Bonnie's Blog With Bonnie & Steve Minsky

Complementary and Alternative Medicine Therapies for Cold and Flu Season: What Is the Science?

nutrocon@aol.com (nutrocon@aol.com) — Fri, 06 Nov 2009 15:34:00 +0000

Bonnie - this review appeared in Medscape, the most comprehensive physician website for releasing and reviewing clinical data. This should give you some ammunition when somebody tells you there is no proof that natural cold and flu remedies are effective and safe.

This was a very long commentary, so we could not provide every word. You can read the entire piece at http://www.medscape.com/viewarticle/711485_2. We highlighted specific points of interest in bold for quick perusing.

Medscape Family Medicine
Kathi J. Kemper, MD, MPH
November 2, 2009

Commentary

Influenza-like illnesses (ILI) and upper respiratory tract infections (URTI) typically peak in prevalence in the late fall through early spring. Home remedies and natural products have long been used to prevent and treat common viral illnesses. How should clinicians advise patients about the effectiveness and safety of these remedies when used to enhance immune function to prevent or treat virally mediated ILI or URTI?

Home Remedies

Home remedies range from diet (chicken soup or garlic) and dressing (warm head and feet) to poultices and vaporizers. Culturally, some families avoid cold foods (including dairy) and encourage spicy foods (such as garlic and ginger). Hot tea with honey and lemon is another popular remedy during winter months. Some mothers rub salves containing menthol, thyme, or eucalyptus on the sick family member's chest, and others make mustard poultices or enforce wearing hats, scarves, or warm socks. Hot steam or cool mist vaporizers are commonly used to increase household humidity and soothe dry respiratory passages; neti pots (small vessels with long narrow spouts) and saline rinses are used to wash viruses, allergens, and mucus out of the nose. Whether home remedies are effective prophylactic or therapeutic agents, or just make patients feel better to use them, these practices are generally safe and support cultural identity and self-efficacy, and their use can be tolerated by healthcare providers.

Sleep and Fluids

"Drink plenty of fluids" is well-worn advice that may have a basis in its common sense consequences. Dehydration can dry the respiratory mucosal surfaces; however, there is little evidence that drowning in extra fluids improves resistance to viral infections. On the other hand, the frequent trips to the restroom necessitated by larger than usual intake of fluids may promote additional hand washing, thereby reducing the spread of infections.

"Get plenty of sleep" is another adage voiced by grandmothers as well as clinicians, with the intent of supporting immune function. Sleep deprivation is associated with disruptions of immune function. In laboratory studies, depriving healthy adults of sleep induces a significant increase in both pro-inflammatory and anti-inflammatory markers (ie, E-selectin, intracellular adhesion molecule-1, interleukin [IL]-1beta, and IL-1 receptor antagonist) and a significant decrease in C-reactive protein and IL-6. Sleep deprivation can also impair the immune response to influenza vaccine. In a study of adult volunteers, influenza immunizations were administered to one group after 4 nights of partial sleep deprivation (sleep restricted to 4 hours per night) and to a second group after 4 full nights (7.5-8.5 hours per night) of sleep. Ten days after vaccination, mean antibody titers in the sleep-deprived volunteers were less than half of those in the volunteers who had normal sleep durations. Because individuals with poorer responses to vaccines also experience higher rates of illness, these findings support the concept that adequate amounts of sleep are important for optimal immunity during respiratory illness seasons. There are no data to suggest that excessive sleep (more than 10-12 hours per night for adolescents and adults) further improves immune function, but it appears prudent to avoid sleep deficits.

Natural Health Products

A growing number of randomized controlled trials have evaluated the effectiveness of natural health products. What is the scientific evidence for the effectiveness and safety of vitamin and mineral supplements, herbal products, or probiotics and homeopathic remedies in preventing or treating ILI and URTI?

Vitamins and Minerals

Vitamin C. Vitamin C (ascorbic acid) is the vitamin most often associated with warding off viral respiratory infections. A Cochrane systematic review of 30 randomized trials involving more than 11,000 adults concluded that prophylactic vitamin C supplementation (200 mg or more daily) is not effective in reducing the incidence of URTI in most adults (odds ratio 0.96; CI 0.92-1.0). On the other hand, a subgroup analysis of 642 very healthy adults engaged in highly physically stressful activities (marathon runners, skiers, and soldiers on subarctic exercises) showed a 50% decrease in the risk of developing a cold among those who took vitamin C supplements.[5] In the 30 studies that examined the impact of prophylactic vitamin C supplementation on the duration of URTI symptoms, vitamin C conferred a consistent benefit on reduction of cold duration (8% in adults and 14% in children). Of the 7 studies that assessed the impact of therapeutic vitamin C supplementation (taking vitamin C after symptoms had begun), there was no overall benefit on the severity or duration of URTI symptoms.

Vitamin C has mild in vitro antiviral activity against influenza virus,[6,7] and vitamin C deficiency impairs effective immune response to influenza viral infections in male mice.[8] However, clinical studies supporting the use of supplemental vitamin C to prevent or treat seasonal or atypical influenza are lacking. Side effects of vitamin C (in daily doses exceeding 3 to 6 g) include diarrhea and upset stomach; otherwise, the side effect profile of vitamin C is similar to that of placebo. Vitamin C appears to be most useful as a prophylactic agent to reduce the duration of URTI symptoms in children and in healthy adults undergoing physical stress. It does not appear to be useful once symptoms have started, and there is insufficient evidence to recommend its use for prophylaxis or treatment of ILI.

Vitamin D. Despite widespread fortification of food with vitamin D and the use of multivitamins, suboptimal vitamin D levels are increasingly reported in adults and pediatric populations in North America, particularly among those who are overweight and those with darker skin pigmentation. For example, according to the National Health and Nutrition Examination Survey (NHANES), the prevalence of optimal vitamin D levels (30 ng/mL or higher) in non-Hispanic blacks fell from 12% in 1988-1994 to 3% in 2001-2004. In addition to its well known effects on bone health, vitamin D is an important immune regulator, stimulating innate immunity and moderating inflammation.

A secondary analysis of NHANES data from 1988-1994 showed an inverse relationship between vitamin D levels and incidence of URTI. These results have been supported by other studies that show an increased risk for severe acute lower respiratory illness in people with low vitamin D levels. Historically, the association between rickets and risk for severe respiratory infection is well known, and vitamin D deficiency is associated with an increased risk for influenza.

Controlled trials of vitamin D supplementation, however, have had mixed results. In a randomized controlled trial of healthy adults with normal vitamin D levels, supplementation with 2000 IU of vitamin D daily had no significant impact on URTI incidence, duration, or severity. In a controlled trial of vitamin D supplementation to decrease bone loss in black women, a secondary finding was a significant reduction in the incidence of URTI and ILI respiratory illnesses among the women receiving vitamin D supplementation, particularly during the winter months. In controlled trials, serious side effects from vitamin D supplements have been rare.

Given the historical and epidemiologic data, randomized controlled trials of vitamin D supplementation to prevent and treat URTI and influenza are urgently needed, and while results of such studies are pending, it is prudent to avoid vitamin D insufficiency.

Zinc. The essential mineral, zinc, plays an important role in immune function. Zinc is a structural component of many enzymes and serves as an intracellular signal between immune cells. The activity of virtually all immune cells is modulated by zinc, and zinc deficiency leads to dysfunction of both humoral and cell-mediated immunity and increases susceptibility to infection.

Zinc deficiency is associated with an increased incidence and severity of pneumonia. In developing countries, zinc supplementation has been shown to decrease the incidence of childhood pneumonia. A meta-analysis of studies reported that zinc supplementation reduced the incidence of acute lower respiratory tract infections in children by approximately 15%. The effectiveness of zinc supplements in preventing or treating influenza-like illnesses requires additional research in better nourished populations.

Studies of the effectiveness of zinc supplements in preventing or treating URTIs have had mixed results. In a 2009 study of healthy Air Force cadets, zinc supplementation (15 mg daily for 7 months) was not associated with a decrease in the incidence of upper respiratory illnesses. Open-label studies of a zinc gluconate glycine lozenge suggested a 25% reduction in the duration of cold symptoms in children who received the lozenge. In a meta-analysis of 8 randomized, placebo-controlled trials of zinc supplementation in the treatment of recent-onset colds, 4 trials showed significant improvements, and the other 4 trials showed no improvement.

The benefits of zinc supplementation were most apparent among those who began taking zinc shortly after symptoms began, and who used products that did not contain citric or tartaric acid. A larger analysis of 14 controlled trials of zinc supplementation that were published from 1996 to 2006 suggested that zinc was not more effective than placebo as a remedy for colds. A more recent randomized controlled trial in Turkish children who started zinc supplementation shortly after cold symptoms developed showed a significant decrease in symptom severity but not in symptom duration. In another recent trial, adults were randomly assigned to zinc lozenges (13.3 mg of zinc acetate every 2-3 hours while awake) or placebo. The zinc group showed significant improvements in symptom severity and duration without significant adverse effects.

Zinc gluconate glycine lozenges are generally safe and well tolerated, but they can cause a metallic taste, nausea, and upset stomach. Because of the risk of choking, lozenges should not be given to young children. Nasal swabs and nasal sprays that contain zinc have led to anosmia (loss of sense of smell); these products should be avoided until further studies demonstrate safety.

