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

Meat animals: Perils of using antibiotics and others drugs

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

The meat you buy at the grocery store comes from a variety of sources which in turn have an eclectic plethora of strategies on growing these animals.

One big factor is the use of antibiotics in animals. This is important that alterations in meat from the bacteria as well as the residual antibiotic in the meat consumed has led to an exponential rise of antibiotic resistant organisms that we may at times suffer from as a disease.

Statement of the problem

An astonishing amount of antibiotic, 300 mg of antibiotics is used in production of every kilogram of meat and eggs. Estimation of the seriousness of the role of animal reservoir in emerging antibiotic resistant bacteria in humans is no easy task.

Emerging evidence suggests that while the main culprit is the indiscriminate antibiotic use by us, the antibiotic use in animals continues to play increasing role.

Historical perspective

Originally the antibiotics were used to treat or stave off infections. However, little known fact from recent times is that antibiotics are frequently used to promote growth in these animals, thus bigger the animal, the greater the pay off!

Stokestad and Jukes reported very low sub-therapeutic doses of antibiotics (1/10 to 1/100 of the therapeutic dose) administered animals in feed improves feed-to-weight ratio for poultry, swine, and beef cattle. This allowed the practice to become widespread while ignoring the potential for deleterious consequences on human health.

Effect of antibiotic use in animals on farm dwellers/workers

Subsequent studies found that animal growth promotants (AGPs) resulted in more resistant bacteria in the gut of not just the farm animals but also the farm workers as compared to when AGPs were not used.

A landmark study reported in 1976 by Levy and colleagues and published in the New England Journal of Medicine examined the impact of low-dose oxytetracycline as an AGP on the intestinal bacteria of chickens and farm workers.

Amazingly, investigators found not only the chickens with antibiotic resistant bacteria but also in the gut of the family living on the farm. 

Consequences of antibiotic use in animals

According to Price and colleagues from the Translational Genomics Research Institute (TGen), Pathogen Genomics Division, Flagstaff, Arizona, methicillin-resistant Staphylococcus aureus clonal complex 398 (CC398) since its discovery in the early 2000s,has become a rapidly emerging cause of human infections, most often associated with livestock exposure.

Their findings suggest a bidirectional exchange between animals and humans and highlight underscore the public health risks of antibiotic used meat animals. 

According to World Health organization, “A crisis has been building up over decades, meaning that today common yet life-threatening infections are becoming difficult or even impossible to treat. It is time to take much stronger action worldwide to avert an ever-increasing health and economic burden.” 

How do altered bacteria contaminate the food chain?

Contamination resulting in animal to human transmission occurs not just via food but also directly by contact and indirectly via the food chain, water, air, and use of manure in food farm soil. Bacteria continue to survive to some extent in skin as well as feces and then make their way into not just the meat but also people as well as equipment involved in handling or cooking the meat.

Antibiotic use in fish farming is also booming. Water borne bacterial transfer to humans may be a much larger problem as compared to one from terrestrial animal to humans.

Above cobweb of transmissions results in an ecological imbalance leading to more and more resistant and pathogenic bacteria.

Are there any more problems beyond resistant bacteria?

Beyond the obvious increased prevalence of antibiotic resistant bacteria, the altered meat and or the antibiotic may affect down the food chain, including but not limited to our intestinal milieu, especially our intestinal bacteria and our internal ecological balance.

Effect on human health

The antibiotic use in animals affects not just the health of people on the farm but distant people along the food chain who consume it.

Factors affecting health consequences:

• Type of antibiotic
• Dose of antibiotic
• Any other drugs used
• Number of animals treated

 Relationship between diet, intestinal bacteria and health status has been clearly established, and suggests that diet-driven changes in intestinal bacteria correlate with health decline. 

Just one example of Clostridium difficile—a potential next big killer

C. difficile is seen as bacteria in the gastrointestinal tract most mammals and birds. In addition to the increasing resistance, its infection early in life has been linked to diverse disorders. Although there is no direct evidence proving transmission of Clostridium difficile from animals to humans, strong circumstantial evidence suggests that it might be a zoonotic disease. 

Effect of reduced antibiotic use on antibiotic resistance in meat animals

Agers from the National Food Institute, Technical University of Denmark, writing in the Antimicrobial Agents and Chemotherapy demonstrated that discontinuation of an already low use of cephalosporin antibiotics in pig production has significantly reduces the occurrence of resistant E. coli bacteria. 

