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

Lactose intolerant? Do you know what you can and should do?

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Lactose intolerance is a very common problem worldwide include U.S. and the prevalence depends upon nationality, race and ethnicity. American Academy of Pediatrics committee on Nutrition lead by Dr. Heyman has recently provided an update in the journal Pediatrics.

Bear in mind the following facts:

1. Many people who have lactose-intolerance are not necessarily lactase deficient.
2. Most people even if lactose-intolerant are able to tolerate equivalent of a glass of milk per day.
3. Most lactose intolerant persons can enjoy yogurt, cheese and reduced-lactose milk without any problems.
4. If you chose to avoid dairy products completely, it is imperative that you take calcium supplements as a substitute.

Do you or anyone in your family has lactose intolerance? How do you manage it?

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Exercise and waist versus hip fat

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Obese individuals may be characterized as "apple-shaped" and "pear-shaped". Waist fat is not just important for many of us to fit into a smaller dress size but note that it is the waist fat that contributes more to increased risk of obesity-related illnesses. Diet alone won't help much here. The current study demonstrates clearly that exercise is needed and explains why.

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Dr. You and colleagues from the Center on Aging at Wake Forest University sought to examine the impact of low calorie diet with or without low impact or high intensity exercise on abdominal (waist) and hip fat and the size of fat cells in these body regions. They published their findings in the International Journal of Obesity.

They studied 45 middle aged obese women with an average BMI of 33. Biopsies were done before and after intervention.

Not surprisingly, all three groups had similar decline in body weight, fat mass, percent fat and waist as well as hip size to similar degree.

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Surprisingly, the adipocyte (fat cell) size in the waist region was markedly less in the exercise groups versus diet alone. On the other hand, there were no differences in the fat cells in the hip region.

Thus exercise program when added to dieting reduces abdominal fat cell size in the waist of obese women. Thus even without weight loss, exercise can cause a positive impact on distribution of body fat. This fat distribution has profound health implications on the management of health problems like diabetes and heart disease associated with waist fat obesity.

Do you restrict your caloric intake? Do you have a regular exercise program that you follow? If you practice both, do you follow both equally, or one more than other?

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Black tea soothes rattled nerves

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Stressed out? Don't go for the alcoholic drink. Instead enjoy a cup of black tea.

Numerous benefits have been ascribed to black and green tea over the recent years and the study by Dr. Steptoe and colleagues (Psychopharmacology) further support for evidence for beneficial effects of black tea.

These investigators examined the effect of 6-week ingestion of black tea versus placebo on bodily responses to stress. This included stress induced effect on cardiovascular system, cortisol and platelets. These were measured before and after two challenging behavioral tasks.

The authors found the cardiovascular responses (blood pressure, heart rate and subjective stress ratings) were not affected by black tea suggesting that black tea does not affect the actual stress experienced. On the other hand, black tea consumption resulted in lower post-stress cortisol and greater subjective relaxation accompanied by lesser platelet activation.

The obvious conclusion from the above study is that black tea mediated health benefits may be due to faster recovery of the body to baseline after a stressful experience.

Do you like tea and/or drink it regularly? Are you a fan of green or black tea? Do you drink it for health benefits or just the taste and smell of it?

 

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Food triggers for migraine	Botox works at both ends. Cheers!
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Depressed? Want alternative medicine options?	Risks of heartburn and ulcer medications
Constipation? Think your colon has kinks?	Confused about probiotics on market? Knowledge is power

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Cola fizz versus bone fizzle and weak bones? Your choice!

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There has been an ongoing debate on the health effects of consumption of carbonated beverages. Colas contain caffeine and phosphoric acid that can have adverse health consequences.

Dr. Tucker and colleagues from the Tuft University in Boston examined if the cola consumption is associated with bone density in women. They published their findings in the American Journal of Clinical Nutrition.

Bone density was measured at the spine and 3 hip sites in 1413 women and 1125 men. Food-frequency questionnaire was used to assess dietary consumption.