Homeopathic zinc products are extremely dilute preparations that are generally very safe; they are not the same as non-homeopathic (allopathic) zinc lozenges or nasal swabs. There are no published clinical trials evaluating the effectiveness of homeopathic zinc as a remedy for URTI or ILI.

Overall, in spite of inconsistent evidence, it seems prudent to avoid zinc deficiency, although zinc supplementation in healthy, well nourished populations does not appear to reduce the risk for upper respiratory infections. Data on the effectiveness of lozenges in reducing the duration and severity of established URTIs have been mixed. Although lozenges appear to be safe, zinc nasal gels and swabs have side effects. Homeopathic zinc preparations are also safe, but clinical trial evidence of a benefit in preventing or treating URTI or ILI is lacking.

Herbal Products

In traditional practice, herbs are used to treat symptoms or for short term systemic support (up to 8 weeks) during cold and flu season. Herbs such as echinacea are generally not taken for longer than 6-8 weeks. Ginseng may be used for longer periods by elderly or debilitated patients. Other natural products, such as garlic, elderberry juice or jam, and honey, are considered foods and may be taken daily for long periods of time as part of a normal diet.

Andrographis. Andrographis paniculata is a bitter herb used in ayurvedic medicine (traditional medicine from India). Although not as well known in the United States as other herbs, andrographis has support from several clinical trials as a therapy for URTI. A review of 7 trials involving nearly 900 patients, including children, suggests that andrographis is significantly more effective than placebo in treating cold symptoms if started promptly (within 36-48 hours) after their onset. Russian studies have favorably compared andrographis to amantadine as a treatment for influenza infection. Andrographis supplements are generally well tolerated, but anaphylaxis has occurred. Additional studies are needed to determine its effectiveness in preventing URTIs and preventing or treating ILI in diverse populations in North America.

Echinacea. Research generally supports the use of high quality Echinacea purpurea products by adults to prevent or treat URTI. A 2007 meta-analysis of 14 controlled trials in adults concluded that E purpurea taken prophylactically decreased the odds of the common cold developing by 58% and decreased the duration of a cold by 1.4 days (both statistically significant). A 2006 Cochrane review evaluated studies of echinacea as a therapy for URTIs. Although most of the 16 studies that evaluated echinacea using aerial plant parts found that echinacea was more effective than placebo as a treatment for URTIs, it was suggested that additional rigorous trials are needed. A large controlled trial in pediatric patients found that echinacea may help prevent pediatric colds when taken during cold and flu season; however, echinacea does not seem to reduce the duration or severity of symptoms when used to treat colds in children. In vitro, echinacea inhibits the production of pro-inflammatory cytokines induced by the influenza virus and shows direct antiviral activity. Additional research to explore the clinical significance of this observation in preventing or treating ILI is needed. In most studies, echinacea has been well tolerated, but allergies and skin rashes are possible. There is substantial variability in echinacea products sold in the United States. Most of the studies that showed positive results used Echinacea Madaus, which uses aerial portions of the E purpurea species.

Elderberry. European black elderberry (Sambucus nigra) juice, is widely used to treat URTI and ILI. In vitro, elderberry binds to and prevents infection with influenza H1N1 virus. Studies from Israel and Norway suggest that black elderberry extract (1-4 tablespoons daily for 3-5 days for adults) can inhibit the growth of influenza viruses in vitro and shorten the duration of influenza symptoms while enhancing antibody levels against the virus. However, additional studies are needed to confirm these effects in more diverse North American populations (including children) before elderberry becomes a routine recommendation for preventing or treating ILI. No studies have demonstrated effectiveness of elderberry extracts in preventing or treating URTI. Elderberry is generally well tolerated, although allergic reactions are possible.

Garlic. Garlic (Allium sativum) is a commonly used food and folk remedy for preventing and treating the common cold. One high-quality trial of the effect of garlic supplementation on the common cold found that a daily garlic supplement (180 mg allicin content for 12 weeks) significantly reduced the incidence of the common cold. Randomized clinical trials have not addressed the effectiveness of garlic in treating URTIs or in the prevention or treatment of influenza. Garlic is generally safe, but its unpleasant effects on breath, belching, and body odor are well known.

Ginseng. Randomized clinical trials suggest that prophylactic standardized North American ginseng (Panax quinquefolium) supplements taken daily for 4 months can significantly reduce the incidence (by approximately 25%) and duration (by approximately 6 days) of URTIs in adults. In traditional herbal medicine, this herb is given to elderly or debilitated patients, not to healthy adults or children. Randomized controlled trials have not evaluated its benefits as a treatment once symptoms have begun. Additional research is needed to assess the effectiveness of ginseng in preventing and treating URTIs in pediatric patients. A randomized controlled trial from Italy evaluated the benefits of a standardized product of a different ginseng species (Panax ginseng) as an adjunct to influenza immunization. Taking 100 mg of P ginseng daily for 4 weeks before and 8 weeks after influenza immunization was associated with significantly higher antibody levels and natural killer cell activity compared with taking placebo. More research is needed to assess the safety and effectiveness of ginseng when used as a single agent to prevent or treat ILI in adult and pediatric patients. Ginseng may cause hypertension and agitation in large doses but otherwise is generally safe.

Honey. Honey is a home remedy commonly used to treat the symptoms of respiratory infections, particularly scratchy throats and coughs. A randomized controlled trial of 105 children with colds supports the use of buckwheat honey to quiet coughs that interfere with sleep. Honey has not undergone formal study to evaluate its prophylactic effects on the incidence of URTIs or in the prevention or treatment of ILI. Because of the risk for botulism, honey should not be given to children younger than 1 year old.

Pelargonium. African geranium (Pelargonium sidoides) is a native plant of South Africa used by Zulu and Basuto people. Two systematic reviews of 3 adult trials and 3 pediatric trials (most of which used the plant extract EPs 7630) concluded that pelargonium may be effective in alleviating symptoms of the common cold and bronchitis in adults. The benefits of pelargonium in treating cold symptoms were confirmed in a randomized controlled trial published in 2007. Additional research is needed to determine its effectiveness in preventing URTIs and in preventing or treating ILI in diverse populations. The product is well tolerated; side effects of the most common preparation include allergic reactions and upset stomach.

Probiotics

Probiotics encompass a large heterogenous group of bacteria that are normal inhabitants of the human gastrointestinal tract. These live microorganisms have undergone intensive study as treatments for gastrointestinal problems such as diarrhea, constipation, and IBS and as therapy for atopic conditions.

Recently, research has focused on the potential role of probiotics in preventing respiratory illnesses in adults and children. For example, in a controlled study in 10 healthy adults, taking 1 daily capsule of Bacillus coagulens, for 30 days significantly increased T-cell production of tumor-necrosis factor-alpha in response to exposure to adenovirus and influenza A (H3N2 Texas strain).

More than a dozen studies on the effectiveness of probiotics in preventing URTIs have been conducted, with mixed results. Most studies have shown some decrease in the severity and number of illness days in participants randomly assigned to treatment groups. Recent randomized, placebo-controlled, double-blind studies conducted over 3 winter seasons in healthy adult volunteers in Italy evaluated several synbiotic preparations. These preparations contained 3 to 5 strains of Lactobacillus plantarum, L rhamnosus, and Bifidobacterium lactis; lactoferrin; and prebiotics such as short-chain fructooligosaccharides (FOS) or galactooligosaccharides (GOS). The overall incidence, duration, and severity of URTI and ILI were significantly decreased in participants treated with synbiotics vs those in the placebo group. A study in Germany that evaluated the prophylactic effect of probiotics in healthy adults who took probiotics containing the strains L gasseri PA 16/8, B longum SP 07/3, and B bifidum MF 20/5 (5 x 107 colony forming units per tablet) daily for at least 3 months documented a significant reduction in days with cold symptoms and in the severity of symptoms and fever. On the other hand, 2 studies using other strains to prevent respiratory tract infections (one study of young men undergoing French commando training and another in marathon runners) did not show any benefit of probiotics. In addition to studying different populations, these studies may have had divergent results because probiotics have strain-specific effects on immune function.

Furthermore, various probiotics can have different effects on resistance to and recovery from viral infections when taken in combination with prebiotics such as FOS or GOS. In a randomized, double-blind, placebo-controlled study of children who were 3-5 years of age, participants who received either L acidophilus NCFM or L acidophilus NCFM in combination with B animalis subspecies lactis Bi-07 (vs placebo) WE RECOMMEND THESE TWO STRAINS twice daily for 6 months showed significant reductions in the incidence and duration of fever, cough, and rhinorrhea. Antibiotic use was also reduced by more than 65% and absences from daycare were reduced by approximately 30% compared with children receiving placebo.

