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

Anemia may impair your thinking

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Anemia is very common across the world. Similarly, cognitive decline is an unfortunate but common occurrence among older individuals. Now comes a study that links anemia as a risk factor for the impaired executive function in the elderly. This was reported in the September issue of Journal of the American Geriatrics Society.

Is It Leaky Gut or Leaky Gut Syndrome?

 Dr. Chaves and colleagues from Johns Hopkins University in Baltimore, Maryland studied 364 high-functioning older women. Only 30 of these had anemia, i.e. hemoglobin level less than 12 g/dl. The average age of the patients was 74 years. They were all in good physical shape. Multiple tests were conducted to test executive function. Scores were adjusted for age, education, race and disease status etc.

These investigators found that elderly patients with anemia were four to five times more likely to perform poorly on executive function tests compared with those with normal hemoglobin concentration.

Whether it is a mere association or that anemia actually leads to decline of executive function remains unknown. Anemia could potentially cause a reduced oxygenation of brain via reduced oxygen carrying capacity of blood, thus leading to cognitive decline. It is also possible that this is an association reflecting degeneration of brain tissues due to decreased oxygenation.

Of note that this study was conducted in elderly women. Whether these results apply to younger subjects and males also remains to be established. Also, be advised that the normal values for hemoglobin are different for men and women.

Bottomline: Anemia affects the whole body, not just physically but perhaps also mentally. 

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Want natural plant products repair unhealthy skin?

Natural anti-aging plants for healthy skin: photochemoprevention

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Hippocrates aptly stated, All disease begins in gut."

Skin exposed to the sun (ultraviolet or UV rays) suffers damage leading to sunburn cells, photoaging, and skin cancer. Photochemoprevention is the strategy that utilizes agents capable of preventing these harmful effects. Many of these include botanical antioxidants. Botanicals are present not only in our diet but also in many skin care products. 

Is It Leaky Gut or Leaky Gut Syndrome?

Drs Afaq and Mukhtar reviewed the data in the paper titled, "Botanical antioxidants in the prevention of photocarcinogenesis and photoaging" published in the journal Experimental Dermatology.

Green tea is a popular beverage is savored by over two-thirds of the world's population.  It inhibits photocarcinogenesis and reduces tumor burden in animal models. Even tumor regression has been noted. Treatment using green tea components reduces ultraviolet or UV-induced skin damage (roughness and sagging).  

Pomegranate is a popular fruit in Eastern cultures and exerts its actions via its possesses strong antioxidant and anti-inflammatory properties. Oral feeding of its components (PFE) inhibits UV-induced skin damage in animal models.

Resveratrol (grapes, nuts, fruits, and red wine) has potent antioxidant with anti-inflammatory and antiproliferative properties. Topical application in mice inhibits UV induced skin damage. Topical application of skin with resveratrol also inhibits tumorigenesis.

Genistein (soy, ginkgo biloba extract, and Greek sage) has antioxidant and anti-carcinogenic effects in skin. Oral feeding increases the antioxidant enzyme activity in the mice skin.

What do you think about above data? Would it prompt you to use these more as part of your overall skin management?

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Filling up your stomach is life shortening

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Several studies have looked at the impact of calorie restriction in animals. Not only does calorie restriction increase life span, it also retards the onset of disease processes including cancer. Body function is maintained much longer.

Although the disease processes are slowed, the aging process itself is not reversed. Mechanisms underlying this beneficial effect of calorie restriction are not well understood and multiple factors have been implicated. 

Is It Leaky Gut or Leaky Gut Syndrome?

It has been proposed that periods of fasting may be better than a permanent state of undernutrition. The concept of fasting has been promoted by many Eastern cultures as a measure of positive health and spiritual cleansing. Even intermittent fasting is helpful.

Alternate day strategy of fasting one day and then eating ad lib the next has been shown to be very health friendly.

So next time think twice when you are tempted to clean out the piece of brownie or chocolate in front of you. And here is my question to you: Would what is written in this piece make any difference? 

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Helicobacter pylori as a lifesaver in cancer: Yes, it is true!

