Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Alcohol, bone osteoporosis and bone fracture risk

Alcohol and bones? Does alcohol help or hurt bones? Modest drinking helps against osteoporosis as compared to abstainers and heavy drinkers. Don't you love it!

Berg and colleagues examined the literature studying effect of alcohol drinking hip fracture, bone density, non-hip fracture, bone density loss over time, bone response to estrogen replacement, and bone remodeling. They found that as compared to abstainers, subjects imbibing 0.5 to 1.0 drinks per day had lower hip fracture risk. In contrast, the risk was higher in subjects enjoying more than 2 drinks per day. Modest drinking is thus better than no drinking or heavy alcohol drinking.

The investigators also found a positive impact alcohol consumption on bone density.

Now that you know that alcohol tends to prolong life and may build healthy bones, are you more likely to enjoy a drink a day, to keep the doctor away. Please share your thoughts. Cheers!

Fish type, mercury and heart benefits

Fish, omega-3 fatty acids and heart: Fish contain high amounts of omega-3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid) which have been proven to be cardioprotective, i.e. good for heart. They prevent heart attacks.  Studies suggest that there is 29% reduction in mortality over 2 years inpatients who have had heart attacks.

The evidence is strong enough for the American Heart Association to recommend increased intake of omega 3-fatty acids. The good news is that mercury content of all the fish is not the same. The mercury content of predatory fish is much higher because they eat other fish containing mercury and indirectly attain much higher levels mercury than the fish at the lower end of the food chain.

The beneficial effect if fish intake can be demonstrated with as few as 1 fish per week, and greater intake provides even greater protection.

Fish, mercury and toxicity: The benefits of fish intake are tempered by the concern over mercury intake through fish and the resultant potential for neurotoxicity.

Low versus high mercury fish: The good news is that mercury content of all the fish is not the same. The mercury content of predatory fish is much higher because they eat other fish containing mercury and indirectly attain much higher levels mercury than the fish at the lower end of the food chain.

Identifying low versus high mercury fish: Sardines, salmon, and shrimp have lower mercury content than the predatory sharks, tuna, sword fish and orange roughy.

Farmed fish: Even more importantly, the farmed fish have the lowest mercury content while providing the same benefit.

Limiting the mercury content: The exposure to mercury can be lowered by limiting the amount of fish ingested and eating the fish with lower mercury content.

Recommendations for fish intake: Institute of Medicine provides conservative recommendations regarding fish consumption. Non-pregnant persons may eat 1 predatory fish meal and 2-3 low mercury fish meals per week. Pregnant women should not eat more than 1 predatory fish meal per 2 weeks; however they may eat other fish 2-3 times per week.

Both wild and farmed fish are beneficial.

Above is based on an article in Nature Clin Practice (2008).

Right diet for child's sex: son or daughter?

Boy? Girl? Would-be mother’s diet, i.e. preconception diet, can help make the choice. This comes from a study titled, You are what your mother ate”, published in the journal Proc Biol Sci in 2008. If son is the choice, the woman before pregnancy should be pigging out!

There is paucity of information about natural and/or environmental factors affecting mechanisms of sex allocation in human evolutionary process. The investigators studied 740 women. The women with the highest energy intake preconception were likely to have sons. While food intake during pregnancy had no impact, women with the top third intake food intake had sons 56% of the times, whereas only 45% from the group from the lower third of energy intake had sons.

Interestingly, women eating cereal everyday prior to conceiving had almost 90% chance of having a son as compared to those eating just one bowl or less of cereal per week. Women having sons ate about 300 more calories than the ones who had girls. Potassium rich diet is also likely to lead to a male child.

Is it because boys tend to be bigger and larger energy investment tilts balance?

Are these results plausible? While more data is needed to confirm these findings, these results are consistent with laboratory data related to fertilitization and survival of male embryos.

“Our results support hypotheses predicting investment in costly male offspring when resources are plentiful”, wrote the authors. These results also have implications for artificial gender selection in fertility clinics.

Do you think diet can or does affect ultimate sex of the would-be baby? Do you know of someone who goes by this theory and practice it? Please share your story.

Nurses smell stool for diarrhea cause: nursing nose makes odiferous diagnosis

Can nurses smell the diagnosis better than doctors and tests? Especially by smelling stool for cause of diarrhea?

Nurses have long been contributing to astute observations that have stood the test of time. A shining example is Sister Mary Joseph's nodule.

All diarrheas are not the same and nurses can smell and actually diagnose the cause for diarrhea. An early diagnosis can help early specific treatment.

While rotavirus gastroenteritis appears clinically to be similar to other types of diarrhea, nurses were able to correctly diagnose Rotavirus as the cause in 69% on the bases of the stool smell alone. This was reported by Poulton and colleagues in the Archives of Diseases in Childhood.

Clostridium difficile diarrhea can be devastating and prompt treatment may help attenuate the seriousness pending results of investigations. Johansen and colleagues studied diarrheal stool sample and found that nurses could identify Clostridium difficile toxin positivity in 31 out of 37 cases yielding a sensitivity and specificity of 84 and 77% respectively. The authors concluded that there is a characteristic “Clostridial odor” that helps nurses identify the cause.

These results of the odiferous diagnosis were confirmed in a more recent study by Burdette and Bernstein and published in the journal Clinical Infectious Diseases 2007.

Do you believe the data above that nurses have sharp noses and can actually identify cause of diarrhea? Do you think it is because they tend to be more perceptive as an occupation OR that nurses are predominantly women and that women are more perceptive than men? Please share your thoughts.

Apple a day, keeps colon cancer away

Does apple help health or is it a myth? Can it help against cancer? Do apple pectin and juice extract produce anticarcinogens during the fermentation in the colon? The answer seems to be yes.

Dr. Waldecker and colleagues in the journal Nutrition 2008 studied the fermentation supernatants from incubation of human fecal slurry with apple pectin and apple juice extracts. The Inhibition of the enzyme histone deacetylase (HDAC) seems to play a central role in these anticancer effects. The authors found that  fecal slurry from fermentations with pectin was rich in butyrate and very active in HDAC inhibition in colon tumor cell lines.

The HDAC-inhibitory potency from pectin-rich fermentations correlated with the butyrate levels. Fecal slurry from fermentations with apple juice extract had lower butyrate yields but similar HDAC inhibition and potentially similar anticarcinogenic effect.

This is how it works: Apple fermentation leads to increase in short chain fatty acids like butyrate. Butyrate is a chemopreventive metabolite that can prevent the occurrence of colorectal cancer. The mechanism is via inhibition of histone deacetylase leading to retarding the carcinogensis, the process of tumor formation.

The authors concluded that apple products exert anticarginogenic effects in the colon.

What are your thoughts about fruit in general and apple in particular? Are you going to go more for fruits or apples in the grocery store? Please share your thoughts.

Organic food heals Crohn’s disease

Organic food—expensive! Should we eat this expensive organic food for better health in Crohn’s?

