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

Autism and ADHD: Role of Gut & Maternal-Fetal Immune Dysfunction

By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

The problem

Studies indicate increasing incidence of autism spectrum disorders and ADHD.  Lack of a specific laboratory abnormality and reliance on symptom complex makes diagnosis unclear/controversial  in many cases. Likewise, one cannot distinguish whether the clinical manifestations are as a result of different diagnosis or  symbolize diverse manifestations of a similar various genetic and/or environmental factors underlying the diagnosis of neurodevelopmental and neuropsychiatric disorders like autism spectrum disorders and ADHD.

Genetics versus environment

While a strong genetic predisposition is suspected, less than half of the variance can be explained by genetic influences. The role of environmental influences is being increasingly appreciated although the specific factors involved may be very diverse and not yet clearly identified. Prenatal injury like an infection interacts with other environmental and genetic factors in shaping the risk of postnatal brain dysfunction.

 Increased prevealnce of allergic disorders in autism/ADHD along with streptococcus-mediated neuropsychiatric disorders suggest that critical tole of the immune system in causing and/or perpetuating such disorders.

Perhaps, autism and ADHD occur as a result of “perfect storm” when genetic or environmental  imbalances conspire together at any/many of the crucial steps involved in the development of nervous system.

Gut at the cross-roads on interplay between immune and nervous system

One  factor of “perfect storm” that may be involved is the immune system which develops as a result of not just the genetic make-up but also the environmental factors especially during its maturation.  The gut and its trillions of bacteria as they move from neonatal pattern to the adult bacterial pattern play a critical role in the final make-up of the immune system.

Any disturbances along in later life can still upset the proverbial apple-cart making things worse. Conversely, modulation of gut bacteria has the potential to module the immune system, the neuro-immune interactions along with multiple diverse clinical manifestations of diseases like autism. Immune activation caused by bacterial components that may enter across leaky gut are known to impair attention.

Evidence that exclusion diets as well as use of probiotics is of benefit in many patients with autism and ADHD lends further support to the the hypothesis of critical role of gut.

Immune alterations in neuropsychiatric disorders like autism/ADHD

 Evidence suggests ongoing inflammation in brain specimens, elevated pro-inflammatory cytokine profiles in brain and blood, increased presence of brain-specific auto-antibodies and abnormal immune cell function in neurodevelpopmental disorders.  There is increased incidence of allergic sensitization and allergic rhinitis in ADHD.

According to Careaga and Ashwood, of University of California, Davis, CA, changes have been documented  in immune cell number, cytokines,  cellular function at rest and in response to immunological challenge in autism. The worse the immune dysfunction,, the greater the  impairment in behaviors that are core features of autism especially impaired social interactions and communication.

Maternal versus fetus immune system

Pregnancy contributes to an exponential increase in complexity of immune interactions since mother's immune system has to be tolerant of both the fetus and its antigens while at the same time maintaining a  healthy immuneresponsive system  that can mount an effective defensive responses to real pathogens. 

Conversely, the fetus is constantly exposed to “environmental aliens” made up of maternal components including maternal immune system e.g. antibodies, cytokines and immune complexes.

Maternal IgG antibodies during pregnancy and early infancy

Just like the semi-permeable or exclusionary intestinal barrier, the placenta is also a selective barrier  allowing nutrition as well as neuro-endocrine-immune signals to go through to the growing fetus while blocking potentially harmful pathogens.

Among the factors allowed passage to the fetus are protective maternal IgG antibodies such that their levels in new born fetus are higher than even in the mother. This allows the new born baby ready-made means of immunity while its own immune system is immature and not up to speed.

Maternal autoantibodies

Unanticipated chaos may in fetus when mother has autoantibodies which are acting already against her own tissues. These antibodies can also cross the placenta into the growing fetus. Usually such harmful antibodies disappear by about 6 months after birth.

However, their presence in the fetus in-utero and early infancy which is a critical period for neuro-immune developmental and gene expression processes has potential to affect the growth and development of different organs including brain and as such impact the life over short and long term.

Examples of such dysfunction include transient myasthenia gravis (short term) and neonatal lupus causing cardiac defects (long term).

Maternal antibodies,  blood-brain barrier and central nervous system

While IgG antibodies cannot usually cross blood brain barrier and gain access to the brain in adults, such is not the case in fetus because of immature barrier structure and function. Genetic predisposition to delayed or dysfunctional or nonselective barrier function may be involved in pathogenesis of autism.

Maternal  antibodies and/or immune complexes mimicking targets in fetal brain may sometimes occur as a result of a toxin or infectious exposure leading to inflammation in the brain and long term damage.

Maternal IgG and neurodevelopmental disorders

Comparison of kids with autism and controls has shown the presence of fetal brain specific antibodies targeting fetal brain proteins are found in kids with autism. Some of these aberrant antibodies correlate with poor expressive language scores, other antibodies appear to  be involved with increased irritability on the Aberrant Behavioral Checklist. Thus diverse patterns of abnormal antibodies may be found leading to diverse manifestations.

Conclusion of Immune dysfunction and neurodevelopmental disorders

Patients with autism and their families display many  immune abnormalities including cytokines that are mediators of immune activities but are also  critical to development and function of the nervous system.  

There is a dramatic change in immune cell pathways as well cytokines during an infectious episode as well as during toxic exposures and as such may be at crossroads between the interplay of genetic and immune factors underlying autism. Potentially damaging pro-Inflammatory cytokines with potential to interact with brain have  been documented in autism

Alterations in immune function are associated with increased behavioral problems in patients with autism. Whether these changes represent a cause-effect relationship or a mere association remains to be clearly established.

Potential significance of research on immune system and autism

Greater specificity of Identification of immune interactions with nervous system during its early development would allow for development of specific targets for therapeutic interventions. 

References: 1. Careaga M and Ashwood P. Autism spectrum disorders: from immunity to behavior. Methods Mol Biol. 2012.  2. Braunschweig et al. Behavioral correlates of maternal antibody status among children with autism. J Autism Dev Disord. 2012. 3. Onore  et al. The role of immune dysfunction in the pathophysiology of autism. Brain Behav Immun. 2012. 