Similarly, a randomized, double-blind placebo-controlled trial involving more than 500 children attending daycare in Finland showed that daily milk intake supplemented with Lactobacillus GG significantly reduced absences related to respiratory infections and reduced the severity of infections. In a crossover study of children with cystic fibrosis who are prone to serious respiratory infections, probiotic supplementation was associated with significantly fewer episodes of pulmonary exacerbations requiring hospitalization compared with supplementation with oral rehydration solution. In a study of formula-fed infants whose diets were supplemented with L rhamnosus GG and B lactis Bb-12 or placebo from ages 2 months through 12 months, there was a significant reduction in the incidence of acute otitis media, recurrent respiratory infections, and antibiotic use among those receiving the probiotics. In a similar study conducted with more than 200 infants attending Israeli child care centers, infants who received L reuteri had significantly fewer days with fever and fewer clinic visits, child care absences, and antibiotic prescriptions compared with those who received B lactis (Bb-12) or placebo, but there was no difference in the number of days with URTI. In a Swedish study, more than 900 pregnant women were randomly assigned to receive either placebo or probiotics (L rhamnosus GG and LC705, B breve Bb99 and Propionibacterium freudenreichii subspecies shermanii) for 4 weeks before expected delivery. Their infants continued to receive the same products with GOS for 6 months after birth. During 2 years of follow-up, the infants exposed to probiotics had significantly fewer URTI illnesses compared with the placebo-treated infants. Probiotics in food or supplements are generally safe and well tolerated in adults, children, pregnant women, and even premature infants. Sepsis-like illnesses have been described in case reports when probiotics were administered intravenously to severely immune-compromised patients.

Homeopathic Remedies

Homeopathy (or homeopathic medicine) was developed in Germany more than 200 years ago. A central homeopathic principle is that of similars, or "like cures like," meaning that a disease can be cured by a substance that produces symptoms similar to those of the disease or condition. Homeopathic remedies are extremely dilute preparations of the active substance (usually a natural ingredient) that are believed to have healing properties. Controversy exists among homeopaths about whether any homeopathic remedies are useful to prevent URTI or ILI in otherwise healthy adults. Typically, treatment depends on a broad constellation of emotional and mental characteristics as well as physical symptoms, so a remedy would not be selected purely to treat the flu or a cold per se. However, a number of homeopathic remedies are marketed as cold and flu products. Oscillococcinum is among the most popular products for ILI. A 2006 Cochrane review Oscillococcinum, including 3 prevention trials and 4 treatment trials, concluded that this remedy was not effective in preventing ILI; on the other hand, average treatment with Oscillococcinum (compared with placebo) was associated with a 0.28 day reduction in duration of ILI symptoms and marginally increased the chances that a patient would consider the treatment effective. Homeopathic remedies are very safe, and although their usefulness for ILI is only marginal, these remedies can be tolerated.

Conclusion

Upper respiratory tract illnesses and influenza-like illnesses are common, as is the use of home remedies and natural products to prevent and treat them. The strongest data for prevention of URTI in both adult and pediatric patients are from studies on probiotics. Although studies of black elderberry and andrographis are promising, no research has evaluated the optimal roles of these products with atypical H1N1 influenza infections. Aside from common sense precautions (avoiding honey for children less than 1 year old to reduce the risk for botulism; avoid giving bacterial products to severely immunocompromised patients), natural products are generally very safe, and their use can be tolerated.

H1N1 Vaccine is safe for which groups?

nutrocon@aol.com (nutrocon@aol.com) — Thu, 05 Nov 2009 18:03:00 +0000

While the World Health Organization, Centers for Disease Control, and the Department of Health and Human Services are telling pregnant women and children that they should be first in line to receive the H1N1 vaccine, we thought you should be aware of the following.

If you go to this link at flu.gov, you will find a list of the three H1N1 injectable vaccines available in the US. The package inserts reveal the following:

CSL
"Recommended only for adults 18 and over. Safety and effectiveness has not been established in persons younger than 18, and in pregnant and nursing women."

Novartis
"Vaccine safety and effectiveness has not been established in children younger than 4, and in pregnant and nursing women."

Sanofi Pasteur
"Safety and effectiveness has not been established in children younger than 6 months, and in pregnant and nursing women."

Should we expect parents to specify which manufactured vaccine they prefer based upon their children's age? Most people have no idea this information exists.

For pregnant and nursing women, the decision to vaccinate becomes even more excruciating, in light of the fact that there is no legal recourse. H1N1 vaccine manufacturers have complete immunity from vaccine injury lawsuits.

Again, we are simply trying to make this information available to allow you to make the best possible decision regarding the H1N1 vaccine.

Leave your comments below.

Slim Down Your Favorite Recipes

nutrocon@aol.com (nutrocon@aol.com) — Thu, 05 Nov 2009 17:42:00 +0000

Substitutes for high fat milk or cream:
Use lowfat milk or milk substitute (preferably with no added sugar); if a recipe calls for one cup ½ & ½ use ¼ - 1/3 cup with the rest water.

Substitutes for high fat cheese:
Blue cheese> Feta
High fat mozzarella> low fat mozzarella
Other cheeses> use half the amount called for in the recipe and flavor the rest with Parmesan, Romano, Asiago, and/or Manchego cheese

Substitute for sour cream:
Use the same amount of lowfat or no fat Greek yogurt (this will also give you an extra boost of protein and calcium.

Make soups and stews the day before and refrigerate so that you can easily remove the hardened fat (or made on the same day, use the fat skimmer).
To make delicious “skinny” gravy:
Remove all fat (with a fat skimmer) from the pan drippings. Add homemade or low sodium organic broth, and optional wine, for enhanced flavor.

To reduce saturated fat and salt:
Trim all fat before cooking meat and poultry. Boost flavor with aromatic herbs, pureed vegetables, low sodium organic vegetable/chicken broth/V-8, and lots of onion, garlic, and/or shallots to add flavor while removing excess fat and sodium. If you add a little salt directly before serving, the salt flavor will be stronger. Reheating with microwaving will also enhance a salty taste.

To reduce sugar for homemade baked goods:
Cut the amount of sugar called for in half. Enhance a “sweet flavor” with spices such as vanilla, nutmeg, cinnamon, ginger, and allspice. Also, using strong flavored sugars such as pure maple syrup, agave, honey and molasses enhance the taste of “sweet” while using lower amounts.

To reduce saturated and trans fats for homemade baked goods:
If a recipe calls for more than one egg, use one whole egg with the rest egg whites (2 egg whites= one whole egg). Cut the amount of butter in half. Substitute the rest with fruit purees (such as applesauce) and/or a healthy oil such as canola, avocado, or safflower. Make sure to add extra flour if switching from a solid to a liquid. If a recipe calls for lard or margarine, substitute with one of the healthy, no trans fat spreads (our favorite is Earth Balance). Add nuts or nut butters to recipes to enhance the “mouth feel” and flavor of fat (it also keeps you more satisfied with a smaller portion).

Top Ten Healthy Holiday Tips Updated.

nutrocon@aol.com (nutrocon@aol.com) — Thu, 05 Nov 2009 17:29:00 +0000

For Healthy Holiday Parties and Family Celebrations

Eat before you go to a party, especially foods high in protein and healthy fats. Your blood sugar will be more stable so you won’t eat as much.
Alcohol is loaded with calories. Try substituting with sparkling water or club soda (an added benefit is feeling more full with water so you won’t eat as much). The best advice is choosing non-alcoholic, low calorie beverages such as a virgin bloody Mary, fruit flavored tea, or flavored water (without sugar or sugar substitutes added). If you do consume alcohol, remember that alcohol may inhibit your ability to make smart food choices. Sip your drinks slowly. For each alcoholic beverage, have 8 oz. sparkling water or club soda in between. Add a small amount of lemon, lime, or other fruit juice to your water for added flavor.
Don’t make a meal out of appetizers. Sample one or two, then wait for the main course. If fresh vegetables are served as appetizers, fill up on low carbohydrate, low calorie tomatoes, peppers, cucumbers, artichoke hearts, celery, and zucchini. At a buffet, graze to take a taste of enticing items, but spend most of your time with the raw vegetables and heart healthy guacamole and humus dips. Socialize away from the food table so you won’t be tempted to continue eating while talking.
If you know you’ll want to have a rich dessert (instead of fruit), keep the fat and carbohydrate calories low the rest of the day to compensate. Also, forego second helpings of the dinner to save “calorie” room for dessert. Encourage family and friends to take a brisk walk between dinner and dessert. You’ll be surprised by how much less you’ll crave!
Watch out for raw foods (raw fish, steak tartar and eggnog made with raw eggs) or foods left out too long at room temperature. They could harbor harmful pathogens such as salmonella, shigella, listeria, or e coli.
Eat your meal slowly so that you’ll feel full with less food. It typically takes your stomach about 20 minutes to let your brain know that you are full. Try to avoid or limit foods high in saturated fat like heavy gravies. These are typically very high in calories. For example: 8 oz. eggnog = 340 calories, 1 slice pie with whipping cream = 520 calories; 1 cup standard poultry stuffing = 500 calories.
Exercise more to burn more calories during the holidays. Cycling, fast-walking, and cross-country skiing are great ideas. Even shoveling the snow off of your driveway and sidewalk counts.
Offer to bring your favorite healthy recipe to the party and spend most of your time eating it. Let your host keep the leftovers from your dish. If you’re hosting the meal or party, send leftovers home with your guests. It’s a friendly gesture and saves your from temptation!
If you have food sensitivities or allergies, call your host before the party to determine what foods would be safe. There is nothing worse than having an allergic reaction or digestive distress when you are trying to have fun.
Don’t begin a diet during the holidays or become obsessive about avoiding tempting holiday fare. If you restrict yourself too much, you’ll either be depressed or “pig out” later. Remember that the average adult gains 6 lbs. from Thanksgiving Day through New Year’s Day. If you can even maintain your weight during the holidays, you’ll be one step ahead when it is time to make your New Year’s resolutions.