Why farmers don’t want to stop using antibiotics in farm animals?

• Antibiotics promote growth resulting in more meat per feed of financial benefit.
• However, the argument that stopping antibiotic use would lower the meat production may not be credible based on experience in Denmark.
• Diminishing antibiotic use in animals has actualy resulted in increase in pork production, This has been termed--The “Bacon Boost” Similar lack of adverse effects has been documented in poultry as well.

Beware of the many vested interests

In addition to purported benefit of growth of animals and hence more money for farmers:

• Veterinarians who sell antibiotics to farmers
• Pharmaceutical companies who manufacture antibiotics/drugs
• Lobbyists who lobby against regulation of antibiotic use in animals
• Politicians who get campaign donations from lobbyists

Are there alternatives to antibiotic use to promote animal growth?

Use of probiotics and synbiotics (probiotic plus prebiotic) has been advocated for containing this antibiotic resistance and bacterial contamination.

Santini and colleagues suggest that an alternative and effective approach to antibiotic administration to livestock to reduce bacterial contamination is the use of probiotics. Just as in humans, this would help augment the animal’s natural defense mechanism against infections.

Baffoni and colleagues from the Department of Agro environmental Sciences and Technologies, University of Bologna, Bologna, Italy, have shown that a Bifidobacterium-based synbiotic product can reduce the transmission of C. jejuni bacteria in broiler chickens along the poultry food chain which is of course important for poultry consumers. 

Role of healthy additive cocktails in animals

Rodriguez and colleagues from Spain have shown that cereal diets like Wheat- and barley-based diets with or without additives like enzymes (xylanase plus β-glucanase), prebiotic, probiotics affect broiler chicken performance, digestibility of the meat as well as intestinal bacteria of the chicken. 

Can the alternate options make up for the growth promoting effects of AGPs

Improve farming practices and breeding programs:

• Reduced animal density
• Improved hygienic conditions
• Judicious use of antibiotics
• Use of additives like enzymes, prebiotics, probiotics, and vaccines

Above factors can more than make up for growth promoting effects of AGPs.

Graveland et al from the Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands studied MRSA bacterial colonization in veal calves and humans working and living on the MRSA in farm workers/dweller humans was 1% when less than 20% of the calves were carriers. In contrast, humans had greater than 10% prevalence in farms with higher carrier prevalence in calves. 

Benefits of manipulating bacteria in meat animals

The modulation of intestinal microflora in food animals without using any antibiotics would serve two purposes:

1) modulation of number and type of bacteria in animal’s gut would contribute to health and superior growth in the animal 

2) Decrease transmission of pathogenic bacteria to humans reducing the possibility of foodborne disease,

The latter in turn would reduce disruption of normal healthy pattern of the human microbiota thus also reduce potential for chronic ailments associated with dysbiosis, e.g. allergic and inflammatory diseases etc.

Are there any other drugs in meat besides antibiotics

A Consumer Report study found small amounts of drug ractopamine used to promote growth. While it is legal in the U.S. America, it has been banned in many countries including China, European Union. Side-effects of this drug include anxiety and restlessness. 

Are their actual antibiotics in meat you eat?

Yes indeed. Even though most meat is proclaimed to be antibiotic free, most of it does contain small amounts of a variety of antibiotics fed to the animals. The USDA is now using more sensitive tests for antibiotic detection after the USDA inspector general's report said, "the effects of these residues on human beings who consume such meat are a growing concern." Obviously, this issue has not been studied over long term but may be contributing to dysbiosis related diseases, 

What are out regulatory agencies doing?

The European Union banned the use of antibiotics in food animals for growth. In Denmark, farmers suspected of inappropriately using antibiotics for non-infection reasons are issued a “Yellow card” akin to football games in the U.S.

Food and Drug Administration in the United States only asks voluntary cessation of antiotic and drug use and encourages judicious use. FDA works collaboratively with veterinary and animal producer organizations to develop and distribute information to support the judicious use of antimicrobial drugs in food-producing animals.

 The Government Accountability Project (GAP) The Washington, D.C.-based non-profit advocacy organization has sued the FDA for declining request for information withheld data pertaining to the sale of antibiotics for use in food animals under the Freedom of Information Act.

