October 10, 2002 Research Update

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

Stability of ascorbic acid in commercially available orange juices

Given how much of a fan I am of high (gram) doses of vitamin C, the idea that any type of juice could be considered a good source of vitamin C doesn't make sense to me. This article finds that Vit C degrades rather quickly in juice as it nears its expiration date and that frozen has a higher content than pastuerized. Anyone surprised?

Entrez-PubMed

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Back, neck, and shoulder pain in Finnish adolescents

From a business standpoint, this ain't such bad news. Unfortunately, there is currently no shortage of adults with musculoskeletal pain and we don't need to add children to this already-too-long list. Children experiencing pain at this age does not bode well for future musculoskeletal health. If these kids do not get proper care now(i.e. chiropractic....), future episodes will generally increase in severity. It is possible that this increase is from a combination of factors, including decreased physical activities, heavier backpacks in school (I know this is a problem in the US, not sure if the same problem exists in Finland) and a more pro-inflammatory diet with more animal products and less fresh fruits and veggies.

bmj.com Abstracts: Hakala et al. 325 (7367): 743

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Brassica, Biotransformation and Cancer Risk: Genetic Polymorphisms Alter the Preventive Effects of Cruciferous Vegetables

Sorry for the long title, but this article once again moves far beyond what today's clinicians recognize: the compounds in broccoli and related veggies are good for us. This article begins to look at potential explanations for variations in response to the compounds found in cruciferous vegetables. Genetic variations in enzyme efficiency, variations in levels found in the vegetables themselves (usually based on growing processes) and variations from differences in preparation. Really an advanced article beginning to look past acceptance of benefit into the factors affecting level of benefit.

nutrition.org -- Abstracts: Lampe and Peterson 132 (10): 2991

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Breast Cancer Risk Associated w/ Lignans Differs by CYP17 Genotype

Ditto. All of us here, right now, are observed the dawn of the future of medicine. Granted, it may be several generations before mainstream medicine actually begins to read their own journals and pick up on this stuff. We are seeing the matching of lifestyle factors to the genes of a patient. In the near future, a simple genetic test may be able to spell out what YOU need to do to drastically lower or eliminate your risk of most chronic diseases. And this knowledge is not far off at all...probably no more than a few years at most.

nutrition.org -- Abstracts: McCann et al. 132 (10): 3036

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Human Adenovirus Promotes Weight Gain in Monkeys

While I don't have much to say on this topic (surprised?), I must admit that I have never given much thought to an infectious etiology for obesity. I just hope that we do not tread too heavily down this path, releasing patients of their own personal responsibility with lifestyle changes promoting a helthy weight and blaming excess weight on a virus that is beyond our control.

nutrition.org -- Abstracts: Dhurandhar et al. 132 (10): 3155

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Steroid and Cytokine Regulation of MMP Expression in Endometriosis

Cutting through the technical jargon, this article brings to light a potentially important factor for treatment of endometriosis. Progesterone is key here. Progesterone inhibits the ability of an enzyme, MMP, to establish endometriosis. This ability of progesterone can itself be inhibited by certain mechanisms. This study finds that the use of retinoic acid (vitamin A related compounds) and transforming growth factor beta (a cytokine controling cell maturation) can restore progesterone's protective ability. As added info, many women today, as a result of exposure to way too many exogenous estrogens, go through anovulatory cycles. Without the release of an ovum during a normal menstrual cycle, the body lacks that normal exposure to progesterone that is so needed for normal female reproductive function.

JCEM -- Abstracts: Bruner-Tran et al. 87 (10): 4782

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CLA Causes Isomer-Dependent Oxidative Stress and Elevated CRP

Before you run for your biochemistry book, let me give you a quick refresher. Conjugated linoleic acid has two main forms: t10c12 and t9c11. These are pretty evenly mixed in most commercial preparations of CLA. However, negative side effects such as fatty liver have been observed with its use. This study and others point the finger at the t10c12 isomer as the main culprit. What does this mean? Nothing right now, but keep an eye out for preparations with only the t9c11 isomer in the future.

Circulation -- Abstracts: Risérus et al. 106 (15): 1925

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Modest Weight Training Improves Bone Strength in Older Men, Women

This nice thing about this article is that it really stresses how much a simple exercise program can impact the health of our elderly. I know that in my office, the patients that exercise regularly (strength training and aerobic) are in overall much better health--better mobility and less (if any medication) use.

