June 2012 Archives

Naturopathic Fun Facts

By Sarah LoBisco, ND

Below are some recent summaries on the latest findings in diagnostic tests and health risks. My June 2012 Top Reads on my home page explains more....

CT Scans in Children Increase Risk for Leukemia

Use of CT scans in children to deliver cumulative doses of about 50 mGy might almost triple the risk of leukaemia and doses of about 60 mGy might triple the risk of brain cancer. Because these cancers are relatively rare, the cumulative absolute risks are small: in the 10 years after the first scan for patients younger than 10 years, one excess case of leukaemia and one excess case of brain tumour per 10 000 head CT scans is estimated to occur. Nevertheless, although clinical benefits should outweigh the small absolute risks, radiation doses from CT scans ought to be kept as low as possible and alternative procedures, which do not involve ionising radiation, should be considered if appropriate.

Pearce, M. et al.Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. The Lancet, Early Online Publication, 7 June 2012. doi:10.1016/S0140-6736(12)60815-0

Diagnostic Imaging Use Increases

During the 15-year study period, enrollees underwent a total of 30.9 million imaging examinations (25.8 million person-years), reflecting 1.18 tests (95% CI, 1.17-1.19) per person per year, of which 35% were for advanced diagnostic imaging (computed tomography [CT], magnetic resonance imaging [MRI], nuclear medicine, and ultrasound). Use of advanced diagnostic imaging increased from 1996 to 2010; CT examinations increased from 52 per 1000 enrollees in 1996 to 149 per 1000 in 2010, 7.8% annual increase (95% CI, 5.8%-9.8%); MRI use increased from 17 to 65 per 1000 enrollees, 10% annual growth (95% CI, 3.3%-16.5%); and ultrasound rates increased from 134 to 230 per 1000 enrollees, 3.9% annual growth (95% CI, 3.0%-4.9%). Although nuclear medicine use decreased from 32 to 21 per 1000 enrollees, 3% annual decline (95% CI, 7.7% decline to 1.3% increase), PET imaging rates increased after 2004 from 0.24 to 3.6 per 1000 enrollees, 57% annual growth. Although imaging use increased within all health systems, the adoption of different modalities for anatomic area assessment varied. Increased use of CT between 1996 and 2010 resulted in increased radiation exposure for enrollees, with a doubling in the mean per capita effective dose (1.2 mSv vs 2.3 mSv) and the proportion of enrollees who received high (>20-50 mSv) exposure (1.2% vs 2.5%) and very high (>50 mSv) annual radiation exposure (0.6% vs 1.4%). By 2010, 6.8% of enrollees who underwent imaging received high annual radiation exposure (>20-50 mSv) and 3.9% received very high annual exposure (>50 mSv).

Conclusion  Within integrated health care systems, there was a large increase in the rate of advanced diagnostic imaging and associated radiation exposure between 1996 and 2010.

Rebecca Smith-Bindman, et al. Use of Diagnostic Imaging Studies and Associated Radiation Exposure for Patients Enrolled in Large Integrated Health Care Systems, 1996-2010. JAMA. June 13, 2012, Vol 307, No. 22. http://jama.jamanetwork.com/article.aspx?articleid=1182858

Safer Pediatric Radiation Guidelines in Order

May 18, 2012 -- The realization that 1-size-fits-all radiography can be bad for children has forged a coalition between federal regulators, physicians, physicists, and medical device manufacturers to make medical imaging involving exposure to ionizing radiation safer for young patients.

The US Food and Drug Administration (FDA) took action May 9 as part of this collaboration by releasing proposed guidance encouraging manufacturers to consider the safety of children in the design of new X-ray imaging devices. The federal agency recommended equipment features that would alter the performance of X-ray imaging devices designed for general clinical use to address the specific requirements of younger patients.