Implications for us in nutshell

While there is no direct evidence of benefit, a prudent exercise may be:

• Infants and children in early life when their intestinal bacterial fingerprint is being established should not consumed antibiotic treated meat
• Kids/adults with psychological issues pursue organic meat in order to avoid effects of antibiotics as well as other drugs that affect brain.
• Patients with chronic disorders associated with dysbiosis, intestinal permeability or leaky gut and chronic low grade inflammatory state may best be served by avoiding antibiotic meats as well.

What is your opinion of organic meat versus non-organic meat? Is it worth the extra cost?  Dr. Minocha would appreciate your thoughts/comments.

Read reviews of  Guide to Alternative Medicine and the Digestive System 

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Use of elimination diet in autism	Food allergies and intolerance are not the same
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ADHD, Diet and Artificial Food Colors Additives

ADHD and Diet, Food Color Controversy

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

ADHD, a common neurodevelopmental disorders presents with diverse clinical manifestations. The etiology/pathogenesis of this disorder continues to remain an enigma. A variety of hypothesis have been put forth in this context.

While genetic predisposition has been implicated, this does not explain the entire variance and as such the role of environment has been highlighted. Neurobehavioral toxicity may occur due to a wide variety of chemicals/toxins widely spread across the environment.

Potential environmental injury/toxic factors

• Toxin exposure (prenatal and perinatal)
• Birth injury
• Low birth weight
• Social conflicts and stress
• Diet
• Intestinal milieu including bacteria
• Food additives/preservatives

Role of diet in historical context

Of the factors outlined above, the role of gut and diet has received increasing attention in recent years. These include the role of food allergies as well as exposure to food additives (colors and flavors) and preservatives.

1920s    Food allergies were implicated in causing learning and behavioral problems.

1972      Food additive hypothesis was proposed by Feingold who proposed a Feingold diet which excluded any natural salicylates in food as well as food additives

1982    National Institute of Health (NIH) consensus development conference recommended further studies

1983     Kavale  meta-analysis concluded that clinical impact of diet is too small to be meaningful

2004    Schab and Trinh meta-analysis concluded that artificial food colorings contribute to behavioral symptoms in hyperactive syndromes like ADHD.

2007   McCann population based study concluded that food colors and/or sodium benzoate preservative in diet is linked to hyperactivity in children.

2008 European Union Parliament imposed requirement for warning labels on foods containing six colors. Overall, the FDA approves 9 colors for use in foods of which Orange B is not approved in Europe.  The synthetic colors requiring warning labels in Europe include Allra Red AC, tartrazine, sunset yellow, quinoline yellow, carmoisine and ponceau. The latter three are not approved in the U.S.

2008 Center for Science in the Public Interest (CSPI) filed a petition asking the FDA to regulate the use of food colorings.

2011 FDA concluded that scientific evidence did not support cause-effect relationship between food colorings and ADHD manifestations

2011 Food and Drug Administeration (FDA) approved synthetic colors include Brilliant blue, indigotine, green S or fast green, orange B, citrus, amaranth, erythrosine, allura red, tartrazine and sunset yellow.

2011 Stevens qualitative review of 35 years of research concluded that food additives play a role in a subset of ADHD patients and exclusion diets may be helpful in such cases.

The Stevens review also concluded that in kids with suspected senstitivies to synthetic food coloring additives, up to 89% improve when exposed to greater than 100 mg of artificial food coloring. 

State of current literature on role of diet, food color additives and ADHD

The issue of role of food additives and ADHD continues to be mired in debate. The European and US authorities have taken different policy approaches to this issue.

Dr. Nigg and colleagues from the Oregon Health and Science University, Portland, OR,conducted a systematic review and meta-analysis in an attempt to review the up to date literature and hopefully resolve the controversy.

Their findings were published in an article titled, “ Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives” in the Journal of American Academy Child Adolescent Psychiatry (2012).

Methods of ADHD and diet, food coloring study:

• An extensive search of medical literature was conducted including Medline/PubMed.
• The 53 human studies published between 1976 to Feb 2011 were graded for relevance
• Overall 35 publications met the inclusion criteria.
• Rational grouping of parent/observer data
• Rational grouping of psychometric laboratory test data
• Meta-analytic computations were conducted using appropriate software.

Results of ADHD and diet, food coloring meta-analysis:

Effects of exclusion of food additives/colors as part of overall elimination diet:

• The results from open-labelled trials yielded a 47% response rate.
• The six controlled trials found that elimination diet that included eliminations of food colorings and additives result in a response rate of 41.5 percent.
• These results indicate that dietary restriction results in a reliable and clinically meaningful impact.