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Good Teeth, Gums Reduce Risk of Diseases In Distant Organs

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Why is oral-dental health so important?

By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

Oral cavity is involved in first encounter for foreign bodies and pathogens to the respiratory and gastrointestinal tract.

• Orodental space represents the tip of the spear for most things good and bad (food, drugs, toxins, pathogens) that enter the body especially the gastrointestinal tract.
• Ironically, the status of orodental cavity may reflect the overall health including nutritional and immunological status.
• Orodental changes may be cause of effect or what is happening in the body. 

Orodental flora

Oral cavity is  “dirty”. A variety of bacteria are present including pathogens that have potential for local and body-wide repercussions.

• As many as 500 species are encountered and most of them are not pathogenic.
• In the presence of immune dysfunction, the pathogenic bacteria can become pathogenic manifesting in chronic inflammatory periodontal disease and can then affect the entire body.
• Orodental activities, as simple as chewing, flossing brushing and minor procedures like  scaling result in release of bacteria into blood circulation, although the  bacteremia is usually transient.
• However, the release of bacteria or their toxic product into the circulation have potential to seed another nidus of infection/inflammation setting off a deleterious chain reaction.

 Is localized focus of infection anywhere significant

Poor oral-dental health implies a localized focus of infection.

• The word “localized” may be a misnomer since a localized focus of infection need not have localized effects only.
• Not unlike cancer, metastasis of bacterial infection may occur in the form of bacteremia, release of bacterial toxin into the circulation.
• Metastatic inflammation describes the phenomenon wherein bacterial antigen released into circulation interacts with an antibody resulting in immune complexes that can have their own disease processes. 

Localized focus of infection: A historical perspective

Concept of localized focus of infection is not new; in fact it is rooted in history of medicine since ancient times

• Hippocrates successfully treated a case of arthritis by performing tooth extraction.
• Dr. C.H. Mayo in 1914 declared in Journal of American Medical Association that “root abscesses and pus pockets connecting them are often the source of acute and  chronic rheumatism”. 

Localized orodental infection foci

• Much of  the research has focused on periodontal lesions and their systemic effects beyond oral cavity
• Caries is also increasingly attracting attention in recent times
• WHO considers caries a global health problem 

How does focus of infection including orodental affect body

Diffusion or metastasis of bacteria, toxins and antigens into the body can initiate or worsen a distant and/or generalized illness. Affects can be far away including heart and brain

• Administration of components of normal mouth bacteria (commensal) Porphyromonus gingivalis exacerbates encephalomyelitis in mice.
• An additional concept gaining traction is involvement of RAGE. 

The emerging RAGE concept (Anger at cellular level)

RAGE (Receptor for Advanced Glycation End Products ) has been implicated in multiple disorders.

• Signaling through RAGE has been implicated as a nemesis for diverse pathologies including periodontal disease, cardiovascular diseases, complications of diabetes mellitus including diabetic vasculopathy, Alzheimer disease, cancer, and neurologic conditions.
• An excess of AGEs (Advanced Glycation End Products) has been documented  in numerous organ systems including brain of patients with autism.
• RAGE are plentiful in gums and are  released into circulation when gums are inflamed.
• AGE-RAGE axis has been postulated as the mechanism of a variety of associations of orodental diseases and increased diseases beyond oral cavity including heart, blood vessels and nervous system [Katz et al 2010].

Oral-dental lesions in GI diseases

• Concept of oral-dental lesions in gastrointestinal diseases with far-reaching effects in various parts of the body  is well established.
• Examples include inflammatory bowel disease, Behcet’s disease, celiac disease etc. 

Effects of poor health on oral cavity

In addition to gastrointestinal disorders, aphthous lesions may occur due to immune dysfunction related to infections, malnutrition, allergies, stress and hematological and malignant disorders. More details in upcoming post.

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FODMAP diet and foods: Implications in health and disease

By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

FODMAP DIET: ROLE IN IRRITABLE BOWEL, LEAKY GUT AND ALTERATION IN INTESTINAL BACTERIA

What is FODMAP and FODMAP Diet (Gibson and Shepherd 2010)

FODMAP is an acronym applied to group of short chain carbohydrates and sugar alcohols comprised of Fermentable Oligo- Di and Monosaccharides And Polyols

Disease associations: High FODMAP diet have been implicated in the rising tide of a variety of disorders.

• Crohn’s disease
• Celiac disease
• Irritable bowel syndrome
• Chronic fatigue syndrome
• Autism

FODMAPs share thee physiological properties:

• Poor absorption in small intestine
• Osmotically active small molecules
• Rapid fermentation by gut flora: the smaller the length of carbohydrate, faster the fermentation

High luminal FODMAP foods undergo rapid fermentation and create metabolic products that predispose to enhanced intestinal permeability, altered intestinal flora, intestinal gases and predispose to small bowel bacterial overgrowth (SIBO).

Examples of high FODMAP foods/diet include:

• Fructose (fruits, honey, high fructose corn syrup)
• Lactose (diary products)
• Fructo-oligosaccharides or fructans (wheat, onions)
• Galacto-oligosaccharides or galactans ( raffinose and stachyose) contained in legumes, beans, cabbage, onions etc.
• Polyols (sorbitol, mannitol, xylitol, maltitol) contained in apples, pears, plums etc. and low calorie sweeteners. Polydextrose and isomalt are frequently used as artificial sweeteners, are poorly absorbed.

What happens when you ingest high FODMAP diet

• Excess intake and delivery of undigested carbohydrates to the colon renders them subject to bacterial fermentation.
• The metabolic fermentation products including increased organic acids (short chain fatty acids), increased surfactant activity, increased gases (hydrogen, carbon dioxide, methane and hydrogen sulfide) and gut distension injure intestinal barrier by in part causing apoptosis.
• Short chain fatty acids (SCAFAs) excess excess has been shown to increase intestinal permeability in animal models.
• The gas content of gut plays an important role in gastrointestinal symptoms.