Brice, J. FDA Proposal Aims at Lower Doses for Pediatric X-Ray. Medscape. May 18, 2012. http://www.medscape.com/viewarticle/764097?src=ptalk

PSA and Mammograms (Mercola)

• The United States Preventive Services Task Force (USPSTF) has given the prostate-specific antigen test (PSA test) a "D" rating, meaning that "there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits"
• The screening is no longer recommended as a routine test for men of any age, following a review of research that shows only zero to one out of every 1,000 men who are screened would actually benefit from the exam, while many others would suffer from the side effects of unnecessary treatments, ranging from impotence to death
• USPSTF is not suggesting the PSA screening never be used, just that it shouldn't be offered to every man at his yearly visit; the test would still be available as individual cases dictate, such as if a man is symptomatic or has a very high risk of aggressive prostate cancer

·         Reuters reported:

"If a biopsy finds seemingly malignant cells, as happens to 120 in 1,000 screened men, about 90 percent of men opt for surgery, radiation or hormone-deprivation therapy. Up to five men in 1,000 opting for surgery will die within a month of the operation; 10 to 70 more will have serious cardiovascular complications such as a stroke or heart attack. After radiotherapy and surgery, 200 to 300 of 1,000 men suffer incontinence, impotence or both. Hormone-deprivation therapy causes erectile dysfunction in about 400 of 1,000 men."

·         In many ways, mammograms are the equivalent of the PSA test for women. In 2009, revised mammogram guidelines were issued by the USPSTF, which found that the benefits of mammogram screening do not outweigh the risks for women under the age of 50. Therefore, they recommend that women wait to get regular screenings until the age of 50, and only get one every other year thereafter. This caused a backlash from women and doctors who felt their "life-saving" screening tool was being taken away, and certain public health agencies, like the American Cancer Society, did not modify their recommendations and still recommend yearly mammograms starting at 40.

Mercola, J. Could Your Annual Doctor's Visit Cause More Harm Than Good. mercola.com. June 23, 2012. http://articles.mercola.com/sites/articles/archive/2012/06/23/prostate-screening-negative-effects.aspx?e_cid=20120623_DNL_art_2

By Sarah A LoBisco, ND

Naturopathic Fun Facts!

...a continuation and support to my homepage weekly blogs....

The Power of the Mind-Body (Dr. Hyman)

In his recent newsletter, Dr. Hyman discusses how the mind controls outcomes in our body!

Just consider these facts:

• 95% of all illness is caused or worsened by stress.
• Low socio-economic status is associated with poorer health outcomes and risk of death from all causes. This not related to poorer health habits, but to feelings of powerlessness and loss of control.
• Internalized racism and stress are associated with high amounts of belly fat.
• Stress hormones damage the hippocampus - the memory center in the brain causing memory loss and dementia.
• In a study of people who volunteered to have cold viruses injected into their noses, only people with a high level of perceived stress got colds.
• Women with metastatic breast cancer survived twice as long if they were part of a support group
• Belonging to a group - a religious group, a bowling club, a quilting group - reduces risk of death from all causes and increases longevity despite health habits.
• In a study of doctors, those who scored high on hostility questionnaires had a higher risk of heart attacks than those who smoked, were overweight, had high blood pressure or didn't exercise!

The good news is we can change our beliefs and attitudes and their effects on our mind and our body. You may need to learn a few new skills, but they are essential survival skills we never learned in school or from our families.

-Hyman, M. UltraWellness Lesson 7: The Mind/Body & Body/Mind Effect. April 28, 2010. http://drhyman.com/blog/2010/04/28/ultrawellness-lesson-7-the-mindbody-bodymind-effect/

Conventional Care in Camden Uses Group Support of Practitioners to help High Spenders and High Risk Patients (Medscape interview)

The power of the doctor as healer (verses prescription pad writer) is revealed below. The power of the doctor as healer (verses prescription pad writer) is revealed below. This interview explains how a compassionate medical physician uses team building and social support to assist with health outcomes.

Dr. Brenner: We learned pretty quickly that we're wasting a lot of money in healthcare to deliver disorganized and fragmented and expensive services. When we ranked order by numbers of visits to the hospital and ER from most to least frequent, we found someone who had been to the hospital over 100 times a year. We also found that 1% of the patients were driving 30% of the cost. This was mind-boggling! We are wasting all of this money on people going in and out of the ER over and over and over.

Medscape: How did your organization -- the Camden Coalition of Healthcare Providers -- get started?

Dr. Brenner: In January 2002, we formed a breakfast group with frontline family physicians in solo practice who had been working for a long time in Camden. We didn't do hospital rounds or hang out with each other, so we had breakfast every quarter. We invited speakers and got to know each other. After about 3 years, out of this group we formed and incorporated the Camden Coalition of Healthcare Providers.

Medscape: Who's in the Coalition now?