Role of synthetic food additives:

• The studies generally included subjects who had followed some kind of modified version of Feingold restricted diet and then were challenged with food additives in some fashion like cookies, capsules etc.
• For studies based on parental reports, the estimated size effect was 0.18 and was highly significant. Parents reported higher greater effects with higher doses without any impact of duration of exposure.
• For the 10 studies utilizing teacher/observer reports comprising a total of 323 subjects, the results on impact of food coloring showed a trend towards statistical significance (p=0.07).
• Six studies comprising 154 kids utilized psychometric tests of attention for analysis. The results revealed a reliable significant effect of food coloring on the psychometric tests in ADHD. The results were significant when studies included colors only or FDA approved colors only.

Proportion of kids reacting to colors:

• 14 studies comprising of 241 pre-seleccted kids responsive to elimination diets, studied proportion of kids reacting to colors.
• While the overall the event rate was 18 percent, it was 24% when only the studies utilizing well-defined criteria were analyzed.
• Using these results from preselected kids were diet responsive, it was estimated that 8% of kids with ADHD have symptoms related to food colors.

Conclusion of the ADHD, diet, food coloring study:

1. Some kids with ADHD react to food additives as assessed by the parents; however it is unclear if this is due to FDA approved colors
2. The results of studies utrilizing parent assessment versus teacher assessment are inconsitant
3. Most studies examined effect of variety of combinations of colors thus rendering analysis of any specific color difficult.
4. Inconsistency in parent-teacher observation studies notwithstanding, the studies utiliziing objective psychometric tests of attention showed reliable and significant effect of food colors with an effect size of 0.27. These affects could not be explained by publication bias.
5. The adverse effect of food additives appears to be 1/3^rd to 1/6^th the size of effect of drugs used to treat the disorder.
6. As many as 33% 9of kids with ADHD may respond to dietary exclusions. Since 8% have symptoms related to food colors, the precise mechanism for response to elimination diet remains obscure.
7. There is paucity of studies dealing exclusively with FDA approved food colors or unselected study samples.

Note:

1. Some of the kids sensitive to food color additives also display sensitivity to onsalicylate foods like milk, chocolate, soy, eggs, wheat, corn, legumes/lentils in addition to salicylate-rich foods like grapes, tomatoes, and citrus.
2. Many experts argue that "cosensitivity" is more of a rule rather than an exception.

Other topics of interest:

1. Autism, leaky gut and elimination diets
2. Can probiotics strengthen selective intestinal barrier or leaky gut?
3. Autism related to gut bacteria?
4. Melatonin is not just for sleep. It helps gut too
5. Toileting posture: Taking care of business well!

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ADHD Treatment: Chinese Compound Herbal Preparation Helps Attention, Impulse Control

Role of Compound Herbal Prepapration for Attention Deficit Hyperactivity Disorder (ADHD)

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

Treatment of ADHD or ADD poses numerous challanges. A wide variety of drugs including CNS stimulants, antidepressand and bupropion are frequently used. The response to these medications is variable; besides they are beset with adverse undesirable effects. Parents are frequently looking for alternate herbal, natural and nutrition remedies. 

Background of CHP-ADHD Study:

Compund herbal preparations or CHP derived from Chinese Herbal Medicine  is one such potential strategy. One of the hypothesis underlying ADHD causes is deficiency of essential micronutrients and compound herbal preparations are believe to have coginition enhancing properties by replenishing essential fatty acids, phospholipids, vitamins and minerals.

Dr. Katz and colleagues  from the Sheba Medical Center in Israel examined the efficacy of Nur­ture & Clar­ity in ADHD and published their findings in the paper, "A compound herbal preparation (CHP) in the treatment of children with ADHD: a randomized controlled trial" in the Journal of Attention Disorders 2010.

