Natural Medicine Update

COMMENTARY: This report adds to a growing body of evidence that dietary intake of a specific fatty acid present in fish oils (docosahexaenoic acid [DHA]) is needed to promote optimal brain development.

DHA, which is needed by the body for normal development of the brain and of visual function. This omega-3 fatty acid can be manufactured in the body from a precursor molecule, alpha-linolenic acid, which is present in some vegetable oils and nuts, and in small quantities in certain other foods. However, it is not clear whether infants have the capability to manufacture as much DHA as their rapidly developing nervous systems need.

Moreover, alpha-linolenic acid tends to be in short supply in the typical Western diet, potentially rendering it even more difficult for infants to obtain an adequate supply of DHA.

Therefore, a dietary supply of this fatty acid (through the mother) seems to be important for the growing fetus and infant.

I give my pregnant patients a plant based DHA source that has very little or no Vit A.

COMMENTARY: A sharp increase in cases of the disorder occurred in 1993-4 after immunisation . There were 74 cases in 1994, compared with only 37 cases in 1993 and 23 in 1991. Although the number of reports of vaccine associated cases of the syndrome has remained low in recent years—between 20 and 40—the sudden increase in 1994 raised concerns about vaccine safety.

In a fact finding session earlier this month, the committee heard reviews of studies since 1976, when the numbers of vaccine associated cases of the syndrome stopped the US immunisation campaign against "swine flu." By then, 45 million people had been vaccinated. Ultimately, 581 cases of Guillain-Barré syndrome were reported that year, said the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

Initial studies suggested a causal relation between Guillain-Barré syndrome and the vaccine. Subsequently this was challenged on several grounds, including that the cases had been gathered by public health officers who had not been trained to diagnose the syndrome; reports were not based on medical records; some cases accepted by the CDC failed to meet the criteria for the syndrome; and the publicity over the possible link had biased the reporting of cases.

A later study, in 1991, reviewed all the cases of the syndrome in adults (whether vaccinated or unvaccinated) from two states. Using a standard definition of Guillain-Barré syndrome, it rejected 29% of them, said Dr Robert Chen of the CDC’s immunisation safety branch.

A 1998 study, summarised for the committee, showed that if there was a risk of flu vaccine causing the syndrome, it was extremely small. Dr Tamar Lasky from the University of Maryland School of Medicine put it at between 1 and 2 cases per million vaccinated persons a year.

One possible cause is that flu vaccine contains Campylobacter, said Dr Chen. He said that the vaccine is made in chicken eggs and that 40-50% of chickens are infected with Campylobacter, which is difficult to eradicate.

COMMENTARY: In a study to be published in the journal Biology of Reproduction, researchers collected samples from the underarms of men who refrained from using deodorant for four weeks. The extracts were then blended and applied to the upper lips of 18 women, aged 25 to 45.

The women rated their moods on a fixed scale for a period of six hours. The findings suggested something in the perspiration brightened their moods and helped them feel less tense.

Blood analyses also showed a rise in levels of the reproductive luteinizing hormone that typically surge before ovulation.

Wysocki, a study co-author, said the research could point to a “chemical communication” subtext between the sexes that enables men and women to coordinate their reproductive efforts subliminally.

There was no sign women were sexually aroused by male perspiration. In fact, the women never suspected they had men’s sweat under their noses and believed they were helping to test alcohol, perfume or lemon floor wax.

“The study was done in quite a sterile environment. It’s not strange that they were not thinking sexual thoughts,” said Wysocki. “In a more sensual setting, exposure to these odors might facilitate the emergence of sexual mood or feelings.”

Funded by the National Institutes of Health, researchers said the study could lead to new fertility therapies and treatments for premenstrual syndrome if the active agent in male perspiration could be isolated.

COMMENTARY: The results suggest this is nothing more than a placebo effect. The researchers conclude the pills are still an effective treatment for short-term relief from hot flashes and night sweats, but nothing else.

“The average woman will not experience an improvement in her quality of life by taking this pill,” said Jennifer Hays of Baylor College of Medicine, a psychologist who directed the analysis.

While hormone replacement decreases hip fractures and colon cancer, it slightly increases the chance of heart attacks, strokes and breast cancer.

Despite those findings, many women vowed to stick with hormone replacement because they felt it helps their memory and mood and generally made them think and feel better. The new report rejects that contention, too.