Is It Leaky Gut or Leaky Gut Syndrome?

These investigators found that women who drank cola daily had lower bone density than those who did not. Bone density was low whether or not you drank diet cola or regular cola. There was also significant impact of decaffeinated cola although to a lesser degree.

The effect of cola is gender specific. No adverse effect of cola on bone density was seen for men in this study.

It should also be noted that there was no significant impact of non-cola carbonated beverage consumption and bone density.

So ladies, next time you go for your daily cola fizz, think of your bones.

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Some more topics of interest or click to go to Home page

feeding disorders anorexia nervosa and bulimia	Whole fruit against fruit juice. What should you take?
Melatonin  is not just for sleep: use for healthy digestion	Is mangosteen healthy and does it prevent sickness?
Chronic back pain? Acupuncture may be the answer	Homeopathy for fibromyalgia
Obese? Bacteria in your colon may be the issue!	Healthy travel, prevent motion sickness
Breast feeding merits, alternatives	Yoga improves sex in both sexes
Acupuncture for chronic heartburn?	Folic acid supplement to prevent cancer controversial.
Reduce mortality with this vegetarian diet and treat obesity too	Does tea improve health?

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Watch your weight daily to keep extra pounds off

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As anyone who has been on a weight loss program knows, losing excess weight is often easier than keeping it off.

Dr. Wing and colleagues from Brown Medical School  studied 314 subjects who had lost weight in the preceding 2 years as part of weight loss program. They divided them into three groups for further study. One group received face to face intervention while others were based on quarterly newsletters or Internet. The intervention involved emphasis on daily self-weighing and self-regulation.

Is It Leaky Gut or Leaky Gut Syndrome?

They concluded that face to face intervention involving self-regulation program based on daily weighing is superior to receiving quarterly newsletters.

While it is intuitive that a regular self-monitoring of body would be important for long-term weight maintenance, this study emphasizes that only those active face to face teaching about eating or exercise habits is likely to keep most of the extra pounds off.

Bottom line: Self-regulation is important and that includes weighing everyday for maintaining a successful weight loss program.

Have you been involved in a diet or weight loss program? Which diet plan did you use and how effective was it and for how long? What are your thoughts on commercial weight loss diet plans? 

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Fruit or vegetables for stomach cancer prevention?

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The role of frequent intake of fruits and vegetables to prevent cancer continues to be a matter of debate. The current study adds to the age-old thinking that fruits and vegetables are good for you!

Dr. Larsson and colleagues from Karolinska Institutet in Stockholm, Sweden studied prospectively this question in over 8000 men and women. They hypothesized that fruit and vegetable intake protects against stomach cancer and published their findings in the journal Cancer Epidemiol Biomarkers and Prev.

Is It Leaky Gut or Leaky Gut Syndrome?

They found that vegetable consumption lowered the risk of gastric cancer, whereas fruit intake was not helpful in this regard. Among vegetables, green leafy vegetables and root vegetables lowered the risk of gastric cancer significantly.

I would like to point out that there are studies that have demonstrated fruit intake is better for cancer prevention. Until more data is available, we should have both as part of our daily diet.

How many servings of fruits and vegetables do you eat everyday? Do you just like the taste or eat them for health reasons? 

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Why are my GERD acid reflux symptoms not getting better?

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Persistent heartburn or acid reflux

Have you wondered why your symptoms due to reflux may not be getting better despite medications for gastroesophageal reflux disease or (GERD or chronic heartburn). It just might be that you have not just acid reflux but also non-acid reflux. The GERD medications block acid from forming but do not actually prevent reflux of stomach contents into the esophagus.

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Asthma is considered to be one of the common non-esophageal problems related to reflux disease. Dr. Condino and colleagues from the University of Colorado Health Sciences Center, Denver, Colorado studied children with asthma and GERD and published their findings in the Journal of Pediatrics.

They wished to examine the proportion of acid and nonacid reflux events in children with asthma who were thought to concurrent gastroesophageal reflux. A combined impedance-pH monitoring was used to assess acid and non-acid reflux episodes. Twenty-four kids were participated in the study.