Composition of compound herbal prepapation (CHP brand name Nur­ture & Clar­ity)

• Paeo­niae Alba
• With­a­nia Som­nifera
• Cen­tella Asi­at­ica
• Spir­ulina Platen­sis
• Bacopa Monieri
• Mel­lissa Offic­i­nalis

Design of CHP-ADHD Study:

• Double blind, randomized, placebo controlled
• Tertiarry care university  medical center
• N=120 kids with a new diagnosis of ADHD based on DSM-IV codes
• Intervention: Compound herbal preparation (n=80) versus placebo (n=40)

Results of CHP-ADHD Study:

1. 91% of kids in treatment and 48% in the control group completed the study
2. Treatment group demonstarted a significant improvement in total TOVA scores as well as 4 subscales
3. The significance of the improved difference between the Chinese  compound herbal preparation (CHP)  treatment versus  placebo group was seen even when using the higher standard of comparison i.e. Intent to treat analysis

Conclusions of Compound Chinese Herbal Prepartion-ADHD Study:

Compound herbal preparation treatment is benficial in treatment of ADHD or ADD and improves the following symptoms:

• Attention
• Cognition
• Impulse control 

Learn about 12-point autism treatment program OR more topoics of interest below

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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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Cranberry versus antibiotic TMP-SMX for preventing recurrent urinary tract infections or UTI

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

Is it better to take antibiotics rather than cranberry to prevent urinary tract infections?

Urinary tract infections including bladder infections are common amongst women. Literature supports the use of Cranberries and cranberry juice for preventing urinary tract infections (UTIs). Cranberry is popular because it is natural and devoid of puported side-effects related to antibiotics expecially over long term.

The study authored by Beerepoot and colleagues from the Academic Medical Center in Amsterdam was published in Archives of Internal Medicine. While the study showed antibiotics to be better at preventing UTI over 1 year, are they really supeior to Cranberry over longer term?

Not so fast! There is a subtext to the overall cost to one's health associated with antibiotic TMP-SMX use which I discuss after the author's conclusions.

Study methods: The study involved 221 premenopausal women with history of recurrent urinary tract infections (UTI). Subjects received either TMP-SMX 480 mg once a day or cranberry capsules 500 mg twice a day for 12 months.

Results

1. Mean number of UTIs Cranberry 4.0 vs TMP-SMX 1.8
2. Proportion of women with atleast 1 UTI Cranberry 78% vs TMP-SMX 71%
3. Median time to symptomatic UTI Cranberry 8 months vs TMP-SMX 4 months
4. Antibiotic resistence to E. coli (UTI bacteria) Cranberry 28% vs TMP-SMX 91%

Authors' conclusions: Use of TMP-SMX antibiotic is superior to cranberry for over a period of 12 months at the expense of antibiotic resistence.

My comments

1. The antibiotic group in this study likely had an inherent advantage since the bioavailabilty of active compound in the antibiotic greater than the cranberry capsule group (Clinical significance to be established).
2. The superiority of antibiotic TMP-SMX over 1 year not withstanding, the occurance of more than 90% antibiotic resistence gives me pause and makes me wonder if the results would have reversed if the study was extended over longer term, say 5 years.
3. The long term of use of broad spectrum antibiotic such as TMP-SMX is fraught with dangers, many not well understood including the effect on overall health due to disruption of the bacterial balance and homeostasis in the gut.
4. Many women have moved somewhat past cranberry alone and are using it in combination with mannose.

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Carnitine supplements as treatment of autism?

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Levo-carnitine treatment improves autistic spectrum disorders

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

Abnormalities of mitochondria are widely prevalent in patients with autistic spectrum disorders. Prevalence of abnormal biomarker values of mitochondrial dysfunction is higher in patients with autism. Biomarkers of mitochondrial dysfunction include carnitine and lactate.

 

Filipek from the University of California in Irvine, Ca have demonstrated that patients with autistic spectrum disorders have higher prevalence of carnitine deficiency. Carnitine deficiency has been attributed to the mitochondrial defects. Such alterations could in turn play in role in pathogenesis of effects on brain as manifested by various behavioral effects.

 

Literature suggests potential role for carnitine supplementation for treatment of autism; however, thus far, there has been lack of good randomized controlled trials to examine the effect of carnitine.

 

Hypothesis: L-carnitine supplementation ameliorates the effects of mitochondrial dysfunction in patients with autistic spectrum disorders.

 

Study: Geier and colleagues from the Institute of Chronic Illness in Silver Springs, MD conducted a double blind, randomized placebo controlled trial to evaluate the effect of levocarnitine in 30 patients with autism spectrum disorders.

 

Intervention: Liquid L-carnitine 50 mg/kg bodyweight per day or placebo for 3 months.

Outcome measures:

• Childhood Autism Rating Scale (CARS)
• Hand muscle testing
• Modified clinical global impression (CGI)
• Autism Treatment Evaluation Checklist (ATEC)
• Treatment adherence measurement (TAM)
• Frequency and intensity of side effect rating (FISER)
• Global rating of side effect burden (GRSEB)
• Patient report of incidence of side effects (PRISE)

Results: L-carnitine treatment led to significant improvement in: Childhood Autism Rating Scale, hand muscle testing, modified clinical global impression, and Autism Treatment Evaluation Checklist.