Eating Well on a Budget

nutrocon@aol.com (nutrocon@aol.com) — Wed, 04 Nov 2009 14:57:00 +0000

Eat In More and Out Less

The U.S. Department of Agriculture’s Economic Research Service found that spending on food away from home accounted for nearly half of every American food dollar in 2008. While they require more planning, home-cooked meals are an excellent way to minimize your grocery bill and they are typically healthier than the options you may find when dining out. Consumers seem to be getting the message. A 2009 survey says 46% of consumers claim that their families eat out less often.

To save money while cooking at home, try some of these tips:

Make at least one meal meatless.
Choose recipes that utilize eggs or dried beans – like pinto or northern beans – as the main protein.
Double your recipes and freeze leftovers or extra amounts of meat, bread, and cooked vegetables.
Bring leftovers for lunch to work or use the excess ingredients as inspiration for future meals.
Eat dinner as a family, or consider having a weekly potluck with neighbors to reduce the cost per person of your meals.
Clip coupons
Subscribe to a healthy cooking magazine, or peruse recipe books for healthy ideas. We love Eating Well, our Best of the Mediterranean Diet and Recipes to Live By.
Plan Meals for the Week in Advance:
A meal planning chart or simple shopping list for the week are great tools for the budget-minded, health-conscious consumer.
Knowing what you already have in the pantry and what you intend to make ahead of time reduces impulse spending, saves time, and improves the nutritional value of your meal.
Post meal plans on the refrigerator door where the entire family can see it and refer back to it throughout the week.
Only shop once a week:
This makes it easier to avoid unnecessary purchases and encourages you to stick to your weekly menu. Have a snack before you visit the grocery store. Shopping on an empty stomach can lead to impulse buying.
Grocery Store Shopping Tips:
- “Shop the perimeter,” remembering that the least healthy and most overpriced packaged foods are concentrated in the middle aisles.
- If fresh fruits and vegetables are cost-prohibitive, try the frozen versions. Frozen produce is often flash frozen at the source, locking in nutrients.
- Choose prepared foods with short ingredient lists and minimal additives or artificial ingredients.
- Buying “economy” or “family size” containers is sometimes, but not always, a better buy. Larger packages that have a lower cost per unit than their smaller counterparts are only going to save you money if you will truly eat all of the food in the package. If it spoils and has to be thrown away, it could just be a waste of your money.
- Be cautious of stores’ shrinking food packages and their content while prices stay the same. Common changes include packaging redesign that holds fewer ounces by way of indented container bottoms, cartons that hold 1/4 less of a quart, and boxes that remain the same size but actually have smaller bags of product inside.

Artificial Sweeteners and salt tied to kidney issues

nutrocon@aol.com (nutrocon@aol.com) — Tue, 03 Nov 2009 16:00:00 +0000

A diet high in salt or artificially sweetened drinks increases the risk of kidney function decline, two studies show. "There are currently limited data on the role of diet in kidney disease," said researcher Dr. Julie Lin, of Brigham and Women's Hospital in Boston. "While more study is needed, our research suggests that higher sodium and artificially sweetened soda intake are associated with greater rate of decline in kidney function."

The first study looked at diet and kidney function decline in more than 3,000 women enrolled in the national Nurses' Health Study. The researchers found that "in women with well-preserved kidney function, higher dietary sodium intake was associated with greater kidney function decline, which is consistent with experimental animal data that high sodium intake promotes progressive kidney disease."

The second study looked at the association between sugar- and artificially-sweetened beverages and kidney function decline in the same group of women. The researchers found an association between two or more servings per day of artificially sweetened soda and a two-fold increased risk of faster kidney function decline. There was no connection between sugar-sweetened beverages and kidney function decline. The association between artificially sweetened beverages and kidney function decline persisted after Lin and colleague Dr. Gary Curhan accounted for other factors, such as age, obesity, high blood pressure, diabetes, smoking, physical activity, caloric intake and cardiovascular disease.

The studies were to be presented this week at the annual meeting of the American Society of Nephrology, in San Diego.

Aspirin should only be for heart patients

nutrocon@aol.com (nutrocon@aol.com) — Tue, 03 Nov 2009 15:14:00 +0000

The use of aspirin to ward off heart attacks and strokes in those who do not have obvious cardiovascular disease should be abandoned, researchers say.The United Kingdom's Drugs and Therapeutics Bulletin (DTB) study says aspirin can cause serious internal bleeding and does not prevent cardiovascular disease deaths. It says doctors should review all patients currently taking the drug for prevention of heart disease. The Royal College of GPs says it supports the DTB's recommendations. Low-dose aspirin is widely used to prevent further episodes of cardiovascular disease in people who have already had problems such as a heart attack or stroke. Given the evidence, the DTB's statement on aspirin prescription is a sensible one.

The DTB said a recent analysis of six controlled trials involving a total of 95,000 patients published in the journal the Lancet does not back up the routine use of aspirin in these patients because of the risk of serious gastrointestinal bleeds and the negligible impact it has on curbing death rates. Dr Ike Ikeanacho, editor of the DTB, said: "Current evidence for primary prevention suggests the benefits and harms of aspirin in this setting may be more finely balanced than previously thought, even in individuals estimated to be at high risk of experiencing cardiovascular events, including those with diabetes or elevated blood pressure."

June Davison, senior cardiac nurse at the British Heart Foundation said: "It is well established that aspirin can help prevent heart attacks and strokes among people with heart and circulatory disease - so this group of people should continue to take aspirin as prescribed by their doctor. "However, for those who do not have heart and circulatory disease the risk of serious bleeding outweighs the potential preventative benefits of taking aspirin. "We advise people not to take aspirin daily. The best way to reduce your risk of developing this disease is to avoid smoking, eat a diet low in saturated fat and rich in fruit and vegetables and take regular physical activity."

Bonnie - whoah! These are the boldest statements I have seen on this issue in decades. Finally, doctors are getting it!

Affects from harmful artery plaque lessened with omega-3

nutrocon@aol.com (nutrocon@aol.com) — Mon, 02 Nov 2009 15:32:00 +0000

Unstable carotid artery plaques – those in danger of rupturing and leading to a stroke – contain more inflammation and significantly less omega-3 fatty acids than asymptomatic plaques. This suggests that increasing the levels of omega-3 fatty acids in carotid artery plaques could either prevent strokes or improve the safety of treatment. This may be accomplished by increasing dietary intake of foods rich in omega-3 fatty acids.

The study in the journal, Vascular Pharmacology, says that our bodies produce only a small amount of omega-3 fatty acids, so most of what we need has to come from eating omega-3 fatty acid-rich foods like fish (salmon, tuna, trout, herring, etc.) or from supplements.

Steve - this is a very important study because it explains the different forms of artery plaques and their affect on the body.

Processed food linked to depression?

nutrocon@aol.com (nutrocon@aol.com) — Mon, 02 Nov 2009 15:29:00 +0000

Eating a diet high in processed food increases the risk of depression. What is more, people who ate plenty of vegetables, fruit and fish actually had a lower risk of depression. Data on diet among 3,500 middle-aged civil servants was compared with depression five years later, the British Journal of Psychiatry reported. The team said the study was the first to look at the UK diet and depression.

They split the participants into two types of diet - those who ate a diet largely based on whole foods, which includes lots of fruit, vegetables and fish, and those who ate a mainly processed food diet, such as sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products. After accounting for factors such as gender, age, education, physical activity, smoking habits and chronic diseases, they found a significant difference in future depression risk with the different diets. Those who ate the most whole foods had a 26% lower risk of future depression than those who at the least whole foods. By contrast people with a diet high in processed food had a 58% higher risk of depression than those who ate very few processed foods.

Steve - the results of this study should not come as a surprise to anyone. When your blood sugar is balanced, that alone is enough to repel many symptoms of depression.

Understanding the Essential Folate

nutrocon@aol.com (nutrocon@aol.com) — Fri, 30 Oct 2009 15:15:00 +0000

Folate is integral for producing and repairing healthy cells, as well as encouraging optimal detoxification. Thus, it is essential that folate is metabolized properly.

Folic acid, the form most commonly in supplements and fortified food, is a synthetic oxidized form not found naturally in food. It must be converted to tetrahydrofolate. Evidence shows that in a large majority of the human population (maybe 25%), this process may be slow and inefficient due to negative epigenetic expression, leaving us with extended exposure to unconverted folic acid. There is a belief that with this overload, a very small part of the population may be at higher risk for certain forms of cancer. Recent data has clarified this issue, which should allay any concern.

Last week, Harvard researchers reported “no evidence for an increased risk of advanced or multiple cancerous adenomas” from folic acid, according to a double-blind, randomized trial.