Would organic diet be better for healing Crohn’s?

Gasche and colleagues from Austria tested the hypothesis that organic diet is better for treating Crohn’s disease.

Patients with Crohn’s received organic diet or a control diet (low-fiber, low-fat, and high-carbohydrate). Outcome measures included MRI, endoscopy, Crohn's Disease Activity Index (CDAI), and the Inflammatory Bowel Disease Questionnaire (IBDQ).

Organic food diet showed improvement in their intestinal lesions not seen in patients assigned to a high-carbohydrate diet. The investigators concluded that food as part of the modern Western lifestyle may cause persistence of intestinal Crohn's lesions.

Diet and environmental have been linked to risk for Crohn’s disease. Diet and environment are not mutually exclusive. The increase in incidence of Crohn’s disease in recent decades suggests environmental risk factors associated with a Western lifestyle may contribute to Crohn’s disease.

What kind of diet do you prefer? Would you be willing to spend more for organic food in your diet based on this study?

Placebo pain relievers and price

Placebo pain relief, really?

Yes, placebos work for pain, so say Dr. Weber et al. in JAMA…the more the price, the better the placebos work. After all you get what you pay for.

Some doctors probably do use placebos knowingly or unknowingly for chronic painful conditions that they can’t find effective treatments? These may include irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, interstitial cystitis etc.

The question arises, should the doctors use placebos knowingly? If yes, the more expensive ones?

And where do you draw the line? Should the doctor be allowed to have a shop displaying remedies in his clinic?

Please share your thoughts.

Diet Crohn’s disease risk

Diet as risk for Crohn’s disease?

Over the years, some dietary foods predominant in vegetables and fruit have been thought of as protective. In contrast, fatty foods have been thought as increasing the risk for Crohn's disease. The literature however has been inconsistent. As such, the controversy continues as the precise cause of Crohn’s disease remains an enigma.

Dr. D’Souza and colleagues from Canada reported the results of their study in Inflammatory Bowel Diseases 2008. They examined the dietary patterns and risk for Crohn's disease in children in a case-control study fashion. Subjects included newly diagnosed Crohn’s disease compared with population and/or hospital-based controls.

Dietary patterns were assessed using a food frequency questionnaire. The study comprised of 149 cases of Crohn’s disease and 251 controls.

Girls consuming diet consisting of meats, fatty foods, and desserts had an increased risk by 4.7 fold. In contrast, boys and girls enjoying diet consisting of vegetables, fruits, olive oil, fish, grains, and nuts had a the risk decreased substantially.

The authors concluded that specific dietary patterns could be associated with higher or lower risks for Crohn’s disease in children.

Do you or someone you know has Crohn’s disease? What are your thoughts on the relationship of diet and Crohn’s disease or ulcerative colitis?

Aphrodisiac foods as sex stimulants

Do sex and aphrodisiac food really mix well? Recommendations for aphrodisiac sex stimulants especially for erectile dysfunction are rooted more in beliefs, mythology than in science.

Chocolate has been known as “nourishment of the Gods” since ancient times. A combo of a passionate fruit like strawberry dipped in chocolate may just be enough to give a big jump start to the mood of just about anyone.

Fruits: Pomegranates, passion fruit, pears, and berries (raspberries and strawberries) take the cake in this category. Other aphrodisiac foods contributing to sexual desire, stimulation and libido include apples, bananas, cherries, figs and grapes.

Vegetables: Asparagus has the reputation passion stimulant both in Ayurvedic medicine as well as Arabic folklore and is invigorating both for men and women. A juicy tomato, or "love apple," a potent source of the antioxidant, lycopene, was once a highly sought-after libido enhancer. Artichoke, avocado, carrots, celery, cucumbers have been bestowed with legendary aphrodisiac reputation for revitalizing sexual system.

Nuts and seeds: Both pine nuts and pumpkin seeds are aphrodisiac adjuvants. Almonds and pistachios are other popular sexual stimulants.

Seafood especially oysters: Legend has it that Casanova use to cherish 50 oysters every morning. It is loaded with zinc, which is needed for many critical biochemical reactions. While just the act of savoring raw oysters can be stimulating by themselves, make sure with your doctor that it okay for you to enjoy this delicacy especially if there is any question about immune system.

Herbs and Spices Mint, cinnamon, cardamom, saffron are frequently associated with sexual stimulations. Others potential aphrodisiacs include basil, rosemary and cloves. Beware however of some sexual herbal stimulants that actually have unapproved drug aphrodisiac substrates.

Alcohol: Another glass of wine please? While planning a romantic meal, do not forget the role of alcohol. Drink in modest amount only if you don’t want to be disappointed later!

Supplements: Keep in mind that our hectic life styles does not frequently allow for a well balanced diet every day. A daily multivitamin/mineral/antioxidant supplement offers extra health insurance. Talk to your doctor about it.

Last but not the least, don’t “eat” the meal, slowly savor it. Foods may provide sexual substrates, but how you eat (enjoy) it can have an even bigger stimulant effect on the mood.

Bottomline: Do you believe in role of food in romance? Do you think some particular foods or how they are prepared or enjoyed helps setting up the right mood and enjoyable experience? Please share your thoughts.

Glutamine immunity on gut immune system

Immune system in the gut? Glutamine for gut immunity?

Lets first discuss immunity especially gut health and immunity.

Did you know that as much as 25-75% of our immune system is located inside our gastrointestinal system? Immune system is spread throughout body in an effort to have immune defenses all around for our protection. In fact, it is one of the largest organ systems in our body and serves to protect us from forces outside as well as within.

In addition to our GI immune system, our non-immune defenses include the gut flora, physical barrier between the luminal contents and inside of our body, chemical barrier as well as gut motility that helps to keep things moving down and out as in good sanitation.

The intestinal wall acts as a barrier to the noxiuos luminal contents. It is also involved in transport of nutrients. At the same time, intestinal wall is also helping with immunological surveillance since the gut is constantly exposed to injurious agents like toxins etc.

Based on above, dietary modifications by altering the intestinal milieu have potential to alter the expression of genes in the epithelium.

What does glutamine have to do with immunity? Additional glutamine may be one way to boost one’s immunity. Studies have documented that feeding additional glutamine can improve immune function, reduce complications and hospital stay and perhaps improve survival in sick patients. The results are best seen when glutamine is combined with other immune-nutrients.

How does glutamine work? It is an energy source for immune cells as well as gut enteroicytes. It is required for synthesis of nucleotides and proteins etc. In addition, it enhances T and B-cell function, facilitates phagocytosis as well as bacterial killing.

Do you believe in nutritional supplements? Do you take glutamine or any other nutritional supplements? Does this article change your mind in any way? Please share your thoughts.

GERD Acupuncture treatment

Did you know that acupuncture may be an effective GERD or chronic reflux treatment?

