormone therapy in selected nursing home patients could be withdrawn without adverse effect. Thyroid hormone therapy was successfully withdrawn from one half of the nursing home residents studied. Previous studies conducted in community-dwelling patients have shown similar findings. Many older patients began taking thyroid hormone therapy when younger either for inappropriate reasons or for what turned out to be transient hypothyroidism. If the findings of this study are generalizable for other nursing home residents, there are important implications for health and health care costs.

Tungstate Improves Glucose Homeostasis in Diabetic Rats

I must admit, this is the first I've ever heard of tungstate being used for anything other the light bulbs; let alone health care. But, there was a time I would've said the same of lithium, vanadium or chromium when it came to glucose control. Live and learn...

Diabetes 2001;50:131-138 Dr. Joan J. Guinovart from Universitat de Barcelona and colleagues have previously shown that tungstate lowers blood glucose levels in rats made insulin deficient to simulate type 1 diabetes. In the current study, the researchers administered tungstate orally to 7.5-week-old Zucker diabetic fatty rats, which are "considered the closest available rat model to human type 2 diabetes associated with obesity." The animals had begun to show hyperglycemia, and the treatment temporarily reversed this for about 10 days. Glucose levels then rose again but stabilized at about 200 mg/dL at day 24. In contrast, the glucose level of untreated rats rose to a maximum value of 450 mg/dL. Tungstate treatment caused serum triglyceride levels to fall by 42%, and normalized hepatic concentrations of glucose-6-phosphate. The researchers also found that the treatment led to 55% higher glycogen levels in the liver compared with untreated diabetic or healthy rats. Treatment did not cause a significant change in phosphotyrosine-modified proteins in cultured hepatocytes from diabetic animals. "These data suggest that tungstate administration to Zucker diabetic fatty rats causes a considerable reduction of glycemia, mainly through a partial restoration of hepatic glucose metabolism and a decrease in lipotoxicity," Dr. Guinovart and colleagues conclude.

Aspirin for the Heart May Be Unsafe for Low-Risk Individuals

I come across many people in the community who have self-prescribed aspirin to protect against heart attacks. Many of them are unaware that the evidence is still weak for primary prevention (preventing the initial attack) and that, even if you lower your risk for heart attack you increase your risk for stroke. Care to pick? Personally--I would rather lower my heart disease risk with twenty lifestyles changes that don't increase my risk of stroke (and will probably actually decrease it!).

Heart 2001;85:265-271 Dr. L. E. Ramsay and colleagues, from the Royal Hallamshire Hospital in Sheffield, UK, performed a meta-analysis of four randomized controlled trials that assessed the beneficial and harmful effects of aspirin as a preventive measure for coronary heart disease. From this, the researchers were able to determine the usefulness of aspirin therapy based on a person's risk of a coronary event. For people with a 1.5% or greater coronary event risk per year, aspirin is a safe and worthwhile means of primary prevention, Dr. Ramsay's group determined. In people with a 1% risk, aspirin is safe, they found, but it is unlikely to be of much therapeutic value. However, in people with a 0.5% coronary event risk per year, aspirin therapy is actually unsafe, according to the report. In this group, the bleeding risks of aspirin are likely to outweigh any beneficial effects. "Aspirin cannot be prescribed safely for primary prevention of coronary heart disease without formal estimation of coronary disease event risk of the individual," the researchers emphasize. "Accurate risk estimation requires counting and weighing of major risk factors for coronary heart disease, using risk functions derived from epidemiologic studies such as Framingham."

Lp(A) Levels and ApoE4 Allele Predictive of Coronary Events in Men

The Lp(a) marker has been used in many functional medicine lab's coronary risk profiles for years now. And to that homocysteine, cholesterol, CRP, fibrinogen and several others and you get a very good picture of cardiovascular risk. Remember that many of today's chronic diseases have more than one contributing factor--do you think checking only one factor (cholesterol) is anywhere near all we need to be doing these days to evaulate cardiovascular risk? I've got a better idea--save the money on the lab tests and just start leading a healthy lifestyle...

Am J Med 2001;110:22-32,71-72 Adjusted multivariate analysis revealed cholesterol level, diabetes, smoking status, diastolic blood pressure, Apo-AI, age, and Lp(a) as independent risk factors for cardiac events. Dr. Seed and colleagues found that "coronary events were lowest in the group with Lp(a) levels below 2.9 mg/dL (the 25th percentile), highest in those with levels higher than 26.3 mg/dL (the 75th percentile), and intermediate in the group with levels of 2.9 to 26.3 mg/dL." In the second study, Dr. Angelo Scuteri and colleagues, from the National Institutes of Health, in Baltimore, measured apoE genotypes in 730 men and women who participated in the Baltimore Longitudinal Study of Aging. The researchers identified the apoE4 allele in 200 subjects. On follow-up, 104 of the 730 subjects had coronary events. These events were significantly more frequent in subjects with the apoE4 allele (20%) than in those without it (12%), Dr. Scuteri's team reports. "In a multivariate model, apoE4 was an independent predictor of coronary events in men (risk ratio 2.9), but not in women (risk ratio 0.9)," they note. Dr. Scuteri and colleagues also found that cholesterol levels did not appear to mediate the association. Despite the findings of these two studies, Dr. Peter W. F. Wilson, from Boston University School of Medicine, maintains that there is nothing definitive about using these markers as predictors of cardiac events. In an accompanying editorial, he writes that "improvement in vascular disease risk prediction with apoE allele determination is marginal [and] for Lp(a), the situation is [even] more murky."