Eating plenty of folate may reduce the risk of colorectal cancer by 64% in women consuming more than 300 mcg. daily compared to those consuming less than 200 mcg. A review paper published by Joel Mason from USDA Human Nutrition Research Center on Aging at Tufts University, best addressed folate's effect on colorectal health. “Under most circumstances, adequate intake of folate appears to assume the role of a protective agent against cancer, most notably colorectal cancer,” wrote Dr Mason. A possible explanation for the contradictory results of studies with folic acid and colorectal cancer may be the difference between the synthetic and natural forms of the vitamin. “The fact that folic acid, which is not a naturally occurring form of the vitamin, is used by food and pharmaceutical industries for fortification and supplementation is potentially of importance.” On passage through the intestinal wall, folic acid is converted to 5-methyltetrahydrofolate, the naturally circulating form of folate.

Some studies have suggested that oral doses of folic acid in high doses may overwhelm this conversion pathway, leading to measurable levels of folic acid in the blood. “There has been some concern that this oxidized, non-substituted form of folate might feasibly be detrimental because it is not a naturally occurring co-enzymatic form of the vitamin,” Mason added. Bonnie - the concern only comes from excessively high doses of folate, which according to the next study, is non-existent. As the new Harvard study reported, at normal levels this is not an issue.

Intakes of folic acid from fortified foods and supplements do not lead to excessive intakes. “At current fortification levels, US adults who do not consume supplements or who consume an average of 400 micrograms folic acid/d from supplements are unlikely to exceed the upper limit in intake for folic acid,” wrote Robert Berry from the Centers for Disease Control and Prevention. Less than 3 per cent of the study population exceeded the tolerable upper level of 1,000 micrograms a day. Because of this study and other successes seen around the world, the United Kingdom Food Standard Agency just recommended that folic acid be added to bread on a mandatory basis. A total of 51 countries now have some degree of mandatory fortification of flour with folic acid.

What Would We Be Without Folic Acid Fortification and Supplementation?

Drugs that interfere with the action of folic acid produce a six-fold increase in birth defects in pregnant women.

The Scottish Spina Bifida Association said 15 babies had been born in Scotland with the condition since January 2009 - double the normal number. It said folic acid supplements, which research suggests can prevent many cases, were often taken too late. Scotland does not have a folic acid fortification program.
Low maternal folate levels are linked to the development of attention-deficit/hyperactivity problems in children at age seven to nine years. Researchers state that maternal nutrition contributes to an individuals' development, with potential consequences for their behavior later in life. The long term effects of poor maternal nutrition may even branch out to the child's ability to interact with peers or form social bonds.
Johns Hopkins researchers state that taking folic acid and iron supplements together during pregnancy may reduce infant mortality by 31 per cent.
Low serum folate concentration is associated with an altered morphology of human bone in older adults.

Folate may prevent premature birth and heart defects. Now pregnancy specialists are asking if it's time for the government to boost the amount being added to certain foods to help ensure mothers-to-be get enough.

Texas researchers analyzed nearly 35,000 pregnancies and found that women who reported taking folic acid supplements for at least a year before becoming pregnant cut in half their risk of having a premature baby. Their risk of having very early preemies, the babies least likely to survive, dropped even more.

Canadian researchers analyzed 1.3 million births in Quebec since 1990 to look for heart defects, the most common type of birth defect. They found the rate of serious heart defects has dropped 6 percent a year since Canada began its own food fortification in December 1998.

The U.S. Preventive Services Task Force recommend that women take a daily supplement with 400 micrograms to 800 micrograms of folic acid daily. But because only about a third of non-pregnant women take precautionary folic acid supplements, fortifying foods made with enriched flour ensures everyone gets a modest amount.

Increased intake of folate and folic acid may reduce the risk of hearing loss in men by 20 per cent. Researchers used the most recent figures from the Health Professionals Follow-up Study cohort from years 1986 to 2004, a group consisting of 51,529 male health professionals. The study identified 3,559 cases of men with hearing loss. When the nutritional data was analyzed, men over the age of 60 with high folate intake from foods and supplements had a 20 per cent decrease in risk of developing hearing loss.

Supplements of folic acid may improve cardiovascular health and reduce the prevalence of peripheral arterial disease (PAD). Daily doses of 400 micrograms of folic acid led to significant improvements in blood pressure and improved blood flow after 16 weeks of supplementation. Furthermore, equal doses of 5-methyltetrahydrofolate (5-MTHF), the naturally circulating form of folate, produced the same results, leading the researchers to conclude that “5-MTHF may be a safe and effective alternative to folic acid in those who have a genetic predisposition to synthesizing folic acid.”

Dosage Recommendations

Do not exceed 1 gram (1000 mcg.) of supplemental folate unless supervised by a licensed health professional.
Make sure that along with folate, you supplement with an adequate amount of vitamin B-12 and vitamin B-6 .

Because testing for a genetic predisposition to synthesizing folic acid is prohibitively expensive, insure yourself by supplementing with all three forms of folate (folic acid, 5-methyltetrahydrofolate, 5 formyl tetrahydrofolate; available in Metagenics ActiFolate).

References
Nutrition Reviews, April 2009
Proceedings on the National Academy of Sciences, August 2009
European Journal of Clinical Nutrition, August 2009
British Journal of Surgery, September 2009
BBC News, 2009
American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting, October 2009
British Journal of Clinical Pharmacology, October 2009
Journal of Child Psychology and Psychiatry, November 2009
American Journal of Epidemiology, November 2009
American Journal Clinical Nutrition, November 2009; December 2009

Recipe Du Jour November

nutrocon@aol.com (nutrocon@aol.com) — Fri, 30 Oct 2009 15:12:00 +0000

Immune Boosting Broth

Bonnie - you've heard the old adage, chicken soup can cure colds. But this chicken broth really can boost your immune system with tons of quercetin-loaded allium veggies (onion, garlic, leek, shallot). The bones even provide a bioavailable source of calcium.

Note: use of free-range or organic chicken/turkey carcass and organic vegetables preferred

2 small or one large chicken/turkey carcass (leave some meat on the bones)
6-8 inner celery stalks, with leaves
4-8 cloves garlic, minced
2 large shallots, diced
1 medium yellow or white onion, diced
2 large leeks (use mostly white part), sliced or 1 c. chopped chives
12 c. filtered water
1 c. carrots, peeled and sliced optional
1 c. parsley leaves
1 T. olive, grapeseed, or avocado oil
sea salt and white pepper, to taste

Directions: in a large soup pot, saute garlic, shallot, onion, and leek in oil until translucent. Add all other ingredients. Bring to a rolling boil. Turn down the heat to simmer. Cover and cook for two hours. Strain and cool.

Freeze in containers of multiple sizes. Use in soups, stews, mashed potatoes, casseroles, or any dish in which you want flavor and an immune boost!

Yield: 3 quarts

Do you have your own immune-boosting recipe? Please share in the comments box below.

Research Highlights November

nutrocon@aol.com (nutrocon@aol.com) — Fri, 30 Oct 2009 15:11:00 +0000

American Journal of Clinical Nutrition

Cocoa polyphenols may modulate inflammatory mediators in patients at high risk of cardiovascular disease.
In NHANES 20003-2004 study, vitamin C status improved, and the prevalence of vitamin C deficiency was significantly lower than NHANES 1988-1994. Increase in vitamin C supplementation in addition to adequate dietary intake are believed to be responsible.
Iodine supplementation improved perceptual reasoning in mildly iodine-deficient children and suggests mild iodine deficiency could prevent children from attaining their full intellectual potential.
Consumption of four egg yolks daily, and possibly two egg yolks (rich in lutein and zexanthin) for five weeks benefited macular health in older adults with low macular pigment optical density. HDL cholesterol increased and LDL cholesterol stayed the same in this population whom were mostly taking statin medication.
Nutritional supplementation in girls is associated with substantial increases in their offspring's (more for sons) birth weight, height, head circumference, height-for-age score, and weight for age score.
Glutathione enzyme deficient persons have an increased risk of vitamin C deficiency than persons with normal glutathione. Bonnie Translation: glutathione deficiency is an epigenetic methylation pathway breakdown, brought upon by environmental forces. The cells have to use up more vitamin C than usual to compensate. For these individuals, can you say Allergy Fighters? It contains vitamin C and reduced glutathione.

Journal of Nutrigenetics and Nutrigenomics

Dietary intake of fish and -3 polyunsaturated fatty acids (-3 PUFAs) may decrease the risk of prostate cancer development and progression to advanced stage disease. This could reflect the anti-inflammatory effects of PUFAs, possibly through mediation of cyclooxygenase (COX), a key enzyme in fatty acid metabolism and inflammation. Despite promising experimental evidence, epidemiological studies have reported somewhat conflicting results regarding the effects of fish/PUFAs on prostate cancer development and progression. The literature suggests that fish, and particularly long-chain -3 PUFAs, may have a more pronounced protective effect on biologically aggressive tumors or on their progression, and less on early steps of carcinogenesis. Moreover, the impact of LC -3 PUFAs may be modified by variation of the COX-2 gene. Overall, results to date support the hypothesis that long-chain -3 PUFAs may impact prostate inflammation and carcinogenesis via the COX-2 enzymatic pathway.