Gastroesophagaeal reflux disease or GERD affects tens of millions of people in the US. Proton pump inhibitors (PPIs) are the most effective medical therapy. Patients on PPI therapy are usually started on once a day dosing. However, many patients require double dose, i.e. twice a day dosing for PPIs for relief of reflux symptoms.

Long term use of PPIs is not without long term side-effects.  Many patients choose to employ complementary and alternative medicine therapies instead. Chinese medicine is an ancient system of holistic medicine effective for treatment of variety of gastrointestinal and non-digestive disorders as well as mental conditions and has been used in this context.

Dickman and colleagues examined whether addition of acupuncture rather than another dose of PPI (omeprazole) to the regimen of once a day PPI dose for GERD would be beneficial. Acupuncture was conducted at 5 points selected to calm the stomach system. The investigators found a dramatic difference in relief by addition of acupuncture to the regimen as compared to another dose of omeprazole.

Acupuncture may work better since it treats whole body acting at multiple processes than stomach acid alone.

Do you have chronic heartburn or GERD? What treatment to you take? What are your thoughts on long term use of PPIs versus use of alternative and complimentary therapy like acupuncture. If you are taking medical treatment for GERD, would you be willing to add or even substitute it with some form of CAM? Please share your thoughts.

Sex addiction on internet treated by naltrexone

Internet sex addiction is fast becoming one of the newer compulsive behaviors with immense health as well as psychosocial implications. Although triggers and manifestations be variable and unique for different individuals, the final neurochemical pathways are probably similar. Hence, one successful treatment modality against one is likely to be successful against other. One such option is naltrexone is an opiate blocker and is currently approved for alcoholism.

Drs. Bostwick and Bucci from the Mayo Clinic (Mayo Clinic Proc Feb 2008) report naltrexone based successful treatment of compulsive internet use for sexual gratifications, both self and virtual as well as spontaneous off-line sexual encounters with others he had met online.

The patient is a 24 year old male who presented complaining of “sexual addiction” that was affecting his job as well as his marital life. He attributed  this habit to his discovery of grandfather’s pornographic material as a child. Prior to online sexual fantasies and encounters, he used to indulge in phone sex on 900-lines. At the same time he felt guilty about his addition since he is a devout Christian.

He had tried multiple treatment modalities including antidepressants, psychotherapy, sexual addicts anonymous, pastoral counseling without any benefit.

He was then started on naltrexone resulting in sustained success at avoiding compulsive internet use. The discontinuation of naltrexone resulted in relapse of internet sexual habit which again resolved on restarting naltrexone.

Do you know of anyone around you who has had addiction problems, especially internet addiction and even more specifically internet based sex addiction. I am interested in knowing how the readers feel about internet based sex adiction in general, its impact on life and this report specifically.

Hiccup home remedies, causes and drugs

Hiccup or singultus (from singult in Latin meaning catching breath while sobbing.) is an involuntary nuisance bodily action of no functional value. Most hiccups resolve spontaneously without any active intervention. Hiccups may occur even prior to birth.

Hiccup frequency varies with individual (4 to 20 per minute, going as high as 60/minute in some cases). Similarly the duration of hiccups is variable from few minutes to hours, days and even weeks.

An episode of hiccups may last as long as 48 hours. Some patients have persistent hiccups lasting as long as one month. Intractable hiccup episodes may continue beyond 2 months in rare cases.

How hiccups occur?

Hiccups occur due to contraction of muscles of diaphragm and inspiratory respiratory muscles causing sudden inspiration with closure of the glottis. What provokes a bout of hiccups remains an enigma. “Hiccup reflex arc” comprising of connection of intercostal muscles with multiple nervous connections including phrenic and vagus nerves, sympathetic nervous system, central nervous system (probably brain stem especially respiratory centers. has been implicated.

What causes hiccups?

A bout of hiccup is usually instigated by distention of the stomach as a result overeating or excessive air in stomach due to carbonated beverages, swallowing air. Simple things like upper respiratory infection or a hair in ear in contact with ear drum can provoke an episode. Gastroesophageal reflux disease (GERD), and hiatal hernia have also been implicated. More serious causes include tumors and infections throat, ears and brain. AIDS is another possible cause.

Other stimulants include a drugs, toxins, alcoholism, kidney failure, sudden excitement and changes in temperature, alcohol intake, and tobacco use. Stress has also been implicated.

Failure to identify a cause for persistent or intractable hiccups may suggest a psychogenic etiology. Occurrence of hiccups during sleep makes a psychogenic cause less likely.

Investigations: Most episodes of hiccups are brief, self-limiting and don’t require investigations. Work up should be undertaken in cases of persistent and intractable hiccups. This generally includes a thorough history and physical exam, as well as simple labs like complete blood count (CBC), comprehensive metabolic panel., liver and pulmonary function tests, drug and tox screen. The use of x rays, CT or MRI scans, EEG, lumbar puncture, EGD (esophagogastroduodenoscopy or upper GI scope) needs to be individualized. Treatment of hiccups — There is paucity of rigorously tested scientific data on this subject. Of course if an underlying cause is found, treatment can be directed at that the cause.

Drug options:These include chlorpromazine, antireflux or anti GERD heartburn medications like Prilosex, muscle relaxants like Baclofen, prokinetic like metoclopramide (Reglan), antidepressants and antiepileptic agents.

One AIDS patient used marijuana to get rid of his hiccups.

Home or non-drug remedies: These time tested home remedies for hiccups have been passed on through the generations.

My favorite is closing the ears with your fingers/hands while drinking water through a straw.

Other popular home remedies include:

• Take a deep breath and hold as long as you can
• Gargle with ice water
• Pull the tongue
• Valsalva
• Bite on lemon

There are also reports of successful use of alternative and complementary therapies like hypnosis and acupuncture.

As a last resort, surgery as well as implantation of breathing pacemakers and vagus nerve stimulators have been undertaken.

Do you know of someone with a major hiccup problem? Do you know of a home remedy that works for you. Please share with us.

Nutrient dense or calorie dense foods

Foods may be nutrient dense or calorie dense. Nutrient-dense foods are opposite of opposite of calorie-dense.

Nutrient-dense foods provide healthy nutrition while calorie dense foods provide empty calories without any significant additional nutrients. Given a choice, prefer a nutrient dense foods as compared to calorie dense.

Consider the following:

• There are 6 nutrient components of food: carbohydrates, fats, proteins, vitamins, minerals, and water.
• Nutrient dense foods include whole-grain breads, cereals, rice, beans, pasta, vegetables.
• One cup of strawberries contains only 150 calories, but 3.5g fiber, and high in vitamin C and folate.
• Empty calories or calorie dense foods include candy bars, donuts, and cookies which contain carbohydrates and fats but only insignificant amounts of vitamins and minerals.

Bottomline about nutrient-dense versus calorie-dense: If you have a choice between snack of fruit like strawberries or apple versus a candy bar or donut, prefer a the fruit.