Changes in carnitine levels in serum were positively associated with improvements in associated with hand muscle strength, cognitive scores, and Childhood Autism Rating Scale scores.

 

Conclusions: L-carnitine supplementation results in clinical improvement in several clinical parameters in patients with autistic spectrum disorders.

Dr. Minocha’s opinion: The results of the study are dramatic and provocative; however, further substantiation may be in order.

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Autism, leaky gut and elimination diets

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Autism: Is it linked to leaky gut syndrome? Do elimination diets help?

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

There has been a lot of “buzz” about the role of increased intestinal permeability (intestinal hyperpermeability) or leaky gut syndrome in the pathogenesis of autism and autistic spectrum disorders or ASD. A leaky gut may allow absorption of larger molecules especially peptides etc. derived from food which then in turn could potentially affect the neurological function manifesting as behavioral problems.

Let’s look at some of the facts:

• Celiac disease that is related to gluten may present with clinical picture of autism.   
• D’Eufemia et al from La Sapienza University in Italy performed a lactulose-mannitol test to evaluate the intestinal permeability in 21 autistic and 40 control kids. The investigators reported that abnormal permeability through a damaged or dysfunctional gut (i.e.leaky gut) was present in 43% of the autistic kids and none of the control children. 
• De Magistris and colleagues from the Second University of Naples, Italy studied alterations in intestinal permeability in kids with autism and their first degree relatives. Abnormal permeability or leaky gut was seen in 37% of kids with autism, as compared to 21% in first degree relatives and only 5% in healthy controls. Faecal calprotectin was increased in 24% of autistic kids, 12% of first degree relatives and none in controls. The investigators concluded that the results support the “leaky gut” hypothesis and measurement of intestinal permeability may identify those kids with autism that  may benefit from elimination diet. In addition, the high prevalence of abnormalities in the relatives indicates that genetic factors involving tight junctions may play a role in the pathogenesis. 
• American Academy of Pediatrics feels that the literature supporting the role of leaky gut in autism is “limited” and that more studies are needed.

If leaky gut plays a role in autism, exclusion of certain foods like gluten and casein with potentially noxious products may help the patients.

• Knivsberg et al. from the Stavanger University College, Norway conducted a randomized controlled trial of effect of gluten free, casein-free diet in kids with autism and found that development of children at the end of 12-months who underwent dietary intervention with gluten-free, casein-free diet was superior to the controls who were on their usual diet. 
• Elder eta l from the University of Florida conducted a double blind cross over trial of casein free, gluten free diet in kids with autistic spectrum disorder. Outcome parameters include autistic symptoms and urinary peptide levels. Overall, there were no differences between the two groups. However, parents of 9 of the 15 kids wanted to continue the diet and reported subjective clinical improvement. 
• A Cochrane database review by Millward and colleagues from the Derbyshire Children’s Hospital in Derby, UK and Literature and Evidence Research Unit at Nottinghamshire Healthcare Trust in Woodbeck, UK conducted a systematic review and meta-analysis of literature on the role of elimination diets in autistic spectrum disorder. The authors identified two randomized controlled trials albeit small. Elimination diet showed benefit in overall autistic traits, social isolation and overall ability to interact. 
• Rossingnol from the International Child Development Resource Center, Melbourne, FL in 2009 gave a grade C recommendation for the use of elimination diets in autistic kids. 
• Since the publication of the above reports, opinions as well as the position statement of American Academy of Pediatrics, another randomized controlled trial has been published. Whiteley et al. from the University of Sutherland in the United Kingdom conducted a 2-stage single blinded randomized controlled trial of gluten free and casein free diet in kids with ASD. Outcome measures included Autism Diagnostic Observation Schedule (ADOS) and the Gilliam Autism Rating Scale (GARS) as markers for  core autism behaviours, Vineland Adaptive Behaviour Scales (VABS) to evaluate the developmental level, along with nd Attention-Deficit Hyperactivity Disorder - IV scale (ADHD-IV) for assessment of  inattention and hyperactivity. Results at 12-months demonstrated a significant improvement in the intervention group on the  ADOS, GARS and ADHD-IV. Results at 24 months showed benefit was sustained at 24 months although the clinical impact showed a plateau.