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Helicobacter pylori infection of the stomach has been having its ups and downs. We all know that it is implicated in pathogenesis of peptic ulcers (gastric and duodenal ulcer), gastritis and certain forms of cancers. On the other hand, some data has also suggested that the presence of infection is protective against gastroesophageal reflux disease (GERD) or chronic heartburn.

Now comes a study by Dr Meimarakis and colleagues from University Hospitals in Munich, Germany showing the beneficial effect of H. pylori infection in patients who have had curative surgery for stomach gastric cancer (gastric adenocarcinoma).

Is It Leaky Gut or Leaky Gut Syndrome?

These investigators studied 166 patients who had surgery for gastric adenocarcinoma between 1992 and 2002. They published their results in the journal Lancet Oncol (2006)

They found that there was 3-fold advantage for H. pylori infected patients with respect to relapse-free and overall survival. For example, the overall survival was 61.9 months in patients positive for H pylori, compared to 19.2 months in patients who did not have H pylori infection.

Considering the problems this infection causes and the advantages it bestows, this celebrity bacteria continues to be a baffling friend and a foe!

Have you been tested or treated for H. pylori infection for any reason? Do any philosophical thoughts come to your mind about this organism, which can be a good, or bad depending upon the situation? At the very least, we should not be killing this poor bug indiscriminately. 

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Botox or nitrogylcerine for anal fissure?

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Chronic anal fissures are common. As anyone who has had these would testify, these are very painful and can be difficult to heal. One patient once described it as pieces of glass in the raw area.

Although surgery is effective, it is accompanied by the risk of fecal incontinence.

Nitroglycerin (NTG) ointment helps in healing. More recently botox (botulinum toxin A) fad has invaded the realm of treatment of chronic anal fissures also. We all have heard of botox parties. So which one is better, the very cheap nitroglycerin ointment or the very expensive and very hyped botox.

Is It Leaky Gut or Leaky Gut Syndrome?

Study

Dr. Fruehauf and colleagues from University Hospital Zurich in Zurich, Switzerland compared application nitroglycerin ointment (0.2%) locally in the area of fissure twice daily for 2 weeks versus a single injection of Botox directly into anal sphincter. The results of their findings were published in American Journal of Gastroenterology.

Results

• Fifty patients with chronic anal fissure were studied.
• At the end of the initial treatment for 2 weeks 52% of those using nitroglycerine (NTG) had healed as compared to only 24% who received Botox.
• When treatments were switched at end of two weeks for those who had not healed, additional patients accomplished healing with NTG but none with botox.

Conclusion

The authors concluded that nitroglycerin ointment is superior to the more expensive and invasive botox injection for chronic anal fissures although it is accompanied by mild side effects such as headaches.

Have you or someone you know has had anal fissure? How was your experience and what was done to heal it? Please share your thoughts.

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Colon polyps and cancer? Curry to the rescue!

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Turmeric curry powder curcumin reduces colon polyps

A recent study done in small human sample indicates that naturally occurring substances such as quercetin and curcumin (a phytochemical) may reduce risk of colon cancer. While curcumin is the active ingredient of the Indian curry spice turmeric, foods rich in quercetin include apples, green and black tea, onions, raspberries red grapes, citrus fruits, broccoli and leafy green vegetables and cherries.

Is It Leaky Gut or Leaky Gut Syndrome?

Bearing in mind the epidemiological data suggesting that daily consumption of curcumin-containing turmeric and quercetin-rich foods lower the incidence of gastrointestinal cancers, Dr. Cruz-Correa and colleagues from the Cleveland Clinic, Florida, performed a study in 5 human subjects with familial adenomatous polyposis or FAP. They published their findings in the journal Clinical Gastroenterology and Hepatology (2006).

Each patient received 480mg of curcumin and 20 mg of quercetin three times a day for a period of six months. While the dose of quercetin was similar to usual daily consumption in diet, the dose of curcumin was considerably higher.

Results

These investigators found that while the average number of polyps dropped 60 per cent, and the average size of polyp decreased by half. Periods of poor compliance were associated with an increase in number of polyps.