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Fructose sweetener, appetite and obesity

Use of fructose as artificial sweetener has been subject of media reports recently. Some have advised against using fructose because of potential for increased appetite and weight gain. However, multiple studies using fructose in humans have failed to support effect of fructose and the association may be weak at best.

Fructose and glycemic index: Dr. Bantle in a recent review article, “Is fructose the optimal low glycemic index sweetener?” suggests that , there is not yet any convincing evidence that dietary fructose does increase energy intake.

Fructose and food intake and satiety: Soenen and colleagues from Netherlands found no differences in satiety or energy intake after high-fructose corn syrup, sucrose, or milk preloads.

Glucose fructose ratio and food intake, satiety: Similarly, Akhavan and Anderson from Canada studied the effects of glucose-to-fructose ratios in solutions on subjective satiety, food intake, and satiety hormones in young men. They found that sucrose, high fructose corn syrup, and G50:F50 (50:50 solution of glucose and fructose) solutions do not differ significantly in their short-term effects on subjective and physiologic measures of satiety, uric acid and food intake at a subsequent meal.

Bottomline about fructose: As always, moderation is the key. Just because there is paucity of evidence to support deleterious effects of fructose, does not mean that you should load up on fructose in your diet. Naturally occurring fructose in your daily consumption of fruits and vegetables should not be a problem.

Do you use sugar or artificial sweeteners? Do you have any prefered kind? Please share your thoughts about fructose and artificial sweeteners.

Dysphagia swallowing problems with normal upper GI endoscopy

Dysphagia or swallowing problems can occur in patients despite all tests including upper GI (UGI) xray and upper GI endoscopy (EGD or esophagogastroduodenoscopy) showing normal esophagus or no obstruction to the food pipe. This is called nonobstructive dysphagia. However patients continue to have problems complaining that the food ends up in the esophagus and this will not go down or go down slowly.

First, what is dysphagia? Dysphagia means difficulty swallowing. It is of two types: 1) transfer or oropharyngeal dysphagia and 2) esophageal dysphagia.

Dysphagia or difficulty swallowing can be due to problem with transfer of food between them mouth and the upper esophageal sphincter, resulting in failure of food to enter into the esophagus.  This is transfer dysphagia. Esophageal dysphagia implies food has difficulty arriving from the upper esophageal sphincter past the lower esophageal sphincter of the esophagus into the stomach.

Non-obstructive dysphagia involves a variety of causes including motility being abnormal or some unrecognized disorder like eosinophilic esophagitis. Eosinophilic esophagitis can only be confirmed by performing biopsies of the esophagus and documenting increased number of eosinophils in the biopsy specimens. Motility disorders can be confirmed by performing esophageal manometry.

Frequently despite expensive and extensive investigations, no cause is found for nonobstructive dysphagia and food still feels like hanging up in esophagus. GERD may be the culprit in some cases. In such cases, aggressive acid suppression for acid reflux using high doses of proton pump inhibitors (acid blockers like Prilosec, Prevacid, Nexium, Protonix, Aciphex) may be helpful.

We used to perform dilation of esophagus using large dilator. However majority of the evidence including our study suggests that such dilation of the esophagus is not effective if there is no narrowing of esophagus.

Do you or someone in your family have dysphagia or swallowing problems. Did the investigations turn up to be normal or abnormal and what was done to treat the problem.

Feeding tube gastrostomy, PEG, feeding disorder in dementia

The issue of feeding in patients with dementia is complex. The feeding disorder, dysphagia, swallowing problms result in inadequate feeding or nutrition are common in dementia patients. A feeding tube (PEG or surgical gastrostomy) is often done. The question is, does it help? Are we helping our loved ones or are we just making ourselves good. If you were the one making the determnation for your elderly loved one and were told that such feeding tubes, PEG (gastrostomy tube) are unlikely help in anyway or change anything, what would you think? What would be your position when asked for consent?

A recent study examined  the issue of published evidence related to alternative feeding via tubes in patients with dementia. Garrow and colleagues reviewed the evidence found that available evidence does not support any beneficial impact of artificial feeding on survival, pressure ulcers, nutritional status, or aspiration pneumonia. The authors suggest that hand feeding may be a viable alternative in such patients although there is no head-to-head comparison of such feeding with artificial feeding via gastrostomy tube, whether surgical or endoscopic (PEG).

Finucane and colleagues argue that medical system favors use of tube feeding despite lack of beneficial effect, and affects decision-makers, physicians and administrators . There is constant urge to "do something" in sick patients especially when clinical situation is turning downhill.  The medical system wishes to avoid regulatory sanctions, bad publicity, and risk for malpractice law suits.

Getting back to our original question, should the medical system withold feeding tubes in case of patients with dementia unable to feed themselves adequately? How would you react as surrogate decision maker regarding giving consent for feeding tube in your loved one with dementia who is ingest himself or herself. 

Chronic abdominal pain or IBS in kids

Chronic abdominal pain, IBS or irritable bowel syndrome in children is a major, perplexing problem. Some have it as abdominal colic, others get termed as "irritable bowel syndrome" or "spastic colon". A recent study published in Archives of Disease in Childhood, December 2007  showed that chronic abdominal pain or tummy ache occurs in 33% girls and 13% boys of 11-14 years of age.

Only a parents knows the magnitude of the problem of abdominal pain and how nerve-wrecking it can be for the entire family. They try all sorts of things, medicines, healers and frequently no relief. Usually no physical abnormalities are found despite extensive investigations. Now there is hope if you like to think outside of the box.

A recent study double blind randomized controlled trial compared usual medical treatment with gut directed hypnosis. The study titled " Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial" was published in the prestigious journal Gastroenterology.

The investigators found that gut directed hypnosis was significantly superior to standard medical therapy. In fact the relief of chronic abdominal pain was sustained at 12 months in hypnosis group versus standard therapy (85% versus 25%) even though hypnosis sessions occurred for only 3 months.

Do you or someone in your family have chronic abdominal pain? Have you tried alternative therapies like hypnosis, cognitive behavioral therapy? If not, would you try hypnosis if other therapies are not working for you?

Colitis, diverticulitis and diverticulosis

Terms like colitis, diverticulitis, diverticulosis and irritable bowel syndrome, spastic colon can be confusing. Colitis, diverticulitis, IBS, irritable bowel syndrome, spastic colon although different are often used interchangeably by some people. Colitis means inflammation of the colon or large intestines. Colitis may be acute or chronic and may occur due to infections, drugs, toxins, ischemia, radiation therapy etc. Colitis may also be a manifestation of chronic IBD or idiopathic inflammatory bowel disease (ulcerative colitis and Crohn’s disease).

Diverticulosis is the presence of divertculi (plural for diverticulum), usually in the colon. The colonic divertculosis is very common in the western society presumably because of lack of fiber in diet. As many as 50% or more may have colonic diverticulosis by the age of 50 years and this number may exceed 80% by the time one reaches the age of 80 years. Usually these diverticuli are asymptomatic and an incidental finding on barium enema or colonoscopy. In a minority of cases, they may cause complications such as diverticulitis and bleeding etc which may even become life-threatening.