“There is a myth that hormone therapy improves quality of life, even in women without menopausal symptoms. This study dispels the myth,” said Dr. JoAnn Manson of Harvard’s Brigham and Women’s Hospital in Boston.

Experts now say the hormones’ only acceptable use is for the short-term relief of severe menopausal symptoms.

COMMENTARY: The researchers looked at nearly 30,000 women from the Iowa Women's Health Study. All had answered a food questionnaire in 1986 that assessed how much and how often they ate certain foods as well as their vitamin and supplement intake.

Years later, there were 158 cases of rheumatoid arthritis among the women. The diets of those women were compared with those of study participants who remained free of the illness.

The doctors found that women getting less than 40 micrograms of beta-cryptoxanthin, which is found in citrus fruits like oranges and grapefruit, were at a slightly higher risk of developing rheumatoid arthritis than women who consumed more than that amount.

When they looked at the amount of zinc in each woman's diet, they found that those who took zinc supplements had a lower risk of rheumatoid arthritis. But getting an equivalent amount of zinc from food was not associated with decreased risk.

The message to the general consumer, is here's another reason to eat your fruits and vegetables.

Not only can they protect you from chronic diseases such as cancer and heart disease, but now they may also prevent rheumatoid arthritis.

COMMENTARY: Using data from an ongoing health study of more than 22,000 US physicians, researchers at Boston's Brigham and Women's Hospital measured the relationship between body size and age to the risk of prostate cancer in 1,634 men who developed the cancer.

Prostate cancer is the second-biggest cancer killer of men in the United States. The American Cancer Society estimates that 220,000 new cases of prostate cancer will be diagnosed in 2003 and nearly 30,000 men will die from it.

But the disease's mortality rate is relatively low because it is a slow-growing cancer, easily cured if caught early.

The average age at which a man is diagnosed with prostate cancer is 70, but African Americans and men with a family history of the disease are at higher risk.

The study population of US physicians included about 7% to 8% minorities, a number too small to draw conclusions.

The Harvard researchers looked at three categories of height: under 5 ft. 10 inches, between 5 ft. 10 and 5 ft. 11 and taller than 5 ft. 11. Age was stratified to younger than 50 years, 50 years to 59 years, and over 60 years.

The results, announced at a meeting in San Diego of American College of Preventive Medicine, show that tallness appeared to raise the risk of prostate cancer by 23% to 43%, but only over age 50.

The relative risk is fairly modest compared to other high risk groups--men with a family history of prostate cancer have an increased risk of 200% to 300%, Gaziano noted.

The study detected no relationship between either body mass index or weight and the risk of prostate cancer.

COMMENTARY: They found a single genetic change that was much more common in people with a family history of colon cancer and extremely common in people diagnosed with colon cancer.

Feinberg, Hengmi Cui, Marcia Cruz-Correa and others tested 172 patients at a colonoscopy clinic. They were looking for a specific genetic change called loss of imprinting.

This is not a genetic mutation, but a mistake in how the genes work. People get two copies of each gene — one from each parent — but some are imprinted so that only one copy works.

Feinberg’s lab had previously found that a gene called IGF2, which controls production of insulin-like growth factor 2, had “loss of imprinting” in some forms of cancer.

“In this case both copies are working. This is a gene for cell growth and it makes sense that getting a double dose might lead to cancer,” he said. They looked for this change both in the blood and in samples taken from the patients’ colons.

Those who had colon cancer or who had it in the past were nearly 22 times as likely to have the change, they found — and they could detect it in the blood in most cases.

Now they will have to see if other patients who had the change go on to develop cancer, Feinberg said.

And if the tests hold true in larger groups of people, it may be possible to develop a quick blood test to look for colon cancer risk.

COMMENTARY: Couples should not rush to fertility clinics and doctors should not intervene too fast with treatments unless there are obvious reasons for the couple not conceiving.

Infertility is defined as failure to get pregnant after a year of trying.

Many fertility clinics report couples coming in at younger ages, but the new research shows that even couples in their late 30s have a 91 percent chance of getting pregnant naturally within two years.

The study, which analyzed details of 782 couples from seven European cities, was presented Wednesday at a meeting of the European Society of Human Reproduction and Embryology.

Couples are waiting longer these days before starting families and experts have recently discovered that the age of the man matters too.

Research earlier this year suggested that fertility declines earlier than previously thought — in the late 20s for women and late 30s for men.

There is a large amount of normal variability in fertility and many couples who have below-average, but normal, fertility may fail to conceive within a year.