Bottom-line: While there is controversy, my "belief" is consistent with Reichelt and Knivsberg from the Rikshospitalet Medical Centre, University of Oslo in Norway who conclude in Annals of Clinical Psychiatry that a gut-to-brain axis connection in autism is both possible and probable based on the effect of diet on excreted compounds and behavior in conjunction with the clinical data available. Obviously, large studies over time will be needed to resolve the controversy.

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Other topics of interest:

1. Can probiotics strengthen selective intestinal barrier? 
2. Autism related to gut bacteria? 

Autism treatment strategies at the 12-point treatment program for autism.

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It's the vegetarian diet, stupid

Digestion, Health & Nutrition             Facebook Dr. Anil

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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Whole fruit versus fruit juice

Digestion, Health & Nutrition                          Facebook Dr. Anil

 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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Riboflavin prevents migraine headache

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Riboflavin or Vitamin B2 for migraine prophylaxis

 

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

Complementary and alternative medicine is being used for numerous chronic disorders including pain. A disorder of mitochondrial energy metabolism has been implicated in pathogenesis of migraine headaches. Riboflavin may help correct that. Riboflavin deficiency is rare. Studies indicate that high dose of B2 have prophylactic effects against migraine headaches. 

 

Study

Schoenen et al. from the Department of Neurology, University of Liège, CHR Citadelle, Belgium conducted a randomized, double-blind, placebo-controlled examined the role of riboflavin (400 mg/d) in patients (n=55) suffering from 2 to 8 attacks of migraine headaches per month. 

 

Results

Greater than 50% improvement was seen in 54% of treatment group as compared to 19% in placebo. Riboflavin reduced the headache days from 57% as compared to 19% in placebo group. This was associated with a significant improvement in migraine index score of 39 in treatment group as compared to 8% in placebo. The number-needed-to-treat for effective response was 2.3.

 

 

Migraine in children and adolescents

 

Study

Condo and colleagues from the Department of Neurological Sciences, University of Bologna, Bologna, Italy, conducted a retrospective study to examine the role of riboflavin for preventing migraine heaaches in pediatric and adolescent patients (n=41). The findings about beneficial effect of riboflavin were published in the Journal of Headache and Pain.

Methods

Subjects with migraine headaches receieved 200 or 400 mg/day oral dose of riboflavin for 3, 4 or 6 months.

Results

The riboflavin supplementation resulted in a significant reduction in migraine episode frequency and intensity (p<0.05). 

Follow up these subjects revealed that 68 percent of the subjects demonstrated a 50% or greater reduction in frequency of attacks. Adverse events included vomiting and increased appetite which the authors felt were unrelated to the riboflavin administration.

It should however be noted that other studies in children have however provided opposing results.

Do you take riboflavin or anyother vitamin or supplement to prevent migraines? Please share.

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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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Disclaimer: Everything on this site including the blog and the ads are for your information only. . Please do your own due diligence and consult your health care professional advisor. 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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Disclaimer: Everything on this site is for information only. I am not your doctorst. Please do your own due diligence. Consult your doctor. Dr. Minocha does not offer any opinion as to the ads on this site.

 

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)

Quinoa, Chenopodium quinoa, a high protein pseudocereal or pseudograin

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Quinoa, a complete nutrient dense food 

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

Quinoa (Chenopodium quinoa ) is considered a pseudocereal or pseudograin. High nutritional value of Quinoa has been recognized since ancient times.  For the record, I purchased quinoa flakes and enjoyed them as cereal :Quick and easy to make, tastes good. 

Click to read more about quinoa

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor. Please your health care professional advisor. 

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GERD and asthma

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Heartburn (acid reflux) and bronchial asthma 

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

 GERD  or gastroesophageal reflux disease typically causes heart burn but several atypical manifestations may result of the reflux. The association between gastro-esophageal reflux disease and asthma has long been suspected and definite proof has been lacking.

 

Study:  Havemann and colleagues conducted a systematic review to examine the estimate of the strength and direction of the association between GERD and asthma. Twenty-eight studies were included in the data analysis.

Results: The average prevalence of asthma in individuals with GERD was 4.6% as compared to 3.9% among controls. The odds ratios showed significant correlation 5.5 (95% CI 1.9-15.8) for the prevalence of GERD symptoms in patients with asthma.

Similarly, it was 2.3 (95% CI 1.8-2.8) for prevalence of asthma in patients with GERD.