A total of 1184 reflux events were recorded. Of these, 51% were nonacid related. Similarly, 555 symptom episodes were recorded. Of these, only 27% were related to any reflux episode.

The authors concluded that kids with asthma have both acid and nonacid reflux episodes with equal frequency, but majority of non-reflux symptoms including cough is not related to reflux of any kind.

This study highlights the ongoing debate among experts about the relative significance of GERD in causing non-esophageal problems like asthma, chronic cough, laryngitis etc. This study adds to the growing data that although GERD plays a role in a subset of patients, its role in pathogenesis overall may be overrated.

Do you have GERD or any problems related to that like noncardiac chest pain, asthma, cough, laryngitis or bad breath etc? How well are your symptoms controlled? Are you satisfied with medications or have required surgery? 

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Home page

Tips to prevent alcohol hangover	Homeopathy: fact or fiction?
Natural treatments of headache migraine?	Do you have intestinal gas problems?
Food allergies? Learn about them!	Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
Are colitis and diverticulitis    the same?	About aphrodisiac foods to make your day  or night: Fact or fiction
Constipation: Make #2 easy on you.	Do artificial sweeteners increase risk of cancer?

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Effect of fatty versus lean fish on health

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I always thought all fish were similar. Well, I was wrong!

A recent Swedish study by Dr. Wolk and colleagues examined the impact of ingestion on fatty versus lean fish on the risk for Kidney cancer (renal cell carcinoma) in a cohort of 61,433 subjects. The study was published in JAMA.

They found that fatty fish consumption was associated with reduced risk for renal cancer. However, there was no impact of lean fish or other seafood versus no consumption. Exclusion of the first two years of follow-up did not change the results.

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Can you guess as to why the difference in outcome between the two kinds of fish? It is purely a matter of speculation at this time. It may be due to significant differences between lean and fatty fish in the content of omega-3 fatty acids and vitamin D.

For example, fatty cold-water fish have up to a 20- to 30-times higher omega-3 polyunsaturated fatty acid, eicosapentaenoic acid, and docosahexanoic acid as compared to the lean fish. These are known to inhibit carcinogenesis. Similarly, low vitamin D levels have been linked to cancer development and the lean fish have lower vitamin D than their fatty counterparts.

Do you like or eat fish regularly? Do you consume fish more than red meat? Would the above report alter your eating habits? 

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Chronic low back pain: Tried acupuncture?	Chronic acid reflux and acupuncture?
Vegetarian diet: Does it affect mortality?	Natural treatments of depression
Got Migraine? Food triggers and natural treatments!	FODMAP diet: one type of elimination diet to try
Gut bacteria in fetus and future health?	Constipation: How to take care of business
Intestinal gas: Do you have it?	Vitamin D deficiency is common: You may have it!
Do cranberry and/or mannose protect against urinary tract infections or UTI	Leaky gut syndrome

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

Micronutrients in autism superior to medications	Autism controversy: Do patients have more constipation
Leaky gut syndrome	Mangosteen: Is it good for health?
Autism: Role of leaky gut	Autism: Role of gut bacteria
Intestinal bacteria in health and disease	L-carnitine is of benefit in autism
Vitamin D and autism	Autism controversy: Role of Vitamin D
Migraine triggers and natural treatments	Celiac disease or gluten sensitive enteropathy

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Uncontrolled diabetes, less brain

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Diabetes tends to cause problems throughout body and glucose is a fuel for the brain. Question arises if too much blood glucose is bad for the brain function?

Dr. Yaffee and colleagues from the University of California in San Francisco wished to examine the impact of poorly controlled diabetes on the mental function especially in older persons and the potential for developing dementia.

Is It Leaky Gut or Leaky Gut Syndrome?

These authors studied 1983 women including 53 diabetics. In this cohort, they examined relationship between the control of blood glucose (HbA1C level) and the risk for developing dementia.