Archives of Neurology

The incidence and prevalence of dementia are expected to increase several-fold in the coming decades. Given that the current pharmaceutical treatment of dementia can only modestly improve symptoms, risk factor modification remains the cornerstone for dementia prevention. Some of the most promising strategies for the prevention of dementia include vascular risk factor control, cognitive activity, physical activity, social engagement, diet, and recognition of depression. In observational studies, vascular risk factors—including diabetes, hypertension, dyslipidemia, and obesity—are fairly consistently associated with increased risk of dementia. In addition, people with depression are at high risk for cognitive impairment. Population studies have reported that intake of antioxidants or polyunsaturated fatty acids may be associated with a reduced incidence of dementia, and it has been reported that people who are cognitively, socially, and physically active have a reduced risk of cognitive impairment. Most promising, interventions of cognitive and physical activity improve cognitive performance and slow cognitive decline.

New England Journal of Medicine

Chronic mucocutaneous candidiasis may be manifested as a primary immunodeficiency characterized by persistent or recurrent infections of the mucosa or the skin with candida species. An autosomal recessive form of susceptibility to chronic mucocutaneous candidiasis is associated with genomic homozygous mutations in CARD9.

Food and Chemical Toxicology

Flavonoids are known to have antioxidant activity that may limit DNA damage and help prevent degenerative diseases, including cancer. However, our knowledge of flavonoids’ role in DNA protection/repair mechanism(s) is limited. This study investigated the effects of quercetin on DNA oxidation and DNA repair in Caco-2 cells with or without oxidant (H2O2) challenge. Quercetin significantly reduced oxidative DNA damage, as measured by the number of single-strand breaks identified by single cell gel electrophoresis. Quercetin treatment also caused a measurable increase in the mRNA expression of human 8-oxoguanine DNA glycosylase (hOGG1). In addition, the highest level of quercetin tested maintained hOGG1 expression at basal levels or higher for up to 12 h after H2O2 treatment, while oxidant treatment alone resulted in significant reduction of hOGG1 at 8 h. Our study indicates that quercetin could protect DNA both by reducing oxidative DNA damage and by enhancing DNA repair through modulation of DNA repair enzyme expression.

Pilgrim Snacks

nutrocon@aol.com (nutrocon@aol.com) — Fri, 30 Oct 2009 15:03:00 +0000

Eat snacks like the Pilgrims did for one month? This is exactly what my Granddaughter's second grade class is doing right now. Her teacher is asking that every student bring in a Pilgrim-like snack for one month. The lesson is to help the students appreciate the living conditions on the boat ride over to the Americas. The diet was very repetitive and the rations were small.

This got us to thinking. What did the Pilgrims really eat and can our clients learn from it? It also begs the question: would it be a good challenge for all of us to adhere to these foodstuffs during Thanksgiving month?

As you can see below, aside from the fact that the foodstuffs had no preservatives (except salt), they are in desperate need of a 21st century update!

Biscuits (hard tack) - our alternative: Blue Diamond Nut Thins, Mary's Gone Crackers, or Flatbread
Holland cheese - our alternative: imported Dutch Gouda
Salted pork - our alternative: Shelton's Turkey Sticks
Dried beef - our alternative: Golden Valley Organic Beef Jerky
Salted fish - our alternative: SnackMasters Salmon Jerky
Oatmeal - long cooking variety
Wheatmeal - our alternative: Cream of Wheat or Wasa crackers
Beans/Peas - organic canned beans, hummus, Trader Joes dried peas
Butter - organic
Aqua-vitae (a strong liquor made from distilling beer or wine) - our alternative: for kids, Unsweetened Tea; for adults, Schnapp's or Chambord
Beer (the primary drink for everyone, water was often considered unsafe) - our alternative: for kids, Filtered Flat or Naturally Sparkling Water; for adults, non-alcoholic rice beer

The glaring omission is fruits, vegetables, nuts, and seeds, which did not keep on long ship voyages or were too expensive. We would highly suggest making these part of your Pilgrim Snacks.

As long as you keep the snack balanced (always a healthy fat/protein with a carb) and the serving size small, enjoy Pilgrim Snacks!

Med Diet delays need for diabetes drugs

nutrocon@aol.com (nutrocon@aol.com) — Fri, 30 Oct 2009 14:49:00 +0000

In this randomized controlled trial, 108 subjects with newly diagnosed type 2 diabetes were assigned to a Mediterranean-style diet (MED) while 107 were assigned to a low-fat diet based on American Heart Association guidelines.

The MED diet was rich in vegetables and whole grains, low in red meat, had a goal of no more than 50% of calories from complex carbohydrates, and no less than 30% of calories from fat (mainly olive oil). Both diets restricted energy intake to 1800 calories per day for men and 1500 for women, and each group received equal guidance on increasing physical activity. Subjects were followed for up to 4 years to assess the primary outcome of time to introduction of antihyperglycemic drug therapy. Per protocol, drug therapy was initiated when HbA1c exceeded 7% at 2 consecutive 3-month intervals. Secondary outcome measures included changes in weight, glycemic control, lipid levels, and blood pressure.

At the end of the trial, 44% of MED subjects required antihyperglycemic drugs compared with 70% of low-fat diet subjects.

Both groups lost weight, and though the MED group lost significantly more in the first year.

Other measures of glycemic control (changes in level of HbA1c, plasma glucose, serum insulin, HOMA insulin sensitivity, and adiponectin) all favored the MED participants. High-density lipoprotein (HDL) cholesterol increased and triglycerides decreased significantly more in the MED group.

Viewpoint

Current American Diabetes Association guidelines recommend the initiation of metformin immediately upon diagnosis of type 2 diabetes along with lifestyle changes designed to induce weight loss. However, oral antihyperglycemics fail over time, creating the need for ever-intensifying drug regimens. Results of the current study demonstrate that a Mediterranean-style diet can delay the need for antihyperglycemic agents for at least 3 years for most newly diagnosed patients.

This is a truly remarkable finding. Because the current guidelines are focused on weight loss, they recommend either a low-carbohydrate or low-fat calorie-restricted diet. The present study finds clear superiority with a low-carbohydrate approach.

This study suggests that while weight loss may be an important goal for most diabetic patients, how that weight loss is achieved might make a difference in long-term maintenance of glycemic

Annals of Internal Medicine

Steve - we have been blessed with a cornucopia of wonderfully positive diet and lifestyle research recently. It is very encouraging to see.

Scientists Discover Influenza's Achilles Heel: Antioxidants

nutrocon@aol.com (nutrocon@aol.com) — Fri, 30 Oct 2009 14:39:00 +0000

As the nation copes with a shortage of vaccines for H1N1 influenza, a team of Alabama researchers have raised hopes that they have found an Achilles' heel for all strains of the flu -- antioxidants.

In an article appearing in the November 2009 print issue of the FASEB Journal, they show that antioxidants -- the same substances found in plant-based foods -- might hold the key in preventing the flu virus from wreaking havoc on our lungs.

"The recent outbreak of H1N1 influenza and the rapid spread of this strain across the world highlights the need to better understand how this virus damages the lungs and to find new treatments," said Sadis Matalon, co-author of the study. "Additionally, our research shows that antioxidants may prove beneficial in the treatment of flu."

Matalon and colleagues showed that the flu virus damages our lungs through its "M2 protein," which attacks the cells that line the inner surfaces of our lungs (epithelial cells). Specifically, the M2 protein disrupts lung epithelial cells' ability to remove liquid from inside of our lungs, setting the stage for pneumonia and other lung problems. The researchers made this discovery by conducting three sets of experiments using the M2 protein and the lung protein they damage.

First, frog eggs were injected with the lung protein alone to measure its function. Second, researchers injected frog eggs with both the M2 protein and the lung protein and found that the function of the lung protein was significantly decreased. Using molecular biology techniques, scientists isolated the segment of the M2 protein responsible for the damage to the lung protein. Then they demonstrated that without this segment, the protein was unable to cause damage. Third, the full M2 protein (with the "offending" segment intact) and the lung protein were then re-injected into the frog eggs along with drugs known to remove oxidants. This too prevented the M2 protein from causing damage to the lung protein. These experiments were repeated using cells from human lungs with exactly the same results.

"Although vaccines will remain the first line of intervention against the flu for a long time to come, this study opens the door for entirely new treatments geared toward stopping the virus after you're sick," said Gerald Weissmann, M.D., Editor-in-Chief of the FASEB Journal, "and as Thanksgiving approaches, this discovery is another reason to drink red wine to your health."

Bonnie - what are the chances that the CDC adds antioxidants and probiotics as first line therapies to fight influenza? Unfortunately, slim and none.

Diet And Intestinal Bacteria Linked To Healthier Immune Systems

nutrocon@aol.com (nutrocon@aol.com) — Thu, 29 Oct 2009 13:40:00 +0000

Insoluble dietary fiber not only keeps you regular, say Australian scientists, it also plays a vital role in the immune system, keeping certain diseases at bay.

The indigestible part of all plant-based foods pushes its way through most of the digestive tract unchanged, acting as a kind of internal broom. When it arrives in the colon, bacteria convert it to energy and compounds known as 'short chain fatty acids'. These are already known to alleviate the symptoms of colitis, an inflammatory gut condition.

Similarly, probiotics and prebiotics, food supplements that affect the balance of gut bacteria, reduce the symptoms of asthma and rheumatoid arthritis, also inflammatory diseases.