It should be noted that the positive results of this could be due solely to curcumin, since the normal diet provides similar amount of quercetin.

Do you or someone you know has colon polyps or cancer. Remember that colon cancer is largely preventable and colon cancer screening saves lives. Many physicians consider colonoscopy to be the best method for colorectal cancer screening. 

Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health

Gas and boating in irritable bowel syndrome

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Pooling of gas within the digestive tract and difficulty moving it downstream to get rid of it has been implicated in production of bloating and abdominal discomfort including infantile colic. However, the part of bowel involved in intestinal gas retention has not been well defined.

Is It Leaky Gut or Leaky Gut Syndrome?

Salvioli and colleagues from the University of Barcelona recently performed a study of small bowel reaction to infusion of fat into the intestine and published their findings in the American Journal of Gastroenterology (August 2006). These investigators studied six patients with irritable bowel syndrome and compared them to healthy controls.

The authors found that in patients with IBS, there is gas retention associated with abdominal distention and distress. They concluded that fat infusion into the bowel inhibits propulsion of gas in the small intestine via reflex inhibition of small bowel transit. This is not accompanied by any significant effects on the colon.

Based on these results and those of some other recent studies, it may be concluded that the origin of bloating and distention symptoms lies in the small intestine.

Do you or someone you know has gas problems? If so, what measures have you taken to feel better? 

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Can Acupuncture Heal Depression

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Acupuncture has been advocated for management of many chronic disorders. Multiple trials have studied its efficacy in depression, which affects 2.3 to 3.2 percent of men and 4.5 to 9 percent of women.

Is It Leaky Gut or Leaky Gut Syndrome?

Dr. Leo and colleagues from State University of New York at Buffalo conducted a systematic review of the existing randomized controlled trials on this topic and published their findings in the Journal of Affective Disorders .

These investigators found that comparison of acupuncture with control conditions suggests evidence for the efficacy of acupuncture in depression. They also found that acupuncture might be as effective as antidepressants. Data from studies comparing acupuncture with sham acupuncture however was not supportive.

                    Click to read more about acupuncture

A Cochrane Database Review found that there is insufficient evidence to recommend the use of acupuncture for depression

What are your thoughts on alternative and complimentary therapies (CAM)? Have you or someone close to you has used them? Given a choice between a CAM therapy versus traditional therapy, which one would you use?

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Accutane, acne, heart and liver

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Physicians frequently use isotretinoin (Accutane®) as a weapon against acne. Previous data has demonstrated that Accutane is associated with birth defects. Now comes a study suggesting that there is also an increased potential for heart and liver problems.

Is It Leaky Gut or Leaky Gut Syndrome?

Dr. Zane and colleagues from University of California conducted this retrospective study and published their findings in Archives of Dermatology (August 2006). The study group consisted of 13 772 patients who underwent Accutane® treatment between March 1995 and September 2002.

They found a significant increase in serum lipid and liver enzyme (transaminases) levels. However, the liver enzyme abnormalities were mild. Abnormal lab tests in most patients returned to normal when they quit taking the drug.

The authors qualified their conclusions by stating that the clinical significance of these laboratory abnormalities during isotretinoin therapy remains to be determined.

Do you have or had acne? How did it effect you, physically or emotionally? What treatments did you take? Feel free to share your thoughts. 

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Direct consumer drug advertising

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Knowledge is power. Sunshine is a great disinfectant.

Despite these well known and agreed upon principles, I have mixed feelings about direct to consumer advertising by the drug companies. ONe of the recent ones to enter this arena is the commercials for Orlistat or Xenical®, the drug used for obesity.

Considering the fact that obesity is rampant in our society, it would appear to be a wise choice. DTC campaigns certainly make the consumer aware of the products and its potential applicability to him or her.

On the other hand, there is potential for people to quit doing the appropriate life-style changes (diet and exercise) in favor of pharmacological cure! Many people in the health-care community fear that there is over-use of medications as a result of such consumer-oriented campaigns.