Problems occur especially when high FODMAP diet is consumed fast:

The process if rapid, can be especially “explosive”. This occurs when large amounts of undigested carbohydrates are exposed to disproportionately high and potentially pathogenic bacteria in gut e.g. small bowel bacterial overgrowth.

Type of food versus speed

• Oligosaccharides (smaller chain length carbs) and sugars are metabolized at a much faster rate than the longer chain length molecules like dietary soluble fiber.
• The speed of bacterial fermentation and generation of metabolic products varies according to substrate (lactulose >inulin> resistant starch)
• FODMAP elimination diet plan requires global and not individual product restriction.

FOMAP drawbacks

• Low FODMAP diet diminishes access to benefits of prebiotics like fiber
• Effects of high fiber/prebiotics

1. Increased bowel fluid by osmotic effects

2. Increased motility

3. Increased generation of short chain fatty acids that serve as food for colonocytes

4. Increase in beneficial strains of bacteria like bifidobacteria.

FODMAP diet and vegetarians

• Legumes and milk products are a major source of nutrition for vegetarians.
• Since the goal of FODMAP strategy is overall reduction, greater cuts need to be made in other categories in order to accomplish the desired goals.  
• Eat good carbs!

Turning harmful effects of FODMAPs into benefits

• A lower proportion of rapidly fermentable carbohydrates along with greater amount of slowly fermentable carbohydrates have potential for ameliorating harmful effects of FODMAPs and shifting the balance towards benefits.
• For example, ingestion of raw potato starch, guar gum and arabinoxylan causes intestinal injury especially involving enzymatic activities. The deleterious effects of these foods do not occur if they are consumed along with slowly fermentable wheat bran.
• Considering the demonstrated potential health benefits of prebiotics, the harm versus benefits may be individual specific based on diet consumed, gastrointestinal flora, rapidity and amount of bacterial fermentation, and presence of comorbid conditions in the context of genetic susceptibility.

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Aquatic water therapy for chronic pain: Myth or reality?

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AQUATIC THERAPY FOR PAIN: Fact or fiction 

By A. Minocha MD, author: Guide to Alternative Medicine and Digestive System

Aquatic therapy also known as Water aerobic therapy or pool therapy refers to the physical therapy and rehabilitation performed in water without the need for weights.

• Scientific data and expert opinions indicate that it provides therapeutic benefit in fibromyalgia. 
• Aquatic therapy has potential for benefit in patients with other types of chronic pain disorders and cancer and neuro-rehabilitation.
• Human trials suggest that aquatic therapy also provides short-term benefit in patients with osteoarthritis.

A variety of hydrofitness devices are available and can be individualized.

Principles of aquatic or water therapy

Water provides resistance and is believed to be healthier than the use of weights. The hydrostatic pressure produces forces perpendicular to the bodys surface Water buoyancy helps support the weight of the patient.

The combination of water resistance and  buoyancy reduces weight bearing and stress placed on the joints allowing low impact exercises with reduced joint stress as compared to exercises on land.

A decrease in stress on joints makes it easier for patients to get benefits of exercise with lesser pain/stress.

Types of aquatic therapy

Water enthusiasts have many options regarding not only depth of water, i.e.shallow versus deep water therapy but also the format of exercises that they may enjoy and find easy to perform consistent with their health. Various types of aquatic therapy are available:

Ai Chi: Developed by Jun Konno of Japan, it combined deep breathing associated with slow movements of limbs and torso. 

Ai Chi Ne: This is a partner requiring 2-person exercise program involving breathing and stretch exercises.

BackHab: This may be undertaken as an individual or a group. It is specially tailored for patients with physical impairments including back problems. It includes walking in water and a variety of limb movements tailored to the patient’s health problems.

Bad Ragaz: Initially developed in Germany, it is described as  the Bad Ragaz Ring Method targeting  muscle re-education via utilizing particular ways of resistance, endurance, and  range of motion.

The Burdenko Method: The Burdenko Method combines land and water exercise therapy for athletic training as well as physically challenged subjects.

Feldenkrais: Created by nuclear physicist Moshe Feldenkrais, it is based on principle that our movements etc depend upon the way we think and feel. Thus exercises of combining breathing and flexibility of movement are undertaken in context of awareness of old patterns and concerted effort to modify them to improve the overall other aspects of life. Touch and tissue manipulation by the therapist may be involved.

Halliwick: It is a 10-point program of motor learning and mental adjutments that specializes in teaching patients with a variety of physical or mental disabilities to get involved with water activities exercises with the goal of getting them to move about and swim in water independently in water, and to swim.

Wassertanzen: Wassertanzen means water dance. This type of aquatic therapy is a dynamic movement therapy that involves exercises below the water surface utilizing nose clips. This form of therapy is unique in the sense that it involves the patient surrendering control of his/her breath to go under water.

Water Yoga: Yoga exercises are performed with subject in waist- to chest-depth water. 

Watsu: Created by Harold Dull, watsu as the name suggests is a combination of water and shiatsu wherein the subject is held in warm water by the therapist and moved around using water resistance as the source of massage. Watsu aims to integrate massage, muscle stretching and dance. It has been described as especially suited for elderly and pregnant.

Yogalates: It uses a combination of yoga, Pilates, and Ai Chi. 

Miscellaneous aquatic therapies: Other modifications/styles include Lyu Ki Dou and Water Pilates

Contraindications to aquatic/water therapy

• Significant cardiac or respiratory disease
• Fever and active  infections
• Urinary or stool incontinence
• Consult your physician prior to any exercise program 

Significance in of aquatic therapy in health and sickness

• While there is lack of data on the role of aquatic therapy in digestive health, data on its beneficial effect in chronic pain disorders like fibromyalgia indicates that it may have potential for therapeutic benefit in chronic functional bowel disorders. 
• Randomized controlled trials indicate that an exercise program thrice a week in a warm pool improves symptoms of fibromyalgia.
• Thomas and Blotman conclude that aerobic-only exercise provides improves physical function and may be therapeutic for tender points and pain in fibromyalgia.