Published October 28 in Nature, breakthrough research by a Sydney-based team makes new sense of such known facts by describing a mechanism that links diet, gut bacteria and the immune system.

PhD student Kendle Maslowski and Professor Charles Mackay from the Garvan Institute of Medical Research, in collaboration with the Co-operative Research Centre for Asthma and Airways, have demonstrated that GPR43, a molecule expressed by immune cells and previously shown to bind short chain fatty acids, functions as an anti-inflammatory receptor.

"The notion that diet might have profound effects on immune responses or inflammatory diseases has never been taken that seriously" said Professor Mackay. "We believe that changes in diet, associated with western lifestyles, contribute to the increasing incidences of asthma, Type 1 diabetes and other autoimmune diseases. Now we have a new molecular mechanism that might explain how diet is affecting our immune systems."

"We're also now beginning to understand that from the moment you're born, it's incredibly important to be colonized by the right kinds of gut bacteria," added Kendle. "The kinds of foods you eat directly determine the levels of certain bacteria in your gut."

The conclusions drawn from the current research provide some of the most compelling reasons yet for eating considerably more unprocessed whole foods -- fruits, vegetables, grains, nuts and seeds.

Bonnie - music to my ears!

Statins have dramatic effect on the brain

nutrocon@aol.com (nutrocon@aol.com) — Thu, 29 Oct 2009 13:40:00 +0000

A study in the October Journal of Lipid Research finds that statin drugs can have profoundly different effects on brain cells -both beneficial and detrimental.

These findings reinforce the idea that great care should be taken when deciding on the dosage and type of statin given to individuals, particularly the elderly.

John Albers and colleagues compared the effects of two commercially used statins, simvastatin and pravastatin, on two different types of brain cells, neurons and astrocytes (support cells that help repair damage). By directly applying the drugs to cells as opposed to administering them to animals, they could eliminate differences in the drugs' ability to cross the blood-brain barrier as a reason for any differing effects.

Albers and colleagues looked at the expression of genes related to neurodegeneration, and found that indeed, despite using biologically equivalent drug concentrations, differences were seen both between cells, and between drugs; for example, simvastatin reduced the expression of the cholesterol transporter ABCA1 by approximately 80% in astrocytes, while pravastatin lowered expression by only around 50%. Another interesting difference was that while both statins decreased expression of the Tau protein -associated with Alzheimer's disease -- in astrocytes, they increased Tau expression in neurons; pravastatin also increased the expression of another Alzheimer's hallmark, amyloid precursor protein (APP).

While increased levels of these two proteins may account for potential risks of disease, Albers and colleagues also note that large decreases in cholesterol proteins like ABCA1 should be considered. Brain cholesterol levels tend to be reduced in elderly people, and in such individuals the long-term effects of statin therapy could lead to transient or permanent cognitive impairment.

Bonnie - this should make anyone considering or currently taking statins think twice. As we have alluded numerous times, cognitive impairment is a possibility in those taking statins.

Does it still seem plausible to get most of the adult population on statin medication as Big Pharma is trying to do? Especially when there are other options for healthy lipids along with diet and lifestyle modification. We found this chart on hearthealthyonline.com

Medicine-------Lower Triglycerides------Raise HDL-------Lower LDL
Niacin-------------20-50 percent---------------15-35 percent----5-25 percent
Fish Oil Pills---25-30 percent----------------little effect--------little effect
Fibric Acids----7-30 percent-----------------1-20 percent-----5-25 percent
Statins------------7-30 percent-----------------5-15 percent-----8-55 percent

Fish Oil and Rheumatoid Arthritis

nutrocon@aol.com (nutrocon@aol.com) — Thu, 29 Oct 2009 13:37:00 +0000

New research from Queen Mary, University of London and Harvard Medical School has revealed precisely why taking fish oils can help with conditions like rheumatoid arthritis.

In a paper published in Nature October 28, researchers describe how the body converts an ingredient found in fish oils into another chemical called Resolvin D2 and how this chemical reduces the inflammation that leads to a variety of diseases.

The research also suggests that Resolvin D2 could be the basis for a new treatment for diseases including sepsis, stroke and arthritis. Unlike other anti-inflammatory drugs, this chemical does not seem to suppress the immune system.

The researchers, who were funded by the Arthritis Research Campaign, the Welcome Trust and the National Institutes of Health, looked at a particular ingredient of fish oils called DHA. They were able to show how the body converts DHA* into Resolvin D2 and discover its exact chemical structure.

"This research is important because it explains at least one way in which fish oils can help in different types of arthritis. We can also work on this chemical and see if it can be used not only to treat or even prevent arthritis, but also as a possible treatment for a variety of other diseases associated with inflammation," stated researchers.

Curcumin found to kill cancer cells

nutrocon@aol.com (nutrocon@aol.com) — Wed, 28 Oct 2009 14:45:00 +0000

A molecule found in a curry ingredient can kill esophageal cancer cells in the laboratory, suggesting it might be developed as an anti-cancer treatment, scientists said on Wednesday.

Researchers at the Cork Cancer Research Center in Ireland treated esophageal cancer cells with curcumin -- a chemical found in the spice turmeric, which gives curries a distinctive yellow color -- and found it started to kill cancer cells within 24 hours.

The cells also began to digest themselves, they said in a study published in the British Journal of Cancer.

Bonnie - this is not anything new. Curry is a wonderful spice to use for many of us. Unfortunately, many others do not tolerate it very well, especially those with salicylate issues.

In depth look into agave

nutrocon@aol.com (nutrocon@aol.com) — Tue, 27 Oct 2009 15:34:00 +0000

Agave Syrup May Not Be So Simple
By Laura Johannes
Wall Street Journal

Agave is not just for tequila anymore. The sap from the Mexican plant is now increasingly being sold as a natural sweetener called agave nectar. Companies that sell it say it saves calories and raises blood sugar less than conventional sugar. Doctors are skeptical that it is healthier, and a major testing lab issued a warning that it is not safe for diabetics.

Agave (pronounced ah gav ee), sometimes mistaken for a cactus because of its spiky, sword-shaped leaves, is a flowering plant in the lily family. Its nectar is popping up in beverages, baked goods and on restaurant menus; it is also gaining popularity as an all-purpose sweetener, often next to honey in supermarket aisles.

Agave-nectar composition varies, but typically is primarily fructose. It has about the same amount of calories as sugar, or slightly more, but companies say its sweeter flavor allows you to cut the amount, saving calories.

Agave's other claim to healthfulness is that it has a low glycemic index, meaning it breaks down more slowly creating less of a sugar rush. At least two companies have marketed their products as a good alternative for diabetics. But the Glycemic Research Institute, a Washington, D.C., laboratory, issued a warning Friday that diabetics experienced "severe and dangerous side effects" during testing of an agave nectar. "The diabetics passed out on the floor and had to be taken to the hospital," says Ann de Wees Allen, chief of biomedical research at the lab. She declined to say how much of the product the diabetics consumed during the test, saying that would be disclosed after a complete analysis of the results.

The product tested was a maple-flavored version of the Volcanic Nectar brand agave, sold by Global Goods Inc., of Highland, Utah. Company President Brian Oaks said the product, which has never been sold, had a significant amount of maple syrup in it, which likely caused the problems. Dr. Allen says the nectar had an extremely small amount of maple syrup in it and is almost identical to the company's flagship agave product.

Previous tests, in which diabetics consumed a small amount of Volcanic Nectar agave, had resulted in the lab awarding a "diabetic friendly" seal to the Volcanic Nectar product, which it has since rescinded. The lab has stopped testing agave on humans amid safety concerns. Also, Dr. Allen says the lab refused to test four other agave products after a chemical analysis it commissioned from another lab found they were mixed with high-fructose corn syrup, which was not disclosed on the label. She declined to name the brands. 'Free-for-All Food'

If you're hoping to use agave to lose weight, nutritionists warn it has as many, or more, calories as sugar. "I worry that people may get confused and start thinking it is a free-for-all food," says Gillian Arathuzik, a dietician at the Joslin Diabetes Center in Boston. Agave is 1.4 to 1.6 times as sweet as sugar, says Sabra Van Dolsen, president of Colibree Co., an Aspen, Colo., company that sells Nekutli brand agave nectar. Calories vary from brand to brand, but are typically more than sugar. Nekutli, for example, has 60 calories per tablespoon. A tablespoon of white sugar has 45 calories. Since agave is sweeter, you can use less, proponents say. Stephen Richards, chief executive of BetterBody Foods & Nutrition LLC of Salt Lake City and author of a self-published agave cookbook, says each cup of sugar can be replaced by one-half to two-thirds cup of agave.

But depending on how refined the product is, agave can have little or no flavor—or taste like honey or maple syrup, according to the companies and our subjective tests. Unscientific testing by a Wall Street Journal reporter found agave to be pleasant in tea, but it imparted a brownish tinge and odd taste to lemonade. When baking, oil can be reduced because agave is liquid, says Mr. Richards. Agave makes baked goods rise slightly faster, which can result in a "cakier" texture, he adds. In our test, blueberry bran muffins made with BetterBody's Xagave brand nectar were identical in flavor to a batch made with brown sugar, though the test muffins rose slightly more. The agave version was nine fewer calories a muffin, a 7% saving.