Where do you stand on this issue? Do you think that the benefits of such consumer-targeted campaigns outweigh the possible overuse? 

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Gastric ulcer, cancer and endoscopy

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Gastric (stomach) ulcers occur frequently and may be cancerous even though they may appear benign during EGD or upper GI endoscopy (upper GI scope). There has been an ongoing debate whether to perform a repeat endoscopy in patients with these ulcers to make sure there is no cancer.

Dr. Hopper and colleagues from United Kingdom examined this issue and published their findings in the journal Gastric Cancer (2006).

Study

These investigators studied 544 patients with apparent benign ulcers of whom 51% underwent a repeat endocopy. Twelve of these ulcers were then found to be cancerous. They compared this group to 296 other patients diagnosed with gastric cancers in this time period.

Results

GU cancer group had earlier stage disease and were to survive long term than patients in the comparison cohort.

Conclusions

Follow up endoscopy of every 50 patients with an apparently benign gastric ulcer will identify 1 patient with cancer. Such an early detection would lead to improved outcome.

Do you have ulcers? Remember gastric ulcers are different from duodenal ulcers since duodenal ulcers rarely are malignant. Most common cause of peptic ulcer disease is the infection with Helicobacter pylori. 

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Does Yoga Help Back Pain?

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Chronic low back pain

Chronic back pain is frequently associated with other common chronic disorders like irritable bowel syndrome, gastroparesis and fibromyalgia etc. Therapeutic strategies to combat backache have been suboptimal. Yoga has been suggested as an option.

Dr. Sherman and colleagues from the University of Washington conducted a randomized, controlled trial.

Study question: Is yoga ore effective for backache as compared to a conventional therapeutic exercise plan versus a self-care book.

Is It Leaky Gut or Leaky Gut Syndrome?

Report: The findings were published their findings in the prestigious Annals of Internal Medicine journal.

Methods: The study involved 101 patients with chronic low back pain. The patients were randomized to the following groups:

• 12-week sessions of yoga
• conventional therapeutic exercises classes
• a self-care book.

Results: The investigators found that at the end of 12 weeks, back-related function in the yoga group was superior to the book and exercise groups.

In addition, these investigators concluded that yoga is more effective than a self-care book for improving function and reducing chronic low back pain, and that the benefits persist for at least several months.

Comments

Results of above study are consistent with some subsequent studies as well as expert opinions including one published in a Mayo Clinic publication indicating that carefully performed yoga may help with back pain.

A practice guideline jointly published by the prestigious American Pain Society and American College of physicians states that there is fair evidence that yoga as well as massage are effective for chronic low back pain.

What are your thoughts on yoga meditation or exercises? Have you had any experience with it? If you had chronic back pain, would you try it? 

Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health

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Are belching problem and reflux related?

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Do you or someone you know has belching problem? We know that belching is a common problem as is gastroesophageal reflux. Much of the belching occurs as a result of swallowing of air. This leads to an obvious question, are belching and reflux related.

Is It Leaky Gut or Leaky Gut Syndrome?

Dr. Bredenoord and colleagues from Netherlands studied this issue and published their findings in the American Journal of Gastroenterology (August 2006).

They studied 12 patients with GERD and compared them to 12 healthy controls. They found that GERD patients swallow air (287 ± 45 Vs 176 ± 24) and belch (52.4 ± 6.6 Vs 32.7) more frequently than controls. 

However, based on the results of air infusion in these subjects, they concluded that that air swallowing is not the cause of increased gastroesophageal reflux. 

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Acupuncture and stroke rehabilitation

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Stroke is a major cause of death, disability and dependency. Acupuncture has been increasingly advocated as a modality for rehabilitation of such patients.

Dr. Wu and colleagues from Si Chuan University in China recently conducted review of the literature examining the role of acupuncture and published their findings in the journal Cochrane Database of Systematic Reviews .

Is It Leaky Gut or Leaky Gut Syndrome?

After a comprehensive search, they found 5 truly randomized unconfounded clinical trials (368 patients) comparing acupuncture with placebo acupuncture, sham acupuncture or no acupuncture in patients with subacute or chronic stage of stroke.