It may be appropriate to delay assisted reproduction until the couple has failed to conceive naturally in 18 to 24 months.

A factor that we have seen at the clinic is that following the BTD can increase a couples chance of conceiving by reducing food induced opposing antibodies in the female reproductive tract.

COMMENTARY: The new approach, proposed by German epidemiologist Hermann Brenner, is commonly used in other areas of medicine, such as predicting life expectancy.

In the Lancet study, Brenner analyzed more than 1.7 million patients recorded in the U.S. National Cancer Institute database.

He found that the new method estimates American breast cancer patients had a 71 percent chance of surviving 15 years, while the conventional approach put the chance at 58 percent.

Similarly, the 15-year survival rate for American men with testicular cancer was 91 percent, compared to 86 percent with the old method.

The survival rate for ovarian cancer five years after diagnosis was 55 percent with the new method, compared with 49 percent previously.

The conventional method of estimating cancer-patient survival, called the cohort approach, estimates the chances of surviving a particular cancer for, say 10 years, by looking at what has happened to patients diagnosed between 1990 and 2000.

“Cohort estimates are generally not appropriate for predicting the survival of newly diagnosed patients since the estimates are heavily weighted toward the survival experience of patients diagnosed many years in the past,” said Paul Dickman, a professor of biostatistics at the Karolinska Institute in Stockholm, Sweden, who is a proponent of the new method but was not connected with the latest study.

The new approach, called period analysis, is based only on recent years — for example, on patients who were alive and under follow-up during the year 2000.

COMMENTARY: The diet type is much less important than the actual restriction in calories.

A group of Australian researchers led by Dr. L. J. Moran at the University of Adelaide assigned 45 overweight women with PCOS to either high- or low-protein diets.

The high-protein diet consisted of 30% protein and 40% carbohydrates, while the low-protein diet included 15% protein and 55% carbohydrates. The women were expected to eat a calorie-restricted diet--approximately 1400 calories per day--for 12 weeks, then to spend another 4 weeks consuming enough calories to maintain, but not change, their body weight.

Study participants were also asked to exercise at least 3 times a week.

Only 14 women assigned to each diet were able to complete the entire program. The authors discovered that both diets resulted in roughly the same amount of weight loss, and the same decrease in body fat and insulin levels.

Almost half of all participants improved the regularity of their periods, the authors note, and 3 out of 20 women trying to conceive did so during the study period. None of the women reported any side effects from the diets.

COMMENTARY: Ellen McDonald, RN and colleagues from McMaster University, Hamilton, Ontario, Canada, systematically reviewed the evidence of 10 randomized trials evaluating the effects of air filtration systems on asthmatic patients.

They abstracted data on the methodolgic quality, population, intervention, and outcomes from studies identified using MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Collaboration.

Of the 10 studies reviewed, five enrolled adults only and one included children only. A total of 216 patients were included in all the studies, with the sample size ranging from 9 to 45 subjects.

A significant decrease in airway responsiveness associated with air filter use was reported in two studies. An association was observed between air filters and significantly lower total symptoms scores and lower sleep disturbance score.

The investigators observed no association between air filter utilization and any differences in medication use or morning peak expiratory flow values.

COMMENTARY: A review of research by scientists from the International Agency for Research on Cancer (IARC) in Lyon, France and the London-based charity Cancer Research UK shows that the longer women use the pill the greater their chances of developing the disease.

Women who used the pill five years or less had a 10 percent increased risk. Up to nine years pushed it up to 60 percent and a decade or more doubled the risk compared to women who have never taken the Pill.

"This study shows that the use of hormonal contraceptives for long periods of time may increase the risk of cervical cancer," said Dr. Amy Berrington, of Cancer Research UK's unit at the Radcliffe Infirmary in Oxford.

Cervical cancer is the second most common cancer in women worldwide with more than 470,000 new cases each year. If it is diagnosed and treated early survival rates are good.

The sexually transmitted human papillomavirus (HPV) is linked to the majority of cervical cancer cases. An earlier study found that long-term use of the Pill could quadruple the risk of the cancer in women with HPV.

Berrington said the latest analysis, which was commissioned by the World Health Organization and is reported in The Lancet medical journal, shows a raised risk of cervical cancer regardless of whether a woman has the virus.

COMMENTARY: The U.S. Food and Drug Administration said it was launching a formal inquiry of the estrogen/androgen combination it approved for hot flashes back in 1976.