Bonnie - I would never recommend agave to hypoglycemic or diabetic individuals. For them, I put this into the same category as honey or pure maple syrup even though it is low glycemic.

Epigenetics and Autism

nutrocon@aol.com (nutrocon@aol.com) — Tue, 27 Oct 2009 14:35:00 +0000

Researchers at Duke University Medical Center have uncovered a new genetic signature that correlates strongly with autism and which doesn't involve changes to the DNA sequence itself. Rather, the changes are in the way the genes are turned on and off. The finding may suggest new approaches to diagnosis and treatment of autism.

The researchers found higher-than-usual numbers of gene-regulating molecules called methyl groups in a region of the genome that regulates oxytocin receptor expression in people with autism.

"In both blood samples and brain tissue, the methylation status of specific nucleotides in the oxytocin receptor gene is significantly higher in someone with autism, about 70 percent, compared to the control population, where it is about 40 percent," said co-lead author Simon G. Gregory, Ph.D., assistant professor in the Duke Department of Medicine. The work appears in BMC Medicine journal online.

Oxytocin is a hormone secreted into the bloodstream from the brain, and also released within the brain, where it has a bearing on social interaction. Previous studies have shown that giving oxytocin can improve an autistic person's social engagement behavior and it is being explored as a potential treatment of the disorder. Higher methylation of the oxytocin receptor gene may make a person less sensitive to the hormone.

"These results provide a possible explanation of why social isolation forms part of the autism spectrum – because an autistic individual's ability to respond to oxytocin may be limited," Gregory said. " Oxytocin has been tied to levels of trust and ability to read social cues."

Although the methylation status of the OXTR gene is not a definitive diagnosis of autism by itself, a test for methylation might be used along with other clinical tests for diagnosing autism. Gregory said that methylation-modifying drugs also may be a new avenue for treatments.

Though not a change to the DNA sequence itself, methylation status can be inherited, by what is known as epigenetics - inherited changes in gene regulation.

"The epigenetic link to autism is extremely exciting as it provides another opportunity for us to explore the heritability of this disorder and argues the importance of exploring epigenetic markers in complex disease," said co-lead author Jessica J. Connelly, Ph.D., assistant professor in the Department of Medicine at the University of Virginia.

Steve - there is that buzzword again: epigenetics. If you recall what we have been saying for the last several years, environmental, dietary, and lifestyle choices all contribute to gene expression. If our choices are poor, such as exposing ourselves to poor diet and exposing ourselves and our unborn children to an excessive environmental toxic load, we overload methylation genes, thus negatively expressing genes we would rather keep latent. Soon enough, science will understand this connection and public health officials will have to take a long, hard look at the gigantic weight of toxicity that burdens the human population.

Confidence in supplements at all-time high.

nutrocon@aol.com (nutrocon@aol.com) — Mon, 26 Oct 2009 19:48:00 +0000

Consumer confidence in dietary supplements reached a high point in 2009, with 84 percent of American adults indicating that they are confident in the safety, quality and effectiveness of dietary supplements compared to 81 percent last year, according to a new survey conducted by Ipsos-Public Affairs for the Council for Responsible Nutrition (CRN). In the last several years, confidence levels in dietary supplements have been on a gradual rise, with 80 percent of American adults indicating a favorable level of confidence in dietary supplements in 2007, and 79 percent of American adults responding similarly in 2006.

According to the results from the 2009 CRN Consumer Survey on Dietary Supplements, confidence in dietary supplements isn’t the only thing on the rise—the on-line survey also showed a slightly higher percentage of adults who label themselves as supplement users, with 65 percent classifying themselves as such. In 2008, 64 percent of American adults identified themselves as supplement users. These numbers are also consistent with previous years’ findings, as 68 percent and 66 percent of Americans identified themselves as supplement users in 2007 and 2006, respectively.

Consumers can also feel more confident given that in its first year of existence, the serious adverse event reporting system for dietary supplements demonstrated a strong safety profile when viewed within the context of similar reporting systems for other regulated industries.

Also up slightly this year is the percentage of consumers who regularly take a multivitamin; with 78 percent reporting they do so compared to 75 percent of supplement users who reported taking a multivitamin regularly in 2008.

1 in 5 kids vitamin D deficient

nutrocon@aol.com (nutrocon@aol.com) — Mon, 26 Oct 2009 14:51:00 +0000

At least one in five U.S. children aged 1 to 11 don't get enough vitamin D and could be at risk for a variety of health problems including weak bones.

By a looser measure, almost 90 percent of black children that age and 80 percent of Hispanic kids could be vitamin D deficient — "astounding numbers" that should serve as a call to action, said Dr. Jonathan Mansbach, lead author of the new analysis and a researcher at Harvard Medical School and Children's Hospital in Boston.

The findings add to mounting evidence about vitamin D deficiency in children, teens and adults, a concern because of recent studies suggesting the vitamin might help prevent serious diseases, including infections, diabetes and even some cancers.

Exactly how much vitamin D children and adults should get, and defining when they are deficient, is under debate. Doctors use different definitions, and many are waiting for guidance expected in an Institute of Medicine report on vitamin D due next year. The institute is a government advisory group that sets dietary standards.

The new analysis, released by the journal Pediatrics, is the first assessment of varying vitamin D levels in children aged 1 through 11.

Previous studies in the journal this year found low levels were prevalent in U.S. teens, and also showed kids with low levels had higher blood pressure and cholesterol levels, and were more likely to be overweight.

The new analysis uses data from a 2001-06 government health survey of nearly 3,000 children. They had blood tests measuring vitamin D levels.

Bonnie - there are actually updated levels as we reported last week in our eNewsletter.

What Risks Are Associated With High-Dose Crestor?

nutrocon@aol.com (nutrocon@aol.com) — Fri, 23 Oct 2009 15:24:00 +0000

Jodi H. Walker, PharmD
Medscape Pharmacists

Rosuvastatin, a hydroxy-methylglutaryl coenzyme A reductase inhibitor, is approved in doses ranging from 5 mg to 40 mg daily. Rosuvastatin is a potent statin, about twice as potent as atorvastatin, 4 times as potent as simvastatin, and at least 8 times as potent as pravastatin and lovastatin. Dosing rosuvastatin at 80 mg exceeds the manufacturer's maximum daily dose and is not approved by the US Food and Drug Administration (FDA).

This dose has been evaluated in clinical trials, however. In fact, the manufacturer initially was developing an 80-mg dose. Although rosuvastatin 80 mg monotherapy resulted in the greatest reduction of low-density lipoprotein (LDL) cholesterol (65%) compared with other studied statins, it also was associated with increased risk for muscle toxicity (eg, myopathy, rhabdomyolysis) and renal toxicity (eg, proteinuria, hematuria, increased serum creatinine). According to preapproval documents, among patients receiving the 80-mg dose, the incidence rates of myopathy (1%) and rhabdomyolysis (0.4%) were higher than those reported in the original new drug application and labeling of approved statins.

Preapproval documents also noted a high frequency of elevated creatine kinase levels associated with rosuvastatin compared with other statins. The FDA ultimately denied approval of the 80-mg dose because of safety concerns and the limited additional benefit compared with the 40-mg dose.

Cases of rhabdomyolysis and renal failure have been reported since marketing of rosuvastatin, including a recent case of rhabdomyolysis associated with the 80-mg dose. Risk factors for rosuvastatin-induced myopathy and rhabdomyolysis include age 65 years or older, Asian ethnicity, hypothyroidism, renal impairment, and coadministration with cyclosporine, lopinavir/ritonavir (Kaletra®), fibrates, niacin, or gemfibrozil.

General risks for statin-induced rhabdomyolysis have been proposed and include hepatic dysfunction, hypertriglyceridemia, small body frame and frailty, metabolic muscle diseases, drugs affecting statin metabolism or elimination, postoperative status, and chronic alcohol use.

Due to risk for myopathy and rhabdomyolysis, the lowest effective rosuvastatin dose should be used. A lower initial dose of 5 mg is recommended for patients of Asian ethnicity, patients with severe renal impairment, and patients taking concomitant lopinavir/ritonavir. A reduced initial dose should be considered in patients receiving fibrates or niacin; coadministration with gemfibrozil should be avoided. The 40-mg dose is only recommended for patients who have not achieved their LDL goal with 20 mg.

Choosing to prescribe rosuvastatin 80 mg is influenced by several issues: patient risk factors for rhabdomyolysis, concomitant medications, comorbid conditions, and need for close monitoring. The benefits and risks inherent in such dosing depend on the individual patient. Patients who receive any dose of rosuvastatin should be monitored closely after any dosage adjustments. All patients on rosuvastatin should be counseled to seek immediate medical attention for signs and symptoms of rhabdomyolysis, including muscle pain, muscle weakness or cramps, and dark urine. If rhabdomyolysis is suspected, the statin should be discontinued immediately and supportive measures taken.

Living with gluten intolerance one year after diagnosis

nutrocon@aol.com (nutrocon@aol.com) — Fri, 23 Oct 2009 15:12:00 +0000

No Pain, No Gain One Year After Diagnosis of Gluten Intolerance
By Erin Madison
Great Falls Tribune
http://www.greatfallstribune.com/article/20091021/LIFESTYLE/910210312/1024/rss04