Bottomline: Aquatic therapy is well suited for healing as well as health maintenance for diverse patient populations. Besides wide margin of therapeutic safety, the therapist can easily develop a specifically targeted therapeutic program for diverse clinical conditions.

An interesting topic: Is fasting good or bad for health?

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Do Zinc supplements prevent pneumonia in kids

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Effect of zinc supplementation on risk of pneumonia in children

By A. Minocha MD, author: Guide to Alternative Medicine and Digestive System

Pneumonia is common in children younger than five years of age and may even be fatal especially in infants and low socio-economic status. Several studies have evaluated the effect of zinc on preventing respiratory tract infection and a pneumonia related decrease in childhood mortality.

Study:

Lassi and colleagues from AK University Hospital examined the literature and conducted a meta-analysis to study the  efficacy of zinc supplementation for reducing risk of pneumonia in kids. The results of the study were reported in the Cochrane Database Reviews (2010).

The investigators considered randomised controlled trials (RCTs) examining the efects of  supplementation of zinc on the risk of pneumonia in children aged 2 to 59 months of age. The database included six trials (n= 7850 children)

Result of zinc supplements on lower respiratory infections:

Zinc supplementation reduced the incidence of pneumonia by 13 percent  (risk ratio 0.87;  0.81 to 0.94).

Zinc supplementaion, based on one study reduced the prevalence of pneumonia by 41% (RR 0.59; 0.35 to 0.99).

Conclusions: Zinc supplementation reduces the incidence and prevalence of pneumonia in kids. By the way, here is a previous post on similar topic.

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Is complimentary and alternative medicine beneficial in fibromylagia

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 Evidence for beneficial effect of alternative medicine in fibromylagia

By A. Minocha MD, author: Guide to Alternative Medicine and Digestive System

There is paucity of medications to relieve the suffering of chronic pain disorders like fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome etc. Patients continue to resort to therapeutic interventions for fibromyalgia that may or may not be effective. Complimentary and alternative medicines form a big part. But are they effective?

De Silva and colleagues from School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen, Scotland, UK, critically examined  the evidence related to beneficial effects of regarding complementary and alternative medicines (CAMs) in fibromyalgia. The study was published in the journal Rheumatology.

Study

These investigators performed a systematic review of the randomized controlled trials of fibromyalgia comparing  complimentary and alternative medicine therapies with  treatments or placebo. Methodologic quality of all studies included in analysis was assessed as moderate. 

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 Results

Homeopathy

Three studies in this critical analysis involved the use of homeopathic care. All three studies demonstrated improvement in pain.

Nutritional supplements of benefit 

• Anthocyanidins
• Capsaicin
• S-adenosylmethionine 

Nutritional supplements lacking benefit

• Soy

Some data this yr since publication of above review

Yoga and exercise

A randomized controlled trial by Carson and colleagues from Oregan Health and Sciences University found a 8-week yoga program to be of benefit.

Another randomized controlled trial  reported that moderate to high intensity nordic walking improves functional acpacity of patients without improving pain.

A randomized controlled trial from Wang and colleagues and published in the New England Journal of Medicine concluded that Tai Chi results in improvements in Fibromylagia Impact Questionaire as well as quality of life.

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Traditional Chinese medicine (TCM)

A systemetic review examined 25 randomized controlled trials evaluating the role of traditional Chinese medicine including acupuncture for fibromyalgia. Overall 10 trials merited examination as part of meta-analysis. The investigators concluded that TCM therapies are of benefit for treatment of fibromylagia.

                            Click to read about acupuncture

Cognitive behavioral therapy

Bernardy and colleagues performed a systematic review and meta-analysis on role of cognitive behavioral therapy (CBT) in fibromyalgia and published their results in the Journal of Rheumatology. The investigators concluded that CBT improves coping with pain and reduces depressed mood and health care seeking behavior.

Do you or someone you know have chronic pain disorder like fibromyalgia? Have you tried any of the alternative medicines? Please share your experience.

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It's the vegetarian diet, stupid

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Vegetarian diet linked to lower mortality

By A. Minocha MD, author: Guide to Alternative Medicine and Digestive System

The war over body weight control consumes billions of dollars with numerous books and pundits promoting their own versions of anti-obesity and weight loss . Atkins' low carb diet has been one of the most popular fad to hit the market in recent years.

Concerns:

Questions have been raised about benefits versus risks of low carbohydrate diet as promoted by diet, i.e. is the weight loss being achieved at the risk to overall health? The concerns got heightened when Dr. Atkins himself died at least in part related to heart related illness.

An authoritative answer:

The report of a study funded by the National Institute of Health and published in the prestigious Annals of Internal Medicine, the official publication of the American College of Physicians.

 Study title and authors/affiliations:

The authors of the report titled,"Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort studies" are Fung and colleagues from the Simmons College, Harvard School of Public Health, Boston, Massachusetts, and National University of Singapore, Singapore.

Study goals and follow up:

The authors asessed the type of low-carbohydrate diets, either animal-based (primarly animal fat and protein) or vegetable-based (predominantly vegetable sources of fat and protein) of the subjects based on scientifically validated food-frequency questionnaires done during during follow-up of the study subjects.

Study sources:

Nurses' Health Study and Health Professionals' Follow-up Study

Study subjects:

85,168 women and 44, 548 men without heart disease, cancer, or diabetes at baseline formed the data base. Over follow up, there were 12,555 deaths.

Results:

• Low-carbohydrate diet was associated with a modest increase in overall mortality
• The animal low-carbohydrate diet score was linked to higher all-cause mortality, cardiovascular mortality and cancer mortality.
• Higher vegetable low-carbohydrate diet consumption was associated with lower all-cause mortality and  cardiovascular mortality.

Conclusions:

 A low-carbohydrate animal based diet is associated with higher all-cause mortality in both men and women. In contrast, a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates.

Not surprisingly Atkins; competitor Dean Ornish diet protagonists have jumped on these conclusuion as part of the weight control diet propaganda war.