Heterogeneity between the trials notwithstanding, four out of these five trials suggested the odds of improvement in global neurological deficit to be higher in the acupuncture group as compared to the control group. On the other hand, one trial showed no significant improvement of motor function between the two groups.

The authors recommended that despite the above results, large, methodologically-sound trials are required in order to clearly establish the role of acupuncture in patients with stroke. 

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Does eating hot dogs affect your risk of getting cancer?

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Hot dogs and colon cancer

Hippocrates stated, "All illness begins in gut." Another adage, "You are what you eat."

Full disclosure first: I don't like hot dogs.

Having said that, I now have another reason not to like them. I never thought of them as very nutritious, but now a new study has demonstrated that hot dogs contain compounds that cause DNA mutations and thus have potential to increase your risk for cancer.

Drs. Mirvish and his colleagues from the University of Nebraska Medical Center have previously shown that hot dogs contain  N-nitroso compounds (NOCs) which have potential to cause colon cancer.

Is It Leaky Gut or Leaky Gut Syndrome?

Hot dogs are preserved with various preservatives including sodium nitrite which may be precursor for  N-nitroso compounds (NOCs). As noted above, NOCs increase risk for cancer in lab animals. 

These authors studied the hot dogs bought from the market and found that when these were mixed with nitrites, the result was an increase in these DNA-mutating NOCs. When these hot dog extracts were added to Salmonella, they caused a 2 to 4-fold increase in DNA mutation levels. It is well known that the DNA mutations in the wall of gastrointestinal tract can increase the risk for cancer like colon cancer.

So what is take home message from above. One, that such findings are not limited to hot dogs alone but apply to other foods as well. Second, there is a great deal of variation in concentrations of chemicals in various brands in the market. The key is to buy foods with least amount of these added chemicals.

I wonder how people react to studies like this. Does it alter your shopping behavior? Feel free to share your thoughts.

Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health

 

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Control hostility and anger for better breathing

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Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health

We know that emotions, stress and inflammation are inter-connected.

Dr Kubzansky and colleagues from Harvard School of Public Health tested the hypothesis that hostility contributes to faster rates of decline in lung respiratory function among older adults.

They reported their findings in a paper titled, "Angry breathing: a prospective study of hostility and lung function in the normative aging study" published in the journal Thorax 2006.

Is It Leaky Gut or Leaky Gut Syndrome?

These investigators demonstrated differences in baseline pulmonary function between persons with different levels of hostility. In addition, they found that lung function deteriorates at a faster rate in persons with chronic hostility and anger than in those who are cool, calm and collected.

Comments

This is an important finding to bear in mind on the anniversary of 9/11. Thousands of people especially at the World trade Center site as well as in and around New York were directly or indirectly impacted and have suffered emotional, physical and psychological injuries.

Many of them suffer from inhalation induced problems of pulmonary function. Therapy to help heal emotional and psychological wounds in such cases may be just as important as the treatment of their direct inhalation injuries.

Where were you on 9/11 and what were you doing at that tragic moment? What do you think about the practical applications advice in this note? 

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Does drinking during pregnancy impact alcohol use by kids as early adults?

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Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health

Does mom's drinking during pregnancy predict if the child would grow up to be an  alcoholic. This question was studied by Dr. Alati and colleagues from Australia. They published their findings in Archives of General Psychiatry (2006) and the answer is an absolute yes.

These investigators found that alcohol consumption in early pregnancy was associated with almost 3 times risk of the child developing alcohol disorder as an adult. The risk was somewhat lower, although still increased at 1.35 times if alcohol consumption occurred during late pregnancy.

I believe that the problem of risk of alcohol intake during during pregnancy are so well known that I haven't seen or met anyone for many many years. Do you agree? 

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Old heartburn, multiple definitions

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Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health

Human beings (and perhaps animals too) have had heartburn since times immemorial. With the advent of "internet medicine", TV advertising, and advancement in medical knowledge, the distinctions between the various symptoms (heartburn, chest pain etc), the disease (gastroesophageal reflux disease or GERD) and complications frequently gets blurred.