They found that in women with HbA1C level of 7% or greater, the risk for developing mild cognitive impairment (MCI) was increased nearly 4-fold. Overall, the risk for developing MCI or dementia was enhanced almost three-fold.

Take home message: We should consider HbA1C monitoring in elderly patients at risk for mild cognitive impairment or dementia.

Do you or someone close to you has diabetes mellitus? Do you try to control the blood glucose compulsively? Are you convinced of the significance of the good blood glucose control? 

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Optimal body fitness crucial before bariatric Surgery

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If you are overweight and contemplating bariatric surgery, do not defer your exercise plan until after you have had bariatric surgery. Do not forget that this surgery like any other can have significant complications including death. An otherwise fit obese person is much more likely to have successful surgical outcome with fewer complications than someone that is not.

Is It Leaky Gut or Leaky Gut Syndrome?

Dr McCullough, and colleagues from William Beaumont Hospital, in Michigan studied 109 patients who underwent bariatric surgery. Peak oxygen consumption during exercise testing was used as a measure of cardiorespiratory fitness. Their findings were published in the August 2006 issue of the journal Chest.

These investigators found that significant complications occurred in 16.6% patients with low peak oxygen consumption as compared to 2.8% patients with higher peak oxygen consumption. Similarly, poorly fit patients required longer hospital stays and had to be readmitted to the hospital more frequently.

Bottom line, if you are overweight and contemplating bariatric surgery, do not put off exercising till after your surgery. Optimize your cardiorespiratory fitness to get the optimal surgical results.

Do you exercise frequently? Do you have a formal exercise plan and/or work with a trainer? No matter what your body weight is, exercise is needed!

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Is coffee is good for your brain?

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Do you like coffee? I must confess that I start my day with coffee and savor it generously throughout the day. This report is sure to make people like me happy.

Dr. van Gelder and colleagues from the National Institute for Public Health and the Environment in The Netherlands examined if coffee consumption is associated with decline in cognitive function in cognitive decline in elderly men.

Is It Leaky Gut or Leaky Gut Syndrome?

They prospectively studied six hundred and seventy six healthy men over a period of 10 years and published their findings in the European Journal of Clinical Nutrition (August 2006).

These investigators used Mini-Mental State Examination to assess cognitive function. Coffee consumption was estimated in cups per day.

So do you drink coffee? If yes, how much? If not, would this report tempt you to drink coffee. Remember however, above report notwithstanding, excess of everything is usually bad. 

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Type of surgery for body weight loss matters

Are you overweight and considering surgery? Then you probably already know that medical treatment and lifestyle measures provide only modest benefit in most patients. Many patients opt for surgery.

Three different kinds of surgeries are performed, with Lap-Band and the gastric bypass being the most common. Duodenal switch surgery , on the other hand has not gained popularity.

Who should undergo duodenal switch surgery as opposed to bypass? This was answered in a study by Dr. Prachand and colleagues from the University of Chicago. Their findings were published in the journal Annals of Surgery .

Study subjects

350 patients super-obese (BMI greater than 50) who underwent bariatric surgery were included in the study.

Results of weight loss surgery

Duodenal switch resulted in greater total weight loss. In fact, the likelihood of successful excess weight loss greater than 50% was higher for patients who underwent duodenal switch surgery.

Conclusions

Duodenal switch may be a better option for super-obese patients. Bear in mind that no surgery is safe and there have been conflicting reports about the safety and complications due to bariatric surgery. Patients can and rarely do die as a result of complications of bariatric surgery.

NOTE: Research is moving at fast pace and results are individual specific. Your doctor is the best judge.

Do you know of anyone who has had weight loss surgery? How were the results-both short and long term? 

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Second opinion in medicine

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The issue of second opinions in health profession frequently sparks a debate. The thoughts are diverse depending upon if you are a patient, versus his/her physician versus health policy maker.