Here is some more on vegetarianism

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Does homeopathy help sleep in coffee-related insomnia

Homeopathy and coffee induced sleep disorder insomnia

By A. Minocha MD, author: Guide to Alternative Medicine and Digestive System

Coffee is notorious for messing up sleep. People try all kinds of remedies to combat that including alcohol! Can the homeopathy (alternative and complimentary medicine) help you sleep? While animal studies indicate effect of homeopathic medicines on sleep such as non rapid eye movement sleep, there is paucity of objective literature in humans.

Dr. Bell and colleagues from the University of Arizona College of Medicine in Tuson, AZ examined the role of homeopathy in coffee related insomnia in young adults.  Authors used the objective parameters of the science of polysomnography to examine the effects of homeopathic remedies in coffee induced sleep dysfunction or insomnia.

Study:

Subjects of both sexes and aged between 18 and 31 years scoring  who scored above-average scores on standardized personality scales were recruited. Sleep recordings were were perfromed at subjects' homes on successive pairs of nights once per wee.

A total of eight recordings were conducted over a month long period.

Subjects (N=54) received either placebo pellets or verum pellets of one of two homeopathic remedies, Nux Vomica or Coffea Cruda. Subjects cmaintained subjective data in their daily morning sleep diaries and weekly Pittsburgh sleep quality index scales.

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 Results on effect of homeopathy on sleep:

Verum remedies significantly increased total sleep time and Non REM sleep. They also had significant impact on awakenings and stage changes.

Conclusions on effect of homeopathy on coffee induced sleep problems:

The investigators concluded that these findings of effects of homeopathic remedy effects are similar though not identical to those reported in animals with the same homeopathic  remedies. They speculated that the effects may be mediated via initial disruption of the nonlinear dynamics of sleep patterns by the verum remedies.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger. 

 

Whole fruit versus fruit juice

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 Should I eat whole fruit or drink fruit juice                 

By A. Minocha MD, author: Guide to Alternative Medicine and Digestive System

The obvious and perhaps the best option between fruit and fruit juice might be to eat the whole fruit and not just the fruit juice. On the other hand, some of us don't like to eat fruit itself for a variety of reasons like taste, convenience or that we don't like the mess associated with it.

Fruit juices also offer opportunity for health fortification programs to combat other nutrient deficiencies. Fruit juice offers no nutritional advantage over fruit unless of course a fortified version of fruit juice is being used.

• Fortification of orange juice with vitamin D is as effective as an oral supplement in maintaining vitamin D status in adults.

However there has been a controversy brewing that suggests that fruit juices may not be helpful and actually cause harm.

Criticisms of fruit and vegetable juice

 

1. Fruit juice increases blood sugar and worsens glycemic control. This may be overblown as long as we are considering the fruit juice itself and not a juice with sugars added. In the latter case, the summation of effect might depend on how much sugar has been added. Just like anything else, moderation is the key and works for most people.

• Wilson and colleagues from Winona State University conducted a cross-sectional study examined the effects of unsweetened low calorie and normal-calorie cranberry juice formulations on the postprandial glycemic response in healthy humans. Results indicated that the consumption of a low-calorie cranberry juice is associated with a favorable glycemic response and may be beneficial for persons with impaired glucose tolerance.

2. Fruit juice has no fiber. This again is lumping all juices. There are juices with pulp just as there are juices made from whole fruit.

3. Kids who drink juice become obese. While one study did suggest the link between excess juice consumption and obesity, another one found that kids who drank more juice have lower body mass index than those who drank less juice. Still other studies have shown no effect on body weight.

4. Fruit juice undergoes pasteurization and hence has no beneficial bacteria. Personally, I doubt that a proclaimed attribute of fruits is the intake of bacteria beneficial or otherwise. You should always clean the fruit well before eating. When in developing contries, peel off the skin before eating.

5. Drinking fruit juice may be harmful to the heart. However, preponderance of scientific evidence suggests otherwise as some of the studies cited below indicate.

• Ghanim et al. from SUNY, Buffalo, NY demonstrated that orange juice neutralizes the proinflammatory effect of a high-fat, high-carbohydrate meal and prevents endotoxin increase.
• A Japanese study documented that four week supplementation with mixed fruit and vegetable juice concentrates increases protective serum antioxidants and folate and decreases plasma homocysteine.
• Dalgard et al showed that supplementation with orange and blackcurrant juice improves inflammatory markers in patients with peripheral arterial disease.
• Tart cherry juice improves antioxidant defenses in older adults as shown by an increased capacity to counteract an oxidative challenge and reduced oxidative damage to nucleic acids.
• A study of pear, apple, orange, grape, peach, plum, kiwi, melon, and watermelon juices prepared from pure fruits ground evaluated effect on antioxidant staus in healthy subjects. Within 30 minutes after consumption, orange, melon, grape, peach, plum, apple, and kiwi juices inhibited reactive oxygen species generation. This radical scavenging effect lasted mostly for up to 90 minutes while grape juice displayed antioxidant activity until 2 hours after supplementation. The authors concluded that fruit juices may reduce damage from oxidative stress via antioxidant activity of fruits in scavenging the reactive oxygen species generated in human plasma.
• Gouado and colleagues from University of Douala, Douala, Cameroon, examined the systemic levels of carotenoids from mangoes and papaya consumed as juice, fresh or dried slices in healthy volunteers. Breakfast served to fasting subjects during breakfast, included bread, yogurt and one of the three forms of fruit. Blood samples were collected at 0, 4 and 8 hours. All three forms of consumption contributed to the rise of serum retinol levels. A comparison between the three forms revealed that papaya and mangoes consumed in form of juice or fresh fruit are the best forms because they had higher bioavailability values.
• A double blind randomized controlled trial of 59 healthy subjects examined the effect of a commercially available encapsulated fruit and vegetable juice powder concentrate (FVJC) on functional indices of health over a 77 day period. The FVJC group tended to have fewer total symptoms than the placebo group (P < 0.076) and this was accompanied by an increase in plasma nutrients and antioxidant capacity, reduction in DNA strand breaks, and an increase in circulating gammadelta-T cells.
• Udani et al conducted an 8 week randomized, double-blind, placebo-controlled study to examine the effect of multiple dosages of a proprietary Mangosteen Juice blend (3, 6 or 9 oz twice a day) on indicators of inflammation and antioxidant levels in obese patients with elevated C-reactive protein (CRP) levels. Authors found that proprietary mangosteen juice blend reduced CRP levels (increased change from baseline) compared to placebo for those taking 18 oz per day.
• Kiefer et al conducted a double-blind randomized cross-over design study involving 59 healthy men and women (40-60 years of age)to examine the effect of supplementation with a natural phytonutrient preparation from fruits and vegetables found that supplementation with mixed fruit and vegetable juice concentrates effectively increased plasma levels of important antioxidant nutrients and folate.
• A randomized double-blind, crossover trial (n=32 men) of supplementation with the encapsulated mixed extract (Juice Plus) compared to placebo found tht the supplement increased the concentrations of plasma beta-carotene, retinol, alpha-tocopherol, ascorbic acid and folic acid while reducing plasma homocysteine. Glucose, insulin and lipid concentrations were unaffected.  Authors concluded that the supplementation produced responses consistent with a reduction in risk of cardiovascular disease.