24th annual meeting of the American Society of Bone and Mineral Research

A modest weight training program done twice a week helps improve bone mineral density (BMD) in older men and women, according to findings presented here at the 24th annual meeting of the American Society of Bone and Mineral Research. The study involved 49 men and 78 women between the ages of 60 to 71 years, who were assigned to several different training regimens for a total of 40 weeks of training. Participants exercised either two or three times a week, and lifted either heavier loads with fewer repetitions or lighter loads with more repetitions. According to Dr. Micahel Bemben of the University of Oklahoma, if subjects lifted 40% of their strength, they did 16 repetitions in three sets, and if they lifted 80% of their strength, they did eight repetitions in three sets. Subjects were matched in terms of the amount of work done in each training session. Results at 40 weeks showed that men responded to the training with a significant increase in BMD of the spine and both men and women had significant increases in hip BMD. Total body BMD also increased significantly in women at the end of the 40-week training program. Participants also had "big improvements" in their strength such that at the end of 40 weeks, "they were lifting a fair amount of weight," Dr. Bemben said. "We think older people have more time but they are just as busy as younger people if not busier, and at least for bone data, it didn't seem to matter whether they exercised two or three times a week or whether they worked with high loads or load loads," Dr. Bemben. "So it's probably fair to say that you could hope to see at least maintenance [of bone strength] lifting lighter loads at 40% of your strength, twice a week."

Nearly All Headache Seen in Primary Care Is Migraine

Based on this article, I'm sure that I could go to my PCP right now with the headache I am experience as a result of beating my forehead against the computer screen and it would promptly be diagnosed as migraine. I'm sorry, this is a very biased opinion, but I started to believe that headaches are no longer a diagnosis that should be handled within mainstream medicine. Sure, we need to rule out aneurysms and tumors, but that's well within the scope and competence of most chiropractors. Currently, and I'm sure this will change at some point in the future, but I have achieved 100% resolution of all headache patients in my office that have listened to all the recommendations and lifestyle changes necessary. And I can't begin to tell you how many of those patients were given a diagnosis of migraine by previous doctors. Ironically, although most of these patients came in with multiple types of headaches (which is very, very common), true migraines are quite rare in my office. Needless to say, this article just plain floors me. One question I do have is, in the physical exam given, does anyone actually ever touch the neck????????

14th Migraine Trust International Symposium

The overwhelming majority of people who visit their primary care physician complaining of episodic headache have migraine, but an inaccurate patient self-diagnosis can lead to misclassification, researchers said at the 14th Migraine Trust International Symposium on Tuesday. Dr. Stewart Tepper, from the New England Center for Headache in Stamford, Connecticut, reported an analysis of findings from the 14-country, multicenter Landmark study, which enrolled 1,217 patients attending a primary care physician with a complaint of headache. At the beginning of the study, each patient made a self-diagnosis, and was given a diagnosis by their doctor. They then kept diaries for each of their next six headache attacks. The diaries of around 400 patients with newly diagnosed migraine or non-migraine headache were reviewed by Dr. Carl Dahlhof from Sweden, Dr. Andrew Dowson from the UK, Dr. Larry Newman from the US and Dr. Tepper. The panel assigned a diagnosis based on International Headache Society criteria. Ninety-four percent had either migraine or migrainous headaches, Dr. Tepper said. "If a patient comes in and complains of episodic migraine and the exam's normal, it's migraine until proven otherwise," he told Reuters Health. The expert panel then looked at the correlation between the primary care physician's diagnosis, the patient's self-diagnosis and the diagnosis based on the analysis of the six diary entries. "If the GP diagnosed the patient as having migraine then 98% of the time the GP was correct. If the patient diagnosed themselves as having migraine, there was a high chance they were right," Dr. Tepper said. "However, where things went awry was if primary care doctors diagnosed non-migraine. Then there was an 80% likelihood the patient had migraine. If the patients self-diagnosed non-migraine, there was an 85% likelihood the patient had migraine." Several factors were linked to the misdiagnosis, but the most important seemed to be an inaccurate self-diagnosis by the patient, he said. "If the patient said to the GP I don't think I've got migraine, then the GP would say OK. It didn't seem to matter about the intensity of the headache or the frequency of the headache, it was what the patient said the headache was that drove the diagnosis." Dr. Dowson commented, "These were very remarkable findings, we were not in any way expecting this." He noted that only migraine was commonly severe enough to make people visit their doctor. "We know there are many, many hurdles for patients to get to the doctor and then to get the message across, so what we're saying here is that tension-type headache is not severe enough to make people go and see their doctor and jump those initial hurdles. If someone comes in and says that they're having problems with their headaches, probably one of the first questions you should ask is, are these headaches that stop you doing things? Does it actually affect your quality of life? If the answer's yes, they're liable to be migraine."