Standardised Ginseng Extract G115® in Chronic Bronchitis

It is nice to see studies coming out using natural medicine and Western medicine in harmony. Too many times today natural therapeutics are viewed with skepticism and even fear, when in reality they can many times improve the way we currently do things.

Clin Drug Invest 21(1):41-45, 2001 In the group receiving G115® ginseng extract, bacterial clearance was significantly faster than in those receiving antibacterials alone. These results indicate a beneficial effect of G115® ginseng extract on the reduction of bacterial counts in the bronchial systems of patients with acute attacks of chronic bronchitis. Patients in whom the elimination of bacteria from the bronchial system is particularly difficult may benefit from the use of ginseng.

Why Are Antibiotics Prescribed for Patients With Acute Bronchitis?

This study asks the question of providers, despite multiple studies showing no benefit to using antibiotics in acute bronchitis, why are antibiotics still being prescribed? The answer? They don't really know!! No patterns were detected based on signs and symptoms, so the authors concluded that it must be due to "other factors, such as nonclinical cues..." What is that? Maybe the Merck rep bought lunch that day...

J Am Board Fam Pract 13(6):398-402, 2000 Thirty-five (26%) patients received antibiotics for their acute bronchitis. Adults were more likely to receive antibiotics than children (34% vs 3%, P < .001). Analysis of 20 different symptoms and physical findings showed that symptoms and signs were poor predictors of antibiotic use. Likewise, no significant differences were found based on prescribing habits of individual providers or provider level of training. Conclusion: In a setting where antibiotic use for acute bronchitis had been decreased through an ongoing quality-improvement effort, it did not appear that providers selectively used antibiotics for patients with certain symptoms or signs. Other factors, such as nonclinical cues, might drive antibiotic prescribing even after clinical variation is suppressed.

Fiber Intake Affects Risk of Oral, Pharyngeal and Esophageal Cancer

The results of this study indicate nearly half the risk of cancer in those taking in higher amounts of fiber from various sources. If you remember back a few months ago when one research study showed no protection of fiber on colon cancer (which was commented on in this newsletter...) the findings were all over the news. Didn't hear this study anywhere, did you? I still firmly believe that fiber IS protective against colon cancer, and this study showing protection in other areas of the GI tract just confirm my beliefs.

Int J Cancer 2001;91:283-287 Dr. Cristina Bosetti, of Istituto di Ricerche Farmacologiche Mario Negri in Milan, Italy, and colleagues used data from a case-control study conducted in Italy to investigate the relation between consumption of various types of fiber and oral, pharyngeal and esophageal cancer. Cases included 271 patients with oral cancer, 327 with pharyngeal cancer and 304 with esophageal cancer. Controls included 1950 subjects with acute, nonneoplastic diseases. The subjects were interviewed during their hospital stay using a validated food frequency questionnaire. The researchers calculated odds ratios after adjustment for age, sex, and other confounding factors, including alcohol and tobacco consumption and energy intake. According to the report, "the odds ratios for the highest versus the lowest quintile of intake of oral, pharyngeal and esophageal cancer combined were 0.40 for total (Englyst) fiber, 0.37 for soluble fiber, 0.52 for cellulose, 0.48 for insoluble noncellulose polysaccharide, 0.33 for total insoluble fiber, and 0.38 for lignin." The investigators report that the inverse relation was similar for vegetable fiber, fruit fiber and grain fiber, with odds ratios of 0.51, 0.60 and 0.56, respectively. However, the inverse relation was somewhat stronger for oral and pharyngeal cancer than for esophageal cancer. The odds ratios were similar for the two sexes. "The present results confirm the findings of other studies of upper digestive tract neoplasms conducted in North America and Europe, dealing mainly with whole grain cereals," Dr. Bosetti and colleagues comment.

Ketogenic Diet May Interfere With Normal Platelet Aggregation

Never heard of the ketogenic diet? It was originally designed for children with seizures who did not respond to anti-seizure meds. Nowadays the diet is amazingly similar to the high-protein, Atkin's type diet. This dietary pattern truly opens the body up to so many adverse health effects in the short term, not to mention the long term effects of avoiding whole grains, that I cannot understand why anyone would attempt it. The only type of patient I could support on this type of diet is one with syndrome X, where the body is becoming insulin resistant. In this case, the damage avoided by lowering insulin levels may balance out the bad effects of the diet.

Ann Neurol 2001;49:98-103 Excessive bruising and bleeding occurs in about one third of epileptic children who are on a ketogenic diet, according to Chicago-based investigators. Chart reviews of 10 such patients and prospective screening of 41 others revealed an increased frequency of bruising in 31.4%, and other bleeding symptoms in 5.9%. Dr. Elizabeth Berry-Kravis and associates o