6. Administration of fruit juice to kids predisposes them to chronic allergic disorders. This notion came from contact dermatitis seen in some kids. The concept of increased risk of chronic allergic disorders has not been confirmed by scientific data.

Caution: Fruit juice just like any other food is a source of calories and should be accounted for in any nutritional counselling. Moderation is the key. Consult your physician.

 

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Prevent motion sickness during travel

By A. Minocha MD, author: Guide to Alternative Medicine and Digestive System

Thanks to globalization, the world is a small place and getting smaller everyday. As the socioeconomic status of people improves, they tend to travel far and wide (driving, sea voyage and flying), both for business and pleasure.

Whether it is driving long distance, sea journey or flying, one must be aware of health risks associated with travel.  Many of these risks can be ameliorated by being proacative. Motion sickness also known as travel sickness is one of them.

Following is a list of some of measures you may take to prevent motion sickness:

1. Minimize motion effect and thus risk of motion sickness by positioning yourself at the site of least shakiness or motion. The possibilities of least motion include getting a room in the middle of ship or having a seat over the wings in the airplanes.

2. Try taking a nap rather than reading.

3. Abstain from alcohol intake! Alcohol induced nausea, vomiting will only add on to risk effect of motion and disequilibrium to worsen symptoms of motion sickness.

4. Eat only small amount of food (avoid no fried or junk foods). A banana or yogurt are good examples. All yogurts are not created equal.

5. Drink water while minimizing carbonated beverages.

6. Avoid eating before short flights.

7. Those at high risk for motion sickness may take over the counter (OTC) medications like other preventative drugs like Benadryl, scopolamine or meclizine an hour before departure. Skin patches are available for some drugs. Be sure to talk to your physician prior to using these or any other drugs because they have potential for major side effects especially among elderly individuals.

8. Ginger is effective in nausea and vomiting of pregnancy and may be effective in motion/travel sickness. Take ginger powder/capsules or chew fresh ginger root slice. Dose 1g every 4-6 hours as needed.

9. Acupuncture has also been shown to be effective in preventing nausea vomiting. Click to read more about acupuncture     

Above all, relax and be safe. Plan so you don't rush have to rush.

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Saccharin, aspartame and cancer risk

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Cancer risk and consumption of arificial sweeteners especially saccharin, aspartame

 By A. Minocha MD, author: Guide to Alternative Medicine and Digestive System

• There has been an ongoing controversy over the health risks especially cancer risks due to consumption of artificial non-nutritive sweeteners like saccharin and aspartame. Most of the data about cancer risk has been based on animal studies. Question arises: What is the human data on cancer risk due to artificial sweeteners due to saccharin and/or aspartame.

  Gallus and colleagues from Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.provided an analysis of the integrated network of case-control studies between 1991 and 2004 in Italy on variety of cancers. The findings were published in the journal Annals of Oncology. The odds ratios for saccharin use and cancer risk are as follows:

  • Oropharynx 0.83 (95% CI 0.30-2.29)
  • Esophagus 1.58 (95% CI 0.59-4.25)
  • Colon 0.95 (95% CI 0.67-1.35)
  • Rectum 0.93 (95% CI 0.60-1.45)
  • Larynx 1.55 (95% CI 0.76-3.16)
  • Breast 1.01 (95% CI 0.77-1.33)
  • Ovaries 0.46 (95% CI 0.29-0.74) --------------Reduced risk
  • Prostate 0.91 (95% CI 0.59-1.40)
  • Kidneys 0.79 (95% CI 0.49-1.28)

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• Oral cavity and pharynx 0.77 (95% CI 0.39-1.53)
• Esophagus 0.77 (95% CI 0.34-1.75)
• Colon cancer 0.90 (95% CI 0.70-1.16)
• Rectum 0.71 (95% CI 0.50-1.02)
• Larynx 1.62 (95% CI 0.84-3.14)
• Breast cancer 0.80 (95% CI 0.65-0.97) --------Reduced risk
• Ovaries  0.75 (95% CI 0.56-1.00)
• Prostate 1.23 (95% CI 0.86-1.76)
• Kidneys 1.03 (95% CI 0.73-1.46)

 

 

In fact there was a significant less likelihood with use of total sweeteners and the risk for breast and ovarian cancer. On the other hand, there was a significant trend for total sweetener consumption and for laryngeal cancer.

Conclusion of the study: The authors concluded that there is a lack of association between saccharin, aspartame and other sweeteners and the risk of several common neoplasms.

Update of above analysis for more cancers and sweetener risk: Bosetti and colleagues examined the role of sweeteners on cancer risk especially saccharin and other artificial or low-calorie sweeteners including aspartame. They conducted an update of their analysis of an integrated network of case-control studies conducted in Italy between 1991 and 2004 including data on cancers of the stomach, pancreas, and endometrium. The findings were published in the journal Cancer Epidemio Biomarkers Prev (2009).