Diverticulitis occurs as a result of micro-perforation in the colon at the site of diverticulum. It is usually on the left side of colon and usually contained giving rise to localized infection and inflammation. This usually responds to medical measures including antibiotics. At times, such a perforation may form an abscess, cause bacteremia and become even become life-threatening. Surgery may be needed in severe cases.

Diverticular bleed occurs more commonly from right sided diverticulosis. It is usually painless and massive and usually requires hospitalization and blood transfusions. Majority of such bleeds stop spontaneously. Recurrent cases may need suregry.

Do you or someone you know has colitis or diverticulosis? What has been your experience with these terms? Please share your thoughts.

Yes, heartburn without acid reflux

Do you have chronic heartburn or GERD? Did you know that many patients with heartburn (chronic acid reflux) or gastroesophageal reflux disease (GERD) do not get relief even from the strongest acid blocking medications also known as proton pump inhibitors PPIs. Lack of response in "GERD" or chronic reflux patients may occur due to a variety of reasons which include:

1. Some patients may require higher than normal dose, for example twice a day PPI instead of once a day. This can be documented by doing 24 hour pH monitoring while taking the medication.
2. Although heartburn in majority of patients is due to acid reflux, it may be also occur as a result of reflux of non-acid gastric contents into the esophagus. Obviously, acid blocking medications are not going to help if the refluxate does not have much acid. These patients may be helped by anti-reflux surgery to prevent any kind of reflux.
3. A small fraction of patients may have symptoms of heartburn in the absence of any kind of reflux, acid or non-acid. Assuming cardiac etiology has been excluded, this is believed to be in part due to lowered pain threshold. Medications that raise pain threshold may be helpful to some extent. A combined pH monitoring and impedance testing can help distinguish this from acid and non-acid reflux.

Do you or someone you know have GERD or heartburn? What treatments have been effective and to what degree? Please feel free to share your thoughts. By the way, do not forget the potential benefit of lifestyle measures on chronic gastroesophageal reflux disease.

Better clear liquid diet for Colonoscopy preparation

Colonoscopy or endoscopy of colon (large intestine) is often dreaded by some. Colonoscopy is also called lower GI scope and is different from barium enema. Colonic cleaning and clear liquid diet is needed as part preparation as a prelude to colonoscopy. Colonoscopy as well as barium enema patients go through this misery of colonoscopy preparation on liquids like water or clear juices, carbonated beverages, electrolyte-rich sports drinks like Gatorade ®, flavored drinks e.g. Crystal-Light ®, Jello, sorbet and plain tea/coffee.

Lesser known fact is that there are clear nutritional supplements available that serve the purpose equally well and you would be less hungry since they also provide nutrition. These include Enlive ® (ww.rosstore.com), ResourceBreeze ® (ww.novartisnutrition.com) and Carnation Instant Breakfast ® juice drink (www. Nestle-nutrition.com). Do not use regular Carnation Instant breakfast as part of clear liquid diet.

Mix-and-match the clear liquids with the clear liquids nutritional supplements and try your tasty mixed drinks such as slushies, ice-pops etc.

Caution: do not use anything any red, purple liquids.

Have you or someone you know has had a colonoscopy? What was your experience with clear liquid diet prior to the exam? Could you suggest some recipes employing above components that the readers could use to make their pre-colonoscopy experience better?

Resolve to be healthy

The winds of public debate seem to be blowing towards a discussion about health care for everyone in the country.

Plans being currently discussed range from national health insurance to tax credits, and of course the hybrid plans involving both extremes. It is remarkable that all of the plans primarily involve paying at the back end for many of the chronic preventable diseases.

None of the currently discussed plans offer a comprehensive disease prevention strategy that would attack the roots of many of our sicknesses like heart disease, stroke and cancer. The disease prevention strategy would of course require tough decisions at all levels.

Tough options might include eliminating subsidies and perhaps even taxing unhealthy products that breed chronic illnesses and lifestyles. Use this money to build gyms and walking trails all over to the country and make them accessible to the population free of cost. At the same time, invest more money on safe bicycle trails in towns and cities including connecting suburbia to downtowns. This would be not only be a healthy and cost-effective strategy but would also curb pollution and our addiction to oil.

Use economic principles to force changes in eating habits. One strategy might be to impose extra-tax on “All you can eat” meals and establishments. At the same time, why not offer tax credit for establishments which offer only set number of calories per meal as a platter.

The strategy would not be successful without active participation by the business community. Healthy workers lead to increased productivity. Large businesses with connected buildings should post “mile-posts” to encourage walking. Malls should create green and covered extended walkways between parking areas and buildings so able-bodied people can easily walk extra from their cars. Every building elevator should have a sign encouraging able-bodied individuals to walk if going up only for one or two floors.

Living a long healthy life is a privilege. Let us not take it for granted. We should elect leaders who believe in the concept, “prevention is better than cure”. At the same time, we must get down from our “spoilt high horse” and take personal responsibility-eat healthy (and less in most cases) and exercise our way out of the health care crisis.

Do antioxidants lower cancer risk

Antioxidants are frequently in news related to cancer. Experts differ on role of these antioxidants in health and sickness including cancer.

Antioxidants in esoohageal cancer

Antioxidants have been studied in esophageal cancer (cancer of esophagus) which is one of the fastest growing cancers in the US. Antioxidants as part of nutrition is a potentially modifiable factor in cancer. Use of antioxidants has been advocated but studies have been conflicting. Lack of antioxidants in the body has potential to increase risk for cancer through oxidative stress and DNA damage etc.

Dr. Kubo and colleagues from University of Californiain San Fransisco recently conducted a meta-analysis of these studies and recently published their results in the American Journal of Gastroenterology 2007.

These investigators identified 10 studies. Summary estimates suggested that greater ingestion of anti-oxidants like vitamin C, beta-carotene or vitamin A, and vitamin E resulted in lower incidence of esophageal cancer. Individuals ingesting highest levels of beta-carotene/vitamin A or vitamin C had about 50% reduction in risk for cancer of esophagus. Vitamin E intake was however not helpful.

By the way, recent data suggested beneficial effect of beta-carotene in mental health also.

Do you take anti-oxidants or any other nutritional supplements? What are your thoughts on these supplements? Please feel free to share.

Does botox works at both ends: check anal fissures

You have heard about botox or botulinum toxin for skin wrinkles. Seems funny considering its use in anal fissure? By the way, botox or botulinum toxin has other uses too, like in achalasia, gastroparesis due to pyloric spasm etc.

Anal fissure

Anal fissure (different from hemorrhoids) can really be a pain the rear. Although acute anal fissures can be managed by conservative measures alone, the optimal medical treatment for chronic anal fissure is still lacking. Surgery is effective for treatment of anal fissure but has significant morbidity.