Dr. Scott Haig at the Columbia University College of Physicians and Surgeons issues a strong indictment of medical profession by arguing that large number of physicians are quick to refer patients to another doctor rather than managing the situation themselves. This, according to him, is not only inefficient medicine but bad medicine.

Is It Leaky Gut or Leaky Gut Syndrome?

Dr. Haig may be on to something that is not frequently verbalized by many of us. We all see such occurrences not too infrequently where the health care provider has made his/her money doing the easy part including the expensive procedures and then sends over the patient to someone else for second opinion to deal with issues that actually required some thinking.

On the other hand, what is the patient to do, especially when faced with a life-threatening diagnosis like cancer and/or complicated set of options?

Like it or not, second opinion with all its disadvantages is a fact of life and we should all be thankful that we have that option.

What do you think? Did you think it was a good exercise or do you feel you had to do out of frustration with your health care provider. Have you had occasions where you considered a second opinion? Did you think it was worth the cost and effort? 

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Obese men are less fertile

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Dr. Salmen and colleagues from the National Institute of Environmental Health Sciences, Research Triangle Park, NC recently examined the association between male body mass index and infertility in couples and published their findings in the journal Epidemiology .

Is It Leaky Gut or Leaky Gut Syndrome?

They found that more the excess weight, the more likely the infertility. Every 3-unit increase in BMI may cut a man's fertility by about 10 percent, Erectile dysfunction does not explain the discrepency since the relationship was similar for older and younger men.

So if you are an overweight male and would like to have children, losing weight might be a cheaper option compared to cost of infertility clinics. 

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Plant diet for prostate cancer?

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Cancer of prostate is extremely common as men grow older. Controversy surrounds various treatment modalities. If the patient receives treatment, a rising PSA level after treatment for cancer prostate is a marker for disease recurrence.

Dr. Saxe and colleagues from University of California, San Diego sought to examine if a plant-based diet plus stress management training could be beneficial to the patients.

A rise of PSA level was used a marker for disease progression. Fourteen patients with recurrent prostate cancer were recruited for this 6-month trial. The authors published their findings in Sept 2006.

Is It Leaky Gut or Leaky Gut Syndrome?

These investigators found that the rate of PSA rise decreased significantly as a result of the intervention suggesting less progression or worsening of disease. In fact, median PSA doubling time increased from 11.9 months before the study to 112 months during the intervention period.

This pilot study confirms the negative impact of western diet on the prostate cancer and further reinforces the importance of plant food as a natural anti-cancer intervention.

What are your thoughts on predominantly plant food diet versus western diet? Do you know of anyone who may have benefited from diet intervention?

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Eat chilli for a healthy heart

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Do you like hot chilli? I like it but I avoid it. Why? I enjoy it while eating, but it really hurts while exiting!.

Drs. Ahuja and colleagues from University of Tasmania, Launceston, Australia sought to examine the effects of regular chilli ingestion on metabolic and vascular function in a randomized cross-over dietary intervention study. They published their findings in European Journal of Clinical Nutrition (August 2006).

Is It Leaky Gut or Leaky Gut Syndrome?

Thirty-six participants (22 women and 14 men) consumed 30 g/day of a chilli blend or a bland diet for 4 weeks each. Multiple parameters were measured.

While there was no difference in metabolic parameters studied, these authors found that regular chilli consumption reduces resting heart rate and increases effective blood flow to heart muscle in men.

Bottomline, chilli may be good for your heart too! By the way, do you like Chilli? 

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Green tea heals breast cancer

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Numerous studies have documented the beneficial effects of green tea on health including prevention of breast cancer. You might ask, what about the patients who already have breast cancer?

Here is a recent study that shows that the combination of green tea and tamoxifen (a common chemotherapeutic agent used for certain breast cancers) is better than either agent alone.

Is It Leaky Gut or Leaky Gut Syndrome?

Dr. Sartippour and colleagues from the from the University of California Los Angeles Medical Center in Los Angeles published in the journal Carcinogenesis (June 2006).