The invesigators found that after adjusting for confounding factors, odds ratios (indicating less or more risk; if you just want conclusions, just scroll down) ever users of sweeteners versus nonusers were as follows:

• Gastric cancer 0.80 (95% CI, 0.45-1.43)
• Pancreatic cancer 0.62 (95% CI, 0.37-1.04)
• Endometrial cancer 0.96 (95% CI, 0.67-1.40)

Conclusions of the updated cancer risk study: The authors concluded that the findings lent further support to the evidence on the absence of an adverse effect of low-calorie sweetener (including aspartame) consumption on the risk of common cancers in the Italian population.

 

What do you think about the health risks due to artificial sweetners including cancer and metabolic risks? please share your thoughts. 

 

 

 

Vitamin D deficiency: Is it a growing epidemic

Digestion, Health & Nutrition                          Facebook Dr. Anil

By A. Minocha MD, author: Guide to Alternative Medicine and Digestive System

Vitamin D or calciferol is actually a group of compounds with the molecule comprised of a cholesterol backbone. 1,25(OH)2-vitamin D is the physiologically active form of vitamin D. Several of the metabolites are biologically active.

Sources of vitamin D:

Body vitamin D include is derived from production in skin as well as intestinal absorption.

Skin: Exposure of skin to sunlight leads to production of vitamin D in body.

Diet: In addition to vitamin D fortified milk, the dietary sources rich in vitamin D include fatty fish, cod-liver oil, and eggs. Vitamin D2 or ergocalciferol, a plant steroid is used for milk fortification. Other products that may be fortified include cereals, breads etc. Diet usually provides Vitamin D3.

Vitamin D homeostasis:

Factors involved in vitamin D homeostasis include parathyroid hormone, serum calcium, and phosphorus levels, estrogen, placental growth hormone, and prolactin etc.

Functional significance of vitamin D:

Vitamin D and its metabolites are intricately related to calcium homeostasis and bone metabolism. With increasingly limited exposure to sun, Vitamin D insufficiency as measured by low levels of 25-OH vitamin D is a growing epidemic across the world especially among adolescents and the elderly.

 

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Pathologic disease states with vitamin D involvement:

 

Although rickets in rare these days, subclinical vitamin D deficiency is common.

Since calcium metabolism is involved in not just in numerous metabolic functions in the body including bones, vitamin D deficiency may play a role not just in osteoporosis but also in impairment of immune function,increased risk of various malignancies including colon cancer as well as increased risk for heart disease.

Cancer: An increase of 25 nmol/L in 25-hydroxy-vitamin D levels is associated with a 17 percent decrease total cancer risk.

Bone fractures: Vitamin D and calcium supplementation reduces the risk of falls and fractures.

Vitamin D levels and mortality: Low levels of vitamin D are an increased risk of all cause mortality whereas supplementation of vitamin D results in reduced of all-cause mortality

Vitamin D levels: Best marker is the serum 25-OH vitamin D concentration. While there are considerable disagreements on the “normal” , a level below 20 to 30 ng/ml is considered abnormal. The "normals" may vary with the labs as well.

Vitamin D deficiency:

Vitamin D deficiency can be seen in 57 percent of hospitalized patients of whom 22 percent are severely deficient [Thomas 1998] Vitamin D stores decline with age, especially in the winter because of reduced sun exposure.

The deficiency or resistance may occur due to inadequate dietary intake, malabsorption, lack of sun exposure, liver or kidney dysfunction,or there may be end-organ resistence to vitamin D metabolites. Chronic use of corticosteroids results in decreased vitamin D dependent calcium absorption and hence bone disease.

 

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Dose of vitamin D:

The tolerable upper intake level for vitamin D for healthy adults is 2000 IU per day. A minimum of 200 IU per day is needed in healthy adults.  Many experts argue that the normal daily dose of vitamin D should be 1000-2000 IU per day. Some patients may even require higher doses and should be undertaken under close medical supervision.

Pregnant and lactating mothers: 400 IU/d

Infants who are exclusively breast fed: 400 IU/d. Since infant formulas are fortified with vitamin D, formula-fed infants require supplementation if they consume less than 1000 mL daily of formula.

Elderly: 800 IU/d plus atleast 1.2 g of elemental calcium per day.

Special cases:  

Patients noncompliant with daily vitamin D therapy may benefit from high dose intermittent therapy (100,000 units every four months).

Prevention and treatment of osteoporosis 800 IU (20 micrograms) per day. 

Toxic dose of vitamin D: Greater than 2000 IU per day.

 

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Toxicity of vitamin D:

Vitamin D is not innocuous and excess ingestion can lead to vitamin D intoxication. Subjects prone to this include not only those those who consume megadoses of supplements but also in patients on vitamin D replacement therapy for a variety of disorders. Manifestations of toxicity include hypercalcemia, hypercalciuria, altered mental status, polyuria, polydipsia, anorexia, vomiting, muscle weakness, and bone demineralization with pain.

Caveat:

I would like to pint out that some experts have questioned the issue of extent of prevelance of vitamin D deficiency for a variety of good reasons including in part to the paucity of reliable and reproducible blood tests and that the need for vitamin D may be different in different population sub-groups.

 

Are you taking any vitamin D supplements? If so, what dose and have you talked to your doctor about it? Have you had your vitamin D levels checked? Please share your thoughts.

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Doctors are human too!

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Doctors are not superhuman. In fact, half of them graduated in the bottom half of the class!

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Enjoy grapefruit, lose weight

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By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

Grapefruit is  healthy and grapefruit diet fad occurred in early part of last century. Is it myth or does it have scientific basis that grapefruit can ameliorate diet induced obesity.