Is It Leaky Gut or Leaky Gut Syndrome?

Vakil and colleagues published (American Journal of Gastroenterology August 2006) the recommendations from the International Consensus group comprising of 44 experts from 18 countries. These were based on thorough literature search and appropriate grading of evidence followed by voting processes among the experts. Consensus was defined as agreement among at least two-thirds of participants.

1. GERD is defined as condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. The symptoms are considered troublesome when they adversely affect the person's well being.
2. Reflux symptoms that are not troublesome or cause complications do not qualify as GERD.
3. The patient should determine whether the symptoms are troublesome. Having said that, generally mild symptoms 2 or more per week or moderate to severe symptoms once a week are usually considered troublesome by patients.'
4. Heartburn may have non-reflux related causes.
5. Chest pain indistinguishable from ischemic heart disease may occur due to GERD.
6. The use of the term "Barrett's esophagus" is variably interpreted and lacks clarity. The notion that intestinal metaplasia is a prerequisite for diagnosis is not uniformly accepted.

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Diabetes and risk for colon polyps

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Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health

Colorectal cancer has been linked to obesity and insulin resistance has been implicated in the pathogenesis. We know that 95% of colorectal cancer arises from colorectal polyps of adenoma type.

Although diabetes mellitus type 2 has been linked to cancer of colon/rectum, the data regarding it association with colorectal adenoma polyps is sparse.

Dr. Jill Elwing and colleagues from Washington University School of Medicine in St. Louis, Missouri studied the association between diabetes mellitus (type 2) and adenoma polyps in colon or rectum. They published their findings in the American Journal of Gastroenterology (August 2006) in a study titled, "Type 2 diabetes mellitus: the impact on colorectal adenoma risk in women ."

Is It Leaky Gut or Leaky Gut Syndrome?

The authors wished to examine if the diabetic women have increased rates of colorectal adenomas relative to a group of nondiabetic women. Confounding risk factors studied included age, race, diabetes, hypertension, hypercholesterolemia, body mass index, and the use of nonsteroidal anti-inflammatory drugs.

Results

• The risk of any adenoma among diabetic women was 37% as compared to 24% in controls. Rate of advanced adenomas was also higher (14%vs 6%).
• Furthermore, adenoma rate among obese diabetic women was 42% as compared to 23% among non-obese, nondiabetic women.

Conclusions

Women with type 2 diabetes mellitus have higher rates of colorectal adenomas as compared to lean and nondiabetic women. These results lend further support to the hypothesis that type 2 diabetes plays an important role in the string of the adenoma-carcinoma sequence. 

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Chicken to the rescue after exercise

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Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health

Essence of chicken is produced by hot water extraction of chicken meat and contains the chicken nutrients including proteins, peptides and amino acids. It is believed that because of process of extraction, it may be easier to absorb into the body. In many ways, it may be similar to the traditional chicken soup.

Dr. Lo and colleagues from the National College of Physical Education and Sports in Taiwan, examined the effects of chicken essence (CE) supplementation on exercise performance capabilities.

They published their findings in the paper titled " Effects of postexercise supplementation of chicken essence on the elimination of exercise-induced plasma lactate and ammonia" in the Chinese Journal of Physiology (Dec 2005).

These investigators studied if the chicken essence supplementation causes changes of blood lactate and ammonia during recovery after exercise and thus improve exercise performance. They conducted a randomized, double blind, crossover study in 12 healthy subjects who performed a single bout of exercise to exhaustion.

Within five minutes after finishing exercise, they consumed chicken essence or placebo. Blood samples were collected before exercise and then after exercise during recovery period.

As expected, the exercise exhaustion significantly increased the levels of blood lactate and ammonia levels in both groups, which gradually declined during recovery.

However, both the ammonia and lactate levels were significantly lower in the chicken essence group, as compared to the placebo.

They concluded that CE supplementation after exercise results in lower plasma lactate and ammonia levels and thus could potentially enhance physiological recovery after exercise.

I wonder how many people use chicken soup or chicken essence? Please share your thoughts. 

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