Botox or botulinum toxin for anal fissures

Recently, Brisinda and colleagues (Br J Surg 94:162-7) from Italy compared the efficacy of local nitroglycerine ointment versus botulinum toxin (botox). Botox group had superior healing rates at both 4 and 8 weeks. Adverse events were more likely to be due to nitroglycerine.

This finding of a comparison between two medical treatments must be interpreted in the context of data on comparison with placebo where nitroglycerine has only been marginally superior. In contrast, the efficacy of botox was similar to placebo. Until long term studies can show superiority of botox over placebo, its use for routine treatment of chronic anal fissure may not be prudent.

Have you used botox for any reason? Do you or someone you know has chronic fissures? Please share the remedies that have or have not worked for you.

Is folic acid supplement good or bad ?

Folic acid or folate supplementation is considered part of alternative medicine.Folate/folic acid is involved in numerous vital biochemical reactions in the body. Multiple studies have documented that folic acid supplementation during pregnancy reduces the risk of neural tube defects.

Folate/folic acid in cancer

Since folate deficiency may contribute to abnormal DNA synthesis, it has been widely believed that folic acid supplementation may help prevent certain cancers. Multiple previous studies including the Nurses Heart Study found beneficial effect of folic acid in colon but not breast cancer.

In contrast to the observational studies, results from a recent randomized controlled trial suggest that folic acid may actually be harmful and increase the risk of colon cancer. Cole and colleagues studied the role of folic acid supplementation in 1021 men and women with a recent history of colorectal adenomas. Repeat colonoscopy was done at 3 years and than 3 or 5 years later.

The authors found that there was an increased risk of cancer/advanced colon lesions in the folic acid group. Interestingly, the investigators also found there was an increased risk of non-colonic cancers, primarily prostate cancer.

Interestingly, Lashner and  colleagues reported (1993) that higher folic acid levels increase risk for colon cancer in patients with ulcerative colitis. Subsequently, the same investigator based on his two other studies suggested that folic acid supplementation probably reduces risk of colon cancer in ulcerative colitis. Folic acid supplementation has been recommended in patients with ulcerative colitis.

In recent years, the wheat flour and other grains have been fortified with folic acid. Interestingly, there has been a concommitant increase in colon cancer during the same period.

While pregnant females should continue to get folic acid supplementation, the policy of adding folic acid to wheat flour and grains may need to be re-evaluated. However, so as to temper our enthusiasm for denigrating folic acid supplementation altogether, we have another recent study that documents that folic acid supplements reduce risk of stroke by 18 percent.

Do you take vitamin, mineral or other nutritional supplements? What are your thoughts on the literature about folate or folic acid and cancer. Certainly, one size does not fit all!

Beta carotene and brain function, Alzheimer’s disease

How oxidation hurts brain and antioxidants may help?

Antioxidants like beta carotene (pro-vitamin A) have potential to inhibit processes harmful to brain and cognitive function potentially delaying Alzheimer’s disease . Oxidative reactions contribute to brain aging resulting in a declining function and beta carotene considered to be nutritional supplement as part of alternative medicine may inhibit the harmful process.

However thus far, beta carotene supplementation for enhancing health benefits has yielded mixed results at best. While enhancing immunity in children, the effect in cancer and heart disease has largely been disappointing. Such supplementation may also be deleterious in certain people.

Betacarotene supplements and cognitive decline

A recent Physician Health Study Group from the Harvard Medical school studied the effect of betacarotene on cognitive function. It demonstrated that beta carotene supplementation over long term retards the aging related cognitive decline. A global score on a battery of five cognitive tests was used as an outcome measure in this placebo-controlled study.

The authors found that men taking 50 mg beta-carotene every other day for an average of 18 years had better cognitive function as compared to the placebo. Verbal memory was also superior in the group taking these supplements. These results suggest that nutrition supplementation with antioxidants of betacarotene type would delay the onset of Alzheimer’s disease.

Although the study was conducted in men, it is likely although not certain that similar effects would be seen on cognition/brain in women also.

Given the conflicting data thus far, the jury is still out whether taking beta carotene supplements may be helpful for overall health. One verdict is probably clearer: best way to get this vitamin might be five servings of fruits and vegetables per day!

What do you think about the concept of taking nutritional supplements including anatioxidants and betacarotene? Do you or someone close to you take them on a beta carotene or any other supplements on a regular basis? Please share your thoughts.

Acetaminophen, arthritis drugs and constipation

Constipation is a widely prevalent disorder. Similarly acetaminophen and other NSAIDs or arthitis drugs are also commonly used. Constipation is more likely to occur in women and the elderly. The causes of constipation are not fully understood. A variety of medications including many heart, blood pressure drugs as well as anti-depressants may contribute to this problem.

Acetaminophen, NSAIDs and constipation

Now comes a study from the Mayo Clinic showing that commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin and aspirin-like medications commonly used for arthritis increase the risk for constipation.

Dr. Chang and colleagues found that subjects who chronically consume over 7 tablets of acetaminophen per week had 2.7 times increased risk for constipation. The risk due to aspirin and other NSAIDs was increased almost two times as compared to those who did not.

Be advised that NSAIDs, both OTC and prescription strength have potential for side-effects and as this study demonstrates they also increase the potential for constipation.

Do you take acetaminophen, aspirin or other NSAIDs regularly. Do you suffer from constipation? Do you take any OTC or prescription remedy for constipation? Please share your thoughts.

Does zinc supplement help in respiratory infection?

Do you take any supplements like vitamin C, vitamin E, ginger when you have cold? I take vitamin C supplements (added zinc recently) when I have symptoms of cold/flu. One of my physician friends told me he takes zinc supplements for same cold.

Zinc and pneumonia, respiratory infections

Check out this report in American J Clinical Nutrition (2007) showing beneficial effects of zinc in pneumonia patients. Meydani and colleagues conducted this study at the Tufts University. It was funded by among others, the National Institute of Aging and the USDA.

This observational study was conducted at 33 Boston nursing homes. Elderly Subjects received essential vitamins and minerals, including zinc everyday.

The investigators then compared patients with normal versus low zinc levels. They found that patients with normal zinc levels had a much lower all-cause mortality rate.

In addition, subjects with normal zinc levels had lower occurrence rate of pneumonia and the total number of new antibiotic prescriptions. Duration of pneumonia and days of antibiotic use was also lesser among normal zinc level subjects.

While this study is an observational one and no cause and effect relationship can be established, it does provide strong scientific support to my friend who takes zinc during his cold/flu occurrences.

Do you believe in nutritional supplements? What remedy do you use when you or someone in your family develops cold/flu? Do you take vitamic C or zinc for this purpose? Please share your thoughts.

Eat fast, get fat

Obesity and diet

Obese and overweight people try to lose weight for obesity by dieting using many fad diets.

Fast versus slow eating and obesity

Did you ever notice that the people who are eating fast are also frequently overweight. We are likely to ascribe obesity and overweight status and inability to lose weight to stress, lack of exercise etc. One factor that gets overlooked is the fast eating versus slow eating and brain-gut satiety or fullfilment signals or connections.