The FDA said it knew of at least two currently marketed products affected by its action but did not name them.Belgian drug maker Solvay markets two estrogen/androgen combinations under the name Estratest.

"FDA is acting because it does not believe there is substantial evidence that androgens contribute to the effectiveness of these combination products to treat hot flashes in menopausal women who do not find relief from these symptoms when using estrogens alone".

The agency said it was aware that these products were being prescribed for female sexual dysfunction, a use not covered by the 1976 approval.While there might be significant benefits of such unapproved uses of a drug, the FDA said, there were important benefits in demonstrating safety and effectiveness through well-planned clinical investigations.

Debate has raged for years over the use of post-menopausal hormone therapy beyond hot flashes and night sweats, amid conflicting reports over whether it prevents brittle bones and heart disease.

COMMENTARY: In the study, men with the highest blood levels of a protein called C-reactive protein (CRP) were nearly four times more likely than men with the lowest levels to have a stroke a decade or more later.

More research is needed, according to a team led by Dr. J. David Curb at the Pacific Health Research Institute in Honolulu, Hawaii, to see whether measuring CRP levels can identify otherwise healthy people who may have an increased risk of cardiovascular disease.

Other studies have suggested that CRP increases the risk of artery disease, heart attack and stroke. However, researchers have been unsure how the protein is related to the risk of stroke in different age groups and in people with high and low risks of cardiovascular disease.

To investigate, the team of researchers followed about 8,000 Japanese-American men aged 48 to 70 for thromboembolic stroke - a type of stroke that occurs when a clot blocks an artery supplying blood to the brain. All of the men had their CRP levels measured in the late 1960s as part of the Honolulu Heart Program.

After 20 years of follow-up, 259 men had a stroke. This group of men was compared to 1,348 men who participated in the study who did not have a history of heart disease or stroke. Men who had the highest blood levels of CRP at the start of the study were almost four times more likely to have a stroke 10 to 15 years after the study began than men with the lowest levels of the protein, Curb's team reports.

What's more, even among men without diabetes and high blood pressure -- conditions that increase the risk for stroke -- high levels of CRP corresponded with a 60 to 70 percent increase in stroke risk.

Men aged 55 and younger who had the highest levels of CRP had a three-fold increased risk for stroke, and nonsmokers had a nearly six times greater risk of stroke than men with the lowest levels of CRP.

However, CRP levels were not a good indicator of stroke risk in men older than 55, past or current smokers or in men who had high blood pressure or diabetes.

Still, the findings do not rule out that inflammation may play a role in the risk for stroke among individuals who have other risk factors for stroke.

COMMENTARY: THE FINDINGS in Wednesday’s Journal of the American Medical Association add to mounting evidence questioning doctors’ long-standing belief that hormone supplements benefit the heart by mimicking the effects of natural estrogen, which helps keep cholesterol at healthy levels.

The new research provides follow-up data on a study that was among the first to challenge that belief. The original data showed that heart patients followed for an average of about four years had more heart attacks in the first year on hormone treatment, but fewer in subsequent years. The trend suggested that benefits might occur only after long-term use.

Wyeth Pharmaceuticals, which makes the estrogen-progestin supplement Prempro used in the research, paid for the follow-up study.

The researchers found no such benefit after tracking many of the same 2,763 women for nearly three more years. During the follow-up, there were 111 heart events, including fatal and nonfatal heart attacks, in women on hormones than in those taking dummy supplements.

However, the blood clot rate was twice as high in the hormone group over the entire 6.8 years of study, with most of the risk occurring in the first few years. The rate of gallbladder disease requiring surgery was nearly 50 percent higher, bolstering evidence linking these conditions to hormone use.

The results suggest that women with heart disease should not take hormone supplements, said co-researcher Dr. Deborah Grady of the University of California at San Francisco. Grady said evidence that risks outweigh the benefits is strong enough to suggest that even women without heart disease should avoid supplement use except on a short-term basis to relieve hot flashes and other menopause symptoms.

Information on the effects of hormones in healthy postmenopausal women is expected to come in 2005 from the Women’s Health Initiative, a large national study comparing results from women taking hormones for 12 years with those on placebo pills.

If you are considering HRT talk it over with your doctor. A wise choice would be to try natural alternatives first and only resort to the stronger hormones if all else fails.