These investigators found green tea potentiated the inhibitory effects of tamoxifen on human breast cells in vitro. In addition, the mice treated with both green tea and tamoxifen had the smallest tumor size as compared to use of either agent.

This study gives us one more reason to sing praises of green tea. Do you drink green tea? I do.

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GERD acupuncture treatment	Placebo pain relievers and price

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More brain or more testosterone? Your choice please!

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Now if you are a man, and were asked this question, what would be your answer? Okay, don't answer, just enjoy this post.

Dr. Estrada and colleagues from Yale University, New Haven, Connecticut recently (Journal of Biological Chemistry Sept 2006) published their findings about the deleterious effects of high testosterone on brain cells. They found that elevated testosterone leads to death of neurons. This of course would have long term effects on brain function.

Thus both too little and too much of testosterone is bad for you. Be careful before jumping on the steroid bandwagon for building muscles.

In case the ladies are wondering about effect of estrogen, well, evidence suggests that estrogen may be neuroprotective.

A note of caution: This study was not based on a human trial but an in vitro study in the laboratory. 

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Chronic low back pain? Acupuncture needles to the rescue

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Chronic low back pain a major source of health problem and gets more common as we grow older. The treatment has in many cases been frustrating despite intake of medications that themselves have significant side effects.

Now comes study that the ancient remedy acupuncture may be be superior to the current regimes (drugs, physiotherapy, manipulation, massage, transcutaneous electrical nerve stimulation or TENS, and back exercises).

Click to read more about acupuncture

Dr. Thomas and colleagues from the School of Health and Related Research, University of Sheffield (UK) conducted a randomized controlled trial to compare a short course of 10 acupuncture treatments spread over a three-month course with the standard treatment. 241 patients with chronic low back pain greater than 1 year were studied.

Is It Leaky Gut or Leaky Gut Syndrome?

At the end of two years, these investigators found that the acupuncture treatment was superior in improving the bodily pain of the patients although functional disability was not improved.

• A recent metaanalysis confirmed that acupuncture provides better outcomes in patients with chronic back pain.
• Not just chronic back pain, literature also indicates that acupuncture offers superior benefit for acute back pain.

Take home message: Over long term, "new" and "advanced" may not necessarily be better as compared to ancient treatments.

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Leaky gut syndrome	Quinoa, a complete food even NASA likes
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Day care infections: Try probiotics	Whole fruit versus fruit juice
Effects of gut bacteria starts during pregnancy	Honey and cough
Breast milk benefits and alternatives	Implications of FODMAP diet health and sickness
Cranberry juice versus antibiotics for urinary tract infections	ADHD: Causes, role of diet, gut and treatment
Mangosteen benefits: myths or reality	Food allergies and intolerances
Does Vegetarian diet reduce mortality	Nutritional supplements for liver disease
Aquatic therapy for chronic pain	CT (CAT) scans and risk of cancer

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Balancing good and evil of aspirin effect on heart and stomach

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I get this question almost everyday. "Aspirin is good for my heart but bad for my stomach. What should I do?" The answer to this simple question is how ever not very simple since we are comparing apples and oranges.

Every patient needs to be individualized and trade-off assessed. Having said that, if you are at high risk for ulcers and low risk for heart disease, the cardiac protection by aspirin may not be worth it.

A recent study by Drs. Hernandez-Diaz and Garcia examined estimated risk of gastrointestinal complications due to aspirin among patients in different types of patients. The factors included advanced age, male sex, prior ulcer history and use of non-steroidal anti-inflammatory drugs (NSAIDs).

Is It Leaky Gut or Leaky Gut Syndrome?

They estimated that average excess risk of upper gastrointestinal complications is 5 extra cases per 1,000 aspirin users per year. It is however increased to 10 or even more extra cases per 1,000 person-years in certain high-risk populations.

Take home message: The gastrointestinal complication risk in your case may offset the cardioprotective benefit if your risk of ulcers is high while the cardiovascular risk is low. Because of an element of subjectivity, it is possible that different physicians may come to different conclusions in any particular case.

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