Dr. Brenner: Our board now consists of 3 hospitals, 2 federally qualified health centers, 6 primary care offices, a homeless shelter, 2 behavioral health providers, a church group, and AARP. So, we probably have 12 physicians; some residents; hospital administrators; and a mix of other people, including patients, on the board. The Coalition has become a very stable, nonprofit structure upon which to build interventions.

-Carol Peckham; Jeffrey C. Brenner, MD. Finding Hot Spots: A How-To Interview with Jeffrey Brenner. Medscape. June 12, 2012. http://www.medscape.com/viewarticle/764826?src=mp&spon=38

Work-stress and Depression (Medscape)

Given the link between the stress systems and depression, it is plausible to assume that not only acute stress related to negative life events, but also more chronic psychological stress may be of etiological importance in the development of depression.^[4] Recently, an increasing research interest has been focused on possible work-related stress exposures, such as long working hours and mental health. Several issues support the idea that extensive working might be depressogenic. First, employees working long hours are likely to have reduced time available for sleep and recovery from work, potentially leading to chronic fatigue, poor health-related behaviors and, eventually, deterioration in health.^[5,6] Second, they may also be exposed for longer periods of time to psychosocial and physical workplace hazards, such as high demands (which can also be an underlying cause of extended working hours) and other poor working conditions, as compared with those working shorter days.^[6] Third, prospective cohort studies and case-control studies have linked long working hours to an increased risk of stress-related chronic diseases, such as coronary heart disease.^[5]

-Marianna Virtanen &; Mika Kivimäki.Saved by the Bell: Does Working too much Increase the Likelihood of Depression? Posted: 05/23/2012; Expert Rev Neurother. 2012;12(5):497-499. © 2012 Expert Reviews Ltd.http://www.medscape.com/viewarticle/764041?src=mp&spon=38

Give yourself the gift of success!

"I can't." "I won't." "I would, but..."

Hold on a moment. Hit pause.

When, how and how often do you use these three phrases? Now think about what you're really saying ...

In essence, each of these three phrases says "stop." They create a block that keeps us from moving forward, from making changes, or from allowing growth and mobility by anchoring ourselves to a particular outcome. When we use one of these sentences, we cut off possibility with others, and more importantly, ourselves!

Case in point: I have a girlfriend who is ill. Just yesterday -- even though she's better today than she was several weeks ago -- she said, "I'm never going to get better." Now, I understand how depressing it can be to feel sick and lose hope, but she *is* getting better and will continue to in all likelihood.

What saddens me is that worse than telling this to me and the world, she's telling this to herself! Instead of giving her immune system support for her healing, she's flooding herself with negativity. Can you imagine your beautiful, living, breathing, cells' confusion as they cry: "But we are getting better!" How can anything prosper in a negative environment?

If we look at any situation in our lives, whether its healing or any other issue, and we hear or we believe that there is no hope, it's much easier to give up the fight, rather than struggle to overcome our obstacles and challenges.

Why not set up the best possible scenario for your own betterment by encouraging yourself to heal? None of us know what tomorrow will bring. So, use the tools that bring health: Visualization, laughter, positive reinforcement. Find your strength in happiness. It's just common sense.

The other night I was out to dinner with my friend, Rob and he put it this way: "If you think you can, you possibly will, but it you think you can't, you definitely won't!"

I've been on a course of self love - learning to embrace myself - my strengths and weaknesses and while it's not always easy, I firmly believe that this enhances my life and my health. There is power in our words, power in our beliefs, our thoughts. So let's give ourselves the best possibility for healing and say, "I can!" and "I will!"

As mentioned in the previous weeks on my homepage, the functional medicine conference provided those of us who attended with more inspiration, science, and supportive tools for addressing the root cause of disease specific for the individual. After attending the conference, I'm still in awe of how Functional Medicine never ceases to explain or leave behind any individuals labeled "medical mysteries".  (Please visit my homepage for this week's discussion on functional medicine and how it addresses biochemical individualized medicine).

Dr. Houston, as well as all our other mentors and presenters at the conference, spoke of these medical outliers who feel like they are "oversensitive" to the world. These individuals may experience annoying, unexplained, and negative reactions to medicines, strange responses to environmental stimuli, and seemingly disconnected symptoms. We learned from these geniuses that these people are just annoying patients who like to be sick, but those who need the holistic mind-body-biochemical approach that functional medicine offers.

