October 18, 2001 Research Update

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

TNF--dependent maturation of local dendritic cells is critical for activating the adaptive immune response to virus infection

I know this is a very long title, but I wanted to illustrate a point. TNF-alpha is an integral part of the immune response and we are only now just beginning to understand how it works. Using the new class of drugs for Crohn's and rheumatoid arthritis that blocks TNF-alpha just seems dangerous to me if we don't even fully understand what it does. PNAS -- Abstracts: Trevejo et al. 98 (21): 12162 http://www.pnas.org/cgi/content/abstract/98/21/12162

Tuberculosis Associated with Infliximab, a TNF–Neutralizing Agent

It's always enteresting to see articles come out in different journals that all seem to revolve around a common theme. In this case, we see that the new "wonder drug" for Crohn's and RA may have some severe side effects. I could accept these side effects in some patient if there were no alternative. However, with many autoimmune diseases, there are many options such as elimination diets, fasting and oral tolerance that can help control the disease. NEJM -- Abstracts: Keane et al. 345 (15): 1098 http://content.nejm.org/cgi/content/short/345/15/1098?query=TOC

AMA promotes benefits of "genetically improved" foods

The concept of GMO (genetically modified organism) is very controversial. The main problem is that we are creating new proteins that the body has never before been exposed to, creating a myriad of opportunities for new food allergies/sensitivities. On the other hand, many of the GMO products are produced to make the organism grow better or more hardy and resistant to disease. Personally, I choose not to put any GMOs into my body if I can help it. And, by the way, when did the AMA become such a wonderful reference source? bmj.com Hopkins 323 (7317): 828f http://bmj.com/cgi/content/full/323/7317/828/f

Nutrition and diet in the clinical management of multiple sclerosis

This article is always a nice one to hopefully wake up some of those in the medical community that consider nutritional advice for those with autoimmune diseases to be pointless. MS is one of those diseases that can be managed well with strong lifestyle changes designed to lower overall inflammatory burden and also to stablize the blood brain barrier. Interestingly, I remember an article awhile back that addressed the approach to stablizing the blood brain barrier and found the recommendations very similar to changes I would recommend to improve someone's overall health. Remember...taking care or yourself is taking care of yourself--no matter what disease you happen to have. Synergy : Journal of Human Nutrition & Dietetics 14 (5), 349-357 http://www.blackwell-synergy.com/Journals/content/abstracts/jhn/2001/14/5/abstract_jhn308.asp?journal=jhn&issueid=7404&artid=135274&cid=jhn.2001.5&ftype=abstracts

Lack of symptom benefit of presumptive H pylori eradication therapy

Forty-nine percent failure rate tells me that something is very wrong with our approach to this condition. Much like some many other things, I am beginning to feel that the presence of H. pylori is not the problem and is merely the symptom. The problem is that there is an environment that is conducive to the growth of this organism. Possibly vitamin C deficiency, possible hypochlorhydria, possibly chronic stress or hypoadrenism. So we eradicate the bug but don't fix the environment. So of course it comes back. Synergy : Alimentary Pharmacology & Therapeutics 15 (11), 1769-1775 http://www.blackwell-synergy.com/Journals/content/abstracts/apt/2001/15/11/abstract_apt1100.asp?journal=apt&issueid=7374&artid=134673&cid=apt.2001.13&ftype=abstracts

Anti-TNF, IL-10, antibiotics in indometacin-induced bowel inflammation

This is an interesting article that implicates both TNF-alpha and anaerobic bacteria in the development of Crohn's disease. So we are using fancy new drugs to block TNF-alpha (we all know my opinion on THIS one...); where is the other half of the therapy designed to address to harmful bacteria? A global approach to Crohn's includes probiotics, avoidance of refined sugars and managing insulin levels and obesity (both stimulate TNF-alpha production). Synergy : Alimentary Pharmacology & Therapeutics 15 (11), 1827-1836 http://www.blackwell-synergy.com/Journals/content/abstracts/apt/2001/15/11/abstract_apt1111.asp?journal=apt&issueid=7374&artid=134681&cid=apt.2001.13&ftype=abstracts

Surgery Advocated as Primary Treatment for Many Cases of GERD

I consider this topic, and this article, especially disturbing. To Western medicine, there are only two options to reflux disease: acid blockers or surgery. My gosh!! Have we forgotten that food allergy is known to play a strong role in lower esophageal tone? Cow's milk allergy and GERD are well accepted bedfellows in infants--why do we forget this concept when the patient becomes an adult? How about avoiding the nightshade vegetables, caffeine and alcohol long before any pharmaceutical intervention?? Remember--it is not the acid causing the problem, it's acid getting where it's not supposed to be...

87th Clinical Congress of the American College of Surgeons Surgery is the only way to cure gastroesophageal reflux disease (GERD) and should be the preferred treatment for Barrett esophagus, according to Dr. Jeffrey H. Peters of the University of California, Los Angeles. Dr. Peters made the case for Nissen fundoplication during a debate on surgical versus medical management of GERD at the 87th Clinical Congress of the American College of Surgeons. In an interview with Reuters Health, Dr. Peters challenged a recent report in The Journal of the American Medical Association, in which Dr. Stuart Jon Spechler and others concluded that antireflux surgery does not obviate the need for medications in most GERD patients. According to Dr. Peters, Dr. Spechler's group reported that 40% of GERD patients treated with surgery died within 10 to 13 years, and most of the surviving patients required proton pump inhibitors. Dr. Peters challenged the accuracy of those data and said that most of the surgery patients who were put on medical therapy following surgery had no indication for treatment. "If you look carefully at these patients, you will find that only 10% had acid indications that required proton pump inhibition," he said. Dr. Peters added that surgery should be offered to patients with pH-positive, non-erosive GERD and said surgery is the "preferred treatment for patients with endoscopic esophagitis — but it should be the primary treatment for Barrett's esophagus." He said, too, that successful GERD surgery is often more dependent on "repair of the hiatal hernia rather than lower sphincter repair." Dr. Joel Richter, head of gastroenterology at the Cleveland Clinic Foundation, represented the medical side of the debate and disagreed with Dr. Peters' claim that surgery can cure GERD. "In some patients you may get a good result for 5 or 10 years, but these patients are going to once again become symptomatic. I think it is more accurate to call surgery a functional repair." He added that "abdominal stressors don't go away just because you perform surgery." But Dr. Peters responded, "In a sense abdominal stressors do go away, because after a good repair, these patients can't vomit." Dr. Richter pointed out that surgery is "very dependent on good surgeons performing good operations on the right patients." Before a standing-room-only crowd of surgeons, Dr. Peters' remarks received long ovations, while Dr. Richter's remarks were greeted with polite applause.