Here at the clinic the majority of women are able to go through menopause using natural HRT and take care of their bodies by doing aerobic and weight bearing exercises.

COMMENTARY: The people who are sensitive to androstenone are also more likely to use odors as a way of evaluating people.

Androstenone is an often-touted human pheromone, or chemical attractant, found in certain body secretions, such as human sweat. Men release the most androstenone, but women also secrete the chemical in small amounts.

About half of people cannot smell androstenone at all. In those that do catch a whiff, around half enjoy the odor, rating it as musky or similar to sandalwood. However, for the rest, the smell can resemble the foul scent of urine or sweat.



Since androstenone is only a small component of body odor, even those whose noses are blind to the particular chemical can pick up on a person's overall scent. When people do smell androstenone, it may put a certain note on a body that wouldn't be there otherwise.

In the experiment, Pierce and his team tested the androstenone-smelling abilities of 258 undergraduate students, average age 19. The investigators asked the students to smell samples of concentrated androstenone and amyl acetate, a clear liquid with a banana-like odor. They were then asked to rate how strongly another person's odor would affect their feelings about him or her.

Fifty-five participants could not detect an odor from androstenone, although all could smell the amyl acetate. Androstenone smelling ability tended to correlate with how much participants judged a person by his or her smell, with androstenone-smellers saying they were much more likely to like or dislike people based on odor. Those who rated the androstenone as unpleasant had stronger feelings about people based on smell than those who enjoyed the odor, Pierce and his team noted.

The next step in this research is to test a person's ability to sniff out other odors, and whether that also relates to how much that person uses odor to rate others in a social context. Not surprisingly, one of the next odors they plan to look at is underarm odor.

COMMENTARY: For Years, doctors and patients alike have struggled with the question of whether the benefits of the drugs, estrogen and progestin, outweigh their risks.

Given to replace the hormones that naturally decline after menopause, the drugs relieve hot flashes, mood swings and night sweats. And early research suggested the hormones also improve a woman’s overall health.

Instead, the large Women’s Health Initiative has found that combined hormone replacement therapy raises a woman’s risk of breast cancer, stroke and heart disease.

Doctors have been anxiously awaiting the results of the trial — the first and largest study to compare the effects of the drugs to placebo in healthy women.

Upon stopping the trial, the federal government immediately sent a letter to the 16,000 participants and their doctors, advising them to stop the drugs.

DO NOT PANIC

But women taking the medications should not panic, experts stressed, noting that the absolute risk of harm to any individual is extremely small.

And there are some benefits — chiefly a reduced risk of colorectal cancer and hip fractures, the study showed.

THE BOTTOM LINE

Women who are currently taking estrogen plus progestin should have a serious talk with their doctor to see if they should continue it,” said study author Dr. Jacques Rossouw of the National Heart, Lung, and Blood Institute.

Not only did this therapy not prevent heart disease, it actually increased the risk of heart disease, strokes and blood clots. Compared with placebo, HRT raised the risk of strokes by 41 percent, heart attacks by 29 percent and breast cancer cases by 26 percent, the study showed.

Women taking the hormones for the short-term for hot flashes and other symtoms of menopause may not have a higher risk of disease but taking the drugs for years is no longer advisable, experts said. For women who have had hysterectomies and who need HRT, estrogen alone may be safer.The study did not address the question of taking estrogen alone. Its benefits and risks are being evaluated in a second clinical trial of 11,000 women, also by the Women’s Health Initiative.

This is very important to all of you out there taking HRT. Please contact your doctor and talk it over. Here at the clinic we support many women with alternatives to HRT.

You do have Options!!!!!!!

COMMENTARY: After analyzing data from more than 14,500 women, Dr. Deirdre Murphy from the University of Bristol and others found that about one in eight women who have a C-section take more than a year to become pregnant again, compared with 1 in 12 of those who deliver vaginally.

The study accounted for other factors that might have reduced fertility, including the ages of both mother and father, how long they had lived together, whether oral contraceptives had previously been used, smoking and drinking and ethnic background.

It also eliminated women who decided not to have another child after caesarean, by only looking at women who actually did become pregnant again.

The increased difficulty in conceiving remained significant after taking these factors into consideration, the researchers report in the July issue of Human Reproduction.

For some women, a caesarean is a necessity to deliver the baby safely. On other occasions the decision may not be as clear-cut. We need more research into the long-term effects of all methods of delivery, so that doctors and midwives are better equipped to help women make informed decisions.