In fact, there is a lag period of about 10-20 minutes between the time your stomach is full and the brain starts to sense and process this signal. In the meantime, the most of us just continue eating and enjoying the great culinary delights--the faster eaters more likely to consume during that lag phase period.

Eating strategies for weight control

One way to overcome this might be to drink a glass of water 5-10 minutes before meal. In addition, eat your salad first (as most of us do). Avoid the usual dressings and just squeeze some lime or lemon on the salad as people in India frequently do. Then take a break for a few minutes again before starting the main course.

Other helpful tips to avoid over-eating:

1. Take smaller portions of food especially during buffet. Studies have shown that using smaller plates for food and smaller scoops for desserts like ice-cream helps lower the consumption.
2. When eating out, ask for the carry-out box before starting meal and put away as much as half of your main course to take home! You save money and cooking time for another meal and also keep your weight in check!
3. Remember, it is not avoiding certain foods that matters the most, it is the amount of food calories consumed. And surely do not bank on exercise to take care of all the excess calories you put in. Exercise is very important for health but using it as sole means to lose weight without reducing consumption is a sure way to failure.

Are you a fast or slow eater? Please share your tid-bits about weight loss and dieting that you found to be helpful over the long run.

BLACK RASPBERRIES PREVENT CANCER

Nutrition especially fruits like black raspberries can impact health including cancer. Yes, black raspberries may prevent cancer.

Mechansim of black raspberries

Black raspberries are a rich natural source of chemopreventive phytochemicals and have been documented to prevent cancer of oral cavity, esophagus and colon in experimental animals.

The potential anti-cancer components of  raspberries include the following:

• Vitamins A, C, E and folic acid
• Calcium
• Selenium, beta and alfa carotene, lutein
• Polyphenols
• Phytosterols

Black raspberry extract prevents esophageal cancer by 40-60% and colon cancer by 60-80% in experimental models of these tumors in rodents.

Ethanol-extract of berries prevents ultra-violet induced skin cancer in mice.

In addition, black raspberries lower blood cholesterol by 10-15 percent.

Do you like raspberries? Are you likely to add or increase black raspberries in your diet? Please share your thoughts.

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DIET FOR CROHN'S DISEASE PATIENTS

A patient with Crohn's disease (aka regional enteritis which is one part of chronic inflammatory bowel disease, the other one being ulcerative colitis) asked me, "what kind of diet should I eat and what should I avoid?". By the way, the term Crohn's diease should not be confused with irritable bowel syndrome or diverticular disease.

Diet, nutrition and Crohn's disease

The issue of diet in Crohn's disease is a tough one since there are not many good studies to help guide a recommendation. In general, it is a good idea to avoid anything that makes your gut go awry. In addition, I would suggest the following:

1. Studies  implicate diets rich in sugar, iron and aluminum in the pathogenesis of Crohn's disease. Thus, in the absence of evidence otherwise, it may be prudent to keep this in mind as we eat and drink everyday. 

• Avoid refined sugars which are abundant in sweets, candy and carbonated beverages.
• Talk to your doctor before taking iron supplements to make sure you indeed need them.
• Tea, and some herbs and leafy vegetables are high in aluminum naturally. Food processing contributes to aluminum in diet. Aluminum in diet may also come from dood additives, bakery products, powdered foods and drinks, and processed cheeses. Aluminium in food may also be derived from aluminum utensils and cans/cartons. The degree to which these contribute to aluminum in food is controversial.

In most cases of flare up of Crohn's disease, it might be prudent to eat low fiber, low lactose diet and avoid irritants like alcohol, tomatoes, spicy foods, and caffeine.

Similar dietary precautions for Crohn's disease would apply to patients with ulcerative colitis also.

Most importantly, always talk to your doctor before imposing any dietary restrictions in any sort of health condition, including Crohn's disease or ulcerative colitis.

IRRITABLE BOWEL SYNDROME

Irritable bowel syndrome (IBS) or spastic colon affects 10-20 percent population. It is likely that you or someone you know has irritable bowel syndrome. But what is this irritable bowel syndrome or spastic colon or IBS?

Irritable bowel syndrome

IBS is a symptom based diagnosis of unclear etiology. It should not be confused with diverticulosis or diverticultis. Irritable bowel syndrome is probably is not a single disease. More likely, IBS is comprised of multiple diseases, all lumped into one at the present time for lack of understanding its pathogenesis. Infantile colic is considered by many to be a variant of IBS in infants and kids.

Features of irritable bowel syndrome and Rome criteria

Irritable bowel syndrome is a functional disorder characterized by chronic (at least three months in the preceding one year) abdominal pain and a disturbance of bowel habit. The disturbed bowel habit of IBS may manifest as diarrhea, constipation or alternating diarrhea with constipation. Pain frequently improves with defecation. A waxing and waning pattern of symptoms is seen in most patients. The precise conglomeration of symptom complex is defined under ROME III criteria.

What causes irritable bowel syndrome?

The pathogenesis of irritable bowel syndrome remains an enigma and no single etiology fits all cases. IBS is predominantly seen in young females but can be seen in adults of any age and either sex. It is more prevalent among Caucasian Americans than African Americans. Motility disorder has been frequently implicated; however no consistent motility pattern can be demonstrated. Visceral hypersensitivity (pain with a stimulus not severe enough to cause pain in healthy subjects) is seen in many patients. Autonomic dysregulation has also been implicated. A dysfunction of 5-HT system is supected in many cases. Stress does not cause it but does tend to exacerbate symptoms. Food allergy or intolerance may be present in some cases.

Many patients attribute the onset of disease to a bout of flu-like illness e.g. viral gastroenteritis, travelers diarrhea. Low grade inflammation in the gut can be documented in many cases. Several authors claim small intestinal bacterial overgrowth to be the cause in most cases of IBS although these observations have not been confirmed by others.

IBS consensus

Overall, in the absence of clear cut cause, a bio-psychosocial model for pathogenesis for irritable bowel syndrome has been proposed. This model emphasizes the role of mind-body interactions with the environment. In this context, it should be noted that there is an increased prevelance of certain chronic pain disorders in IBS patients, e.g. functional dyspepsia, fibromyalgia, chronic fatigue syndrome, interstitial cystitis, chronic back pain etc.

Diagnostic strategy for irritable bowel syndrome

While the diagnosis of irritable bowel syndrome should be positive, physicians frequently perform studies to exclude any treatable cause. The work up for IBS should be individualized and may include complete blood count (CBC), routine chemistries and stool studies. Flexible sigmoidoscopy or colonoscopy may be performed depending upon age and risk for colon cancer and suspicion for alternative diagnosis like inflammatory bowel disease (Crohn's disease and ulcerative colitis). Celiac sprue should be excluded by antibody testing for anti-tissue transglutaminase antibody. The use of anti-gliadin antibody has largely been abandoned.  Anti-endomysial antibody testing is expensive and not cost-effective. Lactose hydrogen breath test may be done to exclude lactose intolerance. Small bowel bacterial overgrowth can be excluded by hydrogen breath test or cultures of small bowel aspirate.