As far as the cardiovascular topic, Dr. Houston awestruck his audience when he was able to provide scientific evidence and biochemical explanations between the gaps in treatment outcomes based on serum cholesterol, lipid, and inflammatory markers.  One example left me with my mouth, "catching flies!"

Dr. Houston gave us the evidence on why those with low LDL and lipids may still experience heart disease and why those with high lipid panels may actually be at a lower risk!  This had more to do than just the amount of cholesterol in the blood, or in lipid particle size (with smaller sizes more likely to clog the vessels). Heart dysfunction was created by "infinite insults" with three finite results (inflammation, oxidative damage, and immune dysfunction). Our job as Functional medicine doctors was to find what infinite insult created these three finite results that caused cholesterol in one's body to be a risk factor for disease! We have to ask how the biological environment is interacting with an active infection, blood sugar imbalance, environmental toxins, or other triggers that  are causing these negative changes on the vasculature.

Below is an article highlighted by Dr. Mercola on one factor in heart disease, getting the right kind of fat in your diet.

Less Saturated Fat in Your Diet = Higher Risk of Heart Disease (Dr. Mercola)

Since the introduction of low-fat foods, heart disease rates have progressively climbed, even as studies kept debunking Keys research--repeatedly finding that saturated fats in fact support heart health. For example:

·         A meta-analysis published two years agoⁱⁱ, which pooled data from 21 studies and included nearly 348,000 adults, found no difference in the risks of heart disease and stroke between people with the lowest and highest intakes of saturated fat.

·         In a 1992 editorial published in the Archives of Internal Medicine, Dr. William Castelli, a former director of the Framingham Heart study, statedⁱⁱⁱ:

"In Framingham, Mass., the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person's serum cholesterol. The opposite of what... Keys et al would predict...We found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories, weighed the least and were the most physically active."

·         Another 2010 study published in the American Journal of Clinical Nutrition found that a reduction in saturated fat intake must be evaluated in the context of replacement by other macronutrients, such as carbohydrates^iv. When you replace saturated fat with a higher carbohydrate intake, particularly refined carbohydrate, you exacerbate insulin resistance and obesity, increase triglycerides and small LDL particles, and reduce beneficial HDL cholesterol. The authors state that dietary efforts to improve your cardiovascular disease risk should primarily emphasize the limitation of refined carbohydrate intake, and weight reduction. -Mercola, J. Why I believe Over Half of Your Diet Should Consist of This. May 31, 2012. http://articles.mercola.com/sites/articles/archive/2012/05/31/coconut-oil-for-healthy-heart.aspx?e_cid=20120531_DNL_art_1

Interestingly, Dr. Houston provided evidence that high saturated fat diets were linked to lower stroke risk, but higher cardiovascular disease. He explained how even with food, we can't look at things in isolation from our cellular biology. It is the combination of saturated fats with highly processed foods and sugar or in too high of a ratio that can and does create inflammation in the vessels of the body. However, I have good news--- if these fats were taken with antioxidants and other substances, the effect could be mediated--good news for those who like sweet potato fries. J

References:      

MARK HOUSTON, MD, MS. Coronary Heart Disease Risk Factors, Noninvasive Cardiovascular Testing, and Metabolic Cardiology. June 2, 2012.  IFM  Phoenix, AZ. A New Era in Preventing, Managing, and Reversing Cardiovascular and Metabolic Dysfunction

JEFFREY BLAND, PHD. The Impact of a Toxic Environment and Unhealthy Lifestyle Factors on Cardiometabolic Disease. June 1, 2012.. IFM  Phoenix, AZ. A New Era in Preventing, Managing, and Reversing Cardiovascular and Metabolic Dysfunction.

MARK HOUSTON, MD, MS . Release the Pressure: Effective Interventions for the Treatment of Hypertension. June 2, 2012.  IFM  Phoenix, AZ. A New Era in Preventing, Managing, and Reversing Cardiovascular and Metabolic Dysfunction.

Eldon Taylor. May 29, 2012: Biology of Belief and Spontaneous Evolution. HayHouse Radio. http://www.hayhouseradio.com/episode_preview.php?author_id=432.

By Sarah A LoBisco, ND

What's a WHAMs? You'll have to check out my homepage to find out...but it's definitely related to individualized medicine-the functional medicine way!

Below are some articles that support and give evidence to how the enivironment we bath our cells in, via food and lifestyle choices, affect how our genes and cells express themselves-either in health or dis-ease. This is the concept of epigenetics, a field in medicine that is giving people power beyond their genetic destiny.