Animal studies on positive effects of grapefruit:

One of the compunds in grapefruit juice is nootkatone. Studies by Murase and colleagues have shown that consumption of nootkatone containing diet over long term by experimental animal models reduces weight gain induced by high fat and high sugar diet. This is accompanied by decreased abdominal fat. Remarkably, these beneficial changes are accompanied by improved physical performance, exercise capacity and endurance.

Human data:

Ken Fujioka from Scripps clinic has shown that grapefruit ingestion results in significant weight loss and improved insulin resistance as compared to placebo.

Molecular mechanism of grapefruit:

Nootkatone, contained in grapefruit enhances energy metabolism via stimulation of AMPK  in the skeletal muscles and liver.

Do you enjoy grapefruit and believe in its weight loss capability? Do you or someone you know has been on grapefruit diet? Please share your thoughts.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Coconut oil repairs your skin naturally and heals

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Coconut oil for a healthy shining and vibrant skin

By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

Coconutoil is widely used for skin and hair care in Eastern cultures especially India and is believed to have skin healing and nurturing properties.

Nevin et al from University of Kerala examined the skin wound healing properties of topical (local) application virgin coconut oil in animals.

Design of coconutoil skin study: Skin wound injury model in rats was used. Skin wound injury was created experimentally. 24 hours later the wound was treated with 0.5 or 1 ml of the virgin cocnut oil for 10 days. There no application on the skin wounds of control rats.

Results of coconutoil skin study: Examination of skin wounds indicated a much rapid epithelization and healing of the wounds in the coconut oil group. This was accompanied by a greater collagen cross-linking and higher turnover of collagen.The level of antioxidant enzyme activities was higher at 10 days and returned to normal by day 14 in the coconut oil treated group.

Antioxidant enzyme activities, and reduced glutathione and malondialdehyde levels were found to be increased on the 10th day after wounding, which were found to have returned to normal levels on day 14 in the treated wounds. In addition, the treated wounds had lower lipid peroxide levels as compared to controls.

Histopathological examination of the wound tissue showed that wounds treated with coconut oil had higher fibroblast proliferation and neovascularization.

Conclusions of coconutoil skin study: The beneficial skin caring effect of virgin coconut oil is due to the overall effect of multiple biologically active compunds present in it.

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Kid getting infection from day care center? Try probiotics

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By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

There is growing body of literature on benefits of prebiotics and probiotics in reducing risk of infections in elderly as well as in children. Yet, they have not achieved a mainstream acceptance yet for a variety of reasons.

Hojsak and colleagues conducted a randomized, double-blind, placebo-controlled trial to examine the efficacy of Lactobacillus GG (LGG) in preventing gastrointestinal and respiratory tract infections in children attending day care centers. The findings were published in the journal Clinical Nutrition.

281 kids were recruited to the study. Study subjects received 10⁹ colony-forming units(CFU) in a fermented milk product for a period of 3 months. Placebo group was administered the same post-pasteurized fermented milk product.

 

Kids taking LGG suffered fewer respiratory infections and those who did develop respiratory infections had a milder shorter course. However, there was no impact on lower respiratory infections. Similarly there was no effect on frequency or severity of gastrointestinal infections.

                                        Listing of some probiotics on market

Do you or someone you know takes probiotics for prevention on a regular basis? If so what has been your experience. Please share your thoughts.

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Iron supplements and leaky gut or intestinal permeability

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By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

The effect of iron supplementation on intestinal permeability was examined as part of a randomized iron plus multi-micronutrient (without iron) supplementation trial in Zambian children (n=153; mean age 10.2 years) over period of ten months.

Iron supplementation resulted in a higher lactulose to mannitol ratio indicating increased intestinal permeability as compared to controls whereas there was no impact of no effect of multi-micronutrient supplementation. The authors (Nchito and colleagues) speculated that this could in part explain the deleterious health effects of iron documented in some studies.

Preponderance of evidence suggests that unselected addition of multiple micronutrients to iron supplementation in children with iron deficiency anemia only marginally improve response as assessed by hemoglobin; on the other hand, these additional unselected micronutrients may have an adverse impact of their own and the routine use for treatment of iron deficiency anemia may not be justified.

Bottom line is everything should be in moderation; iron can be toxic; you should take iron if you need it, but be sure that you do actually need it in consultation with your physician.

Are you taking iron supplements? Have your iron levels been checked on periodic basis? Please share your thoughts.

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 Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Yogurt gaining popularity

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Health conscious Americans are increasingly using fermented foods ranging from yogurt to kimchee because of the potential health benefits in a variety of chronic ailments. This was reported by Chicago Tribune/Tribune Media Services (4/28/2010)

Obesity and beverage calories over time

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By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

Obesity is a growing epidemic. It is atleast in part related to the increasing consumption of calories from beverages. In fact, beverage associated calories nearly doubled from 1965 through 2002.

 Duffy and colleagues examined the trends and patterns of beverage consumption among adults based on nationally representative Nationwide Food Consumption Surveys (1965, 1977 to 1978) and the National Health and Nutrition Surveys (1988 to 1994, 1999 to 2002).

There was an increase in percentage of calories from beverages from 11.8% in 1965 to 21% to 2002. Beverage patterns in 2002 were predominantly by a greater number of beverages as reflected by an increase in alcohol, soda, and diet beverages.

The authors concluded that an addressing the increased use of calorically sweetened, nutrient-deficient beverages would be an important tool for weight management.

Note: Sugar free does not always mean calorie free!

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

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Ambient temperature and mortality

Digestion, Health & Nutrition                          Facebook Dr. Anil

By A. Minocha MD, author: Guide to Alternative Medicine and the Digestive System

There is growing amount of literature studying impact of elevated ambient temperature and mortality. Basu and colleagues from California examined the epidemiological data published from January 2001 to December 2008.They excluded studies associated with heat waves as were studies focusing on effect of cold temperature. Thirty-six studies were analyzed.

After adjusting for confounding factors like ozone, the authors found an independent association between temperature and mortality. Elevated temperature increases risk of mortality related to cardiovascular, respiratory, cerebrovascular, diseases. Blacks, women, children and elderly and persons of lower socioeconomic status were more vulnerable.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

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