Treatment of irritable bowel syndrome

The management of IBS patients follows a step-wise fashion and is largely symptom based. Realistic goals need to be established. Reassurance with a lot of hand-holding goes a long way in helping patient cope with the symptoms of IBS. Placebo response rate in irritable bowel syndrome may be as high as fifty percent.  High fiber diet and fluid are frequently prescribed as first line of treatment for IBS of all types. Patients with diarrhea may be helped by lactose-avoidance.

Over the counter laxatives or  prescription medication Zelnorm are used in cases with constipation predominant IBS. Of note, Zelnorm was withdrawn from US market on March 30, 2007 because of unacceptable side-effects.

Constipating agents like Imodium and Lomotil may be needed in patients with diarrhea predominant IBS. Lotronex is useful for diarrhea-predominant IBS but has high risk for ischemic colitis. Its availability is limited and its use in IBS has largely been abandoned by most physicians in the US.  Its is not to be used for irritable bowel syndrome of constipation type. Antispasmodic agents e.g. Bentyl are frequently prescribed for abdominal pain associated with irritable bowel syndrome but provide only limited benefit at best.

Small bowel bacterial overgrowth is treated with antibiotics. Gluten-free diet helps patients with Celiac sprue.

Role of antidepressents in irritable bowel syndrome

Low dose tricyclic antidepressants (e.g. imipramine, desipramine) raise the pain threshold and are frequently prescribed to IBS patients not responding to above strategies; however their side-effects can be problematic.  Although frequently prescribed, there is less data about the use of newer antidepressant agents like SSRIs for management of IBS.

Several trials have documented positive impact of probiotics in IBS patients. Cognitive behavioral therapy, hypnosis, IBS classes, yoga, Chinese herbal medicine etc have  also been used successfully in irritable bowel syndrome. Limited data points to efficacy of melatonin (over-the-counter sleep-aid) in IBS.

MILK BANK

Breast milk feeding of babies by lactating mothers is gaining in popularity and so is use of milk banks.

Use of donor milk from milk bank

Human milk may be obtained from milk bank in case of mothers unable to feed the baby. In case of premature babies, the quantity of nutrients in breast milk may not meet the great nutrient needs.

Donor pasteurized human milk may serve as a useful proxy for the mother's own milk. Human milk supplements, or fortifiers, may be used to supplement the nutrient content of unfortified breast milk. Host defense benefits are also observed in such situations.

Milk bank guidelines

In order to maximize benefits and minimize risks of donated milk from milk banks, strict guidelines have been set forth by the Human Milk Bank of North America. These include the following:

• Screening of donors of milk by clinical history and blood tests to exclude HIV, hepatitis B and C, HTLV and syphillis.
• Milk is collected, pooled and pasteurized.
• Creamatocrit is also performed to determine the calorie/nutrient content.

Pasteurization of donor milk results in killing of several viruses with only a limited impact on antibodies, growth factors, lysozyme etc. However, microwaving does significantly destroy the anti-infective components in the milk.

Note that no GVHD (graft versus host disease) occurs as a result of milk therapy.

What do you think about milk banks? Would you use it for your child if the physician recommended?

Breast feeding

Benefits of breast milk

Most of us only think that  breast milk feeding helps the baby fight infections. Did you know that breast feeding lowers the risk of sudden infant death syndrome (SIDS), diabetes mellitus, leukemia, lymphoma, asthma, hypercholesterolemia and obesity? Breast milk feeding results also results in improved cognitive function. in the child. Human milk is also available from milk banks.

Benefits for breast feeding moms

Mothers who breast feed also derive benefits including early return to pre-pregnancy weight, and lower risk of breast and ovarian cancer.

Contraindications of breast feeding

Breast feeding may not be undertaken in following cases:

• galactose 1-phosphate uridyltransferase deficiency
• mothers who have active untreated TB
• mothers receiving radiation therpy
• mothers receiving chemotherapy for cancer
• mothers with HIV
• mothers using street/recreational drugs
• mothers with herpes simplex lesions on a breast. However,if only one breast is affected, feeding may be accomplished from the other without lesions.

Breast fed infants should receive vitamin D supplementation.

In cases of infants weaned prior to the age of 1 year, iron-fortified infant formula and not cow's milk should be used.

If breast milk is not an option, milk obtained from milk banks may be used.

What are your thoughts about milk banks as well as the donors and recepients.

Human milk therapy

Breast milk feeding is gaining in popularity.

Milk from different sourses

Milk is species specific, and thus human milk is superior to all other milk for consumption by infants. Did you know that human milk is also available at Milk banks?

Human milk and nutrition for baby

Human milk has all essential macronutrients required for growth and development. It has multiple beneficial enzymatic, hormonal and immune components.

Milk contains lactoferrin and lysozyme. Lactoferrin binds iron and reduces nutrients available for the growth of bacteria.

IgA antibodies in human milk have protective functions. Human milk therapy has been shown to reduce infections and the occurance of NEC (necrotising enterocolitis) in kids. In addition, it also has epidermal growth factor which plays an important role in growth and development.

Milk and neonates

The neonates have a highly vulnerable intestinal wall which is constantly being bombarded by noxious luminal environment of the intestines. Human milk plays an important role in interactions of the nutritional milieu as well as the bowel microflora with the host (baby). This has important implications for the health and sickness that may affect even extraintestinal systems such as the lung and brain.

The child/baby may get human milk may be obtained from breast feeding and milk banks.

What are your thoughts on breast feeding? Please feel free to share.

Ice cream for pregnancy

Getting pregnant or conceiving can sometimes be difficult. Couples trying to get pregnant try all sorts of innovative conception techniques. And of course, many women have ice cream craving during pregnancy. Did you know that ice cream can help getting pregnant or conception?

Ice cream and pregnancy

Dr. Chavarro and colleagues from the Harvard School of Public Health report a delicious new strategy, i.e. enjoy more of ice cream! Their findings were published in Feb 2007 issue of Human Reproduction.

How does ice cream help with conception?

This recommendation is based on the hypothesis that dairy foods impair ovulatory function. The authors studied followed 18, 555 married, pre-menopausal women who tried to become pregnant during an 8-year period. Dietary patterns were studied using food-frequency questionnaires. They found that 438 couples were infertile due to ovulatory disorder.

After taking into account the impact of other factors like age, parity, body mass index, total calorie intake, physical activity, tobacco and alcohol use, and the use of contraceptive agents, the authors found an inverse correlation between dairy fat intake and anovulatory infertility.

Low fat foods and infertility

For example, women who ate two or more portions of low-fat dairy foods per day had a 85% increased risk of ovulation-related infertility, compared to women who ate