Fat and Pepper!

Cool! A study on using pepper to burn fat! Eat to burn!

Moreover, a luciferase reporter assay indicated that pipierine significantly represses the rosiglitazone-induced PPARy transcriptional activity. Finally, GST-pull down assays demonstrated that piperine disrupts the rosiglitazone-dependent interaction between PPAR? and coactivator CBP. Genome-wide analysis using microarray further supports the role of piperine in regulating genes associated with lipid metabolism. Overall, these results suggest that piperine, a major component of black pepper, attenuates fat cell differentiation by down-regulating PPARy activity as well as suppressing PPARy expression, thus leading to potential treatment for obesity-related diseases.

- Ui-Hyun Park, Hong-Suk Jeong, Eun-Young Jo, Taesun Park, Seung Kew Yoon, Eun-Joo Kim, Ji-Cheon Jeong, and Soo-Jong Um. Piperine, a Component of Black Pepper, Inhibits Adipogenesis by Antagonizing PPAR? Activity in 3T3-L1 Cells. Journal of Agricultural and Food Chemistry. 201260 (15), 3853-3860

Obesity and Fish Oil

How what you put in your mouth affects your body's biochemistry. Specifically, eating certain foods trigger brain chemicals that make you crave more or feel good!

Unfortunately, it appears that America's excessive intake of omega-6 fatty acids also stimulates appetite, thanks to the fact that they body uses them to make the appetite-driving endocannabinoids. As we said, the body makes appetite-enhancing endocannabinoids from omega-6 AA, which abounds in beef, pork, and poultry. But the body also makes omega-6 AA from the short-chain omega-6 fat called linoleic acid (LA), which predominates in the most commonly consumed vegetable oils (corn, soy, safflower, sunflower, cottonseed). This sets the stage for the exciting results of Dr. Hibbeln's animal study, which affirms the idea that America's "omega imbalance" promotes overeating and obesity.

-Craig Weatherby . Omega-6 Fats Drive Obesity; Omega-3s Help: Mouse study reported at a conference we attended affirms the idea that America's omega-imbalance promotes obesity and alcohol abuse. Vitalchoice Newsletter. 6/5/12. http://newsletter.vitalchoice.com/e_article002446647.cfm?x=blbcR6f,b1h0JlRD

Individualized Medicine and Racial/Ethnic Differences (Medscape)

Most studies focus on the white male population, but it doesn't account for ethnicity or sex differences. This study did!

Women with GDM are at increased risk for type 2 diabetes in later life. However, results from several randomized trials have demonstrated that increased physical activity and weight loss can reduce the risk for type 2 diabetes among women with a history of GDM;^[29] little is known about the effectiveness of such prevention interventions among Asian/Pacific Islander women with a history of GDM, particularly among those with a BMI in the normal range. Some evidence suggests that Asians in general may be more prone to insulin resistance than non-Hispanic blacks or non-Hispanic whites, which may be due to the difference in the distribution of fat stores between the groups and Asians' higher body fat percentages at given BMI levels.^[30] Therefore, traditional strategies for decreasing insulin resistance, such as high fiber consumption and increased physical activity, may be especially effective in this population.^[31]

To our knowledge, our study provides the first population-based race/ethnicity-specific estimates of the contribution of overweight and obesity to GDM prevalence. Using linked birth certificate and hospital discharge datasets is the best available approach to examine racial/ethnic disparities in the contribution of BMI to GDM risk at the population level.

Our study has limitations. Prepregnancy weight and height were obtained from birth certificates and may not be based on measurements obtained in clinical settings. Estimates of obesity prevalence based on self-reported height and weight tend to be lower than those based on measured height and weight.

-Shin Y. Kim, MPH; Lucinda England, MD, MSPH; William Sappenfield, MD, MPH; Hoyt G. Wilson, PhD; Connie L. Bish, PhD, MPH; Hamisu M. Salihu, MD, PhD; Andrea J. Sharma, PhD, MPH.Racial/Ethnic Differences in the Percentage of Gestational Diabetes Mellitus Cases Attributable to Overweight and Obesity. Florida, 2004-2007. Posted: 05/24/2012; Prev Chronic Dis. 2012;9 © 2012 Centers for Disease Control and Prevention (CDC). http://www.medscape.com/viewarticle/763156