Click to read about  How to Stop Heartburn: Simple Ways to Heal Heartburn and Acid Reflux

Conclusions of the study: The authors concluded that while GERD and bronchial asthma are related, there is paucity of data establishing a causal association.

My opinion: the two disorders are linked to a significant degree in only a subset of patients. Identifying that subset of patients in who GERD or gastroesophageal reflux disease plays a significant role is however difficult.

Other potential atypical manifestations of GERD include noncardiac chest pain, hoarseness, loss of dental enamel, chronic cough, bad breath, dysphagia etc.

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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.

 

 

Entericoated aspirin, NSAIDs ulcers, dannon yogurt, FDA approved, medical radiation, rotavirus vaccination

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

Patients concerned about side effects of aspirin especially the risk of gastrointestinal ulcers often take entericoated formulations of aspirin to avoid such complications.

Though patients often believe these pills pose a lower risk of stomach upset, they actually don’t appear to have much effect on the more serious damage that aspirin can cause.

“That’s a huge misunderstanding,” says David A. Johnson, a past president of the American College of Gastroenterology and a professor at Eastern Virginia Medical School. Read more here.

Dannon must pay consumers up to $45 million in damages for falsely advertising the health benefits of its yogurt, under the terms of a class action settlement reached Tuesday in federal court in Cleveland, reports Cleveland.com. The targets of the class action were two Dannon yogurt products -- Activia and DanActive -- pitched in TV ads by actress Jamie Lee Curtis. Read more at dannonsettlement.com.

 The terms "FDA approved" or "FDA registered." are reassuraing while purchasing health care products.  According to Daniel Carpenter, professor of government at Harvard University, and as published in Los Angles Times, these words "FDA approved" or "FDA registered" don't mean as much as consumers often assume. "FDA certification of a product is never a guarantee of safety or effectiveness of anything," Carpenter says.

A House subcommittee heard from various experts calling for standardization of medical radiation to enhance effectiveness and safety as reported in the New York Times, Saying that recent news reports about radiation accidents had “raised huge concerns for me,” Frank Pallone Jr. the chairman of the Energy and Commerce subcommittee on health, said he was shocked that the people who operate radiologic devices need not be licensed in many states and that “the requirements to report errors and the penalties for making errors are basically nonxistent or not enforced.”

The efficacy of the pentavalent rotavirus vaccine was assessed among infants in the United States was studied by Wang et al. from Harvard University. A large, national, health insurance claim database was studied. Use of the vaccine resulted in a 66% decrease in acute gastroenteritis related hospitalization and visits to emergency rooms as well as a 74% reduction in costs.

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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.

 

Fiber formula diet prevents gut infection

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

The gastrointestinal tract is full of bacteria, more so in colon than other parts of gut. Normal bacteria play a variety of beneficial roles in the body including enhancing immune function and preventing infections.

Clostridium difficile (C. difficile) is a common cause of nosocomial diarrhea including antibiotic-associated diarrhea. Lately, this bacteria has become increasingly virulent resulting in increased relapses as well as greater morbidity and mortality. The recurrences of Clostridium difficile infection can be so severe that total bacterial flora replacement or transplant from healthy donor may be needed.

A less recognized cause of Clostridium difficile diarrhea, in addition to use of proton pump inhibitors or PPIs like Nexium, Prevacid, Protonix or Prilosec etc., is the increasing use of elemental diets in formula  fed hospitalized patients over extended periods. Since most if not all of the elemental diet is absorbed in the small intestine, it deprives the colonocytes as well as the colonic bacteria of their source of nutrition. These sources of nutrition in a healthy diet include prebiotics like dietary fiber, fructo-ogosaccharides, and resistant starch.

Dr. O’Keefe states that lack of bacterial fermentation in the colon leads to suppression imbalance of good versus bad bacteria or dysbioisis. The good bacteria include butyrate-producers and bifidobacteria. Such dysbioisis is unhealthy and leads to permissive environment for C. difficile which overwhelms the gastrointestinal immune defenses. This allows these harmful bacteria to colonize and proliferation leading to infection.

As such,a change of tube feeding formula from elemental diet to a prebiotic or fiber containing diet as soon a possible has potential to reduce the prevalence and severity of C. difficile induced infection.

Have you or someone you know has suffered from C. difficile diarrhea caused by bacteria or other factors? If so, how was it treated. What do you think about fiber rich diet for health? Please share your thoughts and ideas

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.